Showing papers on "Depression (differential diagnoses) published in 2011"
TL;DR: The aim of this Review was to summarise the evidence regarding seven potentially modifiable risk factors for AD: diabetes, midlife hypertension, mid life obesity, smoking, depression, cognitive inactivity or low educational attainment, and physical inactivity.
Abstract: At present, about 33·9 million people worldwide have Alzheimer's disease (AD), and prevalence is expected to triple over the next 40 years. The aim of this Review was to summarise the evidence regarding seven potentially modifiable risk factors for AD: diabetes, midlife hypertension, midlife obesity, smoking, depression, cognitive inactivity or low educational attainment, and physical inactivity. Additionally, we projected the effect of risk factor reduction on AD prevalence by calculating population attributable risks (the percent of cases attributable to a given factor) and the number of AD cases that might be prevented by risk factor reductions of 10% and 25% worldwide and in the USA. Together, up to half of AD cases worldwide (17·2 million) and in the USA (2·9 million) are potentially attributable to these factors. A 10-25% reduction in all seven risk factors could potentially prevent as many as 1·1-3·0 million AD cases worldwide and 184,000-492,000 cases in the USA.
2,269 citations
TL;DR: Non-depressed people with insomnia have a twofold risk to develop depression, compared to people with no sleep difficulties, so early treatment programs for insomnia might reduce the risk for developing depression in the general population and be considered a helpful general preventive strategy in the area of mental health care.
1,829 citations
TL;DR: Interview-defined depression and anxiety is less common in patients with cancer than previously thought, although some combination of mood disorders occurs in 30-40% of patients in hospital settings without a significant difference between palliative-care and non-palliatives-care settings.
Abstract: Summary Background Substantial uncertainty exists about prevalence of mood disorders in patients with cancer, including those in oncological, haematological, and palliative-care settings. We aimed to quantitatively summarise the prevalence of depression, anxiety, and adjustments disorders in these settings. Methods We searched Medline, PsycINFO, Embase, and Web of Knowledge for studies that examined well-defined depression, anxiety, and adjustment disorder in adults with cancer in oncological, haematological, and palliative-care settings. We restricted studies to those using psychiatric interviews. Studies were reviewed in accordance with PRISMA guidelines and a proportion meta-analysis was done. Findings We identified 24 studies with 4007 individuals across seven countries in palliative-care settings. Meta-analytical pooled prevalence of depression defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria was 16·5% (95% CI 13·1–20·3), 14·3% (11·1–17·9) for DSM-defined major depression, and 9·6% (3·6–18·1) for DSM-defined minor depression. Prevalence of adjustment disorder alone was 15·4% (10·1–21·6) and of anxiety disorders 9·8% (6·8–13·2). Prevalence of all types of depression combined was of 24·6% (17·5–32·4), depression or adjustment disorder 24·7% (20·8–28·8), and all types of mood disorder 29·0% (10·1–52·9). We identified 70 studies with 10 071 individuals across 14 countries in oncological and haematological settings. Prevalence of depression by DSM or ICD criteria was 16·3% (13·4–19·5); for DSM-defined major depression it was 14·9% (12·2–17·7) and for DSM-defined minor depression 19·2% (9·1–31·9). Prevalence of adjustment disorder was 19·4% (14·5–24·8), anxiety 10·3% (5·1–17·0), and dysthymia 2·7% (1·7–4·0). Combination diagnoses were common; all types of depression occurred in 20·7% (12·9–29·8) of patients, depression or adjustment disorder in 31·6% (25·0–38·7), and any mood disorder in 38·2% (28·4–48·6). There were few consistent correlates of depression: there was no effect of age, sex, or clinical setting and inadequate data to examine cancer type and illness duration. Interpretation Interview-defined depression and anxiety is less common in patients with cancer than previously thought, although some combination of mood disorders occurs in 30–40% of patients in hospital settings without a significant difference between palliative-care and non-palliative-care settings. Clinicians should remain vigilant for mood complications, not just depression. Funding None.
1,761 citations
01 Jan 2011
TL;DR: An intervention involving nurses who provided guideline-based, patient-centered management of depression and chronic disease significantly improved control of medical disease and depression.
