Early-life risk factors for late-onset depression

OBJECTIVE: To assess differences between women with no history of depression (No MDD), early-onset depression (EOD), and late-onset depression (LOD) on psychosocial risk factors (marital conflict and lack of social support), neuroticism, and overall self-rated health. METHOD: Diagnostic data from a community-based longitudinal study of women at mean ages 39, 42, 48, and 59 was used to create three groups of women (No MDD, EOD and LOD). These groups were then compared on psychosocial, personality, and overall health risk assessed approximately 10 years prior to diagnosis. RESULTS: There were no differences between the groups on marital conflict and social support. Those with EOD scored higher than those in the LOD and No MDD groups on neuroticism. Importantly, those with LOD reported poorer health than those with No MDD 10 years prior to diagnosis. CONCLUSIONS: These findings provide support for the notion that poor health and not psychosocial risk factors or neuroticism predispose otherwise healthy adults to developing depression for the first time in late-life.     

The association of depression and multimorbidity in the elderly: implications for the assessment of depression

Background: Depression and multimorbidity are common in the elderly. Assessing depression might be difficult because of the overlap of depressive and somatic symptoms, possibly leading to confounded results. Methods: This study investigates the frequency of depression, multimorbidity and their association, the potential impact of multimorbidity on the assessment of depression by the Patient Health Questionnaire, and whether using a cut point might cause misleading results in the elderly German population (60–85 years, n= 1659). Results: Depressive syndromes are significantly more frequent in multimorbid respondents. Multimorbidity is associated with higher item scores, especially in the somatic items, and multimorbid respondents show higher depression severity levels in comparison to non‐multimorbid persons. Conclusion: There are associations between multimorbidity and depressive symptoms, therefore potentially confounding prevalence rates. As such, causal pathways of these associations should be studied under a longitudinal perspective in future studies.     

Childhood abuse and late‐life depression: Mediating effects of psychosocial factors for early‐ and late‐onset depression

Objective

Childhood abuse makes people vulnerable to developing depression, even in late life. Psychosocial factors that are common in late life, such as loneliness or lack of a partner, may explain this association. Our aim was to investigate whether the association between childhood abuse and depression in older adults can be explained by psychosocial factors.

Methods

Cross‐sectional data were derived from the Netherlands Study of Depression in Older Persons (aged 60‐93), including 132 without lifetime depression, 242 persons with an early‐onset depression (<60 years), and 125 with a late‐onset (≥60 years) depression. Childhood abuse (yes/no) and a frequency‐based childhood abuse index were included. Multinomial regression and multivariable mediation analyses were used to examine the association between childhood abuse and the onset of depression, and the influence of loneliness, social network, and partner status.

Results

Multinomial regression analyses showed a significant association between childhood abuse and the childhood abuse index with early‐ and late‐onset depression. Multivariable mediation analyses showed that the association between childhood abuse and early‐onset depression was partly mediated by social network size and loneliness. This was particularly present for emotional neglect and psychological abuse, but not for physical and sexual abuse. No psychosocial mediators were found for the association between childhood abuse and late‐onset depression.

Conclusions

A smaller social network and feelings of loneliness mediate the association between childhood abuse and early‐onset depression in older adults. Our findings show the importance of detecting childhood abuse as well as the age at depression onset and mapping of relevant psychosocial factors in the treatment of late‐life depression.     

Progressing a spectrum model for defining non-melancholic depression

OBJECTIVE: To further develop a 'spectrum model' for non-melancholic disorders that encompasses underlying personality styles and clinical patterning. METHOD: In a sample of patients with non-melancholic depression, we studied four personality constructs influencing risk to depression, assessing associational strength and specificity between personality scores and symptom and coping response patterns. RESULTS: Analyses refined four personality dimensions (anxious worrying, irritability, social inhibition, and self-centredness) for testing the model. For all dimensions, personality style was specifically linked with a mirroring 'coping' response. Quantification of specific links allowed development of a spectrum model for the non-melancholic depressive disorders in which underpinning personality style showed some specific links with the clinical 'pattern' of symptoms and coping repertoires. CONCLUSION: The model has the capacity to assist clinical assessment, identify aetiological personality influences and allow specific treatment effects for the heterogeneous non-melancholic depressive disorders to be determined.     

Development of a quality assessment instrument for trials of treatments for depression and neurosis

There is evidence that the quality of controlled clinical trials affects the results that are obtained. A systematic approach to the assessment of quality is required for psychiatric research. This study set out to develop an instrument for the assessment of the quality of controlled trials of interventions for depressive and non‐psychotic conditions. A pilot study led to the development of a scale containing 23 items covering a wide range of aspects of quality including objective formulation, design, presentation of results, analysis and quality of conclusions. Scoring criteria were devised and the scale was then subjected to reliability testing using a random sample of trials of treatment for depression and ‘neurosis’. The scale showed moderate inter‐rater reliability and results were comparable to those obtained with shorter instruments. It was quick and easy to use. There were significant correlations between year of publication and overall quality score with later studies showing higher quality. The instrument developed here provides a systematic approach to the assessment of quality for use in critical appraisal of individual studies and meta‐analysis. However, the scoring process should be used cautiously since inter‐rater agreement was only moderate. Copyright © 2001 Whurr Publishers Ltd.     

