Screening people with anxiety/depression for suitability for guided self-help

The aim of this study was to test a questionnaire for screening people with anxiety/ depression for their suitability for certain forms of computer-guided self-help. A total of 196 referrals completed the screening questionnaire. Three clinicians each independently judged the referrals' broad problem type and suitability. Referrals were randomized to 1 of 3 clinicians for a screening interview. The results show that inter-clinician agreement was good for questionnaire-based problem type and suitability, and excellent for screening interview-based problem type and suitability. Agreement between the questionnaire and interview was good on problem type but poor on suitability. Compared with the screening interview, the questionnaire detected suitable patients well but unsuitable patients less well. In conclusion, by quickly scanning the completed questionnaire, clinicians were able sensitively to detect patients' problem types that were suitable for certain forms of self-help. Some unsuitability items need refining.     

Obstructive sleep apnea and depression

Is there an association between obstructive sleep apnea (OSA) and depression? OSA is a common breathing-related sleep disorder. There have been reports that depressive symptoms can be associated with this sleep disorder. A number of investigations have addressed this issue. Although some have found no correlation, most studies have concluded that there is an association between OSA and depressive symptoms. Other investigations have shown that depressive symptoms improve with treatment of OSA, and that untreated OSA may contribute to treatment resistance in some cases of mood disorders. Within the framework of current psychiatric diagnostic criteria, the depressive symptoms associated with OSA can be viewed as a combination of a mood disorder secondary to a primary medical condition and an adjustment disorder with depressed mood. The question of whether OSA causes depressive symptoms can perhaps be best answered by viewing OSA and depression as having certain symptoms that are common to both disorders.     

Perceived stress correlates with disturbed sleep: a link connecting stress and cardiovascular disease

The association between stress and cardiovascular disease (CVD) risk is becoming established. A mechanistic link clarifying the intermediate steps between the experience of stress and the development of CVD would support this association. We sought to examine the role of perceived stress as a factor associated with disturbed sleep with the goal of providing an explanation for the stress-CVD connection. We performed a cross-sectional analysis of data recorded by subjects at entry to our CVD prevention program. Data collection included questionnaire surveys, anthropometrics, and a CVD-relevant laboratory panel. Of 350 consecutively enrolled subjects (mean age 54.4 ± 12.4 [SD] years, 138 men, 39%), 165 (47%) scored above the mean for stress measures. These high-stress subjects displayed an increased cardiovascular risk profile including elevated body mass index (mean ± SD 31.1 ± 5.9 vs. 29.0 ± 5.9, r(s) = 0.175), increased waist circumference (102 ± 17 cm vs. 98 ± 14, r(s) = 0.135), and elevated high-sensitivity serum C-reactive protein (0.384 mg/dl vs. 0.356, r(s) = 0.109). High-stress subjects also demonstrated greater daytime sleepiness (Epworth Sleepiness Scale: 10.4 ± 5.0 vs. 7.8 ± 4.8, r(s) < 0.316), greater fatigue (fatigue scale: 5.4 ± 2.2 vs. 3.4 ± 2.4, r(s) = 0.484), poorer sleep quality (Pittsburgh Sleep Quality Index: 8.5 ± 4.4 vs. 5.9 ± 4.0, r(s) = 0.416), and shorter sleep duration (20 min less/24 h, r(s) = negative 0.177) with a higher risk for sleep apnea (60% at high risk vs. 40%, p = 0.003) than low-stress subjects. High stress was associated with significant disturbances in sleep duration and sleep quality. Stress levels also correlated with daytime consequences of disturbed sleep. The stress-sleep connection may be an important mechanistic mediator of the association between stress and CVD.     

The children's depression adjective check lists (C-DACL) with emotionally disturbed adolescent boys

In this study of the reliability and validity of the Children's Depression Adjective Check Lists (C-DACL; Brewer & Lubin, 1987) with emotionally disturbed adolescent boys (N=50),data were collected on two occasions. Internal consistency (alpha) was .89 and .94 for form H and .89 and .95 for form I. Alternate form reliabilities were .86 and .95. Split-half reliabilities were .80 and .89 for form H and .68 and .86 for form I. Concurrent validity was determined by correlations between C-DACL and the Self-Rating Scale of Depressed Mood. Correlations were .65 and .80 for H and .54 and .80 for I. Data from the present study were tested against data from emotionally disturbed adolescent girls (Sokoloff & Lubin, 1983), with boys scoring significantly lower on both forms (H and I) of the C-DACL.     

