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PubMed1997

Screening for anxiety and depression in primary care with the Duke Anxiety-Depression Scale.

BACKGROUND AND OBJECTIVES: Anxiety and depression are highly prevalent and underdiagnosed in primary care. This study tested the seven-item Duke Anxiety-Depression Scale (DUKE-AD) in primary care adult patients as a screener for anxiety and depression as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). METHODS: Receiver operating characteristic curves (ROC) and odds ratios were used to test screener accuracy, and sensitivities and specificities were used to test screener efficiency in patients with anxiety and/ or depression. RESULTS: In 481 patients, the ROC area for patients with major anxiety disorders (panic disorder, agoraphobia, or generalized anxiety) was 72.3%. The ROC area for major depressive disorders (major depressive disorder and/or dysthymia) was 78.3%, and the ROC area for both major anxiety and/or depressive disorders was 76.2%. Odds ratios for these same groups after controlling for sociodemographic factors were 1.043, 1.057, and 1.053, respectively. Sensitivities and specificities for these groups at the DUKE-AD score cutoff point of > 30 on a 0-100 scale were 71.4% and 59.2%, 81.8% and 63.6%, and 73.9% and 66.1%, respectively. CONCLUSIONS: The DUKE-AD is a brief, easily scored questionnaire that serves as a valid screener for DSM-III-R anxiety and depression in the primary care setting.

Adolescent↗
PubMed1997

The Children's Depression Inventory as a screen for depression in Thai children.

This study examines the utilization of the Children's Depression Inventory (CDI), Thai version, as a screen for depression in Thai children. Subjects which consisted of 139 children aged 10-15 years filled out the CDI and were evaluated with structured psychiatric interview by a child psychiatrist who was blind to the results of the CDI. Children with interview validated depression had significantly elevated CDI scores (mean = 18.5, SD = 6.1) compared with nondepressed children (mean = 9.3, SD = 4.1), P > 10(-6). Furthermore, the CDI scores increased as the severity of depression increased. Using the Receiver Operating Characteristic Curve, a cut-point of 15 produced the best overall screening characteristics (sensitivity = 79%, specificity = 91% and accuracy = 87%). The results of this study indicate that the CDI efficiently differentiated depressed from non-depressed children. Since the CDI is an economical, easy to adiminister and readily analyzable instrument, it should be used as a screen for depression and a supplant for clinical evaluation and follow-up in the treatment of depression in children.

Adolescent↗
PubMed2026

Acupuncture improves depressive symptoms and prefrontal cortical function in mild to moderate depressive disorder: A randomized sham-controlled trial and fNIRS study.

BACKGROUND: Depressive disorder is a common mental illness associated with substantial functional impairment. Although pharmacotherapy is widely used, its effectiveness is often limited by adverse effects and poor adherence. Acupuncture has been increasingly applied as a complementary treatment for depression, and its neurobiological characteristics remain unclear. OBJECTIVE: This randomized, sham-controlled trial aimed to evaluate the clinical efficacy of acupuncture for mild to moderate depressive disorder and to investigate its effects on prefrontal cortical function using functional near-infrared spectroscopy (fNIRS). METHODS: Patients with mild to moderate depressive disorder were randomly assigned to a real acupuncture (RA) group or a sham acupuncture (SA) group and received standardized treatment for 8 weeks. Clinical outcomes were assessed using the Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), Short Form-36 Health Survey (SF-36), and a traditional Chinese medicine syndrome score. A subset of participants underwent fNIRS assessment during resting-state and task-based conditions to evaluate prefrontal cortical activation and functional connectivity. RESULTS: Compared with baseline, the RA group showed significant reductions in SDS and SAS scores and significant improvements in SF-36 emotional domains, with effects emerging at Week 4 and persisting up to 12 weeks after treatment. Improvements were greater and more stable in the RA group than in the SA group. fNIRS analyses revealed enhanced activation in dorsolateral and medial prefrontal regions and strengthened prefrontal functional connectivity following acupuncture, whereas neural changes in the SA group were limited. CONCLUSION: Acupuncture is effective for improving depressive and anxiety symptoms and quality of life in patients with mild to moderate depressive disorder. Modulation of prefrontal cortical activation and connectivity may underlie its antidepressant effects.

Humans↗
PubMed2001

Depression, depressive symptoms and mortality in persons aged 65 and over living in the community: a systematic review of the literature.

