Predictors Of Major Depression Research Articles

Prevalence and Predictors of Major Depression in HIV-Infected Patients on Antiretroviral Therapy in Bamenda, a Semi-Urban Center in Cameroon

Recent blue-ribbon panel reports have concluded that HIV treatment programs in less wealthy countries must integrate mental health identification and treatment into normal HIV clinical care and that research on mental health and HIV in these settings should be a high priority. We assessed the epidemiology of depression in HIV patients on antiretroviral therapy in a small urban setting in Cameroon by administering a structured interview for depression to 400 patients consecutively attending the Bamenda Regional Hospital AIDS Treatment Center. One in five participants met lifetime criteria for MDD, and 7% had MDD within the prior year. Only 33% had ever spoken with a health professional about depression, and 12% reported ever having received depression treatment that was helpful or effective. Over 2/3 with past-year MDD had severe or very severe episodes. The number of prior depressive episodes and the number of HIV symptoms were the strongest predictors of past-year MDD. The prevalence of MDD in Cameroon is as high as that of other HIV-associated conditions, such as tuberculosis and Hepatitis B virus, whose care is incorporated into World Health Organization guidelines. The management of depression needs to be incorporated in HIV-care guidelines in Cameroon and other similar settings.

Prevalence and Predictors of Major Depression in HIV-Infected Patients on Antiretroviral Therapy in Bamenda, a Semi-Urban Center in Cameroon

Prevalence and Predictors of Major Depression in HIV-Infected Patients on Antiretroviral Therapy in Bamenda, a Semi-Urban Center in Cameroon

P02-497 - Prenatal depression: role of childhood stressors, current stressors and past emotional disorders

BackgroundVery few studies have conducted a multivariate analysis incorporating both the major predictors of depression in women, in accordance with comprehensive developmental models of depression, and specific stressors associated with the biological and psychosocial state of the mother-to-be.MethodologyWe used a cross-sectional cohort design to analyze the associations between prenatal depression and potential risk factors. 693 French-speaking women with singleton pregnancies at 20–28 weeks’ gestation were consecutively recruited. Fifty women with missing values were subsequently excluded from the analysis. Depressive symptoms were assessed on the Edinburgh Postnatal Depression Scale. Risk factors were either extracted from the computerized obstetric records or assessed by means of self-administered questionnaires. The associations between prenatal depression and the potential risk factors were assessed using log-binomial regression models to obtain a direct estimate of relative risk.Principal findingsThe following factors were found to be significant in the multivariate analysis: level of education, past psychiatric history, stress related to the health and viability of the fetus and stress related to severe marital conflicts or to serious difficulties at work. An association was also found with the previous delivery of a child with a major or minor birth defect. Univariate analyses revealed a strong association with childhood adversity (parental rejection and family secrets).ConclusionsOur study identifies several risk factors that could easily be assessed in clinical practice. It draws attention to the impact of previously delivering a child with a birth defect and to the association with childhood adversity.

Prevalence of symptoms of depression among patients with chronic kidney disease

Depression is the most common psychiatric illness in patients with chronic kidney disease (CKD). Depression has been shown to affect mortality in end-stage renal disease patients. The objective of this study was to determine prevalence of depressive symptoms among CKD patients. A cross-sectional study of patients with CKD (Stages 3-5) attending the renal clinic of a tertiary hospital was conducted. Demographic and clinical data were documented. A self-administered Zung depression questionnaire was administered. The Zung depression questionnaire has 20 weighted questions. Individuals with a total score of 50 are considered to be depressed, while a score of 70 and above is indicative of severe depression. One hundred and eighteen patients and fifty controls were interviewed. There were 73 (61.9%) males and 45 (38.1%) female patients. The mean age did not differ: males 43.8 ± 15.4 years, females 43.2 ± 14.7 yrs, P = 0.83. The prevalence of depression among the CKD patients was 23.7%, while for the control group was 2%; χ2 = 10.14, P < 0.001. Further analysis showed that CKD patients on dialysis were more likely to be depressed than the pre-dialysis patients with frequency of depressive symptoms of 34.5% for dialysis patients versus 13.3% in pre-dialysis patients; χ2 = 6.17, P = 0.01. No difference was observed in the mean Zung score among males, and female patients mean Zung score was 40.1 in females and 40.7 in male patients; P > 0.05. Depression is highly prevalent among our patients with CKD and treatment modality was the major predictor of depression among our patients.

