Differences In Severity Of Depression Research Articles

Differences in Depression Severity in Family Caregivers of Hospitalized Individuals With Dementia and Family Caregivers of Outpatients With Dementia

To determine if family caregivers of hospitalized individuals with dementia exhibit greater depression severity than caregivers of outpatients. Caregivers were recruited during care recipient treatment. Measures assessed depression, stress, burden, and grief. Forty-one caregivers of a hospitalized patient and 44 caregivers of an outpatient (total N = 85) were recruited. The groups did not differ except caregivers of hospitalized patients were younger and less likely to reside with the care recipient. Regarding depression, 63.4% of caregivers of a hospitalized patient and 43.2% of caregivers of an outpatient scored within the clinical depressive symptoms range. Independent sample t-tests showed that caregivers of a hospitalized patient had greater severity of depression, burden, and grief. Caregiving for a hospitalized person remained a significant predictor of greater depression severity in regression models. Family caregiving for a person hospitalized for psychiatric treatment of dementia is a risk factor for depression.

Differences in depression severity and frequency of relapses in opiate addicts treated with methadone or opiate blocker after detoxification

Relapse of opiate dependence is a common occurrence after detoxification and introduction of opiate addicts in abstinence from opiates. Clinical evaluation showed that over 90% of opiate addicts exhibit depressive manifestations during detoxification, or develop post-detoxification depression. The aim of this study was to determine differences in the frequency of relapses, severity and course of depression during a of 6-month period, and previous patterns of use of opioids in the two groups of opiate addicts treated by two different therapeutic modalities. The results of the two groups of opiate addicts were compared: the patients on substitution methadone treatment (M) and the patients treated with opiate blocker naltrexone (B). In all the patients, clinical and instrumental evaluations confirmed depressive syndrome. Opioid relapses were diagnosed by the panel test for rapid detection of metabolites of opiates in urine. Then they were brought in connection with scores of depression and addiction variables. The Hamilton Depression Scale (HAMD) and Zunge Depression Scale were the applied instruments for measuring the level of depression. All the subjects completed a questionnaire Pompidou (short version). Psychological measurements were carried out during a 6-month follow-up on three occasions. The presence of opiate metabolites in urine was controlled every two weeks. Both groups of patients (M and B) had high scores on HAMD during the study. The group on methadone had a strong depression in all three measurements. There was a drop in the level of depression in both experimental groups over time, which was accompanied by a decrease in the incidence of recurrence. In both tested groups the frequency of relapses was positively correlated with earlier addiction variables - intravenous application of opioids, the experience of overdose, the absence of immunization against hepatitis C and hepatitis C virus carriers. The opioid relapse behavior is associated with a marked depression in post-detoxification period. The tested group M had a more expressed depression which is consistent with the literature data. In both tested groups the frequency of relapses was positively correlated with individual addiction variables associated with latent suicidal behavior. Diagnosing and monitoring depression of opiate addicts as well as timely remediation of post-detoxification depression symtoms, could help in prevention of opiate relapse.

Tumor Epidermal Growth Factor Receptor Genotype and Depression in Stage IV Non-Small Cell Lung Cancer

Depression appears to be associated with worse survival from cancer, but underlying mechanisms for this association are unknown. In the present study, we explored the degree to which tumor genotype may be associated with depression in patients with non-small cell lung cancer (NSCLC). We examined differences in depression severity and rates of positive screens for major depressive disorder among newly diagnosed patients with stage IV NSCLC and known epidermal growth factor receptor (EGFR) genotype. Newly diagnosed patients (n = 53) with metastatic NSCLC attending an initial thoracic oncology consultation completed self-report questionnaires regarding demographics, smoking behavior, and depression before meeting with their oncologist. Biopsy samples were subsequently genotyped, including screening for EGFR mutations. We conducted a retrospective chart review to obtain clinical data, including tumor stage, performance status, and EGFR genotype. Twelve patients (22.6%) tested positive for EGFR mutation. No EGFR mutation-positive cases met the screening criteria for major depressive disorder, in comparison with 29.3% of patients with wild-type EGFR (p = .03). Mutations of EGFR were also associated with lower depression severity than with wild-type EGFR, independent of gender, performance status, and smoking history (p < .05). This finding persisted for both the cognitive-affective and somatic domains of depression symptoms. EGFR mutations were associated with lower depression severity and lower rates of probable major depressive disorder in patients with metastatic NSCLC, based on mood screening performed before results of genotyping were known. Findings support further work to explore the directionality of the associations and potential biological pathways to depression.

