Self-rated Depression Scores Research Articles

Relaxation for depression

Many members of the public have negative attitudes towards antidepressants. Psychological interventions are more acceptable but require considerable therapist training. Acceptable psychological interventions that require less training and skill are needed to ensure increased uptake of intervention. A potential intervention of this sort is relaxation techniques. To determine whether relaxation techniques reduce depressive symptoms and improve response/remission. The register of trials kept by the Cochrane Collaboration Depression, Anxiety and Neurosis Group was searched up to February 2008. We also searched the reference lists of included studies. Studies were included if they were randomised or quasi-randomised controlled trials of relaxation techniques (progressive muscle relaxation, relaxation imagery, autogenic training) in participants diagnosed with depression or having a high level of depression symptoms. Self-rated and clinician-rated depression scores and response/remission were the primary outcomes. Two reviewers selected the trials, assessed the quality and extracted trial and outcome data, with discrepancies resolved by consultation with a third. Trial authors were approached for missing data where possible and missing data were estimated or imputed in some cases. Continuous measures were summarised using standardised mean differences and dichotomous outcomes by risk ratios. There were 15 trials with 11 included in the meta-analysis. Five trials showed relaxation reduced self-reported depression compared to wait-list, no treatment, or minimal treatment post intervention (SMD -0.59 (95% CI -0.94 to -0.24)). For clinician-rated depression, two trials showed a non-significant difference in the same direction (SMD -1.35 (95% CI -3.06 to 0.37)).Nine trials showed relaxation produced less effect than psychological (mainly cognitive-behavioural) treatment on self-reported depression (SMD = 0.38 (95% CI 0.14 to 0.62)). Three trials showed no significant difference between relaxation and psychological treatment on clinician-rated depression at post intervention (SMD 0.29 (95% CI -0.18 to 0.75)).Inconsistent effects were found when comparing relaxation training to medication and there were few data available comparing relaxation with complementary and lifestyle treatments. Relaxation techniques were more effective at reducing self-rated depressive symptoms than no or minimal treatment. However, they were not as effective as psychological treatment. Data on clinician-rated depressive symptoms were less conclusive. Further research is required to investigate the possibility of relaxation being used as a first-line treatment in a stepped care approach to managing depression, especially in younger populations and populations with subthreshold or first episodes of depression.

New Evidence for the Association of the Serotonin Transporter Gene (SLC6A4) Haplotypes, Threatening Life Events, and Depressive Phenotype

Since the first report of the significant gene-environment interaction (G x E) in depression published by Caspi et al., the literature is considerably contradictory in this field. To clarify this question, we analyzed the interaction between the serotonin transporter gene (SLC6A4) and threatening life events (TLE) on Zung Self-Rating Depression Score (ZSDS). Five markers tagging the whole SLC6A4 gene (5-HTTLPR and 4 single nucleotide polymorphisms: rs2020942, rs140700, rs3798908, rs1042173) were genotyped in 567 nonclinical individuals. Generalized linear models were used to analyze single marker associations, and likelihood ratio tests and score tests were used for haplotype analysis. Haplotype analysis revealed a significant global effect of haplotypes on ZSDS score in high TLE subgroup (p = .008). Besides the 5-HTTLPR, rs140700 tagging the middle region of the gene had significant effects. Subjects carrying the A allele of rs140700 scored lower on ZSDS independently of 5-HTTLPR carrier status. Explained variances for depressive phenotype were 1%, 4%, and 6% when 5-HTTLPR, 5-HTTLPR x TLE and 5-HTTLPR x rs140700 x TLE were included in the model, respectively. Our results demonstrate heterogeneity of individuals carrying S alleles of 5-HTTLPR in association with high TLE providing possible explanation for the inconsistency of previous studies. In addition to the promoter, the middle region of the SLC6A4 gene carries the G x G x E interaction for mood, and this new model provided a higher explained variance. We report the first evidence for the significant effects of haplotypes of the SLC6A4 gene and threatening life events on depressive phenotype.

