Lifetime Risk Of Major Depression Research Articles

Depression in Women with Spontaneous 46, XX Primary Ovarian Insufficiency

Context: A high prevalence of depressive symptoms is observed in women with primary ovarian insufficiency (POI) compared with women in whom the menopause is normally timed. Indeed, studies suggest that depression and/or its pharmacological treatment contribute to the onset of POI. Objectives: We characterize the prevalence of psychiatric disorders and the timing of onset of clinically significant depression relative to both the diagnosis of POI and the onset of menstrual irregularity in women with POI. Design and Setting: We conducted a cross-sectional clinic-based study at the National Institutes of Health Clinical Research Center. Patients: A total of 174 women with spontaneous 46, XX POI and 100 women with Turner syndrome participated in the study. Main Outcome Measures: The structured clinical interview for DSM-IV was performed. Results: Lifetime histories of depression in POI exceeded rates of depression reported in women with Turner syndrome and community-based samples of women (P < 0.001). The onset of depression frequently preceded the diagnosis of POI but occurred after the onset of menstrual irregularity. Analyses standardizing the periods of risk for depression showed that similar numbers of depressions occurred before and after these events. Conclusions: POI is associated with an increased lifetime risk for major depression. Attention to the presence of depression in POI should become an important part of the care for these women. The onset of depression frequently occurs after signs of altered ovarian function but before the diagnosis of POI. Thus, in some women the association between POI and depression suggests an overlapping pathophysiology rather than a causal relationship.

Depression in Women with Spontaneous 46, XX Primary Ovarian Insufficiency

Context A high prevalence of depressive symptoms is observed in women with primary ovarian insufficiency (POI) compared with women in whom the menopause is normally timed. Indeed, studies suggest that depression and/or its pharmacological treatment contribute to the onset of POI. Objectives We characterize the prevalence of psychiatric disorders and the timing of onset of clinically significant depression relative to both the diagnosis of POI and the onset of menstrual irregularity in women with POI. Design and Setting We conducted a cross-sectional clinic-based study at the National Institutes of Health Clinical Research Center. Patients A total of 174 women with spontaneous 46, XX POI and 100 women with Turner syndrome participated in the study. Main Outcome Measures The structured clinical interview for DSM-IV was performed. Results Lifetime histories of depression in POI exceeded rates of depression reported in women with Turner syndrome and community-based samples of women (P < 0.001). The onset of depression frequently preceded the diagnosis of POI but occurred after the onset of menstrual irregularity. Analyses standardizing the periods of risk for depression showed that similar numbers of depressions occurred before and after these events. Conclusions POI is associated with an increased lifetime risk for major depression. Attention to the presence of depression in POI should become an important part of the care for these women. The onset of depression frequently occurs after signs of altered ovarian function but before the diagnosis of POI. Thus, in some women the association between POI and depression suggests an overlapping pathophysiology rather than a causal relationship.

Depression in Women with Spontaneous 46, XX Primary Ovarian Insufficiency

A high prevalence of depressive symptoms is observed in women with primary ovarian insufficiency (POI) compared with women in whom the menopause is normally timed. Indeed, studies suggest that depression and/or its pharmacological treatment contribute to the onset of POI. We characterize the prevalence of psychiatric disorders and the timing of onset of clinically significant depression relative to both the diagnosis of POI and the onset of menstrual irregularity in women with POI. We conducted a cross-sectional clinic-based study at the National Institutes of Health Clinical Research Center. A total of 174 women with spontaneous 46, XX POI and 100 women with Turner syndrome participated in the study. The structured clinical interview for DSM-IV was performed. Lifetime histories of depression in POI exceeded rates of depression reported in women with Turner syndrome and community-based samples of women (P < 0.001). The onset of depression frequently preceded the diagnosis of POI but occurred after the onset of menstrual irregularity. Analyses standardizing the periods of risk for depression showed that similar numbers of depressions occurred before and after these events. POI is associated with an increased lifetime risk for major depression. Attention to the presence of depression in POI should become an important part of the care for these women. The onset of depression frequently occurs after signs of altered ovarian function but before the diagnosis of POI. Thus, in some women the association between POI and depression suggests an overlapping pathophysiology rather than a causal relationship.

