scholarly journals Response style and severity and chronicity of depressive disorders in primary health care

2016 ◽  
Vol 33 (1) ◽  
pp. 1-8
Author(s):  
K. Riihimäki ◽  
M. Vuorilehto ◽  
P. Jylhä ◽  
E. Isometsä
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Depressive Disorders ◽  
Rating Scale ◽  
Response Styles ◽  
Related Phenomenon ◽  
Eysenck Personality Inventory ◽  
Primary Care Patients ◽  
Depressive Episodes

AbstractBackgroundResponse styles theory of depression postulates that rumination is a central factor in occurrence, severity and maintaining of depression. High neuroticism has been associated with tendency to ruminate. We investigated associations of response styles and neuroticism with severity and chronicity of depression in a primary care cohort study.MethodsIn the Vantaa Primary Care Depression Study, a stratified random sample of 1119 adult patients was screened for depression using the Prime-MD. Depressive and comorbid psychiatric disorders were diagnosed using SCID-I/P and SCID-II interviews. Of the 137 patients with depressive disorders, 82% completed the prospective five-year follow-up with a graphic life chart enabling evaluation of the longitudinal course of episodes. Neuroticism was measured with the Eysenck Personality Inventory (EPI-Q). Response styles were investigated at five years using the Response Styles Questionnaire (RSQ-43).ResultsAt five years, rumination correlated significantly with scores of Hamilton Depression Rating Scale (r = 0.54), Beck Depression Inventory (r = 0.61), Beck Anxiety Inventory (r = 0.50), Beck Hopelessness Scale (r = 0.51) and Neuroticism (r = 0.58). Rumination correlated also with proportion of follow-up time spent depressed (r = 0.38). In multivariate regression, high rumination was significantly predicted by current depressive symptoms and neuroticism, but not by anxiety symptoms or preceding duration of depressive episodes.ConclusionsAmong primary care patients with depression, rumination correlated with current severity of depressive symptoms, but the association with preceding episode duration remained uncertain. The association between neuroticism and rumination was strong. The findings are consistent with rumination as a state-related phenomenon, which is also strongly intertwined with traits predisposing to depression.

Rumination And Primary Care Depression

2016 ◽  
Vol 33 (S1) ◽  
pp. S422-S422 ◽  
Author(s):  
K. Riihimäki ◽  
M. Vuorilehto ◽  
P. Jylhä ◽  
E. Isometsä
Keyword(s):  
Primary Care ◽  
Depressive Disorders ◽  
Rating Scale ◽  
Response Styles ◽  
Related Phenomenon ◽  
Eysenck Personality Inventory ◽  
Primary Care Patients ◽  
Competing Interest ◽  
Depressive Episodes

IntroductionResponse styles theory postulates that rumination is a central factor in occurrence, severity and maintaining of depression. High neuroticism has been associated with tendency to ruminate.ObjectiveTo evaluate the relationships between rumination, neuroticism and depression in a naturalistic prospective cohort of primary care patients with depressive disorders with life-chart methodology.AimsWe hypothesized, that rumination would correlate with severity and duration of depression and with concurrent anxiety, gender and neuroticism.MethodsIn the Vantaa Primary Care Depression Study, a stratified random sample of 1119 adult patients was screened for depression using the Prime-MD. Depressive and comorbid psychiatric disorders were diagnosed using SCID-I/P and SCID-II. Of the 137 patients with depressive disorders, 82% completed the five-year follow-up with a graphic life chart. Neuroticism was measured with the Eysenck Personality Inventory (EPI-Q). Response styles were investigated at five years using the Response Styles Questionnaire (RSQ-43).ResultsRumination correlated significantly with Hamilton Depression Rating Scale (r = 0.54), Beck Depression Inventory (r = 0.61), Beck Anxiety Inventory (r = 0.50), Beck Hopelessness Scale (r = 0.51) and Neuroticism (r = 0.58). Rumination correlated also with proportion of follow-up time spent depressed (r = 0.38). In multivariate regression, high rumination was significantly predicted by current depressive symptoms and neuroticism, but not by anxiety symptoms or preceding duration of depressive episodes.ConclusionsRumination correlated with current severity of depression, but the association with preceding episode duration remained uncertain. The association between neuroticism and rumination was strong. The findings are consistent with rumination as a state-related phenomenon, which is also strongly intertwined with traits predisposing to depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals AB0118 REMISSION OF ANXIETY AND DEPRESSIVE DISORDERS IMPROVES HAQ TREATMENT RESPONSE IN RHEUMATOID ARTHRITIS PATIENTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1088.1-1088
Author(s):  
A. Abramkin ◽  
T. Lisitsyna ◽  
D. Veltishchev ◽  
O. Seravina ◽  
O. Kovalevskaya ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Depressive Symptoms ◽  
Treatment Response ◽  
Depressive Disorders ◽  
Rating Scale ◽  
Functional Limitations ◽  
Minor Depression ◽  
Factors Associated ◽  
Lower Baseline