95 Additive prognostic value of self-rating depression scores and plasma B-type natriuretic peptide in chronic heart failure

95 Additive prognostic value of self-rating depression scores and plasma B-type natriuretic peptide in chronic heart failure

Treatments for Later-Life Depressive Conditions: A Meta-Analytic Comparison of Pharmacotherapy and Psychotherapy

To improve interventions for depressed older adults, data are needed on the comparative effects of pharmacotherapy versus psychotherapy. Given that most older adults with clinically significant depressive symptoms do not have major depression, data on treatments for minor depression and dysthymia are especially needed. Meta-analysis was used to integrate the results of 89 controlled studies of treatments focused on acute major depression (37 studies) and other depressive disorders (52 studies conducted with mixed diagnostic groups, including patients with major depression, minor depression, and dysthymia). A total of 5,328 older adults received pharmacotherapy or psychotherapy in these studies. Clinician-rated depression scores improved, on average, by 0.80 standard deviation (SD) units; self-rated depression scores improved by 0.76 SD units. Clinician-rated depression improved by 0.69 SD units in pharmacotherapeutic studies and by 1.09 SD units in psychotherapeutic studies. Self-rated depression improved by 0.62 SD units and 0.83 SD units, respectively. An interesting finding was the stronger improvements in clinician-rated depression among control subjects participating in medication studies, compared to those in psychotherapeutic studies. Available treatments for depression work, with effect sizes that are moderate to large. Comparisons of psychotherapy and pharmacotherapy must be interpreted with caution, in part because medication studies are more likely to use a credible active placebo, which may lead to smaller adjusted effect sizes in medication studies. Given that psychotherapy and pharmacotherapy did not show strong differences in effect sizes, treatment choice should be based on other criteria, such as contraindications, treatment access, or patient preferences.

Treatments for Later-Life Depressive Conditions: A Meta-Analytic Comparison of Pharmacotherapy and Psychotherapy

Objective: To improve interventions for depressed older adults, data are needed on the comparative effects of pharmacotherapy versus psychotherapy. Given that most older adults with clinically significant depressive symptoms do not have major depression, data on treatments for minor depression and dysthymia are especially needed. Method: Meta-analysis was used to integrate the results of 89 controlled studies of treatments focused on acute major depression (37 studies) and other depressive disorders (52 studies conducted with mixed diagnostic groups, including patients with major depression, minor depression, and dysthymia). A total of 5,328 older adults received pharmacotherapy or psychotherapy in these studies. Results: Clinician-rated depression scores improved, on average, by 0.80 standard deviation (SD) units; self-rated depression scores improved by 0.76 SD units. Clinician-rated depression improved by 0.69 SD units in pharmacotherapeutic studies and by 1.09 SD units in psychotherapeutic studies. Self-rated depression improved by 0.62 SD units and 0.83 SD units, respectively. An interesting finding was the stronger improvements in clinician-rated depression among control subjects participating in medication studies, compared to those in psychotherapeutic studies. Conclusions: Available treatments for depression work, with effect sizes that are moderate to large. Comparisons of psychotherapy and pharmacotherapy must be interpreted with caution, in part because medication studies are more likely to use a credible active placebo, which may lead to smaller adjusted effect sizes in medication studies. Given that psychotherapy and pharmacotherapy did not show strong differences in effect sizes, treatment choice should be based on other criteria, such as contraindications, treatment access, or patient preferences.

The Self-Efficacy Questionnaire for Depression in Adolescents (SEQ-DA)

The 12-item clinician or self-administered Self-Efficacy Questionnaire for Depression in Adolescents (SEQ-DA) was developed as a measure of perceived ability to cope with depressive symptomatology. This study examined the reliability and validity of the SEQ-DA in a clinical population of 130 adolescents that were receiving treatment for depression. Psychometric evaluation revealed good internal consistency and test-retest reliability. Results indicated that higher SEQ-DA scores were associated with lower self-rated depression scores (Reynolds Adolescent Depression Scale), which is evidence of good construct validity. Further, higher SEQ-DA scores prior to treatment predicted better outcome at the end of the 3 months of treatment and at 6 months post-treatment. Therefore, the SEQ-DA has a potentially useful role in clinical work and research with depressed young people.

