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No description available.

Objective: To determine: 1) 12-month prevalence rates of major depressive disorder (MDD) by race, comparing African Americans and Hispanics with whites, while controlling for covariates; 2) if there are any differences in treatment (i.e., pharmacotherapy, provider, and CAM) for MDD among African Americans, Hispanics and whites diagnosed with major depressive disorder (MDD) in the past 12 months; and 3) if there are any racial differences in DSM-IV diagnosed alcohol and/or drug abuse among those with a diagnosis of 12-month MDD. Methods: This retrospective study utilized data from the National Comorbidity Survey-Replication, which was designed to collect information on the mental health status of a nationally representative sample (n = 9282) of U.S. adults. Respondents with an MDD diagnosis in the past 12 months were included. The dependent variables were: 12-month MDD, pharmacotherapy, provider (mental health specialist), CAM and alcohol and/or drug abuse. Pharmacotherapy was examined by assessing respondents’ reported antidepressant use and whether the medication used was an SSRI/SNRI. The primary independent variable was race. Additional covariates included: age, gender, income, education, marital and employment status. Logistic regression was used to address the study objectives. Results: African Americans were significantly less likely to be diagnosed with MDD during the preceding 12-month period, when compared to whites, while controlling for covariates (OR= 0.6, p = 0.0169). Other significant variables for prevalence were female gender (OR= 1.8, p <0.0001), divorced/separated (OR= 2.0, p <0.0001) and not in the labor force (e.g., homemaker/retired) (OR= 1.5, p = 0.0033). Although African Americans and Hispanics reported lower antidepressant use, the results were not significant. With respect to SSRIs/SNRIs, African Americans reported significantly lower use, when compared to whites (OR= 0.3, p = 0.0309). Hispanics in the study were less likely to see a mental health professional (OR = 0.2, p = 0.0002). CAM use was significantly lower among individuals with less than 12 years, 12 years and 13 to 15 years of education (OR = 0.3, p = 0.0110; OR = 0.3, p = 0.0035; OR = 0.7, p = 0.0368, respectively) when compared to respondents with 16 years or more of education. When examining alcohol and/or drug use in those with diagnosed MDD in the preceding 12 months, females were less likely to be abusers (OR = 0.4, p = 0.0204). Conclusion: Among respondents with a diagnosis of MDD, race plays an important role in the types of treatment utilized to manage the disorder. Considering, the disability associated with depression, greater efforts are needed to improve antidepressant therapy for African Americans and mental health specialty treatment for Hispanics. / text

Postnatal depression (PND) is a serious and debilitating condition that disrupts women's lives at a time when they are already under stress, adapting to the substantial demands having a baby creates. PND is linked with adverse effects on the development of the child and the family system, including poor marital adjustment and elevated levels of depression in male partners. Implications, not only for men's health, but also for the amount and quality of support men can provide for their partners and children are far-reaching. Preventative programmes for the treatment of PND have been widely advocated, but are rare in the literature. Even fewer, are treatment programmes that include male partners. This study compared the efficacy of a structured Cognitive Behavioural Therapy (CBT) programme for the treatment of PND, delivered in 3 different ways, within an Australian semi-rurallcoastal community. Thirty-nine women, diagnosed with PND, completed 10 weeks of either 'individual' (n=9), 'group women only' (n=16) or 'group partners involved' (n=14) intervention and were compared with a control support group (n=7). Pre-intervention, women in the study reported the presence of a number of psychosocial risk factors for PND and almost 20% of the men in this sample were also depressed according to the BDI-II. Partners of the women in the 'group partners involved' treatment completed a 6-week CBT group programme especially designed for men (n=13). Partners of the women involved in the other interventions acted as a control group (n=16). Depression, anxiety, parenting stress, relationship adjustment and social support measures were taken using standardized instruments at pre-intervention, post-test and at 3- and 6-month follow-up. Qualitative information about the experiences of PND and the intervention programme was obtained through focus group interviews. The intervention programme was evaluated by questionnaire by both participants and their general practitioners or allied health professionals who had referred them to the programme. Results indicated that, overall, the 10-week, structured CBT programme was far more effective in treating PND than attending a support group. Over time, group therapy outperformed individual therapy for depression and anxiety. Including partners in intervention meant significantly improved outcomes at 6-month follow-up for depression, anxiety and relationship adjustment for women. When male partners were included, women's social support levels were significantly higher at 3-month follow-up. Post-intervention men who participated in the men's group were significantly less depressed and stressed, and showed higher levels of social support than controls. The intervention programme was rated highly by both participants and referrers for effectiveness and acceptability, with the psychoeducational information and CBT strategies rated as the most useful components. Participants viewed the inclusion of male partners in PND treatment as fundamental and strongly recommended increased community and professional awareness of PND and its consequences. The important implications for clinical practice and resource allocation raised by this study are addressed.

