Rates Of Major Depressive Disorder Research Articles

Cross-cultural examination of measurement invariance of the Beck Depression Inventory-II.

Given substantial rates of major depressive disorder among college and university students, as well as the growing cultural diversity on many campuses, establishing the cross-cultural validity of relevant assessment tools is important. In the current investigation, we examined the Beck Depression Inventory-Second Edition (BDI-II; Beck, Steer, & Brown, 1996) among Chinese-heritage (n = 933) and European-heritage (n = 933) undergraduates in North America. The investigation integrated 3 distinct lines of inquiry: (a) the literature on cultural variation in depressive symptom reporting between people of Chinese and Western heritage; (b) recent developments regarding the factor structure of the BDI-II; and (c) the application of advanced statistical techniques to the issue of cross-cultural measurement invariance. A bifactor model was found to represent the optimal factor structure of the BDI-II. Multigroup confirmatory factor analysis showed that the BDI-II had strong measurement invariance across both culture and gender. In group comparisons with latent and observed variables, Chinese-heritage students scored higher than European-heritage students on cognitive symptoms of depression. This finding deviates from the commonly held view that those of Chinese heritage somatize depression. These findings hold implications for the study and use of the BDI-II, highlight the value of advanced statistical techniques such as multigroup confirmatory factor analysis, and offer methodological lessons for cross-cultural psychopathology research more broadly.

Ovarian hormone fluctuation, neurosteroids, and HPA axis dysregulation in perimenopausal depression: a novel heuristic model.

In this conceptual review, the authors propose a novel mechanistic candidate in the etiology of depression with onset in the menopause transition ("perimenopausal depression") involving alterations in stress-responsive pathways, induced by ovarian hormone fluctuation. The relevant literature in perimenopausal depression, including prevalence, predictors, and treatment with estrogen therapy, was reviewed. Subsequently, the growing evidence from animal models and clinical research in other reproductive mood disorders was synthesized to describe a heuristic model of perimenopausal depression development. The rate of major depressive disorder and clinically meaningful elevations in depressive symptoms increases two- to threefold during the menopause transition. While the mechanisms by which ovarian hormone fluctuation might impact mood are poorly understood, growing evidence from basic and clinical research suggests that fluctuations in ovarian hormones and derived neurosteroids result in alterations in regulation of the HPA axis by γ-aminobutyric acid (GABA). The authors' heuristic model suggests that for some women, failure of the GABAA receptor to regulate overall GABA-ergic tone in the face of shifting levels of these neurosteroids may induce HPA axis dysfunction, thereby increasing sensitivity to stress and generating greater vulnerability to depression. The proposed model provides a basis for understanding the mechanisms by which the changing hormonal environment of the menopause transition may interact with the psychosocial environment of midlife to contribute to perimenopausal depression risk. Future research investigating this model may inform the development of novel pharmacological treatments for perimenopausal depression and related disorders, such as postpartum depression and premenstrual dysphoric disorder.

Mental health as a clinical hallmark of cancer

A diagnosis of cancer bears a tremendous psychological impact on a patient’s psyche. It is common for individuals diagnosed with cancer to develop anger, anxiety and/or depression during the first year of the disease. However, the moderate rate of major depressive disorder and the high rate of minor depressive disorder are accompanied by sub-threshold forms of depression that are at risk to be under-recognised and untreated.

Treatment of mood disorders in multiple sclerosis.

Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system with a significant comorbidity with depressive disorders. Prevalence rates for major depressive disorder (MDD) range from 36% to 54% and the rate is around 22% for adjustment disorders. Selective serotonin reuptake inhibitors (SSRIs) are considered well-tolerated first-line treatment. Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are generally reserved for second-line use after SSRIs, because of sedating or anticholinergic side effects. SNRIs, with the exception of duloxetine, and combinations of newer antidepressants have failed to treat depression due to their side effects profile and frequent interaction with other drugs. Among SSRIs, sertraline is usually the first option, starting at 25mg/day and increasing to 50mg/day; and waiting a few weeks to assess drug effects before increasing the dose. The maximum is generally 200mg/day in a single dose. Paroxetine is the second choice, starting at 10mg/day for the first 5days, and then at 20mg/day thereafter. The maximum dose is about 50mg/day in a single dose. Fluvoxamine is used at 100-200mg/day, starting with 25mg/day, and increasing 25mg/day every 5days until 200mg/day is reached. We should take into account increasing blood level amounts of MS treatments (corticosteroids and cyclophosphamide) with fluvoxamine. With duloxetine, doses will be at 60-120mg/day. The initial dose for depression is 40mg/day in two doses; it can increase to 60mg/day in one to two doses if necessary. The maximum dose is generally 120mg/day. Duloxetine may increase liver problems through interaction with these MS treatments: teriflunomide, interferon beta-1a, and interferon beta-1b. Considering psychotherapy, only cognitive behavior therapy and mindfulness-based interventions have shown efficacy in improving depression disorders in MS. A comprehensive treatment for depression should include pharmacotherapy and psychotherapy.

