Depressive Symptom Profiles Research Articles

S13. DO PATIENTS WITH RECENT-ONSET DEPRESSION DIFFER CLINICALLY AND NEUROBIOLOGICALLY FROM DEPRESSED PATIENTS WITH A CLINICAL HIGH-RISK STATE FOR PSYCHOSIS?

BackgroundMajor depressive disorder (MDD) is one of the most common mental disorders, with a lifetime prevalence of 14.6%. The impact of depression is considerable; poor social and economic functioning and significant life limitations [1]. Depression is also the most common co-morbidity seen with other mental disorders. The prevalence of depressive disorder in schizophrenia has been reported to be around 40% [2]. When examining very early phases of illness, in groups identified as at clinical high risk (CHR) for psychosis, high rates of ‘co-morbid’ axis one diagnoses are reported, with over 50% reaching criteria for a depressive disorder. Those people with schizophrenia send depression are significantly more likely to relapse, to be a safety concern (be arrested, victimized or suicidal), have greater substance-related problems and poorer recovery [2]. In addition, depression has been linked to increased risk of transition from CHR to FEP, suggesting that in this group depression also indicates a poorer outcome [3]. Currently, the diagnosis of depression is based on the phenomenological evaluation of symptoms and behavior. However, there remains significant debate around the heterogeneity of depressive symptoms and their function as prognostic indicators [4]. Neuroimaging holds “diagnostic potential” for depression [5]. However, studies show that brain alterations are often small and reliability is difficult, and there has been no neuroimaging investigation of depression as a co-morbid diagnosis. We aim to further understand the symptom profile of depression in emerging mental disorders, including in the clinical high risk group (CHR) and recent onset psychosis (ROP) as compared to those with recent onset depression (ROD). This has important implications for the accurate identification of a potentially malleable target for treatment, and indeed development of novel therapeutic options. We also aim to explore the ability of brain imagining (structural MRI) to add accuracy to the classification prediction modelsMethodsData from the PRONIA study, an EUFP7 funded 8 center study recruiting ROD, CHR and ROP participants will be presented. Analysis will include demographic information and BDI-II (Beck Depression Inventory), CAARMS (Comprehensive Assessment of the At Risk Mental State), SANS (Scale for the assessment of negative symptoms) total score PANSS (Positive and negative Symptom Score) and SPI-A together with structural MRI imaging. We will report descriptive detail from the PRONIA discovery sample (n716), machine learning classification with Neurominer® and VBM analysis of sMRI scans across groups.ResultsData from BDI-II symptom endorsement suggests a ‘classical depression phenotype’ corresponding to Becks ‘cognitive triad’; “life is pointless, future hopeless, self as worthless” may separate depression in ROD from ROP, with other symptoms potentially able to separate ROP from ROD. In classification, a 65% sensitivity and specificity are found. Data will also be presented on the CHR group and their alignment, together with VBM analysis for structural MRI examining correlates with highly weighted classifying symptoms in and across all three groups.DiscussionWhen given early in the course of illness, interventions have the greatest potential impact, and characterization and accurate diagnosis of depression in emerging mental disorders is an important goal. This study suggests it may be possible to accurately identify depression in different diagnostic categories, including major depressive disorder, psychosis and clinical high risk, and that neuroimaging holds potential to add to diagnostic accuracy in complex co-morbid disorders.

Effect of prenatal mindfulness training on depressive symptom severity through 18-months postpartum: A latent profile analysis.

We examined whether prenatal mindfulness training was associated with lower depressive symptoms through 18-months postpartum compared to treatment as usual (TAU). A controlled, quasi-experimental trial compared prenatal mindfulness training (MMT) to TAU. We collected depressive symptom data at post-intervention, 6-, and 18-months postpartum. Latent profile analysis identified depressive symptom profiles, and multinomial logistic regression examined whether treatment condition predicted profile. Three depressive symptom severity profiles emerged: none/minimal, mild, and moderate. Adjusting for relevant covariates, MMT participants were less likely than TAU participants to be in the moderate profile than the none/minimal profile (OR = 0.13, 95% CI = 0.03-0.54, p = .005). Prenatal mindfulness training may have benefits for depressive symptoms during the transition to parenthood.

