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Jiang Y, Lu Y, Cai Y, Liu C, Zhang XY. Prevalence of suicide attempts and correlates among first-episode and untreated major depressive disorder patients with comorbid dyslipidemia of different ages of onset in a Chinese Han population: a large cross-sectional study. BMC Psychiatry 2023; 23:10. [PMID: 36600266 PMCID: PMC9814200 DOI: 10.1186/s12888-022-04511-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Patients with dyslipidemia are at increased risk for suicide, especially those with major depressive disorder (MDD). Few studies have investigated the independent effects of suicide attempts on comorbid dyslipidemia in patients with MDD. Moreover, there are no comparisons of differences in factors associated with suicide attempts among patients with MDD with dyslipidemia at different ages of onset. The aim of this study was to investigate the prevalence of suicide attempts and associated variables in first episode and untreated patients with MDD with comorbid dyslipidemia at different ages of onset. METHODS We recruited 1718 patients with first-episode untreated MDD in this study. Demographical and clinical data were collected, and lipid profiles, thyroid function, and blood glucose levels were measured. The Hamilton Depression Scale 17 (HAMD-17), Hamilton Anxiety Scale (HAMA), Clinical Global Impression Severity Scale (CGI), and Positive and Negative Syndrome Scale (PANSS) positive subscale were assessed for depression, anxiety and illness severity, as well as psychotic symptoms, respectively. RESULTS The percentage of patients with MDD with comorbid dyslipidemia was 61% (1048/1718). Among patients with MDD with comorbid dyslipidemia, the incidence of suicide attempts was 22.2% (170/765) for early adulthood onset and 26.5% (75/283) for mid-adulthood onset. Independent factors associated with suicide attempts in early adulthood onset patients with MDD with dyslipidemia were as follows: HAMA score (B = 0.328, P < 0.0001, OR = 1.388), Suspicion /persecution (B = -0.554, P = 0.006, OR = 0.575), CGI (B = 0.878, P < 0.0001, OR = 2.406), systolic blood pressure (B = 0.048, P = 0.004, OR = 1.049), hallucinatory behavior (B = 0.334, P = 0.025, OR = 1.397), and TPOAb (B = 0.003, p < 0.0001, OR = 1.003). Independent factors associated with suicide attempts in mid-adulthood onset patients with MDD with comorbid dyslipidemia were as follows: HAMA score (B = 0.182, P < 0.0001, OR = 1.200), CGI (B = 1.022, P < 0.0001, OR = 2.778), and TPOAb (B = 0.002, P = 0.009, OR = 1.002). CONCLUSION Our findings suggest an elevated risk of suicide attempts in patients with MDD with comorbid dyslipidemia. The incidence of suicide attempts was similar in the early- and mid-adulthood onset subgroups among patients with MDD with dyslipidemia, but the factors associated with suicide attempts were different in these two subgroups.
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Affiliation(s)
- Yang Jiang
- Guangxi Zhuang Autonomous Region Brain Hospital, Guangxi Liuzhou, 545005, China
| | - Yaoyao Lu
- Guangxi Zhuang Autonomous Region Brain Hospital, Guangxi Liuzhou, 545005, China
| | - Yi Cai
- Department of Psychosomatic Disorders, Shenzhen Mental Health Center/Shenzhen KangNing Hospital, Shenzhen, 518000, Guangdong, China
| | - Chengjiang Liu
- Department of General Medicine, Anhui Medical University, He Fei, 230601, China
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China.
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Abstract
Frozen shoulder is a common debilitating disorder characterized by shoulder pain and progressive loss of shoulder movement. Frozen shoulder is frequently associated with other systemic conditions or occurs following periods of immobilization, and has a protracted clinical course, which can be frustrating for patients as well as health-care professionals. Frozen shoulder is characterized by fibroproliferative tissue fibrosis, whereby fibroblasts, producing predominantly type I and type III collagen, transform into myofibroblasts (a smooth muscle phenotype), which is accompanied by inflammation, neoangiogenesis and neoinnervation, resulting in shoulder capsular fibrotic contractures and the associated clinical stiffness. Diagnosis is heavily based on physical examination and can be difficult depending on the stage of disease or if concomitant shoulder pathology is present. Management consists of physiotherapy, therapeutic modalities such as steroid injections, anti-inflammatory medications, hydrodilation and surgical interventions; however, their effectiveness remains unclear. Facilitating translational science should aid in development of novel therapies to improve outcomes among individuals with this debilitating condition.
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Prevalence of suicidal ideation and planning in patients with major depressive disorder: A meta-analysis of observation studies. J Affect Disord 2021; 293:148-158. [PMID: 34192629 DOI: 10.1016/j.jad.2021.05.115] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Suicidal ideation (SI) and suicide planning (SP) are associated with an increased risk of future suicide. We performed a meta-analysis of observational studies to estimate the prevalence of SI and SP in patients with major depressive disorder (MDD) and its associated factors. METHODS A systematic literature search was conducted in PubMed, EMBASE, PsycINFO and Web of Science from their commencement date until 7 October 2020. Original studies containing data on the prevalence of SI and SP in individuals with MDD were analyzed. RESULTS Forty-six articles covering 53,598 patients were included in the meta-analysis. The overall prevalence of SI was 37.7% (95% confidence interval (CI): 32.3-43.4%) and the pooled prevalence of SP was 15.1% (95% CI: 8.0--26.8%). Subgroup analyses revealed that the timeframe over which SI was assessed, source of patients, study design, and diagnostic criteria were significantly associated with the pooled prevalence of SI. Meta-regression analyses revealed that the Hamilton Depression Rating Scale (HAMD) score and percentage of male participants were positively associated with the pooled prevalence of SI. Study quality and mean age were negatively associated with the pooled prevalence of SI. In contrast, survey year and study quality were negatively associated with pooled prevalence of SP LIMITATION: SI and SP were self-reported and subject to recall bias and impression management. CONCLUSIONS SI and SP are common in patients with MDD, especially among inpatients. Preventive measures and treatments focusing on factors associated with SI and SP may reduce the risk of suicide in patients with MDD.
