Somatic-affective Symptoms Research Articles

A preliminary review of the Beck Depression Inventory-II (BDI-II) in veterans: Are new norms and cut scores needed?

The Beck Depression Inventory-II (BDI-II) is used within the Veterans Health Administration (VHA) to measure depression symptom severity. This naturalistic study aimed to examine VHA-specific BDI-II use and establish normative data and psychometric properties. Initial BDI-II data for 152,260 individual veterans were extracted from preexisting medical records using the VA Informatics and Computing Infrastructure. BDI-II scores were compared against Beck, Steer, and Brown (1996)'s original sample, as well as across veteran subgroups. Exploratory and confirmatory factor analyses were also conducted. Similar to Beck et al.'s (1996) sample, the BDI-II was most frequently administered in outpatient psychiatric VHA settings, although it was also used in inpatient and medical settings. Veterans scored significantly higher on the BDI-II than the original comparison groups. This was true across diagnostic categories. The largest discrepancy was seen between nondepressed veterans and corresponding patients from the original sample (Cohen's d = 1.34). Older veterans endorsed less severe levels of depression symptomatology. Additionally, a 2-factor model similar to Beck et al.'s (1996) original solution provided the best fit to the data. Veterans reported higher levels of somatic-affective symptoms than cognitive symptoms. Although potentially useful, the BDI-II requires further investigation in veterans. Standard cut scores are not recommended for use in this population when evaluating severity of depression. A cut score of 27 or higher best differentiated between veterans with and without mood disorders in the current sample. Treatment providers should also consider using BDI-II factor scores, rather than the total score, to measure depressive symptom change. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Clinical correlation of vitamin D in depression

Background: Literature has substantially advanced our understanding of the action of vitamin D in depression, much is still unknown concerning how vitamin D relates to dimensions of depression. Hence, authors aimed to examine the relationship of vitamin D in patients of depression, its correlation with the severity of depression and different symptom domains of depression.Methods: This Hospital based case control study included 75 patients with depression and 50 controls who were age and gender matched. Beck’s Depression Inventory II was used to assess the severity and symptom domains of depression. Vitamin D levels was assessed using Enhanced Chemiluminescence Technique.Results: Vitamin D deficiency was found significantly (<0.001*) among cases than controls. Significant (0.003*) inverse correlation was observed between severity of depression and vitamin D level.In cognitive symptoms, pessimism, punishment feeling, self-criticism, suicidal thoughts and worthlessness were found significantly higher among vitamin D deficient patients. However, in somatic-affective symptoms, crying, indecisiveness, loss of energy, irritability, concentration difficulty and being tired were the significant by prominent symptoms in vitamin D deficient patients.Conclusions: Vitamin D (<50 nmol/L) was found to be significantly associated with depressive symptoms with cognitive and somatic-affective symptoms being affected by vitamin D deficiency.

Is it all about Depression? Determinants of Burnout among Employees Referred for Inpatient Treatment of Job-Related Stress Disorders.

Objectives: There is an ongoing debate as to whether job burnout and depression are overlapping concepts or differ from each other, although this has not been scrutinized in inpatients. To further elucidate the robustness of this relationship, we used three different measurements of depression. We further examined the influence of psychological distress, perceived stress and sleep quality in the link between depressive symptoms and burnout. Methods: We investigated 723 consecutive inpatients, aged 23 to 82 years, 51.2 % women, referred to a hospital specialized in the treatment of job stress-related disorders. Patients completed the Maslach Burnout Inventory, the Beck Depression Inventory, the Hospital Anxiety and Depression Scale, the Brief Symptom Inventory, the Perceived Stress Scale, and the Pittsburgh Sleep Quality Index. Results: We found significant correlations between burnout total scores as well as subscales (emotional exhaustion, depersonalization, lack of accomplishment) and depressive symptoms, virtually independent of the applied depression measure. The shared variance ranged between 1.1 % and 19.4 %. Greater levels of burnout were directly associated with cognitiveaffective symptoms and, although to a lesser extent, also with somatic-affective symptoms of depression. In the multivariable analysis, significantly more total burnout symptoms were revealed in more depressed and younger patients, in men than women, and in employees with greater levels of psychological distress and perceived stress, respectively. Conclusions: The findings suggest that although burnout and depression do not represent the same psychopathology, there is considerable overlap between the two constructs; the extent of this overlap may vary depending upon the applied depression measure.