A longitudinal study of women's depression symptom profiles during and after the postpartum phase.

An issue of critical importance for psychiatry and women's health is whether postpartum depression (PPD) represents a unique condition. The Diagnostic and Statistical Manual of Mental Disorders asserts that major depressive disorder (MDD) may present with peripartum onset, without suggesting any other differences between MDD and PPD. The absence of any distinct features calls into question the nosologic validity of PPD as a diagnostic category. The present study investigates whether symptom profiles differ between PPD and depression occurring outside the postpartum phase. In a prospective, longitudinal study of parturient women (N=239), we examine the manifestation of depression symptoms. We assess factor structure of symptom profiles, and whether factors are differentially pronounced during and after the postpartum period. Factors were revealed representing: Worry, Emotional/Circadian/Energetic Dysregulation, Somatic/Cognitive, Appetite, Distress Display, and Anger symptoms. The factor structure was validated at postpartum and after-postpartum timepoints. Interestingly, the Worry factor, comprising anxiety and guilt, was significantly more pronounced during the postpartum timepoint, and the Emotional/Circadian/Energetic Dysregulation factor, which contained sadness and anhedonia, was significantly less pronounced during the postpartum period. These results suggest that PPD may be a unique syndrome, necessitating research, diagnosis, and treatment strategies distinct from those for MDD. Results indicate the possibility that Worry is an enhanced feature of PPD compared to depression outside the postpartum period, and the crucial role of sadness/anhedonia in MDD diagnosis may be less applicable to PPD diagnosis.

Clinical features of depression in the elderly and younger patients at tertiary care center of Saurashtra, India - A comparative study

Background: Depression in the elderly has serious consequences such as poor quality of life, dependency, increases comorbidity, and premature death. Symptom profile of depression in the elderly was not extensively researched in India. Objectives: The objective of the study is to compare clinical features of depression between elderly and younger groups and its relation to various sociodemographic variables between two groups. Materials and Methods: A cross-sectional, observational, comparative study carried out at tertiary care center of Jamnagar. Forty patients with depression for each elderly and younger groups were selected using simple convenient sampling from the outpatient department and inpatient department of the Department of Psychiatry, M. P. Shah Government Medical College and Guru Gobind Singh Hospital, Jamnagar. Depression was diagnosed using diagnostic and statistical manual of mental disorder-5 diagnostic criteria for major depressive disorder. HAM-D-17 was used for assessment and comparison of clinical features of depression between two groups. Mini–Mental State Examination used to rule out dementia in elderly patients. Descriptive statistics, t-test, Chi-square test, and binary logistic regression were used for statistical analysis. Results: Symptom profile of depression is somewhat different in the elderly compare to younger patients. Elderly patients with depression compared to young scored significantly less for depressed mood (odds ratio [OR]: 0.98, P = 0.001) and genital symptoms (OR: 0.20, P = 0.038) but significantly higher for somatic symptoms - gastrointestinal (OR: 5.18, P = 0.049) and somatic symptoms - general (OR: 7.06, P = 0.023) and insomnia - delayed (OR: 4.15, P = 0.042). Conclusions: Clinical features of depression are different in the elderly as depressed mood is often masked. Somatic symptoms and insomnia are often reported by elderly depressed patients than younger patients.

Indian Association for Geriatric Mental Health's multicentric study on depression in elderly: Symptom profile and influence of gender, age of onset, age at presentation, and number of episodes on symptom profile

