The prediction of suicidal intent in depressed patients

The aim of the present study was to examine the relationships between suicidal ideation or suicidal attempts and severity of depression, presence of personality disorders, and sociodemographic factors in a population of depressed in-patients. A total of 338 adult depressed psychiatric in-patients were examined and classified according to DSM-III criteria as having major depression with or without melancholic or psychotic features, adjustment disorder with depressed mood or dysthymic disorder. Scores on the Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI) and Zung Self-Rating Depression and Anxiety Scales (SDS and SAS) were measured. We found that suicidal ideation was significantly related to severity of depression (according to the HDRS and all self-rating scales), a lower global assessment of functioning the year before hospitalization, and previous psychiatric hospitalizations. The items with the strongest predictive value for suicidal ideation were hopelessness, depressed mood, feelings of guilt, loss of interest and low self-esteem. These symptoms predicted 43% of the variance in suicidal ideation. None of the above predictors of suicidal ideation was related to suicidal attempts. Depressed patients with a personality disorder attempted significantly more suicidal attempts and showed more suicidal ideation than depressed patients without personality disorder. No significant correlations were found between suicidal ideation or suicide attempts and gender, marital status, employment status or psychosocial stressors during the previous 6 months.     

State and trait anxiety, coping styles and depression among psychiatric inpatients.

Examined relationships among state and trait anxiety, coping styles, and depression in 17 male and 26 female adult psychiatric inpatients. Ss completed measures of state and trait anxiety, situation perception, depression and coping styles (Multidimensional Anxiety Scales, Multidimensional Coping Inventory, and Beck Depression Inventory) at 2 times (approximately 2 days after admission to the hospital and approximately 4 days after the 1st test administration). Results reveal significant positive correlations between level of depressive symptomatology and both state and trait anxiety. Emotion-oriented coping was positively correlated with depression, whereas task-oriented coping was negatively correlated with depression. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric evaluation of physical rehabilitation patients

We conducted a study to demonstrate the frequency and types of psychiatric/psychological symptoms. A Structured Interview according to the DSM-III-R was conducted which demonstrated that 46 (41.4%) of 111 rehabilitation inpatients met the criteria for some forms of psychiatric disorders: 34 patients for major depression, 10 for adjustment disorder with anxious mood, and 2 for posttraumatic stress disorder. The remaining 65 patients (58.6%) showed normal reactions to their diseases. Average length of hospital stay for patients with major depression was significantly longer than those with no or the other types of psychiatric disease. They were also tested with Zung's Self-Rating Anxiety Scale (SAS), Zung's Self-Rating Depression Scale (SDS), and Profile of Mood States (POMS). Three psychological tests were useful in detecting depression or adjustment disorder among rehabilitation patients; however, these tests are not always specific to the type of psychiatric disorders. Patients with higher scores in those three tests should be referred to a psychiatric consultant for detailed examinations and proper treatments, if necessary.     

Tripartite structure of positive and negative affect, depression, and anxiety in child and adolescent psychiatric inpatients.

The tripartite model of depression and anxiety suggests that depression and anxiety have shared (generalized negative affect) and specific (anhedonia and physiological hyperarousal) components. In one of the 1st studies to examine the structure of mood-related symptoms in youngsters, this model was tested among 116 child and adolescent psychiatric inpatients, ages 8–16 (M?=?12.46; SD?=?2.33). Consistent with the tripartite model, a 3-factor (Depression, Anxiety, and Negative Affect) model represented the observed data well. Follow-up analyses suggested that a nonhierarchical arrangement of the 3 factors may be preferable to a hierarchical one. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validity of the MMPI-2 Depression content scale with psychiatric inpatients

The concurrent and construct validity of the MMPI-2 Depression content scale was examined for a group of 62 psychiatric inpatients. Correlation coefficients with other measures of depression, hopelessness, low self-esteem, and suicide ideation ranged from .58 to .66 and were statistically significant. Also, the Depression content scale successfully differentiated patients according to psychiatric diagnosis (depressed versus nondepressed) and assessed suicide risk (at risk versus not at risk). Thus, the concurrent and construct validities of the scale were supported.     

Self-reinforcement and recall: Differential deficits in depressed and nondepressed psychiatric inpatients.

16 depressed and 12 nondepressed psychiatric inpatients and 19 nondepressed hospital employees (18–60 yrs old) were administered the Beck Depression Inventory, Hamilton Rating Scale for Depression, and a verbal recognition task. Ss' administration and recall of self-reinforcements and self-punishments were assessed. As predicted, depressed Ss administered fewer self-reinforcements and a greater number of self-punishments than hospital employees; however, they did not differ on either of these measures from nondepressed patients. In terms of recall, depressed patients recalled giving themselves fewer reinforcements and a greater number of punishments than was actually the case. Whereas a low rate of self-reinforcement may be characteristic of global psychopathology, deficits in the recall of self-reinforcement and self-punishment were specific to depression. Results are discussed with reference to both cognitive and self-reinforcement conceptualizations of depression. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of maternal depression in perceptions of child maladjustment.