A Reproductive Subtype of Depression

The lifetime risk for major depression in women is well known to be twice the risk in men and is especially high during the reproductive years between menarche and menopause. A subset of reproductive-age women experience depressive episodes that are triggered by hormonal fluctuations. Such "reproductive depressions" involve episodes of depression that occur specifically during the premenstrual, postpartum, and perimenopausal phases in women. These reproductive subtypes of depression can be conceptualized as a specific biological response to the effects of hormonal fluctuations in the brain. The different types of reproductive depressions are associated with each other, have unique risk factors that are distinct from nonreproductive depression episodes, and respond to both hormonal and nonhormonal interventions. This review uses a PubMed search of relevant literature to discuss clinical, animal, and genetic evidence for reproductive depression as a specific subtype of major depression. Unique treatment options, such as hormonal interventions, are also discussed, and hypotheses regarding the underlying biology of reproductive depression-including interactions between the serotonergic system and estrogen, as well as specific effects on neurosteroids-are explored. This review will provide evidence supporting reproductive depression as a distinct clinical entity with specific treatment approaches and a unique biology that is separate from nonreproductive depression.

Religious service attendance and spiritual well-being are differentially associated with risk of major depression

The complex relationships between religiosity, spirituality and the risk of DSM-IV depression are not well understood. We investigated the independent influence of religious service attendance and two dimensions of spiritual well-being (religious and existential) on the lifetime risk of major depression. Data came from the New England Family Study (NEFS) cohort (n=918, mean age=39 years). Depression according to DSM-IV criteria was ascertained using structured diagnostic interviews. Odds ratios (ORs) for the associations between high, medium and low tertiles of spiritual well-being and for religious service attendance and the lifetime risk of depression were estimated using multiple logistic regression. Religious service attendance was associated with 30% lower odds of depression. In addition, individuals in the top tertile of existential well-being had a 70% lower odds of depression compared to individuals in the bottom tertile. Contrary to our original hypotheses, however, higher levels of religious well-being were associated with 1.5 times higher odds of depression. Religious and existential well-being may be differentially associated with likelihood of depression. Given the complex interactions between religiosity and spirituality dimensions in relation to risk of major depression, the reliance on a single domain measure of religiosity or spirituality (e.g. religious service attendance) in research or clinical settings is discouraged.

Fetal growth restriction and the development of major depression

To test the association between fetal growth restriction and the lifetime risk of major depression and the number of recurrent episodes. Study subjects (n = 1101) were offspring of participants in the Providence, RI, site of the National Collaborative Perinatal Project. Cox regression was used to investigate the relation between measures of birth size and the lifetime risk of depression and the mean number of depressive episodes was compared across categories of birth size. There was no association between low birth weight, gestational age, ponderal index and small for gestational age and the lifetime risk of major depression, or the number of recurrent episodes. Fetal growth restriction, as reflected by multiple measures of birth size, is not associated with the risk of a major depression or the subsequent recurrence of depressive episodes. Results of this study do not support a 'fetal programming' effect in depression.

Use of Selective Serotonin-Reuptake Inhibitors in Pregnancy and the Risk of Birth Defects

