Untreated Depressive Symptoms Research Articles

Active psychoeducational components of antistigma interventions for untreated depressive symptoms: Specific effects of continuum beliefs?

Active psychoeducational components of antistigma interventions for untreated depressive symptoms: Specific effects of continuum beliefs?

The differential influence of self-construal on the effect of self-efficacy on the help-seeking process: A quasi-experimental online study among people with untreated depressive symptoms

BackgroundDespite available professional healthcare, people often delay or avoid help-seeking. Understanding the underlying reasons is crucial and research has explored the role of self-efficacy in this context. Additionally, studies have highlighted the significance of culturally influenced self-construals in individuals' health behaviour. There seems to be a relationship between self-efficacy and self-construal.The aim of the study is to explore the influence of self-efficacy on help-seeking, considering self-construal as a moderator. Differential experiences of self-efficacy and varying associations among help-seeking variables based on self-construal are posited. MethodsA quasi-experimental online study is conducted with a baseline assessment, including self-efficacy interventions, and follow-ups at three and six months. Self-construal groups are compared, i.e., independent vs. interdependent individuals. A series of multi-group path analyses are conducted to examine potential variations in the interventional effects and among the help-seeking variables respective of help-seeking instance, i.e. professional mental health care or informal care. Self-construal functions as the global moderator. ResultsThe study included N = 1′368 participants, 65.6 % identifying as female and an average age of 42.38 (SD = 15.22). More independent compared to more interdependent individuals were older, more frequently identified as male, had higher socioeconomic status, fewer depressive symptoms, and greater self-efficacy. Multi-group path analyses for professional mental health care (CFI = 0.992, RMSEA = 0.018, SRMR = 0.004) and informal help (CFI = 0.999, RMSEA = 0.004, SRMR = 0.006) demonstrated excellent model fits. The analysis for informal help was interpretable, as the unconstrained model had a significantly better fit than the constrained model. There were varying associations among help-seeking variables based on self-construals. The intervention effect was differential, with independent participants benefiting significantly (β = 0.203), while the effect was non-significant for interdependent participants. DiscussionThe study's findings, strengths, and limitations are discussed in relation to current research. Results indicate differential experiences of self-efficacy interventions based on individuals' self-construal. Moreover, varying associations among help-seeking variables suggest self-construal-based differences in their interrelationships. These findings highlight the importance of considering self-construal in health related research.

The Seeking Mental Health Care model: prediction of help-seeking for depressive symptoms by stigma and mental illness representations

BackgroundOnly about half the people with depression seek professional health care services. To constitute the different predictors and associating variables of health care utilisation, we model the process and aim to test our hypothesised Seeking Mental Health Care Model. The model includes empirical influences on the help-seeking process to predict actual behaviour and incorporates superordinate (stigma, treatment experiences) as well as intermediate attitudinal variables (continuum and causal beliefs, depression literacy and self-efficacy).MethodAll variables are examined in an online study (baseline, three- and six-month follow-up). The sample consisted of adults with depressive symptoms (PHQ-9 sum score ≥ 8), currently not receiving mental health care treatment. To examine the prediction of variables explaining help-seeking behaviour, a path model analysis was carried out (lavaan package, software R).ResultsAltogether, 1368 participants (Mage = 42.38, SDage = 15.22, 65.6% female) were included, 983 participating in at least one follow-up. Model fit was excellent (i.e., RMSEA = 0.059, CFI = 0.989), and the model confirmed most of the hypothesised predictions. Intermediary variables were significantly associated with stigma and experiences. Depression literacy (ß = .28), continuum beliefs (ß = .11) and openness to a balanced biopsychosocial causal model (ß = .21) significantly influenced self-identification (R2 = .35), which among the causal beliefs and self-efficacy influenced help-seeking intention (R2 = .10). Intention (ß = .40) prospectively predicted help-seeking behaviour (R2 = .16).ConclusionThe Seeking Mental Health Care Model provides an empirically validated conceptualisation of the help-seeking process of people with untreated depressive symptoms as a comprehensive approach considering internal influences. Implications and open questions are discussed, e.g., regarding differentiated assessment of self-efficacy, usefulness of continuum beliefs and causal beliefs in anti-stigma work, and replication of the model for other mental illnesses.Trial registrationGerman Clinical Trials Register: DRKS00023557. Registered 11 December 2020. World Health Organization, Universal Trial Number: U1111–1264-9954. Registered 16 February 2021.