Abstract: Patients with depression and poorly controlled diabetes, coronary heart disease, or both have an increased risk of adverse outcomes and high health care costs. We conducted a study to determine whether coordinated care management of multiple conditions improves disease control in these patients.
1,294 citations
TL;DR: The current study suggests that the degree of HPA hyperactivity can vary considerably across patient groups, consistent with HPAhyperactivity as a link between depression and increased risk for conditions, such as diabetes, dementia, coronary heart disease, and osteoporosis.
Abstract: Objectives To summarize quantitatively the literature comparing hypothalamic-pituitary-adrenal (HPA) axis function between depressed and nondepressed individuals and to describe the important sources of variability in this literature. These sources include methodological differences between studies, as well as demographic or clinical differences between depressed samples. Methods The current study used meta-analytic techniques to compare 671 effect sizes (cortisol, adrenocorticotropic hormone, or corticotropin-releasing hormone) across 361 studies, including 18,454 individuals. Results Although depressed individuals tended to display increased cortisol (d = 0.60; 95% confidence interval [CI], 0.54-0.66) and adrenocorticotropic hormone levels (d = 0.28; 95% CI, 0.16-0.41), they did not display elevations in corticotropin-releasing hormone (d = 0.02; 95% CI, -0.47-0.51). The magnitude of the cortisol effect was reduced by almost half (d = 0.33; 95% CI, 0.21-0.45) when analyses were limited to studies that met minimal methodological standards. Gender did not significantly modify any HPA outcome. Studies that included older hospitalized individuals reported significantly greater cortisol differences between depressed and nondepressed groups compared with studies with younger outpatient samples. Important cortisol differences also emerged for atypical, endogenous, melancholic, and psychotic forms of depression. Conclusions The current study suggests that the degree of HPA hyperactivity can vary considerably across patient groups. Results are consistent with HPA hyperactivity as a link between depression and increased risk for conditions, such as diabetes, dementia, coronary heart disease, and osteoporosis. Such a link is strongest among older inpatients who display melancholic or psychotic features of depression.
910 citations
TL;DR: An overview of how depression affects the quality of life of the subject and is also a huge burden for both the family of the depressed patient and for society at large is presented.
Abstract: Recent epidemiological surveys conducted in general populations have found that the lifetime prevalence of depression is in the range of 10% to 15%. Mood disorders, as defined by the World Mental Health and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, have a 12-month prevalence which varies from 3% in Japan to over 9% in the US. A recent American survey found the prevalence of current depression to be 9% and the rate of current major depression to be 3.4%. All studies of depressive disorders have stressed the importance of the mortality and morbidity associated with depression. The mortality risk for suicide in depressed patients is more than 20-fold greater than in the general population. Recent studies have also shown the importance of depression as a risk factor for cardiovascular death. The risk of cardiac mortality after an initial myocardial infarction is greater in patients with depression and related to the severity of the depressive episode. Greater severity of depressive symptoms has been found to be associated with significantly higher risk of all-cause mortality including cardiovascular death and stroke. In addition to mortality, functional impairment and disability associated with depression have been consistently reported. Depression increases the risk of decreased workplace productivity and absenteeism resulting in lowered income or unemployment. Absenteeism and presenteeism (being physically present at work but functioning suboptimally) have been estimated to result in a loss of $36.6 billion per year in the US. Worldwide projections by the World Health Organization for the year 2030 identify unipolar major depression as the leading cause of disease burden. This article is a brief overview of how depression affects the quality of life of the subject and is also a huge burden for both the family of the depressed patient and for society at large.
906 citations
TL;DR: This work considers recent systematic reviews, meta-analyses, and randomised controlled trials to consider identification and treatment of depression in older adults, especially as older patients may have different presentations and needs than younger ones.
Abstract: #### Summary points
Depression is a major contributor to healthcare costs and is projected to be the leading cause of disease burden in middle and higher income countries by the year 2030.w1 Depression in later life, traditionally defined as age older than 65, is associated with disability, increased mortality, and poorer outcomes from physical illness. Most clinicians will encounter older patients with depression in their day to day practice, but although treatment is as effective for older patients as for younger adults, the condition is often under-recognised and under-treated. According to WHO data, proportionately more people aged over 65 commit suicide than any other age group, and most have major depression. Older people who attempt suicide are more likely to die than younger people, while in those who survive, prognosis is worse for older adults.1
With a progressively ageing population worldwide, identification and treatment of depression in older adults becomes increasingly important, especially as older patients may have different presentations and needs than younger ones. We consider recent systematic reviews, meta-analyses, and randomised controlled trials to …
848 citations
TL;DR: Current evidence linking late-life and earlier-life depression and dementia, and the primary underlying mechanisms and implications for treatment are summarized and analyzed.
