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Background Adolescent depression can severely interfere with age-appropriate and lifetime development and functionality. Physical functioning in daily life (as a means of individual support) as well as social support from family and friends have been shown to enhance adolescent resilience against depression. By applying a multisystemic model of resilience, this study investigates how these resources reciprocally influence each other and how they interact with depression over time. Methods Longitudinal data (three assessments over three years) from the Resilient Youth in Stressed Environments project was analyzed using panel network analysis to investigate short- and long-term uni- and bidirectional effects. The sample consisted of N = 500 adolescents from Canada (mean age = 18.49, SD = 3.01, 56.40% young women) at the first assessment. Results Depression seemed to fluctuate, while the resources showed significant stability over the course of the study. Perceived family and friend support were not significantly influenced by depression while they had significantly negative temporal effects on depression. Only physical functioning showed a negative feedback loop, notably with somatic symptoms of depression. Family and friend support shared a reinforcing feedback loop, while physical functioning was not related to either type of support. Limitations Future studies should address the low average of depressive symptomatology and subjective, global measures of social support. Conclusions The resources show potential time-dependent effects: symptom-specific resources need to be applied in the short-term, while a pool of multisystemic resilience resources seems necessary over the long-term to increase the resilience to depression among adolescents.

BACKGROUND: Disturbed sleep is a core symptom of major depressive disorder (MDD), with nearly 90% of those with MDD reporting disturbed sleep. However, combining insomnia and hypersomnia into a single diagnostic domain ignores distinct biological differences between those symptom presentations. To better understand depression it may be necessary to explore these symptoms independently, beginning with the more prevalent insomnia. METHOD: The present study evaluated global insomnia symptom severity in a broad sample of MDD outpatients from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, excluding patients who reported hypersomnia symptoms. The three insomnia-related symptoms from the 16-item Quick Inventory of Depressive Symptomatology- clinician rated (QIDS-C) were combined to create a global insomnia score to classify baseline insomnia severity. A modified depression severity score was then used to assess depression severity (mQIDS-C), excluding sleep-related items. RESULTS: A repeated measures ANCOVA revealed a significant improvement in insomnia score over the acute phase treatment (F = 33.1, d.f. = 6, 9897, p < 0.0001). Improvement in insomnia score over the acute phase treatment remained statistically significant even after controlling for change in depression severity (p = 0.0004). Participants with one point higher insomnia score at baseline were significantly less likely to remit at study exit (odds ratio = 0.88, 95% confidence interval = 0.85, 0.92, p < 0.0001) even after controlling for baseline depression severity. LIMITATIONS: Objective confirmation of sleep profiles was not available. CONCLUSION: Greater severity of insomnia reduces likelihood of MDD remission, and insomnia symptoms improved independent of depression remission.

Background: Metabolic syndrome (MetS) has been associated with both early- and late-life depression. This study investigated whether baseline MetS and its individual components are associated with the course of depression over six years among older persons with a formal depression diagnosis.Methods: Data were used from 378 older persons with a depressive disorder from the Netherlands Study of Depression in Old age (NESDO) with a 6-year follow-up. A formal depression diagnosis according to DSM-IV-TR criteria was ascertained with the Composite International Diagnostic Interview. Severity of depressive symptoms was assessed with the Inventory of Depressive Symptomatology at 6-month intervals. Metabolic syndrome (MetS) was defined according the modified National Cholesterol Education Programme - Adult Treatment Panel III criteria. Primary outcome was time to remission from depression. We applied cox regression analysis for the primary outcome and linear mixed models for secondary analyses.Results: Neither MetS nor its individual components were associated with time to remission from depression (MetS: HR = 1.03; 95% CI = 0.74 - 1.44; p = 0.85), or with depression severity (MetS: B = 0.02; SE = 0.04; p = 0.64) and course of depressive symptoms (MetS: B = -0.01; SE = 0.01; p = 0.23) over 6-years follow-up.Limitations: Attrition was relatively high (46.8%). Furthermore, we only had information on formal depression diagnosis at baseline, 2-year, and 6-year follow-up.Conclusions: We found no evidence for an effect of baseline presence of metabolic dysregulation on the course of formally diagnosed depression in older persons. Metabolic syndrome in depressed patients should be clinically monitored for other reasons than predicting chronicity or severity of depression.