Dependent Stressful Life Events and Prior Depressive Episodes in the Prediction of Major Depression

Most environmental risk factors for psychiatric disorders cannot be studied experimentally, making causal attributions difficult. Can we address this question by using together 2 major methods for causal inference: natural experiments and specialized statistical methods? To determine the causal relationship between dependent stressful life events (dSLEs) and prior depressive episodes (PDEs) and major depression (MD). Assessment of risk factors and episodes of MD at interview. Statistical analyses used the co-twin control and propensity score-matching methods. General community. Four thousand nine hundred ten male and female twins from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. Episodes of MD. We found that dSLEs were strongly associated with risk for MD in female (odds ratio [OR], 5.85) and male (4.55) twins in the entire sample and, at considerably lower levels, in female (2.29) and male (2.19) monozygotic twins discordant for dSLE exposure. A case-control sample matched on propensity score showed a moderate association in female (OR, 1.79) and male (1.53) twins. A PDE strongly predicted risk for MD in female (OR, 3.68) and male (5.20) twins in the entire sample. In monozygotic pairs discordant for exposure, the association was weaker in male (OR, 1.41) and absent in female (1.00) twins. A case-control sample matched on propensity score showed a moderate association between PDE and depressive episodes in male (OR, 1.58) and female twins (1.66). Although dSLEs have a modest causal effect on the risk for MD, a large proportion of the observed association is noncausal. The same pattern is seen for PDEs, although the causal impact is somewhat more tenuous. For environmental exposures in psychiatry that cannot be studied experimentally, co-twin control and propensity scoring methods--which have complementary strengths and weaknesses--can provide similar results, suggesting their joint use can help with the critical question of causal inference.

Predictors of incident major depression in diabetic outpatients with subthreshold depression

The objective of the study was to determine rates and risks of major depression in diabetes outpatients with subthreshold depression. This study is based on data of a stepped care-based intervention study in which diabetic patients with subthreshold depression were randomly allocated to low-intensity stepped care, aimed at reducing depressive symptoms, or to care as usual. Patients had a baseline Center for Epidemiologic Studies Depression Scale (CES-D) score ≥ 16, but no baseline major depression according to the Mini International Neuropsychiatric Interview (MINI). Demographic, biological and psychological characteristics were collected at baseline. The MINI was used to determine whether participants had major depression during 2-year follow-up. Predictors of major depression were studied using logistic regression models. Of the 114 patients included at baseline, 73 patients were available at 2-year follow-up. The 2-year incidence of major depression was 42% (n=31). Higher baseline anxiety levels [odds ratio (OR)=1.25; 95% confidence interval (CI), 1.04-1.50; P=0.018] and depression severity levels (OR=1.09; 95% CI, 1.00-1.18; P=0.045) were predictors of incident major depression. Stepped care allocation was not related to incident major depression. In multivariable models, similar results were found. Having a higher baseline level of anxiety and depression appeared to be related to incident major depression during 2-year follow-up in diabetic patients with subthreshold depression. A stepped care intervention aimed at depression alone did not prevent the onset of depression in these patients. Besides level of depression, anxiety might be taken into account in the prevention of major depression in diabetic patients with subthreshold depression.

