Depression Research and Treatment The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Breastfeeding and Postpartum Depression: An Overview and Methodological Recommendations for Future Research Mon, 11 Apr 2016 13:02:14 +0000 Emerging research suggests that a relationship exists between breastfeeding and postpartum depression; however, the direction and precise nature of this relationship are not yet clear. The purpose of this paper is to provide an overview of the relationship between breastfeeding and postpartum depression as it has been examined in the empirical literature. Also, the potential mechanisms of action that have been implicated in this relationship are also explored. PubMed and PsycINFO were searched using the keywords: breastfeeding with postpartum depression, perinatal depression, postnatal depression. Results of this search showed that researchers have examined this relationship in diverse ways using diverse methodology. In particular, researchers have examined the relationships between postpartum depression and breastfeeding intention, initiation, duration, and dose. Due to a number of methodological differences among past studies we make some recommendations for future research that will better facilitate an integration of findings. Future research should (1) use standardized assessment protocols; (2) confirm diagnosis through established clinical interview when possible; (3) provide a clear operationalized definition for breastfeeding variables; (4) clearly define the postpartum period interval assessed and time frame for onset of symptoms; (5) be prospective or longitudinal in nature; and (6) take into consideration other potential risk factors identified in the empirical literature. Carley J. Pope and Dwight Mazmanian Copyright © 2016 Carley J. Pope and Dwight Mazmanian. All rights reserved. Prevalence and Severity of Depression and Its Association with Substance Use in Jimma Town, Southwest Ethiopia Wed, 16 Mar 2016 07:26:13 +0000 Background. Depression is a significant contributor to the global burden of disease and affects 350 million people worldwide. Substance use could be the risk factor for depression. Objective. We aim to determine the prevalence and severity of depression and its association with substance use. Methods. A cross-sectional study was conducted on a sample of 650 respondents in Jimma town in March 2014. A multistage stratified sampling method was conducted. Structured questionnaire and Beck’s Depression Inventory (BDI-II) scale were used for data collection. Data analysis was done using the SPSS Version 20.0 for Windows. Results. The participation rate of respondents was 590/650 (90.77%). The proportion of females was 300 (50.9%). The current prevalence of depression was 171 (29.0%). Based on the BDI-II grading of the severity of depression, 102 (59.6%) had mild, 56 (32.7%) had moderate, 13 (7.6%) had severe depression. In the present study, age of 55 years and above [OR = 5.94, CI: 2.26–15.58], being widowed [OR = 5.18, CI: 1.18–22.76], illiterates [OR = 9.06, CI: 2.96–27.75], khat chewing [OR = 10.07, CI: 5.57–18.25], cigarette smoking [OR = 3.15, CI: 1.51–6.58], and shisha usage [OR = 3.04, CI: 1.01–9.19] were significantly and independently associated with depression. Conclusion. The finding depicted that depression was a moderate public health problem. Advanced age, being widowed, illiterate, khat chewing, and cigarette and shisha smocking could be the potential risk factors for depression. Risk reduction is recommended. Andualem Mossie, Dagmawi Kindu, and Alemayehu Negash Copyright © 2016 Andualem Mossie et al. All rights reserved. Psychometric Limitations of the Center for Epidemiologic Studies-Depression Scale for Assessing Depressive Symptoms among Adults with HIV/AIDS: A Rasch Analysis Thu, 03 Mar 2016 15:14:29 +0000 The Center for Epidemiological Studies-Depression (CES-D) scale is a widely used measure of depressive symptoms, but its psychometric properties have not been adequately evaluated among adults with HIV/AIDS. This study used an item response theory approach (Rasch analysis) to evaluate the CES-D’s validity and reliability in relation to key demographic and clinical variables in adults with HIV/AIDS. A convenience sample of 347 adults with HIV/AIDS (231 males, 93 females, and 23 transgenders; age range 22–77 years) completed the CES-D. A Rasch model application was used to analyze the CES-D’s rating scale functioning, internal scale validity, person-response validity, person-separation validity, internal consistency, differential item functioning (DIF), and differential test functioning. CES-D scores were generally high and associated with several demographic and clinical variables. The CES-D distinguished 3 distinct levels of depression and had acceptable internal consistency but lacked unidimensionality, five items demonstrated poor fit to the model, 15% of the respondents demonstrated poor fit, and eight items demonstrated DIF related to gender, race, or AIDS diagnosis. Removal of misfitting items resulted in minimal improvement in the CES-D’s substantive and structural validity. CES-D scores should be interpreted with caution in adults with HIV/AIDS, particularly when comparing scores across gender and racial groups. Caryl L. Gay, Anders Kottorp, Anners Lerdal, and Kathryn A. Lee Copyright © 2016 Caryl L. Gay et al. All rights reserved. A Possible Role of Anhedonia as Common Substrate for Depression and Anxiety Wed, 02 Mar 2016 06:49:28 +0000 Depression and anxiety are often comorbid, in up to 70% of cases, and the level of one or the other may fluctuate, leading now to a diagnosis of depression, now to a diagnosis of anxiety. For these reasons, and for the presence of many other common factors, it has been suggested that both are part of the same continuum of problems and that they have a common substrate. This paper