Presence Of Comorbid Depression Research Articles

Presence of Co-morbid Depression among Diabetics of Less than 5 Years Duration in a Tertiary Care Institution, Chennai, Tamil Nadu, India: A Cross-sectional Study

Introduction: Depression is a significant co-morbid condition for diabetics. Co-morbid depression results in worsened diabetes complications, deleterious effects on self-care activities, non adherence, and poor treatment outcomes. Aim: To assess the prevalence of depression among type 2 diabetic patients attending a tertiary hospital and to find its association with socio-demographic and lifestyle factors. Materials and Methods: A hospital-based cross-sectional study was done in the diabetic clinic of Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India between June 2016 and August 2016, involving 500 patients with Type II Diabetes Mellitus (T2DM) of less than five years’ duration. The prevalence of depression was calculated using Beck’s Depression Inventory Scale for a period of three months. The results were expressed in proportions, and the association of factors was tested using the Chi-square test and multivariable logistic regression analysis. A p-value <0.05 was considered statistically significant. Results: The study included 500 participants, of whom the majority (276, 55%) were female, with a mean age of 46.2 years. The prevalence of depression was 55 (11%). It was found that being female, illiterate, and unemployed were significantly associated with depression. Among disease-related factors, diabetes duration of 3-5 years, insulin injection usage, and the presence of diabetic complications were significantly associated with depression. Regarding lifestyle factors, the prevalence of depression was significantly higher among those who were non adherent to dietary modification practices and those with family worries and work-related tension. Multivariable logistic regression analysis revealed that the independent predictors of depression among diabetics were the presence of diabetic complications {Odds Ratio (OR)-2.48 (1.27-4.84)}, family worries {OR-2.54 (1.34-4.80)}, non adherence to follow-up {OR-2.61 (1.37-4.99)}, and non compliance with dietary modifications {OR-2.93 (1.43-5.99)}. Conclusion: The present study revealed that about one in 10 (11%) diabetics with less than five years’ duration have associated depression, with significant independent predictors being non compliant behaviours, the presence of complications, and family issues. Hence, diabetics should be screened simultaneously for depression, giving due attention to those with complications, family issues, and non compliant behaviours.

Neuropsychological assessment fails to predict relapse among cigarette smokers: A prospective study of neurocognitive abilities

ObjectivesUnderstanding the factors that lead to relapse is a major challenge for the clinical support of smoking cessation. Neurocognitive abilities such as attention, executive functioning and working memory, are possible predictors of relapse and can be easily assessed in everyday clinical practice. In this prospective longitudinal study, we investigated the relationship between pre-smoking cessation neurocognitive performance and relapse at six months in a sample of patients being treated for their tobacco dependence. Methods130 tobacco consumers were included in the study. They completed a comprehensive neuropsychological and clinical assessment before smoking cessation. The targeted abilities were intelligence, inhibition, shifting, working memory updating, verbal fluency and decision-making. ResultsThe rate of tobacco relapse at 6 months was 58%. Logistic regressions were used to assess which variables best explained relapse. None of the neuropsychological tests was a significant predictor of relapse at either 1, 3 or 6 months, either alone, or controlling for other covariates acting as significant predictors of relapse. ConclusionsCommon neuropsychological tests, even those specifically targeting executive functioning such as inhibition, are not useful predictors of the success of a smoking cessation program in a clinical setting. Other variables, such as motivation to quit smoking or the presence of comorbid depression or anxiety disorders, appear to be more useful predictors of relapse.

The association of comorbid depression with mortality and amputation risk in patients with chronic limb-threatening ischemia

