Criteria For Depressive Episode Research Articles

The Relationship Between Childhood Trauma and Non-Suicidal Self-Injury Behavior in Adolescents with Depression: The Mediating Role of Rumination.

Non-suicidal self-injury (NSSI) behavior is very common in adolescents with depression, and childhood trauma is considered one of the distal risk factors for its exacerbation. Rumination caused by adverse traumatic experiences, which can be transferred through NSSI behavior, can alleviate symptoms of depression in adolescents. The current research focuses on the relationship between the three, further exploring whether rumination is a mediator in the relationship between childhood trauma and NSSI behavior on the basis of previous studies, and provides some suggestions for future early intervention for adolescents with depression. A total of 833 adolescent patients with depression who met the DSM-5 criteria for depressive episode were recruited from 12 hospitals in China. The Chinese version of the Function Assessment of Self-mutilation, Childhood Trauma Questionnaire, and Rumination Inventory were used as research tools. The scores of childhood trauma and rumination in adolescents with depression in the NSSI group were higher than those in the non-NSSI group. A Pearson's correlation analysis showed that childhood trauma was positively correlated with rumination (r=0.165, P<0.01), different types of childhood trauma were significantly positively correlated with rumination and its three factors, and these results were statistically significant. Rumination partially mediated the relationship between childhood trauma and NSSI behavior in depressed adolescent patients (effect size=0.002), and the effect in female participants (effect size=0.003), was greater than that in male participants (effect size=0.002). Childhood trauma and rumination were key factors for NSSI behavior in adolescents with depression. Childhood trauma not only has a direct effect on NSSI behavior in adolescent depression, but also plays an indirect effect on NSSI behavior through rumination.

Women’s Mental Health and Pregnancy Loss: What Should We Be Aware Of?

IntroductionPregnancy loss (PL) – by induced or spontaneous termination of pregnancy – is common, although its consequences on women’s mental health are often neglected in clinical practice.ObjectivesTo understand the existence of psychiatric morbidity in women, associated with PL, as well as related risk factors.MethodsNon-systematic review of literature through search on PubMed/MEDLINE for publications up to 2021, following the terms ‘pregnancy loss’, ‘psychiatry disorder’, ‘depression’ and ‘anxiety’.ResultsAfter a PL, anxiety is the most frequent symptomatology in 41% of women. Depression occurs in 22-36% of women in the first two weeks after PL, declining over time. Symptoms compatible with Post Traumatic Stress Disorder (PTSD) are found in 25% of women with PL in the first month. Women who meet criteria for PTSD are more likely to present criteria for Depressive Episode. Substance Use Disorder and Prolonged Grief Disorder are also reported, the latter having, as predictors, previous relational difficulties, poor social support and absence of descendants. Risk factors associated with significant psychopathology within PL are, for example, nulliparity, infertility, previous PL, longer gestation time, lower marital satisfaction, previous psychiatric illness, and history of abuse.ConclusionsIn clinical practice, the risk of psychopathology in women with PL should be considered. This population should be actively questioned about the presence of symptoms, as well as their persistence and impact, requiring timely and appropriate pharmacological and psychotherapeutic intervention. Perinatal Mental Health interventions show important gains in the overall health of women and their offspring.DisclosureNo significant relationships.

Validity of retrospectively-reported depressive episodes

BackgroundDepression and other psychopathology are often assessed retrospectively. Few studies have evaluated the validity of these reports by comparing prospectively-assessed symptoms to retrospective reports during the same time period. MethodsThis study utilized a subset of participants (n = 68) from the Oregon Adolescent Depression Project who completed at least one mailer assessment of depressive symptoms during a retrospectively-reported depressive episode. Participants completed up to seven mailer assessments of depression and suicidal ideation and diagnostic assessments that included retrospectively-reported depressive episodes that coincided with the mailer assessments. ResultsMultilevel linear models examined differences in depressive symptoms and suicidal ideation during and between retrospectively-reported depressive episodes. Results showed that individuals reported significantly higher levels of depression and suicidal ideation for retrospectively-reported depressive episodes compared to when they were not in depressive episodes. In addition, the average level of depressive symptoms endorsed during retrospectively-reported depressive episodes reached established clinical cut-offs. LimitationsAlthough we were able to determine whether symptoms during retrospectively-reported depressive episodes approached clinical cut-offs, we were unable to examine whether symptoms met criteria for depressive episodes. Additionally, we could not examine whether episode severity related to recall ability, and other forms of psychopathology were not assessed. ConclusionThese findings provide critical evidence for the validity of retrospectively-reported depressive episodes. Future research should examine whether these findings generalize across varying recall periods and retrospective assessments for other psychopathology.

