The relationship between life satisfaction and alexithymia was studied in a sample of 229 patients as a part of a naturalistic follow-up study of depression in Finnish primary health care. The measures were the abbreviated Life Satisfaction Scale and the 20-item Toronto Alexithymia Scale. Depression was assessed by telephone with the short form of the Composite International Diagnostic Interview. Of all subjects, 19.2% were alexithymic, and 9.2% were depressed. Alexithymia was negatively associated with life satisfaction even when depression and other confounding factors were controlled for. Alexithymia is a risk factor for life dissatisfaction in primary-care patients.
The role of questionnaires is important in improving the recognition of major depression.
Our aims were: 1) to compare the differences of structure between the Depression Scale (DEPS) and other instruments, and 2) to study whether the DEPS items function in the same way with patients grouped by gender, by age or by education, at the same time taking into account the level of depression.
The item topics of the DEPS and five other self-rating questionnaires (BDI-II, CES-D, HADS-D, PHQ-9, SCL-90-D), an interviewer rating scale (HAMD-17) and two diagnostic interviews for depression (ICD-10, DSM-IV) were listed in a table. The format of the questionnaires and the rating scale were compared. Differential item functioning (DIF) analysis using empirical material (n=1522) and logistic regression models was done to predict DEPS item responses across dichotomous categories for gender, age and education.
The DEPS scale items covered essential symptoms of depression. Of the instruments assessed, the DEPS seemed the most simple. DIF analyses with the DEPS scale revealed some socio-demographic variation in which symptoms were endorsed after matching for DEPS sum score. Clinically the DEPS has good applicability and accuracy for screening depression in working aged primary care patients.
Factors associated with low self-esteem in non-depressive subjects increase the individual's vulnerability to depression (causal risk factors), and factors correlated to low self-esteem in depressive subjects make the current disorder more severe (pathoplastic risk factors). Using the Rosenberg Self-Esteem Scale and Depression Scale we intended to explore correlates of low self-esteem in non-depressive and depressive subjects in a random sample of 1643 individuals attending community health centres in Central Finland. According to our study, self-esteem in non-depressive men was affected mainly by poor socioeconomic situation; in depressive men particularly low self-esteem was associated with negative family factors. Low self-esteem in non-depressive women was correlated to poor socioeconomic situation, poor health, and negative family factors. In depressive women self-esteem was affected by poor physical and poor mental health. Taking into consideration causal and pathoplastic risk factors, general practitioners can improve recognition of depression. By paying attention to pathoplastic factors, it is possible to improve detection of more severe forms of depression.
The quick and simple Depression Scale (DEPS) has been a popular self-rating depression scale in Finland for nearly 15 years. The purpose was to assess the validity of the DEPS in various subgroups of patients.
Primary care patients, aged 18-64, completed a postal questionnaire including the DEPS. Of the 1643 patients all screen-positive subjects and every 10th screen-negative subject were invited for interview (the Present State Examination, PSE). Complete DEPS scores were available for 410 patients. They were grouped by gender, age, marital status, perceived physical health, basic education and the Michigan Alcoholism Screening Test (MAST) score. Separately for each subgroup, receiver operating characteristic (ROC) curve analyses were done, sensitivity, specificity, area under the curve (AUC), predictive values and likelihood ratios were calculated, and Cronbach's alpha was estimated.
The DEPS was valid in general, but best for patients with basic education longer than 9 years.
The key statistical figures for the DEPS were comparable to the figures for other short self-rating scales.
The DEPS is a valid case finder for primary care patients in the age group 18-64 years, and especially suitable for more highly educated patients. Future studies comparing the DEPS with other simple depression rating scales are needed.
There are no great differences in the symptom profiles of depression between the genders in observer rating scales, but women self-report more symptoms.
To compare gender differences in symptom profiles of clinical depression in primary care with a short self-report depression scale and an observer-rated scale for social functioning.
A sample of 436 primary care patients aged 18-64 years were screened using the Depression Scale (DEPS) and interviewed using the Present State Examination (PSE). Level of social functioning was also assessed. Sum scores and single items of DEPS were compared between men and women in the groups of both depressive and non-depressive patients,and the interactions between gender and depression were analysed.
Depressive men scored poorer on both instruments. Feeling that everything is an effort and feeling worthless were typical for depressive men. Feeling blue was more typical for non-depressive women than for non-depressive men.
