scispace - formally typeset
Search or ask a question

Showing papers on "Depression (differential diagnoses) published in 2008"


Journal ArticleDOI
TL;DR: Mildtraumatic brain injury occurring among soldiers deployed in Iraq is strongly associated with PTSD and physical health problems 3 to 4 months after the soldiers return home, and after adjustment for PTSD and depression, mild traumatic brain injury was no longer significantly associated with these physical health outcomes or symptoms, except for headache.
Abstract: Of 2525 soldiers, 124 (4.9%) reported injuries with loss of consciousness, 260 (10.3%) reported injuries with altered mental status, and 435 (17.2%) reported other injuries during deployment. Of those reporting loss of consciousness, 43.9% met criteria for post-traumatic stress disorder (PTSD), as compared with 27.3% of those reporting altered mental status, 16.2% with other injuries, and 9.1% with no injury. Soldiers with mild traumatic brain injury, primarily those who had loss of consciousness, were significantly more likely to report poor general health, missed workdays, medical visits, and a high number of somatic and postconcussive symptoms than were soldiers with other injuries. However, after adjustment for PTSD and depression, mild traumatic brain injury was no longer significantly associated with these physical health outcomes or symptoms, except for headache. Conclusions Mild traumatic brain injury (i.e., concussion) occurring among soldiers deployed in Iraq is strongly associated with PTSD and physical health problems 3 to 4 months after the soldiers return home. PTSD and depression are important mediators of the relationship between mild traumatic brain injury and physical health problems.

2,436 citations


Journal ArticleDOI
TL;DR: This review presents the major current approaches to understanding the biologic mechanisms of major depression and defines depression as a heterogeneous disorder with a highly variable course, an inconsistent response to treatment, and no established mechanism.
Abstract: Depression is related to the normal emotions of sadness and bereavement, but it does not remit when the external cause of these emotions dissipates, and it is disproportionate to their cause. Classic severe states of depression often have no external precipitating cause. It is difficult, however, to draw clear distinctions between depressions with and those without psychosocial precipitating events. 1 The diagnosis of major depressive disorder requires a distinct change of mood, characterized by sadness or irritability and accompanied by at least several psychophysiological changes, such as disturbances in sleep, appetite, or sexual desire; constipation; loss of the ability to experience pleasure in work or with friends; crying; suicidal thoughts; and slowing of speech and action. These changes must last a minimum of 2 weeks and interfere considerably with work and family relations. On the basis of this broad definition, the lifetime incidence of depression in the United States is more than 12% in men and 20% in women. 2 Some have advocated a much narrower definition of severe depression, which they call melancholia or vital depression. 3 A small percentage of patients with major depression have had or will have manic episodes consisting of hyperactivity, euphoria, and an increase in pleasure seeking. Although some pathogenetic mechanisms in these cases and in cases of major depressive disorder overlap, a history of mania defines a distinct illness termed bipolar disorder. 4 Depression is a heterogeneous disorder with a highly variable course, an inconsistent response to treatment, and no established mechanism. This review presents the major current approaches to understanding the biologic mechanisms of major depression.

1,841 citations


01 Jan 2008
TL;DR: A comprehensive study of the post-deployment health-related needs associated with post-traumatic stress disorder, major depression, and traumatic brain injury among OEF/OIF veterans, the health care system in place to meet those needs, gaps in the care system, and the costs associated with these conditions and with providing quality health care to all those in need is presented.
Abstract: : Since 2001, 1.64 million U.S. troops have been deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) in Afghanistan and Iraq. Evidence suggests the psychological toll of these deployments may be disproportionately high compared with the physical injuries of combat. Concerns have been most recently centered on two combat-related injuries in particular: post-traumatic stress disorder and traumatic brain injury. Many recent reports have referred to these as the signature wounds of the Afghanistan and Iraq conflicts. With the increasing incidence of suicide and suicide attempts among returning veterans, concern about depression is also on the rise. The study discussed in this monograph focuses on post-traumatic stress disorder, major depression, and traumatic brain injury, not only because of current high-level policy interest but also because, unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other service members, family members, and society in general. All three conditions affect mood, thoughts, and behavior; yet these wounds often go unrecognized and unacknowledged. The effect of traumatic brain injury is still poorly understood, leaving a large gap in knowledge related to how extensive the problem is or how to address it. RAND conducted a comprehensive study of the post-deployment health-related needs associated with post-traumatic stress disorder, major depression, and traumatic brain injury among OEF/OIF veterans, the health care system in place to meet those needs, gaps in the care system, and the costs associated with these conditions and with providing quality health care to all those in need. This monograph presents the results of that study. These results should be of interest to mental health treatment providers; health policy makers, particularly those charged with caring for our nation's veterans; and U.S. service men and women, their families, and the concerned public.

1,624 citations


Journal ArticleDOI
TL;DR: Results from a series of clinical studies suggesting that childhood trauma in humans is associated with sensitization of the neuroendocrine stress response, glucocorticoid resistance, increased central corticotropin-releasing factor activity, immune activation, and reduced hippocampal volume are summarized, indicating the existence of biologically distinguishable subtypes of depression as a function of childhood trauma.

