Depression Treatment: MAJOR DEPRESSIVE DISORDER in VULNERABLE GROUPS of OLDER ADULTS, THEIR COURSE and TREATMENT, and PSYCHIATRIC COMORBIDITY.

MAJOR DEPRESSIVE DISORDER IN VULNERABLE GROUPS OF OLDER ADULTS, THEIR COURSE AND TREATMENT, AND PSYCHIATRIC COMORBIDITY.

Filed under: Depression Treatment

Depress Anxiety. 2013 Feb 19;
Chou KL, Cheung KC

BACKGROUND: Although a number of epidemiology studies of major depressive disorder (MDD) in older adults have been reported, most of them suffer four limitations: (1) the sample was not nationally representative; (2) the sample was relatively small or only one or two sociodemographic correlates of MDD were examined; (3) psychiatric comorbidity was not examined; and (4) the clinical characteristics of MDD were not reported. This study (1) examines the prevalence of DSM-IV MDD across different demographics, especially the vulnerable ones; (2) identifies clinical characteristics of DSM-IV MDD, such as onset, course, and treatment; and (3) evaluates the comorbidity of DSM-IV MDD with anxiety disorder, substance-use disorder, and personality disorder. METHODS: We analyzed data on 8,205 individuals aged 65 or older from the National Epidemiologic Survey on Alcohol and Related Conditions (2001-2002), a nationally representative survey of the noninstitutionalized US household population. The Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version assessed MDD, anxiety, substance use, personality disorders, and pathological gambling. The survey also included demographic characteristics: age, sex, race/ethnicity, marital status, education, employment status, personal income, urban vs. rural residence, and region of the country. RESULTS: Marital status and gender were associated with MDD, whereas race and socioeconomic characteristics were not. Specifically, the prevalence rates of past-year MDD were significant greater for females (3.6%) than males (2.0%) and higher for widowed (4.9%) or separated/divorced (3.5%) than married (1.85%). The mean onset age was 50 years and the average number of lifetime episodes was 4.4. Only half of older adults with MDD had received treatment, even though one-fourth had thought about suicide. Anxiety disorder, substance dependence, and pathological gambling were highly associated with MDD. CONCLUSION: Prevention could be targeted to older women and those who were widowed, separated, or divorced and low treatment rate was also alarming. More research is needed for the comorbid psychiatric disorders in late-life depression because of their impact on the course and prognosis of MDD.
HubMed – depression

A TRICKY OBJECT TO CLASSIFY: EVIDENCE, POSTPARTUM DEPRESSION AND THE DSM-IV.

Filed under: Depression Treatment

J Hist Behav Sci. 2013 Feb 19;
Godderis R

The concept of evidence has become central in Western healthcare systems; however, few investigations have studied how the shift toward specific definitions of evidence actually occurred in practice. This paper examines a historical case in psychiatry where the debate about how to define evidence was of central importance to nosological decision making. During the fourth revision of the Diagnostic andStatistical Manual of Mental Disorders a controversial decision was made to exclude postpartum depression (PPD) as a distinct disorder from the manual. On the basis of archival and interview data, I argue that the fundamental issues driving this decision were related to questions about what constituted suitable hierarchies of evidence and appropriate definitions of evidence. Further, although potentially buttressed by the evidence-based medicine movement, this shift toward a reliance on particular kinds of empirical evidence occurred when the dominant paradigm in American psychiatry changed from a psychodynamic approach to a research-based medical model.
HubMed – depression

Screening for distress in cancer patients: A multicenter, nationwide study in Italy.

Filed under: Depression Treatment

Cancer. 2013 Feb 19;
Grassi L, Johansen C, Annunziata MA, Capovilla E, Costantini A, Gritti P, Torta R, Bellani M,

BACKGROUND: Routine screening for distress is internationally recommended as a necessary standard for good cancer care, given its high prevalence and negative consequences on quality of life. The objective of the current study was to contribute to the Italian validation of the Distress Thermometer (DT) to determine whether the single item DT compared favorably with referent criterion measures. METHODS: In total, 1108 outpatients with cancer were recruited from 38 representative oncology centers in Italy. Each participant completed the DT and a list of 34 possible cancer-related problems (the Problem List), the Hospital Anxiety and Depression Scale (HADS), the 18-item Brief Symptom Inventory (BSI-18), and a short visual analog scale to determine the understandability of the tools. RESULTS: Receiver operating characteristic analysis revealed that DT cutoff scores ?4 and ?5 had optimal sensitivity and specificity relative to both HADS and BSI-18 cutoff scores for general caseness and more severe psychological distress, respectively. Patients with DT scores ?4 (cases) were more likely to be women; to have had psychological problems in the past; to report more stressful events in the last year; and to currently have more family, emotional, and physical problems related to cancer or cancer treatment. Patients indicated that the DT was easier to fill out and to understand than the HADS, but not the BSI-18. CONCLUSIONS: The DT was identified as a simple and effective screening instrument for detecting distress in Italian cancer patients as a first step toward more properly referring those in need to psychosocial intervention. Cancer 2013;. © 2013 American Cancer Society.
HubMed – depression

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