Clinical features of depression in Asia: results of a large prospective, cross-sectional study

Global, regional, and national trends in incidence of depression among women, 1990-2019: An analysis of the global burden of disease study

Depression is a common mental disorder and more women are affected by depression than men. In this study, we aimed to analyze the trends in the incidence of depression among women from 1990 to 2019 and their associations with sociodemographic and universal health coverage indices based on data from the Global Burden of Disease study 2019. It was observed that while the incidence rate of depression among women decreased by an average of 0.35% per year at the global level, the incidence rate increased at the regional level for the high sociodemographic index region by an average of 0.39% per year from 1990 to 2019. And the global downward trend in incidence rate from 1990 to 2019 was contributed by the downward trend from 2000 to 2009. In Spearman correlation analyzes at the level of country/territory, a negative correlation between the estimated annual percentage change in the incidence rate and the universal health coverage index was found (ρ=-0.15).

What Do Patients Want in the Treatment of Major Depressive Disorder? Taiwan's TAILOR Survey

In Taiwan, the number of patients being treated for depression has been increasing over recent decades, but there remain some key unmet needs for these patients. One issue is the low rate of help-seeking, which may be at least partially attributable to the stigma of depression in Asian societies. Stigma also contributes to underdiagnosis, because stigmatised patients may emphasise somatic symptoms (e.g. lethargy/fatigue, sleep disorders or changes in appetite), fearing how they will be perceived if they discuss psychological symptoms with their physician. Underdiagnosis may also result from cross-cultural differences, because assessment scales and screening tools are usually developed in Western populations and may not have the same validity in Asian patients. Depression in Taiwan appears to be undertreated, with a high rate of suboptimal antidepressant dosages and inadequate duration of therapy. Patients may discontinue treatment earlier than recommended for a number of reasons related to their own beliefs about treatment, their relationship with their physicians, or the effects of the medication (adverse effects, slow onset of effect, or lack of effect on comorbid symptoms). Moreover, frequently there is discordance between how patients and physicians define treatment success in depression. Patients are more likely to achieve a benefit from treatment which remains persistent when physicians and patients are closely aligned on treatment goals. To better understand the experiences, preferences and attitudes of patients with depression in Taiwan, the Target Antidepressant Initiation choice to unLock positive patient Outcomes and Response (TAILOR) survey was conducted in 340 adult outpatients receiving treatment for major depressive disorder (MDD). The results of the TAILOR survey highlight the personal and perceived stigma of depression, current barriers to seeking help and maintaining treatment, and opportunities to improve shared decision-making, medication adherence and clinical outcomes for Taiwanese patients with MDD.

Internet addiction in adolescent psychiatric patient population: A hospital-based Study from China

BACKGROUND

Internet is gradually reshaping adolescents' behaviors in China. It is important to identify the prevalence and risk factors to predict Internet addiction among adolescent psychiatric patients.

METHODS

The survey was conducted among inpatient or outpatient adolescent patients with mental disorders. All participants were interviewed face-to-face and completed Young Internet Addiction Test and other relevant assessments. Binary logistic regression analysis was used to exam between-group differences of internet addiction.

RESULT

The prevalence for internet addiction (mild to severe) in adolescent psychiatric patients was 80.2%, where the prevalence for "medium and severe internet addiction was 25.5%. Logistic regression analysis identified two independent predictors for "medium and severe internet addiction" including the total score of Adolescent Non-suicidal-self-injury (NSSI) Behavior Function Assessment Scale (ANBFAS) and the diagnosis of generalized anxiety disorder (GAD) (R² =0.27, p = .02 for total ANBFAS score, p = .01 for GAD) in psychiatric adolescent patients.

CONCLUSION

The prevalence of internet addiction is notably high among adolescent psychiatric patients in China. Coping for Internet addiction in adolescent psychiatric patients should conclude the coping of NSSI and GAD.