Cardiometabolic risk in young adults with depression and evidence of inflammation: A birth cohort study

BackgroundYoung adults with depression and evidence of inflammation may represent a high-risk group for cardiometabolic disorders, but studies of cardiometabolic risk in this population are scarce. We aimed to examine: (1) the prevalence of low-grade inflammation in young-adults with depression; (2) cross-sectional and longitudinal associations between cardiometabolic risk factors and depression with or without evidence of inflammation. MethodThe ALSPAC birth cohort participants were assessed for depression and serum high-sensitivity C-Reactive Protein (CRP) levels at age 18, alongside cardiometabolic measures (fasting insulin, fasting plasma glucose, low-density lipoprotein, high-density lipoprotein, triglycerides, smoking, alcohol intake) at age 18 years, and body mass index at ages 9, 13 and 18 years. Low-grade inflammation was defined as CRP>3 mg/L. Multinomial regression was used to examine associations of cardiometabolic markers with depression cases with and without evidence of inflammation. Sensitivity analyses were conducted to examine for interactions between depression, inflammation and cardiometabolic traits. ResultsOut of 2932 participants, 215 met ICD-10 criteria for depressive episode at age 18 years; 23 (10.7 %) had CRP>3 mg/L and 57 (26.5 %) had CRP 1−3 mg/L. Depressive episode with raised CRP (>3 mg/L) was associated with higher triglycerides (adjusted OR = 2.09; 95 % C.I., 1.35−3.24), higher BMI (adjusted OR = 1.13; 95 % C.I., 1.05−1.22) and insulin insensitivity (adjusted OR = 1.12; 95 % C.I., 1.01−1.26), and longitudinally with higher BMI at ages 9 (adjusted OR = 1.27; 95 % C.I., 1.10−1.48) and 13 (adjusted OR = 1.23; 95 % C.I., 1.09−1.38). There was evidence for interaction between BMI and CRP for the risk of depression at age 18 (adjusted OR for the interaction term = 1.56; 95 % C.I. 0.98–2.02) and between CRP and depressive symptoms for the risk of increased BMI at age 18 (adjusted β for the interaction term = 0.05; 95 % C.I. 0.00−0.12). ConclusionsA notable proportion of young adults with depression have evidence of inflammation. These individuals are at increased risk of cardiometabolic disorders. Management of cardiometabolic risk in depressed individuals with evidence of inflammation should form part of routine clinical practice.

Dysproporcja pomiędzy częstością występowania zaburzeń lękowych i depresyjnych w populacji mieszkańców powiatu żywieckiego a korzystaniem z psychiatrycznej opieki zdrowotnej

Introduction: The aim of the article is to estimate the disproportion between the incidence of anxiety disorders and depression in adult population of the Żywiec Poviat and the use of mental health care. Material and methods: An anonymous survey was conducted in a randomly selected group of adults living in the Żywiec Poviat. 1659 completed questionnaires were obtained. The Hospital Anxiety and Depression Scale (HADS) was used as a screening tool. The data were compared with the number of outpatient and hospitalized people in psychiatric health care facilities in the poviat. Results: The study released a significant disproportion between the occurrence of anxiety disordes and treatment for this reason. In outpatient settings 1.23% of people suffering from anxiety used medical care, 0.06% were hospitalized. A similar situation applies to the disproportion between the occurrence of depression and treatment for this reason. Among people whose symptoms implement the criteria of depressive episode, 1.11% used outpatient treatment and 0.14% were hospitalized. Conclusion: Prevelence of anxiety disorders and depression and related to this health needs in examinated population significantly exceeds the real use of psychiatric healthcare. Constant underestimation of health needs in the field of psychiatry can be a result and one of the causes of this phenomenon. For better planning of activities in the field of health policy, it is necessary to perform epidemiological studies that reveal scale of the problem.

