Seeking Treatment For Depression Research Articles

Treatment-seeking behavior and barriers to mental health service utilization for depressive symptoms and hazardous drinking: The role of religious and traditional healers in mental healthcare of Northwest Ethiopia.

Understanding mental healthcare seeking and associated factors is essential for planning mental health services. This study aimed to assess treatment seeking and barriers to care for depressive symptoms and hazardous drinking in a community sample of Northwest Ethiopia. A cross-sectional study was conducted to screen 1,728 participants for depressive symptoms (n = 414) and hazardous drinking (n = 155). Participants were asked whether they had sought mental healthcare. We also assessed the barriers to seeking mental healthcare. Logistic regression was used to identify associated factors. Among people with depressive symptoms, 14.3%, 15.5%, and 19.6% sought treatment from healthcare settings, non-healthcare settings, or any sources, respectively. Religious places (39.5%) were the most helpful treatment sources. People with low levels of internalized stigma (adj OR = 3.00 [1.41, 6.42]) and positive attitudes towards mental illness (adj OR = 2.84 [1.33, 6.07]) were nearly threefold more likely to seek depression treatment. No participants with hazardous drinking sought treatment from healthcare settings, and only 1.3% had sought help from families/friends. Over 97% of participants with depressive symptoms and hazardous drinking reported at least one barrier to treatment-seeking from a healthcare setting. Religious and traditional healers were as important as healthcare settings for treatment-seeking.

Telehealth-Supported Decision-making Psychiatric Care for Suicidal Ideation: Longitudinal Observational Study.

BackgroundSuicide is a leading cause of death in the United States, and suicidal ideation (SI) is a significant precursor and risk factor for suicide.ObjectiveThis study aimed to examine the impact of a telepsychiatric care platform on changes in SI over time and remission, as well as to investigate the relationship between various demographic and medical factors on SI and SI remission.MethodsParticipants included 8581 US-based adults (8366 in the treatment group and 215 in the control group) seeking treatment for depression, anxiety, or both. The treatment group included patients who had completed at least 12 weeks of treatment and had received a prescription for at least one psychiatric medication during the study period. Providers prescribed psychiatric medications for each patient during their first session and received regular data on participants. They also received decision support at treatment onset via the digital platform, which leveraged an empirically derived proprietary precision-prescribing algorithm to give providers real-time care guidelines. Participants in the control group consisted of individuals who completed the initial enrollment data and completed surveys at baseline and 12 weeks but did not receive care.ResultsGreater feelings of hopelessness, anhedonia, and feeling bad about oneself were most significantly correlated (r=0.24-0.37) with SI at baseline. Sleep issues and feeling tired or having low energy, although significant, had lower correlations with SI (r=0.13-0.14). In terms of demographic variables, advancing age and education were associated with less SI at baseline (r=−0.16) and 12 weeks (r=−0.10) but less improvement over time (r=−0.12 and −0.11, respectively). Although not different at baseline, the SI expression was evident in 34.4% (74/215) of the participants in the control group and 12.32% (1031/8366) of the participants in the treatment group at 12 weeks. Although the participants in the treatment group improved over time regardless of various demographic variables, participants in the control group with less education worsened over time, after controlling for age and depression severity. A model incorporating the treatment group, age, sex, and 8-item Patient Health Questionnaire scores was 77% accurate in its classification of complete remission. Those in the treatment group were 4.3 times more likely (odds ratio 4.31, 95% CI 2.88-6.44) to have complete SI remission than those in the control group. Female participants and those with advanced education beyond high school were approximately 1.4 times more likely (odds ratio 1.38, 95% CI 1.18-1.62) to remit than their counterparts.ConclusionsThe results highlight the efficacy of an antidepressant intervention in reducing SI, in this case administered via a telehealth platform and with decision support, as well as the importance of considering covariates, or subpopulations, when considering SI. Further research and refinement, ideally via randomized controlled trials, are needed.

Annals for Educators - January 2022.

Annals for Educators - January 2022.

Depression, fitness, and student willingness to pursue university counseling and alternative antidepressant options.

