Changes In Depression Status Research Articles

Personality traits and change in depression status at 18 months: Findings from a British Psychiatric Morbidity Survey

BackgroundDepression is a common mental disorder, yet it shows low remission rates. The available evidence on personality traits as factors associated with the course of depression has common methodological limitations. Identifying personality traits linked with depression can improve understanding of the course of illness. Therefore, we aimed to investigate personality traits that are associated with the course of depression over 18 months. Methodslongitudinal data of 2366 Adult Psychiatric Morbidity Survey respondents were analysed. Assessments were applied at two-time points (baseline) and follow-up (about 18 months later). We assessed the total score on the screening questionnaire from the Structured Clinical Interview (SCID-II) for the dependent, obsessive-compulsive, and borderline personalities. Depression was measured using the revised Clinical Interview Schedule (CIS-R) version. ResultsAn increase of one score on the borderline personality scale at baseline increased the odds of experiencing persistent depression by 1.50 times (OR = 1.50, 95 % CI [1.22–1.86]), depression onset by 1.30 times (OR = 1.30, 95 % CI [1.14–1.50]), and recovery by 1.52 times (OR = 1.52, 95 % CI [1.35–1.70]), comparing to no depression group. Elevated scores of dependent personality traits significantly predicted depression persistence (OR = 1.95, 95 % CI [1.52–2.49]). An increase of one score on the obsessive-compulsive personality scale increases the odds of depression onset by 1.21 times (OR = 1.21, 95 % CI [1.04–1.39]). LimitationsThe APMS survey defined depression statuses in a limited sense, which may affect the generalisability of these results. ConclusionThe present study confirms previous findings and contributes evidence suggesting that personality dysfunctions worsen depression outcomes.

Association between changes in depressive symptoms and falls: The China health and retirement longitudinal study (CHARLS)

PurposeThis study aimed to investigate the impact of depressive symptoms and changes in depressive status on falls among middle-aged and older population in China. MethodsWe used two waves of interview data (time 1 [T1] and time 2 [T2], 2 years from T1) from a nationally representative sample of the China Health and Retirement Longitudinal Study (CHARLS), which included a total of 14,356 participants (male 6859; mean age: 59.5 ± 9.3 years). Depressive symptoms were assessed using the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CES-D-10). Participants were categorized into four groups based on changes in their CES-D-10 scores over a 2-year follow-up period. Self-reported falls were evaluated, and logistic regression models and restricted cubic splines (RCS) were employed to examine the relationship between depressive symptoms and fallen. ResultsParticipants who had experienced falls had higher CES-D-10 scores and were more likely to have depressive symptoms. Depressive symptoms at T1 were significantly associated with falls during the follow-up period. After adjusting for covariables, increasing CES-D-10 scores were associated with higher adjusted odds ratios (ORs) for falling prevalence: 1.230 (95 % CI, 1.041–1.453), 1.579 (95 % CI, 1.331–1.873), 1.745 (95 % CI, 1.472–2.070), and 2.366 (95 % CI, 1.972–2.838). Participants who experienced depressive symptoms at either T1 or T2, as well as those with persistent depressive symptoms from T1 to T2, were both at higher risk for future falls. The worsening of depressive symptoms significantly increased the likelihood of falls. ConclusionThis study revealed a significant association between depressive symptoms and changes in depressive status with subsequent falls in older adults. The heightened fall risk among individuals with depressive symptoms underscores the importance of addressing mental health as an integral part of comprehensive fall prevention strategies.

Mediterranean Diet Interventions for Depressive Symptoms in Adults with Depressive Disorders: A Protocol for a Systematic Review and Meta-Analysis.

The associations between Mediterranean diet (MD) adherence and depression levels have been synthesized from observational studies. However, a systematic review with meta-analysis including randomized controlled trials (RCTs) on this relationship in adults with depressive disorders remains lacking. This protocol was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis for Protocols statement. MEDLINE (PubMed), Cochrane CENTRAL, PsycINFO, Scopus, and Web of Science databases will be systematically searched to identify studies published from database inception up to 30 September 2022. The inclusion criteria will comprise RCTs reporting pre-post changes in depression status (symptoms or remission) after a MD intervention compared to a control condition in adults over 18 years with depressive disorders. Pooled effect sizes and 95% confidence intervals will be calculated using the DerSimonian random-effects model. This study protocol determines the methodological approach for the systematic review and meta-analysis that will summarize the available evidence on the efficacy of MD interventions on depressive symptoms in adults with depressive disorders. The findings from this review may have implications for public mental health programs. The results will be disseminated through peer-reviewed publication, conference presentation, and infographics. No ethical approval will be required since only published data will be used. PROSPERO registration number: CRD42022341895.