Rapid Symptom Improvement in Major Depressive Disorder Using Accelerated Repetitive Transcranial Magnetic Stimulation

Objective

Repetitive transcranial magnetic stimulation (rTMS) has contributed to increase in the remission rate for patients with major depressive disorder (MDD). However, current rTMS treatment is practically inconvenient because it requires daily treatment sessions for several weeks. Accelerated rTMS treatment is as efficient and safe for MDD patients as conventional rTMS.

Methods

Fifty-one patients with MDD participated in this study; they were randomized into accelerated rTMS (n = 21), conventional rTMS (n = 22), and sham-treatment (n = 8) groups. The accelerated and conventional rTMS groups received 15 sessions for 3 days and 3 weeks, respectively. The sham-treatment group received 15 sham rTMS sessions for 3 days. Primary outcome was assessed using self-report and clinician-rated Korean Quick Inventory of Depressive Symptomatology (KQIDS-SR and KQIDS-C, respectively). Adverse effects were monitored using the Frequency, Intensity, and Burden of Side Effects Rating scale. Changes in depressive symptoms were compared among the three groups using mixed model analyses.

Results

For the KQIDS-SR score, there was a significant main effect of "time" (F_3,47 = 11.05, p < 0.001), but no effect of "group" (F_2,47 = 2.04, p = 0.142), and a trend-level interaction effect of "group × time" (F_6,47 = 2.26, p = 0.053). Improvement in depressive symptoms, based on the KQIDS-SR score 3 weeks after treatment, was more prominent in the accelerated rTMS group than in the sham-treatment group (p = 0.011). Tolerability was comparable among the three groups.

Conclusion

The accelerated rTMS treatment group showed rapid improvement of depressive symptoms compared with the sham-treatment and conventional rTMS treatment groups. Therefore, accelerated rTMS treatment could be a viable option for MDD, with improved accessibility.

Self-reported depressive symptoms in dental students: Systematic review with meta-analysis

OBJECTIVE

This study aimed to systematically review the literature about the prevalence of self-reported depressive symptoms in dental students.

METHODS

PUBMED, SCOPUS, and EMBASE databases were search up to January 2020 with the following focused questions: "What is the prevalence of self-reported depression symptom in dental students?" and "Are sex and years of educational training associated with self-reported depressive symptom in dental students?". Observational studies that applied a questionnaire assessing depression were eligible. Standard mean differences (SMD) and pooled odds ratios (OR) were calculated for the questionnaires' scores and self-reported depressive symptom, respectively.

RESULTS

Fifty-eight studies were included, and 15 different questionnaires were used. The prevalence of self-reported depressive symptoms/at least mild depression ranged from 2.75% to 89.84%, and the pooled overall prevalence was 29% (95% confidence interval [CI]: 26-34). Meta-analysis showed significantly lower scores in the questionnaires for self-reported depressive symptoms of male students (SMD: -0.22; 95% CI: -0.42 - -0.03). Conversely, no significant difference was detected for the OR of self-reported depressive symptom in the comparison between sex (OR: 1.11 - 95% CI: 0.77-1.62). Similarly, no significant difference was observed for the different school years regardless of the analytical strategy used.

CONCLUSION

It was concluded that female dental students presented more self-reported depressive symptoms, but no difference is demonstrated during the years of dental education.

Subjective depressive symptoms associated with pain in patients with major depressive disorder: Findings from the study on the aspect of Asian depression

PURPOSE

To examine subjective depressive symptoms associated with physical pain symptoms (PPSs) in Asian patients with major depressive disorder (MDD).

DESIGN AND METHODS

Four PPSs, including headache, chest pain, low back pain, and muscle pain, and subjective depressive symptoms were assessed using the Symptom Checklist-90-Revised.

FINDINGS

Out of 528 participants, 390 (73.9%) had at least one PPS. After adjusting for sex, depression severity, disability, fatigue, physical health status, and mental health status, PPSs were found to be associated with crying easily, blaming oneself, feeling lonely, feeling blue, and worrying too much.

PRACTICAL IMPLICATIONS

Almost three-quarters of Asian patients with MDD experience PPSs. PPSs are associated with some subjective feelings of depression.

