Major depressive disorder in Taiwan defined by the Chinese diagnostic Interview Schedule

Associations between lifetime mental disorders and suicidal behaviors: findings from the Taiwan psychiatry morbidity survey

BACKGROUND

East Asia has high suicide rates but low prevalence of mental disorders. We examined the associations between prior lifetime mental disorders (mood disorders, anxiety disorders, substance use disorders, and impulse control disorders) and subsequent suicidal behaviors (suicidal ideation and attempts in the general population and suicide plans, planned attempts, and unplanned attempts in suicidal ideators) in Taiwan.

METHODS

This survey applied the World Mental Health Survey Composite International Diagnostic Interview to a population representative sample of noninstitutionalized adults between 2003 and 2005. Odds ratios (ORs) obtained using discrete-time survival analysis were used to estimate population attributable fractions (PAFs) of suicidal behaviors due to lifetime mental disorders.

RESULTS

Lifetime mental illness was a significant risk factor for subsequent suicidal behaviors (except unplanned attempts among ideators) despite the relatively low prevalence of mental disorders in people with suicidality (16.1%-35.0%). Each diagnosis increased the odds of suicidal ideation. In terms of acting on suicidal ideation, mood disorders were most strongly associated with having plans (OR = 10.0; 95% confidence interval, CI 4.3-21.1), whereas substance use disorders most strongly with either planned (OR = 27.3; 95% CI 6.3-118.5) or unplanned attempts (OR = 14.5; 95% CI 1.7-121.5). PAFs of all mental disorders on suicidality lay between 20 and 30% (except 11% of unplanned attempts among ideators). Mood, anxiety, and substance use disorders had higher PAFs than impulse control disorders.

CONCLUSIONS

In addition to mood disorders, considering anxiety and substance use disorders is essential in devising population-based suicide prevention strategies.

Increased risk of major depressive disorder in sleep apnea patients in Taiwan

The association between sleep apnea (SA) and depression had been reported in a few previous studies. However, whether SA increases the risk of major depressive disorder (MDD) has not been studied comprehensively in a large-scale study. We performed this population-based cohort study to assess the association between SA and MDD. We identified adult patients having SA from the Taiwan National Health Insurance Research Database and excluded those having MDD before SA diagnosis. Thirty control subjects were randomly selected to match to each SA patient by age and sex. Totally, 10,259 SA patients were matched to 102,590 control subjects. The incidence rate and cumulative incidence of MDD were significantly higher in SA patients than in the control subjects (both p < 0.0001). Multivariable Cox regression analysis showed that SA remained an independent risk factor for incident MDD after adjusting for age, sex, residency, income level, and comorbidities (hazard ratio = 2.9 [95% CI 2.8–3.1], p < 0.0001). In summary, SA patients have an increased risk to develop MDD. Physicians caring for SA patients must pay attention to their psychosocial health status.

Gender Disparity in the Risk of Hypertension in Subjects With Major Depressive Disorder

Objects: The aim of our study was to investigate whether major depressive disorder (MDD) increased the risk of hypertension using propensity score matching (PSM) in patients with MDD in Taiwan. Methods: In this study, we recruited all samples from a random sample sub-dataset of one million insured individuals from 2005. A total of 743,114 outpatients were included in our study. We used PSM (nearest neighbor matching) stratified by age, hospital level, insurance amount, and Charlson Comorbidity Index score. Results: The hazard ratio (HR) of hypertension was significantly greater in the male MDD outpatients (HR = 1.116, P = 0.004) than in the female MDD outpatients (HR = 0.93, P = 0.02). Using PSM, we selected 27,988 outpatients with hypertension and 27,988 outpatients without hypertension for a nested case-control study. In this analysis, female outpatients with MDD (relative risk = 0.852) had lower risks of hypertension. Male outpatients without/with MDD (relative risk = 1.987/3.018) showed a synergistic interaction with gender in which male patients had a higher risk of hypertension in a multiplicative model. Furthermore, MDD appeared to have an interaction effect with gender (HR = 1.82, P < 0.001) in the proportional hazards model analysis. Antidepressant use also increased the risk of hypertension (HR = 1.16, P < 0.001). Conclusions: There was gender disparity in the risk of hypertension in subjects with MDD. MDD outpatients who used antidepressants had a higher risk of suffering from hypertension. A large-scale, population-based study is warranted to generalize these results in the future.

Major depressive disorder in patients with type 2 diabetes mellitus: Prevalence and clinical characteristics

BACKGROUND

This study investigated the prevalence of major depressive disorder (MDD) among Taiwanese patients with type 2 diabetes mellitus (T2DM).

METHODS

We enrolled patients with at least one service claim for ambulatory or inpatient care with a principal diagnosis of MDD and at least two service claims for ambulatory care or one service claim for inpatient care with a principal diagnosis of T2DM, as listed in Taiwan's National Health Insurance database.

