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Background: While several studies have suggested that bipolar disorder may elevate risk of cardiovascular disease, few studies have examined the relationship between mania or hypomania and cardiovascular disease. The purpose of this study is to examine history of manic and hypomanic episodes as an independent risk factor for cardiovascular disease (CVD) during an 11.5 year follow-up of the Baltimore Epidemiologic Catchment Area Follow-up Study.Methods: All participants were psychiatrically assessed face-to-face based on Diagnostic Interview Schedule in 1981 and 1982 and were categorized as having either history of manic or hypomanic episode (MHE; n=58), major depressive episode only (MDE; n=71) or no mood episode (NME; n=1339). Incident cardiovascular disease (CVD; n=67) was determined by self-report of either myocardial infarction (MI) or congestive heart failure (CHF) in 1993-6.Results: Compared with NME subjects, the odds ratio for incident CVD among MHE subjects was 2.97 (95% confidence interval: 1.40, 6.34) after adjusting for putative risk factors.Conclusions: These data suggest that a history of MHE increase the risk of incident CVD among community residents. Recognition of manic symptoms and addressing related CVD risk factors could have long term preventative implications in the development of cardiovascular disease in the community. [ABSTRACT FROM AUTHOR]

Background: We aimed to examine the occurrence of major depressive disorder (MDD) in a population-based youth sample, assessing both categorical and dimensional presentations of the disorder and its clinical and sociodemographic correlates., Methods: We analyzed cross-sectional data from the latest assessment of the 1993 Pelotas Birth Cohort (n = 3,780), a population-based study from Brazil that followed individuals up to age 22 years. We estimated point-prevalence for categorical diagnosis of MDD and comorbid diagnoses using DSM criteria in a structured interview by trained psychologists. Dimensional symptomatology was assessed with the Brazilian Portuguese version of the Center for Epidemiological Studies-Depression Scale-Revised (CES-D-R)., Results: Point-prevalence of a current unipolar major depressive episode was 2.85% (95%CI 2.37-3.43%). The CES-D-R showed a mean of 9.20 (SD=9.72), with an area under the curve of 0.93 (95%CI 0.91 to 0.95) for the categorical diagnosis of MDD using a cutoff point of 16. Sad mood and somatic symptoms were the most frequent, and also had lower levels of latent values required for endorsement. Sad mood and anhedonia items were the most central items in the network structure., Conclusions: In a population-based sample of youths from a middle-income country, MDD prevalence estimates and comorbidity profile were consistent with previous global literature. A focus on symptoms might advance our understanding about MDD among youths by disentangling the heterogeneity of the disorder., (Copyright © 2021. Published by Elsevier B.V.)