Network analysis of the depressive symptom profiles in Asian patients with depressive disorders: Findings from the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD).

AimWe aimed to estimate the network structures of depressive symptoms using network analysis and evaluated the geographic regional differences in theses network structures among Asian patients with depressive disorders.MethodsUsing data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP‐AD), the network of the ICD‐10 diagnostic criteria for depressive episode was estimated from 1174 Asian patients with depressive disorders. The node strength centrality of all ICD‐10 diagnostic criteria for a depressive episode was estimated using a community‐detection algorithm. In addition, networks of depressive symptoms were estimated separately among East Asian patients and South or Southeast Asian patients. Moreover, networks were estimated separately among Asian patients from high‐income countries and those from middle‐income countries.ResultsPersistent sadness, fatigue, and loss of interest were the most centrally situated within the network of depressive symptoms in Asian patients with depressive disorders overall. A community‐detection algorithm estimated that when excluding psychomotor disturbance as an outlier, the other nine symptoms formed the largest clinically meaningful cluster. Geographic and economic variations in networks of depressive symptoms were evaluated.ConclusionOur findings demonstrated that the typical symptoms of the ICD‐10 diagnostic criteria for depressive episode are the most centrally situated within the network of depressive symptoms. Furthermore, our findings suggested that cultural influences related to geographic and economic distributions of participants could influence the estimated depressive symptom network in Asian patients with depressive disorders.

Relapse prevention in adults with major depressive disorder treated with vilazodone: a randomized, double-blind, placebo-controlled trial.

This randomized withdrawal study assessed relapse prevention with vilazodone in adults with major depressive disorder. After 20 weeks of open-label treatment with vilazodone 40 mg/day, responders were randomized (1 : 1 : 1) to 28 weeks of double-blind, fixed-dose treatment with vilazodone 20 mg/day, vilazodone 40 mg/day, or placebo. The primary efficacy endpoint was time to first relapse, defined as Montgomery-Åsberg Depression Rating Scale total score of at least 18 and meeting major depressive episode criteria, Montgomery-Åsberg Depression Rating Scale total score of at least 18 at two consecutive visits, or discontinuation for an insufficient therapeutic response. Of 1204 patients who received open-label treatment, 564 completed treatment and were randomized (placebo=192, vilazodone 20 mg/day=185, vilazodone 40 mg/day=187). No significant difference was detected in time to relapse during the double-blind period (P>0.05). The crude percentage of patients that relapsed was similar between treatment groups (placebo=12.6%; vilazodone 20 mg/day=11.4%; vilazodone 40 mg/day=13.4%). The most common treatment-emergent adverse events were diarrhea (29.6%), nausea (24.0%), and headache (14.0%) during open-label treatment and headache (8.9%), nasopharyngitis (8.4%), and diarrhea (7.5%) during double-blind treatment in the combined vilazodone groups (20 and 40 mg/day). In conclusion, time to relapse with vilazodone was not statistically different from placebo. Vilazodone was generally well tolerated in adults with major depressive disorder.

Determinants of access to health care for depression in 49 countries: A multilevel analysis

BackgroundThe relative importance of individual and country-level factors influencing access to diagnosis and treatment for depression across the world is fairly unknown. MethodsWe analysed cross-national data from the WHO World Health Surveys. Depression diagnosis and access to health care were ascertained using a structured interview. Logistic Bayesian Multilevel analyses were performed to establish individual and country level factors associated with: (1) receiving a diagnosis and (2) accessing treatment for depression if a diagnosis was ascertained. ResultsThe sample included 7870 individuals from 49 countries who met ICD-10 criteria for depressive episode in the past 12 months. A third (32%) of these individuals had ever been diagnosed with depression in their lifetime. Among those diagnosed with depression, 66% reported to have ever received treatment for depression. Although individual factors were more important determinants of access to treatment for depression, country-level factors explained 27.6% of the variance in access to diagnosis and 24.1% in access to treatment. Access to treatment for depression improved with increasing country income. Female gender, better education, the presence of physical co-morbidity, more material assets, and living in urban areas were individual level determinants of better access. LimitationsData on other contextual factors was not available. Unmet need was likely underestimated, since only lifetime treatment data was available. ConclusionThis study highlights major inequalities in access to a diagnosis and treatment of depression. Unlike the prevalence of depression, where contextual factors have shown to have less importance, a significant proportion of the variance in access to depression care was explained by country-level income.