Obesity is one of the most prevalent somatic comorbidities of Major Depressive Disorder (MDD). We aimed to investigate the relationship between body mass index (BMI) and MDD, the symptomatology of the disorder as well as the outcome of antidepressant treatment.Early medication change (EMC) trial participants with BMI measurement (n = 811) were categorized according to WHO-criteria in normal or low weight (BMI 25), overweight (25- 30), and obese (≥30). Depression severity and BMI was assessed in weekly intervals up to 8 weeks. BMI at baseline and course of BMI during the study were investigated in linear regression models as possible moderators of therapy response. Possible moderators such as plasma concentrations of applied drugs, sex, comorbidities or age were controlled.388 (48%) patients showed normal weight, 251 (31%) were overweight and 172 (21%) obese. Linear regression analyses revealed an association between BMI and antidepressant therapy outcome: Overweight patients showed the best response to antidepressant treatment. BMI at baseline was significantly correlated with improvement in neurovegetative and cognitive symptoms of depression. Furthermore, weight gain during the study was associated with better therapy response, independent of symptom complex. Other moderators including serum concentrations of drugs were not able to explain the differences between the BMI groups.Secondary exploratory analysis. No investigation of visceral fat.We showed for the first time that patients with higher initial increase in BMI showed larger decrease in depression severity during study. The underlying mechanisms are unclear and require further investigation.

Background: The study explores the association between pain and functional impairment in patients with partially remitted MDD, considering both clinician and patient reported outcomes. Methods: Multicenter, observational, and cross-sectional study, with 583 outpatients with partially remitted MDD. Measures of pain intensity (VAS), functional impairment (SOFAS), depressive symptomatology (HAM-D6), and remission from MDD and functional status from a patient-centered perspective (RDQ) were collected. VAS scores (cut-off: 30) were used to divide the sample in two groups: no pain (n = 274) and pain (n = 309). Descriptive data, correlation and regression analyses were obtained. Results: Functional impairment (SOFAS) and pain (VAS) were negatively and significantly correlated in the total sample, and in the group with pain. Lower pain predicted higher functioning. The pain sub-sample was older, less educated, with higher medical comorbidities, higher HAM-D6 scores, and lower functionality (SOFAS). In the RDQ, the pain group showed significantly higher scores in the symptom-related subscales, and lower scores in the subscales related to positive mental health, functioning and wellbeing. Limitations: Correlational and observational design. The criteria and instruments used to measure pain and to define a threshold might limit the generalizability of findings. Conclusions: Pain and functionality should be assessed and treated in patients with MDD in partial remission. Our results indicate that functionality should be assessed with a broader perspective, that also considers positive mental health features.

Background Placebo-controlled clinical trials are the standard in the design of clinical studies for the licensing of new drugs. Medical and ethical concerns regarding placebo use still exist in clinical trials of depressed patients. The aim of this study was to investigate the attitudes toward placebo-controlled clinical trials and to assess factors related to the willingness to participate in such trials among depressed patients in Japan. Methods A total of 206 depressed patients aged 49.5 ± 15.7 years (mean ± SD) who were admitted to three psychiatric hospitals were recruited for a cross-sectional study from June 2015 to March 2016. After a thorough explanation of the placebo, the study participants completed a brief 14-item questionnaire developed to evaluate patients' attitudes regarding possible participation in placebo-controlled clinical trials. The Quick Inventory of Depressive Symptomatology was also administered to assess depressive symptoms. Results The results indicated that 47% of the patients would be willing to participate in a placebo-controlled clinical trial. Expectations for the improvement of disease, desire to receive more medical care, encouragement by family or friends, and desire to support the development of new drugs were associated with the willingness to participate in such trials, whereas a belief that additional time would be required for medical examinations and fear of exacerbation of symptoms due to placebo use were associated with non-participation. Limitations Patients were asked about possible participation in placebo-controlled clinical trials. Conclusions Less than half of the respondents were willing to participate in placebo-controlled clinical trials. Attitudes toward participation in a placebo-controlled clinical trial need to be considered when deciding whether to conduct such a trial.

Developing accurate and time-efficient tools to measure depressive symptoms in schizophrenia is important for research and clinical practice. This study tested the psychometric properties of the Chinese version of the 16-item Quick Inventory of Depressive Symptomatology (QIDS-SR) in depressed schizophrenia patients.This study included 337 clinically stable patients with schizophrenia. The severity of depressive symptoms was assessed using the Montgomery-Asberg Depression Rating Scale (MADRS), QIDS-SR at baseline and 2 weeks later. Negative symptoms and extrapyramidal symptoms were measured with the negative symptom score of Brief Psychiatric Rating Scale (BPRS) and the Simpson-Angus Scale of Extrapyramidal Symptoms (SAS), respectively.Internal consistency (Cronbach׳s alpha) was 0.73 and 0.67 for QIDS-SR at the baseline and endpoint, respectively. The intra-class correlation coefficient (ICC) for test-retest reliability over the two weeks was 0.77. Two domains (involvement and energy) at baseline and one domain (energy) at endpoint had the highest item-total correlations. The QIDS-SR total score was significantly correlated with the MADRS total score at baseline (r=0.44, p0.01). Weak correlations of the QIDS-SR score with the scores of the BPRS negative (r=0.18) and the SAS (r=0.05) indicate good discriminant validity. The QIDS-SR showed unidimensional measurement properties in exploratory factor analysis at both baseline. The main limitation of the study is that only clinically stable schizophrenia patients were included.The QIDS-SR has acceptable psychometric properties in stable schizophrenia patients and may be useful in both research and clinical practice.

