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The Combined Effect of Exercise and Behavioral Therapy for Depression and Anxiety: Systematic Review and Meta-Analysis. Behav Sci (Basel) 2020; 10:bs10070116. [PMID: 32674359 PMCID: PMC7407099 DOI: 10.3390/bs10070116] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 01/08/2023] Open
Abstract
Behavioral therapy (BT) and exercise are efficacious treatments for depression and anxiety when employed separately. The combination of BT and exercise (BT+Ex) may augment improvements but the combined effect of these therapies is not fully elucidated. The purpose of this meta-analysis was to determine if BT+Ex yielded a significant reduction in depression and anxiety symptoms compared to BT alone (BT). Randomized controlled studies published prior to September 2019 were searched among several databases (PUBMED, MEDLINE, PsychArticle, and Cochrane Central Register of Clinical Trials). Studies that measured depression and anxiety symptoms following BT+Ex vs. BT were extracted and analyzed. The effect of these therapies on depression and anxiety were analyzed. Subgroup analyses were performed to evaluate the effect of exercise intensity (moderate and high), exercise type (aerobic and combined exercise), and baseline levels of depression. The moderating effects of gender, age, and treatment duration were performed. Data were extracted from 18 studies (1686 participants, mean age = 47 years, 65% female). There was a significant effect of BT+Ex on symptoms of depression. The effect of BT+Ex was significant for moderate intensity exercise and elevated baseline levels of depression. Age moderated the effect for depression. There was a significant effect of BT+Ex on depressive symptoms in humans. Exercise intensity and elevated depressive symptoms may play a role in the effect of exercise.
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Prognostic evaluation in palliative care: final results from a prospective cohort study. Support Care Cancer 2018; 27:2095-2102. [DOI: 10.1007/s00520-018-4463-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
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Mental and physical health outcomes following the Relaxation Response Resiliency Program (3RP) in a clinical practice setting. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2016.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Helvik AS, Corazzini K, Selbæk G, Bjørkløf GH, Laks J, Šaltytė Benth J, Østbye T, Engedal K. Health-related quality of life in older depressed psychogeriatric patients: one year follow-up. BMC Geriatr 2016; 16:131. [PMID: 27388445 PMCID: PMC4936227 DOI: 10.1186/s12877-016-0310-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 06/17/2016] [Indexed: 11/16/2022] Open
Abstract
Background Knowledge about long-term change in health related quality of life (HQoL) among older adults after hospitalization for treatment of depression has clinical relevance. The aim was firstly to describe the change of HQoL one year after admission for treatment of depression, secondly to explore if improved HQoL was associated with remission of depression at follow-up and lastly to study how HQoL in patients with remission from depression were compared to a reference group of older persons without depression. Method This study had the one year follow-up information of 108 older patients (≥60 years), all hospitalized for depression at baseline, and a reference sample of 106 community-living older adults (≥60 years) without depression. HQoL was measured using the EuroQol Group’s EQ-5D Index and a visual analog scale (EQ-VAS). Depression and remission were diagnosed according to ICD-10. Socio-demographic variables (age, gender, and education), depressive symptom score (Montgomery-Aasberg Depression Rating Scale), cognitive functioning (Mini Mental State Examination scale), instrumental activities of daily living (the Lawton and Brody’s Instrumental Activities of Daily Living Scale), and poor general physical health (General Medical Health Rating) were included as covariates. Results HQoL had improved at follow-up for the total group of depressed patients, as indicated by better scores on the EQ-5D Index and EQ-VAS. In the multivariate linear regression model, improved EQ-5D Index and EQ-VAS was significantly better in those with remission of depression and those with better baseline physical health. In adjusted analyses, the HQoL in patients with remission from depression at follow-up did not differ from the HQoL in a reference group without depression. Conclusion Older hospital patients with depression who experienced remission one year after admission gained HQoL and their HQoL was comparable with the HQoL in a reference group of older adults without depression when adjusting for differences in socio-demographics and health conditions.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. .,St. Olav's University Hospital, Trondheim, Norway. .,Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway.
