Non-specific Depressive Symptoms Research Articles

The mediating role of health literacy between the presence of chronic disease and psychological distress among older persons in Xi’an city of China

BackgroundThe increased number of older persons in China, and the prevalence of most chronic diseases raised with age significantly increased the total disease burden. When a person ages, psychological distress happens when they are faced with stressors that they cannot cope with. Psychological distress refers to non-specific symptoms of depression, anxiety, and stress. Health literacy influences several health outcomes, such as emotional functioning among the population. The primary purpose of this study is to examine the mediator role of health literacy between the presence of chronic disease and psychological distress among older persons living in Xi’an city. Thus, this study used the Cognitive Behavior Theory (CBT) as a combination of the basic behavioral and cognitive psychology principles to explain the cognitive processes associated with psychological distress.MethodsThis study employs a quantitative research design using a cross-sectional survey of 300 older persons over 60 years living in the six urban districts of Xi’an city. Data were collected using the Health Literacy Questionnaire (HLQ) and the Depression Anxiety Stress Scale (DASS-21). This study employed descriptive statistics and inferential methods to analyze the data. The inferential methods applied structural equation modeling (SEM) to test the hypothesis of the mediator role of health literacy between the presence of chronic disease and psychological distress.ResultsIn this study, chronic disease had an effect on health literacy among older persons living in Xi’an city (β=-0.047, p < 0.01); chronic disease impact on psychological distress among older persons living in Xi’an city (β = 0.047, p < 0.01); health literacy was identified effect on psychological distress among older persons in Xi’an city (β=-0.738, p < 0.001); health literacy as a partial mediator between chronic disease and psychological distress (β = 0.07, p < 0.01).ConclusionPsychological distress among older persons is affected by chronic disease and health literacy. Health literacy had a partial mediating effect on the presence of chronic disease and psychological distress. Improved health literacy measures should be considered when treating older persons with psychological distress.

Cut-off scores of the Depression Anxiety Stress Scale-8: Implications for improving the management of chronic pain.

Mental distress, non-specific symptoms of depression and anxiety, is common in chronic pelvic pain (CPP). It contributes to poor recovery. Women's health nurses operate in multidisciplinary teams to facilitate the assessment and treatment of CPP. However, valid cut-off points for identifying highly distressed patients are lacking, entailing a gap in CPP management. This instrumental cross-sectional study identified a statistically derived cut-off score for the Depression Anxiety Stress Scale-8 (DASS-8) among 214 Australian women with CPP (mean age = 33.3, SD = 12.4, range = 13-71 years). Receiver operator characteristic curve, decision trees and K-means clustering techniques were used to examine the predictive capacity of the DASS-8 for psychiatric comorbidity, pain severity, any medication intake, analgesic intake and sexual abuse. The study is prepared according to the STROBE checklist. Cut-off points resulting from the analysis were ordered ascendingly. The median (13.0) was chosen as an optimal cut-off score for predicting key outcomes. Women with DASS-8 scores below 15.5 had higher analgesic intake. CPP women with a DASS-8 score above 13.0 express greater pain severity, psychiatric comorbidity and polypharmacy. Thus, they may be a specific target for nursing interventions dedicated to alleviating pain through the management of associated co-morbidities. At a cut-off point of 13.0, the DASS-8 may be a practical instrument for recommending a thorough clinician-based examination for psychiatric comorbidity to facilitate adequate CPP management. It may be useful for evaluating patients' response to nursing pain management efforts. Replications of the study in different populations/countries are warranted.