Effects of home massage rehabilitation therapy for the bed-ridden elderly: a pilot trial with a three-month follow-up

To assess the effects of home massage rehabilitation therapy on the bed-ridden elderly. Alternatively allocated trial. Subjects' homes, three home nursing stations, 13 visit care stations and one day service centre in Aichi prefecture, Japan. Bed-ridden patients who were 65 years and above, no dementia, stable general condition, and receiving no rehabilitation therapy. Thirty-minute sessions of home massage rehabilitation therapy by a massage practitioner 2 or 3 days a week for three consecutive months or usual care. Barthel Index (BI), Subjective Satisfaction and Refreshment Scale, Apathy Scale and Self-rating Depression Score. Fifty-three subjects were recruited, 26 in the home massage rehabilitation group (HMG) and 27 in the routine care group without massage (RCG). The protocol was completed for 40 subjects, 22 in the HMG and 18 in the RCG. There were no significant differences between the baseline characteristics of both groups; age, presence of spouse, diseases associated with disabilities and use of day care rehabilitation (p = 0.76, 0.36, 0.94 and 0.71, respectively). The total BI score of the HMG (15.27+/-4.51) at baseline was nonsignificantly lower (p= 0.03) than those of the RCG (11.44+/-5.90). Subjective Satisfaction and Refreshment Scale, Apathy Scale and Self-rating Depression Score of both groups at baseline were matched (p = 0.12, 0.32 and 0.89, respectively). There were no statistical differences between the intergroup changes over time in BI, Subjective Satisfaction and Refreshment Scale, Apathy Scale and Self-rating Depression Score (p = 0.35, 0.08, 0.70 and 0.55, respectively). Home massage rehabilitation therapy did not show a positive effect on the bed-ridden elderly, either mentally or physically. We would require large-size trials to determine whether it is effective.

Empathy and aggression: two faces of ecstasy? A study of interpretative cognitive bias and mood change in ecstasy users.

As central 5-hydroxytryptamine (5-HT) is attenuated for a period following a single dose of MDMA ("ecstasy") and low 5-HT is associated with aggression, then MDMA users may be more aggressive in the days following an acute dose of the drug. This study therefore aimed to determine if acute use of MDMA is associated with aggression 4 and 7 days later. Twenty-nine MDMA users and 32 controls were compared on self-rated aggression and depression on the night of drug use (day 0), 4 and 7 days later. On day 4, participants performed an interpretative bias task in which they processed ambiguous sentences that could be interpreted in either an aggressive or neutral way (e.g. "The painter drew the knife"). MDMA users had faster response times in completing ambiguous aggressive sentences than neutral sentences; controls showed the opposite pattern of performance. In a subsequent recognition task, MDMA users were more confident in judging, and responded faster to, aggressive than neutral sentences; controls again showed the opposite pattern of effects. The level of aggressive interpretative bias positively correlated with extent of MDMA use. Midweek, MDMA users had higher self-rated aggression and depression scores than controls; on day 7, scores of both groups were similar. MDMA users display a cognitive bias towards interpreting ambiguous information in an aggressive way a few days after taking the drug. Self-rated mid-week low mood and mid-week aggression do not persist 7 days after use of the drug. This pattern of results is consistent both with the acute and residual effects of MDMA on central 5-HT and with the notion that 5-HT plays a role in modulating human aggression.

Persistent social dysfunction in anxious and depressed patients with personality disorder.

To determine the long-term social function of psychiatric patients with anxiety and depressive disorders and to relate this to personality status and other factors. A cohort of 210 patients (mean age 35 years) with dysthymic disorder, generalized anxiety disorder or panic disorder diagnosed using a structured interview (SCID) were assessed at baseline for personality status using the Personality Assessment Schedule (PAS) and ratings of anxiety and depression. Exactly 12 years later social function was assessed using the Social Functioning Questionnaire (SFQ) and personality reassessed with the PAS by a rater blind to initial personality status. Individual social function items were examined in those with and without personality disorders. Social function was significantly better in those with little or no baseline personality disturbance (P < 0.001) and the domains of close relationships, stress in completing tasks, use of spare time and family relationships showed the largest personality differences. A multiple linear regression model showed that self-rated depression scores, single marital status and personality status were the main baseline variables predicting social function at 12 years. Although personality characteristics may change over time social dysfunction persists and persistent social dysfunction in mental state disorders may be a strong indicator of personality disturbance rather than an indicator of treatment resistance.