Are Treatment Preferences Relevant in Response to Serotonergic Antidepressants and Cognitive-Behavioral Therapy in Depressed Primary Care Patients? Results from a Randomized Controlled Trial Including a Patients’ Choice Arm

Background: Little is known about the influence of depressed patients’ preferences and expectations about treatments upon treatment outcome. We investigated whether better clinical outcome in depressed primary care patients is associated with receiving their preferred treatment. Methods: Within a randomized placebo-controlled single-centre 10-week trial with 5 arms (sertraline; placebo; cognitive-behavioral group therapy, CBT-G; moderated self-help group control; treatment with sertraline or CBT-G according to patients’ choice), outcomes for 145 primary care patients with mild-to-moderate depressive disorders according to DSM-IV criteria were investigated. Preference for medication versus psychotherapy was assessed at screening using a single item. Post-baseline difference scores for the Hamilton Depression Rating Scale (HAMD-17) were used to assess treatment outcome (mixed-model repeated-measures regression analysis). Results: Depressed patients receiving their preferred treatment (n = 63), whether sertraline or CBT-G, responded significantly better than those who did not receive their preferred therapy (n = 54; p = 0.001). The difference in outcome between both groups was 8.0 points on the HAMD-17 for psychotherapy and 2.9 points on the HAMD-17 for treatment with antidepressants. Results were not explained by differences in depression severity or dropout rates. Conclusions: Patients’ relative preference for medication versus psychotherapy should be considered when offering a treatment because receiving the preferred treatment conveys an additional and clinically relevant benefit (HAMD-17: +2.9 points for drugs; +8.0 points for CBT-G) in outcome.

Gender Differences among Patients with a Single Depressive Episode

Background: Studies on gender differences in depression have usually included a mixture of patients with first-episode, chronic and recurrent depression. Consequently, the results might be confounded by the history of depression among participants. The present study evaluated gender differences in sociodemographic, clinical and treatment variables among patients suffering exclusively from single-episode depression. Method: Systematic recruitment of 301 participants via the Danish Psychiatric Central Research Register and assessment by means of questionnaires and interviews regarding psychiatric diagnoses, personality traits and disorders, stressful life events, family history, and treatment response. Results: Female patients showed a higher level of neuroticism and more residual anxiety symptoms after treatment of the depression. There were no gender differences in severity of depression, psychiatric co-morbidity (including personality disorders), stressful life events prior to onset, family loading of psychiatric disorders, or treatment outcome. Conclusion: The results provide evidence for a higher level of anxiety and neuroticism among females with a recent onset of depression, whereas other clinical characteristics of first-episode depression were equivalent between male and female patients. Only patients with contact to a psychiatric hospital were included; thus, the results cannot be generalized to patients in primary care.

Clinical study of comparing comorbidity between depression and neurological disorder with depressive disorder

To compare the clinical traits in comorbidity between depression and neurological disorder with depressive disorder and explore the characteristic of the outpatients with neurological disorder comorbidity in depression. According to Diagnosis and Statistic Manual for Mental Disorder-IV (DSM-IV) criteria, outpatients were diagnosed as depressive disorder at Departments of Neurology and Psychology. We used HAMD-17 scale to evaluate the patient's severity. There was no statistical difference in severity of depression in two groups. But the clinical traits showed significant differences between two outpatient groups: the outpatients with neurological disorder comorbidity in depression were elder, had more somatic disorders and a higher retard symptom factor score while the other are relative younger, have less physical disorders and higher the core symptom factor score on the other hand. The patients of comorbidity between depression and neurological disorders have unique clinical traits. Thus it will be helpful to improve the identification of diagnosis and choose an appropriate treatment if we know the differences well.

P01-71 - Are treatment preferences relevant for response to serotonergic antidepressants and cognitive-behavioural therapy in depressed primary care patients?

