Relationship between severity of obesity and mental health: an Australian community survey

Introduction
In Australia the incidence of obesity is increasing rapidly and has become a significant public health concern. In addition to the many physical consequences of obesity many studies have reported significant mental health consequences, including major depression, mood and anxiety disorders. The purpose of this study was to explore the relationship between severity of obesity and perceived mental health in an Australian community sample.

Methods
A cross-sectional survey design was used. A total of 118 participants, aged between 19 and 75 years with a body mass index (BMI) ≥ 30 kg/m2 returned a completed questionnaire. The SF-36 Health Survey, Kessler Psychological Distress Scale, Social Interaction Anxiety Scale and the Multidimensional Scale of Perceived Social Support were used.

Results
After adjusting for age, gender, perceived social support and physical health quality of life, obesity was not significantly associated with mental health quality of life (SF-36). The strongest factor influencing mental health was perceived physical health. Mediation analyses suggest that physical health mediates the relationship between obesity and mental health quality of life.

Discussion
Our findings support the view that physical health mediates the relationship between obesity and mental health. Public health interventions should focus on reducing the impact of obesity on physical health by encouraging participation in healthy lifestyles, which in turn, may improve mental wellbeing.

The relationship between suicide and violence in schizophrenia: analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) dataset

Background

Suicide and violence often co-occur in the general population as well as in mentally ill individuals. Few studies, however, have assessed whether these suicidal behaviors are predictive of violence risk in mental illness.

Aims

The aim of this study is to investigate whether suicidal behaviors, including suicidal ideation, threats, and attempts, are significantly associated with increased violence risk in individuals with schizophrenia.

Method

Data for these analyses were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trial, a randomized controlled trial of antipsychotic medication in 1460 adults with schizophrenia. Univariate Cox regression analyses were used to calculate hazard ratios (HRs) for suicidal ideation, threats, and attempts. Multivariate analyses were conducted to adjust for common confounding factors, including: age, alcohol or drug misuse, major depression, antisocial personality disorder, depression, hostility, positive symptom, and poor impulse control scores. Tests of discrimination, calibration, and reclassification assessed the incremental predictive validity of suicidal behaviors for the prediction of violence risk.

Results

Suicidal threats and attempts were significantly associated with violence in both males and females with schizophrenia with little change following adjustment for common confounders. Only suicidal threats, however, were associated with a significant increase in incremental validity beyond age, diagnosis with a comorbid substance use disorder, and recent violent behavior.

Conclusions

Suicidal threats are independently associated with violence risk in both males and females with schizophrenia, and may improve violence risk prediction.

Treatment response for acute depression is not associated with number of previous episodes: lack of evidence for a clinical staging model for major depressive disorder

Mental illness has been observed to follow a neuroprogressive course, commencing with prodrome, then onset, recurrence and finally chronic illness. In bipolar disorder and schizophrenia responsiveness to treatment mirrors these stages of illness progression, with greater response to treatment in the earlier stages of illness and greater treatment resistance in chronic late stage illness.

Using data from 5627 participants in 15 controlled trials of duloxetine, comparator arm (paroxetine, venlafaxine, escitalopram) or placebo for the treatment of an acute depressive episode, the relationship between treatment response and number of previous depressive episodes was determined. Data was dichotomised for comparisons between participants who had >3 previous episodes (n=1697) or ≤3 previous episodes (n=3930), and additionally for no previous episodes (n=1381) or at least one previous episode (n=4246). Analyses were conducted by study arm for each clinical trial, and results were then pooled.

There was no significant difference between treatment response and number of previous depressive episodes. This unexpected finding suggests that treatments to reduce symptoms of depression during acute illness do not lose efficacy for patients with a longer history of illness.

