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Scott AJ, Correa AB, Bisby MA, Dear BF. Depression and Anxiety Trajectories in Chronic Disease: A Systematic Review and Meta-Analysis. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:227-242. [PMID: 37607505 DOI: 10.1159/000533263] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION People living with chronic diseases are at an increased risk of anxiety and depression, which are associated with poorer medical and psychosocial outcomes. Many studies have examined the trajectories of depression and anxiety in people with specific diseases, including the predictors of these trajectories. This is valuable for understanding the process of adjustment to diseases and informing treatment planning. However, no review has yet synthesised this information across chronic diseases. METHODS Electronic databases were searched for studies reporting trajectories of depression or anxiety in chronic disease samples. Data extracted included sample characteristics, results from trajectory analyses, and predictors of trajectories. Meta-analysis of the overall pooled prevalence of depression and anxiety trajectories was conducted, and qualitative synthesis of disease severity predictors was undertaken. RESULTS Following search and screening, 67 studies were included (N = 61,201 participants). Most participants followed a stable nonclinical trajectory for depression (69.0% [95% CI: 65.6, 72.2]) and anxiety (73.4% [95% CI: 66.3, 79.5]). Smaller but meaningful subsamples followed a trajectory of depression and anxiety symptoms consistently in the clinical range (11.8% [95% CI: 9.2, 14.8] and 13.7% [95% CI: 9.3, 19.7], respectively). Several clinical and methodological moderators emerged, and qualitative synthesis suggested that few aspects of disease severity were associated with participants' trajectories. CONCLUSION Most people with chronic disease follow a trajectory of distress that is low and stable, suggesting that most people psychologically adjust to living with chronic disease. Evidence also suggests that the nature and severity of the disease are not meaningful predictors of psychological distress.
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Affiliation(s)
- Amelia J Scott
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Ashleigh B Correa
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Madelyne A Bisby
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Blake F Dear
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
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Criterion and construct validity of the Beck Depression Inventory (BDI-II) to measure depression in patients with cancer: The contribution of somatic items. Int J Clin Health Psychol 2023; 23:100350. [DOI: 10.1016/j.ijchp.2022.100350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/25/2022] [Indexed: 11/27/2022] Open
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The Four Horsemen of the Apocalypse: Cancer, Depression, Vitamin D Deficiency, and Obesity: An Observational Study. DISEASE MARKERS 2023; 2023:9652491. [PMID: 36703643 PMCID: PMC9873440 DOI: 10.1155/2023/9652491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/26/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023]
Abstract
Objective Studies aiming at illuminating the complex relationships between cancer, obesity, 25-hydroxy vitamin D (25-OHD) deficiency, and body fat percentage are ongoing. The objective of this study was to investigate the relationships between 25-OHD deficiency, visceral fat tissue, and the Beck Depression Inventory (BDI) in cancer patients. Methods This study was conducted from 2013 to 2022. Patients' demographic data, such as age, sex, and body mass index (BMI), and laboratory parameters, including prealbumin, albumin, calcium, phosphorus, parathyroid hormone, 25-OHD, magnesium, hemoglobin, fat percentage, and C-reactive protein, were recorded. The Beck Depression Inventory was used to determine depression levels. Results A total of 223 colon cancer patients aged 19-84 undergoing chemotherapy at our clinic were included in this prospective study. The male patients' mean BMI was 22.91 ± 3.74 kg/m2, whereas that of the female patients was 26.17 ± 3.75 kg/m2. The difference was statistically significant (p < 0.001). The mean total Beck Depression Inventory score was 13 ± 9. In this patient population, 105 (47.09%) patients had minimal depression, 69 (30.94%) had mild depression, 35 (15.70%) had moderate depression, and 14 (6.28%) had severe depression. The Beck Depression Inventory score was negatively and strongly associated with BMI and moderately and negatively associated with albumin levels. Conclusion This study reveals a significant correlation between 25-OHD levels and the Beck Depression Inventory scores among cancer patients. We believe that 25-OHD levels may be used to determine the presence of depressive symptoms in cancer patients. However, further comprehensive multicentre studies are needed to draw more definitive conclusions.
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Fraile-Martinez O, Alvarez-Mon MA, Garcia-Montero C, Pekarek L, Guijarro LG, Lahera G, Saez MA, Monserrat J, Motogo D, Quintero J, Alvarez-Mon M, Ortega MA. Understanding the basis of major depressive disorder in oncological patients: Biological links, clinical management, challenges, and lifestyle medicine. Front Oncol 2022; 12:956923. [PMID: 36185233 PMCID: PMC9524231 DOI: 10.3389/fonc.2022.956923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/23/2022] [Indexed: 12/03/2022] Open
Abstract
In recent years, the incidence of different types of cancer and patient survival have been rising, as well as their prevalence. The increase in survival in recent years exposes the patients to a set of stressful factors such as more rigorous follow-up and more aggressive therapeutic regimens that, added to the diagnosis of the disease itself, cause an increase in the incidence of depressive disorders. These alterations have important consequences for the patients, reducing their average survival and quality of life, and for these reasons, special emphasis has been placed on developing numerous screening tests and early recognition of depressive symptoms. Despite that cancer and major depressive disorder are complex and heterogeneous entities, they also share many critical pathophysiological mechanisms, aiding to explain this complex relationship from a biological perspective. Moreover, a growing body of evidence is supporting the relevant role of lifestyle habits in the prevention and management of both depression and cancer. Therefore, the present study aims to perform a thorough review of the intricate relationship between depression and cancer, with a special focus on its biological links, clinical management, challenges, and the central role of lifestyle medicine as adjunctive and preventive approaches to improve the quality of life of these patients.
