Showing papers on "Depression (differential diagnoses) published in 1995"
TL;DR: Depression while in the hospital after an MI is a significant predictor of 18-month post- MI cardiac mortality and significantly improves a risk-stratification model based on traditional post-MI risks, including previous MI, Killip class, and PVCs.
Abstract: Background We previously reported that major depression in patients in the hospital after a myocardial infarction (MI) substantially increases the risk of mortality during the first 6 months. We examined the impact of depression over 18 months and present additional evidence concerning potential mechanisms linking depression and mortality. Methods and Results Two-hundred twenty-two patients responded to a modified version of the National Institute of Mental Health Diagnostic Interview Schedule (DIS) for a major depressive episode at approximately 7 days after MI. The Beck Depression Inventory (BDI), which measures depressive symptomatology, was also completed by 218 of the patients. All patients and/or families were contacted at 18 months to determine survival status. Thirty-five patients met the modified DIS criteria for major in-hospital depression after the MI. Sixty-eight had BDI scores ≥10, indicative of mild to moderate symptoms of depression. There were 21 deaths during the follow-up period, includ...
1,571 citations
Journal Article•
1,556 citations
TL;DR: A multifaceted intervention consisting of collaborative management by the primary care physician and a consulting psychiatrist, intensive patient education, and surveillance of continued refills of antidepressant medication improved adherence to antidepressant regimens in patients with major and with minor depression and resulted in more favorable depressive outcomes.
Abstract: Objective. —To compare the effectiveness of a multifaceted intervention in patients with depression in primary care with the effectiveness of "usual care" by the primary care physician. Design. —A randomized controlled trial among primary care patients with major depression or minor depression. Patients. —Over a 12-month period a total of 217 primary care patients who were recognized as depressed by their primary care physicians and were willing to take antidepressant medication were randomized, with 91 patients meeting criteria for major depression and 126 for minor depression. Interventions. —Intervention patients received increased intensity and frequency of visits over the first 4 to 6 weeks of treatment (visits 1 and 3 with a primary care physician, visits 2 and 4 with a psychiatrist) and continued surveillance of adherence to medication regimens during the continuation and maintenance phases of treatment. Patient education in these visits was supplemented by videotaped and written materials. Main Outcome Measures. —Primary outcome measures included short-term (30-day) and long-term (90-day) use of antidepressant medication at guideline dosage levels, satisfaction with overall care for depression and antidepressant medication, and reduction in depressive symptoms. Results. —In patients with major depression, the intervention group had greater adherence than the usual care controls to adequate dosage of antidepressant medication for 90 days or more (75.5% vs 50.0%;P Conclusion. —A multifaceted intervention consisting of collaborative management by the primary care physician and a consulting psychiatrist, intensive patient education, and surveillance of continued refills of antidepressant medication improved adherence to antidepressant regimens in patients with major and with minor depression. It improved satisfaction with care and resulted in more favorable depressive outcomes in patients with major, but not minor, depression. (JAMA. 1995;273:1026-1031)
1,424 citations
TL;DR: In this article, a study was conducted to clarify how genetic liability and stressful life events interact in the etiology of major depression and found that genetic factors influence the risk of onset of depression in part by altering the sensitivity of individuals to the depression-inducing effect of stressful events, including death of a close relative, assault, serious marital problems and divorce/breakup.
Abstract: Objective This study was undertaken to clarify how genetic liability and stressful life events interact in the etiology of major depression. Method Information about stressful life events and onset of major depressive episodes in the past year was collected in a population-based sample of female-female twin pairs including 2,164 individuals, 53,215 person-months of observation, and 492 onsets of depression. Results Nine "personal" and three aggregate "network" stressful events significantly predicted onset of major depression in the month of occurrence, four of which predicted onset with an odds ratio of > 10 and were termed "severe": death of a close relative, assault, serious marital problems, and divorce/breakup. Genetic liability also had a significant impact on risk of onset of depression. For severe stressful events, as well as for 10 of the 12 individual stressful events, the best-fitting model for the joint effect of stressful events and genetic liability on onset of major depression suggested genetic control of sensitivity to the depression-inducing effects of stressful life events. In individuals at lowest genetic risk (monozygotic twin, co-twin unaffected), the probability of onset of major depression per month was predicted to be 0.5% and 6.2%, respectively, for those unexposed and exposed to a severe event. In those at highest genetic risk (monozygotic twin, co-twin affected), these probabilities were 1.1% and 14.6%, respectively. Linear regression analysis indicated significant Genotype by Environment interaction in the prediction of onset of major depression. Conclusions Genetic factors influence the risk of onset of major depression in part by altering the sensitivity of individuals to the depression-inducing effect of stressful life events.