Clinical Practice Guidelines for the Management of Generalised Anxiety Disorder (GAD) and Panic Disorder (PD).

Short description of anxiety disorders Generalized Anxiety Disorder (GAD) Definition: One of the anxiety disorders, where the primary symptoms of anxiety are present at most days for at least several weeks at a time, and usually for several months. The symptoms should usually involve elements of: (a) Apprehension (worries about future misfortunes, feeling “ on edge”, etc) (b) Motor tension (restlessness, inability to relax, trembling) (c) Autonomic over activity (light-headedness, sweating, tachycardia, tachypnea, dry mouth etc) The transient appearance of depressive symptoms, does not rule out the diagnosis of GAD as main diagnosis. The sufferer must not meet the full criteria for depressive episode, phobic disorder, panic disorder or OCD. Patients with generalised anxiety disorder have high anxiety and are worried about intrapsychic conflicts or external environmental events. They have multiple somatic symptoms of anxiety, restlessness, difficulty in concentration, irritability, fatigue, muscular tensions and difficulty in sleeping particularly early insomnia. They have vague apprehension about future events and fear of unknown. Common features observed in anxiety disorders include: Panic Disorder- Episodes of intense fear or discomfort accompanied by severe autonomic activity, palpitations, sweating, dyspnoea, chocking sensation or other somatic symptoms like chest pain, trembling, nausea, discomfort or fluttering sensation in abdomen and impending fear of death. Patient perceives it as a serious medical condition and invariably reaches to a medical emergency setup where after thorough physical evaluation he is declared normal. Phobias- Many patients with GAD suffer from irrational, unrealistic fears and acute autonomic reactions to certain specific situations or extreme fear to certan inanimate objects. They include agarophobia (fear of open spaces) fear of crowds, being out side home alone or traveling in a bus train or car. Some may have fear in closed spaces (claustrophobia) fear of heights (acrophobia) fear of opposite sex (hetero-phobia) fear of sight of blood (erythrophobia) or fear of facing certain social situations (social anxiety disorder) the common feature among all phobias being intense fear, increased autonomic activity and avoidance behavior (avoiding the fearful object or situation). Obsessive compulsive disorder- (OCD) has been seperately dealt with in details in these guidelines however the patients suffering from OCD have recurrent repetitive unwanted intrinsic thoughts (obsessions) or actions (compulsions) or both which lead to extreme distress, loss of time and impairment of functioning of the individual. The obsessious include douts, ideas of contamination, sexual thoughts or religious preoccupations or negative thoughts towards gods/goddess, the compulsions include activities like counting, checking, repeating, washing hoarding and touching objects, some have to and fro movements of body parts. Patient is aware of the irrationality of thoughts/actions but cannot control them, which produces intense anxiety and autonomic arousal with feelings of helplessness and guilt. Post-traumatic stress disorder (PTSD) - Usually it occurs after a terrifying event that involving physical or psychological traumatic event. It may also occure because of witnessing or experiencing a serious harm to other significant persons in life. Patients have terrifying recollections of the event, or nightmares. Some patients have an experience of living the event in an illusionary or imaginary situation with hallucinations, or flashback episodes. The patients suffer from intense psychological or physical distress. Many patients develop loss of interest, estrangement from others, sleep disturbances, irritability, difficulty concentrating, hypervigilance, and exaggerated startle response. This phenomenon may persist for one month or more before it is diagnosed.

