Comorbid Major Depression Research Articles

Are Patients with Childhood Onset of Insomnia and Depression More Difficult to Treat Than Are Those with Adult Onsets of These Disorders? A Report from the TRIAD Study.

To determine if patients with childhood onsets (CO) of both major depression and insomnia disorder show blunted depression and insomnia treatment responses to concurrent interventions for both disorders compared to those with adult onsets (AO) of both conditions. This study was a secondary analysis of data obtained from a multisite randomized clinical trial designed to test the efficacy of combining a psychological/behavior insomnia therapy with antidepressant medication to enhance depression treatment outcomes in patients with comorbid major depression and insomnia. This study included 27 adults with CO of depression and insomnia and 77 adults with AO of both conditions. They underwent a 16-week treatment including: (1) a standardized two-step pharmacotherapy for depression algorithm, consisting of escitalopram, sertraline, and desvenlafaxine in a prescribed sequence; and (2) either cognitive behavioral insomnia therapy (CBT-I) or a quasi-desensitization control (CTRL) therapy. Main outcome measures were the 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Insomnia Severity Index (ISI) completed pre-treatment and every 2 weeks thereafter. The AO and CO groups did not differ significantly in regard to their pre-treatment HRSD-17 and ISI scores. Mixed model analyses that adjusted for the number of insomnia treatment sessions attended showed that the AO group achieved significantly lower, subclinical scores on the HRSD-17 and ISI than did the CO group by the time of study exit. Moreover, a significant group by treatment arm interaction suggested that HRSD-17 scores at study exit remained significantly higher in the CO group receiving the CTRL therapy than was the case for the participants in the CO group receiving CBT-I. Greater proportions of the AO group achieved a priori criteria for remission of insomnia (49.3% vs. 29.2%, p = 0.04) and depression (45.5% vs. 29.6%, p = 0.07) than did those in the CO group. Patients with comorbid depression and insomnia who experienced the first onset of both disorders in childhood are less responsive to the treatments offered herein than are those with adult onsets of these comorbid disorders. Further research is needed to identify therapies that enhance the depression and insomnia treatment responses of those with childhood onsets of these two conditions.

Persistent Depressive Disorder or Dysthymia: An Overview of Assessment and Treatment Approaches

Persistent depressive disorder or dysthymia is a recurrent depressive disorder with no clearly demarcated episodes. Onset is insidious and can occur in adolescence or adulthood. Dysthymia frequently remains unrecognized and undiagnosed for years. Co-morbid major depression, anxiety, personality, somatoform and substance abuse disorders are common. Symptoms center on sad mood, pessimism and hopelessness. Sufferers experience significant functional impairment and are at risk of death by suicide. Those most at risk are female, unmarried, live in high income countries and have family histories of depression. Screening instruments include the Cornell Dysthymia Rating Scale (CDRS). Typical treatments are antidepressant medications and cognitive behavioral analysis system of psychotherapy (CBASP). This paper provides health professionals with an overview of assessment and treatment approaches in dysthymia.

Can We Use MDDScore for the Identification of Comorbid Major Depressive Disorder (MDD) in Patients with Chronic Pain?

The prevalence of patients with chronic pain who display depressive symptoms is quite high, with depression potentially an integral component of chronic pain. Since the current subjective clinical diagnostic systems were not designed to assess depression in patients with chronic pain, they fail to adequately capture the nature of mood states of these patients. It is difficult to apply these assessment tools to segregate unipolar depression (MDD) from the demoralization inherent in chronic pain states. MDDScore™, a multivariate biomarker blood test for depression, was used to determine if it was possible to identify biomarker patterns consistent with major depressive disorder in multiple chronic pain states. Three study groups were analyzed, and included: (i) patients (n=93) with centralized Chronic Intractable Pain (CIP), (ii) patients (n=20) with chronic pain of diverse origin from Scripps Pain Clinic (SPC) and (iii) prospectively collected patients (n=28) with comorbid arthritis and depressive symptoms. A very distinct bimodal pattern was observed. Forty-nine of 93 CIP patients (52.7%), 18 of 28 (64.2%) of the arthritis patients, and 9 of 20 (45%) patients with chronic pain of diverse origin from Scripps Pain Clinic had MDDScores of ≥5. Thus, the biomarker panel could segregate patients into two major groups based upon MDDScores. These data suggest but not prove we can objectively identify chronic pain patients with a higher probability of comorbid major depression. Importantly, we can use the biomarkers on the MDDScore panel to gain insight into and gauge the residual (post-treatment) level of inflammation in these intensively treated patients. To this end, we determined and compared the serum concentrations of alpha-1 antitrypsin (A1AT), Myeloperoxidase (MPO) and soluble tumor necrosis factor receptor type 2 (sTNFR2) in each of the patient populations studied.

