Stephen R Wisniewski

University of Pittsburgh, Pittsburgh, Pennsylvania, United States

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Publications (399)2120.23 Total impact

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    ABSTRACT: Primary care management decisions for patients with symptomatic lumbar spinal stenosis (LSS) are challenging, and nonsurgical guidance is limited by lack of evidence. To compare surgical decompression with physical therapy (PT) for LSS and evaluate sex differences. Multisite randomized, controlled trial. ( NCT00022776). Neurologic and orthopedic surgery departments and PT clinics. Surgical candidates with LSS aged 50 years or older who consented to surgery. Surgical decompression or PT. Primary outcome was physical function score on the Short Form-36 Health Survey at 2 years assessed by masked testers. The study took place from November 2000 to September 2007. A total of 169 participants were randomly assigned and stratified by surgeon and sex (87 to surgery and 82 to PT), with 24-month follow-up completed by 74 and 73 participants in the surgery and PT groups, respectively. Mean improvement in physical function for the surgery and PT groups was 22.4 (95% CI, 16.9 to 27.9) and 19.2 (CI, 13.6 to 24.8), respectively. Intention-to-treat analyses revealed no difference between groups (24-month difference, 0.9 [CI, -7.9 to 9.6]). Sensitivity analyses using causal-effects methods to account for the high proportion of crossovers from PT to surgery (57%) showed no significant differences in physical function between groups. Without a control group, it is not possible to judge success attributable to either intervention. Surgical decompression yielded similar effects to a PT regimen among patients with LSS who were surgical candidates. Patients and health care providers should engage in shared decision-making conversations that include full disclosure of evidence involving surgical and nonsurgical treatments for LSS. National Institutes of Health and National Institute of Arthritis and Musculoskeletal and Skin Diseases.
    Annals of internal medicine 04/2015; 162(7):465-473. DOI:10.7326/M14-1420 · 16.10 Impact Factor
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    ABSTRACT: One percent of women experience bipolar disorder and are likely to suffer from mood disorders during the postpartum period, potentially impacting interaction with their infants.
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    ABSTRACT: Background: Women report many nonvasomotor symptoms across the menopausal transition, including sleep disturbances, depressed mood, and sexual problems. The co-occurrence of these three symptoms may represent a specific menopausal symptom triad. We sought to evaluate the interrelatedness of disturbed sleep, depressed mood, and sexual problems in the Study of Women's Health Across the Nation (SWAN) and determine the characteristics of women exhibiting this symptom triad. Methods: SWAN is a multisite, multiethnic observational cohort study of the menopausal transition in the United States. Sleep disturbance, sexual problems, and depressed mood were determined based on self-report. Women who reported all three symptoms simultaneously were compared to those who did not. Logistic regression models estimated the association of demographic, psychosocial, and clinical characteristics with the symptom triad. Results: Study participants (n=1716) were 49.8 years old on average and primarily in very good or excellent health. Sixteen and a half percent had depressed mood, 36.6% had a sleep problem, and 42.2% had any sexual problem. Five percent of women (n=90) experienced all three symptoms. Women with the symptom triad compared with those without had lower household incomes, less education, were surgically postmenopausal or late perimenopausal, rated their general health as fair or poor, and had more stressful life events and lower social support. Conclusions: The symptom triad of sleep disturbance, depressed mood, and sexual problems occurred in only 5% of women, and occurred most often among women with lower socioeconomic status, greater psychosocial distress, and who were surgically menopausal or in the late perimenopause.
