Comparison of clinical characteristics of opium-induced and independent major depressive disorder

Psychiatric disorders and among them depression are common in substance dependent patients. The aim of this study is to compare the clinical characteristics of those that appear to have substance-induced depression and those that have independent major depression. One-hundred eighty-four independent and 187 opium-induced (OID) depressed male patients that met the DSM-IV criteria for major depressive disorder were randomly selected. Standard demographic data, including age, marital, employment and education status, were collected. The primary measure of depressive signs and symptoms was Hamilton Depression Scale (HAMD-21). The two groups were compared with each other for the HAMD total and subscales scores. The two groups were matched regarding age, educational level and marital status. Opium-induced depressed patients were more severely depressed and motor retarded and also they had more social and occupational problems. Gastrointestinal, sexual and somatic complaints were more common among them too. MDD patients had better insight than the other group. The results demonstrate that it is possible to differentiate between substance-induced and independent depression. Such differentiation might be important for establishing prognosis and optimal treatment.     

The significance of nonmarital cohabitation: marital status and mental health benefits among middle-aged and older adults

OBJECTIVES: According to the 2000 Census, about 1.2 million persons over age 50 are currently cohabiting. Do these unmarried cohabiting partnerships provide adults with mental health benefits that are similar to those enjoyed by marrieds? We extended prior work on marital status and depression by including cohabitation in our conceptualization of marital status. METHODS: We used data from the 1998 Health and Retirement Study (N = 18,598) to examine the relationship between marital status and depressive symptoms among adults over age 50. We also examined gender differences in this association. RESULTS: We found that cohabitors report more depressive symptoms, on average, than do marrieds, net of economic resources, social support, and physical health. Additional analyses revealed that only among men do cohabitors report significantly higher depression scores. Cohabiting and married women as well as cohabiting men experience similar levels of depression, and all of these groups report levels that are significantly higher than married men's. DISCUSSION: Our findings demonstrate the importance of accounting for nontraditional living arrangements among persons aged 50 and older. Cohabitation appears to be more consequential for men's than women's depressive symptoms.     

Depression in elderly hospitalized patients with medical illness

Depressive symptoms and disorders were identified by structured psychiatric interview in 130 consecutively admitted male inpatients aged 70 years and over. Major depression was found in 11.5% and other depressive syndromes in 23%. While depressive symptoms and syndromes are common among the medically ill, this study demonstrated the need for careful diagnostic assessment of older patients with depressive symptoms before initiating treatment that may itself convey significant risk. Sociodemographic and health characteristics of older men at higher risk for depression were also identified. Patients more likely to be depressed were over age 75 years, had less formal education, experienced cognitive dysfunction, suffered from more severe medical illness (particularly recent myocardial infarction), and had a history of psychiatric illness. Depressive symptoms were also common among patients with renal or neurologic diseases, those having a family history of psychiatric illness, the unmarried, and the more severely disabled. Given the impact of depression on recovery from medical illness, compliance with medical therapy, and costs of extended hospital stays, detection and treatment of this disorder are imperative.     

Family functioning and social support for older patients with depression in an urban area of Shanghai,China

PurposeGeriatric depression is now very common and leads to significant economic costs and family burden in China. Families with a depressed patient often report problematic family functioning in Western samples, and lack of social support is strongly associated with geriatric depression. However, the relationship between geriatric depression, family functioning and social support in mainland China has not been well studied.Materials and methodsThis study compared family functioning and social support in a Chinese sample of elderly patients with major depression and non-depressed elderly people, and evaluated the impact of family functioning, social support and socio-demographic factors on depression. A questionnaire was administered to 102 elderly patients with major depression and 107 non-depressed elderly people.ResultsThe elderly patients with major depression had worse family functioning and lower social support than elderly individuals without depression. Multivariate linear regression analysis showed associations between depressive symptoms and unhealthy family functioning, lower social support and single marital status.ConclusionsThe findings suggest that family interventions and improvement of social support are important in reducing depression among elderly patients. In addition, strategies to alleviate geriatric depression should be considered by the whole society, the community, family members and the depressed elderly patients themselves.     

