Greater Depression Severity Research Articles

Clinical Predictors of Extrapyramidal Symptoms Associated With Aripiprazole Augmentation for the Treatment of Late-Life Depression in a Randomized Controlled Trial.

Augmentation with aripiprazole is an effective pharmacotherapy for treatment-resistant late-life depression (LLD). However, aripiprazole can cause extrapyramidal symptoms (EPS) such as akathisia and parkinsonism; these symptoms are distressing and can contribute to treatment discontinuation. We investigated the clinical trajectories and predictors of akathisia and parkinsonism in older patients receiving aripiprazole augmentation for treatment-resistant LLD. Between 2009 and 2013, depressed older adults who did not remit with venlafaxine were randomized to aripiprazole or placebo in a 12-week trial. Participants were 60 years or older and met DSM-IV-TR criteria for major depressive episode with at least moderate symptoms. The presence of akathisia and parkinsonism was measured at each visit using the Barnes Akathisia Scale (BAS) and Simpson-Angus Scale (SAS), respectively. In an exploratory analysis, we examined a broad set of potential clinical predictors and correlates: age, sex, ethnicity, weight, medical comorbidity, baseline anxiety severity, depression severity, concomitant medications including rescue medications, and aripiprazole dosage. Twenty-four (26.7%) of 90 participants randomized to aripiprazole and who had akathisia scores available developed akathisia compared to 11 (12.2%) of 90 randomized to placebo. Greater depression severity was the main predictor of treatment-emergent akathisia. Most participants who developed akathisia improved over time, especially with reductions in dosage. Fifteen (16.5%) of 91 participants taking aripiprazole and who had parkinsonism scores available developed parkinsonism, but no clinical predictors or correlates were identified. Akathisia is a common side effect of aripiprazole, but it is typically mild and responds to dose reduction. Patients with greater baseline depression may warrant closer monitoring for akathisia. More research is needed to understand the course and predictors of treatment-emergent EPS with antipsychotic augmentation for treatment-resistant LLD. ClinicalTrials.gov identifier: NCT00892047.

Association between presenteeism and health-related quality of life among Japanese adults with chronic lower back pain: a retrospective observational study

ObjectivesThis study investigated the relationship between presenteeism and health-related quality of life (HRQoL) among Japanese adults with chronic lower back pain (CLBP).DesignThis was a retrospective, cross-sectional study.SettingData were collected via...

Psychopathological and sociodemographic features in treatment-resistant unipolar depression versus bipolar depression: a comparative study

BackgroundSome authors have hypothesized that Treatment-Resistant Unipolar Depression (TRD-UP) should be considered within the bipolar spectrum disorders and that hidden bipolarity may be a risk factor for TRD-UP. However, there are neither studies comparing clinical and sociodemographic data of patients with TRD-UP versus Bipolar (BP) disorders nor are there any examining differences versus Bipolar type I (BP-I) and Bipolar type II (BP-II).MethodsCharts analysis was conducted on 194 patients followed at the Mood Disorders Clinic of the McGill University Health Center. Sociodemographic, clinical features and depression scales were collected from patients meeting DSM-IV criteria for TRD-UP (n = 100) and BP (n = 94). Binary logistic regression analysis was conducted to examine clinical predictors independently associated with the two disorders.ResultsCompared to BP, TRD-UP patients exhibited greater severity of depression, prevalence of anxiety and panic disorders, melancholic features, Cluster-C personality disorders, later onset of depression and fewer hospitalizations. Binary logistic regression indicated that higher comorbidity with anxiety disorders, higher depression scale scores and lower global assessment of functioning (GAF) scores, and lower number of hospitalizations and psychotherapies differentiated TRD-UP from BP patients. We also found that the rate of unemployment and the number of hospitalizations for depression was higher in BP-I than in BP-II, while the rate of suicide attempts was lower in BP-I than in BP-II depressed patients.ConclusionsThese results suggest that TRD-UP constitutes a distinct psychopathological condition and not necessarily a prodromal state of BP depression.

