The results of a 6-month treatment for depression on symptoms, life satisfaction, and community activities among individuals aging with a disability.

Objective: To evaluate the results of treating major depression in individuals aging with a disability. Design: Pre-post quasi-experimental design with a treatment and comparison group over 6 months. Participants: Participants were people with a disability living in a community in Southern California. Fifty-four participants who accepted treatment were compared with 22 individuals who declined treatment. Interventions: Combination of psychotherapy and antidepressant medication. Measures: Depressive symptoms, life satisfaction, and community activities. Results: Treated individuals improved significantly on all 3 measures. Average depression scores declined 50% (p = .001). There was a nonsignificant 12% decline in the comparison group. Conclusion: These results suggest that depression is treatable in this population. Studies that overcome obstacles to randomized clinical trials are needed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of spa therapy to improve the quality of life of chronic low back pain patients

OBJECTIVES: This study assessed the effectiveness of adding spa therapy to usual drug treatment in chronic low back pain patients. METHODS: A total of 224 patients were assigned randomly to either a treatment (n=128) or a control (n=96) group. Subjects in both groups received usual drug therapy. Those in the treatment group also underwent spa therapy in Vittel, France, for 6 days a week for 3 consecutive weeks. Effectiveness was assessed using a quality-of-life scale (the Duke Health Profile), clinical measures, and the Roland and Morris disability questionnaire. Groups were compared using an analysis of variance with repeated measures. RESULTS: At both 3 weeks and 3 months, patients in the treatment group exhibited significant improvement in measures of: physical and mental dimensions of quality of life, anxiety, depression, pain duration, pain intensity, and functional disability. CONCLUSION: This study suggests that spa therapy is an effective treatment for chronic low back pain patients.     

The effect of compensation involvement on the reporting of pain and disability by patients referred for rehabilitation of chronic low back pain

STUDY DESIGN: In this prospective, observational, cohort study of 192 individuals with chronic low back pain, the group of individuals was divided based on compensation involvement, and their presentation pain and disability, treatment recommendations, and compliance were compared. For 85 of these individuals who completed a spine rehabilitation program, their pain and disability at 3 and 12 months were compared. OBJECTIVES: To test the theory that individuals with compensation involvement presented with greater pain and disability and would report less change of pain and disability after rehabilitation efforts. BACKGROUND: Previous studies have produced conflicting results concerning this issue. METHODS: Individuals were recruited as consecutive patients referred for consultation at a spine rehabilitation center. Pain, depression, and disability were assessed using self-report questionnaires at evaluation and at 3 and 12 months. Rehabilitation services consisted of aggressive, quota-based exercises aimed at correcting impairments in flexibility, strength, endurance, and lifting capacity, identified through quantification of back function. Multifactoral analysis of variance models were used to control for baseline differences between compensation and noncompensation patients during analysis of target variables. RESULTS: The compensation group included 96 patients; these patients reported more pain, depression, and disability than the 96 patients without compensation involvement. These differences persisted when baseline differences were controlled for with multifactoral analysis of variance models. Treatment recommendations and compliance were not affected by compensation. For patients completing the spine rehabilitation program, length of treatment, flexibility, strength, lifting ability, and lower extremity work performance before and after treatment and patient satisfaction ratings were similar for the compensation and noncompensation groups. At 3 and 12 months, improvements in depression and disability were noted for both groups, but were statistically and clinically less substantial for the compensation group. At the 12 month follow-up visit, pain scores improved for the noncompensation group, but not for the compensation group. CONCLUSIONS: In chronic low back pain, compensation involvement may have an adverse effect on self-reported pain, depression, and disability before and after rehabilitation interventions.     

