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Thomas E Oxman - One of the best experts on this subject based on the ideXlab platform.
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Problem-solving treatment and coping styles in primary care for Minor Depression.
Journal of Consulting and Clinical Psychology, 2008Co-Authors: Thomas E Oxman, Mark T. Hegel, Jay G Hull, Allen J DietrichAbstract:Research was undertaken to compare problem-solving treatment for primary care (PST-PC) with usual care for Minor Depression and to examine whether treatment effectiveness was moderated by coping style. PST-PC is a 6-session, manual-based, psychosocial skills intervention. A randomized controlled trial was conducted in 2 academic, primary care clinics. Those subjects who were eligible were randomized (N = 151), and 107 subjects completed treatment (57 PST-PC, 50 usual care) and a 35-week follow-up. Analysis with linear mixed modeling revealed significant effects of treatment and coping, such that those in PST-PC improved at a faster rate and those initially high in avoidant coping were significantly more likely to have sustained benefit from PST-PC.
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problem solving treatment and coping styles in primary care for Minor Depression
Journal of Consulting and Clinical Psychology, 2008Co-Authors: Thomas E Oxman, Mark T. Hegel, Jay G Hull, Allen J DietrichAbstract:Research was undertaken to compare Problem-Solving Treatment for Primary Care (PST-PC) to usual care (UC) for Minor Depression and examine whether treatment effectiveness was moderated by coping style. PST-PC is a six-session, manual-based, psychosocial skills intervention. A randomized controlled trial was conducted in two academic, primary care clinics. A total of 141 subjects were eligible and randomized, and 107 completed treatment (57 PST-PC, 50 UC) and a 35-week follow-up. Analysis using linear mixed modeling revealed significant effects of treatment and coping such that those in PST-PC improved at a faster rate, and those initially high in avoidant coping were significantly more likely to have sustained benefit from PST-PC.
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watchful waiting for Minor Depression in primary care remission rates and predictors of improvement
General Hospital Psychiatry, 2006Co-Authors: Mark T. Hegel, Thomas E Oxman, Jay G Hull, Karin Swain, Holly SwickAbstract:Objectives: The objectives of this study were to determine remission rates and predictors of improvement for Minor Depression following a 1-month watchful waiting period in primary care and to describe the watchful waiting processes. Methods: Prior to randomization into a clinical trial for Minor Depression, 111 participants were entered into a 1-month watchful waiting period. Depression severity and predictors of improvement were measured at the start of watchful waiting. At the end of watchful waiting, remission rates were calculated and predictor variables were analyzed for their contribution toward predicting improvement. Results: Remission rates were low, ranging from 9% to 13%, depending on the measure. Avoidant coping style and frequency of engaging in active pleasant events at baseline accounted for the majority of change in Depression. During watchful waiting, about one fifth of the sample (21%) had at least one contact with their physician and 27% reported using self-initiated treatments. Conclusions: There is a low likelihood of spontaneous remission for treatment-seeking samples with Minor Depression in primary care. An avoidant coping style seriously interferes with remission, and engaging in regular active pleasant events confers an advantage. Feasible interventions for primary care that promote activity and decrease avoidant coping styles may improve outcomes. These findings may not generalize to community and non-treatment-seeking samples.
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patient beliefs predict response to paroxetine among primary care patients with dysthymia and Minor Depression
Journal of The American Board of Family Practice, 2003Co-Authors: Mark D Sullivan, Thomas E Oxman, Ellen Frank, James E Barrett, Wayne Katon, Joan Russo, John W WilliamsAbstract:Background: Dysthymia and Minor Depression are common problems in primary care, but it is not known how patient health beliefs shape response to antidepressant treatment of these less severe forms of Depression. Methods: Three hundred thirty-three primary care patients with dysthymia or Minor Depression received at least 4 weeks of paroxetine or placebo in a multicenter, randomized controlled 11-week trial. Patient health beliefs and other characteristics were examined as predictors of treatment adherence and Depression remission. Results: Patient beliefs were not predictive of adherence to paroxetine or placebo. Patients with less endorsement of biological beliefs about their condition (odds ratio [OR] = 3.40), higher perceived general health (OR = 3.38), meeting criteria for dysthymia (OR = 2.37), and age younger than 60 years (OR = 2.68) were more likely to achieve remission on paroxetine. Patient beliefs did not predict remission on placebo. Those with lower severity of Depression symptoms at baseline (OR = 2.70) and women (OR = 2.18) were most likely to achieve remission on placebo. Conclusions: Our results suggest that patients with dysthymia or Minor Depression are more likely to respond to antidepressant medication if they do not see their Depression as a biological illness and see themselves as generally healthy. It is clearly not necessary for patients to believe that their dysthymia or Minor Depression is biological to respond to antidepressant medication.
