Adolescent dissociation and alexithymia are distinctive but overlapping phenomena

Findings on the association between dissociation and alexithymia in adult populations are inconsistent. Dissociation has also been related to other types of psychopathology. Few studies have been published on these connections among adolescents. We examined the association between Adolescent Dissociative Experiences Scale (A-DES) scores and those for the Toronto Alexithymia Scale (TAS), the 21-item Beck Depression Inventory (BDI-21) and the Youth Self-Report (YSR), as well as subscales of the TAS and the YSR, in a sample of Finnish adolescents aged 13 to 18 years (n=4019). Factor analysis suggested that dissociation can be considered distinctive from other psychopathology. A-DES scores, however, associated strongly with several other scales and subscales measuring psychiatric symptoms. In logistic regression models the strongest associations were observable between the A-DES and TAS subscale 'difficulty identifying feelings' (DIF) and the YSR subscale 'thought problems'. Thus, dissociation and alexithymia can be considered distinctive but overlapping phenomena.

Is alexithymia a risk factor for major depression, personality disorder, or alcohol use disorders? A prospective population-based study

OBJECTIVE

Disagreements concerning the stability of alexithymia and its ability to predict subsequent psychiatric disorders prevail. The aim of this 7-year follow-up study was to examine whether alexithymia predicts subsequent major depression, personality disorder, or alcohol use disorders in a population-based sample.

METHODS

The four-phase Kuopio Depression Study (KUDEP) was conducted in the eastern part of Central Finland. The study population (aged 25-64, n=2050) was randomly selected from the National Population Register. Data were collected in 1998, 1999, and 2001. In 2005, a subsample (n=333, 43 were excluded) of the 3-year follow-up population (1998-2001) was gathered and their diagnoses of mental disorders were confirmed by the Structure Clinical Interview for DSM-IV Axis I (SCID-I). Alexithymia was measured using the Toronto Alexithymia Scale (TAS-20) and depressive symptoms using the Beck Depression Inventory (BDI-21). For both of these measures, two groups were formed based on the median of their sum score (summing the 1998, 1999, and 2001 scores). Logistic regression analyses were performed.

RESULTS

BDI sum scores, but not those of TAS, were associated with subsequent major depressive disorder, personality disorder, and alcohol use disorders in 2005. The BDI sum scores explained 35.7% of the variation in concurrent TAS sum scores.

CONCLUSION

Alexithymia did not predict diagnoses of major depressive disorder, personality disorder, or alcohol use disorders. Alexithymia was closely linked to concurrent depressive symptoms. Thus, depressive symptoms may act as a mediator between alexithymia and psychiatric morbidity.

Serum adiponectin and resistin levels in major depressive disorder

OBJECTIVE

To examine the role of the adipose-tissue-derived low-grade inflammation markers adiponectin and resistin in major depressive disorder (MDD) in a population-based sample.

METHOD

Serum levels of adiponectin and resistin were measured from 70 DSM-IV MDD subjects and 70 healthy controls. Depression severity was assessed with the 29-item Hamilton Depression Rating Scale.

RESULTS

The MDD group had lowered serum adiponectin levels. Regression modelling with adjustments for age, gender, overweight, several socioeconomic and lifestyle factors, coronary heart disease and metabolic syndrome showed that each 5.0 microg/ml decrease in serum adiponectin increased the likelihood of MDD by approximately 20% (P = 0.01). The resistin levels correlated with atypical (P = 0.02), but not with typical depressive symptoms (P = 0.12).

CONCLUSION

Our findings suggest that the lowered adiponectin levels in MDD are depression-specific and not explained by conventional low adiponectin-related factors such as such as coronary heart disease and metabolic disorders.

Serum chemokine levels in major depressive disorder

OBJECTIVE

To examine the role of chemokines of two major chemokine families, CC and CXC, in major depressive disorder (MDD) in a population-based sample.

METHOD

The serum levels of CC chemokines MCP-1 and MIP-1beta, and CXC chemokine IL-8 were measured from 122 participants (MDD group, n=61; controls, n=61). Depression severity was assessed with the 29-item Hamilton Depression Rating Scale.

RESULTS

The MDD group had lower levels of MCP-1, MIP-1beta and IL-8 than the healthy controls. The likelihood of major depressive disorder for participants with chemokine levels below the median (MCP-1: < 26.26 pg/mL; MIP-1beta: < 42.57 pg/mL; IL-8: < 2.86 pg/mL) was 3.6 (p=0.002) for MIP-1beta and 2.4 (p=0.037) for IL-8 in regression models adjusted for age, gender, body mass index, smoking, and alcohol consumption. MCP-1 did not associate with the presence of MDD after adjustments for potential confounders. Further adjustments for somatic illnesses or medications did not affect these findings.

CONCLUSION

Our findings suggest that depression-related alterations of inflammatory markers may be more complex than previously assumed, and that at least some of the chemokines may be down-regulated.

Unemployment and ill health: a connection through inflammation?

Background

Unemployment is a source of acute and long-term psychosocial stress. Acute and chronic psychosocial stress can induce pronounced changes in human immune responses. In this study we tested our hypothesis that stress-induced low-grade tissue inflammation is more prevalent among the unemployed.

Methods

We determined the inflammatory status of 225 general population subjects below the general retirement age (65 years in Finland). Those who had levels of both interleukin-6 (≥ 0.97 pg/mL) and high-sensitivity C-reactive protein (≥ 1.49 mg/L) above the median were assessed to have an elevated inflammatory status (n = 72).

Results

An elevated inflammatory status was more common among the unemployed than among other study participants (59% versus 30%, p = 0.011). In the final multivariate model, those who were unemployed had over five-fold greater odds for having an elevated inflammatory status (OR 5.20, 95% CI 1.55-17.43, p = 0.008).