Aortic and lower-extremity arterial disease: evaluation with MR angiography versus conventional angiography

BACKGROUND: Few data are available regarding the impact of improved depression treatment on daily functioning and disability. METHODS: In two studies of more intensive depression treatment in primary care, patients initiating antidepressant treatment were randomly assigned to either usual care or to a collaborative management programme including patient education, on-site mental health treatment, adjustment of antidepressant medication, behavioural activation and monitoring of medication adherence. Assessments at baseline as well as 4 and 7 months included several measures of impairment, daily functioning and disability: self-rated overall health, number of bodily pains, number of somatization symptoms, changes in work due to health, reduction in leisure activities due to health, number of disability days and number of restricted activity days. RESULTS: Average data from the 4- and 7-month assessments in both studies, intervention patients reported fewer somatic symptoms (OR 0.68, 95% CI 0.46, 0.99) and more favourable overall health (OR 0.50, 95% CI 0.28, 0.91). While intervention patients fared better on other measures of functional impairment and disability, none of these differences reached statistical significance. CONCLUSIONS: More effective acute-phase depression treatment reduced somatic distress and improved self-rated overall health. The absence of a significant intervention effect on other disability measures may reflect the brief treatment and follow-up period and the influence of other individual and environmental factors on disability.     

Cognitive, assertive, and insight-oriented group therapies in the treatment of reactive depression in women.

33 nonpsychotic, nonsuicidal women (mean age 35.1 yrs) who scored between 15 and 31 on the Beck Depression Inventory (BDI) and whose depression was situationally related were assigned to 6-wk cognitive, assertive, or insight-oriented group therapy. Ss were administered a standardized interview, BDI, Rathus Assertiveness Schedule, Personality Data Form, and 4 tape-recorded scenes requiring an assertive response before and after the groups and at a 2-mo follow-up. Results show all groups improved significantly in depression, rationality, and assertiveness. Assertive and insight groups improved significantly more in rationality regarding acceptance than the cognitive group. At follow-up, none of the assertive groups, 18% of the cognitive group, and 45% of the insight group had sought further treatment. Additionally, the assertive group was significantly more rational regarding frustrating events and self-worth. The assertive and insight groups made significantly more gains and were more assertive than the cognitive group. A 3 (change in depression) by 3 (treatment group) ANOVA showed high-depression-change and medium-depression-change Ss changed significantly more in assertiveness and rationally than low-depression change Ss. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of group progressive-relaxation training and cognitive-behavioral group therapy for chronic low back pain.

36 20–63 yr old chronic low-back-pain outpatients were randomly assigned to group progressive-relaxation training, cognitive-behavioral group therapy, or waiting list/attention conditions. Both relaxation-training and cognitive-behavioral-therapy Ss improved significantly on self-report measures of pain, depression, and disability (e.g., Sickness Impact Profile, Beck Depression Inventory) and on a significant-other-rated measure of physical and psychosocial dysfunction pre- to posttreatment, whereas waiting-list Ss did not. Posttreatment, cognitive-behavioral-therapy Ss did not differ from relaxation-training Ss on most variables, but they did rate themselves as having improved more in ability to tolerate pain and participate in normal activities. At 1-mo follow-up, relaxation-training Ss showed no significant further improvement and had a significant increase in pain. Cognitive-behavioral-therapy Ss demonstrated further improvement at 1-mo follow-up on several measures of pain, depression, and disability. A 1?–2 yr mail follow-up indicated a marked reduction in health-care use for Ss in both treatments, and the cognitive-behavioral-therapy Ss had improved markedly in time spent working. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Control cognitions and psychological disturbance in people with contrasting physically disabling conditions

PURPOSE: This study examines the role of control cognitions, i.e. locus of control (LOC), in predicting adaptation to two contrasting physically disabling conditions. METHOD: Locus of control beliefs were investigated in terms of their relationship with psychological distress (anxiety and depression) experienced by people facing either spinal cord injury (SCI) or multiple sclerosis (MS). The role of pain experience was also considered in terms of its impact on psychological distress in both groups. RESULTS: Results indicated that although SCI subjects were more internally oriented than MS subjects, internality was not linked to lower levels of depression or anxiety in either group, although within the SCI group an external LOC was associated with increased depression and physical disability. CONCLUSIONS: For people facing a future with the challenge of physical disability, the pattern of progression of disability over time may be of significance in the development of psychological distress.     