Gender Differences in Depressive Symptoms in Thai Individuals with Depressed Mood and/or Anhedonia: A Differential Item Functioning Approach

This study used the item response theory-based log-likelihood-ratio technique for differential item functioning (IRT-LR DIF) to determine gender differences in seven add-on major depressive episode criteria in Thai people living in community. Of a population of 17,480 Thai people living in community, 322 men (3.79%) and 487 women (5.63%) currently were of depressed mood and/or anhedonia. Of seven symptoms, only cognitive deficit had a statistically significant DIF (G 2 of 7.3, df = 2, p = 0.007; Benjamini-Hochberg adjusted p = 0.049). The uniform DIF suggested that men had a significantly but marginally lower threshold value for endorsing cognitive deficit than women (threshold difference = −0.25). While the discrimination parameters of this cognitive symptom were greater than 2.0 (men = 2.10 and women = 2.29), their difference was as low as −0.19. Most depressed symp-toms have similar criterion functioning in both genders. However, Thai men may be more likely to have a cognitive deficit than their female counterparts.

Aspects of quality of life in depression

IntroductionThe quality of life in patients with depression may be a measure of the efficiency of its management. Although quality of life is a subjective concept, difficult to assess, it may be reflected by the degree of social adaptation and the individual's level of functioning.ObjectiveThe study evaluates the time evolution of depressive symptoms and of some parameters attesting the quality of life in patients diagnosed with depression who are on antidepressant treatment.AimsHighlighting the evolution in time of depressive symptoms and patients’ perceptions on some aspects of quality of life.MethodsThere were included 23 patients who met the criteria of depressive episode, single or within recurrent depressive disorder, according to the International Classification of Diseases (ICD-10-AM), requiring antidepressant treatment. Subjects were evaluated at baseline and after 12 weeks of treatment using the Hamilton Rating Scale for Depression (HAMD), Sheehan disability scale (SDS), Social Adjustment Scale – Self-report (SASS).ResultsStatistically significant decrease in mean HAMD scores was observed in the second administration. There were registered statistically significant differences of scores obtained in the two administrations for the 17 items of the SASS scale. Correlations with statistical significance between HAMD scores and some of the SDS areas were observed.ConclusionsResults showed a favorable course of depressive symptoms while under treatment and differences in time of subjects’ perception on several aspects evaluated on SASS for the group studied. Correlations with statistical significance between HAMD scores and some SDS areas were observed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Neuropsychological functioning across different states of bipolar disorder: mania or hypomania and depression

Aim of the studyThe aim of the study was to compare neuropsychological functioning across different states of bipolar disorder: mania/hypomania and depression.Subject or material and methodsCognitive functions were examined in 30 depressed bipolar patients aged 18-68 who fulfilled DSM-IV criteria for depressive episode (Hamilton Depression Rating Scale score ≥ 11) and 30 manic or hypomanic bipolar patients aged 23-68 who fulfilled DSM-IV criteria for manic or hypomanic episode (Young Mania Rating Scale ≥ 11). The comparison group consisted of 30 healthy subjects aged 23-71 without history of psychiatric or neurological disorders. A neuropsychological battery assessed executive functions and fluency (Wisconsin Card Sorting Test – WCST and Controlled Oral Word Association Test FAS, Stroop Color-Word Interference Test), working memory and attention (Trail Making Test Part B - TMT, N-back Test), psychomotor speed (TMT A) and reaction time (N-back Test).ResultsThe bipolar groups showed cognitive dysfunctions in working memory, fluency, attention, psychomotor speed and reaction time in relation to the comparison group. The manic/hypomanic group was also impaired on WCST, a measure of executive functions, which was not observed in depressive patients. Manic/hypomanic patients were significantly more impaired on executive functions than the depressed group.DiscussionThe obtained results are partly consistent with the previous results.ConclusionsA poorer neuropsychological performance was observed in different states of bipolar disorder but during manic/hypomanic state cognitive deficits were more serious regarding executive functions.

