Vagus nerve stimulation therapy in a patient with treatment-resistant depression: a case report of long-term follow-up and battery end-of-service

This is the first case report of a patient who received long-term (69-month) adjunctive vagus nerve stimulation (VNS) therapy for treatment-resistant depression (TRD) and reached VNS battery end-of-service (EOS). The patient is a 41-year-old female with depression who entered a study of adjunctive VNS therapy for TRD. Her Hamilton Rating Scale for Depression (HAM-D) scores dropped from a mean of 33.5 (pre-implantation baseline period) to 16 at the end of the 12-week acute-phase treatment period, and then fluctuated from <7 (normal range) to scores in the moderately depressed range (approximately 20) during long-term follow-up. Three and one-half years after VNS implantation, the patient's HAM-D scores began to increase from a score of 18 to a peak score of 27 approximately 16 months later (5-years post-implantation). The patient subsequently reported that she could no longer feel stimulation from the device and device interrogation 2 weeks later indicated battery EOS. The patient was hospitalized due to worsened depression, the pulse generator was replaced, and medication adjusted. HAM-D scores through the subsequent 9 months of follow-up returned to a pattern of fluctuations within the range noted during the long-term follow-up period prior to VNS battery EOS.     

A Propensity Score Analysis of Homework Adherence-Outcome Relations in Cognitive Behavioral Therapy for Depression

Little is known about whether or not a consistently high level of homework adherence over the course of therapy benefits patients. This question was examined in two samples of patients who were receiving individual Cognitive Behavioral Therapy (CBT) for depression (Ns = 128 [Sequenced Treatment Alternatives to Relieve Depression: STAR-D] and 183 [Continuation Phase Cognitive Therapy Relapse Prevention: C-CT-RP]). Logistic and linear regression and propensity score models were used to identify whether or not clinician assessments of homework adherence differentiated symptom reduction and remission, as assessed by the Hamilton Depression Rating Scale-17 (HDRS-17), the Quick Inventory of Depressive Symptomatology–Self-Reported Scale (QIDS-SR), and the QIDS–Clinician Scale (QIDS-C). CBT-related response and remission were equally likely between both high and low homework adherers in both studies and in all models. But in propensity adjusted models that adjusted for session attendance, for both the STAR-D and C-CT-RP samples, greater homework adherence was significantly associated with greater response and remission from depression in the first and last 8 sessions of CBT. Our results suggest that homework adherence can account for response and remission early and late in treatment, with adequate session attendence.     

Validation of the Depression Anxiety Stress Scale-21 (DASS-21) in a non-clinical sample of South African working adults

This study investigated the psychometric properties of the Depression Anxiety Stress Scale-21 (DASS-21) in a non-clinical sample of working people. Working South African persons (N = 269; females = 62%; mean age = 33, SD = 11.5) completed the DASS-21, as well as the Center for Epidemiologic Studies Depression Scale-Revised (CESD-R) and the Generalized Anxiety Disorder Scale-7 (GAD-7). Results following Confirmatory Factor Analysis and correlational analysis yielded a three-factor structure (depression, anxiety, and stress) for the DASS-21. The evidence for discriminant and convergent validity was strong. Additionally, we found good reliabilities for the overall scale as well as the subscales. The DASS-21 appears a valid and reliable instrument for measuring depression, anxiety, and stress in the workplace. Future studies should investigate differential item functioning and equivalence of items among South African working populations.     

The Psychometric Properties of an Internet-Administered Version of the Depression Anxiety and Stress Scales (DASS) in a Sample of Dutch Adults

Psychometric work on the widely used Depression Anxiety and Stress Scales (DASS) has mostly used classical psychometrics and ignored common internet-administered versions. Therefore, the present study used not only classical, but also modern psychometrics based on item response theory (IRT) to evaluate an internet-administered version of the DASS (Dutch translation). Internet-administered DASS data were collected as part of a large internet-based study in the Dutch adult population (n = 7972). Initially, external correlates (i.e. demographics other measures) and some classical psychometrics (internal consistency, convergent/divergent validity) of the DASS scales were evaluated. Next, IRT was used to investigate the scales’ dimensionality, discrimination and item-functioning. Finally, the DASS depression scale was further investigated by linking it to the more clinically-oriented Quick Inventory of Depressive Symptomatology (QIDS) using item response theory (IRT). Initial classical psychometric analyses supported the scales’ internal consistency (alpha = 0.94–0.98) and convergent/divergent validity. IRT analyses showed that each of the DASS scales was only suitable to measure variations in a very narrow and rather mild severity range. Linking the DASS depression scale with the QIDS also showed that the DASS depression scale discriminated best in the mild-moderate severity range, but not at higher severity levels that were covered by the QIDS. In conclusion, the scales of the internet-administered DASS show good internal consistency and validity. However, users should be aware that the scales discriminate best at mild-moderate severity ranges in the general population.     

