Diagnostic Criteria For Major Depression Research Articles

Mental health literacy and the experience of depression in a community sample of gay men

BackgroundGay men are at higher risk of suffering from a variety of psychiatric disorders, yet the mental health literacy of this population has remained largely unknown. MethodsIn 2007 and 2011, surveys were conducted among gay men in Geneva, Switzerland, recruited by probability-based time-space sampling. Based on a case vignette of a man with major depression, respondents were asked a series of questions about labelling, perceived risk, and help-seeking beliefs. Men meeting caseness for major depression were asked open questions about perceived causes and additional help-seeking/self-help. ResultsAmong the 762 respondents, 14.7% met diagnostic criteria for major depression (MDD) in the past 12 months. The vignette was labelled depression by 44.1% of the entire sample, and 61.9% of the men with MDD. Discrimination (33.2%), acceptance or rejection by others (21.4%), and loneliness (24.9%) were the most common reasons given for greater susceptibility among gay men, yet men with MDD reported problems with love/relationship (32.5%) and work (28.9%) as the most common perceived causes of recent depression, and problems with love/relationship (21.9%), accepting one's homosexuality (21.1%), and family (20.2%) at initial outset. The highest proportions of gay men rated non-medical options such as a close friend (91.6%), relaxation exercises or meditation (84.4%), and physical activity (83.5%) as being helpful for the depression vignette. LimitationsNo probes used for open questions, and findings generalizable only to gay men in the sampling scheme. ConclusionsThere are many commonalities in labelling, perceived causes, and help-seeking with general populations, but also numerous specificities in mental health literacy and experience among gay men.

Cognitive factors maintaining persecutory delusions in psychosis: The contribution of depression.

Depression is common in people with schizophrenia, but how it might directly contribute to the persistence of psychotic symptoms has rarely been tested. The key aim of the present study was to test whether depression and associated cognitive processes predict the maintenance of persecutory delusions. Three groups of participants were tested at baseline: 60 patients with persecutory delusions in the context of a schizophrenia spectrum diagnosis, 30 patients with depression, and 30 nonclinical controls. They completed interviewer and self-report assessments of depression and paranoia, and measures of six cognitive factors (schematic beliefs, experiential avoidance, autobiographical memory, problem solving, rumination, worry style). The patients with persecutory delusions were then assessed again, six months later. It was found that 50% of the patients with persecutory delusions met diagnostic criteria for major depression. Cognitive processes found to be associated with depression across the groups were negative schematic beliefs about the self, experiential avoidance and rumination, but not autobiographical memory or problem solving. The severity of initial depression in patients with persecutory delusions predicted the persistence of paranoia over six months. A number of cognitive factors also predicted the persistence of persecutory delusions, including negative schematic beliefs about the self, worry, and problem-solving difficulties. In conclusion, depression is common in patients with current persecutory delusions, and it shows similar cognitive features to major depressive disorder. The results of this study indicate that depression and related processes may contribute to the maintenance of paranoia. Trials are warranted of depression-related therapeutic techniques for people with persecutory delusions.

What Is a Psychiatrist’s Role in Treating Patients on Disability?

An expert on depression and workplace disability urges psychiatrists to view employers as partners in restoring workers with depression to mental good health.

Suffering Compounded: The Relationship between Abuse History and Distress in Five Palliative Care Domains

Research with breast cancer patients suggests that abuse survivors experience more psychological distress and disorders, particularly depression and anxiety, than patients without abuse histories. However, we do not yet understand the impact of abuse on other palliative care domains for individuals with other cancer types. This study explores the relationship between past abuse and distress in a group of cancer patients referred for palliative care. This study also explores differences in distress level and likelihood of meeting diagnostic criteria for major depression and generalized anxiety disorder between patients with and without abuse histories. Data were from 164 new, palliative care outpatients who completed an initial clinician-administered assessment and the James Supportive Care Screening patient self-report. Multivariate analyses of variance were conducted to explore differences between patients who reported an abuse history and those who did not on the number of items endorsed and associated distress on five palliative care domains. Chi-square tests were conducted to identify differences in diagnosis of depression and anxiety between patients with and without abuse histories. Twenty-eight percent reported abuse histories. Patients with abuse histories endorsed more physical problems, psychological concerns, and spiritual concerns and greater distress related to psychological and spiritual concerns than patients without abuse histories. Patients with abuse histories more frequently received diagnoses of major depression disorder and generalized anxiety disorder. These differences underscore the impact of abuse on the adjustment of cancer patients referred for palliative care. Assessment of patient abuse history by palliative care teams and referral for psychological treatment may help reduce patient distress.