Abstract: Depression is highly common throughout the life course and dementia is common in late life. Depression has been linked with dementia, and growing evidence implies that the timing of depression may be important in defining the nature of this association. In particular, earlier-life depression (or depressive symptoms) has consistently been associated with a more than twofold increase in dementia risk. By contrast, studies of late-life depression and dementia risk have been conflicting; most support an association, yet the nature of this association (for example, if depression is a prodrome or consequence of, or risk factor for dementia) remains unclear. The likely biological mechanisms linking depression to dementia include vascular disease, alterations in glucocorticoid steroid levels and hippocampal atrophy, increased deposition of amyloid-β plaques, inflammatory changes, and deficits of nerve growth factors. Treatment strategies for depression could interfere with these pathways and alter the risk of dementia. Given the projected increase in dementia incidence in the coming decades, understanding whether treatment for depression alone, or combined with other regimens, improves cognition is of critical importance. In this Review, we summarize and analyze current evidence linking late-life and earlier-life depression and dementia, and discuss the primary underlying mechanisms and implications for treatment.
846 citations
TL;DR: A summary of self-report adult measures that are considered to be most relevant for the assessment of depression in the context of rheumatology clinical and/or research practice are presented.
Abstract: This article presents a summary of self-report adult measures that are considered to be most relevant for the assessment of depression in the context of rheumatology clinical and/or research practice. This piece represents an update of the special issue article that appeared in Arthritis Care & Research in 2003; the current review followed similar selection criteria for inclusion of assessment tools. Specifically, measures were selected based on several considerations, including ease of administration, interpretation, and adoption by arthritis health professionals from varying backgrounds and training perspectives; self-report measures providing data from the patient or research participant’s perspective; availability of adequate psychometric literature and data involving rheumatology populations; and frequent use in both clinical and research practice with adult rheumatology populations. This study was not intended to be exhaustive. Clinicianadministered, semistructured depression interviews requiring specialized training such as the Hamilton Rating Scale for Depression and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition were not included. Additionally, measures without sufficient use within rheumatology populations, such as the World Health Organization Composite International Diagnostic Interview depression module and the National Institutes of Health Patient-Reported Outcomes Measurement Information System, were also not included in this review. Self-report measures that have been included in this review are as follows: Beck Depression Inventory-II, Center for Epidemiologic Studies Depression Scale, Geriatric Depression Scale, Hospital Anxiety and Depression Scale, and Patient Health Questionnaire-9. Some of these measures have become integrated into routine clinical practice (as screening tools) in large managed-care organizations, and these specifics have been included in this article. Included within each measure review are “additional references” that, while not cited within the review itself, may be of interest to the arthritis health professional who intends to use this instrument in their clinical practice or as part of a research study. As a general comment regarding any assessment of depression, while care was taken to include measures that require little training to administer and interpret, users without psychological background/experience in the management of clinical issues related to depression and crisis situations may need contingency plans for clinical supervision and/or referral sources. Any individual meeting or close to meeting the diagnostic criteria for depressive disorders needs appropriate management and/or referral, including being provided with referral options for different treatment approaches (pharmacologic and/or psychological). Additionally, suicide risk associated with depression must be taken seriously and promptly addressed. Clinicians should have existing plans to immediately deal with anyone who is an imminent danger to self or others (including mandated reporting). Researchers and clinicians ought to identify behavioral health experts (e.g., psychologists, psychiatrists, social workers) who can assist with appropriately handling these types of crisis situations should they be identified in the context of rheumatology clinical or research environments.
734 citations
TL;DR: Exercise compares favorably to antidepressant medications as a first-line treatment for mild to moderate depression and has also been shown to improve depressive symptoms when used as an adjunct to medications.