RESULTS

We enrolled 715,756 people from the general population (GP), 61,589 patients with T2DM but without MDD, and 778 patients with both T2DM and MDD. The prevalence of MDD increased from 0.70% to 1.25% in the patients with T2DM, whereas it increased from 0.25% to 0.67% in the GP from 2000 to 2010. The higher prevalence of MDD was associated with the female sex, residing in the southern regions of Taiwan, and having comorbidities of cerebrovascular disease and anxiety disorder as well as higher comorbidity severity (Charlson comorbidity index, 1-2 and > 2).

LIMITATIONS

One limitation is the use of secondary data on diagnoses of MDD and T2DM. Another limitation is that we could not access some crucial related variables.

CONCLUSIONS

The prevalence of MDD was higher in the patients with T2DM than in the GP. In this study, the prevalence of MDD in the patients with T2DM was lower than that reported in Western countries.

The relation between the patient health questionnaire-15 and DSM somatic diagnoses

BACKGROUND

Our purpose was to examine the reliability and validity of the Chinese version of the Patient Health Questionnaire-15 (PHQ-15) in Taiwan, and to explore its relation to somatoform disorders (DSM-IV) and to somatic symptom and related disorders (DSM-5).

METHODS

We recruited 471 individuals, 151 with somatoform disorders and 200 with somatic symptom and related disorders. Subjects completed the Chinese version of the PHQ-15, Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and received a DSM-IV- and DSM-5-based diagnostic interview. We performed exploratory factor analysis and assessed test-retest reliability, internal consistency, and correlation with BDI-II/BAI to confirm reliability and validity, and carried out ROC curve analysis to determine suitability for evaluation or screening purposes. PHQ-15 scores were compared between patients with various DSM-IV psychiatric diagnoses (such as DSM-IV somatoform disorders, panic disorder, other anxiety/depressive disorders) or no DSM-IV diagnosis and patients with DSM-5 somatic symptom and related disorders or no DSM-5 diagnosis.

RESULTS

The Chinese version identified cardiopulmonary, pain-fatigue, and gastrointestinal as major factors and had good reliability (0.803-0.930), internal consistency (0.637-0.861), and correlation coefficients with BDI-II/BAI (0.407-0.619, 0.536-0.721, respectively). The PHQ-15 scores were similar in patients with somatoform disorders and patients with panic disorder; higher in patients with somatoform disorders and panic disorder than in patients with other anxiety/depressive disorders; and significantly higher in patients with somatic symptom and related disorders than in patients without this diagnosis. The AUC of the PHQ-15 was 0.678 (cutoff 6/7) for screening somatoform disorders (DSM-IV) and 0.725 (cutoff 4/5) for screening somatic symptom and related disorders (DSM-5).

CONCLUSIONS

The Chinese version of the PHQ-15 is suitable for evaluating somatic symptom and related disorders. The preponderance of somatic symptom disorder in our sample, lack of evaluation of functional disorders, and recruitment solely from psychiatric clinics are possible limitations.

Symptom Patterns in Depression and “Subthreshold” Depression among Adolescents in Hong Kong and the United States

This study compared the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) Major Depressive Disorder (MDD) diagnostic interview information from a representative, stratified sample of 85 (selected from 2,212) Hong Kong and 1,706 age- and sex-matched U.S. adolescents. Current prevalence rates (Hong Kong: 2.2%, 95% Confidence Interval [CI] = 1.3% to 3.1%; United States: 2.2%, 95% CI = 1.6% to 3.0%) were similar in the two cultures. More Hong Kong compared to U.S. adolescents reported fatigue/loss of energy and fewer reported irritability. All Hong Kong participants with MDD reported fatigue, sleep, and concentration difficulties. Hong Kong adolescents who did not meet criteria for MDD but reported high levels of depressive symptoms showed social function and cognitions similar to youth with MDD and dissimilar to nondepressed youth. The results suggest that adolescent MDD is as prevalent in Hong Kong as in the West and that “subthreshold” depression is not a benign condition. Comparisons of symptom patterns in the two cultures showed culture’s influences on expressions of distress.

Meta-Analysis of the COMT Val158Met Polymorphism in Major Depressive Disorder: Effect of Ethnicity

