Do depressive symptoms predict mortality in older people?

Context: Depressive symptoms are common in older persons, and may predict mortality.

Objectives: To determine: (1) If depressive symptoms predict mortality; (2) If there is a gradient in this effect; and (3) Which depressive factors predict mortality.

Population: In 1991–1992, 1751 community-dwelling older persons, sampled from a population-based registry, were interviewed.

Measures: The Center for Epidemiologic Studies – Depression (CES-D), age, gender, the Modified Mini-Mental State Examination, self-rated health, and functional status.

Outcome measure: Time to death.

Analysis: Those scoring 16+ on the CES-D were considered depressed. To determine if a gradient was present, the CES-D was treated as a continuous variable. Four depressive factors from the CES-D (depressed affect, positive affect, somatic, and interpersonal) were analyzed. Cox regression models were constructed.

Results: The mortality in those with depressive symptoms was higher in those without depressive symptoms (Hazard Ratio of 1.71, p < 0.001, Log rank test). In multivariable models, this association was no longer significant after accounting for self-rated health and functional status. There was a gradient in risk of mortality across the range of the CES-D. Somatic factors, depressed affect, and positive affect were all associated with mortality in bivariate analyses, but not in multivariable models adjusting for functional status. Interpersonal factors were not associated with mortality.

Conclusions: Depressive symptoms predict mortality in older persons.     

Who is at risk of post-MI depressive symptoms?

OBJECTIVE: The aim of this study was to identify cardiologic, psychologic, and demographic risk factors in two groups of patients with post-myocardial infarction (MI) depressive symptoms (in-hospital and during the postdischarge year). METHODS: Patients admitted for MI were assessed for depressive symptoms with the Beck Depression Inventory (BDI) during hospitalization and 3, 6, and 12 months post-MI. We contrasted both groups with nondepressed patients. RESULTS: Pre-MI vital exhaustion, living alone, history of depressive disorder, history of MI, poor performance on exercise tolerance testing, and female gender were significantly and independently associated with in-hospital depressive symptoms. Pre-MI vital exhaustion, history of depressive disorder, female gender, poor ejection fraction, and longer hospital stay were independent predictors of the development of postdischarge depressive symptoms. CONCLUSIONS: Post-MI depressive symptoms seem largely driven by the psychological and social consequences of the MI in patients vulnerable to depression, as indexed by a history of depression and vital exhaustion.     

How do memory processes relate to the development of posttraumatic stress symptoms following childbirth?

Some women develop posttraumatic stress symptoms (PTSS) following childbirth but little is known about memory processes following childbirth. Models of traumatic memory debate the role of memory disorganization. This study investigates whether there is an association between memory disorganization and PTSS in new mothers. One hundred and twenty-two women were recruited within 72 h of giving birth, completing measures of cognitive and emotional experience, and analgesia, and a narrative account of the birth. 68 of these women responded to a six-week follow-up and completed measures of memory disorganization and PTSS. There was a relationship between memory disorganization and PTSS at follow-up, but not at recruitment. The organization of the immediate narrative may not distinguish between those who later do or do not develop symptoms. Emotional evaluation may be the key factor in facilitating or inhibiting the memory construction process, linking memory to subsequent disorganization and hence to symptoms.     

Does the dexamethasone suppression test relate to subtypes, factors, symptoms, or severity?

Results of the dexamethasone suppression test (DST) are frequently abnormal in depression but not always. We performed the DST in 95 depressed inpatients to determine whether abnormal DST results were associated with individual symptoms of depression, latent behavioral "factors," melancholia, or severity of depression. Initial insomnia, agitation, loss of sexual interest, and weight loss correlated significantly with nonsuppression. Using multiple regression, these four symptoms contributed independently to the variance in DST results and more closely associated with the DST results than did severity or the diagnosis of melancholia or endogenous subtype. Factor analysis failed to identify a factor that correlated with the DST results more significantly than did the individual symptoms. Our findings and a literature review suggest that DST nonsuppression associates with certain vegetative signs of depression but not with such symptoms as loss of interest or anhedonia nor with "psychological" symptoms such as guilt, worthlessness, helplessness, hopelessness, or suicidal ideation.     

