Symptom Checklist Depression Scale Research Articles

Effect of a Collaborative Care Model on Depressive Symptoms and Glycated Hemoglobin, Blood Pressure, and Serum Cholesterol Among Patients With Depression and Diabetes in India

Mental health comorbidities are increasing worldwide and worsen outcomes for people with diabetes, especially when care is fragmented. To assess whether collaborative care vs usual care lowers depressive symptoms and improves cardiometabolic indices among adults with diabetes and depression. Parallel, open-label, pragmatic randomized clinical trial conducted at 4 socioeconomically diverse clinics in India that recruited patients with type 2 diabetes; a Patient Health Questionnaire-9 score of at least 10 (range, 0-27); and hemoglobin A1c (HbA1c) of at least 8%, systolic blood pressure (SBP) of at least 140 mm Hg, or low-density lipoprotein (LDL) cholesterol of at least 130 mg/dL. The first patient was enrolled on March 9, 2015, and the last was enrolled on May 31, 2016; the final follow-up visit was July 14, 2018. Patients randomized to the intervention group (n = 196) received 12 months of self-management support from nonphysician care coordinators, decision support electronic health records facilitating physician treatment adjustments, and specialist case reviews; they were followed up for an additional 12 months without intervention. Patients in the control group (n = 208) received usual care over 24 months. The primary outcome was the between-group difference in the percentage of patients at 24 months who had at least a 50% reduction in Symptom Checklist Depression Scale (SCL-20) scores (range, 0-4; higher scores indicate worse symptoms) and a reduction of at least 0.5 percentage points in HbA1c, 5 mm Hg in SBP, or 10 mg/dL in LDL cholesterol. Prespecified secondary outcomes were percentage of patients at 12 and 24 months who met treatment targets (HbA1c <7.0%, SBP <130 mm Hg, LDL cholesterol <100 mg/dL [<70 mg/dL if prior cardiovascular disease]) or had improvements in individual outcomes (≥50% reduction in SCL-20 score, ≥0.5-percentage point reduction in HbA1c, ≥5-mm Hg reduction in SBP, ≥10-mg/dL reduction in LDL cholesterol); percentage of patients who met all HbA1c, SBP, and LDL cholesterol targets; and mean reductions in SCL-20 score, Patient Health Questionnaire-9 score, HbA1c, SBP, and LDL cholesterol. Among 404 patients randomized (mean [SD] age, 53 [8.6] years; 165 [40.8%] men), 378 (93.5%) completed the trial. A significantly greater percentage of patients in the intervention group vs the usual care group met the primary outcome (71.6% vs 57.4%; risk difference, 16.9% [95% CI, 8.5%-25.2%]). Of 16 prespecified secondary outcomes, there were no statistically significant between-group differences in improvements in 10 outcomes at 12 months and in 13 outcomes at 24 months. Serious adverse events in the intervention and usual care groups included cardiovascular events or hospitalizations (4 [2.0%] vs 7 [3.4%]), stroke (0 vs 3 [1.4%]), death (2 [1.0%] vs 7 [3.4%]), and severe hypoglycemia (8 [4.1%] vs 0). Among patients with diabetes and depression in India, a 12-month collaborative care intervention, compared with usual care, resulted in statistically significant improvements in a composite measure of depressive symptoms and cardiometabolic indices at 24 months. Further research is needed to understand the generalizability of the findings to other low- and middle-income health care settings. ClinicalTrials.gov Identifier: NCT02022111.

Moderators of Outcome in Problem-Solving Therapy for Depression in Primary Care.

The purpose of this study was to conduct a secondary analysis of data from trials of problem-solving therapy in primary care (PST-PC) to examine differential outcomes by gender or race-ethnicity. The participants were 352 patients with depression treated with PST-PC in multiple primary care sites in the United States. Women's depressive symptoms improved more over time than men's. Hopkins Symptom Checklist depression scale scores decreased significantly (t=-10.12, df=692, p<0.001) (estimate=-0.02, 95% confidence interval=-0.03, -0.02). Although patients from racial-ethnic minority groups had more depressive symptoms over time than patients from nonminority groups, there was no evidence of differential change by racial-ethnic group. These data add to the literature supporting the usefulness of PST-PC without evidence of differential effects for patients from racial-ethnic minority or nonminority groups.

