Subtypes of depressive symptoms and inflammatory biomarkers: An exploratory study on a sample of HIV-positive patients

Depressive symptoms cause major impairment and may accelerate HIV progression despite the use of antiretroviral medication. The somatic symptoms criteria for HIV infection and depression partially overlap, which can make differential diagnosis challenging. Because of chronic inflammation caused by HIV infection, HIV-positive patients may develop somatic and affective-cognitive symptoms of depression. Inflammation-related depression is primarily characterized with severe somatic symptoms such as fatigue and sleep disturbance. This study sought to explore the patterns of somatic and cognitive-affective depressive symptoms that characterize HIV-positive patients. Our specific aims were (1) to identify subtypes of depressive symptoms in a sample of HIV-positive patients; and (2) to test the subtypes’ difference on inflammatory and HIV disease progression biomarkers. HIV-positive men and women (N = 102) with and without depressive symptoms were randomly selected from an Italian HIV clinic. Depressive symptoms (PHQ-9), viral load (VL), CD4+, Il-6, TNF-α, and monocytes were assessed. The three subtypes formed using Latent Class Analysis (LCA) identified patients with (1) severe cognitive-affective and somatic depressive symptoms; (2) severe/moderate somatic symptoms; and (3) absent or low depressive symptoms. The subtype with severe/moderate somatic symptoms was characterized with elevated levels of Il-6 and monocytes. No difference on HIV progression biomarkers was found. The subtypes of depressive symptoms might help differentiating depressive symptoms from HIV- and inflammatory-related somatic symptoms. When present, cognitive-affective and/or somatic symptoms cause significant impairment to patients’ lives and thus warrant further assessment and treatment.     

NGAL and other markers of inflammation as competitive or complementary markers for depressive symptom dimensions in heart failure

Objectives. Neutrophil gelatinase-associated lipocalin (NGAL) is an inflammatory marker associated with the pathophysiology of heart failure (HF), the psychopathology of depression and the co-existing symptoms of depression in HF patients. The aim of this study is to determine whether the association of serum NGAL levels with depressive symptoms dimensions in HF is independent of well-known inflammatory markers. Methods. Serum NGAL, high sensitive C-reactive protein (hsCRP), tumour necrosis factor-α (TNF-α), its two soluble receptors; sTNFR1, sTNFR2, Interleukin-6 (IL-6) and leukocytes were measured in 104 patients with HF at baseline and 12 months. Depressive symptoms were evaluated using the Beck Depression Inventory (BDI) at both timepoints. Correlations between NGAL and inflammatory markers and depressive symptoms dimensions were determined. The effect of hsCRP, IL-6, TNF-α, sTNFR1, sTNFR2 and leukocytes on the association of NGAL with depressive symptoms was determined and adjusted for time, demographics, cardiac disease severity, and kidney function. Results. NGAL levels were significantly correlated with hsCRP, TNF-α, sTNFR1, sTNFR2 and leukocytes. NGAL was significantly associated with somatic depressive symptoms, independent of abovementioned markers. Conclusions. Serum NGAL is an independent inflammatory marker for somatic depressive symptoms in HF and may function as an immunopathogen linking somatic symptoms of depression to HF.     

Neuroticism,introversion, and major depressive disorder—traits,states, or scars?

Background: The extent to which measures of the personality dimensions of neuroticism and introversion are influenced by symptoms of depression and anxiety or by episodes of depression, and whether neuroticism alone or both traits predispose one to depression remain unclear. Methods: Major depressive disorder patients (n=193) from the Vantaa Depression Study were interviewed at baseline and at 6 and 18 months, and a general population comparison group (n=388) was surveyed by mail. Patients' scores of neuroticism and extraversion‐introversion were compared between time points, and before and after a possible recurrence of depression between interviews. Patients' scores at an index interview, when the level of depression was lowest, were compared with scores of the general population, after controlling for anxiety and depression. Results: Among depressive patients, neuroticism scores declined (from 17.2, SD 3.7–13.7, SD 5.6, P<0.001) and extraversion scores increased (from 10.0, SD 4.7–11.2, SD 4.5, P<0.001) with recovery during follow‐up. The scores were not influenced by a recurrence of depression between measurements. In logistic regression, patients had higher neuroticism (odds ratio, OR 1.11, P=0.001) and lower extraversion (OR 0.92, P=0.003) than the general population. Conclusions: The overall level of neuroticism is markedly and introversion somewhat higher in depressive patients than in the general population. Anxiety symptoms have some, and depressive symptoms a strong influence on neuroticism scores, but only depression has an impact on introversion during a depressive episode. In medium‐term follow‐up, depressive episodes are unlikely to result in a personality scar persisting after recovery from an episode. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

