Family History Of Major Depression Research Articles

Data mining algorithm predicts a range of adverse outcomes in major depression

BackgroundCourse of illness in major depression (MD) is highly varied, which might lead to both under- and overtreatment if clinicians adhere to a 'one-size-fits-all' approach. Novel opportunities in data mining could lead to prediction models that can assist clinicians in treatment decisions tailored to the individual patient. This study assesses the performance of a previously developed data mining algorithm to predict future episodes of MD based on clinical information in new data. MethodsWe applied a prediction model utilizing baseline clinical characteristics in subjects who reported lifetime MD to two independent test samples (total n = 4226). We assessed the model's performance to predict future episodes of MD, anxiety disorders, and disability during follow-up (1–9 years after baseline). In addition, we compared its prediction performance with well-known risk factors for a severe course of illness. ResultsOur model consistently predicted future episodes of MD in both test samples (AUC 0.68–0.73, modest prediction). Equally accurately, it predicted episodes of generalized anxiety disorder, panic disorder and disability (AUC 0.65–0.78). Our model predicted these outcomes more accurately than risk factors for a severe course of illness such as family history of MD and lifetime traumas. LimitationsPrediction accuracy might be different for specific subgroups, such as hospitalized patients or patients with a different cultural background. ConclusionsOur prediction model consistently predicted a range of adverse outcomes in MD across two independent test samples derived from studies in different subpopulations, countries, using different measurement procedures. This replication study holds promise for application in clinical practice.

Electrocortical reactivity to negative and positive facial expressions in individuals with a family history of major depression

Facial expressions signaling threat and mood-congruent loss have been used to probe abnormal neural reactivity in major depressive disorder (MDD) and may be implicated in genetic vulnerability to MDD. This study investigated electro-cortical reactivity to facial expressions in 101 unaffected, adult first-degree relatives of probands with MDD and non-relative controls (n = 101). We investigated event-related potentials (ERPs) to five facial expressions of basic emotion: fear, anger, disgust, sadness and happiness under both subliminal (masked) and conscious (unmasked) presentation conditions, and the source localization of group differences. In the conscious condition, controls showed a distinctly positive-going shift in responsive to negative versus happy faces, reflected in a greater positivity for the VPP frontally and the P300 parietally, and less negativity for the N200. By contrast, relatives showed less differentiation of emotions, reflected in less VPP and P300 positivity, particularly for anger and disgust, which produced an enhanced N200 for sadness. These group differences were consistently source localized to the anterior cingulate cortex. The findings contribute new evidence for neural disruptions underlying the differentiation of salient emotions in familial risk for depression. These disruptions occur to the appraisal (∼200 ms post-stimulus) through to the context evaluation (∼300 ms+ post-stimulus) phases of emotion processing, consistent with theories that risk for depression involves biased or attenuated processing of emotion.

Depressed Multiple-Suicide-Attempters - A High-Risk Phenotype.

There is compelling evidence that suicide attempts are among the strongest predictors of suicide and future suicide attempts. This study aimed to examine psychopathology in multiple-suicide attempters. We compared the demographic and clinical features of three groups: depressed patients without a history of suicide attempts (non-attempters), depressed patients with a history of one to three suicide attempts (attempters), and depressed patients with a history of four or more suicide attempts (multiple attempters). We found that attempters and multiple attempters had higher levels of depression, hopelessness, aggression, hostility, and impulsivity and were more likely to have borderline personality disorder and family history of major depression or alcohol use disorder compared with non-attempters, but did not differ between each other on these measures. Multiple attempters had greater suicidal ideation at study entry and were more likely to have family history of suicide attempt compared with attempters. Importantly, multiple attempters had greater suicide intent at the time of the most medically serious suicide attempt and more serious medical consequences during their most medically serious suicide attempt compared with attempters. The cross-sectional design of the study. Our data suggest that multiple-suicide attempters require careful evaluation as their behavior can have serious medical consequences.

