Work and family roles and the association with depressive and anxiety disorders: differences between men and women

BACKGROUND: This study examined the associations of (combinations of) social roles (employee, partner and parent) with the prevalence of anxiety and depressive disorders and whether social roles contribute to the explanation of the female preponderance in these disorders. METHOD: This was a cross-sectional study using data from 3857 respondents aged 25-55 of NEMESIS (Netherlands Mental Health Survey and Incidence Study). Depression and anxiety disorders were measured using the CIDI 1.1. RESULTS: The OR of depressive disorders and anxiety disorders among women compared to men was 1.71 (95% CI: 1.40-2.10). Among both genders, the partner role was associated with decreased risks of depression and anxiety and the parent role was not. The work role was a significant protective factor of depression and anxiety for men (OR=0.40; 95% CI: 0.24-0.69) but not for women (OR=0.86; 95% CI: 0.66-1.12). The effect of the work role was positive among women without children (OR=0.28; 95% CI: 0.14-0.54), but not among those with children (OR=1.01; 95% CI: 0.75-1.35). The gender risk for depression and anxiety decreased significantly by adding the work role variables into the model. LIMITATIONS: This was a cross-sectional study. This study did not give insight into the quality of social roles. CONCLUSION: The work role contributed to the explanation of the female preponderance in depression and anxiety disorders. Considering depression and anxiety among women, a focus upon quality and meaning of the work role, and barriers in combining the work role and parent role may be essential.     

Comorbidity associated with atrial fibrillation: a general practice-based study.

BACKGROND: Atrial fibrillation is an important risk factor for ischaemic stroke. Anticoagulation treatment with warfarin can substantially reduce the risk of stroke in people with atrial fibrillation but concerns about their side-effects have limited their use in clinical practice. However there has been little population-based research on the comorbidity associated with atrial fibrillation and on the prevalence of potential contraindications to anticoagulantion treatment among these patients. AIM: To determine the prevalence of known risk factors for ischaemic stroke and possible contraindications to anticoagulant treatment among patients with atrial fibrillation. METHOD: One-year prospective cohort study in 60 general practices in England and Wales with a total population of 502,493 people. Age and sex specific prevalence rates and relative risks of risk factors for ischaemic stroke and possible contraindications to antithrombotic treatment were calculated. RESULTS: The number of patients who had a diagnosis of atrial fibrillation during the year was 1,414 (0.3%) patients. The prevalence of other nsk factors for ischaemic stroke in patients with atrial fibrillation increased with age in men, from 48% (relative risk [RR] = 3.78, 95% confidence interval [95% CI] = 3.23-4.41) at 45 to 64 years to 64% (RR = 2.21, 95% CI = 2.00-2.44) at 75years and over A similar increase of 50% (RR = 4.36, 95% CI = 3.54-5.38) to 60% (RR = 2.07, 95% CI = 1.91-2.23) was seen in women. The percentage of men with atrial fibrillation with at least one contraindication to antithrombotic treatment was 5% at 45 to 64 years and 14% at 75 years and over. Among women with atrial fibrillation, 7% had a contraindication at 45 to 64 years and 16% at 75 years and over. The all-ages relative risk of a contraindication was 1.17 (95% CI = 0.92-1.48) in men and 1.53 (95% CI = 1.28-1.83) in women. Forty per cent (575) of patients with atrial fibrillation had at least one risk factor for ischaemic stroke and no contraindications to antithrombotic treatment. CONCLUSION: Atrial fibrillation is associated with a substantial increase in the prevalence of risk factors for ischaemic stroke. By contrast, potential contraindications for antithrombotic treatment are more evenly distributed among patients with and without atrial fibrillation. Around 40% of patients with atrial fibrillation in primary care are at high risk of stroke and have no contraindicationsfor antithrombotic treatment.     

