Criteria For Depressive Disorder Research Articles

A Survey on the Prevalence of Depression in Blood Donors with Hepatitis C in Shiraz.

BackgroundDepression is the most common psychiatric disorder associated with hepatitis C.ObjectivesThis study aimed to survey the prevalence rate of depression in patients with Hepatitis C Virus (HCV) before they were aware of their HCV test result.MethodsThis cross-sectional study was conducted on all blood donors with confirmed positive HCV test results who donated blood between March 21, 2012 to March 21, 2013 at Fars blood transfusion center in Iran as case group and age- and sex-matched blood donors with negative screening test results as control group. A semi-structured interview based on DSM IV-TR depressive disorder criteria and Beck depression inventory (BDI) was conducted. BDI contained 21 items, each scored from 0 to 3 and total score of 0 to 63 for the whole scale computed by summing up all the items. A cut-off score of ≥ 19 indicated clinically significant depressive symptoms. The prevalence rate and risk factors of depression were determined.ResultsThe most frequent risk factors for HCV infection were intravenous drug abuse (59.3%), unsafe sexual contact (30.5%), and history of being imprisoned (25.4%). The prevalence rate of depression in the HCV group was 55.9 % (95% CI: 42.99% - 68.87%) that was significantly higher than the corresponding rate of the control group as 17.7 % ( 95% CI: 8.49% - 28.79%) (P < 0.001). The severity of depression was also more in the HCV group (P < 0.001). Besides, the prevalence rate of depression was higher among HCV patients with lower education level, previous history of drug abuse, unsafe sexual contact, and previous history of psychiatric diseases. The prevalence rate of depression was higher in the case group even after adjusting for other variables.ConclusionsOur study underlined the remarkable prevalence of depression among HCV patients. Therefore, designing depression screening tests is suggested to help such patients before starting the treatment.

Self-stigma and quality of life in patients with depressive disorder: a cross-sectional study.

BackgroundSelf-stigma is a maladaptive psychosocial phenomenon that can affect many areas of patients’ lives and have a negative impact on their quality of life (QoL). This study explored the association between self-stigma, QoL, demographic data, and the severity of symptoms in patients with depressive disorder.Patients and methodsPatients who met the International Classification of Diseases, 10th revision, research criteria for depressive disorder were enrolled in this cross-sectional study. All outpatients completed the following measurements: the Quality of Life Enjoyment and Satisfaction Questionnaire, the Internalized Stigma of Mental Illness Scale, demographic questionnaire, and the objective and subjective Clinical Global Impression-Severity scales that measure the severity of disorder. A total of 81 depressive disorder patients (with persistent affective disorder – dysthymia, major depressive disorder, or recurrent depressive disorder) and 43 healthy controls participated in this study.ResultsCompared with the healthy control group, a lower QoL was observed in patients with depressive disorder. The level of self-stigma correlated positively with total symptom severity score and negatively with QoL. Multiple regression analysis revealed that the overall rating of objective symptom severity and score of self-stigma were significantly associated with QoL.ConclusionThis study suggests a lower QoL in patients with depressive disorder in comparison with healthy controls and a negative impact of self-stigma level on QoL in patients suffering from depressive disorders.

Prevalence and clinical characteristics of insomnia and its subtypes in the Korean elderly

BackgroundInsomnia is known to be associated with psychiatric disorders, other sleep disorders and medical conditions, but the prevalence of insomnia diagnosis has never been estimated according to its subtypes. We studied the prevalence and clinical characteristics of insomnia diagnosis and its subtypes in the Korean elderly population. MethodsAmong 1423 sampled elderly individuals aged 60 years or older, 881 subjects participated in this study. The Athens Insomnia Scale was applied to detect insomnia symptoms, and insomnia diagnosis was finally evaluated using the international classification of sleep disorders, 2nd edition. To define insomnia subtypes, the DSM-IV-based interview, detailed history on sleep disorders and semi-structured interview for medical conditions were performed. Subsyndromal depression was defined when depressive symptoms did not meet the criteria for depressive disorders. ResultsThe prevalence of insomnia disorder was 32.8% in all subjects, with the prevalence being significantly higher in women than in men (37.9% vs. 25.2%; p<0.001). The prevalence of insomnia subtypes was as follows; psychophysiological insomnia (PI), 20.5%; insomnia due to mental disorder 7.2%; insomnia due to general medical conditions 2.9%; insomnia in other sleep disorders 2.2%, and insomnia due to substance use 0.2%. Among subjects with PI, subsyndromal depression was diagnosed in 53.7%. ConclusionsNearly one third of Korean elderly individuals suffer from insomnia and insomnia patients showed diverse comorbid conditions, especially depressive symptoms. By establishing insomnia subtypes, we can plan to treat comorbid conditions as well as insomnia itself.

