Affective disorders among women in the general population and among those referred to psychiatrists. Clinical features and demographic correlates

Personality traits as risk factors of depression and anxiety among Japanese students

The aim of this study is to examine the effects of personality (temperament and character) on specific depression and specific anxiety. A total of 541 Japanese undergraduates were investigated by using the Temperament and Character Inventory (TCI) and the Hospital Anxiety and Depression (HAD) scale. Hierarchical multiple regression analyses demonstrated that specific depression was predicted by lower Reward-Dependence, Persistence, Self-Directedness, Cooperativeness, and Self-Transcendence; specific anxiety was predicted by higher Novelty-Seeking, Harm-Avoidance, Persistence, and Self-Transcendence, and lower Self-Directedness. Immaturity of Self-Directedness is a risk factor for negative affectivity. Immaturity of all character dimensions is a risk factor for specific depression. The relationship between Harm-Avoidance and depression in previous studies may be linked partly to somatic symptoms that were deliberately eliminated in the HAD scale.

Psychological sequelae of medical and surgical abortion at 10-13 weeks gestation

BACKGROUND

Although not much research comparing the emotional distress following medical and surgical abortion is available, few studies have compared psychological sequelae following both methods of abortion early in the first trimester of pregnancy. The aim of this review was to assess the psychological sequelae and emotional distress following medical and surgical abortion at 10-13 weeks gestation.

METHODS

Partially randomized patient preference trial in a Scottish Teaching Hospital was conducted. The hospital anxiety and depression scales were used to assess emotional distress. Anxiety levels were also assessed using visual analog scales while semantic differential rating scales were used to measure self-esteem. A total of 368 women were randomized, while 77 entered the preference cohort.

RESULTS

There were no significant differences in hospital anxiety and depression scales scores for anxiety or depression between the groups. Visual analog scales showed higher anxiety levels in women randomized to surgery prior to abortion (P < 0.0001), while women randomized to surgical treatment were less anxious after abortion (P < 0.0001). Semantic differential rating scores showed a fall in self-esteem in the randomized medical group compared to those undergoing surgery (P = 0.02).

CONCLUSIONS

Medical abortion at 10-13 weeks is effective and does not increase psychological morbidity compared to surgical vacuum aspiration and hence should be made available to all women undergoing abortion at these gestations.

A comparison of medical and surgical termination of pregnancy: choice, emotional impact and satisfaction with care

OBJECTIVE

To investigate whether women having medical or surgical terminations of pregnancy differ in their emotional distress before or after the procedure. To evaluate whether choice of procedure occurs, the factors influencing type of procedure and the effect of choice on emotional responses and satisfaction with care.

DESIGN

A prospective comparative study.

SETTING

A termination of pregnancy unit in a University Teaching Hospital.

PARTICIPANTS

Two hundred and seventy-five women attending for medical or surgical first trimester termination of pregnancy.

METHODS

Interviews concerning choice and measures of emotional status were completed prior to terminations. Four weeks after termination emotional functioning was reassessed together with satisfaction with care.

RESULTS

Women having a surgical termination waited longer for the procedure and were at more advanced gestation than those having the medical termination. There were no differences in emotional responses related to type of procedure or gestation. One-quarter remained highly anxious at four weeks. Medical and surgical groups did not differ in emotional status prior to termination. Those having the medical procedure rated it as marginally more stressful and experienced more post-termination physical problems and disruption to life. Seeing the fetus was associated with more intrusive events (nightmares, flashbacks, unwanted thoughts related to the experience). One-quarter of the medical and 67% of the surgical group reported having no choice in type of procedure. Only 53% of the medical group would choose the same procedure again compared with 77% of the surgical group.

CONCLUSIONS

Termination method did not influence emotional adjustment. Many women were not offered genuine choice of procedure. Having choice was considered very important but was unrelated to emotional distress or satisfaction with care.

Access to mental health care in an inner-city health district. II: Association with demographic factors

BACKGROUND

In addition to clinical and service factors, planners need to take account of the influence of demographic variables, especially ethnicity, on access to mental health care.