The prevalence of and potential risk factors for female urinary incontinence in Beijing, China

OBJECTIVES: To survey and evaluate the prevalence and potential risk factors of female urinary incontinence (UI) in Beijing, China. DESIGN: A population-based cross-sectional study was performed from April to July 2005. We randomly sampled 1.0% of female residents aged 20 years and older from year 2000 national census data, totaling 5,300 women. All of the women were interviewed face to face using a modified questionnaire based on the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms. Data were collected and analyzed. RESULTS: The overall prevalence of female UI was 38.5%. Prevalence rates of female stress urinary incontinence (SUI), female urge urinary incontinence, and female mixed urinary incontinence were 22.9%, 2.8%, and 12.4%, respectively. The prevalence rate of female UI was more than 50% in postmenopausal women. In multiple logistic models, multiple vaginal deliveries (odds ratio [OR]=2.1; 95% CI: 1.443-3.179), age (OR=1.7; 95% CI: 1.039-2.742), postmenopausal status (OR=1.5; 95% CI: 1.182-1.983), chronic pelvic pain (OR=1.4; 95% CI: 1.134-1.814), obesity (OR=1.4; 95% CI: 1.205-1.721), lack of exercise (OR=1.3; 95% CI: 1.105-1.509), constipation (OR=1.3; 95% CI: 1.109-1.586), and hypertension (OR=1.2; 95% CI: 1.053-1.474) were identified as potential risk factors of female SUI. No association between female SUI and offspring birth weight, occupation, or chronic diseases was observed in this study. Only 12.8% of women with UI and 7.4% of women with SUI seek medical help. CONCLUSIONS: UI is a major disorder that affects female quality of life. The prevalence of female UI is high (38.5%) in Beijing. Among the different types of UI, SUI was the most prevalent (22.9%). Potential risk factors identified for female SUI were multiple vaginal deliveries, age, postmenopausal status, chronic pelvic pain, obesity, lack of exercise, constipation, and hypertension.     

Asthma and depressive and anxiety disorders among young persons in the community

BACKGROUND: The objectives of the study were to examine linkages between asthma and depressive and anxiety disorders in a birth cohort of over 1000 young persons studied to the age of 21 years. Specifically, the study aimed to ascertain the extent to which associations between asthma and depressive and anxiety disorders could be explained by non-observed fixed confounding factors. METHOD: Asthma and depressive and anxiety disorders were measured prospectively over the course of a 21-year longitudinal study. Fixed effects logistic regression models were used to determine the relationship between asthma and depressive and anxiety disorders, adjusting for potentially confounding factors. RESULTS: Asthma in adolescence and young adulthood was associated with increased likelihood of major depression (OR 1.7, 95 % CI 1.3-2.3), panic attacks (OR 1.9, 95 % CI 1.3-2.8), and any anxiety disorder (OR 1.6, 95% CI 1.2-2.2). Associations between asthma and depressive and anxiety disorders were adjusted for confounding factors using a fixed effects regression model which showed that, after control for fixed confounding factors, asthma was no longer significantly related to major depression (OR 1.1), panic attacks (OR 1.1), or any anxiety disorder (OR 1.2). Additional post hoc analyses suggested that exposure to childhood adversity or unexamined familial factors may account for some of the co-morbidity of asthma and depressive and anxiety disorders. CONCLUSIONS: These results confirm and extend previous findings by documenting elevated rates of depressive and anxiety disorders among young adults with asthma, compared with their counterparts without asthma, in the community. The weight of the evidence from this study suggests that associations between asthma and depressive and anxiety symptoms may reflect effects of common factors associated with both asthma and depressive and anxiety disorders, rather than a direct causal link. Future research is needed to identify the specific factors underlying these associations.     

The 5-HTTLPR s/s genotype at the serotonin transporter gene (SLC6A4) increases the risk for depression in a large cohort of primary care attendees: the PREDICT-gene study.

