What moderator characteristics are associated with better prognosis for depression?

A retrospective data analysis was conducted to evaluate the usefulness of baseline characteristics in predicting treatment response to antidepressant medication in 97 outpatients with nonpsychotic major depression treated for up to sixteen weeks with nefazodone. Baseline demographics (gender), illness features (symptom severity, length of illness, length of current episode, number of episodes, age of onset, longitudinal subtype, endogenicity, melancholia, family history of mood disorders), and social features (living status) were evaluated. Response to treatment was defined as a >/= 50% reduction in the 17-item Hamilton Rating Scale for Depression (HRSD(17)) score. The results of a survival analysis indicated that patients with shorter histories of illness (< 4 years), a negative family history of depression, and those who were either married or were living with someone were more likely to have a positive outcome during the acute phase treatment of depression. The main findings are consistent with extensive previous literature indicating a better short-term outcome of depression where illness is shorter, where there is no family history, and where there is better social support.

Reductions in Stress and Depressive Symptoms in Mothers of Substance-Exposed Infants, Participating in a Psychosocial Program

OBJECTIVE

Depression profoundly impairs psychosocial functioning. Depression can have disruptive effects on a person's family, with significant impact on the psychosocial development of the children. Recent research suggests that a mother's depressive symptoms may increase parenting stress and that parenting stress may, in turn, increase depressive symptoms, with a possible negative cycle to this process. Little is known about how these two factors interact in drug-involved mothers. This study examines how the NEW CONNECTIONS intervention (a parental education and support program for drug-involved parents) acts on parental stress and symptoms of depression.

METHODS

The study site was the NEW CONNECTIONS Infant Intervention Program. The Beck Depression Inventory-II (BDI-II) and the Parenting Stress Index (PSI) were administered to drug- and alcohol-involved mothers (N = 120) at baseline and after the intervention (Week 12).

RESULTS

Four of the seven PSI domains of parenting stress showed a significant reduction (Demandingness, Competence, Isolation, and Role Restriction). Changes in four domains were significantly correlated with reductions in depressive symptoms (Competence, Isolation, Attachment, and Role Restriction). There was a significant reduction in depressive symptoms as measured by the BDI-II.

CONCLUSION

Reduction in some aspects of parenting stress is associated with reduction in depressive symptoms in mothers of substance-exposed infants who participated in the NEW CONNECTIONS psychosocial intervention targeting the parent-child relationship.

A computerized clinical decision support system as a means of implementing depression guidelines

The authors describe the history and current use of computerized systems for implementing treatment guidelines in general medicine as well as the development, testing, and early use of a computerized decision support system for depression treatment among "real-world" clinical settings in Texas. In 1999 health care experts from Europe and the United States met to confront the well-documented challenges of implementing treatment guidelines and to identify strategies for improvement. They suggested the integration of guidelines into computer systems that is incorporated into clinical workflow. Several studies have demonstrated improvements in physicians' adherence to guidelines when such guidelines are provided in a computerized format. Although computerized decision support systems are being used in many areas of medicine and have demonstrated improved patient outcomes, their use in psychiatric illness is limited. The authors designed and developed a computerized decision support system for the treatment of major depressive disorder by using evidence-based guidelines, transferring the knowledge gained from the Texas Medication Algorithm Project (TMAP). This computerized decision support system (CompTMAP) provides support in diagnosis, treatment, follow-up, and preventive care and can be incorporated into the clinical setting. CompTMAP has gone through extensive testing to ensure accuracy and reliability. Physician surveys have indicated a positive response to CompTMAP, although the sample was insufficient for statistical testing. CompTMAP is part of a new era of comprehensive computerized decision support systems that take advantage of advances in automation and provide more complete clinical support to physicians in clinical practice.

Effects of fluoxetine on the polysomnogram in outpatients with major depression

This study investigated the effects of open-label fluoxetine (20 mg/d) on the polysomnogram (PSG) in depressed outpatients (n = 58) who were treated for 5 weeks, after which dose escalation was available (< or = 40 mg/d), based on clinical judgment. Thirty-six patients completed all 10 weeks of acute phase treatment and responded (HRS-D < or = 10). PSG assessments were conducted and subjective sleep evaluations were gathered at baseline and at weeks 1, 5, and 10. Of the 36 subjects who completed the acute phase, 17 were reevaluated after 30 weeks on continuation phase treatment and 13 after approximately 7 weeks (range 6-8 weeks) following medication discontinuation. Acute phase treatment in responders was associated with significant increases in REM latency, Stage 1 sleep, and REM density, as well as significant decreases in sleep efficiency, total REM sleep, and Stage 2 sleep. Conversely, subjective measures of sleep indicated a steady improvement during acute phase treatment. After fluoxetine was discontinued, total REM sleep and sleep efficiency were found to be increased as compared to baseline.

