Longitudinal characteristics of the Center for Epidemiologic Studies--Depression Scale

Comparisons of physical activity and understanding of the importance of exercise according to dialysis modality in maintenance dialysis patients

Data regarding the status of physical activity or understanding of the importance of exercise, such as barriers of exercise or enablers of exercise, in dialysis patients were insufficient. This study aimed to evaluate the status of physical activity and the understanding of the importance of exercise in Korean dialysis patients. The study participants were recruited from 27 hospitals or dialysis centers (n = 1611). Physical activity was evaluated using the Korean version of the International Physical Activity Questionnaire-Short Form. High physical activity was defined as ≥ 600 metabolic equivalent of task (MET). Knowledge about the importance of exercise, enabler for regular exercise, benefits of exercise, and barrier to exercise was evaluated. Health-related quality of life (HRQoL) was assessed by the Kidney Disease Quality of Life version 1.3. The number of participants in the hemodialysis (HD) and peritoneal dialysis (PD) groups was 1247 and 364, respectively. The intensity of physical activity did not differ between the two modalities. The time of physical activity was longer in HD patients than in PD patients, which resulted in greater MET values and the number of high physical activity. There were 762 (61.1%) HD patients and 281 (77.2%) PD patients who heard of the importance of exercise (P < 0.001). In both HD and PD patients, dialysis staff played the most significant role as educators on the importance of exercise and enablers of exercise. The most important barriers to exercise were poor motivation and fatigue in both modalities. HD patients exhibited greater differences in HRQoL scales across two physical activity levels, compared to PD patients. Our study showed that the barrier to exercise and the enablers of exercise were poor motivation/fatigue and encouragement from dialysis staff, respectively.

Depressive Symptomatology, Racial Discrimination Experience, and Brain Tissue Volumes Observed on Magnetic Resonance Imaging

Not much is known about brain structural change in younger populations and minorities. The cross-sectional relationship between depressive symptomatology and racial discrimination with structural measures of brain tissue volume was investigated using magnetic resonance images of 710 participants in the Coronary Artery Risk Development in Young Adults CARDIA Study in 2010. Those reporting depressive symptoms and racial discrimination had lower total brain matter volume compared with those who reported neither (-8.8 mL, 95% confidence interval (CI): -16.4, -1.2), those who reported depressive symptoms only (-10.9 mL, 95% CI: -20.4, -1.4), and those who reported racial discrimination only (-8.6 mL, 95% CI: -16.5, -0.8). Results were similar for total normal white matter. There were 103% higher odds (odds ratio = 2.03, 95% CI: 1.32, 3.14) of being in the highest quartile of white matter hyperintensities in those with depressive symptoms only compared to those without. Although tests for interaction by race were not statistically significant, sensitivity analyses stratified by race revealed inverse associations with total brain matter and total white matter volumes only among black participants with combined depressive symptomatology and experience of racial discrimination, and positive associations only among white participants with depressive symptoms with presence of white matter hyperintensities, suggesting future studies may focus on race.

Self-reported exhaustion, physical activity, and grip strength predict frailty transitions in older outpatients with chronic diseases

Effective screening instruments are necessary for evaluating the outcomes of early interventions for the prevention or delay of disability in older persons. This study examined how transitions in frailty items over 1 year and the baseline components of a comprehensive geriatric assessment were associated with improvements in frailty at a 2-year follow-up in a sample of older patients.This was a single-center prospective observational study of older patients aged 65 years and over with chronic diseases (n = 103), who were followed through a hospital-based program over 2 years. Frailty was evaluated via the modified Fried Frailty Index and a comprehensive geriatric assessment.We noted significant improvements in weight loss (P = .016) and self-reported exhaustion (P = .006), and a less decrease in grip strength (P = .009) at the 1-year follow-up. Furthermore, baseline cerebral vascular accident diagnosis (P = .022), high polypharmacy (P = .037), a higher Geriatric Depression Scale score (P = .033), and a lower Mini Nutritional Assessment score (P = .039) were significantly associated with improved frailty at the 2-year follow-up. Furthermore, improvement in self-reported exhaustion (odds ratio [OR]: 4.7, 1.4-16.1, P = .014) and physical activity (OR: 3.8, 1.0-13.7, P = .046), and a less decrease in grip strength (OR: 4.0, 1.3-12.5, P = .017) at the 1-year follow-up were significantly associated with improved frailty at the 2-year follow-up.Self-reported exhaustion, physical activity, and grip strength are easy, quick, and feasible screening tests for improvements in frailty in clinical practice.

Depression in Primary Caregivers of Patients Listed for Liver or Kidney Transplantation

Background

No studies have examined depression in primary caregivers of adult patients listed for liver or kidney transplantation.

Objective

To determine the prevalence of depression among primary caregivers of patients listed for liver or kidney transplantation and to compare these 2 groups.

Design

A cross-sectional survey was conducted. The Center for Epidemiologic Studies Depression Scale and a demographic questionnaire were sent out and returned by mail.