Sexual dysfunction in first-episode schizophrenia spectrum disorders

Sexual dysfunction (SD) is common in patients with schizophrenia. In this study, we examined the prevalence and correlates of SD in a sample of patients with first-episode schizophrenia spectrum disorders (FES) (n = 77). Sexual functioning was examined using the Arizona Sexual Experiences Scale. Clinical measures of interest included the duration of untreated psychosis, psychopathology, depressive symptoms, functionality, and quality of life. Biochemical testing was also performed to measure prolactin, lipid profiles, and fasting glucose levels. In total, 27 (35%) patients met the criteria for SD, which was significantly more prevalent in females than males (p = 0.027). Higher depression scores, poorer social and occupational functioning, and lower high-density lipoprotein cholesterol levels predicted overall SD. Female sex, more pronounced global psychopathology, and poorer quality of life were also predictors of domain-specific SD, adjusting for the extent of antipsychotic exposure. SD has a high prevalence in patients with FES, particularly females. There is a need for a more nuanced understanding of SD in recent-onset schizophrenia, and to establish its relevance in terms of comorbid depressive symptoms and poor quality of life. SD may require specific attention and tailored treatment in females with FES. • We examined the prevalence and correlates of SD in FES. • SD was assessed in 77 patients with FES using the ASEX. • Female sex and depressive symptoms predicted SD. • Females had worse SD across multiple ASEX domains (1, 2, 4, 5). • FES characteristics were associated with SD in a sex- and domain-specific manner.

The Lived Experience of Pain and Depression Symptoms during Pregnancy.

Depressive symptoms and pain are prevalent during pregnancy. Untreated pain and depressive symptoms occurring together may have a negative effect on maternal and newborn outcomes, yet little is known about women's experiences with pain and depressive symptoms during pregnancy. The purpose of this study is to describe the lived experience of depressive symptoms and pain occurring in women during the third trimester of pregnancy. A descriptive phenomenological study was conducted. Women during postpartum were recruited from a previous cross-sectional study of women in their third trimester that evaluated the relationship between pain, depression, and quality of life. Twenty-four women entered their responses into an online secure research Web site. These data were analyzed using Colaizzi's method of descriptive phenomenological analysis. Four themes that described the essence of women's experiences with both pain and depressive symptoms were identified. They were pregnancy: feeling minimized, unheard and overwhelmed; attempting or trying but not treated: living with pain and pain interference; pain, sleep loss, and suffering; and pain and depressive symptoms: helpless, hopeless, and suffering. If a woman presents with pain, additional nursing assessments of her sleep and emotional state may be needed. Likewise, a positive depression symptom screening suggests the need for a more in-depth exploration of pain, pain interference, poor sleep, and mental health symptoms. Because the women perceive their pregnancy as minimized, nurses may need to assist in setting realistic expectations and encouraging social support. Nurses listening to women describing these conditions may be essential in promoting the women's wellbeing.

Untreated depressive symptoms significantly worsen quality of life in old age and may lead to the misdiagnosis of dementia: a cross-sectional study

BackgroundSeveral studies demonstrated the role of depressive mood and cognitive impairment in the background of elevated mortality and decreased Quality of Life (QoL) in old age. Our aim was to assess depressive and cognitive symptoms among older people in order to determine if those are recognized and treated or not, to elucidate the association between them and to investigate their impact on QoL.MethodsIn the framework of the ICT4Life project self-administered questionnaires and clinical screening tools were used to assess QoL, depressive symptoms and cognitive functions of 60 older persons over the age of 65.ResultsMales found to be depressed (53.8 vs. 40.4%) and cognitively declined (53.8 vs. 48.9%) more frequently; and had higher scores on the depression (6.85 vs. 5.32) and lower on the QoL (47.38 vs. 50.19) scales. Depressed older persons had lower cognitive levels (24.39 vs. 21.52) and their QoL was significantly poorer (53.97 vs. 43.85) than that of the non-depressed subjects. Depressive symptoms were detected in almost half of the older adults (43.9%), and the majority (80.77%) did not receive antidepressant medication.ConclusionsDepressive and cognitive symptoms found to be common among older people, but were not recognized and treated in most cases. Close correlation between depression and cognitive impairment was also confirmed, as well as the key role of depression in the background of pseudo-dementia and QoL decline. Early recognition of depressive symptoms is important not only to treat the underlying mood disorder, but also to improve QoL of older persons.