Analysis of the effect of weight loss through bariatric surgery on depression

Bariatric surgery results in significant improvement in health related quality of life and depressive symptoms irrespective of the wide range of weight change. This experiment was planned to assess the incidence of depression in obese respondents and to analyse the change in depression after weight loss through bariatric surgery.To analyse the incidence of depression in obese individuals undergoing bariatric surgery and the significance of change in depression status after weight loss.The study was conducted in a multispecialty hospital having obesity clinic and bariatric surgery unit. The depression level before the study and at six months post surgery was assessed using a standard tool named Beck’s inventory. Study period was from 2015 to 2017.Respondents having BMI of 33-50 Kg/m belonging to both the genders in the age range of 18-65 years. The respondents having BMI more than 50Kg/m were excluded in this study.18 respondents who underwent bariatric surgery were included in the study. Percentage distribution, Pearson correlation coefficient, ANOVA, and Paired t test were the tools utilised in statistical analysis of the data.Schedule to assess change in nutritional status using a structured questionnaire considering anthropometric, biochemical, clinical and dietary parameters, and standard tool named Beck’s Depression Inventory, which is a tool for depression status. The surgery patients had initial Beck Score ranging from 1 to 14 indicating mild depression which on follow up reduced to 0 to 7. The weight loss in both genders were similar to each other. The change in intake of nutrients and the scores of depression were more prominent in men than that of women. Respondents pre operatively had mild mood disturbances which after weight loss, became a normal mood.Thus it can be concluded that weight loss through bariatric surgery is effective in reducing depression.

Identifying High-Risk Factors of Depression in Middle-Aged Persons with a Novel Sons and Spouses Bayesian Network Model.

It has been reported repeatedly that depression in middle-aged people may cause serious ramifications in public health. However, previous studies on this important research topic have focused on utilizing either traditional statistical methods (i.e., logistic regressions) or black-or-gray artificial intelligence (AI) methods (i.e., neural network, Support Vector Machine (SVM), ensemble). Previous studies lack suggesting more decision-maker-friendly methods, which need to produce clear interpretable results with information on cause and effect. For the sake of improving the quality of decisions of healthcare decision-makers, public health issues require identification of cause and effect information for any type of strategic healthcare initiative. In this sense, this paper proposes a novel approach to identify the main causes of depression in middle-aged people in Korea. The proposed method is the Sons and Spouses Bayesian network model, which is an extended version of conventional TAN (Tree-Augmented Naive Bayesian Network). The target dataset is a longitudinal dataset employed from the Korea National Health and Nutrition Examination Survey (KNHANES) database with a sample size of 8580. After developing the proposed Sons and Spouses Bayesian network model, we found thirteen main causes leading to depression. Then, genetic optimization was executed to reveal the most probable cause of depression in middle-aged people that would provide practical implications to field practitioners. Therefore, our proposed method can help healthcare decision-makers comprehend changes in depression status by employing what-if queries towards a target individual.

Preliminary Evidence That Cortical Amyloid Burden Predicts Poor Response to Antidepressant Medication Treatment in Cognitively Intact Individuals With Late-Life Depression

Amyloid accumulation, the pathological hallmark of Alzheimer's disease, may predispose some older adults to depression and cognitive decline. Deposition of amyloid also occurs prior to the development of cognitive decline. It is unclear whether amyloid influences antidepressant outcomes in cognitively intact depressed elders. A pharmacoimaging trial utilizing florbetapir (18F) PET scanning followed by 2 sequential 8-week antidepressant medication trials. Twenty-seven depressed elders who were cognitively intact on screening. After screening, diagnostic testing, assessment of depression severity and neuropsychological assessment, participants completed florbetapir (18F) PET scanning. They were then randomized to receive escitalopram or placebo for 8 weeks in a double-blinded two-to-one allocation rate. Individuals who did not respond to initial treatment transitioned to a second open-label trial of bupropion for another 8 weeks. Compared with 22 amyloid-negative participants, 5 amyloid-positive participants exhibited significantly less change in depression severity and a lower likelihood of remission. In the initial blinded trial, 4 of 5 amyloid-positive participants were nonremitters (80%), while only 18% (4 of 22) of amyloid-negative participants did not remit (p = 0.017; Fisher's Exact test). In separate models adjusting for key covariates, both positive amyloid status (t = 3.07, 21 df, p = 0.003) and higher cortical amyloid binding by standard uptake value ratio (t = 2.62, 21 df, p = 0.010) were associated with less improvement in depression severity. Similar findings were observed when examining change in depression status across both antidepressant trials. In this preliminary study, amyloid status predicted poor antidepressant response to sequential antidepressant treatment. Alternative treatment approaches may be needed for amyloid-positive depressed elders.