The effects of fluoxetine on the polysomnogram of depressed outpatients: a pilot study

The effects of fluoxetine (FLU) and its active metabolite, norfluoxetine (NFLU), on the polysomnogram (PSG) of nine depressed outpatients (eight with major depression; one with bipolar II, depressed phase disorder) were investigated by contrasting PSG values prior to treatment and during administration of FLU. The PSG changes were correlated with daily dose, cumulative dosage, single serum concentrations, and the total area under the serum concentration curve (AUC) of both FLU and NFLU. Fluoxetine clearly increased both stage 1 sleep time and rapid-eye-movement (REM) latency and decreased both percent REM and REM density. With a few exceptions, the cumulative dosage of FLU and the AUC of FLU and NFLU were better predictors of the changes in awake and movement time in the PSG than single-sample concentrations of FLU and NFLU taken at the time of PSG assessment.

Regional cerebral blood flow alterations in unipolar depression

Forty-seven symptomatic inpatients and outpatients with major depression (13 nonendogenous, 23 endogenous, and 11 psychotic by Research Diagnostic Criteria) were compared with 138 normal control subjects. Absolute regional cerebral blood flow (rCBF, ml/minute/100 g) was measured with 133Xe single photon emission computed tomography. Flow ratios (region of interest/global flow) and residual scores (the difference between patient flow ratios and expected normal flow ratios, as derived from the control population) were also computed. Results revealed significant age x region x depression subtype interactions for absolute, ratio, and residual flow data. Consequently, a test of group means (or analysis of covariance) could not be used to examine between-group differences. Multiple regression analyses were employed to study the effects of age on rCBF. This analysis revealed that different, though sometimes overlapping, regions exhibited different age effects on rCBF in different depressive subtypes. Thus, diagnostic-subtype-dependent age effects on rCBF precluded comparisons of mean values within or across regions for subject groups, but distinguished between symptomatic depressed patients and control subjects and among patient groups. Possible causes of such effects include variations in duration of illness or medication history or sensitization phenomena.

Stability of self-esteem: assessment, correlates, and excuse making

We examined stability and level of self-esteem as predictors of excuse making; the extent to which self-ratings of stability are related to a statistical index of self-esteem stability; and the relations between stability and certainty of self-esteem and a variety of other psychological constructs. Regarding excuse making, our findings indicated that for high self-esteem individuals, instability was related to greater excuse making following success, but not following failure. However, for low self-esteem individuals, instability was related to greater excuse making following failure, but not following success. Other findings indicated that self-ratings of stability were only minimally related to a statistical measure of stability based on repeated assessments of self-esteem obtained in naturalistic contexts. Finally, stability of self-esteem was not significantly correlated with certainty of self-esteem. In addition, the pattern of correlations that emerged between certainty and other constructs suggested that uncertainty reflects the phenomenal experience of a tenuous self-view. On the other hand, stability of self-esteem appears to reflect the extent to which one's self-view is malleable, which may not be completely available to conscious awareness. Our discussion focuses on the nature of self-esteem stability and the roles of stability and level of self-esteem in reactions to evaluative events.

Stability of self-esteem as a moderator of the relation between level of self-esteem and depression

The hypothesis that stability of self-esteem would moderate the predictive relationship between level of self-esteem and depression was tested. Specifically, level of self-esteem was hypothesized to relate more strongly to subsequent depression for individuals with stable self-esteem than for individuals with unstable self-esteem. Results strongly supported this hypothesis. Implications for the relation between level of self-esteem and depression, and for the moderator variable approach to personality and prediction, are discussed.

