Family history of psychiatric disorder and low self-confidence: predictors of depressive symptoms at 12-month follow-up

We examined effects of two risk factors for depression, family psychiatric history and Low Self-Confidence, on (1) baseline characteristics of major depression and (2) depressive symptoms one year later. Subjects (N = 104) in the midst of a depressive episode were assigned to one of three family history subtypes identified in earlier research: Pure Depressive Disease (PDD) Depressive Spectrum Disease (DSD), Sporadic Depressive Disease (SDD). Results indicate that effects of Self-Confidence on depressive symptoms at follow-up varied by family subtype. In multivariate analyses with controls for demographic and illness characteristics, the mean follow-up depressive score was below the depressive threshold for PDD subjects and above it for SDD subjects regardless of the level of Self-Confidence. In contrast, DSD subjects with High Self-Confidence reported significantly more symptoms than those with Low Self-Confidence.

Age and impaired subjective support. Predictors of depressive symptoms at one-year follow-up

We followed a cohort of subjects (predominantly inpatients) suffering a major depressive episode in midlife and late-life for 1 year (N = 118). In this follow-up study, we examined three hypotheses. a) Elder subjects suffering major depression, compared with middle-aged subjects, will more likely report endogenous symptoms and less likely report decreased life satisfaction symptoms at 1-year follow-up. b) Impaired social support during the index episode will predict poor life satisfaction, but not endogenous symptoms at 1-year follow-up, regardless of age. c) Impaired social support during the index episode will be more predictive of decreased life satisfaction symptoms in midlife, compared with late life, at 12-month follow-up. The first two hypotheses were not supported, but the third hypothesis was. Both decreased life satisfaction and endogenous symptoms at outcome were significantly predicted by impaired social support during the index episode. Impaired social support predicted a poor outcome from an episode of major depression in both middle life and late life in controlled analyses. However, the effect of impaired subjective social support was conditional on age. Subjective social support appears to have a decreasing influence on the report of both endogenous and decreased life satisfaction symptoms for older individuals.

Subjective social support and depressive symptoms in major depression: separate phenomena or epiphenomena

One hundred and twenty-five middle-aged and elderly adults suffering from a major depressive episode were evaluated during the index episode and at six and twelve month follow-up. Subjective (emotional) social support and depressive symptoms (CES-D) were evaluated during each interview. Contigency table and correlation analyses reveal that subjective support and depressive symptoms are interrelated but separate constructs.

RAS mutations in patients following cytotoxic therapy for lymphoma

The occurrence of Myelodysplastic Syndrome (MDS) and Acute Myeloblastic Leukaemia (AML) following cytotoxic therapy for neoplastic disease is well recognised. RAS mutations are common in patients with MDS and AML. To determine whether these lesions are found as early markers of secondary disease, we have studied the incidence of RAS mutations in the peripheral blood of 70 patients in complete remission from lymphoma. Patients were treated by standard chemotherapy regimes and/or localised radiotherapy. Treatment had been given 6 months to 14 1/2 years previously and no patient showed any sign of residual disease. Genomic DNA from peripheral blood leukocytes was amplified in vitro at target codons of N, K and H RAS genes, and mutations detected by hybridisation with oligonucleotide probes. RAS mutations were detected in 9 subjects. One patient with an N12 valine (Val) substitution had been in complete remission from Hodgkin's disease (HD) for 9 years. DNA from this patient registered in a nude mouse tumorigenicity assay (NMT). The N12 Val mutation was not detected in the original tumour tissue from the same patient. A second patient in remission from HD showed evidence of co-existent N12 cysteine (Cys) and N13 valine (Val) substitutions which were not detected in presentation material or unaffected tissues. All patients are currently haematologically normal, indicating that clones of mutant RAS bearing cells may be detected prior to any overt sign of disease.

Social support and the outcome of major depression

One hundred and fifty middle-aged and elderly adults with a diagnosis of major depression were assessed initially as in-patients, and were reinterviewed 6-32 months later. Both size of social network and subjective social support were significant predictors of depressive symptoms at follow-up, with baseline depression scores and other predictors of outcome status statistically controlled. Subjective social support was most strongly associated with major depression; this effect was significantly stronger for middle-aged than older adults, and for men than women. Differences in the effects of marital status, size of social network, and subjective social support also suggest the importance of distinguishing between involvement in and quality of interpersonal relationships.