1,440 citations


Journal ArticleDOI
TL;DR: Depression is associated with a 60% increased risk of type 2 diabetes, and Type 2 diabetes isassociated with only modest increasedrisk of depression.
Abstract: OBJECTIVE —It has been argued that the relationship between depression and diabetes is bi-directional, but this hypothesis has not been explicitly tested. This systematic review examines the bi-directional prospective relationships between depression and type 2 diabetes. RESEARCH DESIGN AND METHODS —A search was conducted using Medline for publications from 1950 through 2007. Reviewers assessed the eligibility of each report by exposure/outcome measurement and study design. Only comparative prospective studies of depression and type 2 diabetes that excluded prevalent cases of depression (for diabetes predicting depression) or diabetes (for depression predicting diabetes) were included. Two sets of pooled risk estimates were calculated using random effects: depression predicting type 2 diabetes and type 2 diabetes predicting depression. RESULTS —Of 42 full-text publications reviewed, 13 met eligibility for depression predicting onset of diabetes, representing 6,916 incident cases. Seven met criteria for diabetes predicting onset of depression, representing 6,414 incident cases. The pooled relative risk (RR) for incident depression associated with baseline diabetes was 1.15 (95% CI 1.02–1.30). The RR for incident diabetes associated with baseline depression was 1.60 (1.37–1.88). CONCLUSIONS —Depression is associated with a 60% increased risk of type 2 diabetes. Type 2 diabetes is associated with only modest increased risk of depression. Future research should focus on identifying mechanisms linking these conditions.

1,271 citations


Journal ArticleDOI
TL;DR: It is suggested that the average prevalence of major depressive disorder in PD is substantial, but lower than generally assumed.
Abstract: Prevalence rates of depressive disorders in Parkinson's disease (PD) vary widely across studies, ranging from 2.7% to more than 90%. The aim of this systematic review was to calculate average prevalences of depressive disorders taking into account the different settings and different diagnostic approaches of studies. Using Medline on Pubmed, a systematic literature search was carried out for studies of depression in Parkinson's disease. A total of 104 articles were included and assessed for quality; 51 articles fulfilled the quality criteria. Multiple publications from the same database were not included in the meta‐analysis. In the remaining 36 articles, the weighted prevalence of major depressive disorder was 17% of PD patients, that of minor depression 22% and dysthymia 13%. Clinically significant depressive symptoms, irrespective of the presence of a DSM defined depressive disorder, were present in 35%. In studies using a (semi) structured interview to establish DSM criteria, the reported prevalence of major depressive disorder was 19%, while in studies using DSM criteria without a structured interview, the reported prevalence of major depressive disorder was 7%. Population studies report lower prevalence rates for both major depressive disorder and the clinically significant depressive symptoms than studies in other settings. This systematic review suggests that the average prevalence of major depressive disorder in PD is substantial, but lower than generally assumed. © 2007 Movement Disorder Society

1,006 citations


Journal ArticleDOI
TL;DR: Pregnancy per se is not associated with increased risk of the most prevalent mental disorders, although the risk of major depressive disorder may be increased during the postpartum period.
Abstract: Pregnancy and the postpartum period are widely considered periods of increased vulnerability to psychiatric disorders.1–12 Psychiatric disorders during pregnancy are associated with poor maternal health13–19 and inadequate prenatal care.20–22 Maternal psychiatric disorders during pregnancy and the postpartum period are also associated with numerous adverse outcomes for the offspring, including maladaptive fetal growth and development,22–36 poor cognitive development and behavior during childhood and adolescence,23–32 and negative nutritional and health effects.13, 33–38 For these reasons, accurate information about the mental health status of women during pregnancy and the postpartum period is urgently needed. Most of what is known about psychiatric problems among pregnant women comes from findings among clinical samples, often without non-pregnant control groups. In these samples, the prevalence of psychiatric disorders ranges from 15% to 29%.15, 20–22, 39–47 Risk factors identified in these studies include lack of romantic partner, prior history of psychiatric disorder, and lifetime exposure to traumatic events. 22, 41, 42, 45, 48–50 Only 5% to 14% of women received treatment for the psychiatric disorder.15, 40, 41 However, no previous study used sampling methodology permitting accurate estimation of the prevalence of psychiatric disorders among pregnant women in the United States. Further, no previous study included non-pregnant women of comparable age drawn from the general population in order to identify the specific contribution of pregnancy or the postpartum period to the risk of psychiatric disorders. Many studies were limited by use of screening scales rather than diagnostic measures for DSM-IV criteria. Finally, prior studies assessed only mood and anxiety disorders rather than a broader range of psychopathology. As the result of these gaps in research on mental disorders during pregnancy and the postpartum period, accurate national information on the mental health of pregnant women is lacking. Such information is needed for focused planning at the national and local level, and to inform the development of prevention and intervention programs. The current study addresses these critical gaps in knowledge. In a nationally representative sample of pregnant women, we present 12-month prevalence of DSM-IV psychiatric disorders, compare these with the prevalence of psychiatric disorders in non-pregnant women of childbearing age, identify risk factors for such disorders, and provide estimates of lifetime and 12-month rates of treatment-seeking among pregnant and non-pregnant women with DSM-IV psychiatric disorders.