Inpatients with major depressive disorder: Psychometric properties of the new Multidimensional Depression Scale.

The New Multi-dimensional Depression Scale (NMDS) is one of the most comprehensive scales that measures depression symptoms in four domains, including emotional, cognitive, somatic, and interpersonal. This study aimed to evaluate the factor structure and psychometric properties of the NMDS in a group of Iranian inpatients with Major Depressive Disorder (MDD). At first, the scale was translated into Persian and used as part of a battery consisting of the Beck Depression Inventory-II (BDI-II), Oxford Happiness Inventory (OHI), Beck Anxiety Inventory (BAI), and Short Form Health Survey (SF-36). The battery was administered to 271 inpatients with MDD (90 men and 181 women) aged from 18 to 60 who had been referred to psychiatric hospitals in Tehran, Iran. Confirmatory factor analysis of the Persian version of the NMDS upheld its original four-factor structure. Moreover, the results showed its good internal consistency (Cronbach's alpha coefficient ranging from 0.70 for the emotional subscale to 0.83 for the interpersonal subscale). In addition, the NMDS scores were correlated with other constructs in empirically and theoretically expected ways, which provides evidence for the convergent (positive significant relationships with anxiety and cognitive and somatic-affective symptoms of depression) and divergent (negative significant relationships with happiness and mental health and physical health) validity of the scale. These findings supported the Persian version of the NMDS as a reliable and valid measure for the assessment of depression symptoms in patients with MDD.

Changing depressive symptoms following percutaneous coronary intervention, clustering and effect on adherence – The THORESCI study

BackgroundDepressive symptom dimensions may have a differential effect on cardiac prognosis. It is yet unknown whether and how depressive symptoms change together over time and how this may affect disease progression. We examined the clustering of changing depressive symptoms over the first 6 months after percutaneous coronary intervention (PCI), and examined the influence of the change profile on the predictive value of depression for treatment adherence at 6 months post-PCI. MethodsPCI patients (N=219, age: 62±15, 20% women) reported on depressive symptoms (PHQ-9, BDI; 30 symptoms) and adherence (MOS-GAS) at 1 and 6 months post-PCI. Principal component analysis (PCA) was performed on the individual symptom change scores. Multivariable linear regression examined the role of change profiles in predicting general treatment adherence, while adjusting for demographic and clinical characteristics. ResultsFour change-factors emerged from PCA. One somatic-affective change-factor (10 symptoms), two cognitive-affective change-factors (6 general cognitive-affective and 7 severe cognitive symptoms) and one mixed factor were identified. We extracted 5 symptom change profiles. Linear regression showed the moderating role of the change profiles. In patients reporting a net increase in depressive symptoms, higher cognitive affective symptoms (β=−.46, p=.001) and higher somatic-affective symptoms (β=−.29; p=.044) were associated with worse general adherence. DiscussionFour distinct depressive symptom change-factors were identified that moderated the association of somatic-affective and cognitive-affective depressive symptom levels with general treatment adherence. This is of clinical importance as not only current symptoms, but also symptom change over the preceding months may be important to consider in screening and risk prediction.

