Using the PHQ-9 for depression screening and treatment monitoring for Chinese Americans in primary care

OBJECTIVE: Because Chinese Americans are known to underutilize mental health services, routine screening for depression in primary care clinics has been advocated as a means of identifying Chinese-American patients with depression and initiating appropriate treatment. This analysis evaluated the utility of the nine-item depression module of the Patient Health Questionnaire (PHQ-9) for depression screening and monitoring treatment outcomes among Chinese Americans at a primary health care setting. METHODS: A total of 3,417 patients who presented for an initial or annual physical examination with their primary care providers were screened for depression between January and October 2003 at the Charles B. Wang Community Health Center, a primary health care center in New York City serving primarily low-income Chinese Americans. The depression screen was a two-tier process: if patients endorsed one or more of three initial questions on an abridged version of the PHQ-9, they were then administered the PHQ-9. RESULTS: A total of 141 individuals (4.1 percent) had clinically significant depressive symptoms (PHQ-9 score of 10 or higher). Women were more likely to have significant levels of depressive symptoms than men (17.3 percent compared with 11.6 percent). A total of 114 of the 141 patients with clinically significant depressive symptoms received treatment plans initiated by their primary care provider. Forty (35.1 percent) responded to treatment (50 percent decrease in PHQ-9 score) by eight weeks of treatment. CONCLUSIONS: The PHQ-9 can be used to screen for depression as well as guide depression treatment planning among Chinese Americans in primary care. Screening for major depression with the PHQ-9 in primary care settings should be considered for appropriate identification and treatment of depression for Chinese-American patients.     

Familial aggregation of depression, but no familial aggregation of individual depressive symptoms.

BACKGROUND: Familial aggregation of major depression might indicate a genetic liability for the disorder. The complete disorder or, alternatively, only some individual symptoms might be inherited. Under the latter condition, an increased frequency of inherited symptoms might consecutively increase the likelihood to reach the threshold for depression in relatives and, thus, might cause the familial aggregation of depression. Up to now, no study investigated the possibility of a relationship between individual depressive symptoms and the familial aggregation of depression. METHODS: The familial aggregation of early-onset depression (age-at-onset < 60 years, EOD) but less so of late-onset depression (LOD) has been shown in this sample. To assess the hypothesis of an inheritance of individual depressive symptoms as a possible cause of the familial aggregation of depression, frequencies of symptoms were compared in relatives of depressed patients and of controls using forward logistic regression analyses. RESULTS: Some individual depressive symptoms showed clustering in relatives of patients with depression, but the pattern of inheritance was inconsistent, i.e. the clustering of symptoms was different between non-depressed and depressed relatives of patients with EOD and LOD, respectively. No intra-familial clustering of specific depressive symptoms within families of depressed subjects could be observed. CONCLUSIONS: Due to the inconsistencies in the clustering of individual symptoms in non-depressed and depressed relatives and the lack of intra-familial clustering, the familial aggregation of depression is unlikely to be caused by the aggregation of individual depressive symptoms. An inheritance of the vulnerability for complete depressive disorders influenced by environmental factors is more likely.     

Depression in older Chinese migrants to Auckland

OBJECTIVE: This study was conducted to identify risk factors for depressive symptomatology among older Chinese migrants. METHOD: One hundred and sixty-two Chinese migrants aged 55 years or older, living in the community and recruited via Chinese community organizations and general practitioners, were interviewed using a Chinese version of the Geriatric Depression Scale and measures of stressful life events, morbid conditions, self-rated health, acculturation, social support and service utilization. RESULT: Twenty-six percent of participants met the criteria for depressive symptomatology. No recent migrants showed symptoms of depression. Multiple logistic regression analysis showed that lower emotional support, greater number of visits to a doctor, difficulties in accessing health services and low New Zealand cultural orientation increased the risk of showing symptoms of depression. CONCLUSION: Significant numbers of older Chinese migrants appear to be depressed or at risk for depression and, while participants with depressive symptoms consulted general practitioners more than their counterparts without such symptoms, they reported greater difficulty in accessing health services. The findings point to the need for further epidemiological study of this growing sector of the population and investigation of the nature of its engagement with health services. Social support and aspects of acculturation may play a significant role in preventing depression. This also requires further investigation.     

