Risk Of Subsequent Depression Research Articles

Frequency of contact with non-cohabitating adult children and risk of depression in elderly: A community-based three-year longitudinal study in Korea

PurposeOur study aimed to assess the longitudinal association of frequency of contact with non-cohabitating adult children and risk of depression in the elderly. MethodsElderly aged ≥60 years were included from Living Profiles of Older People Survey (LPOPS) in Korea. The baseline assessment, Wave 1, was conducted in 2008, and follow-up assessment, Wave 2, was conducted in 2011. We included participants who completed both waves and excluded those who met the following criteria: no adult children, living with adult children, cognitive impairment at either waves, and depression at baseline (n=4398). We defined infrequent contact as <1 time per month face-to-face contact or <1 time per week phone contact and classified participants into four groups based on contact method and frequency. Depression was measured using the 15-item geriatric depression scales (SGDS-K). ResultsIn multivariable logistic regression analysis, infrequent face-to-face and phone contact group had adjusted odds ratio (OR) of 1.86 (95% CI, 1.44–2.42) when compared with frequent face-to-face and phone contact group. Frequent face-to-face contact with infrequent phone contact group and infrequent face-to-face contact with frequent phone contact group had adjusted OR of 1.49 (95% CI, 1.12–1.98) and 1.44 (95% CI, 1.15–1.80), respectively, when compared with frequent face-to-face and phone contact group. ConclusionThese results propose that the risk of subsequent depression in elderly is associated with frequency of contact with non-cohabitating adult children. Moreover, the efficacy of face-to-face contact and that of phone contact were similar, while the group lacking both types of contact demonstrated the highest risk of depression.

The impact of involuntary exit from employment in later life on the risk of major depression and being prescribed anti-depressant medication

Objectives: Involuntary employment exit in later life has been shown to be a risk factor for poor physical and mental health. This study aims to examine the relationship between involuntary employment exit in later life and subsequent risk of reporting major depression or being prescribed anti-depressant medication (ADM).Method: Data were drawn from four waves of the Swedish Longitudinal Occupational Survey of Health (SLOSH). This is a nationally representative longitudinal cohort survey of persons employed in Sweden in 2003 and 2005. The sample was restricted to respondents who had exited the labour market aged 50+ years between 2006 and 2012 (N = 1433). Major depression was measured using the Symptom Checklist Core Depression Scale (SCL-CD6). Prescription ADM redeemed from a pharmacy was based on the National Prescribed Drug Register.Results: After controlling for socio-demographic variables, health, health behaviours, and baseline depression, involuntary employment exit was associated with an increased risk of reporting major depression (OR 3.16; CI 1.32–7.61) and becoming newly prescribed ADM (HR 2.08; CI 1.03–4.21) compared to voluntary employment exit.Conclusion: Involuntary employment exit represents a risk for subsequent depression in later life. Mental health and social services ought to consider identifying these individuals for possible intervention programs to reduce the burden of depression in later life.

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AbstractYouth with psychosis‐spectrum symptoms found to have neurocognitive delaysSuicide attempts no greater with some antidepressants than othersAnxiety and disruptive behavior increase risk of subsequent depression in children with ADHDStudy finds long‐lasting effects of SSRIs in brains of monkeysSide effects increase with number of psychiatric medications in childrenADHD medications increasing among young womenAtomoxetine‐induced hypomania in a 10‐year‐old boy with ADHD and social anxietyEffexor recall

Physical activity patterns and risk of depression in young adulthood: a 20-year cohort study since childhood

Little is known about how physical activity patterns during childhood and adolescence are associated with risk of subsequent depression. We examined prospective and retrospective associations between leisure physical activity patterns from childhood to adulthood and risk of clinical depression in young adulthood. Participants (759 males, 871 females) in a national survey, aged 9-15 years, were re-interviewed approximately 20 years later. Leisure physical activity was self-reported at baseline (1985) and follow-up (2004-2006). To bridge the interval between the two time-points, historical leisure activity from age 15 years to adulthood was self-reported retrospectively at follow-up. Physical activity was categorized into groups that, from a public health perspective, compared patterns that were least beneficial (persistently inactive) with those increasingly beneficial (decreasing, increasing and persistently active). Depression (major depressive or dysthymic disorder) was assessed using the Composite International Diagnostic Interview. Compared with those persistently inactive, males who were increasingly and persistently active had a 69 and 65 % reduced risk of depression in adulthood, respectively (all p < 0.05). In retrospective analyses, females who were persistently active had a 51 % reduced risk of depression in adulthood (p = 0.01). Similar but non-significant trends were observed for leisure physical activity in females and historical leisure activity in males. Results excluded those with childhood onset of depression and were adjusted for various sociodemographic and health covariates. Findings from both prospective and retrospective analyses indicate a beneficial effect of habitual discretionary physical activity since childhood on risk of depression in young adulthood.