Conclusion

This preliminary finding suggests that stress-induced low-grade inflammation might be a link between unemployment and ill health.

Association of depressive symptoms and metabolic syndrome in men

OBJECTIVE

To explore the relationship between several indicators of depression and metabolic syndrome (MetS).

METHOD

A population-based sample with high (HMS group) or low (LMS group) levels of mental symptoms, including those of depression, in three follow-ups participated in a clinical examination in 2005 (n = 223). MetS was determined according to the NCEP criteria.

RESULTS

The prevalence of MetS was 49% in men and 21% in women. Men with MetS had higher rates of major depressive disorder than other men. They also displayed higher Hamilton Rating Scale for Depression (HDRS) scores and more often signs of suicidality. In logistic regression analyses, higher HDRS scores (OR 1.31, 95% CI 1.04-1.64) and belonging to the HMS group (OR 10.1, 95% CI 1.98-51.3) were independent associates for MetS but only in men.

CONCLUSION

The results highlight that there is an association between long-term depressive symptoms and the emergence of MetS, especially in men.

The prevalence of alexithymia and its relationship with Youth Self-Report problem scales among Finnish adolescents

This study investigated the relationship between alexithymia, depressive symptoms, and Youth Self-Report (YSR) self-image profiles among 13 to 18-year-old adolescents (n = 7087) attending school in Kuopio, Finland. The final sample consisted of 3936 adolescents (1801 boys, 2135 girls) who completed structured self-rating questionnaires (Toronto Alexithymia Scale [TAS] 20, Beck Depression Inventory [BDI], and YSR) during class periods at school. The overall prevalence of alexithymia was 7.3%. However, girls in all age groups were more frequently alexithymic than boys. Regardless of sex, alexithymic youths reported more depressive symptoms as well as internalizing and externalizing problems than the others. A YSR total score of more than 70 was recorded among 33.4% of alexithymic compared with 3.7% of nonalexithymic adolescents. The TAS-20 correlated significantly with the BDI score, YSR total score, and with internalizing problems. This study revealed alexithymia among adolescents to be associated with various complications such as depressive symptoms, high scores in YSR problem scales, and difficulties in social relationships. Our findings indicate that these adolescents are at high risk of mental disorders and require treatment interventions.

Hypogonadism, decreased sexual desire, and long-term depression in middle-aged men

INTRODUCTION

In middle-aged men, the associations between long-term depressive symptoms and circulating testosterone levels are poorly known, although it is known that testosterone levels decrease with age.

METHODS

A health questionnaire was mailed to a population-based sample from the National Population Register in 1998, 1999, and 2001. Based on their self-reported mental symptoms, a total of 116 men were selected for clinical examination in 2005. Half of them had high and the others low levels of adverse mental symptoms in all three previous follow-ups. A structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders-IV was performed. Depressive symptoms were assessed with the Beck Depression Inventory (BDI) and the Hamilton Depression Rating Scale (HDRS). The Aging Males' Symptoms scale was also compiled and testosterone levels were determined.

RESULTS

In the entire study sample, serum free testosterone levels correlated negatively with both BDI and HDRS scores. In the hypogonadism group (based on free testosterone, 19.8% of the sample), clinically significant depression (BDI score > or = 13) was more than three times as frequent as in the other men (34.8% vs. 10.4%), the odds ratio after multiple adjustments being 4.98 (95% confidence interval 1.66-14.95). A decrease in sexual desire was common in hypogonadism (36%). Nevertheless, it also associated with clinically significant depression, irrespective of free testosterone levels.

DISCUSSION

Long-term and current depressive symptoms, a decreased sexual desire, and low serum free testosterone levels are associated in middle-aged men. Hypogonadism per se and as a cause of decreased sexual desire may be a contributory and possibly treatable factor underlying male depression.

CONCLUSIONS

The findings highlight the need for hormonal status assessment in middle-aged depressive men.

Mental health and well-being in a 6-year follow-up of patients with depression: assessments of patients and clinicians

BACKGROUND

Psychiatric patients have the right to strive for well-being and not only be confined to symptom reduction. Studies are needed to assess global well-being during recovery from depression by comparing the assessments of patients and clinicians.

METHOD

A 6-year natural follow-up of 185 depressive out-patients was carried out with health questionnaires at baseline, 0.5, 1, 2 and 6 years, including scales on depression (BDI, HDRS), general psychopathology (SCL), functional capacity (GAF, SOFAS) and life satisfaction (LS). A structured diagnostic interview was carried out at baseline, 2 and 6 years. Complete follow-up data were obtained from 121 patients.

RESULTS

In general, depressive patients mainly attained a normal mood, adequate functional capacity and life satisfaction. Those with a slow recovery improved with successive treatment contacts, eventually reaching levels of mental health not significantly different from the others. Throughout the follow-up, recovery was similarly shown with the self-reported BDI-21, SCL-90 and LS-4, while intercorrelations between clinician ratings were low at baseline.

CONCLUSIONS

Adequate mental health and global well-being can be reached among depressive patients, but it may take time in treatment. Subjective assessments are reliable. The 4-item life satisfaction scale is a global well-being indicator and a valid treatment outcome measure.

Temporal cortex dopamine D2/3 receptor binding in major depression

The aim of this study was to assess the dopamine function of the temporal cortex in major depressive disorder using [(123)I]epidepride to image D(2/3) receptor binding sites. Ten major depressives and 10 healthy controls were selected from a general population sample for single-photon emission computed tomography imaging. Among the major depressives there was a strong bilateral correlation between the scores on the 21-item Hamilton Depression Rating Scale and D(2/3) receptor binding. Dopaminergic abnormalities may be present in the temporal cortices of major depressives.