910 citations


Journal ArticleDOI
TL;DR: The findings suggest a possible link between recurrent sport-related concussion and increased risk of clinical depression and emphasize the importance of understanding potential neurological consequences of recurrent concussion.
Abstract: GUSKIEWICZ, K. M., S. W. MARSHALL, J. BAILES, M. MCCREA, H. P. HARDING JR, A. MATTHEWS, J. R. MIHALIK, and R. C. CANTU. Recurrent Concussion and Risk of Depression in Retired Professional Football Players. Med. Sci. Sports Exerc., Vol. 39, No. 6, pp. 903–909, 2007. Purpose: The purpose of our study was to investigate the association between prior head injury and the likelihood of being diagnosed with clinical depression among retired professional football players with prior head injury exposure. Methods: A general health questionnaire, including information about prior injuries, the SF-36 (Short Form 36), and other markers for depression, was completed by 2552 retired professional football players with an average age of 53.8 (T 13.4) yr and an average professional football-playing career of 6.6 (T 3.6) yr. A second questionnaire focusing on mild cognitive impairment (MCI)-related issues was completed by a subset of 758 retired professional football players (50 yr and older). Results: Two hundred sixty-nine (11.1%) of all respondents reported having prior or current diagnosis of clinical depression. There was an association between recurrent concussion and diagnosis of lifetime depression (W 2 = 71.21, df =2 ,P G 0.005), suggesting that the prevalence increases with increasing concussion history. Compared with retired players with no history of concussion, retired players reporting three or more previous concussions (24.4%) were three times more likely to be diagnosed with depression; those with a history of one or two previous concussions (36.3%) were 1.5 times more likely to be diagnosed with depression. The analyses controlled for age, number of years since retirement, number of years played, physical component score on the SF-36, and diagnosed comorbidities such as osteoarthritis, coronary heart disease, stroke, cancer, and diabetes. Conclusion: Our findings suggest a possible link between recurrent sport-related concussion and increased risk of clinical depression. The findings emphasize the importance of understanding potential

908 citations


Journal ArticleDOI
TL;DR: This study suggests that DBS is relatively safe and provides significant improvement in patients with TRD and likely acts by modulating brain networks whose dysfunction leads to depression.

905 citations


Journal ArticleDOI
TL;DR: Antenatal depressive symptoms appear to be as common as postnatal depressive symptoms and previous depression, current depression/anxiety, and low partner support are found to be key antenatal risk factors for postnatal depression in this large prospective cohort, consistent with existing meta-analytic surveys.

875 citations


Journal Article
TL;DR: The review of literature presents the conclusions of several meta-analyses that have reviewed psychosocial interventions for late-life depression and anxiety, and intervention studies concerning the effectiveness of cognitive behavioral therapy, interpersonal therapy, reminiscence therapy, and alternative therapies with depressed and/or anxious older adults are reviewed.
Abstract: Depression and anxiety are the most common psychiatric conditions in late life. Despite their prevalence, we know relatively little about their unique manifestation in older adults. And, Although the most common intervention for late-life depression and anxiety continues to be medication, research on psychosocial interventions for late-life depression and anxiety has burgeoned in the past several years. Unfortunately, this growing body of intervention research has yet to be widely translated into improved systems of care for late-life depression. This article is one step toward synthesizing the knowledge in this growing area of research. The review of literature presents the conclusions of several meta-analyses that have reviewed psychosocial interventions for late-life depression and anxiety. In addition, intervention studies concerning the effectiveness of cognitive behavioral therapy, interpersonal therapy, reminiscence therapy, and alternative therapies with depressed and/or anxious older adults are reviewed. A brief description of various approaches to psychosocial intervention with anxious and/or depressed older adults is also presented.

Journal ArticleDOI
TL;DR: Cross-lagged regression analyses indicated that low self-esteem predicted subsequent levels of depression, but depression did not predict subsequent Levels of Self-esteem, and the results supported the vulnerability model, but not the scar model, of self- esteem and depression.
Abstract: Low self-esteem and depression are strongly correlated in cross-sectional studies, yet little is known about their prospective effects on each other. The vulnerability model hypothesizes that low self-esteem serves as a risk factor for depression, whereas the scar model hypothesizes that low self-esteem is an outcome, not a cause, of depression. To test these models, the authors used 2 large longitudinal data sets, each with 4 repeated assessments between the ages of 15 and 21 years and 18 and 21 years, respectively. Cross-lagged regression analyses indicated that low self-esteem predicted subsequent levels of depression, but depression did not predict subsequent levels of self-esteem. These findings held for both men and women and after controlling for content overlap between the self-esteem and depression scales. Thus, the results supported the vulnerability model, but not the scar model, of self-esteem and depression.

