Depression

Adaptation to disability among middle-aged and older adults: the role of assimilative and accommodative coping.

Boerner K. J Gerontol B Psychol Sci Soc Sci. 2004 Jan;59(1):P35-42. Arlene R. Gordon Research Institute, Lighthouse International, New York, NY 10022, USA. kboerner@lighthouse.org

The purpose of this study was to investigate the links among coping, disability, and mental health among adults who are confronted with age-related vision loss. Drawing on the model of assimilative and accommodative coping (e.g., Brandtstadter, 1999), hierarchical regressions were designed to examine the effects of coping and disability on mental health. Participants were 55 middle-aged and 52 older adults who had been recruited from a community-based rehabilitation agency. Findings demonstrate a critical role of accommodative coping for adaptation, with beneficial effects on mental health that were more pronounced in the case of high disability for younger participants. Finally, findings suggest that dealing with disability may pose more of a mental health risk in middle than in late adulthood.

 

Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized controlled trial.

Lin EH, Katon W, Von Korff M, Tang L, Williams JW Jr, Kroenke K, Hunkeler E, Harpole L, Hegel M, Arean P, Hoffing M, Della Penna R, Langston C, Unutzer J; IMPACT Investigators. JAMA. 2003 Nov 12;290(18):2428-9. Comment on: JAMA. 2003 Dec 3;290(21):2803 Center for Health Studies, Group Health Cooperative, Seattle, Wash 98101, USA. lin.e@ghc.org

Context: Depression and arthritis are disabling and common health problems in late life. Depression is also a risk factor for poor health outcomes among arthritis patients.

Objective: To determine whether enhancing care for depression improves pain and functional outcomes in older adults with depression and arthritis.

Design, Setting, and Participants_: Preplanned subgroup analyses of Improving Mood-Promoting Access to Collaborative Treatment (IMPACT), a randomized controlled trial of 1801 depressed older adults (> or =60 years), which was performed at 18 primary care clinics from 8 health care organizations in 5 states across the United States from July 1999 to August 2001. A total of 1001 (56%) reported coexisting arthritis at baseline.

Interventions: Antidepressant medications and/or 6 to 8 sessions of psychotherapy (Problem-Solving Treatment in Primary Care).

Main Outcome Measures: Depression, pain intensity (scale of 0 to 10), interference with daily activities due to arthritis (scale of 0 to 10), general health status, and overall quality-of-life outcomes assessed at baseline, 3, 6, and 12 months.

Results: In addition to reduction in depressive symptoms, the intervention group compared with the usual care group at 12 months had lower mean (SE) scores for pain intensity (5.62 [0.16] vs 6.15 [0.16]; between-group difference, -0.53; 95% confidence interval [CI], -0.92 to -0.14; P =.009), interference with daily activities due to arthritis (4.40 [0.18] vs 4.99 [0.17]; between-group difference, -0.59; 95% CI, -1.00 to -0.19; P =.004), and interference with daily activities due to pain (2.92 [0.07] vs 3.17 [0.07]; between-group difference, -0.26; 95% CI, -0.41 to -0.10; P =.002). Overall health and quality of life were also enhanced among intervention patients relative to control patients at 12 months.

Conclusion: In a large and diverse population of older adults with arthritis (mostly osteoarthritis) and comorbid depression, benefits of improved depression care extended beyond reduced depressive symptoms and included decreased pain as well as improved functional status and quality of life.

 

Exercise and depressive symptoms: a comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology.

Penninx BW, Rejeski WJ, Pandya J, Miller ME, Di Bari M, Applegate WB, Pahor M. J Gerontol B Psychol Sci Soc Sci. 2002 Mar;57(2):P124-32. Sticht Center on Aging, Department of Internal Medicine. Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA. bpenninx@wfubmc.edu

This study examines and compares the effect of aerobic and resistance exercise on emotional and physical function among older persons with initially high or low depressive symptomatology. Data are from the Fitness, Arthritis and Seniors Trial, a trial among 439 persons 60 years or older with knee osteoarthritis randomized to health education (control), resistance exercise, or aerobic exercise groups. Depressive symptoms (assessed by the Center for Epidemiologic Studies—Depression scale) and physical function (disability, walking speed, and pain) were assessed at baseline and after 3, 9, and 18 months. Compared with results for the control group, aerobic exercise significantly lowered depressive symptoms over time. No such effect was observed for resistance exercise. The reduction in depressive symptoms with aerobic exercise was found both among the 98 participants with initially high depressive symptomatology and among the 340 participants with initially low depressive symptomatology and was the strongest for the most compliant persons. Aerobic and resistance exercise significantly reduced disability and pain and increased walking speed both, and to an equal extent, in persons with high depressive symptomatology and persons with low depressive symptomatology.

 

Pain-related disability among older male veterans receiving primary care.

Reid MC, Guo Z, Towle VR, Kerns RD, Concato J. J Gerontol A Biol Sci Med Sci. 2002 Nov;57(11):M727-32. Clinical Epidemiology Unit, VA Connecticut Healthcare System, West Haven 06516, USA. ary.reid@yale.edu

Background: Pain is common among older persons and is associated with substantial disability, but factors that increase the risk for pain-related disability remain poorly defined. We sought to identify factors associated with disability due to pain in a sample of older veterans receiving primary care.

Methods: Participants (N = 494) in this cross-sectional study included male veterans aged 65 years and older who were enrolled in a Veterans Affairs primary care clinic and who reported pain within the prior 12 months. Candidate factors included demographic, psychological, medical, and pain (e.g., intensity, site, duration) characteristics and were ascertained during face-to-face interviews. We assessed participants’ level of pain-related disability by asking them to rate on a 0 to 10 scale the extent to which pain interfered with their ability to do daily activities (0 = no interference at all and 10 = no longer doing daily activities due to pain). Patients with scores of 0, 1-6, and 7-10 (approximate upper quartile) were classified as having no, low/moderate, and high pain-related disability.

Results: The distribution of pain-related disability was none = 149 (30%), low/moderate = 210 (43%), and high = 135 (27%). Factors associated with high (vs. no) pain-related disability included the presence of depressive symptoms, defined as a score of 16 or greater on the Center for Epidemiologic Studies-Depression scale (adjusted odds ratio [AOR] = 3.12, 95% confidence interval [CI] = 1.42-6.85), and pain intensity, defined as a one-unit increase on a 0-10 numeric rating scale (AOR = 1.84, 95% CI = 1.61-2.12). Other factors associated with high pain-related disability included the presence of pain on most days of every month (AOR = 3.59, 95% CI = 1.82-7.08) and low back pain (AOR = 2.36, 95% CI = 1.13-4.94). Depressive symptoms, pain intensity, and the presence of pain on most days of every month were also significantly and independently associated with low/moderate (vs. no) pain-related disability.

Conclusion: Pain-related disability is common among older male veterans receiving primary care. As modifiable factors, depressive symptoms and pain intensity are associated with pain-related disability and represent appropriate targets for intervention efforts among older persons with pain.

 

Qigong as a psychosocial intervention for depressed elderly with chronic physical illnesses.

Tsang HW, Cheung L, Lak DC. Int J Geriatr Psychiatry. 2002 Dec;17(12):1146-54.
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong. rshtsang@polyu.edu.hk

Literature uncovers that depression is common in elderly people. The problem is more serious in elderly with chronic physical illnesses. Although the relationship between physical problems and depression is well documented, the underlying mechanism is basically unknown. This article proposed after a comprehensive literature review that depression in elderly with chronic physical illnesses results from disability and a reduction in psychosocial resources. If depression is left untreated, suicide may be a consequence. In view of this, various forms of psychosocial interventions are developed based on mainstream western medicine. The authors argue that qigong, a form of Chinese therapeutics, has the effect of alleviating clinical depression and thus improves quality of life. A simple form of dynamic qigong, namely the Eight-Section Brocades, is suggested to serve the purpose. A theory which explains the psychosocial effect of qigong is hypothesized.

 

Spotlight on sertraline in the management of major depressive disorder in elderly patients.

Muijsers RB, Plosker GL, Noble S. CNS Drugs. 2002;16(11):789-94. Adis International Limited, Mairangi Bay, Auckland, New Zealand.

Sertraline is a selective serotonin reuptake inhibitor (SSRI) with well established antidepressant and anxiolytic activity. Results from several well designed trials show that sertraline (50-200 mg/day) is effective in the treatment of major depressive disorder in elderly patients (> or =60 years of age). Primary endpoints in most studies included the Hamilton Depression Rating Scale (HDRS), Clinical Global Impression score and the Montgomery-Asberg Depression Rating Scale. Sertraline was significantly more effective than placebo and was as effective as fluoxetine, nortriptyline and imipramine in elderly patients. During one trial, amitriptyline was significantly more effective than sertraline (mean reduction from baseline on one of six primary outcomes [HDRS]), although no quantitative data were provided. Subgroup analysis of data from a randomised, double-blind trial in elderly patients with major depressive disorder suggests that vascular morbidity, diabetes mellitus or arthritis does not affect the antidepressant effect of sertraline. Secondary endpoints from these clinical trials suggest that sertraline has significant benefits over nortriptyline in terms of quality of life. In addition, significant differences favouring sertraline in comparison with nortriptyline and fluoxetine have been recorded for a number of cognitive functioning parameters. Sertraline is generally well tolerated in elderly patients with major depressive disorder and lacks the marked anticholinergic effects that characterise the adverse event profiles of tricyclic antidepressants (TCAs). The most frequently reported adverse events in patients aged > or =60 years with major depressive disorder receiving sertraline 50-150 mg/day were dry mouth, headache, diarrhoea, nausea, insomnia, somnolence, constipation, dizziness, sweating and taste abnormalities. The tolerability profile of sertraline is generally similar in younger and elderly patients. Sertraline has a low potential for drug interactions at the level of the cytochrome P450 enzyme system. In addition, no dosage adjustments are warranted for elderly patients solely based on age.