    Journal of Women's Health 01/2015; 24(2). DOI:10.1089/jwh.2014.4798 · 1.90 Impact Factor
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    ABSTRACT: To evaluate the association between neuromuscular blocking agents and outcome, intracranial pressure, and medical complications in children with severe traumatic brain injury. A secondary analysis of a randomized, controlled trial of therapeutic hypothermia. Seventeen hospitals in the United States, Australia, and New Zealand. Children (< 18 yr) with severe traumatic brain injury. None for this secondary analysis. Children received neuromuscular blocking agent on the majority of days of the study (69.6%), and the modified Pediatric Intensity Level of Therapy scores (modified by removing neuromuscular blocking agent administration from the score) were increased on days when neuromuscular blocking agents were used (9.67 ± 0.21 vs 5.48 ± 0.26; p < 0.001). Children were stratified into groups based on exposure to neuromuscular blocking agents (group 1 received neuromuscular blocking agents each study day; group 2 did not). Group 1 had increased number of daily intracranial pressure readings more than 20 mm Hg (4.4 ± 1.1 vs 2.4 ± 0.5;p = 0.015) and longer ICU and hospital length of stay (p = 0.003 and 0.07, respectively, Kaplan-Meier). The Glasgow Outcome Score-Extended for Pediatrics at hospital discharge and 3, 6, and 12 months after traumatic brain injury and medical complications observed during the acute hospitalization were similar between groups. Administration of neuromuscular blocking agents was ubiquitous and daily administration of neuromuscular blocking agents was associated with intracranial hypertension but not outcomes-likely indicating that increased injury severity prompted their use. Despite this, neuromuscular blocking agent use was not associated with complications. A different study design-perhaps using randomization or methodologies-of a larger cohort will be required to determine if neuromuscular blocking agent use is helpful after severe traumatic brain injury in children.
    Pediatric Critical Care Medicine 01/2015; DOI:10.1097/PCC.0000000000000344 · 2.33 Impact Factor
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    ABSTRACT: Most patients with major depressive disorder (MDD) report clinically significant sleep problems. Pre-treatment insomnia has been associated with poorer treatment outcomes in some antidepressant trials, leading to suggestions that combined treatment regimens may be more successful in this subgroup. This study investigated this question using data from the CO-MED trial. Adult outpatients with chronic and/or recurrent MDD were randomly assigned in 1:1:1 ratio to 28 weeks of single-blind, placebo-controlled antidepressant treatment with (1) escitalopram+placebo, (2) bupropion-sustained-release+escitalopram, or (3) venlafaxine-extended-release+mirtazapine. We compared baseline characteristics, tolerability, and treatment outcomes at 12 and 28 weeks for patients with and without pre-treatment insomnia. Of the 665 evaluable patients, the majority (88.3%) reported significant pre-treatment insomnia. Those with pre-treatment insomnia were more likely to be female (69.3% vs. 57.7%) and African-American (29.1% vs. 11.8%). Those with pre-treatment insomnia symptoms reported higher rates of concurrent anxiety disorders, lower rates of alcohol and substance use disorders, and greater impairment in psychosocial functioning. The two groups did not differ in either tolerability or treatment outcomes among the three antidepressant treatments. Insomnia symptoms, while common in patients with chronic/recurrent MDD were not predictive of response, remission, or tolerability with either single or combined antidepressant medications. Copyright © 2014 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 11/2014; 174C:157-164. DOI:10.1016/j.jad.2014.11.026 · 3.71 Impact Factor
  • Jennifer L. Barkin, Katherine L. Wisner, Stephen R. Wisniewski
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    ABSTRACT: Objective To evaluate the psychometric properties of the Barkin Index of Maternal Functioning (BIMF).DesignPrincipal component factor rotation was used to conduct an exploratory factor analysis of the BIMF to determine if more concise versions exist.SettingPatients were recruited from a large, urban medical center in the Northeast.ParticipantsThe BIMF was administered at an initial home visit along with several other self-report and clinical assessments to women who scored ≥ 10 on the Edinburgh Postnatal Depression Scale during the 4- to 6-week postpartum period.Methods The BIMF was administered between October 2008 and September 2010. The distribution of BIMF item responses was examined along with interitem correlations. To establish construct validity, correlation coefficients were produced for the BIMF in relation to several other variables or assessments. A factor analysis was performed using principal component factor rotation.ResultsThe factor analysis revealed a two-factor solution. The items that loaded on factor 1 gauged the mother's perception of her own competency in the maternal role and the items that made up factor 2 focused on the mother's needs. Items related to judgment from others and anxiety did not load on either factor.Conclusions The BIMF may be administered in its 18-item version, as two separate subscales, or in its original 20-item format. A clinical threshold should be developed to facilitate accurate identification of mothers who are struggling with functioning during the postpartum period.
    Journal of Obstetric Gynecologic & Neonatal Nursing 10/2014; 43(6). DOI:10.1111/1552-6909.12505 · 1.20 Impact Factor
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    ABSTRACT: To examine the impact of prenatal exposure to both serotonin reuptake inhibitors (SRIs; during any trimester) and maternal major depressive disorder (MDD; by DSM-IV criteria) on infant functioning. We hypothesized that infants with prenatal exposure to SRIs or MDD would have lower psychomotor, mental, and behavioral scores compared with nonexposed infants.
