Effects of childhood adversity on the volumes of the amygdala subnuclei and hippocampal subfields in individuals with major depressive disorder.

Background: Reductions in total hippocampus volume have frequently been reported in MRI studies in major depressive disorder (MDD), but reports of differences in total amygdala volume have been inconsistent. Childhood maltreatment is an important risk factor for MDD in adulthood and may affect the volume of the hippocampus and amygdala. In the present study, we examined associations between the volumes of the amygdala subnuclei and hippocampal subfields and history of childhood maltreatment in participants with MDD. Methods: We recruited 35 patients who met the DSM-IV criteria for MDD and 35 healthy controls. We acquired MRI data sets on a 4.7 T Varian Inova scanner. We manually delineated the amygdala subnuclei (lateral, basal and accessory basal nuclei, and the cortical and centromedial groups) and hippocampal subfields (cornu ammonis, subiculum and dentate gyrus) using reliable volumetric methods. We assessed childhood maltreatment using the Childhood Trauma Questionnaire in participants with MDD. Results: In participants with MDD, a history of childhood maltreatment had significant negative associations with volume in the right amygdala, anterior hippocampus and total cornu ammonis subfield bilaterally. For volumes of the amygdala subnuclei, such effects were limited to the basal, accessory basal and cortical subnuclei in the right hemisphere, but they did not survive correction for multiple comparisons. We did not find significant effects of MDD or antidepressant treatment on volumes of the amygdala subnuclei. Limitations: Our study was a cross-sectional study. Conclusion: Our results provide evidence of negative associations between history of childhood maltreatment and volumes of medial temporal lobe structures in participants with MDD. This may help to identify potential mechanisms by which maltreatment leads to clinical impacts.

An investigation of light and sound levels on intensive care units in China.

BACKGROUND: The intensive care units' (ICU) environment is considered clinically relevant sources of stress for patients. OBJECTIVES: To measure 24-h sound and light levels in 7 ICUs in China [four medical (MICU), two surgical (SICU) and one coronary (CCU) ICUs] and to identify the main sources related to increased sound levels. METHODS: Sound pressure and light levels were monitored for specific times over a 24-h period using a digital sound level meter and a light detector in 7 ICUs. Sound pressure levels were measured for 20min every hour. The main events at the time of peak noise levels were recorded. Light levels were measured every 2h at three locations for each ICU: near a window, in the centre of the room, at eye level of a patient receiving assisted ventilation. RESULTS: The mean value of 24-h sound pressure levels exceeded 50dB(A) in all ICUs, ranging from 56.5 to 70.1dB(A). The SICUs and CCU had higher sound pressure readings from 0700h to 1600h, compared to the MICUs where the sound pressure readings reflected less variability across the 24-h period. Marked differences were observed in luminance levels among various ICUs and also across the 24-h period for all three locations. The mean highest level of nocturnal luminance at eye level of patients receiving assisted ventilation ranged from 15 to 489lx before midnight (1800-2400h) and 10 to 239lx after midnight (2401-0759h). CONCLUSIONS: High sound pressure levels are prevalent throughout 24h in the ICUs, especially in the SICU. Many of the readings exceeded international standards. Peak sound pressure levels were related primarily to staff activities and the alarm sounds of machines. ICU patients are exposed to high levels of artificial light continuously throughout the day and night.

Effects of earplugs and eye masks combined with relaxing music on sleep, melatonin and cortisol levels in ICU patients: a randomized controlled trial.

