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Shadzi MR, Salehi A, Vardanjani HM. Problematic Internet Use, Mental Health, and Sleep Quality among Medical Students: A Path-Analytic Model. Indian J Psychol Med 2020; 42:128-135. [PMID: 32346253 PMCID: PMC7173655 DOI: 10.4103/ijpsym.ijpsym_238_19] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/09/2019] [Accepted: 10/02/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND There is a close association between problematic Internet use (PIU), sleep quality, and mental health problems. To evaluate which mental health problem is more associated with coexistence of both PIU and poor sleep quality, we hypothesized a model in which PIU influences sleep quality directly and also through the mediation of three different mental health problems. METHODS A total of 402 medical students completed the Persian versions of the Internet Addiction Test, 21-item Depression Anxiety Stress Scale, and Pittsburgh Sleep Quality Index. A maximum likelihood structural equation model was used to assess the hypothesis. For assessment of the indirect effects, bootstrapping was conducted. RESULTS PIU predicted poor sleep quality through indirect pathways by the mediation of mental health problems (P < 0.001). Poor sleep quality were associated with depressive symptoms (P < 0.001), anxiety (P = 0.035), and stress (P < 0.001); however, the direct pathways from stress and anxiety to poor sleep quality were not statistically significant (P > 0.05). CONCLUSION Findings extend our previous knowledge about the interrelationships between PIU, sleep disturbances, and mental health problems by unveiling the key role of depressive symptoms.
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Affiliation(s)
| | - Alireza Salehi
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Shaffer KM, Kim Y, Carver CS, Cannady RS. Effects of caregiving status and changes in depressive symptoms on development of physical morbidity among long-term cancer caregivers. Health Psychol 2017; 36:770-778. [PMID: 28639819 PMCID: PMC5551905 DOI: 10.1037/hea0000528] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Cancer caregiving burden is known to vary across the survivorship trajectory and has been linked with caregivers' subsequent health impairment. Little is known, however, regarding how risk factors during long-term survivorship relate to vulnerability to caregivers' health during that period. This study examined effects of caregiving status and depressive symptoms on development of physical morbidity by 5 years postdiagnosis. METHOD Family caregivers (N = 491; Mage = 55.78) completed surveys at 2 (Time 1 [T1]) and 5 years (T2) after their care recipients' cancer diagnosis. Demographic and caregiving context variables known to affect caregivers' health were assessed at T1. Self-reported depressive symptoms and a list of physical morbid conditions were assessed at T1 and T2. Caregiving status (former, current, or bereaved) was assessed at T2. RESULTS Hierarchical negative binomial regression revealed that current caregivers at T2 (p = .02), but not those bereaved by T2 (p = .32), developed more physical morbid conditions between T1 and T2 compared with former caregivers, controlling for other variables. Independently, caregivers reporting either newly emerging or chronically elevated depressive symptoms at T2 (ps < .03), but not those whose symptoms remitted at T2 (p = .61), showed greater development of physical morbidity than did those reporting minimal depressive symptoms at both T1 and T2. CONCLUSIONS Results highlight the roles of long-term caregiving demands and depressive symptoms in cancer caregivers' premature physical health decline. Clinical attention through the long-term survivorship trajectory should be emphasized for caregivers of patients with recurrent or prolonged illness and to address caregivers' elevated depressive symptoms. (PsycINFO Database Record
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Affiliation(s)
- Kelly M. Shaffer
- University of Miami, Department of Psychology
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry & Behavioral Sciences
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3
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Ng TP, Nyunt MSZ, Feng L, Feng L, Niti M, Tan BY, Chan G, Khoo SA, Chan SM, Yap P, Yap KB. Multi-Domains Lifestyle Interventions Reduces Depressive Symptoms among Frail and Pre-Frail Older Persons: Randomized Controlled Trial. J Nutr Health Aging 2017; 21:918-926. [PMID: 28972245 DOI: 10.1007/s12603-016-0867-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND We investigated the effect of multi-domain lifestyle (physical, nutritional, cognitive) interventions among frail and pre-frail community-living older persons on reducing depressive symptoms. METHOD Participants aged 65 and above were randomly allocated to 24 weeks duration interventions with nutritional supplementation (N=49), physical training (N=48), cognitive training (N=50), combination intervention (N=49) and usual care control (N=50). Depressive symptoms were assessed by the Geriatric Depression Scale (GDS-15) at baseline (0M), 3 month (3M), 6 month (6M) and 12 month (12M). RESULTS Mean GDS scores in the control group increased from 0.52 (0M) and 0.54 (3M) to 0.74 (6M), and 0.83 (12M). Compared to the control group, interventions showed significant differences (∆=change) at 6M for cognitive versus control (∆=-0.39, p=0.021, group*time interaction p=0.14); physical versus control (∆ =-0.37, p=0.026, group*time interaction p=0.13), and at 12M for nutrition versus control (∆ =-0.46, p=0.016, group*time interaction p=0.15). The effect for combination versus control was significant at 6M (∆ =-0.43, p=0.020) and 12M (∆ =-0.51, p=0.005, group*time interaction p=0.026). Estimated 12-month cumulative incidence of depressive symptoms (GDS≥2) relative to control were OR=0.38, p=0.037 (nutrition); OR=0.71, p=0.40 (cognitive); OR=0.39, p=0.042 (physical training) and OR=0.38, p=0.037 (combination). Changes in gait speed and energy level were significantly associated with changes in GDS scores over time. CONCLUSION Multi-domain interventions that reverse frailty among community-living older persons also reduce depressive symptomatology. Public health education and programmatic measures combining nutritional, physical and cognitive interventions for at-risk frail older people may likely benefit psychological wellbeing.
