Long-term Depressive Symptoms Research Articles

Depressive symptoms among young breast cancer survivors: the importance of reproductive concerns

Breast cancer diagnosis and treatment can negatively impact fertility in premenopausal women and influence reproductive planning. This study investigates whether concerns about reproduction after breast cancer treatment were associated with long-term depressive symptoms. Participants include 131 women diagnosed with early-stage breast cancer at age 40 or younger participating in the Women's Healthy Eating and Living (WHEL) Survivorship Study. Participants were enrolled an average of 1.5 years postdiagnosis and depressive symptoms were monitored 6 times throughout the average additional 10 year follow-up period. Detailed recall of reproductive concerns after treatment was collected an average of 12 years postdiagnosis. Multilevel regression was used to evaluate whether mean long-term depressive symptoms differed as a function of reproductive concerns and significant covariates. Multilevel regression identified greater recalled reproductive concerns as an independent predictor of consistent depressive symptoms after controlling for both social support and physical health (B = 0.02, SE = 0.01, P = 0.04). In bivariate analyses, being nulliparous at diagnosis and reporting treatment-related ovarian damage were both strongly associated with higher reproductive concerns and with depressive symptoms. Reported reproductive concerns after breast cancer treatment were a significant contributor to consistent depressive symptoms. Younger survivors would benefit from additional information and support related to reproductive issues.

Persistent cognitive depressive symptoms are associated with coronary artery calcification

ObjectivesThe association between depression and sub-clinical atherosclerosis remains unclear. By assessing depressive symptoms only at one point in time, most previous studies have failed to ascertain long-term exposure. We examined the association of long-term depressive symptoms assessed at three time points (over 10 yrs) with a marker of sub-clinical atherosclerosis. MethodsParticipants included 454 healthy, non-medicated men and women from the Whitehall II epidemiological cohort without known cardiovascular disease (CVD). Depressive symptoms were assessed at three time points (over 10 yrs) and coronary atherosclerosis was assessed at follow-up in terms of coronary artery calcification (CAC). Results18.9% of the sample reported depressive symptoms at least once during follow-up. Participants that were persistently depressed had over a two-fold increased risk of detectable CAC (Agatston score>0) (odds ratio [OR]=2.56, 95% CI, 1.14–5.78) and high CAC (Agatston score≥100) (OR=2.36, 1.04–5.35) compared with never depressed after adjustment for age, sex, and a range of conventional cardiac risk factors. These associations were more robust in men. Participants who were depressed on only one occasion were not at elevated risk of CAC. ConclusionsPersistent cognitive symptoms of depression assessed over several time points, but not on a single occasion, are related to sub-clinical coronary atherosclerosis in men free of known CVD and diabetes.

ORIGINAL RESEARCH—ENDOCRINOLOGY: Hypogonadism, Decreased Sexual Desire, and Long-Term Depression in Middle-Aged Men

In middle-aged men, the associations between long-term depressive symptoms and circulating testosterone levels are poorly known, although it is known that testosterone levels decrease with age. A health questionnaire was mailed to a population-based sample from the National Population Register in 1998, 1999, and 2001. Based on their self-reported mental symptoms, a total of 116 men were selected for clinical examination in 2005. Half of them had high and the others low levels of adverse mental symptoms in all three previous follow-ups. A structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders-IV was performed. Depressive symptoms were assessed with the Beck Depression Inventory (BDI) and the Hamilton Depression Rating Scale (HDRS). The Aging Males' Symptoms scale was also compiled and testosterone levels were determined. In the entire study sample, serum free testosterone levels correlated negatively with both BDI and HDRS scores. In the hypogonadism group (based on free testosterone, 19.8% of the sample), clinically significant depression (BDI score > or = 13) was more than three times as frequent as in the other men (34.8% vs. 10.4%), the odds ratio after multiple adjustments being 4.98 (95% confidence interval 1.66-14.95). A decrease in sexual desire was common in hypogonadism (36%). Nevertheless, it also associated with clinically significant depression, irrespective of free testosterone levels. Long-term and current depressive symptoms, a decreased sexual desire, and low serum free testosterone levels are associated in middle-aged men. Hypogonadism per se and as a cause of decreased sexual desire may be a contributory and possibly treatable factor underlying male depression. The findings highlight the need for hormonal status assessment in middle-aged depressive men.