HIV infection and depression

Major depression is highly prevalent among HIV‐positive patients (HIVpp). The prevalence of depression ranges between 18% and 81%, depending on the population studied and the methodology of the study. The etiology of depression in HIVpp is likely determined by: (i) biological factors (alterations in the white matter structure, hypothalamic–pituitary–thyroid dysfunction, Tat‐protein‐induced depressive behavior); (ii) psychosocial factors (HIV stigma, occupational disability, body image changes, isolation and debilitation); (iii) history or comorbidity of psychiatric illness; and (iv) the perinatal period in HIVpp women. Symptomatology of depression differs between HIVpp and HIV‐negative patients (HIVnp). Depression may also alter the function of lymphocytes in HIVpp and decrease natural killer cell activity, contributing to the increased mortality in these patients. Selective serotonin re‐uptake inhibitors are considered the first‐line treatment. Treatment of depression can improve quality of life and lead to a better prognosis of HIV infection.     

Late mortality in severe depression

OBJECTIVE: To assess late mortality among psychiatric in-patients with severe depression/melancholia. METHOD: 1,206 in-patients rated at discharge on a multidimensional diagnostic schedule had received the diagnosis severe depression/ melancholia between 1956 and 1969. A first follow-up was made in 1984. The present follow-up constitutes 675 survivors 15-42 years after the first admission. They were followed-up by means of the general population register and local parish registers to January 1st 1998. RESULTS: At this second follow-up another 279 patients were deceased, standardized mortality ratio 1.3, indicating a continuous increased mortality late in the course of depression. Eleven suicides (4%) were included, eight men and three women, which was less than the 22% found in the first investigation. Male patients showed a higher suicide rate than female patients late in the course. CONCLUSION: The general mortality and suicide rate remain increased late in the course.     

Prevalence and correlates of depression in Chinese oldest-old

BACKGROUND: In Hong Kong, the aged population will be increased rapidly in the coming three decades and the oldest-old (aged 80 and above) is the fastest growing age group. In this paper, we examined the prevalence rate and the correlates of depression for the oldest-old. METHOD: This article analyzes cross-sectional data collected from a representative community sample of 1 903 Chinese elderly people aged 60 or above in Hong Kong. Respondents were interviewed in face-to-face format with structural questionnaire. RESULT: Using 8 as the cut-off point for the 15-item Geriatric Depression Scale, we found that the prevalence rate was greater for the oldest-old (31.1% +/- 9.7%) than for the young-old (aged between 60 and 69; 19.1% +/- 2.8%) and the old-old (aged 70 and 79; 22.4% +/- 4.2%) groups. Logistic regression analyses revealed that financial strain, poor self-rated health, loneliness, and heart disease were significantly and positively related to depression in the oldest-old after gender, marital status, education, living arrangement, functional disability, sensory impairment, cognitive ability, and the presence of eight medical conditions were controlled. Interestingly, financial strain, self-rated health, and loneliness were found to be significant correlates of depression in the young-old and the old-old groups, too. CONCLUSION: Depression is a serious problem for the oldest-old but a number of correlates are consistently identified in the oldest-old, as well as the two other age groups in the elderly population. Therefore, aged care service practitioners must take these correlates into consideration in their prevention and treatment for depression for all different age groups in the aged.     

Psychotherapy for depression among children and adolescents: a systematic review

OBJECTIVE: To examine the clinical benefit, the harm and the cost-effectiveness of psychotherapies in comparison with no treatment, waiting-list controls, attention-placebos, and treatment as usual in depressed youths. METHOD: Meta-analyses were undertaken by using data from all relevant randomized-controlled trials identified by a comprehensive literature search. The primary outcome was relative risk (RR) of response. RESULTS: We identified 27 studies containing 35 comparisons and 1,744 participants. At post-treatment, psychotherapy was significantly superior (RR = 1.39, 95% CI 1.18-1.65, P = 0.0001, number-needed to treat 4.3). There was an evidence of the existence of small study effects, including a publication bias (P < 0.001). The superiority of psychotherapy was no longer statistically significant (1.18 [0.94-1.47], P = 0.15) at 6-month follow-up. None of the studies reported adverse effects or cost-effectiveness outcomes. CONCLUSION: Although the findings were biased by some small positive trials, psychotherapies appear to help depressed youths for the short term, but are no longer significantly favourable at 6-month follow-up.     

Antenatal screening for postnatal depression: a systematic review

OBJECTIVE: To describe the screening properties of the antenatal tools which have been developed to predict depression after birth and to summarize the implications of the findings for antenatal screening. METHOD: Systematic review and secondary analysis of published papers. RESULTS: Sixteen studies including sufficient data for the calculation of screening properties were identified. The majority developed a study-specific screening instrument. Outcome assessments used the Edinburgh Postnatal Depression Scale or standardized diagnostic psychiatric interviews, or both. In the two largest population-based studies, the proportion of women screening as positive ('at risk' of postnatal depression) was 16 and 52%, respectively, and of these only 35 and 8% actually developed depression after birth. CONCLUSION: No screening instrument(s) met the criteria for routine application in the antenatal period. Factors that may have affected poor sensitivity and positive predictive values include the exclusion of key domains in predicting risk, particularly personality, a past history of abuse and postnatal events, the contribution of which may be being under-estimated in studies evaluating antenatal risk prediction tools.     

