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PubMed1991

The Cronholm-Ottosson Depression Scale: the first depression scale designed to rate changes during treatment.

In 1960 Ottosson published the first specific depression rating scale (the Cronholm-Ottosson Depression Scale) designed to be sensitive in measuring change during antidepressive therapy. Ottosson and his group have never used factor analysis to validate the scale, as the items of the scale were used factor analysis to validate the scale, as the items of the scale were selected on a preconceived idea for homogeneity, i.e. having a monotonic correspondence to the underlying dimension of severity of depression. The most appropriate method of testing the construct validity of the Cronholm-Ottosson Depression Scale is latent structure analysis. Using the original Ottosson data, a latent structure analysis has been made showing that the 8 items of the scale are homogeneously related, i.e. can be ordered on one dimension of severity of depression. The descriptive statistic of a 50% reduction of pretreatment score (or more) equaled the global clinical score of moderate to excellent improvement. Both scales showed that, already after 4 electroconvulsive treatments, about 80% of depressed patients who received adequate fits had moderate to excellent improvement, whereas only around 40% of depressed patients who received inadequate fits improved moderately or excellently.

Affective Disorders, Psychotic↗
PubMed1997

Performance of the Hamilton Depression Rating Scale in depressed patients in the United Arab Emirates.

Cross-cultural variation in the frequencies and modes of expression of depressive symptoms may influence the validity of depression rating scales. The most widely used instrument for this purpose, namely Hamilton's Depression Rating Scale (HDRS), has not been systematically evaluated in Arab countries. This study evaluates the face validity of the HDRS-21 by studying symptom frequencies, factor structure and symptom clusters in 100 UAE depressed patients. Concurrent validity is tested by comparing total HDRS scores with global estimates of severity made by clinicians, admission status, impairment of social and occupational functioning, and the endogenicity score of the Newcastle (NC) Diagnostic Index. Total HDRS scores show highly significant agreement with three independent measures of severity of depression. Rank orders of the most and least frequent symptoms are consistent with studies of similar design. Marked differences lie in more retardation and somatization and fewer cognitive components in the present study. Principal-component analysis confirmed the heterogeneous structure of the scale, separating a group of core depressive symptoms, and endogenous, somatization, anxiety and psychotic symptom components. The internal consistency (reliability) of the whole scale is moderate, and improves in the core symptom factor. The main conclusion is that the HDRS is sensitive to severity of depression in the UAE culture. However, it measures heterogeneous aspects, and its internal consistency suffers as a result. High levels of retardation and somatization contribute significantly to the total score in socially developing communities.

Adolescent↗
PubMed2005

Reliability and validity of the Geriatric Depression Scale in depression in Parkinson's disease.

The objective of this study was to investigate reliability and validity of the self rated 30 item Geriatric Depression Scale (GDS) in screening and diagnosis of depression in Parkinson's disease (PD). The study sample comprised 109 non-demented patients with PD admitted to the movement disorders outpatient unit. The reference diagnosis of depression was made according to DSM-IV criteria. Discriminant validity and internal consistency of the total scale were studied. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated for different cutoff scores. Receiver operating characteristics (ROC) analysis was also carried out. The sample comprised 56 patients with and 53 without depression. In the discriminant validity analysis, the mean total GDS score of subjects with depression was significantly higher compared with those without depression. The Cronbach's alpha score was 0.92 and the split half correlation coefficient 0.91. The cutoff score of 13/14 provided the highest sum of sensitivity and specificity level. The sensitivity of this cutoff score was 0.78 and specificity 0.85, while PPV was 0.84 and NPV 0.79. The area under the curve value in the ROC analysis was 0.891. Sensitivity and specificity analysis showed that cutoff scores of 8/9 or 9/10 could be useful for screening and 14/15 or 15/16 for diagnostic purposes. This study showed that the 30 item GDS, with its high discriminant validity, internal consistency, and reasonably clear cutoff scores, could be a useful screening or diagnostic self rated depression scale in patients with PD.

Adult↗
PubMed2007

Hippocampal volume and subcortical white matter lesions in late life depression: comparison of early and late onset depression.

