Depression is still underrecognized and undertreated

Occurrence of depressive tendency and associated social factors among elderly persons forced by the Great East Japan Earthquake and nuclear disaster to live as long-term evacuees: a prospective cohort study

PURPOSE

This study examined the incidence of depression and associated factors among elderly persons from Iitate village after the March 2011 earthquake.

METHOD

This was a prospective cohort study. As a baseline survey, in May 2010 a self-assessment Basic Checklist (BCL) was distributed to 1611 elderly villagers, of which 1277 responded. Of these respondents, 885 without a tendency to depression (69.3%) were given a follow-up survey in May 2013. The BCL was used to assess depression tendency, instrumental activities of daily living (IADL), physical function, nutritional status, oral function, homeboundness, cognitive function and social activities. Univariate analysis was used to examine differences in risk between those with a presence of depression tendency (PDT) and those without (non-PDT) depending on demographic and BCL variables. Variables found to be significant were analysed by Poisson regression analysis.

RESULTS

Of the 438 respondents in the second survey, 163 (37.2%) showed depression tendency. PDT risk was significantly increased by female gender, age, history of diabetes and cognitive disorder. It was significantly reduced by increased IADL. Engagement in social activities decreased PDT risk in rental accommodation.

DISCUSSION

Renters faced a higher risk of PDT than persons evacuated in groups to purpose-built housing. The inclusion of social activities in the multivariate Poisson regression analysis weakened this effect. Female gender, a history of diabetes, reduced IADL and a tendency to cognitive disorder each independently affected PDT risk. These findings may inform future responses to earthquakes and the technical disasters that may accompany them.

Changes in severity of depressive symptoms and mortality: the Italian Longitudinal Study on Aging

BACKGROUND

Depression is recognized as being associated with increased mortality. However, there has been little previous research on the impact of longitudinal changes in late-life depressive symptoms on mortality, and of their remission in particular.

METHOD

As part of a prospective, population-based study on a random sample of 5632 subjects aged 65-84 years, with a 10-year follow-up of vital status, depressive symptoms were assessed by the 30-item Italian version of the Geriatric Depression Scale (GDS). The number of participants in the GDS measurements was 3214 at baseline and 2070 at the second survey, 3 years later. Longitudinal changes in depressive symptoms (stable, remitted, worsened) were examined in participants in both evaluations (n=1941). Mortality hazard ratios (MHRs) according to severity of symptoms and their changes over time were obtained by means of Cox proportional hazards regression models, adjusting for age and other potentially confounding factors.

RESULTS

Severity is significantly associated with excess mortality in both genders. Compared to the stability of depressive symptoms, a worsened condition shows a higher 7-year mortality risk [MHR 1.46, 95% confidence interval (CI) 1.15-1.84], whereas remission reduces by about 40% the risk of mortality in both genders (women MHR 0.55, 95% CI 0.32-0.95; men MHR 0.59, 95% CI 0.37-0.93). Neither sociodemographic nor medical confounders significantly modified these associations.

CONCLUSIONS

Consistent with previous reports, the severity and persistence of depression are associated with higher mortality risks. Our findings extend the magnitude of the association demonstrating that remission of symptoms is related to a significant reduction in mortality, highlighting the need to enhance case-finding and successful treatment of late-life depression.

The clinical research center for depression study: baseline characteristics of a korean long-term hospital-based observational collaborative prospective cohort study

OBJECTIVE

The Clinical Research Center for Depression (CRESCEND) study is a 9-year observational collaborative prospective cohort study for the clinical outcomes in participants with depressive disorders in Korea. In this study, we examined the baseline characteristics of the depressive participants as the hospital-based cohort.

METHODS

Participants were assessed using various instruments including the Clinical Global Impression scale, 17-item Hamilton Depression Rating Scale (HDRS-17), Hamilton Anxiety Rating Scale, Brief Psychiatric Rating Scale, Social and Occupational Functioning Assessment Scale, Beck Depression Inventory-Second Edition, Scale for Suicide Ideation, and World Health Organization Quality of Life assessment instruments-abbreviated version. Also, personal histories of medical and psychiatric illnesses and the range of socio-epidemiologic and clinical data were collected from each participant.