991 citations
TL;DR: A significant, stable association between depression and memory impairment was revealed, and analyses indicated that it is likely that depression is linked to particular aspects of memory, the linkage is found in particular subsets of depressed individuals, andMemory impairment is not unique to depression.
Abstract: The existing evidence paints an unclear picture of whether an association exists between depression and memory impairment. The purpose of this investigation was to determine whether depression is associated with memory impairment, whether moderator variables determine the extent of this association, and whether any obtained association is unique to depression. Meta-analytic techniques were used to synthesize data from 99 studies on recall and 48 studies on recognition in clinically depressed and nondepressed samples. Associations between memory impairment and other psychiatric disorders (e.g., schizophrenia, dementia) were also examined. A significant, stable association between depression and memory impairment was revealed. Further analyses indicated, however, that it is likely that depression is linked to particular aspects of memory, the linkage is found in particular subsets of depressed individuals, and memory impairment is not unique to depression.
901 citations
TL;DR: Depressed patients have substantial and long-lasting decrements in multiple domains of functioning and well-being that equal or exceed those of patients with chronic medical illnesses.
Abstract: Background: Cross-sectional studies have found that depression is uniquely associated with limitations in wellbeing and functioning that were equal to or greater than those of chronic general medical conditions such as diabetes and arthritis. However, whether these relative limitations persist over time is not known. Methods: We conducted a 2-year observational study of 1790 adult outpatients with depression, diabetes, hypertension, recent myocardial infarction, and/or congestive heart failure. Change in functional status and wellbeing was compared for depressed patients vs patients with chronic general medical illnesses, controlling statistically for medical comorbidity, sociodemographics, system, and specialty of care. Results: Over 2 years of follow-up, limitations in functioning and well-being improved somewhat for depressed patients; even so, at the end of 2 years, these limitations were similar to or worse than those attributed to chronic medical illnesses. Similar patterns were observed for depressed patients in the mental health specialty sector and those in the general medical sector, but the patients in the mental health specialty sector improved more. More severely depressed patients improved more in functioning, but even initially depressed patients without depressive disorder had substantial persistent limitations. Conclusion: Depressed patients have substantial and long-lasting decrements in multiple domains of functioning and well-being that equal or exceed those of patients with chronic medical illnesses.
840 citations
TL;DR: Residual symptoms were more common in subjects with more severe initial illness, but were not related to any other predictors, including longer prior illness, dysthymia, or lower dose of drug treatment during the illness episode.
Abstract: This paper draws attention to an important adverse outcome in depression, the occurrence of residual symptoms after partial remission. Among patients with definite major depression followed every 3 months to remission and thereafter, residual symptoms reaching 8 or more on the Hamilton Depression Scale 17-item total were present in 32% (19) of the 60 who remitted below major depression by 15 months. The pattern was of mild but typical depressive symptoms. Residual symptoms were more common in subjects with more severe initial illness, but were not related to any other predictors, including longer prior illness, dysthymia, or lower dose of drug treatment during the illness episode. There were weak associations with personality that might have been consequences of symptom presence. Residual symptoms were very strong predictors of subsequent early relapse, which occurred in 76% (13/17) of those with residual symptoms and 25% (10/40) of those without.
779 citations
TL;DR: The association between alcohol dependence and major depression was greater than the association between abuse and major Depression and the association was consistently greater for females and blacks, compared to their male and non-black counterparts.
626 citations
TL;DR: It appears that major depression is more often an exacerbation of a chronic mood disturbance, with roots in long-standing vulnerability factors; while minor depression isMore often a reaction to the stresses commonly experienced in later life.
TL;DR: Treatment of depression in patients with cancer improves their dysphoria and other signs and symptoms of depression, improves quality of life, and may improve immune function and survival time.