Is improvement in comorbid major depression associated with longer survival in people with cancer? A long-term follow-up of participants in the SMaRT Oncology-2 and 3 trials

ObjectiveThere is evidence that patients with cancer have worse survival if they have comorbid major depression, but uncertainty whether a reduction in depression severity improves survival. We aimed to address this question. MethodsWe did a secondary analysis of data from participants in the SMaRT Oncology-2 and 3 trials of depression treatment in patients with cancer and comorbid major depression (total n = 642). Participants' data were analysed as cohorts, defined by treatment (usual care or Depression Care for People with Cancer, an intensive treatment programme, in both trials) and cancer prognosis (good or poor, in SMaRT Oncology-2 and 3 respectively). We measured change in depression severity from randomisation to 12 weeks using Symptom Checklist Depression Scale (SCL-20) scores and assessed survival by linked mortality data. We used Cox regression to estimate the effect of a one-unit decrease in SCL-20 score on survival, controlling for measured confounders. ResultsWe found no evidence for an association between improvement in depression and survival in any of the four cohorts, after adjusting for age, sex, primary cancer, baseline cancer severity and baseline depression severity. Pooling the cohorts in a fixed-effects meta-analysis yielded an estimated 7% reduction in the hazard of death per one-unit decrease in SCL-20 score. This finding was not statistically significant; the 95% confidence interval extended from a 26% decrease to an 18% increase in hazard of death. ConclusionWe found no evidence that reduction in severity of comorbid major depression is associated with longer survival in patients with cancer.

Long-term clinical and cost-effectiveness of collaborative care (versus usual care) for people with mental-physical multimorbidity: cluster-randomised trial.

Collaborative care can support the treatment of depression in people with long-term conditions, but long-term benefits and costs are unknown.AimsTo explore the long-term (24-month) effectiveness and cost-effectiveness of collaborative care in people with mental-physical multimorbidity. A cluster randomised trial compared collaborative care (integrated physical and mental healthcare) with usual care for depression alongside diabetes and/or coronary heart disease. Depression symptoms were measured by the symptom checklist-depression scale (SCL-D13). The economic evaluation was from the perspective of the English National Health Service. 191 participants were allocated to collaborative care and 196 to usual care. At 24 months, the mean SCL-D13 score was 0.27 (95% CI, -0.48 to -0.06) lower in the collaborative care group alongside a gain of 0.14 (95% CI, 0.06-0.21) quality-adjusted life-years (QALYs). The cost per QALY gained was £13 069. In the long term, collaborative care reduces depression and is potentially cost-effective at internationally accepted willingness-to-pay thresholds.Declaration of interestNone.

Can flow experiences be protective of work-related depressive symptoms and burnout? A genetically informative approach

BackgroundGenetic research on depression and burnout has focused mostly on adverse factors, although various aspects in daily life related to positive coping and well-being have been shown to potentially be protective. Using a large genetically informative sample, we aim to explore the potential relationship between flow proneness and work-related depressive symptoms and burnout. MethodsAbout 10,000 Swedish twins filled in the Swedish Flow Proneness Questionnaire, a subscale of the Hopkins Symptom Checklist (SCL) depression scale, and the Emotional Exhaustion subscale of the Maslach Burnout Inventory-General Survey. A higher score indicated more flow, less emotional exhaustion and less depression. The classical twin design and co-twin control analyses were applied. ResultsPhenotypic correlations were .43 between depressive symptoms and flow proneness, .34 between burnout and flow proneness, and .62 between depressive symptoms and burnout. Broad-sense heritabilities (G) ranged between 33–35% for the three variables. Associations between the variables were due to significant genetic as well as non-shared environmental influences. Co-twin control analyses showed that associations remained significant when controlling for all genetic and shared familial factors, in line with a causal relationship. LimitationsAlthough the co-twin control design can test for consistency of associations with a causal relationship, it cannot unequivocally establish causality. ConclusionsGenetic liability has a substantial influence on associations between flow proneness and emotional problems at work (depression, burnout). However, the presence of significant environmental correlations is in line with a (partly) causal relationship between flow and work related depression and burnout, which in turn may suggest that interventions which increase flow could potentially reduce emotional problems at work.

