Clinical Levels Of Depression Research Articles

Association Between Clinical Depression and Endothelial Function Measured by Forearm Hyperemic Reactivity

To assess associations between clinically significant depression (major depressive disorder [MDD] and minor depressive disorder [MiDD]) and endothelial function (EF), via forearm hyperemic reactivity (FHR), in patients referred for myocardial perfusion imaging. Studies have linked MDD to impaired EF, an early marker of coronary heart disease (CHD) and risk factor for cardiac events, in healthy, noncardiac patients, although no studies have assessed the MDD-EF association in patients with or at risk for CHD. Depression was assessed, using the Primary Care Evaluation of Mental Disorders structured interview in 323 patients (n = 242 men; mean age = 59 years) with or at risk for CHD. FHR was assessed, using a dynamic nuclear imaging technique that measures the dilatory capability of the brachial artery during hyperemic challenge. The relative uptake ratio (RUR) of blood flow between hyperemic and nonhyperemic arms was used to measure FHR. Patients with MDD and MiDD had lower RURs (mean values = 3.31 and 3.34, respectively), indicating poorer EF than patients without depression (mean = 4.27) (F = 5.19, p < .01), irrespective of CHD status. All results were adjusted for covariates including sociodemographic, medical, biochemical, and physiological variables. Patients with clinical levels of depression had worse FHR than patients without depression, irrespective of CHD status and after adjusting for covariates. Data extend previous findings, suggesting that the link between clinical depression and worse CHD outcomes may be mediated by EF.

Intergenerational and Interconnected: Mental Health and Weil-Being in Grandparent Caregiver Families

Research shows that a substantial number of grandparent caregivers are caring for children with developmental delays or emotional or behavioral problems, and that many caregivers have clinical levels of depression. This study explores grandparent-caregiver families’ mental health needs as well as use of and barriers to accessing mental health services. Interviews with families revealed unmet mental health needs and an interconnectedness between grandchildren's and their grandparent caregivers’ well-being. In the survey component, service providers described problems highly consistent with those reported by grandmothers, including school-related or attention-related concerns among children and depression, stress, and frustration among grandparents. Findings suggest implications for practitioners and policymakers regarding service access, expectations about services, and the fit between clients’ needs and the services available.

Poor and Depressed, The Tip of the Iceberg: The Unmet Needs of Enrollees in an Indigent Health Care Plan

Depression is a leading cause of disability [World Health Organization (WHO), 2001] with economic costs exceeding 63 billion dollars per year in the US [U.S. Department of Health and Human Services (DHHS), 1999]. The challenges of treating depression among the poor are compounded by broader social needs. This study examined the prevalence of depression and psychosocial needs among enrollees in an indigent health care plan. Results indicated clinical levels of depression were present in 28.6% of respondents (n=1,405). Depressed respondents were significantly more likely (p<0.001) to have co-occurring alcohol (OR=1.78; CI(95) =1.32-2.40), drug (OR=2.67; CI(95) =1.80-3.98), and health (OR=5.44; CI(95) = 4.12-7.19) problems compared to non-depressed respondents. Significantly more social needs were also associated with depression. Depressed respondents averaged 7.8 needs compared to 3.6 among non-depressed respondents. Needs included a significantly increased likelihood (p<0.001) of lacking sufficient food (OR=2.56; CI(95) =1.97-3.34), shelter (OR=3.67; CI(95) =2.23-6.05), or money (OR=3.18; CI(95) = 2.39-4.23) and having more legal (OR=2.95; CI(95) =2.22-3.92) and family (OR=3.00; CI(95) =2.32-3.86) problems. The high rates of co-occurring social needs among individuals with clinical depression underscores the need for comprehensive, coordinated care in order to improve their quality of life and also reduce high utilization of crisis management services.

Mother-Infant Interaction, Life Events and Prenatal and Postpartum Depressive Symptoms Among Urban Minority Women in Primary Care

Prenatal and postpartum depression are significant mental health problems that can have negative effects on mother-infant interactions. We examined the relationships among mother-infant interactions, depressive symptoms, life events, and breastfeeding of low-income urban African American and Hispanic women in primary care settings. Participants were 89 African American and Hispanic women who were part of a larger mental health intervention study conducted in community health centers. Questionnaire data on depression, as well as negative and positive life events, were collected during pregnancy and at three-months postpartum, while mother-infant interaction observations and breastfeeding practice were only collected at three-months postpartum. The ratings of maternal behavior for 'depressed' mothers did not differ from 'nondepressed' mothers. Except for gaze aversion behavior, infants' behavior while interacting with their mothers did not differ by maternal depression level. Hierarchical regression analyses revealed that maternal positive life events positively predicted infant interactional summary ratings, while maternal negative life events were inversely associated with maternal interactional summary ratings. To improve services in primary care, perinatal screenings for depression can help identify those women most at risk. When follow-up use of structured diagnostic instruments is not possible or cost-effective, clinician assessment of severity of depression will determine women with clinical levels of depression. Reducing negative life events is beyond the control of women or clinicians but cognitive interventions to help women focus on positive life events can reduce the deleterious effects of depression on mothers and their infants.

