Association of age and packed red blood cell transfusion to 1-year survival--an observational study of ICU patients.

OBJECTIVES: To compare the 1-year survival for different age strata of intensive care unit (ICU) patients after receipt of packed red blood cell (PRBC) transfusions. BACKGROUND: Despite guidelines documenting risks of PRBC transfusion and data showing that increasing age is associated with ICU mortality, little data exist on whether age alters the transfusion-related risk of decreased survival. METHODS: We retrospectively examined data on 2393 consecutive male ICU patients admitted to a tertiary-care hospital from 2003 to 2009 in age strata: 21-50, 51-60, 61-70, 71-80 and >80 years. We calculated Cox regression models to determine the modifying effect of age on the impact of PRBC transfusion on 1-year survival by using interaction terms between receipt of transfusion and age strata, controlling for type of admission and Charlson co-morbidity indices. We also examined the distribution of admission haematocrit and whether transfusion rates differed by age strata. RESULTS: All age strata experienced statistically similar risks of decreased 1-year survival after receipt of PRBC transfusions. However, patients age >80 were more likely than younger cohorts to have haematocrits of 25-30% at admission and were transfused at approximately twice the rate of each of the younger age strata. DISCUSSION: We found no significant interaction between receipt of red cell transfusion and age, as variables, and survival at 1 year as an outcome.

Functioning status of adult children of depressed parents: a 23-year follow-up.

BACKGROUND: We compared adult offspring of depressed or control parents who were followed for 23 years. Comparisons were on depression symptoms, physical functioning and disability, social functioning, and utilization of help and coping. Also examined was whether the parent's course of depression (stably remitted, partially remitted, non-remitted) was associated with offspring functioning. METHOD: Depressed parents successfully followed at 23 years (n=248, 82%) identified 215 adult offspring; 67% returned questionnaires. Matched control parents successfully followed (n=235, 79%) identified 261 adult offspring; 68% completed questionnaires. RESULTS: Adult offspring of depressed parents were more impaired than adult offspring of controls (with gender and education controlled) in the domains of depression and disability, and obtained more help for mental health problems. They also reported more severe recent stressors and relied more on active cognitive coping and seeking alternative rewards to cope. Adult offspring of depressed and control parents were comparable in a number of domains: psychiatric and behavioral problems other than depression, physical functioning and pain, social functioning, and hospitalizations and medication use for depression. Adult offspring of parents with a non-remitted course of depression were the most likely to show impaired functioning compared with controls. CONCLUSIONS: Having a parent with depression is associated with more depression and disability in adulthood, but does not have debilitating effects in other life domains. Nonetheless, it may be important for offspring of depressed parents, particularly offspring of parents with a non-remitting depression course, to recognize their elevated risk of depression and potential need for help.

Drinking to cope, emotional distress and alcohol use and abuse: a ten-year model.

OBJECTIVE: This study examines the ability of baseline drinking to cope to predict drinking behavior across an ensuing 10-year period. In addition, it examines whether a propensity to consume alcohol to cope with stressors strengthens the link between emotional distress and drinking behavior. METHOD: The study uses survey data from a baseline sample of 421 adults (54% women) assessed four times over a 10-year period (i.e., baseline and 1-, 4- and 10-year follow-ups). RESULTS: Baseline drinking to cope was associated with more alcohol consumption and drinking problems at all four observations across the 10-year interval. Baseline drinking to cope also predicted increases in both alcohol consumption and drinking problems in the following year. Moreover, change in drinking to cope was positively linked to changes in both alcohol consumption and drinking problems over the interval. Individuals who had a stronger propensity to drink to cope at baseline showed a stronger link between both anxiety and depressive symptoms and drinking outcomes. CONCLUSIONS: Findings demonstrate the power of alcohol-related coping strategies in predicting long-term drinking behavior and they illustrate one way in which such coping is linked to alcohol use and abuse. More broadly, they underscore the importance of considering individual differences in emotion-based theories of drinking behavior.

Self-help group participation among substance use disorder patients with posttraumatic stress disorder.

Debate has ensued about whether substance use disorder (SUD) patients with comorbid posttraumatic stress disorder (PTSD) participate in and benefit from 12-step groups. One hundred fifty-nine SUD-PTSD and 1,429 SUD-only male patients were compared on participation in 12-step activities following an index episode of treatment. Twelve-step participation was similar for SUD patients with and without PTSD. PTSD patients with worldviews (e.g., holding disease model beliefs) that more closely matched 12-step philosophy participated more in 12-step activities. Although greater participation was associated with better concurrent functioning, participation did not prospectively predict outcomes after case mix adjustment. An exception was that greater participation predicted decreased distress among PTSD patients whose identity was more consistent with 12-step philosophy. In summary, PTSD patients participate in and benefit from 12-step participation; continuing involvement may be necessary to maintain positive benefits.

Long-term posttreatment functioning among patients with unipolar depression: an integrative model.

This study tested an integrative structural equation model of posttreatment functioning among 165 depressed patients followed for an average of 9 years after the end of an episode of treatment. The model examined (a) the link between life change and psychosocial resource change and (b) the role of resource change in mediating the relationship between life change and change in depression. An increase in the preponderance of negative over positive life events was associated with a decline in resources and an increase in depressive symptoms. A decline in resources was associated with an increase in depressive symptoms. The association between changes in events and depressive symptoms was completely mediated through resource change. These findings indicate that life stressors contribute to posttreatment depression through an erosion of personal and social resources.

Resource loss, resource gain, and depressive symptoms: a 10-year model.