We investigated (a) the relation of maternal depression to perceptions of externalizing and internalizing disorders in children and (b) quality of communication in a mother–child interaction task as a function of maternal depression and perceptions of the child. 64 children of unipolar or bipolar mothers, chronic medically ill or normal mothers were studied; clinical diagnoses, children's reports, and teachers' ratings served as objective criteria of children's maladjustment. Maternal depression defined by current symptomatology on the Beck Depression Inventory and by psychiatric status was not associated with misperceptions of psychopathology. Maternal depression interacted with children's actual behaviors to predict mothers' perceptions: nondepressed mothers were less accurate reporters of problems in children than were depressed mothers. Depressed mothers who perceived maladjustment in their disturbed children made more negative comments in interactions than did nondepressed mothers of disturbed children. The apparent mutual impact of mothers' and children's maladjustment requires fuller exploration in offspring studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expectancies, mood, and performance of depressed and nondepressed psychiatric inpatients on chance and skill tasks.

The learned helplessness model of depression predicts that, compared with nondepressed patients, depressed patients will demonstrate psychomotor deficits, provide lower subjective evaluations of their performance, and perceive reinforcement in skill tasks as more response independent. These predictions were tested in 32 depressed (mean age 35 yrs) and 32 nondepressed (mean age 38 yrs) psychiatric inpatients, who had been administered the Quick Test and the Beck Depression Inventory. Ss performed card- and peg-sorting tasks in which measures of performance, ratings of mood and expectancy of success, and subjective evaluations of performance were obtained under chance and skill reinforcement conditions. Although some support was obtained for the prediction that depressives provide lower evaluations of their performance than nondepressives, the other predictions were not supported. Comparisons between depressed and nondepressed schizophrenics indicate that the mood of depressed schizophrenics was especially sensitive to task outcome for both skill and chance conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disability in geriatric depression

OBJECTIVE: The authors' purpose was to identify the relationship of disability to clinical measures that are part of a comprehensive psychiatric examination of depressed elderly patients. METHOD: The disability of 75 elderly inpatients and outpatients with major depression whose cognitive function ranged from normality to mild dementia was assessed with the Philadelphia Multilevel Assessment Instrument. Age at onset of depression, chronicity of depression, severity of depression, cognitive impairment, medical burden, social support and living environment were assessed with standardized instruments. RESULTS: Impairment in instrumental activities of daily living was significantly associated with advanced age, severity of depression, and medical burden. The relationship of depressive symptoms to impairment in instrumental activities of daily living was not influenced by age or medical burden. Anxiety and depressive ideation as well as retardation and weight loss were significantly associated with impairment in instrumental activities of daily living. Interviewer-rated global disability was associated with advanced age at onset of depression, medical burden, and overall cognitive impairment. Specifically, a disturbance in initiation and perseveration was significantly related to global disability. CONCLUSIONS: Impairment in instrumental activities of daily living appears to be a relatively independent dimension of health status that is related to depressive symptoms, particularly anxiety and depressive ideation as well as retardation and weight loss. Global disability may be associated with impairment in initiation and perseveration and with late onset of depression. These findings provide a basis for studies investigating whether psychotherapy aimed at depressive ideation and rehabilitation efforts focused on instrumental activities of daily living can improve the outcome of geriatric depression.     

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.     

Psychopharmacologic treatment of depression in the medically ill

Appropriate selection of an antidepressant agent in medically ill patients requires a careful risk-benefit assessment matching the pharmacokinetic and pharmacodynamic properties of the drug being considered against the patient's physiological vulnerabilities, potential for drug interactions, and primary symptoms of the patient's depression. While in the past antidepressant drug selection was limited by the almost sole availability of the tricyclic antidepressants, newer drugs such as selective serotonin reuptake inhibitors, bupropion, and venlafaxine have vastly simplified treating depression in the medically ill. In refractory cases of depression in patients with medical illness, electroconvulsive therapy can be used with appropriate anesthetic management.     

Long-term stability of depression, anxiety, and stress syndromes.

At Time 1, 3,540 participants completed the Depression Anxiety Stress Scales (DASS). At Time 2, 3 to 8 years later, the DASS was readministered to 882 of these participants. There was strong evidence for selective stability of the syndromes of depression, anxiety, and stress. Each Time 2 scale was best predicted by the same scale at Time 1, with no significant increase in prediction from the other 2 Time 1 scales. Stability of the 3 syndromes did not vary systematically over the intervals studied. The results support the longitudinal stability of depression, anxiety, and stress and, in particular, draw attention to the distinction between anxiety symptoms and tension–stress symptoms. The results were interpreted as supporting the existence of syndrome-specific vulnerabilities, over and above a primary general vulnerability to emotional distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex differences in the sensitivity of two self-report depression scales in older depressed inpatients.

Both the Geriatric Depression Scale (J. A. Yesavage et al; see record 1984-02939-001) and the Beck Depression Inventory were less effective in identifying depressed men than women in a sample of 191 geriatric psychiatric inpatients with major unipolar depression. From one quarter to one half of the men were missed cases, depending on the cutoff score used. Separate cutoff scores for older men and women on depression screening instruments may be appropriate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relations between the Pleasant Events Schedule, depression, and other aspects of psychopathology.

