Psychiatric disorders among obese binge eaters

This study compared the prevalence of psychiatric disorders among obese binge eaters (n = 25) and obese non—binge eaters (n = 25) of similar age and weight. Subjects were interviewed by clinicians who were blind to the patients' binge status using the Diagnostic Interview Schedule. Sixty percent of bingers met criteria for one or more psychiatric disorders, compared with 28% of nonbingers, with differences most apparent in affective disorder; 32% of obese bingers reported a history of affective disorder versus only 8% of nonbingers. Obese binge eaters also reported significantly more psychiatric symptoms, especially symptoms of depression, anxiety, and sexual dysfunction.     

Somatotyping of schizophrenic and affective disorder patients

INTRODUCTION: Constitutional traits have been found to show a distinct relevance to major psychiatric disorders. Syndromal modified expressivity is also closely related to somatotypic constitution. In this view somatotyping appears valuable in diagnosis and prognosis of mental disorders. AIM: The present study was conducted in an attempt to outline somatotypic characteristics of schizophrenia and affective disorders with the aim of providing a logical basis for diagnosis of these major psychiatric disorders. MATERIAL AND METHODS: The somatotype of 54 schizophrenic and 68 affective disorder inpatients who fulfil the DSM-IV criteria for schizophrenia (subjects with schizophreniform, schizoaffective, schizoid and schizotypal personality disorders were excluded from the sample) and affective disorder (bipolar and unipolar) was assessed using the Health-Carter anthropometric method. RESULTS: The overall assessment of the somatotypes determined both groups as endomorphs mesomorphs with somatotype components 4.50-4.44-1.90 for schizophrenic patients and 5.87-5.40-0.36 for affective disorder patients. The difference between the two groups was statistically significant for any of the somatotype components. CONCLUSION: It is suggested that the constitutional and somatotypic characterization appears reasonable element in the multifactorial analysis of diagnostic decisions in these major psychiatric disorders.     

Psychiatric illness in patients presenting for obesity treatment

The prevalence of DSM-III-R Axis I psychiatric disorders was investigated in a sample of 54 obese patients at the time of presentation for weight reduction treatment. Patients were interviewed using the Structured Clinical Interview for DSM-III-R Axis I diagnosis (SCID-I) designed to probe for the major Axis I syndromes. High rates of affective disorders, particularly those with depressive symptomatology, were found. Twenty-six percent of patients were in the midst of a current Axis I affective disorder at the time of examination. Forty-eight percent had a history of affective disorder, and 57% had at least one lifetime Axis I diagnosis. Only one patient met criteria for an Axis I eating disorder. Patients with psychiatric diagnoses could not be discriminated from those without on the basis of Body Mass Index. However, the former had significantly more impairment as measured by the Beck Depression Inventory and the Global Assessment of Functioning. These findings may have implications for the assessment and treatment of obese patients in clinical and research settings.     

Depressive states and health problems in caregivers of the disabled elderly at home

This study investigated the prevalence of depression and health problems in caregivers for the disabled elderly at home, and identified factors associated with the risk of depression. Four hundred thirty-four caregivers for disabled elderly persons in a suburban city were surveyed by in-home interviews. Two hundred ten non-caregivers were also interviewed as an age and gender-matched control group. Overall, 16.8% of caregivers met the DSM-III-R criteria for major depression and 10.6% met the criteria for depressive disorders not otherwise specified, for a total of 27.4% meeting the criteria for affective disorders, while 8.6% of controls met the criteria for depressive disorders not otherwise specified. The prevalence of major depression in caregivers was associated with mental problems and ADL limitations of the elderly. Moreover, non-cooperation by other family members or relatives contributed to an increase in the prevalence of depression. Caregivers who met the criteria for major depression had a higher frequency and longer duration of upper respiratory infections than other caregivers or controls, and showed greater fatigue than the other caregivers or controls. Approximately 90% of caregivers who met the criteria for major depression had also insomnia. Overall, it was shown that caregivers who met the criteria for major depressin had not only emotional distress but also higher morbidity.     

