Showing papers in "International Review of Psychiatry in 1996"
TL;DR: The average prevalence rate of non-psychotic postpartum depression based on the results of a large number of studies is 13% as discussed by the authors, and the average prevalence estimates are affected by the nature of the assessment method.
Abstract: The average prevalence rate of non-psychotic postpartum depression based on the results of a large number of studies is 13%. Prevalence estimates are affected by the nature of the assessment method...
3,004 citations
TL;DR: In this paper, the relative importance of social, psychological and biological influences on the sex difference in depression was assessed, including the epidemiology of macrosocial variables and age effects, and exploration of relevant psychological attributes, including temperament, personality, and attributional and coping styles.
Abstract: The high prevalence of depressive disorder in women is well established. However, it has not been convincingly explained. This reflects a more general failure of research to provide a comprehensive aetiological account of depression. The examination of the sex difference can be used as a probe to evaluate how far we have gone in substantiating integrated models of depressive disorder. In this paper, I review several lines of investigation in order to assess the relative importance of social, psychological and biological influences on the sex difference in depression. These include the epidemiology of macrosocial variables and age effects, and the exploration of relevant psychological attributes, including temperament, personality, and attributional and coping styles. We must also consider the experience of psychosocial adversity, and in particular the possibility of an increased susceptibility of women to some forms of stress. Both the tendency to affiliation and the requirement for social support seem st...
244 citations
TL;DR: There is evidence for an association between postpartum depression and a number of indices of adverse child outcome as mentioned in this paper, such as adverse child outcomes, cognitive development, and behavioural disturbance.
Abstract: There is evidence for an association between postpartum depression and a number of indices of adverse child outcome. In infants of mothers with postpartum depression, deficits have been found in their early interactions and their cognitive functioning. A high rate of insecure attachment is also apparent. There is also evidence for a longer term association: cognitive development in the four-year-olds of mothers who have had a postpartum depression appears compromised (at least in boys from lower socio-economic backgrounds), and there is an association with behavioural disturbance. Longitudinal analyses reveal that the impaired patterns of early interaction occurring between mother and infant in the context of the maternal mood disorder may be an important determinant of some of these adverse child outcomes. With respect to cognitive development, there is evidence of a sensitive developmental period, although its precise parameters are uncertain. Observational and experimental studies are needed to elucida...
227 citations
TL;DR: More than 10% of fathers suffer from psychiatric morbidity in the postnatal period as mentioned in this paper and depression among fathers is associated with having depressed partners, having an unsupportive relationship and being unemployed.
Abstract: More than 10% of fathers suffer from psychiatric morbidity in the postnatal period. Depression amongst fathers is associated with having depressed partners, having an unsupportive relationship and being unemployed. Depression in fathers therefore occurs in highly vulnerable families and may have an important impact on the emotional development of the infant. Developing effective screening and treatment methods for these families is an important priority for future research
100 citations
TL;DR: The cumulative evidence indicates that HIV status or stage of illness are not by themselves strong predictors of mood or anxiety disorders, but risk group membership and a prior history of depression appear to be more strongly related.
Abstract: This paper summarizes the available data on prevalence of psychiatric disorders in HIV+ samples. Primary emphasis is placed on studies using structured interviews for diagnosis and including matched HIV seronegative comparison groups. Such comparison groups permit determination of whether membership in a given risk group, or HIV infection as such, largely account for differences in rates of disorder compared to total population rates. The cumulative evidence indicates that HIV status or stage of illness are not by themselves strong predictors of mood or anxiety disorders. Risk group membership and a prior history of depression appear to be more strongly related. Whether one-month prevalence rates of major depression for non-intravenous drug users in the 5–8% range are considered ‘high’ (more than double the total population rates in the Epidemiologic Catchment Area studies) or unexpectedly low (compared to those with other terminal illnesses or the initial reports of HIV-related psychopathology from the m...
64 citations
TL;DR: The evidence for a low suicide risk in postnatal and pregnant women and by implication people of both sexes who have children is assessed.