The COMT (catechol-O-methyltransferase) Val158Met polymorphism (rs4680) is a potential susceptibility variant for major depressive disorder (MDD). Although many genetic studies have examined the association between MDD and this polymorphism, the results were inconclusive. In the present study, we conducted a series of meta-analyses of samples consisting of 2905 MDD cases and 2403 controls with the goal of determining whether this variant indeed has any effect on MDD. We revealed a significant association in the comparison of Val/Val + Val/Met vs. Met/Met (OR =1.180; 95 % CI = 1.019, 1.367; P = 0.027), Val/Met vs. Val/Val (OR =1.18; 95 % CI = 1.038, 1.361; P = 0.013), and Val/Met vs. Met/Met (OR =1.229; 95 % CI = 1.053, 1.435; P = 0.009). Further meta-analyses of samples with European ancestry demonstrated a significant association of this SNP with MDD susceptibility in Val/Val + Val/Met vs. Met/Met (OR =1.231, 95 % CI = 1.046, 1.449; P = 0.013) and Val/Met vs. Met/Met (OR =1.284, 95 % CI = 1.050, 1.484; P = 0.012). For the samples with East Asian ancestry, we found a significant association in both allelic (Val vs. Met: OR =0.835; 95 % CI = 0.714, 0.975; P = 0.023) and genotypic (Met/Met + Val/Met vs. Val/Val: OR =1.431, 95 % CI = 1.143, 1.791; P = 0.002; Val/Met vs. Val/Val: OR =1.482, 95 % CI = 1.171, 1.871; P = 0.001) analyses. No evidence of heterogeneity among studies or publication bias was observed. Together, our results indicate that the COMT Val158Met polymorphism is a vulnerability factor for MDD with distinct effects in different ethnic populations.

Retrospective observation of mental disorders during postpartum period: Results from the Singapore mental health study

Background

The perinatal period has been identified as a period of vulnerability for various disorders (particularly anxiety and depressive disorders), which have been associated with negative outcomes for both mother and infant. The current study utilized data from the Singapore Mental Health Study (SMHS) to examine the temporal relationship between mental disorders and the perinatal period, as well as associated risk factors.

Methods

Life table estimation method was used to derive the estimated hazard rate for any mood or anxiety disorders following pregnancy. Multivariate logistic regression was used to examine the association between socio-demographic factors and onset of mental disorders after the first pregnancy.

Results

Among women with children (n = 2278), 1.5 % were found to have an onset of any mental disorder (i.e., mood disorders, anxiety disorders, alcohol use disorders), within 2 years after pregnancy. A peak in hazard rate was noted at approximately 1 year following pregnancy for anxiety disorders but not mood disorders. Women who were married, employed and physically healthy were less likely to have had developed any mental disorder.

Conclusions

The prevalence of mental disorders during pregnancy and postpartum was found to be low among women with children in our community sample, with increased vulnerability following delivery. The results offer some insight into the occurrence of mental disorders during the perinatal period among women in Singapore.

A community-based study of the relationship between somatic and psychological distress in Hong Kong

Although the predominantly somatic presentation of distress has been used to explain low rates of emotional illnesses and health service use in Chinese communities, this concept of somatization has not been examined by concurrently studying the profile of somatically and psychologically distressed Chinese individuals. A random population-based sample of 3014 adults underwent a structured telephone interview that examined their sociodemographic characteristics, somatic distress (Patient Health Questionnaire-15, PHQ-15), non-specific psychological distress (Kessler Scale-6, K6), health service use, and functional impairment. Four groups of individuals identified by PHQ-15 and K6 cut-off scores were compared. Results showed that PHQ-15 and K6 scores were positively correlated. The large majority of respondents (85.9%) reported both somatic and psychological distress. The proportions of Low Distress Group, Somatically Distressed Group, Psychologically Distressed Group, and Mixed Distress Group were 69.2%, 5.0%, 15.8%, and 10.0%, respectively. Specific age range, male gender, greater family income, higher education level, and retirement were associated with decreased odds of somatic and/or psychological distress. Although psychological distress best predicted impairment, somatic distress best predicted health service use. Mixed distress predicted most impairment and health service use. Thus, psychological distress and somatic distress commonly coexist across Chinese sociodemographic groups. This speaks against the conventional notion of somatization and is consistent with recent findings of a higher prevalence of emotional illnesses in Chinese people. That psychologically distressed individuals are more impaired but less inclined to seek help than somatically distressed individuals may partly explain low levels of help-seeking for mental disorders found in epidemiological studies.

Anti-anxiety efficacy of Sudarshan Kriya Yoga in general anxiety disorder: A multicomponent, yoga based, breath intervention program for patients suffering from generalized anxiety disorder with or without comorbidities

BACKGROUND

Surdashan Kriya Yoga (SKY) is a procedure that in various studies, has shown evidences of efficacy in alleviating Depression and Anxiety disorders, but in Europe and USA it has not been studied yet on a Caucasian population as an adjunct therapy for psychiatric Disorders.

METHODS

The study involved a sample of consenting women and men (n = 69) who received SKY therapy for a six-month time period. They were assessed at recruitment, after two weeks, after three months and after six months using Hamilton Rating Scale for Anxiety (HRSA), Hamilton Rating Scale for Depression (HRSD), Zung Self-Rating Anxiety Scale (ZSAS), Zung Self-Rating Depression Scale (ZSDS) and Symptom Checklist-90 (SCL-90).

RESULTS

All the analyses have shown that SKY therapy significantly reduces the scores of Anxiety and Depression. This is plain, especially after the initial SKY treatment, which is followed by a long plateau phase that seems to verge on no Anxiety/Depression scores. It was found that SKY effects lead to a significant convergence between the self-assessment (Zung Self-Rating Scale) and hetero-assessment (Hamilton Rating Scale).