Background: Few rigorous studies have examined the factor structure of major depression symptoms as assessed by current diagnostic systems. This study evaluated four competing models of depressive symptomatology among a large, heterogeneous sample of U.S. veterans. Methods: To determine the best fitting model of major depressive symptoms among four competing models, this study conducted a series of confirmatory factor analyses on a national sample of 986,647 U.S. veterans. Results: A two-factor model first reported by Krause, Reed, and McArdle (2010) provided superior fi tt o symptom-level data compared to three other models. The optimal model consists of a somatic factor including anhedonia, sleep difficulties, fatigue, appetite changes, concentration difficulties, and psychomotor agitation; and a non-somatic factor including depressed mood, feelings of worthlessness, and thoughts of death. Factorial invariance testing found this model to be invariant by gender and major depression diagnosis. Limitations: A widely used self-report measure of depression was used and the sample consisted solely of veterans so further study is needed with clinician-administered measures and non-veteran samples. Conclusions: Together, these findings support separating symptoms of major depression into somatic and non-somatic factors which may have clinical relevance, and help clarify debates about the factor structure of depressive symptoms. Published by Elsevier B.V.

Background: Traditionally, assessment of psychiatric symptoms has been relying on their retrospective report to a trained interviewer. The emergence of smartphones facilitates passive sensor-based monitoring and active real-time monitoring through time-stamped prompts; however there are few validated self-report measures designed for this purpose.Methods: We introduce a novel, compact questionnaire, Mood Zoom (MZ), embedded in a customised smart-phone application. MZ asks participants to rate anxiety, elation, sadness, anger, irritability and energy on a 7-point Likert scale. For comparison, we used four standard clinical questionnaires administered to participants weekly to quantify mania (ASRM), depression (QIDS), anxiety (GAD-7), and quality of life (EQ-5D). We monitored 48 Bipolar Disorder (BD), 31 Borderline Personality Disorders (BPD) and 51 Healthy control (HC) participants to study longitudinal (median +/- iqr: 313 +/- 194 days) variation and differences of mood traits by exploring the data using diverse time-series tools.Results: MZ correlated well (vertical bar R vertical bar>0. 5, p 0. 3, p Limitations: All reported scores rely on self-assessment; there is a lack of ongoing clinical assessment by experts to validate the findings.Conclusions: MZ could be used for efficient, long-term, effective daily monitoring of mood instability in clinical psychiatric practice. (C) 2016 The Authors. Published by Elsevier B.V.

We aimed to investigate the association between depressive symptoms and various male sexual functions, and to identify which depressive symptoms are most predictive of erectile dysfunction (ED).This was an analytic cross-sectional study with 160 sexually active men aged 50 or above recruited from a large primary care treatment centre. The 5 domains (erectile function, EF; intercourse satisfaction, IS; orgasmic function, OF; sexual desire, SD; overall satisfaction, OS) of the International Index of Erectile Function (IIEF-15) were used to assess various sexual functions. Depressive symptomatology was measured by Geriatric Depression Scale and reconfirmed with General Health Questionnaire.The level of depressive symptoms was negatively associated with erectile function (p0.01), orgasmic function (p=0.02), intercourse satisfaction (p=0.04) and overall satisfaction (p0.01), and was independent of age, education and number of health conditions, but was not associated with sexual desire (p=0.97). Erectile dysfunction was significantly associated with age (OR=1.12; 95% CI 1.05-1.19; p0.01) and level of depressive symptoms (OR=1.39; 95% CI 1.05-1.85; p=0.02) after multivariate adjustment. In particular, only "low mood" (p=0.03) and "worthlessness" (p=0.03) remained positively associated with ED after multivariate adjustments.Cross-sectional design cannot demonstrate direction of causality.We are the first to implicate "low mood" and "worthlessness" in the association between depressive symptoms and ED, and this is the first study to investigate the association in Chinese.