Untreated and under-treated depressive symptoms in people with multiple sclerosis in an Australian context: A secondary analysis

BackgroundThe lifetime prevalence of depression in people with multiple sclerosis (MS) is ∼50% and international studies have reported untreated and under-treated depressive symptoms in this population. AimWe aimed to identify whether this translates to an Australian context requiring attention by Australian healthcare services. MethodsWe undertook secondary analysis of two studies totalling 217 participants (Study 1: N = 107; Study 2: N = 110) with relapsing remitting or secondary progressive MS, recruited from two hospital outpatient MS clinics and via email advertisement through MS Limited. Depressive symptoms were measured using the Beck Depression Inventory-Second Edition (BDI-II; Study 1), Patient Health Questionnaire – Nine (PHQ-9) and Center for Epidemiological Studies Depression-Revised (CESD-R; Study 2). FindingsIn study 1, 11.9% of participants not taking antidepressant medication and 25.0% who were taking antidepressant medication reported moderate-to-severe depressive symptoms. In study 2, 21.0% and 23.5% of participants not taking antidepressant medication, while 37.9% and 55.1% taking antidepressant medication, reported moderate-to-severe depressive symptoms, measured by the PHQ-9 and CESD-R, respectively. Across both studies, people with MS taking antidepressant medication reported higher severity of depressive symptoms compared to those not taking antidepressant medication. ConclusionThese findings indicate untreated and undertreated depressive symptoms within an Australian context, highlighting the important role of nurses to educate people with MS about depressive symptoms, as well as to undertake symptom screening and monitoring. Further research is required to verify the extent of the issue and identify barriers to detection and treatment of depressive symptoms in Australians living with MS.

Ready, Willing and Able? An Investigation of the Theory of Planned Behaviour in Help-Seeking for a Community Sample with Current Untreated Depressive Symptoms

Applying health behaviour change models, such as the theory of planned behaviour (TPB), to help-seeking for mental health problems can address the deficit in health care utilisation. However, previous studies largely focused on help-seeking intentions and not behaviour, which might be problematic due to the intention-behaviour gap. Hence, TPB and help-seeking were examined in a German community sample with current untreated depressive symptoms: 188 adults (Mage = 50.34; SD = 16.19; 70.7% female) participated in a baseline interview and survey measuring components of the TPB (attitudes, subjective norms and perceived behavioural control) and help-seeking intentions. They reported actual help-seeking from mental health professionals via telephone surveys 3 and 6 months later. To better understand the potential gap between help-seeking intentions and behaviour and to investigate the contributions of readiness, willingness and ability to seek help, two path models were constructed in accordance with the TPB controlling for covariates. Attitudes (β = .24), subjective norms (β = .25) and self-efficacy (β = .15) were significantly associated with intentions (R2 = 26%), which predicted help-seeking (Cox and Snell’s pseudo-R2 = 23%); controllability did not predict help-seeking. In sum, the TPB provides a reliable framework to explore help-seeking behaviour for mental health problems. Based on these findings, prevention efforts should focus on readiness and willingness to seek help (e.g. foster positive attitudes and social support of treatment). However, the role of ability, operationalised as perceived behavioural control and (perceived) barriers to help-seeking, warrants further research, as self-efficacy but not controllability was associated with help-seeking.

Title: Brief Implicit Association Tests of Stigmatizing Attitudes, Awareness of Mental Distress and Label-Avoidance: A Study in People with Depressive Symptoms.