ObjectiveThere is increasing evidence that depression is a risk factor for worse outcomes in patients with peripheral artery disease. The association of depression in patients with chronic limb-threatening ischemia (CLTI) is not well described, nor is the impact of medical treatment for depression in this patient population. The objective of this study was to investigate the prevalence of depression in patients with CLTI, its association on major amputation and all-cause mortality, and whether medical antidepressant treatment is associated with improvement in these outcomes in patients with depression. MethodsA retrospective review of all adult patients (≥18 years old) diagnosed with CLTI from January 1, 2007, to December 31, 2018, at a single academic medical center was performed. Collected data included patient demographics, comorbidities, and diagnosis of depression within 6 months of initial CLTI diagnosis. We also collected data on use of antidepressant medications. Outcomes evaluated were need for major lower extremity amputation and all-cause mortality. Multivariable logistic regression models estimated the adjusted effects of comorbid depression and antidepressant medication use on major amputation and all-cause mortality. Kaplan-Meier survival curves illustrated the probabilities of survival and limb salvage over time, stratified by diagnosis of comorbid depression. Multivariable Cox proportional hazards models estimated the adjusted effects of comorbid depression on time to major amputation and all-cause mortality, and the adjusted effect of antidepressant treatment on time to all-cause mortality. ResultsA total of 2987 patients with CLTI were identified. Mean age was 68.6 years (standard deviation, 12.9 years); 56.5% were male, and 43.5% were female. Comorbid depression within 6 months of CLTI diagnosis was present in 7.1% of the cohort (212 patients). In multivariable analysis, comorbid depression was associated with a 68% increase in the odds of major amputation (adjusted odds ratio [aOR], 1.68; 95% confidence interval [CI], 1.19-2.37; P < .01), a 164% increase in the odds of all-cause mortality among patients not taking antidepressants (aOR, 2.64; 95% CI, 1.31-5.32; P = .03), and only a 6% increase in the odds of all-cause mortality among patients taking antidepressants (aOR, 1.06; 95% CI, 0.72-1.55; P = .99). The effect of comorbid depression on mortality varied significantly by whether or not the patient was taking an antidepressant medication (P = .02). ConclusionsComorbid depression in the patient population with CLTI is associated with a worse prognosis for major lower extremity amputation overall, and a worse prognosis for all-cause mortality among patients not taking an antidepressant. Furthermore, antidepressant treatment in the presence of comorbid depression in this patient population is associated with an improvement in the odds of all-cause mortality, illustrating the potential importance of medical management of depression.

Abstract TP167: Burden And Impact Of Comorbid Depression On In-hospital Outcomes Of Acute Ischemic Stroke-related Admissions In Women Of Reproductive Age Group: A Propensity-matched Analysis

Background: Depression has been identified as a risk factor for acute cerebrovascular events. Due to limited data focused on young females, we studied the burden and impact of comorbid depression on outcomes of acute ischemic stroke (AIS)-related admissions in young women of the reproductive age group. Methods: We used the National Inpatient Sample (2018) to identify admissions of young females (age 18-44 years) with AIS; and further classified it into two demographically (age, race, payer status, income) matched (1:1) groups based on the presence of comorbid depression. Comorbidities and outcomes were compared using relevant ICD-10 codes. Multivariable regression was used to analyze the association of comorbid depression with in-hospital mortality. Results: In 15850 young females admitted with AIS in 2018, 2465 (15.6%) had comorbid depression. Post-matching, the study cohort consisted of 4610 women admitted with AIS (Median age: 37, 66.2% whites) and 2305 women in each cohort, with and without depression. The matched AIS-depression arm often had younger women (median 37 vs 39 years), patients from the lower-income quartile (47.3% vs. 34.5%), and higher rates of obesity, peripheral vascular disease, and prior history of stroke but a lower prevalence of CVD risk factors [Table 1]. The depression arm had a non-significant odd of all-cause mortality (OR 1.32, 95%CI:0.64-2.74) when adjusted for sociodemographic confounders and comorbid risk factors (p=0.452). The LOS was shorter (median 4 vs 5 days) with comparable hospital charges in the depression arm vs. no depression arm (p&lt;0.001). Conclusion: This study revealed a nearly 15% burden of depression in young females admitted for AIS without significant impact on all-cause mortality when controlled for confounders. The impact of depression on long-term AIS outcomes needs further evaluation.

The Geriatric Depression Scale Predicts Glycemic Control in Older Adult with Type 2 Diabetes Mellitus: A Longitudinal Study.

The presence of comorbid depression and diabetes is associated with worse glycemic control, higher complication and greater mortality risk than expected by each condition alone. The association between various levels of severity of depressive symptoms and glycemic control over time among type 2 diabetic older patients was unclear. This study aimed to investigate a longitudinal association between depression and HbA1c among type 2 diabetic older patients. Type 2 diabetes patients aged 60 years and above with normal cognition were recruited from the outpatient department from 1 June 2020 to 1 July 2021. The Thai Geriatric Depression Scale (TGDS) and HbA1c were assessed at five time points (baseline and every 12 weeks) for 1 year. A linear mixed effect model was used. Of the 161 enrolled participants, 146 completed the study. At baseline, 14% were susceptible to depression or having depression (TGDS score 6 and above), and there was a significant correlation between HbA1c and depression (r = 0.26, p ≤ 0.01). The longitudinal analysis indicated that TGDS was a significant predictor of HbA1c in the next visit, and the relationship was J-shaped. A TGDS below 5 was associated with decreasing HbA1c in the next visit, but the association became positive at a TGDS score at 5 or higher. The presence of significant symptoms of depression was associated with glycemic control in the next 3-month interval OPD visit event, although major depressive disorder has not yet been established.