What does the beck depression inventory measure in myocardial infarction patients? a psychometric approach using item response theory and person‐fit

Observed associations between depression following myocardial infarction (MI) and adverse cardiac outcomes could be overestimated due to patients’ tendency to over report somatic depressive symptoms. This study was aimed to investigate this issue with modern psychometrics, using item response theory (IRT) and person‐fit statistics to investigate if the Beck Depression Inventory (BDI) measures depression or something else among MI‐patients. An IRT‐model was fit to BDI‐data of 1135 MI patients. Patients’ adherence to this IRT‐model was investigated with person‐fit statistics. Subgroups of “atypical” (low person‐fit) and “prototypical” (high person‐fit) responders were identified and compared in terms of item‐response patterns, psychiatric diagnoses, socio‐demographics and somatic factors. In the IRT model, somatic items had lower thresholds compared to depressive mood/cognition items. Empirically identified “atypical” responders (n = 113) had more depressive mood/cognitions, scored lower on somatic items and more often had a Comprehensive International Diagnostic Interview (CIDI) depressive diagnosis than “prototypical” responders (n = 147). Additionally, “atypical” responders were younger and more likely to smoke. In conclusion, the BDI measures somatic symptoms in most MI patients, but measures depression in a subgroup of patients with atypical response patterns. The presented approach to account for interpersonal differences in item responding could help improve the validity of depression assessments in somatic patients. Copyright © 2015 John Wiley & Sons, Ltd.     

Depressive symptoms and quality of life after thrombolysis in stroke: the TEMPiS study

Intravenous thrombolysis leads to a reduction of post-stroke disability. No data exist about whether depression and poor quality of life (QoL) remain relevant problems in patients with good functional outcome. We assessed mood and QoL at 3 and 6 months after stroke in consecutive patients who received intravenous thrombolysis in stroke centers and telemedicine hospitals within the TEMPiS network. The Beck Depression Inventory (BDI) was used with BDI ≥18 indicating clinically relevant depressive symptoms. Stroke specific quality of life (SSQOL) was used for QoL assessment with the definition of SSQOL total score <60% for poor QoL. Associations of BDI and SSQOL with baseline parameters and modified Rankin scale (mRS) in follow-up were analyzed. In patients with known mRS 0–4 at 3 months (N = 213), BDI was available in 74% and SSQOL in 77%. At 3 and 6 months, 23 and 18% of patients had clinically relevant depressive symptoms; 25 and 24% reported a poor QoL. The mRS at 3 months correlated with BDI (r = 0.43, p < 0.01) and SSQOL (r = −0.75, p < 0.01). BDI ≥18 was observed in 11% of patients with mRS 0–1 and 16% in mRS 0–2. Severe stroke (NIHSS ≥12) at admission (OR 1.23, 0.57–2.66; p = 0.57) was not predictive for depressive symptoms but for poor QoL (OR 2.77, 95%CI 1.34–5.74). Depressive symptoms and impaired QoL are observed in a substantial proportion of stroke patients at 3 months after intravenous thrombolysis. Health professionals should be aware that thrombolysed patients may have relevant mood disorders despite good functional outcome.     

Sleep disturbance and deficits of sustained attention following stroke

Objective: To simultaneously investigate the prevalence of and impact that the poststroke complications of daytime sleepiness, poor sleep quality, depression, and fatigue may be having upon deficits of sustained attention, as assessed using the Psychomotor Vigilance Task (PVT). Method: Twenty-two patients with stroke (mean age: 68.23 ± 12.17 years) and 20 healthy control participants (mean age: 68.1 ± 9.5 years) completed subjective measures of daytime sleepiness, sleep quality, fatigue, and depression and an objective measure of sustained attention as assessed using the PVT. Results: Patients with stroke compared to controls showed heightened levels of fatigue (p = .001, η² = .29) and depression (p = .002, η² = .23), plus greater deficits of sustained attention as reflected by poorer performance across all PVT outcome measures including: slower mean reaction times (p = .002, η² = .22); increased number of lapses (p = .002, η² = .24); and greater variability in reaction time (RT) responses (p = .016, η² = .15). Reaction time distribution analysis suggested that daytime sleepiness and sleep quality had little influence across PVT performance; however, depressive symptomology was associated with longer RT responses, indicative of inattention, and fatigue impacted upon the entire distribution of PVT responses. Conclusions: PVT performance illustrated significant deficits across the domain of sustained attention for patients with stroke in comparison to healthy controls, in terms of inattention as well as slower sensory–motor speed. The common poststroke complications of depressive symptomology and fatigue appear to be associated with these deficits in sustained attention, warranting further investigation.     