Affective ratings and startle modulation in people with nonclinical depression

This study tested predictions based on the emotion context insensitivity (ECI) hypothesis of Rottenberg, Gross, and Gotlib (2005) that a nonclinical sample of people with depressive symptoms would show reduced responses to both positive and negative stimuli relative to people without depression and would show an enhanced response to novelty. Seventy individuals completed diagnostic questionnaires, made ratings of 21 affectively valenced pictures, and then viewed the same 21 pictures and 21 novel pictures while startle blink responses were recorded from electromyographic activity of the orbicularis oculi. People with scores on the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) indicative of depression demonstrated a lack of affective startle modulation compared to the nondepression group. For all participants, the startle response was larger for novel pictures than for previously viewed pictures, but scores on the BDI were not related to response to novelty. Taken together, the results suggest that nonclinical depression is associated with a lack of affective modulation of startle, as has been shown for clinical depression.     

Assessment of depression and diagnosis of depressive disorder among psychiatrically disturbed children

This study examined the relations between performance on alternative measures of childhood depression and diagnosis of depressive disorder. Hospitalized inpatient children (N=770, ages 7–13) with a diagnosis of depressive disorder (Research Diagnostic Criteria) were compared with a matched sample of patients whose diagnoses excluded depression. Children and parents completed four standardized depression scales plus measures designed to assess associated features including hopelessness, selfesteem, and internalizing symptoms. The results indicated that (1) alternative depression measures, whether completed by children or parents, yielded scores that were significantly higher for children with a diagnosis of depression; (2) parent ratings of severity of depression were consistently higher among the measures than the child ratings; (3) optimal cutoff scores derived for each measure correctly classified approximately 60% of depressed and nondepressed cases; (4) different cutoff scores were required for the same measure, depending on whether children or parents were the raters; and (5) using a battery of measures and combining these in a stepwise discriminant function yielded over 80% classification accuracy. The implications of the results for selection of cases for clinical research are discussed.Completion of this research was supported by a Research Scientist Development Award (MH00353) and by a Clinical Research Center Grant for the Study of Affective Disorders (MH30915) from the National Institute of Mental Health. The authors are grateful to members of the clinical research team of the Child Psychiatric Treatment Service, who greatly facilitated this research.     

Goodness of fit between prenatal maternal sleep and infant sleep: Associations with maternal depression and attachment security

The current study prospectively examined the ways in which goodness of fit between maternal and infant sleep contributes to maternal depressive symptoms and the mother-child relationship across the first years of life. In a sample of 173 mother-child dyads, maternal prenatal sleep, infant sleep, maternal depressive symptoms, and mother-child attachment security were assessed via self-report, actigraphy, and observational measures. Results suggested that a poor fit between mothers’ prenatal sleep and infants’ sleep at 8 months (measured by sleep diary and actigraphy) was associated with maternal depressive symptoms at 15 months. Additionally, maternal depression mediated the association between the interplay of mother and infant sleep (measured by sleep diary) and mother-child attachment security at 30 months. Findings emphasize the importance of the match between mother and infant sleep on maternal wellbeing and mother-child relationships and highlight the role of mothers’ perceptions of infant sleep.     

Social comparison,coping and depression in people with spinal cord injury

The present study among 70 people with spinal cord injury examined the prevalence and correlates of identification (seeing others as a potential future) and contrast (seeing others in competitive terms) in social comparison as related to coping and depression. The most prevalent social comparison strategy was downward contrast (a positive response to seeing others who were worse-off), followed by upward identification (a positive response to perceiving better-off others as a potential future), downward identification (a negative response to perceiving worse-off others as a potential future), and upward contrast (a negative response to seeing others who were better-off). Those with less severe lesions reported the highest levels of upward contrast, coping through blaming others, and depression. Downward contrast was particularly related to constructive coping, and upward identification to wishful thinking. The less adaptive social comparison strategies, i.e., upward contrast and downward identification, were quite strongly related to wishful thinking and blaming others. Particularly upward contrast, i.e., feeling bad as response to seeing that others are better-off, was related to depression.     