Clinical features of and risk factors for major depression with history of postpartum episodes in Han Chinese women: A retrospective study

BackgroundWe sought to investigate the clinical features of and risk factors for recurrent major depression (MD) with history of postpartum episodes (PPD) in Han Chinese women and the differences between first-onset postpartum MD (MD that has its first lifetime depressive episode in the postpartum period) and first-onset non-postpartum MD (MD with history of PPD and has its first lifetime depressive episode in a period other than postpartum). MethodsData were derived from the China, Oxford and Virginia Commonwealth University Experimental Research on Genetic Epidemiology (CONVERGE) study (N=6017 cases) and analyzed in two steps. We first examined the clinical features of and risk factors for MD patients with (N=981) or without (N=4410) a history of PPD. We then compared the differences between first-onset postpartum MD (N=583) and first-onset non-postpartum MD (N=398) in those with a history of PPD. Linear, logistic and multinomial logistic models were employed to measure the associations. ResultsA history of PPD was associated with more guilt feelings, greater psychiatric comorbidity, higher neuroticism, earlier onset and more chronicity (OR 0.2–2.8). Severe premenstrual symptoms (PMS) and more childbirths increased the risk of PPD, as did a family history of MD, childhood sexual abuse, stressful life events and lack of social support (OR 1.1–1.3). In the MD with history of PPD subsample, first-onset postpartum MD was associated with fewer recurrent major depressive episodes, less psychiatric comorbidity, lower neuroticism, less severe PMS and fewer disagreements with their husbands (OR 0.5–0.8), but more childbirths (OR 1.2). LimitationsData were obtained retrospectively through interview and recall bias may have affected the results. ConclusionsMD with history of PPD in Han Chinese women is typically chronic and severe, with particular risk factors including severe PMS and more childbirths. First-onset postpartum MD and first-onset non-postpartum MD can be partly differentiated by their clinical features and risk factors, but are not clearly distinctive.

Role of Lithium Augmentation in the Management of Major Depressive Disorder

The high rate of non-responders to initial treatment with antidepressants requires subsequent treatment strategies such as augmentation of antidepressants. Clinical guidelines recommend lithium augmentation as a first-line treatment strategy for non-responding depressed patients. The objectives of this review were to discuss the current place of lithium augmentation in the management of treatment-resistant depression and to review novel findings concerning lithium's mechanisms of action. We conducted a comprehensive and critical review of randomized, placebo-controlled trials, controlled and naturalistic comparator studies, and continuation-phase and discontinuation studies of lithium augmentation in major depression. The outcomes of interest were efficacy, factors allowing outcome prediction and results from preclinical studies investigating molecular mechanisms of lithium action. Substantial efficacy of lithium augmentation in the acute treatment of major depression has been demonstrated in more than 30 open-label studies and 10 placebo-controlled trials. In a meta-analysis addressing the efficacy of lithium in 10 randomized, controlled trials, it had a significant positive effect versus placebo, with an odds ratio of 3.11 corresponding to a number-needed-to-treat (NNT) of 5 and a mean response rate of 41.2% (versus 14.4% in the placebo group). The main limitations of these studies were the relatively small numbers of study participants and the fact that most studies included augmentation of tricyclic antidepressants, which are not in widespread use anymore. Evidence from continuation-phase studies is sparse but suggests that lithium augmentation should be maintained in the lithium-antidepressant combination for at least 1 year to prevent early relapses. Concerning outcome prediction, single studies have reported associations of better outcome rates with more severe depressive symptomatology, significant weight loss, psychomotor retardation, a history of more than three major depressive episodes and a family history of major depression. Additionally, one study suggested a predictive role of the -50T/C single nucleotide polymorphism of the glycogen synthase kinase 3 beta (GSK3B) gene in the probability of response to lithium augmentation. With regard to novel mechanisms of action, GABAergic, neurotrophic and genetic effects might explain the effects of lithium augmentation. In conclusion, augmentation of antidepressants with lithium remains a first-line, evidence-based management option for patients with major depression who have not responded adequately to antidepressants. While the mechanisms of action are currently widely studied, further clinical research on the role of lithium potentiation of the current generation of antidepressants is warranted to reinforce its role as a gold-standard treatment for patients who respond inadequately to antidepressants.

Family history of major depression and residual symptoms in responder and non-responder depressed patients

BackgroundLittle is known about the extent to which a family history of major depression (MD) affects residual depressive symptoms in responder and non-responder patients suffering from MD. MethodsNine hundred eighty-six patients with MD were recruited within the context of a large multicenter project. Information about the family history of MD, as well as about total depressive symptoms and specific depressive clusters, was collected and analyzed. ResultsNo significant difference was observed in overall depressive symptoms between patients with and those without a family history of MD. However, non-responder patients with a family history of MD showed significantly higher scores in core symptoms as compared with responder patients without a family history of MD. ConclusionsNon-responder MD patients with a positive family history of MD could represent a slightly different sub-group of MD patients with more consistent core depressive symptoms as compared with responder patients without a family history of MD. However, taking into account the retrospective assessment of data, the use of positive or negative family history as a dichotomous indicator of familial loading and the cross-sectional design of the present study, further research is needed to draw more definitive conclusions.