Psychiatric disorders in elderly patients admitted in a general hospital]

STUDY OBJECTIVE. To determine the prevalence of psychiatric disorders, especially depressive illness, in elderly medical inpatients. SETTING. University Hospital Leiden. DESIGN. Two-stage design. PATIENTS AND METHODS. In six somatic wards a series of 250 patients were randomly selected and screened with two self-rating scales for depression (Beck Depression Inventory, Geriatric Depression Scale) and one screening scale for cognitive dysfunctions (Mini-Mental State Examination). The 52 drop-outs differed significantly from the other patients only in a greater general illness severity, and a higher prevalence of a psychiatric history. Eighty-two patients were selected for a diagnostic procedure with a standardised, semi-structured psychiatric interview, and were classified according to the DSM III-R. Fifty-nine of them were probable cases according to the screening instruments, 23 were selected at random from the probable non-cases. RESULTS. A psychiatric disorder was detected in 25 patients, all but one patient with schizophrenia were found in the group of probable cases. Only five patients were classified as major depression, which lead to a prevalence rate of 2.9% (95% CI 0.4-5.4%). We found evidence of many psychiatric disorders in the group of 52 drop-outs, but these were mostly organic psychiatric disorders, and just one mood disorder. CONCLUSION. The prevalence of major depression is lower than found until now among elderly medical inpatients.     

Continuing female predominance in depressive illness.

This paper examines gender differences in temporal trends for major depressive disorder in childhood, adolescence, and young adulthood. The study sample, a high-risk group from the National Institute of Mental Health Collaborative Study on the Psychobiology of Depression, includes 2000 first-degree relatives of probands with affective disorder. The age-specific incidence rates were analyzed to determine the effect of gender, age, period, and cohort on depression by age 35. Women had nearly a twofold increase in risk of major depressive disorder, with rates peaking between adolescence and early adulthood. Vulnerability to depression was highest in the 1960s and 1970s. The rate increase in recent decades has not corresponded to a reduction in the gender differences.     

A controlled family study of anorexia nervosa: Evidence of familial aggregation and lack of shared transmission with affective disorders

Lifetime prevalence rates of eating disorders and affective disorder were determined in biological relatives of probands with anorexia nervosa, affective disorder, and other types of psychiatric disturbance. Anorexia nervosa was found to cluster in families with intergenerational transmission, and was absent among relatives of controls. Significantly higher rates of affective disorder were found among relatives of anorexics with coexisting depression, suggesting that these probands transmit two disorders to relatives. The results indicate there is familial resemblance for anorexia nervosa, and that the liability is different from that operating in the transmission of affective disorders.     

Assessment of suicidal behaviour in general practice

AIM: To assess the prevalence of suicidal behavior (wish to die, suicidal thoughts, suicide attempts) and to determine the characteristics of suicide attempters in primary care, including screening for major mental disorders. METHOD: A Hungarian urban general practitioner's district with 1248 inhabitants was screened for suicidal behavior as well as for major mental disorders. All the patients (n=382) who visited their general practitioner within a two-week period were asked to participate. 277 patients completed the Prime-MD questionnaire, an easy-to-use diagnostic instrument developed for general practitioners to recognize the most common psychiatric disorders, like depressive (major depressive disorder, minor depressive disorder), anxiety (panic disorder, generalized anxiety disorder), somatoform, eating and alcohol related disorders. Detailed data about suicidal thoughts and attempts were also collected by the structured questions of MINI-Plus diagnostic interview. RESULTS: Prevalence of suicide attempts in primary care was 2.9%. 9% of the patients had either suicidal thoughts or suicide attempts in the previous month. Suicidal patients were more ready to use psychotropic drugs, they assessed their health status more poorly, and had more mental symptoms than the control group (non-suicidal patients). 60% of suicidal patients and 11.5% of the investigated population had a current depressive episode. Beside depressive symptoms, anxiety disorders and alcohol problems were also more common among suicidal patients. The rate of previous psychiatric treatments was also higher in suicidal patients, who generally visited their general practitioners less frequently than non-suicidal patients. According to multivariate logistic regression, suicidal patients are more ready to take antidepressants, they tend to have more previous psychiatric treatments and suicidal attempts, and they visit their general practitioners less frequently and have a current depressive episode. CONCLUSION: Suicidal behavior and mental disorders are frequent in primary care. Since almost every tenth patient visiting their general practitioner has suicidal thoughts or depressive or anxiety disorder, the recognition of suicide risk and mental disorders is very important in primary care. As for preventing suicides, the diagnosing and treating of mental disorders -especially affective disorders- are very important for general practitioners. In addition to pharmacotherapy, psychotherapies are also important in treating patients in crisis situations, or with suicidal thoughts or depressive disorder. The modified Prime-MD questionnaire can be an effective, easy-to-use method in the hand of the general practitioners to identify suicidal risk and to recognize the most common mental disorders in the average population.     

