Independent Predictors Of Depression Research Articles

Elderly patients and cancer: A European Delphi modified consensus to improve frailty screening

in geriatrics and oncology. For elderly patients with cancer, its impact is significant in terms of quality of life, morbidity and mortality, nevertheless, it is under-diagnosed and under-treated. Our hypothesis is that certain socio-demographic, clinical and treatmentrelated characteristics are associated with depression during chemotherapy and identification would allow early detection of patients needing specific treatment. Objectives: To identify prognostic factors associated with depressive symptoms among cancer patients aged 70 years and older, during chemotherapy. To assess whether the efficacy and safety of chemotherapy are associated with depression. Methods: A regional prospective multicentre cohort, of cancer patients aged 70 years and older, receiving first-line chemotherapy and a comprehensive geriatric assessment at baseline and before the fourth treatment cycle. Depressive symptoms were measured by the Geriatric Depression Scale (GDS). Prognostic and associated factors were sought using a logistic regression model. The complete case analysis was compared with an analysis after multiple imputation, due to missing data. Results:Among the 344 patientswithGDS at the start of chemotherapy, 260 had a second assessment before the fourth treatment cycle. The prevalence of depressive symptoms at fourth cycle was 45%. Independent predictors of depression were malnutrition (OR =5.1, p=0.014), risk of malnutrition (OR= 1.6, p=0.014) and depressive symptoms at baseline (OR = 6.7, p b0.001). Parameter estimates were similar after multiple imputation. Patients who lived alone had a higher risk of depressive symptoms, but this result was not confirmed after multiple imputation. Effective chemotherapy was associated with a lower risk of depression especially after multiple imputation (OR =0.42, p=0.018). Conclusion: We highlight the prognostic role of depressive symptoms and nutritional status at baseline on the occurrence of subsequent depression during chemotherapy, which has not been identified previously. This can be usefull to identify cancer patients at risk for depression and to start as early as possible specific treatments with demonstrated benefits. The role of chemotherapy on depressive symptoms requires further study.

Bidirectional association between weight change and depression in mid-aged women: a population-based longitudinal study

There is some evidence for a bidirectional association between obesity and depression. However, studies examining weight change and depression are scarce and report inconsistent findings. The objective was to investigate the relationship between average annual percentage weight change and depression in mid-aged women. This was a prospective cohort study. A total of 8246 women aged 45-50 years at baseline participating in the Australian Longitudinal Study on Women's Health were surveyed every 3 years over a 12-year period. Information on body mass index and depression was collected at each survey. We used regression models to investigate the effect of weight change predicting depression and vice versa, by calculating odds ratios (ORs) with 95% confidence intervals (CIs). Weight gain was associated with an increased risk of prevalence (OR 1.39, 95% CI 1.25-1.56) and incidence (OR 1.30, 95% CI 1.14-1.49) of depression. However, in time-lagged analyses, where weight change between the two preceding surveys was used to predict incidence of depression at the current survey, no statistically significant associations with depression were found. Compared with women without depression, women with prevalent and incident depression had an increased risk of weight gain (OR 1.29, 95% CI 1.19-1.40 and OR 1.20, 95% CI 1.05-1.38, respectively). When incidence of depression was lagged with respect to weight change between the two subsequent surveys, depression remained associated with an increased risk (OR 1.19, 95% CI 1.00-1.41) of gaining weight. These findings suggest that depression may cause weight gain over the next 3 years, but that weight change (loss or gain) may not lead to depression. Further research at shorter intervals, perhaps 6 monthly or yearly is needed to ascertain whether weight change is an independent predictor of depression in the shorter term.