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treatment of Minor Depression
American Journal of Geriatric Psychiatry, 2002Co-Authors: Thomas E Oxman, Anjana SenguptaAbstract:Minor Depression is one of the most common types of depressive disorders, but the benefit of Depression-specific treatments for Minor Depression is less clear than for major Depression. The authors reviewed the available evidence-base for the treatment of Minor Depression as conceptualized in DSM-IV or RDC, conducting a computer literature search to identify randomized treatment trials that included Minor Depression and a control condition, and identifying 10 studies meeting these criteria. Effect sizes, defined as difference in proportions, could be calculated for eight of the studies, and ranged from 0.46 to −0.08. There was no evidence that older persons were less responsive to treatment than younger persons. Few studies have been specifically designed to test treatments for Minor Depression. The studies are quite variable. Nonspecific treatment factors common to both Depression treatments and to active control conditions appear potent and may be of benefit for persons with Minor Depression.
Lisa A Brenner - One of the best experts on this subject based on the ideXlab platform.
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a longitudinal study of major and Minor Depression following traumatic brain injury
Archives of Physical Medicine and Rehabilitation, 2012Co-Authors: Tessa Hart, Jeanne M Hoffman, Christopher R Pretz, Richard E Kennedy, Allison N Clark, Lisa A BrennerAbstract:Abstract Hart T, Hoffman JM, Pretz C, Kennedy R, Clark AN, Brenner LA. A longitudinal study of major and Minor Depression following traumatic brain injury. Objective To examine patterns of change and factors associated with change in Depression, both major (major depressive disorder [MDD]) and Minor, between 1 and 2 years after traumatic brain injury (TBI). Design Observational prospective longitudinal study. Setting Inpatient rehabilitation centers, with 1- and 2-year follow-up conducted primarily by telephone. Participants Persons with TBI (N=1089) enrolled in the Traumatic Brain Injury Model Systems database, followed at 1 and 2 years postinjury. Interventions Not applicable. Main Outcome Measure Patient Health Questionnaire-9. Results Among participants not depressed at 1 year, close to three fourths remained so at 2-year follow-up. However, 26% developed MDD or Minor Depression between the first and second years postinjury. Over half of participants with MDD at year 1 also reported MDD the following year, with another 22% reporting Minor Depression; thus three fourths of those with MDD at year 1 experienced clinically significant symptoms at year 2. Almost one third of those with Minor Depression at year 1 traversed to MDD at year 2. Polytomous logistic regression confirmed that worse Depression at year 1 was associated with higher odds of Depression a year later. For those without Depression at year 1, symptom worsening over time was related to year 2 problematic substance use and lower FIM motor and cognitive scores. For those with Depression at year 1, worsening was associated with lower cognitive FIM, poor social support, and preinjury mental health issues including substance abuse. Conclusions Major and Minor Depression exist on a continuum along which individuals with TBI may traverse over time. Predictors of change differ according to symptom onset. Results highlight importance of long-term monitoring for Depression, treating Minor as well as major Depression, and developing interventions for comorbid Depression and substance abuse.
