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Duffy L, Lewis G, Marston L, Kendrick T, Kessler D, Moore M, Wiles N, Lewis G. Clinical factors associated with relapse in depression in a sample of UK primary care patients who have been on long-term antidepressant treatment. Psychol Med 2024; 54:951-961. [PMID: 37753652 DOI: 10.1017/s0033291723002659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
BACKGROUND This paper investigates whether age of onset of depression, duration of the last episode, number of episodes, and residual symptoms of depression and anxiety are associated with depression relapse in primary care patients who have been on long-term maintenance antidepressant treatment and no longer meet ICD10 criteria for depression. METHODS An observational cohort using data from ANTLER (N = 478), a double-blind placebo-controlled trial. The primary outcome was time to relapse using the retrospective CIS-R. Participants were followed for 12 months. RESULTS Primary outcome was available for 468 participants. Time to relapse in those with more than five previous episodes of depression was shorter, hazard ratio (HR) 1.84 (95% confidence interval [CI] 1.23-2.75) compared to people with two episodes; HR 1.57 (95% CI 1.01-2.43) after adjustment. The residual symptoms of depression at baseline were also associated with increased relapse: HR 1.05 (95% CI 1.01-1.09) and HR 1.06 (95% CI 1.01-1.12) in the adjusted model. There was evidence of reduced rate of relapse in older age of onset group: HR 0.86 (95% CI 0.78-0.95); HR attenuated after adjustment HR 0.91 (95% CI 0.81-1.02). There was no evidence of an association between duration of the current episode and residual anxiety symptoms with relapse. CONCLUSIONS The number of previous episodes and residual symptoms of depression were associated with increased likelihood of relapse. These factors could inform joint decision making when patients are considering tapering off maintenance antidepressant treatment or considering other treatments to prevent relapse.
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Affiliation(s)
- Larisa Duffy
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London W1 T 7NF, UK
| | - Gemma Lewis
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London W1 T 7NF, UK
| | - Louise Marston
- Research Dept. of Primary Care and Population Health, University College London, UCL Medical School, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
- Priment Clinical Trials Unit, University College London, UCL Medical School, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Tony Kendrick
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, UK
| | - David Kessler
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Moore
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, UK
| | - Nicola Wiles
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London W1 T 7NF, UK
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Heuschen CBBCM, Mocking RJT, Zantvoord JB, Figueroa CA, Schene AH, Denys DAJP, Ruhé HG, Bockting CLH, Lok A. Suicidal ideation in remitted major depressive disorder predicts recurrence. J Psychiatr Res 2022; 151:65-72. [PMID: 35461004 DOI: 10.1016/j.jpsychires.2022.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/21/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Each year almost 800.000 people die from suicide, of which up to 87% are affected by major depressive disorder (MDD). Despite the strong association between suicidality and MDD, it remains unknown if suicidal symptoms during remission put remitted recurrent MDD patients (rrMDD) at risk for recurrence. METHODS At baseline we compared sociodemographic characteristics and suicidal symptoms in un-medicated rrMDD participants to matched never-depressed controls. We used the HDRS17 and IDS-SR30 to assess suicidal symptoms and depressive symptomatology. Next, we studied the longitudinal association between baseline suicidal symptoms and time to recurrence(s) in rrMDD during a 2.5-year follow-up period using cox regression analyses. Further, we studied with longitudinal data whether suicidal symptoms and depressive symptomatology were cross-sectionally associated using mixed model analysis. RESULTS At baseline, rrMDD participants (N = 73) had higher self-reported suicidal symptoms than matched never-depressed controls (N = 45) (χ2 = 12.09 p < .002). Self-reported suicidal symptoms were almost four times higher (27.9% versus 6.9%) compared to clinician-rated suicidal symptoms in rrMDD at baseline. Self-reported baseline suicidal symptoms, but not clinician-rated symptoms, predicted earlier MDD-recurrence during follow-up, independent of other residual depressive symptoms (χ2 = 7.26, p < .026). Higher suicidal symptoms were longitudinally related to higher depressive symptoms (HDRS17; F = 49.87, p < .001), IDS-SR30; (F = 22.36, p < .001). CONCLUSION This study showed that self-reported - but not clinician-rated - suicidal symptoms persist during remission in rrMDD and predict recurrence, independent from residual symptoms. We recommend to monitor both suicidal and depressive symptomatology during remission in rrMDD, preferably also including self-reported questionnaires apart from clinician-rated. It would be beneficial for future research to assess suicidality using questionnaires primarily designed for measuring suicidal ideation.
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Affiliation(s)
- Caroline B B C M Heuschen
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands.
| | - Roel J T Mocking
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands
| | - Jasper B Zantvoord
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands
| | - Caroline A Figueroa
- School of Social Welfare, University of California, Berkeley, United States; University Medical Centre Utrecht, Heidelberglaan, 100 3584 CX, Utrecht
| | - Aart H Schene
- Dept. of Psychiatry, Radboudumc, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Damiaan A J P Denys
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands
| | - Henricus G Ruhé
- Dept. of Psychiatry, Radboudumc, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Claudi L H Bockting
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Public Health Institute, Amsterdam UMC, Amsterdam, the Netherlands; Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Anja Lok
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Public Health Institute, Amsterdam UMC, Amsterdam, the Netherlands; Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
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3
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Yang H, Gao S, Li J, Yu H, Xu J, Lin C, Yang H, Teng C, Ma H, Zhang N. Remission of symptoms is not equal to functional recovery: Psychosocial functioning impairment in major depression. Front Psychiatry 2022; 13:915689. [PMID: 35958633 PMCID: PMC9360322 DOI: 10.3389/fpsyt.2022.915689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
The ultimate goal of depression treatment is to achieve functional recovery. Psychosocial functioning is the main component of functional impairment in depressed patients. The concept of psychosocial functioning has an early origin; however, its concept and connotation are still ambiguous, which is the basic and key problem faced by the relevant research and clinical application. In this study, we start from the paradox of symptoms remission and functional recovery, describe the concept, connotation, and characteristics of psychosocial functioning impairment in depressed patients, and re-emphasize its importance in depression treatment to promote research and clinical applications related to psychosocial functioning impairment in depressed patients to achieve functional recovery.
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Affiliation(s)
- Hao Yang
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Shuzhan Gao
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jiawei Li
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Haoran Yu
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jingren Xu
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chenchen Lin
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Hua Yang
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Changjun Teng
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Ma
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ning Zhang
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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4
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Sasaki N, Carrozzino D, Nishi D. Sensitivity and concurrent validity of the Japanese version of the Euthymia scale: a clinimetric analysis. BMC Psychiatry 2021; 21:482. [PMID: 34607582 PMCID: PMC8489037 DOI: 10.1186/s12888-021-03494-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 09/23/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Euthymia is characterized by the lack of mood disorders, the presence of positive affects, psychological flexibility and well-being, a unifying outlook on life, and resistance to stress. The Euthymia Scale (ES) is a 10-item self-rating clinimetric index assessing euthymia. OBJECTIVES The present study was conducted to examine the clinimetric sensitivity and concurrent validity of the Japanese version of the Euthymia Scale (ES-J). METHODS A cross-sectional online survey was conducted. The Mini-International Neuropsychiatric Interview was used to determine the presence of past or current major depressive episodes (MDE). The clinimetric sensitivity was evaluated using the Analysis of Variance (ANOVA). Pearson's correlation coefficients were performed to examine the concurrent validity of the ES-J. RESULTS A total of 1030 eligible participants completed the survey. The ES-J differentiated healthy subjects from complete remission (i.e., those with a past history of MDE without current MDE) (p < 0.001), from those with past or current history of MDE (p < 0.001), subjects with current MDE from those with sub-threshold symptoms of depression (p < 0.001), and healthy participants from subjects with moderate to severe symptoms of psychological distress (p < 0.001). The associations between the ES-J and measures of psychological well-being, resilience, life satisfaction, and social support were significantly positive (0.353 < r < 0.666, p < 0.001). A negative relationship between the ES-J and measures of psychological distress was also found (r = - 0.595, p < 0.001). CONCLUSIONS The findings of the present study indicated that the ES-J is a valid and highly sensitive clinimetric index, which can be used as a screening measure in the clinical process of assessment of recovery, particularly when symptoms are expected to be mild and/or when dealing with subclinical symptoms of psychological distress and depression. The findings of this study also support the use of the ES-J to detect vulnerability to depression and to identify subjects at higher risk of relapse.
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Affiliation(s)
- Natsu Sasaki
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Danilo Carrozzino
- Department of Psychology “Renzo Canestrari”, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
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5
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Moriarty AS, Meader N, Snell KI, Riley RD, Paton LW, Chew-Graham CA, Gilbody S, Churchill R, Phillips RS, Ali S, McMillan D. Prognostic models for predicting relapse or recurrence of major depressive disorder in adults. Cochrane Database Syst Rev 2021; 5:CD013491. [PMID: 33956992 PMCID: PMC8102018 DOI: 10.1002/14651858.cd013491.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Relapse (the re-emergence of depressive symptoms after some level of improvement but preceding recovery) and recurrence (onset of a new depressive episode after recovery) are common in depression, lead to worse outcomes and quality of life for patients and exert a high economic cost on society. Outcomes can be predicted by using multivariable prognostic models, which use information about several predictors to produce an individualised risk estimate. The ability to accurately predict relapse or recurrence while patients are well (in remission) would allow the identification of high-risk individuals and may improve overall treatment outcomes for patients by enabling more efficient allocation of interventions to prevent relapse and recurrence. OBJECTIVES To summarise the predictive performance of prognostic models developed to predict the risk of relapse, recurrence, sustained remission or recovery in adults with major depressive disorder who meet criteria for remission or recovery. SEARCH METHODS We searched the Cochrane Library (current issue); Ovid MEDLINE (1946 onwards); Ovid Embase (1980 onwards); Ovid PsycINFO (1806 onwards); and Web of Science (1900 onwards) up to May 2020. We also searched sources of grey literature, screened the reference lists of included studies and performed a forward citation search. There were no restrictions applied to the searches by date, language or publication status . SELECTION CRITERIA We included development and external validation (testing model performance in data separate from the development data) studies of any multivariable prognostic models (including two or more predictors) to predict relapse, recurrence, sustained remission, or recovery in adults (aged 18 years and over) with remitted depression, in any clinical setting. We included all study designs and accepted all definitions of relapse, recurrence and other related outcomes. We did not specify a comparator prognostic model. DATA COLLECTION AND ANALYSIS Two review authors independently screened references; extracted data (using a template based on the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS)); and assessed risks of bias of included studies (using the Prediction model Risk Of Bias ASsessment Tool (PROBAST)). We referred any disagreements to a third independent review author. Where we found sufficient (10 or more) external validation studies of an individual model, we planned to perform a meta-analysis of its predictive performance, specifically with respect to its calibration (how well the predicted probabilities match the observed proportions of individuals that experience the outcome) and discrimination (the ability of the model to differentiate between those with and without the outcome). Recommendations could not be qualified using the GRADE system, as guidance is not yet available for prognostic model reviews. MAIN RESULTS We identified 11 eligible prognostic model studies (10 unique prognostic models). Seven were model development studies; three were model development and external validation studies; and one was an external validation-only study. Multiple estimates of performance measures were not available for any of the models and, meta-analysis was therefore not possible. Ten out of the 11 included studies were assessed as being at high overall risk of bias. Common weaknesses included insufficient sample size, inappropriate handling of missing data and lack of information about discrimination and calibration. One paper (Klein 2018) was at low overall risk of bias and presented a prognostic model including the following predictors: number of previous depressive episodes, residual depressive symptoms and severity of the last depressive episode. The external predictive performance of this model was poor (C-statistic 0.59; calibration slope 0.56; confidence intervals not reported). None of the identified studies examined the clinical utility (net benefit) of the developed model. AUTHORS' CONCLUSIONS Of the 10 prognostic models identified (across 11 studies), only four underwent external validation. Most of the studies (n = 10) were assessed as being at high overall risk of bias, and the one study that was at low risk of bias presented a model with poor predictive performance. There is a need for improved prognostic research in this clinical area, with future studies conforming to current best practice recommendations for prognostic model development/validation and reporting findings in line with the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement.
