The relationship between depressive symptoms and subjective well-being in newly admitted patients with schizophrenia

Background

Depressive symptoms are common in schizophrenia and are considered core features of the disorder. The purpose of the present study was to examine the relationship between depressive symptoms and subjective well-being in newly admitted patients with schizophrenia.

Methods

Eighty newly admitted patients were comprehensively evaluated for subjective well-being, schizophrenic symptoms, and depressive symptoms using the Subjective Well-Being Under Neuroleptics Scale (SWN), the Positive and Negative Syndrome Scale (PANSS), and the Beck Depression Inventory. Correlation coefficients were obtained between depressive symptoms and subjective well-being while controlling for the influence of the severity of psychotic symptoms, extrapyramidal side effect, and subjective attitude toward antipsychotics, as assessed by the PANSS, the Drug-Induced Extrapyramidal Symptoms Scale, and the Drug Attitude Inventory, respectively.

Results

The SWN score had a significant negative correlation with the PANSS depression factor score (P < .001). Correlation analysis also revealed a significant negative correlation between the SWN score and the Beck Depression Inventory score (P < .001).

Conclusions

The results of our study suggest that depressive symptoms are significantly associated with a low subjective well-being in newly admitted patients with schizophrenia and that the relationship is significant even after controlling for the influence of potential confounding variables. Detection and appropriate management of depressive symptoms in schizophrenic patients may affect their perceptions of their own well-being.     

Prevalence of depression and correlates of depressive symptoms for residents in the urban part of Jeju Island, Korea

AIMS: This study examined the prevalence of depression and depressive symptoms, and the correlates of depressive symptoms, and proposes some methods for reducing risk of depression in residents of the urban part of Jeju Island in Korea. METHODS: In all, 1050 residents were selected using multiphasic cluster sampling to represent each district. Of the 981 respondents, 413 were men and 568 were women. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to evaluate depression (CES-D score over 25) and depressive symptoms (CES-D score over 21). Multiple logistic regression analysis was performed for comparisons. RESULTS: The prevalence of depression in males and females was comparable, at 9.47 and 11.36%, respectively. The prevalence of depressive symptoms in men was 15.01%, while in women the level rose to 18.37%. Those with high self-assessed level of stress scores were significantly more likely to have depressive symptoms than those with low self-assessed level of stress scores (odds ratio (OR) = 5.73 (95% confidence interval (95% CI), 1.29-25.36)). Residents at high risk of problem drinking (CAGE score over 3) were significantly more likely to have depressive symptoms than those with a CAGE score under 1 (OR = 3.43 95% CI, 1.77-6.66). Respondents who slept poorly had more depressive symptoms than respondents who slept well (OR = 2.11 95% CI, 1.37-3.23). Females were significantly more likely to have more depressive symptoms than males (OR = 1.70 95% CI, 1.08-2.68). CONCLUSIONS: The prevalence of depression and depressive symptoms in urban Jeju Island is similar to that in a nation-wide sample. By providing intensive mental health services to those who have high stress levels, problem drinking, and poor health behavior, early detection of depressive symptoms in the community will be important for improving general health status.     

Donald W. Winnicott,Martin Buber and the Theory of Personal Relationships†

Background: Affective temperaments have been shown to be related to psychiatric disorders and suicidal behaviors. Less is known about the potential contributory role of affective temperaments on suicide risk factors. In the present study, we investigated whether the effect of affective temperaments on suicide risk was mediated by other variables, such as hopelessness, mentalization deficits, dissociation, psychological pain, and depressive symptoms. Methods: Several assessment instruments, including the Mini International Neuropsychiatric Interview (MINI); the Temperament Evaluation of Memphis, Pisa, and San Diego Autoquestionnaire (TEMPS-A); the Beck Hopelessness Scale (BHS); the Gotland Male Depression Scale (GMDS); the Dissociative Experiences Scale (DES); the Psychological Pain Assessment Scale (PPAS); and the Mentalization Questionnaire (MZQ), were administered to 189 psychiatrically hospitalized patients (103 women, 86 men) in Rome, Italy. Results: In single-mediator models, hopelessness, depressive symptoms, and mentalization, but not psychological pain or dissociation, were significant mediators in the association between prevalent temperament and suicide risk. In a multiple-mediator model, a significant indirect effect was found only for depression. Results demonstrated that patients with negative temperaments reported higher suicide risk, psychological pain, hopelessness, and depression, and less mentalization than patients with no prevalent temperament or hyperthymic temperaments. Conclusions: Hopelessness, depression, and mentalization are all factors that mediate the relation between affective temperaments and suicide risk. Identifying factors that mediate the effects of affective temperamental makeup on suicide risk should enhance screening and intervention efforts.     