Abstract: This article reviews the challenge of diagnosing depression in patients with cancer. Major depression and depressive symptoms, although commonly encountered in medical populations, are frequently underdiagnosed and undertreated. This is especially true for patients with cancer in whom the diagnosis of major depression is clouded by neurovegetative symptoms that may be secondary to either cancer or depression. Well-established biological markers for major depression are proposed as diagnostic adjuncts in patients with cancer. Studies using biological markers in depressed patients with and without cancer are reviewed, and the implications of diminished immune function in depressed patients with cancer are discussed. The limited database on treatment of depression in patients with cancer also is reviewed. Treatment of depression in these patients improves their dysphoria and other signs and symptoms of depression, improves quality of life, and may improve immune function and survival time. Guidelines for future research are proposed.
TL;DR: While many depressed primary care patients may go unrecognized and untreated, this group appears to have milder and more self-limited depression.
Abstract: OBJECTIVE To evaluate the recognition, management, and outcomes of depressed patients presenting in primary care. DESIGN Epidemiologic survey with 12-month follow-up. SETTING Primary care clinics of a staff-model health maintenance organization. PATIENTS AND MAIN OUTCOME MEASURES Consecutive primary care attenders aged 18 to 65 years (n = 1952) were screened using the 12-item General Health Questionnaire (GHQ-12), and a stratified random sample (n = 373) completed a psychiatric assessment, including the Composite International Diagnostic Interview (CIDI), the 28-item GHQ, and a brief self-rated disability questionnaire (BDQ). Three-month follow-up assessment (n = 347) repeated the GHQ-28 and BDQ, and 12-month follow-up (n = 308) repeated the CIDI, GHQ-28, and BDQ. Use of psychotropic drugs and mental health services was assessed using computerized pharmacy and visit registration records. RESULTS Structured interviews found 64 cases of current major depression (weighted prevalence, 6.6%) and 58 cases of current subthreshold depression (weighted prevalence, 8.8%). Of those with major depression, 64% (n = 41) were recognized as psychologically distressed by the primary care physician, 56% (n = 36) filled at least one antidepressant prescription during the next 3 months, and 39% (n = 25) made at least one specialty mental health visit. Compared with recognized cases, those with unrecognized major depression were less symptomatic at baseline (GHQ-28 score, 15.31 vs 11.07; P = .006) but showed a similar rate of improvement over 12 months (F test for difference in slopes, P = .93). CONCLUSIONS While many depressed primary care patients may go unrecognized and untreated, this group appears to have milder and more self-limited depression. A narrow focus on increased recognition may not improve overall outcomes. Treatment resources might be best directed toward more intensive follow-up and relapse prevention among those now treated.
TL;DR: D diagnosis of depression is associated with a generalized increase in use of health services that is only partially explained by comorbid medical conditions, and in the primary care sector, this greater medical utilization exceeds direct treatment costs for depression.
Abstract: Background: While an extensive literature documents the influence of depression on general medical services utilization, estimates of the economic burden of depression have focused on the direct costs of depression treatment. Higher use of general medical services may contribute significantly to the true cost of depressive illness. Methods: Computerized record systems of a large staffmodel health maintenance organization (HMO) were used to identify consecutive primary care patients with visit diagnoses of depression (n=6257) and a comparison sample of primary care patients with no depression diagnosis (n=6257). The HMO accounting records were used to compare components of health care costs. Results: Patients diagnosed as depressed had higher annual health care costs ($4246 vs $2371, P Conclusions: Diagnosis of depression is associated with a generalized increase in use of health services that is only partially explained by comorbid medical conditions. In the primary care sector, this greater medical utilization exceeds direct treatment costs for depression. The persistence of utilization differences suggests that recognition and initiation of treatment alone are not adequate to reduce utilization differences.
TL;DR: Epidemiologic data from around the world demonstrate that major depression is approximately twice as common in women than men and that its first onset peaks during the childbearing years, especially during the reproductive years.
Abstract: Epidemiologic data from around the world demonstrate that major depression is approximately twice as common in women than men and that its first onset peaks during the childbearing years. Progress has been made in understanding the epidemiology of depression and in developing effective treatments. Much remains to be learned about the basic pathogenesis of depression and the specific treatment needs of depressed women and their offspring, especially during the reproductive years.
TL;DR: Results revealed that major psychopathology, such as depression and substance abuse, did not precede or cause the development of chronic pain disability, and the presence of a robust “psychosocial disability factor” that is associated with those injured workers who are likely to develop chronic low back pain disability problems.
