Understanding the influence of depression on self-efficacy, work status and condom use among HIV clients in Uganda

Objectives

Depression is common among persons living with HIV/AIDS in sub-Saharan Africa, yet few studies in the region have assessed the relationship of depression to economic well-being and risk-reduction behavior. Among HIV clients in Uganda, we examined whether depression is directly related to self-efficacy, work status, and condom use, as well as indirectly through its interaction with physical health functioning.

Methods

Baseline data from a prospective longitudinal cohort of 602 clients entering HIV care were examined. In separate multivariate analyses, we examined whether depression [both depressive severity and clinical depression, as measured by the nine-item Patient Health Questionnaire (PHQ-9)], physical health functioning, and their interaction were predictors of current work status, consistent condom use, and general self-efficacy, controlling for measures of social support, stigma, and demographics.

Results

Mean PHQ-9 score was 5.2 (S.D.=3.9; range=0-24) and 13% had scores ≥10 (indicator of clinical depression). Not being depressed, better physical health, and their interaction were predictors of working, while lower depressive severity, lower physical health, and their interaction were associated with always using condoms. Better physical health was predictive of greater self-efficacy, but not depression; general self-efficacy was predictive of both work status and condom use.

Conclusions

Effective diagnosis and treatment of depression may be critical to maximizing the benefits of HIV treatment with regard to both HIV prevention and restoring the social and economic health of persons living with HIV.     

Common mental disorders and disability pension award: Seven year follow-up of the HUSK study

Objective

Rates of disability pension (DP) awards remain high in most developed countries. We aimed to estimate the impact of anxiety and depression on DPs awarded both for mental and for physical diagnoses and to estimate the relative contribution of sub case-level anxiety and depression compared with case-level symptom loads.

Methods

Information from a large cohort study on mental and physical health in individuals aged 40-46 (N=15,288) was linked to a comprehensive national database of disability benefits. Case-level and sub case-level anxiety and depression were defined as scores on the Hospital Anxiety and Depression Scale of ≥8 and 5-7, respectively. The outcome was incident award of a DP (including ICD-10 diagnosis) during 1-7-year follow-up.

Results

DP awards for all diagnoses were predicted both from case-level anxiety [HR 1.90 (95% CI 1.50-2.41)], case-level depression [HR 2.44 (95% CI 1.65-3.59] and comorbid anxiety and depression [HR 4.92 (95% CI 3.94-6.15)] at baseline. These effects were only partly accounted for by adjusting for baseline somatic symptoms and diagnoses. Anxiety and depression also predicted awards for physical diagnoses [HR 3.26 (95% CI 2.46-4.32)]. The population attributable fractions (PAF) of sub case-level anxiety and depression symptom loads were comparable to those from case-level symptom loads (PAF anxiety 0.07 versus 0.11, PAF depression 0.05 versus 0.06).

Conclusion

The long-term occupational impact of symptoms of anxiety and depression is currently being underestimated. Sub case-level symptom loads of anxiety and depression make an important and previously unmeasured contribution to DP awards.     

Depression and cognitive deficits in geriatric schizophrenia

Objective

Past reports have found patients with comorbid depression and schizophrenia spectrum disorders exhibit greater deficits in memory and attention compared to schizophrenia spectrum disorder patients without depressive symptoms. However, in contrast to younger schizophrenia patients, the few past studies using cognitive screens to examine the relationship between depression and cognition in inpatient geriatric schizophrenia have found that depressive symptomatology was associated with relatively enhanced cognitive performance. In the current study we examined the relationship between depressive symptoms and cognitive deficits in geriatric schizophrenia spectrum disorder patients (n = 71; mean age = 63.7) on an acute psychiatric inpatient service.

Method

Patients completed a battery of cognitive tests assessing memory, attention and global cognition. Symptom severity was assessed via the PANSS and Calgary Depression Scale for Schizophrenia.

Results

Results revealed that geriatric patients' depression severity predicted enhancement of their attentional and verbal memory performance. Patients' global cognitive functioning and adaptive functioning were not associated with their depression severity.

Conclusion

Contrary to patterns typically seen in younger patients and non-patient groups, increasing depression severity is associated with enhancement of memory and attention in geriatric schizophrenia spectrum disorder patients. Also, diverging from younger samples, depression severity was unassociated with patients adaptive and global cognitive functioning.     

Oxytocin does not modify GH, ACTH, cortisol and prolactin responses to Ghrelin in normal men

Background

In order to test the possible effect of Oxytocin (OT) on Ghrelin-stimulated GH, PRL, ACTH and cortisol, ten healthy normal men were studied.