BACKGROUND: Reduced hippocampal volume and increased prevalence of subcortical white matter lesions are associated with both recurrent early onset depression (EOD) and late onset depression (LOD). It is not clear whether these two factors differentially affect the age of onset of first depression. Therefore, we wished to investigate the relationship between age of first depression onset and hippocampal volume, with adjustment for subcortical white matter lesions. METHODS: MRI brain scans were used to compare hippocampal volumes and white matter lesions between age matched female patients (>60 years) with recurrent EOD and LOD and healthy controls. RESULTS: When comparing the three groups and adjusting for age, the Mini-Mental State Examination score, total brain volume and total hippocampal volume were significantly smaller in patients with EOD compared with controls (5.6 vs 6.1 ml; p = 0.04). The prevalence of larger subcortical white matter lesions was higher in patients with LOD compared with patients with EOD (47% vs 8%; p = 0.002). Patients with LOD did not differ in hippocampal volume from patients with EOD or from controls. CONCLUSIONS: In late life depression, age of first depression onset may distinguish between different independent neuropathological mechanisms. A small hippocampus volume may be a neuroanatomical marker of EOD depression and larger subcortical white matter lesions could be an intermediate between cerebrovascular disease and LOD.

Age of Onset↗
PubMed1988

Parkinson's disease and depression: psychometric properties of the Beck Depression Inventory.

Although the Beck Depression Inventory (BDI) is one of the most frequently employed measures of depression in Parkinson's disease, the somatic items included in the scale raise questions about its ability to differentiate depression from manifestations of the disease. The internal consistency and validity of the BDI as a measure of depression in a sample of 119 Parkinson's disease patients and 76 controls were studied. Results from an item analysis suggested that depression in Parkinson's disease patients is not a somatic artifact. Internal consistency reliability within the Parkinson's disease group was high. The factorial validity of the BDI was confirmed in both Parkinson's disease and control subjects. The results also indicated that Parkinsonian symptoms of depression can be measured separately from symptoms of the disease. These data suggest that the BDI including the somatic items is a reliable and valid measure of depression in Parkinson's disease and control subjects.

Depressive Disorder↗
PubMed2005

Anger attacks in depression--evidence for a male depressive syndrome.

BACKGROUND: It has been proposed that aggression and especially anger attacks play an important role in the symptomatology of depression. Furthermore, it has been hypothesized that these symptoms are more prevalent in males than in females. METHODS: We conducted a study in 217 depressed patients (104 females, 113 males) without psychiatric comorbidity using questionnaires. Study subjects had previously been treated as inpatients and were contacted after discharge from hospital by mail or phone. Overall response rate was 69.6%. Patients were asked to retrospectively rate their state during their last depression. RESULTS: Males obtained higher scores on irritability (p = 0.010) and showed a tendency to overreact (p = 0.018) during their last depressive episode. They had suffered significantly more often from anger attacks than female patients (4.3 +/- 7.52 versus 1.2 +/- 2.97 anger attacks per month; p = 0.001). Further multivariate analyses displayed that men had significantly lower impulse control and more frequently showed symptomatic substance intake and hyperactive behavior during their depression, whereas women suffered more often from hypersomnia and heaviness in limbs (p < 0.0001). CONCLUSION: Our findings are indicative of gender differences in symptoms related to lowered impulse control in depressed patients. Further study is required to replicate and extend our results and to assess the significance of aggression as a gender-specific diagnostic criterion for depression.

Aggression↗
PubMed1988

Double depression and episodic major depression: demographic, clinical, familial, personality, and socioenvironmental characteristics and short-term outcome.

The authors compared 31 outpatients with double depression to 50 outpatients with episodic major depression. Patients with double depression exhibited significantly greater impairment, more severe depressive symptoms, greater comorbidity, more personality disturbance, lower levels of social support, more chronic strains, and higher rates of bipolar II and nonbipolar affective disorders in first-degree relatives. In addition, in a 6-month follow-up, the patients with double depression were significantly less likely to recover, and a higher proportion experienced hypomanic episodes than did patients with episodic major depression. These data provide strong support for the clinical significance of double depression.

Adult↗
PubMed2004

Prospective study of clinical predictors of suicidal acts after a major depressive episode in patients with major depressive disorder or bipolar disorder.