High incidence of clinically relevant depressive symptoms in vulnerable persons of 75 years or older living in the community

Objectives: Clinically relevant depressive symptoms are highly prevalent in people who are 75 years of age or older. However, very old people with a vulnerable health status are under-represented in studies focussing on incidence and risk factors, while the risk of developing depressive symptoms is expected to be very high in this group. The incidence rates of clinically relevant depressive symptoms and their predictors were investigated in a vulnerable elderly population.

Methods: In a community-based cohort, 651 vulnerable elderly (75+) people were identified by means of the COOP-WONCA charts (Dartmouth Coop Functional Health Assessment Charts/World Organisation of Family Doctors). To study the incidence of clinically relevant symptoms of depression and their predictors, 266 people with no symptoms (Centre for Epidemiologic Studies Depression Scale, CES-D score <16 at baseline) were selected and measured again at six and 18 months. The incidence of clinically relevant symptoms of depression was defined as a CES-D score ≥16, in combination with at least a five-point change between measurements. Logistic regression analyses were applied to determine risk indicators.

Results: After 18 months, the incidence rate of all clinically relevant symptoms of depression was 48% (95% confidence interval, CI 44.2–51.8). No specific risk factors were identified within this population.

Conclusion: Our estimates of the incidence of depressive symptoms were considerably higher than those previously found in elderly populations living in the community. A vulnerable health status is associated with a high risk of depressive symptoms.     

Depression in Chinese elderly populations

There is a scarcity of systematic reports on the prevalence of depression in Chinese elderly populations. The available reports used a variety of diagnostic and screening instruments to identify elderly depression. Furthermore, samples were drawn from different elderly populations. In spite of these difficulties, the reports are consistent in terms of the prevalence rates of severe depression which is lower than those reported in Western studies; though the prevalence rates of depressive symptoms approach those of most Western countries. However, the Chinese elderly showed a particular sensitivity to social factors either as vulnerability or protection factors for depression. There is a consistent social dimension in depressive complaints by Chinese elderly; hence the need to construct specific culturally sensitive instruments and to establish within ethnic group norms and diagnostic criteria for elderly depression. Current intervention efforts to prevent and ameliorate depression in the community‐dwelling elderly will be discussed.     

Old age depression and its treatment

The Numbers of elderly people are gradually increasing in our society, and mood disorders are progressively increasing among older people. Old age depression may also occur after life events: the death of the significant other, economical reasons, health problems (neurological and/or cardiovascular diseases, arthritis, cancer, nutritional deficiency) and can develop into a depressive state. Old age depression is often mistreated, or undertreated, and also underdiagnosed, and this for several reasons: older people reduce their social relations, depression very often presents as a comorbidity with organic diseases (that cover and mask depressive symptoms); finally,the patient may believe that a depressive state is a normal course of life in older people. Recovering from depression is really feasible both in young/adults and in old people, but in older people we can find a higher frequency of admission to hospital, or mortality or suicidality. The depressive symptoms in old age depression is similar to those in adults, however the following aspects require special care, in order to ensure a correct diagnosis despite the presence of comorbidities: - the mood: in contrast with the young and adult, old people often do not complain about their low mood; - the psychotic simptoms: hypocondriacal and psychotic, including hallucinatory symptoms are often present; - the anxiety symptoms: these are often present together with neuro-sensory symptoms; - the somatic symptoms: the comorbidity with organic diseases can mask and overlap the depressive state; - reduction of congnitive functioning: in these cases, which are quite frequent, it is essential to make a differential diagnosis from "pseudodementia" and "dementia". In conclusion, several factors contribute to the onset of depression in old age, so that we can assert that it is a really a multifactorial disease.     