| | | | - Geir Selbæk
- Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.,Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Guro Hanevold Bjørkløf
- Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway
| | - Jerson Laks
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Post Graduation Program in Translational Medicine, Universidade do Grande Rio (Unigranrio), Rio de Janeiro, Brazil
| | - Jūratė Šaltytė Benth
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Clinical Medicine, Ahus Campus, University of Oslo, Oslo, Norway.,Research Centre, HØKH, Akershus University Hospital, Lørenskog, Norway
| | | | - Knut Engedal
- Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway
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Topitz A, Benda N, Saumer G, Friedrich F, König D, Soulier N, Freidl M. [Prevalence and recognition of depression among inpatients of non-psychiatric hospital departments]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2015; 29:63-70. [PMID: 25868683 DOI: 10.1007/s40211-015-0145-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 03/17/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE The purpose of this study is to compare the prevalence of depression among different types of hospital departments. Furthermore, it compares different methods for assessment of its recognition by non-psychiatric physicians. METHODS 993 inpatients of internal, surgical, gynecological and physical rehabilitation wards of community hospitals were interviewed by research psychiatrists using the Clinical Interview Schedule. Ward physicians were asked to fill in a short questionnaire in order to assess whether they could correctly identify patients with mental illnesses. In addition, routine discharge diagnoses were assessed. RESULTS Of the total sample, 13.3 % suffered from depression. Depression was most frequent on physical rehabilitation units (24.2 %), followed by surgical (9.8 %) and internal (9.5 %) wards. On gynecological wards, prevalence of depression was lowest (8.7 %). Of those suffering from depression, 45.7 % were identified as mentally ill by non-psychiatric ward physicians when using questionnaire data. Only 21.0 % of the depressed received a psychiatric discharge diagnosis, which equals less than half of those identified by questionnaire. RESULTS Of the total sample, 13.3 % of patients suffered from depression. Depression was most frequent in physical rehabilitation units (24.2 %), followed by surgical (9.8 %) and internal (9.5 %) wards. In gynecological wards, the prevalence of depression was the lowest (8.7 %). Of those suffering from depression, 45.7 % were identified as mentally ill by non-psychiatric ward physicians when using questionnaire data. Only 21.0 % of the depressed received a psychiatric discharge diagnosis, less than half of those identified by the questionnaire. CONCLUSIONS Depression is very common among inpatients of physical hospital departments. Unfortunately, depression is frequently overlooked in everyday clinical work. Routine discharge diagnoses give only very limited information about how often ward physicians recognize mental disorders. Furthermore, hospital discharge diagnoses should not be used for planning mental health services.
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Affiliation(s)
- Andrea Topitz
- Klinische Abteilung für Sozialpsychiatrie, Univ.-Klinik für Psychiatrie und Psychotherapie Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich,
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Abstract
OBJECTIVE Mortality on medical intensive care units (ICU) is approximately 25%. It is associated with age, severity of illness, and comorbidities. Preexisting depression is a risk factor for worse outcome in many diseases. The impact of depression on outcome of ICU patients has not been investigated. We assessed a possible association between mortality and preexisting depressive mood at the time of ICU admission. The primary end point was 28-day mortality. METHODS This single-center cohort study was conducted in a tertiary medical ICU. Two hundred patients were evaluated for preexisting depressive mood at ICU admission, determined by Hospital Anxiety and Depression Scale (HADS) score ≥8 in the depression dimension in patients with appropriate cognitive function. Patients with insufficient cognitive function were assessed using observer rating by next of kin by Hammond scale (cutoff ≥4) and/or a modified version of the Hospital Anxiety and Depression Scale for observer rating (cutoff ≥10). RESULTS In total, 66 (33%) of 200 patients were classified with preexisting depressive mood. Forty-nine (24.5%) of 200 patients had died by day 28. Of these, 23 (47%) had preexisting depressive mood as compared with 43 of 151 (29%) 28-day survivors (p = .017). Multiple logistic regression analysis revealed that preexisting depressive mood at the time of ICU admission is an independent risk factor for 28-day (odds ratio = 2.2, 95% confidence interval = 1.08-4.5, p = .030) and in-hospital mortality (median time till death = 20.5 [2-186] days, odds ratio = 2.58, 95% confidence interval = 1.31-5.1, p = .006). CONCLUSION Preexisting depressive mood might be an independent risk factor for 28-day mortality in medical ICU patients. This could have diagnostic and therapeutic implications for critically ill patients.
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Hou Y, Li X, Yang L, Liu C, Wu H, Xu Y, Yang F, Du Y. Factors associated with depression and anxiety in patients with end-stage renal disease receiving maintenance hemodialysis. Int Urol Nephrol 2014; 46:1645-9. [PMID: 24619584 DOI: 10.1007/s11255-014-0685-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 02/25/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To investigate anxiety, depression, and related factors in patients with end-stage renal disease (ESRD) receiving maintenance hemodialysis and provide a reference for the establishment of a healthier life for such patients. METHODS A total of 81 patients were enrolled in the study. Qualified participants filled out self-rating anxiety scale (SAS) and depression self-assessment scale (SDS) questionnaires as well as assessments of health knowledge and health self-efficacy. Linear regression analysis was performed to relate demographic factors, lifestyle habits, and nutrition parameters to SDS and SAS score indices. RESULTS The mean SAS and SDS score indices for the 81 patients were 52.96 and 46.71, respectively; 56 patients (69.1 %) had a depressive disorder (SDS score ≥ 50), and 31 patients (36.9 %) had anxiety symptoms (SAS score ≥ 50). SAS score index correlated with gender (p < .05) and history of alcohol use (p < .01), whereas SDS score index correlated with administration of erythropoietin (EPO) (p < .05) as well as gender and history of alcohol use. CONCLUSION History of alcohol consumption may predict less depressive symptoms and more anxiety among Chinese patients living in a northeastern Chinese city with ESRD. EPO administration may reduce anxiety in patients with ESRD. Female patients were more prone to anxiety, whereas males were more likely to show symptoms of depression. These factors should be evaluated by nephrologists treating patients with ESRD.
