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PubMed2006

Factors influencing mother-child reports of depressive symptoms and agreement among clinically referred depressed youngsters in Hungary.

BACKGROUND: Psychiatric assessments of children typically involve two informants, the child and the parent. Understanding discordance in their reports has been of interest to clinicians and researchers. We examine differences between mothers' and children's report of children's depressive symptom severity, and factors that may influence their reports and level of agreement. We hypothesized that agreement between mother and child would improve if (1) the mother is depressed, due to improved recall of mood congruent symptoms, (2) the child is older, due to better social-cognitive and communication skills, and (3) the child is a female. METHODS: Subjects were 354 children (158 girls; mean age 11.69 years, SD: 2.05 years) with Major Depressive Disorder. Depressive symptoms were evaluated by a semi-structured interview separately with the mother and the child. Agreement on symptom severity was based on concordance of the presence and extent of symptoms. RESULTS: Maternal reports were significantly higher than their son's but not daughters'. Girls, particularly with increasing age, reported higher levels of symptoms; however mothers' reports were not affected by child sex or age. Maternal depression predicted more severe symptom reports for both children and mothers. Agreement between the mother and the child increased as children got older. LIMITATIONS: The same clinician interviewed the mother and the child, which might inflate rates of agreement. However, this method mirrors clinical evaluation. CONCLUSION: During a clinical interview one must consider the age and sex of the child and the depressive state of the mother in assimilating information about the child.

Adolescent↗
PubMed2006

The DEX/CRH neuroendocrine test and the prediction of depressive relapse in remitted depressed outpatients.

Hypothalamo-pituitary-adrenal (HPA) system dysfunction is the most characteristic biological alteration found in a majority of depressed patients. Accumulating evidence suggests that the combined dexamethasone (DEX)/corticotropin-releasing hormone (CRH) test is highly sensitive to detect HPA system abnormalities. The aim of this study was to evaluate whether the DEX/CRH test has a predictive value for the risk of depressive relapse in outpatients who are in clinical remission from a major depressive episode. Thirty-eight depressed outpatients (23 women, 15 men) in remission (MADRS score < or =8) underwent the DEX/CRH test and were followed up for 12 months regarding the occurrence of a new depressive episode. In parallel we recruited 24 controls (13 men and 11 women). The main result is a statistically significant difference concerning the delta and AUC numbers for cortisol plasmatic values between the group of patients who relapsed during the 1-year follow-up and control subjects, but not between the group of patients with prolonged remission and controls. These results suggest that in outpatients who are in clinical remission from a major depressive episode, high delta and AUC values in the DEX/CRH test compared to controls subjects can be associated with a higher risk of relapse.

Adult↗
PubMed2006

Are men more depressed than women in Norway? Validity of the Hospital Anxiety and Depression Scale.

OBJECTIVE AND METHODS: The aim was to evaluate the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) by comparing the gender-specific scores with another self-rated measure of mental health (MH), the SF-12 Health Survey, in a large general population (N=16,116). RESULTS: Using a score of 8 as a cut-off point for depression, the odds ratio for depression among men versus women was 1.29 [P<.0001; 95% confidence interval (CI): 1.16-1.43]. This contrasted with the results from the SF-12, in which the women had markedly and significantly poorer scores than men did. The women also reported a higher use of medicine for depression. Two of the seven HADS-D questions, related to interest in personal appearance and the ability to enjoy television, radio, and books, explained 70% of the higher depression scores among men. CONCLUSION: The results suggest that the validity related to gender differences in HADS-D is highly questionable.

Adult↗
PubMed2004

Agitated depression: a valid depression subtype?

