Objective: To determine patterns of use, prescription medicine costs, office-based visit costs and quality of life (QOL) across classes of antidepressants/psychotherapy in elderly cancer patients. Methods: Medical Expenditure Panel Survey data files from 2005-2015 for cancer patients with depression aged 18 years or older were used for the study. Frequencies of patients under specific classes of antidepressants/psychotherapy were identified. Costs and QOL scores were compared using Analysis of Variance (ANOVA). Generalized linear models, linear/multinomial logistic regression were used for analyses adjusted for demographics, overall health status, number and type of comorbidities. Results: The study sample consisted of 17,671 cancer patients with depression. 32.08% patients had an antidepressant prescribed whereas 15.30% reported psychotherapy. SSRI (62.44%) was the most frequently prescribed class. The prescription and office-based visits costs were adjusted for demographics, overall health status, number and type of comorbidities. These adjusted prescription costs were the highest for SNRI (Mean = $112.92), adjusted office-based (psychotherapy) visit costs were the highest for those receiving psychotherapy only without any antidepressant (Mean = $166.39/visit). QOL scores were higher amongst patients who had combinations of antidepressants prescribed, specifically SSRI with either a TCA or SNRI as compared to those who were prescribed an individual class or those who did not receive any treatment at all. Conclusion: Antidepressants were prescribed more often than psychotherapy amongst cancer patients with depression in the United States. The prescription costs and associated QOL scores were higher amongst those with antidepressants prescribed as compared to those receiving psychotherapy with or without an antidepressant for cancer patients with depression in the United States.

The purpose of this quantitative, nonexperimental study was to analyze and explore the predictors for postpartum depression (PPD) and the strength of these predictors using a secondary data set from the Fragile Families and Child Wellbeing Study from Princeton, Pennsylvania State, and Columbia Universities. By incorporating the biopsychosocial model and feminist theory as the theoretical frameworks for this research, PPD was conceptualized as a serious, multidimensional psychological condition. Using logistic regression, many predictors were identified as etiological for PPD, including subjective attitudes about ideal and introjected characteristics ascribed to women as primary caretakers. These beliefs prevent the extension and acceptance of social support from others, as well as the internalization of negative self-images. Furthermore, it was conceptualized that hormonal influences and lifestyle are risk factors that significantly affect the expression of PPD. According to study results, financial stressors and emotional stressors from a dissatisfaction of parenting were the strongest predictors of PPD among mothers. This study provides an important contribution to the existing literature and enhanced social change initiatives by making public the effect of social supports, biology, and their intersection on emic PPD experiences and expectations using participant's life experiences. Furthermore, this study provides information to the behavioral health and obstetric community that will ensure greater access to postpartum care.

Thesis (M Med (Family Medicine)) -- University of Limpopo, 2010. / Depression commonly Occurs in chronic diseases such as HIV-AIDS and "Depression makes chronic disease worse: WHO", depression is expected to become the second-leading cause of disease burden by the year 2020, after heart disease. Depression can exacerbate chronic disease (WHO, 2007, Kerr L.K. & Kerr L.D., 2001). From the University of New Mexico Health Sciences Center (2009), it has been confirmed that depression is very common in people living with HIV/AIDS and the rate of depression among them was estimated as high as 60%. This was previously confirmed by Moosa and Jeenah (2007).' In Tanzania life events were found to be part in the aetiology of depression and that the rates had increased in recent years (Mbatia et aI., 2009).The authors recommend the strengthening of training of primary health care workers to detect depression and provide pharmacological and psychological treatment. The South African Journal of Psychiatry, states that depression in the world is exceedingly common