The European Journal of Psychiatry

The role of Personality, Mood, Subjective Health, and Stress in Depressive Symptoms among High School Students

Background and Objectives: Traditionally, depression among adolescents has been considered uncommon, with around 5% estimated to suffer from depressive disorder. The purpose is to investigate occurrence and psychological correlates for depressive symptoms in male and female high school adolescents in urban and rural settings. Methods: Participants were 1,069 high school students (response rate 92.0%) with a mean age of 17.6 years. The instruments used were the Zung Depression Self-Rating Scale (SDS), Life Regard Index (LRI), the Neuroticism scale by Eysenck (EPQ-N), the Tension and Effort Stress Inventory (TESI), the Subjective Health Complaints scale (SHC), and the Sense of Humour Questionnaire (SHQ-6). Results: Analyzes of Variance showed sex and urban/rural main effects, and/or interactions (boys and rural students showing highest positive ratings). Stepwise regression analyzes on depression showed all but the TESI variables to significantly explain 41% of the variance in depression. The Sense of Humour and Life Regard Index were strong contributors to depression (55% of variation) when effects of bodily complaints and scores on stressors and efforts were eliminated. Conclusions: The present study showed an unexpectedly high prevalence of severe (12.7%) as well as moderate depressive symptoms (total of 49.2%). Therefore, the results indicate an increase of adolescent depression in recent years. Negative and positive mood, as well as sense of humour, goals in life, and fulfilment of goals seemed to be protecting. Prevalence of depressive symptoms in adolescents was shown to be higher than expected. Positive resource variables appeared to be protecting.

Depression in the elderly community: I. Prevalence by different diagnostic criteria and clinical profile

Background and Objectives: Depression is one of the most intriguing disorders in the elderly. We conjecture that prevalence of depression in the community vary according to the diagnostic criteria used. Furthermore, we anticipate that important proportions of depression go untreated or inadequately treated in a Southern European city. Metodology: This report is part of the Zaragoza Study (or ZARADEMP 0), an epidemiological project to document psychiatric morbidity in a representative sample of the elderly. A two - phase design was completed in a sample of n= 1080 elderly (65+ years). Standardized instruments were used, and the Geratric Mental State (GMS) was the main instrument. Cases of depression were diagnosed with three different sets of diagnostic criteria: AGECAT syndrome, AGECAT diagnosis and DSM - IV criteria. Descriptive statistics were used. Results: In support of the working hypothesis, the prevalence of depression tended to be lower when stringent diagnostic criteria were used. It was 7.0 % with AGECAT syndrome, 5.7% with AGECAT diagnosis among the cases, 4.8% with DSM - IV criteria. Anxiety, co - morbid syndromes were frequent among the cases (45.5%) and 18.2% of them had co - morbid AGECAT organic syndromes. Differential psychopathological profiles are observed between cases of major and minor depression. Undertreament or inadequate treatment was very frequent, and only 54.5% of major depression cases were on antidepressants. Conclusions: The prevalence of depression in the elderly varies according to diagnostic criteria used, and does not increase with age. Co-morbid anxiety and "organic" syndromes are common, and only half the major depressive cases were on antidepressants.

Depression in the elderly community: II. Outcome in a 4.5 years follow-up

Background and Objectives: In this study, we test to what extent negative outcomes of depression reported in different countries may be confirmed in a Southern European population. Methods: This is a follow-up (mean 4.5 years) of the elderly sample interviewed in the baseline of the Zaragoza Study (or ZARADEMP 0). The general methodology is described in the previous paper. The same two-phase procedure completed at baseline was also implemented at follow-up and the same standardized instruments were used. Cases of depression at follow-up were diagnosed with AGECAT criteria. Operational criteria were also used for definition of both "incident case of depression" and "chronic case of depression". Results: Six hundred and sixty three elderly (61.4%) were reassessed at follow-up, and 216 died in the follow-up period. A negative outcome of both, major and minor depression was observed. Taken together, the pessimistic outcome (death, chronicity or conversion to other psychiatric diagnosis) was observed in 70.5% of cases of depression, but only in 30.8% of "non-cases", the differences being statistically significant (Z = 6.7; p <0.001). Similarly, a high proportion of subcases of depression had a negative prognosis (48.5%), the differences with "non-cases" also being statistically significant (Z = 2.7; p <0.005). Incidence rate of depression was 14.4 (95% C.I.: 11.0-18.6) the rate being significantly higher in women when compared to men. Conclusions: This is the first report of a negative outcome of depression in a representative sample of the elderly in a Southern European city. Subcases of depression also had a negative outcome. The clinical significance in AGECAT cases of depression is emphasized.