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 1. Disease Burden and Principles of Care.

The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. This section is the first of six guidelines articles. In Canada, the annual and lifetime prevalence of MDD was 4.7% and 11.3%, respectively. MDD represents the second leading cause of global disability, with high occupational and economic impact mainly attributable to indirect costs. DSM-5 criteria for depressive disorders remain relatively unchanged, but other clinical dimensions (sleep, cognition, physical symptoms) may have implications for depression management. e-Mental health is increasingly used to support clinical and self-management of MDD. In the 2-phase (acute and maintenance) treatment model, specific goals address symptom remission, functional recovery, improved quality of life, and prevention of recurrence. The burden attributed to MDD remains high, whether from individual distress, functional and relationship impairment, reduced quality of life, or societal economic cost. Applying core principles of care, including comprehensive assessment, therapeutic alliance, support of self-management, evidence-informed treatment, and measurement-based care, will optimize clinical, quality of life, and functional outcomes in MDD.

Prevalence and Clinical Correlators of Undiagnosed Significant Depressive Symptoms Among Individuals with Type 2 Diabetes In A Mediterranean Population.

Objective: To determine the frequency and clinical parameters, of clinically significant depressive symptoms among a type 2 diabetes (T2DM) sample from a Mediterranean area without an established diagnosis of depressive disorder (DD). Methods: 320 subjects with T2DM were recruited randomly from Primary-Care settings and the Endocrine Department from a tertiary center in Mallorca (Spain). 91 healthy individuals matched by age, gender and BMI were used as controls. All participating patients graded by the presence of DD by using the "Beck Depression Inventory" (BDI), considering pathological a cut-off score equal or greater than 16. Results: 27.2% T2DM subjects had significant symptoms of DD compared with 12.1% in the control group (p<0.01). BDI score was higher among T2DM when compared with controls (12±9.6 vs. 7.4±5, p<0.0001). The proportion of females (68% vs. 37%, p<0.0001), subjects without an active job (68% vs. 45%, p=0.01) and singles (38% vs. 18%, p=0.007) was greater among T2DM with a BDI≥16. Subjects with criteria for DD had a higher BMI (31.99±5.96 vs. 30.53±5.62, p=0.03). Fasting plasma glucose was higher among T2DM with a BDI≥16 (162±70 vs. 147±45 mg/dl, p=0.02) as well as HbA1c levels (7.9±1.8% vs. 7.4±1.4%, p=0.01), triglycerides (203±183 vs. 161±103 mg/dl; p=0.03) and LDL-cholesterol (112±31 vs. 104±35 mg/dl; p=0.03). Gender, marital status, BMI and triglycerides were independently related to the presence of DD after a logistic regression model. Conclusions: Relevant depressive symptoms are more prevalent among Mediterranean T2DM subjects than in general population. Main clinical correlators of significant depressive symptoms are gender, marital status and BMI.