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Affiliation(s)
- T P Ng
- A/P Tze-Pin Ng, Gerontology Research Programme, National University of Singapore, Department of Psychological Medicine, NUHS Tower Block, 9th Floor, 1E Kent Ridge Road, Singapore 119228 Fax: 65-67772191, Tel: 65-67723478
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Seemüller F, Obermeier M, Schennach R, Bauer M, Adli M, Brieger P, Laux G, Riedel M, Falkai P, Möller HJ. Stability of remission rates in a 3-year follow-up of naturalistic treated depressed inpatients. BMC Psychiatry 2016; 16:153. [PMID: 27206634 PMCID: PMC4875666 DOI: 10.1186/s12888-016-0851-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/05/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Remission is a common outcome of short-term trials and the main goal of acute and longterm treatment. The longitudinal stability of remission has rarely been investigated under naturalistic treatment conditions. METHODS Naturalistic multisite follow-up study. Three-year symptomatic long-term outcome of initially hospitalized tertiary care patients (N = 784) with major depressive episodes. Remission rates as well as the switch rates between remission and non-remission were reported. RESULTS After one, two and three years 62 %, 59 % and 69 % of the observed patients met criteria for remission. During the follow-up 88 % of all patients achieved remission. 36 % of maintained remission from discharge to 3-years, 12 % of all patients never reached remission and 52 % percent showed a fluctuating course switching from remission to non-remission and vice versa. There was considerable transition between remission and non-remission. For example, from discharge to 1 year, from 1 to 2, and from 2 to 3 years 25 %, 21 % and 11 % lost remission. CONCLUSION Cumulative outcome rates are encouraging. Absolute rates at predefined endpoints as well as the fluctuations between these outcomes reflect the variable and chronic nature of major depression.
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Affiliation(s)
- Florian Seemüller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstrasse 7, 80336, Munich, Germany. .,Department of Psychiatry, Psychosomatic and Psychotherapy, kbo-Lech-Mangfall-Klinik, Garmisch-Patenkirchen, Germany.
| | - Michael Obermeier
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Rebecca Schennach
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Dresden, Technical University Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Campus, Charité Mitte (CCM), Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Brieger
- Department of Psychiatry and Psychotherapy, Martin-Luther University Halle-Wittenberg, Julius-Kühn-Str.7, 06097 Halle, Germany ,Department of Psychiatry, Psychosomatic and Psychotherapy, Bezirkskrankenhaus Kempten, Robert-Weixlerstrasse 46, 87435 Kempten, Germany
| | - Gerd Laux
- Department of Psychiatry and Psychotherapy, kbo-Inn-Salzach-Klinikum, Gabersee 7, 83512 Wasserburg, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstrasse 7, 80336 Munich, Germany ,Department of Psychiatry and Psychotherapy, Vinzenz von Paul Hospital, Rottweil, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstrasse 7, 80336 Munich, Germany
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Alexopoulos GS, Raue PJ, McCulloch C, Kanellopoulos D, Seirup JK, Sirey JA, Banerjee S, Kiosses DN, Areán PA. Clinical Case Management versus Case Management with Problem-Solving Therapy in Low-Income, Disabled Elders with Major Depression: A Randomized Clinical Trial. Am J Geriatr Psychiatry 2016; 24:50-59. [PMID: 25794636 PMCID: PMC4539297 DOI: 10.1016/j.jagp.2015.02.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To test the hypotheses that (1) clinical case management integrated with problem-solving therapy (CM-PST) is more effective than clinical case management alone (CM) in reducing depressive symptoms of depressed, disabled, impoverished patients and that (2) development of problem-solving skills mediates improvement of depression. METHODS This randomized clinical trial with a parallel design allocated participants to CM or CM-PST at 1:1 ratio. Raters were blind to patients' assignments. Two hundred seventy-one individuals were screened and 171 were randomized to 12 weekly sessions of either CM or CM-PST. Participants were at least 60 years old with major depression measured with the 24-item Hamilton Depression Rating Scale (HAM-D), had at least one disability, were eligible for home-based meals services, and had income no more than 30% of their counties' median. RESULTS CM and CM-PST led to similar declines in HAM-D over 12 weeks (t = 0.37, df = 547, p = 0.71); CM was noninferior to CM-PST. The entire study group (CM plus CM-PST) had a 9.6-point decline in HAM-D (t = 18.7, df = 547, p <0.0001). The response (42.5% versus 33.3%) and remission (37.9% versus 31.0%) rates were similar (χ(2) = 1.5, df = 1, p = 0.22 and χ(2) = 0.9, df = 1, p = 0.34, respectively). Development of problem-solving skills did not mediate treatment outcomes. There was no significant increase in depression between the end of interventions and 12 weeks later (0.7 HAM-D point increase) (t = 1.36, df = 719, p = 0.17). CONCLUSION Organizations offering CM are available across the nation. With training in CM, their social workers can serve the many depressed, disabled, low-income patients, most of whom have poor response to antidepressants even when combined with psychotherapy.