Some implications of the analyst feeling disturbed while working with disturbed patients

The analyst's experience of patients' disturbances is explored as an aspect of analytic technique. A number of premises are examined. First, it is expected that the analyst is committed to tolerating and understanding disturbances evoked in him by his patients' personalities and their disturbances. Second, that he regards the disturbances evoked in him as a form of manifest content to be understood in the usual method of association. Third, countertransference attitudes may propel the analyst toward rapid formulaic conceptions of his patients' disturbances or to considerations of diagnostic designations carrying serious, if not pejorative implications, such as borderline, narcissistic, perverse, or sociopathic. Such attitudes may also underlie the urge to consider psychotropic medications in response to the patients' disturbances. A selected review of the literature as well as illustrative work with disturbing patients are presented in support of the paper's premises.     

A pilot study of cognitive-behavioral therapy of insomnia in people with mild depression

In some cases, insomnia and depression may have a reciprocal relationship, in which each aggravates and maintains the other. To test the hypothesis that reduction of insomnia would result in reduction of depression in patients (N=10) with both disorders, a repeated-measures design was used comparing depression and insomnia levels before and after 6 sessions of cognitive-behavioral therapy of insomnia. Posttreatment, 100% of completers (n=8) had a normalized sleeping pattern, and 87.5% had normalized depression scores. Significant posttreatment improvement was seen in sleep onset latency (-31 min), wake time after sleep onset (-24 min), total sleep time (+65 min), sleep efficiency (+14%), and sleep quality (+19%), which was maintained at 3-month follow-up. A decreasing trend occurred in depression scores from pre- to posttreatment, which reached significance at 3-month follow-up. Intent-to-treat analyses showed similar results.     

Spirituality,quality of life,and depression in older people with dementia

ABSTRACT

This study aimed to observe dementia’s role in the relationship between spirituality, quality of life, and depression in aging. The sample included 61 participants between 65 and 98 years old, separated into two groups: participants diagnosed with dementia (N = 31) and control participants (N = 30). There was no significant difference in spirituality between demented and control participants; however, different patterns of correlation were observed between spirituality, depression, and quality of life in these groups. Although the level of spirituality did not differ despite dementia, this pathology would appear to play a role in the relationship between spirituality, quality of life, and depression.     

Early interventions with disturbed mother-infant relationships

The aim of this paper is to validate the hypothesis that successful psychodynamic intervention in the case of disturbed mother-infant relationships may be possible. Based on 120 referred cases, three types of intervention emerged: Intervention Group A: These mothers feel numbed when their babies are in an acute state of distress and show active signs of refusing to live. Intervention Group B: These mothers feel concern about an on-going difficulty with their baby and are prepared to explore the problem with the therapist. Intervention Group C: These mothers feel angry when their children show signs of distress and react in a persecuted way toward the baby. Due to the difficulty in helping mothers in this situation, a different approach was explored. Clinical case studies are presented to illustrate each of these types of intervention.     

Burden, depression, and anxiety in caregivers of people with amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurodegenerative disease caused by the degeneration of motor neurons. The burden for ALS caregivers is quite high. There are still few studies that have investigated the emotional impact of ALS care. We conducted a cross-sectional study among 40 ALS caregivers, assessing general worries, burden of care, depression, anxiety, perception of social support, and patients' severity of disease. Caregiver burden, depression, and anxiety were positively related with each other, and all these variables had a negative relation with social support. Patient's loss of physical functions was positively related with caregiver burden, anxiety, and somatic expression of depression. Caregivers expressed worries for their own health conditions. Given these results, we consider the hypothesis of an emotional-somatic impact of ALS care. The implications and limitations are discussed.     

Internalised HIV-stigma,loneliness, depressive symptoms and sleep quality in people living with HIV

Objective: People living with HIV (PLWH) commonly report sleep disturbances which are associated with long-term health consequences, including disease progression. PLWH also experience internalised stigma as a result of their HIV status, which can be associated with increased loneliness and depression. Little attention focuses on the impact of these factors on sleep. Therefore, we examined whether internalised HIV-stigma was indirectly related to poorer sleep quality through higher levels of loneliness and depressive symptoms.