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major and Minor Depression after traumatic brain injury
Archives of Physical Medicine and Rehabilitation, 2011Co-Authors: Tessa Hart, Allison N Clark, Lisa A Brenner, Jennifer Bogner, Thomas A Novack, Inna Chervoneva, Risa Nakaserichardson, Juan Carlos ArangolasprillaAbstract:OBJECTIVE: To examine Minor as well as major Depression at 1 year posttraumatic brain injury (TBI), with particular attention to the contribution of Depression severity to levels of societal participation. DESIGN: Observational prospective study with a 2-wave longitudinal component. SETTING: Inpatient rehabilitation centers, with 1-year follow up conducted primarily by telephone. PARTICIPANTS: Persons with TBI (N=1570) enrolled in the TBI Model System database and followed up at 1-year postinjury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FIM, Patient Health Questionnaire-9, Participation Assessment with Recombined Tools-Objective, Glasgow Outcome Scale-Extended, and the Satisfaction With Life Scale. RESULTS: Twenty-two percent of the sample reported Minor Depression, and 26% reported major Depression at 1-year post-TBI. Both levels of Depression were associated with sex (women), age (younger), preinjury mental health treatment and substance abuse, and cause of injury (intentional). There was a monotonic dose-response relationship between severity of Depression and all 1-year outcomes studied, including level of cognitive and physical disability, global outcome, and satisfaction with life. With other predictors controlled, Depression severity remained significantly associated with the level of societal participation at 1-year post-TBI. CONCLUSIONS: Minor Depression may be as common as major Depression after TBI and should be taken seriously for its association to negative outcomes related to participation and quality of life. Findings suggest that, as in other populations, Minor and major Depression are not separate entities, but exist on a continuum. Further research should determine whether people with TBI traverse between the 2 diagnoses as in other patient groups.
Anjana Sengupta - One of the best experts on this subject based on the ideXlab platform.
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treatment of Minor Depression
American Journal of Geriatric Psychiatry, 2002Co-Authors: Thomas E Oxman, Anjana SenguptaAbstract:Minor Depression is one of the most common types of depressive disorders, but the benefit of Depression-specific treatments for Minor Depression is less clear than for major Depression. The authors reviewed the available evidence-base for the treatment of Minor Depression as conceptualized in DSM-IV or RDC, conducting a computer literature search to identify randomized treatment trials that included Minor Depression and a control condition, and identifying 10 studies meeting these criteria. Effect sizes, defined as difference in proportions, could be calculated for eight of the studies, and ranged from 0.46 to −0.08. There was no evidence that older persons were less responsive to treatment than younger persons. Few studies have been specifically designed to test treatments for Minor Depression. The studies are quite variable. Nonspecific treatment factors common to both Depression treatments and to active control conditions appear potent and may be of benefit for persons with Minor Depression.
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status of Minor Depression or dysthymia in primary care following a randomized controlled treatment
General Hospital Psychiatry, 2001Co-Authors: Thomas E Oxman, Anjana Sengupta, Ellen Frank, James E Barrett, Wayne Katon, John W Williams, Mark T. HegelAbstract:Abstract This report describes the rates of recovery and remission from Minor Depression or dysthymia in primary care patients three months after completing a randomized controlled treatment trial. The subjects were primary care patients who received ≥4 treatment sessions with Problem-Solving Treatment, paroxetine, or placebo and who completed an independent assessment 3 months after the study (201 with Minor Depression, 229 with dysthymia). The 17-item Hamilton Rating Scale for Depression (HAMD), semistructured questions about postintervention Depression treatments, and baseline medical comorbidity, neuroticism, and social function were the primary measures. For Minor Depression 76% and for dysthymia 68% of subjects who were in remission at the end of the 11-week treatment trial were recovered (HAMD ≤6) three months after the treatment trial. Of patients who were not in remission at 11 weeks, for Minor Depression 37% and for dysthymia 31% went on to achieve remission at 25 weeks. The majority of patients chose not to use antidepressants or psychotherapy after the trial. Patients with Minor Depression that had greater baseline social function and lower neuroticism scores were more likely to be recovered. For patients with Minor Depression, these findings suggest a need for some matching of continuation and maintenance treatment to patient characteristics rather than uniform, automatic treatment recommendations. Because of the chronic, relapsing nature of dysthymia, practical improvements in encouraging effective continuation and maintenance phases of treatment are indicated.