Journal ArticleDOI
01 Apr 2008-Sleep
TL;DR: A spectrum of insomnia (defined by duration and frequency) comorbid with, rather than secondary to, depression is supported, which confirms the persistent nature of insomnia and the increased risk of subsequent depression among individuals with insomnia.
Abstract: EPIDEMIOLOGIC STUDIES SHOW THAT 20% TO 35% OF THE GENERAL POPULATION REPORT INSOMNIA SYMPTOMS, AND THAT 10% TO 20% HAVE A CLINICALLY significant insomnia syndrome.1–5 Fewer data are available to address 2 other important questions regarding the epidemiology of insomnia: its natural history and its relationship with psychiatric disorders. Several studies have indicated that insomnia is often a chronic condition,6–8 but many of these studies have used retrospective designs or prospective designs with limited duration or limited number of follow-up evaluations. Results of other studies9,10 have suggested that, at least for older adults, incidence and remission rates for narrowly defined insomnia are about equal. Thus, uncertainty exists regarding the course and chronicity of insomnia. The 2005 National Institutes of Health State of the Science Conference Statement on the Manifestations and Management of Chronic Insomnia in Adults identified studies addressing this issue as an important direction for insomnia-related research: “Longitudinal observational studies are needed to identify factors affecting incidence of, natural history of, and remission from chronic insomnia.11” A number of risk factors for chronic insomnia have been identified, including medical problems, female sex, and increasing age.4,5,12–16 However, depression and depressive symptoms are the largest and most consistent risk factors for insomnia.7,17 Conversely, insomnia is a frequent symptom of depression, and it is often hypothesized to be an antecedent or risk factor. To date, however, relatively few studies have examined prospective longitudinal data from representative community samples to define the relationship between insomnia and depression; these studies were recently reviewed.18 Data from the Epidemiologic Catchment Area Study showed that insomnia was associated with an increased risk of depression if it was present at 2 interviews over a 1-year follow-up interval but not if it was present only at the initial interview.3 Weissman and colleagues4 examined Epidemiologic Catchment Area data and found that insomnia not comorbid with a psychiatric disorder was associated with a significantly increased risk of developing first-episode major depression, alcohol abuse, and panic disorder within a 1-year follow-up period. Other studies have found similar relationships between insomnia and depression among older adults19 and younger adults 20 with 2- to 3-year follow-up intervals, even after controlling for prior depressive symptoms. Finally, Chang et al21 reported a prospective study of 1053 male medical students with annual follow-up questionnaires over a mean of 34 years. Insomnia and difficulty sleeping under stress predicted depression, as assessed by questionnaires and the general health questionnaire. In contrast with these studies, but consistent with the results of Ford and Kamerow, were the earlier findings of the Zurich Study,22 comprising a 2- to 7-year follow-up of young adults. Although we found strong cross-sectional associations between insomnia and depression, we did not find that insomnia predicted future depression. Although a considerable amount of data suggests an association between insomnia and subsequent depression, previous studies have been limited by the representativeness of their samples, the duration and frequency of follow-up, or the definition of insomnia. The current analyses from the Zurich Study include a representative population sample, a follow-up interval of 21 years, and the ability to examine different patterns of insomnia, including a conservative case definition based on Diagnostic and Statistical Manual (DSM)-IV criteria for primary insomnia. The aims of these analyses were (1) to describe the prevalence and prospective course of insomnia in a representative young adult sample and (2) to describe the cross-sectional and longitudinal associations between insomnia and depression, including the question of whether insomnia predicts depression or vice versa.

Journal ArticleDOI
TL;DR: Substantial and consistent evidence is found that chronic depression, stressful events, and trauma may negatively affect HIV disease progression in terms of decreases in CD4 T lymphocytes, increases in viral load, and greater risk for clinical decline and mortality.
Abstract: Despite advances in HIV treatment, there continues to be great variability in the progression of this disease This paper reviews the evidence that depression, stressful life events, and trauma account for some of the variation in HIV disease course Longitudinal studies both before and after the advent of highly active antiretroviral therapies (HAART) are reviewed To ensure a complete review, PubMed was searched for all English language articles from January 1990 to July 2007 We found substantial and consistent evidence that chronic depression, stressful events, and trauma may negatively affect HIV disease progression in terms of decreases in CD4 T lymphocytes, increases in viral load, and greater risk for clinical decline and mortality More research is warranted to investigate biological and behavioral mediators of these psychoimmune relationships, and the types of interventions that might mitigate the negative health impact of chronic depression and trauma Given the high rates of depression and past trauma in persons living with HIV/AIDS, it is important for healthcare providers to address these problems as part of standard HIV care