Aim of the Study: To assess the symptom profile of depression among elderly patients presenting to psychiatric outpatient settings. An additional aim was to evaluate the influence of gender, age of onset, age at presentation, and type of episode (i.e., the first episode versus recurrent depressive episodes) on symptom profile of geriatric depression. Materials and Methods: This multicentric study was conducted at eight centers in which 488 elderly patients (aged ≥60 years) with depression were evaluated on Geriatric Depression Scale (GDS-30), Generalized Anxiety Disorder-7 Scale (GAD-7), Patient Health Questionnaire-15 (PHQ-15) scale, and Columbia Suicide Severity Rating Scale. Results: Males had significantly higher prevalence of comorbid substance dependence, whereas females had significantly higher prevalence of comorbid psychiatric disorders. As per the GDS-30, about two-third or more of the study sample had symptoms of feeling helpless (71.7%), often getting restless and fidgety (70.1%), dropped many of their activities (68.4%), frequently feel like crying (67.4%), trouble concentrating (67%), feels pretty worthless (66.4%), often feeling downhearted and blue (65.8%), frequently getting upset over little things (64.8%), and not satisfied with life (62.9%). More than two-third of the sample had all the symptoms of anxiety as per the GAD-7 and 7 out of the 14 somatic symptoms as per the PHQ-15. When comparisons were made between males and females, significant difference in prevalence was noted for some of the depressive symptoms as assessed by the GDS-30 and somatic symptoms as assessed by the PHQ-15, but no differences emerged in terms of anxiety symptoms. Significantly higher proportion of females reported active suicidal ideation with specific plan and intent and had higher intensity of suicidal ideations. Differences in symptom profile were also noted with regard to age of onset (

Depressive symptoms in Friedreich ataxia

Background/Objective: Almost no attention has been paid to depression in Friedreich ataxia (FRDA), a highly disabling cerebellar degenerative disease. Our aim was to study the presence and the profile of depressive symptoms in FRDA and their relationship with demographic-disease variables and cognitive processing speed. Method: The study groups consisted of 57 patients with a diagnosis of FRDA. The Beck Depression Inventory-II was used to assess symptoms of depression. Speed of information processing was measured with a Choice Reaction time task. Results: The mean BDI score for patients was significantly higher than the mean score in the general population. Twenty one percent of participants scored in the moderate/severe range. A Cognitive-Affective score and a Somatic-Motivational score was calculated for each patient. Patients’ scores in both dimensions were significantly higher than the scores in the general population. Demographic and disease variables were not related with symptoms of depression, except for severity of ataxia. Depressive symptoms predict cognitive reaction times. The greater proportion of variance was explained by the Cognitive-Affective dimension. Conclusions: Our data show that both somatic-motivational and cognitive affective symptoms of depression are frequent in individuals with FRDA. In addition, depressive symptoms may influence cognition, especially, the cognitive and affective symptoms.

Evaluating the efficacy of an integrated motivational interviewing and multi-modal exercise intervention for youth with major depression: Healthy Body, Healthy Mind randomised controlled trial protocol.

BackgroundRecent meta-analytic reviews suggest exercise can reduce depression severity among adults with major depressive disorder (MDD); however, efficacy studies with depressed youth are limited. Few studies have investigated the efficacy of multi-modal exercise interventions in this population, addressed treatment engagement, or explored the differential effects of exercise on depressive symptom profiles.ObjectivesThis paper describes the study protocol and recruitment pattern for an assessor blinded, two-arm randomised controlled trial investigating the efficacy of an integrated motivational interviewing (MI) and multi-modal exercise intervention in youth diagnosed with MDD. Associations between depressive symptom profiles (cognitive, somatic and affective) and psychological, physiological (fitness), and biological (blood biomarker) outcomes will also be examined.MethodsParticipants aged 15–25 years with current MDD were recruited. Eligible participants were randomised and stratified according to gender and depression severity to either an immediate or delayed (control) group. The immediate group received a brief MI intervention followed by a 12-week small group exercise intervention (3 times per week for 1 h), all delivered by personal trainers. The delayed control group received the same intervention 12-weeks later. Both groups were reassessed at mid-treatment or mid-control, post-treatment or post-control, and follow-up (12 weeks post-treatment).Results68 participants were recruited and randomly allocated to an intervention group.ConclusionThis trial will increase our understanding of the efficacy of multi-modal exercise interventions for depression and the specific effects of exercise on depressive symptom profiles. It also offers a novel contribution by addressing treatment engagement in exercise efficacy trials in youth with MDD.

