1
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Huang X, Sun Y, Wu A, Zhang X. Differences in the prevalence and clinical correlates of comorbid suicide attempts in patients with early- and late-onset major depressive disorder. Front Psychiatry 2023; 14:1173917. [PMID: 37588029 PMCID: PMC10426903 DOI: 10.3389/fpsyt.2023.1173917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/09/2023] [Indexed: 08/18/2023] Open
Abstract
Objective There are many studies on differences in the onset age of major depressive disorder (MDD) patients. However, study on differences in clinical correlates of suicide attempts between early- and late-onset MDD patients is limited. The aim of this study was to investigate the differences in the prevalence and clinical correlates of suicide attempts in patients with early- and late-onset MDD in China. Methods A total of 1718 adult outpatients with MDD were recruited. Demographic and clinical data were collected. The 17-item Hamilton Rating Scale for Depression (HAMD-17), Hamilton Anxiety Rating Scale (HAMA), Positive and Negative Syndrome Scale (PANSS) positive subscale, and Clinical Global Impression-Severity (CGI-S) Scales were used to assess their depressive, anxiety, psychotic symptoms, and the severity of the clinical symptoms, respectively. Results The prevalence of suicide attempts was higher in late-onset MDD patients (291/1369, 21.3%) than in early-onset MDD patients (55/349, 15.8%) (p = 0.023). However after Bonferroni correction no significant difference was found in the prevalence of suicide attempts in late-onset and late-onset MDD patients (p > 0.05). In both early- and late-onset groups, univariate analysis showed that the following characteristics were significantly associated with suicide attempts: HAMA, HAMD and PANSS positive subscale scores, thyroid stimulating hormone (TSH) levels, blood glucose levels, systolic blood pressure (SBP), and diastolic blood pressure (DBP). In both the early- and late-onset groups, the prevalence rates of severe anxiety disorder and psychotic symptoms were significantly higher in the suicide attempt group than in the non-suicide attempt group. In regression analysis, disease duration, TSH levels and HAMA score were independently associated with suicide attempts in the early-onset group, while TSH levels, HAMA and HAMD score were independently associated with suicide attempts in the late-onset group. Conclusion This study suggests that suicide attempts are not frequent in early-onset outpatients with MDD compared with late-onset, and some clinical correlates are associated with suicide attempt in early- and late-onset MDD.
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Affiliation(s)
- Xiao Huang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yuan Sun
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Anshi Wu
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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2
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A systematic review on the potential use of machine learning to classify major depressive disorder from healthy controls using resting state fMRI measures. Neurosci Biobehav Rev 2023; 144:104972. [PMID: 36436736 DOI: 10.1016/j.neubiorev.2022.104972] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/08/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Major Depressive Disorder (MDD) is a psychiatric disorder characterized by functional brain deficits, as documented by resting-state functional magnetic resonance imaging (rs-fMRI) studies. AIMS In recent years, some studies used machine learning (ML) approaches, based on rs-fMRI features, for classifying MDD from healthy controls (HC). In this context, this review aims to provide a comprehensive overview of the results of these studies. DESIGN The studies research was performed on 3 online databases, examining English-written articles published before August 5, 2022, that performed a two-class ML classification using rs-fMRI features. The search resulted in 20 eligible studies. RESULTS The reviewed studies showed good performance metrics, with better performance achieved when the dataset was restricted to a more homogeneous group in terms of disease severity. Regions within the default mode network, salience network, and central executive network were reported as the most important features in the classification algorithms. LIMITATIONS The small sample size together with the methodological and clinical heterogeneity limited the generalizability of the findings. CONCLUSIONS In conclusion, ML applied to rs-fMRI features can be a valid approach to classify MDD and HC subjects and to discover features that can be used for additional investigation of the pathophysiology of the disease.
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3
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Clinical and psychopathological correlates of duration of untreated illness (DUI) in affective spectrum disorders. Eur Neuropsychopharmacol 2022; 61:60-70. [PMID: 35810585 DOI: 10.1016/j.euroneuro.2022.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 11/23/2022]
Abstract
Affective disorders represent psychopathological entities lying on a continuum, characterized by high prevalence and functional impairment. A delay in treatment initiation might increase the burden associated with affective spectrum disorders. The present study was aimed at analyzing the correlates of a long duration of untreated illness (DUI) in these conditions. We recruited subjects diagnosed with affective disorders, both in- and outpatients, and collected information concerning socio-demographic, clinical, and psychopathological characteristics. Long DUI was defined according to previous research criteria as >2 years for Bipolar Disorders or >1 year for Depressive Disorders. Bivariate analyses were performed to compare subjects with a long and short DUI (p<0.05). A logistic regression was operated to evaluate the correlates of long DUI. In the present sample (n=135), 34.1% (n=46) subjects showed a long DUI. This subgroup presented with more physical comorbidities (p=0.003), higher body mass index (BMI) (p<0.001), more frequent anxiety onset (p=0.018), younger onset age (p=0.042), and more severe depressive symptoms (Hamilton Depression Rating Scale item 1-depressed mood (p=0.032) and item 2-guilt feelings (p=0.018)). At the logistic regression, higher severity of depressed mood (OR 1.568), higher BMI (OR 1.264), and younger age at onset (OR 0.935) were associated with long DUI. The present study confirmed a possible role of DUI as a construct underpinning higher clinical severity in affective spectrum disorders, possibly linked to worse illness course and unfavorable outcomes. Intervention strategies targeting physical comorbidities and depressive symptoms severity may decrease disease burden in subjects with a long DUI.