Abstract: Depression and anxiety are the most common psychiatric conditions seen in the general medical setting, affecting millions of individuals in the United States. The treatments for depression and anxiety are multiple and have varying degrees of effectiveness. Physical activity has been shown to be associated with decreased symptoms of depression and anxiety. Physical activity has been consistently shown to be associated with improved physical health, life satisfaction, cognitive functioning, and psychological well-being. Conversely, physical inactivity appears to be associated with the development of psychological disorders. Specific studies support the use of exercise as a treatment for depression. Exercise compares favorably to antidepressant medications as a first-line treatment for mild to moderate depression and has also been shown to improve depressive symptoms when used as an adjunct to medications. While not as extensively studied, exercise has been shown to be an effective and cost-efficient treatment alternative for a variety of anxiety disorders. While effective, exercise has not been shown to reduce anxiety to the level achieved by psychopharmaceuticals.
TL;DR: Collaborative depression care has been shown to be an effective way to deliver these treatments to large primary care populations with depression and chronic medical illness.
Abstract: There is a bidirectional relationship between depression and chronic medical disorders. The adverse health risk behaviors and psychobiological changes associated with depression increase the risk for chronic medical disorders, and biological changes and complications associated with chronic medical disorders may precipitate depressive episodes. Comorbid depression is associated with increased medical symptom burden, functional impairment, medical costs, poor adherence to self-care regimens, and increased risk of morbidity and mortality in patients with chronic medical disorders. Depression may worsen the course of medical disorders because of its effect on proinflammatory factors, hypothalamic-pituitary axis, autonomic nervous system, and metabolic factors, in addition to being associated with a higher risk of obesity, sedentary lifestyle, smoking, and poor adherence to medical regimens. Both evidence-based psychotherapies and antidepressant medication are efficacious treatments for depression. Collaborative depression care has been shown to be an effective way to deliver these treatments to large primary care populations with depression and chronic medical illness.
TL;DR: The CESD-R exhibited good psychometric properties, including high internal consistency, strong factor loadings, and theoretically consistent convergent and divergent validity with anxiety, schizotypy, and positive and negative affect.
Abstract: Depression has a huge societal impact, making accurate measurement paramount. While there are several available measures, the Center for Epidemiological Studies Depression Scale (CESD) is a popular assessment tool that has wide applicability in the general population. In order to reflect modern diagnostic criteria and improve upon psychometric limitations of its predecessor, the Center for Epidemiologic Studies Depression Scale--Revised (CESD-R) was recently created, but has yet to be publicized. This study explored psychometric properties of the CESD-R across a large community sample (N=7389) and smaller student sample (N=245). A newly proposed algorithmic classification method yielded base-rates of depression consistent with epidemiological results. Factor analysis suggested a unidimensional factor structure, but important utility for two separate symptom clusters. The CESD-R exhibited good psychometric properties, including high internal consistency, strong factor loadings, and theoretically consistent convergent and divergent validity with anxiety, schizotypy, and positive and negative affect. Results suggest the CESD-R is an accurate and valid measure of depression in the general population with advantages such as free distribution and an atheoretical basis.
TL;DR: Given the millions of youth, high school, collegiate, and professional athletes participating in contact sports that involve repetitive brain trauma, as well as military personnel exposed to repeated brain trauma from blast and other injuries in the military, CTE represents an important public health issue.
Abstract: Chronic traumatic encephalopathy (CTE) has been linked to participation in contact sports such as boxing and American football. CTE results in a progressive decline of memory and cognition, as well as depression, suicidal behavior, poor impulse control, aggressiveness, parkinsonism, and, eventually, dementia. In some individuals, it is associated with motor neuron disease, referred to as chronic traumatic encephalomyelopathy, which appears clinically similar to amyotrophic lateral sclerosis. Results of neuropathologic research has shown that CTE may be more common in former contact sports athletes than previously believed. It is believed that repetitive brain trauma, with or possibly without symptomatic concussion, is responsible for neurodegenerative changes highlighted by accumulations of hyperphosphorylated tau and TDP-43 proteins. Given the millions of youth, high school, collegiate, and professional athletes participating in contact sports that involve repetitive brain trauma, as well as military personnel exposed to repeated brain trauma from blast and other injuries in the military, CTE represents an important public health issue. Focused and intensive study of the risk factors and in vivo diagnosis of CTE will potentially allow for methods to prevent and treat these diseases. Research also will provide policy makers with the scientific knowledge to make appropriate guidelines regarding the prevention and treatment of brain trauma in all levels of athletic involvement as well as the military theater.