LIMITATIONS

The study should be replicated on a larger clinical sample in a controlled trial to learn more about the effectiveness of SKY Protocol.

CONCLUSIONS

Participation in SKY adjunct therapy ten days intense workshop and follow-ups, coupled with daily individual and independent practice of a simplified protocol of breathing techniques (30 min), can lead to significant reduction in levels of Anxiety and Depression.

Anxiety, depression and related factors in family caregivers of newly diagnosed lung cancer patients before first treatment

OBJECTIVE

This study aimed to (i) explore the prevalence and levels (severity) of anxiety and depression in family caregivers (FCs) of patients newly diagnosed with advanced lung cancer (stage IIIb or IV) before first treatment, and (ii) identify the factors related to FCs' anxiety and depression.

METHODS

For this cross-sectional study, 106 patient-FC dyads were recruited from a medical center in northern Taiwan. FCs' anxiety and depression were measured using the self-report Hospital Anxiety and Depression Scale, and FCs' ability to manage patients' symptoms was assessed using the Self-Efficacy in Symptom Management Scale. FCs' risks for anxiety and depression were separately identified using two multivariate logistic regression models.

RESULTS

This study found two major results. First, before patients' first treatment, 50.9% and 32.1% of FCs were at risk for anxiety and depression, respectively. FCs' overall mean anxiety and depression scores were 7.7 (SD = 4.7) and 6.1 (SD = 4.5), respectively. Second, both FCs' anxiety and depression were significantly related to four factors: caring for another sick family member, younger age, having pain problems, and lower self-efficacy in managing symptoms.

CONCLUSION

Family caregivers of patients newly diagnosed with advanced lung cancer had anxiety and depression before the patients' first treatment. We strongly suggest developing and testing interventions to reduce FCs' psychological distress and enhance their quality of life, thus ensuring better quality of patient care.

Increased risk of hypertension in patients with major depressive disorder: a population-based study

OBJECTIVE

We conducted this study to detect the prevalence, incidence, and risk factors of hypertension in Taiwanese patients with major depressive disorder (MDD).

METHODS

The National Health Research Institute provided a database of 1,000,000 random subjects for study. We obtained a random sample of 766,427 subjects, aged ≥18 years in 2005. Study subjects had at least one service claim during 2005 for either outpatient or inpatient care with a primary diagnosis of MDD or with a primary or secondary diagnosis of hypertension and combined with antihypertensive drug treatment were identified. We also compared the incidence of hypertension among patients with MDD and the general population from 2006 through 2008.

RESULTS

The 1-year prevalence of hypertension in patients with MDD was higher than that in the general population (21.21% vs. 13.28%, risk ratio, 1.22; 95% confidence interval, 1.17-1.28). Compared with the general population, patients with MDD had a higher prevalence of hypertension in all age, sex, insurance amount, region, and urbanicity groups. The average annual incidence of hypertension in patients with MDD from 2006 to 2008 was higher than that in the general population (3.96% vs. 2.90%, risk ratio, 1.19; 95% confidence interval, 1.08-1.31). Compared with the general population, patients with MDD had a higher incidence of hypertension in all age, and male groups.

CONCLUSIONS

Patients with MDD had a higher prevalence and a higher incidence of hypertension than that in the general population. Age, male gender, and antipsychotic use were risk factors for hypertension among patients with MDD.

Low prevalence of major depressive disorder in Taiwanese adults: possible explanations and implications

BACKGROUND

This study examined the prevalence of major depressive disorder (MDD), and the correlations and co-morbid conditions associated with MDD, in the adult Taiwanese population, which a previous estimate in the 1980s had found to be at the lower end of the spectrum worldwide. Possible explanations for the reported low prevalence of MDD were evaluated.

METHOD

As part of a survey of common psychiatric disorders in a nationally representative sample of individuals aged ≥ 18 years who were non-institutionalized civilians in Taiwan, a face-to-face interview using the paper version of the World Mental Health Survey of the World Health Organization (WHO) Composite International Diagnostic Interview (WMH-CIDI) was conducted between 2003 and 2005. Functional impairment and help-seeking behaviors were compared between Taiwanese subjects with MDD and their counterparts in the USA.

RESULTS

Among the 10 135 respondents, the lifetime prevalence of MDD was 1.20% [standard error (S.E.)=0.2%]. Individuals who were divorced or widowed, aged ≤ 40 years, and female were at increased risk, whereas rural residents were at lower risk for MDD. The proportion of MDD cases co-morbid with other psychiatric disorders in this study was much lower than in the US study. Only one-third of Taiwanese individuals with MDD sought help despite having twice the number of lost workdays compared with the US sample.

CONCLUSIONS

Despite the low prevalence of MDD in Taiwanese adults, the pattern of low help-seeking behavior and profound functional impairment indicates much room for improvement in the early detection of and intervention in major depression in this population.