Depressive symptoms and body mass index: co-morbidity and direction of association in a British birth cohort followed over 50 years.

An unhealthy body mass index (BMI) has been associated with depression but the direction of association is uncertain. Our aim was to estimate the co-morbidity and direction of association between BMI and depressive symptoms at several ages, from childhood to mid-adulthood. The data were from 18,558 individuals born in 1 week in March 1958, in England, Scotland and Wales, with follow-up at ages 7, 11, 16, 23, 33, 42, 45 and 50 years. Depression (scores>or=90th percentile) was identified from child/adolescent (teacher questionnaires) and adult (self-complete questionnaires and clinical interview) measures. BMI (kg/m2) measured in child/adolescence and adulthood was classified as underweight, normal, overweight or obese. In cross-sectional analyses, obesity and underweight (not overweight) from 11 to 45 years were associated respectively with 1.3-2.1 and 1.5-2.3 times the risk of depression compared with normal weight. Using the time-lagged generalized estimating equation (GEE) approach, we tested (a) whether underweight or obesity at prior ages (7 to 45 years) predicted subsequent risk of depression (11 to 50 years), adjusting for baseline depression; and (b) whether depression at prior ages (7 to 42 years) predicted subsequent risk of underweight or obesity (11 to 45 years), adjusting for baseline BMI. In longitudinal analyses, underweight predicted subsequent depression in both sexes [odds ratio (OR) 1.25, 95% confidence interval (CI) 1.11-1.40] and depression predicted subsequent underweight in males only (OR 1.84, 95% CI 1.52-2.23). Obesity predicted subsequent depressive symptoms in females only (OR 1.34, 95% CI 1.14-1.56), but depression did not predict obesity. Clinicians should consider screening routinely for depression patients with unhealthy BMI, namely underweight and obesity, and vice versa.

Physical Activity and the Prevention of Depression

Given its high prevalence and impact on quality of life, more research is needed in identifying factors that may prevent depression. This review examined whether physical activity (PA) is protective against the onset of depression. A comprehensive search was conducted up until December 2012 in the following databases: MEDLINE, Embase, PubMed, PsycINFO, SPORTDiscus, and Cochrane Database of Systematic Reviews. Data were analyzed between July 2012 and February 2013. Articles were chosen for the review if the study used a prospective-based, longitudinal design and examined relationships between PA and depression over at least two time intervals. A formal quality assessment for each study also was conducted independently by the two reviewers. The initial search yielded a total of 6363 citations. After a thorough selection process, 30 studies were included for analyses. Among these, 25 studies demonstrated that baseline PA was negatively associated with a risk of subsequent depression. The majority of these studies were of high methodologic quality, providing consistent evidence that PA may prevent future depression. There is promising evidence that any level of PA, including low levels (e.g., walking <150 minutes/weeks), can prevent future depression. From a population health perspective, promoting PA may serve as a valuable mental health promotion strategy in reducing the risk of developing depression.

Vitamin D and common mental disorders in mid-life: Cross-sectional and prospective findings

The relationship between vitamin D and common mental disorders (CMDs) remains unclear. We aimed to determine if behaviours affecting vitamin D concentrations differ between individuals with or without CMDs and evaluate, cross-sectionally and prospectively, the extent to which the association between 25(OH)D and CMDs are explained by these behaviours. Data are from the 1958 British birth cohort (n=7401). Behaviours were ascertained by questionnaire at age 45 years. CMDs (depression, anxiety, panic, phobia) were assessed using the Clinical Interview Schedule-Revised at 45 years and depression using Mental Health Inventory-5 at 50 years. Participants with CMDs at 45 years differed from others on some but not all vitamin D related behaviours. There were inverse, cross-sectional associations at 45 years of 25(OH)D with depression and panic, which persisted after adjustment for vitamin D related behaviours (OR=0.57, 95% CI: 0.40,0.81 and OR=0.33, 95% CI: 0.40,0.81, respectively). Association between 25(OH)D and subsequent (50 years) risk of depression was non-linear (p=0.01), with lower risk for participants with 25(OH)D between 50 and 85nmol/l compared with those with lower or higher concentrations. This study provides support for an association of low 25(OH)D concentrations with current and subsequent risk of depression in mid-adulthood.

