Anger attacks in depression--evidence for a male depressive syndrome

Validity of Gotland Male Depression Scale for male depression in a community study: the Sudurnesjamenn study

BACKGROUND

Several studies suggest a "male depressive syndrome", where not only the standard symptoms of major depressive disorder (MDD) but also symptoms of anxiety, anger, irritability and antisocial behaviour are prominent.

METHOD

In a community study, 534 males were screened for possible depression by the Gotland Male Depression Scale (GMDS) and Beck's Depression Inventory (BDI). For comparison psychiatrists examined a sub-sample of healthy and depressive males (n=137). The validity of the GMDS was compared both with the BDI and MDD diagnosis according to DSM-IV.

RESULTS

GMDS was as good as BDI for screening males. ROC-curve analysis gave AUC 0.945 (95% CI 0.923-0.968) for GMDS when tested against BDI. Second, when both scales were tested by ROC-curves against DSM-IV, the GMDS had AUC=0.861 (95% CI 0.800-0.921) and BDI had AUC=0.822 (95% CI 0.751-0.893). The estimated prevalence was 14-15%.

LIMITATIONS

Low participation rate (25%) in the screening phase.

CONCLUSION

GMDS is a valid screening tool for detecting male depression (MDD). Furthermore it is a short self-rating scale, easy to use in daily practice to screen for depression. Our results support recent reports of high prevalence of depressions in the community which supports active screening of males in clinical practice.

Psychodynamic Psychotherapy for Double Depression and Intermittent Explosive Disorder

This is a single case study utilizing time-series analysis for a young adult man with major depressive disorder and dysthymic disorder (i.e., double depression [DD]) and intermittent explosive disorder (IED). Treatment consisted of long-term psychodynamic psychotherapy (LTPP) with an emphasis on facilitating emotional expression and fostering autonomy. During 13 months of therapy, the patient completed daily measures related to his presenting complaint, including overall distress and episodes of rage. These data were examined for clinically significant change across baseline and two phases of treatment using Simulation Modeling Analysis for time-series data. Results indicated improvement in overall distress and in rage episodes. In addition to daily measures, the patient completed a measure of general psychological functioning at monthly intervals throughout treatment, the results of which indicated no reliable change. Complicating factors and implications of treatment are discussed, including the efficacy of LTPP in the treatment of DD and IED.

The presentation of depression in the British Army

BACKGROUND

The British Army is predominately composed of young men, often from disadvantaged backgrounds, in which Depression is a common mental health disorder.

OBJECTIVES

To construct a predictive model detailing the presentation of depression in the army that could be utilised as an educational and clinical guideline for Army clinical personnel.

METHOD AND PARTICIPANTS

Utilising a Constructivist Grounded Theory, phase 1 consisted of 19 interviews with experienced Army mental health clinicians. Phase 2 was a validation exercise conducted with 3 general practitioners.

RESULTS

Depression in the Army correlates poorly with civilian definitions, and has a unique interpretation.

CONCLUSION

Young soldiers presented with symptoms not in the International Classification of Disorders and older soldiers who feared being medically downgraded, sought help outside the Army Medical Services. Women found it easier to seek support, but many were inappropriately labelled as depressed. Implications include a need to address the poor understanding of military stressors; their relationships to depressive symptoms and raise higher awareness of gender imbalances with regard to access and treatment. The results have international implications for other Armed forces, and those employed in Young Men's Mental Health. The results are presented as a simple predictive model and aide memoire that can be utilised as an educational and clinical guideline. There is scope to adapt this model to international civilian healthcare practice.

Validity and clinical utilization of the Chinese version of the Gotland Male Depression Scale at a men's health polyclinic

INTRODUCTION

Symptoms of depression in males, such as aggression and irritability, are different from those in females. However, there are no adequate scales for detecting possible diagnoses in the Chinese population. The aim of this study was to assess whether the Chinese version of the Gotland Male Depression Scale (CV-GMDS) could identify male depression as effectively as the English version.

