What factors indicate prognosis for adults with depression in primary care? A protocol for meta-analyses of individual patient data using the Dep-GP database

Background: Pre-treatment severity is a key indicator of prognosis for those with depression. Knowledge is limited on how best to encompass severity of disorders. A number of non-severity related factors such as social support and life events are also indicators of prognosis. It is not clear whether this holds true after adjusting for pre-treatment severity as a) a depressive symptom scale score, and b) a broader construct encompassing symptom severity and related indicators: “disorder severity”. In order to investigate this, data from the individual participants of clinical trials which have measured a breadth of “disorder severity” related factors are needed. Aims: 1) To assess the association between outcomes for adults seeking treatment for depression and the severity of depression pre-treatment, considered both as i) depressive symptom severity only and ii) “disorder severity” which includes depressive symptom severity and comorbid anxiety, chronicity, history of depression, history of previous treatment, functional impairment and health-related quality of life. 2) To determine whether i) social support, ii) life events, iii) alcohol misuse, and iv) demographic factors (sex, age, ethnicity, marital status, employment status, level of educational attainment, and financial wellbeing) are prognostic indicators of outcomes, independent of baseline “disorder severity” and the type of treatment received. Methods: Databases were searched for randomised clinical trials (RCTs) that recruited adults seeking treatment for depression from their general practitioners and used the same diagnostic and screening instrument to measure severity at baseline – the Revised Clinical Interview Schedule; outcome measures could differ between studies. Chief investigators of all studies meeting inclusion criteria were contacted and individual patient data (IPD) were requested. Conclusions: In total 13 RCTs were found to meet inclusion criteria. The Dep-GP database was formed from the 6271 participants. This protocol outlines how these data will be analysed. Registration: PROSPERO CRD42019129512 (01/04/2019)

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What factors indicate prognosis for adults with depression in primary care? A protocol for meta-analyses of individual patient data using the Dep-GP database

Wellcome Open Research ◽

10.12688/wellcomeopenres.15225.2 ◽

2019 ◽

Vol 4 ◽

pp. 69

Author(s):

Joshua E.J. Buckman ◽

Rob Saunders ◽

Zachary D. Cohen ◽

Katherine Clarke ◽

Gareth Ambler ◽

...

Keyword(s):

Social Support ◽

Depressive Symptom ◽

Life Events ◽

Symptom Severity ◽

Individual Patient Data ◽

Inclusion Criteria ◽

Related Factors ◽

History Of ◽

Depressive Symptom Severity ◽

Pre Treatment

Background: Pre-treatment severity is a key indicator of prognosis for those with depression. Knowledge is limited on how best to encompass severity of disorders. A number of non-severity related factors such as social support and life events are also indicators of prognosis. It is not clear whether this holds true after adjusting for pre-treatment severity as a) a depressive symptom scale score, and b) a broader construct encompassing symptom severity and related indicators: “disorder severity”. In order to investigate this, data from the individual participants of clinical trials which have measured a breadth of “disorder severity” related factors are needed. Aims: 1) To assess the association between outcomes for adults seeking treatment for depression and the severity of depression pre-treatment, considered both as i) depressive symptom severity only and ii) “disorder severity” which includes depressive symptom severity and comorbid anxiety, chronicity, history of depression, history of previous treatment, functional impairment and health-related quality of life. 2) To determine whether i) social support, ii) life events, iii) alcohol misuse, and iv) demographic factors (sex, age, ethnicity, marital status, employment status, level of educational attainment, and financial wellbeing) are prognostic indicators of outcomes, independent of baseline “disorder severity” and the type of treatment received. Methods: Databases were searched for randomised clinical trials (RCTs) that recruited adults seeking treatment for depression from their general practitioners and used the same diagnostic and screening instrument to measure severity at baseline – the Revised Clinical Interview Schedule; outcome measures could differ between studies. Chief investigators of all studies meeting inclusion criteria were contacted and individual patient data (IPD) were requested. Conclusions: In total 15 RCTs met inclusion criteria. The Dep-GP database will include the 6271 participants from the 13 studies that provided IPD. This protocol outlines how these data will be analysed. Registration: PROSPERO CRD42019129512 (01/04/2019)

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What factors indicate prognosis for adults with depression in primary care? A protocol for meta-analyses of individual patient data using the Dep-GP database

Wellcome Open Research ◽

10.12688/wellcomeopenres.15225.3 ◽

2020 ◽

Vol 4 ◽

pp. 69

Author(s):

Joshua E.J. Buckman ◽

Rob Saunders ◽

Zachary D. Cohen ◽

Katherine Clarke ◽

Gareth Ambler ◽

...