Individuals with more severe depression fail to sustain nucleus accumbens activity to preferred music over time

We investigated the ability of preferred classical music to activate the nucleus accumbens in patients with Major depressive disorder (MDD). Twelve males with MDD and 10 never mentally ill male healthy controls (HC) completed measures of anhedonia and depression severity, and listened to 90-second segments of preferred classical music during fMRI. Compared to HCs, individuals with MDD showed less activation of the left nucleus accumbens (NAcc). Individuals with MDD showed attenuation of the left NAcc response in later compared to earlier parts of the experiment, supporting theories that MDD involves an inability to sustain reward network activation. Counter intuitively, we found that NAcc activity during early music listening was associated with greater depression severity. In whole-brain analyses, anhedonia scores predicted activity in regions within the default mode network, supporting previous findings. Our results support theories that MDD involves an inability to sustain reward network activation. It also highlights that pleasant classical music can engage critical neural reward circuitry in MDD.

Clinical correlates of negative health events in a research sample with epilepsy

AimsIn spite of advances in care, people with epilepsy experience negative health events (NHEs), such as seizures, emergency department (ED) visits, and hospitalizations. Being able to identify characteristics that are associated with NHE risk can help inform care approaches that reduce complications and burden. This analysis using baseline data from a larger randomized epilepsy self-management clinical trial assessed the relationship between demographic and clinical variables vs. seizure-related complications among people with epilepsy. MethodsData were derived from a baseline sample of a larger prospective study of 120 individuals with epilepsy who experienced an NHE within the last 6months. Demographic characteristics, depression assessed with the 9-item Patient Health Questionnaire (PHQ-9) and the Montgomery–Asberg Depression rating scale (MADRS), quality of life assessed with the 10-item Quality of Life in Epilepsy Inventory (QOLIE-10), self-efficacy assessed the Epilepsy Self-Efficacy Scale (ESES), social support assessed with the Multidimensional Scale of Perceived Social Support (MSPSS), self-management assessed with the Epilepsy Self-Management Scale (ESMS), and stigma assessed with the Epilepsy Stigma Scale (ESS) were all examined in association with past 6-month NHE frequency and 30-day seizure frequency. ResultsExcept for lower levels of education and lower levels of income being associated with higher 30-day and 6-month seizure frequency, demographic variables were generally not significantly associated with NHEs. Higher 30-day seizure frequency was associated with greater depression severity on PHQ-9 (p<0.01) and MADRS (p<0.01). Higher 6-month seizure frequency was also associated with greater depression severity on PHQ-9 (p<.001) and MADRS (p=0.03). Both 30-day and 6-month seizure frequency were significantly negatively associated with QOLIE-10 (p<0.001). Both 30day (p=0.01) and 6-month (p=0.03) seizure frequency were associated with worse stigma on ESS. Total NHE count was associated with more severe depression on PHQ-9 (p=0.02), and MADRS (p=0.04), worse quality of life on QOLIE-10 (p<0.01), and more stigma on ESS (p=0.03). ConclusionsConsistent with previous literature, more frequent seizures were associated with worse depression severity and quality of life. A finding that is less established is that higher seizure frequency is also associated with worse epilepsy-related stigma. Epilepsy self-management approaches need to address depression and stigma as well as seizure control.

The person-specific interplay of melatonin, affect, and fatigue in the context of sleep and depression

The aim of the present study was to reveal how positive affect (PA), negative affect (NA), fatigue, and melatonin are inter-related in individuals with and without MDD. We used a unique dataset with up to 90 measurements of 14 depressed and 15 pair-matched non-depressed participants and the novel network analysis approach Group Iterative Multiple Model Estimation (GIMME) to reveal how affect, fatigue, and melatonin were related across time at the group- and the person-specific level. Thereafter, we investigated how individual differences in the role of melatonin were related to sleep and depression severity.PA and NA (β=−0.47), and PA and fatigue (β=−0.44) were related contemporaneously in the full sample. Substantial between-person differences were found. In 83% of the study participants, melatonin was related to either affect or fatigue. Those who did not have associations with melatonin in their networks had relatively greater depression severity, worse sleep quality, and lower energy expenditure.This study revealed the possibilities of network mapping for dynamic person-specific psychological and biological data. The results underline not only the presence of large heterogeneity, but also show that despite this heterogeneity, meaningful generalizations can be made regarding the interplay of melatonin with affect and fatigue in depression.