Methods

Tests: Ghrelin (0.2 μg/kg body weight (BW)) as an iv bolus; Ghrelin plus OT (2 IU as bolus plus 0.07 IU/min administered for 90 min).

Results

The administration of OT did not change GH, PRL, ACTH and cortisol release induced by Ghrelin.

Conclusions

The data suggests that in humans OT did not modulate the GH, PRL, ACTH and cortisol response to Ghrelin.     

Relationship between lunar phases and serious crimes of battery: a population-based study

Objective

The hypothesis of a lunar influence on human abnormal behavior is still widespread, although research has led to conflicting findings. Therefore, a population-based study to assess the influence of lunar phases on violent crimes was conducted.

Methods

The study included all serious crimes of battery (aggravated assaults) committed in Middle Franconia (Bavaria, Germany) between 1999 and 2005 (n = 23?142). Data were analyzed regarding lunar phase, sex, and place of crime scene (outdoor vs indoor).

Results

No significant associations between full, absent, and the moon's interphases and serious crimes of battery could be detected. Furthermore, a Fourier analysis was conducted that failed to produce an association between violence and the moon's phases.

Discussion

Several possible explanations for the presented results are discussed including biological and social mechanisms.

Conclusions

The present study fails to find a significant association between lunar phases and crimes of battery.     

History of depressive episodes as a risk factor for illness severity in early inflammatory arthritis

Objective

Psychosocial research in arthritis consistently demonstrates a relationship between depression and disease characteristics such as severity of illness and physical disability. In this study, we examine how a history of clinical depression identified through diagnostic interviews influences disease outcome measures in patients with early inflammatory arthritis (EIA) in the absence of current depression.

Methods

Patients in the early phase (more than 6-weeks, less than 1-year duration) of inflammatory arthritis were recruited from a larger EIA registry, which recorded sociodemographic data, current depressive symptoms and measures of disease severity. Current and history of major depression was assessed by a structured clinical interview. Eighty-one patients without current major depression were divided into two groups: 28 with and 53 without a history of depression.

Results

There were no significant differences between the two groups in age, sex, education, income, or level of current depressive symptoms. Compared with patients with no history of major depression, those with a history of depressive episodes had higher self-ratings of disease activity and were assessed as having more severe disease and poorer physical functioning by their physicians.

Conclusion

This study indicates that a history of major depression represents a risk factor for disease severity in EIA. This may reflect an enduring physiological effect of depression that influences subsequent inflammatory arthritis or an underlying shared process between these two disease entities.     

Verbal learning contributes to cognitive insight in schizophrenia independently of affective and psychotic symptoms

Objective

Patients with schizophrenia exhibit distorted beliefs and experiences, and their own evaluation of this is labeled cognitive insight. We examined the relationship between cognitive insight and neurocognition, as well as the contribution of neurocognition in explaining cognitive insight.

Method

Clinically characterized patients with schizophrenia (n = 102) were assessed with a measure of cognitive insight, Beck Cognitive Insight Scale (BCIS) and a neuropsychological test battery. The contribution of neurocognition to the explained variance in BCIS components self-reflectiveness (i.e. objectivity and reflectiveness) and self-certainty (i.e. overconfidence in own beliefs) was examined controlling for current affective and psychotic symptoms.

Results

A significant negative correlation was found between self-certainty and verbal learning, whereas no associations were found between self-reflectiveness and any of the neuropsychological tests. Verbal learning was added significantly to the explained variance in self-certainty after controlling for potential confounders.

Conclusion

High self-certainty was associated with poor verbal learning. This suggests that overconfidence in own beliefs is associated with cognitive dysfunction in schizophrenia.     

Pain as a predictor of depression treatment outcomes in women with childhood sexual abuse

Objectives

Childhood sexual abuse (CSA) increases risk for both depression and pain in women. Pain is associated with worse depression treatment response. The contribution of pain to depression treatment outcomes in women with histories of CSA is unknown. This study examined whether clinically significant pain would be associated with worse depression and functioning outcomes among women with CSA histories treated with interpersonal psychotherapy.

Method

Participants were 66 women with major depression and CSA who presented to a community mental health center. An interpersonal psychotherapy protocol planned for 14 weekly sessions followed by 2 biweekly sessions. Patients were classified as experiencing high pain or low pain based on reported pain severity and interference with functioning. Generalized estimating equations were used to assess change over time in intent-to-treat analyses.

