Anxiety, independent of depressive symptoms, is associated with in-hospital cardiac complications after acute myocardial infarction

Objective

Post-myocardial infarction (MI) anxiety, independent of demographic and medical variables, has been linked to in-hospital cardiac complications in prior studies, but such studies have not included a concomitant assessment of depressive symptoms. The aim of this exploratory study was to determine whether post-MI anxiety was associated with in-hospital cardiac complications, independent of depressive symptoms.

Methods

Subjects within 72 hours of acute MI (n=110) were prospectively assessed for anxiety [using the Beck Anxiety Inventory (BAI)] and depressive symptoms (using the Beck Depression Inventory-II and structured interview diagnoses of major depressive disorder). Individual in-hospital complications and pooled serious cardiac complications (defined as recurrent ischemia, reinfarction, congestive heart failure, and ventricular arrhythmia requiring intervention) were recorded via chart review.

Results

On hierarchical multiple logistic regression analysis that accounted for demographic variables, cardiac illness, and depressive symptoms, post-MI anxiety was significantly associated with pooled serious in-hospital cardiac complications (P=.003). In addition, when the anxiety measure was limited to only the psychological symptoms of anxiety (“BAI-P”), post-MI anxiety remained an independent predictor of cardiac complications (P=.015).

Conclusions

These findings suggest that the association of post-MI anxiety with in-hospital cardiac complications exists above and beyond the effects of depression. Larger studies are needed to confirm these findings, and treatment studies are needed to determine the impact of anxiety treatment on in-hospital cardiac outcomes.     

Electrodermal hyporeactivity as a trait marker for suicidal propensity in uni- and bipolar depression

Background

A meta-analysis of studies investigating electrodermal activity in depressed patients, suggested that electrodermal hyporeactivity is sensitive and specific for suicide.

Aims

To confirm this finding and to study electrodermal hyporeactivity relative to type and severity of depression, trait anxiety, its stability and independence of depressive state.

Method

Depressed inpatients (n = 783) were tested for habituation of electrodermal responses and clinically assessed using the Beck Depression Inventory (BDI) and the STAI-Trait scale for trait anxiety.

Results

The high sensitivity and raw specificity of electrodermal hyporeactivity for suicide were confirmed. Its prevalence was highest in bipolar disorders and was independent of severity of depression, trait anxiety, gender and age. Hyporeactivity was stable, while reactivity changed into hyporeactivity in a later depressive episode.

Conclusions

The findings support the hypothesis that electrodermal hyporeactivity is a trait marker for suicidal propensity in depression.     

Turning the pink cloud grey: Dampening of positive affect predicts postpartum depressive symptoms

Objective

Maladaptive response styles to negative affect have been shown to be associated with prospective (postpartum) depression. Whether maladaptive styles to positive affect are also critically involved is understudied, even though anhedonia (a correlate of low positive affectivity) is a cardinal symptom of depression. The present study is the first to investigate the predictive value of cognitive response styles to both negative (depressive rumination) and positive affect (dampening) for postpartum depressive symptoms.

Methods

During the third trimester of pregnancy, 210 women completed self-report instruments assessing depression (symptom severity and current and/or past episodes) and scales gauging the presence of depressive rumination and dampening. Of these women, 187 were retained for postpartum follow-up, with depressive symptoms being reassessed at 12 (n = 171) and 24 (n = 176) weeks after delivery.

Results

Regression analyses showed that higher levels of dampening of positive affect during pregnancy predicted higher levels of depressive symptoms at 12 and 24 weeks postpartum, irrespective of initial symptom severity, past history of depression and levels of rumination to negative affect. Prepartum trait levels of rumination, however, did not predict postpartum symptomatology when controlled for baseline symptoms and history of major depressive episode(s).

Conclusions

The results of this investigation suggest that the way women cognitively respond to positive affect contributes perhaps even more to the development of postpartum depression than maladaptive response styles to negative affect.     

