Response bias influences mental health symptom reporting in patients with obstructive sleep apnea

Heterogeneity in patterns of posttraumatic stress disorder symptoms and sleep disturbances among firefighters: Latent profile analyses

Firefighters are at increased risk for posttraumatic stress disorder (PTSD) symptoms and sleep disturbances due to occupational trauma exposure as well as the nature of their job (e.g., shift work, workplace stress). PTSD symptoms co-occur with sleep disturbances, including poor sleep quality, short sleep duration, and low sleep efficiency. No published studies have examined subgroups of firefighters based on PTSD symptoms and sleep disturbances. Thus, we used latent profile analysis to identify the best-fitting class solution to categorize firefighters based on endorsed PTSD symptoms and sleep disturbances and examined relations between the optimal class solution and health covariates (i.e., anger reactions, depression symptoms, emotion regulation difficulties, number of traumatic event types). The sample included 815 trauma-exposed firefighters (M_age = 38.63; 93.20% male). Results indicated three latent subgroups: High PTSD-Sleep Disturbances, Moderate PTSD-Sleep Disturbances, and Low PTSD-Sleep Disturbances. Multinomial logistic regression indicated that endorsing greater anger reactions, depression symptoms, and emotion regulation difficulties increased the chances of being in the more severe classes. Endorsing greater number of traumatic event types increased the chances of being in the Moderate vs. Low PTSD-Sleep Disturbances Classes. Findings improve our understanding of subgroups of firefighters based on PTSD and sleep disturbances and underscore the importance of addressing depression symptoms, anger management, and emotion regulation skills for firefighters reporting more severe PTSD symptoms and sleep disturbances.

Association of Anxiety and Depression in Obstructive Sleep Apnea Patients: A Systematic Review and Meta-Analysis

Background: Obstructive sleep apnea (OSA) has been associated with mental disorders, but the strength of this association is unknown. The aim of our study was to investigate the association among OSA, depression, and anxiety in adults and to quantitatively summarize the results. Methods: A literature search in Medline, PubMed, PsycInfo, Scopus, and Web of Science was conducted. Seventy-three articles were selected for study. Results: The pooled prevalence of depressive and anxious symptoms in OSA patients was 35% (95% CI, 28-41%) and 32% (95% CI, 22-42%), respectively. Conclusions: The association between OSA, anxiety, and depression indicates the value of an early diagnosis and personalized treatment of OSA to improve mental disorders conditioning compliance to therapy. These conditions share a probably bidirectional relationship.

Long-Term Mental Health Outcomes in Mothers and Siblings of Children With Cancer: A Population-Based, Matched Cohort Study

PURPOSE

Although a diagnosis of childhood cancer can have a profound effect on the entire family unit, its impact on the long-term mental health of family members is not well characterized.

METHODS

A provincial childhood cancer registry in Ontario, Canada, was linked to birth records to identify separate population-based cohorts of mothers and siblings of children diagnosed with cancer between 1998 and 2014. The mother and sibling cohorts were matched to corresponding population controls and linked to health services data. The rate of mental health-related outpatient visits (family physician, psychiatrist) and the incidence of severe psychiatric events (psychiatric emergency department visit, psychiatric hospitalization, suicide) were compared between mothers and siblings and their controls. Possible predictors of mental health outcomes were examined, including demographics, characteristics of the cancer-affected child, and cancer treatment.

RESULTS

We identified 4,773 mothers and 7,897 siblings of children diagnosed with cancer during the study period. Compared with controls, both groups experienced elevated rates of outpatient visits (mothers: rate ratio [RR], 1.4; P < .0001; siblings: RR, 1.1; P < .0001). The risk of severe psychiatric events was not increased in either cohort. Mother and sibling demographic factors associated with increased risk of adverse mental health included younger maternal age at cancer diagnosis, low socioeconomic status, and rural residence among mothers and older sibling age among siblings. Treatment-related variables pertaining to the cancer-affected child were not associated with mental health outcomes. Mental health outcomes clustered within families.

CONCLUSION

Both mothers and siblings experience elevated and prolonged need for mental health-related health care as compared with the general population. Demographic risk factors predict subpopulations at highest risk. Increased psychosocial support for family members during and after cancer therapy is warranted.

