Alexithymia,empathy, negative affect and physical symptoms in patients with asthma

Although alexithymia has been found to be associated with physical symptoms in psychosomatic disorders such as asthma, mechanisms linking this association are unknown. However, affective alexithymic features may be associated with physical symptoms in the presence of deficits in affective characteristics such as low empathy and high negative affect. This study aimed to assess direct effects of alexithymic traits on physical symptoms and indirect effects of these subscales through empathy and negative affect (e.g. depressive, anxious and stress symptoms) by controlling for asthma severity in patients with asthma. Three hundred patients with asthma completed the Toronto Alexithymia Scale‐20 (TAS‐20), the Basic Empathy Scale (BES), the Depression Anxiety Stress Scales‐21 (DASS‐21) and the Physical Symptoms Inventory (PSI). After controlling for asthma severity, the results showed that alexithymia subscales of the TAS‐20 had no direct effects on physical symptoms, but the difficulty in identifying feelings (DIF) subscale of the TAS‐20 was associated with affective empathy and negative affect. Affective empathy was significantly related to negative affect. Affective empathy and negative affect were associated with physical symptoms. The affective subscale of alexithymia on the TAS‐20, that is DIF, indirectly affected physical symptoms through affective empathy and negative affect. Findings suggest that patients with asthma who have high levels of DIF may show high physical symptoms in the presence of low affective empathy and high negative affect.     

Affective symptoms at index hospitalization in childhood and depressive symptoms in adulthood: a "catch-up" study

PURPOSE: To analyze whether affective symptoms during psychiatric treatment in childhood or adolescence could predict the later development of depressive symptoms. METHOD: We used a "catch-up" design. A cohort of former child and adolescent psychiatric patients was assessed in adulthood with standardized instruments according to the criteria of ICD-10 (SCAN) and dimensional values for depression (both self-reported and observer-rated). Initial affective symptoms had been extracted from clinical records according to a standardized system (AMDP). RESULTS: We assessed 164 former patients. Twelve percent of these fulfilled diagnostic criteria of an affective disorder (F3) according to ICD-10. In univariate analyses of variance the depression scores were significantly related to affective symptoms during childhood treatment, even if the presence of an affective disorder at catch-up was considered as an independent covariate variable. Nevertheless, the latter variable explained a large part of the variance of depression scores, while initial affective symptoms explained no more than 6%. CONCLUSION: Affective symptoms in childhood and adolescence may predict the later development of subthreshold depressive symptomatology.     

Using the Job-Related Affective Well-Being Scale (JAWS) to investigate affective responses to work stressors

Prior research linking job stressors to psychological strains has been limited to a small number of emotional reactions. This article describes research linking job stressors to a wide range of affective states at work. In Study 1, a multidimensional scaling procedure was used on a matrix of similarity judgments by 51 employees of 56 job-related affective statements to support a 2-dimensional view of affective well-being. In Study 2, ratings of the affect statements by 100 employees further supported the contention that the dimensions were pleasure-displeasure and degree of arousal. In Study 3, 114 full-time university employees responded to the Job-Related Affective Well-Being Scale, which was found to be related to measures of job stressors as well as job satisfaction and physical symptoms.     

Age differences in symptoms of depression and anxiety: examining behavioral medicine outpatients

This study examined whether symptoms of depression and concomitant anxiety differed between older and younger medical outpatients referred to a behavioral medicine clinic. In a sample of 178 male veterans aged 21–83 years, older adults (60 years) reported lower overall depressive symptoms on the Beck Depression Inventory (BDI) and anxiety symptoms on the State-Trait Anxiety Inventory than did younger adults (<60 years). Depressive symptoms were highly prevalent. Among older adults, 60.0% scored 10 or higher on BDI and 33.8% scored 16 or higher. Among younger adults, 70.8% scored 10 or higher on BDI, and 48.7% scored 16 or higher. The age difference in overall depressive symptoms was driven by cognitive–affective symptoms. While older adults had lower cognitive–affective symptoms than did younger adults, the two groups did not differ on somatic-performance symptoms. These results suggest the importance of assessing cognitive–affective depressive symptoms in both older and younger male medical outpatients.     

Empathy in adults with clinical or subclinical depressive symptoms

Background

Depression is associated with problems in social functioning. Impaired empathic abilities might underlie this association. Empathy is a multidimensional construct and involves both affective and cognitive processes. We reviewed the literature to find out to what extent depression may be associated with abnormal levels of affective and cognitive empathy. We also explored potential gender differences in these associations.