TL;DR: The review considers the literature on Major Depression beginning with a brief historical overview, its classification, and a synthesis of the current knowledge regarding prevalence and course and concludes that recovery may not be permanent and future episodes carry the threat of chronicity.
TL;DR: This review of recent research on prenatal depression suggests that it is a strong predictor of postpartum depression and is more common than post partum depression.
Abstract: This review of recent research on prenatal depression suggests that it is a strong predictor of postpartum depression and is more common than postpartum depression. Prenatal depression has been associated with excessive activity and growth delays in the fetus as well as prematurity, low birthweight, disorganized sleep and less responsiveness to stimulation in the neonate. Infants of depressed mothers have difficult temperament, and later in development attentional, emotional and behavioral problems have been noted during childhood and adolescence, as well as chronic illnesses in adulthood. Several variables have confounded the effects of prenatal depression including comorbid anxiety and anger as well as stressful life events. Potential mediating variables are low prenatal maternal dopamine and serotonin levels and elevated cortisol and norepinephrine. The associated intrauterine artery resistance may limit blood flow, oxygen and nutrients to the fetus. Some studies also suggest the heritability of developmental problems for the children of prenatally depressed mothers, including ADHD and antisocial behavior. Multivariate, longitudinal research is needed to disentangle these confounding and mediating variables.
TL;DR: It is shown that pain and depression have strong and similar effects on one another when assessed longitudinally over 12 months, and a change in severity of either symptom predicts subsequent severity of the other symptom.
TL;DR: The high prevalence and associated adverse health outcomes of late-life subthreshold depression indicate the major public health significance of this condition and suggest a need for further research on its neurobiology and treatment.
TL;DR: A meta-analysis of over 25 years of research into the relationship between post-myocardial infarction (MI) depression and cardiac prognosis was conducted to investigate changes in this association over time and to investigate subgroup effects.
TL;DR: Chronic post-SARS is characterized by persistent fatigue, diffuse myalgia, weakness, depression, and nonrestorative sleep with associated REM-related apneas/hypopneas, an elevated sleep EEG cyclical alternating pattern, and alpha EEG sleep anomaly.
Abstract: The long term adverse effects of Severe Acute Respiratory Syndrome (SARS), a viral disease, are poorly understood. Sleep physiology, somatic and mood symptoms of 22 Toronto subjects, 21 of whom were healthcare workers, (19 females, 3 males, mean age 46.29 yrs.+/- 11.02) who remained unable to return to their former occupation (mean 19.8 months, range: 13 to 36 months following SARS) were compared to 7 healthy female subjects. Because of their clinical similarities to patients with fibromyalgia syndrome (FMS) these post-SARS subjects were similarly compared to 21 drug free female patients, (mean age 42.4 +/- 11.8 yrs.) who fulfilled criteria for fibromyalgia. Chronic post-SARS is characterized by persistent fatigue, diffuse myalgia, weakness, depression, and nonrestorative sleep with associated REM-related apneas/hypopneas, an elevated sleep EEG cyclical alternating pattern, and alpha EEG sleep anomaly. Post- SARS patients had symptoms of pre and post-sleep fatigue and post sleep sleepiness that were similar to the symptoms of patients with FMS, and similar to symptoms of patients with chronic fatigue syndrome. Both post-SARS and FMS groups had sleep instability as indicated by the high sleep EEG cyclical alternating pattern rate. The post-SARS group had a lower rating of the alpha EEG sleep anomaly as compared to the FMS patients. The post-SARS group also reported less pre-sleep and post-sleep musculoskeletal pain symptoms. The clinical and sleep features of chronic post-SARS form a syndrome of chronic fatigue, pain, weakness, depression and sleep disturbance, which overlaps with the clinical and sleep features of FMS and chronic fatigue syndrome.
TL;DR: Deep brain stimulation remains a safe and effective treatment for treatment-resistant depression and functional impairment in the areas of physical health and social functioning progressively improved up to the last follow-up visit.