Depressive symptoms are associated with reduced neutrophil function in hip fracture patients

Hip fracture is a common trauma in older adults with a high incidence of depression, which relates to poorer prognosis including increased risk of infection. Ageing is accompanied by reduced immunity, termed immunesenescence, resulting in increased susceptibility to infection. We examined whether physical trauma (hip fracture) and psychological distress (depressive symptoms) had additive effects upon the aged immune system that might contribute to poor outcomes after injury. Neutrophil function was assessed in 101 hip fracture patients (81 female) 6 weeks and 6 months after injury and 43 healthy age-matched controls (28 female). Thirty eight fracture patients had depressive symptoms at 6 weeks. No difference in neutrophil phagocytosis of Escherichia coli was observed between controls and hip fracture patients, but superoxide production was significantly reduced in hip fracture patients with depressive symptoms compared with patients without symptoms (p = .001) or controls (p = .004) at 6 weeks. Superoxide production improved 6 months following fracture to the level seen in controls. We detected elevated serum cortisol, reduced dehydroepiandrosterone sulphate (DHEAS) and an increased cortisol:DHEAS ratio in fracture patients with depressive symptoms compared with patients without depressive symptoms or controls at 6 weeks and 6 months after injury. Serum IL6, TNFα and IL10 were higher among patients with depressive symptoms at 6 weeks. The cortisol:DHEAS ratio and IL6 levels related to depressive symptom scores but not to neutrophil function. In conclusion, depressive symptoms related to poorer neutrophil function after hip fracture, but this was not driven by changes in stress hormone or cytokine levels.     

Prevention of poststroke depression: 1 year randomised placebo controlled double blind trial of mianserin with 6 month follow up after therapy

OBJECTIVES: (1) To test whether early prophylactic antidepressive treatment by mianserin is able to prevent poststroke depression, and (2) to discover whether mianserin as an antidepressant has any beneficial influence on the outcome of ischaemic stroke. METHODS: A randomised, double blind, placebo controlled study involved 100 consecutive patients under 71 years old admitted to hospital for an acute ischaemic stroke; they were enrolled to receive 60 mg/day mianserin or placebo for 1 year. They were examined on admission, and at 2, 6, 12, and 18 months with depression, stroke, and functional outcome scales. RESULTS: According to DSM-III-R, the prevalence of major depression was 6% at the initial stage, 11% at 1 year, and 16% at 18 months. At no time point did prevalences differ between the treatment groups, nor were differences found in depression scales, although at 2 months a greater improvement from initial assessment on the Hamilton depression scale was evident in patients on mianserin (p=0.05). Some beneficial changes on the Hamilton depression scale and Beck depression inventory were found in patients older than 56 (median age) and in men treated with mianserin, but not in other subgroups. Mianserin treatment did not affect stroke outcome as measured by neurological status, nor did it have any influence on functional outcome as measured by Rankin scale or Barthel index. CONCLUSION: It was not possible to show that early initiation of antidepressant therapy can prevent poststroke depression, because the prevalence of poststroke depression remained low even in patients on placebo. In this stroke population with a low rate of depressive patients, antidepressive medical treatment failed to affect stroke outcome.     

Associations between characteristics of stroke survivors and caregiver depressive symptoms: a critical review

Background: Poststroke depression is common in stroke survivors. Evidence suggests that caregivers of stroke survivors also experience depression, at rates similar to survivors (30–40%). While much research has focused on developing better understanding of poststroke depression in stroke survivors, stroke caregiver depression has received less attention. Available research suggests that characteristics of the survivor such as age, gender, relation to caregiver, mental health, and physical or cognitive deficits correlate with and may be contributing factors for caregiver depression. Knowledge of risk factors for stroke caregiver depression could translate to better screening, management, and prevention, but further investigation is needed.