The clinical application of three screening tools for recognizing post-partum depression

Postnatal depression is a major health issue for childbearing women world-wide, as it is not always identified early. This study aimed to evaluate the clinical application of three screening instruments for the early recognition of post-partum depression, the Postpartum Depression Prediction Inventory, the Postpartum Depression Screening Scale and the Edinburgh Postnatal Depression Scale, and to examine nurse interventions following use of the instruments. Data were collected at two points, at 28 weeks prenatal (107 women) and eight weeks postnatal (84 women). Results showed that 17% of the women scored significant symptoms of post-partum depression and 10–15% had a positive screen for major postnatal depression. There was a statistically significant correlation between the total score on the Postpartum Depression Screening Scale and the Edinburgh Postnatal Depression Scale. Of those eight women identified as being at risk, seven had received anticipatory guidance and five had received counselling by the nurses. The Postpartum Depression Prediction Inventory enabled nurses to identify women at risk of post-partum depression and offer interventions.

Treatment of depression in low-level residential care facilities for the elderly

Background: The rate of recognition and treatment of depressed older people in nursing homes is low. Data from the low-level residential care population have not been reported. This study aimed to collect information about the treatment of depression among older persons living in low-level residential care (hostels).

Method: The participants comprised 300 elderly residents from ten low-level residential care facilities from various suburbs in metropolitan Melbourne. The participants were interviewed by a trained clinical psychologist to determine the presence or absence of major or minor depressive disorder using the Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I). Each participant was also administered the Standardized Mini-mental State Examination (SMMSE) to determine level of cognitive function. The clinical psychologist then reviewed all cases in consultation with a geropsychiatrist experienced in the diagnosis of depression among older people, prior to assigning a diagnosis of depression.

Results: An important finding in this study was the low treatment for currently depressed residents, with less than half of those in the sample who were depressed receiving treatment. However, 61 of the 96 residents out of the sample of 300 who were on antidepressants were not currently depressed.

Conclusion: There is an under recognition and under treatment of currently depressed older people in low-level residential care facilities (hostels) just as has been reported in studies in nursing homes. However, there are high numbers receiving antidepressants who are not currently depressed.

Health behaviors among individuals with schizophrenia and depression

This article presents findings from a study that evaluated the utility of Protection Motivation Theory to explain cardiovascular health behaviors among people with schizophrenia (n = 83) and depression (n = 70). Results indicated that the prevalence of overweight, cigarette smoking and a sedentary lifestyle were greater among people with a mental illness compared to individuals without a mental illness. Major predictors were high levels of fear of cardiovascular disease, lack of knowledge of correct dietary principles, lower self-efficacy, limited social support and psychiatric symptoms. Implications of these results are discussed in designing education and preventive health programs for individuals with schizophrenia and Mental Depressive Disorder (MDD).

Subjective wellbeing, homeostatically protected mood and depression : a synthesis

This paper concerns the idea that Subjective Wellbeing (SWB) is managed by a system of psychological devices which have evolved for this purpose. It is proposed that this management is actually directed at the protection of Homeostatically Protected Mood, as the major component of SWB. We normally experience HPMood as a combination of contentment, happiness and positive arousal. A theoretical description of this construct is offered that can account for many of the commonly observed empirical characteristics of SWB data. It is further proposed that when homeostasis fails, due to the overwhelming nature of a negative challenge, people lose contact with HPMood and experience the domination of negative rather than positive affect. If this condition is chronic, people experience the clinical condition we call depression.

Anger and aggression in the presence of anxiety and depression

This portfolio considers major theories of aggression and relates them to four individual case studies. Each client has difficulties with anger and aggression and all had additional emotional difficulties, specifically depression and anxiety.

Depression and pain : an overview

Background: Depression and pain are both burdensome ailments that affect a major proportion of the population. It is evident that depression and pain frequently coexist, with treatment and outcome implications.

Objective: To review the literature on the nature, prevalence and co-morbidity of depression and pain, the biological and psychological mechanisms involved and treatment options, thus presenting a broad overview of the current information available.

Methods: Relevant sources were identified from PubMed and Medline databases using a combination of keywords including depression, pain, prevalence, co-morbidity, biological and psychological mechanisms, serotonin (5-HT), norepinephrine (NE), hypothalamic-pituitary-adrenal (HPA) axis, amygdala, functional magnetic resonance imaging (fMRI), antidepressant and psychological therapy.