RESULTS

One thousand one hundred eighty three participants were recruited from 18 hospitals. The mean age of the participants was 47.9±15.9 year-old, 74.4% were female, 82.9% had been diagnosed of major depressive disorder, 40.9% were experiencing their first depressive episode, and 21.4% had a past history of suicide attempts. The majority (85.3%) of the participants were moderately to severely ill. The average HDRS-17 was 19.8±6.1. Significant gender differences at baseline were shown in age, education, marriage, employment, religion, and first depressive episode.

CONCLUSION

The baseline findings in the CRESCEND study showed some different characteristics of depression in Korea, suggesting a possibility of ethnic and cultural factors in depression.

Cross-National Comparisons of Antidepressant Use Among Institutionalized Older Persons Based on the Minimum Data Set (MDS)

On a examiné l'usage des antidépresseurs dans des échantillons provenant d'établissements de soins de longue durée de Toronto (Canada), Sapporo et Naie (Japon), Reykjavik (Islande) et Prague (République tchéque). C'est seulement en Islande que la majorité des résidents souffrant de dépression recevaient des antidépresseurs. Le taux de dépression et l'usage des antidépresseurs sont généralement faibles au Japon. On a constaté un écart important entre le diagnostic de dépression et le comportement dépressif en République tchèque. Dans tous les pays examinés, environ la moitié des utilisateurs d'antidépresseurs ne présentent pas de symptômes évidents de dépression. Dans certains pays, l'usage des antidépresseurs était moins élevé chez les résidentes, chez les aîné(e)s plus âgés ou plus handicapés. La dépression est clairement sous-diagnostiqué en République tchèque mais les faibles taux de dépression au Japon sont plus difficiles à interpréter. Étant donné l'opinion largement répandue voulant que la dépressione passe souvent inaperçue et soit done mal soignée, les résultats de l'étude laissent entendre que l'on pourrait améliorer les mesures prises dans les cas de dépression grâce à des outils comme le MDS.

Validation of Muñoz's Mood Screener in a Nonclinical Spanish Population

Abstract. This study evaluates the utility of Muñoz's Mood Screener for detection of major depressive episodes in a nonclinical Spanish population. The Mood Screener was administered by face-to-face interview to 554 subjects (65.9% women; age 18-34 years) who were recruited by stratified random sampling from a population of 27,587 university students. Thereafter, two expert clinicians who were blind to the Mood Screener results independently administered a clinical interview (SCID-CV) as an aid in evaluating the subjects for the same disorder. κ for agreement between the clinicians' consensus diagnosis and the Mood Screener was 0.758, and with the clinicians' diagnosis as reference the Mood Screener had a sensitivity of 0.969, a specificity of 0.967, positive and negative predictive values of 0.646 and 0.998, respectively, and positive and negative likelihood ratios of 29.75 and 0.032, respectively. These results support the interviewer-administered Mood Screener as a valid instrument for screening for major depressive episodes in the target population.

Validity of the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease

OBJECTIVE

Depression is common but frequently undetected in patients with coronary artery disease (CAD). Self-report screening instruments for assessing depression such as the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire-9 (PHQ-9) are available but their validity is typically determined in depressed patients without comorbid somatic illness. We investigated the validity of these instruments relative to a referent diagnostic standard in recently hospitalized patients with CAD.

METHOD

Three months post-discharge for a cardiac admission, 193 CAD patients completed the HADS and PHQ-9. The Mini International Neuropsychiatric Interview (MINI) was the criterion standard. Scale reliability was calculated using Cronbach's alpha. Convergent validity was computed using Pearson's intercorrelations. Sensitivity and specificity for various cut-off scores for both measures and for the PHQ-9 categorical algorithm were calculated using receiver operating characteristics (ROC). For analyses, participants were assigned to two groups, 'major depressive disorder' or 'any depressive disorder'.

RESULTS

For all calculations, alpha was 0.05 and tests were two-tailed. Internal consistencies for the two measures were excellent. Criterion validity for the PHQ-9 and HADS was good. We found no statistical differences between the PHQ-9 and HADS for detecting either group; however, the categorical algorithm of the PHQ-9 for diagnosing major depression had a superior LR+ when compared with the summed HADS or PHQ-9. The operating characteristics of the screening instruments for 'any depressive disorder' were slightly lower than for 'major depressive disorder'. Some optimum cut-off scores were lower than the generally recommended cut-off scores, particularly when screening for major depression (e.g., > or = 5/6 vs. > or = 10 and > or = 8 for PHQ-9 and HADS, respectively). Lowering the cut off scores substantially improved the sensitivity of these instruments while retaining specificity, thereby improving their usefulness to screen for CAD patients with depression.

