Suicidal ideation and social exchanges among at-risk veterans referred for a behavioral health assessment

Purpose

The current study examined the independent association between positive (e.g., emotional and instrumental support) and negative (e.g., insensitive behavior, unwanted advice from others) social exchanges and suicidal ideation among veterans referred for a behavioral health assessment.

Methods

The sample included 606 veterans [mean age = 54.96 (SD = 14.96)] referred by primary care for a clinical mental health/substance abuse (MH/SA) assessment following a positive MH/SA screen. Data on sociodemographics, MH/SA conditions (e.g., depression, PTSD, anxiety, and alcohol abuse), the self-reported frequency of positive and negative social exchanges, and suicidal ideation were extracted from clinical interviews and evaluated.

Results

Veterans were primarily male, non-married, and had adequate financial resources, and approximately half were White. 74.4 and 20.3 % met criteria for a MH/SA condition and suicidal ideation, respectively. Multiple logistic regression analyses revealed that, adjusting for sociodemographics, physical functioning, and comorbid MH/SA conditions, veterans reporting more frequent negative exchanges with network members were significantly more likely to report suicidal ideation. Positive exchanges, in contrast, were not significantly related to the outcome. Inadequate finances and MH/SA conditions also were significantly related to suicidal ideation.

Conclusions

Findings highlight the value of exploring the quality of social exchanges among veterans in primary care who screen positive for behavioral health issues, as such information has the potential to inform screening and intervention efforts aimed at reducing suicidal ideation.     

Social support and physical activity as moderators of life stress in predicting baseline depression and change in depression over time in the Women’s Health Initiative

Purpose

To determine whether social support and/or physical activity buffer the association between stressors and increasing risk of depression symptoms at baseline and at 3-year follow-up.

Methods

This is a secondary analysis of data from the Women’s Health Initiative Observational Study. 91,912 community-dwelling post-menopausal women participated in this prospective cohort study. Depression symptoms were measured at baseline and 3 years later; social support, physical activity, and stressors were measured at baseline.

Results

Stressors at baseline, including verbal abuse, physical abuse, caregiving, social strain, negative life events, financial stress, low income, acute pain, and a greater number of chronic medical conditions, were all associated with higher levels of depression symptoms at baseline and new onset elevated symptoms at 3-year follow-up. Social support and physical activity were associated with lower levels of depressive symptoms. Contrary to expectation, more social support at baseline strengthened the association between concurrent depression and physical abuse, social strain, caregiving, and low income. Similarly, more social support at baseline increased the association between financial stress, income, and pain on new onset depression 3 years later. Physical activity similarly moderated the effect of caregiving, income, and pain on depression symptoms at baseline.

Conclusion

Stressors, social support, and physical activity showed predicted main effect associations with depression. Multiplicative interactions were small in magnitude and in the opposite direction of what was expected.     

Stressful childhood experiences and health outcomes in sexual minority populations: a systematic review

Purpose

Stressful childhood experiences (SCE) are associated with many different health outcomes, such as psychiatric symptoms, physical illnesses, alcohol and drug abuse, and victimization experiences. Lesbian, gay, bisexual, and transgender (LGBT) people are at risk to be victims of SCE and show higher prevalence of SCE when compared with heterosexual controls.

Methods

This review analyzed systematically 73 articles that addressed different types of SCE in sexual minority populations and included items of household dysfunction. The samples included adults who identified either their sexual orientation as non-heterosexual or their gender identity as transgender.

Results

The studies reported childhood sexual abuse (CSA), childhood physical abuse (CPA), childhood emotional abuse (CEA), childhood physical neglect, and childhood emotional neglect. Items of household dysfunction were substance abuse of caregiver, parental separation, family history of mental illness, incarceration of caregiver, and witnessing violence. Prevalence of CSA showed a median of 33.5 % for studies using non-probability sampling and 20.7 % for those with probability sampling, the rates for CPA were 23.5 % (non-probability sampling) and 28.7 % (probability sampling). For CEA, the rates were 48.5 %, non-probability sampling, and 47.5 %, probability sampling. Outcomes related to SCE in LGBT populations included psychiatric symptoms, substance abuse, revictimization, dysfunctional behavioral adjustments, and others.