Using an annual over-75 health check to screen for depression: validation of the short Geriatric Depression Scale (GDS15) within general practice.

OBJECTIVE: To validate the short Geriatric Depression Scale (GDS15) as a screening instrument and determine the optimal cutpoint for detecting depression among older people living in the community. DESIGN: Two stage study with the first stage consisting of a health check of people aged 75 years and over by a practice nurse which included the GDS15. A second-stage diagnostic interview including the criterion standard was carried out blind to GDS15 score.SETTING: A large general practice in Melton Mowbray, Leicestershire, UK. PATIENTS: A random sample (stratified according to first-stage GDS15 score) of 257 older people living in the community, without significant cognitive impairment, were selected for the second-stage diagnostic interview. MEASURES: The first-stage GDS15 score was compared with diagnostic status for depression and anxiety disorders (according to ICD-10 criteria) and presence of depressive symptoms at the second-stage clinical interview. RESULTS: Ninety-three per cent of those eligible for the study were successfully screened with the GDS15. A cutpoint of <3/3+ had a sensitivity of 100% and specificity of 72% in detecting cases of depression but fewer than one in five of those testing positive reached a diagnostic threshold. Only 25% of those with a diagnosis of depression had any mention of mental health problems in their medical notes in the year prior to the clinical interview. For detecting depressive symptoms the same cutpoint was 79% sensitive and 78% specific with a positive predictive value of 46%. CONCLUSIONS: Used as part of an annual over-75 health check in primary care, the GDS15 would detect a significant amount of hidden morbidity which would serve the original purpose of the annual elderly health checks in the UK.     

The sensitivity of somatic symptoms in post-stroke depression: a discriminant analytic approach

BACKGROUND: Somatic and neurocognitive symptoms of depression may overlap with the physical symptoms of stroke, and thus make the diagnosis of post-stroke depression difficult. AIM: To assess the sensitivity of individual depressive symptoms and their contribution to the diagnosis of post-stroke depression. PATIENTS AND METHODS: Two hundred and six patients with first-ever stroke, participating in a longitudinal study, were administered the Structured Clinical Interview for DSM-IV and the Hamilton Depression Rating Scale (HAM-D). In a discriminant analysis the relative contribution of the individual HAM-D items to the diagnosis of major depressive disorder was evaluated. RESULTS: The cumulative incidence of post-stroke major depressive disorder was 32%. The discriminant model based on HAM-D item scores was highly significant (p<0.001) and classified 88.3% of patients correctly as depressed or nondepressed. As expected, 'depressed mood' discriminated best between depressed and non-depressed stroke patients. 'Reduced interests' had a relatively low sensitivity and may in part reflect 'apathy', which often is considered a separate construct. With the exception of 'suicidal thoughts', most psychological symptoms, such as 'hypochondriasis', 'lack of insight' and 'feelings of guilt', were not very sensitive. Some somatic symptoms, such as 'reduced appetite', 'psychomotor retardation', and 'fatigue' had high discriminative properties. CONCLUSION: Psychological, neurocognitive and somatic symptoms of depression differ among themselves in terms of diagnostic sensitivity, and should be considered individually. Some somatic symptoms are highly sensitive for depression and should not be neglected by following an 'exclusive' or 'attributional' approach to the diagnosis of PSD.     

Comparison of the prevalence and risk factors for depressive symptoms among elderly nursing home residents in Taiwan and Hong Kong

BACKGROUND: Depression in the elderly has become a serious health care issue worldwide. However, no studies have compared the prevalence and risk factors for depressive symptoms among institutionalized Chinese elders living in different regions. OBJECTIVES: To explore and compare the prevalence and risk factors for depressive symptoms among elderly residents of nursing homes in Taiwan and Hong Kong. METHODS: Random sampling was used to recruit participants from eight nursing homes in each region. A total of 150 elders from Taiwan and 214 elders from Hong Kong participated. RESULTS: The prevalence of depressive symptoms was significantly higher in participants from Hong Kong (65.4%) than in Taiwan (43.3%). Logistic regression analysis indicated that gender, satisfaction with living situation, perceived health condition, and perceived income adequacy significantly predicted depressive symptoms in elderly nursing home residents in Taiwan. Significant predictors of depressive symptoms in the Hong Kong sample were satisfaction with living situation, cognitive status, and functional status. CONCLUSIONS: It is important to consider risk factors specific to a target population when developing depression intervention programs.     