Effet des saisons sur la sémiologie des troubles bipolaires

IntroductionBipolar disorder (BD) is a common and severe psychiatric disorder. BD's severity and prognosis are related to a high manic or depressive episode recurrence rate, which is about 60–80% 2years after an episode, despite a well-conducted treatment. These mood relapses may have a seasonal pattern (SP). This communication summarizes the state of knowledge about the effect of seasons on BP semiology. Materials and methodsThis synthesis will be divided in three clinical perspectives: i) examination in health service registries of seasonal rates of hospital admission for mood episode for patients with BD; ii) a dimensional approach examining seasonal symptom variance; and iii) a categorical approach comparing subjects with and without SP. ResultsFindings from the three clinical perspectives demonstrate that mood episodes but also BD symptomatology suffer from seasonal fluctuations. Worldwide and replicated observations show two peaks of admission for manic episode: A major in spring/summer and, to a lesser extent, one in autumn. Admissions for depressive episodes peak in early winter and, to a lesser extent, in summer. It appears that climatic conditions can influence or trigger the BD symptomatology. Dimensional studies observed that mood, cognitive, suicidal, irritability and aggression characteristics present seasonal fluctuations. From a categorical perspective, studies reported that 25% of patients with BD met DSM-IV criteria for depressive episodes with SP, and 15% for manic episodes with SP. Clinical characteristics statistically associated with depressive episodes with SP were subtype II and number of depressive episodes, and were different according to gender. Finally, this SP was underpinned by a genetic influence, more especially the circadian gene NPAS2, which may play an important role. ConclusionsThere is consistent evidence that seasons have effects on BD semiology. A better understanding of the underlying mechanisms would facilitate the development of personalized chronobiological therapeutic and preventive strategies and integration of SP in decision algorithms.

Mental health correlates of victimization classes among homeless youth

Literature reports high rates of street victimization among homeless youth and recognizes psychiatric symptoms associated with such victimization. Few studies have investigated the existence of victimization classes that differ in type and frequency of victimization and how youth in such classes differ in psychiatric profiles. We used latent class analysis (LCA) to examine whether classes of homeless youth, based on both type and frequency of victimization experiences, differ in rates of meeting diagnostic criteria for major depressive episodes and posttraumatic stress disorder (PTSD) in a sample of homeless youth (N=601) from three regions of the United States. Results suggest youth who experience high levels of direct and indirect victimization (high-victimization class) share similarly high rates of depressive episodes and PTSD as youth who experience primarily indirect victimization only (witness class). Rates of meeting criteria for depressive episodes and PTSD were nearly two and three times greater, respectively, among the high victimization and witness classes compared to youth who never or rarely experienced victimization. Findings suggest the need for screening and intervention for homeless youth who report direct and indirect victimization and youth who report indirect victimization only, while prevention efforts may be more relevant for youth who report limited victimization experience.

Cognitive functioning in depression period of bipolar disorder

Aim of the studyStudy aims were to compare neuropsychological functioning of depressed bipolar patients and healthy controls and to estimate relationship between cognitive functions and depressive symptoms.Subject or material and methodsCognitive functions were examined in 30 depressed bipolar patients aged 18-68 (M=45,6; 18 women and 12 men) who fulfilled ICD-10 criteria for depressive episode (Hamilton Depression Rating Scale score ≥ 11). The comparison group consisted of 30 healthy subjects aged 23-71 (M=46,2; 20 women and 10 men) matched in aged, years of education and gender to bipolar group. A neuropsychological battery assessed executive functions and working memory.ResultsThe bipolar patients in depression reviled neuropsychological deficits in working memory and some aspects of executive functions in comparison to healthy group. Only in WCST test both groups received similar results. Neuropsychological functioning seems to be independent of the severity of depressive symptoms.DiscussionDifferent aspects of working memory and executive functions are impaired in depression period of bipolar disorder and they seem independent of the severity of depressive symptoms. These results are consistent with previous reports.ConclusionsIn patients with bipolar depression cognitive assessment should be taken into account in the diagnosis and the disturbances in executive functions and working memory should be treated with neuropsychological rehabilitation and / or pharmacotherapy.