Prevalence of Depression in Patients With Chest Pain and Non-Obstructive Coronary Artery Disease

Many studies have demonstrated the prevalence of depression in patients with coronary artery disease (CAD), but few have examined this relation in those with chest pain who do not have obstructive CAD on angiography. The aim of this study was to compare the prevalence of depression amongst patients with chest pain in the presence or absence of obstructive CAD and a healthy control group without chest pain. This prospectively designed, observational cohort study used 2 independent data sets: (1) The Queen Elizabeth Hospital Coronary Angiogram Database (n = 1,144), consisting of 819 patients with obstructive CAD and 325 patients with nonobstructive CAD (NoCAD), all of whom had chest pain and (2) the North West Adelaide Health Study (NWAHS; n = 3,168), a population-based biomedical cohort, from which patients with chest pain were excluded. The presence of depression was determined by a previously validated method using the Short Form 36. The prevalence of depression differed among the 3 groups, with 63% in those with NoCAD, 53% in those with CAD, and only 24% in the healthy NWAHS cohort. Analysis of the angiography cohort revealed age, gender, antidepressant medication, previous myocardial infarction, previous airway disease, Short Form 36 physical summary score, Seattle Angina Questionnaire physical limitation score, and NoCAD on angiography to be independent predictors of depression. In conclusion, these findings highlight the importance of screening for depression in patients with NoCAD.

Tobacco smoking predicts depression and poorer quality of life in heart disease

BackgroundWe report on the prospective association between smoking and depression and health-related quality of life (HRQOL) in patients with coronary artery disease (CAD).MethodsProspective study of 193 patients with assessment of depression occurring 3-, 6- and 9- months (T1, 2, and 3, respectively) following discharge from hospital for a cardiac event. HRQOL was assessed at T3. T1 depression was assessed by clinical interview; T2 and T3 depression was assessed by self-report. Smoking at time of cardiac event was assessed by self-report. Multivariate analyses controlled for known demographic, psychosocial and clinical correlates of depression.ResultsSmoking at the time of index cardiac event increased the likelihood of being diagnosed with Major Depressive Disorder (MDD) at T1 by 4.30 [95% CI, 1.12-16.46; p < .05]. The likelihood of receiving a diagnosis of minor depression, dysthymia or MDD as a combined group was increased by 8.03 [95% CI, 2.35-27.46; p < .01]. Smoking did not reliably predict depression at T2 or T3 and did not reliably predict persistent depression. Smoking increased the likelihood of being classified as depressed according to study criteria at least once during the study period by 5.19 [95% CI, 1.51-17.82; p < .01]. Smoking independently predicted worse mental HRQOL.ConclusionsThe findings support a role for smoking as an independent predictor of depression in CAD patients, particularly in the first 3 months post-cardiac event. The well-established imperative to encourage smoking cessation in these patients is augmented and the findings may add to the evidence for smoking cessation campaigns in the primary prevention of depression.

Sexual dysfunction predicts depression among women on hemodialysis

Depression is common in patients on hemodialysis (HD), and its treatment fails in many cases. Among women on HD, sexual dysfunction (SD) can be an underestimated cause of depression and an impending factor for successful therapy. We aimed to evaluate the association between SD and depression among end-stage renal disease (ESRD) women undergoing HD and to test SD as an independent predictor of depression. We studied 55 ESRD women undergoing HD from a single renal unit. We compared sociodemographic, clinical and laboratory data and presence of SD between depressed and non-depressed participants, and tested SD as an independent predictor of depression. Demographic data, time on dialysis, underlying etiology of ESRD and laboratory results were assessed in renal unit records. Classification of economic class was according to the criteria of the Brazilian Association of Research Institutes. Each participant was assigned a low-, medium- or high-risk index based on comorbidity. Depression was classified by the 20-Item Version of the Center for Epidemiologic Studies Depression Scale using a score ≥18 to classify depression. The Female Sexual Function Index was used to evaluate sexual function considering a cutoff of 26 to classify SD. Thirty-three (56.8 %) women were depressive and 46 (79.3 %) women presented SD. Depressed an non-depressed women did not differ in sociodemographic, clinical and laboratory results, but the prevalence of SD among depressed patients was higher compared to non-depressed women, respectively, 90.1 versus 64 % (p = 0.029). SD was an independent predictor of depression (OR = 5.62; CI 95 % 1.33-23.7; p = 0.01). SD must be discarded among women on HD classified as depressive. Treatment of depression among women with SD should include a specific approach to SD.

