Discrepancies between self and observer ratings of depression. The relationship to demographic, clinical and personality variables

BACKGROUND: The observer-rated Hamilton depression scale (HamD) and the self-report Beck Depression Inventory (BDI) are among the most commonly used rating scales for depression, and both have well demonstrated reliability and validity. However, many depressed subjects have discrepant scores on these two assessment methods. The present study evaluated the ability of demographic, clinical and personality factors to account for the discrepancies observed between BDI and HamD ratings. METHOD: The study group consisted of 94 SCID-diagnosed outpatients with a current major depressive disorder. Subjects were rated with the 21-item HamD and completed the BDI and the NEO-Five Factor Inventory. RESULTS: Younger age, higher educational attainment, and depressive subtype (atypical, non-melancholic) were predictive of higher BDI scores relative to HamD observer ratings. In addition, high neuroticism, low extraversion and low agreeableness were associated with higher endorsement of depressive symptoms on the BDI relative to the HamD. In general, these predictive variables showed a greater ability to explain discrepancies between self and observer ratings of psychological symptoms of depression compared to somatic symptoms of depression. LIMITATIONS: The study does not determine which aspects of neuroticism and extraversion contribute to the observed BDI/HamD discrepancies. CONCLUSIONS: Depression ratings obtained with the BDI and HamD are frequently discordant and a number of patient characteristics robustly predict the discrepancy between these two rating methods. The value of multi-modal assessment in the conduct of research on depressive disorders is re-affirmed.     

The relationship of religious variables to death depression and death anxiety

The present research explored the relationship of religious variables to death anxiety and death depression in 200 persons from the general population in what is apparently the first study to correlate religious variables with death depression. Persons with lower death depression had greater strength of conviction, greater belief in afterlife, and were less likely to say that the most important aspect of religion is that it offers the possibility of life after death. Persons with less death anxiety were found to have greater strength of conviction. The findings were discussed in relationship to previous research that has suggested that religious belief is associated more closely with death anxiety level than is religious practice.     

The relationship between flexibility of coping to stress and depression

The present study was conducted to examine the relationship between flexibility of coping to interpersonal stress and mental health as represented by scores on a self-report depression scale (CES-D) in 87 college students. Subjects were first required to complete the Interpersonal Stress-Coping Inventory (ISI) to identify each subject's coping type (ISIpre). They were then asked to complete ISI again (ISIpost) assuming that the coping strategy they adopted in ISIpre did not work well. The results of ISIpre and ISIpost were then compared and the flexibility of coping to stress of each individual was analyzed in terms of his/her tendencies: (a) to abandon the type they adopted in ISIpre (Level A flexibility); and (b) to adopt a new coping type (Level B flexibility). Flexible copers in both Levels A and B were shown to be significantly less depressive as represented by scores in CES-D, those fulfilling both flexibility criteria being the least depressive. The results were discussed with reference to mental health and to functional fixedness/recentering in problem solving.     

The relationship between job stress,burnout and clinical depression

The definition and phenomenological features of 'burnout' and its eventual relationship with depression and other clinical conditions are reviewed. Work is an indispensable way to make a decent and meaningful way of living, but can also be a source of stress for a variety of reasons. Feelings of inadequate control over one's work, frustrated hopes and expectations and the feeling of losing of life's meaning, seem to be independent causes of burnout, a term that describes a condition of professional exhaustion. It is not synonymous with 'job stress', 'fatigue', 'alienation' or 'depression'. Burnout is more common than generally believed and may affect every aspect of the individual's functioning, have a deleterious effect on interpersonal and family relationships and lead to a negative attitude towards life in general. Empirical research suggests that burnout and depression are separate entities, although they may share several 'qualitative' characteristics, especially in the more severe forms of burnout, and in vulnerable individuals, low levels of satisfaction derived from their everyday work. These final issues need further clarification and should be the focus of future clinical research.     

Cortisol nonsuppression in depression: relationship to clinical variables

The dexamethasone suppression test was performed in 63 depressed patients and 43 normal controls. Cortisol nonsuppression was found in 47.6% of the depressed patients and 4.6% of the controls. Among depressed patients both age and reported weight loss, but not severity of depression, were significantly related to postdexamethasone plasma cortisol levels. Patients who were cortisol suppressors had experienced significantly more life events before the onset of depression and had significantly higher hostility scores on a personality questionnaire than cortisol nonsuppressors.     

