Browsing by Subject "Depressive Disorder, Major"
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Item Change in Psychosocial Functioning during Cognitive therapy for Depression(2009-01-09) Dunn, Todd Wilson; Jarrett, Robin B.Major Depressive Disorder (MDD) is a highly prevalent and recurrent disorder that impairs peoples' work, relationships, and leisure activities. Cognitive Therapy (CT) improves this impairment in psychosocial functioning in adults with MDD, but questions remain as to how improvements occur both independently and in relation to depressive symptoms. To address this issue, the current study developed a theoretical framework based on social cognitive theory to conceptualize change in psychosocial functioning during CT and tested it with structural equation modeling. Using data from 470 patients undergoing acute-phase CT (A-CT) for MDD, results showed that: a) change in psychosocial functioning and depressive symptom severity occurred independently of each other, b) change in psychosocial functioning during the first month of A-CT partially mediated change in depressive symptom severity from treatment baseline to week seven of A-CT, and c) psychosocial functioning at week seven of A-CT significantly predicted subsequent depressive symptom severity. In terms of the theoretical framework, results suggested that when people with MDD were exposed to an environmental stimuli (i.e., acute-phase CT), change in their behavior (i.e., psychosocial functioning) partially mediated change in personal factors (i.e., depressive symptom severity) and not vice versa. By disentangling the sequence of change in psychosocial functioning and depressive symptom severity, this study pushed the field one step closer to understanding how A-CT treats the impairment in psychosocial functioning associated with MDD.Item Cognition and Suicide: The Relationship Between Problem-Solving and Suicidal Behavior(2009-01-14) Roaten, Kimberly Dayle; Claassen, CindySuicide represents a significant threat to a large number of individuals each year. This study sought to create an adult version of an adolescent suicide prediction instrument created by Orbach and colleagues (Subject Experience of Problem Irresolvability, 1999). An additional objective was to examine the relationship between the suicide attempters' experience of certain previously-researched interpersonal dynamics and lethality of suicide attempts. Eighty-three participants from a large, publicly-funded teaching hospital emergency department in Dallas completed a battery of questionnaires including a newly developed adult version of the SEPIA . Of the 83 participants, 42 individuals presented for psychiatric evaluation after a suicide attempt, and 41 patients presented for treatment of unintentional traumatic injury.. An independent samples t-test suggested that the SEPIA-A accurately discriminates between individuals who have attempted suicide and those who have not (t = 5.41, p = 0.00). In addition, analysis of the internal reliability of the SEPIA-A yielded a Cronbach's alpha of 0.97. Further analyses were conducted to refine and examine the items included on the newly constructed SEPIA. Finally, a significant positive correlation was noted between scores on the SEPIA-A and the BHS (r = 0.64). Overall, the results of the current study support further development of the SEPIA-A and provide encouraging results regarding its ability to distinguish between suicidal and non-suicidal individuals. The final step in the present study was the compilation of a revised version of the SEPIA, based on item-to-scale analyses, to be used in future studies examining the instrument's utility as a risk assessment measure.Item Does Depressive Severity Have an Immediate Effect on Therapeutic Distance at Mid-Acute Phase in Cognitive Therapy for Recurrent Major Depressive Disorder?(2011-02-01T19:33:39Z) Bowers, Alycia D.; Minhajuddin, AbuThe degree to which severity of depression predicted Therapeutic Distance (TD) was researched with 375 patients with recurrent Major Depressive Disorder who received Cognitive Therapy. Therapeutic Distance was calculated by subtracting Working Alliance Inventory-Form C (WAI-C) from Working Alliance Inventory-Form T (WAI-T). Therapeutic Distance of each of the three subscales of the WAI was also calculated in order to determine whether the severity of depression predicted TD in the Bond, Task, or Goal subscales. The extent to which the severity of depression had an effect on the TD from midpoint to endpoint of the study was determined. Furthermore, the severity of depression and response to treatment at the first blind evaluation was analyzed. Results suggested that depressive severity was not predictive of TD overall or of the three subscales. However, when looking at TD over time, it seems that TD task is significantly different from midpoint to endpoint of the acute phase CT. Additionally, it appears that regardless of the severity of depression, the