Major depression, parental mental disorder and early family relationships

Sixty middle-aged urban women with a major depressive episode diagnosed in a community survey were compared with those 400 participants of the study who had no history of major depression. The study design is retrospective. The depressed women's parents had been in contact with psychiatric services twice as often as those of never depressed women. The rate of paternal alcoholism was however the same in both groups. As compared with the controls, women with major depression reported significantly more often frequent corporal punishment, poor relationship with mother, having been misunderstood by parents, and unhappy childhood.     

Social origins of major depression: the role of provoking agents and vulnerability factors

An examination of the Brown-Harris etiological model of depressive disorder was accomplished by analyzing data from a community study of 800 middle-aged urban Swedish women. The sample included 53 onset cases of major depressive episode (DMS-III) in a 1-year period. In the analysis, interaction was defined according to the additive model employed by Brown & Harris. Occurrence of provoking agents was not significantly related to onset of depressive episode. None of the four vulnerability factors of the model showed significant interaction with provoking agents as expected from the model. One of them, lack of intimacy, increased significantly the risk of major depression in its own right, i.e. in the absence of provoking agent. Possible explanations for the major discrepancies of results between the original Camberwell study and the present one are briefly discussed.     

Social representations of major depression in West and East Germany

Background: In a population survey that was carried out in 1990, differences between the former Federal Republic of Germany and the German Democratic Republic were observed with regard to the social representation of depression. Back then, we predicted that in a few years these differences would have reduced. To test this hypothesis, a second survey was conducted in 2001.Method: In 1990, a representative survey was carried out in both parts of Germany. A total of 3098 personal, fully structured interviews were completed, 2118 in West Germany and 980 in East Germany. The survey was repeated in 2001 using the same measures. This time, 5025 interviews were conducted, 4005 in West Germany and 1020 in East Germany.Results: While in 1990 there had been numerous differences between the two parts of Germany with regard to the social representation of depression, in 2001 most of these differences had disappeared. Lay concepts of depression held by interviewees from East Germany have assimilated to those held by interviewees from West Germany. In both parts of Germany, a marked change in favor of biological conceptualizations of depression was observable, with heredity and brain disease more frequently being seen as a cause in 2001.Conclusion: The hypothesis that the differences between lay concepts of depression that were prevalent in West and East Germany in 1990 would have reduced by 2001 was supported by our results. Our study shows that cultural processes, such as the process of acculturation that took place in Germany between 1990 and 2001, have an effect on the social representation of mental disorders.     

The relationship of social setting to major depression

ABSTRACT– Sixty middle-aged women with a major depressive episode diagnosed in a community survey were compared with those 400 participants of the study who had no history of major depression. The husbands income and the family income were lower in the depressed group even when adjustment was made for age and marital status. The depressives were more often divorced or widowed than were controls. As a direct consequence of this, women with major depression lived in smaller residences and were more seldom owners of a summerhouse. The proportions of women working full-time, part-time or not working outside home were the same in those with major depression and the controls. The level of adversity (life events and long-term major difficulties) during the year preceding the study was increased in the depressed group when adjustment was made for age, marital status and social class differences. A larger proportion of the depressed women reported marital and job dissatisfaction. Variables reflecting social isolation did not differ between groups. There were no differences between depressed and undepressed regarding churchgoing, but fewer of the former stated that they believed in God.     

Early parental loss and depression history: associations with recent life stress in major depressive disorder

Although exposure to early adversity and prior experiences with depression have both been associated with lower levels of precipitating life stress in depression, it is unclear whether these stress sensitization effects are similar for all types of stress or whether they are specific to stressors that may be particularly depressogenic, such as those involving interpersonal loss. To investigate this issue, we administered structured, interview-based measures of early adversity, depression history, and recent life stress to one hundred adults who were diagnosed with major depressive disorder. As predicted, individuals who experienced early parental loss or prolonged separation (i.e., lasting one year or longer) and persons with more lifetime episodes of depression became depressed following lower levels of life stress occurring in the etiologically-central time period of three months prior to onset of depression. Importantly, however, additional analyses revealed that these effects were unique to stressors involving interpersonal loss. These data highlight potential stressor-specific effects in stress sensitization and demonstrate for the first time that individuals exposed to early parental loss or separation, and persons with greater histories of MDD, may be selectively sensitized to stressors involving interpersonal loss.     