Estimates of the lifetime risk of major depression in women range from 10% to 25%, peaking during the reproductive years. Today, selective serotonin-reuptake inhibitors (SSRIs) are the most commonly used type of antidepressant medication. Recent studies suggest that taking these drugs while pregnant may be associated with birth defects in general and with congenital heart defects in particular. The investigators have analyzed data from 9622 case infants having major birth defects and 4092 control infants who were born in the years 1997 to 2002 and enrolled in the National Birth Defects Prevention Study. Both cases and controls were chosen through birth defects surveillance systems in 8 states. The mothers took part in a standardized phone interview dealing with exposure to potential risk factors, including medications, before and during pregnancy. Exposure was defined as taking any SSRI from 1 month before to 3 months after conception. Combining cases and control subjects, 3% of study participants reported having used a SSRI at some time before or during pregnancy, and 2.3% during the designated 4-month interval. No significant association was found between the maternal use of SSRIs during early pregnancy and congenital heart defects. There were, however, 3 conditions associated with maternal use of SSRIs. They included anencephaly (adjusted odds ratio [OR], 2.4; 95% confidence interval [CI], 1.1–5.1); craniosynostosis (OR, 2.5; 95% CI, 1.5–4.0); and omphalocele (OR, 2.8; 95% CI, 1.3–5.7). None of the mothers of case infants having defects associated with SSRI use were found to have been exposed at the same time to medications known to have teratogenic effects. This study failed to establish any association between the maternal use of SSRIs during early pregnancy and an elevated risk of congenital heart defects—or of several other classes of birth defects. Three associations were observed, but the absolute risks were small in view of the baseline risk of birth defects inherent in all pregnancies. At the same time, maternal stress and depression during pregnancy have been implicated in adverse reproductive outcomes, and discontinuing antidepressant therapy in pregnant women who are seriously depressed may negatively affect both the mother and infant.

Hypomania with and without Dysphoria: Comparison of comorbidity and clinical characteristics of respondents from a national community sample

Objective To compare rates of comorbidity, treatment utilization, the course of illness, and past year social functioning of Hypomania with and without Dysphoria Hypomania (mixed state). Method The National Epidemiological Survey on Alcohol and Related Conditions (NESARC) was a nationally representative face-to-face survey of 43,093 respondents, aged 18 years and older, conducted in 2001 through 2002. The target population of the survey is the civilian, noninstitutionalized population residing in the United States. Results Dysphoric Hypomania was associated with an increased lifetime risk for major depression, dysthymic disorder, anxiety disorders and personality disorders compared to Non-Dysphoric Hypomania. The former group had an earlier onset age of major depression, more episodes major depression and hypomania, and had a higher rate of treatment contact than the later group. Past year personal income and the frequency of full-time employment were lower in the Dysphoric Hypomania compared to Non-Dysphoric Hypomania. Conclusions Dysphoric Hypomania is a more severe and persistent mood disorder compared to Non-Dysphoric Hypomania.

Growing Depression Risk Faces Baby Boomers

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessGrowing Depression Risk Faces Baby BoomersJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:4 Nov 2005https://doi.org/10.1176/pn.40.21.0020According to the National Comorbidity Survey conducted in the 1990s, young adults used to have the largest lifetime risk of major depression. Now it is middle-aged adults, suggests a new study on the prevalence of major depression among Americans.Lead author Deborah Hasin, Ph.D., a professor of clinical public health at Columbia University, published the results in the October Archives of General Psychiatry.Although the reason for this finding is not certain, Hasin said in an interview, she suspects that it may reflect depressed baby boomers moving into middle age—“the same age cohort reflecting their increased risk as they march through the decades.” She also added that she was not surprised by the finding, although she “found it very intriguing and important.”Hasin's new study, in fact, appears to be the largest American study conducted on the subject of major depression. It was based on the 2001-2002 National Epidemiologic Survey of Alcoholism and Related Conditions, which conducted face-to-face interviews with some 43,000 Americans aged 18 and older from all 50 states. The interview format used to generate diagnoses was the National Institute on Alcohol Abuse and Alcoholism's Alcohol Use Disorder and Associated Disabilities Interview Schedule–DSM-IV Version.In contrast, the three previous studies that provided information about major depression prevalence—the Epidemiologic Catchment Area study, National Comorbidity Survey, and National Comorbidity Survey-R—interviewed only 19,000, 5,900, and 5,600 Americans, respectively.This new study also yields other potentially valuable findings regarding the prevalence of major depression:Study results showed a 12-month major depression prevalence rate of 5 percent and a lifetime major depression prevalence rate of 13 percent. These results are not all that different from those of the National Comorbidity Survey and the National Comorbidity Survey-R, which were conducted from 1990-1992 and from 2001-2002, respectively. However, they are considerably higher than the findings produced by the Epidemiologic Catchment Area study in the 1980s, which yielded figures of 3 percent and 5 percent, respectively.“ The U.S. rates of major depressive disorder are clearly higher than they were in the 1980s,” the investigators wrote.Even after sociodemographic factors were taken into consideration, both current (within the past 12 months) and lifetime major depression were found to be significantly linked with various anxiety disorders (especially generalized anxiety disorder); various personality disorders (especially avoidant and dependent personalities), and substance dependence.Regarding substance dependence, people with a current major depression were twice as likely to have alcohol or nicotine dependence as those without a major depression and four times as likely to have a drug dependence. Data were similar for those with a lifetime history of a major depression. Why major depression showed a stronger relationship to drug dependence than to alcohol or nicotine dependence remains to be explained, the researchers said.By comparison, only a weak relationship between major depression and substance abuse emerged. Hasin said that she considers this finding—“that major depression had a much stronger relationship to alcohol and drug dependence than to abuse”—one of the most important to come from the study, because it underscores that substance abuse and dependence are different entities.Finally, whereas blacks, Hispanics, and Asians were found to be significantly less at risk of a major depression than whites were, Native Americans were found to be more at risk. This latter finding appears to contradict that of another recently published study that found Native Americans to have a lower lifetime risk of major depression (Psychiatric News, October 7). However, that study was quite different in design. It compared some 3,000 individuals from two American Indian tribes with members of the general American population surveyed in the National Comorbidity Survey.The study was funded by the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse.An abstract of “Epidemiology of Major Depressive Disorder” is posted at<http://archpsyc.ama-assn.org/cgi/content/abstract/62/10/1097>.▪ Arch Gen Psychiatry 2005 62 1097 ISSUES NewArchived

