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Aggestrup AS, Martiny F, Lund Henriksen L, Davidsen AS, Martiny K. Interventions promoting recovery from depression for patients transitioning from outpatient mental health services to primary care: A scoping review. PLoS One 2024; 19:e0302229. [PMID: 38709769 PMCID: PMC11073719 DOI: 10.1371/journal.pone.0302229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/28/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Major Depressive Disorder (MDD) is one of the most prevalent mental disorders worldwide with significant personal and public health consequences. After an episode of MDD, the likelihood of relapse is high. Therefore, there is a need for interventions that prevent relapse of depression when outpatient mental health care treatment has ended. This scoping review aimed to systematically map the evidence and identify knowledge gaps in interventions that aimed to promote recovery from MDD for patients transitioning from outpatient mental health services to primary care. MATERIALS AND METHODS We followed the guidance by Joanna Briggs Institute in tandem with the PRISMA extension for Scoping Reviews checklist. Four electronic databases were systematically searched using controlled index-or thesaurus terms and free text terms, as well as backward and forward citation tracking of included studies. The search strategy was based on the identification of any type of intervention, whether simple, multicomponent, or complex. Three authors independently screened for eligibility and extracted data. RESULTS 18 studies were included for review. The studies had high heterogeneity in design, methods, sample size, recovery rating scales, and type of interventions. All studies used several elements in their interventions; however, the majority used cognitive behavioural therapy conducted in outpatient mental health services. No studies addressed the transitioning phase from outpatient mental health services to primary care. Most studies included patients during their outpatient mental health care treatment of MDD. CONCLUSIONS We identified several knowledge gaps. Recovery interventions for patients with MDD transitioning from outpatient mental health services to primary care are understudied. No studies addressed interventions in this transitioning phase or the patient's experience of the transitioning process. Research is needed to bridge this gap, both regarding interventions for patients transitioning from secondary to primary care, and patients' and health care professionals' experiences of the interventions and of what promotes recovery. REGISTRATION A protocol was prepared in advance and registered in Open Science Framework (https://osf.io/ah3sv), published in the medRxiv server (https://doi.org/10.1101/2022.10.06.22280499) and in PLOS ONE (https://doi.org/10.1371/journal.pone.0291559).
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Affiliation(s)
- Anne Sofie Aggestrup
- The Research Unit for Mental Health Centre Copenhagen, Copenhagen Affective Disorder Research Centre (CADIC), New Interventions in Depression (NID) Group, Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Frederiksberg Hospital, Frederiksberg, Denmark
| | - Frederik Martiny
- The Research Unit for and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Social Medicine, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Line Lund Henriksen
- The Research Unit for Mental Health Centre Copenhagen, Copenhagen Affective Disorder Research Centre (CADIC), New Interventions in Depression (NID) Group, Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Frederiksberg Hospital, Frederiksberg, Denmark
| | - Annette Sofie Davidsen
- The Research Unit for and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Martiny
- The Research Unit for Mental Health Centre Copenhagen, Copenhagen Affective Disorder Research Centre (CADIC), New Interventions in Depression (NID) Group, Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Frederiksberg Hospital, Frederiksberg, Denmark
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Strawn JR, Mills JA, Suresh V, Mayes T, Gentry MT, Trivedi M, Croarkin PE. The impact of age on antidepressant response: A mega-analysis of individuals with major depressive disorder. J Psychiatr Res 2023; 159:266-273. [PMID: 36774767 PMCID: PMC9993423 DOI: 10.1016/j.jpsychires.2023.01.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Understanding how age affects antidepressant response in patients with major depressive disorder has been complicated by small and heterogeneous studies. Yet, understanding how age-across the lifespan-contributes to variation in response could inform treatment selection across the lifespan. This study sought to identify how age impacts antidepressant response using participant-level data from large, NIH-sponsored trials in individuals with MDD aged 12-74 years. MATERIALS AND METHODS Participant-level data were abstracted from three NIH-sponsored trials of pharmacotherapy (Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) Study, Treatment of Adolescent Depression Study (TADS), and the Combining Medications to Enhance Depression Outcomes Study (COMED)) in patients with MDD. Bayesian Hierarchical Models (BHMs) of individual treatment trajectories were developed using Hamiltonian Monte Carlo No U-Turn Sampling. The individual trajectory of improvement in depressive symptoms (Clinical Global Impression-Severity [CGI-S] and CGI-S equivalent from COMED) was modeled across studies and across individuals with logarithmic trend "random effects" coefficients BHMs. Age and sex (and their interaction) were examined categorically across patients. RESULTS Study participants (N = 907) were 29.7 ± 17 years of age, 66.3% women, and had a mean baseline CGI-S score of 4.6 ± 0.9. Patients ≤21 years and those >55 years had slower and less response to pharmacotherapy compared to those aged 21-35. Additionally, women improved more than men, and this effect did not differ across ages. DISCUSSION The patient's age should be considered in predicting antidepressant response, particularly in older and younger individuals who may benefit from other interventions to enhance treatment response.
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Affiliation(s)
- Jeffrey R Strawn
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH 45219, USA; Department of Pediatrics, Divisions of Clinical Pharmacology and Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45267, USA.
| | - Jeffrey A Mills
- Carl H. Lindner College of Business, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Vikram Suresh
- Carl H. Lindner College of Business, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Taryn Mayes
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX 75235, USA
| | - Melanie T Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Madhukar Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX 75235, USA
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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Solis EC, Carlier IVE, van der Wee NJA, van Hemert AM. The clinical and cost-effectiveness of a self-management intervention for patients with persistent depressive disorder and their partners/caregivers: study protocol of a multicenter pragmatic randomized controlled trial. Trials 2021; 22:731. [PMID: 34688307 PMCID: PMC8542316 DOI: 10.1186/s13063-021-05666-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/28/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND After regular treatment, patients with persistent depressive disorder (PDD) may remain in specialized psychiatric outpatient care without achieving remission. Lacking other options, these patients often receive long-term, non-protocolized care as usual (CAU) that does not involve the partner/caregiver of the patient. Although the revised depression treatment guidelines suggest focusing on psychiatric rehabilitation and self-management as the next treatment step for PDD, an evidence-based cost-effective self-management protocol for PDD is lacking. This study investigates the "Patient and Partner Education Program for All Chronic Illnesses" (PPEP4All) as a brief self-management protocol that could lead to lower costs, higher quality of life, and less disease burden in PDD patients and their partners/caregivers. METHODS Presented is the rationale and methods of a multicenter pragmatic randomized controlled trial to evaluate the clinical efficacy and cost-effectiveness of PPEP4All for patients with PDD and their partners/caregivers. In accordance with current recommendations, a mixed methods research approach is used with both quantitative and qualitative data. A total of 178 eligible outpatients with PDD and their partners/caregivers are recruited and randomized to either PPEP4All or CAU. Those assigned to PPEP4All receive nine weekly self-management sessions with a trained PPEP4All therapist. Primary and secondary outcome measurements are at 0, 3, 6, and 12 months. DISCUSSION This project will result in the implementation of a self-management intervention for patients with PDD, meeting an urgent need in mental healthcare. Using PPEP4All can optimize the quality and efficiency of care for both patients with PDD and their partners/caregivers. TRIAL REGISTRATION Netherlands Trial Register Identifier NTR5973 . Registered on 20 July 2016.