Abstract: Study design An inception cohort design was used in which 421 patients were evaluated systematically with a standard battery of psychosocial assessment tests (Structured Interview for DSM-III-R Diagnosis, Minnesota Multiphasic Personality Inventory, and Million Visual Pain Analog Scale) within 6 weeks of acute back pain onset. Objectives The present study evaluated the predictive power of a comprehensive assessment of psychosocial and personality factors in identifying acute low back pain patients who subsequently develop chronic pain disability problems (as measured by job-work status at 1-year follow-up evaluation). Summary of background data There has been a relative paucity of prospective research in the United States comprehensively evaluating potential psychosocial risk factors that are associated with those injured workers who subsequently fail to return to work and productivity after 1 year because of low back pain disability. Such research has been quite limited because of the time and cost involved in conducting prospective studies. Methods All study patients were symptomatic with lumbar pain syndrome for no more than 6 weeks. These acute patients were tracked every 3 months, culminating in a structured telephone interview being conducted 1 year after the initial evaluation to document return-to-work status. Results Logistic regression analyses, conducted to differentiate between patients who were back at work after 1 year versus patients who were not because of the original back injury, revealed the importance of three psychosocial measures: self-reported pain and disability, scores on Scale 3 of the Minnesota Multiphasic Personality Inventory, and workers' compensation and personal injury insurance status. The model generated correctly classified 90.7% of the cases. Results revealed that major psychopathology, such as depression and substance abuse, did not precede or cause the development chronic pain disability. Conclusions These results show the presence of a robust "psychosocial disability factor" that is associated with those injured workers who are likely to develop chronic low back pain disability problems. Based on these data, a statistical algorithm has been generated that can identify those acute patients who will require early intervention to prevent the development of chronic disability. The second major result is that preinjury or concomitant psychopathology does not appear to predispose patients to chronic pain disability, although high rates of psychopathology have been shown in chronic low back pain. Future research should be directed at emotional vulnerability and psychosocial events in the period after the injury that may lead to chronicity.
TL;DR: Married, middle-class women who met diagnostic criteria for depression and a comparable group of nondepressed women were videotaped interacting with their infants at home at 2, 4, and 6 months to highlight the need to distinguish between transient and protracted depression effects on the mother-infant relationship and infant outcome.
Abstract: Married, middle-class women who met diagnostic criteria for depression and a comparable group of nondepressed women were videotaped interacting with their infants at home at 2, 4, and 6 months. When depression was defined in terms of 2-month diagnosis, there were no differences between depressed and comparison mothers or babies in either positive interaction during feeding, face-to-face interaction, or toy play. However, women whose depressions lasted through 6 months were less positive with their infants across these 3 contexts than women whose depressions were more short-lived, and their babies were less positive during face-to-face interaction. These data highlight the need to distinguish between transient and protracted depression effects on the mother-infant relationship and infant outcome
TL;DR: It was found that those for whom the index episode was a recurrence of depression were at raised risk for further episodes of postnatal depression but not for non-postpartum episodes.
Abstract: BACKGROUND It is unclear whether the causative factors of non-psychotic postnatal depression are the same as those of depression at other times.
METHOD The course and recurrence of postnatal depression was studied in two groups of primiparous women experiencing an index episode of postnatal depression: those for whom the mood disorder had arisen de novo (n = 34), and those for whom it was a recurrence of previous affective disturbance (n = 21). The mental state of these two groups, together with a psychiatrically well control group (n = 40), was studied for five years.
RESULTS It was found that those for whom the index episode was a recurrence of depression were at raised risk of further non-postpartum episodes but not postpartum episodes, and that those for whom the index episode had arisen de novo were at raised risk for further episodes of postnatal depression but not for non-postpartum episodes.
CONCLUSION These findings suggest a specific nosologic reference for the concept of postnatal depression.
TL;DR: A sample of 192 financially impoverished, inner-city women was assessed for clinical depression twice during pregnancy and once postpartum, finding Particularly heightened risk for antepartum depression was found among single women who did not have a cohabiting partner.