Affects,demographic variables,and health

The revised Multiple Affect Adjective Check List (MAACL-R) was given to a national probability sample that consisted of 1,543 adults who also were interviewed, which provided demographic data and self-ratings of health, medication use, and social activities. Standardization procedures have reduced markedly the acquiescence factor and the correlations among the dysphoric affect scales in the MAACL-R. The demographic variables of sex, race, age, education, occupation, income, marital status, religion, geographial area of residence, and size of town or city were related to some of the scales. Positive affect was related directly to self-ratings of health; dysphoric affect was related negatively to these ratings. Frequencles of volunteer activities and social activities in general correlated negatively with depression and positively with positive affect scales.     

Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum

Examined the prevalence of depression in a heterogeneous sample of 360 pregnant women. Subjects were assessed with respect to both depressive symptomatology and diagnostic status during pregnancy and after delivery. At both assessments, approximately 25% of the sample reported elevated levels of depressive symptomatology. In contrast, 10% of the women met diagnostic criteria for depression during pregnancy, and 6.8% were depressed postpartum. However, only half of the cases of postpartum depression were new onset (3.4%); the remaining women receiving a diagnosis in the postpartum had also been depressed during pregnancy. Finally, depression during pregnancy was related to different sociodemographic variables than was postpartum depression, suggesting that depression at these two times may be associated with different psychological or etiological factors.     

Age of onset in chronic major depression: relation to demographic and clinical variables, family history, and treatment response

BACKGROUND: The clinical and etiological significance of the early-late onset distinction in chronic major depressive disorder was explored. METHOD: Subjects were 289 outpatients with DSM-III-R chronic major depression drawn from a multi-site study comparing the efficacy of sertraline and imipramine in the acute and long-term treatment of chronic depression. Patients received comprehensive evaluations using semi-structured interviews and rating scales. RESULTS: Early-onset chronic major depression was associated with a longer index major depressive episode and higher rates of recurrent major depressive episodes, comorbid personality disorders, lifetime substance use disorders, depressive personality traits, and a history of psychiatric hospitalization. In addition, more early-onset patients tended to have a family history of mood disorders. The early-late onset distinction was not associated with differences in symptom severity, functional impairment, or treatment response. LIMITATIONS: Family members were not interviewed directly; there were a large number of statistical comparisons; and interrater reliability of the assessments was not evaluated. CONCLUSIONS: Early-onset chronic major depression has a more malignant course and is associated with greater comorbidity than late-onset chronic major depression.     

Age at onset in geriatric depression: relationship to clinical variables

The significance of age at onset of first depressive episode was evaluated in an elderly depressed population. A prospective study of 71 consecutively admitted inpatients with a diagnosis of major unipolar depression examined the relationship between age at onset of illness and several clinical variables. Subjects divided into early-onset (EO) and late-onset (LO) groups, matched for current age, did not significantly differ in terms of symptomatology, cognitive impairment, physical illness, family history or treatment responsivity. These findings do not support a nosologic separation of EO and LO depression in geriatric patients.     

Self-esteem,optimism, and postpartum depression

This study was conducted to assess the predictive utility of self-esteem and dispositional optimism to postpartum depression. Forty-five British women completed standard measures of self-esteem, optimism, and postpartum depression several weeks before childbirth. Depression was again measured at two and six weeks postpartum. Optimism was associated with less depressive symptoms during pregnancy and at two weeks postpartum, while self-esteem was associated with lower depression over all three administrations. After controlling for optimism and earlier levels of depressive symptoms, self-esteem remained associated with lower levels of depressive symptoms two weeks postpartum. This suggests that self-esteem and not optimism appears to be a reliable contributing factor to the differential susceptibility to depression in the early postpartum period. © 1997 John Wiley & Sons, Inc.     