Dialectical Behavior Therapy for Depressed Older Adults: A Randomized Pilot Study

OBJECTIVE Although there is evidence for the efficacy of antidepressants and for some individual and group psychotherapy interventions for depressed older adults, a significant number of these do not respond to treatment. Authors assessed the benefits of augmenting medication with group psychotherapy. METHODS They randomly assigned 34 (largely chronically) depressed individuals age 60 and older to receive 28 weeks of antidepressant medication plus clinical management, either alone (MED) or with the addition of dialectical behavior therapy skills-training and scheduled telephone coaching sessions (MED+DBT). RESULTS Only MED+DBT showed significant decreases on mean self-rated depression scores, and both treatment groups demonstrated significant and roughly equivalent decreases on interviewer-rated depression scores. However, on interviewer-rated depression, 71% of MED+DBT patients were in remission at post-treatment, in contrast to 47% of MED patients. At a 6-month follow-up, 75% of MED+DBT patients were in remission, compared with only 31% of MED patients, a significant difference. Only patients receiving MED+DBT showed significant improvements from pre- to post-treatment on dependency and adaptive coping that are proposed to create vulnerability to depression. CONCLUSION Results from this pilot study suggest that DBT skills training and telephone coaching may offer promise to effectively augment the effects of antidepressant medication in depressed older adults. Although there is evidence for the efficacy of antidepressants and for some individual and group psychotherapy interventions for depressed older adults, a significant number of these do not respond to treatment. Authors assessed the benefits of augmenting medication with group psychotherapy. They randomly assigned 34 (largely chronically) depressed individuals age 60 and older to receive 28 weeks of antidepressant medication plus clinical management, either alone (MED) or with the addition of dialectical behavior therapy skills-training and scheduled telephone coaching sessions (MED+DBT). Only MED+DBT showed significant decreases on mean self-rated depression scores, and both treatment groups demonstrated significant and roughly equivalent decreases on interviewer-rated depression scores. However, on interviewer-rated depression, 71% of MED+DBT patients were in remission at post-treatment, in contrast to 47% of MED patients. At a 6-month follow-up, 75% of MED+DBT patients were in remission, compared with only 31% of MED patients, a significant difference. Only patients receiving MED+DBT showed significant improvements from pre- to post-treatment on dependency and adaptive coping that are proposed to create vulnerability to depression. Results from this pilot study suggest that DBT skills training and telephone coaching may offer promise to effectively augment the effects of antidepressant medication in depressed older adults.

A study of factors influencing intensity and annoyance in vertigo or dizziness

For 74 men and 123 women averaging 52.5 years of age with vertigo and dizziness, we recorded the age, gender, vertigo type, duration of illness, concomitant symptoms, and vestibular and psychological test results and used a 100 mm horizontal visual analog scale (VAS) to quantitatively assess sensation intensity and annoyance in vertigo or dizziness. Factors influencing these 2 quantitative assessment parameters were analyzed by stepwise multiple regression analysis. Factors influencing sensation intensity were nausea or vomiting as a concomitant symptom, duration of vertigo or dizziness (within a day), and first episode onset. Intensity of sensation to vertigo or dizziness, self-rating depression score (SDS), and gender (female) were selected as significantly influencing annoyance. These results suggest that rational care of significant factors that involve the intensity and annoyance in vertigo is essential to treating patients with vertigo or dizziness.

Dialectical Behavior Therapy for Depressed Older Adults: A Randomized Pilot Study

Although there is evidence for the efficacy of antidepressants and for some individual and group psychotherapy interventions for depressed older adults, a significant number of these do not respond to treatment. Authors assessed the benefits of augmenting medication with group psychotherapy. They randomly assigned 34 (largely chronically) depressed individuals age 60 and older to receive 28 weeks of antidepressant medication plus clinical management, either alone (MED) or with the addition of dialectical behavior therapy skills-training and scheduled telephone coaching sessions (MED+DBT). Only MED+DBT showed significant decreases on mean self-rated depression scores, and both treatment groups demonstrated significant and roughly equivalent decreases on interviewer-rated depression scores. However, on interviewer-rated depression, 71% of MED+DBT patients were in remission at post-treatment, in contrast to 47% of MED patients. At a 6-month follow-up, 75% of MED+DBT patients were in remission, compared with only 31% of MED patients, a significant difference. Only patients receiving MED+DBT showed significant improvements from pre- to post-treatment on dependency and adaptive coping that are proposed to create vulnerability to depression. Results from this pilot study suggest that DBT skills training and telephone coaching may offer promise to effectively augment the effects of antidepressant medication in depressed older adults.

Assessing the effects of age, sex and shared environment on the genetic aetiology of depression in childhood and adolescence.