Neuroimaging and clinical predictors of fatigue in Parkinson disease

BackgroundFatigue is disabling in Parkinson disease. It is often associated with other non-motor symptoms, but little is known about its underlying pathophysiology. ObjectiveTo investigate neuroimaging (using dopaminergic and cholinergic PET) and clinical factors associated with fatigue severity in PD. Methods133 PD subjects (96M/37F) completed the Fatigue Severity Scale, Movement Disorders Society-Sponsored Revision of the Unified PD Rating Scale (MDS-UPDRS), Hoehn-Yahr staging, validated scales for depression, anxiety, apathy, sleep, and cognition, and underwent [11C]methyl-4-piperidinyl propionate (PMP) acetylcholinesterase (AChE) and [11C]dihydrotetrabenazine (DTBZ) monoaminergic PET imaging. We explored contributions to PD fatigue using separate regression models based either on neuroimaging parameters or clinicometric scales. ResultsIn a neuroimaging regression model, neither striatal DTBZ uptake nor AChE PMP uptake were predictors of fatigue in PD. In a post-hoc neuroimaging regression model, stratifying the total cohort into mild vs. moderate-to-severe PD, striatal DTBZ uptake was a significant predictor of fatigue in mild but not moderate-to-severe PD. In a clinicometric regression model, higher Beck Depression Inventory-somatic subscore, higher levodopa dose equivalents and younger age were all significant predictors of fatigue in PD, but the MDS-UPDRS non-motor experiences of daily living score was the best predictor overall. ConclusionsCholinergic uptake was not a predictor of fatigue in PD, but nigrostriatal dopaminergic denervation predicted fatigue in mild disease. Total non-motor symptom burden, somatic affective symptoms, levodopa dose equivalents, and younger age were independent clinical predictors of fatigue.

Evolution of Depressive Symptoms From Pregnancy to the 12th Month Postpartum – a Prospective Study with Non-depressed Women

Objectives To investigate in non-depressed perinatal women, whichBeck Depression Inventory-II (BDI-II) and Postpartum Postpartum DepressionScreening Scale (PDSS) scores and proportions of symptomatic items significantlydiffer through the perinatal period. Methods 273 women were assessed with the Diagnostic Interviewfor Genetic Studies, BDI-II and the PDSS at the third trimester of pregnancy/T0(mean age =29.42±7.159 years; mean weeks gestation=32.6±3.61),three/T1, six/T2 and twelve/T3 months postpartum. Results Significantlyhigher scores in T0 than in T1/T2/T3 and in T1 than in T2/T3 were found for: Total PDSS, Sleeping-Eating Disturbances, Emotional Liability, Total BDI-II andits dimension Somatic-Anxiety. Only T0 and T1/T2 didnot significantly differ in Anxiety/Insecurity, Mental Confusion, and Loss of Self. In Guilty/Shame only T1 was significantly higher than T3. Suicidalthoughts were significantly higher in T0 than T1 and lower in T1 than T2/T3. Theproportions of symptomatic items systematically and significantly decreased fromT0 to T3 in changes of sleep, loss of interest in sex, feeling overwhelmed. Significantlyhigher symptomatic proportions in T0 than in all post-partum moments were foundfor: loss of energy, irritability, fatigue, changes in appetite, crying, indecisiveness and worthlessness (these last three also higher in T1 than inT3). Agitation was significantly higherin T1 than in T0. All the cognitive-affective symptoms from BDI-II and PDSSdid not differ. Conclusion From pregnancy to the twelfth month postpartum the depressivesymptomatology, particularly somatic-affective symptoms, significantlydecreased. However even for the women who are not clinically depressed, theperinatal period requires considerable psychological adjustment.

Associations between depression and diabetes in the community: do symptom dimensions matter? Results from the Gutenberg Health Study.

ObjectivesWhile a bidirectional relationship between diabetes and depression has been established, there is little knowledge if the associations are due to somatic-affective or cognitive-affective dimensions of depression.Research Design and MethodsIn a population-based, representative survey of 15.010 participants we therefore studied the associations of the two dimensions of depression with diabetes and health care utilization among depressed and diabetic participants. Depression was assessed by the Patient Health Questionnaire PHQ-9.ResultsWe found a linear and consistent association between the intensity of depression and the presence of diabetes increasing from 6.9% in no or minimal depression to 7.6% in mild, 9% in moderate and 10.5% in severe depression. There was a strong positive association between somatic-affective symptoms but not with cognitive-affective symptoms and diabetes. Depression and diabetes were both independently related to somatic health care utilisation.ConclusionsDiabetes and depression are associated, and the association is primarily driven by the somatic-affective component of depression. The main limitation of our study pertains to the cross-sectional data acquisition. Further longitudinal work on the relationship of obesity and diabetes should differentiate the somatic and the cognitive symptoms of depression.