INTRODUCTION: Intensive care unit (ICU) environmental factors such as noise and light have been cited as important causes of sleep deprivation in critically ill patients. Previous studies indicated that using earplugs and eye masks can improve REM sleep in healthy subjects in simulated ICU environment, and improve sleep quality in ICU patients. This study aimed to determine the effects of using earplugs and eye masks with relaxing background music on sleep, melatonin and cortisol levels in ICU patients. METHODS: Fifty patients who underwent a scheduled cardiac surgery and were expected to stay at least 2 nights in Cardiac Surgical ICU (CSICU) were included. They were randomized to sleep with or without earplugs and eye masks combined with 30-minute relaxing music during the postoperative nights in CSICU. Urine was analyzed for nocturnal melatonin and cortisol levels. Subjective sleep quality was evaluated using the Chinese version of Richards-Campbell Sleep Questionnaire (a visual analog scale, ranging 0-100). RESULTS: Data from 45 patients (20 in intervention group, 25 in control group) were analyzed. Significant differences were found between groups in depth of sleep, falling asleep, awakenings, falling asleep again after awakening and overall sleep quality (P < 0.05). Perceived sleep quality was better in the intervention group. No group differences were found in urinary melatonin levels and cortisol levels for the night before surgery, and the first and second nights post-surgery (P > 0.05). The urinary melatonin levels of the first and second postoperative nights were significantly lower than those of the night before surgery (P = 0.01). The opposite pattern was seen with urinary cortisol levels (P = 0.00). CONCLUSION: This combination of non-pharmacological interventions is useful for promoting sleep in ICU adult patients; however, any influence on nocturnal melatonin levels and cortisol level may have been masked by several factors such as the timing of surgery, medication use and individual differences. Larger scale studies would be needed to examine the potential influences of these factors on biological markers and intervention efficacy on sleep. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR-IOR-14005511 . Registered 21 November 2014.

Predictors of depressive symptoms and physical health in caregivers of individuals with schizophrenia.

This cross-sectional study examined relationships among factors influencing caregiver burden, depressive symptoms, and physical health in family caregivers of individuals with schizophrenia. Two hundred family caregivers of individuals with schizophrenia completed standardized questionnaires related to depressive symptoms, physical health, perceptions of burden, coping, and social support. The results revealed that 19.5% of family caregivers of individuals with schizophrenia experienced significant depressive symptoms and 65.5% perceived themselves in poor physical health. Burden, self-controlling coping strategies, and physical health status were all independently predictive of depressive symptoms. Two emotion-focused coping strategies (self-controlling and escape-avoidance) were independently predictive of caregiver burden. Only burden predicted physical health status. The findings suggest that health professionals who provide community care for those with schizophrenia need to consider the "unit of care" as the family rather than the individual. The health status of family caregivers should be routinely assessed. Individualized interventions to reduce family burden could include community-based health professionals as well as trained community volunteers, opportunities for social interaction, and improving self-care for all family members.

All you have to do is call; a pilot study to improve the outcomes of patients with coronary artery disease.

BACKGROUND: Studies have identified prevalence rates of major depression in patients with cardiovascular disease to range from 16% to 23%, whereas 65% of patients report some symptoms after a myocardial event. Depression has been shown to be strongly related to overall poorer outcomes in patients with coronary artery disease. PURPOSE: The purpose of this pilot study was to assess the potential benefit of providing follow-up information regarding mental health resources to patients who had undergone cardiac catheterization and had reported significant levels of depression symptoms. Two methods of providing this follow-up information (personal telephone interaction and mailed-out written information) were compared. METHODS: As part of the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease registry, patients completed baseline questionnaires, including the 10-item Center for Epidemiologic Studies Depression (CES-D) Scale. Patients reporting a score of 10 or higher were randomly assigned to one of three groups. Group A patients were contacted by mail, whereas Group B patients were contacted through a telephone follow-up call by a nurse. Both groups received information regarding community- and hospital-based mental health resources. Six weeks after the initial contact, patients in Groups A and B and those in a third control group (Group C) were called and asked to complete a repeat CES-D via telephone interview. Logistic regression modeling was used to determine the influence of the intervention on the change in depression scores from baseline to 6 weeks. RESULTS: Ninety-eight respondents had both baseline and 6-week CES-D scores. The mean age of the respondents was 64.9 years, and women constituted 27% of the sample. There was no statistically significant clinical difference between the three groups. Regression analysis demonstrated that patients who were contacted by either telephone or mail were significantly more likely to report improvement in the CES-D scores (odds ratio = 3.03, p = .03) as compared with the control group. Furthermore, respondents who were phoned reported the highest percentage of improved CES-D scores as compared with the mailed and control groups. CONCLUSIONS: This pilot study demonstrated that early recognition strategies and referral protocols that address mental health needs are effective in decreasing the reported depressive symptomatology of this high-risk population. Proactively addressing mental health issues as an integral part of the overall treatment with patients with coronary artery disease could potentially improve the health outcomes in this population.

Sex differences in prodromal symptoms of patients with acute coronary syndrome: a pilot study.

