Presence Of Depressive Symptomatology Research Articles

Effective emotion regulation as a protective factor of depression symptoms in Slovak adolescents during a COVID-19 pandemic

The aim of our study was to verify relationships between individual difficulties in emotion regulation (ER), ER strategies (cognitive reappraisal and expressive suppression), and compassion (to self and others) with the presence of depressive symptomatology in a sample of Slovak adolescents during the second wave of the COVID-19 pandemic. In the sample of 140 Slovak adolescents (age between 17–19 years) was administrated The Beck Depression Inventory- II. (Beck et al., 1996), The Overall Depression Severity and Impairment Scale (Bentley et al., 2014), The Emotion Regulation Questionnaire (Gross & John, 2003), The Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004), The Sussex-Oxford Compassion for the Self Scale and The Sussex-Oxford Compassion for Others Scale (Gu et al., 2019). Results revealed that difficulties in ER (all subscales) and expressive suppression were in positive relationships with depression symptoms. Cognitive reappraisal and self-compassion were in negative relationships with depression symptoms. Lack of ER strategies and cognitive reappraisal (inversely) were the strongest predictors of depressive symptoms. These findings suggest that ER strategies (mainly cognitive reappraisal) could be assumed as protective factors in adolescent depression symptoms development in stressful circumstances of the COVID-19 pandemic.

Depression Disorders in Mexican Adolescents: A Predictive Model.

Depression is a type of mood disorder that can impact individuals of any age. A variety of factors, including biological, psychological, and environmental factors, can contribute to the likelihood of developing depression. If the environment in which a person exists does not support its occurrence, the disorder may not manifest. The current research follows a retrospective, correlational approach, utilizing a non-probability sample of 557 high school students from public schools in Mexico City. This sample includes 181 males and 376 females, aged between 15 and 18 years, with an average age of 15.66 and a standard deviation of 0.68. The main objective of this research is to identify the variables that serve as risk factors for the development of depressive disorders in Mexican adolescents in high school. The data show that 78% of the adolescents in the total sample were at risk of depression, which is consistent with what has been reported by other researchers. The regression model shows that alcohol and drug consumption is associated with and influences the emergence and presence of depressive symptomatology and major depressive disorder. Adolescents with different sexual orientations than heterosexuals are twice as likely to suffer depression and emotional dysregulation. It was confirmed that the developmental stage and adolescence contributes as a context that favors the evolution of such a symptomatology.

Mental Health of Brazilian Immigrant Women: The Role of Discrimination, Social Support, and Community Strengths.

Little is known about the mental health status of Brazilians living in the U.S. We assessed the prevalence and correlates of depression to guide the development of culturally relevant community-based mental health interventions. An online survey was conducted between July and August 2020 among a sample of Brazilian women living in the U.S. (age 18 and over, born in Brazil, English or Portuguese speaking) recruited through Brazilian social media pages and community organizations. The survey assessed depression using the Center for Epidemiological Study Depression Scale (CES-D-10), the Everyday Discrimination Scale (EDS), the Oslo Social Support Scale (OSSS), and community strengths (CS). We first assessed the correlation between CES-D-10 scores and EDS, OSSS, and CS. We found that half of the participants (52.2%) had CES-D-10 scores of 10 or greater, indicating the presence of depressive symptomatology. In a multivariable model controlling for significant covariates (age, time lived in U.S.), EDS was positively associated with CES-D-10 scores (β = 0.64, 95% CI = 0.45, 0.83), while OSSS was negatively associated with CES-D-10 scores (β =-0.53, 95% C I= -0.80, -0.27). No statistically significant relationship was observed between CES-D-10 and CS scores. In this sample of Brazilian immigrant women, depressive symptomatology was highly prevalent, and experiences of discrimination were associated with increased symptoms of depression. There is a need to understand and address mental health in Brazilian immigrant women.

