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Showing papers on "Depression (differential diagnoses) published in 1993"


Journal ArticleDOI
TL;DR: Age of onset analysis shows that this sex difference begins in early adolescence and persists through the mid-50s and means that the higher prevalence of 12-month depression among women than men is largely due to women having a higher risk of first onset.

2,113 citations


Journal ArticleDOI
20 Oct 1993-JAMA
TL;DR: Major depression in patients hospitalized following an MI is an independent risk factor for mortality at 6 months and its impact is at least equivalent to that of left ventricular dysfunction (Killip class) and history of previous MI.
Abstract: Objective. —To determine if the diagnosis of major depression in patients hospitalized following myocardial infarction (Ml) would have an independent impact on cardiac mortality over the first 6 months after discharge. Design. —Prospective evaluation of the impact of depression assessed using a modified version of the National Institute of Mental Health Diagnostic Interview Schedule for major depressive episode. Cox proportional hazards regression was used to evaluate the independent impact of depression after control for significant clinical predictors in the data set. Setting. —A large, university-affiliated hospital specializing in cardiac care, located in Montreal, Quebec. Patients. —All consenting patients (N=222) who met established criteria for Ml between August 1991 and July 1992 and who survived to be discharged from the hospital. Patients were interviewed between 5 and 15 days following the MI and were followed up for 6 months. There were no age limits (range, 24 to 88 years; mean, 60 years). The sample was 78% male. Primary Outcome Measure. —Survival status at 6 months. Results. —By 6 months, 12 patients had died. All deaths were due to cardiac causes. Depression was a significant predictor of mortality (hazard ratio, 5.74; 95% confidence interval, 4.61 to 6.87;P=.0006). The impact of depression remained after control for left ventricular dysfunction (Killip class) and previous Ml, the multivariate significant predictors of mortality in the data set (adjusted hazard ratio, 4.29; 95% confidence interval, 3.14 to 5.44;P=.013). Conclusion. —Major depression in patients hospitalized following an Ml is an independent risk factor for mortality at 6 months. Its impact is at least equivalent to that of left ventricular dysfunction (Killip class) and history of previous Ml. Additional study is needed to determine whether treatment of depression can influence post-MI survival and to assess possible underlying mechanisms. (JAMA. 1993;270:1819-1825)

1,975 citations


Journal ArticleDOI
TL;DR: Female subjects had significantly higher rates at all age levels for unipolar depression, anxiety disorders, eating disorders, and adjustment disorders; male subjects had higher rates of disruptive behavior disorders.
Abstract: Data were collected on the point and lifetime prevalences, 1-year incidence, and comorbidity of depression with other disorders (Diagnostic and Statistical Manual of Mental Disorders [3rd ed., rev.]) in a randomly selected sample (n = 1,710) of high school students at point of entry and at 1-year follow-up (n = 1,508). The Schedule for Affective Disorders and Schizophrenia for School-Age Children was used to collect diagnostic information; 9.6% met criteria for a current disorder, more than 33% had experienced a disorder over their lifetimes, and 31.7% of the latter had experienced a second disorder. High relapse rates were found for all disorders, especially for unipolar depression (18.4%) and substance use (15.0%). Female subjects had significantly higher rates at all age levels for unipolar depression, anxiety disorders, eating disorders, and adjustment disorders; male subjects had higher rates of disruptive behavior disorders.

1,746 citations


Journal ArticleDOI
TL;DR: The development of effective treatments for youth who fit the above-noted risk profiles should be given high priority.
Abstract: Objective The objective of this study was to determine the psychiatric risk factors for adolescent suicide. Method Sixty-seven adolescent suicide victims were compared with 67 demographically matched community controls. Psychiatric disorder was assessed in suicide victims using a psychological autopsy protocol and in controls using similar semistructured psychiatric interviews. Risk factors were quantified by use of the odds ratio (OR), that is, the relative frequency of the occurrence of a given condition in the suicides compared with the controls. Results The most significant psychiatric risk factors associated with adolescent suicide were major depression (OR = 27.0), bipolar mixed state (OR = 9.0), substance abuse (OR = 8.5), and conduct disorder (OR = 6.0). Substance abuse was a more significant risk factor when comorbid with affective illness than when alone (OR = 17.0 versus 3.3). The majority of depressed suicide victims had a primary affective disorder (82%). A significant minority (31%) of depressed suicide victims had been depressed less than 3 months. Previous suicide attempts, suicidal ideation, and homicidal ideation also were associated with adolescent suicide. Conclusions The development of effective treatments for youth who fit the above-noted risk profiles should be given high priority. J. Am. Acad. Child Adolesc. Psychiatry , 1993, 32, 3:521–529.