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Serra G, Iannoni ME, Trasolini M, Maglio G, Frattini C, Casini MP, Baldessarini RJ, Vicari S. Characteristics Associated with Depression Severity in 270 Juveniles in a Major Depressive Episode. Brain Sci 2021; 11:440. [PMID: 33805486 PMCID: PMC8066522 DOI: 10.3390/brainsci11040440] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction: Severe depression is prevalent in young persons and can lead to disability and elevated suicidal risk. Objectives: To identify clinical and demographic factors associated with the severity of depression in juveniles diagnosed with a major mood disorder, as a contribution to improving clinical treatment and reducing risk of suicide. Methods: We analyzed factors associated with depression severity in 270 juveniles (aged 6-18 years) in a major depressive episode, evaluated and treated at the Bambino Gesù Children's Hospital of Rome. Depressive symptoms were rated with the revised Children's Depression Rating Scale (CDRS-R) and manic symptoms with the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) Mania Rating Scale (K-SADS-MRS). Bivariate comparisons were followed by multivariable linear regression modeling. Results: Depression severity was greater among females than males (55.0 vs. 47.2), with the diagnosis of a major depressive disorder (MDD) vs. bipolar disorder (BD; 53.8 vs. 49.3), and tended to increase with age (slope = 1.14). Some symptoms typical of mania were associated with greater depression severity, including mood lability, hallucinations, delusions, and irritability, whereas less likely symptoms were hyperactivity, pressured speech, grandiosity, high energy, and distractibility. Factors independently and significantly associated with greater depression severity in multivariable linear regression modeling were: MDD vs. BD diagnosis, female sex, higher anxiety ratings, mood lability, and irritability. Conclusions: Severe depression was significantly associated with female sex, the presence of some manic or psychotic symptoms, and with apparent unipolar MDD. Manic/psychotic symptoms should be assessed carefully when evaluating a juvenile depressive episode and considered in treatment planning in an effort to balance risks of antidepressants and the potential value of mood-stabilizing and antimanic agents to decrease the severity of acute episodes and reduce suicidal risk.
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Affiliation(s)
- Giulia Serra
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, 00165 Rome, Italy; (M.E.I.); (M.T.); (G.M.); (C.F.); (M.P.C.); (S.V.)
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA 02478, USA;
| | - Maria Elena Iannoni
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, 00165 Rome, Italy; (M.E.I.); (M.T.); (G.M.); (C.F.); (M.P.C.); (S.V.)
| | - Monia Trasolini
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, 00165 Rome, Italy; (M.E.I.); (M.T.); (G.M.); (C.F.); (M.P.C.); (S.V.)
| | - Gino Maglio
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, 00165 Rome, Italy; (M.E.I.); (M.T.); (G.M.); (C.F.); (M.P.C.); (S.V.)
| | - Camilla Frattini
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, 00165 Rome, Italy; (M.E.I.); (M.T.); (G.M.); (C.F.); (M.P.C.); (S.V.)
- Department of Clinical and Dynamic Psychology, Medicine and Psychology Faculty, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Pia Casini
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, 00165 Rome, Italy; (M.E.I.); (M.T.); (G.M.); (C.F.); (M.P.C.); (S.V.)
- Psychiatric Emergency in adolescence Departmental Unit Umberto I General Hospital, 00161 Rome, Italy
| | - Ross J. Baldessarini
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA 02478, USA;
- Department of Psychiatry, Harvard Medical School, Boston, MA 02478, USA
| | - Stefano Vicari
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, 00165 Rome, Italy; (M.E.I.); (M.T.); (G.M.); (C.F.); (M.P.C.); (S.V.)
- Child Neuropsychiatry, Catholic University, 00168 Rome, Italy
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Liang S, Zhang J, Zhao Q, Wilson A, Huang J, Liu Y, Shi X, Sha S, Wang Y, Zhang L. Incidence Trends and Risk Prediction Nomogram for Suicidal Attempts in Patients With Major Depressive Disorder. Front Psychiatry 2021; 12:644038. [PMID: 34248696 PMCID: PMC8261285 DOI: 10.3389/fpsyt.2021.644038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 05/24/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Major depressive disorder (MDD) is often associated with suicidal attempt (SA). Therefore, predicting the risk factors of SA would improve clinical interventions, research, and treatment for MDD patients. This study aimed to create a nomogram model which predicted correlates of SA in patients with MDD within the Chinese population. Method: A cross-sectional survey among 474 patients was analyzed. All subjects met the diagnostic criteria of MDD according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). Multi-factor logistic regression analysis was used to explore demographic information and clinical characteristics associated with SA. A nomogram was further used to predict the risk of SA. Bootstrap re-sampling was used to internally validate the final model. Integrated Discrimination Improvement (IDI) and Akaike Information Criteria (AIC) were used to evaluate the capability of discrimination and calibration, respectively. Decision Curve Analysis (DCA) and the Receiver Operating Characteristic (ROC) curve was also used to evaluate the accuracy of the prediction model. Result: Multivariable logistic regression analysis showed that being married (OR = 0.473, 95% CI: 0.240 and 0.930) and a higher level of education (OR = 0.603, 95% CI: 0.464 and 0.784) decreased the risk of the SA. The higher number of episodes of depression (OR = 1.854, 95% CI: 1.040 and 3.303) increased the risk of SA in the model. The C-index of the nomogram was 0.715, with the internal (bootstrap) validation sets was 0.703. The Hosmer-Lemeshow test yielded a P-value of 0.33, suggesting a good fit of the prediction nomogram in the validation set. Conclusion: Our findings indicate that the demographic information and clinical characteristics of SA can be used in a nomogram to predict the risk of SA in Chinese MDD patients.
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Affiliation(s)
- Sixiang Liang
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jinhe Zhang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Qian Zhao
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Amanda Wilson
- Department of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Juan Huang
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yuan Liu
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xiaoning Shi
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Sha Sha
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yuanyuan Wang
- Department of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Ling Zhang
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
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Ssegonja R, Sampaio F, Alaie I, Philipson A, Hagberg L, Murray K, Sarkadi A, Langenskiöld S, Jonsson U, Feldman I. Cost-effectiveness of an indicated preventive intervention for depression in adolescents: a model to support decision making. J Affect Disord 2020; 277:789-799. [PMID: 33065819 DOI: 10.1016/j.jad.2020.08.076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/07/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Adolescent depression has negative health and economic outcomes in the short- and long-term. Indicated preventive interventions, in particular group based cognitive behavioural therapy (GB-CBT), are effective in preventing depression in adolescents with subsyndromal depression. However, little is known about the cost-effectiveness of these interventions. METHODS A Markov cohort model was used to conduct cost-effectiveness analyses comparing a GB-CBT indicated preventive intervention for depression, to a no-intervention option in a Swedish setting. Taking a time horizon of 5- and 10 years, incremental differences in societal costs and health benefits expressed as differences in the proportion of cases of depression prevented, and as quality adjusted life years (QALYs) gained were estimated. Through univariate and probabilistic sensitivity analyses, the robustness of the results was explored. Costs, presented in 2018 USD, and effects were discounted at a yearly rate of 3%. RESULTS The base-case analysis showed that GB-CBT indicated preventive intervention incurred lower costs, prevented a larger proportion of cases of depression and generated higher QALYs compared to the no-intervention option for both time horizons. Offering the intervention was even a cost saving strategy and demonstrated a probability of being cost-effective of over 95%. In the sensitivity analyses, these results were robust to the modelling assumptions. LIMITATIONS The study considered a homogeneous cohort and assumed a constant annual decay rate of the relative treatment effect. CONCLUSIONS GB-CBT indicated preventive interventions for depression in adolescence can generate good value for money compared to leaving adolescents with subsyndromal depression untreated.