Increasing evidence suggests that there are sex/gender differences in the presentation and prodromal symptoms of acute coronary syndrome (ACS). The purpose of this pilot study was to identify sex differences in the prodromal symptoms of ACS using the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS). Telephone surveys using the MAPMISS were conducted between 4 and 6 months after the ACS event. Seventy-six patients (24 women) participated in the study. The women generally reported higher prodromal scores. Moreover, scores demonstrated differences in prodromal symptoms based on menopausal status. The premenopausal and perimenopausal women reported a greater number and higher frequency of symptoms compared with the men and menopausal women. The results of this study suggest that both men and women report nontraditional prodromal symptoms of ACS. In addition, there appears to be a difference in the frequency and number of symptoms reported based on menopausal status.

Management of Inflammatory Bowel Disease during Pregnancy and Breastfeeding Varies Widely: A Need for Further Education.

Background. Inflammatory bowel disease (IBD) affects patients in their young reproductive years. Women with IBD require maintenance therapies during pregnancy and breastfeeding. However, physician management of IBD during pregnancy and breastfeeding has not been well characterized. Objective. To characterize physician perceptions and management of IBD during pregnancy and breastfeeding. Methods. A cross-sectional survey of Canadian physicians who are involved in the care of women with IBD was conducted. The survey included multiple-choice and Likert scale questions about perceptions and practice patterns regarding the management of IBD during pregnancy and breastfeeding. Results. 183 practicing physicians completed the questionnaire: 97/183 (53.0%) gastroenterologists; 75/183 (41.0%) general practitioners; and 11/183 (6.0%) other physicians. Almost half (87/183, 47.5%) of the physicians felt comfortable managing pregnant IBD patients. For specified IBD medications, proportions of physicians who indicated they would continue them during pregnancy were as follows: sulfasalazine, 47.4%; oral mesalamine, 67.0%; topical mesalamine, 70.3%; oral prednisone, 68.0%; topical prednisone, 78.0%; oral budesonide, 61.6%; topical budesonide, 75.0%; ciprofloxacin, 15.3%; metronidazole, 31.4%; azathioprine, 57.1%; methotrexate, 2.8%; infliximab, 55.6%; adalimumab, 78.1%. Similar proportions of physicians would continue these medications during breastfeeding. A higher proportion of gastroenterologists than nongastroenterologists indicated appropriate use of these IBD medications during pregnancy and breastfeeding. Conclusions. Physician management of IBD during pregnancy and breastfeeding varies widely. Relative to other physicians, responses of gastroenterologists more frequently reflected best practices pertaining to medications for control of IBD during pregnancy and breastfeeding. There is a need for further education regarding the management of IBD during pregnancy and breastfeeding.

Decreased prefrontal Myo-inositol in major depressive disorder.

BACKGROUND: Postmortem studies have shown robust prefrontal cortex glial losses and more subtle neuronal changes in major depressive disorder (MDD). Earlier proton magnetic resonance spectroscopy (1H-MRS) studies of the glial marker myo-inositol in MDD were subject to potential confounds. The primary hypothesis of this study was that MDD patients would show reduced prefrontal/anterior cingulate cortex levels of myo-inositol. METHODS: Thirteen nonmedicated moderate-severe MDD patients and 13 matched control subjects were studied (six male, seven female per group). Proton magnetic resonance spectroscopy stimulated echo acquisition mode spectra (3.0 T; echo time=168 msec; mixing time=28 msec; repetition time=3000 msec) were obtained from prefrontal/anterior cingulate cortex. Metabolite data were adjusted for tissue composition. RESULTS: Patients with MDD showed significantly lower myo-inositol/creatine ratios (.94+/-.23) than control subjects (1.32+/-.37) [F(1,23)=6.9; p=.016]. CONCLUSIONS: These data suggest a reduction of myo-inositol in prefrontal/anterior cingulate cortex in MDD, which could be a consequence of glial loss or altered glial metabolism. Additional in vivo studies of glial markers could add to the understanding of the pathophysiology of MDD.

Does the level of reproductive knowledge specific to inflammatory bowel disease predict childlessness among women with inflammatory bowel disease?