Religiosity,subjective well-being,and depression in Saudi children and adolescents

To explore the associations between religiosity and both subjective well-being (SW-B) and depression, a sample of 7211 Saudi school children and adolescents was recruited (2159 boys, 5052 girls). Their ages ranged from 11 to 18 years (M _age = 16.1, SD = 1.5 for boys; M _age = 15.6, SD = 1.9 for girls). They responded to five self-rating-scales of religiosity and SW-B, that is, happiness, satisfaction, mental health, and physical health, as well as the Multidimensional Child and Adolescent Depression Scale. It was found that males obtained significantly higher mean scores than their female counterparts on the religiosity and the SW-B self-rating-scales, whereas females obtained a significantly higher mean score on depression than their male peers. All the correlations among males and female were significant between religiosity and both SW-B rating scales (positive) and depression (negative). A principle components analysis was conducted. A high-loaded and bipolar factor was disclosed and labelled “Religiosity and well-being vs. depression.” In the stepwise multiple regression, the main predictor of religiosity in both sexes was satisfaction. In the light of the high mean score on religiosity, it was concluded that religiosity is an important element in the lives of the present sample of Saudi Muslim children and adolescents. Based on the correlations and factor analysis, it was also concluded that religious persons (in this sample) are happier, healthier, and less depressed.     

Sociodemographic correlates of assimilation of refugees from Kurdistan

Successful assimilation of refugees in their host country is an important prerequisite of psychological well-being. Refugees' satisfaction in the new country is one of key indicators of their assimilation. The satisfaction with their host country was assessed for 54 Kurdish refugees of mean age of 35.8 yr. (SD= 10.9) via an 8-item rating scale partly based on Cernovsky's Assimilation Scale. The 36 men and 18 women had resided in the host country for a mean of 4.5 yr. (SD=4.0). An overall score was calculated from ratings of satisfaction with personal safety, health, employment, food, financial security, social life, and entertainment. This overall score was unrelated to age, sex, and employment status. Those who emigrated at a younger age (r = -.28, p = .03) and those with lower education reported more satisfaction with their host country (r = -.28, p = .03) perhaps because they could more easily and rapidly re-establish social status comparable to what they had in their homeland than could older refugees from Kurdistan's higher educational strata.     

Mean Beck Depression Inventory-II total scores by type of bipolar episode

The 1996 Beck Depression Inventory-II was administered to 120 outpatients diagnosed with DSM-IV-TR bipolar I disorders who had recently experienced manic, mixed, or depressed episodes. A focused contrast supported the hypothesis that the mean Beck-II total score for the 40 patients with depressed episodes (M=34.1, SD = 13.2) was higher than the mean Beck-II total score for the 40 patients with mixed episodes (M=25.9, SD= 13.6) which was, in turn, higher than the mean Beck-II total score for the 40 patients with manic episodes (M= 11.7, SD=7.8, p<.001). The Beck Depression Inventory-II appears to be useful for measuring self-reported depression in patients with bipolar I disorders.     

Mean Beck Depression Inventory-II scores of outpatients with dysthymic or recurrent-episode major depressive disorders

The Beck Depression Inventory-II, published in 1996, was administered to 100 adult outpatients (Age M=43.1 yr., SD=15.6) who were diagnosed with a recurrent-episode Major Depressive Disorder and 100 outpatients (Age M=42.8 yr., SD=15.7) who were diagnosed with a Dysthymic Disorder. Each diagnostic group was composed of 50 men and 50 women who did not have a comorbid depressive disorder. The mean Beck Depression Inventory-II total score and the mean number of symptoms endorsed by the outpatients with a Major Depressive Disorder were significantly (ps<.001) higher than those for outpatients with a Dysthymic Disorder. The usefulness of the Beck Depression Inventory-II was discussed in helping clinicians discriminate between these two unipolar disorders.     

Depression and cocaine dependence

Presence of depression in cocaine-dependent users is relevant for treatment of these persons. This study assessed the presence of depressive symptomatology with a published Spanish translation of the Beck Depression Inventory for a sample of 115 Spanish cocaine-dependent users who were in outpatient treatment at Centers of Drug Dependence of Galicia, Spain. The mean score was 13.7 (SD = 10.3), with 24.3% of the sample having scores which indicate clinical depression (cut off > or =21). These data underscore the need to assess the presence of depression in cocaine-dependent users who require treatment.     