Cortisol and depression: three questions for psychiatry

Cortisol plays a multifaceted role in major depression disorder (MDD). Diurnal rhythms are disturbed, there is increased resistance to the feedback action of glucocorticoids, excess cortisol may induce MDD, basal levels may be higher and the post-awakening cortisol surge accentuated in those at risk for MDD. Does this suggest new avenues for studying MDD or its clinical management? The relevant literature was reviewed. Cortisol contributes to genetic variants for the risk for MDD and the way that environmental events amplify risk. The corticoids' influence begins prenatally, but continues into adulthood. The impact of cortisol at each phase depends not only on its interaction with other factors, such as psychological traits and genetic variants, but also on events that have, or have not, occurred previously. This review suggests that the time is now right for serious consideration of the role of cortisol in a clinical context. Estimates of cortisol levels and the shape of the diurnal rhythm might well guide the understanding of subtypes of MDD and yield additional indicators for optimal treatment. Patients with disturbed cortisol rhythms might benefit from restitution of those rhythms; they may be distinct from those with more generally elevated levels, who might benefit from cortisol blockade. Higher levels of cortisol are a risk for subsequent depression. Should manipulation of cortisol or its receptors be considered as a preventive measure for some of those at very high risk of future MDD, or to reduce other cortisol-related consequences such as long-term cognitive decline?

Diabetes mellitus and risk of subsequent depression: A longitudinal study

BackgroundFindings of previous studies on the association between diabetes and the risk of depression are contradictory. Furthermore, much less is known concerning the association among young adults. ObjectiveTo investigate whether diabetes is associated with an increased risk of subsequent development of depression, with emphasis on age-specific variations. DesignA cohort study. SettingClaims data of one million subjects randomly selected from 23 million people covered by the Taiwan National Health Insurance program. ParticipantsFrom the claims data, we identified 14,048 patients aged ≥20years with newly diagnosed diabetes in 2000–2002 and randomly selected 55,608 non-diabetic subjects for comparison, that were frequency-matched by calendar year, age, and gender. Incidence rates of depression to the end of 2007 were identified, and risks were compared between the two groups. ResultsThe incidence of depression was 1.80-times higher in the diabetic group than in nondiabetic subjects over a median follow-up of 6.5years (adjusted hazard ratio [HR]=1.46, 95% confidence interval [CI]: 1.24–1.71). Age-specific HRs for incidence of depression in relation to diabetes were not statistically different between the patient subgroups aged 20–39, 40–49, 50–59, 60–69 and ≥70years (p value for age-diabetes interaction=0.33). Stratified analyses showed that the association was much stronger for subjects without comorbid cardiovascular disease than for those with this comorbidity. Insulin treatment was associated with a 43% reduced risk of depression in diabetic patients. ConclusionsIn this population-based study, diabetic patients were at a higher risk for subsequent depression. Adequate treatment reduced the risk.