BACKGROUND:Depression prevalence in college students is three to six times higher than US adults. Counseling utilization increased by 30%–40% despite reports of student unwillingness to pursue therapy. Pursuance of alternative options, like exercise or meditation, is rarely reported. This study examined students’ willingness to seek depression treatment through university mental health services (UMHS) and alternative options (AO).MATERIALS AND METHODS:This was a cross-sectional study. Students (n = 780) completed a survey including validated depression and estimated cardiorespiratory fitness instruments. Yes/Maybe/No responses regarding willingness to seek UMHS and AO were analyzed for associations with demographics, depression status, and fitness level. Descriptive and inferential analyses were employed.RESULTS:Students were more likely to select “Yes” for AO than UMHS (χ2 = 104.145, P < 0.001). Low-fit students (χ2 = 8.35, P = 0.02) and those in depression treatment (χ2 = 15.182, P < 0.001) selected “Yes” to UMHS more often than expected. Younger (χ2 = 7.893, P = 0.02), nondepressed (χ2 = 7.355, P = 0.03), and fit students (χ2 = 10.617, P = 0.005) chose “Yes” while males selected “No” (χ2 = 8.99, P = 0.01) more often than expected for AO. Approximately 31% of students reported having moderate-to-severe depression, 7.8% were in treatment, and 55% were classified as having low fitness levels.CONCLUSIONS:The findings of this study should be considered when developing antidepressant programming on university campuses.

Health care use and treatment-seeking for depression symptoms in rural India: an exploratory cross-sectional analysis

BackgroundThere is a large “treatment gap” for depression worldwide. This study aimed to better understand the treatment gap in rural India by describing health care use and treatment-seeking for depression.MethodsData were analysed from a two round cross-sectional community survey conducted in rural Madhya Pradesh between May 2013 and December 2016. We examined the proportion of individuals who screened positive for depression (≥10) on the Patient Health Questionnaire (PHQ-9) who sought treatment in different sectors, for depression symptoms and for any reason, and compared the latter with health service use by screen-negative individuals. We analysed the frequency with which barriers to healthcare utilisation were reported by screen-positive adults. We also analysed the association between seeking treatment for depression and various predisposing, enabling and need factors using univariable regression.Results86% of screen-positive adults reported seeking no depression treatment. However, 66% had used health services for any reason in the past 3 months, compared to 46% of screen-negative individuals (p < 0.0001). Private providers were most frequently consulted by screen-positive adults (32%), while only 19% consulted traditional providers. Structural barriers to healthcare use such as cost and distance to services were frequently reported (54 and 52%, respectively) but were not associated with treatment-seeking for depression. The following factors were found to be positively associated with treatment-seeking for depression: higher symptom severity; lack of energy, lack of interest/pleasure, low self-esteem, or slow movements/restlessness on more than 7 days in the past 2 weeks; being married; having discussed depression symptoms; and reporting problems with medication availability and supply as a barrier to healthcare. No evidence was found for an association between treatment-seeking for depression and most socio-economic, demographic or attitudinal factors.ConclusionsThese findings suggest that the majority of adults who screen positive for depression seek healthcare, although not primarily for depression symptoms, indicating the need to improve detection of depression during consultations about other complaints. Private providers may need to be considered in programmes to improve depression treatment in this setting. Further research should test the hypotheses generated in this descriptive study, such as the potential role of marriage in facilitating treatment-seeking.

Perceptions of Residents and Their Training Directors Regarding Wellness Education, Program Support, and Access to Depression Treatment: the DEPRESS-Ohio Study.

This study determines the extent to which residents and their program directors have discordant perceptions regarding wellness, support, and treatment opportunities for trainees. In addition, the authors examined whether psychiatry residents differed in their perceptions compared with residents in other specialties. Residents and their program directors from each of 10 specialties were electronically surveyed after IRB approval and giving informed consent. Of 42 program directors responding, over 92% indicated they provided wellness education and programming; however, a significantly lower percentage of 822 trainees were aware of this (81.2% and 74.9%, respectively). A similar disparity existed between program directors (PDs) who knew where to refer depressed residents for help (92.9%) and residents who knew where to seek help (71%). Moreover, 83.3% of program directors believed they could comfortably discuss depression with a depressed resident, but a lower percentage of their trainees (69.1%) felt their training directors would be supportive. A significantly greater percentage of program directors (40.5%) believed seeking treatment for depression might compromise medical licensure than did residents (13.0%). Psychiatry residents were significantly more aware of wellness, support, and access than were residents from other specialties. The availability of wellness education, programming, program director accessibility, and knowing where to ask for help if depressed does not seem to be adequately communicated to many residents. Moreover, program directors disproportionately see depression treatment as a risk to medical licensure compared with their residents. Psychiatry residents seem to be more aware of program director support and access to care than their colleagues.