This study aims to develop and implement brief implicit association tests (BIATs) assessing stigmatizing attitudes towards mental illness, awareness of mental distress and self-identification as having a mental illness. We recruited 229 people (age range 18-80years) with currently untreated depressive symptoms. In addition to BIATs, explicit measures assessed depression severity, contact experience and self-identification as having a mental illness. BIATs showed good feasibility. Age and educational differences were observed for each BIAT. Regarding depression severity, people with mild depression severity showed stronger implicit label-avoidance. Novel BIATs proved feasible and future research should investigate the predictive value of implicit measures on help seeking in people with mental illness.

Association Between Severity of Depression and Cardiac Risk Factors Among Women Referred to a Cardiac Rehabilitation and Prevention Clinic.

Depression comorbid with cardiovascular disease is associated with higher rates of morbidity and mortality, with studies suggesting that this is especially true among women. This study examined depressive symptoms and their relationship to cardiac risk factors among women referred to a women's cardiac rehabilitation and primary prevention program. A secondary analysis of data collected between 2004 and 2014 for 1075 women who completed a baseline assessment at the Women's Cardiovascular Health Initiative, a women-only cardiac rehabilitation and prevention program in Toronto, Canada. Descriptive statistics for sociodemographic variables, quality of life (SF-36), and cardiac risk factors were stratified by depression symptom severity using cutoff scores from the Beck Depression Inventory-2nd version (BDI-II) and compared with analysis of variance and χ statistics. Prevalence of antidepressant use among those with moderate to high depressive symptoms was assessed as an indicator of under- or untreated depression. Overall, 38.6% of women scored above the BDI-II cutoff for depression; 23.6% in the moderate or severe range. Socioeconomic status and quality of life decreased with increasing depression severity. Body mass index increased with depressive severity (P < .001), as did the percentage of individuals with below target age predicted fitness (P < .001). Only 39.0% of women in the moderate and severe BDI-II groups were taking antidepressants. In this sample, we found a significant prevalence of untreated and undertreated depressive symptoms among women with, or at high risk of developing, cardiovascular disease. Additional strategies are needed to identify these patients early and link them to appropriate treatment.

Prenatal exposure to selective serotonin reuptake inhibitors and non-verbal cognitive functioning in childhood.

Selective serotonin reuptake Inhibitors (SSRIs) are frequently used during pregnancy. Evidence about the long-term consequences of prenatal SSRI exposure on child neurodevelopment is controversial. We prospectively investigated whether prenatal SSRI exposure was associated with childhood non-verbal cognition in a population-based study, and contrasted it to exposure to depressive symptoms (without SSRIs). We included 71 children prenatally exposed to SSRIs, 385 children prenatally exposed to maternal depressive symptoms and 5427 unexposed children. Child executive functioning was assessed by maternal report at 4 years ( n=4020). Non-verbal intelligence was measured at 5 years ( n=5001) and children were tested with a neuropsychological battery at 7 years ( n=1194). Prenatal SSRI exposure was not related to maternal reported executive function at 4 years, nor was it related with observed non-verbal intelligence at age 5 or neuropsychological function at 7 years. Exposure to untreated maternal depressive symptoms was related to maternal reported shifting problems and emotional control problems at 4 years. No associations between exposure to depressive symptoms and observed non-verbal IQ at 5 years or neuropsychological function at 7 years were found. This population-based study suggests that neither SSRI use nor untreated depressive symptoms during pregnancy had a major impact on child non-verbal cognition.

Patient with Major Depressive Disorder Responds to L-Methylfolate Post-Genetic Testing

The current case describes a 69 year old Caucasian male with a long history of untreated depressive symptoms. At age 68, the patient was started on a treatment regime for depression, but remission was not achieved. Genetic testing was performed to determine if this patient’s genetic background could help explain his resistance and suggest a more effective treatment strategy. The results of the genetic test showed variations in four pharmacodynamic-related genes, including MTHFR. These results supported the use of several medications in the current regime and indicated the addition of L-methylfolate which led to complete remission of depression symptoms.

