Mental disorders as risk factors for suicidal behavior in young people: A meta-analysis and systematic review of longitudinal studies.

BACKGROUND: Suicide is the second leading cause of death for young people. OBJECTIVE: To assess mental disorders as risk factors for suicidal behaviour among adolescents and young adults including population-based longitudinal studies. METHOD: We conducted a systematic literature review. Bibliographic searches undertaken in five international databases and grey literature sources until January 2017 yielded a total of 26,883 potential papers. 1701 full-text articles were assessed for eligibility of which 1677 were excluded because they did not meet our eligibility criteria. Separate meta-analyses were conducted for each outcome (suicide death and suicide attempts). Odds ratio (OR) and 95% confidence intervals (95%CI) and beta coefficients and standard errors were calculated. RESULTS: 24 studies were finally included involving 25,354 participants (12-26 years). The presence of any mental disorder was associated with higher risk of suicide death (OR = 10.83, 95%CI = 4.69-25.00) and suicide attempt (OR = 3.56; 95%CI 2.24-5.67). When considering suicidal attempt as the outcome, only affective disorders (OR = 1.54; 95%CI = 1.21-1.96) were significant. Finally, the results revealed that psychiatric comorbidity was a primary risk factor for suicide attempts. LIMITATIONS: Data were obtained from studies with heterogeneous diagnostic assessments of mental disorders. Nine case-control studies were included and some data were collected in students, not in general population. CONCLUSIONS: Mental disorders and comorbidity are strong predictors of suicide behaviour in young people. Detection and management of the affective disorders as well as their psychiatric comorbidity could be a crucial strategy to prevent suicidality in this age group.

Funciones ejecutivas en la depresión / Executive functions in depression

Las funciones ejecutivas (FE) se han definido como el conjunto de procesos cognitivos necesarios para formular objetivos, planificarlos y ejecutarlos. Las FE se estudiaron inicialmente en traumatismos craneales o lesiones del sistema nervioso central. Investigaciones recientes han mostrado que las alteraciones cognitivas (y de manera particular en las FE) constituyen una manifestación central de diferentes trastornos mentales, entre ellos la depresión. En pacientes con respuesta e incluso remisión de la sintomatología depresiva persisten síntomas residuales relacionados con las FE. La gravedad de la depresión, el subtipo clínico, la edad, la comorbilidad o los diferentes tratamientos parecen contribuir a las diferencias encontradas en las alteraciones de las FE. Los tratamientos farmacológicos y no farmacológicos de la depresión deben tener en cuenta de manera prioritaria estos hallazgos clínicos y de investigación (AU)

Executive functions (EF) have been defined as all the cognitive processes needed to formulate, plan and execute a goal. EF were initially studied in traumatic brain injuries or central nervous system lesions. Recent research has shown that cognitive alterations (and, in particular, EF) are a central manifestation of mental disorders, including depression. Patients with response and even remission of depressive symptoms still have residual symptoms related to EF. The differences found in EF alterations are influenced by the severity of the depression, the clinical subtype, age, comorbidities and the distinct treatments. Both pharmacological and non-pharmacological treatments of depression should give priority to these clinical and research findings (AU)

The CORE system for sub-typing melancholic depression: Adaptation and psychometric properties of the Spanish version.

We report the development procedure for a Spanish version of the CORE measure for subtyping melancholic depression and its psychometric properties. The sample comprised two subsets of depressive patients: 117 in-patients clinically assessed after admission and before discharge; and 34 in- and out-patients who were video-recorded, with each recording being rated by independent raters and re-rated six months later. The internal consistency of the Spanish version of the CORE was high, with Cronbach's alpha coefficient of 0.93 for the total CORE score. High intra-class correlation coefficient for the total score (0.96) and the three subscales (around 0.8) indicate high inter-rater reliability. Baseline and six-month ratings of video-recordings showed high test-retest reliability. Regarding construct validity, the correlation between the CORE and the Newcastle endogeneity scale scores was 0.64. A ROC curve generated an optimal cut-off of 10 to predict the definition of endogeneity/melancholia based on the Newcastle score >=6 and the DSM-IV-TR definition of melancholia. The comparison between the CORE scores at admission and at discharge revealed large differences, indicating demonstrable sensitivity to change. The Spanish version of the CORE system is a reliable and valid instrument for sub-typing depression in terms of melancholic versus non-melancholic sub-types.