Impaired neurobehavioral alertness quantified by the psychomotor vigilance task is associated with depression in the Wisconsin Sleep Cohort study

BackgroundExcessive daytime sleepiness plays an important role in the presentation and course of mood disorders. Standard objective measures of daytime sleep propensity are of little to no value in depressive illness. This study examined the psychomotor vigilance task (PVT), an objective measure of neurobehavioral alertness, and its cross-sectional and longitudinal associations with depressive symptomatology in the Wisconsin Sleep Cohort Study. MethodsThe sample consisted of 1569 separate 10-min PVT assessments conducted in 942 unique individuals. Cross-sectional and longitudinal conditional logistic regression models were used to estimate associations between the primary outcome of depression symptomatology (adjusted Zung scale≥50) and six separate PVT variables: mean reciprocal reaction time (1/RT); total lapses (RTs≥500 msec; LAPSE); total false responses (FALSE); reciprocal of the mean of the 10% fastest (FAST) and 10% slowest (SLOW) RTs; and slope of the linear regression line for all transformed 1/RTs (SLOPE). ResultsIn fully-adjusted cross-sectional models, 1/RT, LAPSE, FAST, and SLOW were each significantly associated with depression, such that worse neurobehavioral alertness was associated with higher odds of depressive symptomatology. Similar, though attenuated, findings were observed in fully-adjusted conditional longitudinal models that examined within-subject changes in depression status in the subset of participants with repeated PVT assessments. FALSE and SLOPE were not associated with depression in either cross-sectional or conditional longitudinal models. ConclusionsThese findings suggest components of the PVT are associated with depressive symptomatology. Further research is indicated to clarify the role of the PVT in the assessment of hypersomnolence in mood disorders.

Association between Changes in Depressive State and Cognitive Function.

Dementia is defined as a severe form of cognitive impairment. Research concerning the two-way relationship between depression and cognitive impairment has been conducted; however, there has been little analysis of cognitive function following changes in depressive status. This study describes the association between changes in depressive state and cognitive function in a Korean geriatric population sample. Using the Korean Longitudinal Study of Aging (KLoSA) database, Mini-Mental State Examination (MMSE) scores and Center for Epidemiologic Studies Depression Scale (CESD-10) indexes were used for measuring cognitive function and depression, respectively. The survey population was divided into four case categories by change in depressive status: normal to normal (Group A), normal to depressive (Group B), depressive to normal (Group C), and depressive to depressive (Group D). Analysis of variance, multiple regression analysis, and subgroup analysis were used for statistical examination. In the multiple regression analysis between MMSE values and depressive status change groups, with Group A as the reference, β in all other groups was negative, and its absolute value was large in the order of D, B, and C in both men (B: −0.717, C: −0.416, D: −1.539) and women (B: −0.629, C: −0.430, D: −1.143). There were also significant results in the subgroup analysis in terms of age, working status, participation in social activities, regular physical activities, and number of chronic medical conditions. In conclusion, both cases—those suffering from depression and those having suffered from it before—experience cognitive impairment. The degree of cognitive function being impaired is greater in the case of depression-onset than that of depression-remission. Age, stimulating activities, and chronic conditions are also strongly relevant to cognitive decline accompanied by changes in depressive state.

Early Pubertal Timing and Testosterone Associated With Higher Levels of Adolescent Depression in Girls.