Symptoms of anxiety and depression in the course of cognitive decline

BACKGROUND/AIMS: Anxiety and depression are common inpatients with cognitive decline and Alzheimer's disease (AD), and recognition and treatment of these symptoms can improve their quality of life. The present study investigates anxiety and depression in different phases of cognitive decline. METHODS: The sample consisted of five groups of elderly people in different phases of cognitive decline; four from a community-based sample (Longitudinal Aging Study Amsterdam), and one group of elderly people diagnosed with AD. ANOVAs were performed to investigate group differences in the severity and prevalence of anxiety and depression, and comorbid anxiety and depressive symptoms. RESULTS: The prevalence rates of anxiety, comorbid anxiety and depressive symptoms and depressive symptoms follow a pattern of an increasing prevalence as cognitive performance declines and a decrease in the prevalence when cognitive functioning is severely impaired. AD patients report fewest anxiety symptoms. CONCLUSION: We found that the prevalence of anxiety symptoms, depressive symptoms and comorbid anxiety and depressive symptoms seems to increase in the early phase of cognitive decline, and decreases as cognitive functioning further declines. Elderly diagnosed with AD report less anxiety as expected, probably due to lack of insight caused by AD.     

Prevalence and correlates of depression among Saudi elderly.

OBJECTIVES: To assess the prevalence of depression and associated factors in elderly people in Saudi Arabia.METHOD: A cross-sectional national survey of the elderly population of Saudi Arabia was conducted between January 1994 and December 1995. A stratified two-stage sampling technique was used to select the study subjects. In the first stage, a random sample of primary health care centres (PHCs) was selected in each of the five administrative regions of the country. The family health records (FHR) of each selected PHC were reviewed and a list of the elderly (60 years and over) was compiled. In the second stage, a sample of the subjects was selected from the FHR and contacted for a personal interview. The subjects' physical, social and environmental health status were assessed by an interview during which a structured questionnaire was completed. The Geriatric Depression Scale (GDS) was used to screen for depression. Other items of information in the questionnaire included subjects' sociodemographic characteristics, activities of daily living (ADL), laboratory and radiological investigations.RESULTS: The total number of elderly subjects included in this study was 7970. Their mean age+/-standard deviations was 68.8+/-7.7 (male 69.1+/-.7.7; and female 67.7+/-7.5) years. Depressive symptoms were reported in 3110 (39%) of the subjects, and 8.4% were in the severe depressive symptoms score group. Personal characteristics that correlated strongly with depression were poor education (p=0.001), unemployment (p=0.001), divorced or widowed status (p=0.001), old age and being a female (p=0.001). Living in a remote rural area with poor housing arrangements and limited accessibility within the house and poor interior conditions were also significantly associated with high depressive symptoms (p=0.001). Limited privacy, such as having a particular room specified for the elderly, was associated with more depressive symptoms than sharing a room with another person (p=0. 001). Lower incomes inadequate for personal needs as well as depending on charity or other relatives were associated with more cases of depression (p=0.001). The proportion of cases of depression correlated positively with the number of medical diagnoses and medications received (p=0.001). Significant depression was associated with loss of a close relative, living alone and limited participation in recreational activities. Perception of poor health and dependence on others for daily activities were associated with more depressive symptoms (p=0.001). Also health problems, especially faecal or urinary incontinence, were associated with more depressive symptoms (p=0.001).CONCLUSION: Depressive symptoms are common among Saudi elderly. Detection and management rates were low. Primary care teams could help these patients if properly trained. A simple instrument such as the Geriatric Depression Scale is useful and easily administered.     