Developmental Model of Depression Applied to Prenatal Depression: Role of Present and Past Life Events, Past Emotional Disorders and Pregnancy Stress

BackgroundSeveral risk factors for depression during pregnancy have already been established. However, very few studies have conducted a multivariate analysis incorporating both the major predictors of depression in women, in accordance with comprehensive developmental models of depression, and specific stressors associated with the biological and psychosocial state of the mother-to-be.Methodology/Principal FindingsWe used a cross-sectional cohort design to analyze the associations between prenatal depression and potential risk factors. 693 French-speaking women with singleton pregnancies at 20–28 weeks' gestation were consecutively recruited at Caen University Hospital. Fifty women with missing values were subsequently excluded from the analysis. Depressive symptoms were assessed on the Edinburgh Postnatal Depression Scale. Risk factors were either extracted from the computerized obstetric records or assessed by means of self-administered questionnaires. The associations between prenatal depression and the potential risk factors were assessed using log-binomial regression models to obtain a direct estimate of relative risk (RR). The following factors were found to be significant in the multivariate analysis: level of education (p<0.001), past psychiatric history (adjusted RR = 1.8, 95% confidence interval (CI): 1.1;2.8, p = 0.014), stress related to the health and viability of the fetus (adjusted RR = 2.6, 95% CI: 1.6;4.1, p<0.001), and stress related to severe marital conflicts (adjusted RR = 2.4, 95% CI: 1.5;3.9, p<0.001) or to serious difficulties at work (adjusted RR = 1.6, 95% CI :1.04;2.4, p = 0.031). An association was also found with the previous delivery of a child with a major or minor birth defect (adjusted RR = 2.0, 95% CI: 1.04;4.0, p = 0.038). Univariate analyses revealed a strong association with childhood adversity (parental rejection: RR = 1.8, 95% CI: 1.2;2.8, p = 0.0055 and family secrets: RR = 2.0, 95% CI: 1.2;3.1, p = 0.0046) and with lack of partner support (RR = 0.50, 95% CI: 0.30;0.84, p = 0.0086).Conclusions/SignificanceOur study identifies several risk factors that could easily be assessed in clinical practice. It draws attention to the impact of previously delivering a child with a birth defect. The association with childhood adversity warrants further study.

Prodromal symptoms and atypical affectivity as predictors of major depression in juveniles: implications for prevention.

Given the long-term morbidity of juvenile-onset major depressive disorder (MDD), it is timely to consider whether more effort should be dedicated to its primary and secondary prevention. We reviewed studies of prodromal symptoms that may herald a first episode pediatric MDD and considered whether that literature has made an impact on secondary prevention (efforts to prevent progression from symptoms to full disorder). We also reviewed studies of children at familial risk for MDD that addressed atypical affectivity and the regulation of sad, dysphoric affect (mood repair) and related physiological systems, and considered whether research in those areas has made an impact on primary prevention of pediatric MDD (efforts to prevent the disorder). A compelling body of literature indicates that depressive symptoms in youngsters predict subsequent MDD across the juvenile (and early adult) years and that any combination of several symptoms for at least one week is informative in that regard. These findings are echoed in the case selection criteria used by many secondary prevention programs. Convergent findings also indicate that (compared to typical peers) young offspring at familial risk for depression manifest low positive affectivity and compromised mood repair, along with signs of dysfunction in three intertwined physiological systems that contribute to affectivity and mood repair (the hypothalamic-pituitary-adrenal (HPA) axis, cerebral hemispheric asymmetry, and cardiac vagal control). While all these affect-related parameters are suitable for case selection and as intervention targets, they have not yet made an impact on primary prevention programs. According to recent meta-analyses, attempts to prevent pediatric depression have not lived up to expectations. Based on our review, possible reasons for this include: (a) the use of case selection criteria that yield samples heterogeneous with regard to whether the symptoms are truly prodromal to an episode of MDD or are trait-like (which could affect response to the intervention), (b) failure to fully capitalize on the broad-ranging literature on vulnerability to pediatric MDD, as evidenced by the infrequent use of family history of depression (a robust index of vulnerability) or combined indices of vulnerability for case selection, and (c) lack of synchrony between dimensions of vulnerability and the content of the prevention program, as indicated by the overwhelming use of cognitive-behavioral interventions, irrespective of subjects' age, developmental readiness, and whether or not they evidenced the relevant cognitive vulnerability. Prevention trials of pediatric MDD could benefit from new approaches to case selection that combine various indices of vulnerability, more effective use of existing findings, and new or modified interventions that are developmentally sensitive.