Background: Evidence suggests that long-term trajectories of depressive symptoms vary greatly throughout the population, with some individuals experiencing few or no symptoms, some experiencing transient symptoms and others experiencing chronic depression. The goal of this paper is to review studies that examined heterogeneity in long-term trajectories of depressive symptoms and summarize the current knowledge regarding (a) the number and patterns of trajectories and (b) antecedents and outcomes associated with different trajectory patterns., Methods: We conducted a systematic review of literature in the Medline and PsychINFO databases. Articles were included if they (a) modeled trajectories of depressive symptoms, (b) used a group-based trajectory modeling approach, (c) followed participants for 5+ years and (d) had a sample size of at least 200., Results: We identified 25 studies from 24 separate cohorts. Most of the studies identified either 3 or 4 distinct trajectory classes. Trajectories varied in terms of severity (low, medium, high) and stability (stable, increasing, decreasing). In most studies, the majority of participants had consistently few or no depressive symptoms, but a notable minority (usually <10%) reported persistent symptoms. Predictors of trajectories with greater symptom burden included female gender, lower income/education and non-white race. Other predictors were specific to different populations (e.g. mothers, older adults). High symptom burden trajectories were associated with poor psychiatric and social outcomes., Limitations: Comparisons between studies were qualitative., Conclusions: Trajectories of depression symptoms in the general population are heterogeneous, with most individuals showing minimal symptoms but a notable minority experiencing chronic high symptom burden., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: There is a need for brief instruments to screen for depression in adolescents that are valid, reliable and freely available. The aim of this study was to investigate the psychometric properties of a 10-item version of the CESD-R (CESDR-10) in two national adolescent samples., Methods: Sample 1 consisted of N=3777 youths (mean age 15.7) and Sample 2 contained N=1150 adolescents (mean age 14.5). We performed confirmatory factor analysis, evaluated construct validity, examined differential item functioning, and assessed internal consistency reliability (α)., Results: The results suggest generally strong psychometric properties for the CESDR-10. The CFA 1-factor model showed good model fit. Construct validity was partially supported in Sample 1 and mostly supported for Sample 2 based upon the characteristics examined. The CESDR-10 showed configural and metric invariance across both samples and full measurement invariance across sex. There were no notable differences in discrimination parameters or clinically significant differential item functioning between samples or sexes., Limitations: Criterion related validity was not assessed in this study. Further studies should evaluate the scale in comparison to a psychiatric diagnosis. In addition, this study utilized a web-based format of administration which may influence participants׳ answers. In future studies, the CESDR-10 should be administered in other settings to more thoroughly establish its generalizability., Conclusion: In clinical and non-clinical settings alike, time pressures make the availability of brief but valid screening measures critical. Findings support future use of the CESDR-10., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: While evidence suggests that depression is associated with medical morbidity and mortality, the potential role of mania has received less attention. This analysis evaluated the association between manic spectrum episodes and risk of all-cause mortality over a 26-year follow-up in a population-based study., Methods: Participants included 14,870 adults (mean age 48.2 ± 20.3; 58.2% female; 31.1% non-white) from four sites of the Epidemiologic Catchment Area Study who completed the Diagnostic Interview Schedule (DIS) mania assessment between 1980 and 1983 and had vital status data available through 2007. Participants were grouped into four mutually exclusive categories based on DIS mania assessment: (1) manic episode (n=46); (2) hypomanic episode (n=195); (3) sub-threshold manic symptoms (n=1041); and (4) no manic spectrum episodes (n=13,588). To determine vital status, participants were matched with the National Death Index. Participants with manic spectrum episodes were compared to those without such episodes with regard to mortality after 26 years., Results: After adjusting for major depressive symptoms and demographic differences, odds of mortality at follow-up for participants with lifetime manic spectrum episodes in the 30-44 and 45-64 year age cohorts at baseline were higher than those with no lifetime manic spectrum episodes in the same age cohorts (OR=1.39, 95% CI=[1.00, 1.93] and OR=1.41, 95% CI=[1.02, 1.95] respectively)., Conclusions: History of lifetime manic spectrum episodes in early to mid adulthood is associated with increased risk of all-cause mortality in mid to late life., Limitations: Future studies of mania and mortality should evaluate specific causes of mortality., (© 2013 Elsevier B.V. All rights reserved.)

Objective: The research agenda for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) has emphasized the need for a more etiologically-based classification system, especially for stress-induced and fear-circuitry disorders. Testable hypotheses based on threats to survival during particular segments of the human era of evolutionary adaptedness (EEA) may be useful in developing a brain-evolution-based classification for the wide spectrum of disorders ranging from disorders which are mostly overconsolidationally such as PTSD, to fear-circuitry disorders which are mostly innate such as specific phobias. The recently presented Paleolithic-human-warfare hypothesis posits that blood-injection phobia can be traced to a "survival (fitness) enhancing" trait, which evolved in some females of reproductive-age during the millennia of intergroup warfare in the Paleolithic EEA. The study presented here tests the key a priori prediction of this hypothesis-that current blood-injection phobia will have higher prevalence in reproductive-age women than in post-menopausal women., Method: The Diagnostic Interview Schedule (version III-R), which included a section on blood and injection phobia, was administered to 1920 subjects in the Baltimore ECA Follow-up Study., Results: Data on BII phobia was available on 1724 subjects (1078 women and 646 males). The prevalence of current blood-injection phobia was 3.3% in women aged 27-49 and 1.1% in women over age 50 (OR 3.05, 95% CI 1.20-7.73). [The corresponding figures for males were 0.8% and 0.7% (OR 1.19, 95% CI 0.20-7.14)]., Conclusions: This epidemiological study provides one source of support for the Paleolithic-human-warfare (Paleolithic-threat) hypothesis regarding the evolutionary (distal) etiology of bloodletting-related phobia, and may contribute to a more brain-evolution-based re-conceptualization and classification of this fear circuitry-related trait for the DSM-V. In addition, the finding reported here may also stimulate new research directions on more proximal mechanisms which can lead to the development of evidence-based psychopharmacological preventive interventions for this common and sometimes disabling fear-circuitry disorder.