Conclusions

LGBT populations showed high prevalence of SCE. Outcomes related to SCE ranged from psychiatric symptoms and disorders to physical ailments. Most studies were based in the USA. Future research should aim to target culturally different LGBT population in the rest of the world.     

Five-year predictive validity of DSM-IV conduct disorder research diagnosis in 4½–5-year-old children

Objective

This longitudinal study of a non-referred, population-based sample tested the 5-year predictive validity of the DSM-IV conduct disorder (CD) research diagnosis in children 4½–5 years of age.

Method

In the E-Risk Study, a representative birth cohort of 2,232 children, mothers were interviewed and teachers completed mailed questionnaires to assess children’s past 6-month CD symptoms. A follow-up assessment was conducted when children were 10 years old.

Results

CD-diagnosed 5-year-olds were significantly more likely than controls to have behavioural and educational difficulties at age 10. Increased risk for age-10 educational difficulties persisted after controlling for age-5 IQ and ADHD diagnosis. Although the majority of CD-diagnosed 5-year-olds had no CD symptoms at age 10, findings suggest that these “remitted” children continued to experience behavioural and educational problems 5 years later despite their apparent remission from CD.

Conclusions

DSM-IV CD symptoms validly identify preschool-aged children who continue to have behavioural and educational problems in middle-childhood.     

Physical activity patterns and risk of depression in young adulthood: a 20-year cohort study since childhood

Purpose

Little is known about how physical activity patterns during childhood and adolescence are associated with risk of subsequent depression. We examined prospective and retrospective associations between leisure physical activity patterns from childhood to adulthood and risk of clinical depression in young adulthood.

Methods

Participants (759 males, 871 females) in a national survey, aged 9–15 years, were re-interviewed approximately 20 years later. Leisure physical activity was self-reported at baseline (1985) and follow-up (2004–2006). To bridge the interval between the two time-points, historical leisure activity from age 15 years to adulthood was self-reported retrospectively at follow-up. Physical activity was categorized into groups that, from a public health perspective, compared patterns that were least beneficial (persistently inactive) with those increasingly beneficial (decreasing, increasing and persistently active). Depression (major depressive or dysthymic disorder) was assessed using the Composite International Diagnostic Interview.

Results

Compared with those persistently inactive, males who were increasingly and persistently active had a 69 and 65 % reduced risk of depression in adulthood, respectively (all p < 0.05). In retrospective analyses, females who were persistently active had a 51 % reduced risk of depression in adulthood (p = 0.01). Similar but non-significant trends were observed for leisure physical activity in females and historical leisure activity in males. Results excluded those with childhood onset of depression and were adjusted for various sociodemographic and health covariates.

Conclusions

Findings from both prospective and retrospective analyses indicate a beneficial effect of habitual discretionary physical activity since childhood on risk of depression in young adulthood.     

Severity of club drug dependence and perceived need for treatment among a sample of adult club drug users in Shanghai,China

Purpose

Examine the severity of club drug dependence and perceived need for treatment, and further identify their determinants among a sample of club drug users in Shanghai, China.

Methods

Two hundred and seventy-six club drug users were recruited using respondent-driven sampling (RDS). Severity of dependence on club drugs was measured using the Severity of Dependence Scale (SDS).

Results

69.9 % reported dependence on club drugs (i.e., SDS ≥ 4) and 36.6 % reported severe dependence (i.e., SDS ≥ 6). One-eighth (12.7 %) perceived need for drug treatment. Severe dependence on club drugs was more likely among those who reported recent use of ecstasy and those who had more depressive symptoms, but less likely among those reporting recent use of methamphetamine. Perceived need for treatment was more likely among those who lived with a spouse or boy/girlfriend, but less likely among those had prior drug treatment experience and more severe club drug dependence.