Does depression prior to caregiving increase vulnerability to depressive symptoms among caregivers of persons with Alzheimer's disease?

Based on the vulnerability model of depression, this study tested the hypothesis that caregivers with prior depression are more likely to be depressed during caregiving than caregivers without prior depression. We further hypothesized an interaction effect in which caregivers with prior depression would be affected more by care-recipient dependency in activities of daily living and care-recipient depressive symptoms than those without prior depression. In a sample of 111 caregivers of persons with Alzheimer's disease, in an additive regression model, neither 'prior depressive symptoms' nor the clinically more serious 'prior depressive syndrome' was related to depressive symptoms during caregiving. In an interaction model, for caregivers with either 'no prior depression' or 'prior depressive symptoms,' the greater the care-recipient dependencies in instrumental activities of daily living (IADL), the greater were the depressive symptoms during caregiving. For caregivers with a 'prior depressive syndrome', however, the greater the IADL dependency, the fewer were the depressive symptoms during caregiving. This unexpected finding suggests that caregivers with a history of clinically significant depression are not necessarily more prone to depressive symptoms when caregiving responsibilities, at least for instrumental activities, are high. This result questions the vulnerability model of depression when applied to older caregivers.     

Which factors predict case management services and how do these services relate to client outcomes?

The current study explores two issues: which factors predict case management services and which case management services predict outcomes. Thirty individuals with schizophrenia participated in the study. Information regarding clients' characteristics and the working alliance was collected within the first 2 months of participation in the program and again 1 year later. Case managers completed a daily contact log for each client over the course of the year. Results suggest that the working alliance is a strong predictor of case management services. The working alliance and the frequency with which housing and medication were discussed were strong predictors of community functioning outcomes. Directions for future research are provided that are based upon these preliminary findings.     

Do depressive symptoms in memory-impaired elders predict probable Alzheimer's disease?

Our purpose was to determine whether performance on the Geriatric Depression Scale (GDS) predicted the development of probable Alzheimer's disease (AD) in memory-impaired non-demented participants. Participants were followed for two years, after which they underwent a diagnostic assessment: 27 developed probable AD, 98 remained cognitively impaired but not demented, and 18 developed other neurological conditions.The GDS did not contribute significantly to the prediction of probable AD, it was not related to scores on selected neuropsychological tests, but it was related to complaints of memory on a self-report scale. These findings highlight the need to consider patient characteristics and the method of assessing depression when examining the role of depression in dementia.     

How does locus of control and inflated sense of responsibility relate to obsessive-compulsive symptoms in Turkish adolescents?

This study aimed to examine the effects of responsibility attitudes, locus of control and their interactions on the general obsessive-compulsive (OC) symptomatology and the dimensions of OC symptoms in a sample of Turkish adolescents (n=385), their ages varied from 16 to 20 with a mean of 17.23 (S.D.=.68). The results of the present study revealed a significantly positive relationship between responsibility attitudes and general OC symptomatology. However, locus of control did not appear as a significant predictor of general OC symptomatology. Furthermore, results revealed that there was a significant interaction effect of responsibility attitudes with locus of control on OC symptomatology. That is, an inflated sense of responsibility and the presence of an external locus of control produced the highest level of OC symptoms. Related to the dimensions of OC symptoms, responsibility was a weak predictor of obsessive thinking symptoms, and a moderate predictor of cleanliness and checking symptoms. Locus of control and its interaction with responsibility attitudes only significantly predicted obsessional thinking symptoms.     

What explains the relation between family poverty and childhood depressive symptoms?