Biphasic Pattern of Depression and Its Predictors during Pegylated Interferon-Based Therapy in Chronic Hepatitis B and C Patients

It remains unclear whether depression in chronic hepatitis B (CHB) and chronic hepatitis C (CHC) during pegylated interferon-based therapy is associated with the virus, drug or ethnic background. We aimed to perform a prospective study to evaluate the clinical course of depression and its predictors in consecutive non-cirrhotic CHB and CHC patients of the same ethnicity receiving pegylated interferon-based therapy. The occurrence and severity of depression were actively assessed by the Hamilton Depression Rating Scale before therapy and at weeks 2, 4, 6, 8, 10, 12 and every 4 weeks during treatment until the end of therapy. Extensive numbers of variables (repeated measurements, time variables and interactions between all variables) were included in generalized estimating equations to analyse the predictors of depression. A total of 158 consecutive patients (73 CHB and 85 CHC patients) were enrolled. Depression (Hamilton Depression Rating Scale ≥ 11) occurred in a biphasic pattern at treatment weeks 2-10 and weeks 16-36. Treatment weeks < 10 predicts more depression, and treatment weeks >12 predicts less depression, suggesting the predictability of the time variable during treatment on depression. Furthermore, CHC or pre-existing depression is an independent predictor of depression in these patients (P < 0.001). Depression occurred in a biphasic pattern during pegylated interferon-based therapy and should be early and actively assessed, especially in patients with CHC or pre-existing depression.

Depression among family caregivers of community-dwelling older people who used services under the Long Term Care Insurance program: a large-scale population-based study in Japan

Objective: To identify predictors for depression among family caregivers of community-dwelling older people under the Long Term Care Insurance (LTCI) program in Japan through a large-scale population-based survey.Method: All 5938 older people with disabilities, using domiciliary services under the LTCI in the city of Toyama, and their family caregivers participated in this study. Caregiver depression was defined as scores of ≥16 on the Center for Epidemiological Studies Depression Scale (CES-D). Other caregiver measures included age, sex, hours spent caregiving, relationship to the care recipient, income adequacy, living arrangement, self-rated health, and work status. Care recipient measures included age, sex, level of functional disability, and severity of dementia. The data from 4128 pairs of the care recipients and their family caregivers were eligible for further analyses. A multiple logistic regression analysis was used to examine the predictors associated with being at risk of clinical depression (CES-D of ≥16).Results: Overall, 34.2% of caregivers scored ≥16 on the CES-D. The independent predictors for depression by logistic regression analysis were six caregiver characteristics (female, income inadequacy, longer hours spent caregiving, worse subjective health, and co-residence with the care recipient) and one care-recipient characteristic (moderate dementia).Conclusion: This is one of the first population-based examinations of caregivers of older people who are enrolled in a national service system that provides affordable access to services. The results highlighted the importance of monitoring caregivers who manifest the identified predictors to attenuate caregiver depression at the population level under the LTCI.

Predictors of anxiety and depression in Egyptian thalassemic patients: A single center study

Thalassemic patients are vulnerable to emotional and behavioral problems. Each patient age group exhibits problems unique to that stage of development, and although up to 80% of thalassemic patients are likely to have psychological disorders, e.g., anxiety and depression, predictors of these disorders remain poorly understood. The present study was designed to assess the prevalence of anxiety and depression in a sample of Egyptian thalassemic patients and to identify predictors of these psychiatric disorders. A case-control study was conducted in 218 thalassemic patients, with 244 healthy subjects as a control. All patients and control subjects were subjected to thorough evaluation of medical history and clinical examination, and examined by a psychiatrist using the clinician version of the structured clinical interview for DSM-IV (SCID-CV), hospital anxiety and depression scale and Coopersmith self-esteem inventory. Abnormal and borderline anxieties were reported by 36.7 and 20.6% of thalassemic patients, respectively, while abnormal and borderline depressions were reported by 32.1 and 16.1% of patients, respectively. Hospitalization, low self-esteem, diabetes mellitus and heart failure were independent predictors of anxiety. The independent predictors of depression were heart failure, hospitalization, diabetes mellitus, short stature and delayed puberty. Thalassemic patients were more vulnerable to anxiety and depression, indicating that screening and management for such psychiatric disorders should be considered in treating all such patients.

Social stress and depression during pregnancy and in the postnatal period in British Pakistani mothers: a cohort study.

