Platelet supersensitivity to thrombin stimulation in depression: a possible mechanism for the association with cardiovascular mortality.

The mortality risk associated with cardiovascular disease is significantly increased in patients with major depression and panic disorder. The mechanism of this phenomenon is unclear. Thrombin is responsible for platelet aggregation and shape change, and it plays a significant role in the development of thromboembolic events. In this study, we examined the platelet second messenger intracellular calcium response to thrombin stimulation in patients with major depression (n = 13), major depression after response to electroconvulsive therapy (ECT; n = 13), subsyndromal depression (n = 16), schizophrenia (n = 15), and control subjects (n = 65). Patients with major depression had significantly higher intracellular calcium responses to thrombin stimulation than control subjects, patients with subsyndromal depression, and patients with schizophrenia (p < 0.05). Electroconvulsive therapy did not significantly change this supersensitivity. This suggests that the platelet response to activation in patients with major depression is supersensitive. This study suggests a possible mechanism for the increased risk of cardiovascular disease that is seen in these two psychiatric disorders. The lack of difference between the control and subsyndromal depression groups appears to validate current diagnostic thresholds in depression. The failure of nonpharmacologic treatment to alter this marker suggests that it may be a trait marker of depression.

Selective serotonin reuptake inhibitors in mixed anxiety-depression.

The overlap between the depressive and anxiety disorders is extremely common. The introduction of the selective serotonin reuptake inhibitors (SSRIs) has, more than any other development, bridged the gap in terms of efficacy in both sets of disorders. A substantial body of data exists suggesting that the available SSRIs have substantial efficacy in anxiety symptoms co-occurring with depression. The clear utility of the SSRIs in disorders classified apart from depression is also established. Whilst panic disorder is the best studied, evidence on the efficacy of the SSRIs in disorders that previously did not attract much pharmacotherapeutic interest, such as social anxiety disorder and post-traumatic stress disorder is accumulating.

Validity of the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease.

Depression is common but frequently undetected in patients with coronary artery disease (CAD). Self-report screening instruments for assessing depression such as the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire-9 (PHQ-9) are available but their validity is typically determined in depressed patients without comorbid somatic illness. We investigated the validity of these instruments relative to a referent diagnostic standard in recently hospitalized patients with CAD.

The impact of whole-of-diet interventions on depression and anxiety: a systematic review of randomised controlled trials

Non-pharmacological approaches to the treatment of depression and anxiety are of increasing importance, with emerging evidence supporting a role for lifestyle factors in the development of these disorders. Observational evidence supports a relationship between habitual diet quality and depression. Less is known about the causative effects of diet on mental health outcomes. Therefore a systematic review was undertaken of randomised controlled trials of dietary interventions that used depression and/or anxiety outcomes and sought to identify characteristics of programme success.

Co-morbid depression and chronic illness related to coping and physical and mental health status

A partial latent structural regression analysis was used to evaluate the role of coping resources, depression, diet and exercise on mental and physical health status. The sample consisted of 113 participants (59 females and 54 males) with a mean age of 59.38 years (SD = 10.52). Coping resources, depression and exercise explained 52 and 26% of the variance in mental and physical health status, respectively. Fewer coping resources predicted higher levels of depression and both predicted worse mental health. Only higher levels of depression predicted worse physical health status. There were also significant indirect effects of coping on mental and physical health status through depression. The development of cognitive, social and emotional coping strategies is important for managing depression and supporting positive mental health. These results highlight the important role of health psychologists in the care of individuals with chronic illness. Additionally, the management of depression is important in maintaining positive physical health.

Long-term efficacy of a tele-health intervention for acute coronary syndrome patients with depression: 12-month results of the MoodCare randomized controlled trial

Depression is common after a cardiac event; however it often remains untreated. Previously, we reported the efficacy and feasibility of a 6-month tele-health programme (MoodCare), which integrates depression management into a cardiovascular disease (CVD) risk reduction programme for Acute Coronary Syndrome (ACS) patients with low mood. Here, we evaluate the long-term efficacy of the programme at 12-month follow-up.