The Relationship of Psychological Symptoms among Mothers of Children in Different Body Mass Index Categories

We tried to emphasize the importance of psychological status analysis of the mothers of children, who have abnormal Body Mass Index (BMI), when treating these children. Materials and methods: Our study enrolled mothers of 150 children in normal, high and low BMI categories who were admitted to Kagithane State Hospital. The inclusion criteria required that these children had no chronic disease, developmental defect, and diagnosed psychological or physical disease impairing the reliability of the interview. Symptom Check List (SCL-90-R) and Beck Depression Scale (BDS) were used on all mothers of these children. In this study, BDS values of high BMI children’s mothers were significantly higher than those of normal BMI children’s mothers and BDS values of mothers of low BMI children were found to be higher than those of mothers of normal BMI children. The SCL-90-R results between mothers of high and normal BMI, high and low BMI, normal and low BMI children were statistically significant. We observed the effect of the psychological state of the family on childhood eating habits and the higher incidence of childhood feeding problems in families with psychopathology. Currently family therapy is indicated according to guidelines in solving eating disorders in children. This approach may also be useful for children with abnormal BMI.

Organized Self-Management Support Services for Chronic Depressive Symptoms: A Randomized Controlled Trial.

This study aimed to determine whether a self-management support service was more effective than treatment as usual in reducing depressive symptoms and major depressive episodes and increasing personal recovery among individuals with chronic or recurrent depressive symptoms. The study was a randomized controlled trial of a self-management support service consisting of depression self-management training, recovery coaching, and care coordination. The 18-month intervention included regular telephone or in-person contacts with a care manager and a structured group program co-led by a professional therapist and a trained peer specialist. Intervention (N=150) and control (N=152) participants ages ≥ 18 with chronic or recurrent depressive symptoms were recruited from five clinics in Seattle, Washington. Outcome measures included the Hopkins Symptom Checklist depression scale, the Recovery Assessment Scale, the Patient-Rated Global Improvement scale, and the percentage of participants with a major depressive episode. Interviewers were masked to treatment condition. Repeated-measures estimates of the long-term effect of the intervention versus usual care (average of the six-, 12-, and 18-month outcomes adjusted for age, gender, and site) indicated that intervention participants had less severe symptoms (p=.002) and higher recovery scores (p=.03), were less likely to be depressed (odds ratio [OR]=.52, p=.001), and were more likely to be much improved (OR=1.96, p=.001). These findings support providing regular outreach care management and a self-care group offering a combined behavioral and recovery-oriented approach for people with chronic or recurrent depressive symptoms.

The validity of the symptom checklist depression and anxiety subscales: A general population study in Sweden

BackgroundThe Symptom Checklist (SCL) is used as a screening tool in patient settings, but is also used as a diagnostic proxy for depression and anxiety in public health surveys. However, there are few validation studies based on general population samples. This study aims to validate the SCL subscales for depression and anxiety in a general population sample in Stockholm, Sweden. MethodsWe used a stratified random sample answering first a postal questionnaire covering SCL (n=8613) and then a semi-structured psychiatric interview based using Schedules for Clinical Assessment in Neuropsychiatry (SCAN, n=881). Agreement between SCL depression (SCL-DEP) and anxiety (SCL-ANX) scales and their respective DSM-IV disorder was examined by ROC analysis. Discriminant analysis was performed with factor analysis on the SCL depression and anxiety items. The SCL-DEP scale was also compared with the ability of the Major Depression Inventory (MDI) in detecting depressive disorders. ResultsA factor analysis with two factors differentiated the two subscales, with some cross loading items. The SCL-DEP and ANX subscales agreement with depression and anxiety disorders was good. SCL-DEP MDI performed better in detecting DSM-IV depression. LimitationsThe questionnaire only included the SCL depression, anxiety and hostility subscales and not the full SCL-90. Also, no other anxiety scale was available for comparison. ConclusionWe conclude that depression and anxiety subscales are suitable instrument for proxies of depression and anxiety disorder in public health surveys.

Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial

Medical conditions are often complicated by major depression, with consequent additional impairment of quality of life. We aimed to compare the effectiveness of an integrated treatment programme for major depression in patients with cancer (depression care for people with cancer) with usual care. SMaRT Oncology-2 is a parallel-group, multicentre, randomised controlled effectiveness trial. We enrolled outpatients with major depression from three cancer centres and their associated clinics in Scotland, UK. Participants were randomly assigned in a 1:1 ratio to the depression care for people with cancer intervention or usual care, with stratification (by trial centre) and minimisation (by age, primary cancer, and sex) with allocation concealment. Depression care for people with cancer is a manualised, multicomponent collaborative care treatment that is delivered systematically by a team of cancer nurses and psychiatrists in collaboration with primary care physicians. Usual care is provided by primary care physicians. Outcome data were collected up until 48 weeks. The primary outcome was treatment response (≥50% reduction in Symptom Checklist Depression Scale [SCL-20] score, range 0-4) at 24 weeks. Trial statisticians and data collection staff were masked to treatment allocation, but participants could not be masked to the allocations. Analyses were by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN40568538. 500 participants were enrolled between May 12, 2008, and May 13, 2011; 253 were randomly allocated to depression care for people with cancer and 247 to usual care. 143 (62%) of 231 participants in the depression care for people with cancer group and 40 (17%) of 231 in the usual care group responded to treatment: absolute difference 45% (95% CI 37-53), adjusted odds ratio 8·5 (95% CI 5·5-13·4), p<0·0001. Compared with patients in the usual care group, participants allocated to the depression care for people with cancer programme also had less depression, anxiety, pain, and fatigue; and better functioning, health, quality of life, and perceived quality of depression care at all timepoints (all p<0·05). During the study, 34 cancer-related deaths occurred (19 in the depression care for people with cancer group, 15 in the usual care group), one patient in the depression care for people with cancer group was admitted to a psychiatric ward, and one patient in this group attempted suicide. None of these events were judged to be related to the trial treatments or procedures. Our findings suggest that depression care for people with cancer is an effective treatment for major depression in patients with cancer. It offers a model for the treatment of depression comorbid with other medical conditions. Cancer Research UK and Chief Scientist Office of the Scottish Government.

Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): a multicentre randomised controlled trial in patients with lung cancer

The management of depression in patients with poor prognosis cancers, such as lung cancer, creates specific challenges. We aimed to assess the efficacy of an integrated treatment programme for major depression in patients with lung cancer compared with usual care. Symptom Management Research Trials (SMaRT) Oncology-3 is a parallel-group, multicentre, randomised controlled trial. We enrolled patients with lung cancer and major depression from three cancer centres and their associated clinics in Scotland, UK. Participants were randomly assigned in a 1:1 ratio to the depression care for people with lung cancer treatment programme or usual care by a database software algorithm that used stratification (by trial centre) and minimisation (by age, sex, and cancer type) with allocation concealment. Depression care for people with lung cancer is a manualised, multicomponent collaborative care treatment that is systematically delivered by a team of cancer nurses and psychiatrists in collaboration with primary care physicians. Usual care is provided by primary care physicians. The primary outcome was depression severity (on the Symptom Checklist Depression Scale [SCL-20], range 0-4) averaged over the patient's time in the trial (up to a maximum of 32 weeks). Trial statisticians and data collection staff were masked to treatment allocation, but patients and clinicians could not be masked to the allocations. Analyses were by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN75905964. 142 participants were recruited between Jan 5, 2009, and Sept 9, 2011; 68 were randomly allocated to depression care for people with lung cancer and 74 to usual care. 43 (30%) of 142 patients had died by 32 weeks, all of which were cancer-related deaths. No intervention-related serious adverse events occurred. 131 (92%) of 142 patients provided outcome data (59 in the depression care for people with lung cancer group and 72 in the usual care group) and were included in the intention-to-treat primary analysis. Average depression severity was significantly lower in patients allocated to depression care for people with lung cancer (mean score on the SCL-20 1·24 [SD 0·64]) than in those allocated to usual care (mean score 1·61 [SD 0·58]); difference -0·38 (95% CI -0·58 to -0·18); standardised mean difference -0·62 (95% CI -0·94 to -0·29). Self-rated depression improvement, anxiety, quality of life, role functioning, perceived quality of care, and proportion of patients achieving a 12-week treatment response were also significantly better in the depression care for people with lung cancer group than in the usual care group. Our findings suggest that major depression can be treated effectively in patients with a poor prognosis cancer; integrated depression care for people with lung cancer was substantially more efficacious than was usual care. Larger trials are now needed to estimate the effectiveness and cost-effectiveness of this care programme in this patient population, and further adaptation of the treatment will be necessary to address the unmet needs of patients with major depression and even shorter life expectancy. Cancer Research UK and Chief Scientist Office of the Scottish Government.