working alliance was established rather quickly and remained fairly stable throughout the acute phase of the study.Item Exploring Mechanisms of Depression-Related Behavior and Rapid Antidepressant Action(2011-12-12) Autry, Anita Ellen; Monteggia, LisaMajor Depressive Disorder is a serious mental disorder with a profound disease burden, particularly in the United States. Intriguingly, this disease is almost twice as prevalent in females compared to males. Presently, antidepressant treatment for patients with Major Depressive Disorder requires chronic use and first-line treatment is often ineffective. The neurotrophic hypothesis of depression suggests that a) neurotrophins, in particular brain-derived neurotrophic factor, are necessary for maintaining normal mood states and that b) increases in neurotrophin signaling mediate therapeutic effects of clinical antidepressants. In the laboratory, we have explored aspects of the neurotrophic hypothesis of depression and made progress toward understanding the role of brain-derived neurotrophic factor in depression-related animal models as well as its role in the cellular mechanisms underlying antidepressant efficacy. First, we examined whether loss of brain-derived neurotrophic factor in forebrain neurons impacted susceptibility to chronic stress, an animal model of depression, in a gender-specific manner. Next we examined the contribution of dorsal raphe nucleus brain-derived neurotrophic factor signaling on traditional antidepressant efficacy. Finally, we uncovered a novel role for brain-derived neurotrophic factor in mediating effects of rapid antidepressant efficacy. In the course of my studies, we have found that brain-derived neurotrophic factor expression may be more important for protecting females from negative behavioral effects of chronic stress; that brain-derived neurotrophic factor receptor activation in dorsal raphe is essential for traditional antidepressant efficacy; and finally that brain-derived neurotrophic factor is required for the action of novel rapid antidepressant ketamine.Item Exploring Partner-Assisted Therapy (PAT) for Perinatal Depression: Are Partner Support and Non-Verbal Communications Associated with Women’s Treatment Response?(2013-01-17) Ceccotti, Nadia Laurence; Wiebe, Deborah, J. Ph.D.Background: Poor partner support is a risk factor for perinatal depression, a disease with adverse consequences for mother, baby, and partner. This pilot study explored changes in partner verbal/non-verbal supportive behaviors, including overt displays of emotional expression, during interactions between romantic partners and depressed perinatal women participating in Partner-Assisted Therapy (PAT). A novel approach for perinatal depression currently under investigation, PAT includes the partner of a depressed woman as an active participant in her treatment over eight acute sessions and one follow-up. This is the first study to date that investigates psychotherapeutic processes by analyzing the spontaneous display of support and positive affect in romantic partners during their engagement in psychotherapy sessions. Methods: Eleven couples (females between ³ 8 weeks pregnant and ² 12 weeks postpartum, diagnosed with Major Depressive Disorder) attended eight weekly psychotherapy sessions along with their partners. Two raters coded video recordings from sessions one, four and eight (acute phase). Partner support (positive helping behaviors) was coded using the Social Support Interaction Coding System, marital affect was coded using the Specific Affect Coding System, and warm touch by the male partner to his depressed spouse were recorded by frequency and duration of time. The associations between partner support and the change in the female partnerÕs symptoms of depression were then investigated. Results: Our hypothesis of the inverse correlation between partner support (an increase over time) and treatment outcome was partially supported. The hypotheses that warm touch and positive marital affect would increase over time were not supported in this sample. Conclusion: Findings suggest that an increase in partner support over time in treatment is partially associated with a decrease in female depressive symptoms. Future investigations with larger samples would support more confident interpretations and allow meaningful explorations into the processes of partner support and their implication for perinatal depression.Item Family Functioning in Adolescents with Major Depressive Disorder(2005-08-11) O'Malley, Ann Siobhan; Kennard, Beth D.Poor family functioning is common among children and adolescents with Major Depressive Disorder (MDD). Previous research suggests that depressed children describe their families as less cohesive, supportive, communicative, and as more conflictual than do their nondepressed peers. The present study examined the relationship between family functioning and severity of child/adolescent and parental depressive illness