Children's unique experience of depression: Using a developmental approach to predict variation in symptomatology

Background  

Current clinical knowledge suggests that children can have different types of depressive symptoms (irritability and aggression), but presents no theoretical basis for these differences. Using a developmental approach, the present study sought to test the relationship between developmental level (mental age) and expression of depressive symptoms. The primary hypothesis was that as children's mental age increased, so would the number of internalizing symptoms present.     

Point prevalence and correlates of depression in a national community sample with multiple sclerosis

Objective

The prevalence of depression in multiple sclerosis (MS) is known to be elevated, but nearly all available studies have estimated period prevalence. The objective of this study was to estimate the point prevalence of depression in a representative community sample using the Patient Health Questionnaire, Brief (PHQ-9).

Methods

The data source for this study was the Survey of Living with Neurological Conditions in Canada, which was derived from a representative sample of household residents.

Results

The sample included 630 respondents with MS. With application of the standard PHQ-9 cut point (10 +), the prevalence of depression was 26.0% (95% confidence interval 18.9%–33.0%). Depressed subjects had lower quality of life; an increased frequency of suicidal ideation; and more often reported a negative disease course, high stress, low social support and stigmatization.

Conclusions

This study adds to the existing literature by providing point prevalence data: in any 2-week period, about one quarter of community residents with MS experience substantial levels of depressive symptoms.     

Prediction of childhood ADHD symptoms to quality of life in young adults: Adult ADHD and anxiety/depression as mediators

Childhood attention-deficit/hyperactivity disorder (ADHD) symptoms may persist, co-occur with anxiety and depression (ANX/DEP), and influence quality of life (QoL) in later life. However, the information about whether these persistent ADHD and ANX/DEP mediate the influence of childhood ADHD on adverse QoL in adulthood is lacking. This study aimed to determine whether adult ADHD symptoms and/or ANX/DEP mediated the association between childhood ADHD and QoL. We assessed 1382 young men aged 19–30 years in Taiwan using self-administered questionnaires for retrospective recall of ADHD symptoms at ages 6–12, and assessment of current ADHD and ANX/DEP symptoms, and QoL. We conducted mediation analyses and compared the values of mediation ratio (P_M) by adding mediators (adult ADHD and ANX/DEP), individually and simultaneously into a regression model with childhood ADHD as an independent variable and QoL as a dependent variable. Our results showed that both adult ADHD and ANX/DEP symptoms significantly mediated the association between childhood ADHD and QoL (P_M = 0.71 for ANX/DEP, P_M = 0.78 for adult ADHD symptoms, and P_M = 0.91 for both). The significance of negative correlations between childhood ADHD and four domains of adult QoL disappeared after adding these two mediators in the model. Our findings suggested that the strong relationship between childhood ADHD and adult life quality can be explained by the presence of persistent ADHD symptoms and co-occurring ANX/DEP. These two mediators are recommended to be included in the assessment and intervention for ADHD to offset the potential adverse life quality outcome in ADHD.     

ADHD in international adoptees: a national cohort study

Several investigators have reported an increased frequency of attention/hyperactivity symptoms in international adoptees, though population-based studies are lacking. In this national cohort study, we aimed to determine the prevalence of ADHD medication in international adoptees in Sweden, in comparison to the general population. A further purpose was to study gender, age at adoption and region of origin as predictors of ADHD medication in international adoptees. The study population consisted of all Swedish residents born in 1985–2000 with Swedish-born parents, divided into 16,134 adoptees, and a comparison population of 1,326,090. ADHD medications were identified in the Swedish Prescribed Drug Register during 2006. Logistic regression was used to calculate the odds ratios. The rates of ADHD medication were higher in international adoptees than in the comparison population for both boys (5.3 vs. 1.5% for 10–15-year olds) and girls (2.1 vs. 0.3% for 10–15-year olds). International adoptees from all regions of birth more often consumed ADHD medication compared with the majority population, but the age and sex adjusted odds ratios were particularly high for adoptees from Eastern Europe, Middle East/Africa and Latin America. Adjusting for maternal education and single parenthood increased the odds ratios even further. The risk also increased with higher age at adoption. Adoptees from Eastern Europe have a very high risk for ADHD medication. A structured identification and support programme should be tailored for this group. Adoptees from other regions have a more moderately increased risk, which should be communicated to adoptive parents and to professionals who care for adoptees in their clinical practice.     

