Depressive symptomatology in coronary artery bypass graft surgery patients.

Depression is commonly reported in coronary artery bypass graft (CABG) surgery patients. This study assesses the relationship of preoperative characteristics, life stressors, social support, major cardiac and neurologic outcomes and other complications to depressive symptomatology. Demographic and clinical data, CES-D score and information on life stressors and social support were collected from 237 patients; 92% completed 6-month follow-up. CES-D score > or = 16 was defined as significant depressive symptomatology. Significant depressive symptomatology was found in 43% of patients preoperatively and 23% postoperatively. In multivariate models, low social support (p = 0.008), presence of at least one life stressor within a year of surgery (p = 0.006), moderate to severe dyspnea (p = 0.003), little to no available help (p = 0.05) and less education (p = 0.05) were associated with higher preoperative CES-D score, while longer intensive care unit (ICU) stay (p = 0.0001) and little or no available help (p = 0.0008) predicted higher postoperative CES-D scores when controlling for preoperative CES-D scores. Neither pre- nor postoperative depressive symptomatology was related to major outcomes or other complications. A high rate of significant depressive symptomatology exists in CABG patients preoperatively, and it decreases significantly postoperatively. Patients with the above preoperative characteristics as well as those who stay in the ICU postoperatively for more than 2 days might benefit from psychosocial interventions.     

Influence of the interaction between the serotonin 1A receptor C-1019G polymorphism and negative life stressors on the development of depression

The current study aimed to investigate the interaction between the serotonin 1A receptor gene (HTR1A) C-1019G polymorphism and recent negative life stressors on depression in a Korean community sample. The HTR1A C-1019G polymorphism was genotyped in 416 community-dwelling Koreans (156 males, 260 females; 44.37 ± 14.67 years old). Lifetime and current major depressive episodes were diagnosed using the Structured Clinical Interview for DSM-IV. The Center for Epidemiological Studies for Depression Scale (CES-D) was self-applied and face-to-face interviews investigating negative life stressors within the last 6 months were also performed. The results indicated that there were significant interactions between the C-1019G polymorphism and negative life stressors on CES-D scores (p = 0.02) as well as on current major depressive episodes (p = 0.002), but not on past major depressive episodes. G carriers alone had higher CES-D scores and more frequently experienced major depressive episodes after stressors. The interaction between the C-1019G polymorphism in HTR1A and recent negative life stressors accounted for current major depressive episodes and depressive symptoms. Our findings suggest that people with this gene variant may be more susceptible to developing depression especially after negative life stressors.     

Associations between loneliness, depressive symptoms and perceived togetherness in older people

This study explores the associations of loneliness with depressive symptoms in a five-year follow-up and describes how the six dimensions of perceived togetherness explain loneliness and depressive symptoms at baseline. The data were collected on 207 residents of Jyväskylä, central Finland, who at baseline in 1990 were aged 80; and 133 residents who at follow-up in 1995 were aged 85. Loneliness was assessed using a questionnaire item with four preset response options, perceived togetherness using the Social Provisions Scale, and depressive symptoms using the CES-D scale. A recursive structural equation model showed that in women but not in men, depressive symptoms predicted more experiences of loneliness. Those who were lonely were more depressed (CES-D score 16 or over) and experienced less togetherness than those who were not. Loneliness was explained by reliable alliance, social integration and attachment; and depressive symptoms were explained by guidance, reassurance of worth, reliable alliance and attachment. A common feature in both loneliness and depressive symptoms was a lower level of perceived emotional togetherness in social interaction.     

Genetic Liability for Depression,Social Factors and Their Interaction Effect in Depressive Symptoms and Depression Over Time in Older Adults

ObjectivesThe objectives of this study were to investigate the effect of genetic and social factors on depressive symptoms and depression over time and to test whether social factors moderate the relationship between depressive symptoms and its underlying genetics in later life.MethodsThe study included 2,279 participants with a mean follow-up of 15 years from the Longitudinal Aging Study Amsterdam with genotyping data. The personal genetic loading for depression was estimated for each participant by calculating a polygenic risk scores (PRS-D), based on 23,032 single nucleotide polymorphisms associated with major depression in a large genome-wide association study. Partner status, network size, received and given emotional support were assessed via questionnaires and depressive symptoms were assessed using the CES-D Scale. A CES-D Scale of 16 and higher was considered as clinically relevant depression.ResultsHigher PRS-D was associated with more depressive symptoms whereas having a partner and having a larger network size were independently associated with less depressive symptoms. After extra adjustment for education, cognitive function and functional limitations, giving more emotional support was also associated with less depressive symptoms. No evidence for gene-environment interaction between PRS-D and social factors was found. Similar results were found for clinically relevant depression.ConclusionGenetic and social factors are independently associated with depressive symptoms over time in older adults. Strategies that boost social functioning should be encouraged in the general population of older adults regardless of the genetic liability for 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.     