Abstract: Childbearing women have a high rate of psychiatric disorder and a high risk of suicide would therefore be predicted. This review assesses the evidence for a low suicide risk in postnatal and pregnant women, and by implication people of both sexes who have children, a phenomenon first commented on by Durkheim a century ago but rarely researched since then
47 citations
TL;DR: In this paper, the authors explored two aspects of maternal thinking in postnatal depression which might affect detection and treatment, and examined women's perceptions of their symptoms, relating these to whether they seek help and accept treatment.
Abstract: Postnatal depression affects 10–15% of all mothers but in many cases it is undetected and untreated. This paper explores two aspects of maternal thinking in postnatal depression which might affect detection and treatment. Firstly, it reviews the evidence that there are cognitive differences between women in the postnatal period and that the vulnerability to depression postnatally for some women may reflect a particular cognitive style. Secondly, it examines women's perceptions of their symptoms, relating these to whether they seek help and accept treatment. The importance of maternal thinking in the treatment of postnatal depression, particularly by health visitors is discussed
44 citations
TL;DR: This chapter concentrates on the role of the health visitor in relation to the needs of women whose depressions have until recently remained unrecognized.
Abstract: Most health professionals working with women and their families around the time of childbirth are by now aware that having a baby leads to a greatly increased risk of mental illness and emotional distress. Women with puerperal psychosis and severe depression are likely to be identified as needing psychiatric help, but they are unfortunately only the tip of the iceberg. This chapter concentrates on the role of the health visitor in relation to the needs of women whose depressions have until recently remained unrecognized. They are a large group; at least one in every ten women develops clinical depression in the months after delivery. They are also an important group, not only in terms of personal suffering but because they have direct responsibility for other vulnerable members of the community. Without help or treatment, postnatal depression can not only mar a woman's experience of herself as mother, it can affect her infant's social and cognitive development. Her other children may be affected, also her...
42 citations
TL;DR: Using the principles of health needs assessment this chapter describes how the health needs of this group of patients may be assessed and how services can be developed appropriate to the local situation.
Abstract: Psychiatric disorder following childbirth is common and much of it serious, warranting psychiatric attention. In addition childbirth poses a predictable and major risk to the mental health of women suffering from serious mental illness. Without appropriate and swift treatment there may be adverse consequences, not only for the mother but also for her children. Psychiatric services with the requisite skills and resources are necessary to meet the needs of these mothers, their infants and families. Using the principles of health needs assessment this chapter describes how the health needs of this group of patients may be assessed and how services can be developed appropriate to the local situation
39 citations
TL;DR: In this paper, the extent to which infant homicides can be attributed to mental illness and/or social problems is discussed, and evidence suggests that another underlying causative factor is probably implicated, namely a relationship pattern which is predominantly disorganized and violent, and which is transmitted from generation to generation.
Abstract: In Britain, infanticide is a significant contributor to infant mortality. It may also be an extreme indicator of more widespread but unrecognized infant abuse. Using data from epidemiological studies, this paper describes demographic features of parents who kill their infants, and characteristics of their victims. The extent to which infant homicides can be attributed to mental illness and/or social problems is discussed. Evidence is presented which suggests that another underlying causative factor is probably implicated, namely a relationship pattern which is predominantly disorganized and violent, and which is transmitted from generation to generation. There is need for further systematic and qualitative research into the precursors and circumstances surrounding the homicide of infants so that appropriate preventative strategies can be developed
37 citations
TL;DR: In the United States, HIV illness commonly strikes in families already struggling with substance abuse, psychiatric disorder, and multi-generational histories of victimization and trauma, which can complicate family adaptation to the stressors of HIV disease.