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Affiliation(s)
- Richard Ssegonja
- Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden.
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden
| | - Iman Alaie
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Anna Philipson
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Lars Hagberg
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Krahn Murray
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Canada
| | - Anna Sarkadi
- Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden; Murdoch Children's Research Institute, Melbourne, Australia
| | - Sophie Langenskiöld
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Ulf Jonsson
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden; Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Pediatric Neuropsychiatry Unit, Sweden; Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden
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Serra G, Koukopoulos A, De Chiara L, Koukopoulos A, Sani G, Tondo L, Girardi P, Reginaldi D, Baldessarini R. Early clinical predictors and correlates of long-term morbidity in bipolar disorder. Eur Psychiatry 2020; 43:35-43. [DOI: 10.1016/j.eurpsy.2017.02.480] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/31/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022] Open
Abstract
AbstractObjectives:Identifying factors predictive of long-term morbidity should improve clinical planning limiting disability and mortality associated with bipolar disorder (BD).Methods:We analyzed factors associated with total, depressive and mania-related long-term morbidity and their ratio D/M, as %-time ill between a first-lifetime major affective episode and last follow-up of 207 BD subjects. Bivariate comparisons were followed by multivariable linear regression modeling.Results:Total % of months ill during follow-up was greater in 96 BD-II (40.2%) than 111 BD-I subjects (28.4%; P = 0.001). Time in depression averaged 26.1% in BD-II and 14.3% in BD-I, whereas mania-related morbidity was similar in both, averaging 13.9%. Their ratio D/M was 3.7-fold greater in BD-II than BD-I (5.74 vs. 1.96; P < 0.0001). Predictive factors independently associated with total %-time ill were: [a] BD-II diagnosis, [b] longer prodrome from antecedents to first affective episode, and [c] any psychiatric comorbidity. Associated with %-time depressed were: [a] BD-II diagnosis, [b] any antecedent psychiatric syndrome, [c] psychiatric comorbidity, and [d] agitated/psychotic depressive first affective episode. Associated with %-time in mania-like illness were: [a] fewer years ill and [b] (hypo)manic first affective episode. The long-term D/M morbidity ratio was associated with: [a] anxious temperament, [b] depressive first episode, and [c] BD-II diagnosis.Conclusions:Long-term depressive greatly exceeded mania-like morbidity in BD patients. BD-II subjects spent 42% more time ill overall, with a 3.7-times greater D/M morbidity ratio, than BD-I. More time depressed was predicted by agitated/psychotic initial depressive episodes, psychiatric comorbidity, and BD-II diagnosis. Longer prodrome and any antecedent psychiatric syndrome were respectively associated with total and depressive morbidity.
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Baez LM, Heller AS. Impact of age at onset on the phenomenology of depression in treatment-seeking adults in the STAR*D trial. J Affect Disord 2020; 262:381-388. [PMID: 31740109 PMCID: PMC6917830 DOI: 10.1016/j.jad.2019.10.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/02/2019] [Accepted: 10/25/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND - Adolescence is characterized by biological, emotional, and behavioral changes. The onset of depression during this vulnerable time may confer specific risks. This study examined whether symptoms of depression were associated with age at onset (AAO), and whether AAO impacted depression symptom networks in adulthood. METHODS - Data were from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. 3,184 depressed participants were included in analyses. A series of multiple regressions examined whether pretreatment differences in depression item-level symptom severity varied by AAO. Participants were divided into four groups based on AAO; GLASSO networks of depressive symptoms were estimated in each group and tests of differences between networks were performed. RESULTS - Earlier AAO was associated with more severe symptom levels, with the exception of sleep-which increased with AAO, and loss of libido, psychomotor disturbance, and appetite-weight disturbance, which were invariant with AAO. In network analyses, the adolescent AAO symptom network significantly differed from the young adult and middle age AAO networks in structure and strength. In contrast, the child AAO network differed from the middle age AAO network in strength only. LIMITATIONS - Age at onset was recalled retrospectively and may be subject to bias. Future prospective studies should be conducted to address this limitation. CONCLUSIONS - Adolescence stands out as a time when onset of depression is associated with specific network characteristics. The unique severity of symptoms and network strength and structure caused by onset of depression during adolescence highlights the long-lasting impact of depression on the developing brain.
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Affiliation(s)
- Lara Michelle Baez
- Department of Psychology, University of Miami, PO Box 248185, Coral Gables, FL 33124-0751, United States.
| | - Aaron Shain Heller
- Department of Psychology, University of Miami, PO Box 248185, Coral Gables, FL 33124-0751, United States
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Serra G, Koukopoulos A, De Chiara L, Koukopoulos AE, Sani G, Tondo L, Girardi P, Reginaldi D, Baldessarini RJ. Early clinical predictors of long-term morbidity in major depressive disorder. Early Interv Psychiatry 2019; 13:999-1002. [PMID: 30511367 DOI: 10.1111/eip.12768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 06/04/2018] [Accepted: 11/04/2018] [Indexed: 11/29/2022]
Abstract
AIMS To identify early clinical factors predictive of later morbidity in major depressive disorder (MDD). METHODS We analysed factors associated with long-term depressive morbidity (%-time ill) between a first-lifetime major depressive episode and last follow-up of 116 adults diagnosed with DSM-IV major depressive disorder. Bivariate comparisons were followed by multivariable linear regression modelling. RESULTS Three factors were independently associated with an average of 25%-time-depressed over 17 years at risk: (a) agitated-mixed, or psychotic features in initial major depressive episodes, (b) anxiety syndromes prior to a first-lifetime major depressive episode, and (c) anxiety symptoms in childhood. CONCLUSION Early anxiety symptoms and syndromes and agitated-mixed or psychotic initial depressive episodes predicted more long-term depressive morbidity in MDD.