大学生幸福感提升的纵向研究：适合度和努力的调节作用

考察提升大学生幸福感的不同干预练习的效果及其调节变量。120名大学生参与前测,其中104名完成5周的干预和后测。随机分配大学生每周从事感激、乐观和生活事件记录,对他们的幸福感和抑郁进行前测和后测。结果表明,5周干预练习后,与记录生活事件组相比,感激组的幸福感显著上升,感激组和乐观组的抑郁显著下降;另外,与练习活动更匹配和更努力的被试获益更大。可见感激和乐观是对中国大学生有效的幸福感干预练习,且个人与练习的适合度和个体的努力程度调节干预效果。     

Parenting Competency Across Pregnancy and Postpartum Among Urban Minority Women

Taking a life-course perspective, we explored the sense of parenting efficacy during the pregnancy-postpartum transition among a group under-represented in much of adult developmental research, minority women. Our intent was to describe the women's report of parenting competency in a major life transition occurring within the context of an impoverished urban environment. We also explored associations with depression, social support, and life events. One hundred and eighty-two African-American and Hispanic mothers at community health centers in low-income urban areas completed measures early in the third trimester and again at 3 months postpartum. Across time, the levels of reported parental efficacy and satisfaction increased while depressive symptoms decreased. Negative life events and levels of depressive symptomatology differentially influenced women's experience of parenting satisfaction and efficacy feelings before and after their babies were born.     

Overgeneral autobiographical memory predicts changes in depression in a community sample

This study investigated whether overgeneral autobiographical memory (OGM) predicts the course of symptoms of depression and anxiety in a community sample, after 5, 6, 12 and 18 months. Participants (N = 156) completed the Autobiographical Memory Test and the Depression Anxiety Stress Scales-21 (DASS-21) at baseline and were subsequently reassessed using the DASS-21 at four time points over a period of 18 months. Using latent growth curve modelling, we found that OGM was associated with a linear increase in depression. We were unable to detect changes over time in anxiety. OGM may be an important marker to identify people at risk for depression in the future, but more research is needed with anxiety.     

The role of coping, anxiety, and stress in depression post-acute coronary syndrome

Depressive symptoms are common and can affect prognosis following acute coronary syndromes (ACS). This study examined the psychological factors, coping, anxiety, and perceived stress associated with depression following ACS. Psychological variables were assessed in 15 females and 66 males (M = 57 years, SD = 12). Repeated measures at 2, 12, and 24 weeks post-ACS compared depression, anxiety, perceived stress, and coping resources as determined by the Cardiac Depression Scale, Beck Depression Inventory-II, State Trait Anxiety Inventory, Perceived Stress Scale, and Coping Resources Inventory. Depression, anxiety, and perceived stress remained high in the depressed group across time. Coping scores at 2 weeks post-ACS predicted depression scores at 24 weeks post-ACS. It appears that trait anxiety and coping resources are related to depressive symptoms post-ACS.     

体验购买、实物购买与幸福感:关系需要满足的中介作用

基于自我决定理论,本研究考察了体验购买与实物购买这两种购买方式与个体享乐幸福感和意义幸福感的关系,并探索了个体的关系需要满足在其中的中介作用。采用回忆范式启动不同购买经历之后,被试依次完成关系需要满足问卷、享乐幸福感与意义幸福感量表。结果显示,体验购买组的享乐幸福感和意义幸福感都显著高于实物购买组;关系需要满足程度在购买类型与享乐幸福感、意义幸福感的关系间分别起到中介作用,这表明购买类型通过满足个体的关系需要进而提升其享乐幸福感和意义幸福感水平。     

Score reliability for tests constructed for African-American populations

Test score reliabilities and sample sizes (N) used to establish the reliabilities are described for a variety of tests constructed for African-American populations. The sample size was 341. The average internal consistency reliability was .74 (SD = .16) with a median value of .77. The median N was 131. The mean internal consistency reliability and median N for tests intended for assessment of individuals were only .72 and 96, respectively.     