Depressive Symptoms in Chinese-American Subjects with Cognitive Impairment

To compare the prevalence of depressive symptoms and frequency of antidepressant use between a group of elderly Chinese-American subjects with and without cognitive impairment and a group of matched white subjects. A secondary aim was to examine the clinical and demographic predictors of depressive symptoms across these groups. The study was conducted at an academic neurology subspecialty clinic. This was a case-control study with 140 Chinese-American subjects and 140 demographically and cognitively matched white subjects. In each group, there were 48 cognitively normal and 92 cognitively impaired participants (49 with mild cognitive impairment, 43 with Alzheimer disease). The proportion of individuals with significant depressive symptoms, as indicated by a Geriatric Depression Scale score ≥6 of 15, and frequency of antidepressant use were compared across groups by using χ(2) analysis. Factors predicting depressive symptoms, including racial and diagnostic group, age, gender, Mini-Mental State Examination score, level of functional impairment, education level, and medical comorbidities, were assessed by using linear regression analysis. Significant depressive symptoms were more common in cognitively impaired Chinese-American (35%) than cognitively impaired white (15%; χ(2)[1] = 9.4; p = 0.004) subjects. Chinese-American subjects with cognitive impairment were less likely to be receiving treatment for depression (12%) than white subjects with cognitive impairment (37%; χ(2)[1] = 15.6; p = 0.002). Racial and diagnostic group, age, level of functional impairment, Mini-Mental State Examination score, and education level were all statistically significant independent predictors of Geriatric Depression Scale score. Elderly Chinese-American subjects with cognitive impairment are at increased risk for unrecognized and untreated depressive symptoms compared with elderly white subjects with cognitive impairment. Education level may contribute to this risk or it may be a surrogate marker for other factors contributing to depressive symptoms in this group.

Depressive symptoms in first episode psychosis: a one-year follow-up study

BackgroundDepressive symptoms are common in patients with first episode psychosis (FEP) and have serious consequences for them. The main aims of this study were to examine the course of depression in FEP patients and explore whether any patient characteristics at baseline predicts depressive symptoms after one year.MethodA total of 198 FEP patients with schizophrenia spectrum disorders were assessed for depressive symptoms with Calgary Depression Scale for Schizophrenia (CDSS) at baseline and 127 were followed for one year. A CDSS score [greater than or equal to] 6 was used as a cut-off score for depression.ResultsApproximately 50% of the patients were depressed (CDSS[greater than or equal to]6) at baseline. At follow-up approximately 35% had depression. The course of depressive symptoms varied, 26% was depressed at both baseline and follow-up, 9% became depressed during the follow-up, 22% remitted from depression during the 12 months and 43% was neither depressed at baseline nor at follow-up. Poor childhood social functioning, long duration of untreated psychosis (DUP) and depressive symptoms at baseline predicted depression at 12 months follow-up.ConclusionDepressive symptoms are frequent in the first year after onset of psychosis. Patients with poor social functioning in childhood, long DUP and depressive symptoms at baseline are more prone to have depressive symptoms after one year. These patients should be identified and proper treatment provided.

Effects of a stepped-care intervention programme among older subjects who screened positive for depressive symptoms in general practice: the PROMODE randomised controlled trial

to determine (cost)-effectiveness of a stepped-care intervention programme among subjects ≥ 75 years who screened positive for depressive symptoms in general practice. the pragmatic cluster-randomised controlled trial with 12-month follow-up. sixty-seven Dutch general practices. two hundred and thirty-nine subjects ≥ 75 years screened positive for untreated depressive symptoms (15-item Geriatric Depression Scale ≥ 5). usual care (34 practices, 118 subjects) was compared with the stepped-care intervention (33 practices, 121 subjects) consisting of three steps: individual counselling; Coping with Depression course; and-if indicated-referral back to general practitioner to discuss further treatment. Measurements included severity of depressive symptoms [Montgomery-Åsberg Depression Rating Scale (MADRS)], quality of life, mortality and costs. at baseline subjects mostly were mildly/moderately depressed. At 6 months MADRS scores had improved more in the usual care than the intervention group (-2.9 versus -1.1 points, P=0.032), but not at 12 months (-3.1 versus -4.6, P=0.084). No significant differences were found within two separate age groups (75-79 years and ≥ 80 years). In intervention practices, 83% accepted referral to the stepped-care programme, and 19% accepted course participation. The control group appeared to have received more psychological care. among older subjects who screened positive for depressive symptoms, an offered stepped-care intervention programme was not (cost)-effective compared with usual care, possibly due to a low uptake of the course offer. www.controlled-trials.com/ISRCTN 71142851v.

