Greater Depressive Symptomatology Research Articles

Polypharmacy prevalence rates in the treatment of unipolar depression in an outpatient clinic

Objective Unipolar depression is a complex illness with an ever increasing number of pharmacological treatments available. As the number of available medication options increases, so does the potential for polypharmacy, a practice with possible complications. Such complications include a greater number of side effects with the initiation of additional medications and the consequences of drug–drug interactions. Therefore, it is important to understand the effects of polypharmacy on efficacy of treatment as well as whether polypharmacy is instituted after appropriate initial monotherapy trials. This study attempts to answer these questions. Methods Patient names for this investigation were provided by residents in the UMass Medical School Psychiatry Residency program. The charts of these patients were analyzed to collect data regarding demographics, clinical data about the illness, medication names, types, duration of use and to access efficacy using the Clinical Global Impression (CGI). Results Of 160 reviewed charts, 135 subjects were included in the final analyses (others excluded due to incomplete data or no depression diagnosis). Patients were on average on 2.0 medications (SD = 0.5) with 2.1 past trials. A greater number of current antidepressant medications did not correlate with a greater improvement in CGI, implying that polypharmacy did not necessarily lead to greater efficacy. The impact of illness severity, as measured by comorbidities, substance abuse, and trauma history, were included in the analysis, and did not significantly change this outcome. Additionally, prescription patterns themselves were examined, including reasons for termination of medication trials, the impact of side-effects, and the number of patients that had complete monotherapy trials before transitioning to polypharmacy. Study limitations Small sample size, retrospective review, one CGI rater. Conclusions First, many patients did not receive an adequate monotherapy trial, as defined by dose and duration, before progressing to polypharmacy. Secondly, the use of two or more medications concurrently did not appear to increase efficacy as measured by CGI. Due to study limitations, direct comparison of the efficacy of one and two medications was not significant; however the study did demonstrate a general correlation between polypharmacy and greater depressive symptomatology. This suggests the need for optimizing monotherapy regimens before initiating polypharmacy that may not lead to improvement in symptoms.

Family caregiver social problem-solving abilities and adjustment to caring for a relative with vision loss.

To examine the prevalence of persons at risk for depression among family caregivers of visually impaired persons and the extent to which social problem-solving abilities are associated with caregiver depressive symptomatology and life satisfaction. Family caregivers were defined as adults who accompanied their adult relative to an appointment at a low-vision rehabilitation clinic and self-identified themselves as the primary family caregiver responsible for providing some form of assistance for their relative due to vision impairment. Demographic variables, depressive symptoms, life satisfaction, caregiver burden, and social problem-solving abilities were assessed in caregivers. The patient's visual acuity and depressive symptoms and their relationship to the caregiver's depressive symptoms and life satisfaction were also examined. Ninety-six family caregivers were enrolled. Of those, 35.4% were identified as at risk for depression. Among caregivers, dysfunctional or ineffective social problem-solving abilities were significantly associated with greater depressive symptomatology and decreased life satisfaction after adjustment for caregiver burden and demographic and medical variables for both the caregiver and the visually impaired patient. Problem orientation or motivation to solving problems was also significantly associated with caregiver depression and satisfaction with life. A substantial number of caregivers of visually impaired adults experience psychosocial distress, particularly among those who possess poor social problem-solving abilities. These results underscore the need for routine screening and treatment of emotional distress among individuals caring for relatives with vision impairments. Future research should examine the extent to which psychosocial interventions targeting caregiver social problem-solving skills may be useful not only in improving caregiver quality of life but also in subsequently enhancing rehabilitation outcomes for the visually impaired care recipient.

