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1.
BMC Psychiatry ; 19(1): 90, 2019 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-30871544

RESUMO

BACKGROUND: The treatment of major depressive disorder, a highly prevalent disorder associated with pronounced burden, is a large challenge to healthcare systems worldwide. Internet based self-management interventions seem to be a cost effective way to complement the treatment of depressed patients, but the accumulating evidence is mainly based on the comparison to waitlist controls and treatment as usual, which might lead to an overestimation of effects. Furthermore, studies assessing long-term effects and possible negative outcomes are still rare. METHODS/DESIGN: The proposed study evaluates the efficacy of the German version of the iFightDepression® tool in comparison to an active control condition. A total of 360 patients with mild to moderate depressive symptoms are included into a two-armed randomized controlled trial. They receive one of two six week interventions; either the iFightDepression® tool or progressive muscle relaxation serving as the control condition. Both intervention groups receive information material, weekly tasks via the internet and regular phone calls as part of the intervention. The primary outcome is change in depressive symptoms after the intervention period, as measured with the Inventory of Depressive Symptomatology. Satisfaction with the program, usability, changes in perceived quality of life, and possible negative effects are assessed as secondary outcomes. DISCUSSION: This study represents the first randomized controlled trial on the iFightDepression® self-management tool in its German version, aiming at efficacy, but also at providing new insights into so far understudied aspects of E-mental health programs, namely the specificity of the treatment effect compared to an active control condition, it's continuity over a time course of 12 months, and possible negative effects of these internet based interventions. TRIAL REGISTRATION: International trial-registration took place through the "international clinical trials registry platform" (WHO) with the secondary ID 080-15-09032015. German Clinical Trial Registration: DRKS00009323 (DRKS.de, registered on 25 February 2016).


Assuntos
Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/terapia , Transtorno Distímico/psicologia , Transtorno Distímico/terapia , Autogestão/psicologia , Adulto , Transtorno Depressivo Maior/epidemiologia , Transtorno Distímico/epidemiologia , Feminino , Humanos , Masculino , Qualidade de Vida/psicologia , Autogestão/métodos , Resultado do Tratamento
2.
J Affect Disord ; 241: 206-215, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30130686

RESUMO

BACKGROUND: Information on the natural course of subthreshold depression and risk factors for the development of a full-blown depressive disorder in the general population is scarce. This information is crucial to understand the development of depression and to advance indicated depression prevention. METHODS: Using longitudinal data from a representative population-based study (the Netherlands Mental Health Survey and Incidence Study-2) we assessed 3-year course of subthreshold depression (depressive symptoms causing clinically significant distress for at least 2 weeks, or for 3 days per month for a year; n = 120), compared to an asymptomatic group (n = 4111) and a depressive disorder group (major depression or dysthymia; n = 294). Next, risk factors for the development of a depressive disorder among adults with subthreshold depression were determined. RESULTS: Twelve percent of the subthreshold cases developed a full-blown depressive disorder during 3-year follow-up. Risk factors were lower social support, having recurrent short episodes of depressive symptomatology, remitted and current anxiety disorder, remitted substance use disorder, lifetime suicide thoughts, a chronic physical disorder and diminished mental and physical functioning. LIMITATIONS: The number of subjects with subthreshold depression that developed a depressive disorder was small. This limits the possibility to detect significant risk factors. CONCLUSION: Only a minority of the subthreshold cases developed a full-blown depressive disorder over three years. This shows that subthreshold depression does not, by itself, carry an a priori risk to warrant focusing indicated prevention. The identified risk factors could help to detect those subthreshold cases in whom depression prevention is economically and practically viable.


Assuntos
Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Progressão da Doença , Transtorno Distímico/psicologia , Adulto , Transtornos de Ansiedade/psicologia , Doença Crônica/psicologia , Estudos de Coortes , Transtorno Depressivo Maior/epidemiologia , Transtorno Distímico/epidemiologia , Feminino , Seguimentos , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Fatores de Risco , Apoio Social
3.
J Affect Disord ; 238: 513-521, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-29936389

RESUMO

AIM: To determine the prevalence of affective disorders in Turkey among a representative sample of Turkish population. METHODS: This study was conducted as a part of the "The Epidemiology of Childhood Psychopathology in Turkey" (EPICPAT-T) Study, which was designed by the Turkish Association of Child and Adolescent Mental Health. The inclusion criterion was being a student between the second and fourth grades in the schools assigned as study centers. The assessment tools used were the K-SADS-PL, and a sociodemographic form that was designed by the authors. Impairment was assessed via a 3 point-Likert type scale independently rated by a parent and a teacher. RESULTS: A total of 5842 participants were included in the analyses. The prevalence of affective disorders was 2.5 % without considering impairment and 1.6 % when impairment was taken into account. In our sample, the diagnosis of bipolar disorder was lacking, thus depressive disorders constituted all the cases. Among depressive disorders with impairment, major depressive disorder (MDD) (prevalence of 1.06%) was the most common, followed by dysthymia (prevalence of 0.2%), adjustment disorder with depressive features (prevalence of 0.17%), and depressive disorder-NOS (prevalence of 0.14%). There were no statistically significant gender differences for depression. Maternal psychopathology and paternal physical illness were predictors of affective disorders with pervasive impairment. CONCLUSION: MDD was the most common depressive disorder among Turkish children in this nationwide epidemiological study. This highlights the severe nature of depression and the importance of early interventions. Populations with maternal psychopathology and paternal physical illness may be the most appropriate targets for interventions to prevent and treat depression in children and adolescents.


