Department of General Practice and Community Medicine, Section for General Practice, University of Oslo, Blindern, Oslo, Norway. o.r.haavet@medisin.uio.no
The aim of this study is to examine the possible changes in depressive symptoms related to various adverse experiences, based on a three-year follow-up among adolescents.
All 10(th) graders invited to enter the youth section of the Oslo Health Study 2001 (n = 3,811) constituted a baseline of a longitudinal study. A high level of mental distress (Hscl-10 score = 1.85) according to the different life experiences was compared, at baseline (15 years) and follow-up (18 years).
All adverse experiences were associated with a high Hscl-10 score except parents not living together and death of a close person at 15 and 18 years for boys, and death of a close person at 18 years of age for girls. A development from high Hscl-10 score at baseline to low score at follow up was defined as recovery from mental distress. The proportion of the youth that had a high Hscl-10 score related to reporting adverse life experiences at age 15, followed by a low Hscl-10 score three years later proved to be between 44% and 89% among boys and between 16% and 31% among girls.
From a three year longitudinal perspective the recovery from mental distress is substantial and higher among boys than among girls. However, mental distress seems to persist in a considerable proportion of the adolescents. Consequently, it is insufficient to brush aside traumas and hurt and rely on a time healing process only.
Depression is a major concern for public health. Both adverse working conditions and low socio-economic position are suspected to increase risk of depression. In a representative sample of the Danish workforce we investigated (i) whether adverse psychosocial working conditions, defined by the effort-reward imbalance (ERI) model, predicted onset of severe depressive symptoms after 5-year follow-up and (ii) whether the effect of ERI was differential across occupational grades.
A cohort of 2701 Danish employees filled in a questionnaire on work and health in 2000 and 2005. ERI was measured with four effort and seven reward items. Depressive symptoms were assessed with the five-item Mental Health Inventory. Participants scoring = 52 points were defined as cases. We used logistic regression to investigate the association of ERI and occupational grade in 2000 with onset of severe depressive symptoms in 2005. Analyses were adjusted for socio-demographics, health behaviours, survey method, self-rated health, sleep disturbances and non-severe depressive symptoms at baseline.
High ERI predicted onset of severe depressive symptoms at follow-up, after adjustment for co-variates and occupational grade (OR = 2.19, 95% CI = 1.12-4.25). Participants with high ERI and low occupational grade showed a considerably higher OR (2.43, 95% CI = 1.07-5.53) compared to participants with low/medium ERI and low grade (OR = 1.45, 95% CI = 0.72-2.92), high ERI and high grade (OR = 1.26, 95% CI = 0.59-2.70) and low/medium ERI and high grade (reference group).
Adverse psychosocial working conditions predicted onset of severe depressive symptoms. The effect was stronger among employees of lower occupational grades compared to those of higher grades.
Objective of the study were: to specify the features of clinical presentations and dynamics of anorexia nervosa (AN) developed in adolescence during the current depression; to study affective disorders preceding the onset of AN and to analyze comorbidity of these two pathologies. We examined 21 female patients, aged from 15 to 17 years old (mean age 16.7 ± 0.8 years). It was shown that depressive symptoms developed 4-11 months (mean 7.9 ± 2.5 months) before the onset of AN. The development of AN was associated with depression and might be considered as one of mechanisms of formation of eating disorders that might be termed as affective mechanism. Thus, we can specify a variant of adolescent/juvenile depression, or depression with eating disorders. The variant represents a protracted depressive state with overvalued ideas to improve body image and to restrict calories which is combined with adynamic affect associated with anxiety, melancholy and dysphoria.
The aim of this study was to investigate factors associated with alexithymia in patients (n=153) with coronary heart disease (CHD) verified by coronary angiography.
Self-rated depression was assessed using 21-item Beck Depression Inventory (BDI) and other psychiatric symptoms with Symptom Check List-90 (SCL-90). Life satisfaction was assessed using a separate scale. The Structured Clinical Interview (SCID I and II) for DSM-III-R was used to identify mental disorders. Assessments took place 1 day before angiography.
Twenty-one percent of CHD patients (n=32) were assessed as being alexithymic according to the Toronto Alexithymia Scale (TAS-20). Alexithymics were more often blue-collar workers, incapable of working, dissatisfied with life, and depressed than the other CHD patients. Occurrences of mental disorders were not associated with alexithymia. Logistic regression analysis revealed that factors independently associated with alexithymia were currently or previously being a blue-collar worker (adjusted odds ratio, AOR: 4.8), self-rated depression (AOR: 3.2), and dissatisfaction with life (AOR: 2.9).
In CHD patients alexithymia was unrelated to cardiovascular risk factors or exercise capacity but was related to self-rated depression and decreased life satisfaction. Alexithymia is associated with the enhanced psychosocial burden of suffering CHD. This patient group may need more individual support and attention than other CHD patients.
Firstly, to investigate the association between depression, anxiety and urinary incontinence (UI) in a 10-year longitudinal study of women. Secondly, to investigate the association between possible differences in the stress- and urgency components of UI and different severities of depression and anxiety by age groups.
