Depressive symptoms in stable chronic schizophrenia: prevalence and relationship to psychopathology and treatment

The prevalence and correlates of the depressive syndrome were explored in a population of 120 patients with stable, chronic schizophrenia living in the community. The presence of clinically significant depressive symptoms was defined by a score of 17 or greater on the Beck Depression Inventory. Patients were examined to assess severity of schizophrenic symptoms and medication side-effects. Sixteen of the 120 patients (13.3%) had significant depressive symptoms. Depressive symptoms were significantly correlated with the hostility/suspiciousness (P<0.0001), the positive symptom (P=0.0009) factor of the BPRS and with scores on the Significant Others Scale, a measure of patients' perceived lack of social support (P=0.0004). The association between depression and akathisia approached significance (P=0.007). There was no correlation with demographic variables, alcohol intake, antipsychotic dosage or anticholinergic dosage. Using a scale that rates the subjective aspects of the depressive syndrome, we found no evidence of a relationship between depression and negative symptoms in this population. These results indicate that persistent depressive symptoms in stable patients in the community are related to the degree of persistent positive psychotic symptoms, patient perceptions of social support and, weakly, to the degree of akathisia but not other aspects of antipsychotic treatment.     

Genetic Liability for Depression,Social Factors and Their Interaction Effect in Depressive Symptoms and Depression Over Time in Older Adults

ObjectivesThe objectives of this study were to investigate the effect of genetic and social factors on depressive symptoms and depression over time and to test whether social factors moderate the relationship between depressive symptoms and its underlying genetics in later life.MethodsThe study included 2,279 participants with a mean follow-up of 15 years from the Longitudinal Aging Study Amsterdam with genotyping data. The personal genetic loading for depression was estimated for each participant by calculating a polygenic risk scores (PRS-D), based on 23,032 single nucleotide polymorphisms associated with major depression in a large genome-wide association study. Partner status, network size, received and given emotional support were assessed via questionnaires and depressive symptoms were assessed using the CES-D Scale. A CES-D Scale of 16 and higher was considered as clinically relevant depression.ResultsHigher PRS-D was associated with more depressive symptoms whereas having a partner and having a larger network size were independently associated with less depressive symptoms. After extra adjustment for education, cognitive function and functional limitations, giving more emotional support was also associated with less depressive symptoms. No evidence for gene-environment interaction between PRS-D and social factors was found. Similar results were found for clinically relevant depression.ConclusionGenetic and social factors are independently associated with depressive symptoms over time in older adults. Strategies that boost social functioning should be encouraged in the general population of older adults regardless of the genetic liability for depression.     

Depressive factors and their relationships with other symptom domains in schizophrenia, schizoaffective disorder, and psychotic depression

Relationships among different symptom domains were investigated in patients with acute exacerbation of schizophrenia with depressive symptoms, psychotic depression, or schizoaffective disorder, depressive subtype. Scores for depression and depressive factors were correlated with positive, negative, and extrapyramidal symptoms within diagnostic categories. No between-group differences in the relationship of different symptom domains could be found, and no substantial relationship between depression and positive symptoms could be revealed in any diagnostic subgroup. Only the retardation factor of depression showed a significant overlap with negative symptoms; depressive core symptoms did not. Core symptoms of depression were independent from other symptoms in all investigated diagnostic groups. Depression seems to represent a heterogeneous symptom domain with unique relationships of components to positive and negative symptoms across nosological borders. A more differentiated assessment, analysis, and treatment of depressive symptoms is therefore recommended for patients with combined depressive and psychotic symptoms.     

Symptoms of depression in older adults with multiple sclerosis (MS): comparison with a matched sample of younger adults

The study considered for the first time depression in older adults with multiple sclerosis (MS). Depression symptom scores of 27 persons aged over 65 years who were part of a large study of persons with MS (n = 529), were compared with those of a matched sample of younger adults from the same study. The association between cognitive (attitudinal) variables known to explain significant variance in depressive symptoms in younger adults with MS was then considered in the older adult sample. Consistent with findings from studies with general community samples, older adults with MS reported significantly fewer depressive symptoms than younger adults with MS. The relationship between cognitive variables and depressive symptoms found previously in younger adults was also evident for the older adults. Multiple sclerosis related helplessness was found to be significantly higher in older as opposed to younger adults with MS, the opposite of what was predicted given the differences between the groups in depression scores. Differences in the cognitive variables do not appear to explain the differences between older and younger adults with MS in terms of depressive symptoms. This finding offers support for the view that a decrease in emotional responsiveness may explain differences in depressive symptoms between younger and older adults with MS, rather than this being the result of differences in emotional control exerted via cognitive means.     