A cross-sectional study of mental health and well-being and their associations in the UK veterinary profession

Background

Veterinary surgeons are at elevated risk of suicide, with a proportional mortality ratio around four times that of the general population and approximately twice that of other healthcare professions. There has been much speculation regarding possible mechanisms underlying increased suicide risk in the profession but little empirical research. We aimed to assess the contribution of mental health and well-being to the elevated risk, through a postal questionnaire survey of a large stratified random sample of veterinary surgeons practising within the UK.

Methods

A questionnaire was mailed twice to 3,200 veterinary surgeons. Anxiety and depressive symptoms, alcohol consumption, suicidal ideation, positive mental well-being, perceptions of psychosocial work characteristics, and work–home interaction were assessed using valid and reliable existing instruments and a series of bespoke questions previously developed through informal focus groups.

Results

Evaluable questionnaires were returned by 1,796 participants, a response rate of 56.1%. The demographic and occupational profile of respondents was representative of the UK veterinary profession. The prevalence of ‘caseness’ (i.e. HADS subscale score ≥8) for anxiety, depression, and co-morbid anxiety and depression was 26.3, 5.8 and 4.5%. 5.4% of respondents were non-drinkers, 32.0% low-risk drinkers, and 62.6% ‘at-risk’ drinkers (i.e. AUDIT-C score ≥4 for women, ≥5 for men). The 12-month prevalence of suicidal thoughts was 21.3%.

Conclusions

Compared to the general population, the sample reported high levels of anxiety and depressive symptoms; higher 12-month prevalence of suicidal thoughts; less favourable psychosocial work characteristics, especially in regard to demands and managerial support; lower levels of positive mental well-being; and higher levels of negative work–home interaction. The levels of psychological distress reported suggest ready access to and knowledge of lethal means is probably not operating in isolation to increase suicide risk within the profession.     

The relationship between alexithymia and perinatal depressive symptomatology

OBJECTIVE: The purpose of this study was to examine the relationship between alexithymia and perinatal depressive symptoms and the stability of the alexithymia construct in a sample of low-income, predominantly Latina women during pregnancy and the early postpartum period. METHODS: Seventy-seven pregnant women completed self-report questionnaires and were classified as "high risk" or "low risk" for developing a major depressive episode based on a history of depression and/or current high depressive symptom scores. Measures included the Toronto Alexithymia Scale, the Center for Epidemiological Studies Depression Scale, and the Maternal Mood Screener, and were completed during pregnancy and at postpartum month 2. RESULTS: Alexithymia was positively associated with depressive symptoms during pregnancy and early postpartum. Women at high risk for depression had significantly higher alexithymia levels than low-risk women during pregnancy but not during postpartum. Alexithymia and depressive symptoms were independently and strongly correlated across the ante- and postpartum periods. Hierarchical regression analyses indicate that alexithymia scores at postpartum were predicted by alexithymia scores during pregnancy, above and beyond the variance explained by the depressive symptom scores during pregnancy and postpartum. CONCLUSION: Alexithymia is positively correlated with depressive symptoms during the perinatal period and is a stable phenomenon.     