in the general population. The lifetime prevalence rates are between nine to 20%. In chronic diseases the rate of depression is between 15 to 360/0,which is high. (Moosa & Jeenah, 2007). Untreated depression can lead to missing medication doses and lower the patient's quality of life (aidsinfonet.org, 2009). It has also been established that depression is linked to poor Highly Anti¬retroviral Therapy (HAART) adherence (Kacanek D., Jacobson D.L., Spiegelman D., Wanke c., Isaac R. & Wilson LB., 2010). Primary care based aualitv improvement programs for depression have shown to improve the quality of care, satisfaction with care and health outcomes, functioning, economic productivity and household wealth at reasonable cost (WHO 2010, Kumar & Encinosa W., 2009, Hoberg M.A. et aI., 2008). Study setting The study was conducted in the Rustenburg district of North West province. The comprehensive management of HIV/AIDS is part of the district health system that is implemented in this province. Voluntary Counselling and Testing (VCT) is offered to patients at the clinics or health centre (Primary Health care facilities). A positive rapid test, done in the clinic or health centre, is followed by collection of blood for confirmation, using a second rapid test and two Enzyme linked immuno sorbent assay (ELISA) and assessing CD4 levels at the h.ospital's laboratory. Patients with two rapid tests and two ELISA positives, and a CD4 of less than 200 or clinical stage three, according to revised World Health Organisation (WHO) clinical staging of HIV/AIDS (J.G. Barlett, J.E. Gallant & F.M. Conradie, 2008) are referred to wellness clinic / Job Shimankana Tabane (JST) hospital, for initiation of Anti¬Retroviral Therapy (ART). Once stable on treatment for more than six months, patients are referred down to the nearest clinic or health centre for follow up. Why is the study necessary? As a medical officer at one of the down referral primary health care facilities, the researcher encountered patients who were on antiretroviral therapy, that frequently presented with symptoms consistent with depression but these patients were not aware of the depression. x The researcher became concerned about the lack of identification of depression among adult patients on antiretroviral therapy for human immunodeficiency virus (HIV) in my district, with subsequent lack of appropriate management. After conducting an informal enquiry from some of the patients about symptoms that could be attributed to depression, the researcher became convinced that most of the patients were depressed, although they were not aware of it. The magnitude of the problem had not been explored in Rustenburg before. This is when the researcher decided to conduct a study on screening for depression amongst adult patients on antiretroviral therapy for human immunodeficiency virus in my district. The result of this study will inform the development of protocols used in the provision of comprehensive care to these patients. Methodoloav A descriptive cross-sectional study was conducted amongst adult patients on antiretroviral therapy for Human Immunodeficiency Virus (HIV) who attended one clinic and two health centres, all three accredited in terms of HIV management, in Rustenburg district (South Africa) during December 2009. A hundred and seventeen (117) adult patients, who consulted three Health Centres and agreed to participate in the study were sequentially selected for inclusion in the study. A questionnaire, adapted from the World Health Organization's (WHOs), Zung self-rating depression score by a trained nurse, was used to evaluate depression among the participants. Descriptive analysis of the data was done. The Medical Research, Ethics and Publications Committee (MREC) of the University of Limpopo/ Medunsa campus approved the intended study (Registration Number: MREC/M/29/2009). Results Amongst the 117 participants 81(69.2 %) had mild depression, 2 (1.7%) had moderate depression, 1(0.9 %) had severe depression and 33 (28.2%) did not have depression. Depression was equally common amongst males and females, 77.1% for males and 69.5% for females. Depression was most common on patients taking a regimen that contains efavirens, lamivudine and stavudine. Conclusion Depression is common among adult patients on antlretroviral therapy for Human Immunodeficiency Virus (HIV) attending primary health care facilities in Rustcenburg District. Most of the patients are mildly depressed, as demonstrated by this study research.

