Content validity of the Sheehan Irritability Scale in patients with major depressive disorder

Does risk-taking or alcohol misuse mediate the association between anger and suicidal ideation in male depression?

Anger is among the core symptoms in male-specific inventories of depression and has consistently been linked with suicidal ideation. In this study, we assessed whether this link may be mediated via other prominent symptoms of depression in men, namely risk-taking and alcohol misuse. We used self-reported data from 322 men responding to a 3-wave survey over 6 months. Regression with mediation analysis was employed to test whether anger at baseline predicted suicidal ideation six months later through the mediating effects of risk-taking or alcohol misuse at 3 months. We found a statistically significant indirect effect (indicating a mediation effect) of anger at baseline on suicidality at 6-months follow-up through risk taking at 3-months follow-up (effect = 0.007, SE = 0.003, 99% Confidence interval = 0.0002 to 0.0161). Anger at baseline was not significantly associated with alcohol misuse at 3-months follow-up (β = .062, t = 0.919, p = .358), thus nullifying alcohol misuse as a possible mediator between anger and suicidal ideation. In conclusion, the results of this study suggest that risk-taking, but not alcohol misuse, may be a mediator between anger and suicidal ideation in the context of male depression. If these results are replicated, assessing anger and risk-taking may inform monitoring of suicidality. Also, anger and risk-taking may be promising targets for treatment aimed at reducing the risk of suicide.

Patient Expectations and Experiences of Antidepressant Therapy for Major Depressive Disorder: A Qualitative Study

PURPOSE

This qualitative study explored patient perceptions of the most burdensome symptoms of major depressive disorder (MDD), the impact of symptoms on patients' daily lives, and patient expectations and experiences regarding the timing of onset of antidepressant pharmacotherapy.

PATIENTS AND METHODS

Data were collected through facilitated, patient focus-group sessions in the USA between May and June 2019. Participants were adults with confirmed MDD who reported a major depressive episode within the past 2 years, for which they had received pharmacologic treatment for ≥6 weeks. The semi-structured discussion focused on the key topics of bothersome symptoms of MDD, the impact of symptoms on quality of life, and the effects of antidepressant treatment. Interviews were audio-recorded; findings were summarized using a content-analysis approach.

RESULTS

Five focus-group sessions were undertaken, involving a total of 29 patients (each attended one session; mean age, 43.4 years; 72.4% female). Mean time since confirmed diagnosis of MDD was 13.1 years. The most commonly prescribed antidepressants received were bupropion (41.4% of participants), escitalopram (34.5%), and sertraline (34.5%). The most frequently reported bothersome MDD symptoms were fatigue (mentioned by 58.6% of participants), lack of motivation/loss of interest (51.7%), anxiety/panic (44.8%), sadness (41.4%), and lack of concentration/brain fog (41.4%). Socialization, family life, and work were the areas in which quality of life was most impacted. Participants expressed dissatisfaction with their antidepressant treatment. Fast symptom resolution was mentioned as a priority (defined as <1 week by 38.5% of participants and ≤1 month by 65.4%). Most participants had not experienced fast relief from their symptoms with current or previous antidepressant medications.

CONCLUSION

Results of this qualitative study suggest that fatigue, anhedonia, cognitive symptoms, and anxiety are some of the most bothersome symptoms for patients with MDD and highlight the importance of obtaining rapid relief from these symptoms in order to improve outcomes and patient satisfaction with antidepressant medication.

Irritability characteristics and parameters in an international sample

BACKGROUND

Irritability is a symptom of fifteen psychiatric disorders and is widely known to scholars and the public. However, little is known about irritability as an individual construct. The purpose of the current study is to identify conceptualizations of specific characteristics of irritability.

METHODS

In this study, 402 participants from 10 countries answered nine qualitative questions about their personal causes, experience, and consequences of irritability as well as how they perceived the relationship between irritability and anger. They also answered three quantitative questions about the frequency, intensity, and duration of their irritability.

RESULTS

Results indicated that 99.3% of participants reported a lifetime incidence of irritability. On average, participants reported feeling irritable approximately one to two times per week for 30 min with an intensity that was somewhat bothersome. Women reported feeling irritable for a longer duration than men, and residents of China, Singapore, and the USA generally reported having a longer duration than residents of Ireland and the UK. Some themes that appeared unique to irritability were the physiological/biological/internal aspects of irritability and treatments that address emotional and physiological coping such as relaxation and recreation.

LIMITATIONS

Many participants equated irritability with anger, and generalizations by countries should be interpreted with caution due to a small sample within each country.

CONCLUSIONS

These findings support the conceptualization of irritability as a universal construct. It is recommended that future research continue to explore irritability to better help understand it as an independent construct in the context of diagnosis, assessment, research, and treatment.