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treatment of dysthymia and Minor Depression in primary care a randomized trial in patients aged 18 to 59 years
Journal of Family Practice, 2001Co-Authors: James E Barrett, Thomas E Oxman, Ellen Frank, Mark T. Hegel, Wayne Katon, John W Williams, Mark D Sullivan, John E Cornell, Anjana SenguptaAbstract:OBJECTIVE: The researchers evaluated the effectiveness of paroxetine and Problem-Solving Treatment for Primary Care (PST-PC) for patients with Minor Depression or dysthymia. STUDY DESIGN: This was an 11-week randomized placebo-controlled trial conducted in primary care practices in 2 communities (Lebanon, NH, and Seattle, Wash). Paroxetine (n=80) or placebo (n=81) therapy was started at 10 mg per day and increased to a maximum 40 mg per day, or PST-PC was provided (n=80). There were 6 scheduled visits for all treatment conditions. POPULATION: A total of 241 primary care patients with Minor Depression (n=114) or dysthymia (n=127) were included. Of these, 191 patients (79.3%) completed all treatment visits. OUTCOMES: Depressive symptoms were measured using the 20-item Hopkins Depression Scale (HSCL-D-20). Remission was scored on the Hamilton Depression Rating Scale (HDRS) as less than or equal to 6 at 11 weeks. Functional status was measured with the physical health component (PHC) and mental health component (MHC) of the 36-item Medical Outcomes Study Short Form. RESULTS: All treatment conditions showed a significant decline in depressive symptoms over the 11-week period. There were no significant differences between the interventions or by diagnosis. For dysthymia the remission rate for paroxetine (80%) and PST-PC (57%) was significantly higher than for placebo (44%, P=.008). The remission rate was high for Minor Depression (64%) and similar for each treatment group. For the MHC there were significant outcome differences related to baseline level for paroxetine compared with placebo. For the PHC there were no significant differences between the treatment groups. CONCLUSIONS: For dysthymia, paroxetine and PST-PC improved remission compared with placebo plus nonspecific clinical management. Results varied for the other outcomes measured. For Minor Depression, the 3 interventions were equally effective; general clinical management (watchful waiting) is an appropriate treatment option.
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treatment of dysthymia and Minor Depression in primary care a randomized controlled trial in older adults
JAMA, 2000Co-Authors: John W Williams, Ellen Frank, James E Barrett, Wayne Katon, Mark D Sullivan, Tom Oxman, John E Cornell, Anjana SenguptaAbstract:ContextInsufficient evidence exists for recommendation of specific effective treatments for older primary care patients with Minor Depression or dysthymia.ObjectiveTo compare the effectiveness of pharmacotherapy and psychotherapy in primary care settings among older persons with Minor Depression or dysthymia.DesignRandomized, placebo-controlled trial (November 1995–August 1998).SettingFour geographically and clinically diverse primary care practices.ParticipantsA total of 415 primary care patients (mean age, 71 years) with Minor Depression (n = 204) or dysthymia (n = 211) and a Hamilton Depression Rating Scale (HDRS) score of at least 10 were randomized; 311 (74.9%) completed all study visits.InterventionsPatients were randomly assigned to receive paroxetine (n = 137) or placebo (n = 140), starting at 10 mg/d and titrated to a maximum of 40 mg/d, or problem-solving treatment–primary care (PST-PC; n = 138). For the paroxetine and placebo groups, the 6 visits over 11 weeks included general support and symptom and adverse effects monitoring; for the PST-PC group, visits were for psychotherapy.Main Outcome MeasuresDepressive symptoms, by the 20-item Hopkins Symptom Checklist Depression Scale (HSCL-D-20) and the HDRS; and functional status, by the Medical Outcomes Study Short-Form 36 (SF-36) physical and mental components.ResultsParoxetine patients showed greater (difference in mean [SE] 11-week change in HSCL-D-20 scores, 0.21 [0.07]; P = .004) symptom resolution than placebo patients. Patients treated with PST-PC did not show more improvement than placebo (difference in mean [SE] change in HSCL-D-20 scores, 0.11 [0.13] ; P = .13), but their symptoms improved more rapidly than those of placebo patients during the latter treatment weeks (P = .01). For dysthymia, paroxetine improved mental health functioning vs placebo among patients whose baseline functioning was high (difference in mean [SE] change in SF-36 mental component scores, 5.8 [2.02]; P = .01) or intermediate (difference in mean [SE] change in SF-36 mental component scores, 4.4 [1.74]; P = .03). Mental health functioning in dysthymia patients was not significantly improved by PST-PC compared with placebo (P≥.12 for low-, intermediate-, and high-functioning groups). For Minor Depression, both paroxetine and PST-PC improved mental health functioning in patients in the lowest tertile of baseline functioning (difference vs placebo in mean [SE] change in SF-36 mental component scores, 4.7 [2.03] for those taking paroxetine; 4.7 [1.96] for the PST-PC treatment; P = .02 vs placebo).ConclusionsParoxetine showed moderate benefit for depressive symptoms and mental health function in elderly patients with dysthymia and more severely impaired elderly patients with Minor Depression. The benefits of PST-PC were smaller, had slower onset, and were more subject to site differences than those of paroxetine.