2723 – Risk and protective factors for suicidality among croatian war veterans with posttraumatic stress disorder

There are limited data about suicidality among Croatian war veterans. The present study is aimed to assess correlation between suicidality and possible risk and protective factors in PTSD patients. Method The sample consisted of 123 war veterans who completed Suicide Behaviors Questionnaire (SBQ-R), Reasons for Living Inventory (RFL-48), General Health Questionnaire - subscale for suicidal behavior (GHQ), Hopkins Symptom Checklist Depression Scale (HSCL-25) and Harvard Trauma Questionnaire (HTQ). Results indicated that suicidality is correlated with higher PTSD and depression scores, and negatively correlated with reported reasons for living. We discuss our results in terms of their use and applicability in everyday work with patients who are in suicidal risk.

P-1153 - The effectiveness of short- and long-term psychotherapy during a 7-year follow-up

Introduction The majority of studies on the effectiveness of psychotherapy have reported results for relatively short follow-up times. Aims In this study the effectiveness of short- and long-term psychotherapy was compared during a very long follow-up. Methods A total of 326 psychiatric outpatients with mood or anxiety disorder were randomly assigned to solution-focused therapy (12 sessions), short-term psychodynamic (20 sessions) and long-term psychodynamic psychotherapy (240 sessions) in Helsinki Psychotherapy Study. The patients were followed from start of treatment and assessed 11 times during a 7-year follow-up. Symptom Check List (anxiety, depression, and general symptom scale), Work-subscale of the Social Adjustment Scale, and use of auxiliary treatment (psychotherapy, psychotropic medication, and psychiatric hospitalization) were used as outcome measures. Results A reduction in psychiatric symptoms and improvement in work ability and functional capacity was noted in all treatment groups. The short-term therapies were more effective than long-term psychotherapy during the first year, whereas the long-term therapy was more effective after 3 years of follow-up. No significant differences were observed between long- and short-term therapies during the 4 last years of follow-up.A total of 80% of the patients in the short-term therapy groups and 60% in the long-term therapy group used auxiliary treatment. Conclusions Short-term psychotherapy gives faster benefits than long-term psychotherapy, but in the long run no notable differences in symptoms or working ability are seen. Considerably auxiliary treatments are taken after the end of the intervention implying further need of treatment. These findings should be repeated in other populations.

Understanding Depressive Symptoms among High-Risk, Pregnant, African-American Women

Purpose Depression has been shown to be a risk factor of poor pregnancy outcomes among African-American women. The goal of this study was to examine both risk and protective factors of depressive symptoms among urban, high-risk African-American, pregnant women. Methods Data were drawn from a larger randomized controlled trial, Health Outcomes of Pregnancy Education that was a part of the National Institutes of Health–DC Initiative to Reduce Infant Mortality in Minority Populations in the District of Columbia. For purposes of the present study, a sample of African-American pregnant women ( n = 1,044) were recruited from six urban prenatal care clinics. Baseline depressive symptoms were assessed using the Hopkins Symptom Checklist-Depression Scale. Results Forty-four percent of women were confirmed as moderately to severely depressed at baseline. In multivariate linear regression analysis among the total sample, maternal age, intimate partner violence, illicit drug and alcohol use during pregnancy, and reproductive history (no live birth/only loss; no live birth/no loss) were associated with increased depressive symptoms. Being very happy about the pregnancy, having emotional support from others, and reporting more positive expectancies about the ability to regulate negative moods were associated with decreased depressive symptoms. Conclusion Results highlight the importance of attending to the context of high-risk, African-American, pregnant women, paying attention to both risk and protective factors of poor psychological well-being. Implications for future research in this area are discussed.