Assuntos
Bem-Estar da Criança/estatística & dados numéricos , Transtornos do Humor/epidemiologia , Adolescente , Transtornos de Ansiedade/epidemiologia , Criança , Depressão/epidemiologia , Transtorno Distímico/epidemiologia , Estudos Epidemiológicos , Feminino , Humanos , Masculino , Prevalência , Turquia/epidemiologia
4.
J Affect Disord ; 236: 230-242, 2018 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-29751238

RESUMO

BACKGROUND: The purpose of this meta-analytic study was to determine the pooled prevalence estimates of anxiety and depressive disorders among children and adolescents with intellectual disabilities (ID) and to assess the extent to which these pooled prevalence rates differed according to studies' characteristics. METHOD: A systematic literature search was performed in nine databases and 21 studies, published between 1975 and 2015, met the inclusion criteria. RESULTS: The resulting pooled prevalence estimates of combined subtypes of anxiety and depressive disorders were respectively (a) 5.4% and 2.8% across samples; (b) 1.2% and 0.03% among children; and (c) 7.9% and 1.4% among adolescents. Pooled prevalence estimates for specific subtypes of anxiety disorders ranged from (a) 0.2% to 11.5% across samples; (b) 0.7% to 17.6% among children; and (c) 0.6% to 19.8% among adolescents. Pooled prevalence estimates of dysthymic disorder and major depressive disorder were respectively (a) 3.4% and 2.5% across samples; (b) 2.1% and 3.2% among children; and (c) 6.9% and 5.7% among adolescents. Finally, subgroup analyses showed significant variations in the pooled prevalence estimates of combined subtypes of anxiety disorders, obsessive-compulsive disorder, and generalized anxiety disorder; and combined subtypes of depressive disorders. LIMITATIONS: The present findings of this meta-analysis should be interpreted with caution given several limitations related to the characteristics of the populations, diagnostic method and sampling method. CONCLUSION: Findings provide recommendations for future studies investigating psychological disorders among youth with ID, as well as how clinicians and policy makers can improve diagnostic practices and support for youth with ID.


Assuntos
Transtornos de Ansiedade/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Transtorno Distímico/epidemiologia , Deficiência Intelectual/psicologia , Transtorno Obsessivo-Compulsivo/epidemiologia , Adolescente , Transtornos de Ansiedade/psicologia , Criança , Pré-Escolar , Transtorno Depressivo Maior/psicologia , Transtorno Distímico/psicologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Transtorno Obsessivo-Compulsivo/psicologia , Prevalência , Adulto Jovem
5.
Am J Cardiol ; 121(12): 1629-1633, 2018 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-29606323

RESUMO

Although depressive disorders have been associated with increased risk of worse outcomes with cardiovascular diseases (CVDs), its relation with access to and quality of cardiovascular care is not well studied. Accordingly, we sought to assess the association between depressive disorders and access and quality of care among United States veterans with CVD. The 2013 Centers for Disease Control's Behavioral Risk Factor Surveillance Survey was utilized to identify a cohort of 13,126 veterans with CVD. Demographic and clinical history were recorded in adults with and without a depressive disorder (defined as self-reported diagnosis of depression, major depression, minor depression, or dysthymia). Among 13,126 veterans studied, a total of 2,889 (22.0%) adults had a depressive disorder whereas 10,237 (78.0%) did not. The veterans with a depressive disorder were younger, more often female and non-white, and had higher rates of multiple medical co-morbidities. They were more likely to report a delay in receiving medical care and financial barriers to seeking care and taking prescription drugs. They also reported significantly lower rates of aspirin and antihypertensive drug use. In multivariate analysis, depressive disorder was independently associated with higher risk of delay in receiving medical care (OR [odds ratio] 2.07, 95% CI [confidence interval] 1.65 to 2.60), financial barriers to medical care (OR 1.96, 95% CI 1.45 to 2.65), and prescription drugs (OR 1.45, 95% CI 1.02 to 2.08). In conclusion, depressive disorders were associated with impaired access to care among United States veterans with CVD.