PURPOSE: The diagnostic validity of agitated depression (AD, a major depressive episode (MDE) with psychomotor agitation) is unclear. It is not classified in DSM-IV and ICD-10 classification of mental and behavioural disorder (ICD-10). Some data support its subtyping. This study aims to test the subtyping of AD. METHODS: Consecutive 245 bipolar-II (BP-II) and 189 major depressive disorder (MDD) non-tertiary-care MDE outpatients were interviewed (off psychoactive drugs) with Structured Clinical Interview for DSM-IV Axis I Disorders--Clinician Version (SCID-CV), Hypomania Interview Guide (HIGH-C), and Family History Screen. Intra-MDE hypomanic symptoms were systematically assessed. AD was defined as an MDE with psychomotor agitation. Mixed AD was defined as an MDE with four or more hypomanic symptoms (including agitation). FINDINGS: AD was present in 34.7% of patients. AD was mixed in 70.1% of AD patients. AD, vs. non-AD, had significantly (at alpha = 0.05) lower age at onset, more BP-II, females, atypical depressions, bipolar-I (BP-I) and BP-II family history, and was more mixed; racing/crowded thoughts, irritability, more talkativeness, and risky behaviour were significantly more common. Mixed AD, vs. non-AD, had significantly (at alpha = 0.01) lower age at onset, more intra-MDE hypomanic symptoms, BP-II, females, atypical depressions, BP-II family history, and specific hypomanic symptoms (distractibility, racing thoughts, irritable mood, more talkativeness, risky activities). Mixed AD, vs. non-mixed AD, had significantly more intra-MDE hypomanic symptoms (by definition), more recurrences, and more specific hypomanic symptoms (by definition). Non-mixed AD, vs. non-AD, had significantly more intra-MDE hypomanic symptoms and more talkativeness. CONCLUSIONS: AD was common in non-tertiary-care depression outpatients, supporting its diagnostic utility. AD and many bipolar diagnostic validators were associated, supporting its link with the bipolar spectrum. Mixed AD, but not non-mixed AD, had differences vs. non-AD similar to those of AD, suggesting that psychomotor agitation by itself may not be enough to identify AD as a subtype. Findings seem to support the subtyping of mixed AD. This subtyping may have important treatment impact, as antidepressants alone might increase agitation.

Adult↗
PubMed2005

Gradations of clinical severity and sensitivity to change assessed with the Beck Depression Inventory-II in Japanese patients with depression.

Knowledge of what constitutes a minimal clinically important difference and change on a psychiatric rating scale is essential in interpreting its scores. The present study examines the Beck Depression Inventory-II (BDI-II), a recently revised successor to the world's most popular self-rating instrument for depression. BDI-II was administered to 85 patients with major depression, diagnosed with DSM-IV along with its severity specifiers. It was again administered to 40 first-visit patients from the original sample when they returned 14 or more days later. The Clinical Global Impression-Change Scale was rated at the same time. All the ratings were done independent of each other. The BDI-II was able to distinguish between all grades of depression severity. An approximate 10-point difference existed between each severity specifier. The BDI-II was also sensitive to change in depression: a 5-point difference corresponded to a minimally important clinical difference, 10-19 points to a moderate difference, and 20 or more points to a large difference. Given the already established high reliability, content validity, construct validity and factorial validity, and the high sensitivity to between-subject differences and within-subject changes demonstrated in the present study, the BDI-II promises to continue to be a leading self-rating instrument to assess depression severity worldwide.

Cohort Studies↗
PubMed2004

Estimating depression prevalence from the Beck Depression Inventory: is season of administration a moderator?

The existence of winter seasonal affective disorder (SAD) and its milder population variants implies that depression estimates in a given population may tend to be higher in winter than at other times of the year. The aim of this study was therefore to test whether depression prevalence estimates based on the Beck Depression Inventory (BDI) are systematically moderated by season of administration. Existing information from the screening phase of a multicentre investigation of depression prevalence provided the data for the study. Repeated cross-sectional BDI data from samples in the United Kingdom (n=1299), Finland (n=1352), Norway (n=2711) and Spain (n=1246) were analysed for month- and season-of-administration effects. Whether data were measured continuously or as a dichotomous variable (BDI cutoff >/=13), there was no evidence of a systematic seasonal pattern in depression estimates across the four sites. No seasonal effects reached statistical significance at any single site, and trends in the association between winter and elevated BDI scores were positive in two sites (UK and Norway) and negative in two (Finland and Spain). Although limited by a post hoc analysis of existing data, this study provides the strongest evidence to date that season of administration is not a moderator of depression prevalence as estimated by the BDI.

Adolescent↗
PubMed2006

Depression with above-normal plasma vasopressin: validation by relations with family history of depression and mixed anxiety and retardation.