The relationship between childhood trauma history and the psychotic subtype of major depression

Gaudiano BA, Zimmerman M. The relationship between childhood trauma history and the psychotic subtype of major depression. Objective: Increasing evidence exists linking childhood trauma and primary psychotic disorders, but there is little research on patients with primary affective disorders with psychotic features. Method: The sample consisted of adult out‐patients diagnosed with major depressive disorder (MDD) at clinic intake using a structured clinical interview. Patients with MDD with (n = 32) vs. without psychotic features (n = 591) were compared as to their rates of different types of childhood trauma. Results: Psychotic MDD patients were significantly more likely to report histories of physical (OR = 2.81) or sexual abuse (OR = 2.75) compared with non‐psychotic MDD patients. These relationships remained after controlling for baseline differences. Within the subsample with comorbid post‐traumatic stress disorder, patients with psychotic MDD were significantly more likely to report childhood physical abuse (OR = 3.20). Conclusion: Results support and extend previous research by demonstrating that the relationship between childhood trauma and psychosis is found across diagnostic groups.     

Parental bonding and personality in relation to a lifetime history of depression

This study explores whether personality is mediating the effects of adverse parenting on having had a lifetime history of major depressive disorder and whether personality dimensions, related to the development of lifetime depression, are disposed by adverse parenting in cross-sectional data derived from an epidemiological sample of volunteer workers. Of 447 individuals who were asked to complete the Munich Personality Test (MPT), the Parental Bonding Instrument (PBI) and the Inventory to Diagnose Depression Lifetime version (IDDL), 322 subjects were included in the analyses (150 male and 172 female; and 38 were diagnosed as having had a history of depression). Comparisons in fit between logistic regression models revealed that a combination of frustration tolerance and rigidity among personality dimensions, as measured by the MPT, and maternal care among the PBI scales were most primary in predicting a lifetime history of depression. Maternal care was, however, not significantly predictive of dimensional scores on the personality dimensions. Neither frustration tolerance nor rigidity was predicted by any PBI scale. When entering the variables sequentially, maternal care and the personality variables were additive and independent risk factors in predicting a lifetime history of depression. The results of this preliminary study raised an objection to a hypothesis that adverse parenting experienced in childhood disposes one to a dysfunctional personality, which then predisposes one to the development of depression in adulthood.     

Sociopsychological factors relating to suicide prevention in a Japanese rural community: coping behaviors and attitudes toward depression and suicidal ideation

In response to the rise in suicide in Japan since 1998, some suicide prevention measures in local communities have been put into action. However, in the previous suicide prevention measures, sociopsychological factors were not fully taken into consideration. In the present study, the authors surveyed sociopsychological factors relating to suicide and depression (i.e. people's coping behavior and thoughts about depression and suicidal ideation, and their attitudes toward suicide and psychiatric treatment), and their differences in gender and generations. The present study was conducted in a rural area of Japan (Town A), where the suicide rate is much higher than the national average. The authors randomly selected 10% of the residents (i.e. 532 people) aged between 40 and 79 years on the basis of resident registration. Health promotion volunteers in Town A visited these 532 people individually, distributed questionnaires, and asked them to anonymously answer the questionnaire within 4 weeks. Data from 450 residents (193 men, 257 women) were analyzed in the present study. Although there were few gender differences, some significant differences were found between the younger (40-59 years) and older (60-79 years) residents. Generally, the younger were more pessimistic about their mental health than the elderly. It was also noteworthy that about 10% of the people thought that it was natural for them to have suicidal ideation, and about 18% reported that they had experienced suicidal ideation. Some suggestions were given to provide more effective suicide prevention measures.     

