Worse Depressive Symptoms Research Articles

POSSIBILITIES OF ENDOVASCULAR TREATMENT OF PATIENTS WITH INFRARENAL AORTIC OCCLUSION

Quality of life is one of the indicators for a comprehensive assessment of the patient’s condition. Depression and reduced kidney function can impair the quality of life. Cognitive impairmen taffects negatively on patients’ quality of life. We examined 47 patients with stable angina pectoris. It was found that the presence of depressive symptoms is associated with a reduction in the quality of life with using the SF-36 scale. Worsening renal function was also associated with the deterioration of quality of life and worsening of depressive symptoms. The cognitive dysfunction has progressed with decreasing renal function.

Oral Health and Incident Depressive Symptoms: JAGES Project Longitudinal Study in Older Japanese.

To determine whether oral health status predicts depressive symptoms in older Japanese people. Longitudinal study. Twenty-four municipalities in Japan. Community-dwelling individuals aged 65 years and older who responded to mail surveys performed by the Japan Gerontological Evaluation Study in 2010 and 2013 (N = 14,279). Depressive symptoms were assessed using the Geriatric Depression Scale (GDS). Multiple imputations were used to deal with missing data. After excluding participants with depressive symptoms (GDS ≥ 5) at baseline, odds ratios (ORs) and 95% confidence intervals (CIs) for incident depressive symptoms in 2013 were estimated using logistic regression models. After adjusting for sex, age, educational attainment, equivalized household income, marital status, present illness, exercise, frequency of going out, and visits for dental treatment, the following ORs (95% CIs) were observed in simultaneously added oral health variables: 10-19 teeth (OR 1.16, 95% CI 0.99-1.37, reference: ≥20 teeth); 1-9 teeth (1.14, 0.94-1.38, reference: ≥20 teeth); no teeth (1.28, 1.03-1.60, reference: ≥20 teeth); more difficulty chewing tough foods now than 6 months ago (1.24, 1.04-1.47); choking when drinking tea or soup (1.02, 0.84-1.23); feelings of thirst (1.17, 0.99-1.40); difficulty eating food (0.98, 0.80-1.21), difficulty speaking clearly (1.19, 0.89-1.60); problems with smiling (1.24, 0.94-1.65); problems with emotional stability (1.32, 0.86-2.04); and problems enjoying oneself around family, friends, or other people (0.86, 0.42-1.78). These findings suggest that having no teeth and oral health problems may play a role in the development or worsening of depressive symptoms.

Body mass index moderates the relationship between C-reactive protein and depressive symptoms: evidence from the China Health and Retirement Longitudinal Study

The present study aimed to investigate the role of abnormal body mass index (BMI, kg/m2) in the depression-CRP (C-reactive protein) relationship in a healthy middle-aged and elderly Chinese population. Analytical samples were drawn from the China Health and Retirement Longitudinal Study (CHARLS), and participants were categorized by different BMI levels. Depressive subtypes were evaluated both at baseline and follow-up using the Center for Epidemiology Studies Depression scale. Hs-CRP and other variables were measured at baseline. Multiple linear regression analyses were used to evaluate the cross-sectional and longitudinal relationship between depression and baseline hs-CRP. Depression was significantly negatively associated with BMI (ρ = −0.077, p < 0.0001), with underweight associated with worse depressive symptoms than other BMI groups. Both cross-sectional and longitudinal associations between serum hs-CRP and depressive subtypes were significantly positive in the underweight group (p < 0.05). However, in the other BMI groups (from normal weight to obesity), the CRP-depression relationship was no longer significant (p > 0.05). The significant relationship between CRP and depression in the underweight group suggested that not only obesity but also a low BMI could explain a substantial portion of the inflammation-depression link.