Background:Anxiety and depressive disorders (ADD) significantly affect disease activity and functional disability in rheumatoid arthritis (RA) patients. Psychopharmacotherapy (PPT) of ADD attempts to improve RA disease activity and lower progression of functional limitations.Objectives:To determine factors associated with HAQ treatment response in antidepressants-treated RA-patients at five years endpoint.Methods:128 RA-patients (pts) were enrolled, 86% were women with a mean age of 47,4±11,3 (M±SD) yrs. All patients met the full ACR/EULAR 2010 criteria for RA. Functional limitations were assessed using Health Assessment Questionnaire (HAQ), mean HAQ was 1,42±0,78 at baseline. 69,4% RA-pts were already taking prednisone (9 [5; 10] mg/day (Me (25%; 75%)), 84,4% - cDMARDs, 7,8% - bDMARDs (anti-TNF-α – 6,3%, rituximab – 1,6%). ADD were diagnosed by psychiatrist in 123 (96,1%) of RA-pts in accordance with ICD-10 in semi-structured interview. Severity of depression and anxiety was evaluated with Montgomery–Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HAM-A). RA-pts with ADD were divided into the following treatment groups: 1 – сDMARDs (n=39), 2 – сDMARDs + PPT (sertraline or mianserine) (n=43), 3 – сDMARDs + bDMARDs (n=32), 4 – сDMARDs + bDMARDs + PPT (sertraline or mianserine) (n=9). Biologics treatment duration varied from 1 to 6 years, antidepressants – from 6 to 96 weeks. Baseline HAQ scores were 1,39±0,75, 1,42±0,9, 1,58±0,76 and 1,38±0,83 in groups 1-4, respectively. At 5-yrs endpoint in 83 RA-pts differences between baseline and endpoint HAQ scores (Δ HAQ = endpoint HAQ – baseline HAQ) were assessed as HAQ treatment response with minimal clinically important difference (MCID) (Δ HAQ ≥ 0,22). HAQ response rates were 4,2%, 65,5%, 47,6% and 76,7% in groups 1-4, respectively, with the lowest response rate in group 1 (p<0,0001). Logistic regression analysis was conducted to determine factors associated with RA remission rate.Results:By univariate logistic regression, anxiety and depressive symptoms remission at 5-yrs endpoint, baseline HAQ and major depression, lower baseline age, BMI and DAS28, no minor depression and cardiovascular diseases at baseline were significantly (p≤0,2) associated with HAQ treatment response (table 1). These variables were subjected to multivariate stepwise logistic regression. Only remission of anxiety and depressive symptoms at 5-yrs endpoint (OR 6,6 (95%CI 1,78 – 24,43), p=0,005), higher baseline HAQ (OR 2,61 (95%CI 1,12 – 6,11), p=0,027) and lower baseline BMI (OR 0,9 (95%CI 0,85 – 0,96), p=0,001) were independently associated with HAQ treatment response at 5-years follow-up.Table 1.Factors associated with RA remission at 5 years (univariate logistic regression).FactorpOR95%CIlowupAnxiety and depressive symptoms remission at 5-yrs endpoint0,0075,01,56116,016Baseline HAQ0,012,6571,2645,588Baseline major depression0,1422,0820,7825,542Baseline age0,0980,9920,9821,002Body mass index (BMI)0,0480,9810,9631,0Baseline minor depression0,1670,5630,2491,273Cardiovascular diseases0,10,4170,1471,183Baseline DAS280,0080,0771,0712,096Conclusion:higher HAQ and lower BMI at baseline and remission of anxiety and depressive symptoms at 5-yrs endpoint are independently associated with HAQ treatment response (MCID) at 5-years follow-up.Disclosure of Interests:None declared

Outcome of anxiety and depressive disorders in primary care

1997 ◽  
Vol 171 (5) ◽  
pp. 427-433 ◽  
Author(s):  
Clare Ronalds ◽  
Francis Creed ◽  
Kit Stone ◽  
Sarah Webb ◽  
Barbara Tomenson
Keyword(s):  
Primary Care ◽  
Depressive Disorders ◽  
Rating Scale ◽  
Initial Assessment ◽  
High Educational Level ◽  
Depression And Anxiety ◽  
Mild Depression ◽  
Social Difficulties ◽  
High Educational