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Affiliation(s)
- Andrew S Moriarty
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
| | - Nicholas Meader
- Centre for Reviews and Dissemination, University of York, York, UK
- Cochrane Common Mental Disorders, University of York, York, UK
| | - Kym Ie Snell
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - Richard D Riley
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - Lewis W Paton
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | | | - Simon Gilbody
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
- Cochrane Common Mental Disorders, University of York, York, UK
| | | | - Shehzad Ali
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Dean McMillan
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
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6
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Woodhead E, Cronkite R, Finlay A, Wong J, Haverfield M, Timko C. The role of depression course on life functioning and coping outcomes from baseline through 23-year follow-up. J Ment Health 2020; 31:348-356. [PMID: 32667276 DOI: 10.1080/09638237.2020.1793127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although studies have examined how depressed patients' baseline characteristics predict depression course, still needed are studies of how depression course is associated with modifiable long-term outcomes. AIMS This study examined six outcomes of three groups representing distinct depression courses (low baseline severity, rapid decline; moderate baseline severity, rapid decline; and high baseline severity, slow decline): medical functioning, coping patterns, family functioning, social functioning, employment, and work functioning. METHOD Adults with depression at baseline (N = 382; 56% women) were followed for 23 years on self-reported outcomes (79% response rate). Data from the baseline assessment and follow-ups (1, 4, 10, and 23 years) were used in a longitudinal analysis to examine associations between depression course and outcomes. RESULTS All depression course groups declined on medical and social functioning and employment over follow-up. The high- and moderate-severity depression course groups reported poorer coping patterns than the low-severity group. The high-severity depression course group reported poorer family functioning than the moderate-severity group, and had the poorest work functioning outcome, followed by the moderate-severity and then the low-severity groups. CONCLUSIONS Patients with a high- or moderate-severity depression course may benefit from treatment that manages coping patterns and improves family and work functioning.
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Affiliation(s)
- Erin Woodhead
- Psychology Department, San José State University, San Jose, CA, USA
| | - Ruth Cronkite
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Center for Health Policy/Center on Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA.,Department of Sociology, Stanford University, Stanford, CA, USA
| | - Andrea Finlay
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Veterans Affairs, National Center on Homelessness Among Veterans, Menlo Park, CA, USA
| | - Jessie Wong
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Center for Health Policy/Center on Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Marie Haverfield
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Center for Health Policy/Center on Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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7
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Nuggerud-Galeas S, Oliván Blázquez B, Perez Yus MC, Valle-Salazar B, Aguilar-Latorre A, Magallón Botaya R. Factors Associated With Depressive Episode Recurrences in Primary Care: A Retrospective, Descriptive Study. Front Psychol 2020; 11:1230. [PMID: 32581978 PMCID: PMC7290009 DOI: 10.3389/fpsyg.2020.01230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction and Objective The early identification of depressive patients having a poor evolution, with frequent relapses and/or recurrences, is one of the priority challenges in this study of high prevalence mental disorders, and specifically in depression. So, this study aims to analyze the factors that may be associated with an increased risk of recurrence of major depression episodes in patients treated in primary care. Methods A retrospective, descriptive study of cases-controls was proposed. The cases consisted of patients who had been diagnosed with major depression and who had presented recurrences (n = 101), in comparison with patients who had experienced a single major depression episode with no recurrence (n = 99). The variables of the study are age at first episode; number of episodes; perception of severity of the depression episode suffered prior to recurrence; number of residual symptoms; physical and psychiatric comorbidity; history of anxiety disorders; family psychiatric history; high incidence of stressful life events (SLEs); and experiences of physical, psychological, or sexual abuse in childhood. The differences of the variables were compared between the case subjects and the control subjects, using the Mann-Whitney, chi-square, and Fisher's U statistics. A multivariate analysis (ordinary logistic regression) was performed. Results The average age of those suffering more than one depressive episode is significantly older (5 years), and a higher percentage of subjects who have experienced more than one depressive episode have a history of anxiety disorders. In the multivariate analysis, the variables that obtained a significant value in the logistic regression analysis were age (OR: 1.03; value: 0.007) and having suffered sexual abuse during childhood (OR: 1.64; value: 0.072). Conclusion These indicators should be considered by primary care physicians when attending patients suffering from major depression.
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Affiliation(s)
- Shysset Nuggerud-Galeas
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | - Bárbara Oliván Blázquez
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - María Cruz Perez Yus
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Begoña Valle-Salazar
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Primary Health Care, Aragón Health Service, Zaragoza, Spain
| | | | - Rosa Magallón Botaya
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain.,Primary Health Care, Aragón Health Service, Zaragoza, Spain
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8
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Hori H, Katsuki A, Atake K, Yoshimura R, Nakamura J, Baune BT. Risk factors for further sick leave among Japanese workers returning to work after an episode of major depressive disorder: a prospective follow-up study over 1 year. BMJ Open 2019; 9:e029705. [PMID: 31511285 PMCID: PMC6747669 DOI: 10.1136/bmjopen-2019-029705] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We aimed to investigate the risk factors for further sick leave episodes among Japanese workers returning to work after time off with a major depressive disorder. DESIGN A prospective study with 1 year of follow-up. PARTICIPANTS We recruited 103 workers who had returned to work after taking sick leave with a major depressive disorder. Adjusted HRs with 95% CIs were calculated using Cox proportional hazard models to examine the risk of further sick leave. RESULTS In the adjusted analysis, we show that Social Adaptation Self-evaluation Scale scores (HR 0.95; p=0.019), 3-back correct response rate (N-back test) (HR 0.97; p<0.001) and benzodiazepine dosage (diazepam equivalent) (HR1.07; p=0.014) were associated with further episodes of sick leave. CONCLUSIONS Poorer social and cognitive functioning, together with higher diazepam dosages, were associated with an increased likelihood of additional sick leave.
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Affiliation(s)
- Hikaru Hori
- Department of Psychiatry, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Asuka Katsuki
- Department of Psychiatry, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kiyokazu Atake
- Department of Psychiatry, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Reiji Yoshimura
- Department of Psychiatry, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | - Bernhard T Baune
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
- Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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9
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Duncko R, Fischer S, Hatch SL, Frissa S, Goodwin L, Papadopoulos A, Cleare AJ, Hotopf M. Recurrence of Depression in Relation to History of Childhood Trauma and Hair Cortisol Concentration in a Community-Based Sample. Neuropsychobiology 2019; 78:48-57. [PMID: 30897568 DOI: 10.1159/000498920] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/12/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Childhood trauma represents a risk factor for developing depression with increased rates of recurrence. Mechanisms involved include a disturbed regulation of the hypothalamic-pituitary-adrenal (HPA) axis. Hair cortisol concentration (HCC) is a measure of long-term HPA axis activity with less interference from circadian and confounding factors. However, no study has so far used HCC to investigate the role of childhood trauma in recurrent pattern of depressive symptoms. METHODS A community-based sample of 500 participants was recruited, and depression was assessed at 3 time points using the Revised Clinical Interview Schedule. The Childhood Trauma Questionnaire was administered to identify a history of childhood trauma. Hair samples were obtained from 144 participants for analysis of cortisol. RESULTS Patients with recurrent depression had higher rates of childhood trauma compared to participants with no depression. Participants with current-only depression had increased HCC compared to the no depression group, while this was absent in participants with recurrent depression. Within the depressed group (both current-only and recurrent depression), those with a history of childhood physical abuse had lower HCC when compared to those with no such history. CONCLUSIONS Our findings show that retrospectively reported childhood trauma is associated with protracted trajectories of depression and a distinct pattern of long-term HPA axis activity.
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Affiliation(s)
- Roman Duncko
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom, .,Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, United Kingdom,
| | - Susanne Fischer
- University of Zurich, Institute of Psychology, Clinical Psychology and Psychotherapy, Zurich, Switzerland.,Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Souci Frissa
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Laura Goodwin
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Andrew Papadopoulos
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Anthony J Cleare
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, United Kingdom.,Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, United Kingdom
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10
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Bos EH, Ten Have M, van Dorsselaer S, Jeronimus BF, de Graaf R, de Jonge P. Functioning before and after a major depressive episode: pre-existing vulnerability or scar? A prospective three-wave population-based study. Psychol Med 2018; 48:2264-2272. [PMID: 29331152 DOI: 10.1017/s0033291717003798] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The vulnerability hypothesis suggests that impairments after remission of depressive episodes reflect a pre-existing vulnerability, while the scar hypothesis proposes that depression leaves residual impairments that confer risk of subsequent episodes. We prospectively examined vulnerability and scar effects in mental and physical functioning in a representative Dutch population sample. METHODS Three waves were used from the Netherlands Mental Health Survey and Incidence Study-2, a population-based study with a 6-years follow-up. Mental and physical functioning were assessed with the Medical Outcomes Study Short Form (SF-36). Major depressive disorder (MDD) was assessed with the Composite International Diagnostic Interview 3.0. Vulnerability effects were examined by comparing healthy controls (n = 2826) with individuals who developed a first-onset depressive episode during first follow-up but did not have a lifetime diagnosis of MDD at baseline (n = 181). Scarring effects were examined by comparing pre- and post-morbid functioning in individuals who developed a depressive episode after baseline that was remitted at the third wave (n = 108). RESULTS Both mental (B = -5.4, s.e. = 0.9, p < 0.001) and physical functioning (B = -8.2, s.e. = 1.1, p < 0.001) at baseline were lower in individuals who developed a first depressive episode after baseline compared with healthy controls. This effect was most pronounced in people who developed a severe episode. No firm evidence of scarring in mental or physical functioning was found. In unadjusted analyses, physical functioning was still lowered post-morbidly (B = -5.1, s.e. = 2.1, p = 0.014), but this effect disappeared in adjusted analyses. CONCLUSIONS Functional impairments after remission of depression seem to reflect a pre-existing vulnerability rather than a scar.