Conclusion: Sertraline is an effective and well tolerated antidepressant for the treatment of major depressive disorder in patients aged > or =60 years. Since elderly patients are particularly prone to the anticholinergic effects of TCAs as a class, SSRIs such as sertraline are likely to be a better choice for the treatment of major depressive disorder in this age group. In addition, sertraline may have advantages over the SSRIs paroxetine, fluoxetine and fluvoxamine in elderly patients because of the drug’s comparatively low potential for drug interactions, which is of importance in patient groups such as the elderly who are likely to receive more than one drug regimen.

 

Temporal and reciprocal relationship between IADL/ADL disability and depressive symptoms in late life.

Ormel J, Rijsdijk FV, Sullivan M, van Sonderen E, Kempen GI. J Gerontol B Psychol Sci Soc Sci. 2002 Jul;57(4):P338-47. Department of Psychiatry, University of Groningen, The Netherlands. j.ormel@med.rug.nl

A strong association between functional disability and depressive symptoms in older people has frequently been reported. Some studies attribute this association to the disabling effects of depression, others to the depressogenic effects of physical health-related disability. The authors examined the reciprocal effects between depressive symptoms and functional disability and their temporal character in a community-based cohort of 753 older people with physical limitations who were assessed at yearly intervals. They compared structural equation models that differed in terms of direction and speed of effects between patient-reported disability in instrumental and basic activities of daily living (IADL/ADLs) and depressive symptoms. The association between disability and depression could be separated into three components: (a) a strong contemporaneous effect of change in disability on depressive symptoms, (b) a weaker 1-year lagged effect of change in depressive symptoms on disability (probably indirect through physical health), and © a weak correlation between the trait (or stable) components of depression and disability. IADL/ADL disability and depressive symptoms are thus mutually reinforcing over time. Compensatory forces like effective treatment and age-related adaptation may protect elders against this potential downward trend. To improve quality of life in elderly adults, treatment should target disability when it is new and depression when it is persistent.

 

The influence of health, social support quality and rehabilitation on depression among disabled elders.

Horowitz A, Reinhardt JP, Boerner K, Travis LA. Aging Ment Health. 2003 Sep;7(5):342-50. Arlene R. Gordon Research Institute, Lighthouse International, New York, NY 10022, USA. ahorowitz@lighthouse.org

This study examined the influence of health, social support, disability, and vision rehabilitation services on depression among visually impaired older adults seeking vision rehabilitation services. Participants (n = 95) were interviewed at application and approximately two years later. The first hierarchical regression model focused on concurrent relationships at baseline. The second model used baseline health and social support variables, along with indicators of change in vision and use of rehabilitation services, in order to predict change in depression over time. Findings indicate that being unmarried, in poorer health, having lower quality of relationships with family, and lower stability in friendships were significant independent risk factors for initial depression, explaining 50% of the variance. Decline in depression over time was predicted by younger age, better self-rated health, stability of friendships, and use of rehabilitation services that, along with baseline depression, explained 61% of the variance in depressive symptomatology at the two-year follow-up. Findings highlight the importance of qualitative aspects of social support for older disabled adults, as well as the distinction that needs to be made between factors that predict concurrent mental health status and those predicting change in status over time.

 

Clinical outcomes following a trial of sertraline in rheumatoid arthritis.

Slaughter JR, Parker JC, Martens MP, Smarr KL, Hewett JE. Psychosomatics. 2002 Jan-Feb;43(1):36-41. Department of Psychiatry and Neurology, University of Missouri, One Hospital Drive, Columbia, MO 65212, USA.

We report an open-label trial of sertraline in the treatment of major depression in 54 consecutive rheumatoid arthritis (RA) patients meeting DSM-IV criteria for major depressive disorder. We initially surveyed 628 RA outpatients with the Center for Epidemiologic Studies Depression Scale (CES-D) and invited those with depression to be evaluated further and treated. Eighty-four RA patients reporting depressive symptoms agreed to participate in person, and 56 met the criteria for major depressive disorder. Of these 56 patients, 54 agreed to medication treatment and were enrolled in the study. Patients were also randomized to one of three psychological treatment conditions, but for this study, conditions were collapsed because previous research on this sample indicated no significant between-group differences in depression after treatment. Patients were assessed with the CES-D and the Hamilton Rating Scale for Depression after the intervention, at 6-month follow-up, and at 15-month follow-up. At the last follow-up, 41 patients remained for assessment. In this study, sertraline was found to be a safe and efficacious treatment of depression complicating RA.

 

Intervention programs for arthritis and other rheumatic diseases.

Brady TJ, Kruger J, Helmick CG, Callahan LF, Boutaugh ML. Health Educ Behav. 2003 Feb;30(1):44-63 Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3724, USA. tob9@cdc.gov

Disability reduction or prevention programs for people with arthritis and other rheumatic conditions reduce long-term pain and disability but reach only a fraction of their target audience. Few public health professionals are aware of these programs or their benefits. The objective of this study is to review and describe packaged (ready-to-use) arthritis self-management education and exerciselphysical activity programs that have had at least preliminary evaluation. Nine intervention programs (five self-management education programs, and four exercise/physical activity programs) met study criteria. Several of the packaged arthritis interventions reviewed help people with arthritis and other rheumatic conditions maximize their abilities and reduce pain, functional limitations, and other arthritis-related problems. Other packaged interventions show promise in reducing pain, disability, and depression and in increasing self-care behaviors, but they need to be evaluated more extensively.

 

Long-term follow-up of 246 adults with juvenile idiopathic arthritis: predictive factors for mood and pain.

Packham JC, Hall MA, Pimm TJ. Rheumatology (Oxford). 2002 Dec;41(12):1444-9.
Oxford Regional Paediatric Rheumatology Unit, Wexham Park Hospital, Slough SL2 4HL, UK.

Objective: To examine the predictive factors for anxiety, depression and pain in adults with juvenile idiopathic arthritis (JIA).

Patients and Methods: Two hundred and forty-six adults identified with long-standing JIA had an average disease duration of 28.3 yr. Candidate factors potentially predictive for pain, anxiety and depression were assessed by multiple regression analysis.

Results: Of the patients, 31.6% were anxious, 5.2% were depressed, and 21.1% had previously suffered from depression. The percentage of the variance accounted for by other variables was 78.8 for anxiety variance and 54.5 for depression, but there was little influence from physical disease-related factors. Severe pain, measured on a visual analogue scale, occurred in 32.9% of patients, and 22.8% had poor perceived control over their pain. Function, coping strategies, pain self-efficacy, inflammation and previous depression could predict 39.6% of the variance in pain.

Conclusion: Comparing adults with children, disease activity and control over pain remain predictors of pain but become less important than disability and coping strategies.

 

Anemia and macrocytosis in the prediction of serum folate and vitamin B12 status, and treatment outcome in major depression.

Mischoulon D, Burger JK, Spillmann MK, Worthington JJ, Fava M, Alpert JE. J Psychosom Res. 2000 Sep;49(3):183-7 Department of Psychiatry, Depression Clinical and Research Program, Massachusetts General Hospital, 15 Parkman St., WAC-812, Boston, MA 02114, USA. dmischoulon@partners.org

Background: Folate and B12 deficiencies may result in macrocytic anemia, and are common in major depression; hypofolatemia may result in poorer antidepressant response. We wished to determine whether anemia or macrocytosis predict hypofolatemia, low B12, or refractoriness to antidepressants.

Methods: After obtaining serum folate, B12, and hematological indices, 213 depressed adults were treated with fluoxetine 20 mg/day. Amelioration of depressive symptoms was measured.

Results: Neither macrocytosis nor anemia predicted low serum folate/B12, or antidepressant refractoriness. Among 39 patients with hypofolatemia, none had macrocytosis; 28% had low HCT; 41% had low RBC. Among 25 patients with low B12, none had macrocytosis; 24% had low HCT; 28% had low RBC. Among non-responders, 3% had macrocytosis; 24% had low HCT; 25% had low RBC.

Conclusion: Anemia and macrocytosis should not be used to predict folate or B12 deficiencies, or refractoriness to antidepressants. Measurement of folate and B12 should be considered when evaluating treatment refractoriness.

 

Depression and folate status in the US Population.

Morris MS, Fava M, Jacques PF, Selhub J, Rosenberg IH. Psychother Psychosom. 2003 Mar-Apr;72(2):80-7. Comment on:
• Psychother Psychosom. 2003 Mar-Apr;72(2):59-60.
Jean Mayer United States Department of Agriculture, Human Nutrition Research Center on Aging, Tufts University, Boston, Mass., USA. morris@hnrc.tufts.edu

Background: Folate deficiency and low folate status have been linked in clinic studies to depression, persistent depressive symptoms, and poor antidepressant response. These relationships have not been demonstrated in general populations. This study examined associations between depression and folate status indicators in an ethnically diverse general US population sample aged 15-39 years.

Methods: Healthy subjects whose red blood cell (RBC) folate concentrations had been measured were determined to have no depression (n = 2,526), major depression (n = 301), or dysthymia (n = 121) using a diagnostic interview schedule. Serum concentrations of folate and total homocysteine (tHcy) were also measured.

Results: After adjustment for sociodemographic factors, serum vitamin B(12) concentration, alcohol consumption over the past year and current status as to overweight and use of vitamin/mineral supplements, cigarettes and illegal drugs, subjects who met criteria for a lifetime diagnosis of major depression had folate concentrations in serum and RBCs that were lower than those of subjects who had never been depressed. Subjects who met criteria for dysthymia alone had lower RBC folate concentrations than never-depressed subjects, but the serum folate concentrations of the two groups were comparable. Serum tHcy concentration was not related to lifetime depression diagnoses. Low folate status was found to be most characteristic of recently recovered subjects, and a large proportion of such subjects were folate deficient.