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4
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Frailty measures in immuno-metabolic subtypes of late-life depression; A two-year prospective study. Arch Gerontol Geriatr 2022; 99:104603. [DOI: 10.1016/j.archger.2021.104603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 11/22/2021] [Accepted: 11/27/2021] [Indexed: 11/22/2022]
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5
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Montesano A, Medina JC, Paz C, García-Mieres H, Niño-Robles N, García-Grau E, Crespillo JC, García-Gutiérrez A, Alabèrnia-Segura M, Feixas G. Does virtual reality increase the efficacy of psychotherapy for young adults with mild-to-moderate depression? A study protocol for a multicenter randomized clinical trial. Trials 2021; 22:916. [PMID: 34903251 PMCID: PMC8666832 DOI: 10.1186/s13063-021-05809-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 11/08/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The improvement of psychological treatments for depression in young adults is a pressing issue highlighted in the literature. Its relevance is determined not only because young adults are underrepresented in research, but also to prevent chronic severe mental health disorders later in life. Engagement is considered a key factor for a good therapeutic outcome, especially among young patients. In this sense, virtual reality could be particularly suited to engage young adults in the therapy process. This project aims to improve the psychological treatment of mild-to-moderate depression in young adults by testing out the efficacy of virtual reality-enhanced personal construct therapy (PCT-VR), as compared to personal construct therapy alone (PCT) and to the reference standard cognitive behavioral therapy (CBT). In contrast to CBT, PCT neither educates patients about depression nor gives them directions on the changes to be made in their dysfunctional behaviors or cognitions. Rather, PCT explores the coherence (or conflicts) of thoughts and behaviors with respect to the person's sense of identity and focuses on meaning-making processes. METHODS The efficacy of this innovative intervention (PCT-VR) will be compared to PCT and to CBT in a randomized clinical trial. The study includes an appraisal of therapists' adherence and independent assessments to preserve internal validity. The Beck Depression Inventory-II is the primary outcome measure for calculating both statistical and clinical significance, but other outcomes will also be assessed (e.g., functioning, well-being, anxiety, stress) at pre- and post-therapy and at 6-month follow-up. The trial will be conducted in a naturalistic context, mostly at the usual health care center of each patient. A sample of 225 participants is targeted to reach enough statistical power to accomplish the goals of the study. DISCUSSION We expect that providing evidence for PCT-VR will widen the repertoire of evidence-based technology-based psychotherapeutic interventions for young adults and contribute to the prevention of deteriorating courses of the disorder. TRIAL REGISTRATION ClinicalTrials.gov NCT04321525 . Registered on 18 February 2020.
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Affiliation(s)
- Adrián Montesano
- School of Psychology and Educational Sciences, Open University of Catalonia, Barcelona, Spain
| | - Joan C. Medina
- School of Psychology and Educational Sciences, Open University of Catalonia, Barcelona, Spain
| | - Clara Paz
- School of Psychology and Education, Universidad de Las Américas, Quito, Ecuador
| | - Helena García-Mieres
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Noelia Niño-Robles
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
| | - Eugeni García-Grau
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
| | - Josep Cañete Crespillo
- Department of Mental Health, Consorci Sanitari del Maresme, Hospital de Mataró, Mataró, Spain
| | | | - Miquel Alabèrnia-Segura
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
| | - Guillem Feixas
- Department of Clinical Psychology and Psychobiology, The Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain
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6
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Sandstrom A, Perroud N, Alda M, Uher R, Pavlova B. Prevalence of attention-deficit/hyperactivity disorder in people with mood disorders: A systematic review and meta-analysis. Acta Psychiatr Scand 2021; 143:380-391. [PMID: 33528847 DOI: 10.1111/acps.13283] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 01/13/2021] [Accepted: 01/21/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) in mood disorders is associated with unfavorable outcomes, including more frequent mood episodes, and increased risk of suicide. The reported prevalence of ADHD in individuals with mood disorders varies widely. METHODS We searched PsycInfo and PubMed for articles published before September 21st , 2020, using search terms for ADHD and mood disorders. We included original data on the prevalence of ADHD in individuals with bipolar disorder (BD) or major depressive disorder (MDD). We estimated the prevalence of ADHD, by developmental period and disorder using random-effects meta-analyses. We also compared the rate of ADHD in people with MDD and BD, and with and without mood disorders. RESULTS Based on 92 studies including 17089 individuals, prevalence of ADHD in BD is 73% (95% CI 66-79) in childhood, 43% (95% CI 35-50) in adolescence, and 17% (95% CI 14-20) in adulthood. Data from 52 studies with 16897 individuals indicated that prevalence of ADHD in MDD is 28% (95% CI 19-39) in childhood, 17% (95% CI 12-24) in adolescence, and 7% (95% CI 4-11) in adulthood. ADHD was three times more common in people with mood disorders compared to those without and 1.7 times more common in BD compared to MDD. CONCLUSION People with mood disorders are at a significant risk for ADHD. ADHD should be assessed and treated in individuals with BD and MDD. Comprehensive assessment strategies are needed to address challenges of diagnosing ADHD alongside mood disorders.