Telephone-Delivered, Interpersonal Psychotherapy for HIV-Infected Rural Persons With Depression: A Pilot Trial

Telephone-Delivered, Interpersonal Psychotherapy for HIV-Infected Rural Persons With Depression: A Pilot Trial

High ω-6 and Low ω-3 Fatty Acids are Associated With Depressive Symptoms and Neuroticism

To examine the concentrations of omega-3 and omega-6 polyunsaturated fatty acids in serum obtained from nonpatient community volunteers not selected for hypercholesterolemia. Previously we reported that the relative concentrations of omega-3 and omega-6 polyunsaturated fatty acids in serum covary with depressive symptomatology and neuroticism in hypercholesterolemic adults. A total of 116 adults without current Axis I psychopathology completed the Beck Depression Inventory (BDI) and the NEO Personality Inventory--Revised (NEO-PI-R). Fasting serum phospholipid eicosapentaenoic (EPA), docosahexaenoic (DHA), and arachidonic acid (AA) were determined (% of total pool). Higher AA and AA:EPA ratio, adjusted for age, gender, and race, were associated with greater depressive symptomatology (BDI score of >or=10). Lower EPA, and higher AA, AA:EPA ratio and AA:DHA ratio were associated with greater NEO-PI-R Neuroticism. The six Neuroticism subscales were each associated with two or more fatty acid measurements. In conjunction with other reports, these findings suggest that the omega-3 and omega-6 fatty acids are related to negative affect at both the symptom and trait levels.

Screening for Psychological Distress in Cancer Patients: Challenges and Opportunities

Screening for Psychological Distress in Cancer Patients: Challenges and Opportunities

Un Corazón Saludable: Factors Influencing Outcomes of an Exercise Program Designed to Impact Cardiac and Metabolic Risks among Urban Latinas

A high prevalence of physical inactivity, metabolic risk factors, and depression place Latinas in peril of developing cardiovascular disease. "Un Corazón Saludable: A Healthy Heart" was developed to engage urban Latinas in physical activity and increase awareness of cardiac and metabolic risk factors. Two hundred and twenty-five Latinas enrolled in the program that included salsa aerobics and culturally sensitive health education modules. Cardiac and metabolic risk factors measured in this study were body mass index (BMI), waist-to-hip ratio, abdominal obesity, and blood pressure. Psychosocial risk factors measured included depressive symptoms and perceived social support. Fifty-two percent of the enrollees completed the program. Results indicated decreases in BMI, abdominal obesity, and symptoms of depression among Latinas who completed the program. Those who did not complete the program were younger, had greater depressive symptomatology, reported poorer social support, and they tended to be caregivers and U.S. born. Focus groups of program participants ascertained that caregiving and family obligations were major barriers to exercise while social support was a major facilitator of exercise. This research indicates that programs developed to recognize and address cultural barriers can impact physical and psychosocial risk factors among urban Latinas who are able to attend. Program retention may improve if future exercise programs conducted through community-base organizations offered support to Latinas regarding issues that interfere with self-care and health promotion. Future programs should consider including mental health and social service case management as part of comprehensive exercise/educational programs.

Early Family Environment, Current Adversity, the Serotonin Transporter Promoter Polymorphism, and Depressive Symptomatology

Mixed evidence has suggested that homozygous carriers of the short allele (s/s) of the serotonin transporter gene-linked polymorphic region (5-HTTLPR) may be at increased risk for depression, if they have also been exposed to early or current adversity/stress. We address this debate by examining the relation of a stressful early family environment, recent adversity/stress, and the 5-HTTLPR to depressive symptomatology in a normal sample. A nonclinical sample of 118 young adult men and women completed assessments of early family environment, recent stressful events, psychosocial resources, and psychological distress, including depressive symptomatology. The 5-HTTLPR was genotyped using a standard protocol with DNA extracted from oral fluid. A stressful early family environment was significantly related to depressive symptomatology. In addition, gene-by-environment (GxE) interactions were observed between the 5-HTTLPR and both early family environment and current adversity/stress. Individuals homozygous for the short allele had greater depressive symptomatology if they had experienced early or recent adversity but significantly less depressive symptomatology if they reported a supportive early environment or recent positive experiences, compared with participants with the s/l or l/l genotype. Early or current environment, in conjunction with the serotonin transporter polymorphism, predicts depressive symptomatology.

Substance Use Disorder Comorbidity in Major Depressive Disorder: A Confirmatory Analysis of the STAR*D Cohort

The demographics and clinical features were compared between those with (29.4%) and without concurrent substance use disorder (SUD) in 2541 outpatients with major depression (MDD) enrolled in the Sequenced Treatment Alternatives to Relieve Depression study. Compared to those without SUD, MDD patients with concurrent SUD were more likely to be younger, male, divorced or never married, and at greater current suicide risk, and have an earlier age of onset of depression, greater depressive symptomatology, more previous suicide attempts, more frequent concurrent anxiety disorders, and greater functional impairment (p = 0.048 to <0.0001). They were also less likely to be Hispanic and endorse general medical comorbidities (p = 0.006 and 0.002, respectively).

