A pilot study on the effects of the transition of paediatric to adult health care in patients with haemophilia and in their parents: patient and parent worries, parental illness-related distress and health-related Quality of Life.

The aim of this pilot study was to investigate the effects of the transition from paediatric to adult health care services in haemophilia patients and their parents. We compared pretransition children (n = 9) and their parents (n = 18) to posttransition patients (n = 8) and their parents (n = 21). Pre- and posttransition patients did not differ in self-rated health-related quality of life (QoL) or worries about the transition. Fathers of posttransition patients rated their son's QoL as poorer than those of pretransition patients (P = 0.034) and indicated higher levels of illness-related distress than fathers of pretransition patients (P = 0.034). The findings indicate that the transition affects parents more than patients. Moreover, we found gender differences in parental worries about the transition. The findings indicate that programmes designed to facilitate the transition in haemophilic patients should also address the patients' parents.

Relationship between perception of facial emotions and anxiety in clinical depression: does anxiety-related perception predict persistence of depression?

Within the framework of interpersonal theories on depression, it was postulated 1) that an anxiety-related mood-congruent bias with respect to the perception of facial expressions could be demonstrated in clinically depressed patients: 2) that the perception of negative facial emotions would be associated with co-occurring anxiety levels rather than with depression, and 3) that the putative anxiety-related bias would predict the subsequent course of depression. Such relationships would support the possible causal role of negative biases for the persistence of depression. Thirty-nine depressed patients (thirty-six patients met the criteria for major depression, two had a dysthymic disorder and one patient suffered from a cyclothymic disorder) were studied. The patients judged schematic faces with respect to the emotions they express (fear, happiness, anger, sadness, disgust, surprise, rejection and invitation) at admission (T0), and after 6 (T1) and 30 (T2) weeks. Severity of depression (BDI) and anxiety (SCL-90) were assessed at these three points. We found considerable support for the first 2 hypotheses: a) The perception of negative emotions was related to anxiety but not to depression (at T0 this association was significant and at T1 and T2 tendencies were found); b) When the level of depression was controlled for, significant relationships remained (emerged) between anxiety and the perception of negative emotions at each of the three different time points; c) Anxiety and perception of negative emotions covaried within subjects when large changes in depression/anxiety were involved, i.e. after 30 weeks. This relationship disappeared when depression change was partialled out. The third hypothesis was not confirmed: The perception of negative emotions did not predict the course of depression. Although a direct relationship with depression persistence and a negative bias in the perception of interaction-relevant stimuli (i.e. facial emotions) in anxious depressed patients could not be found, the existence of such anxiety-related negative bias forms indirect evidence for the notion that this negative bias may mediate rejective attitudes of others towards depressives and consequently may contribute to an unfavorable course of depression.

Nonverbal attunement between depressed patients and an interviewer predicts subsequent improvement.

Depressed patients' support-seeking behaviour and the responses to this behaviour by others (support-giving) are presumed to play a causal role in depression. In interactions between normals, attuning nonverbal behaviour (i.e., equalizing levels of specific behavioural activities) is important for satisfaction of the participants with the interaction. We investigated the attunement of nonverbal support-seeking and support-giving of 31 depressed patients and 1 interviewers during a 20-min admission interview. We defined attunement as the absolute difference between patients' and interviewers' nonverbal behaviour. It was found that the more attunement increased over the interview, the more favourable the subsequent course of depression was. The findings emphasize the potential role of interpersonal processes in depression.

Nonverbal interpersonal attunement and extravert personality predict outcome of light treatment in seasonal affective disorder.

We investigated whether personality and nonverbal interpersonal processes can predict the subsequent response to light treatment in seasonal affective disorder (SAD) patients. In 60 SAD patients, Neuroticism and Extraversion were assessed prior to light treatment (4 days with 30 min of 10.000 lux). From videotaped clinical interviews, the nonverbal interpersonal attunement (i.e. equalizing durations and frequencies of elements of behaviour between conversation partners) was registered for the patients' support seeking and the interviewers' support giving behaviour. The higher Extraversion and the more the patients and the interviewers got attuned over the interview, the more favourable the outcome of light treatment was. Hence, personality and nonverbal interpersonal processes may be involved in the response to light treatment in SAD.

Multi-level prediction of short-term outcome of depression: non-verbal interpersonal processes, cognitions and personality traits.