Mark T. Hegel - One of the best experts on this subject based on the ideXlab platform.
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problem solving treatment and coping styles in primary care for Minor Depression
Journal of Consulting and Clinical Psychology, 2008Co-Authors: Thomas E Oxman, Mark T. Hegel, Jay G Hull, Allen J DietrichAbstract:Research was undertaken to compare Problem-Solving Treatment for Primary Care (PST-PC) to usual care (UC) for Minor Depression and examine whether treatment effectiveness was moderated by coping style. PST-PC is a six-session, manual-based, psychosocial skills intervention. A randomized controlled trial was conducted in two academic, primary care clinics. A total of 141 subjects were eligible and randomized, and 107 completed treatment (57 PST-PC, 50 UC) and a 35-week follow-up. Analysis using linear mixed modeling revealed significant effects of treatment and coping such that those in PST-PC improved at a faster rate, and those initially high in avoidant coping were significantly more likely to have sustained benefit from PST-PC.
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Problem-solving treatment and coping styles in primary care for Minor Depression.
Journal of Consulting and Clinical Psychology, 2008Co-Authors: Thomas E Oxman, Mark T. Hegel, Jay G Hull, Allen J DietrichAbstract:Research was undertaken to compare problem-solving treatment for primary care (PST-PC) with usual care for Minor Depression and to examine whether treatment effectiveness was moderated by coping style. PST-PC is a 6-session, manual-based, psychosocial skills intervention. A randomized controlled trial was conducted in 2 academic, primary care clinics. Those subjects who were eligible were randomized (N = 151), and 107 subjects completed treatment (57 PST-PC, 50 usual care) and a 35-week follow-up. Analysis with linear mixed modeling revealed significant effects of treatment and coping, such that those in PST-PC improved at a faster rate and those initially high in avoidant coping were significantly more likely to have sustained benefit from PST-PC.
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watchful waiting for Minor Depression in primary care remission rates and predictors of improvement
General Hospital Psychiatry, 2006Co-Authors: Mark T. Hegel, Thomas E Oxman, Jay G Hull, Karin Swain, Holly SwickAbstract:Objectives: The objectives of this study were to determine remission rates and predictors of improvement for Minor Depression following a 1-month watchful waiting period in primary care and to describe the watchful waiting processes. Methods: Prior to randomization into a clinical trial for Minor Depression, 111 participants were entered into a 1-month watchful waiting period. Depression severity and predictors of improvement were measured at the start of watchful waiting. At the end of watchful waiting, remission rates were calculated and predictor variables were analyzed for their contribution toward predicting improvement. Results: Remission rates were low, ranging from 9% to 13%, depending on the measure. Avoidant coping style and frequency of engaging in active pleasant events at baseline accounted for the majority of change in Depression. During watchful waiting, about one fifth of the sample (21%) had at least one contact with their physician and 27% reported using self-initiated treatments. Conclusions: There is a low likelihood of spontaneous remission for treatment-seeking samples with Minor Depression in primary care. An avoidant coping style seriously interferes with remission, and engaging in regular active pleasant events confers an advantage. Feasible interventions for primary care that promote activity and decrease avoidant coping styles may improve outcomes. These findings may not generalize to community and non-treatment-seeking samples.