Meta-analysis in psychiatric genetics

The article reviews literature on methods for meta-analysis of genetic linkage and association studies, and summarizes and comments on specific meta-analysis findings for psychiatric disorders. The Genome Scan Meta-Analysis and Multiple Scan Probability methods assess the evidence for linkage across studies. Multiple Scan Probability analysis suggested linkage of two chromosomal regions (13q and 22q) to schizophrenia and bipolar disorder, whereas Genome Scan Meta-Analysis on a larger sample identified at least 10 schizophrenia linkage regions, but none for bipolar disorder. Meta-analyses of pooled ORs support association of schizophrenia to the Ser311Cys polymorphism in DRD2 and the T102C polymorphism in HTR2A, and of attention deficit hyperactivity disorder to the 48-bp repeat in DRD4. The 5-HTTLPR polymorphism in the serotonin transporter gene (SLC6A4) may contribute to the risk of bipolar disorder, suicidal behavior, and neuroticism, but association to the lifetime risk of major depression has not been shown. Meta-analyses support linkage of schizophrenia to regions where replicable associations to candidate genes have been identified through positional cloning methods. There are additional supported regions where susceptibility genes are likely to be identified. Linkage meta-analysis has had less clear success for bipolar disorder based on a smaller dataset. Meta-analysis can guide the prioritization of regions for study, but proof of association requires biological confirmation of hypotheses about gene actions. Elucidation of causal mechanisms will require more comprehensive study of sequence variation in candidate genes, better statistical and meta-analytic methods to take all variation into account, and biological strategies for testing etiologic hypotheses.

Socioeconomic status in childhood and the lifetime risk of major depression

Background Major depression occurs more frequently among people of lower socioeconomic status (SES) and among females. Although the focus of considerable investigation, the development of SES and sex differences in depression remains to be fully explained. In this study, we test the hypotheses that low childhood SES predicts an increased risk of adult depression and contributes to a higher risk of depression among females. Methods Participants were 1132 adult offspring of mothers enrolled in the Providence, Rhode Island site of the US National Collaborative Perinatal Project between 1959 and 1966. Childhood SES, indexed by parental occupation, was assessed at the time of participants' birth and seventh year. A lifetime history and age at onset of major depressive episode were ascertained via structured interviews according to diagnostic criteria. Survival analyses were used to model the likelihood of first depression onset as a function of childhood SES. Results Participants from lower SES backgrounds had nearly a twofold increase in risk for major depression compared to those from the highest SES background independent of childhood sociodemographic factors, family history of mental illness, and adult SES. Analyses of sex differences in the effect of childhood SES on adult depression provided modest support for the hypothesis that childhood SES contributes to adult sex differences in depression. Conclusions Low SES in childhood is related to a higher risk of major depression in adults. Social inequalities in depression likely originate early in life. Further research is needed to identify the pathways linking childhood conditions to SES differences in the incidence of major depression.