BACKGROUND: No recent attempt has been made to synthesize information on mortality and depression despite the theoretical and practical interest in the topic. Our objective was to estimate in the older population the influence on mortality of depression and depressive symptoms. METHODS: Data sources were: Medline, Embase, personal files and colleagues' records. Studies were considered if they included a majority of persons aged > or = 65 years at baseline either drawn from a total community sample or drawn from a random sample from the community. Samples from healthcare facilities were excluded. Effect sizes were extracted from the papers; if they were not included in the published papers, effect sizes were calculated if possible. No attempt was made to contact authors for missing data. RESULTS: We found 21 reports on 23 cohorts using depression diagnosis. For 15 of these, odds ratios were pooled using the Greenland method based on confidence intervals (CIs), giving an estimated odds ratio for mortality with depression of 1.73 (95% CI 1.53 to 1.95). A fixed effects meta-regression of these studies suggested that longer follow-up predicted smaller effect sizes (log odds ratios -0.096 per year (95% CI -0.179 to -0.014)). There is a weak suggestion of a reduced effect of depression on mortality for women. We were unable to pool effect sizes from the 17 studies using symptom totals and scales, or from eight studies of specific symptoms. CONCLUSIONS: The studies show that diagnosed depression in community-resident older people is associated with increased mortality. The picture for sex differences is still unclear.

Aged↗
PubMed2005

Cohort study of depressive moods in Thai women during late pregnancy and 6-8 weeks of postpartum using the Edinburgh Postnatal Depression Scale (EPDS).

OBJECTIVE: To identify depressive moods as measured by the Edinburgh Postnatal Depression Scale in late pregnancy and postpartum, explore associated factors and assess changes in depressive moods. METHODS: A cohort study of 610 pregnant Thai women was conducted. The self-reporting EPDS was completed at 36-40 weeks and at 6-8 weeks postpartum. RESULT: The prevalence of depressive moods (scores of 10 or more on the EPDS) was 20.5% during pregnancy and 16.8% at postpartum. Factors related to depressive moods in late pregnancy included marital status, evidence of irritable moods before menstruation, and attitudes towards this pregnancy. Unmarried women, women having irritable moods before menstruation or women having negative attitudes towards this pregnancy had double risk. Related factors during the postpartum period included religion, evidence of irritable moods before menstruation, perception of pregnancy complications and attitudes towards this pregnancy (p < 0.01). Women who perceived of having complications during this pregnancy, those who had irritable moods before menstruation or had negative attitudes towards this pregnancy had also double risk. The depressive moods were significantly reduced postnatally. CONCLUSION: One-fifth of pregnant and postpartum women experienced depressive moods but the severity declined at postpartum.

Adult↗
PubMed2006

Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms.

BACKGROUND: The prevalence of postpartum depression (PPD) is currently considered to be 10-15%. Most studies were performed with a brief unidimensional instruments (mostly the Edinburgh Postnatal Depression Scale-EPDS) with focus on depression and not on other symptoms and disorders. Most cited studies were conducted in Western economically developed countries. METHODS: We reviewed the literature on prevalence of postpartum depression and depressive symptoms in a wide range of countries. RESULTS: 143 studies were identified reporting prevalence in 40 countries. It is demonstrated that there is a wide range of reported prevalence of PPD ranging from almost 0% to almost 60%. In some countries like Singapore, Malta, Malaysia, Austria and Denmark there are very few reports of PPD or postpartum depressive symptoms, whereas in other countries (e.g. Brazil, Guyana, Costa Rica, Italy, Chile, South Africa, Taiwan and Korea) reported postpartum depressive symptoms are very prevalent. CONCLUSIONS: We believe that the widely cited mean prevalence of PPD-10-15% is not representative of the actual global prevalence and magnitude of the problem, due to the wide range of reports. The variability in reported PPD might be due to cross-cultural variables, reporting style, differences in perception of mental health and its stigma, differences in socio-economic environments (e.g. poverty, levels of social support or its perception, nutrition, stress), and biological vulnerability factors. The elucidation of the underlying processes of this variability as well as the diversity of postpartum normal versus abnormal expressions of symptoms may contribute to better understanding of the diversified ante, peri- and postpartum phenomena.

Cross-Cultural Comparison↗
PubMed2006

Predictive validation study of the Edinburgh Postnatal Depression Scale in the first week after delivery and risk analysis for postnatal depression.