Altered resting state functional connectivity of fear and reward circuitry in comorbid PTSD and major depression.

Individuals with comorbid posttraumatic stress disorder and major depressive disorder (PTSD-MDD) often exhibit greater functional impairment and poorer treatment response than individuals with PTSD alone. Research has not determined whether PTSD-MDD is associated with different network connectivity abnormalities than PTSD alone. We used functional magnetic resonance imaging (fMRI) to measure resting state functional connectivity (rs-FC) patterns of brain regions involved in fear and reward processing in three groups: patients with PTSD-alone (n = 27), PTSD-MDD (n = 21), and trauma-exposed healthy controls (TEHCs, n = 34). Based on previous research, seeds included basolateral amygdala (BLA), centromedial amygdala (CMA), and nucleus accumbens (NAcc). Regardless of MDD comorbidity, PTSD was associated with decreased connectivity of BLA-orbitalfrontal cortex (OFC) and CMA-thalamus pathways, key to fear processing, and fear expression, respectively. PTSD-MDD, compared to PTSD-alone and TEHC, was associated with decreased connectivity across multiple amygdala and striatal-subcortical pathways: BLA-OFC, NAcc-thalamus, and NAcc-hippocampus. Further, while both the BLA-OFC and the NAcc-thalamus pathways were correlated with MDD symptoms, PTSD symptoms correlated with the amygdala pathways (BLA-OFC; CMA-thalamus) only. Comorbid PTSD-MDD may be associated with multifaceted functional connectivity alterations in both fear and reward systems. Clinical implications are discussed.

Hair cortisol concentrations and cortisol stress reactivity in generalized anxiety disorder, major depression and their comorbidity

Studies investigating cortisol secretion in patients with generalized anxiety disorder (GAD) have reported heterogeneous findings. Further, current knowledge on the specificity of endocrine changes for GAD and/or comorbid major depression (MD) is limited. Hence, the current study investigated long-term integrated cortisol secretion, as indexed by hair cortisol concentrations (HCC), and experimentally-induced cortisol stress reactivity in relation to GAD, MD and their comorbidity. Carefully characterized groups of 17 GAD patients including 8 with comorbid MD (GAD-MD), 12 MD patients and 21 healthy controls were recruited. Alongside psychometric data, HCC (N = 43) and salivary cortisol stress reactivity in response to the Trier Social Stress Test (N = 45) were determined. Findings revealed that MD patients exhibited lower HCC compared to controls and GAD patients, with no differences between the latter two groups. Interestingly, when the GAD group was separated into two groups based on MD comorbidity, lower HCC in MD patients were found compared to controls and GAD-noMD patients, but did not show differences when compared to GAD-MD patients. No HCC differences were seen between GAD-MD or GAD-noMD patients and healthy controls. No TSST group differences emerged. Our findings suggest MD to be related to long-term attenuation in cortisol secretion. While no group differences emerged between patients with GAD, neither with nor without MD, and controls, the current results provide tentative evidence that MD determines long-term endocrine changes, with pure GAD showing a distinct pattern. Future studies are needed to confirm our findings in larger samples of pure and comorbid groups.

Comments on Bozzatello et al. Supplementation with Omega-3 Fatty Acids in Psychiatric Disorders: A Review of Literature Data. J. Clin. Med. 2016, 5, 67.

Paola Bozzatello et al. [1] have done a comprehensive qualitative review of the potential use of long-chain polyunsaturated fatty acids in the prevention and treatment of mental disorders.[...].

Mirtazapine in comorbid major depression and an alcohol use disorder: A double-blind placebo-controlled pilot trial

This was a first double-blind, placebo-controlled pilot study to evaluate the efficacy of the novel antidepressant medication mirtazapine for treating both the depressive symptoms and the level of alcohol consumption of subjects with comorbid major depressive disorder and an alcohol use disorder (MDD/AUD). The results of two previous studies of mirtazapine in MDD/AUD subjects had suggested efficacy for mirtazapine for decreasing their level of depressive symptoms, but level of alcohol consumption had not been assessed in those studies. All subjects in this 12-week pilot study were randomized to either mirtazapine or placebo, and also received motivational enhancement therapy. Between-group analyses involving the outcome measures of depressive symptoms, level of alcohol consumption, and level of alcohol craving indicated no significant differences between groups, possibly because of limited sample size. However, within-group t tests in the mirtazapine group showed a significant decrease in depressive symptoms by week 2, also noted at all subsequent assessments (weeks 3, 4, 6, 8, 10, and 12) during the 12-week study. In contrast, no significant decrease in depressive symptoms was noted in the placebo group until week 8. No evidence of efficacy was found for mirtazapine for decreasing level of alcohol consumption in MDD /AUD subjects.