The Hopkins Symptom Checklist-25 is a sensitive case-finder of clinically important depressive states in elderly people in primary care

OBJECTIVE: No depression rating scale has yet been designed to identify all clinically important depressive states in elderly. Therefore, this study investigated the Hopkins Symptom Checklist-25 (HSCL-25), a self-rating scale for depression, to see if it was a sensitive indicator of major, minor and subsyndromal depression. METHODS: Structured interviews of 37 people with a high depressive score and an age and sex matched control group comprised of 37 persons with a low depressive score in HSCL-25, in order to compare the HSCL-25 ratings with the Montgomery-Asberg-Depression Rating Scale (MADRS) as well as with the criteria for major, minor and subsyndromal depression. RESULTS: The sensitivity for identifying any depression was 94% and the specificity was 94% for HSCL-25 compared to the diagnostic criteria for depressive disorders. CONCLUSIONS: HSCL-25 is a sensitive case-finder of any depressive disorder and may be useful in general practice and for screening studies of depression in elderly people.     

Medication use and nonadherence to psychoactive medication for mental health problems by community-living canadian seniors with depression

Objectives: To determine the relation between level of depression and psychoactive medication use and nonadherence in Canadian seniors, given that late-life depression is a common, serious mental health problem in Canada. Methods: Canadian Community Health Survey-Mental Health and Well-Being respondents aged 65 years and older (n = 7736) comprised the study sample. Using the Composite International Diagnostic Interview to assess depressive symptoms, we created 4 depression levels to capture a spectrum of depressive disorders and (or) symptoms: major depression, comorbid major depression, depressive symptoms, and no depressive symptoms. Psychoactive medications assessed included sleep aids, anxiolytics, and mood stabilizers and (or) antidepressants (AD). Nonadherence was defined as either not taking medication as recommended or taking medication at a lower dosage than prescribed. Results: In total, 22.5% of respondents took psychoactive medication for a mental health problem in the previous 12 months. Psychoactive medication use was 46.8% for major depression, 43.1% for comorbid major depression, 34.0% for depressive symptoms, and 17.6% for no depressive symptoms. Rates of psychoactive medication use ranged from 46.5% of those with major depression, to 17.6% of those with no depressive symptoms. Overall, the rate of nonadherence to psychoactive medication was 31%; rates were highest among those with depressive symptoms (37.4%) and lowest among those with no depressive symptoms (27.4%). All 3 depressive categories were associated with greater odds of use and nonadherence. Conclusion: All 3 depression categories were associated with increased use of and nonadherence to psychoactive medication; however, rates of AD and (or) mood stabilizer use for clinically significant depression were low.     

Depression and mental health help‐seeking behaviors in a predominantly African American population of children and adolescents with epilepsy

Purpose: To determine whether previously undetected symptoms of depression and psychiatric help‐seeking behaviors are associated with demographic or epilepsy‐related variables in a predominantly African American sample of pediatric epilepsy patients. Methods: Ninety‐six serially recruited parent–child dyads (55% African American, 39% Caucasian) completed the Short Mood and Feelings Questionnaire (SMFQ). Regression analyses determined whether depressive symptoms measured by the SMFQ were associated with demographic (age, gender, and ethnic background) or epilepsy‐related variables (age of seizure onset, duration of epilepsy, seizure type, time since last seizure, and number of antiepileptic drugs). Dyads with positive SMFQ screens (score ≥12) received information about depression and were advised to seek mental health services. Six months later, parents completed follow‐up interviews to ascertain mental health service utilization. Results: Thirty‐five participants (36.5%) screened positive for probable depression. Greater number of antiepileptic drugs was the only predictor variable independently associated with greater (worse) depression scores (p = 0.005). At 6‐month follow‐up, 12 patients (36.4%) had received mental health care, whereas 21 guardians (63.6%) denied depressive symptoms in their child and never sought mental health services (two dyads lost to follow‐up). Logistic regression analyses found no associations between demographic, epilepsy‐related, or depressive variables and psychiatric help‐seeking. Discussion: This study indicates the necessity and feasibility of screening for previously undetected symptoms of depression in pediatric epilepsy clinics serving diverse populations, particularly among patients receiving antiepileptic polytherapy. Additional research on the correlates of depressive symptoms and determinants of psychiatric help‐seeking is needed to develop evidence‐based interventions for youths with epilepsy and symptoms of depression.     

