Depression Treatment: Family-Based Study of AVPR1B Association and Interaction With Stressful Life Events on Depression and Anxiety in Suicide Attempts.

Family-based study of AVPR1B association and interaction with stressful life events on depression and anxiety in suicide attempts.

Filed under: Depression Treatment

Neuropsychopharmacology. 2013 Feb 19;
Ben-Efraim YJ, Wasserman D, Wasserman J, Sokolowski M

The cortisol response to psychosocial stress may become dysregulated in stress-related disorders. It is potentiated by pituitary secretion of adrenocorticotropic hormone (ACTH), which is in part regulated by arginine vasopressin receptor-1B (AVPR1B). AVPR1B variants were previously reported to associate with mood and anxiety disorders. This study aims, for the first time, to investigate association of AVPR1B genetic variants with mood and anxiety outcomes in suicidal behavior. Using a family-based study design of 660 complete nuclear family trios with offspring who have made a suicide attempt (SA), we tested the direct association and linkage of AVPR1B single-nucleotide polymorphisms (SNPs) with SA, as well as with depression and anxiety in SA. Main findings were the association and linkage of AVPR1B exon 1 SNP rs33990840 and a major 6-SNP haplotype representative of all common AVPR1B-SNPs, on the outcome of high Beck Depression Inventory (BDI) scores in SA. In contrast, genetic associations with lifetime diagnoses of depression and anxiety in SA or gene-environment interactions (GxEs) between AVPR1B variants and stressful life events (SLEs), were not significant. An exploratory screen of interactions between AVPR1B and corticotropin-releasing hormone receptor-1 (CRHR1), the principal pituitary regulator of ACTH secretion, showed no support for gene-gene interactions on the studied outcomes. The results suggest that AVPR1B genetic variation, e.g. non-synonymous SNP rs33990840 mediating putative consequences on ligand binding, plays a role in SA etiology characterized by elevated depression symptoms, without involving AVPR1B-moderation of SLEs.Neuropsychopharmacology accepted article preview online, 19 February 2013; doi:10.1038/npp.2013.49.
HubMed – depression

Preoperative Zung depression scale predicts patient satisfaction independent of the extent of improvement after revision lumbar surgery.

Filed under: Depression Treatment

Spine J. 2013 Feb 16;
Adogwa O, Parker SL, Shau DN, Mendenhall SK, Bydon A, Cheng JS, Asher AL, McGirt MJ

BACKGROUND CONTEXT: Patient satisfaction ratings are increasingly being used in health care as a proxy for quality and are becoming the focal point for several quality improvement initiatives. Affective disorders, such as depression, have been shown to influence patient-reported outcomes and self-interpretation of health status. We hypothesize that patient psychiatric profiles influence reported satisfaction with care, independent of surgical effectiveness. PURPOSE: To assess the predictive value of preoperative depression on patient satisfaction after revision surgery for same-level recurrent stenosis. STUDY DESIGN: Retrospective cohort study. PATIENT SAMPLE: Fifty-three patients undergoing a revision surgery for symptomatic same-level recurrent stenosis. OUTCOME MEASURES: Patient-reported outcome measures were assessed using an outcomes questionnaire that included questions on health state values (EuroQol-5D [EQ-5D]), disability (Oswestry Disability Index [ODI]), pain (visual analog scale [VAS]), depression (Zung self-rating depression scale), and Short Form 12 (SF-12) physical and mental component scores (PCS and MCS). Patient satisfaction was dichotomized as either “YES” or “NO” on whether they were satisfied with their surgical outcome 2 years after the surgery. METHODS: A total of fifty-three patients undergoing revision neural decompression and instrumented fusion for same-level recurrent stenosis-associated back and leg pain were included in this study. Preoperative Zung self-rating depression score (ZDS), education status, comorbidities, and postoperative satisfaction with surgical care and outcome was assessed for all patients. Baseline and 2-year VAS for leg pain (VAS-LP), VAS for low back pain (VAS-BP), ODI, SF-12 PCS and MCS, and health-state utility (EQ-5D) were assessed. Factors associated with patient satisfaction after surgery were assessed via multivariate logistic regression analysis. RESULTS: Two years after surgery, a significant improvement was reported in all outcome measures: VAS-BP (5±2.94 vs. 9.28±1, p<.001), VAS-LP (3.43±2.95 vs. 9.5±0.93, p<.001), ODI (21.75±12.07 vs. 36.01±6, p<.001), SF-12 PCS (32.30±11.01 vs. 25.13±5.84, p<.001), SF-12 MCS (47.48±10.96 vs. 34.91±12.77, p<.001), EQ-5D (0.60±0.31 vs. 0.18±0.22, p<.001), and ZDS (37.52±11.98 vs. 49.90±10.88, p<.001). Independent of postoperative improvement in pain and disability (surgical effectiveness), increasing preoperative Zung depression score was significantly associated with patient dissatisfaction 2 years after revision lumbar surgery (Odds ratio=0.67 [confidence interval: 0.38, 0.87], p<.001). CONCLUSIONS: Our study suggests that independent of the surgical effectiveness, the extent of preoperative depression influences the reported patient satisfaction after revision lumbar surgery. Quality improvement initiatives using patient satisfaction as a proxy for quality should account for the patients' baseline depression as potential confounders. HubMed – depression

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