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Affiliation(s)
- Giulia Serra
- Child Psychiatry Unit, Dept. of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts.,Lucio Bini Mood Disorder Center, Rome, Italy
| | - Athanasios Koukopoulos
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts.,Lucio Bini Mood Disorder Center, Rome, Italy
| | - Lavinia De Chiara
- NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Alexia E Koukopoulos
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Lucio Bini Mood Disorder Center, Rome, Italy
| | - Gabriele Sani
- Lucio Bini Mood Disorder Center, Rome, Italy.,NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Leonardo Tondo
- Child Psychiatry Unit, Dept. of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts.,Lucio Bini Mood Disorder Center, Cagliari, Sardinia, Italy
| | - Paolo Girardi
- Lucio Bini Mood Disorder Center, Rome, Italy.,NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Daniela Reginaldi
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts.,Lucio Bini Mood Disorder Center, Rome, Italy
| | - Ross J Baldessarini
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts
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Dong M, Zeng LN, Lu L, Li XH, Ungvari GS, Ng CH, Chow IHI, Zhang L, Zhou Y, Xiang YT. Prevalence of suicide attempt in individuals with major depressive disorder: a meta-analysis of observational surveys. Psychol Med 2019; 49:1691-1704. [PMID: 30178722 DOI: 10.1017/s0033291718002301] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Suicide attempt (SA), which is one of the strongest predictors of completed suicide, is common in major depressive disorder (MDD) but its prevalence across epidemiological studies has been mixed. The aim of this comprehensive meta-analysis was to examine the pooled prevalence of SA in individuals with MDD. METHODS A systematic literature search was conducted in PubMed, Embase, PsycINFO, Web of Science and Cochrane Library from their commencement date until 27 December 2017. Original studies containing data on prevalence of SA in individuals with MDD were analyzed. RESULTS In all, 65 studies with a total of 27 340 individuals with MDD were included. Using the random effects model, the pooled lifetime prevalence of SA was 31% [95% confidence interval (CI) 27-34%], 1-year prevalence was 8% (95% CI 3-14%) and 1-month prevalence was 24% (95% CI 15-34%). Subgroup analyses revealed that the lifetime prevalence of SA was significantly associated with the patient setting, study region and income level, while the 1-month prevalence of SA was associated with only the patient setting. CONCLUSION This meta-analysis confirmed that SA was common in individuals with MDD across the world. Careful screening and appropriate interventions should be implemented for SA in the MDD population.
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Affiliation(s)
- Min Dong
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
| | - Liang-Nan Zeng
- Department of Neurosurgery,The Affiliated Hospital of Southwest Medical University,Luzhou,China
| | - Li Lu
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
| | - Xiao-Hong Li
- The National Clinical Research Center for Mental Disorders, China & Center of Depression, Beijing Institute for Brain Disorders & Mood Disorders Center, Beijing Anding Hospital, Capital Medical University,Beijing,China
| | - Gabor S Ungvari
- University of Notre Dame Australia/Marian Centre,Perth,Australia
| | - Chee H Ng
- Department of Psychiatry,University of Melbourne,Melbourne, Victoria,Australia
| | - Ines H I Chow
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
| | - Ling Zhang
- Department of Epidemiology and Health Statistics,School of Public Health, Capital Medical University & Beijing Municipal Key Laboratory of Clinical Epidemiology,Beijing,China
| | - Yuan Zhou
- CAS Key Laboratory of Behavioral Science & Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences,Beijing,China
| | - Yu-Tao Xiang
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
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Schat A, van Noorden MS, van Amelsvoort T, Giltay EJ, van der Wee NJA, Noom MJ, Vermeiren RRJM, Zitman FG. Age-related characteristics of outpatients with anxiety disorders: the Leiden routine outcome monitoring study. Int J Psychiatry Clin Pract 2017. [PMID: 28622045 DOI: 10.1080/13651501.2017.1324035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE It has been hypothesised that clinically important age-related differences between adults with anxiety disorders exist; this study aims to elucidate these differences. METHODS We analysed data from 1950 outpatients diagnosed with DSM-IV-TR anxiety disorders treated at a Dutch hospital or affiliated mental healthcare centres. Three age-groups (young- (18-25; n = 435), mid- (26-40; n = 788) and older adult (41-65; n = 727)) were compared with regard to social demographic characteristics, diagnostic characteristics, anxiety symptom profile, general psychiatric symptom profile and generic health status, in addition, linear analyses were carried out with age as a continuous variable. RESULTS Average age was 36.48 years (SD 11.71), 62.8% were female. Significant associations with age emerged for gender, employment, education level, living situation, observed depression, agoraphobia (AP), social phobia, aches and pains, inner tension, sleep, interpersonal sensitivity, observed hostility, physical functioning, role limitations due to physical problems, vitality and bodily pain in categorical and continuous analyses. Self reported hostility was only significant in group-wise comparisons; role limitations due to emotional problems were only significant in linear analyses (all at p < .001). CONCLUSIONS This study identified clinically relevant differences between younger and older adult outpatients with anxiety disorders. Clinicians should take these findings into account, as they may support treatment.
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Affiliation(s)
- Anke Schat
- a Department of Psychiatry , Leiden University Medical Center , Leiden , The Netherlands
| | - Martijn S van Noorden
- a Department of Psychiatry , Leiden University Medical Center , Leiden , The Netherlands
| | - Therese van Amelsvoort
- b Department of Psychiatry , Maastricht University Medical Center , Maastricht , The Netherlands
| | - Erik J Giltay
- a Department of Psychiatry , Leiden University Medical Center , Leiden , The Netherlands
| | - Nic J A van der Wee
- a Department of Psychiatry , Leiden University Medical Center , Leiden , The Netherlands
| | - Marc J Noom
- c Department of Psychiatry , Zaans Medical Center , Zaandam , The Netherlands.,d Department of Child and Adolescent Psychiatry , Mental Health Center GGZ Eindhoven , Eindhoven , The Netherlands.,e Department of Child Development and Education , University of Amsterdam , Amsterdam , The Netherlands
| | - Robert R J M Vermeiren
- f Department of Child and Adolescent Psychiatry , Curium-Leiden University Medical Center , Leiden , The Netherlands
| | - Frans G Zitman
- a Department of Psychiatry , Leiden University Medical Center , Leiden , The Netherlands
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Serra G, Koukopoulos A, De Chiara L, Napoletano F, Koukopoulos A, Sani G, Faedda GL, Girardi P, Reginaldi D, Baldessarini RJ. Child and Adolescent Clinical Features Preceding Adult Suicide Attempts. Arch Suicide Res 2017; 21:502-518. [PMID: 27673411 DOI: 10.1080/13811118.2016.1227004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The objective of this study was to identify the predictive value of juvenile factors for adult suicidal behavior. We reviewed clinical records to compare factors identified in childhood and adolescence between adult suicidal versus nonsuicidal major affective disorder subjects. Suicide attempts occurred in 23.1% of subjects. Age-at-first-symptom was 14.2 vs. 20.2 years among suicidal versus nonsuicidal subjects (p < 0.0001). More prevalent in suicidal versus non-suicidal subjects by multivariate analysis were: depressive symptoms, hyper-emotionality, younger-at-first-affective-episode, family suicide history, childhood mood-swings, and adolescence low self-esteem. Presence of one factor yielded a Bayesian sensitivity of 64%, specificity of 50%, and negative predictive power of 86%. Several juvenile factors were associated with adult suicidal behavior; their absence was strongly associated with a lack of adult suicidal behavior.