Using addiction severity profiles to differentiate cocaine-dependent patients with and without comorbid major depression

This study compared pretreatment addiction severity profiles of 339 abusers in three diagnostic groups: cocaine dependence only (CO), cocaine dependence with substance-induced major depression (SIMD), and cocaine dependence with independent major depression (IMD). Depressed subjects reported more severe problems than non-depressed subjects across numerous domains, regardless of diagnostic etiology. These findings support the need for specialized treatment approaches targeting depressive symptoms or life stress for cocaine-dependent patients with IMD or SIMD, though patients with IMD may require additional attention for chronic and comorbid psychiatric and medical problems.     

Symptoms of depression and anxiety in Serbian patients with systemic sclerosis: impact of disease severity and socioeconomic factors

This study aimed to assess symptoms of depression and anxiety in Serbian patients with systemic sclerosis (SSc) and to estimate the impact of disease severity and socioeconomic factors on development of depression and anxiety in SSc. Thirty-five patients with SSc and 30 age- and gender-matched healthy individuals participated. Symptoms of depression and anxiety were evaluated using the Beck’s depression inventory and Zung’s anxiety self-assessment scale. We estimated the impact of gender, age, economic status, marital status, disease duration, disease subset (limited or diffuse), and some clinical features on development of depressive symptoms and anxiety in patients with SSc. Symptoms of depression were found in 68.6% of patients (compared with 23.3% in the control group), were more frequent in patients with longer disease duration and in female and older patients, and were more common in unemployed and retired patients than in employed individuals. No differences in anxiety and depressive symptoms was noticed between patients with limited and diffuse SSc or those with or without restrictive lung disease, pulmonary hypertension, finger-tip ulcers, and heart involvement. Symptoms of depression were associated with severe pain. Symptoms of anxiety were found in 80% of patients compared with 13.3% of healthy individuals and were equally as frequent in patients of different gender, age, socioeconomic status, and disease duration and severity. Symptoms of depression and anxiety are common in Serbian patients with SSc. Depressive symptoms depended mostly on socioeconomic factors, disease duration, and pain intensity, whereas disease severity had no significant impact on development of depressive symptoms and anxiety.     

新型冠状病毒肺炎疫情下医养结合养老机构内工作人员心理健康状况及其影响因素

目的了解新型冠状病毒肺炎(COVID-19)疫情流行期间烟台市医养结合养老机构工作人员心理状况及相关影响因素。方法通过微信发送调查问卷的方式对烟台地区医养结合养老机构工作人员进行心理状况调查,包括一般资料问卷、焦虑自评量表(SAS)、抑郁自评量表(SDS)并分析抑郁焦虑的影响因素。采用SPSS 22.0统计软件进行分析。组间比较采用非参数检验。采用logistic逐步回归法分析疫情下影响工作人员焦虑或抑郁的危险因素。结果本次参加调查人员中,有焦虑者共15例(6.4%),其中轻度焦虑10例,中度焦虑4例,重度焦虑1例。有抑郁者共37例(15.8%),其中轻度抑郁23例,中度抑郁13例,重度抑郁1例。医养结合养老机构工作人员中,性别、学历、职称、职业等因素对SAS、SDS评分影响较小,差异无统计学意义(P>0.05)。年龄、工作年限、婚姻状况、抑郁严重程度对SAS评分有影响,差异有统计学意义(P<0.05);年龄、婚姻状况、焦虑严重程度对SDS评分有影响,差异有统计学意义(P<0.05)。logistic回归分析显示,抑郁是发生焦虑的独立影响因素(B=3.435,OR=31.040;P<0.001),焦虑是发生抑郁的独立影响因素(B=3.269,OR=26.272;P<0.001),而性别、年龄、学历、婚姻状况、职称、职业、工作年限等与两者均无相关性(P>0.05)。结论医养结合养老机构工作人员中,抑郁、焦虑情绪存在相互影响,应给予该部分群体早期、适当的心理干预。     