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Minor Depression and 'Subthreshold' Anxiety Symptoms in Older Adults: Psychosocial Therapies and Special Considerations
2002Co-Authors: Mark T. Hegel, Melinda A. Stanley, Patricia E. AreanAbstract:GENERATIONS A new focus on these common causes of distress and impairment. In recent years more attention has been given to identifying and treating mental disorders in older adults. By and large, these efforts have focused on disorders delineated in the American Psychiatric Association's Diagnostic and Sta/Manual of Mental Disorders (DSM-IV). However, another class of disorders is also beginning to receive attention: "subthreshold" mental disorders. Although these sets of symptoms do not meet the full criteria to be classified as specific mental disorders, they are nonetheless associated with clinically significant distress or impairment (Pincus, Davis, and McQueen,1999). In this article we will discuss two specific subthreshold conditions, "Minor Depression" and "subthreshold generalized anxiety disorder," and the evidence for the efficacy of psychosocial therapies for these conditions for older adults. Minor Depression Minor Depression is typically defined as the presence of at least two but fewer than five depressive symptoms, including depressed mood or loss of interest in normal daily activities, during the same two-week period with no history of major depressive episode or dysthymic disorder but with clinically significant impairment or distress (American Psychiatric Association, 1994). Minor Depression is highly prevalent in older adults in the community (9.9 percent) (Hybels, Blazer, and Pieper, 2001) and in primary care (5.2 percent) (Lyness et al., 1999). In mixed-age samples Minor Depression has been shown to be associated with levels of functional impairment comparable to those caused by medical illnesses (Wells et al., 1992) and with increased expenditures on medical care (Johnson, Weissman, and Klerman, 1992). Morbidity has been less extensively studied in samples of older adults, but the morbidity rates of elders with Minor Depression may be assumed to be at least comparable to samples with medical illnesses given the higher prevalence of complicating medical conditions. A recent study has shown Minor Depression to be associated with an increased risk for mortality in older men (Penninx et al., 1999). Although assessment of the prevalence of Minor Depression in racial and ethnic Minority populations tends to be clouded by linguistic and cultural differences in expressing affective and somatic symptoms, recent research taking into account these measurement challenges indicates that Minor Depression is very common in older ethnic Minorities in primary care. According to Arean and Alvidrez (2001), as many as io percent of older African Americans, 15 percent of older Latinos, and 12 percent of older Asians meet criteria for Minor Depression. SCREENING FOR Minor Depression One of the most common instruments for screening and tracking Depression in primary care is the Patient Health Questionnaire Nine-- Item Depression Module (PHQ-9). The patient fills out the questionnaire, and the information can yield a diagnosis of major or Minor Depression. While psychometric studies have yet to be done on the utility of the PHQ-9 with Minority elders, the instrument is available in Spanish and Chinese. PSYCHOSOCIAL THERAPIES FOR Minor Depression Empirically derived treatment guidelines have been established for major Depression. However, a paucity of studies, which have yielded conflicting findings, means that no specific guidelines are currently available for pharmacologic or psychosocial treatment of Minor Depression. Psychosocial therapies are particularly appealing for older adults because they often have medical conditions as well, leading to an increased possibility of adverse drug interactions. Since the research on treating Minor Depression in older adults is so limited, we will review the evidence for psychosocial treatments of Minor Depression in both younger and older adults together. The interventions examined include cognitive-behavioral, interpersonal, and problem-solving therapy, as well as physical exercise. …
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status of Minor Depression or dysthymia in primary care following a randomized controlled treatment
General Hospital Psychiatry, 2001Co-Authors: Thomas E Oxman, Anjana Sengupta, Ellen Frank, James E Barrett, Wayne Katon, John W Williams, Mark T. HegelAbstract:Abstract This report describes the rates of recovery and remission from Minor Depression or dysthymia in primary care patients three months after completing a randomized controlled treatment trial. The subjects were primary care patients who received ≥4 treatment sessions with Problem-Solving Treatment, paroxetine, or placebo and who completed an independent assessment 3 months after the study (201 with Minor Depression, 229 with dysthymia). The 17-item Hamilton Rating Scale for Depression (HAMD), semistructured questions about postintervention Depression treatments, and baseline medical comorbidity, neuroticism, and social function were the primary measures. For Minor Depression 76% and for dysthymia 68% of subjects who were in remission at the end of the 11-week treatment trial were recovered (HAMD ≤6) three months after the treatment trial. Of patients who were not in remission at 11 weeks, for Minor Depression 37% and for dysthymia 31% went on to achieve remission at 25 weeks. The majority of patients chose not to use antidepressants or psychotherapy after the trial. Patients with Minor Depression that had greater baseline social function and lower neuroticism scores were more likely to be recovered. For patients with Minor Depression, these findings suggest a need for some matching of continuation and maintenance treatment to patient characteristics rather than uniform, automatic treatment recommendations. Because of the chronic, relapsing nature of dysthymia, practical improvements in encouraging effective continuation and maintenance phases of treatment are indicated.