Conclusions

Our findings suggest that educational activities should be implemented to raise public awareness about the powerful addictive properties of club drugs, along with efforts to reduce stigma towards drug abuse and psychiatric disorders. Programs to motivate drug users to seek treatment and encourage treatment linkage are urgently needed.     

Symptomatic and functional recovery in depression in later life

Objectives

Functional limitations give an indication of the total impact of diseases, such as depression, on individuals health and recovery. This study examines the change in several domains of functioning over 2 years in older persons depressed at baseline (non-remitted group and remitted group after 2 years) and in a non-depressed comparison group.

Methods

Data were used from a cohort study (Netherlands Study of Depression in Older persons [NESDO]) consisting of depressed older persons ≥?60 years (N?=?378) and a non-depressed comparison group (N?=?132) with 2 years of follow-up (attrition rate 24%). Functional limitations (outcome) were assessed with the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire every 6 months. Total scores and domain scores were used. Depression was classified according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria at baseline and at 2-year follow-up. Severity of depression (predictor) was assessed with the Inventory of Depressive Symptomatology (IDS) at 6-month intervals.

Results

Linear mixed models showed that the level of functional limitations differed between the three groups during 2 years of follow-up. The non-remitted group had the highest level of functional limitations during 2 years, followed by the remitted group. Stable low levels of functional limitations were found for the non-depressed group. Remission from depression was accompanied by improvements in functioning, however, compared to the non-depressed comparison group significant functional limitations remained. Higher severity of depression appeared as risk factor for a declining course of functioning, especially the social aspects of functioning.

Methodological considerations

Participants that were more severely depressed and more functionally impaired at baseline had higher attrition rates than the participants that were included in the analytical sample.

Conclusion

This study showed that depression in later life has long-term debilitating effects on functioning, enduring even after remission from depression. This implies that depression treatment in later life should aim broader than just symptomatic recovery, but also include functional recovery.

     

Stress and development of depression and heavy drinking in adulthood: moderating effects of childhood trauma

Purpose

Studies suggest that childhood trauma is linked to both depression and heavy drinking in adulthood, and may create a lifelong vulnerability to stress. Few studies have explored the effects of stress sensitization on the development of depression or heavy drinking among those who have experienced traumatic childhood events. This study aimed to determine the effect of childhood trauma on the odds of experiencing depression or heavy drinking in the face of an adult life stressor, using a large population-based Canadian cohort.

Methods

A total of 3,930 participants were included from the National Population Health Survey. The associations among childhood trauma, recent stress and depression/heavy drinking from 1994/1995 to 2008/2009 were explored using logistic regression, as were interactions between childhood trauma and recent stress. A generalized linear mixed model was used to determine the effects of childhood trauma and stressful events on depression/heavy drinking. Analyses were stratified by sex.

Results

Childhood trauma significantly increased the odds of becoming depressed (following 1 event: OR = 1.66; 95 %CI 1.01, 2.71; 2+ events, OR = 3.89; 95 %CI 2.44, 6.22) and drinking heavily (2+ events: OR = 1.79; 95 %CI 1.03, 3.13). Recent stressful events were associated with depression, but not heavy drinking. While most interaction terms were not significant, in 2004/2005 the association between recent stress and depression was stronger in those who reported childhood trauma compared to those with no childhood trauma.

Conclusions

Childhood trauma increases risk for both depression and heavy drinking. Trauma may moderate the effect of stress on depression; the relationship among trauma, stress and heavy drinking is less clear.     

Verläufe von Traumafolgen bei ehemaligen politisch Inhaftierten der DDR

Background

In a sample of ex-political prisoners in the GDR examined in the middle of the 1990s, a follow-up examination carried out 15 years later investigated alterations in the diagnosis and symptom prevalence of post-traumatic stress syndrome PTSS) as well as other psychiatric disorders. The diagnosis course given by the clinicians was compared with the retrospective subjective estimations by participants.