Symptoms of Major Depression and Tricyclic Side Effects in Primary Care Patients

OBJECTIVE: To examine the prevalence and course of symptoms resembling side effects of tricyclic antidepressants among primary care patients experiencing major depression and receiving nortriptyline pharmacotherapy. DESIGN: Prospective cohort study. PATIENTS: Seventy-five patients meeting DSM-III-R criteria for a current major depression. SETTING: Four Pittsburgh (Pa.) ambulatory health centers affiliated with residency programs. MEASUREMENTS AND MAIN RESULTS: Symptoms resembling tricyclic side effects were assessed at baseline and at monthly intervals using the Somatic Symptoms Checklist. The Hamilton Rating Scale for Depression and Diagnostic Interview Schedule were used to assess depressive severity and history of generalized anxiety or panic disorder, respectively. Symptoms resembling tricyclic side effects, including thirst (54%), palpitations (51%), and dry mouth (48%), were commonly experienced before commencing pharmacotherapy. Patients with severe depressive episodes and those with a history of an anxiety or panic disorder had significantly more physical symptoms than those with milder episodes of depression and were more likely to drop out of care (n = 25) before completing the acute phase of pharmacotherapy. Patients who completed the acute phase of pharmacotherapy and those who entered its continuation phase (n = 43) experienced significant reductions in many depressive and physical symptoms (p < .001). CONCLUSIONS: Symptoms resembling tricyclic side effects are common among depressed primary care patients before beginning pharmacotherapy and generally remit with the depressive episode. Better awareness of major depression's somatic effects and the consequences of therapy could result in better management of both physicians' and patents' expectations regarding antidepressant pharmacotherapy.     

Depression predicts higher rates of heroin use on desipramine with buprenorphine than with methadone

The effect of lifetime depression was examined in a randomized clinical trial in 164 opioid- and cocaine-dependent patients who were treated with desipramine in combination with either methadone or buprenorphine. We examined treatment retention, illicit opioid and cocaine use, and depressive symptoms, and found that opioid-free urines at baseline, but not later in treatment, were greater among the depressed than non-depressed patients. Among the depressed patients, depressive symptoms at baseline, but not later in treatment, were greater in patients treated with buprenorphine than methadone. Desipramine did not reduce depressive symptoms more than placebo. Finally, the depressed patients treated with desipramine and buprenorphine showed the least improvement in opioid-free urines, while the non-depressed patients treated with desipramine and methadone had more opioid-free urines than those patients treated with placebo desipramine. Cocaine-free urines showed no association with depression. This poor outcome with desipramine and buprenorphine suggests that this medication combination is not indicated in depressed opioid-dependent patients.     

Patient ethnicity and the identification and active management of depression in late life

BACKGROUND: Black Americans are more likely to obtain mental health care from a primary care physician than from a mental health specialist. We investigated the association of ethnicity with the identification and active management of depression among older patients. METHODS: Cross-sectional survey of 355 older adults with and without significant depressive symptoms. At the index visit, the physician's ratings of depression and reports of active management were obtained on 341 of the 355 patients who completed in-home interviews. RESULTS: Older black patients were less likely than older white patients to be identified as depressed (unadjusted odds ratio [OR], 0.40; 95% confidence interval [CI], 0.25-0.63) and their depression was less likely to be actively managed in the 6 months before the interview (unadjusted OR, 0.63; 95% CI, 0.19-2.16). In multivariate models that controlled for potentially influential characteristics such as patient age, sex, marital status, level of education, functional status, physical health, severity of depressive symptoms, severity of anxiety symptoms, attitudes about depression, number of office visits in the last 6 months, and the physician's rating of how well they knew the patient, the associations of identification (OR, 0.25; 95% CI, 0.17-0.39) and management (OR, 0.57; 95% CI, 0.19-1.77) with patient ethnicity remained substantially unchanged. CONCLUSION: Our study calls attention to the role ethnicity may play in the identification and active management of depression among older primary care patients.     