Methods

We used PsycInfo and Medline to conduct a systematic review of all studies on empathy and depression conducted in individuals with a primary diagnosis of major depressive disorder (MDD; patient samples) or in individuals with primarily subclinical depressive symptoms (analog samples).

Results

Thirty-seven studies met the inclusion criteria. The results indicated that depression was related to one type of affective empathy. Specifically, depression was related to high levels of empathic stress but not to abnormal empathic concern. Further, depression was related to limited cognitive empathy, as indicated by poor perspective taking, theory of mind, and empathic accuracy.

Limitations

Few studies have considered the variable gender in their design and analyses. Between and within study variation in demographic and clinical variables limits the interpretation of results. Self-report measures of empathy are subjective and vulnerable to bias. Poor performance on the more objective laboratory tasks might partially be explained by the broader cognitive deficits commonly observed in depression. Lastly, because all studies used a cross-sectional design, causality is difficult to establish.

Conclusions

Empathic abilities may be impaired in depression. The relation between empathy, depression, and gender is unclear. Future studies could use implicit and more ecologically valid measures of empathy. Insight into impaired empathy in depression may not only help explain poor social functioning in MDD but also benefit clinician–patient interactions.     

Body mass index, eating attitudes, and symptoms of depression and anxiety in pregnancy and the postpartum period

OBJECTIVE: This report describes associations between body mass index (BMI; kg/m2), eating attitudes, and affective symptoms across pregnancy and the postpartum period in a sample of 64 women. METHODS: As part of a larger study, women were recruited during pregnancy and followed prospectively to 14 months postpartum. Measures included self-reported prepregnancy and 4-month postpartum BMI as well as pregnancy, 4-month, and 14-month postpartum eating attitudes (EAT), depressive symptoms (CES-D), and anxiety symptoms (STAI). RESULTS: During pregnancy, symptoms of depression or anxiety were not significantly correlated with concurrent eating attitudes or measures of BMI. However, at 14 months postpartum, measures of eating attitudes and both depression and anxiety symptoms were associated. Measures of BMI were associated with depressive and anxiety symptoms at both 4 and 14 months postpartum. Four-month eating attitudes and BMI predicted 14-month postpartum depressive symptoms, beyond pregnancy, and 4-month postpartum measures of affective symptoms. Results suggested that overweight women were at risk for elevated anxiety at 4 months and depressive symptoms at both 4 and 14 months postpartum. CONCLUSIONS: These results provide evidence for a significant, albeit moderate, relationship between BMI, eating attitudes, and symptoms of depression and anxiety in the postpartum period that are not present during pregnancy.     

Insight, symptoms and neurocognition in bipolar I patients

BACKGROUND: Level of insight and its relationship to clinical variables and neurocognitive functions was assessed in bipolar I patients. METHODS: Verbal memory, executive functioning, sustained attention, general intelligence and other neurocognitive functions were compared between 37 chronic in- and outpatients and 31 matched normal controls. Detailed psychiatric interviews were completed to define the level of symptomatology and psychosocial functioning. Insight was assessed by the Scale to Assess Unawareness of Mental Disorder (SUMD). RESULTS: Seventy percent of the patients were classified as having impaired insight. Prevalence of impaired insight was 47% and 94% in remitted and symptomatic patients, respectively. Symptomatic patients scored significantly below remitted patients on insight and neurocognition. Illness and symptom unawareness were related to overall level of symptoms, measures of memory, conceptual ability and right hand psychomotor speed and accuracy. Misattribution of symptoms and signs was correlated to visuomotor speed and visuospatial performance in addition to affective symptoms and thought disturbance. CONCLUSIONS: Our findings support the hypothesis that impaired insight and other neurocognitive dysfunctions were present in a large percentage of cases among symptomatic as well as remitted bipolar patients. This may be of clinical relevance and raises important questions about the course and outcome of the illness.     

Affective temperaments: Unique constructs or dimensions of normal personality by another name?

Background

Current models theorize that affective temperaments underlie the development and expression of mood psychopathology. Recent studies support the construct validity of affective temperaments in clinical and non-clinical samples. However, one concern is that affective temperaments may be describing characteristics that are better captured by models of normal personality. We conducted two studies examining: (a) the association of affective temperaments with domains and facets of normal personality, and (b) whether affective temperaments accounted for variance in mood symptoms and disorders, impairment, and daily-life experiences over-and-above variance accounted for by normal personality.