Depressive Symptoms and Their Psychosocial Correlates Among Older Somali Refugees and Native Finns

In this study, we analyzed the manifestation of somatic-affective and cognitive depressive symptoms among older Somali refugees and native Finns. Second, we explored how depressive symptoms, alexithymia, and somatization are associated in the two groups. Finally, we analyzed how two psychosocial factors, sense of coherence (SOC) and social support, are connected to depressive symptoms among Somalis and Finns. The participants were examined with the Beck Depression Inventory (BDI) for depressive symptoms, the Symptom Checklist–90–Revised (SCL-90-R) for somatization, Toronto Alexithymia Scale (TAS-20) for alexithymia, and the Sense of Coherence (SOC-13) concept for SOC. Social support was indicated by help received from social networks and marital status. Results showed that Somalis manifested more somatic-affective symptoms of depression than Finns, whereas Finns manifested more cognitive symptoms than Somalis. The association between depressive symptoms and alexithymia was stronger in the Finnish group, whereas the association between depressive symptoms and somatization was stronger in the Somali group. The association between alexithymia and somatization did not differ between the groups. A weak SOC explained depressive symptoms among Somalis and Finns, but poor social support did not explain depression in either group. The results are discussed in relation to Somali and Finnish cultures, mental health beliefs, and immigrant populations.

Predictors of suicidal ideation among depressed veterans and the interpersonal theory of suicide

BackgroundWe assessed whether key constructs of the interpersonal theory of suicide were associated with suicidal ideation in depressed US Veterans. Methods443 patients of the Veterans Health Administration diagnosed with a depressive disorder completed the Beck Depression Inventory, Interpersonal Support Evaluation List, and Beck Hopelessness Scale, from which we derived measures of burdensomeness, belongingness, and hopelessness consistent with the interpersonal theory of suicide. Measures of active and passive suicidal ideation were constructed from the Beck Suicide Scale and Beck Depression Inventory obtained at baseline and 3-months follow-up. Multivariable logistic regression was used to identify predictors of passive and active suicidal ideation while adjusting for demographic characteristics and somatic-affective symptoms of depression (e.g., anhedonia, insomnia). ResultsBurdensomeness and hopelessness were significantly associated with passive suicidal ideation at baseline and 3 months follow-up, but belongingness and the interaction between belongingness and burdensomeness were not significant predictors as proposed by the interpersonal theory of suicide. Somatic-affective depressive symptoms, but not any of the main effects predicted by the interpersonal theory of suicide or their interactions, were associated with active suicidal ideation at baseline. No factors were consistently associated with active suicidal ideation at 3 months follow-up. LimitationsThe measure of burdensomeness used in this study only partially represents the construct described by the interpersonal theory of suicide. ConclusionWe found little support for the predictions of the interpersonal theory of suicide. Hopelessness appears to be an important determinant of passive suicidal ideation, while somatic-affective depression symptoms may be a key contributor to active suicidal ideation.

Somatic-Affective Symptoms of Depression Have a Stronger Association with Insulin Resistance than Cognitive Symptoms

Somatic-Affective Symptoms of Depression Have a Stronger Association with Insulin Resistance than Cognitive Symptoms

Associations between depression and different measures of obesity (BMI, WC, WHtR, WHR)

BackgroundGrowing evidence suggests that abdominal obesity is a more important risk factor for the prognosis of cardiovascular and metabolic diseases than BMI. Somatic-affective symptoms of depression have also been linked to cardiovascular risk. The relationship between obesity and depression, however, has remained contradictory. Our aim was therefore to relate body mass index (BMI) and different measures for abdominal obesity (waist circumference, WC, waist-to-hip ratio, WHR, waist-to-height ratio, WHtR) to somatic vs. cognitive-affective symptoms of depression.MethodsIn a cross-sectional population based study, data on the first N = 5000 participants enrolled in the Gutenberg Health Study (GHS) are reported. To analyze the relationship between depression and obesity, we computed linear regression models with the anthropometric measure (BMI, WC, WHR, WHtR) as the dependent variable and life style factors, cardiovascular risk factors and psychotropic medications as potential confounders of obesity/depression.ResultsWe found that only the somatic, but not the cognitive-affective symptoms of depression are consistently positively associated with anthropometric measures of obesity.ConclusionsWe could demonstrate that the somatic-affective symptoms of depression rather than the cognitive-affective symptoms are strongly related to anthropometric measures. This is also true for younger obese starting at the age of 35 years. Our results are in line with previous studies indicating that visceral adipose tissue plays a key role in the relationship between obesity, depression and cardiovascular disease.