The prevalence of depression and anxiety disorders in patients with euthyroid Hashimoto’s thyroiditis: a comparative study

Objective

The aim of this study was to examine the current prevalence of major depression and anxiety disorders in patients with euthyroid Hashimoto’s thyroiditis (HT) and euthyroid goiter.

Method

The study sample was formed by consecutive 51 and 45 patients who were admitted to the endocrinology outpatient clinic and diagnosed with euthyroid HT and endemic/nonendemic goiter, respectively, and 68 healthy controls. Current diagnoses of psychiatric disorders were determined using the Structured Clinical Interview for DSM-IV. Beck Depression Inventory and Beck Anxiety Inventory were applied to the participants.

Results

There was a statistically significant difference among the three groups in terms of major depression (P=.001), any mood or anxiety disorder (P=.000), any depressive disorder (P=.020), any anxiety disorder (P=.016) and obsessive–compulsive disorder (OCD) (P=.013). In the HT group, the prevalence of depression (P=.000), OCD (P=.005) and panic disorder (P=.041) was significantly higher than that in the control group. In the goiter group, depression (P=.006), any depressive disorder (P=.03), and any mood or anxiety disorder (P=.000) were significantly common in comparison to the control group. No significant difference was found between the HT and goiter groups.

Conclusions

Euthyroid HT and euthyroid goiter increase predisposition to major depression and anxiety disorders, and thyroid autoimmunity and other thyroid pathologies should be investigated in euthyroid patients with chronic and treatment-resistant complaints.     

Exposure to secondhand smoke and depression and anxiety: A report from two studies in the Netherlands

Objective

Previous population-based studies suggest that exposure to secondhand smoke (SHS) is related to increased depressive symptoms and poor mental health among non-smokers. We examined whether these associations could be replicated in two independent Dutch samples.

Methods

Non-smoking adults were selected from two studies: 1) the Netherlands Study of Depression and Anxiety (NESDA), comprising individuals with current and remitted depressive and/or anxiety disorders, and healthy controls and 2) the Netherlands Twin Register (NTR), comprising twin-family studies on health-related behaviors. In both studies, SHS exposure was assessed with plasma cotinine levels (1–14 ng/ml vs. < 1 ng/ml). In NESDA, outcomes were current depressive and/or anxiety disorders, and depression and anxiety symptom severity scores. In NTR, the Adult Self Report derived DSM-subscales for depressive and anxiety problems, and anxious depressive scores were analyzed.

Results

In NESDA non-smokers (n = 1757), increased plasma cotinine level (≥ 1 ng/ml) was not related to current depressive and/or anxiety disorders [odds ratio (OR) 0.96, P = .77], nor to depression or anxiety severity indicators. Similarly, in NTR non-smokers (n = 1088) cotinine levels ≥ 1 ng/ml were not associated with the DSM-subscale for depressive problems [unstandardized regression coefficient (B) 0.04, P = .88], nor to other depression and anxiety measures.

Conclusions

In non-smoking adults from patient and population samples, we found no evidence that plasma cotinine levels were related to either depressive and/or anxiety disorders, or to depressive and anxiety symptoms. This suggests that SHS exposure is not related to depression and anxiety in non-smoking adults.     

Anxiety and depressive disorders in dialysis patients: association to health-related quality of life and mortality

Objective

To examine the associations between depressive/anxiety disorders (DAs), perceived health-related quality of life (HRQOL) and mortality in dialysis patients.

Methods

Patients were assessed for depressive and DAs with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders. The HRQOL was assessed with the Medical Outcome Short Form 36 (MOS SF-36), and the Beck Depression Inventory and Hospital Anxiety and Depression Scale were also applied. Sociodemographic, clinical and laboratory data were also collected.