825 citations


Journal ArticleDOI
TL;DR: The majority of suicide victims suffered from comorbid mental disorders, and needs to be taken into account when analyzing the relationship between suicide and mental disorders and in planning treatment strategies for suicide prevention in clinical practice.
Abstract: OBJECTIVE: The purpose of this study was to investigate the prevalence and comorbidity of current mental disorders defined by DSM-III-R among a random sample of suicide victims from a nationwide suicide population. METHOD: Using a psychological autopsy method, the authors collected comprehensive data on all suicide victims in Finland during 1 year. Retrospective axis I-III consensus diagnoses were assigned to 229 (172 male, 57 female) victims. RESULTS: One or more diagnoses on axis I were made for 93% of the victims. The most prevalent disorders were depressive disorders (59%) and alcohol dependence or abuse (43%). The prevalence of major depression was higher among females (46%) than among males (26%). Alcohol dependence was more common among the males (39% versus 18% for females). A diagnosis on axis II was made for 31% and at least one diagnosis on axis III for 46% of the cases. Only 12% of the victims received one axis I diagnosis without any comorbidity. CONCLUSIONS: The majority of suicide victims suffered from comorbid mental disorders. Comorbidity needs to be taken into account when analyzing the relationship between suicide and mental disorders and in planning treatment strategies for suicide prevention in clinical practice. Language: en

798 citations


Journal ArticleDOI
TL;DR: No significant difference in the point prevalence of depression at six months was found between the postnatal and control women, nor in the six-month period prevalence, but a threefold higher rate of onset of depression was found within five weeks of childbirth.
Abstract: In a two-stage screening procedure using the Edinburgh Postnatal Depression Scale and Goldberg's Standardised Psychiatric Interview, 232 women six months after delivery were compared with control women individually matched for age, marital status and number of children, obtained from general practitioner lists, who were not pregnant nor had had a baby in the previous 12 months. No significant difference in the point prevalence of depression at six months was found between the postnatal (9.1%) and control women (8.2%) nor in the six-month period prevalence (13.8% postnatal, 13.4% controls), but a threefold higher rate of onset of depression was found within five weeks of childbirth. The possible explanations relate to the long duration of depression in women with young children, and the stressful effect of childbirth and its psychosocial sequelae.

776 citations


Journal ArticleDOI
01 Jul 1993-Stroke
TL;DR: Evidence is provided of a differentiation of factors likely to be implicated in the development of depression after stroke based on the period of time since the stroke event.
Abstract: BACKGROUND AND PURPOSE: This prospective study was designed to examine the contributions of neurobiological, functional, and psychosocial factors to major depression after stroke. In addition, the ...

681 citations


Journal ArticleDOI
TL;DR: An increased prevalence of depression in diabetes relative to the general population is highly suggested by the literature, but biases and methodological problems commonly encountered in prevalence studies may interfere with the strength of this conclusion.
Abstract: OBJECTIVE To determine the prevalence of depression in adult diabetic populations through a comprehensive literature review and to critically evaluate the methods and findings of such studies from an epidemiological perspective. RESEARCH DESIGN AND METHODS A systematic review of the scientific literature revealed a total of 20 studies, 14 of which had been conducted since 1988. Nine of the studies were controlled investigations, whereas the remaining 11 studies did not contain comparison groups. The studies included both treatment and community samples. RESULTS The range of the prevalence of current depression obtained from structured diagnostic interviews in diabetic samples was 8.5–27.3% ( = 14.0%) in controlled studies and 11.0–19.9% ( = 15.4%) in uncontrolled studies. These rates are at least three times the prevalence of major depressive disorder found in the general adult population of the U.S. Investigations using depression symptom scales corroborated these findings, as the range of clinically significant depression symptomatology in diabetic samples was 21.8–60.0% ( = 32.4%) in controlled studies and 10.0–28.0% ( = 19.6%) in uncontrolled studies. CONCLUSIONS An increased prevalence of depression in diabetes relative to the general population is highly suggested by the literature, but biases and methodological problems commonly encountered in prevalence studies may interfere with the strength of this conclusion. An increased prevalence of depression in diabetes relative to other somatic illnesses remains unproven. The pervasive impact of depression on quality of life and its potential negative effect on diabetes management warrant recognition and treatment of the affective disorder in diabetic individuals.