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Affiliation(s)
- Andrea Sandstrom
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
| | - Nader Perroud
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
| | - Barbara Pavlova
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
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7
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Perrini F, Matrone M, de Bartolomeis A, Montano A, Amici E, Callovini G, Cuomo I, de Persis S, Lombardozzi G, Battagliese G, Porrari R, Kotzalidis GD, De Filippis S. Developmental trajectories in psychiatric disorders: does substance/alcohol use moderate the effects of affective temperaments as moderators of age at onset? A study in post-acute, hospitalized patients with psychotic or DSM-5 bipolar or major depressive disorders. J Addict Dis 2021; 39:373-387. [PMID: 33587024 DOI: 10.1080/10550887.2021.1886568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Age-at-onset (AAO) affects psychiatric disorder outcome; substance (SUDs) or alcohol use disorders (AUDs) may influence their onset. Affective temperaments may affect early AAO and drug-use proneness. Objectives: To investigate whether SUD/AUD moderated temperamental effects in determining AAO of mental disorders. Methods: We included 300 post-acute inpatients with schizophrenia-spectrum and other psychotic (SSOPDs), major depressive (MDD) or bipolar (BD) disorders (168 men; mean age, 40.63 years ± 11.82 men, 43.21 years ± 12.69 women) with (N = 110) or without (N = 190) SUD/AUD. Patients completed cross-sectionally TEMPS-A. We carried moderation analysis with each regression-significant TEMPS temperament as independent variable, SUD/AUD presence/absence as dichotomous moderator, and AAO as dependent variable. Significance was set at p < 0.05. Results: AAO was lower in patients with SUD/AUD diagnosis than in patients without (23.74 ± 10.09 vs. 27.73 ± 10.35, respectively, p = 0.001, η2 = 0.034). SUD/AUD patients scored higher on the hyperthymic (10.22 ± 4.08, p < 0.001, η2 = 0.069) and irritable (8.26 ± 4.69, p < 0.01, η2 = 0.026) temperaments than nonSUD/AUD patients. Moderation analysis showed only direct effects of irritable (β = -0.55, p < 0.005) and hyperthymic (β = -0.95, p < 0.001) temperaments on AAO and no significant SUD/AUD and interaction effects. Limitations. Cross-sectional design. Conclusions: When irritable and hyperthymic traits prevail over other temperaments, AAO is earlier in SSOPDs, MDD, and BD. SUD/AUD presence/absence does not moderate the relationship between temperament and AAO.
