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Hoang CT, Amin V, Behrman JR, Kohler HP, Kohler IV. Heterogenous trajectories in physical, mental and cognitive health among older Americans: Roles of genetics and life course contextual factors. SSM Popul Health 2023; 23:101448. [PMID: 37520306 PMCID: PMC10372459 DOI: 10.1016/j.ssmph.2023.101448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/13/2023] [Accepted: 06/08/2023] [Indexed: 08/01/2023] Open
Abstract
We investigate the roles of genetic predispositions, childhood SES and adult educational attainment in shaping trajectories for three important components of the overall health of older adults -- BMI, depressive symptoms and cognition. We use the Health & Retirement Study (HRS) and group-based trajectory modeling (GBTM) to identify subgroups of people who share the same underlying trajectories ages 51-94 years. After identifying common underlying health trajectories, we use fractional multinomial logit models to estimate associations of (1) polygenic scores for BMI, depression, ever-smoked, education, cognition and subjective wellbeing, (2) childhood SES and (3) educational attainment with the probabilities of trajectory group memberships. While genetic predispositions do play a part in predicting trajectory group memberships, our results highlight the long arm of socioeconomic factors. Educational attainment is the most robust predictor-it predicts increased probabilities of belonging to trajectories with BMI in the normal range, low depressive symptoms and very-high initial cognition. Childhood circumstances are manifested in trajectories to a lesser extent, with childhood SES predicting higher likelihood of being on the low depressive symptoms and very-high initial cognition trajectories. We also find suggestive evidence that associations of educational attainment on the probabilities of being on trajectories with BMI in the normal range, low depressive symptoms and very-high initial cognition vary with genetic predispositions. Our results suggest that policies to increase educational attainment may improve population health by increasing the likelihood of belonging to "good" aging trajectories.
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Affiliation(s)
| | | | - Jere R. Behrman
- William R. Kenan, Economics and Sociology, University of Pennsylvania, USA
| | - Hans-Peter Kohler
- Fredrick J. Warren Professor of Demography, University of Pennsylvania, USA
| | - Illiana V. Kohler
- Population Studies Center and Department of Sociology, University of Pennsylvania, USA
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Torbati A, Ullrich HS, Cano MÀ, Essa S, Harvey L, Arbona C, Vaughan EL, Majd M, Fagundes C, de Dios MA. Sociosexual domains as mediators of the relationship between trait depression and sexual risk: A serial mediation analysis in a sample of Iranian American adults. Journal of Affective Disorders Reports 2022. [DOI: 10.1016/j.jadr.2022.100362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Van Leeuwen E, van Driel ML, Horowitz MA, Kendrick T, Donald M, De Sutter AI, Robertson L, Christiaens T. Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults. Cochrane Database Syst Rev 2021; 4:CD013495. [PMID: 33886130 PMCID: PMC8092632 DOI: 10.1002/14651858.cd013495.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Depression and anxiety are the most frequent indication for which antidepressants are prescribed. Long-term antidepressant use is driving much of the internationally observed rise in antidepressant consumption. Surveys of antidepressant users suggest that 30% to 50% of long-term antidepressant prescriptions had no evidence-based indication. Unnecessary use of antidepressants puts people at risk of adverse events. However, high-certainty evidence is lacking regarding the effectiveness and safety of approaches to discontinuing long-term antidepressants. OBJECTIVES To assess the effectiveness and safety of approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults. SEARCH METHODS We searched all databases for randomised controlled trials (RCTs) until January 2020. SELECTION CRITERIA We included RCTs comparing approaches to discontinuation with continuation of antidepressants (or usual care) for people with depression or anxiety who are prescribed antidepressants for at least six months. Interventions included discontinuation alone (abrupt or taper), discontinuation with psychological therapy support, and discontinuation with minimal intervention. Primary outcomes were successful discontinuation rate, relapse (as defined by authors of the original study), withdrawal symptoms, and adverse events. Secondary outcomes were depressive symptoms, anxiety symptoms, quality of life, social and occupational functioning, and severity of illness. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane. MAIN RESULTS We included 33 studies involving 4995 participants. Nearly all studies were conducted in a specialist mental healthcare service and included participants with recurrent depression (i.e. two or more episodes of depression prior to discontinuation). All included trials were at high risk of bias. The main limitation of the review is bias due to confounding withdrawal symptoms with symptoms of relapse of depression. Withdrawal symptoms (such as low mood, dizziness) may have an effect on almost every outcome including adverse events, quality of life, social functioning, and severity of illness. Abrupt discontinuation Thirteen studies reported abrupt discontinuation of antidepressant. Very low-certainty evidence suggests that abrupt discontinuation without psychological support may increase risk of relapse (hazard ratio (HR) 2.09, 95% confidence interval (CI) 1.59 to 2.74; 1373 participants, 10 studies) and there is insufficient evidence of its effect on adverse events (odds ratio (OR) 1.11, 95% CI 0.62 to 1.99; 1012 participants, 7 studies; I² = 37%) compared to continuation of antidepressants, without specific assessment of withdrawal symptoms. Evidence about the effects of abrupt discontinuation on withdrawal symptoms (1 study) is very uncertain. None of these studies included successful discontinuation rate as a primary endpoint. Discontinuation by "taper" Eighteen studies examined discontinuation by "tapering" (one week or longer). Most tapering regimens lasted four weeks or less. Very low-certainty evidence suggests that "tapered" discontinuation may lead to higher risk of relapse (HR 2.97, 95% CI 2.24 to 3.93; 1546 participants, 13 studies) with no or little difference in adverse events (OR 1.06, 95% CI 0.82 to 1.38; 1479 participants, 7 studies; I² = 0%) compared to continuation of antidepressants, without specific assessment of withdrawal symptoms. Evidence about the effects of discontinuation on withdrawal symptoms (1 study) is very uncertain. Discontinuation with psychological support Four studies reported discontinuation with psychological support. Very low-certainty evidence suggests that initiation of preventive cognitive therapy (PCT), or MBCT, combined with "tapering" may result in successful discontinuation rates of 40% to 75% in the discontinuation group (690 participants, 3 studies). Data from control groups in these studies were requested but are not yet available. Low-certainty evidence suggests that discontinuation combined with psychological intervention may result in no or little effect on relapse (HR 0.89, 95% CI 0.66 to 1.19; 690 participants, 3 studies) compared to continuation of antidepressants. Withdrawal symptoms were not measured. Pooling data on adverse events was not possible due to insufficient information (3 studies). Discontinuation with minimal intervention Low-certainty evidence from one study suggests that a letter to the general practitioner (GP) to review antidepressant treatment may result in no or little effect on successful discontinuation rate compared to usual care (6% versus 8%; 146 participants, 1 study) or on relapse (relapse rate 26% vs 13%; 146 participants, 1 study). No data on withdrawal symptoms nor adverse events were provided. None of the studies used low-intensity psychological interventions such as online support or a changed pharmaceutical formulation that allows tapering with low doses over several months. Insufficient data were available for the majority of people taking antidepressants in the community (i.e. those with only one or no prior episode of depression), for people aged 65 years and older, and for people taking antidepressants for anxiety. AUTHORS' CONCLUSIONS Currently, relatively few studies have focused on approaches to discontinuation of long-term antidepressants. We cannot make any firm conclusions about effects and safety of the approaches studied to date. The true effect and safety are likely to be substantially different from the data presented due to assessment of relapse of depression that is confounded by withdrawal symptoms. All other outcomes are confounded with withdrawal symptoms. Most tapering regimens were limited to four weeks or less. In the studies with rapid tapering schemes the risk of withdrawal symptoms may be similar to studies using abrupt discontinuation which may influence the effectiveness of the interventions. Nearly all data come from people with recurrent depression. There is an urgent need for trials that adequately address withdrawal confounding bias, and carefully distinguish relapse from withdrawal symptoms. Future studies should report key outcomes such as successful discontinuation rate and should include populations with one or no prior depression episodes in primary care, older people, and people taking antidepressants for anxiety and use tapering schemes longer than 4 weeks.
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Affiliation(s)
- Ellen Van Leeuwen
- Clinical Pharmacology Unit, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Mieke L van Driel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Mark A Horowitz
- Division of Psychiatry, University College London, London, UK
| | - Tony Kendrick
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - Maria Donald
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - An Im De Sutter
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Lindsay Robertson
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Thierry Christiaens
- Clinical Pharmacology Unit, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
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Batail JM, Coloigner J, Soulas M, Robert G, Barillot C, Drapier D. Structural abnormalities associated with poor outcome of a major depressive episode: The role of thalamus. Psychiatry Res Neuroimaging 2020; 305:111158. [PMID: 32889511 DOI: 10.1016/j.pscychresns.2020.111158] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 08/01/2020] [Accepted: 08/07/2020] [Indexed: 12/28/2022]
Abstract
An identification of precise biomarkers contributing to poor outcome of a major depressive episode (MDE) has the potential to improve therapeutic strategies by reducing time to symptomatic relief. In a cross-sectional volumetric study with a 6 month clinical follow-up, we performed baseline brain grey matter volume analysis between 2 groups based on illness improvement: 27 MDD patients in the "responder" (R) group (Clinical Global Impression- Improvement (CGI-I) score ≤ 2) and 30 in the "non-responder" (NR) group (CGI-I > 2), using a Voxel Based-Morphometry analysis. NR had significantly smaller Grey Matter (GM) volume in the bilateral thalami, in precentral gyrus, middle temporal gyrus, precuneus and middle cingulum compared to R at baseline. Additionally, they exhibited significant greater GM volume increase in the left anterior lobe of cerebellum and posterior cingulate cortex. The latter result was not significant when participants with bipolar disorder were excluded from the analysis. NR group had higher baseline anxiety scores. Our study has pointed out the role of thalamus in prognosis of MDE. These findings highlight the involvement of emotion regulation in the outcome of MDE. The present study provides a step towards the understanding of neurobiological processes of treatment resistant depression.
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Affiliation(s)
- J M Batail
- Centre Hospitalier Guillaume Régnier, Academic Psychiatry Department, Rennes F-35703, France; Univ Rennes, INRIA, CNRS, IRISA, INSERM, Empenn U1228 ERL, Rennes F-35042, France; Univ Rennes, "Comportement et noyaux gris centraux" research unit (EA 4712), Rennes F-35000, France.
| | - J Coloigner
- Univ Rennes, INRIA, CNRS, IRISA, INSERM, Empenn U1228 ERL, Rennes F-35042, France
| | - M Soulas
- Centre Hospitalier Guillaume Régnier, Academic Psychiatry Department, Rennes F-35703, France
| | - G Robert
- Centre Hospitalier Guillaume Régnier, Academic Psychiatry Department, Rennes F-35703, France; Univ Rennes, INRIA, CNRS, IRISA, INSERM, Empenn U1228 ERL, Rennes F-35042, France; Univ Rennes, "Comportement et noyaux gris centraux" research unit (EA 4712), Rennes F-35000, France
| | - C Barillot
- Univ Rennes, INRIA, CNRS, IRISA, INSERM, Empenn U1228 ERL, Rennes F-35042, France
| | - D Drapier
- Centre Hospitalier Guillaume Régnier, Academic Psychiatry Department, Rennes F-35703, France; Univ Rennes, INRIA, CNRS, IRISA, INSERM, Empenn U1228 ERL, Rennes F-35042, France; Univ Rennes, "Comportement et noyaux gris centraux" research unit (EA 4712), Rennes F-35000, France
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Tam J, Mezuk B, Zivin K, Meza R. U.S. Simulation of Lifetime Major Depressive Episode Prevalence and Recall Error. Am J Prev Med 2020; 59:e39-47. [PMID: 32446751 DOI: 10.1016/j.amepre.2020.03.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/09/2020] [Accepted: 03/20/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Simulation models can improve measurement and understanding of mental health conditions in the population. Major depressive episodes are a common and leading cause of disability but are subject to substantial recall bias in survey assessments. This study illustrates the application of a simulation model to quantify the full burden of major depressive episodes on population health in the U.S. METHODS A compartmental model of major depressive episodes that explicitly simulates individuals' under-reporting of past episodes was developed and calibrated to 2005-2017 National Surveys on Drug Use and Health data. Parameters for incidence of a first major depressive episode and the probability of under-reporting past episodes were estimated. Analysis was conducted from 2017 to 2019. RESULTS The model estimated that 30.1% of women (95% range: 29.0%-32.5%) and 17.4% of men (95% range: 16.7%-18.8%) have lifetime histories of a major depressive episode after adjusting for recall error. Among all adults, 13.1% of women (95% range: 8.1%-16.5%) and 6.6% of men (95% range: 4.0%-8.3%) failed to report a past major depressive episode. Under-reporting of a major depressive episode history in adults aged >65 years was estimated to be 70%. CONCLUSIONS Simulation models can address knowledge gaps in disease epidemiology and prevention and improve surveillance efforts. This model quantifies the under-reporting of major depressive episodes and provides parameter estimates for future research. After adjusting for under-reporting, 23.9% of adults have a lifetime history of major depressive episodes, which is much higher than based on self-report alone (14.0%). Far more adults would benefit from depression prevention strategies than what survey estimates suggest.
