Age Of First Depressive Episode Research Articles

Childhood-onset depression and arterial stiffness in young adulthood

ObjectivesThe literature on childhood-onset depression and future compromised vascular function is suggestive but limited. The objective of this study was to determine if arterial stiffness, a predictor of future cardiovascular disease (CVD), measured in young adulthood, is associated with childhood-onset depression. MethodsCardiometabolic risk factors and pulse wave velocity (PWV), a measure of arterial stiffness, were cross-sectionally assessed in young adults with a history of childhood-onset depression (clinical diagnosis of major depressive episode or dysthymic disorder; N = 294 probands; initially recruited via child mental health facilities across Hungary; mean age of first depressive episode = 10.4 years), their never-depressed full biological siblings (N = 269), and never-depressed controls (N = 169). The mean ages of probands, siblings, and controls at the PWV visit were 25.6, 25.0, and 21.7 years, respectively, and 8.8% of the probands were in a current depressive episode. ResultsControlling for age, sex, age*sex, education, and family clusters, PWV (m/s) did not statistically differ across the groups (probands = 7.01; siblings = 6.98; controls = 6.81). However, after adjusting for key covariates, there were several across-group differences in CVD risk factors: compared to controls, probands and siblings had higher diastolic blood pressure and lower high-density lipoprotein cholesterol, probands had higher triglycerides, and siblings had higher body mass index (all p < 0.05). ConclusionWe found limited evidence of an association between a history of childhood-onset depression and young adulthood arterial stiffness. However, our findings of elevated cardiovascular risk factors in those with childhood-onset depression suggest that pediatric depression may predispose to increased CVD risk later in life and warrants further investigation.

Differences in the cognitive profile of depression between racial groups.

There is little research concerning whether race is associated with different clinical presentations of psychiatric disorders. Understanding the racial aspects of cognitive differences among depressed adults could help identify specific targets for depression treatment. We recruited 59 participants (52.5% white, 47.5% African American), age 18 to 60, with a current diagnosis of major depressive disorder (MDD). All participants underwent a cognitive battery that included tasks assessing decision-making, response inhibition, working memory, and executive planning. Differences between white and African American groups were analyzed using analysis of variance or equivalent nonparametric tests. There were no differences in demographic variables of age, sex, and education, but white individuals reported a significantly earlier age of first depressive episode compared with African American individuals. The African American group, however, showed significantly lower quality of decision-making and less risk adjustment on the Cambridge Gambling Task, and made more errors on the Spatial Working Memory task. Our finding that specific cognitive domains differ as a function of racial differences in MDD might have differential prognostic and treatment implications.

LIFETIME DEPRESSION AND RISK OF ALZHEIMER’S DISEASE: A 44-YEAR LONGITUDINAL POPULATION STUDY OF WOMEN

It has been suggested that depression may increase the risk of Alzheimer's disease (AD). Longitudinal studies on this association are however lacking. The analyses originate from the Prospective Population Study of Women in Gothenburg, Sweden. A representative sample of 800 women was examined at baseline 1968 (aged 38 to 54 years), and re-examinations (n=6) were done until 2012. Both dementia and depression was diagnosed according to DSM-III-R criteria, and based on information from neuropsychiatric examinations, informant interviews, hospital records, and registry data. For those who had an episode of depression before baseline hospital registers were used. Sub-type of AD dementia was diagnosed according to NINCDS-ADRDA criteria. During the 44-years of follow-up, 133 women developed AD and 598 died. Sixty-seven percent of the women had any-type depression during life-span (44% had major depression). Mean age of first depressive episode was 42 years. History of major depression increased the risk of developing AD with above 90%, compared to those without depression. Minor depression was not associated to AD. The risk of AD was related to age of onset of depression. Compared to women without depression, HR (95% CI) for AD was 3.35 (1.70–6.59) in women with first depressive episode before age twenty, 1.66 (1.06–2.59) in women with first episode in early midlife (20–49 years), and 2.16 (1.22–3.79) in women with first episode after age 70. Those with depression onset in late midlife (50–69 years) had no increased risk of AD. Depression was not associated with vascular dementia or other types of dementia. All analyses were adjusted for age, education and ApoE genotype. We found that major depression, early-life depression, early midlife depression, and late-life depression were associations with higher incidence of AD.