Methods

Study 1 included 522 young adults who completed the TEMPS-A and the NEO-PI-3. Study 2 included 145 participants who were administered the TEMPS-A, NEO-FFI, interviews assessing psychopathology and impairment, and an assessment of daily life experiences.

Results

Study 1 revealed that personality domains and facets accounted for one-third to one-half of the variance in affective temperaments. However, study 2 demonstrated that affective temperaments accounted for unique variance in measures of psychopathology, impairment, and daily-life experiences after partialling variance associated with personality domains. Specifically, cyclothymic/irritable temperament predicted bipolar disorders, impairment, borderline personality traits, urgency, and anger in daily life. Hyperthymic temperament predicted hypomanic episodes, grandiosity, sensation seeking, and increased activity in daily life.

Limitations

The study was limited by the fact that only domain, not facet-level, measures of FFM were available in study 2.

Conclusions

The findings support the validity of hyperthymic and cyclothymic/irritable temperaments as indicators of clinical psychopathology and indicate that they provide information beyond normal personality.     

Sleep difficulties are associated with increased symptoms of psychopathology

Sleep problems often co-occur with psychopathological conditions and affective dysregulation. Individuals with mood disorders have significantly higher rates of sleep disturbances than healthy individuals, and among those with mood disorders, sleep problems are associated with lower rates of remission and response to treatment. Sleep disruption may itself be a risk factor for various forms of psychopathology, as experimental sleep deprivation has been found to lead to increased affective, cognitive, and somatic symptoms within healthy volunteers. However, little is known about the relationship between recurring sleep complaints in a naturalistic environment and symptoms of psychopathology among healthy individuals. In the present study, 49 healthy adults (21 males and 28 females) reported sleep quality and completed the Personality Assessment Inventory, a standardized self-report assessment of symptoms of psychopathology. Consistent with prior published findings during total sleep deprivation, individuals endorsing self-reported naturally occurring sleep problems showed higher scores on scales measuring somatic complaints, anxiety, and depression. Furthermore, the reported frequency of sleep disturbance was closely linked with the severity of self-reported symptoms. While causal directionality cannot be inferred, these findings support the notion that sleep and emotional functioning are closely linked.     

Premenstrual symptoms are associated with psychological and physical symptoms in early pregnancy

The reproductive life of women is characterised by a number of distinct reproductive events and phases (e.g. premenstrual phase, peripartum, perimenopause). The hormonal transitions during these phases are often associated with both psychological and physical symptoms. Associations between these reproductive phases have been shown by numerous studies. However, the relationship between symptoms during the premenstrual phase and during early pregnancy has received little attention thus far, although early pregnancy is a time of dramatic hormonal as well as physical adaptation. Findings are based on a prospective longitudinal study with N?=?306 pregnant women (MARI study). Three hundred five women that had menstrual bleeding in the year before pregnancy rated the severity of psychological and physical symptoms during premenstrual phases in the year preceding pregnancy. Besides this, they rated the severity of the same symptoms during early pregnancy (weeks 10 to 12 of gestation). The overall severity of premenstrual symptoms was significantly associated with the overall severity of early pregnancy symptoms (b?=?0.4, 95 % CI?=?0.3–0.5; p?<?0.001). The overall severity of early pregnancy symptoms was best predicted by the severity of premenstrual irritability. The best predictor for a particular symptom in early pregnancy mostly was the corresponding premenstrual symptom. The associations between premenstrual and early pregnancy symptoms support the reproductive hormone sensitivity hypothesis that some women are prone to repeatedly experience specific psychological and physical symptoms during different reproductive phases. The findings further imply that the nature of symptoms might be rather consistent between different reproductive phases.     

Automatic processing of facial emotion in schizophrenia with and without affective negative symptoms

Introduction. It is assumed that people spontaneously evaluate any incoming stimulus as pleasant or unpleasant. The evaluative response appears to structure perception and to have direct links to emotional states.Methods. To investigate the automatic processing of face valence a sequential priming task based on emotional face stimuli was administered to schizophrenia patients with a flat affect expression, schizophrenia patients suffering from anhedonia, schizophrenia patients not suffering from anhedonia or flat affect, and healthy controls. The Scale for the Assessment of Negative Symptoms (Andreasen, 1989) was applied to evaluate affective symptoms and categorise patients into groups.Results. Schizophrenia patients without affective negative symptoms exhibited reversed priming effects similar to that of healthy subjects. In contrast, flat affect patients and anhedonic patients showed only a prime effect due to negative facial valence. In the flat affect patient group, negative prime faces facilitated the evaluation of target faces, whereas in the anhedonic patient group negative prime faces tended to inhibit the evaluation of subsequent target faces.Conclusions. The present findings support the idea that chronic schizophrenia patients extract automatically the valence of emotional facial expression but they also suggest processing differences between schizophrenia patients as a function of affective symptoms.     