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Affiliation(s)
- Filippo Perrini
- Von Siebenthal Neuropsychiatric Hospital, Genzano di Roma, Italy.,Istituto A.T. Beck-Diagnostic Centre, Research and Training in Cognitive-Behavioral Psychotherapy, Rome, Italy
| | - Marta Matrone
- Von Siebenthal Neuropsychiatric Hospital, Genzano di Roma, Italy.,Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University, Naples, Italy
| | - Andrea de Bartolomeis
- Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University, Naples, Italy
| | - Antonella Montano
- Istituto A.T. Beck-Diagnostic Centre, Research and Training in Cognitive-Behavioral Psychotherapy, Rome, Italy
| | - Emanuela Amici
- Von Siebenthal Neuropsychiatric Hospital, Genzano di Roma, Italy
| | - Gemma Callovini
- Von Siebenthal Neuropsychiatric Hospital, Genzano di Roma, Italy.,Department of Mental Health, ASL Rieti, Rieti, Italy
| | - Ilaria Cuomo
- Von Siebenthal Neuropsychiatric Hospital, Genzano di Roma, Italy.,Istituto Penitenziario Regina Coeli, ASL RM1, Rome, Italy
| | | | | | - Gemma Battagliese
- Centro di Riferimento Alcologico della Regione Lazio, RM1, Rome, Italy
| | - Raffaella Porrari
- Von Siebenthal Neuropsychiatric Hospital, Genzano di Roma, Italy.,Centro di Riferimento Alcologico della Regione Lazio, RM1, Rome, Italy
| | - Georgios D Kotzalidis
- Von Siebenthal Neuropsychiatric Hospital, Genzano di Roma, Italy.,NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
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8
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Xiao L, Zhou JJ, Feng Y, Zhu XQ, Wu WY, Hu YD, Niu YJ, Hu J, Wang XY, Gao CG, Zhang N, Fang YR, Liu TB, Jia FJ, Feng L, Wang G. Does early and late life depression differ in residual symptoms, functioning and quality of life among the first-episode major depressive patients. Asian J Psychiatr 2020; 47:101843. [PMID: 31731143 DOI: 10.1016/j.ajp.2019.101843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 01/06/2023]
Abstract
AIMS & OBJECTIVES Age differences exist in many aspects in patients with major depressive disorder (MDD). The present study aims to examine the effect of age on treatment outcomes in first-episode MDD. METHODOLOGY A total of 982 first-episode major depressive patients, who were above 18 years old and admitted in both psychiatric hospitals and units of general hospitals were recruited for the present study. These patients were newly treated and responded to 8-12 weeks of antidepressant treatment. Depressive symptoms, psychosocial functioning and quality of life were measured using standardized instruments. The study population was divided into three age groups: early adult (18-44 years old), middle adult (45-59 years old), and late adult (60-85 years old). RESULTS Earlier age was associated with greater symptom severity, severer depressive symptoms in hypersomnia, concentration/decision making, negative view of the self, suicide ideation and restlessness, more impaired function, poorer satisfaction in social relationship and economic status, when compared to late adults with MDD (all P < 0.05). In the multivariable analyses, among the other variables, early age remained as an independent correlation of residual depressive severity (middle age vs. early age: OR = 0.631, 95%CI[0.462, 0.862]; old age vs. early age: OR = 0.521, 95%CI[0.348, 0.780]) and functional impairment. Comorbidity of physical illness had a negative contribution to all treatment outcomes. CONCLUSION In first major depressive episode, early age was strongly associated with depressive severity and functional impairment after responding to antidepressant treatment. Early-life depression may be an indicator of MDD for poor clinical outcomes and high clinical burden.
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Affiliation(s)
- Le Xiao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jing-Jing Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yuan Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xue-Quan Zhu
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Wen-Yuan Wu
- Department of Psychiatry, Tongji Hospital of Tongji University, Shanghai, China
| | - Yong-Dong Hu
- Department of Clinical Psychology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ya-Juan Niu
- Department of Psychiatry, Beijing HuiLongGuan Hospital, Beijing, China
| | - Jian Hu
- Department of Psychiatry, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xue-Yi Wang
- Department of Psychiatry, the First Hospital of Hebei Medical University, Hebei, China
| | - Cheng-Ge Gao
- Department of Psychiatry, the First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Ning Zhang
- Department of Psychiatry, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yi-Ru Fang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tie-Bang Liu
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, China
| | - Fu-Jun Jia
- Department of Psychiatry, Guangdong Mental Health Center, Guangdong General Hospital, Guangzhou, China
| | - Lei Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Anding Hospital, Capital Medical University, Beijing, China.
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Anding Hospital, Capital Medical University, Beijing, China.
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9
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Age at onset of first suicide attempt: Exploring the utility of a potential candidate variable to subgroup attempters. Asian J Psychiatr 2018; 37:40-45. [PMID: 30107315 DOI: 10.1016/j.ajp.2018.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/03/2018] [Accepted: 08/05/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE Our objective was to explore the utility of age at first suicide attempt in identifying subgroups of suicide attempters. METHODS In a retrospective study design, we collected information from the clinical charts of 895 patients assessed over a seven-year period. Admixture analysis was used to determine the best fitting theoretical model for distribution of age at first attempt that divided the sample. Subsequently, multivariate analysis was performed to identify variables that distinguished the subgroups identified. RESULTS The theoretical solution that best explained the observed distribution of age at first suicide attempt was a mixture of two Gaussian distributions with a cut-off of 31 years for the two subgroups. In logistic regression analysis, male gender (Odds ratios [OR] 3.047, 95% Confidence Interval (CI) 1.818-5.106), fewer years of formal schooling (OR 3.384, 95% CI 1.701-6.734) and being married (OR 23.36, 95% CI 10.753-50.000), were more commonly associated with the late onset subgroup (age at first attempt >31 years). Further, the late onset subgroup had poorer global functioning (OR 0.980, 95% CI 0.962 to 0.998). CONCLUSION Age at onset of first suicide attempt is a useful candidate marker to delineate an early and late onset subgroup among suicide attempters. These results are likely to inform customization of suicide prevention strategies.