Studied the relations between the Mood Related subscale of the Pleasant Events Schedule (PES), depression, and other psychopathology. 100 psychiatric inpatients and outpatients (mean age 35.7 yrs) had diagnoses of either major, nonmajor, or no depression. All Ss completed the PES, the Beck Depression Inventory, the State-Trait Anxiety Inventory, and a Dutch personality questionnaire. Results show that the PES correlated negatively with depression as well as with anxiety and (social) neuroticism. Principal components analysis revealed 2 factors, negative and positive affect. The latter was dominated by PES scores. Using factor scores, the 3 diagnostic groups could be meaningfully discriminated. It is concluded that depression may be better described using 2 affect dimensions rather than 1. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Properties of endodontic hand instruments used in rotary motion. Part 3. Resistance to bending and fracture

INTRODUCTION: Mixed anxiety and depression disorder (MAD) has been recognized in ICD-10 as a diagnostic group including those anxious and depressed patients who do not fit criteria for any major axis 1 disorders. Mad is usually treated with a combination on AD and BZD although recent reports suggest that SSRI might have both anxiolytic and AD intrinsic properties. METHODS: 36 patients diagnosed of MAD (ICD-10 criteria) underwent treatment with a flexible dose of sertraline for 8 weeks. No BDZ werre allowed during the trial. Efficacy was tested with the Clinical Global Improvement Scale and with changes in Hamilton Depression and Anxiety Scales. Personality scales, including the Cloninger's TCI and the Eysenck's EPQ were used to test the predictive value of personality traits in treatment. RESULTS: Anxiety was reduced in 55% and depression in 60%. At the 8th week, 27 patients were responder (CGI 1-2). 2 patients discontinued the trial and only one due to adverse events. CONCLUSIONS: Sertraline demonstrated excellent tolerability in these MAD patients, despite the high levels of baseline anxiety in the group. Efficacy was as high as described in patients with major depression. These results warrant further placebo controlled pharmacological trials of SSRI in MAD.     

Validity of selected MMPI–A content scales.

The authors examined the convergent and discriminant validity of selected Minnesota Multiphasic Personality Inventory—Adolescent (MMPI–A) content scales, including Anxiety, Depression, Health Concerns, Alienation, Anger, Conduct Problems, and Social Discomfort. Sixty-two adolescent psychiatric inpatients completed the MMPI–A and a battery of self-report measures of constructs similar to those measured by the content scales. Evidence for convergent and discriminant validity was generally strong, although the Anxiety and Depression content scales did not discriminate well between these 2 constructs. This finding is discussed in terms of L. A. Clark and D. Watson's (1991) tripartite model of anxiety and depression. Overall, findings support the validity and potential utility of the content scales. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differentiating anxiety and depression: A test of the cognitive content-specificity hypothesis.

The development and initial psychometric properties of the Cognition Checklist (CCL), a scale to measure the frequency of automatic thoughts relevant to anxiety and depression, are described in this article. Item analyses of the responses of 618 psychiatric outpatients identified a 14-item depression and a 12-item anxiety subscale that were significantly related, respectively, to the revised Hamilton Rating Scales for Depression and Anxiety. Patients diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980) with anxiety disorders had higher mean CCL anxiety scores than patients with DSM-III depression disorders who, in turn, had higher mean CCL depression scores. The validity of the CCL supports the content-specificity hypothesis of the cognitive model of psychopathology (Beck, 1976). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Significance of prior episodes of depression in two patient populations.

Perhaps the single best predictor of current depression is a prior episode of depression. This study examined the significance of prior depressive episodes in a weighted sample of 425 primary medical care (PC) patients. It also compared the 53 PC patients with major depression with 93 depressed psychiatric patients with respect to percentage of recurrences versus 1st episodes. PC patients with prior depression were over 8 times more likely to be currently depressed than those without such a history. Having at least 1 prior episode of depression was modestly more sensitive, but less specific, than an elevated Center for Epidemiologic Studies—Depression Scale score in predicting current depression. Most currently depressed patients in both PC (85%) and psychiatry (78%) had prior episodes of depression. These findings highlight the importance of assessing history of depression in research and clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression in general medical settings. Implications of three health policy studies for consultation-liaison psychiatry

Prepaid or prospective reimbursement has implications for the consultation-liaison (C-L) psychiatrist. The author reviews results from three health policy studies that indicated 1) degree of reliance on general medical providers for mental health care is not affected by generosity of fee-for-service (FFS) coverage, but is greater in some prepaid health care systems; 2) psychological sickness of depressed outpatients visiting general medical providers is similar across prepaid and FFS systems of care; 3) prepaid care is associated with lower rates of detection of depression and counseling in the general medical sector; 4) depression outcomes in the general medical sector are similar under prepaid or FFS care; 5) quality of care for depressed patients is moderate to low in the general medical sector; and 6) depressed elderly inpatients receive higher quality of psychological care in psychiatric units, but they receive higher quality of physical care in general medical wards. The discussion emphasizes the C-L psychiatrist's role in educating general medical providers, improving outcomes for the sickest patients, and improving psychosocial care in prepaid practices.