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Affiliation(s)
| | - Patrick J Raue
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Charles McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Dora Kanellopoulos
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Joanna K Seirup
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Jo Anne Sirey
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Samprit Banerjee
- Department of Public Health, Weill Cornell Medical College, White Plains, NY
| | - Dimitris N Kiosses
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Patricia A Areán
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
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Kenney SR, Lac A, LaBrie JW, Hummer, JF, Pham A. Mental health, sleep quality, drinking motives, and alcohol-related consequences: a path-analytic model. J Stud Alcohol Drugs 2013; 74:841-51. [PMID: 24172110 PMCID: PMC3817046 DOI: 10.15288/jsad.2013.74.841] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 04/29/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Poor mental health, sleep problems, drinking motivations, and high-risk drinking are prevalent among college students. However, research designed to explicate the interrelationships among these health risk behaviors is lacking. This study was designed to assess the direct and indirect influences of poor mental health (a latent factor consisting of depression, anxiety, and stress) to alcohol use and alcohol-related consequences through the mediators of global sleep quality and drinking motives in a comprehensive model. METHOD Participants were 1,044 heavy-drinking college students (66.3% female) who completed online surveys. RESULTS A hybrid structural equation model tested hypotheses involving relations leading from poor mental health to drinking motives and poorer global sleep quality to drinking outcomes. Results showed that poor mental health significantly predicted all four subscales of drinking motivations (social, coping, conformity, and enhancement) as well as poor sleep. Most of the drinking motives and poor sleep were found to explain alcohol use and negative alcohol consequences. Poor sleep predicted alcohol consequences, even after controlling for all other variables in the model. The hypothesized mediational pathways were examined with tests of indirect effects. CONCLUSIONS This is the first study to assess concomitantly the relationships among three vital health-related domains (mental health, sleep behavior, and alcohol risk) in college students. Findings offer important implications for college personnel and interventionists interested in reducing alcohol risk by focusing on alleviating mental health problems and poor sleep quality.
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Affiliation(s)
- Shannon R. Kenney
- Department of Psychology, Loyola Marymount University, Los Angeles, California
| | - Andrew Lac
- Department of Psychology, Loyola Marymount University, Los Angeles, California
| | - Joseph W. LaBrie
- Department of Psychology, Loyola Marymount University, Los Angeles, California
| | - Justin F. Hummer,
- Department of Psychology, Loyola Marymount University, Los Angeles, California
| | - Andy Pham
- Department of Psychology, Loyola Marymount University, Los Angeles, California
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The age-by-disease interaction hypothesis of late-life depression. Am J Geriatr Psychiatry 2013; 21:418-32. [PMID: 23570886 PMCID: PMC3549303 DOI: 10.1016/j.jagp.2013.01.053] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 04/20/2012] [Accepted: 06/19/2012] [Indexed: 12/28/2022]
Abstract
The phenomenologic diagnosis of depression is successful in increasing diagnostic reliability, but it is a classification scheme without biologic bases. One subtype of depression for which evidence suggests a unique biologic basis is late-life depression (LLD), with first onset of symptoms after the age of 65. LLD is common and poses a significant burden on affected individuals, caretakers, and society. The pathophysiology of LLD includes disruptions of the neural network underlying mood, which can be conceptualized as the result of dysfunction in multiple underlying biologic processes. Here, we briefly review current LLD hypotheses and then describe the characteristics of molecular brain aging and their overlap with disease processes. Furthermore, we propose a new hypothesis for LLD, the age-by-disease interaction hypothesis, which posits that the clinical presentation of LLD is the integrated output of specific biologic processes that are pushed in LLD-promoting directions by changes in gene expression naturally occurring in the brain during aging. Hence, the brain is led to a physiological state that is more susceptible to LLD, because additional pushes by genetic, environmental, and biochemical factors may now be sufficient to generate dysfunctional states that produce depressive symptoms. We put our propositions together into a decanalization model to aid in illustrating how age-related biologic changes of the brain can shift the repertoire of available functional states in a prodepression direction, and how additional factors can readily lead the system into distinct and stable maladaptive phenotypes, including LLD. This model brings together basic research on neuropsychiatric and neurodegenerative diseases more closely with the investigation of normal aging. Specifically, identifying biologic processes affected during normal aging may inform the development of new interventions for the prevention and treatment of LLD.