Prevalence and predictors of depressive symptoms in older premenopausal women: the Harvard Study of Moods and Cycles

BACKGROUND: The Harvard Study of Moods and Cycles is a community-based cohort study designed to evaluate the relationship between major depression and changes in menstrual and ovarian function. METHODS: All women aged 36 to 44 years with a verifiable address from 7 Boston, Mass, metropolitan communities were selected from the Massachusetts Town Books. A self-administered questionnaire assessed demographic characteristics and menstrual history, depression history, and current depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D]) in 4161 women. RESULTS: We observed a score of 16 or more on the CES-D in 22.4% of women surveyed, and 8.6% scored 25 or more. Widowed, divorced, or separated women were twice as likely as married women to have depression scores greater than 16 (95% confidence interval, 1.6-2.8), and smokers in the upper tertile of pack-years were 1.9 times more likely to have CES-D scores of 16 or more (95% confidence interval, 1.5-2.3). Relative to nulliparous women, those with 1 or 2 children had a 30% lower risk of historic mood disorder, and those with 3 or more children had an even greater reduction in risk (odds ratio, 0.4; 95% confidence interval, 0.3-0.6). Menstrual cycle irregularities were largely unassociated with current or past depression. However, 5 of 8 premenstrual symptoms were significantly associated with CES-D scores of 16 or more. CONCLUSIONS: These findings corroborate the prevalence of depression reported by other community-based studies, and also support a relationship between depressive symptoms and marital status, cigarette smoking, nulliparity, and premenstrual symptoms.     

Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample

OBJECTIVE: Previous research has shown high prevalence rates of depression in multiple sclerosis patients seen in specialty clinics. The relationships among depressive symptoms and severity, duration, and course of multiple sclerosis are controversial. METHOD: A survey was mailed to members of the Multiple Sclerosis Association of King County (Wash.). Of the 1,374 eligible participants, 739 returned the survey, a response rate of 53.8%. Data about demographic characteristics, employment, and duration and course of multiple sclerosis were collected. Severity of multiple sclerosis was determined by the Expanded Disability Status Scale, self-report version. Severity of depressive symptoms was evaluated with the Center for Epidemiologic Studies Depression Scale (CES-D Scale). Analysis of covariance was used to compare mean CES-D Scale scores across categories of multiple sclerosis, and logistic regression was used to identify variables associated with clinically significant depression. RESULTS: Clinically significant depressive symptoms (CES-D Scale score > or =16) were found in 41.8% of the subjects, and 29.1% of the subjects had moderate to severe depression (score > or =21). Subjects with advanced multiple sclerosis were much more likely to experience clinically significant depressive symptoms than subjects with minimal disease. Shorter duration of multiple sclerosis was associated with a greater likelihood of significant depressive symptoms, but the pattern of illness progression was not. CONCLUSIONS: In this large community sample, the severity of multiple sclerosis was more strongly associated with depressive symptoms than was pattern of illness. Clinicians should evaluate depression in patients with recent diagnoses of multiple sclerosis, major changes in functioning, or limited social support.     

Religious denomination as a symptom-formation factor of depression in older Dutch citizens

OBJECTIVES: The type of symptoms in depression is likely to be influenced by cultural environment. As religion represents an important cultural resource for older adults, it is hypothesised that religious denomination represents a symptom-formation factor of depression in the older generation. Focusing on older Dutch citizens, it is expected that depressed Calvinists report: (1) less depressed affect, (2) more vegetative symptoms, and (3) more guilt feelings, than Roman Catholics and non-church members. METHODS AND PROCEDURES: The Center for Epidemiologic Studies Depression Scale (CES-D) was used to distinguish depressed (N=395) and non-depressed (N=2333) older adults, and to assess depressive symptom-profiles. The Diagnostic Interview Schedule (DIS) was used to assess major depressive episodes and criterion-symptoms of depression. RESULTS: Depressed Calvinists, especially males, had higher scores on the vegetative CES-D subscale. The same was found for non-church members with Calvinist parents. Among those who have had a major depressive episode in later life (N=84), support was found for all hypotheses. Feelings of guilt were also more prevalent among Roman Catholics. CONCLUSIONS: Religious denomination modified the type of symptoms in late-life depression. As a Calvinist background was associated with less depressive affect and more inhibition, there is a risk of underdiagnosis of major depression in older Calvinists in The Netherlands.     