Subthreshold depression in adolescence and mental health outcomes in adulthood

BACKGROUND: There is increasing interest in the extent to which individuals with subthreshold depression face increased risks of subsequent major depression and other disorders. OBJECTIVE: To examine linkages between the extent of depressive symptoms (asymptomatic, subthreshold, major depression) at ages 17 to 18 years and mental health outcomes up to age 25 years in a New Zealand birth cohort. DESIGN: Data were gathered during the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of 1265 New Zealand children (635 males, 630 females). SETTING: General community sample. PARTICIPANTS: The analysis was based on 1006 participants who represented 80% of the original cohort. MAIN OUTCOME MEASURES: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition symptom criteria for major depression and anxiety disorder, treatment-seeking, suicidal ideation, and suicide attempt. RESULTS: There were significant associations (P<.01) between the extent of depression at ages 17 to 18 years and rates of subsequent depressive symptoms, major depression, treatment for depression, anxiety disorder, treatment for anxiety disorder, suicidal ideation, and suicide attempts. After adjustment for covariate factors, the extent of depression at ages 17 to 18 years remained associated with later depression and suicidal tendencies. Planned comparisons showed that sample members with subthreshold depression had a similar prognosis to those meeting criteria for major depression. CONCLUSIONS: Findings suggest that sample members with subthreshold depression are a group with elevated risks of later depression and suicidal behaviors. Current diagnostic procedures, which classify people with subthreshold depression into complex discrete groups, might obscure the fact that depressive symptoms are dimensional and range from none to severe.     

Identifying Depressed Patients With a High Risk of Comorbid Anxiety in Primary Care

BACKGROUND: Depressive and anxiety disorders are highly prevalent in the primary care setting. There is evidence that patients with depression and comorbid anxiety are more severely impaired than patients with depression alone and require aggressive mental health treatment. The goal of this study was to assess the impact of comorbid anxiety in a primary care population of depressed patients. METHOD: 342 subjects diagnosed with a DSM-IV-defined major depressive episode, dysthymia, or both were asked 2 questions about the presence of comorbid anxiety symptoms (history of panic attacks and/or flashbacks). Patient groups included depression only (N = 119), depression and panic attacks (N = 51), depression and flashbacks (N = 97), and depression and both panic attacks and flashbacks (N = 75). Groups were compared on demographics, mental health histories, and health-related quality-of-life variables. Data were gathered from January 1998 to March 1999. RESULTS: Those patients with depression, panic attacks, and flashback symptoms as compared with those with depression alone were more likely to be younger, unmarried, and female. The group with depression, panic attacks, and flashbacks was also more likely to have more depressive symptoms, more impaired health status, worse disability, and a more complicated and persistent history of mental illness. Regression analysis revealed that the greatest impact on disability, presence of depressive symptoms, and mental health outcomes was associated with panic attacks. CONCLUSION: By asking 2 questions about comorbid anxiety symptoms, primary care providers evaluating depressed patients may be able to identify a group of significantly impaired patients at high risk of anxiety disorders who might benefit from collaboration with or referral to a mental health specialist.     

Impact of culture on depressive symptoms of elderly Chinese immigrants.