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Wang L, Feng Z, Yang G, Yang Y, Wang K, Dai Q, Zhao M, Hu C, Zhang R, Liu K, Guang Y, Xia F. Depressive symptoms among children and adolescents in western china: An epidemiological survey of prevalence and correlates. Psychiatry Res 2016; 246:267-274. [PMID: 27741479 DOI: 10.1016/j.psychres.2016.09.050] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/26/2016] [Indexed: 11/19/2022]
Abstract
The aim of this study is to determine the prevalence and correlates of depressive symptoms in a school-based sample of 7-17-year-old children and adolescents in west-central China. A large cross-sectional sample survey of 10657 children and adolescents was conducted in Chongqing, a municipality in west-central China. Data were collected from the Children's Depression Inventory (CDI), Adolescent Self-Rating Life Events Checklist (ASLEC) and social-demographic variables which were evaluated with a structured scale. The total prevalence of depression risk was 23.9%. The risk factors for depressive symptoms included age older than 12 years, grade lower than 10, having unmarried parents, being taken care of by people other than two parents (single parent, grandparent(s), other relatives, or others), and living in a low-income family. The pressures of health and adaptation, interpersonal relationship, and study were also strong predictors of depressive symptoms. The prevalence of depressive symptoms among children and adolescents in Chongqing of China is relatively high compared with most figures reported in other cities. There is an urgent need to develop efficacious interventions aimed at the prevention and early recognition of childhood and adolescent depression.
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Affiliation(s)
- Lifei Wang
- Department of Behavioral Medicine, School of psychology, Third Military Medical University, Chongqing 400038, China
| | - Zhengzhi Feng
- Department of Behavioral Medicine, School of psychology, Third Military Medical University, Chongqing 400038, China.
| | - Guoyu Yang
- Department of Developmental and Educational Psychology of Army man, School of psychology, Third Military Medical University, Chongqing 400038, China
| | - Yaling Yang
- Chongqing Foundation for Poverty Alleviation, Chongqing 400020, China
| | - Kaifa Wang
- Department of Mathematics, College of Basic Medical Science, Third Military Medical University, Chongqing 400038, China
| | - Qin Dai
- Department of Nursing Psychology, School of Nursing, Third Military Medical University, Chongqing 400038, China
| | - Mengxue Zhao
- Department of Developmental and Educational Psychology of Army man, School of psychology, Third Military Medical University, Chongqing 400038, China
| | - Chaobing Hu
- Key Applied Psychology Lab, School of Education, Chongqing Normal University, Chongqing 401331, China
| | - Rui Zhang
- Department of Behavioral Medicine, School of psychology, Third Military Medical University, Chongqing 400038, China
| | - Keyu Liu
- Department of Behavioral Medicine, School of psychology, Third Military Medical University, Chongqing 400038, China
| | - Yu Guang
- Department of Behavioral Medicine, School of psychology, Third Military Medical University, Chongqing 400038, China
| | - Fan Xia
- Department of Behavioral Medicine, School of psychology, Third Military Medical University, Chongqing 400038, China
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14
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Schat A, van Noorden MS, Noom MJ, Giltay EJ, van der Wee NJA, de Graaf R, Ten Have M, Vermeiren RRJMM, Zitman FG. A cluster analysis of early onset in common anxiety disorders. J Anxiety Disord 2016; 44:1-8. [PMID: 27665086 DOI: 10.1016/j.janxdis.2016.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 08/03/2016] [Accepted: 09/07/2016] [Indexed: 11/24/2022]
Abstract
Early onset is regarded as an important characteristic of anxiety disorders, associated with higher severity. However, previous findings diverge, as definitions of early onset vary and are often unsubstantiated. We objectively defined early onset in social phobia, panic disorder, agoraphobia, and generalised anxiety disorder, using cluster analysis with data gathered in the general population. Resulting cut-off ages for early onset were ≤22 (social phobia), ≤31 (panic disorder), ≤21 (agoraphobia), and ≤27 (generalised anxiety disorder). Comparison of psychiatric comorbidity and general wellbeing between subjects with early and late onset in the general population and an outpatient cohort, demonstrated that among outpatients anxiety comorbidity was more common in early onset agoraphobia, but also that anxiety- as well as mood comorbidity were more common in late onset social phobia. A major limitation was the retrospective assessment of onset. Our results encourage future studies into correlates of early onset of psychiatric disorders.
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Affiliation(s)
- A Schat
- Leiden University Medical Center, Department of Psychiatry, P.O. Box 7500, 2300 RC Leiden, The Netherlands.
