摘要 :
Objectives: This study investigated trajectories of mothers' and fathers' depressive symptoms from prenatal to 24 months postpartum. Prenatal correlates of the trajectories were also examined.
摘要 :
Introduction Depression is a common comorbidity in multiple sclerosis. Depression in MS often requires treatment due to its negative impact on quality of life, functioning, and MS outcomes. However, there have been very few random...
展开
Introduction Depression is a common comorbidity in multiple sclerosis. Depression in MS often requires treatment due to its negative impact on quality of life, functioning, and MS outcomes. However, there have been very few randomized controlled trials of treatment of depression in MS. Most reviews of this topic have consequently presented a predominantly negative assessment of antidepressant treatment, concluding, for example, that there is insufficient evidence to guide treatment or that evidence only exists for a few uncommon antidepressant medications or forms of treatment. Areas covered This review will provide a summary of currently available literature on depression in MS, with an emphasis on the clinical utility of available information. This includes information from published therapeutic trials, but also how general aspects and principles of depression treatment can guide neurotherapeutics in this area. Expert opinion Management of depression in MS should be guided primarily by available evidence on depression treatment and not exclusively by the small and inadequate literature of randomized controlled trials. Differential diagnosis is important since depression manifests across a broad spectrum of morbidity in MS, a reality that has real-world implications for treatment. Basic guiding principles can support management of depression in people with MS.
收起
摘要 :
Depression is a significant health issue for women of reproductive age. A number of professional organizations have issued guidance regarding perinatal depression screening. However, some health care providers are reluctant to scr...
展开
Depression is a significant health issue for women of reproductive age. A number of professional organizations have issued guidance regarding perinatal depression screening. However, some health care providers are reluctant to screen women. This column takes a second look at two recent research studies in which investigators examined the barriers to and facilitators of perinatal depression screening.
收起
摘要 :
Postpartum depression (PPD) is an important mental health issue affecting approximately 10 % of women. Self-report screening measures represent utility for detecting PPD in both clinical and research settings. The current study so...
展开
Postpartum depression (PPD) is an important mental health issue affecting approximately 10 % of women. Self-report screening measures represent utility for detecting PPD in both clinical and research settings. The current study sought to inspect the accuracy of two screening measures compared to clinical interviews. As part of an ongoing clinical trial, 1,392 women between the ages of 18 and 45 were screened for PPD using the Patient Health Questionnaire-9 (PHQ-9) and a six-item scale developed from CDC Pregnancy Risk Assessment questions (PRAMS-6). Three item subscales of the PRAMS-6 were also inspected - three depression (PRAMS-3D) and three anxiety items (PRAMS-3A). Receiver operating characteristics compared the diagnostic accuracy of the PHQ-9, PRAMS-6, PRAMS-3D, and PRAMS-3A to both the Structured Clinical Interview for the DSM-IV (SCID) and the Hamilton Rating Scale for Depression. The PHQ-9, PRAMS-6, and PRAMS-3D all showed moderate accuracy at diagnosing PPD. Diagnostic cut points are provided. The PRAMS-6 instrument is a brief and effective screening tool for PPD. The time frame of symptom assessment may account for some variability in accuracy between the PHQ-9 and PRAMS screening instruments.
收起
摘要 :
Depression is a heterogeneous disorder with a wide range of presentations. Most patients with depression are seen in primary care, where it is often unrecognized; thus, screening for depression is important. Medical conditions can...
展开
Depression is a heterogeneous disorder with a wide range of presentations. Most patients with depression are seen in primary care, where it is often unrecognized; thus, screening for depression is important. Medical conditions can mimic depression and vice versa. For mild cases of depression, symptom monitoring and nonpharmacologic strategies are generally recommended initially, whereas psychotherapy and antidepressant drugs are first-line treatment for moderate to severe cases. Patients with depression often experience relapse, recurrence, or both, and multiple options are available. Primary care providers are central to screening, diagnosing, and subsequently treating or referring these patients. (C) 2020 Elsevier Inc. All rights reserved.
收起
摘要 :
Background/objectives/introduction Depression during pregnancy or postpartum carries the same risks as general depression as well as additional risks specific to pregnancy, infant health and maternal well-being. The purpose of thi...