Sleep apnea is associated with an increased risk of mood disorders: a population-based cohort study

PURPOSE

The symptoms of sleep apnea, such as sleep fragmentation and oxygen desaturation, might be risk factors for subsequent mood disorder (MD), but associations between sleep apnea and MD remain unclear. This nationwide population-based study thus aimed to identify the risk of MD in patients with vs. without sleep apnea.

METHODS

This cohort study used data from the National Health Insurance database. In total, 5415 patients diagnosed with sleep apnea between 2000 and 2010 were evaluated, and 27,075 matched non-sleep apnea enrollees were included as a comparison cohort. All subjects were followed until 2011. The Cox proportional hazard ratio (HR) was used to investigate the relationship between MD and sleep apnea while controlling covariates and comorbidities of sleep apnea.

RESULTS

Of 5415, 154 patients with sleep apnea (2.84 %) were diagnosed with MD during the follow-up period in comparison with 306 of 27,075 individuals (1.13 %) without antecedent sleep apnea. After adjusting for the selected factors and comorbidities, we found that patients with sleep apnea were from 1.82- to 2.07-fold greater risk of MD than the comparisons. Of the three subcategories of MD (major depressive disorder, bipolar disorder, and unspecified MD), sleep apnea had the highest predisposing risk with respect to major depressive disorder (adjusted HR from 1.82 to 2.07) and bipolar disorder (adjusted HR from 2.15 to 3.24).

CONCLUSIONS

There is a greater likelihood of MD manifesting in patients with a history of sleep apnea. Health professionals are thus advised to carefully monitor the psychological impacts of sleep apnea.

Rethinking Social Desirability Scales: From Impression Management to Interpersonally Oriented Self-Control

Social desirability (specifically, impression management) scales are widely used by researchers and practitioners to screen individuals who bias self-reports in a self-favoring manner. These scales also serve to identify individuals at risk for psychological and health problems. The present review explores the evidence with regard to the ability of these scales to achieve these objectives. In the first part of the review, I present six criteria to evaluate impression management scales and conclude that they are unsatisfactory as measures of response style. Next, I explore what individual differences in impression management scores actually do measure. I compare two approaches: a defensiveness approach, which argues that these scales measure defensiveness that stems from vulnerable self-esteem, and an adjustment approach, which suggests that impression management is associated with personal well-being and interpersonal adjustment. Data from a wide variety of fields including social behavior, affect and well-being, health, and job performance tend to favor the adjustment approach. Finally, I argue that scales measuring impression management should be redefined as measures of interpersonally oriented self-control that identify individuals who demonstrate high levels of self-control, especially in social contexts.

What pre-deployment and early post-deployment factors predict health function after combat deployment?: a prospective longitudinal study of Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) soldiers

Background

Physical and mental function are strong indicators of disability and mortality. OEF/OIF Veterans returning from deployment have been found to have poorer function than soldiers who have not deployed; however the reasons for this are unknown.

Methods

A prospective cohort of 790 soldiers was assessed both pre- and immediately after deployment to determine predictors of physical and mental function after war.

Results

On average, OEF/OIF Veterans showed significant declines in both physical (t=6.65, p<.0001) and mental function (t=7.11, p<.0001). After controlling for pre-deployment function, poorer physical function after deployment was associated with older age, more physical symptoms, blunted systolic blood pressure reactivity and being injured. After controlling for pre-deployment function, poorer mental function after deployment was associated with younger age, lower social desirability, lower social support, greater physical symptoms and greater PTSD symptoms.

Conclusions

Combat deployment was associated with an immediate decline in both mental and physical function. The relationship of combat deployment to function is complex and influenced by demographic, psychosocial, physiological and experiential factors. Social support and physical symptoms emerged as potentially modifiable factors.

Psychological distress among Plains Indian mothers with children referred to screening for Fetal Alcohol Spectrum Disorders

Background

Psychological distress (PD) includes symptoms of depression and anxiety and is associated with considerable emotional suffering, social dysfunction and, often, with problematic alcohol use. The rate of current PD among American Indian women is approximately 2.5 times higher than that of U.S. women in general. Our study aims to fill the current knowledge gap about the prevalence and characteristics of PD and its association with self-reported current drinking problems among American Indian mothers whose children were referred to screening for fetal alcohol spectrum disorders (FASD).

