Depression as a mediator between spousal bereavement and mortality from cardiovascular disease: appreciating and managing the adverse health consequences of depression in an elderly surviving spouse

Bereavement in the elderly is becoming a more frequent phenomenon as a result of the aging of the population. The death of an elderly spouse increases psychologic morbidity, particularly depressive symptoms, as well as mortality. Depression increases the risk of death independent of age or bereavement, and can thus exacerbate the health effects of losing a spouse. This magnifier effect is especially pernicious because bereavement and depression both tend to increase cardiovascular mortality rates. Primary care physicians should be alert for signs of mood disorders in elderly persons who have recently lost a spouse. Potential therapies for depression in an elderly bereaved individual include pharmacologic agents, psychotherapy, and psychosocial support. Data also support the value of encouraging religious patients to continue with spiritual observances. Although these approaches decrease mood disorders, it is not yet clear whether they also reduce the risk of death or cardiovascular disease.     

Depressive symptoms in HIV disease

Although depressive symptoms are common in people living with HIV/AIDS, their reported prevalence varies greatly across HIV-positive populations, ranging from 21% to 97%. Comparing these rates is complicated by the varied conceptualization of depression as a major depressive disorder (clinical depression) or depressive symptoms, and by the use of multiple methods of measurement. Knowledge of predictors of depressive symptoms can assist health care providers in the identification of those who are most at risk. Appropriate diagnosis, treatment, and referral are critical, because depressive symptoms have been associated with poorer disease outcomes. Additionally, self-management symptoms can be used to supplement more traditional treatment methods.     

Sickle cell disease: a stigmatizing condition that may lead to depression

Individuals with a chronic illness such as sickle cell disease are at risk for depression. Moreover, they are at risk for untreated depression. Depression may go untreated because of the stigma and high rates of disability associated with this chronic illness that most often affects African Americans in the United States. The purpose of this cross-sectional study was to describe depressive symptoms using the Beck Depression Inventory Fast Screen in a sample of 232 African American adults with sickle cell disease. Respondents reported higher levels of depression (26%) and depressive symptoms (32%) than did the overall United States population (9.5%). All adults with chronic illnesses need to be screened for depression in primary care practice sites where the diagnosis and treatment of depression needs to be coordinated.     

SICKLE CELL DISEASE: A STIGMATIZING CONDITION THAT MAY LEAD TO DEPRESSION

Individuals with a chronic illness such as sickle cell disease are at risk for depression. Moreover, they are at risk for untreated depression. Depression may go untreated because of the stigma and high rates of disability associated with this chronic illness that most often affects African Americans in the United States. The purpose of this cross-sectional study was to describe depressive symptoms using the Beck Depression Inventory Fast Screen in a sample of 232 African American adults with sickle cell disease. Respondents reported higher levels of depression (26%) and depressive symptoms (32%) than did the overall United States population (9.5%). All adults with chronic illnesses need to be screened for depression in primary care practice sites where the diagnosis and treatment of depression needs to be coordinated.     

Depression in the elderly. Characteristics and clinical management

Major depression and clinically significant depressive symptoms occur commonly in the community-dwelling, medically ill, and institutionalized elderly. Both major depression and depressive symptoms need thorough evaluation and treatment because of the significant morbidity and mortality associated with these syndromes. Depression may be difficult to diagnose, especially in the medically ill elderly, because of the masking of depressive symptoms by somatic complaints or the presumption that symptoms are attributable to concurrent medical illness. Therefore, the clinician must be alert to the possibility of depression in the elderly patient. Although no specific diagnostic test is available, rating scales can be useful in screening for depression in the elderly patient. It is necessary to rule out medical illness or medications as contributing factors to depression. Psychotherapy and psychopharmacology, alone or in combination, are effective treatments for most elderly patients with depression. ECT is a safe and effective treatment for major depression in this population. Depression in the elderly is potentially a chronic and relapsing illness with significant associated medical and social morbidity. Because of their frequent contact with the elderly, nurses play a particularly important role in the diagnosis and treatment of depression. They need to recognize typical and atypical symptoms of depression and must be familiar with the potential side effects of antidepressant treatment. Close monitoring for these potential side effects can minimize disability. By working as a team with physicians, psychologists, and others, nurses have a necessary role in the care of the elderly depressed patient.     