Depressive symptoms and disorder are experienced by a significant proportion of young people and have long-lasting deleterious effects. The aims of the current investigation were to examine the aetiology of depressive symptoms using a twin design. In particular to examine the effects of sex, age, maternal depression and anxiety symptoms and to examine the aetiology of high depression scores. Questionnaires were sent to the families of a population-based sample of twins aged between 8 and 17 years. Parents and children over the age of 11 were asked to complete the Mood and Feelings Questionnaire and Hospital Anxiety and Depression Scale (mothers only). Responses were obtained from 1463 families and data were analysed using genetic model fitting and DeFries and Fulker regression analysis. Depressive symptoms, particularly when self-rated, were significantly genetically influenced. There was evidence of significant heterogeneity according to age, with shared environmental factors more important and genetic factors less important for children aged 8 to 10 than for adolescents aged 11 to 17 years. Some but not all of the shared environmental influences on parent-rated depressive symptoms were accounted for by maternal symptoms of depression and anxiety. There was a significant effect of gender for self-rated depressive symptoms. For boys, genetic factors were of greater importance and common environmental influences of less importance than for girls. Shared environmental effects had a substantial influence on high self-rated depression scores. Adolescents who scored highly on self-rated depression questionnaires experienced significantly more shared life events and their mothers had significantly higher internalising symptoms than adolescents who scoredwithin the normal range. The results of this study add to the evidence that the aetiology of depressive symptoms differs by age, with genetic factors becoming more important from childhood to adolescence. Some but not all of the shared environmental effect observed for mother-rated depression scores is due to maternal depression and anxiety symptoms. For self-rated depressive symptoms, the importance of genetic and environmental factors may also differ by sex, with genetic influences more important for boys. The aetiology of high depression symptom scores, when self-rated, appears to differ from scores within the normal range in that shared environmental factors appear to be more important. Further research is needed to identify these shared environmental factors using longitudinal models that test genetic and environmental mediation.

Psychosocial study of depression in early pregnancy.

The psychosocial correlates of depression during pregnancy were explored. Pregnant women attending the antenatal clinic of a general hospital (n = 1329) received a set of questionnaires including Zung's Self-Rating Depression Score (SDS). SDS high scores (> 49) (the cases: n = 179) were compared with low scores (< 38) (the controls; n = 343). The cases were characterised by: first delivery; more nausea, vomiting, and anorexia; more menstrual pains and premenstrual irritability; early paternal loss; lower maternal care and higher paternal overprotection; higher public self-consciousness score; more smoking and use of medication in pregnancy; unwanted pregnancy; negative psychological response to the pregnancy by the woman and husband; poor intimacy by the husband; and having remarried. Depression in early pregnancy is determined mainly by psychosocial factors.

Harman and Norharman in Alcoholism: Correlations with Psychopathology and Long‐Term Changes

In the search for mechanisms specific for alcoholism, it has become evident that beta-carbolines (BCs; e.g., harman and norharman) are compounds that may act on brain reward systems, thereby mediating an increase in voluntary ethanol (ETOH) drinking in animals. This study was undertaken to analyze relationships between these compounds and clinical variables (e.g., family history, personality data, and affect) in alcoholics and to trace the time course of blood concentrations in subjects abstaining from alcohol for at least 6 months. Nonalcoholics were investigated during sober and ETOH-loading conditions (1 g ETOH/kg body weight). Levels of harman were elevated in the chronically intoxicated alcoholics and correlated with the scores on the self-rating depression (SDS) and the self-rating anxiety (SAS) scales. The group of alcoholics with at least one alcoholic parent had higher levels than the group without such a history. Levels remained elevated for 6 months. Norharman levels were only slightly elevated on the day of admission. They were correlated to high harm avoidance and SDS scores. A family history of alcoholism and the severity of alcoholism as assessed by the number of ICD-10 criteria fulfilled were correlated with norharman levels. Long-term observation revealed elevated levels of norharman after 3 months of abstinence, but not after 6 months. The association of harman levels with anxiety and depression demonstrated in the present study suggests that alcoholics with high harman levels use alcoholic beverages as self-medication in an attempt to overcome possible anxiogenic/depressiogenic actions of harman. Norharman levels are less strongly associated with these mood states, but significantly correlated to harm avoidance tendencies. It has been suggested that the activity of the indolergic neurons is relatively high in individuals with a high harm avoidance score. Biosynthesis of norharman might be stimulated under these conditions (tryptamine serves as precursor).