| | - M S van Noorden
- Leiden University Medical Center, Department of Psychiatry, P.O. Box 7500, 2300 RC Leiden, The Netherlands
| | - M J Noom
- Zaans Medisch Centrum, Department of Psychiatry, Kon. Julianaplein 58, 1502 DV Zaandam, The Netherlands; Mental Health Center GGZ Eindhoven, dept. of child and adolescent psychiatry, Doctor Poletlaan 40, 5626 ND Eindhoven, The Netherlands
| | - E J Giltay
- Leiden University Medical Center, Department of Psychiatry, P.O. Box 7500, 2300 RC Leiden, The Netherlands
| | - N J A van der Wee
- Leiden University Medical Center, Department of Psychiatry, P.O. Box 7500, 2300 RC Leiden, The Netherlands
| | - R de Graaf
- Netherlands Institute of Mental Health and Addiction, P.O. Box 725, 3500 AS, Utrecht, The Netherlands
| | - M Ten Have
- Netherlands Institute of Mental Health and Addiction, P.O. Box 725, 3500 AS, Utrecht, The Netherlands
| | - R R J M M Vermeiren
- Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Center, Endegeesterstraatweg 27, 2342 AK Oegstgeest, The Netherlands
| | - F G Zitman
- Leiden University Medical Center, Department of Psychiatry, P.O. Box 7500, 2300 RC Leiden, The Netherlands
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15
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Major depressive disorder and subthreshold depression in prepubertal children from the Danish National Birth Cohort. Compr Psychiatry 2016; 70:65-76. [PMID: 27624424 DOI: 10.1016/j.comppsych.2016.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 11/21/2022] Open
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16
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Yang F, Zhao H, Wang Z, Tao D, Xiao X, Niu Q, Wang Q, Li Y, Guo L, Li J, Li K, Xia J, Wang L, Shang X, Sang W, Shao C, Gan Z, He K, Zhao X, Tian T, Xu D, Gu D, Weng X, Li H, Tian J, Yang L, Li Q, Yang Q, Wang H, Dang Y, Dai L, Cui Y, Ye D, Cao J, Guo L, Kang Z, Liu J, Chen B, Liu J, Zhang J, Yang D, Jiao B, Yu F, Geng F, Li L, Yang H, Dai H, Wang H, Liu C, Liu H, Peng L, Wang X, Wei S, Liu X, Li C, Liu Z, Zhang Q, Di D, Flint J, Shi S, Kendler KS. Age at onset of recurrent major depression in Han Chinese women - a replication study. J Affect Disord 2014; 157:72-9. [PMID: 24581831 DOI: 10.1016/j.jad.2014.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 01/08/2014] [Accepted: 01/09/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND The relationship between age at onset (AAO) and major depression (MD) has been studied in US, European and Chinese populations. However, larger sample studies are needed to replicate and extend earlier findings. METHODS We re-examined the relationship between AAO and the clinical features of recurrent MD in Han Chinese women by analyzing the phase I (N=1848), phase II (N=4169) and total combined data (N=6017) from the CONVERGE project. Linear, logistic, multiple linear and multinomial logistic regression models were used to determine the association of AAO with continuous, binary and categorical variables. RESULTS The effect size of the association between AAO and clinical features of MD was quite similar in the phase I and phase II samples. These results confirmed that MD patients with earlier AAO tended to suffer more severe, recurrent and chronic illness and cases of MD with earlier AAO showed increased neuroticism, greater family history and psychiatric comorbidity. In addition, we showed that earlier AAO of MD in Han Chinese women was associated with premenstrual symptoms, postnatal depression, a highly authoritarian or cold childhood parental rearing style and a reduced probability for having melancholia. LIMITATIONS Data were collected retrospectively through interview and recall bias may have affected the results. CONCLUSIONS MD with earlier AAO in Han Chinese women shows a distinct set of clinical features which are similar to those reported in Western populations.
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Affiliation(s)
- Fuzhong Yang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Hongsu Zhao
- Zhejiang Traditional Chinese Medical Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Zhoubing Wang
- No. 4 Hospital of Jiangsu University, Zhenjiang, Jiangsu, People's Republic of China
| | - Danhong Tao
- Xinhua Hospital of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Xue Xiao
- The First Hospital of China Medical University, Heping District, Shenyang, Liaoning, People's Republic of China
| | - Qihui Niu
- No. 1 Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Qian Wang
- Beijing Anding Hospital of Capital University of Medical Sciences, Beijing, People's Republic of China
| | - Yajuan Li
- Xian Mental Health Center, Xian, Shaanxi, People's Republic of China
| | - Liyang Guo
- No. 1 Hospital of Medical College of Xian Jiaotong University, Xian, Shaanxi, People's Republic of China
| | - Jianying Li
- No. 1 Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Kan Li
- Mental Hospital of Jiangxi Province, No. 43 Shangfang Road, Nanchang, Jiangxi, People's Republic of China
| | - Jing Xia
- ShengJing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Lina Wang
- Shandong Mental Health Center, Jinan, Shandong, People's Republic of China
| | - Xiaofang Shang
- Nanjing Brain Hospital, Nanjing, Jiangsu, People's Republic of China
| | - Wenhua Sang
- Hebei Mental Health Center, Baoding, Hebei, People's Republic of China
| | - Chunhong Shao
- Department of Psychiatry, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China
| | - Zhaoyu Gan
- No. 3 Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Kangmei He
- Shanghai Tongji University affiliated Tongji Hospital, Shanghai 200065, People's Republic of China
| | - Xiaochuan Zhao
- First Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Tian Tian
- Tianjin Anding Hospital, Hexi District, Tianjin, People's Republic of China
| | - Dan Xu
- Shenzhen Kang Ning Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Danhua Gu
- Weihai Mental Health Center, Weihai, Shandong, People's Republic of China
| | - Xiaoqin Weng
- Psychiatric Hospital of Henan Province, No.388 Middle Jianshe Road, Xinxiang, Henan, People's Republic of China
| | - Haimin Li
- Mental Health Center of West China Hospital of Sichuan University, No. 28 South Dianxin Street, Wuhou District, Chengdu, Sichuan, People's Republic of China
| | - Jing Tian
- No. 1 Hospital of Jinan University, Guangzhou, Guangdong, People's Republic of China
| | - Lijun Yang
- Jilin Brain Hospital, Siping, Jilin, People's Republic of China
| | - Qiang Li
- No. 1 Mental Health Center Affiliated Harbin Medical University, Harbin, Heilongjiang, People's Republic of China
| | - Qingzhen Yang
- Chongqing Mental Health Center, Chongqing, People's Republic of China
| | - Hui Wang
- No. 1 Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yamei Dang
- Guangzhou Brain Hospital (Guangzhou Psychiatric Hospital), No. 36 Mingxin Road, Fangcun Avenue, Liwan District, Guangzhou, Guangdong, People's Republic of China
| | - Lei Dai
- Dalian No.7 Hospital & Dalian Mental Health Center, Dalian, Liaoning, People's Republic of China
| | - Yanping Cui
- No. 3 Hospital of Heilongjiang Province, Beian, Heilongjiang, People's Republic of China
| | - Dong Ye
- Sichuan Mental Health Center, Mianyang, Sichuan, People's Republic of China
| | - Juling Cao