Maternal depression and child behavioural outcomes

Depression is a leading cause of disability worldwide,1 with higher prevalence in women than in men. The postpartum period might confer additional risk to women; rates of major depressive disorder are raised slightly in the postnatal period relative to women who are not pregnant.2 Postpartum depression affects about 15% of women.3 Little is known about maternal depression in countries of low and middle income, although in a review of 47 studies spanning pregnancy and the postnatal period, common maternal mental health disorders (including depression) were noted in 19·8% of women.

An exploratory analysis of go/nogo event-related potentials in major depression and depression following traumatic brain injury

Rates of major depressive disorder (MDD) following traumatic brain injury (TBI) are estimated to be between 20% and 45%, a higher prevalence than that seen in the general population. These increased rates may be due to specific changes in brain function following TBI. Event related potentials (ERPs) are well suited for measuring the electrophysiological differences between groups in areas of cognitive processing impaired in both MDD and TBI, such as response inhibition. The current study presented an emotional Go/Nogo task (with schematic emotional faces as stimuli) to participants with TBI, participants with MDD, and participants with both TBI and MDD (TBI-MDD). Topographical distribution of activity and global field power comparisons were made across stimulus-locked epochs between these groups and healthy controls. The results indicated that ERPs were not altered by TBI alone. Both MDD and TBI-MDD groups showed similar alterations in topographical distribution and global field power in the N2 window, as well as late epoch alterations. The MDD and TBI-MDD groups showed significantly less fronto-central negativity during the N2 window in Nogo trials compared with the control group. The MDD and TBI-MDD groups also showed significantly less global field power in Nogo trials than Go trials during the N2 window while the control group showed the opposite pattern. The MDD and TBI-MDD groups showed no mood-congruent bias in behavioural or ERP measures. The results suggest that TBI-MDD displays similar electrophysiological changes to those found in the MDD group without TBI.

