Depressed pathological gamblers

Depressed gamblers (n = 14) were compared with normal controls (n = 41) for antecedent life events. The depressed gamblers had experienced significantly more life events, and undesirable or exit life events, during the 6 months before the onset of depression.     

Causal relationship between stressful life events and the onset of major depression.

OBJECTIVE: Stressful life events are associated with the onset of episodes of major depression. However, exposure to stressful life events is influenced by genetic factors, and these factors are correlated with those that predispose to major depression. The aim of this study was to clarify the degree to which stressful life events cause major depression. METHOD: The authors assessed the occurrence of 15 classes of stressful life events and the onset of DSM-III-R major depression over a 1-year period in female twins ascertained from a population-based registry. The sample contained 24,648 person-months and 316 onsets of major depression. Stressful life events were individually rated on contextual threat and dependence (the degree to which the stressful life event could have resulted from the respondent's behavior). The nature of the relationship between stressful life events and major depression was tested by 1) discrete-time survival analysis examining the relationship between dependence and the depressogenic effect of stressful life events and 2) a co-twin control analysis. RESULTS: While independent stressful life events were significantly associated with onsets of depression, when level of threat was controlled, the association was significantly stronger for dependent events. The odds ratio for onset of major depression in the month of a stressful life event was 5.64 in all subjects, 4.52 within dizygotic pairs, and 3.58 within monozygotic pairs. CONCLUSIONS: Stressful life events have a substantial causal relationship with the onset of episodes of major depression. However, about one-third of the association between stressful life events and onsets of depression is noncausal, since individuals predisposed to major depression select themselves into high-risk environments.     

Is life stress more likely to provoke depressive episodes in women than in men?

One of the most consistent findings in psychiatric research is that rates of major depression are at least twofold higher among women than among men. Although there is considerable agreement in the literature that life events play a role in producing, triggering, or maintaining episodes of depression, less is known about the relationship among gender, life events, and depression. In the present study, we compared the rates, focus (“interpersonal” vs. “noninterpersonal”), and timing of stressful life experiences reported in rigorous interviews of male and female patients with unipolar recurrent depression and nondepressed contrast subjects. Consistent with hypotheses, female patients were more likely to experience stressful life experiences than their male counterparts; rates of stressful life experiences did not differ between female and male controls. Unexpectedly, rates of interpersonal stress did not differ among males and females regardless of patient or control status. We also found no significant differences in the timing of pre-onset events: stressful events were generally concentrated in the period immediately preceding onset for both men and women. Thus, although these data suggest that life stress may play a larger role in the provocation of recurrent episodes of depression for women than for men, there do not seem to be sex differences in the extent to which interpersonal vs. noninterpersonal events and difficulties are associated with depression onset or in the temporal distribution of events. Implications of these results are discussed in the context of research on other putative factors contributing to gender differences in rates of depression. Depression and Anxiety 6:95–105, 1997. © 1997 Wiley-Liss, Inc.     

Anxiety and depression in patients with the abdominal pelvic pain syndrome

The authors matched gynecologic patients with the abdominal pelvic pain syndrome (N = 41) with other gynecologic patients. They administered to both groups self-rating scales of anxiety, depression, anger-hostility, and somatization of the Hopkins Symptom Checklist and of the Symptom Questionnaire, a questionnaire about disruptions in early home life, and a questionnaire of recent stressful events. Patients with pain rated themselves on the average significantly more anxious, depressed, and hostile, and had more somatic symptoms than other patients; 56% of the patients with pain rated themselves within the normal ranges on all scales. There were no significant differences between the two groups in reports of disruptions of early home life and recent losses. The findings are consistent with the view that patients with the abdominal pelvic pain syndrome are psychologically a heterogeneous group; in many patients, depression and anxiety may be consequences of persistent pain.     

Closely spaced stressful life events precede the onset of benign essential blepharospasm and hemifacial spasm.