Assuntos
Doenças Cardiovasculares/epidemiologia , Transtorno Depressivo/epidemiologia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde , Veteranos/estatística & dados numéricos , Distribuição por Idade , Idoso , Angina Pectoris/epidemiologia , Angina Pectoris/terapia , Anti-Hipertensivos/uso terapêutico , Aspirina/uso terapêutico , Doenças Cardiovasculares/terapia , Estudos de Coortes , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/terapia , Transtorno Depressivo Maior/epidemiologia , Transtorno Distímico/epidemiologia , Status Econômico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Razão de Chances , Inibidores da Agregação de Plaquetas/uso terapêutico , Prevalência , Indicadores de Qualidade em Assistência à Saúde , Autorrelato , Distribuição por Sexo , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Fatores de Tempo , Estados Unidos/epidemiologia
6.
J Affect Disord ; 234: 327-334, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29605793

RESUMO

BACKGROUND: Though high rates of co-occurring cannabis use and depression are well-documented, data regarding the association between cannabis use and dysthymia is scarce. The aim of this cross-sectional study was to explore clinical correlations of cannabis use among individuals with dysthymia, as well as the changes in the association between cannabis use and dysthymia across six decades of birth cohorts. METHODS: Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III; 2012-2013; N = 36,309). Participants were divided into six birth cohorts (1940s-1990s), based on their decade of birth, and individuals with dysthymia were further categorized by 3 levels of lifetime cannabis use: non-users, non-CUD users, and CUD-users. We compared rates of co-occurring psychiatric and substance use disorders among cannabis users vs non-users and conducted logistic regression analyses in order to determine the odds of dysthymia among cannabis users across six decades. RESULTS: Rates of several psychiatric disorders, such as personality disorders, and substance use disorders were higher among individuals with dysthymia who used cannabis compared to those who did not. The interaction between cannabis use (without a CUD) and birth cohort was associated with a decrease in the odds of dysthymia (OR=0.90, 95% CI 0.84-0.97) and remained significant after controlling for confounding variables. Similar changes over time were not demonstrated for CUD users. LIMITATIONS: Likelihood for recall bias and misclassification based on cross-sectional nature of the study and on respondents' self-reports of symptoms throughout their lifetime. CONCLUSIONS AND IMPLICATIONS: Our study's findings demonstrate that the association between cannabis use (but not CUDs) and dysthymia has weakened over time. These findings highlight the need for further research examining changes over time in the relationship between cannabis use and associated psychiatric disorders.


Assuntos
Transtorno Distímico/epidemiologia , Abuso de Maconha/epidemiologia , Fumar Maconha/epidemiologia , Transtornos Mentais/epidemiologia , Adolescente , Adulto , Comorbidade/tendências , Estudos Transversais , Transtorno Distímico/complicações , Feminino , Humanos , Masculino , Fumar Maconha/tendências , Pessoa de Meia-Idade , Estados Unidos/epidemiologia
7.
Depress Anxiety ; 35(4): 339-345, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29489041

RESUMO

BACKGROUND: Comorbidity of obsessive-compulsive disorder (OCD) with other mental disorders has been demonstrated repeatedly. Few longitudinal studies, however, have evaluated the temporal association of prior OCD and subsequent mental disorders across the age period of highest risk for first onset of mental disorders. We examined associations between prior OCD and a broad range of subsequent mental disorders and simulated proportions of new onsets of mental disorders that could potentially be attributed to prior OCD, assuming a causal relationship. METHODS: Data from 3,021 14- to 24-year-old community subjects were prospectively collected for up to 10 years. DSM-IV OCD and other DSM-IV mental disorders were assessed with the Munich-Composite International Diagnostic Interview. We used adjusted time-dependent proportional hazard models to estimate the temporal associations of prior OCD with subsequent mental disorders. RESULTS: Prior OCD was associated with an increased risk of bipolar disorders (BIP; [hazard ratio, HR = 6.9, 95% confidence interval, CI, (2.8,17.3)], bulimia nervosa [HR = 6.8 (1.3,36.6)], dysthymia [HR = 4.4 (2.1,9.0)], generalized anxiety disorder (GAD; [HR = 3.4 (1.1,10.9)], and social phobia [HR = 2.9 (1.1,7.7)]). Of these outcome disorders, between 65 and 85% could be attributed to OCD in the exposed group, whereas between 1.5 and 7.7% could be attributed to OCD in the total sample. CONCLUSIONS: This study provides strong evidence that prior OCD is associated with an increased risk of subsequent onset of BIP, bulimia nervosa, dysthymia, GAD, and social phobia among adolescents and young adults. Future studies should evaluate if early treatment of OCD can prevent the onset of these subsequent mental disorders.