Everyday competence and depressive symptoms: Social support and sense of control as mediators or moderators?

Depression is common among the elderly members of Hong Kong Chinese society. The objectives of the present study are to assess the relationship between everyday competence and depressive symptoms and to test whether sense of control and social support mediate and moderate the impact of deterioration in everyday competence on depressive symptoms. The respondents were 393 people aged 60 years and older from a cross-sectional study of a representative community sample of the elderly population in Hong Kong and they were interviewed using a structured questionnaire. In multiple regression analyses, we found that everyday competence was significantly and negatively related to depressive symptoms (beta = -0.26, p < 0.01) after we had adjusted age, gender, marital status, years of education, self-rated health status, and number of chronic illnesses. Moreover, both sense of control and social support were mediators in the linkage between everyday competence and depression. However, neither sense of control nor social support moderated the effect of everyday competence on depression. Findings suggest that both sense of control and social support play important roles in the relationship between everyday competence and depression.     

Social comparison in Chinese older adults

Depression is quite common among the elderly members of Hong Kong Chinese society. This study examined the role of social comparison in the relationship between depressive symptoms and four key life domains including: physical health, financial situation, relationships with adult children, and social support from friends. The respondents were 411 people aged 60 years or older from a survey of a representative community sample of the elderly population in Hong Kong. Using multiple regression models, the authors found that social comparison mediated the effect of support from friends on depressive symptoms and social comparison was the partial mediator in the linkage between financial strain and depressive symptoms. Moreover, social comparison also moderated the effect of physical health and support from friends on depressive symptoms. Lastly, we found that self-efficacy and self-esteem were moderators in the relationship between depressive symptoms and all four key life domains including physical health, financial situation, relationship with adult children, and social support from friends, whereas sense of control over physical health and sense of control over support from friends moderated the effect of social comparison on physical health and support from friends, respectively, on depressive symptoms.     

Predictors of recovery from major depression among geriatric psychiatry inpatients: the importance of caregivers' beliefs

Caregiver support is an important factor in recovery from depression among older patients. We examined whether caregivers' perceptions regarding patients' ability to control depressive symptoms were related to depression recovery. Depression treatment, demographics, number of depressive symptoms, and health were controlled. The sample comprised 51 geriatric psychiatry inpatients who met DSM-IV criteria for major depression and who had a primary caregiver. Depression was assessed at both admission and discharge. Caregivers were asked to indicate whether they believed their patient-relatives could control their depressive symptoms. At discharge, 33 patients (64.7%) were "remitted" and 18 (35.3%) were "nonremitted." Multivariate analyses indicated that receiving electroconvulsive treatment, having fewer depressive symptoms caregivers perceived to be within patient control, and being female predicted depression remission at discharge. This study highlights the important relationship between family dynamics and course of depression.     

Loneliness and depression in independent living retirement communities: risk and resilience factors

Socio-emotional selectivity theory posits that as individuals age, they desire less social stimulation and novelty, and tend to select close, reliable relationships to meet their emotional needs. Residence in congregate facilities affords social exposure, yet does not guarantee access to close relationships, so that loneliness may be a result. Further, the gerontology literature has suggested that loneliness in late life may be a risk factor for serious mental health concerns such as depression. This article examined data on loneliness and depressive symptoms from older adults aged 60-98, residing in two age-segregated independent living facilities. Overlap between those scoring in the depressed range on the Geriatric Depression Scale and those scoring more than one standard deviation above the mean on the UCLA Loneliness Scale was less than 50%, although zero-order correlation of the two continuous scores was moderately high. Potential risk and resilience factors were regressed on the continuous scores of the two scales in separate hierarchical multiple regression analyses. Depression was predicted by being older, number of chronic health conditions, grieving a recent loss, fewer neighbor visitors, less participation in organized social activities and less church attendance. Grieving a recent loss, receiving fewer visits from friends, and having a less extensive social network predicted loneliness. In addition, loneliness scores explained about 8% of the unique variance in depression scores, suggesting it is an independent risk factor for depressive symptoms. Loneliness scores were seen to be more widely dispersed in these respondents, with less variance explained by the available predictors. Suggestions are made for addressing loneliness in older adults as a means of preventing more serious mental health consequences.     

