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Reynolds CF, Thomas SB, Morse JQ, Anderson SJ, Albert S, Dew MA, Begley A, Karp JF, Gildengers A, Butters MA, Stack JA, Kasckow J, Miller MD, Quinn SC. Early intervention to preempt major depression among older black and white adults. Psychiatr Serv 2014; 65:765-73. [PMID: 24632760 PMCID: PMC4050338 DOI: 10.1176/appi.ps.201300216] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study objective was to assess the efficacy of problem-solving therapy for primary care (PST-PC) for preventing episodes of major depression and mitigating depressive symptoms of older black and white adults. The comparison group received dietary coaching. METHODS A total of 247 participants (90 blacks, 154 whites, and three Asians) with subsyndromal depressive symptoms were recruited into a randomized depression prevention trial that compared effects of individually delivered PST-PC and dietary coaching on time to major depressive episode and level of depressive symptoms (Beck Depression Inventory) over two years. Cumulative intervention time averaged 5.5-6.0 hours in each study arm. RESULTS The two groups did not differ significantly in time to major depressive episodes, and incidence of such episodes was low (blacks, N=8, 9%; whites, N=13, 8%), compared with published rates of 20%-25% over one year among persons with subsyndromal symptoms and receiving care as usual. Participants also showed a mean decrease of 4 points in depressive symptoms, sustained over two years. Despite greater burden of depression risk factors among blacks, no significant differences from whites were found in the primary outcome. CONCLUSIONS Both PST-PC and dietary coaching are potentially effective in protecting older black and white adults with subsyndromal depressive symptoms from developing episodes of major depression over two years. Absent a control for concurrent usual care, this conclusion is preliminary. If confirmed, both interventions hold promise as scalable, safe, nonstigmatizing interventions for delaying or preventing episodes of major depression in the nation's increasingly diverse older population.
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Affiliation(s)
- Charles F. Reynolds
- University of Pittsburgh, School of Medicine, Psychiatry, 3811 O’Hara Street, BT 758, Pittsburgh, Pennsylvania, 15213
| | | | - Jennifer Q. Morse
- Western Psychiatric Institute & Clinic - Psychiatry, 3811 O’Hara St. Personality Studies, Pittsburgh, Pennsylvania 15213
| | - Stewart J. Anderson
- University of Pittsburgh Graduate School of Public Health - Department of Biostatistics, Pittsburgh, Pennsylvania
| | - Steven Albert
- University of Pittsburgh - Behavioral & Community Health Science, Pittsburgh, Pennsylvania 15261
| | - Mary Amanda Dew
- University of Pittsburgh - Psychiatry, 3811 O’Hara Street, Pittsburgh, Pennsylvania 15213
| | - Amy Begley
- Western Psychiatric Institute & Clinic - Psychiatry, 3811 O’Hara St. Personality Studies, Pittsburgh, Pennsylvania 15213
| | - Jordan F. Karp
- University of Pittsburgh School of Medicine - Psychiatry, Western Psychiatric Institute and Clinic 3811 O’Hara Street, Pittsburgh, Pennsylvania 15213
| | - Ariel Gildengers
- University of Pittsburgh School of Medicine - Dept of Psychiatry, 3811 O’Hara Street, Pittsburgh, Pennsylvania 15213
| | - Meryl A. Butters
- University of Pittsburgh Medical Center - Geriatric Psychiatry, 3811 O’Hara St. Rm. E-462 WPIC, Pittsburgh 15213
| | | | - John Kasckow
- VA Pittsburgh Health Care System - Behavioral Health, 7180 Highland Dr, Pittsburgh, Pennsylvania 15206. University of Pittsburgh Medical Center - Western Psychiatric Institute and Clinics, 3811 O’Hara St, Pittsburgh, Pennsylvania 15213
| | - Mark D. Miller
- University of Pittsburgh, Shcool of Medicine - Psychiatry, Pittsburgh, Pennsylvania
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Stahl ST, Albert SM, Dew MA, Lockovich MH, Reynolds CF. Coaching in healthy dietary practices in at-risk older adults: a case of indicated depression prevention. Am J Psychiatry 2014; 171:499-505. [PMID: 24788282 PMCID: PMC4083759 DOI: 10.1176/appi.ajp.2013.13101373] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Prevention of major depressive disorder is important because current treatments are only partially adequate in reducing symptom burden and promoting health-related quality of life. Lifestyle interventions may be a desirable prevention strategy for reasons of patient preference, particularly among older patients from minority groups. Using evidence from a randomized depression prevention trial for older adults, the authors found that coaching in healthy dietary practices was potentially effective in protecting at-risk older adults from developing incident episodes of major depression. The authors describe the dietary coaching program (highlighted in a case example) as well as the feasibility and potential efficacy of the program within the context of evidence-based interventions for preventing episodes of major depression and mitigating symptoms of depression. Older adults receiving dietary coaching experienced a low incidence of major depressive episodes and exhibited a 40%-50% decrease in depressive symptoms, as well as enhanced well-being, during the initial 6-week intervention; these gains were sustained over 2 years. The authors also describe why lifestyle interventions like coaching in healthy dietary practices may hold promise as effective, practical, nonstigmatizing interventions for preventing episodes of major depressive disorder in older adults with subsyndromal depressive symptoms.