Erratum to: Influence of family history of major depression, bipolar disorder, and suicide on clinical features in patients with major depression and bipolar disorder

Erratum to: Influence of family history of major depression, bipolar disorder, and suicide on clinical features in patients with major depression and bipolar disorder

Antecedents of manic versus other first psychotic episodes in 263 bipolar I disorder patients

As initial episode type can predict later morbidity in bipolar disorder, we tested the hypothesis that clinical antecedents might predict initial episode types. We studied 263 first-episode, adult, DSM-IV-TR type I bipolar disorder (BD-I) subjects within the McLean-Harvard-International First-Episode Project. Based on blinded assessments of antecedents from SCID examinations and clinical records, we compared first lifetime manic vs. other (mixed, depressive, or non-affective) major psychotic episodes. We identified 32 antecedents arising at early, intermediate or later times, starting 12.3±10.7 years prior to first lifetime major psychotic episodes. Based on multivariate modeling, antecedents associated significantly and independently with other (n=113) more than manic (n=150) first lifetime major psychotic episodes ranked by odds ratio: more early attentional disturbances, more late depression, more early perplexity, more detoxification, more early unstable mixed affects, more antidepressants, more early dysphoria, more intermediate depression, more early impulsivity, more late anhedonia, longer early-to-intermediate intervals, more intermediate substance abuse, more family history of major depression, and younger at earliest antecedents. Antecedents selectively preceding manic more than other first psychotic episodes included more late behavioral problems and more risk of familial BD-I. Clinical antecedents in adult, BD-I patients, beginning a decade before first major episodes and progressing through sequential stages were dissimilar in manic vs. other first psychotic episodes.

Influence of family history of major depression, bipolar disorder, and suicide on clinical features in patients with major depression and bipolar disorder

The extent to which a family history of mood disorders and suicide could impact on clinical features of patients suffering from major depression (MD) and bipolar disorder (BD) has received relatively little attention so far. The aim of the present work is, therefore, to assess the clinical implications of the presence of at least one first- and/or second-degree relative with a history of MD, BD and suicide in a large sample of patients with MD or BD. One thousand one hundred and fifty-seven subjects with MD and 686 subjects with BD were recruited within the context of two large projects. The impact of a family history of MD, BD, and suicide-considered both separately and together-on clinical and socio-demographic variables was investigated. A family history of MD, BD, and suicide was more common in BD patients than in MD patients. A positive family history of mood disorders and/or suicide as well as a positive family history of MD and BD separately considered, but not a positive history of suicide alone, were significantly associated with a comorbidity with several anxiety disorders and inversely associated with age of onset. The clinical implications as well as the limitations of our findings are discussed.

CLINICAL PREDICTORS OF FAMILIAL DEPRESSION IN HAN CHINESE WOMEN

BackgroundA number of clinical features potentially reflect an individual's familial vulnerability to major depression (MD), including early age at onset, recurrence, impairment, episode duration, and the number and pattern of depressive symptoms. However, these results are drawn from studies that have exclusively examined individuals from a European ethnic background. We investigated which clinical features of depressive illness index familial vulnerability in Han Chinese females with MD.MethodsWe used lifetime MD and associated clinical features assessed at personal interview in 1,970 Han Chinese women with DSM-IV MD between 30–60 years of age. Odds Ratios were calculated by logistic regression.ResultsIndividuals with a high familial risk for MD are characterized by severe episodes of MD without known precipitants (such as stress life events) and are less likely to feel irritable/angry or anxious/nervous.ConclusionsThe association between family history of MD and the lack of a precipitating stressor, traditionally a characteristic of endogenous or biological depression, may reflect the association seen in other samples between recurrent MD and a positive family history. The symptomatic associations we have seen may reflect a familial predisposition to other dimensions of psychopathology, such as externalizing disorders or anxiety states. Depression and Anxiety 0:1–6, 2011. © 2011 Wiley-Liss, Inc.