Measuring improvement in depression in cancer patients: a 50% drop on the self-rated SCL-20 compared with a diagnostic interview

Objective To determine the validity of a 50% drop in the 20-item Symptom Checklist Depression Scale (SCL-20) score against the “gold standard” of no longer meeting criteria for major depression as assessed using a diagnostic interview in an outpatient cancer population and also to examine the validity of other potential cut-offs (i.e., percentage drops). Materials and Methods Secondary analysis of data from a randomized trial which compared collaborative care with usual care for cancer patients with major depression. A total of 194 trial participants who had both SCL-20 scores and depression diagnoses on the Structured Clinical Interview for DSM-IV at both baseline and at 12-week outcome formed the analyzed sample. Results A 50% reduction in the SCL-20 score from baseline to 12 weeks correctly identified the patients who no longer met criteria for major depression in 153 (78.9%) of 194 (95% CI 73.1% to 84.6%) cases. Most of those misclassified had not achieved a 50% reduction in SCL-20 score despite no longer meeting criteria for major depression. Examination of the performance of percentage drops other than 50% on the SCL-20 using a receiver operating characteristics (ROC) curve and histogram of misclassification suggested that the 50% drop was best if both a low overall misclassification rate and the minimizing of false positives of improvement were required. Conclusions A 50% reduction in the SCL-20 score performs well as a conservative measure of change in depression status in cancer patients.

Collaborative Care for Depressed Patients With Chronic Medical Conditions: A Randomized Trial in Puerto Rico

Collaborative Care for Depressed Patients With Chronic Medical Conditions: A Randomized Trial in Puerto Rico

A Randomized, Double-Blind, Placebo-Controlled Study of Testosterone Treatment in Hypogonadal Older Men With Subthreshold Depression

Hypogonadism and subthreshold depression are common conditions in elderly men. The objective of this study was to examine the effect of testosterone treatment in older, hypogonadal men with subthreshold depression. A randomized, double-blind, placebo-controlled study was conducted at a university-affiliated Veterans Affairs Medical Center among men aged 50 years or older (N = 33) with screening total testosterone levels of <or= 280 ng/dL and subthreshold depression (dysthymia or minor depression, according to DSM-IV). Recruitment for the study was conducted from November 2002 through May 2005. Participants received either 7.5 g of testosterone gel or placebo gel daily for 12 weeks, followed by a 12-week open-label extension phase during which all subjects received 7.5 g of testosterone gel. The primary outcome measure was the change in the Hamilton Rating Scale for Depression (HAM-D) score from baseline to the end of the double-blind phase. Secondary outcome measures were remission of subthreshold depression (defined a priori as a HAM-D score <or= 7) and changes in the Hopkins Symptom Checklist depression scale, the Medical Outcomes Study 36-Item Short-Form Health Survey, and the short-form 16-item Quality of Life Enjoyment and Satisfaction Questionnaire. At the end of the double-blind phase, testosterone-treated men had a greater reduction in HAM-D scores (p = .024) and a higher remission rate of subthreshold depression (52.9% vs. 18.8%, p = .041) than did placebo-treated men, but there were no differences in other secondary outcome measures between groups. At the end of the open-label phase, the testosterone group had sustained improvement, the control group improved, and there were no differences between groups in any outcome measures. These results suggest that testosterone replacement may be efficacious treatment for subthreshold depression in older men with hypogonadism. Larger studies are needed to corroborate these findings. clinicaltrials.gov Identifier: NCT00202462.

Ethyl-eicosapentaenoic acid for the treatment of psychological distress and depressive symptoms in middle-aged women: a double-blind, placebo-controlled, randomized clinical trial

Background:Psychological distress (PD) and depressive symptoms are commonly observed during menopausal transition. Studies suggest that omega-3 (n–3) fatty acids may help alleviate depression.Objective: The objective was to compare enriched ethyl-eicosapentaenoic acid (E-EPA) supplementation with placebo for the treatment of PD and depressive symptoms in middle-aged women.Design: Women with moderate-to-severe PD (n= 120) were randomly assigned to receive 1.05 g E-EPA/d plus 0.15 g ethyl-docosahexaenoic acid/d (n= 59) or placebo (n= 61) for 8 wk. The main outcomes were 8-wk changes in PD scores [Psychological General Well-Being Schedule (PGWB)] and depressive scales [20-item Hopkins Symptom Checklist Depression Scale (HSCL-D-20) and the 21-item Hamilton Depression Rating Scale (HAM-D-21)].Results: At baseline, women with PD were mildly to moderately depressed, and 24% met the major depressive episode (MDE) criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. After 8 wk, outcomes improved in both groups, but no significant differences were noted between them. Stratification analyses for MDE diagnosis at baseline indicated that differences in adjusted 8-wk changes between the E-EPA group without MDE (n= 46) and the placebo group (n= 45) were 8.0 (95% CI: 0.6, 15.3; P= 0.034) for the PGWB, −0.2 (95% CI: −0.01, −0.4; P= 0.040) for the HSCL-D-20, and −2.7 (95% CI: −0.3, −5.1; P= 0.030) for the HAM-D-21. Differences in adjusted 8-wk changes between the E-EPA group with MDE (n= 13) and the placebo group (n= 16) were not significant.Conclusions: To our knowledge, this is the first trial of n–3 supplementation in the treatment of PD and depressive symptoms in middle-aged women. In women with PD without MDE at baseline, the 8-wk changes in PD and depressive scales improved significantly more with E-EPA than with placebo. This trial was registered at >http://www.controlled-trials.comas ISRCTN69617477.