Exercise addicts with injuries are in risk of depression

IntroductionExercise addiction is characterized by increasing exercise amounts, withdrawal symptoms and lack of control. Exercisers with addiction continue to exercise in spite of pain and injury because they use exercise to regulate emotions, identity and self-esteem. How do they react to injuries?ObjectivesIt is hypothesized that exercise addiction is a risk factor for emotional distress when an injury occur due to withdrawal symptoms and lack of identity.AimsTo estimate the prevalence of exercise addiction in exercisers with injuries at the musculoskeletal system and to test the relationship between addiction and emotional distress (depression and stress).MethodsThe Exercise Addiction Inventory was used to identify exercise addiction. To measure depression and stress we used the Major Depression Inventory (MDI) and the Perceived Stress Scale (PSS). Participants (n = 694) were regular exercisers with injuries at foot, knee or shoulder at an orthopedic hospital department.ResultsThe prevalence of exercise addiction was 7.6%. We found that exercisers with addiction reported more emotional distress in terms of higher MDI-scores 18.0 (SD = 11.0) versus 11.7 (SD = 9.1); P = 0.00 and in total PSS-score 17.6 (SD = 7.2) versus 13.9 (SD = 6.8); P = 0.00. Chi2 analyses showed that 25% of the addicted exercisers met the criteria for clinical depression, while only 11% of the non-addicted exercisers were depressed; P = 0.00.ConclusionsExercisers with addiction appear at somatic departments treating musculoskeletal injuries. It is a vulnerable group characterized by elevated levels of depressive symptoms and clinical stress. We recommend to offer psychological interventions focusing on emotional distress and prevention of re-injury by reducing excessive and obsessive exercise patterns.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Abstract PD4-4: Prevalence, health care utilization and costs of concomitant depression among breast cancer survivors

Abstract Purpose: Concomitant conditions in a cohort of non-elderly breast cancer survivors (BCS) were examined with a focus on the prevalence, healthcare utilization, and costs of diagnosed depression. Little research has been conducted on how concomitant depression among cancer survivors impacts utilization and costs of care. Methods. Using administrative claims data from the Military Health System Data Repository (MHSDR), a cohort of 2,851 BCS was identified with at least 2 years survival from the time of diagnosis. Concomitant conditions were based on ICD-9 codes; codes 296.2, 296.3, 298.0, and 311 were used to identify depression. Fiscal year 2009 was used as the index year to calculate healthcare utilization and costs. Bivariate analyses and logistic regression analysis were used to examine group differences and predictors of having received a diagnosis of depression. Findings. The most common concomitant chronic conditions in the BCS cohort were hypertension (50.0%), mood disorders or adjustment disorders (37.5%), heart disease (23.0%), diabetes (19.9%), history of tobacco use (19.7%), asthma or chronic obstructive pulmonary disease (16%), and obesity (16.8%). About 15.9% of the BCS were diagnosed with depression in the year prior to, at the time of, or in the 2-year follow up period after the cancer diagnosis. With bivariate analysis, significant differences were found between BCS with and without depression: those with depression had higher mean number of hospital stays (.33 vs .11), mean number of bed days (1.94 vs .58), mean number of ambulatory visits (34.26 vs 20.42), and mean number of pharmacy prescriptions (45.49 vs 27.60). For follow up care, BCS with a diagnosis of depression cost, on average, $7174 more annually then those without a diagnosis of depression ($15,471 vs $8,297). No demographic characteristics significantly increased the likelihood of having received a diagnosis of depression. Discussion. The results show much higher annual health care utilization and costs for BCS diagnosed with depression compared to BCS without a diagnosis of depression. These findings may reflect the health care plan provided to military-related beneficiaries, a plan that has few restrictions for cancer follow up care if medically ordered. Claims data contains no information about cancer stage, a correlate of health care utilization and costs. Overall, the findings provide empirical evidence that there is a fiscal incentive to screen and manage mild symptoms prior to patients meeting diagnostic criteria for clinical depression. Assumedly, timely screening and rapid intervention will lead to improved quality of life for the patient, decreased utilization of health care resources, and cost savings for health care plans. In this respect, the findings support the 2014 ASCO recommendations regarding screening and treatment for depression and anxiety. Conversely, the data intimate that adoption of the ASCO recommendations will lead to higher costs as more individuals are positively screened and referred for treatment. Who, what, or how such services will be afforded merits sustained inquiry. The opinions expressed herein are those of the author and are not necessarily representative of the opinions or policies of the Department of Defense. Citation Format: Diana D Jeffery. Prevalence, health care utilization and costs of concomitant depression among breast cancer survivors [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr PD4-4.