Contribution of long duration of undiagnosed bipolar disorder to high frequency of relapse: A naturalistic study in China

BackgroundWith attention to misdiagnosis of bipolar disorder (BP), long duration of undiagnosed bipolar disorder (DUBP) had been reported recently in years. This study aims to investigate the contributions of long DUBP to the frequency of relapse in bipolar patients, and explore affect factors of DUBP. MethodFrom 26 hospitals throughout China, 3896 participants diagnosed with BP according to International Classification of Diseases 10th criteria were enrolled in this study. Socio-demographic and clinical data were collected from medical records and specific questionnaires through clinical interviews with patients and their relatives. Results(1) Our results showed that the mean of DUBP was 40.52months. In total, 779 patients (19.995%) reported DUBP greater than 5years, and 1931 patients (49.564%) reported their DUBP greater than 2years. The number of mood episodes was averaged 5.44, and the frequency ratio of (hypo) mania to depressive episodes was 1.49 (3.27/2.19). (2) Multiple linear regression analysis revealed that DUBP was significantly contributed to the number of relapse (Beta=0.072, p<0.001) after considering the confounding including gender, age at study entry, age of onset, age of first (hypo) manic episodes, age of first depressive episodes, type of first episodes and family history of mental illness. (3) Factors including age at the study entry (Beta=0.526, p<0.001), age of onset (Beta=−1.654, p<0.001), age of first (hypo) manic episode (Beta=0.348, p<0.001), age of first depressive episode (Beta=0.983, p<0.001), depression as the type of first episode (Beta=0.058, p<0.001) and family history of mental illness (Beta=0.029, p<0.05) were significantly contributed to long DUBP. ConclusionIt was concluded that long DUBP might lead to high frequent relapse in bipolar patients. The factors correlated with long DUBP include older age, early age of onset, depression as the type of first episode and family history of mental illness. The findings of our study suggest emergency task to early reorganization of bipolar disorder, and improving clinicians' recognition of bipolar disorder from patients with depressive episodes, especially in children and adolescents.

Blood Transcriptomic Markers in Patients with Late-Onset Major Depressive Disorder.

We investigated transcriptomic markers of late-onset major depressive disorder (LOD; onset age of first depressive episode ≥ 50 years) from the genes expressed in blood cells and identified state-dependent transcriptomic markers in these patients. We assessed the genes expressed in blood cells by microarray and found that the expression levels of 3,066 probes were state-dependently changed in the blood cells of patients with LOD. To select potential candidates from those probes, we assessed the genes expressed in the blood of an animal model of depression, ovariectomized female mice exposed to chronic ultra-mild stress, by microarray and cross-matched the differentially expressed genes between the patients and the model mice. We identified 14 differentially expressed genes that were similarly changed in both patients and the model mice. By assessing statistical significance using real-time quantitative PCR (RT-qPCR), the following 4 genes were selected as candidates: cell death-inducing DFFA-like effector c (CIDEC), ribonuclease 1 (RNASE1), solute carrier family 36 member-1 (SLC36A1), and serine/threonine/tyrosine interacting-like 1 (STYXL1). The discriminating ability of these 4 candidate genes was evaluated in an independent cohort that was validated. Among them, CIDEC showed the greatest discriminant validity (sensitivity 91.3% and specificity 87.5%). Thus, these 4 biomarkers should be helpful for properly diagnosing LOD.

Childhood predictors of lifetime suicide attempts and non-suicidal self-injury in depressed adults.

Adverse childhood experiences are well-recognized risk factors for a variety of mental health issues, including depression, suicide attempts and non-suicidal self-injury. However, less is known about whether childhood adversity, in the form of low parental care, overprotection and abuse, is associated with suicide attempt and non-suicidal self-injury within a sample of depressed adults. The sample of outpatients (n = 372) was drawn from two randomized depression trials. Childhood adversity variables, depression severity, age of first depressive episode (major depression episode onset), lifetime suicide attempt and non-suicidal self-injury were recorded at baseline. The association between variables and outcome measures was examined using partial correlations, univariate and multivariate logistic regressions. Low maternal care was significantly associated with suicide attempt; low paternal care was associated with non-suicidal self-injury; overprotection was not associated with either outcome. Other risk factors for suicide attempt were major depression episode onset and baseline depression severity. Major depression episode onset was also a risk factor for non-suicidal self-injury. Abuse, regardless of how it was measured, was not significantly associated with either behaviour after adjusting for its correlations with low maternal or paternal care. In this sample of depressed adults, the quality of ongoing, intra-familial relationships, as measured by levels of parental care, had a greater impact on suicide attempt and non-suicidal self-injury than abuse. As the findings were not a priori hypotheses, they require replication. Although the cross-sectional study design limits causal determination, the findings suggest different childhood risk factors for suicide attempt and non-suicidal self-injury and underscore the impact of low parental care on these two behaviours. These findings signal to clinicians the importance of asking specifically about suicide attempts, and non-suicidal self-injury, as well as levels of parental care in childhood. When endorsed, low parental care may be considered an important factor in contextualizing a patient's depression and potential risk for suicide and non-suicidal self-injury.