A statistical analysis of the classification of depression in a mixed community and clinical sample

Depressive symptoms in three samples are assessed using grade-of-membership analysis to clarify the distribution of depressive symptoms across traditional affective diagnoses. The technique is used to examine whether depressive symptoms and symptoms frequently associated with depressive disorders cluster into recognizable syndromes or pure types that parallel current operational diagnoses. Three hundred and ninety subjects were studied to address the question: among a mixed population with a range of depressive symptoms, will syndromes resembling endogenous depression and demoralization emerge from the range of presentation of depressive symptoms? A single pure type is nearly identical to the DSM-III classification of major depression with melancholia. No such pure type emerged that resembled demoralization.

Age differences in life events: a multivariate controlled analysis

Effects of age on the distribution of specific life events experienced during the past year by community-based adults were examined controlling for sex, race, education, marital status, and place of residence. The controlled analyses were done using logistic regression. Data were gathered via personal interview from 3,798 respondents ages eighteen years and over who participated in the Epidemiologic Catchment Area (ECA), community survey from North Carolina. Respondents were placed in one of four age groups. The percentage of respondents reporting each of the nineteen events examined ranged from 0.5 percent for death of spouse to 19.1 percent for death of loved one. Age was an important predictor in the controlled analysis for thirteen of the seventeen life events examined. A majority of differences occurred between the youngest and oldest age groups. Age differences were not found for illness of one week or more involving activity limitation.

Relationship of health and demographic characteristics to Mini-Mental State examination score among community residents

Mini-Mental State findings from an age 60+ random community sample (N = 1681) indicate that score is related to education, age and race (but not sex) and to functional status, but not to selected aspects of physical or mental health. Adjustment for demographic characteristics, particularly education, is recommended lest cognitive impairment be overestimated.

Maternal and child health services for medically indigent children and pregnant women

Millions of low-income children and women of childbearing age are completely uninsured. Medicaid, the nation's largest public health financing program for the poor, is an inadequate resource for uninsured families with children. By 1984, the program served only 46% of the poor and near-poor, down from 65% in 1976. To assess the availability of maternity and pediatric services for low income uninsured women and children, a survey of 51 Title V Maternal and Child Health agency officials was conducted in 1986. While nearly all states (48) offer some prenatal care programs for indigent women, restrictive eligibility requirements and limited distribution meant that these programs reached only a small proportion of those in need. Only one state, Massachusetts, offered a truly statewide program to all uninsured pregnant women with incomes under 185% of the poverty level. Twenty-three states reported the existence of inpatient maternity programs for indigent women. Yet these, too, were extremely limited. Sixteen programs restricted funds either to women who participated in certain designated maternity programs or else only to those who were identified as high risk prior to the labor and delivery period. Fifteen state agencies reported that hospitals were denying admission to women about to deliver. Another 13 reported that hospitals were denying admission to women not yet in "active" labor. Six additional states were aware of patient dumping but did not identify the specific populations that were affected. Forty-six states reported the existence of pediatric outpatient programs. However, the majority (30) offered only "well-child" care. Seven states maintained pediatric programs limited to only certain ages of children; three of these imposed an age requirement as low as 2 years or younger. Only two states reported the availability of any pediatric inpatient programs financed or administered by Title V agencies other than those for children with special health care needs.

Major depression with melancholia: a comparison of middle-aged and elderly adults

Patients admitted to an inpatient psychiatric service were screened to identify middle-aged (35 to 50 years of age) and elderly (60 years of age and over) patients suffering from a major depressive episode with melancholia. Thirty-seven subjects (18 middle-aged and 19 elderly) were identified. Criteria symptoms for depression and symptoms specifically associated with melancholic or endogenous depression did not differ across age groups, with few exceptions. Major depression with melancholia in this hospitalized population was symptomatically similar in the middle-aged and elderly. The syndrome is therefore relatively common on this inpatient service and should be easily recognized.

Organizational position and perceptions of problems in a nursing home

This paper examines perceptions of problems expressed by persons living and working in a 100-bed skilled nursing home. Data were obtained from administrative staff, professional and nonprofessional nursing staffs, therapy staff, auxiliary staff, and residents by means of interview, observation, and analyses of records. The relationship between perceptions of problems and location within the organization and the scope and content of roles played was studied. We sought to ascertain the extent to which members agree or disagree with one another as to what are problems, to locate areas of agreement and disagreement, and to relate the results to the broader issue of the quality of care provided elderly institutionalized persons. Position and associated roles of members were found to be related to perceptions of problems. Differential perceptions of the numbers of problems and their priority were observed. Some problems were mentioned more frequently than others. Perceptions of problems varied both within and between organizational units. A person's location within the nursing home was related to the identification of problems as important and the frequency with which different problems were mentioned.