Abstract: Objective:A prevalence of at least 30% for treatment-resistant depression has prompted the investigation of alternative treatment strategies. Deep brain stimulation (DBS) is a promising targeted approach involving the bilateral placement of electrodes at specific neuroanatomical sites. Given the invasive and experimental nature of DBS for treatment-resistant depression, it is important to obtain both short-term and long-term effectiveness and safety data. This report represents an extended follow-up of 20 patients with treatment-resistant depression who received DBS to the subcallosal cingulate gyrus (Brodmann's area 25). Method:After an initial 12-month study of DBS, patients were seen annually and at a last follow-up visit to assess depression severity, functional outcomes, and adverse events. Results:The average response rates 1, 2, and 3 years after DBS implantation were 62.5%, 46.2%, and 75%, respectively. At the last follow-up visit (range=3–6 years), the average response rate was 64.3%. Functional ...
TL;DR: In this article, the authors examined the possibility that inflammatory processes may underlie this constellation of symptoms and found that women treated with chemotherapy endorsed higher levels of all symptoms and also had higher plasma levels of sTNF-RII than women who did not receive chemotherapy (all P <.05).
Abstract: Purpose Fatigue, depression, and sleep disturbance are common adverse effects of cancer treatment and frequently co-occur. However, the possibility that inflammatory processes may underlie this constellation of symptoms has not been examined. Patients and Methods Women (N = 103) who had recently finished primary treatment (ie, surgery, radiation, chemotherapy) for early-stage breast cancer completed self-report scales and provided blood samples for determination of plasma levels of inflammatory markers: soluble tumor necrosis factor (TNF) receptor II (sTNF-RII), interleukin-1 receptor antagonist, and C-reactive protein. Results Symptoms were elevated at the end of treatment; greater than 60% of participants reported clinically significant problems with fatigue and sleep, and 25% reported elevated depressive symptoms. Women treated with chemotherapy endorsed higher levels of all symptoms and also had higher plasma levels of sTNF-RII than women who did not receive chemotherapy (all P < .05). Fatigue was pos...
TL;DR: Decreasing depression symptoms over the first year were associated with longer subsequent survival for women with MBC in this sample, and causation cannot be assumed based on this analysis.
Abstract: Purpose Numerous studies have examined the comorbidity of depression with cancer, and some have indicated that depression may be associated with cancer progression or survival. However, few studies have assessed whether changes in depression symptoms are associated with survival. Methods In a secondary analysis of a randomized trial of supportive-expressive group therapy, 125 women with metastatic breast cancer (MBC) completed a depression symptom measure (Center for Epidemiologic Studies–Depression Scale [CES-D]) at baseline and were randomly assigned to a treatment group or to a control group that received educational materials. At baseline and three follow-up points, 101 of 125 women completed a depression symptom measure. We used these data in a Cox proportional hazards analysis to examine whether decreasing depression symptoms over the first year of the study (the length of the intervention) would be associated with longer survival.
TL;DR: Offspring of postnatally depressed mothers are at increased risk for depression by 16 years of age, partially explained by within child vulnerability established in infancy and the early years, and by exposure to family adversity.
Abstract: Objective The aim of this study was to determine the developmental risk pathway to depression by 16 years in offspring of postnatally depressed mothers. Method This was a prospective longitudinal study of offspring of postnatally depressed and nondepressed mothers; child and family assessments were made from infancy to 16 years. A total of 702 mothers were screened, and probable cases interviewed. In all, 58 depressed mothers (95% of identified cases) and 42 nondepressed controls were recruited. A total of 93% were assessed through to 16-year follow-up. The main study outcome was offspring lifetime clinical depression (major depression episode and dysthymia) by 16 years, assessed via interview at 8, 13, and 16 years. It was analysed in relation to postnatal depression, repeated measures of child vulnerability (insecure infant attachment and lower childhood resilience), and family adversity. Results Children of index mothers were more likely than controls to experience depression by 16 years (41.5% versus 12.5%; odds ratio=4.99; 95% confidence interval=1.68–14.70). Lower childhood resilience predicted adolescent depression, and insecure infant attachment influenced adolescent depression via lower resilience (model R 2 = 31%). Family adversity added further to offspring risk (expanded model R 2 = 43%). Conclusions Offspring of postnatally depressed mothers are at increased risk for depression by 16 years of age. This may be partially explained by within child vulnerability established in infancy and the early years, and by exposure to family adversity. Routine screening for postnatal depression, and parenting support for postnatally depressed mothers, might reduce offspring developmental risks for clinical depression in childhood and adolescence.