Risk and promotive factors related to depressive symptoms among Japanese youth

Symptoms of depression include feelings of sadness, loneliness, suicidal ideation, and self-dislike. Adolescent depression is viewed as a problem in Japan, but there is little research on the correlates of depression in Japanese youth. Therefore, the purpose of this study was to investigate the prevalence of depression in Japanese youth and to examine correlates of depression using a risk and promotive factor framework. This study examined the symptoms of depression among 802 Japanese youth attending postsecondary schools in the Sapporo area. Separate analyses were conducted for males and females to determine whether the importance of risk and promotive factors varied by gender. The results showed that many factors that had been linked to depressive symptoms in Western samples were predictive of depressive symptoms in Japanese youth. The risk and promotive factors accounted for 50% and 59% of the variance in depressive symptoms for the female and male subsamples, respectively.     

Saliva testosterone and cortisol in male depressive syndrome,a community study. The Sudurnesjamenn Study

Abstract

Introduction: The association between testosterone levels and depression is unclear. The relationship has been described as complex, i.e. more U (J)-shaped than linear in some previous studies. Aim: The primary aim of this study was to examine the relationship between saliva testosterone level variations and different levels of male depressive symptoms in a community sample. The secondary aim was to investigate whether simultaneous testing of evening cortisol and testosterone improved the detection of depression. Methods: In a community study, 534 males were screened, using the Beck Depression Inventory (BDI), the Gotland Male Depression Scale (GMDS) and the Montgomery–Åsberg Depression Rating Scale (MADRS). Those with signs of depression (n = 65) and randomly selected controls (n = 69) had psychiatric evaluation for depressive disorder. In a sub-sample (n = 51) saliva testosterone was measured twice on a single day. Results: Testosterone morning values were significantly higher than evening values (236 vs. 145 pg/ml, P = 0.009). Evening testosterone was significantly higher in depressive males, according to both MADRS (P = 0.028) and BDI (P = 0.036). Having depression increased the likelihood of being in the highest third of testosterone levels (BDI P = 0.021; MADRS P = 0.018). Positive correlation was between total BDI score and elevated evening testosterone with and without psychotropics (P = 0.017; P = 0.002). Correlation was between elevated evening cortisol and evening testosterone levels (P = 0.021) though simultaneous testing did not increase specificity of detecting depression. Conclusion: Evening saliva testosterone measurements seem the most informative, as they correlate with male depressive syndrome. Simultaneous testing for evening cortisol and evening testosterone levels did not increase specificity for clinical diagnosis of depressive disorder.     

Depressive symptoms during adolescence: comparison between epidemiological and high risk sampling

Purpose

Both epidemiological (unselected) and high risk (screening on known risk criteria) samplings have been used to investigate the course of affective disorders. Selecting individuals on multiple risk criteria may create a sample not comparable to individuals with similar risk criteria within the general population. This study compared depressive symptoms across the two sampling methods to test this possibility.

Methods

The high risk Cambridge Hormones and Moods Project (CHAMP) screened and recruited adolescents aged 12 to 16. A total of 905 (710 high risk) individuals participated and were reassessed at three follow-ups. The ROOTS epidemiological sample consisted of 1,208 14-year-olds reassessed at 15.5 and 17?years. The risk profile for CHAMP was recreated in the ROOTS study. Both samples completed the Moods and Feelings Questionnaire, a self-report measure of current depressive symptoms.

Results

Comparing individuals with the same high risk profiles across the CHAMP and ROOTS studies revealed no significant differences in mean depression scores. Combining the samples revealed that for females, mean depression scores were maintained from 12 to 15?years then declined by 17?years. For males, scores declined from 12 throughout adolescence. High risk status led to consistently higher levels of depressive symptoms in female adolescents but result in little change within male adolescents.

Conclusions

The high risk design recruited adolescents with a depression symptoms profile comparable to the general population for both sexes. High risk status may alter the trajectory of depressive symptoms in female adolescents only. Males may be less sensitive to recent adversity.     

Psychological Distress for African-American Adolescent Males: Exposure to Community Violence and Social Support as Factors

This study examined exposure to community violence and depressive and post-traumatic stress disorder (PTSD) symptoms within a non-random sample of low-income, African-American male adolescents. The moderating effect of social support on these relationships was also examined. Seventy-seven African-American adolescent males were recruited from an inner-city, Midwestern high school and surveyed on exposure to violence, depression, post-traumatic stress, and social support. Regression analyses revealed that exposure to violence was significantly associated with both depressive and PTSD symptoms. However, social support was not found to moderate the relationship between exposure to community violence and psychological distress. Implications for intervention are discussed.     