Visual disfigurement and depression.

Approximately 10% of the population has a facial disfigurement, such as a scar, blemish, or deformity that severely affects the ability to lead a normal life, and 2 to 3% have a clearly visible blemish. They may experience depressive symptoms due to disfigurement, stressful life events, or other causes. Depression is a painful and costly disorder that is often unrecognized and untreated in specialty practices; it is linked with higher costs of care, lengths of stay, and rates of rehospitalization. Often, these individuals seek plastic surgery to repair the disfigurement, and depressive symptoms are not uncommon preoperatively, perioperatively, and postoperatively. In addition, depressive disorders exist among 20 to 32% of people with a medical disease. Major depression is a recurring and disabling illness that typically responds to treatment with psychotherapy, antidepressants, and social support. Nurses have a major role to play in screening for and detecting depression so it can be evaluated and referred for treatment. Nurses also provide education, psychosocial support, and advocacy for patients with depression. Identifying those with depressed symptoms allows the nurse to recommend treatment, offer referrals, and provide supportive interventions.     

Factors Associated with Depression in African American Patients Being Treated for Cancer Pain

BackgroundAmong cancer patients in the United States, African American cancer patients have the highest mortality rate and shortest survival rate. Although depression is known as a predictor of mortality in cancer and a potential barrier to health care utilization, research on depression in African American patients is limited. Cancer pain can interfere with an individual’s ability to cope with depression.AimsTo identify factors that are associated with a positive screening of depressive symptoms assessed by the PHQ-8 in African American patients treated for cancer pain.DesignSecondary data analysis of a cross-sectional study of opioid adherence.SettingMedical oncology, palliative care, and radiation oncology clinics in Atlanta, Georgia.Participants/SubjectsAfrican American patients with cancer pain in the parent study.MethodsIndependent samples t-test was used to assess variable correlations with and without depressive symptoms. Adjusted logistic regression was conducted to identify factors that were associated with presence of depressive symptoms.ResultsMean patient age was 55.6 years, and nearly 38% had a PHQ-8 score of >10 indicating presence of moderate to severe depressive symptoms. Participants with depressive symptoms had significantly higher means for anxiety and pain interference with mood than those without depressive symptoms. Factors that were significantly associated with depressive symptoms were anxiety, pain interfering with mood, and lack of involvement with a religious congregation.ConclusionsThe findings of this study help to identify African American cancer patients at risk for depression and demonstrates the need for increased screening for depression in this underserved population.     

Stress,perceived support,resourcefulness and depressive symptoms in Taiwanese adolescents

Aims and objective. This study investigated (1) the prevalence of self‐reported depressive symptoms among first‐year students at an Institute of Technology in southern Taiwan; (2) whether perceived support and resourcefulness were associated with these adolescents’ depressive symptoms and (3) the moderating and mediating effects of learned resourcefulness on the relationship between stressors and the adolescents’ depressive symptoms. Background. An individual with adequate social support or resourcefulness may see stressors as less threatening or be more resilient in dealing with stressors compared with depressed individuals. The prevalence of depression in the global population increased rapidly during this past decade and consequently may have had a negative impact on population health outcomes. Among adolescents there has recently been an increased incidence of depression‐related suicide reports. Design. A cross‐sectional, correlational design. Method. Adolescents (n = 913) were recruited to complete the following: the SDI in Chinese, the Inventory of Social Supportive Behaviours Scale – Modified and the Self‐Control Schedule. Data analysis consisted of Pearson correlation and multiple regression analysis. Results. The prevalence of depression among participants was 13·4%. Participants who were younger, expressed lower satisfaction with their grades, perceived their health as worse, described peer relationship problems and exhibited smoking behaviour were more likely to have depressive symptoms. We observed five partially mediating effects of resourcefulness on stressors (age, perceived health, peer relationships, grades satisfaction and smoking behaviour) and depressive symptoms and one moderating effect of resourcefulness on the relationship between peer and depressive symptoms. Conclusions. Learned resourcefulness may play a critical role in decreasing depressive symptoms. Relevance to clinical practice. These findings offer healthcare providers and educators information about the need for possible cognitive–behavioural interventions that could improve adolescents’ relationships with their peers, enhance their satisfaction of grades and moderate or prevent depressive symptoms among this population. Moreover, it might decrease the prevalence of adolescent suicide.     