The course of dissociation in the general population: a 3-year follow-up study

OBJECTIVE

There have been no previous general population studies on the stability of dissociative symptoms. The aim of this study was to examine the course of and the changes in dissociative symptoms and factors associated with these changes during a 3-year follow-up of a Finnish general population sample.

METHODS

The general population sample included a cohort of 1497 subjects. Dissociative symptoms were assessed with the Dissociative Experiences Scale (DES) and the DES-taxon (DES-T). Depressive symptoms and suicidal ideation were measured with the Beck Depression Inventory (BDI). The sample was categorized into low dissociators with DES scores less than 20 and high dissociators with DES scores of 20 or more.

RESULTS

At baseline, 98 subjects were high dissociators. On follow-up, 28 of them were still high dissociators, whereas among 70 subjects, the DES score declined below the cutoff score. During the follow-up period, 28 of 1399 subjects became new high dissociators, and constantly low dissociators consisted of 1371 of 1399 subjects. Dissociative taxon membership was detected in 39 subjects either at baseline or at follow-up, but only 4 of them met the criteria at both assessments. Stable high dissociation was associated with an increase in the BDI score on follow-up, baseline suicidal ideation, a younger age, a reduced working ability, and smoking. Risk factors for becoming a new high dissociator were an increase in the BDI score, a younger age at baseline, and a reduced working ability. Among the baseline high dissociators, recovery from high dissociation was associated with a decline in the BDI score at follow-up and with no suicidal thoughts, older age, and a good working ability at baseline.

CONCLUSIONS

Only a small proportion of the general population had constantly high levels of dissociative symptoms. The stability of dissociative taxon membership was weaker than the stability of the continuous variables of dissociation. The dissociative experiences had a tendency to change, and these changes were associated with changes in the BDI scores. Further studies are needed to reveal the factors associated with the changes in dissociative symptoms.

Partial remission indicates poor functioning and a high level of psychiatric symptoms: a 3-phase 6-year follow-up study on major depression

Patients with depression in partial remission are at high risk of relapse, but factors associated with being in this outcome group are not well known. We conducted a clinical survey to examine the course of major depression in 87 patients during a follow-up period of 6 years. Beck Depression Inventory (BDI) scores indicated the outcome of depression, i.e. remission, partial remission or fully symptomatic, at 6, 12 and 24 months and after 6 years. The prevalence of partial remission varied from 16% to 23% at different follow-ups. All symptom and functioning scale scores indicated at every assessment that the partial depression group managed better than those in the fully symptomatic group, but worse than those in remission. Partial remission was associated with a significant impairment in psychosocial functioning and a high level of symptoms throughout the follow-up. The partial remission group must be recognized and actively treated.

Health-related quality of life in a population-based sample of men with long-term mental symptoms

It is not known whether somatic factors related to overall health and lifestyles or psychological factors, including confirmed psychiatric diagnoses, are associated with the health-related quality of life (HRQL) of men in a population-based sample. The aim of this study was to investigate socio-demographic, somatic and psychological factors associated with HRQL in men having mental symptoms during the 7 previous years. This cross-sectional sample of men (n=63) was investigated in 2004-05 and was based on a previous three-phase follow-up study that began in 1998. Blood pressure, body mass index, waist circumference, serum lipids and testosterone levels were measured. Psychiatric diagnoses were confirmed with using the Structured Clinical Interview for DSM-IV. Several mental symptoms were assessed with standardized scales. HRQL was measured with the RAND-36 using the physical (PCS) and mental component summary (MCS) scores. A poor HRQL in PCS was found in 73% of men and in MCS in 54%. Depressive symptoms, life dissatisfaction, male symptoms of aging and alexithymia were associated with both impaired PCS and MCS scores. Hopelessness, lifetime and current diagnoses of major depressive disorder and signs of suicidality only associated with a poorer MCS score. Somatic factors describing lifestyles and overall health only weakly associated with HRQL. In general, HRQL was poor in men having long-term mental symptoms. Mental health factors were strongly associated with PCS and MCS scores of HRQL. In improving HRQL in men, both physical and mental domains should be targeted in preventive and curative strategies.

Dissociation in a general population of Finnish adolescents

Only a few studies have been published concerning dissociation in general population adolescents. We assessed dissociation using the Adolescent Dissociative Experiences Scale (A-DES) in a sample of Finnish adolescents aged 13 to 18 years (n = 4019). The A-DES had good internal reliability and factor analysis suggested a 1-factor solution to be optimal. The younger participants had somewhat higher A-DES scores, but there were no differences between the genders. The mean A-DES score of 0.88 in the whole sample was lower than that in previous studies in other countries. A high level of dissociation was associated with an age of 15 or less, daily smoking, frequent use of alcohol, abuse of legal drugs, cannabis use, social isolation, and poor school performance in mathematics.

Common-sense descriptions of depression as social representations

BACKGROUND

Major depression is such a prevalent illness worldwide that practically everyone has either direct or indirect experience of it. It is important, then, from both practical and theoretical points of view, to examine this particular experience and related conceptions.

AIM

Drawing on the theory of social representations, this research set out to examine the ways in which people define depression in terms of the symptoms they attribute to people they know personally and consider to suffer from depression.

METHOD

A group of adult participants (n = 117) were instructed to think of an individual whom they knew personally and considered to suffer from depression, to indicate the age and gender of the person, and to describe his/her symptoms.

RESULTS

A great majority of the female participants thought of a female, while the male participants thought of male and female target persons quite evenly. The symptoms attributed to depression with fair unanimity included fatigue and decreased capacity to work, to concentrate, to make decisions and to take part in hobbies. The descriptions of the depressive person were quite unanimously distinguished from the signal symptoms attaching to schizophrenia. The descriptions varied according to the characteristics of the target individuals, and their gender and age in particular, rather than the characteristics of the participants.

CONCLUSION

People have perceptive personal experiences of depression, which are guided by socially shared interpretative frameworks.