Associations between organizational and incident factors and emotional distress in emergency ambulance personnel

This study examined the prevalence and correlates of post-traumatic stress disorder (PTSD), anxiety and depression among emergency ambulance personnel. A questionnaire and reminder were sent anonymously to 1029 emergency ambulance personnel in a large ambulance service. Among the 617 respondents, levels of PTSD symptoms did not differ according to grade, but men had a higher prevalence rate than women. Key predictors of the severity of symptoms were organizational stress, the frequency of experiencing potentially traumatic incidents, length of service, and dissociation in response to an index incident. The degree of organizational, but not incident-related, stress discriminated between 'cases' and 'non-cases'. Nine and 23% of recorded scores indicated clinical levels of depression and anxiety respectively. Several work factors were associated with these emotions, explaining 38% of anxiety and 31% of depression scores. Both organizational and individually based interventions may be necessary to minimize PTSD and other emotional disorders among ambulance personnel.

The validity of the family relationships index as a screening tool for psychological risk in families of cancer patients

The Family Relationships Inventory (FRI) has been proposed as a measure of psychological risk however its validity has only been tested in one cross-sectional study against another measure of family functioning where patients had less than six months to live. The current study presented longitudinal data on the validity of the FRI in identifying family dysfunction, and clinical levels of depression and anxiety in 48 families where the patient had been recently diagnosed. Over the three phases, the FRI identified all families at risk of family dysfunction, 88% or more families with one or more members with clinical depression and 78% or more with a member with clinical levels of anxiety. The FRI was also far more sensitive in identifying families with a member with clinical levels of depression and anxiety than the General Functioning (FAD-GF) scale of the Family Assessment Device. Although other measures of screening adequacy (such as specificity), suggested that the FRI identified too many false positives, the higher sensitivity of the FRI makes it preferable to the FAD-GF as a screening measure for families at risk of a poor psychological outcome in the oncology setting. However, because of the FRI's poor specificity, further follow-up of those families that are identified as being at some risk of a poor psychological outcome should be undertaken before referral to a mental health professional is warranted.

Anxiety and Depressive Symptoms Measured by the Hospital Anxiety and Depression Scale as Predictors of Time to Recurrence in Localized Cutaneous Melanoma

The purpose of this study was to investigate anxiety and depression as predictors for recurrence-free survival in cutaneous melanoma, when corrected for known prognostic factors. The association between known prognostic factors and anxiety and depression were also studied. Consecutive patients (n = 437) completed the Hospital Anxiety and Depression Scale (HAD) approximately three months after diagnosis of melanoma. Neither anxiety, nor depression turned out to be prognostic factors for time to recurrence. A higher proportion of young patients, women, patients without ulcerated tumours, patients with tumours with low mitotic index and Clark's level II tumours scored ≥8 (possible clinical levels of anxiety) on the anxiety scale. Furthermore, on the depression scale, a higher proportion of young patients scored ≥8 (possible clinical level of depression). Using the HAD scale, a well-validated instrument for assessing anxiety and depression in patients with somatic diseases, our data did not show any associations between anxiety or depression and outcome in terms of recurrence in patients with localized disease.

The psychological impact of a cancer diagnosis on families: The influence of family functioning and patients' illness characteristics on depression and anxiety

A diagnosis of cancer is a very stressful event for the patients and their families. Patients, partners and other family members can suffer from clinical levels of depression and severe levels of anxiety and stress reactions. The similarity in levels of distress between patients and partners and patients and offspring suggests that there are common factors that impact on families' distress levels. The current study examined levels of depression and anxiety in newly diagnosed adult patients (n = 48) and their adult relatives (n = 99). Family functioning and patients' illness characteristics were identified as factors that might impact on families' depression and anxiety. Results from multilevel models indicated that family functioning was important. Families that were able to act openly, express feelings directly, and solve problems effectively had lower levels of depression. Direct communication of information within the family was associated with lower levels of anxiety. Aside from differences anxiety due to cancer type, patients' illness characteristics appear to be risk factors in patients' but not relatives' depression and anxiety. The results from the current study suggest that researchers and clinicians need to be family-focused as cancer affects the whole family, not just the patient.

The psychosocial impact of cancer: exploring relationships between conditional goal setting and depression.

This study explores depression in cancer patients with reference to conditional goal setting (CGS) theory. CGS theory proposes that depressed individuals believe that personal happiness is conditional upon attainment of specific goals (personal CGS). Other individuals may set important goals believing that goal achievement is a necessary prerequisite of social acceptance and approval (social CGS). CGS has been found to contribute to depression in normal populations. 15.2% of the 67 newly diagnosed cancer patients in this study showed clinical levels of depression. A significant relationship was identified between personal CGS, rumination and depression, as predicted in CGS theory. Two months later, 46.7% of patients demonstrated clinical levels of depression. This later experience of depression was significantly related to social CGS. The results suggest CGS involving a misdirected pursuit of happiness is initially associated with depression whereas subsequent experiences of depression are related to a misdirected pursuit of social acceptance. Implications are discussed in terms of understanding the cancer patients' motivations controlling goal setting. It is suggested that successful psychotherapy for depression in cancer patients needs to examine the motivations controlling goal setting in addition to the process of goal pursuit.

