Diagnosing depression in the medically ill: validity of a lay-administered structured diagnostic interview

Understanding the validity of structured psychiatric diagnostic interviews in medically ill patients will advance the ability to conduct research into the treatment and management of these disorders in general medical settings. We compared the University of Michigan version of the CIDI Fulop et al., 1987 (Composite International Diagnostic Interview) for major depression to a clinical gold standard, derived through Spitzers Longitudinal, Expert, All Data Fulop et al., 1987 (LEAD) criteria based on the SCID-III-R. A convenience sample of medical inpatients was administered the SCID-III-R and the CIDI for major depression in random order. A physician panel reviewed the SCID interview and other pertinent data and determined whether patients had a lifetime or current Fulop et al., 1987 (past month) diagnosis of major depression. The CIDI was scored with and without hierarchical exclusions for mania, hypomania, substance use, or medical illness. When the UM-CIDI was scored for a lifetime diagnosis of major depression without hierarchical exclusions, agreement above chance Fulop et al., 1987 (κ) was very good Fulop et al., 1987 (κ=0.67) between the CIDI and the physician panel and good Fulop et al., 1987 (κ=0.46) when the UM-CIDI was scored with exclusions. Agreement above chance for diagnosis of a recent disorder was better for UM-CIDI scoring with exclusions Fulop et al., 1987 (κ=0.51) compared to scoring without exclusions Fulop et al., 1987 (κ=0.43). Predictive value-positive was excellent in both scoring versions for a lifetime diagnosis Fulop et al., 1987 (82%) and good to very good for current depression Fulop et al., 1987 (46% and 62%). In all cases predictive value-negative was very good to excellent (77–93%). Discordant cases were almost uniformly due to difficulties in attribution of symptoms to medical illnesses. We conclude that the CIDI can perform acceptably as a research instrument to diagnose major depression in medically ill patients, potentially supplemented by clinician review of cases identified by the CIDI with current disorder.     

Treatment validity of different diagnostic concepts of depression

This study evaluates the comparative treatment validity of four different but overlapping sets of criteria for the diagnosis of depression: the St. Louis, New York, Texas Actuarial, and Composite criteria. Results revealed that none of the criteria offered predictive strength or demonstrated particular advantages over the others. Patients excluded by each of the various criteria tended to do as well as those included; a small percentage of patients included by each of the criteria were nonresponders to drug therapy. Once a clinical and psychometric diagnosis was established, then no additional (short-term) prognostic information was gained by further scrutiny with the various research diagnostic criteria examined.     

High-end specificity of the children's depression inventory in a sample of anxiety-disordered youth

Using a receiver operating characteristic (ROC) analysis, the present study investigated the ability of the Children's Depression Inventory (CDI) to correctly detect depression in a sample of treatment-seeking anxious youth (N=44). The ADIS-C/P was used to determine diagnostic status of participants. Anxious children who met diagnostic criteria for a depressive disorder scored higher on the CDI than anxious children who did not meet criteria for a depressive disorder, supporting the CDI as a continuous measure of depressive symptomatology. In contrast, with regard to detecting a depressive disorder, CDI cut scores did not achieve favorable values across diagnostic utility indices (including the cut score of 13 that has been recommended). These findings support the CDI as a continuous measure of depressive symptoms, but do not support the CDI as a sole assessment for a diagnosis of depression within a sample of anxiety-disordered youth.     

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.     

The protective role of friendship on the effects of childhood abuse and depression

Background: This study explored the relationships between childhood maltreatment (sexual, physical, and emotional abuse, as well as neglect), adult depression, and perceived social support from family and friends. Methods: As part of an NIH‐funded study of risk and resilience at a public urban hospital in Atlanta, 378 men and women recruited from the primary care and obstetrics gynecology clinic waiting areas answered questions about developmental history, traumatic experiences, current relationship support, and depressive symptoms. Results: Childhood emotional abuse and neglect proved more predictive of adult depression than childhood sexual or physical abuse. In females only, perceived friend social support protected against adult depression even after accounting for the contributions of both emotional abuse and neglect. Conclusions: These findings may elucidate the particular importance of understanding the effects that emotional abuse and neglect have on adult depression, and how perceived friendship support may provide a buffer for women with a history of early life stress who are at risk to develop adult depression. Depression and Anxiety, 2009. Published 2008 Wiley‐Liss, Inc.     

Interrelationship of childhood trauma, neuroticism, and depressive phenotype

Both childhood trauma (CT) and genetic factors contribute to the pathophysiology of depression. We studied the relationship of CT to age of onset (AO) of depression, personality traits, and expression of symptom dimensions in 324 adults with recurrent unipolar depression. Subjects received structured psychiatric interviews and completed CT, depressive symptom, and personality rating questionnaires. Experience of at least one type of trauma was reported by 79.9% of subjects, and the most common forms of trauma were physical neglect, emotional abuse, and emotional neglect. There was an earlier AO of depression in the groups that reported CT compared to those that reported none, with earliest AO occurring in those who had experienced the highest levels of CT. There were no significant correlations between overall CT scores and neuroticism or extraversion. Total CT was a significant (P=.008) predictor of the Mood symptom dimension, mostly accounted for by emotional abuse (P=.019), and physical neglect predicted the Anxiety symptom dimension (P=.002). All types of CT are commonly reported in individuals with depression, and emotional abuse and physical neglect, though previously less well identified, appear to have an important role in the pathogenesis of depressive disorders. The effect of CT on individuals with an underlying genetic vulnerability to depression may result in differences in depressive phenotype characterized by earlier AO of depression and the expression of specific depressive symptom dimensions.     

