The Modified Hamilton Rating Scale for Depression: reliability and validity

Compounded depression and family functioning during the acute episode and at 6-month follow-up

Thirty-seven inpatients with pure major depression were compared with 41 inpatients with compounded depression (major depression with coexistent axis I, II, and/or III disorders) to assess the impact of the patients' illness on their families. Families of patients with compounded depression had worse family functioning (especially in their ability to solve problems and in maintaining acceptable standards of behavior), both during the acute depressive episode and at 6-month follow-up. A significantly smaller percentage of patients with compounded depression had recovered by 6 months (28%) than those with pure depression (51%).

Depressed mood in chronic low back pain: relationship with stressful life events

This study investigated the relationship between stressful life events and depressed mood in chronic low back pain (CLBP), using both self-report and observer-rated assessments of life happenings and depression. We hypothesized that CLBP patients with depressed mood (N = 15) would report significantly more untoward life events and ongoing life difficulties compared to CLBP patients without depressed mood (N = 17) and controls (N = 19). This prediction was confirmed. Subjects also were rated as being either in a high stress or low stress condition. Patients with depressed mood were more likely to be in the high stress condition than were either non-depressed patients or volunteers. Furthermore, the increased stress reported by the distressed group appeared to be a direct consequence of back pain-related life events, rather than from other life problems. We conclude that previously reported associations between life events and CLBP are a function of the relationship between stressful life events and depressive symptoms, which are prevalent in CLBP.

The early--late onset distinction in DSM-III-R dysthymia

DSM-III-R recently introduced early-late and primary-secondary subtypes of dysthymia. The present study explored the validity of the DSM-III-R early-late onset distinction by comparing early- and late-onset primary dysthymics on demographic, clinical and familial variables and short-term outcome. Compared to the late-onset dysthymics, the early-onset group had higher lifetime rates of superimposed major depressive episodes and anxiety disorders, had sought treatment significantly more frequently, had a higher rate of major affective disorders in first-degree relatives, and exhibited higher levels of depression throughout the course of a 6-month follow-up study. These data provide preliminary support for the validity of the DSM-III-R early-late onset distinction in dysthymia.

Depression assessment in Brazil. The first application of the Montgomery-Asberg Depression Rating Scale

Cross-cultural investigation in psychiatry is revealing the need for standardised instruments in diagnosing and assessing depression. Recently, a new instrument was developed to evaluate depressed patients, namely the Montgomery-Asberg Depression Rating Scale (MADRS). The present study introduced the MADRS in Brazil, comparing it to the Hamilton Depression Rating Scale, the Visual Analogue Mood Scale (a self-rating scale), and with the global clinical assessment of independent Brazilian psychiatrists. The results show correlation between MADRS and the three other assessments, indicating that it is a useful and operational instrument to evaluate depressed patients. They also support the application of the MADRS in cross-cultural studies of depression in Brazil and other countries. These results are critically discussed.

Relationship between dysfunctional cognitions and depressive subtypes

The results of this study suggest that the relationship between cognitions and severity of depression hypothesized by cognitive theorists may be relevant only to a subgroup of depressives. In a sample of 40 inpatients with major depression who received the Dexamethasone Suppression Test (DST), scores on the Dysfunctional Attitude Scale were equivalent in suppressor and nonsuppressor groups, as well as in melancholic and nonmelancholic depressive groups. Neither was there a difference between suppressors and nonsuppressors on measures of depression. However, in the nonmelancholic group, there was a significant relationship between dysfunctional cognitions and severity of depression. This relationship was not found in the melancholic group. Finally, independent of diagnostic and biological subtype, patients with elevated levels of dysfunctional cognitions when compared with the remaining sample revealed greater severity of depression, more days in hospital and more readmissions to hospital.