Assuntos
Transtornos de Ansiedade/epidemiologia , Transtorno Bipolar/epidemiologia , Bulimia Nervosa/epidemiologia , Transtorno Distímico/epidemiologia , Transtorno Obsessivo-Compulsivo/epidemiologia , Adolescente , Adulto , Comorbidade , Feminino , Humanos , Estudos Longitudinais , Masculino , Adulto Jovem
8.
Epilepsia ; 59(2): 431-439, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29318616

RESUMO

OBJECTIVE: Mood disorders are the most common comorbid conditions in epilepsy, but the cause remains unclear. One possible explanation is a shared genetic susceptibility to epilepsy and mood disorders. We tested this hypothesis by evaluating lifetime prevalence of mood disorders in relatives with and without epilepsy in families containing multiple individuals with epilepsy, and comparing the findings with rates from a general population sample. METHODS: The Composite International Diagnostic Interview was administered to 192 individuals from 60 families, including 110 participants with epilepsy of unknown cause (50 focal epilepsy [FE], 42 generalized epilepsy [GE], 6 FE and GE, 12 unclassifiable) and 82 relatives without epilepsy (RWOE). Odds ratios (ORs) for lifetime prevalence of mood disorders in participants with versus without epilepsy were computed through logistic regression, using generalized estimation equations to account for familial clustering. Standardized prevalence ratios (SPRs) were used to compare prevalence in family members with general population rates. RESULTS: Compared with RWOE, ORs for mood disorders were significantly increased in participants with FE (OR = 2.4, 95% confidence interval [CI] = 1.1-5.2) but not in those with GE (OR = 1.0, 95% CI = 0.4-2.2). In addition, prevalence of mood disorders was increased in individuals with epilepsy who had ≥1 relative with FE. Compared with general population rates, mood disorders were significantly increased in individuals with FE but not in those with GE. Rates were also increased in RWOE, but not significantly so (SPR = 1.4, P = .14). SIGNIFICANCE: These findings are consistent with the hypothesis of shared genetic susceptibility to epilepsy and mood disorders, but suggest (1) the effect may be restricted to FE, and (2) the shared genetic effect on risk of mood disorders and epilepsy may be restricted to individuals with epilepsy, that is, to those in whom the genetic risk for epilepsy is "penetrant."


Assuntos
Transtorno Bipolar/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Transtorno Distímico/epidemiologia , Epilepsias Parciais/epidemiologia , Epilepsia Generalizada/epidemiologia , Síndromes Epilépticas/epidemiologia , Família , Adolescente , Adulto , Feminino , Predisposição Genética para Doença , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/epidemiologia , Razão de Chances , Prevalência , Fatores Sexuais , Adulto Jovem
9.
Psychooncology ; 27(1): 99-105, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28125166

RESUMO

BACKGROUND: Breast cancer bears considerable morbidity and mortality and is well known to increase the risk of major depression, whereas religiosity has been reported to be protective. We searched for an association between depression and religiosity in breast cancer patients. We also sought to find an association between depression and various sociodemographic and disease variables. METHODS: One hundred two patients were interviewed. Sociodemographic, cancer profile, and religiosity questionnaires were administered. We screened for depressive disorders by using the Mini-International Neuropsychiatric Interview and the Beck Depression Inventory. RESULTS: Most of our participants (n = 79; 77.4%) had high religiosity score. The prevalences of lifetime major depression, current major depression, and major depression after cancer diagnosis were 50.9%, 30.1%, and 43.1%, respectively. We could not find a correlation between religiosity and current depression, while the association with depression after cancer diagnosis was close to but did not reach statistical significance (P = .055) and in favor of a deleterious role of religiosity. Depression was only linked to marital status and insurance coverage. No association was found with disease-related variables. CONCLUSIONS: Religiosity does not seem to be protective against depression development. The stress of cancer appears to be the main culprit in increasing the risk of depression.


Assuntos
Neoplasias da Mama/psicologia , Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Transtorno Distímico/epidemiologia , Religião , Adulto , Idoso , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/etnologia , Estudos Transversais , Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Transtorno Distímico/psicologia , Feminino , Humanos , Entrevistas como Assunto , Líbano/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários
10.
Depress Anxiety ; 35(1): 10-17, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28640965

RESUMO

BACKGROUND: Although depression is a risk factor for cardiovascular disease (CVD), it is unknown whether this risk varies across depressive disorder subtypes. Thus, we investigated atypical major depressive disorder (MDD) and double depression as predictors of new-onset CVD in a nationally representative sample of U.S. adults. METHODS: Prospective data from 28,726 adults initially free of CVD who participated in Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were examined. Lifetime depressive disorder subtypes (Wave 1) and incident CVD (Wave 2) were determined by structured interviews. RESULTS: We identified 1,116 incident CVD cases. In demographics adjusted models, the atypical MDD group had a higher odds of incident CVD than the no depression history (OR = 2.19, 95% CI: 1.71-2.81, P < .001), dysthymic disorder only (OR = 1.61, 95% CI: 1.08-2.39, P = .019), and nonatypical MDD (OR = 1.46, 95% CI: 1.11-1.91, P = .006) groups. Likewise, the double depression group had a higher odds of incident CVD than the no depression history (OR = 2.17, 95% CI: 1.92-2.45, P < .001), dysthymic disorder only (OR = 1.59, 95% CI: 1.16-2.19, P = .004), and MDD only (OR = 1.46, 95% CI: 1.20-1.77, P < .001) groups. Relationships were similar but attenuated after adjustment for CVD risk factors and anxiety disorders. CONCLUSIONS: Adults with atypical MDD or double depression may be subgroups of the depressed population at particularly high risk of new-onset CVD. Thus, these subgroups may (a) be driving the overall depression-CVD relationship and (b) be in need of earlier and/or more intense CVD primary prevention efforts to reduce their excess CVD burden.