Abstract 13136: Physically Frail Adults With Heart Failure Have Worse Physical and Affective Symptoms

Introduction: Heart failure (HF) is a complex clinical syndrome associated with significant symptom burden; however, our understanding of the relationship between symptoms and physical frailty in HF is limited. Hypothesis: There is a significant relationship between physical frailty and symptoms among adults with HF. Methods: A sample of adults with symptomatic HF were enrolled in a cross-sectional study. Physical frailty was measured according to the five dimensions of the Frailty Phenotype Criteria: shrinking, weakness, slowness, physical exhaustion and low physical activity. Physical symptoms were measured with the HF Somatic Perception Scale-Dyspnea subscale, the Epworth Sleepiness Scale, and the Brief Pain Inventory short form. Affective symptoms were measured with the Patient Health Questionnaire-9 and the Brief Symptom Inventory-Anxiety scale. Generalized linear modeling was used to quantify associations between physical frailty and symptoms, controlling for Seattle HF Model (SHFM) score. Results: The mean age of the sample ( n = 50) was 57.5±9.7 years, 66% were male, 92% had New York Heart Association class III/IV HF, and 66% had non-ischemic etiology. Half of the sample (50%) had physical frailty. Those with physical frailty had more than twice the level of dyspnea ( p = 0.001), 73% worse wake disturbances ( p &lt; 0.001), and 86% worse depressive symptoms ( p = 0.001) compared with those not physically frail, adjusting for SHFM score. There were no differences in pain or anxiety. Conclusions: Physically frail adults with HF have considerably worse dyspnea, wake disturbances, and depression. Targeting physical frailty may help identify and improve physical and affective symptoms in HF.

Relation of Angina Pectoris to Outcomes, Quality of Life, and Response to Exercise Training in Patients With Chronic Heart Failure (from HF-ACTION)

Angina pectoris (AP) is associated with worse outcomes in heart failure (HF). We investigated the association of AP with health-related quality of life (HRQoL), exercise capacity, and clinical outcomes and its interaction with exercise training in an HF population. Wegrouped 2,331 patients with HF with reduced ejection fraction in the Heart Failure: AControlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) trial of usual care±exercise training according to whether they had self-reported AP byCanadian classification score. HRQoL and clinical outcomes were assessed by AP status.In HF-ACTION, 406 patients (17%) had AP at baseline (44% with Canadian classification score ≥II) with HF severity similar to those without AP. Patients with AP had similar baseline exercise capacity but worse depressive symptoms and HRQoL. AP was associated with 22% greater adjusted risk for all-cause mortality/hospitalizations, driven by hospitalizations. There was significant interaction between baseline AP and exercise training peak VO2 change (p= 0.019) but not other end points. Exercise training was associated with greater peak VO2 improvement after 3months in patients with AP (treatment effect= 1.25ml/kg/min, 95% CI 0.6 to 1.9). In conclusion, AP was associated with worse HRQoL and depressive symptoms. Despite greater peak VO2 improvement with exercise training, patients with AP experienced more adverse outcomes.

Characteristics and correlates of stealing in college students.

Stealing is a fairly common behaviour among young adults. Understanding the potential associations and characteristics of individuals who steal may help educational institutions, health services and young people themselves resolve difficulties before the behaviour impacts on their academic performance and health. We aim to test the hypothesis that desires to steal among students would be associated with worse academic achievements and higher rates of mood and impulse control disorders. One thousand eight hundred and five students completed the College Student Computer User Survey online and were included in this analysis at a large Midwestern United States University. Responders were grouped according to self-reported stealing urges and behaviours and were compared on measures of psychosocial function, mental health disorders and impulsivity. Urges to steal were associated with worse depressive symptoms, higher levels of perceived stress and a number of psychiatric disorders including bipolar disorder and multiple disorders of impulse control (kleptomania, compulsive sexual behaviour, skin picking, trichotillomania and compulsive buying). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE AND/OR FUTURE RESEARCH: These following data indicate that stealing for many college students may be considered within a spectrum of impulsive behaviours. • Illegal behaviours among students point to mental health difficulties among them. • Our findings may provide clinicians, researchers and health professionals with a clearer picture of a range of impulsive behaviours among college students and promote treatment for this group. • Our findings could also inform preventative approaches to impulsive problems in young adults.