In this sample of primary care patients, there were differences in the symptom profiles of depression between men and women. Depressive men more commonly had serious symptoms than depressive women. Clinically, male depression deserves more attention. The psychosocial profile of public primary care patients in Finland warrants further research.
The role of a functional polymorphism in the transcriptional control region of serotonin transporter gene (5-HTTLPR, SERTPR) has been studied intensively in major depression and in the response to selective serotonin inhibitors (SSRIs) in major depression. The findings have been contradictory, although majority of the studies indicate that the short allele is associated with poor response to SSRIs in major depression. In the present study, we evaluated the association of 5-HTTLPR with treatment response to SSRI medication in Finnish Caucasian MDD patients. A secondary purpose was to study the possible association of this particular polymorphism with major depressive disorder. The aim of the study was to replicate the previous findings in this area. Primary outcomes of the treatment were remission, defined by an exit score of seven or less, and response, defined by a reduction of at least 50% on the MADRS. We had also a control population of 375 healthy blood donors, as a secondary objective was to evaluate the possible association of this particular polymorphism with major depressive disorder. Twenty-nine of the 85 (34.1%) patients reached the remission and 58.8% achieved the predefined response criteria. The l/l genotype of 5-HTTLPR was presented in 51.7% of those patients who achieved remission vs. 25.0% in the non-remitters (P = 0.03). The result remained statistically significant after adjusting for age, gender, medication and MADRS points at the study entry. However, the small sample size limits the reliability of this result.
Brain-derived neurotrophic factor (BDNF) is suggested to play a role in the aetiology of major depression and in the antidepressant response in patients with major depression. Several BDNF gene polymorphisms have been investigated in the above-mentioned context. The aim of the present study was to examine the role of two BDNF gene polymorphisms (rs11030101 and rs61888800) in relation to the response to selective serotonin reuptake inhibitor medication in 106 patients of Finnish origin suffering from major depression. The secondary objective was to evaluate the association of these two BDNF polymorphisms in major depression, as we also had a control population of 386 healthy individuals. We did not find any significant differences in the distribution of these two BDNF gene polymorphisms in our patient population in relation to remission or response to treatment with selective serotonin reuptake inhibitor. Also, there were no significant differences between the patients and the controls.
The objective of this study was to examine how the outcomes of a structured diagnostic interview for depression are related to the results of a self-report scale in alexithymic and nonalexithymic groups.
Subjects (N=389) recruited from primary care and psychiatric care completed the Depression Scale (DEPS) and the 20-item Toronto Alexithymia Scale. Major depression was diagnosed using the Composite International Diagnostic Interview-Short-Form by telephone.
In the group without major depression, the DEPS scores of the alexithymic subjects were significantly higher than those of the nonalexithymic subjects. In the group with major depression, the ideal cutoff points of the DEPS, assessed by receiver operating characteristic analyses, were essentially higher for the alexithymic patients.
Alexithymic subjects without major depression may be rated as depressive if the only criterion is the score on a self-report scale. Furthermore, alexithymic patients may require higher cutoff points in a self-report depression scale.
There is a need for a simple depression questionnaire also capable of assessing the severity of depression. The Depression Scale (DEPS), has been a very popular self-rating depression questionnaire in Finland for >15 years.
Our aim was to examine whether the DEPS has the ability to differentiate clearly defined levels of depression in primary care patients.
Primary care patients aged 18-64 years completed a postal questionnaire including the DEPS. All screen-positive subjects and every 10th screen-negative subject were invited for interview using the Present State Examination (PSE) as the gold standard. Complete DEPS score was available for 410 patients. Descriptive statistics of the DEPS in the six diagnostic PSE classes were computed. Four of the PSE classes were selected for further analyses of depression severity. Receiver Operating Characteristic curves, sensitivity, specificity, ideal cut-off points and area under the curve were calculated. The ability of the DEPS to differentiate levels of functioning was also evaluated.
The DEPS identified three groups of patients: those with no psychiatric symptoms, those with some depressive symptoms and those with clinical depression. The margins between the levels were thin: the ideal cut-off point for clinical depression was 11/12 and for any level of depression 9/10. The DEPS was also able to differentiate three levels of functioning.
The DEPS has some ability to identify severity of depression in primary care patients. Further research with larger unscreened material is called for.