Results

Patients with depressive disorders reported more impaired HRQOL on four of the eight subscales, while those with a depressive disorder comorbid with DA reported more impairment on all MOS SF-36 subscales compared to those without any psychiatric disorder. During the observation period, 50% of those with depression, 28% of those with anxiety and 33% of patients with DA disorder died. A survival analysis did not indicate that patients with depressive or DAs had a higher mortality than patients without such disorders.

Conclusion

Dialysis patients with depressive disorders reported impaired HRQOL, whereas those with DAs did not. Patients with DA reported the most serious HRQOL impairment. No evidence was obtained to support the hypothesis that depressive and DAs contributed to compromised survival in dialysis patients. In patients with depression, DAs should also be assessed as they significantly contribute to impaired HRQOL.     

History of depressive and/or anxiety disorders as a predictor of treatment response: A post hoc analysis of a 12-week, randomized, double-blind, placebo-controlled trial of paroxetine controlled release in patients with fibromyalgia

Background

Despite of a high comorbidity of depressive and/or anxiety disorders with fibromyalgia, information on the clinical implications of this comorbidity is limited but antidepressants are commonly prescribed to treat fibromyalgia in clinical practice. We investigated whether a history of depressive and/or anxiety disorders was associated with response to paroxetine controlled release (CR) in the treatment of fibromyalgia.

Methods

One hundred sixteen (116) fibromyalgia subjects were randomized to receive paroxetine CR or placebo for 12 weeks. The primary outcome was treatment response defined as ≥ 25% reduction in the Fibromyalgia Impact Questionnaire (FIQ) score. In multivariate logistic regression, we determined if a history of depression and/or anxiety disorders was an independent predictor of response to paroxetine CR.

Results

In logistic regression, the history of depression and/or anxiety did not predict treatment response as measured by ≥ 25% reduction in Fibromyalgia Impact Questionnaire (FIQ) score (OR = 0.66, 95% CI = .29–1.49, Wald = 0.97, p = 0.32), while the drug status (paroxetine CR) was significantly associated with treatment response (OR = 2.57, CI = 1.2–5.61, Wald = 5.5, p = 0.02).

Conclusion

A significant proportion of patients with fibromyalgia had a history of anxiety and or depressive disorders. However response to treatment of fibromyalgia symptoms with paroxetine CR was not associated with a history of depressive and/or anxiety disorders. Our findings need to be confirmed in more adequately-powered and well-designed subsequent studies.     

Hemoglobin levels in persons with depressive and/or anxiety disorders

Objective

Both low and high hemoglobin levels lead to more physical diseases, and both are linked to mortality. Low hemoglobin, often classified as anemia, has also been linked to more depressive symptoms, but whether both hemoglobin extremes are associated with depressive disorder and potentially also with anxiety disorder has not been examined before. This study examines to which extent hemoglobin levels are associated with depression and anxiety disorders in a large cohort.

Methods

The study sample consisted of 2920 persons from the Netherlands Study of Depression and Anxiety. Hemoglobin levels were determined after venipuncture. Depressive and anxiety disorders were determined according to a DSM-IV-based psychiatric interview. Clinical psychiatric characteristics included the severity of depression and anxiety, the duration of symptoms, the age of onset and the antidepressant use.

Results

Higher hemoglobin levels were found in those with current depressive and/or anxiety disorders after sociodemographic adjustment and both higher, and lower hemoglobin levels were found in persons with higher depression and anxiety severity. However, after full adjustment for sociodemographics, disease indicators and lifestyle, associations were no longer significant.

Conclusions

This cohort study showed that there is no independent association between depressive and/or anxiety disorders and hemoglobin levels or anemia status.     

Psychiatric factors related to sexual functioning in patients with Parkinson's disease

Introduction

This research deals with the topic of sexual life among people suffering from Parkinson's disease (PD) and with selected factors related to sexual functioning in these patients. Parkinson's disease is a serious chronic disease whose symptoms as well as treatment substantially affect the sexual life of the patients. Despite this fact, very little published work has dealt with this topic.

