[Remission, Response, and Its Prediction in Depressive Inpatients.]

[Remission, Response, and its Prediction in Depressive Inpatients.]

Psychother Psychosom Med Psychol. 2013 Feb 26;
Harbeck S, Kliem S, Wollburg E, Braukhaus C, Kröger C

Using mean comparisons and effect sizes to report effects of inpatient treatment, this not reveals, how many inpatients benefit from treatment and which characteristics predict the positive outcome. Several characteristics were collected from 1 533 consecutive inpatients with an episode of depression. The pre-post-effect size in the Beck Depression Inventory was 1.29 (95%-CI: 1.23; 1.36). The rate of remission was 39.5%. The rate of response was 57.8% based on the reliable change index (RCI) and 72.4% based on the percental symptom improvement. The regression model with the RCI as outcome variable was stabile in the cross-validation. A negative predictive impact was demonstrated by the depressive symptoms at treatment beginning, whereas higher assessment of physical health and higher level of education were found to be positively associated. A consistent definition of response seems essential for cross-study and cross-methodological comparisons. HubMed – depression


Community-Based Accompaniment and Psychosocial Health Outcomes in HIV-Infected Adults in Rwanda: A Prospective Study.

AIDS Behav. 2013 Feb 27;
Thomson DR, Rich ML, Kaigamba F, Socci AR, Hakizamungu M, Bagiruwigize E, Binagwaho A, Franke MF

We examined whether the addition of community-based accompaniment to Rwanda’s national model for antiretroviral treatment (ART) was associated with greater improvements in patients’ psychosocial health outcomes during the first year of therapy. We enrolled 610 HIV-infected adults with CD4 cell counts under 350 cells/?L initiating ART in one of two programs. Both programs provided ART and required patients to identify a treatment buddy per national protocols. Patients in one program additionally received nutritional and socioeconomic supplements, and daily home-visits by a community health worker (“accompagnateur”) who provided social support and directly-observed ingestion of medication. The addition of community-based accompaniment was associated with an additional 44.3 % reduction in prevalence of depression, more than twice the gains in perceived physical and mental health quality of life, and increased perceived social support in the first year of treatment. Community-based accompaniment may represent an important intervention in HIV-infected populations with prevalent mental health morbidity. HubMed – depression


The prevalence of fibromyalgia and its relation with headache characteristics in episodic migraine.

Clin Rheumatol. 2013 Feb 27;
Küçük?en S, Genç E, Y?lmaz H, Sall? A, Gezer IA, Karahan AY, Salba? E, Cingöz HT, Nas O, U?urlu H

The objective of this study was to assess the prevalence of fibromyalgia (FM) in patients with episodic migraine and to evaluate the relationship between migraine characteristics and FM. One hundred and eighteen consecutive patients (mean age?=?38 years, 75 % women) fulfilling the International Classification of Headache Disorders-II criteria for migraine with (n?=?22) and without (n?=?96) aura from an outpatient headache clinic of a university hospital were evaluated. The diagnosis of FM was made based on the 1990 American College of Rheumatology classification criteria. Participants completed some self-administered questionnaires ascertaining sociodemographics, headache severity, frequency and duration, headache-related disability (Headache Impact Test [HIT-6]) and Migraine Disability Assessment Scale, widespread musculoskeletal pain (visual analog scale), depression (Beck depression inventory), anxiety (Beck anxiety inventory), sleep quality (Pittsburgh Sleep Quality Index), fatigue (Multidimensional Assessment of Fatigue), and quality of life (Short Form-36 Health Survey [SF-36]). In patients with FM, the tender point count and the Fibromyalgia Impact Questionnaire were employed. FM was diagnosed in 37 (31.4 %) of the patients. FM comorbidity was equally distributed across patients with and without aura. Severity of migraine headache, HIT-6, and anxiety were especially associated with FM comorbidity. Patients suffering from migraine plus FM reported lower scores on all items of the SF-36. This study indicates that the assessment and management of coexisting FM should be taken into account in the assessment and management of migraine, particularly when headache is severe or patients suffer from widespread musculoskeletal pain. HubMed – depression


The clinical manifestations of lumbar disease are correlated with self-rating depression scale scores.