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Mezuk B, Edwards L, Lohman M, Choi M, Lapane K. Depression and frailty in later life: a synthetic review. Int J Geriatr Psychiatry 2012; 27:879-92. [PMID: 21984056 PMCID: PMC3276735 DOI: 10.1002/gps.2807] [Citation(s) in RCA: 179] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 08/23/2011] [Accepted: 08/24/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND Many of the symptoms, consequences, and risk factors for frailty are shared with late-life depression. However, thus far, few studies have addressed the conceptual and empirical interrelationships between these conditions. This review synthesizes existing studies that examined depression and frailty among older adults and provides suggestions for future research. METHODS A search was conducted using PubMed for publications through 2010. Reviewers assessed the eligibility of each report and abstracted information on study design, sample characteristics, and key findings, including how depression and frailty were conceptualized and treated in the analysis. RESULTS Of 133 abstracted articles, 39 full-text publications met inclusion criteria. Overall, both cross-sectional (n = 16) and cohort studies (n = 23) indicate that frailty, its components, and functional impairment are risk factors for depression. Although cross-sectional studies indicate a positive association between depression and frailty, findings from cohort studies are less consistent. The majority of studies included only women and non-Hispanic Whites. None used diagnostic measures of depression or considered antidepressant use in the design or analysis of the studies. CONCLUSIONS A number of empirical studies support for a bidirectional association between depression and frailty in later life. Extant studies have not adequately examined this relationship among men or racial/ethnic minorities, nor has the potential role of antidepressant medications been explored. An interdisciplinary approach to the study of geriatric syndromes such as late-life depression and frailty may promote cross-fertilization of ideas leading to novel conceptualization of intervention strategies to promote health and functioning in later life.
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Affiliation(s)
- Briana Mezuk
- Department of Epidemiology and Community Health, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
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Zannas AS, McQuoid DR, Steffens DC, Chrousos GP, Taylor WD. Stressful life events, perceived stress, and 12-month course of geriatric depression: direct effects and moderation by the 5-HTTLPR and COMT Val158Met polymorphisms. Stress 2012; 15:425-34. [PMID: 22044241 PMCID: PMC3319482 DOI: 10.3109/10253890.2011.634263] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Although the relation between stressful life events (SLEs) and risk of major depressive disorder is well established, important questions remain about the effects of stress on the course of geriatric depression. Our objectives were (1) to examine how baseline stress and change in stress is associated with course of geriatric depression and (2) to test whether polymorphisms of serotonin transporter (5-HTTLPR) and catechol-O-methyltransferase (COMT Val158Met) genes moderate this relation. Two-hundred and sixteen depressed subjects aged 60 years or older were categorized by remission status (Montgomery-Asberg depression rating scale≤6) at 6 and 12 months. At 6 months, greater baseline numbers of self-reported negative and total SLEs and greater baseline perceived stress severity were associated with lower odds of remission. At 12 months, only baseline perceived stress predicted remission. When we examined change in stress, 12-month decrease in negative SLEs and level of perceived stress were associated with improved odds of 12-month remission. When genotype data were included, COMT Val158Met genotype did not influence these relations. However, when compared with 5-HTTLPR L/L homozygotes, S allele carriers with greater baseline numbers of negative SLEs and with greater decrease in negative SLEs were more likely to remit at 12 months. This study demonstrates that baseline SLEs and perceived stress severity may influence the 12-month course of geriatric depression. Moreover, changes in these stress measures over time correlate with depression outcomes. 5-HTTLPR S carriers appear to be more susceptible to both the effects of enduring stress and the benefit of interval stress reduction.
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Affiliation(s)
- Anthony S Zannas
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
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Katon WJ. Epidemiology and treatment of depression in patients with chronic medical illness. DIALOGUES IN CLINICAL NEUROSCIENCE 2011. [PMID: 21485743 PMCID: PMC3181964 DOI: 10.31887/dcns.2011.13.1/wkaton] [Citation(s) in RCA: 435] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
There is a bidirectional relationship between depression and chronic medical disorders. The adverse health risk behaviors and psychobiological changes associated with depression increase the risk for chronic medical disorders, and biological changes and complications associated with chronic medical disorders may precipitate depressive episodes. Comorbid depression is associated with increased medical symptom burden, functional impairment, medical costs, poor adherence to self-care regimens, and increased risk of morbidity and mortality in patients with chronic medical disorders. Depression may worsen the course of medical disorders because of its effect on proinflammatory factors, hypothalamic-pituitary axis, autonomic nervous system, and metabolic factors, in addition to being associated with a higher risk of obesity, sedentary lifestyle, smoking, and poor adherence to medical regimens. Both evidence-based psychotherapies and antidepressant medication are efficacious treatments for depression. Collaborative depression care has been shown to be an effective way to deliver these treatments to large primary care populations with depression and chronic medical illness.
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Affiliation(s)
- Wayne J Katon
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195-6560, USA.