Researchers Link Normal Grief to Major Depression

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessResearchers Link Normal Grief to Major DepressionJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:3 Aug 2007https://doi.org/10.1176/pn.42.15.0028aFor some time now, psychiatric scientists have been making forays into the nether world of bereavement, and their efforts seem to be leading to some clarification of what grief for a loved one is and what it is not.Normal grief for a loved one, for example, does not seem to be the same as complicated or traumatic grief. The latter is characterized by persistent difficulty in accepting the death, recurrent pangs of intense grief, preoccupation with thoughts and images of the deceased, and avoidance of reminders of the loss (Psychiatric News, July 6, 2005; April 6).Also, the depression stemming from complicated grief does not seem to be the same as major depression.On the other hand, depression stemming from normal grief seems to be very closely related to major depression, two psychiatrists now conclude. Sidney Zisook, M.D., a professor of psychiatry at the University of California at San Diego, and Kenneth Kendler, M.D., a professor of psychiatry and human genetics at Virginia Commonwealth University, presented data backing their theory in the June Psychological Medicine.Zisook and Kendler searched all English-language reports in Medline up to November 2006 to identify published data about key characteristics that define bereavement depression and standard major depression. They then compared characteristics for both types of depression.Several of their results indicated that bereavement depression might be a separate disorder from major depression. For example, although women are more vulnerable to major depression, men may be equally as vulnerable to bereavement depression.Most of their analysis, however, suggested that bereavement depression is closely related to major depression. For instance, bereavement depression, like major depression, is more common in younger adults than in older ones, more likely to occur in individuals with a personal or family history of major depression, more likely to occur in persons in poor health than in good health, and more likely to occur in those with little social support.Furthermore, both bereavement depression and major depression are accompanied by heightened adrenocortical activity, impaired immune responses, and sleep disturbances. And bereavement depression has clinical characteristics similar to those of major depression—impaired psychosocial function, comorbidity with a number of anxiety disorders, and symptoms of worthlessness and suicidality.“Overall, the prevailing evidence more strongly supports similarities than differences between bereavement-related depression and standard major depression,” Zisook and Kendler concluded.These findings have important clinical implications, Zisook and Kendler believe. For example, DSM-IV-TR guidelines for diagnosing depression indicate that bereavement depression can only be diagnosed as major depression if it exceeds two months or if specific symptoms, such as suicidal ideation, morbid preoccupation with worthlessness, or psychomotor retardation, are present. Yet if bereavement depression is the same as major depression these guidelines may be invalid.On the other hand, if depression following the death of a loved one should be largely excluded from the definition of major depression, then should depression following other types of losses, say a divorce or bankruptcy, also be excluded from it? Currently, “DSM-IV-TR singles out bereavement as the only stressful life event that excludes the diagnosis of major depressive episode when all other features are present,” Zisook and Kendler noted.“The ideal study to test the validity of the bereavement exclusion,” they pointed out, “would compare individuals with depressive syndromes beginning within two months of the loss of a loved one...[to individuals with] major depressive episodes of similar duration and symptom profile whose onset is unrelated to the death of a loved one.” But “Unfortunately, we found no such studies in the literature,” they said.What about treatment? “The ultimate decision of when, whether, and how to treat the depression,” Zisook told Psychiatric News,“ should be made on the basis of considerations generally used for other, nonbereavement-related depressions, such as past history of depression and response to treatment, severity and chronicity of the episode, comorbidity, anxiety level, suicidal ideation, effects on functioning, supports, et cetera. The decision should not be based on time since the death of a loved one.”Zisook and Kendler's review was not supported by outside funding.An abstract of “Is Bereavement-Related Depression Different Than Non-Bereavement-Related Depression?” is posted at<http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=1018312>.▪ ISSUES NewArchived

Distinguishing Bipolar Major Depression From Unipolar Major Depression With the Screening Assessment of Depression-Polarity (SAD-P)

