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PubMed2004

The 13- and 20-item Hopkins Symptom Checklist Depression Scale: psychometric properties in primary care patients with minor depression or dysthymia.

OBJECTIVE: Depression scales that are responsive to changes in clinical symptoms are important for clinical monitoring and outcomes assessment in longitudinal studies. We evaluated the psychometric properties and responsiveness to clinical change of the 13- and 20-item versions of the Hopkins Symptom Checklist Depression Scale (HSCL-D). METHODS: A secondary data analysis from a large 11-week, multicenter clinical trial, comparing three treatments was performed. Adult patients with minor depression or dysthymia and a score of > or = 10 on the Hamilton Depression Rating Scale (HDRS) were recruited from primary care clinics. Item-total correlations and Cronbach alphas were computed for HSCL-D-13 and HSCL-D-20. Clinical response at 11 weeks was defined by a Hamilton Depression Rating Scale (HDRS) < 10, clinical remission by a HDRS < 7, and criterion symptom remission by < or = 1 DSM-III-R criterion symptoms. Standardized effect sizes and Guyatt's responsiveness statistic were determined for the 13- and 20-item HSCL-D. RESULTS: Of the 656 subjects enrolled, 511 (77.9%) had complete data and were included in the analysis. Patients were 61.1 +/- 15.0 years old; minor depression was diagnosed in 238, dysthymia in 273. Both scales had good internal consistency; Cronbach's alpha = 0.835 and 0.859 for the 13- and 20-items questionnaires respectively. Standardized effect sizes for clinical response (0.62 for the HSCL-D-13; 0.66 for the HSCL-D-20), clinical remission (0.69 and 0.70), and criterion symptom remission (0.65 and 0.67) showed moderate to large effects and did not differ significantly for the two versions. Responsiveness was virtually identical for patients with minor depression and dysthymia but responsiveness was substantially lower for ethnic minorities. CONCLUSION: The HSCL-D-13 and 20-item versions have similar responsiveness to change. For use in European Americans, we recommend the HSCL-D-13 if response burden is the preeminent consideration. To more fully capture DSM criterion symptoms, we recommend the HSCL-D-20.

Adolescent↗
PubMed1975

Some preliminary observations on a questionnaire technique for classifying depressive illness: its relationship with clinical diagnosis and a biological technique for depressive classification.

A questionnaire designed to assist in the classification of depressive illness, was administered to 20 acute depressive patients and 10 normal controls. Patient classification according to the decision rules employed by the questionnaire, were compared with patient classification arrived at by symptomatic (diagnostic) and physiological (G.S.R. inhibition threshold) means. It was found that a preponderance of patients classified as "endogenous depressives" by the questionnaire technique, also had clinical diagnoses of endogenous depression, and had low G.S.R. inhibition thresholds relative to normals. Furthermore a preponderance of patients classified as "non-endogenous depressives" by the questionnaire technique, had clinical diagnoses of neurotic depressive illness, and had high G.S.R. inhibition thresholds relative to normals. This supports the assertion that the questionnaire technique has some validity in the classification of depressive illness.

Adjustment Disorders↗
PubMed2003

Depression-free days as a summary measure of the temporal pattern of response and remission in the treatment of major depression: a comparison of venlafaxine, selective serotonin reuptake inhibitors, and placebo.