Design: 181 PLWH from across the United States completed an online survey.

Main Study Measures: Internalised HIV-stigma was assessed using the HIV-Stigma Scale, loneliness was assessed using the UCLA-Loneliness Scale-Short Form, depressive symptoms were assessed with the Center for Epidemiologic Studies–Depression Index, and Sleep Quality was assessed using the Pittsburgh Sleep Quality Index.

Results: Internalised HIV-stigma was indirectly associated with poorer global sleep quality and daytime sleep dysfunction through both loneliness and depressive symptoms.

Conclusions: PLWH who experience HIV-related stigma may experience greater feelings of loneliness, which are related to increased depressive symptoms and poorer sleep quality. Interventions focused on improving sleep in PLWH should focus on multiple factors that influence sleep, including psychosocial factors such as stigma, social isolation and depressive symptoms.     

HPA axis and sleep: identifying subtypes of major depression

It is increasingly acknowledged that the diagnosis of major depression encompasses patients who do not necessarily share the same disease biology. Though the diagnostic criteria allow the specification of different subtypes, e.g. melancholic and atypical features, a consensus still has to be reached with regard to the clinical symptoms that clearly delineate these subtypes. Beside clinical characteristics, biological markers may help to further improve identification of biologically distinct endophenotypes and, ultimately, to devise more specific treatment strategies. Alterations of the hypothalamus-pituitary-adrenal (HPA) axis and sleep architecture are not only commonly observed in patients with major depression, but the nature and extent of these alterations can help to identify distinct subtypes. Thus, a HPA overdrive, due to enhanced secretion of corticotropin-releasing hormone (CRH) and an impaired negative feedback via glucocorticoid receptors, seems to be most consistently observed in patients with melancholic features. These patients also show the clearest sleep-electroencephalogram (EEG) alterations, including disrupted sleep, low amounts of slow wave sleep (SWS), a short rapid eye movement (REM) latency and a high REM density. In contrast, patients with atypical features are characterized by reduced activity of the HPA axis and ascending noradrenergic neurons in the locus coeruleus. Though sleep-EEG alterations have been less thoroughly examined in these patients, there are data to suggest that SWS is not reduced and that REM sleep parameters are not consistently altered. While the atypical and melancholic subtypes of major depression may represent the extremes of a spectrum, the distinct clinical features provide an opportunity to further explore biological markers, as well as environmental factors, contributing to these clinical phenotypes. Moreover, dysregulations of the HPA axis and sleep-EEG alterations can also be induced in rodents, thereby allowing alignment of critical biological aspects of a human disease subtype with an animal model. Such "Translational Research" efforts should help to develop targeted therapies for distinct patient populations.     

Techniques for handling resistances in group psychotherapy with severely disturbed patients

There has been an increased interest in recent years in the treatment of those with severe psychopathology through application of object relations theory and modern ego psychology. Yet, for the past 20 years, such patients have been treated in day hospitals where rehabilitation and socialization concepts have been employed. This paper integrates some of the advances in psychoanalytic theory with more established methods of milieu therapy. In the patients studied, the therapists noted the presence of severe envy, dependency, passivity and with-holding, an intolerance for aggression along with an intransigent, paranoid-schizoid position. The techniques described here worked through the effects of these resistances so that the patients could use the psychotherapy group, and the entire milieu, more constructively than they did before.Ruthe Feilbert-Willis, C.S.W. was formerly Senior Social Worker in the Adolescent and Adult Day Hospital at The New York Hospital-Cornell Medical Center, in White Plains, New York.He was a psychiatric resident at The New York Hospital-Cornell Medical Center, in White Plains, New York, during the time the clinical work of this paper was undertaken.     

WISC short forms with emotionally disturbed children

The complete WISC protocols of 100 emotionally disturbed children were rescored according to 30 selected-subtest and 1 selected-item methodologies and then compared for their correspondence to the standard form. High correlations between all of the short forms and the standard WISC were obtained. However, 16 of the selected-subtest short forms and the selected-item short form resulted in a significantly different mean than the standard. In addition, all short forms resulted in a high percentage of individuals changing IQ classification. Results are interpreted as indicating the inappropriateness of short forms with emotionally disturbed children when individual scores are of prime interest.