Alteraciones cognitivas y depresión: una revisión crítica / Cognitive impairments and depression: a critical review

Las alteraciones cognitivas constituyen un síntoma nuclear de los trastornos depresivos. Analizamos las revisiones sistemáticas y los metaanálisis publicados en los últimos 10 años (2004-2014) que estudian el rendimiento cognitivo de pacientes deprimidos teniendo en cuenta las variables de edad, características clínicas y demográficas, gravedad de la sintomatología, número de episodios previos, remisión clínica, subtipos depresivos y tratamiento farmacológico. Se incluyeron 12 trabajos tras la búsqueda en bases de datos internacionales. Las funciones afectadas en primeros episodios fueron la velocidad psicomotora, la atención, el aprendizaje y la memoria visual, así como las funciones ejecutivas. Los pacientes deprimidos en fase de remisión presentan una mejoría en las tareas de atención, aunque sin alcanzar los niveles de rendimiento de los controles sanos. El subtipo melancólico parece contribuir a las diferencias en los déficits cognitivos expresados. Pacientes tratados con fármacos antidepresivos clásicos obtienen peores resultados en las puntuaciones compuestas de inhibición, en las pruebas de fluidez verbal, en las puntuaciones de memoria de trabajo verbal y en las puntuaciones compuestas de memoria de trabajo viso-espacial. Futuros estudios deben explorar la naturaleza longitudinal y la relevancia clínica de los síntomas cognitivos, determinar la dirección etiopatogénica de los mismos y su impacto en la funcionalidad global. De manera particular será relevante analizar en los nuevos fármacos antidepresivos su capacidad de mejorar no solo la sintomatología afectiva sino también las alteraciones cognitivas

Cognitive disturbances are core symptoms of depressive disorders. We assess the systematic reviews and meta-analysis studies published over the last 10 years (2004-2014) that address cognitive performance of depressed patients and taking into account age; clinical and demographic features; symptom severity; number of previous episodes; clinical remission; depressive subtypes and pharmacological treatment. Twelve (12) papers were included after search in international databases. In first episode depression the cognitive domains affected were psychomotor speed, attention, visual learning and memory as well as executive functions. Depressive patients in remission phase improved their performance in attention tasks although they did not achieve similar performance levels as healthy controls. Melancholic patients seem to have a different pattern of cognitive impairment compared with non-melancholic depressive patients. Patients treated with the current antidepressants perform worse in inhibition tasks, verbal fluency, and working memory scores as well as on composite scores of visual and verbal working memory. Future research should study longitudinal outcome and clinical relevance of cognitive symptoms, determine their underlying etiopathogenesis and how they impact on clinical functioning. Specifically, it would be important to analyze the ability of the new antidepressant drugs to improve affective symptoms as well as cognitive dysfunctions

Cognitive impairments and depression: a critical review.

Cognitive impairments are core symptoms of depressive disorders. We assess the systematic reviews and meta-analysis studies published over the last 10 years (2004-2014) that address cognitive performance of depressed patients and taking into account age; clinical and demographic features; symptom severity; number of previous episodes; clinical remission; depressive subtypes and pharmacological treatment. Twelve (12) papers were included after search in international databases. In first episode depression the cognitive domains affected were psychomotor speed, attention, visual learning and memory as well as executive functions. Depressive patients in remission phase improved their performance in attention tasks although they did not achieve similar performance levels as healthy controls. Melancholic patients seem to have a different pattern of cognitive impairment compared with non-melancholic depressive patients. Patients treated with the current antidepressants perform worse in inhibition tasks, verbal fluency, and working memory scores as well as on composite scores of visual and verbal working memory. Future research should study longitudinal outcome and clinical relevance of cognitive symptoms, determine their underlying etiopathogenesis and how they impact on clinical functioning. Specifically, it would be important to analyze the ability of the new antidepressant drugs to improve affective symptoms as well as cognitive dysfunctions.

Cognitive impairment in remitted and non-remitted depressive patients: A follow-up comparison between first and recurrent episodes.

Cognitive impairment is a core symptom of depressive disorders associated with poor social function. New research is needed to analyze depression-related symptoms in cognitive impairment and to observe if they are reversible or not during clinical remission in patients with or without previous episodes. None of the previous studies has analyzed the differences between first and recurrent episodes in a long-term follow-up study related with remission state. The aim of our study was to compare cognitive performance and assess the impact of previous depressive episodes in a sample of patients in acute phase and in remission six month later. 79 depressive patients were assessed at baseline. The instruments used for clinical and cognitive assessment were: Hamilton Depression Rating Scale, Mini-Mental State Examination and the Clinical Global Impression Rating Scales, Trail Making Test parts A and B, Digital Span subtest of WAIS, Stroop Colour Word Test, Tower of London, Controlled Verbal Fluency Task, Semantic Verbal Fluency and Finger Tapping Test. A repeated measures MANCOVA with education as covariate was used. No differences were found at baseline between first episode and recurrent depressive patients. At six month, remitted patients scored significant better in TMT-A, TMT-B, Animals and Tower of London total time. Remitted first depressive patients scored significant worse than remitted recurrent depressive patients. The main finding of the study is the effect of remission on cognitive function despite previous episodes. However first episode remitted patients seemed to have poor access to long term memory than recurrent remitted patients.