BACKGROUND: Postnatal depression is a major public health problem. The aim of this study is to validate the use of the Edinburgh Postnatal Depression Scale (EPDS) in the early postpartum, and to identify the markers for risk of postnatal depression. METHODS: 815 women filled out an EPDS and general information questionnaire between the third and the fifth day postpartum. The women with an EPDS score of >8 and a randomized control group from those with scores of <8 were contacted 8 weeks postpartum. 363 women therefore had a structured diagnostic interview by telephone at 8 weeks postpartum (MINI-DSM-IV), without knowledge of their EPDS scores, to screen for a major or minor depressive episode. RESULTS: The sensitivity of EPDS was measured as 0.82 [0.78-0.86], with a positivity threshold of 9.5/30. For an estimated prevalence for all depressive episodes of 16.1%, the positive predictive value of EPDS was measured as 42.8% [39.1-46.5%]. Multivariate risk analysis using logistical regression identified the following as risk markers for postnatal depression: previous history of depression (postnatal or other), unemployment, premature delivery or stopping breast-feeding in the first month for non-medical reasons. CONCLUSION: The use of EPDS between the third and fifth day postpartum is valid. An EPDS score of >10 should be completed by a clinical assessment and suitable management. The risk markers identified here are clinical indices that can be used for first-line early screening by non-psychiatric health workers.

Adolescent↗
PubMed2001

Hopelessness depression as a distinct dimension of depressive symptoms among clinical and non-clinical samples.

Subtyping depression has been an interest of theorists and clinicians for at least four centuries. In this paper, we examined the validity of the symptom cluster component of the hopelessness theory of depression. We used structural equation modeling analyses on large samples of psychiatric outpatients (N=1604, 844, and 680) and Air Force cadets (N=1404) who completed the items of the Beck Depression Inventory (BDI). Findings were supportive of the hopelessness depression cluster as a distinct depressive syndrome. Implications for the nosology of depression and for depression theory were discussed.

Adolescent↗
PubMed1999

The nature of the depressive experience in analogue and clinically depressed samples.

The use of university students as analogue subjects in depression research remains a controversial one, because it is not clear if the depressive experience of analogue and clinical samples differs qualitatively or quantitatively. Accordingly, this study directly compared 101 adult outpatients with major depressive disorder to 175 analogue depressed university students on self-report severity ratings of DSM-IV symptoms of major depressive episode. Several goodness-of-fit indices revealed that the covariance matrices of the depression symptoms were very similar in the two samples. These and other results from the study supported a phenomenological continuity hypothesis. Further, although the two samples differed quantitatively, the nature of the depressive experience did not appear to be one of transient and mild distress for many individuals in the analogue sample.

Adolescent↗
PubMed1998

Minor depressive disorder and subsyndromal depressive symptoms: functional impairment and response to treatment.

BACKGROUND: This study quantifies functional impairment and depressive symptomatology in patients with minor depressive disorder (MinD) and subsyndromal depressive symptomatology (SSD) before and after 8 weeks of treatment with fluvoxamine. Study patients were compared and contrasted with archival data from a sample of the general population measured by the Medical Outcome Survey Short Form 36. METHOD: Fifteen patients with MinD and 15 patients with SSD were identified from primary care clinics, referrals and newspaper advertisements. Patients signed informed consent and were offered open label treatment with fluvoxamine 25-100 mg/day. Patients were seen biweekly and measures of functional impairment and depressive symptomatology were gathered systematically. RESULTS: MinD and SSD were associated with dysfunction and disability when compared to archival normative data from the general population. Eight week treatment with fluvoxamine was associated with a substantial decrease in depressive symptomatology and a normalization of psychosocial functioning. CONCLUSION: This is the first study to quantify functional impairment and the severity of depressive symptomatology in a clinical sample of patients with MinD and SSD, and to demonstrate that treatment with a selective serotonin reuptake inhibitor decreases depressive symptomatology and improves psychosocial functioning. Placebo-controlled double-blind confirmation of these preliminary observations seems warranted.

Antidepressive Agents, Second-Generation↗
PubMed2000

The Edinburgh Postnatal Depression Scale (EPDS) and the detection of major depressive disorders in early postpartum: some concerns about false negatives.