ObjectivesLittle is known about the influence of patients’ preferences and expectations about offered treatments for depression on treatment outcome. Therefore, we investigated whether in primary care patients with depressive disorders receiving a preferred treatment is associated with a better clinical outcome.MethodsWithin a randomized, placebo-controlled, single-centre, 10-week trial with five arms (sertraline; placebo; cognitive-behavioural group therapy (CBT-G); moderated self-help group control; treatment with sertraline or CBT-G according to patients’ choice), 145 primary care patients with mild-to-moderate depressive disorders according to DSM-IV criteria were investigated. Preference for medication versus psychotherapy was assessed at the time of patients’ screening using a single item. To assess therapy outcome, the post-baseline sum scores of the Hamilton Depression Rating Scale (HAMD-17) were used.ResultsDepressed patients receiving their preferred treatment (sertraline or CBT-G) (N=63) responded significantly better than those who did not receive their preferred therapy (N=54) (p = 0.001). The difference in outcome between both groups was 8.0 points on HAMD-17 for psychotherapy and 2.9 points on HAMD-17 for treatment with antidepressants. This result is not explained by differences in depression severity or drop-out rates.ConclusionsPatients’ preference for pharmaco- versus psychotherapy should be considered when offering a treatment because receiving the preferred treatment conveys an additional and clinically relevant benefit (HAMD-17: +2.9 points for drugs; +8.0 points for CBT-G) in outcome.

Longitudinal neuroendocrine changes assessed by dexamethasone/CRH and growth hormone releasing hormone tests in psychotic depression

Although psychotic depression has been reported to exhibit a greater degree of dysregulation of hypothalamic-pituitary-adrenocortical (HPA) function than non-psychotic depression, little is known concerning hypothalamic-pituitary-somatotropic (HPS) function in psychotic depression and how neuroendocrine function changes after treatment. To investigate the longitudinal changes in HPA and HPS system function in psychotic depression, we performed repeated dexamethasone/corticotropin releasing hormone (DEX/CRH) tests and growth hormone (GH) releasing hormone (GHRH) tests in inpatients with major depressive disorder. The psychotic depression group exhibited greater elevation of ACTH responses to the DEX/CRH test and stronger decreases in GH responses to the GHRH test than the non-psychotic depression group at admission. At discharge, the neuroendocrine responses to the DEX/CRH test of the psychotic depression group were still stronger than those of the non-psychotic depression group, though there were no significant differences in severity of depression between the groups. There were significant longitudinal changes in neuroendocrine responses to the DEX/CRH test between admission and discharge. The psychotic depression group exhibited increased GH responses to GHRH at discharge compared with those at admission, whereas no significant longitudinal change in GH response was found in the non-psychotic depression group. Consequently, there were no significant differences in GH responses to GHRH between the psychotic and non-psychotic depression groups at discharge. The results of GHRH test showed no significant relationships with severity of depression except psychotic features and the results of the DEX/CRH test. Our findings suggest that the HPS axis may be associated with psychotic features rather than general severity of depression. Further longitudinal studies are needed to clarify the role of HPS function in psychotic depression and whether sustained dysregulation of HPA function in psychotic depression is associated with a poor outcome after discharge.

A comparison of baseline sociodemographic and clinical characteristics between major depressive disorder patients with and without diabetes: A STAR ⁎D report

Background Patients with major depressive disorder (MDD) have high rates of medical comorbidities which can impair MDD treatment. Yet little is known regarding associations between the presence of a serious comorbidity and MDD treatment. The purpose of this study was to examine the baseline sociodemographic and clinical characteristics of MDD outpatients with and without diabetes mellitus to evaluate possible associations between these characteristics and the presence of comorbid diabetes. Methods We gathered baseline sociodemographic and clinical data for 4041 participants with non-psychotic MDD who enrolled in the STAR ⁎D, a large-scale depression treatment protocol, and made comparisons between participants with and without diabetes. Results Participants with diabetes were more likely to be male, older, black, Hispanic, unemployed, and have less education, a lower income, higher mental functioning, lower physical functioning, atypical features, increased appetite, psychomotor slowing and leaden paralysis, and were less likely to have concurrent alcohol abuse/dependence, mood reactivity or problems with concentration. We found no significant differences between groups regarding depression severity. Limitations The primary limitation is the lack of a clinical diagnosis of diabetes. Conclusions We found no difference in depression severity between participants with and without diabetes. Diabetes was associated with physical symptoms of depression. Thus treatments for these participants should be directed toward these symptoms.