Link Seen Between Mental Disorders, Diabetes in New Study

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessLink Seen Between Mental Disorders, Diabetes in New StudyJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:2 Jun 2014https://doi.org/10.1176/appi.pn.2014.6a1AbstractFindings about a link between diabetes and both eating disorders and intermittent explosive disorder reinforce the importance of integrating psychiatric and general medical care.In a large international study, researchers found an association among binge-eating disorder, bulimia nervosa, depression, and intermittent explosive disorder and the later occurrence of type-2 diabetes.The study was headed by Peter de Jonge, Ph.D., a professor of psychiatry at the University of Groningen in the Netherlands, who along with colleagues conducted face-to-face household surveys of some 52,000 community-dwelling adults in 19 countries. Most of the surveys were based on nationally representative household samples, except for those from Colombia, Mexico, and China, which were based on representative household samples in urban areas.The results are published in the April Diabetologia, the journal of the European Association for the Study of Diabetes.The World Health Organization Composite International Diagnostic Interview was used to retrospectively evaluate the lifetime prevalence and age at onset of 16 DSM-IV psychiatric disorders, including several anxiety disorders, mood disorders, impulse control disorders, and substance use disorders. Anorexia nervosa was excluded because there was too low a prevalence of it in the study population to produce reliable analyses.Subjects were also asked whether their physicians had diagnosed them for type-2 diabetes, and if so, when the diagnosis occurred.The researchers then looked to see whether they could find any significant links between the mental disorders of interest and subjects’ subsequent diagnosis of type-2 diabetes, while taking comorbidity of the various mental disorders into account.Their data did point to links between diabetes and four mental disorders—binge-eating disorder, bulimia nervosa, major depressive disorder, and intermittent explosive disorder. The odds ratio for developing diabetes was especially high for individuals with binge-eating disorder or bulimia—3 to 1 in the case of the former and 2 to 1 in the case of the latter.“These findings support the focus on depression as having a role in diabetes onset, but suggest that this focus may be extended towards impulse-control disorders,” the researchers said.They suggested that the association between binge eating and diabetes and between bulimia and diabetes “point to the importance of glucose dysregulation. . .which may eventually result in later diabetes.” As for the link they found between intermittent explosive disorder and later development of diabetes, it’s possible that it might be explained by “low levels of HDL cholesterol and decreased serotonin functioning, both of which have been associated with aggression and diabetes.”The findings also have clinical implications, the researchers pointed out. For example, if depression is indeed a risk factor for type-2 diabetes, and if it is successfully treated, could such treatment decrease the chances of people developing type-2 diabetes? “This is theoretically plausible, since the typical age of onset of depression is considerably lower than the typical age of diabetes onset,” they noted.Also, the lifetime rate of major depressive disorder in individuals with eating disorders has been found to be as high as 50 percent to 75 percent, they said. It thus “remains possible for a person to develop an eating disorder, become depressed later on, and in the end develop diabetes. Targeting the eating disorder in this case will theoretically be a far more promising approach [to preventing diabetes] than focusing solely on depression.”“Perhaps further studies could evaluate the possibility that impulse-control disorders, including eating disorders and intermittent-explosive disorder, may serve as risk factors for depression and diabetes, or that these disorders are expressions of an underlying pathology that might lead to diabetes.”“Although affective disorders are well known to be associated with diabetes, this international epidemiological study finds an association between glucose dysregulation and a variety of other psychiatric disorders as well,” psychiatrist Thomas Wise, M.D., medical director of Inova Health Systems in Falls Church, Va., and a psychosomatic medicine expert, said in an interview with Psychiatric News. The research also “reinforces the urgent need to develop practical models of psychiatric integration into primary and specialty care settings to work as part of a team utilizing disease and behavioral approaches for such serious comorbid disorders.”The study was funded by the National Institute of Mental Health, the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, multiple international organizations, and several pharmaceutical companies. ■An abstract of “Association Between DSM-IV Mental Disorders and Diabetes Mellitus: A Role for Impulse Control Disorders and Depression” can be accessed here. ISSUES NewArchived

Impaired upper alpha synchronisation during working memory retention in depression and depression following traumatic brain injury

Rates of major depressive disorder (MDD) following traumatic brain injury (TBI) are higher than in the general population. Individuals with depression following traumatic brain injury (TBI-MDD) exhibit working memory (WM) impairments. Electrophysiological evidence has suggested that parieto-occipital upper alpha synchronisation may enhance WM retention by inhibiting irrelevant processes. The current research assessed whether retention period WM parieto-occipital upper alpha activity is disrupted in groups with TBI-only (N=20), MDD (N=17), and TBI-MDD (N=15) compared to healthy controls (N=31). Behavioural data indicated poorer performance in MDD and TBI-MDD. Parietal-occipital upper alpha was reduced in the MDD and TBI-MDD groups, but was unaffected in TBI-only. These results suggest inhibitory deficits may account for WM impairments in MDD and TBI-MDD, and that for individuals with TBI-MDD it may be the depression rather than the TBI that impairs WM.

Depression in homeless mothers: addressing an unrecognized public health issue.

Homeless mothers experience disproportionately high rates of major depressive disorder compared with the general population. Stressed by their circumstances, these women struggle to protect their families. Children living with a depressed parent have poorer medical, mental health, and educational outcomes. Despite the adverse impact on children, depression among mothers experiencing homelessness remains unacknowledged, unrecognized, and untreated. This article reviews the evidence supporting preventive and therapeutic interventions with low-income and homeless mothers and children, and finds that few services have been adapted and evaluated for use in the homelessness service system. Based on the robust evidence describing positive outcomes in programs for low-income parents with depression, the authors propose guidelines for adapting and implementing services directly by programs serving homeless families. Once families are housed and urgent issues addressed, they recommend assessing all family members, routinely providing culturally competent parenting supports, trauma-informed services, and treatment for major depressive disorders. They also emphasize the critical importance of creating child-centered spaces and developmental services for the children. To ensure quality care, training must be available for the staff. Given the increasing numbers of homeless families and high rates of maternal depression and its negative impact on children, support for these programs should become a high public health priority.