Media coverage of celebrity suicide caused by depression and increase in the number of people who seek depression treatment

We examined how media coverage of a celebrity who died by suicide due to depression was associated with the change in the number of people who visited a psychiatrist for depression. For this, of all news articles published in South Korea between 2010 and 2017, we identified all cases in which a celebrity died by suicide due to depression. Further, from the Korean health big data system, we collected monthly data on the number of people who visited a psychiatrist for depression. Regression analyses showed that, when there was media coverage of celebrity suicide due to depression in a particular month, more people visited a psychiatrist for depression—not in the same month but in the following month. We also found that, when there was media coverage of celebrity suicide due to depression, more news articles provided information about depression treatment or prevention. But, the increase in the number of such news articles did not play mediating roles between the media coverage of celebrity suicide, of which depression was known to be the main cause, and the increase in the number of visits to a psychiatrist.

Intention to Seek Depression Treatment in Latina Immigrant Mothers

Background: Postpartum depression in Latina immigrant mothers can lead to adverse outcomes in both mothers and babies, yet depression treatment remains suboptimal.Aims: The aims were to determine predictors of intention to seek depression treatment and to determine if intention to seek depression treatment differed in those with significant symptoms of depression.Methods: Based upon the theory of planned behavior (TPB), a cross-sectional study design was used. A convenience sample of Latina immigrant mothers (n = 50) were interviewed in Spanish. Certified translation services were used to translate study instruments to Spanish. Descriptive analysis and multivariable logistic regression techniques were used for data analysis.Results: While increases in attitudes were associated with intention to seek depression treatment, increased social support and perceived control were associated with a decrease in intention to seek treatment.Conclusions: The differing role of social support in Latina immigrant mothers should be explored.

Childhood abuse in adult women with unipolar depression seeking treatment at a tertiary care centre in India, compared to healthy women

IntroductionChildhood abuse has been reported as a precursor and maintaining factors for adult psychiatric disorders. Childhood physical abuse, neglect and sexual abuse have been independently reported in women with depression. There is a serious dearth of literature on the incidence of childhood abuse among women with depression from India.Objectives &amp; aimsWe investigated and compared the incidence of childhood abuse (overall) – physical, emotional and sexual (individual components)- among women seeking treatment for unipolar depression (UD) compared to healthy women (HW).MethodsWe compared the data of women diagnosed with UD (n = 134) from a larger pool of women seeking treatment for psychiatric disorders from our hospital (n = 609) with HW (n = 100) for the purpose of this study. The participants were screened using the MINI International Neuropsychiatric Interview (MINI) and for childhood abuse using the ISPCAN Child Abuse Screening Tool - Retrospective (ICAST)-R. The incidence of childhood abuse between the two groups was compared using the Chi-squared test.ResultsThe UD women have significantly more childhood emotional abuse than HW (69.5% vs 30.5%; χ2 = 4.819, P &lt; 0.05). There was no statistically significant difference between the two groups on overall abuse, physical or sexual abuse (all P &gt; 0.16).ConclusionsConsistent with world literature, significantly more childhood emotional abuse was seen among Indian women with UD compared to HW. It is likely that that repeated emotional abuse in childhood leads to negative attributions among children, later getting generalised to life events resulting in depression in adulthood.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Pilot Feasibility Study of a Brief, Tailored Mobile Health Intervention for Depression among Patients with Chronic Pain

This pilot feasibility study investigated a brief, tailored mobile health intervention to provide brief treatment and motivate further depression treatment seeking among patients with comorbid chronic pain. The computer tablet intervention was delivered in a hospital clinic using a blended motivational interviewing and cognitive behavioral therapy approach. Individuals were at least age 18, and screened positive for depression during a visit for chronic pain. Participants completed assessments before the intervention and at two-week follow-up. The 64 participants were most often over 50 years old, female, and Caucasian. Participant ratings demonstrated an increase in interest to seek depression treatment and willingness to make life changes to mitigate symptoms. A significant reduction in mean depression score and non-significant reductions on both measures of disability were observed. This intervention was feasible and acceptable, demonstrated promise in reducing depression and increasing treatment interest, and should be tested in a trial.