The role of late life depressive symptoms on the trajectories of insomnia symptoms during antidepressant treatment

ObjectiveSleep disturbances are common in late life depression; however, changes in insomnia symptoms during antidepressant treatment need to be characterized further. The objective of this study was two-fold: 1) to describe longitudinal trajectories of insomnia symptoms in older adults receiving antidepressant treatment and 2) to examine whether baseline depressive symptoms were associated with trajectories of sleep over time. MethodsData was obtained from 680 older adults (aged ≥ 60) with major depression who participated in one of two protocolized open-label antidepressant treatment clinical trials (Maintenance Therapies in Late Life Depression [MTLD-3]; Incomplete Response in Late Life Depression: Getting to Remission [IRL-GRey]). Depression (total score minus sleep items) and sleep (sum of sleep items) outcomes were derived from the Hamilton Depression Rating Scale in the MLTD-3 and Montgomery-Asberg Depression Rating Scale in the IRL-GRey. ResultsBoth datasets identified 5 possible trajectories of insomnia symptoms with about half of the older adults having clinically significant baseline sleep disturbances and minimal improvement following a course of antidepressant treatment (i.e., sub-optimal sleep trajectory). Furthermore, across both datasets, worse baseline depression severity was associated with sub-optimal sleep trajectories. ConclusionIn older adults receiving antidepressant treatment, those with clinically significant baseline sleep disturbances and greater depression severity may require adjunctive sleep-focused treatment to ameliorate sleep symptoms.

Psychosocial Correlates of Jordanian Adolescents' Help-Seeking Intentions for Depression: Findings From a Nationally Representative School Survey.

Little is known about help-seeking for depression among Jordanian adolescents who are a vulnerable population with high rates of depressive symptoms and few mental health services. The purpose of this study was to (1) explore Jordanian adolescents' helpseeking intentions for depression and (2) examine whether depression stigma, depression severity, or their interaction are associated with Jordanian adolescents' willingness to seek help for depression and the type of treatment they would seek. In collaboration with the Jordanian Ministry of Education, we conducted a nationally representative, school-based survey of adolescents aged 12-17 years ( N = 2,349). One fourth of the adolescents reported they would not seek professional help for depression, and those respondents had higher average depression scores. Among those adolescents willing to seek help, the most likely sources included family member (57%), school counselor (46%), psychiatrist (43%), religious leader (39%), and general health practitioner (28%). Lower stigma scores were associated with greater likelihood to seek psychotherapy or visit a psychiatrist, while higher stigma scores were associated with increased likelihood to seek help from a school counselor or a family member. Jordanian adolescents experience significant barriers to seeking professional help for depression. However, even among adolescents with greater depression severity and depression stigma, school counselors were identified as a key resource for help. These findings suggest that school-based interventions may fill a critical service need for adolescents with depression and other mental health problems. School nurses should be leveraged along with counselors to address mental health issues in this vulnerable population.

Sleep disturbance may impact treatment outcome in bipolar disorder: A preliminary investigation in the context of a large comparative effectiveness trial

BackgroundBipolar patients experience sleep disturbances during and between mood episodes. Yet the impact of sleep on treatment with different medications has not been fully explored. The purpose of this paper is to explore the potential impact of poor sleep at baseline on outcomes in a randomized effectiveness trial of quetiapine and lithium. MethodsThe Bipolar CHOICE study was a 6-month, parallel group, multisite randomized controlled trial. Participants with bipolar disorder (N = 482; 59% female and age 18–70 years) received quetiapine or lithium. Patients were allowed to also receive adjunctive personalized treatments, which were guideline-informed, empirically-based medications added to treatment as needed. Medication changes were recorded as necessary clinical adjustments (NCA). Fisher's exact tests, mixed-regression models, and Mann-Whitney U tests were used to assess demographic and clinical characteristics as well as whether sleep disturbance would predict outcomes. Results63% of patients had baseline sleep disturbance. Individuals with sleep disturbance had worse bipolar illness severity, greater severity of depression, mania, anxiety, irritability, and psychosis, were less likely to have sustained response (17% vs. 29%; adjusted RR: 0.55, 95% CI: 0.38–0.78, p = 0.0006) and had more NCAs (median 0.71 vs. 0.59, p = 0.03). LimitationsOur findings were limited by how we defined sleep disturbance, and by how severity of sleep disturbance was assessed with one item with a non-sleep specific measure. ConclusionsBaseline sleep disturbance was associated with more severe bipolar symptoms and worse 6-month outcomes. Further research is warranted on improving sleep in bipolar disorder, especially the role of psychosocial interventions.