    The Journal of Clinical Psychiatry 10/2014; 75(10):1088-95. DOI:10.4088/JCP.13m08902 · 5.14 Impact Factor
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    ABSTRACT: Introduction The purpose of this study was to determine which of four common approaches to coding maternal-infant interaction best discriminates between mothers with and without postpartum depression. Methods After extensive training, four research assistants coded 83 three minute videotapes of maternal infant interaction at 12 month postpartum visits. Four theoretical approaches to coding (Maternal Behavior Q-Sort, the Dyadic Mini Code, Ainsworth Maternal Sensitivity Scale, and the Child-Caregiver Mutual Regulation Scale) were used. Twelve month data were chosen to allow the maximum possible exposure of the infant to maternal depression during the first postpartum year. The videotapes were created in a laboratory with standard procedures. Inter-rater reliabilities for each coding method ranged from .7-.9. The coders were blind to depression status of the mother. Results Twenty seven of the women had major depressive disorder during the 12 month postpartum period. Receiver Operating Characteristics analysis indicated that none of the four methods of analyzing maternal infant interaction discriminated between mothers with and without major depressive disorder. Conclusion Limitations of the study include the cross-sectional design and the low number of women with major depressive disorder. Further analysis should include data from videotapes at earlier postpartum time periods, and alternative coding approaches should be considered. Nurses should continue to examine culturally appropriate ways in which new mothers can be supported in how to best nurture their babies.
    Archives of Psychiatric Nursing 09/2014; DOI:10.1016/j.apnu.2014.08.012 · 1.03 Impact Factor
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    ABSTRACT: Background Most depression rating scales are multidimensional and the resulting heterogeneity may impede identification of coherent biomarkers. The aim of this study was to compare the psychometric performance of the multidimensional 17-item Hamilton Depression Rating Scale (HAM-D17) and the 30-item Inventory of Depressive Symptomatology (IDS-C30) to that of their unidimensional six-item melancholia subscales (HAM-D6 and IDS-C6). Methods A total of 2,242 subjects from level 1 (citalopram) of the Sequenced Treatment Alternatives to Relieve Depression (STAR⁎D) study were included in the analysis. Symptom change, response and remission rates were compared for HAM-D6 versus HAM-D17 and for IDS-C6 versus IDS-C30. The changes in total scores on these scales were compared to the change in Quality of Life Enjoyment and Satisfaction Questionnaire (QLES-Q) score using correlation analysis. Results The response to treatment was significantly greater according to the HAM-D6 and IDS-C6. Furthermore, the correlation of changes in depression-ratings with changes in QLES-Q scores were comparable for the subscales and full scales. Limitations STAR⁎D was not designed to answer the research questions addressed in this analysis. Conclusions Our findings indicate that the HAM-D6 and IDS-C6 melancholia scales capture a coherent construct in depression. The syndrome reflected in these scales is unidimensional, sensitive to specific pharmacological intervention, and therefore likely to have biological validity. We therefore believe that “melancholia” thus defined could be a valuable construct under the Research Domain Criteria (RDoC), which specifically aims at identifying the neurobiology underlying mental disorders and provide drugable targets. Clinical trial registration NCT00021528
    Journal of Affective Disorders 07/2014; 163. DOI:10.1016/j.jad.2014.03.049 · 3.71 Impact Factor
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    ABSTRACT: Abstract Objective: To explore relationships between baseline and changes in fatigue during treatment with outcomes in patients with major depressive disorder (MDD) receiving citalopram monotherapy. Research design and methods: Secondary analyses of data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Level 1 treatment phase (≤14 weeks citalopram monotherapy). Fatigue was assessed with item 14 on energy level from the 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16; scored 0-3: 0=no fatigue, 3=maximal fatigue); prospective fatigue: assessment of fatigue at Level 1 entry and exit (no fatigue, treatment-emergent fatigue, remitted fatigue, or residual fatigue). Clinical trial registration:, NCT00021528 Main outcome measures: Remission of depressive symptoms (17-item Hamilton Rating Scale for Depression ≤7 or QIDS-SR16 ≤5); Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form; Short-Form Health Survey Mental and Physical subscales; and Work and Social Adjustment Scale (WSAS). Results: At baseline, of 2,868 patients included in the analyses, 5.5% had a QIDS-SR16 item 14 score of 0; 22.9%, a score of 1; 53.6%, a score of 2; and 18.0%, a score of 3. During Level 1 treatment, 3.5% of patients had no prospective fatigue, 2.1% had treatment-emergent fatigue, 33.6% had fatigue remitting during treatment, and 60.8% had residual fatigue. Female gender, unemployment, fewer years of education, and lower monthly income were significantly associated with higher rates of baseline fatigue (all P<.0001). Higher levels of baseline or prospective fatigue were associated with reduced likelihood of remission, decreased overall satisfaction (P<.0001), and reduced mental and physical function at outcome (P≤.05). Patients with higher baseline or prospective fatigue reported higher WSAS total scores (P<.0001), indicative of more severe functional impairment. Conclusions: Lower baseline fatigue, or remission of fatigue during antidepressant treatment in patients with MDD, are associated with higher rates of remission of depressive symptoms and better function and quality of life. Study limitations include use of the STAR*D Level 1 sample (citalopram as only antidepressant), use of a proxy measure of energy/fatigue (item 14 from the QIDS-SR16), and the secondary post-hoc analysis design.