Abstract: A sample of 192 financially impoverished, inner-city women was assessed for clinical depression twice during pregnancy and once postpartum. At the first and second antepartum interviews, respectively, 27.6% and 24.5% of the women were depressed, controlling for pregnancy-related somatic symptoms. Postpartum depression was found among 23.4% of women. These rates are about double those found for middle-class samples. Particularly heightened risk for antepartum depression was found among single women who did not have a cohabiting partner. African American and European American women did not differ in rates of depression. Antepartum depression was a weak but significant risk factor for postpartum depression.
TL;DR: Major depression is associated with poor adherence to a regimen of prophylactic aspirin after the diagnosis of coronary artery disease and this may explain the increased risk of medical morbidity and mortality found in depressed medical patients.
Abstract: Little is known about the effects of depression on adherence to medical treatment regimens in older patients with chronic medical illnesses. Poor adherence may explain the increased risk of medical morbidity and mortality found in depressed medical patients. Ten of 55 patients over the age of 64 with coronary artery disease met the criteria for major depression from the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987). All patients were prescribed a twice-per-day regimen of low dose aspirin to reduce their risk for myocardial infarction. Medication adherence was assessed for 3 weeks by an unobtrusive electronic monitoring device. Depressed patients adhered to the regimen on 45% of days, but nondepressed patients, on 69% (p < .02). Thus, major depression is associated with poor adherence to a regimen of prophylactic aspirin after the diagnosis of coronary artery disease.
TL;DR: Adolescent unipolar MDD predicts continued risk for recurrences with persistence of depressive episodes and psychosocial morbidity into adulthood as well as sustained periods of remission associated with good social adjustment.
Abstract: Objective This study examined the longitudinal clinical course and adult sequelae of adolescent unipolar major depressive disorder (MDD) using a controlled longitudinal design. Method Subjects were 28 adolescents (15.4 ± 1.3 years) with systematically diagnosed unipolar MOD and 35 group-matched control subjects who participated in a crosssectional electroencephalogram sleep and neuroendocrine study. Using standardized instruments, interviewers who were blind to subjects' initial diagnoses conducted follow-up clinical assessments 7.0 ± 0.5 years later in 94% of the original cohort. Results The depressed group showed high rates of recurrence of MDD episodes during the interval period (69%). They also had elevated rates of new-onset bipolar disorder (19%). Twenty-three percent of subjects with an initial diagnosis of MDD had no additional depressive episodes after the index assessment. The rate of new onset of depression in the controls was 21%. Low socioeconomic status predicted recurrence of depressive episodes in the MDD group. MDD subjects with recurrence(s) and controls with new onset of depression during the follow-up period had significant psychosocial morbidity, as evidenced by disruption in interpersonal relationships and dissatisfaction with life and decrease in global functioning, compared with both MDD subjects with no further episodes and control subjects who had never been psychiatrically ill. These psychosocial deficits persisted after remission from depressive episode(s). Conclusions Adolescent unipolar MDD predicts continued risk for recurrences with persistence of depressive episodes and psychosocial morbidity into adulthood. A sizable minority, however, have sustained periods of remission associated with good social adjustment.
TL;DR: Multivariate analyses showed that depressive symptoms, anxiety, and history of major depression each had an impact independent of each other, as well as of measures of cardiac disease severity.
Abstract: This study examine the importance of major depression symptoms, history of major depression, anxiety, anger-in, anger-out, and perceived social support, measured in the hospital after a myocardial infarction (MI), in predicting cardiac events over the subsequent 12 months in a sample of 222 patients. Cardiac events included both recurrences of acute coronary syndromes (unstable angina admissions and survived and nonsurvived MI recurrences) and probable arrhythmic events (survived cardiac arrests and arrhythmic deaths). Major depression, depressive symptoms, anxiety, and history of major depression all significantly predicted cardiac events. Multivariate analyses showed that depressive symptoms, anxiety, and history of major depression each had an impact independent of each other, as well as of measures of cardiac disease severity.
TL;DR: The revised Clinical Interview Schedule (CIS-R) and the Hospital Anxiety and Depression (HAD) Scale were used to estimate the prevalence of mood disorders among 78 consecutive admissions to a general medical ward in a university general hospital in Brazil and confirm the high prevalence of Mood disorders among medical in-patients.