METHOD

Estimated prevalence rates were calculated from epidemiological surveys undertaken in three settings: psychiatric services, primary care and the general population. Associations between demographic factors and service use were examined using the 'pathways to care' model.

RESULTS

Considerable differences in access to mental health care were found, particularly according to ethnicity. The major impediment to Asians accessing care occurred at the interface between primary and secondary care, whereas the most striking feature for Blacks was the poor level of case recognition by GPs.

CONCLUSIONS

In order to improve the uptake of mental health care, new initiatives should target those who are most likely to be unwell but least likely to access services. Purchasers and providers need to address differential patterns of use when developing and reviewing services.

Familial depression versus depression identified in a control group: are they the same?

Subjects who meet the criteria for an affective syndrome possibly are aetiologically heterogeneous. An approach to this possibility involves examining affectively ill subjects obtained by different methods of ascertainment. This study compares depressed and manic subjects who are related to affectively ill probands with affectively ill subjects who were obtained from a study of a control population, and, therefore, were less likely to be familial. The subjects were identified in a large collaborative study of depression where both family members as well as controls were personally interviewed and followed up for 6 years after admission to the study. Data were obtained on subtypes of affective disorder using the Research Diagnostic Criteria and information was gathered about psychiatric hospitalizations, suicide attempts, alcoholism and psychological functioning prior to admission. Similar assessments were made for the comparison groups for the 6 year period between intake and follow-up. Relatives of bipolar I/schizoaffective manic probands were more likely to show mania than affectively ill controls or relatives of unipolar/schizoaffective depressed probands. Affectively ill controls were less likely to be hospitalized and less likely to suffer from an incapacitating depression. They were also likely to have functioned in a more healthy fashion than the affectively ill relatives of the bipolars and unipolars, in the 5 years before admission to the study. In the 6 year follow-up, both the subjects themselves and raters assessed the depressed controls as functioning better than the affectively ill relatives of the probands. Further, assessment of global adjustment during the 6 year period was worse for the relatives of affectively ill probands than for the depressed controls. Length of major depression was longer in relatives of bipolar and unipolar probands than in controls. Though all of the subjects in this study met research criteria for an affective illness, there were marked differences in the qualitative aspects of these illnesses with the relatives of affectively ill probands, who functioned less well and had longer and more severe episodes and more hospitalizations.

Prevalence of postnatal psychiatric morbidity in mothers and fathers

In the first study to systematically examine postnatal depression in fathers, we examined depression in 200 postnatal couples, using a two-stage design. The prevalence of depression ascertained by the 13-item Edinburgh Postnatal Depression Scale (EPDS), using a cut-off score for 'caseness' of 13 or more in an unselected postnatal sample, was 27.5% in mothers at six weeks postpartum, 25.7% in mothers at six months postpartum, 9.0% in fathers at six weeks postpartum, and 5.4% in fathers at six months postpartum. The prevalence did not differ significantly in either mothers or fathers from a control group of parents with children between three and five years of age. As expected, mothers had a significantly higher prevalence of psychiatric 'caseness' at both six weeks and six months postpartum than fathers. Fathers were significantly more likely to be cases if their partners were also cases. The hypothesis that different aetiological factors would be important in brief and persistent disorders in mothers was upheld.

Depression in the community: a comparison of treated and non-treated cases in two non-referred samples

Family studies in non-patient samples may help to clarify whether or not treatment-seeking behaviour is substantially determined by clinical features of depression. Life-time risks of depression were investigated by structured clinical interviews (SADS-LA) in both a high-risk sample of depressed patients' first-degree relatives and an unscreened control sample of the general population: 34.6% of the high-risk sample versus 23.1% of controls were cases of depression, with a female preponderance in both groups. The rates of treated depression were 17.0% versus 8.5%. Female sex, greater age, higher severity of episodes, manic or hypomanic episodes recurrent course, and introverted and anancastic personality were factors increasing the rate of treated cases in both samples, as well as familial loading with treated depression. Late onset and chronicity of depression did not significantly affect these proportions, but controlling for the effects of retrospective assessment by focusing only on depression within the past year confirmed the results. However, the major finding of a familial influence in treatment-seeking behaviour might be due to a personality factor running in families, as well as to a sharing of common environmental factors.