Aim

This research focuses on describing the structure of deterioration of sexual functions of the patients suffering from PD, and statistical analysis of the interdependence of selected factors (age, duration of the disease, subjective score of the impact of the disease, depression, anxiety) as well as the patients’ sexual satisfaction. The most substantial factors influencing sexual satisfaction of men and women with PD are analysed and their impact assessed, the greatest stress being put on psychiatric factors.

Methods

The research project examined a group of 103 people with PD. In order to identify the specifics of the patients’ sexual lives, two questionnaire-sets were designed (separate for men and women), containing psychological (BDI-II, STAI) and sexological (FSFI, IIEF, GRISS) questionnaires.

Main outcome measures

The main outcome measures were depression, state and trait anxiety, sexual satisfaction, erectile function, the Female Sexual Function Index.

Results

The acquired data was statistically elaborated using the programme SPSS. The results of the sexological questionnaires show a decrease in overall sexual functioning and the presence of sexual dysfunctions related to PD. With the help of regression models it was elicited that in case of men with this illness, the most influential factor on their sexual life is depression and their subjective scoring of the illness, in the case of women the prevailing factors are depression and anxiety.

Conclusions

Sexuality for people suffering from Parkinson's disease is a very complex issue and psychiatric factors (depression, anxiety) have an important impact on the sexual functioning of the patients.     

Meta-cognitive beliefs as a mediator for the relationship between Cloninger’s temperament and character dimensions and depressive and anxiety symptoms among healthy subjects

Background

Previous studies suggest that temperament and character may impact depression and anxiety through dysfunctional cognition. This study targets the mediating role of meta-cognitive beliefs in the relationship between Cloninger’s temperament and character dimensions and symptoms of depression and anxiety.

Method

One hundred and sixty-one healthy subjects filled out Cloninger’s Temperament Character Inventory (TCI), a Metacognitions Questionnaire (MCQ), the Beck Depression Inventory (BDI) and the State and Trait Anxiety Inventory (STAI). Correlation and mediation analyses according to Baron and Kenny’s method were performed.

Results

Harm avoidance (HA) and self-directedness (SD) were related to depression and anxiety. HA was related to negative beliefs about uncontrollability of thoughts and to beliefs about cognitive confidence. SD was associated with the same types of meta-cognitive beliefs and with general negative beliefs. Cooperativeness (CO) was related to positive beliefs about worry, beliefs about cognitive confidence and to general negative beliefs. Self-transcendence (ST) was related to all types of meta-cognitive beliefs. Mediation analysis revealed that the relationship between HA and depression and anxiety is partially mediated by certain types of meta-cognitive beliefs. The same results were obtained for the relationship between SD and depression and anxiety. General negative beliefs fully mediated the relationship between CO and depression and the relationship between ST and anxiety.

Conclusions

Meta-cognitive beliefs mediate the relationship between temperament and character dimension and depressive and anxiety symptoms, thus providing further evidence for the meta-cognitive theory of emotional disorders as presented by Wells and Matthews (Behav Res Ther 1996;32:867-870).     

Comorbid atypical depression in borderline personality disorder is common and correlated with anxiety-related psychopathology

Background

The core features of borderline personality disorder (BPD) are affective instability, unstable relationships and identity disturbance. Axis I comorbidities are frequent, in particular affective disorders. The concept of atypical depression is complex and often underestimated. The purpose of the study was to investigate the comorbidity of atypical depression in borderline patients regarding anxiety-related psychopathology and interpersonal problems.

Methods

Sixty patients with BPD were assessed with the Structured Clinical Interviews for DSM-IV Axis I and II Disorders (SCID I, SCID II) as well as the Atypical Depression Diagnostic Scale (ADDS). Additionally, patients completed a questionnaire (SCL-90-R, BDI, STAI, STAXI, IIP-C).