The prevalence of depression increases dramatically during puberty in girls. Earlier work in this sample reported that the sex steroids estradiol and testosterone were associated with increased depression in girls. Using three additional data waves (983 new observations), we retest the relative contributions of pubertal timing, pubertal status, and sex hormones on the increases in female depression. Eight waves of data from the prospective, representative Great Smoky Mountains Study were used covering female participants in the community who were 9 to 16 years of age (3,005 assessments of 630 girls; 1993-2000). Structured interviews assessed depressive disorders. Youth rated their pubertal status using Tanner stage drawings, and sex steroids were assayed from dried blood spots. Risk for depression during puberty was associated with both age and Tanner stage in univariate models. In adjusted models accounting for pubertal timing and sex steroids, the apparent effects of age and Tanner stage were attenuated both in terms of statistical significance and effect size. The only significant predictors of change in depression status during puberty were early pubertal timing (odds ratio= 5.8, 95% CI= 1.9-17.9, p= .002 after age 12 years) and higher testosterone levels (odds ratio= 2.0, 95% CI= 1.1-3.8, p= .03 for quartile-split variable). The added observations have modified the original conclusions, implicating the following: testosterone only, but not estradiol; and early pubertal timing, but not age or pubertal status per se. These findings argue for multiple pubertal determinants of depression risk, including factors that are socially and biologically mediated.

Changes in depression status during the year after breast cancer surgery and impact on quality of life and functioning.

Although breast cancer patients' depression changes over time, most longitudinal studies have assessed the influence of only baseline depression on quality of life (QoL). Therefore, this study investigated the influence of changes in depression status on QoL in the year after surgery. Participants were interviewed at 2-5days and at 1year after surgery. Depression was diagnosed at both time points, and participants were classified into four groups: no, recovered, incident, and persistent depression. QoL-related functioning and symptoms were evaluated with the EORTC QLQ-C30 questionnaire and the interaction of depression and QoL was analyzed using a repeated-measures analysis of covariance (RMANCOVA). Of the 306 participants, 247 were evaluated at 1year after surgery; 165 had no depression, 40 had recovered from depression, 24 had incident depression, and 18 had persistent depression. The RMANCOVA revealed significant time-by-group interactions; the no-depression group exhibited better recovery in general QoL and functioning, whereas the persistent-depression group showed the worst recovery. QoL and functioning improved in the recovered depression group, but worsened in the group with incident depression. The different impacts of changes in depression status on QoL highlight the importance of periodic screening for depression.

Rates and predictors of depression status among caregivers of patients with COPD hospitalized for acute exacerbations: a prospective study.

BackgroundHospitalization is common for acute exacerbation of COPD, but little is known about its impact on the mental health of caregivers.ObjectiveThe aim of this study was to determine the rates and predictors of depressive symptoms in caregivers at the time of hospitalization for acute exacerbation of COPD and to identify the probability and predictors of subsequent changes in depressive status 3 months after discharge.Materials and methodsThis was a prospective study. Depression symptoms were measured in 87 caregivers of patients hospitalized for exacerbation at hospitalization and 3 months after discharge. We measured factors from four domains: context of care, caregiving demands, caregiver resources, and patient characteristics. Univariate and multivariate multiple logistic regressions were used to determine the predictors of depression at hospitalization and subsequent changes at 3 months.ResultsA total of 45 caregivers reported depression at the time of hospitalization. After multiple adjustments, spousal relationship, dyspnea, and severe airflow limitation were the strongest independent predictors of depression at hospitalization. Of these 45 caregivers, 40% had a remission of their depression 3 months after discharge. In contrast, 16.7% of caregivers who were not depressive at hospitalization became depressive at 3 months. Caregivers caring >20 hours per week for patients with dependencies had decreased odds of remission, and patients having dependencies after discharge increased the odds of caregivers becoming depressed.ConclusionDepressive symptoms are common among caregivers when patients are hospitalized for exacerbation of COPD. Although illness factors are determinants of depression at hospitalization, patient dependence determines fluctuations in the depressive status of caregivers.

Changes in depression status in low socioeconomic perinatal subjects in rural India after supervised physical exercise: A randomized controlled study.