Reliability and Validity of the Spanish Version of the Crisis in Family Systems–Revised

Increasing the representation of Spanish-speaking study participants requires development and dissemination of reliable and valid translated scales. In the urrent study the construct validity was assessed of the Spanish version of the Crisis n Family Systems-Revised, a measure of contemporary life stressors, with a convenience sample of 377 parents interviewed in a study of childhood asthma, although over half of the respondents did not have children with asthma. Most respondents were foreign-born women between 20 to 60 years old (M=35, SD=7). 52% had not completed high school or its equivalent, and 55% reported a household income of dollar 15,000 or less. For a subsample of 25 respondents test-retest reliability was .86 over 2 wk. Reporting more life stressors was associated with greater depressive symptomatology, poorer physical and mental health function, and lower household income. These relationships support the construct validity of the test in Spanish. This study provided strong evidence that this version is a valid and reliable measure of life stressors for a Spanish-speaking population living in the United States.

Illness perceptions among cardiac patients: Relation to depressive symptomatology and sex

Objective This study examined cardiovascular disease (CVD) illness perceptions and how they relate to depressive symptomatology among women and men. Methods Acute coronary syndrome (ACS) patients at two hospitals were approached, and 661 consented to participate (504 men, 157 women; 75% response rate). Participants completed a survey including the Hospital Anxiety and Depression Scale (HADS) and Illness Perception Questionnaire (IPQ). Results Women perceived a significantly more chronic course ( P<.001) and more cyclical episodes ( P<.05) than men did, while men perceived greater personal control ( P<.001) and treatability ( P<.05) than women did. Participants perceived diet, heredity, and stress as the greatest CVD causes. For women ( F=5.49, P<.001), greater depressive symptomatology was significantly related to younger age ( P<.05), lower activity status ( P<.001), and perceiving a chronic time course ( P<.01). For men ( F=7.68, P<.001), greater depressive symptomatology was significantly related to being non-white ( P<.05), lower activity status ( P<.001), less exercise behavior ( P=.01), and three illness perceptions, namely, perceiving a chronic course ( P<.05), greater consequences ( P<.001), and lower treatability ( P<.05). Conclusion Women, compared with men, are more likely to attribute CVD to causes beyond their control and to perceive CVD as a chronic, untreatable condition. Illness perceptions were related to depressive symptomatology, which suggests that interventions to reframe these perceptions may be warranted to improve emotional health in the context of CVD.

Prospective Examination of Anxiety Persistence and Its Relationship to Cardiac Symptoms and Recurrent Cardiac Events

Background: The current study builds on previous research demonstrating a link between anxiety and inhospital recurrent ischemic and arrhythmic events, by examining the effects of persistent anxiety on recurrent events 1 year later. Methods: 913 patients with unstable angina (UA) and myocardial infarction (MI) from 12 coronary care units were recruited, and follow-up data were collected at 6 and 12 months after the event. Measures included cardiac symptomatology, healthcare utilization, the anxiety subscale of the Primary Care Evaluation of Mental Disorders , the phobic anxiety subscale of the Middlesex Hospital Questionnaire, and the Beck Depression Inventory. Results: Over one third of participants with UA and MI experienced elevated anxiety at the time of the ischemic event, and these symptoms persisted for 1 year in 50% of anxious participants. Although participants with anxiety reported more atypical cardiac symptomatology, the prevalence of typical cardiac symptoms such as chest pain did not differ based on anxiety. After controlling for the severity of the coronary event, family income, sex, diabetes, and smoking, the following variables were significantly predictive of self-reported recurrent cardiac events at 6 months or 1 year: older age, family history of cardiovascular disease, greater depressive symptomatology at baseline, and anxiety at 6 months. Only 38% of anxious patients were asked about such symptoms, indicating underutilization of effective psychotherapeutic treatment. Conclusions: Over and above the effects of depressive symptomatology (among other confounding variables), nonphobic anxiety appears to have a negative effect on self-reported outcome following an ischemic coronary event. Anxiety symptomatology is underrecognized and undertreated, and examination of effects of treatment on secondary prevention must be pursued.