1034 – The metabolic syndrome and late-life depression

The association between depression and metabolic syndrome is becoming more obvious. We examined the relationship between the number and individual components of metabolic syndrome and late-life depressive symptom clusters. In 1279 individuals aged 50 through 70 participating in the Nijmegen Biomedical Study (Cross-sectional populationbased survey), we measured all metabolic syndrome components and depressive symptoms using the Beck Depression Inventory (BDI). Principal components analysis of BDI-items yielded two factors, representing a cognitive-affective and a somatic-affective symptom-cluster. Multiple regression analyses adjusted for confounders were conducted with BDI sum score and both depression symptom-clusters as dependent variables, respectively. We explored the differences in this association between men and women. In fully adjusted models, both presence of the metabolic syndrome as well as number of components was associated with the BDI sumscore(resp. β=0.063;p=0.022 vs. β=0.112;p< 0.001), the latter showing the strongest association. These associations were primarily driven by the somatic-affective symptom-cluster. Testing individual components of the metabolic syndrome, showed that in men waist circumference, triglycerides and HDL cholesterol were significantly associated with depression, whereas in women only the waist circumference. The specific association somatic-affective symptoms suggest confounding by a (subclinical) somatic condition in stead of a real association with classical depression. The identified sex-differences suggest different pathways between depression and metabolic perturbations in men only. However, as vascular disease develops at higher ages in women and findings were in the same direction but non-significant in women, future research in older women sample should confirm our findings.

Depressive symptom clusters are differentially associated with atherosclerotic disease

Depression increases the risk of subsequent vascular events in both cardiac and non-cardiac patients. Atherosclerosis, the underlying process leading to vascular events, has been associated with depression. This association, however, may be confounded by the somatic-affective symptoms being a consequence of cardiovascular disease. While taking into account the differentiation between somatic-affective and cognitive-affective symptoms of depression, we examined the association between depression and atherosclerosis in a community-based sample. In 1261 participants of the Nijmegen Biomedical Study (NBS), aged 50-70 years and free of stroke and dementia, we measured the intima-media thickness (IMT) of the carotid artery as a measure of atherosclerosis and we assessed depressive symptoms using the Beck Depression Inventory (BDI). Principal components analysis (PCA) of the BDI items yielded two factors, representing a cognitive-affective and a somatic-affective symptom cluster. While correcting for confounders, we used separate multiple regression analyses to test the BDI sum score and both depression symptom clusters. We found a significant correlation between the BDI sum score and the IMT. Cognitive-affective, but not somatic-affective, symptoms were also associated with the IMT. When we stratified for coronary artery disease (CAD), the somatic-affective symptom cluster correlated significantly with depression in both patients with and patients without CAD. The association between depressive symptoms and atherosclerosis is explained by the somatic-affective symptom cluster of depression. Subclinical vascular disease thus may inflate depressive symptom scores and may explain why treatment of depression in cardiac patients hardly affects vascular outcome.

Depression among southern rural African American women: a factor analysis of the Beck Depression Inventory-II.

This is the first reported study involving a factor analysis of the Beck Depression Inventory-II, which was administered to a sample of southern rural African American women. To determine the factor structure of the Beck Depression Inventory-II using data collected from southern rural African American women. Using a correlational, descriptive design, 206 southern rural African American women were invited to participate in a face-to-face interview that occurred in a variety of community-based settings. The factor analysis of the Beck Depression Inventory-II resulted in a two-factor solution. Symptoms such as pessimism and worthlessness loaded high on the first factor (cognitive). The second factor explained somatic-affective symptoms of depression, with factor loadings high on tiredness and fatigue and loss of energy. The application of the Beck Depression Inventory-II among African American people would generate needed information about how depressive symptoms may be expressed among them. Knowledge gained from this study promises to be useful for developing appropriate research studies and population-specific treatment approaches for this group of women.