Chronic and acute stress and the prediction of major depression in women.

This study explored the relatively neglected role of chronic stress in major depression, examining the independent contributions of co-occurring chronic and acute stress to depression, whether chronic stress predicts acute life events, and whether the two types of stress interact such that greater chronic stress confers greater sensitivity-or resistance-to the depressive effects of acute stressors. From a sample of 816 community women, those who had a major depression onset in the past 9 months and those without major depressive episodes (MDE) onset and with no history of current or recent dysthymic disorder were compared on interview-based measures of antecedent acute and chronic stress. Chronic stress interviews rated objective stress in multiple everyday role domains, and acute stress was evaluated with contextual threat interviews. MDE onset was significantly associated with both chronic and acute stress; chronic stress was also associated with the occurrence of acute events, and there was a trend suggesting that increased acute stress is more strongly associated with depression in those with high versus low chronic stress. Results suggest the importance of including assessment of chronic stress in fully understanding the extent and mechanisms of stress-depression relationships.

Predictors of Alzheimer's Disease Caregiver Depression and Burden: What Noncaregiving Adults Can Learn From Active Caregivers

This study examined similarities and differences between active caregivers (adult children and spouses whose family member had Alzheimer's disease) and not-as-yet caregiving adults (adult children and spouses whose family members are older, but do not as yet suffer from Alzheimer's disease). The objective was to determine what factors predict depressed mood and caregiver burden. Findings indicated that there were both differences and similarities between active caregivers and not-as-yet caregivers. While personality (extraversion) and anxiety about their own aging were the major predictors of depression for active caregivers, perceptions of a lack of social support was the major predictor of depression for not-as-yet caregivers. Regarding caregiver burden, perceived lack of social support, internal attributions of causality, and anxiety about their own aging were predictors for both groups. These findings are not only in concert with past research on the well-being of active caregivers, but they also importantly provide would-be caregiving adults with important information regarding caring for a family member with Alzheimer's disease. These findings suggest that not-as-yet-caregiving adults could better prepare for potential caregiving distress by learning active self-care skills, identifying what is meaningful about both growing older and about caregiving, and building a social network of support, all in anticipation of active caregiving.

Predictors of Major Depression Six Months After Admission for Outpatient Treatment

This study examined the rate and predictors of major depression six months after outpatient mental health admission. Assessments were conducted at admission and three and six months later among 166 participants. Antidepressant treatment adequacy and depression outcomes were assessed at follow-ups. Predictors of major depression at six months included nonremission status at three months (odds ratio [OR]=3.56, p=.003), inadequacy of early pharmacotherapy (OR=2.73, p=.009), worse physical functioning measured by the 36-Item Short-Form Health Survey (OR=.975, p<.001), and being unmarried (OR=2.54, p=.031). The findings support the effects of baseline physical disability, marital status, early treatment adequacy, and early remission on the course of major depression. The identification of individuals who do not receive intensive pharmacotherapy or who have not recovered by three months may provide opportunities for interventions to optimize six-month outcomes and to prevent the development of a persistent depression.

Entrapment and perceived status in graduate students experiencing a recurrence of major depression.