BACKGROUND: The purpose of this study was to assess the possible role of major stressful life events, complicated grief, and depression in the pathogenesis of benign essential blepharospasm (BEB) and hemifacial spasm (HFS). METHODS: This was a case-control study involving 23 participants with BEB/HFS and 23 control subjects, comparing the frequency of major stressful life events, depression on the Beck Depression Inventory-II, and complicated grief on the Inventory of Complicated Grief. RESULTS: There was no difference in the rate of depression or complicated grief between participants with BEB/HFS (57%) and control subjects (48%). Participants with BEB/HFS experienced a significantly (P = 0.0048) shorter time interval between two major stressful life events (median, 0.3 year) than did the control group (median, 3.0 years). The proportion of participants who had suffered two major stressful lifetime events separated by 1 year or less was significantly greater for participants with BEB/HFS than for control subjects (P = 0.0007). CONCLUSIONS: The onset of BEB and HFS was often preceded by a major lifetime stressor. The development of these conditions was significantly related to the number of stressful life events occurring within the preceding year rather than to the total number of stressful life events. Subjects who sustain closely spaced stressful life events may be at increased risk of developing BEB and HFS.     

伴与不伴焦虑症状的难治性抑郁症临床特征的比较

目的 探讨伴焦虑症状的难治性抑郁症的临床特征.方法 将327例难治性抑郁症患者,按照17项汉密尔顿抑郁量表(HAMD17)焦虑/躯体化因子≥7分,分为焦虑组(229例)和无焦虑组(98例),比较2组患者的人口学特征和临床特征;对伴焦虑症状的危险因素进行Logistic回归分析.结果 焦虑组平均年龄、首发年龄、HAMD17总分、汉密尔顿焦虑量表(HAMA)总分高于无焦虑组[(42.58±11.77)岁vs(36.78±11.84)岁,(34.60±11.66)岁vs(30.04±12.60)岁,(27.83±6.93)分vs(23.39±5.59)分,(21.11±6.61)分vs(13.88±4.68)分],差异有统计学意义(P＜0.01).焦虑组和无焦虑组性别(男:女,OR=0.51)、有无强迫症状(OR=3.67)、未成年和成年发病的构成比(OR=0.36)的差异有统计学意义(P＜0.01).年龄(OR=1.05)、HAMD17总分(OR=1.17)、有自杀观念(OR=2.70)和强迫症状(OR=4.59)与难治性抑郁症伴焦虑症状相关(P＜0.05).结论 伴焦虑症状的难治性抑郁症患者具有年龄较大、女性倾向较高、首发年龄较晚、成年发病的倾向较高、抑郁程度更严重、更可能伴强迫症状等特点;年龄、抑郁严重程度、自杀观念和强迫症状可能是难治性抑郁症伴焦虑症状的危险因素.     

Life events and depression in children with pervasive developmental disorders

To determine the role of life events in the occurrence of depression in children with pervasive developmental disorders (PDD), we compared 11 patients (DSM-III-R; 9 male; 2 female; Mage: 11.0 years; Mfull-scale IQ: 75.3) with PDD and depression, with an age- and sex- matched control group of patients with PDD without depression (DSM-III-R; 9 male; 2 female; Mage: 9.8 years; Mfull-scale IQ: 60.6). Information was collected about the occurrence of unpleasant life events in the 12 months prior to the onset of depression. Depressed children experienced significantly more life events in the 12 months prior to the onset of depression. Exit events such as bereavement were more common in the depressed group. Findings suggest that, as in the general population, significant life events, particularly those with a negative impact, may contribute to the occurrence of depression in children with PDD. Future studies should explore the role of both biologic factors and environmental Stressors in the onset of depression in this population.From the Department of Psychiatry, University of Michigan. The authors thank Deanna Miner, Barbara Shaw, Laurie McGovern and the staff of the Child Psychiatry Inpatient Unit for their support.     

Interpersonal impairment and the prediction of depressive symptoms in adolescent children of depressed and nondepressed mothers

OBJECTIVE: Different pathways to youth depression should be explored. Based on an interpersonal impairment perspective on depression, the currently depressed children of depressed mothers were hypothesized to differ in predictors of their depression compared with depressed children of nondepressed mothers. Chronic social difficulties were expected to be more predictive of depressive symptoms in offspring of depressed women, while recent stressful life events were expected to predict depression in offspring of never-depressed women. METHOD: A community sample of 812 fifteen-year-old children of depressed and nondepressed women was studied in Queensland, Australia, between 1996 and 1999; chronic and episodic stress in the past 6 to 12 months were examined in relation to current depressive disorders. RESULTS: Depressive states in children of depressed mothers were more associated with chronic interpersonal difficulties than were the depressions of children of nondepressed women, and the latter group had greater increases in depression level associated with episodic stressors than did children of depressed women. CONCLUSIONS: The results may reflect greater depression reactivity to chronic social difficulties among offspring of depressed mothers. Depressive experiences may have different predictors in subgroups of depressed youths and imply potentially different courses and needs for treatment.     