Depression in Substance-Dependent Delinquents

Depression often is comorbid with conduct disorder. The purpose of this study is to assess whether, among youths with conduct disorder, those with depression differ in other ways from those without depression. Ninety-nine delinquent boys (aged 13 through 19 years) were evaluated with the Diagnostic Interview Schedule for Children and other instruments. All boys had conduct disorder and substance use disorders. Staff-rated and self-rated depression scores correlated significantly. Twenty-one boys had major depression and/or dysthymia. Depressed boys had more substance dependence diagnoses and were more likely to have attention-deficit hyperactivity disorder, posttraumatic stress disorder, and anxiety disorders, compared with the nondepressed boys. Depressed boys tended to develop conduct symptoms earlier than did the nondepressed boys. Depression scores did not change after at least 4 weeks of abstinence, for either depressed or nondepressed boys. Depressed delinquents have more substance dependence diagnoses, tend to initiate behavioral problems at an earlier age, have increased anxiety and attentional problems, and more trauma effects, than nondepressed delinquents. Depression does not appear to be related to substance intoxication, since it is not alleviated after 4 weeks of abstinence. Such boys may require combined psychiatric and substance treatment.

Seasonality in severity of depression: relationships to suicide and homicide occurrence.

Some previous studies have reported seasonal or monthly variations in the occurrence of depressive syndromes. The present study was carried out in order to investigate seasonality in severity of depression. Toward this end, the authors measured the Zung Self-Rating Depression (ZD) and Anxiety (ZA) Scales scores in 104 consecutively admitted depressed patients between November 1983 and April 1985. The data were analyzed by means of spectral analysis of a single time series. Up to 47.9% of the variance in the weekly average of the ZD scores could be explained by two significant rhythms of 51 (circannual) and 7 weeks. Peaks in ZD scores were observed in April-May, with lows occurring in August-September. Up to 30.8% of the variance in the weekly average of ZA scores was explained by a circannual rhythm. Our results show that there is a true seasonality in the severity of illness of depressed subjects. There were significant correlations between the weekly average in severity of illness and the chronograms of suicide (positively) and homicide (negatively) occurrence in Belgium.

Depression and diabetic neuropathy: a complex relationship.

In a group of 64 non-insulin-dependent diabetic females, a significant positive correlation between Zung self-rated depression scores and objective measurements of diabetic peripheral neuropathy was limited to those women with Zung scores greater than 50 (depressed group, n = 12). In the overall group, there was no significant linear or quadratic relationship between peripheral neuropathy and depression scores. The associations between depression, peripheral neuropathy, and diabetes are discussed.

The prevalence of neuropathic symptoms in diabetic patients newly referred to our hospital.

100 diabetic patients who were newly referred to our hospital and 50 normal controls received 1) physical and chemical examinations, 2) a self-rating depression score (SDS), and 3) an examination consisting of 18 questions to detect subjective neuropathic symptoms. Many more neuropathic symptoms were found in diabetics than in normal controls; these symptoms included pain and numbness of the extremities, cold sensation, dizziness, constipation, impotence and sweating disorders. Few patients with neuropathic symptoms, however, exhibited neurological findings (tendon reflex, sensory disturbance or dorsal pulsation) or blood glucose control measured by HbA1. The likelihood of symptoms in the feet or in the urogenital tract increased with the duration of diabetes mellitus. Diabetics were significantly more depressive than normal controls shown by the result of SDS.

A Cross-Cultural Survey of Depressive Symptomatology in Normal Adults

Depression as a diagnostic entity consists of signs and symptoms which may be manifest in normal individuals. The purpose of this study was to determine how much depressive symptomatology as measured by the Self-rating Depression Scale is present in a normal adult population representing different countries and cultures. A total of 1981 normal subjects was tested in six countries. Rank ordering of the mean SDS indices showed Czechoslovakia to be highest, followed by Sweden, Germany, Spain, England, and the U. S. A. Statistical testing by using analysis of variance indicated that these differences were quantitatively significant. Factor analysis of items indicated qualitative similarities across the countries studied, as evidenced by the fact that loadings were larger on items reflecting the psychological features of depression in all countries studied. This is in contrast to factor analysis results of previous data from depressed patients, where the factor loadings contained physiological as well as psychological items. A similarity between rank ordering of self-rated depression scores and reported suicide death rates for the countries studied was noted.