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Affiliation(s)
- Ericka C. Solis
- Department of Psychiatry, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Ingrid V. E. Carlier
- Department of Psychiatry, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Nic J. A. van der Wee
- Department of Psychiatry, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Albert M. van Hemert
- Department of Psychiatry, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Zoun MHH, Koekkoek B, Sinnema H, van der Feltz-Cornelis CM, van Balkom AJLM, Schene AH, Smit F, Spijker J. Effectiveness of a self-management training for patients with chronic and treatment resistant anxiety or depressive disorders on quality of life, symptoms, and empowerment: results of a randomized controlled trial. BMC Psychiatry 2019; 19:46. [PMID: 30691421 PMCID: PMC6348638 DOI: 10.1186/s12888-019-2013-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 01/04/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Anxiety and depressive disorders are common mental disorders. A substantial part of patients does not achieve symptomatic remission after treatment in specialized services. Current care as usual (CAU) for these patients consists of long-term supportive contacts. Termination of CAU is often not considered to be an option due to persistent symptoms, a low level of functioning, and the absence of further treatment options. A new intervention, ZemCAD, offers a program focused on rehabilitation and self-management, followed by referral back to primary care. METHODS This multicenter randomized controlled trial was carried out in twelve specialized outpatient mental health care services in the Netherlands. Consenting and eligible patients were invited for the MINI interview and the baseline questionnaire. Assessments were done at 6 (T1), 12 (T2) and 18 (T3) months post baseline. We used linear mixed model analysis (LMM) to ascertain the effectiveness of the ZemCAD group relative to the CAU group on quality of life, symptom severity and empowerment. RESULTS In total 141 patients were included. The results at 18-month follow-up regarding to quality of life and symptom severity, showed no significant differences between the ZemCAD group and the CAU group, except on the 'social relationships'-domain (d = 0.37). With regard to empowerment a significant difference between both groups was observed in the total empowerment score and one empowerment dimension (d = 0.45 and d = 0.39, respectively). After the ZemCAD intervention, more patients went from specialized outpatient mental health services back to a less specialized health care setting with less intensive treatment, such as primary care. CONCLUSION The findings in this study suggest that patients with chronic and treatment-resistant anxiety and depression using the ZemCAD intervention improve on empowerment but not on symptom severity or quality of life. Since little is known about the effects of rehabilitation and self-management in patients with chronic and treatment resistant anxiety and depressive disorders, this is a first attempt to provide a proof-of-concept study in this under-researched but important field. TRIAL REGISTRATION Netherlands Trial Register: NTR3335 , registered 7 March 2012.
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Affiliation(s)
- Maringa H. H. Zoun
- 0000 0004 0444 9382grid.10417.33Behavioural Science Institute, Radboud University Medical Center, PO Box 9104, 6500 HE Nijmegen, The Netherlands ,0000 0004 0466 1666grid.491369.0Pro Persona Mental Health Care, Wolfheze 2, 6874 BE, Wolfheze, The Netherlands ,0000 0004 0466 1666grid.491369.0Pro Persona Mental Health Care, Wagnerlaan 2, 6815, AG Arnhem, The Netherlands
| | - Bauke Koekkoek
- 0000 0004 0466 1666grid.491369.0Pro Persona Mental Health Care, Wolfheze 2, 6874 BE, Wolfheze, The Netherlands ,0000 0000 8809 2093grid.450078.eResearch Group for Social Psychiatry and Mental Health Nursing, HAN University of Applied Science, PO Box 6960, 6503 GL Nijmegen, The Netherlands
| | - Henny Sinnema
- Institute for Nursing Studies, HU University of Applied Sciences, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands
| | - Christina M. van der Feltz-Cornelis
- 0000 0004 0418 4513grid.491213.cTop Clinical Centre for Body, Mind and Health, GGZ Breburg, Lage Witsiebaan 4, 5042 DA Tilburg, The Netherlands ,0000 0004 1936 9668grid.5685.eDepartment of Health Sciences, HYMS, York Biomedical Research Institute, University of York, Room ARRC/204, Area 4, ARRC Building, YO10 5DD Yorkshire Heslington, UK
| | - Anton J. L. M. van Balkom
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Psychiatry and Amsterdam Public Health Research Institute, VU University Medical Centre and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | - Aart H. Schene
- 0000 0004 0444 9382grid.10417.33Department of Psychiatry, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands ,0000000122931605grid.5590.9Donders Institute for Brain, Cognition and Behavior, Radboud University, Montessorilaan 3, 6525 HR, Nijmegen, The Netherlands
| | - Filip Smit
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Clinical, Neuro and Developmental Psychology, VU University Medical Centre, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands ,0000 0004 0435 165Xgrid.16872.3aDepartment of Epidemiology and Biostatistics, VU University Medical Centre, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands ,0000 0001 0835 8259grid.416017.5Trimbos Institute (Netherlands Institute of Mental Health and Addiction), PO Box 725, 3500 AS Utrecht, The Netherlands
| | - Jan Spijker
- 0000 0004 0444 9382grid.10417.33Behavioural Science Institute, Radboud University Medical Center, PO Box 9104, 6500 HE Nijmegen, The Netherlands ,0000 0004 0466 1666grid.491369.0Pro Persona Mental Health Care, Wolfheze 2, 6874 BE, Wolfheze, The Netherlands
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Köhler S, Chrysanthou S, Guhn A, Sterzer P. Differences between chronic and nonchronic depression: Systematic review and implications for treatment. Depress Anxiety 2019; 36:18-30. [PMID: 30300454 DOI: 10.1002/da.22835] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/20/2018] [Accepted: 08/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is still uncertainty if and to what extent chronic depression (CD) presents with specific features especially in contrast to the nonchronic course of major depressive disorder (non-CD). This systematic review aims to summarize the existing literature regarding sociodemographic factors, psychopathology, and course of disease in patients with CD in comparison to patients with non-CD. METHODS A structured database search (MEDLINE, PsycINFO, Web of Science, CENTRAL) was performed. All studies comparing CD with non-CD patients were included. Twenty-eight studies, including cohort studies, cross-sectional studies, and observational studies, were identified in which both subgroups were diagnosed according to DSM-IV or DSM-5, respectively. Primary outcome were group comparisons focused on sociodemographic factors, childhood adversity, onset of the disorder, comorbidities, severity and course of the depressive symptoms, and specific psychopathology. RESULTS Patients with CD had an earlier onset of depressive symptoms, higher rates of psychiatric comorbidities, and a complicated treatment course (e.g., higher rates of suicidality) compared to non-CD. We also found some evidence for specific features in the psychopathology of CD patients (submissive and hostile interpersonal styles) in contrast to non-CD patients. Results were inconsistent with regard to childhood maltreatment. No differences were found regarding the severity of depressive symptoms and most sociodemographic factors. CONCLUSION Despite some inconsistencies, the results of this review verified important differences between CD and non-CD. However, future research is needed to characterize especially the specific psychopathology of CD in comparison to non-CD patients to develop more tailored treatment strategies.
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Affiliation(s)
- Stephan Köhler
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Sophia Chrysanthou
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Anne Guhn
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Philipp Sterzer
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
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Abstract
UNLABELLED ABSTRACTBackground:The use of the pharmacopsychometric triangle to enhance patient-reported well-being as the ultimate goal of treatment has most intensively been studied in patients with a major depressive episode. METHODS The review is structured on the pharmacopsychometric triangle in which the desired clinical effect of an antidepressive medication is balanced against the undesired side effects induced by this medication in terms of restored well-being. As a biological treatment, the antidepressive medication is compared clinically with both electroconvulsive therapy and psychological treatment. RESULTS In the process of this review, evidence from a dose-response study in patients suffering from a major depressive episode with an adequate duration and symptom severity has demonstrated that the dose-response relationship emerged when using the patient-reported well-being outcome rather than the symptomatic reduction as outcome. CONCLUSION The pharmacopsychometric triangle is in patients with major depressive episodes providing important information within positive psychiatry.