MATERIALS AND METHODS

A total of 231 male outpatients were sampled from a men's health polyclinic. We used questionnaires to evaluate the characteristics and mood status of participants, including the CV-GMDS, the Chinese version of the Beck Depressive Inventory II (CV-BDI-II), and the Chinese version of the Aging Males' Symptoms (CV-AMS) scale. Cronbach's α-coefficient and Levene's test were used to investigate internal consistency and homogeneity, respectively. External validity was evaluated using Spearman's correlation coefficient. A factor analysis was conducted to evaluate the conceptual structure of the CV-GMDS, and a regression analysis was used to determine the relationship of the CV-AMS scale with the CV-GMDS and CV-BDI-II.

RESULTS

The mean age of the 231 participants was 46.1 years (standard deviation 11.0). Of the participants, 36.8% (n=85) were found to have depression according to the CV-GMDS and 34.6% (n=80) according to the CV-BDI-II. The internal consistency of the CV-GMDS was demonstrated by a Cronbach's α of 0.933, and the test of homogeneity revealed a P-value of 0.762. The external validity for the CV-GDMS and CV-BDI-II was demonstrated by an intercorrelation of 0.835. The third and fourth items of the GMDS differed from the others, and the CV-GMDS showed a better relationship (R (2)=0.616) with the CV-AMS scale than the CV-BDI-II did.

CONCLUSION

The CV-GMDS is a satisfactory and suitable psychometric questionnaire for detecting depression among a Chinese-speaking middle-aged or older male population. The results of this study could be used as a basis for investigating specific male depression and aging symptoms.

The co-occurrence of major depressive disorder among individuals with posttraumatic stress disorder: a meta-analysis

Although co-occurring posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) is associated with greater distress, impairment, and health care utilization than PTSD alone, the magnitude of this problem is uncertain. This meta-analysis aimed to estimate the mean prevalence of current MDD co-occurrence among individuals with PTSD and examine potential moderating variables (U.S. nationality, gender, trauma type, military service, referral type) that may influence the rate of PTSD and MDD co-occurrence. Meta-analytic findings (k = 57 studies; N = 6,670 participants) revealed that 52%, 95% confidence interval [48, 56], of individuals with current PTSD had co-occurring MDD. When outliers were removed, military samples and interpersonal traumas demonstrated higher rates of MDD among individuals with PTSD than civilian samples and natural disasters, respectively. U.S. nationality, gender, and referral type did not significantly account for differences in co-occurrence rates. This high co-occurrence rate accentuates the importance of routinely assessing MDD among individuals with PTSD and continuing research into the association between these disorders.

Beyond workers' compensation: men's mental health in and out of work

The mental health of men is an important issue with significant direct and indirect costs emerging from work-related depression and suicide. Although the merits of men's community-based and workplace mental health promotion initiatives have been endorsed, few programs are mandated or formally evaluated and reported on. Conspicuously absent also are gender analyses detailing connections between masculinities and men's work-related depression and suicide on which to build men-centered mental health promotion programs. This article provides an overview of four interconnected issues, (a) masculinities and men's health, (b) men and work, (c) men's work-related depression and suicide, and (d) men's mental health promotion, in the context of men's diverse relationships to work (including job insecurity and unemployment). Based on the review, recommendations are made for advancing the well-being of men who are in as well as of those out of work.

Mental health correlates of anger in the general population: findings from the 2007 National Survey of Mental Health and Wellbeing

OBJECTIVE

The aim of the present study is to examine the mental health correlates of anger in the general population using data collected as part of the 2007 Australian National Survey of Mental Health and Wellbeing (2007 NSMHWB).

METHOD

The 2007 NSMHWB was a nationally representative household survey of 8841 Australians aged between 16 and 85 years. The survey assessed for 30-day DSM-IV mental health disorders and 30-day anger symptoms.

RESULTS

A range of mood, anxiety and substance use disorders were found to be independently associated with symptoms of anger after controlling for demographics and comorbidity. These included major depressive disorder, bipolar disorder, social phobia, generalised anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder, and alcohol and drug use disorders.