Personality traits and the reporting of affective disorder symptoms in depressed patients

BACKGROUND: A deeper understanding of the influences on self-reported mood symptoms could inform the debate about the utility of self-report instruments and enhance the assessment and treatment of affective disorders. We tested the hypotheses that higher Neuroticism is associated with the over-reporting of affective symptoms and lower Openness to Experience is associated with the under-reporting of affective symptoms. METHODS: Subjects were 134 inpatients of ages 50 and over diagnosed with a mood disorder. Personality was assessed with the Revised NEO Personality Inventory. Self-reported depression was assessed with the Beck Depression Inventory-II; observer-rated depression was assessed via the Hamilton Depression Rating Scale. Symptom-reporting was defined as the ratio of self-reported to observer-rated symptoms. RESULTS: As hypothesized, multivariate linear regression analyses revealed that high Neuroticism contributed to patients' over-reporting of mood symptoms. Contrary to the hypothesis, low Openness was associated with high ratios of self-reported to observer-rated mood symptoms. LIMITATIONS: Cross-sectional design and unclear generalizability to racial/ethnic minorities. CONCLUSIONS: Traits are important correlaters of self-reported vs. observer-rated symptoms in patients with affective disorders. To the extent that economic imperatives and other pressures impel greater reliance on self-report data in mental health research and services, there will be a corresponding need for prospective research on the determinants and clinical implications of discrepancies between self-reports and observer ratings.     

When, why and for whom there is a relationship between physical activity and menopause symptoms

Objectives

The relationship between enhanced physical activity and decreased menopause symptoms is equivocal. In this study we sought to better understand this relationship by examining the association of physical activity to different symptom domains and by examining mediating and moderating variables.

Study design

Women participating in a randomized control trial on physical activity were given a menopause symptom measure (MENQOL) at follow-up. Of the 280 women participating, 113 (mean age = 52) reported having symptoms they attributed to menopause. Regression analyses were run to examine if change in physical activity predicted fewer symptoms. Exercise self-efficacy was examined as a mediator and depressive symptoms as a moderator.

Results

An increase in physical activity from baseline was found to be related to reporting fewer total menopause symptoms (β = −0.22, p = .02). When the total menopause symptoms score was examined by domain, increased physical activity was found to be related to reporting fewer general symptoms attributed to menopause (psychosocial (β = −0.18, p = .05) and physical (β = −0.23, p = .01)), but had no effect on specific symptoms of menopause (vasomotor and sexual). Exercise self-efficacy was found to mediate the relationship between increased physical activity and total, physical and psychosocial menopause symptoms. Finally, for individuals with high depressive symptoms, those who increased physical activity the most reported fewer sexual symptoms of menopause.

Conclusion

This study suggests that physical activity participation is associated with lower general symptom reporting as opposed to specifically impacting menopause symptoms. Further, exercise self-efficacy mediates the relationship between physical activity and general menopause symptoms, suggesting a psychological pathway.     

Modifiable factors associated with changes in postpartum depressive symptoms

Up to 50% of mothers report postpartum depressive symptoms yet providers do a poor job predicting and preventing their occurrence. Our goal was to identify modifiable factors (situational triggers and buffers) associated with postpartum depressive symptoms. Observational prospective cohort telephone study of 563 mothers interviewed at 2 weeks and 6 months postpartum. Mothers reported on demographic factors, physical and emotional symptoms, daily function, infant behaviors, social support, and skills in managing infant and household. Mothers were categorized into four groups based on the presence of depressive symptoms at 2 weeks and at 6 months postpartum: never, always, late onset, and remission groups. Fifty-two percent did not have depressive symptoms at 2 weeks or at 6 months (never group), 14% had symptoms at both time points (always group), 10% had late onset, and 24% had early onset of symptoms with remission. As compared with women in the never group, women in the always and late onset groups had high-risk characteristics (e.g., past history of depression), more situational triggers (e.g., physical symptoms), and less robust social and personal buffers (i.e., social support and self-efficacy). As compared with the never group, mothers in the remission group had more situational triggers and fewer buffers initially. Changes in situational triggers and buffers were different for the four groups and were correlated with group membership. Situational triggers such as physical symptoms and infant colic, and low levels of social support and self-efficacy in managing situational demands are associated with postpartum depressive symptoms. Further research is needed to investigate whether providing education about the physical consequences of childbirth, providing social support, and teaching skills to enhance self-efficacy will reduce the incidence of postpartum symptoms of depression.     

