The "Clinician's illusion" and the epidemiology, diagnosis and treatment of depressive disorders

Major Depression and Its Recurrences: Life Course Matters

Major depression is one of the most prevalent and debilitating personal and public health conditions worldwide. Less appreciated is that depression's tremendous burdens are not shared equally among all who become depressed. Some will suffer recurrences over the rest of their lives, whereas half or more will never have a recurrence. Based on these two distinctive life course prototypes, we propose a subtype distinction for research on the origins and lifetime course of major depression. A pressing goal is to determine at the time of depression's first onset who will follow which clinical trajectory. The lack of recognition of this distinction has resulted in many obstacles, including conceptual biases, methodological oversights, and definitional dead ends. Current theories are reviewed and compared. The implications for contemporary diagnostic controversies, reevaluating research on treatment and prevention, and enhancing the predictive strength of traditionally weak indicators of recurrences and recurrent depression are discussed. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Strength is negatively associated with depression and accounts for some of the sex difference

Background

Depression occurs about twice as often in women as in men, a disparity that remains poorly understood. In a previous publication, Hagen and Rosenström predicted and found that grip strength, a highly sexually dimorphic index of physical formidability, mediated much of the effect of sex on depression. Striking results like this are more likely to be published than null results, potentially biasing the scientific record. It is therefore critical to replicate and extend them.

Methodology

Using new data from the 2013–14 cycle of the National Health and Nutrition Examination Survey, a nationally representative sample of US households (n = 3650), we replicated models of the effect of sex and grip strength on depression reported in Hagen and Rosenström, along with additional potential confounds and a new detailed symptom-level exploration.

Results

Overall, the effects from the original paper were reproduced although with smaller effect sizes. Grip strength mediated 38% of the effect of sex on depression, compared to 63% in Hagen and Rosenström. These results were extended with findings that grip strength had a stronger association with some depression symptoms, like suicidality, low interest and low mood than with other symptoms, like appetite changes.

Conclusions

Grip strength is negatively associated with depression, especially its cognitive–affective symptoms, controlling for numerous possible confounds. Although many factors influence depression, few of these reliably occur cross-culturally in a sex-stratified manner and so are unlikely to explain the well-established, cross-cultural sex difference in depression. The sex difference in upper body strength occurs in all populations and is therefore a candidate evolutionary explanation for some of the sex difference in depression.

Lay summary: Why are women at twice the risk of developing depression as men? Depression typically occurs during social conflicts, such as physical or sexual abuse. Physically strong individuals can often single-handedly resolve conflicts in their favor, whereas physically weaker individuals often need help from others. We argue that depression is a credible cry for help. Because men generally have greater strength than women, we argue that men may be more likely to resolve conflicts using physical formidability and women to signal others for help. We find that higher grip strength is associated with lower depression, particularly symptoms like feeling down or thoughts of suicide and that strength accounts for part of the sex difference in rates of depression.

Determinants of anxiety and depression in patients with cubital tunnel syndrome

BACKGROUND

The aim of this cross-sectional study to assess the proportions of anxiety and depression in patients with CuTS, and to explore the associated demographic and clinical features.

METHODS

From May 2011 to January 2017, 246 patients diagnosed with CuTS were recruited. The Hospital Anxiety and Depression Scale was used to assess the proportions of depression and anxiety. Patient demographic and clinical data were collected. Univariate analysis and multivariate regression were carried out to identify the variables that were independently associated with anxiety and depression.

RESULTS

The proportions of depression and anxiety were 17.9% (n = 44) and 14.2% (n = 35), respectively. Five patients had both possible/probable anxiety and depression. Logistic regression analysis revealed that diabetes mellitus was independently associated with depression; and the modified McGowan grade was independently associated with anxiety.

CONCLUSIONS

In patients with CuTS, the proportions of depression and anxiety were 17.9% and 14.2%, respectively. Early screening for anxiety and depression is beneficial for patients with CuTS.

Self-reported depressive symptoms in dental students: Systematic review with meta-analysis

OBJECTIVE

This study aimed to systematically review the literature about the prevalence of self-reported depressive symptoms in dental students.

METHODS

PUBMED, SCOPUS, and EMBASE databases were search up to January 2020 with the following focused questions: "What is the prevalence of self-reported depression symptom in dental students?" and "Are sex and years of educational training associated with self-reported depressive symptom in dental students?". Observational studies that applied a questionnaire assessing depression were eligible. Standard mean differences (SMD) and pooled odds ratios (OR) were calculated for the questionnaires' scores and self-reported depressive symptom, respectively.

RESULTS

Fifty-eight studies were included, and 15 different questionnaires were used. The prevalence of self-reported depressive symptoms/at least mild depression ranged from 2.75% to 89.84%, and the pooled overall prevalence was 29% (95% confidence interval [CI]: 26-34). Meta-analysis showed significantly lower scores in the questionnaires for self-reported depressive symptoms of male students (SMD: -0.22; 95% CI: -0.42 - -0.03). Conversely, no significant difference was detected for the OR of self-reported depressive symptom in the comparison between sex (OR: 1.11 - 95% CI: 0.77-1.62). Similarly, no significant difference was observed for the different school years regardless of the analytical strategy used.

CONCLUSION

It was concluded that female dental students presented more self-reported depressive symptoms, but no difference is demonstrated during the years of dental education.