Differential impact of isolated psychotic symptoms on treatment outcome of major depressive disorder in the STAR*D cohort of Whites, Blacks and Latinos

Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States
Journal of Affective Disorders (Impact Factor: 3.38). 03/2013; 150(2). DOI: 10.1016/j.jad.2013.02.012
Source: PubMed


OBJECTIVE: To determine whether isolated psychotic symptoms are more likely to be endorsed by depressed Latinos as opposed to other ethnic-racial groups; whether these symptoms affect Latinos similarly to other ethnic-racial groups in terms of treatment response; and whether they are more likely to be associated with anxiety disorders in depressed Latinos. METHODS: We analyzed data from STAR⁎D subjects who self identified as White, Black, or Latino. Rates of isolated psychotic symptoms were assessed by the self-rated Psychiatric Diagnostic Screening Questionnaire (PDSQ) and compared between ethnic-racial groups. Depressive remission outcomes were compared within each ethnic-racial group between subjects who endorsed psychotic symptoms versus no psychotic symptoms. Associations between isolated psychotic symptoms and anxiety disorders were also examined. RESULTS: Among 2597 eligible subjects with at least one post-baseline assessment and available PDSQ data excluding first-rank symptoms, the prevalence of auditory-visual hallucination was 2.5% in Whites (n=49/1928), 11.3% in Blacks (n=45/398) 6.3% in Latinos (n=17/270) (χ(2)=64.9; df=2; p<0.001). Prevalence of paranoid ideation was 15.5% in Whites (n=299/1927), 31.5% in Blacks (n=126/400), and 21.1% in Latinos (n=57/270) (χ(2)=57.3; df=2; p<0.001). Among Whites and Blacks but not Latinos, depressive remission rates were worse in subjects with auditory-visual hallucinations compared to those without them. Paranoid ideation had a significant negative impact on remission in Whites only. In all ethnic-racial groups, a significant association was found between auditory-visual hallucinations and PTSD and panic disorder. LIMITATIONS: The STAR*D study did not include any structured clinician-based assessment of psychotic symptoms. CONCLUSION: Latinos do not appear to have worse outcomes when treated for MDD with auditory-visual hallucinations, differently from Whites and Blacks.

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    • "I n the Sequenced Treatment Alternatives to Relieve Depression study, the endorsement of isolated psychotic symptoms significantly predicted worse outcome among black and white subjects but not among Latinos (Cassano et al., 2013). One hypothesis for this finding is that a subset of Latino subjects classified as having isolated psychotic symptoms were instead experiencing psychosislike symptoms (nonpsychotic manifestations, neutral to the clinical outcome). "
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