Comorbidity of Late-Life Depression in the United States: A Population-based Study

This study sought to determine the clinical and sociodemographic correlates and the treatment-seeking rate of major depressive disorder (MDD), diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, among older adults and its association with comorbid psychiatric disorders and perceived health status. Data were drawn from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, a large cross-sectional survey (N= 43,093) representative of the US population. Compared with participants aged 65 years and older without a 12-month diagnosis of MDD, those with MDD were more likely to have lifetime and 12-month comorbid psychiatric disorders. Except for lifetime dysthymia, we found no significant interaction between rates of current somatic comorbidity, lifetime and 12-month psychiatric comorbidity, and age groups. Compared with younger participants with a 12-month MDD, they had an older age at onset, reported a similar number of lifetime major depressive episodes and perceived health status, and had lower mental health service utilization rates. Current major depression in the elderly seems to be as disabling as in younger adults in terms of comorbid psychiatric disorders and impaired quality of life. Poorer prognosis of MDD in older adults might be explained by a lower perceived need of treatment, resulting in a lower rate of treatment-seeking behavior.

Clinical depression while caring for loved ones with breast cancer

IntroductionThe period of the cancer patients undergoing treatment is also the most stressful time for their family caregivers. This study aimed to determine the rates of major depressive disorder and dysthymia; and their associated factors in the caregivers during this time. MethodsOne hundred and thirty caregiver–patient dyads attending the oncology centre for breast cancer treatment participated in this cross-sectional study. While the data on the patients’ socio-demographic and illness characteristics were obtained from their medical record, the caregivers completed three self-report measures: 1) socio-demography and the caregiving factor questionnaire, 2) Multi-dimensional Perceived Social Support (MSPSS) and 3) Depression, Anxiety and Stress Scale (DASS-21). Subsequently, those with “probable depression” identified from the DASS-21 score were interviewed using The Mini-International Neuropsychiatric Interview (MINI) to obtain the diagnoses of depressive disorders. ResultsTwenty-three of the 130 caregivers (17.69%) were diagnosed to have depressive disorders, where 12.31% (n=16) had major depressive disorder and 5.38% (n=7) had dysthymic disorder. Factors associated with depression include ethnicity, duration of caregiving, the patients' functional status and the caregivers' education level. Logistic regression analysis showed that the patients' functional status (p<0.05, OR=0.23, CI=0.06–0.86) and the caregivers' education level (p<0.05, CI=9.30, CI=1.82–47.57) were significantly associated with depression in the caregivers attending to breast cancer patients on oncology treatment. ConclusionsA significant proportion of family caregivers were clinically depressed while caring for their loved ones. Depression in this population is a complex interplay between the patients' factors and the caregivers' factors.

Major depressive disorder symptoms in male and female young adults

This research aimed to compare the prevalence rates of major depressive disorder (MDD) and to differentiate the presence and severity of depressive symptoms between women and men aged 18–24 years. In this population-based, cross-sectional study (n = 1560), young adults were screened with the Mini International Neuropsychiatric Interview for MDD (n = 137). Participants then completed a self-report questionnaire to gather sociodemographic data, and the presence of each symptom of depression was assessed with the Beck Depression Inventory. The proportion of women (12.2%) with MDD was higher than that of men (5.3%). The symptoms of depression found to be significantly more prevalent in women were sadness, crying, difficulty making decisions, and lack of energy, as well as self-criticism, irritability, changes in self-image, work difficulty, and loss of interest in sex. Sadness and self-criticism were significantly more severe in women than in men. The presentation of depressive symptoms in young adults with MDD differed between men and women.