Perception of Stigma and Its Associated Factors Among Patients With Major Depressive Disorder: A Multicenter Survey From an Asian Population

Stigma of major depressive disorder (MDD) is an important public health problem. This study aimed to examine the level of perceived stigma and its associated factors in MDD patients in five Asian countries, including China, Korea, Malaysia, Singapore, and Thailand. A total of 547 outpatients with MDD were included from Asian countries. We used the stigma scale of the Explanatory Model Interview Catalogue (EMIC) to assess stigma. The Montgomery-Asberg Depression Rating Scale (MADRS), Symptoms Checklist 90-Revised (SCL-90-R), Fatigue Severity Scale (FSS), Sheehan Disability Scale (SDS), 36-Item Short-Form Health Survey (SF-36), and Multidimensional Scale of Perceived Social Support (MSPSS) were used to assess symptoms, clinical features, functional impairment, health status, and social support. The stigma scores of patients under 55 years old were significantly higher than those equal to or greater than 55 years old (P < 0.001). The stigma scores exhibited significant negative correlation with age; MSPSS scores of family, friends, and others; and SF-36 subscale of mental health, but significant positive correlation with MADRS, FSS, SDS, and SCL-90-R subscale scores of depression, interpersonal sensitivity, obsession-compulsion, psychoticism, and somatization. Multivariate regression analysis revealed that age, SCL-90-R interpersonal sensitivity, obsession-compulsion, psychoticism, MSPSS scores of friends and others, and SF-36 of mental health were significantly associated with the level of perceived stigma. These findings suggest that MDD patients who are young, have a high degree of interpersonal sensitivity and psychoticism, have low health-related quality of life, and have low social support are the target population for stigma interventions in Asia.

Patient-reported depression severity and cognitive symptoms as determinants of functioning in patients with major depressive disorder: a secondary analysis of the 2-year prospective PERFORM study

PURPOSE

To investigate the temporal interrelationship between depression severity, cognitive symptoms, and functioning in patients with major depressive disorder (MDD) in the PERFORM study (NCT01427439).

PATIENTS AND METHODS

PERFORM was a 2-year, multicenter, prospective, noninterventional cohort study in outpatients with MDD who were either initiating antidepressant monotherapy or undergoing their first switch of antidepressant. Patients were enrolled by a general practitioner or psychiatrist. Structural equation model (SEM) analysis was used to explore temporal associations between patient-reported depression severity (9-item Patient Health Questionnaire score), cognitive symptoms (5-item Perceived Deficits Questionnaire score), and functional impairment (Sheehan Disability Scale total score). Standardized regression coefficients (SRCs) were used to evaluate the relationship between each outcome and scores from the most recent prior visit over the 2 years of follow-up.

RESULTS

Between February 25, 2011, and February 19, 2015, 1,159 eligible patients with MDD completed the baseline and ≥1 follow-up visit at 194 sites in five European countries (France, Germany, Spain, Sweden, and the UK). Overall, 1,090 patients had assessments for ≥1 outcome measure at two consecutive visits. Severity of cognitive symptoms at baseline and Months 2 and 18 predicted functional impairment at Months 2, 6, and 24, respectively (SRC: 0.18, 0.15, and 0.22; P<0.001). Depression severity at Months 2, 6, and 12 predicted functional impairment at Months 6, 12, and 18, respectively (SRC: 0.17, 0.25, and 0.22; P<0.001). Severity of cognitive symptoms at baseline and Month 18 predicted depression severity at Months 2 and 24, respectively (SRC: 0.19 and 0.22; P<0.001). Functional impairment did not significantly predict the severity of depression or cognitive symptoms, and depression severity did not significantly predict the severity of cognitive symptoms at any time point.

CONCLUSION

Patient-reported severity of cognitive symptoms appears to be an independent and significant determinant of subsequent functional impairment and depression severity in patients with MDD.