657 citations


Journal ArticleDOI
TL;DR: In women, the relationship between neuroticism and the liability to major depression is substantial and largely the result of genetic factors that predispose to both neuroticismand major depression.
Abstract: Objective: To elucidate the nature of the etiologic relationship between personality and major depression in women. Design: A longitudinal twin design in which twins completed a time 1 questionnaire and, 15 months later, were personally interviewed for the occurrence of major depression during the last year and completed a time 2 questionnaire. Both questionnaires contained short forms assessing neuroticism and extraversion. Participants: 1733 twins from female-female pairs ascertained from the population-based Virginia Twin Registry. Results: Extraversion was unrelated to lifetime or 1-year prevalence of major depression. Neuroticism was strongly related to lifetime prevalence of major depression and robustly predicted the prospective 1-year prevalence of major depression in those who, at time 1, denied previous depressive episodes. However, controlling for levels of neuroticism at time 1, levels of neuroticism at time 2 were moderately elevated in those who had had an episode of major depression between times 1 and 2 ("scar" effect) and substantially elevated in those experiencing an episode of major depression at time 2 ("state" effect). In those who developed major depression, levels of neuroticism did not predict time to onset. In the best-fit longitudinal twin model, the proportion of the observed correlation between neuroticism and the liability to major depression that is due to shared genetic risk factors was estimated at around 70%, that due to shared environmental risk factors at around 20%, and that due to a direct causal effect of major depression on neuroticism (via both "scar" and "state" effects) at around 10%. Approximately 55% of the genetic liability of major depression appeared to be shared with neuroticism, while 45% was unique to major depression. Conclusion: In women, the relationship between neuroticism and the liability to major depression is substantial and largely the result of genetic factors that predispose to both neuroticism and major depression.

648 citations


Journal ArticleDOI
11 Sep 1993-BMJ
TL;DR: Psychiatric symptoms and disorder are frequent after major and less severe road accident injury, and post-traumatic symptoms are common and disabling.
Abstract: OBJECTIVE--To determine the psychiatric consequences of being a road traffic accident victim. DESIGN--Follow up study of road accident victims for up to one year. SETTING--Emergency department of the John Radcliffe Hospital, Oxford. SUBJECTS--188 consecutive road accident victims aged 18-70 with multiple injuries (motorcycle or car) or whiplash neck injury, who had not been unconscious for more than 15 minutes, and who lived in the catchment area. MAIN OUTCOME MEASURES--Present state examination "caseness"; post-traumatic stress disorder and travel anxiety; effects on driving and on being a passenger. RESULTS--Acute, moderately severe emotional distress was common. Almost one fifth of subjects, however, suffered from an acute stress syndrome characterised by mood disturbance and horrific memories of the accident. Anxiety and depression usually improved over the 12 months, though one tenth of patients had mood disorders at one year. In addition, specific post-traumatic symptoms were common. Post-traumatic stress disorder occurred during follow up in one tenth of patients, and phobic travel anxiety as a driver or passenger was more common and frequently disabling. Emotional disorder was associated with having pre-accident psychological or social problems and, in patients with multiple injuries, continuing medical complications. Post-traumatic syndromes were not associated with a neurotic predisposition but were strongly associated with horrific memories of the accident. They did not occur in subjects who had been briefly unconscious and were amnesic for the accident. Mental state at three months was highly predictive of mental state at one year. CONCLUSIONS--Psychiatric symptoms and disorder are frequent after major and less severe road accident injury. Post-traumatic symptoms are common and disabling. Early information and advice might reduce psychological distress and travel anxiety and contribute to road safety and assessing "nervous shock."

612 citations


Journal ArticleDOI
TL;DR: The model suggested that at least four major and interacting risk factor domains are needed to understand the etiology of major depression: traumatic experiences, genetic factors, temperament, and interpersonal relations.
Abstract: Objective The authors develop an exploratory, integrated etiologic model for the prediction of episodes of major depression in an epidemiologic sample of women. Method Both members of 680 female-female twin pairs of known zygosity from a population-based register were assessed three times at greater than 1-year intervals. The last two assessments included a structured interview evaluation for presence of episodes of major depression, defined by DSM-III-R, in the preceding year. The final structural equation model contained nine predictor variables: genetic factors, parental warmth, childhood parental loss, lifetime traumas, neuroticism, social support, past depressive episodes, recent difficulties, and recent stressful life events. Results The best-fitting model predicted 50.1% of the variance in the liability to major depression. The strongest predictors of this liability were, in descending order, 1) stressful life events, 2) genetic factors, 3) previous history of major depression, and 4) neuroticism. While 60% of the effect of genetic factors on the liability to major depression was direct, the remaining 40% was indirect and mediated largely by a history of prior depressive episodes, stressful life events, lifetime traumas, and neuroticism. The model suggested that at least four major and interacting risk factor domains are needed to understand the etiology of major depression: traumatic experiences, genetic factors, temperament, and interpersonal relations. Conclusions Major depression is a multifactorial disorder, and understanding its etiology will require the rigorous integration of genetic, temperamental, and environmental risk factors.