Abstract: The revised Clinical Interview Schedule (CIS-R) and the Hospital Anxiety and Depression (HAD) Scale were used to estimate the prevalence of mood disorders among 78 consecutive admissions to a general medical ward in a university general hospital in Brazil (43 males and 35 females; mean age = 43.2yr). Interviewers also completed a 5-point symptom severity scales for anxiety and depression. The definition of cases of anxiety [and depression] was based on two criteria: a. score > or = 2 on the CIS-R section of anxiety [> or = 4 on the CIS-R sections of depression and depressive ideas]; and b. score > or = 2 on the clinical severity scale for anxiety [score > or = 2 on the clinical severity scale for depression]. A 39% prevalence rate of affective disorders was found. Sixteen (20.5%) patients met criteria for anxiety, most of the disorders being of mild severity. Twenty-sic patients (33%) were depressed, 7 of them in a moderate degree. The HAD was easily understood by the patients. Anxiety and depression subscales had internal consistency of 0.68 and 0.77, respectively. At a cut-off point of 8/9 sensibility and specificity were 93.7% and 72.6% for anxiety, and 84.6% and 90.3% for depression. HAD items correlated positively with the respective subscales. To a lesser degree, they also correlated with the alternative subscale. Our findings confirm the high prevalence of mood disorders among medical in-patients. In clinical practice, the HAD may have a useful role in detecting those patients requiring further psychological care.
TL;DR: It is suggested that enhancing long-term social support can have a significant impact on depression in caregivers.
Abstract: Caregivers of Alzheimer's disease patients often suffer from depression. Using a longitudinal treatment/control study, we examined the effects of a comprehensive support program on depression in spouse-caregivers. This psychosocial intervention program treats the primary caregiver and family members over the entire course of the disease through individual and family counseling, the continuous availability of ad hoc counseling, and support group participation. In the first year after intake, the control group became increasingly more depressed, whereas the treatment group remained stable. By the eighth month, treated caregivers were significantly less depressed than those in the control group. These results suggest that enhancing long-term social support can have a significant impact on depression in caregivers.
TL;DR: The results suggest that the higher occurrence of anxiety disorders in females than males beginning early in life might explain in large part the higher female risk for major depression.
Abstract: The role of anxiety disorders in the development of sex differences in major depression is analyzed. Data come from a longitudinal epidemiologic study of young adults in the Detroit, Michigan area. The Diagnostic Interview Schedule, revised according to DSM-III-R, was used at baseline to measure lifetime psychiatric disorders and at follow-up to measure psychiatric disorders during the 3.5-year interval since baseline assessment. Consistent with previous reports, the lifetime prevalence of major depression was nearly two-fold higher in females than in males. The sex difference was primarily in major depression comorbid with anxiety disorders. Results from Cox-proportional hazards models, with time-dependent covariates, showed that prior anxiety disorder increased the risk for subsequent major depression in both sexes, with no evidence of an interaction. History of anxiety disorder, including number of prior anxiety disorders, accounted for a considerable part of the observed sex difference in major depression. Controlling for prior anxiety reduced by more than 50% the coefficient that estimates the association between gender and major depression. The results suggest that the higher occurrence of anxiety disorders in females than males beginning early in life might explain in large part the higher female risk for major depression. They emphasize the need for further research on sex differences in anxiety disorders.
TL;DR: Depressed patients with traumatic brain injuries are more functionally disabled and perceive their injury and cognitive impairment as more severe, despite the lack of significant differences in objective measures of severity of injury and Mini-Mental State examination scores.
Abstract: Objective : This study examined psychiatric sequelae of traumatic brain injuries in outpatients and their relation to functional disability Method : Fifty consecutive outpatients with traumatic brain injuries who came to a brain injury rehabilitation clinic for initial evaluation were examined for DSM-III-R diagnoses with the use of the National Institute of Mental Health Diagnostic Interview Schedule The patients completed the Medical Outcomes Study Health Survey to assess functional disability and a questionnaire to assess postconcussion symptoms and self-perceptions of the severity of their brain injuries and cognitive functioning Results : Thirteen (26%) of the patients had current major depression, and an additional 14 (2 8%) reported a first-onset major depressive episode after the injury that had resolved Twelve (24%) had current generalized anxiety disorder, and four (8%) reported current substance abuse The group with depression and/or anxiety was significantly more impaired than the nondepressed/nonanxious patients according to the Medical Outcomes Study Health Survey measures of emotional role functioning, mental health, and general health perceptions The depressed/anxious group also rated their injuries as significantly more severe and their cognitive functioning as significantly worse, despite the lack of significant differences in objective measures of severity of injury and Mini-Mental State examination scores The depressed patients reported significantly more postconcussion symptoms that were increasing in severity over time Conclusions : Depression and anxiety are common in outpatients with traumatic brain injuries Patients with depression or anxiety are more functionally disabled and perceive their injury and cognitive impairment as more severe Depressed patients report more increasingly severe postconcussion symptoms
TL;DR: The impact of comorbidity was strongest for academic problems, mental health treatment utilization, and past suicide attempts; intermediate on measures of role functioning and conflict with parents; and nonsignificant on physical symptoms.
