Early-life risk factors for late-onset depression

OBJECTIVE: To assess differences between women with no history of depression (No MDD), early-onset depression (EOD), and late-onset depression (LOD) on psychosocial risk factors (marital conflict and lack of social support), neuroticism, and overall self-rated health. METHOD: Diagnostic data from a community-based longitudinal study of women at mean ages 39, 42, 48, and 59 was used to create three groups of women (No MDD, EOD and LOD). These groups were then compared on psychosocial, personality, and overall health risk assessed approximately 10 years prior to diagnosis. RESULTS: There were no differences between the groups on marital conflict and social support. Those with EOD scored higher than those in the LOD and No MDD groups on neuroticism. Importantly, those with LOD reported poorer health than those with No MDD 10 years prior to diagnosis. CONCLUSIONS: These findings provide support for the notion that poor health and not psychosocial risk factors or neuroticism predispose otherwise healthy adults to developing depression for the first time in late-life.     

Construction and validation of a quality of life instrument for young adults

Assessment of quality of life (QOL) in young adults has become an increasingly important field of research as information on the QOL of children and adults accumulates. The purpose of this study is to report on the development of the Young Adult Quality Of Life (YAQOL) instrument, a measure of QOL for young adults aged 18-25. The YAQOL, which is comprised of 14 multi-item scales that assess physical health and aspects of psychological well-being, social relationships, role function, and environmental context, was administered to a general population sample of 751 young adults. Scale structure was confirmed by item-internal consistency, item discriminant validity, and inter-scale correlations. Reliability coefficients ranged from 0.88 to 0.63 across scales (mean = 0.73). Eight YAQOL scales discriminated clearly between young adults with and without chronic physical conditions, 12 scales discriminated between young adults with and without personality disorder, and negative associations were demonstrated between YAQOL scale scores and psychiatric disorder symptoms. Demographic differences in the YAQOL scales were consistent with theoretical expectations and previous empirical work. Overall, findings support the reliability and utility of the YAQOL as a measure of QOL in young adults in the general population. Additional psychometric properties will continue to be evaluated as more data become available.     

The efficacy of religious service attendance in reducing depressive symptoms

Purpose

To examine whether religiosity may help people ward off depression, we investigated the association between religious service attendance and depressive symptom scores in a community-based 30-year follow-up longitudinal study.

Methods

This study used data on 754 subjects followed over 30 years and evaluated at four time points. Linear mixed effects models were used to assess the association between religious service attendance and depressive symptoms development; frequency of attendance and age also were used as predictors. Demographic factors, life-time trauma, family socioeconomic status, and recent negative events were considered as control variables.

Results

Depressive symptom scores were reduced by an average of 0.518 units (95 % CI from ?0.855 to ?0.180, p < 0.005) each year in subjects who attended religious services as compared with subjects who did not. The more frequent the religious service attendance, the stronger the influence on depressive symptoms when compared with non-attendance. Yearly, monthly, and weekly religious service attendance reduced depression scores by 0.474 (95 % CI from ?0.841 to ?0.106, p < 0.01), 0.495 (95 % CI from ?0.933 to ?0.057, p < 0.05) and 0.634 (95 % CI from ?1.056 to ?0.212, p < 0.005) units on average, respectively, when compared with non-attendance after controlling for other covariates.

Conclusion

Religious service attendance may reduce depressive symptoms significantly, with more frequent attendance having an increasingly greater impact on symptom reduction in this 30-year community-based longitudinal study.     

Parenting behaviors associated with risk for offspring personality disorder during adulthood

CONTEXT: Research has suggested that some types of parental child-rearing behavior may be associated with risk for offspring personality disorder (PD), but the association of parenting with offspring PD has not been investigated comprehensively with prospective longitudinal data. OBJECTIVE: To investigate the association of parental child-rearing behavior with risk for offspring PD during adulthood. DESIGN: The Children in the Community study, a prospective longitudinal investigation. SETTING AND PARTICIPANTS: A community-based sample of 593 families interviewed during childhood (mean age, 6 years), adolescence (mean ages, 14 and 16 years), emerging adulthood (mean age, 22 years), and adulthood (mean age, 33 years) of the offspring. MAIN OUTCOME MEASURE: The Structured Clinical Interview for DSM-IV Personality Disorders. RESULTS: Ten types of parenting behavior that were evident during the child-rearing years were associated with elevated offspring risk for PD during adulthood when childhood behavioral or emotional problems and parental psychiatric disorders were controlled statistically. Parental behavior in the home during the child-rearing years was associated with elevated risk for offspring PD at mean ages of 22 and 33 years. Risk for offspring PD at both assessments increased steadily as a function of the number of problematic parenting behaviors that were evident. Low parental affection or nurturing was associated with elevated risk for offspring antisocial (P = .003), avoidant (P = .01), borderline (P = .002), depressive (P = .02), paranoid (P = .002), schizoid (P = .046), and schizotypal (P<.001) PDs. Aversive parental behavior (eg, harsh punishment) was associated with elevated risk for offspring borderline (P = .001), paranoid (P = .004), passive-aggressive (P = .046), and schizotypal (P = .02) PDs. CONCLUSIONS: Parental behavior during the child-rearing years may be associated with risk for offspring PD that endures into adulthood. This risk may not be attributable to offspring behavioral and emotional problems or parental psychiatric disorder, and it may not diminish over time. Low parental nurturing and aversive parental behavior during child rearing may both be associated with elevated risk for offspring PDs.     