BACKGROUND: Women with inflammatory bowel disease (IBD) may choose to remain childless due to a lack of IBD-specific reproductive knowledge. OBJECTIVES: To examine the effects of IBD-specific reproductive knowledge and discussion of family planning with a physician on childlessness among women with IBD. METHODS: Female IBD patients 18 to 45 years of age completed the Crohn's and Colitis Pregnancy Knowledge questionnaire (CCPKnow), and answered questions regarding reproductive history, plans to have children and discussion of family planning with a physician. CCPKnow scores were grouped according to poor (0 to 7), adequate (8 to 10), good (11 to 13) and very good (14 to 17). RESULTS: Of 434 eligible women, 248 (57.1%) completed the questionnaires. Of these 248 women, 51.6% were childless and, among these, 12.9% were voluntarily childless and 12.1% were trying to become pregnant. Childless women had a lower median CCPKnow score than women with children (6.0 versus 8.0; P=0.001). After adjusting for current age and marital status, each one point increase in the CCPKnow score corresponded to 8% lower odds of childlessness (OR 0.92 [95% CI 0.86 to 0.99]), 9% lower odds of voluntary childlessness (OR 0.91 [95% CI 0.79 to 1.0]) and 20% higher odds of trying to become pregnant (OR 1.2 [95% CI 1.0 to 1.4]). Discussion of family planning with a gastroenterologist corresponded to 72% lower odds of a poor CCPKnow score (OR 0.28 [95% CI 0.15 to 0.53]) and of voluntary childlessness (OR 0.28 [95% CI 0.057 to 1.3]). CONCLUSION: In the present study, higher IBD-specific reproductive knowledge lowered the odds of childlessness among women with IBD. Discussion of family planning with a physician was associated with higher CCPKnow scores and lower odds of voluntary childlessness.

Increased beclomethasone-induced vasoconstriction in women with posttraumatic stress disorder.

It has been hypothesized that patients with posttraumatic stress disorder (PTSD) show increased glucocorticoid sensitivity. The study tested beclomethasone-induced vasoconstriction (BIV), a measure of peripheral glucocorticoid sensitivity, in women with PTSD. A case-control design was employed in 33 PTSD patients and 33 healthy controls. BIV was tested using beclomethasone dipropionate (1-100 micro g/ml). Vasoconstriction was assessed after 15-18 h. Waking and afternoon salivary cortisol concentrations were measured. BIV ratings were significantly increased in PTSD at beclomethasone concentrations from 10-100 micro g/ml. Salivary cortisol concentrations did not differ between groups or correlate with BIV. Preliminary evidence has been found for increased peripheral glucocorticoid sensitivity in PTSD. Further study is required to replicate this finding and assess its relationship to the pathophysiology of the disorder.

Career advancement and educational opportunities: experiences and perceptions of internationally educated nurses.

The number of internationally educated nurses is increasing in the Canadian workforce. Recruitment of internationally educated nurses is often seen as a solution to ongoing nursing shortages. However, international recruitment needs to be accompanied by strategies to ensure long-term retention. One of the criteria for successful retention is the availability and accessibility of career advancement and educational opportunities. Little research exists on the opportunities for career advancement and education for internationally educated nurses in Canada. This interpretive descriptive study was conducted to look at the perceptions of internationally educated nurses regarding career advancement and educational opportunities in Alberta, Canada. Eleven internationally educated nurses, working as registered nurses in Alberta, were interviewed using semi-structured interviews. Five themes were identified: motherhood as a priority, communication and cultural challenges, process of skill recognition, perceptions of opportunity and need for mentorship.

Fronto-limbic volumetric changes in major depressive disorder.

BACKGROUND: Fronto-limbic dysregulation in major depressive disorder (MDD) may be influenced by early life stress and antidepressant treatment. The present structural MRI study aimed to determine the relationship between amygdala, cingulate and subgenual prefrontal cortex volumes in MDD and their associations with child abuse and antidepressants. METHODS: Right-handed subjects (21-50 years), meeting DSM-IV criteria for MDD, either with (n=19) or without (n=20) childhood sexual or physical abuse. Healthy controls (n=34) were matched for age, sex, education and smoking. 3D-MPRAGE images with a spatial resolution of 1.5 mm×1.0 mm×1.0 mm were acquired with a Siemens Sonata 1.5 T system. Volumes of subgenual prefrontal cortex, amygdala and affective, cognitive, superior and posterior divisions of cingulate cortex were analyzed using DISPLAY software using reliable volumetric protocols. Groups were compared using ANCOVA, with intracranial volume as a covariate. RESULTS: MDD subjects had low cingulate (cognitive division) and high amygdala volumes. Low cingulate volume was related to abuse and treatment history. Amygdala volume was predicted by subgenual prefrontal and cingulate (cognitive division) volumes and the presence of paracingulate cortex. LIMITATIONS: This study was cross sectional and the sample size was limited for subgroup and correlational analyses. SUMMARY: Our data suggest that MDD may be associated with alterations in anterior cingulate cortex and amygdala. Morphological variation, early stress and stress-protective factors may contribute to differences in fronto-limbic structures in MDD.