BackgroundDepressive disorders are common and disabling among perinatal women. The rates are high in ethnic minority groups. The causes are not known in British Pakistani women. The aim of this study was to estimate the rates, correlates and maintaining factors of perinatal depression in a Pakistani sample in UK. The design used was a cross-sectional two phase population based survey with a prospective cohort study.MethodsAll women in 3rd trimester attending antenatal clinic were screened with the Edinburgh postnatal depression scale (EPDS). Women scoring 12 or more on EPDS and a random sample of low scorers were interviewed using the Schedules for Assessment in Neuropsychiatry (SCAN) and the Life Events and Difficulties schedule (LEDS). Social support was assessed with the Multidimensional Scale for Perceived Social Support (MSPSS). They were reassessed 6 months after the delivery using the same measures.ResultsThe weighted prevalence of depression was 16.8%. Depressed mothers had more marked non health difficulties (housing, financial and marital). They had less social support and were socially isolated. Marked social isolation and marked non-health related difficulties were independent predictors of depression. Analyses of all the possible risk factors, comparing 26 persistent depressed with 27 depression resolved group showed significant differences in the MSPSS subscales between the two groups.LimitationsThe study lacked inter-rater reliability testing between the individuals carrying out diagnostic interviews. The study sample did not accurately represent the general population and information about the origins of depression in this group of mothers was limited.ConclusionDepression in British Pakistani mothers is associated with social isolation, poor social support and severe and persistent social difficulties. The findings will have implications in planning suitable services for this group.

Preoperative high-sensitivity C-reactive protein predicts depression in patients undergoing coronary artery bypass surgery: A single-center prospective observational study

Our objective was to reveal the contribution of preoperative high-sensitivity C-reactive protein (hsCRP) levels to the risk of depression in patients undergoing coronary artery bypass grafting (CABG). In this study, 232 consecutive patients undergoing elective CABG were evaluated for depression utilizing the 9-item Patient Health Questionnaire scale at least 3 days before surgery and 6 months after CABG. In addition, peripheral blood samples were collected at baseline and the circulation levels of hsCRP were measured. The preoperative and postoperative rate of depression was 18.1%. Interestingly, preoperative depression was independently associated with women (odds ratio [OR], 2.49; 95% confidence interval [CI], 1.13-5.50) and log-transformed hsCRP (OR, 1.16; 95% CI, 1.06-1.27) after adjusting for various factors using logistic regression, including age, sex, and university-level education. Postoperative depression was only associated with log-transformed hsCRP (OR, 1.15; 95% CI, 1.05-1.25) in these patients. Log-transformed hsCRP remained associated with future depression after adjusting for postoperative medications or major adverse cardiovascular events during the follow-up period. The present study is the first to report elevated serum hsCRP is an independent predictor for depression in CABG patients not only preoperatively but also up to 6 months after surgery. These clinical findings may reveal a potential target for improving prognosis in CABG patients with depression.

P-585 - Depression and anxiety in elderly immigrants in Germany - a transcultural analysis

Background The association between migration and mental health remains unclear. To ensure an adequate health care of migrants, differentiated information on the association of migration and cultural background and mental disorders is necessary. Method Cross-sectional study on depression and anxiety of migrants from Turkey, Italy, Spain, and ethnic German resettled from the states of the former Soviet Union (n = 435). Questionnaires were distributed by non-health specific counselling agencies of welfare associations and migrants’ self-organisations. Results High rates of anxiety (anxiety: 43.2%; generalised anxiety disorder: 23.0%) as well as depression (minor depression: 20.4%; major depression: 15.8%) were found. The Turkish migrants have the highest degrees of symptoms, whereas the Spanish migrants have the lowest one. Logistic regression analyses show that retired migrants with lower school qualification and feeling unwell in Germany have a higher probability of suffering from anxiety or depressive disorders. Additionally, Turkish migrants show a higher likeliness for depression, than the other migrant groups. Conclusion Our results suggest that migrants in Germany have a higher risk of current anxiety and depression than natives. The cultural background is an independent predictor for depression but not of anxiety.