An anxious-retarded subtype of depression has been derived from the DSM-IV category of melancholia. It is defined by combined high scores for anxiety and retardation, and is related to family history of depression and increased plasma vasopressin (AVP) levels. Central problems concerning this hypothesized subcategory are whether elevated plasma AVP is related to family history, whether it would be better operationalized by a cut-off level for plasma AVP than as continuous variable, and whether the anxious-retarded phenotype would be better described in terms that account for full variability of mixed anxiety and retardation. A previous study suggested that above-normal plasma AVP was a more useful endophenotypic parameter than plasma AVP as a continuous variable. To answer these and related questions, 81 patients were investigated. Receiver Operating Characteristic analyses yielded a cut-off value of 5.56 pg/ml for above-normal plasma AVP, log-transformed plasma AVP (ln (AVP)) was used as continuous variable, and the correlation between anxiety and retardation was used to account for full variability of the anxious-retarded phenotype. Family history was related to above-normal plasma AVP (n = 16) and non-significantly to ln (AVP). Depression with above-normal plasma AVP, as well as familial depression with above-normal plasma AVP, showed a high correlation between anxiety and retardation, and this correlation was significantly higher than that found in the depressed patient control groups. The data support the delimitation of a largely familial depression with above-normal plasma AVP, vasopressinergic activation of the hypothalamus-pituitary-adrenal axis and a variable anxious-retarded phenotype.

Adult↗
PubMed2003

The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression.

The 16-item Quick Inventory of Depressive Symptomatology (QIDS), a new measure of depressive symptom severity derived from the 30-item Inventory of Depressive Symptomatology (IDS), is available in both self-report (QIDS-SR(16)) and clinician-rated (QIDS-C(16)) formats. This report evaluates and compares the psychometric properties of the QIDS-SR(16) in relation to the IDS-SR(30) and the 24-item Hamilton Rating Scale for Depression (HAM-D(24)) in 596 adult outpatients treated for chronic nonpsychotic, major depressive disorder. Internal consistency was high for the QIDS-SR(16) (Cronbach's alpha =.86), the IDS-SR(30) (Cronbach's alpha =.92), and the HAM-D(24) (Cronbach's alpha =.88). QIDS-SR(16) total scores were highly correlated with IDS-SR(30) (.96) and HAM-D(24) (.86) total scores. Item-total correlations revealed that several similar items were highly correlated with both QIDS-SR(16) and IDS-SR(30) total scores. Roughly 1.3 times the QIDS-SR(16) total score is predictive of the HAM-D(17) (17-item version of the HAM-D) total score. The QIDS-SR(16) was as sensitive to symptom change as the IDS-SR(30) and HAM-D(24), indicating high concurrent validity for all three scales. The QIDS-SR(16) has highly acceptable psychometric properties, which supports the usefulness of this brief rating of depressive symptom severity in both clinical and research settings.

Adolescent↗
PubMed2002

The importance of psychosocial factors, gender, and severity of depression in distinguishing between adjustment and depressive disorders.

BACKGROUND: This study evaluated the severity of depressive symptomatology as it relates to: (a) sociodemographic factors and (b) the occurrence and type of acute and chronic psychosocial triggers or life events before admission. METHODS: In total, 718 psychiatric inpatients were assessed with the AMDP-system by the treating psychiatrist within the first 2 days after admission. RESULTS: In the females, sociodemographic factors (being married, children in the household, higher education and the quality of interactions) but not psychosocial stressors or life events were found to be related to severity of depression on admission. Females showed more severe depressive syndromes than males, however, depression severity in males was independent of sociodemographic factors, life events or psychosocial triggers. LIMITATIONS: Clinical assessment was based on retrospective history taking. The sample consisted of inpatients only, the results require replication using larger and more diverse samples. CONCLUSION: Gender differences and life conditions such as familial distress are related to severity of depression. The present criteria for the differentiation between depressive disorders and adjustment disorders are not independent and should be substituted by a multiaxial assessment.

Acute Disease↗
PubMed2003

Differentiating moderate and severe depression using the Montgomery-Asberg depression rating scale (MADRS).