Eating styles in major depressive disorder: Results from a large-scale study

Depressed persons have been found to present disturbances in eating styles, but it is unclear whether eating styles are different in subgroups of depressed patients. We studied the association between depressive disorder, severity, course and specific depressive symptom profiles and unhealthy eating styles. Cross-sectional and course data from 1060 remitted depressed patients, 309 currently depressed patients and 381 healthy controls from the Netherlands Study of Depression and Anxiety were used. Depressive disorders (DSM-IV based psychiatric interview) and self-reported depressive symptoms (Inventory of Depressive Symptomatology) were related to emotional, external and restrained eating (Dutch Eating Behavior Questionnaire) using analyses of covariance and linear regression. Remitted and current depressive disorders were significantly associated with higher emotional eating (Cohen's d = 0.40 and 0.60 respectively, p < 0.001) and higher external eating (Cohen's d = 0.20, p = 0.001 and Cohen's d = 0.32, p < 0.001 respectively). Little differences in eating styles between depression course groups were observed. Associations followed a dose-response association, with more emotional and external eating when depression was more severe (both p-values <0.001). Longer symptom duration was also associated to more emotional and external eating (p < 0.001 and p = 0.001 respectively). When examining individual depressive symptoms, neuro-vegetative depressive symptoms contributed relatively more to emotional and external eating, while mood and anxious symptoms contributed relatively less to emotional and external eating. No depression associations were found with restrained eating. Intervention programs for depression should examine whether treating disordered eating specifically in those with neuro-vegetative, atypical depressive symptoms may help prevent or minimize adverse health consequences.

Does the presence of multiple sclerosis impact on symptom profile in depressed patients?

ObjectiveMajor depressive disorder (MDD) is common in patients with multiple sclerosis (MS) but may remain unrecognized because of overlapping symptoms and different presentation due to its specific MS-related neurobiological aetiology. We aimed to investigate the clinical profile of MDD in MS. MethodsIn a sample of MDD patients with MS (n=83) and without MS (n=782), MDD characteristics, 30 depressive symptoms, and sum scores of cognitive, somatic, atypical and melancholic symptom clusters were compared using logistic regression analyses and analysis of co-variance. ResultsMDD in MS was characterized by older age of onset (p<0.001), and fewer comorbid anxiety disorders (37% versus 72%; p<0.001). The symptom ‘future pessimism’ was more common in MS patients (OR=1.62; 95%CI=1.02–2.59). ‘Diminished capacity for pleasure/enjoyment’ (OR=0.44; 95%CI=0.24–0.78), ‘increased appetite’ (OR=0.40; 95%CI=0.19–0.85), ‘arousal symptoms’ (OR=0.49; 95%CI=0.28–0.84), and ‘panic/phobic symptoms’ (OR=0.49; 95%CI=0.29–0.84) were less common in MS patients. Twenty-five symptoms (83%) out of 30, including depression's core symptoms (sadness and loss of interest) were not differentially associated with MS and no differences existed for the symptom clusters. ConclusionOnly subtle differences in depressive symptom profiles existed between MDD patients with and without MS. The clinical profile of depression remains valid among MS patients, although it presents with diminished anxiety distress and comorbidity.

Child Maltreatment, Delinquent Behavior, and School Factors as Predictors of Depressive Symptoms from Adolescence to Adulthood: A Growth Mixture Model

Previous methodological approaches have not been flexible enough to model the heterogeneity of depressive symptoms or to identify variations between prototypical trajectories conditional on risk and protective factors. The current study examined latent class trajectories of depressive symptoms using data from 3,819 respondents of the Adolescent Health Survey. Four trajectory profiles of depressive symptoms were identified: low-stable, high-decreasing, low-increasing, and moderate-decreasing. A broad array of risk factors were included into the modeling procedure to identify predictors of group membership. Relative to the low-stable group, membership in one of the three symptomatic groups (i.e., heightened depressive symptoms) was predicted by poverty, low self-esteem, gender, drinking frequency, poor academic outcomes, delinquency, and child maltreatment type. This study contributes to our understanding about the longitudinal manifestations of depression and identifies a broad array of factors significantly related to pathways of resilience.