Results

High pain patients entered treatment with greater depression symptom severity than low pain patients. Although both high and low pain patients demonstrated improvement in mood, high-pain patients continued to report more depressive symptoms posttreatment. Furthermore, high pain patients demonstrated less change in their emotion-related role functioning over the course of treatment than low pain patients.

Limitations

Small sample size, secondary analyses, lack of a control group, and limited assessment of pain all limit confidence in the findings of this study.

Conclusion

Findings support the evidence that depression is particularly severe and difficult to treat in patients with CSA and pain. Clinicians should evaluate pain in depressed patients with CSA histories. Role functioning may prove to be a particularly important target in the treatment of patients with pain.     

Major depression is associated with lower omega-3 fatty acid levels in patients with recent acute coronary syndromes

Background

Polyunsaturated fatty acids (PUFAs) are intrinsic cell membrane components and closely involved in neurotransmission and receptor function. Lower omega-3 levels are associated with increased risk of coronary artery disease (CAD), increases in cardiac events in CAD patients, and depression. We sought to examine relationships between depression and serum levels of omega-3 and omega-6 PUFAs in patients recovering from acute coronary syndromes (ACS).

Methods

We carried out a case-control study of serum PUFA levels and current major depression in 54 age- and sex-matched pairs approximately 2 months following ACS.

Results

Depressed patients had significantly lower concentrations of total omega-3 and docosahexaenoic acid (DHA), and higher ratios of arachidonic acid (AA) to DHA, AA to eicosapentaenoic acid (EPA), and n-3 to n-6 than controls. There were no baseline differences in any potential risk or protective factors for depression.

Conclusions

Results are consistent with previous reports in depressed patients without CAD, and with literature concerning omega-3 levels and risk of CAD events. Dietary, genetic, and hormonal factors may all play a role in both depression and CAD. Both prospective studies and randomized trials are needed to help clarify the interrelationships.     

Hippocampal volume in borderline personality disorder with and without comorbid posttraumatic stress disorder: A meta-analysis

Background

Several studies have found a reduction in hippocampal volume in borderline personality disorder (BPD) patients.

Methods

In order to investigate the degree to which comorbid posttraumatic stress disorder (PTSD) could account for reduction in hippocampal volume in these patients, we conducted a systematic review and meta-analysis of studies that compared hippocampal volume in BPD patients with and without PTSD relative to healthy controls.

Results

Seven articles, involving 124 patients and 147 controls, were included. We found a statistically significant reduction for the left and right hippocampus. Data from the four studies that discriminated BPD patients with and without PTSD indicate that hippocampal volumes were reduced bilaterally in BPD patients with PTSD, relative to healthy controls, but that results were mixed for BPD patients without PTSD, relative to healthy controls.

Conclusions

Results from this meta-analysis suggest that hippocampal volumes are reduced in patients with BPD, relative to healthy controls, but particularly in cases in which patients are diagnosed with comorbid PTSD.     

Racial and ethnic differences in diabetes mellitus among people with and without psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions

Objective

This study examined racial/ethnic differences in the prevalence of diabetes mellitus in a nationally representative sample of adults with and without common psychiatric disorders.

Method

Data were drawn from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N=34,653). Logistic regression models adjusting for sociodemographic variables and diabetes risk factors were used to examine racial/ethnic differences in 12-month prevalence rates of diabetes by psychiatric status.

Results

Among people without psychiatric disorders, African Americans, Hispanics and American Indians/Alaska Natives, but not Asians/Pacific Islanders, had significantly higher rates of diabetes than non-Hispanic whites even after adjusting for sociodemographic variables and diabetes risk factors. In the presence of psychiatric disorders, these health disparities persisted for African Americans and Hispanics, but not for American Indians/Alaska Natives. No significant interactions between race/ethnicity and psychiatric disorders in the odds of diabetes were found across any group.

Conclusion

Policies and services that support culturally appropriate prevention and treatment strategies are needed to reduce racial/ethnic disparities in diabetes among people with and without psychiatric disabilities.     

Meaning in life, anxiety, depression, and general health among smoking cessation patients

Objective

Psychosocial factors play a widely recognized role in health and health care utilization. The present study investigated relations among meaning in life, depression, anxiety, and social support with self-reported general health.

Method

Ninety-nine smoking cessation group patients were recruited to complete questionnaires during their third week of treatment.

Results

Depression was the strongest predictor of perceived general health. However, the interaction of people's experience of meaning in life and their propensity to seek deeper meaning in their lives predicted variance in perceived health above and beyond depression. Furthermore, propensity to seek meaning in life was the only psychosocial correlate of people's perceived social benefits of health care utilization.

