The burden of cyclothymia on alcohol dependence

Background

The relationship between cyclothymic temperament and alcoholism remains insufficiently explored.

Methods

A sample of 125 alcohol-dependent patients diagnosed according to DSM-IV-TR criteria (APA, 2000) was recruited from a clinical setting. Cyclothymic temperament was diagnosed according to the Portuguese version of the Akiskal and Akiskal (2005) temperament scale.

Results

Alcohol dependent patients who score positive (above mean) for CT present to some extent a more severe profile of alcohol-related problems.

Limitations

Correlational study

Conclusions

CT traits in alcohol dependents seems to influence whether subjects engage earlier in pathological alcohol use and present particular alcohol-related problems, in particular Cloninger type II alcoholism phenotype.     

DSM-5 mixed specifier for manic episodes: Evaluating the effect of depressive features on severity and treatment outcome using asenapine clinical trial data

Background

To describe the frequency of mixed specifier as proposed in DSM-5 in bipolar I patients with manic episodes, and to evaluate the effect of mixed specifier on symptom severity and treatment outcome.

Methods

This post-hoc analysis used proxies for DSM-5 mixed features specifier by using MADRS or PANSS items.

Results

Of the 960 patients analysed, 34%, 18% and 4.3% of patients, respectively, had ≥3 depressive features with mild (score ≥1 for MADRS items and ≥2 for PANSS item), moderate (score ≥2 MADRS, ≥3 PANSS) and severe (score ≥3 MADRS, ≥4 PANSS) symptoms. In patients with ≥3 depressive features and independent of treatment: MADRS remission (score ≤12) rate decreased with increasing severity (61–43%) and YMRS remission (score ≤12) was similar for mild and moderate patients (36–37%), but higher for severe (54%). In asenapine-treated patients, the MADRS remission rate was stable regardless of baseline depressive symptom severity (range 64–67%), whereas remission decreased with increasing severity with olanzapine (63–38%) and placebo (49–25%). Reduction in YMRS was significantly greater for asenapine compared with placebo at day 2 across the 3 severity cut-offs and continued to decrease throughout the treatment period. The difference between olanzapine and placebo was statistically significant in mild and moderate patients.

Limitations

Results are from post-hoc analyses.

Conclusions

These analyses support the validity of proposed DSM-5 criteria. They confirm that depressive features are frequent in bipolar patients with manic episodes. With increasing baseline severity of depressive features, treatment outcome was poorer with olanzapine and placebo, but remained stable with asenapine.     

Presentation and prevalence of PTSD in a bipolar disorder population: A STEP-BD examination

Background

Co-occurring psychiatric diagnoses have a negative impact on quality of life and change the presentation and prognosis of bipolar disorder (BD). To date, comorbidity research on patients with BD has primarily focused on co-occurring anxiety disorders and trauma history; only recently has there been a specific focus on co-occurring PTSD and BD. Although rates of trauma and PTSD are higher in those with bipolar disorder than in the general population, little is known about differences across bipolar subtypes.

Methods

Using the NIMH STEP-BD dataset (N=3158), this study evaluated whether there were baseline differences in the prevalence of PTSD between participants with bipolar disorder I (BDI) and bipolar disorder II (BDII), using the MINI and the Davidson Trauma Scale. Differences in PTSD symptom clusters between patients with BDI and BDII were also evaluated.

Results

A significantly greater proportion of participants with BDI had co-occurring PTSD at time of study entry (Χ²(1)=12.6; p<.001). BDI and BDII subgroups did not significantly differ in re-experiencing, avoidance, or arousal symptoms.

Limitations

The analysis may suggest a correlational relationship between PTSD and BD, not a causal one. Further, it is possible this population seeks treatment more often than individuals with PTSD alone. Finally, due to the episodic nature of BD and symptom overlap between the two disorders, misdiagnosis is possible.

Conclusions

PTSD may be more prevalent in patients with BDI. However, the symptom presentation of PTSD appears similar across BD subtypes. Individuals should be thoroughly assessed for co-occurring diagnoses in an effort to provide appropriate treatment.     

PAC1 receptor (ADCYAP1R1) genotype is associated with PTSD's emotional numbing symptoms in Chinese earthquake survivors

Background

Genetic factors are important in the development of posttraumatic stress disorder (PTSD) following exposure to traumatic events. However, the molecular genetic underpinnings of this disorder remain largely unresolved. The present study investigated the association between ADCYAP1R1 rs2267735 genotype and PTSD symptoms in a highly traumatized sample of Chinese adults.