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Affiliation(s)
- Yue Hou
- Department of Nephrology, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin Province, China
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Pompili M, Venturini P, Montebovi F, Forte A, Palermo M, Lamis DA, Serafini G, Amore M, Girardi P. Suicide risk in dialysis: review of current literature. Int J Psychiatry Med 2014; 46:85-108. [PMID: 24547611 DOI: 10.2190/pm.46.1.f] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Studies have shown that patients with end-stage kidney disease (ESKD) are at risk of experiencing suicidal ideation and suicide attempt. STUDY DESIGN The aim of the present review was to investigate whether there was a relationship between dialysis and suicide. A careful systematic review of the literature was conducted to determine the potential association between dialysis and suicide. SELECTION CRITERIA FOR STUDIES Abstracts that did not explicitly mention suicide and dialysis were excluded. We identified as specific fields of interest in the analysis of dialysis or ESRD and suicidal behavior. RESULTS A total of 26 articles from peer-reviewed journals were considered and the most relevant articles (N = 13) were selected for this review. OUTCOMES It has been posited that suicidal ideation, occurring in dialysis, may arise from co-morbid depression and psychiatric symptoms are frequent in patients who underwent dialysis. LIMITATIONS The present review should be considered in the light of some limitations. We did not carry out a meta-analysis because data from most of the studies did not permit it. Samples included different measurements and different outcomes, and they assessed patients at different time points. CONCLUSIONS The available data suggest that the risk of self-harm may be higher than expected in dialysis patients especially in those who suffer by depression and anxiety. Moreover, although the majority of deaths among dialysis patients is preceded by withdrawal from treatment, suicide remains a separate phenomenon.
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Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs-Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy.
| | | | | | | | | | - Dorian A Lamis
- Emory University School of Medicine, Atlanta, Georgia, USA
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Kim JH, Yoon S, Won WY, Lee C, Lee CU, Song KY, Min JA, Lyoo IK, Kim TS. Age-specific influences of emotional distress on performance status in cancer patients. Psychooncology 2013; 22:2220-6. [DOI: 10.1002/pon.3276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 02/06/2013] [Accepted: 02/09/2013] [Indexed: 01/22/2023]
Affiliation(s)
- Ji-Hyun Kim
- Department of Psychiatry; Catholic University of Daegu School of Medicine; Daegu South Korea
| | - Sujung Yoon
- Department of Psychiatry; Catholic University of Korea College of Medicine; Seoul South Korea
- The Brain Institute and Department of Psychiatry; University of Utah School of Medicine; Salt Lake City UT USA
| | - Wang-Youn Won
- Department of Psychiatry; Catholic University of Korea College of Medicine; Seoul South Korea
| | - Chul Lee
- Department of Psychiatry; Catholic University of Korea College of Medicine; Seoul South Korea
| | - Chang-Uk Lee
- Department of Psychiatry; Catholic University of Korea College of Medicine; Seoul South Korea
| | - Kyo Young Song
- Division of Gastrointestinal Surgery, Department of Surgery; Catholic University of Korea College of Medicine; Seoul South Korea
| | - Jung-Ah Min
- Department of Psychiatry; Catholic University of Korea College of Medicine; Seoul South Korea
| | - In Kyoon Lyoo
- Division of Life and Pharmaceutical Sciences and Ewha Brain Institute; Ewha University; Seoul South Korea
| | - Tae-Suk Kim
- Department of Psychiatry; Catholic University of Korea College of Medicine; Seoul South Korea
- The Brain Institute and Department of Psychiatry; University of Utah School of Medicine; Salt Lake City UT USA
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Battes LC, Pedersen SS, Oemrawsingh RM, van Geuns RJ, Al Amri I, Regar E, de Jaegere PPT, Serruys P, van Domburg RT. Beta blocker therapy is associated with reduced depressive symptoms 12 months post percutaneous coronary intervention. J Affect Disord 2012; 136:751-7. [PMID: 22032873 DOI: 10.1016/j.jad.2011.09.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 09/30/2011] [Accepted: 09/30/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Beta blocker therapy may induce depressive symptoms, although current evidence is conflicting. We examined the association between beta blocker therapy and depressive symptoms in percutaneous coronary intervention (PCI) patients and the extent to which there is a dose-response relationship between beta blocker dose and depressive symptoms. METHODS Patients treated with PCI (N=685) completed the depression scale of the Hospital Anxiety and Depression Scale 1 and 12 months post PCI. Information about type and dose of beta blocker use was extracted from medical records. RESULTS Of all patients, 68% (466/685) were on beta blocker therapy at baseline. In adjusted analysis, beta blocker use at 1 month post PCI (OR: 0.82; 95% CI: 0.53-1.26) was not significantly associated with depressive symptoms. At 12 months post PCI, there was a significant relationship between beta blocker use and depressive symptoms (OR: 0.51; 95% CI: 0.31-0.84), with beta blocker therapy associated with a 49% risk reduction in depressive symptoms. There was a dose-response relationship between beta blocker dose and depressive symptoms 12 months post PCI, with the risk reduction in depressive symptoms in relation to a low dose being 36% (OR: 0.64; 95% CI: 0.37-1.10) and 58% (OR: 0.42; 95% CI: 0.24-0.76) in relation to a high dose. CONCLUSIONS Patients treated with beta blocker therapy were less likely to experience depressive symptoms 12 months post PCI, with there being a dose-response relationship with a higher dose providing a more pronounced protective effect.