Conclusion: Low folate status was detectable in depressed members of the general US population. Folate supplementation may be indicated during the year following a depressive episode.

 

Folate for depressive disorders.

Taylor MJ, Carney S, Geddes J, Goodwin G. Cochrane Database Syst Rev. 2003;(2):CD003390. Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK, OX3 7JK. john.geddes@psych.ox.ac.uk

Background: There are a number of effective interventions for the treatment of depression. It is possible that the efficacy of these treatments will be improved further by the use of adjunctive therapies such as folate.

Objective: 1. To determine the effectiveness of folate in the treatment of depression 2. To determine the adverse effects and acceptability of treatment with folate.

Search Strategy: The Cochrane Controlled Trials Register (CCTR), and the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR) incorporating results of group searches of EMBASE, MEDLINE, LILACS, CINAHL, PSYNDEX and PsycLIT were searched. Reference lists of relevant papers and major textbooks of affective disorder were checked. Experts in the field and pharmaceutical companies were contacted regarding unpublished material.

Selection Criteria: All randomised controlled trials that compared treatment with folic acid or 5’-methyltetrahydrofolic acid to an alternative treatment, whether another antidepressant medication or placebo, for patients with a diagnosis of depressive disorder (diagnosed according to explicit criteria).

Data Collection and Analysis: Data were independently extracted from the original reports by two reviewers. Statistical analysis was conducted using Review Manager version 4.1.

Main Results: Three trials involving 247 people were included. Two studies involving 151 people assessed the use of folate in addition to other treatment, and found that adding folate reduced Hamilton Depression Rating Scale scores on average by a further 2.65 points (95% confidence interval 0.38 to 4.93). Fewer patients treated with folate experienced a reduction in their HDRS score of less than 50% at ten weeks (relative risk (RR) 0.47, 95% CI 0.24 to 0.92) The number needed to treat with folate for one additional person to experience a 50% reduction on this scale was 5 (95% confidence interval 4 to 33). One study involving 96 people assessed the use of folate instead of the antidepressant trazodone and did not find a significant benefit from the use of folate. The trials identified did not find evidence of any problems with the acceptability or safety of folate.

Reviewer’s Conclusion: The limited available evidence suggests folate may have a potential role as a supplement to other treatment for depression. It is currently unclear if this is the case both for people with normal folate levels, and for those with folate deficiency.

 

Folate, vitamin B12, and homocysteine in major depressive disorder.

Fava M, Borus JS, Alpert JE, Nierenberg AA, Rosenbaum JF, Bottiglieri T. Am J Psychiatry. 1997 Mar;154(3):426-8 Depression Clinical and Research Program, Clinical Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114, USA. favam@A1.mgh.harvard.edu

Objective: The authors examined the relationships between levels of three metabolites (folate, vitamin B12, and homocysteine) and both depressive subtype and response to fluoxetine treatment in depressed patients.

Methods: Fluoxetine, 20 mg/day for 8 weeks, was given to 213 outpatients with major depressive disorder. At baseline, depressive subtypes were assessed, and a blood sample was collected from each patient. Serum metabolite levels were assayed. Response to treatment was determined by percentage change in score on the 17-item Hamilton Depression Rating Scale.

Results: Subjects with low folate levels were more likely to have melancholic depression and were significantly less likely to respond to fluoxetine. Homocysteine and B12 levels were not associated with depressive subtype or treatment response.

Conclusion: Overall, the results are consistent with findings linking low folate levels to poorer response to antidepressant treatment. Folate levels might be considered in the evaluation of depressed patients who do not respond to antidepressant treatment.

 

Folinic acid (Leucovorin) as an adjunctive treatment for SSRI-refractory depression.

Alpert JE, Mischoulon D, Rubenstein GE, Bottonari K, Nierenberg AA, Fava M. Ann Clin Psychiatry. 2002 Mar;14(1):33-8 Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston 02114, USA. jalpert@partners.org

Low folate is associated with poorer response to selective serotonin reuptake inhibitors (SSRIs) in major depressive disorder (MDD). Folate supplementation in MDD has been studied in other settings with promising results. The objective of this study was to assess the efficacy of methylfolate as an adjunctive treatment among adults with MDD and inadequate response to an SSRI. Twenty-two adults (59% female; mean age 45.2 +/- 11.0 years) with DSM-IV MDD, partial or nonresponse to an SSRI after at least 4 weeks of treatment, and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score > or = 12 were enrolled in this 8-week prospective open trial. Exclusion criteria included current use of anticonvulsants or psychotropics other than an SSRI, or B12 deficiency. Leucovorin (folinic acid), which is metabolized to methylfolate, was added to SSRIs at 15-30 mg/day. Folate levels rose from 28 +/- 19 ng/mL to 301 +/- 203 ng/mL (p < 0.001). HAM-D-17 scores among the 16 completers decreased from 19.1 +/- 3.9 to 12.8 +/- 7.0 (p < 0.01). However only 31% of completers and 27% of the intent-to-treat (ITT) sample achieved response (> or = 50% reduction in HAM-D-17 scores), and only 19% of completers and 18% of the ITT sample achieved remission (HAM-D-17 < or = 7). Leucovorin appears to be modestly effective as an adjunct among SSRI-refractory depressed individuals with normal folate levels. The application of leucovorin as an adjunct in the setting of refractory depression deserves further study.

 

Vitamin B12, folate, and homocysteine in depression: the Rotterdam Study.

Tiemeier H, van Tuijl HR, Hofman A, Meijer J, Kiliaan AJ, Breteler MM. Am J Psychiatry. 2002 Dec;159(12):2099-101. Department of Epidemiology and Biostatistics, Erasmus Medical Centre, PO Box 1738, 3000 DR Rotterdam, The Netherlands.

Objective: The associations of vitamin B(12), folate, and homocysteine with depression were examined in a population-based study.

Methods: The authors screened 3,884 elderly people for depressive symptoms. Subjects with positive screening results had psychiatric workups. Folate, vitamin B(12), and homocysteine blood levels were compared in 278 persons with depressive symptoms, including 112 with depressive disorders, and 416 randomly selected reference subjects. Adjustments were made for age, gender, cardiovascular disease, and functional disability.

Results: Hyperhomocysteinemia, vitamin B(12) deficiency, and to a lesser extent, folate deficiency were all related to depressive disorders. For folate deficiency and hyperhomocysteinemia, the association with depressive disorders was substantially reduced after adjustment for functional disability and cardiovascular disease, but for vitamin B(12) this appeared independent.

Conclusion: The association of vitamin B(12) and folate with depressive disorders may have different underlying mechanisms. Vitamin B(12) may be causally related to depression, whereas the relation with folate is due to physical comorbidity.

 

Hyperhomocyst(e)inemia, related vitamins and dementias.

Delport R. J Nutr Health Aging. 2000;4(4):195-6 Department of Chemical Pathology, Faculty of Medicine, University of Pretoria, PO Box 2034, Pretoria 0001, South Africa. rdelport@medic.up.ac.za

Vitamin B12 and to a lesser extent folate deficiencies have been associated with dementias. Both these vitamins are determinants of plasma total homocysteine concentrations. In this review the frequency distributions of plasma vitamin B12, folate and homocysteine in South African males (# 51 yrs and > 51 yrs) illustrate the lower vitamin B12 levels in older subjects, and the shift toward elevated homocysteine concentrations in elderly people. Vitamin B12 deficiency appears to be associated with neuropsychiatric disorders, including dementias, but no causal relationship based on biochemical evidence has so far been established. Supplementation with vitamin B12 improves some neurological abnormalities and reverses only mild dementia of recent onset, but does not slow the progression of dementia. Elevated homocysteine levels appears to affect cognitive function, as measured by spatial copying skills and visual event-related potentials. Measurement of plasma homocysteine may help identify individuals with vitamin deficiencies and hyperhomocysteinemia. The relation between B-vitamins, homocysteine and dementia needs to explored further before vitamin supplementation is advocated to prevent or reverse neuropsychiatric disorders.

 

Hyperhomocysteinemia and vitamin B-12 deficiency in elderly using Title IIIc nutrition services.

Johnson MA, Hawthorne NA, Brackett WR, Fischer JG, Gunter EW, Allen RH, Stabler SP. Am J Clin Nutr. 2003 Jan;77(1):211-20 Department of Foods and Nutrition, University of Georgia, Athens, USA.

Background: The effect of the folate food fortification program on the prevalence of hyperhomocysteinemia in the older population with coexisting vitamin B-12 deficiency is not known.

Objective: The objective was to determine the prevalence of hyperhomocysteinemia and vitamin B-12 deficiency in elderly who were using Title IIIc nutrition services, after folate food fortification in the United States.

Design: Demographic, nutritional, cognitive, routine diagnostic, and serum methylmalonic acid (MMA) and total homocysteine (tHcy) tests were performed in a convenience sample of 103 elderly enrolled in nutrition service programs in rural northeast Georgia. A subgroup (n = 27) was treated with vitamin B-12, 2.5 mg, and a multivitamin with 400 micro g folic acid, 2 mg vitamin B-6, and 27 mg ferrous fumarate.

Results: The total cohort included 103 participants (+/- SD age: 76.4 +/- 8.1; 80% female; 68% white, 32% African American). Vitamin B-12 deficiency (serum vitamin B-12 < 258 pmol/L and MMA > 271 nmol/L) was present in 23%. Mean serum folate was high, 39.3 nmol/L, and no subject had serum folate < 6.8 nmol/L. Mean tHcy was 17.6 +/- 7.2 micro mol/L in vitamin B-12-deficient subjects and 10.8 +/- 3.6 micro mol/L in those who were nondeficient. Determinants of high tHcy were vitamin B-12 deficiency, high serum creatinine, and low red blood cell folate. Those with vitamin B-12 deficiency were more likely to have poor cognition (58% compared with 20%, P < 0.001) and anemia (38% compared with 18%, P = 0.042). High-dose oral B-12 therapy lowered mean MMA and tHcy by 49% and 32%, respectively.