Stability of anxiety and depression in a national sample of adults with human immunodeficiency virus

We examined the stability of anxiety and depression in a national sample of patients with human immunodeficiency virus (HIV) using data from the HIV Cost and Services Utilization Study. We also investigated risk factors for developing new cases of anxiety and depression. Analyses were conducted using multiple logistic regressions to control for key demographic and clinical factors. Our results showed a general stability of these psychiatric conditions across 6 months, with no dramatic increase in new cases. Overall prevalence declined over time, but a subgroup of patients, particularly those with major depression, evidenced persistent psychopathology. Having a high baseline HIV symptom count and a growing number of HIV symptoms significantly increased the likelihood of anxiety and depression persisting to follow-up and of developing new such cases. Our findings indicate that living with HIV does not necessarily lead to increased psychiatric distress but that palliation of HIV symptoms is paramount to patients' mental health.     

Patterns of health care costs associated with depression and substance abuse in a national sample

OBJECTIVE: The associations between self-reported depressive and substance use disorders and estimated health care costs were examined in a representative national sample. METHODS: Data were from the 1994 National Health Interview Survey (N=77,183). Respondents who reported depressive symptoms or major depression (depressive syndromes) or a substance abuse disorder in the past year were compared with respondents who did not report these conditions. The mean number of inpatient days and outpatient visits in both the general medical and the specialty mental health settings were determined, and costs per individual were calculated based on mean costs of such care in each respondent's geographic region. Multivariate models were constructed to calculate mean costs, controlling for demographic variables, insurance coverage, and physical health status. RESULTS: Individuals with self-reported depressive syndromes or substance abuse had mean health care costs that were $1,766 higher than costs for individuals without these conditions. Depressive syndromes were associated with increases in both inpatient and outpatient costs. However, substance abuse was almost exclusively associated with increased inpatient expenditures rather than outpatient costs. The magnitude of increased costs associated with mental disorders was substantially larger for patients in fee-for-service plans than for those in health maintenance organizations. Only 14.3 percent of visits made by individuals reporting depressive syndromes or substance abuse were made to specialty health providers (psychiatrists, psychologists, and social workers). CONCLUSIONS: Health care costs of people with self-reported mental illness varied significantly across diagnoses and systems of care. It is crucial that researchers estimating increased costs associated with mental illness account for both diagnostic and system factors that can influence the estimates.     

ADHD and epilepsy in childhood

Attention-deficit-hyperactivity disorder (ADHD) has been associated with childhood epilepsy; prevalence figures have ranged from 8 to 77%, depending on the sample studied and the criteria used for diagnosis. In the general population the prevalence of ADHD is approximately 5%, with the majority of affected children having ADHD combined type. As part of a larger study of behavioral problems in children with epilepsy, we assessed 175 children (90 males, 85 females; age range 9 to 14 years, mean age was 11 years 10 months, SD 1 year 8 months) for evidence of ADHD. The children had at least a 6-month history of epilepsy. The primary caregiver completed both the Child Behavior Checklist (CBCL) and the Child Symptom Inventory-4 (CSI) or Adolescent Symptom Inventory-4 (ASI). On the CBCL, the mean attention problem T score was 64.6 (SD 10.5) for adolescents and 67.9 (SD 11.6) for children. On the CSI or ASI, 20 of 175 children met DSM-IV criteria for ADHD combined type; 42 of 175 had ADHD predominantly inattentive type; and 4 of 175 met criteria for ADHD predominantly hyperactive-impulsive type. There were significant correlations between the CBCL attention score and inattention (r = 0.68) and hyperactivity-impulsivity (r = 0.59). Sex, seizure type, and focus of seizure discharge were not predictors of symptoms of ADHD. Children with epilepsy are at risk for symptoms of ADHD. They differ from other samples of children with ADHD by the higher proportion of children with ADHD predominantly inattentive type and by an equal male: female ratio.     

ADHD medication use in a population-based sample of twins

OBJECTIVE: To determine treatment patterns for youth attention-deficit/hyperactivity disorder (ADHD) symptoms in a general population sample of 1,610 twins. METHOD: Twin pairs ages 7 to 17 years and parents ascertained from birth records in the state of Missouri were interviewed using the Missouri Assessment of Genetics Interview for Children between 1996 and 2001. Multivariate logistic regression analyses were used to determine which factors were significant in answering three questions about treatment for ADHD. RESULTS: Of 302 boys, 177 (58.6%) and 26 of 57 girls (45.6%) who met full DSM-IV criteria for ADHD received stimulant medication in this sample. Of 314 youths, 111 (35.4%) who received stimulant medication did not meet DSM-IV criteria for ADHD. When controlling for comorbidity and other factors, the number of impairing ADHD symptoms and having a cotwin who was also brought to treatment for ADHD correlated with referral or treatment in youths without ADHD. Youths without ADHD who were treated had a large number of ADHD symptoms. CONCLUSION: As is shown in earlier studies, children with ADHD are being undertreated. Complex factors, including comorbid disorders and family history of ADHD treatment, affect treatment patterns in the general population.     