抑郁性神经症和重性抑郁症的临床特征差异比较分析

目的：比较抑郁性神经症（ND）和重性抑郁症（MD）的临床特征的差异。方法：对符合CCMD－2－R诊断标准的30例ND和32例MD进行 对照分析。结果：两组患者在起病年龄、发病诱因、内向性格、阳性家族史、用药及转归方面均无显著性差异，在临床症状上的差异也仅表现在严重程度上。结论：ND具有心境障碍的性质。作者认为ND的分类学位置值得重新考虑。     

Two different putative genetic animal models of childhood depression.

BACKGROUND: In an attempt to model childhood depression, we examined whether existing genetic animal models of depression in adult rats are also valid in prepubertal rats. METHODS: Two different "depressed" rat lines were studied: the Flinders Sensitive Line (FSL) and their controls, Sprague-Dawley (SD); and the Wistar Kyoto (WKY) line and their controls, Wistar. We hypothesized that male prepubertal FSL and WKY rats would show increased swim test immobility and different patterns of social play and of basal plasma levels of corticosterone and adrenocorticotropic hormone (ACTH) compared with control rats. RESULTS: Prepubertal FSL and WKY rats exhibited significantly longer duration of immobility than control rats in the swim test. The FSL rats demonstrated significantly higher levels of social play behaviors and lower levels of corticosterone and ACTH compared with SD control rats, whereas WKY rats demonstrated significantly lower levels of social play behaviors and higher plasma levels of corticosterone and ACTH compared with Wistar control rats. CONCLUSIONS: The results might suggest that prepubertal FSL and WKY rats are both putative genetic animal models of childhood depression, exhibiting separate patterns and symptoms of childhood depression.     

Preschool sleep and depression interact to predict gray matter volume trajectories across late childhood to adolescence

There is a close relationship between sleep and depression, and certain maladaptive outcomes of sleep problems may only be apparent in individuals with heightened levels of depression. In a sample enriched for preschool depression, we examined how sleep and depression in early childhood interact to predict later trajectories of gray matter volume. Participants (N = 161) were recruited and assessed during preschool (ages 3–6 years) and were later assessed with five waves of structural brain imaging, spanning from late childhood to adolescence. Sleep and depression were assessed using a semi-structured parent interview when the children were preschool-aged, and total gray matter volume was calculated at each scan wave. Although sleep disturbances alone did not predict gray matter volume/trajectories, preschool sleep and depression symptoms interacted to predict later total gray matter volume and the trajectory of decline in total gray matter volume. Sleep disturbances in the form of longer sleep onset latencies, increased irregularity in the child’s sleep schedule, and higher levels of daytime sleepiness in early childhood were all found to interact with early childhood depression severity to predict later trajectories of cortical gray matter volume. Findings provide evidence of the interactive effects of preschool sleep and depression symptoms on later neurodevelopment.     

不同时段脑卒中后抑郁的药物干预治疗对比研究

目的使用HAMD、MoCA、SAS和NIHSS四项量表综合评价脑卒中后72 h、1和2月发生脑卒中后抑郁(post-stroke depression,PSD)患者的抗抑郁药物干预效果,为不同时段的PSD药物干预提供临床研究依据。方法入选脑卒中病例223例,于脑卒中后72 h予HAMD评分,≥8分者随机分为72 h对照组和72 h治疗组;余患者于脑卒中后1月再次予HAMD评分,评分≥8分者随机分为1月对照组、1月治疗组;余患者于脑卒中后2月再次予HAMD评分,评分≥8分者同前再随机分为2月对照组、2月治疗组;各组均予常规药物及相同的康复治疗方案,治疗组加用帕罗西汀20 mg/d治疗。对以上各组病例于脑卒中后3个月随访,进行HAMD(24项版)量表、SAS量表、MoCA量表及NIHSS量表的评分。结果 (1)72 h治疗组与对照组比较,HAMD评分无显著差异(P>0.05),而MoCa、SAS和NIHSS评分均有显著差异(P≤0.01);1月治疗组与对照组比较,SAS评分无显著差异(P>0.05),而HAMD、SAS和NIHSS评分均有显著差异(P<0.01),2月治疗组与对照组的四项量表评分比较均有显著差异(P<0.01);(2)72 h、1月和2月治疗组在第3个月随访时的MoCa、SAS、HAMD及NIHSS评分均无显著差异(P>0.05)。结论 (1)脑卒中后不同时间出现PSD患者的抗抑郁干预效果有时间段差异,PSD出现时间越晚,抗抑郁治疗达到明显效果所需的时间越短;(2)脑卒中患者发生PSD后及早予抗抑郁药物治疗,不仅可改善抑郁,对焦虑、认知和神经功能康复也有积极效果。     