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Zoun MHH, Koekkoek B, Sinnema H, Muntingh ADT, van Balkom AJLM, Schene AH, Smit F, Spijker J. Effectiveness and cost-effectiveness of a self-management training for patients with chronic and treatment resistant anxiety or depressive disorders: design of a multicenter randomized controlled trial. BMC Psychiatry 2016; 16:216. [PMID: 27388878 PMCID: PMC4936240 DOI: 10.1186/s12888-016-0927-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 06/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many patients with anxiety or depressive disorders achieve no remission of their symptoms after evidence-based treatment algorithms. They develop a chronic course of the disorder. Current care for these patients usually consists of long-term supportive contacts with a community psychiatric nurse and pharmacological management by a psychiatrist. Data on the effectiveness of these treatments is lacking. A psychosocial rehabilitation approach, where self-management is an increasingly important part, could be more suitable. It focuses on the restoration of functioning and enhancement of patients' autonomy and responsibility. Treatment with this focus, followed by referral to primary care, may be more (cost-)effective. METHODS A multicenter randomized controlled trial is designed for twelve participating specialized outpatient mental health services in the Netherlands. Patients with chronic and treatment resistant anxiety or depressive disorders, currently receiving supportive care in specialized outpatient mental health care, are asked to participate. After inclusion, patients receive the baseline questionnaire and are randomized to the intervention group or the usual care control group. The intervention focuses on rehabilitation and self-management and is provided by a trained community psychiatric nurse, followed by referral to primary care. Measurements take place at 6, 12, and 18 months after baseline. This study evaluates both the effectiveness (on quality of life, symptom severity, and empowerment), and cost-effectiveness of the intervention compared to usual care. In addition, a questionnaire is designed to get insight in which self-management strategies patients use to manage their disorder, and in the experiences of patients with the change of care setting. DISCUSSION In this study we evaluate the effectiveness and cost-effectiveness of a self-management intervention for patients with chronic and treatment resistant anxiety or depressive disorders in specialized outpatient mental health care. The results of this study may provide a first 'proof-of-concept' in this under-researched but important field, and might be relevant for a large group of patients in the context of a transition of the Dutch health care system. TRIAL REGISTRATION Netherlands Trial Register: NTR3335 , registered 7 March 2012.
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Affiliation(s)
- Maringa H. H. Zoun
- />Behavioural Science Institute, Radboud University Medical Center, PO Box 9104, 6500 HE Nijmegen, The Netherlands
- />Pro Persona Mental Health Care, Wolfheze 2, 6874 BE Wolfheze, The Netherlands
| | - Bauke Koekkoek
- />Pro Persona Mental Health Care, Wolfheze 2, 6874 BE Wolfheze, The Netherlands
- />Research Group for Social Psychiatry & Mental Health Nursing, HAN University of Applied Science, PO Box 6960, 6503 GL Nijmegen, The Netherlands
| | - Henny Sinnema
- />Trimbos Institute (Netherlands Institute of Mental Health and Addiction), PO Box 725, 3500 AS Utrecht, The Netherlands
| | - Anna D. T. Muntingh
- />Department of Psychiatry and EMGO+ Institute, VU University Medical Centre and GGZ inGeest, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
| | - Anton J. L. M. van Balkom
- />Department of Psychiatry and EMGO+ Institute, VU University Medical Centre and GGZ inGeest, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
| | - Aart H. Schene
- />Department of Psychiatry, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Filip Smit
- />Trimbos Institute (Netherlands Institute of Mental Health and Addiction), PO Box 725, 3500 AS Utrecht, The Netherlands
- />Department of Clinical, Neuro and Developmental Psychology, VU University Medical Centre, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
- />Department of Epidemiology and Biostatistics, VU University Medical Centre, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Jan Spijker
- />Behavioural Science Institute, Radboud University Medical Center, PO Box 9104, 6500 HE Nijmegen, The Netherlands
- />Pro Persona Mental Health Care, Wolfheze 2, 6874 BE Wolfheze, The Netherlands
- />Trimbos Institute (Netherlands Institute of Mental Health and Addiction), PO Box 725, 3500 AS Utrecht, The Netherlands
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Boschloo L, Schoevers RA, Beekman ATF, Smit JH, van Hemert AM, Penninx BWJH. The four-year course of major depressive disorder: the role of staging and risk factor determination. PSYCHOTHERAPY AND PSYCHOSOMATICS 2015; 83:279-88. [PMID: 25116639 DOI: 10.1159/000362563] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 03/29/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Much is still unclear about the mechanisms underlying the course of major depressive disorder (MDD). This study aimed to identify risk factors that predict a poor prognosis of MDD while taking into consideration its chronicity at baseline. METHODS In patients with MDD (n = 767), we examined whether baseline clinical factors, sociodemographics, childhood trauma, personality and life events predicted the 4-year course (i.e., sustained recovery, temporary recovery and chronic course) of MDD. Baseline chronicity of MDD was taken into account by testing whether associations were different for patients with nonchronic versus chronic MDD at baseline. RESULTS In patients with nonchronic MDD at baseline, 27.8% developed a chronic disorder during follow-up, whereas 53.0% of patients with chronic MDD at baseline had a persistent chronic disorder during follow-up. Severity of MDD, childhood trauma and greater age were important general risk factors for a poor prognosis, independent of MDD chronicity at baseline. In contrast, low extraversion was only important for the course of nonchronic MDD at baseline, while higher education and negative life events (in patients with high neuroticism) were only relevant for the course of chronic MDD at baseline. CONCLUSIONS One out of 4 patients with nonchronic MDD progressed to a chronic disorder, while half of the patients with chronic MDD remained chronic during follow-up. Since several risk factors for a poor prognosis differed for patients with nonchronic and chronic MDD at baseline, treatment targets should be adjusted for current chronicity of MDD.
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Affiliation(s)
- Lynn Boschloo
- University of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE)/University Center Psychiatry (UCP), University Medical Center Groningen, Groningen
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Langenecker SA, Jacobs RH, Passarotti AM. Current Neural and Behavioral Dimensional Constructs across Mood Disorders. Curr Behav Neurosci Rep 2014; 1:144-153. [PMID: 25147755 DOI: 10.1007/s40473-014-0018-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Our understanding of the underlying neurobiology for mood disorders is still limited. We present an integrated model for conceptualizing and understanding mood disorders drawing upon a broad literature pertinent to mood disorders. The integrated model of emotion processing and regulation incorporates the linguistic constructs of the Research Domain Criteria (RDoC) initiative. In particular, we focus on the Positive Valence domain/circuit (PVC), highlighting recent reward research and the Negative Valence domain/circuit (NVC), highlighting rumination. Furthermore, we also illustrate the Cognitive Control and Problem Solving (CCaPS) circuit, which is heavily involved in emotion regulation, as well as the default mode network (DMN) and interactions between circuits. We conclude by proposing methods for addressing challenges in the developmental study of mood disorders including using high-risk design that incorporates risk for many disorders.
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Affiliation(s)
- Scott A Langenecker
- The University of Illinois at Chicago Department of Psychiatry ; The University of Illinois at Chicago Cognitive Neuroscience Center
| | - Rachel H Jacobs
- The University of Illinois at Chicago Department of Psychiatry ; The University of Illinois at Chicago Cognitive Neuroscience Center ; The University of Illinois at Chicago Institute for Juvenile Research
| | - Alessandra M Passarotti
- The University of Illinois at Chicago Department of Psychiatry ; The University of Illinois at Chicago Cognitive Neuroscience Center ; The University of Illinois at Chicago Institute for Juvenile Research
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Persistence of chronic major depression: a national prospective study. J Affect Disord 2013; 151:306-12. [PMID: 23866303 DOI: 10.1016/j.jad.2013.06.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/07/2013] [Accepted: 06/08/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic major depressive disorder (CMDD) is highly prevalent and associated with high personal and societal cost. Identifying risk factors for persistence and remission of CMDD may help in developing more effective treatment and prevention interventions. METHODS Prospective cohort study of individuals participating in the National Epidemiologic Survey on Alcohol and Related Conditions (Wave 1; n=43,093) and its 3-year follow-up (Wave 2; n=34,653) who met a diagnosis of CMDD at the Wave 1 assessment. RESULTS Among the 504 respondents who met criteria for present CMDD at Wave 1, only 63 (11.52%) of them continued to meet criteria of CMDD. A history of childhood sexual abuse, earlier onset of MDD, presence of comorbidity and a history of treatment-seeking for depression predicted persistence of CMDD three years after the baseline evaluation. LIMITATIONS Our sample is limited to adults, our follow-up period was only three-years and the diagnosis of CMDD at baseline was retrospective. CONCLUSIONS CMDD shows high rates of remission within three years of baseline assessment, although some specific risk factors predict a persistent course. Given the high personal and societal cost associated with CMDD, there is a need to develop and disseminate effective interventions for CMDD.