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10
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Serafini G, Gonda X, Monacelli F, Pardini M, Pompili M, Rihmer Z, Amore M. Possible predictors of age at illness onset and illness duration in a cohort study comparing younger adults and older major affective patients. J Affect Disord 2018; 225:691-701. [PMID: 28917196 DOI: 10.1016/j.jad.2017.08.077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/18/2017] [Accepted: 08/27/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Major affective conditions are associated with significant disability and psychosocial impairment. Whether specific socio-demographic and clinical characteristics may distinguish subgroups of patients in terms of prognosis and illness trajectories is a matter of debate. METHODS The sample of this naturalistic cohort study included 675 currently euthymic patients with major affective disorders of which 428 (63.4%) were diagnosed with unipolar and 247 (36.6%) with bipolar disorders. RESULTS Younger adults with a longer duration of untreated illness and residual inter-episodic symptoms were more likely to be single or divorced, students, with an earlier age of first treatment/hospitalization, longer duration of substance abuse and duration of illness than older patients who were, conversely, more likely to be widowed and retired. Multivariate analyses showed a significant positive contribution to age at illness onset by marital status, nonpsychiatric medications, substance abuse, psychiatric diagnosis (bipolar vs. unipolar), age at first treatment/hospitalization, duration of illness, and current age. According to a further analysis, we also found a significant positive contribution to duration of illness by marital status, educational level, positive history of psychiatric conditions in family, substance abuse, psychiatric diagnosis (bipolar vs. unipolar), age at illness onset, age at first treatment, and certain cardiovascular disorders. CONCLUSIONS There are substantial socio-demographic and clinical differences that may help to distinguish specific subgroups of patients; however, additional studies are requested to replicate these results and further investigate the main factors underlying our findings.
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Affiliation(s)
- Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Kutvolgyi Clinical Center, Semmelweis University, Budapest, Hungary; MTA-SE Neurochemistry and Neuropsychopharmacology Research Group, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary; NAP-A-SE New Antidepressant Target Research Group, Semmelweis University, Hungary
| | - Fiammetta Monacelli
- Department of Internal Medicine and Medical Specialties, DIMI, Section of Geriatrics, Genoa, Italy
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy; Magnetic Resonance Research Centre on Nervous System Diseases, University of Genoa, Genoa, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Zoltan Rihmer
- Department of Psychiatry and Psychotherapy, Kutvolgyi Clinical Center, Semmelweis University, Budapest, Hungary
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
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11
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Montlahuc C, Curis E, Jonas SF, Bellivier F, Chevret S. Age-at-onset subsets of bipolar I disorders: A critical insight into admixture analyses. Int J Methods Psychiatr Res 2017; 26:e1536. [PMID: 27766706 PMCID: PMC6877114 DOI: 10.1002/mpr.1536] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 08/05/2016] [Accepted: 08/16/2016] [Indexed: 11/06/2022] Open
Abstract
Gaussian mixture analysis is frequently used to model the age-at-onset (AAO) in bipolar I disorder and identify homogeneous subsets of patients. This study aimed to examine whether, using admixture analysis of AAO, cross-sectional designs (which cause right truncation), unreliable diagnosis for individuals younger than 10 years old (which causes left truncation) and the selection criterion used for admixture analysis impact the number of identified subsets. A simulation study was performed. Different criteria - the likelihood ratio test (LRT), the Akaike information criterion (AIC), and the Bayesian information criterion (BIC) - were compared using no, left and/or right truncation simulated data. The error rate of each criterion (percentage of erroneous number of detected subsets) was estimated. An application to two real databases, including 2,876 and 1,393 patients, is provided. Without data truncation and regardless of the distribution of AAO, the LRT and the AIC had much higher error rates (12% and 33%, respectively) than the BIC (1%). For a homogeneous population, the error rate increased with the introduction of left truncation. This study shows that the number of subsets identified using admixture analysis may depend on the sample size, the selection criterion, and the study design.