Efficacy of low-intensity psychological intervention applied by ICTs for the treatment of depression in primary care: a controlled trial.

BACKGROUND: Depression is one of the most common disorders in Psychiatric and Primary Care settings and is associated with significant disability and economic costs. Low-intensity psychological interventions applied by Information and Communication Technologies (ICTs) could be an efficacious and cost-effective therapeutic option for the treatment of depression. The aim of this study is to assess 3 low-intensity psychological interventions applied by ICTs (healthy lifestyle, positive affect and mindfulness) in Primary Care; significant efficacy for depression treatment has previously showed in specialized clinical settings by those interventions, but ICTs were not used. METHOD: Multicenter controlled randomized clinical trial in 4 parallel groups. Interventions have been designed and on-line device adaptation has been carried out. Subsequently, the randomized controlled clinical trial will be conducted. A sample of N = 240 mild and moderate depressed patients will be recruited and assessed in Primary Care settings. Patients will be randomly assigned to a) healthy lifestyle psychoeducational program + improved primary care usual treatment (ITAU), b) focused program on positive affect promotion + ITAU c) mindfulness + ITAU or d) ITAU. The intervention format will be one face to face session and four ICTs on-line modules. Patients will be diagnosed with MINI psychiatric interview. Main outcome will be PHQ-9 score. They will be also assessed by SF-12 Health Survey, Client Service Receipt Inventory, EuroQoL-5D questionnaire, Positive and Negative Affect Scale, Five Facet Mindfulness Questionnaire and the Pemberton Happiness Index. Patients will be assessed at baseline, post, 6 and 12 post-treatment months. An intention to treat and per protocol analysis will be performed. DISCUSSION: Low-intensity psychological interventions applied by Information and Communication Technologies have been not used before in Spain and could be an efficacious and cost-effective therapeutic option for depression treatment. The strength of the study is that it is the first multicenter controlled randomized clinical trial of three low intensity and self-guided interventions applied by ICTs (healthy lifestyle psychoeducational program; focused program on positive affect promotion and brief intervention based on mindfulness) in Primary Care settings. TRIAL REGISTRATION: Current Controlled Trials ISRCTN82388279 . Registered 16 April 2014.

Validación de la versión española de la escala Screening for Somatoform Symptoms-2 para la evaluación de síntomas somáticos en Atención Primaria / Validation of the Spanish version of the Screening for Somatoform Symptoms-2 scale for use in Primary Care

OBJETIVO: Estudiar la validez diagnóstica y aportar los valores de sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo de la versión española de la escala Screening for Somatoform Symptoms-2(SOMS-2) en una muestra de pacientes de AP. DISEÑO: Estudio de validación. Emplazamiento: Centros de salud de AP de Aragón y Baleares. PARTICIPANTES: Ciento nueve pacientes somatizadores prodecedentes de un ensayo clínico previo y 56 pacientes no somatizadores incluidos para la validación de la escala. MEDICIONES PRINCIPALES: Sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y α de Cronbach. RESULTADOS: De un total de 165 sujetos, el 75% fueron mujeres y el 60% presentó trastorno de somatización y/o trastorno de ansiedad o depresivo. La SOMS-2 de 53 ítems y con un punto de corte de 4 presentó una sensibilidad del 97%, una especificidad del 68%, un valor predictivo positivo del 85%, un valor predictivo negativo del 92% y una alta consistencia interna (α de Cronbach = 0,926). CONCLUSIONES: La versión española de la SOMS-2 constituye un instrumento de cribado eficaz, útil y de fácil administración para la evaluación de los trastornos somatomorfos en AP. Los resultados de sensibilidad, especificidad y consistencia interna son similares a los de estudios previos de validación de la SOMS-2 en otras lenguas europeas

OBJECTIVE: To study the diagnostic validity and to provide the sensitivity, specificity, positive predictive value and negative predictive value of the Spanish version of the Screening for Somatoform Symptoms-2 (SOMS-2) scale in a PC population sample. DESIGN: Validation study. SETTING: PC centres in Aragon and Balearic Islands, Spain. PARTICIPANTS: A sample of 109 patients from a clinical trial with somatoform disorders and 56 patients without somatoform disorder were included for the scale validation. Main outcome measures: Sensitivity, specificity, positive predictive value, negative predictive value and Cronbach's α coefficient. RESULTS: Of the total sample of 165 subjects, 75% were women and 60% had a diagnosis of somatization disorder and/or anxiety or depressive disorder. The 53-item version of the SOMS-2 with a cut-off point of 4 showed a sensitivity of 97%, a specificity of 68%, a positive predictive value of 85%, a negative predictive value of 92%, and high internal consistency (Cronbach α = 0.926). CONCLUSIONS: The Spanish version of the SOMS-2 seems to be a reliable screening tool, easy to complete and useful for the assessment of somatoform disorders in PC settings. The results for specificity, sensitivity, and internal consistency are similar to previous studies in other European languages