The survey on outpatients with depressive disorders in a community health service center of Shanghai

Objective To investigate the prevalence of depressive disorders in the outpatients of a community health service center in Shanghai. Methods Eight hundred and forty-seven outpatients were screened with the Hospital Anxiety and Depression Scale (HADS). Of the screened outpatients, the patients with depressive scale score of HADS ≥8 were assessed with the MINI international neuropsychiatric interview (M.I.N.I.) and made the diagnosis of depressive disorder according to the criteria of DSM-IV. Results Eight hundred and thirty-eight outpatients completed the effective investigation, and 295 (35.2%) outpatients had a HADS score ≥ 8. Of the enrolled 838 patients, 16.1% (135/838) met the criteria for depressive disorders with major depressive episode 12.6% (106/838), dysthymia 2.5% (21/838) and bipolar depression 1.0% (8/838). Conclusion The prevalence rates of depressive symptoms and depressive disorders are high in the community health service center that deserved to be paid more attention for recognition, diagnosis and treatment. Key words: Depressive disorder; Outpatient; Community health service; Cross-sectional survey

Results of Isolated Lateral Retinacular Reconstruction for Iatrogenic Medial Patellar Instability

The aim of this study was to assess the outcomes of an isolated lateral retinaculum reconstruction for iatrogenic medial patellar instability (IMPI) in patients with continued pain after failed lateral retinacular release (LRR), including associated psychometric analysis. Pain was assessed using the visual analog scale (VAS) and disability was determined with the Lysholm scale. Psychological variables such as anxiety, depression, catastrophizing, and fear-of-movement beliefs were studied by using self-administered psychometric questionnaires. All 17 patients (13 women and 4 men) in this retrospective study had undergone LRR previously for anterior knee pain or lateral patellar instability. Four patients had undergone LRR plus proximal (Insall) realignment, and one had undergone LRR plus a medial tibial tubercle transfer. After their procedures, all had disabling symptoms. All patients underwent reconstructive surgery for IMPI. At a minimum follow-up of 2 years (range, 2 to 8 years), the mean preoperative VAS score was 7.6 (range, 5 to 9) and improved to 1.9 (range, 0 to 8) at the time of final follow-up (P < .001). The mean preoperative Lysholm score was 36.4 (range, 20 to 55), and the knee was described as bad (<65 points) in all cases. Postoperatively, it improved to 86.1 (range, 70 to 94) at final follow-up (P < .001). Before surgery, 4 patients (24%) had the clinical criteria for depression, 10 (59%) had anxiety, 7 (41%) had "catastrophizing" ideas concerning pain, and all (100%) had kinesiophobia (fear of movement). After surgery, none of the patients had depression or anxiety, none had catastrophizing ideation, and only 53% had kinesiophobia. Reconstruction of the deep transverse layer of the lateral retinaculum (LR) using a central strip of the iliotibial band for IMPI in patients with continued pain after failed LRR can successfully treat these severely disabled patients. Level IV, therapeutic case series.

Considerations On The Effectiveness Of Valdoxan Therapy In Depressive And Anxiety Disorders

Anxiety and depression are some of the most common psychiatric comorbidities, and at the same time the psychiatric disorders with the highest prevalence in the general population (between 30 % and 50 % of adults diagnosed with major depressive disorder associate an anxiety disorder spectrum, and about 50 % of patients diagnosed with an anxiety disorder also meet the diagnostic criteria for depressive disorder ). Only a few therapeutic strategies address both the anxiety and depressive disorders and the existing ones are far from being satisfactory due to the latency of onset of action, poor tolerability and the potential for addiction phenomena. Although part of the latest psychotropic class, Agomelatine has demonstrated efficacy on depressive symptoms and associated sleep disorders. Increasingly numerous recent studies demonstrate the anxiolytic effect of Agomelatine, both on depressive disorders associated with anxiety disorders and on anxiety symptoms ( generalized anxiety disorder). Keywords:Valdoxan, depressive, anxiety disorders

Screening by the Patient Health Questionnaire–9 Items for Indian Adolescents With Depression

Ganguly et al [1] reported the screening ability of the Patient Health Questionnaire–9 (PHQ-9) items for Indian adolescents with depression by targeting Depressive Disorder criteria of the International Statistical Classification of Diseases, 10th Revision. They recommended a cutoff value of 5/4 for screening depression. I have some concerns about their study.