BACKGROUND: This article develops and applies depression-free days (DFDs) as a summary measure of the temporal pattern of response and remission in a comparison of venlafaxine (a dual-action serotonin-norepinephrine reuptake inhibitor) with selective serotonin reuptake inhibitors (SSRIs) and placebo. METHOD: Weekly data on the 17-item Hamilton Rating Scale for Depression (HAM-D-17) from 2046 patients with DSM-III-R/IV-established moderate-to-severe major depression, participating in 1 of 8 randomized, double-blind, controlled studies that compared venlafaxine with an SSRI (fluoxetine, paroxetine, or fluvoxamine) or with both placebo and an SSRI, were used to estimate DFDs. Maximum DFDs were imputed to maintained HAM-D-17 scores < or = 7 (asymptomatic depression) over time, minimum DFDs to persistent HAM-D-17 scores > or = 15 (acutely symptomatic depression), and prorated DFDs to intermediate HAM-D-17 scores. A secondary construct was developed to test sensitivity to a less stringent upper threshold of acutely symptomatic depression (HAM-D-17 score > or = 22). Using a tertiary construct, sensitivity to a more stringent lower threshold representing elimination of residual symptoms was also evaluated. The construct validity of the primary and the secondary DFDs measures was assessed in terms of their correlation with sustained low clinical global severity of illness (scores of 1 or 2 on the Clinical Global Impressions-Severity of Illness scale). for each construct, DFDs were compared across the 3 treatment groups and corresponding effect sizes were generated. RESULTS: Overall, sustained low clinical global severity of illness was associated with 38.3 median (interquartile range, 29.8 to 44.2) DFDs relative to 5.7 (interquartile range, 0 to 20.6) median DFDs associated with nonsustained low clinical global severity; similar differences emerged in terms of sustained asymptomatic depression. The venlafaxine group (N = 851) experienced a median of 18.8 (interquartile range, 0.4 to 34.6) DFDs compared with a median of 13.6 (interquartile range, 0 to 29.8) DFDs in the SSRI group (N = 749) and 7.4 (interquartile range, 0 to 26.2) DFDs in the placebo group (N = 446) (p <.0001 overall; venlafaxine vs. SSRIs, p =.0015, effect size = 0.2; venlafaxine vs. placebo, p <.0001, effect size = 0.4; and SSRIs vs. placebo, p =.0007, effect size = 0.2). The secondary and tertiary DFDs constructs yielded similar, albeit narrower, differences in all comparisons. CONCLUSION: The construct of DFDs was found to be a useful summary measure of sustained remission. Active treatments were associated with more DFDs than placebo, and venlafaxine with more DFDs than SSRIs, consistent with corresponding differences in sustained remission.

Algorithms↗
PubMed2004

[Examining the causal model of depression: the relation between depressogenic schemata and depression].

This study examines the causal relation between depressogenic schemata and depression. Three structural equation models were tested two times among 149 students during five months: (1) one-way causal relation from depressogenic schemata to depression, (2) one-way causal relation from depression to depressogenic schemata, (3) reciprocal relation between depressogenic schemata and depression. Results showed the third model is the most adequate among three models. It is possible that depressogenic schemata influences depression and depression also has some effects on depressogenic schemata. As a result of reviewing previous studies, it is thought that there is a continuity is between clinical and non-clinical groups. Therefore, the findings of this study is useful in understanding the clinical image of depression.

Adolescent↗
PubMed2006

Screening for postpartum depression in military women with the Postpartum Depression Screening Scale.

Each year, approximately 16,000 women on active duty in the U.S. military experience the birth of a child. A descriptive, longitudinal, prospective design was used to gather data with the Postpartum Depression Screening Scale. Depression was measured after delivery but before hospital discharge (time 1), 2 weeks after delivery (time 2), and 6 to 8 weeks after delivery (time 3). Mothers were found to be experiencing the greatest severity of symptoms in the category of sleeping and eating disturbances. Almost one-half of the mothers in this study scored either significant postpartum depressive symptoms or positive screening for postpartum depression after delivery. This number remained virtually unchanged at time 2. By time 3, 40% of women still reported depressive symptoms. At 2 weeks and 6 weeks after delivery, 13% and 11% of mothers, respectively, had positive screening for postpartum depression, consistent with the national average of 10 to 15%. Future research is needed to examine issues surrounding postpartum depression of military women.

Adolescent↗
PubMed1999

Using an annual over-75 health check to screen for depression: validation of the short Geriatric Depression Scale (GDS15) within general practice.