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Riemann D. Does effective management of sleep disorders reduce depressive symptoms and the risk of depression? Drugs 2010; 69 Suppl 2:43-64. [PMID: 20047350 DOI: 10.2165/11531130-000000000-00000] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The link between co-morbid insomnia and depression has been demonstrated in numerous groups. Insomnia has been associated with: (1) an increased risk of developing subsequent depression; (2) an increased duration of established depression; and (3) relapse following treatment for depression. In addition, specific insomnia symptoms, such as nocturnal awakening with difficulty resuming sleep, are more strongly associated with depression than classic symptoms of insomnia. Participants of a workshop, held at the 6th annual meeting of The International Sleep Disorders Forum: The Art of Good Sleep in 2008, evaluated whether the effective management of sleep disorders could reduce both concurrent depressive symptoms and the risk of developing subsequent depression. Following the workshop, a targeted literature review was conducted. Initial evidence demonstrated that in patients with insomnia and co-morbid depression either pharmacological treatment of insomnia or psychological treatment in the form of cognitive behavioural therapy for insomnia improved both insomnia and depressive symptoms. Although these appeared to be promising treatment strategies, however, of the 27 identified treatment studies, only one large well-designed randomized controlled trial comparing the efficacy of eszopiclone plus fluoxetine with placebo plus fluoxetine demonstrated unequivocal evidence that improvements in insomnia symptoms conferred additive benefits on depressive outcomes. In addition, it was unclear whether any differences exist in efficacy between sedating versus non-sedating pharmacotherapies for insomnia in this patient group. Further studies of sufficient sample size and duration are needed to evaluate combinations of pharmacological (either sedating or non-sedating) and psychological interventions in co-morbid insomnia and depression. This article reviews the level of evidence, recommendations and areas of particular interest for further study and discussion arising from this workshop.
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Affiliation(s)
- Dieter Riemann
- Department of Psychiatry and Psychotherapy, Freiburg University Medical Center, Freiburg, Germany.
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Matteson-Rusby SE, Pigeon WR, Gehrman P, Perlis ML. Why treat insomnia? PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2010; 12:PCC.08r00743. [PMID: 20582296 PMCID: PMC2882812 DOI: 10.4088/pcc.08r00743bro] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 03/06/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To make the case that insomnia is better conceptualized, not as a symptom, but as a primary disorder. DATA SOURCES PubMed was searched from 1975-2009 using the search terms insomnia, insomnia and treatment, insomnia and cost, and insomnia and treatment and safety. STUDY SELECTION English-language articles and other materials were selected to address the following claims: insomnia is unremitting, insomnia is disabling, insomnia is costly, insomnia is pervasive, insomnia is pernicious, and insomnia treatment is safe and effective. DATA EXTRACTION/SYNTHESIS Insomnia, at least when chronic, should be conceptualized as a comorbid condition, one for which effective interventions are available. CONCLUSIONS It is speculated that treatment for insomnia will only become the norm when it has been demonstrated that treatment not only addresses the problem of insomnia but also serves to reduce medical and psychiatric morbidity. At that time, the question will no longer be "Why treat insomnia?" but instead "When isn't insomnia treatment indicated?"
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Affiliation(s)
- Sara E Matteson-Rusby
- Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester, New York and Behavioral Sleep Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia
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A longitudinal community-based study of chronic illness, cognitive and physical function, and depression. Am J Geriatr Psychiatry 2009; 17:632-41. [PMID: 19634203 PMCID: PMC3690465 DOI: 10.1097/jgp.0b013e31819c498c] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Recent studies have tried to determine which aspects of chronic illness heighten the risk for depression, with functional impairment receiving the most attention. There is growing evidence that functional impairment accounts for most of the association between chronic illness and depression. This study examines the relative contribution of cognitive function, physical function, and chronic illness to depression 2 years later in a nationwide sample of elders aged 70 and older. METHODS This is a longitudinal community-based study of 5,289 elders completing two waves of assessment in the Asset and Health Dynamics among the Oldest Old study. Depression assessment included an abbreviated version of the CES-D and of the Composite International Diagnostic Interview (the CESD-8 and the CIDI-S). Cognitive function, physical function, and presence of chronic illness assessed at Wave 1 were examined as predictors of depression at Wave 2 while controlling for Wave 1 CESD-8 score. RESULTS In a full multivariate model, most baseline cognitive function, physical function, and chronic illness variables predicted depression as measured by the CESD-8 at Wave 2. The associations were markedly weaker between baseline variables and the Wave 2CIDI-S. The Wave 1 CESD-8 score predicted all-cause mortality by Wave 2 (Z =3.13; p Z = 0.002) even after controlling for key health and functioning variables. CONCLUSION Chronic illness, physical function, and cognitive function all independently predict depressive morbidity in late-life. The CIDI-S appeared less informative about these key relationships when compared to the CESD-8. The significance of depressive symptoms was demonstrated by their independent association with all-cause mortality at 2-year follow-up.