Objectives: To examine the existing literature and synthesize evidence surrounding survivor characteristics and their association with poststroke depressive symptoms in caregivers.

Methods: Medline, PsychInfo, and CINAHL databases were searched with variations of keywords: “stroke,” “caregiver” and “depression.” Studies analyzing associations between at least one stroke survivor characteristic and caregiver depressive symptoms were included.

Results: Seventeen studies met eligibility criteria. They analyzed a wide range of survivor characteristics. Many survivor characteristics lacked convincing evidence of an association with caregiver depressive symptoms. However, a trend emerged supporting an association between survivor depressive symptoms and caregiver depressive symptoms.

Conclusions: Health-care providers should be aware that depressive symptoms in one member of a stroke survivor-caregiver dyad may indicate risk for depressive symptoms in the other. Screening both individuals may lead to earlier detection and provide information to guide interventions. Knowing risk factors for stroke caregiver depression may improve prevention/management, but further investigation is needed.     

Depressive symptoms in caregivers immediately after stroke

Background: Caregivers of stroke survivors often suffer depressive symptoms that interfere with their own health. Early recognition may lead to attenuation of symptoms and better health and well-being for caregivers.

Objective: We examined characteristics of caregivers and stroke survivors associated with caregivers’ depressive symptoms in the early poststroke period.

Methods: We conducted a prospective, longitudinal exploratory observational study with a convenience sample of 63 caregivers of older adult (≥ 65 years) stroke survivors recruited from urban acute-care settings. We enrolled caregivers by 2 weeks poststroke (T1) and revisited them 4 weeks later (T2). Depressive symptoms were measured using the Patient Health Questionnaire-9. A separate unadjusted linear mixed model was computed to explore significant associations between each caregiver or stroke-survivor characteristic and depressive symptoms.

Results: Caregivers, on average, reported mild depressive symptoms at T1 and T2. Each of the following characteristics was independently associated with caregiver depressive symptoms over the first 6 weeks poststroke: caregiver uncertainty (p < 0.001), perceived stress (p < 0.001) but not cortisol levels (p = 0.858 on waking, p = 0.231 evening), coping (p < 0.001), social support (p = 0.006), race (p = 0.022), income (p = 0.001), time spent on care (p = 0.039), and stroke-survivor race (p = 0.033) and functional status (p = 0.003). At T2, caregiver depressive symptoms were correlated with evening cortisol level (p = 0.001).

Conclusions: Caregiver and stroke-survivor characteristics may help identify caregivers at highest risk for early depressive symptoms and guide interventions aimed at their resolution.     

躯体化症状为主抑郁症患者的述情障碍

目的:探讨以躯体化症状为主抑郁症患者和以情绪症状为主抑郁症患者述情障碍的差异。方法:50例以躯体化症状为主抑郁症患者(躯体症状组)、50例以情绪症状为主抑郁症患者(情绪症状组)和50名正常健康者(正常对照组)参加研究,采用90项症状自评量表(SCL-90)、汉密尔顿抑郁量表(HAMD)和多伦多述情障碍量表进行评定。结果:躯体症状组SCL-90总分、躯体化、焦虑、人际敏感、恐怖、偏执因子分及HAMD的焦虑/躯体化因子评分均高于情绪症状组(P<0.01或P<0.05),情绪症状组在强迫、抑郁因子评分及HAMD的认知障碍、阻滞、日夜变化、睡眠障碍及绝望因子分高于躯体症状组(P<0.05或P<0.01)。躯体症状组与情绪症状组仅在述情障碍因子II评分差异有统计学意义(P<0.05),而在述情障碍总分及因子分上均高于正常对照组(P<0.05或P<0.001)。结论:以躯体化症状为主和以情绪症状为主抑郁症患者均存在述情障碍,以前者更缺乏识别情绪和躯体感受能力。     

Prevalence and characteristics of depression in mild cognitive impairment: the Sydney Memory and Ageing Study