This study examined a broadened conceptualization of the stress and coping process that incorporated a more dynamic approach to understanding the role of psychosocial resources in 326 adults studied over a 10-year period. Resource loss across 10 years was significantly associated with an increase in depressive symptoms, whereas resource gain across 10 years was significantly associated with a decrease in depressive symptoms. In addition, change in the preponderance of negative over positive events across 10 years was inversely associated with change in resources during the period. Finally, in an integrative structural equation model, the association between change in life events and depressive symptoms at follow-up was completely mediated through resource change.

Symptom-based predictors of a 10-year chronic course of treated depression.

The high likelihood of a chronic course of depression underscores the need to identify at intake patients most at risk for long-term nonremission. In a naturalistic study of 313 unipolar depressed patients, potential symptom-based risk factors were assessed at treatment intake and were used to predict a chronic course of treated depression over a 10-year interval. The prototypic chronically depressed patient was an individual who at baseline experienced more severe symptoms of fatigue, loss of interest in usual activities, trouble sleeping, and thoughts about death or suicide; was not calm, successful, or self-confident; and did not socialize with friends outside the home, and frequently coped with stressors by avoiding other people. A larger number of risk factors was associated with a higher likelihood of experiencing a chronic course. High-risk patients who received more psychological treatment during the index episode were more likely to experience a long-term course of remission or partial remission.

Depression and outpatient medical utilization: a naturalistic 10-year follow-up.

The current investigation described the relationship between depression and outpatient medical utilization in a sample of 424 treatment-seeking individuals diagnosed with a depressive disorder and a demographically matched community sample of 424 men and women. This relationship was assessed longitudinally from baseline (intake for the patient sample) to 1-, 4-, and 10-year follow-ups. Patients and community individuals demonstrated distinct patterns of depressive symptoms and outpatient medical utilization: patients declined in symptoms and medical utilization following treatment, although they continued to have higher levels of depressive symptoms and outpatient utilization than controls at each follow-up period. Community controls demonstrated no change from baseline in symptoms or utilization at any follow-up. Higher levels of depressive symptoms was associated with increased outpatient medical utilization over the 10 years, even when age, sex, marital status, medical comorbidity, and patient status were controlled. Results add further evidence for a relationship between symptoms of depression and outpatient utilization by documenting this relationship in a posttreatment sample. Furthermore, the findings underscore the need for long-term follow-ups in investigations of the association between treatment for depression and the outpatient medical utilization of depressed individuals.

Life circumstances and personal resources as predictors of the ten-year course of depression.

A 10-year naturalistic study of 313 patients who entered treatment for unipolar depression and a community comparison group of 284 nondepressed adults was conducted. We compared life stressors, social resources, personal resources, and coping among patients who were remitted (N = 76), partially remitted (N = 146), or nonremitted (N = 91). Compared with the controls and the remitted patients, the partially remitted and nonremitted patients consistently experienced more life stressors and fewer social resources, were less easygoing, and relied more on avoidance coping. A less easygoing disposition, fewer close relationships, and more reliance on avoidance coping were associated with higher odds of experiencing a course of partial remission or nonremission. In addition, more depressive symptoms and medical conditions predicted nonremission.

Risk factors for sustained nonremission of depressive symptoms: a 4-year follow-up.

Previous studies have suggested that a considerable number of depressed patients suffer from sustained or repeated episodes of depressive symptoms. We developed a risk factor index based on data obtained at admission to treatment predicting sustained nonremission of depressive symptoms over 4 years for a sample of 370 unipolar depressed inpatients and outpatients. The six risk factors for sustained nonremitted depression are: less education, more severe initial depressive mood and ideation, secondary major depression, prior treatment, comorbid medical conditions, and fewer close relationships. These findings suggest that identification of these risk factors before selecting treatment type and intensity may improve long-term clinical outcomes.

Family and extrafamily resources and the 10-year course of treated depression.

A group of 313 depressed patients and 284 controls was assessed at baseline (treatment intake for the patients) and at 1-year, 4-year, and 10-year follow-ups. Stably remitted patients achieved levels of family and extrafamily resources that were comparable with those of the controls. Although partially remitted and nonremitted patients' social resources improved, they continued to show deficits in these areas relative to controls and stably remitted patients. Several indexes of social resources predicted stable remission: more family independence, fewer family arguments and less conflict, and more helpful friends and activities with friends. Assessment of social resources at treatment intake and short-term follow-ups can help identify and provide intervention foci for patients at risk for nonremission of depression.

Life stressors, social resources, coping, and the 4-year course of unipolar depression.

Little is known about the effects of psychosocial factors on the long-term course of unipolar depression. This article examines the 4-year stability and change in life stressors, social resources, and coping, and their effect on the course of treated unipolar depression among 352 men and women. Depressed patients were assessed at treatment intake and at 1-year and 4-year follow-ups. Over the 4 years, patients improved in symptom outcomes, the quality of social resources, and coping responses; there were some declines in life stressors. Life stressors, social resources, and coping were related to patient functioning concurrently, after controlling for demographics, initial treatment, and initial dysfunction severity. Preintake medical conditions and family conflict consistently predicted poorer long-term outcomes. The findings imply that medical conditions and family conflict are important risk factors that predict poorer long-term outcome of depression.

Difficulty of follow-up and posttreatment functioning among depressed patients.

Evaluations of treatment outcome may obtain positively biased findings by failing to reassess patients who are difficult to follow and who may also be functioning more poorly than those who are successfully followed. We consider whether difficulty of follow-up is related to pre- and posttreatment functioning by reassessing 95% of a sample of 424 depressed patients after a 12-month interval. In contrast to earlier findings with other patient populations (e.g., alcoholic patients), there was no strong or consistent tendency for depressed patients who were more difficult to follow to be functioning more poorly after treatment. Moreover, poor functioning at treatment intake was not predictive of later difficulty of follow-up. However, patients who were younger, single, and of lower occupational level were somewhat more difficult to follow.