Journal ArticleDOI
TL;DR: While physician recognition of psychiatric distress in primary care varied widely with different criteria for recognition, the same pattern of reduction of recognition with increasing level of somatization was found for all criteria.
Abstract: Objective: The authors examined the effect of patients’ style of clinical presentation on primary care physicians’ recognition of depression and anxiety. Method: The subjects were 685 patients attending family medicine clinics on self-initiated visits. They completed structured interviews assessing presenting complaints, self-report measures of symptoms and hypochondriacal worry, the Diagnostic Interview Schedule (DIS), and the Center for Epidemiologic Studies Depression Scale (CES-D). Physician recognition was determined by notation ofany psychiatric condition in the medical chart over the ensuing 12 months. Results: The authors identified three progressively more persistent forms of somatic presentations, labeled “initial, “ “facultative, “ and “true “ somatization. 1 5 patients with CES-D scores of 1 6 or higher, 80% made somatized presentations; of7S patients with DIS-diagnosed major depression or anxiety disorder, 76% made somatic presentations. Among patients with DIS major depression or anxiety disorder, somatization reduced physician recognition from 77%, f or psychosocial presenters, to 22%, for true somatizers. The same pattern was found for patients with high CES-D scores. In logistic regression models education, seriousness of concurrent medical illness, hypochondriacal worry, and number oflifetime medically unexplained symptoms each increased the likelihood of recognition, while somatized presentations decreased the rate of recognition. Conclusions: While physician recognition of psychiatric distress in primary care varied widely with different criteria for recognition, the same pattern of reduction of recognition with increasing level of somatization was found for all criteria. In contrast, hypochondriacal worry and medically unexplained somatic symptoms increased the rate of recognition. (Am J Psychiatry 1993; 150:734-741)

Journal ArticleDOI
01 Jan 1993-Spine
TL;DR: These are the first results to indicate that certain psychiatric syndromes appear to precede chronic iow-back pain (substance abuse and anxiety disorders), whereas others (specifically, major depression) develop either before or after the onset of chronic low- back pain.
Abstract: Two hundred chronic low-back pain patients entering a functional restoration program were assessed for current and lifetime psychiatric syndromes using a structured psychiatric interview to make DSM-III-R diagnoses. Results showed that, even when the somewhat controversial category of somatoform pain disorder was excluded, 77% of patients met lifetime diagnostic criteria and 59% demonstrated current symptoms for at least one psychiatric diagnosis. The most common of these were major depression, substance abuse, and anxiety disorders. In addition, 51% met criteria for at least one personality disorder. All of the prevalence rates were significantly greater than the base rate for the general population. Finally, and most importantly, of these patients with a positive lifetime history for psychiatric syndromes, 54% of those with depression, 94% of those with substance abuse, and 95% of those with anxiety disorders had experienced these syndromes before the onset of their back pain. These are the first results to indicate that certain psychiatric syndromes appear to precede chronic low-back pain (substance abuse and anxiety disorders), whereas others (specifically, major depression) develop either before or after the onset of chronic low-back pain. Such findings substantially add to our understanding of causality and predisposition in the relationship between psychiatric disorders and chronic low-back pain. They also clearly reveal that clinicians should be aware of potentially high rates of emotional distress syndromes in chronic low-back pain and enlist mental health professionals to help maximize treatment outcomes.

Journal ArticleDOI
TL;DR: A multiple regression analysis was conducted, and hopelessness was 1.3 times more important than depression was for explaining suicidal ideation.
Abstract: The relevance of a clinical diagnosis of depression for explaining the discrepant relationships of hopelessness and depression with suicidal ideation was studied. The Beck Depression Inventory (BDI), Hopelessness Scale (BHS), and the Scale for Suicide Ideation (SSI) were administered to 1,306 (72.8%) patients with at least one DSM-III-R mood disorder and 488 (27.3%) patients without any mood disorders. A multiple regression analysis was conducted, and hopelessness was 1.3 times more important than depression was for explaining suicidal ideation. The interactions of the BDI and BHS with diagnostic group were not significant.

Journal Article
TL;DR: In the general population, this cardinal symptom of fibromyalgia is common and identifies a group who are more likely also to report symptoms of fatigue and depression.
Abstract: Objective To establish the prevalence of chronic widespread pain and associated symptoms in a general population sample. Methods Cross sectional postal survey of 2,034 adults in the north of England. Results The point prevalence of chronic widespread pain was 11.2%. The symptom was strongly associated with other somatic complaints and with measures of depression and anxiety. Conclusion In the general population, this cardinal symptom of fibromyalgia is common and identifies a group who are more likely also to report symptoms of fatigue and depression.