CONCLUSIONS

This study is the first epidemiological investigation of the mental health correlates of anger in the Australian general population. Anger can have extremely maladaptive effects on behaviour and can lead to serious consequences for the individual and for the community. The findings of the present study denote the importance of assessing anger symptoms among individuals presenting with these common mental health disorders.

Irritable mood in adult major depressive disorder: results from the world mental health surveys

BACKGROUND

Although irritability is a core symptom of DSM-IV major depressive disorder (MDD) for youth but not adults, clinical studies find comparable rates of irritability between nonbipolar depressed adults and youth. Including irritability as a core symptom of adult MDD would allow detection of depression-equivalent syndromes with primary irritability hypothesized to be more common among males than females. We carried out a preliminary examination of this issue using cross-national community-based survey data from 21 countries in the World Mental Health (WMH) Surveys (n = 110,729).

METHODS

The assessment of MDD in the WHO Composite International Diagnostic Interview includes one question about persistent irritability. We examined two expansions of the definition of MDD involving this question: (1) cases with dysphoria and/or anhedonia and exactly four of nine Criterion A symptoms plus irritability; and (2) cases with two or more weeks of irritability plus four or more other Criterion A MDD symptoms in the absence of dysphoria or anhedonia.

RESULTS

Adding irritability as a tenth Criterion A symptom increased lifetime prevalence by 0.4% (from 11.2 to 11.6%). Adding episodes of persistent irritability increased prevalence by an additional 0.2%. Proportional prevalence increases were significantly higher, but nonetheless small, among males compared to females. Rates of severe role impairment were significantly lower among respondents with this irritable depression who did not meet conventional DSM-IV criteria than those with DSM-IV MDD.

CONCLUSION

Although limited by the superficial assessment in this single question on irritability, results do not support expanding adult MDD criteria to include irritable mood.

Faux masculinities among college men who experience depression

Depression is a significant problem among college men that can be complicated by masculine ideals of stoicism, reluctance to seek help, and risky self-management strategies. Underpinning these issues are complexities in recognizing what behaviors might be indicative of college men’s depressive symptoms. Findings drawn from a qualitative study of 25 Canadian-based college men who self-identified or were diagnosed with depression revealed three predominant masculine identities: the angry man; the solitary man; and the risk-reliant man. Within each of these themes men embodied aspects of idealized masculinity that were difficult to distinguish as symptoms of depression or as representative of the activities with which many college men partake. The angry man identity described men who expressed anger, at least in part, to dissipate depression invoked pain and emotional distress. The solitary man category included men who self-isolated, fearing that others would recognize and judge them as harboring depression. Risk-reliant men employed strategies including alcohol and other drug overuse rather than relinquish control by engaging with professional health care providers and services. Guided by the overall findings we argue this phenomenon as ‘faux masculinities’ – characterized by men’s engagement in practices consistent with idealized masculine identities but that emerge from and/or in response to the experience of depression. Faux masculinities are discussed within the context of the challenges posed for college men and their health care providers in pointing toward targeted depression interventions.

Influence of early life stress on later hypothalamic-pituitary-adrenal axis functioning and its covariation with mental health symptoms: a study of the allostatic process from childhood into adolescence

The hypothalamic-pituitary-adrenal (HPA) axis is a primary mechanism in the allostatic process through which early life stress (ELS) contributes to disease. Studies of the influence of ELS on children's HPA axis functioning have yielded inconsistent findings. To address this issue, the present study considers multiple types of ELS (maternal depression, paternal depression, and family expressed anger), mental health symptoms, and two components of HPA functioning (traitlike and epoch-specific activity) in a long-term prospective community study of 357 children. ELS was assessed during the infancy and preschool periods; mental health symptoms and cortisol were assessed at child ages 9, 11, 13, and 15 years. A three-level hierarchical linear model addressed questions regarding the influences of ELS on HPA functioning and its covariation with mental health symptoms. ELS influenced traitlike cortisol level and slope, with both hyper- and hypoarousal evident depending on type of ELS. Further, type(s) of ELS influenced covariation of epoch-specific HPA functioning and mental health symptoms, with a tighter coupling of HPA alterations with symptom severity among children exposed previously to ELS. Results highlight the importance of examining multiple types of ELS and dynamic HPA functioning in order to capture the allostatic process unfolding across the transition into adolescence.