BackgroundFactors related to the outcome of depression and anxiety in primary care are not fully understood.MethodAdult patients in general practice with depressive, anxiety or panic disorder (n=148; DSM–III–R criteria) were studied prospectively for six months to determine the factors most closely associated with outcome. The Psychiatric Assessment Schedule, Hamilton Depression Rating Scale, Clinical Anxiety Scale and Life Events and Difficulties Schedule interviews were performed at index consultations and repeated six months later. Variables associated with outcome were assessed by multiple regression analysis.ResultsGood outcome was predicted by mild depression at initial assessment, high educational level, and being in employment. At follow-up the most important predictor of improvement was reduction in marked difficulties over the six months. Recognition and management by the GP was most frequent in patients with severe disorder; such patients were least likely to improve because of the severity of their depression and marked social difficulties.ConclusionsThis naturalistic study helps to provide a framework for further studies with more precisely defined groups of people with depression. An effective treatment strategy for people with marked depression and ongoing social difficulties is especially needed.

Incidence and predictors of suicide attempts among primary-care patients with depressive disorders: a 5-year prospective study

2013 ◽  
Vol 44 (2) ◽  
pp. 291-302 ◽  
Author(s):  
K. Riihimäki ◽  
M. Vuorilehto ◽  
T. Melartin ◽  
J. Haukka ◽  
E. Isometsä
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Substance Abuse ◽  
Depressive Disorder ◽  
Depressive Disorders ◽  
Suicide Attempts ◽  
Major Depressive ◽  
Primary Care Patients ◽  
Dsm Iv

BackgroundNo previous study has prospectively investigated incidence and risk factors for suicide attempts among primary care patients with depression.MethodIn the Vantaa Primary Care Depression Study, a stratified random sample of 1119 patients was screened for depression, and Structured Clinical Interviews for DSM-IV used to diagnose Axis I and II disorders. A total of 137 patients were diagnosed with a DSM-IV depressive disorder. Altogether, 82% of patients completed the 5-year follow-up. Information on timing of suicide attempts, plus major depressive episodes (MDEs) and partial or full remission, or periods of substance abuse were examined with life charts. Incidence of suicide attempts and their stable and time-varying risk factors (phases of depression/substance abuse) were investigated using Cox proportional hazard and Poisson regression models.ResultsDuring the follow-up there were 22 discrete suicide attempts by 14/134 (10.4%) patients. The incidence rates were 0, 5.8 and 107 during full or partial remission or MDEs, or 22.2 and 142 per 1000 patient-years during no or active substance abuse, respectively. In Cox models, current MDE (hazard ratio 33.5, 95% confidence interval 3.6–309.7) was the only significant independent risk factor. Primary care doctors were rarely aware of the suicide attempts.ConclusionsOf the primary care patients with depressive disorders, one-tenth attempted suicide in 5 years. However, risk of suicidal acts was almost exclusively confined to MDEs, with or without concurrent active substance abuse. Suicide prevention among primary care patients with depression should focus on active treatment of major depressive disorder and co-morbid substance use, and awareness of suicide risk.

scholarly journals Antidepressant treatment for primary care patients with depressive symptoms: Data from the diamond longitudinal cohort study

2020 ◽  
Vol 54 (4) ◽  
pp. 367-381
Author(s):  
Sandra K Davidson ◽  
Helena Romaniuk ◽  
Patty Chondros ◽  
Christopher Dowrick ◽  
Jane Pirkis ◽  
...  
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Antidepressant Treatment ◽  
Factors Associated ◽  
History Of ◽  
Primary Care Patients ◽  
General Practices ◽  
Antidepressant Use ◽  
History Of Depression

Background: In light of emerging evidence questioning the safety of antidepressants, it is timely to investigate the appropriateness of antidepressant prescribing. This study estimated the prevalence of possible over- and under-treatment with antidepressants among primary care attendees and investigated the factors associated with potentially inappropriate antidepressant use. Methods: In all, 789 adult primary care patients with depressive symptoms were recruited from 30 general practices in Victoria, Australia, in 2005 and followed up every 3 months in 2006 and annually from 2007 to 2011. For this study, we first assessed appropriateness of antidepressant use in 2007 at the 2-year follow-up to enable history of depression to be taken into account, providing 574 (73%) patients with five yearly assessments, resulting in a total of 2870 assessments. We estimated the prevalence of use of antidepressants according to the adapted National Institute for Health and Care Excellence guidelines and used regression analysis to identify factors associated with possible over- and under-treatment. Results: In 41% (243/586) of assessments where antidepressants were indicated according to adapted National Institute for Health and Care Excellence guidelines, patients reported not taking them. Conversely in a third (557/1711) of assessments where guideline criteria were unlikely to be met, participants reported antidepressant use. Being female and chronic physical illness were associated with antidepressant use where guideline criteria were not met, but no factors were associated with not taking antidepressants where guideline criteria were met. Conclusions: Much antidepressant treatment in general practice is for people with minimal or mild symptoms, while people with moderate or severe depressive symptoms may miss out. There is considerable scope for improving depression care through better allocation of antidepressant treatment.