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Kornfield R, Zhang R, Nicholas J, Schueller SM, Cambo SA, Mohr DC, Reddy M. "Energy is a Finite Resource": Designing Technology to Support Individuals across Fluctuating Symptoms of Depression. Proc SIGCHI Conf Hum Factor Comput Syst 2020; 2020:10.1145/3313831.3376309. [PMID: 33585841 PMCID: PMC7877799 DOI: 10.1145/3313831.3376309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
While the HCI field increasingly examines how digital tools can support individuals in managing mental health conditions, it remains unclear how these tools can accommodate these conditions' temporal aspects. Based on weekly interviews with five individuals with depression, conducted over six weeks, this study identifies design opportunities and challenges related to extending technology-based support across fluctuating symptoms. Our findings suggest that participants perceive events and contexts in daily life to have marked impact on their symptoms. Results also illustrate that ebbs and flows in symptoms profoundly affect how individuals practice depression self-management. While digital tools often aim to reach individuals while they feel depressed, we suggest they should also engage individuals when they are less symptomatic, leveraging their energy and motivation to build habits, establish plans and goals, and generate and organize content to prepare for symptom onset.
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Affiliation(s)
| | | | - Jennifer Nicholas
- Northwestern University Chicago, IL, USA
- University of Melbourne Melbourne, Australia
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Van Leeuwen E, van Driel ML, De Sutter AIM, Anderson K, Robertson L, Christiaens T. Discontinuation of long-term antidepressant use for depressive and anxiety disorders in adults. Hippokratia 2020. [DOI: 10.1002/14651858.cd013495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Ellen Van Leeuwen
- Ghent University; Clinical Pharmacology Unit of the Department of Pharmacology; Ghent Belgium 9000
- Ghent University; Department of Family Medicine and Primary Health Care; Ghent Belgium
| | - Mieke L van Driel
- The University of Queensland; Primary Care Clinical Unit, Faculty of Medicine; Brisbane Queensland Australia 4029
| | - An IM De Sutter
- Ghent University; Department of Family Medicine and Primary Health Care; Ghent Belgium
| | - Kristen Anderson
- The University of Queensland; School of Pharmacy; Brisbane Australia
| | - Lindsay Robertson
- University of York; Cochrane Common Mental Disorders; Heslington York UK YO10 5DD
| | - Thierry Christiaens
- Ghent University; Clinical Pharmacology Unit of the Department of Pharmacology; Ghent Belgium 9000
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Johnson A, Rainville JR, Rivero-Ballon GN, Dhimitri K, Hodes GE. Testing the Limits of Sex Differences Using Variable Stress. Neuroscience 2020; 454:72-84. [PMID: 31917340 DOI: 10.1016/j.neuroscience.2019.12.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 02/07/2023]
Abstract
Depression is a chronic disease that affects nearly twice as many women as men, and symptoms can differ by sex. Preclinical models disproportionately use male subjects and test a single behavioral endpoint immediately at the cessation of stress. We conducted variable stress in male and female mice for 6, 28, and 56 days, and measured behavior with a battery chosen to match research domain criteria. To examine individual differences, we generated a composite z score to measure stress susceptibility across behavioral tests. We also tested behavior following a 30-day recovery period to evaluate the duration of the stress effects. Females, but not males, were susceptible to 6 days of variable stress when behavioral testing started 24 h later. If behavioral testing was conducted 30 days later both males and females expressed stress related behaviors. Males and females were stress susceptible to 28 days of variable stress and effects were long lasting. Both sexes habituated to 56 days of variable stress, but anxiety associated measures still showed persistence. Performance on specific behavioral tests was often different between individuals and between sexes, and not all stressed animals were susceptible to all tested behaviors. These studies confirm that behavioral sex differences are detected in response to variable stress, and reveal information about individual differences. Use of a test battery that measures varying endophenotypes can be combined into a single stress susceptibility score as a tool similar to the scales/inventories used for the study of depression in humans. We present these data with the goal of furthering the field's understanding sex differences and how they shape the biology of mood disorders.
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Affiliation(s)
- Alyssa Johnson
- School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Jennifer R Rainville
- School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - G Nicole Rivero-Ballon
- School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Katerina Dhimitri
- School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Georgia E Hodes
- School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA.
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Abstract
PURPOSE OF REVIEW This article discusses the prevalence of the major mood disorders (major depressive disorder and bipolar disorder) in the community and within neurologic settings, articulates the steps taken to make a diagnosis of major depressive disorder or bipolar disorder, and reviews old and newer treatment options with proven efficacy for the treatment of these two conditions. RECENT FINDINGS New medications are available as treatment options for major depressive disorder and bipolar disorder, such as intranasal and IV ketamine, and somatic treatments, such as deep brain stimulation and vagal nerve stimulators, are being used to target treatment-resistant depression. SUMMARY Mood disorders are common in neurologic settings. They are disabling and increase morbidity and mortality. Clinicians should have a high index of suspicion if they suspect their patients seem more distressed or incapacitated than would be warranted by their neurologic disorders. If a patient does have a mood disorder, validating the patient's experience, initiating treatment, and, if necessary, referring the patient to a primary care physician or psychiatrist are appropriate steps.
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Serafini G, Santi F, Gonda X, Aguglia A, Fiorillo A, Pompili M, Carvalho AF, Amore M. Predictors of recurrence in a sample of 508 outpatients with major depressive disorder. J Psychiatr Res 2019; 114:80-87. [PMID: 31051436 DOI: 10.1016/j.jpsychires.2019.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Specific predictors of relapse/recurrence in major depressive disorder (MDD) have been identified but evidence across studies are inconsistent. This study aimed to identify the most relevant socio-demographic/clinical predictors of MDD recurrence in a sample of 508 outpatients. METHODS This naturalistic cohort study included 508 currently euthymic MDD patients (mean age = 54.1 ± 16.2) of which 53.9% had a single and 46.1% recurrent depressive episodes. A detailed data collection was performed and illness histories were retraced through clinical files and lifetime computerized medical records. RESULTS Compared to patients with single episode, MDD patients with recurrent episodes significantly differ regarding current age, gender, working status, positive history of psychiatric disorders in family, first-lifetime illness episode characteristics, first-episode and current psychotic symptoms, current melancholic features and seasonality, age at first treatment, duration of untreated illness, and comorbid cardiovascular/endocrinological conditions. However, after multivariate analyses controlling for current age, gender, educational level, working status differences, psychiatric conditions in family, and age of illness episode, recurrence was associated with older age (p ≤ .001), younger age at first treatment (p ≤ .005), being treated with previous psychoactive treatments (p .001), and longer duration of untreated illness (p .001). CONCLUSIONS The variables associated with MDD recurrence identified in the current study may aid in the stratification of patients who could benefit from more intensive maintenance treatments for MDD. However, clinicians should rapidly identify cases that are not likely to recur in order to avoid unnecessary treatments which are commonly considered as the standard of care.
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Affiliation(s)
- Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Francesca Santi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary; NAP-2-SE New Antidepressant Target Research Group, Semmelweis University, Budapest, Hungary
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Suicide Prevention Center, Sant'Andrea Hospital, University of Rome, Rome, Italy
| | - André F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Abstract
BACKGROUND Potentially modifiable risk factors for developing dementia have been identified. However, risk factors for increased mortality in patients with diagnosed dementia are not well understood. Identifying factors that influence prognosis would help clinicians plan care and address unmet needs.AimsTo investigate diagnosed depression and sociodemographic factors as predictors of mortality in patients with dementia in UK secondary clinical care services. METHOD We conducted a cohort study of patients with a dementia diagnosis in an electronic health records database in a UK National Health Service mental health trust. RESULTS In 3374 patients with 10 856 person-years of follow-up, comorbid depression was not associated with mortality (adjusted hazard ratio 0.94; 95% CI 0.71-1.24). Single patients had higher mortality than those who were married (adjusted hazard ratio 1.25; 95% CI 1.03-1.50). Patients of Asian ethnicity had lower mortality rates than White British patients (adjusted hazard ratio 0.50; 95% CI 0.34-0.73). CONCLUSIONS Clinically diagnosed depression does not increase mortality in patients with dementia. Patients who are single are a potential high-mortality risk group. Lower mortality rates in Asian patients with dementia that have been reported in the USA also apply in the UK.Declaration of interestNone.
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Affiliation(s)
- Gemma Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, UK,Correspondence: Gemma Lewis, Division of Psychiatry, University College London, 149 Tottenham Court Road, London W1T 7NF, UK.
| | - Nomi Werbeloff
- Division of Psychiatry, Faculty of Brain Sciences, University College London, UK
| | - Joseph F. Hayes
- Division of Psychiatry, Faculty of Brain Sciences, University College London and Camden and Islington NHS Foundation Trust, UK
| | - Robert Howard
- Division of Psychiatry, Faculty of Brain Sciences, University College London and Camden and Islington NHS Foundation Trust, UK
| | - David P. J. Osborn
- Division of Psychiatry, Faculty of Brain Sciences, University College London and Camden and Islington NHS Foundation Trust, UK
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Paavonen V, Luoto K, Lassila A, Leinonen E, Kampman O. Temperament and character profiles are associated with depression outcome in psychiatric secondary care patients with harmful drinking. Compr Psychiatry 2018; 84:26-31. [PMID: 29677572 DOI: 10.1016/j.comppsych.2018.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/27/2018] [Accepted: 04/04/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Temperament and character profiles have been associated with depression outcome and alcohol abuse comorbidity in depressed patients. How harmful alcohol use modifies the effects of temperament and character on depression outcome is not well known. Knowledge of these associations could provide a method for enhancing more individualized treatment strategies for these patients. METHODS We screened 242 depressed patients with at least moderate level of depressive symptoms. The Alcohol Use Disorders Identification Test (AUDIT) was used for identifying patients with marked alcohol use problems (AUP, AUDIT≥11). After 6 weeks of antidepressive treatment 173 patients were assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS), and the Temperament and Character Inventory (TCI-R). Outcome of depression (MADRS scores across three follow-up points at 6 weeks, 6 months and 24 months) was predicted with AUP, gender, and AUP x Gender and AUP x Time interactions together with temperament and character dimension scores in a linear mixed effects model. RESULTS Poorer outcome of depression (MADRS scores at 6 weeks, 6 months and 24 months) was predicted by AUP × Time interaction (p = 0.0002) together with low Reward Dependence (p = 0.003). Gender and all other temperament and character traits were non-significant predictors of the depression outcome in the mixed effects model. CONCLUSIONS Possibly due to the modifying effect of alcohol use problems, high Reward Dependence was associated with better depression treatment outcome at 6 months. Harm Avoidance and Self-Directedness did not predict depression outcome when alcohol use problems were controlled.