Age differences in depressive symptoms, antisocial behavior, and negative perceptions of family, school, and peers among adolescents

OBJECTIVES: To examine age differences among adolescents in the perceptions of family, school, and peers and their relationship with depressive and antisocial symptoms. METHOD: The sample consisted of 11,516 adolescents, aged 12 to 18 years, coming from a large representative community sample from 212 randomly selected schools in the Netherlands. In the period between October 1992 and January 1993, subjects filled out a self-report questionnaire on perceptions of family, school, and peer group environment; depressive symptoms; and antisocial behavior. Multivariate analyses of variance were performed to analyze age differences in the perceptions of family, school, and peers. Relationships with depressive and antisocial symptoms were studied by means of multiple regression analyses. RESULTS: Significant age differences were found for all 3 social support systems, with negative perceptions of family increasing with age, negative perceptions of peers decreasing with age, and negative perceptions of school remaining fairly stable after an initial increase at age 13. Independent of age, negative perceptions of the family had the-strongest relationship with depressive symptoms and antisocial behavior. In addition, depressive symptoms had a stronger independent relationship with negative perceptions of peers than with negative perceptions of school, while antisocial behavior had a stronger relationship with negative perceptions of school. No remarkable interaction effects between the 3 social support systems were found. CONCLUSIONS: Although age differences existed in the reporting of negative perceptions of family, school, and peers, the strong relationship with dysfunctioning in adolescence invariantly held true throughout the school years of adolescence.     

Are Negative Mood States Associated with Cognitive Function in Newly Diagnosed Patients with Epilepsy?

PURPOSE: The association of self-reported subclinical depressive symptoms and negative mood states with cognitive functioning was evaluated in 51 consecutive newly diagnosed adult persons with epilepsy. METHODS: Emotional state was assessed with Profile of Mood States (POMS) and Brief Depression Scale (BDS) and was correlated with a battery of neuropsychological tests. RESULTS: Patients with epilepsy reported more depressive symptoms in BDS than in controls. They also had more feeling of bewilderment and less vigor on POMS. Higher scores in BDS and in POMS inefficiency scale were associated with slower nondominant hand tapping, but emotional state did not correlate with cognitive measures within the epilepsy group. CONCLUSIONS: Self-reported symptoms of depression and negative mood states were not extensively or significantly associated with cognitive function, and they do not explain the cognitive impairments observed in cognition in newly diagnosed patients with epilepsy.     

The relationship of social support,social networks and negative events with depression in patients with coronary artery disease

This study examined the relationship of social relationships and negative life events with major depression among 335 inpatients with coronary artery disease (CAD) who were free of neurological illnesses. Depression was assessed using the Duke Depression Evaluation Schedule, a structured psychiatric interview which included the Diagnostic Interview Schedule depression sub-scale, two scales for measuring instrumental and self-maintenance activities of daily living, a measure of negative events and four dimensions of social support. Twenty-seven subjects met DSM-IV criteria for major depression. Examination of the bivariate relationships indicated that being younger, having at least one problem with an ADL and/or one IADL, being non-white, experiencing a greater number of negative events, lack of perceived social support and a lack of social interactions were significantly related to an increased likelihood of being depressed. In multivariate analyses depressed subjects were significantly more likely to report a greater number of negative events than non-depressed individuals after adjusting for sociodemographic and ADL measures. A lack of perceived social support and increased number of negative events increased the likelihood of reporting major depressive symptoms among CAD patients. Understanding the causes of depression in CAD patients may have clinical utility in that reduction in depression may lead to a decreased risk of future CAD events.     

An experience-sampling study of depressive symptoms and their social context

Both clinical and subclinical depression are associated with social impairment; however, few studies have examined the impact of social contact in the daily lives of people with depressive symptoms. The current study used the experience-sampling methodology to examine associations between depressive symptoms, social contact, and daily life impairment in 197 young adults. Depressive symptoms were associated with increased isolation, negative affect, anhedonia, and physical symptoms, decreased positive affect, and social and cognitive impairment in daily life. For people with more depressive symptoms, being with social partners who were perceived as close was associated with greater decreases in negative affect, as well as increases in positive affect. Ironically, participants with depressive symptoms reported spending less time with people whom they perceived as close, minimizing the protective effects of socializing. These results suggest that people experiencing depressive symptoms may be especially sensitive to the nature of social interactions.     

The protective role of friendship on the effects of childhood abuse and depression

Background: This study explored the relationships between childhood maltreatment (sexual, physical, and emotional abuse, as well as neglect), adult depression, and perceived social support from family and friends. Methods: As part of an NIH‐funded study of risk and resilience at a public urban hospital in Atlanta, 378 men and women recruited from the primary care and obstetrics gynecology clinic waiting areas answered questions about developmental history, traumatic experiences, current relationship support, and depressive symptoms. Results: Childhood emotional abuse and neglect proved more predictive of adult depression than childhood sexual or physical abuse. In females only, perceived friend social support protected against adult depression even after accounting for the contributions of both emotional abuse and neglect. Conclusions: These findings may elucidate the particular importance of understanding the effects that emotional abuse and neglect have on adult depression, and how perceived friendship support may provide a buffer for women with a history of early life stress who are at risk to develop adult depression. Depression and Anxiety, 2009. Published 2008 Wiley‐Liss, Inc.     