A 5-year prospective study of predictors for functional and work disability among primary care patients with depressive disorders

2015 ◽  
Vol 30 (1) ◽  
pp. 51-57 ◽  
Author(s):  
K. Riihimäki ◽  
M. Vuorilehto ◽  
E. Isometsä
Keyword(s):  
Primary Care ◽  
Work Disability ◽  
Depressive Disorders ◽  
Labour Force ◽  
Dropping Out ◽  
Level Of Functioning ◽  
Long Term Follow Up ◽  
Depressive Episodes

AbstractObjective:To study prevalence of and predictors for functional and work disability among primary care (PC) patients with depressive disorders in prospective long-term follow-up.Methods:The Vantaa Primary Care Depression Study followed up prospectively 137 patients with depressive disorders for 5 years with a life chart. Information on level of functioning in general and in different dimensions, employment, sick leaves and disability pensions were obtained from interviews and patient records.Results:Level of functioning and work ability were strongly associated with time spent depressed and/or current severity of depression. Patients who belonged to the labour force at baseline spent one-third of the follow-up off work due to depression; two-thirds were granted sick leaves, and one-tenth a disability pension due to depression. Longer duration of depression, co-morbid disorders and having received social assistance predicted dropping out from work.Conclusion:Duration of depressive episodes appears decisive for long-term disability among PC patients with depression. Patients spent one-third of the follow-up off work due to depression, and remaining outside the labour force is a common outcome. Psychiatric and somatic co-morbidities, education and socio-economic means influence the level of functioning and ability to work, but are not equally important for all areas of life.

An intervention for depressive symptoms using a commercial game in a mental health impatient setting. (Preprint)

2019 ◽  
Author(s):  
Pablo Rodrigo Guzman Cortez ◽  
Matias Marzocchi ◽  
Neus Freixa Fontanals ◽  
Mercedes Balcells-Olivero
Keyword(s):  
Mental Health ◽  
Depressive Symptoms ◽  
Health Outcomes ◽  
Serious Games ◽  
Rating Scale ◽  
Depressive Symptomatology ◽  
Pilot Test ◽  
Potential Health ◽  
Depressive Episodes ◽  
Hamilton Rating Scale

BACKGROUND Computerized mental health interventions have shown evidence of their potential benefit for mental health outcomes in young users. All of the studied interventions available in the review and scientific literature can be classified as "serious games". Serious games are computerized interventions designed from the start with the objective of improving specific desired health outcomes. Moreover, there are reports of users experiencing subjective benefits in mental health after playing specific commercial games. These were games not intentionally made with a therapeutic objective in the design process. An example is the videogame "Journey", first released for the Playstation 3 console in 2012 which won "Game of the Year" in the 2013 D.I.C.E awards. The creator of the game describes the game as a short, 2-3-hour narrative experience in which the player goes through the "Hero's Journey" following a classic 3-part structure. There were more than 100 testimonials from players describing how the game helped them cope with psychological or personal issues. Some of them explicitly described recovering from depressive episodes through playing the game. OBJECTIVE To conduct a pilot test of the efficacy of the videogame Journey in reducing depressive symptoms in an acute impatient setting METHODS Depressive symptomatology was measured before and after the intervention using the Hamilton Rating Scale for Depression (HRSD) The intervention was conducted in an isolated room using a Playstation 3 console with the videogame "Journey" developed by Thatgamecompany. No internet access was allowed. The game was played over the course of 4 30-45 min sessions in a two week period. RESULTS The initial score in the Hamilton Rating Scale for Depression (HRSD) was 30, indicating a very severe depression. After the intervention the HRSD score was 10, showing a mild depression. CONCLUSIONS The Videogame Journey, a commercial game first available for the Playstation 3 console in 2012, was not created as a serious game with potential health benefits. Our pilot test is the first case report of a commercial game showing a potential effect in reducing depressive symptoms, which is consistent with the previous informal reports of users online.