Journal ArticleDOI
TL;DR: It is indicated that depressed mood following stroke is associated with an increased risk of subsequent mortality, and patients who are depressed and socially isolated seem to be particularly vulnerable.
Abstract: Objective Depression has been linked to higher than expected mortality from natural causes, particularly among elderly patients with physical illness. The authors examined the effect of depression on mortality among a group of stroke patients followed up for 10 years. Method A consecutive series of 103 patients was assessed for major or dysthymic (minor) depression approximately 2 weeks after stroke with the use of a structured mental status examination and DSM-III diagnostic criteria. Vital status was determined for 91 of these patients 10 years later. Results Forty-eight (53%) of the 91 patients had died. Patients with diagnoses of either major or minor depression were 3.4 times more likely to have died during the follow-up period than were nondepressed patients, and this relationship was independent of other measured risk factors such as age, sex, social class, type of stroke, lesion location, and level of social functioning. The mortality rate among depressed patients with few social contacts was especially high: over 90% had died. Conclusions These results indicate that depressed mood following stroke is associated with an increased risk of subsequent mortality. Patients who are depressed and socially isolated seem to be particularly vulnerable.

Journal ArticleDOI
TL;DR: It is suggested that geriatric depression with reversible dementia is a clinical entity that includes a group of patients with early-stage dementing disorders and is an indication for a thorough diagnostic workup and frequent follow-ups in order to identify treatable neurological disorders.
Abstract: Objective: The goals ofthis longitudinal investigation were 1) to study the rate of development of irreversible dementia in elderly depressed patients with a dementia syndrome that subsided after improvement ofdepression and 2) to compare it with that ofdepressed, neverdemented patients. Method: The subjects were 57 elderly patients consecutively hospitalized f or major depression. At entry into the study, 23 subjects also met criteria for “reversible dementia, “ while 34 were without dementia. After a systematic clinical evaluation, the subjects were followed up at approximately yearly intervals for an average of 33.8 months. Results: Irreversible dementia developed significantly more frequently in the depressed group with reversible dementia (43 %) than in the group with depression alone (1 2%). Survival analysis showed that the group with reversible dementia had a 4.69-times higher chance of having developed dementia at follow-up than the patients with depression alone. No clinical characteristics at entry into the study were found to discriminate the subjects who developed irreversible dementia during the follow-up period from those who remained nondemented. � clusions: These findings suggest that geriatric depression with reversible dementia is a clinical entity that includes a group ofpatients with early-stage dementing disorders. Therefore, identification ofa reversible dementia syndrome is an indication for a thorough diagnostic workup and frequent follow-ups in order to identify treatable neurological disorders. (Am-”J Psychiatry 1993; 150:1693-1699)

Journal ArticleDOI
01 Jun 1993-Spine
TL;DR: The outcome of back pain was predicted by pain- related disability and days in pain rather than by recency of onset, so it may be more meaningful to distinguish characteristic levels of pain intensity, pain-related disability, and pain persistence than to classify patients as acute or chronic.
Abstract: Outcomes of primary care back pain patients (N = 1128) were studied at 1 year after seeking care. Changes in depression depending on outcome, and predictors of poor outcome were evaluated. Less than one back pain patient in five reported recent onset (first onset within the previous 6 months). One year after seeking care, the large majority of both recent and nonrecent-onset patients reported having back pain in the previous month (69% vs. 82%). A significant minority of both recent and nonrecent-onset patients had either a poor functional outcome (14% vs. 21%) or continuing high intensity pain without appreciable disability (10% vs. 16%). Predictors of poor outcome included pain-related disability, days in pain, lower educational attainment, and female gender. Among initially dysfunctional patients with persistent pain, one half were improved and one third had a good outcome at the 1-year follow-up. Among initially dysfunctional patients who experienced a good outcome, elevated depressive symptoms improved to normal levels at follow-up. The outcome of back pain was predicted by pain-related disability and days in pain rather than by recency of onset, so it may be more meaningful to distinguish characteristic levels of pain intensity, pain-related disability, and pain persistence than to classify patients as acute or chronic.