BACKGROUND: MADRS cut-off scores for moderate and severe depression were estimated in relation to the Hamilton Depression Rating Scale (HAMD(17)) and the Clinical Global Impressions Scale (CGI). METHOD: HAMD(17), MADRS, and CGI ratings from patients with major depression (DSM-IV) were analyzed (N=85). Receiver operating characteristics (ROC) curves were applied. RESULTS: Mean age was 51.4+/-14.5 years, 69% were female. Mean MADRS scores were 23.4+/-13.2, HAMD(17), MADRS, and CGI scores were highly correlated (r>0.85; P<0.0001). Best separation between moderate and severe depression according to CGI criteria was achieved with a MADRS score of 31 (sensitivity 93.5%, specificity 83.3%). LIMITATIONS: Studies to validate severity gradations including DSM-IV or ICD-10 diagnostic severity categories are recommended. CONCLUSIONS: Empirically based MADRS cut-off scores to separate moderate from severe depression on the basis of HAMD(17) and CGI severity ratings in patients with major depression were yielded.

Adult↗
PubMed2000

WFS1 gene mutation search in depressive patients: detection of five missense polymorphisms but no association with depression or bipolar affective disorder.

BACKGROUND: Wolfram syndrome (WFS) is an autosomal recessive neurodegenerative disorder. Recently, the WFS1 gene was isolated, and approximately 80% of the mutations responsible for WFS were found in exon 8 of WFS1. It has been noted that heterozygous carriers of the WFS gene are 26-fold more likely to be hospitalized for depression, and it has been estimated that approximately 25% of all people hospitalized for depression may carry the WFS gene(s). METHODS: We searched for mutations in exon 8 of WFS1 in 30 depressive patients with a history of hospitalization and whose age at onset was under 40 years. We also examined 47 bipolar affective patients and 62 control subjects for an association. RESULTS: A were detected. Four of the six were novel. No nonsense or frameshift mutation was detected. Genotypic and allelic distributions were similar between the depressive patients and the controls. No association with bipolar affective disorder was suggested. LIMITATIONS: Because of the small sample size, the probability of finding at least one patient with WFS-responsible mutation(s) was 70% if depression is associated with WFS1 mutation(s) in 5% of patients. CONCLUSION: It is not likely that WFS1 mutations are responsible for as much as 25% of depressive illness.

Adult↗
PubMed1997

Dysfunctional parenting: over-representation in non-melancholic depression and capacity of such specificity to refine sub-typing depression measures.

We examine the proposition that dysfunctional parenting is more likely to be experienced by those with non-melancholic (compared to melancholic) depression and that, as a consequence, such specificity allows the validity of varying definitions of melancholia to be examined and their utility sharpened. We study a sample of 245 non-psychotic patients meeting DSM-III-R criteria for a major depressive episode and assign them to melancholic and non-melancholic sub-sets according to five separate sub-typing measures (DSM-III-R; DSM-IV; Newcastle; 'Clinical' and CORE criteria). We assess dysfunctional parenting by use of the Parental Bonding Instrument (PBI), and by structured psychiatrist assessment and self-report ratings of a range of dysfunctional parental experiences, with independent assessment and self-report ratings of a range of dysfunctional parental experiences, with independent assessment of the last by reports from corroborative witnesses and from the patients' referring therapists. The five sub-typing measures assigned varying percentages of the sample (24-42%) to a 'melancholic' sub-type. When Newcastle Index assignments were examined, there was no evidence that dysfunctional parenting had any specificity to non-melancholic depression. Neither the DSM-III-R nor DSM-IV systems demonstrated specificity in relation to PBI scores, but several interview-assessed dysfunctional parenting characteristics were over-represented in their non-melancholic sub-sets. 'Clinical' definition showed the greatest over-representation of dysfunctional parenting to those assigned as having non-melancholic depression. The CORE measure, a behaviourally weighted measure of psychomotor disturbance, was the next most differentiating. Importantly, those assigned as having non-melancholic depression by all five measures were more likely to be rated by corroborative witnesses as being exposed to anomalous parenting, validating the subjects' self-reports, arguing against results being an artefact of clinician-based assessment, and supporting the specificity of dysfunctional parenting to a depressive sub-type.

Adolescent↗
PubMed2001

Estradiol alleviates depressive-like symptoms in a novel animal model of post-partum depression.

