ABSTRACT
Background: The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) is the most commonly used instrument to assess burnout. Although various factors have been reported to influence its validity, the influence of major depressive disorder (MDD) has not been previously considered. We developed this study to investigate the influence of MDD on the psychometric properties of the MBI-HSS in nursing assistants. Results: From a sample of 521 nursing assistants, we found in those with MDD (n = 138, 24.56%) a degree of data misfit into the model, revealed by non-acceptable values for the root mean square error of approximation (RMSEA; 0.073; p = 0.004) and for the comparative fit index (CFI; 0.912), while in the non-MDD group these indices were acceptable and good, respectively, for RMSEA (0.048; p = 0.639) and for CFI (0.951). Also, we found higher coefficients of correlation among MBI-HSS factors and less items loading properly in their respective factors in the MDD subset, when compared to the non-MDD subset. For the total sample, while original 3-factor solution was an acceptable model, the bifactor model fitted data better. Conclusions: MDD may impair the construct validity of MBI-HSS subscales, by increasing measurement error and decreasing model fitness. Therefore, researchers and health professionals should be aware of potential changes in the psychometric properties of the MBI-HSS when applied in subjects with depression.
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OBJECTIVES: We developed this study to investigate the association of fibromyalgia with personality traits, controlling for depression and other potential confounders. METHODS: We assessed personality traits using the Cloninger's Temperament and Character Inventory (TCI) in 78 female patients with fibromyalgia and in a control group of 78 subjects without fibromyalgia. The Mini-International Neuropsychiatric Interview was used to assess depression and anxiety diagnoses. To investigate the association between fibromyalgia and the Cloninger's Temperament and Character Inventory we performed unadjusted and adjusted analyses of covariance, using the TCI score as dependent variable and adjusting the model for depression, anxiety and for clinical and socio-demographic variables. We used a backward selection method to choose the final model. RESULTS: In the unadjusted analysis, fibromyalgia was associated with all personality traits, except persistency. After adjusting for depression and anxiety, patients with fibromyalgia presented decreased novelty seeking compared to controls; the differences in other personality traits were no longer significant. Novelty seeking was also correlated with the length of history of fibromyalgia and pain intensity. CONCLUSIONS: Decreased novelty seeking may be a personality trait associated with fibromyalgia. Depression and anxiety should be considered potential confounders in the evaluation of personality traits in this population.
Subject(s)
Depression/psychology , Fibromyalgia/psychology , Personality , Adult , Anxiety/psychology , Case-Control Studies , Exploratory Behavior , Female , Humans , Male , Middle Aged , Personality Inventory , Severity of Illness Index , TemperamentABSTRACT
BACKGROUND: Anhedonia constitutes a coherent construct, with neural correlates and negative clinical impact, independent of depression. However, little is known about the neural correlates of anhedonia in stroke patients. In this study, we investigated the association of post-stroke anhedonia with salivary cortisol levels and stroke location and volume. PATIENTS AND METHODS: A psychiatrist administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition to identify anhedonia in 36 inpatients, without previous depression, consecutively admitted in a neurology clinic in the first month after a first-ever ischemic stroke. Salivary cortisol levels were assessed in the morning, evening, and after a dexamethasone suppression test. We used magnetic resonance imaging and a semi-automated brain morphometry method to assess stroke location, and the MRIcro program according to the Brodmann Map to calculate the lesion volume. RESULTS: Patients with anhedonia had significantly larger diurnal variation (P-value =0.017) and higher morning levels of salivary cortisol (1,671.9±604.0 ng/dL versus 1,103.9±821.9 ng/dL; P-value =0.022), and greater stroke lesions in the parahippocampal gyrus (Brodmann area 36) compared to those without anhedonia (10.14 voxels; standard deviation ±17.72 versus 0.86 voxels; standard deviation ±4.64; P-value =0.027). The volume of lesion in the parahippocampal gyrus (Brodmann area 36) was associated with diurnal variation of salivary cortisol levels (rho=0.845; P-value =0.034) only in anhedonic patients. CONCLUSION: Our findings suggest that anhedonia in stroke patients is associated with the volume of stroke lesion in the parahippocampal gyrus and with dysfunction of the hypothalamic-pituitary-adrenal axis.
ABSTRACT
The relationship between depression and cognitive impairment, frequent after stroke, is complex and has not been sufficiently elucidated. OBJECTIVE: To review the relationship between post-stroke depression and cognitive impairment. METHODS: We performed a PubMed database search spanning the last ten years, using the terms post-stroke depression, cognitive dysfunction, cognitive impairment and neuropsychological tests. Our target studies were original quantitative studies that investigated the relationship between post-stroke depression (PSD) and cognitive impairment in stroke patients. Articles published in English, Spanish, Italian and Portuguese were considered. Selection criteria were the use of neuropsychological tests to assess cognitive function, and of either instruments to diagnose major depression, or scales to assess depressive symptoms, within the first three months after stroke. RESULTS: Six original quantitative studies fulfilled the criteria. The prevalence of PSD within the first three months after stroke ranged from 22% to 31%. Incidence ranged from 25% to 27% and was evaluated in only two studies. PSD was associated with increased cognitive impairment. Cognitive impairment was reported in 35.2% to 87% of the patients. Post-stroke cognitive deficits were reported mostly in executive function, memory, language, and speed of processing. CONCLUSION: Executive dysfunction and depression occur in stroke survivors, are frequently coexistent, and also associated with worse stroke prognosis. Healthcare professionals need to address and provide adequate treatment for depression and executive dysfunctions in stroke patients early in the first three months after stroke. Future studies should evaluate the efficacy of programs evaluating the early detection and treatment of PSD and executive dysfunction in stroke survivors.
A depressão e o déficit cognitivo são frequentes após o acidente vascular cerebral. A relação entre as duas condições é complexa e não tem sido suficientemente elucidada. OBJETIVO: Fazer uma revisão da relação entre a depressão pós-AVC e prejuízo cognitivo. MÉTODOS: Foi realizada uma pesquisa no banco de dados PubMed nos últimos dez anos. Nosso foco foi estudos quantitativos originais que investigaram a relação entre depressão e comprometimento cognitivo em pacientes com AVC. Os termos depressão, disfunção cognitiva, comprometimento cognitivo e testes neuropsicológicos foram usados para pesquisa. Foram considerados artigos publicados em Inglês, Espanhol, Italiano e Português. Os critérios de seleção foram o uso de testes neuropsicológicos para avaliar a função cognitiva com também o uso de instrumentos para diagnosticar a depressão maior ou escalas para avaliar sintomas depressivos nos primeiros três meses após o AVC. RESULTADOS: Seis estudos quantitativos originais preencheram os critérios de seleção. A prevalência de depressão pós-AVC nos primeiros três meses após o AVC variou de 22% a 31%. A incidência de depressão pós-AVC variou de 25% a 27% e foi avaliada apenas em dois estudos. A depressão pós-AVC esteve associada com comprometimento cognitivo mais acentuado. Disfunção cognitiva pós-AVC foi relatada em 35,2% a 87% dos pacientes. Déficits cognitivos pós-AVC foram encontrados principalmente em função executiva, memória, linguagem e velocidade de processamento. CONCLUSÃO: A disfunção executiva e a depressão ocorrem em pacientes de AVC, sendo frequentemente concomitantes e associadas a um pior prognóstico. Os profissionais de saúde devem diagnosticar e fornecer um tratamento adequado para a depressão e disfunção executiva nos primeiros três meses após o AVC. Mais estudos devem avaliar a efetividade de programas de detecção precoce e tratamento da depressão e disfunção executiva pós-AVC.