The Removal of the Bereavement Exclusion in the DSM-5: Exploring the Evidence

Since 1980, the DSM-III and its various iterations through the DSM-IV-TR have systematically excluded individuals from the diagnosis of major depressive disorder if symptoms began within months after the death of a loved one (2 months in DSM-IV), unless the depressive syndrome was 'severely' impairing and/or accompanied by specific features. This criterion became known as the 'bereavement exclusion'. No other adverse life events were noted to negate the diagnosis of major depressive disorder if all other symptomatic, duration, severity and distress/impairment criteria were met. However, studies since the inception of the bereavement exclusion have shown that depressive syndromes occurring after bereavement share many of the same features as other, non-bereavement related depressions, tend to be chronic and/or recurrent if left untreated, interfere with the resolution of grief, and respond to treatment. Furthermore, the bereavement exclusion has had the unintended consequence of suggesting that grief should end in only 2 months, or that grief and major depressive disorder cannot co-occur. To prevent the denial of diagnosis and the consideration of sometimes much needed care, even after bereavement or other significant losses, the DSM-5 no longer contains the bereavement exclusion. Instead, the DSM-5 now permits the diagnosis of major depressive disorder after and during bereavement and includes a note and a comprehensive footnote in the major depressive episode criteria set to guide clinicians in making the diagnosis in this context. The decision to make this change was widely and publically debated and remains controversial. This article reports on the rationale for this decision and the way the DSM-5 now addresses the challenges of diagnosing major depressive disorder in the context of someone grieving the loss of a loved one.

Detecting Depression in Patients with Coronary Heart Disease: a Diagnostic Evaluation of the PHQ-9 and HADS-D in Primary Care, Findings From the UPBEAT-UK Study

ObjectivePeople with coronary heart disease (CHD) are at heightened risk of depression, and this co-occurrence of conditions is associated with poorer outcomes including raised mortality. This study compares the diagnostic accuracy of two depression case finding instruments in CHD patients relative to a diagnostic standard, the revised Clinical Interview Schedule (CIS-R).MethodsThe Patient Health Questionnaire (PHQ-9), the Hospital Anxiety and Depression Scale depression subscale (HADS-D) and the CIS-R depression module were administered to 803 patients identified from the CHD registers of GP practices in Greater London.ResultsOf 730 recruited patients without previously identified depression, 32 (4.4%) met ICD-10 depressive episode criteria according to the CIS-R. For the PHQ-9 and HADS-D lower cut-points than those routinely recommended were associated with improved case identifying properties. The PHQ-9 appeared the superior instrument using a cut-point of ≥8 (sensitivity=94%; specificity=84%). Using categorical scoring the PHQ-9 was 59% sensitive and 95% specific. For the HADS-D using cut-point ≥5, sensitivity was 81% and specificity was 77%.Areas under the curves (AUC) (standard error) were 0.95 (0.01) and 0.88 (0.02) for the PHQ-9 and HADS-D, and 0.91 (0.02) for PHQ-9 using the categorical algorithm. Statistically significant differences between AUCs of the PHQ-9 and the HADS-D favoured the former. Severity ratings compared across measures indicated inconsistency between recommended bandings: the PHQ-9 categorised a larger proportion of participants with mild and moderate depression.ConclusionThis is the first large-scale investigation of the accuracy of these commonly used measures within a primary care CHD population. Our results suggest that although both scales have acceptable abilities and can be used as case identification instruments for depression in patients with CHD, the PHQ-9 appeared diagnostically superior. Importantly, optimal cut-off points for depression identification in this population appear to differ from standard values, and severity ratings differ between these measures.