Journal ArticleDOI
TL;DR: Neuropsychiatric symptoms are nearly universal in dementia, yet little is known about their longitudinal course in the community and how these symptoms change over time.
Abstract: Background Neuropsychiatric symptoms are nearly universal in dementia, yet little is known about their longitudinal course in the community. Objective To estimate point and 5-year period prevalence of neuropsychiatric symptoms in an incident sample of 408 dementia participants from the Cache County Study. Methods The Neuropsychiatric Inventory assessed symptoms at baseline and at 1.5 years, 3.0 years, 4.1 years, and 5.3 years. Point prevalence, period prevalence and mean symptom severity at each time point were estimated. Results Point prevalence for delusions was 18% at baseline and 34–38% during the last three visits; hallucinations, 10% at baseline and 19–24% subsequently; agitation/aggression fluctuated between 13% and 24%; depression 29% at baseline and 41–47% subsequently; apathy increased from 20% at baseline to 51% at 5.3 years; elation never rose above 1%; anxiety 14% at baseline and 24–32% subsequently; disinhibition fluctuated between 2% and 15%; irritability between 17% and 27%; aberrant motor behavior gradually increased from 7% at baseline to 29% at 5.3 years. Point prevalence for any symptom was 56% at baseline and 76–87% subsequently. Five-year period prevalence was greatest for depression (77%), apathy (71%), and anxiety (62%); lowest for elation (6%), and disinhibition (31%). Ninety-seven percent experienced at least one symptom. Symptom severity was consistently highest for apathy. Conclusions Participants were most likely to develop depression, apathy, or anxiety, and least likely to develop elation or disinhibition. Give converging evidence that syndromal definitions may more accurately capture neuropsychiatric co-morbidity in dementia, future efforts to validate such syndromes are warranted. Copyright © 2007 John Wiley & Sons, Ltd.

Journal ArticleDOI
TL;DR: Information about experiences of childhood maltreatment may help to identify depressed individuals with elevated inflammation levels and, thus, at greater risk of cardiovascular disease.
Abstract: CONTEXT: The association between depression and inflammation is inconsistent across research samples. OBJECTIVE: To test whether a history of childhood maltreatment could identify a subgroup of depressed individuals with elevated inflammation levels, thus helping to explain previous inconsistencies. DESIGN: Prospective longitudinal cohort study. SETTING: New Zealand. PARTICIPANTS: A representative birth cohort of 1000 individuals was followed up to age 32 years as part of the Dunedin Multidisciplinary Health and Development Study. Study members were assessed for history of childhood maltreatment and current depression. MAIN OUTCOME MEASURES: Inflammation was assessed using a clinically relevant categorical measure of high-sensitivity C-reactive protein (>3 mg/L) and a dimensional inflammation factor indexing the shared variance of continuous measures of high-sensitivity C-reactive protein, fibrinogen, and white blood cells. RESULTS: Although depression was associated with high levels of high-sensitivity C-reactive protein (relative risk,1.45; 95% confidence interval,1.06-1.99), this association was significantly attenuated and no longer significant when the effect of childhood maltreatment was taken into account. Individuals with current depression and a history of childhood maltreatment were more likely to have high levels of high-sensitivity C-reactive protein compared with control subjects (n = 27; relative risk, 2.07; 95% confidence interval, 1.23-3.47). In contrast, individuals with current depression only had a nonsignificant elevation in risk (n = 109; relative risk, 1.40; 95% confidence interval, 0.97-2.01). Results were generalizable to the inflammation factor. The elevated inflammation levels in individuals who were both depressed and maltreated were not explained by correlated risk factors such as depression recurrence, low socioeconomic status in childhood or adulthood, poor health, or smoking. CONCLUSIONS: A history of childhood maltreatment contributes to the co-occurrence of depression and inflammation. Information about experiences of childhood maltreatment may help to identify depressed individuals with elevated inflammation levels and, thus, at greater risk of cardiovascular disease. Language: en

Journal ArticleDOI
01 Oct 2008-Chest
TL;DR: The proceedings of a multidisciplinary workshop on anxiety and depression in COPD aimed to shed light on the current understanding of these comorbidities, and outline unanswered questions and areas of future research needs.

Journal ArticleDOI
TL;DR: A potential consideration for future diagnostic classification would be to describe basic diagnostic criteria for a single overarching disorder and to optionally code additional diagnostic features that allow a more detailed classification into specific depressive, anxiety and somatoform subtypes.

Journal ArticleDOI
TL;DR: Major depression is a frequent but underrecognized and undertreated condition among breast cancer patients, which causes amplification of physical symptoms, increased functional impairment and poor treatment adherence.