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Spijker J, van Straten A, Bockting CLH, Meeuwissen JAC, van Balkom AJLM. Psychotherapy, antidepressants, and their combination for chronic major depressive disorder: a systematic review. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:386-92. [PMID: 23870720 DOI: 10.1177/070674371305800703] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Recommendations for treatment of chronic major depressive disorder (cMDD) are mostly based on clinical experiences and on the literature on treatment-resistant depression (TRD) but not on a systematic review of the literature. METHOD We conducted a systematic review of 10 randomized controlled trials (RCTs), with 17 comparisons between antidepressants (ADs), psychotherapy, or the combination of both interventions. RESULTS The best evidence is for the combination of psychotherapy and ADs, and especially for the combination of the cognitive behavourial analysis system of psychotherapy and ADs. Evidence is very weak for both ADs alone and psychotherapy alone. Assessment of TRD was mostly absent in the studies. CONCLUSION The best treatment for cMDD is a combination of psychotherapy and ADs. However, there is a lack of well-performed RCTs in both ADs and psychotherapy and their combination for cMDD. Therefore, the conclusions are preliminary.
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Affiliation(s)
- Jan Spijker
- Program for Mood Disorders Pro Persona, Mental Health Care, Nijmegen, the Netherlands.
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Murphy JA, Byrne GJ. Prevalence and correlates of the proposed DSM-5 diagnosis of Chronic Depressive Disorder. J Affect Disord 2012; 139:172-80. [PMID: 22381955 DOI: 10.1016/j.jad.2012.01.033] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 01/30/2012] [Accepted: 01/30/2012] [Indexed: 10/28/2022]
Abstract
CONTEXT The draft proposal to add Chronic Depressive Disorder to DSM-5 will combine DSM-IV Dysthymic Disorder and Major Depressive Disorder, with chronic specifier, into a single diagnosis. OBJECTIVE The objective of this study is to estimate the prevalence and correlates of the proposed DSM-5 diagnosis of Chronic Depressive Disorder using unit record data from the 2007 Australian National Survey of Mental Health and Wellbeing. DESIGN Secondary analysis of a nationally representative household survey. SETTING Urban and rural census tracts. PARTICIPANTS One individual between the ages of 16 and 85 years from 8841 households was interviewed for the survey. MAIN OUTCOME MEASURE Lifetime prevalence estimates for chronic and non-chronic depression were determined using data from the World Health Organization's Composite International Diagnostic Interview, version 3.0 (WMH-CIDI 3.0). RESULTS Chronic depression of at least two years' duration had a lifetime prevalence of 4.6% (95% CI: 3.9-5.3%) and was found in 29.4% (95% CI: 25.6-33.3%) of individuals with a lifetime depressive disorder. Higher rates of psychiatric co-morbidity (OR=1.42; 95% CI=1.26-1.61), older age (OR=1.04; 95% CI=1.02-1.05), a younger age of onset (OR=0.97; 95% CI=0.95-0.98) and more frequent episodes of depression (OR=1.75; 95% CI=1.07-2.86) were found to be significant correlates of chronic depression. The first episode of depression for individuals with chronic depression often developed after the death of someone close (OR=2.38; 95% CI 1.16-5.79). CONCLUSIONS Chronic depression is highly prevalent among community-residing persons and has a set of correlates that discriminate it from non-chronic depression. The distinction between chronic and non-chronic depression proposed for DSM-5, in the form of Chronic Depressive Disorder, seems to be warranted.
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Affiliation(s)
- Jenifer A Murphy
- The University of Queensland, School of Medicine, Academic Discipline of Psychiatry, K Floor, Mental Health Centre, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia.
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van Noorden MS, van Fenema EM, van der Wee NJA, Zitman FG, Giltay EJ. Predicting outcome of depression using the depressive symptom profile: the Leiden Routine Outcome Monitoring Study. Depress Anxiety 2012; 29:523-30. [PMID: 22555849 DOI: 10.1002/da.21958] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 03/26/2012] [Accepted: 03/30/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To investigate the predictive value of items for individual depressive symptoms measured with the self-rated Beck Depression Inventory-Revised (BDI-II) self-report scale on outcome in a large naturalistic cohort of depressive outpatients. METHODS We used a cohort of 1,489 adult patients aged 18-65 years with major depressive disorder or dysthymic disorder established with the MINI-Plus diagnostic interview. All patients had a routine outcome monitoring baseline measurement in 2004-2009, with a maximum of 2 years follow-up. We used multivariable Cox regression models to predict remission (MADRS < 10; where MADRS stands for Montgomery-Åsberg Depression Rating Scale) and response (≥50% improvement), and adjusted for clinical and demographic characteristics (i.e. marital status, level of education, working status, comorbid anxiety, avoidant and borderline personality traits, and suicidality) that were identified as predictors in earlier studies. RESULTS Of the 21 BDI-II items, the items "pessimism" and "loss of energy" independently predicted for both remission and response. For pessimism, the hazard ratio (HR) for remission was 0.81 (95% confidence interval [CI]: 0.73-0.89, P < .001) and for loss of energy, the HR was 0.81 (95% CI: 0.72-0.92, P = .001). CONCLUSIONS These findings of robust prediction of poor outcome by baseline items of "pessimism" and "loss of energy" in a naturalistic treatment setting may help clinicians to identify depressive patients in need for additional or alternative therapeutic approaches.
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Affiliation(s)
- Martijn S van Noorden
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
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14
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Xia J, He Q, Li Y, Xie D, Zhu S, Chen J, Shen Y, Zhang N, Wei Y, Chen C, Shen J, Zhang Y, Gao C, Li Y, Ding J, Shen W, Wang Q, Cao M, Liu T, Zhang J, Duan H, Bao C, Ma P, Zhou C, Luo Y, Zhang F, Liu Y, Li Y, Jin G, Zhang Y, Liang W, Chen Y, Zhao C, Li H, Chen Y, Shi S, Kendler KS, Flint J, Wang X. The relationship between neuroticism, major depressive disorder and comorbid disorders in Chinese women. J Affect Disord 2011; 135:100-5. [PMID: 21824661 PMCID: PMC3220767 DOI: 10.1016/j.jad.2011.06.053] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 06/29/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The personality trait of neuroticism is a risk factor for major depressive disorder (MDD), but this relationship has not been demonstrated in clinical samples from Asia. METHODS We examined a large-scale clinical study of Chinese Han women with recurrent major depression and community-acquired controls. RESULTS Elevated levels of neuroticism increased the risk for lifetime MDD (with an odds ratio of 1.37 per SD), contributed to the comorbidity of MDD with anxiety disorders, and predicted the onset and severity of MDD. Our findings largely replicate those obtained in clinical populations in Europe and US but differ in two ways: we did not find a relationship between melancholia and neuroticism; we found lower mean scores for neuroticism (3.6 in our community control sample). LIMITATIONS Our findings do not apply to MDD in community-acquired samples and may be limited to Han Chinese women. It is not possible to determine whether the association between neuroticism and MDD reflects a causal relationship. CONCLUSIONS Neuroticism acts as a risk factor for MDD in Chinese women, as it does in the West and may particularly predispose to comorbidity with anxiety disorders. Cultural factors may have an important effect on its measurement.