Explosive anger in postconflict Timor Leste: interaction of socio-economic disadvantage and past human rights-related trauma

BACKGROUND

Countries emerging from major conflict commonly experience recurrent periods of communal instability. A psychosocial theory, Adaptation and Development after Persecution and Trauma (ADAPT), suggests that experiences of past human rights abuses interact with socio-economic disadvantage in the postconflict period to generate or maintain explosive forms of anger. Previous research has supported a link between trauma exposure and anger but the role of ongoing socio-economic disadvantage requires further clarification.

METHODS

The present study examined a structural equation model based on cross-sectional epidemiological data (n = 1245) collected in post-conflict Timor Leste in 2004. The model included four trauma dimensions derived from a prior factor analysis; a latent variable of post-conflict distress symptoms (derived from measures of PTSD and depression/anxiety); an index of socio-economic distress; and an indigenously-based measure of explosive anger.

RESULTS

The final model yielded a good fit (chi-square = 26.59 df = 20 p = 0.15 CFI = 0.99; TLI = 0.99; RMSEA = 0.016). Postconflict distress symptoms mediated the associations of trauma dimensions and socio-economic disadvantage with anger. Trauma dimensions associated with human rights violations and witnessing murder were partly mediated by ongoing socio-economic disadvantage in the path to postconflict distress and anger.

LIMITATIONS

Longitudinal studies will be needed to confirm the chronological sequencing of these relationships.

CONCLUSIONS

The study offers empirical support for a link between past trauma related to human rights violations and ongoing socio-economic disadvantage in the path to distress and anger.

Comprehensive behavioral analysis of patients with a major depressive episode

BACKGROUND

A major depressive episode diagnosed according to DSM-IV criteria can be accompanied by symptoms that DSM-IV does not include. These symptoms are sometimes classified as comorbidities. Our study assessed altered behavioral modes during a major depressive episode; ie, if 1 or more modes of behavior operated less or even not at all ("never"), or if the operation of others was more frequent or even constant ("always"). We hypothesize that these altered behavioral modes, especially the extreme positions "never" (hypomodes) and "always" (hypermodes) might correlate with depression scores and thus represent a typical symptom of depression.

MATERIAL/METHODS

We used the 35-item Salzburg Subjective Behavioral Analysis (SSBA) questionnaire to measure altered behavioral modes in 63 depressed patients and 87 non-depressed controls. Depression was assessed using the Hamilton Depression Scale.

RESULTS

In our test group (n=63) we found a total of 888 extreme positions. The mean number of extreme positions per patient was 11.15±5.173 (SD). Extreme positions were found in all 35 behavioral modes. The mean Hamilton score was 22.08±7.35 (SD). The association of the incidence of extreme positions and the Hamilton score in our test group was highly significant (Spearman's Rho=0.41; p=.001). In the control group (n=87), only 11 persons were found to display extreme positions, with a total of only 25.

CONCLUSIONS

Although this study has several limitations, such as the small sample or the use of a questionnaire in the validation procedure, the significant correlation of extreme positions and the Hamilton score indicate that altered modes of behavior as detected with the SSBA might be typical symptoms in a major depressive episode.

Understanding how men experience, express and cope with mental distress: where next?

In line with the shift towards prioritising lay accounts and narratives of chronic illness in sociology, there is an emerging literature on men, their subjectivities and experiences of mental distress. We argue in this paper that subjectivities and distress among men are an important area for critical sociological research. Very little is known about men's subjectivities or the meanings they give to - and how they cope with or seek help for - distress. At the same time, current theories of gender relations, performativity and wellbeing as they pertain to men are likely to shed further light on subjectivity and distress. However, current theories (and qualitative research involving men and women) are pointing to considerable complexity. In this paper, we outline what is known about distress and men, and consider the utility of gender relations, performativity, subjectivities and wellbeing for a better understanding of distress. We also ask: What other factors influence distress, and how should these be considered in relation to men and masculinities? What are the implications for research and policy?