Abstract 15794: Changes in Patient and Caregiver Depression and Anxiety Post-implantation of a Ventricular Assist Device

Introduction: The impact of ventricular assist device (VAD) therapy on affective symptoms among patients with advanced heart failure (HF) and their informal caregivers is not well understood. Hypothesis: We hypothesized that patients’ affective symptoms would improve post-implant, while caregivers’ affective symptoms would worsen. Methods: Prospective, longitudinal data was collected on patients and their caregivers (n=25 dyads) prior to and at 30 and 90 days after VAD implantation. Depression was measured using the Patient Health Questionnaire-8 (PHQ-8; range 0-24, higher scores indicate worse depressive symptoms), and anxiety was measured using the Anxiety Scale of the Brief Symptom Inventory (BSI-ANX; range 0-4; higher scores indicate worse anxiety) in patients and their caregivers. Pre vs. post VAD comparisons in affective symptoms were examined using paired t-tests. Results: Patients requiring VAD implantation were 54.9±12.5 years of age and mostly male (84.0%), while caregivers were 53.9±11.1 years of age and mostly female (80.0%); a majority (72.0%) of dyads were spouses. Patient depression decreased significantly from pre-implant (9.3±5.6) to 30 days (6.9±5.4; t=2.2, p=0.04) and 90 days post-implant (3.6±3.6; t=5.3, p&lt;0.01); patient anxiety also decreased from pre-implant (1.0±0.9) to 30 days (0.5±0.7; t=2.9, p&lt;0.01) and 90 days post-implant (0.3±0.4; t=4.5, p&lt;0.01). In contrast, there were no significant changes in caregiver depression from pre-implant (6.0±5.2) to 30 days (5.2±4.4; t=0.5, p=0.6) and 90 days post-implant (6.6±5.7; t=-0.4, p=0.7) or in caregiver anxiety from pre-implant (0.8±0.6) to 30 days (0.5±0.4; t=1.5, p=0.2) and 90 days post-implant (0.6±0.7; t=0.9, p=0.4). Conclusions: Although depression and anxiety improved dramatically for patients after VAD implantation, the pre-implant affective symptom burden of caregivers was substantially higher than national norms at baseline and was not ameliorated over time. As patient symptoms improve with VAD therapy, their caregivers may benefit from psychosocial interventions to address protracted symptoms of depression and anxiety.

Abstract 17587: Implications of Angina Pectoris on Quality of Life, Functional Capacity and Clinical Outcomes in Chronic Heart Failure Patients: Insights From HF-ACTION

Background: Angina pectoris (AP) is associated with worse outcomes in heart failure (HF) patients, but less is known about implications on health related quality of life (HRQoL) and functional capacity. Methods: We assessed HRQoL, functional capacity and outcomes in chronic HF patients with reduced EF in the HF-ACTION trial of usual care +/- exercise training based on whether patients had AP. AP was patient-reported based on recent symptoms or development during exercise testing. We assessed all-cause mortality/hospitalization in patients with AP vs. no AP using multivariable Cox proportional hazards regression. We assessed for an interaction between AP status and exercise training with respect to outcomes and the change in quality of life and functional capacity from baseline to 3 months. Results: In HF-ACTION, 406 (17%) patients had AP at baseline with 44% of these reporting ≥ class II symptoms. Patients with AP more often had ischemic etiology, but had similar EF, NT-proBNP and beta-blocker use. Baseline 6-minute walk distance and peak VO 2 were similar in both groups, but patients with AP had worse depressive symptoms and HRQoL. After risk adjustment, AP was associated with a 22% greater risk of all-cause mortality/hospitalization (Figure). There was evidence of an interaction between baseline AP and exercise training on change in peak VO 2 (P=0.019), but not for HRQoL or clinical outcomes. The median change in peak VO 2 with exercise training was 0.8 mL/kg/min with AP vs. 0.6 mL/kg/min without AP. Conclusion: AP was associated with worse HRQoL and more depressive symptoms. Despite a greater improvement in peak VO 2 with exercise training, patients with AP experienced more adverse events. Clinicians should consider routine assessment and management of AP in HF patients as well as the associated symptoms related to depression and implications on quality of life.

