Higher Beck Depression Inventory-II Research Articles

The impact of severe depression on the survival of older patients with end-stage kidney disease.

Incidence of depression increases in patients with end-stage kidney disease (ESKD). We evaluated the association between depression and mortality among older patients with ESKD, which has not been studied previously. This nationwide prospective cohort study included 487 patients with ESKD aged >65 years, who were categorized into minimal, mild-to-moderate, and severe depression groups based on their Beck Depression Inventory-II (BDI-II) scores. Predisposing factors for high BDI-II scores and the association between the scores and survival were analyzed. The severe depression group showed a higher modified Charlson comorbidity index value and lower serum albumin, phosphate, and uric acid levels than the other depression groups. The Kaplan-Meier curve revealed a significantly lower survival in the severe depression group than in the minimal and mild-to-moderate depression groups (p = 0.011). Multivariate Cox regression analysis confirmed that severe depression was an independent risk factor for mortality in the study cohort (hazard ratio, 1.39; 95% confidence interval, 1.01-1.91; p = 0.041). Additionally, BDI-II scores were associated with modified Charlson comorbidity index (p = 0.009) and serum albumin level (p = 0.004) in multivariate linear regression. Among the three depressive symptoms, higher somatic symptom scores were associated with increased mortality. Severe depression among older patients with ESKD increases mortality compared with minimal or mild-to-moderate depression, and patients with concomitant somatic symptoms require careful management of their comorbidities and nutritional status.

#5293 THE IMPACT OF SEVERE DEPRESSION ON THE SURVIVAL OF OLDER PATIENTS WITH END-STAGE KIDNEY DISEASE

Abstract Background and Aims Incidence of depression increases in patients with end-stage kidney disease (ESKD). We evaluated the association between depression and mortality among older patients with ESKD, which has not been studied previously. Method This nationwide prospective cohort study included 487 patients with ESKD aged > 65 years, who were categorized into minimal, mild-to-moderate, and severe depression groups based on their Beck Depression Inventory-II (BDI-II) scores. BDI-II scores were separated into three symptom domains: affective, cognitive, and somatic depressive symptoms. The association between the depression groups and survival were analyzed using multivariate Cox proportional hazard regression models. Predisposing factors for high BDI-II scores were evaluated using logistic regression analysis. The associations among the three depressive-symptom domains and survival were also analyzed. Results The severe depression group showed a higher modified Charlson comorbidity index value and lower serum albumin, phosphate, and uric acid levels than the other depression groups. The Kaplan–Meier curve revealed a significantly lower survival in the severe depression group than in the minimal and mild-to-moderate depression groups (P = 0.011). Multivariate Cox regression analysis confirmed that severe depression was an independent risk factor for mortality in the study cohort [hazard ratio (HR), 1.39; 95% confidence interval (CI), 1.01–1.91; P = 0.041). BDI-II scores were associated with modified Charlson comorbidity index (P = 0.009) and serum albumin level (P = 0.004) in multivariate linear regression. Among the three depressive symptoms, higher somatic symptom scores were associated with increased mortality (HR, 2.45; 95% CI, 1.25–4.79; P = 0.009). Conclusion Among older patients with ESKD, severe depression increases mortality compared with minimal or mild-to-moderate depression. And patients with concomitant somatic symptoms require careful management of their comorbidities and nutritional status.

Abstract 10133: Cerebrovascular Imaging Biomarkers, Neuropsychiatric Symptoms, and Mild Cognitive Impairment

Introduction: Cerebrovascular disease (CVD) and neuropsychiatric symptoms (NPS) are common in older adults and are independently associated with cognitive impairment. In addition, vascular depression (a late-life depression) is hypothesized to be associated with cerebrovascular pathology. Hypothesis: CVD pathology imaging biomarkers (e.g., white matter hyperintensities (WMH), infarctions) are associated with depression and anxiety, and both (depression/anxiety and CVD imaging biomarkers) are independently associated with mild cognitive impairment (MCI). Methods: This cross-sectional study included 1739 Mayo Clinic Study of Aging participants (≥50 years old) without dementia, with comprehensive cognitive evaluations and available data on the Beck Depression Inventory II (BDI), the Beck Anxiety Inventory (BAI) and imaging CVD biomarkers via FLAIR-MRI (i.e., WMH% of total intracranial volume (TIV) and brain infarctions). We used linear and logistic regression models to examine the associations adjusting for age, sex, education, and apolipoprotein E ε4 status. Results: Participants’ mean age (SD) was 71.11 (10.61) years (53.3% males). Higher WMH% TIV burden was significantly associated with higher BDI (b= 0.082, 95%CI: 0.031, 0.133), p=0.002) and BAI scores (b= 0.088, 95%CI: 0.037, 0.140), p=0.001); the presence of infarctions was also associated with a higher BDI score. Both WMH %TIV burden (OR: 1.20 (95%CI:1.05, 1.38), p=0.008) and BDI score (OR: 1.38 (95%CI:1.21, 1.57), p<0.001) were significantly associated with MCI when included simultaneously in the model. We observed similar associations for CVD biomarkers and BAI score with MCI. Conclusions: CVD imaging biomarkers and NPS, as measured by BDI and BAI scores, could represent two distinct processes associated with cognitive impairment. Studies are ongoing to further examine these associations and delineate how CVD, NPS, and other pathophysiology processes (e.g., Alzheimer’s disease) interact and are associated with cognitive impairment.