Background This study investigates whether cognitive impairment is evident in inpatients diagnosed with Major Depression (MD) following electro-convulsive therapy (ECT), and if so, whether it is independent from depressive symptomatology. Methods Speed of information processing was measured using the inspection time (IT) task. IT was compared between twelve inpatients diagnosed with MD receiving ECT and twelve age-, gender-, verbal IQ-, and depression and anxiety severity matched control inpatients diagnosed with MD not receiving ECT, over four testing sessions (prior to ECT, following one ECT session, following the completion of an ECT block, and 4 to 6 weeks after the ECT block (follow-up)). Results The mean IT score for the inpatients diagnosed with MD who received ECT slowed significantly from the first ECT to immediately after the ECT block, and was significantly faster at follow-up. The mean IT score of the inpatients diagnosed with MD not receiving ECT gradually but significantly became faster over the entire equivalent time period. Limitations Small sample sizes. Conclusions ECT temporarily slows information processing speed in MD patients, independent of depression symptomatology.

Few studies have investigated the relationship between structural brain abnormalities and dimensions of depressive symptomatology.In the current study, we examined the relationship between cortical structural abnormalities and specific behavioral dimensions relevant to depression in a sample of unmedicated patients with major depressive disorder (MDD, n=57) and demographically similar healthy control volunteers (HC, n=29). All subjects underwent diagnostic assessment with the SCID, MRI at 3T, and dimensional assessments using the visual analog scales (VAS). Cortical regions were extracted for each subject, and group comparisons of cortical volume (CV), surface area (SA), and cortical thickness (CT) were performed controlling for multiple comparisons using a bootstrapping technique. Regions demonstrating group differences were analyzed for correlation with specific dimensions assessments.As compared with HC, MDD subjects exhibited reduced CV within the left supramarginal gyrus, right ventrolateral prefrontal cortex (VLPFC), entorhinal cortex, parahippocampal gyrus, fusiform gyrus and pericalcarine; reduced SA in the right VLPFC, cuneus, and left temporal pole; and reduced CT in the right rostral anterior cingulate cortex (rACC) (all p's0.05, corrected). The largest effect occurred within the right VLPFC for CV and SA (MDDHC; effect sizes: 0.60). CV in the right VLPFC inversely correlated with sadness, fatigue and worry; CT in the right rACC inversely correlated with irritability and fatigue.Future studies will be required to further map the anatomical changes in depression to behavioral dimensions.Our results indicate that specific cortical abnormalities are associated with specific behavioral components linked to depression.

Background The relationship between tobacco and depressive symptoms has been examined. However, there is little information on the evolution of these symptoms when an individual quits. The aim of this study was to analyze the evolution of depressive symptoms over time (pre-, post-treatment, 1-, 3-, 6-, and 12-months follow-up) in relation to smoking status 12 months after having received a psychological treatment for smoking cessation. Method The sample was made up of 242 adults who received cognitive-behavioral treatment for smoking cessation (64.4% women; mean age=41.71 years). The BDI-II was used to assess depressive symptomatology. Participants were classified into three groups according to smoking status at 12-months follow-up (abstainers, relapsers, and smokers). Results There were no significant differences in depressive symptoms among the three groups at pretreatment. At the end of treatment, abstainers and relapsers presented less depressive symptomatology than smokers. At follow-up, abstainers continued to present less depressive symptomatology than smokers, whereas in relapsers, symptoms began to increase as the relapses occurred. Regarding the evolution of depressive symptomatology, the abstainer and relapser groups showed a significant reduction at the end of treatment. Only in the group of abstainers did the decrease continue during 12 months follow-up. Limitations The decrease of the initial sample size from 562 to 242 participants. Variables such as self-esteem and self-efficacy were not assessed. Conclusions Smoking cessation is associated with a decrease in depressive symptomatology, that is maintained over time. In contrast, relapse is associated with an increase of such symptoms. These findings signify the potential importance of addressing depressive symptomatology in smoking cessation treatment.

Despite a substantial association between professional burnout and depression, the exact nature of the relationship is unclear. It is hypothesized that an underlying susceptibility for depression is associated with an enhanced risk for professional burnout. In the present study, the relationship was examined between indices of personal and familial history of depression and current symptoms of burnout.Respondents were 3385 employees of different work settings (61% female, age 18-65 years), who completed questionnaires regarding demographic variables, working hours, personal and familial history of depression, current depressive symptomatology, and current symptoms of professional burnout.After controlling for background variables, the strongest predictor of all three burnout facets was current depressive symptomatology. Independent of the effects of background variables and current depressive symptoms, having ever experienced a depressive episode further predicted current symptoms of two burnout facets: emotional exhaustion (OR=1.82, 95% CI=1.38-2.40, P0.001) and cynicism (OR=1.51, 95% CI=1.16-1.98, P=0.002). In addition, a history of depression in close family members independently predicted current symptoms of emotional exhaustion (OR=1.63, 95% CI=1.27-2.10, P0.001), while a trend appeared for a similar effect on cynicism (OR=1.23, 95% CI=0.96-1.58, P=0.095).The study is based on a cross-sectional retrospective design.A predisposition for depression, as reflected by a personal and familial history of depression, may enhance the risk for burnout.