Journal ArticleDOI
TL;DR: Anxiety and depression predict greater MACE risk in patients with stable CAD, supporting future research into common genetic, environmental, and pathophysiologic pathways and treatments.
Abstract: Context Anxiety and depression are associated with mechanisms that promote atherosclerosis. Most recent studies of emotional disturbances in coronary artery disease (CAD) have focused on depression only. Objective To assess the 2-year cardiac prognostic importance of the DSM-IV –based diagnoses of major depressive disorder (MDD) and generalized anxiety disorder (GAD) and self-report measures of anxiety and depression and their co-occurrence. Design, Setting, and Patients Two-year follow-up of 804 patients with stable CAD (649 men) assessed using the Beck Depression Inventory II (BDI-II), the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), and the Structured Clinical Interview for DSM-IV (masked to self-reports) 2 months after acute coronary syndromes. Main Outcome Measures Major adverse cardiac events (MACEs) (cardiac death, myocardial infarction, cardiac arrest, or nonelective revascularization) in the 2 years after baseline. Results Of the 804 patients, 57 (7.1%) met the criteria for MDD and 43 (5.3%) for GAD (11 [1.4%] had comorbidity); 220 (27.4%) had elevated BDI-II scores (≥14), and 333 (41.4%) had elevated HADS-A scores (≥8), with 21.1% overlap. Major depressive disorder (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.38-4.73), GAD (OR, 2.47; 95% CI, 1.23-4.97), elevated BDI-II (OR, 1.81; 95% CI, 1.20-2.73), elevated HADS-A score (OR, 1.66; 95% CI, 1.12-2.47), and continuous standardized scores on the BDI-II (OR, 1.31; 95% CI, 1.05-1.62) and the HADS-A (OR, 1.43; 95% CI, 1.19-1.73) all predicted MACEs. After covariate control, only the P value associated with the continuous BDI-II score increased to above .10. Most of the risk associated with elevated symptoms was in patients with psychiatric disorders. However, patients with comorbid MDD and GAD or elevated anxiety and depression symptoms were not at greater MACE risk than those with only 1 factor. Conclusion Anxiety and depression predict greater MACE risk in patients with stable CAD, supporting future research into common genetic, environmental, and pathophysiologic pathways and treatments.

Journal ArticleDOI
TL;DR: There is a need for more successful management of sleep disturbance in depression, in order to improve quality of life in these patients and reduce an important factor in depressive relapse and recurrence.
Abstract: Links between sleep and depression are strong. About three quarters of depressed patients have insomnia symptoms, and hypersomnia is present in about 40% of young depressed adults and 10% of older patients, with a preponderance in females. The symptoms cause huge distress, have a major impact on quality of life, and are a strong risk factor for suicide. As well as the subjective experience of sleep symptoms, there are well-documented changes in objective sleep architecture in depression. Mechanisms of sleep regulation and how they might be disturbed in depression are discussed. The sleep symptoms are often unresolved by treatment, and confer a greater risk of relapse and recurrence. Epidemiological studies have pointed out that insomnia in nondepressed subjects is a risk factor for later development of depression. There is therefore a need for more successful management of sleep disturbance in depression, in order to improve quality of life in these patients and reduce an important factor in depressive relapse and recurrence.

Journal Article
01 Jan 2008-Sleep
TL;DR: In this paper, the authors investigated the cross-sectional and longitudinal associations between insomnia and depression in a representative sample of young adults with 6 interviews spanning 20 years and distinguished four duration-based subtypes of insomnia: 1-month insomnia associated with significant distress, 2-to 3-week insomnia, recurrent brief insomnia, and occasional brief insomnia.
Abstract: Study Objectives: (1) To describe the prevalence and prospective course of insomnia in a representative young-adult sample and (2) to describe the cross-sectional and longitudinal associations between insomnia and depression Design: Longitudinal cohort study Setting: Community of Zurich, Switzerland Participants: Representative stratified population sample Interventions: None Measurements and Results: The Zurich Study prospectively assessed psychiatric, physical, and sleep symptoms in a community sample of young adults (n = 591) with 6 interviews spanning 20 years We distinguished 4 duration-based subtypes of insomnia: 1-month insomnia associated with significant distress, 2- to 3-week insomnia, recurrent brief insomnia, and occasional brief insomnia The annual prevalence of 1-month insomnia increased gradually over time, with a cumulative prevalence rate of 20% and a greater than 2-fold risk among women In 40% of subjects, insomnia developed into more chronic forms over time Insomnia either with or without comorbid depression was highly stable over time Insomnia lasting 2 weeks or longer predicted major depressive episodes and major depressive disorder at subsequent interviews; 17% to 50% of subjects with insomnia lasting 2 weeks or longer developed a major depressive episode in a later interview "Pure" insomnia and "pure" depression were not longitudinally related to each other, whereas insomnia comorbid with depression was longitudinally related to both Conclusions: This longitudinal study confirms the persistent nature of insomnia and the increased risk of subsequent depression among individuals with insomnia The data support a spectrum of insomnia (defined by duration and frequency) comorbid with, rather than secondary to, depression