- No. 2 Hospital of Lanzhou University, No. 82, Cuiyingmen, Lanzhou, Gansu, People's Republic of China
| | - Li Guo
- The Fourth Military Medical University Affiliated Xijing Hospital, Xian, Shaanxi, People's Republic of China
| | - Zhen Kang
- Liaocheng No. 4 Hospital, Liaocheng, Shandong, People's Republic of China
| | - Jimeng Liu
- Ningbo Kang Ning Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Bin Chen
- Fuzhou Psychiatric Hospital, Cangshan District, Fuzhou, Fujian, People's Republic of China
| | - Jinhua Liu
- Suzhou Guangji Hospital, Suzhou, Jiangsu, People's Republic of China
| | - Jinling Zhang
- Mental Health Center of Shantou University, Shantou, Guangdong, People's Republic of China
| | - Donglin Yang
- Jining Psychiatric Hospital, Jining, Shandong, People's Republic of China
| | - Bin Jiao
- No. 2 Xiangya Hospital of Zhongnan University, Changsha, Hunan, People's Republic of China
| | - Fengyu Yu
- Harbin No. 1 Special Hospital, Harbin, Heilongjiang, People's Republic of China
| | - Feng Geng
- Anhui Mental Health Center, Hefei, Anhui, People's Republic of China
| | - Ling Li
- Changchun Mental Hospital, Changchun, Jilin, People's Republic of China
| | - Haiying Yang
- Huaian No. 3 Hospital, Huaian, Jiangsu, People's Republic of China
| | - Hong Dai
- Huzhou No. 3 Hospital, Huzhou, Zhejiang, People's Republic of China
| | - Hongli Wang
- Mudanjiang Psychiatric Hospital of Heilongjiang Province, Mudanjiang, Heilongjiang, People's Republic of China
| | - Caixing Liu
- Qingdao Mental Health Center, No. 299 Nanjing Road, Shibei District, Qingdao, Shandong, People's Republic of China
| | - Haijun Liu
- Tangshan No. 5 Hospital, Tangshan, Hebei, People's Republic of China
| | - Longyan Peng
- Daqing No. 3 Hospital of Heilongjiang Province, Daqing, Heilongjiang, People's Republic of China
| | - Xiaoping Wang
- Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Shaojun Wei
- Guangxi Longquanshan Hospital, Liuzhou, Guangxi, People's Republic of China
| | - Xiaojuan Liu
- Tianjin First Center Hospital, Tianjin, People's Republic of China
| | - Chang Li
- Wuhan Mental Health Center, Wuhan, Hubei, People's Republic of China
| | - Zhengrong Liu
- Anshan Psychiatric Rehabilitation Hospital, Anshan, Liaoning, People's Republic of China
| | - Qiwen Zhang
- Hainan Anning Hospital, Haikou, Hainan, People's Republic of China
| | - Dongchuan Di
- Mental Health Institute of Jining Medical College, Jining, Shandong, People's Republic of China
| | - Jonathan Flint
- Wellcome Trust Centre for Human Genetics, Oxford OX3 7BN, United Kingdom
| | - Shenxun Shi
- Department of Psychiatry, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China.
| | - Kenneth S Kendler
- Virginia Commonwealth University, Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Box 980126, Richmond, VA 232980126, USA.
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Schat A, van Noorden MS, Noom MJ, Giltay EJ, van der Wee NJA, Vermeiren RRJM, Zitman FG. Predictors of outcome in outpatients with anxiety disorders: the Leiden routine outcome monitoring study. J Psychiatr Res 2013; 47:1876-85. [PMID: 24074517 DOI: 10.1016/j.jpsychires.2013.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 09/04/2013] [Accepted: 09/09/2013] [Indexed: 12/01/2022]
Abstract
Little is known about the predictors of outcome in anxiety disorders in naturalistic outpatient settings. We analyzed 2-year follow-up data collected through Routine Outcome Monitoring (ROM) in a naturalistic sample of 917 outpatients in psychiatric specialty care in order to identify factors predicting outcome. We included patients with panic disorder with or without agoraphobia, agoraphobia without panic, social phobia, or generalized anxiety disorder. Main findings from Cox regression analyses demonstrated that several socio-demographic variables (having a non-Dutch ethnicity [HR = 0.71)], not having a daily occupation [HR = 0.76]) and clinical factors (having a diagnosis of agoraphobia [HR = 0.67], high affective lability [HR = 0.80] and behavior problems [HR = 0.84]) decreased chances of response (defined as 50% reduction of anxiety severity) over the period of two years. Living with family had a protective predictive value [HR = 1.41]. These results may imply that factors that could be thought to limit societal participation, are associated with elevated risk of poor outcome. A comprehensive ROM screening process at intake may aid clinicians in the identification of patients at risk of chronicity.
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Affiliation(s)
- A Schat
- Leiden University Medical Centre, Department of Psychiatry, P.O. Box 7500, 2300 RC Leiden, The Netherlands.
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18
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Developing a European research network to address unmet needs in anxiety disorders. Neurosci Biobehav Rev 2013; 37:2312-7. [DOI: 10.1016/j.neubiorev.2013.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 12/10/2012] [Accepted: 01/04/2013] [Indexed: 11/23/2022]
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Wesselhoeft R, Sørensen MJ, Heiervang ER, Bilenberg N. Subthreshold depression in children and adolescents - a systematic review. J Affect Disord 2013; 151:7-22. [PMID: 23856281 DOI: 10.1016/j.jad.2013.06.010] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 06/12/2013] [Accepted: 06/13/2013] [Indexed: 01/17/2023]
Abstract
BACKGROUND Depressive disorders are disabling conditions striking at all ages. In adults, subthreshold depression (SD) is viewed as being on a continuum with major depressive disorder (MDD). Whether this holds for children and adolescents, is still unclear. We performed the first systematic review of SD in subjects below 18 years, in order to explore if childhood SD and MDD share causal pathways, phenomenology and outcomes, supporting a dimensional view. METHODS A critical systematic review in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. A review protocol was developed a priori, and all reports were assessed by two reviewers. RESULTS The literature search generated 941 eligible references and 24 studies were included. Although diagnostic criteria for SD showed great variability, similarities for SD and MDD were striking. Both were common conditions with similar risk factor patterns. Clinical characteristics in both groups were depressed mood, suicidal ideation and high comorbidity. Outcomes were almost equally poor, with increased psychiatric morbidity and health service use. SD intervention studies showed promising results. LIMITATIONS Reports with data on SD not reported in keywords or abstract may have been missed by the search strategy. CONCLUSION A dimensional view of depressive disorders is also supported in children and adolescents, suggesting SD to be a precursor to MDD. Although SD is a somewhat milder condition than MDD, it has severe outcomes with psychopathology and impairment. There is a need of identifying cost-efficient and longlasting interventions in order to prevent development of early SD into MDD.
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Affiliation(s)
- Rikke Wesselhoeft
- Department of Child and Adolescent Mental Health Odense, Research Unit (University Function), Mental Health Services in the Region of Southern Denmark, University of Southern Denmark, Odense, Denmark.