The effect of 12-wk ω-3 fatty acid supplementation on in vivo thalamus glutathione concentration in patients “at risk” for major depression

ObjectivesAs life expectancy increases, the need to prevent major health disorders is clear. Depressive symptoms are common in older adults and are associated with cognitive decline and greater risk for transitioning to major depression. Oxidative stress may be implicated in the pathophysiology of major depression and can be measured in vivo using proton magnetic resonance spectroscopy via the neurometabolite glutathione (GSH). Evidence suggests ω-3 fatty acid (FA) supplementation may prevent depression and directly affect GSH concentration. The aim of this study was to examine the effect of ω-3 FA supplementation on in vivo GSH concentration in older adults at risk for depression. MethodsFifty-one older adults at risk for depression were randomized to receive either four 1000-mg ω-3 FA supplements daily (containing eicosapentaenoic acid 1200 mg plus docosahexaenoic acid 800 mg) or placebo (four 1000-mg paraffin oil placebo capsules daily) for 12 wk. Participants underwent magnetic resonance spectroscopy, as well as medical, neuropsychological, and self-report assessments at baseline and after 12 wk of supplementation. GSH was measured in the thalamus and calculated as a ratio to creatine. Depressive symptoms were measured using the Patient Health Questionnaire. ResultsCompared with the group given the ω-3 FA supplements, the placebo group had greater change in the GSH-to-creatine ratio in the thalamus (t = 2.00; P = 0.049) after the 12 wk intervention. This increase was in turn associated with a worsening of depressive symptoms (r = 0.43; P = 0.043). ConclusionsDepressive symptom severity in older adults appears to be associated with increased brain levels of GSH, a key marker of oxidative stress. Importantly, ω-3 FA supplementation may attenuate oxidative stress mechanisms, thereby offering benefits for depression prevention.

Pain interference in youth with neurofibromatosis type 1 and plexiform neurofibromas and relation to disease severity, social-emotional functioning, and quality of life.

The physical manifestations of neurofibromatosis type 1 (NF1) can cause chronic pain. This study investigated the impact of pain in youth with NF1 and plexiform neurofibromas (PNs) and its relationship to disease factors, social-emotional functioning, and quality of life (QOL) within a biopsychosocial framework. Caregivers of 59 children and adolescents with NF1 and PNs (6-18 years), and 41 of these youth (10-18 years), completed questionnaires assessing social-emotional functioning and QOL, including an item on pain interference. Measures of disease severity included total PN volume by percent body weight and number of disease complications. Both caregiver (73%) and self-report (59%) ratings indicated that pain interferes with the child's daily functioning despite 33% taking pain medication. Based on caregivers' behavior ratings, more symptoms of anxiety and larger tumor volumes predicted greater pain interference, while greater pain interference, worse depressive symptoms, and more disease complications predicted poorer QOL. As rated by adolescents, more symptoms of anxiety predicted greater pain interference, while greater pain interference and social stress predicted poorer QOL. Further, social-emotional problems mediate the relationship between pain interference and QOL. Thus, pain interferes with daily functioning in the majority of youth with NF1 and PNs even when using pain medication. The impact of pain interference, disease severity, and particularly social-emotional problems on QOL highlights the interaction between physical and psychological states in NF1. Future research and treatment of pain in this population should utilize a biopsychosocial approach and involve multidisciplinary therapies including psychological interventions that target social-emotional functioning.

Unconscious biases: racial microaggressions in American Indian health care.

This article reports on the prevalence and correlates of microaggressive experiences in health care settings reported by American Indian (AI) adults with type 2 diabetes mellitus (T2DM). This community-based participatory research project includes two AI reservation communities. Data were collected via in-person article-and-pencil survey interviews with 218 AI adults diagnosed with T2DM. Greater than one third of the sample reported experiencing a microaggression in interactions with their health providers. Reports of microaggressions were correlated with self-reported history of heart attack, worse depressive symptoms, and prior-year hospitalization. Depressive symptom ratings seemed to account for some of the association between microaggressions and hospitalization (but not history of heart attack) in multivariate models. Microaggressive experiences undermine the ideals of patient-centered care and in this study were correlated with worse mental and physical health reports for AIs living with a chronic disease. Providers should be cognizant of these subtle, often unconscious forms of discrimination.