Prevalence of mental health disorders among low-income African American adolescents

Data on the prevalence of mental health disorders for low-income, urban African American adolescents are scarce. This study presents data about the burden of mental disorders for this understudied population. Mental disorders were assessed using the Diagnostic Interview Schedule for Children (C-DISC), Youth Self-Report (YSR), and Child Behavior Checklist (CBCL) among a sample of adolescents and their caregivers from very impoverished neighborhoods in a Southern city. Based on the C-DISC, 3.8, 5.1 and 7.7% of adolescents met diagnostic criteria for major depression, post-traumatic stress disorder, and conduct disorder, respectively. There were significant differences among some of the mental health disorders based on adolescent and caregiver characteristics such as sex, school status, caregiver work status, and income level. We found a low prevalence of alcohol, marijuana, and substance abuse and dependence disorders. Information about the prevalence of mental health disorders in specific communities and populations can assist in addressing unmet needs, planning for services and treatment, and reducing health disparities.

The effects on depression of Internet-administered behavioural activation and physical exercise with treatment rationale and relapse prevention: study protocol for a randomised controlled trial

BackgroundDespite their potential as low-threshold, low-cost and high-flexibility treatments of depression, behavioural activation and physical exercise have not yet been directly compared. This study will examine the effects of these interventions, administered via the Internet. The added effect of providing a treatment rationale will also be studied, as well as a relapse prevention program featuring cognitive behavioural therapy components.Methods/DesignThis randomised controlled trial will include 500 participants meeting the diagnostic criteria for major depression, recruited in multiple cycles and randomised to either a waiting list control group with delayed treatment, or one of the four treatment groups: (1) physical exercise without a clear treatment rationale; (2) physical exercise with treatment rationale; (3) behavioural activation with treatment rationale; or (4) behavioural activation without a clear treatment rationale. Post treatment, half of the participants will be offered a relapse prevention program. Primary outcome measure will be the Patient Health Questionnaire 9-item. Secondary measures include diagnostic criteria for depression, as well as self-reported anxiety, physical activity and quality of life. Measurements - done via telephone and the Internet - will be collected pre-treatment, weekly during treatment period, immediately post treatment and then monthly during a 24-month follow-up period.DiscussionThe results of this study will constitute an important contribution to the body of knowledge of the respective interventions. Limitations are discussed.Trial registrationClinicalTrials.gov: NCT01619930

Assessing the psychological health of captive and wild apes: A response to Ferdowsian et al. (2011).

As many studies of cognition and behavior involve captive animals, assessing any psychological impact of captive conditions is an important goal for comparative researchers. Ferdowsian and colleagues (2011) sought to address whether captive chimpanzees show elevated signs of psychopathology relative to wild apes. They modified a checklist of diagnostic criteria for major depression and posttraumatic stress disorder in humans, and applied these criteria to various captive and wild chimpanzee populations. We argue that measures derived from human diagnostic criteria are not a powerful tool for assessing the psychological health of nonverbal animals. In addition, we highlight certain methodological drawbacks of the specific approach used by Ferdowsian and colleagues (2011). We propose that research should (1) focus on objective behavioral criteria that account for species-typical behaviors and can be reliably identified across populations; (2) account for population differences in rearing history when comparing how current environment impacts psychological health in animals; and (3) focus on how changes in current human practices can improve the well-being of both captive and wild animals.

A target-driven collaborative care model for Major Depressive Disorder is effective in primary care in the Netherlands. A randomized clinical trial from the depression initiative