The effect of hormone withdrawal following hormone-simulated "pregnancy" on "depressive-like behavior" in the Forced Swim Test (FST) was investigated in female Long-Evans rats. Females were randomly assigned to "pregnant", "pregnant"+estradiol benzoate (EB), and control groups. Both the "pregnant" and "pregnant"+EB groups received daily injections of the hormones estradiol and progesterone to simulate the 23-day gestational period in the rat. However, the "pregnant"+EB group continued to receive daily estradiol injections after "pregnancy". All groups were tested 48 h after the last injection of the pregnancy period in the FST and subsequently in the Open Field Test (OFT). Results revealed that the "pregnant" rats exhibited significantly increased immobility and decreased struggling and swimming behaviors as compared to the "pregnant"+EB and control groups. These findings could not be explained by an overall depression in general locomotor activity among "pregnant" rats, as the "pregnant" rats made more area crossings in the OFT. Thus "pregnant" rats exhibited behaviors consistent with "depressive-like" symptoms "post-partum" (after their hormone regime was discontinued). Continual treatment with high levels of estradiol in the "pregnant"+EB group, however, reversed the exhibition of these behaviors. These results imply that withdrawal from chronic high levels of pregnancy-associated hormones (estradiol and progesterone) can produce depressed symptomology in rodents, which can be prevented by prolonging exposure to high levels of estradiol through the post-partum period. These findings are the first demonstration of "depressive-like" symptoms in a rodent model of post-partum pregnancy and the ability of high levels of estradiol to attenuate these "depressive-like" symptoms.

Analysis of Variance↗
PubMed2002

[Variables associated with the risk of postpartum depression. Edinburgh Postnatal Depression Scale].

OBJECTIVE: To find some of the variables associated with values on the Edinburgh Postnatal Depression Scale (EPDS) which suggest postnatal depression in women living in the province of Soria. DESIGN: Population-based case study with controls. SETTING: Soria Health Region. PARTICIPANTS: Women living in Soria giving birth in the INSALUD General Hospital between January and October 2000. MAIN MEASUREMENTS: Questionnaire sent by mail, containing socio-economic variables, pathology background, gynaecological and obstetric details, the EPDS and the APGAR Family score. Those questionnaires filled in between the third and eighth week after birth were considered valid. RESULTS: 340 questionnaires out of 556 sent out were received back (61.2% reply rate). 34 were excluded for lack of data or evident mistakes. 15.7% (95%, CI, 11.6-19.8) of the women scored 13 or more on the EPDS and were at risk of suffering postnatal depression. The independent variables associated with postnatal depression were: age of mother, poor or very poor economic situation, personal history of disturbed states of mind, being anaesthetised during birth and family dysfunction. CONCLUSIONS: The risk of postnatal depression was mainly related to socio-economic and family variables. Identification of these variables along with application of the EPDS after giving birth raises the alarm for a possible postnatal depression, and enables the study and follow-up in benefit of the mother and of the subsequent evolution of the new-born to be initiated.

Adult↗
PubMed1997

Serotonergic function and negative and depressive symptomatology in schizophrenia and major depression.

BACKGROUND: Serotonergic abnormalities are found in both major depressive disorder (MDD) and schizophrenia. Depressive symptoms commonly occur alongside the negative or defect symptoms in schizophrenia and antiserotonergic drugs may be particularly effective in their treatment. We wished to explore whether these symptoms could be distinguished biologically by directly comparing serotonergic function in these two illnesses. METHOD: Fifteen patients with MDD and 13 patients with schizophrenia underwent testing with the specific serotonin releasing agent D-fenfluramine (D-FEN). Prolactin and cortisol responses were measured to ascertain central serotonergic function. Individual patient results were compared with their own carefully matched control to correct for the effect of age, sex, weight and menstrual cycle, before the two patient groups were then compared. RESULTS: Prolactin responses differed significantly between the two patient groups, being lower in MDD patients and higher in schizophrenia patients than their individually matched controls. Cortisol responses did not differ. Within the schizophrenia group, increased serotonergic function correlated positively with depressive symptoms, but there was no such correlation with defect symptoms. Depressive scores were negatively correlated with the presence of negative symptoms in the schizophrenic group. CONCLUSIONS: Schizophrenia and MDD have distinct and opposite neuroendocrine responses to D-FEN. There is no evidence that depressive symptoms in these two conditions have a common serotonergic basis. Moreover, these responses distinguished between negative and depressive symptoms in our schizophrenic group.