Assessment of Risk Factors Related to Suicide Attempts in Patients With Bipolar Disorder

We compared the characteristics of patients with bipolar disorder with and without a history of suicide attempts to identify the risk factors of suicide in this disorder. Among 212 patients with bipolar disorder, 44 (21.2%) patients had histories of suicide attempts. Suicide attempters were younger and more likely to be diagnosed with bipolar II. The variables that differentiated those who did from those who did not attempt suicide included age at first contact, lifetime history of antidepressant use, major depressive episode, mixed episode, auditory hallucinations, rapid cycling, the number of previous mood episodes, age of first depressive episode, and age of first psychotic symptoms. Strong predictors of suicide attempts were younger age at onset, lifetime history of auditory hallucinations, and history of antidepressant use. Antecedent depressive episodes and psychotic symptoms predicted the first suicide attempt in patients with bipolar disorder. This study could help clinicians to understand the major risk factors of suicidal behavior in bipolar disorder.

P-488 - Socio-demographic and clinical risk factors on the non-recovery of the major depressive disorder: a 52-week follow-up study

Unfortunately, many patients who remit fully or partially from an episode of major depression continue to have difficulty in achieving the recovery. Our study assesses the effect of some probable risk factors on the non-recovery in a group of major depressive patients. Sixty patients, 18 to 65 years of age, with current major depressive disorder defined using DSM-IV-TR criteria were participated in the study. They began a 24-week course of open-label acute plus continuation phase treatment mainly with SSRIs, especially escitalopram. Maintenance treatment was not planned for not affecting the natural course. All participants were evaluated by CGI-S, BDI, HAMD-17, PSQI, and ISI at weeks 0, 4, 12, 24, and 52. Logistic regression analysis was done to predict the effect of some probable risk factors that obtained from 1st evaluation (at week 0) on the non-recovery (at week 52) and current age, number of previous episodes, age of first depressive episode, and episode type (first-episode versus double or chronic or recurrent) were found to be statistically significant. Early recognition of the socio-demographic and clinical risk factors impairing the recovery process of the major depressive disorder may be important for developing an individualised treatment plan.

Depression, Hypothalamic Pituitary Adrenal Axis, and Hippocampal and Entorhinal Cortex Volumes—The SMART Medea Study

Structural brain changes have often been found in major depressive disorder (MDD), and it is thought that hypothalamic-pituitary-adrenal (HPA) axis hyperactivity may explain this relation. We investigated the association of MDD and history of depression with hippocampal and entorhinal cortex volumes and whether HPA axis activity explained this association. In 636 participants with a history of atherosclerotic disease (mean age 62 ± 9 years, 81% male) from the second Manifestation of ARTerial disease-Memory depression and aging (SMART-Medea) study, a 12-month diagnosis of MDD and history of depression were assessed. Age of first depressive episode was classified into early-onset depression (< 50 years) and late-onset depression (≥ 50 years). HPA axis regulation was assessed by four morning saliva samples, two evening samples, and one awakening sample after .5 mg dexamethasone. Hippocampus and entorhinal cortex volume were manually outlined on three-dimensional T1-weighted magnetic resonance images. General linear models adjusted for demographics, vascular risk, antidepressant use, and white matter lesions showed that ever having had MDD was associated with smaller hippocampal volumes but not with entorhinal cortex volumes. Remitted MDD was related to smaller entorhinal cortex volumes (p < .05). Participants with early-onset depression had smaller hippocampal volumes than those who were never depressed (p < .05), whereas participants with late-onset depression had smaller entorhinal cortex volumes (p < .05). HPA axis activity did not explain these differences. We found differential associations of age of onset of depression on hippocampal and entorhinal cortex volumes, which could not be explained by alterations in HPA axis regulation.