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Affiliation(s)
- Linda C Battes
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
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Armaly Z, Farah J, Jabbour A, Bisharat B, Qader AAE, Saba S, Zaher M, Haj EE, Hamzi M, Bowirrat A. Major depressive disorders in chronic hemodialysis patients in Nazareth: identification and assessment. Neuropsychiatr Dis Treat 2012; 8:329-38. [PMID: 22888253 PMCID: PMC3415363 DOI: 10.2147/ndt.s31903] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Depression illnesses are commonly observed in hemodialysis (HD) patients, which can influence the quality of life of end-stage renal disease patients. We evaluate the prevalence and predictive risk factors of depression in the Arab population undergoing HD in Nazareth, Israel. METHODS We conducted a prospective study that included 71 patients in the HD unit with a mean age of 61.9 ± 14.13 years who had undergone HD and 26 healthy control subjects with a mean age of 59.3 ± 7.3. Beck's Depression Inventory and Hamilton Depression Scale assessments were administered. Blood analysis for hematological and biochemical parameters was obtained. Diagnosis was made using the Diagnostic and Statistical Manual of Mental Disorders scale to correlate psychological variables with clinical, hematological, and biochemical parameters. Statistical analysis was carried out using analysis of variance followed by Tukey post-hoc multiple comparison tests. RESULTS The prevalence of depression was 43.7% in HD patients. Between HD patients and controls, cortisol values were 16.96 ± 0.5476 and 11.96 ± 1.116, respectively (P < 0.0001; 95% confidence intervals [CI]: 2.416-6.825). Between depressed HD patients versus control subjects, cortisol values were 16.48 ± 0.72 and 11.96 ± 1.116, respectively (P = 0.0013; 95% CI: 1.878-7.184). Hematological and biochemical parameters were compared between depressed HD and nondepressed patients, but differences between the two groups were found to be insignificant (P > 0.05). CONCLUSION Our HD patients were severely depressed. Studies of glucocorticoid turnover activity such as cortisol, a potent chemical stress hormone, may be used as a model and marker for early diagnosis of depression among HD patients. The strong familial support system in Arabic traditions has failed to decrease depression among these patients.
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Affiliation(s)
- Zaher Armaly
- The Nazareth Hospital, Hospital Affiliated with Galilee Medical School- Bar Ilan University, Zefat, Israel
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Abstract
OBJECTIVE Type D personality has been established as a predictor of adverse clinical events in patients with cardiovascular diseases. To date, all studies except one have been conducted by a single research group. Thus, the aim of our study was to provide an independent replication of the results regarding the prognostic validity of Type D personality in a German sample of cardiac patients. METHODS Cardiac patients (n = 1040) were recruited from cardiac rehabilitation centers (n = 484), an outpatient clinic (n = 249), and a university hospital (n = 307). Main analyses were based on the combined data from these three subsamples. Cardiac health status, medical risk factors, sociodemographic characteristics, psychological symptoms, and Type D personality were assessed at baseline. The primary end point was all-cause mortality. The Cox proportional hazards regression model was used to estimate the relative risk of death. RESULTS Vital status was known for 977 patients (22.5% women; mean [standard deviation] = 63.3 [10.7] years). Within the follow-up time (mean [standard deviation] = 71.5 [3.6] months), 172 patients died. Type D personality was found in 25.2% of survivors and in 22.2% of nonsurvivors (χ²= 0.78, p = .38). Depressive symptoms (p = .13) and anxiety (p = .27) were also not predictive of mortality. In the multivariate analyses, neither Type D (p = .95) nor negative affectivity (p = .71) and social inhibition (p = .59), as well as their interaction (p = .88), were associated with all-cause mortality. CONCLUSIONS In the present study, Type D personality and its constituents are not associated with increased mortality in patients with heart disease. The discrepancies with previous results deserve further investigation.