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Affiliation(s)
- Oscar Fraile-Martinez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Miguel A. Alvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
- *Correspondence: Miguel A. Alvarez-Mon, ;
| | - Cielo Garcia-Montero
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Leonel Pekarek
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Oncology Service, Guadalajara University Hospital, Guadalajara, Spain
| | - Luis G. Guijarro
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Unit of Biochemistry and Molecular Biology, Department of System Biology, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas (CIBEREHD), University of Alcalá, Alcala de Henares, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Psychiatry Service, Center for Biomedical Research in the Mental Health Network, University Hospital Príncipe de Asturias Centro de Investigación Biomédica en Red en el Área temática de Salud Mental (CIBERSAM), Alcalá de Henares, Spain
| | - Miguel A. Saez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Pathological Anatomy Service, Central University Hospital of Defence-UAH Madrid, Alcala de Henares, Spain
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Domitila Motogo
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
| | - Javier Quintero
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
- Department of Legal Medicine and Psychiatry, Complutense University, Madrid, Spain
| | - Melchor Alvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Immune System Diseases-Rheumatology, Oncology Service an Internal Medicine, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas (CIBEREHD), University Hospital Príncipe de Asturias, Alcala de Henares, Spain
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Cancer Registry and Pathology Department, Principe de Asturias University Hospital, Alcala de Henares, Spain
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Beresford T, Teschke PU, Hipp D, Ronan PJ. Psychological Adaptive Mechanism Maturity, Age, and Depression Symptoms in Advanced-Stage Cancer Patients. Front Psychol 2021; 12:718476. [PMID: 34764906 PMCID: PMC8575870 DOI: 10.3389/fpsyg.2021.718476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/21/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Previously, we reported that the maturity of Psychological Adaptive Mechanism (PAM; alternatively, ego defense mechanism) endorsement, but not depression symptom severity, predicted 5-year survival rates in adult cancer patients and that study controlled for age as a significant variable. In this investigation, we hypothesized that greater PAM maturity would correlate significantly with age and with fewer depression symptoms in a larger sample. Methods: In this cross-section study, adult cancer outpatients (N=293) completed the Defense Style Questionnaire (DSQ), the Beck Depression Inventory (BDI), and provided additional clinical data. Spearman’s correlation and multiple regression modeling provided statistical tests of the study hypotheses. Results: Contrary to our hypothesis, DSQ PAM maturity endorsement did not correlate significantly with increasing age. Greater PAM maturity ratio on the DSQ (p<0.0001) and current antidepressant use (p<0.05), however, both provided inverse associations with total BDI symptom frequency (p<0.01). Age was inversely associated with BDI mood (p<0.0001) and somatic scores (p<0.04). Items that worsened BDI symptom frequency included self-reported mood-altering anti-cancer medications and any psychiatric history. Cancer stage, time since diagnosis, and chemotherapy treatment did not correlate with DSQ or BDI scores. Multiple regression analysis found that the correlated items accounted for 17.2% of the variance in mood symptoms and 4.9% in somatic symptoms. Specifically, adaptive maturity and age associated with fewer depression symptoms, while cancer medications affecting mood, and a previous psychiatric history each predicted higher frequency of depression scores. Conclusion: The results suggest that PAM maturity likely predicts fewer depression symptoms while younger age associates with more depression symptoms in this clinical sample. Centrally, acting cancer medications, such as glucocorticoids, and any history of psychiatric disorder correlated with increased depression symptom frequencies. In this cross-section study, antidepressant medications indicated higher frequencies of depressive symptoms, likely reflecting their use in persons previously diagnosed with depression. Further research should target factors that improve PAM maturity as a potential treatment target, especially in younger age groups.
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Affiliation(s)
- Thomas Beresford
- School of Medicine, University of Colorado, Aurora, CO, United States.,Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Health Care System, Aurora, CO, United States
| | | | - Daniel Hipp
- Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Health Care System, Aurora, CO, United States
| | - Patrick J Ronan
- Sanford School of Medicine, University of South Dakota, Vermillion, SD, United States.,VA Medical Center-Sioux Falls, Sioux Falls, SD, United States
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John F, Michelhaugh SK, Barger GR, Mittal S, Juhász C. Depression and tryptophan metabolism in patients with primary brain tumors: Clinical and molecular imaging correlates. Brain Imaging Behav 2021; 15:974-985. [PMID: 32767048 DOI: 10.1007/s11682-020-00305-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Patients with brain tumors have an increased risk for depression, whose underlying pathomechanism may involve dysregulated tryptophan/kynurenine metabolism. In this study, we analyzed the relation of depressive symptoms to clinical and tumor characteristics as well as cerebral and systemic tryptophan metabolism in patients with primary brain tumors. Sixty patients with newly-diagnosed or recurrent primary brain tumor underwent testing with the Beck Depression Inventory-II (BDI-II), and 34 patients also had positron emission tomography (PET) imaging with alpha-[11C]methyl-L-tryptophan (AMT). BDI-II scores were correlated with clinical and tumor-related variables, cerebral regional AMT metabolism measured in the non-tumoral hemisphere, and plasma tryptophan metabolite levels. Sixteen patients (27%) had BDI-II scores indicating depression, including 6 with moderate/severe depression. High BDI-II scores were independent of clinical and tumor-related variables except lower Karnofsky Performance Status scores. In patients with recurrent malignant gliomas, depression was associated with shorter survival (hazard ratio: 3.7; p = 0.048). High BDI-II total and somatic subscale scores were associated with higher frontal cortical and thalamic AMT metabolic values measured on PET. In contrast, plasma tryptophan and kynurenine metabolite levels did not correlate with the BDI-II scores. In conclusion, our results confirm previous data that depression affects more than ¼ of patients with primary brain tumors, it is largely independent of tumor characteristics and is associated with shorter survival in patients with recurrent malignant gliomas. On PET imaging, higher tryptophan metabolism in the frontal cortex and thalamus was found in those with brain tumor-associated depression and supports the role of dysregulated tryptophan/kynurenine metabolism in this condition.