Screening, referral and treatment for depression in patients with coronary heart disease

In 2003, the National Heart Foundation of Australia position statement on "stress" and heart disease found that depression was an important risk factor for coronary heart disease (CHD). This 2013 statement updates the evidence on depression (mild, moderate and severe) in patients with CHD, and provides guidance for health professionals on screening and treatment for depression in patients with CHD. The prevalence of depression is high in patients with CHD and it has a significant impact on the patient's quality of life and adherence to therapy, and an independent effect on prognosis. Rates of major depressive disorder of around 15% have been reported in patients after myocardial infarction or coronary artery bypass grafting. To provide the best possible care, it is important to recognise depression in patients with CHD. Routine screening for depression in all patients with CHD is indicated at first presentation, and again at the next follow-up appointment. A follow-up screen should occur 2-3 months after a CHD event. Screening should then be considered on a yearly basis, as for any other major risk factor for CHD. A simple tool for initial screening, such as the Patient Health Questionnaire-2 (PHQ-2) or the short-form Cardiac Depression Scale (CDS), can be incorporated into usual clinical practice with minimum interference, and may increase uptake of screening. Patients with positive screening results may need further evaluation. Appropriate treatment should be commenced, and the patient monitored. If screening is followed by comprehensive care, depression outcomes are likely to be improved. Patients with CHD and depression respond to cognitive behaviour therapy, collaborative care, exercise and some drug therapies in a similar way to the general population. However, tricyclic antidepressant drugs may worsen CHD outcomes and should be avoided. Coordination of care between health care providers is essential for optimal outcomes for patients. The benefits of treating depression include improved quality of life, improved adherence to other therapies and, potentially, improved CHD outcomes.

Posttraumatic Stress Disorder in Adult Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is characterized by clinically significant functional impairment due to symptoms of inattention and/or hyperactivity and impulsivity. Previous research suggests a link, in child samples, between ADHD and posttraumatic stress disorder (PTSD), which is characterized by (1) chronically reexperiencing a traumatic event, (2) hyperarousal, and (3) avoiding stimuli associated with the trauma while exhibiting numbed responsiveness. This study sought to address the link between ADHD and PTSD in adults by providing a comprehensive comparison of ADHD patients with and without PTSD across multiple variables including demographics, patterns of psychiatric comorbidities, functional impairments, quality of life, social adjustment, and familial transmission. Participants in our controlled family study conducted between 1998 and 2003 were 190 adults with DSM-IV ADHD who were attending an outpatient mental health clinic in Boston, Massachusetts; 16 adults with DSM-IV ADHD who were recruited by advertisement from the greater Boston area; and 123 adult controls without ADHD who were recruited by advertisement from the greater Boston area. All available first-degree relatives also participated. Subjects completed a large battery of self-report measures (the Quality of Life Enjoyment and Satisfaction Questionnaire, items from the Current Behavior Scale, the Social Adjustment Scale Self-Report, and the Four Factor Index of Social Status) designed to assess various psychiatric and functional parameters. Diagnoses were made using data obtained from structured psychiatric interviews (Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version, and the Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Epidemiologic Version). The lifetime prevalence of PTSD was significantly higher among adults with ADHD compared with controls (10.0% vs 1.6%; P = .004). Participants with ADHD and those with ADHD + PTSD did not differ in core symptoms of ADHD nor in age at onset, but those with ADHD + PTSD had higher rates of psychiatric comorbidity than those with ADHD only (including higher lifetime rates of major depressive disorder, oppositional defiant disorder, social phobia, agoraphobia, and generalized anxiety disorder) and worse quality of life ratings for all domains. Familial risk analysis revealed that relatives of ADHD probands without PTSD had elevated rates of both ADHD (51%) and PTSD (12%) that significantly differed from rates among relatives of controls (7% [P ≤ .001] and 0% [P ≤ .05], respectively). A similar pattern of elevated risk for ADHD and PTSD (80% and 40%) was observed in relatives of probands with ADHD + PTSD (P ≤ .001 for both conditions). The comorbidity of PTSD and ADHD in adults leads to greater clinical severity in terms of psychiatric comorbidity and psychosocial functioning. The familial coaggregation of the 2 disorders suggests that these disorders share familial risk factors and that their co-occurrence is not due to diagnostic errors.

Systematic depression screening in high-risk patients attending primary care: a pragmatic cluster-randomized trial.