Assuntos
Doenças Cardiovasculares/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Transtorno Distímico/epidemiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estados Unidos/epidemiologia
11.
Asian J Psychiatr ; 30: 159-162, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29055250

RESUMO

BACKGROUND: Physicians do not always confidently diagnose psychiatric disorders. The present study was conducted to identify the clinical characteristics of patients in whom a definitive diagnosis of major depressive disorder (MDD) could not be established. METHODS: The participants were 199 consecutive outpatients with MDD, who were comprehensively diagnosed using the Mini International Neuropsychiatric Interview (MINI). The physician in charge of each patient quantified his/her sense of self-confidence in diagnosing the patient with MDD using the self-rating questionnaire in which the score ranged from 1 (not at all confident) to 5 (definitely MDD). Using multiple logistic regression, the demographic and clinical factors of the patients in the low diagnostic confidence group (score less than or equal to 3, n=79) were compared with those in the high diagnostic confidence group (more than 3, n=120). RESULTS: Comorbidity of anxiety disorders (odds ratio (OR), 4.7), absence of remission (OR, 3.6), and non-melancholic features (OR, 3.5) were identified as the most discriminative variables associated with the low diagnostic confidence of MDD. CONCLUSION: The results show that physicians were unable to confidently diagnose MDD in 40% of the cases, and that comorbidity of anxiety disorders, absence of remission, and non-melancholic features independently predicted the diagnostic uncertainty of MDD.


Assuntos
Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/fisiopatologia , Adulto , Idoso , Transtornos de Ansiedade/epidemiologia , Comorbidade , Transtorno Depressivo Maior/epidemiologia , Transtorno Distímico/epidemiologia , Feminino , Humanos , Entrevista Psicológica , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Remissão Espontânea , Incerteza
12.
J Diabetes Complications ; 31(11): 1571-1579, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28893494

RESUMO

AIMS: Information on the burden and risk factors for diabetes-depression comorbidity in the US is sparse. We used data from the largest all-payer, nationally-representative inpatient database in the US to estimate the prevalence, temporal trends, and risk factors for comorbid depression among adult diabetic inpatients. METHODS: We conducted a retrospective analysis using the 2002-2014 Nationwide Inpatient Sample databases. Depression and other comorbidities were identified using ICD-9-CM codes. Logistic regression was used to investigate the association between patient characteristics and depression. RESULTS: The rate of depression among patients with type 2 diabetes increased from 7.6% in 2002 to 15.4% in 2014, while for type 1 diabetes the rate increased from 8.7% in 2002 to 19.6% in 2014. The highest rates of depression were observed among females, non-Hispanic whites, younger patients, and patients with five or more chronic comorbidities. CONCLUSIONS: The prevalence of comorbid depression among diabetic inpatients in the US is increasing rapidly. Although some portion of this increase could be explained by the rising prevalence of multimorbidity, increased awareness and likelihood of diagnosis of comorbid depression by physicians and better documentation as a result of the increased adoption of electronic health records likely contributed to this trend.


Assuntos
Transtornos de Adaptação/epidemiologia , Transtorno Depressivo/epidemiologia , Complicações do Diabetes/psicologia , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 2/psicologia , Transição Epidemiológica , Transtornos da Personalidade/epidemiologia , Transtornos de Adaptação/terapia , Adulto , Fatores Etários , Estudos de Coortes , Comorbidade , Estudos Transversais , Transtorno Depressivo/terapia , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/terapia , Complicações do Diabetes/complicações , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/terapia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Transtorno Distímico/epidemiologia , Transtorno Distímico/terapia , Feminino , Hospitalização , Humanos , Reembolso de Seguro de Saúde , Masculino , Transtornos da Personalidade/terapia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Estados Unidos/epidemiologia
13.
Psychiatr Serv ; 68(11): 1164-1171, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-28669288

RESUMO

OBJECTIVE: Effectiveness of collaborative care for perinatal depression has been demonstrated for MOMCare, from early pregnancy up to 15 months postpartum, for Medicaid enrollees in a public health system. MOMCare had a greater impact on reducing depression and improving functioning for women with comorbid posttraumatic stress disorder (PTSD) than for those without PTSD. This study estimated the incremental benefit and cost and the net benefit of MOMCare for women with major depression and PTSD. METHODS: A randomized trial (September 2009 to December 2014) compared the MOMCare collaborative care depression intervention (choice of brief interpersonal psychotherapy or pharmacotherapy or both) with enhanced maternity support services (MSS-Plus) in the public health system of Seattle-King County. Among pregnant women with a probable diagnosis of major depression or dysthymia (N=164), two-thirds (N=106) met criteria for probable PTSD. Blinded assessments at three, six, 12, and 18 months postbaseline included the Symptom Checklist-20 depression scale and the Cornell Services Index. Analyses of covariance estimated gain in depression free days (DFDs) by intervention and PTSD status. RESULTS: When the analysis controlled for baseline depression severity, women with probable depression and PTSD in MOMCare had 68 more depression-free days over 18 months than those in MSS-Plus (p<.05). The additional depression care cost per MOMCare participant with comorbid PTSD was $1,312. The incremental net benefit of MOMCare was positive if a DFD was valued at ≥$20. CONCLUSIONS: For women with probable major depression and PTSD, MOMCare had significant clinical benefit over MSS-Plus, with only a moderate increase in health services cost.


