The effect of self-reported and observed job conditions on depression and anxiety symptoms: A comparison of theoretical models.

The demand/control/support and effort/reward imbalance models have relied on self-reported methods to describe how poor psychosocial working conditions lead to harmful health outcomes. The hindrance/utilization model uses an observational methodology to assess these relationships. Cross-sectional observational and self-reported data from 98 civil servants participating in the Whitehall II Study of British civil servants were used to test whether work conditions measured by each of the three theoretical models explained a significant amount of the variance in depression and anxiety symptoms. Observational measures were also used to assess potential common methods variance bias between the self-reported job conditions and the outcomes. Results showed that the demand/control/support model explained the most variance in depression and anxiety symptoms and the associations were not wholly due to common methods variance. Moreover, measures associated with job resources (e.g., skill discretion, social support and skill utilization) had a protective effect on depression and anxiety symptoms. Exertion-related conditions (e.g., demands, effort, over commitment) were not consistently associated with depression or anxiety symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of physical health functioning, mental health, and sociodemographic factors in determining the intensity of mental health care use among primary care medical patients.

The present study examined sociodemographic and attitudinal predisposing factors (gender, age, marital status, health insurance, household income, attitudes about mental health care), and need/illness variables (depression severity, physical and mental health functional status) as predictors of past-year mental health care use intensity (i.e., visit counts) and use/nonuse. The sample included 283 adult primary care patients from the Midwestern United States in a cross-sectional study. Nonlinear regression models demonstrated that past-year treatment use intensity was significantly associated with both married status and poorer physical health functioning, while the use (vs. nonuse) of treatment was associated with depression severity. A sociodemographic and attitudinal multivariate predictor model only explained 5% of the variance in treatment use intensity, but a need/illness model significantly contributed an additional 23% variance. Poorer physical health functioning was significant in predicting treatment use intensity, while depression severity was significant in predicting the use (vs. nonuse) of treatment. Results demonstrate the particular importance of physical health problems in determining the intensity of mental health care use, and depression severity in determining the use/nonuse of treatment, notwithstanding the restricted sociodemographic contour of the sample. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The central role of restricted normal activities in adjustment to illness and disability: A model of depressed affect.

Research has consistently indicated that health-related stressors affect depressive symptoms largely to the extent that they restrict routine activities. Beyond the impact of illness severity, psychosocial variables (age, income adequacy, social support, and personality) also contribute to restricted activities. Moreover, after controlling for illness severity and psychosocial factors, activity restriction explains significant portions of the variance in symptoms of depression. Thus, depressed affect is at least partially a function of restricted activities. Further specifying the processes through which activities come to be restricted should not only provide clues about points of intervention but also aid in early identification of individuals at risk for poor adaptation. In addition to treating illness symptoms and depression, interventions can be designed to increase participation in routine activities, even in the presence of illness symptoms, depression, or both. Implications of activity restriction studies for intervention are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Major depressive disorder in older adolescents: prevalence, risk factors, and clinical implications

In this article we summarize our current understanding of depression in older (14-18 years old) adolescents based on our program of research (the Oregon Adolescent Depression Project). Specifically, we address the following factors regarding adolescent depression: (a) phenomenology (e.g., occurrence of specific symptoms, gender and age effects, community versus clinic samples); (b) epidemiology (e.g., prevalence, incidence, duration, onset age); (c) comorbidity with other mental and physical disorders; (d) psychosocial characteristics associated with being, becoming, and having been depressed; (e) recommended methods of assessment and screening; and (f) the efficacy of a treatment intervention developed for adolescent depression, the Adolescent Coping With Depression course. We conclude by providing a set of summary statements and recommendations for clinicians.     

How ill is the patient at this time? Cues determining clinician's global judgments.

Studied the relationship between an unstructured global rating of severity of illness and structured ratings of individual symptoms (e.g., Brief Psychiatric Rating Scale) in 278 25-60 yr old depressed women. Correlational analyses revealed that patients rated as more severely ill were those showing psychomotor retardation, depressive delusions, agitation, guilt, initial insomnia, hopelessness, suicidal tendencies, verbal complaint of depressed feelings and observed appearance of depression, and less short-term reactivity of mood. Findings suggest that patients showing greater severity on the core symptoms of depression and more characteristics of psychotic or endogenous depression are perceived as more ill. A multiple regression equation derived from 30 symptoms accounted for 56% of variance in the global scale. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"The cenral role of restricted normal activities in adjustment to illness and disability: A model of depressed affect": Correction.