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Affiliation(s)
- Flóra John
- Department of Pediatrics, Wayne State University and PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien St, MI, Detroit, 48201, USA
| | - Sharon K Michelhaugh
- Department of Neurosurgery, Wayne State University, 4201 St. Antoine St., Detroit, MI, 48201, USA
| | - Geoffrey R Barger
- Department of Neurology, Wayne State University, 4201 St. Antoine St, Detroit, MI, 48201, USA
- Karmanos Cancer Institute, 4100 John R. St, Detroit, MI, 48201, USA
| | - Sandeep Mittal
- Department of Neurosurgery, Wayne State University, 4201 St. Antoine St., Detroit, MI, 48201, USA
- Karmanos Cancer Institute, 4100 John R. St, Detroit, MI, 48201, USA
- Virginia Tech Carilion School of Medicine, Roanoke, VA, 24014, USA
- Virginia Tech School of Neuroscience, Blacksburg, VA, 24061, USA
| | - Csaba Juhász
- Department of Pediatrics, Wayne State University and PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien St, MI, Detroit, 48201, USA.
- Department of Neurosurgery, Wayne State University, 4201 St. Antoine St., Detroit, MI, 48201, USA.
- Department of Neurology, Wayne State University, 4201 St. Antoine St, Detroit, MI, 48201, USA.
- Karmanos Cancer Institute, 4100 John R. St, Detroit, MI, 48201, USA.
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Goyal NG, Maddocks KJ, Johnson AJ, Byrd JC, Westbrook TD, Andersen BL. Cancer-Specific Stress and Trajectories of Psychological and Physical Functioning in Patients With Relapsed/Refractory Chronic Lymphocytic Leukemia. Ann Behav Med 2019; 52:287-298. [PMID: 30084895 DOI: 10.1093/abm/kax004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Chronic lymphocytic leukemia is the most prevalent adult leukemia. The disease is incurable with a cycling of treatment and relapse common. Little is known about the psychological and physical functioning of patients with relapsed/refractory chronic lymphocytic leukemia. Cancer-specific stress is an important individual difference variable that predicts psychological and physical outcomes. Purpose To examine cancer-specific stress at treatment initiation as a predictor of psychological and physical functioning trajectories in patients with relapsed/refractory chronic lymphocytic leukemia during the first 5 months of treatment. Methods Patients with relapsed/refractory chronic lymphocytic leukemia (N = 152) enrolled in a phase II clinical trial completed self-report measures at treatment initiation (baseline), 1, 2, and 5 months of treatment. Cancer-specific stress at baseline was examined as a predictor of psychological (cognitive-affective depressive symptoms, negative mood, mental health quality of life) and physical functioning (fatigue interference, sleep problems, physical health quality of life), controlling for demographic and treatment variables. Results Using multilevel modeling, higher baseline cancer-specific stress was related to worse psychological (cognitive-affective depressive symptoms, negative mood, mental health quality of life) and physical functioning (fatigue interference, sleep problems) at baseline and more rapid improvements during the next 5 months. Despite these improvements, higher baseline cancer-specific stress remained associated with poorer 5-month psychological, though not physical, functioning. Conclusions Findings suggest cancer-specific stress at treatment initiation may be a risk factor for poorer psychological functioning during treatment for patients with relapsed/refractory chronic lymphocytic leukemia.
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Affiliation(s)
- Neha G Goyal
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC
| | - Kami J Maddocks
- Division of Hematology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH
| | - Amy J Johnson
- Division of Hematology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH
| | - John C Byrd
- Division of Hematology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH
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The interplay between inflammation, oxidative stress, DNA damage, DNA repair and mitochondrial dysfunction in depression. Prog Neuropsychopharmacol Biol Psychiatry 2018; 80:309-321. [PMID: 28669580 DOI: 10.1016/j.pnpbp.2017.06.036] [Citation(s) in RCA: 188] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/05/2017] [Accepted: 06/29/2017] [Indexed: 12/13/2022]
Abstract
A growing body of evidence suggests that inflammation, mitochondrial dysfunction and oxidant-antioxidant imbalance may play a significant role in the development and progression of depression. Elevated levels of reactive oxygen and nitrogen species - a result of oxidant-antioxidant imbalance - may lead to increased damage of biomolecules, including DNA. This was confirmed in depressed patients in a research study conducted by our team and other scientists. 8-oxoguanine - a marker of oxidative DNA damage - was found in the patients' lymphocytes, urine and serum. These results were confirmed using a comet assay on lymphocytes. Furthermore, it was shown that the patients' cells repaired peroxide-induced DNA damage less efficiently than controls' cells and that some single nucleotide polymorphisms (SNP) of the genes involved in oxidative DNA damage repair may modulate the risk of depression. Lastly, less efficient DNA damage repair observed in the patients can be, at least partly, attributed to the presence of specific SNP variants, as it was revealed through a genotype-phenotype analysis. In conclusion, the available literature shows that both oxidative stress and less efficient DNA damage repair may lead to increased DNA damage in depressed patients. A similar mechanism may result in mitochondrial dysfunction, which is observed in depression.