A Pilot Study of Telephone Care Management and Structured Disease Self-Management Groups for Chronic Depression

The authors developed, implemented, and pilot-tested intervention programs to provide effective care for chronic or recurrent depression. A total of 104 patients with chronic or recurrent depression were randomly assigned to one of four groups: continued usual behavioral health care, usual care plus telephone monitoring and care management by a care manager, usual care plus care management plus a peer-led chronic-disease self-management group program, or usual care plus care management plus a professionally led depression psychotherapy group. Outcomes in intent-to-treat analyses were assessed at three, six, nine, and 12 months and included treatment participation rates, Hopkins Symptom Checklist depression scale scores, major depression (Structured Clinical Interview for DSM-IV), Patient-Rated Global Improvement ratings, treatment satisfaction, and adequacy of medication. Participation in care management was high in the three intervention groups. Close to 60% of participants invited to both group interventions attended at least an initial meeting, but a greater number assigned to the care management plus the professionally led group continued participation through the 12-month period. The sample was too small to reliably detect small or moderate differences in clinical outcomes, but various measures consistently favored the care management plus professionally led group. It is feasible to direct additional intervention services to patients with persistent or recurring depression. A larger trial of organized self-management support for chronic depression will be necessary for a definitive evaluation of program effectiveness.

Screening for Depression and PTSD in a Cambodian Population Unaffected by War

The Hopkins Symptom Checklist depression scale (HSCL-D) and the Harvard Trauma Questionnaire (HTQ) have been used extensively in international studies, particularly among refugees and conflict-affected populations. Like many other screening measures, however, the HSCL-D and HTQ have not been subjected to extensive epidemiologic testing, particularly among communities not affected by war. The present study examined the psychometric properties of the HSCL-D and HTQ by comparing the measures with the Structured Clinical Interview for DSM-IV (SCID) among ethnic Cambodians living in Surin, Thailand, a community that was spared the long period of mass violence that affected Cambodia proper. The PTSD data of the HTQ were then contrasted with those obtained from a refugee clinic. The main finding was that in the Surin study, the screening measures showed greater agreement with the SCID in identifying noncases (negative prediction) than cases (positive prediction). In contrast, in the earlier clinic study, the HTQ showed high positive and moderately low negative prediction. The results support previous observations that clinical interviews such as the SCID may be more conservative in identifying cases. We raise the possibility, however, that structured interviews may perform differently across clinic and community populations. In particular, clinicians may be more accurate in identifying cases than noncases in highly symptomatic clinic populations, with the converse applying in low prevalence community populations. These issues warrant further investigation to specify more clearly the value of using the two approaches to case identification.

A randomized trial of telephone psychotherapy and pharmacotherapy for depression: Continuation and durability of effects.

Randomized trial evidence and expert guidelines are mixed regarding the value of combined pharmacotherapy and psychotherapy as initial treatment for depression. This study describes long-term results of a randomized trial (N = 393) evaluating telephone-based cognitive-behavioral therapy (CBT) plus care management for primary care patients beginning antidepressant treatment versus usual care. In a repeated measures linear model with adjustment for baseline scores, the phone therapy group showed significantly lower mean Hopkins Symptom Checklist (HSCL) Depression Scale scores (L. Derogatis, K. Rickels, E. Uhlenhuth, & L. Covi, 1974) from 6 months to 18 months versus usual care, F(1, 336) = 11.28, p = .001. Average HSCL depression scores over the period from 6 months to 18 months were 0.68 (SD = 0.55) in the telephone therapy group and 0.85 (SD = 0.65) in the usual-care comparison group. Addition of a brief, structured CBT program can significantly improve clinical outcomes for the large number of patients beginning antidepressant treatment in primary care.