Síndrome de fragilidade entre pessoas idosas longevas de uma macrorregião de saúde em Minas Gerais

Abstract Objective to identify frailty conditions and their associated factors among oldest old individuals living in the urban area of a health macro-region of Minas Gerais state. Methods a cross-sectional study of 314 oldest old from a health macro-region in Minas Gerais state, Brazil, was conducted. Data were collected from households by applying instruments validated for use in Brazil. Descriptive and multinomial logistic regression analyses (p<0.05) were carried out. Results In the sample assessed, 44.3% of the oldest old were frail, 44.3% pre-frail and 11.4% non-frail. The pre-frail condition was associated with living alone (p=0.047) and very poor/poor physical performance (p=0.026), while frailty was associated with very poor/poor physical performance (p<0.001), the presence of depressive symptomatology (p=0.029) and of ≥5 morbidities (p=0.003). Conclusion pre-frail and frail conditions predominated among the oldest old assessed. Maintaining physical performance is an aspect that can be targeted by health professionals in oldest old to delay pre-frailty and frailty.

Correlates and Effects of Alcohol Use Expectancies Among Persons Living with HIV in Uganda.

Unhealthy alcohol use fuels difficulties with HIV disease management and potentiates secondary transmission of HIV but less is known about how these alcohol use expectancies may shape alcohol use behaviors, particularly in the presence of depressive symptomatology. In this paper, we utilize data from a prospective study of 208 people living with HIV in Southwest Uganda, to examine the correlates of alcohol use expectancies and their association with unhealthy alcohol use. Affective depressive symptoms were positively associated with alcohol use expectancies. Gender moderation was observed such that depression was more strongly associated with alcohol use expectancies among women. In unadjusted analyses, alcohol use expectancies were marginally associated with unhealthy alcohol use and this association was not significant in adjusted analyses. Findings underscore the need to strengthen screening for depression and alcohol use within HIV care services, particularly among women.

27. Associations between postpartum depression and hypertensive disorders of pregnancy

Objectives To identify the possible relationships between PPD and HDP in women in a public maternity, and the associated factors. Study design Prospective cross-sectional study with 168 puerperal women diagnosed with HDP (hypertensive women) and their controls (normotensive women) and their newborns. Diagnosis of SAH was indicated when systolic pressure was 140 mmHg or higher or diastolic pressure was 90 mmHg or higher; the diagnosis and severity of the disease were based on blood pressure, proteinuria, and clinical and laboratory findings. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess the risk of postpartum depression. Scores ⩾12 were considered to indicate the presence of depressive symptomatology. Main outocome measures Probability of depressive symptoms according to the EPDS. Results The probability of postpartum depressive symptoms was positively related with the diagnosis of hypertensive disorders of pregnancy (rS = 0.219, p ⩽ 0.004), premonitory signs (rS = 0.171, p = 0.027), use of magnesium sulfate (rS = 0.199, p = 0.010), and DBP (rS = 0.165, p = 0.033), and use of milk formula during hospitalization (rS = 0.152, p = 0.048). Conclusions Puerperal women diagnosed with HDP are more likely to have depressive symptoms.

Alteraciones neuropsicológicas en la narcolepsia con cataplejía: una revisión

To describe the current state of the art about the main cognitive deficits that appear in patients affected with narcolepsy with cataplexy (NT1). The majority of the studies have found that the most impaired cognitive functions are attention (especially maintenance of attention or sustained attention), speed of information processing and executive functions (in particular, verbal fluency and resistance to the stimuli interference). These data indicate the difficulty to use the available cognitive resources of the patient. These alterations are similar to those present in other hypersomnias, although they might differ in intensity. Moreover, most of the studies emphasize a high prevalence of different depressive and anxious disorders. It has been suggested that predisposition to anxiety could be part of the characteristic phenotype of these patients. Anxiety could act either as a trigger for the disease or a consequence of the disease. Cognitive deficits in patients with NT1 appear in long lasting and/or monotonous tasks and in high cognitive demanding tasks. The presence of depressive symptomatology, together with excessive daytime sleepiness in these patients could affect their performance in neuropsychological test, and it might be related to their subjective perception of the cognitive deficits.