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Affiliation(s)
- Claire Montlahuc
- Service de Biostatistique et Information médicale, Hôpital Saint Louis, AP-HP, Paris, France.,ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Emmanuel Curis
- Service de Biostatistique et Information médicale, Hôpital Saint Louis, AP-HP, Paris, France.,Laboratoire de biomathématiques, faculté de pharmacie, université Paris Descartes, Sorbonne Paris Cité, Paris, France.,VariaPsy UMR-S 1144, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Sarah Flora Jonas
- Laboratoire de biomathématiques, faculté de pharmacie, université Paris Descartes, Sorbonne Paris Cité, Paris, France.,VariaPsy UMR-S 1144, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Frank Bellivier
- VariaPsy UMR-S 1144, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, GH Saint-Louis - Lariboisière - F. Widal, AP-HP, Paris, France.,Fondation FondaMental, CHU de Créteil, Créteil, France
| | - Sylvie Chevret
- Service de Biostatistique et Information médicale, Hôpital Saint Louis, AP-HP, Paris, France.,ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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12
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Gómez-Restrepo C, Bohórquez A, Tamayo Martínez N, Rondón M, Bautista N, Rengifo H, Medina Rico M. Trastornos depresivos y de ansiedad y factores asociados en la población de adolescentes colombianos, Encuesta Nacional de Salud Mental 2015. ACTA ACUST UNITED AC 2016; 45 Suppl 1:50-57. [DOI: 10.1016/j.rcp.2016.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/28/2016] [Accepted: 09/29/2016] [Indexed: 11/15/2022]
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13
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Schat A, van Noorden MS, Noom MJ, Giltay EJ, van der Wee NJA, de Graaf R, Ten Have M, Vermeiren RRJMM, Zitman FG. A cluster analysis of early onset in common anxiety disorders. J Anxiety Disord 2016; 44:1-8. [PMID: 27665086 DOI: 10.1016/j.janxdis.2016.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 08/03/2016] [Accepted: 09/07/2016] [Indexed: 11/24/2022]
Abstract
Early onset is regarded as an important characteristic of anxiety disorders, associated with higher severity. However, previous findings diverge, as definitions of early onset vary and are often unsubstantiated. We objectively defined early onset in social phobia, panic disorder, agoraphobia, and generalised anxiety disorder, using cluster analysis with data gathered in the general population. Resulting cut-off ages for early onset were ≤22 (social phobia), ≤31 (panic disorder), ≤21 (agoraphobia), and ≤27 (generalised anxiety disorder). Comparison of psychiatric comorbidity and general wellbeing between subjects with early and late onset in the general population and an outpatient cohort, demonstrated that among outpatients anxiety comorbidity was more common in early onset agoraphobia, but also that anxiety- as well as mood comorbidity were more common in late onset social phobia. A major limitation was the retrospective assessment of onset. Our results encourage future studies into correlates of early onset of psychiatric disorders.
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Affiliation(s)
- A Schat
- Leiden University Medical Center, Department of Psychiatry, P.O. Box 7500, 2300 RC Leiden, The Netherlands.
| | - M S van Noorden
- Leiden University Medical Center, Department of Psychiatry, P.O. Box 7500, 2300 RC Leiden, The Netherlands
| | - M J Noom
- Zaans Medisch Centrum, Department of Psychiatry, Kon. Julianaplein 58, 1502 DV Zaandam, The Netherlands; Mental Health Center GGZ Eindhoven, dept. of child and adolescent psychiatry, Doctor Poletlaan 40, 5626 ND Eindhoven, The Netherlands
| | - E J Giltay
- Leiden University Medical Center, Department of Psychiatry, P.O. Box 7500, 2300 RC Leiden, The Netherlands
| | - N J A van der Wee
- Leiden University Medical Center, Department of Psychiatry, P.O. Box 7500, 2300 RC Leiden, The Netherlands
| | - R de Graaf
- Netherlands Institute of Mental Health and Addiction, P.O. Box 725, 3500 AS, Utrecht, The Netherlands
| | - M Ten Have
- Netherlands Institute of Mental Health and Addiction, P.O. Box 725, 3500 AS, Utrecht, The Netherlands
| | - R R J M M Vermeiren
- Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Center, Endegeesterstraatweg 27, 2342 AK Oegstgeest, The Netherlands
| | - F G Zitman
- Leiden University Medical Center, Department of Psychiatry, P.O. Box 7500, 2300 RC Leiden, The Netherlands
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14
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Birrell L, Newton NC, Teesson M, Slade T. Early onset mood disorders and first alcohol use in the general population. J Affect Disord 2016; 200:243-9. [PMID: 27148903 DOI: 10.1016/j.jad.2016.04.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/18/2016] [Accepted: 04/16/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mood disorders and alcohol use are common in the general population and often occur together. This study explored how early onset mood disorders relate to age of first alcohol use in the Australian general population. METHODS Discrete time survival analysis modelled the odds of first alcohol use among those with, versus without, an early onset DSM-IV mood disorders (major depression, dysthymia or bipolar disorder). Data came from the 2007 Australian National Survey of Mental Health and Wellbeing (N=8841). RESULTS Early onset mood disorders as an overall class were not significantly related to the odds of first alcohol use in any given year. On examining the different types of mood disorders individually early onset bipolar disorder was a significant predictor of first alcohol use. The analysis then looked at interactions with time and found that after the age of 14 years the presence of an early onset mood disorder significantly increased the odds of first alcohol use by 32%. LIMITATIONS Retrospective recall was used to determine age of onset data which is subject to known biases and replication is recommended in some subgroup analysis due to smaller sample sizes. CONCLUSIONS Mood disorders, particularly bipolar disorder, act as unique risk factors for first alcohol use in the general population and show significant interactions with developmental timing. The findings point to the potential utility of prevention programs that target alcohol use and mood disorders together from early adolescence.
