In 2 meta-analyses on gender differences in depression in nationally representative samples, we advance previous work by including studies of depression diagnoses and symptoms to (a) estimate the magnitude of the gender difference in depression across a wide array of nations and ages; (b) use a developmental perspective to elucidate patterns of gender differences across the life span; and (c) incorporate additional theory-driven moderators (e.g., gender equity). For major depression diagnoses and depression symptoms, respectively, we meta-analyzed data from 65 and 95 articles and their corresponding national data sets, representing data from 1,716,195 and 1,922,064 people in over 90 different nations. Overall, odds ratio (OR) = 1.95, 95% confidence interval (CI) [1.88, 2.03], and d = 0.27 [0.26, 0.29]. Age was the strongest predictor of effect size. The gender difference for diagnoses emerged earlier than previously thought, with OR = 2.37 at age 12. For both meta-analyses, the gender difference peaked in adolescence (OR = 3.02 for ages 13-15, and d = 0.47 for age 16) but then declined and remained stable in adulthood. Cross-national analyses indicated that larger gender differences were found in nations with greater gender equity, for major depression, but not depression symptoms. The gender difference in depression represents a health disparity, especially in adolescence, yet the magnitude of the difference indicates that depression in men should not be overlooked. (PsycINFO Database Record

Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms.

A revision of the 2000 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in May 2006. Key areas in treating depression were reviewed, and the strength of evidence and clinical implications were considered. The guidelines were drawn up after extensive feedback from participants and interested parties. A literature review is provided, which identifies the quality of evidence to inform the recommendations, the strength of which are based on the level of evidence. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse, and stopping treatment.

/pdf/evidence-based-guidelines-for-treating-depressive-disorders-2py43vtx76.pdf

Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2000 British Association for Psychopharmacology guidelines

Online social media fatigue and psychological wellbeing—A study of compulsive use, fear of missing out, fatigue, anxiety and depression.

A revision of the British Association for Psychopharmacology guidelines for treating depressive disorders with antidepressants was undertaken in order to specify the scope and target of the guidelines and to update the recommendations based explicitly on the available evidence. A consensus meeting, involving experts in depressive disorders and their treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from participants and interested parties. A literature review is given which identifies the quality of evidence followed by recommendations, the strength of which are based on the level of evidence. The guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing, management when initial treatment fails, continuation treatment, maintenance treatment to prevent recurrence and stopping treatment.

Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 1993 British Association for Psychopharmacology guidelines:

ContextDepressive disorders are highly prevalent in the general population,
but recognition and accurate diagnosis are made difficult by the lack of a
simple confirmatory test.ObjectiveTo review the accuracy and precision of depression questionnaires and
the clinical examination for diagnosing clinical depression.Data SourcesWe searched the English-language literature from 1970 through July 2000
using MEDLINE, a specialized registry of depression trials, and bibliographies
of selected articles.Study SelectionCase-finding studies were included if they used depression questionnaires
with easy to average literacy requirements, evaluated at least 100 primary
care patients, and compared questionnaire results with accepted diagnostic
criteria for major depression. Eleven questionnaires, ranging in length from
1 to 30 questions, were assessed in 28 published studies. Reliability studies
for the clinical examination required criterion-based diagnoses made by at
least 2 clinicians who interviewed the patient or reviewed a taped examination.
Fourteen studies evaluated interrater reliability.Data ExtractionPairs of authors independently reviewed articles. For case-finding studies,
quality assessment addressed sample size and whether patients were selected
consecutively or randomly, the criterion standard was administered and interpreted
independently of and blind to the results of the case-finding instrument,
and the proportion of persons receiving the criterion standard assessment
was less than or more than 50% of those approached for criterion standard
assessment. For reliability studies, quality assessment addressed whether
key patient characteristics were described, the interviewers collected clinical
history independently, and diagnoses were made blinded to other clinicians'
evaluations.Data SynthesisIn case-finding studies, average questionnaire administration times
ranged from less than 1 minute to 5 minutes. The median likelihood ratio positive
for major depression was 3.3 (range, 2.3-12.2) and the median likelihood ratio
negative was 0.19 (range, 0.14-0.35). No significant differences between questionnaires
were found. For mental health care professionals using a semistructured interview,
agreement was substantial to almost perfect for major depression (κ
= 0.64-0.93). Nonstandardized interviews yielded somewhat lower agreement
(κ = 0.55-0.74). A single study showed that primary care clinicians
using a semistructured interview have high agreement with mental health care
professionals (κ = 0.71).ConclusionsMultiple, practical questionnaires with reasonable performance characteristics
are available to help clinicians identify and diagnose patients with major
depression. Diagnostic confirmation by mental health care professionals using
a clinical interview or by primary care physicians using a semistructured
interview can be made with high reliability.

Is This Patient Clinically Depressed

Depression is a common mental disorder; effective methods for treating it are also available. Its recognition and diagnosis are prerequisite to effective treatment. A majority of depressed patients are generally managed in the primary care setting; only a half of the cases, however, are identified at their first visit. Screening instruments to improve recognition of depression have therefore been developed. The Depression Scale (DEPS), consisting of 10 items, was developed and tested in primary care patients aged 18 to 64 years. Clinical assessments were made on the basis of Present State Examination interviews with 436 patients. The DEPS proved to be satisfactory. Increasing age and poor education had an adverse effect on the screening process, however. The sensitivity of the DEPS for clinical depression was 74% and the specificity for non-depression 85%. The sensitivity for severe depression was 84% and the specificity for symptom-free patients 93%. The DEPS seems to improve the recognition of depression in primary care and may also be suitable for screening depression in the general population and for identifying high-risk groups.

Screening for depression in primary care. Development and validation of the Depression Scale, a screening instrument for depression.

Depression is a common disorder in the general population. However, its prevalence among patients attending various health-care facilities is less well known. There have been very few Finnish studies of this topic. The Tampere Depression Project (TADEP) dealt with the prevalence of depression and factors associated with it in individuals seen in community health centres (CHC) and in psychiatric-service (PS) patients. The diagnosis of depression was based on a standardized Present State Examination interview and a DSM-III-R assessment, carried out on 436 CHC patients and 428 PS patients. The severity of depression was assessed using the Hamilton Rating Scale of Depression. About 10% of CHC patients and 50% of PS patients suffered from clinical depression. In addition to these, some depressive symptoms were displayed by just under 10% of subjects. Similar prevalence rates were obtained by the various methods used. The 1-year prevalence rate of clinical depression was 20% for the CHC patients and almost 60% for the PS patients. Mild depression represented the largest group. In the CHC group, depression was found more often in middle-aged and widowed subjects and in patients with a lower educational level and blue-collar workers than in others. In the PS group, depression was found more often in women, the oldest subjects and the widowed than in others.

O. Poutanen

Papers

Screening for depression in primary care. Development and validation of the Depression Scale, a screening instrument for depression.

Prevalence of depression among patients seen in community health centres and community mental health centres