CONCLUSIONS

Both instruments have acceptable properties for detecting depression in recently hospitalized cardiac patients, and neither scale is statistically superior when summed scores are used. The categorical algorithm of the PHQ-9 for diagnosing major depression has a superior LR+ compared to the summed PHQ-9 and HADS scores. Use of the generally recommended cut-off scores should be cautious. In light of the aversive outcomes associated with depression in CAD, screening for depression is a clinical priority.

Reliability and validity of the Hospital Anxiety and Depression Scale and the Beck Depression Inventory (Full and FastScreen scales) in detecting depression in persons with hepatitis C

BACKGROUND

We examined the performance the Beck Depression Inventory (BDI) and its short form (BDI-FS) and the Hospital Anxiety and Depression Scale depression (HADS-D) and anxiety (HADS-A) subscales in detecting depression in a group of patients with hepatitis C.

METHODS

SCID-CV was used to establish DSM-IV diagnosis. Sensitivity, specificity, positive and negative predictive values were used to assess test performance and Cohen's Kappa to measure agreement with DSM diagnosis.

RESULTS

Twenty-five of 88 participants had a DSM-IV depressive diagnosis. There was considerable non-overlap between 'caseness' on the BDI and HADS (Kappa=0.44). The HADS depression subscale had poor sensitivity (52%) and poor agreement with clinical diagnosis (Kappa=0.35). The full BDI had a sensitivity of 88% and a Kappa of 0.54 against a sensitivity of 84% and Kappa of 0.42 for the short form. The HADS anxiety subscale predicted depression as well as the depression subscale (sensitivity 88%, Kappa 0.47).

CONCLUSIONS

Neither the BDI nor the HADS agrees well with the clinical diagnosis of depressive disorder, nor do they agree well with one another. The anxiety subscale of the HADS appears to measure depression at least as well as the depressive subscale.

Reliability and validity of the Japanese version of the World Health Organization-Five Well-Being Index in the context of detecting depression in diabetic patients

The present study had two aims. The first was to evaluate the reliability and the validity of the Japanese version of the World Health Organization (WHO)-Five Well-Being Index (WHO-5-J) as a brief well-being scale. The second was to examine the discriminatory validity of this test as a screening tool for current depressive episodes in diabetic patients. A sample of 129 diabetic patients completed the WHO-5-J. Of these, 65 were also interviewed by psychiatrists to assess whether they had any current depressive episodes according to DSM-IV. The internal consistency was evaluated using Cronbach's alpha, the Loevinger coefficient of homogeneity, and factor analysis. The external concurrent validity was evaluated by correlations with the external scales potentially related to subjective well-being. Discriminatory validity was evaluated using receiver operating characteristic (ROC) analysis. Cronbach's alpha and the Loevinger coefficient were estimated to be 0.89 and 0.65, respectively. A factor analysis identified only one factor. The WHO-5-J was significantly correlated with a number of major diabetic complications, depression, anxiety, and subjective quality of life. ROC analysis showed that the WHO-5-J can be used to detect a current depressive episode (area under curve: 0.92; 95% confidence interval: 0.85-0.98). A cut-off of <13 yielded the best sensitivity/specificity trade-off: sensitivity, 100%; specificity, 78%. The WHO-5-J was thus found to have a sufficient reliability and validity, indicating that it is a useful instrument for detecting current depressive episodes in diabetic patients.

Psychosocial aspects of the functional gastrointestinal disorders

This report reviews recent research on the psychosocial aspects of the functional gastrointestinal disorders (FGIDs). A review and evaluation of existing literature was conducted by a multidisciplinary committee of experts in this field. This report is a synopsis of a chapter published in the Rome III book. The committee reached consensus in finding considerable evidence supporting the association between psychological distress, childhood trauma and recent environmental stress, and several of the FGIDs but noted that this association is not specific to FGIDs. There is also considerable evidence that psychosocial variables are important determinants of the outcomes of global well-being, health-related quality of life, and health care seeking. In line with these descriptive findings, there is now increasing evidence that a number of psychological treatments and antidepressants are helpful in reducing symptoms and other consequences of the FGIDs in children and adults. The FGIDs are a result of complex interactions between biological, psychological, and social factors, and they can only be treated satisfactorily when all these factors are considered and addressed. Therefore, knowledge about the psychosocial aspects of FGIDs is fundamental and critical to the understanding, assessment, and treatment of these disorders. More extensive physician training is needed if these aspects of treatment are to be used effectively and widely in clinical practice.