Background: Depression within the older adult population is common. Previous reviews of the literature have considered the efficacy of psychological therapies for older adults. However, they have exclusively focussed on evidence provided by randomised controlled trials neglecting emergent evidence from other therapeutic modalities. Despite the efficacy of psychological and pharmacological treatments many depressed older people go without treatment. The barriers to treatment remain unclear, however the literature has previously suggested that they may fall within three factors; patients, health care providers and health care organisations. This study focussed on patient related factors. The literature has suggested that older adults not be as accurate in recognising symptoms of depression than adults of working age. In turn, lack of recognition of the presence of a mental health problem may influence older adult’s attitudes to seeking psychological help. The literature suggests a number of factors may influence treatment seeking attitudes in older people. These may include accuracy of depression recognition, cognitive fusion; engagement in valued activities although these did not appear to have previously been considered. Aims: The aims of this thesis were addressed by the systematic review of the literature and empirical research paper comprising it. Systematic review aimed, in light of a recent efficiency target issued by the The Scottish Government to update the literature relating to the efficacy of standalone psychological therapies for older adults and to consider the efficiency implications of the results. The empirical article had two overall aims. It sought to determine the predictive effect of attitudes to ageing and degree of depression on older adult’s ability to conceptualise their symptoms of psychological distress as depression. This study also sought to consider, in light of a paucity of empirical evidence to date, the relative predictive effect of attitudes to ageing, depression, recognition of depression symptoms, cognitive fusion and engagement in valued activities on the treatment seeking attitudes of a cohort of depressed older adults. Method: A systematic review of the literature was undertaken to consider the efficacy and efficiency of psychological therapies in the treatment of late life depression. An empirical cross sectional survey recruiting older adults (n = 281), aged ≥ 65 years was undertaken to examine the effects of depression, cognitive fusion, attitudes to ageing, and valued behaviour on attitudes to seeking professional psychological help. Results: In the systematic review, of the 1493 articles identified 11 were retained for review. Papers reviewed considered the effectiveness psychological interventions including: Cognitive Behavioural Therapies, Reminiscence Therapies, Acceptance and Commitment Therapy and Problem Solving Therapy. The results of the statistical analysis in the empirical work suggested that a significant proportion of ‘depressed’ older adults (n = 43) recruited to our study were not able to recognise they were depressed at the time of their participation in the study. A binomial logistic regression suggested that depression severity rather than attitudes to ageing predicted depression recognition in this sample. A hierarchical multiple regression undertaken to analyse the predictive influence of depression, depression recognition, cognitive fusion, attitudes to ageing and engagement in valued activities suggested that non of these variables significantly predicted our sample’s attitudes to seeking professional psychological help. Conclusions: Our results demonstrate that there is increasing evidence that some psychological therapies could be offered as alternatives to antidepressant medication for older people and within an efficient model of stepped care. The results of the empirical element of this project suggest that attitudes to ageing and cognitive fusion are both predictors of attitudes to treatment seeking. The results further suggest that many depressed older people don’t recognise when they are depressed suggesting a lack of mental health. These findings suggest several implications for clinical practice, psychological therapies and public health.