Previous reports and meta-analyses have yielded inconclusive results as to whether the s/s genotype at the 5-HTTLPR serotonin transporter polymorphism confers increased risk for depression. We tested the association between s/s genotype and depression in a large cohort (n = 737) of Spanish primary care consecutive attendees participating in a European study on predictors for depression in primary care (PREDICT study). Participants were administered the Composite International Diagnostic Interview (CIDI) depression subscale allowing diagnoses using ICD-10 criteria for depressive episodes. Participants were genotyped to establish 5HTTLPR genotype. Both univariable and multivariable associations between the s/s genotype and depression were tested twice using two different depressive outcomes (ICD-10 depressive episode and ICD-10 severe depressive episode). We found an association between the s/s genotype and both depressive outcomes that was independent of age, sex, family history of psychological problems among first degree relatives and presence of comorbid generalized anxiety disorder. When comparing s/s homozygous versus the rest, the adjusted odds ratio for any ICD-10 depressive episode and for severe ICD-10 depressive episode were 1.50 (95% CI: 1.0-2.2; P = 0.045) and 1.79 (95% CI: 1.1-2.8; P = 0.016), respectively. The association was significantly stronger with increasing severity of depression (chi2 for linear association=6.1; P = 0.013) suggesting a dose-dependent relationship. Our results are consistent with previous reports suggesting a small but independent effect by the s/s 5-HTTLPR genotype increasing the risk for depression.     

HIV infection in rural villages of Cameroon

OBJECTIVE: To evaluate HIV-1 antibody seroprevalence and risk factors for HIV seropositivity in rural areas of Cameroon. METHOD: The prevalences of HIV antibodies in 53 villages in rural Cameroon visited during May-October 2000 were determined with an HIV1/2 rapid assay, standard ELISA, and western blot. Demographic data and risk factors were elicited via face-to-face interviews with a structured questionnaire. RESULTS: HIV seroprevalence was 5.8% (243/4156, 95% confidence interval [CI] = 5.1-6.6) overall, 6.3% (151/2394, 95% CI = 5.4-7.4) among females and 5.2% (92/1762, 95% CI = 4.3-6.4) among males. HIV seroprevalence among persons aged 15 - 70 years did not differ significantly by province (5.6% in Center, 4.5% in East, 6.9% in South, and 5.8% in South-West) ( =.10). Analysis of age- and gender-standardized prevalence by village across provinces indicated a near-significant difference (nonparametric Wilcoxon signed rank test, =.06), with highest prevalence in South-West, followed by South, Center, and East. Multivariate analysis revealed that single women were significantly more likely to be HIV seropositive than were married or widowed women. Women with a history of sexual relations while traveling were at significantly increased risk of HIV seropositivity (OR adjusted for age and marital status = 2.4, 95% CI = 1.4-9.7). Among men, those who reported ever having a sexually transmitted disease were at significantly increased risk of HIV-seropositivity (OR adjusted for age = 1.8, 95% CI = 1.1-2.8). CONCLUSION: We have documented a wide range of HIV prevalences among rural villages of Cameroon. Age, marital status (in women) and sexual risk factors appear to be associated with HIV infection in this setting.     

Gender differences in depression: findings from the STAR*D study

BACKGROUND: Epidemiologic research consistently reports gender differences in the rates and course of major depressive disorder (MDD). The STAR*D (Sequenced Treatment Alternatives to Relieve Depression) multicenter trial provides a unique opportunity to explore gender differences in outpatients with nonpsychotic MDD. METHODS: This sample included the first 1500 outpatients with MDD who enrolled in STAR*D. Nearly two-thirds of the sample (62.8%) were women. Baseline sociodemographic factors, comorbidities, and illness characteristics were analyzed by gender. RESULTS: Women (62.8% of the sample) had a younger age at onset of the first major depressive episode. They commonly reported concurrent symptoms consistent with anxiety disorders, somatoform disorder, and bulimia as well as atypical symptoms. Alcohol and drug abuses were more common in men. LIMITATIONS: This report is a subpopulation of the entire STAR*D sample. These exploratory analyses aimed to identify potential gender differences for further hypothesis testing. CONCLUSIONS: The gender-specific rate of MDD in this study population is proportional to rates found in community samples with a 1.7:1 prevalence of MDD in women vs. men which argues against increased treatment seeking in women.     