The association between depressive symptoms and cigarette smoking in an urban primary care sample

OBJECTIVE: To examine the relationship between cigarette smoking and depressive symptoms in an urban primary care sample. METHODS: Eligible participants were 526 patients aged eighteen to sixty-four presenting in the waiting rooms of two university affiliated internal medicine clinics. Participants were asked to complete a brief interview which ascertained current depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D), demographic information, and smoking status using a modified version of the Fagerstrom Test for Nicotine Dependence (FTND). RESULTS: Smoking status differed significantly by age, gender, education, and employment status. Mean level of depressive severity also differed by smoking status. Current smokers with nicotine dependence symptoms had significantly higher CES-D scores than those who had never smoked, ex-smokers, and non-dependent smokers. Logistic regression analyses indicated that gender, employment status, age, and smoking status were significantly associated with CES-D scores > or = 16. Exploratory analyses suggested that among smokers with a symptom of nicotine dependence, significantly more women than men had clinically significant levels of depressive symptoms. CONCLUSIONS: The association between smoking behavior and depressive symptoms in the present study is consistent with that reported in population-based and psychiatric samples. Symptoms of nicotine dependence were significantly associated with clinical levels of depressive symptoms. Primary care physicians may wish to inquire about depressive symptoms among smokers, because these symptoms may interfere with patients' efforts to quit.     

Changes in social support and their impact on psychosocial outcome over a 5-year period for African American and White dementia caregivers

BACKGROUND: African Americans have been found to be more resilient to the caregiving role than Whites. Amount of social support and satisfaction with social support were studied as possible explanations for these racial differences. METHODS: Family caregivers of patients diagnosed as having dementia participated in a longitudinal study. There were 166 caregiver-patient dyads enrolled and annual follow-up assessments were completed. Linear random effects regression models examined the longitudinal trajectories of social support, depressive symptoms, and life satisfaction over 5 years of community follow-up. Social support was also included as a time-dependent predictor of depressive symptoms and life satisfaction. RESULTS: The number of helpful support persons available decreased significantly for both racial groups. African American caregivers reported more satisfaction with their social support networks than Whites. They also reported fewer depressive symptoms and higher levels of life satisfaction when compared to their White counterparts. Higher levels of satisfaction with social support were associated with fewer depressive symptoms and increased levels of life satisfaction and explained a portion of the racial differences on these measures of psychosocial outcome. CONCLUSIONS: The resilience of African American caregivers, as displayed by their fewer depressive symptoms and higher levels of life satisfaction, was partially explained by their higher levels of satisfaction with social support. Results suggest that health care providers should view low levels of social support as a possible precursor to poor psychological outcomes in caregivers. Future research should focus on social support and cultural variables that might explain racial differences in caregiver outcomes.     

抗抑郁治疗在脑卒中功能恢复中的作用

目的 探讨脑血管意外伴抑郁症状患者应用抗抑郁药物治疗对其病程及预后的影响。方法 经CES-D筛选出伴抑郁症状的125例脑血管意外患者,随机分为两组。治疗组65名,非治疗组62名,两组在年龄,性别,神经功能缺损及CES-D评分等项目上无明显差异。治疗组予抗抑郁药物PROZAC20mgqd治疗,平均治疗时间为175±43.8天,一月及一年后再对两组进行CES-D及神经功能缺损的评定及比较。结果治疗组一月及一年后CES-D评分均有明显下降(p<0.001),神经功能恢复也明显好于非治疗组(P<0.01)。结论 脑血管意外伴抑郁症状者给予抗抑郁治疗对其病情改善和预后均有好处。     