TL;DR: Health Interview Survey and Health Examination Survey have been used to assess the frequency of CWP in the general population, and both techniques are poorly standardised, which hampers comparison of data pertaining to different populations and countries.
Abstract: Chronic widespread pain (CWP) due to musculoskeletal conditions is a major social burden. The case definition of CWP relies on pain, chronicity (more than 3 months' duration) and widespread distribution (both sides of the body including the axial skeleton). Health Interview Survey (HIS) and Health Examination Survey (HES) have been used to assess the frequency of CWP in the general population. Unfortunately, both techniques are poorly standardised, which hampers comparison of data pertaining to different populations and countries. A major effort in the European Union (EU) is the development of common strategies to investigate musculoskeletal pain through HIS. Issues to be addressed include: (1) loss of daily life functions due to pain; (2) pain duration and rhythm; (3) affected sites; and (4) type of pain. We know that musculoskeletal pain affects between 13.5% and 47% of the general population, with CWP prevalence varying between 11.4% and 24%. Risk factors for musculoskeletal pain include age, gender, smoking, low education, low physical activity, poor social interaction, low family income, depression, anxiety and sleep disorders, as well as performing manual work, being a recent immigrant, non-Caucasian and widowed, separated or divorced.
TL;DR: The presented evidence suggests that exercise and physical activity have beneficial effects on depression symptoms that are comparable to those of antidepressant treatments.
Abstract: Depression is a very prevalent mental disorder affecting 340 million people globally and is projected to become the leading cause of disability and the second leading contributor to the global burden of disease by the year 2020. In this paper, we review the evidence published to date in order to determine whether exercise and physical activity can be used as therapeutic means for acute and chronic depression. Topics covered include the definition, classification criteria and treatment of depression, the link between β-endorphin and exercise, the efficacy of exercise and physical activity as treatments for depression, properties of exercise stimuli used in intervention programs, as well as the efficacy of exercise and physical activity for treating depression in diseased individuals. The presented evidence suggests that exercise and physical activity have beneficial effects on depression symptoms that are comparable to those of antidepressant treatments.
TL;DR: Although combat-related PTSD was strongly associated with postconcussive symptoms and psychosocial outcomes 1 year after soldiers returned from Iraq, there was little evidence of a long-term negative impact of concussion/MTBI history on these outcomes after accounting for PTSD.
Abstract: Context Troops deployed to Iraq and Afghanistan are at high risk for exposure to combat events resulting in mild traumatic brain injury (MTBI) or concussion and posttraumatic stress disorder (PTSD). The longer-term impact of combat-related concussion/MTBI and comorbid PTSD on troops' health and well-being is unknown. Objective To assess longitudinal associations between concussion/MTBI and PTSD symptoms reported in theater and longer-term psychosocial outcomes in combat-deployed National Guard soldiers. Design Longitudinal cohort study. Participants were surveyed in Iraq 1 month before returning home (time 1) and 1 year later (time 2). Self-reports of concussion/MTBI and PTSD were assessed at times 1 and 2. Based on time 1 concussion/MTBI status (defined as an injury during deployment with loss of consciousness or altered mental status) and time 2 postdeployment probable PTSD status, soldiers were compared on a range of time 2 psychosocial outcomes. Participants Nine hundred fifty-three US National Guard soldiers. Setting The time 1 sample was assessed during redeployment transition briefings held at military installations in the Iraq combat theater. The time 2 sample was assessed using mailed surveys sent to the homes of US National Guard service members. Main Outcome Measures Postconcussive, depression, and physical symptoms; alcohol use; social functioning; and quality of life assessed at time 2 using valid clinical instruments. Results The rate of self-reported concussion/MTBI during deployment was 9.2% at time 1 and 22.0% at time 2. Soldiers with a history of concussion/MTBI were more likely than those without to report postdeployment postconcussive symptoms and poorer psychosocial outcomes. However, after adjusting for PTSD symptoms, concussion/MTBI was not associated with postdeployment symptoms or outcomes. Time 1 PTSD symptoms more strongly predicted postdeployment symptoms and outcomes than did concussion/MTBI history. Conclusions Although combat-related PTSD was strongly associated with postconcussive symptoms and psychosocial outcomes 1 year after soldiers returned from Iraq, there was little evidence of a long-term negative impact of concussion/MTBI history on these outcomes after accounting for PTSD. These findings and the 2-fold increase in reports of deployment-related concussion/MTBI history have important implications for screening and treatment.