Resting frontal EEG asymmetry as an endophenotype for depression risk: sex-specific patterns of frontal brain asymmetry

Resting frontal electroencephalographic (EEG) asymmetry has been hypothesized as a marker of risk for major depressive disorder (MDD), but the extant literature is based predominately on female samples. Resting frontal asymmetry was assessed on 4 occasions within a 2-week period in 306 individuals aged 18-34 (31% male) with (n = 143) and without (n = 163) lifetime MDD as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (American Psychiatric Association, 1994). Lifetime MDD was linked to relatively less left frontal activity for both sexes using a current source density (CSD) reference, findings that were not accounted for solely by current MDD status or current depression severity, suggesting that CSD-referenced EEG asymmetry is a possible endophenotype for depression. In contrast, results for average and linked mastoid references were less consistent but demonstrated a link between less left frontal activity and current depression severity in women.

Men and Depression: Current Perspectives for Health Care Professionals

Epidemiological and health care utilization rates document potential underidentification and under-treatment of men who may suffer from major depression. Limitations in diagnostic criteria may prevent health care professionals from clearly recognizing depression in the men they treat. Societal norms related to masculine gender role socialization may create barriers to help seeking for men who could benefit from treatment for depression. This review integrates up-to-date research with clinical reports and offers recommendations for health care professionals. The primary goals of the recommendations are to increase sensitivity to male patients who may suffer from depression and to equip professionals with scientifically informed strategies for recognizing and responding to men who are identified with depression.

A comparison between the Beck's Depression Inventory and the Gotland Male Depression Scale in detecting depression among men visiting a drop-in clinic in primary care

BACKGROUND

Anger attacks and alcohol use may mask depressive symptoms in men. Only the Gotland Male Depression Scale (GS) includes such items.

AIMS

To study the usefulness of the GS and Beck Depression Inventory (BDI) in detecting depression among men in primary care.

METHODS

At a family doctor's drop-in clinic in Stockholm, Sweden, all men were invited into the study 2 days a week (opportunistic screening). On other days, the men who mentioned mental symptoms were invited (targeted screening). The men filled in BDI, GS and a social questionnaire. The doctor invited the men with BDI > or = 10 and /or GS > or = 13 to a repeat visit. The outcome was depression diagnosed according to DSM-IV and the severity was assessed with the Montgomery-Asberg Depression Rating Scale.

RESULTS

223 men were recruited, 190 by opportunistic and 33 by targeted screening. Seventeen per cent of the men reported an alcohol consumption that might put them at risk. In the opportunistic screening, 23% scored BDI > or = 10 and 14% scored GS > or = 13. The prevalence of depression in the opportunistic screening was 10.5%. The proportion of depressed men in the targeted screening was 60.6%. In total, 40 men were depressed, 63% had a mild and 35% moderate depression. The correlation between the scales was 0.80. The GS identified no additional cases.

CONCLUSIONS

Clinical depression was quite common among those men who often had a high alcohol consumption, indicating an advantage for the GS when screening for depression among men. In primary care, a targeted screening procedure seems to be the most feasible method.

Depression in adults with intellectual disability: symptoms and challenging behaviour

BACKGROUND

Psychiatric evaluation of adults with intellectual disability (ID) remains complex because of limitations in verbal abilities, atypical clinical presentation and challenging behaviour. This study examines the clinical presentation of adults with depression compared with bipolar disorder, anxiety disorders and non-psychiatric control patients.

METHOD

This study is a retrospective record review of the initial psychiatric diagnostic evaluation for 300 adult patients with ID drawn from a clinic population. Patients with major depression (n = 85) were compared with those with bipolar disorder (n = 70), anxiety disorders (n = 30) and control patients without psychiatric disorder (n = 27). Key symptoms of depression assessed during the interview were examined as well as challenging behaviour.