Die vorliegende prospektive, monozentrische Beobachtungsstudie einer konsekutiv rekrutierten Kohorte hatte zum Ziel, den Zusammenhang zwischen Depressivität und Schmerzen nach orthopädischen Eingriffen zu untersuchen. Zudem sollte geprüft werden, ob eine bestehende Depressivität vermehrte postoperative Schmerzen vorhersagen kann und umgekehrt präoperative Schmerzen ein Prädikator für postoperative Depressivität sind. Die Stichprobe bestand aus 200 im Zeitraum von Februar 2009 bis Mai 2009 rekrutierten stationär behandelten Patienten der Orthopädischen Klinik König-Ludwig-Haus in Würzburg. Die Patienten waren im Durchschnitt 58,5 Jahre alt. 42% der Teilnehmer waren männlich. Es wurden Patienten eingeschlossen, die sich unterschiedlichen orthopädischen Operationsarten unterzogen. Häufig waren vor allem arthroskopische Schulteroperationen, sowie endoprothetische Versorgungen am Hüft- und Kniegelenk. Die Patienten füllten bei Aufnahme und während ihres folgenden Klinikaufenthaltes Fragebögen zur Schmerzerfassung und zur depressiven Symptomatik (Patient Health Questionnaire, PHQ-9) aus. In der vorliegenden Studie konnte ein längsschnittlicher Zusammenhang zwischen Depressivität und erhöhtem Schmerzlevel nachgewiesen werden. Depressivität ist ein Prädiktor für postoperativen Schmerz, bei Adjustierung für den präoperativen Schmerz. Ebenso ist präoperativer Schmerz ein vorhersagender Faktor für postoperative Depressivität, bei Adjustierung für den präoperativen Wert der Depressivität. Außerdem sagt frühe postoperative Depressivität erhöhte Schmerzlevel bei Entlassung voraus und hohe Schmerzlevel zwei Tage postoperativ eine vermehrte Depressivität vor Entlassung, jeweils nach Adjustierung für den frühen postoperativen Wert des Kriteriums. Da es keine Hinweise für die Priorität des einen Prädiktors über den anderen gibt, ist die Wirkrichtung vermutlich bidirektional. Somit sollte eine postoperative Schmerztherapie sowohl die Therapie der Schmerzen als auch der Depression beinhalten, um suffizient niedrige Schmerzlevel zu erreichen. Schlussendlich sollten experimentelle Studien angefertigt werden, um den möglichen Benefit einer adjuvanten Therapie der Depressivität während der perioperativen Phase auf den postoperativen Schmerz zu untersuchen. / In this prospective cohort study, 200 patients scheduled for orthopedic surgery were enrolled. They were evaluated on different times before and after the surgery. Pain and Depressive Symptoms were monitored (VAS and PHQ). Cross-lagged multiple regression analyses were performed. As we already know from other studies, we found significant links between depressive symptoms and perioperative pain, within a time point and across time intervals. No causal priority of one factor over the other was evident. Our results suggest that early postoperative depressive symptoms predicts pain at discharge and preoperative pain predicts postoperative depressive symptoms. The evidence regarding the causal relationships between depressive symptoms and perioperative pain, however, must be tested in future research.

Bei Erwachsenen ist ein Zusammenhang zwischen Depressionen und Herzerkrankungen bekannt. Als möglicher Mechanismus hierfür gilt eine Veränderung der kardialen autonomen Funktion, messbar über eine verminderte Herzfrequenzvariabilität (HRV) und eine höhere Herzfrequenz. Es finden sich in der Literatur erste Hinweise, dass auch bei Kindern und Jugendlichen mit Depressionen Veränderungen der kardialen autonomen Regulation zu beobachten sind. In der vorliegenden Studie an der Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie Würzburg wurde erstmals die kardiale autonome Funktion bei depressiven Kindern und Jugendlichen mit Hilfe von Langzeit-EKGs untersucht. Geprüft wurde hierbei, ob depressive Störungen im Kindes- und Jugendalter mit einer gestörten kardialen autonomen Regulation in Form einer verminderten HRV und einer erhöhten Herzfrequenz vergesellschaftet sind. Zudem wurde der Einfluss einer antidepressiven Therapie untersucht. Die Ergebnisse der Studie zeigen, dass depressive Kinder und Jugendliche im Vergleich zu gesunden eine signifikant höhere mittlere Herzfrequenz im Langzeit-EKG aufweisen. Zudem hatten sie leicht verminderte HRV-Parameter, wobei dieser Unterschied nicht statistisch signifikant war. Eine Veränderung der HRV oder der Herzfrequenz im Therapieverlauf konnte nicht belegt werden. Weitere größere Studien sind nötig, um die Zusammenhänge zwischen Depressionen und Veränderungen der kardialen autonomen Funktion im Kindes- und Jugendalter zu erforschen. / In adults, a correlation between depression and heart diseases is known. One potential pathophysiological mechanism is the change of the cardiac autonomic function, which can be measured by decreased heart rate variability (HRV) and higher heart rate. There are few first studies indicating that changes of the cardiac autonomic regulation can be observed in depressed children and adolescents, too. In this study at the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (University of Wuerzburg), the cardiac autonomic function in depressed children and adolescents was assessed with long-term ECGs. We examined, if depression in childhood and adolescence is associated with an altered cardiac autonomic regulation with reduced HRV and higher heart rate. Furthermore, we examined the influence of antidepressant treatment. Our Data shows, that depressed children and adolescents have a significantly higher mean heart rate than healthy controls. They had slightly diminished HRV parameters as well. This difference, however, was not statistically significant. There were no changes of HRV or heart rate during the therapy of depression. Further larger studies are needed to clarify the relation between depression and changes of the cardiac autonomic function in childhood and adolescence.