CYP2C19 polymorphisms are associated with severity of depression at initial evaluation and after the treatment independently of the prescribed medications: 4 weeks prospective study.

The cytochrome P-450 2C19 (CYP2C19) enzyme is involved in the metabolism of numerous antidepressants. It also metabolises some endogenous substrates, which could also confer to vulnerability. We aimed to establish whether the severity of depression and treatment response are associated with the genetically predicted CYP2C19 phenotype. We assessed the CYP2C19 genotype-predicted metabolic phenotypes (normal, intermediate or ultrarapid, there were no poor metabolisers) in patients with moderate or severe depression. We used the self-rated Beck Depression Inventory-II (BDI-II) scale and the clinician-rated Montgomery-Åsberg Depression Rating Scale (MADRS) at baseline, after 2 and 4 weeks of an empirical treatment trial. Patients and clinicians were blind to the genetic testing results. Seventy-six patients participated in the present study. At baseline, impaired CYP2C19 metabolisers, compared to normal metabolisers, had higher BDI-II (P = 0.046; ηp2 = 0.08) but not MADRS score. Intermediate metabolisers more often had a diagnosis of severe depression than normal metabolisers (P = 0.003). After 4 weeks of empirical treatment, intermediate metabolisers had significantly higher MADRS and BDI-II scores than normal metabolisers (P = 0.006; ηp2 = 0.131 and P = 0.030; ηp2 = 0.091). These differences were independent of the use of CYP2C19-metabolised medications in the treatment trial, as well as the treatment discrepancy status. Intermediate CYP2C19 polymorphism-predicted activity was associated with more severe depression after an empirical treatment trial. The lack of association between the prescription of CYP2C19-metabolised drugs and treatment response calls for a further look into the role of endogenous substrates of CYP2C19.

Depression and tryptophan metabolism in patients with primary brain tumors: Clinical and molecular imaging correlates

Patients with brain tumors have an increased risk for depression, whose underlying pathomechanism may involve dysregulated tryptophan/kynurenine metabolism. In this study, we analyzed the relation of depressive symptoms to clinical and tumor characteristics as well as cerebral and systemic tryptophan metabolism in patients with primary brain tumors. Sixty patients with newly-diagnosed or recurrent primary brain tumor underwent testing with the Beck Depression Inventory-II (BDI-II), and 34 patients also had positron emission tomography (PET) imaging with alpha-[11C]methyl-L-tryptophan (AMT). BDI-II scores were correlated with clinical and tumor-related variables, cerebral regional AMT metabolism measured in the non-tumoral hemisphere, and plasma tryptophan metabolite levels. Sixteen patients (27%) had BDI-II scores indicating depression, including 6 with moderate/severe depression. High BDI-II scores were independent of clinical and tumor-related variables except lower Karnofsky Performance Status scores. In patients with recurrent malignant gliomas, depression was associated with shorter survival (hazard ratio: 3.7; p = 0.048). High BDI-II total and somatic subscale scores were associated with higher frontal cortical and thalamic AMT metabolic values measured on PET. In contrast, plasma tryptophan and kynurenine metabolite levels did not correlate with the BDI-II scores. In conclusion, our results confirm previous data that depression affects more than ¼ of patients with primary brain tumors, it is largely independent of tumor characteristics and is associated with shorter survival in patients with recurrent malignant gliomas. On PET imaging, higher tryptophan metabolism in the frontal cortex and thalamus was found in those with brain tumor-associated depression and supports the role of dysregulated tryptophan/kynurenine metabolism in this condition.