    Current Medical Research and Opinion 06/2014; 30(10):1-29. DOI:10.1185/03007995.2014.936553 · 2.37 Impact Factor
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    ABSTRACT: Background Respiratory tract infections are a major cause of outpatient visits, yet only a portion is tested to determine the etiologic organism. Multiplex reverse transcriptase polymerase chain reaction (MRT-PCR) assays for detection of multiple viruses are being used increasingly in clinical settings. Methods During January–April 2012, outpatients with acute respiratory illness (≤7 days) were tested for influenza using singleplex RT-PCR (SRT-PCR). A subset was assayed for 18 viruses using MRT-PCR to compare detection of influenza and examine the distribution of viruses and characteristics of patients using multinomial logistic regression. Results Among 662 participants (6 months–82 years), detection of influenza was similar between the MRT-PCR and SRT-PCR (κ = 0·83). No virus was identified in 267 (40.3%) samples. Commonly detected viruses were human rhinovirus (HRV, 15·4%), coronavirus (CoV, 10·4%), respiratory syncytial virus (RSV, 8·4%), human metapneumovirus (hMPV, 8·3%), and influenza (6%). Co-detections were infrequent (6·9%) and most commonly occurred among those <18 years old. In regression analyses, compared with non-viral illnesses, RSV and hMPV were significantly more frequent in children and less frequent in 18- to 49-year-olds than in those ≥50 years (P = 0·01), fever was more common in hMPV and influenza infections (P = 0·008), nasal congestion was more frequent in CoV, HRV, hMPV, influenza and RSV infections (P = 0·001), and body mass index was higher among those with influenza (P = 0·036). Conclusions Using MRT-PCR, a viral etiology was found in three-fifths of patients with medically attended outpatient visits for acute respiratory illness during the influenza season; co-detected viruses were infrequent. Symptoms varied by viral etiology.
    Influenza and Other Respiratory Viruses 05/2014; 8(4). DOI:10.1111/irv.12247 · 1.90 Impact Factor
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    ABSTRACT: Background. We analyzed the public STAR*D database to better characterize the baseline clinical characteristics and functional outcomes of patients with major depressive disorder (MDD) who experienced partial response in order to better understand the burden associated with this outcome. Method. Patients (n=2,876) received treatment with citalopram. The last available Quick Inventory of Depressive Symptoms (QIDS-SR) from the 12-week treatment period was used to assign subjects to one of three groups: remitters QIDS-SR≤5; non-responders QIDS-SR >5 and <25% reduction from baseline; and partial responders QIDS-SR >5 and ≥25% reduction from baseline. Baseline sociodemographic and clinical characteristics were compared across groups, as well as functional outcomes at Level 1 exit. Results. Of the 2,876 patients, 943 patients (33%) were classified as remitters, 1069 (37%) as partial responders, and 854 (30%) as non-responders. The groups differed on a number of pre-treatment course of illness variables and comorbidities. In addition, remitters, partial responders, and non-responders all separated on posttreatment quality of life and functional outcomes at Level 1 exit. Conclusion. Partial responders demonstrated significant functional impairment at Level 1 exit, differing significantly from the patients who remitted on quality of life, mental and physical functioning, and social and work-related impairment. Adjusted outcomes showed similar differences. Differences in baseline rates of suicidality, comorbidity, and atypical presentations of depression were also observed between outcome groups. Given the substantial clinical and economic burden associated with functional impairment in depression, the need to fully treat partially responding patients to achieve depression remission and restoration of functioning is highlighted by this work. (Journal of Psychiatric Practice 2014;20:178-187).