Distinctive clinical characteristics and suicidal tendencies of patients with anxious depression

This study evaluated clinical characteristics and suicidality of patients with anxious depression in a large cohort of samples. Data were collected from 1003 patients who were depressed. A total of 461 patients were diagnosed with anxious depression and 542 were diagnosed with nonanxious depression. After adjusting for the severity of depression, those in the anxious depression group had significantly younger onset age, had been suffering from depression for a longer period, were more likely to experience a recurrence, and obtained lower scores on a scale assessing quality of life. The anxious depression group was characterized by a significantly higher proportion of individuals reporting significant suicidal ideation and previous suicide attempts, and those in this group tended to obtain higher scores on the Scale for Suicide Ideation. The present findings that were drawn from detailed evaluation of suicidality strongly support previous results assessed only with the help of clinical reports. More attention should be paid to assess suicide risk in these patients.     

Comparison of severe life stress in depressed mothers and non‐mothers: Do children matter?

Given the high rates of maladjustment among children of depressed mothers, parenting is likely to cause significant life stress in this population, potentially worsening the course of mothers' depression. The present study is a comparison of severe life stress in 38 mothers and 62 non-mothers receiving treatment for recurrent major depression. Life stress was assessed using the Life Events and Difficulties Schedule [Brown and Harris, 1978a]. We hypothesized that mothers would evidence a greater number of severe life events and marked difficulties both in the year prior to the onset of their depressive index episode and in the time period following the onset of their current depressive episode. Prior to depression onset, mothers reported a significantly greater number of entrapping difficulties, but not marked difficulties, severe events, entrapping events, or humiliating events. However, following the onset of depression, mothers experienced a significantly greater number of severe events, entrapping events, marked difficulties, and entrapping difficulties, but not humiliating events. Mothers' elevated levels of stress were attributable to child-related stress, predominantly related to children's psychological and behavioral problems. Our findings suggest that comprehensive treatment for mothers with major depression needs to address their parenting style and any psychological problems experienced by their children.     

Life events and personality characteristics in depression

Evidence from many sources supports the view that stressful life events might be relevant for the onset and development of depression, but their pathogenic role is still only poorly understood. One approach in trying to elucidate the role of life events in depression, might be to study them from a multi-factorial point of view, taking into account the vulnerability of the individual experiencing them. As part of such an investigation, 138 depressed patients with a mean age of 45 years have participated in a study of life events and personality traits. In particular, it was tested whether aspects of aggression might interact with the occurrence and perception of external stressful events. Patients who scored high on outward aggression had experienced more stressful events, and patients who scored high on inhibition of aggression had experienced fewer, but more negatively. It is concluded that a combined study of the occurrence of life events and the personality characteristics of the patients experiencing them might enhance our understanding of the pathogenic role of life events in depression.     

Depressed women with panic attacks

Of a group of 288 depressed female inpatients, 43 (15%) had secondary panic attacks. Compared to other depressives, the subgroup with panic attacks had significantly higher frequencies of anorexia, weight loss, gastrointestinal disturbances, hypochondriasis, and psychomotor agitation, and significantly lower frequencies of melancholic symptoms, including loss of interest in usual activities, guilt feelings, delusional thinking, psychomotor retardation, and orientation or memory impairment. Patients with panic attacks were less likely to have a depressed parent and were more likely to be described as having been nervous, worrisome, sensitive, and sexually dysfunctional before the onset of depression. Phenomenologically, they resembled "anxious depressives" as described by other authors.     