OBJECTIVE: To validate the short Geriatric Depression Scale (GDS15) as a screening instrument and determine the optimal cutpoint for detecting depression among older people living in the community. DESIGN: Two stage study with the first stage consisting of a health check of people aged 75 years and over by a practice nurse which included the GDS15. A second-stage diagnostic interview including the criterion standard was carried out blind to GDS15 score. SETTING: A large general practice in Melton Mowbray, Leicestershire, UK. PATIENTS: A random sample (stratified according to first-stage GDS15 score) of 257 older people living in the community, without significant cognitive impairment, were selected for the second-stage diagnostic interview. MEASURES: The first-stage GDS15 score was compared with diagnostic status for depression and anxiety disorders (according to ICD-10 criteria) and presence of depressive symptoms at the second-stage clinical interview. RESULTS: Ninety-three per cent of those eligible for the study were successfully screened with the GDS15. A cutpoint of <3/3+ had a sensitivity of 100% and specificity of 72% in detecting cases of depression but fewer than one in five of those testing positive reached a diagnostic threshold. Only 25% of those with a diagnosis of depression had any mention of mental health problems in their medical notes in the year prior to the clinical interview. For detecting depressive symptoms the same cutpoint was 79% sensitive and 78% specific with a positive predictive value of 46%. CONCLUSIONS: Used as part of an annual over-75 health check in primary care, the GDS15 would detect a significant amount of hidden morbidity which would serve the original purpose of the annual elderly health checks in the UK.

Aged↗
PubMed1998

Testing two elements of spirituality in depressed and non-depressed elders.

Depression is a common source of morbidity and mortality among elders in North America and has a significant impact on their quality of life. Meaning in life and self transcendence, indicators of spirituality, have been linked to the experience of well-being in the elderly. Nurses are challenged to find ways to tap these natural resources as a means of addressing the serious problem of depression in the aged. The purpose of this study was to compare patterns of depression, meaning in life and self-transcendence as measured in three instruments in a group of elders 75 years of age and older. The Geriatric Depression Scale, Purpose in Life Test and Self-Transcendence Scale were completed by 77 elders residing independently or semi-independently in one of three retirement communities. Significant negative relationships were found between depression and meaning in life, and between depression and self-transcendence. A significant positive relationship was found between meaning in life and self-transcendence. Demographic data further contributed to patterns of depression and well-being in this group. The study conclusions support the importance of meaning in life and self-transcendence for well-being in the elderly. Based on the study results, suggestions are offered about ways to enhance health and well-being in this cohort.

Aged↗
PubMed2000

An examination of the sensitivity of the six-item Hamilton Rating Scale for Depression in a sample of patients suffering from major depressive disorder.

OBJECTIVES: To compare the sensitivity of the 6-item Hamilton Rating Scale for Depression (HRSD6) with the more widely used 17-item Hamilton Rating Scale for Depression (HRSD17) in patients suffering from major depressive disorder, with or without melancholia and/or dysthymic disorder. A secondary objective was to compare the sensitivity of the HRSD6 to the Montgomery-Asberg Depression Rating Scale (MADRS). DESIGN: Retrospective analysis of 4 clinical trials that tested antidepressant therapies. SETTING: Outpatient treatment in a major psychiatric hospital. PARTICIPANTS: One hundred and forty-three male and female outpatients meeting the criteria of the DSM-III-R or DSM-IV for major depressive disorder. OUTCOME MEASURES: HRSD17, HRSD6 and MADRS. RESULTS: The HRSD6 correlated strongly with the HRSD17, both at baseline and termination of treatment, and for the subgroups of double depression and melancholia. The HRSD6 was also correlated significantly with the MADRS at both measurement times, and for the subgroups. Paired t-tests with the HRSD6, HRSD17 and MADRS demonstrated equal sensitivity to change over the course of treatment, both in the full sample and in the dysthymic and melancholic subgroups. CONCLUSIONS: The HRSD6 appears to be as sensitive to change over treatment as the HRSD17 and the MADRS. A shorter, less time-consuming measure of depression may have utility in clinical practice and research.