Methods

Participants included 326 victims who experienced 2008 Wenchuan earthquake and lost their children during the disaster. PTSD symptoms were assessed with the PTSD Checklist (PCL). The ADCYAP1R1 rs2267735 SNP was genotyped with the Sequenom iPlex chemistries and the MassARRAY system.

Results

The results indicated that although the rs2267735 ‘CC’ genotype was not associated with total PTSD symptoms, it could significantly predict severity of PTSD's emotional numbing symptoms in women.

Limitations

A relatively small sample exposed to specific traumatic events was used, and PTSD was assessed using a self-reported instrument.

Conclusions

The findings suggest that the PACAP–PAC1 receptor pathway may play an important role in female human responses to traumatic stress, and carry implications for better understanding and treating of posttraumatic psychopathology.     

They know their trauma by heart: An assessment of psychophysiological failure to recover in PTSD

Background

Posttraumatic stress disorder (PTSD) develops following exposure to atraumatic event and is characterized by persistent intense reactivity to trauma related cues. Equally important, but less studied, is the failure to restore physiological homeostasis after these excessive reactions. This study investigates psychophysiological markers of sustained cardiac activity after exposure to reminders of traumatic event in PTSD patients.

Methods

Participants passively listened to neutral and personal traumatic event while electrocardiogram was continuously recorded. Heart rate (HR) and heart rate variability (HRV) were analyzed in 19 PTSD patients and 16 trauma-exposed controls.

Results

Both PTSD patients and trauma exposed controls exhibited a significant increase in HR to the exposure of their personal trauma. PTSD patients sustained the increase of HR while controls recovered to basal levels. In PTSD patients, sustained HR was positively associated with re-experiencing symptoms. The PTSD group also showed a reduced HRV (a measure of parasympathetic influence on the heart) during personal trauma exposure and lack of recovery.

Limitations

The sample size was small and PTSD patients were under medication.

Conclusions

Our findings provide an experimental account of the failure of PTSD patients to exhibit physiological recovery after exposure to trauma-related stimuli. PTSD patients exhibited a sustained tachycardia with attenuation of HRV that persisted even after cessation of the stressor. Re-experiencing symptoms facilitated engagement in the trauma cues, suggesting that, in their daily-life, patients most likely present repeated episodes of sustained over-reactivity, which may underpin the emotional dysregulation characteristic of PTSD.     

Children's risk and resilience following a natural disaster: Genetic vulnerability,posttraumatic stress,and depression

Objective

We examined children’s risk and resilience following a natural disaster, evaluating the role of stress, social support, and two genetic markers: the short allele of the serotonin transporter gene (5-HTTLPR), and the met allele of the Brain-Derived Neurotrophic Factor (BDNF).Under high levels of hurricane exposure or hurricane-related stressors, we expected children displaying the markers would report greater symptoms of posttraumatic stress disorder (PTSD) and depression than children without these markers. Social support was explored as an additional moderating variable.

Method

Eight months after Hurricane Ike, 116 children (M age=8.85 years, SD=.89; 54% girls) residing in Galveston, Texas, provided saliva samples and completed measures of hurricane exposure and stress, and symptoms of PTSD and depression; 80 also completed a social support measure.

Results

For BDNF, analyses revealed several Gene by Environment interactions; greater stress was related to more symptoms of PTSD and depression, and this effect was stronger for children with the met allele. No findings emerged for 5-HTTLPR. Stressors and social support also were associated with children’s PTSD and depressive symptoms.

Limitations

Findings should be tempered by the relatively small sample, especially for analysis that included social support.

Conclusions

The met allele (BDNF) may play a role in children’s disaster reactions. Further research should consider the complex interplay between genes, stressors, support, and psychological outcomes over time.     

Age-dependent symptomatology of depression in hospitalized patients and its implications for DSM-5

Background

We investigated effects of current age and age at onset on symptomatology of depression with reference to proposed revisions in DSM-5.

Methods

The study entailed medical records of 326 inpatients diagnosed with major depressive disorder, including 520 depressive episodes, with 113 first episodes lifetime. Subjects were divided into three groups: young-adults, middle-aged adults and older adults.

Results

In young-adults, active suicidal ideation, lifetime suicidal attempts, irritability, anhedonia and persistent depressive symptoms between the episodes were more frequent than in the other groups. Among older adults, depression was associated with insomnia, hypochondriasis, somatization, decreased appetite, weight loss, memory impairment and decreased activity. The older age was not associated with higher number of previous episodes of depression, bigger severity or duration of a single episode or a different degree of remission. Early-onset depression was associated with more suicidal attempts.