Association of depressive symptoms and metabolic syndrome in men

To explore the relationship between several indicators of depression and metabolic syndrome (MetS). A population-based sample with high (HMS group) or low (LMS group) levels of mental symptoms, including those of depression, in three follow-ups participated in a clinical examination in 2005 (n = 223). MetS was determined according to the NCEP criteria. The prevalence of MetS was 49% in men and 21% in women. Men with MetS had higher rates of major depressive disorder than other men. They also displayed higher Hamilton Rating Scale for Depression (HDRS) scores and more often signs of suicidality. In logistic regression analyses, higher HDRS scores (OR 1.31, 95% CI 1.04-1.64) and belonging to the HMS group (OR 10.1, 95% CI 1.98-51.3) were independent associates for MetS but only in men. The results highlight that there is an association between long-term depressive symptoms and the emergence of MetS, especially in men.

Predictors of depressive symptoms 12 months after surgical treatment of early‐stage breast cancer

Nearly half of the women with breast cancer (BC) show depressive symptoms in the first year after diagnosis. This has a major impact on patients' lives. Therefore, the aim of this study was to identify predictors of depressive symptoms 12 months after surgical treatment. Furthermore, the stability of depressive symptoms across 12 months was investigated for persons scoring high versus low/moderately on agreeableness, trait anxiety, and neuroticism. From the 609 women with an abnormality in the breast, 223 appeared to have early-stage BC. A depressive symptoms questionnaire (Center for Epidemiological Studies-Depression Scale) was completed before diagnosis and 1, 3, 6, and 12 months after surgical treatment. In addition, patients completed questionnaires on personality (State Trait Anxiety Inventory, Neuroticism-Extraversion-Openness-Five Factor Inventory), fatigue (Fatigue Assessment Scale), and aspects of quality of life (World Health Organization Quality of Life assessment instrument-100). Before diagnosis and 1 year later, 40.9% and 27.8% of the women, respectively, scored above the established cut-off score for depressive symptoms. Depressive symptoms significantly improved in this period. Patients reported higher scores, when they had a breast-conserving therapy (BCT), scored low on agreeableness, scored high on neuroticism, or reported higher scores on depressive symptoms or fatigue before diagnosis. Other clinical and socio-demographic factors did not predict depressive symptoms. Besides BCT, fatigue, and depressive symptoms, personality, especially neuroticism and agreeableness, predicted depressive symptoms 1 year after surgical treatment. Therefore, it is important to screen patients on these characteristics in order to prevent long-term depressive symptoms.

Prediction of depressive symptoms up to three years post-stroke

To describe the long-term course of depressive symptoms up to 3 years post-stroke and to develop a prediction model for depressive symptoms 1 and 3 years post-stroke. Longitudinal follow-up study. Data were analysed for 131 patients with a first-ever supratentorial stroke admitted for inpatient rehabilitation in the Netherlands The Center for Epidemiologic Studies-Depression scale was used to assess post-stroke depressive symptoms at 6 months, 1 and 3 years post-stroke. Post-stroke depressive symptoms were present 6 months, 1 year and 3 years post-stroke in 23.7%, 25.2% and 16.0% of the patients, respectively. At all 3 assessments post-stroke depressive symptoms were absent in 65.6% of the patients and present in 12.2% of the patients. Of the patients with post-stroke depressive symptoms 6 months post-stroke, 41.9% had recovered from post-stroke depressive symptoms 3 years post-stroke. The most important predictor of post-stroke depressive symptoms 1 and 3 years post-stroke was post-stroke depressive symptoms 6 months post-stroke (area under the curve 0.75 and 0.85). Male gender was an additional predictor for post-stroke depressive symptoms 3 years post-stroke. Long-term post-stroke depressive symptoms are highly predictable at 6 months post-stroke. If a patient has not recovered from post-stroke depressive symptoms within the first 6 months post-stroke there is a high risk of chronic post-stroke depressive symptoms.

Relation between personality and quality of postoperative recovery in day surgery patients

Personality factors have been found to influence long-term postoperative depressive symptoms, health and distress in inpatients. To our knowledge, no studies have analysed whether the personality traits of day surgery patients relate to postoperative recovery. Hence, this study aims to explore possible relationships between personality traits and the quality of postoperative recovery in patients undergoing day surgery. Our study used a consecutive sample of 260 day surgery patients to explore possible relationships between personal traits, measured by a short Big Five scale, and postoperative recovery, measured by modified Quality of Recovery-40, on postoperative days 1, 7 and 14. We found a positive correlation in changes of 'physical independence' and 'extroversion' (r = 0.20; P = 0.010) and 'intellect' (r = 0.18; P = 0.021) on postoperative days 1 and 7. These correlations were not observed on postoperative day 14. With regard to the change between days 7 and 14, correlations were found between 'physical interdependence' and 'agreeableness' and between 'physical interdependence' and 'conscientiousness' (r = -0.17; P = 0.028-0.030 for both). Day surgery patients appear to be a homogenous group with stable personalities, demonstrating some minor correlations between personality traits and the quality of postoperative recovery on days 1, 7 and 14. However, further studies are needed.