Background: This study evaluates the role of depression as a specific risk factor for hypertension., Methods: This study analyzed the prospective data in the Baltimore Epidemiologic Catchment Area (ECA) Follow-up Study (n=1920), a longitudinal population-based study of mental illness in East Baltimore. Incident cases of hypertension as assessed by self-report (n=148) in 1993 were compared to the remaining cohort without hypertension (n=901) across three waves of ECA interviews (1981, 1982, 1993). Depression and related symptoms were measured at baseline (1981) by the Diagnostic Interview Schedule (DIS) and categorized as dysphoria, dysthymia, or major depressive episode (MDE) according to Diagnostic and Statistical Manual (DSM) III criteria., Results: Individuals with a major depressive episode compared to those who reported never having dysphoria had a marginally significant increased risk for hypertension (Odds Ratio (OR)=2.16; 95% Confidence Interval (CI) (0.94,4.98)) after adjustment for age, gender, race, body mass index, Nam-Powers socioeconomic score, alcohol usage, smoking, exercise, diabetes status, and number of general medical visits. MDE reported to have begun more than a year before the baseline measurement was associated with an increased risk for incident hypertension (Adjusted OR=3.67, 95% CI (1.25,10.79)., Limitations: Potential misclassification of self-reported hypertension outcome., Conclusions: Even though the data are based on self-report of hypertension, these findings suggest that depression may be an independent risk factor for hypertension particularly for those with recurrent episodes or a long term history of the disease.

Background: There is an ongoing research effort to test if depression is a homogeneous clinical syndrome and to identify valid and useful subtypes based on the number and nature of depressive symptoms. This study summarizes the patterns of depressive symptoms evident in a prospective study of the general population and examines the validity of potential subtypes by studying their course and etiologic heterogeneity., Methods: A general population sample of 1920 adults (aged 18-96) from the Baltimore Epidemiologic Catchment Area (ECA) follow-up study (1981 to 1993/6) were examined. Data on diagnoses, symptoms, course and risk factors were collected using the Diagnostic Interview Schedule (DIS). Latent class analysis was applied to summarize symptom patterns. Course characteristics and risk factor profiles were compared among potential subtypes based on the number of symptom groups or symptom patterns. Logistic regression models were used to examine the etiologic heterogeneity among potential subtypes based on symptoms., Results: The number of symptom groups gave the most efficient insight into differential etiologic processes. Severe depression (7-9 symptom groups) was associated with female gender, family history of depression but not with stressful life events before the onset of the first episode. Moderate (5-6 symptom groups) and mild depression (3-4 symptom groups) were associated with family history of depression, stressful life events before the onset, but not with female gender. The latent class model generated patterns of depressive psychopathology as follows: anhedonia, suicidal, psychomotor, and severely depressed subtypes. The Anhedonia subtype showed a course and risk factor profile distinct from the others., Limitations: The measurement of psychopathology was based on self-reported DIS interviews instead of psychiatric assessments. Recall or report bias cannot be excluded in the ascertainment of family history and stressful life events., Conclusions: Depression is heterogeneous, even below the threshold of syndromal diagnosis. The severity of an episode appears to be more informative than the pattern of symptoms, with the possible exception of a putative anhedonic subtype.