Assuntos
Antidepressivos/uso terapêutico , Serviços de Saúde Comunitária/métodos , Análise Custo-Benefício , Transtorno Depressivo Maior/terapia , Transtorno Distímico/terapia , Pobreza , Complicações na Gravidez/terapia , Psicoterapia Breve/métodos , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Antidepressivos/economia , Serviços de Saúde Comunitária/economia , Comorbidade , Transtorno Depressivo Maior/economia , Transtorno Depressivo Maior/epidemiologia , Transtorno Distímico/tratamento farmacológico , Transtorno Distímico/economia , Transtorno Distímico/epidemiologia , Feminino , Humanos , Colaboração Intersetorial , Gravidez , Complicações na Gravidez/economia , Complicações na Gravidez/epidemiologia , Psicoterapia Breve/economia , Transtornos de Estresse Pós-Traumáticos/economia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Populações Vulneráveis , Adulto Jovem
14.
Rev Neurol ; 65(2): 63-69, 2017 Jul 16.
Artigo em Espanhol | MEDLINE | ID: mdl-28675257

RESUMO

INTRODUCTION: Depression and cognitive impairment maintain a close and complex relationship, which could be modified by pharmacological treatment. AIM: To analyze the influence of depression and antidepressive medication on the initial diagnosis and the evolution of cognitive impairment. PATIENTS AND METHODS: All the patients derived to a Neurology clinic due to complaints or suspicion of cognitive impairment, during a period of nine years, were studied. The influence of demographic and depression-related variables on initial cognitive diagnosis, cognitive-functional situation and 1-year evolution were analyzed. RESULTS: A total of 582 patients were included (mean age: 77.6 ± 7.0; 64.9% women). Frequency of current and past depression were, respectively, 25.4% and 17.2%. In addition, 20.6% of the patients were taking antidepressant medication and 31.2% were on anxiolytic/hypnotic treatment. One-year follow-up visit was available in 320 (59.8%) of patients. In the adjusted analysis, anxiolytic/hypnotic treatment was associated with a worse cognitive-functional situation in the initial visit, while past depression and presence of dystimia were associated with a favorable evolution (p < 0.05). CONCLUSIONS: Past or current depression are not associated with bad prognosis in patients derived to neurologist due to possible cognitive impairment.


Assuntos
Disfunção Cognitiva/psicologia , Depressão/psicologia , Transtorno Depressivo/psicologia , Idoso , Idoso de 80 Anos ou mais , Ansiolíticos/uso terapêutico , Antidepressivos/uso terapêutico , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Comorbidade , Demência/diagnóstico , Demência/epidemiologia , Demência/etiologia , Demência/psicologia , Depressão/epidemiologia , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/epidemiologia , Progressão da Doença , Transtorno Distímico/tratamento farmacológico , Transtorno Distímico/epidemiologia , Transtorno Distímico/psicologia , Escolaridade , Feminino , Seguimentos , Humanos , Hipnóticos e Sedativos/uso terapêutico , Masculino , Testes de Estado Mental e Demência , Prognóstico , Avaliação de Sintomas
15.
Acta Psychiatr Scand ; 136(3): 300-312, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28512767

RESUMO

OBJECTIVE: Hardly any studies exist on the duration of major depressive disorder (MDD) and factors that explain variations in episode duration that lack biases. This limits clinical decision-making and leaves patients wondering when they will recover. METHOD: Data were used from the Netherlands Mental Health Survey and Incidence Study-2, a psychiatric epidemiological cohort study among a nationally representative adult population. Respondents with a newly originated depressive episode were selected: 286 MDD and 107 minor depressive disorder (MinDD) cases. DSM-IV diagnoses were assessed with the Composite International Diagnostic Interview 3.0 and episode duration with the Life Chart Interview. RESULTS: Among MDD cases, median episode duration was 6 months, mean duration was 10.7 months, and 12% had not recovered at 36 months. Longer duration was associated with comorbid dysthymia, anxiety disorder, psychotropic medication use (i.e. antidepressants or benzodiazepines prescribed by a mental health professional), mental health care use and suicidal behaviour. Better physical and mental functioning before depression onset predicted shorter duration. Among MinDD cases, shorter median duration (3 months) but similar mean duration (8.7 months), risk of chronicity (10% not recovered at 36 months) and risk indicators for episode duration were found. CONCLUSION: As the risk of chronicity was similar for MDD and MinDD, MinDD cannot be dismissed as a merely brief mood state.