Suicide Behavior and Its Predictors in Patients with Schizophrenia in Ethiopia.

Background People with schizophrenia (PWS) are at greater risk of suicide. However, suicide behaviors that occur in PWS are often overlooked, inadequately characterized, and not consistently integrated into treatment. Despite this burden and consequences in Ethiopia, there is a dearth of studies concerning suicide behavior in PWS. Therefore, this study is aimed at assessing the magnitude of suicide behavior and its predictors among PWS in Ethiopia. Methods An institution based cross-sectional study was employed. Data were collected using the structured interviewer-administered questionnaire from a sample of 300 PWS at Amanuel Mental Specialized Hospital (AMSH). The revised version of Suicide Behavior Questionnaire (SBQ-R) was used to assess suicide behavior in PWS. The data was collected from March 1 to 30, 2019. Binary logistic regression was performed to identify independent predictors of suicidal behavior at 95% confidence level. Statistical significance was declared at p value <0.05. Result A total of 300 patients with schizophrenia participated in the study. More than two-thirds of 203 (67.7%) of the participants were males, and 116 (38.7%) participants were between the ages of 28 and 37 years. We found that the prevalence of suicide behavior among PWS was 30.3%. Being unemployed (AOR = 3.65, CI = 1.32, 10.05), family history of suicide (AOR = 3.16, CI = 1.38, 7.23), substance use (AOR = 2.51, CI = 1.13, 5.59), current positive psychotic symptoms (hallucination (AOR = 6.39, CI = 2.86, 14.29), and delusion (AOR = 4.15, CI = 1.95, 14.29) and presence of comorbid depression (AOR = 4.81, CI = 1.98, 11.68) were independent significant predictors with suicidal behavior in PWS. Conclusion The prevalence of suicidal behavior among PWS was found to be high. Hence, designing strategies for early screening and intervention is the most critical prevention strategy of suicide in PWS.

Depression among Patients with Schizophrenia in Ethiopian Mental Health Hospital: Association with Sociodemographic and Clinical Variables: A Cross-Sectional Study.

Background Depression is a significant contributor to the global burden of disease and affects all individuals throughout their lifetime. Patients with schizophrenia are frequently attacked by depression during their total illness duration. Presence of comorbid depression in schizophrenia makes the patients more deteriorating and disabling course and poor outcome. Aim of the Study. To determine the prevalence of depression and highlight the associated sociodemographic and clinical factors in patients with schizophrenia in a specialized hospital in Addis Ababa, Ethiopia. Setting. This study was conducted at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. Methods An institutional based cross-sectional study was conducted from May to June 2018. Depression was measured by Calgary Depression Scale for Schizophrenia on 455 samples of patient with schizophrenia and systematic sampling was used to select the study participants. Oslo Social Support Scale and Alcohol, Smoking, and Substance Involvement Screening Test were used to assess social support and substance use factors, respectively. A bivariable and multivariable logistic regression analysis model was performed to control the confounding factors. Odds ratio (OR) with the corresponding 95% confidence interval (95% CI) was determined to evaluate the strength of association. Results A total of 445 patients responded to the questionnaire, which yields a response rate of 97.8%. The Magnitude of depression among schizophrenia patients was 24.9%. A multivariable logistic regression analysis model showed that being female [AOR 2.00, 95% CI: 1.25-3.18], divorced/widowed [AOR 2.39, 95% CI: 1.04-5.49], current substance use [AOR 1.95, 95% CI: 1.17-3.25], and poor social support [AOR 2.75, 95% CI: 1.35-5.61] were significantly associated with depression in schizophrenia. Conclusion The magnitude of depression among schizophrenia was 24.9%. Being female, divorced/widowed, current substance use, and poor social support were associated with depression among patients with schizophrenia. Regular screening and prompt management of depressive symptoms among patients with schizophrenia is of particular importance to reduce the burden of the condition.

Factors associated with depression in people with epilepsy: a retrospective case-control analysis.