Prevalence and incidence of diagnosed depression disorders in patients with diabetes: a national population-based cohort study

OBJECTIVE

This study aimed to investigate the prevalence and incidence of diagnosed depression disorders among patients with diabetes in Taiwan.

METHODS

Study subjects were identified by at least one service claim for ambulatory or inpatient care with a principal diagnosis of depression disorder, and at least two service claims for ambulatory care or one service claim for inpatient care with a principal diagnosis of diabetes from 2000 to 2004, as found in the National Health Insurance database.

RESULTS

The 1-year prevalence of diagnosed depression disorders in the general population was 11.22 per 1000 in 2000, while the 5-year cumulative diagnosed prevalence increased to 40.76 per 1000 in 2004. The 1-year prevalence rate of diagnosed depression disorders among patients with diabetes was 33.95 per 1000 in 2000, and the 5-year cumulative prevalence increased to 92.17 per 1000 in 2004. Patients with diabetes had a higher 5-year cumulative prevalence and annual incidence than the general population throughout the observation period. A higher diagnosed prevalence was associated with a monthly income <US*$640 using multiple logistic regression analysis. Cox regression analysis revealed that a lower incidence was associated with male gender.

CONCLUSIONS

The prevalence and annual incidence density of diagnosed depression disorders in patients with diabetes were significantly higher than those in the general population. The prevalence of diagnosed depression disorder among patients with diabetes in Taiwan was lower than the rate in Western countries.

The Association between Economic Status and Depressive Symptoms: An Individual and Community Level Approach

OBJECTIVE

The study was conducted to investigate the association between economic status and depressive symptoms by comparing the prevalence rates of depressive symptoms at community level and analyzing the possibility of depressive symptoms at individual level.

METHODS

A survey was conducted from November, 2006 to November, 2007 on 966 and 992 representative subjects recruited by stratified clustered sampling in two regions located in Seoul. We used a standardized questionnaire including the Center for Epidemiologic Studies-Depression and questions on the socioeconomic characteristics. The adjusted prevalence rates of depressive symptoms were compared at community level, and multiple logistic regression analysis was performed to determine the association between depressive symptoms and economic statuses at individual level among each region.

RESULTS

The adjusted prevalence of depressive symptoms was higher in the region with a high socioeconomic status (23.1%) than in the region with a lower economic status (16.6%)(p<0.001). However, logistic regression analysis of individual level revealed that a higher economic status was significantly associated with a lower possibility of depressive symptoms among the females in the low economic status region. This tendency was not observed among the males in both of the regions.

CONCLUSION

The association between economic status and depressive symptoms was found to be different when it was approached at community level or individual level. In addition, the association of two variables was different by gender at individual level. Further studies that consider the third mediators are needed to determine the association between the two variables.

Increased risk of cancer subsequent to severe depression--a nationwide population-based study

BACKGROUND

Empirical findings on the association between a history of depression and subsequent cancer incidence are mixed and inconclusive. A link between depression and cancer would gain greater credence if it can be sustained across cultures. This nationwide, population-based study aimed to prospectively examine the relationship between a psychiatric diagnosis of depression in an inpatient setting and the risk of developing cancer in the following five years in Taiwan.

METHOD

This study used data from the Taiwan National Health Insurance Research Database. A total of 778 patients hospitalized for depression from 1998 to 2003 were recruited, together with 3890 matched non-depressive enrollees as a comparison cohort. Each patient was tracked five years to identify the occurrence of any type of cancer. The Cox proportional hazards models were carried out to compute the risk of cancer between study and comparison cohorts, following adjustment for residence and socio-demographic characteristics.

RESULTS

We found that during a five-year follow-up, 61 severely depressed patients (7.8%) and 212 patients in the non-depressed comparison cohort (5.5%) received cancer diagnoses. For adults age 18 and older, having been hospitalized with a diagnosis of depressive disorder was independently associated with a 1.62-fold (95% CI: 1.12, 2.34) overall increased risk of subsequent cancer during five years of follow-up, after adjusting for residence and socio-demographic characteristics.

CONCLUSION

Our results suggest depression is significantly associated with increased risk of cancer in a rather short follow-up time. Our results call attention to the immediate health impacts of severe depression on patients.

The clinical research center for depression study: baseline characteristics of a korean long-term hospital-based observational collaborative prospective cohort study

OBJECTIVE

The Clinical Research Center for Depression (CRESCEND) study is a 9-year observational collaborative prospective cohort study for the clinical outcomes in participants with depressive disorders in Korea. In this study, we examined the baseline characteristics of the depressive participants as the hospital-based cohort.

METHODS

Participants were assessed using various instruments including the Clinical Global Impression scale, 17-item Hamilton Depression Rating Scale (HDRS-17), Hamilton Anxiety Rating Scale, Brief Psychiatric Rating Scale, Social and Occupational Functioning Assessment Scale, Beck Depression Inventory-Second Edition, Scale for Suicide Ideation, and World Health Organization Quality of Life assessment instruments-abbreviated version. Also, personal histories of medical and psychiatric illnesses and the range of socio-epidemiologic and clinical data were collected from each participant.