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Affiliation(s)
- E H Bos
- Department of Developmental Psychology,Behavioural and Social Sciences,University of Groningen,Groningen,The Netherlands
| | - M Ten Have
- Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands
| | - S van Dorsselaer
- Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands
| | - B F Jeronimus
- Department of Developmental Psychology,Behavioural and Social Sciences,University of Groningen,Groningen,The Netherlands
| | - R de Graaf
- Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands
| | - P de Jonge
- Department of Developmental Psychology,Behavioural and Social Sciences,University of Groningen,Groningen,The Netherlands
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11
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Buckman JEJ, Underwood A, Clarke K, Saunders R, Hollon SD, Fearon P, Pilling S. Risk factors for relapse and recurrence of depression in adults and how they operate: A four-phase systematic review and meta-synthesis. Clin Psychol Rev 2018; 64:13-38. [PMID: 30075313 PMCID: PMC6237833 DOI: 10.1016/j.cpr.2018.07.005] [Citation(s) in RCA: 190] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 02/16/2018] [Accepted: 07/21/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE To review and synthesise prognostic indices that predict subsequent risk, prescriptive indices that moderate treatment response, and mechanisms that underlie each with respect to relapse and recurrence of depression in adults. RESULTS AND CONCLUSIONS Childhood maltreatment, post-treatment residual symptoms, and a history of recurrence emerged as strong prognostic indicators of risk and each could be used prescriptively to indicate who benefits most from continued or prophylactic treatment. Targeting prognostic indices or their "down-stream" consequences will be particularly beneficial because each is either a cause or a consequence of the causal mechanisms underlying risk of recurrence. The cognitive and neural mechanisms that underlie the prognostic indices are likely addressed by the effects of treatments that are moderated by the prescriptive factors. For example, psychosocial interventions that target the consequences of childhood maltreatment, extending pharmacotherapy or adapting psychological therapies to deal with residual symptoms, or using cognitive or mindfulness-based therapies for those with prior histories of recurrence. Future research that focuses on understanding causal pathways that link childhood maltreatment, or cognitive diatheses, to dysfunction in the neocortical and limbic pathways that process affective information and facilitate cognitive control, might result in more enduring effects of treatments for depression.
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Affiliation(s)
- J E J Buckman
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - A Underwood
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - K Clarke
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - R Saunders
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - S D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - P Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - S Pilling
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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12
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Ten Have M, de Graaf R, van Dorsselaer S, Tuithof M, Kleinjan M, Penninx BWJH. Recurrence and chronicity of major depressive disorder and their risk indicators in a population cohort. Acta Psychiatr Scand 2018; 137:503-515. [PMID: 29577236 DOI: 10.1111/acps.12874] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The naturalistic course of major depressive disorder (MDD) and risk indicators for recurrence and chronicity are best studied using a population sample without clear selection bias. However, such studies are scarce. This limits clinical decision-making concerning monitoring and maintenance treatment. METHOD Data were used from the Netherlands Mental Health Survey and Incidence Study-2, a psychiatric epidemiological cohort study among a representative adult population. Two groups at baseline were selected to study recurrence and chronicity of MDD at follow-up. Diagnoses were assessed with the Composite International Diagnostic Interview 3.0. RESULTS Among remitted MDD cases (n = 746), the cumulative recurrence rate was 4.3% at 5 years, 13.4% at 10 years and 27.1% at 20 years. Time to recurrence was predicted by vulnerability characteristics (childhood abuse, negative life events, parental psychopathology), physical health, functioning, clinical characteristics of depression (previous episodes, severity, medication use), psychiatric comorbidity and mental health use. Among current MDD cases (n = 242), 12% developed a chronic depressive episode over 6 years. Chronic course was predicted by similar risk indicators as recurrence, except for vulnerability characteristics and physical health. CONCLUSION These risk indicators may help to identify patients requiring monitoring and who could benefit from preventive interventions or maintenance treatment.
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Affiliation(s)
- M Ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - R de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - S van Dorsselaer
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - M Tuithof
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - M Kleinjan
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - B W J H Penninx
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
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13
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Verhoeven FEA, Wardenaar KJ, Ruhé HGE, Conradi HJ, de Jonge P. Seeing the signs: Using the course of residual depressive symptomatology to predict patterns of relapse and recurrence of major depressive disorder. Depress Anxiety 2018; 35:148-159. [PMID: 29228458 DOI: 10.1002/da.22695] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 08/29/2017] [Accepted: 09/09/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is characterized by high relapse/recurrence rates. Predicting individual patients' relapse/recurrence risk has proven hard, possibly due to course heterogeneity among patients. This study aimed to (1) identify homogeneous data-driven subgroups with different patterns of relapse/recurrence and (2) identify associated predictors. METHODS For a year, we collected weekly depressive symptom ratings in 213 primary care MDD patients. Latent class growth analyses (LCGA), based on symptom-severity during the 24 weeks after no longer fulfilling criteria for the initial major depressive episode (MDE), were used to identify groups with different patterns of relapse/recurrence. Associations of baseline predictors with these groups were investigated, as were the groups' associations with 3- and 11-year follow-up depression outcomes. RESULTS LCGA showed that heterogeneity in relapse/recurrence after no longer fulfilling criteria for the initial MDE was best described by four classes: "quick symptom decline" (14.0%), "slow symptom decline" (23.3%), "steady residual symptoms" (38.7%), and "high residual symptoms" (24.1%). The latter two classes showed lower self-esteem at baseline, and more recurrences and higher severity at 3-year follow-up than the first two classes. Moreover, the high residual symptom class scored higher on neuroticism and lower on extraversion and self-esteem at baseline. Interestingly, the steady residual symptoms and high residual symptoms classes still showed higher severity of depressive symptoms after 11 years. CONCLUSION Some measures were associated with specific patterns of relapse/recurrence. Moreover, the data-driven relapse/recurrence groups were predictive of long-term outcomes, suggesting that patterns of residual symptoms could be of prognostic value in clinical practice.
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Affiliation(s)
- Floor E A Verhoeven
- University Medical Center Groningen, RGOc, University of Groningen, Groningen, The Netherlands
| | - Klaas J Wardenaar
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henricus G Eric Ruhé
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Psychiatry, Warneford Hospital, University of Oxford, United Kingdom
| | - Henk Jan Conradi
- Department of Clinical Psychology, University of Amsterdam, The Netherlands
| | - Peter de Jonge
- Faculty of Behavioural and Social Sciences, Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands
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14
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Rodgers S, Vandeleur CL, Strippoli MPF, Castelao E, Tesic A, Glaus J, Lasserre AM, Müller M, Rössler W, Ajdacic-Gross V, Preisig M. Low emotion-oriented coping and informal help-seeking behaviour as major predictive factors for improvement in major depression at 5-year follow-up in the adult community. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1169-1182. [PMID: 28748306 DOI: 10.1007/s00127-017-1421-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 07/14/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE Given the broad range of biopsychosocial difficulties resulting from major depressive disorder (MDD), reliable evidence for predictors of improved mental health is essential, particularly from unbiased prospective community samples. Consequently, a broad spectrum of potential clinical and non-clinical predictors of improved mental health, defined as an absence of current major depressive episode (MDE) at follow-up, were examined over a 5-year period in an adult community sample. METHODS The longitudinal population-based PsyCoLaus study from the city of Lausanne, Switzerland, was used. Subjects having a lifetime MDD with a current MDE at baseline assessment were selected, resulting in a subsample of 210 subjects. Logistic regressions were applied to the data. RESULTS Coping styles were the most important predictive factors in the present study. More specifically, low emotion-oriented coping and informal help-seeking behaviour at baseline were associated with the absence of an MDD diagnosis at follow-up. Surprisingly, neither formal help-seeking behaviour, nor psychopharmacological treatment, nor childhood adversities, nor depression subtypes turned out to be relevant predictors in the current study. CONCLUSIONS The paramount role of coping styles as predictors of improvement in depression found in the present study might be a valuable target for resource-oriented therapeutic models. On the one hand, the positive impact of low emotion-oriented coping highlights the utility of clinical interventions interrupting excessive mental ruminations during MDE. On the other hand, the importance of informal social networks raises questions regarding how to enlarge the personal network of affected subjects and on how to best support informal caregivers.
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Affiliation(s)
- S Rodgers
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 1930, 8021, Zurich, Switzerland.
- Epidemiology, Biostatistics and Prevention Institute, Swiss MS Registry, University of Zurich, Zurich, Switzerland.
| | - C L Vandeleur
- Department of Psychiatry, Psychiatric Epidemiology and Psychopathology Research Centre, Lausanne University Hospital, Lausanne, Switzerland
| | - M-P F Strippoli
- Department of Psychiatry, Psychiatric Epidemiology and Psychopathology Research Centre, Lausanne University Hospital, Lausanne, Switzerland
| | - E Castelao
- Department of Psychiatry, Psychiatric Epidemiology and Psychopathology Research Centre, Lausanne University Hospital, Lausanne, Switzerland
| | - A Tesic
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 1930, 8021, Zurich, Switzerland
| | - J Glaus
- Department of Psychiatry, Psychiatric Epidemiology and Psychopathology Research Centre, Lausanne University Hospital, Lausanne, Switzerland
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - A M Lasserre
- Department of Psychiatry, Psychiatric Epidemiology and Psychopathology Research Centre, Lausanne University Hospital, Lausanne, Switzerland
| | - M Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 1930, 8021, Zurich, Switzerland
| | - W Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 1930, 8021, Zurich, Switzerland
- Collegium Helveticum, University of Zurich and Swiss Federal Institute of Technology, Zurich, Switzerland
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
| | - V Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 1930, 8021, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, Swiss MS Registry, University of Zurich, Zurich, Switzerland
| | - M Preisig
- Department of Psychiatry, Psychiatric Epidemiology and Psychopathology Research Centre, Lausanne University Hospital, Lausanne, Switzerland
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15
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Kessing LV, Andersen PK. Evidence for clinical progression of unipolar and bipolar disorders. Acta Psychiatr Scand 2017; 135:51-64. [PMID: 27858964 DOI: 10.1111/acps.12667] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE It is a widely held belief that affective disorders are progressive of nature; however, some recent reviews have questioned this belief. The objective of the present systematic literature review was to present evidence for associations between number of affective episodes and (i) the risk of recurrence of episodes, (ii) probability of recovery from episodes, (iii) severity of episodes, (iv) the threshold for developing episodes, and (v) progression of cognitive deficits in unipolar and bipolar disorders. METHOD A systematic review comprising an extensive literature search conducted in Medline, Embase, and PsychInfo up to September 2016 and including cross-references from identified papers and reviews. RESULTS Most of the five areas are superficially investigated and hampered by methodological challenges. Nevertheless, studies with the longest follow-up periods, using survival analysis methods, taking account of the individual heterogeneity all support a clinical progressive course of illness. Overall, increasing number of affective episodes seems to be associated with (i) increasing risk of recurrence, (ii) increasing duration of episodes, (iii) increasing symptomatic severity of episodes, (iv) decreasing threshold for developing episodes, and (v) increasing risk of developing dementia. CONCLUSION Although the course of illness is heterogeneous, there is evidence for clinical progression of unipolar and bipolar disorders.