A multicenter, double-blind, placebo-controlled study of sildenafil citrate in Canadian men with erectile dysfunction and untreated symptoms of depression, in the absence of major depressive disorder

Depression and erectile dysfunction (ED) often co-occur. Phosphodiesterase type 5 inhibitors are effective in men with ED and untreated depression, or ED secondary to antidepressants. This study evaluated sildenafil treatment in Canadian men with clinically diagnosed ED (Sexual Health Inventory for Men score ≤ 21) and mild-to-moderate untreated depressive symptoms [Beck Depression Inventory II (BDI-II) score 14-28], but excluding major depressive disorder. Pretreatment screening using the Sexual Health Inventory for Men and BDI-II showed that men with ED were more likely to have depression than men without ED, and ED severity was a predictor of depression (P=0.0226). Two hundred and two men were randomized to 6 weeks of double-blind treatment with placebo (n=98) or sildenafil (n=104), initial dose of 50 mg, adjustable to 25 or 100 mg. The men were evaluated on all domains of the International Index of Erectile Function and the Sex Effects Questionnaire, Global Efficacy Questions, and Event-log data. Compared with placebo, patients treated with sildenafil had significantly greater changes from baseline in BDI-II scores (P<0.001). All International Index of Erectile Function domains and the Sex Effects Questionnaire components were also significantly improved in sildenafil group (P<0.01). The most common adverse events included headache, dyspepsia, vasodilatation, and respiratory tract infections and were generally mild in intensity.

Untreated Depressive Symptoms Among Cognitively-Intact, Community Dwelling Filipino Patients With Parkinson Disease

ABSTRACTThe objective of this study is to determine the prevalence of depressive symptoms and its correlation with the quality of life among cognitively intact, community dwelling Filipino patients with Parkinson disease (PD) not treated pharmacologically for depression. In this prospective, cross-sectional study 76 PD patients were included. Demographic data were obtained including: age, gender, onset of disease, disease duration, and medication intake. The Mini Mental State Examination (MMSE) was performed to exclude significant cognitive impairment. The Montgomery Asberg Depression Rating Scale (MADRS) was administered to quantify the degree of depressive symptoms. The degree of depressive symptoms was correlated with the SF 36 and UPDRS Parts II and III. Our cohort of patients had a mean age of 61 years (range: 42–81 years), and disease duration of 2.7 years (33 months); 46 (61%) experienced significant depressive symptoms based on the MADRS cutoff score of >14. Depressive symptoms were associated with poorer performance on both UPDRS Parts II and III and SF 36. Untreated depressive symptoms among Filipinos with PD may be higher compared to other PD populations but prospective and age-matched controlled studies will need to be performed to confirm these preliminary observations. The presence of depressive symptoms was significantly correlated with poorer quality of life and level of functioning.

Time to Depression Treatment in Primary Care Among HIV-infected and Uninfected Veterans

Multiple factors, including patient characteristics, competing demands, and clinic type, impact delivery of depression treatment in primary care. Assess whether depression severity and HIV serostatus have a differential effect on time to depression treatment among depressed patients receiving primary care at Infectious Disease or General Medicine clinics. Multicenter prospective cohort, (Veterans Aging Cohort Study), comparing HIV-infected to uninfected patients. The total cohort consisted of 3,239 HIV-infected and 3,227 uninfected patients. Study inclusion criteria were untreated depressive symptoms, based on a Patient Health Questionnaire (PHQ-9) score of greater than 9, and no antidepressants or mental health visits in the 90 days prior to PHQ-9 assessment. Treatment was defined as antidepressant receipt or mental health visit within 90 days following PHQ-9 assessment. Depression severity based on PHQ-9 scores was defined as mild-moderate (greater than 9 to 19) and severe (20 or greater). Kaplan-Meier curves were used to estimate time to treatment by depression severity and HIV serostatus. Cox proportional hazards methods adjusted for covariates were used. Overall, 718 (11%) of the cohort met inclusion criteria, 258 (36%) of whom received treatment. Median time to treatment was 7 days [95% confidence interval (CI) = 4, 13] and was shortest for severely depressed HIV-infected patients (0.5 days; 95% CI = 0.5, 6, p = 0.04). Compared to mildly-moderately depressed uninfected patients, severely depressed HIV-infected patients were significantly more likely to receive treatment [adjusted hazard ratio (HR) 1.67, 95% CI = 1.07, 2.60), whereas mildly-moderately depressed HIV-infected patients (adjusted HR 1.10, 95% CI = 0.79, 1.52) and severely depressed uninfected patients (adjusted HR 0.93, 95% CI = 0.60, 1.44) were not. In this large cohort, time to primary care treatment of depression was shortest among severely depressed HIV-infected patients. Regardless of HIV serostatus, if depression was not treated on the assessment day, then it was unlikely to be treated within a 90-day period, leading to the majority of depression being untreated.