    Journal of Psychiatric Practice 05/2014; 20(3):178-87. DOI:10.1097/01.pra.0000450317.76117.62 · 1.35 Impact Factor
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    ABSTRACT: To assess the efficacy of collaborative care for behavior problems, attention-deficit/hyperactivity disorder (ADHD), and anxiety in pediatric primary care (Doctor Office Collaborative Care; DOCC). Children and their caregivers participated from 8 pediatric practices that were cluster randomized to DOCC (n = 161) or enhanced usual care (EUC; n = 160). In DOCC, a care manager delivered a personalized, evidence-based intervention. EUC patients received psychoeducation and a facilitated specialty care referral. Care processes measures were collected after the 6-month intervention period. Family outcome measures included the Vanderbilt ADHD Diagnostic Parent Rating Scale, Parenting Stress Index-Short Form, Individualized Goal Attainment Ratings, and Clinical Global Impression-Improvement Scale. Most measures were collected at baseline, and 6-, 12-, and 18-month assessments. Provider outcome measures examined perceived treatment change, efficacy, and obstacles, and practice climate. DOCC (versus EUC) was associated with higher rates of treatment initiation (99.4% vs 54.2%; P < .001) and completion (76.6% vs 11.6%, P < .001), improvement in behavior problems, hyperactivity, and internalizing problems (P < .05 to .01), and parental stress (P < .05-.001), remission in behavior and internalizing problems (P < .01, .05), goal improvement (P < .05 to .001), treatment response (P < .05), and consumer satisfaction (P < .05). DOCC pediatricians reported greater perceived practice change, efficacy, and skill use to treat ADHD (P < .05 to .01). Implementing a collaborative care intervention for behavior problems in community pediatric practices is feasible and broadly effective, supporting the utility of integrated behavioral health care services.
    PEDIATRICS 03/2014; 133(4). DOI:10.1542/peds.2013-2516 · 5.30 Impact Factor
  • Annals of the Rheumatic Diseases 01/2014; 72(Suppl 3):A53-A53. DOI:10.1136/annrheumdis-2013-eular.221 · 9.27 Impact Factor
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    ABSTRACT: To evaluate energy expenditure in a cohort of children with severe traumatic brain injury. A prospective observational study. A pediatric neurotrauma center within a tertiary care institution. Mechanically ventilated children admitted with severe traumatic brain injury (Glasgow Coma Scale < 9) with a weight more than 10 kg were eligible for study. A subset of children was co-enrolled in a phase 3 study of early therapeutic hypothermia. All children were treated with a comprehensive neurotrauma protocol that included sedation, neuromuscular blockade, temperature control, antiseizure prophylaxis, and a tiered-based system for treating intracranial hypertension. Within the first week after injury, indirect calorimetry measurements were performed daily when the patient's condition permitted. Data from 13 children were analyzed (with a total of 32 assessments). Measured energy expenditure obtained from indirect calorimetry was compared with predicted resting energy expenditure calculated from Harris-Benedict equation. Overall, measured energy expenditure/predicted resting energy expenditure averaged 70.2% ± 3.8%. Seven measurements obtained while children were hypothermic did not differ from normothermic values (75% ± 4.5% vs 68.9% ± 4.7%, respectively, p = 0.273). Furthermore, children with favorable neurologic outcome at 6 months did not differ from children with unfavorable outcome (76.4% ± 6% vs 64.7% ± 4.7% for the unfavorable outcome, p = 0.13). Contrary to previous work from several decades ago that suggested severe pediatric traumatic brain injury is associated with a hypermetabolic response (measured energy expenditure/predicted resting energy expenditure > 110%), our data suggest that contemporary neurocritical care practices may blunt such a response. Understanding the metabolic requirements of children with severe traumatic brain injury is the first step in development of rational nutritional support goals that might lead to improvements in outcome.