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Bortolato B, Hyphantis TN, Valpione S, Perini G, Maes M, Morris G, Kubera M, Köhler CA, Fernandes BS, Stubbs B, Pavlidis N, Carvalho AF. Depression in cancer: The many biobehavioral pathways driving tumor progression. Cancer Treat Rev 2016; 52:58-70. [PMID: 27894012 DOI: 10.1016/j.ctrv.2016.11.004] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 10/15/2016] [Accepted: 11/05/2016] [Indexed: 12/11/2022]
Abstract
Major Depressive Disorder (MDD) is common among cancer patients, with prevalence rates up to four-times higher than the general population. Depression confers worse outcomes, including non-adherence to treatment and increased mortality in the oncology setting. Advances in the understanding of neurobiological underpinnings of depression have revealed shared biobehavioral mechanisms may contribute to cancer progression. Moreover, psychosocial stressors in cancer promote: (1) inflammation and oxidative/nitrosative stress; (2) a decreased immunosurveillance; and (3) a dysfunctional activation of the autonomic nervous system and of the hypothalamic-pituitaryadrenal axis. Consequently, the prompt recognition of depression among patients with cancer who may benefit of treatment strategies targeting depressive symptoms, cognitive dysfunction, fatigue and sleep disturbances, is a public health priority. Moreover, behavioral strategies aiming at reducing psychological distress and depressive symptoms, including addressing unhealthy diet and life-style choices, as well as physical inactivity and sleep dysfunction, may represent important strategies not only to treat depression, but also to improve wider cancer-related outcomes. Herein, we provide a comprehensive review of the intertwined biobehavioral pathways linking depression to cancer progression. In addition, the clinical implications of these findings are critically reviewed.
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Affiliation(s)
| | - Thomas N Hyphantis
- Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Sara Valpione
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Medical Oncology, The Christie NHS Trust, Manchester, United Kingdom
| | - Giulia Perini
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Michael Maes
- IMPACT Strategic Research Centre, Deakin University, School of Medicine and Barwon Health, Geelong, VIC, Australia; Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Psychiatry, Faculty of Medicine, State University of Londrina, Londrina, Brazil; Department of Psychiatry, Medical University Plovdiv, Plovdiv, Bulgaria; Revitalis, Waalre, The Netherlands
| | - Gerwyn Morris
- Tir Na Nog, Bryn Road Seaside 87, Llanelli SA152LW, Wales, UK
| | - Marta Kubera
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Science, Krakow, Poland
| | - Cristiano A Köhler
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Fortaleza, CE, Brazil
| | - Brisa S Fernandes
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, and Barwon Health, Geelong, Australia; Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom; Faculty of Health, Social Care and Education, Anglia Ruskin University, Bishop Hall Lane, Chelmsford CM1 1SQ, United Kingdom
| | - Nicholas Pavlidis
- Department of Medical Oncology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina 45110, Greece
| | - André F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Fortaleza, CE, Brazil.
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Abstract
Commonly used medications can have neuropsychiatric and behavioral effects that may be idiosyncratic or metabolic in nature, or a function of interactions with other drugs, toxicity, or withdrawal. This article explores an approach to the patient with central nervous system toxicity, depending on presentation of sedation versus agitation and accompanying physical signs and symptoms. The effects of antihypertensives, opioids, antibiotics, antiepileptic agents, steroids, Parkinson's disease medications, antipsychotics, medications for human immunodeficiency virus infection, cancer chemotherapeutics, and immunotherapies are discussed. A look at the prevalence of adverse reactions to medications and the errors underlying such occurrences is included.
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Affiliation(s)
- Sai Krishna J Munjampalli
- Department of Neurology, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
| | - Debra E Davis
- Department of Neurology, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.
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Abstract
BACKGROUND Up to 37% of colorectal cancer (CRC) survivors report depressive and anxiety symptoms. The identification of risk factors for depressive or anxiety symptoms might help focus supportive care resources on those patients most in need. The present study aims to explore which factors are associated with heightened anxiety or depression symptom severity. METHODS In this cross-sectional study, individuals diagnosed with CRC 3.5 to 6 years ago completed questionnaires on sociodemographic information, medical comorbidities, anxiety symptoms (Beck Anxiety Inventory), and depressive symptoms (Inventory of Depressive Symptomatology). The general linear model analysis of covariance was used to identify factors associated with heightened anxiety or depressive symptom severity. RESULTS The sample included 91 CRC survivors, 40.7% women, mean age 69.1 years. A minority of CRC survivors had moderate (3.4%) or severe (2.3%) anxiety symptoms, and moderate (7.7%) or severe (0%) depressive symptoms. Shorter time since diagnosis and higher number of comorbid diseases were associated with higher anxiety symptom severity. Female sex and higher number of comorbid diseases were associated with higher depressive symptom severity. CONCLUSION From this explorative study, it follows that survivors with multiple comorbid diseases, shorter time since diagnosis, and female survivors might be at risk for higher anxiety and/or depressive symptom severity. Survivors with these characteristics might need extra monitoring.
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Bosnyák E, Kamson DO, Behen ME, Barger GR, Mittal S, Juhász C. Imaging cerebral tryptophan metabolism in brain tumor-associated depression. EJNMMI Res 2015; 5:56. [PMID: 26475140 PMCID: PMC4608955 DOI: 10.1186/s13550-015-0136-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 10/09/2015] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Depression in patients with brain tumors is associated with impaired quality of life and shorter survival. Altered metabolism of tryptophan to serotonin and kynurenine metabolites may play a role in tumor-associated depression. Our recent studies with alpha[(11)C]methyl-L-tryptophan (AMT)-PET in brain tumor patients indicated abnormal tryptophan metabolism not only in the tumor mass but also in normal-appearing contralateral brain. In the present study, we explored if tryptophan metabolism in such brain regions is associated with depression. METHODS Twenty-one patients (mean age: 57 years) with a brain tumor (10 meningiomas, 8 gliomas, and 3 brain metastases) underwent AMT-PET scanning. MRI and AMT-PET images were co-registered, and AMT kinetic parameters, including volume of distribution (VD', an estimate of net tryptophan transport) and K (unidirectional uptake, related to tryptophan metabolism), were measured in the tumor mass and in unaffected cortical and subcortical regions contralateral to the tumor. Depression scores (based on the Beck Depression Inventory-II [BDI-II]) were correlated with tumor size, grade, type, and AMT-PET variables. RESULTS The mean BDI-II score was 12 ± 10 (range: 2-33); clinical levels of depression were identified in seven patients (33 %). High BDI-II scores were most strongly associated with high thalamic AMT K values both in the whole group (Spearman's rho = 0.63, p = 0.004) and in the subgroup of 18 primary brain tumors (r = 0.68, p = 0.004). Frontal and striatal VD' values were higher in the depressed subgroup than in non-depressed patients (p < 0.05); the group difference was even more robust when moderately/severely depressed patients were compared to patients with no/mild depression (frontal: p = 0.005; striatal: p < 0.001). Tumor size, grade, and tumor type were not related to depression scores. CONCLUSIONS Abnormalities of tryptophan transport and metabolism in the thalamus, striatum, and frontal cortex, measured by PET, are associated with depression in patients with brain tumor. These changes may indicate an imbalance between the serotonin and kynurenine pathways and serve as a molecular imaging marker of brain tumor-associated depression. TRIAL REGISTRATION ClinicalTrials.gov NCT02367469.