Determinants of Quality of Life in Pre-Frail Older Adults According to Phenotypic Criteria: the VERISAUDE Study

Frailty is a dynamic clinical syndrome considered as part of an age-associated continuum of severity, including pre-frailty as an intermediate frailty status with potential reversibility to robustness. The main purpose of this study was to analyse the relationship between the different domains of quality of life, functional dependence and depressive symptomatology in older adults diagnosed as pre-frail, before progression to frailty occurs. Logistic regression analyses were conducted to examine whether sex, age, level of education and scores in the Geriatric Depression Scale 15-item Short Form (GDS-SF) and the Instrumental Activities of Daily Living Lawton scale determine the worst score in the WHOQOL-BREF (World Health Organization Quality of Life) in older adults meeting one or two frailty phenotypic criteria. Depressive symptomatology (GDS-SF score) was the main determinant of poor quality of life in both groups, and in all areas of WHOQOL-BREF. Age was only associated with poor satisfaction with own health. Female sex and low educational level were linked to low physical QOL and poor self-rated health, respectively, but only in older adults meeting one frailty criterion. Association between functional status and WHOQOL-BREF scores was only found in the univariate analysis. These results underline the importance of identifying multiple aspects, but mainly the presence of depressive symptomatology, as risk factors for all dimensions of quality of life in the pre-frailty process, where interventions might be targeted to reduce the progression of pre-frailty and frailty in older adults.

Memory impairment in older adults' diversionary thoughts.

The diversion paradigm was created in the context of explaining the effect of the instruction to forget some recently encoded material in the list-method of the directed forgetting paradigm. The current study of healthy older adults employed the diversion paradigm with two main goals: to determine whether thinking about an autobiographical memory interferes with the recall of recently encoded information and to explore whether the degree of forgetting depends on the temporal distance created by the diversionary thought. Ninety non-institutionalized Portuguese older adults (47 females and 43 males), aged 65–69 years, with education levels of between 3 and 6 years participated in this study. The exclusion criteria were as follows: presence of depressive symptomatology (assessed with the Geriatric Depression Scale-30) and global cognitive deterioration (assessed with the Mini–Mental State Examination). Concerning the diversion paradigm, one group was instructed to think about an autobiographical event (remembering one’s childhood home or the last party that one had attended) after studying one word list (List 1) and before viewing the second word list (List 2). After a brief distraction task, the participant had to recall the words from both of the studied lists. In the control group, the procedure was the same, but the diversionary thought was substituted by a speed reading task. The obtained results showed the amnesic effect of diversionary thought but did not show a greater degree of forgetting when the autobiographical events in the diversionary thoughts were temporally more distant. Considering the practical implications of these results, this study alerts us to the importance of promoting strategies that enable older adults to better remember important information and effectively forget irrelevant information.

Depressive symptomatology and cortisol concentrations in elderly community residents: a cross-sectional study.

Researches seek to understand the links between adverse health outcomes and cortisol concentrations. However, the relationship between depressive symptomatology and cortisol concentrations is controversial in the literature. To analyze the relationship between the depressive symptomatology and the cortisol concentrations in elderly community residents in the Brazilian Northeast. Cross-sectional study is composed of 256 elderly (≥65years). Depressive symptomatology was evaluated by the Center for Epidemiologic Studies-Depression Scale and cortisol concentrations by salivary collection (upon waking, 30 and 60min after waking, at 3pm and before bed), in addition to composite measurements. Sociodemographic and health conditions were evaluated. For analysis of the cortisol measurements in relation to depressive symptomatology, and between genders, the Student's t test was used. For cortisol measurements in every curve, analysis of variance for repeated measurements with Bonferroni post hoc test was used. There were significant salivary cortisol differences upon awakening, among elderly with and without depressive symptomatology (p=0.04). There was no significance in relation to gender. Between measurements of each curve, elderly with depressive symptomatology showed no significant difference between the 1st measure in relation to the 2nd and 3rd, and also between the 4th and 5th, demonstrating higher cortisol night levels in elderly with depressive symptomatology, without decline, with curve plane aspect. The relationship between depressive symptomatology and hypocortisolism throughout the day seems to exist. However, in Brazil, adverse life conditions can lead to chronic stress and be sufficient factors to superpose biggest differences that could exist in relation to the presence of depressive symptomatology.

