Minor Depression: Midway between Major Depression and Euthymia
[Show abstract] [Hide abstract] ABSTRACT: The diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) for assessment of depression in elderly persons in primary care settings in the United States has not been previously addressed. Thus, the purpose of this study was to evaluate the test performance of the PHQ-9 for detecting major and minor depression in elderly patients in primary care. A prospective study of diagnostic accuracy was conducted in two primary care, university-based clinics in the Pacific Northwest of the United States. Seventy-one patients aged 65 years or older participated; all completed the PHQ-9 and the 15-item Geriatric Depression Scale (GDS) and underwent the Structured Clinical Interview for Depression (SCID). Sensitivity, specificity, area under the receiver operating characteristic (ROC) curve, and likelihood ratios (LRs) were calculated for the PHQ-9, the PHQ-2, and the 15-item GDS for major depression alone and the combination of major plus minor depression. Two thirds of participants were female, with a mean age of 78 and two chronic health conditions. Twelve percent met SCID criteria for major depression and 13% minor depression. The PHQ-9 had an area under the curve (AUC) of 0.87 (95% confidence interval [CI], 0.74-1.00) for major depression, while the PHQ-2 and the 15-item GDS each had an AUC of 0.81 (95% CI for PHQ-2, 0.64-0.98, and for 15-item GDS, 0.70-0.91; P = 0.551). For major and minor depression combined, the AUC for the PHQ-9 was 0.85 (95% CI, 0.73-0.96), for the PHQ-2, 0.80 (95% CI, 0.68-0.93), and for the 15-item GDS, 0.71 (95% CI, 0.55-0.87; P = 0.187). Based on AUC values, the PHQ-9 performs comparably to the PHQ-2 and the 15-item GDS in identifying depression among primary care elderly.0Comments 46Citations
- "We hypothesized that, because the PHQ-9 items map directly to DSM-IV criteria for depression, the PHQ-9 would have test performance characteristics at least comparable to the GDS but perhaps less ease of use (due to its more complex response format). We were interested in minor as well as major depression, because minor depression is more prevalent in primary care than major depression, is associated with adverse effects on functioning and may increase the risk of subsequent major depression in older primary care patients [24,25], increases health care use and costs , and may be responsive to treatment262728. Because brief screening tools may be preferable for use in primary care settings, we also examined the sensitivity and specificity of the PHQ-2, an abbreviated version of the PHQ- 9, in identifying patients with major and minor depression. "
[Show abstract] [Hide abstract] ABSTRACT: The hypothalamic-pituitary-adrenal (HPA)-axis regulates the response to stressful events and is expected to be involved in the pathogenesis of depression. The glucocorticoid receptor (GR) regulates the activity of the HPA-axis. Both GR gene polymorphisms and childhood adversity are known to be associated with increased risk for depression. In the Longitudinal Aging Study Amsterdam, a large population based sample of older men and women, 906 subjects were genotyped. An association study was performed to determine the relationship between GR gene polymorphisms, childhood adversity, HPA-axis markers and depressive symptoms. A gene-environment interaction between the GR polymorphisms 22/23EK and 9beta and childhood adversity resulted in an increased risk of clinically relevant depressive symptoms. Without childhood adversity no increased risk was present. The 22/23EK variant was also associated with a lower Free Cortisol Index in the presence of childhood adversity. Persons that are heterozygous for the BclI variant, in contrast with wild-type and BclI-homozygotes, had lower serum levels of cortisol binding globulin and had no increased risk of recurrent depressive symptoms in the presence of childhood adversity. We found a gene-environment (G x E) interaction between common variants of the GR gene and childhood adversity, demonstrating a vulnerable phenotype for developing clinically relevant depressive symptoms at old age. This G x E interaction also influenced HPA-axis markers providing support for the involvement of the HPA-axis in both stress regulation and the pathogenesis of depression.0Comments 69Citations
- "subtreshold depression is high (5–15% in primary care) and it is a important risk factor for developing MDD. Subthreshold depression is often chronic or recurrent and the functional status of patients is impaired for many years [Beekman et al., 2002; Kennedy et al., 2004; Kroenke, 2006; Lyness et al., 2006]. Several lines of evidence indicate that disturbances of the hypothalamus-pituitary-adrenal (HPA) axis are involved in the pathogenesis of depression [de Kloet et al., 2005] and the risk of recurrence [Appelhof et al., 2006]. "
- [Show abstract] [Hide abstract] ABSTRACT: Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, 2007. Objetivo: Investigar a prevalência de transtorno depressivo maior em pacientes hipertensos matriculados em um centro de referência universitário para tratamento de hipertensão arterial e outros fatores de risco cardiovasculares. Métodos: estudo transversal, descritivo, em amostra aleatória representativa obtida de forma sistemática de pacientes em atendimento contínuo na Liga de Hipertensão Arterial da Universidade Federal de Goiás. Aplicou-se o Inventário de Depressão de Beck (BDI) para rastreamento de sintomas depressivos e a entrevista estruturada SCID I/P-DSM-IV para avaliação diagnóstica de transtorno depressivo maior. Foram constituídos um grupo com pacientes portadores de depressão maior, denominado grupo estudo (GE) e um grupo com pacientes não portadores de depressão maior, denominado grupo controle (GC). Variáveis sócio-demográficas, pressão arterial e bioquímica sanguínea foram avaliadas no momento da coleta de dados. Resultados: Foram entrevistados 285 pacientes tendo sido encontrada prevalência de 20% de depressão maior na população investigada. A idade média foi significativamente menor para o GE, com predomínio do sexo feminino. A prática de atividade física regular foi também significativamente menor entre os pacientes do GE que também apresentaram valores mais elevados de pressão arterial diastólica e de colesterolemia. Conclusão: Foi encontrada uma prevalência de Transtorno Depressivo Maior em pacientes hipertensos superior àquela encontrada na população geral, além de dados consistentes quanto a maior nível de pressão arterial diastólica, colesterolemia e menor realização de atividade física entre indivíduos do Grupo Estudo. Isso aponta para uma necessidade de maior atenção para o diagnóstico dos transtornos depressivos em pacientes hipertensos em atendimento primário e ambulatorial. _________________________________________________________________________________________ ABSTRACT Objective: Investigating the prevalence of major depression disorders in hypertensive patients enrolled in a university reference center for the treatment of hypertension and other cardiovascular risk factors. Methods: cross-sectional, descriptive study of a representative randomized sample of patients, obtained according to a systematic protocol, among individuals enrolled for continuous treatment at the Hypertension League of the Universidade Federal de Goiás. The Beck Depression Inventory (BDI) was administered for detecting the depressive symptoms, and the SCID I/P-DSM-IV structured interview, for the diagnostic classification of the major depressive disorder. Two groups were formed, one with patients with major depressive disorder, called study group (SG) and another with patients without depression, called control group (CG). Sociodemographic variables, blood pressure and plasma biochemistry were evaluated at the time of the interview. Results: From the two-hundred eighty-five patients who were evaluated the results indicated a 20% prevalence of major depression in the population included in the study. The mean age was significantly lower for the SG, where female individuals were predominant. Regular physical activity was less common among patients in the SG; and higher diastolic blood pressure values as well as cholesterolemia were also found in this group. Conclusion: these results show a higher prevalence of major depressive disorder among these patients, relative to the population as a whole. More attention should be paid to establishing an adequate diagnosis for depressive disorders in hypertensive patients, both in primary care facilities and in outpatient clinics.0Comments 0Citations
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