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Affiliation(s)
- Jing Xia
- ShengJing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, Liaoning, 110817, PR China
| | - Qiang He
- ShengJing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, Liaoning, 110817, PR China
| | - Yihan Li
- Wellcome Trust Centre for Human Genetics, Oxford OX3 7BN, UK
| | - Dong Xie
- Wellcome Trust Centre for Human Genetics, Oxford OX3 7BN, UK
| | - Suoyu Zhu
- Fudan University affiliated Huashan Hospital, No. 12 Wulumuqi Zhong Road, Shanghai, 200040, PR China
| | - Jing Chen
- Shanghai Jiao Tong University School of Medicine affiliated Shanghai Mental Health Centre, No. 600 Wan Ping Nan Road, Shanghai 200030, PR China
| | - Yuan Shen
- Shanghai Tongji University affiliated Tongji Hospital, No. 389 Xinchun Road, Shanghai 200065, PR China
| | - Ning Zhang
- Nanjing Brain Hospital, No. 264 Guangzhou Road, Nanjing, Jiangsu, 210029, PR China
| | - Yan Wei
- No. 4 Affiliated Hospital of Jiangsu University, No. 246 Nan Men Da Street, Zhenjiang, Jiangsu, 212001, PR China
| | - Chunfeng Chen
- Zhejiang Traditional Chinese Medical Hospital, No. 54 You Dian Road, Hangzhou, Zhejiang 310006, PR China
| | - Jianhua Shen
- Tianjin Anding Hospital, No.13 Liu Lin Road, Hexi District, Tianjin, 300222, PR China
| | - Yan Zhang
- Shandong Mental Health Center, No. 49 East Wenhua Road, Jinan, Shandong 250014, PR China
| | - Chengge Gao
- No. 1 Hospital of Medical College of Xian Jiaotong University, No. 277 West Yan Ta Road, Xi'an, Shaanxi, 710061, PR China
| | - Youhui Li
- No.1 Hospital of Zhengzhou University, No.1 East Jianshe Road, Zhengzhou, Henan 450052, PR China
| | - Jihong Ding
- No. 1 Mental Health Center Affiliated Harbin Medical University, No 23 You Zheng Jie, Nangang District, Harbin, Heilongjiang, PR China
| | - Wenwu Shen
- Mental Health Center of West China Hospital of Sichuan University, No. 28 Dian Xin Nan Jie, Wu Hou District, Chengdu, Sichuan 610041, PR China
| | - Qian Wang
- Beijing Anding Hospital, Capital Medical University, No.5 An Kang Hutong Deshengmen wai, Xicheng District, Beijing 100088, PR China
| | - Meiyue Cao
- Hebei Mental Health Center, No.572 Dongfeng Road, Baoding, Hebei 071000, PR China
| | - Tiebang Liu
- Shenzhen Kangning Hospital, No.1080, Cui Zu Street, Luo Hu, Shenzhen, 518020, PR China
| | - Jinbei Zhang
- No. 3 Affiliated Hospital of Sun Yat-sen University, No.600 Tian He Road, Tian He District, Guangzhou, Guangdong, 510630, PR China
| | - Huijun Duan
- No.1 Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Taiyuan, Shanxi, 030001, PR China
| | - Cheng Bao
- Mental Hospital of Jiangxi Province, No. 43 Shangfang Road, Nanchang, Jiangxi, 330029, PR China
| | - Ping Ma
- The First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Guangzhou, 510630, PR China
| | - Cong Zhou
- Wuhan Mental Health Center, No.70, You Yi Road, Wuhan, 430022, PR China
| | - Yanfang Luo
- No.3 Hospital of Heilongjiang Province, No.135 Jiao Tong Lu, Beian, Heilongjiang, PR China
| | - Fengzhi Zhang
- Jilin Brain Hospital, No.98 Zhong Yang Xi Lu, Siping, Jilin, 136000, PR China
| | - Ying Liu
- The First Hospital of China Medical University, No.155 Nanjing Bei Jie, He Ping District, Shenyang, 110001, PR China
| | - Yi Li
- Dalian No. 7 People's Hospital & Dalian Mental Health Center, No.179 Ling Shui Lu, Gan Jing Zi District, Dalian, PR China
| | - Guixing Jin
- The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031, PR China
| | - Yutang Zhang
- Lanzhou University Second Hospital, Second Clinical Medical College of Lanzhou University, No. 82, Cui Ying Men, Lanzhou, Gansu, 730030, PR China
| | - Wei Liang
- Psychiatric Hospital of Henan Province, No.388 Jian She Zhong Lu, Xinxiang, Henan, PR China
| | - Yunchun Chen
- The Fourth Military Medical University affiliated Xijing Hospital, No.17, Changle West Road, Xi'an, Shaanxi, 710032, PR China
| | - Changyin Zhao
- No. 4 People's Hospital of Liaocheng, No. 47 Hua Yuan Bei Road, Liaocheng, Shandong, 252000, PR China
| | - Haiyan Li
- Guangzhou Brain Hospital/Guangzhou Psychiatric Hospital, No.36 Ming Xin Lu, Fang Cun Da Dao, Li Wan District, Guangzhou 510370, PR China
| | - Yiping Chen
- Clinical Trial Service Unit, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Shenxun Shi
- Fudan University affiliated Huashan Hospital, No. 12 Wulumuqi Zhong Road, Shanghai, 200040, PR China
- Shanghai Jiao Tong University School of Medicine affiliated Shanghai Mental Health Centre, No. 600 Wan Ping Nan Road, Shanghai 200030, PR China
| | - Kenneth S. Kendler
- Virginia Commonwealth University, Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA 23298-0126, USA
| | - Jonathan Flint
- Wellcome Trust Centre for Human Genetics, Oxford OX3 7BN, UK
- Corresponding author at: Department of Psychiatry, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, Liaoning, 100004, PR China.
| | - Xumei Wang
- ShengJing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, Liaoning, 110817, PR China
- Corresponding author at: Department of Psychiatry, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, Liaoning, 100004, PR China.
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Ley P, Helbig-Lang S, Czilwik S, Lang T, Worlitz A, Brücher K, Petermann F. Phenomenological differences between acute and chronic forms of major depression in inpatients. Nord J Psychiatry 2011; 65:330-7. [PMID: 21271948 DOI: 10.3109/08039488.2011.552121] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Chronic forms of depression are highly prevalent especially in inpatient settings. Defined only by episode duration greater than 2 years, heterogeneous diagnoses like dysthymic disorder, double depression, major depression and recurrent major depression are included. Chronic depression is considered difficult to treat, although its distinguishing characteristics remain unclear. AIMS The purpose of the present study was empirically to approach proposed differences between acute and chronic forms of depression. METHODS 80 psychiatric inpatients positively screened for depression and diagnosed with the Composite International Diagnostic Interview (CIDI), completed a set of questionnaires regarding symptom severity (a simplified version of the Beck Depression Inventory), dysfunctional attitudes (Dysfunctional Attitudes Scale), ruminative response style (Response Styles Questionnaire, Why Ruminate Scale) and interpersonal problems (Inventory of Interpersonal Problems; IIP). RESULTS 30 patients were diagnosed with chronic forms of depression; 34 patients with acute depression. Patients did not differ regarding symptom severity, ruminative response styles, all but one subscales of the IIP or presence of comorbid post-traumatic stress disorder. However, chronic depression did show higher dysfunctional attitudes than acute depression, and reported higher rates of socially avoidant behavior. CONCLUSIONS In line with previous findings, acute and chronic forms of depression differed in dysfunctional attitudes, which might actually reflect a distinguishing pattern of chronicity. Chronic depression patients also reported higher socially avoidant behavior, which might be crucial to focus in treatment. Surprisingly, other variables that are assumed to characterize chronic depression could not be confirmed as distinguishing features. Future research should take etiological aspects into account.
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Affiliation(s)
- Pia Ley
- Biological Psychology and Neuropsychology, University of Hamburg, Von-Melle-Park 11, D-20146 Hamburg, Germany.