Adult↗
PubMedDate not supplied

History of depression and subsyndromal depression in women smokers.

While Major Depressive Disorder (MDD) is associated with difficulty quitting smoking, few studies have examined the role of subsyndromal depression (SubD). We examined pretreatment differences in smoking, weight concerns, and negative affect among three groups of women (N = 281) enrolling in a smoking cessation program who responded to a self-report questionnaire about the lifetime presence of MDD symptoms: self-report positive for MDD, self-report positive for SubD, and self-report negative for depression (fulfilling either DSM-III-R symptom or duration criteria, but not both). Compared to MDD Subjects (Ss), SubD Ss were more likely to report eating disordered behaviors. Compared to Non-Depressed (Non-Dep) Ss, SubD Ss initiated smoking earlier, and reported greater previous withdrawal symptoms, more eating disordered behaviors, and higher anxiety, depression, and stress. Compared to Non-Dep Ss, MDD Ss reported a greater smoking rate during their heaviest usage period, greater previous withdrawal symptoms, lower self-efficacy to manage food intake (especially during negative affect situations), and greater depression and anxiety. Many of these significant differences disappeared when SubD Ss were combined with Non-Dep Ss and compared with MDD Ss as is done traditionally. SubD does not appear to be on a continuum with Non-Dep and MDD groups, but rather warrants further investigation as a discrete subset of smokers. The implications for assessment and treatment are discussed.

Adult↗
PubMed2000

Habituation of the blink reflex in first-episode schizophrenia, psychotic depression and non-psychotic depression.

OBJECTIVE: Electrophysiological recording of the electrically elicited blink reflex is the most reliable method of investigating habituation of the startle reflex. The purpose of this study was to compare the habituation and the late R3-component of the blink reflex between control subjects (N=19) and first-episode patients with schizophrenia (N=17), psychotic depression (N=23), and severe non-psychotic depression (N=25). METHODS: The blink reflex was evoked by electrical stimulation of the supraorbital nerve, and the deficient habituation of the R2i-component was measured with a computer-assisted integral area measurement. Prefrontal executive function of the patients was assessed with the Wisconsin Card Sorting Test. Current psychiatric symptoms were assessed with the Brief Psychiatric Rating Scale, the Hamilton Depression Scale, the Positive and Negative Syndrome Scale, and the Calgary Depression Scale. RESULTS: Deficient habituation of the blink reflex and occurrence of the late R3 component were associated both with a previous diagnosis of psychotic disorder and with the presence of current psychosis. The sensitivity and specificity of the abnormal habituation of the blink reflex in detecting psychotic disorder were 0.50 and 0.80, respectively. The abnormalities of the blink reflex were not associated with psychotropic medication. In schizophrenic patients, defective habituation of the blink reflex was associated with negative and cognitive symptoms, and in depressive patients with the presence of delusions. CONCLUSIONS: The deficient habituation of the blink reflex and occurrence of the late R3 component seem to be both trait and state markers of a psychotic disorder. The results suggest that schizophrenia and psychotic depression share some common neurobiological mechanisms involved in the modulation of the startle reflex.

Adult↗
PubMed2002

Depression and the heart: a systematic overview of definition, measurement, consequences and treatment of depression in cardiovascular disease.

Depression is an independent risk factor in the pathogenesis of cardiovascular disease and it is a prevalent disorder after cardiovascular disease associated with negative outcome in terms of mortality and morbidity. It is a dangerous condition requiring adequate screening and treatment, however, it often remains undiagnosed and thus untreated. Non-psychiatric healthcare workers, like nurses, general practitioners, physiotherapists and cardiologists are the health providers most closely involved in the management of patients with cardiovascular disease. They can play an important role in screening cardiovascular patients for depressive symptoms and in referring them for treatment. The purpose of this article therefore is to provide an evidence-based framework, aiming to educate non-psychiatric healthcare providers on depressive disorder in the context of chronic cardiovascular disease. In this paper, an overview of the definition, prevalence and consequences of depression will be discussed. Moreover, an overview of measurement methods and treatment modalities for depression will be provided. In addition, a step-by-step guide is provided in order to help non-psychiatric healthcare providers in dealing with depressed patients.

Algorithms↗