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Affiliation(s)
- L V Kessing
- Department O, Psychiatric Center Copenhagen, Copenhagen, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - P K Andersen
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
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16
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Buszewicz M, Griffin M, McMahon EM, Walters K, King M. Practice nurse-led proactive care for chronic depression in primary care: a randomised controlled trial. Br J Psychiatry 2016; 208:374-80. [PMID: 26795423 DOI: 10.1192/bjp.bp.114.153312] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 04/15/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Management of long-term depression is a significant problem in primary care populations with considerable on-going morbidity, but few studies have focused on this group. AIMS To evaluate whether structured, nurse-led proactive care of patients with chronic depression in primary care improves outcomes. METHOD Participants with chronic/recurrent major depression or dysthymia were recruited from 42 UK general practices and randomised to general practitioner (GP) treatment as usual or nurse intervention over 2 years (the ProCEED trial, trial registration:ISRCTN36610074). RESULTS In total 282 people received the intervention and there were 276 controls. At 24 months there was no significant improvement in Beck Depression Inventory (BDI-II) score or quality of life (Euroquol-EQ-VAS), but a significant improvement in functional impairment (Work and Social Activity Schedule, WSAS) of 2.5 (95% CI 0.6-4.3,P= 0.010) in the intervention group. The impact per practice-nurse intervention session was -0.37 (95% CI -0.68 to -0.07,P= 0.017) on the BDI-II score and 70.33 (95% CI 70.55 to -0.10,P= 0.004) on the WSAS score, indicating that attending all 10 intervention sessions could lead to a BDI-II score reduction of 3.7 points compared with controls. CONCLUSIONS The intervention improved functioning in these patients, the majority of whom had complex long-term difficulties, but only had a significant impact on depressive symptoms in those engaging with the full intervention.
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Affiliation(s)
- Marta Buszewicz
- Marta Buszewicz, MBBS, MRCGP, MRCPsych, Mark Griffin, MSc, Elaine M. McMahon, BA, MPhil, Kate Walters, MBBS, MSc, PhD, Research Department of Primary Care & Population Health, University College London (Royal Free Campus), London; Michael King, MBBS, PhD, FRCPsych, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Mark Griffin
- Marta Buszewicz, MBBS, MRCGP, MRCPsych, Mark Griffin, MSc, Elaine M. McMahon, BA, MPhil, Kate Walters, MBBS, MSc, PhD, Research Department of Primary Care & Population Health, University College London (Royal Free Campus), London; Michael King, MBBS, PhD, FRCPsych, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Elaine M McMahon
- Marta Buszewicz, MBBS, MRCGP, MRCPsych, Mark Griffin, MSc, Elaine M. McMahon, BA, MPhil, Kate Walters, MBBS, MSc, PhD, Research Department of Primary Care & Population Health, University College London (Royal Free Campus), London; Michael King, MBBS, PhD, FRCPsych, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Kate Walters
- Marta Buszewicz, MBBS, MRCGP, MRCPsych, Mark Griffin, MSc, Elaine M. McMahon, BA, MPhil, Kate Walters, MBBS, MSc, PhD, Research Department of Primary Care & Population Health, University College London (Royal Free Campus), London; Michael King, MBBS, PhD, FRCPsych, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Michael King
- Marta Buszewicz, MBBS, MRCGP, MRCPsych, Mark Griffin, MSc, Elaine M. McMahon, BA, MPhil, Kate Walters, MBBS, MSc, PhD, Research Department of Primary Care & Population Health, University College London (Royal Free Campus), London; Michael King, MBBS, PhD, FRCPsych, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
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17
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Monden R, Stegeman A, Conradi HJ, de Jonge P, Wardenaar KJ. Predicting long-term depression outcome using a three-mode principal component model for depression heterogeneity. J Affect Disord 2016; 189:1-9. [PMID: 26398565 DOI: 10.1016/j.jad.2015.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/25/2015] [Accepted: 09/09/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Depression heterogeneity has hampered development of adequate prognostic models. Therefore, more homogeneous clinical entities (e.g. dimensions, subtypes) have been developed, but their differentiating potential is limited because neither captures all relevant variation across persons, symptoms and time. To address this, three-mode Principal Component Analysis (3MPCA) was previously applied to capture person-, symptom- and time-level variation in a single model (Monden et al., 2015). This study evaluated the added prognostic value of such an integrated model for longer-term depression outcomes. METHODS The Beck Depression Inventory (BDI) was administered quarterly for two years to major depressive disorder outpatients participating in a randomized controlled trial. A previously developed 3MPCA model decomposed the data into 2 symptom-components ('somatic-affective', 'cognitive'), 2 time-components ('recovering', 'persisting') and 3 person-components ('severe non-persisting depression', 'somatic depression' and 'cognitive depression'). The predictive value of the 3MPCA model for BDI scores at 3-year (n=136) and 11-year follow-up (n=145) was compared with traditional latent variable models and traditional prognostic factors (e.g. baseline BDI component scores, personality). RESULTS 3MPCA components predicted 41% and 36% of the BDI variance at 3- and 11-year follow-up, respectively. A latent class model, growth mixture model and other known prognostic variables predicted 4-32% and 3-24% of the BDI variance at 3- and 11-year follow-up, respectively. LIMITATIONS Only primary care patients were included. There was no independent validation sample. CONCLUSION Accounting for depression heterogeneity at the person-, symptom- and time-level improves longer-term predictions of depression severity, underlining the potential of this approach for developing better prognostic models.
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Affiliation(s)
- Rei Monden
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Department of Psychiatry, (CC-72), PO Box 30.001, 9700 Groningen, The Netherlands.
| | - Alwin Stegeman
- University of Groningen, Heijmans Institute of Psychological Research, Groningen, The Netherlands
| | - Henk Jan Conradi
- University of Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands
| | - Peter de Jonge
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Department of Psychiatry, (CC-72), PO Box 30.001, 9700 Groningen, The Netherlands
| | - Klaas J Wardenaar
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Department of Psychiatry, (CC-72), PO Box 30.001, 9700 Groningen, The Netherlands
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18
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Lamers F, Beekman ATF, van Hemert AM, Schoevers RA, Penninx BWJH. Six-year longitudinal course and outcomes of subtypes of depression. Br J Psychiatry 2016; 208:62-8. [PMID: 26294366 DOI: 10.1192/bjp.bp.114.153098] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 12/02/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Clinical and aetiological heterogeneity have impeded our understanding of depression. AIMS To evaluate differences in psychiatric and somatic course between people with depression subtypes that differed clinically (severity) and aetiologically (melancholic v. atypical). METHOD Data from baseline, 2-, 4- and 6-year follow-up of The Netherlands Study of Depression and Anxiety were used, and included 600 controls and 648 people with major depressive disorder (subtypes: severe melancholic n = 308; severe atypical n = 167; moderate n = 173, established using latent class analysis). RESULTS Those with the moderate subtype had a significantly better psychiatric clinical course than the severe melancholic and atypical subtype groups. Suicidal thoughts and anxiety persisted longer in those with the melancholic subtype. The atypical subtype group continued to have the highest body mass index and highest prevalence of metabolic syndrome during follow-up, although differences between groups became less pronounced over time. CONCLUSIONS Course trajectories of depressive subtypes mostly ran parallel to each other, with baseline severity being the most important differentiator in course between groups.
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Affiliation(s)
- F Lamers
- F. Lamers, A. T. F. Beekman, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Center, Amsterdam; A. M. van Hemert, Department of Psychiatry, Leiden University Medical Center, Leiden; R. A. Schoevers, Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen; B. W. J. H. Penninx, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Center, Amsterdam, The Netherlands
| | - A T F Beekman
- F. Lamers, A. T. F. Beekman, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Center, Amsterdam; A. M. van Hemert, Department of Psychiatry, Leiden University Medical Center, Leiden; R. A. Schoevers, Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen; B. W. J. H. Penninx, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Center, Amsterdam, The Netherlands
| | - A M van Hemert
- F. Lamers, A. T. F. Beekman, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Center, Amsterdam; A. M. van Hemert, Department of Psychiatry, Leiden University Medical Center, Leiden; R. A. Schoevers, Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen; B. W. J. H. Penninx, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Center, Amsterdam, The Netherlands
| | - R A Schoevers
- F. Lamers, A. T. F. Beekman, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Center, Amsterdam; A. M. van Hemert, Department of Psychiatry, Leiden University Medical Center, Leiden; R. A. Schoevers, Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen; B. W. J. H. Penninx, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Center, Amsterdam, The Netherlands
| | - B W J H Penninx
- F. Lamers, A. T. F. Beekman, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Center, Amsterdam; A. M. van Hemert, Department of Psychiatry, Leiden University Medical Center, Leiden; R. A. Schoevers, Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen; B. W. J. H. Penninx, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Center, Amsterdam, The Netherlands
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19
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Wright AA, Hensley CP, Gilbertson J, Leland JM, Jackson S. Defining patient acceptable symptom state thresholds for commonly used patient reported outcomes measures in general orthopedic practice. ACTA ACUST UNITED AC 2015; 20:814-9. [DOI: 10.1016/j.math.2015.03.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 03/12/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
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20
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Wardenaar KJ, Monden R, Conradi HJ, de Jonge P. Symptom-specific course trajectories and their determinants in primary care patients with Major Depressive Disorder: Evidence for two etiologically distinct prototypes. J Affect Disord 2015; 179:38-46. [PMID: 25845748 DOI: 10.1016/j.jad.2015.03.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND The course-heterogeneity of Major Depressive Disorder (MDD) hampers development of better prognostic models. Although latent class growth analyses (LCGA) have been used to explain course-heterogeneity, such analyses have failed to also account for symptom-heterogeneity of depressive symptoms. Therefore, the aim was to identify more specific data-driven subgroups based on patterns of course-trajectories on different depressive symptom domains. METHODS In primary care MDD patients (n=205), the presence of the MDD criterion symptoms was determined for each week during a year. Weekly 'mood/cognition' (MC) and 'somatic' (SOM) scores were computed and parallel processes-LCGA (PP-LCGA) was used to identify subgroups based on the course on these domains. The classes׳ associations with baseline predictors and 2-/3-year outcomes were investigated. RESULTS PP-LCGA identified four classes: quick recovery, persisting SOM, persisting MC, and persisting SOM+MC (chronic). Persisting SOM was specifically predicted by higher baseline somatic symptomatology and somatization, and was associated with more somatic depressive symptomatology at long-term follow-up. Persisting MC was specifically predicted by higher depressive severity, thinking insufficiencies, neuroticism, loneliness and lower self-esteem, and was associated with lower mental health related quality of life and more mood/cognitive depressive symptomatology at follow-up. LIMITATIONS The sample was small and contained only primary care MDD patients. The weekly depression assessments were collected retrospectively at 3-month intervals. CONCLUSIONS The results indicate that there are two specific prototypes of depression, characterized by either persisting MC or persisting SOM, which have different sets of associated prognostic factors and long-term outcomes, and could have different etiological mechanisms.