The TRH test in the diagnosis of major and minor depression

(1) The effect of TRH on TSH and GH release was studied in 144 consecutive psychiatric admissions. The magnitude of the TSH response to TRH differentiated unipolar from clinically similar and dissimilar groups. (2) Of 41 patients with unipolar depression, 31 had a ΔTSH of ≤7 μI.U./ml while only 1 of 12 bipolar and 0 of 10 minor depressive patients had a ΔTSH of ≤7 μI.U./ml. (3) A ΔTSH of ≤7 μI.U./ml is a frequent finding in unipolar depression and infrequently associated with other psychiatric diagnoses. (4) The data reported support the hypothesis that patients with a ΔTSH of ≤7 are unipolar depressives. (5) Six of 12 bipolar and 17 of 41 unipolar depressives had a GH response to TRH while none of the patients with a minor depression had a significant GH response. These data suggest that major and minor depressions can be separated on the basis of the TRH-induced GH response test. (6) The magnitude of the TRH-induced TSH response and the presence of a pathological GH response may be extremely useful in differentiating manics from schizophrenics and other similarly appearing patient groups. (7) The TRH test is useful in clinical differential diagnosis of dysphoric states and as a confirmatory laboratory test for major depressive disease and unipolar depression.     

The neuropsychological profile of psychotic major depression and its relation to cortisol.

BACKGROUND: Our study described the neuropsychological profile of psychotic major depression (PMD) compared to nonpsychotic major depression (NPMD) patients and psychiatrically healthy controls (HC). We predicted that higher cortisol levels would be associated with greater cognitive deficits. METHODS: Twenty-nine PMDs, 24 NPMDs, and 26 HCs were recruited at Stanford University Medical Center. Psychiatric ratings, cortisol levels from 1800-0900 hours, and neuropsychological test data were obtained. RESULTS: PMDs had more severe cognitive impairments compared with NPMDs and HCs with the exception of simple verbal attention. PMDs had elevated mean cortisol levels from 1800 to 0100 hours which were significantly correlated with poorer verbal memory and psychomotor speed performance. Cortisol slopes from 1800 to 0100 hours were also significantly correlated with verbal memory and working memory. CONCLUSIONS: While PMDs' ability to attend passively to information appears intact, they have more difficulty processing, manipulating, and encoding new information. Elevated cortisol levels, as seen in PMD patients, are associated with poorer cognitive performance especially related to verbal memory for lists of words and working memory.     

The prevalence of current major depression and dysthymia in a Norwegian general practice

Existing studies suggest that depression is underdiagnosed and undertreated in general practice, and that the known prevalence of this mood disorder in a primary care population may represent only the ‘tip of the iceberg'. A total of 100 consecutive patients in an average Norwegian general practice were tested, of whom 31 patients were diagnosed as having a depressive illness in this study; 28 patients were diagnosed as having current major depression and three as having dysthymia. In total, 21 of the 28 patients with current major depression presented with other symptoms as their major complaints at the consultation in which they were tested. Twelve of these 21 patients had some kind of pain problem.     

The relationship of DSM-III-R personality disorder to clinical variables in patients with major depression: Possible difference between personality disorder clusters

Abstract The relationship of DSM-III-R personality disorder (PD) to demographic and clinical variables was investigated based on 96 consecutive outpatients with major depression. No significant difference in the variables was found between those with and those without PD. Those with PD from each cluster were compared with those without PD in terms of the variables. In these comparisons many relationships of PD to the variables were found, and these relationships were different between the three PD clusters detailed in DSM-III-R. Patients with cluster B PD demonstrated a prominent uniqueness in his/her relationship to the variables. This uniqueness was similar to what had been reported previously with regard to patients with PD. There was no significant difference in the variables between those with cluster C PD and those without PD. Those with cluster A PD may have a negative family history of affective disorders.     

Cognitive function in late life depression: relationships to depression severity, cerebrovascular risk factors and processing speed.

BACKGROUND: A number of studies have examined clinical factors linked to worse neuropsychological performance in late life depression (LLD). To understand the influence of LLD on cognition, it is important to determine if deficits in a number of cognitive domains are relatively independent, or mediated by depression- related deficits in a basic domain such as processing speed. METHODS: Patients who met DSM-IV criteria for major depression (n = 155) were administered a comprehensive neuropsychological battery of tasks grouped into episodic memory, language, working memory, executive function, and processing speed domains. Multiple regression analyses were conducted to determine contributions of predictor variables to cognitive domains. RESULTS: Age, depression severity, education, race and vascular risk factors all made significant and independent contributions to one or more domains of cognitive function, with all five making independent contributions to processing speed. Age of onset made no independent contribution, after accounting for age and vascular risk factors. Of the five cognitive domains investigated, changes in processing speed were found to most fully mediate the influence of predictor variables on all other cognitive domains. CONCLUSIONS: While slowed processing speed appears to be the most core cognitive deficit in LLD, it was closely followed by executive function as a core cognitive deficit. Future research is needed to help clarify mechanisms leading to LLD- related changes in processing speed, including the potential role of white matter abnormalities.     