Keyword(s):

Social Support ◽

Depressive Symptom ◽

Life Events ◽

Symptom Severity ◽

Individual Patient Data ◽

Inclusion Criteria ◽

Related Factors ◽

History Of ◽

Depressive Symptom Severity ◽

Pre Treatment

Background: Pre-treatment severity is a key indicator of prognosis for those with depression. Knowledge is limited on how best to encompass severity of disorders. A number of non-severity related factors such as social support and life events are also indicators of prognosis. It is not clear whether this holds true after adjusting for pre-treatment severity as a) a depressive symptom scale score, and b) a broader construct encompassing symptom severity and related indicators: “disorder severity”. In order to investigate this, data from the individual participants of clinical trials which have measured a breadth of “disorder severity” related factors are needed. Aims: 1) To assess the association between outcomes for adults seeking treatment for depression and the severity of depression pre-treatment, considered both as i) depressive symptom severity only and ii) “disorder severity” which includes depressive symptom severity and comorbid anxiety, chronicity, history of depression, history of previous treatment, functional impairment and health-related quality of life. 2) To determine whether i) social support, ii) life events, iii) alcohol misuse, and iv) demographic factors (sex, age, ethnicity, marital status, employment status, level of educational attainment, and financial wellbeing) are prognostic indicators of outcomes, independent of baseline “disorder severity” and the type of treatment received. Methods: Databases were searched for randomised clinical trials (RCTs) that recruited adults seeking treatment for depression from their general practitioners and used the same diagnostic and screening instrument to measure severity at baseline – the Revised Clinical Interview Schedule; outcome measures could differ between studies. Chief investigators of all studies meeting inclusion criteria were contacted and individual patient data (IPD) were requested. Conclusions: In total 15 RCTs met inclusion criteria. The Dep-GP database will include the 6271 participants from the 13 studies that provided IPD. This protocol outlines how these data will be analysed. Registration: PROSPERO CRD42019129512 (01/04/2019)

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The contribution of depressive ‘disorder characteristics’ to determinations of prognosis for adults with depression: an individual patient data meta-analysis

Psychological Medicine ◽

10.1017/s0033291721001367 ◽

2021 ◽

pp. 1-14

Author(s):

Joshua E. J. Buckman ◽

Rob Saunders ◽

Zachary D. Cohen ◽

Phoebe Barnett ◽

Katherine Clarke ◽

...

Keyword(s):

Primary Care ◽

Depressive Symptoms ◽

Depressive Symptom ◽

Panic Disorder ◽

Symptom Severity ◽

Individual Patient Data ◽

Antidepressant Treatment ◽

Patient Data ◽

History Of ◽

Depressive Symptom Severity

Abstract Background This study aimed to investigate general factors associated with prognosis regardless of the type of treatment received, for adults with depression in primary care. Methods We searched Medline, Embase, PsycINFO and Cochrane Central (inception to 12/01/2020) for RCTs that included the most commonly used comprehensive measure of depressive and anxiety disorder symptoms and diagnoses, in primary care depression RCTs (the Revised Clinical Interview Schedule: CIS-R). Two-stage random-effects meta-analyses were conducted. Results Twelve (n = 6024) of thirteen eligible studies (n = 6175) provided individual patient data. There was a 31% (95%CI: 25 to 37) difference in depressive symptoms at 3–4 months per standard deviation increase in baseline depressive symptoms. Four additional factors: the duration of anxiety; duration of depression; comorbid panic disorder; and a history of antidepressant treatment were also independently associated with poorer prognosis. There was evidence that the difference in prognosis when these factors were combined could be of clinical importance. Adding these variables improved the amount of variance explained in 3–4 month depressive symptoms from 16% using depressive symptom severity alone to 27%. Risk of bias (assessed with QUIPS) was low in all studies and quality (assessed with GRADE) was high. Sensitivity analyses did not alter our conclusions. Conclusions When adults seek treatment for depression clinicians should routinely assess for the duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment alongside depressive symptom severity. This could provide clinicians and patients with useful and desired information to elucidate prognosis and aid the clinical management of depression.