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Pigeon WR, Hegel M, Unützer J, Fan MY, Sateia MJ, Lyness JM, Phillips C, Perlis ML. Is insomnia a perpetuating factor for late-life depression in the IMPACT cohort? Sleep 2008; 31:481-8. [PMID: 18457235 DOI: 10.1093/sleep/31.4.481] [Citation(s) in RCA: 189] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Insomnia and depressive disorders are significant health problems in the elderly. Persistent insomnia is a risk factor for the development of new-onset and recurrent major depressive disorder (MDD). Less clear is whether persistent insomnia may perpetuate MDD andlor dysthymia. The present longitudinal study examines the relationship of insomnia to the continuation of depression in the context of an intervention study in elderly subjects. DESIGN Data were drawn from Project IMPACT, a multisite intervention study, which enrolled 1801 elderly patients with MDD and/or dysthymia. In the current study, subjects were assigned to an insomnia-status group (Persistent, Intermediate, and No Insomnia) based on insomnia scores at both baseline and 3-month time points. Logistic regressions were conducted to determine whether Persistent Insomnia was prospectively associated with increased risk of remaining depressed and/or achieving a less than 50% clinical improvement at 6 and at 12 months compared with the No Insomnia reference group. The Intermediate Insomnia group was compared with the other 2 groups to determine whether a dose-response relationship existed between insomnia type and subsequent depression. SETTING Eighteen primary clinics in 5 states. PARTICIPANTS Older adults (60+) with depression. MEASUREMENTS AND RESULTS Overall, patients with persistent insomnia were 1.8 to 3.5 times more likely to remain depressed, compared with patients with no insomnia. The findings were more robust in patients receiving usual care for depression than in patients receiving enhanced care. Findings were also more robust in subjects who had MDD as opposed to those with dysthymia alone. CONCLUSIONS These findings suggest that, in addition to being a risk factor for a depressive episode, persistent insomnia may serve to perpetuate the illness in some elderly patients and especially in those receiving standard care for depression in primary care settings. Enhanced depression care may partially mitigate the perpetuating effects of insomnia on depression.
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Affiliation(s)
- Wilfred R Pigeon
- Department of Psychiatry, University of Rochester Medical Center, Rochester NY, USA.
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15
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Gallo JJ, Bogner HR, Morales KH, Post EP, Lin JY, Bruce ML. The effect of a primary care practice-based depression intervention on mortality in older adults: a randomized trial. Ann Intern Med 2007; 146:689-98. [PMID: 17502629 PMCID: PMC2818643 DOI: 10.7326/0003-4819-146-10-200705150-00002] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Few studies have tested the effects of a depression intervention on the risk for death associated with depression. OBJECTIVE To test whether an intervention to improve depression care can modify the risk for death. DESIGN Practice-based, randomized, controlled trial. SETTING 20 primary care practices in New York, New York, and Philadelphia and Pittsburgh, Pennsylvania. PATIENTS 1226 randomly sampled patients identified through a 2-stage, age-stratified (60 to 74 years and > or =75 years) depression screening. INTERVENTION Depression care manager working with primary care physicians to provide algorithm-based care. MEASUREMENTS Depression status based on clinical interview and vital status at 5 years by using the National Death Index. RESULTS At baseline, 396 patients met criteria for major depression and 203 patients met criteria for clinically significant minor depression. After a median follow-up of 52.8 months, 223 patients died. Patients with depression in intervention practices were less likely to have died than those in usual care practices (adjusted hazard ratio, 0.67 [95% CI, 0.44 to 1.00]). Risk for death was reduced in patients with major depression (adjusted hazard ratio, 0.55 [CI, 0.36 to 0.84]) but not in patients with clinically significant minor depression (adjusted hazard ratio, 0.97 [CI, 0.49 to 1.92]). The benefit seemed to be almost entirely attributable to a reduction in deaths due to cancer. LIMITATIONS The mechanism for an effect on deaths due to cancer is unclear. Depression status, cause of death, and vital status might have been misclassified. CONCLUSIONS Older primary care patients with major depression in practices that implemented depression care management were less likely to die over a 5-year period than were patients with major depression in usual care practices. The effect seemed to be limited to deaths due to cancer. The mechanism for such an effect is unclear and warrants further investigation. ClinicalTrials.gov registration number: NCT00000367.
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Affiliation(s)
- Joseph J Gallo
- Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
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16
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Abstract
Macrostructure describes the temporal organization of sleep based on successive epochs of conventional length, while microstructure, which is analyzed on the basis of the scoring of phasic events, provides additional important dynamic characteristics in the evaluation of both normal and pathological sleep processes. Relationships between sleep, sleep disorders, and psychiatric disorders are quite complex, and it clearly appears that both the macrostructure and the microstructure of sleep are valuable physiologically and clinically. Psychiatric patients often complain about their sleep, and they may show sleep abnormalities that increase with the severity of their illness. Changes in the occurrence and frequency of phasic events during sleep may be associated with specific psychiatric disorders, and may provide valuable information for both diagnosis and prognosis of these disorders.
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Affiliation(s)
- Alain Muzet
- Centre National de la Recherche Scientifique, CNRS-CEPA, Strasbourg, France.