Conclusion

Psychosocial factors, particularly depression and the two primary dimensions of meaning in life (experiencing and seeking), were related to perceived health. Meaning in life thus emerges as a variable worth further scrutiny in the health of clinical populations.     

Longitudinal epidemiology of major depression as assessed by the Brief Patient Health Questionnaire (PHQ-9)

Background

Most diagnostic interviews depend on recall of past symptoms and may be vulnerable to recall bias. The objective of this study was to describe the epidemiology of major depression using an approach that is less reliant on recall using an assessment scale, the 9-item Brief Patient Health Questionnaire (PHQ-9). The pattern observed is relevant both to understanding major depression epidemiology and to assessing a possible role for the PHQ-9 as a screening instrument.

Method

Random digit dialing was used to select a sample of 3304 community residents. Each respondent was assessed with a baseline interview followed by a series of 6 subsequent follow-up interviews 2 weeks apart.

Results

Prevalence was between 2.5% and 3.3% during each interview, consistent with prior reports. The incidence of new episodes was surprisingly high, and many of the episodes were brief. Similarly, high rates of recovery (according to PHQ-9 scoring) were seen early in follow-up but declined subsequently. Episodes of major depression detected by the PHQ-9 tended to be preceded and followed by elevated levels of depressive symptoms.

Conclusions

The long-standing episodes of major depression typical of clinical practice appear to represent a minority of episodes occurring in the community. These results suggest that, in general population screening applications, the PHQ-9 will identify many respondents having brief and perhaps self-limited episodes. Although some episodes are characterized by large increases in symptoms, many respondents appear to move above and below the diagnostic threshold as a result of small changes in their symptom levels. Efforts to develop more effective approaches to screening may benefit from severity-based decision rules and serial measurement strategies.     

Sex differences in response to citalopram: a STAR*D report

Objective

Controversy exists as to whether women with depression respond better to selective serotonin reuptake inhibitors (SSRIs) than men. The purpose of this report was to determine whether men and women differ in their responses to treatment with the SSRI citalopram using a large sample of real world patients from primary and psychiatric specialty care settings.

Method

As part of the sequenced treatment alternatives to relieve depression (STAR∗D) study, 2876 participants were treated with citalopram for up to 12-14 weeks. Baseline demographic and clinical characteristics and outcomes were gathered and compared between men and women.

Results

At baseline, women were younger, had more severe depressive symptoms and were more likely to have: early onset; previous suicide attempt(s); a family history of depression, alcohol abuse or drug abuse; atypical symptom features; and one or more of several concurrent psychiatric disorders. Despite greater baseline severity and more Axis I comorbidities, women were more likely to reach remission and response with citalopram than men.

Conclusions

Women have a better response to the SSRI citalopram than men, which may be due to sex-specific biological differences particularly in serotonergic systems.     

Psychometric properties of the Chinese 15-item Patient Health Questionnaire in the general population of Hong Kong

Objective

The objective was to examine the reliability and validity of the Chinese 15-item Patient Health Questionnaire (PHQ-15) in the general population of Hong Kong.

Methods

A random community-based sample of 3014 respondents aged 15-65 was interviewed through telephone using a structured Chinese-language questionnaire that included the PHQ-15, Sheehan Disability Scale, questions about health service use and sociodemographic variables. A random subsample of 200 respondents was reinterviewed for assessing test-retest reliability.

Results

The PHQ-15 exhibited satisfactory internal consistency (Cronbach's α=0.79) and stable 1-month test-retest reliability. Being female, younger age, lower education and lower income levels were associated with higher scores. “Bothered a lot” somatic symptoms were less common than in clinical studies, but their general profile was comparable to those found in Western community studies. Pains in the limbs, trouble sleeping and feeling tired (11.2%-16.9%) were the most common, whereas fainting spells and sexual problems (0.6%-0.7%) were the least so. Using principal component analysis, we extracted four clinically meaningful factors that explained 49.7% of the variance. These factors might be termed “cardiopulmonary,” “gastrointestinal,” “pain” and “neurological.” Somatic symptom severity was positively associated with functional impairment and health service use.

Conclusion

The Chinese PHQ-15 exhibits satisfactory reliability and preliminary evidence of validity in a general population. Revealing a typical profile of somatic symptom severity, it is a promising tool for the empirical examination of somatization in Chinese people.     