Patients with bipolar I or II major depression are often misdiagnosed with unipolar major depression. The goal of this study was to develop and validate a brief instrument to screen for bipolar disorder in patients actively ill with major depression. The sample consisted of subjects who enrolled in the National Institute of Mental Health-Collaborative Program on the Psychobiology of Depression-Clinical Studies from 1978 to 1981 during an episode of major depression and included 91 subjects with bipolar I major depression, 52 with bipolar II major depression, and 338 with unipolar major depression diagnosed according to Research Diagnostic Criteria. Most of the subjects were inpatients at the time of enrollment, and subjects were prospectively followed for up to 20 years. In order to create, test, and cross-validate the screening instrument, a split-sample data analytic procedure was performed. This procedure yielded 3 groups of subjects: the bipolar I index sample, the bipolar I cross-validation sample, and the bipolar II cross-validation sample. Each group included subjects with bipolar major depression and subjects with unipolar major depression. Within the bipolar I index sample, subjects with bipolar I major depression at study intake were compared with subjects with unipolar major depression at study intake on a pool of 59 sociodemographic and clinical candidate variables. The 3 variables showing the greatest disparity between bipolar I subjects and unipolar subjects were selected for the screen, the Screening Assessment of Depression-Polarity (SAD-P). The operating characteristics of the SAD-P were then examined within the bipolar I index sample, bipolar I cross-validation sample, and bipolar II cross-validation sample. The items selected for the screening instrument were (1) presence of delusions during the current episode of major depression, (2) number of prior episodes of major depression, and (3) family history of major depression or mania. The screen identified bipolar major depression with a sensitivity of 0.82 in the bipolar I index sample, 0.72 in the bipolar I cross-validation sample, and 0.58 in the bipolar II cross-validation sample. With regard to misclassifying subjects with unipolar major depression, the screen provided a positive predictive value of 0.36 in the bipolar I index sample, 0.29 in the bipolar I cross-validation sample, and 0.27 in the bipolar II cross-validation sample. We suggest using the 3-item SAD-P as a preliminary screen for bipolar disorder in patients who present with an active episode of major depression.

Genetics and genomics of depression

Depressive disorders are among the most common psychiatric diseases, with prevalence estimates ranging from 5% to a maximum of 20%. Despite their high prevalence and socioeconomic impact, little is known about their etiology. Heritability estimates demonstrate up to a 50% genetic component based on family aggregation and contrasting monozygotic and dizygotic twin studies. The low relative risk to siblings ( λsib <1.5) makes the search for their genetic determinants very tedious. Gene-environment interaction has been recognized for a long time in the pathophysiology of depression, and its best biological substratum at present is represented by the serotonin transporter (5-HTT) gene, where several copies of its short allele culminate in depression and suicide in response to lifelong stress events. Many total genome scans have been performed with variable results, the most authoritative being the one of Utah pedigrees with a strong family history of major depression. It identified a locus on chromosome 12 encompassing a gene cluster and sex-specific predisposition. Nevertheless, recent genome scan meta-analysis yielded somewhat disappointing conclusions with a relatively low significance for quantitative trait loci on chromosomes 9, 10, 14, and 18. Studies on animal models have contributed to the chromosomal mapping of many behavioral traits, including anxiety, the stress response, and depression. Although F2 crosses constitute a classical approach, novel models of recombinant inbred strain and recombinant congenic strain animals allow for a rapid initial localization of any traits. This type of analysis has led us to uncover significant loci for the stress response and anxiety in rats and mice.

Predisposition Locus for Major Depression at Chromosome 12q22-12q23.2

Major depression disorder is a common psychiatric disease with a major economic impact on society. In many cases, no effective treatment is available. The etiology of major depression is complex, but it is clear that the disease is, to a large extent, determined genetically, especially among individuals with a familial history of major depression, presumably through the involvement of multiple predisposition genes in addition to an environmental component. As a first step toward identification of chromosomal loci contributing to genetic predisposition to major depression, we have conducted a genomewide scan by using 628 microsatellite markers on 1,890 individuals from 110 Utah pedigrees with a strong family history of major depression. We identified significant linkage to major depression in males at marker D12S1300 (multipoint heterogeneity LOD score 4.6; P=.00003 after adjustment for multiple testing). With additional markers, the linkage evidence became highly significant, with the multipoint heterogeneity LOD score at marker D12S1706 increasing to 6.1 (P=.0000007 after adjustment for multiple testing). This study confirms the presence of one or more genes involved in psychiatric diseases on the q arm of chromosome 12 and provides strong evidence for the existence of a sex-specific predisposition gene to major depression at 12q22-q23.2.