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Gellis ZD, Kenaley BL, Have TT. Integrated Telehealth Care for Chronic Illness and Depression in Geriatric Home Care Patients: The Integrated Telehealth Education and Activation of Mood (I-TEAM) Study. J Am Geriatr Soc 2014; 62:889-95. [DOI: 10.1111/jgs.12776] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Zvi D. Gellis
- Center for Mental Health and Aging; School of Social Policy and Practice; University of Pennsylvania; Philadelphia Pennsylvania
| | | | - Thomas Ten Have
- Center for Clinical Epidemiology and Biostatistics; Perelman School of Medicine; University of Pennsylvania; Philadelphia Pennsylvania
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Abstract
PURPOSE OF REVIEW This review updates the literature on depression in age-related macular degeneration (AMD). Treatment for AMD has been revolutionized since the 2004 review of depression and AMD. New data describing the prevalence of depression in AMD, as well as novel interventions for managing depression in AMD, are discussed. RECENT FINDINGS Depression continues to be prevalent in AMD and new information is available on the pathways by which impaired vision leads to depression. Strategies for the treatment of depression in patients with impaired vision have evolved. SUMMARY AMD is still a major risk factor for depression and people with activity restriction due to vision loss are at greatest risk. An integrated approach to depression management in older adults with impaired vision may be the best course of action.
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Affiliation(s)
- Robin J Casten
- Department of Psychiatry and Human Behavior, Jefferson Medical College, Philadelphia, PA 19107, USA.
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Casten RJ, Rovner BW. Depressive and Cognitive Disorders in Patients with AMD. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/978-3-642-36324-5_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Sanders JB, Bremmer MA, Deeg DJH, Beekman ATF. Do depressive symptoms and gait speed impairment predict each other's incidence? A 16-year prospective study in the community. J Am Geriatr Soc 2012; 60:1673-80. [PMID: 22905679 DOI: 10.1111/j.1532-5415.2012.04114.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate whether gait speed predicts incident depressive symptoms and whether depressive symptoms predict incident gait speed impairment; to ascertain the presence of shared risk factors for these associations. DESIGN The Longitudinal Aging Study Amsterdam, a prospective cohort study with five follow-up cycles over 16 years. SETTING Population based. PARTICIPANTS One thousand nine hundred twenty-eight respondents for incident depressive symptoms (mean age 68.9 ± 8.5) and 1,855 respondents for incident gait speed impairment (mean age 68.0 ± 8.2). MEASUREMENTS Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale; gait speed was measured, back and forth, during a 3-m walk as quickly as possible, with a 180° turn. Multivariate analyses were performed for both sexes using Cox regression. RESULTS Incident depressive symptoms occurred in 24% of respondents. In univariate analyses, gait speed at baseline predicted incident depressive symptoms in men and women; after adjustment for covariates, this association persisted in men only. Examining the reverse association, 34% of respondents developed gait speed impairment. Depressive symptoms at baseline were univariately associated with incident gait speed impairment in women but not in men; this association did not persist after adjustment. The bidirectional associations did not share the same explanatory variables. CONCLUSION Gait speed predicts depressive symptoms in men. The geriatric giants of depressive symptoms and slowed gait speed in late life appear to result from different pathologies, both of which therefore require their own treatment strategies.