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Wagner CJ, Dintsios CM, Metzger FG, L'Hoest H, Marschall U, Stollenwerk B, Stock S. Longterm persistence and nonrecurrence of depression treatment in Germany: a four-year retrospective follow-up using linked claims data. Int J Methods Psychiatr Res 2018; 27:e1607. [PMID: 29446186 PMCID: PMC6877203 DOI: 10.1002/mpr.1607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/15/2017] [Accepted: 12/20/2017] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To measure persistence and nonrecurrence of depression treatment and investigate potential risk factors. METHODS We retrospectively observed a closed cohort of insurees with new-onset depression treatment in 2007 and without most psychiatric comorbidity for 16 quarters (plus one to ascertain discontinuation). We linked inpatient/outpatient/drug-data per person and quarter. Person-quarters containing specified depression services were classified as depression-treatment-person-quarters (DTPQ). We defined longterm-DTPQ-persistence as 16 + 1 continuous DTPQ and longterm-DTPQ-nonrecurrence as 12 continuous quarters without DTPQ and used multivariate logistic regression to explore associations with these outcomes. RESULTS Within first 16 quarters, 28,348 patients' first period (total time) persisted for a mean/median 5.4/3 (8.7/8) quarters. Fourteen percent had longterm-DTPQ-persistence, associated (p < .05) with baseline hospital (odds ratio, OR = 1.80), psychotherapy/specialist-interview and antidepressants (OR = 1.81), age (years, OR = 1.03), unemployment (OR = 1.21), retirement (OR = 1.31), and insured as a dependent (OR = 1.32). Thirty-four percent had longterm-DTPQ-nonrecurrence, associated with psychotherapy/specialist-interview (OR = 1.40), antidepressants (OR = 0.54), female sex (OR = 0.84), age (years, OR = 0.99), retirement (OR = 1.18), and insured as a dependent (OR = 0.88). Women differed for episodic and not chronic treatment. CONCLUSION Treatment measures compared to survey's symptoms measures. We suggest further research on "treatment-free-time." Antidepressants(-) and psychotherapy/specialist-interview(+) were significantly associated with longterm-DTPQ-nonrecurrence. This was presumably moderated by possible short-time/low-dosage antidepressants use(-) and selective therapy assignment(+). Sample selectivity limited data misclassification.
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Affiliation(s)
- Christoph J Wagner
- Institute for Health Economics and Clinical Epidemiology (IGKE), Cologne University Hospital, Cologne, Germany
| | - Charalabos Markos Dintsios
- Institute for Health Services Research and Health Economics, Heinrich Heine University, Duesseldorf, Germany
| | - Florian G Metzger
- Department of Psychiatry and Psychotherapy and Geriatric Centre, Tuebingen University Hospital, Tuebingen, Germany
| | - Helmut L'Hoest
- Department of Medicine and Health Services Research, BARMER Statutory Health Insurance Fund (former BARMER GEK), Wuppertal, Germany
| | - Ursula Marschall
- Department of Medicine and Health Services Research, BARMER Statutory Health Insurance Fund (former BARMER GEK), Wuppertal, Germany
| | - Bjoern Stollenwerk
- Helmholtz Zentrum Muenchen, Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology (IGKE), Cologne University Hospital, Cologne, Germany
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Abstract
Response rates to available treatments for psychological and chronic pain disorders are poor, and there is a considerable burden of suffering and disability for patients, who often cycle through several rounds of ineffective treatment. As individuals presenting to the clinic with symptoms of these disorders are likely to be heterogeneous, there is considerable interest in the possibility that different constellations of signs could be used to identify subgroups of patients that might preferentially benefit from particular kinds of treatment. To this end, there has been a recent focus on the application of machine learning methods to attempt to identify sets of predictor variables (demographic, genetic, etc.) that could be used to target individuals towards treatments that are more likely to work for them in the first instance. Importantly, the training of such models generally relies on datasets where groups of individual predictor variables are labelled with a binary outcome category - usually 'responder' or 'non-responder' (to a particular treatment). However, as previously highlighted in other areas of medicine, there is a basic statistical problem in classifying individuals as 'responding' to a particular treatment on the basis of data from conventional randomized controlled trials. Specifically, insufficient information on the partition of variance components in individual symptom changes mean that it is inappropriate to consider data from the active treatment arm alone in this way. This may be particularly problematic in the case of psychiatric and chronic pain symptom data, where both within-subject variability and measurement error are likely to be high. Here, we outline some possible solutions to this problem in terms of dataset design and machine learning methodology, and conclude that it is important to carefully consider the kind of inferences that particular training data are able to afford, especially in arenas where the potential clinical benefit is so large.
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Affiliation(s)
- Agnes Norbury
- Computational and Biological Learning Laboratory, Department of Engineering, University of Cambridge, Cambridge, CB2 1PZ, UK
| | - Ben Seymour
- Computational and Biological Learning Laboratory, Department of Engineering, University of Cambridge, Cambridge, CB2 1PZ, UK
- Center for Information and Neural Networks, National Institute of Information and Communications Technology, Osaka, 565-0871, Japan
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15
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Abstract
Response rates to available treatments for psychological and chronic pain disorders are poor, and there is a substantial burden of suffering and disability for patients, who often cycle through several rounds of ineffective treatment. As individuals presenting to the clinic with symptoms of these disorders are likely to be heterogeneous, there is considerable interest in the possibility that different constellations of signs could be used to identify subgroups of patients that might preferentially benefit from particular kinds of treatment. To this end, there has been a recent focus on the application of machine learning methods to attempt to identify sets of predictor variables (demographic, genetic, etc.) that could be used to target individuals towards treatments that are more likely to work for them in the first instance. Importantly, the training of such models generally relies on datasets where groups of individual predictor variables are labelled with a binary outcome category - usually 'responder' or 'non-responder' (to a particular treatment). However, as previously highlighted in other areas of medicine, there is a basic statistical problem in classifying individuals as 'responding' to a particular treatment on the basis of data from conventional randomized controlled trials. Specifically, insufficient information on the partition of variance components in individual symptom changes mean that it is inappropriate to consider data from the active treatment arm alone in this way. This may be particularly problematic in the case of psychiatric and chronic pain symptom data, where both within-subject variability and measurement error are likely to be high. Here, we outline some possible solutions to this problem in terms of dataset design and machine learning methodology, and conclude that it is important to carefully consider the kind of inferences that particular training data are able to afford, especially in arenas where the potential clinical benefit is so large.
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Affiliation(s)
- Agnes Norbury
- Computational and Biological Learning Laboratory, Department of Engineering, University of Cambridge, Cambridge, CB2 1PZ, UK
| | - Ben Seymour
- Computational and Biological Learning Laboratory, Department of Engineering, University of Cambridge, Cambridge, CB2 1PZ, UK
- Center for Information and Neural Networks, National Institute of Information and Communications Technology, Osaka, 565-0871, Japan
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16
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Albrecht JS, Park Y, Hur P, Huang TY, Harris I, Netzer G, Lehmann SW, Langenberg P, Khokhar B, Wei YJ, Moyo P, Simoni-Wastila L. Adherence to Maintenance Medications among Older Adults with Chronic Obstructive Pulmonary Disease. The Role of Depression. Ann Am Thorac Soc 2016; 13:1497-504. [PMID: 27332765 DOI: 10.1513/AnnalsATS.201602-136OC] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Among individuals with chronic obstructive pulmonary disease (COPD), depression is one of the most common yet underrecognized and undertreated comorbidities. Although depression has been associated with reduced adherence to maintenance medications used in other conditions, such as diabetes, little research has assessed the role of depression in COPD medication use and adherence. OBJECTIVES The objective of this study was to assess the impact of depression on COPD maintenance medication adherence among a nationally representative sample of Medicare beneficiaries newly diagnosed with COPD. METHODS We used a 5% random sample of Medicare administrative claims data to identify beneficiaries diagnosed with COPD between 2006 and 2010. We included beneficiaries with 2 years of continuous Medicare Parts A, B, and D coverage and at least two prescription fills for COPD maintenance medications after COPD diagnosis. We searched for prescription fills for inhaled corticosteroids, long-acting β-agonists, and long-acting anticholinergics and calculated adherence starting at the first fill. We modeled adherence to COPD maintenance medications as a function of new episodes of depression, using generalized estimated equations. MEASUREMENTS AND MAIN RESULTS Our primary outcome was adherence to COPD maintenance medications, measured as proportion of days covered. The exposure measure was depression. Both COPD and depression were assessed using diagnostic codes in Part A and B data. Covariates included sociodemographics, as well as clinical markers, including comorbidities, COPD severity, and depression severity. Of 31,033 beneficiaries meeting inclusion criteria, 6,227 (20%) were diagnosed with depression after COPD diagnosis. Average monthly adherence to COPD maintenance medications was low, peaking at 57% in the month after first fill and decreasing to 35% within 6 months. In our adjusted regression model, depression was associated with decreased adherence to COPD maintenance medications (odds ratio, 0.93; 95% confidence interval, 0.89-0.98). CONCLUSIONS New episodes of depression decreased adherence to maintenance medications used to manage COPD among older adults. Clinicians who treat older adults with COPD should be aware of the development of depression, especially during the first 6 months after COPD diagnosis, and monitor patients' adherence to prescribed COPD medications to ensure best clinical outcomes.
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Hoertel N, Blanco C, Oquendo MA, Wall MM, Olfson M, Falissard B, Franco S, Peyre H, Lemogne C, Limosin F. A comprehensive model of predictors of persistence and recurrence in adults with major depression: Results from a national 3-year prospective study. J Psychiatr Res 2017; 95:19-27. [PMID: 28759845 PMCID: PMC5653405 DOI: 10.1016/j.jpsychires.2017.07.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 10/19/2022]
Abstract
Identifying predictors of persistence and recurrence of depression in individuals with a major depressive episode (MDE) poses a critical challenge for clinicians and researchers. We develop using a nationally representative sample, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 34,653), a comprehensive model of the 3-year risk of persistence and recurrence in individuals with MDE at baseline. We used structural equation modeling to examine simultaneously the effects of four broad groups of clinical factors on the risk of MDE persistence and recurrence: 1) severity of depressive illness, 2) severity of mental and physical comorbidity, 3) sociodemographic characteristics and 4) treatment-seeking behavior. Approximately 16% and 21% of the 2587 participants with an MDE at baseline had a persistent MDE and a new MDE during the 3-year follow-up period, respectively. Most independent predictors were common for both persistence and recurrence and included markers for the severity of the depressive illness at baseline (as measured by higher levels on the general depressive symptom dimension, lower mental component summary scores, prior suicide attempts, younger age at onset of depression and greater number of MDEs), the severity of comorbidities (as measured by higher levels on dimensions of psychopathology and lower physical component summary scores) and a failure to seek treatment for MDE at baseline. This population-based model highlights strategies that may improve the course of MDE, including the need to develop interventions that target multiple psychiatric disorders and promotion of treatment seeking to increase access to timely mental health care.
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Affiliation(s)
- Nicolas Hoertel
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA; Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France; INSERM UMR 894, Psychiatry and Neurosciences Center, France.