BackgroundSystematic screening for depression in high-risk patients is recommended but remains controversial. The aim of this study was to assess the effectiveness of such screening in everyday clinical practice on depression recognition.MethodsA pragmatic, cluster randomized, controlled study that randomized primary care physicians (PCPs) in Spain either to an intervention or control group. The intervention group (35-PCPs) received training in depression screening and used depression screening routinely for at least 6 months. The control group (34-PCPs) managed depression in their usual manner. Adherence to (1–6; never-very frequently), feasibility (1–4; unfeasible-very feasible), and acceptance (1–5; very poor-very good) of the screening were evaluated. Underrecognition (primary outcome) and undertreatment rates of major depressive disorder (MDD) in the two groups were compared 6 months after randomization in a random sample of 3737 patients assigned to these PCPs using logistic regression adjusting for the clustering effect.ResultsNo significant differences were found for recognition rates (58.0% vs. 48.1% intervention vs. control; OR [95%CI] 1.40 [0.73-2.68], p = 0.309). The undertreatment rate did not differ significantly either (p = 0.390). The mean adherence to depression screening was 4.4 ± 1.0 (‘occasionally’), the mean feasibility was 3.1 ± 0.5 (‘moderately feasible’), and the mean acceptance was 4.2 ± 0.6 (‘good’).ConclusionsThis research was not able to show effectiveness of the systematic screening for MDD in high-risk patients on depression recognition in primary care. The poor adherence to screening implementation could partially explain the results. These reflect the difficulties of putting into practice the clinical guidelines usually based on interventional research.Trial registrationClinicaltrials.gov NCT01662817

Why does the lifetime prevalence of major depressive disorder in the elderly appear to be lower than in younger adults? Results from a national representative sample

BackgroundThe explanation of the lower lifetime prevalence rate of major depressive disorder (MDD) in older adults compared to younger people in community surveys is debated. This study examines the hypothesis that the decrease of the lifetime prevalence of MDD in older adults may be due to an age-related difference in the lifetime prevalence of subthreshold hypomania and, to a lesser extent, to the increased rate of medical induced-depression. MethodsData were derived from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), a national representative sample of 43,093 adults of the United States population. We examined lifetime prevalence rates of pure MDD and MDD plus subthreshold hypomania (D(m)) by age, assuming that the lifetime prevalence of pure MDD in older adults would be similar to that in the youngest cohort, consequent to an inverse age-D(m) relationship. We further considered non-hierarchical MDD (i.e., general medical condition depressive disorders were not ruled out) with the same method. ResultsThe lifetime prevalence of D(m) among depressed adults aged 65 years and over was substantially lower compared to the youngest group. When considering non-hierarchical MDD, the odds ratio of the lifetime prevalence estimates of non-hierarchical pure MDD in older adults compared to the youngest group appeared not significantly different from 1. ConclusionsFindings indicate that the decrease of lifetime prevalence of MDD in older adults may be due to an age-related difference in the lifetime prevalence of subthreshold hypomania and, to a lesser extent, to the increased rate of medical induced-depression.

Major depressive disorder and factorial dimensions among individuals with recent-onset spinal cord injury.

We examine the rates of major depressive disorder, single episode determined by the Inventory to Diagnose Depression (IDD) in a clinical sample of persons with recent-onset spinal cord injury (SCI; ≤52 weeks) participating in an inpatient SCI rehabilitation program. We also analyzed the factor structure of the IDD measure in an attempt to replicate the factor structure reported by Frank et al. (1992), and we examined item endorsement patterns. A retrospective chart review was conducted. Participants were 354 individuals (93 women, 261 men) in an inpatient SCI rehabilitation program. Fifteen percent of the sample met criteria for a major depressive disorder (MDD). A higher rate of depression was observed among women. A "dysphoria" factor accounted for 24% of the variance in the final four-factor model. The four-factor solution explained a total of 35.5% of the variance, with an "anhedonia" factor contributing 4.6%, a "sleep" factor contributing 3.5%, and an "appetite" factor contributing 3.5%, respectively. Items assessing symptoms of insomnia, weight loss, worrying about health, and decreased energy had the highest percentage of endorsement to meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for clinical significance. The rate of single episodes of MDD determined by the IDD parallels the rate observed with the Patient Health Questionnaire-9 (PHQ-9). The factor structure of the IDD was similar to that reported by Frank et al. (1992). Information provided by the IDD about the presence and severity of MDD symptoms can inform interventions for persons with SCI.