Journal Article•
TL;DR: There was no variation in antidepressant use by income group, but males were more likely than females to have seen a mental health professional in the past year and there was no significant difference in length of use between males and females.
Abstract: In 2005–2008, 11% of Americans aged 12 and over took antidepressant medication. There were significant differences in antidepressant medication usage rates between groups. Females were 2½ times as likely as males to take antidepressants. Antidepressant use was higher in persons aged 40 and over than in those aged 12–39. Non-Hispanic white persons were more likely to take antidepressants than other race and ethnicity groups. Other studies have shown similar age, gender, and race and ethnicity patterns (2,3). There was no variation in antidepressant use by income group. Among persons taking antidepressants overall, there was no significant difference in length of use between males and females. Among persons taking antidepressants, males were more likely than females to have seen a mental health professional in the past year. About 8% of persons aged 12 and over with no current depressive symptoms took antidepressant medication. This group may include persons taking antidepressants for reasons other than depression and persons taking antidepressants for depression who are being treated successfully and do not currently have depressive symptoms.Slightly over one-third of persons aged 12 and over with current severe depressive symptoms were taking antidepressants. According to American Psychiatric Association guidelines, medications are the preferred treatment for moderate to severe depressive symptomatology (4). The public health importance of increasing treatment rates for depression is reflected in Healthy People 2020, which includes national objectives to increase treatment for depression in adults and treatment for mental health problems in children (5).
TL;DR: Their differential course trajectory justifies separate consideration of pure depression, pure anxiety and comorbid anxiety-depression in clinical practice and psychiatric nosology.
Journal Article•
TL;DR: This report summarizes data from selected CDC surveillance systems that measure the prevalence and impact of mental illness in the U.S. adult population and recommends that national and state-level mental illness surveillance should measure a wider range of psychiatric conditions and should include anxiety disorders.
Abstract: Mental illnesses account for a larger proportion of disability in developed countries than any other group of illnesses, including cancer and heart disease. In 2004, an estimated 25% of adults in the United States reported having a mental illness in the previous year. The economic cost of mental illness in the United States is substantial, approximately $300 billion in 2002. Population surveys and surveys of health-care use measure the occurrence of mental illness, associated risk behaviors (e.g., alcohol and drug abuse) and chronic conditions, and use of mental health-related care and clinical services. Population-based surveys and surveillance systems provide much of the evidence needed to guide effective mental health promotion, mental illness prevention, and treatment programs. This report summarizes data from selected CDC surveillance systems that measure the prevalence and impact of mental illness in the U.S. adult population. CDC surveillance systems provide several types of mental health information: estimates of the prevalence of diagnosed mental illness from self-report or recorded diagnosis, estimates of the prevalence of symptoms associated with mental illness, and estimates of the impact of mental illness on health and well-being. Data from the CDC 2005-2008 National Health and Nutrition Examination Survey indicate that 6.8% of adults had moderate to severe depression in the 2 weeks before completing the survey. State-specific data from the CDC 2006 Behavioral Risk Factor Surveillance System (BRFSS), the most recent BRFSS data available, indicate that the prevalence of moderate to severe depression was generally higher in southeastern states compared with other states. Two other CDC surveys on ambulatory care services, the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, indicate that during 2007-2008, approximately 5% of ambulatory care visits involved patients with a diagnosis of a mental health disorder, and most of these were classified as depression, psychoses, or anxiety disorders. Future surveillance should pay particular attention to changes in the prevalence of depression both nationwide and at the state and county levels. In addition, national and state-level mental illness surveillance should measure a wider range of psychiatric conditions and should include anxiety disorders. Many mental illnesses can be managed successfully, and increasing access to and use of mental health treatment services could substantially reduce the associated morbidity.