Overall Severity Of Depression Research Articles

Severity and symptoms of depression in older adults presenting to mental health services during COVID‐19 lockdown – an experience from south London region

AbstractBackgroundSocial restrictive measures during COVID‐19 pandemic has influenced people’s mental health conditions across different countries. Global studies indicated an increased prevalence of anxiety disorder and depression with varied impacts among different age groups. Most studies in the elderly have been done via surveys or internet medias missing out on people with no access to digital technology tools. We aimed to investigate the prevalence of depression among elderly people aged 65 years and above who attended mental health service for older adults (MHOA).MethodsRetrospective data was collected from the South London and Maudsley NHS Foundation Trust (SLaM) Biomedical Research Centre (BRC) Case Register for MHOA. Using this large mental health care database in South London, United Kingdom, we identified referrals to MHOA during the first UK lockdown (March ‐ July 2020) and compared those to a corresponding pre‐COVID period (February ‐ July 2019). Logistic regression analysis adjusted for age, gender, ethnicity, diagnosis and living conditions were done to examine association between COVID‐19 lockdown and severity and symptoms of depression.Results536 patients were referred and seen within the MHOA during the first UK COVID‐19 lockdown period compared to 1,455 patients during the pre‐COVID‐19 corresponding period. We found presence of COVID‐19 lockdown had no effect on overall severity of depression but significantly associated with depressive symptoms such as anhedonia (1.64, 95% CI 1.14‐2.37, p = 0.008), lack of energy (1.65. 95% CI 1.65 (1.25‐2.16), p<0.001), tearfulness (1.43, CI% 1.15‐1.78, p = 0.001), agitation (1.32, CI% 1.07‐1.63, p = 0.009), disturbed sleep (1.37, CI% 1.11‐1.70, p = 0.003) and guilt feelings (1.45, CI% 1.04‐2.03, p = 0.030)ConclusionsThere was an increased prevalence of certain depressive symptoms among older adults within MHOA during first COVID‐19 lockdown which implies impact of isolation and possibly physical ill‐health on mental well‐being. This needs to be explored further for potential prevention and managements.

EEG CORRELATES OF SOMATIC DISORDERS IN DEPRESSIVE PATIENTS WHO SURVIVED AND HAVE NOT BEEN ILL WITH COVID-19

IntroductionCoronavirus infection is accompanied by the development of a wide range of neuropsychiatric and somatic complications.ObjectivesThe aim of the study is to assess the severity of somatic disorders and to identify their EEG correlates in depressive patients who had and did not have COVID-19.MethodsThe study involved 30 female depressive patients (F31.3-4, F21.3-4 + F34.0, according to ICD-10), aged 16-25 years, who previously had a mild or asymptomatic coronavirus infection (group "COVID”), and 40 depressive patients matched in gender, age and syndrome structure to patients of the “COVID” group, but who did not have COVID-19 (“non-COVID” group). The pre-treatment severity of depressive symptoms was assessed by the total sum, and by sums of clusters: depression (items 1, 2, 3, 7, 8), anxiety (items 9, 10, 11), sleep disorders (items 4, 5 , 6) and somatic disorders (items 12, 13, 14) of HDRS-17 scale. All patients underwent pre-treatment multichannel (16 leads) recordings of the background EEG followed by analysis of the absolute EEG spectral power (SP) in 8 narrow frequency sub-bands. Statistical analysis of the data was carried out using the methods of descriptive statistics and correlation analysis of the IBM SPSS Statistics, v.22 software package.ResultsThe values of the total sums of scores of individual clusters (depression, anxiety, sleep disorders) of the HDRS-17 scale in the “COVID” and “non-COVID” groups did not differ statistically. The exception was a significantly higher (p>0.01) number of complaints of somatic disorders (weakness, heaviness and pain in the muscles, a feeling of loss of energy, loss of strength, decreased libido) in patients who had COVID compared to those who did not (2.4±1.0 and 1.4±1.1 points, respectively). In the “non-COVID” group, the HDRS-17 somatic disorder cluster scores positively correlated with SP values of beta2 EEG (20–30 Hz) in leads F3, F8, and P3. which reflects the increased activation of brain stem structures, characteristic for depressive conditions. In the “COVID” group, these scores correlated with the SP values of alpha3 (11-13 Hz, in leads F4, F8, C4 and T4) and beta2 (20-30 Hz, in C4) not positively, but negatively. Thus, the severity of somatic complaints in patients of this group is associated not with greater, but with less activation of the brain (in particular, of the right hemisphere), which, presumably, may be associated with the “exhaustion” of the central mechanisms of regulation of autonomic functions after suffering COVID disease.ConclusionsCOVID (in a mild or asymptomatic form) did not show a significant effect on the overall severity of depression of the studied group of patients who recovered from COVID, with the exception of a significantly greater severity of their somatic complaints compared to the group of patients who had not been ill with COVID. The study supported by the RSF grant No. 21-18-00129.Disclosure of InterestNone Declared