How does social functioning in the early stages of psychosis relate to depression and social anxiety?

Aims: The study aims to compare social functioning in young people considered to be at risk of psychosis with those meeting criteria for first episode psychosis (FEP) and controls, and to determine the association between social functioning and positive and negative symptoms, depressive symptoms, and social anxiety. Methods: This study examined social functioning in 20 individuals at risk of psychosis, 20 FEP patients and 20 healthy controls. Social functioning was measured using the Social Functioning Scale and World Health Organization Disability Assessment Scale. Psychiatric variables were also measured using the Comprehensive Assessment of At‐Risk Mental States, the Brief Psychiatric Rating Scale, the Brief Social Phobia Scale, and the Depression Anxiety and Stress Scale. Results: At‐risk individuals had comparable social deficits to the FEP group, and both patient groups had significantly poorer social functioning than controls. Importantly, social functioning was most strongly associated with depressive and social anxiety symptoms and to a lesser extent with positive symptoms. However, negative symptoms did not appear to relate to social functioning. Conclusion: Social functioning impairments precede the onset of full‐threshold psychosis and may therefore be a significant marker for the illness. Additionally, associated psychiatric symptoms such as depression and social anxiety may provide an avenue for early interventions of social functioning deficits in psychosis.     

A Network Model of Positive Resources,Temperament, Childhood Trauma,and Comorbid Symptoms for Patient with Depressive Disorders

ObjectiveTemperament, positive resources, childhood trauma, and other clinical comorbid symptoms are related to depressive symptom severity. Here, we used network analysis to examine the interrelations between these clinical factors in patients with depressive disorders. MethodsPatients with depressive disorders (n=454) completed self-report questionnaires evaluating clinical symptoms, childhood trauma, temperament, and positive resources. To identify network pattern and the most central aspect, we performed network analysis and centrality analyses. First, we analyzed the network pattern in total participants. Second, we established two groups of those with severe depressive symptoms and those with mild depressive symptoms and compared their network patterns. ResultsDeficient optimism and depression were the central factors in the network of total participants. In the group with severe depressive symptoms, lack of social support and childhood emotional trauma showed high centrality. Deficient social support and other positive resources played central roles in the group with mild depressive symptoms. ConclusionNetwork pattern of psychological factors was different between those with mild or severe depression. Lack of positive resources is an important factor in psychological processes in both mild and severe depression. However, childhood emotional trauma may play a relatively important role in patients with severe depressive symptoms.     

Depressive and anxiety symptoms in patients with schizophrenia and schizophreniform disorder

BACKGROUND: Symptoms of depression and anxiety are frequently encountered in the course of schizophrenia and are of considerable clinical importance. They may compromise social and vocational functioning, and they are associated with an increased risk of relapse and suicide. Various treatment approaches have been reported to be successful. METHOD: The sample comprised 177 patients with DSM-III-R or DSM-IV schizophrenia or schizophreniform disorder who were participants in multinational clinical drug trials at our academic psychiatric unit over a 7-year period and who were assessed by means of the Positive and Negative Syndrome Scale (PANSS). Analysis was performed on baseline PANSS scores. The depression/anxiety score was compared in the men and women, first-episode and multiple-episode patients, and those with predominantly positive and negative syndromes. Correlations were sought between depression/anxiety scores and age, total PANSS score, positive score, negative score, general psychopathology score, and treatment outcome. Multivariate analysis was applied to determine contributions of individual variables toward depression/anxiety and outcome scores. RESULTS: Depression and anxiety symptoms were more severe in women (p = .007), first-episode patients (p = .02), and those with predominantly positive symptoms (p < .0001). Depression/anxiety scores were significantly correlated to age (r = -0.31, p < .0001), PANSS positive scores (r = 0.39, p < .0001), and treatment outcome (r = 0.25, p = .006). Multivariate analysis bore out these results, with the exception that first episode was not a significant predictor of depression and anxiety scores. CONCLUSION: PANSS depressive/anxiety scores were generally low in our sample, perhaps because patients with schizoaffective disorder were excluded. The finding that these symptoms were more prominent in women and first-episode patients is in keeping with previous literature. The higher scores in first-episode patients are likely due to the higher positive symptom scores in these patients. The association between depressive/anxiety scores and positive symptoms but not with negative symptoms points to a specific relationship between affective symptoms and the positive symptom domain of schizophrenia. The presence of depressive and anxiety symptoms may predict a more favorable outcome to treatment, although this may only apply to the acute exacerbations of the illness.     