INSOMNIA AND DAYTIME SLEEPINESS ARE RISK FACTORS FOR DEPRESSIVE SYMPTOMS IN THE ELDERLY

STUDY OBJECTIVES: Previous studies have reported that and excessive daytime sleepiness (EDS) may predict depression in adults. However, these associations have not been investigated in community-dwelling elderly taking into account EDS, and sleep medication. DESIGN: Four-year longitudinal study. SETTING: The French Three-City Study. PARTICIPANTS: 3824 subjects aged ≥ 65 years and free of depressive symptoms at baseline. MEASUREMENTS AND RESULTS: Questionnaires were used to evaluate insomnia symptoms, EDS, and sleep medication at baseline. Depressive symptoms (DEP-s) were assessed using the Center for Epidemiologic Studies-Depression scale at baseline, and at 2-year and 4-year follow-up. Logistic regression models controlling for potential confounders were generated to determine whether sleep disturbances were associated with incident DEP-s and to determine the effect of individual symptoms. Insomnia symptoms and EDS independently increased the risk of incident DEP-s (OR=1.23, 95% CI=1.01-1.49 and OR=2.05, 95% CI=1.30-3.23, respectively). Poor sleep quality and difficulty in initiating and in maintaining sleep-but not early morning awakening-were identified as risk factors of DEP-s, with risk increasing with the frequency of symptoms. Sleep medication was not only a risk factor for DEP-s independent of symptoms (OR=1.62, 95% CI=1.26-2.09), but also independent of EDS (OR=1.71 95%=1.33-2.20). CONCLUSIONS: Insomnia EDS, and the use of medication independently increase the risk of subsequent depression in the elderly. In clinical practice, disturbed sleep and prolonged use of sleep medication may be early indicators or potentially reversible risk factors for depression, suggesting the need for further clinical interventional research.

Insomnia and Daytime Sleepiness Are Risk Factors for Depressive Symptoms in the Elderly

Previous studies have reported that insomnia and excessive daytime sleepiness (EDS) may predict depression in adults. However, these associations have not been investigated in community-dwelling elderly taking into account insomnia symptoms, EDS, and sleep medication. Four-year longitudinal study. The French Three-City Study. 3824 subjects aged ≥ 65 years and free of depressive symptoms at baseline. Questionnaires were used to evaluate "insomnia symptoms", EDS, and sleep medication at baseline. Depressive symptoms (DEP-s) were assessed using the Center for Epidemiologic Studies-Depression scale at baseline, and at 2-year and 4-year follow-up. Logistic regression models controlling for potential confounders were generated to determine whether sleep disturbances were associated with incident DEP-s and to determine the effect of individual insomnia symptoms. Insomnia symptoms and EDS independently increased the risk of incident DEP-s (OR=1.23, 95% CI=1.01-1.49 and OR=2.05, 95% CI=1.30-3.23, respectively). Poor sleep quality and difficulty in initiating and in maintaining sleep-but not early morning awakening-were identified as risk factors of DEP-s, with risk increasing with the frequency of insomnia symptoms. Sleep medication was not only a risk factor for DEP-s independent of insomnia symptoms (OR=1.62, 95% CI=1.26-2.09), but also independent of EDS (OR=1.71 95%=1.33-2.20). Insomnia symptoms, EDS, and the use of medication independently increase the risk of subsequent depression in the elderly. In clinical practice, disturbed sleep and prolonged use of sleep medication may be early indicators or potentially reversible risk factors for depression, suggesting the need for further clinical interventional research.

Mental health and unintentional injurers: results from the national co-morbidity survey replication

ObjectiveTo examine whether unintentionally injuring others is associated with subsequent mental illness, and whether mental illness is a risk factor for unintentionally injuring others.MethodsOnset of first psychiatric diagnoses was compared...

The Use of Statins After a Cardiac Intervention Is Associated With Reduced Risk of Subsequent Depression

Depression is associated with immune activation as well as oxidative stress. Statins have in vitro and in vivo antiinflammatory and antioxidative properties. We prospectively investigated whether the use of statins was associated with a reduced risk of development of depression in individuals who have had a cardiac event or intervention. Participants were recruited between May 2005 and March 2006 from the Geelong Hospital, Geelong, Australia, a tertiary hospital in regional Australia that serves a catchment area shown to be representative of the broader Australian community. Patients who were hospitalized for angioplasty, myocardial infarction, or coronary artery bypass graft surgery (N = 193) were followed up prospectively for 9 months to assess development of depression. Depression data were collected 3 months postdischarge (T1) by structured clinical interview (using the Mini International Neuropsychiatric Interview, version 5) and 9 months postdischarge (T2) by self-report (using the Hospital Anxiety and Depression Scale). Major depressive disorder, minor depression, and dysthymia were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Data on statins were collected from medical records. The association between statin therapy and depression was tested using both linear and logistic regression models controlling for clinical, psychological, and demographic confounders. At discharge, 157 participants (81.3%) were receiving statin therapy. Adjusting for possible confounders, taking statins at discharge had a protective effect on depression at T1, reducing the likelihood of dysthymia, minor depression, or major depression by 69% (95% CI, 0.097-0.972; P = .045). At the T2 end point, statin therapy again had a protective effect and was associated with a 79% reduction in the likelihood of depression (95% CI, 0.052-0.876; P = .032). The linear regression model to predict depression at T2 was significantly different from zero (F(11,180) = 8.686, P < .001) and explained 36.3% of the variance in depression. The use of statins was associated with significant reduction in the risk of depression in individuals who have had a cardiac event. This supports the role of oxidative and inflammatory processes in depression and opens the door to rational and novel pathophysiologically based therapies distinct from conventional antidepressants.