Methods

A total of 93 ex-political prisoners participated in the follow-up study (85 %) with an average age of 64 years. Diagnoses and symptoms were collated using structured clinical interviews and questionnaires. The retrospective subjective estimation of progression of the participants was calculated using a PTSS symptom index based on four symptom groups (intrusions, avoidance, numbing and hyperarousal).

Results

At the time of follow-up PTSS was present in 33 % of participants (in 1997 it was 29 %). In 1994 this was present in only approximately 50 % of cases and in the other 50 % it concerned newly incident or remission cases. The next most common diagnoses were major depression episodes (26 %), panic (with or without agoraphobia 24 %) and somatoform disorders (19 %). In the PTSS symptom profile intrusions, flashbacks and alienation feelings decreased with time but in contrast irritability and shock reactions increased. The subjective self-estimation of the course of PTSS symptoms by the participants often gave a resilient (never PTSS) or delayed and rarely a remission course pattern in comparison to the diagnosing clinicians.

Conclusions

The results indicate a trauma-related long-term morbidity which is, however less stable than previously assumed.     

The course of postdisaster psychiatric disorders in directly exposed civilians after the US Embassy bombing in Nairobi, Kenya: a follow-up study

Purpose

While disasters are common in Africa, disaster studies in Africa are underrepresented in the published literature. This study prospectively examined the longitudinal course of psychopathology, coping, and functioning among 128 directly exposed Kenyan civilian survivors of the 1998 US Embassy bombing in Nairobi.

Methods

The Diagnostic Interview Schedule/Disaster Supplement assessed predisaster and postdisaster psychiatric disorders and variables related to coping, functioning, safety, and religion near the end of the first and third postdisaster years.

Results

Total postdisaster prevalence of posttraumatic stress disorder (PTSD) at the 3-year follow-up was 49; 28 % of the sample still had active PTSD. Delayed-onset PTSD was not observed. Posttraumatic symptoms decayed more slowly in individuals with than those without PTSD. PTSD was more prevalent and chronic than major depression. Those with current PTSD or major depression reported more functioning problems than those without. The length of hospitalization for injuries after the bombing predicted major depression remission, but no predictors of PTSD remission were found.

Conclusions

Despite differences in coping and social variables, longitudinal psychopathology in the Nairobi terrorism survivors appeared broadly similar to results in Western disaster populations. These findings contribute to the understanding of disaster mental health in Africa and may have implications for generalizability of psychiatric effects of terrorist attacks around the globe.     

Childhood Sexual Abuse and Sociodemographic Factors Prospectively Associated with Intimate Partner Violence Perpetration Among South African Heterosexual Men

Background

Intimate partner violence directed at women by men continues to be a global concern. However, little is known about the factors associated with perpetrating intimate partner violence among heterosexual men.

Purpose

History of childhood sexual abuse and other sociodemographic variables were examined as potential factors associated with severe intimate partner violence perpetration toward women in a sample of heterosexual men in South Africa.

Methods

Longitudinal logistic generalized estimating equations examined associations of childhood sexual abuse and sociodemographic variables at baseline with intimate partner violence perpetration at subsequent time points.

Results

Among participants with a steady female partner, 21.81 % (190/ 871) reported perpetrating intimate partner violence in the past year at baseline. Having a history of childhood sexual abuse (p < .001), binge drinking (p = .002), being employed (p = .050), and more difficulty controlling sexual impulses in order to use a condom (p = .006) at baseline were associated with self-reported intimate partner violence perpetration in the past year at subsequent time points.

Conclusions

With high levels of recent severe physical and/or sexual intimate partner violence perpetration in South Africa, comprehensive interventions are urgently needed. To more fully address gender-based violence, it is important to address associated factors, including exposure to childhood sexual abuse that could impact behavior later in life and that have long-lasting and deleterious effects on men and their female partners.