Which factors are important predictors of non-recovery from major depression? A 2-year prospective observational study

Our aim was to study factors associated with long-term non-recovery from major depression. A total of 109 patients with major depression were followed prospectively for 2 years. A diagnosis of major depression based on SCID interviews at follow-up indicated non-recovery. The effect of several established risk factors was assessed. A third (30%) of the patients did not recover. Severity of initial depression were associated with poor outcome according to univariate analysis. Nevertheless, personality disorder and rural area of residence were associated with non-recovery in final multivariate analysis. Major depression in patients with personality disorder should be treated as effectively as possible. Moreover, service planning in rural areas needs attention.

Recovery from depression: a two-year follow-up study of general population subjects

BACKGROUND

The recovery from depression and factors associated with it are not well known in the general population.

AIMS

To conduct a two-year follow-up of general population subjects and investigate their recovery from depression.

METHODS

Individuals who were assessed as suffering from depression on the basis of Beck Depression Inventory (BDI) scores were monitored for two years.

RESULTS

Sixty-five per cent were still depressed after two years of follow-up. Negative life events had occurred more often in those who had remained depressed than in the others. Logistic regression analysis revealed that a high initial BDI score and a worsening of a subject's economic situation during the follow-up period were associated with failure to recover. Lack of use of health services was associated with non-recovery.

CONCLUSION

Depression may be more chronic in the general population than previously has been thought.

The relationship between psychological and somatoform dissociation in the general population

We assessed psychological and somatoform dissociation and their relationships in the general population. The study questionnaires included the Dissociative Experiences Scale, the Somatoform Dissociation Questionnaire, the Beck Depression Inventory, and background characteristics. Four study groups were formed: subjects with low dissociation scores (N = 1334), with high psychological dissociation (N = 93), with high somatoform dissociation (N = 93), and with high psychological and somatoform dissociation (N = 65). Those with high psychological and somatoform dissociation differed clearly from the other groups. They had depressive symptoms, suicidal ideation, a reduced working ability, a poor financial situation, poor general health, and inadequate social support more frequently than subjects in the other groups. Thus, a considerable amount of ill health was recorded in this group.

Alexithymia after traumatic brain injury: its relation to magnetic resonance imaging findings and psychiatric disorders

OBJECTIVE

People with traumatic brain injury (TBI) were studied to assess the prevalence of alexithymia and its relationship to magnetic resonance imaging (MRI) findings and psychiatric disorders.

METHODS

Fifty-four participants, 67% men, were evaluated after a median of 30 years since TBI. A control group was matched for age, gender, and severity of depression. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20). In patients with TBI, axis I psychiatric disorders were assessed with the Schedules for Clinical Assessment in Neuropsychiatry (SCAN, version 2.1), and axis II disorders with the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). MRI examinations were carried out with a 1.5 T MRI scanner.

RESULTS

Alexithymia was significantly more common in patients with TBI than in controls (31.5% versus 14.8%; odds ratio 2.64, 95% confidence interval 1.03-6.80). None of the variables representing TBI, ie, severity of TBI or the presence, laterality, or location of contusions on MRI, was associated with the TAS-20 total scores. Several current axis I and II psychiatric disorders, particularly organic personality syndrome, were connected to higher TAS-20 scores.

CONCLUSION

Alexithymia is common, along with psychiatric disorders, in patients with TBI. Both of them may reflect dysfunction of the injured brain. In clinical practice, alexithymic features should be taken into consideration in psychosocial rehabilitation after TBI.

Adverse childhood experiences, stressful life events or demographic factors: which are important in women's depression? A 2-year follow-up population study

OBJECTIVE

The aim of this study was to simultaneously test adverse background factors, namely adverse childhood experiences (ACEs), stressful life events and prior depressive symptoms, for their ability to predict recovery and non-recovery from depression in women among the general population.

METHOD

A stratified random sample of women (n = 835) from the general population was collected at baseline in 1999. Depression (Beck Depression Inventory, BDI-21), ACEs and background factors were assessed by postal questionnaire at baseline. Two years later, stressful life events during the study phase, social support, use of health services and current depression (BDI > or = 13) were similarly assessed.

RESULTS

Adverse childhood experiences were common among depressed women and these past experiences together with the use of health services were associated with recovery from depression. Financial difficulties and a poor subjective health status associated with non-recovery and current stressful life events increased the likelihood of depression on follow-up. Furthermore, the important variables explaining depression on follow-up were the quality of social support and the existence of prior depressive symptoms at baseline.

CONCLUSIONS

Our results suggest that women's current depression especially associates with stressful life events, insufficient social support, poor subjective health and financial difficulties. It seems possible that past adverse experiences predispose women to depression, but current stressful events actualize these symptoms. In addition, use of health services are associated with recovery in women who had ACEs.

Factors associated with pathological dissociation in the general population

OBJECTIVE

This study assessed the prevalence of pathological dissociation in the general population, and the relationship between pathological dissociation and sociodemographic and several psychiatric variables.

METHOD

The stratified population sample consisted of 2001 subjects. The study questionnaires included the Dissociative Experiences Scale, the Dissociative Experiences Scale-Taxon, the Toronto Alexithymia Scale, the Beck Depression Inventory, and sociodemographic background.

RESULTS

The prevalence of pathological dissociation (DES-T >/= 20) was 3.4% in the general population and did not differ significantly between genders. Men scored higher than women in the amnesia subscale, and women in the absorption and imaginative involvement subscale. The relationship between pathological dissociation, alexithymia, depression and suicidality was strong. The likelihood of pathological dissociation was nearly nine-fold higher among depressive subjects, more than seven-fold higher among alexithymic subjects, and more than four-fold higher among suicidal subjects than among the others. Frequent alcohol consumption also associated significantly with pathological dissociation.