Abstract: As rates of HIV infection and AIDS increase in women of child bearing age, HIV/AIDS has evolved into a disease of families with children. This is reflected in increasing numbers of HIV-infected children as well as rapidly growing numbers of children and adolescents losing parents to AIDS. Each stage of HIV disease, including diagnosis of HIV infection, illness progression, late-stage illness, death, and family reconfiguration presents particular mental health challenges to infected parents and their affected children. Children who are themselves HIV-infected must also confront the psychological issues of adapting to a chronic, terminal illness as well as the effects of HIV progression on development and cognition. In the United States, HIV illness commonly strikes in families already struggling with substance abuse, psychiatric disorder, and multi-generational histories of victimization and trauma. Where present, these problems can complicate family adaptation to the stressors of HIV disease. Clinicians w...
TL;DR: Bereavement in homosexual men was associated with increased distress in a dose-response relationship with the number of losses, but more recent research suggests that this is not the case, though a relationship with increased grief level and with perceived self-threat is still recognized.
Abstract: The loss of a loved one is a potent and frequent life stressor for those infected with HIV and those at risk for infection. Early in the epidemic, bereavement in homosexual men was associated with increased distress in a dose-response relationship with the number of losses. More recent research suggests that this is not the case, though a relationship with increased grief level and with perceived self-threat is still recognized. A change in the form of bereavement response to a reaction resembling chronic, post-traumatic distress is also possible. Future research using a stressor-support-coping model is advocated to investigate this possibility. Studies on the effect of bereavement should be conducted with other HIV infected and at-risk groups. Brief, supportive, group psychotherapy for recent loss and total loss burden due to HIV/AIDS is advocated to prevent associated psychological morbidity. The effects of such interventions on immune measures and the clinical progression of HIV disease also merits inv...
TL;DR: It is suggested that activation of the HPA axis is a useful marker of environmental predisposition towards depression and that HPA activation may be a mediator as well as a marker of the environmental influence on depression.
Abstract: Recent studies on the relationship between depression and the hypothalamic pituitary adrenal axis are of general interest from three points of view. Firstly, exactly the same adaptive changes are s...
TL;DR: In this paper, a review endeavours to bring together aspects of perinatal and transcultural psychiatry, both subjects have been central to the author's research and clinical work for two decades.
Abstract: This review endeavours to bring together aspects of perinatal and transcultural psychiatry—both subjects have been central to the author's research and clinical work for two decades. It is argued that if a comprehensive understanding of perinatal mental disorder is to be obtained then a cultural approach is necessary. The observations of social anthropologists that postnatal rituals and taboos are less common in Western than in non-industrialized societies, and that lack of social support may predispose to postnatal depression (PND) are described. There is a need for transcultural studies to investigate further these plausible hypotheses using qualitative as well as quantitative research methods
TL;DR: The evidence relating postpartum mood disorder to endocrine factors is reviewed, with particular reference to thyroid hormones, progesterone, cortisol and oestrogen.
Abstract: The evidence relating postpartum mood disorder to endocrine factors is reviewed, with particular reference to thyroid hormones, progesterone, cortisol and oestrogen. The findings on non-psychotic depression and thyroid dysfunction are the most robust, but such biological changes have to be seen as interacting with psychological and social factors to produce depression. Hormone treatment trials in specific subgroups of postnatal women would enhance our understanding of aetiology
TL;DR: The authors found that depression may be intimately connected with the emotional processing of memories of specific traumatic or adversarial experiences, such as childhood and recent adversity, which are relatively powerful predictors of depression onset.
Abstract: Cognitive theories of depression have proposed that negative attitudes about the self are activated either by recent life events or by the experience of depression itself, and contribute either to the onset or the course of the disorder, or to both. However, attitudinal measures have been relatively unsuccessful in predicting in advance who is likely to become depressed. In contrast, biographical details of childhood and recent adversity are relatively powerful predictors of depression onset. Other recent research has found that depressed patients often experience high levels of repeated intrusive memories of specific instances of adversity. Both reports of abuse, as well as intrusion and avoidance of memories of this abuse, are related to the production of over-general memories on an autobiographical memory test and to other measures of depressive attitudes and cognitions. These findings suggest that depression may be intimately connected with the emotional processing of memories of specific traumatic or...