Depression and physical disability outcomes in depressed medically ill hospitalized older adults

The authors examined depression/disability outcomes in hospitalized older medical patients during the year after hospital discharge to assess the pattern and rate of changing depression and disability, the causal relationship between these variables, and to identify patients at greatest risk for poor outcomes. A group of 119 medical patients at Duke Hospital were both depressed and disabled; they were followed for a median of 47 weeks after hospital discharge. Time-series analyses showed that depression and disability tended to track together, and most changes occurred within the first 6 months after discharge. Blacks were more likely to remit from depression despite continued disability and less likely to experience continued depression despite decreased disability. Patients with a history of depression were less likely to experience improvement in depression unless disability improved. Number of medical diagnoses and depression severity independently predicted poorer depression outcomes. Certain characteristics of patients during hospitalization predict depression/disability outcomes after discharge.     

Pilot trial of immunoglobulin versus plasma exchange in patients with Guillain-Barré syndrome

We compared intravenous immunoglobulin (IVIG) and plasma exchange (PLEX) in the treatment of 50 patients with Guillain-Barré syndrome (GBS). Standard outcome measures did not differ for the two groups. Sixty-one percent of the PLEX-treated group and 69% of the IVIG-treated group improved by one disability grade at 1 month. The complication rate was higher in the PLEX-treated group. We conclude that the efficacy of IVIG in the treatment of GBS is comparable with that of PLEX and that it can be used safely, although we had a small number of patients. We did not observe a higher relapse rate with IVIG. The usefulness of combination therapy is unknown at this time.     

A symptom profile of hospitalization-requiring depression among the elderly related to clinical subgroups. A way to improve diagnostics

The objectives were to study clinical symptoms of major depression in later life by using relevant assessment scales of psychopathology, behavioural disorders, and physical functioning. The evaluations on admission and at discharge were based on interdisciplinary observations and interview of patients. The study was carried out during twelve months in a psychogeriatric university department and encompassed 202 patients. All (N = 80) (40%) patients who had a principal diagnosis of major depression are accounted for. Mean age was 79.5 years. Results of the assessments all showed significant improvements (p = 0.0000-0.0024). The overall results of the assessments show that the key symptom of sadness is often missing, muted, or overshadowed by other symptoms, and that behavioural disturbancies and functional disability may be important symptoms in geriatric depression. In conclusion: adequate treatment of major depression in the elderly significantly improves psychopathology, behavioural disorders and physical functioning. When dealing with mental disorders in this age group, awareness of the five clinical presentations in major geriatric depression, i.e. dementoform, somatoform neurotiform, eretic and classic geriatric depression, may target the diagnostic procedure.     

Consequences of major and minor depression in later life: a study of disability, well-being and service utilization

BACKGROUND: The consequences of major depression for disability, impaired well-being and service utilization have been studied primarily in younger adults. In all age groups the consequences of minor depression are virtually unknown. In later life, the increased co-morbidity with physical illness may modify the consequences of depression, warranting special study of the elderly. With rising numbers of elderly people, excess service utilization by depressed elderly represents an increasingly important issue. METHODS: Based on a large, random community-based sample of older inhabitants of the Netherlands (55-85 years), the associations of major and minor depression with various indicators of disability, well-being and service utilization were assessed, controlling for potential confounding factors. Depression was diagnosed using a two-stage screening design. Diagnosis took place in all subjects with high depressive symptom levels and a random sample of those with low depressive symptom levels. The study sample consists of all participants to diagnostic interviews (N = 646). RESULTS: As in younger adults, associations of both major and minor depression with disability and well-being remained significant after controlling for chronic disease and functional limitations. Adequate treatment is often not administered, even in subjects with major depression. As the vast majority of those depressed were recently seen by their general practitioners, treatment could have been provided in most cases. Bivariate analyses show that major and minor depression are associated with an excess use of non-mental health services, underscoring the importance of recognition. In multivariate analyses the evidence of excess service utilization was less compelling. CONCLUSIONS: Both major and minor depression are consequential for well-being and disability, supporting efforts to improve the recognition and treatment in primary care. However, controlled trials are necessary to assess the impact this may have on service utilization.     

Coping effectiveness training during acute rehabilitation of spinal cord injury/dysfunction: A randomized clinical trial.