Depressive symptoms in chronically ill elderly people in residential homes

Physical ill health is known to be a risk factor for depression. However, little is known about the relationship between chronic illness and depression in older people living in residential homes. This study looked at the differences in the level of depressive symptoms between patients with different types of chronic illness, and the relationship between chronic illness and depression when other risk factors of depression were controlled for. Four hundred and twenty-four people living in residential homes in the Netherlands were included in the study. Residents with cognitive impairment were excluded. The degree of depression was assessed with the Geriatric Depression Scale (GDS) and psychological distress was measured with the MOS-SF-20 mental health sub-scale. Other risk factors included functional impairment, earlier depression, degree of pain, life events and social support. Few residents had no chronic illness and almost half of them had more than one illness. There was only modest evidence to suggest that chronic illnesses were related to depressive symptomatology or psychological distress. However, other risk factors were found to be much stronger predictors of depression and psychological distress. The results should be treated with caution because of the limitations of the study. Nevertheless, the results suggest that chronic illness is not the best predictor of depression in people living in residential care homes.     

Predictors of somatic symptoms in depressive disorder

We explored the relative contribution of potential psychological predictors of somatic symptoms in outpatients with major depressive disorder, including; 1) severity of depression; 2) general anxiety; 3) hypochondriacal worry; 4) somatosensory amplification; and, 5) alexithymia by sampling 100 consecutive outpatients with DSM-IV diagnoses of major depressive disorder attending the psychiatry clinics of general hospitals in Turkey. The subjects were rated by clinicians on depressive symptomatology (Hamilton Depression Rating Scale), and anxiety (Hamilton Anxiety Scale), and completed self-report measures of Hypochondriacal worry (7-item version of the Whiteley Index), the Somatosensory Amplification Scale, and the Toronto Alexithymia Scale. Multivariate models tested the independent contribution of each of the scales to the level of somatic symptoms as measured by a modified version of the SCL-90 somatization scale. At the bivariate level, somatic symptoms were associated with female gender and lower educational level, as well as the Hamilton Depression and Anxiety scales, the Whitely Index, and the Somatosensory Amplification and Alexithymia scales. In multiple regression models incorporating all variables, female gender and higher scores on the anxiety, somatosensory amplification and alexithymia scales all made independent contributions to the level of somatic symptoms and accounted for 54% of the variance. Therefore, somatic symptoms in depression are related to concomitant anxiety, tendency to amplify somatic distress, and difficulty identifying and communicating emotional distress. However, these factors do not account for the tendency for women to report more somatic symptoms.     

Genetic Liability for Depression,Social Factors and Their Interaction Effect in Depressive Symptoms and Depression Over Time in Older Adults

ObjectivesThe objectives of this study were to investigate the effect of genetic and social factors on depressive symptoms and depression over time and to test whether social factors moderate the relationship between depressive symptoms and its underlying genetics in later life.MethodsThe study included 2,279 participants with a mean follow-up of 15 years from the Longitudinal Aging Study Amsterdam with genotyping data. The personal genetic loading for depression was estimated for each participant by calculating a polygenic risk scores (PRS-D), based on 23,032 single nucleotide polymorphisms associated with major depression in a large genome-wide association study. Partner status, network size, received and given emotional support were assessed via questionnaires and depressive symptoms were assessed using the CES-D Scale. A CES-D Scale of 16 and higher was considered as clinically relevant depression.ResultsHigher PRS-D was associated with more depressive symptoms whereas having a partner and having a larger network size were independently associated with less depressive symptoms. After extra adjustment for education, cognitive function and functional limitations, giving more emotional support was also associated with less depressive symptoms. No evidence for gene-environment interaction between PRS-D and social factors was found. Similar results were found for clinically relevant depression.ConclusionGenetic and social factors are independently associated with depressive symptoms over time in older adults. Strategies that boost social functioning should be encouraged in the general population of older adults regardless of the genetic liability for depression.     