Time and the psychiatric interview: The negotiation of temporal criteria of the depressive disorder

In this article, I am concerned with doctors' negotiations of the temporal dimension of the diagnostic criteria of depressive disorders during the first psychiatric interview. The data come from 16 initial psychiatric interviews recorded by doctors in three psychiatric hospitals in Poland. Taking a constructionist view of discourse and psychiatric practices, I shall argue that the discursive practice related to temporal information about patients' illnesses serves in gaining information, which is useful in the medical model of psychiatric diagnosis. The doctors positioned the patients' experiences on the timeline when the illness history was taken and temporal information authenticated the information. Conversely, the patients' current conditions were constructed in a limitless present, which allowed the psychiatrists to remove the relativity.

Prevalence of restless leg syndrome in subjects with depressive disorder

Background:Restless legs syndrome (RLS) is known to be associated with depression. We hypothesized that RLS in depression is linked to the severity, duration, and frequency of depressive episodes.Materials and Methods:Subjects fulfilling DSM-IV-TR criteria of depressive disorders were included in this study after seeking informed consent. Using structured interview of MINI-Plus their demographic data and history were recorded. Severity of depression was assessed with the help of HAM-D. Insomnia was diagnosed following ICSD-2 criteria. RLS was diagnosed according to IRLSSG criteria. Descriptive statistics, Chi-square test, independent sample t test and MANOVA were computed with the help of SPSS v 17.0.Results:RLS was reported by 31.48% of sample. There was no gender difference in prevalence of RLS (X2 =0.46; P=0.33). There was no difference in the age , total duration of depressive illness and number of depressive episodes between RLS and non-RLS groups (F=0.44; P=0.77; Wilk's Lambda=0.96). The HAM-D score was higher in the non-RLS group (P=0.03). Onset of RLS symptoms was not related to onset of depressive symptoms.Conclusion:RLS is prevalent in depressive disorder. However, onset of RLS is unrelated to age and number or duration of depressive disorders.

Should criteria be specified for depressive disorder not otherwise specified?

BackgroundMany patients have clinically significant symptoms of depression that do not meet the DSM-IV diagnostic thresholds for major depressive disorder (MDD) or dysthymic disorder. DSM-IV does not specify criteria for depressive disorder not otherwise specified (DDNOS). While it is not surprising that research on subthreshold depression has used diverse criteria, some consensus has emerged to define minor depression analogous to MDD, though requiring fewer than the 5 symptoms required to diagnose MDD. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined how many patients diagnosed with DDNOS met the DSM-IV proposed research criteria for minor depression, and we compared the demographic and clinical profiles of patients diagnosed with DDNOS who did and did not meet the criteria for minor depression MethodsThree thousand four hundred psychiatric patients presenting to the Rhode Island Hospital outpatient practice were evaluated with semi-structured diagnostic interviews for DSM-IV Axis I and Axis II disorders and measures of psychosocial morbidity. ResultsMore than 6% of the 3400 patients were diagnosed with DDNOS (n=227). Only a minority of the patients with DDNOS met the criteria for minor depression (39.8%). There was no difference between patients with “subthreshold” depression who did and did not meet the DSM-IV research criteria for minor depression in demographic characteristics, the prevalence of comorbid Axis I or Axis II disorders, history of major depressive disorder, and family history of depression. LimitationsThe present study was conducted in a single outpatient practice in which the majority of patients were white, female, and had health insurance. Although the study was limited to a single site, a strength of the recruitment procedure was that the sample was not selected for participation in a treatment study, and exclusion and inclusion criteria did not reduce the representativeness of the patient groups. While we examined a number of validators, we did not systematically record the treatment the patients received and the outcome of treatment. ConclusionsAmongst psychiatric outpatients with clinically significant depression not meeting criteria for MDD or dysthymic disorder, there was little difference between patients who did and did not meet the DSM-IV research criteria for minor depressive disorder.