The structure of depressive symptoms and characteristics and their relation to overall severity in major depressive disorder

Although many investigators have examined symptoms of major depressive disorder (MDD), the multivariate relations among these features of depression and their relative associations with overall severity of depression are not well understood. The present study is the first to examine the underlying factor structure of depression across a broad set of constructs and to model the multivariate association of these factors with the overall severity of depression. We conducted a large-scale factor analysis and multiple regression in a sample of participants diagnosed with MDD (N = 233) and healthy controls (N = 235). We obtained a five-factor solution composed of the following factors: (1) anxiety; (2) behavioral activation; (3) core symptoms; (4) rumination; and (5) emotional intensity. The core symptoms factor, composed primarily of DSM-5 diagnostic criteria for MDD, was the only factor that showed a consistent, significant association with overall severity of depression and functional impairment. Rumination combined with behavioral inhibition and positive and negative affect combined with each other to form coherent constructs that may be useful in examining differences among depressed individuals. These findings provide an important data-driven framework for the multidimensional symptom structure of depression and suggest several actionable ways for improving clinical assessment and treatment for individuals with MDD.

Profiles of depressive symptoms and the association with anxiety and quality of life in breast cancer survivors: a latent profile analysis.

The aim of this study was to examine profiles of depressive symptoms and the association with anxiety and quality of life (QOL) in breast cancer survivors. A cross-sectional multicenter survey involving 5 hospitals in Korea was implemented between February 2015 and January 2017. A self-report survey included the Patient Health Questionnaire-9, Short Form 36, and State and Trait Anxiety Scale. Data from 347 patients were analyzed. Latent profile analysis identified five profiles of depressive symptoms: (1) "no depression" (63.98%); (2) "mild depression with sleep problems" (16.43%); (3) "mild depression" (8.65%); (4) "moderate depression with anhedonia" (7.78%); and (5) "moderately severe depression" (3.17%). Results from Fisher's exact test and analysis of variance (ANOVA) to examine whether sociodemographic and clinical characteristics distinguish the classes indicated that marital status, income and education as well as C-reactive protein distinguished a few classes. Multivariate analysis of covariance and analysis of covariance results indicated that both types of anxiety as well as several dimensions of QOL differed between the identified classes. The current results suggest that although identified classes were characterized overall by severity of depression, a few classes also reflected pronounced individual symptom patterns, warranting tailored interventions for these symptom patterns, along with overall severity of depression.

How should the severity of depression be rated on self-report depression scales?

Almost all depression measures have been developed without discussing how to best conceptualize and assess the severity of depression. The most valid rating format of depression severity scales is unsettled and has been little studied. In the present study from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared the validity of alternative approaches towards rating the severity of depressive symptoms. Data was collected using TurkPrime. One hundred eighty-five participants currently in treatment for a mental health problem completed a self-report measure of depression and rated the symptoms on two 4-point ordinal scales assessing symptom frequency and symptom intensity. The respondents also rated their global level of depression severity and completed a measure of psychosocial functioning and quality of life. The symptom ratings based on intensity and frequency were highly correlated with each other, and equally highly correlated with subjects’ global rating of overall severity of depression, as well as ratings of psychosocial functioning and quality of life. A composite index of severity based on the sum of frequency and severity ratings was no more highly correlated with the external validators. The results of the present study suggest that ratings of depressive symptoms based on either symptom intensity or symptom frequency are equally valid.