Diagnosing multiple sclerosis in childhood

By presenting the cases of 3 children with laboratory supported definite multiple sclerosis [LSDMS] according to Poser's diagnostic criteria, we illustrate the difficulties of diagnosing MS in childhood. In search for appropriate diagnostic criteria for childhood MS, the literature on childhood MS is reviewed, and the 3 cases presented are compared with the 15 hitherto reported with the diagnosis LSDMS. Specific difficulties of diagnosing MS in childhood are discussed. They include history taking in children, the multiple differential diagnostic possibilities, and the various clinical presentations. Due to these specific difficulties in childhood MS, we conclude that a strict use of Poser's criteria is indispensable, especially in childhood MS.     

抑郁症与精神分裂症中妄想对照研究

目的：探讨精神病性抑郁症与精神分裂症妄想症状的差异。方法：对65例精神病性抑郁症及115例精神分裂症患者妄想差异的比较。结果：精神病性抑郁症妄想的发生率及多种妄想并存率显著低于精神分裂症;缺乏夸妄想,但罪恶、疑病等妄想发生率显著高于精神分裂症;被害妄想对象不如精神分裂症泛化,2次住院的妄想再现率明显低于精神分裂症。结论：精神病性抑郁症的妄想继发于情感症状,处于从属地位,没有与情感背景完全对立的妄想,与精神分裂症的妄想有诸多差异。     

儿童期虐待、自尊、自我效能感对医学生焦虑抑郁影响的路径分析

目的:探讨医学生儿童期虐待、自尊、自我效能感与焦虑抑郁症状的关系。方法:采用整群抽样法,对某医学院262名医学生进行调查,使用儿童期虐待史自评量表(PRCA)、自尊量表(SES)、一般自我效能感(GSES)、贝克抑郁自评问卷、焦虑自评量表等问卷进行现场测试,用结构方程模型分析软件Amos7.0作路径分析。结果:儿童期虐待对焦虑、抑郁有直接正向影响(Sβ=0.342,0.389;P<0.01),对自尊、自我效能感有直接负向影响(Sβ=-0.130,-0.148;P<0.05);自尊对焦虑、抑郁有直接负向影响(Sβ=-0.061,-0.217;P<0.05),自我效能感对焦虑、抑郁有直接负向影响(Sβ=-0.133,-0.087;P<0.05)。结论:自尊、自我效能感作为中介变量调节儿童期虐待对医学生焦虑、抑郁症状的影响。     

Correlations among self-esteem, aggression, adverse childhood experiences and depression in inmates of a female juvenile correctional facility in Japan

Aim:  The purpose of this study was to examine the following hypothesis: (i) Self-esteem and aggressiveness, adverse childhood experiences (ACE), and a depressive tendency interact with each other. (ii) The subjects show a strong depressive tendency, and each of the other factors exerts a main effect on, and interacts with, the depressive tendency.
Method:  The subjects were 91 juveniles (all female) admitted to a female juvenile correctional facility between November 2005 and December 2006. They were aged 15–19 years, with a mean age of 17.0 (SD = 1.18) years. Self-esteem scale, aggression scale, ACE questionnaire, and depression scale were conducted.
Results:  Significant main effects (R² = 0.50, P  < 0.001) on the depression score were observed in self-esteem (β = −0.41, P  < 0.001) and aggression (β = 0.21, P  < 0.05). Self-esteem, aggression, ACE, and depression were found to be interrelated.
Conclusion:  Low self-esteem was also shown to exert marked effects on various factors. About half of the inmates of the facility were depressed, and the main effects of self-esteem, aggression, and the ACE score were shown to influence the depression score.     

A comparison of five diagnostic systems for childhood schizophrenia and infantile autism

Five diagnostic systems designed to differentiate infantile autism and early childhood schizophrenia were compared by deriving scores on 44 children referred consecutively to the same clinical center. While the autistic scales devised by Rimland, Polan and Spencer, Lotter, and the British Working Party correlated significantly, the degree of correspondence (35%) indicated that several children obtained high autistic scores in one system but low scores in another. The BWP's term schizophrenia has more correspondence with the term autism used by others than with Rimland's schizophrenia. In the DeMyer-Churchill categorical system (early schizophrenia, primary autism, secondary autism, and non-psychotic subnormal), primary autism most resembles Rimland's concept of infantile autism as measured by his E-1 version. All other systems differentiate psychotic from non-psychotic children but do not distinguish any of the psychotic subgroups.This study was supported in part by Public Health Service Grant No. MH05154 and also by LaRue D. Carter Memorial Hospital, State of Indiana, Indianapolis, Ind.The authors wish to thank Dr. Bernard Rimland for providing his scoring key.