The Mediterranean diet and micronutrient levels in depressive patients / Dieta mediterránea y niveles de micronutrientes en pacientes depresivos

Introduction: An inverse association between depression and some serum micronutrient levels (selenium, zinc, iron, magnesium, vitamin B and folic acid) has been reported. In addition, other studies reported that this micronutrient supplementation may improve depressed mood. The Mediterranean diet contains a sufficient amount of the micronutrients mentioned, although no study has reported an association between diet prescription and increased levels of them in depressive patients. Objective: To examine the impact of dietary patterns recommendations on micronutrient levels in depressive patients. Methods: 77 outpatients were randomly assigned either to the active (hygienic-dietary recommendations on diet, exercise, sleep, and sun exposure) or control group. Outcome measures were assessed before and after the six month intervention period. Results: Serum selenium and zinc levels were slightly low at basal point and serum selenium was inversely correlated with severity of depression (r=-0.233; p=0.041). A better outcome of depressive symptoms was found in the active group. Nevertheless, no significant differences in micronutrient levels were observed after the Mediterranean diet pattern prescription, probably due to an insufficient adherence. Conclusion: Selenium, zinc, iron, magnesium, vitamin B12 and folic acid serum levels didn`t increase in depressed patients after six months of the Mediterranean diet pattern prescription (AU)

Introducción: Se ha comunicado una correlación inversa entre depresión y el nivel sérico de algunos micronutrientes (selenio, zinc, hierro, magnesio, vitamina B y ácido fólico). Además, otros estudios han señalado que la suplementar de estos micronutrientes puede mejorar la depresión. La dieta mediterránea proporciona una suficiente cantidad de los micronutrientes mencionados, aunque ningún estudio ha probado si la prescripción de dicha dieta puede incrementar los niveles de micronutrientes en pacientes depresivos. Objetivo: Examinar el impacto de recomendar un patrón dietético mediterráneo en los niveles de micronutrientes de pacientes deprimidos. Material y Métodos: 77 pacientes ambulatorios se aleatorizaron entre un grupo de intervención (recomendaciones higiénico-dietéticas sobre dieta, ejercicio, sueño y exposición solar) y un grupo control. La evolución fue evaluada antes y después de los seis meses del periodo de intervención. Resultados: Los niveles de selenio y de zinc fueron ligeramente bajos en la determinación basal y el nivel de selenio correlacionaba inversamente con la severidad de la depresión (r=-0.233; p=0.041). El grupo activo evolucionó mejor de la clínica depresiva. Sin embargo, no se observaron diferencias significativas en los niveles de micronutrientes después de la prescripción del patrón de dieta mediterránea probablemente a causa de una insuficiente adherencia. Conclusión: Los niveles séricos de selenio, zinc, hierro, magnesio vitamina B12 y ácido fólico no aumentaron en pacientes depresivos seis meses después de prescribir un patrón de dieta mediterránea (AU)

Cognitive function after clinical remission in patients with melancholic and non-melancholic depression: a 6 month follow-up study.

BACKGROUND: Cognitive symptoms are core symptoms with an impact on functioning in depression. Remission is considered as the main objective of the management and treatment of depression. This study was aimed to compare cognitive performance between melancholic (MelD) and non-melancholic depression (NMelD) and to determine whether these cognitive alterations remain after clinical remission. METHODS: We performed a 6 month follow-up study of 88 melancholic and non-melancholic depressive patients. Sociodemographic and clinical characteristics were recorded. Depression was examined using the Hamilton Depression Rating Scale and the CORE Index for Melancholia. Cognitive performance was assessed with the Trail Making Test (TMT), the Digit Span subtest of the WAIS-III, Stroop Colour Word Test (SCWT), the Tower of London (TOL DX), the Controlled Oral Word Association Test (FAS), Semantic Verbal Fluency and Finger Tapping Test (FTT). RESULTS: MelD patients show worse performance than N-MelD at baseline, with significant differences at Digit Span subtest of WAIS Part I and Part II, SCWT Part I and Part II, TOL DX, Total Problem Solving, Total Execution Time and FTT- Preferred hand. Cognitive impairment remains at six months follow-up after clinical remission in MelD. In the comparison between remitted and non-remitted patients, cognitive impairment in Trail Making Test Part B and Verbal and Semantic Fluency (Animals) remains after clinical remission in MelD group but not in non-melancholic patients. LIMITATIONS: The use of psychopharmacological treatment and the small sample of melancholic patients. CONCLUSIONS: Patients with MelD do not improve cognitive performance despite clinical remission compared with remitted NMelD patients. The persistence of some cognitive dysfunctions in MelD remitted patients could represent a trait marker of a different depressive subtype and not be secondary to disease severity.