Background:Perinatal depression is a major public health problem, affecting up to a quarter of all pregnant women in rural Asean countries and often leads to psychologic symptoms, lower quality of life, and higher health care costs. The purpose of this study was to assess the impact of supervised physical exercise on depression level of perinatal subjects.Subjects/Intervention:60 subjects who fulfill the selection criteria were randomly assigned to exercise (Group-1, n=30) and control group (Group-2, n=30). Participants completed general screening form and Physical health questionnaire-9 (PHQ-9) before their intervention and again 4 weeks and 8 weeks later. Group-1 underwent aerobic training with 60-65% maximum heart rate and Group-2 was prescribed with handouts for 4 weeks.Statistics:Repeated-measures analysis of variance (ANOVA) was use to analyze group differences over time while controlling for baseline differences.Results:Demographic and the baseline values show homogenous population (P>0.05). Patients in both groups experienced significant reduction in depression level. Group A showed reduction of 91.70% (P=0.00) as compared to Group B 69.01% (P=0.00).Conclusion:These results suggest that supervised physical exercise provides better improvement in depression status in perinatal subjects than providing handouts alone.

Effects of depression on the subsequent year's healthcare expenditures among older adults: two-year panel study.

This study investigated changes in depression status over 2 years and examined whether having depression in Year 1 is associated with greater healthcare expenditures in Year 2 among community-dwelling older adults. This study analyzed the Medical Expenditure Panel Survey (Panel 13, 2008-2009) for a nationally representative sample of 1,740 older adults (65+). The two self-reported depression measures used were the ICD-9-CM (depression) and Patient Health Questionnaire-2 (potential depression, scores 3 or higher). Using the combined two-part models, additional healthcare costs at Year 2 associated with the Year 1 depression status were calculated by the service type after adjusting for predisposing, enabling, and need covariates assessed at Year 2. Over 7.9% of older adults reported depression and an additional 6.5% presented with potential depression. The ICD-9 depression status was relatively stable; 84% continued reporting depression during Year 2. Those with depression at Year 1 spent $3,855 more on total healthcare, $1,053 more on office-based visits, and $929 more on prescription drugs during Year 2 compared with non-depressed people after controlling for other covariates, including healthcare needs (p < .05). While potential depression was less persistent (31.1% remained potentially depressed at Year 2), potential depression was associated with lower socio-economic status and greater healthcare expenditures from home health services and emergency department visits during Year 2. These results indicate the importance of monitoring depression in older adults, considering its impacts on the increases in healthcare expenditures in the following year even after controlling for co-occurring health conditions.

Sigma-1 receptor concentration in plasma of patients with late-life depression: a preliminary study

BackgroundRecently, the sigma-1 receptor has been shown to play a significant role in the neural transmission of mood by regulating N-methyl-D-aspartate receptors. Additionally, the sigma-1 receptor has been reported to influence cognitive functions including learning and memory. In this study, we measured plasma sigma-1 receptor concentrations before and after antidepressant treatment in patients with late-life major depressive disorder (MDD) and explored whether changes in depressive status are related to sigma-1 receptor concentrations.MethodsThe study participants were 12 subjects with late-life MDD diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. All of the participants were over 60 years old. Immediately prior to and 8 weeks after the start of treatment, sigma-1 receptor concentration and mental status, including depressive symptoms (Hamilton Depression Rating Scale; HAM-D), were measured. Treatment for depression was performed according to a developed algorithm based on the choice of treatments. We examined the association between changes in sigma-1 receptor concentration and HAM-D scores during antidepressant treatment. For the measurement of plasma sigma-1 receptor concentration, blood plasma samples were separated by sodium dodecyl sulfate polyacrylamide gel electrophoresis. Western blots were performed using a specific antibody that acts against the sigma-1 receptor, and the net densities of each band were quantified.ResultsAll participants showed improvement in depressive symptoms, which was indicated by a significant decrease in the HAM-D scores. The mean plasma sigma-1 receptor concentration also increased significantly following antidepressant treatment. However, no significant correlations were found between changes in plasma sigma-1 receptor concentration and changes in HAM-D scores.ConclusionIn this preliminary study, we demonstrated that the sigma-1 receptor concentration in plasma increases following antidepressant treatment in patients with late-life MDD. Further studies are warranted to confirm this finding with a larger number of patients.