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Chen CK, Tsai YC, Hsu HJ, Wu IW, Sun CY, Chou CC, Lee CC, Tsai CR, Wu MS, Wang LJ. Depression and Suicide Risk in Hemodialysis Patients With Chronic Renal Failure. PSYCHOSOMATICS 2010. [DOI: 10.1016/s0033-3182(10)70747-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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CASTELLI L, BINASCHI L, CALDERA P, MUSSA A, TORTA R. Fast screening of depression in cancer patients: the effectiveness of the HADS. Eur J Cancer Care (Engl) 2010; 20:528-33. [DOI: 10.1111/j.1365-2354.2010.01217.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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A new method to assess perceived well-being among elderly people--a feasibility study. BMC Geriatr 2009; 9:55. [PMID: 19958553 PMCID: PMC2791757 DOI: 10.1186/1471-2318-9-55] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 12/03/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A simple but countable electronic device has been developed to gain reliable information on elderly patients' perceived well-being. The device has been tested and proven to be technically functional and countable. It was now tested in two care homes for the elderly and two private homes to evaluate if it provided solid information about the well-being of elderly persons. This report illustrates the practical usage of the device and shows its efficiency in gathering solid well-being information from the focus group. METHODS The test arrangement was carried out by assigning a group of volunteers (n = 10) in care homes for the elderly for two weeks. The time period was long enough to collect a sufficient amount of information to evaluate the perceived well-being of the test subjects. Perceived well-being was assessed by using a Con-Dis device and by filling out an attached questionnaire - RAI - at the same time. RAI consisted of questions concerning mood, pain and quality of life. A standardised RAVA questionnaire with 12 questions concerning test subject's health was also answered once during the two-week time period by each test subject. After the test period the data obtained by Con-Dis was compared with the findings collected using questionnaires. RESULTS A statistically significant correlation was found between perceived well-being (measured by Con-Dis) and questionnaire-based mood (r = 0,66, Pearson Correlation Coefficient) and quality of life (r = 0,68). No statistically significant correlation was found between perceived well-being and pain (r = 0,28). Technical functionality and feasibility of Con-Dis were good during the test period. Some problems arose because the test subjects were elderly and some in poor physical condition. CONCLUSION On the basis of the collected results, the Con-Dis device presented information on the test subjects' perceived well-being that appeared to correlate with certain aspects of their health status. The test subjects' mood and quality of life but not pain had a statistically significant association with the perceived well-being level measured by Con-Dis.
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Single item on positive affect is associated with 1-year survival in consecutive medical inpatients. Gen Hosp Psychiatry 2009; 31:8-13. [PMID: 19134503 DOI: 10.1016/j.genhosppsych.2008.09.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 09/22/2008] [Accepted: 09/22/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the independent effects of positive and negative affect items on mortality in consecutive medical inpatients. METHODS Consecutive general medical inpatients were asked to complete the Hospital Anxiety and Depression Scale (HADS) at admission. Prognostic indicators were obtained from patients' records and physicians' ratings. The study end point was mortality from all causes at 1 year. RESULTS The baseline assessment was completed by 575 patients (87.7%). Survival data were available for 572 of these (86 deaths). HADS depression scores and several physical risk indicators predicted mortality. Independent effects could be observed for HADS item 1 ("Can enjoy things as much as before") adjusted for physicians' ratings of prognosis, a principal diagnosis of hemato-oncological disease and Charlson comorbidity scores. In contrast, HADS depression items 2-7 (Model 1) as well as positive HADS depression scores did not contribute significantly to the prediction of mortality. CONCLUSION Our present results suggest that one single item on positive affect independently predicts 1-year survival in consecutively admitted medical inpatients. Interestingly, this item has a stronger association with survival status than the presence of depressed mood.
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Cole MG. Does depression in older medical inpatients predict mortality? A systematic review. Gen Hosp Psychiatry 2007; 29:425-30. [PMID: 17888809 DOI: 10.1016/j.genhosppsych.2007.07.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 07/05/2007] [Accepted: 07/06/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine whether depression in older medical inpatients predicts mortality. METHOD Medline, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews were searched for potentially relevant articles; the bibliographies of relevant articles were searched for additional references. Retrieved studies were screened to meet five inclusion criteria. Validity of studies was assessed according to four criteria adapted from the Evidence-Based Medicine Working Group. Data were abstracted from each study and tabulated. Data synthesis involved a qualitative meta-analysis. RESULTS Many of the studies had methodological limitations. Six reported that depression predicted increased mortality, five reported that depression did not predict mortality, and one reported that depression predicted decreased mortality when there was a history of prior depression. Unadjusted risk ratios for death ranged from 0.60 to 12.6; adjusted risk ratios ranged from 0.42 to 7.4. The disparate findings may be explained in part by differences in the proportions of young older patients and men enrolled in the different studies. CONCLUSION The evidence that depression in older medical inpatients predicts mortality is inconclusive. There is a need for further studies that pay attention to design, populations enrolled, and analysis.
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Affiliation(s)
- Martin G Cole
- Department of Psychiatry, St. Mary's Hospital Center, McGill University, Montreal, Quebec, Canada.