Hintergrund: Kardiovaskuläre Erkrankungen sind die führende Todesursache in Ländern der westlichen Welt. Die Koronare Herzkrankheit (KHK) macht über die Hälfte dieser Todesfälle aus. Obwohl die Risikofaktoren der KHK in den vergangenen Jahrzehnten ausreichend erforscht wurde, ist in in den letzten Jahren ein weiterer potentieller Risikofaktor von Interesse geworden: die Depression. Es konnte gezeigt werden, dass eine gehäufte Komorbidität zwischen KHK und depressiver Symptomatik besteht und dass das gleichzeitige Vorliegen von KHK und Depression mit schlechterer Prognose und erhöhter Mortalität verknüpft ist. Die vorliegende retrospektive Arbeit beschäftigte sich mit dem postoperativen Outcome von Patienten mit depressiver Erkrankung, die sich einem herzchirurgischen Eingriff unterzogen hatten, im Vergleich zu einem Kollektiv psychisch gesunder Patienten. Studienhypothese war, dass Depression das Risiko von postoperativer Mortalität, peri- und postoperativer Komplikationen und stationären Wiederaufnahmen erhöht. Material und Methoden: Insgesamt wurden 294 Patienten, die im Zeitraum von Januar 2008 bis einschließlich März 2013 in der Klinik für Thorax-, Herz- und thorakale Gefäßchirurgie des Universitätsklinikum Würzburg am Herzen operiert wurden, eingeschlossen. Es wurden prä-, peri- und postoperative Daten aus den digitalen Patientenakten, Anästhesie- und Operationsprotokollen erhoben und in Erhebungsbögen festgehalten. An statistischen Test wurden der T-Test und der Chi-Quadrat-Test benutzt. Als primären Endpunkt definierten wir die postoperative 30-Tages-Mortalität. Resultate: In der Gruppe der depressiven Patienten verstarben 8 Patienten und 11 Patienten wurden in der Herz-Thorax-Chirurgie wiederaufgenommen. Wir konnten keinen Unterschied zu den nicht depressiven Patienten feststellen (Mortalität p=0,213, Rehospitalisation p=0,578). Es konnte ein hoch-signifkanter Zusammenhang zwischen Depression und dem Risiko für postoperatives Delir gezeigt werden (p=0,002). Konklusion: Wir konnten keinen Unterschied zwischen der 30-Tages-Letalität und der Rehospitaliseriungsrate nach Herzoperation zwischen präoperativ depressiven und nicht depressiven Patienten feststellen. Wir konnten zeigen, dass Patienten mit präoperativer Depression ein erhöhtes Risiko haben postoperatives Delir zu erleiden. Wir zogen daraus die Schlussfolgerung, dass die Diagnosestellung und Therapie von Depression und depressiver Symptomatik in Patienten mit koronarer Herzkrankheit von klinischer Relevanz ist um eine optimale chirurgische Behandlung zu gewährleisten. / Background: Cardiovascular diseases and especially coronary artery disease (CAD) are the leading cause of mortality in countries of the western world. Although the common risk factors for CAD are well known, in the past years one potential other factor has become of interest: depression. Studies have identified depression as an independent risk factor for development of morbidity and mortality in CAD patients, however the risk for patients undergoing open-heart surgery for CAD is sparsely described in literature. Aim of study was to investigate how peri- and intra-operative complications, 30-day mortality and readmission rate after open-heart cardiovascular surgery for CAD differ in patients with depression from non-depressed patients. Our hypothesis was, that depression is a risk factor for increased 30-day mortality, peri- and intraoperative complications and readmission in open-heart surgery for CAD patients as shown for all CAD patients in litterature. Material and methods: We included 294 patients that underwent open-heart surgery for CAD at the Department of Thoracic and Cardiovascular Surgery at the University Hospital in Würzburg from January 2008 until March 2013. Baseline data was obtained from patient charts as were peri- and intra-operative complications. We used T-test and Chi2 test. The primary endpoint was assessment of 30-day mortality and readmission rate. Results: Eight patients died during follow-up and 11 patients were readmitted within 30-days after surgery for patients with depression and this did not differ from patients without depression (mortality p=0.213, readmission p=0.578). Of over 30 peri- and intraoperative complications included in analysis we identified an association between preoperative depression and risk of postoperative delirium (p=0.002). Conclusion: We found no difference between 30-day mortality and readmission rate between patients with and without depression prior to open-heart cardiovascular surgery. We did identify patients with depression having an increased risk of developing postoperative delirium. We concluded that screening and treatment of depressive symptoms of patients with the need of open—heart cardiovascular surgery is of clinical interest in order to identify and prevent development of postoperative delirium.