This paper presents a phenomenological study of three false negative cases according to the Edinburgh Postnatal Depression Scale (EPDS) of major depressive disorder identified by a semi-structured clinical interview. In a study of 87 unselected women with 23 of them suffering from a major depressive disorder (according to the Research Diagnostic Criteria), three cases of major depressive disorders were not identified as potential cases by the EPDS. The symptomatology of these three false negative cases was also assessed by a semi-structured interview (Present State Examination). Comparisons between EPDS scores and the scores of two other self report questionnaires (the General Health Questionnaire-28 and the Center for Epidemiologic Studies-Depression Scale) suggest that EPDS is better at identifying depressed postnatal women with anhedonic and anxious symptomatology rather than those whose depression presents mainly with psychomotor retardation.

Adult↗
PubMed2003

Correlation between serum lipid, lipoprotein concentrations and anxious state, depressive state or major depressive disorder.

The purpose of this study was to investigate the correlation between serum lipid, lipoprotein concentrations and anxious state, depressive state or major depressive disorder. A total of 207 patients admitted for general health screening were recruited during a 1-year period. Using the Chinese Health Questionnaire, the Taiwanese Depression Questionnaire and the semi-structured clinical interview for DSM-IV, one psychiatrist screened all participants for the presence of anxiety or depressive disorders. Blood samples for serum lipid and lipoprotein concentrations and physical examination records were collected simultaneously. For patients who did not have systemic diseases (n=162), we found that high-density lipoprotein (HDL) cholesterol and the ratio of total cholesterol (TC)/HDL differed significantly among anxious state, depressive state and normal groups in men after age adjustment. On the other hand, the ratios of TC/HDL and low-density lipoprotein (LDL)/HDL showed significant differences between patients with major depressive disorder and normal controls in women. This study suggested that the level of HDL cholesterol and the ratios of TC/HDL and LDL/HDL (atherogenic index) might be another markers of the possible association between serum lipids and anxiety or depression.

Adult↗
PubMed1999

Depressive illness, depressive symptomatology and regional cerebral blood flow in elderly people with sub-clinical cognitive impairment.

BACKGROUND: Depressive illness in dementia is often assumed to be a unitary clinical phenomenon. AIM: To describe changes in patterns of depressive symptomatology with time, and associated changes in cerebral blood flow to the frontal and temporal regions. METHOD AND RESULTS: 397 elderly people with sub-clinical cognitive dysfunction were observed over 3 years. Sixteen percent of them developed dementia during the study The prevalence of depressive symptomatology was higher in this group than in the general population, especially in women, who also had higher recovery rates. A changing profile of depressive symptoms was found in depressed elderly people progressing to dementia, with fewer affective symptoms and increases in agitation and motor slowing. These changes were paralleled by greater reductions in left temporal regional cerebral blood flow than in non-depressed subjects with Alzheimer's disease. CONCLUSION: In dementia, there may be two separate and interacting depressive syndromes whose differentiation may be clinically important.

Aged↗
PubMed2006

Depression and somatic symptoms scale: a new scale with both depression and somatic symptoms emphasized.

The authors' preliminary study selected 22 items for Depression and Somatic Symptoms Scale (DSSS), including depression subscale (DS) and somatic subscale (SS). The aim of the study was to test reliability and validity of the DSSS. The study enrolled 135 consecutive outpatients (34 male and 101 female) experiencing a major depressive episode (the MDE group), 95 of whom (25 male and 70 female) accepted 1 month of treatment (the treatment group). Diagnosis was confirmed by using the Structured Clinical Interview for 4(th) edition with text revision Diagnostic and Statistical Manual Axis I Disorders. The DSSS and Hamilton Depression Rating Scale (HAMD) were given and evaluated. Cronbach's alpha was used to assess internal consistency. The correlation between the improvement percentage (IP) for the HAMD and the IP for the DSSS was calculated for the treatment group. Factor analysis was performed by using the principal-axis factoring method with promax rotation. Cronbach's alpha values of the DSSS and its subscales ranged from 0.73 to 0.94. Pearson correlation coefficients for the relationship between the DSSS and HAMD ranged from 0.63 to 0.86. In the treatment group, DSSS and HAMD scores were significantly decreased after treatment and the IP for the HAMD and the DSSS were similar and correlated (correlation coefficient = 0.78). The results of the factor analysis demonstrated that most of the items in DS and SS appropriately loaded in Depression and Somatic factors, respectively. The discriminative ability of the DSSS for anxiety comorbidities was not inferior to that of the HAMD. Therefore, the DSSS is reliable and sensitive to the treatment and has acceptable convergent, factorial, and distinct-groups validities. Because it assesses both depression and somatic symptoms, DSSS may overcome the deficiency of other depression scales with few somatic items.