This study investigated factors associated with depression in people with epilepsy. All adult patients attending our epilepsy clinic in 2018 were screened for inclusion in this study. Eligible patients were divided into case and control groups, depending on the presence of co-morbid depression. Depressive disorders were diagnosed by a psychiatrist. Demographics and clinical characteristics, including epilepsy features and antiepileptic drug use, were compared between groups. The factors contributing to onset of depression after diagnosis of epilepsy were further analysed by binomial logistic regression. Statistical significance was set at P<0.05. Forty four patients with epilepsy who had depression and 514 patients with epilepsy who did not have depression were included in this study (occurrence rate=7.9%). Female sex (P=0.005), older age (P<0.001), temporal lobe epilepsy (P=0.01), and higher number of antiepileptic drugs used (P=0.003) were associated with depression in patients with epilepsy. No differences were observed in other epilepsy-related factors including aetiology, seizure type, and laterality of epileptic focus. Binomial logistic regression showed that female sex (P=0.01; odds ratio [OR]=3.56), drug-resistant epilepsy (P<0.001; OR=4.79), and clonazepam use (P<0.001; OR=14.41) were significantly positively associated with risk of depression after epilepsy diagnosis, whereas valproate use (P=0.03; OR=0.37) was significantly negatively associated with risk of depression. Female sex, refractoriness, and clonazepam use may be risk factors for depression after epilepsy diagnosis. Valproate may protect against depression in people with epilepsy. Better understanding of clinical features may aid in medical management or research studies regarding co-morbid depression in people with epilepsy.

Functional gastrointestinal disorders negatively affect health-related quality of life in MS.

To determine the prevalence of functional gastrointestinal disorders, the demographic and clinical characteristics associated with the presence of functional gastrointestinal disorders, and the effects of these disorders with health-related quality of life (HRQOL) in a large, diverse population of persons with MS. In 2014, we surveyed participants in the North American Research Committee on Multiple Sclerosis registry regarding functional gastrointestinal disorders using the Rome III questionnaire. Participants also reported their sociodemographic characteristics, disability status using Patient Determined Disease Steps, the presence of comorbid depression and anxiety, health behaviors, and HRQOL using the RAND-12. We determined the prevalence of each gastrointestinal disorder using the Rome III criteria. Using multivariable logistic regression models, we assessed the factors associated with the presence of each bowel disorder. Using linear regression, we evaluated the association between functional gastrointestinal disorders and HRQOL. Of 6,312 eligible respondents, 76.5% were female, with a mean (SD) age of 58.3 (10.2) years. Forty-two percent of respondents (n = 2,647) had a functional gastrointestinal disorder, most often irritable bowel syndrome (IBS), which affected 28.2% of participants. The prevalence of all functional gastrointestinal disorders increased with greater disability, and the prevalence of IBS increased with longer disease duration. After adjusting for sociodemographic and clinical characteristics, functional gastrointestinal disorders were associated with lower physical and mental HRQOL (both p < 0.0001). Functional gastrointestinal disorders are common in MS and are associated with reduced HRQOL.

Association of Mental Health Conditions With Participation in Cardiac Rehabilitation.

BackgroundMental health conditions are associated with adverse cardiovascular outcomes in patients with ischemic heart disease, and much of this risk can be attributed to poor health behaviors. Although all patients with ischemic heart disease should be referred for cardiac rehabilitation (CR), whether patients with mental health conditions are willing to participate in CR programs is unknown. We sought to compare CR participation rates among patients with ischemic heart disease with versus without comorbid depression and/or posttraumatic stress disorder (PTSD).Methods and ResultsWe used national electronic health records to identify all patients hospitalized for acute myocardial infarction or coronary revascularization at Veterans Health Administration hospitals between 2010 and 2014. Multivariable logistic regression models were used to determine whether comorbid depression/PTSD was associated with CR participation during the 12 months after hospital discharge. Of the 86 537 patients hospitalized for ischemic heart disease between 2010 and 2014, 24% experienced PTSD and/or depression. Patients with PTSD and/or depression had higher CR participation rates than those without PTSD or depression (11% versus 8%; P<0.001). In comparison to patients without PTSD or depression, the odds of participation was 24% greater in patients with depression alone (odds ratio, 1.24; 95% CI, 1.15–1.34), 38% greater in patients with PTSD alone (odds ratio, 1.38; 95% CI, 1.24–1.54), and 57% greater in patients with both PTSD and depression (odds ratio, 1.57; 95% CI, 1.43–1.74).ConclusionsAmong patients with ischemic heart disease, the presence of comorbid depression and/or PTSD is associated with greater participation in CR, providing an important opportunity to promote healthy lifestyle behaviors and reduce adverse cardiovascular outcomes among these patients.