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Affiliation(s)
- K J Wardenaar
- University of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Centre Groningen (UMCG), Groningen, The Netherlands.
| | - R Monden
- University of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - H J Conradi
- University of Amsterdam, Department of Clinical Psychology, The Netherlands
| | - P de Jonge
- University of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Centre Groningen (UMCG), Groningen, The Netherlands
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Donovan KA, Gonzalez BD, Small BJ, Andrykowski MA, Jacobsen PB. Depressive symptom trajectories during and after adjuvant treatment for breast cancer. Ann Behav Med 2015; 47:292-302. [PMID: 24158626 DOI: 10.1007/s12160-013-9550-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The course of depressive symptoms during and after breast cancer treatment is not well understood. PURPOSE We identified patient subgroups based on distinct trajectories of depressive symptoms and determined whether subgroups could be distinguished by personal characteristics and coping strategies. METHODS Breast cancer patients completed the Center for Epidemiologic Studies-Depression Scale on clinically meaningful occasions and during the posttreatment period. The Illness Management Questionnaire was completed prior to treatment. RESULTS A three-class mixture model provided the best fit to the data. Subgroup membership was significantly (p < .05) associated with marital status, history of depression, and focusing on symptoms. In multivariate analysis, marital status and focusing on symptoms remained significant (p < .05) predictors of subgroup membership. CONCLUSIONS Distinct trajectories can be identified during and after adjuvant breast cancer therapy. Predictors of these trajectories have implications for addressing depressive symptoms in this clinical population and for future research.
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Affiliation(s)
- Kristine A Donovan
- Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, MRC-PSY, Tampa, FL, 33612, USA,
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Fuller-Thomson E, Battiston M, Gadalla TM, Brennenstuhl S. Bouncing back: remission from depression in a 12-year panel study of a representative Canadian community sample. Soc Psychiatry Psychiatr Epidemiol 2014; 49:903-10. [PMID: 24401913 DOI: 10.1007/s00127-013-0814-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE This study sought to investigate time to remission from depression in a community-based sample of adults followed for 12 years. METHODS Data were derived from the National Population Health Survey (1994/5-2006/7 and 1996/7-2008/9). Fully 1,128 adults were included who were depressed at baseline according to DSM-III/CIDI-SF criteria. Kaplan-Meier and Cox proportional hazards procedures were used to determine time to remission and the demographic (e.g., gender and marital status), psychosocial (e.g., social support and adverse childhood experience) and health-related (e.g., pain, health conditions and alcohol use) factors with which it is associated. RESULTS More than three quarters of the sample (77 %) no longer screened positive for depression at 2 years, and nearly the entire sample (94 %) had remitted by 12 years. Adverse childhood experiences (i.e., childhood abuse and parental additions), lack of social support, the presence of pain and health conditions (i.e., migraines, arthritis and back pain) each predicted more time to remission. The only factor associated with time to remission in the multivariate analysis was a history of childhood physical abuse. CONCLUSIONS Most community members with depression get better after 2 years and nearly all will have remitted, at least once, by 12 years. The results of this study may help guide the development of interventions for chronic depression that focus on early prevention of childhood abuse.
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Affiliation(s)
- Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. W, Toronto, ON, M5S 1V4, Canada,
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Sharpley CF, Bitsika V, Wootten AC, Christie DRH. Differences in major depressive disorder and generalised anxiety disorder symptomatology between prostate cancer patients receiving hormone therapy and those who are not. Psychooncology 2014; 23:1350-5. [PMID: 24789575 DOI: 10.1002/pon.3566] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/30/2014] [Accepted: 04/07/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study is to explore the associations between hormone treatment variables and depression, and the nature of depression in prostate cancer (PCa) patients by comparing the severity and symptom profile of anxiety and depression in men who were currently receiving hormone therapy (HT) versus those who were not. METHOD Self-reports of anxiety and depression on standardized scales of GAD and major depressive disorder (MDD) were collected from 156 PCa patients across two recruitment sites in Australia. Patients who were currently receiving HT were compared with patients not receiving HT for their severity and symptom profiles on GAD and MDD. RESULTS Participants receiving HT had significantly higher GAD and MDD total scores than patients who were not receiving HT. In addition, the symptom profiles of these two HT subgroups were differentiated by significantly higher scores on the key criteria for GAD and MDD plus fatigue and sleeping difficulties but not the remaining symptoms of GAD and MDD. However, there were no significant differences between HT subgroups for the degree of functional impairment experienced by these symptoms. CONCLUSION Although these data confirm the association between HT and anxiety/depression, the range of GAD and MDD symptoms influenced is relatively restricted. Moreover, functional ability does not appear to be impaired by HT. These findings clarify the ways in which HT affects PCa patients and suggests that a simple total scale score for anxiety and depression may not be as helpful in designing treatment as consideration of the symptomatic profiles of PCa patients receiving HT.
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Affiliation(s)
- Christopher F Sharpley
- Brain-Behaviour Research Group, University of New England, Armidale, New South Wales, Australia; Centre for Autism Spectrum Disorders, Bond University, Robina, Queensland, Australia
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Sado M, Shirahase J, Yoshimura K, Miura Y, Yamamoto K, Tabuchi H, Kato M, Mimura M. Predictors of repeated sick leave in the workplace because of mental disorders. Neuropsychiatr Dis Treat 2014; 10:193-200. [PMID: 24511234 PMCID: PMC3916086 DOI: 10.2147/ndt.s55490] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Mental disorders create a considerable burden to society. Previous studies have shown that productivity loss constitutes the largest proportion of the total societal burden. For depression and anxiety disorders, in particular, more than half of the associated productivity loss occurs in the workplace. Many previous studies have clarified the risk factors for the relapse/recurrence of mental disorders in health care settings. However, the risk factors for repeated sick leave among mental disorders prevalent in the workplace have not yet been adequately evaluated. OBJECTIVE The objective of this study was to investigate which variables could predict repeated sick leave for workers with a history of sick leave because of mental disorders. METHODS Data regarding 194 subjects employed at a manufacturing company were obtained. Mental disorders were defined as disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). The duration between the return to work (RTW) and the repeated sick leave was regarded as a dependent variable. The subjects' age at the RTW, sex, age at the time of employment, job tenure, diagnosis, number of previous sick leave days, duration of most recent sick leave, and employee rank were examined as explanatory variables. Univariate analyses using a log-rank test and a multivariate analysis using the Cox proportional hazard model were conducted. RESULTS The results of the univariate analyses showed that the number of previous sick-leave episodes was a significant predictor of repeated sick leave. A multivariate analysis revealed that age at RTW and the number of previous sick-leave episodes were significant variables. CONCLUSION Age and the number of previous sick-leave episodes appeared to be predictors of repeated sick leave. Therefore, effective intervention to prevent repeated sick leave for those with high risk is quite crucial. Analyses including various work-related factors with subjects from multiple companies should be conducted in future studies.
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Affiliation(s)
- Mitsuhiro Sado
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Joichiro Shirahase
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kimio Yoshimura
- Department of Health Policy and Management, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yuki Miura
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiro Yamamoto
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hajime Tabuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Motoichiro Kato
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Risk factors for onset of multiple or long major depressive episodes versus single and short episodes. Soc Psychiatry Psychiatr Epidemiol 2013. [PMID: 23179095 DOI: 10.1007/s00127-012-0626-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Major depressive disorder may vary according to number and duration of episodes. It is unclear whether risk factors for onset of multiple or long episodes of depression (MDE) differ from risk factors for the onset of single and short ones. METHODS Data were used from a cohort study of 5,256 GP attendees without major depressive disorder at baseline, who were followed up three times (predictD). The numbers and duration of MDE were noted and categorized into no episodes, single and short (≤3 months), and multiple or long (>3 months) episodes at follow-up. Log-binomial regression models were used to calculate relative risks between the groups for 18 risk factors examined at baseline. RESULTS 165 persons (3 %) had a single and short MDE and 328 (6 %) had multiple or long MDE at follow-up. Lower education, anxiety, problems at work and financial strain significantly increased the risk of multiple or long MDE when compared to single and short MDE. Younger people were at reduced risk of multiple or long MDE. CONCLUSIONS Our findings suggest that several risk factors can be identified that may help to predict onset of different types of MDE. These factors are easy to assess and may be used in the prevention of depression.
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26
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Do hormone treatments for prostate cancer cause anxiety and depression? Int J Clin Oncol 2013; 19:523-30. [DOI: 10.1007/s10147-013-0569-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 05/09/2013] [Indexed: 10/26/2022]
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Ormel J, Jeronimus BF, Kotov R, Riese H, Bos EH, Hankin B, Rosmalen JGM, Oldehinkel AJ. Neuroticism and common mental disorders: meaning and utility of a complex relationship. Clin Psychol Rev 2013; 33:686-697. [PMID: 23702592 DOI: 10.1016/j.cpr.2013.04.003] [Citation(s) in RCA: 324] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 03/27/2013] [Accepted: 04/21/2013] [Indexed: 11/30/2022]
Abstract
Neuroticism's prospective association with common mental disorders (CMDs) has fueled the assumption that neuroticism is an independent etiologically informative risk factor. This vulnerability model postulates that neuroticism sets in motion processes that lead to CMDs. However, four other models seek to explain the association, including the spectrum model (manifestations of the same process), common cause model (shared determinants), state and scar models (CMD episode adds temporary/permanent neuroticism). To examine their validity we reviewed literature on confounding, operational overlap, stability and change, determinants, and treatment effects. None of the models is able to account for (virtually) all findings. The state and scar model cannot explain the prospective association. The spectrum model has some relevance, especially for internalizing disorders. Common causes are most important but the vulnerability model cannot be excluded although confounding of the prospective association by baseline symptoms and psychiatric history is substantial. In fact, some of the findings, such as interactions with stress and the small decay of neuroticism's effect over time, are consistent with the vulnerability model. We describe research designs that discriminate the remaining models and plea for deconstruction of neuroticism. Neuroticism is etiologically not informative yet but useful as an efficient marker of non-specified general risk.
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Affiliation(s)
- Johan Ormel
- Department of Psychiatry Interdisciplinary Center Psychopathology and Emotion regulation (ICPE) University of Groningen University Medical Center Groningen P.O.Box 30.001, 9700 RB Groningen, The Netherlands
| | - Bertus F Jeronimus
- Department of Psychiatry Interdisciplinary Center Psychopathology and Emotion regulation (ICPE) University of Groningen University Medical Center Groningen P.O.Box 30.001, 9700 RB Groningen, The Netherlands
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, NY, USA
| | - Harriëtte Riese
- Department of Psychiatry Interdisciplinary Center Psychopathology and Emotion regulation (ICPE) University of Groningen University Medical Center Groningen P.O.Box 30.001, 9700 RB Groningen, The Netherlands.,Department of Epidemiology Interdisciplinary Center Psychopathology and Emotion regulation (ICPE) University of Groningen University Medical Center Groningen P.O.Box 30.001, 9700 RB Groningen, The Netherlands
| | - Elisabeth H Bos
- Department of Psychiatry Interdisciplinary Center Psychopathology and Emotion regulation (ICPE) University of Groningen University Medical Center Groningen P.O.Box 30.001, 9700 RB Groningen, The Netherlands
| | | | - Judith G M Rosmalen
- Department of Psychiatry Interdisciplinary Center Psychopathology and Emotion regulation (ICPE) University of Groningen University Medical Center Groningen P.O.Box 30.001, 9700 RB Groningen, The Netherlands
| | - Albertine J Oldehinkel
- Department of Psychiatry Interdisciplinary Center Psychopathology and Emotion regulation (ICPE) University of Groningen University Medical Center Groningen P.O.Box 30.001, 9700 RB Groningen, The Netherlands
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Wardenaar KJ, Giltay EJ, van Veen T, Zitman FG, Penninx BWJH. Dimensions of the inventory of depressive symptomatology as predictors of the course of depressive and anxiety disorders. J Psychiatr Res 2012; 46:1655-61. [PMID: 22995629 DOI: 10.1016/j.jpsychires.2012.08.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 07/18/2012] [Accepted: 08/23/2012] [Indexed: 02/05/2023]
Abstract
For depressive and anxiety disorders general course characteristics are known. However, prognosis varies among patients with the same diagnosis. The current study investigated whether the more homogeneous symptom dimensions of mood/cognition and anxiety/arousal, could be used to predict more differentiated prognoses than with overall course-categories. One-thousand-and-fifty-three subjects with a depressive and/or anxiety disorder from the Netherlands Study of Depression and Anxiety (NESDA) were assessed at baseline and at 2-year follow-up. Dimensions of mood/cognition and anxiety/arousal were extracted from the Self Report Inventory of Depressive Symptomatology (IDS-SR). Diagnoses at baseline and follow-up were assessed with a standardized psychiatric interview. Course trajectories were assessed with a life chart interview. Increased mood/cognition scores predicted single depression (OR = 1.80) and comorbid depression-anxiety (OR = 2.00 [CI: 1.28-2.54]) at follow-up and unfavourable course trajectories of depressive symptomatology (OR = 1.94-2.08). Increased anxiety/arousal predicted single panic disorder at follow-up (OR = 2.21 [CI: 1.62-3.03]) and unfavourable course trajectories of anxiety symptomatology (OR = 1.38-1.42). All associations remained significant when adjusted for other prognostic factors, including baseline diagnosis. In conclusion, the widely used IDS-SR can be used to measure two dimensions that contribute prognostic value on top of other, previously known prognostic factors.