Prevalence and geographic disparity of depressive symptoms among middle-aged and elderly in China

BACKGROUND: To evaluate the prevalence of and risk factors for depressive symptoms among middle-aged and elderly Chinese in northern and southern China. METHODS: A population-based cross-sectional survey was performed in Beijing and Shanghai. Participants included 3289 community residents aged 50-70. Socio-demographic, lifestyle and health-related information were obtained by a standardized questionnaire. Clinically relevant depressive symptoms were assessed by the Center for Epidemiological Studies of Depression Scale (CES-D). RESULTS: The prevalence of depressive symptoms in the total study population was 9.5% (6.7% for men and 11.7% for women), and it was significantly higher in participants from Beijing than those from Shanghai (14.9% vs. 4.1%, P < 0.001). Multivariate logistic regression analyses indicated that this geographic disparity was independent of gender, age, marital status, living status, education level, health status, mobility, social activities and medical insurance (odds ratio, 3.94; 95% confidence interval, 2.86-5.40). LIMITATIONS: No clinical diagnostic validation was performed and the prevalence might be underestimated due to our exclusion criteria. CONCLUSIONS: Approximately one in ten middle-aged and elderly Chinese might suffer from depressive symptoms. Furthermore, the prevalence is substantially higher among residents in the north of China compared to the south. Prospective studies are required to confirm the results and identify the major risk factors contributing to this geographic disparity.     

Does insomnia kill?

STUDY OBJECTIVES: We investigated the prevalence and hazard ratios for insomnia complaints in a large cohort of middle-aged men and women. DESIGN: The Atherosclerosis Risk in Communities Study is a prospective study of cardiovascular disease. Using multivariate regression analysis, we predicted the likelihood of endorsing the insomnia complaints by age, sex, alcohol intake, smoking, diabetes, heart disease, menopausal status, use of hypnotics, hypertension, depressive symptoms, education level, body mass index, respiratory symptoms, and pulmonary function status. We predicted the hazard ratios (HR) of death at 6.3 +/- 1.1 year by endorsement of insomnia complaints and by hypnotic use controlling for covariates. SETTING: North American communities. PARTICIPANTS: 13563 participants aged 45 to 69 years at baseline INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The prevalence of insomnia complaints in this cohort was 23%. Predictors of insomnia complaints were female sex (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.45-0.70 for men), annual family income below 50,000 dollars (OR 1.23, CI 1.09-1.40), age 40 to 49 years (OR 1.29, CI 1.11-1.50), depressive symptoms (OR 5.05, CI 4.60-5.55), heart disease (OR 1.89, CI 1.67-2.14), severe airflow obstruction (OR 1.61, CI 1.17-2.22), pulmonary symptoms (OR 1.71, CI 1.5-1.95), and restrictive lung disease (OR 1.27, CI 1.10-1.47). After controlling for covariates, insomnia complaints were not associated with an increased risk for death (OR 1.01, CI 0.85-1.21), nor was the use of hypnotics (OR 1.38, CI 0.90-2.13). CONCLUSIONS: In this cohort, the prevalence of insomnia complaints was 23%. After controlling for confounders, neither insomnia complaints nor hypnotic use predicted increased mortality over 6.3 years.     

Sex differences in subclinical and DSM-IV pathological gambling: results from the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND: To examine sex differences in DSM-IV subclinical and pathological gambling in nationally representative data of the US population. METHOD: Data come from a large (n = 43093) representative sample of the adult US population. RESULTS: The lifetime prevalence rate of DSM-IV pathological gambling was 0.64% (95% CI 0.50-0.78) for men and 0.23% (95% CI 0.17-0.29) for women, whereas the lifetime prevalence of subclinical pathological gambling was 6.79% (95% CI 6.32-7.26) for men and 3.26% (95% CI 2.93-3.59) for women. For subclinical pathological gambling, men were significantly (p < 0.01) more likely than women to have smoked more than two packs of cigarettes a day, to be classified as heavy drinkers and to have lifetime diagnoses of alcohol and drug use disorders. Women with subclinical and pathological gambling were significantly more likely than men to have lifetime mood and anxiety disorders. With respect to pathological gambling, women had later ages of onset of the disorder, and were significantly more likely than men to report gambling to relieve depressed mood and to prefer casino gambling. Rates of treatment-seeking for DSM-IV pathological gambling were low for both men and women. CONCLUSIONS: There are important sex differences in the prevalence, symptom pattern, sociodemographic and clinical correlates and course of DSM-IV subclinical and pathological gambling. Results underscore the need to investigate sex differences in the social determinants, neurobiology and treatment response of DSM-IV subclinical and pathological gambling.     