Gender roles in persistent sex differences in health-related quality-of-life outcomes of patients with coronary artery disease.

BACKGROUND: The increased recognition of significant sex/gender differences in health status outcomes, and the implications for clinical practice and service delivery, has led to calls for more gender sensitivity and specificity in research endeavors as well as within clinical practice. Previous investigations by our research group have consistently identified important sex differences in both changes in health status from baseline to 1 year and in health status outcomes of patients treated for coronary artery disease (CAD), with women reporting poorer health-related quality of life (HRQoL) compared with men. OBJECTIVE: The objective of this study was to examine whether persistent sex differences in the health status of patients with CAD may be attributed to social factors such as gender roles. METHODS: Sex differences in baseline clinical and demographic characteristics of patients who completed the 1-year follow-up survey were examined using t tests and χ(2) analyses. Structural equation modeling, an inclusive statistical modeling approach for testing hypotheses about relationships among measured and latent variables (concepts not observed or measured directly), was used to test our theoretical model. RESULTS: HRQoL data were collected on 2403 patients 1 year after index catheterization. The results indicated that the model fit was substantially improved by the addition of the conceptualized gender-role variable. Furthermore, there was a significant effect of gender role on QoL (-0.106; P < 0.05). Age, coronary anatomy, ejection fraction, physical limitation, anginal frequency, and gender role variables in this model were able to explain 51% of the variance in HRQoL. In particular, reported physical limitations, anginal frequency, and gender role had large statistically significant direct effects on HRQoL. CONCLUSIONS: Advances in the treatment of CAD have led to significant decreases in mortality rates. Our current challenge is to minimize the long-term impact of CAD on HRQoL outcomes. While a substantial body of literature has examined the correlations between gender-role attributes and a wide variety of both positive and negative outcomes, this area has not been explored in patients with cardiovascular disease. These findings suggest that further study of the influence of gender role (using a gender-role measurement) on HRQoL is needed.

Gender as a determinant of responses to a self-screening questionnaire on anxiety and depression by patients with coronary artery disease.

BACKGROUND: Because patients with coronary artery disease (CAD) could benefit from interventions to decrease psychological distress, it is important to identify these individuals. Both salivary cortisol level and the Hospital Anxiety and Depression Scale (HADS) are recognized measures of stress/anxiety and depression. OBJECTIVES: This study was designed to determine whether there is an association between anxiety and depression, as measured by the HADS, and salivary cortisol levels among patients with CAD, and whether this association is affected by gender. METHODS: All adult residents of Alberta, Canada, undergoing their first cardiac catheterization for CAD (>or=50% occlusion of >or=2 coronary arteries) were eligible for participation in this study. A 14-question survey (the HADS) and 3 saliva-collection devices (a 1-day supply) were sent to the participants' home within 1 week of their initial cardiac catheterization. Participants were asked to take saliva samples for determination of cortisol levels on waking and at 30 and 60 minutes after waking, and then return the completed questionnaire and saliva samples using a prepaid express mailing envelope. RESULTS: Seventy-one adults (52 men and 19 women) participated in the study. Mean (SD) ages were 68.4 (4.6) years for men and 69.1 (4.4) years for women. Among the women, significant negative correlations were found between the HADS anxiety score and the wake-up and 30-minute cortisol levels (higher HADS scores were associated with lower cortisol levels) (all, P < 0.05). Also among women, negative correlations were found between the HADS depression score and the salivary cortisol values, but the differences were not statistically significant. Conversely, among the men, nonsignificant positive correlations were found between the HADS anxiety scores and the salivary cortisol levels (higher HADS scores were associated with higher cortisol levels), and statistically significant positive correlations were observed between the HADS depression scores and all 3 salivary cortisol values (all, P < 0.05). CONCLUSIONS: Our findings suggest that the HADS is an appropriate screening instrument for anxiety and depression in patients with CAD. In particular, the scale appears to be sensitive for measuring anxiety in women and depression in men. When the HADS is used clinically as a screening tool, it should be examined through a "gender-based lens.".