Adult↗
PubMed2000

The relation of religious belief and practices, depression, and hopelessness in persons with clinical depression.

Religious belief and practices have been associated with lower levels of depression in persons dealing with stressful situations. In this study, researchers examined this relationship in 271 persons diagnosed with clinical depression. It was hypothesized that religious belief and practices would be associated with lower depression and that this relationship would be mediated by hopelessness. Religious belief, but not religious behavior, was a significant predictor of lower levels of hopelessness and depression beyond demographic variables. Through the relation of religious belief to lower levels of hopelessness, religious belief was indirectly related to less depression. There was also a small direct positive association of belief with depression, pointing to the complexity of the role belief plays for religious persons. Further study is needed for a better understanding of different ways religion affects depressed persons.

Adaptation, Psychological↗
PubMed2001

Consensus statement on transcultural issues in depression and anxiety from the International Consensus Group on Depression and Anxiety.

OBJECTIVE: To provide primary care physicians with a better understanding of transcultural issues in depression and anxiety. PARTICIPANTS: The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Five faculty invited by the chair also participated: Laurence J. Kirmayer, Jean-Pierre Lepine, Keh-Ming Lin, Osamu Tajima, and Yutaka Ono. EVIDENCE: The consensus statement is based on the 5 review articles that are published in this supplement and the scientific literature relevant to the issues reviewed in these articles. CONSENSUS PROCESS: Group meetings were held over a 2-day period. On day 1, the group discussed the review articles, and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all attendees. CONCLUSION: The consensus statement underlines the prevalence of depression and anxiety disorders across all cultures and nations while recognizing that cultural differences exist in symptom presentation and prevalence estimates. In all countries, the recognition of depression by clinicians in the primary care setting is low (generally less than 50%), and the consensus group recommends a 2-step process to aid the recognition and diagnosis of depression. In line with the low recognition of depression and anxiety disorders is the finding that only a small proportion of patients with depression or anxiety are receiving appropriate treatments for their condition. Biological diversity across ethnic groups may account for the differential sensitivity of some groups to psychotropic medication, but this area requires further investigation.

Anxiety Disorders↗
PubMed2003

[Prevalence of postpartum depression in Spanish mothers: comparison of estimation by mean of the structured clinical interview for DSM-IV with the Edinburgh Postnatal Depression Scale].

BACKGROUND AND OBJECTIVE: Our objectives were: To estimate the prevalence of postpartum depression (PD) by two evaluation methods: Structured Clinical Interview for DSM-IV (SCID), and self-report Edinburgh Postnatal Depression Scale (EPDS), and to identify the EPDS cut-off to provide an unbiased estimation of PD prevalence. PATIENTS AND METHOD: We report data from all women (n = 1191) attending to postnatal routine checking visits at six weeks postpartum during one year in the Gynaecology and Obstetrics Department of the Hospital Clínic of Barcelona (Spain). A two-stage method was used. In the first stage, all women selected completed the EPDS. In the second stage, all women with an EPDS score >= 9 (probable PD cases) and a randomized sample of 16% with a score < 9 were evaluated by a psychiatrist using the SCID interview to establish a psychiatric diagnosis of major and minor depression. 402 postpartum women were offered the SCID interview; 68 of them refused to participate. RESULTS: The prevalence of depression according to the SCID interview was 10.15% (CI 95%, 8.43-11.87). The prevalence of major depression was 3.6% (CI 95%, 2.55-4.67) and it was 6.5% (CI 95%, 5.14-7.95) for minor depression. An EPDS cut-off of 11/12 provided an unbiased estimation of the postpartum depression prevalence rate. CONCLUSIONS: Our results justify the need to use different EPDS cut-offs. A cut-off of 10/11 is effective for identifying the population at risk and a cut-off of 11/12 is useful to estimate the prevalence in epidemiological studies.

Adult↗
PubMed2003

Evaluation of a depression health management program to improve outcomes in first or recurrent episode depression.