Fathers' and mothers' perceptions of their child and maternal depressive symptoms

Fathers' reports concerning their children have seldom been considered in the previous studies on maternal depression and child development. The literature on parental reports in general suggests that discrepancies in mothers' and fathers' perceptions are associated with the psychological state of the parent and the gender of the child. As part of a prospective follow-up study, fathers' and mothers' perceptions of children's social competence and behavioural/emotional problems were assessed by the Child Behavior Checklists (CBCLs) when the firstborn children were 8-9 years old. The depressive symptoms of the mothers were screened by the Edinburgh Postnatal Depression Scale (EPDS) at the same time point. The level of children's social competence and behavioural/emotional problems reported by the fathers were analysed by background factors. The reports of both parents were explored by the gender of the child and by the presence of maternal depressive symptoms. The concordance of parental reports concerning child's social competence was high, but fathers usually reported lower problem levels than mothers, particularly for boys' problems. The presence of maternal depressive symptoms was associated with child's high problem levels from both fathers' and mothers' perspective. Parental ratings of children's externalizing problems in particular were associated with high maternal depressive symptom level.     

Symptoms of psychosis and depression in middle-aged and older adults with psychotic disorders: the role of activity satisfaction

The presence of depressive symptoms among patients with psychosis is well documented in the literature. Behavioral models of depression emphasize the role of environmental factors in the onset and maintenance of depressive symptoms. The purpose of this study was to examine the efficacy of an activity-buffering model of well-being, in which increased satisfaction with leisure activities serves to moderate the relationship between symptoms of psychosis and multiple measures of well-being. Participants were 210 middle-aged and older adults with a diagnosis of schizophrenia or schizoaffective disorder. Analyses examined the main and interactive effects of positive symptoms, negative symptoms, and activity satisfaction for predicting both depressive symptoms and overall well-being. Results indicated that when individuals were less satisfied with their leisure activities, the relationship between negative symptoms and depressive symptoms was significant (p < 0.001). However, when individuals had high satisfaction, negative symptoms and depressive symptoms were no longer related (p = 0.243). Similar results were observed for overall well-being. These results provide initial support for an activity-buffering model of well-being among middle-aged and older patients with psychosis. Behavioral therapies which encourage engagement in reinforcing activities may provide additional benefits to existing treatments for psychosis, including reduced depression, improved well-being, and possibly functional outcomes.     

Cognitive coping and depressive symptoms in the elderly: a longitudinal study

The objective of the present longitudinal study was to examine the relationship between cognitive coping strategies and depressive symptoms at old age. At the two and a half year follow-up study, a community sample of 99 people aged 67 years and older filled out a self-report questionnaire comprising the Geriatric Depression Scale, the Cognitive Emotion Regulation Questionnaire and a negative life events checklist. Cognitive coping strategies seemed to play an important role in relation to depressive symptoms in late life. Elderly persons with more depressive symptoms reported to use acceptance, rumination and catastrophizing to a significantly higher extent and positive reappraisal to a significantly lower extent than those with lower depression scores. After controlling for negative life events and prior depressive symptoms, acceptance and positive reappraisal retained their significant relationship with current depressive symptoms. It is suggested that intervention programs should pay attention to these aspects by challenging the 'maladaptive' strategies, and by supplying the more 'adaptive' strategies. This could be linked to the well-established cognitive therapies.     

Postnatal depression and social supports in Vietnamese, Arabic and Anglo-Celtic mothers

The significance of a western woman's social supports to postnatal depression is well documented. We examine which deficits in components of their social support network are associated with postnatal depression in women from a non-English-speaking background. The social support network and postnatal mood of 105 Anglo-Celtic, 113 Vietnamese and 98 Arabic women were assessed at 6 weeks postpartum. The role of social supports in determining scores on the Edinburgh Postnatal Depression Scale (EPDS) was analysed using multiple regressions. For Anglo-Celtic women, low postnatal mood was associated with perceived need for more emotional support from partners and mothers. For Vietnamese women, low postnatal mood was associated with poor quality of relationship with the partner and a perceived need for more practical help from him. For Arabic women, low postnatal mood was associated with perceived need for more emotional support from partners. We conclude that cultural factors mediate the relation between social supports and postnatal depression. Accepted: 3 March 1998