Allison N Clark - One of the best experts on this subject based on the ideXlab platform.
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a longitudinal study of major and Minor Depression following traumatic brain injury
Archives of Physical Medicine and Rehabilitation, 2012Co-Authors: Tessa Hart, Jeanne M Hoffman, Christopher R Pretz, Richard E Kennedy, Allison N Clark, Lisa A BrennerAbstract:Abstract Hart T, Hoffman JM, Pretz C, Kennedy R, Clark AN, Brenner LA. A longitudinal study of major and Minor Depression following traumatic brain injury. Objective To examine patterns of change and factors associated with change in Depression, both major (major depressive disorder [MDD]) and Minor, between 1 and 2 years after traumatic brain injury (TBI). Design Observational prospective longitudinal study. Setting Inpatient rehabilitation centers, with 1- and 2-year follow-up conducted primarily by telephone. Participants Persons with TBI (N=1089) enrolled in the Traumatic Brain Injury Model Systems database, followed at 1 and 2 years postinjury. Interventions Not applicable. Main Outcome Measure Patient Health Questionnaire-9. Results Among participants not depressed at 1 year, close to three fourths remained so at 2-year follow-up. However, 26% developed MDD or Minor Depression between the first and second years postinjury. Over half of participants with MDD at year 1 also reported MDD the following year, with another 22% reporting Minor Depression; thus three fourths of those with MDD at year 1 experienced clinically significant symptoms at year 2. Almost one third of those with Minor Depression at year 1 traversed to MDD at year 2. Polytomous logistic regression confirmed that worse Depression at year 1 was associated with higher odds of Depression a year later. For those without Depression at year 1, symptom worsening over time was related to year 2 problematic substance use and lower FIM motor and cognitive scores. For those with Depression at year 1, worsening was associated with lower cognitive FIM, poor social support, and preinjury mental health issues including substance abuse. Conclusions Major and Minor Depression exist on a continuum along which individuals with TBI may traverse over time. Predictors of change differ according to symptom onset. Results highlight importance of long-term monitoring for Depression, treating Minor as well as major Depression, and developing interventions for comorbid Depression and substance abuse.
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major and Minor Depression after traumatic brain injury
Archives of Physical Medicine and Rehabilitation, 2011Co-Authors: Tessa Hart, Allison N Clark, Lisa A Brenner, Jennifer Bogner, Thomas A Novack, Inna Chervoneva, Risa Nakaserichardson, Juan Carlos ArangolasprillaAbstract:OBJECTIVE: To examine Minor as well as major Depression at 1 year posttraumatic brain injury (TBI), with particular attention to the contribution of Depression severity to levels of societal participation. DESIGN: Observational prospective study with a 2-wave longitudinal component. SETTING: Inpatient rehabilitation centers, with 1-year follow up conducted primarily by telephone. PARTICIPANTS: Persons with TBI (N=1570) enrolled in the TBI Model System database and followed up at 1-year postinjury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FIM, Patient Health Questionnaire-9, Participation Assessment with Recombined Tools-Objective, Glasgow Outcome Scale-Extended, and the Satisfaction With Life Scale. RESULTS: Twenty-two percent of the sample reported Minor Depression, and 26% reported major Depression at 1-year post-TBI. Both levels of Depression were associated with sex (women), age (younger), preinjury mental health treatment and substance abuse, and cause of injury (intentional). There was a monotonic dose-response relationship between severity of Depression and all 1-year outcomes studied, including level of cognitive and physical disability, global outcome, and satisfaction with life. With other predictors controlled, Depression severity remained significantly associated with the level of societal participation at 1-year post-TBI. CONCLUSIONS: Minor Depression may be as common as major Depression after TBI and should be taken seriously for its association to negative outcomes related to participation and quality of life. Findings suggest that, as in other populations, Minor and major Depression are not separate entities, but exist on a continuum. Further research should determine whether people with TBI traverse between the 2 diagnoses as in other patient groups.