Indiana University-Purdue University Indianapolis (IUPUI) / Depression is a heterogeneous mental health condition, varying in presentation across individuals. A candidate etiology that may help account for this heterogeneity is the neurotrophin hypothesis of depression, which proposes that stress downregulates brain-derived neurotrophic factor (BDNF) expression, leading to aberrant neurogenesis and depression. This etiology may manifest in a distinct symptom profile that may be reflected in depressive symptoms or symptom clusters. The effect of psychological interventions on BDNF is not known. Additionally, it is not known if BDNF levels mediate intervention effects on depressive symptom clusters. Using data from the eIMPACT trial (NCT02458690, supported by R01 HL122245), I examined baseline associations of BDNF with depressive symptoms and depressive symptom clusters. Also, I examined if the modernized collaborative care intervention for depression (internet CBT, telephonic CBT, and select antidepressant medications) affected BDNF and if changes in BDNF mediated intervention effects on cognitive/affective and somatic depressive symptom clusters. 216 participants (primary care patients with depression and elevated cardiovascular disease risk ≥50 years from a safety net healthcare system) were randomized to 12 months of the eIMPACT intervention (n=107) or usual primary care for depression (primary care providers supported by embedded behavioral health clinicians and affiliated psychiatrists; n=109). Plasma BDNF was measured with commercial ELISA kits. Depressive symptoms were assessed by the PHQ-9 (M=15.1, SD=5.0) from which cognitive/affective and somatic subscale scores were computed. No significant baseline associations were observed between BDNF and individual depressive symptoms or depressive symptom clusters. The intervention did not improve BDNF over 12 months. Similarly, 12-month changes in BDNF were not associated with 12-month changes in PHQ-9 cognitive/affective or somatic subscale scores. However, the intervention significantly improved PHQ-9 cognitive/affective and somatic subscale scores over 12 months. 12-month changes in BDNF did not mediate the effect of the intervention on 12-month changes in the PHQ-9 subscale scores. These findings suggest that modernized collaborative care for depression does not improve BDNF. Modernized collaborative care does yield improvements in both cognitive/affective and somatic depressive symptom clusters, albeit not via changes in BDNF.

Master of Science / School of Family Studies and Human Services / Joyce Baptist / This study examined the efficacy of EMDR therapy as a treatment for unipolar depression. Results provide preliminary evidence for the efficacy of EMDR therapy. Of the 12 participants that received 10 sessions of EMDR therapy, four met the criteria for “Recovered,” six “Improved” and two reported no change in severity of depressive symptoms. Results further indicated that participants who experienced decline in depressive symptoms within the first six sessions of treatment had a higher probability to be meet the criteria for “Recovered.” A small sample comparison between EMDR therapy (n = 4) and CBT (n = 4) did not find any significant difference in terms of treatment outcome. In phase 2, participants in both groups either improved or recovered after 10 sessions of treatment. Sudden gains analysis indicated that 5 out of 12 EMDR therapy participants had sudden gains. Participants in sudden gains group were more likely to meet “Recovered” criteria than participants in no-gains group. Examination of attention bias found that depression was positively related to negative affect fixation duration and negatively related to positive affect fixation duration when only using female affect images. These findings support previous research that used attention bias to differentiate depressed and non-depressed persons. Clinical implication and further research are discussed.

M.A. (Counseling psychology) / The primary objective of this research was to combat and where possible obviate depression amongst young adult females by means of a psycho-educational program developed by the researcher. A secondary objective of the study was to develop a behaviour evaluation questionnaire intended to evaluate perceivable depressive behaviour. In this research a pretest-posttest research design was employed. The sample comprised 50 first year matriculated female students who entered for a youth worker course of the Apostolic Faith Mission of South Africa for 1990. The 50 women were allocated to five groups of 10 each from which three experimental and two control groups were randomly selected. It was anticipated that the psycho-educational program would bring about a statistical significant improvement in the mood and self concept of the experimental group. The Beck Depression Inventory (BDI) and "Ridgard-gedragsevalueringsvraelys" (RGV), the latter completed by a supervisor, were utilized to determine depression amongst the students. The "Adolessente Selfkonsepskaal" (ASKS) of Vrey was also used to evaluate self concept in the groups.

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O objetivo deste estudo foi realizar uma analises econômica dos fármacos antidepressivos aplicáveis no tratamento da distimia, objetivando o uso racional de fármacos. O debate a cerca da competição alegada aos novos fármacos antidepressivos (SSRI e atípicos) e os antigos, menos dispendiosos como TCAs e IMAOs têm implicações para a prática clínica e prescrições. Distimia é uma depressão de natureza crônica mas de menor severidade que a depressão maior. Vários tratamentos com diferentes fármacos têm sido propostos, mas em decorrência de muitas variáveis, não é possível até o presente momento determinar qual o tratamento de escolha . A conclusão foi que a escolha do fármaco deve ser realizada levando-se em conta características individuais, efeitos colaterais e custos. / The objective of this study was to do the economic analyses of antidepressant drugs support for the treatment of dysthymia for the rational use perspective of antidepressants d rugs. The debate over the competing claims newer antidepressants drugs (SSRIs and atypical) and the older, cheaper TCAs and IMAOs has implications for clinical practive and prescribing expenditure. Dysthymia is a depressive disorder of chronic nature but of less severity than major depression. Many d rug treatments have been proposed for the treatment of dysthymia, but with so many potencial comparisons it is not possible at the present time to determine which is the treatment of choice. The conclusion was that the choice of drug must be made maching patient individual characteristics, side-effects and costs.