Cognitive symptoms in major depressive disorder: associations with clinical and functional outcomes in a 6-month, non-interventional, prospective study in China

Objective: Cognitive symptoms in major depressive disorder (MDD) are common and may negatively impact clinical and functional outcomes. The Prospective Research Observation to Assess Cognition in Treated patients with MDD (PROACT) study aimed to assess the prevalence and course of cognitive symptoms, and their associations with clinical and functional outcomes during 6 months of antidepressant treatment, in a real-world setting among Chinese patients with MDD. Patients and methods: Outpatients (n=598) aged 18-65 years with MDD and a total score ≥17 on the Hamilton Depression Rating Scale - 17 Items (HAM-D₁₇) were observed over 6 months after initiating new antidepressant monotherapy, with follow-up visits at months 1, 2, and 6. Cognitive symptoms were assessed using the Perceived Deficits Questionnaire - Depression (PDQ-D) and cognitive performance using the Digit Symbol Substitution Test (DSST). Results: At baseline, 76.9% of patients had indications of cognitive symptoms (PDQ-D total score ≥21); at month 6, this was reduced, but still present in 32.4%. Across the 6-month study period, patients improved across cognitive, clinical and functional assessments. High levels of cognitive symptoms (PDQ-D) consistently predicted worse clinical outcomes, ie, lower odds for remission and increased odds for relapse, as well as worse patient-reported functional outcomes and lower quality of life. In contrast, cognitive performance (DSST) predicted performance-based functioning but only a few patient-reported functional outcomes (absenteeism and quality of life), and no clinical outcomes. PDQ-D and DSST scores were uncorrelated at baseline. Conclusion: The study highlights the importance of assessing and targeting cognitive symptoms for increasing patients' chances of recovery and restoring functioning in the treatment of MDD. The results further highlight the relevance of complementary assessment methods to fully capture aspects of cognitive symptoms in patients with depression.

Cognitive complaints and predictors of perceived cognitive dysfunction in adults with major depressive disorder: Findings from the Cognitive Dysfunction in Asians with Depression (CogDAD) study

BACKGROUND

Several studies have described the presence of perceived cognitive dysfunction amongst Asian patients with major depressive disorder (MDD). To date, no study has been conducted investigating the predictors of perceived cognitive dysfunction amongst Asian MDD patients.

METHODS

This was a post-hoc analysis of the Cognitive Dysfunction in Asian patients with Depression (CogDAD) study. Descriptive statistics were used to describe the most common cognitive complaints by patients. Univariate and multivariate analyses were performed to determine variables associated with perceived cognitive dysfunction (Perceived Deficit Questionnaire-Depression, PDQ-D).

RESULTS

The CogDAD study population is comprised of MDD patients with mild-to-moderate depression (Patient Health Questionnaire 9-item [PHQ-9]: 11.3 ± 6.9) who reported perceived cognitive dysfunction (PDQ-D = 22.6 ± 16.2). The most common cognitive complaints were: mind drifting (42.3%), trouble making decision (39.6%) and trouble concentrating (38.0%). Predictors of perceived cognitive dysfunction were: being Southeast Asians (vs. Taiwanese) (p < 0.001), current episode longer than 8 weeks (vs. 1-8 weeks) (p < 0.05), the presence of disability (vs. no disability) (p < 0.05), younger age (p < 0.01), and higher PHQ-9 total scores (p < 0.001).

LIMITATIONS

The causal relationship between predictive variables and PDQ-D could not be tested due to the cross-sectional nature of the study. Furthermore, a neuropsychological test was not included in the CogDAD study and use of concomitant medications, including anti-depressants, could have impacted patient's perceived cognitive ability.

CONCLUSIONS

The present study results suggest a potential role for subjective cognitive assessment in patients with MDD who are young, with long durations of depression or severe depression.

Functional impairment in patients with major depressive disorder: the 2-year PERFORM study

BACKGROUND

The Prospective Epidemiological Research on Functioning Outcomes Related to Major depressive disorder (PERFORM) study describes the course of depressive symptoms, perceived cognitive symptoms, and functional impairment over 2 years in outpatients with major depressive disorder (MDD) and investigates the patient-related factors associated with functional impairment.