Conclusion: Vitamin B-12 deficiency was prevalent and was associated with poor cognition, anemia, and hyperhomocysteinemia.

 

Vitamin B12, folate, and homocysteine in depression: the Rotterdam Study.

Tiemeier H, van Tuijl HR, Hofman A, Meijer J, Kiliaan AJ, Breteler MM. Am J Psychiatry. 2002 Dec;159(12):2099-101 Department of Epidemiology and Biostatistics, Erasmus Medical Centre, PO Box 1738, 3000 DR Rotterdam, The Netherlands.

Objective: The associations of vitamin B(12), folate, and homocysteine with depression were examined in a population-based study.

Methods: The authors screened 3,884 elderly people for depressive symptoms. Subjects with positive screening results had psychiatric workups. Folate, vitamin B(12), and homocysteine blood levels were compared in 278 persons with depressive symptoms, including 112 with depressive disorders, and 416 randomly selected reference subjects. Adjustments were made for age, gender, cardiovascular disease, and functional disability.

Results: Hyperhomocysteinemia, vitamin B(12) deficiency, and to a lesser extent, folate deficiency were all related to depressive disorders. For folate deficiency and hyperhomocysteinemia, the association with depressive disorders was substantially reduced after adjustment for functional disability and cardiovascular disease, but for vitamin B(12) this appeared independent.

Conclusion: The association of vitamin B(12) and folate with depressive disorders may have different underlying mechanisms. Vitamin B(12) may be causally related to depression, whereas the relation with folate is due to physical comorbidity.

 

Low serum folate levels as a risk factor for depressive mood in patients with chronic epilepsy.

Rosche J, Uhlmann C, Froscher W. J Neuropsychiatry Clin Neurosci. 2003 Winter;15(1):64-6. Department of Neurology and Epileptology, University of Ulm, Ravensburg, Germany.

This study takes into consideration whether low serum folate levels may contribute to depressive mood in patients with chronic epilepsy. The serum folate levels and the score on the Self-Rating Depression Scale (SDS) were examined in 46 patients with chronic epilepsy. Patients with a score indicating at least minor depression on the SDS had a significantly lower serum folate level than patients with a normal score on SDS. There was a significant negative correlation between the serum folate levels and the SDS score. A serum folate level below 7.5 ng/ml was significantly associated with a pathological score on SDS. Because a serum folate level of 7.5 ng/ml is in the normal range for many laboratories, further studies using total plasma homocysteine as a sensitive measure of functional folate deficiency are required to elucidate the impact of folate metabolism on depressive mood in patients with chronic epilepsy.

 

Vitamin B(12) deficiency and depression in physically disabled older women: epidemiologic evidence from the Women's Health and Aging Study.

Penninx BW, Guralnik JM, Ferrucci L, Fried LP, Allen RH, Stabler SP Am J Psychiatry. 2000 May;157(5):715-21 Epidemiology, Demography, and Biometry Program, National Institute on Aging, Bethesda, MD 20892-9205, USA.

Objective: It has been hypothesized that adequate concentrations of vitamin B(12) and folate are essential to maintain the integrity of the neurological systems involved in mood regulation, but epidemiologic evidence for such a link in the general population is unavailable. This study examined whether community-dwelling older women with metabolically significant vitamin B(12) or folate deficiency are particularly prone to depression.

Methods: Serum levels of vitamin B(12), folate, methylmalonic acid, and total homocysteine were assayed in 700 disabled, nondemented women aged 65 years and over living in the community. Depressive symptoms were measured by means of the Geriatric Depression Scale and categorized as no depression, mild depression, and severe depression.

Results: Serum homocysteine levels, serum folate levels, and the prevalences of folate deficiency and anemia were not associated with depression status. The depressed subjects, especially those with severe depression, had a significantly higher serum methylmalonic acid level and a nonsignificantly lower serum vitamin B(12) level than the nondepressed subjects. Metabolically significant vitamin B(12) deficiency was present in 14.9% of the 478 nondepressed subjects, 17. 0% of the 100 mildly depressed subjects, and 27.0% of the 122 severely depressed women. After adjustment for sociodemographic characteristics and health status, the subjects with vitamin B(12) deficiency were 2.05 times as likely to be severely depressed as were nondeficient subjects.
p. Conclusion: In community-dwelling older women, metabolically significant vitamin B(12)deficiency is associated with a twofold risk of severe depression.

 

Assessment and diagnosis of depression in people with intellectual disability.

McBrien JA. J Intellect Disabil Res. 2003 Jan;47(Pt 1):1-13. Plymouth Primary Care Trust/University of Plymouth, LDS, Westbourne Unit, Scott Hospital, Plymouth PL2 2PQ, UK. judith.mcbrien@pcs-tr.swest.nhs.uk

Background: Despite widespread acceptance that depression can occur in adults with intellectual disability (ID), the difficulties encountered in its assessment and diagnosis have hampered the individual clinician, and meant that questions of prevalence, treatment choice and outcome remain problematic.

Methods: The present paper reviews the progress in this field since three reviews, all published in the mid-1990s, recommended further attention to three interlinked issues: diagnostic criteria, the symptoms of depression in this group and the lack of rating scales.

Results: Despite a further 11 published papers and other studies in progress, the method of diagnosis for people with severe and profound ID remains debatable, with some authors advocating adherence to standard criteria, others suggesting adding criteria to the standard ones and yet others believing that substitute criteria are called for. However, for those with mild to moderate ID, a consensus is emerging that standard diagnostic criteria are appropriate. There has been progress in examining some of the symptoms which might constitute depression in people with ID. New diagnostic criteria issued by the Royal College of Psychiatrists are to be welcomed. There is an assumption in much of the research that symptoms of behaviour commonly termed challenging or maladaptive must be atypical symptoms of depression, but none of the studies reviewed demonstrate this effectively. This is compounded by methodological flaws in the way that depressed samples are arrived at for further study. Although new rating scales have emerged, there is as yet no gold standard diagnostic tool for depression amongst people with ID.

Conclusion: It is suggested that, given these difficulties, the validity of the conceptual frameworks for depression is still in doubt. It remains the case that large-scale, collaborative, prospective studies are called for.

 

Depressive symptoms in intellectual disability: does gender play a role?

Lunsky Y. J Intellect Disabil Res. 2003 Sep;47(Pt 6):417-27. Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. yona_lunsky@camh.net

Background: Gender issues remain largely unaddressed in the dual diagnosis arena, even in the area of depression where there is a 2:1 female to male ratio in the general population. This paper argues that women with intellectual disability (ID) report higher levels of depressive symptoms than men with ID and that risk factors for depression identified for women in the general population are relevant to this group.

Methods: Findings are based on structured interviews with 99 men and women with ID, with corroborative information provided from caregivers and casebook reviews.

Results: Overall, women reported higher levels of depression than men. Individuals with higher depression scores were more lonely and had higher stress levels than individuals with lower scores. Women with higher depression scores were more likely to report coming from abusive situations, to have poor social support from family and to be unemployed when compared to women with lower scores, but similar differences were not found when comparing men with higher and lower depression scores.

Conclusion: Men and women who report experiencing these psychosocial correlates of depression should be a target group for future prevention efforts, taking gender specific concerns into consideration.

 

Development and psychometric properties of the Glasgow Depression Scale for people with a Learning Disability. Individual and carer supplement versions.

Cuthill FM, Espie CA, Cooper SA. Br J Psychiatry. 2003 Apr;182:347-53.
University of Glasgow, Scotland, UK.

Background: There is no reliable and valid self-report measure of depressive symptoms for people with learning disabilities. AIMS: To develop a scale for individuals with learning disability, and a supplementary scale for carers.

Methods: Items were generated from a range of assessment scales and through focus groups. A draft scale was piloted and field tested using matched groups of people with or without depression, and their carers. The scale was also administered to a group without learning disabilities for criterion validation.

Results: The Glasgow Depression Scale for people with a Learning Disability (GDS-LD) differentiated depression and non-depression groups, correlated with the Beck Depression Inventory – II (r=0.88), had good test-retest reliability (r=0.97) and internal consistency (Cronbach’s alpha=0.90), and a cut-off score (13) yielded 96% sensitivity and 90% specificity. The Carer Supplement was also reliable (r=0.98; alpha=0.88), correlating with the GDS-LD (r=0.93).

Conclusion: Both scales appear useful for screening, monitoring progress and contributing to outcome appraisal.

 

Intellectual disabilities, depressive episode, diagnostic criteria and Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC-LD).

Smiley E, Cooper SA. J Intellect Disabil Res. 2003 Sep;47 Suppl 1:62-71.
West of Scotland Higher Training Scheme, University of Glasgow, Glasgow, UK.

Background: Depressive episode is one of the most common types of psychiatric illness that occurs in adults with intellectual disabilities.

Methods: A comprehensive literature search was undertaken using Medline, PsychLIT and hand-searching of key journals. This paper reviews the evidence and integrates findings, to report how evidence relates to the development of the new Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation[DC-LD] depressive episode criteria.

Results: This area is better researched than many others, providing evidence on clinical symptomatology and presentation. In view of the lack of utility of standard diagnostic criteria developed for use with the general population, and set within the historical context, there are clearly identified reasons for the introduction of DC-LD. The depressive episode category has been informed by the evidence, and field trials showed excellent validity compared with the gold standard of learning disabilities psychiatric assessment.

Conclusion: The DC-LD depressive episode category may improve clinical diagnosis and facilitate research. Its usefulness and limitations are yet to be determined in detail.

 

Treatment of previously undiagnosed psychiatric disorders in persons with developmental disabilities decreased or eliminated self-injurious behavior.