THE VALIDITY OF THE HAMILTON DEPRESSION RATING SCALE AS A SCREENING AND DIAGNOSTIC INSTRUMENT FOR DEPRESSION IN PATIENTS WITH EPILEPSY

Aim: To evaluate the concurrent validity of the Hamilton Depression Rating Scale (HAMD-17) against ICD10 criteria for depressive disorder and its performance as a screening and diagnostic tool for depression in patients with epilepsy (PWE). Subjects and Methods: One hundred and six PWE underwent clinical psychiatric examination followed by evaluation on HAMD-17. ICD-10 criteria for comorbid depressive disorder were applied. Internal consistency was assessed using Cronbach’s α. A “receiver operating characteristics” (ROC) curve was obtained and the sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated for different cut-off points of the HAMD-17. Results: Internal consistency measured by Cronbach’s ± was 0.74. Maximal discrimination between depressed and non depressed was obtained at a cut-off score of 8/9 (sensitivity 0.93, specificity 0.98). High sensitivity and NPV at the same cut-off score (sensitivity 0.93, NPV 1.0) show the screening properties, and high specificity and PPV at cut-offs 9/10, the diagnostic properties of the instrument. The area under the ROC curve (AUC=0.746) indicates the concurrent validity of the HAMD-17 score with the ICD-10 criteria for depressive disorder. Conclusion: The validity of the HAMD-17 against ICD-10 criteria for depressive disorder in PWE in our study is fair. The concurrent administration of diagnostic criteria can ascertain the presence of core symptoms of depression.

Saliva cortisol and male depressive syndrome in a community study. The Sudurnesjamenn study

Background: The degree and direction of hypothalamic–pituitary–adrenal (HPA) dysfunction to male mental health is unclear. Aims: The aim of the study was to investigate the relationship between cortisol and male mental health. Methods: In this community study, 534 males were screened, using the Beck Depression Inventory (BDI), Gotland Male Depression Scale (GMDS) and a general health questionnaire. Those with signs of depression (n = 65) and controls (n = 69) were evaluated in a psychiatric examination according to the DSM-IV criteria for depressive disorder (DD). In a sub-sample (n = 51) saliva cortisol was measured five times on a single day. Results: Evening cortisol was significantly higher in untreated individuals with DD. Significantly higher evening cortisol (at 22 h) correlated also with a history of physical disorder, a history of any mental disorder and MADRS score ≥ 20 (Montgomery–Åsberg Depression Rating Scale). High cortisol, measured as AUC (area under curve), correlated with a high MADRS score but not with any other health variable tested. Morning cortisol did not correlate with any health variable; however, cortisol awakening response (CAR) could not be investigated. The BDI and GMDS scores did not correlate with cortisol measurements. Conclusion: Evening saliva cortisol measurement seems most informative, as it correlates with male depressive syndrome in our study but replications with larger studies are needed.

Vitamin D Nutritional Status and Antenatal Depressive Symptoms in African American Women

Vitamin D deficiency is associated with depression; however, no studies have examined the relationship of vitamin D and antenatal depression. Antenatal depression increases the risk of adverse birth outcomes and poorer postpartum maternal and infant health. African American women are at increased risk for vitamin D deficiency and antenatal depression. Thus, we examined if early pregnancy vitamin D nutrition (VDN) was associated with antenatal depressive symptoms among African American women in the second trimester of pregnancy. Women (n=178) were recruited from obstetrics clinics of a large health system. VDN was assessed by serum 25-hydroxyvitamin D (25-OHD). Depression symptoms were measured with the Center for Epidemiological Studies Depression (CES-D) scale; CES-D≥16 equates with criteria for clinical depression. Logistic regression was used to examine the association of log-transformed 25-OHD and elevated depression symptoms (CES-D≥16). Mean 25-OHD was 13.4±8.4 ng/mL; most women (82.6%, n=147) were vitamin D inadequate or deficient (25-OHD<20 ng/mL). Mean CES-D was 15.2±10.7, and 74 (41.6%) women had a CES-D≥16, suggestive of clinical depression. A significant inverse relationship was found between log (25-OHD) and CES-D≥16 (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.29-0.99, p=0.046). For every 1-unit increase in log (25-OHD) (corresponding to ~2.72 ng/mL increase in 25-OHD), the odds of CES-D≥16 decreased by 46%. African American women with lower VDN exhibit increased depressive symptoms. Research on vitamin D supplementation for reducing antenatal depressive symptoms is needed.