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Maria A Oquendo
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA
| | - Melanie M Wall
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA
| | - Bruno Falissard
- Centre de Recherche en Epidemiologie et Santé des Populations (CESP), Paris-Saclay University, Paris-Sud University, UVSQ, INSERM, APHP, Paris, France
| | - Silvia Franco
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA
| | - Hugo Peyre
- Assistance Publique-Hôpitaux de Paris (APHP), Robert-Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France
| | - Cédric Lemogne
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
| | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
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Abstract
Although the belief that creativity is related to psychopathology is prevalent, empirical evidence is limited. Research findings relating to mood disorder in particular are mixed, possibly as a result of differing research approaches (e.g., assessing the creativity of individuals with versus without mood disorder opposed to the prevalence of mood disorder in creative versus noncreative individuals). Therefore, a systematic review and meta-analysis were conducted to investigate prior research examining the link between mood disorder and creativity from three distinct research approaches. Multilevel random effects models were used to calculate the overall effect size for studies that assessed (a) creativity in a clinical versus nonclinical sample ( k = 13), (b) mood disorder in a creative versus noncreative sample ( k = 10), and (c) the correlation between dimensional measures of creativity and mood disorder symptoms ( k = 15). Potential moderators were examined using meta-regression and subgroup analyses, as significant heterogeneity was detected among the effects in all three analyses. Results reveal a differential strength and pattern of effects across the three analyses, suggesting that the relationship between creativity and mood disorder differs according to the research approach. The theoretical implications of results and potential mechanisms responsible for the relationship between creativity and mood disorder are discussed.
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Abstract
In this Perspective on the study by Bryant and colleagues, Alex Tsai discusses the evidence supporting lay worker-administered, behavioral interventions for women survivors of interpersonal violence.
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Affiliation(s)
- Alexander C. Tsai
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Mbarara University of Science and Technology, Mbarara, Uganda
- MGH Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- * E-mail:
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Albert K, Gau V, Taylor WD, Newhouse PA. Attention bias in older women with remitted depression is associated with enhanced amygdala activity and functional connectivity. J Affect Disord 2017; 210:49-56. [PMID: 28012352 DOI: 10.1016/j.jad.2016.12.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 12/09/2016] [Accepted: 12/12/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cognitive bias is a common characteristic of major depressive disorder (MDD) and is posited to remain during remission and contribute to recurrence risk. Attention bias may be related to enhanced amygdala activity or altered amygdala functional connectivity in depression. The current study examined attention bias, brain activity for emotional images, and functional connectivity in post-menopausal women with and without a history of major depression. METHODS Attention bias for emotionally valenced images was examined in 33 postmenopausal women with (n=12) and without (n=21) a history of major depression using an emotion dot probe task during fMRI. Group differences in amygdala activity and functional connectivity were assessed using fMRI and examined for correlations to attention performance. RESULTS Women with a history of MDD showed greater attentional bias for negative images and greater activity in brain areas including the amygdala for both positive and negative images (pcorr <0.001) than women without a history of MDD. In all participants, amygdala activity for negative images was correlated with attention facilitation for emotional images. Women with a history of MDD had significantly greater functional connectivity between the amygdala and hippocampal complex. In all participants amygdala-hippocampal connectivity was positively correlated with attention facilitation for negative images. LIMITATIONS Small sample with unbalanced groups. CONCLUSIONS These findings provide evidence for negative attentional bias in euthymic, remitted depressed individuals. Activity and functional connectivity in limbic and attention networks may provide a neurobiological basis for continued cognitive bias in remitted depression.
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Abstract
OBJECTIVE It is a widely held belief that affective disorders are progressive of nature; however, some recent reviews have questioned this belief. The objective of the present systematic literature review was to present evidence for associations between number of affective episodes and (i) the risk of recurrence of episodes, (ii) probability of recovery from episodes, (iii) severity of episodes, (iv) the threshold for developing episodes, and (v) progression of cognitive deficits in unipolar and bipolar disorders. METHOD A systematic review comprising an extensive literature search conducted in Medline, Embase, and PsychInfo up to September 2016 and including cross-references from identified papers and reviews. RESULTS Most of the five areas are superficially investigated and hampered by methodological challenges. Nevertheless, studies with the longest follow-up periods, using survival analysis methods, taking account of the individual heterogeneity all support a clinical progressive course of illness. Overall, increasing number of affective episodes seems to be associated with (i) increasing risk of recurrence, (ii) increasing duration of episodes, (iii) increasing symptomatic severity of episodes, (iv) decreasing threshold for developing episodes, and (v) increasing risk of developing dementia. CONCLUSION Although the course of illness is heterogeneous, there is evidence for clinical progression of unipolar and bipolar disorders.
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Affiliation(s)
- L V Kessing
- Department O, Psychiatric Center Copenhagen, Copenhagen, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - P K Andersen
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
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Singh R, Liles MA, Montagne M. Identifying and describing patient perspectives on long-term antidepressant use. Cogent Psychology 2016. [DOI: 10.1080/23311908.2016.1223902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Reshmi Singh
- Department of Pharmacy, University of Wyoming College of Health Sciences, 1000 E. University Ave., Dept. 3375, Laramie, WY 82071, USA
| | - Marie A. Liles
- Department of Global Patient Safety, Eli Lilly and Company, Indianapolis, IN, USA
| | - Michael Montagne
- Department of Pharmacy, Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Ave., Boston, MA 02115, USA
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Taştan KT, Öztekin CÖ, Kaya AK, Demirhan BD. Bir Üniversite Hastanesinde Çalışanların Depresyon Düzeyleri ve Etkileyen Faktörler. Ankara Med J 2016. [DOI: 10.17098/amj.93463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Boden JM, Foulds JA. Major depression and alcohol use disorder in adolescence: Does comorbidity lead to poorer outcomes of depression? J Affect Disord 2016; 206:287-93. [PMID: 27643961 DOI: 10.1016/j.jad.2016.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/29/2016] [Accepted: 09/08/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Comorbid major depression (MD) and alcohol use disorder (AUD), particularly in adolescents, have been shown to be associated with poorer subsequent MD outcomes. METHODS Longitudinal data were used to model associations between a four-level classification of MD/AUD during the period 15-18 years (neither; MD-only; AUD-only; comorbid MD/AUD) and MD over the period 18-35 years. These associations were then adjusted for confounding by a series of factors measured in childhood. RESULTS The three disorder groups had rates of adult MD during the period 18-35 years that were significantly (p<.05) higher than that of the group with no disorder. Furthermore, those in the comorbid MD/AUD group had significantly (p <.05) higher rates of adult MD than those in the AUD-only group, and marginally (p <.10) higher rates of adult MD than those in the MD-only group. After adjustment for confounding, the difference in rates of adult MD between the MD-only group and the MD/AUD group were no longer statistically significant. The factors that explained the associations were gender, childhood behavior problems, and exposure to physical and sexual abuse. LIMITATIONS The data were obtained by self-report, and may have been subject to biases. CONCLUSIONS The results of these analyses suggest that marginally higher rates of depression to age 35 amongst the comorbid MD/AUD group were explained by increased exposure to adverse childhood circumstances amongst members of the comorbid group. Adolescent MD/AUD comorbidity is likely to be a risk marker, rather than a causal factor in subsequent MD.
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de Groot M, Crick KA, Long M, Saha C, Shubrook JH. Lifetime Duration of Depressive Disorders in Patients With Type 2 Diabetes. Diabetes Care 2016; 39:2174-2181. [PMID: 27729427 PMCID: PMC5127229 DOI: 10.2337/dc16-1145] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/25/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Depression in patients with type 2 diabetes (T2D) is associated with long-term complications, disability, and early mortality. No studies have systematically examined the length of episodes and remission in adults with major depressive disorder (MDD) and T2D. This study examined the course of depressive disorders in patients with T2D and MDD. RESEARCH DESIGN AND METHODS Participants (N = 50) enrolled in a behavioral intervention for adults with T2D and MDD were interviewed using the Structured Clinical Interview for DSM-IV-TR to assess history of depressive disorders at baseline (lifetime history), postintervention, and 3-month follow-up. Onset and remission dates were recorded for all Axis I depressive disorders from birth to final interview. RESULTS Average number of MDD episodes was 1.8 with a mean duration of 23.4 months (SD 31.9; range 0.5-231.3). Over the life course, mean exposure to MDD was 43.1 months (SD 46.5; range 0.5-231.3). Kaplan-Meier survival curve analysis indicated median episode duration decreased with subsequent episodes (14 months, first episode; 9 months, second episode; P < 0.002). In patients with multiple depressive episodes, recovery time was shorter with each subsequent episode (P = 0.002). No differences in length of episode or remission were observed based on chronology of T2D diagnosis. CONCLUSIONS The overall exposure to depression in this sample of adults with T2D represents a substantial period of time that can contribute to negative medical and psychiatric outcomes. Recurrent episodes decrease in duration as do recovery periods, resulting in a waxing and waning pattern. Findings from this study underscore the need to effectively diagnose and treat depression in patients with T2D to minimize risk of future depressive episodes.
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Affiliation(s)
- Mary de Groot
- Diabetes Translational Research Center, Indiana University School of Medicine, Indianapolis, IN
| | - Kent A Crick
- Diabetes Translational Research Center, Indiana University School of Medicine, Indianapolis, IN
| | - Molly Long
- Diabetes Translational Research Center, Indiana University School of Medicine, Indianapolis, IN
| | - Chandan Saha
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Jay H Shubrook
- Touro University California College of Osteopathic Medicine, Vallejo, CA
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Kovacs M, Obrosky S, George C. The course of major depressive disorder from childhood to young adulthood: Recovery and recurrence in a longitudinal observational study. J Affect Disord 2016; 203:374-381. [PMID: 27347807 PMCID: PMC4975998 DOI: 10.1016/j.jad.2016.05.042] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The episodic nature of major depressive disorder (MDD) in clinically referred adults has been well-characterized, particularly by the NIMH Collaborative Depression Study. Previous work has established that MDD also is episodic prior to adulthood, but no study has yet provided comprehensive information on the actual course of MDD in clinically referred juveniles. Thus, the present investigation sought to characterize recovery, recurrence, and their predictors across multiple episodes of MDD in initially 8- to 13-year-old outpatients (N=102), and to estimate freedom from morbidity ("well-time") across the years. METHOD Clinically referred youngsters with MDD were repeatedly assessed in an observational study across two decades (median follow up length: 15 years). Survival analytic techniques served to model recovery from the 1st, 2nd and 3rd lifetime episodes of MDD, the risk of developing the 2nd, 3rd, and 4th episodes, and the effects of traditional psychosocial and clinical predictors of outcomes. "Well-time" across the follow-up and its predictors also were examined. RESULTS Recovery rates ranged from 96% to 100% across MDD episodes; episode lengths ranged from 6 to 7 months. Up to 72% of those recovered from the first episode of MDD had a further episode; median inter-episode intervals were about 3-5 years. No single demographic, social, or clinical variable, nor treatment, consistently predicted recovery/recurrence. Psychiatric morbidity over time derived mostly from non-affective disorders, which, however, did not alter the course of MDD. LIMITATIONS The sample was relatively small and power to detect small effects further declined with each MDD episode recurrence. CONCLUSIONS Echoing findings on adults, the course of pediatric-onset MDD in this clinical sample was unequivocally episodic. Traditional course predictors had limited temporal stability, highlighting the need to examine novel predictor variables. The ongoing risk of depression episodes into the second and third decades of life suggests that prevention efforts should start in late childhood.