SECOND-STAGE TREATMENTS FOR RELATIVE NONRESPONDERS TO COGNITIVE BEHAVIORAL THERAPY (CBT) FOR PANIC DISORDER WITH OR WITHOUT AGORAPHOBIA-CONTINUED CBT VERSUS SSRI: A RANDOMIZED CONTROLLED TRIAL

Cognitive behavioral therapy (CBT) and pharmacotherapy are efficacious for the short-term treatment of panic disorder. Less is known about the efficacy of these therapies for individuals who do not respond fully to short-term CBT. The current trial is a second-step stratified randomized design comparing two treatment conditions-selective serotonin reuptake inhibitor (SSRI; paroxetine or citalopram; n = 34) and continued CBT (n = 24)-in a sample of individuals classified as treatment nonresponders to an initial course of CBT for panic disorder. Participants were randomized to 3 months of treatment and then followed for an additional 9 months. Only treatment responders after 3 months were maintained on the treatment until 12-month follow-up. Data analysis focused on panic disorder symptoms and achievement of response status across the first 3 months of treatment. Final follow-up data are presented descriptively. Participants in the SSRI condition showed significantly lower panic disorder symptoms as compared to continued CBT at 3 months. Results were similar when excluding individuals with comorbid major depression or analyzing the entire intent-to-treat sample. Group differences disappeared during 9-month naturalistic follow-up, although there was significant attrition and use of nonstudy therapies in both arms. These data suggest greater improvement in panic disorder symptoms when switching to SSRI after failure to fully respond to an initial course of CBT. Future studies should further investigate relapse following treatment discontinuation for nonresponders who became responders. Clinicaltrials.gov Identifier: NCT00000368; https://clinicaltrials.gov/show/NCT00000368.

Mental state decoding impairment in major depression and borderline personality disorder: meta-analysis.

Patients with major depression and borderline personality disorder are characterised by a distorted perception of other people's intentions. Deficits in mental state decoding are thought to be the underlying cause of this clinical feature. To examine, using meta-analysis, whether mental state decoding abilities in patients with major depression and borderline personality disorder differ from those of healthy controls. A systematic review of 13 cross-sectional studies comparing Reading in the Mind of the Eyes Test (RMET) accuracy performance of patients with major depression or borderline personality disorder and healthy age-matched controls (n = 976). Valence scores, where reported, were also assessed. Large significant deficits were seen for global RMET performance in patients with major depression (d = -0.751). The positive RMET valence scores of patients with depression were significantly worse; patients with borderline personality disorder had worse neutral scores. Both groups were worse than controls. Moderator analysis revealed that individuals with comorbid borderline personality disorder and major depression did better than those with borderline personality disorder alone on accuracy. Those with comorbid borderline personality disorder and any cluster B or C personality disorder did worse than borderline personality disorder alone. Individuals with both borderline personality disorder and major depression performed better then those with borderline personality disorder without major depression for positive valence. These findings highlight the relevance of RMET performance in patients with borderline personality disorder and major depression, and the importance of considering comorbidity in future analysis.

Theory of mind in social anxiety disorder, depression, and comorbid conditions

Social anxiety disorder is characterized by marked interpersonal impairment, particularly when presenting with comorbid major depression. However, the foundational social-cognitive skills that underlie interpersonal impairment in comorbid and non-comorbid manifestations of SAD has to date received very little empirical investigation. In a sample of 119 young adults, the current study examined differences in theory of mind (ToM), defined as the ability to decode and reason about others’ mental states, across four groups: (a) non-comorbid SAD; (b) non-comorbid Lifetime MDD; (c) comorbid SAD and Lifetime MDD; and (d) healthy control. The non-comorbid SAD group was significantly less accurate at decoding mental states than the non-comorbid MDD and control groups. Further, both the comorbid and non-comorbid SAD groups made significantly more ‘excessive’ ToM reasoning errors than the non-comorbid MDD group, suggesting a pattern of over-mentalizing. Findings are discussed in terms of their implications for understanding the social cognitive foundations of social anxiety.