The neural correlates of perceived energy levels in older adults with late-life depression

Late-life depression is common among older adults. Although white-matter abnormality is highly implicated, the extent to which the corticospinal tract is associated with the pathophysiology of late-life depression is unclear. The current study aims to investigate the white-matter structural integrity of the corticospinal tract and determine its cognitive and functional correlates in older adults with late-life depression. Twenty-eight older adults with clinical depression and 23 healthy age-matched older adults participated in the study. The white matter volume and the white matter hyperintensities (WMHs) of the corticospinal tract, as well as the global WMHs, were measured. Psychomotor processing speed, severity of depression, perceived levels of energy and physical functioning were measured to examine the relationships among the correlates in the depressed participants. The right corticospinal tract volume was significantly higher in depressed older adults relative to healthy controls. Moreover, the right corticospinal tract volume was significantly associated with the overall severity of depression and accounted for 17% of its variance. It further attenuated the relationship between the severity of depression and perceived levels of energy. Our findings suggested that higher volume in the right corticospinal tract is implicated in LLD and may relate to lower perceived levels of energy experienced by older adults with depression.

Validation of the Arabic version of the MADRS scale among Lebanese patients with depression

AimTo use the Arabic version of the MADRS in Lebanese depressed patients, check its validity and reproducibility compared to other versions of the questionnaire and assess risk factors affecting the total MADRS score. MethodsThis case-control study, performed between September 2016 and January 2017, included 200 patients (100 patients, 100 controls). The questionnaire included two parts, the first one concerning the socio-demographic characteristics another one that included the Montgomery-Asberg Depression Rating Scale (MADRS) questions, which was translated from English to Arabic through an initial translation and back translation process. ResultsThe MADRS scale items converged over a solution of one factor that had an Eigenvalue over 1, explaining a total of 83.90% of the variance. A Kaiser-Meyer-Olkin measure of sampling adequacy of 0.953 was found, with a significant Bartlett's test of sphericity (P<0.001). A stepwise linear regression, using the total MADRS score as continuous variable, showed that a university level of education would significantly decrease the total MADRS score by 20 points (beta=−20.02, CI: from −26.337 to −13.709, P<0.001). Unemployment was significantly more associated with an increase in the total MADRS score level by 10.23 points (beta=10.23, CI: 3.944–16.526, P=0.002). ConclusionThis study shows that the Arabic version of the MADRS has promising psychometric properties, and thus it is a good tool to use for the diagnosis of patients with depression. Based on this study, health care professionals and researchers can readily use the MADRS questionnaire to estimate the overall severity of depression among psychiatric patients in Lebanon.

Clinical Significance of the Number of Depressive Symptoms in Major Depressive Disorder: Results from the CRESCEND Study.

Our study aimed to establish the relationship between the number of depressive symptoms and the clinical characteristics of major depressive disorder (MDD). This would enable us to predict the clinical significance of the number of depressive symptoms in MDD patients. Using data from the Clinical Research Center for Depression (CRESCEND) study in Korea, 853 patients with DSM-IV MDD were recruited. The baseline and clinical characteristics of groups with different numbers of depressive symptoms were compared using the χ2 test for discrete variables and covariance (ANCOVA) for continuous variables. In addition, the scores of these groups on the measurement tools were compared by ANCOVA after adjusting the potential effects of confounding variables. After adjusting the effects of monthly income and history of depression, a larger number of depressive symptoms indicated higher overall severity of depression (F [4, 756] = 21.458, P < 0.001) and higher levels of depressive symptoms (F [4, 767] = 19.145, P < 0.001), anxiety symptoms (F [4, 765] = 12.890, P < 0.001) and suicidal ideation (F [4, 653] = 6.970, P < 0.001). It also indicated lower levels of social function (F [4, 760] = 13.343, P < 0.001), and quality of life (F [4, 656] = 11.975, P < 0.001). However, there were no significant differences in alcohol consumption (F [4, 656] = 11.975, P < 0.001). The number of depressive symptoms can be used as an index of greater illness burden in clinical psychiatry.