Factor Structure of the Automatic Thoughts Questionnaire in a Clinical Sample

None of the published factor analyses of the Automatic Thoughts Questionnaire—Negative (ATQ-N; Hollon & Kendall, 1980) have been with adult clinical populations. To address this omission, we examined the factor structure of the ATQ-N among an adult sample (N = 178) seeking treatment for depression. A series of confirmatory factor analyses revealed poor fit indices with all previous models, suggesting that the automatic thinking of depressed clients is composed of different cognitive dimensions than that of nonclinical samples. An exploratory analysis with our clinical sample identified five factors with eigenvalues >1 (demoralization, self-criticism, brooding, amotivation, and interpersonal disappointment) that accounted for 61% of the variance. Of these five factors, only the first two independently accounted for significant variability in levels of depression. Implications of the results and for further use of the ATQ-N within cognitive therapeutic research and practice are discussed.

Treating Youth Depression and Anxiety: A Randomised Controlled Trial Examining the Efficacy of Computerised versus Face‐to‐face Cognitive Behaviour Therapy

Barriers to accessing psychologists for the treatment of depression and anxiety include a shortage of specialised therapists, long waiting lists, and the affordability of therapy. This study examined the efficacy of a computerised‐based self‐help program (MoodGYM) delivered in‐conjunction with face‐to‐face cognitive behavioural therapy (CBT) to expand the delivery avenues of psychological treatment for young adults (aged 18–25 years). Eighty‐nine participants suffering from depression and/or generalised anxiety were randomly allocated to a control intervention or to one of three experimental groups: receiving face‐to‐face CBT, receiving computerised CBT (cCBT), or receiving treatment in‐conjunction (face‐to‐face CBT and cCBT). While MoodGYM did not significantly decrease depression in comparison to the control group, significant decreases were found for anxiety. MoodGYM delivered in‐conjunction with face‐to‐face CBT is more effective in treating symptoms of depression and anxiety compared with standalone face‐to‐face or cCBT. This study suggests that for youth who are unable to access face‐to‐face therapy—such as those in rural or remote regions, or for communities in which there is stigma attached to seeking help—computerised therapy may be a viable option. This is an important finding, especially in light of the current capacity‐to‐treat and accessibility problems faced by youth when seeking treatment for depression and/or anxiety.

Increased Prospective Health Service Use for Depression among Adults with Childhood Onset Bipolar Disorder

To examine the prospective relationship between age of onset of bipolar disorder and the demographic and clinical characteristics, treatment, new onset of psychiatric comorbidity, and psychosocial functioning among adults with bipolar disorder. As part of the National Epidemiologic Survey on Alcohol and Related Conditions, 1600 adults who met lifetime Statistical Manual of Mental Disorders, 4th edition criteria for bipolar disorder-I (n = 1172) and bipolar disorder-II (n = 428) were included. Individuals were evaluated using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV version for Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and data were analyzed from Waves 1 and 2, approximately 3 years apart. Individuals with bipolar disorder were divided into three age at onset groups: childhood (<13 years old, n = 115), adolescence (13-18 years old, n = 396), and adulthood (>19 year old, n = 1017). After adjusting for confounding factors, adults with childhood-onset bipolar disorder were more likely to see a counselor, have been hospitalized, and have received emergency room treatment for depression compared with those with adulthood-onset bipolar disorder. By contrast, there were no differences in the severity of mania or hypomania, new onset of comorbidity, and psychosocial functioning by age of bipolar disorder onset. Childhood-onset bipolar disorder is prospectively associated with seeking treatment for depression, an important proxy for depressive severity. Longitudinal studies are needed in order to determine whether prompt identification, accurate diagnosis, and early intervention can serve to mitigate the burden of childhood onset on the long-term depressive burden of bipolar disorder.