PMU30 CHANGE IN THE PREVALENCE OF DEPRESSION AMONG PEOPLE WITH HYPERTENSION BETWEEN THE JNC 7 AND ACC/AHA 2017 GUIDELINES: US NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY (NHANES), 2008-2016 COHORT

Presence of comorbid depression in patients with hypertension is associated with adverse healthcare consequences including increased mortality, morbidity, and disability. Given the change in the guidelines for hypertension diagnosis by ACC in 2017, it's imperative to study its impact on the prevalence of depression in this population. Hence, the primary objective of this research study was to evaluate the change in the prevalence of depression among hypertensive (DAH) between the JNC 7 and the 2017 ACC/AHA guidelines using NHANES data. A cohort study was conducted using NHANES data from 2008-2016. The PHQ-9 questionnaire in NHANES was used to measure depression. JNC 7 and ACC/AHA 2017 guidelines were used to define hypertension. Descriptive statistics and survey linear regressions were used to analyze prevalence of DAH using the different guidelines controlling for race and sex. Predictors of depression were analyzed using survey logistic regression models. Preliminary analysis shows that the overall unadjusted prevalence of DAH was 62.8%. The unadjusted prevalence of DAH was found to be 64% using the JNC 7 guideline and 62% using the 2017 ACC/AHA guideline. Further analysis and adjusting for age, race/ethnicity and sex shows that the prevalence of DAH is significantly lower in the 2017 ACC/AHA guideline compared to the JNC 7 guideline by nearly 2.15%. There was also a decrease in the unadjusted and adjusted prevalence of DAH after applying the guidelines among all race/ethnicities and by sex, with the use of older guideline resulting in a greater prevalence of depression. With the change in the guidelines for measurement and diagnosis of hypertension, there was significant decrease in the prevalence of DAH. The distribution of the prevalence of DAH between hypertension categories also changed with the current guidelines. Further research into effective screening and management for depression, and future longitudinal follow-up of this population is needed.

Incremental hospital utilization and mortality associated with co-morbid depression in pediatric hospitalizations

ObjectiveThe objective of this study was to evaluate the association between hospital utilization and mortality and the presence of co-morbid depression in pediatric hospitalizations. MethodsUsing the Kids' Inpatient Database (KID) for 2012, a nationally representative database of all inpatient admissions in the United States of America for patients younger than 21 years of age compiled by the Health Care Utilization Project (HCUP), we obtained hospital records for children aged 6–20 years with any one of the 10 most common diagnoses in this population excluding affective disorders. After using one to one propensity score matching on age, race, gender, obesity, insurance type, hospital location and hospital size to ensure exchangeability between the groups, we compared the Length of Stay (LOS), Total Hospital Costs (THC) and mortality in children with and without reported comorbidity depression. We employed descriptive statistics and linear regression methods in our analyses ResultsA total of 667,968 discharges were extracted estimating a total of 937,971 discharges for children aged 6 - 20 with a primary diagnosis of any one of the 10 most common non-affective diagnoses in 2012. The prevalence of comorbid depression was about 2.9%. Propensity score matching produced 17,071 pairs. The mean LOS among patients with comorbid depression (4.63 days) was 0.89 days (95% CI: 0.74–1.05 days) higher than among patients without comorbid depression (3.74 days). The mean THC among patients with comorbid depression ($10,643) was $2,961 (95% CI: $2,401–$3,512) higher than among children without comorbid depression ($7,682). The odds of death as an outcome among the depressed was 1.77 (95% CI 1.13–2.77) times the odds among non-depressed patients. ConclusionsThese findings show that comorbid depression significantly increases hospital utilization and mortality in childhood hospitalizations.