Enhancing Relationship Satisfaction Among College Student Couples: An Emotionally Focused Therapy (EFT) Approach

Hold Me Tight: Conversations for Connection (HMT; Johnson, 2008) is a newly developed research-based program to enhance relationship satisfaction. The preliminary study describes the effectiveness of this intervention as it pertains to college student couples. The study included 28 self-selected college participants (14 couples) who were pretested to determine level of relationship distress (DAS), trust between partners (RTS), and symptoms of depression (BDI-II) prior to completing the 8-week education program. Pre- and post-changes were examined for statistical and clinical significance. Results indicated that there was a statistically significant change over time on all measures and that the DAS showed a greater degree of change for the women. The DAS showed significant clinical change for the majority of female and half of male participants. The RTS showed relatively little change that could not be due to random variability. Two of three women and three of four men with mild or worse depression symptoms at pretest showed clinically meaningful improvement on the BDI-II. Student debriefing sessions provided positive feedback regarding group content and structure. Implications for relationship education as it pertains to college couples are discussed.

Prognostic understanding, quality of life (QOL), and mood in patients undergoing hematopoietic stem cell transplantation (HCT).

219 Background: In advanced cancers, patients’ prognostic perceptions influence their medical decisions. However, little is known about how patients with hematologic malignancies undergoing HCT and their family caregivers (FC) understand their prognosis. We examined prognostic perception in these patients during hospitalization for HCT and its relationship with QOL and mood. Methods: We conducted a longitudinal study of patients (and FC) hospitalized for HCT. At baseline (6 days pre-HCT), we used a 10-item questionnaire to measure patients’ and FC information preferences, and perception of prognosis. Using 2-items, we also asked oncologists regarding the patients’ prognosis. At day-6, day+1, day+8 of HCT, we assessed QOL (Functional Assessment of Cancer Therapy-Bone Marrow Transplantation FACT-BMT), and mood (Hospital Anxiety and Depression Scale). We examined the relationship between patients’ prognostic perception and their QOL and mood during hospitalization for HCT using multivariable linear mixed models. Results: We enrolled 97% of consecutively eligible patients undergoing autologous (n=30), myeloablative (n=30) or reduced intensity (n=30) allogeneic HCT. Most patients (80/90, 88.9%) and FC (41/47, 87.1%) believed that it is ‘extremely’ or ‘very’ important to know about prognosis. However, the majority of patients (66/85, 77.6%) and FC (33/46, 71.7%) reported an inaccurate and more optimistic perception of the patients’ prognosis compared to the oncologist (P &lt; 0.0001). Patients with accurate prognostic understanding reported lower QOL (P = 0.03) and worse depressive symptoms (P = 0.04) with a steeper increase in depression (P = 0.006) over time compared to patients with an inaccurate optimistic prognostic perception. Conclusions: The majority of patients and FC reported inaccurate and more optimistic perception of prognosis compared with the oncologist. Patients with an accurate perception of their prognosis had lower QOL, higher depression, and a steeper increase in depression during hospitalization for HCT. Interventions are needed to improve prognostic understanding while providing adequate psychosocial support during HCT.

Influence of depressive symptoms on dopaminergic treatment of Parkinson's disease.

Introduction: Depressive symptoms are very common in patients with Parkinson’s disease (PD) and have a significant impact on the quality of life. Dopaminergic medication has been shown to have an influence on the development of depressive symptoms.Materials and methods: The present study analyzed two groups of non-demented patients with PD, with and without depressive symptoms, and reported the correlations between antiparkinsonian medication [specifically levodopa (l-DOPA) and dopaminergic agonists] with depressive symptoms.Results: A strong statistically significant positive correlation between l-DOPA dosages and the level of depressive symptoms has been revealed, suggesting that higher l-DOPA dosages correlate with a worsening of depressive status. No significant correlation was found with dopamine agonists.Discussion: The results of this study show that in patients with PD, higher l-DOPA dosages correlate with worse depressive symptoms. From this point of view, PD patients need to be better diagnosed with respect to depressive symptoms and need additional treatment adjustment when clinical manifestations of depression are present. Clinicians must be aware that dopaminergic drugs are not sufficient to alleviate depressive symptoms.