Results

Forty-five BPD patients (81.8%) had a comorbid affective disorder of which 15 (27.3%) were diagnosed with an atypical depression.In comparison to patients with major depressive disorder or no comorbid depression, patients with atypical depression showed significant higher scores in psychopathological symptoms regarding anxiety and global severity as well as interpersonal problems.

Conclusions

The presence of atypical depression in borderline patients is correlated with psychopathology, anxiety, and interpersonal problems and seems to be of clinical importance for personalized treatment decisions.     

Understanding catastrophic worry in eating disorders: process and content characteristics

Background and objectives

The majority of people with eating disorders (ED) experience high levels of comorbid anxiety and depression, yet the maintenance processes of these in ED remain largely unknown. Worry, a defining cognitive feature and important maintenance factor of anxiety, has not been well-studied amongst people with ED. This is the first study to explore both the process and content characteristics of catastrophic worry in ED.

Methods

Twenty-nine patients with anorexia nervosa (AN), 15 patients with bulimia nervosa (BN) and 37 healthy controls (HC) completed measures assessing anxiety, depression, worry and eating disorder pathology. Catastrophic worry was assessed using the Catastrophizing Interview and catastrophic worry content was explored using qualitative Thematic Analysis.

Results

Compared to HCs, ED groups had higher levels of anxiety, depression and worry and they generated a greater number of catastrophic worry steps. Worry was further found associated with depressive symptomatology in those with ED. Worry content for the ED groups included ED themes, but also themes reflecting broader inter and intrapersonal concerns.

Limitations

The degree to which worry is driven by depressive versus anxious symptomatology remains unclear. The current study does not include an anxious or depressed control group, and results should be considered in the light of relatively small samples sizes.

Conclusion

Findings indicate that interventions that target worry processes may be a useful adjunct to treatment for those ED patients with clinical worry levels.     

The mediator role of ruminative thinking style in the relationship between dysfunctional attitudes and depression

Background

The main aim of the present study was to examine whether ruminative thinking styles (brooding and reflection) mediate the effects of dysfunctional attitudes on depressive symptoms.

Methods

120 psychotropic drug-naive first episode depression patients recruited from Bulent Ecevit University School of Medicine psychiatry department and Zonguldak State Hospital psychiatry department outpatient clinics were involved in the study. Participants completed the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Beck Depression Inventory (BDI), Dysfunctional Attitude Scale (DAS) and Ruminative Responses Scale (RRS-short version). Regression analyses together with the Sobel tests were performed for testing the mediator hypothesis.

Results

According to the path model, the level of brooding fully mediated the relationship between dysfunctional attitudes and depressive symptomatology but reflection did not play a mediator role in the relationship between dysfunctional attitudes and depressive symptoms.

Conclusions

Assessment of brooding with both mental status examination and specific measurements and focusing on brooding as an intervention strategy would be beneficial components for an effective treatment of depression.     

Depression and Anxiety Following Myocardial Infarction and Their Inverse Associations with Future Health Behaviors and Quality of Life

Background

Post-myocardial infarction (MI) depression and anxiety were found to predict prognosis and quality of life.

Purpose

The purpose of this study was to test a behavioral pathway from post-MI depression/anxiety to future quality of life.

Methods

This is a longitudinal cohort study. Five hundred forty patients (≤65 years old) filled out questionnaires after a first MI, including socio-demographics, pre-MI health status and behaviors, MI severity, social support, sense of coherence, depression, and anxiety. Reports of health behaviors were obtained 5 years and of quality of life 10 years later.

Results

A structural equations model confirmed that depression and anxiety were directly related to poorer quality of life 10 years later. These relationships were partly mediated by a positive association between anxiety and health behaviors at 5 years and a negative one between depression and health behaviors.

Conclusions

The opposite effects of anxiety and depression underscore the need to attend to both emotional reactions to MI while encouraging preventive health behaviors.     