Chronic arterial occlusive disease.

Cardiovascular disease continues to be a major cause of death in the United States. Although the number of deaths has decreased in the past several years, disability from the disease remains significant because of its systemic nature. As the population continues to age, peripheral vascular disease (PVD) will become increasingly prevalent in society as a result of the process of atherosclerosis. This article focuses on the care of patients with PVD. Risk factors, presenting signs and symptoms, and diagnostic and therapeutic modalities associated with chronic arterial occlusive disease, as well as nursing responsibilities and interventions, are discussed.     

Depressive syndrome and ischemic cardiopathy

The prevalence of ischemic heart disease and depressive syndrome in the occidental population is high. Clinical depression appears to be an independent risk factor for coronary heart disease. Depression after an acute coronary event exerts a profoundly negative effect on quality of life and is related to poor prognosis (increased mortality rates and further cardiac events). Moreover, medical therapy in patients with ischemic heart disease and depressive symptoms is not free of problems. The purpose of this review is to present the relationships between depression and cardiovascular disease on the data collected from different studies and make recommendations for improving assessment and treatment of depressive symptoms in the family practice, internal medicine or cardiologist setting. Only an interdisciplinary integration among basic scientists and clinicians, will decrease the comorbidity.     

Treating persistent depressive symptoms in post-ACS patients: the project COPES phase-I randomized controlled trial

Depression and sub-syndromal depressive symptoms are important predictors of morbidity and mortality after acute coronary syndrome (ACS). Prior trials of depression treatment in post-ACS patients have demonstrated no improvement for event-free survival, and only modest improvement in depression symptoms. These trials have raised a number of important issues regarding timing of depression intervention, acceptability of depression treatment to ACS patients, and safety for subsets of the treated population. This article describes Project COPES (Coronary Psychosocial Evaluation Studies), a multi-center Phase-I randomized clinical trial. Project COPES uses a patient preference depression treatment that has previously been found acceptable to medical patients, and a 3-month pre-randomization observation period to insure depression status. The study sample will include 200 post-ACS patients. The primary outcome is patient satisfaction with depression care. Secondary, exploratory aims include the acceptability of depression treatment, reduction in depressive symptoms, and the effects of treatment on two key pathways--medication adherence and inflammation--hypothesized to link depression to post-ACS prognosis. These analyses will provide important data to inform subsequent clinical trials with this population.     

Depression and COPD in older people: a review and discussion

Depression affects approximately 40% of patients with chronic obstructive pulmonary disease (COPD) and is largely untreated. This review draws on the author's studies and the available literature to examine the problem. Older people with COPD experience moderate levels of depression, but this goes largely unrecognized and untreated. The prevalence, severity and risk factors for depression in this population are discussed. Treatment, in the form of pulmonary rehabilitation and antidepressant drug therapy, are discussed, but in the absence of well-controlled trials, it is difficult to draw any firm conclusions about the benefits of these therapies. However, an appropriate home care package, with the support of respiratory nurses, is of some benefit to housebound patients with COPD because it helps to relieve depression and improve their quality of life, especially among those with a high level of depressive symptoms.     

Depression in multiple sclerosis: a longitudinal analysis

High rates of depression have been documented in persons with multiple sclerosis (MS), but few studies have examined depression over time. This analysis considered data from 607 persons with MS in a 7-year period as part of an ongoing longitudinal study of quality of life in chronic illness. Latent growth curve analysis was used to examine trajectories in depression and the effects of covariates such as age, time since diagnosis of MS, type of MS, and functional limitations on the extent to which depression changed in the study period. Results of the analysis indicated that depressive symptoms fluctuated over time for individuals but did not show a tendency to an overall significant increase or decrease for the group as a whole. Younger age, longer time since diagnosis of MS, progressive forms of MS, and greater extent of functional limitation were predictive of greater depressive symptoms at Time 1. With the exception of functional limitation, which showed an association with depression at all periods, these variables did not predict changes in depressive symptoms over time. Gender was not a significant predictor of changes in depressive symptoms, nor did women have higher rates of depression as expected from previous research. The results of this analysis indicate the importance of screening for depression in all persons with MS.     