OBJECTIVES: To evaluate the impact of telephone counseling and educational materials on medication adherence and persistency among members with newly diagnosed depression enrolled in a pharmacy benefit management-sponsored disease management program. STUDY DESIGN: Longitudinal cohort observation. METHODS: The study population comprised 505 members with a new or recurrent episode of depression who consented and enrolled in a depression disease management program. After written consent was obtained, program participants received up to 4 telephone-counseling calls and 5 educational mailings focused on the importance of medication compliance, barriers to medication compliance, quality of life, symptoms, and satisfaction with the program. A control group of 3744 members was selected from client companies that opted not to offer the depression program. Measures of medication adherence, persistency with prescription drug therapy, and patient refill timeliness were computed for both groups and compared. RESULTS: Patients enrolled in the depression disease management program were significantly more likely to adhere to their medication regimen during acute (89.0% vs 67.7%, P < .001) and continuation treatment phases (81.1% vs 57.6%, P < .001). In addition, members enrolled in the program were significantly more likely to continue their therapy after 7 months (77.8% vs 49.5%, P < .001) and refilled their prescriptions on a more timely basis (0 vs 18 days, P < .001). CONCLUSIONS: A pharmacy benefit management-sponsored health management depression program succeeded in encouraging patients with new or recurrent depression to stay on antidepressant medication and to reach treatment goals outlined by best practice guidelines.

Antidepressive Agents↗
PubMed2006

Changes in depression and quality of life during inpatient treatment of depression.

OBJECTIVE: The aim of the study was to evaluate the changes in the symptoms of depression and subjective quality of life improvement during inpatient treatment. MATERIAL AND METHODS: A total of 87 patients were assessed during the first five days of hospitalization and during naturalistic follow-up at the time of discharge using Composite International Diagnostic Interview Short Form (CIDI-SF), structured interview for depressive symptoms assessment, and World Health Organization Quality of Life Abbreviated Questionnaire. RESULTS: Results indicate that symptoms of depression decrease and quality of life increases during inpatient treatment. However, high frequency of residual symptoms was observed. More than half of all patients reported ten or more symptoms at time of discharge. Although same gender differences in the frequency and severity of depressive symptoms were observed at time of admission, gender did not impact significantly treatment outcomes. Older age, comorbid somatic diseases, higher number of depressive symptoms at the time of admission, CIDI-SF confirmed major depressive episode, and lower quality of life were related to poor outcome of the treatment. Multiple regression analyses suggested that CIDI-SF confirmed major depressive episode and physical health domain of the quality of life were the most significant predictors of the outcome. CONCLUSION: Combination of measures of clinical assessment and quality of life can be useful for more complete patients' evaluation and the prediction of treatment outcome.

Adult↗
PubMed2006

Is it possible to predict postnatal depression? Research into the origin of blues and depression. The role of the gynaecologist.

PURPOSE OF INVESTIGATION: the authors investigated the role of the gynaecologist in trying to predict postnatal depression. Women suffering from postnatal depression (PND) are the expression of a failure to adapt to the unjust demands that society makes on them. Isolation and the lack of social support during and after the pregnancy are very strong factors of risk for postpartum depression. The problem is serious and it develops rapidly, within two weeks of childbirth. It requires immediate and continuous treatment. There is also some risk of infanticide or suicide. METHODS: submission of a questionnaire based on the EPDS (Edinburgh Postnatal Depression Scale) to 222 pregnant women between 28 and 40 weeks of gestation. RESULTS: 28.4% of the patients resulted positive to the test (score > 12 points) and the hypothesis would seem to be that there is a continuum between depression suffered pre- and postpartum, and that the depression begins during pregnancy and then becomes more acute or less latent at the time of confinement. CONCLUSIONS: the gynaecologist must have a role in helping to achieve an early diagnosis of the depression, because the earlier the problem is recognised the greater are the possibilities of therapy and preventing any consequences for the entire family group.