Health‐related qualıty of lıfe, sleep qualıty, and depressıon in peritoneal dialysis and hemodıalysıs patıents

Health-related quality of life (HRQoL) and sleep quality (SQ) were impaired in patients with end-stage renal disease (ESRD). The impairment of both HRQoL and SQ and being in a depressive mood were found to be associated with increased morbidity and mortality in dialysis patients. We aimed to investigate the association between SQ, HRQoL, and depression, and to define independent predictors of SQ and depression in peritoneal dialysis (PD) and hemodialysis (HD) patients. Ninety HD patients (41 females, 49 males with mean age 50 ± 15.7 years) and 64 PD patients (27 females, 37 males with mean age 52.4 ± 15.3 years) receiving renal replacement therapy for at least 3 months were screened for the assessment of SQ, HRQoL, and depression in this cross-sectional study. A modified postsleep inventory, Short Form of Medical Outcomes Study (SF-36) and Beck depression inventory (BDI) were applied to all patients for evaluating SQ, HRQoL, and depression, respectively. HD and PD patients had similar total SQ scores. Physical and mental component scale of HRQoL were found to be significantly higher in HD patients (p < 0.001). PD patients were found to be much more in depressive mood when compared with HD patients (p < 0.001). Independent predictors of depression in patients were mental component scale of HRQoL, gender (being female), and dialysis modality (being PD patient). Physical component scale was also found to be an independent predictor of SQ. This study showed that despite similar SQ scores between two groups, HD patients had better HRQoL and less depression than PD patients.

Depression symptoms and body dissatisfaction association among polycystic ovary syndrome women

Objective One publication reported that lower body satisfaction and lower education were independent predictors of depression in polycystic ovary syndrome (PCOS) in women. This study replicates that analysis using different instruments, and adds androgen levels to the model. Methods Cross-sectional analysis of questionnaires (Quick Inventory of Depressive Symptomatology-Self-Report, Body Esteem Scale) and serum androgens from a community cohort with (n=94) and without (n=96) PCOS, matched by BMI category. Non-parametric tests, Spearman correlations, and negative binomial regression models were analyzed. Results Depression symptoms were common (40–60% in lean, overweight and obese BMI categories) in the PCOS cohort, albeit generally of mild severity. The PCOS women had similar depression symptom severity (P > .20) and similar body dissatisfaction (P ≥ .25) as the regularly cycling women in total and stratified by BMI category. In both the PCOS and non-PCOS cohorts, depression symptom severity was positively correlated with dissatisfaction with physical appearance and physical conditioning (P < .02). Body dissatisfaction (especially perception of physical conditioning) was strongly associated with more severe depression symptoms in non-obese PCOS women (BMI < 30, P < .04) before and after controlling for age, testosterone and free testosterone. In contrast, for obese women with PCOS, depression was unrelated to body dissatisfaction after controlling for age. Conclusions Among non-obese PCOS women, their subjective body image was strongly associated with the severity of their depression symptoms. Most of the obese PCOS cohort had low body satisfaction and depression symptoms, therefore individual differences in the body dissatisfaction scores were not helpful in identifying depression symptom severity. Neither testosterone nor free testosterone was associated with depression symptom severity in PCOS women after controlling for body dissatisfaction and age.

Depression in Patients with Nonalcoholic Fatty Liver Disease and Chronic Viral Hepatitis B and C

Patients with chronic liver disease (CLD) and depression may be at a higher risk for various complications, including impaired quality of life and more advanced liver disease. The purpose of this study was to determine the prevalence of depression in CLD patients (non-alcoholic fatty liver disease (NAFLD), Hepatitis B (HBV), and Hepatitis C (HCV)) and to identify potential clinical and laboratory correlates of depression in these patients. We used a database of CLD patients that contains extensive clinical (including self-reported depression) and laboratory data for each patient. We compared the prevalence of depression in patients with HBV, HCV, and NAFLD. We also used regression models to find independent predictors of depression in these patients. Of 878 CLD patients, 207 (23.6%) had a diagnosis of depression (NAFLD 27.2%, HCV 29.8%, and HBV 3.7%). Examination of predictors of depression differed by the type of chronic liver disease. For NAFLD, independent predictors of depression were the presence of hypertension, smoking, history of lung disease, being female, and non-African-American. For HBV patients, the only independent predictor of depression was excessive alcohol consumption (defined as >10 g/d), while for HCV patients, independent predictors were being female and non-Asian, presence of fatigue, and excessive alcohol intake. This study demonstrates that individuals with NAFLD and HCV have a higher prevalence of depression than HBV patients and the rates of depression reported for the general population. The most consistent correlates of depression status in CLD patients are being female and excessive alcohol consumption.