Couple Therapy for Depression Within a Naturalistic Setting in Finland: Factors Related to Change of the Patient and the Spouse

The study examined factors related to change in treatments for depression in couple therapy (CT; N = 29) and treatment-as-usual (TAU; N = 22). Treatments were adapted in accordance with the patient’s need. The patients’ depressive symptoms, general mental health and marital satisfaction were assessed at baseline and at 6 months post-baseline. The Hamilton Depression Rating Scale, the Beck Depression Inventory (BDI), the Symptom Check List-90, and the Dyadic Adjustment Scale (DAS) were used for the patients. The BDI and the DAS were used for the spouses. The couples in CT group assessed their subjective distress (SD) at every session by using the Outcome Rating Scale. The results showed that the spouses’ gender, the spouses’ depressive symptoms at baseline, and the number of therapy sessions were related to differing changes in the CT and TAU groups at the 6-month post-baseline assessment. The spouses in the CT group demonstrated a higher treatment response than those in the TAU group. In the CT group, the spouse’s benefit from the treatment was related to SD at the outset on the part of either the patient or the spouse or both. The change in the patient’s SD predicted the patient’s change in depressive symptoms, general mental health, and was associated with the patient’s change in marital satisfaction. The study emphasizes the importance of the spouse’s involvement in the treatment of depression, the provision of feedback on SD, and discussion of individual well-being and relational issues, in addition to the focus on depression.     

A longitudinal analysis of anxiety and depressive symptoms

The authors modeled depressive and anxiety symptom data from 1,391 participants in a longitudinal study of middle-aged and older Swedish twins (M age = 60.9 years, SD = 13.3). Although anxiety and depression were highly correlated, a model with distinct Anxiety and Depression factors fit the data better than models with Positive and Negative Affect factors or a single Mental Health factor. Lack of well-being was associated with anxiety rather than depression. Over two 3-year intervals, anxiety symptoms led to depressive symptoms, but the relationship was not reciprocal. Anxiety symptoms were more stable than depression. These findings provide additional support for the idea that anxiety symptoms may reflect a personality trait such as neuroticism more than do depressive symptoms and suggest that low positive affect may not be as specific to depression among older adults as in younger people.     

Evaluation of the effect of Spiritual care on patients with generalized anxiety and depression: a randomized controlled study

The present study was conducted to assess the effect of spiritual care in patients with depression, anxiety or both in a randomized controlled design. The participants were randomized either to receive spiritual care or not and Hamilton anxiety rating scale-A (HAM-A), Hamilton depression rating scale-D (HAM-D), WHO-quality of life-Brief (WHOQOL-BREF) and Functional assessment of chronic illness therapy – Spiritual well-being (FACIT-Sp) were assessed before therapy and two follow-ups at 3 and 6 week. However, with regard to the spiritual care therapy group, statistically significant differences were observed in both HAM-A and HAM-D scales between the baseline and visit 2 (p < 0.001), thus significantly reducing symptoms of anxiety and depression, respectively. No statistically significant differences were observed for any of the scales during the follow-up periods for the control group of participants. When the scores were compared between the study groups, HAM-A, HAM-D and FACIT-Sp 12 scores were significantly lower in the interventional group as compared to the control group at both third and sixth weeks. This suggests a significant improvement in symptoms of anxiety and depression in the spiritual care therapy group than the control group; however, large randomized controlled trials with robust design are needed to confirm the same.     

“Do More,Feel Better”: Pilot RCT of Lay-Delivered Behavioral Activation for Depressed Senior Center Clients

This pilot randomized control trial (RCT) tested “Do More, Feel Better” (DMFB), a lay-delivered Behavioral Activation intervention for depressed senior center clients. The study examined: (1) the feasibility of training older lay volunteers to fidelity; and (2) the acceptability, safety, and impact of the intervention. Twenty-one lay volunteers at four senior centers were trained in DMFB. Fifty-six depressed clients were randomized to receive 9 sessions of DMFB or Behavioral Activation delivered by social workers (MSW BA). Research assessments of overall client activity level (BADS) and depression severity (HAM-D) were conducted at baseline and Weeks 3, 6, and 9. Eighty-one percent of lay volunteers who underwent training were formally certified in DMFB. Depressed clients receiving each intervention reported high levels of satisfaction and showed large and clinically significant changes in 9-week activity level (d ≥ 1.35) and depression severity (d ≥ 3.34). Differences between treatment groups were very small for both activity level (d_MSW = 0.16; 95% CI, -0.70 to 1.02) and depression (d_MSW = 0.14; 95% CI, -0.63 to 0.91). Increases in activity level were associated with decreases in depression (β = -0.42; 95% CI, -0.55 to -0.30). Both interventions appeared to work as intended by increasing activity level and reducing depression severity. “Do More, Feel Better” shows the potential of evidence-based behavioral interventions delivered by supervised lay volunteers, and can help address the insufficient workforce available to meet the mental health needs of community-dwelling older adults.