Purpose: To compare coping effectiveness training (CET) with supportive group therapy (SGT) for anxiety, depression, and adjustment to injury in an acute spinal cord injury/dysfunction (SCI/D) rehabilitation population. CET was shown to result in decreased anxiety and depression symptoms when compared to historical no-treatment control groups (Kennedy, Duff, Evans, & Beedie, 2003; King & Kennedy, 1999). The present study sought to extend those findings with a comparison of CET to an alternative active therapy condition, SGT. Research Method: Participants (N = 40) entering a hospital-based program were assigned to treatment condition using block randomization. Questionnaire mood measures were completed at program admission, program discharge, and 3-month postdischarge follow-up. Adjustment to disability was assessed at follow-up only. Analyses of variance tested for group differences in anxiety, depression, and adjustment to injury. Results: Both groups reported reductions in mood symptoms with no differences between treatment conditions. However, similar reductions were obtained after fewer sessions of CET. Symptoms of depression increased in both groups following hospital discharge. Conclusions: Clinical and research implications, including innovative interventions during the period after discharge, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomised placebo-controlled trial of monthly intravenous immunoglobulin therapy in relapsing-remitting multiple sclerosis. Austrian Immunoglobulin in Multiple Sclerosis Study Group

BACKGROUND: Multiple sclerosis is an autoimmune disorder characterised by the repeated occurrence of demyelinating lesions within the central nervous system. Uncontrolled studies and experimental evidence suggest beneficial effects of repeated administration of intravenous immunoglobulin (IVIg) by immunomodulating mechanisms and induction or remyelination. We aimed to investigate the efficacy of IVIg in a randomised double-blind multicentre study. METHODS: Patients with relapsing-remitting multiple sclerosis were randomly assigned a monthly dose of IVIg (0.15-0.2 g/kg bodyweight) or placebo. Duration of treatment was 2 years. The primary outcome measures were the effect of treatment on clinical disability-measured by the absolute change in Kurtzke's expanded disability status scale (EDSS) score- and the proportion of patients with improved, stable, or worse clinical disability (> or = 1.0 grade on EDSS score). FINDINGS: Of the 243 patients screened, 150 met our eligibility criteria and were randomly assigned to IVIg or placebo. Before the start of treatment two patients in the placebo group dropped out, so there were 75 patients in the IVIg group and 73 in the placebo group. Intention-to-treat analysis showed that IVIg treatment had a beneficial effect on the course of clinical disability. The EDSS score decreased in the IVIg-treated patients and increased in the placebo group (-0.23 [95% CI -0.43 to -0.03] vs 0.12 [-0.13 to 0.37], p = 0.008). In the IVIg group, the numbers of patients with improved, stable, or worse clinical disability were 23 (31%), 40 (53%), and 12 (16%) compared with ten (14%), 46 (63%), and 17 (23%) in the placebo group. Side-effects were reported in three (4%) IVIg-treated patients and in four (5%) placebo-group patients, but were not directly linked to study medication. INTERPRETATION: Monthly IVIg is an effective and well-tolerated treatment for patients with relapsing-remitting multiple sclerosis.     

Varicella vaccine in immunocompromised patients

OBJECTIVE: To determine the prevalence of depressive symptoms and their relationship to disability in older low vision patients. DESIGN: Panel study with 2-year follow-up. PARTICIPANTS: Community-residing older people (N = 31). MEASUREMENTS: Geriatric Depression Scale, Community Disability Scale, and Snellen visual acuity. RESULTS: Twelve of 31 patients (38.7%) had GDS scores > or = 11 at baseline. Two years later, 10 of these 12 patients remained depressed, and three of the 19 (15.8%) previously nondepressed patients had become depressed. Depressed patients tended to be more disabled functionally than nondepressed patients at follow-up. The correlation of disability with depression and with vision were examined for the entire sample and revealed a strong correlation between disability and depression (r = .40; P = .013) compared with that of disability and vision (r = .34; P = .032) at baseline and at follow-up: depression (r = .68; P = .001), vision (r = .45; P = .006). There was no significant correlation between depression and vision at baseline (r = .06; P = .383), but there was a trend toward correlation at follow-up (r = .28; P = .067). CONCLUSION: Depressive symptoms are prevalent and persistent among low vision patients and appear more highly related to disability than is vision. The frequent occurrence of depression and the availability of effective treatment argue for its recognition and treatment as possible ways to reduce disability in older persons with low vision.     