[Validation of the Spanish version of the Screening for Somatoform Symptoms-2 scale for use in Primary Care]. / Validación de la versión española de la escala Screening for Somatoform Symptoms-2 para la evaluación de síntomas somáticos en Atención Primaria.

OBJECTIVE: To study the diagnostic validity and to provide the sensitivity, specificity, positive predictive value and negative predictive value of the Spanish version of the Screening for Somatoform Symptoms-2 (SOMS-2) scale in a PC population sample. DESIGN: Validation study. SETTING: PC centres in Aragon and Balearic Islands, Spain. PARTICIPANTS: A sample of 109 patients from a clinical trial with somatoform disorders and 56 patients without somatoform disorder were included for the scale validation. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive predictive value, negative predictive value and Cronbach's α coefficient. RESULTS: Of the total sample of 165 subjects, 75% were women and 60% had a diagnosis of somatization disorder and/or anxiety or depressive disorder. The 53-item version of the SOMS-2 with a cut-off point of 4 showed a sensitivity of 97%, a specificity of 68%, a positive predictive value of 85%, a negative predictive value of 92%, and high internal consistency (Cronbach α=0.926). CONCLUSIONS: The Spanish version of the SOMS-2 seems to be a reliable screening tool, easy to complete and useful for the assessment of somatoform disorders in PC settings. The results for specificity, sensitivity, and internal consistency are similar to previous studies in other European languages.

Metabolic syndrome improvement in depression six months after prescribing simple hygienic-dietary recommendations.

BACKGROUND: Changes in diet and exercise have been separately demonstrated to improve Depression, although scientific evidence available is scarce. In a previously published controlled study, just recommending these and other lifestyle measures (sleep restriction and sunlight exposure) in combination once, patients experienced improvements in their depressive symptoms six months later. In this sample, one in three depressive patients had metabolic syndrome (MetS) at baseline. First line treatment of MetS condition is hygienic-dietetic, being Mediterranean diet and exercise especially important. Therefore we analyzed if lifestyle recommendations also improved their metabolic profile. FINDINGS: During the sixth month evaluation, a smaller number of patients from the group receiving hygienic-dietary recommendations met MetS criteria comparing with the control group. CONCLUSIONS: This study suggests that costless lifestyle recommendations, such as exercise and Mediterranean diet, have the capacity to promote both mental and physical health in a significant proportion of depressive patients. Further research is needed to confirm or discard these preliminary findings.

Adherencia terapéutica en pacientes depresivos de atención primaria: un estudio longitudinal / Therapeutic adherence in primary care depressed patients: a longitudinal study

Introducción: La falta de adherencia se asocia a una reducción de la eficacia del tratamiento antidepresivo, incrementando la probabilidad de recurrencias y la persistencia de los síntomas clínicos. Los pacientes con mala adherencia a la medicación presentan más enfermedades médicas concomitantes y más sintomatología somática y generan mayor uso de los servicios de salud. Método: Estudio observacional y longitudinal del grado de adherencia terapéutica en pacientes con trastorno depresivo atendidos en 3 centros de Atención Primaria (AP). Se realizaron 8 evaluaciones a lo largo de 6 meses a un total de 29 sujetos mayores de 18 años, con diagnóstico DSM-IV-TR de Depresión Mayor. Se pretendía determinar el grado de adherencia al tratamiento, analizar los datos sociodemográficos y perfiles clínicos que intervienen en la adherencia y observar la evolución de la sintomatología depresiva. Resultados: Un 72.4% de los pacientes mostraron una buena adherencia terapéutica. Aparecieron diferencias estadísticamente significativas en el Drug Attitude Inventory (U=107.5; p=0.036), instrumento que evalúa el efecto percibido de la medicación, con una mejor percepción en los pacientes con buena adherencia. En estos pacientes se produjo una reducción progresiva en la puntuación de la Escala de Hamilton en cada una de las 6 visitas de seguimiento, alcanzando remisión de síntomas en la evaluación del 4º mes. En el análisis de supervivencia no se observaron diferencias significativas entre ambos grupos [Log Rank (χ2=1.610, p=0.205)]. Conclusiones: La adherencia encontrada en este estudio longitudinal en AP es elevada y se asocia a una mejoría en el curso de la enfermedad. Un mejor efecto percibido del tratamiento está significativamente relacionado con una mejoría en la sintomatología depresiva