Increasing Self-Empowerment related to Depression among Court-Involved Youth: The Moods Matter Project

Increasing Self-Empowerment related to Depression among Court-Involved Youth: The Moods Matter Project One of the most prevalent and serious mental health disorders among adolescents is depression. In fact, the 2004 National Survey on Drug Use and Health estimated the lifetime prevalence rate of depression among adolescents at 14% (Office of Applied Studies, Substance Abuse and Mental Health Services Administration, 2005). Three to eight percent of adolescents are diagnosed with Major Depressive Disorder making it more common among this age group than other chronic childhood disorder, including asthma (Jackson & Lurie, 2006). Since adolescent depression does not typically occur in isolation, depressed adolescents are at greater risk of co-morbid issues such as substance abuse, educational challenges, problems with social relationships, and conduct disorders (Zalsman, Brent, & Weersing, 2006). Moreover, suicide, a byproduct of depression, is the third leading cause of death among individuals 15-24 years of age in the United States (Kochanek, Murphy, Anderson, & Scott, 2004). For court-involved youth, the prevalence of depression and other mental health disorders is even greater. In fact, approximately 40-85% of children within the child welfare system suffer from one or more mental health disorders (Austin, 2005) and between 65-70% of youth in the juvenile justice system meet the criteria for a mental health disorder (Skowyra & Cocozza, 2006) including depression. The disproportionate incidence of depression among court-involved youth indicates the need for specific interventions designed to meet the needs of this special population. However, whereas several evidence-based practices to prevent depression have been developed in recent years (Garber, Clarke, & Weersing, 2009; Gillham, Reivich, Jaycox, Seligman, & Silver, 1990; Mufson, et al.,2004; Spence, Sheffield, & Donovan, 2005 ), none have been designed to specifically address the unique needs of court-involved youth. Namely, studies must be designed to address needs related to adolescents with limited, if any, social and family supports, and challenges related to the brief periods of time available to intervene with this population. In response to these needs, the Moods Matter project, a brief cognitive behaviorally-based group intervention was designed to increase knowledge and resources related to depression to promote self-sufficiency and empowerment. Literature Review Depression among Court-Involved Youth The increased risk for depression associated with court-involved adolescents is often due to exposure to early trauma (Birhmaher, et al., 2001). In fact, Garber and Flynn (2001) found that individuals with a history of child maltreatment might adopt a negatively skewed cognitive style as a result of the experience of early trauma. As a result, these individuals may possess a cognitive schema that tends to interpret events in a manner that promotes self-blame and negativity, and a sense that the glass is half empty rather than half full. This endorsement of such a negatively skewed cognitive style is thought to contribute to the risk of subsequent depression. Furthermore, this type of environmental conditioning or sensitization to depression appears to place individuals that were exposed to adversity at an early age at disproportionate risk for chronic depression following life challenges of varying degrees (Monroe & Harkness, 2005; Harkness, Bruce, & Lumley, 2006). As a result, these individuals may be conditioned to continuously interpret events, regardless of their realistic severity, as overwhelming, and thus, experience feelings of helplessness that further contribute to their depression. Additionally, individuals with a history of child maltreatment may experience shorter times of wellness in between depressive episodes (Harkness, et. al., 2006). Thus, the chronic nature of depression compounded by only brief reprieves experienced by these individuals may place them at significant risk of sustaining adequate functional ability, and living healthy, full lives. …

Polymorphisms in BDNF (Val66Met) and 5-HTTLPR, morning cortisol and subsequent depression in at-risk adolescents