Methods

Secondary analysis of cross-sectional data was conducted from maternal interviews of referred American Indian mothers (n = 152) and a comparison group of mothers (n = 33) from the same Plains culture tribes who participated in an NIAAA-funded epidemiology study of FASD. Referred women were from one of six Plains Indian reservation communities and one urban area who bore children suspected of having an FASD. A 6-item PD scale (PD-6, Cronbach's alpha = .86) was constructed with a summed score range of 0-12 and a cut-point of 7 indicating serious PD. Multiple statistical tests were used to examine the characteristics of PD and its association with self-reported current drinking problems.

Results

Referred and comparison mothers had an average age of 31.3 years but differed (respectively) on: education (<high school: 47.4%, 9.1%), PD-6 mean scores (3.57, 1.48), current prevalence of serious PD (19.1%, 0.0%), and a current drinking problem (31.6%, 12.1%). Among referred mothers, those with a current drinking problem had a significantly higher mean PD-6 score. Having PD, serious PD, and 2 specific scale items significantly increased the odds that a referred mother would have a current drinking problem.

Conclusions

Psychological distress among referred mothers is significantly associated with having a self-reported drinking problem. FASD prevention requires multi-level prevention efforts that provide real opportunities for educational attainment and screening and monitoring of PD and alcohol use during the childbearing years. Mixed methods studies are needed to illuminate the social and cultural determinants at the base of the experience of PD and to identify the strengths and protective factors of unaffected peers who reside within the same communities.

Dream-enacting behaviors in a normal population

STUDY OBJECTIVES

Determine the prevalence and gender distributions of behaviors enacted during dreaming ("dream-enacting [DE] behaviors") in a normal population; the independence of such behaviors from other parasomnias; and the influence of different question wordings, socially desirable responding and personality on prevalence.

DESIGN

3-group questionnaire study.

SETTING

University classrooms

PARTICIPANTS

Three undergraduate samples (Ns = 443, 201, 496; mean ages = 19.9 +/- 3.2 y; 20.1 +/- 3.4 y; 19.1 +/- 1.6 y).

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

Subjects completed questionnaires about DE behaviors and Social Desirability. Study 1 employed a nonspecific question about the behaviors, Study 2 employed the same question with examples, and Study 3 employed 7 questions describing specific behavior subtypes (speaking, crying, smiling/laughing, fear, anger, movement, sexual arousal). Somnambulism, somniloquy, nightmares, dream recall, alexithymia, and absorption were also assessed. Factor analyses were conducted to determine relationships among DE behaviors and their independence from other parasomnias. Prevalence increased with increasing question specificity (35.9%, 76.7%, and 98.2% for the 3 samples). No gender difference obtained for the nonspecific question, but robust differences occurred for more specific questions. Females reported more speaking, crying, fear and smiling/laughing than did males; males reported more sexual arousal. When controlling other parasomnias and dream recall frequency, these differences persisted. Factor solutions revealed that DE behaviors were independent of other parasomnias and of dream recall frequency, except for an association between dream-talking and somniloquy. Sexual arousal was related only to age. Behaviors were independent of alexithymia but moderately related to absorption.

CONCLUSIONS

Dream-enacting behaviors are prevalent in healthy subjects and sensitive to question wording but not social desirability. Subtypes are related, differ with gender and occur independently of other parasomnias.

Temporal trends in health-related quality of life among hemodialysis patients in the United States

BACKGROUND AND OBJECTIVES

Health-related quality of life (HRQOL) is a measure of the well being of hemodialysis patients and an independent prognostic predictor. Our aim was to determine whether HRQOL among hemodialysis patients has changed over time.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We retrospectively analyzed data collected by Dialysis Clinic, Inc. from adult patients starting hemodialysis between January 1, 1997 and May 31, 2006. The primary outcome was HRQOL assessed by Short Form 36, 6 to 18 months after and closest to the 1-year anniversary of starting hemodialysis. Secular trends were analyzed by linear regression for continuous variables and logistic regression for categorical ones. Year of starting dialysis was the predictor. A five-point difference on a 0 to 100 scale was considered clinically significant.

RESULTS

Short Form 36 scores were available for 11,079 patients. Role physical, general health, vitality, social functioning, and physical component summary scores were unchanged among patients over the study period. Statistically significant (P < 0.05) but clinically insignificant changes were observed in physical functioning (-0.2 points/yr), bodily pain (+0.2 points/yr), mental health (+0.15 points/yr), and mental component summary scores (+0.13 points/yr). Only role emotional showed clinically significant improvement. Trends were unchanged after adjusting for age, gender, race, diabetes, hemoglobin, phosphorous, Kt/V, and albumin.