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Affiliation(s)
- Edit Bosnyák
- Department of Pediatrics, Wayne State University, 3901 Beaubien Street, Detroit, MI, 48201, USA.
- PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien Street, Detroit, MI, 48201, USA.
| | - David O Kamson
- Department of Pediatrics, Wayne State University, 3901 Beaubien Street, Detroit, MI, 48201, USA.
- PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien Street, Detroit, MI, 48201, USA.
| | - Michael E Behen
- Department of Pediatrics, Wayne State University, 3901 Beaubien Street, Detroit, MI, 48201, USA.
- PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien Street, Detroit, MI, 48201, USA.
| | - Geoffrey R Barger
- Department of Neurology, Wayne State University, 4201 St. Antoine, Detroit, MI, 48201, USA.
- Karmanos Cancer Institute, Detroit, MI, USA.
| | - Sandeep Mittal
- Department of Neurosurgery, Wayne State University, 4160 John R., Suite 930, Detroit, MI, 48201, USA.
- Department of Oncology, Wayne State University, Detroit, MI, USA.
- Karmanos Cancer Institute, Detroit, MI, USA.
| | - Csaba Juhász
- Department of Pediatrics, Wayne State University, 3901 Beaubien Street, Detroit, MI, 48201, USA.
- Department of Neurology, Wayne State University, 4201 St. Antoine, Detroit, MI, 48201, USA.
- PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien Street, Detroit, MI, 48201, USA.
- Karmanos Cancer Institute, Detroit, MI, USA.
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Schrepf A, Lutgendorf SK, Pyter LM. Pre-treatment effects of peripheral tumors on brain and behavior: neuroinflammatory mechanisms in humans and rodents. Brain Behav Immun 2015; 49:1-17. [PMID: 25958011 PMCID: PMC4567396 DOI: 10.1016/j.bbi.2015.04.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/14/2015] [Accepted: 04/17/2015] [Indexed: 12/12/2022] Open
Abstract
Cancer patients suffer high levels of affective and cognitive disturbances, which have been attributed to diagnosis-related distress, impairment of quality of life, and side effects of primary treatment. An inflammatory microenvironment is also a feature of the vast majority of solid tumors. However, the ability of tumor-associated biological processes to affect the central nervous system (CNS) has only recently been explored in the context of symptoms of depression and cognitive disturbances. In this review, we summarize the burgeoning evidence from rodent cancer models that solid tumors alter neurobiological pathways and subsequent behavioral processes with relevance to affective and cognitive disturbances reported in human cancer populations. We consider, in parallel, the evidence from human clinical cancer research demonstrating that affective and cognitive disturbances are common in some malignancies prior to diagnosis and treatment. We further consider the underlying neurobiological pathways, including altered neuroinflammation, tryptophan metabolism, prostaglandin synthesis and associated neuroanatomical changes, that are most strongly implicated in the rodent literature and supported by analogous evidence from human cancer populations. We focus on the implications of these findings for behavioral researchers and clinicians, with particular emphasis on methodological issues and areas of future research.
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Affiliation(s)
- Andrew Schrepf
- Department of Psychology, University of Iowa, Iowa City, IA 52242, USA
| | - Susan K Lutgendorf
- Department of Psychology, University of Iowa, Iowa City, IA 52242, USA; Departments of Urology and Obstetrics and Gynecology, University of Iowa, Iowa City, IA 52242, USA
| | - Leah M Pyter
- Institute for Behavioral Medicine Research, Departments of Psychiatry and Behavioral Health and Neuroscience, Ohio State University, Columbus, OH 43210, USA.
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14
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Affiliation(s)
- S Dauchy
- Gustave Roussy, Villejuif, France
| | | | - M Reich
- Centre Oscar Lambret, Lille, France
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15
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Vichaya EG, Chiu GS, Krukowski K, Lacourt TE, Kavelaars A, Dantzer R, Heijnen CJ, Walker AK. Mechanisms of chemotherapy-induced behavioral toxicities. Front Neurosci 2015; 9:131. [PMID: 25954147 PMCID: PMC4404721 DOI: 10.3389/fnins.2015.00131] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/01/2015] [Indexed: 11/13/2022] Open
Abstract
While chemotherapeutic agents have yielded relative success in the treatment of cancer, patients are often plagued with unwanted and even debilitating side-effects from the treatment which can lead to dose reduction or even cessation of treatment. Common side effects (symptoms) of chemotherapy include (i) cognitive deficiencies such as problems with attention, memory and executive functioning; (ii) fatigue and motivational deficit; and (iii) neuropathy. These symptoms often develop during treatment but can remain even after cessation of chemotherapy, severely impacting long-term quality of life. Little is known about the underlying mechanisms responsible for the development of these behavioral toxicities, however, neuroinflammation is widely considered to be one of the major mechanisms responsible for chemotherapy-induced symptoms. Here, we critically assess what is known in regards to the role of neuroinflammation in chemotherapy-induced symptoms. We also argue that, based on the available evidence, neuroinflammation is unlikely the only mechanism involved in the pathogenesis of chemotherapy-induced behavioral toxicities. We evaluate two other putative candidate mechanisms. To this end we discuss the mediating role of damage-associated molecular patterns (DAMPs) activated in response to chemotherapy-induced cellular damage. We also review the literature with respect to possible alternative mechanisms such as a chemotherapy-induced change in the bioenergetic status of the tissue involving changes in mitochondrial function in relation to chemotherapy-induced behavioral toxicities. Understanding the mechanisms that underlie the emergence of fatigue, neuropathy, and cognitive difficulties is vital to better treatment and long-term survival of cancer patients.
