scholarly journals Critical Predictors for the Early Detection of Conversion From Unipolar Major Depressive Disorder to Bipolar Disorder: Nationwide Population-Based Retrospective Cohort Study (Preprint)

2019 ◽  
Author(s):  
Ya-Han Hu ◽  
Kuanchin Chen ◽  
I-Chiu Chang ◽  
Cheng-Che Shen
Keyword(s):  
Bipolar Disorder ◽  
Major Depressive Disorder ◽  
Cohort Study ◽  
High Risk ◽  
Retrospective Cohort ◽  
Risk Group ◽  
Population Based ◽  
Major Depressive ◽  
Risk Stratification Model

BACKGROUND Unipolar major depressive disorder (MDD) and bipolar disorder are two major mood disorders. The two disorders have different treatment strategies and prognoses. However, bipolar disorder may begin with depression and could be diagnosed as MDD in the initial stage, which may later contribute to treatment failure. Previous studies indicated that a high proportion of patients diagnosed with MDD will develop bipolar disorder over time. This kind of hidden bipolar disorder may contribute to the treatment resistance observed in patients with MDD. OBJECTIVE In this population-based study, our aim was to investigate the rate and risk factors of a diagnostic change from unipolar MDD to bipolar disorder during a 10-year follow-up. Furthermore, a risk stratification model was developed for MDD-to-bipolar disorder conversion. METHODS We conducted a retrospective cohort study involving patients who were newly diagnosed with MDD between January 1, 2000, and December 31, 2004, by using the Taiwan National Health Insurance Research Database. All patients with depression were observed until (1) diagnosis of bipolar disorder by a psychiatrist, (2) death, or (3) December 31, 2013. All patients with depression were divided into the following two groups, according to whether bipolar disorder was diagnosed during the follow-up period: converted group and nonconverted group. Six groups of variables within the first 6 months of enrollment, including personal characteristics, physical comorbidities, psychiatric comorbidities, health care usage behaviors, disorder severity, and psychotropic use, were extracted and were included in a classification and regression tree (CART) analysis to generate a risk stratification model for MDD-to-bipolar disorder conversion. RESULTS Our study enrolled 2820 patients with MDD. During the follow-up period, 536 patients were diagnosed with bipolar disorder (conversion rate=19.0%). The CART method identified five variables (kinds of antipsychotics used within the first 6 months of enrollment, kinds of antidepressants used within the first 6 months of enrollment, total psychiatric outpatient visits, kinds of benzodiazepines used within one visit, and use of mood stabilizers) as significant predictors of the risk of bipolar disorder conversion. This risk CART was able to stratify patients into high-, medium-, and low-risk groups with regard to bipolar disorder conversion. In the high-risk group, 61.5%-100% of patients with depression eventually developed bipolar disorder. On the other hand, in the low-risk group, only 6.4%-14.3% of patients with depression developed bipolar disorder. CONCLUSIONS The CART method identified five variables as significant predictors of bipolar disorder conversion. In a simple two- to four-step process, these variables permit the identification of patients with low, intermediate, or high risk of bipolar disorder conversion. The developed model can be applied to routine clinical practice for the early diagnosis of bipolar disorder.

scholarly journals Critical Predictors for the Early Detection of Conversion From Unipolar Major Depressive Disorder to Bipolar Disorder: Nationwide Population-Based Retrospective Cohort Study

10.2196/14278 ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. e14278 ◽  
Author(s):  
Ya-Han Hu ◽  
Kuanchin Chen ◽  
I-Chiu Chang ◽  
Cheng-Che Shen
Keyword(s):  
Bipolar Disorder ◽  
Major Depressive Disorder ◽  
Cohort Study ◽  
High Risk ◽  
Retrospective Cohort ◽  
Risk Group ◽  
Population Based ◽  
Major Depressive ◽  
Risk Stratification Model