Background: This study evaluated stability and change in the level of maternal depressive symptomatology over the course of the first postpartum year in a community cohort of 106 first-time mothers of full-term, healthy infants. Effects of diagnosed depression and infant gender were also assessed. Methods: At 2 months postpartum (intake), mothers were classified into one of two symptom groups on the basis of their total score on the Center for Epidemiological Studies–Depression Scale (CES-D): high (CES-D score ≥16, 46%) or normative (CES-D score=2–12, 54%). Mothers completed the CES-D again at 3, 6, and 12 months postpartum. At 12 months, maternal diagnostic status for major depression and related disorders was evaluated using the Diagnostic Interview Schedule-III–Revised. Results: Mothers in the High symptom group at intake continued to have significantly higher CES-D scores at 3, 6, and 12 months than mothers in the Normative symptom group at intake, and a third in the High symptom group at intake had a subsequent CES-D score above the clinical cutoff (≥16). Maternal CES-D scores were significantly correlated across visits. In regressions controlling for diagnostic status and infant gender, mothers’ CES-D score at the most recent prior assessment contributed significant unique variance to mothers’ CES-D score at each subsequent assessment. CES-D scores were higher at 3 months if mothers had diagnosed depression and were parenting a son, and higher at 12 months if mothers had both diagnosed depression and a prior, high CES-D score. Limitations: Findings may not generalize to multipara or high-risk cohorts. Conclusions: First-time mothers with high levels of depressive symptomatology at 2 months postpartum (especially those with diagnosed depression) are at increased risk of continuing to experience high levels of depressive symptomatology throughout the first postpartum year. Implications for preventative intervention services are discussed.

Background: It has been established that depressed patients manifest a higher risk of committing suicide. The role of delusional experiences accompanying depressive symptomatology as a risk factor for suicidal behaviour has been investigated but the results are inconsistent. Method: In the present study, 40 elderly depressed inpatients with psychotic features (DSM-IV criteria) were compared to 64 elderly depressed patients without such features in terms of suicide attempts. Results: The results of univariate and multivariate analyses were negative: Psychotic and nonpsychotic depressed patients did not differ with respect to attempted suicide. Conclusion: The results of the present study support the notion that psychotic features do not increase the risk for the elderly depressed patients to attempt suicide.

Background Attachment theory has been conceptualised as an emotion regulation theory. Research attributes the occurrence of depressive symptoms to a dysfunction of emotion regulation. Anxious attachment and avoidant attachment, which are two dimensions of insecure attachment, are hypothesised to lead to the development of hyperactivating and deactivating emotion regulation strategies. Methods This systematic review examines the literature on the role of emotion regulation and its relationship with attachment and depressive symptomatology. Furthermore, we examined evidence for hyperactivating and deactivating strategies. Results Nineteen papers were identified. Adolescent studies demonstrated associations of varying strength and found unreliable and contradictory results for emotion regulation as a mediator. Conversely, adult studies provided strong evidence for emotion regulation as a mediator. The hypothesis that hyperactivating strategies mediate anxious attachment and depressive symptoms was consistently supported. Mixed evidence was provided for deactivating strategies as mediators to avoidant attachment and depressive symptomatology. Limitations Limitations of methodology and quality of studies are identified with particular attention drawn to problems with conceptual singularity and multicollinearity. Conclusions Despite mixed variable findings, this review indicates that emotion regulation is a mediator between attachment and depression. Hyperactivating strategies, in particular, have been consistently noted as mediators for anxious attachment and depressive symptomatology, whereas evidence for deactivating strategies as mediators between avoidant attachment and depressive symptoms has been mixed. Future research should test the mediators of attachment and symptoms and examine theoretically grounded models of psychopathology, such as metacognitive and cognitive models using clinical samples.

Background: Lack of longitudinal studies on the relationship between pubertal progress and changes in depression during adolescence. Methods: Changes in the Anxious/Depressed scores of the Child Behavior Checklist and Youth Self-Report were predicted from pubertal progress. Subjects were young adolescents from the Dutch general population, aged 10–12 years at T1 and 12–14 years at T2. From the 1327 parent reports, 207 showed a change that exceeded the cut-off for inclusion in the analyses. From the 1414 self-reports, 476 exceeded the cut-off. Results: Apart from increase, decrease in depression was common. Pubertal progress was inversely related to the parent reports of boys' depression only. Conclusion: Self-perceptions of depressive symptoms change independently from pubertal progress, whereas changes observable to parents are inversely related to it in boys. Limitations: Progress was not measured across the whole pubertal development. Clinical relevance: One can expect parents to observe a decrease in boys' depression in the period when most pubertal progress is made. More attention should be paid to decreases in depressive symptomatology.