proposes the possibility that anhedonia may be an important component of this possible common substrate, and it tries to identify the mechanism with which anhedonia could contribute to causing both depression and anxiety. It also proposes an explanation why an intense pleasure could improve both depression and anxiety. Luigi Grillo Copyright © 2016 Luigi Grillo. All rights reserved. Symptom Endorsement and Sociodemographic Correlates of Postnatal Distress in Three Low Income Countries Mon, 15 Feb 2016 13:15:57 +0000 Background. Maternal mental illness has been implicated in adverse child development outcomes. Factors such as context and culture may influence experiences of maternal distress and explain differences in outcomes across settings. Methods. We analyzed baseline data from 5,647 mothers in Ethiopia, India (Andhra Pradesh), and Vietnam participating in an ongoing cohort study (Young Lives) to compare symptom endorsement and sociodemographic correlates of distress. Maternal distress was assessed using the Self-Reporting Questionnaire-20 Items (cutoff: ≥8). Logistic regressions were stratified by sample to identify correlates of distress. Results. Symptom endorsement was similar among distressed women, particularly with regard to feeling unhappy (76%, 80%, and 79%). Notable differences were observed in three items assessing Depressive Thoughts, which were most highly endorsed in Ethiopia (49%–56%). Having a child experiencing a life-threatening event was correlated with distress in all three samples. A variety of correlates were unique to only one sample. Conclusions. There were multiple similarities but also notable differences across sites in the expression and correlates of maternal distress. Feeling unhappy appears to be a hallmark feature of distress. Correlates highlight the relationship between distress and indicators of poverty, child wellbeing, and economic shocks. Differences demonstrate the value of further exploration of cross-cultural differences. Amanda J. Nguyen, Emily E. Haroz, Tamar Mendelson, and Judith Bass Copyright © 2016 Amanda J. Nguyen et al. All rights reserved. Efficacy of Electroconvulsive Therapy in Bipolar Disorder with Mixed Features Tue, 05 Jan 2016 14:00:42 +0000 Introduction. Mixed states represent a frequent presentation of bipolar disorder, associated with higher resistance to psychopharmacology. Limited evidence supports the use of ECT in these patients. We aim to report our experience on treating bipolar mixed states with ECT. Methods. Retrospective data were collected from all bipolar patients submitted to acute ECT treatment, between June 2006 and June 2011. Three groups were created in terms of affective polarity of the episode. CGI rating was used to establish clinical remission and demographic and clinical variables were compared among groups. Long-term outcome was assessed through readmission measures, considering the use of continuation or maintenance ECT. Results. During the study time frame, a total of 50 ECT course treatments were performed on 41 bipolar patients. All affective episodes, except one mixed state, showed a positive clinical response. Patients with mixed state presentation tended to be younger and have an earlier first hospitalization than depressed patients. No differences were found in terms of ECT sessions performed, length of hospital admission, referral to continuation ECT treatment, number of readmissions, and time until next readmission. Conclusions. Our results support the effectiveness of ECT in patients experiencing a mixed affective state. Miguel Palma, Berta Ferreira, Nuno Borja-Santos, Bruno Trancas, Céu Monteiro, and Graça Cardoso Copyright © 2016 Miguel Palma et al. All rights reserved. Perinatal Depression and Patterns of Attachment: A Critical Risk Factor? Sun, 20 Dec 2015 13:05:16 +0000 Background. This study aims to verify if the presence and severity of perinatal depression are related to any particular pattern of attachment. Methods. The study started with a screening of a sample of 453 women in their third trimester of pregnancy, who were administered a survey data form, the Edinburgh Postnatal Depression Scale (EPDS) and the Experience in Close Relationship (ECR). A clinical group of subjects with perinatal depression (PND, 89 subjects) was selected and compared with a control group (C), regarding psychopathological variables and attachment patterns. Results. The ECR showed a prevalence of “Fearful-Avoidant” attachment style in PND group (29.2% versus 1.1%, ); additionally, the EPDS average score increases with the increasing of ECR dimensions (Avoidance and Anxiety). Conclusion. The severity of depression increases proportionally to attachment disorganization; therefore, we consider attachment as both an important risk factor as well as a focus for early psychotherapeutic intervention. Valentina Meuti, Franca Aceti, Nicoletta Giacchetti, Giuseppe Mattia Carluccio, Michela Zaccagni, Isabella Marini, Orazio Giancola, Paola Ciolli, and Massimo Biondi Copyright © 2015 Valentina Meuti et al. All rights reserved. Illness Attitudes Associated with Seasonal Depressive Symptoms: An Examination Using a Newly Developed Implicit Measure Thu, 10 Dec 2015 06:47:41 +0000 The Dual Vulnerability Model of seasonal depression posits that seasonal vegetative symptoms are due to a physiological vulnerability, but cognitive and mood symptoms are the result of negative appraisal of vegetative changes. In addition, rumination may be associated with stronger negative attitudes toward vegetative symptoms. This is the first study to examine implicit attitudes toward vegetative symptoms. We hypothesized that illness attitudes about fatigue moderate the relationship between the severity of vegetative symptoms and the severity of cognitive symptoms and that the illness attitudes are associated with rumination. This study also developed