Sub-grouping non-melancholic major depression using both clinical and aetiological features

SCOPE for Research: mental health consumers' priorities for research compared with recent research in Australia

OBJECTIVE

The aim of this study was to identify consumer priorities for research on depression and bipolar disorder in Australia.

METHOD

Australian consumers with personal experience of depression or bipolar disorder were surveyed online about research priorities for their condition using a questionnaire developed from an earlier qualitative phase of the SCOPE for Research project. Participants were asked to rate the importance of a number of broad research areas, specific research topics, target groups and settings in which to conduct research. These ratings were then compared to the content of relevant Australian research published between 1997 and 2006.

RESULTS

Consumers rated research into the management and treatment of depression and bipolar disorder of highest priority. Further, consumers rated those at risk of a mood disorder as the most important target groups for research and prioritized research conducted in health settings such as community mental health services ahead of research in other settings. There was some concordance between consumers' ratings of the broad topic areas and settings in which to conduct research and the amount of published research on these topic areas and settings. However, there was little published research on the highest ranked consumer-rated specific topics and target groups for research.

CONCLUSIONS

Overall, there were substantial differences between the priorities of consumers and the recent research output, suggesting gaps in the Australian research base on mood disorders. The results of this study should be used to inform future research to ensure that it is guided by the priorities of the ultimate beneficiaries of the research, mental health consumers.

Depression research and treatment: Are we skating to where the puck is going to be?

This paper critically reviews empirical findings regarding current key assumptions underlying the nature and treatment of depression which heavily rely on the DSM approach. This review shows that empirical evidence provides little support for these assumptions. In response to these findings, an etiologically based, biopsychosocial, dynamic interactionism model of depression is proposed. This model could foster further integration in research on depression and assist in the development of guidelines for the treatment of depression that are better informed by research findings and more congruent with complex clinical realities.

The relation between depression and anxiety: an evaluation of the tripartite, approach-withdrawal and valence-arousal models

Epidemiological studies have consistently reported that depressive and anxiety disorders co-occur frequently. This paper reviews the evidence for three models that have been proposed to explain the relation between these two conditions-the tripartite, the approach-withdrawal, and valence-arousal models. Specifically, we focus on predictions that the three models generate for cross-sectional studies, prospective and family/twin studies of personality, and EEG studies. In sum, no model was strongly supported across all types of studies, though specific aspects of each model were. Because of the heterogeneity of depression and anxiety disorders, a model with 2-4 factors or dimensions may not be sufficient to explain the relation between the two conditions.

Examining the utility of a temperament model for modelling non-melancholic depression

OBJECTIVE

Depression is currently modelled dimensionally, along severity, duration and recurrency dimensions. An alternative model allows dimensional expressions of temperament and personality to influence risk to onset as well as persistence. Here, we examine the utility of a temperament model.

METHOD

A questionnaire assessing temperament dimensions and a number of depression variables was administered to a large routine general practice sample and with the temperament measure also completed by a small clinical sample.

RESULTS

'Anxious worrying' and 'irritable' dimensions were identified as internalizing and externalizing expressions of a trait anxiety dimension, three other 'temperament' dimensions (i.e. 'introversion', 'self-centred' and 'obsessive') were refined, while a 'self-blame' dimension intruded into the factor analytic solution. High scores on the 'anxious worrying' dimension were associated with all depression parameters. The 'irritable', 'introversion' and 'self-blame' dimensions were less clearly linked with depression variables, while higher scores on the 'self-centred' and 'obsessional' dimensions did not appear to increase the chance of depression onset, persistence or recourse to treatment.

CONCLUSION

A temperament-based approach appears to have some conceptual utility in modelling depression, and particularly, the non-melancholic disorders. It is likely, however, to require complementing with refined at-risk personality dimensions.

Recognizing the anxious face of depression

"Anxious depression" is used variably both by researchers and clinicians to describe admixtures of anxiety and depressive symptoms. The authors sought to determine the best model for conceptualizing anxious depression by studying a sample of depressed patients referred to a tertiary referral unit. Anxiety and depression were assessed using a comprehensive set of mixed symptoms that were subsequently refined to provide separate anxiety and depressive factors, and patients were trichotomized into groups of low, medium, and high anxiety on the basis of their total anxiety factor scores. Associations between the constructs of anxiety and depression in different depressive subgroups were explored, and the severity of depressive symptoms and other clinical variables across the three anxiety groupings was assessed. Depression variables were not linearly associated in a consistent pattern with anxiety-defined groups, arguing against a simple interdependence model driven by a higher-order variable such as depression severity. By contrast, the state anxiety categories were linked strongly with lifetime anxiety disorder prevalence, with some associations linear and with others evidencing a trend break association. The authors found support for a model of anxious depression, whereby anxiety both predisposes to nonmelancholic depression and contributes to its presentation by shaping its clinical features. Such a model and its definition assist in clarifying the cause of anxious depression and its treatment.

Predictors of 1-year outcome in depression

OBJECTIVE

We compared several different methods for assessing depression 'recovery' over a 1-year review interval, to determine the utility of the contrasting approaches. Second, we assessed baseline predictors of 1-year outcome and recovery status. Third, we examined the extent to which predictors showed consistency across the variable definitions of outcome and recovery.

METHODS

Twelve-month outcome was assessed in a sample of 182 subjects who at baseline assessment met DSM criteria for a major depressive episode. The contrasting methods involved a defined percentage reduction in Beck Depression Inventory self-rating scores, formalised change point definitions, no longer meeting DSM-IV major depression criteria, and clinical global improvement (CGI) ratings.

RESULTS

Sixty-one per cent reached formalised change point criteria for full remission or recovery when trajectories across the 12-month interval were examined. Other measures quantified recovery rates ranging from 43% to 70%. Those with a psychotic or melancholic depression were more likely to have achieved recovery status in some analyses. Non-recovery at 12 months was predicted most consistently by higher baseline levels of anxiety and depression; high trait anxiety and a lifetime anxiety disorder; disordered personality function; and having reported exposure to acute and enduring stressors at baseline assessment.

CONCLUSIONS

While the CGI was the superior system in terms of number of significant discriminating predictors of outcome, the change point definitional approach provides much greater information across the follow-up interval, arguing for their complementary utility. As several currently identified baseline predictors of outcome (i.e. anxiety, disordered personality function) also predicted onset of depression, their relevance as both depression-inducing and depression-propagating variables is suggested.