Neuroleptic-free youth at ultrahigh risk for psychosis evidence diminished emotion reactivity that is predicted by depression and anxiety

Although abnormalities in emotional response have long been considered a core feature of the chronic phase of schizophrenia, few investigations have examined emotional response in individuals at ultrahigh-risk (UHR) for psychosis. We investigated whether neuroleptic-free UHR (n=29) and healthy control (n=32) participants differed in emotional reactivity and emotion regulation on a laboratory-based task that required reporting levels of positive and negative affect to pleasant, unpleasant, and neutral stimuli. Results indicated that the UHR group evidenced reduced emotional reactivity, including decreased positive emotion to pleasant stimuli and decreased negative emotion to unpleasant stimuli. Furthermore, within the UHR group, attenuated positive emotion to pleasant stimuli was associated with greater severity of depression and anxiety. There were no group differences in self-reported emotion regulation effectiveness to unpleasant or pleasant stimuli. Findings suggest that UHR youth display a profile of emotional experience abnormalities that differs from the chronic phase of illness, which can be characterized as reduced positive emotion reactivity to pleasant stimuli (i.e., anhedonia) that may be driven by mood and anxiety symptoms.

Factors Associated With Greater Severity of Depression in Chilean Primary Care Patients.

To determine clinical and psychosocial variables associated with increased depression severity in patients who consult public primary health care clinics (PHCs) in Chile. The study included 394 patients diagnosed with major depressive disorder (MDD) according to ICD-10 criteria who were evaluated between February and September 2014 using a sociodemographic interview, the Mini-International Neuropsychiatric Interview (MINI), a screening for childhood trauma, a scale for partner violence, the Life Events Survey (LES), and the Hamilton Rating Scale for Depression (HRSD). Positive correlations were determined between greater severity of depression and more frequency of depressive episodes (r = 0.2, P < .01), psychiatric comorbidities (r = 0.36, P < .01), number of childhood traumatic events (r = 0.19, P < .01), intimate partner violence events (r = 0.155, P < .01), and stressful life events (r = 0.13, P < .05). Inverse correlation was determined with the age at first episode (r = -0.16, P < .01). The psychiatric comorbidities explained most of the variability of depressive symptoms (11.7%); addition of child abuse to the comorbidities increased the correlation to 12.7%. The different covariates considered in this sample showed that psychiatric comorbidity played the principal role in explaining the severity of depression.

Correlates of quality of life among individuals with epilepsy enrolled in self-management research: From the US Centers for Disease Control and Prevention Managing Epilepsy Well Network.