TL;DR: In this paper, the authors examined the association of personality disorders and HIV infection and found that individuals who are HIV-infected have a higher prevalence of borderline and antisocial personality disorder.
Abstract: Few studies have examined the association of personality disorders and HIV infection. Although limited by methodological considerations, most studies to date suggest that individuals who are HIV-infected have a higher prevalence of borderline and antisocial personality disorder. Explanations for this phenomenon are tentative. Studies suggest that impulsivity and substance abuse are associated both with HIV-high risk behavior and personality disorder. It is plausible, therefore, that the poor impulse control and substance abuse which often accompany personality disorder may lead to the practice of high risk behaviors, thus placing uninfected individuals with personality disorder at increased risk for HIV infection. Treatment of HIV infected individuals with personality disorders is time consuming and difficult. Psychodynamic as well as cognitive approaches have been utilized.
TL;DR: A review of recent controlled studies in the field of family-genetic aspects of juvenile depressive disorders can be found in this article, where the main challenges for the future concern the need to differentiate specific from non-specific effects of parental depressive disorder, to differentiate varieties of parental and child psychopathology, to consider genetic as well as environmental transmission, and to investigate the mechanisms involved in individual differences in children's responses.
Abstract: Over the past decade there has been increasing interest in family-genetic aspects of juvenile depressive disorders. This interest arises both because early onset of adult depression is associated with an increased familial loading of the disorder and because the children of depressed parents have been found to have increased rates of depression. This paper reviews recent controlled studies in the field. Substantive findings will be highlighted, along with conceptual and methodological issues that arise when applying family-genetic methods to the study of psychopathology in children. The main challenges for the future concern the need to differentiate specific from non-specific effects of parental depressive disorder, to differentiate varieties of parental and child psychopathology, to consider genetic as well as environmental transmission, and to investigate the mechanisms involved in individual differences in children's responses.
TL;DR: The importance of a comparative population approach for the latter is emphasized as an adjunct to genetically sensitive designs since the latter deal only with variance arising from individual variability within a population.
Abstract: Almost all genetic research on depression, until recent work with the Virginia Twin Register, has been based on ‘non-neurotic’ conditions seen in in-patient settings. While these have provided firm evidence for genetic effects, they are not relevant for the bulk of depressive disorders. The importance of a comparative population approach for the latter is emphasized as an adjunct to genetically sensitive designs since the latter deal only with variance arising from individual variability within a population. This means that it is possible for population differences in rates of disorder to be essentially determined by parallel differences in psychosocial factors even on the conservative assumption that a genetic liability is present in every instance of the disorder. The perspective is particularly important where, as with depression, a clinically relevant condition can show large differences in rates between populations. Behavioural genetic concepts of heritability and shared environment are discussed in ...
TL;DR: In this article, effects of ovarian hormones on cognitive functions and mood are emerging and modulation of neurotransmitter systems involved in the pathogenesis of affective disorders, particularly the serotonergic and dopamine systems, have been reported.
Abstract: Over recent years research into steroid-CNS interactions has moved beyond reproductive functions. Effects of ovarian hormones on cognitive functions and mood are emerging and modulation of neurotransmitter systems involved in the pathogenesis of affective disorders, particularly the serotonergic and dopamine systems, have been reported. However, most clinical and basic science research has focused on effects of steroid exposure rather than those of steroid exposure followed by withdrawal which is more relevant to the aetiology of postnatal, premenstrual and menopausal affective disorders. However, promising target sites for such experiments have been identified and future research in this area is likely to see interesting times ahead
TL;DR: Recommendations are made to improve the quality of information from single case studies and to prevent infants from being exposed to drugs in breast-milk if there are any concerns about their health and development.