Limitations

The study was retrospective and the sample may be treated only as representative for hospitalized depressed patients.

Conclusions

Age and age at onset are important factors influencing the course and symptomatology of a depressive episode. Depressive episodes with anxiety and with suicide risk severity are important specifiers that vary with the age at onset and/or age of the patient and should be considered for inclusion in the DSM-5 revision.     

Structural brain alterations in bipolar disorder II: A combined voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) study

Background

Brain structural changes have been described in bipolar disorder (BP), but usually studies focused on both I and II subtypes indiscriminately and investigated changes in either brain volume or white matter (WM) integrity. We used combined voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) analysis to track changes in the grey matter (GM) and WM in the brains of patients affected by BPII, as compared to healthy controls.

Methods

Using VBM and DTI, we scanned 20 DSM-IV-TR BPII patients in their euthymic phase and 21 healthy, age- and gender-matched volunteers with no psychiatric history.

Results

VBM showed decreases in GM of BPII patients, compared to controls, which were diffuse in nature and most prominent in the right middle frontal gyrus and in the right superior temporal gurus. DTI showed significant and widespread FA reduction in BPII patients in all major WM tracts, including cortico-cortical association tracts.

Limitations

The small sample size limits the generalisability of our findings.

Conclusions

Reduced GM volumes and WM integrity changes in BPII patients are not prominent like those previously reported in bipolar disorder type-I and involve cortical structures and their related association tracts.     

Course sequences in bipolar disorder: Depressions preceding or following manias or hypomanias

Background

Inferior response to lithium treatment has been reported in bipolar disorder (BD) patients with mania or hypomania following episodes of major depression (DMI) versus preceding depression (MDI), with intervening euthymic periods. However, additional characteristics of BD course-patterns require further assessment.

Methods

We reviewed computerized clinical records and life-charts of 855 DSM-IV-TR BD-I or -II patients assessed and followed at mood-disorder centers in Cagliari or Rome to characterize their predominant course-sequences.

Results

Morbidity over an average of 9.5 cycles in 18 years was characterized for sequencing of illness-episodes and euthymic intervals. Prevalent sequences included: major depression–hypomania (15.0%), mania–major depression (14.6%), major depression–mania (11.6%), and rapid-cycling (9.6%). Among subjects grouped by course-sequences (based on mania, mixed-states, or hypomania and major or minor depression), depression-before-[hypo]mania (DMI) cases were more likely to be women, diagnosed BD-II, have first-episodes of depressive or anxiety disorder, spend more time ill in depression, and benefit less with long-term mood-stabilizing treatments than with the opposite pattern (MDI). MDI patients were more likely to have substance-abuse and receive long-term mood-stabilizer treatments. Meta-analysis of 5 previous reports plus present findings found inferior treatment-response in DMI vs. MDI cases at a pooled risk-difference of 29% [CI: 18–40%] (p<0.0001).

Limitations

Some data were retrospective and subject to recall bias, and treatment was clinical (non-randomized).

Conclusions

The DMI course was strongly associated with first-episode depression or anxiety, excess depressive morbidity, and inferior treatment response, especially for depression.     

Food insecurity and its association with co-occurring postnatal depression,hazardous drinking,and suicidality among women in peri-urban South Africa

Background

Although the public health impacts of food insecurity and depression on both maternal and child health are extensive, no studies have investigated the associations between food insecurity and postnatal depression or suicidality.

Methods

We interviewed 249 women three months after they had given birth and assessed food insecurity, postnatal depression symptom severity, suicide risk, and hazardous drinking. Multivariable Poisson regression models with robust standard errors were used to estimate the impact of food insecurity on psychosocial outcomes.

Results

Food insecurity, probable depression, and hazardous drinking were highly prevalent and co-occurring. More than half of the women (149 [59.8%]) were severely food insecure, 79 (31.7%) women met screening criteria for probable depression, and 39 (15.7%) women met screening criteria for hazardous drinking. Nineteen (7.6%) women had significant suicidality, of whom 7 (2.8%) were classified as high risk. Each additional point on the food insecurity scale was associated with increased risks of probable depression (adjusted risk ratio [ARR], 1.05; 95% CI, 1.02–1.07), hazardous drinking (ARR, 1.04; 95% CI, 1.00–1.09), and suicidality (ARR, 1.12; 95% CI, 1.02–1.23). Evaluated at the means of the covariates, these estimated associations were large in magnitude.