RESULTS

Three symptoms were useful in differentiating depressed patients from all other groups: sad mood, crying, and anhedonia. Withdrawal, suicidality, and awakening during the night were significant compared with anxiety patients and controls; however, few patients reported suicidality. Bipolar patients were significantly different from depressed patients for elevated mood, acute anger episodes, increase in verbalization, pressure of speech, talk of sexual themes, increase in appetite and poor concentration. Anxiety patients had more fearfulness without withdrawal, sad mood, crying, anhedonia and suicidality. Challenging behaviour was most pronounced in bipolar patients; for depressed patients, aggression and impulsivity were significant compared with anxiety patients and controls. Overall, the control patients presented with few symptoms in any category.

CONCLUSIONS

Sad mood, crying and anhedonia are key significant features of depression. Most patients with ID cannot meet the required number of DSM criteria or suggested DM-ID adapted criteria for major depression. Many depressive symptoms were reported in modest numbers and this was probably related to deficiencies in self-report or observational skills of caregivers. Challenging behaviour is not diagnostically specific. It is, however, a key atypical feature of depression.

Crying as a gendered indicator of depression

Crying is a gendered activity; women in the general population are known to cry more than men. However, crying is also used as a sign of depression. Its use may explain some of the discrepancy in rates of depression in men and women. We suggest that crying is an invalid indicator because of its gendered status and should be removed from the diagnostic criteria for depression. Men may show other symptoms when depressed more than women, such as aggression and irritability. The inclusion of crying items in depression instruments may therefore introduce a gender bias in the assessment of depression.

No effect ofn-3 long-chain polyunsaturated fatty acid (EPA and DHA) supplementation on depressed mood and cognitive function: a randomised controlled trial

Low dietary intakes of then-3 long-chain PUFA (LCPUFA) EPA and DHA are thought to be associated with increased risk for a variety of adverse outcomes, including some psychiatric disorders. Evidence from observational and intervention studies for a role ofn-3 LCPUFA in depression is mixed, with some support for a benefit of EPA and/or DHA in major depressive illness. The present study was a double-blind randomised controlled trial that evaluated the effects of EPA+DHA supplementation (1·5 g/d) on mood and cognitive function in mild to moderately depressed individuals. Of 218 participants who entered the trial, 190 completed the planned 12 weeks intervention. Compliance, confirmed by plasma fatty acid concentrations, was good, but there was no evidence of a difference between supplemented and placebo groups in the primary outcome – namely, the depression subscale of the Depression Anxiety and Stress Scales at 12 weeks. Mean depression score was 8·4 for the EPA+DHA group and 9·6 for the placebo group, with an adjusted difference of − 1·0 (95 % CI − 2·8, 0·8;P = 0·27). Other measures of mood, mental health and cognitive function, including Beck Depression Inventory score and attentional bias toward threat words, were similarly little affected by the intervention. In conclusion, substantially increasing EPA+DHA intake for 3 months was found not to have beneficial or harmful effects on mood in mild to moderate depression. Adding the present result to a meta-analysis of previous relevant randomised controlled trial results confirmed an overall negligible benefit ofn-3 LCPUFA supplementation for depressed mood.

Posttraumatic embitterment disorder in comparison to other mental disorders

BACKGROUND

The term 'posttraumatic embitterment disorder' (PTED) was recently introduced to describe a subtype of adjustment disorders, characterized by prolonged embitterment, severe additional psychopathological symptoms and great impairment in most areas of life in reaction to a severe negative but not life threatening life event. The aim of this study is an empirical description and validation of the clinical concept of PTED, by comparing clinically defined PTED patients with patients suffering from other mental disorders on measures of posttraumatic stress and psychopathological distress.

METHODS

Fifty inpatients, suffering from PTED according to previously defined clinical diagnostic criteria, were compared with another 50 patients, matched by age and gender, who did not meet clinical criteria for PTED but for other mental disorders. Psychiatric diagnoses were assessed by the Mini International Neuropsychiatric Interview. Self-report measures included the Bern Embitterment Scale, the Impact of Event Scale, the PTED Self-Rating Scale and the SCL-90.