Cost-effectiveness of integrated collaborative care for comorbid major depression in patients with cancer

ObjectivesComorbid major depression is associated with reduced quality of life and greater use of healthcare resources. A recent randomised trial (SMaRT, Symptom Management Research Trials, Oncology-2) found that a collaborative care treatment programme (Depression Care for People with Cancer, DCPC) was highly effective in treating depression in patients with cancer. This study aims to estimate the cost-effectiveness of DCPC compared with usual care from a health service perspective. MethodsCosts were estimated using UK national unit cost estimates and health outcomes measured using quality-adjusted life-years (QALYs). Incremental cost-effectiveness of DCPC compared with usual care was calculated and scenario analyses performed to test alternative assumptions on costs and missing data. Uncertainty was characterised using cost-effectiveness acceptability curves. The probability of DCPC being cost-effective was determined using the UK National Institute for Health and Care Excellence's (NICE) cost-effectiveness threshold range of £20,000 to £30,000 per QALY gained. ResultsDCPC cost on average £631 more than usual care per patient, and resulted in a mean gain of 0.066 QALYs, yielding an incremental cost-effectiveness ratio of £9549 per QALY. The probability of DCPC being cost-effective was 0.9 or greater at cost-effectiveness thresholds above £20,000 per QALY for the base case and scenario analyses. ConclusionsCompared with usual care, DCPC is likely to be cost-effective at the current thresholds used by NICE. This study adds to the weight of evidence that collaborative care treatment models are cost-effective for depression, and provides new evidence regarding their use in specialist medical settings.

Feasibility of Pairing Behavioral Activation With Exercise for Women With Type 2 Diabetes and Depression: The Get It Study Pilot Randomized Controlled Trial

Major depressive disorder is often comorbid with diabetes and associated with worse glycemic control. Exercise improves glycemic control and depression, and thus could be a parsimonious intervention for patients with comorbid diabetes and major depression. Because patients with diabetes and comorbid depression are often sedentary and lack motivation to exercise, we developed a group exercise intervention that integrates strategies from behavioral activation therapy for depression to increase motivation for and enjoyment of exercise. We conducted a 6-month pilot randomized controlled trial to test the feasibility of the behavioral activation exercise intervention (EX) for women with diabetes and depression. Of the 715 individuals who contacted us about the study, 29 participants were randomized to the EX condition or an enhanced usual care condition (EUC), which represents 4.1% of participants who initially contacted us. Inclusion criteria made recruitment challenging and limits the feasibility of recruiting women with diabetes and depression for a larger trial of the intervention. Retention was 96.5% and 86.2% at 3 and 6months. Participants reported high treatment acceptability; use of behavioral activation strategies and exercise class attendance was acceptable. No condition differences were observed for glycemic control, depressive symptoms, and physical activity, though depressive symptoms and self-reported physical activity improved over time. Compared to participants in the EUC condition, participants in the EX condition reported greater exercise enjoyment and no increase in avoidance behavior over time. Using behavioral activation strategies to increase exercise is feasible in a group exercise setting. However, whether these strategies can be delivered in a less intensive manner to a broader population of sedentary adults, for greater initiation and maintenance of physical activity, deserves further study.

Cross section comparative study for comorbid migraine and major depression in epileptic patients: demographic, clinical, electroencahpalograhy and therapeutic implications

Overlapping relationships among migraine, epilepsy and major depression have been identified in both cross-sectional case–control and prospective studies. Clinical and neurophysiological examination of such comorbidity can illuminate shared pathophysiology, and can have profound implications for diagnosis, prognosis, and treatment. During the period of January 2013 through July 2013, 87 cases were diagnosed as epilepsy in remission according to International League Against Epilepsy criteria. Migraine diagnosis was made according to the current International Classification of Headache Disorders-II. EEG and brain MRI were done to confirm the clinical diagnosis and physiological correlates. Diagnosis of depression was based on detailed clinical and psychiatric assessment according to the DSM IV using SCID 1 and Hamilton depression scale for assessment of severity. A history of migraine was present in 19 (21.83%), while major depression was present in 36(41.37%) of 87 epileptic patients. Comorbidity of migraine and major depression was significantly evident in younger age group (p = 0.000) and females (p = 0.01). Electroencephalography showed significantly more central and temporal epileptic discharge in patients with comorbid migraine and frontotemporal focal discharge in patients with major depression (p = 0.014). Migraine onset was more likely to have occurred 1–3 years after epilepsy was diagnosed in (36.84%) of comorbid cases. It is important to address comorbidity in treating patients with epilepsy. The diagnosis of atypical migraine symptoms can be quite difficult, in such cases EEG may be useful. Some antiepileptic drugs (AEDs) like divalproex sodium (valproate) and topiramate are effective in preventing migraine attacks, while others including phenytoin, oxcarbazepine, vigabatrin and clonazepam, are not effective in migraine prophylaxis. The antiepileptic drugs most closely associated with depression on initiation of treatment are vigabatrin, phenobarbitone, and topiramate.Further research on the nature and causes of the co-morbidity remains needed.