at baseline, whether the presence of healthier family functioning at baseline predicted a differential response to acute treatment with fluoxetine, and whether self-report measures were a better predictor of outcome than clinician or observer rated measures. The family functioning of 168 depressed children and adolescents (ages 8 to 17) and one or both parent(s), and treatment response from the 12-week acute treatment phase of an NIMH-funded study of discontinuation phase treatment for MDD were examined. At study entry and exit, information was collected about the severity of MDD, parental affective symptomatology, and self-reported, clinician reported, and observationally reported family functioning. Participants received 12 weeks of open treatment with fluoxetine, using flexible dosing (10mg-40mg) in order to maximize treatment response. Results indicate a robust treatment response for depressive symptoms across all participants, with an overall response rate of 77% and a remission rate of 66%. There were no significant differences in severity of depression and initial family functioning. Maternal depression was found to be significantly correlated or approaching significance for all five global measures of family functioning examined in this study (including self report, clinician report, and observational report). There were no significant associations found between family functioning at baseline and symptom improvement, although children/adolescents who responded early to treatment had reported significantly healthier family cohesion than late responders to treatment. There were no significant differences in outcome of depressive symptoms based on baseline family functioning. As parents rated their family's health competence functioning in the healthy direction, so did clinicians. Our findings suggest that it is very important to include families in the treatment process for depressed patients, including assessing and addressing parental psychopathology.Item The Impact of Trauma History on Acute Treatment Outcomes in Pediatric Major Depressive Disorder(2011-12-14) Mahoney, Jodi Rae; Kennard, Betsy D.The impact of childhood trauma on depression in youth was examined through a secondary analysis of pooled data from three studies of Major Depressive Disorder (MDD) in youth. A total of 292 children and adolescents ages 7 to 18 (53% male, 70% Caucasian, mean age = 12.83), received open treatment with fluoxetine for a period of 6 to 12 weeks. Youth were separated into three trauma history groups: no trauma, trauma—no abuse, and abuse. Associations between trauma history and demographic and clinical characteristics of depression were examined. The effects of trauma and abuse history on depression severity and remission rates following acute treatment with fluoxetine were explored using depression severity scores from the Children’s Depressive Rating Scale-Revised (CDRS-R) and remission status, defined as a score of ≤ 28 on CDRS-R and a Clinical Global Impressions (CGI) Improvement score of 1 or 2. Abuse history was associated with older age, older age of depression onset, longer length of illness, and suicidal ideation and behavior at baseline. Abuse history was also associated with some differences in initial depressive symptom profiles among children. The hypothesis that youth with a history of abuse would demonstrate lower remission rates at the end of acute treatment was partially supported. Odds ratios indicated that youth without a history of abuse were twice as likely to have remitted at the end of acute treatment when compared to those with no abuse history. This finding did not remain significant after controlling for the effects of age and family history of depression. No differences were found in depression severity across the acute phase of treatment based on trauma history. Additionally, trauma history was not associated with a difference in youth’s time to achieve remission. Results should be considered in context of small sample sizes and limited assessment of trauma in the current study. These results suggest the importance of thoroughly assessing for trauma history, especially abuse, and considering the impact of these events on youth’s depressive presentation and treatment needs.Item Improving Depressive Symptom Measurement in Adolescents: A Psychometric Evaluation of the Quick Inventory of Depressive Symptomatology, Adolescent Verison(2009-06-17) Haley, Charlotte Louise; Kennard, Beth D.Major depressive disorder (MDD) in children and adolescents is a common and debilitating psychiatric disorder. Current instruments used to identify the presence of and monitor the treatment of depression in adolescents vary in validity, reliability, appropriateness, cost and ease of administration, such that there is not yet an established instrument that meets all the needs of clinicians working with adolescents. The 16-item Quick Inventory of Depressive Symptomatology (QIDS16), developed and successfully