Differences between patients with borderline personality disorder who do and do not have a family history of bipolar disorder

Diagnostic confusion sometimes exists between bipolar disorder and borderline personality disorder (BPD). To improve the recognition of bipolar disorder researchers have identified nondiagnostic factors that point toward bipolar disorder. One such factor is the presence of a family history of bipolar disorder. In the current report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared the demographic, clinical, and psychosocial characteristics of patients with BPD who did and did not have a family history of bipolar disorder. A large sample of psychiatric outpatients were interviewed with semi-structured interviews. Three hundred seventeen patients without bipolar disorder were diagnosed with DSM-IV borderline personality disorder. Slightly less than 10% of the 317 patients with BPD (9.5%, n=30) reported a family history of bipolar disorder in their first-degree relatives. There were no differences between groups in any specific Axis I or Axis II disorder. The patients with a positive family history were significantly less likely to report excessive or inappropriate anger, but there was no difference in the frequency of other criteria for BPD such as affective instability, impulsivity, or suicidal behavior. The patients with a positive family history reported a significantly higher rate of increased appetite and fatigue. There was no difference in overall severity of depression, scores on the Global Assessment of Functioning, history of psychiatric hospitalizations, suicide attempts, time unemployed due to psychiatric reasons during the 5years before the evaluation, and ratings of current and adolescent social functioning. There was no difference on any of the 5 subscales of the childhood trauma questionnaire. Overall, we found few differences between BPD patients with and without a family history of bipolar disorder thereby suggesting that a positive family history of bipolar disorder was not a useful marker for occult bipolar disorder in these patients.

The Latent Symptom Structure of the Beck Depression Inventory: Second Edition in Latina Pregnant Women

Pregnancy represents a unique period of time when women are at an increased risk of developing depression. Although the Beck Depression Inventory-Second Edition (BDI-II) is one of the most widely used self-report measures of depression symptomology, its psychometric properties and underlying factor structures have not been determined for antenatal women and among Latinas. The current study evaluated the latent symptom structure of the BDI-II in a community-based sample of Latina pregnant women (N=217) identified to be at high risk for depression. Exploratory factor analyses were used to identify underlying salient individual item loadings for two- and three-factor models. Confirmatory factor analyses then examined several different indices to determine the best model fit. Examination of exploratory and confirmatory factor analyses supports a three-factor oblique structure of the BDI-II composed of Cognitive-Affective, Somatic, and Pregnancy Symptoms. The three-factor model provides clinicians with the ability to target specific constellations of depressive symptoms instead of relying on the BDI-II total score that represents the overall severity of depression in this population.

Prevalence and association of somatic symptoms in patients with Major Depressive Disorder

BackgroundPainful and non-painful somatic symptoms are often reported in patients with depressive disorder. The proper identification of depression-relevant somatic symptoms is important for the accurate diagnosis of depression, development of treatment strategies and measurement of outcome. The objective of this study was to characterize the relationship between somatic symptoms and depression in patients diagnosed with Major Depressive Disorder (MDD), using data from randomized drug trials carried out by a pharmaceutical company. MethodsPooled ‘blinded’ data from 2191 patients enrolled in randomized, multicenter, double-blind placebo-controlled studies for the treatment of MDD were analyzed. Somatic symptoms were assessed using the Somatic Symptoms Inventory (SSI) and the Hamilton Depression Rating Scale (HAMD) was used to assess symptoms of depression. ResultsThe most common somatic symptom reported by patients with MDD was ‘feeling fatigued, weak, or tired all over’, with 78% of patients reporting ‘moderate’ levels or above. This was followed by ‘feeling that not in as good physical health as most of your friends’ (59%), ‘not feeling well most of the time in the past few years’ (54%), and ‘feeling weak in parts of body’ (45%). ‘Headache’ was the most common pain-related symptom with 43% reporting ‘moderate’ or above. Pearson's product-moment correlations revealed that somatic symptoms generally increased as a function of overall depressive (r=0.43), with ‘feeling fatigued, weak, or tired all over’ (r=0.50), ‘feeling that not in as good physical health as most of your friends’ (r=0.42), ‘feeling weak in parts of body’ (r=0.41), ‘heavy feeling in arms and legs’ (r=0.34), ‘not feeling well most of the time in the past few years’ (r=0.32), and ‘headache’ (r=0.31) showing the strongest correlation with overall HAMD scores. Non-parametric item response analyses showed that many somatic symptoms demonstrate good relationship between item response and the overall severity of depression. In particular, ‘feeling fatigued, weak, or tired all over’ exhibited good discriminative properties across the full range of severity for depression. LimitationsThe analysis utilized data from a ‘restricted’ patient population in drug trials sponsored by a pharmaceutical company. ConclusionsThese results demonstrate a high prevalence and association of somatic symptoms in patients with MDD, including feelings of fatigue, physical malaise and pain-related symptoms, which could be potentially useful in the assessment of depression and in the evaluation of treatment strategies.