Test of the depression distress amplification model in young adults with elevated risk of current suicidality

Suicide is a leading cause of death among young adults and the rate of suicide has been increasing for decades. A depression distress amplification model posits that young adults with comorbid depression and anxiety have elevated suicide rates due to the intensification of their depressive symptoms by anxiety sensitivity cognitive concerns. The current study tested the effects of anxiety sensitivity subfactors as well as the depression distress amplification model in a very large sample of college students with elevated suicide risk. Participants were 721 college students who were at elevated risk of suicidality (scored>0 on the Beck Scale for Suicide Ideation). Consistent with prior work, anxiety sensitivity cognitive concerns, but not physical or social concerns, were associated with suicidal ideation. Consistent with the depression distress amplification model, in individuals high in depression, anxiety sensitivity cognitive concerns predicted elevated suicidal ideation but not among those with low depression. The results of this study corroborate the role of anxiety sensitivity cognitive concerns and the depression distress amplification model in suicidal ideation among a large potentially high-risk group of college students. The depression distress amplification model suggests a specific mechanism, anxiety sensitivity cognitive concerns, that may be responsible for increased suicide rates among those with comorbid anxiety and depression.     

Recognition of depressive symptoms in the elderly: what can help the patient and the doctor

The general public heavily underrecognizes depression and depressive symptoms. This underrecognition is more pronounced among elderly people, and this study is an initial attempt to quantify the problem in a Greek elderly sample. Additionally the authors attempt to identify patient-related factors, which can assist a subject to recognize the depressive symptoms and the general practitioner to note their existence. Members of senior citizen centers (n = 682) participated in presentations about "depression in the elderly" and completed a questionnaire including the GDS-4 scale, four questions concerning depression risk factors and a question concerning a recent visit to a physician for depressive symptoms. Amongst those participating, 35.8% presented depressive symptoms (GDS-4 > or = 2). The calculated rate for recognition of depression in the studied population was very low (17.3%). Patients with depressive symptoms were more often females and had a higher proportion of past history of depression and a lack of social support. Patients with a past history of depression and more severe forms of illness consulted a doctor more frequently. Finally, subjects suffering from depressive symptoms and comorbid medical illness were characterized by a higher proportion of past history, lack of support, and existence of multiple risk factors. The authors propose that the inclusion in public campaigns of activities with an experiential dimension, e.g., patient videos and the use of a very simple screening tool, such as the GDS-4 scale by general practitioners (GP), could be helpful in improving the recognition of depressive symptoms by the patient and his/her relatives and its diagnosis by the doctor. This proposition awaits formal proof in future studies.     

Depressive symptoms in propranolol users

Depressive symptoms were measured in 34 white male patients receiving propranolol treatment for cardiovascular illness. The Hamilton Rating Scale for Depression and the Hudson Generalized Contentment Scale were used to measure depressive symptoms. Patients with a positive personal or family history of depression had significantly higher depression scores than those with a negative history. Although there was no correlation between propranolol dosage and depressive symptoms for the population as a whole, among patients with a negative history there was a highly significant positive correlation between propranolol dosage and depression scores.     

The assessment of temperament, quality of life and intensity of depressive symptoms in patients with Hodgkin's disease in different stages of the illness

Hodgkin's disease is an oncology illness of unknown aetiology connected with high risk of psychological disturbances, depressive symptoms and poorer quality of life. The aim of this study was to assess temperamental factors, intensity of depression and quality of life in patients with Hodgkin's disease in the diagnostic period, active oncology treatment and in remission. In this study 50 subjects with a diagnosis of Hodgkin's disease participated, all aged 20-65 years. Temperament was assessed using the Zawadzki and Strelau Temperament Scale, quality of life was measured using the WHO QL scale. The intensity of depressive symptoms was evaluated by the 17-item Hamilton Depression Rating Scale. The results obtained suggested a possibility of changes in temperamental factors of patients with Hodgkin's disease in different stages of the illness, a significant increase of depressive symptoms and the association between intensity of depression and quality of life as well as intensity of temperamental changes. The differences between the results obtained in male and female subjects with Hodgkin's disease indicate different coping mechanisms in male and female patients.     