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16
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Rubio JM, Markowitz JC, Alegría A, Pérez-Fuentes G, Liu SM, Lin KH, Blanco C. Epidemiology of chronic and nonchronic major depressive disorder: results from the national epidemiologic survey on alcohol and related conditions. Depress Anxiety 2011; 28:622-31. [PMID: 21796739 PMCID: PMC3212845 DOI: 10.1002/da.20864] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Burden related to major depressive disorder (MDD) derives mostly from long-term occurrence of symptoms. This study aims to examine the prevalence, sociodemographic correlates, patterns of 12-month and lifetime psychiatric comorbidity, lifetime risk factors, psychosocial functioning, and mental health service utilization of chronic major depressive disorder (CMDD) compared to nonchronic major depressive disorder. METHODS Face-to-face interviews were conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093). RESULTS The 12-month and lifetime prevalence of CMDD within the population meeting criteria for MDD was 26.5% and 24.0%, respectively. Individuals reporting a chronic course of MDD were socioeconomically and educationally disadvantaged, tended to be older, report loss of spouse or history of divorce, live in rural areas, have public assistance, low self-esteem, worse overall health and more likely to report comorbidities, most importantly dysthymia, generalized anxiety disorder, avoidant, and dependant personality disorder. Individuals with chronic MDD were more likely to report familial but not childhood onset risk factors for MDD. Those suffering CMDD were more likely to seek and receive mental health care than other forms of MDD, even though it took longer to start treatment. CONCLUSION Chronic course of MDD is related to still worse socioeconomic conditions, educational achievement, more comorbidities, and family risk factors, although other courses of MDD carried greater risk of unmet treatment.
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Affiliation(s)
- Jose M. Rubio
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032
| | - John C. Markowitz
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032,Weill Medical College of Cornell University New York, NY 10065
| | - Analucía Alegría
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032
| | - Gabriela Pérez-Fuentes
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032
| | - Shang-Min Liu
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032
| | - Keng-Han Lin
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032
| | - Carlos Blanco
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032
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17
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Hölzel L, Härter M, Reese C, Kriston L. Risk factors for chronic depression--a systematic review. J Affect Disord 2011; 129:1-13. [PMID: 20488546 DOI: 10.1016/j.jad.2010.03.025] [Citation(s) in RCA: 158] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 03/24/2010] [Accepted: 03/25/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND One of five patients with an acute depressive episode develops chronic depression. Risk factors for a current depressive episode to become chronic are insufficiently known. This review was conducted to examine which factors represent a risk factor for the development of chronic depression for patients diagnosed with a depressive episode. METHOD Medline, Psycinfo, ISI Web of Science, CINHAL and BIOSIS Previews were searched up until September 2007, complemented by handsearching in the December 1987 to December 2007 issues of Journal of Affective Disorders and investigating reference lists of included articles and existing reviews. On the basis of a formal checklist, two investigators independently decided which studies to include or exclude. RESULTS 25 relevant primary studies with a total of 5192 participants were included in the systematic review. Overall the methodological quality of the included studies was found to be sufficient. Data synthesis was performed via vote counting. The following risk factors were identified: younger age at onset, longer duration of depressive episode, and family history of mood disorders. Psychological comorbidity i.e. anxiety disorders, personality disorders and substance abuse, low level of social integration, negative social interaction and lower severity of depressive symptoms repeatedly appeared concurrently with chronic depression. LIMITATIONS Most included studies were cross-sectional thus drawing causal conclusions with regard to risk factors proved to be difficult. CONCLUSION Risk factors for a current depressive episode to become chronic were identified. To date only few significant longitudinal studies on this topic are available.
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Affiliation(s)
- Lars Hölzel
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Germany.
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18
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Blanco C, Okuda M, Markowitz JC, Liu SM, Grant BF, Hasin DS. The epidemiology of chronic major depressive disorder and dysthymic disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2010; 71:1645-56. [PMID: 21190638 PMCID: PMC3202750 DOI: 10.4088/jcp.09m05663gry] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 11/10/2009] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine the prevalence of chronic major depressive disorder (CMDD) and dysthymic disorder, their sociodemographic correlates, patterns of 12-month and lifetime psychiatric comorbidity, lifetime risk factors, psychosocial functioning, and mental health service utilization. METHOD Face-to-face interviews were conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093). RESULTS The 12-month and lifetime prevalences were greater for CMDD (1.5% and 3.1%, respectively) than for dysthymic disorder (0.5% and 0.9%, respectively). Individuals with CMDD and dysthymic disorder shared most sociodemographic correlates and lifetime risk factors for major depressive disorder. Individuals with CMDD and dysthymic disorder had almost identically high rates of Axis I and Axis II comorbid disorders. However, individuals with CMDD received higher rates of all treatment modalities than individuals with dysthymic disorder. CONCLUSIONS Individuals with CMDD and dysthymic disorder share many sociodemographic correlates, comorbidity patterns, risk factors, and course. Individuals with chronic depressive disorders, especially those with dysthymic disorder, continue to face substantial unmet treatment needs.
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Affiliation(s)
- Carlos Blanco
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032
- New York State Psychiatric Institute, New York, NY 10032
| | - Mayumi Okuda
- New York State Psychiatric Institute, New York, NY 10032
| | - John C. Markowitz
- New York State Psychiatric Institute, New York, NY 10032
- Weill Medical College of Cornell University New York, NY 10065
| | - Shang-Min Liu
- New York State Psychiatric Institute, New York, NY 10032
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892
| | - Deborah S. Hasin
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032
- New York State Psychiatric Institute, New York, NY 10032
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032
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Handa H, Ito A, Tsuda H, Ohsawa I, Ogawa T. Low level of parental bonding might be a risk factor among women with prolonged depression: a preliminary investigation. Psychiatry Clin Neurosci 2009; 63:721-9. [PMID: 19781015 DOI: 10.1111/j.1440-1819.2009.02018.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIMS The aim of the present study was to determine whether or not the effect of parenting by the father and mother on outcomes for depression may be different between male and female subjects. METHODS A total of 115 patients were involved in this investigation: 74 had states of depression that continued for more than 2 years, and 41 had symptoms that remitted within 4 months. The Parental Bonding Instrument (PBI) was used to test for gender differences in the PBI score, the level of education, and the age at which the depression began, using an unpaired t-test. RESULTS It is suggested that female patients with low paternal care and low levels of education have a higher likelihood of showing symptoms of prolonged depression in a primary episode. No relationship was found among prolongation of depression, educational level, and parental care in male patients. Furthermore, comparing the PBI quadrants established by Parker showed that female patients who were exposed to paternal care as 'Affectionless Control', had a tendency towards a higher risk of prolonged depression than female patients who received 'Optimal Parenting'. CONCLUSION Especially in female patients, the prolongation of depression is likely a result of low levels of paternal care and low education.
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Affiliation(s)
- Hiroko Handa
- Department of Psychopathology and Psychotherapy Graduate School of Medicine, Nagoya University, Nagoya 464-8601, Japan
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20
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Wiersma JE, van Schaik DJF, van Oppen P, McCullough JP, Schoevers RA, Dekker JJ, Blom MBJ, Maas K, Smit JH, Penninx BWJH, Beekman ATF. Treatment of chronically depressed patients: a multisite randomized controlled trial testing the effectiveness of 'Cognitive Behavioral Analysis System of Psychotherapy' (CBASP) for chronic depressions versus usual secondary care. BMC Psychiatry 2008; 8:18. [PMID: 18366729 PMCID: PMC2322972 DOI: 10.1186/1471-244x-8-18] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 03/25/2008] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND 'Cognitive Behavioral Analysis System of Psychotherapy' (CBASP) is a form of psychotherapy specifically developed for patients with chronic depression. In a study in the U.S., remarkable favorable effects of CBASP have been demonstrated. However, no other studies have as yet replicated these findings and CBASP has not been tested outside the United States. This protocol describes a randomized controlled trial on the effectiveness of CBASP in the Netherlands. METHODS/DESIGN The purpose of the present paper is to report the study protocol of a multisite randomized controlled trial testing the effectiveness of 'Cognitive Behavioral Analysis System of Psychotherapy' (CBASP) for chronic depression in the Netherlands. In this study, CBASP in combination with medication, will be tested versus usual secondary care in combination with medication. The aim is to recruit 160 patients from three mental health care organizations. Depressive symptoms will be assessed at baseline, after 8 weeks, 16 weeks, 32 weeks and 52 weeks, using the 28-item Inventory for Depressive Symptomatology (IDS). Effect modification by co morbid anxiety, alcohol consumption, general and social functioning and working alliance will be tested. GEE analyses of covariance, controlling for baseline value and center will be used to estimate the overall treatment effectiveness (difference in IDS score) at post-treatment and follow up. The primary analysis will be by 'intention to treat' using double sided tests. An economic analysis will compare the two groups in terms of mean costs and cost-effectiveness from a societal perspective. DISCUSSION The study will provide an answer to the question whether the favorable effects of CBASP can be replicated outside the US. TRIAL REGISTRATION The Dutch Cochrane Center, NTR1090.