Prevention of Relapse With Maintenance Electroconvulsive Therapy in Elderly Patients With Major Depressive Episode

To evaluate the effectiveness and safety of maintenance electroconvulsive therapy (mECT) in elderly patients with treatment-resistant Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition major depressive episode. Seven elderly patients with treatment-resistant major depressive episode were treated with a complete ECT cycle. Thereafter, they received one monthly ECT session as maintenance for 1 year. Response to treatment was defined as at least a 50% drop from baseline on the Hamilton Depression Rating Scale (HamD) and remission as not meeting criteria for major depression, a HamD score of 7 or less, and Clinical Global Impressions-Severity of Illness score of 1. We compared their response with the response of 7 elderly patients with treatment-resistant major depression who were treated with a full cycle of ECT but did not receive mECT (non-mECT). We compared the 2 groups for the number of relapses or recurrences of major depressive episodes after remission was achieved; a relapse or a recurrence occurred when HamD scores were 14 or higher, or when Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision major depressive episode criteria were met, or when Clinical Global Impressions-Severity of Illness score was 3 or higher and increased by at least 2 points from response/remission. The mECT group (4 women and 3 men; mean age, 73 years) had significantly less mean relapses/recurrences (0 vs 1.57) and hospitalizations (0 vs 1) and received less drug treatment than the nonMECT group (similar for age and sex composition) during the 12-month follow-up period. All patients with mECT improved during treatment and did not relapse. Maintenance ECT protected elderly patients from recurrent depressive episodes from relapsing/recurring more than standard ECT.

Screening for depression in epilepsy clinics. A comparison of conventional and visual‐analog methods

Depression is an important but underdiagnosed complication of epilepsy. This study compares potentially suitable screening tools head-to-head. We enrolled 266 attendees with a confirmed diagnosis of epilepsy at a specialized neurologic epilepsy service in London and compared verbal self-report and visual analog (VAS) screening methods for depression. These included two generic depression scales (Hospital Anxiety and Depression Scale [HADS], Beck Depression Inventory II [BDI-II]), one epilepsy specific scale (Neurological Disorders Depression Inventory for Epilepsy [NDDI-E]) and one new visual-analog scale (Emotional Thermometers [ET]). We used Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for major depression and International Classification of Diseases, Tenth Revision (ICD-10) criteria for depressive episode as the reference standard. Against ICD-10-defined depression the most accurate scales by receiver operating characteristic (ROC) curve area were HADS Total (HADS-T, 0.924), BDI-II (0.898) and NDDI-E (0.897). New visual-analog methods had similar accuracy measured either in combination or individually. Although no test performed well in a case-finding role, several performed well as a rule-out initial step, owing to high negative predictive value and specificity. In this role, the optimal performing conventional tools were the HADS depression subsscale (HADS-D) and the NDDI-E and the optimal single VAS were the depression thermometer (DepT) and the distress thermometer (DT). Against DSM-IV- defined major depression, results were similar with optimal performance by the HADS-T, BDI-II, and NDDI-E, but here the anxiety thermometer (AnxT) as well as DepT and DT also offered good performance. Given that no test performed well in a case-finding role, we suggest that these tests are used as an initial first step to rule out patients who are unlikely to have depression. We suggest that the six-item NDDI-E or seven-item HADS-D should be considered if a conventional scale is preferred and that the revised ET4 be considered if a visual-analog method is required. Follow-up examination and intervention, where indicated, are necessary in all those who screen positive on any measure as these are not intended as diagnostic tools.

Primary care physicians’ and psychiatrists’ approaches to treating mild depression

To measure how primary care physicians (PCPs) and psychiatrists treat mild depression. We surveyed a national sample of US PCPs and psychiatrists using a vignette of a 52-year-old man with depressive symptoms not meeting Major Depressive Episode criteria. Physicians were asked how likely they were to recommend an antidepressant counseling, combined medication, and counseling or to make a psychiatric referral. Response rate was 896/1427 PCPs and 312/487 for psychiatrists. Compared with PCPs, psychiatrists were more likely to recommend an antidepressant (70% vs. 56%), counseling (86% vs. 54%), or the combination of medication and counseling (61% vs. 30%). More psychiatrists (44%) than PCPs (15%) were 'very likely' to promote psychiatric referral. PCPs who frequently attended religious services were less likely (than infrequent attenders) to refer the patient to a psychiatrist (12% vs. 18%); and more likely to recommend increased involvement in meaningful relationships/activities (50% vs. 41%) and religious community (33% vs. 17%). Psychiatrists treat mild depression more aggressively than PCPs. Both are inclined to use antidepressants for patients with mild depression.