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A randomized trial of aerobic exercise for major depression: examining neural indicators of reward and cognitive control as predictors and treatment targets

Psychological Medicine ◽

10.1017/s0033291720002573 ◽

2020 ◽

pp. 1-11 ◽

Cited By ~ 1

Author(s):

C. J. Brush ◽

Greg Hajcak ◽

Anthony J. Bocchine ◽

Andrew A. Ude ◽

Kristina M. Muniz ◽

...

Keyword(s):

Depressive Symptoms ◽

Depressive Symptom ◽

Major Depression ◽

Cognitive Control ◽

Aerobic Exercise ◽

Symptom Severity ◽

Reward Processing ◽

Symptom Reduction ◽

Depressive Symptom Severity ◽

Pre Treatment

Abstract Background Aerobic exercise has demonstrated antidepressant efficacy among adults with major depression. There is a poor understanding of the neural mechanisms associated with these effects. Deficits in reward processing and cognitive control may be two candidate targets and predictors of treatment outcome to exercise in depression. Methods Sixty-six young adults aged 20.23 years (s.d. = 2.39) with major depression were randomized to 8 weeks of moderate-intensity aerobic exercise (n = 35) or light stretching (n = 31). Depressive symptoms were assessed across the intervention to track symptom reduction. Reward processing [reward positivity (RewP)] and cognitive control [error-related negativity (ERN)] were assessed before and after the intervention using event-related brain potentials. Results Compared to stretching, aerobic exercise resulted in greater symptom reduction (gs = 0.66). Aerobic exercise had no impact on the RewP (gav = 0.08) or ERN (gav = 0.21). In the aerobic exercise group, individuals with a larger pre-treatment RewP [odds ratio (OR) = 1.45] and increased baseline depressive symptom severity (OR = 1.18) were more likely to respond to an aerobic exercise program. Pre-treatment ERN did not predict response (OR = 0.74). Conclusions Aerobic exercise is effective in alleviating depressive symptoms in adults with major depression, particularly for those with increased depressive symptom severity and a larger RewP at baseline. Although aerobic exercise did not modify the RewP or ERN, there is preliminary support for the utility of the RewP in predicting who is most likely to respond to exercise as a treatment for depression.

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Serotonin transporter polymorphism (5HTTLPR), severe childhood abuse and depressive symptom trajectories in adulthood

BJPsych Open ◽

10.1192/bjpo.bp.115.000380 ◽

2015 ◽

Vol 1 (1) ◽

pp. 104-109 ◽

Cited By ~ 2

Author(s):

Timothy B. Nguyen ◽

Jane M. Gunn ◽

Maria Potiriadis ◽

Ian P. Everall ◽

Chad A. Bousman

Keyword(s):

Depressive Symptom ◽

Childhood Abuse ◽

Serotonin Transporter ◽

Symptom Severity ◽

Cross Sectional ◽

Symptom Trajectories ◽

History Of ◽

Depressive Symptom Severity ◽

Serotonin Transporter Polymorphism

BackgroundCross-sectional studies suggest that the serotonin transporter promoter region polymorphism (5-HTT gene-linked polymorphic region,5HTTLPR) moderates the relationship between childhood abuse and major depressive disorder.AimsTo examine whether the5HTTLPRpolymorphism moderates the effect childhood abuse has on 5-year depressive symptom severity trajectories in adulthood.MethodAt 5-year follow-up, DNA from 333 adult primary care attendees was obtained and genotyped for the5HTTLPRpolymorphism. Linear mixed models were used to test for a genotype × childhood abuse interaction effect on 5-year depressive symptom severity trajectories.ResultsAfter covariate adjustment, homozygoussallele carriers with a history of severe childhood abuse had significantly greater depressive symptom severity at baseline compared with those without a history of severe childhood abuse and this effect persisted throughout the 5-year period of observation.ConclusionsThe5HTTLPR s/sgenotype robustly moderates the effects of severe childhood abuse on depressive symptom severity trajectories in adulthood.