OBJECTIVES: The impact of culture on mental health has been inadequately researched. This study examines the effect of cultural factors on the depressive symptoms reported by elderly Chinese immigrants in Canada. METHOD: Data from 1537 elderly Chinese immigrants who took part in a cross-sectional multisite survey on the health and well-being of older Chinese-Canadians were used. Participants were identified through telephone screening of randomly selected telephone numbers listed with Chinese surnames. A structured questionnaire was used to conduct face-to-face interviews. A Chinese version of the 15-item Geriatric Depression Scale was used to assess depressive symptoms. RESULTS: Close to one-quarter of the elderly Chinese immigrants reported having at least a mild level of depressive symptoms. Having more cultural barriers and a higher level of identification with Chinese cultural values resulted in a higher probability of being depressive. CONCLUSIONS: The importance of the sociocultural determinants of mental health is demonstrated. The health delivery system should be more sensitive to the unique ethnic and cultural differences of older immigrants.     

Depression with atypical features in the National Comorbidity Survey: classification,description, and consequences

BACKGROUND: Atypical depression has been found to be distinct from other types of depression in terms of psychiatric symptom profile and treatment response. However, debate continues regarding its specific characteristics, impact, and diagnostic criteria. The current study was conducted to increase understanding of atypical depression diagnosed using only the reversed vegetative symptoms of hypersomnia and hyperphagia. METHODS: An atypical depression group (n = 304 [36.4% of the depressed sample; 39.0% when weighted to approximate the national population]) was identified within the US National Comorbidity Survey, which assessed psychiatric disorders among a nationally representative sample using the Composite International Diagnostic Interview. The atypical group was identified based on DSM-III-R criteria for a major depressive episode, in addition to atypical features of hypersomnia and hyperphagia. Comparison groups were those with nonatypical depression (n = 532) and individuals without a psychiatric disorder (n = 4071). RESULTS: Compared with nonatypical depression, atypical depression was associated with a greater percentage of women and an earlier age of onset. The atypical group also reported higher rates of most depressive symptoms, suicidal thoughts and attempts, psychiatric comorbidity (panic disorder, social phobia, and drug dependence), disability and restricted activity days, use of some health care services, paternal depression, and childhood neglect and sexual abuse (P<.05). Compared with people without psychiatric disorders, the atypical group reported higher rates of disability and restricted activity days, use of all mental health care services, parental depression, and childhood abuse (P<.001). CONCLUSIONS: This analysis of a nationally representative US sample suggests that overeating and oversleeping can be used to identify an atypical depression subgroup that is distinct from other depressed patients in terms of demographics, psychiatric comorbidities, and abuse history. Findings also suggest that atypical depression is associated with increased distress, suicidal ideation, and disability compared with nonatypical depression.     

Prevalence of depression and correlates of depressive symptoms for residents in the urban part of Jeju Island, Korea

AIMS: This study examined the prevalence of depression and depressive symptoms, and the correlates of depressive symptoms, and proposes some methods for reducing risk of depression in residents of the urban part of Jeju Island in Korea. METHODS: In all, 1050 residents were selected using multiphasic cluster sampling to represent each district. Of the 981 respondents, 413 were men and 568 were women. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to evaluate depression (CES-D score over 25) and depressive symptoms (CES-D score over 21). Multiple logistic regression analysis was performed for comparisons. RESULTS: The prevalence of depression in males and females was comparable, at 9.47 and 11.36%, respectively. The prevalence of depressive symptoms in men was 15.01%, while in women the level rose to 18.37%. Those with high self-assessed level of stress scores were significantly more likely to have depressive symptoms than those with low self-assessed level of stress scores (odds ratio (OR) = 5.73 (95% confidence interval (95% CI), 1.29-25.36)). Residents at high risk of problem drinking (CAGE score over 3) were significantly more likely to have depressive symptoms than those with a CAGE score under 1 (OR = 3.43 95% CI, 1.77-6.66). Respondents who slept poorly had more depressive symptoms than respondents who slept well (OR = 2.11 95% CI, 1.37-3.23). Females were significantly more likely to have more depressive symptoms than males (OR = 1.70 95% CI, 1.08-2.68). CONCLUSIONS: The prevalence of depression and depressive symptoms in urban Jeju Island is similar to that in a nation-wide sample. By providing intensive mental health services to those who have high stress levels, problem drinking, and poor health behavior, early detection of depressive symptoms in the community will be important for improving general health status.