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Gripp S, Moeller S, Bölke E, Schmitt G, Matuschek C, Asgari S, Asgharzadeh F, Roth S, Budach W, Franz M, Willers R. Survival Prediction in Terminally Ill Cancer Patients by Clinical Estimates, Laboratory Tests, and Self-Rated Anxiety and Depression. J Clin Oncol 2007; 25:3313-20. [PMID: 17664480 DOI: 10.1200/jco.2006.10.5411] [Citation(s) in RCA: 202] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To study how survival of palliative cancer patients relates to subjective prediction of survival, objective prognostic factors (PFs), and individual psychological coping. Patients and Methods Survival was estimated according to three categories (< 1 month, 1 to 6 months, and > 6 months) by two physicians (A and B) and the institutional tumor board (C) for 216 patients recently referred for palliative radiotherapy. After 6 months, the accuracy of these estimates was assessed. The prognostic relevance of clinical symptoms, performance status, laboratory tests, and self-reported emotional distress (Hospital Anxiety and Depression Scale) was investigated. Results In 61%, 55%, and 63% of the patients, prognoses were correctly estimated by A, B, and C, respectively. κ statistic showed fair agreement of the estimates, which proved to be overly optimistic. Accuracy of the three estimates did not improve with increasing professional experience. In particular, the survival of 96%, 71%, and 87% of patients who died in less than 1 month was overestimated by A, B, and C, respectively. On univariate analysis, 11 of 27 parameters significantly affected survival, namely performance status, primary cancer, fatigue, dyspnea, use of strong analgesics, brain metastases, leukocytosis, lactate dehydrogenase (LDH), depression, and anxiety. On multivariate analysis, colorectal and breast cancer had a favorable prognosis, whereas brain metastases, Karnofsky performance status less than 50%, strong analgesics, dyspnea, LDH, and leukocytosis were associated with a poor prognosis. Conclusion This study revealed that physicians' survival estimates were unreliable, especially in the case of patients near death. Self-reported emotional distress and objective PFs may improve the accuracy of survival estimates.
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Affiliation(s)
- Stephan Gripp
- Department of Radiation Oncology, University Hospital Düsseldorf at Heinrich-Heine-University, Düsseldorf, Germany.
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Gomez-Caminero A, Blumentals WA, Russo LJ, Brown RR, Castilla-Puentes R. Does panic disorder increase the risk of coronary heart disease? A cohort study of a national managed care database. Psychosom Med 2005; 67:688-91. [PMID: 16204424 DOI: 10.1097/01.psy.0000174169.14227.1f] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The association between panic disorder (PD) and coronary heart disease (CHD) was examined in a large national managed care database. METHODS The Integrated Health Care Information Services managed care database is a fully de-identified, Health Insurance Portability and Accountability Act-compliant database and includes complete medical history for more than 17 million managed care lives; data from more than 30 United States health plans covering 7 census regions and from patient demographics, including morbidity, age, and gender. A cohort study was designed with a total of 39,920 PD patients and an equal number of patients without PD. The Cox proportional hazards regression models were used to assess the risk of CHD adjusted for age at entry into the cohort, tobacco use, obesity, depression, and use of medications including angiotensin converting enzyme inhibitors, beta blockers, and statins. RESULTS Patients with PD were observed to have nearly a 2-fold increased risk for CHD (HR = 1.87, 95% CI = 1.80-1.91) after adjusting for these factors. There was some evidence of a possible trend toward increased risk in a subgroup of patients diagnosed with depression. After controlling for the aforementioned covariates and comparing these patients with those who did not have a diagnosis of depression, it was noted that patients with a comorbid diagnosis of depression were almost 3 times more likely to develop CHD (HR = 2.60, 95% CI = 2.30-3.01). CONCLUSIONS The risk of CHD associated with a diagnosis of PD suggests the need for cardiologists and internists to monitor panic disorder to ensure a reduction in the risk of CHD.
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Affiliation(s)
- Andres Gomez-Caminero
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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Mecocci P, Cherubini A, Mariani E, Ruggiero C, Senin U. Depression in the elderly: new concepts and therapeutic approaches. Aging Clin Exp Res 2004; 16:176-89. [PMID: 15462460 DOI: 10.1007/bf03327382] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Depression is one of the leading causes of suffering in the elderly, but it is often under-diagnosed and under-treated, partly due to the false belief that depression is a common aspect of aging. Depression in the elderly is frequently comorbid with medical illnesses, may often be expressed by somatic complaints, and may be a risk factor for other diseases such as dementia and coronary artery disease. Depression decreases the quality of life and increases disability and the risk of mortality, also due to suicide. Although several effective antidepressant drugs are available, with a favorable therapeutic index, non-pharmacological treatments, such as psychotherapy and exercise, should receive greater attention, since combination therapy is probably more effective.
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Affiliation(s)
- Patrizia Mecocci
- Section of Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy.
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21
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Herrmann-Lingen C. Zur Bedeutung depressiver Störungen für die somatische Medizin/ The importance of depressive disorders in somatic medicine. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2003; 49:391-407. [PMID: 14579205 DOI: 10.13109/zptm.2003.49.4.391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Depressive disorders--including mild and subthreshold forms--are frequent in medical patients, although often not recognized. Over the past decades accumulating scientific evidence has demonstrated their clinical relevance. Depressive disorders and also elevated scores on self-rating scales for depressive symptoms are clearly related to disease behavior and quality of life. In many physical conditions they also predict adverse outcome, including premature death. This paper gives an overview of the literature on the relevance and treatment of comorbid depression in patients with HIV infection, cancer and coronary heart disease. It shows that the subjective effects of depression are rather similar in different somatic conditions. In addition, depression also interacts with the physical course of different diseases. However, the specific physiological mediators involved vary among different somatic diseases and have not yet been completely understood. Despite this uncertainty an improved recognition and treatment of comorbid depression can be recommended. Supportive interventions focussing on coping demands as well as regular psychotherapy and in some cases antidepressant medication may be indicated. While it still appears premature to establish generally applicable treatment guidelines, an individualized approach with regard to the different treatment alternatives for individual patients should be advocated.