A biopsychosocial model as a guide for psychoeducation and treatment of depression

Effective treatment of severe or chronic unipolar depression requires the combination of pharmacological and psychotherapeutic interventions, and demands a theoretical paradigm integrating biological and psychosocial aspects of depression. Supported by recent research, we propose in our article a biopsychosocial diathesis-stress model of depression. Its basic aim is psychoeducational: to provide therapists, patients, and their environment a constructive conceptual framework to understand depressive complaints, vulnerability, and stress. The core of the model consists of the concept of psychobiological vulnerability, which is determined by risk factors-of a biogenetic, psychological, somatic, and societal nature-and by protective factors. Life events with an idiosyncratic, stress-inducing value interact with this vulnerability, triggering severe or chronic distress that affects the individual's resilience and leads to symptoms of depression. The pathogenesis of depression is symbolized by a negative downward loop, in which interactions among symptoms, vulnerability, and stressors drive the patient toward a depressive condition. Moreover, experiencing recurrent depression influences psychobiological vulnerability, the occurrence of stressors, and tremendously increases the risk of further relapse. The model stresses the self-evident integration of biological and psychological therapeutic interventions that need to focus on symptom reduction and on relapse prevention. Moreover, it offers the patient and therapist a psychoeducational context in which the individual's vulnerability and depressive symptoms can be treated. Finally, applications of the depression model as a therapeutic approach to severe depression in the phases of remoralization, symptom reduction, and relapse prevention are presented.     

Randomized trial of Internet-based relapse prevention for partially remitted depression

Holländare F, Johnsson S, Randestad M, Tillfors M, Carlbring P, Andersson G, Engström I. Randomized trial of Internet‐based relapse prevention for partially remitted depression. Objective: To investigate whether Internet‐based cognitive behaviour therapy (CBT) can prevent relapse in persons with partially remitted major depression after previous treatment. Method: Seventy‐one women and 13 men (N = 84) with partially remitted major depression after treatment were randomly assigned to either 10 weeks of Internet‐based CBT or to a control group. Self‐help material was used in combination with e‐mail contact with a personal therapist. Monthly self‐ratings of depressive symptoms were made, and diagnostic interviews were conducted before and after the treatment period, as well as 6 months later. Results: Significantly fewer participants in the CBT group experienced relapse (4/38 or 10.5%) compared with those in the control group (14/37 or 37.8%). The difference in relapse rates between groups occurred early in the study period and was still apparent after 6 months. A trend towards a larger reduction in depressive symptoms was observed at post‐treatment in the participants who received CBT compared with controls. Reduction in depressive symptoms reduced the risk of relapse. A trend towards a higher remission rate was found in the CBT group at the 6 month follow‐up. Conclusion: Internet‐based CBT seems promising in preventing relapse in persons with partially remitted major depression after previous treatment.     

Spinal reflex excitability and homosynaptic depression after a bout of whole-body vibration

Although whole-body vibration (WBV) affects neuromuscular performance, it remains unclear whether the effects are due to spinal reflex potentiation or inhibition, or differ between muscle groups. This study aimed to identify the effect of WBV on measures of spinal reflex excitability (H-reflex) and homosynaptic depression (HD) in the soleus (SOL) and medial gastrocnemius (MG) muscles. H-reflex and HD measurements were made in the SOL and MG muscle of 20 participants before and after a bout of WBV. H-reflex and HD were measured every 15 seconds for 10 minutes post-WBV and averaged at 1-minute increments. H-reflex amplitude was depressed for the first minute post-vibration, whereas the effect of HD was reduced for the first 2 minutes post-vibration. WBV significantly decreases spinal reflex excitability and HD, but it does so transiently and independent of muscle group.     

Cost-effectiveness of cognitive self-therapy in patients with depression and anxiety disorders

Objective: Self‐therapy interventions could potentially reduce healthcare expenses and the need for care in the treatment of depression and anxiety disorders. This study assessed the cost‐effectiveness of cognitive self‐therapy (CST) in patients with these disorders. Method: A total of 151 patients were randomly assigned to CST or treatment as usual (TAU), and followed during 18 months. The Symptom Checklist 90 (SCL‐90) was the primary outcome measure of the study. The reference year was 2003 (US$1.00 = €0.92). Results: Mean costs of patients in the CST group (US$4364) were lower than that of the patients who received TAU (US$5241). The results of the SCL‐90 were slightly in favour of CST. Valuing an additional unit of health outcome at US$108 will lead to an 83% probability that CST is cost‐effective. Conclusion: Cognitive self‐therapy appears to be cost‐effective. Wider implementation of CST may relieve the burden of many patients with emotional disorders whose treatment needs cannot be met in current healthcare systems.