Toward a very brief self-report to assess the core symptoms of depression (VQIDS-SR5 ).

OBJECTIVE: To develop a short, 5-item measure of the core symptoms of depression based on the 16-item Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR16 ) and to evaluate psychometric properties of this new measure (Very Quick Inventory of Depressive Symptomatology - Self-Report: VQIDS-SR5 ). METHOD: Using data from a convenience sample of the Combining Medications to Enhance Depression Outcomes (CO-MED) trial, we evaluated the psychometric properties of the VQIDS-SR5 , its sensitivity to change, and its comparability to the QIDS-SR16 and clinician-rated scales (QIDS-C16 and VQIDS-C5 ). RESULTS: The VQIDS-SR5 has a single-factor structure with an acceptable internal consistency (Cronbach's alpha: 0.67-0.81). The VQIDS-SR5 was as sensitive to change as its parent scale, then QIDS-SR16 and, detected change at an earlier time frame. Additionally, the VQIDS-SR5 was comparable to the QIDS-SR16 , QIDS-C16 , and VQIDS-C5 . CONCLUSION: The VQIDS-SR5 can effectively evaluate the core symptoms of depression during the course of treatment.

Pro-inflammatory cytokines as predictors of antidepressant effects of exercise in major depressive disorder.

Exercise is an efficacious treatment for major depressive disorder (MDD) and has independently been shown to have anti-inflammatory effects in non-depressed subjects. Patients with MDD have elevated inflammatory cytokines but it is not known if exercise affects inflammation in MDD patients and whether these changes are clinically relevant. In the TReatment with Exercise Augmentation for Depression (TREAD) study, participants who were partial responders to a selective serotonin reuptake inhibitor were randomized to receive one of two doses of exercise: 16 kilocalories per kilogram of body weight per week (KKW), or 4 KKW for 12 weeks. Blood samples were collected before initiation and again at the end of the 12-week exercise intervention. Serum was analyzed using a multiplexed ELISA for interferon-γ (IFN-γ), interleukin-1ß (IL-1ß), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). Higher baseline levels of TNF-α were associated with greater decrease in depression symptoms over the 12-week exercise period (P<0.0001). In addition, a significant positive correlation between change in IL-1ß and change in depression symptom scores was observed (P=0.04). There were no significant changes in mean level of any cytokine following the 12-week intervention, and no significant relationship between exercise dose and change in mean cytokine level. Results suggest that high TNF-α may differentially predict better outcomes with exercise treatment as opposed to antidepressant medications for which high TNF-α is linked to poor response. Our results also confirm findings from studies of antidepressant medications that tie decreasing IL-1ß to positive depression treatment outcomes.

Does exercise improve self-reported sleep quality in non-remitted major depressive disorder?

BACKGROUND: Sleep disturbances are persistent residual symptoms following remission of major depressive disorder (MDD) and are associated with an increased risk of MDD recurrence. The purpose of the current study was to examine the effect of exercise augmentation on self-reported sleep quality in participants with non-remitted MDD. Method Participants were randomized to receive selective serotonin reuptake inhibitor (SSRI) augmentation with one of two doses of exercise: 16 kilocalories per kilogram of body weight per week (KKW) or 4 KKW for 12 weeks. Depressive symptoms were assessed using the clinician-rated Inventory of Depressive Symptomatology (IDS-C). The four sleep-related items on the IDS-C (Sleep Onset Insomnia, Mid-Nocturnal Insomnia, Early Morning Insomnia, and Hypersomnia) were used to assess self-reported sleep quality. RESULTS: Significant decreases in total insomnia (p < 0.0001) were observed, along with decreases in sleep onset, mid-nocturnal and early-morning insomnia (p's <0.002). Hypersomnia did not change significantly (p = 0.38). Changes in total, mid-nocturnal and early-morning insomnia were independent of changes in depressive symptoms. Higher baseline hypersomnia predicted a greater decrease in depression severity following exercise treatment (p = 0.0057). No significant moderating effect of any baseline sleep on change in depression severity was observed. There were no significant differences between exercise treatment groups on total insomnia or any individual sleep item. CONCLUSIONS: Exercise augmentation resulted in improvements in self-reported sleep quality in patients with non-remitted MDD. Given the prevalence of insomnia as a residual symptom following MDD treatment and the associated risk of MDD recurrence, exercise augmentation may have an important role in the treatment of MDD.