It was hypothesized that personality factors determine the short-term outcome of depression, and that they may do this via non-verbal interpersonal interactions and via cognitive interpretations of non-verbal behaviour. Twenty-six hospitalized depressed patients entered the study. Personality factors in the study were Neuroticism (N) and Extraversion (E). Non-verbal interpersonal interactions were studied by measuring patients' 'support seeking behaviour' and interviewers' 'support giving behaviour' from videotaped clinical interviews. The attunement between patients' and interviewers' behaviour (reflecting interpersonal satisfaction) was calculated over the time course of the interviews. Cognitions were assessed by measuring the perception of emotions from schematic faces. A stepwise multiple regression analysis showed that the higher the levels of E were, the less negative emotions were perceived from ambiguous faces (A-neg), and the more the patients and the interviewers got non-verbally attuned during the baseline interviews, the more favourable the short-term outcome of depression (as assessed over 6 weeks) turned out to be (adj.R2 = 0.48, P = 0.001). High levels of A-neg explained the relationship between high levels of N and an unfavourable short-term outcome of the depression (Pearson's r between N and short-term outcome of depression, P = 0.041, partial correlation after correction for A-neg, P = 0.157). The results show that personality, non-verbal interpersonal behavioural processes and cognitive factors are partially independent and partially linked in their relationship with the short-term outcome of depression. Research on non-verbal behavioural processes extends the empirical basis for the integration of personality, cognitions and interpersonal factors in depression theory.

Observed behavior of patients with seasonal affective disorder and an interviewer predicts response to light treatment.

We investigated whether observable behavior of seasonal affective disorder (SAD) patients and an interviewer during an interview before light treatment is related to the response to the light treatment. Different observed behavioral elements of 24 SAD patients and of 2 interviewers, assessed before light treatment, were reduced to "behavioral factors." Forward multiple regression analyses were applied to investigate whether these factors might predict the response to light therapy (3 h of bright light between 09:00 and 12:00 h or between 18:00 and 21:00 h on 5 consecutive days). In addition, it was investigated whether the interviewers' factors could be predicted from the patients' factors. Both patients' and interviewers' factors predicted the response to light treatment. Response-related factors of patients and interviewers were interrelated. The results suggest that behavioral processes may play a role in the mechanisms underlying the response to light treatment in SAD. They support the relevance of interpersonal theories in seasonal depression.

Gender-specific mechanisms associated with outcome of depression: perception of emotions, coping and interpersonal functioning.

We proposed that a negative bias in the perception of facial expressions would affect the way in which deficient coping and interpersonal functioning influenced the risk of persistent depression. Furthermore, we hypothesised that cognitions, coping strategies, and interpersonal functioning would be more likely to contribute to the prediction of outcome of depression among women than among men. At admission, 60 in-patients with major depression judged 12 schematic faces with respect to the emotions that they expressed (fear, happiness, anger, sadness, disgust, surprise, rejection and invitation). In addition, difficulty in assertiveness and social distress, and coping strategies for dealing with stressful events were measured with self-report questionnaires. At admission and 6 weeks later, the severity of depression was evaluated with the Beck Depression Inventory. Women who were inclined to perceive high levels of negative emotions from facial expressions and who reported high levels of social distress at admission were less likely to be improved after 6 weeks. Among women, these high levels of perception of negative emotions and high levels of social distress tended to predict the persistence of depression independently. A propensity to perceive negative facial expressions may underlie the unfavourable course of depression, especially among women.

Nonverbal interpersonal sensitivity and persistence of depression: perception of emotions in schematic faces.

Deficits in the decoding of facial emotional expressions may play a role in the persistence of depression. In a prospective longitudinal study, 33 depressed outpatients (30 major depression, 2 dysthymia, and 1 cyclothymic disorder) judged schematic faces with respect to the emotions they expressed (fear, happiness, anger, sadness, disgust, surprise, rejection, and invitation) at admission (T0) and again 6 and 30 weeks later. Severity of depression (BDI) was assessed at these three times. Those patients who perceived less sadness, rejection, or anger in faces at T0 were less likely to show a favorable course of depression after 6 weeks (sadness, anger) or after 30 weeks (sadness, rejection, anger). These relationships could not be ascribed to initial levels of depression, age, or gender. The perception of sadness and rejection did not change over time, and therefore may have trait-like qualities. Depression appears to be more persistent in the subgroup that is hyposensitive to (negative) facial signals.

Prevalence and incidence of dementia among 75-80-year-old community-dwelling elderly in different districts of Antwerp, Belgium: the Antwerp Cognition (ANCOG) Study.