validated as an accurate, brief and economical measure of depressive symptom severity in adults, has been modified to an adolescent version (QIDS-A17). Results from recent studies suggest that the QIDS-A17 may meet the need for a freely available, easy to administer, psychometrically-sound measure of core depressive symptoms for adolescents that can be used both as a screening tool and as a measure of symptom severity in both research studies and clinical practice. The current study aims to validate the QIDS-A17 instruments, including the self-report format (QIDS-A-SR), and two clinician-rated formats (QIDS-A-C[Adolescent] and QIDS-A-C[Composite]) in an adolescent outpatient population. The study included 103 outpatient adolescents ranging from 8 to 17 years of age. During a single visit, adolescents completed the QIDS-A-SR. A clinician completed the clinician-rated versions separately for adolescents (QIDS-A-C[Adolescent]) and parents (QIDS-A-C[Composite]) and the Children's Depression Rating Scale-Revised (CDRS-R). Classical Test Theory (CTT) analysis found all three QIDS-A17 measures to show strong internal consistency and correlate significantly to the CDRS-R, although the CDRS-R was the most reliable. Factor and parallel analysis found all four measures to be unidimensional. Item Response Theory (IRT) analysis found results that complemented the reliability results found in CTT. All four measures demonstrated diagnostic validity based on univariate and multivariate logistic regression, ANOVA, and MANOVA analyses. Scores on all four measures were equated to create conversion tables to facilitate translation of scores between tests. Although the three clinician-rated measures (CDRS-R, QIDS-A-C[Adolescent], QIDS-A-C[Composite]) were slightly more reliable than the QIDS-A-SR, the QIDS-A-SR demonstrated satisfactory reliability, validity, and discriminate utility such that it can be used effectively in settings that would benefit from a quick, valid, freely available self-report measure of depression in adolescents.Item Medication Adherence in Children and Adolescents With Major Depressive Disorder(2006-08-11) Sternweis, Kathryn VanArsdale; Hughes, CarrollMajor Depressive Disorder (MDD) is a serious psychiatric disorder in children and adolescents where antidepressant adherence remains an important issue. The present study uses electronic monitoring (Medication Event Monitoring System, APREX, Fremont, California [MEMS® caps]) to compare various methods of measuring adherence. Subjects who met the Diagnostic and Statistical Manual of Mental Disorders' (DSM-IV) criteria for MDD participated in a randomized controlled trial involving fluoxetine. A subset of patients had their medication adherence monitored for up to 12 weeks using MEMS caps, blood levels, self-report, medication diaries, physicians' estimates, and pill counts. Throughout the 12-week process, patients also completed a number of questionnaires assessing treatment expectancy, side effects, family functioning, school functioning, cognitive beliefs, depressive symptoms, and the identity of the individual(s) dispensing medication.Item Pattern Analysis of Response to Acute Fluoxetine Treatment in the Prediction of Relapse in Children and Adolescents(2008-09-12) Eggertsen, Ann Stevens Airy; Hughes, Carroll W.Major depressive disorder (MDD) is increasingly recognized as a common and serious affliction among children and adolescents. Antidepressant drug trials aimed at addressing the problem frequently encounter problems in establishing drug efficacy due to the prevalence of placebo effects that are especially prominent in this population, and likewise, placebo responding clouds clinical decisions regarding which patients will benefit from continuation treatment to prevent relapse. Using the method of pattern analysis, Quitkin and his colleagues (1984, 1987) have shown that in the acute treatment of depressed adults, true drug benefits are characterized by delayed and persistent improvement, whereas placebo effects tend to occur early and not persist. The present study extends this method to the pediatric population by examining the relationship between Quitkin response patterns during acute fluoxetine treatment and subsequent risk for relapse during randomized placebocontrolled continuation. A total of 168 children age 7 to 18 meeting DSM criteria for MDD first entered 12 weeks of acute treatment on open-label fluoxetine 10.40 mgs with frequent assessment. Using patient response patterns derived from sequential CGI improvement ratings during this period, patients were identified as either true drug or placebo pattern responders in the manner of Quitkin. After 12 weeks, 102 acute responders were randomized to 6 months of continuation treatment on fluoxetine or placebo and monitored for relapse. True drug responders showed an enhanced and very robust fluoxetine-placebo treatment effect (significantly fewer relapses on fluoxetine), whereas placebo