Burnout in a sample of Alzheimers disease caregivers in Brazil

Background and Objectives: Caregiver burden has been associated to both caregiver and patient factors, but little is known about their relationship to burnout. We aimed at investigating burnout correlations to the sociodemographic and clinical variables of a sample of caregivers of Alzheimers disease (AD) outpatients. Methods: AD patients (n=69) and their caregivers completed a sociodemographic questionnaire, Maslach Burnout Inventory, Beck Depression and Anxiety Inventories. Patients were administered the Mini Mental State Examination, the Neuropsychiatric Inventory, Clinical Dementia Rating and the Functional Activities Questionnaire. Burnout and each dimension (emotional exhaustion, depersonalization, and reduced personal accomplishment) were correlated to caregivers sociodemographic characteristics, burden of care, anxious and depressive symptoms as well as to the patients behavioral, functional and cognitive profile. Results: Burden of care was the only variable that associated to caregiver burnout. Emotional exhaustion was the most prevalent dimension and associated to all caregivers and patients clinical variables. Conclusions: Caregiver burden associated to burnout, and emotional exhaustion is the dimension mostly associated to dementia severity and psychiatric morbidity in caregivers.

Reliability of clinical ICD-10 diagnoses among electroconvulsive therapy patients with chronic affective disorders

Background and Objectives: Diagnostic reliability is of major concern both to clinicians and researchers. The aim has been to investigate the trustworthiness of clinical ICD-10 affective disorder diagnoses for research purpose. Methods: 150 ECT patients with chronic affective disorders were investigated. A standardized schema for basic anamnesis and the Operational Criteria Checklist for Psychotic and Affective Illness (OPCRIT) were used. The sensitivity, specificity, positive and negative predictive values of clinical affective disorder ICD-10 diagnoses and the formal agreement between clinical ICD-10, OPCRIT ICD-10 and DSM-IV diagnoses were determined using unweighted κ-statistics. Results: The sensitivity, specificity, positive and negative predictive values of the clinical bipolar diagnoses was 0.55, 0.75, 0.42 and 0.84, respectively. The sensitivity, specificity, positive and negative predictive values of the clinical unipolar diagnoses was 0.79, 0.55, 0.77 and 0.58, respectively. The agreement between clinical ICD-10 and OPCRIT ICD-10 bipolar vs. non-bipolar diagnoses was low, κ = 0.28. The agreement between clinical ICD-10 and OPCRIT ICD-10 unipolar vs. non-unipolar diagnoses was low, κ = 0.35. The agreement between OPCRIT ICD-10 and DSM-IV diagnoses on bipolar vs. non-bipolar disorders was high, κ = 0.91, and the agreement on unipolar vs. non-unipolar disorders was fairly high, κ = 0.78. Conclusions: This study demonstrates that the reliability of clinical ICD-10 diagnoses of affective disorders from chronic subjects with a history of ECT is problematic despite sample homogeneity on basic clinical, demographic and epidemiological parameters.

Minor physical anomalies in Tourette syndrome

Background and Objectives: The prevalence of minor physical anomalies (prenatal errors of morphogenesis) was evaluated in patients with Tourette syndrome to get indirect data on the possible role of aberrant neurodevelopment in the aetiology of Tourette syndrome. No published study is known on the minor physical anomaly prevalence in this recently intensively investigated disorder, and connecting to current opinions on a possible role of aberrant neurodevelopment in Tourette syndrome it seems important to introduce trait marker research focusing on brain maldevelopment. Methods: A scale developed by Méhes1,2 was used to detect the presence or absence of 57 minor physical anomalies in 24 patients with Tourette syndrome and in 24 matched controls 21 boys and 3 girls were evaluated, the age of onset of illness among the Tourette patients was between the age of 5 and 13. Results: The mean value of all minor physical anomalies was significantly higher among the group of patients compared with controls. (Mann - Whitney U - value: 49, 50, -Z = - 4,92, p = 0,001) In the case of 7 minor physical anomalies we could demonstrate statistically significant differences between the Tourette and the control sample. In the case of 4 minor malformations (supernumary nipples, prominent forehead, tongue with smooth and rough spots, double posterior hair whorl) and of 3 phenogenetic variants (antimongoloid slant, inner epicanthic folds, high arched palate) a significantly higher frequency was observed compared with control individuals. However after Bonferroni correction for the Fishers Exact test, only double posterior hair whorl and high arched palate showed a significantly higher frequency compared to control children (p = 0.001). Conclusions: The overrepresentation of minor physical anomalies in Tourette syndrome can strongly support the view that this disorder is related to pathological factors operating early in development.