Adult↗
PubMed2004

Association of tryptophan hydroxylase gene polymorphism with depression, anxiety and comorbid depression and anxiety in a population-based sample of postpartum Taiwanese women.

Depression and anxiety disorders often coexist clinically and both are known to have a genetic basis, but the mode of inheritance is too complicated to be determined so far. Serotonin is the biogenic amine neurotransmitter most commonly associated with depression and anxiety. Since tryptophan hydroxylase (TPH1) is the rate-limiting enzyme in serotonin biosynthesis, its role in the pathophysiology of these psychiatric diseases has been intensively studied. In this study, we examined whether polymorphism of the TPH1 gene is related to the etiology of major depression, anxiety and comorbid depression and anxiety. Five single nucleoside polymorphisms of the TPH1 gene were studied in a population-based sample of postpartum Taiwanese women consisting of 120 subjects with depression or/and anxiety and 86 matched normal controls. A significant difference (P = 0.0107) in genotype frequency for the T27224C polymorphism was found between the comorbid and normal groups, and risk analysis showed that the C allele conferred a strong protective effect (odds ratio = 0.27; 95% confident interval = 0.11-0.7). Three-allele haplotypes involving T27224C polymorphism were constructed and haplotype associations between particular haplotype combinations and various diseases identified. However, the associations were weak and the overall haplotype frequency profiles in all groups were similar. The results suggest that depression, anxiety, and comorbid depression and anxiety disorders may have related etiologies. In addition, this study suggests that the TPH1 gene might play a role in the pathogenesis of these closely related disorders.

Adult↗
PubMed1990

Depressive symptoms by self-report in adolescence: phase I of the development of a questionnaire for depression by self-report.

As the first step in validating a criteria-based, self-report depression questionnaire specifically for children and adolescents and to determine the prevalence of self-reported depressive symptoms, we studied 3,294 high school students of mixed ethnic background in a large urban school district. They completed the Weinberg Screening Affective Scale. The 21-item Beck Depression Inventory was also completed to allow comparison with a previous study. The prevalence of clinically significant depressive symptoms suggesting depression by self-report ranged from 18% on the Beck Depression Inventory to 13% on the Weinberg Screening Affective Scale. Hispanic females had the highest scores, while white males had the lowest. Being behind in school, female, and nonwhite predicted more self-reported depressive symptoms.

Adolescent↗
PubMed1997

[Depression following a first heart infarct; similarities with and differences from 'ordinary' depression].

OBJECTIVE: To determine frequency and clinical features of major depressive disorder according to DSM IV criteria in patients following a first myocardial infarction. DESIGN: Questionnaire. SETTING: Departments of Cardiology and Psychiatry, University Hospital Maastricht, the Netherlands. METHOD: Depression was assessed using the Zung 'Self-rating depression scale' (Zung-SDS) and the 'Symptom checklist' (SCL)-90 in 228 patients who filled the questionnaires out themselves (response: 60-70%), 1, 3, 6 en 12 months after their first heart attack. When the score on one or both lists was above threshold, the patient was invited for a clinical interview with a psychiatrist. RESULTS: One month post infarction 10% were diagnosed with a major depressive episode, a percentage which increased to 34% one year post infarction. The clinical features of the depression in these patients were the same as in a matched sample of depressed psychiatric inpatients without a cardiac history, except that hostility was significantly increased in the post-infarction patients. There was no mortality. CONCLUSION: Depressive disorder is a frequent comorbid disease after a first myocardial infarction.

Depression↗
PubMed1985

Treatment outcome validation of DSM-III depressive subtypes. Clinical usefulness in outpatients with mild to moderate depression.

An algorithm for transcribing Research Diagnostic Criteria diagnoses for depressive disorders to similar categories in the DSM-III was applied to 103 depressed outpatients previously diagnosed by Research Diagnostic Criteria. All had Hamilton Depression Rating Scale scores of 18 or less. Among 64 patients completing a six-week, double-blind study comparing desipramine hydrochloride with placebo, desipramine was significantly more effective than placebo in patients with DSM-III major depression but not in those with dysthymic disorder. Among patients with major depression, a significant drug-placebo response difference was demonstrated even in those without melancholia. These findings support the clinical usefulness of the DSM-III in the treatment of depressed outpatients. Independent of DSM-III diagnosis, however, evidence of panic attacks seemed to identify patients who benefited from desipramine therapy. This suggests that the DSM-III hierarchy, which excludes consideration of panic in patients with major depression, may require revision.

Anxiety Disorders↗