METHODS

This was a 2-year observational study in 1,159 outpatients with MDD aged 18-65 years who were either initiating antidepressant monotherapy or undergoing their first switch of antidepressant. Functional impairment was assessed by the Sheehan Disability Scale and the Work Productivity and Activity Impairment questionnaire. Patients assessed depression severity using the nine-item Patient Health Questionnaire and severity of perceived cognitive symptoms using the five-item Perceived Deficit Questionnaire. To investigate which patient-related factors were associated with functional impairment, univariate analyses of variance were performed to identify relevant factors that were then included in multivariate analyses of covariance at baseline, month 2, months 6 and 12 combined, and months 18 and 24 combined.

RESULTS

The greatest improvement in depressive symptoms, perceived cognitive symptoms, and functional impairment was seen immediately (within 2 months) following initiation or switch of antidepressant therapy, followed by more gradual improvement and long-term stabilization. Improvement in perceived cognitive symptoms was less marked than improvement in depressive symptoms during the acute treatment phase. Functional impairment in patients with MDD was not only associated with severity of depressive symptoms but also independently associated with severity of perceived cognitive symptoms when adjusted for depression severity throughout the 2 years of follow-up.

CONCLUSION

These findings highlight the burden of functional impairment in MDD and the importance of recognizing and managing cognitive symptoms in daily practice.

Cognitive Dysfunction in Asian Patients with Depression (CogDAD): A Cross-Sectional Study

BACKGROUND

Cognitive dysfunction is a predominant symptom of Major Depressive Disorder (MDD), contributing to functional impairment.

OBJECTIVE

The primary objective of this study was to assess and describe perceived cognitive dysfunction amongst Asian patients diagnosed with MDD. The secondary objective was to explore the associations between depression severity, perceived cognitive dysfunction and functional disability.

METHODS

This was a multi-country, multi-centre, cross-sectional study. Adults with a current episode of MDD were recruited from 9 university/general hospital clinics in Asia. During a single study visit, psychiatrists assessed depression severity (Clinical Global Impression-Severity, CGI-S); patients completed questionnaires assessing depression severity (Patient Health Questionnaire-9 items, PHQ-9), perceived cognitive dysfunction (Perceived Deficit Questionnaire-Depression, PDQ-D) and functional disability (Sheehan Disability Scale, SDS).

RESULTS

Patients (n=664), predominantly women (66.3%), were aged 46.5±12.5 years, lived in urban areas (81.3%) and were employed (84.6%). 51.5% of patients were having their first depressive episode; 86.7% were receiving treatment; 82.2% had a current episode duration >8 weeks. Patients had mild-to-moderate depression (CGI-S=3.3±1.0; PHQ-9=11.3±6.9). Patients reported perceived cognitive dysfunction (PDQ-D=22.6±16.2) and functional disability (SDS=11.3±7.9). PHQ-9, PDQ-D and SDS were moderately-to-highly correlated (PHQ-9 and SDS: r=0.72; PHQ-9 and PDQ-D: r=0.69; PDQ-D and SDS, r=0.63). ANCOVA showed that after controlling for patient-reported depression severity (PHQ-9), perceived cognitive dysfunction (PDQ-D) was significantly associated with functional disability (SDS) (p<0.001).

CONCLUSIONS

Asian patients with MDD reported perceived cognitive dysfunction. There is a need for physicians to evaluate cognitive dysfunction in the clinical setting in order to reach treatment goals, including functional recovery beyond remission of mood symptoms.

Clinical and socio-demographic correlates of anxious distress in Asian outpatients with major depressive disorder

BACKGROUND

Anxious distress in major depressive disorder (MDD) is common and associated with poor outcomes and management difficulties.

AIMS

This post hoc analysis aimed to examine the socio-demographic and clinical correlates of anxiety distress in Asian outpatients with MDD.

METHODS

Instead of two out of five specifiers defined by the Diagnostic and Statistical Manual Version-5, anxious distress defined in this study was operationalized as the presence of at least two out of four proxy items drawn from the 90-item Symptom Checklist, Revised (SCL-90-R). Other measures included the Montgomery-Asberg Depression Rating Scale (MADRS), the Fatigue Severity Scale, the Sheehan Disability Scale and the Multidimensional Scale of Perceived Social Support.