Cognitive vulnerability to comorbidity: looming cognitive style and depressive cognitive style as synergistic predictors of anxiety and depression symptoms

Background and objectives

Because anxiety and depression are highly comorbid, it is likely that individuals with co-occurring cognitive vulnerabilities to depression and anxiety will experience more severe symptoms of anxiety and depression. However, no study to date has examined the effects of co-occurring (simultaneous) cognitive vulnerabilities to depression and anxiety on the severity of symptoms.

Method

The present study examines the co-occurring effects of Alloy and Abramson’s (1999) Negative Cognitive Style, a vulnerability to depression, and Riskind’s (2000) looming cognitive style, a vulnerability to anxiety.

Results

Results indicated that those with co-occurring vulnerabilities experience a more severe level of anxiety and depression symptoms.

Limitations

The present study used a measure of symptoms rather than actual clinical diagnoses.

Conclusion

These findings address the previously ignored area of cognitive vulnerability to comorbidity. Co-occurring cognitive vulnerabilities to anxiety and depression synergistically confer risk for more severe anxiety and depression symptoms than the individual or additive effects of either vulnerability do alone.     

Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis of 25 years of research

Objective

A meta-analysis of over 25 years of research into the relationship between post-myocardial infarction (MI) depression and cardiac prognosis was conducted to investigate changes in this association over time and to investigate subgroup effects.

Method

A systematic literature search was performed (Medline, Embase and PsycINFO; 1975-2011) without language restrictions. Studies investigating the impact of post-MI depression on cardiovascular outcome, defined as all-cause mortality, cardiac mortality and cardiac events within 24 months after the index MI, were identified. Depression had to be assessed within 3 months after MI using established instruments. Pooled odds ratios (ORs) were calculated using a random effects model.

Results

A total of 29 studies were identified, resulting in 41 comparisons. Follow-up (on average 16 months) was described for 16,889 MI patients. Post-MI depression was associated with an increased risk of all-cause mortality [(OR), 2.25; 95% confidence interval [CI], 1.73-2.93; P<.001], cardiac mortality (OR, 2.71; 95% CI, 1.68-4.36; P<.001) and cardiac events (OR, 1.59; 95% CI, 1.37-1.85; P<.001). ORs proved robust in subgroup analyses but declined over the years for cardiac events.

Conclusions

Post-MI depression is associated with a 1.6- to 2.7-fold increased risk of impaired outcomes within 24 months. This association has been relatively stable over the past 25 years.     

Introducing depression and developmental screenings into the National Programme on Immunization (NPI) in southeast Nigeria: an experimental cross-sectional assessment

Objectives

This study investigates the possibility of introducing depression and developmental screening tools into the National Programme on Immunization (NPI) in southeast Nigeria. The specific objectives were to determine the prevalence of postpartum depression (PPD) among mothers attending immunization clinics and to assess the association of maternal PPD and infant growth in relation to World Health Organization (WHO) recommendations.

Methods

Four hundred and eight (408) mothers completed the sociodemographic questionnaire and the self-report Edinburgh Postnatal Depression Scale (EPDS). The weights, lengths and head circumferences of their infants were recorded, while the WHO recommended equivalents at 50th percentiles were also recorded for each child. The mothers were then interviewed with the major depressive episode module of Mini International Neuropsychiatric Interview (M.I.N.I.) to make diagnosis of depression.

Results

About 24.8% and 15.2% of the mothers were found to be depressed using EPDS and major depressive episode module of M.I.N.I., respectively. It was found that maternal PPD is significantly associated with the growth parameters of weights and lengths of the infants studied but not their head circumference.

Conclusions

NPI may provide appropriate forum for early screening of mothers for PPD and interventions in Nigeria. The NPI would also serve a useful avenue of screening for developmental concerns in Nigerian children.     