CONCLUSIONS

A significant relationship between pathological dissociation, depression, alexithymia, and suicidality was found in the general population. The importance of these factors should be examined in a prospective study design to determine causality.

Daily tea drinking is associated with a low level of depressive symptoms in the Finnish general population

Tea drinking has been suggested to be beneficial in neurodegenerative diseases where depressive mood is a common symptom. Nevertheless, it is not known whether there are any associations between tea drinking and depression in general populations. In this study we investigated these associations in a sample of the Finnish general population (n = 2011) using a postal questionnaire and the Beck Depression Inventory (BDI). Those who reported drinking tea daily were less depressed than the others. They had a lower mean BDI score and also a lower prevalence of depression. None of those whose daily tea intake was five cups or more had depression. Several potential confounding factors were included in the final sex- and age-adjusted multivariate logistic regression model which suggested that those who drink tea daily may have a significantly reduced risk of being depressed (adjusted odds ratio 0.47, 95% confidence interval 0.27-0.83). In conclusion, an inverse relationship between daily tea drinking and the risk of being depressed was found in a relatively large general population sample. Nevertheless, the underlying mechanisms are unresolved and further studies are needed.

Suicidal ideation among help-seeking adolescents: association with a negative self-image

Self-image and factors associated with suicidal ideation were studied among adolescents (N=168, age 17.7+/-2.3 years, 72% girls) seeking psychiatric assessment. The Structured Clinical Interview, Beck Depression Inventory and Offer Self-Image Questionnaire were used. Suicidal ideation (SI) was reported by 64% of subjects, of whom 20% received no psychiatric diagnosis and 58% had depressive disorders. SI in boys associated with being bullied at school and talking about one's problems only with friends, and in girls with a negative attitude towards the future and a negative self-image of one's own mental health. Because suicidal ideation frequently occurs without formal psychiatric diagnosis it should be assessed separately. Special attention should be paid to adolescents' negative self-perception.

Alexithymia and suicidal ideation: a 12-month follow-up study in a general population

Alexithymic features are often associated with depression, which is the most important risk factor for suicidal behaviors. Nevertheless, little is known about the associations between alexithymia and suicidality. In this 12-month follow-up study we investigated the relationship between alexithymia and suicidal ideation in a sample of the general population (N = 1,563) using the 20-item Toronto Alexithymia Scale (TAS-20) and the 21-item Beck Depression Inventory (BDI). Suicidal ideation was more common among subjects with alexithymia than among nonalexithymic subjects (32% v 9% at baseline and 36% v 9% after 12 months). In cross-sectional analyses, alexithymia associated with the presence of suicidal ideation even after adjustment for sex, age, and several psychosocial and socioeconomic factors and the presence of depression. Moreover, after adjustment for depression at baseline, the decrease and increase in alexithymic features during the study period associated independently with recovery from and the occurrence of suicidal ideation, respectively. Nevertheless, these associations were no longer independent when adjusted for concomitant changes in the level of depressive symptoms. In conclusion, if depression presents alexithymic features the subject has an additive impact on the risk of suicidal ideation.

Do stressful life-events or sociodemographic variables associate with depression and alexithymia among a general population?--A 3-year follow-up study

This 3-year follow-up study examined background factors, stressful life-events, and changes in alexithymia and depression scores in four groups of subjects from a general population (N = 1,339): alexithymic (A), depressed (D), simultaneously alexithymic/depressed (AD), and non-alexithymic/non-depressed (O). Alexithymia was assessed using the 20-item version of the Toronto Alexithymia Scale (TAS) and depression using the 21-item Beck Depression Inventory (BDI). A questionnaire screening sociodemography and stressful life-events was also used. The results showed that alexithymia was associated with male gender and blue-collar working, whereas depressive symptoms associated with female gender, older age, poor subjective health, poor financial situation, and low life satisfaction. During the follow-up the sum of stressful life-events was higher among groups AD and D than in groups A and O. The most common stressful life-events were the death of a close relative or friend, a negative change in the health of a family member, and financial problems. The TAS scores decreased only in groups A and AD. The BDI scores decreased in group AD but remained relatively unchanged in group D. Interestingly, if only those without depressive symptoms are considered, alexithymia appears to be a rarer phenomenon than has been reported previously. Furthermore, it seems that depressive symptoms were chronic and long-lasting among the general population.

Relationships among alexithymia, adverse childhood experiences, sociodemographic variables, and actual mood disorder: a 2-year clinical follow-up study of patients with major depressive disorder

This 2-year follow-up study examined relationships among alexithymia, adverse childhood experiences, sociodemographic variables, and actual mood disorder among patients with major depressive disorder (N=106). Alexithymia was assessed with the Toronto Alexithymia Scale (TAS-20), depression with the Beck Depression Inventory, and actual mood disorder with the Structured Clinical Interview for DSM-III-R. A questionnaire that assessed sociodemographic characteristics and adverse childhood experiences was also used. Long-lasting alexithymic features were associated with blue-collar work, harsh discipline, unhappiness of the childhood home, depression at 12 months, and major depressive disorder diagnosis at 24 months. Furthermore, the results showed that alexithymic features could also be situational reactions to depression.

Factors associated with hopelessness: a population study

BACKGROUND

Hopelessness is associated with depression and suicidality in clinical as well as in non-clinical populations. However, data on the prevalence of hopelessness and the associated factors in general population are exiguous.

AIMS

To assess the prevalence and the associated factors of hopelessness in a general population sample.

METHODS

The random population sample consisted of 1722 subjects. The study questionnaires included the Beck Hopelessness Scale (HS), Beck Depression Inventory (BDI), Toronto Alexithymia Scale (TAS-20) and Life Satisfaction Scale (LS).