RESULTS

According to the Mini International Neuropsychiatric Interview both groups fulfilled the criteria for many disorders with a significantly higher occurrence of major depression and chronic adjustment disorder but less generalized anxiety disorder lifetime in PTED patients. Patients with PTED scored significantly higher on the global scores and on most subdimensions of the SCL-90, the Impact of Event Scale, the Bern Embitterment Scale and the PTED Self-Rating Scale.

CONCLUSIONS

Clear differences were found between PTED patients and patients with other mental disorders in regard to the quality and intensity of psychopathological as well as posttraumatic stress symptoms. PTED can help further subclassify and specify adjustment and reactive disorders.

Antecedents, concomitants and consequences of anger attacks in depression

Anger attacks are episodes of intense anger with autonomic arousal, which occur in response to often trivial provocations. This study explores some of the antecedents, concomitants, and consequences of anger attacks in patients with depression. The sample comprised three groups: depression with anger attacks (n=20), depression without anger attacks (n=20) and normal controls (n=20). Subjects were administered the Mini International Neuropsychiatric Interview, the Anger Attack Questionnaire, Irritability, the Depression Anxiety Scale, the State-Trait Anger Expression Inventory, the Psychoticism Extraversion Neuroticism Inventory, the Hassles Scale, the World Health Organization Quality of Life-BREF Version and the Dysfunctional Analysis Questionnaire. Depressed patients with anger attacks exhibited more suicide-related phenomena and dysfunction scores in comparison to depressed patients without anger attacks. Depressed patients with anger attacks also had higher scores of anxiety, irritability, trait-anger, anger-out, anger expression, psychoticism, hassles, and poor quality of life in comparison to the other two groups. In conclusion, anger attacks adversely affect the lives of depressed patients and their family members and may serve as a qualifier for partially distinct syndrome of depression.

„Male depression“ in einer Bevölkerungsstichprobe junger Männer

The concept of male depression basically assumes that the well-known depressive symptoms in males are compensated for or masked by external behavioral patterns, which are atypical for depression and therefore not included in conventional depression inventories. In a community sample of young males (n=1,004) the general well-being and risk of male depression were investigated using the WHO-5 Well-Being Scale and the Gotland Scale for Male Depression. The main questions focused on the analysis of symptoms dependent on the risk of male depression. Hypotheses were related to depressive symptoms being masked by distress symptoms, to the dimensionality of the Gotland Scale, to different symptom clusters and to the contribution of isolated symptoms to the risk of depression. The results demonstrated a reduced well-being and a risk of male depression in 22% of the respondents. The data gave no evidence to support the hypothesis that depressive symptoms are masked by distress symptoms or for latent depression and stress components. However, a "depression cluster" and a "distress cluster" could be differentiated by cluster analyses giving indications of the clinical relevance of the male distress symptoms for the development of depression. The more severe these are, the higher is the risk of male depression. Finally, the results are discussed in the face of the limitations of the study, the previous evidence and open questions.

Anger, depression and personality dimensions in patients with migraine without aura

BACKGROUND

Migraine without aura causes acute and chronic pain and partially compromises patients' social functioning and work performance. Over the past years, psychiatric comorbidities were frequently observed in these patients, together with coping difficulties and typical personality traits. The aim of this study was to identify whether migraine patients and controls share distinctive personality traits.

METHODS

105 consecutive patients suffering from migraine without aura referred to the Headache Center of Turin University were enrolled in the study and compared to a control group of 79 healthy subjects. Patients and controls completed several psychometric questionnaires, including the Temperament and Character Inventory, the Beck Depression Inventory and the State-Trait Anger Expression Inventory.

RESULTS

Patients suffering from migraine show more depressive symptoms, difficult anger management with a tendency to hypercontrol, and a distinctive personality profile with high harm avoidance, high persistence and low self-directedness. When a logistic regression was performed, the only significant predictors of migraine were temperament variables.

CONCLUSIONS

The results suggest that the personality traits and psychosomatic mechanisms of migraine patients may make them vulnerable to stress and less skilled in coping with pain. These traits correlate with dysregulated neurotransmitter systems which may also be part of the psychobiological components of personality, depressive disorders and migraine itself.