Abstract: Objective To describe the clinical consequences associated with the lifetime occurrence of comorbid psychiatric disorders. Method In a community sample of 1,507 older adolescents (aged 14 through 18 years), subjects with “pure” and comorbid forms of four major psychiatric disorders (depression, anxiety, substance use, and disruptive behavior) were compared on six clinical outcome measures. Results The impact of comorbidity was strongest for academic problems, mental health treatment utilization, and past suicide attempts; intermediate on measures of role functioning and conflict with parents; and nonsignificant on physical symptoms. The greatest incremental impact of comorbidity was on anxiety disorders; the least was on substance use disorders. Although some patterns of comorbidity were much more common in boys (e.g., substance use and disruptive behavior disorder) or in girls (e.g., depression and anxiety), the impact of specific comorbid disorders on the clinical measures was not different for females and males. The effect of comorbidity was not due to current psychopathology. Conclusions The significance of comorbidity differs across specific comorbid disorders and across outcome measures, with some comorbid disorders being much more detrimental, and some outcome measures much more affected, than others.
TL;DR: Despite the widely different rates of depressive illness and alcoholism in different cultures previously reported, the psychiatric antecedents of suicide are the same in the West and the East.
Abstract: Background: As part of the Taiwan Aboriginal Study Project, a case-control study of suicide among two aboriginal groups and the Han Chinese was carried out in East Taiwan. Methods: Biographical reconstructive interviews were conducted for consecutive suicides from each of the three ethnic groups (a total of 116 suicides), 113 of whom were matched with two controls for age, sex, and area of residence. Results: In all three groups, a high proportion of suicides suffered from mental illness before committing suicide (97% to 100%). The two most prevalent psychiatric disorders were depression and alcoholism, and the most common comorbid pattern was depression with substance use disorders. The risk for suicide was significantly associated with all of these psychiatric conditions, previous suicide attempts, and a family history of suicide and depression. Fifty-one percent of all suicides had consulted medical professionals in the previous month. Conclusion: Despite the widely different rates of depressive illness and alcoholism in different cultures previously reported, the psychiatric antecedents of suicide are the same in the West and the East.
TL;DR: The mildness of undetected depression and associated impairment have implications for estimates of the consequences of primary care physicians' low rates of nondetection and for the development of interventional strategies to improve their performance.
TL;DR: The prevalence of depression after stroke in Perth Community Stroke Study patients was comparable with that reported from other studies, and considerably less than thatreported from in-patient and rehabilitation units.
Abstract: BACKGROUND The Perth Community Stroke Study (PCSS) was a population-based study of the incidence, cause, and outcome of acute stroke.
METHOD Subjects from the study were assessed initially, by examination and interview, and at four- and 12-month follow-ups to determine differences in prevalence of depression between the sexes and between patients with first-ever and recurrent strokes.
RESULTS The prevalence of depressive illness four months after stroke in 294 patients from the PCSS was 23% (18-28%), 15% (11-19%) major depression and 8% (5-11%) minor depression. There were no significant differences between the sexes or between patients with first-ever and recurrent strokes. With a non-hierarchic approach to diagnosis of those with depression, 26% of men and 39% of women had an associated anxiety disorder, mainly agoraphobia. Nine per cent of male and 13% of female patients interviewed had evidence of depression at the time of the stroke. Twelve months after stroke 56% of the men were still depressed (40% major and 16% minor), as were 30% of the women (12% major and 18% minor).
CONCLUSION The prevalence of depression after stroke was comparable with that reported from other studies, and considerably less than that reported from in-patient and rehabilitation units.