Pre-Surgical Screening Tools and Risk Factors for Chronic Post-Surgical Pain

&#x0D; This report provides an overview of evidence regarding evidence-based risk factors and pre-surgical screening tools or assessments that may help identify individuals at risk for developing chronic post-surgical pain. This is not a systematic review and a formal critical appraisal was not performed.&#x0D; Our review identified 19 evidence-based risk factors for chronic post-surgical pain from published systematic reviews.&#x0D; &#x0D; The most commonly reported chronic post-surgical pain risk factors were anxiety (7 studies), catastrophizing (pain or general) (catastrophizing is the tendency to exaggerate a situation in a negative manner [e.g., imagine the worst possible outcome]) (6 studies); depression (5 studies); and psychological distress (non-specific symptoms of depression, anxiety, and stress), kinesiophobia (fear of movement), and age (3 studies each). These risk factors were reported among various surgical procedures (e.g., mixed surgery types, total knee and hip replacements, spine surgery) and age populations (adult, pediatric, adult plus pediatric).&#x0D; Definitive conclusions cannot be made regarding particular risk factors and their association with chronic post-surgical pain. The evidence was either mixed and/or associated with limitations in the methodology of the study and unclear whether the results may apply in groups other than those included in the studies.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Our review identified 11 pre-surgical screening tools or assessments that were studied for their ability to predict chronic post-surgical pain. These included various quantitative sensory testing measures (e.g., mechanical, heat or cold, electrical), validated scales of other conditions, and screening tools.&#x0D; &#x0D; Four of the identified screening tools or assessments were found to predict chronic post-surgical pain but their it is unknown whether they can be applied to broader clinical practice (i.e., various surgery types among different age groups). These were only investigated in 1 study among specific populations.&#x0D; These 4 tools or assessments included a pain threshold evaluation performed with a sphygmomanometer (blood pressure monitor comprised of an inflatable cuff) in adults who underwent total knee replacement; the modified Tampa Scale of Kinesiophobia with 13-items (i.e., only the positively scored items) in pediatric patients who underwent orthopedic or general surgery; the Presurgical Psychological Screening algorithm in adults who underwent spine surgery; and the Pediatric Pain Screening tool in pediatric patients who underwent major musculoskeletal surgery.&#x0D; The remaining screening tools or assessments that were identified reported either mixed findings or no association with chronic post-surgical pain in various surgical populations.&#x0D; Definitive conclusions cannot be made for the use of pre-surgical screening tools or assessments to identify risk of developing chronic post-surgical pain.&#x0D; &#x0D; &#x0D;

Exploring blended group interventions for depression: Randomised controlled feasibility study of a blended computer- and multimedia-supported psychoeducational group intervention for adults with depressive symptoms

BackgroundBlended interventions aim to capitalise on the strengths of both computer-based and face-to-face therapy. Studies on this innovative treatment format remain scare. This especially accounts for the group treatment of depression. MethodThe present study applied eclectic psychotherapy methods to an adult sample exhibiting a variety of depressive symptoms (N=46). Participants were recruited by a newspaper inlet and randomised either to a treatment or a waiting list condition. Computer supported components were multimedia group sessions, e-learning, online videos and worksheets, remote therapist-patient communication and online pre-post-assessment. ResultsLarge between-group effect sizes on primary outcome depressiveness (CES-D) (F(1,44)=4.88, p=0.032; d=0.87) and secondary outcome personal resources (resource scales) (F(1,44)=9.04, p=0.004; d=0.73 to F(1,44)=8.82 p=0.005, d=1.15) were found in the intention to treat analysis (ANOVA). Subjective evaluation of the intervention revealed high treatment adherence (91%) and high perceived relevance of supportive computer and multimedia components. Participants rated computer and multimedia components comparable to treatment elements such as group interaction or specific cognitive behavioural exercises, and 25% associated the utilisation of those components with treatment success. Depressiveness and age did not predict the utilisation and the appraisal of computer and multimedia components. DiscussionResults provide preliminary support for the acceptability and feasibility of the investigated blended treatment in a group with non-specific depressive symptoms. However, small sample size and lack of diagnostics restrict generalizability. Additional research in clinical settings is needed.

Targeting and transforming major depression.

To detail limitations to the construct of 'major depression', argue for repositioning it as a proxy for 'clinical depression' and then operationalize it and its principal constituent depressive subtypes, while preserving the DSM criteria-based format. We summarize limitations to major depression being viewed as a diagnostic entity. Data from 391 clinically depressed patients were analysed to identify high-prevalence non-specific depressive symptoms to define 'clinical depression' as well as the features showing specificity to a melancholic depressive subtype. We identified a set of high-prevalence and generalized symptoms for defining clinical depression and with many being current criteria for major depression. We also developed a refined set of melancholic features and with their underlying distributions generating two classes that correlated strongly with clinical diagnoses of a melancholic or non-melancholic depression, thus validating its capacity to so differentiate. We append criteria sets for diagnosing clinical depression and its principal diagnostic subtypes (psychotic, melancholic and non-melancholic). This heuristic study reframes and modifies major depression's criteria set to define a domain of clinical depression with additional criteria and then allowing the delineation of three diagnostic subtypes. If this paradigm shift is accepted and further refined, greater precision in diagnosis, treatment and research would be anticipated.