Socioeconomic status in childhood and the lifetime risk of major depression

Major depression occurs more frequently among people of lower socioeconomic status (SES) and among females. Although the focus of considerable investigation, the development of SES and sex differences in depression remains to be fully explained. In this study, we test the hypotheses that low childhood SES predicts an increased risk of adult depression and contributes to a higher risk of depression among females. Participants were 1132 adult offspring of mothers enrolled in the Providence, Rhode Island site of the US National Collaborative Perinatal Project between 1959 and 1966. Childhood SES, indexed by parental occupation, was assessed at the time of participants' birth and seventh year. A lifetime history and age at onset of major depressive episode were ascertained via structured interviews according to diagnostic criteria. Survival analyses were used to model the likelihood of first depression onset as a function of childhood SES. Participants from lower SES backgrounds had nearly a twofold increase in risk for major depression compared to those from the highest SES background independent of childhood sociodemographic factors, family history of mental illness, and adult SES. Analyses of sex differences in the effect of childhood SES on adult depression provided modest support for the hypothesis that childhood SES contributes to adult sex differences in depression. Low SES in childhood is related to a higher risk of major depression in adults. Social inequalities in depression likely originate early in life. Further research is needed to identify the pathways linking childhood conditions to SES differences in the incidence of major depression.

Depression associated with multiple sclerosis: Looking beyond diagnosis to symptom expression

Background: While it is recognised that patients with multiple sclerosis have a high lifetime risk for major depression, less is known about sub-syndromal presentations of affective instability, i.e., irritability, sadness and tearfulness and how these symptoms of emotional dyscontrol may affect a subject’s overall degree of psychological distress. Methods: A consecutive sample of 100 out-patients with clinically definite multiple sclerosis attending their yearly neurological examination were assessed for major depression [Structured Clinical Interview for DSM-IV (SCID-1)], pathological laughing and crying [Pathological Laughing and Crying Scale (PLACS)], self report questionnaires documenting mood [Beck Depression Inventory (BDI)] and overall psychological distress [the 28 item General Health Questionnaire (GHQ)]. Results: Seventeen percent of subjects received a diagnosis of major depression, 8% had pathological laughing and crying (PLC), 48% had symptoms of emotional dyscontrol without meeting criteria for a formal psychiatric diagnosis and 27% had minimal psychiatric symptoms (emotionally stable). The groups did not differ with respect to neurological variables. However, on a validated index of psychological distress (i.e., GHQ scores ≥5), there were significantly more subjects with major depression and emotional dyscontrol than those deemed emotionally stable ( P<0.0001). Limitations: The small number of patients with PLC ( N=8) curtailed statistical power when it came to analysing this sub-group. Conclusions: Clinicians should be sensitive to complaints such as irritability and sadness in patients with multiple sclerosis, even when symptoms do not fulfil criteria for formal, psychiatric diagnoses. Our data demonstrate that such complaints are associated with levels of psychological distress that approach those experienced by patients with major depression. Given that these sub-syndromes of affective instability respond well to pharmacotherapy, detection and treatment can significantly reduce one important aspect of morbidity associated with multiple sclerosis.