OBJECTIVE: The authors investigated the predictive potential of a stress-diathesis model for suicidal behavior based on correlates of past suicidal acts. In this model, suicidal acts are precipitated by stressors such as life events or a major depressive episode in the setting of a propensity for acting on suicidal urges. This diathesis is expressed as the tendency to develop more pessimism in response to a stressor and/or the presence of aggressive/impulsive traits. The predictive potential of the diathesis was tested by determining whether clinical correlates of past suicidal behavior predict suicidal acts during a 2-year follow-up of patients with a major depressive episode. METHOD: Patients with DSM-III-R major depressive disorder or bipolar disorder (N=308) were assessed at presentation for treatment of a major depressive episode. Potential predictors of suicidal acts in the 2 years after study enrollment were identified on the basis of an association with previous suicidal behavior and were tested by using Cox proportional hazards regression analysis. In addition, pessimism and aggression/impulsivity factors were generated, and their predictive ability was tested by using Cox proportional hazards regression analysis. RESULTS: The three most powerful predictors of future suicidal acts were a history of suicide attempt, subjective rating of the severity of depression, and cigarette smoking, each of which had an additive effect on future risk. The pessimism and aggression/impulsivity factors both predicted suicidal acts, and each factor showed an additive effect. CONCLUSIONS: In addition to obtaining a history of suicidal behavior, clinicians may find it useful to assess patients' current level of pessimism, aggressive/impulsive traits, and comorbidity with substance use disorders, including nicotine-related disorders, to help identify patients at risk for suicidal behavior after major depression. Interventions such as aggressive pharmacotherapeutic prophylaxis to prevent relapse or recurrence of depressive symptoms may protect such at-risk individuals from future suicidal behavior.

Adult↗
PubMed2000

Cost-utility analysis in depression: the McSad utility measure for depression health states.

Cost-utility analysis, used increasingly over the past decade to analyze costs and effects in treating physical diseases, has received little attention in psychiatry. This article briefly introduces the concepts and methods of utility measurement and illustrates it using depression as an example. The authors describe the McSad health state classification system for depression, a direct utility measure for depression, and report results of an application of McSad among 105 patients who had a recent history of depression. Utility measures express patient preferences for specific health states on a scale ranging from 0, representing death, to 1, representing perfect health. These scores provide the weights used to calculate the number of quality-adjusted life-years gained by an intervention or service. McSad allows a patient's depression health state to be classified according to level of functioning in six dimensions of depression and to be compared with other hypothetical depression health states in order to produce utility scores indicating the patient's relative preferences.

Adult↗
PubMedDate not supplied

The Zung Self-rating Depression Scale: screening for depression among the Hong Kong Chinese elderly.

Two studies were conducted respectively to examine the reliability and validity of the standard Zung Self-rating Depression Scale (SDS), and a 10-item shorter version of the same test. In particular, the scale's usefulness as a screening instrument for depression among the Hong Kong Chinese elderly was investigated. In addition to the SDS, the Geriatric Depression Scale and the Chinese Hamilton Depression Scale were used to assess the convergent validity of the SDS. Data were collected from 113 nondepressed community-dwelling and 80 depressed elderly subjects. The findings showed that both the original and the shorter version of the SDS were highly reliable and valid. Both versions were appropriate for use as screening instruments for geriatric depression in Hong Kong. When compared with the original scale, the shorter version appeared to be slightly superior in its sensitivity and specificity in discriminating between the depressed and nondepressed subjects.

Age Factors↗
PubMed2001

Interferon beta-1 a and depression in relapsing-remitting multiple sclerosis: an analysis of depression data from the PRISMS clinical trial.

Depression is a suspected side effect of multiple sclerosis (MS) treatment with interferon beta-1a. However, this has not been confirmed by rigorous studies. Several psychological symptom rating scales were completed during the PRISMS clinical trial of subcutaneous interferon beta-1a (Rebif) for relapsing-remitting MS. We conducted an analysis of these data in order to determine whether symptom elevations were associated with treatment. The PRISMS clinical trial included 560 subjects from 22 centres in nine countries. There were two active treatment arms (44 mcg x 3 and 22 mcg x 3 subcutaneously three times per week) and a placebo group. Two hundred and sixty-seven of these subjects were enrolled at English speaking study centres, where psychiatric symptom ratings were obtained at baseline, 6, 12, 18 and 24 months using the Center for Epidemiological Studies Depression Rating Scale (CES-D), the General Health Questionnaire (GHQ) and the Beck Hopelessness Scale (BHS). After randomization, the groups completing these scales were similar in terms of age, gender, EDSS, duration of illness and employment status. Median CES-D scores in the high dose, low dose and placebo groups at baseline were also similar: 8.0, 7.0 and 8.0, respectively. After 6 months of treatment the median change in CES-D score was zero in all three groups. The proportion of subjects exceeding the traditional CES-D cut-point for clinically significant depression (> 15) after 6 months of treatment was strongly associated with pre-treatment depression (RR 2.9, 95% C.I.: 1.8-4.7), but not with treatment group (chi-square=1.64, d.f.=2, P=0.44). The results were comparable at 12, 18 and 24 months and when ratings from the other scales were evaluated. This analysis confirms that depression is common in persons with MS: the incidence of CES-D depression in the first 6 months of follow-up was 15.6%. However, no evidence of increased depressive symptomatology was observed in association with interferon beta-1a (Rebif).