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Affiliation(s)
- Elisabeth G Vichaya
- Laboratory of Neuroimmunology, Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center Houston, TX, USA
| | - Gabriel S Chiu
- Laboratory of Neuroimmunology, Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center Houston, TX, USA
| | - Karen Krukowski
- Laboratory of Neuroimmunology, Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center Houston, TX, USA
| | - Tamara E Lacourt
- Laboratory of Neuroimmunology, Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center Houston, TX, USA
| | - Annemieke Kavelaars
- Laboratory of Neuroimmunology, Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center Houston, TX, USA
| | - Robert Dantzer
- Laboratory of Neuroimmunology, Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center Houston, TX, USA
| | - Cobi J Heijnen
- Laboratory of Neuroimmunology, Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center Houston, TX, USA
| | - Adam K Walker
- Laboratory of Neuroimmunology, Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center Houston, TX, USA
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16
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Naeim A, Aapro M, Subbarao R, Balducci L. Supportive care considerations for older adults with cancer. J Clin Oncol 2014; 32:2627-34. [PMID: 25071112 DOI: 10.1200/jco.2014.55.3065] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The treatment of cancer presents specific concerns that are unique to the growing demographic of elderly patients. Because the incidence of cancer is strongly correlated with aging, the expansion of supportive care and other age-appropriate therapies will be of great importance as the population of elderly patients with cancer increases in the coming years. Elderly patients are especially likely to experience febrile neutropenia, complications from chemotherapy-induced nausea, anemia, osteoporosis (especially in patients diagnosed with breast or prostate cancer), depression, insomnia, and fatigue. These issues are often complicated by other chronic conditions related to age, such as diabetes and cardiac disease. For many patients, symptoms may be addressed both through lifestyle management and pharmaceutical approaches. Therefore, the key to improving quality of life for the elderly patient with cancer is an awareness of their specific needs and a familiarity with emergent treatment options.
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Affiliation(s)
- Arash Naeim
- Arash Naeim, Rashmi Subbarao, University of California Los Angeles, Los Angeles CA; Lodovico Balducci, Moffitt Cancer Center, Tampa FL; Matti Aapro, The Multidisciplinary Oncology Institute of Clinique de Genolier, Genolier, Switzerland.
| | - Matti Aapro
- Arash Naeim, Rashmi Subbarao, University of California Los Angeles, Los Angeles CA; Lodovico Balducci, Moffitt Cancer Center, Tampa FL; Matti Aapro, The Multidisciplinary Oncology Institute of Clinique de Genolier, Genolier, Switzerland
| | - Rashmi Subbarao
- Arash Naeim, Rashmi Subbarao, University of California Los Angeles, Los Angeles CA; Lodovico Balducci, Moffitt Cancer Center, Tampa FL; Matti Aapro, The Multidisciplinary Oncology Institute of Clinique de Genolier, Genolier, Switzerland
| | - Lodovico Balducci
- Arash Naeim, Rashmi Subbarao, University of California Los Angeles, Los Angeles CA; Lodovico Balducci, Moffitt Cancer Center, Tampa FL; Matti Aapro, The Multidisciplinary Oncology Institute of Clinique de Genolier, Genolier, Switzerland
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17
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Hummler S, Thomas M, Hoffmann B, Gärtner P, Zoz M, Huber G, Ulrich CM, Wiskemann J. Physical performance and psychosocial status in lung cancer patients: results from a pilot study. Oncol Res Treat 2014; 37:36-41. [PMID: 24613907 DOI: 10.1159/000358157] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 11/12/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to assess the physical performance and psychosocial status of lung cancer patients. PATIENTS AND METHODS Patients with predominantly advanced-stage non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) were recruited. Muscle strength was assessed via hand-held dynamometry (HHD) and endurance capacity via the 6-minute walk test (6MWT), and results were compared to healthy reference values. Psychosocial status, lung cancer-specific symptoms, and quality of life (QoL) outcomes were evaluated. RESULTS 39 patients (NSCLC n = 22, SCLC n = 17) with predominantly advanced-stage disease and a median age of 62 years (range 44-83 years) were enrolled. Compared to a healthy reference population, mean muscle strength values of upper (elbow flexion -28.2% (±17.5), elbow extension -12.4% (±11.1)) and lower (knee extension -47.6% (±19.3), hip abduction -44.9% (±14.9), hip flexion -13% (±24.2)) extremities, and 6MWT were lower (male/female: 434/411 m vs. 597/514 m). Lung cancer-specific symptoms and QoL were comparable to published data. CONCLUSION Our results indicate that lung cancer patients experience muscular weakness, lower endurance performance, and decreased QoL compared to a healthy reference population. The feasibility and benefit of a structured exercise intervention in this specific population need to be evaluated, in particular its effect on psychosocial well-being.