Limitations

The study is limited by lack of data on formal DSM-IV diagnoses of major depressive disorder, potential sample selection bias, and inability to assess the causal impact of food insecurity.

Conclusion

Food insecurity is strongly associated with postnatal depression, hazardous drinking, and suicidality. Programmes promoting food security for new may enhance overall psychological well-being in addition to improving nutritional status.     

The effect of information on preferences stated in a choice-based conjoint analysis

Objective

The objective of the study was to investigate the effect of a priori information on preferences for treatment elicited in a discrete choice experiment.

Methods

A convenience sample of 100 subjects was randomly split into two groups. The groups received minimal or extensive information on the treatment of ankle and foot impairment in stroke. Then, they participated in a discrete choice experiment. Possible treatment was described using eight decision criteria with two to four levels each. Part-worth utility coefficients for the criteria levels, criteria importance and overall treatment preference were estimated. It was tested whether the amount of information that was received influenced the outcome of the discrete choice experiment.

Results

In the extensively informed group fewer reversals in the expected order of part-worth utilities were found. Criteria importance for four of the eight criteria and criteria importance ranking between the minimally and extensively informed subject groups were significantly different. The difference in part-worth utility of the levels had a minor effect on the predicted utility of the available treatments.

Conclusion

The lower number of level rank reversals in the extensively informed subjects indicates a better understanding of outcome desirability and thus a better understanding of the decision task. The effect of more extensive information on predicted treatment preference was minimal.

Practice implications

While interpreting the results of a discrete choice experiment, the effect of prior knowledge on the decision problem has to be taken into account. Although information seems to increase the understanding of the decision task, outcomes valuation can also be directed by information and more extensive information increases the cognitive burden which is placed on the subjects. Future research should focus on the exact nature and size of the effects and the results of this study should be clinically validated.     

Differential impact of isolated psychotic symptoms on treatment outcome of major depressive disorder in the STAR*D cohort of Whites,Blacks and Latinos

Objective

To determine whether isolated psychotic symptoms are more likely to be endorsed by depressed Latinos as opposed to other ethnic–racial groups; whether these symptoms affect Latinos similarly to other ethnic–racial groups in terms of treatment response; and whether they are more likely to be associated with anxiety disorders in depressed Latinos.

Methods

We analyzed data from STAR?D subjects who self identified as White, Black, or Latino. Rates of isolated psychotic symptoms were assessed by the self-rated Psychiatric Diagnostic Screening Questionnaire (PDSQ) and compared between ethnic–racial groups. Depressive remission outcomes were compared within each ethnic–racial group between subjects who endorsed psychotic symptoms versus no psychotic symptoms. Associations between isolated psychotic symptoms and anxiety disorders were also examined.

Results

Among 2597 eligible subjects with at least one post-baseline assessment and available PDSQ data excluding first-rank symptoms, the prevalence of auditory–visual hallucination was 2.5% in Whites (n=49/1928), 11.3% in Blacks (n=45/398) 6.3% in Latinos (n=17/270) (χ²=64.9; df=2; p<0.001). Prevalence of paranoid ideation was 15.5% in Whites (n=299/1927), 31.5% in Blacks (n=126/400), and 21.1% in Latinos (n=57/270) (χ²=57.3; df=2; p<0.001). Among Whites and Blacks but not Latinos, depressive remission rates were worse in subjects with auditory–visual hallucinations compared to those without them. Paranoid ideation had a significant negative impact on remission in Whites only. In all ethnic–racial groups, a significant association was found between auditory–visual hallucinations and PTSD and panic disorder.

Limitations

The STAR*D study did not include any structured clinician-based assessment of psychotic symptoms.

Conclusion

Latinos do not appear to have worse outcomes when treated for MDD with auditory–visual hallucinations, differently from Whites and Blacks.     

Affective temperaments and ego defense mechanisms associated with somatic symptom severity in a large sample

Background

Several complex mechanisms including biological, psychological and social factors may contribute to the development of bodily symptoms. Affective temperaments may represent heritable subclinical manifestations of mood disorders, and the concept of ego defense mechanisms has also provided a model for the comprehension of psychopathology. The relationship between affective temperaments, defensive functioning and somatic symptom severity remains unknown.

Methods

We obtained data from a subsample of the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP). Participants completed the Affective and Emotional Temperament Composite Scale (AFECTS), the Defense Style Questionnaire (DSQ-40) and the Symptom Checklist-90-Revised (SCL-90-R). SCL-90-R Somatization scale was used as outcome variable.