The role of parental psychopathology and family environment for social phobia in the first three decades of life

Background: To examine the role of parental psychopathology and family environment for the risk of social phobia (SP) in offspring from childhood to early adulthood, encompassing the high risk period for SP. Methods: A community sample of 1,395 adolescents was prospectively followed‐up over 10 years. Offspring and parental psychopathology were assessed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV) using the Munich Composite International Diagnostic Interview (M‐CIDI), and direct diagnostic interviews in parents were supplemented by family history reports. Parental rearing was assessed by the Questionnaire of Recalled Rearing Behavior administered to offspring. Family functioning was assessed by the McMaster Family Assessment Device administered to parents. Results: Parental SP was associated with offspring's risk to develop SP (OR=3.3, 95%CI:1.4–8.0). Other parental anxiety disorders (OR=2.9, 95%CI:1.4–6.1), depression (OR=2.6, 95%CI:1.2–5.4), and alcohol use disorders (OR=2.8, 95%CI:1.3–6.1) were also associated with offspring SP. Parental rearing styles of overprotection, rejection, and lack of emotional warmth were associated with offspring SP. Family functioning measures were not associated with offspring SP. Analyses of interaction of parental psychopathology and parental rearing indicated combined effects on the risk for offspring SP. Conclusions: Parental psychopathology and rearing were associated with offspring SP, independently as well as in their interaction. Further delineation of these associations is warranted as malleable components of these risk factors may provide potential targets for prevention programs. In addition, parent‐to‐offspring transmission of other internalizing disorders should be considered to examine the degree of diagnostic specificity. Depression and Anxiety, 2009. © 2008 Wiley‐Liss, Inc.     

Environment and vulnerability to major psychiatric illness: a case control study of early parental loss in major depression, bipolar disorder and schizophrenia

The current focus on identifying genes which predispose to psychiatric illness sharpens the need to identify environmental factors which interact with genetic predisposition and thus contribute to the multifactorial causation of these disorders. One such factor may be early parental loss (EPL). The putative relationship between early environmental stressors such as parental loss and psychopathology in adult life has intrigued psychiatrists for most of this century. We report a case control study in which rates of EPL, due to parental death or permanent separation before the age of 17 years were evaluated in patients with major depression (MD), bipolar disorder (BPD) and schizophrenia (SCZ), compared to individually matched, healthy control subjects (MD-Control, 79 pairs; BPD-Control, 79 pairs; SCZ-Control, 76 pairs). Loss of parent during childhood significantly increased the likelihood of developing MD during adult life (OR=3.8, P=0.001). The effect of loss due to permanent separation (P=0.008) was more striking than loss due to death, as was loss before the age of 9 years (OR=11.0, P=0.003) compared to later childhood and adolescence. The overall rate of EPL was also increased in BPD (OR=2.6, P=0.048) but there were no significant findings in any of the subcategories of loss. A significantly increased rate of EPL was observed in schizophrenia patients (OR=3.8, P=0.01), particularly before the age of 9 years (OR=4.3, P=0.01). Comparison of psychosocial, medical and clinical characteristics of subjects with and without a history of EPL, within the larger patient groups from which the matched samples were drawn (MD, n=136; BPD, n=107; SCZ, n=160), yielded few significant findings. Among the controls (n=170), however, subjects who had experienced EPL, reported lower incomes, had been divorced more frequently, were more likely to be living alone, were more likely to smoke or have smoked cigarettes and reported more physical illness (P=0.03-0.001). Long term neurobiological consequences of early environmental stressors such as maternal deprivation have been extensively studied in many animal species. Recently, enduring changes in hypothalamic-pituitary-adrenal axis function, including corticotrophin releasing factor gene expression, have received particular attention. Analogous processes may be implicated in the effect of EPL on human vulnerability to psychopathology, via alterations in responsiveness to stress. Genetic predisposition may influence the degree of susceptibility of the individual to the effects of early environmental stress and may also determine the psychopathological entity to which the individual is rendered vulnerable as a consequence of the stress.