Preliminary Analysis of Age of Illness Onset Effects on Symptom Profiles in Major Depressive Disorder.

Preliminary analysis of age of illness onset effects on symptom profiles in major depressive disorder.

Filed under: Depression Treatment

Int J Geriatr Psychiatry. 2013 Feb 19;
Charlton RA, Lamar M, Ajilore O, Kumar A

OBJECTIVE: Major depressive disorder (MDD) is prevalent across the lifespan, but relatively little is known about how age of illness onset impacts the cognitive and affective presentation of MDD. METHOD: We explore depressive symptoms and cognition in 70 adults (30-89?years old) with MDD. Participants were divided into three groups on the basis of age of MDD onset: early (<30?years), midlife (30-49.9?years), and late (>50?years). Symptoms were assessed using the Hamilton Depression Rating Scale; principal component analysis was used to create symptom component scores. Cognitive functions were measured. RESULTS: The late-onset group were significantly older than the early-onset and midlife-onset groups. Analysis controlled for age and hemoglobin A1c levels, as some participants had diabetes. The late-onset group demonstrated greater weight loss and gastrointestinal symptoms compared with the early-onset group. Suicidal thoughts and sleep disturbance were higher in both the early-onset and late-onset groups compared with the midlife-onset group. Correlations between symptom components and cognitive domains varied by age-of-onset group. DISCUSSION: This preliminary analysis demonstrates cognitive and affective profiles that are both unique to age of onset and common across MDD. Symptom profiles may assist in identifying factors influencing depression and enhance the clinical evaluation and care of individuals struggling with the effects of depression across the lifespan. Copyright © 2013 John Wiley & Sons, Ltd.
HubMed – depression

Patient Perceptions, Physician Communication, and the Implantable Cardioverter-Defibrillator.

Filed under: Depression Treatment

JAMA Intern Med. 2013 Feb 18; 1-7
Hauptman PJ, Chibnall JT, Guild C, Armbrecht ES

IMPORTANCE Implantable cardioverter-defibrillators (ICDs) have changed the way in which patients with chronic ventricular dysfunction are evaluated and treated. OBJECTIVE To examine patient-physician communication at the time the decision is made to implant an ICD. DESIGN, SETTING, AND PARTICIPANTS Forty-one patients with ICDs and 11 cardiologists were recruited by a national marketing research company for a study comprising patient focus groups and standardized patient interviews in 3 different metropolitan areas. INTERVENTIONS Eight patient focus groups and (separately) 22 standardized patient interviews with cardiologists. MAIN OUTCOME MEASURES Patient focus group findings and the results of standardized patient interviews (each cardiologist interviewed 2 patients). RESULTS The mean (SD) patient age was 61.4 (14.7) years; 21 were female. Thirty-three patients could not recall a discussion about periprocedural or long-term complications. On a scale of 1 to 10, the mean (SD) rating of the degree to which patients felt informed before the implant procedure was 5.7 (3.2) (1 indicates “not at all informed,” and 10 indicates “I had all the information I needed or wanted”). The mean (SD) estimated number of patients out of 100 who would be saved by the ICD was 87.9 (20.1). A negative perception on body image and lifestyle was prevalent. Across 22 standardized patient interviews, cardiologists frequently (in >17 of 22 of interviews) did not address or minimized or denied quality-of-life issues and long-term consequences of ICD placement, including the risk for depression, anxiety, and inappropriate delivery of shock or device advisory. In 15 of 22 of the standardized patient interviews, cardiologists used unexplained medical terms or jargon. CONCLUSIONS AND RELEVANCE Patient-physician communication about ICDs is characterized by unclear representation and omission of information to patients, with notable lack of attention to psychological and long-term risks. Training of cardiologists on information exchange with patients may promote informed decision making and preempt threats to patient quality of life.
HubMed – depression

Coping and Psychological Distress in Mothers of Adolescents with Type 1 Diabetes.

Filed under: Depression Treatment

Matern Child Health J. 2013 Feb 19;
Jaser SS, Linsky R, Grey M

The purpose of this study was to describe coping in mothers of adolescents with type 1 diabetes and to examine the association among mothers’ diabetes-related stress and coping strategies and maternal psychological distress (e.g., symptoms of anxiety and depression), adolescent adjustment (e.g., symptoms of depression, quality of life), diabetes-related family conflict, and glycemic control. One hundred and eighteen mother-adolescent dyads completed measures of diabetes-related stress, coping, symptoms of anxiety and depression, quality of life, and family conflict. Data on glycemic control were collected from adolescents’ medical charts. Single/divorced mothers and mothers of color were significantly more likely to use disengagement coping strategies (e.g., avoidance) than White and married/partnered mothers. Mothers’ use of primary control coping (e.g., problem solving) and secondary control coping (e.g., acceptance) strategies was related to fewer symptoms of anxiety (r = – .51, -.39) and depression (r = – .32, -.37) and less family conflict (r = – .22, -.30, all p < .05). Mothers' use of disengagement coping strategies was related to greater symptoms of anxiety (r = .30) and depression (r = .27, both p < .01). Further, secondary control coping was found to mediate the relationship between diabetes-related stress and maternal symptoms of anxiety and depression. Maternal coping was not significantly associated with adolescent outcomes. The ways in which mothers of adolescents with type 1 diabetes cope with diabetes-related stress are associated with psychological distress and family conflict. By identifying and improving mothers' coping through screening and targeted interventions, we may have the potential to improve both maternal and adolescent outcomes. HubMed – depression

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