The present study used a prospective design to test the role of involuntary subordination as a predictor of major depression. Involuntary subordination is a construct derived from social rank theory and has been implicated as a cause of major depression. Its most salient features include feelings of entrapment and unfavourable social comparisons (i.e., low perceived status). An initial sample of 146 graduate students underwent a diagnostic interview to confirm a history of major depression and also completed measures of entrapment and social comparison. After 16 months, participants were assessed for a recurrence of major depression. Participants who experienced a recurrence of depression had significantly higher levels of involuntary subordination (as measured by factor scores of entrapment and social comparison). A logistic regression analysis also showed that involuntary subordination predicted recurrence of depression, even when controlling for current major depression and the number of previous episodes. The present study demonstrates the advantages of adopting a social rank perspective in modeling major depression.

Childhood Sibling Relationships as a Predictor of Major Depression in Adulthood: A 30-Year Prospective Study

The authors examined the quality of sibling relationships in childhood as a predictor of major depression in adulthood. Study subjects were 229 men selected for mental and physical health and followed from ages 20 through 50 and beyond as part of a study of adult psychosocial development. Data were obtained from interviews with participants and their parents at intake and from follow-up interviews and self-report questionnaires completed by participants at regular intervals. These data were used to rate the quality of relationships with siblings, the quality of parenting received in childhood, and family history of depression as well as the occurrence, by age 50, of major depression, alcoholism, and use of mood-altering drugs (tranquilizers, sleeping pills, and stimulants). Poorer relationships with siblings prior to age 20 and a family history of depression independently predicted both the occurrence of major depression and the frequency of use of mood-altering drugs by age 50, even after adjustment for the quality of childhood relationships with parents. Poor relationships with parents in childhood did not predict the occurrence of depression by age 50 when family history of depression and the quality of relationships with siblings were taken into account. Quality of sibling relationships and family history of depression did not predict later alcohol abuse or dependence. Poor sibling relationships in childhood may be an important and specific predictor of major depression in adulthood. Further study of links between childhood sibling relationships and adult depression is warranted.

Childhood Sibling Relationships as a Predictor of Major Depression in Adulthood: A 30-Year Prospective Study

Childhood Sibling Relationships as a Predictor of Major Depression in Adulthood: A 30-Year Prospective Study

Hemispheric Activation and Premenstrual Dysphoria

The relation between premenstrual dysphoria and predictors of major depression remains relatively unexplored. These investigators assessed the association between relative hemispheric activation and premenstrual dysphoria in 12 college students who had high levels of …

Prediction of major depression in Japanese adults: Somatic manifestation of depression in annual health examinations

Background The present study examined whether somatic symptoms found in annual health examinations, could be predictive of major depression in the ensuing year. Method Subjects analyzed were 1027 non-major-depressive workers (706 men, mean age 35) attending annual health examinations at a research institute. All were Japanese and found not to be suffering from major depression when interviewed, according to the semi-structured interviews of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). A self-administered questionnaire containing items relating to twelve major somatic symptoms was completed by all the subjects. The same DSM-IV interviews for the diagnosis of major depression were conducted to calculate the odds ratio of baseline variables for depressive and somatic symptoms, physical examination items, and health-related life-styles for the prediction of major depression in the ensuing year. Results The prevalence of major depression in the ensuing year was 2.5%. For four somatic symptoms (fatigue, lower back pain, dizziness, and nausea), the prevalence was higher (all p < 0.05) in those who complained of each somatic symptom at baseline than in those who did not. Furthermore, the multiple logistic regression analysis indicated that lower back pain and dizziness at baseline were independent risk factors of major depression in the ensuing year [odds ratio (95% confidence intervals), 3.2 (1.1, 8.9) and 6.0 (1.8, 20.1), respectively]. Limitations It is possible that somatic manifestations of depression are culturally bound phenomena and results might be generalizable only to Japanese workers. Conclusion Somatic symptoms reported at annual health examinations may be useful indicators for predicting major depression.

Predictors of major depression in recently diagnosed patients with HIV/AIDS in South Africa.

