Major depression: the importance of clinical characteristics and treatment response to prognosis.

Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle, WA, USA.
Depression and Anxiety (Impact Factor: 4.29). 10/2009; 27(1):19-26. DOI: 10.1002/da.20613
Source: PubMed

ABSTRACT This article analyzed data from the intervention arm of a large treatment trial to demonstrate the importance of clinical severity, course, comorbidity, and treatment response in patient prognosis.
This is a secondary analysis of data from a large primary care-based geriatric depression treatment trial that analyzes outcomes from the measurement-based stepped-care intervention arm (N=871 patients) to determine: whether increasing severity levels of depression at baseline were linked with other factors associated with poor depression outcomes such as double depression, anxiety, medical disorders, and high levels of neuroticism and pain; and whether patients with increasing levels of depressive severity would have more intervention visits and treatment trials based on a stepped-care algorithm, but would be less likely to reach remission and have a greater likelihood of re-emerging depression in the year after intervention.
Increasing levels of depression severity were a robust predictor of lack of remission and were associated with other clinical variables that have been associated with lack of remission in earlier studies such as double depression, anxiety, medical comorbidity, high neuroticism levels, and chronic pain. Patients with higher levels of severity received significantly more intervention visits, more months of antidepressant treatment and more antidepressant trials, but had fewer depression-free days during the 12-month intervention and in the postintervention year.
Patients with higher levels of depression severity had worse clinical outcomes despite receiving greater intensity of treatment. A new classification of depression is proposed based on clinical severity, course of illness and treatment experience.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine the prevalence and factors associated with anxiety and depression among type 2 diabetes outpatients in Malaysia. Descriptive, cross-sectional single-centre study with universal sampling of all patients with type 2 diabetes. Endocrinology clinic of medical outpatient department in a Malaysian public hospital. All 169 patients with type 2 diabetes (men, n=99; women, n=70) aged between 18 and 90 years who acquired follow-up treatment from the endocrinology clinic in the month of September 2013. The validated Hospital Anxiety and Depression Scale (HADS), sociodemographic characteristics and clinical health information from patient records. Of the total 169 patients surveyed, anxiety and depression were found in 53 (31.4%) and 68 (40.3%), respectively. In multivariate analysis, age, ethnicity and ischaemic heart disease were significantly associated with anxiety, while age, ethnicity and monthly household income were significantly associated with depression. Sociodemographics and clinical health factors were important correlates of anxiety and depression among patients with diabetes. Integrated psychological and medical care to boost self-determination and confidence in the management of diabetes would catalyse optimal health outcomes among patients with diabetes.
    BMJ Open 04/2014; 4(4):e004794. · 2.06 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: To evaluate the association of depression, levels of pain and lack of social supportin medical inpatients. METHODS: In a cross sectional observational study, 1,147 adults admitted to the general medical wards of a university hospital were randomized and evaluated during the first week of admission. The following instruments were used: cognitive-affective subscale of the Beck Depression Inventory (BDI-13), Charlson Comorbidity Index and numerical scales to evaluate pain and perception of medical burden. Patients who scored > 10 in the BDI-13 were considered depressed. Social supportwas investigated asking the following question: "How many relatives or friends do you feel at easy and can talk about almost everything?". Those who had less than four relatives or close friends were considered as having lack of social support. The Student T test, Chi-square test and Logistic Regression analysis were used. RESULTS: Of the 1,147 patients that comprised the sample, 25.3% had depression. Educational level [odds ratio (OR): 0.96; confidence interval (CI): 0.89-0.96; p < 0.001], household income (OR: 0.92; CI: 0.86-0.99; p = 0.018), pain levels (OR: 1.04; CI: 1.00-1.08; p = 0.036), lack of social support (OR: 2.02; CI: 1.49-2.72; p < 0.001) and perception worse physical illness severity (OR: 1.07; CI: 1.02-1.13; p = 0.008) were independently associated with depression. CONCLUSION: Depressive medical inpatients report more lack of social support and pain even after controlling for social, demographic and clinical variables.
    Jornal brasileiro de psiquiatria 12/2012; 62(1):1-7.
  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE Indicators of prognosis should be considered to fully inform clinical decision making in the treatment of depression. This study examines whether self-rated health predicts long-term depression outcomes in primary care. METHODS Our analysis was based on the first 5 years of a prospective 10-year cohort study underway since January 2005 conducted in 30 randomly selected Australian primary care practices. Participants were 789 adult patients with a history of depressive symptoms. Main outcome measures include risks, risk differences, and risk ratios of major depressive syndrome (MDS) on the Patient Health Questionnaire. RESULTS Retention rates during the 5 years were 660 (84%), 586 (74%), 560 (71%), 533 (68%), and 517 (66%). At baseline, MDS was present in 27% (95% CI, 23%-30%). Cross-sectional analysis of baseline data showed participants reporting poor or fair self-rated health had greater odds of chronic illness, MDS, and lower socioeconomic status than those reporting good to excellent self-rated health. For participants rating their health as poor to fair compared with those rating it good to excellent, risk ratios of MDS were 2.10 (95% CI, 1.60-2.76), 2.38 (95% CI, 1.77-3.20), 2.22 (95% CI, 1.70-2.89), 1.73 (95% CI, 1.30-2.28), and 2.15 (95% CI, 1.59-2.90) at 1, 2, 3, 4, and 5 years, after accounting for missing data using multiple imputation. After adjusting for age, sex, multimorbidity, and depression status and severity, self-rated health remained a predictor of MDS up to 5 years. CONCLUSIONS Self-rated health offers family physicians an efficient and simple way to identify patients at risk of poor long-term depression outcomes and to inform therapeutic decision making.
    The Annals of Family Medicine 01/2014; 12(1):57-65. · 4.57 Impact Factor