Adjuvants, Immunologic↗
PubMed1976

The relationships between obsessional personality, obsessions in depression, and symptoms of depression.

The relationships between obsessional personality, obsessions in depression, and symptoms of depression were investigated by means of a retrospective study of case notes and item sheets. One hundred and sixty-eight cases of depression, aged 20 to 29 years, were rated for obsessional personality as defined by Ingram (1961). The presence of previous obsessions, of obsessions in depression and of eight symptoms of depression was assessed from the item sheets. Obsessional personality was found to be significantly associated only with a decreased frequency of objective apathy, although it seemed to act to reduce the anxiety experienced by those with obsessions, in depression. Obsessions in depression were associated with rapid changes of mood, anxiety, agitation and overactivity and with a relative absence of retardation.

Adult↗
PubMed1995

Late-life depressive disorder in the community. I. The relationship between MMSE score and depression in subjects with and without psychiatric history.

BACKGROUND: In previous studies cognitive impairment in depressed elderly in-patients tends to be associated with a late onset of depression. This study tests the hypothesis that cognitive impairment is associated with depression only in elderly individuals with no history of psychiatric illness. METHOD: We investigated an age-stratified sample of 4051 elderly people living in the community, aged between 65 and 84 (AMSTEL). The relationship between depression (GMS-AGECAT diagnosis) and scores on the Mini Mental State Examination was studied in subjects with and without a reported psychiatric history (CAMDEX questionnaire). RESULTS: Low MMSE scores (MMSE < or = 25) were only associated with depression in subjects with no psychiatric history (young/old: OR = 2.75, 95% CI = 1.83, 4.19; old/old: OR = 2.21, 95% CI = 1.61, 3.03). CONCLUSIONS: We concluded that the combination of cognitive impairment and first-episode depression in elderly individuals may indicate cerebral deterioration. Depression as such may not be associated with cognitive impairment.

Aged↗
PubMed1996

Comparative incidence of depression in women and men, during pregnancy and after childbirth. Validation of the Edinburgh Postnatal Depression Scale in Portuguese mothers.

BACKGROUND: Comparing women's and men's emotional reactions to childbirth can clarify the impact on mental health of childbirth as a life event. METHOD: Fifty-four first-time mothers attending obstetric services in Oporto, Portugal, and 42 of their husbands or partners participated in a longitudinal study of their mental health. All subjects were given a semi-structured clinical interview (SADS) at 6 months antenatally and at 12 months postnatally and sub-samples were interviewed at 3 months postnatally. At all these times all the mothers and fathers also completed a translated version of a self-rating scale for depression, the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: More women than men had past histories of depression but their rates of depression did not differ significantly during pregnancy. In the first 3 months postnatally, nearly a quarter of the women at risk were found to have become depressed (major, minor and intermittent) in contrast with less than 5% of the men. In the next nine months men were more prone to become depressed than previously and their conditions tended to follow an earlier onset of depression in their spouses. CONCLUSION: Comparisons of EPDS and SADS ratings showed that the translated EPDS was a valid instrument for women but it was less satisfactory when applied to men.

Adolescent↗
PubMed2002

Effects of exercise on depressive symptoms in older adults with poorly responsive depressive disorder: randomised controlled trial.