Behavioral inhibition in childhood predicts smaller hippocampal volume in adolescent offspring of parents with panic disorder.

Behavioral inhibition (BI) is a genetically influenced behavioral profile seen in 15–20% of 2-year-old children. Children with BI are timid with people, objects and situations that are novel or unfamiliar, and are more reactive physiologically to these challenges as evidenced by higher heart rate, pupillary dilation, vocal cord tension and higher levels of cortisol. BI predisposes to the later development of anxiety, depression and substance abuse. Reduced hippocampal volumes have been observed in anxiety disorders, depression and posttraumatic stress disorder. Animal models have demonstrated that chronic stress can damage the hippocampal formation and implicated cortisol in these effects. We, therefore, hypothesized that the hippocampi of late adolescents who had been behaviorally inhibited as children would be smaller compared with those who had not been inhibited. Hippocampal volume was measured with high-resolution structural magnetic resonance imaging in 43 females and 40 males at 17 years of age who were determined to be BI+ or BI− based on behaviors observed in the laboratory as young children. BI in childhood predicted reduced hippocampal volumes in the adolescents who were offspring of parents with panic disorder, or panic disorder with comorbid major depression. We discuss genetic and environmental factors emanating from both child and parent that may explain these findings. To the best of our knowledge, this is the first study to demonstrate a relationship between the most extensively studied form of temperamentally based human trait anxiety, BI, and hippocampal structure. The reduction in hippocampal volume, as reported by us, suggests a role for the hippocampus in human trait anxiety and anxiety disorder that warrants further investigation.

Current Status of Co-Occurring Mood and Substance Use Disorders: A New Therapeutic Target

Mood and substance use disorders commonly co-occur, yet there is little evidence-based research to guide the pharmacologic management of these comorbid disorders. The authors review the existing empirical findings, some of which may call into question current clinical pharmacotherapy practices for treating co-occurring mood and substance use disorders. The authors also highlight knowledge gaps that can serve as a basis for future research. The specific mood disorders reviewed are bipolar and major depressive disorders (either one co-occurring with a substance use disorder). Overall, findings from the relatively small amount of available data indicate that pharmacotherapy for managing mood symptoms can be effective in patients with substance dependence, although results have not been consistent across all studies. Also, in most studies, medications for managing mood symptoms did not appear to have an impact on the substance use disorder. In a recent trial for comorbid major depression and alcohol dependenc...

Gender Comparisons on Quality-of-Life and Comorbid Alcohol Dependence and Major Depression

Introduction and Objectives: Compared to men, substance-addicted women have greater social vulnerabilities that may impact their symptom presentation and overall quality-of-life (QOL). The latter is gaining prominence as an outcome measure and key element of person-centered care. We aimed to compare in this study treatment-seeking men and women with co-morbid alcohol dependence and major depression on measures of depression severity, addiction severity, and quality-of-life and to examine associations between addiction/depression severity and quality-of-life separately in men and women. Methods: Men (n = 34) and women (n = 33) participating in a psychopharmacology trial for co-morbid alcohol dependence and major depression were administered the Addiction Severity Index (ASI), the 25-item Hamilton Rating Scale for Depression (HAM-D), and the Multicultural Quality of Life Index at baseline as part of a large assessment battery. Results: Women reported greater global QOL impairment than men despite being similar on measures of depression and addiction severity. Depression severity, but not addiction severity, was significantly associated with QOL impairment in both men and women. Discussion and Conclusions: Treatment-seeking women with co-morbid major depression and alcoholism report lower QOL (i.e., happiness and life satisfaction) than their male counterparts. Depressive symptoms, but not addiction-related problems, may contribute to global QOL impairment. Alternatively, QOL impairment may increase depressed mood. Overall, QOL assessments may identify areas of impairment and opportunities for health promotion not assessed through traditional measures used in addiction treatment programs, and these measures may be more sensitive to the specific needs of women. Consideration of all these factors is likely to enhance person-centered care.