接受肝移植患者术前焦虑抑郁情绪分析

目的 调查接受体外肝移植患者术前焦虑和抑郁情绪发生率,分析其发生的相关影响因素。方法 采用横断面调查设计和抽样的方法,研究2011年5月～2016年4月在我院接受肝移植患者72例,另选择同期健康体检者72例,采用焦虑自评量表（SAS）和抑郁自评量表（SDS）调查两组人群情绪变化,分别对人口社会学特征和焦虑或抑郁情绪进行调查和评定,应用二分类Logistic逐步回归分析影响因素。结果 接受肝移植的患者焦虑与抑郁评分分别为（46.40±5.30）分和（48.25±4.14）分,焦虑发生率为30.6%,抑郁发生率为43.1%,均明显高于健康人的（29.45±6.34）分、（28.13±5.42）分、5.6%和8.3%（P<0.05）;二分类Logistic逐步回归分析结果显示年龄、受教育程度、家庭月收入和婚姻状况为导致接受肝移植患者焦虑和抑郁情绪发生的主要独立危险因素（P<0.05）。结论 接受肝移植患者术前焦虑和抑郁情绪比较严重,多与患者的年龄、受教育程度、家庭月收入和婚姻状况有关,要积极进行对症护理和干预。     

Gender Differences in Depressive Symptoms Among Older People Living in the Community

Objective: To study gender differences in depressive symptoms among older people. Method: Data obtained from a study of 533 women and 467 men aged 65 and over living independently in Melbourne were analysed to explore any gender differences in depressive symptoms. Results: There is a low prevalence of depressive symptoms among both older men and women living in the community, with a slightly higher prevalence among women. However, women were twice as likely as men to report sufficient symptoms to be classified as depressed. This gender difference was not explained by age, but was fully accounted for by either IADL dependency or marital status. In turn, widows were more likely to be classified as depressed because they were more often lonely. Conclusions: Women are more likely than men to be classified as depressed in community surveys of older people because they are more likely to experience an IADL dependency and because they are more likely as widows to experience loneliness.     

Determinants of Depressive Symptoms Among Japanese Elders Receiving Care from Spouses,Daughters and Daughters-in-Law

Abstract

This study examined determinants of self-reported depressive symptoms among 96 community-dwelling Japanese elders who received care from their spouses, daughters and daughters-in-law. Respondents were recruited from day treatment programs at respite care facilities in northwestern Japan and administered the Geriatric Depression Scale (GDS). Close to 60% of the respondents were mildly depressed. Moderate to severe depression was more common among elders who received care from their spouses than from those who received care from their daughters or daughters-in-law. Regressed with age, health status, ADL impairment, care-receiving stress, coping styles, and characteristics of the caregiver (kin relationship), depression was found associated with age, poor health, care-receiving stress, and passive coping. Caregiver characteristics were not significant in the regression model, suggesting that the quality of the caring relationship was a more important factor than the type of kin relationship.     

The importance of subsyndromal depression in older primary care patients: prevalence and associated functional disability.

OBJECTIVE: Existing diagnostic categories for depression may not encompass the majority of older people suffering clinically significant depressive symptoms. We have described the prevalence of subsyndromal depressive symptoms and tested the hypothesis that patients with subsyndromal depression have greater functional disability and general medical burden than nondepressed subjects but less than patients with diagnosable depressions. METHODS: Subjects were 224 patients, aged 60 years and older, recruited from private internal medicine offices or a family medicine clinic. Validated measures of psychopathology, medical burden, and functional status were used. The subsyndromal depression group was defined by a score of more than 10 on the Hamilton Rating Scale for Depression and by the absence of major or minor depressive disorder. Analyses included multiple regression techniques to determine the presence of group differences adjusted for demographic covariates. RESULTS: Subsyndromal depression was common (estimated point prevalence of 9.9% compared with 6.5% for major depression, 5.2% for minor depression, and .9% for dysthymic disorder), associated with functional disability and medical comorbidity to a degree similar to major or minor depression, and often treated with antidepressant medications. CONCLUSIONS: Although depressive conditions are common and are associated with considerable functional and medical morbidity in older primary care patients, many patients with clinically significant depressive symptoms are not captured by criteria-based syndromic diagnostic categories. Future work should include intervention studies of subsyndromally depressed older persons as well as attention to the course and biopsychosocial concomitants of diagnosable and subsyndromal depressions in this population.     