Background Unipolar major depressive disorder (MDD) and bipolar disorder are two major mood disorders. The two disorders have different treatment strategies and prognoses. However, bipolar disorder may begin with depression and could be diagnosed as MDD in the initial stage, which may later contribute to treatment failure. Previous studies indicated that a high proportion of patients diagnosed with MDD will develop bipolar disorder over time. This kind of hidden bipolar disorder may contribute to the treatment resistance observed in patients with MDD. Objective In this population-based study, our aim was to investigate the rate and risk factors of a diagnostic change from unipolar MDD to bipolar disorder during a 10-year follow-up. Furthermore, a risk stratification model was developed for MDD-to-bipolar disorder conversion. Methods We conducted a retrospective cohort study involving patients who were newly diagnosed with MDD between January 1, 2000, and December 31, 2004, by using the Taiwan National Health Insurance Research Database. All patients with depression were observed until (1) diagnosis of bipolar disorder by a psychiatrist, (2) death, or (3) December 31, 2013. All patients with depression were divided into the following two groups, according to whether bipolar disorder was diagnosed during the follow-up period: converted group and nonconverted group. Six groups of variables within the first 6 months of enrollment, including personal characteristics, physical comorbidities, psychiatric comorbidities, health care usage behaviors, disorder severity, and psychotropic use, were extracted and were included in a classification and regression tree (CART) analysis to generate a risk stratification model for MDD-to-bipolar disorder conversion. Results Our study enrolled 2820 patients with MDD. During the follow-up period, 536 patients were diagnosed with bipolar disorder (conversion rate=19.0%). The CART method identified five variables (kinds of antipsychotics used within the first 6 months of enrollment, kinds of antidepressants used within the first 6 months of enrollment, total psychiatric outpatient visits, kinds of benzodiazepines used within one visit, and use of mood stabilizers) as significant predictors of the risk of bipolar disorder conversion. This risk CART was able to stratify patients into high-, medium-, and low-risk groups with regard to bipolar disorder conversion. In the high-risk group, 61.5%-100% of patients with depression eventually developed bipolar disorder. On the other hand, in the low-risk group, only 6.4%-14.3% of patients with depression developed bipolar disorder. Conclusions The CART method identified five variables as significant predictors of bipolar disorder conversion. In a simple two- to four-step process, these variables permit the identification of patients with low, intermediate, or high risk of bipolar disorder conversion. The developed model can be applied to routine clinical practice for the early diagnosis of bipolar disorder.

Progression of castrate-resistant (CR) disease in nonmetastatic (M0) prostate cancer (PC) patients: A retrospective cohort study using data from the Henry Ford Health System (HFHS).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15147-e15147
Author(s):  
Jennifer Beebe-Dimmer ◽  
Karynsa Cetin ◽  
Cecilia Yee ◽  
Lois Lamerato ◽  
Scott Stryker ◽  
...  
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Specific Antigen ◽  
Population Based ◽  
Entire Cohort ◽  
Increased Risk ◽  
Diverse Patient Population

e15147 Background: Androgen deprivation therapy (ADT) is the cornerstone treatment of advanced PC, but is frequently used in the M0 setting. After a variable period of hormone-sensitivity, most patients develop CR disease (rising prostate-specific antigen [PSA] despite ongoing ADT). These men are at increased risk of developing bone metastases (BMT), particularly in those with higher serum PSA and shorter PSA doubling time (DT). The epidemiology and natural history of M0 CRPC has not been well-studied in a population-based setting. Methods: A retrospective cohort study was conducted using HFHS administrative data and included 691 men diagnosed with M0 PC between 1996 and 2005, who received ADT, with serial PSA measurements to determine CR. Patient records through 12/31/2008 were reviewed for outcomes of interest. CRPC was defined as 2 consecutive PSA rises, with “high risk” defined as PSA ≥8 ng/mL or PSA DT ≤10 months (mos) after the development of CRPC (Smith MR et al. Lancet 379:39-46, 2012). The risk of BMT was estimated for the entire cohort and for the CRPC and high-risk CRPC subsets. Results: Of the 691 patients included in the cohort (median age: 73 years, 48% African American), 98% received only GnRH agonists and 2% had orchiectomy. Median follow-up for the entire cohort after ADT initiation was 49 mos (IQR=45). 101 patients (15%) met criteria for CRPC during follow-up, with a median of 18 mos on active ADT prior to CRPC development (IQR=14). Of CRPC patients, 85% met criteria for high-risk (of those, 16% had PSA ≥8 ng/mL, 12% had PSA DT ≤10 mos, and 72% had both). Among all patients, 12% (n=82) developed BMT during follow-up, with 42% (n=36) of the high-risk CRPC subset developing BMT. Median time from high-risk CRPC to BMT was 9 mos (IQR=17). Conclusions: The HFHS resource allowed for our investigation of PSA characteristics corresponding to disease progression in a racially diverse patient population. A substantial proportion of M0 PC patients on ADT will eventually develop CR disease. Once a patient has CRPC, the risk of BMT is relatively high.