脑卒中后患者抑郁状态及其与社会支持的相关研究

目的探讨脑卒中后患者抑郁状态及其与社会支持的关系。方法采用抑郁自评量表（SDS）,艾森克人格测定（EPQ）,社会支持评定量表（SSRS）对100例住院脑卒中患者进行测评,并对伴有与不伴有抑郁状态的脑卒中患者进行一般情况对照。结果100例中有56例脑卒中患者存在抑郁症状（占56％）,SDS评分均值为42．90±8．81;伴有与不伴有抑郁状态的脑卒中患者在年龄、性别、个性、经济来源、疾病恢复程度与是否伴有其他慢性疾病比较差异有显著意义,而在婚姻状况及文化程度上比较无统计学意义。脑卒中患者较正常人获得的社会支持水平高（P〈0．01）;其抑郁症状的严重度与社会支持呈负相关关系（r=-0．779,P〈0．01）;结论脑卒中患者伴发的抑郁状态与其年龄、性别、个性、经济来源、疾病恢复程度及是否伴有其他慢性疾病有关,抑郁症状的严重度也与社会支持密切相关,应该重视社会支持系统对改善脑卒中患者抑郁状态与作用,以提高其生活质量。     

Depression and its association with diabetes, cardiovascular disease, and birth weight

BACKGROUND: Diabetes increases the risk for depression. AIM: To study the independent effects of diabetes mellitus (DM) and cardiovascular disease (CVD) on the prevalence of depression and to examine low birth weight as a possible common explanatory factor. METHODS: 2003 subjects from the Helsinki Birth Cohort Study underwent a 75-g oral glucose tolerance test and filled out the Beck Depression Inventory. RESULTS: Depressive symptoms were more prevalent among subjects with diabetes (23.5%) than among those with normal glucose tolerance (16.6%) (P < 0.001). A history of CVD also markedly increased the odds of having depressive symptoms (odds ratio (OR) = 2.38, 95% confidence interval (CI) = 1.70-3.32, P < 0.001). The association between DM and depressive symptoms was, however, rendered non-significant when adjusting for the presence of CVD. Being born with a low birth weight doubled the risk for having depressive symptoms (OR = 2.64, 95% CI = 1.42-4.91, P = 0.002) and magnified the association between CVD/DM and depression. CONCLUSION: Diabetes has only a minor independent effect on concurrent occurrence of depressive symptoms, while cardiovascular disease seems to be a more important underlying factor. The association between disease and depression is in particular characteristic to individuals born with a low birth weight.     

抑郁症伴精神病性症状与精神分裂症后抑郁临床特征研究

目的探讨抑郁症伴精神病性症状与精神分裂症后抑郁的临床特征。方法对40例抑郁症伴精神病性症状患者及44例精神分裂症后抑郁患者的一般资料、起病形式、诱因、症状特点及治疗效果等临床资料进行回顾性分析。结果抑郁症起病多受生活事件的影响,抑郁心境伴精神病性症状时,自杀意念和行为及思维迟缓等症状较为突出;精神分裂症后抑郁虽表现有抑郁情绪,但仍有较多患者有与抑郁情绪不相适应的幻觉、妄想性内容。结论两组患者虽应重点防止自杀、冲动,但因病因不同,其侧重点也不同。     

Comorbidity of pain-associated disability and depressive symptoms in connection with sociodemographic variables: results from a cross-sectional epidemiological survey in Hungary.

The purpose of this study was to investigate the prevalence of pain symptoms causing disabilities in every-day activities and their possible connection to depressive symptomatology. A representative sample of 12640 adults from the Hungarian population participated in a door-to-door survey about demographic variables, pain-associated disability, and depressive symptomatology. The overall prevalence of pain-associated disability was 32.7%, significantly lower in men, showing a significant increasing trend with age. A decreasing tendency in prevalence rates was observed in connection with higher educational and occupational status. Results revealed a 30.2% prevalence of depressive symptomatology among interviewees reporting pain-associated disabilities. The co-prevalence of depressive symptoms revealed a significant increasing trend with age and lower educational level. No significant gender difference was found in the co-occurrence of depressive symptoms. This survey concludes that pain symptoms constitute a substantial public health problem in the Hungarian population in forms of emerging disabilities and depression. Epidemiological studies offer a better understanding of sociodemographic differences in health status, and serve the better allocation of professional and economic resources.