Personality variables as predictors of early non-metastatic colorectal cancer patients’ psychological distress and health-related quality of life: A one-year prospective study

Objective We aimed to assess the course of early non-metastatic colorectal cancer patients’ psychological distress and health-related quality of life (HRQOL) and to identify relevant clinical and psychological predictors during a one-year period. Methods Of the 144 early non-metastatic colorectal cancer patients initially assessed for psychological distress symptoms (SCL-90-R), HRQOL (WHOQOL-BREF), sense of coherence (SOC), defense mechanisms (LSI) and hostility (HDHQ), 84 (58.3%) completed the one-year follow-up. Mean (SD) age was 65.1 (9.8) years and 67.4% were male. Mean (SD) disease duration was 1.7 (2.2) years, with 49.3% being diagnosed within the last six months. In 75.0% the site was at colon and in 25.0% at rectum; 2.1% had stage I, 59.0% stage II and 38.9% stage III disease. Results Paranoid ideation, psychoticism, interpersonal sensitivity, anxiety and depressive symptoms increased significantly over the one-year period of the study and most of the HRQOL components were significantly decreased over the same period. Men were at greater risk for further developing depressive symptomatology. Low SOC was independent predictor of depression, while hostility independently predicted anxiety, interpersonal sensitivity and psychoticism symptoms. General psychological distress and low SOC were independent predictors of HRQOL, while repression was also an independent predictor of Physical HRQOL. Conclusions In early non-metastatic colorectal cancer patients, psychological distress symptoms are increased and HRQOL is decreased over one-year period. Symptoms of psychological distress are strong predictors of HRQOL, while personality variables can also predict psychological distress symptoms’ increase and HRQOL decrease over time, and this could be relevant to psychological interventions.

The Relationship With Iron and Health Outcomes in Persons With Restless Legs Syndrome

Restless Legs Syndrome (RLS) is a sleep disorder cause by inadequate iron metabolism. However, no studies have identified the impact of iron in RLS patients on sleep, depression, fatigue, or quality of life (QoL). The aims of this secondary data analysis was to determine relationships (a) between serum iron with RLS symptom severity, sleep quality, daytime sleepiness, depression, fatigue, and quality of life (QoL); and (b) based on demographics, specifically age and ethnicity. Data were collected on iron and ferritin concentrations in 48 persons with RLS. Low serum iron levels were measured in 32% of the participants with only 1 person (4%) treated with iron supplementation. General linear models identified age and race as covariants: (a) being White (p = .047) and higher iron levels (p = .019) were independent predictors of higher social functioning; (b) being White (p = .047) and higher iron levels (p = .004) were independent predictors of less sleepiness; (c) younger age (p = .001) and lower iron levels (p = .025) were independent predictors of depression; and (d) younger age (p = .006) and lower iron levels (p = .005) were independent predictors of fatigue. Findings from this study show that iron supplementation for persons with RLS not only improves motor and sensory symptoms but might also improve sleep, sleepiness, depression, fatigue, and QoL and should be considered by health care providers for treatment of RLS.

Predictors of Depression Among Older African American Cancer Patients

Depression is becoming an increasing concern in cancer patients because of its impact on quality of life. Although risk factors of having depression have been examined in the literature, there has been no research examining these factors in older African American cancer patients. This study explores the demographic and illness-related risk factors in older African American cancer patients. Two hundred eighty-three patients were recruited from outpatient oncology clinics. These older African American patients completed a questionnaire that included the Geriatric Depression Scale as well as sociodemographic characteristics and medical information. chi2 Tests, trend tests, and logistic regression were used to identify the demographic and illness-related factors that predict depression in the sample. The overall prevalence of depression in the sample was 27.2%. Younger age (<65 years), employment status, proximity to family, and multiple symptoms due to cancer or treatment were independent predictors of depression. This study represents the first attempt to describe the risk factors of depression within older African American cancer patients. Findings indicate a high prevalence of depression in African American cancer patients which can be attributed to identifiable risk factors. An understanding of the risk factors associated with depression can be used to identify those cancer patients at risk for depression and initiate early interventions to improve psychological outcomes and lessen the potential burden of cancer on these patients.