an implicit method to assess the appraisal of fatigue as indicating illness. Results supported both hypotheses. Illness attitudes toward fatigue moderated the relationship between vegetative symptoms and cognitive symptoms. Ruminative response style was positively associated with implicit illness attitudes towards fatigue. The study provides support for the role of negative appraisals of vegetative symptoms in the development of cognitive and mood seasonal depressive symptoms. Katherine Meyers and Michael A. Young Copyright © 2015 Katherine Meyers and Michael A. Young. All rights reserved. Cognitive Mechanisms Reciprocally Transmit Vulnerability between Depressive and Somatic Symptoms Wed, 09 Dec 2015 12:27:17 +0000 Despite high comorbidity between depressive and somatic symptoms, cognitive mechanisms that transmit vulnerability between symptom clusters are largely unknown. Dampening, positive rumination, and brooding are three cognitive predictors of depression, with rumination theoretically indicated as a transdiagnostic vulnerability through amplifying and diminishing affect in response to events. Specifically, the excess negative affect and lack of positive affect characteristic of depressive symptoms and underlying somatic symptoms may cause and be caused by cognitive responses to events. Therefore, the current study examined whether comorbidity between depressive and somatic symptoms may be explained by the cognitive mechanisms of dampening and positive rumination in response to positive events and brooding in response to negative events among adults () across eight weeks of assessment. We hypothesized that greater dampening and brooding would reciprocally predict greater depressive and somatic symptoms, while greater positive rumination would reciprocally predict fewer depressive and somatic symptoms. Mediation analyses in AMOS 22 indicated that dampening and brooding mediated reciprocal pathways between depressive and somatic symptoms, but positive rumination did not. Findings propose dampening and brooding as mechanisms of the reciprocal relationship between depressive and somatic symptoms through diminishing positive affect and amplifying negative affect in response to positive and negative events. Kaitlin A. Harding, Karly M. Murphy, and Amy Mezulis Copyright © 2015 Kaitlin A. Harding et al. All rights reserved. Childhood Trauma and Its Relation to Chronic Depression in Adulthood Sun, 29 Nov 2015 09:31:51 +0000 There is a large consensus indicating that childhood trauma is significantly involved in the development of depression. The aim of this study was to examine the prevalence of retrospectively recalled childhood trauma in chronically depressed patients and to investigate a more specific relationship between trauma type and depression. We further asked for the influence of multiple experiences of childhood trauma on the vulnerability to a chronic course of depression in adulthood. 349 chronically depressed patients of the German LAC Depression Study completed the Childhood Trauma Questionnaire, a self-report measure of traumatic experiences in childhood. 75.6% of the chronically depressed patients reported clinically significant histories of childhood trauma. 37% of the chronically depressed patients reported multiple childhood traumatization. Experiences of multiple trauma also led to significantly more severe depressive symptoms. Stepwise multiple regression analysis suggested that childhood emotional abuse and sexual abuse were significantly associated with a higher symptom severity in chronically depressed adults. Yet, expanding the regression model for multiple exposures showed that multiplicity was the only remaining significant predictor for symptom severity in chronically depressed patients. Clinical implications suggest a precise assessment of childhood trauma in chronically depressed patients with a focus on emotional abuse, sexual abuse, and multiple exposures to childhood trauma. This trial is registered with registration number ISRCTN91956346. Alexa Negele, Johannes Kaufhold, Lisa Kallenbach, and Marianne Leuzinger-Bohleber Copyright © 2015 Alexa Negele et al. All rights reserved. Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches Wed, 25 Nov 2015 13:30:55 +0000 Seasonal affective disorder or SAD is a recurrent major depressive disorder with a seasonal pattern usually beginning in fall and continuing into winter months. A subsyndromal type of SAD, or S-SAD, is commonly known as “winter blues.” Less often, SAD causes depression in the spring or early summer. Symptoms center on sad mood and low energy. Those most at risk are female, are younger, live far from the equator, and have family histories of depression, bipolar disorder, or SAD. Screening instruments include the Seasonal Pattern Assessment Questionnaire (SPAQ). Typical treatment includes antidepressant medications, light therapy, Vitamin D, and counselling. This paper provides an overview of SAD. Sherri Melrose Copyright © 2015 Sherri Melrose. All rights reserved. Depressive Symptoms during an Acute Schizophrenic Episode: Frequency and Clinical Correlates Wed, 18 Nov 2015 07:46:05 +0000 Introduction. Depressive symptoms are common in schizophrenia and are associated with poorer functioning, lower quality of life, and an elevated risk of suicidal behaviour. There are few studies on the occurrence and correlates of these symptoms in acutely ill patients with schizophrenia. Method. 