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Affiliation(s)
- Klaas J Wardenaar
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
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Abstract
Internet psychological interventions are efficacious and may reduce traditional access barriers. No studies have evaluated whether any sampling bias exists in these trials that may limit the translation of the results of these trials into real-world application. We identified 7999 potentially eligible trial participants from a community-based health cohort study and invited them to participate in a randomized controlled trial of an online cognitive behavioural therapy programme for people with depression. We compared those who consented to being assessed for trial inclusion with nonconsenters on demographic, clinical and behavioural indicators captured in the health study. Any potentially biasing factors were then assessed for their association with depression outcome among trial participants to evaluate the existence of sampling bias. Of the 35 health survey variables explored, only 4 were independently associated with higher likelihood of consenting-female sex (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.05-1.19), speaking English at home (OR 1.48, 95% CI 1.15-1.90) higher education (OR 1.67, 95% CI 1.46-1.92) and a prior diagnosis of depression (OR 1.37, 95% CI 1.22-1.55). The multivariate model accounted for limited variance (C-statistic 0.6) in explaining participation. These four factors were not significantly associated with either the primary trial outcome measure or any differential impact by intervention arm. This demonstrates that, among eligible trial participants, few factors were associated with the consent to participate. There was no indication that such self-selection biased the trial results or would limit the generalizability and translation into a public or clinical setting.
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Haji Ali Afzali H, Karnon J, Gray J. A proposed model for economic evaluations of major depressive disorder. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2012; 13:501-510. [PMID: 21633818 DOI: 10.1007/s10198-011-0321-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 05/11/2011] [Indexed: 05/30/2023]
Abstract
In countries like UK and Australia, the comparability of model-based analyses is an essential aspect of reimbursement decisions for new pharmaceuticals, medical services and technologies. Within disease areas, the use of models with alternative structures, type of modelling techniques and/or data sources for common parameters reduces the comparability of evaluations of alternative technologies for the same condition. The aim of this paper is to propose a decision analytic model to evaluate long-term costs and benefits of alternative management options in patients with depression. The structure of the proposed model is based on the natural history of depression and includes clinical events that are important from both clinical and economic perspectives. Considering its greater flexibility with respect to handling time, discrete event simulation (DES) is an appropriate simulation platform for modelling studies of depression. We argue that the proposed model can be used as a reference model in model-based studies of depression improving the quality and comparability of studies.
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Affiliation(s)
- Hossein Haji Ali Afzali
- Discipline of Public Health, The University of Adelaide, Level 3, 122 Frome Street, Mail Drop 207, Adelaide, SA 5005, Australia.
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McMahon EM, Buszewicz M, Griffin M, Beecham J, Bonin EM, Rost F, Walters K, King M. Chronic and recurrent depression in primary care: socio-demographic features, morbidity, and costs. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2012; 2012:316409. [PMID: 22720155 PMCID: PMC3375145 DOI: 10.1155/2012/316409] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/28/2012] [Accepted: 04/01/2012] [Indexed: 06/01/2023]
Abstract
Background. Major depression is often chronic or recurrent and is usually treated within primary care. Little is known about the associated morbidity and costs. Objectives. To determine socio-demographic characteristics of people with chronic or recurrent depression in primary care and associated morbidity, service use, and costs. Method. 558 participants were recruited from 42 GP practices in the UK. All participants had a history of chronic major depression, recurrent major depression, or dysthymia. Participants completed questionnaires including the BDI-II, Work and Social Adjustment Scale, Euroquol, and Client Service Receipt Inventory documenting use of primary care, mental health, and other services. Results. The sample was characterised by high levels of depression, functional impairment, and high service use and costs. The majority (74%) had been treated with an anti-depressant, while few had seen a counsellor (15%) or a psychologist (3%) in the preceding three months. The group with chronic major depression was most depressed and impaired with highest service use, whilst those with dysthymia were least depressed, impaired, and costly to support but still had high morbidity and associated costs. Conclusion. This is a patient group with very significant morbidity and high costs. Effective interventions to reduce both are required.
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Affiliation(s)
- Elaine M. McMahon
- Research Department of Primary Care and Population Health, University College London, Upper Third Floor, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
| | - Marta Buszewicz
- Research Department of Primary Care and Population Health, University College London, Upper Third Floor, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
| | - Mark Griffin
- Research Department of Primary Care and Population Health, University College London, Upper Third Floor, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
| | - Jennifer Beecham
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
- Personal Social Services Research Unit, University of Kent, Cornwallis Building, Canterbury, Kent CT2 7NF, UK
| | - Eva-Maria Bonin
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Felicitas Rost
- Research Department of Primary Care and Population Health, University College London, Upper Third Floor, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, Upper Third Floor, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
| | - Michael King
- Research Department of Mental Health Sciences, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
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Haji Ali Afzali H, Karnon J, Gray J. A critical review of model-based economic studies of depression: modelling techniques, model structure and data sources. PHARMACOECONOMICS 2012; 30:461-82. [PMID: 22462694 DOI: 10.2165/11590500-000000000-00000] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Depression is the most common mental health disorder and is recognized as a chronic disease characterized by multiple acute episodes/relapses. Although modelling techniques play an increasingly important role in the economic evaluation of depression interventions, comparatively little attention has been paid to issues around modelling studies with a focus on potential biases. This, however, is important as different modelling approaches, variations in model structure and input parameters may produce different results, and hence different policy decisions. This paper presents a critical review of literature on recently published model-based cost-utility studies of depression. Taking depression as an illustrative example, through this review, we discuss a number of specific issues in relation to the use of decision-analytic models including the type of modelling techniques, structure of models and data sources. The potential benefits and limitations of each modelling technique are discussed and factors influencing the choice of modelling techniques are addressed. This review found that model-based studies of depression used various simulation techniques. We note that a discrete-event simulation may be the preferred technique for the economic evaluation of depression due to the greater flexibility with respect to handling time compared with other individual-based modelling techniques. Considering prognosis and management of depression, the structure of the reviewed models are discussed. We argue that a few reviewed models did not include some important structural aspects such as the possibility of relapse or the increased risk of suicide in patients with depression. Finally, the appropriateness of data sources used to estimate input parameters with a focus on transition probabilities is addressed. We argue that the above issues can potentially bias results and reduce the comparability of economic evaluations.
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Sustained medically unexplained physical symptoms in euthymic patients with recurrent depression: predictive value for recurrence and associations with omega 3- and 6 fatty acids and 5-HTTLPR? J Affect Disord 2012; 136:604-11. [PMID: 22100130 DOI: 10.1016/j.jad.2011.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/19/2011] [Accepted: 10/19/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Identification of potentially modifiable risk factors for recurrence in recurrent depression could provide opportunities to improve preventive interventions. In this study we aimed to examine the predictive value of medically unexplained physical symptoms (MUPS) on time to recurrence in recurrent depression. Additionally, to elucidate pathophysiological mechanisms that could explain the relations between MUPS and depression, we investigate the association between a sustained high level of MUPS, and (I) omega (ω)-3 and -6 fatty acid (FA)-status and (II) functional polymorphisms in the promoter region of the serotonin transporter gene (5-HTTLPR). METHODS Based on three Physical Symptom Checklist (PCS) scores over 12 months, we defined two groups of remitted recurrently depressed patients: 41 patients with a sustained high number of MUPS and 34 patients with a sustained low number or no MUPS. Patients were followed-up for 3.5 years while recurrence of their depression was monitored. In addition, we analyzed patients' erythrocyte's FA-profiles and triallelically genotyped their 5-HTTLPR. RESULTS A sustained high level of MUPS predicted consecutive depression recurrence over 3.5 years (adjusted relative risk 2.8). FA-status and distribution of 5-HTTLPR variant frequencies did not differ between patients with sustained high compared to low/absent MUPS-levels. LIMITATIONS Our sample was relatively small. CONCLUSION Remitted recurrently depressed patients with sustained MUPS have a considerably increased risk of recurrence. Having sustained MUPS is not associated with either erythrocyte ω-3 or -6 FA-levels or 5-HTTLPR polymorphism. Recognition and reducing MUPS in an early state could prevent a (depressive) relapse.
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Wardenaar KJ, Giltay EJ, van Veen T, Zitman FG, Penninx BWJH. Symptom dimensions as predictors of the two-year course of depressive and anxiety disorders. J Affect Disord 2012; 136:1198-203. [PMID: 22177741 DOI: 10.1016/j.jad.2011.11.037] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 11/21/2011] [Accepted: 11/21/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Because of the heterogeneity of known predictive factors, course-predictions for depression and anxiety are often unspecific. Therefore, it was investigated whether symptom-dimensions could be used as more specific course-predictors, on top of already known predictors, such as diagnosis and overall severity. METHODS A sample of 992 subjects with depressive and/or anxiety disorders was followed in a 2-year prospective cohort study. Dimensions of the tripartite model (general distress, anhedonic depression and anxious arousal) were assessed at baseline. Diagnostic and course information were assessed at baseline and 2-year follow-up. RESULTS Dimensional scores at baseline predicted diagnosis after two years and course-trajectories during follow-up. Increased general distress at baseline was associated with comorbid depression-anxiety at follow-up, increased anhedonic depression was associated with single depression and anxious arousal was associated with (comorbid) panic disorders at follow-up. Baseline general distress was associated with an unfavorable course in all patients. All associations were independent and added prognostic information on top of diagnosis and other predictive factors at baseline. LIMITATIONS Only prevalent patients were included at baseline and only three dimensions were measured CONCLUSIONS Symptom dimensions predict the future 2-year course of depression and anxiety. Importantly, the dimensions yield predictive information on top of diagnosis and other prognostic factors at baseline.