Study on clinical features of female patients with recurrent major depression comorbidity with general anxiety disorder

Objective To explore the clinical features of female diagnosed recurrent major depression(MD) comorbidity with general anxiety disorder (GAD). Methods 301 females patients with recurrent major depression were interviewed by specially trained interviewers with using computer evaluation system and divided into comorbidity group and non-comorbidity group according to whether comorbid MD with GAD or without GAD. The comparison between the two groups included items of demographic, clinical data, assessment of psychopathology, Eysenck neuroticism questionnaire (EPQ), stressful life events, parental bonding instrument. Results 25.2% of patients of MD coexistence GAD. There was no significant difference in sociodemographic data between the two groups. Significant differences among total number of depression symptoms(OR=1.439, 95%CI=1.049-1.975, P=0.024), duration of illness(OR=1.253, 95%CI=1.010-1.475, P=0.048), psychomotor agitation(OR=2.031, 95%CI=1.123-3.676, P=0.019), suicidal thought(OR=2.228, 95%CI=1.010-4.912, P=0.047), anxiety(OR=5.547, 95%CI=1.935-15.896, P=0.001), irritable(OR=1.956, 95%CI=1.081-3.542, P=0.027)were identified between the two group. In the comorbidity group, the score of nenroticism dimention derived from EPQ was also higher(OR=2.287, 95%CI=1.674-3.124, P=2.287×10-7)than that of non-comorbidity group. There was no significant difference of stressful life events between two groups(OR=1.118, 95%CI=0.913-1.368, P=0.280). Conclusion This study suggests the phenomena that female patients of recurrent depression disorder comorbidity with general anxiety disorders is common in clinical. The patients comorbid MD and GAD have more symptoms, neuroticism and be worse in severity. Key words: Recurrent major depression; General anxiety disorder; Comorbidity; Female; Clinical feature

Autism spectrum disorder in individuals with anorexia nervosa and in their first- and second-degree relatives: Danish nationwide register-based cohort-study

Clinical and population-based studies report increased prevalence of autism spectrum disorders (ASD) in individuals with anorexia nervosa and in their relatives. No nationwide study has yet been published on co-occurrence of these disorders. To investigate comorbidity of ASD in individuals with anorexia nervosa, and aggregation of ASD and anorexia nervosa in their relatives. In Danish registers we identified all individuals born in 1981-2008, their parents, and full and half siblings, and linked them to data on hospital admissions for psychiatric disorders. Risk of comorbidity of ASD in probands with anorexia nervosa and aggregation of ASD in families of anorexia nervosa probands were increased. However, the risk of comorbid and familial ASD did not differ significantly from comorbid and familial major depression or any psychiatric disorder in anorexia nervosa probands. We confirm aggregation of ASD in probands with anorexia nervosa and in their relatives; however, the relationship between anorexia nervosa and ASD appears to be non-specific.

Psychiatric illness and length of stay in general hospitals: do case finding methods matter?

Several prior studies have investigated whether patients with "non-cognitive" mental disorders (i.e., organic disorders, substance abuse, delirium, and psychotic disorders excluded) have longer Length Of Stay (LOS) than mentally healthy individuals in nonpsychiatric hospital settings. These studies yielded contrasting results. The present paper aims to examine whether methods of psychiatric case finding can explain these differences. Using the Clinical Interview Schedule (CIS) and the General Health Questionnaire (GHQ), 462 in-patients of medical, surgical, gynecological, and rehabilitation departments were assessed for the presence of psychiatric disorders. In multiple regression analysis, all CIS-cases together did not show an association with LOS. Of the diagnostic groups assessed by CIS only major depression showed a significantly prolonged LOS. Using the GHQ sum-score as a continuous variable, LOS was significantly increased while using the GHQ as a dichotomous variable did not show such an association. After removing those suffering from multiple psychiatric diagnoses (such as major depression co-morbid with organic mental illness), none of the case definitions showed a significant association with LOS. It seems that different case finding methods yield different results concerning the association of psychiatric disorders with LOS. When interpreting these results the small size of some subsamples must be taken into consideration.

Collaborative care interventions: a solution to the treatment of depression in the oncology setting

ABSTRACT FROM: Sharpe M, Walker J, Holm Hansen C, et al ., SMaRT (Symptom Management Research Trials) Oncology-2 Team. Integrated collaborative care for comorbid major depression in patients with cancer...