Descriptive Epidemiology of a Depressive Syndrome in a Western Canadian Community Population

To evaluate cross-sectional associations between depressive episodes and a set of potential biopsychosocial determinants in Calgary, Canada.Random digit dialling (RDD) was used to select a sample consisting of 2,542 household residents in Calgary. These subjects were interviewed over the telephone using the Composite International Diagnostic Interview (CIDI) short form for major depression, and a questionnaire evaluating a variety of biopsychosocial variables.The prevalence of major depression was associated with biological (family history of major depression, alcohol consumption, street drug use), psychological (ratings of stress, recent life events) and social factors (social support, marital status, income, level of education).This study confirms that major depression is correlated with a diverse set of potential determinants in community populations, and that the impact of these determinants may differ between different populations. Prospective studies will be needed to further investigate these associations.

Descriptive epidemiology of a depressive syndrome in a Western Canadian community population.

To evaluate cross-sectional associations between depressive episodes and a set of potential biopsychosocial determinants in Calgary, Canada. Random digit dialling (RDD) was used to select a sample consisting of 2,542 household residents in Calgary. These subjects were interviewed over the telephone using the Composite International Diagnostic Interview (CIDI) short form for major depression, and a questionnaire evaluating a variety of biopsychosocial variables. The prevalence of major depression was associated with biological (family history of major depression, alcohol consumption, street drug use), psychological (ratings of stress, recent life events) and social factors (social support, marital status, income, level of education). This study confirms that major depression is correlated with a diverse set of potential determinants in community populations, and that the impact of these determinants may differ between different populations. Prospective studies will be needed to further investigate these associations.

Biopsychosocial correlates of lifetime major depression in a multiple sclerosis population.

The objective of this paper was to evaluate the lifetime and point prevalence of major depression in a population-based Multiple Sclerosis (MS) clinic sample, and to describe associations between selected biopsychosocial variables and the prevalence of lifetime major depression in this sample. Subjects who had participated in an earlier study were re-contacted for additional data collection. Eighty-three per cent (n=136) of those eligible consented to participate. Each subject completed the Composite International Diagnostic Interview (CIDI) and an interviewer-administered questionnaire evaluating a series of biopsychosocial variables. The lifetime prevalence of major depression in this sample was 22.8%, somewhat lower than previous estimates in MS clinic populations. Women, those under 35, and those with a family history of major depression had a higher prevalence. Also, subjects reporting high levels of stress and heavy ingestion of caffeine (>400 mg) had a higher prevalence of major depression. As this was a cross-sectional analysis, the direction of causal effect for the observed associations could not be determined. By identifying variables that are associated with lifetime major depression, these data generate hypotheses for future prospective studies. Such studies will be needed to further understand the etiology of depressive disorders in MS.

Suicide in affectively ill adolescents: a case-control study

Sixty-three adolescent suicide victims with a history of affective illness were compared to 23 adolescent community controls with a lifetime history of affective illness, using a case-control design. Suicide victims were more likely to have had major depression, comorbid substance abuse, a past suicide attempt, family history of major depression, treatment with a tricyclic antidepressant, history of legal problems, and a handgun available in the home. There was a non-significant trend for bipolar depression to convey a higher risk for completed suicide than unipolar depression. Recommendations for the prevention of suicide among those with early onset affective illness are discussed in light of these findings.

Psychiatric impact of the loss of an adolescent sibling to suicide

Twenty-five adolescent siblings of 20 adolescent suicide victims were psychiatrically assessed 6 months after the suicide, and compared to 25 demographically matched controls. Siblings were much more likely to show a new-onset major depression subsequent to exposure to suicide. New-onset depression was associated with previous psychiatric disorder, family history of any psychiatric disorder, and family history of major depression. Mothers of suicide victims, compared to the mothers ofcontrols, were also more likely to be depressed 6 months after the suicide of their child. The development of a family-based intervention for families of adolescent suicides is recommended.

Vicissitudes of Depressed Mood During Four Years of Medical School

We describe the vicissitudes of depressed mood for one medical school class that was assessed repeatedly overtime, from the first day of medical school until several months short of graduation, using the Beck Depression Inventory (BDI). Using an arbitrarily defined BDI cutoff point of 14 or greater, at least 12% of the class showed considerable depressive symptoms at any assessment during the first three years; the largest fraction (25%) was symptomatic near the end of the second year. The median class BDI score increased almost threefold during the first two years. Students were likely to be in a similar class ranking at all assessments, indicating that for many students dysphoric mood was enduring. Those with BDI scores of 21 or greater were more likely to quit medical school. Students with high scores for dysphoria were not more likely to evidence a family history of major depression or concomitant substance abuse. Women medical students were not more vulnerable to depressed mood than men.