Shahnawaz Z, Reppermund S, Brodaty H, Crawford JD, Draper B, Trollor JN, Sachdev PS. Prevalence and characteristics of depression in mild cognitive impairment: the Sydney memory and ageing study. Objective: Depression might be a risk factor for dementia. However, little is known about the prevalence of depressive symptoms in mild cognitive impairment (MCI) and whether mood or motivation‐related symptoms are predominant. Method: A total of 767 non‐demented community‐dwelling adults aged 70–90 years completed a comprehensive assessment, including neuropsychological testing, and a past psychiatric/medical history interview. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS) and Kessler Psychological Distress Scale (K10). Exploratory factor analysis was performed on the GDS and K10 to derive ‘mood’ and ‘motivation’ subscales. Results: A total of 290 participants were classified as having MCI and 468 as cognitively normal (CN). Participants with MCI reported more depressive symptoms, and more MCI participants met the cut‐off for clinically significant symptoms, relative to CN participants. Those with amnestic MCI (aMCI), but not non‐amnestic MCI, had more depressive symptoms and were more likely to meet the cut‐off for clinically significant depressive symptoms, relative to CN participants. Participants with MCI reported more mood‐related symptoms than CN participants, while there were no differences between groups on motivation‐related symptoms. Conclusion: Individuals with MCI, especially aMCI, endorse more depressive symptoms when compared with cognitively intact individuals. These findings highlight the importance of assessing and treating depressive symptoms in MCI.     

Course and Predictors of Subjective Cognitive Complaints During the First 12 Months after Stroke

Background: Subjective Cognitive Complaints (SCC) are common after stroke. This study documents the prevalence and course of SCC in the first year after stroke and determines which patient characteristics in the first 3 months predict subsequent SCC at 1-year follow-up. Methods: Using a longitudinal design, 155 patients (mean age 64.0 ± 11.9 years; 69.7% men) were assessed at 3 and 12 months after stroke. SCC were assessed using the Checklist for Cognitive and Emotional consequences following stroke (CLCE) inventory (content component [CLCE-c] and worry component [CLCE-w]). Potential predictors of 12 months SCC included demographics, stroke severity, objective cognitive impairment, psychological factors (depression, anxiety, perceived stress, fatigue, personality traits, coping style), and activities of daily life functioning assessed at 3 months poststroke. Multiple hierarchical linear regression analyses were used to determine predictors of SCC at 12 months poststroke. Results: SCC remained stable from 3 to 12 months over time (CLCE-c from 3.3 ± 2.4 to 3.3 ± 2.6; CLCE-w: from 1.9 ± 2.2 to 2.1 2.5). Independent predictors of SCC at 12 months were baseline CLCE-c (β = 0.54) and perceived stress (β = 0.23) for content, and baseline CLCE-w (β = 0.57) and depressive symptoms (β = 0.23) for worry. Conclusions: Patients who report SCC at 3 months after stroke are likely to continue having these complaints at 1 year follow-up. Perceived stress and depressive symptoms additionally increase the likelihood of having SCC at 12 months, independent of SCC at 3 months poststroke. Rehabilitation programs that target reduction of stress and depression in the first months after stroke might reduce sustained SCC and improve well-being.     

Persistence of depressive symptoms and gait speed recovery in older adults after hip fracture

Objective

Depression after hip fracture in older adults is associated with worse physical performance; however, depressive symptoms are dynamic, fluctuating during the recovery period. The study aim was to determine how the persistence of depressive symptoms over time cumulatively affects the recovery of physical performance.

Methods

Marginal structural models estimated the cumulative effect of persistence of depressive symptoms on gait speed during hip fracture recovery among older adults (n = 284) enrolled in the Baltimore Hip Studies 7th cohort. Depressive symptoms at baseline and at 2‐month and 6‐month postadmission for hip fracture were evaluated by using the Center for Epidemiological Studies Depression Scale, and persistence of symptoms was assessed as a time‐averaged severity lagged to standardized 3 m gait speed at 2, 6, and 12 months.

Results

A 1‐unit increase in time‐averaged Center for Epidemiological Studies Depression score was associated with a mean difference in gait speed of ?0.0076 standard deviations (95% confidence interval [CI]: ?0.0184, 0.0032; P = .166). The association was largest in magnitude from baseline to 6 months: ?0.0144 standard deviations (95% CI: ?0.0303, 0.0015; P = 0.076). Associations for the other time intervals were smaller: ?0.0028 standard deviations (95% CI: ?0.0138, 0.0083; P = .621) at 2 months and ?0.0121 standard deviations (95% CI: ?0.0324, 0.0082; P = .238) at 12 months.