Symptoms at menopause and care of grandchildren

Objective To study the possible interaction of care of grandchildren with women's symptoms at postmenopause.Methods A cross-sectional, community-based study was carried out recruiting a total of 386 postmenopausal women at public places in the city of León, Mexico. For each woman, we collected data about their interaction with children and grandchildren, and scores of physical and emotional symptoms frequently found at menopause. Levels of follicle stimulating hormone and estradiol in serum were measured.Results Women who met their children more frequently had decreased sexual interest. Women without children or grandchildren had lower scores on the empty nest syndrome (ENS) and non-specific symptoms of depression (NSSD). The care of grandchildren was associated with loss of sexual interest, depression, NSSD and ENS. Age was inversely associated with hot flushes and anxiety. Schooling was strongly associated with lower scores for hot flushes, depression, anxiety and ENS.Conclusions Among other factors associated with symptoms at postmenopause, such as hormone conditions, age and schooling, maternal investment in children and grandchildren may impose a physical and emotional cost that favors the onset of symptoms at postmenopause.

Subscales measuring symptoms of non‐specific depression, anhedonia, and anxiety in the Edinburgh Postnatal Depression Scale

There has been considerable research and clinical interest in the comorbidity of anxiety and depression in the post-partum period, and specifically in the possibility that the commonly used Edinburgh Postnatal Depression Scale (EPDS) incorporates an anxiety component. We hypothesized that the recommended version of factor analysis (Fabrigar, Wegener, MacCallum, & Strahan, 1999) would identify such covert dimensions more reliably than the commonly used principal components analysis with varimax rotation and eigenvalues greater than 1. Principal axis factor extraction with parallel analysis and oblique (direct quartimin) factor rotation was applied to the 10 EPDS items. The study used a sample of recent mothers recruited and assessed via e-mail and the Internet (N=440). In addition to the EPDS, the Hospital Anxiety and Depression Scale (HADS) and the Positive and Negative Affect Scales (PANAS) were also administered. Three factors were found, which were identified as 'non-specific depressive symptoms', 'anhedonia', and 'anxietal symptoms' subscales, respectively. These subscales were regressed on the HADS anxiety and depression and the PANAS positive and negative affectivity scales, with results substantially consistent with current structural models of the taxonomy of the emotional disorders. The data were obtained from a self-selected non-clinical sample. In addition, it is known that the use of computer-based assessment may tend to inflate self-report scores. It was concluded that there is now sufficient evidence that clinicians should not assume the EPDS to be unidimensional, but should assess all three subscales when screening for susceptibility to post-partum depression and/or post-partum anxiety.

A comparative study of nonspecific depressive symptoms and minor depression regarding functional impairment and associated characteristics in primary care

Background Milder forms of depression are highly prevalent in the clinical setting as well as in primary care. However, it is still unclear whether there are distinguishable groups among the various subthreshold syndromes and to what extent they are associated with impairment, thus requiring treatment. Therefore, the study aimed at comparing the degree of impairment in 2 groups of subthreshold depressive patients (nonspecific and minor depressive) with nondepressive patients and with major depressive patients. Another aim of the study was to evaluate the spectrum hypothesis of depressive syndromes. Sampling and methods A sample of 619 primary care patients was studied using the self-administered Patient Health Questionnaire (PHQ). After defining subthreshold depressive syndromes on a criterion basis, frequencies, sociodemographic factors, and impairment of nondepressive, subthreshold depressive, and major depressive patients were compared. Results Nonspecific depressive symptoms (NDS) were diagnosed in 9.1% of the study subjects and minor depression in 6.2%. Subjects with subthreshold depressive disorders did not differ from each other or from subjects with major depression regarding sociodemographic risk factors such as age, sex, or marital status. Yet, a continually increasing impairment from NDS to minor depression to major depression could be found. Moreover, the investigated groups differed with regard to the severity index. Conclusions The results of the study are in accordance with the spectrum hypothesis of depressive syndromes ranging from NDS to minor depression to major depression. Patients with subsyndromal depression showed significant functional impairment to the extent that at least some of these patients probably had a disorder requiring treatment.