How family physicians address diagnosis and management of depression in palliative care patients.

Depression is highly prevalent in palliative care patients. In clinical practice, there is concern about both insufficient and excessive diagnosis and treatment of depression. In the Netherlands, family physicians have a central role in delivering palliative care. We explored variation in family physicians' opinions regarding the recognition, diagnosis, and management of depression in palliative care patients. We conducted a focus group study in a sample of family physicians with varied practice locations and varying expertise in palliative care. Transcripts were analyzed independently by 2 researchers using constant comparative analysis in ATLAS.ti. In 4 focus group discussions with 22 family physicians, the physicians described the diagnostic and therapeutic process for depression in palliative care patients as a continuous and overlapping process. Differentiating between normal and abnormal sadness was viewed as challenging. The physicians did not strictly apply criteria of depressive disorder but rather relied on their clinical judgment and strongly considered patients' context and background factors. They indicated that managing depression in palliative care patients is mainly supportive and nonspecific. Antidepressant drugs were seldom prescribed. The physicians described difficulties in diagnosing and treating depression in palliative care, and gave suggestions to improve management of depression in palliative care patients in primary care. Family physicians perceive the diagnosis and management of depression in palliative care patients as challenging. They rely on open communication and a long-standing physician-patient relationship in which the patient's context is of great importance. This approach fits with the patient-centered care that is promoted in primary care.

P-970 - The study of depression in refugee women in azerbaijan

The study is a part of a large-scale research project implemented by WHO in Azerbaijan. The study is aimed to determine the rates of depression in internally displaced women as well as to define socio-demographic variables affecting vulnerability to depression. The screening for depression was carried out among 733 women at the age of 18–65 who had become refugees due to war conflict in Nagorniy Karabakh. 20-item WHO Self-Reporting Questionnaire was used for screening purposes. 19.2% female refugees did not reveal any symptoms of depression. Yet 24,1% of women presented some depressive complaints which did not meet criteria for depressive disorders. 29,6% had mild to moderate depressive disorders and 27% suffered from severe depression. The high prevalence of depression in refugee women requires development of specific preventive and treatment programs for this population.

Depression and the medicalization of sadness: conceptualization and recommended help-seeking.

Background:Critiques of the validity of the DSM diagnostic criteria for depressive disorder argue that it fails to differentiate between abnormal sadness due to internal dysfunction or depression (sadness without an identifiable cause), and normal sadness (sadness with a clear cause).Aims and Methods:A population survey was undertaken in adult education centres in Spain aiming to explore beliefs about depression and normal sadness. Two hypothetical case vignettes portrayed individuals experiencing deep sadness, both fulfilling criteria for major depressive disorder (DSM-IV), one with a clear cause, the other without an identifiable cause. Three hundred and forty-four (344) questionnaires were obtained (95% response rate).Results:Participants statistically significantly differentiated between the sadness-with-cause vignette, seen more frequently as a normal response, while the one without a cause was seen as pathological. Help-seeking behaviour recommendations followed this distinction: a medical option was statistically significantly more common when there was no cause for sadness. Socio-cultural variation in how people understand and deal with sadness was also found.Conclusions:This study emphasizes the importance of taking into account the context in which depressive symptoms occur as it seems that the absence of an appropriate context is what makes people conceptualize them as abnormal. It also raises questions about the lack of face validity of the current diagnostic classification for depressive disorder that exclusively uses descriptive criteria.