A population-based analysis of distinguishers of bipolar disorder from major depressive disorder

BackgroundMany people with bipolar disorder (BD) in the community are misdiagnosed with major depressive disorder (MDD). A probabilistic model has been proposed to assist in the identification of BD among patients with depressive symptoms, however there are limited population-based data on the key distinguishers of BD from MDD. The objective of this study was to identify distinguishers of BD from MDD in a population-based sample. MethodsPopulation-based data were extracted from the Canadian Community Health Survey: Mental Health and Well-Being. Sociodemographic variables, clinical variables, and depressive symptomatology were compared between subjects with BD (N=467) and MDD (N=4145). Logistic regression analysis was used to identify significant correlates of BD, and areas under the receiver operating characteristic curves (AUCs) were determined for each model. ResultsBD and MDD subjects differed across a number of characteristics. Clinical variables significantly associated with BD included greater number of lifetime depressive episodes, earlier age of first depressive episode, lifetime anxiety disorder, problematic substance use, and lifetime suicide attempt. Symptoms significantly more common during a major depressive episode among BD subjects included agitation, suicidal ideation, anxious symptoms, and irritability. AUCs for these models ranged from 0.72 to 0.81. LimitationsData were not available for all potential distinguishers; subgroups of BD could not be determined; cross-sectional data. ConclusionsThese population-based results reinforce the effort to establish a generalizable probabilistic model that incorporates clinical and symptom variables in order to assist clinicians in the diagnostic assessment of BD.

Intima-media thickness and age of first depressive episode

Intima-media thickness and age of first depressive episode

Intima-media thickness and age of first depressive episode

Background Late life depression, including patients with vascular depression, has been associated with higher levels of intima-media thickness (IMT). Although individuals with vascular depression tend to report a later onset of depression, the relationship of IMT and age of first depressive episode is uncertain in younger adults. We therefore investigated the relationship between IMT and age of first depressive episode in a sample of 202 adults (age range 40–81 years) with major depression (MDD). Methods Depression status was assessed using the Structured Clinical Interview Schedule and the Hamilton Depression Rating Scale. Patients underwent a physical examination in which a medical history was obtained. IMT was measured from the left and right common carotid arteries. Simple regression analyses were used to investigate the association between IMT and self-reported age of first depressive episode. Results IMT was associated with a later onset of first major depressive episode ( b = .225, P = .0005) and this association remained significant after controlling for age, Framingham Stroke Risk Profile, smoking pack years, physical activity, high- and low-density lipoprotein, body mass index, triglyceride levels, and history of chronic medical conditions ( b = .142, P = .028). Each .10 mm increase in IMT was associated with a 2.6-year later reported occurrence of first major depressive episode (MDE). Similarly, higher levels of IMT were associated with fewer previous MDEs ( b = −.149, P = .020) and this effect remained significant in our multivariate model ( b = −.140, P = .030). In contrast, IMT was not associated with current depressive severity ( b = −.024, P = .720). Conclusions Greater levels of IMT are associated with a later onset of depression and fewer previous depressive episodes among middle-aged and older adults, independent of cardiovascular co-morbidities. These findings provide preliminary evidence that increased vascular burden may be associated with a later onset of depression.

Magnetic-resonance morphometry in patients with major depression

Magnetic-resonance morphometry performed on 72 patients with major depression compared with 38 control subjects replicated previously reported, statistically significant reductions in the volumes of the caudate ( P<0.03) and putamen ( P<0.05) in depressed patients. Borderline statistical significance was observed for whole-brain ( P<0.07) and frontal volume ( P<0.10) in a subsample of 32 patients matched on age and sex with 32 control subjects, whereas statistical significance was observed for the full sample ( P<0.007 and P<0.03, respectively). Chronological age was related to volume of the frontal lobes ( P<0.0002), caudate ( P<0.0001), putamen ( P<0.008), thalamus ( P<0.002), cerebellum ( P<0.007), lateral ventricles ( P<0.0001), and ratios of [whole brain]/[whole brain+cerebrospinal fluid (CSF)] ( P<0.0001) and [frontal]/[frontal+CSF] ( P<0.0001). Age of first depressive episode was related to putamen volume after accounting for chronological age ( R 2=0.16, P<0.005), and a correlation of 0.26 ( P<0.04) was observed between caudate volume and global mental status. Results are in accord with previous reports of basal-ganglia abnormalities in depressed patients and support the role of subcortical structures in mediating affective disorder.

Rapidity of symptom onset in depression

Clinical and research descriptions of depressive symptomatology have generally taken a cross-sectional approach. However, the few existing studies examining longitudinal patterns of onset have found rapidity of onset related to patient/family history of affective disorder, depressive stressors, and treatment response. Patients with an onset of major depressive disorder during the previous 5–56 weeks were studied, and information was obtained on which symptoms were present and in which week they began. A rapid onset of symptoms was associated with the endogenous subtype, the absence of past or current nonaffective disorders, older age of first depressive episode, less stressful events before the current episode, and shorter hospitalization. These findings suggest a relationship between rapidity of symptom onset and the concepts of endogenous and primary depression.