Optimizing the ability of the Hamilton Depression Rating Scale to discriminate across levels of severity and between antidepressants and placebos

Efforts to improve the Hamilton Rating Scale for Depression (HRSD) have included shortening the scale by selecting the best performing items, lengthening the scale by assessing additional symptoms, modifying the format and scoring of existing items, and developing structured interview guides for administration. We defined item performance exclusively in terms of the ability of items to discriminate differences among levels of depressive severity which has not be used to guide any revisions of the HRSD conducted to date. Two techniques derived from item response theory were used to improve the ability of the HRSD to discriminate among individuals with different degrees of depressive severity. Item response curves were used to quantify the ability of items to discriminate among individual differences in depressive severity, on the basis of which the most discriminating items were selected. Maximum likelihood estimates were used to compute an optimal depressive severity score, using all items, but which weighted highly discriminating items more so than items that did not discriminate well. The utility of each method was evaluated by comparing a subset of optimally discriminating items and maximum likelihood estimates of depressive severity to the Maier Philipp subscale of the HRSD, in terms of how well scales discriminate treatment effects. Effect sizes for overall change in depression severity as well as effect sizes differentiating response to treatment versus placebo were evaluated in a sample of 491 patients receiving fluoxetine and 494 patients receiving placebo. Results of analyses identified a new subset of items (IRT-6), selected on the basis of their ability to discriminate among differences in depressive severity, that accounted for more variance in full-scale HRSD scores and was better at detecting change in illness severity than the Maier Philipp subscale of the HRSD. The IRT-6 subscale was equally good as the Maier Philipp subscale in differentiating treatment from placebo response. No evidence supporting the benefits of using maximum likelihood estimates to develop optimally performing subscales was found. Implications of the results are discussed in terms of strategies for optimizing the assessment of change in overall depression severity as well as differentiating treatment response.

Child Maltreatment in Depressed Adolescents: Differences in Symptomatology Based on History of Abuse

Research has demonstrated that youth who are sexually or physically abused are at greater risk for developing depression. Although the association between depression and child maltreatment has been well documented, much less is known about the potential differences in the clinical presentation of depressive symptomatology among these victims. The current study examines differences in symptoms of depression in adolescents based on differing histories of abuse (i.e., sexual abuse only, physical abuse only, sexual and physical abuse, and no history of sexual or physical abuse), abuse incident characteristics, and gender. Participants were drawn from a subsample (n = 548) from the National Survey of Adolescents who met criteria for major depressive episode in the past year. Results indicate significant differences in severity of depression and specific depressive symptoms based on type of abuse experienced and gender. Implications for the clinical assessment and treatment of depressed adolescents with regard to abuse history are discussed.

DRD4 receptor gene exon III polymorphism in inpatient suicidal adolescents

Some studies have suggested possible association of the dopamine receptor subtype 4 (DRD4) gene exon III 48 bp repeat polymorphism with novelty seeking behavior. As suicidal behavior in adolescents is linked to risk taking behavior, we evaluated the association of suicidality with DRD4 polymorphism in Israeli inpatient suicidal adolescents. Sixty-nine inpatient adolescents who recently attempted suicide were assessed by structured interview and rating scales for detailed clinical history, diagnoses, suicide intent and risk, impulsivity, violence, and depression. The frequency of DRD4 alleles was compared between the suicidal inpatients and 167 healthy control subjects. No significant association between the DRD4 polymorphism and suicidal behavior was found. Analysis of the suicide-related measures demonstrated a significant difference in depression severity between suicidal inpatients homozygote and heterozygote for the DRD4 alleles (p=0.003). The relevance of this finding to increased depression severity in suicidal adolescents, if replicated, is as yet unclear.