RESULTS

Eleven percent of the subjects reported at least moderate hopelessness. A poor financial situation (OR 3.64), poor subjective health (OR 2.87) and reduced working ability (OR 2.67) independently associated with hopelessness. Moreover, the likelihood of moderate or severe hopelessness was significantly increased in subjects dissatisfied with life (OR 5.99), with depression (OR 4.86), with alexithymia (OR 2.37) and with suicidal ideation (OR 1.85).

CONCLUSIONS

This study demonstrated a moderately high prevalence of hopelessness at the population level. Hopelessness appears to be an important indicator of low subjective well-being in the general population that health care personnel should pay attention to.

Stable hopelessness and its predictors in a general population: a 2-year follow-up study

Information on hopelessness at the population level is limited, and no previous studies have focused on its stability in a general population. We examined the stability and associated factors of hopelessness in a general population sample of 1,389 adults. More than half of those who were hopeless at baseline remained hopeless on follow-up. When those with a mental disorder were excluded, the relative risk for stable hopelessness in unemployed men was 7.2 (95% CI 2.6-19.9), in men with a poor financial situation it was 3.5 (95% CI 1.3-9.3), and in women with a poor financial situation it was 3.8 (95% CI 1.5-9.4). Awareness of the stability of hopelessness offers us newpossibilities in preventative and mental health work.

Life satisfaction in patients with chest pain subsequently diagnosed as coronary heart disease--connection through depressive symptoms?

The aim of this study was to investigate factors associated with life dissatisfaction in symptomatic patients (n = 144) with chest pain subsequently diagnosed as coronary heart disease (CHD) by coronary angiography. Life dissatisfaction was assessed with a four-item life satisfaction scale (LS), depression with the 21-item Beck Depression Inventory (BDI) and other psychiatric symptoms with the symptom check list (SCL). DSM-III-R Axis I and Axis II psychiatric diagnoses were performed by means of the Structured Clinical Interview. All assessments took place one day before angiography. Twenty-four per cent of CHD patients were dissatisfied with their lives. Life dissatisfaction was associated with being unmarried. Dissatisfied patients had Axis I mental disorders and Axis II personality disorders more frequently than others. Psychiatric and depressive symptoms according to the SCL and BDI, respectively, were also higher among dissatisfied patients. In multiple logistic regression analyses, mental disorders were related to life dissatisfaction when age, sex, employment status, New York Heart Association class, duration of chest pain symptoms and work load were controlled in the model. Married subjects had a lower probability of being dissatisfied with their lives than other subjects (Odds Ratio, OR: 0.23). When BDI scores were included in the model, the only factor independently associated with life dissatisfaction was the severity of depressive symptoms (OR: 1.81). To conclude, life dissatisfaction is not primarily determined by the severity of CHD but by the existence of depressive symptoms.

Is the Beck Depression Inventory suitable for screening major depression in different phases of the disease?

This prospective study aimed to assess the suitability of the 21-item Beck Depression Inventory (BDI-21) as a screening method for current episodes of major depressive disorder in different phases of the disease. In a sample of treatment-seeking outpatients (n=125), a structured interview method (SCID) was used twice with a 2-year interval to screen whether the patient had a current episode of major depressive disorder. The validity of the BDI-21 was also analysed by means of receiver operating characteristic (ROC) curves. The results showed that with a cut-off point of 14/15 the BDI-21 can be used to indicate the presence of a major depressive episode regardless of the phase of the major depressive disorder. The sensitivity and specificity were quite satisfactory with this cut-off point. The areas under the ROC curves were large (0.81 at baseline and 0.93 at follow-up). The same BDI-21 cut-off point is suitable for screening major depression among outpatients in any phase of the disease.

Impact of multiple traumatic experiences on the persistence of depressive symptoms--a population-based study

The objective of this population-based study was to determine whether traumatic experiences in general, and multiple traumatic experiences in particular, are associated with persistent self-rated depressive symptoms in adult Finnish subjects over 2 years of follow-up. The study sample included 1405 subjects aged 25-64 years. Subjects (n = 217) who were depressed both at baseline in 1999 and on follow-up 2 years later in 2001 (having persistent depressive symptoms) were compared with subjects (n = 987) having no depressive symptoms either at baseline or on follow-up. All six categories of traumatic experiences (wartime experience, natural disaster, life-threatening accident, victim of violent crime, domestic violence and childhood sexual abuse) pertained to the respondents' whole life span. Odds ratios, adjusted for significant covariates, were obtained from multiple logistic regression models that estimated the likelihood of persistent depressive symptoms in different trauma categories. Persistent depressive symptoms had a significant positive graded relationship with the number of traumatic experiences. The adjusted odds of persistent depression was 6.05 (95% CI 1.76-20.7) for men and 6.99 (95% CI 2.69-18.2) for women in those with three or more traumatic experiences compared with those with no such experiences at all. Multiple traumatic experiences substantially increase the likelihood of persistent depressive symptoms. Mental health intervention, as early as possible, may serve to prevent the chronicity of depressive reactions among victims of multiple traumas.

Life events are important in the course of hopelessness-a 2-year follow-up study in a general population

BACKGROUND

The association between life events and hopelessness in a general population is unknown.

AIM

The aim of this study was to examine the course of hopelessness and how positive and negative life events are associated with it.

METHOD

This was a 2- year follow-up study among general population adults, excluding any with a mental disorder. The impact of 15 occasional life events during the follow-up was assessed and the course of hopelessness measured with the Beck Hopelessness Scale (HS).

RESULTS

Four percent of the study subjects with no hopelessness at baseline and 56% of those with hopelessness at baseline reported hopelessness on follow-up. In multiple logistic regression analyses, a notable worsening of the subjective financial situation was revealed as the most important life event, both in becoming hopeless during the follow-up (OR 5.07; 95% CI 2.20-11.7) and in continued hopelessness (OR 7.51, 95% CI 2.19-25.8). Moreover, considerable interpersonal conflicts at work (OR 3.29, 95% CI 1.17-9.27) were associated with becoming hopeless. However, a notable positive change in common living conditions (OR 0.16, 95% CI 0.04-0.74) was found to be a protective factor against becoming hopeless. All these variables remained significant even when adjusted for change in depression scores (BDI).