Should additional symptoms be included in criteria for atypical depression?

Analyses of a systematic household sample of 750 respondents aged 11-22, 19 with atypical depression, find atypical depression associated with fear of fat, insomnia, headache, and fatigue. Other research suggests adding these symptoms to criteria for atypical depression, rendering them quite similar to criteria used in studies of somatic depression.     

Childhood adversities,interpersonal difficulties,and risk for suicide attempts during late adolescence and early adulthood

BACKGROUND: Data from a community-based longitudinal study were used to investigate the association between childhood adversities, interpersonal difficulties during adolescence, and suicide attempts during late adolescence or early adulthood. METHODS: A community sample of 659 families from Upstate New York was interviewed in 1975, 1983, 1985 to 1986, and 1991 to 1993. During the 1991-1993 interview, the mean age of the offspring was 22 years. RESULTS: Maladaptive parenting and childhood maltreatment were associated with an elevated risk for interpersonal difficulties during middle adolescence and for suicide attempts during late adolescence or early adulthood after age, sex, psychiatric symptoms during childhood and early adolescence, and parental psychiatric symptoms were controlled statistically. A wide range of interpersonal difficulties during middle adolescence were associated with risk for suicidal behavior after the covariates were controlled. Profound interpersonal difficulties during middle adolescence mediated the association between maladaptive parenting or childhood maltreatment and suicide attempts during late adolescence or early adulthood. CONCLUSIONS: Maladaptive parenting and childhood maltreatment may be associated with a risk for severe interpersonal difficulties during adolescence. These interpersonal difficulties may play a pivotal role in the development of suicidal behavior. Youths who are at an elevated risk for suicide may tend to be in need of mental health services that can help them to cope with an extensive history of profound interpersonal difficulties, beginning in childhood and continuing through adolescence.     

The Role of Endoscopy in Suspected Amebiasis

The diagnosis of amebic colitis can be difficult and confusing. The gross endoscopic appearance as well as the results of endoscopic biopsy can be extremely helpful in differentiating amebiasis from other forms of colitis. Clinical symptoms, laboratory studies, x-ray findings, cultures, and even serological studies may not be sufficient for making an accurate diagnosis. To illustrate the potential difficulties we are reporting three patients in whom the diagnosis of amebiasis was considered but in whom endoscopy was important for arriving at the correct diagnosis.     

Macroscopic oropharyngeal signs indicating impaired defensive function of palatine tonsils in adults suffering from recurrent tonsillitis

The present study explored in adults suffering from recurrent tonsillitis the association between macroscopic oropharyngeal signs of recurrent inflammation, immunomorphology of palatine tonsils (counts of neutrophils by CD4 and macrophages by CD68 monoclonal antibodies in tonsillar microcompartments) and the occurrence of post-tonsillectomy bacteremia. The study involved 50 adults (31 females and 19 males) with recurrent tonsillitis. According to predominance of either inflammatory changes or evidence of sclerotic process in palatine tonsils and surrounding tissue macroscopic at oropharyngeal examination, the patients were divided into groups with 'inflammatory-type' and 'sclerotic-type' tonsils. Biochemically detected mean collagen content was significantly higher in 'sclerotic-type' tonsils than in 'inflammatory-type' tonsils (p=0.001). Post-tonsillectomy bacteremia was found in 22 patients (44%). A noteworthy finding was the higher recovery of anaerobes from blood cultures than in previous studies. A logistic regression analysis revealed that the post-tonsillectomy bacteremia was strongly associated with 'sclerotic-type' tonsils (p=0.0015) and with low counts of neutrophils in tonsillar tissue (p=0.047). We conclude that macroscopic oropharyngeal signs of sclerotic process in palatine tonsils indicate impaired tonsillar defense, in terms of lowered counts of neutrophils, increasing the risk of post-tonsillectomy bacteremia.