RESULTS

The data of 496 patients with MDD were included. Anxious distress was found in 371 participants (74.8%). The binary logistic regression analysis found that anxious distress was independently and significantly correlated with working status, higher MADRS scores, severe insomnia and functional impairment.

CONCLUSIONS

Three-fourths of Asian patients with MDD in tertiary care settings may have DSM-5 anxious distress of at least moderate distress. Its prevalence may vary among working groups. The specifier was associated with greater depressive symptom severity, severe insomnia and functional impairment.

Correlates of Disability in Asian Patients With Major Depressive Disorder

PURPOSE

To examine correlates of disability in Asian patients with major depressive disorder (MDD).

DESIGN AND METHODS

Participants were outpatients with DSM-IV MDD. Global disability and three disability domains (i.e., work/school, social life/leisure, and family/home life) were key outcomes. Several socio-demographic and clinical characteristics were determined for their associations with disability.

FINDINGS

The sample was 493 MDD patients. Apart from the number of hospitalizations, the global disability was significantly associated with depression severity, fatigue, physical health, and mental health. Several clinical but only few socio-demographic characteristics associated with the other three disability domains were similar.

PRACTICE IMPLICATIONS

Disability among Asian patients with MDD correlates with the severity of psychiatric symptoms and the hospitalizations due to depression. Socio-demographic characteristics have little impact on the overall disability.

A cross-sectional study of functional disabilities and perceived cognitive dysfunction in patients with major depressive disorder in South Korea: The PERFORM-K study

PERFORM-K was a cross-sectional observational study that investigated functional disability, productivity and quality of life in MDD outpatients in South Korea, and the associations of these with depressive symptoms, perceived cognitive dysfunction and other factors. A total of 312 outpatients who started antidepressant monotherapy underwent a single study interview. Physicians and patients assessed depression severity. Patients also assessed: perceived cognitive dysfunction, functional disability, impaired productivity and quality of life. Patients had moderate to severe depression (MADRS mean total score: 28.9±7.3), and reported marked functional disability (SDS mean total score: 16.7±8.6), impaired productivity (WPAI mean overall work productivity loss: 52.4±31.8%), perceived cognitive dysfunction (PDQ-D mean total score: 29.9±18.6) and impaired quality of life (EQ-5D mean utility index score of 0.726±0.192). Greater functional disability and impairment in daily activities were associated with more severe depression and greater perceived cognitive dysfunction. Irrespective of depression severity, patients with more severe perceived cognitive dysfunction reported worse work-related productivity outcomes (higher presenteeism and greater overall work productivity loss). PERFORM-K confirms the impact of MDD on functional status and well-being in South Korean patients, and highlights the importance of recognising cognitive dysfunction in clinical practice.

Italian neurologists' perception on cognitive symptoms in major depressive disorder

The assessment of cognition is an important part of major depressive disorder (MDD) evaluation and a crucial issue is the physicians' perception of cognitive dysfunction in MDD that remains nowadays a little known matter. The present study aims at investigating the understanding of neurologists' perception about cognitive dysfunction in MDD. An on-line survey addressed to 85 Italian neurologists in the period between May and June 2015 was performed. The questionnaire comprised three sections: the first section collecting information on neurologists' socio-demographic profile, the second investigating cognitive symptoms relevance in relation with different aspects and the third one explicitly focusing on cognitive symptoms in MDD. Cognitive symptoms are considered most significant among DSM-5 symptoms to define the presence of a Major Depressive Episode in a MDD, to improve antidepressant therapy adherence, patients' functionality and concurrent neurological condition, once resolved. Furthermore, an incongruity came to light from this survey: the neurologists considered cognitive symptoms a not relevant aspect to choose the antidepressant treatment in comparison with the other DSM-5 symptoms on one side, but they declared the opposite in the third part of the questionnaire focused on cognitive symptoms. Cognitive symptoms appeared to be a relevant aspect in MDD and neurologists have a clear understanding of this issue. Nevertheless, the discrepancy between neurologists' perception on cognitive symptoms and the antidepressant treatment highlights the feeling of an unmet need that could be filled increasing the awareness of existing drugs with pro-cognitive effects.