Assuntos
Transtornos de Ansiedade , Depressão/fisiopatologia , Transtorno Depressivo Maior/fisiopatologia , Transtorno Distímico , Serviços de Saúde Mental/estatística & dados numéricos , Psicotrópicos/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias , Tentativa de Suicídio/estatística & dados numéricos , Adulto , Transtornos de Ansiedade/epidemiologia , Estudos de Coortes , Comorbidade , Depressão/tratamento farmacológico , Depressão/epidemiologia , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/epidemiologia , Transtorno Distímico/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Fatores de Tempo , Adulto Jovem
16.
Psychiatry Res ; 250: 50-58, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28142066

RESUMO

Although the DSM-5 has suggested the two new categories of Persistent Depressive Disorders (PDD) and Other Specified Depressive Disorders (OSDD), no study so far has applied the DSM-5 criteria throughout the range of depressive disorders. The aims of the present study were to 1) establish the lifetime prevalence of specific depressive disorders according to the new DSM-5 definitions in a community sample, and 2) determine their clinical relevance in terms of socio-demographic characteristics, comorbidity, course and treatment patterns. The semi-structured Diagnostic Interview for Genetic Studies was administered by masters-level psychologists to a random sample of an urban area (n=3720). The lifetime prevalence was 15.2% for PDD with persistent major depressive episode (MDE), 3.3% for PDD with pure dysthymia, 28.2% for Major Depressive Disorder (MDD) and 9.1% for OSDD. Subjects with PDD with persistent MDE were the most severely affected, followed by those with recurrent MDD, single episode MDD, PDD with pure dysthymia and OSDD and finally those without depressive disorders. Our data provide further evidence for the clinical significance of mild depressive disorders (OSDD), but cast doubt on the pertinence of lumping together PDD with persistent MDE and the former DSM-IV dysthymic disorder within the new PDD category.


Assuntos
Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Transtorno Distímico/epidemiologia , Adulto , Comorbidade , Depressão/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtorno Distímico/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Recidiva
17.
J Health Psychol ; 22(10): 1322-1331, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-26837685

RESUMO

This study extended the literature by examining whether three profiles of depression predicted breast cancer status. In 1076 women of the Baltimore Epidemiologic Catchment Area study, depression status and hopelessness were measured at baseline and breast cancer status was ascertained 24 years later. Double depression, but not major depression or dysthymia, was associated with breast cancer. Hopelessness predicted fewer new cases of breast cancer. When double depression and hopelessness were simultaneously entered as predictors, the regression weights of both predictors increased. The role of severe and extended duration depression as well as possible explanations for unexpected findings are discussed.


Assuntos
Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Transtorno Depressivo/psicologia , Idoso , Idoso de 80 Anos ou mais , Baltimore/epidemiologia , Neoplasias da Mama/epidemiologia , Sobreviventes de Câncer/estatística & dados numéricos , Transtorno Depressivo/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Transtorno Distímico/epidemiologia , Transtorno Distímico/psicologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade
18.
Psychiatr Serv ; 68(1): 17-24, 2017 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-27691376

RESUMO

OBJECTIVE: The study examined the effectiveness of a perinatal collaborative care intervention in moderating the effects of adverse neonatal birth events on risks of postpartum depressive symptoms and impaired functioning among women of lower socioeconomic status with antenatal depression. METHODS: A randomized controlled trial with blinded outcome assessments was conducted in ten public health centers, comparing MOMCare (choice of brief interpersonal psychotherapy, pharmacotherapy, or both) with intensive maternity support services (MSS-Plus). Participants had probable diagnoses of major depressive disorder or dysthymia during pregnancy. Generalized estimating equations estimated differences in depression and functioning measures between groups with and without adverse birth events within the treatment arms. A total of 160 women, 43% of whom experienced at least one adverse birth event, were included in the analyses. RESULTS: For women who received MOMCare, postpartum depression scores (measured with the Symptom Checklist-20) did not differ by whether or not they experienced an adverse birth event (mean±SD scores of .86±.51 for mothers with an adverse birth event and .83±.56 for mothers with no event; p=.78). For women who received MSS-Plus, having an adverse birth event was associated with persisting depression in the postpartum period (mean scores of 1.20±.0.61 for mothers with an adverse birth event and .93±.52 for mothers without adverse birth event; p=.04). Similar results were seen for depression response rates and functioning. CONCLUSIONS: MOMCare mitigated the risk of postpartum depressive symptoms and impaired functioning among women of low socioeconomic status who had antenatal depression and who experienced adverse birth events.