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Affiliation(s)
- Christoph Herrmann-Lingen
- Abteilung Psychosomatik und Psychotherapy, Klinik für Psychosomatik und Psychotherapie, Universität Göttingen, von-Siebold-Str. 5, D-37075 Göttingen, Germany.
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Minicuci N, Maggi S, Noale M, Trabucchi M, Spolaore P, Crepaldi G. Predicting mortality in older patients. The VELCA Study. Aging Clin Exp Res 2003; 15:328-35. [PMID: 14661825 DOI: 10.1007/bf03324518] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Mortality at older age, during and after hospitalization, can be determined by several factors, beyond the direct cause for hospital admission, which are not yet fully understood. The aim of this study was to assess predictors of inpatient mortality and one-year mortality in older Italians, hospitalized for dementia, heart failure, chronic obstructive pulmonary disease, stroke, hip fracture and myocardial infarction at the Verona Teaching Hospital, Northern Italy. METHODS At admission, 429 patients aged 65 years and older reported information on: sociodemographic characteristics, Barthel index at admission and two weeks before, and severity of investigated diagnosis; at discharge: diagnosis, comorbid conditions, complications from hospital records, drug therapy, and Barthel index. One year after discharge, an ad hoc questionnaire for those subjects found to have died on phone contact was administered to a proxy to collect data on new hospital admissions, onset of new conditions, need for formal care, a short version of the Barthel index one month before death, and the place of death. RESULTS Sex and specific diseases at admission were not significant predictors of inpatients, nor was one-year mortality in this cohort, whereas the presence of any comorbid conditions doubled the risk of mortality at one year compared with patients without comorbidity. Those patients who had moderate to severe/total dependency in ADL at admission were three times more likely to have died at discharge than those who were independent. The same risk for mortality at one-year follow-up was found in those patients who were severely or totally dependent at preadmission, at admission, or at discharge. CONCLUSIONS Functional status and comorbidity are key risk factors for mortality in the elderly. Therefore, multidimensional assessment, including functional status prior to hospitalization should always be assessed, and should be considered a relevant predictor of short- and long-term outcomes.
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Affiliation(s)
- Nadia Minicuci
- CNR-Institute of Neuroscience, Clinical Section on Aging, Padova, Italy.
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Watkins LL, Schneiderman N, Blumenthal JA, Sheps DS, Catellier D, Taylor CB, Freedland KE. Cognitive and somatic symptoms of depression are associated with medical comorbidity in patients after acute myocardial infarction. Am Heart J 2003; 146:48-54. [PMID: 12851607 DOI: 10.1016/s0002-8703(03)00083-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Depression is common in patients with acute myocardial infarction (AMI) and is associated with adverse health outcomes. However, the extent to which clinical depression is related to comorbid medical conditions is unknown. This study examined the degree of association between clinical depression and medical comorbidity in patients hospitalized with AMI. METHODS Two thousand four hundred and eighty-one depressed or socially isolated patients with AMI were enrolled, as part of the National Heart, Lung, and Blood Institute-sponsored Enhancing Recovery in Coronary Heart Disease clinical trial. A structured interview was used to diagnose major and minor depression and dysthymia; severity of depression was measured by the Hamilton Rating Scale for Depression and the Beck Depression Inventory. Level of social support was measured by the ENRICHD Social Support Instrument. A modified version of the Charlson Comorbidity Index was used to measure the cumulative burden of medical comorbidity. RESULTS The adjusted odds ratios (ORs) for having major depression increased linearly with medical comorbidity (ORs 1.6, 2.2, 2.7 for each increasing medical comorbidity category). This relationship remained after adjusting for coronary heart disease severity (ORs 1.4, 1.7, 1.9, P <.001). The relationship between severity of depression and medical comorbidity was also maintained after excluding somatic symptoms of depression (F = 21.5, P <.0001). CONCLUSIONS Patients with AMI and clinical depression have significantly greater levels of medical comorbidity than nondepressed, socially isolated patients. Further research is needed to determine whether comorbid medical illness contributes to the more frequent rehospitalizations and increased risk of mortality associated with depression.
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Affiliation(s)
- Lana L Watkins
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.