Abstract: All commonly used psychotropic drugs pass into breast-milk. Most of the literature consists of single case studies and there is too little information to permit one to reach firm conclusions about the presence of, or lack of, possible risks to infants. In most instances, and particularly in relation to tricyclic antidepressants about which most is known, it seems probable that the benefits of breast feeding will outweigh the potential and as yet undefined risks to the infants of very small amounts of drugs and their metabolites. Systematic, controlled longitudinal research is needed to check for accumulation of drugs in infants and to exclude both short and long term toxic effects. Such studies may not be justifiable until enough single-case data has accumulated. Recommendations are made to improve the quality of information from single case studies and to prevent infants from being exposed to drugs in breast-milk if there are any concerns about their health and development
TL;DR: The last decade has seen a considerable expansion in our understanding of the nature of social adversities that are implicated in the aetiology of depressive illness as discussed by the authors, drawing attention to the role of humiliation, entrapment and loss experiences.
Abstract: The last decade has seen a considerable expansion in our understanding of the nature of social adversities that are implicated in the aetiology of depressive illness. This paper reviews recent developments in the measurement and specification of such adversity, drawing attention to the role of humiliation, entrapment and loss experiences. These refinements in measurement may lead to a better understanding of the processes that lie behind well-recognized variations in the occurrence of depression between genders, cultural groups and at different phases of the adult life-cycle.
TL;DR: The psychosocial functioning of infected men from the time they learn they are seropositive to their demise is described, and to contrast this to seronegative men are contrasted.
Abstract: By its chronic nature, HIV infection represents a period of time where persons are coping with the social and physiological changes of the infection across the spectrum of acute infection, illness, and death. As a person moves through the stages of infection, he or she also experiences different psychological states, whether they be a reaction to the disease process itself, to social reactions to HIV/AIDS, or to the threat of developing AIDS in the future. The purpose of this article is to describe in both quantitative and qualitative terms the psychosocial functioning of infected men from the time they learn they are seropositive to their demise, and to contrast this to seronegative men. This paper specifically examines the longitudinal patterns of psychological states, social support, social conflict, and HIV-risk behavior as measured prospectively in a cohort of homosexual men in Chicago. The men participating in the Chicago Multicenter AIDS Cohort and Coping and Change Studies enrolled in 1984, before...
TL;DR: Recommendations are made for limiting chronic mental patients’ risk for AIDS that include techniques for reliably assessing individual risk and treating variable impairment of autonomy.
Abstract: Patients with chronic mental illnesses including schizophrenia and bipolar disorder constitute an important risk group for AIDS. Although limited by a lack of control groups, study findings indicate that an important minority of patients report having multiple sexual partners, use alcohol or drugs preceding sexual intercourse, report a history of intravenous drug use, are coerced into unwanted sexual activity, experience homosexual or heterosexual anal intercourse, and fail to use condoms consistently, if at all. Furthermore, chronically and variably impaired autonomy may add to patients’ vulnerability. In this context the author makes recommendations for limiting chronic mental patients’ risk for AIDS that include techniques for reliably assessing individual risk. Preventive clinical interventions include treating variable impairment of autonomy, communication and behavioral skills training targeted to skills deficits while augmented by educational strategies, and outreach to the partners of at-risk pati...
TL;DR: There is evidence from a community survey that depression associated with cardiovascular disease is less likely to be associated with a major life event in the year prior to onset; a genuine endogenous/reactive dichotomy is suggested for late onset depression in old age.
Abstract: Attitudes within our society have for centuries equated old age with a general decline in quality of life, and more specifically old age and its sequelae have been likened to depression. There is some evidence to suggest that ageing may render the brain more susceptible to react in a way that is associated with depression according to current theory. Perhaps surprisingly, epidemiological studies indicate that depression is probably about as common in old age as it is in earlier years. There is less of a familial element to aetiology in late onset depression and perhaps the biological changes associated with ageing make up for this and thus maintain prevalence rates. There is evidence from a community survey that depression associated with cardiovascular disease is less likely to be associated with a major life event in the year prior to onset; a genuine endogenous/reactive dichotomy is suggested for late onset depression in old age.
TL;DR: The combined treatment of substance use and psychiatric disorders may improve the likelihood that patients will receive adequate medical treatment of HIV disease, particularly if integrated systems of care are in place.