The relation between low socioeconomic status (SES) and depression has been well documented in adult populations. A number of studies suggest that family SES may be associated with depression among children and adolescents as well, although the evidence is mixed. We assessed the relation between family income and depressive symptoms among 457 children aged 11-13 years and examined pathways that may explain this relation. In-person interviews of children and their caregivers were conducted, including assessment of family income and administration of the Computer-based Diagnostic Interview Schedule for Children (C-DISC). Family income was significantly associated with depressive symptoms, with children in the lowest income group (<$35,000) reporting a mean of 8.12 symptoms compared to 6.27 symptoms in the middle income group ($35,000-$74,999) and 5.13 symptoms in the highest income group (> or = $75,000; p<0.001). Controlling for the number of stressful life events experienced in the past 6 months attenuated the effect of low family income on depressive symptoms by 28%. Indicators of the family environment explained 45% and neighborhood median household income and aggravated assault rate explained 12% of the relation. The family environment, including parental divorce or separation and perceived parental support, appears to explain most of the relation between low family income and childhood depressive symptoms. Further exploration of the pathways between family SES and depression may suggest potential interventions to reduce the occurrence and persistence of depressive symptoms in children.     

Worsening of depressive symptoms prior to randomization in clinical trials: a possible screen for placebo responders?

A common practice in depression trials is to exclude patients whose depressive symptoms improve between Screen and Baseline evaluations under the assumption that they are more likely to respond to placebo. The present study investigated this contention by examining the relationship between pre-randomization changes in Hamilton depression rating scale (HAMD) scores to post-randomization placebo response and drug-placebo separation. Four randomized, double-blind, placebo-controlled trials (active medication=fluoxetine or paroxetine) were conducted in outpatients with Major Depressive Disorder using a novel design in which a depressive severity inclusion criterion (HAMD >/= 22) was utilized only at Screen. Patients with no change or minimal (1 point) improvement on the HAMD between Screen and Baseline had the lowest placebo response and the best drug-placebo separation. Patients with pre-randomization improvement of 2 points or greater had moderately higher placebo response and poorer drug-placebo separation. Patients who worsened between Screen and Baseline showed the highest placebo response and the poorest drug-placebo separation. There were no obvious differences in demographic variables between the groups which could account for the findings. In our original analyses 3/4 studies failed to show significant drug-placebo separation. When only patients with no change or pre-randomization improvement of 1 point were used in the analyses, 3/4 studies showed significant drug-placebo separation while the other study approached significance, p < 0.07. These results suggest that pre-randomization changes in HAMD scores may predict post-randomization placebo response and drug-placebo separation. Further, pre-randomization increases in HAMD scores (i.e., worsening) may be the best predictor of heightened placebo responding and poor drug placebo separation.     

Which could be a clinically useful definition of depressive mixed state?

Depressive mixed state (DMX) (major depressive episode [MDE] with few superimposed hypomanic symptoms) was reported to be common among depressed outpatients. Study aim was to find if the best clinically useful definition of DMX was one based on a minimum number of hypomanic symptoms, or instead one based on the combination of specific hypomanic symptoms. METHODS: Consecutive 138 bipolar II and 83 unipolar MDE outpatients were interviewed with DSM-IV Structured Clinical Interview. DMX definitions tested were: MDE with three or more hypomanic symptoms (DMX3) and MDE with hypomanic symptoms irritability, distractibility and racing thoughts. RESULTS: DMX3, and the combination of racing thoughts, irritability and distractibility, had the same significant and nonsignificant associations with study variables. DMX3, and the combination of the specific hypomanic symptoms, significantly predicted bipolar II diagnosis. For predicting bipolar II diagnosis, DMX3 had higher specificity (86.7% vs. 50.6%), while the combination of the specific hypomanic symptoms had higher sensitivity (76.8% vs. 51.4%). CONCLUSIONS: A DMX definition with higher specificity (DMX3) for predicting bipolar II diagnosis may be more clinically useful because it may reduce misdiagnosis.