scholarly journals Physical exercise for late-life major depression

2015 ◽  
Vol 207 (3) ◽  
pp. 235-242 ◽  
Author(s):  
M. Belvederi Murri ◽  
M. Amore ◽  
M. Menchetti ◽  
G. Toni ◽  
F. Neviani ◽  
...  
Keyword(s):  
Primary Care ◽  
Major Depression ◽  
Physical Exercise ◽  
Primary Outcome ◽  
Rating Scale ◽  
Late Life ◽  
Lower Intensity ◽  
Progressive Exercise ◽  
Primary Care Patients ◽  
Hamilton Rating Scale

BackgroundInterventions including physical exercise may help improve the outcomes of late-life major depression, but few studies are available.AimsTo investigate whether augmenting sertraline therapy with physical exercise leads to better outcomes of late-life major depression.MethodPrimary care patients (>65 years) with major depression were randomised to 24 weeks of higher-intensity, progressive aerobic exercise plus sertraline (S+PAE), lower-intensity, non-progressive exercise plus sertraline (S+NPE) and sertraline alone. The primary outcome was remission (a score of $10 on the Hamilton Rating Scale for Depression).ResultsA total of 121 patients were included. At study end, 45% of participants in the sertraline group, 73% of those in the S+NPE group and 81% of those in the S+PAE group achieved remission (P = 0.001). A shorter time to remission was observed in the S+PAE group than in the sertraline-only group.ConclusionsPhysical exercise may be a safe and effective augmentation to antidepressant therapy in late-life major depression.

Depressive symptoms in a treated multiple sclerosis cohort

2003 ◽  
Vol 9 (6) ◽  
pp. 616-620 ◽  
Author(s):  
Scott B Patten ◽  
Shanika Fridhandler ◽  
Cynthia A Beck ◽  
Luanne M Metz
Keyword(s):  
Multiple Sclerosis ◽  
Depressive Symptoms ◽  
Interferon Beta ◽  
Rating Scale ◽  
Epidemiological Studies ◽  
Treatment Groups ◽  
Increased Risk ◽  
The University ◽  
Depression Ratings

Background: Recent side effect data from clinical trials of interferon beta in multiple sclerosis (MS) have failed to confirm that these medications are associated with an increased risk of depression. However, these studies have used highly selected samples and the results may not be generalizable to real world settings. Methods: C linical data on subjects from southern A lberta who have applied for, or are receiving, public reimbursement for MS treatment are maintained in a database at the University of C algary Multiple Sclerosis C linic. Depression ratings obtained using the C enter for Epidemiological Studies Depression Rating Scale (C ES-D) are included in this database. In the current analysis, these longitudinal data were used to determine whether depressive symptoms were associated with disease-modifying treatments. Results: A t baseline, ratings were available for 163 subjects. Those choosing interferon beta resembled those choosing glatiramer acetate in most respects. During follow-up, no differences were observed in the prevalence or incidence of depression and C ES-D scores were not found to differ between the treatment groups. Conclusions: The failure to identify higher rates of depression both in previous intervention studies and in the current observational study provides confirmation that these drugs are not substantially associated with the occurrence of depression.

Depressive Disorder in Primary Care

1987 ◽  
Vol 150 (6) ◽  
pp. 737-751 ◽  
Author(s):  
C. V. R. Blacker ◽  
A. W. Clare
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Depressive Disorders ◽  
Psychiatric Morbidity ◽  
Depressive Illness ◽  
Psychiatric Disturbance ◽  
Collaborative Studies ◽  
Effect Of Treatment ◽  
Precise Relationship ◽  
The Relationship

Since the pioneering study of psychiatric morbidity in primary care by Shepherdet alin 1966, it has become increasingly apparent that a substantial proportion (between 20% and 25%) of patients consulting their GP are suffering from some form of psychiatric disturbance (Goldberg & Blackwell, 1970; Hoeperet al,1979). The composition of this psychiatric morbidity has been shown to be almost wholly affective in nature and largely mild in degree. In their important review Jenkins & Shepherd (1983) recently summarised the now extensive findings relating to overall minor psychiatric morbidity in primary care. However, recent collaborative studies between psychiatrists and GPs have identified that within this dilute pool of minor disorders, lurks a significant but poorly served population of patients suffering from depressive disorders which are by no means minor in degree. A number of crucial issues regarding this depression in primary care emerge which the present paper aims to review. In particular, how common is it, and how severe? How does it present and what, if any, are its special characteristics? What is the precise relationship between depressive symptoms and depressive illness presenting to the GP and what is the relationship between physical illness and depression? And finally, what is the course and outcome of depression in this setting and what are the indications for and effect of treatment?

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