Somatic symptoms and depression

Patients with psychiatric illness frequently visit their medical physicians with somatic complaints or amplification of complaints about chronic medical illness, yet few of these patients meet Diagnostic and Statistical Manual of Mental Disorders-Third Edition (DSM-III) criteria for a somatoform disorder. In a sample of 197 medical patients interviewed with the Diagnostic Interview Schedule, only 7.1% met DSM-III criteria for somatization disorder, but nearly one third of these patients met criteria for an abridged notion of somatization. Patients with current and lifetime major depression had significantly higher mean totals of positive somatic symptoms compared with controls who had no psychiatric disorder. Nearly one half of these patients with one or more depressive episodes in the course of their lifetime met the abridged criteria for somatization. This association of major depression with somatization is quite similar to findings from the Epidemiologic Catchment Area study suggesting that major depression, not the somatoform disorders, may be associated with most of the somatization seen in medical clinics.     

Mental disorder and comorbidity among runaway and homeless adolescents.

PURPOSE: To investigate prevalence of mental disorder and comorbidity among homeless and runaway adolescents in small to medium sized cities in four Midwestern states. METHODS: The study presents lifetime, 12-month prevalence, and comorbidity rates for five mental disorders (conduct disorder, major depressive episode, posttraumatic stress disorder, alcohol abuse, and drug abuse) based on UM-CIDI and DISC-R structured interviews from the baseline interviews of a longitudinal diagnostic study of 428 (187 males; 241 females) homeless and runaway adolescents aged 16-19 years (mean age = 17.4 years, SD = 1.05). The data were collected by full-time street interviewers on the streets and in shelters in eight Midwestern cities of various populations. Separate logistic regression models were used to investigate factors associated with meeting criteria for any disorder and two or more disorders. RESULTS: Lifetime prevalence rates were compared with rates for same-aged respondents from the National Comorbidity Survey (NCS). Homeless and runaway adolescents were six times more likely than same-aged NCS respondents to meet criteria for two or more disorders and were from two to 17 times more likely to meet criteria for individual disorders than. CONCLUSIONS: Homeless and runaway adolescents in small and mid-sized Midwestern cities report significant levels of mental disorder and comorbidity that are comparable and often exceed that reported in studies of larger magnet cities.     

Relationship of psychiatric diagnosis and weight loss maintenance in obese breast cancer survivors

OBJECTIVE: Obese breast cancer survivors are a unique population for weight loss counseling because both obesity and a diagnosis of breast cancer can increase the risk of depression. In this pilot study, weight loss maintenance was examined in obese breast cancer survivors with relationship to psychiatric diagnosis. RESEARCH METHODS AND PROCEDURES: Forty-eight subjects were enrolled. The intervention, which used individualized counseling for diet and exercise, lasted 24 months. After a 6-month period of no contact with study subjects, a follow-up body weight was obtained at 30 months. RESULTS: The nine subjects who dropped out of the study before 12 months all failed to complete a structured psychiatric interview. Of the remaining 39 subjects, 9 had major depressive disorder, and 10 had a definable psychiatric disorder of lesser severity such as adjustment disorder. Subjects with any type of psychiatric diagnosis displayed significantly less weight loss at the 12-month time-point than those with no diagnosis (6.3% vs. 12.6% loss of baseline weight, respectively). At the 30-month follow-up visit, subjects with any psychiatric disorder had a mean weight loss of 1.2% of baseline weight compared with 7.8% weight loss in subjects with no diagnosis. DISCUSSION: These results suggest that the presence of psychiatric disorders can interfere with weight loss. Therefore, recognition and treatment of psychiatric disorders may be important in attempts at weight reduction, and this will be especially important in populations such as cancer survivors, who seem to have higher rates of depression and other disorders than the general population.     