Tsiouris JA, Cohen IL, Patti PJ, Korosh WM. J Clin Psychiatry. 2003 Sep;64(9):1081-90. Institute for Basic Research in Developmental Disabilities, George A. Jervis Clinic, 1050 Forest Hill Rd., Staten Island, NY 10314, USA. John.Tsiouris@omr.state.ny.us

Background: Self-injurious behavior (SIB) is one of the most common challenging behaviors in persons with autistic disorder or severe/profound mental retardation. Many psychotropic drugs have been evaluated for their effectiveness in SIB. Results have varied, and no one psychotropic drug has been indicated for SIB. In this prospective, open clinical study, psychotropic drugs were used to treat the previously undiagnosed psychiatric disorder in persons exhibiting SIB.

Methods: Data were collected from 26 individuals with mental retardation (14 males, 12 females), 7 to 45 years of age (mean = 30.3 years), who exhibited SIB. Psychiatric diagnosis was made according to DSM-III-R and DSM-IV criteria. The Behavior Problem Inventory, Yudofsky’s Overt Aggression Scale, repeated direct observation, and information on use of protective devices and Likert scales from log books were used to evaluate degree of SIB. Most of the patients were treated with different psychotropic drugs and behavior modification before they were evaluated for this study, but only 7 of them carried a psychiatric diagnosis. Data were collected between 1987 and 1997.

Results: Depressive disorders, impulse-control disorder, and anxiety disorder were the most common final diagnoses. Neuroleptics were discontinued in 5 patients and tapered by 50% to 75% in 14 patients. Antidepressants were added in 12 patients. Treatment of psychiatric disorders produced significant (p < .001) decrease in the severity of SIB in the 26 patients, and SIB was eliminated in 12 patients. The severity of SIB decreased to mild from a moderate, severe, or extreme degree in 11 patients and from an extreme to a severe degree in 3 patients.

Conclusion: The most effective treatment for SIB that is resistant to environment changes and behavior modification in persons with developmental disabilities is the treatment of their psychiatric disorders with the appropriate psychotropics.

 

The influence of comorbid depression on seizure severity.

Cramer JA, Blum D, Reed M, Fanning K; Epilepsy Impact Project Group. Epilepsia. 2003 Dec;44(12):1578-84. Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue (G7E), West Haven, CT 06516-2770, USA. joyce.cramer@yale.edu

Purpose: To determine the relation between depressive symptoms and seizure severity among people with epilepsy.

Methods: A postal questionnaire was used to survey a nationwide community sample about seizures and depression. The Seizure Severity Questionnaire (SSQ) assessed the severity and bothersomeness of seizure components. The Centers for Epidemiological Studies-Depression scale categorized levels of depression.

Results: Respondents categorized as having current severe (SEV, n = 166), mild-moderate (MOD, n = 74), or no depression (NO, n = 443) differed significantly in SSQ scores (all p < 0.0001). People with SEV or MOD reported significantly worse problems than did those with NO depression for overall seizure recovery (mean, 5.3, 4.9, 4.5, respectively); overall severity (5.0, 4.5, 4.2); and overall seizure bother (5.3, 4.8, 4.4) (all p < 0.005). Cognitive, emotional, and physical aspects of seizure recovery also were rated worse among people with SEV than with NO depression (all p < 0.05). Symptoms of depression were significantly correlated with higher levels of all components of generalized tonic-clonic seizure severity (r = 0.33-0.48; all p < 0.0001), and partial seizures (r = 0.31-0.38; all p < 0.01).

Conclusion: Clinically depressed people with epilepsy reported higher levels of perceived severity and bother from seizures, as well as greater problems with overall seizure recovery than did nondepressed people experiencing similar types of seizures. The pervasive influence of depressive symptoms on reports of seizure activity suggests that people with epilepsy should be screened for depression. These data highlight the importance of detecting and treating depression among people with epilepsy.

 

Electroconvulsive therapy for affective disorders in persons with mental retardation.

Kessler RJ. Psychiatr Q. 2004 Spring;75(1):99-104. Adults and Children with Learning and Developmental Disabilities, Bethpage, New York, USA. kesslerr@acldd.org

Despite the efficacy of electroconvulsive therapy for the treatment of affective disorders there are no systematic studies of its effectiveness or safety in the mentally retarded population. A literature search revealed 16 case reports that suggests that it is both as effective and safe with mentally retarded persons as in the general population. Four additional clinical vignettes, with extensive follow-up observation from four to eleven years, are presented in an effort to enrich the literature on this subject. They include patients with rapid cycling bipolar disorder, bipolar disorder, manic phase, major depression with psychotic features and schizoaffective disorder. Issues of diagnostic difficulty and pharmacologic prophylaxis are addressed.

 

Analyses of nursing home residents with multiple sclerosis and depression using the Minimum Data Set.

Buchanan RJ, Wang S, Tai-Seale M, Ju H. Mult Scler. 2003 Mar;9(2):171-88.
Department of Health Policy and Management, School of Rural Public Health, The Texas A&M University System Health Science Center, College Station, TX 77843-1266, USA. buchanan@srph.tamu.edu

Depression is the most common psychiatric condition among people with multiple sclerosis (MS). A total of 14009 people with MS at admission to a nursing facility were analyzed using the Minimum Data Set and 36% also had depression. This study developed profiles of nursing home residents with MS who also had depression and compared them with other residents with MS. MS residents with depression were significantly more likely to be female and younger than other MS residents, with significant racial differences as well. MS residents with depression were significantly more likely than other MS residents to have a history of mental health conditions, exhibit mood indicators, and have unsettled relationships. Both groups of MS residents had high levels of physical disability, although MS residents with depression tended to be slightly less disabled. MS residents with depression were more likely than other MS residents to experience daily pain and more likely to have the diseases common to all residents with MS. This research found that most MS residents with depression did not receive mental health services, demonstrating that nursing facilities must improve the mental healthcare provided to residents with MS with depression.

 

Anxiety and depression influence the relation between disability status and quality of life in multiple sclerosis.

Janssens AC, van Doorn PA, de Boer JB, Kalkers NF, van der Meche FG, Passchier J, Hintzen RQ. Mult Scler. 2003 Aug;9(4):397-403. Department of Neurology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.

Disability status, depression and anxiety are important determinants of quality of life (QoL) in patients with multiple sclerosis (MS). We investigated whether anxiety and depression influence the relation between disability status and QoL in our cohort of recently diagnosed patients. Disability status [Expanded Disability Status Scale (EDSS)], anxiety and depression [Hospital Anxiety and Depression Scale (HADS)], and QoL (SF-36) were prospectively obtained in 101 MS patients. The relation between EDSS and SF-36 scales was examined using regression analyses, without and with adjustment for anxiety and depression. Interaction effects were investigated by comparing the relation between EDSS and QoL in patients with high and low anxiety and depression. In the unadjusted analyses, EDSS was significantly related to all SF-36 physical and mental health scales. After adjustment for anxiety and depression, EDSS was significantly related only to the SF-36 physical functioning, role-physical functioning and bodily pain scales. The relation between EDSS and these SF-36 scales was consistently higher in patients with more symptoms of anxiety or depression, suggesting that anxiety and depression strengthened the association of EDSS in these SF-36 physical health scales. After adjustment for anxiety and depression, EDSS was not significantly related to the SF-36 mental health scales and the general health scale. This finding is compatible with the hypothesis that anxiety and depression are intermediate factors in the association of EDSS with these SF-36 scales. Screening for symptoms of anxiety and depression is recommended in studies that use QoL as an outcome measure of treatment or intervention efficacy.

 

Depression, fatigue, and health-related quality of life among people with advanced multiple sclerosis: results from an exploratory telerehabilitation study.

Egner A, Phillips VL, Vora R, Wiggers E. NeuroRehabilitation. 2003;18(2):125-33 Department of Health Policy and Management, Rollins School of Public Health of Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA.

This study reports on secondary data, depression, fatigue and health-related quality of life (HRQOL), collected on people with advanced multiple sclerosis (MS) as part of a larger study of the impact of a telerehabilitation intervention on people with severe mobility impairment. People with spinal cord injuries (SCIs) (n=111) and the prevention of pressure sores were the primary group of interest of the project. The focus here is on data collected from people with advanced MS (n=27), who were included as an exploratory cohort, as they experience increased risk of pressure ulcer development as their level of mobility declines. The study consisted of a nine-week intervention with three randomized groups: video, telephone, and standard care. Aside from information on pressure sores, data were also collected on fatigue, depression, and HRQOL for a two-year follow-up period. For the video group HRQOL scores trended higher and fatigue and depression scores lower for 24 months. Fatigue scores were significantly lower for the video group at month six, 12, and 18. In the sample overall, fatigue symptoms were far more prominent than depressive symptoms and affected 100% higher rates of depression than women. At baseline, controlling for Extended Disability Status Score (EDSS), depression and fatigue were correlated. However, contrary to indications from previous cross-sectional studies, no consistent relationship was observed over time between the two. Telerehabilitation interventions for people with advanced MS warrant further investigation. Findings here suggest that such interventions may be beneficial, although the results need affirmation through larger samples. In addition, the higher prevalence of male depression merits serious attention.

 

Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample.

Chwastiak L, Ehde DM, Gibbons LE, Sullivan M, Bowen JD, Kraft GH. Am J Psychiatry. 2002 Nov;159(11):1862-8. Department of Psychiaty and Behavioral Sciences, Harborview Medical Center, Box 359911, Seattle, WA 98104, USA. Ichwast@u.washington.edu

Objective: Previous research has shown high prevalence rates of depression in multiple sclerosis patients seen in specialty clinics. The relationships among depressive symptoms and severity, duration, and course of multiple sclerosis are controversial.

Methods: A survey was mailed to members of the Multiple Sclerosis Association of King County (Wash.). Of the 1,374 eligible participants, 739 returned the survey, a response rate of 53.8%. Data about demographic characteristics, employment, and duration and course of multiple sclerosis were collected. Severity of multiple sclerosis was determined by the Expanded Disability Status Scale, self-report version. Severity of depressive symptoms was evaluated with the Center for Epidemiologic Studies Depression Scale (CES-D Scale). Analysis of covariance was used to compare mean CES-D Scale scores across categories of multiple sclerosis, and logistic regression was used to identify variables associated with clinically significant depression.