Journal ArticleDOI
04 Aug 1993-JAMA
TL;DR: In this paper, the authors assess the long-term impact of trauma and confinement on the functional health and mental health status of Cambodian displaced persons living on the Thailand-Cambodia border.
Abstract: Objective. —To assess the long-term impact of trauma and confinement on the functional health and mental health status of Cambodian displaced persons living on the Thailand-Cambodia border. Design. —Household survey of 993 adults randomly selected from household rosters. Household sample selection by multistage area probability sample. Setting. —Site 2, the largest Cambodian displaced-persons camp on the Thailand-Cambodia border. Participants. —Adults 18 years of age and older selected at random within households; 98% of eligible persons selected agreed to participate. Results. —From 1975 through 1979 (Khmer Rouge regime), more than 85% reported lack of food, water, shelter, and medical care, brainwashing, and forced labor; 54% reported murder of a family member or friend; 36% reported torture; 18% reported head injury; and 17% reported rape or sexual abuse. During the refugee period between 1980 and 1990, 56% reported lack of food or water, 44% reported lack of shelter, 28% reported lack of medical care, 24% reported brainwashing, and 8% reported torture. Since 1980, reports of murder of a family member, head injury, and rape/sexual abuse have decreased to 5%. Reports of experiencing combat situations and shelling attacks have remained consistent between the two time periods, approximately 44% and 30%, respectively. From 1989 to 1990, 25% reported experiencing lack of food or water, and 5% to 10% reported serious injury, combat, and shelling conditions. More than 80% said they were in fair or poor health, felt depressed, and had a number of somatic complaints despite good access to medical services. Fifty-five percent and 15% had symptom scores that correlate with Western criteria for depression and posttraumatic stress disorder, respectively. Fifteen percent to 20% reported health impairments limiting activity, and moderate or severe bodily pain. Despite reported high levels of trauma and symptoms, social and work functioning were well preserved in the majority of respondents. Conclusions. —Reports of extensive trauma, poor health status, and depressive symptoms of this population are of concern in predicting future morbidity and mortality. The health and mental health needs of Cambodian displaced persons and their impact on social and economic behavior should be addressed now that the Cambodians have been repatriated. ( JAMA . 1993;270:581-586)

Journal ArticleDOI
TL;DR: The long-term relationships between various forms of childhood adversity and adult episodes of major depression are explored in a representative household survey of the United States adult (age 25+) population.
Abstract: The long-term relationships between various forms of childhood adversity and adult episodes of major depression are explored in a representative household survey of the United States adult (age 25+) population. Seven of the eight childhood adversities considered are significantly associated with recent (12-month) episodes of depression. These effects are largely indirect consequences of some childhood adversities leading to a life history of depression and prior depression leading to new episodes. Only three of the eight childhood adversities directly affect recent onset or recurrence. The paper closes with a discussion of implications for future research on the long-term effects of childhood adversities.

Journal ArticleDOI
TL;DR: The hypothesis that depression in chronic schizophrenia is in part a psychological response to an apparently uncontrollable life-event, namely the illness and its long-term disabilities is explored and the various possibilities are discussed.
Abstract: This paper explores the hypothesis that depression in chronic schizophrenia is in part a psychological response to an apparently uncontrollable life-event, namely the illness and its long-term disabilities. It is suggested that depression is linked to patients' perception of controllability of their illness and absorption of cultural stereotypes of mental illness. Clinically and operationally diagnosed schizophrenic and manic-depressive patients receiving long-term maintenance treatment were studied. The cross-sectional prevalence of depression in schizophrenics was 29% and 11% for patients with bipolar affective illness. The hypothesis was supported. Multivariate analyses revealed that patients' perception of controllability of their illness powerfully discriminated depressed from non-depressed psychotic patients. Although those patients who accepted their diagnosis reported a lower perceived control over illness and an external locus of control, label acceptance was not associated with lowered depression, self-esteem or unemployment. The cross-sectional nature of the study makes the direction of causality and the role of intrinsic illness variables difficult to ascertain; however, the results set the scene for prospective and intervention studies and the various possibilities are discussed.