Cerebrovascular Disease and Late-Life Depression: A Latent-Variable Analysis of Depressive Symptoms After Stroke

The author used a structural-equation modeling approach to examine depression symptom endorsement between geriatric stroke patients and general-medical geriatric patients. From the literature related to cerebrovascular disease and depression, he predicted that geriatric stroke patients would be more likely to endorse symptoms of withdrawal and affective flattening, and less agitation. Data from 576 geriatric rehabilitation patients were utilized (N=176 with stroke). Confirmatory factor analysis of the Geriatric Depression Scale was conducted to determine the optimal factor structure for examining symptom endorsement differences between the two groups. MIMIC (Multiple Indicators, Multiple Causes) model analyses were incorporated to examine group differences in depression severity and symptom-cluster endorsement. Results indicate that stroke patients did not demonstrate greater depression severity. There were no differences in endorsement of depressive mood. However, stroke patients were more likely to endorse social withdrawal and less likely to endorse agitation symptoms. The current results suggest that geriatric stroke patients were more likely, after controlling for depression severity, to endorse greater social withdrawal and less agitation, but not depressed mood. These findings have implications for the types of symptoms evaluated in the context of geriatric stroke and depression.

Co-occurrence of disturbed sleep and appetite loss differentiates between unipolar and bipolar depressive episodes

The aim of this study was to examine whether the co-occurrence of disturbed sleep and appetite loss, two commonly encountered somatic symptoms of depression, can differentiate the clinical expression of depressive episodes between bipolar (BP) and unipolar patients (UP). Forty BP and 40 UP outpatients were interviewed through the Schedules for the Clinical Assessment in Neuropsychiatry (SCAN) and the presence of sleep disturbance and appetite loss during their most severe depressive episode was determined. Other variables studied were patients' gender and age, clinical characteristics related to the course of the disease (age at onset, duration of illness, and number and frequency of depressive and manic episodes), severity of the worst major depressive episode, and presence or absence of certain associated symptoms during that episode (loss of energy, low interest, feelings of guilt and/or self-reproach, impaired concentration, suicidal ideation, and agitation or retardation). Appetite loss was found to be more frequently present in UP (78%) than BP patients (55%, P<.05). No significant difference in the occurrence of sleep disturbance was found between the two groups. Among BP patients, appetite loss was present in 73% of those with sleep disturbance vs. 33% of those without ( P<.02), while no such difference in co-occurrence of sleep disturbance and appetite loss was noticed among UP patients (74% vs. 85%, respectively, n.s.); this finding did not seem to be related to differences in severity of depression among UP and BP patients. Furthermore, those BP patients with co-occurrence of the two somatic symptoms complained also of loss of energy and low interest more often than those without ( P<.01 and P<.05, respectively). No similar differences were observed among UP patients. The results of the present study suggest that the pathophysiological mechanisms underlying depressive episodes may differ between BP and UP affective disorder, and that those BP patients with simultaneous occurrence of sleep disturbance and appetite loss can be considered to belong to a particular nosologic subgroup with potential therapeutic and prognostic implications.

Child sexual abuse and bulimic symptomatology: relevance of specific abuse variables

Objective: This study examined specific aspects of child sexual abuse in relation to symptom severity among hospitalized patients diagnosed with bulimia nervosa. Method: Participants were 45 hospitalized bulimic women who reported a history of child sexual abuse. Structured interviews were conducted in order to obtain detailed information regarding specific features of the abusive event(s). Participants also completed instruments that measured depression and eating pathology. Results: There were no significant differences in severity of depression or eating disturbance among women reporting differing abusive experiences including intrafamilial versus extrafamilial abuse, abuse with or without the use of physical force, one versus multiple incidents, early abuse versus abuse occurring after age 14, contact versus noncontact abuse, disclosed versus undisclosed, and combined physical/sexual abuse versus sexual abuse alone. Conclusion: The specific characteristics of child sexual abuse are not related to the level of symptomatology for hospitalized bulimic patients. This study suggests that differences in the nature of the abuse may not be as important as the fact that the abuse occurred in the first place.

Influence of Locus of Control and Custody Level on Intake and Prison-Adjustment Depression

This study examines differences in initial and later depressive symptoms of 325 male prisoners based on three levels of custody and four levels of locus of control. Results extend previous findings concerning locus of control and prison-intake depression by including a measure of types of custody and later adjustment depression. Significant differences emerged for both groups with high internal and external locus of control orientations. The highly internal group was the least depressed at both testings. High externals showed a significant increase in reported depression after a period of adjustment to prison and were the only group with a significant reactive depression. There were no differences in depressive severity based on level of custody or its interaction with control orientation. Finally, depression scores that were initially at either extreme declined so that later, adjustment depression scores fell in the mild and moderate range.