Results: Clinically significant depressive symptoms (CES-D Scale score > or =16) were found in 41.8% of the subjects, and 29.1% of the subjects had moderate to severe depression (score > or =21). Subjects with advanced multiple sclerosis were much more likely to experience clinically significant depressive symptoms than subjects with minimal disease. Shorter duration of multiple sclerosis was associated with a greater likelihood of significant depressive symptoms, but the pattern of illness progression was not.

Conclusion: In this large community sample, the severity of multiple sclerosis was more strongly associated with depressive symptoms than was pattern of illness. Clinicians should evaluate depression in patients with recent diagnoses of multiple sclerosis, major changes in functioning, or limited social support.

 

Gender analyses of nursing home residents with multiple sclerosis.

Buchanan RJ, Wang S, Ju H. J Gend Specif Med. 2003;6(2):35-46. Department of Health Policy and Management, School of Rural Public Health, Texas A&M University System Health Science Center, College Station, 77843-1266, USA. buchanan@srph.tamu.edu

Objective: To present gender comparisons of residents with multiple sclerosis (MS) at admission to nursing facilities, including demographic characteristics, health measures, and treatments.

Methods: We analyzed 13,998 admission assessments in the Minimum Data Set for residents with MS recorded between June 23, 1998 and December 31, 2000.
p. Results: Although both male and female residents with MS tended to have severe disability, there were significant gender differences in measures of activities of daily living (ADL) dependency and disability, with males slightly more likely to exhibit total ADL dependence and greater loss of voluntary movement. Females with MS tended to have significantly better cognitive performance and better communication abilities than males with MS. There were significant gender differences in pain symptoms among residents, with one-third of females and one-fifth of males experiencing daily pain. Depression was the most common comorbidity among residents with MS, with females significantly more likely to have this diagnosis. Although females with MS were slightly more likely to have depression or anxiety disorder, males with MS were slightly more likely to receive mental health services.

Conclusion: These analyses demonstrate that many nursing facilities need to improve pain management and mental health care provided to residents with MS, especially to females.

 

Health-related quality of life and depression in an Italian sample of multiple sclerosis patients.

Patti F, Cacopardo M, Palermo F, Ciancio MR, Lopes R, Restivo D, Reggio A.
J Neurol Sci. 2003 Jul 15;211(1-2):55-62. Dipartimento Neuroscienze, Sezione Sclerosi Multipla e Malattie Demielinizzanti, Azienda Policlinico Via Santa Sofia 78, 95123 Catania, Italy. patti@mbox.unict.it

Only few publications have been reported on Health-related Quality of Life (HRQoL) in patients with multiple sclerosis (MS). EDSS is the most common outcome measure for either impairment or disability of MS, but it is not able to catch other aspects of MS impact on HRQoL.The authors performed a cross-sectional study on the group of all patients with MS who were diagnosed at least 4 years before 1998 in Catania (South Italy). One hundred and eighty patients out of 308 were enrolled in the study. SF-36 was used to catch the HRQoL of MS patients. EDSS, Beck Depression Inventory (BDI) and time since diagnosis were investigated as variables affecting the HRQoL of MS patients.The patients showed significant lower mean scores for all SF-36 health dimensions compared with sex- and age-adjusted scores in a general healthy Italian population (p<0.001). EDSS scores correlated only with physical functioning (r=-0.76 p<0.001). As expected, the more severe was the disease, the longer its duration and the lower the patients’ skillness on HRQoL. BDI showed high partial correlations with all SF-36 health domains with r=-0.38 to -0.65 (p<0.001).This study showed that SF-36 is able to assess the HRQoL of MS patients. Depression strongly influenced the HRQoL of MS patients. EDSS and time since diagnosis also affected the HRQoL of MS patients. Our results are comparable with other European studies.

 

Major depression in multiple sclerosis: a population-based perspective.

Patten SB, Beck CA, Williams JV, Barbui C, Metz LM. Neurology. 2003 Dec 9;61(11):1524-7 Department of Community Health Sciences, University of Calgary, Alberta, Canada. patten@ucalgary.ca

Objective: To determine the prevalence of major depression in multiple sclerosis (MS) in a population-based sample controlling for nonspecific illness effects.

Methods: This study used data from a large-scale national survey conducted in Canada: the Canadian Community Health Survey (CCHS). The analysis included 115,071 CCHS subjects who were 18 years or older at the time of data collection. The CCHS interview obtained self-reported diagnoses of MS and employed a brief predictive interview for major depression: the Composite International Diagnostic Interview Short Form for Major Depression. The 12-month period prevalence of major depression was estimated in subjects with and without MS and with and without other long-term medical conditions.

Results: The prevalence of major depression was elevated in persons with MS relative to those without MS and those reporting other conditions. The association persisted after adjustment for age and sex (adjusted odds ratio = 2.3, 95% CI 1.6 to 3.3). Major depression prevalence in MS for those in the 18- to 45-year age range was high at 25.7% (95% CI 15.6 to 35.7).

Conclusion: The prevalence of major depression in the population with MS is elevated. This elevation is not an artifact of selection bias and exceeds that associated with having one or more other long-term conditions.

 

The role of helplessness as mediator between neurological disability, emotional instability, experienced fatigue and depression in patients with multiple sclerosis.

van der Werf SP, Evers A, Jongen PJ, Bleijenberg G. Mult Scler. 2003 Feb;9(1):89-94. Department of Medical Psychology, University Medical Centre Nijmegen, Nijmegen, The Netherlands. s.vanderwerf@cukz.umcn.nl

The aim of this study was to test, in patients with multiple sclerosis (MS), whether the concept of helplessness might improve the understanding of the relationship between disease severity (neurological impairment) and personality characteristics (emotional instability) on one hand, and depressive mood and fatigue severity on the other hand. Data pertain to 89 patients with a definite diagnosis of MS (Expanded Disability Status Scale [EDSS] ratings: 1-8). Helplessness, fatigue severity, depressive mood and emotional instability were rated with validated questionnaires. Model testing revealed that more neurological impairment and more emotional instability were associated with more helplessness, while higher levels of helplessness were associated with more fatigue and depressive mood. The initially observed direct relationship between EDSS and fatigue disappeared. Emotional instability also had a direct significant relationship with depressive mood, and depressive mood had only a small relationship with fatigue severity. The results indicated that helplessness affected both depressive mood and fatigue severity and that fatigue was not merely a symptom of depressive mood. The correlation between neurological impairment and fatigue severity was largely explained by the mediating effect of helplessness. These findings suggest that MS patients troubled by disabling fatigue might benefit from a psychological intervention targeting unfavourable illness cognitions.

 

Readiness to self-manage pain is associated with coping and with psychological and physical functioning among patients with chronic pain.

Jensen MP, Nielson WR, Turner JA, Romano JM, Hill ML. Pain. 2003 Aug;104(3):529-37.Department of Rehabilitation Medicine, P.O. Box 356490, University of Washington School of Medicine, Seattle, WA 98195-6490, USA. mjensen@u.washington.edu

A patient’s readiness to adopt a self-management approach to pain has been suggested as a construct that may explain differences among patients in coping, adjustment, and response to multidisciplinary pain treatment. The pain stages of change questionnaire (PSOCQ; Pain, 72 (1997) 227) was designed to assess four components of this construct. The current study tested the following two hypotheses in two different samples of persons with chronic pain. PSOCQ scales are associated with (1) coping strategies used to manage pain and (2) patient disability and depression. The findings supported the first hypothesis and provided mixed support for the second. The implications of the findings for understanding the readiness to self-manage pain construct and the validity of the PSOCQ for assessing this construct are discussed.

 

A short psychosocial questionnaire for patients with Parkinson's disease: the SCOPA-PS.

Marinus J, Visser M, Martinez-Martin P, van Hilten JJ, Stiggelbout AM. J Clin Epidemiol. 2003 Jan;56(1):61-7. Department of Neurology, Leiden University Medical Center K5 Q 92, P.O. Box 9600, NL-2300 RC Leiden, The Netherlands. J.Marinus@lumc.nl

The purpose of this study was to develop a short questionnaire for psychosocial functioning in patients with Parkinson’s Disease (PD). The SCales for Outcomes in Parkinson’s disease-PsychoSocial questionnaire (SCOPA-PS) was tested in a survey and compared with other instruments and with medical information. This survey was sent to 205 patents with idiopathic PD. Eighty-six percent of the questionnaires were returned. Cronbach’s alpha was 0.83. Two-week test-retest reliability was 0.85 (intraclass correlation coefficient). Construct validity with other scales (Spearman’s rho) was 0.82 for the Parkinson’s Disease Questionnaire-39-item version (PDQ-39), 0.76 for the PDQ-8, 0.69 for the Hospital Anxiety and Depression Scale, -0.61 for the Euroqol, and -0.60 for a visual analogue scale evaluating Quality-of-Life. The summary index revealed a significant increase with increasing disease severity. The SCOPA-PS is a new, short psychosocial questionnaire for patients with PD with good clinimetric properties.

 

Prevalence, etiology, and treatment of depression in Parkinson's disease.

McDonald WM, Richard IH, DeLong MR. Biol Psychiatry. 2003 Aug 1;54(3):363-75 Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.