In a longitudinal, population-based survey study, the EPINCONT part of the HUNT study in Norway, we analyzed questionnaire data on UI, depression and anxiety from 16,263 women from 20 years of age. A multivariate logistic regression model was used to predict the odds of developing anxiety and depression among the women with and without UI at baseline and the odds of developing UI among the women with and without anxiety or depression at baseline.
For women with any UI at baseline we found an association with the incidence of depression and anxiety symptoms, OR 1.45 (1.23-1.72) and 1.26 (1.8-1.47) for mild depression and anxiety respectively. For women with depression or anxiety symptoms at baseline we found an association with the incidence of any UI with OR 2.09 (1.55-2.83) and 1.65 (1.34-2.03) for moderate/severe symptom-score for depression and anxiety, respectively, for the whole sample.
Health Surveillance and Epidemiology Division, Public Health Agency of Canada, 200 Eglantine Driveway, Ottawa, Ontario, Canada. Lil.Tonmyr@phac-aspc.gc.ca
To examine five types of child maltreatment and other risk correlates to establish associations with anxiety and/or depression confirmed or suspected in children investigated by child welfare services.
The present study used the data of a subsample of 10-15-year-olds (n = 4,381) investigated by child welfare services across Canada obtained from the Canadian Incidence Study of Reported Child Abuse and Neglect-2003. The analysis took into account the nested structure of the data by considering the variability existing among families and the clustering of siblings within them. Several models were analyzed for the construction of the presented hierarchical model. Striving for parsimony, we included only statistically significant variables in the final model.
The strongest associations were found with child substance abuse, substantiated emotional maltreatment, primary caregiver's mental health problems, and substantiated sexual abuse. Among the child maltreatment variables, substantiated physical abuse and substantiated exposure to domestic violence did not show any statistically significant associations with anxiety and/or depression in the model.
This analysis helped us in understanding child maltreatment and other adverse experiences in childhood that were related to anxiety and/or depression, which can further aid in the development of mental health and child welfare policies and programs.
Aim of the study was determination of factors of social desadaptation, which negatively affect psychoemotional status and quality of life of elderly patients with chronic heart failure (CHF). We included into the study 248 patients aged 60-85 years and 82 patients aged 39-59 years with NYHA class II-IV CHF. General state of patients we assessed with the help of clinical state assessment scale (CSAS), presence and severity of anxiety and depression -with hospital anxiety and depression scale, exercise tolerance - with 6 minute walk test. Patients of both groups were comparable by sex, severity of the CHF course quality of life, concomitant pathology, and treatment. Clinically manifest depression was found in 22.8% of patients aged 60 years and older and in 16% of patients younger than 60 years (p=0.460), clinically manifest anxiety was found in 22.8% and 20%, respectively (p=0.945). Risk factors of anxiety-depressive state in elderly patients were disability (relative risk [RR] 3.05, 95% confidence interval [CI] 1.04-8.97, p =0.042), insufficient education (RR 2.44, 95%CI 1.08-5.34; p=0.0320, and severe CHF according to CSAS (OR 1.22, 95%CI 1.07-1.4; p=0.003). According to data of multifactorial analysis disability (RR 1.78, 95%CI 1.01-3.13; p=0.045) and severe CHF (RR 1.17, 95%CI 1.07-1.27; p=0.001) were independently related to anxiety-depressive state in elderly patients.
Thus social dysadaptation and medical factors turned out to be leading parameters determining worsening of quality of life and development of anxiety-depressive state in elderly patients with CHF.
The authors objectively evaluated the presence of anxious depressive conditions in patients with gastroesophageal reflux disease (GERD) and studied associations between them and the clinical picture of the disease. Ninety-one patients with GERD were examined. The diagnosis was based on clinical and anamnestic data as well as the results of esophagogastroduodenoscopy and rabeprazole test. Gastrointestinal Symptom Rating Scale (GSRS) was used to assess the severity of GERD symptoms and quality of life. Beck Scale was applied to assess the level of depression. Spielberg test was used to assess reactive and personal anxiety. The psychological status of GERD patients was studied before the beginning of the treatment. Tests and questionnaires were filled by patients on their own. Spielberg test and Beck Scale revealed a high prevalence of psychopathic syndromes among GERD patients. Forty-three per cent of patients had anxious syndrome, while 57% of patients suffered from anxious depressive syndrome; the anxiety level and depression level were clinically significant in 70% of cases and in 23%, respectively. The presence of a direct correlation between the severity of the psychopathological syndromes (according to Spielberg test and Beck Scale) and GSRS data demonstrate that anxiety and depression intensify GERD symptoms and lower the quality of life of these patients. There is no doubt that concomitant anxious and anxious-depressive disturbances need psychotherapeutic and drug correction. Tranquilizers have the priority in neurotic anxious disturbances. In some situations antidepressants are indicated to treat a combination of anxious disturbances and depressive ones.