Introduction: Lack of adherence has been associated to lower efficacy of anti-depressant treatment, increasing the risk of recurrence and persistence of clinical symptoms. Patients with poor medication adherence have more concomitant medical illnesses and somatic symptoms. Furthermore, this increases use of healthcare services. Method: Longitudinal and observational study on therapeutic adherence level in depressive outpatients treated in 3 Primary Care (PC) centers. Eight evaluations during 6 months were carried out in 29 patients over 18, with DSM-IV-TR major depression diagnosis. The purpose of the present study was to determine adherence level, to analyze socio-demographic factors and clinical profiles involved in adherence, and to observe the evolution of depressive symptoms. Results: Good therapeutic adherence was observed in72.4% of patients. Significant differences in the Drug Attitude Inventory (U=107.5; p=0.036) were found. This tool evaluates the perceived effect of the medication, with a better perception observed in adherent patients. In those patients a progressive reduction on the Hamilton Depression Scale was found over the course of six monthly follow-up visits, with clinical remission observed in month 4. The analysis of survival rate did not reveal any significant difference between the two groups [Log Rank (χ2=1.610, p=0.205)]. Conclusions: The therapeutic adherence observed in this longitudinal PC study is high, and it is associated with an improvement in the illness. A better perceived effect of the treatment showed a significant connection to an improvement in symptoms of depression

Therapeutic adherence in primary care depressed patients: a longitudinal study.

INTRODUCTION: Lack of adherence has been associated to lower efficacy of anti-depressant treatment, increasing the risk of recurrence and persistence of clinical symptoms. Patients with poor medication adherence have more concomitant medical illnesses and somatic symptoms. Furthermore, this increases use of healthcare services. METHOD: Longitudinal and observational study on therapeutic adherence level in depressive outpatients treated in 3 Primary Care (PC) centers. Eight evaluations during 6 months were carried out in 29 patients over 18, with DSM-IV-TR major depression diagnosis. The purpose of the present study was to determine adherence level, to analyze socio-demographic factors and clinical profiles involved in adherence, and to observe the evolution of depressive symptoms. RESULTS: Good therapeutic adherence was observed in 72.4% of patients. Significant differences in the Drug Attitude Inventory (U=107.5; p=0.036) were found. This tool evaluates the perceived effect of the medication, with a better perception observed in adherent patients. In those patients a progressive reduction on the Hamilton Depression Scale was found over the course of six monthly follow-up visits, with clinical remission observed in month 4. The analysis of survival rate did not reveal any significant difference between the two groups [Log Rank (χ2=1.610, p=0.205)]. CONCLUSIONS: The therapeutic adherence observed in this longitudinal PC study is high, and it is associated with an improvement in the illness. A better perceived effect of the treatment showed a significant connection to an improvement in symptoms of depression.

The Mediterranean diet and micronutrient levels in depressive patients.

INTRODUCTION: An inverse association between depression and some serum micronutrient levels (selenium, zinc, iron, magnesium, vitamin B and folic acid) has been reported. In addition, other studies reported that this micronutrient supplementation may improve depressed mood. The Mediterranean diet contains a sufficient amount of the micronutrients mentioned, although no study has reported an association between diet prescription and increased levels of them in depressive patients. OBJECTIVE: To examine the impact of dietary patterns recommendations on micronutrient levels in depressive patients. METHODS: 77 outpatients were randomly assigned either to the active (hygienic-dietary recommendations on diet, exercise, sleep, and sun exposure) or control group. Outcome measures were assessed before and after the six month intervention period. RESULTS: Serum selenium and zinc levels were slightly low at basal point and serum selenium was inversely correlated with severity of depression (r=-0.233; p=0.041). A better outcome of depressive symptoms was found in the active group. Nevertheless, no significant differences in micronutrient levels were observed after the Mediterranean diet pattern prescription, probably due to an insufficient adherence. CONCLUSION: Selenium, zinc, iron, magnesium, vitamin B12 and folic acid serum levels didn`t increase in depressed patients after six months of the Mediterranean diet pattern prescription.