72 acutely ill patients with schizophrenia were assessed for depression using the Calgary Depression Scale for Schizophrenia (CDSS). A cut-off score of ≥6 on the CDSS was used to identify clinically significant depressive symptoms. The relationship between depression and illness variables, including psychotic symptom dimensions as measured by the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), was examined. Results. Eleven (15.3%) patients had clinically significant depressive symptoms. These patients scored higher on the positive and general psychopathology scales of the PANSS and had higher rates of suicidal behavior and poorer functioning. The severity of depressive symptoms was positively correlated with the PANSS positive subscale and negatively correlated with the PANSS negative subscale. Discussion. These findings confirm previous reports that depressive symptoms in active schizophrenia is related to the severity of positive psychotic symptoms and is a risk factor for suicidal behaviour in these patients. Ravi Philip Rajkumar Copyright © 2015 Ravi Philip Rajkumar. All rights reserved. Sex Differences in Genetic and Environmental Influences on Adolescent Depressive Symptoms: A Meta-Analytic Review Sun, 15 Nov 2015 09:14:16 +0000 Although sex difference in the mean level of depressive symptoms has been well established, the sex difference in genetic and environmental influences on adolescent depressive symptoms is unclear. The current study conducted a meta-analysis of twin studies on sex differences in self- and parent-reported adolescent depressive symptoms. For self-reports, genetic factors influenced adolescent depressive symptoms equally for boys and girls, accounting for 46% of variation, but shared environmental factors had stronger impacts on adolescent girls’ versus boys’ depressive symptoms (13% versus 1% of the variance). For parent-reports, genetic, shared, and nonshared environmental factors influenced adolescent depressive symptoms equally, with separate estimates of 34%, 35%, and 31%. The implications of sex difference in genetic and environmental etiologies of depressive symptoms are discussed. Jie Chen and Jing Yu Copyright © 2015 Jie Chen and Jing Yu. All rights reserved. Depressive Symptoms: The Interaction between Rumination and Self-Reported Insomnia Wed, 04 Nov 2015 11:41:22 +0000 Objective. Prior research has found consistent support that rumination and insomnia are important risk factors for depressive symptoms. The aim of the present cross-sectional study is to examine the interaction between these two previously well-established risk factors (i.e., rumination and insomnia) in the explanation of depressive symptoms. Design. A total of 417 participants (277 women) with a mean age of 39 (SD = 17.59; range 18–85) completed a cross-sectional survey. Main Outcome Measures. Participants filled out the Response Rumination Scale, the Athens Insomnia Scale, and the short version of the Center for Epidemiologic Studies Depression Scale. Results. It was predicted and found that self-reported insomnia moderated the relationship between rumination and depressive symptoms. We found that particularly participants who reported higher levels of rumination as well as insomnia had the highest depressive symptoms. Conclusion. This study is the first to suggest that particularly individuals exhibiting both self-reported insomnia and higher levels of rumination also report higher levels of depressive symptoms. Health professionals screening for mental problems should be aware of this specific combination of insomnia and rumination. Explanations for this moderation effect were discussed in light of study’s limitations. Monique Malmberg and Junilla K. Larsen Copyright © 2015 Monique Malmberg and Junilla K. Larsen. All rights reserved. No Association of BDNF, COMT, MAOA, SLC6A3, and SLC6A4 Genes and Depressive Symptoms in a Sample of Healthy Colombian Subjects Thu, 08 Oct 2015 08:40:28 +0000 Background. Major depressive disorder (MDD) is the second cause of years lived with disability around the world. A large number of studies have been carried out to identify genetic risk factors for MDD and related endophenotypes, mainly in populations of European and Asian descent, with conflicting results. The main aim of the current study was to analyze the possible association of five candidate genes and depressive symptoms in a Colombian sample of healthy subjects. Methods and Materials. The Spanish adaptation of the Hospital Anxiety and Depression Scale (HADS) was applied to one hundred eighty-eight healthy Colombian subjects. Five functional polymorphisms were genotyped using PCR-based assays: BDNF-Val66Met (rs6265), COMT-Val158Met (rs4680), SLC6A4-HTTLPR (rs4795541), MAOA-uVNTR, and SLC6A3-VNTR (rs28363170). Result. We did not find significant associations with scores of depressive symptoms, derived from the HADS, for any of the five candidate genes (nominal values >0.05). In addition, we did not find evidence of significant gene-gene interactions. Conclusion. This work is one of the first studies of candidate genes for depressive symptoms in a Latin American sample. Study of additional genetic and epigenetic variants, taking into account other pathophysiological theories, will help to identify novel candidates for MDD in populations around the world. Yeimy González-Giraldo, Andrés Camargo, Sandra López-León, and Diego A. Forero Copyright © 2015 Yeimy González-Giraldo et al. All rights reserved. Ketamine, Transcranial Magnetic Stimulation, and Depression Specific Yoga and Mindfulness Based Cognitive Therapy in Management of Treatment Resistant Depression: Review and Some Data on Efficacy Mon, 05 Oct 2015 14:05:07 +0000 Depression affects about 121 million people worldwide and prevalence of major depressive disorder (MDD) in US adults is 6.4%. Treatment resistant depression (TRD) accounts for approximately 12–20% of all depression patients and costs $29–$48 billion annually. Ketamine and repetitive transcranial magnetic stimulation (rTMS) have useful roles in TRD, but their utility in long term is unknown. As per the latest literature, the interventions using Yoga and meditation including the mindfulness based cognitive therapy (MBCT) have been useful in treatment of depression and relapse prevention. We