The Effect of Dance on Depressive Symptoms in Nursing Home Residents

ObjectiveTo evaluate the effect of a dance-based therapy on depressive symptoms among institutionalized older adults. DesignRandomized controlled trial. SettingNursing homes. ParticipantsOlder adults (60 years or older) permanently living in a nursing home. InterventionExercise Dance for Seniors (EXDASE) Program designed for the use in long-term care settings performed once a week for 60 minutes for 3 months. MeasurementsBaseline measures included sociodemographic characteristics, ability to perform basic as well as instrumental activities of daily living, basic mobility, self-rated health, and cognitive status. Outcome measures were collected before and after the intervention and included assessment of depressive symptoms using the geriatric depression scale (GDS). ResultsComparison of participants with MMSE of 15 or higher showed that GDS scores in the intervention group significantly improved (P = .005), whereas the control group had a trend of further worsening of depressive symptoms (P = .081). GLM analysis documented highly statistically significant effect of dance therapy (P = .001) that was not influenced by controlling for intake of antidepressants and nursing home location. Dance therapy may have decreased depressive symptoms even in participants with MMSE lower than 15 and resulted in more discontinuations and fewer prescriptions of antidepressants in the intervention group than in the control group. ConclusionThis study provides evidence that dance-based exercise can reduce the amount of depressive symptoms in nursing home residents. In general, this form of exercise seems to be very suitable and beneficial for this population.

Does the "widowhood effect" precede spousal bereavement? Results from a nationally representative sample of older adults.

Increased mortality risk following spousal bereavement (often called the "widowhood effect") is well documented, but little prior research has evaluated health deteriorations preceding spousal loss. Data are from the Health and Retirement Study, a nationally representative sample of Americans over 50 years old. Individuals who were married in 2004 were considered for inclusion. Outcome data from 2006 on mobility (walking, climbing stairs), number of depressive symptoms, and instrumental activities of daily living (IADLs) were used. Exposure was characterized based on marital status at the time of outcome measurement: "recent widows" (N=396) were bereaved between 2004 and 2006, before outcomes were assessed; "near widows" (N=380) were bereaved between 2006 and 2008, after outcomes were assessed; "married" individuals (N=7,330) remained married from 2004 to 2010, the follow-up period for this analysis. Linear regression models predicting standardized mobility, depressive symptoms, and IADLs, were adjusted for age, race, gender, birthplace, socio-economic status, and health at baseline. Compared to married individuals, recent widows had worse depressive symptoms (β=0.71, 95% confidence interval (CI): [0.57, 0.85]). Near widows had worse depressive symptoms (β=0.21, 95% CI: [0.08, 0.34]), mobility (β=0.14, 95%CI: [0.01, 0.26]), and word recall (β=-0.13, 95%CI: [-0.23, -0.02]) compared to married individuals. Health declines before spousal death suggests some portion of the "widowhood effect" may be attributable to experiences that precede widowhood and interventions prior to bereavement might help preserve the health of the surviving spouse.

Anxiety and Depression in Children With Nonverbal Learning Disabilities, Reading Disabilities, or Typical Development

The main goal of the present study was to shed further light on the psychological characteristics of children with different learning disability profiles aged between 8 and 11 years, attending from third to sixth grade. Specifically, children with nonverbal learning disabilities (NLD), reading disabilities (RD), or a typical development (TD) were tested. In all, 15 children with NLD, 15 with RD, and 15 with TD were administered self-report questionnaires to assess different types of anxiety and depression symptoms. Both NLD and RD children reported experiencing more generalized and social anxiety than TD, the NLD children reported more severe anxiety about school and separation than TD, and the children with RD had worse depressive symptoms than those with NLD or TD.