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Affiliation(s)
- Simone Hummler
- Department of Oncology, Clinic for Thoracic Diseases, Heidelberg, Germany
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18
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Dauchy S, Dolbeault S, Reich M, Barruel F, Le Bihan AS, Machavoine JL. Repérage et traitement de la dépression en cancérologie. PSYCHO-ONCOLOGIE 2013. [DOI: 10.1007/s11839-013-0438-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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19
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Binaschi L, Castelli L, Varetto A, Leombruni P, Torta R. Perception and Expression of Emotional Suffering in Cancer Patients: The Role of Somatic Depressive Symptoms. EUROPE'S JOURNAL OF PSYCHOLOGY 2013. [DOI: 10.5964/ejop.v9i3.529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Pössel P, Adams E, Valentine JC. Depression as a risk factor for breast cancer: investigating methodological limitations in the literature. Cancer Causes Control 2012; 23:1223-9. [DOI: 10.1007/s10552-012-0014-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 06/06/2012] [Indexed: 11/24/2022]
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21
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Which symptoms are indicative of DSMIV depression in cancer settings? An analysis of the diagnostic significance of somatic and non-somatic symptoms. J Affect Disord 2012; 138:137-48. [PMID: 22310033 DOI: 10.1016/j.jad.2011.11.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 11/09/2011] [Accepted: 11/09/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND There have been few studies that have attempted to examine the phenomenology of comorbid depression, in particular the diagnostic value of individual somatic and non-somatic symptoms when attempting to diagnose depression following cancer. METHODS We approached 279 patients up to three times within 9 months of first presentation with a diagnosis of cancer, and collected data following a total of 558 contacts. 176 contacts (31%) were in a palliative stage. Symptoms were elicited by self-report PHQ9 and HADS-D scales. The prevalence of major depression was 12.7% but 29.6% had major or minor depression (any depressive disorder) according to modified DSMIV criteria. RESULTS All symptoms of depression were significant more common in depressed versus non-depressed cancer patients regardless of stage. Against broadly defined any depressive disorder (ADD) the most accurate diagnostic symptoms were all somatic (namely trouble falling or staying asleep or sleeping too much; feeling tired or having little energy; poor appetite or overeating; trouble concentrating on things such as reading). Indeed the optimal symptom insomnia had good case-finding properties and screening properties used alone. A two step combination of three questions give a sensitivity of 100% and specificity of 91.6% against ADD. Against major depressive disorder (MDD) both somatic and non-somatic symptoms were valuable (including but not limited to the PHQ2 stem questions). Only low energy was poorly discriminating which may suggest that the standard ICD10 criteria may not be optimal. When considering depression as defined by the HADS-D (≥ 11), then the three most influential symptoms were psychological closely followed by somatic symptoms. When looking for MDD and HADS-D depression, no single symptom was a good proxy for depression highlighting a possible shortcoming if clinicians attempt to rely on one single question. In a subset of palliative patients feeling bad about yourself and moving or speaking slowly were less influential and outperformed by poor appetite/overeating and feeling tired or having little energy. CONCLUSION This research suggests that most somatic symptoms remain influential when diagnosing depression in the context of cancer and hence should not be omitted indiscriminately, even in palliative stages. The optimal symptoms for diagnosing depression will depend on whether a narrow concept of depression or a broad concept of depression is considered clinically important.
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Abstract
OBJECTIVE Menopausal hot flashes have been associated with increased scores on measures of anxiety. Anxiety measures are typically composed of items measuring somatic and affective symptoms. Because hot flash symptoms are similar to symptoms of somatic anxiety, we wanted to examine the differential contribution of somatic anxiety and affective anxiety to hot flash scores. METHODS A total of 80 psychologically well-functioning postmenopausal women aged 50 to 64 years were administered the Zung Anxiety Index (ZAI), from which total score, somatic anxiety subscale score, and affective anxiety subscale score were calculated. The outcome measure was a hot flash score that incorporated both frequency and severity based on a 7-day diary. A linear regression analysis examined the association between hot flashes and the two anxiety subscales controlling for age, education, and sleep quality. RESULTS Higher score on somatic anxiety was significantly associated with higher hot flash score (P = 0.04), whereas the association with affective anxiety was not significant (P = 0.80). Higher total score on the ZAI was also significantly associated with higher hot flash score (P = 0.02). CONCLUSIONS These results suggest that the positive association between higher ZAI scores and hot flashes in recently postmenopausal women may be due to the overlap between the somatic manifestation of hot flashes and anxiety symptoms rather than to an affective anxiety disturbance. These results have potential implications for the care and treatment of postmenopausal women, but replication is required in other samples including women at different transition stages of menopause and women with psychiatric comorbidities.
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Olaya-Contreras P, Persson T, Styf J. Comparison between the Beck Depression Inventory and psychiatric evaluation of distress in patients on long-term sick leave due to chronic musculoskeletal pain. J Multidiscip Healthc 2010; 3:161-7. [PMID: 21197365 PMCID: PMC3004607 DOI: 10.2147/jmdh.s12550] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Indexed: 11/23/2022] Open
Abstract
Background: Chronic musculoskeletal pain (CMP) is associated with psychological distress and long-term disability. Underlying diagnoses causing long-term sickness absence due to CMP have not been explored enough. In a somatic health care setting, it is important to identify mental health comorbidity to facilitate the selection of appropriate treatment. The objectives of this study were to compare the scores of depressed mood obtained on the Beck Depression Inventory (BDI) with the diagnosis of depression made by a psychiatrist, and to study the prevalence of undiagnosed mental health comorbidity in these patients. Methods and patients: 83 consecutive patients on sick leave (mean duration 21 months) due to CMP who had been referred by the Social Insurance Office to an orthopedist and a psychiatrist for assessment of the patient’s diagnoses and capacity to work. The mean age was 45 (23–61) years, 58% were women and 52% were immigrants. The accuracy of measurements was calculated using the Diagnostic Statistical Manual of Mental Disorders IV as the Gold standard. Results: Psychiatric illness was diagnosed in 87% of the patients. The diagnosis was depression in 56%, other psychiatric illnesses in 31%, whereas 13% were mentally healthy. Of all the patients, only 10% had a previous psychiatric diagnosis. The median value of the BDI score was 26 points in depressed patients, whereas it was 23 in patients with other psychiatric diagnoses. The sensitivity of the BDI to detect depression was 87.5%. We found good agreement between the BDI score and a diagnosis of depression. Conclusion: Undiagnosed psychiatric disorders were commonly seen in patients with CMP. The high sensitivity of the BDI scores enables the screening of mental health comorbidity in patients with a somatic dysfunction. The test is a useful tool for detecting distress in patients who are on long-term sick leave due to CMP and who need additional treatment.