Outcomes of community-based social service interventions in homebound elders

OBJECTIVE: To document within-client change in function and quality of life over 6 months, and determine whether social service interventions, comorbidity, depressive symptoms, social support and stress are predictors of within-patient change. METHOD: Assess homebound elderly referred for social services on depressive symptoms measured by the Geriatric Depression Scale (GDS), comorbidity with the Charlson Index, and stress and support with the Duke instrument. Function was measured by the Functional Autonomy Scale (FAS), measuring Activities of Daily Living (ADL), Independent Activities of Daily Living (IADL), mobility, communication and mental function. The SF-36 measured quality of life. RESULTS: Among 56 new homebound clients with an average age of 82, 33% had depressive symptoms at baseline (>7 on the GDS). At baseline clients were at or below 25th percentile for five of eight domains of the SF-36, and mental and physical summary scores. Further at baseline, 90% had difficulties with mobility and IADLs; 61% had ADL limitations. At 6-month follow-up overall, 26% had depressive symptoms at follow-up. Greater comorbidity was associated with more depressive symptoms at both baseline and follow-up. By 6 months, 18% had deteriorated on the FAS, while 11% improved. More clients had changes in quality of life; regarding the physical component score, 13% had important deterioration, while 63% improved. Similarly, 33% declined on the mental component while 27% improved. CONCLUSION: Among newly homebound elders, those with significant depressive symptoms are more likely to experience deterioration in function and quality of life over 6 months. However, those with more support showed significant improvement in the SF-36 mental component scale at 6 months.     

Validation study of prevalence and correlates of depressive symptomatology in multiple sclerosis

OBJECTIVE: To validate previous research findings on the prevalence of and factors associated with depressive symptoms in a community-dwelling sample of individuals with multiple sclerosis (MS). METHOD: A cross-sectional survey study of 530 individuals with MS from Eastern Washington (EW) was conducted and compared to a previous cross-sectional survey study of 738 individuals with MS from Western Washington (WW). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), and multivariate logistic regression was employed to detect related factors. RESULTS: Prevalence of depressive symptoms was similar in both populations (EW 51%, WW 45%). Factors associated with a clinically significant level of depressive symptoms (CES-D > or =16) in both groups were greater disease severity, shorter disease duration, lower education and less social support (all P<.01). Lower age was also associated with a significant level of depressive symptoms in the WW but not in the EW sample. CONCLUSIONS: Despite differences in disease-related and demographic factors, predictors of depressive symptoms were highly similar in both MS study populations.     

Subjective social support and depressive symptoms in major depression: Separate phenomena or epiphenomena

One hundred and twenty-five middle-aged and elderly adults suffering from a major depressive episode were evaluated during the index episode and at six and twelve month follow-up. Subjective (emotional) social support and depressive symptoms (CES-D) were evaluated during each interview. Contingency table and correlation analyses reveal that subjective support and depressive symptoms are interrelated but separate constructs.     

The relationship between severity of dementia and subjective well-being

The purpose of this study was to describe the relationship between cognitive deficits and self-reported subjective well-being (depression, life satisfaction, and perceived social support). Sixty-three participants who suffered from mild to moderate dementia were interviewed with standardized measurements of subjective well-being. Reliability and validity of the instruments were satisfactory. Zero-order correlations showed significant correlations between depression, life satisfaction, and perceived social support. Cognitive functioning correlated negatively with perceived social support. Hierarchical regression analyses revealed that the interaction of physical diseases and cognitive functioning produced a significant change in depressive symptoms and life satisfaction. Participants with mild dementia reported more depressive symptoms and less life satisfaction than persons with more severe dementia, if there were few constraints on physical health.     

The Effect of Social Isolation on Depressive Symptoms Varies by Neighborhood Characteristics: A Study of an Urban Sample of Women with Pre-School Aged Children

Objectives  To examine how individual characteristics, social isolation, and neighborhood context affect depressive symptoms in a socio-economically diverse population of women with young children. Methods  Interviews were conducted with 261 mothers from 68 neighborhoods in Baltimore between 1998 and 2000. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression scale (CES-D). Neighborhood context was characterized using police and Census data. Multilevel regression was performed. Results  Socially isolated women reported on average 73% (95% CI, 48 and 92%) more depressive symptoms than women who were not socially isolated; however, the association of social isolation and depressive symptoms varied by level of crime in the neighborhood. Social isolation was associated with an average increase in depressive symptoms of 128% (95% CI, 115 and 138%) for women in low-crime neighborhoods but with no change for those in high-crime neighborhoods. The interaction remained significant after controlling for individual- and neighborhood-level socio-demographic characteristics.     