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Affiliation(s)
- Maria Kovacs
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
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Albrecht JS, Huang TY, Park Y, Langenberg P, Harris I, Netzer G, Lehmann SW, Khokhar B, Simoni-Wastila L. New episodes of depression among Medicare beneficiaries with chronic obstructive pulmonary disease. Int J Geriatr Psychiatry 2016; 31:441-9. [PMID: 26284687 PMCID: PMC4758915 DOI: 10.1002/gps.4348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/23/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Depression is a common comorbidity of chronic obstructive pulmonary disease (COPD) and is associated with increased exacerbations, healthcare utilization, and mortality. Among Medicare beneficiaries newly diagnosed with COPD, the objectives of this study were to (1) estimate the rate of new episodes of depression and (2) identify factors associated with depression. METHODS We identified beneficiaries with a first diagnosis of COPD during 2006-2012 using a 5% random sample of Medicare administrative claims data by searching for ICD-9-CM codes 490, 491.x, 492.x, 494.x, or 496. We identified episodes of depression using ICD-9-CM codes 296.2x, 296.3x, and 311.xx. We calculated incidence rates and their 95% confidence intervals (95% CI) and used a discrete time analysis to identify factors associated with development of depression. RESULTS Between 2006 and 2012, 125,348 beneficiaries meeting inclusion criteria were newly diagnosed with COPD. Twenty-three percent developed depression following COPD diagnosis. The annualized incidence rate of depression per 100 beneficiaries following COPD diagnosis was 9.4 (95% CI 9.3, 9.5). Rates were highest in the first 2 months following COPD diagnosis. COPD diagnosis was associated with increased risk of depression (risk ratio 1.76; 95% CI 1.73, 1.79) as were COPD-related hospitalizations (risk ratio 4.59; 95% CI 4.09, 5.15), a measure of COPD severity. CONCLUSIONS Diagnosis of COPD increases the risk of depression. This study will aid in the allocation of resources to monitor and provide support for individuals with COPD at high risk of developing depression.
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Affiliation(s)
- Jennifer S. Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine
| | - Ting-Ying Huang
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy
| | - Yujin Park
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy
| | - Patricia Langenberg
- Department of Epidemiology and Public Health, University of Maryland School of Medicine
| | | | - Giora Netzer
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine
| | - Susan W. Lehmann
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Bilal Khokhar
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy
| | - Linda Simoni-Wastila
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy
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Musliner KL, Munk-Olsen T, Eaton WW, Zandi PP. Heterogeneity in long-term trajectories of depressive symptoms: Patterns, predictors and outcomes. J Affect Disord 2016; 192:199-211. [PMID: 26745437 PMCID: PMC4761648 DOI: 10.1016/j.jad.2015.12.030] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/16/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Evidence suggests that long-term trajectories of depressive symptoms vary greatly throughout the population, with some individuals experiencing few or no symptoms, some experiencing transient symptoms and others experiencing chronic depression. The goal of this paper is to review studies that examined heterogeneity in long-term trajectories of depressive symptoms and summarize the current knowledge regarding (a) the number and patterns of trajectories and (b) antecedents and outcomes associated with different trajectory patterns. METHODS We conducted a systematic review of literature in the Medline and PsychINFO databases. Articles were included if they (a) modeled trajectories of depressive symptoms, (b) used a group-based trajectory modeling approach, (c) followed participants for 5+ years and (d) had a sample size of at least 200. RESULTS We identified 25 studies from 24 separate cohorts. Most of the studies identified either 3 or 4 distinct trajectory classes. Trajectories varied in terms of severity (low, medium, high) and stability (stable, increasing, decreasing). In most studies, the majority of participants had consistently few or no depressive symptoms, but a notable minority (usually <10%) reported persistent symptoms. Predictors of trajectories with greater symptom burden included female gender, lower income/education and non-white race. Other predictors were specific to different populations (e.g. mothers, older adults). High symptom burden trajectories were associated with poor psychiatric and social outcomes. LIMITATIONS Comparisons between studies were qualitative. CONCLUSIONS Trajectories of depression symptoms in the general population are heterogeneous, with most individuals showing minimal symptoms but a notable minority experiencing chronic high symptom burden.
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Affiliation(s)
- Katherine L Musliner
- National Centre for Register-Based Research, University of Aarhus, Aarhus, Denmark; Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD, USA.
| | - Trine Munk-Olsen
- National Centre for Register-Based Research, University of Aarhus, Aarhus, Denmark
| | - William W Eaton
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD, USA
| | - Peter P Zandi
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD, USA
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Johnson JE, Miller TR, Stout RL, Zlotnick C, Cerbo LA, Andrade JT, Wiltsey-Stirman S. Study protocol: Hybrid Type I cost-effectiveness and implementation study of interpersonal psychotherapy (IPT) for men and women prisoners with major depression. Contemp Clin Trials 2016; 47:266-74. [PMID: 26845030 DOI: 10.1016/j.cct.2016.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/25/2016] [Accepted: 01/31/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE This article describes the protocol for a Hybrid Type I cost-effectiveness and implementation study of interpersonal psychotherapy (IPT) for men and women prisoners with major depressive disorder (MDD). The goal is to promote uptake of evidence-based treatments in criminal justice settings by conducting a randomized effectiveness study that collects implementation data, including a full cost-effectiveness analysis. BACKGROUND More than 2.3 million people are incarcerated in the United States on any given day. MDD is the most common severe mental illness among incarcerated individuals. Despite the prevalence and consequences of MDD among incarcerated populations, this study will be the first fully-powered randomized trial of any treatment for MDD in an incarcerated population. DESIGN Given the politically charged nature of the justice system, advantageous health outcomes are often not enough to get an intervention implemented in prisons. To increase the policy impact of this trial, we sought advice from prison providers and administrators about outcomes that would be persuasive to policy-makers and defensible to the public. In this trial, effectiveness questions will be answered using a randomized clinical trial design comparing IPT plus prison treatment as usual (TAU) to TAU alone, with outcomes including depressive symptoms (primary), suicidality, and in prison functioning (enrollment and completion of correctional programs; disciplinary and incident reports; aggression/victimization; social support). Implementation outcomes will include cost-effectiveness; feasibility and acceptability of IPT to clients, providers, and administrators; prison provider intervention fidelity, attitudes, and competencies; and barriers and facilitators of implementation assessed through surveys, interviews, and process notes.
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Affiliation(s)
- Jennifer E Johnson
- Division of Public Health, Michigan State University College of Human Medicine, 200 East 1st St Room 332, Flint, MI 48503, United States.
| | - Ted R Miller
- Pacific Institute of Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, MD 20705, United States.
| | - Robert L Stout
- Decision Sciences Institute, 1005 Main Street Unit 8120, Pawtucket, RI 02860, United States.
| | - Caron Zlotnick
- Butler Hospital and Brown University, 345 Blackstone Blvd., Providence, RI 02906, United States.
| | - Louis A Cerbo
- Rhode Island Department of Corrections, 39 Howard Avenue, Cranston, RI 02920, United States.
| | - Joel T Andrade
- MHM Services, Inc., 110 Turnpike Road, Suite 308, Westborough, MA 01581, United States.
| | - Shannon Wiltsey-Stirman
- National Center for PTSD, Dissemination and Training Division, 795 Willow Road (NC-PTSD 334), Menlo Park, CA 94025, United States.
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Ladapo JA, Elliott MN, Kanouse DE, Schwebel DC, Toomey SL, Mrug S, Cuccaro PM, Tortolero SR, Schuster MA. Firearm Ownership and Acquisition Among Parents With Risk Factors for Self-Harm or Other Violence. Acad Pediatr 2016; 16:742-749. [PMID: 27426038 PMCID: PMC5077672 DOI: 10.1016/j.acap.2016.05.145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/12/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Recent policy initiatives aiming to reduce firearm morbidity focus on mental health and illness. However, few studies have simultaneously examined mental health and behavioral predictors within families, or their longitudinal association with newly acquiring a firearm. METHODS Population-based, longitudinal survey of 4251 parents of fifth-grade students in 3 US metropolitan areas; 2004 to 2011. Multivariate logistic models were used to assess associations between owning or acquiring a firearm and parent mental illness and substance use. RESULTS Ninety-three percent of parents interviewed were women. Overall, 19.6% of families reported keeping a firearm in the home. After adjustment for confounders, history of depression (adjusted odds ratio [aOR], 1.36; 95% confidence interval [CI], 1.04-1.77), binge drinking (aOR 1.75; 95% CI, 1.14-2.68), and illicit drug use (aOR 1.75; 95% CI, 1.12-2.76) were associated with a higher likelihood of keeping a firearm in the home. After a mean of 3.1 years, 6.1% of parents who did not keep a firearm in the home at baseline acquired one by follow-up and kept it in the home (average annual likelihood = 2.1%). No risk factors for self-harm or other violence were associated with newly acquiring a gun in the home. CONCLUSIONS Families with risk factors for self-harm or other violence have a modestly greater probability of having a firearm in the home compared with families without risk factors, and similar probability of newly acquiring a firearm. Treatment interventions for many of these risk factors might reduce firearm-related morbidity.
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Affiliation(s)
- Joseph A. Ladapo
- Departments of Medicine and Population Health, New York University School of Medicine, New York, NY
| | | | | | | | - Sara L. Toomey
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA,Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Sylvie Mrug
- Department of Psychology, University of Alabama, Birmingham, AL
| | | | | | - Mark A. Schuster
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA,Department of Pediatrics, Harvard Medical School, Boston, MA
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Garnaat SL, Boisseau CL, Yip A, Sibrava NJ, Greenberg BD, Mancebo MC, McLaughlin NC, Eisen JL, Rasmussen SA. Predicting course of illness in patients with severe obsessive-compulsive disorder. J Clin Psychiatry 2015; 76:e1605-10. [PMID: 26717540 PMCID: PMC4989860 DOI: 10.4088/jcp.14m09468] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/09/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Few data are available to inform clinical expectations about course and prognosis of severe obsessive-compulsive disorder (OCD). Such information is necessary to guide clinicians and to inform criteria for invasive interventions for severe and intractable OCD. This study sought to examine course and prospective predictors of a chronic course in patients with severe OCD over 5 years. METHOD A selected subset of adults in the Brown Longitudinal Obsessive-Compulsive Study (BLOCS) was included. Adult BLOCS participants were enrolled between 2001 and 2006. All participants in the current study (N = 113) had DSM-IV OCD diagnosis, severe OCD symptoms at baseline, and at least 1 year of follow-up data. RESULTS Cox proportional hazard models were used to examine the general pattern of course in the severe OCD sample based on Longitudinal Interval Follow-Up Evaluation (LIFE) psychiatric status ratings, as well as test predictors of chronically severe course. Results indicated that approximately half of patients with severe OCD at baseline had illness drop to a moderate or lower range of severity during 5 years of follow-up (50.4%) and that marked improvement was rare after 3 years of severe illness. The only unique predictor of a more chronically severe course was patient report of ever having been housebound for a week or more due to OCD symptoms (P < .05). CONCLUSIONS Findings of this study were 3-fold: (1) half of participants with severe OCD have symptom improvement over 5 years of follow-up, (2) the majority of participants that drop out of the severe range of symptom severity do so within the first 3 years of follow-up, and (3) patient-reported history of being housebound for 1 week or more due to OCD is a significant predictor of OCD's remaining severe over the 5-year follow-up.
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Affiliation(s)
- Sarah L. Garnaat
- Butler Hospital, Providence, RI, USA,Alpert Medical School of Brown University, Providence, RI, USA
| | - Christina L. Boisseau
- Butler Hospital, Providence, RI, USA,Alpert Medical School of Brown University, Providence, RI, USA
| | - Agustin Yip
- Butler Hospital, Providence, RI, USA,Alpert Medical School of Brown University, Providence, RI, USA
| | - Nicholas J. Sibrava
- Butler Hospital, Providence, RI, USA,Alpert Medical School of Brown University, Providence, RI, USA
| | - Benjamin D. Greenberg
- Butler Hospital, Providence, RI, USA,Alpert Medical School of Brown University, Providence, RI, USA
| | - Maria C. Mancebo
- Butler Hospital, Providence, RI, USA,Alpert Medical School of Brown University, Providence, RI, USA
| | - Nicole C.R. McLaughlin
- Butler Hospital, Providence, RI, USA,Alpert Medical School of Brown University, Providence, RI, USA
| | - Jane L. Eisen
- Alpert Medical School of Brown University, Providence, RI, USA
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Walker ER, Druss BG. Rate and Predictors of Persistent Major Depressive Disorder in a Nationally Representative Sample. Community Ment Health J 2015; 51:701-7. [PMID: 25527224 DOI: 10.1007/s10597-014-9793-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 12/06/2014] [Indexed: 10/24/2022]
Abstract
This study examined predictors of persistent major depressive disorder over 10 years, focusing on the effects of clinical variables, physical health, and social support. Data from the National Survey of Midlife Development in the United States in 1995-1996 and 2004-2006 were analyzed. Logistic regression was used to predict non-recovery from major depression among individuals who met clinical-based criteria for major depressive disorder at baseline. Fifteen percent of the total sample was classified as having major depression in 1995-1996; of these individuals, 37 % had major depression in 2004-2006. Baseline variables that were significantly associated with persistent major depression at follow-up were being female, having never married, having two or more chronic medical conditions, experiencing activity limitation, and less contact with family. Therefore, treatment strategies focused on physical health, social support, and mental health needs are necessary to comprehensively address the factors that contribute to persistent major depressive disorder.