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Affiliation(s)
- Jenneke E Wiersma
- Department of Psychiatry and Institute for Research in Extramural Medicine, VU University Medical Center and Academic Outpatient Clinic for Affective Disorders, Stichting GGZBuitenamstel-de Geestgronden, Amsterdam, The Netherlands
| | - Digna JF van Schaik
- Department of Psychiatry and Institute for Research in Extramural Medicine, VU University Medical Center and Academic Outpatient Clinic for Affective Disorders, Stichting GGZBuitenamstel-de Geestgronden, Amsterdam, The Netherlands
| | - Patricia van Oppen
- Department of Psychiatry and Institute for Research in Extramural Medicine, VU University Medical Center and Academic Outpatient Clinic for Affective Disorders, Stichting GGZBuitenamstel-de Geestgronden, Amsterdam, The Netherlands
| | - James P McCullough
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
| | | | - Jack J Dekker
- Department of Psychiatry, Mentrum, Amsterdam, The Netherlands
| | - Marc BJ Blom
- Department of Psychiatry, PsyQ, The Hague, The Netherlands
| | - Kristel Maas
- Department of Psychiatry, PsyQ, The Hague, The Netherlands
| | - Johannes H Smit
- Department of Psychiatry and Institute for Research in Extramural Medicine, VU University Medical Center and Academic Outpatient Clinic for Affective Disorders, Stichting GGZBuitenamstel-de Geestgronden, Amsterdam, The Netherlands
| | - Brenda WJH Penninx
- Department of Psychiatry and Institute for Research in Extramural Medicine, VU University Medical Center and Academic Outpatient Clinic for Affective Disorders, Stichting GGZBuitenamstel-de Geestgronden, Amsterdam, The Netherlands
| | - Aartjan TF Beekman
- Department of Psychiatry and Institute for Research in Extramural Medicine, VU University Medical Center and Academic Outpatient Clinic for Affective Disorders, Stichting GGZBuitenamstel-de Geestgronden, Amsterdam, The Netherlands
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21
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Gilmer WS, Trivedi MH, Rush AJ, Wisniewski SR, Luther J, Howland RH, Yohanna D, Khan A, Alpert J. Factors associated with chronic depressive episodes: a preliminary report from the STAR-D project. Acta Psychiatr Scand 2005; 112:425-33. [PMID: 16279871 DOI: 10.1111/j.1600-0447.2005.00633.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify baseline sociodemographic and clinical factors associated with a current chronic major depressive episode (MDE). METHOD Outpatients with major depressive disorder enrolled in 41 US primary or psychiatric care sites were divided into two groups based on self-report of current episode length (<24 or > or =24 months). Logistic regression models were used to identify factors associated with chronicity of current depressive episode. RESULTS About 21.2% of 1380 subjects were in current, chronic MDEs. Older age, less education, lower income, no private insurance, unemployment, greater general medical illness burden, lower physical quality of life, concurrent generalized anxiety disorder, fewer prior episodes, and history of prior suicide attempts were all associated with chronic episodes. Blacks, Hispanics, and patients receiving care in primary as opposed to psychiatric care settings exhibited greater chronicity. CONCLUSION Chronic depressive episodes are common and are associated with greater illness burden, comorbidity, socioeconomic disadvantage, and racial/ethnic minority status.
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Affiliation(s)
- W S Gilmer
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Scheibe S, Preuschhof C, Cristi C, Bagby RM. Are there gender differences in major depression and its response to antidepressants? J Affect Disord 2003; 75:223-35. [PMID: 12880935 DOI: 10.1016/s0165-0327(02)00050-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The prevalence of major depression for women is about twice that for men. This gender difference in prevalence rates has led to much research addressing gender differences in the presentation and features of major depression, and, to a lesser extent, research addressing gender differences in treatment response and personality. However, studies differ considerably in the population sampled, and findings vary significantly. In the current retrospective examination of data, we investigated all of these variables in one single sample of outpatients with major depression seen in a tertiary care centre. METHODS A sample of 139 men and 246 women with major depression receiving antidepressant treatment (SSRIs, TCAs, SNRIs, MAOIs, or RIMAs) in an outpatient setting were contrasted with regard to symptoms and severity of depression, course of illness, treatment response, and personality. RESULTS Women were found to experience more vegetative and atypical symptoms, anxiety, and anger than men, and to report higher severity of depression on self-report measures. Regarding personality, women scored higher on conscientiousness, the extraversion facet warmth, the openness facet feelings, and sociotropy. Effect sizes were small to moderate. No differences were found in the course of the illness and treatment response. LIMITATIONS Findings are not generalizable to inpatient or community samples, and some of the gender differences may be accounted for by gender differences in treatment seeking behaviour. CONCLUSIONS While men and women receiving antidepressant treatment show some gender differences in the psychopathology of major depression, these differences do not appear to translate into differences in response to antidepressants. Gender differences in personality appear less profound than in the average population, indicating the potential role of a certain personality type that predisposes individuals to develop clinical depression, independent of gender. CLINICAL RELEVANCE The current examination underscores the role gender plays in the presentation and treatment of major depression.
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Abstract
The diagnosis of bipolar mood disorder (BP) in preadolescents (pediatric mania) has generated considerable controversy in terms of its estimated prevalence and validity as a diagnostic category. The relative paucity of systematic studies and the current diagnostic confusion related to the disorder are often attributed to the apparent discontinuities in the childhood versus adult presentation of the illness, namely, irritability as the predominant "mood" of mania and a continuous course of symptoms. The goal of this article is to review the current literature and identify sources of confusion relating to pediatric mania by considering results to date within a larger context that include findings from studies on (1) BP illness in adults, (2) mood disorders across the lifespan, (3) the role of development in symptom expression, and (4) patterns of heritability in psychiatric disorders. Whereas much remains to be investigated in the validation of the diagnosis for children, integrating results across studies may provide a framework for understanding the differences in the presentation of severe mood disorders in children and adults.
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Affiliation(s)
- Jill Weckerly
- Child and Adolescent Services Research Center, San Diego, CA 92123, USA
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Abstract
1. Aims of the study were to find the prevalence of female depression, and to study the differences between female and male depression, in private practice. Four hundred forty eight consecutive unipolar and bipolar II depressed outpatients were interviewed with the Structured Clinical Interview for DSM-IV, the Montgomery Asberg Depression Rating Scale, and the Global Assessment of Functioning scale. 2. Prevalence of female depression was 67.8%. Female to male ratio was 2:1. Among the variables investigated (age at intake, age at onset, duration of illness, severity, chronicity, psychosis, recurrences, atypical features, comorbidity), atypical features and comorbidity were significantly associated with female depression. 3. Private practice outpatient female depression (chronic, psychotic, or recurrent) was not more severe than male depression.
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Affiliation(s)
- F Benazzi
- Department of Psychiatry, National Health Service (AUSL), Forlì, Italy.