BackgroundThere is increasing evidence for genetic effects on the hypothalamic–pituitary axis system. More than one gene is likely to moderate corticoid-mediated activity.AimsTo investigate whether the brain-derived neurotrophic factor (BDNF) polymorphism (rs6265, Val66Met) is associated with morning waking salivary cortisol and moderates the corticoid-mediated risk for subsequent depressive episode onset independently of the known effects of 5-HTTLPR (the serotonin transporter gene promoter).MethodHigh-risk adolescents (n = 401) were genotyped for Val66Met BDNF and 5-HTTLPR. Salivary samples were obtained on four consecutive school days within 1 h of waking. There were 365 (91%) remaining participants reassessed at 12 months for episodes of psychiatric disorder in the follow-up period. Of these, 357 (89%) had complete data for multivariate modelling.ResultsThere were 41 (11.2%) individuals who reported a new episode of clinical depression over the follow-up period. Increased risk for subsequent depression was found in carriers of the Val66Val genotype in BDNF with higher morning waking cortisol. This remained present when the known interaction between carriers of a short allele of 5-HTTLPR with higher morning salivary cortisol was taken into account.ConclusionsBoth BDNF and 5-HTTLPR genes show evidence of modifying the risk of a subsequent new depressive episode associated with elevated morning salivary cortisol. In adolescents morning salivary cortisol levels may constitute a biomarker for some forms of unipolar depression.

Diabetes mellitus type II as a risk factor for depression: a lower than expected risk in a general practice setting

The aim of the present study was to determine whether a diagnosis of diabetes mellitus (DM) in a primary setting is associated with an increased risk of subsequent depression. A retrospective cohort design was used based on the Registration Network Family Practice (RNH) database. Patients diagnosed with diabetes mellitus at or after the age of 40 and who were diagnosed between 01-01-1980 and 01-01-2007 (N = 6,140), were compared with age-matched controls from a reference group (N = 18,416) without a history of diabetes. Both groups were followed for an emerging first diagnosis of depression (and/or depressive feelings) until January 1, 2008. 2.0% of the people diagnosed with diabetes mellitus developed a depressive disorder, compared to 1.6% of the reference group. After statistical correction for confounding factors diabetes mellitus was associated with an increased risk of developing subsequent depression (HR 1.26; 95% CI: 1.12–1.42) and/or depressive feelings (HR 1.33; 95% CI: 1.18–1.46). After statistical adjustment practice identification code, age and depression preceding diabetes, were significantly related to a diagnosis of depression. Patients with diabetes mellitus are more likely to develop subsequent depression than persons without a history of diabetes. Results from this large longitudinal study based on a general practice population indicate that this association is weaker than previously found in cross-sectional research using self-report surveys. Several explanations for this dissimilarity are discussed.

Abortion and depression: A population-based longitudinal study of young women

Induced abortion is an experience shared by a large number of women in Norway, but we know little about the likely social or mental health-related implications of undergoing induced abortion. International studies suggest an increased risk of adverse outcomes such as depression, but many studies are weakened by poor design. One particular problem is the lack of control for confounding factors likely to increase the risk of both abortion and depression. The aim of the study was to investigate whether induced abortion was a risk factor for subsequent depression. A representative sample of women from the normal population (n=768) was monitored between the ages of 15 and 27 years. Questions covered depression, induced abortion and childbirth, as well as sociodemographic variables, family relationships and a number of individual characteristics, such as schooling and occupational history and conduct problems. Young women who reported having had an abortion in their twenties were more likely to score above the cut-off point for depression (odds ratio (OR) 3.5; 95% confidence interval (CI) 2.0-6.1). Controlling for third variables reduced the association, but it remained significant (OR 2.9; 95% CI 1.7-5.6). There was no association between teenage abortion and subsequent depression. Young adult women who undergo induced abortion may be at increased risk for subsequent depression.

Prevalence, course, and comorbidity of insomnia and depression in young adults.