COMPARISON OF TWO JOINT PSYCHIATRY/ENDOCRINOLOGY CLINICS STARTED IN A CHRONIC TERTIARY CARE PSYCHIATRIC HOSPITAL AND A FIRST EPISODE PSYCHOSIS PROGRAM

In middle-aged men, the associations between long-term depressive symptoms and circulating testosterone levels are poorly known, although it is known that testosterone levels decrease with age.A health questionnaire was mailed to a population-based sample from the National Population Register in 1998, 1999, and 2001. Based on their self-reported mental symptoms, a total of 116 men were selected for clinical examination in 2005. Half of them had high and the others low levels of adverse mental symptoms in all three previous follow-ups. A structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders-IV was performed. Depressive symptoms were assessed with the Beck Depression Inventory (BDI) and the Hamilton Depression Rating Scale (HDRS). The Aging Males’ Symptoms scale was also compiled and testosterone levels were determined.In the entire study sample, serum free testosterone levels correlated negatively with both BDI and HDRS scores. In the hypogonadism group (based on free testosterone, 19.8% of the sample), clinically significant depression (BDI score ≥ 13) was more than three times as frequent as in the other men (34.8% vs. 10.4%), the odds ratio after multiple adjustments being 4.98 (95% confidence interval 1.66–14.95). A decrease in sexual desire was common in hypogonadism (36%). Nevertheless, it also associated with clinically significant depression, irrespective of free testosterone levels.Long-term and current depressive symptoms, a decreased sexual desire, and low serum free testosterone levels are associated in middle-aged men. Hypogonadism per se and as a cause of decreased sexual desire may be a contributory and possibly treatable factor underlying male depression.The findings highlight the need for hormonal status assessment in middle-aged depressive men. Hintikka J, Niskanen L, Koivumaa-Honkanen H, Tolmunen T, Honkalampi K, Lehto SM, and Viinamäki H. Hypogonadism, decreased sexual desire, and long-term depression in middle-aged men. J Sex Med 2009;6:2049–2057.

Acute deviations from long-term trait depressive symptoms predict systemic inflammatory activity

Objective Depressive symptoms increase morbidity and mortality from coronary heart disease and systemic inflammation has been proposed as the underlying mechanism. While higher levels of inflammatory mediators have been found in dysphoric individuals, it is not known whether long-term or short-term mood changes are responsible for this phenomenon. Methods A sample of 65 young women provided weekly web-based self-ratings of depressive mood over a period of 20 weeks using the CES-D, and systemic inflammation was assessed by measuring plasma interleukin-6 (IL-6) and C-reactive protein (CRP) before and after the observation period. CES-D ratings were used to develop state and trait indicators of depressed mood and evaluate their relationship with inflammatory mediators. Results Hierarchical linear regressions controlling for baseline inflammation, age, and BMI revealed that trait levels of depressive symptoms were not associated with IL-6 ( β = 0.09; n.s.) and CRP ( β = 0.01; n.s.) concentrations after the observation period. In contrast, state levels of depressive symptoms were associated with changes in IL-6, but not CRP, particularly when they were indexed as the disparity between a person’s trait level of symptoms and her CES-D score just prior to IL-6 assessment ( β = 0.35; p = 0.03). Conclusion These results lead us to conclude that in young women, state, rather than trait depressed mood stimulates peripheral inflammation as measured by IL-6. This pattern suggests that in this age group, fast-reacting inflammatory mediators such as IL-6 probably respond to short-term changes, for example, in stress hormones or stress hormone sensitivity, rather than long-term dysregulations of allostatic mechanisms.

Long-term emotional state of multiple sclerosis patients treated with interferon beta

Objective: To assess the long-term emotional state of multiple sclerosis (MS) patients treated with interferon beta (IFNβ) for at least four years. Methods: Patients who had started IFNβ therapy prior to 2000 with a baseline psychological assessment were identified and scheduled for long-term emotional assessment with the following questionnaires-the Hamilton Depression Rating Scale, the Beck Depression Inventory and the State-Trait Anxiety Inventory. Results: A total of 262 patients started IFNβ therapy in our MS clinic within the period 1995-1999. Baseline emotional assessment was available from 246 MS patients. Long-term assessment was conducted on 234 patients. After a mean follow-up of 65 months (43-98), 52 patients (22.3%) had withdrawn from IFNβ therapy. The comparisons, obtained from baseline and follow-up scores, showed an improvement in the depressive and anxiety symptoms of patients who adhered to IFNβ treatment. Logistic regression analysis indicated that an increase in physical disability and the presence of depressive symptoms at baseline were best predictors for long-term depressive symptoms. Conclusions: The present results support the absence of emotional worsening in MS patients treated with IFNβ for a long period of time. Increased disability and the presence of baseline depressive symptoms predicted the presence of depressive symptoms at follow-up.

