Reliability and validity of the Addiction Severity Index among outpatients with severe mental illness.

This study provides psychometric data for the Addiction Severity Index (ASI) when administered to persons with severe and persistent mental disorders. Participants were 97 outpatients (26 women) at a public psychiatric facility. The internal consistency of the composite scores was lower in this psychiatric sample than in previous nonpsychiatric samples. Interrater reliability was acceptable for most composite scores but low for many severity ratings. Several scores showed low temporal stability. Validity evidence was weak for the employment and family-social subscales, acceptable for drug and alcohol subscales, and mixed for psychiatric, medical, and legal subscales. Due to mixed reliability and validity evidence, caution should be exercised when using the ASI with patients having severe mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical self-concept and self-esteem mediate cross-sectional relations of physical activity and sport participation with depression symptoms among adolescent girls.

The authors tested whether physical self-concept and self-esteem would mediate cross-sectional relations of physical activity and sport participation with depression symptoms among 1,250 girls in 12th grade. There was a strong positive relation between global physical self-concept and self-esteem and a moderate inverse relation between self-esteem and depression symptoms. Physical activity and sport participation each had an indirect, positive relation with global physical self-concept that was independent of objective measures of cardiorespiratory fitness and body fatness. These correlational findings provide initial evidence suggesting that physical activity and sport participation might reduce depression risk among adolescent girls by unique, positive influences on physical self-concept that operate independently of fitness, body mass index, and perceptions of sports competence, body fat, and appearance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Frequency and correlates of depression symptoms among long-term adult burn survivors.

Objective: To determine the frequency and correlates of symptoms of depression experienced by long-term burn survivors. Design: An exploratory study of a cross-sectional, self-selected sample. Participants: 311 burn survivors who were at least 3 years postburn (M = 20, SD = 15). Main Outcome Measure: The Short Mood and Feelings Questionnaire, which is a self-report measure of symptoms of depression. Results: Depending on the cutoff score used, 20%-30% of the sample reported clinically significant symptoms of depression. A hierarchical multiple regression model accounted for 59% of the variance in symptoms of depression. Variables were entered in 3 blocks--burn characteristics, demographic characteristics, and psychosocial characteristics. Psychosocial characteristics such as social support and social comfort accounted for a majority of the variance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The cost-effectiveness of a clinical pharmacist intervention among elderly outpatients

We report the close correlation between changes in serum immunoreactive vascular endothelial growth factor 165 (iVEGF165) levels and metastatic tumor burden measured by computed tomography scan before treatment, during the antitumor response, and during early progression in a patient treated with ex vivo gene therapy for renal cell carcinoma. With the researcher blinded to outcome, iVEGF levels were measured in archived serum samples from a patient with metastatic renal cell carcinoma who demonstrated a 7-month partial remission to treatment with autologous, irradiated human GM-CSF gene transduced tumor vaccine. Although a spontaneous regression could not be formally excluded in this patient, the appearance of 20 new pulmonary metastases on computed tomography scan after nephrectomy and before vaccination indicates that if spontaneous regression occurred, it took place at the start of vaccine treatment.     

Environment modifies the association between depression symptoms and smoking among adolescents.

Previous studies have shown a strong correlation between depression and smoking, but the mechanism underlying the relationship is not well understood. This study examined whether the prevalence of smoking in schools influences the relationship between smoking and depression symptoms at the individual level. Information on demographics, tobacco use, and depression symptoms for 3,382 students in Grades 7-12 from 126 schools in Ontario, Canada, was obtained from the 2003 Ontario Student Drug Use Survey (E. Adlaf & A. Paglia, 2003). The effect of school-level smoking was strongly negative (coefficient = -1.05, p = .01), suggesting that depression and smoking at the individual level were strongly related in schools with a lower smoking prevalence but that this relationship diminished as the prevalence of smoking increased. Contextual effects may be important to understanding the link between smoking and depression in adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support, AIDS-related symptoms, and depression among gay men.