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Kennedy GJ, Marcus P. Use of antidepressants in older patients with co-morbid medical conditions: guidance from studies of depression in somatic illness. Drugs Aging 2005; 22:273-87. [PMID: 15839717 DOI: 10.2165/00002512-200522040-00001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Advanced age and medical complexity are characteristics not often associated with participation in randomised, placebo-controlled trials of antidepressants. Thus, evidence for the efficacy of antidepressant treatment among typical seniors with somatic illness and advanced age is scant. Furthermore, there appears to be no clear empirically based delineation between depressive symptoms and depressive disorders among very old, physically ill adults. The increasing numbers of antidepressants and adjunctive medications add to the practitioner's perplexity when confronted with a very old, very depressed patient. Nonetheless, a growing body of evidence from antidepressant studies in the context of age-related somatic illnesses allows reasonable inferences to guide diagnosis and treatment. Once the practitioner and patient agree upon an antidepressant trial, the benefits of prescribed medication should be assessed within the first days rather than first weeks of treatment. The patient and practitioner should expect to escalate the antidepressant to the established therapeutic range rather than seek the lowest dose that is effective. Patients who experience no benefit whatsoever within the first weeks of treatment despite being within the therapeutic range should be offered an alternative promptly. With the results of studies of depression in co-morbid disorders and analyses of treatment response trajectory, the practitioner can be assured that advanced age, physical illness and depression need not go hand in hand.
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Affiliation(s)
- Gary J Kennedy
- Department of Psychiatry and Behavioral Science, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
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18
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Gallo JJ, Bogner HR, Morales KH, Post EP, Ten Have T, Bruce ML. Depression, cardiovascular disease, diabetes, and two-year mortality among older, primary-care patients. Am J Geriatr Psychiatry 2005; 13:748-55. [PMID: 16166403 PMCID: PMC2792894 DOI: 10.1176/appi.ajgp.13.9.748] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Depression is a major contributor to death and disability, but few follow-up studies of depression have been carried out in the primary-care setting. The authors sought to assess whether depression in older patients is associated with increased mortality after a 2-year follow-up interval and to estimate the population-attributable fraction (PAF) of depression on mortality in older primary-care patients. METHODS Longitudinal cohort analysis was carried out in 20 primary-care practices. Participants were identified though a two-stage, age-stratified (60-74 or 75+) depression screening of randomly sampled patients; enrollment included patients who screened positive and a random sample of screened-negative patients. In all, 1,226 persons were assessed at baseline. Vital status at 2 years was the outcome of interest. RESULTS Of 1,226 persons in the sample, 598 were classified as depressed. After 2 years, 64 persons had died. Persons with depression at baseline were more likely to die at the end of the 2-year follow-up interval than were persons without depression, even after accounting for potentially influential covariates such as whether the participant reported a history of myocardial infarction (MI) or diabetes. CONCLUSIONS Among older, primary-care patients over the course of a 2-year follow-up interval, depression contributed as much to mortality as did MI or diabetes.
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Affiliation(s)
- Joseph J Gallo
- Dept. of Family Practice and Community Medicine, School of Medicine, University of Pennsylvania, 3400 Spruce Street, 2 Gates Bldg., Philadelphia, PA 19104, USA.
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van Walraven C, Mamdani MM, Wells PS, Williams JI. Inhibition of serotonin reuptake by antidepressants and upper gastrointestinal bleeding in elderly patients: retrospective cohort study. BMJ (CLINICAL RESEARCH ED.) 2001; 323:655-8. [PMID: 11566827 PMCID: PMC55923 DOI: 10.1136/bmj.323.7314.655] [Citation(s) in RCA: 171] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To determine the association between inhibition of serotonin reuptake by antidepressants and upper gastrointestinal bleeding. DESIGN Retrospective cohort study from population based databases. SETTING Ontario, Canada. PARTICIPANTS 317 824 elderly people observed for more than 130 000 person years. The patients started taking an antidepressant between 1992 and 1998 and were grouped by how much the drug inhibited serotonin reuptake. Patients were observed until they stopped the drug, had an upper gastrointestinal bleed, or died or the study ended. MAIN OUTCOME MEASURE Admission to hospital for acute upper gastrointestinal bleeding. RESULTS Overall, 974 bleeds were observed, with an overall bleeding rate of 7.3 per 1000 person years. After controlling for age or previous gastrointestinal bleeding, the risk of bleeding significantly increased by 10.7% and 9.8%, respectively, with increasing inhibition of serotonin reuptake. Absolute differences in bleeding between antidepressant groups were greatest for octogenarians (low inhibition of serotonin reuptake, 10.6 bleeds/1000 person years v high inhibition of serotonin reuptake, 14.7 bleeds/1000 person years; number needed to harm 244) and those with previous upper gastrointestinal bleeding (low, 28.6 bleeds/1000 person years v high, 40.3 bleeds/1000 person years; number needed to harm 85). CONCLUSIONS After age or previous upper gastrointestinal bleeding were controlled for, antidepressants with high inhibition of serotonin reuptake increased the risk of upper gastrointestinal bleeding. These increases are clinically important for elderly patients and those with previous gastrointestinal bleeding.
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Affiliation(s)
- C van Walraven
- Clinical Epidemiology Unit, Ottawa Health Research Institute, Ottawa Hospital, Civic Campus, Ottawa, ON, Canada K1Y 4E9.