Reports a correction in the original article by Gail M. Williamson (Rehabilitation Psychology, 1998, Vol 43(4), 327–347). The article should have been identified as a Commentary. (The following abstract of this article originally appeared in record 1999-00481-005). Research has consistently indicated that health-related stressors affect depressive symptoms largely to the extent that they restrict routine activities. Beyond the impact of illness severity, psychosocial variables (age, income adequacy, social support, and personality) also contribute to restricted activities. Moreover, after controlling for illness severity and psychosocial factors, activity restriction explains significant portions of the variance in symptoms of depression. Thus, depressed affect is at least partially a function of restricted activities. Further specifying the processes through which activities come to be restricted should not only provide clues about points of intervention but also aid in early identification of individuals at risk for poor adaptation. In addition to treating illness symptoms and depression, interventions can be designed to increase participation in routine activities, even in the presence of illness symptoms, depression, or both. Implications of activity restriction… (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social factors and the psychobiology of depression: Relations between life stress and rapid eye movement sleep latency.

Examined psychosocial factors (i.e., life stress) and biological factors (i.e., REM sleep latency) that are hypothesized to be of complementary importance for defining depressive subtypes in a sample of 61 nonpsychotic, endogenous major depressives. Ss were evaluated on several diagnostic scales for life stress, on EEG sleep data, and on 2 symptom measures for depression. As predicted, persons with severe stress that occurred shortly before depression onset had essentially normal REM latency values; patients without such stress had reduced REM latency values. Both stress and REM latency were also associated with greater severity of self-reported depressive symptoms. Alternative explanations of these findings are discussed, with particular emphasis on different roles of preonset and postonset stressors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Thrombotic thrombocytopenic purpura in adult Still''s disease

Chronic fatigue syndrome (CFS) is often preceded by a viral illness and has recurrent "flu-like" symptoms. We compared demographic, clinical, and laboratory features (markers of inflammation and viral infection) among 717 patients with chronic fatigue (CF) with and without a self-reported postinfectious onset to identify associated clinical and biologic findings and to examine the subset of patients with CFS. Only subjective fever, chills, sore throat, lymphadenopathy, poorer functional status, and attribution of illness to a physical condition were significantly associated with a postinfectious onset. The features of patients with CFS were virtually identical to those of the broader category of patients with CF. We conclude that a postinfectious onset was not associated with a pattern of abnormalities across multiple psychosocial and biologic parameters.     

Longitudinal relationships between depressive symptoms and health in normal older and middle-aged adults.

Comorbidity between health and depression is salient in late life, when risk for physical illness rises. Other community studies have not distinguished between the effects of brief and long-standing depressive symptoms on excess morbidity and mortality. S. Cohen and M. S. Rodriguez's (1995) differential hypothesis of pathways between depression and health was used to examine the relationships between health and depression in a prospective probability sample of 1,479 community-resident middle-aged and older adults. Findings suggest that different durations of depressive symptoms have different relationships to health. Health had an impact on short-term increases in depressive symptoms, but depressive symptoms had a weaker impact on health. The reciprocal impact was indistinguishable from the health influence on depression. In contrast, longer term depressive symptoms had a clear impact on health. The results imply that physical illness can affect depressive states; depressive traits but not states can affect illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Elevated physical health risk among gay men who conceal their homosexual identity.

This study examined the incidence of infectious and neoplastic diseases among 222 HIV-seronegative gay men who participated in the Natural History of AIDS Psychosocial Study. Those who concealed the expression of their homosexual identity experienced a significantly higher incidence of cancer (odds ratio?=?3.18) and several infectious diseases (pneumonia, bronchitis, sinusitis, and tuberculosis, odds ratio?=?2.91) over a 5-year follow-up period. These effects could not be attributed to differences in age, ethnicity, socioeconomic status, repressive coping style, health-relevant behavioral patterns (e.g., drug use, exercise), anxiety, depression, or reporting biases (e.g., negative affectivity, social desirability). Results are interpreted in the context of previous data linking concealed homosexual identity to other physical health outcomes (e.g., HIV progression and psychosomatic symptomatology) and theories linking psychological inhibition to physical illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differences in psychosocial and health correlates of major and minor depression in medically ill older adults