Abstract: Drug users infected with the human immunodeficiency virus (HIV) are a rapidly growing group of patients whose optimal medical and psychiatric care requires that the substance use disorders are assessed and treated. Drug users have high rates of other psychiatric disorders even in the absence of HIV infection. The effects of acute and chronic drug use complicate the assessment of psychiatric symptoms. There is evidence that in the early stages of HIV disease, drug use plays a larger role in producing psychiatric disorders than does HIV itself. In general, neuropsychiatric problems do not appear to progress more rapidly in drug users than in HIV infected homosexual men. However, compliance with and adherence to medical care are major problems in the treatment of drug users. The combined treatment of substance use and psychiatric disorders may improve the likelihood that patients will receive adequate medical treatment of HIV disease, particularly if integrated systems of care are in place.
TL;DR: The concepts, terminology and diagnosis of HIV-associated dementia and related disorders are reviewed, as well as the evidence for its presence in HIV symptomatic and asymptomatic individuals.
Abstract: HIV infection is associated with an increased risk of primary cognitive disorders. These can have important implications for quality of life and the care of people with the disease. In this paper, we review the concepts, terminology and diagnosis of HIV-associated dementia and related disorders. This is followed by discussion of their epidemiology, course and prognosis. The concept of HIV-associated minor cognitive impairment is considered, as well as the evidence for its presence in HIV symptomatic and asymptomatic individuals. The management of HIV-associated dementia is considered next, with discussion of pharmacological, psychological and social interventions. Finally, the question of the prevention of HIV-associated dementia is reviewed.
TL;DR: In this paper, twin family and adoption studies confirm a genetic contribution to the aetiology of depression, which is greater in bipolar compared to unipolar disorder, and the evidence suggests that depression is caused by multiple genes and that these confer a susceptibility to develop the disorder.
Abstract: Twin family and adoption studies confirm a genetic contribution to the aetiology of depression which is greater in bipolar compared to unipolar disorder. The evidence suggests that depression is caused by multiple genes and that these confer a susceptibility to develop the disorder. Data from various twin studies can be applied to a liability threshold model which allow the variance contributed to by genetic and environmental aetiological factors to be determined. The few studies that have examined both genetic and environmental risk factors such as threatening life events in the same subjects have indicated that reactions to such events may also be genetically determined. Thus the relationship between environmental and familial aetiological factors is more complex than originally thought.
TL;DR: The data supporting the thesis that both of these factors may be at work in producing the high rates of major depression and mania in HIV-infected patients are discussed.
Abstract: Major depression and mania have increased prevalence in HIV-infected patients, particularly in clinical settings and at later stages of disease. Varied rates of major depression have been reported but differences in definition, methods of study, and population may partly explain these differences. We describe the clinical characteristics, assessment and treatment of mood disorders in HIV-infected patients, with emphasis on aspects specific to the setting of HIV infection. Diagnosis and treatment are complicated by medical complexity, stigma and psychosocial stress. Treatment is associated with clinical improvement. Mood disorders are associated with impulsivity, substance abuse, hopelessness, and demoralization, all of which may increase risk for HIV infection. Also, HIV-associated subcortical damage may be a risk factor for mood disorders, which are increased in late stage HIV infection. We discuss the data supporting the thesis that both of these factors may be at work in producing the high rates of moo...
TL;DR: Evidence is reviewed that this approach is an appropriate method of studying the common mental disorders, depression and anxiety and a probable cause relationship exists between the prevalence of low income and commonmental disorder, independent of the association between social class and common mental disorder.
Abstract: Depression is a common and disabling condition of importance from the perspective of public health. Public health is concerned with identifying causing factors that can inform population based preventive strategies and the links between social policy and health. Evidence is reviewed that this approach is an appropriate method of studying the common mental disorders, depression and anxiety. A probable cause relationship exists between the prevalence of low income and common mental disorder, independent of the association between social class and common mental disorder. There is a possibility that changes in social policy that would reduce income inequality could reduce the prevalence of common mental disorder.