Occupation and the Prevalence of Major Depression, Alcohol, and Drug Abuse in the United States

These data from the ECA research program clearly indicate considerable variation in prevalence among different occupational groups in the United States for major depression, alcohol abuse/dependence, and drug abuse/dependence. For example, the crude lifetime prevalences for depression ranged from 0.7 to 8.6 per 100; for alcohol it was 7.5 to 32.6, and for drugs it was 3.1 to 10.5. The results also indicate that some occupations are associated with much higher rates of ADM problems. By way of illustration, the 6-month crude prevalence of major depression for the total sample of employed persons 18-64 years of age was 2.9. Six of the occupational groups had prevalences which exceeded this rate. The overall 6-month prevalence of alcohol abuse/dependence was 5.8, and six occupational groups had prevalences in excess of this. Similarly, the overall 6-month prevalence was 2.6 for drug abuse/dependence, and five occupational groups had prevalences which exceeded this. Translated into terms of relative risk, it is clear that among the occupational groups some are at markedly increased risk of ADM disorders. For these comparisons, we used as the baseline group in logistic regression analyses, Job 1, composed of executive, administrative, and managerial occupations. This group is the first in the Census classification, had crude rates near the overall prevalence rates for depression, alcohol, and drugs, and is also one of the occupational categories with the highest prestige. Logistic regression analyses were done with and without controls for differences among occupational groups in gender, age, and educational level. As might be expected, adjustment in general narrowed differences in prevalence among occupational groups, and even on occasion, changed the rank order of groups slightly. However, in general, those groups with higher odds ratios based on crude rates also had higher adjusted odds ratios. Table 6 summarizes our findings, based on the adjusted odds ratios. In this table, we list occupational groups which had a relative risk of 30% or greater above baseline (Job 1), for both 6 month and lifetime prevalences, for each of the three ADM disorders. As can be seen, there is virtually no overlap between risk of depression, on the one hand, and risk of alcohol or drug abuse. The exceptions are Job 4 (sales) which ranked third for major depression and second for alcohol abuse in terms of 6-month prevalence, and Job 9 (farming, fishing, forestry), which had the [table: see text] highest lifetime risk for major depression and the second-highest 6-month risk for drug abuse/dependence.(ABSTRACT TRUNCATED AT 400 WORDS)

Association between family history of affective disorder and the depressive syndrome of Alzheimer's disease

For each of 41 index patients with probable Alzheimer's disease and a first episode of major depression and 71 nondepressed Alzheimer's disease patients, two first-degree relatives were interviewed by a rater blind to presence or absence of depression in the proband. The depressed patients had significantly more first- and second-degree relatives with depression than did control subjects. The lifetime risk for major depression, adjusted for differences in age distribution, was significantly greater in first-degree relatives of index patients, suggesting that depression in Alzheimer's disease is genetically related to primary affective disorder. Alzheimer's disease may be useful for studying aspects of depressive pathophysiology.

Birth cohort trends in major depression: increasing rates and earlier onset in New Zealand

In a community sample of 1498 urban adults (18–64 years) interviewed in their homes with the Diagnostic Interview Schedule (DIS), the 6-month and lifetime prevalence of major depression was higher in females than males. However, in the most recent birth cohort young men had a higher 6-month prevalence of depression. Survival analysis of the cumulative lifetime risk for major depression demonstrated a significant trend in both sexes for depression to be increasing in prevalence, and for it to be occurring at an earlier age. Thus New Zealand, like other countries, may be entering an age of melancholy.

Panic Disorder

One hundred++ ninety-five primary care patients were screened for panic disorder utilizing the National Institute of Mental Health Diagnostic Interview Schedule (DIS) as well as four additional questions that screened for core autonomic symptoms of panic disorder. A spectrum of severity of panic disorder was found. A subgroup of patients, labeled in the study as having simple panic, was found to have anxiety attacks associated with four or more autonomic symptoms, but they did not meet DSM-III recurrence criteria (three anxiety attacks within a 3-week period). Compared to primary care patients without panic attacks, patients with both simple panic and panic disorder exhibited multiple phobias, avoidance behavior, a high lifetime risk of major depression, and elevated scores on self-rating scales of anxiety and depression. The four autonomic screening questions that the authors added to the DIS interview increased the sensitivity of the DIS in identifying patients with panic disorder. Patients with panic disorder who selectively focus on their frightening autonomic symptoms may not be identified by screen questions that only focus on the cognitive awareness of anxiety.