Sleep disturbance among people with major depressive disorders (MDD) in Singapore

BACKGROUND

Sleep problems are common with major depressive disorder (MDD), which has been identified as the most pervasive mental disorder in Singapore.

AIMS

This study aimed to establish the prevalence of sleep disturbance among adults with lifetime and 12-month MDD, as well as its socio-demographic and clinical correlates.

METHOD

Data were collected from the Singapore Mental Health Study, a cross-sectional epidemiological survey of the local residential population aged ≥18 years. Using the CIDI 3.0, 417 and 181 respondents with lifetime and 12-month MDD were included in the analysis.

RESULTS

The prevalence of insomnia-related sleep disturbance among those with lifetime and 12-month MDD was 90.9% and 91.4%, respectively. Multiple logistic regression analyses revealed ethnicity, education and the number of depressive episodes as well as clinical comorbidities such as obsessive compulsive disorder, diabetes and hypertension to be significantly associated with sleep disturbance among those with lifetime MDD. However, only 28.6% of those with sleep disturbance sought help from a professional.

CONCLUSIONS

The proportion of Singaporeans with MDD who have sleep disturbance is high, with increased risk for mental and physical health problems. Given the low rate of treatment contact, individuals with MDD must be screened and treated for sleep disturbance.

Psychological distress and dyslipidemia in chinese police officers: a 4-year follow-up study in Tianjin, China

OBJECTIVE

This study aimed at investigating whether psychological distress in police officers was associated with dyslipidemia.

METHODS

A survey was conducted to examine the psychological distress among 5867 police officers in Tianjin, China, from 2007 to 2011. Psychological distress was measured using the Symptom Check List-90-Revised. Cox proportional hazard regression was used to calculate the hazard ratios (HR) of the incidence of dyslipidemia predicted by psychological distress.

RESULTS

Among the 3300 participants without dyslipidemia at baseline (2567 with dyslipidemia), 60.5% (n = 1829) developed incident dyslipidemia 2.61 years (median) later. The adjusted HR was 1.15 (95% confidence interval, 1.05 to 1.26) after the adjustment of police classifications and other variables. The adjusted HR for police officers in charge of traffic control was 1.30 (95% confidence interval, 1.09 to 1.56).

CONCLUSIONS

Further investigations for associations of psychological factors with dyslipidemia and cardiovascular diseases are needed.

Clinical and sociodemographic correlates of severe insomnia in psychotropic drug-free, Asian outpatients with major depressive disorder

BACKGROUND

Little has been known regarding the correlates of severe insomnia in major depressive disorder (MDD). This post-hoc analysis aimed to examine the sociodemographic and clinical correlates of severe insomnia in psychotropic drug-free, Asian adult outpatients with MDD.

METHODS

Participants were psychotropic drug-free patients with MDD, aged 18-65 years. By using the Symptom Checklist-90 Items, Revised (SCL-90-R), a score of 4 (severe distress) on any one of three insomnia items was defined as severe insomnia. Other measures included the Montgomery-Asberg Depression Rating Scale (MADRS), the Fatigue Severity Scale (FSS), the nine psychopathology subscales of SCL-90-R, the Physical and Mental Component Summaries of Short Form Health Survey (SF-36 PCS and SF-36 MCS), and the Sheehan Disability Scale (SDS).

RESULTS

Of 528 participants, their mean age being 39.5 (SD=13.26) years, 64.2% were females, and 239 (45.3%) had severe insomnia. The logistic regression model revealed that low educational qualifications (less than secondary school completion), high SCL-90-R Depression scores, high SCL-90-R Anxiety scores, and low SF-36 PCS scores were independently correlated with severe insomnia (p's<.05).