Conclusion

Although not statistically significant, the magnitude of the numerical estimates suggests that expressing more depressive symptoms during the first 6 months after hip fracture has a meaningful impact on functional recovery.     

The Depressive Experiences Questionnaire: construct validity and prediction of depressive symptoms in a sample of Chinese undergraduates

Background: The Depressive Experiences Questionnaire (DEQ) was developed to measure two dimensions of depression‐prone personality, Dependency and Self‐criticism. We investigated the construct validity and prediction of DEQ in a Chinese sample, and explored whether Blatt's conceptualizations of depression‐prone personality variables are appropriate for the Chinese context. Methods: The original version of the DEQ was translated into Chinese (DEQ‐C). During the initial assessment, 640 Chinese university students completed the DEQ‐C and the Center for Epidemiologic Studies Depression Scale (CES‐D). Six months later, the CES‐D was re‐administered. Results: A principal components analysis yielded a three‐factor model that was consistent with Blatt's theory. However, these three factors emerged in a different order in comparison to the original sample. Factorial validity was also acceptable with low correlations between each DEQ‐C factor in males (r=.01～?0.14), and females (r=0.19～0.28). Convergent validity was supported by significant positive correlations between the CES‐D and both Dependency and Self‐criticism. Predictive validity was demonstrated by hierarchical multiple regression analyses showing that Self‐criticism predicted increased depressive symptoms both in males (β=0.27, p<0.01) and in females (β=0.16, p<0.05); Dependency predicted levels of depressive symptoms only in females (β=0.11, p<0.05). Conclusions: The Chinese version of the DEQ demonstrated satisfactory validity, including construct validity and predictive validity, the DEQ‐C can be considered as an appropriate tool for assessing personality vulnerability to depression in Chinese college students. Depression and Anxiety, 2009. © 2008 Wiley‐Liss, Inc.     

Two distinct symptom-based phenotypes of depression in epilepsy yield specific clinical and etiological insights

Depression is common but underdiagnosed in epilepsy. A quarter of patients meet criteria for a depressive disorder, yet few receive active treatment. We hypothesize that the presentation of depression is less recognizable in epilepsy because the symptoms are heterogeneous and often incorrectly attributed to the secondary effects of seizures or medication. Extending the ILAE's new phenomenological approach to classification of the epilepsies to include psychiatric comorbidity, we use data-driven profiling of the symptoms of depression to perform a preliminary investigation of whether there is a distinctive symptom-based phenotype of depression in epilepsy that could facilitate its recognition in the neurology clinic. The psychiatric and neuropsychological functioning of 91 patients with focal epilepsy was compared with that of 77 healthy controls (N = 168). Cluster analysis of current depressive symptoms identified three clusters: one comprising nondepressed patients and two symptom-based phenotypes of depression. The ‘Cognitive’ phenotype (base rate = 17%) was characterized by symptoms taking the form of self-critical cognitions and dysphoria and was accompanied by pervasive memory deficits. The ‘Somatic’ phenotype (7%) was characterized by vegetative depressive symptoms and anhedonia and was accompanied by greater anxiety. It is hoped that identification of the features of these two phenotypes will ultimately facilitate improved detection and diagnosis of depression in patients with epilepsy and thereby lead to appropriate and timely treatment, to the benefit of patient wellbeing and the potential efficacy of treatment of the seizure disorder.This article is part of a Special Issue entitled “The new approach to classification: Rethinking cognition and behavior in epilepsy”.     

The validity of dysthymia to predict clinical depressive symptoms as measured by the Hamilton Depression Scale at the 5-year follow-up of patients with first episode depression

Background: In long-term follow-up studies on depression, the Eysenck Neuroticism Scale (ENS) at the score level of dysthymia has been found to be valid at predicting poor outcome.

Aims: The ENS dysthymia level was compared with the Beck Depression Inventory (BDI) level to predict the prevalence of depressive symptoms at the 5-year follow-up of patients initially diagnosed with first episode depression using the Hamilton Depression Scale (HAM-D) to express depressive symptoms.

Methods: A total of 301 in- or outpatients aged 18–70 years with a recent single depressive episode were assessed by ENS, BDI, and HAM-D from 2005–2007. At 5-year follow-up from 2011–2013, the participants were re-assessed by HAM-D. The HAM-D was used to measure depressive symptoms at the 5-year follow-up. The Mokken analysis was used to indicate scalability of the BDI and ENS.