Suicidal Behavior in Adolescents with First-Episode Psychosis

Studies have reported an increased risk for suicide in adults with schizophrenia, but limited data on younger populations are available. We hypothesize that first-episode psychosis is associated with an increased risk of suicidal behavior in adolescents. A retrospective study was conducted with patients (n=102) diagnosed with psychosis not otherwised specified (NOS), schizophreniform disorder, schizoaffective disorder or schizophrenia within six months prior to admission. A control group consisting of ninety-eight patients with other (nonpsychosis) psychiatric diagnoses admitted to the same unit was matched by age, gender and ethnicity. All patients and controls were administered the Brief Psychiatric Rating Scale-Children version to assess severity of psychiatric symptoms and suicidality, and medical records were used to assess suicidal behavior and possible risk factors. When compared to controls, patients with psychosis had over twice as many suicide attempts overall (p<0.01). The 32% incidence of suicide attempts reported in this cohort is nearly double what is reported in adults with psychosis. Depressive symptoms were significantly correlated with increased suicide attempts (p<0.05). There was no significant difference between the number of pediatric psychosis inpatients versus nonpsychotic psychiatric inpatients who attempted suicide. There was, however, a significant difference between the total number of attempts between groups, illustrating that children and adolescents with psychosis are more likely than nonpsychotic psychiatric inpatients to have repeat, or multiple, suicide attempts. Longer duration of untreated psychosis, ADHD and depressive symptoms were found to be the strongest risk factors for patients with psychosis.

Effects of Antidepressant Treatment on Antiretroviral Regimen Adherence Among Depressed HIV-Infected Patients

This study examined whether the relationship between HAART medication adherence and antidepressant treatment varied with HAART regimen complexity. The analysis included 1,192 respondents to the HIV Cost and Service Utilization Study (HCSUS) who were taking HAART. Self-reported past-week HAART adherence, antidepressant use, current mental health status, and an aggregate measure of regimen complexity were used in the analysis. Regression models with interactions between antidepressant treatment of mental health problems, poor emotional well-being or depressive symptoms, and medication complexity were estimated to assess differential associations with adherence. Irrespective of antidepressant treatment, poor mental health status was negatively associated with HAART medication adherence. However, only untreated higher depressive symptoms were strongly associated with maladherence to HAART medication (OR = 0.72 at P < 0.05). Medication complexity was strongly associated with maladherence to HAART medication (OR = 0.96 with P < 0.05) in the model including emotional well-being; and weakly associated with maladherence (OR = 0.97 and P < 0.07) in the model including depressive and/or anxiety symptoms. However, as HAART medication complexity increased, adherence was higher among individuals with poorer mental health but using antidepressants compared to those with better mental health (OR = 1.09 with P < 0.05 in the model including emotional well-being; OR = 1.09 and P < 0.05 in the model including depressive and/or anxiety symptoms), and compared to those with poorer mental health but not using antidepressants (OR = 1.09, P = 0.08 in the model including emotional well-being, and OR = 1.12, P < 0.05 in model including depressive and/or anxiety symptoms). In conclusion, while individuals with poorer mental health generally have poor HAART adherence, their adherence improved with the use of antidepressants as the HAART complexity increased.