Effects of fluoxetine on the polysomnogram in outpatients with major depression.

This study investigated the effects of open-label fluoxetine (20 mg/d) on the polysomnogram (PSG) in depressed outpatients (n = 58) who were treated for 5 weeks, after which dose escalation was available (< or = 40 mg/d), based on clinical judgment. Thirty-six patients completed all 10 weeks of acute phase treatment and responded (HRS-D < or = 10). PSG assessments were conducted and subjective sleep evaluations were gathered at baseline and at weeks 1, 5, and 10. Of the 36 subjects who completed the acute phase, 17 were reevaluated after 30 weeks on continuation phase treatment and 13 after approximately 7 weeks (range 6-8 weeks) following medication discontinuation. Acute phase treatment in responders was associated with significant increases in REM latency, Stage 1 sleep, and REM density, as well as significant decreases in sleep efficiency, total REM sleep, and Stage 2 sleep. Conversely, subjective measures of sleep indicated a steady improvement during acute phase treatment. After fluoxetine was discontinued, total REM sleep and sleep efficiency were found to be increased as compared to baseline.

The effects of fluoxetine on the polysomnogram of depressed outpatients: a pilot study.

The effects of fluoxetine (FLU) and its active metabolite, norfluoxetine (NFLU), on the polysomnogram (PSG) of nine depressed outpatients (eight with major depression; one with bipolar II, depressed phase disorder) were investigated by contrasting PSG values prior to treatment and during administration of FLU. The PSG changes were correlated with daily dose, cumulative dosage, single serum concentrations, and the total area under the serum concentration curve (AUC) of both FLU and NFLU. Fluoxetine clearly increased both stage 1 sleep time and rapid-eye-movement (REM) latency and decreased both percent REM and REM density. With a few exceptions, the cumulative dosage of FLU and the AUC of FLU and NFLU were better predictors of the changes in awake and movement time in the PSG than single-sample concentrations of FLU and NFLU taken at the time of PSG assessment.

Regional cerebral blood flow alterations in unipolar depression.

Forty-seven symptomatic inpatients and outpatients with major depression (13 nonendogenous, 23 endogenous, and 11 psychotic by Research Diagnostic Criteria) were compared with 138 normal control subjects. Absolute regional cerebral blood flow (rCBF, ml/minute/100 g) was measured with 133Xe single photon emission computed tomography. Flow ratios (region of interest/global flow) and residual scores (the difference between patient flow ratios and expected normal flow ratios, as derived from the control population) were also computed. Results revealed significant age x region x depression subtype interactions for absolute, ratio, and residual flow data. Consequently, a test of group means (or analysis of covariance) could not be used to examine between-group differences. Multiple regression analyses were employed to study the effects of age on rCBF. This analysis revealed that different, though sometimes overlapping, regions exhibited different age effects on rCBF in different depressive subtypes. Thus, diagnostic-subtype-dependent age effects on rCBF precluded comparisons of mean values within or across regions for subject groups, but distinguished between symptomatic depressed patients and control subjects and among patient groups. Possible causes of such effects include variations in duration of illness or medication history or sensitization phenomena.

Stability of self-esteem: assessment, correlates, and excuse making.

We examined stability and level of self-esteem as predictors of excuse making; the extent to which self-ratings of stability are related to a statistical index of self-esteem stability; and the relations between stability and certainty of self-esteem and a variety of other psychological constructs. Regarding excuse making, our findings indicated that for high self-esteem individuals, instability was related to greater excuse making following success, but not following failure. However, for low self-esteem individuals, instability was related to greater excuse making following failure, but not following success. Other findings indicated that self-ratings of stability were only minimally related to a statistical measure of stability based on repeated assessments of self-esteem obtained in naturalistic contexts. Finally, stability of self-esteem was not significantly correlated with certainty of self-esteem. In addition, the pattern of correlations that emerged between certainty and other constructs suggested that uncertainty reflects the phenomenal experience of a tenuous self-view. On the other hand, stability of self-esteem appears to reflect the extent to which one's self-view is malleable, which may not be completely available to conscious awareness. Our discussion focuses on the nature of self-esteem stability and the roles of stability and level of self-esteem in reactions to evaluative events.