Using saliva to measure endogenous cortisol in nursing home residents with advanced dementia.

Two research teams determined the feasibility of saliva collection for cortisol measurement in nursing home residents with advanced dementia. Study aims were to: (a) determine if sufficient saliva could be obtained for assay and (b) examine whether cortisol values exhibited range and variability for meaningful interpretation. Useable samples were consistent across sites, suggesting that saliva collection for cortisol assay is a viable method in this setting. Cortisol values showed range and variability. More than half of the residents showed the normal adult pattern of high morning levels decreasing throughout the day. A third of the participants demonstrated an increase in the evening cortisol levels, while the remaining profiles were flat, suggesting hypothalamic-pituitary-adrenal (HPA) dysregulation in this population.

Sex and gender discrepancies in health-related quality of life outcomes among patients with established coronary artery disease.

BACKGROUND: Although eradicating discrepancies in health is of unquestioned importance, there are few studies examining health-related quality of life (HRQOL) among men and women with coronary artery disease (CAD), a highly prevalent and morbid condition among industrialized nations. This study compares the HRQOL outcomes of men and women in Alberta, Canada, 1 year after the documentation of coronary artery disease by cardiac catheterization. METHOD AND RESULTS: Patients' disease-specific HRQOL was assessed 1 year after angiography using the Seattle Angina Questionnaire, whereas their generic health status, burden of depressive symptoms, and social support were respectively quantified with the EuroQol EQ-5D, the Center for Epidemiological Studies Depression Scale (short form), and the Medical Outcomes Study social support scale. The latter 2 instruments were used to adjust Seattle Angina Questionnaire outcomes for potential confounding characteristics hypothesized to be associated with sex and gender. General linear modeling and a change in Seattle Angina Questionnaire scores from baseline to 1 year were used to compare the HRQOL outcomes of men and women, after adjusting for demographics, clinical factors, depressive symptoms, and social support differences between groups. A total of 2394 (60% of those eligible) patients responded to the baseline and the 1-year follow-up survey. The adjusted mean 1-year Seattle Angina Questionnaire scores were significantly higher in men when compared with women, even after adjustment for all clinical factors, social support, depressive symptoms, and baseline HRQOL scales. Not only were women noted to have worse health status at the time of angiography, but despite adjusting for these differences, residual discrepancies in 1-year health status persisted. CONCLUSIONS: Women with coronary artery disease report worse HRQOL 1 year after coronary angiography when compared with men, and the discrepancies observed are only partially accounted for by sex differences in depression and social support. As a result, the measurement of gender roles and perceptions may be the best place to persist on the quest to identifying and understanding the noted discrepancies in cardiac recovery and HRQOL outcomes.

Beclomethasone-induced vasoconstriction in women with major depressive disorder.

OBJECTIVE: It has been hypothesized that abnormal negative feedback of cortisol release in major depressive disorder (MDD) may involve impaired central glucocorticoid receptor (GR) function. Beclomethasone-induced vasoconstriction (BIV) was recently used to test the hypothesis that impaired GR function generalizes to peripheral tissues, and it was reported that BIV was decreased in medicated patients with MDD. The objective was to test the hypothesis that BIV would be reduced in unmedicated women with MDD compared with healthy controls. DESIGN: Case-control. SETTING: A university womens' mental health research unit. PARTICIPANTS: Women aged 18-65 years (n=19) diagnosed, according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, with MDD after a structured interview and clinical assessment. Healthy women pair-matched for age, reproductive and smoking status. PROCEDURES: BIV was tested using a range of beclomethasone dipropionate concentrations (1-100 microg/mL) applied to the forearm, with vasoconstriction scored visually after 15-18 hours by raters blinded to diagnosis and the randomization of the application sites. OUTCOME MEASURE: Visual scores for BIV at each beclomethasone concentration. RESULTS: No significant differences between patients with MDD and controls were found. Postmenopausal women showed less of a response than premenopausal women or women taking sex-hormone preparations. CONCLUSION: The study did not concur with the previous finding that BIV is decreased in MDD. Further research is needed to determine whether the difference in findings is due to medication or to other factors that may have distinguished the samples, including sex, age, reproductive status, illness severity, treatment resistance and setting.