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Affiliation(s)
- Joost B Sanders
- Department of Old Age Psychiatry, Altrecht, Institute for Mental Health Care, Zeist, The Netherlands.
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Ramsay CE, Reisinger Walker E, Ramsay R, Compton MT, Thompson N. An exploration of perceptions of possible depression prevention services for caregivers of elderly or chronically ill adults in rural Georgia. Community Ment Health J 2012; 48:167-78. [PMID: 21132461 DOI: 10.1007/s10597-010-9361-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 11/15/2010] [Indexed: 11/26/2022]
Abstract
Caregiving for elderly or chronically ill adults can be stressful, contributing to a high rate of depression in caregivers. Rural caregivers are at particularly high risk due to reduced access to mental health care services. This study explored the acceptability among rural caregivers of introducing a program to prevent or alleviate depression. Focus groups with caregivers and community members were conducted in four rural counties of Georgia. Caregivers reported high levels of stress and depression and recommended the following interventions: support groups, respite care, a centralized source of information, training for caregivers and other community members, financial support, and a telephone hotline. There were more commonalities than differences across the locations, but some programmatic preferences and acceptability varied.
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Affiliation(s)
- Claire E Ramsay
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 49 Jesse Hill Jr. Drive S.E., Atlanta, GA 30303, USA.
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Abstract
In older adults, several environmental challenges can potentially trigger the onset of an episode of major depression. Vulnerability to these challenges can be influenced by genetics. There is accumulating evidence for an interaction between stress and a serotonin transporter polymorphism, though there is also heterogeneity among studies. Other relevant genes include those encoding for the neuroendocrine stress axis, growth factors, and other monoaminergic systems. Each of these may interact with either predisposing traumas in early childhood or precipitating events later in life.
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Affiliation(s)
- Francis E. Lotrich
- Assistant Professor of Psychiatry, Western Psychiatric Institute and Clinics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Herrera AP, Meeks TW, Dawes SE, Hernandez DM, Thompson WK, Sommerfeld DH, Allison MA, Jeste DV. Emotional and cognitive health correlates of leisure activities in older Latino and Caucasian women. PSYCHOL HEALTH MED 2011; 16:661-74. [PMID: 21391135 DOI: 10.1080/13548506.2011.555773] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study examined differences in the frequency of leisure activity participation and relationships to depressive symptom burden and cognition in Latino and Caucasian women. Cross-sectional data were obtained from a demographically matched subsample of Latino and Caucasian (n = 113 each) postmenopausal women (age ≥60 years), interviewed in 2004-2006 for a multiethnic cohort study of successful aging in San Diego County. Frequencies of engagement in 16 leisure activities and associations between objective cognitive performance and depressive symptom burden by ethnicity were identified using bivariate and linear regression, adjusted for physical functioning and demographic covariates. Compared to Caucasian women, Latinas were significantly more likely to be caregivers and used computers less often. Engaging in organized social activity was associated with fewer depressive symptoms in both groups. Listening to the radio was positively correlated with lower depressive symptom burden for Latinas and better cognitive functioning in Caucasians. Cognitive functioning was better in Latinas who read and did puzzles. Housework was negatively associated with Latinas' emotional health and Caucasians' cognitive functioning. Latino and Caucasian women participate in different patterns of leisure activities. Additionally, ethnicity significantly affects the relationship between leisure activities and both emotional and cognitive health.
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Affiliation(s)
- Angelica P Herrera
- Department of Community Health Sciences, School of Public Health, University of California, Los Angeles, San Diego, USA.