A cross-sectional study of antenatal depression and associated factors in Malawi

Depression, and disabling levels of mixed depressive, anxious and somatic symptoms, termed common mental disorder, occurring in the perinatal period are an important health problem in low- and middle-income countries. In this cross-sectional study, pregnant women were recruited from a district hospital antenatal clinic in Malawi. Symptoms of depression and anxiety, and non-specific somatic symptoms commonly associated with distress, were measured using validated local versions of the Self Reporting Questionnaire (SRQ). In a sub-sample, Diagnostic Statistical Manual (DSM)-IV diagnoses of major and minor depressive disorders were made using the Structured Clinical Interview for DSM-IV. Maternal socio-demographic and health variables were measured, and associations with SRQ score and depression diagnosis were determined. Of 599 eligible women, 583 were included in the analysis. The adjusted weighted prevalence of current major depressive episode and current major or minor depressive episode were 10.7 % (95 % CI 6.9–14.5 %) and 21.1 % (95 % CI 15.5–26.6 %), respectively. On multivariate analysis, SRQ score was significantly associated with lower perceived social support, experience of intimate partner violence, having had a complication in a previous delivery, higher maternal mid-upper arm circumference and more years of schooling. Major depressive episode was associated with lower perceived social support and experience of intimate partner violence. This study demonstrates that antenatal depression/CMD is common in Malawi and is associated with factors that may be amenable to psychosocial interventions.     

Genetic and environmental contributions to cannabis dependence in a national young adult twin sample

BACKGROUND: This paper examines genetic and environmental contributions to risk of cannabis dependence. METHOD: Symptoms of cannabis dependence and measures of social, family and individual risk factors were assessed in a sample of 6265 young adult male and female Australian twins born 1964-1971. RESULTS: Symptoms of cannabis dependence were common: 11.0% of sample (15.1% of men and 7.8% of women) reported two or more symptoms of dependence. Correlates of cannabis dependence included educational attainment, exposure to parental conflict, sexual abuse, major depression, social anxiety and childhood conduct disorder. However, even after control for the effects of these factors, there was evidence of significant genetic effects on risk of cannabis dependence. Standard genetic modelling indicated that 44.7% (95% CI = 15-72.2) of the variance in liability to cannabis dependence could be accounted for by genetic factors, 20.1% (95% CI = 0-43.6) could be attributed to shared environment factors and 35.3% (95% CI = 26.4-45.7) could be attributed to non-shared environmental factors. However, while there was no evidence of significant gender differences in the magnitude of genetic and environmental influences, a model which assumed both genetic and shared environmental influences on risks of cannabis dependence among men and shared environmental but no genetic influences among women provided an equally good fit to the data. CONCLUSIONS: There was consistent evidence that genetic risk factors are important determinants of risk of cannabis dependence among men. However, it remains uncertain whether there are genetic influences on liability to cannabis dependence among women.     

Work stress precipitates depression and anxiety in young, working women and men

BACKGROUND: Rates of depression have been rising, as have rates of work stress. We tested the influence of work stress on diagnosed depression and anxiety in young working adults. METHOD: Participants were enrolled in the Dunedin study, a 1972-1973 longitudinal birth cohort assessed most recently in 2004-2005, at age 32 (n=972, 96% of 1015 cohort members still alive). Work stress (psychological job demands, work decision latitude, low work social support, physical work demands) was ascertained by interview. Major depressive disorder (MDD) and generalized anxiety disorder (GAD) were ascertained using the Diagnostic Interview Schedule (DIS) and diagnosed according to DSM-IV criteria. RESULTS: Participants exposed to high psychological job demands (excessive workload, extreme time pressures) had a twofold risk of MDD or GAD compared to those with low job demands. Relative risks (RRs) adjusting for all work characteristics were: 1.90 [95% confidence interval (CI) 1.22-2.98] in women, and 2.00 (95% CI 1.13-3.56) in men. Analyses ruled out the possibility that the association between work stress and disorder resulted from study members' socio-economic position, a personality tendency to report negatively, or a history of psychiatric disorder prior to labour-market entry. Prospective longitudinal analyses showed that high-demand jobs were associated with the onset of new depression and anxiety disorder in individuals without any pre-job history of diagnosis or treatment for either disorder. CONCLUSIONS: Work stress appears to precipitate diagnosable depression and anxiety in previously healthy young workers. Helping workers cope with work stress or reducing work stress levels could prevent the occurrence of clinically significant depression and anxiety.     