Health-care utilization by disabled persons: a survey in rural Bangladesh

The purpose of the present study was to examine the utilization of health services by disabled persons in rural Bangladesh and to identify associated factors to inform the development of appropriate health services. Household surveys were conducted in two villages of Bangladesh by a trained primary-care specialist who lived in the study area for 4 months. About 81% of the sample had utilized some form of health care with more than half consulting unqualified practitioners of modern medicine. Disabled persons whose families perceived they were disabled were 14 times more likely than others to seek treatment. Being male and in the economically productive age group, having an acquired disability and having some form of belief about disability causation were associated with utilization. The conclusions of the study are that social and cultural barriers prevent certain groups, notably women and demographically dependent age groups, from accessing health care. Those who are economically beneficial to the family usually utilize health services. A combination of educational and economic initiatives such as a disability benefits allowance would strongly promote the health of disabled persons and create a general awareness of disability in Bangladesh. A long-term programme which includes disability training for health-care workers and use of financial institutions and existing local government infrastructure for intensive rehabilitation will improve quality of life for disabled persons and is proposed for urgent implementation.     

The impact of a psychological intervention on quality of life in non-metastatic breast cancer

The aim of this study was to determine whether psychological intervention had a beneficial effect on the quality of life and behaviour of women diagnosed with breast cancer. 36 consecutive patients with non-metastatic breast cancer assigned to surgery and systemic chemotherapy were randomised to receive either psychological intervention (weekly cognitive individual psychotherapy and bimonthly family counselling) or standard follow-up. Personality (16-PF and IIQ), quality of life (FLIC), and depression (BDI) scores were the endpoints for this study, and the questionnaires were completed by the patients at diagnosis, and up to 9 months after diagnosis. Cognitive psychotherapy and family counselling improved both depression and quality of life indexes compared with the control group. Better emotional coping behaviours were also revealed by some changes in personality traits in the intervention group.     

Outcomes following acute hospital care for stroke or hip fracture: how useful is an assessment of anxiety or depression for older people?

OBJECTIVE: To investigate the association between severe life events and mental health outcomes following acute hospital care for older patients with acute stroke or fractured neck of femur. DESIGN: Prospective longitudinal survey of stroke and hip fracture patients admitted to hospital from admission to 6-month follow-up. SETTING: Six district general hospitals, three in the North and three in the South of England. PARTICIPANTS: 642 patients admitted to hospital with an acute stroke (268) or hip fracture (374) resident in a private household at 6 months follow-up. MAIN OUTCOME MEASURES: Hospital Anxiety and Depression Scale, cognitive items of the Survey Psychiatric Assessment Scale, Clackmannan Disability Scale, Severe Life Events Inventory, Wenger Social Support Network Typology. RESULTS: 47% of 6-month survivors of stroke or hip fracture resident in private households had a possible psychiatric illness: dementia (13%), anxiety or depression (41%). 57% had severe or very severe disability and 48% experienced additional life events (17% two or more) after hospital admission. Severe disability was strongly associated with a higher prevalence of anxiety (p < 0.0005) or depression (p < 0.0001). Social contact was associated with a lower prevalence of anxiety (p < 0.01) or depression (p < 0.0001) and social support network type was strongly associated with depression (p < 0.001) but not anxiety (p = 0.096). Number of severe life events was associated with anxiety (p < 0.001) but not depression (p = 0.058). CONCLUSION: Disability is probably a more robust outcome measure than assessments of mental health for older people in uncontrolled studies.     