Effective treatment for postpartum depression is not sufficient to improve the developing mother-child relationship

Maternal depression is prevalent, and puts children at risk. Little evidence addresses whether treatment for maternal depression is sufficient to improve child outcomes. An experiment was conducted testing whether psychotherapeutic treatment for mothers, suffering from major depression in the postpartum period, would result in improved parenting and child outcomes. Participants included depressed women randomly assigned to interpersonal psychotherapy (n = 60) or to a waitlist (n = 60), and a nondepressed comparison group (n = 56). At 6 months, depressed mothers were less responsive to their infants, experienced more parenting stress, and viewed their infants more negatively than did nondepressed mothers. Treatment affected only parenting stress, which improved significantly but was still higher than that for nondepressed mothers. Eighteen months later, treated depressed mothers still rated their children lower in attachment security, higher in behavior problems, and more negative in temperament than nondepressed mothers. Initial response to treatment did not predict reduced risk for poor child outcomes. Early maternal negative perceptions of the child predicted negative temperament and behavior problems 18 months after treatment. Treatment for depression in the postpartum period should target the mother-infant relationship in addition to the mothers' depressive symptoms.     

Psychosocial and demographic predictors of postpartum physical activity

Physical activity promotes better health outcomes across the lifespan, and provides physical and mental health benefits for women who have recently given birth. However, research has not adequately characterized physical activity levels or risk factors for inadequate physical activity during the postpartum period. The objective of the present study was to describe levels and correlates of physical activity at 6 months postpartum in mothers of diverse race/ethnicity (55% African American, 23% White, 22% Hispanic/Latina), with the majority living in or near poverty. We analyzed data collected by the five-site Community Child Health Network study. Women (n?=?1581) were recruited shortly after the birth of a child. Multinomial logistic regression models tested associations of demographic factors and self-reported stress in several life domains with total physical activity levels at 6–9 months postpartum, including activities done at work, at home, for transportation, and leisure. Thirty-five percent of participants in this sample reported low levels of physical activity. African American race, Latina ethnicity, and living in a rural area were associated with low levels of physical activity, whereas working outside the home was associated with high physical activity. Contrary to hypotheses, chronic stress was not associated with physical activity with the exception of financial stress, which predicted greater likelihood of being highly physically active. These findings suggest that optimal postpartum care should integrate physical activity promotion, and that African American, Latina, and rural-dwelling women may benefit most from efforts to promote activity following birth.     

The prevention and psychotherapeutic treatment of postpartum depression

The efficacy of psychotherapeutic interventions for the acute treatment of postpartum depression is strongly supported by empirical data, which suggest that counseling is of benefit as a stand-alone treatment for postpartum depression. Given the paucity of treatment trials using medication for postpartum depression, and the fact that psychotherapeutic interventions do not confer any "exposure" risks to breastfeeding infants, the data also suggest that psychotherapy should be considered a first-line treatment, rather than as an adjunct to medication treatment. There is also some data supporting the use of psychotherapy as a means of preventing postpartum depression, though research is still needed regarding the type of interventions to be used and the types of patients towards whom the interventions should be directed.     

The relationship between maternal attitudes and symptoms of depression and anxiety among pregnant and postpartum first-time mothers

Two studies examined the relationship between maternal attitudes and symptoms of depression and anxiety during pregnancy and the early postpartum period. In the first study, a measure of maternal attitudes, the Attitudes Toward Motherhood Scale (AToM), was developed and validated in a sample of first-time mothers. The AToM was found to have good internal reliability and convergent validity with cognitive biases and an existing measure of maternal attitudes. Exploratory and confirmatory factor analyses determined that the measure comprises three correlated factors: beliefs about others’ judgments, beliefs about maternal responsibility, and maternal role idealization. In the second study, we used the AToM to assess the relationship between maternal attitudes and other psychological variables. The factor structure of the measure was confirmed. Maternal attitudes predicted symptoms of depression and anxiety, and these attitudes had incremental predictive validity over general cognitive biases and interpersonal risk factors. Overall, the results of these studies suggest that maternal attitudes are related to psychological distress among first-time mothers during the transition to parenthood and may provide a useful means of identifying women who may benefit from intervention during the perinatal period.     