Journal ArticleDOI
13 Aug 2008-JAMA
TL;DR: In this paper, the authors used the Ovid/MEDLINE database to search for articles published between 1951 and February 2008 using any combination of the terms brain injury, pain, headache, blast injury, and combat (combat disorders, war, military medicine, wounds and injuries, military personnel, veterans).
Abstract: Context The Centers for Disease Control and Prevention estimates that approximately 1.4 million US individuals sustain traumatic brain injuries (TBIs) per year. Previous reports suggest an association between TBI and chronic pain syndromes (eg, headache) thought to be more common in patients with mild TBI and in those who have sustained brain injury from violent rather than unintentional trauma. Comorbid psychiatric disorders such as posttraumatic stress disorder (PTSD) may also mediate chronic pain symptoms. Objectives To determine the prevalence of chronic pain as an underdiagnosed consequence of TBI and to review the interaction between chronic pain and severity of TBI as well as the characteristics of pain after TBI among civilians and combatants. Evidence Acquisition The Ovid/MEDLINE database was searched for articles published between 1951 and February 2008 using any combination of the terms brain injury, pain, headache, blast injury, and combat (combat disorders, war, military medicine, wounds and injuries, military personnel, veterans). The PubMed and MD Consult databases were searched in a similar fashion. The Cochrane Collaboration, National Institutes of Health Clinical Trials Database, Meta-Register of Current Controlled Trials, and CRISP databases were searched using the keyword brain injury. All articles in peer-reviewed journals reporting original data on pain syndromes in adult patients with TBI with regard to pain prevalence, pain category, risk factors, pathogenesis, and clinical course were selected, and manual searches were performed of their reference lists. The data were pooled and prevalence rates calculated. Evidence Synthesis Twenty-three studies (15 cross-sectional, 5 prospective, and 3 retrospective) including 4206 patients were identified. Twelve studies assessed headache pain in 1670 patients. Of these, 966 complained of chronic headache, yielding a prevalence of 57.8% (95% confidence interval [CI], 55.5%-60.2%). Among civilians, the prevalence of chronic pain was greater in patients with mild TBI (75.3% [95% CI, 72.7%-77.9%]) compared with moderate or severe TBI (32.1% [95% CI, 29.3%-34.9%]). Twenty studies including 3289 civilian patients with TBI yielded a chronic pain prevalence of 51.5% (95% CI, 49.8%-53.2%). Three studies assessed TBI among 917 veterans and yielded a pain prevalence of 43.1% (95% CI, 39.9%-46.3%). PTSD may mediate chronic pain, but brain injury appears to have an independent correlation with chronic pain. Conclusions Chronic pain is a common complication of TBI. It is independent of psychologic disorders such as PTSD and depression and is common even among patients with apparently minor injuries to the brain.

Journal ArticleDOI
TL;DR: The associations between depression, anxiety, obesity and unhealthy behaviors among US adults suggest the need for a multidimensional and integrative approach to health care.

Journal ArticleDOI
TL;DR: These findings suggest that sleep-related symptoms that are present before, during, and after a depressive episode are potentially modifiable factors that may play an important role in achieving and maintaining depression remission.
Abstract: The majority of individuals with depression experience sleep disturbances. Depression is also over-represented among populations with a variety of sleep disorders. Although sleep disturbances are typical features of depression, such symptoms sometimes appear prior to an episode of depression. The bidirectional associations between sleep disturbance (especially insomnia) and depression increase the difficulty of differentiating cause-and-effect relationships between them. Longitudinal studies have consistently identified insomnia as a risk factor for the development of a new-onset or recurrent depression, and this association has been identified in young, middle-aged, and older adults. Studies have also observed that the combination of insomnia and depression influences the trajectory of depression, increasing episode severity and duration as well as relapse rates. Fortunately, recent studies have demonstrated that both pharmacological and nonpharmacological interventions for insomnia may favorably reduce and possibly prevent depression. Together, these findings suggest that sleep-related symptoms that are present before, during, andlor after a depressive episode are potentially modifiable factors that may play an important role in achieving and maintaining depression remission.

Journal ArticleDOI
12 Nov 2008-JAMA
TL;DR: Depression treatment with medication or cognitive behavioral therapy in patients with cardiovascular disease is associated with modest improvement in depressive symptoms but no improvement in cardiac outcomes.
Abstract: Context Several practice guidelines recommend that depression be evaluated and treated in patients with cardiovascular disease, but the potential benefits of this are unclear. Objective To evaluate the potential benefits of depression screening in patients with cardiovascular disease by assessing (1) the accuracy of depression screening instruments; (2) the effect of depression treatment on depression and cardiac outcomes; and (3) the effect of screening on depression and cardiac outcomes in patients in cardiovascular care settings. Data sources MEDLINE, PsycINFO, CINAHL, EMBASE, ISI, SCOPUS, and Cochrane databases from inception to May 1, 2008; manual journal searches; reference list reviews; and citation tracking of included articles. Study selection We included articles in any language about patients in cardiovascular care settings that (1) compared a screening instrument to a valid major depressive disorder criterion standard; (2) compared depression treatment with placebo or usual care in a randomized controlled trial; or (3) assessed the effect of screening on depression identification and treatment rates, depression, or cardiac outcomes. Data extraction Methodological characteristics and outcomes were extracted by 2 investigators. Results We identified 11 studies about screening accuracy, 6 depression treatment trials, but no studies that evaluated the effects of screening on depression or cardiovascular outcomes. In studies that tested depression screening instruments using a priori-defined cutoff scores, sensitivity ranged from 39% to 100% (median, 84%) and specificity ranged from 58% to 94% (median, 79%). Depression treatment with medication or cognitive behavioral therapy resulted in modest reductions in depressive symptoms (effect size, 0.20-0.38; r(2), 1%-4%). There was no evidence that depression treatment improved cardiac outcomes. Among patients with depression and history of myocardial infarction in the ENRICHD trial, there was no difference in event-free survival between participants treated with cognitive behavioral therapy supplemented by an antidepressant vs usual care (75.5% vs 74.7%, respectively). Conclusions Depression treatment with medication or cognitive behavioral therapy in patients with cardiovascular disease is associated with modest improvement in depressive symptoms but no improvement in cardiac outcomes. No clinical trials have assessed whether screening for depression improves depressive symptoms or cardiac outcomes in patients with cardiovascular disease.