Representations of causality and depression. A factorial approach to the resignation model in the depressed patient

The present study investigates causal attributions for stressful life events within the context of Beck's cognitive theory of affective disorders and Seligman's learned helplessness model of depression. The aim was to assess the validity of the depressive attributional style proposed by Seligman, with a clinically depressed population for negative life events. This study presents a factor analysis of the causal attributions of depressed psychiatric in patients measured in relation to one negative life event per subject. The experimental procedure consisted in asking 71 ward depressed patients (51 females and 20 males) to answer 15 items along a seven point scale in order to assess the causes, consequences and control attributed. Statistical treatment using both multidimensional analyses (to describe the dimensions of causality) and univariate comparisons show: 1. The existence of a three dimensional solution, which is interpreted in terms of Seligman's reformulated helplessness model, and which confirms the notion of a "depressive attributional style". 2. A positive relationship between intensity of depression and the tendency to generalize the effects of negative life events (dimension of globality in Seligman's model and generalizability in Beck's). As this relationship is a function of the level of depression it is considered as a psychological state rather than as a personality trait. 3. Inter-sex differences with regard to the attribution of personal versus universal control, with female patients indicating more personal helplessness in relation to others. The results are discussed in relation to epidemiological data and personality theory.     

Severity,chronicity, and timing of maternal depression and risk for adolescent offspring diagnoses in a community sample

BACKGROUND: Risk for depression and other disorders is known to be high among children of depressed mothers, but little is known about the parameters of severity, chronicity, and timing of depression and its effects on children. The study addresses these issues, disaggregating their overlapping effects. METHODS: A sample of 816 women and their 15-year-old children in an Australian community were selected from a large birth cohort study to represent variation in maternal depression history during the child's first 10 years of life. Quantification of maternal depression severity and duration, and dates of occurrence, permitted analyses of youth depression and nondepressive disorders as a function of relative severity, chronicity, and timing of maternal depression. RESULTS: Diagnosable depression in children as old as 15 years was twice as likely among offspring of depressed, as compared with never-depressed mothers. After controls for demographic factors, severity of maternal depression contributed more to children's risk for depression than did chronicity. Children exposed even to 1 to 2 months of maternal major depression, or to more than 12 months of mild depression had elevated risks of depression; however, chronicity of maternal depression was associated more with nondepressive outcomes than was severity. Timing of exposure did not differentially predict risk for the disorder in children when separated from confounding chronicity and severity parameters. CONCLUSIONS: Even relatively brief maternal major depression, but more prolonged mild depression, predicted children's risk for depressive disorders by age 15 years in a community sample. Nondepressive outcomes were more complex to predict, which was due in part to difficulty dating disorder onset in relation to maternal depression. Exposure to maternal depression at any period in the first 10 years equally predicted youth depression if the mother was depressed only once. Further studies are needed to shed light on the mechanisms by which maternal depression has its effects.     

Life events and major depression in a sample of inpatient children

This study reports on the relationship between stressful life events and depression in an inpatient sample of 100 children, age 7 to 12 years. Thirteen children were diagnosed as depressed on the basis of structured interviews. These subjects reported having more negative life events (both unit and weighted) as measured by the life Events Checklist (LEC) than did the remaining sample. They also had lower self-concepts, greater hopelessness, and higher scores on the withdrawal and depression subscales of the Personality Inventory for Children than the nondepressed inpatient group. The significance of these findings is discussed.     

Postpartum and nonpostpartum depression: differences in presentation and response to pharmacologic treatment

Following childbirth, major depression (postpartum depression) affects approximately 8-12% of new mothers. However, little is known about the pharmacological management of postpartum depression, and no studies to date have assessed differences in treatment response between women with postpartum and nonpostpartum major depression. The authors reviewed the records of 26 women with postpartum major depression and 25 women with major depression unrelated to childbearing (nonpostpartum depression) who presented to them for treatment over a 4-year period. Compared with the nonpostpartum depressed patients, the postpartum depressed women were significantly more likely to present with anxious features. Also, cases of postpartum depression were more severe than cases of nonpostpartum depression. While the postpartum patients were equally as likely to recover (as defined by a Clinical Global Impression score of 1 or 2) compared to the nonpostpartum-depressed patients, their time to response was significantly longer. By 3 weeks of pharmacotherapy, 75% of the nonpostpartum cases had recovered, in contrast to only 36% of the postpartum cases. Further, postpartum patients were significantly more likely to be receiving more than one antidepressant agent at the time of response to treatment. Length of depression prior to treatment did not explain the difference in treatment response. Presence of depressive symptoms during pregnancy and timing of onset of the depression (before vs. after 4 weeks of delivery) did not affect likelihood of treatment response in this sample. Women with postpartum depression appear to be significantly more likely than the nonpostpartum women to present with anxious features, take longer to respond to pharmacotherapy for depression, and require more antidepressant agents at the time of response to treatment.     