BackgroundPractice variation in the primary care treatment of depression may be considerable in the Netherlands, due to relatively small and unregulated practices. We adapted the collaborative care model for the treatment of Major Depressive Disorder (MDD) to accommodate existing practice variation and tested whether this had added value over Care as Usual (CAU). MethodsA cluster randomized controlled trial was conducted to compare an adapted target driven collaborative care model with Care as Usual (CAU). Randomization was at the level of 18 (sub)urban primary care centers. The care manager and GP were supported by a web-based tracking and decision aid system that advised targeted treatment actions to achieve rapid response and if possible remission, and that warned the consultant psychiatrist if such treatment advice was not followed up. Eligible patients had a score of 10 or higher on the PHQ9, and met diagnostic criteria for major depression at the subsequent MINI Neuropsychiatric interview. A total of 93 patients were identified by screening. They received either collaborative care (CC) or CAU. Another 56 patients received collaborative care after identification by the GP. The outcome measures were response to treatment (50% or greater reduction of the PHQ9-total score from baseline) at three, six, nine and twelve months, and remission (a score of 0–4 on the PHQ9 at follow-up). ResultsTreatment response and remission in CAU were low. Collaborative care was more effective on achieving treatment response than CAU at three months for the total group of patients who received collaborative care [OR 5.2 ((1.41–16.09), NNT 2] and at nine months [OR 5.6 ((1.40–22.58)), NNT 3]. The effect was not statistically significant at 6 and 12 months. LimitationsA relatively high percentage of patients (36.5%) did not return one or more follow-up questionnaires. There was no evidence for selective non response. ConclusionsOur adapted target driven CC was considerably more effective than CAU for MDD in primary care in the Netherlands. The Numbers Needed To Treat (NNT) to achieve response in one additional patient were low (2–3), which suggest that introducing CC at a larger scale may be beneficial. The relatively large effects may be due to our focus on reducing practice variation through the introduction of easy to use web based tracking and decision aids. The findings are highly relevant for the application of the model in areas where practices tend to be small and for mixed healthcare systems such as in many countries in Europe. Trial registrationDutch trial register ISRCTN15266438 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=820).

Depression Following Traumatic Brain Injury

It is important for clinicians to recognize major depression following traumatic brain injury (TBI) because of its association with poor global and psychosocial outcome, postconcussive symptoms and cognitive deficits. The purpose of this review is to provide an up-to-date selective review of the current understanding of epidemiology, risk factors and management of major depression following TBI. Many studies of prevalence of depression following TBI have not used accepted structured criteria for the diagnoses, but those that did found wide ranges of rates, from 17% to 61%. The risk factors for development of depression following TBI are poorly understood, but past psychiatric history, frontal lesions and atrophy, and family dysfunction have been shown in more than one study to play important roles. There are few controlled trials of the treatment of major depression in patients with TBI using accepted diagnostic criteria for major depression, as well as defined criteria for response and remission. As such, it is important for clinicians to use best practice guidelines for the treatment of major depression in the absence of TBI.

P-935 - Augmentation of antidepressants with bright light therapyin patients with comorbid depression and borderline personality disorder

Borderline personality disorder (BPD) is typically characterized by instability and impairmed behaviour, affectivity, interpersonal relations and lifestyle. The most common condition comorbid with BPD is a depressive episode. Depression is associated with severe disturbance of the circadian rhythms. This is apparent in depressive patients with BPD. Bright light may be an effective in treatment of seasonal affective disorder. Several studies have suggested antidepressant effects of phototherapy in non-seasonal depressive episodes. The treatment of comorbid depressive disorder and borderline personality disorder (BPD) is usually reported to be less successful than the treatment of patients without personality disorder. Studies describing the use of bright light in depressed patients with comorbid BPD have not been published so far. The aim of this open study was to assess the effectiveness of a 6-week combined therapy with the application of bright light (10,000 lux, 6:30 to 7:30 a.m. for 6 weeks) added to SSRIs in drug-resistant depressed patients with comorbid BPD who did not respond with improvement to 6-week administration of antidepressants. The study comprised 13 female patients who met the ICD-10 diagnostic criteria for research and the DSM-IV-TR diagnostic criteria for major depression. The participants were regularly evaluated using the CGI, HAMD and MADRS scales and the BDI and BDI self-report inventories. According to all the assessment instruments, the application of bright white light leads to a significant improvement. However, the results must be interpreted with caution due to the open nature of the study. By IGA MZ CR NT 11047-4/2010

Feasibility and impact of telemonitor-based depression care management for geriatric homecare patients.

The objective of this study was to test the feasibility, acceptability, and preliminary clinical outcomes of a method to leverage existing home healthcare telemonitoring technology to deliver depression care management (DCM) to both Spanish- and English-speaking elderly homebound recipients of homecare services. Three stand-alone, nonprofit community homecare agencies located in New York, Vermont, and Miami participated in this study. Evidence-based DCM was adapted to the telemonitor platform by programming questions and educational information on depression symptoms, antidepressant adherence, and side effects. Recruited patients participated for a minimum of 3 weeks. Telehealth nurses were trained on DCM and received biweekly supervision. On-site trained research assistants conducted in-home research interviews on depression diagnosis and severity and patient satisfaction with the protocol. An ethnically diverse sample of 48 English- and Spanish-only-speaking patients participated, along with seven telehealth nurses. Both patients and telehealth nurses reported high levels of protocol acceptance. Among 19 patients meeting diagnostic criteria for major depression, the mean depression severity was in the "markedly severe" range at baseline and in the "mild" range at follow-up. Results of this pilot support the feasibility of using homecare's existing telemonitoring technology to deliver DCM to their elderly homebound patients. This was true for both English- and Spanish-speaking patients. Preliminary clinical outcomes suggest improvement in depression severity, although these findings require testing in a randomized clinical trial. Implications for the science and service of telehealth-based depression care for elderly patients are discussed.