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Murdoch M, Hodges J, Cowper D, Fortier L, van Ryn M. Racial disparities in VA service connection for posttraumatic stress disorder disability. Med Care 2003; 41:536-49. [PMID: 12665717 DOI: 10.1097/01.mlr.0000053232.67079.a5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND "Service connected" veterans are those with documented, compensative conditions related to or aggravated by military service, and they receive priority for enrollment into the Veterans Affairs (VA) health care system. For some veterans, service connection represents the difference between access to VA health care facilities and no access. OBJECTIVES To determine whether there are racial discrepancies in the granting of service connection for posttraumatic stress disorder (PTSD) by the Department of Veterans Affairs and, if so, to determine whether these discrepancies could be attributed to appropriate subject characteristics, such as differences in PTSD symptom severity or functional status. RESEARCH DESIGN Mailed survey linked to administrative data. Claims audits were conducted on 11% of the sample. SETTING AND SUBJECTS The study comprised 2700 men and 2700 women randomly selected from all veterans filing PTSD disability claims between January 1, 1994 and December 31, 1998. RESULTS A total of 3337 veterans returned usable surveys, of which 17% were black. Only 16% of respondents carried private health insurance, and 44% reported incomes of 20,000 US dollars or less. After adjusting for respondents' sociodemographic characteristics, symptom severity, functional status, and trauma histories, black persons' rate of service connection for PTSD was 43% compared with 56% for other respondents (P = 0.003). CONCLUSION Black persons' rates of service connection for PTSD were substantially lower than other veterans even after adjusting for differences in PTSD severity and functional status.
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Affiliation(s)
- Maureen Murdoch
- Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minnesota 55417, USA.
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Niveles de ansiedad y depresión en enfermos hospitalizados y su relación con la gravedad de la enfermedad. Med Clin (Barc) 2003. [DOI: 10.1016/s0025-7753(03)73707-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Meyer T, Klemme H, Herrmann-Lingen C. [Prevalence and effects of depressive and anxiety symptoms in internal medicine inpatients during the first year after hospital discharge]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2002; 48:174-91. [PMID: 11992327 DOI: 10.13109/zptm.2002.48.2.174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In a prospective follow-up study the German version of the Hospital Anxiety and Depression Scale (HADS) was used to determine the prevalence of anxiety and depressive symptoms in internal medicine inpatients. From a total cohort of 376 admitted study patients questionnaires were completed at admission and after one year follow-up. The data demonstrated that the mean HADS score on the anxiety subscale decreased significantly from 6.7 3.5 at study inclusion to 5.8 3.8 after one year (p < 0.0005) while the mean HADS score on the depression subscale was relatively stable (5.3 3.6 versus 5.4 4.3, p = n.s.). Odds ratios for the prediction of positive HADS results at follow-up were 4.1 (95%-CI 2.0-8.4) for anxiety symptoms and 8.2 (95%-CI 4.6-14.6) for depressive symptoms. Patients with abnormal HADS anxiety scores were significantly more frequently rehospitalized (Odds ratio 1.9; p = 0.028) and also more frequently reported pain symptoms (Odds ratio 2.0; p = 0.019). These results demonstrate the persistence of depressive symptoms and the frequent utilization of health care in internal medicine inpatients with psychiatric disorders in the first year after hospital discharge.
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Affiliation(s)
- Thomas Meyer
- Abteilung Kardiologie und Pneumologie der Georg-August-Universität Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen, Germany.
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Abstract
In late life depression, common comorbid psychiatric disorders are alcohol use, anxiety, and personality disorders. Elderly depressed patients are three to four times more likely to have an alcohol use disorder compared with nondepressed elderly subjects, with a prevalence of 15%-30% in patients with late life major depression. While the presence of a comorbid alcohol use disorder may worsen the prognosis for geriatric depression, limited data suggest that successful treatment of depression combined with reducing alcohol use leads to the best possible outcomes. Most studies show that the overall prevalence of anxiety disorders, particularly panic disorder and obsessive-compulsive disorder, is low in geriatric depression, but generalized anxiety disorder may not be uncommon. It remains unclear if the presence of a comorbid anxiety disorder impacts on the treatment and prognosis of late life major depression. Personality disorders occur in 10%-30% of patients with late life major depression or dysthymic disorder, particularly in patients with early onset depressive illness. Cluster C disorders, including the avoidant, dependent, and obsessive-compulsive subtypes predominate, while Cluster B diagnoses, including borderline, narcissistic, histrionic and antisocial, are rare. Overall, the research database on comorbid psychiatric disorders in major and nonmajor late life depression is relatively sparse. Since comorbid psychiatric disorders affect clinical course and prognosis, and may worsen long-term disability in late life depression, considerably more research in this field is needed.
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Affiliation(s)
- D P Devanand
- Late Life Depression Clinic and the Department of Biological Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York 10032, USA
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Abstract
Depression can be a consequence of medical illness and disability, yet recent literature suggests it may also influence morbidity and mortality through a variety of behavioral and biological mediators. Relatively little is known about the complex temporal relations among behavior, affect, motivation, and pathophysiology to account for the association between depression and mortality. We performed a systematic review of the recent literature (1997-2001) examining the evidence linking depression to non-suicide mortality, describe possible mediators of the depression mortality effect, and identify important next steps in this area of research, including: a) the development of well-specified a-priory mediator models that articulate how depression leads to mortality; b) the conduct of longitudinal studies in which depression and behavioral and pathophyisological mediators are assessed simultaneously; c) treatment studies for depression that include assessments of associated changes in health-related quality of life, medical morbidity, and mortality; and d) treatment studies for behavioral risk factors and medical conditions that include assessment of depressive symptoms.
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Affiliation(s)
- Richard Schulz
- Department of Psychiatry and University Center for Social and Urban Research, University of Pittsburgh, Pennsylvania 15260, USA
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