OBJECTIVE: To analyse the prevalence and incidence of dementia in a population of community-dwelling elderly (aged 75-80), living in socio-economically differing districts of Antwerp (Belgium), taking into account possible gender and educational differences. METHODS: A longitudinal cohort study (N=825) with a 3-year follow-up period (N=363). The Mini Mental State Examination (MMSE) was used as a primary screen of cognitive functioning. Scoring 21 or below led to a second phase examination by a neurologist, including the CAMDEX-R-N and a neurological examination, to provide a tentative aetiological diagnosis of dementia. These procedures were conducted annually during a 3-year follow-up period. RESULTS: In accordance with international literature, the overall prevalence rate of dementia was 8.7%. The cumulative incidence rate (IR) of dementia was 36.60 per 1000Py with annual IRs ranging from 34.39 over 35.16 to 49.04 per 1000Py. Dementia of the Alzheimer type (DAT) was the most occurring prevalent and incident cause. Women appeared to be at higher risk and the occurrence of cognitive deterioration was more prominent in districts with lower socio-economic status, possibly related to a lower education level. CONCLUSION: We demonstrate dementia is a considerable health problem in an urban Belgian population of community-dwelling elderly aged between 75 and 80 years old. In order to prepare health care and social security systems for the future management of dementia, proper epidemiological insight into the current and future magnitude of the burden of dementia, taking into account socio-economic differences, to which this study contributes, are required.

Nonverbal support giving induces nonverbal support seeking in depressed patients.

Nonverbal support seeking behavior of 11 mildly depressed patients was studied in relation to the nonverbal support giving behavior of a female interviewer. The patients were interviewed for 20 minutes during which the interviewer gave high and low nonverbal support for 10 minutes in a cross-over design. Different behavioral elements of the patients and of the interviewer were pooled into behavioral factors. Support seeking behavior (Speaking Effort) was significantly higher when high nonverbal support giving behavior (Encouragement) was displayed (p = .05). Also, a positive relationship between Encouragement and patients' Speech was observed (p = .04). The causal relationship between depressed patients' nonverbal support seeking behavior and an interviewer's nonverbal support giving behavior underscores an interpersonal approach of depression.

Depressed patients' perceptions of facial emotions in depressed and remitted states are associated with relapse: a longitudinal study.

Within the framework of interpersonal and cognitive theories of depression, we investigated whether the perception of facial emotions was associated with subsequent relapse into depression. The 23 inpatients with major depression who remitted (65 admitted patients) were studied at admission (T0), at discharge (T1), and 6 months thereafter to assess relapse. They judged schematic faces with respect to the expression of positive and negative emotions. Six patients (26.1%) relapsed. High levels of perception of negative emotions in faces, either assessed at T0 or at T1, were associated with relapse. Moreover, subjects saw more negative emotions in depressed than in remitted state. Significant results were confined to ambiguous faces, i.e., faces expressing equal amounts of positive and negative emotions. Our data support the hypothesis that a bias toward the perception of others' facial emotions as negative is an enduring vulnerability factor to depression relapse and depressed mood amplifies this negative bias in perception.

An interpersonal view on depression.

Cognitive and behavioural processes may constitute a risk for onset and persistence of depression. People who become depressed frequently show enduring negative cognitions which predispose them to depression. In addition, interpersonal processes are supposed to contribute to the etiology and maintenance of depression. Depression-prone persons are presumed to display deficient or problematic social behaviours that elicit negative reactions in others, finally resulting in withdrawal by family and friends. About 60% of human communication is non-verbal. An ethological approach may therefore contribute to reveal behavioural and cognitive vulnerability factors for depression onset or persistence. Various studies support this presumption: High levels of patients' observed behaviour indicating involvement in the interaction between depressives and clinicians at admission are related with persistence of depression.

Attunement of non-verbal behaviour between depressed patients and a psychiatrist at admission is related to persistence of depression.

According to interpersonal theories on depression, the type of interaction between depression-prone subjects and their social environment plays a causal role in the development and course of depression (e.g. Coyne et al.). So far, interpersonal theories have been tackled mostly by psychometrical methods. However, non-verbal behaviour plays an important role in human social interactions. It is assumed that 60-65% of human communication is non-verbal. Ethological observations have shown that non-verbal interpersonal behaviour of depressed subjects, as assessed prior to treatment, is related to treatment-response or subsequent course of depression. These results are in line with an interpersonal approach of depression.