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Sasso KE, Strunk DR, Braun JD, DeRubeis RJ, Brotman MA. Identifying moderators of the adherence-outcome relation in cognitive therapy for depression. J Consult Clin Psychol 2015. [PMID: 26214542 DOI: 10.1037/ccp0000045] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Little is known about the influence of patients' pretreatment characteristics on the adherence-outcome relation in cognitive therapy (CT) for depression. In a sample of 57 depressed adults participating in CT, the authors examined interactions between pretreatment patient characteristics and therapist adherence in predicting session-to-session symptom change. METHOD Using items from the Collaborative Study Psychotherapy Rating Scale, the authors assessed 3 facets of therapist adherence: cognitive methods, negotiating/structuring, and behavioral methods/homework. Two graduate students rated Sessions 1-4 for adherence. Symptoms were assessed prior to each session with the Beck Depression Inventory-II. Moderators were assessed as part of patients' intake evaluations. RESULTS After correcting for multiple comparisons, patient gender remained a significant moderator of the relationship between cognitive methods and next-session symptom change; cognitive methods more strongly predicted greater symptom improvement for women as compared to men. Pretreatment anxiety and number of prior depressive episodes were significant moderators of the relationship between behavioral methods/homework and next-session symptom change, with greater behavioral methods/homework predicting symptom improvement more strongly among patients high in pretreatment anxiety and among patients with relatively few prior depressive episodes. CONCLUSIONS This is the first study to provide evidence of how therapist adherence is differentially related to outcome among depressed patients with different characteristics. If replicated, these findings may inform clinical decisions regarding the use of specific facets of adherence in CT for depression with specific patients.
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Affiliation(s)
| | | | | | | | - Melissa A Brotman
- Mood and Anxiety Disorders Program, National Institute of Mental Health
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34
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Cui W, Mizukami H, Yanagisawa M, Aida T, Nomura M, Isomura Y, Takayanagi R, Ozawa K, Tanaka K, Aizawa H. Glial dysfunction in the mouse habenula causes depressive-like behaviors and sleep disturbance. J Neurosci 2014; 34:16273-85. [PMID: 25471567 DOI: 10.1523/JNEUROSCI.1465-14.2014] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The lateral habenula (LHb) regulates the activity of monoaminergic neurons in the brainstem. This area has recently attracted a surge of interest in psychiatry because studies have reported the pathological activation of the habenula in patients with major depression and in animal models. The LHb plays a significant role in the pathophysiology of depression; however, how habenular neurons are activated to cause various depression symptoms, such as reduced motivation and sleep disturbance, remain unclear. We hypothesized that dysfunctional astrocytes may cause LHb hyperactivity due to the defective uptake activity of extracellular glutamate, which induces depressive-like behaviors. We examined the activity of neurons in habenular pathways and performed behavioral and sleep analyses in mice with pharmacological and genetic inhibition of the activity of the glial glutamate transporter GLT-1 in the LHb. The habenula-specific inhibition of GLT-1 increased the neuronal firing rate and the level of c-Fos expression in the LHb. Mice with reduced GLT-1 activity in the habenula exhibited a depressive-like phenotype in the tail suspension and novelty-suppressed feeding tests. These animals also displayed increased susceptibility to chronic stress, displaying more frequent avoidant behavior without affecting locomotor activity in the open-field test. Intriguingly, the mice showed disinhibition of rapid eye movement sleep, which is a characteristic sleep pattern in patients with depression. These results provide evidence that disrupting glutamate clearance in habenular astrocytes increases neuronal excitability and depressive-like phenotypes in behaviors and sleep.
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35
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Bauer M, Severus E, Köhler S, Whybrow PC, Angst J, Möller HJ. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders. part 2: maintenance treatment of major depressive disorder-update 2015. World J Biol Psychiatry 2015; 16:76-95. [PMID: 25677972 DOI: 10.3109/15622975.2014.1001786] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
These guidelines for the treatment of unipolar depressive disorders systematically review available evidence pertaining to the biological treatment of patients with major depression and produce a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by all physicians assessing and treating patients with these conditions. The relevant data have been extracted primarily from various treatment guidelines and panels for depressive disorders, as well as from meta-analyses/reviews on the efficacy of antidepressant medications and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and was then categorized into five levels of evidence (CE A-F) and five levels of recommendation grades (RG 1-5). This second part of the WFSBP guidelines on depressive disorders covers the management of the maintenance phase treatment, and is primarily concerned with the biological treatment (including pharmacological and hormonal medications, electroconvulsive therapy and other brain stimulation treatments) of adults and also, albeit to a lesser extent, children, adolescents and older adults.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy , TU Dresden , Germany
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36
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Abstract
Major depressive disorder (MDD) is a common and costly disorder associated with considerable morbidity, disability, and risk for suicide. The disorder is clinically and etiologically heterogeneous. Despite intense research efforts, the response rates of antidepressant treatments are relatively low and the etiology and progression of MDD remain poorly understood. Here we use computational modeling to advance our understanding of MDD. First, we propose a systematic and comprehensive definition of disease states, which is based on a type of mathematical model called a finite-state machine. Second, we propose a dynamical systems model for the progression, or dynamics, of MDD. The model is abstract and combines several major factors (mechanisms) that influence the dynamics of MDD. We study under what conditions the model can account for the occurrence and recurrence of depressive episodes and how we can model the effects of antidepressant treatments and cognitive behavioral therapy within the same dynamical systems model through changing a small subset of parameters. Our computational modeling suggests several predictions about MDD. Patients who suffer from depression can be divided into two sub-populations: a high-risk sub-population that has a high risk of developing chronic depression and a low-risk sub-population, in which patients develop depression stochastically with low probability. The success of antidepressant treatment is stochastic, leading to widely different times-to-remission in otherwise identical patients. While the specific details of our model might be subjected to criticism and revisions, our approach shows the potential power of computationally modeling depression and the need for different type of quantitative data for understanding depression.
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Affiliation(s)
- Selver Demic
- International Graduate School of Neuroscience, Bochum, Germany
- Mercator Research Group “Structure of Memory”, Bochum, Germany
- Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Sen Cheng
- International Graduate School of Neuroscience, Bochum, Germany
- Mercator Research Group “Structure of Memory”, Bochum, Germany
- Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
- * E-mail:
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37
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Gorwood P, Richard-Devantoy S, Baylé F, Cléry-Melin ML, Cléry-Melun ML. Psychomotor retardation is a scar of past depressive episodes, revealed by simple cognitive tests. Eur Neuropsychopharmacol 2014; 24:1630-40. [PMID: 25129432 DOI: 10.1016/j.euroneuro.2014.07.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 07/24/2014] [Accepted: 07/26/2014] [Indexed: 10/24/2022]
Abstract
The cumulative duration of depressive episodes, and their repetition, has a detrimental effect on depression recurrence rates and the chances of antidepressant response, and even increases the risk of dementia, raising the possibility that depressive episodes could be neurotoxic. Psychomotor retardation could constitute a marker of this negative burden of past depressive episodes, with conflicting findings according to the use of clinical versus cognitive assessments. We assessed the role of the Retardation Depressive Scale (filled in by the clinician) and the time required to perform the neurocognitive d2 attention test and the Trail Making Test (performed by patients) in a sample of 2048 depressed outpatients, before and after 6 to 8 weeks of treatment with agomelatine. From this sample, 1140 patients performed the TMT-A and -B, and 508 performed the d2 test, at baseline and after treatment. At baseline, we found that with more past depressive episodes patients had more severe clinical level of psychomotor retardation, and that they needed more time to perform both d2 and TMT. When the analyses were performed again after treatment, and especially when the analyses were restricted to patients with clinical remission, the cognitive tests were the only ones correlated with past depressive episodes. Psychomotor retardation tested at a cognitive level was therefore systematically revealing the burden of past depressive episodes, with an increased weight for patients with less remaining symptoms. If prospectively confirmed, interventions such as cognitive remediation therapy could benefit from a more specific focus on neurocognitive retardation.
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Affiliation(s)
- P Gorwood
- CMME (Groupe Hospitalier Sainte-Anne), Université Paris Descartes, Paris, France; INSERM U894, Centre of Psychiatry and Neurosciences, Paris 75014, France.
| | - S Richard-Devantoy
- Department of Psychiatry and Douglas Mental Health University Institute, McGill Group for Suicide Studies, McGill University, Montreal, Quebec, Canada
| | - F Baylé
- SHU (Groupe Hospitalier Sainte-Anne), 7 rue Cabanis, Paris 75014, France
| | - M L Cléry-Melin
- CMME (Groupe Hospitalier Sainte-Anne), Université Paris Descartes, Paris, France
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38
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Thomson PA, Parla JS, McRae AF, Kramer M, Ramakrishnan K, Yao J, Soares DC, McCarthy S, Morris SW, Cardone L, Cass S, Ghiban E, Hennah W, Evans KL, Rebolini D, Millar JK, Harris SE, Starr JM, MacIntyre DJ, McIntosh AM, Watson JD, Deary IJ, Visscher PM, Blackwood DH, McCombie WR, Porteous DJ. 708 Common and 2010 rare DISC1 locus variants identified in 1542 subjects: analysis for association with psychiatric disorder and cognitive traits. Mol Psychiatry 2014; 19:668-75. [PMID: 23732877 PMCID: PMC4031635 DOI: 10.1038/mp.2013.68] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 04/22/2013] [Accepted: 04/23/2013] [Indexed: 12/16/2022]
Abstract
A balanced t(1;11) translocation that transects the Disrupted in schizophrenia 1 (DISC1) gene shows genome-wide significant linkage for schizophrenia and recurrent major depressive disorder (rMDD) in a single large Scottish family, but genome-wide and exome sequencing-based association studies have not supported a role for DISC1 in psychiatric illness. To explore DISC1 in more detail, we sequenced 528 kb of the DISC1 locus in 653 cases and 889 controls. We report 2718 validated single-nucleotide polymorphisms (SNPs) of which 2010 have a minor allele frequency of <1%. Only 38% of these variants are reported in the 1000 Genomes Project European subset. This suggests that many DISC1 SNPs remain undiscovered and are essentially private. Rare coding variants identified exclusively in patients were found in likely functional protein domains. Significant region-wide association was observed between rs16856199 and rMDD (P=0.026, unadjusted P=6.3 × 10(-5), OR=3.48). This was not replicated in additional recurrent major depression samples (replication P=0.11). Combined analysis of both the original and replication set supported the original association (P=0.0058, OR=1.46). Evidence for segregation of this variant with disease in families was limited to those of rMDD individuals referred from primary care. Burden analysis for coding and non-coding variants gave nominal associations with diagnosis and measures of mood and cognition. Together, these observations are likely to generalise to other candidate genes for major mental illness and may thus provide guidelines for the design of future studies.