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Callahan CM, Wolinsky FD, Stump TE, Nienaber NA, Hui SL, Tierney WM. Mortality, symptoms, and functional impairment in late-life depression. J Gen Intern Med 1998; 13:746-52. [PMID: 9824520 PMCID: PMC1497028 DOI: 10.1046/j.1525-1497.1998.00226.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether depressive symptoms measured at baseline are associated with mortality and to describe the course of depressive symptoms and their relation to physical decline in patients over a 6-year period. DESIGN Prospective cohort study conducted from 1990 through 1996. SETTING Urban academic primary care group practice. PATIENTS A cohort of 3,767 patients aged 60 years and older screened for depressive symptoms during routine office visits using the Centers for Epidemiologic Studies Depression Scale (CES-D) participated in the mortality study. A subsample of 300 patients with CES-D scores 16 or above and a subsample of 100 patients with CES-D scores less than 16 participated in the study of the course of depressive symptoms and physical decline. MEASUREMENTS AND MAIN RESULTS Mortality by December 1995 was measured for all screened patients; reinterviewed patients completed the CES-D and the Sickness Impact Profile (SIP). The mean follow-up period was 45 months (+/- SD 12.2 months); 561 (14.9%) of the patients died by December 1995. In proportional hazards models, age, gender, race, history of smoking, serum albumin value, and an ideal body weight in the lowest 10% were significant correlates of time to death, but the baseline CES-D was not. Patients with depressive symptoms had significantly worse physical and psychosocial functioning scores on the SIP than did patients without depressive symptoms. Using the generalized estimating equation method, the strongest predictor of the current CES-D score was the patient's prior CES-D score. However, worsening physical functioning score on the SIP was also independently correlated with worse CES-D scores p < or = .001). CONCLUSIONS Symptoms of depression were not associated with mortality in this cohort of older adults. However, patients with depressive symptoms reported greater functional impairment than did those without depressive symptoms. Moreover, decline in physical functioning was independently correlated with a concurrent increase in depressive symptoms.
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Affiliation(s)
- C M Callahan
- Regenstrief Institute for Health Care, Richard L. Roudebush VAMC and the Indiana University School of Medicine, Indianapolis 46202-2859, USA
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Abstract
The goal of this article is to provide a life-cycle perspective on the treatment of major depressive episodes in later life. Our studies have suggested that older patients appear to benefit as much, though perhaps more slowly, than mid-life patients from acute combined treatment (nortriptyline+interpersonal psychotherapy) of major depression. Given also the apparently higher relapse rate among the elderly, however, continuation treatment needs to be vigorous and closely monitored. The occurrence of severe life events prior to the index episode and the co-existence of an anxiety disorder both appear to prolong treatment response times, while chronic medical burden per se neither compromises response rates nor prolongs time to response. Self-rated perception of health improves with remission of depression in the elderly. As in mid-life patients, both antidepressant medication (nortriptyline) and interpersonal psychotherapy appear to possess chronic efficacy with respect to the prevention of recurrent episodes and prolongation of wellness. Finally, treatment of depression in the elderly results in improved quality of life, especially in domains of well being and coping. Particular challenges in the treatment of elderly patients are noncompliance and the prevention of suicide. The latter is closely linked to feelings of hopelessness, and these may be persistent in some patients.
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Affiliation(s)
- C F Reynolds
- Mental Health Clinical Research Center for the Study of Late-Life Mood Disorders, University of Pittsburgh School of Medicine, PA, USA
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22
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Abstract
Research evidence indicates that depressive symptoms, or subsyndromal cases of minor or mild depression are very common in the elderly population. However, the nosological status of minor depression is poorly and variable defined, with no current consensus. DSM-IV has, however, introduced a research category of minor depression for future validation and discussion, involving a smaller number of depressive symptoms to obtain a diagnosis than is required for major depression. The elderly population are particularly prone to subsyndromal depression because of their increased tendency to alexithymia (the inability of patients to verbalize or fantasize affective experience) and somatisation, which masks their depression. Furthermore, minor depression is not a stable entity and can predict the development of major depression as well as characterise its sequelae when major depression is in partial remission. Most studies have suggested that minor depression is roughly twice as common as major depression, with an increase in frequency in residential or medical inpatients compared with community-dwelling elderly people. Most studies also confirm the notion that minor depression increases in frequency with age in a curvilinear fashion; there is an increase in symptoms in people aged in their 30s, a decrease in middle age, a steady increase in old age and a very steep increase in people aged greater than 80 years. This effect may be attributable to the concomitant increase in physical morbidity in old age, which is closely associated with minor depression. The exact relationship between cause and effect of comorbid physical illnesses is unclear, but the association is strong for a number of common medical disorders. Impairment of well-being and functional disability is marked in minor depression. There are no available data on the relative risk of suicide in minor depression. Treatment remains unclear, but in the absence of evidence to the contrary, antidepressant medication and psychotherapeutic interventions, alone or combined, are currently the recommended course of action.
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Affiliation(s)
- C Tannock
- Department of Psychiatry, UCL Medical School, Middlesex Hospital Site, London, England
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