    Pediatric Critical Care Medicine 01/2014; 15(3). DOI:10.1097/PCC.0000000000000041 · 2.33 Impact Factor
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    ABSTRACT: Rapid, accurate, and cost-effective methods to identify the cause of respiratory tract infections are needed to maximize clinical benefit. Outpatients with acute respiratory illness were tested for influenza using a singleplex reverse transcriptase polymerase chain reaction (SRT-PCR) method. A multiplex RT-PCR (MRT-PCR) method tested for influenza and 17 other viruses and was compared with SRT-PCR using chi-square tests. Among 935 patients, 335 (36%) tested positive for influenza A and influenza B using SRT-PCR. Using MRT-PCR, 320 (34.2%) tested positive for influenza A and influenza B. This study supports MRT-PCR as a comparable method for detecting influenza among patients seeking outpatient care for acute respiratory illnesses.
    Advances in Virology 01/2014; 2014:274679. DOI:10.1155/2014/274679
  • American Journal of Psychiatry 11/2013; 170(11):1364-5. DOI:10.1176/appi.ajp.2013.13040472r · 13.56 Impact Factor
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    ABSTRACT: Background/Purpose: C reactive protein (CRP) levels have been used extensively to model disease activity in rheumatoid arthritis (RA). However, TNF antagonist therapy (and likely therapy with other biologics) reduce CRP levels, even without associated reductions in RA disease activity. Serum amyloid A (SAA) also models RA disease activity and has been suggested as a better biomarker for RA disease activity. We previously showed that TNF antagonist therapy lowered both SAA and CRP levels to a greater extent than oral disease modifying anti-rheumatic drugs (DMARDs) after adjusting for disease activity. However, TNF antagonists, compared to oral DMARDs, decreased CRP levels more than SAA levels. Our aim was to compare the effect of etanercept (ETN) and/or oral DMARD therapy on serum SAA versus CRP levels, and to determine whether SAA levels model RA disease activity better than CRP levels, especially during treatment with a TNF antagonist. Methods: Samples were analyzed from RA subjects (n = 755) in the Treatment of Early RA (TEAR) study, a randomized, double-blind, comparative effectiveness trial. In the TEAR trial, early RA subjects with less than 2 years of disease duration were randomized to receive either combination ETN/methotrexate (MTX) therapy (n = 244), MTX/hydrochloroquine/sulfasalazine (triple oral) therapy (n = 132) or MTX monotherapy (n = 379). MTX monotherapy subjects with a DAS28-ESR > 3.2 after 6 months were stepped up to either ETN/MTX (n = 205) or triple oral therapy (n = 93). Serum samples and clinical data were collected when treatment was initiated and at 24, 48 and 102 week follow up visits. We used Spearman correlation coefficients (rho) to determine the overall relationship between SAA and CRP levels, and mixed effects models to determine the fit between 1) SAA levels and DAS28-ESR and 2) CRP levels and DAS28-ESR, for subjects treated with ETN/MTX and subjects treated with oral DMARDs, while correcting for baseline SAA and CRP levels, respectively. Akaike information criterion (AIC) and parameter estimates were used to determine model fit, with ΔAIC > 10 used as strong evidence for one model fitting better than another. Results: At the baseline visit, SAA levels were only moderately correlated with CRP levels (rho = 0.42), and the SAA and CRP correlation was similar regardless of treatment or study visit (rho range 0.35 to 0.62). Across all subjects and time points, models of the DAS28-ESR using SAA levels were better than models using CRP; the ΔAIC between the models was 305. The model of DAS28-ESR using SAA was associated with a ~6 fold better fit vs. the CRP model for subjects treated with ETN/MTX, and a ~5 fold better fit vs. the CRP model for subjects treated with oral DMARDs (ΔAIC = 159 vs. ΔAIC = 137, respectively). Conclusion: The lack of a strong correlation between SAA and CRP levels coupled with their different modeling of RA disease activity suggests that SAA levels may be a better biomarker for RA disease activity than CRP, especially during treatment with TNF antagonists.