Stability of self-esteem as a moderator of the relation between level of self-esteem and depression.

The hypothesis that stability of self-esteem would moderate the predictive relationship between level of self-esteem and depression was tested. Specifically, level of self-esteem was hypothesized to relate more strongly to subsequent depression for individuals with stable self-esteem than for individuals with unstable self-esteem. Results strongly supported this hypothesis. Implications for the relation between level of self-esteem and depression, and for the moderator variable approach to personality and prediction, are discussed.

Clinical, cognitive, and demographic predictors of response to cognitive therapy for depression: a preliminary report.

This preliminary study evaluated prognostic indicators or predictors of response to cognitive therapy. The sample included 37 unipolar outpatients with moderate to severe major nonpsychotic depressive disorder, according to Research Diagnostic Criteria. Demographic characteristics (sex, age, marital status, and education), pretreatment severity measures (Hamilton Rating Scale for Depression [HRSD] and Beck Depression Inventory [BDI]), pretreatment cognitive measures (Dysfunctional Attitudes Scale [DAS] and Attributional Style Questionnaire Failure Composite [ASQ-F]), and historical features (length of illness, length of current episode, number of episodes, and age of onset) were used in multiple regression models to predict response. In accord with previous findings, patients who had higher (rather than lower) pretreatment HRSD, BDI, or DAS scores and were single (rather than married) showed a poorer response to cognitive therapy, according to the HRSD. Furthermore, married outpatients with high DAS scores or single patients with low DAS scores showed an intermediate response to cognitive therapy, while single patients with high DAS scores responded the least. Generally, effects were stronger when response was assessed according to clinician-rated severity measures rather than patient self-reports.

Stability and level of self-esteem as predictors of anger arousal and hostility.

We examined stability of self-esteem and level of self-esteem as predictors of dispositional tendencies to experience anger and hostility. We reasoned that individuals with unstable high self-esteem would report especially high tendencies to experience anger and hostility, and that individuals with stable high self-esteem would report particularly low tendencies. We expected individuals with stable and unstable low self-esteem to fall between these two extremes. These predictions were derived from an analysis of anger and hostility that emphasized the instigating role of threats to self-esteem. Stability of self-esteem was assessed through multiple assessments of global self-esteem in naturalistic settings. Results revealed the predicted pattern for the tendency to experience anger and a "motor" component of hostility. The importance of considering both stability and level of self-esteem in analyses of anger and hostility is discussed.

The role of contextual factors in the relationship between physical activity and self-awareness.

Previous research has indicated that performing arousing or unusual activities heightens self-awareness, as indexed by the use of first person singular pronouns in a sentence completion task (McDonald, Harris & Maher, 1983; Wegner & Giuliano, 1980; 1983). This type of self-awareness seems to reflect awareness of oneself as an individual. In the study reported here, we examined the impact of contextual factors on both awareness of oneself as an individual and awareness of oneself as a group member. The latter type of self-awareness was indexed by the use of first person plural pronouns. Subjects either ran or walked in place while in one of three contexts: (1) alone; (2) with co-actors present; or (3) in a group which fostered interaction and interdependence among participants. The results indicated that, relative to the other two contexts, the group context lowered self-awareness as indexed by the use of first person singular pronouns, but enhanced self-awareness as indexed by the use of first person plural pronouns. This is discussed in terms of the impact that social context has on different forms of self-awareness.

Invariance in the MMPI's component structure.

Bernstein and Garbin (1985b) suggested that the Minnesota Multiphasic Personality Inventory's major clinical scales (excluding Scales ? and 5) can be approximated by an oblique three-component structure: (a) Profile Elevation, (b) Test-taking Attitudes, and (c) Optimism-Pessimism, collectively termed the salient weight model. In this study, we found that both this model and the MMPI's principal component structure remain invariant across race, sex, and, as previously noted, context of testing (job applicants vs. inmates in correctional institutions). We further noted that several alternative definitions of Profile Elevation provide equally satisfactory representation of the relations among the scales. This factor invariance is necessary, but not sufficient, for the MMPI to be viewed as unbiased.