Assessing depressive symptoms in persons who die of suicide in mainland China

Background The potential insensitivity to depression of translated diagnostic instruments makes it difficult to assess the relationship of depressive symptoms to suicide in non-Western cultures. Methods Addition of culturally sensitive probes and other modifications were made to the depression section of the Chinese version of the SCID; the standard SCID probes and the expanded-probes are separately used to assess each symptom of depression, the resultant diagnoses and the overall severity of depression. This modified SCID was included in the psychological autopsy interviews with family members and, separately, close associates of 887 suicides and 721 non-suicidal decedents from 23 regions of mainland China. Results Compared to the standard interview, the expanded-probe method increased reported prevalence of major depressive episode among suicide decedents from 26.4% (234/887) to 40.2% (357/887) and for other deaths from 1.0% (7/721) to 2.1% (15/701). The additional 131 cases identified using the expanded-probe method had substantial social impairment and a greatly elevated risk of suicide compared to those with no depressive symptoms (OR = 37.0, 95% CI = 17.6–77.6). Inter-observer reliability for major depressive episode between the two independent interviews was greater for the expanded probe method (ICC = 0.77 vs. 0.67, P < 0.001). For both interview methods there was a strong dose-response relationship between suicide risk and the number and severity of depressive symptoms. Limitations This study uses proxy informants to obtain information about the psychological status of deceased subjects; the value of this expanded-probe method for the diagnosis of depression in non-Western cultures needs to be confirmed with living subjects. Conclusions Adding culture-appropriate probes about depressive symptoms to standardized diagnostic instruments identifies many Chinese subjects with unrecognized depression. Dimensional measures of depressive symptoms are more powerful predictors of suicide risk than categorical diagnoses.

Effects of Cognitive Therapy on Psychological Symptoms and Social Functioning in Residual Depression

Background: About 30% of psychiatric out-patients with major depression demonstrate partial remission. Aims: To explore whether the addition of cognitive therapy (CT) had any differential effect on residual symptoms or social adjustment. Method: Patients with residual symptoms of major depression (n=158) were randomised to receive clinical management (CM) alone, or CM plus 18 sessions of CT. Subjects’ depressive symptoms and social functioning were assessed regularly over 16 months. Results: The addition of CT produced statistically significant differential effects on: two out of four measures of overall severity of depression; specific psychological symptoms (guilt, self-esteem and hopelessness); and social functioning (including dependency, interpersonal behaviour and friction). Conclusions: In patients showing only partial response to antidepressants, the addition of CT produced modest improvements in social and psychological functioning. The implications for research on the mechanisms of action of CT are discussed.

Sexual dysfunction in Saudi depressed male patients

INTRODUCTIONSexual dysfunction is common among depressed male patients; however, its causes are complex and multifactorial. The aim of this study is to identify risk factors for sexual dysfunction associated with depression.METHODSOne hundred and twenty-five consecutive depressed male patients were interviewed at Jeddah Psychiatric Hospital. They were divided in to two groups, on the basis of whether they had sexual dysfunction or not. These two groups were then compared on a number of potential risk factors, using chi-square and odds ratio.RESULTSThe majority of patients had not previously been asked about sexual dysfunction. Seventy-seven (62%) presented with sexual dysfunction and 48 (38%) without. Marital difficulties, hypertension, diabetes, severity of depression and tricyclic antidepressants were significant risk factors. No association was found with demographic origin, occupation, education or marital status. These results are similar in some aspects to those reported in western studies.CONCLUSIONS(a) The majority of doctors do not take a sexual history despite its high prevalence. (b) Physical illness and overall severity of depression were important risk factors.