An investigation into the relationship between salivary cortisol,stress, anxiety and depression

This study examined the relationship between indices of self-reported emotional distress and absolute versus change in cortisol levels. Fifty-four women attending a diagnostic breast clinic completed scales measuring stress, anxiety and depression and provided five saliva samples over the course of a single day for the measurement of cortisol. No significant relationships were evident between absolute cortisol levels and the distress measures. Analysis of the change in cortisol levels revealed a non-linear interaction effect between stress and anxiety and time of day. There was a non-linear relation between time of day and cortisol levels, but the extent of the non-linearity was dependent upon levels of stress and anxiety, not depression. A relationship was apparent between indices of distress and change in cortisol levels, but not absolute levels of the hormone.     

The relationship between post-traumatic stress disorder, depression and cardiovascular disease in an American Indian tribe

BACKGROUND: Empirical findings suggest that psychiatric illness is associated with cardiovascular disease (CVD). The purpose of this study was to compare the strength of the association of lifetime post-traumatic stress disorder (PTSD) and lifetime major depression on CVD among Northern Plains American Indians.METHOD: A total of 1414 participants aged 18-57 years completed a structured interview that assessed psychiatric diagnoses, alcohol abuse/dependence, self-reported CVD, and traditional CVD risk factors including age, sex, education, diabetes, high blood pressure, and smoking. Logistic regression analyses compared the odds ratios of CVD in participants with and without diagnosed PTSD or major depression.RESULTS:The rates of lifetime PTSD and major depression were 15% and 8% respectively. CVD was more commonly reported by participants with PTSD than by those without PTSD (12% v. 5%, p相似文献   

Applying polygenic risk scores to postpartum depression

The etiology of major depressive disorder (MDD) is likely to be heterogeneous, but postpartum depression (PPD) is hypothesized to represent a more homogenous subset of MDD. We use genome-wide SNP data to explore this hypothesis. We assembled a total cohort of 1,420 self-report cases of PPD and 9,473 controls with genome-wide genotypes from Australia, The Netherlands, Sweden and the UK. We estimated the total variance attributable to genotyped variants. We used association results from the Psychiatric Genomics Consortia (PGC) of bipolar disorder (BPD) and MDD to create polygenic scores in PPD and related MDD data sets to estimate the genetic overlap between the disorders. We estimated that the percentage of variance on the liability scale explained by common genetic variants to be 0.22 with a standard error of 0.12, p?=?0.02. The proportion of variance (R ²) from a logistic regression of PPD case/control status in all four cohorts on a SNP profile score weighted by PGC-BPD association results was small (0.1 %) but significant (p?=?0.004) indicating a genetic overlap between BPD and PPD. The results were highly significant in the Australian and Dutch cohorts (R ²?>?1.1 %, p?R ²?=?0.06 %, p?=?0.08), despite the larger MDD group affording more power. Our results suggest an empirical genetic evidence for a more important shared genetic etiology between BPD and PPD than between BPD and MDD.     

Psychotropic drug use in Northern Ireland 1966-80: prescribing trends, inter- and intra-regional comparisons and relationship to demographic and socioeconomic variables

A study of psychotropic drug prescribing, derived from the computerized pricing data in Northern Ireland from 1966, showed that the use of these drugs reached a peak in 1975, when about 12.5% of the adult population were estimated to have been receiving them, and declined in the following 5 years. Benzodioazepines accounted for three-quarters of all psychotropic drugs prescribed in 1980. Benzodiazepine tranquillizer prescribing was consistently 20-30% higher than in the rest of the United Kingdom, in contrast to hypnotic and antidepressant prescribing which has been consistently lower. The rate of increase in benzodiazepine tranquillizer prescribing was greater than in other European countries, but the level remains lower than in Iceland and Denmark. The influence of a number of demographic and socioeconomic variables was studied in an intra-regional analysis of the 1978 data for the 17 health districts in the province, using multivariate and multiple regression statistics. The prescribing of benzodiazepine hypnotics was almost entirely accounted for by the proportion of elderly (over 65 years) and women aged 45-59 years: neuroleptic prescribing was largely a function of factors associated with rural areas (overcrowding and unemployment) and the proportion of elderly; but neither tranquillizer, antidepressant, barbiturate hypnotic nor psychostimulant prescribing were satisfactorily explained by these variables.