Adult outpatients with depression: worse quality of life than in other chronic medical diseases in Argentina

Current research into the impact of major depressive illness on society goes beyond estimating its prevalence, complications or comorbidity patterns, to include research that seeks to establish how this disorder affects individuals' daily functioning and well-being. However, it is unclear whether depression affects such broadly defined quality of life (QOL) outcomes to a similar or an even greater extent than chronic physical illness. The present study assessed QOL in a sample of 48 ambulatory depressed patients who sought psychiatric assistance at a centre in La Plata, Argentina, during a 15-month period. All of them met DSM-IV criteria for current major depression, as diagnosed by clinicians. For the purposes of comparison, we also evaluated the QOL of additional samples of persons who were healthy or who had chronic physical illness. QOL was assessed with the WHOQOL-100, a generic and transcultural instrument developed simultaneously in 15 centres, by the World Health Organization (WHO). Results indicated that QOL was significantly poorer in depressed persons than in either healthy persons or individuals with other frequent chronic pathologies in Argentina. The impact of depression was also found to be related to the seriousness of the episode. We suggest that it is important to include QOL assessments of patients with depressive disorders when evaluating the course and progress of their treatment. Such assessments can be used in health care decision making and resource allocation.     

Depressionen im Alter

Depression is the most frequent psychiatric disorder in old age. Some patients have had depressive episodes or other psychological disorder in an earlier part of their life span. Older people show more somatic or cognitive complaints compared to younger depressives. Risk factors for depression in old age are (incident) physical disorders, sleep disorders or loss of spouse. Depression worsens course and prognosis of comorbid somatic disorders. A major consequence is the high suicide rate in the elderly. Depression is also a risk factor for other disorders like dementia or institutionalisation. The interplay between depression and dementia and other organic brain disorders is complex und still unresolved. Depression in the elderly is a challenge for our health system. Recognition and treatment rates are still too low. Integrative treatment plans for depression with comorbid physical disorders or in various settings should be developed. With the growing elderly population the available evidence for treatment urgently has to be increased. In current practice drug therapies--mostly inadequate--dominate. Psychotherapy should be promoted and the number of old age psychotherapists increased.     

Zur Epidemiologie depressiver Störungen im Alter

The first part of this article (publication in magazine 1/97) focussed on the problems of empirical case finding studies and tried to make an attempt to systematize the prevalence and incidence rates of depressive disorders in the elderly population. This second part of the article deals with prevalence and incidence rates of depressive disorders in general and their depressive subtypes. For depressive disorders alone the average pointprevalence is 16 %. Compared to elderly male subjects, elderly females show a twice as high risk of morbidity. The average pointprevalence for affective disorders is 5,7 %, major depression 1,6 %, manic depression 1,6 %, depressive neuroses 7,6% and personality disorders 5,3 %. Whereas the risk of morbidity for all subtypes of depressive disorders is estimated for elderly females at 2:1, elderly male subjects seem to suffer more often from personality disorders. Mild depression make up two thirds of all depressive cases in elderly people, severe depression make up one third of all cases. It is discussed whether the rate of depressive disorders and depressive subtypes will rise or fall in elderly age cohorts (60 years and older). Compared to younger age cohorts the average pointprevalence for very old individuals is increasing to 37 %. Depressive disorders are increasing in the group of very old male subjects and decreasing in the group of very old female subjects. At least it is discussed whether the prevalence rates of depressive disorders are rising or falling in elderly people (60 years and older) compared to the younger age cohorts (18 years and older). The results indicate that depressive symptomatology is not only a health problem of older but also of younger individuals.     