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Meeks T, Vahia I, Lavretsky H, Kulkarni G, Jeste D. A tune in "a minor" can "b major": a review of epidemiology, illness course, and public health implications of subthreshold depression in older adults. J Affect Disord 2011; 129:126-42. [PMID: 20926139 PMCID: PMC3036776 DOI: 10.1016/j.jad.2010.09.015] [Citation(s) in RCA: 342] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 09/15/2010] [Indexed: 01/04/2023]
Abstract
BACKGROUND With emphasis on dimensional aspects of psychopathology in development of the upcoming DSM-V, we systematically review data on epidemiology, illness course, risk factors for, and consequences of late-life depressive syndromes not meeting DSM-IV-TR criteria for major depression or dysthymia. We termed these syndromes subthreshold depression, including minor depression and subsyndromal depression. METHODS We searched PubMed (1980-Jan 2010) using the terms: subsyndromal depression, subthreshold depression, and minor depression in combination with elderly, geriatric, older adult, and late-life. Data were extracted from 181 studies of late-life subthreshold depression. RESULTS In older adults subthreshold depression was generally at least 2-3 times more prevalent (median community point prevalence 9.8%) than major depression. Prevalence of subthreshold depression was lower in community settings versus primary care and highest in long-term care settings. Approximately 8-10% of older persons with subthreshold depression developed major depression per year. The course of late-life subthreshold depression was more favorable than that of late-life major depression, but far from benign, with a median remission rate to non-depressed status of only 27% after ≥1 year. Prominent risk factors included female gender, medical burden, disability, and low social support; consequences included increased disability, greater healthcare utilization, and increased suicidal ideation. LIMITATIONS Heterogeneity of the data, especially related to definitions of subthreshold depression limit our ability to conduct meta-analysis. CONCLUSIONS The high prevalence and associated adverse health outcomes of late-life subthreshold depression indicate the major public health significance of this condition and suggest a need for further research on its neurobiology and treatment. Such efforts could potentially lead to prevention of considerable morbidity for the growing number of older adults.
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Affiliation(s)
- Thomas Meeks
- Department of Psychiatry, University of California, San Diego (UCSD),Sam and Rose Stein Institute for Research on Aging, UCSD
| | - Ipsit Vahia
- Department of Psychiatry, University of California, San Diego (UCSD),Sam and Rose Stein Institute for Research on Aging, UCSD
| | - Helen Lavretsky
- Department of Psychiatry, University of California, Los Angeles
| | | | - Dilip Jeste
- Department of Psychiatry, University of California, San Diego (UCSD),Sam and Rose Stein Institute for Research on Aging, UCSD
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Hsu CT, Weng CY, Kuo CS, Lin CL, Jong MC, Kuo SY, Chen PF. Effects of a cognitive-behavioral group program for community-dwelling elderly with minor depression. Int J Geriatr Psychiatry 2010; 25:654-5. [PMID: 20474063 DOI: 10.1002/gps.2371] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Lotrich FE. Major depression during interferon-alpha treatment: vulnerability and prevention. DIALOGUES IN CLINICAL NEUROSCIENCE 2010. [PMID: 20135899 PMCID: PMC3181938 DOI: 10.31887/dcns.2009.11.4/felotrich] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Major Depressive Disorder (MDD) during interferons (IFN-α) treatment can occur within a few months of therapy, and shares many homologies with other forms of MDD, Most patients are resilient to the side effect ofinterferon-induced depression (IFN-MDD), but 15% to 40% are vulnerable. Several studies have employed antidepressants to prevent the incidence of an IFN-MDD episode, and the results suggest that prophylactic antidepressants may be specifically useful in those with pre-existing subthreshold depressive symptoms andlor a history of prior MDD episodes. Several other potential markers of vulnerability for IFN-MDD have been implicated in assessments of nondepressed patients before they start IFN-α These include poor sleep quality, premorbid elevations in inflammatory cytokines, genetic polymorphisms in the serotonin system, personality, and social support. The interplay of these factors strongly predicts who is at risk for IFN-MDD, and indicates several potentially modifiable targets for the personalized prevention of IFN-MDD,
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Affiliation(s)
- Francis E Lotrich
- Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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Hong SI, Hasche L, Bowland S. Structural relationships between social activities and longitudinal trajectories of depression among older adults. THE GERONTOLOGIST 2009; 49:1-11. [PMID: 19362999 PMCID: PMC4047289 DOI: 10.1093/geront/gnp006] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 01/09/2008] [Indexed: 11/14/2022] Open
Abstract
PURPOSE This study examines the structural relationships between social activities and trajectories of late-life depression. DESIGN AND METHODS Latent class analysis was used with a nationally representative sample of older adults (N = 5,294) from the Longitudinal Study on Aging II to classify patterns of social activities. A latent growth curve model captured longitudinal changes in depression and tested the impact of social activities while controlling for residential relocation, health status, insurance, and sociodemographics. RESULTS We found 3 different patterns of participation across 8 social activities. Specific activities of volunteering and exercise, self-perception of social activity level as "enough," and a higher participation level pattern were associated with lower initial status and longitudinal changes in depression. IMPLICATIONS Assessing involvement in multiple social activities is important when using social activities to prevent and treat depression. Future work with improved measures can further clarify how specific activities may reduce risk for depression.