Examined the impact of social support and human immunodeficiency virus (HIV)-related conditions on depression among 508 gay men participating in the San Francisco Men's Health Study, a population-based prospective study of single men (aged 25–54 yrs). The number of HIV-related symptoms experienced significantly predicted depression cross-sectionally and 1 yr later. Satisfaction with each of 3 types of social support (emotional, practical, informational) was inversely correlated with depression. Men who were more satisfied with the social support they received were less likely to show increased depression 1 yr later. Degree of satisfaction with informational support appeared especially critical in buffering the stress associated with experiencing HIV symptoms. These findings offer valuable insight in understanding the psychological needs of gay men confronting the acquired immune deficiency syndrome (AIDS) crisis and have important practical implications for designing mental health services to meet those needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical health impairment and depression among older adults

We studied the effect of tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1), and interferon-gamma (IFN-gamma) on the function of thyroid cells and pituitary thyrotrophs. In FRTL-5 rat thyroid cells, both human and murine TNF-alpha inhibited basal and TSH-stimulated [125I]iodide transport. IL-1 shared this action with TNF-alpha, but was less potent. IL-1 and IFN-gamma did not cause a further reduction of TNF-alpha-induced inhibition of [125I]iodide transport. TNF-alpha, phorbol ester 12-myristate 13-acetate (PMA), and calcium ionophore (CI) A23817 all inhibited [125I]iodide transport, but high doses of PMA and CI also blocked the inhibitory action of TNF-alpha on [125I]iodide transport. Inhibition of protein kinase A and protein kinase C by H7 or HA inhibited TSH-stimulated iodide transport, but did not block the TNF-alpha action, suggesting that the mechanism of TNF-alpha action on thyroid cells is independent of protein kinase A and C. In pituitary cells, both human and murine TNF-alpha did not affect basal TSH secretion, but TNF-alpha reduced TRH-stimulated TSH secretion. This study provides further in vitro evidence that TNF-alpha inhibits the function of the hypothalamus-pituitary-thyroid axis acting directly on both the pituitary and thyroid glands.     

Physical attractiveness and mental illness.

Investigated the relation between physical attractiveness and mental disorder in 2 studies of women. In the 1st study, 23 hospitalized mental patients, 30 university employees, and 29 shoppers served as Ss. Results show that the hospitalized mental patients were decidedly less physically attractive than normal controls, based either on live (face-to-face) ratings or on ratings of photographs of the Ss by judges who were unaware of the Ss' mental statuses. Early and current adjustment were reliably associated with appearance for both mental patients and nonpatients. A 2nd study of 50 mental patients replicated some of the 1st study's findings and further examined the consequences of appearance within a psychiatric hospital setting. As compared to the more attractive patients, homelier patients were less socially responsive in a standardized interview procedure, had more severe diagnoses, were hospitalized for longer periods, and received fewer visitors from the community. Physical attractiveness accounted for a large significant amount of length-of-hospitalization variation when degree of psychopathology and other possible moderator variables were controlled statistically. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Endogenous depression in the elderly: Prevalence and agreement among measures.

Describes agreement among diagnoses made according to 5 definitions of endogenous depression in a sample of 99 depressed elders and discusses the relationship among these systems and selected demographic and clinical characteristics. Poor to fair agreement was generally demonstrated, except for Research Diagnostic Criteria (R. Spitzer et al, 1978) and Diagnostic and Statistical Manual of Mental Disorders-III—Revised (DSM-III—R), which demonstrated excellent agreement. Mostly, demographic and clinical variables (e.g., severity of depression) were unrelated to endogeneity diagnoses. The conclusion was reached that these criteria are not all measuring the same construct in older adults and that the relationship between depression severity and endogeneity should be discussed in terms of specific definitions rather than in general terms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tobacco withdrawal signs and symptoms among women with and without a history of depression.

A past history of depression is associated with a decreased likelihood of quitting smoking. Tobacco withdrawal may be a mechanism through which depression history impedes smoking cessation. This research examined the influence of depression history on unmedicated tobacco withdrawal signs (polysomnographic measures of sleep) and symptoms (self-reported urge, negative affect, hunger, and sleep) among women (N/& =/&13). Depression history was associated with differential withdrawal-induced changes in several REM sleep parameters. Self-report and other polysomnography (sleep fragmentation, slow-wave sleep) measures displayed statistically significant withdrawal effects but did not discriminate between depression history groups. These results suggest that REM sleep parameters may be sensitive to differential tobacco withdrawal responses that are not readily apparent through self-reported symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of stressful circumstances, illness symptoms, and depressed mood among adolescents.

This study assessed the relationship of stressful life circumstances to illness symptoms and depressed mood among adolescent girls (in the 7th through the 11th grades). At two times, respondents indicated whether each of 20 commonly experienced circumstances had occurred to them and whether they rated its occurrence as positive or negative. Additionally, they completed an illness symptoms checklist and a standard measure of depressed mood. Cross-sectional analyses showed that circumstances rated negatively were associated with poor physical and mental health. Perspective analyses, controlling for initial physical or mental health status, revealed that negative circumstances led to reports of greater illness symptoms or depressed mood only when positive circumstances were low. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The symptoms of major depression.