Mood stabilizer augmentation in apparently “unipolar” MDD: predictors of response in the naturalistic French national EPIDEP study

Background: Mood stabilizers (MS), especially Lithium, are used in augmentation strategies for resistant depression. However the broader bipolar spectrum (depressions with brief [i.e. 2 days] hypomania, cyclothymic and hyperthymic temperaments) has rarely been explored in such strategies. The aim of the current report is to search for predictive factors for response to mood stabilizers when used as augmentation therapy after excluding clear-cut hypomania and focusing on DSM-IV major depressive disorder (UP-MDD), which is best designated as apparently “unipolar”. Method: From the total sample of 452 major depressives (MDE) included in the French National study EPIDEP, 256 were classified as UP-MDD after eliminating DSM-IV bipolar II (≥4 days of hypomania); conservatively, we also excluded MDD with hypomania associated with antidepressants. Lifetime treatment history of UP-MDD revealed that 59 (23.3%) had received at least one MS (lithium, valpromide [French variant of divalproex], and carbamazepine) in the past; from this sub-population, 18 were considered retrospectively as good responders (30%, GR) versus 41 poor responders (70%, PR) to MS augmentation on the basis of the clinical judgment of the treating psychiatrist. Results: Comparative analyses between patients who received MS and those who did not, revealed the former group as having higher levels on the hypomania checklist and cyclothymic and depressive temperaments. The delay to MS installation was significantly longer in the PR versus GR. The profile of GR could be described as follows: younger current age, higher education; symptom-free interval between major episodes; and fewer prior depressive episodes and hospitalizations; and higher rate of MS prescription. However, no significant differences were obtained from hypomania assessment and affective temperament ratings (cyclothymic, hyperthymic, depressive). During the index (most recent) depressive episode, we obtained a significantly higher rating of “suicidal thoughts” associated with higher levels of “sadness–guilt,” psychomotor agitation, and lower “retardation–fatigue” (all from the HAM-D) in the PR group; better and faster response to current treatment (as prospectively assessed) were also observed in the GR. At this time, overall severity of depression was not linked to the quality of response to the MS. Limitations and conclusion: Despite its retrospective design, these analyses have important implications in the management of difficult or resistant “unipolar” depression by using MSs as augmentation strategy. Clinicians appeared to have used “subtle” hypomanic and cyclothymic features as a justification for augmentation. However, these features per se were not predictive of response to such augmentation. Instead, the profile of augmentation response to failed antidepressants appears to be an “activated depression” (significantly less retardation and withdrawal and higher agitation associated with greater intensity of painful and guilt-ridden sadness with suicidality), and the significantly higher rate of and earlier prescription of MSs in the course of recurrent MDD. These data suggest that resistant depressives should not stay on antidepressant or antidepressant combination for too long; MS augmentation must be instituted without much delay.

Two depression rating instruments in Nigerian patients

Having been developed in a foreign culture, the extent to which items on the Hamilton Depression Rating Scale (HDRS) and the Zung Self-Rating Scale (ZS) reflect the features of depression as obtained in clinical interviews in Nigeria is uncertain. Also, items predictive capabilities for the severity of depression and the extent of concurrence between the two scales in assessing depression need to be ascertained. Seventy- eight patients who met the ICD 10 criteria for major depressive disorder completed the ZS and had the HDRS completed on them. These patients, (in addition to six others) had their case records examined and their symptoms of depression extracted. The predictive values of each item on the scales to the overall severity of depression, the intra-scale and inter-scale items correlations were calculated. Sleeplessness, somatic symptoms and sad mood were the commonest symptoms reported by patients with major depressive disorder. The Zung Scale showed that joylessness, lack of clarity of the mind, and difficulty taking decisions were also very common. The HDRS had better access to somatic symptoms than the Zung Scale, although items on the Zung Scale generally had better predictive value of the overall severity of depression than items on the HDRS. The HDRS had a moderate inter-scale correlation (r=0.43) relative to the Zung Scale, but only three equivalent items (depressed mood, suicide and impaired appetite) on the two scales had moderate and significant correlations. The HDRS and the ZS are very useful rating scales in depression but some modifications and additions will make them more applicable.