Introducción: Se ha comunicado una correlación inversa entre depresión y el nivel sérico de algunos micronutrientes (selenio, zinc, hierro, magnesio, vitamina B y acido fólico). Además, otros estudios han señalado que la suplementar de estos micronutrientes puede mejorar la depresión. La dieta mediterránea proporciona una suficiente cantidad de los micronutrientes mencionados, aunque ningún estudio ha probado si la prescripción de dicha dieta puede incrementar los niveles de micronutrientes en pacientes depresivos. Objetivo: Examinar el impacto de recomendar un patrón dietético mediterráneo en los niveles de micronutrientes de pacientes deprimidos. Material y Métodos: 77 pacientes ambulatorios se aleatorizaron entre un grupo de intervención (recomendaciones higiénico-dietéticas sobre dieta, ejercicio, sueño y exposición solar) y un grupo control. La evolución fue evaluada antes y después de los seis meses del periodo de intervención. Resultados: Los niveles de selenio y de zinc fueron ligeramente bajos en la determinación basal y el nivel de selenio correlacionaba inversamente con la severidad de la depresión (r=-0.233; p=0.041). El grupo activo evolucionó mejor de la clínica depresiva. Sin embargo, no se observaron diferencias significativas en los niveles de micronutrientes después de la prescripción del patrón de dieta mediterránea probablemente a causa de una insuficiente adherencia. Conclusión: Los niveles séricos de selenio, zinc, hierro, magnesio vitamina B12 y acido fólico no aumentaron en pacientes depresivos seis meses después de prescribir un patrón de dieta mediterránea.

Prevalencia de trastornos mentales y factores asociados en pacientes de atención primaria mayores de 75 años / Prevalence and factors associated to mental disorders in primary care attenders aged 75 and older

Introducción: Los trastornos mentales en la vejez constituyen un importante problema de salud pública. No obstante, pocos estudios epidemiológicos aportan datos sobre prevalencia y factores de riesgo de enfermedades mentales en personas muy ancianas. El objetivo de este trabajo es evaluarla prevalencia de los trastornos mentales más comunes en atención primaria (AP) y sus factores asociados en pacientes mayores de 75 años. Metodología: Estudio epidemiológico trasversal con una muestra de 426 pacientes muy ancianos atendidos en AP y distribuidos proporcionalmente por provincias y centros de salud. Se utilizó la versión española de la entrevista Primary Care Evaluation of Mental Disorders (PRIME-MD) para diagnosticarlos trastornos psiquiátricos más frecuentes. Resultados: Existe una alta prevalencia y comorbilidad de los trastornos del estado de ánimo, de ansiedad y somatomorfos. El 47.4% de la muestra presenta uno o más trastornos psiquiátricos. Los más prevalentes fueron los trastornos del estado de animo (33.8%), seguidos por los somatomorfos (24.4%) y los de ansiedad (14.3). El 6.3% presenta comorbilidad psiquiátrica ente estos tres diagnósticos. La percepción del paciente sobre su estado de salud y la presencia de patologías físicas se asocia significativamente con estos trastornos mentales. Conclusiones: Los trastornos depresivos, de ansiedad y somatomorfos tienen una alta prevalencia en población muy anciana, con una elevada comorbilidad. Su detección y tratamiento es una cuestión prioritaria en AP (AU)

Background: Mental disorders in old age are a major public health problem. However, few epidemiological studies provide data on prevalence and risk factors of mental illness in older old population. The aim of this study is to assess the prevalence of common mental disorders and their associated factors in primary care patients over 75 years. Method: Cross-sectional epidemiologic study carried out in a sample of 426 older old patients who were attended at Primary Health Care settings, proportionally distributed for provinces and health centers. The Spanish version of the Primary Care Evaluation of Mental Disorders (PRIME-MD)was used in order to diagnose the most common psychiatric disorders in this field. Results: Prevalence and comorbidity rates of affective, anxiety and somatoform disorders are high. 47.4% of the sample presented one or more psychiatric disorder. The most prevalent were affective (33.8%), somatoform (24.4%) and anxiety (14.3%) disorders. 6.3% had comorbidity between affective, anxiety and somatoform disorders. Perceived health status and physical illnesses were significantly associated with these mental disorders. Conclusions: Affective, anxiety and somatoform disorders are highly prevalent in older old population with high rates of comorbidity. Their detection and treatment should be considered a relevant issue in primary care (AU)

[Prevalence and factors associated to mental disorders in primary care attenders aged 75 and older]. / Prevalencia de trastornos mentales y factores asociados en pacientes de atención primaria mayores de 75 años.

BACKGROUND: Mental disorders in old age are a major public health problem. However, few epidemiological studies provide data on prevalence and risk factors of mental illness in older old population. The aim of this study is to assess the prevalence of common mental disorders and their associated factors in primary care patients over 75 years. METHOD: Cross-sectional epidemiologic study carried out in a sample of 426 older old patients who were attended at Primary Health Care settings, proportionally distributed for provinces and health centers. The Spanish version of the Primary Care Evaluation of Mental Disorders (PRIME-MD) was used in order to diagnose the most common psychiatric disorders in this field. RESULTS: Prevalence and comorbidity rates of affective, anxiety and somatoform disorders are high. 47.4% of the sample presented one or more psychiatric disorder. The most prevalent were affective (33.8%), somatoform (24.4%) and anxiety (14.3%) disorders. 6.3% had comorbidity between affective, anxiety and somatoform disorders. Perceived health status and physical illnesses were significantly associated with these mental disorders. CONCLUSIONS: Affective, anxiety and somatoform disorders are highly prevalent in older old population with high rates of comorbidity. Their detection and treatment should be considered a relevant issue in primary care.