Depression treatment after myocardial infarction and long-term risk of subsequent cardiovascular events and mortality: A randomized controlled trial

ObjectiveEvaluating the effects of implementing an antidepressant treatment strategy in depressed myocardial infarction (MI)-patients on long-term cardiovascular outcomes and all-cause mortality. MethodsMI-patients were evaluated for the presence of a diagnosis of post-MI depression at 3, 6, 9 and 12months after hospitalization for MI. A total of 331 depressed MI-patients were randomized to intervention or care-as-usual (CAU). Patients randomized to the intervention were offered several antidepressant treatment options including pharmacological and non-pharmacological therapy. Patients randomized to CAU were not given feedback about their depression status. All patients were free to seek depression treatment outside the study, which was monitored. The primary outcome was a combined endpoint of cardiovascular events and cardiac mortality between randomization and 8years later. All-cause mortality was evaluated as secondary endpoint. ResultsThe intervention did not reduce the risk of the primary outcome (HR: 0.97 (95% CI: 0.67–1.40) n=330) or all-cause mortality (HR: 0.74 (95% CI: 0.41–1.33) n=330). Regardless of randomization status, patients who received depression treatment (n=168) had reduced all-cause mortality rates compared to those who did not receive treatment (n=143, HR: 0.52 (95% CI: 0.28–0.97)). ConclusionImplementing an antidepressant treatment strategy did not reduce the risk of cardiovascular morbidity and mortality compared to usual care. Receiving depression treatment increased survival. It remains unclear whether this represents a direct treatment effect or is due to unmeasured factors that relate to both receiving depression treatment and mortality, such as patients' intrinsic motivation to care for their health.

Ethnicity and Seeking Treatment for Depression: A Canadian National Study

This research was based on data collected in the Health and Mental Health cycle of the Canadian Community Health Survey to assess the effects of ethnic background on seeking treatment for major depression episodes (MDE) and to investigate types of barriers to mental health care reported by members of different racial/ethnic groups. Findings indicated that racial/ethnic background had a significant effect on treatment-seeking rates, controlling for socio-economic, demographic and health factors. Proportion of MDE sufferers with unmet mental health care needs varied significantly across racial/ethnic groups, with the lowest rate reported among Blacks and the highest among South Asians. Results identified some access problems that were common across all racial/ethnic groups and some problems unique to members of specific groups. For example, two-thirds of depressed individuals of all racial/ethnic backgrounds with unmet needs reported personal barriers to treatment, i.e., they decided not to seek treatment. In contrast, rates of accessibility and availability barriers differed significantly across racial/ethnic groups. Results signaled an urgent need for psycho-educational programs aimed at Canadians of all racial/ethnic backgrounds, as well as the need for culturally sensitive screening and intervention policies to ensure equal access to mental health services for all Canadians. Cette recherche s’est faite à partir de données collectées par la partie de l’Enquête sur la santé dans les collectivités canadiennes portant sur la santé mentale, afin d’évaluer les effets du contexte ethnique dans la demande de traitement pour des épisodes majeurs de dépression (EMD), et pour étudier les types d’obstacles aux soins médicaux ad hoc, tels qu’en ont rendu compte des membres de groupes raciaux et ethniques. Selon les résultats, le contexte racial et ethnique joue un rôle important sur les taux de demande de traitement, en contrôlant les facteurs socio-économiques, démographiques et touchant à la santé. La proportion de malades souffrant d’EMD qui n’ont pas reçu de soins médicaux appropriés varie de manière significative d’un groupe à l’autre, les réponses indiquant le taux le plus bas chez les Noirs et le plus élevé chez les Sud-Asiatiques. Nous avons aussi identifié des problèmes d’accès, certains communs à tous les groupes raciaux et ethniques, d’autres propres à des groupes spécifiques. Par exemple, dans tous les contextes concernés, les deux-tiers des personnes dépressives qui n’ont pas reçu de soins adéquats ont indiqué des obstacles d’ordre personnel à un traitement, à savoir qu’elles n’ont pas demandé à en suivre un. Par contraste, les taux d’accessibilité et les obstacles à la disponibilité de soins mentaux diffèrent remarquablement d’un groupe racial ou ethnique à l’autre. Les conclusions indiquent un besoin urgent de dépistage et de politiques d’interventions qui tiennent compte de la culture afin d’assurer un accès égal aux services de santé mentale pour tous les Canadiens.