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Affiliation(s)
- P A Thomson
- Medical Genetics Section, University of Edinburgh Molecular Medicine Centre, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, Edinburgh, UK
| | - J S Parla
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - A F McRae
- University of Queensland Diamantina Institute, The University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - M Kramer
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - K Ramakrishnan
- Medical Genetics Section, University of Edinburgh Molecular Medicine Centre, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, UK
| | - J Yao
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - D C Soares
- Medical Genetics Section, University of Edinburgh Molecular Medicine Centre, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, UK
| | - S McCarthy
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - S W Morris
- Medical Genetics Section, University of Edinburgh Molecular Medicine Centre, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, UK
| | - L Cardone
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - S Cass
- Medical Genetics Section, University of Edinburgh Molecular Medicine Centre, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, UK
| | - E Ghiban
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - W Hennah
- Medical Genetics Section, University of Edinburgh Molecular Medicine Centre, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, UK
- Institute for Molecular Medicine, Finland FIMM, University of Helsinki, Helsinki, Finland
| | - K L Evans
- Medical Genetics Section, University of Edinburgh Molecular Medicine Centre, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, Edinburgh, UK
| | - D Rebolini
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - J K Millar
- Medical Genetics Section, University of Edinburgh Molecular Medicine Centre, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, UK
| | - S E Harris
- Medical Genetics Section, University of Edinburgh Molecular Medicine Centre, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, Edinburgh, UK
| | - J M Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, Edinburgh, UK
| | - D J MacIntyre
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - Generation Scotland7
- Medical Genetics Section, University of Edinburgh Molecular Medicine Centre, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, Edinburgh, UK
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
- University of Queensland Diamantina Institute, The University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Institute for Molecular Medicine, Finland FIMM, University of Helsinki, Helsinki, Finland
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
- Generation Scotland, A Collaboration between the University Medical Schools and NHS, Aberdeen, Dundee, Edinburgh and Glasgow, UK
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | - A M McIntosh
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - J D Watson
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - I J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, Edinburgh, UK
| | - P M Visscher
- University of Queensland Diamantina Institute, The University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | - D H Blackwood
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - W R McCombie
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - D J Porteous
- Medical Genetics Section, University of Edinburgh Molecular Medicine Centre, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, Edinburgh, UK
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Abstract
We examined the effect of a community-based screening program on depression in middle-aged individuals. Ten subdistricts constituting a rural township (2400 inhabitants aged 40-64 years) in northern Japan with a high suicide rate were randomly assigned to intervention (four) and control (six) groups. A 2-year depression-screening program entailing identification and subsequent care support was offered to adults aged 40 to 64 years in the intervention group, accompanied by 4-year ongoing dissemination of educational information in both groups. Change in depressive symptom prevalence was assessed through before-and-after cross-sectional surveys using the Center for Epidemiologic Studies-Depression Scale. Of the 900 targeted individuals, 49.2% participated in the screening. Comparison of data from these surveys after controlling for district-level clustering indicated a greater difference in prevalence between baseline and 5-year follow-up in the intervention group than that in the control. Universal screening and subsequent support seem effective to decrease depressive symptom prevalence among middle-aged individuals in a community setting.
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Abstract
Depression is a common disorder with painful symptoms and, frequently, social impairment and decreased quality of life. The disorder has a tendency to be long lasting, often with frequent recurrence of symptoms. The risk of relapse and the severity of the symptoms may be reduced by correct antidepressant medication. However, the medication is often insufficient, both in respect to dosage and length of time. The reasons for incorrect medication are many, with lack of adherence to treatment being the most important. Although some patients taking antidepressant medication experience side effects, this may not be the most frequent reason for immature discontinuation of treatment. Other reasons for decreased adherence have been investigated in recent years. The patient's beliefs about the disorder and beliefs about antidepressants, including lack of conviction that the medication is needed and fear of dependence of antidepressant medicine, have a great influence on adherence to treatment.
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Ekman M, Granström O, Omérov S, Jacob J, Landén M. The societal cost of depression: evidence from 10,000 Swedish patients in psychiatric care. J Affect Disord 2013; 150:790-7. [PMID: 23611536 DOI: 10.1016/j.jad.2013.03.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 03/04/2013] [Accepted: 03/06/2013] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Depression cost studies have mainly taken a primary care perspective and should be completed with cost estimates from psychiatric care. The objectives of this study were to estimate the societal per-patient cost of depression in specialized psychiatric care in Sweden, and to relate costs to disease severity, depressive episodes, hospitalization, and patient functioning. METHODS Retrospective resource use data in inpatient and outpatient care for 2006-2008, as well as ICD-10 diagnoses and Global Assessment of Functioning (GAF), were obtained from the Northern Stockholm psychiatric clinic (covering half of Stockholm's population aged 18 years and above). As a complement, data from national registers on pharmaceuticals and sick leave were used in order to estimate the societal cost of depression. RESULTS Based on 10,430 patients (63% women), the mean annual per-patient cost was €17,279 in 2008. The largest cost item was indirect costs due to productivity losses (88%), followed by outpatient care (6%). Patients with mild and severe depression had average costs of €14,200 and €21,500, respectively. Total costs were substantially higher during depressive episodes, among patients with co-morbid psychosis or anxiety, for hospitalized patients, and for patients with poor functioning. LIMITATIONS Primary care costs and costs for reduced productivity at work were not included. CONCLUSIONS The main cost item among depression patients in psychiatric care was indirect costs. Costs were higher than previously reported for primary care, and strongly related to hospitalization, depressive episodes, and low functioning. This suggests that effective treatment that avoids depressive episodes and hospitalization may reduce society's costs for depression.
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Affiliation(s)
- M Ekman
- OptumInsight, Stockholm, Sweden.
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García-Peña C, Wagner FA, Sánchez-García S, Espinel-Bermúdez C, Juárez-Cedillo T, Pérez-Zepeda M, Arango-Lopera V, Franco-Marina F, Ramírez-Aldana R, Gallo J. Late-life depressive symptoms: prediction models of change. J Affect Disord 2013; 150:886-94. [PMID: 23731940 PMCID: PMC3759587 DOI: 10.1016/j.jad.2013.05.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 05/03/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression is a well-recognised problem in the elderly. The aim of this study was to determine the factors associated with predictors of change in depressive symptoms, both in subjects with and without baseline significant depressive symptoms. METHODS Longitudinal study of community-dwelling elderly people (>60 years or older), baseline evaluations, and two additional evaluations were reported. Depressive symptoms were measured using a 30-item geriatric depression scale, and a score of 11 was used as cut-off point for significant depressive symptoms in order to stratify the analyses in two groups: with significant depressive symptoms and without significant depressive symptoms. Sociodemographic data, social support, anxiety, cognition, positive affect, control locus, activities of daily living, recent traumatic life events, physical activity, comorbidities, and quality of life were evaluated. Multi-level generalised estimating equation model was used to assess the impact on the trajectory of depressive symptoms. RESULTS A number of 7882 subjects were assessed, with 29.42% attrition. At baseline assessment, mean age was 70.96 years, 61.15% were women. Trajectories of depressive symptoms had a decreasing trend. Stronger associations in those with significant depressive symptoms, were social support (OR.971, p<.001), chronic pain (OR 2.277, p<.001) and higher locus of control (OR.581, p<.001). In contrast for those without baseline significant depressive symptoms anxiety and a higher locus of control were the strongest associations. CONCLUSIONS New insights into late-life depression are provided, with special emphasis in differentiated factors influencing the trajectory when stratifying regarding basal status of significant depressive symptoms. LIMITATIONS The study has not included clinical evaluations and nutritional assessments.
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Affiliation(s)
- Carmen García-Peña
- Epidemiological and Health Research Unit, Ageing Area, Centro Médico Nacional XXI, Instituto Mexicano del Seguro Social, Mexico, DF, Mexico.
| | - Fernando A. Wagner
- Prevention Sciences Research Center and School of Community Health and Policy, Morgan State University, Baltimore, MD, USA
| | - Sergio Sánchez-García
- Epidemiological and Health Research Unit, Ageing Area, Centro Médico Nacional XXI, Instituto Mexicano del Seguro Social, Mexico
| | - Claudia Espinel-Bermúdez
- Epidemiological and Health Research Unit, Ageing Area, Centro Médico Nacional XXI, Instituto Mexicano del Seguro Social, Mexico
| | - Teresa Juárez-Cedillo
- Epidemiological and Health Research Unit, Ageing Area, Centro Médico Nacional XXI, Instituto Mexicano del Seguro Social, Mexico
| | | | | | | | | | - Joseph Gallo
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, USA
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Tosh J, Kearns B, Brennan A, Parry G, Ricketts T, Saxon D, Kilgarriff-Foster A, Thake A, Chambers E, Hutten R. Innovation in health economic modelling of service improvements for longer-term depression: demonstration in a local health community. BMC Health Serv Res 2013; 13:150. [PMID: 23622353 PMCID: PMC3644496 DOI: 10.1186/1472-6963-13-150] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 04/15/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of the analysis was to develop a health economic model to estimate the costs and health benefits of alternative National Health Service (NHS) service configurations for people with longer-term depression. METHOD Modelling methods were used to develop a conceptual and health economic model of the current configuration of services in Sheffield, England for people with longer-term depression. Data and assumptions were synthesised to estimate cost per Quality Adjusted Life Years (QALYs). RESULTS Three service changes were developed and resulted in increased QALYs at increased cost. Versus current care, the incremental cost-effectiveness ratio (ICER) for a self-referral service was £11,378 per QALY. The ICER was £2,227 per QALY for the dropout reduction service and £223 per QALY for an increase in non-therapy services. These results were robust when compared to current cost-effectiveness thresholds and accounting for uncertainty. CONCLUSIONS Cost-effective service improvements for longer-term depression have been identified. Also identified were limitations of the current evidence for the long term impact of services.
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Affiliation(s)
- Jonathan Tosh
- School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK.
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Solomon DA, Fiedorowicz JG, Leon AC, Coryell W, Endicott J, Li C, Boland RJ, Keller MB. Recovery from multiple episodes of bipolar I depression. J Clin Psychiatry 2013; 74:e205-11. [PMID: 23561241 PMCID: PMC3837577 DOI: 10.4088/jcp.12m08049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 10/25/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the duration of bipolar I major and minor depressive episodes and factors associated with time to recovery. METHOD As part of the National Institute of Mental Health Collaborative Depression Study, 219 participants with bipolar I disorder based on Research Diagnostic Criteria analogs to DSM-IV-TR criteria were recruited at 5 academic medical centers from 1978 to 1981 and followed for up to 25 years with the Longitudinal Interval Follow-Up Evaluation. The probability of recovery over time from depressive episodes, the primary outcome measure, was examined with mixed-effects grouped-time survival models. RESULTS The median duration of major depressive episodes was 14 weeks, and over 70% of participants recovered within 12 months of episode onset. The median duration of minor depressive episodes was 8 weeks, and approximately 90% of participants recovered within 6 months of onset of the episode. Aggregated data demonstrated similar durations of the first 3 major depressive episodes. However, for each participant with multiple episodes of major depression or minor depression, the duration of each episode was not consistent (intraclass correlation coefficient = 0.07 and 0.25 for major and minor depression, respectively). The total number of years in episode over follow-up with major plus minor depression prior to onset of a major depressive episode was significantly associated with a decreased probability of recovery from that episode; with each additional year, the likelihood of recovery was reduced by 7% (hazard ratio = 0.93; 95% CI, 0.89-0.98; P = .002). CONCLUSIONS Bipolar I major depression generally lasts longer than minor depression, and the duration of multiple episodes within an individual varies. However, the probability of recovery over time from an episode of major depression appears to decline with each successive episode.