Portuguese

Background: The Phenotype of Frailty is a syndrome composed of five criteria: weight loss, endurance, physical activity, slowness and weakness. The elder is considered frail if he/she has an impairment in three of these domains. It is known that this condition enhances the risk of disability and death. The objective of this study is to identify predictive and protective factors of frailty. Methods: This study includes a representative sample, stratified by age group, of elders living in the community (n=339). We developed a frailty protocol, which integrated the criteria of frailty and bio behavioural, geriatric, functionality, health and mental health selfperception indicators. Results: From the analysis of logistic regression models the demographic predictors are: gender (being a woman) (OR 1.7, 95% CI 1,0 - 2,8), age (more advanced) (OR 2.8, 95% CI 1.6 - 4.9) and educational level (no schooling) (OR 2.6, 95% CI 1.1 – 6.0). The bio behavioural variables and the low respiratory flow predict the condition of frailty (OR 3.3, 95% CI 1.9 – 6.0). Geriatric indicators as falls (OR 3.3, 95% CI 1.5 - 5.6), changes in sensory processes, vision and hearing (OR 2.1, 95% CI 1.2 -3. 8; OR 2.1, 95% CI 1.1 - 4.0 respectively) and the presence of at least one comorbidity (OR 1.8, 95% CI 1.0 - 3.2) are predictors of frailty. Impairment in ADL increases the risk of frailty (OR 2,1, 95% IC 1.2 -3.5). The presence of depressive symptomatology (OR 4.2, 95% IC 1.9-9.2) and cognitive deterioration (OR 2.9, 95% IC 1.6 -5.3) are equally predictive of this condition. On the other hand, maintaining social relations (OR 0.3, 95% IC 0.1-0.5) and a good health self-perception are protective of the condition of frailty (OR 0.4, 95% IC 0.1-0.9). Conclusions: Frailty can be predicted through a set of psychosocial and geriatric factors. Protective indicators such as social relations and subjective health act as protective factors of frailty. Key- words: Ageing, Phenotypic frailty, Predictor factors, Protector indicators.

Differential responses of two related neurosteroids to methylphenidate based on ADHD subtype and the presence of depressive symptomatology

Attention deficit with hyperactivity disorder is a neurodevelopmental disorder associated with alterations in the prefrontal cortex via dopaminergic and noradrenergic neurotransmission. Neurosteroids (e.g. allopregnanolone and dehydroepiandrosterone) modulate the release of multiple neurotransmitters. This study aims to determine the baseline concentrations and daily variations in allopregnanolone and dehydroepiandrosterone in children with attention deficit hyperactivity disorder (ADHD) and to determine the effect of chronic administration of methylphenidate on clinical symptoms and on the concentrations of these two neurosteroids. We included 148 children aged 5 to 14 years, subdivided into two groups: ADHD group (n = 107, with a diagnosis of ADHD (DSM-IV-TR criteria), further classified in subtypes by an "attention deficit and hyperactivity scale" and subgroups by the "Children's Depression Inventory") and a control group (n = 41). The clinical workup included blood samples that were drawn at 20:00 and 09:00 hours, at inclusion in both groups, and after 4.61 ± 2.29 months of treatment only in the ADHD group, for measurements for allopregnanolone and dehydroepiandrosterone. Factorial analysis, adjusted for age and gender, was performed by using Stata 12.0. Methylphenidate induced the doubling of allopregnanolone levels in the predominantly inattentive ADHD patients without depressive symptoms (27.26 ± 12.90 vs. 12.67 ± 6.22 ng/ml, morning values). Although without statistical differences, baseline dehydroepiandrosterone levels were higher and slightly increased after methylphenidate in the ADHD subtype with depressive symptoms (7.74 ± 11.46 vs. 6.18 ± 5.99 ng/ml, in the morning), opposite to the lower baseline levels, and further decrease after methylphenidate in the inattentive subtype with depressive symptoms. Different neurosteroids may have different baseline concentrations and differential responses to methylphenidate treatment as a function of ADHD subtype and subgroup. These differential responses may be a clinical marker of ADHD subtype and/or co-morbidities.

Anxious and depressive components of Edinburgh Postnatal Depression Scale in maternal postpartum psychological problems1)

The Edinburgh Postnatal Depression Scale (EPDS) is a widely used instrument for screening for postpartum depression, but it might also detect anxiety symptoms. To investigate the factor structure of the EPDS administered immediately after delivery and to understand which factors predict a high EPDS score 3 months later. A cohort of 594 Italian mothers delivering a healthy baby at Versilia Hospital completed the EPDS at two points in time: 2 days after delivery (T0) and 3 months later (T1) by telephone interview. EPDS scores were higher at T0 than at T1. Overall, 15.7% of women at 2 days postpartum and 7.6% at 3 months later reported a score >9. The factor analysis of EPDS at T0 indicated a three-factor structure: "depression" (items 7-10), "anxiety" (items 3-6) and "anhedonia" (items 1-2). Anxious symptoms were quantitatively more important than depressive ones (mean 3.9 vs. 1.2) but tended to spontaneously ameliorate at T1, whereas total EPDS score at T1 was better predicted by depressive symptoms at T0 (discriminative ability 0.75 vs. 0.68). This study suggests that EPDS subscales immediately after delivery help understand the spectrum of maternal postpartum psychological problems. Anxious symptoms immediately after delivery are frequent but transient, linked probably to maternity blues or atypical depression, whereas the presence of depressive symptomatology at T0 suggests higher risk of later depressive disorders.