Quality of Life after Bariatric Surgery: A Population-based Cohort Study

Background Bariatric surgery leads to profound weight loss, but postoperative complications and psychosocial issues may impact long-term quality of life. The primary aim of this project was to examine whether such patients have better quality of life and self-reported functional status compared with obese adults who do not have bariatric surgery. Methods This population-based study of patients evaluated for Roux-en-Y gastric bypass surgery involved a survey consisting of baseline and follow-up single-item overall quality-of-life items (Linear Analogue Self-Assessment Questionnaire; LASA), follow-up quality of life (Short-Form-12), and activity (Goldman's Specific Activity Scale). A total of 268 and 273 surveys were mailed, with 148 (55.2%) operative and 88 (32.2%) nonoperative survey responders assessed, respectively. Linear regression was used, adjusting for changes in co-morbidity and functional status, to assess the differences in quality of life and activity level. Individual predictors of higher or better quality-of-life scores also were assessed. Results There were no major differences in baseline characteristics between survey responders and nonresponders. Mean follow-up was 4.0 and 3.8 years in the operative and nonoperative groups, respectively. The change in overall LASA from baseline to follow-up between groups was 3.1 ± 0.4 ( P <.001). The adjusted Short-Form-12 score was 14.4 points higher in operative patients ( P <.001) at follow-up. Operative patients had symptomatic improvement as measured by Specific Activity Scale status (odds ratio 7.5, P <.001) and self-reported exercise tolerance (odds ratio 2.61, P = .01) at follow-up compared with nonoperative patients. Predictors of a high follow-up LASA ( P <.05) included initial treatment for depression, percent of weight lost, and absence of dyslipidemia and cardiovascular disease. Follow-up Short-Form-12 predictors included percent of weight loss, absence of baseline diabetes, baseline depression treatment, and follow-up cardiovascular disease. Conclusions Profound weight loss after bariatric surgery, seeking treatment for depression, and absence of medical co-morbidities appears to predict better quality of life and self-reported functional status.

‘Do you think you suffer from depression?’ Reevaluating the use of a single item question for the screening of depression in older primary care patients

The majority of older adults seek depression treatment in primary care. Despite impressive efforts to integrate depression treatment into primary care, depression often remains undetected. The overall goal of the present study was to compare a single item screening for depression to existing depression screening tools. A cross sectional sample of 153 older primary care patients. Participants completed several depression-screening measures (e.g. a single depression screen, Patient Health Questionnaire-9, Major Depression Inventory, Visual Analogue Scale). Measures were evaluated against a depression diagnosis made by the Structured Clinical Interview for DSM-IV. Overall, 3.9% of the sample was diagnosed with depression. The most notable finding was that the single-item question, 'do you think you suffer from depression?' had as good or better sensitivity (83%) than all other screens. Nonetheless, its specificity of 83% suggested that it has to be followed up by a through diagnostic interview. Additional sensitivity analyses concerning the use of a single depression item taken directly from the depression screening measures supported this finding. An easy way to detect depression in older primary care patients would be asking the single question, 'do you think you suffer from depression?'