Symptoms of Depression in Kidney Transplant Recipients: A Cross-sectional Study

Depression is associated with impaired quality of life and increased morbidity and mortality in patients with end-stage renal disease. Little is known about the prevalence and correlates of depression in kidney transplant recipients. In this study, we aimed to compare depressive symptoms between kidney transplant recipients and wait-listed dialysis patients and identify the correlates of depressive symptoms in the transplant recipient population. Observational cross-sectional study using the Center for Epidemiologic Studies Depression Scale (CES-D) to assess the severity of depressive symptoms. A cutoff score of 18 was used to identify the presence of depression. 1,067 kidney transplant recipients and 214 wait-listed dialysis patients were asked to participate; the final analysis included 854 kidney transplant and 176 wait-listed dialysis patients, respectively. Sociodemographic and clinical variables. Severity of depressive symptoms and presence of depression (CES-D score > or = 18). The prevalence of depression was 33% versus 22% in wait-listed versus transplant patients, respectively (P = 0.002). In multivariate regression, number of comorbid conditions, estimated glomerular filtration rate, perceived financial situation, and marital status were significant and independent predictors of depression in the transplant recipient group. Treatment modality was associated significantly with the presence of depression, even after adjustment for clinical and sociodemographic variables (OR, 2.01; 95% CI, 1.25-3.23; P = 0.004). Self-reported measurement of depressive symptoms. The prevalence of depression is lower in transplant recipients than in wait-listed patients. However, one-fifth of transplant patients are still at high risk of clinically significant depression. Comorbid conditions, socioeconomic status, and treatment modality predicted depressive symptoms in patients with end-stage renal disease.

Predicting depression, anxiety and self-harm in adolescents: The role of perfectionism and acute life stress

Despite the growing evidence that perfectionism is associated with adolescent psychological distress, few studies have investigated this relationship prospectively with measures designed for use in adolescent populations. In the present study, within a diathesis–stress framework, we investigated the extent to which perfectionism and acute life stress predict depression, anxiety and self-harm among adolescent school children ( n = 515) over a 6 month period (Time 1–Time 2). Socially prescribed perfectionism (SPP), self-oriented perfectionism–critical (SOP-critical) and the associated interactions with acute life stress differentially predicted anxiety, depression and self-harm. Acute life stress was an independent predictor of depression, anxiety and self-harm. SPP predicted depression and interacted with acute life stress to predict self-harm. SOP-critical and the SOP-critical by acute life stress interaction predicted anxiety. Self-oriented perfectionism-striving (SOP-striving) did not predict any of the Time 2 measures of distress. The dimensions of perfectionism are differentially associated with psychological distress. Tailored clinical interventions focused on adolescent perfectionism should offer promise in tackling psychological morbidity in adolescence.

Identifying depression in epilepsy in a busy clinical setting is enhanced with systematic screening

Purpose Depression is a highly prevalent, relatively underdiagnosed and undertreated comorbid condition in epilepsy. The purpose of this study was to determine the effect of using a validated self-reporting depression scale on the ability to detect depression in people with epilepsy receiving care in a busy clinical setting. Methods The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) is a 6-item questionnaire validated to screen for depression in people with epilepsy. We performed a retrospective chart review of 192 consecutive patients who had completed the NDDI-E while receiving care at a seizure clinic in the largest public hospital in Houston, Texas. For comparison, charts of 192 consecutive patients receiving care immediately prior to the implementation of the NDDI-E in the same clinic were assessed. Results Fifty-five (28.6%) of patients screened positive for depression with the NDDI-E. They subsequently received a semi-structured psychiatric interview based on the DSM-IV model and 89% ( n = 49) were confirmed to have major depression. Use of the NDDI-E thus resulted in the detection of active depression in 25.5% ( n = 49) of the patients, whereas only 2.6% ( n = 5) of patients in the group not systematically screened were found to have active depression ( p < 0.0001). Thirty-two of the 49 (65%) patients with depression detected by screening were not previously diagnosed or treated. Multivariate analysis revealed that a history of depression, seizure frequency, and topiramate use were independent predictors of depression. Lamotrigine use was protective against depression. Discussion Use of the NDDI-E significantly improved the ability to detect depression in epilepsy patients in a busy clinical practice.