Results: A total of 185 participants were available for the psychometric analysis of the ESN and BDI, and the scalability was found acceptable. In total, 99 patients were available for the predictive analysis. Both the ENS and the BDI were significantly associated with depressive symptoms (HAM-D_17?≥_?8) at the 5-year follow-up (p?Conclusion: Dysthymia as measured by the two self-rating scales ENS and BDI can be considered part of a ‘double depression’ in patients with first episode depression, implying an existence of depressive symptoms at the 5-year follow-up.

Clinical implications: Evaluation of dysthymia or neuroticism is important to perform, even in patients with first episode depression, in order to identify ‘double depression’.     

Personality disorders improve in patients treated for major depression

Mulder RT, Joyce PR, Frampton CMA. Personality disorders improve in patients treated for major depression. Objective: To examine the stability of personality disorders and their change in response to the treatment of major depression. Method: 149 depressed out‐patients taking part in a treatment study were systematically assessed for personality disorders at baseline and after 18 months of treatment using the SCID‐II. Results: Personality disorder diagnoses and symptoms demonstrated low‐to‐moderate stability (overall κ = 0.41). In general, personality disorder diagnoses and symptoms significantly reduced over the 18 months of treatment. There was a trend for the patients who had a better response to treatment to lose more personality disorder symptoms, but even those who never recovered from their depression over the 18 months of treatment lost, on average, nearly three personality disorder symptoms. Conclusion: Personality disorders are neither particularly stable nor treatment resistant. In depressed out‐patients, personality disorder symptoms in general improve significantly even in patients whose response to their treatment for depressive symptoms is modest or poor.     

Association between physical activity levels and depressive symptoms in patients with minor ischemic stroke

ObjectivePost-stroke depression is associated with stroke recurrence and it is necessary to identify its influencing factors. The study aims to determine whether physical activity during hospitalization, as measured by accelerometer, was associated with depression after discharge in patients with minor ischemic stroke.Materials and methodsThis prospective observational study assessed 76 patients with minor ischemic stroke (aged 71.2 years) admitted to an acute care hospital. Depressive symptoms 3 months after discharge from the hospital was assessed using a questionnaire sent by mail. Baseline was set during hospitalization, and accelerometers were used to measure sedentary behavior, light and moderate-to-vigorous physical activities during hospitalization.ResultsThree months after hospital discharge, 14 patients (18.4%) were placed in the depressive symptom group, with significantly more sedentary behavior (p = 0.021), less light physical activity (p = 0.016) and more depressive symptoms during hospitalization (p = 0.005) than in the non-depressive symptom group. Logistic regression analysis showed that sedentary behavior (odds ratio = 1.130, 95% confidence interval = 1.013?1.281, p = 0.028) and light-intensity physical activity (odds ratio = 0.853, 95% confidence interval = 0.746?0.976, p = 0.021) were independent factors for depressive symptoms at three months after discharge. Moderate to vigorous physical activity was not an independent factor.ConclusionsSedentary behavior and light-intensity physical activity during hospitalization were associated with depressive symptoms in patients with minor ischemic stroke after discharge. Reducing sedentary behavior and increasing light-intensity physical activity as part of inpatient rehabilitation may help prevent post-stroke depression.     

First self‐perceived signs and symptoms in emerging psychosis compared with depression

Aim: To investigate differences between the early symptoms of schizophrenia and depressive disorders. Methods: Sixty‐one individuals with an at‐risk mental state (ARMS), 17 of whom later made the transition to psychosis, 37 patients with a first episode of psychosis and 16 controls with depressive disorders were interviewed about first self‐perceived signs and symptoms. Results: In ARMS and first episode of psychosis, on average, first self‐perceived signs or symptoms had occurred about 5–6 years before the interview. In ARMS, including transition to psychosis, ‘loss of energy’ and ‘difficulties concentrating’ were the most frequently recalled first signs. There was much overlap for the four most frequently mentioned symptoms in the three groups. As compared with ARMS, controls with depressive disorders significantly more often recalled ‘depression’ and ‘social isolation’ as the very first signs of disease. Conclusions: Clinicians should consider the development of self‐recalled first signs over time carefully when assessing suspected early prodromal stages of schizophrenia and beginning depressive disorder.