Sociodemographic and Personal Factors Related to Depressive Symptomatology in the Mexican Population Aged 12 to 65

Objective: To describe the prevalence of depressive symptoms in the Mexican population, aged 12 to 65 years, by identifying the main related socio-demographic and personal factors. Methods: Data are drawn from the National Survey on Addictions 2008 (ENA 2008), a random, probabilistic, multistage study. A randomly selected sub-sample of 22,962 persons answered the section on depressive symptomatology, measured with the Center for Epidemiologic Studies Depression Scale (CES-D). Results: The total prevalence for depressive symptomatology was 5.1%; the prevalence was 7.5% for women and 2.5% for men. For women, more evidence of depressive symptoms was seen in the central region, whereas for men, symptoms were homogeneous across the country. Factors related to the presence of depressive symptoms include being divorced (in women) or widowed (in men), having lower educational attainment, perceiving one's place of residence as unsafe, displaying alcohol abuse or dependence, being a regular drug consumer (in men) and having been sexually abused (males and females). Conclusions: The regional distribution of depressive symptomatology in women indicates the need for region-specific prevention programs that take into account the different social problems that affect women's emotional well-being. More research is also needed to support the early identification and intervention of men suffering from depression.     

Psychiatric, psychosocial, and cognitive functioning of female adolescents with ADHD

OBJECTIVE: To characterize the psychiatric, psychosocial, and cognitive functioning of female adolescents with attention-deficit/hyperactivity disorder (ADHD) in comparison with female controls and males with ADHD. Female controls were also compared with male controls to verify gender differences in a nonclinical sample. METHOD: One hundred seven adolescents from Southern Ontario aged 13 to 16 were included: 24 females with ADHD, 35 males with ADHD, 28 control females, and 20 control males. All were assessed with semistructured interviews, questionnaires, and tests of achievement and intellectual functioning. RESULTS: After controlling for parental education and estimated Full Scale IQ, females with ADHD were more impaired than control females in depression, anxiety, distress, teacher relationships, stress, attributional styles, and locus of control and on all cognitive and achievement measures. Females with ADHD were more impaired than males with ADHD in self-reported anxiety, distress, depression, locus of control, and vocabulary scores. These group differences were confirmed by higher ratings by parents and teachers in symptoms of psychopathology. Males with ADHD were more impaired in processing speed. Some gender differences (locus of control and vocabulary scores) were eliminated when controlling for ADHD severity. The absence of any differences between male and female controls indicates gender differences were specific to the clinical groups. CONCLUSION: Females with ADHD are at high risk for more psychological impairment than both males with ADHD and control females. The identified psychosocial problems point to areas for intervention.     

Maternal psychological distress: adult sons' and daughters' mental health and educational attainment

BACKGROUND: Offspring of depressed women have high rates of depressive symptoms and other psychopathology. The authors examined the relationship of mothers' symptoms of depression and anxiety reported during their offspring's childhood and adolescence on depressive disorder and educational achievement of their adult children. METHOD: The data come from a longitudinal cohort study of first graders from Woodlawn, a neighborhood in Chicago, followed from age 6 to 32 years (N = 879). Adult children's depression and educational attainment are regressed on earlier self-reports of mothers' psychological distress. Using multiple logistic regression, the authors controlled for the relationships of poverty, mothers' education, mobility, family structure, mothers' illness, and children's first grade classroom behavior and psychological symptoms. RESULTS: Daughters of mothers with persistent maternal psychological distress had two and a half times the risk of lifetime depressive disorder, but no increased risk of high school dropout. For sons, mothers' psychological distress was not related to depression but was related to poorer educational attainment. CONCLUSIONS: Mothers' depressed feelings during the childrearing years relate to their children's depression and educational attainment as measured in adulthood. The patterns differ for sons and daughters.