Readiness to use compensatory strategies among older adults with functional difficulties

Compensatory strategies (behavioral/environmental modifications) can reduce the difficulties of performing daily living activities, fear of falling, and mortality risk. However, individuals vary in their readiness to use strategies. We examined characteristics associated with readiness to use compensatory strategies, the extent to which level of readiness changed from participation in an intervention (Advancing Better Living for Elders (ABLE)) providing compensatory strategies, and factors predictive of change in readiness level. Data from a randomized trial were used. Participants were 148 older adults assigned to the ABLE intervention designed to enhance daily function through compensatory strategy use. Baseline measures included demographic characteristics, functional difficulty level, presence/absence of depressive symptoms, compensatory strategy use, and social support. At initial (2 weeks from baseline) and final (6 months) ABLE sessions, interventionists rated readiness (1 = precontemplation; 2 = contemplation; 3 = preparation; 4 = action/maintenance) of participants to use strategies. Ordinal logistic regression was used to identify baseline characteristics associated with initial readiness rating. A McNemar-Bowker test of symmetry was used to describe change in readiness, and binary logistic regression was used to identify baseline predictors of change in readiness (from initial to final intervention session). At the initial intervention session, 70.3% (N = 104) scored in pre-action (precontemplation/contemplation, preparation), and 29.7% (N = 44) in action/maintenance. Depressive symptomatology (χ2(2) = 9.08, p = 0.011) and low compensatory strategy use (F(2, 147) = 8.44, p = 0.001) at baseline were associated with lower readiness levels at initial ABLE session. By final ABLE session, most participants demonstrated greater readiness: 72% (N = 105) in action/maintenance, 28% (N = 41) in pre-action (two participants dropped out). A significant baseline predictor of positive change in readiness (from initial to final session) was higher social support levels (b = 0.10, SE = 0.05, Wald = 4.98, p = 0.026). Whereas presence of depressive symptomatology and lower use of compensatory strategies at baseline were associated with lower readiness at initial intervention session, neither predicted change in readiness level. Thus, mood and prior compensatory strategy use do not effect enhancements in readiness to use strategies provided in an intervention. Baseline social support was the strongest predictor of change in readiness suggesting that interventions may need to involve older adults' social networks to enhance acceptability of compensatory strategy use.

Riskli Gebelerde Depresyon ve Yaşam Kalitesini Değerlendiren Bir Vaka-Kontrol Çalışması

Objective: To assess quality of life (QoL), presence of depressive symptomatology and their relationship in normal and high-risk pregnant women. Material and Methods: Two hundred ninety seven pregnant women were screened using brief version of the World Health Organization Quality of Life in Turkish (WHOQOL-BREF TR) and Beck Depression Inventory (BDI). Results: BDI level was found as 17 and over among 34.3% (n= 102) of all women who took part in our study and 42.6% (n= 49) among high-risk pregnants. The incidence of high-risk pregnancies among the pregnants who had 17 and over BDI score was found significantly higher than the ones who took 16 or lower (p= 0.017). High-risk pregnancies were 3-4 times higher among the pregnants whose husbands had education levels of primary, middle and high school than the level of university [orderly OR, %95 CI; 3.222 (1.546-6.714), 4.474 (1.840-10.879), 3.060 (1.430-6.549)]; 1.7-2.8 times higher among the pregnants whose husbands were workers, unemployed and self-employed than the ones whose husbands were official [orderly OR, %95 CI; 2.804 (1.382-5.689), 1.679 (0.434-6.495), 1.853 (0.955-3.598)]; 1.8 times higher among the pregnants who had 17 and over BDI score than the ones who had 16 and under BDI scores [OR= 1.807, %95 CI; (1.108-2.946)]. High-risk pregnancies among the unemployed pregnant women were 3.1 times higher than the employed [OR 95% CI; 3.167 (1.345-7.460)]. QoL scores in the domains of physical health (p< 0.001), psychological health (p= 0.036), social relationships (p< 0.001) and overall health (p< 0.001) were significantly lower among high-risk pregnants than normal ones. Conclusions: In this study a substantial number of pregnant women, especially high-risk ones had depression symptoms, and high-risk pregnancies decreased the quality of life. High-risk pregnant women may need more physical and psychological support.