Parkinson’s disease (PD) is primarily a disease of elderly individuals with a peak age at onset of 55 to 66 years. It is characterized by bradykinesia, rigidity, tremor, and postural instability; and affects approximately 1 million individuals in the US and is the second most common neurodegenerative disease next to Alzheimer’s disease. The motor symptoms of PD are the focus of pharmacotherapy, yet the nonmotor symptoms (e.g., dementia, psychosis, anxiety, insomnia, autonomic dysfunction, and mood disturbances) can be the most disturbing, disabling, and misunderstood aspects of the disease. Depressive symptoms occur in approximately half of PD patients and are a significant cause of functional impairment for PD patients. There is accumulating evidence suggesting that depression in PD is secondary to the underlying neuroanatomical degeneration, rather than simply a reaction to the psychosocial stress and disability. The incidence of depression is correlated with changes in central serotonergic function and neurodegeneration of specific cortical and subcortical pathways. Understanding comorbid depression in PD may therefore add to the understanding of the neuroanatomical basis of melancholia.

 

Randomized controlled trial of the Alexander technique for idiopathic Parkinson's disease.

Stallibrass C, Sissons P, Chalmers C. Clin Rehabil. 2002 Nov;16(7):695-708
School of Integrated Medicine, University of Westminster, London, UK. stallic@wmin.ac.uk

Objective: To determine whether the Alexander Technique, alongside normal treatment, is of benefit to people disabled by idiopathic Parkinson’s disease.

Design: A randomized controlled trial with three groups, one receiving lessons in the Alexander Technique, another receiving massage and one with no additional intervention. Measures were taken pre- and post-intervention, and at follow-up, six months later.

Setting: The Polyclinic at the University of Westminster, Central London.

Participants: Ninety-three people with clinically confirmed idiopathic Parkinson’s disease.

Interventions: The Alexander Technique group received 24 lessons in the Alexander Technique and the massage group received 24 sessions of massage.

Main Outcome Measures: The main outcome measures were the Self-assessment Parkinson’s Disease Disability Scale (SPDDS) at best and at worst times of day. Secondary measures included the Beck Depression Inventory and an Attitudes to Self Scale.

Results: The Alexander Technique group improved compared with the no additional intervention group, pre-intervention to post-intervention, both on the SPDDS at best, p = 0.04 (confidence interval (CI) -6.4 to 0.0) and on the SPDDS at worst, p = 0.01 (CI -11.5 to -1.8). The comparative improvement was maintained at six-month follow-up: on the SPDDS at best, p = 0.04 (CI -7.7 to 0.0) and on the SPDDS at worst, p = 0.01 (CI -11.8 to -0.9). The Alexander Technique group was comparatively less depressed post-intervention, p = 0.03 (CI -3.8 to 0.0) on the Beck Depression Inventory, and at six-month follow-up had improved on the Attitudes to Self Scale, p = 0.04 (CI -13.9 to 0.0).

Conclusion: There is evidence that lessons in the Alexander Technique are likely to lead to sustained benefit for people with Parkinson’s disease.

 

Depression and health-related quality of life.

Gaynes BN, Burns BJ, Tweed DL, Erickson P. J Nerv Ment Dis. 2002 Dec;190(12):799-806. Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, Chapel Hill, North Carolina 27599-7160, USA.

Chronic medical conditions drastically affect the lives of those afflicted, leading to pain, disability, and disruption. Comorbid depression can exacerbate the effects of medical illness and may be an independent source of suffering and disability. Data from the Epidemiological Follow-Up Study (NHEFS) of the first National Health and Nutrition Examination Survey (NHANES I) are used to examine the manner in which depression and comorbid medical conditions interact to affect health-related quality of life (HRQOL). The findings suggest a) that the effects of depression are comparable with those of arthritis, diabetes, and hypertension; and b) that depression and chronic medical illnesses interact to amplify the effects of the medical illness. The data also support the merit of adopting a multidimensional approach to HRQOL rather than treating it unidimensionally.

 

Workforce participation by persons with disabilities: the National Health Interview Survey Disability Supplement, 1994 to 1995.

Zwerling C, Whitten PS, Sprince NL, Davis CS, Wallace RB, Blanck PD, Heeringa SG. J Occup Environ Med. 2002 Apr;44(4):358-64. University of Iowa, College of Public Health, 100 Oakdale Campus, #126 IREH, Iowa City, IA 52242-5000, USA. CZwerling@mail.public-health.uiowa.edu

Using the National Health Interview Survey Disability Supplement of 1994 to 1995, we examined the factors associated with employment among Americans with disabilities. Persons with disabilities who were more educated were more likely to be working. Married men were more likely to work than unmarried men (odds ratio [OR], 1.58). Blacks were less likely to work than whites (OR, 0.56). Persons with disabilities related to cardiovascular disease (OR, 0.23), musculoskeletal disease (OR, 0.37), and respiratory disease (OR, 0.23) were less likely to work than other Americans with disabilities. Among persons with psychiatric disorders, there was considerable variety in the propensity to work. Persons with schizophrenia (OR, 0.24) and paranoid delusional disorder (OR, 0.34) were markedly less likely to work; persons with bipolar disorder (OR, 0.60) and major depression (OR, 0.69) were also less likely to work. Lastly, persons with self-reported alcohol abuse (OR, 1.30) were more likely to work, and persons with self-reported drug abuse (OR, 0.93) were not less likely to work, than others in our study population of Americans with disabilities.

 

A double-blind, placebo-controlled trial of sertraline for depressive symptoms in patients with stable, chronic schizophrenia.

Mulholland C, Lynch G, King DJ, Cooper SJ. J Psychopharmacol. 2003 Mar;17(1):107-12. Department of Mental Health, Queen’s University Belfast, Belfast, UK.

There have been no studies specifically examining the efficacy of selective serotonin reuptake inhibitor antidepressants for the symptoms of depression in schizophrenia. This study aimed to determine the efficacy and safety of sertraline as a treatment for depressive symptoms in patients with stable, chronic schizophrenia. The Beck Depression Inventory (BDI) was used as the principal outcome measure and other measures of depressive symptoms as secondary outcome measures. Twenty-six patients were entered into a double-blind, placebo-controlled, 8-week trial of sertraline and were included in the intent-to-treat (ITT) analysis (13 in each group). Eight patients in the sertraline group and 12 in the placebo group completed at least four weeks in the study and were considered to have had adequate treatment. On the ITT analysis, the mean score on the BDI fell 14.5% for the sertraline group and 5.6% for the placebo group (p > 0.05); the mean score on the Hamilton Depression Rating Scale (HDRS) fell 16.99% for the sertraline group and 8.3% for the placebo group (p > 0.05). When the analysis was repeated for those who had received adequate treatment, the mean BDI score fell by 28% for the sertraline group and 6% for the placebo group (p = 0.1); the mean HDRS score fell 31% for the sertraline group and 8.6% for the placebo group (p = 0.02). On the Clinical Global Impression-Improvement Scale, 10 of the 13 patients on sertraline improved against four of the 13 in the placebo group (p = 0.05). Sertraline-treated patients showed a significant improvement on the anxiety/ depression subscale of the BPRS on ITT analysis (F = 10.1, p = 0.004). There was no significant effect on negative or positive symptoms. Sertraline was well tolerated. The results suggest that sertraline is useful as a treatment for depressive symptoms in schizophrenia.

 

Depression after traumatic brain injury: a National Institute on Disability and Rehabilitation Research Model Systems multicenter investigation.

Seel RT, Kreutzer JS, Rosenthal M, Hammond FM, Corrigan JD, Black K. Arch Phys Med Rehabil. 2003 Feb;84(2):177-84. Defense and Veterans Brain Injury Center, McGuire Veterans Administration Medical Center, Richmond, VA, USA.

Objective: To identify the frequency and manifestations of depression after traumatic brain injury (TBI) and the factors that contribute to developing this mood disorder. p. Design: A prospective, nationwide, multicenter study; 17 centers supplied data from medical records and patient responses on a standardized criterion instrument.

Setting: Traumatic Brain Injury Model Systems programs.

Participants: A demographically diverse sample of 666 outpatients with TBI was evaluated 10 to 126 months after injury.

Interventions: Not applicable.

Main Outcome Measures: Depressive symptoms were characterized with the Neurobehavioral Functioning Inventory by using the Diagnostic and Statistical Manual of Mental Disorders (4th ed; DSM-IV) diagnostic framework. Analysis of variance and Pearson correlations were used to identify factors that were significantly related to depression.

Results: Fatigue (29%), distractibility (28%), anger or irritability (28%), and rumination (25%) were the most commonly cited depressive symptoms in the sample. Twenty-seven percent of patients with TBI met the prerequisite number (>/=5) of criterion A symptoms for a DSM-IV diagnosis of major depressive disorder. Feeling hopeless, feeling worthless, and difficulty enjoying activities were the 3 symptoms that most differentiated depressed from nondepressed patients. Patients who were unemployed at the time of injury and who were impoverished were significantly more likely to report DSM-IV criterion A symptoms than patients who were employed, were students, or were retired due to age. Time after injury, injury severity, and postinjury marital status were not significantly related to depression.

Conclusion: Patients with TBI are at great risk for developing depressive symptoms. Findings provide empirical support for the inclusion of depression evaluation and treatment protocols in brain injury programs. Unemployment and poverty may be substantial risk factors for the development of depressive symptoms. Future research should develop biopsychosocial predictive models to identify high-risk patients and examine the efficacy of treatment interventions.

 

Depression and life satisfaction in patients with traumatic brain injury: a longitudinal study.

Underhill AT, Lobello SG, Stroud TP, Terry KS, Devivo MJ, Fine PR. Brain Inj. 2003 Nov;17(11):973-82. Injury Control Research Center, University of Alabama at Birmingham School of Medicine, Birmingham, AL 34294, USA. andrea.underhill@ccc.uab.edu

Objective: To assess the relationship between depression and life satisfaction among survivors of traumatic brain injury (TBI) over a 3-year period after injury. It was hypothesized that survivors of TBI with depression would have decreased life satisfaction.

Design: Two groups (depression vs no depression) longitudinal design.

Methods: Interviewed survivors of TBI (n = 324) by telephone at 24, 48 and 60 months after hospitalization. At the 24-month interview, 90 (27.8%) respondents reported a post-injury diagnosis of depression and 234 (72.2%) reported no diagnosis. Respondents then completed the Life Satisfaction Index I-A, which was repeated at the 48- and 60-month interviews.