Stress,psychological distress,psychosocial factors,menopause symptoms and physical health in women

Objectives

Relatively few studies have evaluated relationships between stress, psychological distress, psychosocial factors and menopause symptoms, and none have evaluated emotional intelligence (EI) in relation to menopause. In this study, direct and indirect relationships were evaluated between stress, psychological distress, psychosocial factors (e.g. social support, coping, EI), menopause symptom severity and physical health in middle-aged women.

Methods

One hundred and sixteen women aged 45–55 years were recruited through women's health centres and community organizations. They completed a short questionnaire asking about stress, psychological distress (i.e. anxiety, depression), EI, attitude to menopause, menopause symptoms and physical health.

Results

Low emotional intelligence was found to be related to worse menopause symptoms and physical health, and these associations were partly mediated by high stress, anxiety and depression, a negative attitude to menopause and low proactive coping.

Conclusions

Women with high EI appear to hold more positive attitudes to menopause and experience less severe stress, psychological distress and menopause symptoms and better physical health. These results suggest that women who expect menopause to be a negative experience or are highly stressed or distressed may be more likely to experience a more negative menopause.     

Signs and symptoms in the pre-psychotic phase: description and implications for diagnostic trajectories

BACKGROUND: Few studies have examined the underlying factor structure of signs and symptoms occurring before the first psychotic episode. Our objective was to determine whether factors derived from early signs and symptoms are differentially associated with non-affective versus affective psychosis. METHOD: A principal components factor analysis was performed on early signs and symptoms reported by 128 individuals with first-episode psychosis. Factor scores were examined for their associations with duration of untreated illness, drug abuse prior to onset of psychosis, and diagnosis (schizophrenia versus affective psychosis). RESULTS: Of the 27 early signs and symptoms reported by patients, depression and anxiety were the most frequent. Five factors were identified based on these early signs and symptoms: depression, disorganization/mania, positive symptoms, negative symptoms and social withdrawal. Longer duration of untreated illness was associated with higher levels of depression and social withdrawal. Individuals with a history of drug abuse prior to the onset of psychosis scored higher on pre-psychotic depression and negative symptoms. The two mood-related factors, depression and disorganization/mania, distinguished the eventual first-episode diagnosis of affective psychosis from schizophrenia. Individuals with affective psychosis were also more likely to have a 'mood-related' sign and symptom as their first psychiatric change than individuals later diagnosed with schizophrenia. CONCLUSIONS: Factors derived from early signs and symptoms reported by a full diagnostic spectrum sample of psychosis can have implications for future diagnostic trajectories. The findings are a step forward in the process of understanding and characterizing clinically important phenomena to be observed prior to the onset of psychosis.     

Subject selection biases in alcoholic samples: effects on cognitive performance

The effects of subject selection bias in research on cognitive deficits in sober alcoholics were studied in a sample of 523 subjects (98 controls, 276 ineligible alcoholics, 40 eligible alcoholics who declined to participate, and 144 eligible and participatory alcoholics). All subjects received the Shipley Institute of Living Scale (Vocabulary and Abstracting subscales) and measures of anxiety, depressive symptoms, childhood hyperkinesis and attentional deficit disorders were obtained. Results indicate that current guidelines for alcoholic subject selection are biasing analyses toward support of the null hypothesis. Declined alcoholics performed more poorly on the Shipley Abstracting than did the "Used" group, yet did not differ significantly from the Used alcoholic groups on depression or anxiety. Declined alcoholics did, however, report significantly fewer Hk/MBD symptoms than did other alcoholic groups. ANCOVAs that used the affective and childhood disorders as covariates did not alter the differences in cognitive performance described above.     