A longitudinal study of SLC6A4 DNA promoter methylation and poststroke depression

Serotonin transporter gene (SLC6A4) has been shown to play an important role in the pathophysiology of mood disorders including poststroke depression (PSD). SLC6A4 expression is influenced by DNA methylation status and the SLC6A4 linked promoter region (5-HTTLPR) polymorphism. This study aimed to investigate whether SLC6A4 methylation status was associated with depression ascertained at two weeks and one year after stroke taking into account the 5-HTTLPR polymorphism. A total of 286 patients were evaluated two weeks after stroke, and 222 (78%) were followed one year later. Depression was diagnosed according to DSM-IV criteria, and depression severity was assessed by the Hamilton Depression Rating Scale (HAMD) at each evaluation point. The effects of SLC6A4 methylation status on PSD status and HAMD scores were investigated using multivariate logistic regression models and partial correlation tests, respectively. Analyses were repeated after stratification by 5-HTTLPR genotype groups (‘l/l or l/s’ and ‘s/s’). Higher SLC6A4 promoter methylation status was independently associated with PSD both at 2 weeks and more prominently at 1 year after stroke, and was significantly associated with the worsening of depressive symptoms over one year. These findings were significant only in the presence of the 5-HTTLPR s/s genotype. SLC6A4 methylation profile was supported as a potential diagnostic and prognostic biomarker for PSD; associations with SLC6A4 methylation status may represent a target for drug development.

The role of loss and danger events in symptom exacerbation in bipolar disorder

Research concerned with the association between stressful life events [SLEs] and bipolar disorder [BD] is inconsistent. Drawing on the unipolar depression literature, specific classifications of events (in particular, humiliation and loss events) seem to be especially important, while for anxiety disorders loss and danger events have been found to be pertinent. However, little or nothing is known about the relationship between such events and BD. The aim of the present investigation is to examine the association between danger and loss events and symptom exacerbation in BD. A total of 96 BD participants were interviewed using the Life Events and Difficulties Schedule [LEDS] at two time points: baseline and 4 month follow-up. Self-report and observer-rated symptom measures were administered at both interviews. The Beck Depression Inventory-Second Edition and the Montgomery Asberg Depression Rating Scale were used to measure depressive symptoms. The Self-Report Mania Inventory and Clinician-Administered Rating Scale for Mania were used to rate manic symptoms. Independent severe events, independent loss events and independent danger events were found to be significantly associated with worsening of depressive symptoms over an 8-month period. No significant associations were observed for manic symptoms. Specific relationships with different types of SLEs may explain previous discrepant findings concerning the relationship between SLEs and BD.

Relationships Among Pain, Depressed Mood, and Global Status in Fibromyalgia Patients: Post Hoc Analyses of a Randomized, Placebo-Controlled Trial of Milnacipran

Patients with fibromyalgia often experience depressive symptoms in addition to chronic pain and other characteristic symptoms associated with this disorder. To examine the relationships among pain, depressive symptoms, and global status in a clinical trial of milnacipran for fibromyalgia. Data from a randomized, double-blind study (milnacipran 100 mg/d, n = 516; placebo, n = 509) were analyzed. Treatment outcomes included quantitative changes in pain and Beck depression inventory (BDI) scores, mean Patient Global Impression of Change (PGIC) scores, and three responder endpoints: patients with ≥30% pain improvement, PGIC score ≤2, and patients meeting both pain and PGIC responder criteria (2-measure composite responders). Correlations and path analyses were conducted to evaluate relationships among improvements in depressive symptoms, pain, and PGIC. Patients receiving milnacipran had greater decreases in mean pain scores, lower mean PGIC endpoint scores, and higher responder rates regardless of baseline severity of depressive symptoms. The highest responder rates were found in patients with greater than four-point improvement in BDI scores (milnacipran vs. placebo: pain, 57.5% vs. 39.0%; PGIC, 60.1% vs. 38.2%; 2-measure composite, 49.0% vs. 27.9%; all p < 0.01), although significant differences between treatment groups were also found in patients with no improvement or worsening of depressive symptoms. Correlations between changes in BDI and changes in pain or PGIC were low (r ≤ 0.3). Path analyses indicated 87.2% of pain reduction to be a direct effect of milnacipran treatment. Symptom improvements with milnacipran were only weakly associated with baseline depressive symptoms and were largely independent of improvements in depressive symptomatology.