    American College of Rheumatology conference, San Diego, CA; 10/2013
  • ACR/ARHP Annual Meeting, San Diego, CA; 10/2013
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    ABSTRACT: Objective Obesity and major depressive disorder often co-occur. However, differences between obese and normal-weight depressed patients and the moderating effect of obesity on antidepressant treatment outcome have not been well studied.Methods Adults (n = 662) with chronic or recurrent major depressive disorder in the Combining Medications to Enhance Depression Outcomes study were randomized to treatment with escitalopram plus placebo, bupropion plus escitalopram, or venlafaxine plus mirtazapine for a 12-week primary treatment phase and 16-week follow-up. Body mass index (BMI) was calculated at baseline and categorized in accordance with World Health Organization criteria: normal (and low) weight (NW), overweight, Obese I and Obese II+. Outcomes were assessed using a repeated-effects model, unadjusted and adjusted for baseline variables.ResultsObesity was common (46.2%), and 25.5% were NW. Higher BMI was associated with greater medical illness (p < .001), social phobia (p = .003), and bulimia (p = .026). Lower BMI was associated with a higher frequency of posttraumatic stress disorder (p = .002) and drug abuse (p < .001). Treatment outcomes did not differ across BMI classes, including Week 12 remission rates (NW 36%, overweight 40%, Obese I 43%, and Obese II+ 37%; p = .69). However, lower BMI was associated with more frequent (p = .024 [unadjusted] and .053 [adjusted]) and more severe (p = .008 [unadjusted] and .053 [adjusted]) adverse effects.ConclusionsBMI was related to the clinical presentation of depression and prevalence of comorbidities, but not medication use and antidepressant outcomes. Lower BMI classes had higher frequencies of psychiatric comorbidities, which may have obscured the relationship between body weight and antidepressive medication effects.Trial identifier: NCT00590863.
    Psychosomatic Medicine 10/2013; 75(9). DOI:10.1097/PSY.0000000000000000 · 4.09 Impact Factor

Publication Stats

19k Citations
2,120.23 Total Impact Points


  • 1996–2015
    • University of Pittsburgh
      • • Graduate School of Public Health
      • • Department of Epidemiology
      • • Department of Psychiatry
      • • Safar Center for Resuscitation Research
      • • Department of Pediatric Neurosurgery
      Pittsburgh, Pennsylvania, United States
  • 2013
    • Childrens Hospital of Pittsburgh
      Pittsburgh, Pennsylvania, United States
    • Barrow Neurological Institute
      Phoenix, Arizona, United States
  • 2007–2012
    • University of Texas Southwestern Medical Center
      • Department of Psychiatry
      Dallas, TX, United States
    • University of Colorado at Boulder
      Boulder, Colorado, United States
    • U.S. Department of Veterans Affairs
      Washington, Washington, D.C., United States
    • Psychotherapy Associates
      Nebraska City, Nebraska, United States
    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
      Torrance, California, United States
    • Harvard University
      Cambridge, Massachusetts, United States
  • 1998–2012
    • Western Psychiatric Institute and Clinic
      Pittsburgh, Pennsylvania, United States
  • 2011
    • Vanderbilt University
      Nashville, Michigan, United States
  • 2004–2011
    • Columbia University
      • Department of Psychiatry
      New York, New York, United States
  • 2010
    • Virginia Commonwealth University
      • Institute for Women's Health
      Richmond, VA, United States
  • 2008–2009
    • University of North Carolina at Chapel Hill
      • Department of Psychiatry
      Chapel Hill, NC, United States
    • University of Colorado
      • Department of Psychiatry
      Denver, Colorado, United States
    • Eli Lilly
      Indianapolis, Indiana, United States
    • University of Texas at Dallas
      Richardson, Texas, United States
    • University of Pennsylvania
      • Department of Psychiatry
      Philadelphia, PA, United States
    • Mount Sinai School of Medicine
      • Department of Psychiatry
      Manhattan, NY, United States
    • Karolinska Institutet
      • Department of Neuroscience
      Solna, Stockholm, Sweden
    • Northwestern University
      • Asher Center – Study & Treatment of Mood Disorders
      Evanston, Illinois, United States
  • 2006–2007
    • Boston University
      • Department of Psychology
      Boston, Massachusetts, United States
    • Via Christi Health
      Wichita, Kansas, United States
    • Brown University
      • Department of Psychiatry and Human Behavior
      Providence, Rhode Island, United States
    • New York State Psychiatric Institute
      New York, New York, United States
  • 2005
    • Massachusetts General Hospital
      • Department of Psychiatry
      Boston, MA, United States
    • Harvard Medical School
      • Department of Psychiatry
      Boston, MA, United States
  • 1997
    • University of Michigan
      Ann Arbor, Michigan, United States