The relationship between body image disturbance and distress in colorectal cancer patients with and without stomas

Objective

This study aimed to investigate the effect of having a stoma on body image in patients with colorectal cancer and to determine whether disturbances in body image predicted distress.

Methods

A prospective analysis of 79 colorectal cancer patients. Patients were assessed within 9 weeks of surgery and followed up at the end of adjuvant treatment. Body image disturbance, depressive symptoms, anxiety, and general distress were measured at baseline and follow-up.

Results

Patients who received stomas had poorer body image, which worsened over time. Although there were no differences between stoma groups on anxiety or depressive symptoms, those with a late stoma were most depressed. Body image was a strong predictor of initial levels of anxiety, depression, and distress and subsequent anxiety and distress.

Conclusions

These results confirm that stomas negatively impact on the body image of patients with colorectal cancer. Importantly, those whose body image is most disturbed are at risk for experiencing more anxiety and depression. These results underscore the importance of assessing and treating body image disturbance in colorectal patients who receive a stoma.     

Frequency and predictors of obstructive sleep apnea among individuals with major depressive disorder and insomnia

Objective

Disturbances in sleep continuity are common among individuals with major depressive disorder (MDD) and can impact the course of depression and response to treatment. Several studies have examined depressive symptom severity among sleep-disordered patients with obstructive sleep apnea (OSA). In contrast, little is known about OSA in patients with MDD. The goal of this study was to examine the frequency and predictors of OSA in a sample of individuals with comorbid MDD and insomnia.

Methods

Participants were 51 individuals who enrolled in a treatment study on insomnia and depression, met criteria for MDD and comorbid insomnia, and underwent an overnight polysomnography evaluation. An apnea-hypopnea index ≥15 events per hour was used as a cutoff score for OSA. Regression analyses were conducted to examine clinical and demographic predictors of OSA severity as measured by the apnea-hypopnea index.

Results

The results revealed that 39% of the sample met criteria for OSA. The OSA group had significantly higher body mass index (BMI) scores and a significantly greater proportion of men. Regression analysis revealed that male sex, older age, and higher BMI were significant predictors of OSA severity. Neither depression severity nor insomnia severity was a significant predictor.

Conclusions

These findings indicate that the frequency of OSA is higher among individuals with comorbid MDD and insomnia than was previously found among people with either MDD or insomnia alone. In addition, previously identified predictors of OSA (male sex, older age, and high BMI) also apply to this population.     

Prevalence of psychiatric disorders in patients with polycystic ovary syndrome

Objective

To investigate the prevalence of psychiatric disorders among women in ambulatory treatment for polycystic ovary syndrome (PCOS) and to correlate its clinical and demographic aspects with mental disorders.

Methodology

Seventy-two patients in ambulatory treatment at the Endocrinal and Gynaecological Institute of the Federal University of Rio de Janeiro were evaluated using Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition criteria by means of MINI (Mini International Neuropsychiatric Interview, version 4.4). Polycystic ovary syndrome was confirmed according to the ultrasonographic criteria of Adams and by clinical parameters.

Results

Forty-one patients (57%) presented at least one psychiatric diagnosis. Among them, the prevalence of mood disorder reached 78%. The most prevalent diagnostics were major depression (26.4%) and bipolar disorder (11.1%).

Conclusion

A high prevalence of mental disorders was observed, especially major depression and bipolar disorder. The data obtained regarding the relationship between PCOS and mood disorders in a Brazilian sample is in accordance with recent research findings in the same area.     

Patient and general practitioner preferences for the treatment of depression in patients with cancer: How, who, and where?

Objective

The objective of this study was to determine and compare patient and general practitioner (GP) preferences for the treatment of depression in patients with cancer.

Methods

A treatment preference questionnaire was completed by 100 patients who had been diagnosed with both cancer and major depressive disorder and by 86 GPs who had had experience of at least 1 patient with cancer and depression. Participants were asked to rank options for how depression should be treated, who should deliver the treatment, and where treatment should occur.

Results

The top three preferences of patients and GPs for how depression should be treated differed (P<.001). Patients preferred talking treatment alone, whereas GPs preferred a combination of drug and talking treatment. Both patients and GPs preferred treatment to be given by the GP, with older patients having a stronger preference for this. Counselors and cancer nurses were also popular preferences; mental heath professionals were unpopular. The preferred place of treatment was primary care for both patients and GPs, although many patients preferred treatment in the cancer center.

Conclusion

Effective and acceptable services for depressed cancer patients need to take patients and GP preferences into account. A model of service that allows a choice of initial treatment modality and collaborative care between primary care and cancer center nurse would meet this requirement.