Depression and anxiety in patients with hepatitis C: prevalence, detection rates and risk factors

OBJECTIVE

We examined a group of patients awaiting interferon treatment for hepatitis C to estimate the prevalence and detection rates of and risk factors for mood disorders.

METHODS

The Structured Clinical Interview for DSM-IV Axis I Disorders: Clinician Version was used to detect psychiatric disorder. Self-completion instruments were used to rate symptom severity, subjective cognitive function, work and social adjustment, stigma, acceptance of illness and treatment satisfaction.

RESULTS

The 90 participants included 23 women (26%); 33 (37%) had contracted hepatitis C iatrogenically, 42 (47%) through injecting drug use and the remainder (17%) were of unknown origin. There was a 28% 1-month prevalence of depressive disorders, 72% of whom were previously undiagnosed, and a 24% prevalence of anxiety disorders, 86% previously undiagnosed. Current methadone maintenance was strongly associated with risk of depression (odds ratio, 5.0; 95% CI, 1.08-23.0). After adjustment for age and sex, depression was associated with poorer work and social adjustment, lower acceptance of illness, higher illness stigma, poorer reported thinking and concentration, and higher levels of subjective physical symptoms (all P < .05). Anxiety disorders were uncorrelated with any risk factor.

CONCLUSIONS

Depression and anxiety have high prevalences in hepatitis C, and are largely undetected and treated. Depression, but not anxiety, is associated with adverse experiences of illness.

Screening for depression in hemodialysis patients: Associations with diagnosis, treatment, and outcomes in the DOPPS

BACKGROUND

Depressive symptoms and depression are the most frequent psychologic problems reported by hemodialysis patients. We assessed the prevalence of depressive symptoms and physician-diagnosed depression, their variations by country, and associations with treatment by antidepressants among hemodialysis patients. We also assessed whether depressive symptoms were independently associated with mortality, hospitalization, and dialysis withdrawal.

METHODS

The sample was represented by 9382 hemodialysis patients randomly selected from dialysis centers of 12 countries enrolled in the Dialysis Outcomes and Practice Patterns Study (DOPPS II). Depressive symptoms were assessed by the short version of the Center for Epidemiological Studies Depression Screening Index (CES-D), using > or =10 CES-D score as the cut-off value.

RESULTS

Overall prevalence of physician-diagnosed depression was 13.9%, and percentage of CES-D score > or =10 43.0%. While the smallest prevalence of physician-diagnosed depression was observed in Japan (2.0%) and France (10.6%), the percentage of CES-D score > or =10 in these counties was similar to the whole sample. Patients on antidepressants also varied by country, 34.9% and 17.3% among those with physician-diagnosed depression and CES-D scores > or =10, respectively. In Cox models adjusted for several comorbidities, CES-D scores > or =10 were associated with significantly higher relative risks (RR) of death (RR = 1.42; 95% CI = 1.29 to 1.57), hospitalization (RR = 1.12; 95% CI = 1.03 to 1.22), and dialysis withdrawal (RR = 1.55; 95% CI = 1.29 to 1.85).

CONCLUSION

The data suggest that depression is underdiagnosed and undertreated among hemodialysis patients. CES-D can help identify hemodialysis patients who are at higher risk of death and hospitalization. Interventions should target these patients with the goal to improve survival and reduce hospitalizations.

Physicians' perceptions and responses to patient emotion: implications for social work practice in health care

Physicians serve a pivotal role in today's health systems, as they are often the first professional patients must contact for emotion problems. This study surveyed 225 practicing physicians to understand how they perceive patient emotion and the actions they would then take in response to these perceived emotions. In reply to nondescript "emotion complaints" from a patient vignette, these physicians perceived the patient as experiencing anxiety, followed by fear, anger and sadness. Physicians had distinct preferences for psychosocial oriented responses (e.g., explore, reassure, and rationalize) and were least likely to avoid, distract, and ignore. Overall, anxiety and fear generated the greatest number of possible responses from physicians, anger and sadness the fewest.