The Evaluation of the Effectiveness of Relaxation Training and Sleep Hygiene Education for Insomnia of Depressed Patients

Background: Insomnia is a frequent complaint of patients with major depressive disorder. The lifetime prevalence rate of major depressive disorder is 17% (Sadock &amp; Sadock, 2007). Studies have found that a significantly higher percentage of women than men aged 20–55 years report difficulty maintaining sleep (Soares, 2005). Purpose: This scholarly project involved the implementation and evaluation of a relaxation training and sleep hygiene education intervention for female patients who experience major depressive disorder and insomnia. Theoretical Model: Middle-range theory of unpleasant symptoms (Lenz, Pugh, Milligan, Gift, &amp; Suppe, 1997). Sample: A convenience sample of 10 female participants was recruited from an outpatient psychiatric private practice. Methods: Participants attended 4 consecutive, weekly outpatient sessions lasting approximately 1 hr. The initial session consisted of conducting a psychiatric evaluation and administration of the Pittsburgh Sleep Quality Index to measure rating of sleep quantity and quality. Principles of sleep hygiene and relaxation exercises were introduced during the initial session. Subsequent sessions focused on reinforcement of the principles of sleep hygiene and relaxation training. Results: Sleep hygiene education and relaxation training were effective in treating insomnia of depressed patients. Implications for Nursing: Implementation of sleep hygiene education and relaxation training provides nurses with evidence-based treatment alternatives or complements to pharmacotherapy in depressed patients.

‘I am not a depressed person’: How identity conflict affects help-seeking rates for major depressive disorder

BackgroundThere is a significant treatment gap for patients with depression. A third of sufferers never seek help, and the vast majority of those who do only do so after considerable delay. Little is understood regarding poor help-seeking rates amongst people with depression, with existing research mainly focussed on the impact of barriers to treatment. The current study explored psychological factors affecting help-seeking behaviour in clinically depressed individuals.MethodsSemi-structured interviews were conducted with 20 current or previously clinically depressed participants who either had or had not sought professional help. Thematic analysis was used to analyse results.ResultsThe onset of depressive symptoms created conflict with participants’ identity and personal goals. Delays in seeking help were primarily attributed to the desire to protect identity and goals from the threat of depressive symptoms. Participants used avoidance strategies to reduce the perceived threat of depressive symptoms on identity. These strategies interfered with help-seeking. Help-seeking was only undertaken once participants reached a point of acceptance and began to make concessions in their identity and goals, at which time they reduced their use of avoidance.ConclusionsDifficulties resolving conflict between identity and depressive symptoms may account for significant delays in seeking help for depression. The results have implications for predicting health behaviour and improving treatment uptake for depression, and may inform existing help-seeking models.

P.4.a.015 Depressive symptomatology in patients with primary panic disorder with agoraphobia and exposure exercise completion between the treatment sessions

To investigate the reliability, validity and utility of DSM-5 illness anxiety disorder (IAD) and somatic symptom disorder (SSD), and explore their overlap with DSM-IV Hypochondriasis in a health anxious sample.Treatment-seeking patients with health anxiety (N = 118) completed structured diagnostic interviews to assess DSM-IV Hypochondriasis, DSM-5 IAD, SSD, and comorbid mental disorders, and completed self-report measures of health anxiety, comorbid symptoms, cognitions and behaviours, and service utilization.IAD and SSD were more reliable diagnoses than Hypochondriasis (kappa estimates: IAD: 0.80, SSD: 0.92, Hypochondriasis: 0.60). 45% of patients were diagnosed with SSD, 47% with IAD, and 8% with comorbid IAD/SSD. Most patients with IAD fluctuated between seeking and avoiding care (61%), whereas care-seeking (25%) and care-avoidant subtypes were less common (14%). Half the sample met criteria for DSM-IV Hypochondriasis; of those, 56% met criteria for SSD criteria, 36% for IAD, and 8% for comorbid IAD/SSD. Compared to IAD, SSD was characterized by more severe health anxiety, somatic symptoms, depression, and higher health service use, and higher rates of major depressive disorder, panic disorder and agoraphobia.DSM-5 IAD and SSD classifications reliably detect more cases of clinically significant health anxiety than DSM-IV Hypochondriasis. The differences between IAD and SSD appear to be due to severity. Future research should explore the generalizability of these findings to other samples, and whether diagnostic status predicts treatment response and long-term outcome.