Studied the 8 symptoms of Criteria B for major depressive disorder (MDE) in the Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III) in 107 cases and 57 noncases of MDE (all had depressed mood or pervasive anhedonia for more than 2 wks). Sleep change, loss of energy, and appetite change were the most common symptoms, and psychomotor change and feelings of worthlessness the least common, in MDE. Loss of energy and sleep change were the best single symptoms and thoughts of death, feelings of worthlessness, and psychomotor change the worst for both diagnoses. Psychomotor change was the best and thoughts of death the worst indicator of MDE. Absence of sleep change and of loss of energy were the best and absence of thoughts of death, psychomotor change, and feelings of worthlessness the worst indicators of non-MDE. Results suggest that vegetative symptoms are more central to clinical depression than feelings of worthlessness, self-reproach, or guilt. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Shyness and symptoms of illness in young children.

Investigated the association between shyness and symptoms of illness in young children and the types of symptoms differentiating shy and nonshy children. 16 shy children and 16 nonshy children (mean age 7 yrs 3 mo) were matched on sex, parental education, familial stress, and height-weight ratio. For 4 wks, parents recorded their children's health complaints and their own observations and conclusions of their children's health. There were more days on which shy children complained of unwellness and parents observed symptoms of unwellness than for nonshy children. Shy children made more affective complaints and were observed to experience more gastrointestinal upset. Several interpretations of the results are presented including the possibilities that lower thresholds for arousal in the hypothalamic-pituitary-adrenal axes of shy children affected their immunocompetence, that parents of shy children and the children themselves were more sensitive to symptoms of illness, and that feeling unwell may contribute to shy behaviour. Results suggest that the health of shy children merits further study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Symptoms of depression among community-dwelling elderly African-American and white older adults

BACKGROUND: Few studies have explored the variance in individual symptoms by race in older adults. METHODS: Data were analysed from the Duke site of the Established Populations for Epidemiologic Studies of the Elderly (EPESE), a community sample of persons 65 years-of-age and older, 54% of whom were African-Americans. Of the 3401 subjects with adequate data on depressive symptomatology, confirmatory factor analysis and LISREL were first used to confirm the presence of the factor structure previously reported for the CES-D. Next, bivariate analysis was performed to determine the prevalence of individual symptoms by race. Finally, LISREL analysis was performed to control for potential confounding variables. RESULTS: When bivariate comparisons of specific symptoms by race were explored, African-Americans were more likely to report less hope about the future, poor appetite, difficulty concentrating, requiring more effort for usual activities, less talking, feeling people were unfriendly, feeling disliked by others and being more 'bothered' than usual. When LISREL analyses were applied to these data (controlling for education, income, cognitive impairment, chronic health problems and disability and other factors) racial differences in somatic complaints and life satisfaction disappeared, yet differences in interpersonal relations persisted. CONCLUSIONS: This study confirms earlier findings of minimal overall differences in symptom frequency between African-American and non-African-American community-dwelling older adults in controlled studies.     

Relations of diabetes intrusiveness and personal control to symptoms of depression among adults with diabetes.

The generalizability of a model linking illness characteristics to psychosocial well-being was tested in a cross-sectional study of 237 adults with type 2 diabetes. It was hypothesized that diabetic complications increase illness intrusiveness, which in turn increases depressive symptomatology either directly or indirectly by reducing personal control over health outcomes. Illness intrusiveness was defined as the result of disruptions of valued activities and interests due to constraints imposed by the illness. An excellent fit of this model to the data was found using structural equation modeling. The model explained 65% of the variance in depressive symptomatology. Assessment of an alternative model excluding personal control suggested that the extent to which diabetes intrudes in life, rather than diabetic complications per se or personal control, is a key factor in relation to depressive symptomatology in individuals with diabetes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing treatment adherence among outpatients with depression and cocaine dependence: results of a pilot study

OBJECTIVE: This pilot study examined the effect of a modified motivational therapy intervention on outpatient treatment adherence and completion for patients with comorbid depressive disorder and cocaine dependence. METHOD: Depressed cocaine patients, stabilized with antidepressant medications on an inpatient psychiatric unit, were consecutively assigned on discharge to motivational therapy (N = 11) or treatment-as-usual (N = 12) during the first month of outpatient care. Patients were compared on treatment adherence and completion and on 1-year rehospitalization rates. RESULTS: Motivational therapy patients attended significantly more treatment sessions during month 1, completed 30 and 90 days of outpatient care at higher rates, and experienced fewer psychiatric rehospitalizations and days in the hospital during the first year from entry into outpatient treatment. CONCLUSIONS: An outpatient program combining individual and group motivational therapy sessions holds promise for improving treatment adherence and completion among depressed patients with cocaine dependence.     