Early childhood and adolescent risk factors for psychotic depression in a general population birth cohort sample

Background and purpose

In the group of severe mental disorders, psychotic depression (PD) is essentially under-researched. Knowledge about the risk factors is scarce and this applies especially to early risk factors. Our aim was to study early childhood and adolescent risk factors of PD in a representative birth cohort sample with a follow-up of up to 50 years.

Methods

The study was carried out using the Northern Finland Birth Cohort 1966 (NFBC 1966). We used non-psychotic depression (NPD) (n = 746), schizophrenia (SZ) (n = 195), psychotic bipolar disorder (PBD) (n = 27), other psychoses (PNOS) (n = 136) and healthy controls (HC) (n = 8200) as comparison groups for PD (n = 58). We analysed several potential early risk factors from time of birth until the age of 16 years.

Results

The main finding was that parents’ psychiatric illness [HR 3.59 (1.84–7.04)] was a risk factor and a high sports grade in school was a protective factor [HR 0.29 (0.11–0.73)] for PD also after adjusting for covariates in the multivariate Cox regression model. Parental psychotic illness was an especially strong risk factor for PD. The PD subjects had a parent with psychiatric illness significantly more often (p < 0.05) than NPD subjects. Differences between PD and other disorder groups were otherwise small.

Conclusions

A low sports grade in school may be a risk factor for PD. Psychiatric illnesses, especially psychoses, are common in the parents of PD subjects. A surprisingly low number of statistically significant risk factors may have resulted from the size of the PD sample and the underlying heterogeneity of the etiology of PD.

     

ADHD and conduct disorder: an MRI study in a community sample.

MRI studies of children with Attention-Deficit Hyperactivity Disorder (ADHD) have consistently attributed core deficits of inattention and impulsivity to frontal-striatal-cerebellar abnormalities; however, no study has investigated the neuroanatomical characteristics of children with ADHD and Conduct Disorder (CD). This study examined a community sample of 12 children with combined subtype ADHD (aged 8-12, 7 with CD) and 19 healthy controls matched for age, gender, handedness and poverty. Volume measurements, including left/right asymmetries, were quantified from MRI of the total brain, caudate and cerebellar vermis. No significant differences in total brain volume, caudate volume, asymmetry of the hemispheres or asymmetry of the caudate were found between the groups. Measurements of the left and total posterior superior and inferior lobes of the vermis, however, indicated smaller volumes for both pure ADHD and co-morbid children compared to the controls. Analysis of variance demonstrated no significant volumetric differences between the pure ADHD and co-morbid types. Prolonged exposure to methylphenidate was associated with caudate volumes. These results suggest ADHD and ADHD co-morbid with CD have similar deviant cerebellar morphology and replicate previous studies with an epidemiologically derived sample.     

Prevalence of ADHD in a sample of Italian students: A population-based study

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common diagnosis for children and adolescents, although the reported estimates for prevalence are extremely variable worldwide. In the present work we investigate the prevalence of ADHD in a sample of Italian students in a study divided in two phases. In Phase I, a total of 6183 schoolchildren (3178 males and 3005 females, aged range 5–15 years) were screened using the SDAI rating scale for teachers. In Phase II, the parents of children and adolescents who met high screen criteria according to SDAI (cut-off > 14; n = 471, 7.3%) were invited to complete a specific clinical-diagnostic assessment for ADHD with the help of an experienced clinician. Within the entire sample, 107 children dropped out and 12 had mental retardation, whereas 332 subjects (278 males and 54 females, age range 5–14 years) completed the Phase II of the study. One hundred ninety subjects (163 males and 27 females, male: female ratio 6:1, mean age 8 years) were diagnosed with ADHD, indicating a prevalence of 3%. ADHD subtypes included the following: combined (n = 108; 56.8%), inattentive (n = 48; 25.2%) and hyperactive/impulsive (n = 33; 17.3%).Our findings are in line with other reports of ADHD prevalence in the European Countries, and may contribute to underline the impact of this phenomenon in the population, and the need of achieving an improvement in the quality of the public health mental service for the prevention and treatment of ADHD.