(1) To describe the prevalence and prospective course of insomnia in a representative young-adult sample and (2) to describe the cross-sectional and longitudinal associations between insomnia and depression. Longitudinal cohort study. Community of Zurich, Switzerland. Representative stratified population sample. None. The Zurich Study prospectively assessed psychiatric, physical, and sleep symptoms in a community sample of young adults (n=591) with 6 interviews spanning 20 years. We distinguished 4 duration-based subtypes of insomnia: 1-month insomnia associated with significant distress, 2- to 3-week insomnia, recurrent brief insomnia, and occasional brief insomnia. The annual prevalence of 1-month insomnia increased gradually over time, with a cumulative prevalence rate of 20% and a greater than 2-fold risk among women. In 40% of subjects, insomnia developed into more chronic forms over time. Insomnia either with or without comorbid depression was highly stable over time. Insomnia lasting 2 weeks or longer predicted major depressive episodes and major depressive disorder at subsequent interviews; 17% to 50% of subjects with insomnia lasting 2 weeks or longer developed a major depressive episode in a later interview. "Pure" insomnia and "pure" depression were not longitudinally related to each other, whereas insomnia comorbid with depression was longitudinally related to both. This longitudinal study confirms the persistent nature of insomnia and the increased risk of subsequent depression among individuals with insomnia. The data support a spectrum of insomnia (defined by duration and frequency) comorbid with, rather than secondary to, depression.

Incidence of Social Anxiety Disorder and the Consistent Risk for Secondary Depression in the First Three Decades of Life

Epidemiological findings demonstrating an increased risk for individuals with social anxiety disorder (SAD) to develop depression have been challenged by discrepant findings from prospective longitudinal examinations in childhood and early adolescence. To examine patterns of SAD incidence, the consistency of associations of SAD with subsequent depression, and distal and proximal predictors for subsequent depression. Face-to-face, 10-year prospective longitudinal and family study of up to 4 waves. The DSM-IV Munich-Composite International Diagnostic Interview was administered by clinically trained interviewers. Community sample in Munich. Three thousand twenty-one individuals aged 14 to 24 years at baseline and 21 to 34 years at follow-up. Cumulative incidence of SAD and depression (major depressive episode or dysthymia). Cumulative incidence for SAD was 11.0%; for depression, 27.0%. Standardized person-years of incidence for SAD were highest for those aged 10 to 19 years (0.72%) and were low before (0.20%) and after (0.19%) that age range. Depression incidence was different, characterized by delayed and continued high rates. Social anxiety disorder was consistently associated with subsequent depression, independent of age at onset for SAD (relative risk range, 1.49-1.85, controlling for age and sex). Crude Cox regressions showed significant distal (eg, parental anxiety or depression, behavioral inhibition) and proximal SAD characteristics (eg, severity measures, persistence) as predictors. Most associations were attenuated in multiple models, leaving behavioral inhibition (hazard ratio, 1.30 [95% confidence interval, 1.04-1.62; P = .02]) and, less consistently, panic (hazard ratio, 1.85 [95% confidence interval, 1.08-3.18; P = .03]) as the remaining significant predictors. Social anxiety disorder is an early, adolescent-onset disorder related to a substantially and consistently increased risk for subsequent depression. The demonstration of proximal and particularly distal predictors for increased depression risks requires further exploration to identify their moderator or mediator role. Along with previous evidence that comorbid SAD is associated with a more malignant course and character of depression, these results call for targeted prevention with the aim of reducing the burden of SAD and its consequences.

Estimating causal effects from observational data with a model for multiple bias

Conventional analyses of observational data may be biased due to confounding, sampling and measurement, and may yield interval estimates that are much too narrow because they do not take into account uncertainty about unknown bias parameters, such as misclassification probabilities. We used a simple, multiple bias adjustment method to estimate the causal effect of social anxiety disorder (SAD) on subsequent depression. A Monte Carlo sensitivity analysis was applied to data from the Early Developmental Stages of Psychiatry (EDSP) study, and bias due to confounding, sampling and measurement was modelled. With conventional logistic regression analysis, the risk for depression was elevated in the presence of SAD only in the older cohort (age 17-24 years at baseline assessment); odds ratio (OR) = 3.06, 95% confidence interval (CI) 1.64-5.70, adjusted for sex and age. The bias-adjusted estimate was 2.01 with interval limits of 0.61 and 9.71. Thus, given the data and the bias model used, there was considerably more uncertainty about the real effect, but the probability that SAD increases the risk for subsequent depression (OR > 1) was 88.6% anyway. Multiple bias modelling, if properly used, reveals the necessity for a better understanding of bias, suggesting a need to conduct larger and more adequate validation studies on instruments that are used to diagnose mental disorders.