The Association of Free Fatty Acids and Eicosanoids with the Severity of Depressive Symptoms in Stroke Patients

The study was designed to demonstrate the relationship of free fatty acids (FFAs) and eicosanoids levels with the severity of depressive symptoms in stroke. The ischemic stroke patients (n = 74) were included in the prospective study. The risk of depression was evaluated by the Beck Depression Inventory-II (BDI-II) 7 days and 6 months after the stroke onset. FFAs and inflammatory metabolites were determined by gas chromatography and liquid chromatography. In the acute phase of stroke, BDI-II and FFAs inversely correlated with C13:0 tridecanoic acid, C15:1 cis-10-pentadecanoid acid, C17:1 cis-10- heptadecanoid acid, C18:0 stearic acid, C20:3n6 eicosatrienoic acid, C22:1cis13 docosenoic acid and C22:6n3 docosahexaenoic acid (DHA). DHA level was significantly lower in patients with low vs. high BDI-II score. In the follow-up examination, BDI-II score directly correlated with C16:0 palmitic acid. The changes in BDI-II score during 6-month observation inversely correlated with lipoxin A4 and protectin D1, and directly correlated with 5-oxo-ETE. Importantly, the severity of depressive symptoms was associated with n3 PUFA level. Diet-derived FFAs were observed to potentially affect the inflammatory pathways in pathogenesis of depression in stroke and reduced DHA levels can attenuate depressive symptoms in stroke patients.

825-P: Depressive Symptoms Are Associated with Lower Diabetes Self-Management in Adults with Type 1 Diabetes

Depression is increased in people with type 1 diabetes (T1D), and may lead to poor disease self-management and suboptimal glycemic control. Depressive symptoms were assessed in adults with and without longstanding T1D (mean±SD T1D duration 38±8.6 years). A total of 414 participants with T1D (mean±SD age 51±9 years) and 488 participants without T1D (mean±SD age 55±9 years) completed the Beck Depression Inventory II (BDI-II) and the Diabetes Self-Management Questionnaire (DSMQ). BDI-II scores were significantly higher in people with T1D (mean±SD 5.4±5.6%) than in those without T1D (3.8±4.7, p<0.0001). In age-adjusted linear regression models, BDI-II scores were higher in participants with T1D vs. those without T1D in both men (LSmean±SE 5.3±0.4 vs. 3.1±0.3, p<0.001) and women (5.6±0.4 vs. 4.4±0.3, p=0.018). Depressive symptoms were higher in women compared to men among participants without T1D (p=0.01), but not among adults with T1D (p=0.56). Among participants with T1D, 9.7% of women and 10.4% of men (p=0.81) reported clinically elevated symptoms of depression (>13), whereas 7.1% of women and 1.7% of men without T1D reported clinically elevated symptoms of depression (p=0.004). Among participants with T1D, a higher BDI-II score was significantly correlated to HbA1c (r=0.21, p=0.0005). In age, sex, and T1D duration adjusted linear regression models, BDI-II scores >13 were associated with significantly lower total scores on the DSMQ (p<0.0001), and on the DSMQ subscales for Glucose Management (p=0.0005), Dietary Control (p=0.002), and Physical Activity (p=0.006) but not Health Care Use (p=0.73). There were no differences in these associations by sex. Our data demonstrate elevated levels of depressive symptoms in adults with T1D, particularly men, which were associated with lower self-management behaviors. Interventions are needed to address the role of depression on glycemic control and behaviors around glucose management, diet and physical activity in adults. Disclosure C.R. Geno Rasmussen: None. K.A. Driscoll: None. R.M. Sippl: None. A.C. Alman: None. A. Keshawarz: None. J.K. Snell-Bergeon: None. Funding American Diabetes Association (7-13-CD-10 to J.K.S-B.); National Heart, Lung, and Blood Institute; JDRF International

Spouse criticism and hostility during marital interaction: effects on pain intensity and behaviors among individuals with chronic low back pain.

Individuals with chronic pain may experience negative responses from spouse, family, and friends. Responses such as overt criticism and hostility may be associated with worsening pain and function for chronic pain sufferers. We used a laboratory procedure to evaluate whether variability in spouse criticism/hostility exhibited toward chronic low back pain (CLBP) patients during a conflictual discussion predicted variability in patient pain and function during a subsequent pain-induction task. Chronic low back pain patients (n = 71) and their spouses (n = 71) participated in a 10-minute discussion followed by the patient undergoing a 10-minute structured pain behavior task (SPBT). Spouse criticism/hostility perceived by patients and patient Beck Depression Inventory-II (BDI) scores correlated significantly and positively with pain intensity during the SPBT, whereas perceived spouse hostility, patient BDI scores, and spouse trait hostility correlated significantly and positively with observed pain behaviors during the SPBT. Spouse criticism/hostility coded by raters from video recordings interacted significantly with patient BDI scores, such that observed spouse criticism/hostility was related significantly and positively with pain behaviors only for patients with high BDI scores. Patient sex interacted significantly with observed spouse criticism/hostility, such that observed spouse criticism/hostility was related significantly and positively with pain behaviors only for female patients. Results support the hypothesis that spouse criticism and hostility-actually expressed or perceived-may worsen CLBP patient symptoms. Further, women patients and patients high in depressive symptoms appeared most vulnerable to spouse criticism/hostility. Thus, negative marital communication patterns may be appropriate targets for intervention, especially among these 2 at risk groups.