pattern responders showed no significant treatment effect. Pattern analysis was also investigated in the larger, multivariate context of predicting risk for depressive relapse in young patients. Cox proportional hazards regression modeling showed continuation treatment and gender to be strong predictors, with the interaction of pattern X treatment falling just short of significance (p = .07). Overall results of this study suggest that pattern analysis can be useful in drug studies for pediatric depression and contribute to the prediction of relapse.Item Predictors and Correlates of Anxiety in Women Hospitalized With High-Risk Pregnancy(2007-08-08) Labat, Dana Broussard; Evans, H.M.Anxiety during pregnancy often negatively impacts a woman's perception of her pregnancy, as well as affects the development of the fetus and contributes to long-term negative sequelae during subsequent years post-delivery. Despite the increases in attention to the effects of anxiety in the perinatal literature, few studies utilize women with high-risk pregnancy as their population of study. These women would appear to be at a greater risk of experiencing anxiety because of the physical and psychological demands of their complicated pregnancies. Therefore, the current study attempted to determine the demographic and psychosocial correlates of anxiety in this unique population. This investigation also sought to improve significant methodological limitations found in previous published reports by employing a "gold standard" clinical diagnostic interview in addition to self-report measures of anxiety. Finally, this study examined the course of anxiety across hospitalization. From October 2005 to December 2006, 129 participants admitted to a high-risk antenatal unit participated in this investigation. Of those participants, 12% were diagnosed with an anxiety disorder. This prospective investigation revealed significant associations among anxiety symptoms and younger maternal age, lower education and income level, and Medicaid insurance status. Further multivariate analyses revealed that relationship maladjustment, greater number of and elevated perceived distress of stressful life events, and the consideration of termination were also significantly associated with the presence of anxiety symptoms. Logistic regression analyses determined that endorsed depressive symptoms predicted more than a one-and-a-half time's likelihood of increased anxiety symptoms. These findings show that anxiety symptoms are present in women hospitalized with high-risk pregnancy and directly impact the experience of pregnancy. These results demonstrate that identifying potential risk factors of anxiety through routine screenings at initial admission could lead to the development of hospital-based short-term interventions aimed at preventing negative antenatal and postpartum outcomes.Item Predictors of Depression in a High-Risk Hospitalized Pregnancy Population: A Prospective Longitudinal Study(2007-08-08) Miltenberger, Paula Dianne; Evans, H.M.Research is beginning to elucidate the prevalence and effects of antenatal depression on the mother and fetus. However, relatively little focus has been paid to the woman diagnosed with a high-risk pregnancy requiring hospitalization. The present study investigated the predictors and trajectory of depression in women hospitalized on an antepartum unit. The sample consisted of 129 who were hospitalized due to complications during pregnancy. At admission, the women completed self-report measures to assess depressive symptoms, life events as well as personality. Women who exceeded set thresholds on depressive measures were administered a structural clinical interview to assess for a formal diagnosis of Major Depressive Disorder. Additionally, women's depressive symptoms were assessed weekly across hospitalization until discharge. Forty-four percent of the sample exceeded set threshold at admission, indicating they were experiencing high levels of depressive symptoms. Logistic regression was used to determine predictors of group status at admission, based on depressive measures. Results indicated that only life events were predictive of those women exceeding set thresholds. Furthermore, consideration of pregnancy termination and prior psychiatric diagnosis were predictive of Major Depressive Disorder. Growth curve modeling was used to identify trajectory and changes in depressive symptoms over the course of hospitalization. The results indicated that most women experienced a decrease in symptoms over time. In measuring personality, the Depressive Experiences Questionnaire (Blatt, D'Affliti, & Quinlan, 1976) was used to determine if women characterized as self-critical would report more depression during pregnancy than women characterized as dependent. No significant differences were found between the personality scales and depression severity. However, those women who were high on both self-criticism and dependency had the