Clinical, cognitive, and demographic predictors of response to cognitive therapy for depression: a preliminary report

This preliminary study evaluated prognostic indicators or predictors of response to cognitive therapy. The sample included 37 unipolar outpatients with moderate to severe major nonpsychotic depressive disorder, according to Research Diagnostic Criteria. Demographic characteristics (sex, age, marital status, and education), pretreatment severity measures (Hamilton Rating Scale for Depression [HRSD] and Beck Depression Inventory [BDI]), pretreatment cognitive measures (Dysfunctional Attitudes Scale [DAS] and Attributional Style Questionnaire Failure Composite [ASQ-F]), and historical features (length of illness, length of current episode, number of episodes, and age of onset) were used in multiple regression models to predict response. In accord with previous findings, patients who had higher (rather than lower) pretreatment HRSD, BDI, or DAS scores and were single (rather than married) showed a poorer response to cognitive therapy, according to the HRSD. Furthermore, married outpatients with high DAS scores or single patients with low DAS scores showed an intermediate response to cognitive therapy, while single patients with high DAS scores responded the least. Generally, effects were stronger when response was assessed according to clinician-rated severity measures rather than patient self-reports.

Stability of self-esteem as a moderator of the relation between level of self-esteem and depression

The hypothesis that stability of self-esteem would moderate the predictive relationship between level of self-esteem and depression was tested. Specifically, level of self-esteem was hypothesized to relate more strongly to subsequent depression for individuals with stable self-esteem than for individuals with unstable self-esteem. Results strongly supported this hypothesis. Implications for the relation between level of self-esteem and depression, and for the moderator variable approach to personality and prediction, are discussed.

Stability and level of self-esteem as predictors of anger arousal and hostility

We examined stability of self-esteem and level of self-esteem as predictors of dispositional tendencies to experience anger and hostility. We reasoned that individuals with unstable high self-esteem would report especially high tendencies to experience anger and hostility, and that individuals with stable high self-esteem would report particularly low tendencies. We expected individuals with stable and unstable low self-esteem to fall between these two extremes. These predictions were derived from an analysis of anger and hostility that emphasized the instigating role of threats to self-esteem. Stability of self-esteem was assessed through multiple assessments of global self-esteem in naturalistic settings. Results revealed the predicted pattern for the tendency to experience anger and a "motor" component of hostility. The importance of considering both stability and level of self-esteem in analyses of anger and hostility is discussed.

Stability and level of self-esteem as predictors of anger arousal and hostility

We examined stability of self-esteem and level of self-esteem as predictors of dispositional tendencies to experience anger and hostility. We reasoned that individuals with unstable high self-esteem would report especially high tendencies to experience anger and hostility, and that individuals with stable high self-esteem would report particularly low tendencies. We expected individuals with stable and unstable low self-esteem to fall between these two extremes. These predictions were derived from an analysis of anger and hostility that emphasized the instigating role of threats to self-esteem. Stability of self-esteem was assessed through multiple assessments of global self-esteem in naturalistic settings. Results revealed the predicted pattern for the tendency to experience anger and a "motor" component of hostility. The importance of considering both stability and level of self-esteem in analyses of anger and hostility is discussed.

The role of contextual factors in the relationship between physical activity and self-awareness

Previous research has indicated that performing arousing or unusual activities heightens self-awareness, as indexed by the use of first person singular pronouns in a sentence completion task (McDonald, Harris & Maher, 1983; Wegner & Giuliano, 1980; 1983). This type of self-awareness seems to reflect awareness of oneself as an individual. In the study reported here, we examined the impact of contextual factors on both awareness of oneself as an individual and awareness of oneself as a group member. The latter type of self-awareness was indexed by the use of first person plural pronouns. Subjects either ran or walked in place while in one of three contexts: (1) alone; (2) with co-actors present; or (3) in a group which fostered interaction and interdependence among participants. The results indicated that, relative to the other two contexts, the group context lowered self-awareness as indexed by the use of first person singular pronouns, but enhanced self-awareness as indexed by the use of first person plural pronouns. This is discussed in terms of the impact that social context has on different forms of self-awareness.

Invariance in the MMPI's component structure

Bernstein and Garbin (1985b) suggested that the Minnesota Multiphasic Personality Inventory's major clinical scales (excluding Scales ? and 5) can be approximated by an oblique three-component structure: (a) Profile Elevation, (b) Test-taking Attitudes, and (c) Optimism-Pessimism, collectively termed the salient weight model. In this study, we found that both this model and the MMPI's principal component structure remain invariant across race, sex, and, as previously noted, context of testing (job applicants vs. inmates in correctional institutions). We further noted that several alternative definitions of Profile Elevation provide equally satisfactory representation of the relations among the scales. This factor invariance is necessary, but not sufficient, for the MMPI to be viewed as unbiased.