Results

Among 9937 participants (4472 male; 45%), individuals with dysphoric, cyclothymic and depressive temperaments and those who adopted displacement, somatisation and passive aggression as their predominant defense mechanisms presented high somatic symptom severity. Participants with dysphoric temperament and those with higher displacement scores were more likely to endorse numerous bodily symptoms after controlling for age, gender, education and depressive symptoms. Moderator analysis showed that the relationship of dysphoric temperament with somatic symptom severity was much more powerful in people who adopted displacement as their predominant defense.

Limitations

The data was collected from a convenience web-based sample. The study was cross-sectional. There was no information on the presence of established physical illness.

Conclusions

Affective temperaments and defense mechanisms are associated with somatic symptom severity independently of depressive symptoms. These two personality theories provide distinct but interacting views for comprehension of somatic symptom formation.     

Laboratory values in a Spanish population of older adults: a comparison with reference values from younger adults

Objective

To examine the laboratory indices in a population aged 65 years or more and compare them with the reference values used for young adults.

Study design

Distribution patterns of frequently used biochemical and hematological indices were examined in a sample (N = 600) of non-institutionalized adults aged over 65.

Outcome measures

The obtained values were compared with the reference intervals for young adults.

Results

On some of the indices analyzed, large proportions of the participants had values above the upper limit of the reference interval: glucose, 25.0%; urea, 26.6%; creatinine, 27.2% of males; total cholesterol, 54.6%; and low-density lipoprotein cholesterol, 35.8%. Of the participants who met the World Health Organization's diagnostic criteria for diabetes, 31.8% said they had not been previously diagnosed. Similarly, 74.9% of subjects with total cholesterol values above the reference value indicated in the European guidelines on cardiovascular disease said they had not been diagnosed with dyslipidemia, as did 75.5% of those with low-density lipoprotein cholesterol values above the European reference value. The proportion of participants who were not aware that they might be suffering from those disorders was significantly higher among those who reported not having visited their doctor within the last 6 months.

Conclusion

Further studies should examine whether the use of adapted, more appropriate reference values for elderly populations will help physicians to make early and correct diagnoses and to decide when medical intervention is required.     

Appraisal of primary outcome measures used in trials of patient decision support

Objective

To appraise instruments used as primary outcome measures in trials measuring the effectiveness of patient decision support interventions.

Methods

Primary outcome measures were identified in trials of patient decision aids included in the 2003 Cochrane Review. Instruments were appraised for: use in calculating sample size, appropriateness, reliability, validity, responsiveness, precision, interpretability, acceptability, and feasibility.

Results

Of the 35 trials, there were 35 unique primary outcome measures and 8 instruments were appraised. Actual or preferred choice was the primary outcome measure in 18 trials. Two instruments met at least 6 of 8 appraisal criteria: Control Preference Scale (n = 2 trials) and Decisional Conflict Scale (n = 5 trials). The Decision Conflict Scale was used to calculate sample size in 4 trials.

Conclusion

Decision was the most consistent outcome measure. Most publications provided inadequate detail for appraising the instruments. Four instruments (Decisional Conflict, Control Preferences, Genetic Testing Knowledge Questionnaire, and McBride's Satisfaction with Decision) measured one or more International Patient Decision Aid Standards criteria for evaluating effectiveness.

Practice implications

Selecting relevant and high quality outcome measures remains challenging and is an important area for further research in the field of shared decision making.     

A prospective,longitudinal study of metabolic syndrome in patients with bipolar disorder and schizophrenia

Background

Although cross sectional studies have evaluated the prevalence of metabolic syndrome (MetS) in patients with bipolar patients (BPAD), data from longitudinal studies are limited.

Aim

To assess the prevalence of MetS in patients with BPAD, to observe the change in prevalence rate over a period of 6 months, to assess the prevalence of sub-threshold MetS (i.e., patients fulfilling one or two criteria of MetS) and to compare patients with BPAD and schizophrenia on the above mentioned parameters.

Methodology

Seventy five patients with BPAD and 53 patients with schizophrenia were initially evaluated for MetS and then followed up for a period of 6 months.

Results

According to consensus definition, prevalence of MetS at baseline was 40% in BPAD group and 32% in schizophrenia group. Over 6 months of follow-up the prevalence of MetS increased by 8% and 9.4% in the BPAD and the schizophrenia groups respectively. There was no significant difference between the two groups on any of the assessments. Another 28–32% of patients in the BPAD group also fulfilled two criteria and 13–17% fulfilled at least one criterion of MetS at different points of assessment. Similarly, 19–26% of the patients with schizophrenia met at least two and 23–26% of the patients fulfilled at least one criterion of MetS.