CONCLUSIONS

Most HRQOL domains showed either no statistically significant change or statistically but not clinically significant change over almost a decade. These results suggest that, despite important developments in hemodialysis care since 1997, little progress was made in improving HRQOL of hemodialysis patients.

Afraid in the hospital: parental concern for errors during a child's hospitalization

OBJECTIVE

(1) To determine the proportion of parents concerned about medical errors during a child's hospitalization; and (2) the association between this concern and parental self-efficacy with physician interactions.

STUDY DESIGN

Cross-sectional survey.

SETTING

Tertiary care children's hospital.

PARTICIPANTS

Parents of children admitted to the general medical service.

OUTCOME MEASURE

Parental concern about medical errors.

METHODS

: Parents were asked their agreement with the statement "When my child is in the hospital I feel that I have to watch over the care that he/she is receiving to make sure that mistakes aren't made." We used multivariate logistic regression to examine the association between parents' self-efficacy with physician interactions and the need "to watch over a child's care," adjusting for parent and child demographics, English proficiency, past hospitalization, and social desirability bias.

RESULTS

Of 278 eligible parents, 130 completed surveys and 63% reported the need to watch over their child's care to ensure that mistakes were not made. Parents with greater self-efficacy with physician interactions were less likely to report this need (odds ratio [OR], 0.83; 95% confidence interval [CI], 0.72-0.92). All parents who were "very uncomfortable" communicating with doctors in English reported the need to watch over their child's care to prevent mistakes.

CONCLUSIONS

Nearly two-thirds of surveyed parents felt the need to watch over their child's hospital care to prevent mistakes. Parents with greater self-efficacy with physician interactions were less likely to report the need to watch over their child's care while parents with lower English proficiency were more likely to report this need.

The INSPIRE study: do personality traits predict general quality of life (Short form-36) in distressed patients with ulcerative colitis and Crohn's disease?

OBJECTIVE

To assess the role of personality as a predictor of Short form-36 (SF-36) in distressed patients (perceived stress questionnaire, PSQ) with ulcerative colitis (UC) and Crohn's disease (CD).

MATERIAL AND METHODS

Fifty-four patients with CD and 55 with UC (age 18-60 years) who had relapsed in the previous 18 months, i.e. with an activity index (AI) for UC or CD> or =4, PSQ> or =60, and without severe mental or other major medical conditions, completed the Buss-Perry Aggression Questionnaire (BPA), the Neuroticism and Lie scales of the Eysenck Personality Questionnaire (EPQ-N and -L), the Multidimensional Health Locus of Control Scale (LOC) (Internal (I), Powerful Other (PO), Chance (C)), the Toronto Alexithymia Scale (TAS) and the SF-36.

RESULTS

Multiple linear regression analyses controlling for gender, age and clinical disease activity (AI) in separate analyses for UC and CD showed that the mental and vitality subscales were predicted by neuroticism in both UC and CD. The highest explained variance was 43.8% on the "mental" subscale in UC. The social function subscale was related to alexithymia only in UC, while the role limitation and pain subscales were related to personality in CD only. The physical function subscale related differently to personality in UC and CD.

CONCLUSIONS

While mental and vitality subscales were predicted by neuroticism in both UC and CD, other subscales had different relationships to personality, suggesting different psychobiological interactions in UC and CD.

Modeling the hot flash experience in breast cancer survivors

OBJECTIVE

To evaluate relationships among different measures of hot flashes, perceived hot flash interference, and associated outcomes (positive affect, negative affect) while controlling potential covariates.

DESIGN

Breast cancer survivors (N=236) provided demographic data, objective hot flash frequency data via sternal skin conductance monitoring, prospective diary-based hot flash frequency and severity data, and questionnaire data via the Hot Flash Related Daily Interference Scale and the Positive and Negative Affect Scale.

RESULTS

Objective hot flash frequency and subjective hot flash severity emerged as separate factors in the structural equation model. Subjective hot flash frequency was associated with a high degree of unexplained variance (error) and seemed to be a potentially less accurate measure of either frequency or severity. Objective frequency was directly related to greater positive affect. In contrast, greater hot flash severity was (1) directly related to greater perceived hot flash interference and (2) indirectly related to more negative affect and lower positive affect through interference.

CONCLUSIONS

Findings provide a theoretical basis for selecting among symptom measures and anticipating how interventions aimed at different hot flash measures might affect perceived hot flash interference or associated outcomes. Because objective hot flash frequency and subjective hot flash severity seemed to measure different dimensions, measuring both may provide a more comprehensive picture of women's symptom experiences.