     

Gastric emptying in postural tachycardia syndrome: a preliminary report

Purpose

Autonomic neuropathy is widely recognized to be associated with upper gastrointestinal symptoms and abnormal (i.e., rapid or slow) gastric emptying. While patients with postural orthostatic tachycardia syndrome (POTS) may also have gastrointestinal symptoms, our understanding of gastric-emptying disturbances in POTS is very limited. The objectives of this study were to evaluate the relationship between gastric-emptying disturbances and gastrointestinal symptoms in patients with POTS.

Methods

We retrospectively reviewed the medical records of 22 well-characterized patients with POTS and upper gastrointestinal symptoms in whom autonomic (i.e., postganglionic sudomotor, cardiovagal, and adrenergic) functions and gastric emptying were evaluated using standardized techniques and scintigraphy, respectively. Medical records were reviewed retrospectively to assess clinical features, gastric emptying, and autonomic functions.

Results

Over 70 % of patients had nausea and/or vomiting, which was the most common GI symptom; other common symptoms were abdominal pain (59 %), bloating (55 %), and postprandial fullness/early satiety (46 %). Over one-third of patients had abnormal [i.e., rapid (27 %) or delayed (9 %)] gastric emptying. Gastric-emptying disturbances were not significantly associated with GI symptoms, autonomic symptoms or autonomic dysfunction.

Conclusions

Over one-third of patients with POTS and gastrointestinal symptoms have abnormal, more frequently rapid than delayed gastric emptying. These findings need to be confirmed in a larger cohort of patients.     

Conduct disorder behaviors, childhood family instability, and childhood abuse as predictors of severity of adult homelessness among American veterans

Purpose

Despite US federal efforts to end and prevent homelessness among veterans, there has been limited examination of pre-military factors like childhood problems, associated with adult homelessness. This study examined childhood problems among homeless veterans and its relation to severity of homelessness and outcomes in supported housing.

Methods

Using data from 1,161 homeless veterans at 19 sites enrolled in the Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program, three types of childhood problems were examined: conduct disorder behaviors, family instability, and childhood abuse. Multiple regressions were conducted to examine the association between childhood problems and severity of homelessness before supported housing, and childhood problems and outcomes after supported housing.

Results

About one-third reported conduct disorder behaviors, over half reported family instability, and 40 % reported childhood abuse. Greater childhood problems were found in this sample compared to published samples of non-homeless veterans. Conduct disorder behaviors, family instability, and childhood abuse were each weakly associated with lifetime homeless episodes. One year after enrollment in the HUD-VASH program, past conduct disorder behaviors and family instability were not predictive of outcomes, except childhood abuse was related to less social support and lower quality of life.

Conclusions

These findings demonstrate not only the potential impact of childhood abuse on social relationships and quality of life in adulthood, but also the resilience of homeless veterans from adverse childhoods to be successfully housed in a supported housing program.     

Depression and Anxiety Following Myocardial Infarction and Their Inverse Associations with Future Health Behaviors and Quality of Life

Background

Post-myocardial infarction (MI) depression and anxiety were found to predict prognosis and quality of life.

Purpose

The purpose of this study was to test a behavioral pathway from post-MI depression/anxiety to future quality of life.

Methods

This is a longitudinal cohort study. Five hundred forty patients (≤65 years old) filled out questionnaires after a first MI, including socio-demographics, pre-MI health status and behaviors, MI severity, social support, sense of coherence, depression, and anxiety. Reports of health behaviors were obtained 5 years and of quality of life 10 years later.

Results

A structural equations model confirmed that depression and anxiety were directly related to poorer quality of life 10 years later. These relationships were partly mediated by a positive association between anxiety and health behaviors at 5 years and a negative one between depression and health behaviors.

Conclusions

The opposite effects of anxiety and depression underscore the need to attend to both emotional reactions to MI while encouraging preventive health behaviors.     

Longitudinal Relationships Between Depression and Functioning in People with Type 2 Diabetes

Background

The reciprocal relationship between depression and functioning in people with chronic conditions is poorly understood.

Purpose

The aim of the present study was to analyze the dynamic relationship between depression and functioning in a community sample of people with diabetes.