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Affiliation(s)
- David A Solomon
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA, UpToDate, Waltham, MA, USA
| | - Jess G. Fiedorowicz
- Department of Psychiatry, College of Public Health, The University of Iowa, Iowa City, IA, USA,Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, College of Public Health, The University of Iowa, Iowa City, IA, USA,Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Andrew C. Leon
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - William Coryell
- Department of Psychiatry, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Jean Endicott
- New York State Psychiatric Institute, New York, NY, USA
| | - Chunshan Li
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Robert J. Boland
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA, UpToDate, Waltham, MA, USA
| | - Martin B. Keller
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA, UpToDate, Waltham, MA, USA
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Riva-Posse P, Holtzheimer PE, Garlow SJ, Mayberg HS. Practical considerations in the development and refinement of subcallosal cingulate white matter deep brain stimulation for treatment-resistant depression. World Neurosurg 2012; 80:S27.e25-34. [PMID: 23246630 DOI: 10.1016/j.wneu.2012.11.074] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 11/12/2012] [Accepted: 11/27/2012] [Indexed: 12/28/2022]
Abstract
BACKGROUND Deep brain stimulation has been investigated in the past decade as a viable intervention for treatment-resistant depression. METHODS Several anatomic targets have been tested, with the most extensive published experience found for the subcallosal cingulate (SCC) white matter. RESULTS This article reviews the current state of clinical research of SCC deep brain stimulation for treatment-resistant depression, including an overview of the rationale for targeting SCC, practical considerations for subject recruitment and evaluation, surgical planning, and stimulation parameters. CONCLUSION Clinical management of patients in the initial and long-term naturalistic phases of treatment, including the potential role for psychotherapeutic rehabilitation, is discussed.
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Affiliation(s)
- Patricio Riva-Posse
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.
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46
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Lee RSC, Hermens DF, Porter MA, Redoblado-Hodge MA. A meta-analysis of cognitive deficits in first-episode Major Depressive Disorder. J Affect Disord 2012; 140:113-24. [PMID: 22088608 DOI: 10.1016/j.jad.2011.10.023] [Citation(s) in RCA: 507] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 10/18/2011] [Accepted: 10/18/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recurrent-episode Major Depressive Disorder (MDD) is associated with a number of neuropsychological deficits. To date, less is known about whether these are present in the first-episode. The current aim was to systematically evaluate the literature on first-episode MDD to determine whether cognition may be a feasible target for early identification and intervention. METHODS Electronic database searches were conducted to examine neuropsychological studies in adults (mean age greater than 18 years old) with a first-episode of MDD. Effect sizes were pooled by cognitive domain. Using meta-regression techniques, demographic and clinical factors potentially influencing heterogeneity of neuropsychological outcome were also investigated. RESULTS The 15 independent samples reviewed yielded data for 644 patients with a mean age of 39.36 years (SD=10.21). Significant cognitive deficits were identified (small to medium effect sizes) for psychomotor speed, attention, visual learning and memory, and all aspects of executive functioning. Symptom remission, inpatient status, antidepressant use, age and educational attainment, each significantly contributed to heterogeneity in effect sizes in at least one cognitive domain. LIMITATIONS Reviewed studies were limited by small sample sizes and often did not report important demographic and clinical characteristics of patients. CONCLUSIONS The current meta-analysis was the first to systematically demonstrate reduced neuropsychological functioning in first-episode MDD. Psychomotor speed and memory functioning were associated with clinical state, whereas attention and executive functioning were more likely trait-markers. Demographic factors were also associated with heterogeneity across studies. Overall, cognitive deficits appear to be feasible early markers and targets for early intervention in MDD.
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Affiliation(s)
- Rico S C Lee
- Department of Psychology, Macquarie University, NSW, Australia.
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47
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Rush AJ, Wisniewski SR, Zisook S, Fava M, Sung SC, Haley CL, Chan HN, Gilmer WS, Warden D, Nierenberg AA, Balasubramani GK, Gaynes BN, Trivedi MH, Hollon SD. Is prior course of illness relevant to acute or longer-term outcomes in depressed out-patients? A STAR*D report. Psychol Med 2012; 42:1131-1149. [PMID: 22008447 DOI: 10.1017/s0033291711002170] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is commonly chronic and/or recurrent. We aimed to determine whether a chronic and/or recurrent course of MDD is associated with acute and longer-term MDD treatment outcomes. METHOD This cohort study recruited out-patients aged 18-75 years with non-psychotic MDD from 18 primary and 23 psychiatric care clinics across the USA. Participants were grouped as: chronic (index episode >2 years) and recurrent (n = 398); chronic non-recurrent (n=257); non-chronic recurrent (n=1614); and non-chronic non-recurrent (n = 387). Acute treatment was up to 14 weeks of citalopram (≤ 60 mg/day) with up to 12 months of follow-up treatment. The primary outcomes for this report were remission [16-item Quick Inventory of Depressive Symptomatology - Self-Rated (QIDS-SR(16)) ≤ 5] or response (≥ 50% reduction from baseline in QIDS-SR(16)) and time to first relapse [first QIDS-SR16 by Interactive Voice Response (IVR) ≥ 11]. RESULTS Most participants (85%) had a chronic and/or recurrent course; 15% had both. Chronic index episode was associated with greater sociodemographic disadvantage. Recurrent course was associated with earlier age of onset and greater family histories of depression and substance abuse. Remission rates were lowest and slowest for those with chronic index episodes. For participants in remission entering follow-up, relapse was most likely for the chronic and recurrent group, and least likely for the non-chronic, non-recurrent group. For participants not in remission when entering follow-up, prior course was unrelated to relapse. CONCLUSIONS Recurrent MDD is the norm for out-patients, of whom 15% also have a chronic index episode. Chronic and recurrent course of MDD may be useful in predicting acute and long-term MDD treatment outcomes.
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Affiliation(s)
- A J Rush
- Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, Singapore
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48
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Dunlop BW, Holland P, Bao W, Ninan PT, Keller MB. Recovery and subsequent recurrence in patients with recurrent major depressive disorder. J Psychiatr Res 2012; 46:708-15. [PMID: 22475319 PMCID: PMC3677162 DOI: 10.1016/j.jpsychires.2012.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 02/16/2012] [Accepted: 03/01/2012] [Indexed: 10/28/2022]
Abstract
In contrast to "remission" from an episode of major depressive disorder (MDD), for which there is general agreement in the literature, the optimal definition of "recovery" from MDD is uncertain. Previous definitions of recovery have used inconsistent thresholds for symptom severity and duration of wellness. To address the effects of duration and degree of recovery from an episode of MDD on recurrence risk, and the impact of maintenance antidepressant treatment on recurrence, we analyzed 258 patients from a randomized, double-blind study of outpatients with recurrent MDD. All patients had responded to 8½ months of venlafaxine extended release and were subsequently randomized to receive venlafaxine ER or placebo during 2 consecutive 12-month maintenance phases. Four definitions of recovery were used to evaluate recovery rates and time to recurrence: (1) 17-item Hamilton Depression Rating Scale (HAM-D(17)) total score ≤3 with duration ≥120 days; (2) HAM-D(17) ≤3 with duration ≥56 days; (3) HAM-D(17) ≤7 with duration ≥120 days; and (4) HAM-D(17) ≤7 with duration ≥56 days. Recovery definitions using lower symptom severity and longer duration thresholds produced lower rates of recurrence. Patients on placebo were more likely to have a recurrence than patients on venlafaxine ER, with hazard ratio (HR) ranging from 2.5 among patients who recovered by the most relaxed criteria (definition 4), to 5.3 among patients who recovered by the most stringent criteria (definition 1). We conclude that protection against recurrence derives from the degree and duration of recovery, particularly for patients maintained on antidepressant medication.
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Affiliation(s)
- Boadie W. Dunlop
- Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30322, USA,Corresponding author. Tel.: +1 404 727 8969; fax: +1 404 727 3700. (B.W. Dunlop)
| | - Peter Holland
- Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Rd # 287 Boca Raton, FL 33431, USA
| | - Weihang Bao
- Pfizer Inc, 500 Arcola Rd., Collegeville, PA 19426, USA
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Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study. Am J Psychiatry 2012; 169:476-83. [PMID: 22737693 PMCID: PMC3509999 DOI: 10.1176/appi.ajp.2011.11101550] [Citation(s) in RCA: 236] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purposes of this study were to determine time to attainment of symptom remission and to recovery lasting 2, 4, 6, or 8 years among patients with borderline personality disorder and comparison subjects with other personality disorders and to determine the stability of these outcomes. METHOD A total of 290 inpatients with borderline personality disorder and 72 comparison subjects with other axis II disorders were assessed during their index admission using a series of semistructured interviews, which were administered again at eight successive 2-year follow-up sessions. For inclusion in the study, patients with borderline personality disorder had to meet criteria for both the Revised Diagnostic Interview for Borderlines and DSM-III-R. RESULTS Borderline patients were significantly slower to achieve remission or recovery (which involved good social and vocational functioning as well as symptomatic remission) than axis II comparison subjects. However, by the time of the 16-year follow-up assessment, both groups had achieved similarly high rates of remission (range for borderline patients: 78%-99%; range for axis II comparison subjects: 97%-99%) but not recovery (40%-60% compared with 75%-85%). In contrast, symptomatic recurrence and loss of recovery occurred more rapidly and at substantially higher rates among borderline patients than axis II comparison subjects (recurrence: 10%-36% compared with 4%-7%; loss of recovery: 20%-44% compared with 9%-28%). CONCLUSIONS Our results suggest that sustained symptomatic remission is substantially more common than sustained recovery from borderline personality disorder and that sustained remissions and recoveries are substantially more difficult for individuals with borderline personality disorder to attain and maintain than for individuals with other forms of personality disorder.
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50
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Grilo CM, Pagano ME, Stout RL, Markowitz JC, Ansell EB, Pinto A, Zanarini MC, Yen S, Skodol AE. Stressful life events predict eating disorder relapse following remission: six-year prospective outcomes. Int J Eat Disord 2012; 45:185-92. [PMID: 21448971 PMCID: PMC3275672 DOI: 10.1002/eat.20909] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2010] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine prospectively the natural course of bulimia nervosa (BN) and eating disorder not-otherwise-specified (EDNOS) and test for the effects of stressful life events (SLE) on relapse after remission from these eating disorders. METHOD 117 female patients with BN (N = 35) or EDNOS (N = 82) were prospectively followed for 72 months using structured interviews performed at baseline, 6- and 12-months, and then yearly thereafter. ED were assessed with the structured clinical interview for DSM-IV, and monitored over time with the longitudinal interval follow-up evaluation. Personality disorders were assessed with the diagnostic interview for DSM-IV-personality-disorders, and monitored over time with the follow-along-version. The occurrence and specific timing of SLE were assessed with the life events assessment interview. Cox proportional-hazard-regression-analyses tested associations between time-varying levels of SLE and ED relapse, controlling for comorbid psychiatric disorders, ED duration, and time-varying personality-disorder status. RESULTS ED relapse probability was 43%; BN and EDNOS did not differ in time to relapse. Negative SLE significantly predicted ED relapse; elevated work and social stressors were significant predictors. Psychiatric comorbidity, ED duration, and time-varying personality-disorder status were not significant predictors. DISCUSSION Higher work and social stress represent significant warning signs for triggering relapse for women with remitted BN and EDNOS.
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Affiliation(s)
- Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut,Correspondence to: Dr. Carlos M. Grilo, Yale University School of Medicine, P.O. Box 208098, New Haven, CT, 06520.
| | - Maria E. Pagano
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio
| | | | | | - Emily B. Ansell
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Anthony Pinto
- New York State Psychiatric Institute, Columbia University, New York
| | | | - Shirley Yen
- Department of Psychiatry, Brown University, Providence, Rhode Island
| | - Andrew E. Skodol
- Department of Psychiatry, University of Arizona, Tucson, Arizona
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