RESULTS

One thousand one hundred eighty three participants were recruited from 18 hospitals. The mean age of the participants was 47.9±15.9 year-old, 74.4% were female, 82.9% had been diagnosed of major depressive disorder, 40.9% were experiencing their first depressive episode, and 21.4% had a past history of suicide attempts. The majority (85.3%) of the participants were moderately to severely ill. The average HDRS-17 was 19.8±6.1. Significant gender differences at baseline were shown in age, education, marriage, employment, religion, and first depressive episode.

CONCLUSION

The baseline findings in the CRESCEND study showed some different characteristics of depression in Korea, suggesting a possibility of ethnic and cultural factors in depression.

Depression Among the Elderly Chinese in Canada

Cette recherche examine la prévalence de la dépression chez les Chinois(es) aîné(e)s du Canada. On a interrogé 96 Chinois(es) aîné(e)s choisi(e)s au hasard et vivant à Calgary. On a utilisé vine version chinoise en 15 points du Geriatric Depression Scale (échelle de l'évaluation de l'état dépressif des aîné(e)s) comme instrument de mesure. Les résultats indiquent que 9,4 pour 100 des personnes interrogées étaient légèrement déprimées et que 11,5 pour 100 étaient moyennement ou gravement déprimées. Le taux de prévalence général chez les Chinois(es) aîné(e)s est plus élevé que celui de l'ensemble de la population aînée du Canada et plus faible que celui des Chinois(es) aîné(e)s des États-Unis. Les résultats de l'analyse de régression font ressortir les principaux prédicteurs de la dépression de ce groupe de la population: la maladie, le fait d'habiter le Canada depuis longtemps, ne pas connaître l'anglais, être plus jeune, et avoir une mauvaise santé physique. Les résultats soulignent également les besoins du groupe sur le plan de la santé mentale. La recherche présente de plus d'autres éléments et les répercussions pratiques des résultats.

Meta-analysis of the BDNF Val66Met polymorphism in major depressive disorder: effects of gender and ethnicity

Brain-derived neurotrophic factor (BDNF) is a nerve growth factor that has antidepressant-like effects in animals and may be implicated in the etiology of mood-related phenotypes. However, genetic association studies of the BDNF Val66Met polymorphism (single nucleotide polymorphism rs6265) in major depressive disorder (MDD) have produced inconsistent results. We conducted a meta-analysis of studies comparing the frequency of the BDNF Val66Met-coding variant in depressed cases (MDD) and nondepressed controls. A total of 14 studies involving 2812 cases with DSM-III or -IV defined MDD and 10 843 nondepressed controls met the inclusion criteria. Analyses were stratified either by gender or ethnicity (Asian and Caucasian) because MDD is more prevalent in women and in Caucasians and because BDNF allele frequencies differ by ethnicity. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were provided for allelic analyses (Met versus Val), as well as for genotypic analyses (Met/Met and Val/Met versus Val/Val). In the total sample, the BDNF Val66Met polymorphism was not significantly associated with depression. However, the gender stratified analyses revealed significant effects in both the allelic and genotypic analyses in men (OR(MET), 95% CI; 1.27 (1.10-1.47); OR(MET/MET), 95% CI; 1.67 (1.19-2.36)). Stratification according to ethnicity did not show significant effects of the Val66Met polymorphism on MDD. Our results suggest that the BDNF Val66Met polymorphism is of greater importance in the development of MDD in men than in women. Future research into gender issues will be of interest.

Validation of the Perinatal Grief Scale for use in Chinese women who have experienced recent reproductive loss

The primary objective of this research was to validate the short version of the Perinatal Grief Scale (SVPGS) in the Chinese population. The Chinese SVPGS was administered to a sample of Chinese women who had experienced recent reproductive loss (N = 314). The results of the confirmatory factor analysis rejected the original 3-factor model delineated by Potvin (1989). A follow-up exploratory factor analysis suggested an alternative 3-factor model, consisting of a 12-item Sense of Worthlessness subscale, a 7-item Social Detachment subscale, and a 7-item Painful Recollection subscale. Further analysis showed that both the original and Chinese SVPGS demonstrated good internal consistency. Cronbach's alpha equaled .86, .83, .90, and .95, respectively, for the three subscales of Active Grief, Difficulty Coping, and Despair, and the total original SVPGS, and .85, .93, .91, and .95, respectively, for the new subscales of Sense of Worthlessness, Social Detachment, and Painful Recollection, and the total Chinese SVPGS. Both versions demonstrated satisfactory correlations with the participants' psychological distress and spousal emotional support. The authors suggest that both versions are useful in measuring the responses of Chinese women to reproductive loss; the original SVPGS should be used for cross-cultural studies, whereas the Chinese SVPGS should be used for local studies.