Early cognitive impairment predicts long-term depressive symptoms and quality of life after stroke

Objective The aim of the present study was to examine the predictive value of cognitive impairment in the acute phase after stroke as a risk factor for long-term (six to ten months after stroke) depressive symptoms (DS) and a reduced quality of life (QOL), independent of demographic and neurological predictors. Methods We evaluated 143 patients within the first 3 weeks post-stroke. Predictor variables included domain-specific cognitive function, demographic data, vascular risk factors, lesion characteristics, and clinical factors. Predictor variables associated with long-term DS (Montgomery ?sberg Depression Rating Scale ≥ 7) and QOL (Stroke-Specific Quality of Life Scale) were identified with multiple logistic and linear regression. Results Long-term DS were independently predicted by cognitive impairment at baseline, DS at baseline, female sex, diabetes mellitus, and previous TIA(s). Cognitive impairment, increasing age, and functional dependence predicted a reduced QOL, whereas hypercholesterolaemia predicted a better QOL. Among all cognitive disorders, unilateral neglect was the greatest risk factor for DS after 6 months, whereas a disorder in visual perception and construction affected QOL the most. Conclusions Cognitive impairment and vascular risk factors are important predictors of long-term DS and QOL after stroke. The prognostic value of cognition suggests a reactive component in the development or continuation of long-term DS.

The Longitudinal Relationship Between the Use of Long-Term Care and Depressive Symptoms in Older Adults

The aim of this study was to estimate the longitudinal relationship between transitions in the use of long-term care and older adults' depressive symptoms and to investigate whether this relationship could be explained by markers of older adults' underlying health, or other variables including demographics, personality, and partner status. Data were from the Longitudinal Aging Study Amsterdam, which consists of a random, community-based sample of 3,107 older Dutch people (55-85 years of age) stratified by age and gender. The use of informal care, professional home care, and institutional care was recorded, and respondents were screened on depressive symptoms. Follow-up measurements took place at 3 and 6 years. Longitudinal analyses showed significant associations between the enduring use of professional long-term care and an increase in depressive symptoms. Transitions to professional home care or institutional care were also associated with considerably more depressive symptoms after 3 years, whereas transitions from professional home care or institutional care to no care or informal care only were not associated with a change in depressive symptoms. Most of the associations remained significant after indicators of underlying health and other covariates were adjusted for, and also after the data were reanalyzed for respondents with and without functional limitations. This study does not involve a controlled experiment of professional long-term care among older adults. However, the findings suggest the possibility that receiving professional long-term care could introduce new stressors and increase the risk of depressive symptoms. Our analyses illuminate the concerns of elders regarding their use of professional long-term care and may help in planning for more effective delivery of this type of care.

Severe postpartum distress in Icelandic mothers with difficult infants: a follow-up study on their health care.

This article describes help seeking and health care of mothers with a difficult infant who suffered long-term depressive symptoms and a high degree of parenting stress. A subsample of severely distressed mothers (n = 37) was recruited from a cross-sectional national survey and followed up 2 months later by a semi-structured telephone interview. The survey included all Icelandic women who gave birth during a quarter of a year and had a live baby 2 months later (n = 1053). All distressed mothers with a difficult infant were selected from sample respondents on preset scores of two self-report distress measures. The study sample emerged during the selection process for an intervention study from which it was excluded on grounds of very high distress scores. Results showed that 5% of the surveyed population were postpartum severely distressed. Findings from this follow-up study revealed that only one woman of four received health care for severe distress by various professionals. One woman of six received help from others. Very few women utilized the services available at Health Care Centers. About half of the women held attitudes that hindered them in seeking help and health care. It is concluded that postpartum severely distressed women receive little primary health care for mental health problems and the majority of them show little initiative to seek out for help. More active outreach by health professionals is recommended.

Factors associated with long-term depressive symptoms of sexual assault victims

Of 63 sexual assault victims who were a mean 7.9 years postevent, almost two thirds (60%, n = 38) demonstrated some degree of depression. Over half (56%, n = 35) the sample also reported a history of childhood sexual abuse. Three factors had a significant positive association with higher levels of depression: nondisclosure of the assault to significant others due to concerns about stigma; the presence of children living with the victim; and a civil lawsuit pending. One factor, currently being sexually active, had a significant negative association with depression. Results are discussed from the perspective of depression, a common pathway by which unresolved sexual trauma is expressed.