Prevalence and clinical characteristics of major depressive disorder (MDD) without depressed mood in Koreans with MDD: results from the CRESCEND study

ABSTRACTObjective: We examined the prevalence and clinical characteristics of patients with major depressive disorder (MDD) without depressed mood, using data from the Clinical Research Center for Depression (CRESCEND) study in South Korea.Methods: Using analysis of covariance for continuous variables and binary logistic regression analysis for discrete variables, the clinical characteristics of MDD patients with and without depressed mood were compared after controlling for the potential effects of gender. To represent the extent of group differences, we computed Cohen’s d statistics.Results: Of 1009 MDD patients, only 2.2% were without depressed mood. Compared with those with depressed mood, these patients were characterized by a significantly lower rate of current suicidal ideation (adjust odds ratio = 5.258, p = .003; d = 0.193), fewer depressive symptom profiles (F = 8.731, p = .003; d = −0.543) and lower severity scores for overall depression (F = 16.027, p < .0001; d = −0.853), core depressive symp...

Physical Comorbidity and its Impact on Symptom Profile of Depression among Elderly Patients Attending Psychiatry Services of a Tertiary Care Hospital.

Aim:This study aimed to evaluate the prevalence of physical comorbidities among elderly patients with depression attending psychiatric services and the secondary aim of the study was to evaluate the influence of physical comorbidities on symptom profile of depression.Methodology:140 patients with a diagnosis of depression as per the International Classification of Diseases-10 criteria were evaluated on Geriatric Depression Scale (GDS) and a physical comorbidity checklist.Results:More than two-third (72.1%) of the patients had at least one physical illness. Out of those with physical comorbidity, more than half (57 out of 101) had at least 2 physical illnesses. The most commonly involved systems were cardiovascular system (n = 68; 48.6%), followed by endocrinological system (27.1%) and ophthalmological system (26.4%). Most common physical comorbidity was hypertension (47.14%), followed by cataract (25.7%) and diabetes mellitus (25%). The presence of any physical comorbidity, presence of hypertension or presence of diabetes mellitus did not influence the manifestations of depression as assessed by GDS-30.Conclusion:Elderly patients with depression have high rates of physical comorbidities. Clinicians managing elderly patients with depression must get their patient thoroughly evaluated for the presence of various physical comorbidities.

Depressive symptom profiles, cardio-metabolic risk and inflammation: Results from the MIDUS study

BackgroundThis study aimed to (1) provide a comprehensive characterization of depressive symptoms profiles, and (2) examine the cross-sectional association between depressive symptom profiles and cardio-metabolic outcomes, including metabolic syndrome and obesity, while controlling for sociodemographic variables, health behaviors and inflammation. MethodsOur sample was comprised of 1085 participants (55.80% female) enrolled in the MIDUS-II biomarker study. Latent profile analysis (LPA) was used to derive depressive symptom profiles using subscales of the Mood and Anxiety Symptom Questionnaire (MASQ) and the Center for Epidemiologic Studies Depression Scale (CES-D) subscales as well as Pittsburgh Sleep Quality Index (PSQI) global score. Metabolic syndrome was defined according to the Interim Joint Statement definition. CRP was used as a marker of inflammation. ResultsFour depressive symptom profiles were identified. The “No Symptoms” subgroup (60.65% of the sample) had the lowest overall scores across subscales. The “Mild Symptoms” subgroup (26.73%) was characterized by lower scores across indicators, with subscales measuring somatic symptoms being the highest within group. The “Moderate Symptoms” subgroup (10.32%) had higher scores across subscales (1 SD above the mean), with subscales measuring negative affect/loss of interest being the highest within group. Finally, the “Acute symptoms” subgroup (2.30%) was characterized by the highest overall scores (1.5–3 SD above the mean) on all indicators. After controlling for sociodemographic characteristics and health behaviors, the “Moderate Symptoms” subgroup was significantly associated with metabolic syndrome (OR=1.595, p=0.035) and obesity (OR=1.555, p=0.046). Further, there was a trend between the “Mild Symptoms” subgroup and the presence of obesity (OR=1.345, p=0.050). Inflammation attenuated these associations. ConclusionsFour depressive symptom profiles were identified among healthy mid-life individuals in the US. These profiles are differentially associated with cardio-metabolic outcomes. Future work should examine whether distinct symptom profiles may reflect differential pathways to increased risk, and whether tailored management of symptoms is needed.

985. Association between Depressive Symptom Profiles and Stress Reactivity in Adolescents

985. Association between Depressive Symptom Profiles and Stress Reactivity in Adolescents

Heterogeneous Trajectories of Depressive Symptoms in Late Middle Age: Critical Period, Accumulation, and Social Mobility Life Course Perspectives.