Development and Evaluation of the Women's Sexual Interest Diagnostic Interview (WSID): A Structured Interview to Diagnose Hypoactive Sexual Desire Disorder (HSDD) in Standardized Patients

Female sexual dysfunction (FSD) is a common disorder in postmenopausal women. Currently, there is no clear "gold standard" for the diagnosis of FSD. The aim of this study was to evaluate the interrater reliability of the Women's Sexual Interest Diagnostic Interview (WSID), a new structured clinical interview designed to diagnose hypoactive sexual desire disorder (HSDD). The reliability of additional interview questions focused on the diagnosis of other types of FSD was also evaluated. The main outcome measure was the level of agreement in the diagnosis of FSD among clinical experts, between clinical experts and study coordinators, and between clinical experts and patients' self-reported interactive voice response system (IVRS) version of the WSID. Two versions of WSID were developed based on current diagnostic criteria: a clinician-administered version using a structured interview guide, and a patient self-report version using an IVRS. Three sexual medicine experts developed 20 clinical scenarios portraying cases and noncases of HSDD and other FSD diagnostic subtypes. Ten actresses with experience in standardized patient interviewing rehearsed these scenarios and performed the scripted patient roles in a standardized clinical interview with clinical experts (not the author of the script) and study coordinators, on a one-on-one basis, using the WSID interview format. In addition, all actresses completed the IVRS version of the WSID. Interviews were videotaped and viewed by the expert panel. In each instance, the diagnosis that the interview was scripted to portray was considered as the "gold standard." Kappa (kappa) coefficients were utilized to assess the level of agreement among experts, between study coordinators and the "gold standard", and between the IVRS version of the WSID and the "gold standard". All experts agreed with the gold standard diagnosis provided by the author of the script (kappa=1.0). Similarly, there was perfect agreement among the experts on the presence of depressive symptomatology (kappa=1.0). On the related diagnoses of arousal disorder, orgasmic disorder, and sexual pain disorder, kappas of 0.894, 0.966, and 0.946 were observed (P<0.0001 for all comparisons). When study coordinator's WSID diagnoses were compared with the "gold standard," kappa for HSDD was 0.851; sensitivity was 0.864, and specificity and positive predictive value (PPV) were 1.00 (P<0.001 for all comparisons). When diagnoses obtained via IVRS interviews were compared with the "gold standard", kappa for HSDD was 0.802, sensitivity was 0.818, and specificity and PPV were 1.00 (P<0.001 for all comparisons). Agreement as estimated by kappa coefficients was consistently high in both clinician-administered and patient self-reported IVRS versions in the diagnosis of HSDD.

Understanding the causes of depression among prostate cancer patients: development of the effects of prostate cancer on lifestyle questionnaire

Depression among prostate cancer patients remains a major source of distress for them and their families, has been linked with suicide, and has been shown to contribute to poorer longterm treatment outcomes. Most psychological assessment strategies focus upon the presence of depressive symptomatology without identifying the specific causal antecedents that lead to depression among this patient group, although this underlies effective individually-oriented treatment planning and delivery. 150 prostate cancer patients completed self reports on anxiety, depression and lifestyle changes that they had experienced as a result of receiving a diagnosis of, and treatment for their cancer. The principal instrument being investigated was a measure of 50 lifestyle changes that had been developed from previous interviews with prostate cancer patients. Data indicated significant relationships between depression scores and the frequency of unpleasant lifestyle changes and the ratings that participants gave to these changes, supporting a model of depression as an adaptive withdrawal from noxious stimuli and environments. Psychometric data provided a method of deleting several items so that a clinical analysis and a research scale of 36 items was developed for use with prostate cancer patients. Implications for treatment are discussed in terms of accurate identification of antecedents that lead to a further understanding of depression as an 'adaptive' response of active withdrawal from noxious environments.