The differential relation of childhood maltreatment to stress sensitization in adolescent and young adult depression

Childhood maltreatment has been shown to have a stronger etiological relation to depression onset in adolescence than in adulthood. We propose that a maltreatment history may more strongly sensitize individuals to the depressogenic effects of proximal stressful life events in adolescence compared to adulthood. In an amalgamated sample of 176 unipolar depressed adolescents (age 12–17) and emerging adults (age 18–29), we examined the moderating role of age group on the relation of childhood maltreatment to sensitization to stressors that occurred just prior to episode onset. Among adolescents, but not among adults, those with a maltreatment history reported a lower severity level of life events prior to episode onset than reported by those without such a history. Further, this relation was specific to emotional abuse, and not physical or sexual abuse. We suggest that the pathological mechanisms associated with translating childhood maltreatment to depression may differ across developmental periods.     

Parent-child bonding and family functioning in depressed children and children at high risk and low risk for future depression

OBJECTIVE: To evaluate parent-child bonding and familial functioning in depressed children, children at high risk for depression, and low-risk controls. METHOD: Diagnoses of children and their relatives were obtained via structured interviews with all available informants. Depressed children (n = 54) received a diagnosis of current major depressive disorder (MDD). The high-risk children (n = 21) had no lifetime diagnoses of mood disorders, but at least one first-degree relative with a lifetime history of depression. The low-risk controls (n = 23) had no lifetime psychiatric disorders and no first-degree relative with a lifetime history of mood disorders. Parent-child bonding was evaluated with the child's report on the Parental Bonding Instrument (PBI). Familial functioning was evaluated with each parent answering the Family Assessment Device (FAD). RESULTS: Significant differences were found between the MDD and low-risk children on most parameters of the PBI and FAD. The children with MDD reported significantly elevated maternal overprotection, and their fathers scored significantly lower on the FAD scales of Behavioral Control and General Functioning, compared with the high-risk children. Mothers of high-risk children had significantly lower scores on the Roles and Affective Involvement dimensions of the FAD compared with mothers of low-risk children. Current maternal depression had a deleterious effect on the child's perception of maternal protection and paternal care, mother's report on all FAD scales, and father's report on most FAD scales, whether interacting with the child's depression or existing even if the child was not depressed. CONCLUSION: Maternal depression and its interaction with the child's depression appear to have negative consequences for parent-child bonding and family functioning.     

Adolescent onset of the gender difference in lifetime rates of major depression: a theoretical model

Prepubescent boys are, if anything, more likely than girls to be depressed. During adolescence, however, a dramatic shift occurs: between the ages of 11 and 13 years, this trend in depression rates is reversed. By 15 years of age, females are approximately twice as likely as males to have experienced an episode of depression, and this gender gap persists for the next 35 to 40 years. We offer a theoretical framework that addresses the timing of this phenomenon. First, we discuss the social and hormonal mechanisms that stimulate affiliative needs for females at puberty. Next, we describe how heightened affiliative need can interact with adolescent transition difficulties to create a depressogenic diathesis as at-risk females reach puberty. This gender-linked vulnerability explains why adolescent females are more likely than males to become depressed when faced with negative life events and, particularly, life events with interpersonal consequences.     

Social support, life events, and depression during pregnancy and the puerperium

A sample of 99 women was studied prospectively from the second trimester of pregnancy until nine weeks post partum. Depressed and nondepressed women identified at the second-trimester assessment and the postpartum assessment were compared on measures of stressful life events and social support provided by their spouses and close confidants. Nine percent of women during pregnancy and 12% of women after delivery were depressed. Women experiencing postpartum depression reported more stressful life events and less support from their spouses after delivery than the women not experiencing postpartum depression. Women experiencing depression during pregnancy reported somewhat less support from their spouses and more support from their confidants than nondepressed women. The results of the study suggest that different causes may be responsible for prepartum and postpartum depression.