This study investigated patterns of depressive symptoms and whether socioeconomic status (SES) across the life course affects these trajectories using the critical period, accumulation, and social mobility models. This study uses data from 8,532 adults, age 51 to 64, collected over 12 years from the Health and Retirement Study (observations = 25,887). A latent class analysis was performed to examine distinct depressive symptom trajectories; life course models were studied with multinomial logistic regression. Four heterogeneous latent classes were identified for depression: Declining, Low, Increasing, and High and Increasing. The High and Increasing group was associated with a disadvantaged childhood SES, accumulated exposure to socioeconomic risks, and persistent SES disadvantage supporting the three life course models. There was evidence of distinct profiles of depressive symptoms in late middle age and of interrelated life course mechanisms underlying the influences of childhood SES on later life depression.

Symptom profile of depression in elderly: Is assessment with geriatric depression rating scale enough?

Aim of the Study: This study aimed to evaluate the symptom profile, including somatic symptoms among elderly patients with first episode depression using the Geriatric depression scale (GDS-30) and Patient Health Questionnaire-15 (PHQ-15) items version scale. Additional aims were to carry out the factor analysis of symptoms reported on GDS-30 and PHQ-15 among elderly. Methodology: Seventy-nine elderly patients (age ≥60 years) were evaluated on GDS-30 item Hindi version and Hindi version of the PHQ-15. Results: As per GDS-30, the most common symptom noted among elderly was “dropped many of your activities and interests” (91.1%), mind not as clear as it used (88.6%), feeling that life is empty (86.1%), bothered by thoughts you cannot get out of your head (86.1%) and hard to get started on new projects (86.1%), prefer to avoid social gatherings (86.1%). All patients reported at least one somatic complaint as per PHQ-15. The most common somatic symptoms were trouble sleeping (97.5%), feeling tired or having little energy (96.2%), feeling that the heart is racing (52.9%), constipation, loose bowels, or diarrhea (49.6%), shortness of breath (46.8%), nausea, gas or indigestion (45.6%), pain in the arms, legs, or joints (43.3%), and back pain (41.8%). The prevalence of somatic symptoms was not influenced to a large extent by the demographic variables, clinical variables and presence or absence of physical comorbidity. However, the severity of somatic symptoms correlated positively with GDS-30 score. Factor analysis of Hindi version of GDS-30 yielded a four-factor solution, which was similar to many studies across the world. The addition of items of PHQ-15 items of factor analysis still yielded a four-factor solution. Factor 1 of combined GDS-30 and PHQ-15 items included items only from GDS-30 and Factor 3 and 4 included items only from PHQ-15. There was some overlap of items on Factor 2. Conclusion: The present study suggests that GDS-30 does not tap all the symptoms of depression among elderly in the Indian context. Further, the present study shows that GDS-30 is not a one-dimensional scale. Accordingly, the symptom evaluation among elderly depressed patient should go beyond GDS-30.

Screening for Depressive Disorder in Elderly Patients with Chronic Physical Diseases Using the Patient Health Questionnaire-9.

ObjectiveWe aimed to identify depressive symptom profiles that indicated the presence of depressive disorder and present optimal cut-off sub-scores for depressive symptom profiles for detecting depressive disorder in elderly subjects with chronic physical diseases including diabetes, chronic obstructive pulmonary disease/asthma, and coronary artery disease, using the Patient Health Questionnaire-9 (PHQ-9).MethodsTwo hundred and thirty-one elderly patients with chronic physical diseases were recruited consecutively from a university-affiliated general hospital in South Korea.ResultsGreater severities of all 9 depressive symptoms in the PHQ-9 were presented in those with depressive disorder rather than those without depressive disorder. A binary logistic regression modeling presented that little interest [adjusted odds ratio (aOR)=4.648, p<0.001], reduced/increased sleep (aOR=3.269, p<0.001), psychomotor retardation/agitation (aOR=2.243, p=0.004), and concentration problem (aOR=16.116, p<0.001) were independently associated with increased likelihood of having depressive disorder. Receiver operating characteristics (ROC) curve analysis presented that the optimal cut-off value of score on the items for little interest, reduced/increased sleep, psychomotor retardation/agitation and concentration problem (PHQ-9) for detecting depressive disorder was 4 with 61.9% of sensitivity and 91.5% of specificity [area under curve (AUC)=0.937, p<0.001].ConclusionOur findings suggested that the diagnostic weighting of little interest, reduced/increased sleep, psychomotor retardation/agitation, and concentration problem is needed to detect depressive disorder among the elderly patients with chronic physical diseases.