Performance of OCD Patients on WCST in Context of Comorbid Depression

Introduction: Over the years it has been observed that disturbances in cognitive functions including attention, executive functions, visuospatial functions, verbal and non-verbal memory, in OCD (obsessive compulsive disorder) patients are mediated by co morbid neuropsychiatric conditions. It has been observed that comorbid depression in OCD patients is associated with executive function deficits. Wisconsin Card Sorting Test (WCST) is one of the most widely used tests to assess the executive function deficits. Methods: 160 patients fulfilling the DSM-IV criteria for OCD & depression were selected and categorized in 2 sample groups namely OCD with depression (OCDD, n=80) & OCD without depression (OCWD, n=80). Yale Brown Obsessive Scale (Y-BOCS) scale was used for assessment of OCD & Hamilton rating scale of depression (HAM-D) was used for further grading the severity of depression into mild, moderate & severe. The executive function deficits in patients of the three categories of depression with OCD were tested with WCST & intergroup comparisons were made. Results: Both the OCDD & OCWD groups were matched for age, gender, marital status, educational qualification, age of onset of illness & duration of illness. The overall mean age of the patients presenting to the OPD was 32.63 years. The patients in groups OCD with moderate & severe depression completed less categories & committed more perseverative errors as compared to patients in groups OCD without depression & OCD with mild depression. Conclusion: The observations of this study suggest that patients with OCD have impairment in executive functions which are further worsened by the presence of comorbid depression. Assessment of neurocognitive functions of patients with OCD should always include assessment of comorbid depression which will help in providing a patient tailored treatment.

The impact of borderline personality disorder and sub-threshold borderline personality disorder on the course of self-reported and clinician-rated depression in self-harming adolescents

BackgroundStudies on adults suggest that the presence of comorbid depression and Borderline Personality Disorder (BPD) is associated with an elevated risk of self-harming behaviours and that self-harming behaviours, when present, will have higher severity. This comorbidity, furthermore, complicates clinical assessments, which may be an obstacle to early identification and proper intervention. Adolescents who self-harm frequently report high levels of depressive symptoms, but this is often not reflected in the clinicians’ assessment. BPD is still a controversial diagnosis in young people, and less is known about the clinical significance of comorbid BPD in adolescent populations.The purpose of the present study was to examine the impact of BPD on the assessment and course of self-reported and clinician-rated depression in self-harming adolescents before and after a treatment period of 19 weeks. We hypothesized that, compared to adolescents without BPD, adolescents with BPD would self-report higher levels of depression at baseline, and that they would have less reduction in depressive symptoms.MethodsA total of 39 adolescents with depressive disorders and BPD-traits participating in a randomised controlled trial on treatment of self-harm with Dialectical Behaviour Therapy adapted for Adolescents or enhanced usual care were included. Adolescents with full-syndrome BPD (n = 10) were compared with adolescents with sub-threshold BPD (n = 29) with respect to their self-reported and clinician-rated depressive symptoms, suicidal ideation and global level of functioning at baseline, and after 19 weeks of treatment (end of trial period).ResultsAt baseline, adolescents with full-syndrome BPD self-reported significantly higher levels of depressive symptoms and suicidal ideation compared to adolescents with sub-threshold BPD, whereas the two groups were rated as equally depressed by the clinicians. At trial completion, all participants had a significant reduction in suicidal ideation, however, adolescents with BPD had a poorer treatment outcome in terms of significantly higher levels of clinician-rated and self-reported depressive symptoms and significantly lower levels of global functioning. At baseline as well as at trial completion, self-reported and clinician-rated levels of depressive symptoms were not significantly correlated in adolescents with BPD. In a multiple linear regression analysis, a diagnosis of BPD and a high baseline level of clinician-rated depressive symptoms predicted higher levels of depressive symptoms at trial completion, whereas receiving Dialectical Behaviour Therapy predicted lower levels of depressive symptoms.ConclusionOur findings suggest that a diagnosis of BPD may have a strong impact on the assessment and course of depressive symptoms in self-harming adolescents. Although rated as equally depressed, adolescents with BPD self-reported significantly higher levels of depressive symptoms and suicidal ideation at baseline, and showed a poorer outcome in terms of higher levels of depressive symptoms and lower levels of global functioning at trial completion compared to adolescents with sub-threshold BPD. Our findings suggest that receiving Dialectical Behaviour Therapy could lead to a greater reduction in depressive symptoms, although firm conclusions cannot be drawn given the limited sample size.Clinicians should be aware of the possibility of underestimating the severity of depression in the context of emotional and behavioral dysregulation. Providing BPD specific treatments seems to be important to achieve sufficient treatment response with regard to depressive symptoms in adolescents with BPD-traits.Trial registrationTreatment for Adolescents With Deliberate Self Harm; NCT00675129, registered May 2008.