Toward family-centered inpatient medical care: the role of parents as participants in medical decisions

OBJECTIVES

To determine parental participation in medical decision-making (MDM) during hospitalization and its association with parental self-efficacy and to explore other factors associated with participation.

STUDY DESIGN

We surveyed parents of children admitted to a pediatric medical unit to measure parental report of participation in MDM during hospitalization and self-efficacy with physician interactions (categorized into tertiles). We performed multivariate logistic regression to evaluate the association between self-efficacy and parental participation, controlling for potential confounders.

RESULTS

One hundred thirty of 278 eligible parents completed surveys and 86% reported participating in MDM about their child's care. After adjusting for covariates, parents with scores in the middle and highest self-efficacy tertiles had higher odds of participating in MDM compared with parents in the lowest tertile. Younger parents and parents of previously hospitalized children were also more likely to participate although parents with a high school education or less were less likely.

CONCLUSIONS

Self-efficacy was significantly associated with parental participation in MDM during hospitalization after adjusting for confounding factors. Interventions to increase self-efficacy may also improve parental participation in MDM.

Prevalence of psychological distress, anxiety and depression in rural communities in Australia

OBJECTIVE

To describe the prevalence of psychological distress, depression and anxiety in three Australian rural settings and to identify the levels of risk by gender and age.

DESIGN AND SETTING

Three cross-sectional surveys in the Greater Green Triangle area covering the south-east of South Australia (Limestone Coast), and south-west (Corangamite Shire) and north-west (Wimmera) of Victoria.

PARTICIPANTS

A total of 1563 people, aged 25-74 years, randomly selected from the electoral roll.

MAIN OUTCOME MEASURES

Psychological distress assessed by the Kessler 10, and anxiety and depression assessed by the Hospital Anxiety and Depression Scale.

RESULTS

The prevalence of psychological distress was 31% for both men and women with two-thirds reporting moderate and one-third high levels of psychological distress. The prevalence of depression and anxiety was approximately 10%. The highest rate of psychological distress, anxiety and depression occurred in the 45-54 years age group. There were no consistent gender or area differences in the prevalence of psychological distress, depression or anxiety.

CONCLUSIONS

A third of the rural population reported psychological distress, with the highest prevalence observed in middle-aged men and women. Thus, health professionals should attend not only to physical health, but also to mental health status in this age group. It is also important to target prevention strategies at the 20% who reported moderate levels of psychological distress in order to prevent the development of more serious conditions.

Why do people report better health by phone than by mail?

CONTEXT

Past research shows that fewer health symptoms are reported by phone than by mail.

OBJECTIVES

We sought to examine whether interview mode-dependent differences in health symptom reporting are the result of socially desirable responding or to expending less cognitive effort when formulating responses, a behavior known as satisficing.

DESIGN

Participants were randomly assigned to telephone interview only or to mail interview followed 2 weeks later by telephone interview.

SETTING & PARTICIPANTS

Participants were American veterans from the Gulf War Registry (n=719).

MAIN OUTCOME MEASURES

Our main outcome measure was the number of mild, moderate, or severe symptoms reported (of 48 possible).

RESULTS

Veterans reported an average of 5 more symptoms via mail than via telephone, F (1, 709) = 32.50, P < 0.001. The difference was mainly the result of symptoms reported by mail as mild but not reported at all by phone. Veterans with higher social desirability scores reported fewer symptoms by phone and mail, F (1, 709) = 10.11, P = 0.001, but social desirability scores did not interact with interview mode. Furthermore, embarrassing symptoms such as genital complaints were no less likely to be reported by phone.

CONCLUSIONS

Reporting of better health in phone surveys is the result of fewer mild symptoms reports but not of socially desirable responding. The findings are consistent with phone interviews encouraging satisficing by limiting the recall of less severe health states. Researchers should handle mild symptom reports with some skepticism.

Sleep Is Related to Physical Function and Emotional Well-Being After Cardiac Surgery

BACKGROUND

Emotional well-being and physical function are important quality-of-life outcomes after cardiac surgery. Alterations in sleep patterns, including sleep deprivation and altered circadian patterning, also are common. The relations among sleep pattern alterations, physical function, and emotional well-being are not well understood.

OBJECTIVE

This study aimed to examine the relations of sleep patterns to physical function and emotional well-being 4 and 8 weeks after cardiac surgery.