scholarly journals Major Depressive Disorder and Stroke Risks: A 9-Year Follow-Up Population-Based, Matched Cohort Study

PLoS ONE ◽  
2012 ◽  
Vol 7 (10) ◽  
pp. e46818 ◽  
Author(s):  
Cheng-Ta Li ◽  
Ya-Mei Bai ◽  
Pei-Chi Tu ◽  
Ying-Chiao Lee ◽  
Yu-Lin Huang ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Cohort Study ◽  
Depressive Disorder ◽  
Population Based ◽  
Matched Cohort ◽  
Major Depressive ◽  
Matched Cohort Study

Metabolic syndrome in subjects with bipolar disorder and major depressive disorder in a current depressive episode: Population-based study

2017 ◽  
Vol 92 ◽  
pp. 119-123 ◽  
Author(s):  
Fernanda Pedrotti Moreira ◽  
Karen Jansen ◽  
Taiane de Azevedo Cardoso ◽  
Thaíse Campos Mondin ◽  
Pedro Vieira da Silva Magalhães ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Bipolar Disorder ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Depressive Episode ◽  
Population Based ◽  
Major Depressive ◽  
Population Based Study ◽  
A Current

scholarly journals Contribution of Religion/spirituality and Major Depressive Disorder to Altruism

2020 ◽  
Author(s):  
Richard Neugebauer ◽  
Priya Wickramaratne ◽  
Connie Svob ◽  
Clayton McClintock ◽  
Marc J. Gameroff ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
High Risk ◽  
Depressive Disorder ◽  
Posttraumatic Growth ◽  
Risk Group ◽  
Statistical Significance ◽  
Positive Association ◽  
High Risk Group ◽  
Self Report ◽  
Major Depressive

Background. In most studies, religiosity and spirituality (R/S) are positively associated with altruism, whereas depression is negatively associated. However, the cross-sectional designs of these studies limit their epidemiological value. We examine the association of R/S and major depressive disorder (MDD) with altruism in a five year longitudinal study nested in a larger prospective study.Methods. Depressed and non-depressed individuals and their first- and second-generation offspring were assessed over several decades. At Year30 after baseline, R/S was measured using participants’ self-report; MDD, by clinical interview. At Year35, participants completed a measure of altruism. Adjusted odds ratios (AOR) were calculated using multivariate logistic regression; statistical significance, set at p<.05. two-tailed.Results. In the overall sample, both R/S and MDD were significantly associated with altruism, AOR 2.52 (95% CI 1.15-5.49) and AOR 2.43 (95% CI 1.05-5.64), respectively; in the High Risk group alone, the corresponding AORs were 4.69 (95% CI 1.39-15.84) and 4.74 (95% CI 1.92-11.72). Among highly R/S people in the High Risk group, the AOR for MDD with altruism was 22.55 (95% CI 1.23-414.60) p<.04; among the remainder, it was 3.12 (95% CI 0.63-15.30), a substantial but non-significant difference.Limitations. Altruism is based on self-report, not observation, hence, vulnerable to bias.Conclusions. MDD’s positive association with elevated altruism concurs with studies of posttraumatic growth in finding developmental growth from adversity. The conditions that foster MDD’s positive association with altruism and the contribution of R/S to this process requires further study.

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