Methods

Participants with diabetes were assessed at baseline and three yearly follow-up assessments (n?=?1,403). Depression was assessed using the Patient Health Questionnaire. Global functioning was assessed using the World Health Organization Disability Assessment Schedule II.

Results

Path analysis suggested a reciprocal relationship between depression and functioning. Baseline depression was associated with functioning at 3 years follow-up through depression and functioning at 1 and 2 years follow-up assessments.

Conclusions

Depression and functioning might interact with each other in a dynamic way: depression at one assessment point might predict poor functioning at the next assessment point, which in turn might predict depression at the next assessment point. This should be taken into account in both treatment and research programs.     

Changes in Condom Use During the First Year of HIV Treatment in Uganda and the Relationship to Depression

Purpose

We examined the effect of antiretroviral therapy (ART), and the predictive role of depression, on condom use with primary partners.

Methods

Data from three studies in Uganda were combined into a sample of 750 patients with a primary sex partner, with 502 starting ART and 248 entering HIV care, and followed for 12 months. Random-effects logistic regression models were used to examine the impact of ART, and the influence of baseline level and change in depression, on condom use with primary partners.

Results

At month 12, 61 % ART and 67 % non-ART patients were consistent condom users, compared to 44 and 41 % at baseline, respectively. Multivariate analysis revealed that consistent condom use increased similarly for ART and non-ART patients, and that minor depression at baseline and increased depression over time predicted inconsistent condom use.

Conclusions

Improved depression diagnosis and treatment could benefit HIV prevention.     

Abuse and other correlates of common mental disorders in youth: a cross-sectional study in Goa, India

Purpose

There is a paucity of known correlates of common mental disorders (CMDs) among the youth age group in India. This analysis aims to determine risk factors associated with a probable diagnosis of CMD in a youth sample in India.

Methods

This is a secondary analysis of data collected via a door-to-door (community) survey of 3,662 youth (aged 16–24 years) in selected urban and rural areas in Goa. The urban and rural areas were selected based on their engagement with a Goan-based mental health charity organisation, Sangath. Point prevalence of CMD was estimated using the general health questionnaire-12 (GHQ-12). Multivariate logistic regression analyses determined factors associated with CMD and associations were stratified by gender.

Results

In total, 3,649 (1,796 urban; 1,853 rural) youth were assessed for probable diagnosis of CMD. There was an almost equal ratio of males (49 %) to females (51 %) in the sample. During the time of the survey, 91 % of the sample was residing with parents, with 83 % being between the ages of 22 and 24 years living with parents. A small proportion of the sample never attended school (1.1 %) with the rest either educated, employed or unemployed. The point prevalence of probable CMD in the sample was 7.87 %; 95 % CI 7.01–8.80 %. Those living in urban areas had a higher prevalence of CMD (9.12 %; 95 % CI 7.90–10.52 %) compared to those living in rural areas (6.60 %; 95 % CI 5.50–7.82 %). After adjusting for a range of potential confounders, independent risk factors for CMD were being older, i.e., between 22- and 24-years old, (OR 1.60; 95 % CI 1.10–2.24; p = 0.015), residing in urban areas (OR 1.51; 95 % CI 1.12–2.04; p = 0.007), physical abuse (beaten in the last 3 months) by parents, teachers or others (OR 3.10; 95 % CI 2.11–4.51; p < 0.001), sexual harassment (OR 2.01; 95 % CI 1.30–3.20; p = 0.003) and sexual abuse (OR 2.54; 95 % CI 1.94–3.33; p < 0.001). Being able to talk about personal problems (OR 0.52; 95 % CI 0.34–0.80; p = 0.003) was a protective factor. After stratifying by gender, sexual harassment, physical and sexual abuse were associated with a likely CMD diagnosis in females and males.

Conclusions

Sexual and recent physical abuses were independent risk factors for CMD in both genders. In addition, being older and being able to discuss problems were associated with CMD diagnosis in females but not in males.     