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Sung SC, Wisniewski SR, Balasubramani GK, Zisook S, Kurian B, Warden D, Trivedi MH, Rush AJ. Does early-onset chronic or recurrent major depression impact outcomes with antidepressant medications? A CO-MED trial report. Psychol Med 2013; 43:945-960. [PMID: 23228340 DOI: 10.1017/s0033291712001742] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prior studies have suggested that major depressive disorder (MDD) with pre-adult onset represents a distinct subtype with greater symptom severity and higher rates of suicidal ideation. Whether these patients have poorer response to various types of antidepressant treatment than those with adult-onset MDD is unclear. Method A total of 665 psychiatric and primary care out-patients (aged 18-75 years) with non-psychotic chronic or recurrent MDD participated in a single-blind, randomized trial that compared the efficacy of escitalopram plus placebo, bupropion sustained-release plus escitalopram, or venlafaxine extended-release plus mirtazapine. We compared participants who self-reported MDD onset (before age 18) to those with a later onset (adult onset) with respect to baseline characteristics and treatment/outcome variables at 12 and 28 weeks. RESULTS Early-onset chronic/recurrent MDD was associated with a distinct set of sociodemographic (female, younger age) and clinical correlates (longer duration of illness, greater number of prior episodes, greater likelihood of atypical features, higher rates of suicidality and psychiatric co-morbidity, fewer medical problems, poorer quality of life, greater history of child abuse/neglect). However, results from unadjusted and adjusted analyses showed no significant differences in response, remission, tolerability of medications, quality of life, or retention at 12 or 28 weeks. CONCLUSIONS Although early-onset chronic/recurrent MDD is associated with a more severe clinical picture, it does not seem to be useful for predicting differential treatment response to antidepressant medication. Clinicians should remain alert to an increased risk of suicidality in this population.
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Affiliation(s)
- S C Sung
- Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, Singapore.
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Rohde P, Lewinsohn PM, Klein DN, Seeley JR, Gau JM. Key Characteristics of Major Depressive Disorder Occurring in Childhood, Adolescence, Emerging Adulthood, Adulthood. Clin Psychol Sci 2013; 1:10.1177/2167702612457599. [PMID: 24273703 PMCID: PMC3833676 DOI: 10.1177/2167702612457599] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper summarizes characteristics of major depressive disorder (MDD) in the Oregon Adolescent Depression Project, using data from 816 participants (56% female; 89% White). Contrasting four developmental periods (Childhood [5-12.9], Adolescence [13-17.9], Emerging Adulthood [18-23.9], Adulthood [24-30]), we examine MDD incidence/recurrence, gender, comorbidity, duration, and suicide attempts across periods. MDD first incidence was lower in Childhood compared to subsequent periods, and higher in Emerging Adulthood than Adulthood. Cumulative incidence was 51%. Recurrence was lower during Childhood than remaining periods, which were comparable. Female gender predicted first incident MDD in all four periods but was unassociated with recurrence. Comorbidity rates were comparable across periods. MDD duration was greater in Childhood than remaining periods. Suicide attempt rates were significantly higher during Adolescence than either Emerging Adulthood or Adulthood. Depression research should focus on MDD during Emerging Adulthood, adolescent suicidal behavior, the continuing role of gender into adulthood, and the ubiquity of MDD.
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Williams JMG, Barnhofer T, Crane C, Duggan DS, Shah D, Brennan K, Krusche A, Crane R, Eames C, Jones M, Radford S, Russell IT. Pre-adult onset and patterns of suicidality in patients with a history of recurrent depression. J Affect Disord 2012; 138:173-9. [PMID: 22310035 PMCID: PMC3315015 DOI: 10.1016/j.jad.2011.12.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 12/05/2011] [Accepted: 12/05/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND This report assesses the association between age of onset of major depression and later suicidality in a sample of 276 recurrently depressed patients recruited for the Oxford/Bangor Staying Well after Depression (SWAD) Trial, and interviewed when in remission. METHODS The study enrolled adult patients with a history of at least three episodes of non-psychotic major depressive disorder from primary care and psychiatric care practices and through community advertisements. At study entry, all participants estimated the age of their first onset of a major depressive episode and completed both self-report and interview-based assessments of past and current suicidal ideation and behavior. Participants were divided into pre-adult and adult onset groups using a cut-off age of 18. RESULTS Forty-eight percent of the sample reported a pre-adult age of onset. Pre-adult age of onset was significantly associated with suicidality, both from self-report and from interviewer assessment even when adjusting for differences in age, gender, employment status, length of the disorder and early adversity. LIMITATIONS Relevant variables were all assessed through retrospective reports. CONCLUSIONS Pre-adult age of onset is closely associated with risk for and severity of later suicidality, replicating, in a sample of patients assessed when in remission, findings from studies that assessed patients when currently depressed. The association of pre-adult age of onset with suicidality is not due to differences in sociodemographic variables, length of the disorder and early adversity.
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Affiliation(s)
- J Mark G Williams
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK.
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Exploring age of onset as a causal link between major depression and nonmedical use of prescription medications. Drug Alcohol Depend 2012; 120:99-104. [PMID: 21802221 PMCID: PMC3206988 DOI: 10.1016/j.drugalcdep.2011.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 06/07/2011] [Accepted: 07/03/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nonmedical use of prescription medications (NUPM) has been associated with major depression (MDD), but the specific processes by which they might interact and influence one another are understudied. This investigation attempted to clarify the relationship between MDD and NUPM by examining whether age of MDD onset influenced current and past NUPM and by examining whether age of NUPM onset influenced lifetime or past year MDD. METHODS These goals were met through use of data from the 2005 to 2007 National Survey on Drug Use and Health. Analyses utilized design-based logistic regression, and current age and order of MDD onset and NUPM initiation were examined in interactions with age of MDD or NUPM onset. RESULTS For each year MDD onset was delayed, odds of lifetime, past year, past 30-day NUPM and substance dependence from NUPM were decreased by 2.3%, 2.6%, 1.9% and 2.3%, respectively. Earlier NUPM onset increased odds of past year (3.8%) and lifetime MDD (4.3%) in young adults, and lifetime MDD (2.5%) in 26-34 age group. Current age also interacted with age of MDD onset, with effects on NUPM pronounced in the 65 and older cohort. Order of MDD/NUPM onset generally did not interact with age of MDD onset, but it did interact with age of NUPM onset; the effects of NUPM onset on past year MDD were only significant in those with NUPM first. CONCLUSIONS These results highlight the need for further investigations of the interactions between depression and NUPM, particularly to evaluate potential causal relationships.
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