This study explored a multifactorial model for the prediction of the intensity of depressive symptoms in postpartum women. Data were gathered from 213 pregnant women during the second trimester of pregnancy and at 6 months postpartum. Participants were assessed according to a number of psychosocial variables. A path analysis indicated that four variables had a direct effect on postpartum depressive symptomatology level: lower occupational status, prenatal depression level, more distal stressors and a personal psychiatric history. Eight variables, which reflected past and present experiences, showed an indirect effect. The implications of these findings are discussed.

This cross-sectional work studies the prevalence of post-partum blues on days 3 and 5 after delivery and the links between post-partum blues and depressive symptomatology, using standardised interviews and rating scales (Kennerley and Gath Blues Scale. MADRS) to screen a consecutive series of 104 women on days three and five after a normal delivery. This study stresses the possibility of a difference between the symptomatology of a benign "classical" post-partum blues, and that of a more intense blues closer to the spectrum of depressive mood disorders and perhaps post-natal depression.

Background The 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) is a newly introduced screening tool, while the Montgomery–Asberg Scale (MADRS) is commonly used in research and clinical practice in China. Converting the total scores between the two instruments could facilitate the comparison of different studies. Methods This study included 1164 patients with major depressive disorder (MDD). The diagnosis was established using the Mini International Neuropsychiatric Interview (MINI). The severity of depressive symptoms was assessed with the Chinese versions of MADRS (C-MADRS) and QIDS-SR (C-QIDS-SR) at baseline and 6 weeks later (exit point). Total scores of both scales were converted using Item Response Theory (IRT) analysis. Results At baseline, the C-MADRS and C-QIDS-SR were not unifactorial, therefore the conversion between them could not be performed. At exit, the C-MADRS and C-QIDS-SR were unifactorial, meeting the unidimensionality assumption of the IRT approach. Depression severity thresholds for the QIDS-SR are suggested as 6–10 for mild, 11–15 for moderate, 16–20 for severe, 21+ for very severe depression and ≤5 for remission ( www.ids-qids.org ). Based on the results of this study, the corresponding C-MADRS thresholds are 9–17 for mild, 18–24 for moderate, 25–33 for severe, 34+ for very severe depression and ≤7 or 8 (7.5) for remission. Conclusions The conversion of C-QIDS-SR and C-MADRS total scores would help researchers understand findings across different studies using these scales.

We contrasted the overall social functioning of pure dysthymics, double depressives, episodic major depressives and normal controls using both interview and self-report measures of social functioning and depression. In addition, we used hierarchical multiple regression to assess the differential impact of several variables (comorbid personality, anxiety and substance use disorders, life stress, duration of dysthymia and severity of depressive symptomatology) on social functioning in the dysthymics and double depressives. Participants included 41 outpatients with early-onset dysthymia alone, 56 outpatients with early-onset dysthymia and concurrent major depression, 45 outpatients with episodic major depression and 45 normal controls. All 3 patient groups were found to be significantly more impaired than normal controls in overall functioning, as well as in every specific role area. Double depression was found to be particularly impairing, both in overall functioning and in every specific role area. In dysthymic patients with and without concurrent major depression, current depressive symptomatology is the strongest predictor of impairment. Taken together, these data suggest that chronic, low-grade depressive symptoms and acute, moderate depressive symptoms have similar, significant and additive effects on social adjustment.

Developing accurate and time-efficient tools to measure depressive symptoms is important for research and clinical practice. This study aimed to test the psychometric properties of the Chinese version of the 16-item Quick Inventory of Depressive Symptomatology - Clinician Rating (C-QIDS-C) and Self-Report (C-QIDS-SR).This study included 998 patients with major depressive disorder (MDD) established using the Mini International Neuropsychiatric Interview (MINI). The severity of depressive symptoms was assessed using the Hamilton Rating Scale for Depression (HAMD), C-QIDS-C and C-QIDS-SR at baseline and 6 weeks later.Internal consistency (Cronbach's alpha) ranged from 0.73 to 0.82 for C-QIDS-C and C-QIDS-SR at both the baseline and exit. The involvement and energy domains at baseline, and sad mood, concentration/decision making, self outlook, involvement and agitation/retardation domains at exit had the highest item-total correlations across the two C-QIDS scales. The C-QIDS-C and C-QIDS-SR total scores were highly correlated with the HAMD total score at both baseline (r=0.61, p0.01 and r=0.54, p0.01, respectively) and exit (r=0.75, p0.01 and r=0.72, p0.01, respectively). The C-QIDS-C, C-QIDS-SR and HAMD were equally sensitive to change of depressive symptoms, suggesting high concurrent validity. The C-QIDS-C and C-QIDS-SR showed uni-dimensional measurement properties in exploratory factor analyses at both baseline and exit.The C-QIDS-C and C-QIDS-SR have excellent psychometric properties and are sensitive measurement of symptom severity in MDD.