Epilepsy is a chronic neurological condition that causes substantial burden on patients and families. Quality of life may be reduced due to the stress of coping with epilepsy. For nearly a decade, the Centers for Disease Control (CDC) Prevention Research Center's Managing Epilepsy Well (MEW) Network has been conducting research on epilepsy self-management to address research and practice gaps. Studies have been conducted by independent centers across the U.S. Recently, the MEW Network sites, collaboratively, began compiling an integrated database to facilitate aggregate secondary analysis of completed and ongoing studies. In this preliminary analysis, correlates of quality of life in people with epilepsy (PWE) were analyzed from pooled baseline data from the MEW Network. For this analysis, data originated from 6 epilepsy studies conducted across 4 research sites and comprised 459 PWE. Descriptive comparisons assessed common data elements that included gender, age, ethnicity, race, education, employment, income, seizure frequency, quality of life, and depression. Standardized rating scales were used for quality of life (QOLIE-10) and for depression (Patient Health Questionnaire, PHQ-9). While not all datasets included all common data elements, baseline descriptive analysis found a mean age of 42 (SD 13.22), 289 women (63.0%), 59 African Americans (13.7%), and 58 Hispanics (18.5%). Most, 422 (92.8%), completed at least high school, while 169 (61.7%) were unmarried, divorced/separated, or widowed. Median 30-day seizure frequency was 0.71 (range 0-308). Depression at baseline was common, with a mean PHQ-9 score of 8.32 (SD 6.04); 69 (29.0%) had depression in the mild range (PHQ-9 score 5-9) and 92 (38.7%) had depression in the moderate to severe range (PHQ-9 score >9). Lower baseline quality of life was associated with greater depressive severity (p<.001), more frequent seizures (p<.04) and lower income (p<.05). The MEW Network Integrated Database offers a unique opportunity for secondary analysis of data from multiple community-based epilepsy research studies. While findings must be tempered by potential sample bias, i.e. a relative under-representation of men and relatively small sample of some racial/ethnic subgroups, results of analyses derived from this first integrated epilepsy self-management database have potential to be useful to the field. Associations between depression severity and lower QOL in PWE are consistent with previous studies derived from clinical samples. Self-management efforts that focus on mental health comorbidity and seizure control may be one way to address modifiable factors that affect quality of life in PWE.

Relation between patterns of intrinsic network connectivity, cognitive functioning, and symptom presentation in trauma-exposed patients with major depressive disorder.

ObjectiveThe present study investigated resting fMRI connectivity within the default mode (DMN), salience (SN), and central executive (CEN) networks in relation to neurocognitive performance and symptom severity in trauma‐exposed patients with major depressive disorder (MDD).MethodGroup independent component analysis was conducted among patients with MDD (n = 21), examining DMN, SN, and CEN connectivity in relation to neurocognitive performance and symptom severity. Activation in these networks was also compared between the patient group and healthy controls (n = 20).ResultsAmong the patient group, higher levels of performance on measures of verbal memory and executive functioning were related to increased connectivity within the DMN (i.e., inferior parietal lobe; precuneus). Greater depression severity was related to reduced connectivity between the SN and a node of the DMN (i.e., posterior cingulate cortex) and higher depersonalization symptoms were related to enhanced connectivity between the SN and a node of the DMN (i.e., middle temporal gyrus). Higher symptoms of depersonalization were also associated with reduced integration of the DMN with the medial frontal gyrus. Relative to controls, patients with MDD showed greater connectivity of the ventromedial prefrontal cortex within the DMN.ConclusionIntrinsic connectivity network patterns are related to cognitive performance and symptom presentation among trauma‐exposed patients with MDD.

Sleep disturbance and its associations with severity of dependence, depression and quality of life among heroin-dependent patients: a cross-sectional descriptive study

BackgroundSleep disturbance is common and may adversely affect treatment outcome, mental health, and quality of life in heroin-dependent patients.Previous studies have focused upon patients receiving treatment. We conducted a cross-sectional descriptive study to explore the 1-month prevalence of sleep disturbance and its associations with socio-demographic, substance-related characteristics, severity of dependence, severity of depression, and quality of life among heroin-dependent patients before entering treatment program.MethodsThe sample (n = 514) comprised individuals with heroin dependence attending the methadone maintenance treatment program and the therapeutic community at a psychiatric center in Nantou, Taiwan between 2008 and 2014. Sleep quality was measured using Pittsburgh Sleep Quality Index (PSQI) with a global score greater than 5 indicating sleep disturbance. Centre for Epidemiologic Studies Depression Scale, Severity of Dependence Scale, and World Health Organization Quality of Life-BREF were also approached. T-test, chi-square tests, and multivariate logistic regression were performed to measure associations between variables and sleep disturbance.ResultsThe 1-month prevalence of sleep disturbance (PSQI > 5) was 76.3% among 514 subjects with heroin dependence. Heroin users with sleep disturbance had significantly more life events in the previous year, higher rate of unemployment, greater cigarette consumption, more substance related criminal convictions, longer length of heroin use, higher rate of injectors, greater severity of dependence, greater severity of depression, and lower quality of life compared to those without sleep disturbance. Severity of dependence, severity of depression, and physical health domain of quality of life remained significantly associated with sleep disturbance after adjusting for other variables.ConclusionHeroin-dependent patients had a high 1-month prevalence of sleep disturbance, and this was associated with greater severity of dependence, greater severity of depression, and poorer physical health-related quality of life. Early assessments and interventions for sleep disturbance among patients with heroin dependence are recommended.