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Affiliation(s)
- Louise Birrell
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS), National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW 2052, Australia.
| | - Nicola C Newton
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS), National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW 2052, Australia.
| | - Maree Teesson
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS), National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW 2052, Australia.
| | - Tim Slade
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS), National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW 2052, Australia.
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15
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Park SC, Sakong JK, Koo BH, Kim JM, Jun TY, Lee MS, Kim JB, Yim HW, Park YC. Potential Relationship between Season of Birth and Clinical Characteristics in Major Depressive Disorder in Koreans: Results from the CRESCEND Study. Yonsei Med J 2016; 57:784-9. [PMID: 26996582 PMCID: PMC4800372 DOI: 10.3349/ymj.2016.57.3.784] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/24/2015] [Accepted: 10/23/2015] [Indexed: 12/21/2022] Open
Abstract
We aimed to examine the potential relationship between season of birth (SOB) and clinical characteristics in Korean patients with unipolar non-psychotic major depressive disorder (MDD). Using data from the Clinical Research Center for Depression (CRESCEND) study in South Korea, 891 MDD patients were divided into two groups, those born in spring/summer (n=457) and those born in autumn/winter (n=434). Measurement tools comprising the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Brief Psychiatric Rating Scale, Scale for Suicidal Ideation, Clinical Global Impression of severity, Social and Occupation Functional Assessment Scale, WHO Quality of Life assessment instrument-abbreviated version, Alcohol Use Disorder Identification Test, and Temperament and Character Inventory were used to evaluate depression, anxiety, overall symptoms, suicidal ideation, global severity, social function, quality of life, drinking, and temperament and character, respectively. Using independent t-tests for continuous variables and χ² tests for discrete variables, the clinical characteristics of the two groups were compared. MDD patients born in spring/summer were on average younger at onset of first depressive episode (t=2.084, p=0.038), had greater loss of concentration (χ²=4.589, p=0.032), and were more self-directed (t=2.256, p=0.025) than those born in autumn/winter. Clinically, there was a trend for the MDD patients born in spring/summer to display the contradictory characteristics of more severe clinical course and less illness burden; this may have been partly due to a paradoxical effect of the 5-HT system.
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Affiliation(s)
- Seon-Cheol Park
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Jeong-Kyu Sakong
- Department of Psychiatry, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Bon Hoon Koo
- Department of Psychiatry, Yeungnam University School of Medicine, Daegu, Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University School of Medicine, Gwangju, Korea
| | - Tae-Youn Jun
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Min-Soo Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Jung-Bum Kim
- Department of Psychiatry, Keimyung University School of Medicine, Daegu, Korea
| | - Hyeon-Woo Yim
- Department of Preventive Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong Chon Park
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Korea.
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16
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Albert U, Manchia M, Tortorella A, Volpe U, Rosso G, Carpiniello B, Maina G. Admixture analysis of age at symptom onset and age at disorder onset in a large sample of patients with obsessive-compulsive disorder. J Affect Disord 2015; 187:188-96. [PMID: 26339929 DOI: 10.1016/j.jad.2015.07.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 07/28/2015] [Accepted: 07/30/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND A number of studies tested for the presence of different homogeneous subgroups of obsessive-compulsive disorder (OCD) patients depending on the age at onset (AAO). However, none of the various thresholds of AAO have been validated. No study examined whether age at symptoms onset (ASO) and age at disorder onset (ADO) each define specific and diverse OCD subgroups. METHODS We used normal distribution mixture analysis in a sample of 483 OCD patients to test whether we could identify subgroups of patients according to the AAO. We tested whether ASO and ADO had different distributions and identified different subgroups of OCD patients, and whether clinical correlates had similar patterns of associations with patients subgroups identified with ASO or ADO. RESULTS The mixture analysis showed a trimodal distribution for ASO (mean ASO: 6.9 years for the early onset, 14.99 years for the intermediate onset, and 27.7 years for the late onset component), and confirmed a bimodal distribution for ADO (mean ADO: 18.0 and 29.5 years). Significant differences in the clinical profile of the subgroups emerged, particularly when identified using ASO. LIMITATIONS Limitations of our study are the retrospective investigation of AAO, and the fact that our sample may not represent the OCD population, as we enrolled patients referring to a tertiary center specialized in the treatment of OCD. Our findings need to be confirmed in community samples. Another limitation is the lack of information on medication status at enrollment. CONCLUSIONS Age at symptom onset and ADO showed distinct patterns of distributions. Similarly, phenotypic delineation was specific for ASO and ADO identified subgroups. Accurate clinical and biological profiling of ADO and ASO subgroups might show distinct genetic liabilities, ultimately leading to better nosological models and possibly to improved treatment decision making of OCD patients.