展开
Background/objectives/introduction Depression during pregnancy or postpartum carries the same risks as general depression as well as additional risks specific to pregnancy, infant health and maternal well-being. The purpose of this study is to document the prevalence of depression symptoms and diagnosis during pregnancy and in the first 3 months postpartum among a cohort of women receiving prenatal care in a large health system. Secondarily, we examine variability in screening results and diagnosis by race, ethnicity, language, economic status and other maternal characteristics during pregnancy and postpartum. Patients/materials and methods A retrospective study with two cohorts of patients screened for depression during pregnancy and postpartum. Out of 7807 patients with at least three prenatal care visits and a delivery in 2016, 6725 were screened for depression (87%) at least once during pregnancy or postpartum. Another 259 were excluded because of missing race data. The final sample consisted of 6523 prenatal care patients who were screened for depression; 4914 were screened for depression in pregnancy, 4619 were screened postpartum (0–3 months). There were 3010 screened during both periods who are present in both the pregnancy and postpartum cohorts. Depression screening results are from the Patient Health Questionnaire (PHQ-9) and diagnosis of depression was measured using ICD codes. For patients screened more than once during either time period, the highest score is used for analysis. Results Approximately, 11% of women had a positive depression screen as indicated by an elevated PHQ-9 score (>10) during pregnancy (11.3%) or postpartum (10.7%). Prevalence of depression diagnosis was similar in the two periods: 12.6% during pregnancy and 13.0% postpartum. A diagnosis of depression during pregnancy was most prevalent among women who were age 24 and younger (19.7%), single (20.5%), publicly insured (17.8%), multiracial (24.1%) or Native American (23.8%), and among women with a history of depression in the past year (58.9%). Among women with a positive depression screen, Black women were less than half as likely as White women to receive a diagnosis in adjusted models (AOR 0.40, CI: 0.23–0.71, p = .002). This difference was not present postpartum. Conclusions Depression symptoms and diagnoses differ by maternal characteristics during pregnancy with some groups at substantially higher risk. Efforts to examine disparities in screening and diagnosis are needed to identify reasons for variability in prenatal depression diagnosis between Black and White women. Key messages Women who were young, single, have public insurance, and women who identify as multiracial or non-Hispanic (NH) Native American were most likely to have a positive depression screen or a diagnosis for depression. After adjustment for confounders, NH Black women with a positive depression screen were about half as likely to have a diagnosis of depression during pregnancy as NH White women. Awareness of the differing prevalence of depression risk screening results, diagnoses and potential for variation in diagnosis may identify opportunities to improve equity in the delivery of essential mental health care to all patients.
收起
摘要 :
We characterized depressive symptoms in the prenatal and/or postpartum periods and examined associated risk factors among 594 women who received care at community health care centers. Women were screened with comprehensive risk as...
展开
We characterized depressive symptoms in the prenatal and/or postpartum periods and examined associated risk factors among 594 women who received care at community health care centers. Women were screened with comprehensive risk assessments, which included the Patient Health Questionnaire-9 depression screen, during pregnancy and at least 4 weeks after delivery. Fifteen percent had depressive symptoms in the prenatal period only; 6 % in the postpartum period only, and 8 % had depressive symptoms in both periods. Risk markers varied for women who reported depressive symptoms at one period only compared with those who reported persistent depressive symptoms. Age (25 years versus younger), having experienced abuse, not living with the infant's father, and cigarette smoking were associated with depressive symptoms at both periods; being US-born, lacking social support, and experiencing food insecurity were associated with reporting symptoms only in the prenatal period, and lack of phone access was associated with risk only in the postpartum period. Our findings confirm the importance of repeated screenings for depressive symptoms during the perinatal period. The variability in risk markers associated with periods of reported depressive symptoms may reflect their varying associations with persistence, new onset, or recovery from depressive symptoms.
收起
摘要 :
Elucidating the true structure of depression is necessary if we are to advance our understanding and treatment options. Central to the issue of structure is whether depression represents discrete types or occurs on a continuum. Na...
展开
Elucidating the true structure of depression is necessary if we are to advance our understanding and treatment options. Central to the issue of structure is whether depression represents discrete types or occurs on a continuum. Nature almost universally operates on the basis of continuums, whereas human perception favors discrete categories. This reality might be formalized into a 'continuum principle': natural phenomena tend to occur on a continuum, and any instance of hypothesized discreteness requires unassailable proof. Research evidence for discrete types falls far short of this standard, with most evidence supporting a continuum. However, quantitative variation can yield qualitative differences as an emergent property, fostering the appearance of discreteness. Depression as a continuum is best characterized by duration and severity dimensions, with the latter understood in terms of depressive inhibition. In the absence of some degree of cognitive, emotional, social, and physical inhibition, depression should not be diagnosed. Combining the dimensions of duration and severity provides an optimal way to characterize the quantitative and related qualitative aspects of depression and to describe the overall degree of dysfunction. The presence of other symptom types occurs when anxiety, hypomanic/manic, psychotic, and personality continuums interface with the depression continuum. (C) 2014 S. Karger AG, Basel
收起
摘要 :
The identification of depression poses significant clinical challenges to physicians, parents and teachers. Symptoms of depression may differ from those of the adult depression. Clinical depression varies in the nature and intensi...
展开
The identification of depression poses significant clinical challenges to physicians, parents and teachers. Symptoms of depression may differ from those of the adult depression. Clinical depression varies in the nature and intensity of its presenting symptoms. It may present with the cardinal symptoms of major depressive disorder. It often goes unidentified and undiagnosed when it presents as masked depression or depressive equivalents.
收起
摘要 :
This article discusses characteristic factors in the presentation of depressive disorders in persons older than age 65 years. Clinical presentation is discussed along with risk and protective factors. Detailed descriptions of test...
展开
This article discusses characteristic factors in the presentation of depressive disorders in persons older than age 65 years. Clinical presentation is discussed along with risk and protective factors. Detailed descriptions of tests useful for screening and diagnosis of depression in the elderly are presented. Each test is reviewed according to time to administer, sensitivity and specificity, outcomes, advantages, and disadvantages. The importance of clinical history and the diagnostic interview, as well as the role of laboratory studies and neuroimaging in the clinical evaluation are discussed.
收起
原文获取