Depressive symptoms and adherence to cardiometabolic therapies across phases of treatment among adults with diabetes: the Diabetes Study of Northern California (DISTANCE).

ObjectiveAmong adults with diabetes, depression is associated with poorer adherence to cardiometabolic medications in ongoing users; however, it is unknown whether this extends to early adherence among patients newly prescribed these medications. This study examined whether depressive symptoms among adults with diabetes newly prescribed cardiometabolic medications are associated with early and long-term nonadherence.Patients and methodsAn observational follow-up of 4,018 adults with type 2 diabetes who completed a survey in 2006 and were newly prescribed oral antihyperglycemic, antihypertensive, or lipid-lowering agents within the following year at Kaiser Permanente Northern California was conducted. Depressive symptoms were examined based on Patient Health Questionnaire-8 scores. Pharmacy utilization data were used to identify nonadherence by using validated methods: early nonadherence (medication never dispensed or dispensed once and never refilled) and long-term nonadherence (new prescription medication gap [NPMG]: percentage of time without medication supply). These analyses were conducted in 2016.ResultsPatients with moderate-to-severe depressive symptoms had poorer adherence than nondepressed patients (8.3% more patients with early nonadherence, P=0.01; 4.9% patients with longer NPMG, P=0.002; 7.8% more patients with overall nonadherence [medication gap >20%], P=0.03). After adjustment for confounders, the models remained statistically significant for new NPMG (3.7% difference, P=0.02). There was a graded association between greater depression severity and nonadherence for all the models (test of trend, P<0.05).ConclusionDepressive symptoms were associated with modest differences in early and long-term adherence to newly prescribed cardiometabolic medications in diabetes patients. Interventions targeting adherence among adults with diabetes and depression need to address both initiation and maintenance of medication use.

How does stigma affect people with psoriasis?

IntroductionPsoriasis is associated with a major additional psychological burden.AimTo investigate whether the extent of skin involvement, stigmatization, and perceived social support are related to depressive symptoms in psoriasis patients.Material and methodsOne hundred and forty-eight psoriasis patients completed in the BSA, the Beck Depression Inventory, Stigmatization Scale, and Multidimensional Scale of Perceived Social Support.ResultsAlmost 13% of participants obtained a BDI total score indicating moderate depressive symptoms. The results of regression analysis revealed that greater depression severity in psoriasis patients is associated with higher levels of psoriasis-related stigma, lower perceived social support, female gender and a shorter duration of the disease, explaining 43% of the variance of depression. The stigmatization was the most powerful predictor of depressive symptoms for psoriasis patients and accounted for 33% of the variance.ConclusionsThe extent of psoriasis does not directly lead to mood disturbance in these patients. Rather, social stigma accounted for this relationship. Strategies for reducing the stigma attached to patients with psoriasis are required.

Unintentional Injuries among Psychiatric Outpatients with Major Depressive Disorder.

BackgroundNo study has investigated the percentages of and factors related to unintentional injuries among psychiatric outpatients with major depressive disorder (MDD). This study aimed to investigate these issues.MethodsOne-hundred and forty-one outpatients with MDD at baseline were enrolled from psychiatric outpatients by systematic sampling, and 119 subjects attended a one-year follow-up. Self-reported unintentional injuries in the past one year were recorded. Psychiatric disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. The severity of depression was evaluated by the Hamilton Depression Rating Scale. Other data, including body weight and height, cigarette smoking, headaches, and medications, were collected. Generalized Estimating Equations were used to investigate independent factors related to unintentional injuries.ResultsAt baseline and follow-up, 40.4% and 27.7% of subjects had experienced at least one unintentional injury in the past one year, respectively. About half of subjects with unintentional injuries needed medical treatment for injuries and had functional impairment due to injuries. A greater severity of depression, cigarette smoking, a higher body mass index, and an older age were independent risk factors related to unintentional injuries.ConclusionUnintentional injuries that increased the medical burden and functional impairment were common among outpatients with MDD and should not be neglected. Treatment of depression, control of body weight, and quitting cigarettes might be helpful to prevent unintentional injuries.