Thyroid and adrenal axis in major depression: a controlled study in outpatients

OBJECTIVE: Major depressive disorder has been associated with changes in the hypothalamus-pituitary-thyroid (HPT) axis and with hypercortisolism. However, the changes reported have been at variance, probably related to in- or outpatient status, the use of antidepressant medication and the heterogeneity of depression. We therefore conducted a controlled study in unipolar depressed outpatients who had been free of antidepressants for at least 3 months. DESIGN: We assessed endocrine parameters in 113 depressed outpatients and in 113 sex- and age-matched controls. METHODS: Patients were included if they had a major depression according to a Structural Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM), fourth edition (SCID-IV) and if they had a 17-item Hamilton rating scale for depression (HRSD) score of > or =16. Endocrine parameters contained serum concentrations of TSH, (free) thyroxine, tri-iodothyronine, cortisol, thyroid peroxidase (TPO) antibody titre and 24-h urinary excretion of cortisol. RESULTS: The serum concentration of TSH was slightly higher in depressed patients as compared with controls (P < 0.001), independent of the presence of subclinical hypothyroidism and/or TPO antibodies (n = 28). All other HPT axis parameters were similar in both groups. The 24-h urinary cortisol excretion was similar in patients and controls. In atypical depression, serum cortisol was lower than in non-atypical depression (P = 0.01). Patients with neither melancholic depression nor severe depression (HRSD > or =23) had altered endocrine parameters. Finally, serum TSH values could not be related to cortisol values. CONCLUSION: When compared with matched control subjects, outpatients with major depression had slightly higher serum TSH, while urinary cortisol levels were similar. Furthermore, we observed lower serum cortisol in atypical depression than in non-atypical depression.     

The 24-hour profile of adrenocorticotropin and cortisol in major depressive illness

The 24-h profile of plasma ACTH and cortisol levels was determined in 18 men suffering from major depressive illness (8 with unipolar depression and 10 with bipolar depression) as well as in 7 age-matched normal men. Blood was sampled every 15 min. The circadian variation and episodic fluctuations were analyzed for each individual profile. Both unipolar and bipolar depressed patients had higher 24-h mean cortisol levels (P less than 0.01) than normal men, but no significant difference in 24-h mean ACTH level was found. The nadir of cortisol secretion occurred almost 3 h earlier in older normal subjects and patients with unipolar depression, regardless of age, than in younger normal subjects. This shift paralleled a similar advance of the ACTH nadir. Early timing of the quiescent period of ACTH-cortisol secretion was also found in several patients with bipolar depression, but did not reach significance at the group level. The hypercortisolism in the depressed patients was associated with an increase in the magnitude, but not the number, of cortisol secretory episodes. About 90% of the cortisol pulses could be related to a concomitant ACTH pulse in normal subjects as well as in both groups of depressed patients. However, concomitant ACTH and cortisol pulses were less correlated in magnitude in depressed patients than in normal subjects. These results indicate that major depressive illness is associated with disturbances of pituitary-adrenal function. The early timing of the nadir of ACTH-cortisol secretion suggests that disorders of circadian time keeping may characterize major endogenous depression.     

Moderators of the effect of social support on depressive symptoms in cardiac patients

Social support and depression have been shown to affect the prognosis of coronary patients, and social support has been found to influence depression in community and patient samples. We investigated the characteristics of coronary patients whose depressive symptomatology was most likely to improve with social support. We predicted that social support would be most beneficial for the most severely depressed, the old, the poor, the most severely ill, and those with poor functional status. Patients (n = 590) with documented coronary artery disease were assessed for depressive symptoms, social support, and functional status while in hospital. They were reassessed for depression 1 month later during a home visit. Depression scores were lower at follow-up (p = 0.001), and improvement was more marked among those reporting more support (p <0.001). The social support effect was strongest among those with high levels of depression at baseline (p <0.001) and those with lower income (p = 0.01). Unexpectedly, social support was more strongly associated with improvement in younger patients (p = 0.01). Social support did not interact with gender, disease severity, or functional status. These findings are partially consistent with the notion that social support is most effective for those who are most vulnerable and/or have few coping resources. These findings also have implications for the design and interpretation of psychosocial interventions.     