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No description available.

Doctor of Philosophy / A large number of neuroendocrine studies indicate a possible relationship between the Hypothalamo-Pituitary-Gonadal (HPG) axis and major depressive illness in men. This observation is not surprising, considering the similarities between the symptom profiles of depression and hypogonadism. However, owing to the strong likelihood that a number of other demographic, clinical and treatment covariates may potentially obscure a possible relationship between HPG and depression, studies in this area have produced somewhat inconsistent results. The main objective of the present study was to investigate the relationship between depression and HPG hormone levels in a population of hospitalised men. Another objective was to examine the relationship of a number of demographic, behavioural, clinical and treatment variables with HPG hormone levels and depression. METHOD: Serum hormones of the HPG axis (Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), Free Testosterone (free T), Total Testosterone (total T) and Sex Hormone Binding Globulin (SHBG)) were compared between fifty-two male patients with Major Depressive Disorder (mean age = 42.04; SD = 14.1) and twenty-five male patients with other psychiatric conditions (mean age = 40.72; SD = 13.8) on admission into hospital. In addition, to elucidate the possible relationship between clinical outcome of depression and gonadal function, HPG parameters were measured in patients with depression 3 to 6 months following discharge. Based on their HDRS (Hamilton Depression Rating Scale) score, patients were categorised as remitters and non-remitters. Demographic, behavioral, clinical and treatment variables were also examined as possible correlates of hormone levels. RESULTS: Comparison between patients with depression and patients with other diagnoses indicated a significantly lower free T and total T in patients with depression. There were no differences in other hormone parameters between the two diagnostic groups. Correlational analyses indicated significant negative relationships between free T and total T and severity as well as duration of depression. Age was inversely correlated to both free T and total T, whereas BMI was negatively correlated with Total T and SHBG. There was a positive relationship between Total T as well as Free T and measures of sexual dysfunction. While no difference in hormone parameters was observed as a function of psychotic features, patients with melancholic features exhibited significantly lower levels of free T and total T compared to patients with no melancholic features. In the multiple regression analyses, age, duration and severity of depression were the strongest predictors of both free and total T. In separate regression analyses somatic features, over and above other features of depression were found to account most in the variability in free T and total T. Longitudinal analysis revealed significantly higher free T and total T levels on follow-up compared to baseline in the patients who remitted. There was no significant change in any of the hormones studies in the non-remitting group. CONCLUSION: The main findings of the present study support previous results that both total and free testosterone levels are lower during depression and that concentrations of free T and total T parallel changes in severity of depressive symptomatology. Further investigations into the mechanism for this observation, and perhaps examinations of testosterone supplementation for treatment of depression are in order.