CONCLUSION

Hopelessness may be persistent in a general population. The impact of life events, especially a notable worsening of the subjective financial situation, is important in becoming or remaining hopeless.

Cluster C personality disorder and recovery from major depression: 24-month prospective follow-up

We investigated whether Cluster C personality disorder (CPD) is associated with recovery from depression. Changes in symptom scales in 30 patients with MD and CPD were compared with changes in 60 patients with MD alone over a 24-month follow-up period. Recovery of patients with MD and comorbid CPD was inferior to recovery of those with MD alone based on the Hamilton and Beck Depression Inventory (BDI) scales, and the SCL-90 total score. Only 18% of those with MD alone but 47% of those with CPD and MD met the criteria for major depression at the end of the 24-month follow-up. Multiple logistic regression analyses revealed an independent association between the lack of recovery (BDI score > 9 at 24 months) and the presence of CPD (OR 4.9, 95% CI 1.5-16.0). Moreover, the presence of CPD associated with the presence of major depression at 24 months (OR 4.2, 95% CI 1.4-12.2). The presence of CPD hinders the alleviation of depressive symptoms in major depression.

Gender differences in the association of adult hopelessness with adverse childhood experiences

BACKGROUND

The impact of childhood traumatic events on long-term psychological development has been widely studied. Nevertheless, little research has been carried out on possible associations between adverse childhood experiences (ACEs) and hopelessness in adulthood, and whether any gender differences exist.

AIM

The aim of this study was to examine the association between ACEs (poor relationship between parents, unhappiness of childhood home, hard parenting, physical punishment, domestic violence, alcohol abuse in primary family) and current hopelessness without any mental disorder in a general population sample.

METHOD

1598 adults (43 % were men), aged 25-64 years, completed self-report measures to assess ACEs and hopelessness by means of the Beck Hopelessness Scale (HS). Logistic regression was used to adjust for the effects of sociodemographic factors on the association between the cumulative number of ACEs and hopelessness.

RESULTS

Whereas several bivariate associations were found between ACEs and hopelessness, none of them remained significant in multivariate analysis. However, men who reported three or more ACEs were 2.79 times (95 % CI 1.17-6.63) and women 2.19 times (95 % CI 1.04-4.65) more likely to be hopeless compared with those without any ACEs. In women (OR 2.25, 95 % CI 1.01-5.00), but not in men, this relationship remained significant after adjusting for several current covariates.

CONCLUSION

Clustering of ACEs may have long-lasting effects by increasing the risk of hopelessness in adulthood, especially in women. Increased awareness of the frequency of ACEs and their subsequent consequences, such as hopelessness, may encourage health care professionals to undertake preventive work in primary and mental health care.

Cluster C personality disorder impedes alleviation of symptoms in major depression

BACKGROUND

We investigated whether cluster C personality disorder (CPD) is associated with recovery from depression.

METHODS

The study design was observational. Diagnoses of major depression (MD) and CPD were confirmed by means of the Structured Clinical Interview for DSM-III-R (SCID-I, -II). Changes in symptom scales in 52 patients with MD and CPD were compared with changes in 65 patients with MD alone over a 6-month follow-up period.

RESULTS

On the Hamilton Depression Rating Scale and Beck Depression Inventory (BDI) scales, recovery of patients with MD and comorbid CPD was inferior to recovery of patients with MD alone. Findings were similar in relation to several other symptom scales. Of those with MD alone 54% had recovered from their depression, but only 16% of those with CPD and MD (BDI score <10 on follow-up). Logistic regression analysis revealed an independent association between lack of recovery and presence of CPD (OR 7.5, 95% CI 2.6-22.2).

LIMITATIONS

Study design was observational.

CONCLUSION

The presence of CPD hinders alleviation of depressive symptoms in major depression.

Partial remission in major depression: a two-phase, 12-month prospective study

We conducted an interview-based survey to predict the clinical course of major depressive disorder during a follow-up period of 12 months. Altogether 86 patients were investigated. A SCID I interview for DSM-III-R axis-I diagnosis was conducted at baseline and a SCID II interview for personality disorders at the 6-month follow-up. Beck Depression Inventory scores indicated the level of depression and were compiled at baseline and at 6 and 12 months. A BDI score between 9 and 14 was considered to indicate partial remission, and score of 0-8 indicated remission. At the 6-month assessment 33% of the patients had remission, 20% were in partial remission, and 47% were in the depressive phase. Older age, personality disorder, and alexithymia were associated with poor response at 6 months. At 12 months 37% had remission, 28% were in partial remission, and 35% were still in the depressive phase. Treatment at the early stage should be effective enough to achieve remission. If the response is not satisfactory within 6 months, a renewed search should be conducted for factors hindering recovery. Comorbid personality disorder is the main factor predicting a poor short-term response in major depressive disorder.

Why do alexithymic features appear to be stable? A 12-month follow-up study of a general population

BACKGROUND

This 12-month follow-up study investigated the prevalence of alexithymia and its relationship with depression in a sample of the general population from Eastern Finland (n = 1,584).

METHODS

Alexithymia was assessed using the 20-item version of the Toronto Alexithymia Scale (TAS) and depression using the 21-item Beck Depression Inventory (BDI).