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Affiliation(s)
- Umberto Albert
- Rita Levi Montalcini Department of Neuroscience, Anxiety and Mood Disorders Unit, University of Turin, Italy Via Cherasco 11, 10126 Torino, Italy.
| | - Mirko Manchia
- Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy Via Liguria 13, 09127 Cagliari, Italy; Department of Pharmacology, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College St, Halifax, Nova Scotia, Canada B3H 4R2
| | | | - Umberto Volpe
- Department of Psychiatry, University of Naples SUN, Napoli, Italy
| | - Gianluca Rosso
- Department of Mental Health, "San Luigi-Gonzaga" Hospital, University of Turin, Orbassano (TO), Italy, Regione Gonzole 10, 10043 Orbassano (To), Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy Via Liguria 13, 09127 Cagliari, Italy
| | - Giuseppe Maina
- Department of Mental Health, "San Luigi-Gonzaga" Hospital, University of Turin, Orbassano (TO), Italy, Regione Gonzole 10, 10043 Orbassano (To), Italy
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17
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Azorin JM, Belzeaux R, Adida M. Age-at-onset and comorbidity may separate depressive disorder subtypes along a descending gradient of bipolar propensity. Behav Brain Res 2015; 282:185-93. [DOI: 10.1016/j.bbr.2015.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/05/2015] [Accepted: 01/07/2015] [Indexed: 10/24/2022]
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18
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Park SC, Hahn SW, Hwang TY, Kim JM, Jun TY, Lee MS, Kim JB, Yim HW, Park YC. Does age at onset of first major depressive episode indicate the subtype of major depressive disorder?: the clinical research center for depression study. Yonsei Med J 2014; 55:1712-20. [PMID: 25323911 PMCID: PMC4205714 DOI: 10.3349/ymj.2014.55.6.1712] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the effects of age at onset of the first major depressive episode on the clinical features of individuals with major depressive disorder (MDD) in a large cohort of Korean depressed patients. MATERIALS AND METHODS We recruited 419 MDD patients of age over 18 years from the Clinical Research Center for Depression study in South Korea. At the start of the study, the onset age of the first major depressive episode was self-reported by the subjects. The subjects were divided into four age-at-onset subgroups: childhood and adolescent onset (ages <18), early adult onset (ages 18-44), middle adult onset (ages 45-59), and late onset (ages 60+). Using analysis of covariance (ANCOVA) and ordinal logistic regression analysis with adjusting the effect of age, the relationships between clinical features and age at onset of MDD were evaluated. RESULTS There was an apparent, but inconsistent correlation between clinical features and age at onset. Earlier onset MDD was significantly associated with higher proportion of female gender [adjusted odds ratio (AOR)=0.570, p=0.022], more previous suicide attempts (AOR=0.635, p=0.038), greater number of previous depressive episodes (F=3.475, p=0.016) and higher scores on the brief psychiatric rating scale (F=3.254, p=0.022), its negative symptom subscale (F=6.082, p<0.0001), and the alcohol use disorder identification test (F=7.061, p<0.0001). CONCLUSION Early age at onset may increase the likelihood of distinguishable MDD subtype, and age at onset of the first major depressive episode is a promising clinical indicator for the clinical presentation, course, and outcome of MDD.
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Affiliation(s)
- Seon-Cheol Park
- Department of Psychiatry, Yong-In Mental Hospital, Yongin, Korea.; Institute of Mental Health, Hanyang University, Seoul, Korea
| | - Sang-Woo Hahn
- Department of Psychiatry, College of Medicine, Soonchunhyang Univeristy, Seoul Hospital, Seoul, Korea
| | - Tae-Yeon Hwang
- Department of Psychiatry, Yong-In Mental Hospital, Yongin, Korea.; WHO Collaborating Center for PR and CMH, Yong-In Mental Hospital, Yongin, Korea
| | - Jae-Min Kim
- Department of Psychiatry, School of Medicine, Chonnam National University, Gwangju, Korea
| | - Tae-Youn Jun
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Soo Lee
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea
| | - Jung-Bum Kim
- Department of Psychiatry, Keimyung University School of Medicine, Daegu, Korea
| | - Hyeon-Woo Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Chon Park
- Institute of Mental Health, Hanyang University, Seoul, Korea.; Department of Psychiatry, College of Medicine, Hanyang University, Guri Hospital, Guri, Korea.
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