Religiosity and the expansion of caregiver stress

We present a stress process framework as a model for understanding how religiosity may influence the expansion of stress. Survey data from informal caregivers to a spouse with Alzheimer'sdisease or a related dementia (n = 200) were analyzed to observe the relationships among three variables: (1) care-related stress, (2) religiosity, and (3) depression. This sample, which has a mean age of 73 years, demonstrates high rates of self-described religiosity, church attendance and frequency of prayer. Using these criteria, women and racial/ethnic minority caregivers are the most religious. In a series of multivariate analyses, we found strong evidence to suggest that there is an expansion of care-related stressors leading to depression in this sample. Religiosity, as measured here, appears to be largely unrelated to stress and stress expansion. We found no evidence to suggest that it moderates stress expansion. However, these data do suggest that one stressor—feelings of role overload—is correlated with greater levels of self-perceived religiosity, which among caregivers who have health problems of their own is associated with greater depressive symptomatology. Thus, for a sub-sample of these caregivers, we find weak evidence of a mediation effect wherein one subjective, non-organizational dimension of religiosity is a conduit of the harmful effects of stress (rather than a suppressor). Results and data limitations are discussed in relation to better assessing the role of religiosity and spirituality in the experience of the stress process.

Erectile Dysfunction in Early, Middle, and Late Adulthood: Symptom Patterns and Psychosocial Correlates

The prevalence of erectile dysfunction (ED) increases with age. However, it may emerge at any time during the adult years, and may bear a close relationship to ongoing psychosocial issues affecting the patient and his partner. The present study examined ED symptomatology and its associated psychosocial context in 560 men aged 19-87 attending a urology clinic for erectile difficulties. We divided participants into three age groups: early adulthood (age 19-39); middle adulthood (40-59); and late adulthood (60+). They completed a self-report assessment battery evaluating medical, psychological, and lifestyle factors empirically or theoretically related to ED. Results showed that although younger men reported more positive overall ratings of their sex life and better overall erectile functioning relative to older men, they also reported comparatively less relationship satisfaction, greater depressive symptomatology, more negative reactions from partners, and less job satisfaction. Results suggest that older men experience less difficulty than younger men adjusting to life with ED.

Spiritual belief and quality of life: The experience of older bereaved spouses

Spiritual wellbeing is a neglected aspect of quality of life in British research on ageing. US research emphasises the health and other benefits of religious belief for American older people. However, whereas the US is still a strongly religious society, in Britain there has been a steady erosion of membership of Christian churches, accompanied by a loss of respect for the authority of the church and an increased freedom of expression in belief. In an exploratory study the implications of spiritual belief for adjustment have been studied in a sample of 28 older bereaved spouses, who have been followed from the first to the second anniversary of the death. Using a recently developed measure of strength of spiritual belief, a clear pattern was found of greater depressive symptomatology and lower perception of personal meaning among those of moderate belief; ie those who still held to a belief in a spiritual power outside of themselves but who were not sure of its efficacy. Investigation of this group of 11 moderate believers provided many illustrations of spiritual questioning, uncertainty and unease. It appears likely that a substantial proportion of the older population in Britain has become isolated from their churches of origin, yet maintains forms of spiritual belief, often hesitant in character. Some may benefit from renewed contact. Statutory health and welfare agencies need to consider their own role in promoting such re‐engagement.

Juego problema y sintomatología depresiva en adolescentes

A clear relationship between gambling and depression has been found among adults. However, this relationship has not been studied among adolescents. The present study analyses this relationship in a representative sample of secondary school adolescents in Galicia (N= 2.790). Problem gambling and at- risk gambling were evaluated using the South Oaks Gambling Screen-Revised Adolescents (SOGS-RA) by Winters et al. (1993) and depressive symptomatology using the Child Depression Inventory, CDI, by Kovacs (1992). The results showed an increase in depressive symptomatology as involvement in gambling increases, with a CDI score of 12.71 for non-gamblers, 14.63 for at-risk gamblers and 19.66 for problem gamblers, with significant differences in all the groups. Differences were also found with respect to age. Those having greater gambling problems also show greater scores in depressive symptomatology when variables such as greater involvement of parents in gambling, academic failure, and worse relationship with their parents were considered. The results as a whole show a consistent relationship between greater involvement in gambling and greater depressive symptomatology.