Insight: its relationship with cognitive function,brain volume and symptoms in schizophrenia

BACKGROUND: Lack of insight is frequently observed in schizophrenia. Relationships have been noted between poor insight, clinical symptoms and cognitive impairments but the findings are inconsistent. There have been some recent attempts to relate poor insight to neuro-anatomical measures. METHOD: We assessed insight, positive and negative symptoms of schizophrenia, cognitive performance, and whole brain volumes in a sample of 78 DSM-IV male schizophrenics and 36 normal male comparison subjects matched for age and IQ. Subjects underwent a dual-echo MRI brain scan to establish grey, white and whole brain volumes. RESULTS: Poor Wisconsin Card Sorting Test performance inversely correlated with insight in schizophrenic patients, as did the symptoms alogia, anhedonia, avolition/apathy, affective flattening, inappropriate affect, thought disorder and delusions. The presence of inappropriate affect, delusions and thought disorder, showed the most significant impact on insight levels. There were no significant correlations between whole brain, white and grey matter volume and degree of insight. CONCLUSIONS: The results suggest that poor insight is significantly related to schizophrenic psychopathology, and confirm that there is a relationship between insight and executive performance. Awareness of illness is not related to any global brain measures, suggesting future investigations should pay attention to more specific cortical regions such as the frontal cortex.     

The validity of DSM symptoms for depression and anxiety disorders during pregnancy

Background

The applicability of the symptom criteria for diagnostic mood and anxiety disorders has in recent times been questioned for women in the perinatal period, due to the overlap of diagnostic symptoms with normal symptoms due to the physical changes of pregnancy or postpartum, (e.g., sleep difficulties).

Method

118 women in their second or early third trimester of pregnancy participated in a telephone interview that included the depression and anxiety modules of the MINI diagnostic interview, and an attributional probe question asking the woman whether endorsement of a symptom was due to the physical changes of her pregnancy or due to her mood or worries.

Results

66% of pregnant women who met criteria for major depression reported that a sufficient number of their symptoms were due to the normal physical changes of their pregnancy, such that they would no longer meet criteria for a diagnosis of major depression. Attributional probing resulted in the rate of major depression falling from 6.8% to 1.7%. The impact on anxiety disorders appears to be less.

Limitations

An important issue is whether women's attributional perceptions are valid, though the face validity of some of their responses means that credence should be given to the findings. In addition, it would be useful from a validity perspective to undertake the same attributional probing with other populations where symptom presence is most likely due to mood, such as unemployed or recently separated adults without physical complaints.

Conclusion

Rates of depressive disorders in pregnancy, using DSM symptom criteria, are significantly over-estimated due to the natural occurrence of many of the symptoms as a result of the pregnancy. Rates of anxiety disorders are also inflated, but to a lesser degree. This means that the validation of self-report mood measures, typically done against DSM diagnoses, is likely to have produced erroneous findings (e.g., optimum cut-off scores). It is probable that a similar finding would be obtained for the postpartum period. Thus future use of DSM symptom criteria for depression and anxiety in perinatal mental health work should use some form of attributional probing question to more accurately understand the applicability of symptoms to a diagnosis in this population.     

The impact of depressive symptoms on the functional status of inner-city patients with asthma.

BACKGROUND: Functional deficits are common in patients with asthma. If there is cooccurring depression, these deficits may be more severe and/or more persistent. OBJECTIVE: This study was undertaken to determine 1) the prevalence and severity of depressive symptoms in a sample of inner-city patients being treated for asthma and 2) the impact of these symptoms on functional status. METHODS: Three hundred seventeen enrollees in an inner-city asthma program were evaluated using the health status questionnaire and the Center for Epidemiologic Studies Depression Scale (CES-D) at baseline and at 3- and 6-month follow-ups. Two groups were created based on patients' CES-D baseline scores, using a commonly used cutpoint to define "caseness" for depression. The two groups were compared using ANOVA, chi2, and the general linear model for repeated measures. RESULTS: Of the sample, 55.01% had a CES-D score greater than the cutpoint for depression. The mean was 29.3 +/- 11.95, well above the scores commonly used to indicate the presence of depression. The depressed group had lower scores on many measures of functional capacity at baseline; whereas both depressed and nondepressed patients improved over time on the physical performance measure (the physical performance measure subscale of the health status questionnaire), the mean score for the depressed group was consistently lower. CONCLUSIONS: The prevalence of depressive symptoms was greater than expected. Depression was persistent and had a major impact on functional capacity. Routine depression screening may be especially important in inner-city patients and other groups thought to be at increased risk for poor outcome.