BACKGROUND: Depression is common in later life. AIMS: To determine whether exercise is effective as an adjunct to antidepressant therapy in reducing depressive symptoms in older people. METHOD: Patients were randomised to attend either exercise classes or health education talks for 10 weeks. Assessments were made "blind" at baseline, and at 10 and 34 weeks. The primary outcome was seen with the 17-item Hamilton Rating Scale for Depression (HRSD). Secondary outcomes were seen with the Geriatric Depression Scale, Clinical Global Impression and Patient Global Impression. RESULTS: At 10 weeks a significantly higher proportion of the exercise group (55% v. 33%) experienced a greater than 30% decline in depression according to HRSD (OR=2.51, P=0.05, 95% CI 1.00-6.38). CONCLUSIONS: Because exercise was associated with a modest improvement in depressive symptoms at 10 weeks, older people with poorly responsive depressive disorder should be encouraged to attend group exercise activities.

Aged↗
PubMed2003

Depression status, medical comorbidity and resource costs. Evidence from an international study of major depression in primary care (LIDO).

BACKGROUND: Despite the burden of depression, there remain few data on its economic consequences in an international context. AIMS: To explore the relationship between depression status (with and without medical comorbidity), work loss and health care costs, using cross-sectional data from a multi-national study of depression in primary care. METHOD: Primary care attendees were screened for depression. Those meeting eligibility criteria were categorised according to DSM-IV criteria for major depressive disorder and comorbid status. Unit costs were attached to self-reported days absent from work and uptake of health care services. RESULTS: Medical comorbidity was associated with a 17-46% increase in health care costs in five of the six sites, but a clear positive association between costs and clinical depression status was identified in only one site. CONCLUSIONS: The economic consequences of depression are influenced to a greater (and considerable) extent by the presence of medical comorbidity than by symptom severity alone.

Absenteeism↗
PubMed1991

Hormonal responses during insulin-induced hypoglycemia in manic-depressed, unipolar depressed, and healthy control subjects.

Early studies using the insulin tolerance test (ITT) in affective disorders reported a blunted GH response in some depressed patients. However, results from subsequent studies were less consistent. These discrepancies resulted in part from limited sample sizes causing diagnostic heterogeneity. In the present study we examined hormonal response patterns during the ITT in 25 bipolar patients (19 depressed and 6 hypomanic), 91 unipolar depressives, and 51 healthy volunteers to determine whether distinct neuroendocrine response patterns characterized specific diagnostic subgroups. We measured the glucose, GH, PRL, and cortisol responses during a 75-min ITT and observed a diminished cumulative GH response in bipolar hypomanic patients compared to bipolar depressives (P = 0.004) and healthy volunteers (P less than 0.001), and a larger cumulative GH response in bipolar depressives compared to unipolar patients (P = 0.02). No differences were observed in either PRL or cortisol responses among subject groups. The present findings suggest that GH responses during the ITT may be more complex than initially described and partially dependent upon affective disorder subtype. Thus, bipolar patients may have distinctive GH response patterns compared to those of unipolar depressives and healthy controls. Moreover, some of the difference observed in the GH response to the ITT may result from the phase of the manic-depressive illness. These data indicate differences in neuroendocrine substrates between affective disorder subtypes.

Adolescent↗
PubMed2005

Sentence completion test for depression (SCD): an idiographic measure of depressive thinking.

OBJECTIVES: This study set out to investigate the reliability and validity of the Sentence Completion Test for Depression (SCD) as a clinical measure. In contrast to questionnaire measures of depressive thinking, respondents finish incomplete sentences using their own words. This elicits idiographic information concurrent with measuring depressive thinking. METHOD: In Study 1, measures of negative thinking were tested between a depressed group and a non-depressed control group. A preliminary item analysis was conducted and replicated on separate samples in Study 2. Psychometric properties of the test were investigated. In Study 3, idiographic validity and sensitivity to change were explored in a sample of clinical cases with reference to cognitive-behavioural case-formulation. RESULTS: In Study 1, the depressed group produced more negatives and fewer positives, and the SCD demonstrated good content validity, internal consistency and inter-rater reliability. The preliminary short-form had comparable psychometric properties, and these were replicated on new samples in Study 2. Sensitivity and specificity values were above 90% in both studies. In Study 3, idiographic content generated hypotheses about target problems and dysfunctional beliefs within cognitive-behavioural case-formulation, and SCD scores were sensitive to clinical change. CONCLUSIONS: The SCD demonstrates good construct validity, internal consistency, inter-rater reliability, sensitivity, and specificity. It offers an idiographic assessment of depression that is complementary to questionnaire measures, particularly by generating hypotheses about target problems and dysfunctional beliefs within a cognitive-behavioural case-formulation. This is achieved without loss to reliability and validity at the nomothetic level.

Adult↗