Depressed Mood Is a Factor in Glycemic Control in Type 1 Diabetes

The diabetes literature contains conflicting evidence on the relationship between depression and glycemic control. This may be due, in part, to the fact that past studies failed to distinguish between patients with type 1 and type 2 diabetes. Because these are actually completely different diseases that are often treated differently and consequently make different demands on patients, the relationship between glycemic control and depressed mood in type 1 and type 2 diabetes was examined separately. The relationship between Beck Depression Inventory (BDI) scores and HbA1c, as an index of long-term glycemic control, was measured in samples of 30 patients with type 1 and 34 patients with type 2 diabetes. Groups of patients with type 1 and type 2 diabetes did not differ in mean BDI score or HbA1c level. Correlation analysis revealed a significant positive relationship between BDI scores and HbA1c in the type 1 group (r = .44, p < .02) but not in the type 2 group (r = -0.06, p > .05). This relationship was evident throughout the entire range of BDI scores and was not restricted to scores indicative of clinical depression. Patients with type 1 diabetes who had higher HbA1c and BDI scores reported a lower frequency of home blood glucose monitoring. Variations in depressive mood, below the level of clinical depression, are associated with meaningful differences in glycemic control in type 1 but not type 2 diabetes. Preliminary data analysis suggests that this effect may be mediated, at least in part, by decreased self-care behaviors in patients with more depressed mood.

Assessment of beliefs in exercise dependence: The development and preliminary validation of the exercise beliefs questionnaire

Exercise dependence (or addiction) is a clinical condition associated with physical and psychological risk. A critical evaluation of the diverse aetiological models and methodological issues in the assessment of the condition highlighted the need to develop a questionnaire measuring maladaptive beliefs about the consequences of not exercising. The paper describes the development and preliminary validation of the Exercise Beliefs Questionnaire (EBQ). Study 1 generated 28 preliminary items for the EBQ based on a semi structured interview ( n = 13). In Study 2, the initial EBQ was administered to 201 subjects and the responses factor analysed. Four factors emerged: social desirability ( α = 0.87), physical appearance ( α = 0.83), mental and emotional functioning ( α = 0.89) and vulnerability to disease and ageing ( α = 0.67). Item total correlations for individual subscales were acceptable. In a further study ( n = 78) test-retest reliability was established. In Study 3, the 21 item EBQ was validated against other measures of exercise dependence ( n = 120) and was shown to discriminate between samples with clinical levels of depression and anxiety. The clinical and theoretical implications of belief assessment in exercise dependence are discussed.

Altered neuroendocrine activity in maltreated children related to symptoms of depression

AbstractThis study examined the effects of stressful environments on physiological and affective functioning among 131 maltreated school-aged children attending a summer day camp. Sixty-six nonmaltreated children also attending the camp served as a comparison group. Salivary Cortisol measures were obtained daily at 10:00 a.m. and at 4:00 p.m. Depression was measured using the Child Depression Inventory. Children with scores of 19 or higher were classified as depressed. Internalizing and externalizing behavior problems were determined from the Teacher Report Form of the Child Behavior Checklist. Children with t scores of 70 or higher were classified as having clinical levels of these problems. Maltreated children had slightly elevated afternoon Cortisol concentrations, but their morning concentrations did not differ significantly from those of nonmaltreated children. Neither clinical levels of depression, internalizing, or externalizing problems were predictive of the elevated afternoon values. Depression among maltreated children was, however, associated with altered activity of the hypothalamic-pituitary-adrenocortical (HPA) axis. Depressed maltreated children had lower morning Cortisol concentrations compared to nondepressed maltreated children and were more likely to show a rise rather than the expected decrease in Cortisol from morning to afternoon. These data replicated earlier findings. There was no evidence that depressed, nonmaltreated children exhibited this change in diurnal Cortisol activity.

Couples undergoing treatment for infertility: dimensions of life satisfaction.

The purpose of this study was to investigate the perceived life, marital, and sexual satisfaction of married couples undergoing treatment for infertility. A survey research design was utilized involving the responses of 43 husband-wife pairs. The findings indicated that wives had a significantly lower level of satisfaction with life than their husbands and that there were significant relationships between husband-wife pairs for both marital and sexual satisfaction. In comparison to paired wives, the responses of 17 wives whose husbands chose not to respond to the survey indicated higher levels of dissatisfaction in all three dimensions of life satisfaction. Furthermore, a majority of the scores for this group indicated clinical levels of depression. It was evident that individuals, especially females, undergoing treatment for infertility experienced stress in various areas of their lives. Hence, suggestions are given to assist caregivers in their endeavor to enhance the quality of life for infertile couples.