RESULTS

The prevalence of alexithymia in each study phase was similar (baseline: 9.7%; follow-up: 10.1%). Mean values of BDI, TAS-20 and subfactors of the TAS-20 also remained unchanged between the study phases. However, by using the original cutoff points, we found that a proportion of the subjects were in a different TAS-20 category on follow-up than at baseline. The mean values of BDI had not changed in those subjects who had similar alexithymia status in both phases, but increased or decreased in parallel with the change in TAS-20 score among all other subjects.

CONCLUSIONS

Our findings indicate that it is important to use a variety of viewpoints when studying changes in alexithymia status. Alexithymia appears to be a stable trait based on the similarity of the mean TAS-20 scores in separate study phases. However, when focusing on the changes in alexithymia status at the individual level, alexithymic features also appear to be state dependent and strongly related to depressive symptoms.

Depression and associated factors in coronary heart disease

OBJECTIVE

To investigate whether depression was associated with cardiac status and socio-demographic factors in patients with coronary heart disease (CHD).

METHODS

The sample consisted of 144 symptomatic patients with CHD. For screening depression the Beck Depression Inventory was administered on the day before elective coronary angiography.

RESULTS

Twenty-four per cent of patients had probable depressive disorder, but none of them had been previously identified as suffering from depression, or been treated for depression. Alexithymia and dissatisfaction with life were common in depressed patients. Logistic regression analysis showed that neither the cardiac status nor sociodemographic factors were associated with depression.

CONCLUSION

Depression is a common finding and should be looked for independently of other risk factors in patients with CHD.

Mood improvement reduces memory complaints in depressed patients

BACKGROUND

The aim was to examine associations between memory complaints, cognitive performance and mood in 174 adult, clinically depressed, neurologically healthy patients at baseline and during six months of follow-up.

METHODS

Subjective memory disturbance was assessed using the Memory Complaint Questionnaire (MCQ). Levels of cognitive function, including memory, were assessed using a battery of neuropsychological tests. Mood and personality traits were assessed using rating scales, including the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS) and the 90-item Symptom Check List (SCL-90).

RESULTS

At baseline, patients complaining of memory disturbances had higher BDI and HDRS scores than patients not complaining of memory problems. They also did less well in objective memory performances but not in other cognitive functions. Complaints of memory problems decreased during the follow-up. This change was associated with mood improvement and with reductions in other mental symptoms but not with changes in cognitive performance. In logistic regression analysis factors independently associated with MCQ change were age (OR 0.96) and BDI change (OR 1.06).

CONCLUSIONS

Subjective memory problems usually decline if depression is alleviated.

Alexithymia in patients with major depressive disorder and comorbid cluster C personality disorders: a 6-month follow-up study

The authors examined the association between alexithymia, cluster C personality disorders (CPD), and severity of depression among 121 outpatients with major depressive disorder (MDD) in a 6-month, follow-up study. Diagnosis of depression and CPD was confirmed by means of the Structured Clinical Interviews for DSM-III-R (SCID I and SCID II). Alexithymia was screened using the 20-item version of the Toronto Alexithymia Scale and severity of depression was assessed using the 21-item Beck Depression Inventory. Results indicated that alexithymic features are common in patients with MDD but often alleviated during recovery from depression. Moreover, comorbid CPD and severity of depression seemed to be associated with poorer recovery from alexithymia. The implications of these findings are discussed.

Are alexithymia and depression distinct or overlapping constructs?: a study in a general population

The aim of this study was to investigate the relationship between alexithymia and depression in a general population sample (N = 1,888), as measured by the 20-item Toronto Alexithymia Scale (TAS-20) and the 21-item Beck Depression Inventory (BDI-21), using factor analysis. The items of the TAS-20 and the BDI-21 loaded on separate factors with only a minor overlap concerning physical worries. However, in a subset of subjects, who were both alexithymic and depressed, loadings were highly overlapping. These findings suggest that alexithymia and depression may be highly associated. Another conclusion might be that psychometric properties of the TAS should be further developed to make differentiation between alexithymia and depression possible.

Alexithymia and Depression: A Prospective Study of Patients With Major Depressive Disorder

The authors conducted a 12-month follow-up study to determine the association between alexithymia and depression in 116 outpatients with major depressive disorder (MDD) and 540 control subjects from the general population. Alexithymia was screened using the Toronto Alexithymia Scale (TAS-20), and depression was assessed using the Beck Depression Inventory (BDI). The results show that the severity of depression was significantly associated with alexithymia. In addition, the BDI scores increased or decreased proportionately with the change in TAS-20 score in both groups. These results lend further support to the idea that alexithymia may be a state-dependent phenomenon.

Alexithymia in patients with coronary heart disease

OBJECTIVE

The aim of this study was to investigate factors associated with alexithymia in patients (n=153) with coronary heart disease (CHD) verified by coronary angiography.

METHOD

Self-rated depression was assessed using 21-item Beck Depression Inventory (BDI) and other psychiatric symptoms with Symptom Check List-90 (SCL-90). Life satisfaction was assessed using a separate scale. The Structured Clinical Interview (SCID I and II) for DSM-III-R was used to identify mental disorders. Assessments took place 1 day before angiography.

RESULTS

Twenty-one percent of CHD patients (n=32) were assessed as being alexithymic according to the Toronto Alexithymia Scale (TAS-20). Alexithymics were more often blue-collar workers, incapable of working, dissatisfied with life, and depressed than the other CHD patients. Occurrences of mental disorders were not associated with alexithymia. Logistic regression analysis revealed that factors independently associated with alexithymia were currently or previously being a blue-collar worker (adjusted odds ratio, AOR: 4.8), self-rated depression (AOR: 3.2), and dissatisfaction with life (AOR: 2.9).

CONCLUSION

In CHD patients alexithymia was unrelated to cardiovascular risk factors or exercise capacity but was related to self-rated depression and decreased life satisfaction. Alexithymia is associated with the enhanced psychosocial burden of suffering CHD. This patient group may need more individual support and attention than other CHD patients.