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Affiliation(s)
- Klaas J Wardenaar
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
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The natural course and outcome of major depressive disorder in primary care: the PREDICT-NL study. Soc Psychiatry Psychiatr Epidemiol 2012; 47:87-95. [PMID: 21057769 PMCID: PMC3249585 DOI: 10.1007/s00127-010-0317-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 10/21/2010] [Indexed: 12/27/2022]
Abstract
PURPOSE To examine the natural course and outcome of major depressive disorder (MDD) in primary care over 39 months. METHODS Prospective cohort study of 1,338 consecutive attendees with follow-up after 6, 12, and 39 months with DSM-IV MDD using the Composite International Diagnostic Interview (CIDI). We measured severity of depressive symptoms (Patient Health Questionnaire 9), somatic symptoms (Patient Health Questionnaire 15), and mental and physical function (Short Form 12, mental and physical component summary). Analysis of variance and random coefficient models were performed. RESULTS At baseline, 174 people (13%) had MDD of which 17% had a chronic and 40% had a fluctuating course, while 43% remitted. Patients with chronic courses had more severe depressive symptoms (mean difference 6.54; 95% CI 4.38-8.70), somatic symptoms (mean difference 3.31; 95% CI 1.61-5.02), and greater mental dysfunction (mean difference -10.49; 95% CI -14.42 to -6.57) at baseline than those who remitted from baseline, independent of age, sex, level of education, presence of a chronic disease, and a lifetime history of depression. CONCLUSIONS Although 43% of patients with MDD attending primary care recover, this leaves a majority of patients (57%) who have a chronic or intermittent course. Chronic courses are associated with higher levels of depressive symptoms and somatic symptoms and greater mental dysfunction at baseline.
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Lamers F, Beekman ATF, de Jonge P, Smit JH, Nolen WA, Penninx BWJH. One-year severity of depressive symptoms: results from the NESDA study. Psychiatry Res 2011; 190:226-31. [PMID: 21802149 DOI: 10.1016/j.psychres.2011.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Revised: 02/10/2011] [Accepted: 07/04/2011] [Indexed: 01/09/2023]
Abstract
The aim of this study was to simultaneously examine a wide range of risk factors and clinical characteristics in their predictive value for the 1-year severity of depressive symptoms. Data from 789 participants in the Netherlands Study of Depression and Anxiety (NESDA), a large psychiatric cohort study, with a major depressive disorder (MDD) at baseline were used. Depression severity at 1-year follow-up was studied using linear and multinomial logistic regression models. Results of the analyses showed that high neuroticism, no partner and older age were found predictive of a poorer outcome independent of baseline clinical characteristics. Further, comorbid anxiety disorder, first episode, having a moderate subtype (vs. melancholic), and higher baseline depression severity predicted poorer outcome. To conclude, both risk factors and clinical characteristics independently predicted 1-year severity of depressive symptoms. The findings indicate that the prediction of prognosis and identification of persons at risk of a poor outcome should not only be based on clinical characteristics, but on risk factors as well.
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Affiliation(s)
- Femke Lamers
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
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Koppers D, Peen J, Niekerken S, Van R, Dekker J. Prevalence and risk factors for recurrence of depression five years after short term psychodynamic therapy. J Affect Disord 2011; 134:468-72. [PMID: 21676466 DOI: 10.1016/j.jad.2011.05.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 05/16/2011] [Accepted: 05/16/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Follow-up research concerning the efficacy of treatment for depression is scarce and varies widely in clinical and methodological terms. Aim was to conduct a five-year follow-up study of recurrence of depression after short supportive Psychodynamic Treatment (PDT) alone or in combination with pharmacotherapy. METHODS Patients who had been treated five years previously for major depressive disorder in a randomised control trial comparing short supportive PDT alone or in combination with pharmacotherapy, were traced. Patients who completed treatment were included. Recurrent episodes in the past five years were identified using CIDI. Severity of symptoms after five years was measured with the Hamilton Rating Scale for Depression and sub-scales Depression, Anxiety and Somatisation of the self-report Symptom Checklist 90. RESULTS 52 (37%) patients of the original sample were localised. 42% had suffered from one or more recurrences during the follow-up period. There was no significant difference between the group who had received psychotherapy and the group who had received combined therapy during the acute phase. Young women and patients with more residual depressive symptoms and less somatic symptoms directly after treatment, were more at risk for recurrence. LIMITATIONS Relatively small study population. Furthermore it was not known if patients received other treatment during the follow-up period. CONCLUSIONS The long-term efficacy of PDT (with or without antidepressants) seemed to be comparable with other psychotherapies for depression. But the high recurrence rate urges us to shift the focus of depression treatment to improving long-term outcome and to the prevention of recurrence, in particular for young women and patients with residual symptoms of depression.
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Affiliation(s)
- D Koppers
- Arkin Institute for Mental Health, Amsterdam, The Netherlands
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Relapse and recurrence prevention in depression: current research and future prospects. Clin Psychol Rev 2011; 31:1349-60. [PMID: 22020371 DOI: 10.1016/j.cpr.2011.09.003] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 08/08/2011] [Accepted: 09/10/2011] [Indexed: 11/22/2022]
Abstract
There is a growing body of literature which indicates that acute phases of psychotherapy are often ineffective in preventing relapse and recurrence in major depression. As a result, there is a need to develop and evaluate therapeutic approaches which aim to reduce the risk of relapse. This article provides a review of the empirical studies which have tested the prophylactic effects of therapy (cognitive-behavioral, mindfulness-based, and interpersonal psychotherapy) targeting relapse and recurrence in major depression. For definitional clarity, relapse is defined here as a return to full depressive symptomatology before an individual has reached a full recovery, whereas recurrence in defined as the onset of a new depressive episode after a full recovery has been achieved. Psychotherapeutic efforts to prevent relapse and recurrence in depression have been effective to varying degrees, and a number of variables appear to moderate the success of these approaches. A consistent finding has been that preventive cognitive-behavioral and mindfulness-based therapies are most effective for patients with three or more previous depressive episodes, and alternative explanations for this finding are discussed. It is noted, however, that a number of methodological limitations exist within this field of research, and so a set of hypotheses that may guide future studies in this area is provided.
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Dowrick C, Shiels C, Page H, Ayuso-Mateos JL, Casey P, Dalgard OS, Dunn G, Lehtinen V, Salmon P, Whitehead M. Predicting long-term recovery from depression in community settings in Western Europe: evidence from ODIN. Soc Psychiatry Psychiatr Epidemiol 2011; 46:119-26. [PMID: 20035318 DOI: 10.1007/s00127-009-0179-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 12/15/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To test the impact of socio-economic and psychological adversity and healthcare on long-term recovery from depression. METHOD A community sample of 347 people with depressive disorders was followed up after 9 years. Baseline socio-economic adversity, social support, healthcare use, and psychiatric history were identified. Respondents completed self-report instruments on current depressive status (Beck depression inventory) and longstanding psychosocial adversity (sexual, physical or emotional abuse). Univariate analyses tested for association between recovery and respondent characteristics. RESULTS Follow-up was achieved for 182 (52%) of the sample, of whom 75 (41%) indicated recovery from depression. Psychological adversity definitely and socio-economic adversity probably were associated with lack of recovery. Baseline healthcare had no apparent impact on outcome. Rurality and support after life events were associated with recovery. History of depression was associated with non-recovery. CONCLUSION Psychological adversity is, and socio-economic adversity may be, associated with long-term non-recovery from depression in community settings.
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Affiliation(s)
- Christopher Dowrick
- School of Population, Community and Behavioural Sciences, University of Liverpool, Whelan Building, Liverpool, L69 3GB, UK.
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Roca M, Armengol S, García-García M, Rodriguez-Bayón A, Ballesta I, Serrano MJ, Comas A, Gili M. Clinical differences between first and recurrent episodes in depressive patients. Compr Psychiatry 2011; 52:26-32. [PMID: 21220062 DOI: 10.1016/j.comppsych.2010.04.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 04/15/2010] [Accepted: 04/29/2010] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Depressive disorder is one of the most common mental disorders in primary care. Depression is often a chronic disorder with recurrent episodes. Little is known about the differences in clinical profile between first and recurrent episodes. The aim of the study is to analyze the differences between clinical presentation of first and subsequent episodes of depressive disorders in primary care patients. METHOD A cross-sectional epidemiologic study in primary care centers in Spain was designed. A total of 10,257 primary care patients having a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition major depressive episode were analyzed. Clinical symptoms were measured using the Montgomery Asberg Depression Scale. Patient Health Questionnaire was used to assess somatic symptoms. RESULTS There were 40.6% of patients who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for recurrent depression. Compared with those diagnosed of their first major depressive disorder, recurrent patients had greater rates and severity of depressive (t = -7.85, P < .001) and somatic symptoms (t = 5.64, P < .001). The severity of symptoms also increases with number of episodes (F = 40.2, P < .001, for depressive symptoms; F = 27.8, P < .001, for somatic symptoms). First-episode patients were more likely to experience reduced appetite (adjusted odds ratio, 1.2) and suicidal thoughts (adjusted odds ratio, 1.2). CONCLUSION There are differences in the clinical profile of initial and recurrent episodes in primary care depressive patients. Each recurrent depressive episode seems to have a greater impact on symptoms and well-being. The identification of a specific depression symptom profile in first or recurrent episodes is needed to improve the long-term management of major depressive episode patients in primary care settings.
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Affiliation(s)
- Miquel Roca
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Palma de Mallorca, Red de Investigación de Actividades Preventivas y de Promoción de la Salud (RedIAPP), Spain.
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Dowrick C, Flach C, Leese M, Chatwin J, Morriss R, Peveler R, Gabbay M, Byng R, Moore M, Tylee A, Kendrick T. Estimating probability of sustained recovery from mild to moderate depression in primary care: evidence from the THREAD study. Psychol Med 2011; 41:141-150. [PMID: 20346195 DOI: 10.1017/s0033291710000437] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND It is important for doctors and patients to know what factors help recovery from depression. Our objectives were to predict the probability of sustained recovery for patients presenting with mild to moderate depression in primary care and to devise a means of estimating this probability on an individual basis. METHOD Participants in a randomized controlled trial were identified through general practitioners (GPs) around three academic centres in England. Participants were aged >18 years, with Hamilton Depression Rating Scale (HAMD) scores 12-19 inclusive, and at least one physical symptom on the Bradford Somatic Inventory (BSI). Baseline assessments included demographics, treatment preference, life events and difficulties and health and social care use. The outcome was sustained recovery, defined as HAMD score <8 at both 12 and 26 week follow-up. We produced a predictive model of outcome using logistic regression clustered by GP and created a probability tree to demonstrate estimated probability of recovery at the individual level. RESULTS Of 220 participants, 74% provided HAMD scores at 12 and 26 weeks. A total of 39 (24%) achieved sustained recovery, associated with being female, married/cohabiting, having a low BSI score and receiving preferred treatment. A linear predictor gives individual probabilities for sustained recovery given specific characteristics and probability trees illustrate the range of probabilities and their uncertainties for some important combinations of factors. CONCLUSIONS Sustained recovery from mild to moderate depression in primary care appears more likely for women, people who are married or cohabiting, have few somatic symptoms and receive their preferred treatment.