present a review of rTMS, ketamine, and MBCT and also report efficacy of a depression specific, innovative, and translational model of Yoga and mindfulness based cognitive therapy (DepS Y-MBCT), developed by the first author. DepS Y-MBCT as an adjunctive treatment successfully ameliorated TRD symptoms in 27/32 patients in an open label pilot trial in TRD patients. Considering the limitations of existing treatment options, including those of ketamine and rTMS when used as the sole modality of treatment, we suggest a “tiered approach for TRD” by combining ketamine and rTMS (alone or along with antidepressants) for rapid remission of acute depression symptoms and to use DepS Y-MBCT for maintaining remission and preventing relapse. Basant Pradhan, Tapan Parikh, Ramkrishna Makani, and Madhusmita Sahoo Copyright © 2015 Basant Pradhan et al. All rights reserved. Elevated Risk of Suicidal Ideation in HIV-Positive Persons Tue, 29 Sep 2015 12:57:58 +0000 Globally, suicide and HIV/AIDS remain two of the greatest healthcare issues, particularly in low- and middle-income countries. Several studies have observed a relationship between suicidal behaviour and HIV/AIDS. Materials and Methods. The main objective of this research was to determine the prevalence of elevated risk of suicidal ideation in HIV-positive persons immediately following voluntary HIV counselling and testing (VCT). The study sample consisted of adult volunteers attending the VCT clinic at a university-affiliated, general state hospital. Participants completed a sociodemographic questionnaire, Beck’s Hopeless Scale, and Beck’s Depression Inventory. Results. A significantly elevated risk of suicidal ideation was found in 83.1% of the patients who tested seropositive. Despite a wide age range in the cohort studied, the majority of patients with suicidal ideation were males in the younger age group (age < 30 years), consistent with the age-related spread of the disease and an increase in suicidal behaviour in younger people. Relevant associated variables are discussed. Conclusion. The results serve as important markers that could alert healthcare professionals to underlying suicide risks in HIV-positive patients. It is recommended that screening for elevated risk of suicidal ideation and prevention of suicidal behaviour should form a routine aspect of comprehensive patient care at VCT clinics. L. Schlebusch and R. D. Govender Copyright © 2015 L. Schlebusch and R. D. Govender. All rights reserved. Increasing Understanding in Children of Depressed Parents: Predictors and Moderators of Intervention Response Wed, 19 Aug 2015 11:25:58 +0000 We evaluated predictors and moderators of differential response to two family-based depression prevention programs for families with a depressed parent: a clinician-facilitated intervention and a lecture group intervention. Individual and family level variables were examined using regression analyses with generalized estimating equations. For the outcome of child understanding of depression, parental changes in child-related behaviors and attitudes predicted greater child understanding (). For the parent outcome of behavior and attitude change, across intervention conditions, younger parent age (), female parent gender (), more chronic and severe parental depression history (), lower SES (), and single-parent status () were associated with better outcomes across conditions. Effect sizes were moderate, ranging from 0.4 to 0.7 SD. Family and marital functioning were not found to be predictors of any outcomes. When both parents were depressed at baseline, there was no difference in the clinician- versus lecture-based approach, and when only the father was depressed, families reported more changes with the clinician condition than with the lecture condition (). Findings from this study can help identify intervention strategies that are appropriate for different types of at-risk individuals and families. Tracy R. G. Gladstone, Peter W. Forbes, Anne Diehl, and William R. Beardslee Copyright © 2015 Tracy R. G. Gladstone et al. All rights reserved. Turkish Version of the Cognitive Distortions Questionnaire: Psychometric Properties Thu, 13 Aug 2015 16:08:15 +0000 Cognitive distortions are interrelated with all layers of cognitions, and they may be part of the treatment once they are accessed, identified, labeled, and changed. From both a research and a clinical perspective, it is of utmost importance to disentangle cognitive distortions from similar constructs. Recently, the Cognitive Distortions Questionnaire (CD-Quest), a brief and comprehensive measure, was developed to assess both the frequency and the intensity of cognitive distortions. The aim of the present study was to assess the psychometric properties of the Turkish version of the CD-Quest in a psychiatric outpatient sample. Demographic and clinical data of the participants were analyzed by descriptive statistics. For group comparisons, Student’s -test was applied. An exploratory principal components factor analysis was performed, followed by an oblique rotation. To assess the internal consistency of the scale Cronbach’s was computed. The correlation coefficient was calculated for test-retest reliability over a 4-week period. For concurrent validity, bivariate Pearson correlation analyses were conducted with the measures of mood severity and negatively biased cognitions. The results revealed that the scale had excellent internal consistency, good test-retest reliability, unidimensional factor structure, and evidence of concurrent and discriminant validity. Sedat Batmaz, Sibel Kocbiyik, and Ozgur Ahmet Yuncu Copyright © 2015 Sedat Batmaz et al. All rights reserved. Prevalence of Depression among Type 2 Diabetic Outpatients in Black Lion General Specialized Hospital, Addis Ababa, Ethiopia Thu, 19 Feb 2015 09:20:45 +0000 Background. The emotional consequences