Relationships of mental disorders and weight status in the Korean adult population

The purpose of this study was to evaluate the associations between weight status and mental disorders, including depressive disorder, anxiety disorder and alcohol use disorder. A total of nationally representative 6,510 subjects aged 18-64 yr was interviewed in face-to-face household survey. Response rate was 81.7%. Mental disorders were diagnosed using the Korean version of the Composite International Diagnostic Interview (K-CIDI). The subjects reported their heights and weights. After adjusting for age and gender, the lifetime diagnosis of depressive disorder had a significant association with only the underweight group (odds ratio [OR], 1.68, 95% confidence interval [CI], 1.19-2.38). The association between underweight and depressive disorder was the strongest for subjects with a high education level (OR, 1.75, 95% CI, 1.2-2.56), subjects with a married/cohabiting status (OR, 1.94, 95% CI, 1.17-3.22) and smokers (OR, 2.58, 95% CI, 1.33-4.98). There was no significant association between obesity and depressive disorder in Korea. But there was a significant association between the underweight group and depressive disorder. The relationship between obesity and mental disorder in a Korean population was different from that in a Western population. These results suggest that the differences of traditional cultures and races might have an important effect on the associations between the weight status and mental disorders.     

青岛市18岁及以上人群精神障碍流行病学调查

目的:了解青岛市≥18岁人群各类精神障碍的现患率和分布特点,为制定全市精神卫生规划提供科学依据。方法:采用多阶段分层整群抽样方法随机抽取青岛市≥18岁居民4800人。首先由精神科护士用扩展的一般健康问卷(GHQ-12)进行筛查,将调查对象分为精神障碍高、中、低危险组;然后用美国精神障碍诊断与统计手册(DSM-IV)轴Ⅰ障碍定式临床检查患者版对不同比例的三组人群进行精神科检查。根据调查设计特征将计算出的患病率进行调整并推广至全市成年人口。结果:4776人完成调查。调整后精神障碍总的现患率(最近1个月)为21.96%(95%CI为19.21%～24.99%)。最常见的特定精神障碍为广泛性焦虑障碍(5.41%)、酒精使用障碍(5.33%)、重性抑郁障碍(3.43%)和心境恶劣障碍(2.72%)。女性总的现患率略低于男性(OR=1.2,95%CI为1.1～1.3),男性酒精使用障碍现患率高于女性(OR=131.2,95%CI为72.6～237.2)。农村与城市居民在精神障碍总的现患率方面的差异无统计学意义(OR=1.1,95%CI为0.6～2.3)。在有精神障碍的人群中,仅6.46%曾经因心理问题在医疗机构就诊,但36.97%精神障碍对其影响程度为中等到严重。结论:青岛市精神障碍的患病率较高,精神障碍已成为迫切需要解决的公共卫生问题,有必要在全市范围内开展和实施全面的精神卫生规划并定期评估其效果。     

Life events and psychosocial factors in elderly suicides--a case-control study.

BACKGROUND: Stressful life events, such as family conflicts, separation, bereavement, somatic illness and financial problems are common antecedents of suicide. Studies on suicide among younger persons dominate the literature, despite the fact that a large proportion of suicides occur among elderly persons. METHODS: The occurrence of stressful life events was investigated among elderly suicide cases and population controls. The study was conducted in the southwestern part of Sweden and included 85 persons (46 males and 39 females) 65 years and above who had committed suicide from January 1994 to May 1996. Population controls (84 males and 69 females) were randomly selected. Interviews were carried out with the controls and with informants for the suicide cases. Questions on sociodemographic background, mental and somatic health status, and life events (0-6, 7-12 and 13-24 months preceding suicide/interview) were included in the interviews. RESULTS: Somatic illness, family discord and financial trouble were significant risk factors during all three time periods. Other risk factors were mental disorder, lower education, feelings of loneliness and previous suicide in the family. Factors associated with a decreased risk included active participation in organizations and having a hobby. Variables that remained in the multivariate logistic regression model were mental disorder (men, odds ratio (OR) = 62.4, 95% CI 17.9-217.5; women, OR = 55.9, 95% CI 14.1-222.3) and family discord (men, OR = 10.0. 95% CI 1.7-59.8; women, OR = 9.2, 95% CI 1.9-44.8). CONCLUSIONS: Mental disorder and family discord were the two major risk factors for suicide among elderly men and women.     