Subjective well-being and 'male depression' in male adolescents

BACKGROUND

The concept of male depression is based on the hypothesis that typical symptoms of depression in men often seem to be masked by non-typical male distress symptoms not considered in common depression inventories. Although there is a large amount of clinical evidence, scientific evidence is still lacking. The study aims at further validating the concept of male depression, by obtaining information on symptoms reported by males, and analyzing the dimensional structure of the Gotland Scale of Male Depression [Rutz, W., 1999. Improvement of care for people suffering from depression: The need for comprehensive education. International Clinical Psychopharmacology 14, 27-33.].

METHODS

A community sample of male adolescents aged 18 (n=1004) was asked to complete the WHO-5 Well-being Index [Bech, P., 1998. Quality of life in the psychiatric patient. London: Mosby-Wolfe.] and the Gotland Scale of Male Depression [Rutz, W., 1999. Improvement of care for people suffering from depression: The need for comprehensive education. International Clinical Psychopharmacology 14, 27-33.]. Principal component analysis with promax rotation was calculated to analyze the dimensional structure of the Gotland Scale. Cluster center analyses were used to classify the sample according to the symptoms' characteristics.

RESULTS

General well-being was rather reduced, and 22% of the respondents were seen to be at risk of male depression. There was no evidence for the hypothesis that young males tend to mask their depressive symptoms with distress symptoms. Depressive and male distress symptoms appeared to be mixed in a dominant factor, while male distress symptoms constitute an additional minor factor. A cluster of 38% of those at risk for depression could be identified who reported significantly elevated male distress symptoms. Irritability turned out to be the single item of the Gotland Scale with the highest item-total correlation.

LIMITATIONS

Risk of depression was not assessed by an additional depression scale or evaluated by a clinical rating.

CONCLUSIONS

Male distress symptoms should be considered when diagnosing depression in men. Further research is needed with respect to comorbidity and differential diagnoses, which should also include bipolar depression.

Validation of a simplified definition of anger attacks

BACKGROUND

Anger attacks, sudden spells of anger with vegetative hyperarousal, are highly prevalent symptoms in depression. Assessment normally requires the use of specific instruments. The aim of this study was the validation of a simplified definition for anger attacks.

METHODS

Anger attacks were assessed in 203 patients suffering from major depression with the Anger Attacks Questionnaire. The first three items of the questionnaire (irritability, overreaction to minor annoyances, episodes with inappropriate anger or rage) were compared separately with the diagnosis, and their value as single screening questions to establish the diagnosis was assessed.

RESULTS

Irritability was only weakly associated with the diagnosis of anger attacks (Cohen's kappa kappa = 0.214 +/- 0.058) and yielded a rather low specificity (0.302), while overreaction to minor annoyances (kappa = 0.869 +/- 0.037) and the question about episodes with inappropriate anger or rage (kappa = 0.901 +/- 0.032) had a high degree of agreement with the diagnosis of the questionnaire (specificity 0.918 and 0.935, respectively). The combination of the two later items resulted in an almost perfect reclassification of cases (kappa = 0.955 +/- 0.022; specificity = 0.971).

CONCLUSIONS

As anger attacks are probably underdiagnosed in clinical practice, simplification of the diagnostic process is imperative. Our results demonstrate that asking one or two simple screening questions suffices to recognize the majority of patients with anger attacks.

Reflections on relevance: Psychotherapy and Psychosomatics in 2005

This article focuses on the mission and relevance of articles published in Psychotherapy and Psychosomatics in 2005. Four areas of articles relevant to the mission of Psychotherapy and Psychosomatics are reviewed: (1) new (psycho-)therapies; (2) cognitive-behavioral therapy; (3) new or newly defined psychopathology, and (4) the impact of or impairment due to various illnesses or treatments. In addition, other clinically important and relevant issues, such as the need for new treatments, suicide during psychotherapy, technological innovations used in psychotherapies and methodology of psychotherapy trials are discussed.