of diabetes have been scrutinized by a number of investigative teams and there are varying reports about the association of depression with type 2 diabetes mellitus. However, there is limited data about this in Ethiopia. Therefore, the purpose of this study was to assess the prevalence of comorbid depression among type 2 diabetic outpatients. Methods and Materials. Institution based cross-sectional study design was conducted on a random sample of 276 type 2 diabetic outpatients from Black Lion General Specialized Hospital. Systematic random sampling technique was used to get these individual patients from 920 type 2 diabetic outpatients who have an appointment during the data collection period. Patients’ depression status was measured using Patient Health Questionnaire 9 (PHQ 9). Result. Totally 264 type 2 diabetic outpatients were interviewed with a response rate of 95.6%. The prevalence of depression among type 2 diabetic outpatients was 13%. Based on PHQ 9 score, 28.4% (75) fulfilled the criteria for mild depression, 12.1% (32) for moderate depression, 2.7% (7) for moderately severe depression, and 1.5% (4) for severe depression. But 45.8% (121) of patients had no clinically significant depression. Conclusion. This study demonstrated that depression is a common comorbid health problem in type 2 diabetic outpatients with a prevalence rate of 13%. Tesfa Dejenie Habtewold, Yosef Tsige Radie, and Nigussie Tadesse Sharew Copyright © 2015 Tesfa Dejenie Habtewold et al. All rights reserved. Memory Impairment following Acute Tricyclic Antidepressants Overdose Wed, 14 Jan 2015 12:48:27 +0000 Background. Psychiatric consultation is necessary for all patients with intentional poisoning and its reliability depends on the proper function of patients’ memory performance. This study aimed to determine the possible memory impairment following acute TCAs’ poisoning. Materials and Methods. In this cross-sectional study, patients with acute TCAs poisoning were allocated to two groups of severe poisoning (with coma, seizures, cardiac arrhythmias, hypotension, and a wide QRS complex) and mild-to-moderate poisoning according to their clinical presentation at the time of hospital admission. All patients underwent memory performance test both immediately and 24 hours after their initial consciousness after admission, using Wechsler Memory Scale (WMS-IV). Results. During the study period, 67 TCA-poisoned patients (aged, 20–64 years) were evaluated, of which 67.2% were female. The mean memory scores of patients immediately and 24 hours after the initial consciousness were and , respectively (). Twenty-four hours after the initial consciousness, memory score was statistically correlated with the amount of ingested drug and the intoxication severity. Conclusion. Following the recovery from somatic symptoms of acute TCA poisoning, patients may still suffer from memory impairment and it seems that this time is not suitable for performing a reliable psychiatric consultation. Nastaran Eizadi-Mood, Shahla Akouchekian, Ahmad Yaraghi, Mehrnazsadat Hakamian, Rasool Soltani, and Ali Mohammad Sabzghabaee Copyright © 2015 Nastaran Eizadi-Mood et al. All rights reserved. Short-Term Effects of Electroconvulsive Therapy on Subjective and Actigraphy-Assessed Sleep Parameters in Severely Depressed Inpatients Tue, 06 Jan 2015 10:12:41 +0000 Background. Sleep disturbances are a key feature of major depression. Electroconvulsive treatment (ECT) may improve polysomnography-assessed sleep characteristics, but its short-term effects on actigraphy-assessed and subjective sleep characteristics are unknown. We therefore aimed to assess the effects of ECT on subjective and objective sleep parameters in a proof-of-principle study. Methods. We assessed subjective and objective sleep parameters in 12 severely depressed patients up to 5 consecutive days during their ECT course, corresponding to a total of 43 nights (including 19 ECT sessions). The 12 patients were 83% female and on average 62 (standard deviation (SD) 14) years old and had an average MADRS score of 40 at baseline (SD 21). Results. Subjective and objective sleep parameters were not directly affected by ECT. The subjective sleep efficiency parameter was similar on the day after ECT and other days. ECT did not affect the number of errors in the Sustained Attention to Response Task. Patients subjectively underestimated their total sleep time by 1.4 hours () compared to actigraphy-assessed sleep duration. Conclusion. ECT did not affect subjective and actigraphy-assessed sleep in the short term. Depressed patients profoundly underestimated their sleep duration. Alexander Hoogerhoud, Andreia W. P. Hazewinkel, Robert H. A. M. Reijntjens, Irene M. van Vliet, Martijn S. van Noorden, Gert Jan Lammers, J. Gert van Dijk, and Erik J. Giltay Copyright © 2015 Alexander Hoogerhoud et al. All rights reserved. The Effect of Educational Intervention on Nurses’ Attitudes and Beliefs about Depression in Heart Failure Patients Wed, 26 Nov 2014 12:47:38 +0000 Systematic depression screening is feasible, efficient, and well accepted; however the lack of consistent assessment in heart failure inpatients suggests barriers preventing its effective diagnosis and treatment. This pilot study assessed the impact of an educational intervention on nurses’ beliefs about depression and their likelihood of routinely screening heart failure patients. Registered nurses from adult medical-surgical units were surveyed before and after an educational intervention to assess their beliefs about depression prevalence and screening in heart failure patients. There was no significant influence on nurses’ beliefs about depression, but the results suggested an increased likelihood that nurses would routinely screen for depression. The moderately significant correlation between beliefs and intent to screen for depression indicates