An alternative perspective on prenatal invasive techniques: Comparison of pre-procedural anxiety and depression scores for patients undergoing chorion villus sampling and amniocentesis

Objective:To compare the pre-procedural anxiety and depression levels of patients undergoing chorion villus sampling (CVS) and amniocentesis (AC).Methods:Patients referred to our department for fetal karyotype analysis with a positive first or second trimester screening test for aneuploidy between January 2013 to June 2015 were included. CVS and AC procedures were performed in patients with gestation periods of between 11-14 and 16-20 weeks, respectively. Anxiety was evaluated using the Spielberger State-Trait Anxiety Inventory (STAI), and depression was assessed using the Beck Depression Inventory II (BDI-II).Results:A total of 1,400 patients were included. Compared to first trimester controls, patients undergoing CVS had significantly higher STAI-state and BDI-II results. Likewise, patients undergoing AC had higher STAI-state and BDI-II scores than controls in the second trimester. In terms of STAI-trait results, no difference was found between the groups. Our results also showed that, compared to AC group, patients undergoing CVS had similar STAI-state, STAI-trait and but higher BDI-II scores.Conclusion:We conclude that evaluating the stress and depression levels of these patients should be one of the routine procedures in pregnancy follow-up.

Factor structure and clinical utility of BDI-II factor scores in postpartum women

BackgroundThe purpose of the current study was to examine the factorial dimensions underlying Beck Depression Inventory-II (BDI-II) in a large ethnically and economically diverse sample of postpartum women and to assess their relative contribution in differentiating clinical diagnoses in a subsample of depressed women. MethodsWe administered the BDI-II to 953 women between 4 and 20 weeks postpartum. Women who had low (1–7) and high (>12) BDI-II total scores were administered the Structured Clinical Interview for the DSM-IV Axis I Disorders (SCID-I). ResultsExploratory (EFA) and confirmatory factor analysis (CFA) revealed three factors, Cognitive, Somatic, and Affective, that accounted for 49.09% of the overall variance of items. Logistic regression analyses showed that somatic and affective factors contributed to diagnosis of major depression, while the somatic factor alone contributed to the diagnosis of depression with comorbid anxiety. The cognitive factor differentiated women with major depression from women who were never depressed. LimitationsOur definition of clinical depression included episodes of depression during the child's lifetime, and depressive symptoms were not necessarily current at the time of the assessment, which may impact the relative contribution of BDI-II factors to clinical diagnosis. ConclusionConceptualizing the structure of the BDI-II using these three factors could contribute to refining the measurement and scoring of depressive symptomatology and severity in postpartum women. Although somatic symptoms of depression may be difficult to differentiate from the physiological changes of normative postpartum adjustment, our results support the inclusion of somatic symptoms of depression in the calculation of a BDI-II total score.

Abstract P090: The Effect of Bupropion on Symptoms of Depression Among Patients Attempting to Quit Smoking Post-Myocardial Infarction: The ZESCA Trial

Background: Bupropion is a smoking cessation drug that can be prescribed immediately following a myocardial infarction (MI). Depression is prevalent during this period, and bupropion, which can also be prescribed as an anti-depressant, may improve symptoms of depression in this population. Methods: The ZESCA Trial is a randomized, double-blind, placebo-controlled trial that examined the efficacy of bupropion as a smoking cessation therapy in 392 hospitalized MI patients. Treatment duration was 9 weeks, and follow-up was 12 months. Depressive symptomatology was defined by a Beck Depression Inventory-II (BDI-II) score > 14. A total of 4 patients were missing baseline BDI-II scores and were excluded from this analysis. Differences in changes in depressive symptomatology from baseline were examined overall and in those with symptoms of depression at baseline. Results: The mean age was 53.9 years (standard deviation [SD] = 10.3), and 84% were male. A total of 20% of patients had depressive symptomatology at baseline. The median BDI-II score was 6.0 (inter-quartile range [IQR] = 2.0, 12.0) overall and 19.0 (16.0, 25.0) among those with depressive symptomatology at baseline. The mean BDI-II score was similar between treatment groups throughout the follow-up period (Figure). Similarly, there were no differences in BDI-II score between treatment groups at baseline or 9 weeks when restricted to those with depressive symptomatology at baseline. In this group, patients randomized to bupropion had a higher BDI-II score at 12 months (bupropion - placebo = 5.98, 95% confidence interval = 0.92, 11.04); the difference is likely due to differential participation at 12 months. At all follow-up visits, there were no differences in change in BDI-II score between treatment groups, both in the overall study population and in those with depressive symptomatology at baseline. Conclusions: Our results suggest that bupropion does not improve symptoms of depression in patients who are attempting to quit smoking post-MI.