Adult↗
PubMed1991

Comorbidity of unipolar depression: I. Major depression with dysthymia.

The degree of current and lifetime comorbidity between major depressive disorder (MDD) and dysthymia (DY) was examined in large community samples of older adolescents (n = 1,710) and adults (n = 2,060). DY was highly comorbid with MDD (lifetime odds ratio of 3.4 for adolescents and 1.6 for adults) and was more likely to precede than to follow MDD, especially in persons who became depressed early in life. MDD was by far the more frequent form of depression: Approximately 80% of the depressed persons experienced only MDD, 10% experienced only DY, and 10% experienced both MDD and DY. The large number of persons who had became depressed twice experienced MDD in the 2nd episode, regardless of the nature of the 1st depression. History of depression was associated with a greater probability for other mental disorders in both adolescents and adults; however, the rates of comorbidity for MDD did not differ from rates for DY or for both MDD and DY.

Adolescent↗
PubMed1988

Diagnosis and subtyping of depressive disorders by quantitative electroencephalography: II. Interhemispheric measures are abnormal in major depressives and frequency analysis may discriminate certain subtypes.

Seventy-six inpatient RDC major depressives (51 primary and 25 secondary), drug free for at least ten days, and 93 normals were examined by quantitative electroencephalography (QEEG). Multivariate analyses of variance were performed on several diagnostic subgroups using QEEG variables identified in an earlier study as discriminators. Decreased interhemispheric coherence in the delta and/or theta frequency bands was present to a statistically significant degree in depressed subjects. Secondary major depressives showed a lesser decrease than did primary major depressives in both anterior and posterior brain regions. Depression secondary to organic brain syndrome was distinguished from other secondary depressions by the presence of significant slow wave excess in the former only. The ability of beta activity to discriminate unipolar from bipolar major depression was confirmed.

Beta Rhythm↗
PubMed1993

[Depressed mothers: the impact of depression on early interactions. An analysis of Anglo-Saxon studies].

Maternal depression remains a public health problem as indicated by many studies focusing on depression in mothers of young children. Although the high prevalence of depression in mothers of infants and young children is now a recognized fact, the detection and management of maternal depression in everyday practice still raises significant problems. This initial review centers on studies providing diagnostic guidelines. The problem of maternal depression and of its impact on the offspring is relevant to the issue of how qualities, abilities, and vulnerabilities are transmitted from one generation to the next. Psychoanalysts, infant psychiatrists, and developmental psychologists show great interest in this field. The current review was restricted to recent Anglo-Saxon studies on depression-related changes in early maternal behavior. The most striking findings are as follows: although depression affects maternal behavior overall, there is considerable variation across mothers; timing alterations (in terms of micro and macro sequences) in mother-child interactions occur in every case and are among the obstacles to harmony and synchronization; subtle alterations in the mother's response to her baby's signals preclude flexibility and anticipation.

Adult↗
PubMedDate not supplied

[Frontal lobe dysfunction and depressive state: relation to endogenous character of depression].

A dysfunction of dorsolateral prefrontal cortex (DLPF) in major depression is suggested by functional imagery and comparative neuropsychology. However, assessment of frontal lobe syndrome with DLPF-dependent tests led to controversial results. To clarify these findings, we administered 5 of these tests (Wisconsin Card Sorting Test, Stroop Test, Trail Making Test, Tower of Toronto, verbal fluency) to 16 major depressive subjects and their 16 controls, before and after 21 days of treatment. Furthermore, we tried to assess the prognostic value of frontal lobe dysfunction, and its relation with the endogenous or exogenous nature of the depression on the one hand, the severity of the depression on the other hand. Our results suggest that the presence of a frontal lobe syndrome (defined by impaired performances at 3 tests or more) is only noted in endogenous depression; after treatment, no impairment is detected. No correlation is found with the severity of the depression. Frontal lobe syndrome does not seem to indicate poorer prognosis for current depressive episode.

Adult↗