J Orthop Sci. 2013 Feb 27;
Tetsunaga T, Misawa H, Tanaka M, Sugimoto Y, Tetsunaga T, Takigawa T, Ozaki T

BACKGROUND: Depression can exacerbate symptoms of chronic pain and worsen disability. The symptoms of lumbar disease may be particularly sensitive to psychological state, but statistical associations between low back pain (LBP) severity and mental health status have not been established. METHODS: Of the 151 patients with LBP, 122 completed questionnaires probing depressive symptoms, LBP severity, and degree of disability. In addition to completing self-report questionnaires, patients provided demographic and clinical information. A self-rating depression scale (SDS) was used to screen for depression. Pain and disability were assessed by the visual analog scale (VAS) and the Roland-Morris disability questionnaire (RDQ), respectively. Overall clinical severity was assessed using the Japanese Orthopaedic Association (JOA) score. Kendall’s tau correlation coefficients were calculated to examine the relationships among these variables. RESULTS: Ninety-four patients (77 %) were in a depressive state as indicated by SDS score ?40, including mild depression group (47 patients, SDS score from 40 to 49) and depression group (47 patients, SDS score ?50). There were only 28 patients in the no depression group (SDS score ?39). There was no significant difference in both age and pain duration among the three groups. The mean VAS score in the depression group (70 ± 19 mm) was higher than both no depression (41 ± 24 mm) and mild depression groups (52 ± 21 mm). The mean JOA score in the no depression group (14 ± 5.0 points) was higher than both mild depression (12 ± 4.0 points) and depression groups (10 ± 6.0 points). The mean RDQ in the depression group (15.1 ± 6.0 points) was higher than both no depression (6.4 ± 5.0 points) and mild depression groups (10.9 ± 5.4 points). Factors significantly correlated with SDS score included VAS, JOA score, and RDQ score. In contrast, SDS did not correlate with patient age or pain duration. CONCLUSIONS: The majority of chronic LBP patients examined were in a depressed state and the severity of depression correlated with pain severity, degree of self-rated disability, and clinical severity. HubMed – depression


Clinical and sociodemographic characteristics associated with suicidal ideation in depressed outpatients.

Can J Psychiatry. 2013 Feb; 58(2): 113-22
Trivedi MH, Morris DW, Wisniewski SR, Nierenberg AA, Gaynes BN, Kurian BT, Warden D, Stegman D, Shores-Wilson K, Rush AJ

Objective: To identify clinical and sociodemographic characteristics associated with suicidal ideation (SI) among patients seeking care for depression in routine primary and psychiatric care settings. Methods: We examined data from 4041 treatment-seeking outpatients with major depressive disorder (MDD) to compare baseline sociodemographic and clinical characteristics of those with and without SI, and the presence or absence of baseline depressive symptoms and psychiatric comorbidities in those with SI. Results: SI was significantly (P < 0.01) associated with numerous sociodemographic characteristics (that is, lower level of education, Caucasian or African American, male, unemployed, and treated in psychiatric care) and clinical features (that is, previous suicide attempt, younger age of MDD onset, greater baseline depressive symptom severity, greater number of depressive symptoms, and presence of agoraphobia and [or] generalized anxiety disorder). Elevated levels of SI at baseline were associated with decreased remission rates. Conclusions: Consistent with past findings, increased rates of SI were associated with greater depressive symptom severity as well as other features suggestive of severity of illness. Our results confirm previous findings of associations between SI and panic and (or) phobic symptoms and anxiety, but did not confirm previous findings of an association between SI and alcohol or drug use and (or) dependence. While selective serotonin reuptake inhibitor monotherapy appeared significantly helpful in reducing SI during the course of treatment, the presence of SI at baseline was found to be a associated with decreased treatment response, with patients reporting SI at the start of treatment being less likely to achieve remission. Clinical Trial Registration Number: Sequenced Treatment Alternatives to Relieve Depression, NCT00021528. HubMed – depression