that educational intervention could ultimately have a positive influence on patient outcomes through early detection and treatment of depression in patients with cardiovascular disease; however the observed increase in the intent to screen without a corresponding change in beliefs indicates other influences affecting nurses’ intent to screen heart failure patients for depression. Patricia Lea Copyright © 2014 Patricia Lea. All rights reserved. Rapid Screening of Psychological Well-Being of Patients with Chronic Illness: Reliability and Validity Test on WHO-5 and PHQ-9 Scales Tue, 18 Nov 2014 12:36:46 +0000 This study intended to test the reliability and validity of two simple psychological screening scales, the World Health Organization Well-being Index (WHO-5) and the 9-item Patient Health Questionnaire (PHQ-9), in patients with chronic illness in Taiwan and to understand the psychological well-being of patients with chronic illness (e.g., metabolic syndrome) in Taiwan and the incidences of psychological problems that follow. The research design of this study was a descriptive cross-sectional study. The sample comprised 310 patients with metabolic syndrome (MS), aged 20 years or more, from the outpatient clinic of a municipal hospital in Taiwan. This study used questionnaires to collect basic information, including physiological indices, WHO-5 and PHQ-9 that were used. “Hospital Anxiety and Depression scale (HADS),” and “World Health Organization Quality of Life—Short-form Version for Taiwan (WHOQOL)”. Results are as follows: (1) compared to PHQ-9, the reliability and validity of WHO-5 are better for screening the psychological well-being of patients with chronic illness. (2) The features of WHO-5 are high sensitivity, briefness, and ease-of-use. The incidence of depression in patients with metabolic syndrome was approximately 1.0–6.5%, which is significantly lower than that of western countries. Shu-Fang Vivienne Wu Copyright © 2014 Shu-Fang Vivienne Wu. All rights reserved. Resource Utilisation and Costs of Depressive Patients in Germany: Results from the Primary Care Monitoring for Depressive Patients Trial Tue, 09 Sep 2014 08:24:42 +0000 Background. Depression is the most common type of mental disorder in Germany. It is associated with a high level of suffering for individuals and imposes a significant burden on society. The aim of this study was to estimate the depression related costs in Germany taking a societal perspective. Materials and Methods. Data were collected from the primary care monitoring for depressive patients trial (PRoMPT) of patients with major depressive disorder who were treated in a primary care setting. Resource utilisation and days of sick leave were observed and analysed over a 1-year period. Results. Average depression related costs of €3813 were calculated. Significant differences in total costs due to sex were demonstrated. Male patients had considerable higher total costs than female patients, whereas single cost categories did not differ significantly. Further, differences in costs according to severity of disease and age were observed. The economic burden to society was estimated at €15.6 billion per year. Conclusion. The study results show that depression poses a significant economic burden to society. There is a high potential for prevention, treatment, and patient management innovations to identify and treat patients at an early stage. Christian Krauth, Jona T. Stahmeyer, Juliana J. Petersen, Antje Freytag, Ferdinand M. Gerlach, and Jochen Gensichen Copyright © 2014 Christian Krauth et al. All rights reserved. Comparing the Effects of Repetitive Transcranial Magnetic Stimulation and Electroconvulsive Therapy in the Treatment of Depression: A Systematic Review and Meta-Analysis Mon, 21 Jul 2014 00:00:00 +0000 Electroconvulsive therapy (ECT) is the longest standing psychiatric treatment available and has unequivocal benefit in severe depression. However this treatment comes with a number of side effects such as memory impairment. On the other hand, Repetitive Transcranial Magnetic Stimulation (rTMS) is a relatively new form of treatment which has been shown to be efficacious in patients suffering from a number of psychopathologies, including severe depression, with few reported side effects. Due to its potential therapeutic efficacy and lack of side effects, rTMS has gained traction in the treatment of depression, with a number of authors keen to see it take over from ECT. However, it is not clear whether rTMS represents a therapeutic alternative to ECT. This meta-analysis will therefore compare the “gold standard” treatment for severe depression, with the relatively new but promising rTMS. A literature search will be performed with the intention to include all randomised clinical trials. The null hypothesis is that there is no difference in the antidepressant efficacy between the two types of treatment modalities. Statistical analysis of Hamilton Depression Rating Scale (HDRS) scores will be performed. Beppe Micallef-Trigona Copyright © 2014 Beppe Micallef-Trigona. All rights reserved. Lovastatin as an Adjuvant to Lithium for Treating Manic Phase of Bipolar Disorder: A 4-Week, Randomized, Double-Blind, Placebo-Controlled Clinical Trial Tue, 15 Jul 2014 09:55:07 +0000 Objectives. Many patients with bipolar disorder suffer from metabolic disorder. Lovastatin is effective for treating major depression. This double-blind randomized placebo controlled clinical trial investigates whether lovastatin is a useful adjuvant to lithium for treating mania. Methods. Fifty-four patients with bipolar disorder-manic phase were randomly allocated into lovastatin or placebo group. The clinical symptoms were assessed at baseline, week 2, and week 4 using Young Mania Rating Scale. Adverse effects were checked. Results. Forty-six out of 54 patients completed this trial. The