Executive dysfunction predicts nonresponse to fluoxetine in major depression

Background: Functional brain imaging studies of major depression have consistently revealed hypometabolism or hypoperfusion in specific regions of the prefrontal cortex and basal ganglia. Studies of cognitive functioning in major depression have suggested that some but not all subjects exhibit cognitive deficits that are consistent with frontal-subcortical dysfunction, although the reasons for this heterogeneity are unclear. In this study, we explored this heterogeneity among depressed subjects by examining the relationship between cognitive functioning and treatment outcome. Method: Subjects with major depression were administered a complete neuropsychological test battery prior to treatment with fluoxetine. Results: There were no significant differences between responders and nonresponders to fluoxetine in terms of age, educational achievement, number of past episodes of depression, and estimated premorbid IQ. However, nonresponders performed significantly worse than responders on several pretreatment measures of executive functioning, after controlling for baseline group differences in depression severity. Limitations: The results are based on a small sample of primarily female subjects, resulting in low statistical power and less generalizability to samples of male subjects with depression. Conclusions: The findings suggest that subtle prefrontal dysfunction in subjects with major depression may be predictive of poor response with particular medications. Assessment of the executive functions may play a particular role in pretreatment identification of subjects likely to respond to specific medications.

Predictors of antidepressant prescription and early use among depressed outpatients.

The rates of antidepressant recommendation and use were determined in outpatients with major depression receiving services in mental health clinics. Site of service and the patients' sociodemographic and clinical characteristics were investigated as possible predictors. Patients admitted to six outpatient clinics were recruited through a two-stage sampling procedure. Patients with major depressive disorder (N = 124) according to the Structured Clinical Interview for DSM-IV--Patient Edition were assessed at admission and 3 months later. Drug therapy was recommended for most patients (71%), and minimal use (at least 1 week) was recorded for 59% of the subjects. White patients were nearly three times as likely to receive a recommendation for antidepressants. Antidepressant recommendation was also associated with severity of depressed mood, recent medication use, and clinic type. Recent antidepressant use was the only variable that predicted whether the patient actually took the recommended medication. Many patients with depression seeking treatment at community mental health clinics do not receive antidepressant drug therapy. The offer of medication is predicted by patient ethnicity, clinic type, and symptom severity. Minority patients are less likely to be offered antidepressant treatment.

Progress in the technology of measurement: Applications of item response models.

Despite advances in psychometric theory and analytic techniques, a number of issues regarding the assessment of depression remain unresolved, including the relative effectiveness of response options (option effectiveness), the ability of existing measures to detect differences in depressive severity (scale discriminability), and the extent to which certain groups of individuals use items and options differently (differential item functioning). One part of the article introduces the fundamentals of nonparametric item response models; the 2nd part of the article illustrates how item response models can be applied to address specific psychometric issues. Although the article focuses on the assessment of depression, the problems addressed in this article are present in virtually every field of psychological research, and the techniques offered may be applied broadly. Analytic techniques based on item response models are not only helpful in identifying and ultimately resolving many of these issues, they are essential to ensure that traits, abilities, and conditions, such as depression, are assessed fairly and equitably.

Cluster analysis of MCMI scores of suicidal psychiatric patients: Four personality profiles

Millon Clinical Multiaxial Inventory (MCMI) scores from 299 suicidal psychiatric outpatients were cluster analyzed in hopes of identifying clinical subgroups and deriving specific treatment indications. The analysis revealed four personality profiles: Negativistic/Avoidant/Schizoid, Avoidant/Dependent/Negativistic, Antisocial, and Histrionic/Narcissistic. This grouping was validated by examining demographics, diagnoses, and scores on several psychometric scales. Results showed few differences in demographics, diagnosis, or intelligence, but significant differences in depression severity, hopelessness, anxiety, problem-solving self-appraisal, and alcohol abuse. Implications for tailoring interventions for subtypes of suicidal patients are discussed. © 1996 John Wiley & Sons, Inc.