Assuntos
Depressão Pós-Parto/terapia , Transtorno Depressivo Maior/terapia , Transtorno Distímico/terapia , Colaboração Intersetorial , Serviços de Saúde Materna , Complicações na Gravidez/terapia , Resultado da Gravidez , Adolescente , Adulto , Depressão Pós-Parto/tratamento farmacológico , Depressão Pós-Parto/epidemiologia , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/epidemiologia , Transtorno Distímico/tratamento farmacológico , Transtorno Distímico/epidemiologia , Feminino , Humanos , Serviços de Saúde Materna/organização & administração , Medicaid/estatística & dados numéricos , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Psicoterapia Breve/métodos , Estados Unidos/epidemiologia , Populações Vulneráveis , Adulto Jovem
19.
Eur J Obstet Gynecol Reprod Biol ; 207: 5-10, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27770705

RESUMO

OBJECTIVE: The aim of this study was to investigate the relationship between anger, impulsiveness, and biochemical parameters (testosterone, insulin, insulin resistance) in women with polycystic ovary syndrome. STUDY DESIGN: We recruited 84 women diagnosed with polycystic ovary syndrome according to the Rotterdam diagnostic criteria. Psychiatric interviews were performed using the Structured Clinical Interview for DSM-IV Axis I Disorders. The Barratt Impulsiveness Scale and the State Trait Anger Expression Inventory were also administered to each participant. Lastly, the women's biochemical parameters, which included total testosterone, free androgen index, dehydroepiandrosterone sulfate, insulin and insulin resistance, thyroid functions, and prolactin, were measured. RESULTS: A statistically significant correlation was found between participants' increasing total testosterone levels and total impulsiveness scores, and their increasing free androgen index levels and motor and non-planning-related impulsiveness (r=0.24, p=0.027; r=0.27, p=0.015; and r=0.26, p=0.017, respectively). High insulin and insulin resistance levels were associated with high non-planning-related impulsiveness scores (r=0.26, p=0.018; and r=0.26, p=0.019). Lastly, high trait anger and anger expression scores were related to high total testosterone and insulin and insulin resistance levels. CONCLUSION: Androgens and glucose dysregulation seemingly affect anger expression as well as the attentional, motor, and non-planning-related impulsiveness of women with polycystic ovary syndrome.


Assuntos
Transtorno Depressivo Maior/epidemiologia , Transtorno Distímico/epidemiologia , Hiperinsulinismo/etiologia , Resistência à Insulina , Transtorno Obsessivo-Compulsivo/epidemiologia , Fobia Social/epidemiologia , Síndrome do Ovário Policístico/psicologia , Adolescente , Adulto , Androgênios/sangue , Comorbidade , Estudos Transversais , Sulfato de Desidroepiandrosterona/sangue , Feminino , Hospitais de Ensino , Humanos , Pessoa de Meia-Idade , Síndrome do Ovário Policístico/epidemiologia , Síndrome do Ovário Policístico/metabolismo , Síndrome do Ovário Policístico/fisiopatologia , Prolactina/sangue , Escalas de Graduação Psiquiátrica , Testosterona/sangue , Turquia/epidemiologia , Adulto Jovem
20.
Medicine (Baltimore) ; 95(29): e4271, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27442660

RESUMO

Numerous studies have investigated the relationship between depression and temporomandibular disorders (TMD), but the conclusions remain vague. The aim of this study was to examine the causal effect between depression and TMD.The reporting of this study conforms to the STROBE statement. In this retrospective cohort study, all samples were recruited from a representative subdataset of 1 million insured persons for the year 2005 Longitudinal Health Insurance Database, who were randomly selected from all beneficiaries enrolled in the National Health Insurance program of Taiwan. We used a propensity score and stratified 926,560 patients into 2 groups (propensity1 = 588,429 and propensity2 = 338,131) and 4 cohorts (propensity1 with depression = 18,038, propensity1 without depression = 570,391, propensity2 with depression = 38,656, propensity2 without depression = 299,475) to detect the development of TMD among the depressive and nondepressive patients between 2004 and 2013.The positive correlative factors of TMD included female, total number of times seeking medical advice (TTSMA) for anxiety state, TTSMA for generalized anxiety disorder, TTSMA for mandible fracture, and TTSMA for unspecified anomaly of jaw size. The propensity2 group was represented by elder and female-predominant patients who used more psychiatric health resources. Among 3 types of depression, only dysthymia (so-called chronic depression) had a causal impact on TMD in the propensity 2 group. In the propensity 2 group, the hazard ratio of dysthymia for TMD measured by Cox's regression was 1.64 (95% confidence interval 1.28-2.09), after adjusting for demographic factors, psychiatric comorbidities, and maxillofacial confounders. The first-onset mean time of TMD as the consequence of dysthymia was 3.56 years (sd = 2.74, min = 0.08, median = 2.99, max = 9.73).This study demonstrates that dysthymia increases the risk of TMD in elderly and female-predominant patients who use more psychiatric health resources.


Assuntos
Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo/epidemiologia , Transtorno Distímico/epidemiologia , Transtornos da Articulação Temporomandibular/epidemiologia , Adulto , Fatores Etários , Idoso , Transtornos de Ansiedade/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vigilância da População , Pontuação de Propensão , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Fatores Sexuais , Estatística como Assunto , Taiwan
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