mania score in the lovastatin group decreased from 40.6 (11.1) at baseline to 12.9 (8.7) and 4.1 (5.4) at weeks 2 and 4, respectively. The score in the placebo group decreased from 41.0 (11.2) at baseline to 12.8 (8.07) and 5.8 (4.6) at weeks 2 and 4, respectively. However, there was no significant difference between groups at week 2 and week 4. The adverse effects rates were comparable between the two groups. No serious adverse effect was found. Tremor and nausea were the most common adverse effects. Conclusions. Lovastatin neither exacerbated nor decreased the symptoms of mania in patients with bipolar disorder. Current results support that the combination of lovastatin with lithium is tolerated well in bipolar disorder. The trial was registered with the Iranian Clinical Trials Registry (IRCT201302203930N18). Ahmad Ghanizadeh, Motahhar OmraniSigaroodi, Ali Javadpour, Mohammad Hossein Dabbaghmanesh, and Sara Shafiee Copyright © 2014 Ahmad Ghanizadeh et al. All rights reserved. Construct Validity and Reliability of the Adult Rejection Sensitivity Questionnaire: A Comparison of Three Factor Models Sun, 06 Jul 2014 09:04:56 +0000 Objectives and Methods. The aim of the study was to investigate the construct validity of the ARSQ. Methods. The ARSQ and self-report measures of depression, anxiety, and hopelessness were administered to 774 Italian adults, aged 18 to 64 years. Results. Structural equation modeling indicated that the factor structure of the ARSQ can be represented by a bifactor model: a general rejection sensitivity factor and two group factors, expectancy of rejection and rejection anxiety. Reliability of observed scores was not satisfactory: only 44% of variance in observed total scores was due to the common factors. The analyses also indicated different correlates for the general factor and the group factors. Limitations. We administered an Italian version of the ARSQ to a nonclinical sample of adults, so that studies which use clinical populations or the original version of the ARSQ could obtain different results from those presented here. Conclusion. Our results suggest that the construct validity of the ARSQ is disputable and that rejection anxiety and expectancy could bias individuals to readily perceive and strongly react to cues of rejection in different ways. Marco Innamorati, Michela Balsamo, Beth Fairfield, Mariantonietta Fabbricatore, Antonino Tamburello, and Aristide Saggino Copyright © 2014 Marco Innamorati et al. All rights reserved. Long-Term Effects of the Treatment of Depressive Female Inpatients in a Naturalistic Study: Is Early Improvement a Valid Predictor of Outcome? Mon, 30 Jun 2014 09:08:26 +0000 Objectives. To examine the predictive value of early improvement for short- and long-term outcome in the treatment of depressive female inpatients and to explore the influence of comorbid disorders (CD). Methods. Archival data of a naturalistic sample of 277 female inpatients diagnosed with a depressive disorder was analyzed assessing the BDI at baseline, after 20 days and 30 days, posttreatment, and after 3 to 6 months at follow-up. Early improvement, defined as a decrease in the BDI score of at least 30% after 20 and after 30 days, and CD were analyzed using binary logistic regression. Results. Both early improvement definitions were predictive of remission at posttreatment. Early improvement after 30 days showed a sustained treatment effect in the follow-up phase, whereas early improvement after 20 days failed to show a persistent effect regarding remission at follow-up. CD were not significantly related neither at posttreatment nor at follow-up. At no time point CD moderated the prediction by early improvement. Conclusions. We show that early improvement is a valid predictor for short-term remission and at follow-up in an inpatient setting. CD did not predict outcome. Further studies are needed to identify patient subgroups amenable to more tailored treatments. Elian Zuercher-Huerlimann, Martin grosse Holtforth, and Ernst Hermann Copyright © 2014 Elian Zuercher-Huerlimann et al. All rights reserved. Leukocyte Gene Expression in Patients with Medication Refractory Depression before and after Treatment with ECT or Isoflurane Anesthesia: A Pilot Study Sun, 13 Apr 2014 16:33:47 +0000 Objective. To evaluate leukocyte gene expression for 9 selected genes (mRNAs) as biological markers in patients with medication refractory depression before and after treatment with ECT or isoflurane anesthesia (ISO). Methods. In a substudy of a nonrandomized open-label trial comparing effects of ECT to ISO therapy, blood samples were obtained before and after treatment from 22 patients with refractory depression, and leukocyte mRNA was assessed by quantitative PCR. Patients’ mRNAs were also compared to 17 healthy controls. Results. Relative to controls, patients before treatment showed significantly higher IL10 and DBI and lower ADRA2A and ASIC3 mRNA (). Both ECT and ISO induced significant decreases after treatment in 4 genes: IL10, NR3C1, DRD4, and Sult1A1. After treatment, patients’ DBI, ASIC3, and ADRA2A mRNA remained dysregulated. Conclusion. Significant differences from controls and/or significant changes after ECT or ISO treatment were observed for 7 of the 9 mRNAs studied. Decreased expression of 4 genes after effective treatment with either ECT or ISO suggests possible overlap of underlying mechanisms. Three genes showing dysregulation before and after treatment may be trait-like biomarkers of medication refractory depression. Gene expression for these patients has the potential to facilitate diagnosis, clarify pathophysiology, and identify potential biomarkers for treatment effects. E. Iacob, S. C. Tadler, K. C. Light, H. R. Weeks, K. W. Smith, A. T. White, R. W. Hughen, T. A. VanHaitsma, L. A. Bushnell, and A. R. Light Copyright © 2014 E. Iacob et al. All rights reserved.