OBJECTIVES: To compare the differences in correlates of different levels of depression in medically ill hospitalized older adults. DESIGN, SETTING, AND PARTICIPANTS: A consecutive series of 542 patients aged 60 or older admitted to the medical inpatient services of Duke Hospital underwent a structured psychiatric evaluation administered by a psychiatrist. MEASUREMENT: A wide range of demographic, social, psychiatric, and physical health data were collected, and associations with major and minor depression were assessed. RESULTS: Compared with patients without depression, those with major depression were more likely to have a history of prior episodes of depression, higher dysfunctional attitude scores, greater overall severity of medical illness, cognitive impairment, and symptoms of pain or other somatic complaints. Specific medical diagnosis was less important a predictor of major depression than overall severity of medical illness. Compared with patients without depression, those with minor depression were more likely to report non-health-related stressors during the year before hospital admission, have a diagnosis of immune system disorder, and have greater severity of medical illness. When major and minor depression were compared directly, on the other hand, no significant differences were observed except for history of depression, and that relationship was weak and present only when the etiologic approach to diagnosis was used. CONCLUSION: During hospital admission, certain psychosocial, psychiatric, and physical health characteristics of older medical patients place them at high risk for different levels of depression. Patients with major and minor depression resemble each other more than they do patients without depression. These findings may help clinicians better understand the causes of different types of depression in this setting and lead to improved diagnosis and treatment.     

Combined medical and psychological symptoms: impact on disability and health care utilization of patients with arthritis

OBJECTIVES: Many reports indicate that patients with combined chronic illness and depressive symptomatology have more disability than those with illness alone, which may influence physician visits. Studies suggest that these combined conditions are unevenly accommodated by the delivery system and nonpsychiatric physicians often fail to recognize or treat these symptoms. To address this need, this study aimed to provide further information on combined conditions and report on relations found among arthritis disease symptoms, depression, and disability. METHODS: The data was derived from a series of statewide surveys assessing the influence of psychosocial factors on disease course and treatment in a community sample of 277 patients under the care of a rheumatologist. A multivariate model was developed to assess these interrelationships, using measures of symptom severity, depression (CESD), disability (activities of daily living, days of restrictive activities, days in bed), service utilizations, and a few personal and health variables. RESULTS: Even after removing somatic items from the CESD to reduce the risk of inflation due to physical disease, evidence was found for additive impact of depression on one measure of disability, days of restrictive activities. Patients with comorbid conditions also were a high-service utilization group. Very few patients reported receiving help in dealing with emotional problems, suggesting presence of substantial unmet need. CONCLUSIONS: Nonpsychiatric physicians need to be aware of the mental health status of chronically ill patients. Although the association between medication use and depression suggests some awareness of the need to treat depression, especially in physically compromised patients, there may be some need to dispense psychological and psychosocial support to those in need.     

Personal meaning, optimism, and choice: existential predictors of depression in community and institutional elderly

The psychosocial model of mental health posits that late-life depression arises from the loss of self-esteem, loss of meaningful roles, loss of significant others, and diminished social contacts. This study examined the unique, combined, and interactive contribution of existential variables (personal meaning, choice/responsibleness, optimism) and traditional measures (social resources, physical health) as predictors of depression in institutionalized and community-residing older adults, average age 77.8 years. Using multiple hierarchical regression, the results showed that choice/responsibleness, social resources, and physical health predicted depression in community elderly; personal meaning, optimism, social resources, and physical health predicted depression in institutionalized elderly. In both samples, the existential variables accounted for unique variance in depression over and above that accounted for by traditional measures. The important role of existential constructs in transcending personal and social losses and feelings of depression are discussed.     

Ability of counselors to detect cognitive impairment among substance-abusing patients: An examination of diagnostic efficiency.

Counselors (N?=?12) in 1 of 2 substance abuse treatment facilities were asked to identify which of their patients (N ?=?97) had general neurocognitive impairment. Counselors were required to base their judgements on information collected from patients during psychosocial history gathering, clinical interviews, physical examinations, brief cognitive screening tests, and substance abuse severity evaluations, but not on neuropsychological test results. All patients were subsequently administered a neuropsychological test battery. Diagnostic agreement between counselors' impressions of patients' cognitive status and patients' actual neuropsychological test performance was poor. Subsequent analyses revealed counselors' impressions about patients' neuropsychological functioning were based on information that did not reliably discriminate between cognitively impaired and intact patients (e.g., years of education and self-reported symptoms of cognitive dysfunction). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The structure of self-reported health in chronic disease patients.

A multidimensional model of self-reported health status in 1,980 patients with 1 or more chronic medical conditions was evaluated. Two dimensions of health were hypothesized: Physical health was defined by measures of physical functioning, role limitations, satisfaction with physical ability, and mobility; mental health was defined by depression, positive affect, anxiety, and feelings of belonging. Physical and mental health were correlated but distinct, sharing about 20% of variance in common. Correlations of 11 other indicators of health with the physical and mental health constructs corresponded to a priori hypotheses. It is concluded that self-reports of physical and mental health are distinguishable and that both constructs need to be represented for comprehensive assessment of health status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital satisfaction and depression as predictors of physical health status.