Perfectionism in chronic and state symptoms of depression.

Tested whether perfectionism dimensions uniquely predict chronic unipolar and chronic bipolar symptoms. A sample of 121 patients and former patients (mean age 46.1 yrs) completed the Multidimensional Perfectionism Scale, the General Behavior Inventory, and the Beck Depression Inventory. The results confirm that the perfectionism dimensions are related to chronicity of depression symptoms. Whereas self-oriented perfectionism was uniquely associated only with chronic unipolar symptoms, both socially prescribed and other-oriented perfectionism were uniquely associated with chronic bipolar symptoms. Importantly, these relationships remained significant after controlling for the effects of concurrent state depression. Finally, only socially prescribed perfectionism was uniquely associated with state depression. The results provide support for the position that perfectionism dimensions are important in both chronic. and state depression symptoms, but the perfectionism dimensions may differ in terms of their degree of association with various facets of depressive phenomena. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Association of symptoms of depression with diagnostic test charges among older adults

BACKGROUND: Previous studies have documented greater use of health services by depressed persons and have postulated that health care costs could be reduced overall through better recognition and treatment of depression. OBJECTIVE: To determine whether a greater burden of medical illness contributes to excess charges for diagnostic tests among older adults with symptoms of depression. DESIGN: Prospective cohort study. SETTING: A primary care group practice at an academic institution. PATIENTS: 3767 patients 60 years of age and older who completed testing on the Centers for Epidemiologic Studies Depression Scale (CES-D) during routine office visits. MEASUREMENTS: Charges for all inpatient and ambulatory diagnostic testing for 2 years, including clinical pathology, diagnostic imaging, and special procedures; number of visits to the ambulatory care center or emergency department; and number of hospitalizations. The Ambulatory Care Group case-mix approach, which is based on ambulatory diagnoses, was used as a measure of health status and expected resource consumption. RESULTS: Patients with symptoms of depression (CES-D scores > or = 16) were significantly younger (66.6 compared with 68.1 years; P < 0.001), more likely to be white (50.5% compared with 33.9%; P = 0.001), and more likely to be female (75.8% compared with 67.6%; P = 0.001) than were those without these symptoms (CES-D scores < 16). They also had more nonpsychiatric comorbid conditions, had more visits to the ambulatory care center (9.2 compared with 7.8; P < 0.001), were more likely to use the emergency department (52.3% compared with 40%; P = 0.001), were more likely to be hospitalized (22.4% compared with 17%; P = 0.002), and had greater median total diagnostic test charges for a period of 1 year ($583 compared with $387; P < 0.001). The difference in charges, most of which were clinical pathology charges (54.2%), persisted into the second year. Ambulatory Care Group assignment was independently associated with diagnostic test charges. The CES-D summary score was not independently associated with diagnostic test charges when controlling for Ambulatory Care Group assignment. CONCLUSIONS: Patients with symptoms of depression accrue greater average diagnostic test charges. However, these data suggest that such patients also have a greater burden of comorbid nonpsychiatric illness. Efforts to improve outcome and decrease cost for patients who have late-life depression must target interventions to improve the care of psychiatric and medical illness concurrently.     

Social learning influences on menstrual symptoms and illness behavior.

Tested the hypothesis that the sick role and modeling during childhood contribute to the way people react to bodily sensations relevant to illness, using data from 351 nursing students (aged 18–39 yrs) on how their mothers reacted to menstrual symptoms and cold symptoms during their adolescence and how their mothers behaved when they themselves had menstrual symptoms. 198 of the students' mothers answered the same questions. Students who had been encouraged to adopt a sick role for menses or whose mothers modeled menstrual distress reported significantly more menstrual symptoms, clinic visits, and disability days for these symptoms as adults. Those encouraged to adopt a sick role for colds or who lived with a chronically ill person reported more clinic visits and disability days for nongynecological symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Examining possible gender differences among cocaine-dependent outpatients.

Potential differences in sociodemographics, drug use, and measures of treatment outcome were examined among 137 male and 51 female cocaine-dependent outpatients. More women than men were unemployed, received public assistance, and were living with their children. Women reported fewer years of regular cocaine use, spending less money per week on cocaine, less prior treatment for cocaine abuse, and were more likely than men to test positive for cocaine at intake. With respect to other drug use, fewer women than men reported using sedatives and tested positive for sedatives at intake. Women reported a lower frequency of alcohol use before intake, and fewer women than men met criteria for cannabis dependence. Men and women experienced comparable improvement during the course of treatment and follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)