Background For decades, research has shown that various skills (e.g., social skills) are associated with depressive symptoms. In recent years, much work has focused on skills for regulating emotion. Unfortunately, nearly all of these studies have investigated isolated skills. By contrast, the aim of the present study was the combined assessment of multiple skills in order to simultaneously analyze their relevance for depressive symptomatology. The authors wanted to identify skill domains that are essential for improving depressive symptoms. Methods The sample consisted of N=124 inpatients assessed at admission and discharge. Seven different skills were measured using a structured multidimensional interview. In addition, the severity of depressive symptoms was assessed. Results Correlations between the improvements in skills and depressive symptoms reached significance for every skill domain ranging from r=.21 to r=.54. A multiple hierarchical regression analysis was conducted with pre-treatment scores of skills. Compared to other domains, only emotion regulation significantly predicted the improvement of depressive symptomatology. Moreover, emotion regulation at pre-treatment turned out to be a moderator of the association between improvements in skills and the reduction of depressive symptoms. Limitations Because this study primarily focused on skills, no conclusions can be drawn regarding the relevance of these skills in relation to other predictors of therapy outcome. Conclusions Even when various skills are tested simultaneously, emotion regulation appears to be the essential skill influencing depressive symptom improvement. Therefore, a targeted enhancement of this skill may help to optimize the outcome regarding the treatment of depressive symptomatology.

This study used a matched clinician and self-rating scale, the Inventory for Depressive Symptomatology (IDS; Rush et al., 1986), in the assessment of 48 patients meeting DSM-III-R criteria for non-psychotic major depressive disorder. Patients generally rated their symptoms as more severe than the clinician, but differences between the self and clinician rating (the delta-IDS) were significantly correlated with non-endogenous depressive subtype, higher levels of neuroticism and dysfunctional attitudes, and lower self-esteem. Multiple linear regression analysis which controlled for severity of depression demonstrated that whilst neuroticism, dysfunctional attitudes and self-esteem accounted for 48.5% of the variance in delta-IDS, the variable accounting for most of the variance was low self-esteem (47.9%).

In this study, the effect of bright white light (2500 lux) and dim light (50 lux) were assessed in 30 patients with non-seasonal major depressive disorder randomly assigned to either procedure. Patients met RDC for major depressive disorder and ICD-9 criteria (296.1 and 296.3). During a 7-day period, the patients were exposed to bright white light (2500 lux) or dim light (50 lux) from 7.00 to 9.00 h daily. The severity of depression was assessed with observer scales (AMDP system, Hamilton depression scale, CGI) and through self-evaluation by self-rating scales (depression scale and list of complaints by von Zerssen). No difference was noted between bright light therapy and dim light, though a significant reduction of depressive symptomatology was observed for all patients during the study. These findings are discussed from a clinical point of view.

Background Qualitative aspects of childhood experiences are believed to have an impact on course in affective disorder. Does perception of parental rearing correlate to persistence of affective illness? Methods In retrospective life charts were recorded every previous illness episode for 38 consecutive patients with treatment-refractory affective disorder. A semi-structured interview was used for collecting information about perception of parental rearing. Results Ten patients perceived themselves as ‘unwanted’ during childhood, and 28 as ‘wanted’. These former were found to have a more malignant illness course, as measured by total days in illness, percent of life in illness, and illness days per episode. Limitations The patient sample was small and the findings require replication. Conclusions Perception of not having been wanted by parents during upbringing might be an important vulnerability factor in the persistence of depressive symptomatology into adult life.