Investigated the multiple correlation between physical health status and a set of marriage-related "predictor" variables. Family practice physicians provided a sample of 104 married couples (average age, 30 yrs). Marital satisfaction, depression, number of visits to physician, and educational level were among the set of cross-validated "predictors" of reported physical health status. The correlation between physical health status (the Cornell Medical Index) and depression (Zung Self-Rating Depression Scale) was significantly greater for wives than husbands. For wives, marital satisfaction (Locke-Wallace Marital Adjustment Test) and depression were related primarily through the uncontrolled variance in physical health status, whereas for husbands a significant relationship between marital satisfaction and depression remained for husbands when physical health status was partialed out. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial effects of level of information and severity of disease on head-and-neck cancer patients

This study examined the psychosocial effects of levels of information available to patients and compared them with those of disease severity. A questionnaire with multiple-choice and open-ended questions assessing quality of life in various domains (e.g., fears and worries, functioning in the family) and scales assessing anxiety, anger, and depression were administered to patients and their partners or closest relatives. The subjects were 55 head-and-neck cancer patients (40 men and 15 women) in disease stages I to IV, grades of tumors G1 to G3-4, with disease durations ranging from three months to 21 years. They were divided into three groups on the basis of the amounts of information they had about their disease and prognosis, and again on the basis of disease severity, based on stages and patients' evaluations. The numbers of psychosocial variables differentiating significantly between the groups deviated significantly from chance in both groupings. The results showed more effects for information than for disease severity. The highly informed were better adjusted in interpersonal relations and had more intimacy with family, but had more fears, anxiety, changes in their lives, worries about health, and concern with physical symptoms. The reports of partners were fewer and lent some support to those of patients. Disease severity affected mostly fears, anxiety, and worries about health.     

Health status, somatization, and severity of posttraumatic stress disorder in Vietnam combat veterans with posttraumatic stress disorder

OBJECTIVE: A two-part study was conducted to examine the health status of Vietnam veterans with posttraumatic stress disorder (PTSD). In part 1, veterans with and without PTSD were compared on health behaviors and on self-reported and physician-rated health problems. Consistency of self-report with physician rating for health problems across the two groups was compared. In part 2, the association between health status and PTSD symptom severity, depression, somatization, and health behaviors in PTSD patients was evaluated. METHOD: In part 1, 276 combat veterans (225 with PTSD and 51 without PTSD) provided health status information, and medical records were reviewed. In part 2, 225 PTSD patients completed standardized PTSD severity, somatization, and depression measures. RESULTS: When analyses controlled for age, socioeconomic status, minority status, combat exposure, alcohol use, and pack-year history, veterans with PTSD reported and were rated as having a greater number of health problems than veterans without PTSD. Agreement between self-report and physician ratings for both groups ranged from low to moderate. Level of agreement between patient and physician was similar across groups. In the analysis of veterans with PTSD, somatization and PTSD symptom severity were significantly related to self-report of health problems, whereas only PTSD symptom severity was related to physician-rated health. Pack-year history was significantly related to self-reported health status in both groups. CONCLUSIONS: The presence and severity of PTSD in veterans were associated with greater physical health problems and conditions. Psychological variables (e.g., PTSD status, PTSD severity, somatization) and a behavioral variable (pack-year history) were related to health status.     

The impact of PTSD, depression, and substance use disorders on disease burden and health care utilization among OEF/OIF veterans.

Growing evidence suggests that posttraumatic stress disorder (PTSD) is associated with poorer health status (e.g., more medical disease, physical symptoms, and sick visits to health care professionals) among veterans who served in Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF) in Iraq. We investigated whether PTSD, depression, and substance use disorders independently predicted health status over time among OEF/OIF veterans. Information regarding psychiatric and medical conditions and health care utilization was culled for 4,463 OEF/OIF veterans enrolled in Veterans Administration primary care for a period of 6 years. Data were analyzed using multilevel modeling and generalized estimating equations. Results suggest that PTSD, depression, and substance use disorders are independently associated with increased medical disease burden and mental health care utilization but not increased medical health care utilization. The association between PTSD and medical disease burden strengthened over time. These data suggest that OEF/OIF veterans with PTSD may be at risk for increasingly poorer physical health in terms of medical disease burden over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)