The influence of different types of war experiences on depression and anxiety in a Ugandan cohort of war-affected youth: the WAYS study

Background

War experiences (WE) are frequently associated with mental health problems. Whether different types of WE vary in predicting which problem, or how severe, in former child soldiers (FCS) remains unknown.

Methods

Using data from the first wave of an on-going longitudinal cohort study (the WAYS study), we investigated relations between types of WE and symptoms of depression/anxiety among FCS in Northern Uganda (N = 539, baseline age = 22.39; SD = 2.03, range 18–25). Using robust Maximum Likelihood estimation in SEM, regression analyses were performed to relate binary indicators of types of WE to a single latent factor capturing symptoms of depression/anxiety.

Results

SEM results showed that “direct personal harm”, “witnessing violence”, “deaths”, “threat to loved ones”, “involvement in hostilities”, and “sexual abuse” indicators were related to reported symptoms of depression/anxiety irrespective of gender and age. Multivariable models revealed independent associations of “witnessing violence” (β = 0.29, SE = 0.09, p < 0.001) and “deaths” (β = 0.14, SE = 0.05, p < 0.001) with symptoms of depression/anxiety in both sexes. “Sexual abuse” (β = 0.32, SE = 0.16, p < 0.001) independently predicted symptoms of depression/anxiety for female but not male youths whilst “threat to loved ones” (β = 0.13, SE = 0.07, p < 0.05) independently predicted symptoms of depression/anxiety in male but not female youths.

Conclusions

Dimensions of WE predicted symptoms of depression/anxiety differently, but it is hard to establish their causal status. Our findings suggest that it might be fruitful to consider such exposure variations of WE when designing interventions to mitigate the symptoms of depression/anxiety on male and female FCS.     

Major depression in young girls is related to altered cortisol awakening response

Background

There is evidence that clinical depression is associated with elevated basal cortisol levels in adult patients.

Objective

The present investigation tries to find out, whether this relationship also holds true in adolescents with major depression.

Methods

For 131 female subjects (63 MDD, 68 controls) the cortisol awakening response (CAR) was measured at 0, 30, 45, and 60 min after awakening. All subjects provided saliva cortisol.

Results

A significantly higher CAR was found in patients. The global mean difference was due to differences 60 and 45 min after awakening.

Limitations

A causal interpretation of the data is restricted, because of its cross-sectional nature. The effect size of the mean differences is rather small.

Conclusion

The observed HPA hyperactivity may be a cause as well as a consequence of depression in childhood.     

Trauma and current symptoms of PTSD in a South East London community

Purpose

This study aimed to estimate the prevalence of symptoms of post-traumatic stress disorder (PTSD) and its association with traumatic events in a representative sample of an inner city population in the UK.

Methods

A representative community sample of 1,698 adults, aged 16 years and over, from two south London boroughs were interviewed face to face with structured survey questionnaires.

Results

The prevalence of current symptoms of PTSD was 5.5 %. Women were more likely to screen positive (6.4 %) than men (3.6 %), and symptoms of PTSD were high in the unemployed (12.5 %), in those not working because of health reasons (18.2 %) and in the lowest household income group (14.8 %). Most (78.2 %) of the study population had lifetime trauma and more than a third (39.7 %) reported childhood trauma. There was an independent association between childhood as well as lifetime trauma and current symptoms of PTSD and a gradient association between an increase in cumulative traumatic events and the likelihood of reporting symptoms of current PTSD (OR 1.8, 95 % CI (1.6–2.1)). Although we observed the highest prevalence of current symptoms of PTSD in those migrated for asylum or political reason (13.6 %), compared to the non-migrants, the prevalence of exposure to most traumatic life events was higher in the non-migrant group.

Conclusion

The present study demonstrates the high prevalence of exposure to trauma in a South East London community and the cumulative effect on current symptoms of PTSD. As PTSD is a condition which is associated with disability and co-morbidity, the association of current PTSD with common adversities in the community should be noted.