Cognitive Decline Affects Subject Attrition in Longitudinal Research

We evaluated prospectively 210 patients with idiopathic Parkinson’s disease (PD) to determine whether cognitive deterioration and disease disability affect subject drop out. Subjects who refused to return for follow-up testing had a greater degree of bradykinesia and overall disability, more advanced disease, fewer years of education and greater depressive symptomatology. However, discriminant analysis indicated that performance on the neuropsychological measures, rather than PD severity, significantly predicted whether patients return for follow-up testing. Our findings indicate that cognitive impairment uniquely contributes to subject attrition, which may distort dementia estimates in PD.

Level and perceived stability of self-esteem prospectively predict depressive symptoms during psychoeducational group treatment.

To investigate the combined roles of level and perceived stability of self-esteem in prospectively predicting depression. Symptoms of depression and anxiety were measured both before and after psychoeducational treatment for depression; level and perceived stability of self-esteem were measured before treatment. Participants were 26 adults (16 female), age range 21-75 years. More stable self-esteem was associated with greater depressive symptomatology at treatment completion, particularly among participants who began treatment with the lowest self-esteem. Effects were specific to symptoms of depression in contrast with anxiety. These results suggest that a stable, well-consolidated negative self-concept is associated with prolonged depression and a poor response to psychosocial interventions.

Self‐concept Differentiation and Depressive Symptomatology in Children

Self‐concept differentiation is the degree to which separate domains of the self‐concept are differentiated from one another. Two studies of children's self‐reported depressive symptomatology and self‐concept differentiation were completed. Study 1 found higher levels of self‐concept differentiation associated with greater depressive symptomatology. Study 2 replicated this finding but further revealed a trend for elevated self‐concept differentiation to be related to a positive outcome at 5‐week follow‐up in the depressed sample.

The detection of dementia and cognitive impairment in a community population of elderly people with Parkinson's disease by use of the CAMCOG neuropsychological test.

To assess cognitive function in elderly subjects with clinically probable Parkinson's disease (PD). A community sample of 126 patients with probable PD completed the CAMCOG, which is the cognitive section of the Cambridge Examination for Mental Disorders, and the Mini-Mental State Examination (MMSE). The performance of the CAMCOG and the MMSE in detecting dementia in this subject group was compared with the results of applying the DSM-IV criteria for dementia to this population. A total of 44% of the group met DSM-IV criteria for dementia, which is higher than most previous prevalence figures for dementia in PD. The CAMCOG was more sensitive than the MMSE in detecting cognitive impairment and more specific than the MMSE in detecting dementia as defined by DSM-IV criteria. Poorer performance on the CAMCOG was related to gender, social class and age (P<0.05). Among subjects with PD, those with dementia, as defined by DSM-IV criteria, were significantly older, had greater depressive symptomatology and had greater motor deficits. A greater proportion of the group with dementia were living in residential care (P<0.05). The CAMCOG appears to be a useful screening instrument for dementia and cognitive impairment in PD. Furthermore, it may prove helpful in detecting those with PD who may be at risk of developing dementia and in longitudinal studies of cognitive function in PD.

Family support and conflict: prospective relations to adolescent depression.

The relations between family support, family conflict, and adolescent depressive symptomatology were examined longitudinally in a sample of 231 female and 189 male adolescents and their mothers. Structural equation models revealed that less supportive and more conflictual family environments were associated with greater depressive symptomatology both concurrently and prospectively over a 1-year period. Conversely, adolescent depressive symptomatology did not predict deterioration in family relationships. Depressive symptomatology and, to a greater extent, family characteristics showed high levels of stability over the 1-year period. Counter to our expectations, the relations between family variable and depressive symptomatology were similar for boys and girls. The results suggest that the quality of family interactions is relevant for understanding the development of depressive symptoms in adolescents.