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Longitudinal course of depressive symptom severity among youths with bipolar disorders: Moderating influences of sustained attention and history of child maltreatment

Journal of Affective Disorders ◽

10.1016/j.jad.2020.12.078 ◽

2021 ◽

Vol 282 ◽

pp. 261-271

Author(s):

Rachel A. Vaughn-Coaxum ◽

John Merranko ◽

Boris Birmaher ◽

Daniel P. Dickstein ◽

Danella Hafeman ◽

...

Keyword(s):

Depressive Symptom ◽

Child Maltreatment ◽

Sustained Attention ◽

Symptom Severity ◽

Bipolar Disorders ◽

Longitudinal Course ◽

History Of ◽

Depressive Symptom Severity

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N-acetylcysteine as an adjunctive treatment to reduce depressive symptom severity when C-reactive protein levels are increased

10.26226/morressier.5971be83d462b80290b52f0e ◽

2017 ◽

Author(s):

Sandra Odebrecht Vargas Nunes

Keyword(s):

Depressive Symptom ◽

Symptom Severity ◽

Adjunctive Treatment ◽

C Reactive Protein ◽

Protein Levels ◽

Reactive Protein ◽

Depressive Symptom Severity

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EFFECTIVENESS OF COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA: INFLUENCE OF SLIGHT-TO-MODERATE DEPRESSIVE SYMPTOM SEVERITY AND WORRYING

Depression and Anxiety ◽

10.1002/da.22258 ◽

2014 ◽

Vol 31 (8) ◽

pp. 662-668 ◽

Cited By ~ 8

Author(s):

Astrid B. H. Hamoen ◽

Else M. Redlich ◽

Al W. de Weerd

Keyword(s):

Depressive Symptom ◽

Cognitive Behavioral Therapy ◽

Symptom Severity ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Depressive Symptom Severity

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Patient-reported outcomes before and after treatment of major depressive disorder

Dialogues in Clinical Neuroscience ◽

10.31887/dcns.2014.16.2/rcohen ◽

2014 ◽

Vol 16 (2) ◽

pp. 171-183 ◽

Cited By ~ 5

Keyword(s):

Depressive Symptom ◽

Symptom Severity ◽

Patient Reported Outcomes ◽

Burden Of Illness ◽

Major Depressive ◽

Patient Reported ◽

Before And After ◽

Depressive Symptom Severity ◽

The Impact ◽

Level 2

Patient reported outcomes (PROs) of quality of life (QoL), functioning, and depressive symptom severity are important in assessing the burden of illness of major depressive disorder (MDD) and to evaluate the impact of treatment. We sought to provide a detailed analysis of PROs before and after treatment of MDD from the large Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. This analysis examines PROs before and after treatment in the second level of STAR*D. The complete data on QoL, functioning, and depressive symptom severity, were analyzed for each STAR*D level 2 treatment. PROs of QoL, functioning, and depressive symptom severity showed substantial impairments after failing a selective serotonin reuptake inhibitor trial using citalopram (level 1). The seven therapeutic options in level 2 had positive statistically (P values) and clinically (Cohen's standardized differences [Cohen's d]) significant impact on QoL, functioning, depressive symptom severity, and reduction in calculated burden of illness. There were no statistically significant differences between the interventions. However, a substantial proportion of patients still suffered from patient-reported QoL and functioning impairment after treatment, an effect that was more pronounced in nonremitters. PROs are crucial in understanding the impact of MDD and in examining the effects of treatment interventions, both in research and clinical settings.

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