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Abstract
OBJECTIVE Aims of the study were to find the prevalence of chronic depression in elderly patients compared with younger patients, and to compare chronic depression between elderly and younger patients, to find if there were clinical differences. A major feature of the study was the inclusion of a large number of bipolar II patients, usually not included in previous studies. METHODS Three hundred and ninety-nine consecutive unipolar (N=200) and bipolar II (N=199) depression outpatients were interviewed with the Structured Clinical Interview for DSM-IV and depression rating scales in a private practice. RESULTS Chronic depression was more common in elderly patients than in younger patients (53.6% vs 40.1%, p=0.0299). Late-life chronic depression patients had later age at onset, longer duration of illness, fewer bipolar II cases, more unipolar cases and more relapses than younger chronic depression patients. CONCLUSIONS Results suggest that late-life depression is more likely to be chronic than depression in younger patients. The subtyping of chronic depression according to age seems supported by a different age at onset and some clinical differences.
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Affiliation(s)
- F Benazzi
- Department of Psychiatry, National Health Service, Public Hospital 'Morgagni', Forlì, Italy.
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McCullough JP, Klein DN, Keller MB, Holzer CE, Davis SM, Kornstein SG, Howland RH, Thase ME, Harrison WM. Comparison of DSM-III-R chronic major depression and major depression superimposed on dysthymia (double depression): Validity of the distinction. JOURNAL OF ABNORMAL PSYCHOLOGY 2000. [DOI: 10.1037/0021-843x.109.3.419] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
The authors conducted a 6-year follow-up of 16 patients with late-life depression to evaluate the relationships between clinical and neuroradiologic variables and disease outcome. Patients had a comprehensive neuropsychiatric evaluation and magnetic resonance imaging (MRI) at baseline and follow-up. Eight of the 16 developed a chronic course of unremitting major depression sufficient to cause significant psychosocial impairment. Six patients with a chronic course and four patients with a non-chronic course of depression had white matter hyperintensities (WMH) on MRI at baseline. Four patients whose WMH increased in size over time developed a chronic unremitting course of depression. No patients with non-chronic depression had large areas of WMH at baseline or exhibited increased WMH size over time. Chronic depression was associated with severity of cerebrovascular risk factors, apathy, and poor quality of life. Treatment and prevention of cerebrovascular disease may improve the outcome of late-life depression.
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Hays JC, Krishnan KR, George LK, Pieper CF, Flint EP, Blazer DG. Psychosocial and physical correlates of chronic depression. Psychiatry Res 1997; 72:149-59. [PMID: 9406904 DOI: 10.1016/s0165-1781(97)00105-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study used a case-control design to address differences in psychosocial, physical and clinical profiles between subjects who presented with a chronic index episode of major depression and those who presented with a non-chronic index episode. Subjects were adult patients participating in the Duke University Mental Health Clinical Research Center (MHCRC) for the Study of Depression in Later Life. Cases (N = 88) who reported duration of depressive symptoms lasting > or = 24 months at enrollment were compared to controls (N = 354) who reported symptoms lasting 1-12 months. The groups were compared with respect to selected demographic and clinical variables, physical function deficits, medical comorbidity, social support constructs and number of recent stressful life events. Social support and physical health were more relevant to chronicity of major depressive illness than were severity of illness or family history. Older age (> 60 years) intensified the deleterious effect of recent negative life events and reduced the deleterious effect of functional impairment on chronic major depression. These findings require special emphasis where treatment for chronic major depression is divorced from considerations of the social environment and functional capacity.
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Affiliation(s)
- J C Hays
- Department of Psychiatry, Duke University Medical Center, Durham, NC 27710, USA.
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Kovacs M, Obrosky DS, Gatsonis C, Richards C. First-episode major depressive and dysthymic disorder in childhood: clinical and sociodemographic factors in recovery. J Am Acad Child Adolesc Psychiatry 1997; 36:777-84. [PMID: 9183132 DOI: 10.1097/00004583-199706000-00014] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To characterize the temporal pattern of depressive disorder in childhood, the first episode of depression was examined, focusing on recovery and its baseline predictors. METHOD The sample includes 112 clinically referred 8- to 13-year-olds with first-episode major depressive or dysthymic disorder participating in a naturalistic follow-up study. Psychiatric diagnoses were based on standardized interviews and operational criteria. Recovery was modeled by multivariate procedures using baseline clinical and demographic predictors. RESULTS Recovery rates were 86% and 7% for major depression and dysthymia, respectively, 2 years after onset. Median duration of major depression was 9 months and was predicted only by underlying dysthymia. Median duration of dysthymic disorder was 3.9 years and was predicted only by comorbid externalizing disorder. In post hoc analyses, no positive treatment effects were detected. CONCLUSIONS First-episode depression in youths is persistent, it generally appears to run its own course, and its naturalistic treatment requires scrutiny. However, because comorbid externalizing disorder apparently affects duration of dysthymia, intervention for behavior problems may shorten this type of depression.
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Affiliation(s)
- M Kovacs
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA
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Pini S, Cassano GB, Simonini E, Savino M, Russo A, Montgomery SA. Prevalence of anxiety disorders comorbidity in bipolar depression, unipolar depression and dysthymia. J Affect Disord 1997; 42:145-53. [PMID: 9105956 DOI: 10.1016/s0165-0327(96)01405-x] [Citation(s) in RCA: 137] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Eighty-seven patients with current episode of depression were assessed by the SCID-P and subdivided in bipolar depressives (N = 24), unipolar depressives (n = 38) and dysthymics (n = 25). Anxiety disorders comorbidity in these three groups was investigated by means of the SCID-P. Panic disorder comorbidity was found in 36.8% of bipolar depressives, 31.4% of unipolar depressives and 13% of dysthymics. Prevalence of obsessive-compulsive disorder was 21.1% in bipolars, 14.3% in unipolars and 8.7% in dysthymics. Generalized anxiety disorder resulted in being much more associated with dysthymia (65.2%) than with bipolar (31.6%) or unipolar depression (37.1%). Social phobia comorbidity was exhibited mainly by unipolars (11.4%), while no cases were detected in the bipolar group. Odds ratios revealed that generalized anxiety disorder is significantly more likely to co-occur with dysthymia. Panic disorder showed a higher trend to be associated with bipolar and unipolar depression. Social phobia was more frequent among unipolar depression.
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Affiliation(s)
- S Pini
- Institute of Psychiatry, University of Verona, Ospedale Policlinico, Italy
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Kovacs M. Presentation and course of major depressive disorder during childhood and later years of the life span. J Am Acad Child Adolesc Psychiatry 1996; 35:705-15. [PMID: 8682751 DOI: 10.1097/00004583-199606000-00010] [Citation(s) in RCA: 244] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To examine whether major depressive disorder (MDD) in childhood, adolescence, and adulthood represents essentially the same diagnostic entity. METHOD Recent publications on clinically referred patients with MDD that met certain selection criteria were examined to abstract information on six phenomenological features of the disorder: episode number, symptom presentation, psychiatric comorbidity, recovery from the index episode, recurrence of MDD, and switch to bipolar illness. The studies included both inpatients and outpatients with an age range of 6 to 80+ years. RESULTS Synthesizing the information across broad age groups revealed that clinically referred depressed youths, compared with adults and the elderly, are almost exclusively first-episode probands, evidence comparable symptom pictures, have similar rates of psychiatric comorbidity, recover somewhat faster from their index episode of MDD, have a similar recurrence rate, and are at greater risk for bipolar switch. CONCLUSIONS MDD in clinically referred youths is similar in many regards to MDD in adults and the elderly. However, the findings that the risk of recurrent MDD among children approximates the rate among adults but, on average, about 20 years earlier in their lives, and that youths with unipolar depression convert to bipolar illness more frequently than do adults, suggest that very early onset MDD is a particularly serious form of affective illness.
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Affiliation(s)
- M Kovacs
- University of Pittsburgh School of Medicine, USA
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