METHODS

Cardiac surgery patients (n = 72) wore wrist actigraphs and completed sleep diaries for 3 days during postoperative weeks 4 and 8. They also completed the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, and the Medical Outcomes Survey Short Form 36 preoperatively and at postoperative weeks 4 and 8. Pearson correlations and hierarchical multiple regression analysis were used to analyze the data.

RESULTS

Mean sleep efficiency was 71% at 4 weeks and 74% at 8 weeks, as measured with wrist actigraphy. According to participants' self-report, 64% experienced sleep disturbance at 4 weeks and 47% at 8 weeks. Sleep pattern variables, including sleep efficiency and self-reported sleep quality, explained 16% of the variance in physical function at 4 weeks. Self-reported sleep quality explained 8% of the variance in physical function at 8 weeks as well as 12% of the variance in emotional well-being at postoperative week 4 and 13% of the variance at postoperative week 8, after control was used for the contributions of baseline physical function, emotional well-being, age, and sex.

CONCLUSIONS

The results suggest that sleep contributes to both physical functional and emotional well-being 4 and 8 weeks after cardiac surgery.

Impact of Nasal Continuous Positive Airway Pressure Therapy on the Quality of Life of Bed Partners of Patients With Obstructive Sleep Apnea Syndrome

BACKGROUND

Continuous positive airway pressure (CPAP) improves daytime sleepiness and quality of life in patients with obstructive sleep apnea syndrome (OSAS). However, few studies have examined the impact of treatment on the quality of life of bed partners of these patients.

METHODS

We prospectively studied 55 couples in which one person (the patient) had OSAS diagnosed and was subsequently commenced on CPAP therapy; 45 of these couples shared a bed on a regular basis. Both partner and patient completed postal questionnaires immediately prior to CPAP therapy and again after a median of 8 weeks (interquartile range [IQR], 6 to 12 weeks) of therapy at home. Questionnaires consisted of the Epworth sleepiness scale (ESS), the UK Short Form-36 health survey, and the hospital anxiety and depression scale. No intervention or advice was given to the partner of the patient receiving CPAP therapy.

RESULTS

In addition to the expected significant benefits reported by patients receiving CPAP, bed partners also reported significant improvements in ESS scores (median, 4 [IQR, 1 to 8.5] before CPAP; median, 2 [IQR, 1 to 5] during CPAP), in addition to measures of anxiety, role limitation due to physical problems, role limitation due to emotional problems, social functioning, mental health, and energy/vitality (all p < 0.05 by Wilcoxon-signed rank testing).

CONCLUSIONS

These data support the hypothesis that partners of patients with OSAS benefit significantly from the CPAP therapy their bed partners receive.

Do somatic complaints predict subsequent symptoms of depression?

BACKGROUND

Evidence suggests substantial comorbidity between symptoms of somatization and depression in clinical as well as nonclinical populations. However, as most existing research has been retrospective or cross-sectional in design, very little is known about the specific nature of this relationship. In particular, it is unclear whether somatic complaints may heighten the risk for the subsequent development of depressive symptoms.

METHODS

We report findings on the link between symptoms of somatization (assessed using the SCL-90-R) and depression 5 years later (assessed using the CES-D) in an initially healthy cohort of community adults, based on prospective data from the RENO Diet-Heart Study.

RESULTS

Gender-stratified multiple regression analyses revealed that baseline CES-D scores were the best predictors of subsequent depressive symptoms for men and women. Baseline scores on the SCL-90-R somatization subscale significantly predicted subsequent self-reported symptoms of depressed mood 5 years later, but only in women. However, somatic complaints were a somewhat less powerful predictor than income and age.

CONCLUSIONS

Our findings suggest that somatic complaints may represent one, but not necessarily the most important, risk factor for the subsequent development of depressive symptoms in women in nonclinical populations. The results also highlight the importance of including social variables in studies on women's depression as well as conducting additional research to further examine predictors of depressive symptoms in men.

Evidence-based medicine in sleep apnea surgery

Since the first description of sleep apnea as a clinical entity, the understanding of it within the medical community has increased significantly. Much research has explored the causes, assessment, and treatment of this disease. This research has resulted in a variety of tools for assessment and approaches to treatment. As research progresses, new data have shed light on the strengths of traditional approaches and their limitations. This article gives background for current approaches and charts a potential future course for sleep apnea assessment and treatment.