抑郁症残留症状及对疾病结局影响

目的：调查抑郁症残留症状及危险因素和其对疾病结局影响。方法：选择100例治疗12周以上抑郁症患者,评估人口社会学资料、抑郁症状、生活事件、应对方式、社会支持、生活质量和社会功能。结果：贝克抑郁自评问卷（BDI）≥5分和汉密顿抑郁量表17项（HAMD17）≥8分的患者比例分别为53％和49％;残留症状与负性生活事件（t=-4．90,P=0．00）、积极应对方式（t=8．22,P=0．00）、消极应对方式（t=-4．53,P=0．00）、社会支持（t=2．01,P=0．05）及家庭支持（t=1．97,P=0．05）明显有关;有残留症状者生活质量和社会功能显著差于无残留症状者（P〈0．01）。结论：抑郁症患者残留症状发牛率相当高．需要心弹社会干预。     

The effects of single and dual sensory loss on symptoms of depression in the elderly

OBJECTIVES: The primary purposes of this study were to determine the effect of dual sensory loss (i.e. combined hearing and vision loss) on depressive symptoms, to determine whether dual sensory loss has an effect on depressive symptoms when controlling for common covariates of depression, and to determine whether persons with dual sensory loss were more likely than those with a single sensory loss to experience depressive symptoms. DESIGN: Secondary analyses of 2001 National Health Interview Survey data. PARTICIPANTS: Nine thousand eight hundred and thirty-two people aged 55 and older residing in the community in the US. MEASUREMENTS: Self-report answers to questions about hearing and vision status, depressive symptoms, health, education level, poverty, social activities, social support, and functional disability (ADL and IADL status). RESULTS: Dual sensory loss had a significant effect on depressive symptoms (OR: 3.2, 95% CI: 2.8-4.0), which was lowered but still significant after controlling for covariates of depression (OR: 2.2, 95% CI: 1.7-2.9). Those with dual sensory loss were not significantly more likely than those with vision loss, but were significantly more likely than those with hearing loss, to experience symptoms of depression. CONCLUSION: Experiencing depressive symptoms is a problem that needs to be addressed with elderly persons with dual sensory loss. Not only is this population more likely to experience these symptoms, because of their sensory losses treatment for them may be problematical. Professionals working with the elderly should be aware of the increased risks of depressive symptoms in those with single or dual sensory loss, and should screen for them. If present, rehabilitation for sensory losses may help decrease them.     

Stress, social support, and symptoms of depression in spouses of the medically ill

This study investigated the level and frequency of depressive symptoms in spouses of dialysis patients, as a function of a) severity of patient disease, b) level of stress experienced by the spouse, and c) perception of support from the ill partner. The subjects were forty patients who had begun dialysis in the last year and their spouses. Measures of depression, impact on family, perceived social support, and disease severity were applied. Significant depressive symptoms were reported by 20 percent of spouses. Symptom severity was not correlated with age, sex, or occupation of the spouses, nor with level of depression or functional impairment of the dialysis patients. The amount of social support received from the ill partner accounted for 37 percent of the variance in spouse depression, while social and financial stressors reported by the spouse explained 13 percent of the variance in spouse symptoms. These findings suggest that depressive symptoms in spouses of dialysis patients are associated with the social and economic consequences of the illness for the family but even more so with the amount of perceived support from the patient. The determinants of this perceived support need further exploration.     

Perceived neighbourhood social cohesion and depressive symptom trajectories in older adults: a 12-year prospective cohort study

Purpose

To model the dynamic age-related rate of change in depressive symptomatology in later life and to test the hypothesis that low perceived neighbourhood social cohesion is associated with steeper trajectories of depressive symptoms in older adults.

Methods

We analysed data on 11,037 participants aged 50+ from the English Longitudinal Study of Ageing. Perceived social cohesion (PSC) of participants’ neighbourhoods was assessed at baseline (2002/2003). Depressive symptoms were measured using CES-D scores (ranging from 0 to 8) on 7 occasions from baseline to 2014/2015. Trajectories of depressive symptoms by baseline PSC were estimated using latent growth modelling.

Results

At baseline, adults with low PSC had more depressive symptoms than age counterparts with high PSC. Consistent with the U-shaped trajectory of depressive symptoms by age, the association between PSC tertile and changes in depressive symptoms over follow-up was modified by age. Fifty-year-old participants with low PSC reported an average decrease in CES-D score from 0.66 to 0.54 during the 12-year follow up, compared to a change from 0.47 to 0.34 for age counterparts with high PSC. By contrast, in persons aged 85 at baseline, the mean CES-D score increased from 1.09 to 1.30 for participants with high PSC, while the rise was greater (from 1.49 to 2.03) among those with low PSC. The main effects and interaction of PSC with age were robust to adjustment for socio-economic and health characteristics.

Conclusions

Depressive symptom trajectories by PSC appear to widen as adults reach old age.