Journal ArticleDOI
01 Dec 1993-JAMA
TL;DR: Overall depression and affective depression predicted a more rapid decline in CD4 lymphocyte counts; this association was not attributable to baseline physiological differences and can be explained neither as a reflection of perceived somatic symptoms nor as the result of differences in recreational drug and alcohol use.
Abstract: Objective. —To investigate whether high levels of depressive symptomatology at baseline predict more rapid decline of CD4 lymphocyte counts and progression of clinical disease in persons infected with the human immunodeficiency virus (HIV). Design. —Prospective cohort study with semiannual data collection waves and up to 66 months of follow-up. Setting. —Population-based probability sample of single men in areas of San Francisco with high case rates of the acquired immunodeficiency syndrome (AIDS). Subjects. —All 330 homosexual or bisexual men who by January 1985 had serological evidence of HIV infection but had not had an AIDS diagnosis. Analysis of CD4 lymphocyte change was performed for 277 subjects (83.9%) who had three or more CD4 lymphocyte counts recorded during the study period January 1985 through July 1990. Outcome Measures. —Depressive symptoms were assessed using the Center for Epidemiologic Studies—Depression scale (CES-D). All subjects were classified according to two indicators of depression: (1) as overall depressed using a cut point of 16 or higher on the complete CES-D, and (2) as affectively depressed using a cut point of more than 1 SD above the mean on a subscale of the CES-D measuring affective depression. Laboratory and symptom measures, antiretroviral use, demographics, and behavioral measures were also used. The primary outcome measure was the rate of change of the CD4 lymphocyte count. Secondary outcomes were AIDS-free survival and mortality. Results. —At baseline 65 subjects (19.7%) were classified as depressed on the overall scale and 53 (16.1%) were classified as depressed on the affective scale. The unadjusted mean rate of CD4 change was 38% greater for overall depressed subjects than for the overall nondepressed (−0.0812 vs −0.0588×10 9 /L[−81.2vs −58.8/μL per year; P =.07) and 34% greater for affectively depressed subjects than for the affectively nondepressed (−0.0804 vs −0.0598×10 9 /L per year; P =.06). In hierarchical multivariate analysis controlling for antiretroviral use, symptoms, and other predictors, baseline overall depression was associated with an excess decline in CD4 count of −0.0285×10 9 /L per year (95% confidence interval, −0.0496 to −0.0073), and baseline affective depression was associated with an excess decline in CD4 count of −0.0236×10 9 /L per year (95% confidence interval, −0.0464 to −0.0008). Neither overall depression nor affective depression was significantly associated with earlier AIDS diagnosis or earlier mortality. Conclusions. —Overall depression and affective depression predicted a more rapid decline in CD4 lymphocyte counts; this association was not attributable to baseline physiological differences. While the mechanism of the association remains unknown and cannot be addressed directly by this study, the data suggest that it can be explained neither as simply a reflection of perceived somatic symptoms nor as the result of differences in recreational drug and alcohol use. Further study is necessary to determine whether treating depression can alter the course of HIV infection. ( JAMA . 1993;270:2568-2573)

Journal ArticleDOI
TL;DR: The HADS was an easily administered tool that identified a large proportion of cancer patients as having high levels of anxiety or depression, however, clinical psychiatric interviews were not performed, so it is not possible to determine what proportion of patients would benefit from treatment.

Journal Article
TL;DR: The results suggest that the psychological symptoms associated with infertility are similar to those associated with other serious medical conditions and standard psychosocial interventions for serious medical illness should also be applied in infertility treatment.
Abstract: To compare the psychological symptoms of infertile women with patients with other chronic medical conditions, subjects completed the Symptom Checklist-90 (Revised) (SCL-90R), a standardized, validated and widely used psychological questionnaire, prior to enrolling in a group behavioral treatment program. All subjects were female and the totals in each program were as follows: 149 with infertility, 136 with chronic pain, 22 undergoing cardiac rehabilitation, 93 with cancer, 77 with hypertension, and 11 with human immunodeficiency virus (HIV)-positive status. The infertile women had global symptom scores equivalent to the cancer, cardiac rehabilitation and hypertension patients, but lower scores than the chronic pain and HIV-positive patients (p < 0.0001 and p < 0.02 respectively). The anxiety and depression scores of the infertile women were significantly lower than chronic pain patients but not statistically different from the other groups. The results suggest that the psychological symptoms associated with infertility are similar to those associated with other serious medical conditions. Therefore, standard psychosocial interventions for serious medical illness should also be applied in infertility treatment.

Journal ArticleDOI
TL;DR: The link between migraine, major depression and anxiety might reflect a common predisposition, and those with such a history had significantly more physical symptoms and were more likely to report job absenteeism, assess their general health as fair or poor, and use mental health services.

Journal Article
TL;DR: This study has shown that sleep disorder is associated with pathology and this must be accompanied by the treatment of underlying disorders and monitoring of future health.
Abstract: Insomnia in elderly people has traditionally been regarded as inevitable and trivial. A longitudinal study was undertaken to examine the prevalence of sleep disturbance among elderly people in an inner London community and its association with demographic variables, depression, dementia and disability. Those aged 65 years and over living at home were interviewed using a validated and reliable semi-structured interview schedule. A total of 705 people were interviewed in 1987-88 and 524 were re-interviewed in 1990. Subjective sleep disturbance was found to be common (33% and 43%, respectively). Sleep disturbance was associated with being a woman, being unmarried, living alone, disability, and current and future depression, but not with dementia or older age. The best predictor of future depression in elderly people who were not depressed was current sleep disturbance. In the presence of current sleep disturbance, the traditional predictors of depression--being a woman, having a disability, being unmarried, living alone and being older--did not contribute further. This study has shown that sleep disorder is associated with pathology. Insomnia in elderly people requires assessment and this must be accompanied by the treatment of underlying disorders and monitoring of future health.