Why are depression and anxiety correlated? A test of the tripartite model.

L. A. Clark and D. Watson's (1991) tripartite model groups the symptoms of depression and anxiety into 3 components: nonspecific symptoms of general distress, which do not distinguish depression and anxiety; physiologic arousal, which is relatively unique to anxiety; and anhedonia (or low positive affect), which is unique to depression. Structural equation modeling was used to test this model with self-report data from 3 different samples: outpatients seeking treatment for mood disorder, anxiety disorder, or both (n = 483) outpatients seeking treatment for substance abuse (n = 453), and college students (n = 516). The tripartite model did not fit any of the sample covariance matrices, because the nonspecific symptoms of depression and anxiety could not be adequately represented by a single General Distress factor. An alternative model, in which the Anhedonia and Nonspecific Depression factors loaded on a second-order Depression factor, while the Somatic Arousal and Nonspecific Anxiety factors loaded on a second-order Anxiety factor, produced an excellent fit in all the groups. The Nonspecific Depression and Nonspecific Anxiety factors were the most valid and specific indicators of depression and anxiety, respectively. Anhedonia and Somatic Arousal were significantly less valid measures of depression and anxiety. The implications of these findings are discussed.

Menopause in normal and uncomplicated NIDDM women: physical and emotional symptoms and hormone profile

Objective: To compare the physical characteristics, emotional symptoms and metabolic conditions of menopausal women with and without non insulin dependent diabetes mellitus (NIDDM). Methods: We studied 100 menopausal women 45–72 years of age, 51 with and 49 without NIDDM, in a cross-sectional design. Biological characteristics were collected and emotional symptoms were assessed with a modified Hamilton and Bech-Rafaelsen scale, scoring depression, anxiety, non specific symptoms of depression (NSSD) and the empty nest syndrome (ENS). Weight, body mass index (BMI), waist/hip and abdomen/hip ratios and percent of body fat were registered. The sulfoconjugated form of the dehydroepiandrosterone (DHEAS), follicle stimulating hormone (FSH), cortisol and fasting, as well as postprandial insulin/glucose ratios, were measured in blood. Results: Women with NIDDM had earlier mean age for menopause, more central obesity and less peripheral fat; they had also more prevalent emotional symptoms than non diabetic menopausal women. In women with NIDDM, symptoms were associated with years since diagnosis and with BMI. In non diabetic menopausal women schooling and attitudes to sexuality were associated with symptoms. FSH was inversely associated with BMI in both diabetic and non diabetic women; postprandial insulin/glucose ratio was correlated with central obesity in the group without NIDDM and cortisol with sitting systolic blood pressure (SBP) in the group with NIDDM. Conclusion: The diagnosis of NIDDM and its metabolic conditions were associated with an increased frequency of some symptoms in menopausal women.

Symptoms at the menopausal and premenopausal years: their relationship with insulin, glucose, cortisol, FSH, prolactin, obesity and attitudes towards sexuality.

The symptoms of 81 premenopausal and 70 menopausal women were studied to determine the association with obesity, attitudes towards sexuality (ATS), and diverse hormone values: fasting and postprandial glucose (FG, PG) and insulin (FI, PI), cortisol, prolactin, follicle-stimulating hormone (FSH). The mean age of the women studied was 49.1 years. The frequency of symptoms was 35.4% for depression, 34.3% for nonspecific symptoms of depression (NSSD), 38.6% for empty nest syndrome (ENS), and 42.3% for anxiety. NSSD, ENS, FSH and cortisol levels all possessed higher values at late-menopausal stage. A multiple regression analysis revealed the following results; NSSD was associated to ATS (negative); sleep alterations were correlated to prolactin, FSH, PI/PG, FI/FG and waist/hip ratio; FSH was associated with both a decreased sexual interest and depression. In the study of hormone levels it was found that cortisol, insulin and FI/FG were associated with ATS; PI, cortisol, FI/FG and PI/PG were associated with body mass index (BMI) and FSH; prolactin and FI/FG were associated with age. We concluded that: (1) data indicative of insulin resistance correlated to both depression and sleep alterations; (2) overweight is related to NSSD, sleep alterations, and hormonal changes.