Factors associated with and impact of pain persistence in Asian patients with depression: a 3-month, prospective observational study

Objective: We investigated the depression outcomes and the factors associated with pain persistence in Asian patients treated for major depressive disorder (MDD).Methods: This observational study enrolled 909 Asian adult inpatients and outpatients. The presence or absence of painful physical symptoms and severity of depression were assessed at baseline and after three months of treatment. Factors associated with pain persistence and outcome of depression were investigated using regression methods.Results: Of the 909 patients enrolled, 684 were included in the analysis and evaluated at three months. Of them, 335 (49%) had no pain at baseline nor follow up, 198 (29%) at baseline but not at follow up and 151 (22%) in both assessments. Pain more frequently persisted in patients who were divorced/widowed/separated, with >1 comorbidity, aged <40 years, with previous MDD episodes, taking pain medications, and with greater depression severity. At three months, response/remission were 84%/73% in the no pain group, 83%/63% in the remitted pain group and 46%/25% in the persistent pain group (differences all p < .0001; all bivariate comparisons were statistically significant with p < .05 except response between no pain and remitted pain). Persistent pain was also associated with less improvement in quality of life and health state.Conclusions: Pain should be taken into account when diagnosing MDD and when tailoring therapy.

The influence of cooperation and defection on social decision making in depression: A study of the iterated Prisoner's Dilemma Game.

This study evaluated the influence of self-reported levels of depression on interpersonal strategic decision making when interacting with partners who differed in their predetermined tendency to cooperate in three separate computerized iterated Prisoner's Dilemma Games (iPDGs). Across 29 participants, cooperation was lowest when interacting with a predominantly defecting partner and highest when interacting with a predominantly cooperating partner. Greater depression severity was related to steadier and continued cooperation over trials with the cooperating partner, seeming to reflect a prosocial response tendency when interacting with this partner. With the unbiased partner, depression severity was associated with a more volatile response pattern in reaction to cooperation and defection by this partner. Severity of depression did not influence cooperation with a defecting partner or expectations about partner cooperation reported before the task began. Taken together, these data appear to show that in predominately positive interactions, as in the cooperating partner condition, depression is associated with less volatile, more consistent cooperation. When such clear feedback is absent, as in the unbiased partner condition, depression is associated with more volatile behavior. Nonetheless, participants were generally able to adapt their behavior accordingly in this dynamic interpersonal decision making context.

Poststroke agitation and aggression and social quality of life: a case control study

Background and objective: Aggression and agitation are common after a stroke. The association between agitation/aggression following stroke and Health-Related Quality of Life (HRQoL) in stroke survivors is unknown. This study aimed to examine the association between agitation/aggression and HRQoL in Chinese stroke survivors.Methods: Three hundred and twenty-four stroke patients entered this cross-sectional study. Agitation/aggression was assessed using the Chinese version of Neuropsychiatric Inventory (CNPI). HRQoL was measured with the Stroke Specific Quality of Life (SSQoL).Results: Three months after the index stroke, agitation/aggression was found in 60 (18.5%) patients. In the agitation/aggression group, 44 patients (73.3%) showed passive agitation/aggression, whereas 16 (26.7%) displayed passive and active agitation/aggression. No patients showed only active agitation/aggression. Patients with agitation/aggression were more likely to have history of diabetes and greater severity of depression, as well as lower SSQoL total score and Personality Changes and Social Role scores. Controlling for diabetes and depression severity did not alter the above results. The Energy and Thinking scores of the SSQoL were significantly lower in the passive/active agitation/aggression group relative to the passive agitation/aggression group (adjusted for CNPI aggression/agitation score).Conclusion: In this study sample, agitation/aggression was preponderantly of the passive type and was associated with poorer HRQoL independently from depression or medical conditions. Patients with both passive and active agitation/aggression had lower Quality of Life (QoL) than patients with only passive agitation/aggression. The causality of the association between low QoL and agitation/aggression needs to be explored in future studies.