Clinical Characteristics and Psychotropic Prescribing Patterns Associated with impaired Concentration in Asians with Depressive Disorders: The REAP-AD Study.

The Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) study aimed to survey and review antidepressant prescribing patterns in different clinical settings in Asian countries/areas. The REAP-AD study collected comprehensive data for psychiatric patients prescribed antidepressants in 10 Asian countries/areas during the period from March to June 2013. Depressive disorders have been an important issue closely associated with ill-health and disability in the realm of mental health. Impaired concentration was found to be a consistent symptom in depressive disorders regardless of clinical course, and a predictor of poor treatment outcome. In this work we aimed to identify clinical characteristics independently associated with impaired concentration in patients with depressive disorders, using data from the REAP-AD study. A total of 336 depressive disorder patients with impaired concentration and 786 depressive disorder patients without impaired concentration were recruited from 40 centers in 10 Asian countries/areas. A binary logistic regression model was fitted to identify the independent correlates of impaired concentration in patients with depressive disorders. After adjusting the effects of covariates, the binary logistic model showed that impaired concentration was independently associated with higher rates of loss of interest (P < 0.0001), fatigue (P < 0.0001), low self-confidence (P < 0.0001) and appetite disturbance (P < 0.0001) and with a lower rate of adjunctive antipsychotic prescription (P = 0.007). Our findings suggest that impaired concentration and its associated depressive symptom profiles constitute a unitary depressive symptom cluster that is also an intervening variable for poor social function.

The effects of gender and depression severity on the association between alpha asymmetry and depression across four brain regions

Data describing the association between EEG asymmetry and depression status have been equivocal. Effects from brain regions involved, depression severity, and the generalisability of findings across genders, have been inconsistently examined and/or verified. This study investigated these issues within a community sample to potentially expand the asymmetry hypothesis to non-severe depression participants. The singular effects of brain region and electrode site, gender, and depression severity, plus the interaction between gender and depression severity across brain regions were investigated in a study of alpha asymmetry among 46 males and 54 females (M age=32.5 yr, SD=14.13 yr) using the Self-rating Depression Scale (Zung, 1973). There was no significant difference across genders or age for depression severity. Dichotomous classification of depressed state produced similar but slightly different results from analysis of the whole range of depression status, although the frontal region was the only area where depression was consistently significantly associated with EEG asymmetry, and then only for females. However, the direction of those differences for females was opposite of that predicted by the EEG asymmetry-depression hypothesis. Several methodological issues that may have contributed to these findings are discussed, with suggestions made for future research that focusses upon individual depression symptom profiles rather than dichotomous or total depression scores in order to assist in developing a clinically-relevant model of EEG asymmetry in depressed persons.

How many different symptom combinations fulfil the diagnostic criteria for major depressive disorder? Results from the CRESCEND study

Background: The polythetic nature of major depressive disorder (MDD) in DSM- IV and DSM-5 inevitably leads to diagnostic heterogeneity.Aims: This study aimed to identify the number of depressive symptom combinations actually fulfilling the DSM-IV diagnostic criteria that can be found in Korean MDD patients and the relative frequencies of each combination.Methods: Using the data from the Clinical Research Center for Depression (CRESCEND) study in South Korea, we enrolled 853 MDD patients diagnosed using DSM-IV and scored as 8 or more on the Hamilton Depression Rating Scale (HAMD). Descriptive statistical analyses were performed to reveal the degree of diagnostic heterogeneity of the MDD.Results: This study identified 119 different depressive symptom combinations. The most common combination consisted of all nine depressive symptom profiles, and nine different combinations were each present in more than 3% of the patients.Conclusion: The findings support the criticism that the diagnosis of MDD is not based on a single mental process, but on a set of ‘family resemblances’.