LIMITATIONS

Insomnia was determined only by the patient's distress. Middle insomnia was not assessed. Psychotropic drug-free patients with MDD are not commonly seen in psychiatric practice.

CONCLUSION

Severe insomnia is common in patients with MDD. It is closely related with low educational qualification, subjective depression and anxiety severity, and poor physical health. These findings may implicate the treatment of comorbid MDD and severe insomnia, for example, sleep hygiene education, pharmacological treatment.

Subjective memory and concentration deficits in medication-free, non-elderly Asians with major depressive disorder: prevalence and their correlates

BACKGROUND

Subjective cognitive impairment (SCI) in major depressive disorder (MDD) is prevalent and correlated with disability. This study aimed to examine the prevalence rates and correlates of subjective memory deficit (SMD) and subjective concentration deficit (SCD) in medication-free, non-elderly Asians with MDD.

METHODS

The SMD and SCD were assessed by using two items of the Symptom Checklist-90-Revised (SCL-90-R). Other measurements of interest included the Montgomery-Asberg Depression Rating Scale (MADRS), the Fatigue Severity Scale (FSS), the Sheehan Disability Scale (SDS), and the Short Form Health Survey (SF-36). Adjusted odds ratios with 95% confidence intervals were calculated.

RESULTS

Of 515 participants from China, Korea, Malaysia, Singapore, Taiwan, and Thailand, 347 (67.4%) and 377 (73.2%) had SMD and SCD, respectively. In total, 420 participants (81.6%) had SMD alone, SCD alone, and both deficits. Severe depression and poor mental health were significant correlates of SMD. Severe depression, clinically significant disability, poor physical health, and poor mental health were significantly independent correlates of SCD. Compared with young adults (18-34 years), older adults aged 50-65 years had a significantly lower risk of SCD (OR=.33, 95% CI: .19-.57).

LIMITATIONS

Only two SCL-90-R items were used to assess the SMD and SCD. The exclusion of MDD patients treated with psychotropic medications eliminated many patients commonly seen in typical clinic settings.

CONCLUSION

SMD and SCD are prevalent in medication-free, non-elderly Asians with MDD. Both deficits are correlated with depression and mental health status. The independent correlation between SCD and disability underscores the crucial role of SCI in MDD.

Clinical and sociodemographic correlates of suicidality in patients with major depressive disorder from six Asian countries

BACKGROUND

East Asian countries have high suicide rates. However, little is known about clinical and sociodemographic factors associated with suicidality in Asian populations. The aim of this study was to evaluate the factors associated with suicidality in patients with major depressive disorder (MDD) from six Asian countries.

METHODS

The study cohort consisted of 547 outpatients with MDD. Patients presented to study sites in China (n = 114), South Korea (n = 101), Malaysia (n = 90), Singapore (n = 40), Thailand (n = 103), and Taiwan (n = 99). All patients completed the Mini-International Neuropsychiatric Interview (MINI), the Montgomery-Asberg Depression Rating Scale (MADRS), the Global Severity Index(SCL-90R), the Fatigue Severity Scale, the 36-item short-form health survey, the Sheehan Disability Scale, and the Multidimensional Scale of Perceived Social Support (MSPSS). Patients were classified as showing high suicidality if they scored ≥ 6 on the MINI suicidality module. Multivariate logistic regression analysis was used to examine sociodemographic and clinical factors related to high suicidality.

RESULTS

One hundred and twenty-five patients were classed as high suicidality. Unemployed status (adjusted odds ratio [OR] 2.43, p < 0.01), MADRS score (adjusted OR 1.08), p < 0.001, and GSI (SCL-90R) score (adjusted OR 1.06, p < 0.01) were positively related to high suicidality. Hindu (adjusted OR 0.09, p < 0.05) or Muslim (adjusted OR 0.21, p < 0.001) religion and MSPSS score (adjusted OR 0.82, p < 0.05) were protective against high suicidality.

CONCLUSIONS

A variety of sociodemographic and clinical factors were associated with high suicidality in Asian patients with MDD. These factors may facilitate the identification of MDD patients at risk of suicide.