Background: There is evidence that antidepressant medication improves social dysfunction during acute treatment in dysthymic patients but it is unknown if the gain in social functioning persists or progresses with longer-term antidepressant treatment. We examine the effect of 6 months of desipramine treatment on social functioning in dysthymic patients. Methods: Forty-six subjects with DSM-III-R dysthymia (70% with superimposed major depression) who had responded to 10 weeks of open-label desipramine (DMI) treatment received 16 additional weeks of continuation DMI. Social functioning was measured at weeks 0, 10 and 26 with the Social Adjustment Scale-Self Report. Results: Euthymia was maintained and a marginally significant trend for further improvement in overall social functioning appeared during continuation treatment. Only 24% of subjects achieved normative level of social adjustment after 6 months of DMI treatment. Limitations: The main limitation was the lack of a placebo control group. Conclusion: Acute improvement in social functioning persists during continuation treatment. However, most dysthymic patients did not achieve a community level of social adjustment. Significant social dysfunction persists in dysthymic patients with low levels of depressive symptomatology after 6 months of intense DMI treatment.

Fifty-nine subjects participated in a telephone follow-up interview 6 years after being hospitalized with a severe major depressive episode and 5 years after completing a 12 month follow-up study. Patient information was used to provide a rating of symptom-free (n = 19), episodic (n = 30), or chronic (n = 10) that described each patient's long-term course of illness. Few variables from the acute stage were related to long-term course of illness; however, early patterns of global and family functioning, number of life events, and rapid reduction in depressive symptomatology were found to be of prognostic significance. For patients whose depression is severe enough to warrant hospitalization, the pattern of functioning in the first few months after discharge from hospital is a strong indicator of the future long-term course.

Because depression is commonly observed in the chronic fatigue syndrome (CFS), the present study sought to determine whether the symptom pattern is similar to that seen in clinically depressed subjects (DEP). Individuals with multiple sclerosis (MS) were chosen as an additional comparison group because MS is a fatiguing illness of known organic etiology. The Beck Depression Inventory (BDI) was used to compare categories of depressive symptomatology. Absolute scores on the BDI were higher for the depressed group on mood and self-reproach symptoms, but were not higher than the CFS group on somatic and vegetative items. Analysis of symptoms as a percentage of total BDI score revealed no significant differences in mood or vegetative items among the three groups. The CFS and MS groups exhibited a significantly lower percentage of self-reproach symptoms than DEP, whereas the DEP group showed a lower percentage of somatic symptoms than the CFS and MS groups.

The mood stabilizing effect of lithium prophylaxis was investigated in a longitudinal design. Eighteen euthymic bipolar outpatients using lithium and 20 non-patient controls completed 13 weekly mood ratings. Groups did not differ in biographical characteristics and pre-test manic and depressive symptomatology. Apart from a higher mean happiness rating in the patient group, no statistically significant differences were found on most mood scores between groups, nor was there a group difference in variability over time. It is concluded that lithium prophylaxis does not have an extreme mood normalizing effect in well-controlled bipolars.

In this study an evaluation of the inter-rater reliability of the Hamilton Depression Rating Scale, the Melancholia Scale and the Montgomery-Asberg Depression Rating Scale has been carried out. Furthermore, the inter-item correlations of these scales have been investigated in relation to diagnostic ratings. It was found that the quantitative scales had satisfactory inter-rater relationship. Only low agreement was found between the quantitative and diagnostic scales, as expected, while there was high agreement between the quantitative scales. The relevance of introducing new scales and the definition of major depression are discussed.

The current study examined the validity of a subscale for endogenomorphic depression derived from the Hamilton Rating Scale for Depression. In a sample of 147 women outpatients with primary depression, subscale (HES) scores were bimodally distributed around the mean score of 7.38. High-HES patients had significantly elevated scores on measures of depressive symptomatology, generalized symptomatic distress, and social impairment relative to low-HES patients. Classifications based on HES scores significantly predicted RDC and DSM-III subtype diagnoses of endogenous and nonendogenous depression. Diagnostic predictions based on the subscale's items were superior to predictions made using the ‘non-endogenomorphic’ Hamilton items. Potential applications for research are discussed.

Twenty inpatients suffering from an adjustment disorder with depressed mood according to the DSM-III criteria were compared with 22 inpatients with a (situationally provoked) major depression without an additional DSM-III/axis I diagnosis, with regard to expert- and self-rated symptomatology, social dysfunction and personality features. Furthermore, social support prior to admission was described. Subjects who had developed an adjustment disorder had less severe depressive symptomatology, associated social dysfunction and premorbid rigidity, and they remitted faster. Social support for both groups was similar to that of healthy controls.

The authors evaluated the depressive symptomatology of 26 adolescent and 27 young adult, hospitalized patients meeting Research Diagnostic Criteria for Major Depressive Disorder. Few differences were found between these two groups with regard to either symptoms or subtypes of depression. Overall, these data indicate that Major Depressive Disorder can be easily identified in younger samples using established criteria. We also report a particularly high percentage of endogenous subtype among our patients. The RDC endogenous subtype of depression among younger inpatients may be more frequent than generally realized.