Listening to the Patient Voice in Narcolepsy: Diagnostic Delay, Disease Burden, and Treatment Efficacy.

Describe common symptoms, comorbidities, functional limitations, and treatment responsiveness among patients with narcolepsy. Investigate the effect of pediatric onset of narcolepsy symptoms on time to diagnosis of narcolepsy and presence of comorbid depression. Cross-sectional survey of 1,699 people in the United States with self-reported diagnosis of narcolepsy. We utilized mixed-methods data analyses to report study findings. Most participants reported receiving a diagnosis of narcolepsy more than 1 y after symptom onset. We found that the strongest predictor of this delayed diagnosis was pediatric onset of symptoms (odds ratio = 2.4, p < 0.0005). Depression was the most common comorbidity but we detected no association with pediatric onset of narcolepsy symptoms. Overall, participants reported that fatigue and cognitive difficulties were their most burdensome symptoms in addition to sleepiness and cataplexy. The majority of participants reported residual daytime fatigue and/or sleepiness despite treatment. Most participants reported they could not perform at work or school as well as they would like because of narcolepsy symptoms. This study provides unique insight into the narcolepsy disease experience. The study quantifies the problem of diagnostic delay for narcolepsy patients in the United States and highlights that symptoms are more likely to be missed if they develop before 18 y of age. These results suggest that narcolepsy awareness efforts should be aimed at parents, pediatric health care providers, school professionals, and children/adolescents themselves. Disease burden is high because of problems with fatigue, cognition, and persistence of residual symptoms despite treatment.

The cost-effectiveness of changes to the care pathway used to identify depression and provide treatment amongst people with diabetes in England: a model-based economic evaluation

BackgroundDiabetes is associated with premature death and a number of serious complications. The presence of comorbid depression makes these outcomes more likely and results in increased healthcare costs. The aim of this work was to assess the health economic outcomes associated with having both diabetes and depression, and assess the cost-effectiveness of potential policy changes to improve the care pathway: improved opportunistic screening for depression, collaborative care for depression treatment, and the combination of both.MethodsA mathematical model of the care pathways experienced by people diagnosed with type-2 diabetes in England was developed. Both an NHS perspective and wider social benefits were considered. Evidence was taken from the published literature, identified via scoping and targeted searches.ResultsCompared with current practice, all three policies reduced both the time spent with depression and the number of diabetes-related complications experienced. The policies were associated with an improvement in quality of life, but with an increase in health care costs. In an incremental analysis, collaborative care dominated improved opportunistic screening. The incremental cost-effectiveness ratio (ICER) for collaborative care compared with current practice was £10,798 per QALY. Compared to collaborative care, the combined policy had an ICER of £68,017 per QALY.ConclusionsPolicies targeted at identifying and treating depression early in patients with diabetes may lead to reductions in diabetes related complications and depression, which in turn increase life expectancy and improve health-related quality of life. Implementing collaborative care was cost-effective based on current national guidance in England.

Using a Recently Developed Self-Report Instrument to Assess Social Anxiety Life Interference in Individuals with Co-occurring Depression: A Known-Groups Analysis.

Social anxiety is a common condition that often entails substantial adverse impacts on social, educational, and occupational functioning. Moreover, social anxiety often co-occurs with depression, making it difficult to distinguish the unique effects of each condition, which can pose a challenge to effective treatment planning and intervention. Until recently, clinicians have not had access to a validated psychometric instrument that measures the degree of life interference stemming from social anxiety, and that distinguishes life interference associated with social anxiety from that associated with depression. Fortunately, recent work has yielded a novel instrument that combines a measure of social anxiety life interference with a measure of depression life interference, providing a measure that can identify functional disruptions uniquely associated with social anxiety, and that may occur in the presence of comorbid depression. The present article reviews two studies describing the development and psychometric properties of the Social Anxiety and Depression Life Interference Inventory (SADLI-24) and adds to the existing literature by demonstrating the discriminative accuracy of the inventory using a “known-groups” methodology. The article concludes by providing recommendations for the practical application of the SADLI-24 and suggesting future directions for research with the instrument.

Generalized anxiety disorder in primary care: mental health services use and treatment adequacy.