Cognitive Risk Factors and Suicide Attempts Among Formerly Hospitalized Adolescents: A Prospective Naturalistic Study

To examine the relationship between cognitive variables and time until suicide attempts among 180 adolescents who were monitored for as much as 6.9 years after discharge from an inpatient psychiatry unit. In a prospective naturalistic study, adolescents were assessed at the time of their psychiatric hospitalization and semiannually thereafter. Suicidal behavior at index hospitalization and over the follow-up period was assessed with semistructured psychiatric diagnostic interviews. At hospitalization, cognitive risk factors were assessed with a problem-solving task and with questionnaires assessing hopelessness, expectations for posthospitalization suicidal behavior, reasons for living, and dysfunctional attitudes. Expectations about future suicidal behavior were related to posthospitalization suicide attempts. Among youths with previous suicide attempts, higher levels of hopelessness were associated with increased risk, and greater survival and coping beliefs were associated with decreased risk for posthospitalization suicide attempts. Hopelessness and survival and coping beliefs were not related to posthospitalization attempts among adolescents without prior suicidal behavior, and hopelessness was not predictive after controlling for overall severity of depression. Expectations for suicidal behavior, hopelessness, and survival and coping beliefs provide important prognostic information about later suicidal behavior and should be targeted in interventions with suicidal youths.

Clinical risk factors for the generation of life events in major depression.

This study examines the relationship of anxiety disorder and dysthymia comorbidity to the generation of life events prior to major depression episode onset in a cross-sectional community sample of 76 women. Those with comorbid anxiety and dysthymia experienced higher rates of events that were at least partly dependent on their own behavior but did not differ from those without these clinical risk factors on independent life events outside of their control. This relationship remained significant even after controlling for overall severity of depression and demographic covariates. The implications of these results for understanding the increased rates of major depression onset and recurrence among those with comorbid anxiety and dysthymia are discussed as avenues of future research.

Pretreatment Differences in Specific Symptoms and Quality of Life Among Depressed Inpatients Who Do and Do Not Receive Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is among the most commonly performed medical procedures requiring general anesthesia in the United States. Nevertheless, very little is known about the characteristics of depressed patients who receive ECT and how they differ from depressed patients receiving psychotropic medication. We conducted a detailed examination of demographic, clinical, and quality-of-life (QOL) measurements in a group of 90 depressed inpatients, and we then used these measurements to contrast the 31 patients who received ECT with the 59 who received alternative therapies. The ECT group did not differ from the non-ECT group in gender composition, marital status, race, education, employment status, overall severity of depression, chronicity of depression, adequacy of prehospitalization antidepressant treatment, extent of physical illness, or extent of social support. The ECT group was older. Furthermore, the ECT group had greater weight loss, worse functioning in activities of daily living (ADLs), and worse functioning in instrumental activities of daily living (IADLs). The differences in weight loss, ADL, and IADL scores disappeared after age adjustment. However, statistical adjustment for age revealed that the ECT group reported worse capacity in their daily living and role functioning than did the non-ECT group. We conclude that the decision to pursue ECT is based in part on the perceived effect of the depression on QOL, as well as the severity of specific symptoms such as weight loss. The elderly seem particularly vulnerable to depression-related functional deficits and weight loss, and this may explain why prior studies showed a differential use of ECT in the elderly.

Cluster analytic validation of the DSM melancholic depression. The threshold model: integration of quantitative and qualitative distinctions between unipolar depressive subtypes

Cluster analysis was performed on the DSM-III symptoms of major depression and symptoms of melancholia identified in a study group consisting of 220 unipolar depressed inpatients a melancholic and non-melancholic cluster. Patients allocated to the melancholic cluster were more severely depressed and they were characterized by psychomotor disorders, a distinct quality of mood, diurnal variation, early morning awakening, and non-reactivity. Our results support the construct validity of the DSM-III melancholic subtype of major depression. This study supports the integrated threshold model: (i) melancholic and non-melancholic depression may be regarded as continuous classes in terms of overall severity of depression; and (ii) both groups form discrete categories with regard to the melancholic symptoms, which emerge as the severity of depression increases.© 1997 Elsevier Science Ireland Ltd.