Journal ArticleDOI
TL;DR: The added morbidity of depression and anxiety with chronic pain is strongly associated with more severe pain, greater disability, and poorer health-related quality of life.
Abstract: Objective:To assess the relationship between depression and anxiety comorbidity on pain intensity, pain-related disability, and health-related quality of life (HRQL).Methods:Analysis of baseline data from the Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study. All patients (

Journal ArticleDOI
TL;DR: There is considerable overlap between the risk profiles for Anxiety and depression in the elderly, which suggests a dimensional approach on the interrelationship between anxiety and depression is more appropriate.

Journal ArticleDOI
TL;DR: In this paper, a meta-analysis of the research literature on the prevalence of mental disorders in adolescents in juvenile detention and correctional facilities was performed, showing that adolescents were more likely to suffer from depression than the general adolescent population.
Abstract: Objective To systematically review and perform a meta-analysis of the research literature on the prevalence of mental disorders in adolescents in juvenile detention and correctional facilities. Method Surveys of psychiatric morbidity based on interviews of unselected populations of detained children and adolescents were identified by computer-assisted searches, scanning of reference lists, hand-searching of journals, and correspondence with authors of relevant reports. The sex-specific prevalence of mental disorders (psychotic illness, major depression, attention-deficit/hyperactivity disorder [ADHD], and conduct disorder) together with potentially moderating study characteristics were abstracted from publications. Statistical analysis involved metaregression to identify possible causes of differences in disorder prevalence across surveys. Results Twenty-five surveys involving 13,778 boys and 2,972 girls (mean age 15.6 years, range 10–19 years) met inclusion criteria. Among boys, 3.3% (95% confidence interval [Cl] 3.0%-3.6%) were diagnosed with psychotic illness, 10.6% (7.3%-13.9%) with major depression, 11.7% (4.1%-19.2%) with ADHD, and 52.8% (40.9%-64.7%) with conduct disorder. Among girls, 2.7% (2.0%-3.4%) were diagnosed with psychotic illness, 29.2% (21.9%-36.5%) with major depression, 18.5% (9.3%-27.7%) with ADHD, and 52.8% (32.4%-73.2%) with conduct disorder. Metaregression suggested that surveys using the Diagnostic Interview Schedule for Children yielded lower prevalence estimates for depression, ADHD, and conduct disorder, whereas studies with psychiatrists acting as interviewers had lower prevalence estimates only of depression. Conclusions Adolescents in detention and correctional facilities were about 10 times more likely to suffer from psychosis than the general adolescent population. Girls were more often diagnosed with major depression than were boys, contrary to findings from adult prisoners and general population surveys. The findings have implications for the provision of psychiatric services for adolescents in detention. J. Am. Acad. Child Adolesc. Psychiatry , 2008; 47(9):1010–1019.

Journal ArticleDOI
TL;DR: The authors found moderate evidence for a relation between the psychological demands of the job and the development of depression, with relative risks of approximately 2.0, but indication of publication bias weakens the evidence.
Abstract: This review is based on a literature search made in January 2007 on request by the Danish National Board of Industrial Injuries. The search in PubMed, EMBASE, and PsycINFO resulted in more than 1,000 publications. This was reduced to 14 after the titles, abstracts, and papers were evaluated by using the following criteria: 1) a longitudinal study, 2) exposure to work-related psychosocial factors, 3) the outcome a measure of depression, 4) relevant statistical estimates, and 5) nonduplicated publication. Of the 14 studies, seven used standardized diagnostic instruments as measures of depression, whereas the other seven studies used self-administered questionnaires. The authors found moderate evidence for a relation between the psychological demands of the job and the development of depression, with relative risks of approximately 2.0. However, indication of publication bias weakens the evidence. Social support at work was associated with a decrease in risk for future depression, as all four studies dealing with this exposure showed associations with relative risks of about 0.6. Even if this literature study has identified work-related psychosocial factors that in high-quality epidemiologic studies predict depression, studies are still needed that assess in more detail the duration and intensity of exposure necessary for developing depression.