PurposeGeneralized Anxiety Disorder (GAD) is a common mental disorder in the primary care setting, marked by persistent anxiety and worries. The aims of this study were to: 1) examine mental health services utilisation in a large sample of primary care patients; 2) explore detection of GAD and minimal standards for pharmacological and psychological treatment adequacy based on recommendation from clinical practice guidelines; 3) examine correlates of treatment adequacy, i.e. predisposing, enabling and needs factors according to the Behavioural Model of Health Care Use.MethodsA sample of 373 adults meeting DSM-IV criteria for Generalized Anxiety Disorder in the past 12 months took part in this study. Data were drawn from the “Dialogue” project, a large primary care study conducted in 67 primary care clinics in Quebec, Canada. Following a mental health screening in medical clinics (n = 14833), patients at risk of anxiety or depression completed the Composite International Diagnostic Interview-Simplified (CIDIS). Multilevel logistic regression models were developed to examine correlates of treatment adequacy for pharmacological and psychological treatments.ResultsResults indicate that 52.5 % of participants were recognized as having GAD by a healthcare professional in the past 12 months, and 36.2 % of the sample received a pharmacological (24.4 %) and/or psychological treatment (19.2 %) meeting indicators based on clinical practice guidelines recommendations. The detection of GAD by a health professional and the presence of comorbid depression were associated with overall treatment adequacy.ConclusionsThis study suggests that further efforts towards GAD detection could lead to an increase in the delivery of evidence-based treatments. Key targets for improvement in treatment adequacy include regular follow up of patients with a GAD medication and access to psychotherapy from the primary care setting.

Personality dimensions in patients with social phobia

Objective: In this study, we aimed to evaluate the properties of temperament and character in patients with social anxiety disorder(SAD) compared to healthy controls, who have similiar socio-demographic characteristics. The secondary aim of study is to investigate the relationship between temperament and character in patients with social anxiety disorder with the presence of comorbid depression and disease severity. Method: This study was conducted at the Outpatient Clinic in the Department of Psychiatry of Sisli Etfal Educating and Researching Hospital. 64 patients with social anxiety disorder whose diagnoses were made by DSM-IV and 64 healthy controls were included in this study. Control group were matched to SAD group according to age, gender and educational status. Cloninger Temperament and Character Inventory, Hamilton Depression Scale and Liebowitz Social Anxiety Scale were administered to the participants. SCID-I/CV (Structured Clinical Interview for DSM-IV Axis I Disorder, Clinical Version) was used to evaluate the psychopathology in patients and control groups. Results: With or without comorbid depression, in SAD group HA(harm avoidance) scores were significantly higher compared to healthy controls and this difference was more pronounced in SAD group with comorbid depression. In addition, P(persistence) score was significantly lower in SAD group with comorbid depression compared to healthy controls while RD (reward dependence) score was significantly lower in SAD group without comorbid depression compared to healthy controls. In terms of character traits, SD(self directedness) and C(cooperativeness) scores were significantly lower in both SAD with or without comorbid depression groups compared to healthy controls. SD (self-directedness) score was significantly lower in generalized SAD group compared to non-generalized SAD group where as HA score was significantly higher in generalized SAD group compared to non-generalized SAD group. It seems that there is a linear relationship between the severity of illness and HA(harm avoidance) scores. Discussion: One of the most important findings of this study is that, HA is not only associated with depression, HA significantly rise in SAD patients without depression. Regardless of other temperament parameters HA has a significant effect on the severity of the SAD, and this supports the hypothesis that the serotonergic system plays a significant role on SAD.

Usability and engagement with an online platform to support the self-management of symptoms and promote the wellbeing of people with cardiovascular disease (CVD)

Cardiovascular disease (CVD) is the leading cause of disability & mortality. Related conditions include: coronary heart disease, stroke, hypertension, diabetes, chronic kidney disease, peripheral arterial disease and vascular dementia. These are conditions that can be managed but not cured. Self-management is the core of effective treatment for CVDs, but can be compromised in the presence of co-morbid depression and anxiety, which has a greater prevalence in CVD patients than in the general population. Co-morbid depression and anxiety can also exacerbate the perceived severity of physical symptoms such as chest pain, breathlessness and fatigue; this commonly leads to increased primary care and emergency department attendance. Access to effective psychological treatment for depression and anxiety for people with CVD (such as cognitive behavioural therapy delivered by the government’s Improving Access to Psychological Therapy services) is limited, waiting lists can be a problem and patients may be unwilling or unable to attend. Online-delivered interventions are a low-cost and non-stigmatising way of delivering therapy and self-management support and are easily accessed.