Results

Of 72 eligible primary caregivers, 42 (58%) participated; the participation rate was similar for caregivers of kidney and liver failure patients (21/32 [66%)] vs 21/40 [53%], P = .3). Mean caregiver age was 54.7 ± 13.6 years. Twenty-three caregivers (54.8%) were spouses, 15 (35.7%) were first-degree relatives, and 26 (62%) were women. Median depression scale score was 5.5 (0–36). Three (7%), 2 (5%), and 3 (7%) participants reported mild, moderate, and severe depression, respectively. Median Center for Epidemiologic Studies Depression Scale score was higher among caregivers of liver versus kidney patients, but the difference was not statistically significant (9 vs 4, P = .2). Depression scale scores did not correlate with age, sex, time listed, or nature or length of relationship with the patient. The prevalence of depression in primary caregivers was 19%; of these caregivers, one third may have had severe depression.

Conclusions

The prevalence of moderate to severe depression in primary caregivers of liver and kidney transplant candidates is significant. The impact of depression on caregivers as well as patients, both before and after transplantation, deserves study. Screening for depression in caregivers could lead to clinical interventions that benefit caregivers and indirectly improve patient outcomes.

The interpersonal theory of suicide applied to male prisoners

The interpersonal theory of suicide proposes that severe suicide ideation is caused by the combination of thwarted belongingness (TB) and perceived burdensomeness (PB), yet few studies have actually examined their interaction. Further, no studies have examined this proposal in male prisoners, a particularly at-risk group. To address this gap, the current study surveyed 399 male prisoners. TB and PB interacted to predict suicide ideation while controlling for depression and hopelessness. High levels of both TB and PB were associated with more severe suicide ideation. The interpersonal theory may aid in the detection, prevention, and treatment of suicide risk in prisoners.

A systematic overview of measurement-based care in the treatment of childhood and adolescent depression

Major depressive disorder (MDD) is one of the most prevalent psychiatric disorders affecting children and adolescents. The significant psychiatric, social, and functional impairments associated with this disorder coupled with the high incidence of relapse indicate a need for continued efforts to enhance treatment. Current empirically supported treatments for childhood and adolescent MDD include psychotropic medications, psychotherapy, and a combination of both treatments, with selection of the most appropriate strategy depending on symptom severity. One strategy to enhance treatment outcome is the use of measurement-based care. This article provides a systematic review of measurement-based care in the treatment of childhood and adolescent MDD. It also presents a comprehensive analysis of widely used depression rating scales and discusses their utility in clinical practice. This review found evidence supporting the utility and benefit of depression rating scales to document depression severity in children and adolescents. We also found evidence suggesting that many of these scales are time efficient, and that both clinician-rated and self-rated scales provide accurate assessment of depressive symptomatology. Future research is warranted to examine the utility of measurement-based care in clinical practice with child and adolescent populations.

Child care and social support modify the association between maternal depressive symptoms and early childhood behaviour problems: a US national study

OBJECTIVE

To investigate the presence and patterns of modification effects of the sex of the child, social support, and childcare on the relation between maternal depressive symptoms and child behaviour problems at two developmental stages.

DESIGN

Analyses are based on prospective longitudinal data from the study of early child care.

PARTICIPANTS

A total of 1216 families were drawn from 10 locations across the USA. Mothers were age 18 or older at the time of the study child's birth and had completed outcome measures for at least one follow up time point (24 months, 36 months).

MAIN OUTCOME MEASURES

Child internalising and externalising behaviour problems assessed at the child's age of 24 months and 36 months, as reported by the mother.

RESULTS

Results from generalised estimating equation analyses showed that the association between child externalising behaviour problems and maternal depressive symptoms varied according to the social support received by the mother (p<0.05). Overall, social support mitigated the relation, but protective effects diminished at increasing levels of depressive symptoms. Associations between child internalising behaviour problems and maternal depressive symptoms varied according to whether or not the child received care from caregivers other than the mother (p<0.05).

CONCLUSIONS

Health providers who are working with mothers with depressive symptoms may want to examine social support that is available to mothers, especially if mothers are not severely depressed. Furthermore, recommendations to begin, continue, or perhaps increase provision of childcare from other caregivers can provide respite for mothers and opportunities for children to engage in protective interactions with others.

Self-concealment, social self-efficacy, acculturative stress, and depression in African, Asian, and Latin American international college students

The primary purpose of this exploratory investigation was to examine self-concealment behaviors and social self-efficacy skills as potential mediators in the relationship between acculturative stress and depression in a sample of 320 African, Asian, and Latin American international college students. The authors found several differences by demography with regard to the study's variables. After controlling for regional group membership, sex, and English language fluency, they found that self-concealment and social self-efficacy did not serve as mediators in the relationship between African, Asian, and Latin American international students' acculturative stress experiences and depressive symptomatology. Implications of the findings are discussed.

Two-year comparison of income, education, and depression among parents participating in regular Head Start or supplementary Family Service Center Services

Changes after 2 years in a Head Start Family Service Center Demonstration Project were assessed through pre-implementation and post-implementation interviews with 80 parents of Head Start children to evaluate changes during the project noted for the children's parents. Compared with parents in regular Head Start, parents in the supplementary Family Service Center project reported more contact with staff, increased their functional literacy scores, and increased their family incomes. The percentage of these parents with high depression scores decreased. These changes encourage implementation of more intensive social services within Head Start programs as a means of effectively assisting Head Start parents.