Depressed mood and quality of life after subarachnoid hemorrhage

BackgroundCognitive impairment is widely considered the main cause of disability and handicap after subarachnoid hemorrhage (SAH). The impact of depression on recovery after SAH remains poorly defined. We sought to determine the frequency of post-SAH depression, identify risk factors for its development, and evaluate the impact of depression on quality of life (QOL) during the first year of recovery. MethodsWe prospectively studied 216 of 534 SAH patients treated between July 1996 and December 2001 with complete one-year follow-up data. Depression was evaluated with the Center for Epidemiological Studies Depression (CES-D) scale, cognitive status with the Telephone Interview for Cognitive Status (TICS), and QOL with the Sickness Impact Profile (SIP) 3 and 12months after SAH. ResultsDepressed mood occurred in 47% of patients during the first year of recovery; 26% were depressed at both 3 and 12months. Non-white ethnicity predicted early (3month) and late (12month) depressions; early depression was also predicted by previously-diagnosed depression, cigarette smoking, and cerebral infarction, whereas late depression was predicted by prior social isolation and lack of medical insurance. Depression was associated with inferior QOL in all domains of the SIP, and changes in depression status were associated with striking parallel changes in QOL, disability, and cognitive function during the first year of recovery. CES-D scores accounted for over 60% of the explained variance in SIP total scores, whereas TICS performance accounted for no more than 6%. ConclusionDepression affects nearly half of SAH patients during the first year of recovery, and is associated with poor QOL. Systematic screening and early treatment for depression are promising strategies for improving outcome after SAH.

Change in depressive status and mortality in elderly persons: Results of a national longitudinal study

The authors aimed to investigate whether a change in depressive status was associated with a change in the risk of mortality in the elderly during a four-year follow-up period. Data came from the Survey of Health and Living Status of the Elderly in Taiwan. A cohort of 1784 men and women in Taiwan aged 65 or older who were assessed on two occasions in 1999 and 2003, and subsequently followed up until 2007. Depressive symptoms were assessed by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). The mortality risk of different depressive statuses was computed after adjustment for a variety of covariates. The data were further analyzed by gender and cause of death. Overall, chronic depression was associated with all-cause mortality (hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.18–2.32) after 4years of follow-up and controlling for covariates. When analyzing by gender, incident depression was associated with mortality in males only (HR=1.54; 95% CI=1.04–2.27). In females, only chronic depression was associated with a higher risk of mortality (HR=1.77; 95% CI=1.08–2.88). The increased risk of mortality with incident depression in males and chronic depression in females was attributed to non-cardiovascular disease (non-CVD) causes more than to CVD causes. In males, chronic depression predicted a higher incidence of CVD deaths. While chronic depression confers a greater risk of mortality in older women, incident depression predicts increased mortality in older men. The link between changing depressive status, gender, ethnicity and mortality warrants further investigation.

Abstract 19: Resolving Post-Stroke Depression is associated with Post-Stroke Functional Recovery

Background/rationale: Depression is common after stroke and is associated with poor functional outcome, but its relationship with the change in functional status after adjustment for other factors remains uncertain. We investigated the independent relationship between depression and post-stroke functional recovery. Methods: Data were obtained as part of the multicenter Adherence eValuation After Ischemic stroke-Longitudinal (AVAIL) registry in which depression assessed by a self-reported depressive symptoms scale (the Patient Health Questionnaire-8; PHQ-8≥10), and modified Rankin scale (mRS) were prospectively assessed 3 and 12 months following hospitalization for ischemic stroke. Univariate logistic analysis followed by multivariable logistic modeling adjusted for race, gender, age and post-hospital rehabilitation, was performed to evaluate the association between depression at each time-point and the change in mRS between 3 and 12 months. Results: Data was available for 1444 patients (55.7% men, 82.6% White) from 97 hospitals in the United States. Relative to 3 months, the 12 month mRS was stable or improved in 692 (75.8%) and worse in 349 (24.2%) patients. Overall, 134 patients were persistently depressed, 126 had resolving depression by 12 months and 104 patients had incident depression at 12 months. Older age, lack of rehabilitation, and 3 and 12 months depression status were associated with worse disability (increasing mRS) between 3 and 12 months. After covariate adjustment, both depression status at 3 and 12 months (p= 0.010) and older age (OR= 1.02, 95% CI 1.01-1.03 per 10-years, p&lt;0.001) remained associated with worsening mRS. Compared with those who were not depressed at either time point, those who had resolving depression (PHQ-8≥10 at 3 but not 12 months) were less likely to have a worsening mRS (OR=0.49, 95%CI 0.29-0.83) whereas the association between incident depression at 12 month and worsening mRS was marginal (OR=1.48, 95% CI 0.95-2.30). Being depressed at both time points was not associated with a worsening in mRS between 3 and 12 months (OR=0.85, 95% CI 0.53-1.34). Conclusion: The change in depressive status between 3 and 12 months following hospitalization for stroke was associated with incremental changes in functional outcome. Patients who had resolving post-stroke depression were less likely to have worsening disability. A reciprocal relationship and a confounding effect between depression and mRS cannot be excluded.