Connecting national survey data with DSM-IV criteria

PURPOSE: To show how connections can be made among items in a nationally representative survey of adolescents and criteria for "Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition" (DSM-IV) diagnoses. METHODS: Data for this study came from the Wave I in-home interview of the National Longitudinal Study of Adolescent Health (Add Health), a nationwide study of approximately 90,000 adolescents and their parents. Proxy variables were developed for four DSM-IV diagnoses based on Wave I survey questions: conduct disorder, alcohol abuse, cannabis abuse, and major depressive disorder (single episode). Prevalence rates, comorbidity rates, and detailed item analyses of these four constructs are reported. RESULTS: Of the adolescents in the sample under study, 3.4% scored above the threshold for conduct disorder. For the alcohol abuse proxy 4.7% scored above the threshold, compared with 6.3% for the cannabis abuse proxy, and 1% scored above the threshold for major depressive disorder (single episode). Adolescents who scored above the threshold for conduct disorder were three times more likely to receive psychological counseling than adolescents who scored below the threshold for conduct disorder. The rates for alcohol abuse, cannabis abuse, and major depressive disorder (single episode) were 2.0, 3.0, and 5.0, respectively. CONCLUSIONS: The prevalence rates for the four constructs in the Add Health data set were generally lower or comparable to prevalence rates found in other epidemiological studies in which DSM-IV criteria were applied. The approach described in this study provides a way to identify adolescents who are likely at risk for the development of mental health problems.     

Reevaluation of secular trends in depression rates.

Results of numerous community surveys of psychiatric illness suggest a striking change in the occurrence of depression, with younger generations experiencing higher lifetime risk and earlier age of onset. Data from the National Institute of Mental Health Epidemiologic Catchment Area Survey (a cross-sectional survey of psychiatric morbidity in five US communities conducted between 1980 and 1984) were reexamined for evidence of methods effects which might contribute to these unexpected findings. A pattern of higher lifetime risk and earlier age of onset among recent birth cohorts was observed for every psychiatric disorder examined, with schizophrenia, major depression, and panic disorder showing equally strong trends. For respondents of all ages, reported first onset of major depression clustered in the 10-year period prior to the study interview, in contrast to the expectation that older respondents would report onset in early adulthood. Examination of individual psychiatric symptoms revealed a nearly universal pattern of decreasing lifetime prevalence among older respondents, a reversal of the expected accumulation of lifetime symptoms with age. These findings suggest that effects of study methods may contribute to the apparent temporal trends in prevalence of depression and that cross-sectional surveys may underestimate lifetime psychiatric morbidity among older respondents. Generational changes in the lifetime risk of depression or other psychiatric disorders may not be reliably assessed by cross-sectional survey data.     

Prevalence and patterns of major depressive disorder in the United States labor force

BACKGROUND AND AIMS OF THE STUDY: In this paper, we identify the 12-month and lifetime prevalence of major depressive disorder in and out of the labor force, and among the employed and unemployed. We examine whether prevalence by labor force and employment status varies by gender and over the life cycle. Finally, we examine whether people can "recover" from depression with time by identifying patterns of labor force participation and employment as time since most recent episode passes. METHODS: We examine data collected as part of the National Comorbidity Survey, a survey representative of the population of the United States designed to identify the prevalence of major mental illnesses. The National Comorbidity Study identified cases of major depression via the Composite International Diagnostic Interview. Using these data, we estimate univariate and bivariate frequency distributions of major depressive disorder. We also estimate a set of multivariate models to identify the effect of a variety of dimensions of major depression on the propensity to participate in the labor force, and be employed if participating. RESULTS: Lifetime and 12-month prevalence rates of depression are similar in and out of the labor force. Within the labor force, however, depression is strongly associated with unemployment. The negative relationship between depressive disorder and employment is particularly strong for middle age workers. Depression and the number of depressive episodes have a differing pattern of effects on labor market outcomes for men and women. We find evidence that labor force participation and employment rates for people with a history of depression increase significantly over time in the absence of additional depressive episodes. DISCUSSION: Labor market status represents an important dimension along which prevalence of major depression varies. The relationship between depression and employment status is particularly strong for middle aged persons, but becomes weaker as time passes since the last depressive episode. Continued exploration of the association between work (or lack of work) and depression may ultimately help in the prediction, treatment and assessment of the illness. IMPLICASIONS FOR PRACTICE AND POLICY: These results present a basic set of facts about the relationship between major depressive disorder and labor market outcomes. We have not, however, attempted to sort out the complexities of this relationship here. These complexities arise at almost every turn. For instance, the high level of prevalence of depression among the unemployed may be due to the possibility that the stresses associated with unemployment trigger depressive episodes or to the possibility that workers who are depressed are more likely to be fired or quit. IMPLICATIONS FOR FURTHER RESEARCH: Our continuing research attempts to address these problems. Understanding when and how depression affects labor market outcomes and when and how labor market outcomes affect depression is an important endeavor for those interested in treating the disease and understanding its consequences.     