Minor depressive disorder in the context of miscarriage

BACKGROUND: Although minor depressive disorder is of considerable clinical and public health importance, it has received limited research attention relative to major depressive disorder. This study examines the incidence rate and relative risk for minor depressive disorder following miscarriage. METHODS: Using a cohort design we tested whether miscarrying women are at increased risk for an episode of minor depression (diagnosed based on research criteria proposed in Appendix B of DSM-IV) in the 6 months following loss. The miscarriage cohort consisted of women attending a medical center for spontaneous abortion (n=229); the comparison group was a population-based cohort of women drawn from the community (n=230). RESULTS: Among miscarrying women, 5.2% experienced an episode of minor depression, compared with 1.0% of community women. The overall relative risk for an episode of minor depression for miscarrying women was 5.2 (95% confidence interval, 1.2-23.6). Relative risk did not vary by length of gestation at the time of loss or attitude toward the pregnancy. The majority of episodes in miscarrying women began within 1 month following loss. Limitations: Minor depression was relatively rare in both study cohorts. The resulting limits on statistical power reduced our ability to identify factors, such as sociodemographic or reproductive history variables that might moderate the effect of miscarriage on risk for minor depression. CONCLUSIONS: These results, in the context of prior work showing increased risks of major depression and depressive symptoms following miscarriage, lend some support to the conceptualization of minor depressive disorder as part of a continuum of symptom severity. Miscarrying women should be evaluated for depression at their follow-up medical visits.     

Self-reported psychotropic drug use and associated factors in a French community sample.

Drug use was examined in a French general population adult sample from a household survey conducted in 1987-8 in a newly built town near Paris. Psychotropic drug use was measured by the percentage of subjects reporting their use during the past week. It was prominently represented by benzodiazepines (90% of psychotropic users), differed strongly between genders (4.6% in men, 10.2% in women) and age groups (higher after 40 years). A lifetime history of major depressive episode (MDE) or of anxiety disorders was associated with a higher proportion of psychotropic drug use. Psychotropic drug use also went with a current well-being questionnaire score. Using a logistic analysis, the following set of variables held for women: well-being score, history of both MDE and anxiety disorder, age, and marital status. Making allowance for the cross-sectional nature of this retrospective survey, these finding confirmed the relatively high level of benzodiazepine drug use in an urban French community sample and emphasized its association with mental health status.     

Prevalence of depression and anxiety in older users of formal Dutch intellectual disability services

BackgroundLittle is known about the prevalence of depression and anxiety among older people with intellectual disabilities (ID). Therefore, the aim of this study was to study the prevalence of depression and anxiety in this population.MethodThis study is a cross-sectional epidemiologic multicentre study which was part of the “Healthy Ageing and Intellectual Disabilities” study. The study population consisted of 990 participants aged ≥50 years with borderline to profound ID which were screened with self-report and informant-report instruments; 290 of them were assessed with a standardized diagnostic interview.ResultsDepressive symptoms were prevalent in 16.8% (95% CI: 14.4–19.1) and significantly associated with higher age. Anxiety symptoms were prevalent in 16.3% (95% CI: 14.0–18.6) and significantly associated with female gender and borderline to mild ID. Major depressive disorder was prevalent in 7.6% (95% CI: 5.2–11.0), anxiety disorders in 4.4% (95% CI: 2.6–7.0) and both in 0.7% (95% CI: 0.2–1.6). There was no relationship with gender, age or level of ID.LimitationsFor most participants, informant-report instruments have been used instead of self-report to overcome communication difficulties or inabilities. Also, a standardized psychiatric diagnostic interview has been used instead of psychiatric diagnoses made by an experienced psychiatrist.ConclusionPrevalence of major depressive disorder is higher and of anxiety disorders lower than in the Dutch general older community-dwelling population.