Extreme attributions predict transition from depression to mania or hypomania in bipolar disorder

Background

Relatively little is known about psychological predictors of the onset of mania among individuals with bipolar disorder, particularly during episodes of depression. In the present study we investigated attributional style as a predictor of onset of hypomanic, manic or mixed episodes among bipolar adults receiving psychosocial treatment for depression. We hypothesized that “extreme” (i.e., excessively pessimistic or optimistic) attributions would predict a greater likelihood of developing an episode of mood elevation.

Method

Outpatients with DSM-IV bipolar I or II disorder (N = 105) enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were randomly allocated to one of three types of intensive psychotherapy for depression or a brief psychoeducational intervention. Patients completed a measure of attributional style at baseline and were followed prospectively for up to one year. All analyses were by intent to treat.

Results

Logistic regressions and Cox proportional hazards models indicated that extreme (both positively- and negatively-valenced) attributions predicted a higher likelihood of (and shorter time until) transition from depression to a (hypo)manic or mixed episode (ps < .04), independent of the effects of manic or depressive symptom severity at baseline. Extreme attributions were also retrospectively associated with more lifetime episodes of (hypo)mania and depression (ps < .05).

Conclusions

Evaluating extreme attributions may help clinicians to identify patients who are at risk for experiencing a more severe course of bipolar illness, and who may benefit from treatments that introduce greater cognitive flexibility.     

The clinical impact of mood disorder comorbidity on social anxiety disorder

Background

High comorbidity rates of mood disorders have been reported in patients with social anxiety disorder (SAD). Our study aims to identify the frequency of comorbid Axis I disorders in patients with SAD and to investigate the impact of psychiatric comorbidity on SAD.

Methods

The study included 247 patients with SAD. Thirty eight patients with bipolar depression (SAD-BD), 150 patients with major depressive disorder (SAD-MDD) and 25 patients who do not have any mood disorder comorbidity (SAD-NOMD) were compared.

Results

Around 90% of SAD patients had at least one comorbid disorder. Comorbidity rates of lifetime MDD and BD were 74.5% and 15.4%, respectively. There was no comorbidity in the SAD-NOMD group. Atypical depression, total number of depressive episodes and rate of PTSD comorbidity were higher in SAD-BD than in SAD-MDD. Additionally, OCD comorbidity was higher in SAD-BD than in SAD-NOMD. SAD-MDD group had higher social anxiety severity than SAD-NOMD.

Conclusions

Mood disorder comorbidity might be associated with increased severity and decreased functionality in patients with SAD.     

Effectiveness of collaborative care for depression in Italy. A randomized controlled trial

Trial design

This was a multicenter cluster-randomized controlled trial.

Participants

A total of 227 patients ≥ 18 years old with a new onset of depressive symptoms who screened positive on the first two items of the Patient Health Questionnaire-9 (PHQ-9) were recruited by primary care physicians (PCPs) of eight health districts of three Italian regions from September 2009 to June 2011.

Intervention

PCPs of the intervention group received a specific collaborative care program including 2 days of intensive training, implementation of a stepped care protocol, depression management toolkit and scheduled meetings with a dedicated consultant psychiatrist.

Objective

The objective was to determine whether a collaborative care program for depression management in primary care leads to higher remission rate than usual PCP care.

Outcomes

Outcome was clinical remission as expressed on PHQ-9 < 5 at 3 months.

Randomization

An independent researcher used computer-generated randomization to assign involved primary care groups to the two alternative arms.

Blinding

PCPs and research personnel were not blinded.

Results

The 223 PCPs enrolled recruited 227 patients (128 in collaborative care arm, 99 in the usual care arm). At 3 months (n= 210), the proportion of patients who achieved remission was higher, though the difference was not statistically significant, in the collaborative care group. The effect size was of 0.11. When considering only patients with minor/major depression, collaborative care appeared to be more effective than usual care (P= .015).

Conclusions

The present intervention for managing depression in primary care, designed to be applicable to the Italian context, appears to be effective and feasible.