Results: It is evident from the research that depression and pain are common co-morbidities. Pain as a physical symptom of depression affects approximately 65% of patients, leading to less favourable outcomes and greater health care utilization. Moreover, depression is a common feature in chronic pain patients and can affect pain threshold and tolerance. Evidence from biological and psychological studies has revealed mechanisms that link chronic pain to depression. Several classes of anti-depressants and psychological interventions have been used successfully in the treatment of somatic symptoms of depression and for a variety of pain syndromes.

Conclusions: Pain and depression are linked by overlapping phenomenology, neurobiology and therapy. They are mutually interacting, and the interaction has significant treatment and outcome implications.

Combination pharmacotherapy in unipolar depression

It is estimated that between 60 and 80% of those with major depressive disorder do not achieve full symptomatic remission from first-line antidepressant monotherapy. Residual depressive symptoms substantially impair quality of life and add to the risk of recurrence. It is now clear that depression would benefit from more vigorous treatment, in order to ameliorate its disease burden. While there are established algorithms in situations of treatment resistance, the use of combination pharmacotherapy in unipolar depression is a relatively under-investigated area of treatment and may be an effective and tolerable strategy that maximizes the available resources. This paper reviews the current evidence for combination pharmacotherapy in unipolar depression and discusses its clinical applications.

A consensus statement for safety monitoring guidelines of treatments for major depressive disorder

Objective: This paper aims to present an overview of screening and safety considerations for the treatment of clinical depressive disorders and make recommendations for safety monitoring.
Method: Data were sourced by a literature search using MEDLINE and a manual search of scientific journals to identify relevant articles. Draft guidelines were prepared and serially revised in an iterative manner until all co-authors gave final approval of content.
Results: Screening and monitoring can detect medical causes of depression. Specific adverse effects associated with antidepressant treatments may be reduced or identified earlier by baseline screening and agent-specific monitoring after commencing treatment.
Conclusion: The adoption of safety monitoring guidelines when treating clinical depression is likely to improve overall physical health status and treatment outcome. It is important to implement these guidelines in the routine management of clinical depression.

Co-morbid cardiovascular disease and depression : sequence of disease onset is linked to mental but not physical self-rated health. Results from a cross-sectional, population-based study

Purpose: Self-rated health has been linked to important health and survival outcomes in individuals with co-morbid depression and cardiovascular disease (CVD). It is not clear how the timing of depression onset relative to CVD onset affects this relationship. We aimed to first identify the prevalence of major depressive disorder (MDD) preceding CVD and secondly determine whether sequence of disease onset is associated with mental and physical self-rated health. Methods: This study utilised cross-sectional, populationbased data from 224 respondents of the 2007 Australian National Survey of Mental Health and Wellbeing (NSMHWB). Participants were those diagnosed with MDD and reported ever having a heart/circulatory condition over their lifetime. Age of onset was reported for each condition. Logistic regression was used to explore differences in self-rated mental and physical health for those reporting pre-cardiac and post-cardiac depression. Results: The proportion of individuals in whom MDD preceded CVD was 80.36% (CI: 72.57-88.15). One-fifth (19.64%, CI: 11.85-27.42) reported MDD onset at the time of, or following, CVD. After controlling for covariates, the final model demonstrated that those reporting post-cardiac depression were significantly less likely to report poor selfrated mental health (OR:0.36, CI: 0.14-0.93) than those with pre-existing depression. No significant differences were found in self-rated physical health between groups (OR:0.90 CI: 0.38-2.14). Conclusions: MDD is most common prior to the onset of CVD. Further, there is an association between pre-morbid MDD and poorer self-rated mental health. To our knowledge, this is the first time this has been demonstrated in a national, population-based survey. As self-rated health has been shown to predict important outcomes such as survival, we recommend that those with MDD be identified as vulnerable to CVD onset and poorer health outcomes