The association of psychiatric disorders and HIV infection in the correctional setting

PURPOSE: Psychiatric disorders, such as bipolar disorder, schizophrenia, and depression, have been associated with both HIV-associated risk behaviors and HIV infection. While the US prison population is reported to exhibit elevated rates of HIV/AIDS and most psychiatric disorders, scarce information currently exists on the association of these conditions in the prison setting. The present study examined the association of six major psychiatric disorders with HIV infection in one of the nation's largest prison populations. METHODS: The study population consisted of 336,668 Texas Department of Criminal Justice inmates who were incarcerated for any duration between January 1, 1999 and December 31, 2001. Information on medical conditions and sociodemographic factors was obtained from an institution-wide medical information system. RESULTS: Inmates diagnosed with HIV infection exhibited elevated rates of major depression, dysthymia, bipolar disorder, schizophrenia, schizoaffective disorder, and non-schizophrenic psychotic disorder. These rates persisted in stratified analyses and in a multivariate analysis that statistically adjusted for gender, race, and age category. CONCLUSION: The present cross-sectional study's finding of a positive association between HIV infection and psychiatric diagnoses among inmates holds both clinical and public health relevance. It will be important for future investigations to prospectively assess the underlying mechanisms of these associations in the correctional setting.     

Are psychological disorders most prevalent among older adults? Examining the evidence

A persistent popular and professional perception is the high rate of psychological disorders among older adults (age 65+), especially higher than among younger adults. To examine the perception's accuracy, data from all psychiatric epidemiology studies conducted since 1950 with random community samples were reviewed. The studies were divided into categories according to type of disorder and instrument used. Prevalence rates were recalculated to compare those under 65 and over with those aged 65 and over. The review reveals that in none of the impairment categories do the preponderance of studies document more disorders among older than younger adults. In contrast, studies indicate more disorders reported by younger than older adults for depressive symptoms, major depression (clinical), and clinical affective disorders. While several methodological caveats are warranted, available data do not support the prevailing perception that psychological disorders are most prevalent among older adults. Despite these findings, future policies should consider older adults a high priority for outpatient mental health services. Older persons use disproportionately fewer outpatient services than other adults; over-utilization of primary care services occurs among all age groups, including older persons; and finally, the co-occurrence of psychological and physical disorders often results in elders' mental disorders not being recognized or treated appropriately in the primary care sector.     

Prevalence and incidence of depression in residential homes for the elderly in the province of Drenthe,the Netherlands: higher than among the elderly in the general population,yet lower than in other residential homes

OBJECTIVE: To determine the prevalence and incidence of major and minor depression in residential homes for the elderly in Drenthe, the Netherlands. DESIGN: Cross-sectional and longitudinal study. METHOD: In eleven residential homes for the elderly in Drenthe, the point-prevalence rate of depressive disorders was determined at baseline (n = 479; mean age = 85 yrs). From the baseline-sample, 295 non-depressed subjects were available to estimate the incidence rate after six months. The diagnostic procedure consisted of two steps. Firstly, all of the subjects were screened for depression using the 'Geriatric depression scale'. In the second step, those with a score > 10 were interviewed using the 'Schedules for clinical assessment in neuropsychiatry' (SCAN) to assess whether there were depressive disorders according to DSM IV criteria. RESULTS: The prevalence of major depression was 4.1% (95% CI: 2.3-5.9) and the same rate was found for minor depression. The 6-month incidence of major and minor depression combined was 2.1% (95% CI: 0.5-3.7). CONCLUSION: The prevalence rate for depressive disorders obtained in our study, was twice as high as reported for the advanced elderly in the general population, whereas the rates were lower than those usually found in residential homes.