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Affiliation(s)
- Song-Iee Hong
- National University of Singapore, Department of Social Work, Faculty of Arts & Social Science Block AS3, Level 4, 3 Arts Link, Singapore.
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Brief interventions to prevent depression in older subjects: a systematic review of feasibility and effectiveness. Am J Geriatr Psychiatry 2008; 16:435-43. [PMID: 18515687 DOI: 10.1097/jgp.0b013e318162f174] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This systematic review proposed to explore the feasibility and effectiveness of brief interventions to prevent depression in older subjects. Computer databases were searched for potentially relevant articles published up until August, 2007. The bibliographies of relevant articles were searched for additional references and all the retrieved articles were screened to meet the following five inclusion criteria: original research, subjects mean age 40 years or more, controlled trial of a brief (<12 weeks) intervention to prevent depression, determination of depression status 6 months or more after enrolment, and use of an acceptable definition of depression. To examine feasibility, study enrolment, completion, and compliance rates were tabulated. To examine effectiveness, differences in depression symptom outcome scores or, when possible, absolute risk reductions (ARR) and relative risk reductions (RRR) for depression were tabulated. Fourteen trials were located. All were trials of brief psychosocial interventions. Many had one or more methodological limitations. Study enrolment rates were 21%-100% (median 45%-49%); completion rates were 53%-100% (median 85%); compliance rates were 29%-100% (median 80%). Eight trials had positive results. In three trials there were significant differences in depression symptom outcome scores favoring the intervention group; in eight trials, ARRs were -17% to 45% (median 6%); RRRs were -125% to 71% (median 33%). It seems that some types of brief psychosocial interventions have the potential to prevent depression in older subjects. Guidelines to improve the quality of future trials are proposed.
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Abstract
OBJECTIVE To determine risk factors for major depression in older medical inpatients. METHOD In a prospective cohort study, 86 older medical inpatients without depression or antidepressant medication were assessed 3, 6, and 12 months after enrollment. Incident major depression was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Potential predictive variables included sociodemographic variables, physical state, cognition, depressive symptoms, medication use, prior depressive episode, social network, support, and bereavement. Cox proportional hazards analysis (with backward variable elimination) was used to determine the best set of predictors. RESULTS Twenty-six patients (30.2%) met criteria for incident major depression. Predictors of major depression included the following: prior depressive episode, birth outside Canada, low comorbidity, inadequate emotional support, fewer children seen, depressed mood, and diurnal variation. The risk of depression increased with the number of risk factors present. CONCLUSION The seven identified risk factors may guide efforts to prevent major depression in older medical inpatients.
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Taylor WD, Steffens DC, Krishnan KR. Psychiatric disease in the twenty-first century: The case for subcortical ischemic depression. Biol Psychiatry 2006; 60:1299-303. [PMID: 17014829 DOI: 10.1016/j.biopsych.2006.05.028] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Revised: 05/10/2006] [Accepted: 05/12/2006] [Indexed: 10/24/2022]
Abstract
The current approach to psychiatric diagnoses involves identifying symptom clusters that fit a specific syndrome. Although this approach has facilitated the field's development, advances in genetics and neuroimaging raise the question of how causality may fit into the diagnostic process. One approach would be a two-axial system, wherein clinical presentation is on one axis and putative risk factors are on the other. This approach applies to subcortical ischemic depression (SID), a diagnosis corresponding to the "vascular depression" hypothesis. Subcortical ischemic depression affects clinical presentation, long-term outcomes, and response to antidepressant therapy, arguing that it is a valid diagnostic entity worth further study.
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Affiliation(s)
- Warren D Taylor
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Affiliation(s)
- Stephen J Bartels
- New Hampshire-Dartmouth Psychiatric Research Center, 2 Whipple Place, Suite 202, Lebanon, NH 03755, USA.
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