highest scores on the depressive measures. These results suggests that women who score high on both self-criticism and dependency scales appear to be the most vulnerable to depressive symptoms during the antepartum period.Item Referral Source as a Predictor of Treatment outcomes in Children and Adolescents with Major Depressive Disorder(2009-09-04) White, Heather Hayes; Kennard, Beth D.Information was obtained from two previously conducted studies of children and adolescents with major depressive disorder (Emslie et al., 2008; Kennard et al., 2008). Study participants were referred from advertisements, clinician or school counselors, and other sources. To date, two studies have examined referral source as a predictor of treatment outcome in youth with MDD, each yielding a different result. Thus, the purpose of the current study was to determine whether referral source is a predictor of treatment outcome in children and adolescents with major depressive disorder. Characteristics of acute study participants including age, gender, ethnicity, severity and duration of illness, suicidal behaviors, and number of comorbid diagnoses were compared between participants from differing referral sources. The findings of this study suggest that referral source is not a predictor of treatment outcome in children and adolescents with major depressive disorder.Item Residual Symptoms in Pediatric Depression after Acute Pharmacological Treatment(2006-08-11) Sowell, Morgan Michelle; Kennard, BethChildren and adolescents with major depressive disorder (MDD) are at an increased risk for school failure, school drop out, and suicidality. Childhood onset of MDD has been linked to an increased likelihood of relapse of MDD in child and adolescent research. Adult studies have found that residual symptoms increase the risk of relapse, and shorten the time to onset of relapse. This study sought to confirm the presence of residual symptoms in children and adolescents after successful treatment with antidepressant medication. An additional objective was to identify predictors of remission in those who have an adequate response to treatment. The participants (N=315) are from a combined data set of two separate studies conducted by Graham J. Emslie investigating the efficacy of fluoxetine 20 mg/day for 8 weeks in children and adolescents with non-psychotic depression. Evaluating the patients using the more stringent criteria of remission in responders, showed that 64% of fluoxetine treated patients, and 56% of placebo treated patients successfully achieved remission. In this subgroup of responders, dysthymic disorder and CDRS-R total baseline score were found to be predictive of responders who remit. Residual symptoms were found to be present in both the fluoxetine and placebo treatment group responders in high frequency. Finally, using the CDRS-R individual item scores of ≥3, fourteen different types of residual symptoms where found for the 86 fluoxetine responders, and eleven different types of residual symptoms were found for the 57 placebo responders.Item Suicidal Ideation in Youth with Depression(2010-11-02T18:20:32Z) Hughes, Jennifer Lynn; Kennard, Betsy D.Suicide is the third leading cause of death in youth ages10 to 24 (Centers for Disease Control, 2007). Frequent thoughts of suicide are a strong predictor of suicide attempt (Kienhorst, de Wilde, Van den Bout, Diekstra, & Wolters, 1990), and most suicide attempters report a history of suicidal ideation (Lewinsohn, Rohde, & Seeley, 1996). Although suicidal ideation does not always intensify into suicidal behavior, a better understanding of suicidal ideation may lead to a greater understanding of suicidal behavior (Reuter, Holm, McGeorge, & Conger, 2008). It has been suggested that suicidality can be conceptualized as a spectrum, ranging from passive thoughts of death to death by suicide (Bridge, Goldstein, & Brent, 2006). Mood disorders, including MDD, are the most common in suicide attempters and those who die by suicide (Bridge et al., 2006; Kelly, Cornelius, & Lynch, 2002; Weissman et al., 1999), and hopelessness has consistently been implicated as being related to attempted suicide and death by suicide (Goldston et al., 2001; Lewinsohn, Rohde, & Seeley, 1994; Shaffer et al., 1996). As up to 85% of adolescents with major depressive disorder (MDD) or dysthymia report experiencing suicidal ideation (Kovacs, Goldston, & Gatsonis, 1993), the co-occurrence of depression and suicidal ideation is high. Therefore, it is important that interventions for depressed youth include strategies to manage suicidal ideation and behavior. In addition, it is important for clinicians to have an awareness of how higher levels of suicidal ideation might affect treatment in depressed youth. Thus, a better understanding of the course of suicidal ideation and behavior during early treatment and a better understanding of how depression treatment affect suicidality have important public health implications.