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Affiliation(s)
- Patricia Olaya-Contreras
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy at The University of Gothenburg, Sweden
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Forkmann T, Vehren T, Boecker M, Norra C, Wirtz M, Gauggel S. Sensitivity and specificity of the Beck Depression Inventory in cardiologic inpatients: how useful is the conventional cut-off score? J Psychosom Res 2009; 67:347-52. [PMID: 19773028 DOI: 10.1016/j.jpsychores.2009.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 04/06/2009] [Accepted: 04/07/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Beck Depression Inventory (BDI) is widely used for depression screening in various patient populations. However, there are still insufficient data about its sensitivity and specificity in nonpsychiatric patients. Furthermore, some research suggests that somatic BDI items heighten its sum score artificially in physically ill patients. The aim of the present study was to validate the conventional BDI cut-off score by examination of its sensitivity and specificity in a mixed sample of cardiac inpatients and compare it to a modified "cognitive-emotional" BDI (BDI(c/e)) after exclusion of somatic items. METHODS A total of 126 cardiologic inpatients were assessed. Receiver operating characteristic curves (ROC) were calculated for total BDI (BDI(t)) and BDI(c/e). Screening performance of cut-off scores was evaluated using the Youden Index (Y). RESULTS With the application of the conventional BDI cut-off score, ROC analysis revealed a moderate overall screening performance with Y=52.6 and an area under the curve (AUC) of 0.83. In contrast, Y improved to 57.5 at a cut-off score of >9, but screening performance was still not optimal. BDI(c/e) showed also a moderate screening performance (AUC=.82); Y was maximized at a cut-off score of >8 (Y=0.53.5). Again, no cut-off score provided optimal screening performance. CONCLUSION The BDI cannot be recommended as a formal screening instrument in cardiac inpatients since no cut-off score for either BDI(t) or BDI(c/e) combined both sufficiently high sensitivity and specificity. However, the shorter BDI(c/e) could be used as alternative to BDI(t) which may be confounded in physically ill patients. Generally, researchers should consider using alternative screening instruments (e.g., the Hospital Anxiety and Depression Scale) instead.
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Affiliation(s)
- Thomas Forkmann
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen, Aachen, Germany.
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25
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Linke SE, Rutledge T, Johnson BD, Vaccarino V, Bittner V, Cornell CE, Eteiba W, Sheps DS, Krantz DS, Parashar S, Bairey Merz CN. Depressive symptom dimensions and cardiovascular prognosis among women with suspected myocardial ischemia: A report from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation. ARCHIVES OF GENERAL PSYCHIATRY 2009; 66:499-507. [PMID: 19414709 PMCID: PMC2697960 DOI: 10.1001/archgenpsychiatry.2009.27] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CONTEXT Symptoms of depression and cardiovascular disease (CVD) overlap substantially. Differentiating between dimensions of depressive symptoms may improve our understanding of the relationship between depression and physical health. OBJECTIVE To compare symptom dimensions of depression as predictors of cardiovascular-related death and events among women with suspected myocardial ischemia. DESIGN Cohort study of women with suspected myocardial ischemia who underwent evaluation at baseline for a history of cardiovascular-related problems, depressive symptoms using the Beck Depression Inventory, and coronary artery disease severity via coronary angiography. Principal components analyses (PCAs) of the Beck Depression Inventory items were conducted to examine differential cardiovascular prognosis according to symptom dimensions of depression. SETTING The Women's Ischemia Syndrome Evaluation (WISE), a multicenter study sponsored by the National Heart, Lung, and Blood Institute to assess cardiovascular function using state-of-the-art techniques in women referred for coronary angiography to evaluate chest pain or suspected myocardial ischemia. PARTICIPANTS Five hundred fifty women (mean [SD] age, 58.4 [11.2] years) enrolled in the WISE study and followed up for a median of 5.8 years. MAIN OUTCOME MEASURES Cardiovascular-related mortality and events (stroke, myocardial infarction, and congestive heart failure). RESULTS When a 3-factor structure from PCA was used, somatic/affective (hazards ratio, 1.35; 95% confidence interval, 1.04-1.74) and appetitive (1.42; 1.21-1.68) but not cognitive/affective (0.89; 0.70-1.14) symptoms predicted cardiovascular prognosis in adjusted multivariate Cox regression analysis. When a 2-factor structure from PCA was used, adjusted results indicated that somatic (hazards ratio, 1.63; 95% confidence interval, 1.28-2.08) but not cognitive/affective (0.87; 0.68-1.11) symptoms predicted worse prognosis. CONCLUSIONS In a sample of women with suspected myocardial ischemia, somatic but not cognitive/affective depressive symptoms were associated with an increased risk of cardiovascular-related mortality and events. These results support the need to research dimensions of depression in CVD populations and have implications for understanding the connection between depression and CVD.
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Affiliation(s)
- Sarah E Linke
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA 92120, USA.
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