Results: The depression group had significantly lower life satisfaction than the no depression group at 24-, 48- and 60-month interviews.

Conclusion: Depression and diminished life satisfaction among survivors of TBI are persistent problems that require the close attention of medical and rehabilitation professionals.

 

Pilot evaluation of a mindfulness-based intervention to improve quality of life among individuals who sustained traumatic brain injuries.

Bedard M, Felteau M, Mazmanian D, Fedyk K, Klein R, Richardson J, Parkinson W, Minthorn-Biggs MB. Disabil Rehabil. 2003 Jul 8;25(13):722-31. Department of Psychology, Lakehead University, Lakehead Psychiatric Hospital, 955 Oliver Road, Thunder Bay, Ontario P7B 5E1, Canada. michel.bedard@lakeheadu.ca

Objective: To examine the potential efficacy of a mindfulness-based stress reduction approach to improve quality of life in individuals who have suffered traumatic brain injuries.

Design: Pre-post design with drop-outs as controls.

Methods: We recruited individuals with mild to moderate brain injuries, at least 1 year post-injury. We measured their quality of life, psychological status, and function. Results of 10 participants who completed the programme were compared to three drop-outs with complete data.

Interventions: The intervention was delivered in 12-weekly group sessions. The intervention relied on insight meditation, breathing exercises, guided visualization, and group discussion. We aimed to encourage a new way of thinking about disability and life to bring a sense of acceptance, allowing participants to move beyond limiting beliefs.

Results: The treatment group mean quality of life (SF-36) improved by 15.40 (SD = 9.08) compared to – 1.67 (SD = 16.65; p = 0.036) for controls. Improvements on the cognitive-affective domain of the Beck Depression Inventory II (BDI-II) were reported (p = 0.029), while changes in the overall BDI-II (p = 0.059) and the Positive Symptom Distress Inventory of the SCL-90R (p = 0.054) approached statistical significance.

Conclusion: The intervention was simple, and improved quality of life after other treatment avenues for these participants were exhausted.

 

Psychiatric morbidity following injury.

O’Donnell ML, Creamer M, Pattison P, Atkin C. Am J Psychiatry. 2004 Mar;161(3):507-14. Department of Psychology, University of Melbourne, Parkville, Australia. mod@unimelb.edu.au

Objective: Accurate information regarding the psychopathological consequences of surviving traumatic injury is of great importance for effective health service design and planning. Regrettably, existing studies vary dramatically in reported prevalence rates of psychopathology within this population. The aim of this study was to identify the prevalence of psychiatric morbidity following severe injury by adopting a longitudinal design with close attention to optimizing the research methodology.

Methods: Consecutive admissions (N=363) to a level 1 trauma service, excluding those with moderate or severe traumatic brain injury, were assessed at three time periods: just before discharge and 3 and 12 months after their injury. Structured clinical interviews were used to assess anxiety disorders, depressive disorders, and substance use disorders. p. Results: Posttraumatic stress disorder (PTSD) and major depressive disorder were the most frequent diagnoses at both 3 and 12 months, with 10% of participants meeting diagnostic criteria for each disorder at 12 months. Over 20% of the group met criteria for at least one psychiatric diagnosis 12 months after their injury. Comorbidity was common, with the most frequent being PTSD with major depressive disorder.

Conclusion: Psychopathology following injury is a frequent and persistent occurrence. Despite the adoption of a rigorous and potentially conservative methodology, one-fifth of participants met criteria for one or more psychiatric diagnoses 12 months after their injury. These findings have major implications for injury health care providers.

 

Depression and functional disability in chronic pediatric pain.

Kashikar-Zuck S, Goldschneider KR, Powers SW, Vaught MH, Hershey AD. Clin J Pain. 2001 Dec;17(4):341-9 Children’s Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Ohio 45229, USA.

Objective: The primary aim of this study was to describe pain characteristics, coping strategies, depression, and functional disability in children and adolescents with chronic pain and to examine potential factors that are associated with functional disability in a pediatric pain population. The secondary aim of this study was to compare functional disability in two chronic pain conditions: localized musculoskeletal pain and chronic daily headaches.

Participants: The participants in this study were 73 pediatric pain patients with a variety of chronic pain conditions. Subjects in the second part of the study were a subset of patients (N = 44) from the pain clinic sample with chronic localized musculoskeletal pain and a subset of patients (N = 38) from the headache center of the same hospital who had chronic daily headaches.

Design: Patients completed self-report measures of pain intensity, depression, coping strategies, coping efficacy, and functional disability.

Results: Results indicated that chronic pain had a substantial impact on the children’s lives and that depression was strongly associated with functional disability. Maladaptive coping was correlated with depression and disability; however, maladaptive coping was not independently associated with functional disability. A comparison between the two groups found significant differences in pain intensity and functional disability. The localized musculoskeletal pain group reported higher levels of disability and more difficulty coping than the chronic daily headache group.

Conclusion: The implications for treatment of chronic pain in children are discussed with an emphasis on greater attention to developmental issues and their relation to coping, emotional functioning, and disability in pediatric pain. Further research examining differences in coping and disability between different pediatric pain groups is also warranted.

 

Depression in type 1 diabetes in children: natural history and correlates.

Grey M, Whittemore R, Tamborlane W. J Psychosom Res. 2002 Oct;53(4):907-11.
Yale School of Nursing, 100 Church Street South, New Haven, CT 06519, USA.

The combination of diabetes and depression in children and adolescents is largely unstudied. The purpose of this article is to review the literature on the natural history and correlates of comorbid diabetes and depression in children and adolescents. Children with diabetes have a two-fold greater prevalence of depression, and adolescents up to three-fold greater, than youth without diabetes. Correlates of depression and diabetes include gender, poorer metabolic control, and family behaviors. Very little is known about treatment in these youth, and more studies are indicated.

 

Peer rejection, social behavior, and psychological adjustment in children with juvenile rheumatic disease.

Sandstrom MJ, Schanberg LE. J Pediatr Psychol. 2004 Jan-Feb;29(1):29-34
Department of Psychology, Williams College, Williamstown, MA 01267, USA. marlene.sandstrom@williams.edu

Objective: To examine the associations among disease status, social competence, and depressive symptoms in children with juvenile rheumatic disease (JRD) and to test the hypothesis that individual differences in children’s social competence account for a significant proportion of variance in depressive symptoms after controlling for disease status variables.

Methods: Thirty-six children with JRD completed standardized instruments to assess pain, health status, and depressive symptoms. The rheumatologist completed a disease severity measure, and teachers provided ratings of peer rejection and social behavior.

Results: Pain, peer rejection, and problematic social behavior were all positively associated with depressive symptoms. Social variables remained significantly associated with depressive symptoms after controlling for level of pain. In addition, peer rejection moderated the association between pain and depressive symptoms, such that children with high levels of pain and high levels of peer rejection reported the highest frequency of depressive symptoms.

Conclusion: Health care providers should assess the social functioning of children with JRD in order to identify socially vulnerable children who may be at increased risk for internalizing problems.

 

Psychiatric adjustment in chronic fatigue syndrome of childhood and in juvenile idiopathic arthritis.

Rangel L, Garralda ME, Hall A, Woodham S. Psychol Med. 2003 Feb;33(2):289-97. Academic Unit of Child and Adolescent Psychiatry, Faculty of Medicine, Imperial College at St Mary’s Campus, London.
Comment in:
Psychol Med. 2003 Feb;33(2):197-201.

Background: High rates of psychopathology and of personality problems have been reported in children and adolescents with chronic fatigue syndrome (CFS). It is not clear whether this is consequent on the experience of chronic physical ill health. We compare psychiatric adjustment in children with CFS and in children suffering from another chronic physical disorder (juvenile idiopathic arthritis or JIA).

Methods: Our sample consisted of 28 children with CFS and 30 with JIA attending tertiary paediatric centres (age range, 11 to 18 years, mean 15, S.D. 2.3). In order to assess psychiatric status and functioning, we used the K-SADS psychiatric interviews, CGAS and Harter Self-Esteem Questionnaire with child subjects; behavioural questionnaires (CBCL) and child personality assessment interviews (PAS) with parent informants.

Results: Psychiatric disorders in the year prior to interview had been present significantly more commonly in the CFS group (72% v. 34% in JIA) and were more impairing to them (CGAS scores of 45 v. 77). Most common diagnoses in both groups were depressive and anxiety disorders. Personality problems were also significantly more frequent in CFS subjects (48% disorder and 26% difficulty v. 11% and 11% in JIA). There were few differences between the two groups in self-esteem.

Conclusion: Psychopathology and personality problems are common in children and adolescents with severe forms of CFS and cannot be explained strictly through the experience of chronic physical illness.

 

Quality of life of adolescents with perceived disabilities.

Edwards TC, Patrick DL, Topolski TD. J Pediatr Psychol. 2003 Jun;28(4):233-41
University of Washington, Center for Disability Policy and Research, Seattle, Washington 98103-8652, USA. toddce@u.washington.edu

Objective: To compare the self-perceived quality of life (QoL) of adolescents with and without disabilities.

Methods: A school-based survey was conducted with 2801 7th to 12th grade students in a rural area of the United States. The Youth Quality of Life Instrument-Surveillance Module and the Youth Quality of Life Group-Disability Screener were completed.

Results: Twenty-one percent of all students surveyed reported having one or more physical, emotional, or learning disabilities. Adolescents with disabilities reported lower QoL than adolescent without disabilities. However, self-rated health, depressive symptoms, and contextual variables were significant covariates in the relationship between disability and QoL.

Conclusion: These findings suggest channels to improve the QoL of adolescents with disabilities. Specifically, reducing social and environmental barriers to promote inclusion of adolescents with disabilities in school, family, and community activities is one practical avenue for reducing disparities in QoL