Relationship between filial piety, meta-cognitive beliefs about rumination and response style theory in depressed Chinese patients

The presentation of depression varies across cultures and the Chinese culture lays considerable emphasis on filial piety. We studied the relationship between filial piety and psychopathology in the Chinese population in Hong Kong. 172 patients of Chinese origin were interviewed using Beck Depression Inventory, response style questionnaire (RSQ) to measure ruminative response styles and filial piety scale. Of 172 individuals, 67 were males and 105 females and mean age was 38.9 years (S.D. 12.74). Severity of depressive symptoms was strongly correlated with ruminative response style. Filial piety and depressive symptoms were negatively correlated, as were filial piety and ruminative styles as well as meta-cognitive beliefs about rumination. This study supports the association between rumination and depression in a clinical sample from a Chinese population. Strong meta-cognitive beliefs about rumination are associated with more severe depressive symptoms, mediated by ruminative response style showing that Culture-specific beliefs are important in clinical assessment of depression.

Relationships between culture and health status: a multi-site study of the older Chinese in Canada

This study examined the relationships between culture and the health status of older Chinese in Canada. Data were collected through face-to-face interviews with a cross-sectional, randomly selected sample of 2,272 older Chinese between 55 and 101 years of age in seven Canadian cities. Health status was assessed by the number of chronic illnesses, by limitations in ADL and IADL, and by information on the Medical Outcome Study Short Form SF-36. Although cultural variables explained only a small proportion of variance in health status, having a stronger level of identification with traditional Chinese health beliefs was significant in predicting physical health, number of illnesses, and limitations on IADL. Other cultural variables, including religion, country of origin, and length of residence in Canada, were also significant in predicting some health variables. Interventions to improve health should focus on strategies to enhance cultural compatibility between users and the health delivery system.

Lifetime and 12-month prevalence of DSM-IV psychiatric disorders among Korean adults

The objective was to estimate the prevalence and correlates of psychiatric disorders in a nationwide sample of Korean adults. Face-to-face interviews were conducted with the Korean version of Composite International Diagnostic Interview 2.1/DSM-IV (N = 6275, response rate 79.8%). The lifetime and 12-month prevalences for all types of DSM-IV disorders were 33.5% and 20.6%, respectively. Those of specific disorders were as follows: 17.2% and 7.1% for alcohol use disorder, 11.2% and 7.4% for nicotine use disorder, 5.2% and 4.2% for specific phobia, 4.3% and 1.7% for major depressive disorder, and 2.3% and 1.0% for generalized anxiety disorder. Among the sociodemographic variables, widowed status, higher income, and rural residence were the risk factors for both lifetime major depressive disorder and alcohol use disorder after controlling for gender, age, and education. The prevalence of psychiatric disorders was higher than those observed in other East-Asian countries and most European countries, but lower than that in the United States. Alcohol use disorder was particularly high in Korea.

The prevalence and incidence of treated major depressive disorder among National Health Insurance enrollees in Taiwan, 1996 to 2003

OBJECTIVE

We used the National Health Insurance (NHI) database to examine the prevalence and incidence of treated major depressive disorder (MDD) and their associated factors.

METHOD

The National Health Research Institute provided a database of 200 432 randomly selected subjects for study. We obtained a population-based random sample aged 15 years or older (n = 136 045) as a fixed cohort dated 1996 to 2003. We identified study subjects with a principal diagnosis of MDD who had at least one service claim during these years for either ambulatory or inpatient care.

RESULTS

From 1996 to 2003, the cumulative treated prevalence increased from 1.67 per 1000 to 17.24 per 1000. From 1997 to 2003, the annual treated incidence increased from 1.89 per 1000 to 2.58 per 1000. A higher incidence of treated MDD was detected in the groups aged 25 to 44 years (hazard ratio [HR] 1.28; 95% confidence interval [CI], 1.13 to 1.45), 45 to 64 years (HR 1.90; 95% CI, 1.66 to 2.16), and 65 years or older (HR 1.87; 95% CI, 1.59 to 2.20); in female subjects (HR 1.97; 95% CI, 1.80 to 2.15); in those with with an insurance amount of US $1281 or more (HR 1.15; 95% CI, 1.01 to 1.31); in those with a fixed premium (HR 1.44; 95% CI, 1.27 to 1.62); and among those who lived in urban areas (HR 1.22; 95% CI, 1.10 to 1.35).

CONCLUSIONS

For treated MDD, the prevalence and incidence in Taiwan were lower than in community studies in Western countries. Individuals with MDD are underdiagnosed and undertreated in Taiwan.