There is increasing evidence that major depression impacts the course of HIV infection, yet few studies have explored demographic and clinical predictors of depression in people who with HIV/AIDS. This study investigated predictors of depression (e.g., demographic and clinical variables, negative life events, and coping response) among outpatients with recently diagnosed HIV/AIDS patients in South Africa. One hundred forty-nine recently diagnosed HIV/AIDS patients (44 males and 105 females; mean time since diagnosis = 5.8, standard deviation [SD] 4.1) were evaluated. Subjects were assessed using the Mini International Neuropsychiatric Interview (MINI), the Carver Brief COPE coping scale, and the Sheehan Disability Scale. In addition, previous exposures to trauma and past risk behaviors were assessed. Three variables: gender (odd ratio [OR] = 1.23; 95% confidence interval [CI] 1.56, 1.93), impact of negative life events (OR = 1.13; CI, 1.03, 1.23), and disability (OR = 1.51, CI, 1.28, 1.80) predicted current major depression. It is well known from non-HIV populations that female gender and increased negative life events predict depression. These data also emphasize the importance of these links in HIV.

Depression and Vulnerability As Assessed by the Rorschach Method

We examined clinically depressed (CD; n = 16), previously depressed (PD; n = 19) and never depressed (ND; n = 18) individuals on 13 theoretically selected Rorschach (Exner, 1993; Rorschach, 1942) variables and on the Beck Depression Inventory (BDI; Beck, Rush, Shaw, & Emery, 1979). The group assignment was made according to the criteria of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). We tested 2 contradictory models for depressive vulnerability, Beck's (Clark & Beck, 1999) and Miranda and Persons's (1988; Persons & Miranda, 1992), in a planned comparison design with focused contrasts. The CDs significantly contrasted the combined group of NDs and the PDs in a pathological direction on 8 of the 13 Rorschach variables and on the BDI. However, the combined group of CDs and PDs also significantly contrasted the NDs in a pathological direction on 3 of these Rorschach variables and on the BDI. In addition, logistic regression analyses indicated that Rorschach indexes significantly improved the prediction of major depression above and beyond that achieved by the BDI. The findings show that the Rorschach method was able to identify (a) cognitive and aggressive disturbances that are present in individuals who are actively depressed but not in individuals who have been depressed in the past or never been depressed and (b) affective and coping disturbances that are present in depressed individuals and to some degree in PD individuals but not in individuals who have not experienced depression. We discuss the scanty evidence of psychological disturbances in PD individuals, as measured with the Rorschach, in relation to the mood-state dependent hypothesis of Miranda and Persons (1988; Persons & Miranda, 1992).

Reporting of somatic symptoms as a screening marker for detecting major depression in a population of Japanese white-collar workers

Objective The objective of this study was to assess screening practices for detecting major depression in workers complaining of somatic symptoms. Methods A total of 1443 Japanese white-collar workers (991 men and 452 women, mean age 34 years) completed a medical symptom checklist (major 12 somatic symptoms) and were diagnosed using the structured clinical interviews of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Results There were 42 cases (2.9%) with major depression in the total sample. Of the 902 subjects without somatic symptoms, only one (0.1%) was identified as having major depression. The prevalence of the disorder was positively associated ( P<.001) with the total number of somatic symptoms, and the area under the receiver operator characteristic curve was 0.92 for men and 0.81 for women, which showed the sensitivity and specificity of the total number of somatic symptoms for detecting major depression. Conclusion The number of reported somatic symptoms is a simple and useful predictor of major depression.

Symposium: Understanding the interaction of stress and gender in the prediction of major depression - Introduction

Three articles from a symposium on stress and depression in women are introduced. Women's exposure to stress, their cognitive and biological coping processes, and the stressful contexts of their lives may all contribute to the higher rates of depression in women compared with men. Mazure and Maciejewski discuss the role of women's cognitions about relevant stressors, Hammen discusses women's interpersonal environment and stress, and Penza, Heim and Nemeroff discuss biological stress reactions and the effects of early exposure to abuse.