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Affiliation(s)
- C Dowrick
- Division of Primary Care, University of Liverpool, Liverpool, UK.
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Hardeveld F, Spijker J, De Graaf R, Nolen WA, Beekman ATF. Prevalence and predictors of recurrence of major depressive disorder in the adult population. Acta Psychiatr Scand 2010; 122:184-91. [PMID: 20003092 DOI: 10.1111/j.1600-0447.2009.01519.x] [Citation(s) in RCA: 300] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Knowledge of the risk of recurrence after recovery of a major depressive disorder (MDD) is of clinical and scientific importance. The purpose of this paper was to provide a systematic review of the prevalence and predictors of recurrence of MDD. METHOD Studies were searched in Medline en PsychINFO using the search terms 'recur*', 'relaps*', 'depress*', 'predict*' and course. RESULTS Recurrence of MDD in specialised mental healthcare settings is high (60% after 5 years, 67% after 10 years and 85% after 15 years) and seems lower in the general population (35% after 15 years). Number of previous episodes and subclinical residual symptoms appear to be the most important predictors. Gender, civil status and socioeconomic status seem not related to the recurrence of MDD. CONCLUSION Clinical factors seem the most important predictors of recurrence. Data from studies performed in the general population and primary care on the recurrent course of MDD are scarce.
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Affiliation(s)
- F Hardeveld
- De Gelderse Roos, Institute for Mental Health Care, Ede, The Netherlands.
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Melchior M, Chastang JF, Leclerc A, Ribet C, Rouillon F. Low socioeconomic position and depression persistence: longitudinal results from the GAZEL cohort study. Psychiatry Res 2010; 177:92-6. [PMID: 20381167 DOI: 10.1016/j.psychres.2009.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 07/31/2009] [Accepted: 08/04/2009] [Indexed: 10/19/2022]
Abstract
Research examining the association between socioeconomic position and depression course has yielded inconsistent results. We tested the association between low socioeconomic position and 7-year depression persistence among 298 community-based individuals with depression (subset of the GAZEL cohort study based in France). Data were analyzed using Generalized Estimating Equation (GEE models). Low socioeconomic position predicted depression persistence (men: low vs. intermediate/high income: OR: 2.52, 95% CI 1.28-4.95; women: low vs. intermediate/high occupational grade: OR: 2.25, 95% CI 1.06-4.80). These associations were reduced and became statistically nonsignificant after controlling for baseline sociodemographic characteristics and stressful life events (men and women), overall health (men), and the severity of mental health difficulties (men and women). Overall, depressed individuals with low socioeconomic position appear disproportionately likely to experience multiple risk factors of long-term depression.
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Weissman MM, Neria Y, Gameroff MJ, Pilowsky DJ, Wickramaratne P, Lantigua R, Shea S, Olfson M. Positive screens for psychiatric disorders in primary care: a long-term follow-up of patients who were not in treatment. Psychiatr Serv 2010; 61:151-9. [PMID: 20123820 PMCID: PMC3670116 DOI: 10.1176/ps.2010.61.2.151] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Screening for psychiatric disorders has gained acceptance in some general medical settings, but critics argue about its value. The purpose of this study was to determine the clinical utility of screening by conducting a long-term follow-up of patients who screened positive for psychiatric disorders but who were initially not in treatment. METHODS A cohort of 519 low-income, adult primary care patients were screened for major depression and bipolar, anxiety, and substance use disorders and reassessed with the Structured Clinical Interview for DSM-IV after a mean of 3.7 years by a clinician blind to the initial screen. Data on treatment utilization was obtained through hospital records. The sample consisted of 348 patients who had not received psychiatric care in the year before screening. RESULTS Among 39 patients who screened positive for major depression, 62% (95% confidence interval=45.5%-77.6%) met criteria for current major depressive disorder at follow-up. Those who screened positive reported significantly poorer mental and social functioning and worse general health at follow-up than the screen-negative patients and were more likely to have visited the emergency department for psychiatric reasons (12.1% and 3.0%, odds ratio [OR]=6.4) and to have major depression (OR=7.6). Generally similar results were observed for patients who screened positive for other disorders. CONCLUSIONS Commonly used screening methods identified patients with psychiatric disorders; about four years later, those not initially in treatment were likely to have enduring symptoms and to use emergency psychiatric services. Screening should be followed up by clinical diagnostic assessment in the context of available mental health treatment.
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Affiliation(s)
- Myrna M Weissman
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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Horn AB, Kneisler L, Schuster H, Traue HC. Subjektive Krankheitskonzepte bei depressiven Störungen. ACTA ACUST UNITED AC 2010. [DOI: 10.1026/0943-8149/a000006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Depressive Störungen sind ein weit verbreitetes und oft chronisches Gesundheitsproblem mit erheblichem Leiden des Individuums und hohen Gesundheitskosten. Die subjektiven Wahrnehmungen einer solchen Erkrankung korrelieren mit deren Bewältigung. Dies kann insbesondere für depressive Störungen angenommen werden, da bei Depressionen die dysfunktionalen kognitiven Bewertungsprozesse sowohl ätiologisch relevant sind als auch die Krankheitsbewältigung ungünstig beeinflussen. Diese Studie hat zum Ziel, Zusammenhänge zwischen Dimensionen der Krankheitskonzepte von Patientinnen und Patienten, der depressiven Symptomatik und positivem Affekt zu untersuchen. Dazu wurden 60 Patientinnen und Patienten einer stationären psychosomatischen Rehabilitationsmaßnahme sowohl im Quer- als auch im Längsschnitt bis zur dreimonatigen Katamnese nach Entlassung befragt. Die Studienteilnehmer wurden weiterhin randomisiert einer Expressiven Schreib- oder einer Kontrollbedingung zugeteilt, um die Effekte dieser Minimalintervention als adjunkte Maßnahme zu untersuchen. Die Ergebnisse zeigen, dass die Wahrnehmung des zeitlichen Verlaufs und des Schwergrads der Depression sowie die emotionalen Repräsentationen der eigenen Erkrankung mit vermehrten depressiven Symptomen assoziiert sind. Im Längsschnitt zeigt sich, dass die Ausprägung kontrollbezogener subjektiver Krankheitskonzepte mit unterschiedlichen Verläufen der depressiven Symptomatik und des Wohlbefindens über einen Zeitraum von 3 Monaten nach Beendigung des stationären Aufenthalts im Zusammenhang stehen. Die subjektiv erlebte Kohärenz des Krankheitskonzepts war nur mit dem Wohlbefinden, aber nicht mit Depression verbunden. Expressives Schreiben konnte in dieser kleinen Gruppe zusätzlich zum stationären Aufenthalt zwar keine signifikanten Verbesserungen erzielen, jedoch zeigt sich, dass Personen mit einer stark ausgeprägten Neigung zu emotionalen Repräsentationen tendenziell mehr vom Schreiben profitieren und dass sich dieser Effekt über die Zeit zu verstärken scheint.
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Affiliation(s)
- Andrea B. Horn
- NCCR „Affective Science”, Klinische Psychologie, Universität Fribourg
| | - Lena Kneisler
- Sektion Medizinische Psychologie, Universitätsklinikum Ulm
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Conradi HJ, de Jonge P. Recurrent depression and the role of adult attachment: a prospective and a retrospective study. J Affect Disord 2009; 116:93-9. [PMID: 19087894 DOI: 10.1016/j.jad.2008.10.027] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 10/29/2008] [Accepted: 10/29/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recurrent depression is associated with interpersonal dysfunctioning which is related to underlying insecure attachment. In this study we examined associations between adult attachment and the long-term course of depression in depressed primary care patients. METHODS Depressed primary care patients were 3-monthly assessed during a prospective 3-year follow-up regarding: (1) severity of depression (BDI); and proportions of: (2) depression-free time; (3) depressive symptom-free time; and (4) time on antidepressants (all CIDI interview). Attachment style was assessed by the Experiences in Close Relationships questionnaire at two points in time: (1) one year before the end of follow-up (1-year prospectively followed subsample; n=68); and (2) at the end of the 3-year follow-up (3-year retrospective subsample; n=145). Mixed model analyses and non-parametric tests were used to determine whether different attachment styles were associated with different courses of depression. RESULTS Fearfully attached patients in the prospective sample reported a statistically significant worse depression course compared with securely attached patients (adjusted mean BDI 12.7 v. 6.8 respectively; F=3.22; p=0.029), which was confirmed in the retrospective sample (adjusted mean BDI 15.7 v. 8.8; F=7.86; p<0.001). They reported significantly more prior depressive episodes and residual symptoms, longer use of antidepressants, and worse social functioning as well. LIMITATIONS Size of the prospective sample was restricted. CONCLUSION Fearfully attached subjects constitute a particularly vulnerable category of depressed patients. Information on their attachment style may provide GPs with indications regarding intensity, goals and approach of treatment.
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Affiliation(s)
- Henk Jan Conradi
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands.
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McKnight PE, Kashdan TB. The importance of functional impairment to mental health outcomes: a case for reassessing our goals in depression treatment research. Clin Psychol Rev 2009; 29:243-59. [PMID: 19269076 PMCID: PMC2814224 DOI: 10.1016/j.cpr.2009.01.005] [Citation(s) in RCA: 243] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 12/12/2008] [Accepted: 01/21/2009] [Indexed: 11/22/2022]
Abstract
Outcomes in depression treatment research include both changes in symptom severity and functional impairment. Symptom measures tend to be the standard outcome but we argue that there are benefits to considering functional outcomes. An exhaustive literature review shows that the relationship between symptoms and functioning remains unexpectedly weak and often bidirectional. Changes in functioning often lag symptom changes. As a result, functional outcomes might offer depression researchers more critical feedback and better guidance when studying depression treatment outcomes. The paper presents a case for the necessity of both functional and symptom outcomes in depression treatment research by addressing three aims-1) review the research relating symptoms and functioning, 2) provide a rationale for measuring both outcomes, and 3) discuss potential artifacts in measuring functional outcomes. The three aims are supported by an empirical review of the treatment outcome and epidemiological literatures.
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Affiliation(s)
- Patrick E McKnight
- Department of Psychology, George Mason University, MSN 3F5, 4400 University Drive, Fairfax, VA 22030-4400, United States.
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Conradi HJ, de Jonge P, Ormel J. Cognitive-behavioural therapy v. usual care in recurrent depression. Br J Psychiatry 2008; 193:505-6. [PMID: 19043158 DOI: 10.1192/bjp.bp.107.042937] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We examined in a primary care sample whether acute-phase cognitive-behavioural therapy (CBT) would be more effective than usual care for patients with multiple prior episodes of depression. Depression outcome was based on a 3-monthly administered Beck Depression Inventory (BDI) during a 2-year follow-up. We confirmed that in patients with four or more prior episodes, CBT outperformed usual care by four points on the BDI, but not in patients with three or fewer prior episodes. Subsequent analyses suggested that CBT may be able to tackle cognitive problems related to rumination in patients with recurrent depression.
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Affiliation(s)
- Henk Jan Conradi
- Department of Psychiatry, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
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