Diagnostic criteria for depression in Parkinson's disease: A study of symptom patterns using latent class analysis

Although major depression is one of the most frequent psychiatric disorders among patients with Parkinson's disease, diagnostic criteria have yet to be validated. The main aim of our study was to validate depressive symptoms using latent class analysis for use as diagnostic criteria for major depression in Parkinson's disease. We examined a consecutive series of 259 patients with Parkinson's disease admitted to 2 movement disorders clinics for regular follow-ups. All patients were assessed with a comprehensive psychiatric interview that included structured assessments for depression, anxiety, and apathy. The main finding was that all 9 Diagnostic and Statistical Manual (4th edition) diagnostic criteria for major depression (ie, depressed mood, diminished interest or pleasure, weight or appetite changes, sleep changes, psychomotor changes, loss of energy, feelings of worthlessness or inappropriate guilt, poor concentration, and suicidal ideation) identified a patient class (severe depression group) with high statistical significance. Latent class analysis also demonstrated a patient class with minimal depressive symptoms (no-depression group), and a third patient class with intermediate depressive symptoms (moderate depression). Anxiety and apathy were both significant comorbid conditions of moderate and severe depression. Taken together, our findings support the use of the full Diagnostic and Statistical Manual (4th edition) criteria for major depression for use in clinical practice and research in Parkinson's disease and suggest that anxiety may be included as an additional diagnostic criterion.

Can advance care planing offer an alternative to people contemplating euthanasia?

BackgroundMany patients with terminal illness and progressive loss of control over their bodies explore the option of euthanasia as a means to regain control. Some of these patients are referred...

Diagnostic Criteria for Depression in Alzheimer Disease: A Study of Symptom Patterns Using Latent Class Analysis

Although depression in Alzheimer disease (AD) has a negative emotional and functional impact on patients and caregivers, specific criteria to diagnose depression in AD are still to be validated. To validate a set of diagnostic criteria for major depression in AD. Cross-sectional design using latent cluster analysis (LCA). Participants were recruited from consecutive referrals to a Memory Clinic of a tertiary hospital. A consecutive series of 971 outpatients with probable AD. Clusters of patients with or without major depression as determined with LCA. A LCA demonstrated three clusters that were considered to represent major depression, minor depression, and no depression. All nine Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for major depression were significantly associated with the major depression cluster. Although a diagnosis of generalized anxiety disorder (GAD) and apathy were also associated with the major depression cluster, irritability was not. The DSM-IV criteria for major depression should be used unmodified to diagnose depression in AD. Future studies should determine whether GAD should be included as an additional diagnostic criterion.

Depression and end-of-life care for patients with cancer

Patients with cancer and depression experience more physical symptoms, have poorer quality of life, and are more likely to have suicidal thoughts or a desire for hastened death than are cancer patients who are not depressed. Despite the ubiquity of depressive symptoms in cancer patients at the end of life, critical questions remain unanswered with respect to etiopathogenesis, diagnosis, and treatment of depression in these vulnerable patients. The pharmacotherapy of depression in patients with advanced cancer should be guided by a palliative care approach focused on symptom reduction, irrespective of whether the patient meets diagnostic criteria for major depression. Earlier and more intensive supportive care for patients with cancer reduces symptom burden and may prolong life for patients with advanced disease. Symptom-oriented clinical trials are needed to improve end-of-life cancer care.

Mapping melancholia: The continuing typological challenge for major depression

The DSM's symptom-based diagnostic criteria for major depression ignore the context in which the symptoms occur, except for a limited bereavement exclusion. Thus, virtually any depressive episode of 5 symptoms lasting 2 weeks is classified as a mental disorder, even if the symptoms occur after a major stressful event (e.g., romantic betrayal, financial reversal, or medical diagnosis) and are common and proportional responses when coping with such loss and stress—such as sadness, insomnia, fatigue, decreased appetite, and difficulty concentrating on usual activities. The DSM's decontextualized symptom-based approach deviates sharply from 2400 years of diagnostic tradition in which the symptoms of intense normal sadness and depressive disorder were considered quite similar, and the context (i.e., whether circumstances provide adequate grounds for a normal-range emotional explanation of the symptoms) was thought to be essential for telling them apart. Horwitz and Wakefield (2007) argued that the DSM's descriptive approach todiagnosis ofmajor depression,whatever its scientific merits, greatly inflates the prevalence of major depressionwith “false positives”—mistaken diagnosis of normal intense sadness reactions as mental disorders. This flaw, they argued, has potentially problematic consequences for prognosis, treatment choice, informed consent, outcome research, community epidemiological surveys, screening, and policy.