Cross-cultural validation of the DMI-10 measure of state depression: the development of a Chinese language version

Depression measurement tools in cross-cultural research require careful design and thorough validation to ensure that cognitive concepts in one culture can be appropriately translated and applied to a differing culture. The aim of this study was to validate the Chinese version of a screening measure of state depression, the 10-item Depression in Medically Ill (DMI-10), and we report three interdependent studies. An initial bilingual test-retest study identified four (of the 10) items as having poor cross-cultural validity. A second study involved focus groups participants exploring the meaning of translated items with Chinese speakers. The third study repeated the bilingual test-retest analyses on the modified DMI-10 form and demonstrated improved correlation coefficients on all items and an excellent overall correlation (r=0.87) between the Chinese and English versions. The Chinese DMI-10 should prove useful as a tool in cross-cultural research to understand the Chinese experience of depression. The findings of this study have methodological implications for cross-cultural research on depression.

Depression in the United States and Japan: Gender, marital status, and SES patterns

A number of investigators have claimed that higher depression scores and higher rates of depressive disorder are found worldwide in women, unmarried persons, and people of low socioeconomic status (SES). A closer look, however, indicates that patterns for Asian countries are less consistent than claimed. As a case in point, using comparable data from the National Family Research of Japan '98 survey (N=6985) and the National Survey of Families and Households in the US (N=8111), we examine the distributions of depressive symptoms by gender, marital status, and SES, with a short form of the CES-D Scale. Bivariate and multivariate analyses show that depressive symptoms are higher in women, unmarried persons, and those with lower family incomes in both countries, but there is no association between education and depression in Japan while symptoms are inversely related to education in the US. We argue that the lack of relationship between education and depression in Japan is not an artifact of measurement but a product of Japan's distinctive stratification processes relating to occupation. Cross-national variations around "general" patterns are important because they offer clues to more specific cultural and structural factors involved in the social etiology of mental disorder.

A Cross-Cultural Investigation of Cognitions and Depressive Symptoms in Adolescents

Adolescents (N=2,272) from Hong Kong and the United States provided information regarding their depressive symptoms, cognitions (self-efficacy, negative cognitive errors, and hopelessness), and stressful events between 2 surveys 6 months apart. Depressive symptoms and hopelessness were higher, and self-efficacy and negative cognitive errors were lower in Hong Kong than in the United States. Cognitions were associated with concurrent depressive symptoms and predicted depressive symptoms 6 months later in both cultures. The "reverse" model was also supported with more variance predicted by depressive symptoms to later cognitions than from cognitions to depressive symptoms. There was some support for the hypothesis that self-efficacy is less salient in collective compared with individualistic cultures. These findings extend cognitive theories of depression to a non-Western culture.

A cross-cultural study of the structure of comorbidity among common psychopathological syndromes in the general health care setting

This study presents analyses of 7 common psychopathological syndromes in the World Health Organization (WHO) Collaborative Study of Psychological Problems in General Health Care (T. B. Ustun & N. Sartorius, 1995). Data on depression, somatization, hypochondriasis, neurasthenia, anxious worry, anxious arousal, and hazardous use of alcohol were analyzed for 14 countries (Ns for each country ranged from 196 to 800). Four models were evaluated: a 1-factor model; a 2-factor model in which all syndromes except hazardous use of alcohol represented internalizing problems; and two 3-factor models. The 2-factor model fit best. These results extend previous research on the 2-factor model to the current complaints of attendees of general health care clinics, to a new set of syndromes, and to a variety of both Western and non-Western countries.

A cross-cultural comparison of depressive symptom manifestation: China and the United States

This study compared depressive symptomatology among Chinese psychiatric outpatients versus the general Chinese population, and across 3 cultural groups--Chinese, Chinese American, and Caucasian American students--by use of the Center for Epidemiological Studies-Depression Scale (CES-D; L. S. Radloff, 1977) and the Chinese Depression Scale (N. Lin, 1989), translated from the CES-D. Results indicate that Chinese patients (n = 112) endorsed a higher proportion of somatic symptoms than nonpatients (n = 112). The intercultural comparison found that Chinese students (n = 98) had the lowest levels of somatic depressive symptom endorsement compared to both U.S. groups (n = 198). These findings seem to suggest that the tendency toward somatic symptom reporting is not any greater among Chinese populations but may be a function of having a mental illness or of help seeking in China.

Ethnicity and adolescent depression: the case of Chinese Americans

This paper is concerned with whether an instrument developed in the U.S. may identify lower rates of major depression among Chinese, because its content may not cover culture-specific symptoms of depression. Data were obtained from approximately 952 Anglo and Chinese American middle school students, aged 10 to 17 years, in the Teen Life Changes Survey conducted in the spring of 1994. We investigated the hypothesis that rates of missing values would be higher, the mean score for total depression items would be lower, and internal consistency reliability and construct validity of the DSM Scale for Depression (DSD) would be lower for Chinese American adolescents compared with Anglo American adolescents. We also examined whether response functions on the DSD item would differ for these two groups. Only the latter was observed. Five of 26 items in the DSD exhibited differential functioning between Anglo and Chinese students. The results suggest that the lower prevalence of depression was not due to the ethnocentric character of the instrument in the Chinese sample. Stronger immunity to depression or other cultural factors may contribute to the lower rate of depression for the Chinese American adolescents in the Teen Life Changes study.