Effect of mood, social connectivity and age in online depression community via topic and linguistic analysis

Depression afflicts one in four people during their lives. Several studies have shown that for the isolated and mentally ill, the Web and social media provide effective platforms for supports and treatments as well as to acquire scientific, clinical understanding of this mental condition. More and more individuals affected by depression join online communities to seek for information, express themselves, share their concerns and look for supports [12]. For the first time, we collect and study a large online depression community of more than 12,000 active members from Live Journal. We examine the effect of mood, social connectivity and age on the online messages authored by members in an online depression community. The posts are considered in two aspects: what is written (topic) and how it is written (language style). We use statistical and machine learning methods to discriminate the posts made by bloggers in low versus high valence mood, in different age categories and in different degrees of social connectivity. Using statistical tests, language styles are found to be significantly different between low and high valence cohorts, whilst topics are significantly different between people whose different degrees of social connectivity. High performance is achieved for low versus high valence post classification using writing style as features. The finding suggests the potential of using social media in depression screening, especially in online setting.

Evaluation of nurses' perceptions of the impact of targeted depression education and a screening and referral tool in an acute cardiac setting.

AIMS AND OBJECTIVES: The aim of this study was to evaluate nurses' perceptions of an education programme and screening and referral tool designed for cardiac nurses to facilitate depression screening and referral procedures for patients with coronary heart disease. BACKGROUND: There is a high prevalence of depression in patients with coronary heart disease that is often undetected. It is important therefore that nurses working with cardiac patients are equipped with the knowledge and skills to recognise the signs and symptoms of depression and refer appropriately. DESIGN: A qualitative approach with purposive sampling and semi-structural interviews was implemented within the Donabedian 'Structure-Process-Outcome' evaluation framework. METHODS: Semi-structured interviews were conducted with 14 cardiac nurses working in a major metropolitan hospital six weeks post-attending an education programme on depression and coronary heart disease. Thematic data analysis was implemented, specifically adhering to Halcomb and Davidson's (2006) pragmatic data analysis, to examine nurse knowledge and experience of depression assessment and referral in an acute cardiac ward. RESULTS: The key findings of this study were that the education programme: (1) increased the knowledge base of nurses working with cardiac patients on comorbid depression and coronary heart disease, and (2) assisted in the identification of depression and the referral of 'at risk' patients. CONCLUSIONS: Emphasis was placed on the translational significance of educating cardiac nurses about depression via the introduction of a depression screening and referral instrument designed specifically for use in the cardiac ward. As a result, participants found they were better equipped to identify depressive symptoms and, guided by the screening instrument, to confidently instigate referral procedures. RELEVANCE TO CLINICAL PRACTICE: Much complexity lies in caring for cardiac patients with depression, including issues such as misdiagnosis. Targeted education, including use of appropriate instruments, has the potential to facilitate early recognition of the signs and symptoms of depression in the acute cardiac setting.

Validation of patient health questionnaire (PHQ) for major depression in Chinese outpatients with multiple somatic symptoms: A multicenter cross-sectional study

Background: Despite the high co-morbidity of depressive symptoms in patients with multiple somatic symptoms, the validity of the 9-item Patient Health Questionnaire (PHQ-9) has not yet been investigated in Chinese patients with multiple somatic symptoms. Methods: The multicenter cross-sectional study was conducted in ten outpatient departments located in four cities in China. The psychometric properties of the PHQ-9 were examined by confirmative factor analysis (CFA). Criterion validation was undertaken by comparing results with depression diagnoses obtained from the Mini International Neuropsychiatric Interview (MINI) as the gold standard. Results: Overall, 491 patients were recruited of whom 237 had multiple somatic symptoms (SOM+ group, PHQ-15 ≥ 10). Cronbach's α of the PHQ-9 was 0.87, 0.87, and 0.90 for SOM+ patients, SOM- patients, and total sample respectively. All items and the total score were moderately correlated. The factor models of PHQ-9 tested by CFA yielded similar diagnostic performance when compared to sum score estimation. Multi-group confirmatory factor analysis based on unidimensional model showed similar psychometric properties over the groups with low and high somatic symptom burden. The optimal cut-off point to detect depression in Chinese outpatients was 10 for PHQ-9 (sensitivity=0.77, specificity=0.76) and 3 for PHQ-2 (sensitivity=0.77, specificity=0.74). Limitations: Potential selection bias and nonresponse bias with applied sampling method. Conclusions: PHQ-9 (cut-off point=10) and PHQ-2 (cut-off point=3) were reliable and valid to detect major depression in Chinese patients with multiple somatic symptoms.