Refining the diagnostic criteria for major depression on the basis of empirical evidence

Refining the diagnostic criteria for major depression on the basis of empirical evidence

AUGMENTATION OF ANTIDEPRESSANTS WITH BRIGHT LIGHT THERAPY IN PATIENTS WITH COMORBID DEPRESSION AND BORDERLINE PERSONALITY DISORDER

Borderline personality disorder (BPD) is typically characterized by instability and impaired behaviour, affectivity, interpersonal relations and lifestyle. The most common condition comorbid with BPD is a depressive episode. Depression is associated with severe disturbance of the circadian rhythms. This is apparent in depressive patients with BPD. Both sleep and diurnal rhythms are disturbed and the symptoms fluctuate. Bright light may be an effective in treatment of seasonal affective disorder, circadian sleep disorder and jet lag. It also improves sleep-wake patterns and behavioural disorders in hospitalized patients with Alzheimer's disease. Several studies have suggested antidepressant effects of phototherapy in non-seasonal depressive episodes. The treatment of comorbid depressive disorder and borderline personality disorder (BPD) is usually reported to be less successful than the treatment of patients without personality disorder. Studies describing the use of bright light in depressed patients with comorbid BPD have not been published so far. The aim of this open study was to assess the effectiveness of a 6-week combined therapy with the application of bright light (10,000 lux, 6:30 to 7:30 a.m. for 6 weeks) added to SSRIs in drug-resistant depressed patients with comorbid BPD who did not respond with improvement to 6-week administration of antidepressants. The study comprised 13 female patients who met the ICD-10 diagnostic criteria for research and the DSM-IV-TR diagnostic criteria for major depression. The participants were regularly evaluated using the CGI, HAMD and MADRS scales and the BDI and BDI self-report inventories. According to all the assessment instruments, the application of bright white light leads to a significant improvement. However, the results must be interpreted with caution due to the open nature of the study.

Antidepressive Therapie bei koronarer Herzkrankheit

Depression is considered an independent risk factor for coronary artery disease (CAD) and other vascular conditions. Moreover, comorbid depressive disorder in CAD patients carries an increased risk of cardiac events and mortality. Among survivors of acute myocardial infarction, up to 20% meet diagnostic criteria for major depression, the presence of which carries a fivefold increased risk of cardiac death within 6 months. Heart patients with depressive comorbidity require particular care for both adequate treatment of their affective disorder and reduction of their cardiac risk. Antidepressant treatment must follow established guidelines; special care is needed to avoid cardiac side effects. In this review, we discuss the pathophysiological and prognostic significance of comorbid depression in CAD and weigh risks and benefits of available treatment options - particularly different drug classes and psychotherapy - in light of recent study results.

Computer Therapy for the Anxiety and Depressive Disorders Is Effective, Acceptable and Practical Health Care: A Meta-Analysis

BackgroundDepression and anxiety disorders are common and treatable with cognitive behavior therapy (CBT), but access to this therapy is limited.ObjectiveReview evidence that computerized CBT for the anxiety and depressive disorders is acceptable to patients and effective in the short and longer term.MethodSystematic reviews and data bases were searched for randomized controlled trials of computerized cognitive behavior therapy versus a treatment or control condition in people who met diagnostic criteria for major depression, panic disorder, social phobia or generalized anxiety disorder. Number randomized, superiority of treatment versus control (Hedges g) on primary outcome measure, risk of bias, length of follow up, patient adherence and satisfaction were extracted.Principal Findings22 studies of comparisons with a control group were identified. The mean effect size superiority was 0.88 (NNT 2.13), and the benefit was evident across all four disorders. Improvement from computerized CBT was maintained for a median of 26 weeks follow-up. Acceptability, as indicated by adherence and satisfaction, was good. Research probity was good and bias risk low. Effect sizes were non-significantly higher in comparisons with waitlist than with active treatment control conditions. Five studies comparing computerized CBT with traditional face-to-face CBT were identified, and both modes of treatment appeared equally beneficial.ConclusionsComputerized CBT for anxiety and depressive disorders, especially via the internet, has the capacity to provide effective acceptable and practical health care for those who might otherwise remain untreated.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12610000030077