Depression and Cocaine Dependence

Presence of depression in cocaine-dependent users is relevant for treatment of these persons. This study assessed the presence of depressive symptomatology with a published Spanish translation of the Beck Depression Inventory for a sample of 115 Spanish cocaine-dependent users who were in outpatient treatment at Centers of Drug Dependence of Galicia, Spain. The mean score was 13.7 (SD = 10.3), with 24.3% of the sample having scores which indicate clinical depression (cut off > or =21). These data underscore the need to assess the presence of depression in cocaine-dependent users who require treatment.

Epidemiology, Diagnosis and Management of Mixed Mania

The presence of depressive symptomatology during acute mania has been termed mixed mania, dysphoric mania, depressive mania or mixed bipolar disorder. Highly prevalent, mixed mania occurs in at least 30% of bipolar patients. Correct diagnosis is a major challenge. The DSM diagnostic criteria, the most widely adopted clinical convention, require a complete manic and complete depressive syndrome co-occurring for at least 1 week. However, recent alternative categorical and dimensional studies of manic phenomenology have shown that there are certain depressive symptoms or constellations that have special clinical importance when describing mixed states, such as depressed mood and anxiety symptomatology that do not overlap with manic symptoms. Patients with mixed mania are over-represented in the subgroup with severe and treatment-resistant symptoms. The course and prognosis of mixed mania are worse than that of pure manic forms in the medium and long term, with higher recurrence rates, higher frequency of co-morbid substance abuse and greater risk of suicidal ideation and attempts. Moreover, mixed manic episodes are usually associated with increased depression during follow-up, greater risk of rapid cycling course and higher prevalence of physical co-morbidities, principally related to thyroid function. All these factors are very relevant to selection of treatment. There are three crucial steps in the treatment of mixed mania--making the correct diagnosis, starting treatment early, and considering not only the acute state but also maintenance treatment and the patient's long-term outcome. Although challenging, acute mixed episodes are treatable. To date there have been no controlled studies devoted exclusively to treatment of mixed mania, and the only controlled data available therefore derive from sub-analyses of randomised clinical trials. Both short-term and maintenance treatments of patients with mixed mania require experience and usually involve the combination of different treatments. As a general rule, there is some consensus about discontinuing antidepressants during mixed mania. Olanzapine, aripiprazole or valproate semisodium (divalproex sodium) are first-line drugs for mild episodes; severe episodes of mixed mania usually require treatment with a combination of valproate semisodium or lithium plus an antipsychotic, preferably an atypical agent. Carbamazepine is also useful for the treatment of mixed mania. High-dose medications are sometimes needed to control the episode, and time to remission is usually longer than in pure mania. Importantly, patients with mixed manic episodes have more adverse events of psychopharmacological treatment. In some cases, electroconvulsive therapy is required.

The role of pain coping strategies in prognosis after whiplash injury: Passive coping predicts slowed recovery

Pain coping strategies are associated with pain severity, psychological distress and physical functioning in populations with persistent pain. However, there is little evidence regarding the relationship between coping styles and recovery from recent musculoskeletal injuries. We performed a large, population-based prospective cohort study of traffic injuries to assess the relationship between pain coping strategies and recovery from whiplash injuries. Subjects were initially assessed within 6 weeks of the injury, with structured telephone interview follow-up at 6 weeks, and 3, 6, 9 and 12 months post-injury. Coping was measured at 6 weeks using the Pain Management Inventory and recovery was assessed at each subsequent follow-up period, using a global self-report question. Multivariable Cox proportional hazards models showed that early use of passive coping strategies was independently associated with slower recovery. Depressive symptomatology (CES-D) was an effect modifier of this relationship. Without depressive symptomatology, those using high levels of passive coping recovered 37% slower than those using low levels of passive coping (HRR = 0.63; 95% CI 0.44–0.91). However, in the presence of depressive symptomatology, those using high levels of passive coping recovered 75% more slowly than those who coped less passively (HRR = 0.25; 95% CI 0.17–0.39). In other words, those with depressive symptoms but who used few passive coping strategies recovered four times more quickly than those with depressive symptoms who used high levels of passive coping. Active coping showed no independent association with recovery. These findings highlight the importance of early assessment of both coping behaviors and depressive symptomatology.