Prospective randomized controlled trial of preservation of the intercostobrachial nerve during axillary node clearance for breast cancer

OBJECTIVE: The authors' goal was to determine whether cognitive behavioral treatment of residual symptoms of depression might have a significant effect on relapse rate. METHOD: A 6-year follow-up assessment was conducted of 40 patients with primary major depressive disorder who had been successfully treated with antidepressants and were randomly assigned to either cognitive behavioral treatment of residual symptoms or standard clinical management. RESULTS: Ten of the patients (50%) in the cognitive behavioral treatment group and 15 (75%) in the standard clinical management group relapsed. The difference did not attain statistical significance. When multiple relapses were considered, patients in the cognitive behavioral treatment group had a significantly lower number of depressive episodes than those in the standard clinical management group. Patients responded to the same antidepressant drug used in the index episode; in two cases (4%), resistance occurred. CONCLUSIONS: The protective effects of cognitive behavioral treatment that were evident at 4-year follow-up faded afterward. Cognitive behavioral treatment of residual symptoms, however, improved the long-term outcome of major depression in terms of total number of episodes during the follow-up period.     

The synthesis and in vitro characterization of the mucoadhesion and swelling of poly(acrylic acid) hydrogels

Depression is a significant problem in epilepsy. Suicides occur in epileptic patients five times more often than in general population. Material included 34 epileptics with 76 suicidal attempts and 24 patients with no history of suicide. Psychical state was studied with Beck Depression Inventory and Hamilton Depression Rating Scale. In the group with suicidal attempts 65% of patients had depression (54.5% of them had major depression) and in group without suicide attempts depression was noted in 54% (23% with major depression). Patients with depression were divided into two groups: group I with suicidal attempts and group II without history of suicide. In group I more patients were alcohol abusers (50% vs 31%), more were treated because of epilepsy longer than 10 years (59% vs 46%) and more had tonic-clonic seizures (82% vs 46%). In group I, 54% of patients were on polytherapy (more than half of them with fenobarbital). In group II, 31% of epileptics were on polytherapy (no one with fenobarbital). Major depression was significantly more frequent in epileptics with suicidal attempts. The severity of depression may influence the risk of suicide. Major depression may be associated with late age of onset of epilepsy, longer treatment duration, tonic-clonic seizures, polytherapy (mainly with fenobarbital) and alcohol abuse.     

The relationship of current psychiatric disorder to functional disability and distress in patients with inflammatory bowel disease

Although prior theories about psychiatric disorders causing inflammatory bowel disease (IBD) have largely been discredited, these same disorders have at times been associated with functional gastrointestinal symptoms such as those found in irritable bowel syndrome. Since functional gastrointestinal symptoms can also occur in patients with organic pathology, we hypothesized that a current psychiatric disorder might amplify or produce additional gastrointestinal symptoms in patients with organic gastrointestinal diseases such as IBD, leading to additive functional disability and decreased quality of life. This pilot study evaluated a sequential sample of 40 IBD patients using the NIMH Diagnostic Interview Schedule, structured interviews for functional gastrointestinal symptoms, and prior episodes of emotional, physical, and sexual abuse as well as self-report measures of personality and disability. We compared IBD patients with and without a current psychiatric disorder while controlling for disease severity. Eight patients with major depression were treated with antidepressants. Patients with a current psychiatric disorder had significantly higher 1) mean number of lifetime psychiatric diagnoses, 2) prevalence rates of prior sexual and physical victimization, and, 3) mean numbers of both gastrointestinal and other medically unexplained symptoms despite no differences in severity of IBD. Significant and trend level differences were apparent on several measures of functional disability. A regression analysis showed that number of psychiatric diagnoses, number of functional gastrointestinal symptoms, and dissociation scale scores significantly discriminated the groups. Treatment of current major depression decreased functional disability despite no objective changes in gastrointestinal disease severity. It was concluded that the presence of a current psychiatric disorder appears to alter the perception of disease severity in patients with IBD. Nonrecognition of the psychiatric disorder may lead to unnecessary and aggressive interventions for IBD patients such as medication changes, invasive testing, or surgery. The presence of a current psychiatric illness also appears to be associated with increased functional disability. Psychiatric evaluation and treatment, therefore, have an important role in the ongoing management of IBD patients with distressing gastrointestinal symptoms not directly attributable to their IBD.