Gender,depression, and ankylosing spondylitis

Depression has been established as a common reaction to rheumatoid arthritis but has rarely beeninvestigated among people with other forms of arthritis. The present study examined the prevalence and determinants of depressive symptoms in people with ankylosing spondylitis, focusing on gender differences and set in the context of widely held medical views concerning the psychosocial nature of ankylosing spondylitis patients. Results showed that approximately one third of the ankylosing spondylitis patients reported a high level of depressive symptoms and that women reported more depression than men. No evidence was found to support the stereotype of the “typical” ankylosing spondylitis patient as being less depressed than people with other forms of arthritis. Pain was found to be a major determinant of depression for women, but was of lesser importance for men. The implications of these findings are discussed.     

Are preoperative depressive symptoms associated with postoperative delirium in geriatric surgical patients?

BACKGROUND: Delirium is common in older surgical patients and predicts negative health outcomes. Whether depressive symptoms are prevalent and predict the development of postoperative delirium in elderly surgical patients has not been investigated. Our study aimed to examine the prevalence and prognostic importance of preoperative depressive symptoms in older surgical patients. METHODS: Patients at least 65 years of age who were scheduled for major noncardiac surgery were recruited. Preoperatively, patients were screened for symptoms of depression using the 15-point Geriatric Depression Scale (GDS). Postoperative delirium was measured using the Confusion Assessment Method. The associations between covariates and preoperative depression, and postoperative delirium were determined by multivariate logistic regression. RESULTS: In the 219 patients studied, the mean age was 73.6 +/- 6 years, 12% of patients reported six or more depressive symptoms, and 32% reported three to five depressive symptoms. By multivariate logistic regression, patient characteristics associated with six or more symptoms of depression included <12 years of education, moderate to severe limitation in functional status, and drinking more than two alcoholic beverages per day. Postoperatively, 46% of patients developed delirium. Patients with a greater number of preoperative depressive symptoms were more likely to develop postoperative delirium (p =.048) and experience a longer duration of postoperative delirium (p =.027). Even after adjusting for covariates associated with depression and postoperative delirium--including age, educational level, functional status, and preoperative alcohol use--patients with more than six preoperative depressive symptoms were still significantly more likely to have a longer duration of postoperative delirium than did those patients with fewer than two depressive symptoms (odds ratio = 2.69, confidence interval = 1.04-6.93). CONCLUSION: Preoperative screening for the presence of depressive symptoms can be performed easily in elderly patients, and yields useful prognostic information relating to postoperative delirium.     

Symptoms of depression in old people in Finland

The study describes common symptoms of depression and age and sex differences in these symptoms in elderly Finns. The symptoms were assessed on the basis of the 22-item Hamilton Rating Scale for Depression (HRSD), and comparisons were made between the symptoms of those diagnosed as depressed and those diagnosed as not depressed in clinical investigations. The most common symptoms in depressed men were general somatic symptoms, initial insomnia, loss of interest in work and activities, middle insomnia, and depressed mood. In depressed women, the most common symptoms were psychic anxiety, general somatic symptoms, initial insomnia, loss of interest in work and activities, and depressed mood. In both these groups the lowest occurrences were found for compulsory symptoms, paranoid symptoms and depersonalization. The symptomatology was most severe in the oldest age group: depressed mood and many somatic symptoms were more common in depressed older male and female age groups than in younger groups. Sex comparisons showed that many symptoms were more severe in depressed women than in depressed men: depressed mood, feelings of guilt, psychic anxiety, somatic anxiety and diurnal variation of symptoms were more common in depressed women. Retardation was the only symptom that was more common in depressed men. Loss of libido did not belong to the symptomatology of depression in the oldest female age group, but in men and in younger female age group it could in some cases indicate occurrence of depression.