Digest

AbstractDepressionAntidepressant RCTs meaningful?The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial of sequenced anti‐depressant therapy recruited a broad population of patients representative of outpatients with depression seeking treatment. By contrast, most randomised controlled trials (RCTs) have more restrictive eligibility criteria. STAR*D investigators have now used their data to assess the impact of this aspect of trial design (Am J Psychiatry 2009;166:599–67).They divided 2855 STAR*D participants into a group meeting standard eligibility criteria based on HAM‐D score &gt;19, lack of comorbidity and duration of current episode less than 24 months (22 per cent) and a second group who did not meet these criteria.Those meeting standard criteria were more likely to be seen in specialist centres, were younger, more educated, more likely to be white, wealthier, married and employed, with a shorter mean duration of illness, less substance abuse, fewer suicide attempts and fewer anxiety or atypical symptoms.The response rate to citalopram in the eligible group was 52 per cent compared with 39 per cent in the non‐eligible group; corresponding remission rates were 34 and 25 per cent (number needed to treat (NNT) 10). Participants meeting RCT criteria also experienced fewer moderate or severe adverse events and fewer admissions to hospital.The authors conclude that the usual RCT criteria select an unrepresentative population that favours better outcomes of treatment.Antidepressants increase diabetes riskLong‐term use of higher doses of antidepressants is associated with an increased risk of diabetes, an analysis of UK primary care data has shown (Am J Psychiatry 2009; 166:591–8).The risk of weight gain during treatment with an antidepressant prompted German psychiatrists to explore a possible link with diabetes. Using the UK General Practice Research Database, they identified 165 958 patients without diabetes who received at least one new prescription for an antidepressant between 1990 and 2005. Exposure was categorised as short (&lt;12 months), medium (12–24 months) or long‐term (&gt;24 months), and low‐dose (median dose or lower) or moderate/high‐dose (above median).A total of 2243 new diagnoses of diabetes were confirmed. Compared with non‐use of anti‐depressants within the previous two years and after adjustment for risk factors and other medication, long‐term use of moderate/high doses was associated with a significantly increased risk of diabetes (rate ratio 1.84, CI 95% 1.35–2.52). Lower doses or shorter use were not associated with increased risk and adjusting for depression severity did not alter the findings. For individual antidepressants, significant increases in risk were associated with amitriptyline, fluvoxamine, paroxetine and venlafaxine but numbers in these sub‐groups were low.More on SSRIs in pregnancySSRI use during pregnancy appears to increase the risk of preterm delivery, a relatively small US study suggests (Am J Psychiatry 2009;166:557–66).Neonatal outcomes were compared in 238 women: 131 did not have depression or use an SSRI; 71 with depression used an SSRI during some or all of their pregnancy; and 36 had depression not treated with an SSRI. The latter group consumed more alcohol but did not smoke more than the others.Neither depression nor SSRI use was associated with an increased risk of minor malformations, maternal weight gain, or changes in infant weight or length. After adjustment for age and ethnicity, continuous SSRI use was associated with a five‐ to six‐fold statistically significant increased risk of preterm delivery (&lt;37 weeks); continuous depression was also associated with an increased risk of marginal statistical significance. There were no differences in delivery complications or neonatal development. Copyright © 2009 Wiley Interface Ltd

Racial/Ethnic Differences in Teen and Parent Perspectives toward Depression Treatment

Purpose There are significant racial/ethnic disparities in youth access to and use of appropriate depression treatment. Although there is a growing literature on racial/ethnic differences in treatment preference among adults, we know very little about whether these differences persist for adolescents and whether parents have an influence on their teens’ treatment perspectives. Methods Teens and parents from a sample of primary care settings were interviewed at baseline and 6 months. We used bivarate and regression analyses to describe racial/ethnic differences in teen and parent depression knowledge and treatment preference and to assess the impact of parental views on teen perspectives. Results Latino and African American teens had lower average scores on antidepressant knowledge ( p < .01) and counseling knowledge than white teens ( p < .01). These racial/ethnic differences were greater among parents ( p < .001). Parent antidepressant knowledge had an impact on teen knowledge when teens reported turning to them for advice (β = 0.20, p < .05). Teen knowledge about medication (odds ratio [OR] = 1.16, p < .01) and counseling (OR = 1.26, p < .001) were associated with a willingness to seek active treatment. Conclusions Racial/ethnic differences in depression treatment knowledge persist, but are more pronounced for parents than teens. Talking to parents who have more knowledge about depression treatment is associated with more teen knowledge and that knowledge is associated with greater willingness to seek depression treatment. Research is needed on the content and type of conversations that parents and teens have about depression treatment, and if there are differences by race/ethnicity.

Intention to Seek Depression Treatment in Adolescent Mothers and a Comparison Group of Adolescent Girls

The aims of the study were (a) to determine the efficacy of the theory of reasoned action in predicting intention to seek depression treatment in adolescent mothers (n = 64) and a comparison group of adolescent girls (n = 65) and (b) to explore the role of empirically suggested variables (e.g., social support and current symptoms of depression) in increasing the explanatory power of the model. Findings between the two groups differed. Subjective norms, but not attitude, was a significant predictor of intention to seek depression treatment in adolescent mothers (F = 4.82, P = .00; R(2) = .14). In the comparison group of adolescent girls, both attitude and subjective norms predicted intention to seek depression treatment (F = 8.56, P = .00, R(2) = .22). The addition of depressive symptoms and social support increased the explanatory power of the model in the comparison group of adolescent girls (R(2) change = 0.10, P = .02) but resulted in the deletion of subjective norms from the regression equation. Implications for further research and practice are discussed.