Journal ArticleDOI
TL;DR: Patients' levels of depression were related to those of their caregivers, however, caregivers' optimism proved to be a significant predictor of their mental health and reactions to caregiving.
Abstract: In this article the paths among cancer patients' physical and mental health and the reactions and mental health of their family caregivers were examined. Data for these analyses came from a cross-sectional sample of cancer patients who were recruited through ambulatory outpatient chemotherapy units, and their family caregivers. Patients' depression was explained largely by their symptomatology and, to a lesser extent, by loss of mobility. Patients' physical limitations impacted caregivers' daily schedules but not their physical health. Patients' levels of depression were related to those of their caregivers. However, caregivers' optimism proved to be a significant predictor of their mental health and reactions to caregiving.

Journal ArticleDOI
TL;DR: It is reasonable to hypothesize that treatment of depressive disorders inHD patients might effect outcome, and Cognitive depression measures may be more useful in predicting outcome in HD patients than standard measures used in nonmedically ill populations.
Abstract: Depression has been identified at the most prevalent psychologic problem in patients with ESRD treated with hemodialysis (HD). Depression has been associated with mortality in HD patients; however, the similarity of the symptoms of depressive disorders to those of uremia and the difficulties in measuring depression and dissociating psychologic from physical aspects of depression in such patients render these studies difficult to evaluate. Conflicting data regarding the effects of depression on survival in HD patients may be the result of using somatic symptoms in quantifying the extent of depression. In this review, studies regarding the diagnosis of depression in HD patients, the association of depression and survival in HD patients in light of recent work on factors related to the morbidity and mortality in the ESRD population, and aspects of therapy for depression in HD patients are considered. Specifically, depression may affect immunologic function, nutrition, and compliance factors that may affect the prescription and delivery of dialysis, which may, in turn, influence outcome. Alternatively, depression may be an independent factor in influencing survival. Cognitive depression measures may be more useful in predicting outcome in HD patients than standard measures used in nonmedically ill populations. Although there are few studies of the effect of treatment of depression on outcome in HD patients, it is reasonable to hypothesize that treatment of depressive disorders in HD patients might effect outcome. Further studies on the association of depression and its treatment and mortality in ESRD patients are warranted.

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TL;DR: It is suggested that anxiety and depression are related manifestations of the underlying neurochemical changes of PD itself and are unlikely to be primarily a psychologic reaction to the illness or a side effect of levodopa treatment.

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TL;DR: These findings suggest that depressive symptoms in patients experiencing their first episode of schizophrenia may represent a core part of the acute illness or may occur as a subjective reaction to the experience of psychotic decompensation.
Abstract: Objective Because findings regarding the prognostic significance of depressive symptoms in schizophrenia and their effect on the course and treatment of schizophrenia have been limited by the effects of previous treatment, retrospective evaluations, and differing definitions and criteria, the authors sought to determine the prevalence and prognostic significance of depressive symptoms in first-episode schizophrenia. Method Thirty-nine men and 31 women experiencing their first episode of schizophrenia were evaluated with behavioral and extra-pyramidal symptom scales before treatment (baseline), biweekly during acute treatment, and then monthly. Extracted scores on the Hamilton Rating Scale for Depression and a "syndromal" definition of depression based on Research Diagnostic Criteria were obtained. Patients were followed prospectively for up to 5 years and received open standardized treatment. Results The prevalence of depressive symptoms at baseline ranged from 75% (patients who met extracted Hamilton and/or syndromal criteria) to 22% (patients who met both criteria). Of 808 psychotic ratings given to the 70 patients over a 5-year follow-up period, 210 (26%) were concurrently rated as depressed; of the 1,754 nonpsychotic ratings, only 70 (4%) were concurrently rated as depressed. Of the 210 depressive symptoms that occurred concurrently with psychosis, 206 (98%) resolved as the psychosis remitted. Depressive symptoms were prodromal to a psychotic relapse in only two (7%) of 27 patients who relapsed. Depressive symptoms correlated more with positive and negative symptoms than with extrapyramidal symptoms. Conclusions These findings suggest that depressive symptoms in patients experiencing their first episode of schizophrenia may represent a core part of the acute illness or may occur as a subjective reaction to the experience of psychotic decompensation. Since most of the depressive symptoms resolved as the psychosis remitted, antidepressant therapy should be limited to patients in whom the depression persists.