Improvements in patient-reported outcomes, symptoms of depression and anxiety, and their association with clinical remission among patients with moderate-to-severe active early rheumatoid arthritis

To assess the association between clinical remission in RA and patient-reported outcomes (PROs), including depression/anxiety symptoms, in adults with moderate-to-severe active early RA. Patients from the COmbination of Methotrexate and ETanercept in Active Early Rheumatoid Arthritis (COMET) trial (104 weeks) with measures on the Hospital Anxiety and Depression Scale at baseline and subsequent visits (n = 389) were included. PROs investigated were the HAQ disability index, pain and fatigue visual analogue scales (VASs), EuroQoL health status VAS and the Medical Outcomes Short Form-36 physical and mental component summaries. The impact of clinical remission as measured by 28-joint DAS (DAS-28) on depression/anxiety symptoms at Week 104 was assessed using logistic regression. Least square means for PRO improvements from baseline were estimated by analysis of covariance. Missing data were imputed using the last observation carried forward method. When depression/anxiety symptoms were absent at baseline, significantly more patients achieved clinical remission, low disease activity and normal functioning at Week 104. Reciprocally, patients who achieved clinical remission were less likely to maintain symptoms of depression or anxiety compared with non-remitters [depression odds ratio (OR): 0.35, P = 0.0233; anxiety OR: 0.48, P = 0.0371]. Fatigue and pain had a significant impact on changes in depression status, but did not influence anxiety status. Finally, clinical remission was significantly associated with improvements in all PRO measures (P < 0.001); conversely, depression/anxiety symptoms reduced PRO improvements. Among moderate-to-severe active early RA patients, clinical remission reduces symptoms of depression/anxiety, and independently improves PROs, thereby suppressing the negative impact of depression/anxiety on these measures.

Measuring improvement in depression in cancer patients: a 50% drop on the self-rated SCL-20 compared with a diagnostic interview

Objective To determine the validity of a 50% drop in the 20-item Symptom Checklist Depression Scale (SCL-20) score against the “gold standard” of no longer meeting criteria for major depression as assessed using a diagnostic interview in an outpatient cancer population and also to examine the validity of other potential cut-offs (i.e., percentage drops). Materials and Methods Secondary analysis of data from a randomized trial which compared collaborative care with usual care for cancer patients with major depression. A total of 194 trial participants who had both SCL-20 scores and depression diagnoses on the Structured Clinical Interview for DSM-IV at both baseline and at 12-week outcome formed the analyzed sample. Results A 50% reduction in the SCL-20 score from baseline to 12 weeks correctly identified the patients who no longer met criteria for major depression in 153 (78.9%) of 194 (95% CI 73.1% to 84.6%) cases. Most of those misclassified had not achieved a 50% reduction in SCL-20 score despite no longer meeting criteria for major depression. Examination of the performance of percentage drops other than 50% on the SCL-20 using a receiver operating characteristics (ROC) curve and histogram of misclassification suggested that the 50% drop was best if both a low overall misclassification rate and the minimizing of false positives of improvement were required. Conclusions A 50% reduction in the SCL-20 score performs well as a conservative measure of change in depression status in cancer patients.

A Longitudinal Study of Maternal Depression and Child Maltreatment in a National Sample of Families Investigated by Child Protective Services

To assess whether a change in depression predicts a mother's change in maltreatment. Observational, repeated measures study. National Survey of Child and Adolescent Well-being, 1999 to 2004. Mothers who retained custody of a child aged 0 to 15 years following a maltreatment investigation and completed at least 2 of 3 surveys (n = 2386). Change in depression status between baseline and 18- and 36-month follow-ups, assessed with the Composite International Diagnostic Interview Short Form. Change in psychological aggression, physical assault, and neglect between baseline and 18- and 36-month follow-ups, assessed with the Conflict Tactics Scale Parent-Child version. One-third (35.5%) of mothers experienced onset or remission of depression. Onset of depression was associated with an increase of 2.3 (95% confidence interval, 0.2-4.4) psychologically aggressive acts in an average 12-month period, but was not statistically significantly associated with change in physical assault or neglect. Depression is positively associated with maternal perpetration of psychological aggression in high-risk families.