Limitation

The study was limited by small sample size, inclusion and the relatively short follow-up period.

Conclusion

40% patients with BPAD and 32% with schizophrenia have MetS and the prevalence of MetS increases by 8–9.4% over 6 months.     

Assessing awareness of appropriate responses to symptoms of stroke

Objective

The study explored (1) the level of awareness, and associates of greater awareness, of the appropriate action to take in response to stroke symptoms; and (2) actions taken in response to potential stroke symptoms, among general practice patients.

Methods

Patients attending general practice clinics in New South Wales, Australia completed a paper and pencil survey.

Results

308 participants returned the survey. 76% indicated they would call an ambulance within 10 min for ‘difficulty speaking or understanding others, with blurred vision (in one eye), and face, arm or leg weakness or numbness (on one side of the body)’. Having a first degree relative with a history of stroke was significantly associated with greater awareness of the appropriate action to take in response to stroke symptoms. Of those reporting they had experienced ‘dizziness, loss of balance or an unexplained fall’ 80% did not call an ambulance at the time of experiencing this symptom.

Conclusion

There appears to be high awareness of the appropriate response to take for stroke symptoms among this sample, however this does not translate into actions when individuals experience a potential stroke symptom.

Practice implications

Education campaigns should be targeted towards individuals without a family history of stroke.     

Study of symptom dimensions and clinical characteristics in Chinese patients with OCD

Background

The current study explored the main symptom dimensions and clinical characteristics of obsessive-compulsive disorder (OCD) in Chinese patients.

Methods

Obsessive-compulsive (OC) symptoms of participants (N=512) were assessed through the Yale–Brown Obsessive Compulsive Scale Checklist (YBOCS-CL). Exploratory category-level and item-level factor analyses were performed. Regression analysis was carried out to study the relationships between clinical characteristics in our sample and the symptom dimensions obtained. Relationships among the clinical characteristics were explored using the chi-square test.

Results

We found five symptom dimensions in the category-level analysis and six similar symptom dimensions in the item-level analysis. Moreover, the factors identified in our study overlapped with the results of prior studies. Association between gender and the symptom dimension of ‘contamination/cleaning’ was observed, with females showing more significant association with this dimension than males. Age of onset was associated with the symptom dimension of ‘symmetry/arranging/repeating/counting’, with the early-onset group more actively associated with this dimension than the late-onset group. Early-onset patients with OCD were more likely to be male and show tic comorbidity.

Limitations

Data from only one site do not represent the full range of Chinese OCD patients. Furthermore, past symptoms may show memory bias. Inherent problems in the YBOCS-CL have also been identified.

Conclusion

Symptoms in Chinese OCD patients are multidimensional. The main components of symptom dimensions of OCD patients show similarity or consistency among different regions and sociocultural backgrounds. The pathogenic mechanism of OCD may show potential distinctions.     

Longitudinal study of PTSD, depression, and quality of life among adolescents after the Parnitha earthquake

Objective

To investigate the course of PTSD, depression, and current quality of life among adolescents 32-months after the 1999 Parnitha earthquake in Greece.

Methods

The follow-up was conducted among 511 adolescents originally evaluated at 3-months post-earthquake using the UCLA PTSD Reaction Index (PTSD-RI), Depression Self-Rating Scale (DSRS), and Quality of Life Questionnaire (QOLQ).

Results

Mean PTSD scores for the whole sample had subsided to mild levels; however, 8.8% were still experiencing moderate to severe levels of symptoms, and 13.6% met criteria for clinical depression. Frequency of experiencing reminders of the earthquake in the past month best explained the variance (15%) in PTSD severity, followed by depression at 3-months (8%). The QOLQ domain scores were negatively correlated with PTSD and depression. Depression at 3-months was the best predictor of QOLQ at 32-months, explaining 16% of the variance.

Limitations

Self-report instruments were used; hence the responses may have been over- or under-estimated; also, the findings may not be generalizable to other ethnic groups.

Conclusion

Ongoing screening is recommended after disaster to identify adolescents who continue to experience moderate to severe levels of PTSD and depressive symptoms. Specific interventions to reduce reactivity to earthquake-related reminders should be a component of post-disaster recovery programs. A quality of life measure can provide important information in addition to traditional scales for monitoring the course of recovery among adolescents after disasters.