This thesis explores the utility of Attachment Theory (Bowlby, 1969; 1973; 1980) as a framework for understanding both the personality and cognitive processing styles associated with depression and vulnerability to depression. In two separate but related studies, the present investigation identified depressive personality characteristics and depressive cognitive processing styles associated with each of the styles of adult attachment defined by Bartholomew and Horowitz's (1991) four-category attachment model. Using self-report data from a sample of 305 respondents (225 female; 80 male), Study 1 explored associations among each of the adult attachment styles and sociotropic and autonomous personality-based vulnerabilities to depression (Beck, 1983). Extending the work of Zuroff and Fitzpatrick (1995; Study 2), associations among the attachment styles and the specific components of the two depressive personality styles, as defined by Robins et al. (1994), were examined. Using cued recall of autobiographical memories for a subsample of 44 of the same respondents (35 female; 9 male), Study 2 explored attachment style group differences in autobiographical memory retrieval, thereby identifying specific depressive cognitive processing biases associated with each adult attachment style. Past research has focused on the assessment of memory accessibility, using either recall latency (Mikulincer & Orbach, 1995; Mikulincer, 1998a) or memory generality (Tasker, MacLeod & Maynard, 1996) to indicate accessibility. In the present study, both latency and generality were used as indicators of memory accessibility, and the content of memories was also examined. In addition, use of a four-category rather than a three-category measure of attachment style permitted distinction of cognitive biases for the fearful-avoidant and dismissive-avoidant styles. The present findings support a notion that the two adult attachment styles understood to be characterised by a negative self-view, namely fearful and preoccupied attachment, are associated with depressive vulnerability. Replicating previous findings (Carnelley, Pietromonaco & Jaffe, 1994), both the fearful and preoccupied styles were associated with state depression and with perceptions of negative parental bonding. The fearful style in particular was associated with perceptions of 'affectionless control' in childhood. As the major focus of this thesis, the fearful and preoccupied attachment styles were each associated with both personality styles and cognitive processing deficits which have previously been linked with depression and depressive vulnerability. In terms of personality styles (Study I), the fearful attachment style was broadly associated with the autonomous personality style, whereas the preoccupied attachment style was broadly associated with the sociotropic personality style, as previously demonstrated by Zuroff and Fitzpatrick (1995; Study 2). By focusing on associations with the individual components of the autonomous and sociotropic vulnerabilities, as defined by Robins et al. (1994), the more specific 'depressive' personality characteristics were identified for both these insecure attachment styles. In particular, the findings suggest that a fearful attachment style involves both avoidant and self-critical characteristics, whereas a preoccupied attachment style involves both dependent and self-critical characteristics. In terms of cognitive processing deficits (Study 2), fearful individuals had difficulty accessing autobiographical memories, indicated by delayed memory recall and reduced memory specificity across a range of memory cues. Indeed, these individuals demonstrated a globalised 'mnemonic interlock' typical of depressed individuals (Williams, 1996) and their memories were predominantly negative in content. In contrast, preoccupied individuals demonstrated a ruminative cognitive processing style, indicated by relatively fast recall of predominantly specific and negative memories across a range of memory cues. However, these individuals had difficulty accessing personally-relevant memories of abandonment, arguably due to both encoding and retrieval deficits emanating from their hypersensitivity to abandonment experiences. Dismissive attachment was associated with the avoidant but not the self-critical aspect of the autonomous personality style and involved a repressive cognitive processing style. This repressive style was indicated by delayed recall of specific negative memories. Nonetheless, unlike the fearful and preoccupied styles, dismissive attachment was not shown to be associated with state depression, suggesting that an avoidant attachment style does not necessarily contribute to depressive vulnerability. Instead, dismissive individuals' use of defensive repression of negative affects and memories appears to be an effective coping mechanism in the maintenance of a positive self-concept and a non-self-critical approach. Furthermore, in light of self-narrative models of personality (e.g., McAdams, 1993; Bruhn, 1990; 1992; 1995; Singer & Salovey, 1993), dismissive individuals' easy access to positive memories, particularly personally-relevant memories of independence, can be viewed as maintaining their positive self-concept. Overall, the findings of the present thesis support the proposition that Attachment Theory provides a framework for understanding both the personality and cognitive processing styles associated with depression. Indeed, the findings suggest that the fearful and preoccupied adult attachment styles can both be regarded as constituting vulnerability factors for depression. As expected, the fearful attachment style was highlighted as conferring greater depressive vulnerability. Thus, the findings provide further insight into the factors involved in the onset and maintenance of depression and highlight the importance of assessing adult attachment style during therapy for depression. Other clinical implications, as well as directions for future research, are outlined.