Adherencia a las recomendaciones sobre estilo de vida en pacientes con depresión / Adherence to lifestyle recommendations by patients with depression

Introducción. La práctica de ejercicio físico y la exposición a la luz solar cada vez tiene mayor respaldo experimental sobre su eficacia antidepresiva coadyuvante en pacientes con depresión leve o moderada. Sin embargo, no hay información objetiva disponible sobre el grado de adherencia que los pacientes depresivos son capaces de desarrollar frente a estas recomendaciones en condiciones de práctica habitual, lo que limita la tendencia del clínico a prescribirlas. Métodos. Se estudia una muestra de 15 pacientes con un episodio depresivo de más de un mes de evolución con tratamiento antidepresivo a los que se les colocó un actígrafo en forma de reloj de pulsera capaz de medir la actividad física y la exposición a la luz durante las 24 horas del día. Una semana después de la evaluación basal estos pacientes fueron aleatorizados en 2 grupos. En el primero de ellos se les pedía en una breve nota por escrito de forma explícita y concreta que aumentaran la actividad física y la exposición a la luz solar, mientras que en el segundo grupo no. Resultados. En la semana posterior a la entrega de las recomendaciones, solo el primer grupo aumentó su actividad física y su exposición a la luz (14,3 y 25,8% respectivamente). Conclusión. Los pacientes con depresión muestran un buen nivel de adherencia a recomendaciones sobre su estilo de vida a corto plazo(AU)

Introduction. There is an increasing amount of evidence showing that physical activity and sun exposure are effective coadjuvant treatments for patients with mild to moderate depression. However, there is a lack of information regarding patient's adherence to these recommendations in daily clinical practice. Methods. We conducted a study including 15 depressive patients who had been under antidepressant treatment for at least one month. They wore a wrist-watch-like actimetry sensor to measure physical activity and sun exposure 24h a day. After one week of baseline assessment, patients were randomized into one of the two arms of the study. Patients in the experimental group received a brief note in which they were explicitly asked to increase both their physical activity level and time of sun exposure, while control group patients did not receive these explicit recommendations. Results. One week after recommendations were delivered, only patients in the experimental group had increased time of sun exposure and physical activity (25.8% and 14.3%, respectively). Conclusions. Depressive patients are able to follow prescribed lifestyle recommendations in the short-term(AU)

Hygienic-dietary recommendations for major depression treatment: study protocol of a randomized controlled trial.

BACKGROUND: Depression is a highly prevalent and disabling mental disorder with an incidence rate which appears to be increasing in the developed world. This fact seems to be at least partially related to lifestyle factors. Some hygienic-dietary measures have shown their efficacy as a coadjuvant of standard treatment. However, their effectiveness has not yet been proved enough in usual clinical practice. METHODS: Multicenter, randomized, controlled, two arm-parallel, clinical trial involving 300 patients over 18 years old with a diagnosis of Major Depression. Major depression will be diagnosed by means of the Mini-International Neuropsychiatric Interview. The Beck Depression Inventory total score at the end of the study will constitute the main efficacy outcome. Quality of Life and Social and Health Care Services Consumption Scales will be also administered. Patients will be assessed at three different occasions: baseline, 6-month follow-up and 12-month follow-up. DISCUSSION: We expect the patients in the active lifestyle recommendations group to experience a greater improvement in their depressive symptoms and quality of life with lower socio-sanitary costs. TRIAL REGISTRATION: ISRCTN73931675.

Adherence to lifestyle recommendations by patients with depression.

INTRODUCTION: There is an increasing amount of evidence showing that physical activity and sun exposure are effective coadjuvant treatments for patients with mild to moderate depression. However, there is a lack of information regarding patient's adherence to these recommendations in daily clinical practice. METHODS: We conducted a study including 15 depressive patients who had been under antidepressant treatment for at least one month. They wore a wrist-watch-like actimetry sensor to measure physical activity and sun exposure 24 hours a day. After one week of baseline assessment, patients were randomised into one of the two arms of the study. Patients in the experimental group received a brief note in which they were explicitly asked to increase both their physical activity level and time of sun exposure, while control group patients did not receive these explicit recommendations. RESULTS: One week after recommendations were delivered, only patients in the experimental group had increased time of sun exposure and physical activity (25.8% and 14.3%, respectively). CONCLUSIONS: Depressive patients are able to follow prescribed lifestyle recommendations in the short-term.