Validity of the bereavement exclusion to major depression: does the empirical evidence support the proposal to eliminate the exclusion in DSM-5?

The DSM-IV major depression "bereavement exclusion" (BE), which recognizes that depressive symptoms are sometimes normal in recently bereaved individuals, is proposed for elimination in DSM-5. Evidence cited for the BE's invalidity comes from two 2007 reviews purporting to show that bereavement-related depression is similar to other depression across various validators, and a 2010 review of subsequent research. We examined whether the 2007 and 2010 reviews and subsequent relevant literature support the BE's invalidity. Findings were: a) studies included in the 2007 reviews sampled bereavement-related depression groups most of whom were not BE-excluded, making them irrelevant for evaluating BE validity; b) three subsequent studies cited by the 2010 review as supporting BE elimination did examine BE-excluded cases but were in fact inconclusive; and c) two more recent articles comparing recurrence of BE-excluded and other major depressive disorder cases both support the BE's validity. We conclude that the claimed evidence for the BE's invalidity does not exist. The evidence in fact supports the BE's validity and its retention in DSM-5 to prevent false positive diagnoses. We suggest some improvements to increase validity and mitigate risk of false negatives.     

Guilt in Bereavement: The Role of Self-Blame and Regret in Coping with Loss

Despite the apparent centrality of guilt in complicating reactions following bereavement, scientific investigation has been limited. Establishing the impact of specific components associated with guilt could enhance understanding. The aim of this study was to examine the relationships between two guilt-related manifestations, namely self-blame and regret, with grief and depression. A longitudinal investigation was conducted 4–7 months, 14 months and 2 years post-loss. Participants were bereaved spouses (30 widows; 30 widowers); their mean age was 53.05 years. Results showed that self-blame was associated with grief at the initial time-point and with its decline over time. Such associations were not found for depression. Initial levels of regret were neither associated with initial levels of grief and depression, nor were they related to the decline over time in either outcome variable. These results demonstrate the importance of examining guilt-related manifestations independently, over time, and with respect to both generic and grief-specific outcome variables. A main conclusion is that self-blame (but not regret) is a powerful determinant of grief-specific difficulties following the loss of a loved one. Implications for intervention are considered.     

Measuring Metacognition in Cancer: Validation of the Metacognitions Questionnaire 30 (MCQ-30)

Objective

The Metacognitions Questionnaire 30 assesses metacognitive beliefs and processes which are central to the metacognitive model of emotional disorder. As recent studies have begun to explore the utility of this model for understanding emotional distress after cancer diagnosis, it is important also to assess the validity of the Metacognitions Questionnaire 30 for use in cancer populations.

Methods

229 patients with primary breast or prostate cancer completed the Metacognitions Questionnaire 30 and the Hospital Anxiety and Depression Scale pre-treatment and again 12 months later. The structure and validity of the Metacognitions Questionnaire 30 were assessed using factor analyses and structural equation modelling.

Results

Confirmatory and exploratory factor analyses provided evidence supporting the validity of the previously published 5-factor structure of the Metacognitions Questionnaire 30. Specifically, both pre-treatment and 12 months later, this solution provided the best fit to the data and all items loaded on their expected factors. Structural equation modelling indicated that two dimensions of metacognition (positive and negative beliefs about worry) were significantly associated with anxiety and depression as predicted, providing further evidence of validity.

Conclusions

These findings provide initial evidence that the Metacognitions Questionnaire 30 is a valid measure for use in cancer populations.     

The Longitudinal Association From Obesity to Depression: Results From the 12‐year National Population Health Survey

Prior observational studies have investigated the association between obesity and depression but evidence remains weak and mixed. There has been a call for high‐quality longitudinal studies to elucidate the etiologic relationship from obesity to depression. The main objective of this study was therefore to investigate whether obesity was a risk factor for depression in a nationally representative sample followed for 12 years. Seven waves of data collection (1994–1995 to 2006–2007) were obtained from the National Population Health Survey (NPHS). Our analyses included 10,545 adults without depression at baseline. Past‐year major depression episode (MDE) was assessed from the Composite International Diagnostic Interview‐Short Form for Major Depression (CIDI‐SFMD). Obesity was estimated using baseline BMI from self‐reported weight and height (obesity: BMI ≥30 kg/m²). Kaplan–Meier survival curves were generated and Cox proportional hazard regression modeling was used to estimate the risk of MDE by obesity status, controlling for sociodemographic and health and lifestyle variables. We found that obesity at baseline did not significantly predict subsequent MDE in women (adjusted hazard ratio (AHR): 1.03, 95% confidence interval (CI) 0.84–1.26) and negatively predicted MDE in men (HR: 0.71, CI 0.51–0.98), after adjusting for important confounders. In summary, our findings suggest that obesity is a significant (negative) predictor of depression in adult men but not in women. These results moderate prior evidence supporting a positive link from obesity to depression.     

Worldwide patterns in species richness of Falconiformes: analytical null models, geometric constraints, and the mid-domain effect.

Recently, the hypothesis that the geographic distribution of species could be influenced by the shape of the domain edges, the so-called Mid-Domain Effect (MDE), has been included as one of the five credible hypotheses for explaining spatial gradients in species richness, despite all the unsuccessful current attempts to prove empirically the validity of MDE. We used data on spatial worldwide distributions of Falconiformes to evaluate the validity of MDE assumptions, incorporated into two different sorts of null models at a global level and separately across five domains/landmasses. Species richness values predicted by the null models of the MDE and those values predicted by Net Primary Productivity, a surrogate variable expressing the effect of available energy, were compared in order to evaluate which hypothesis better predicts the observed values. Our tests showed that MDE continues to lack empirical support, regardless of its current acceptability, and so, does not deserve to be classified as one possible explanation of species richness gradients.     

Some evidence of a female advantage in object location memory using ecologically valid stimuli

A female advantage in object recall is assumed to derive from an adaptation to gathering/foraging. Support for the Gathering Hypothesis has relied upon stimuli and methodologies that lack ecological validity. We report two studies in which object recognition and object location memory were addressed using real plants within naturalistic arrays. In the first, females were significantly quicker than males at finding specific plants in some small arrays, and they made significantly fewer mistakes in a larger array. Next, females also located plants in a large and complex array significantly faster than males. We thus find some support for the Gathering Hypothesis using ecologically valid methods.     

Validation of the Spanish Center for Epidemiological Studies Depression and Zung Self-Rating Depression Scales: A Comparative Validation Study

Background

Depressive disorders are leading contributors to burden of disease in developing countries. Research aiming to improve their diagnosis and treatment is fundamental in these settings, and psychometric tools are widely used instruments to support mental health research. Our aim is to validate and compare the psychometric properties of the Spanish versions of the Center for Epidemiological Studies Depression Scale (CES-D) and the Zung Self-Rating Depression Scale (ZSDS).

Methodology/Principal Findings

A Spanish version of the CES-D was revised by 5 native Spanish speaking psychiatrists using as reference the English version. A locally standardized Spanish version of the ZSDS was used. These Spanish versions were administered to 70 patients with a clinical diagnosis of DSM-IV Major Depressive Episode (MDE), 63 without major depression but with clinical diagnosis of other psychiatric disorders (OPD), and 61 with no evidence of psychiatric disorders (NEP). For both scales, Cronbach''s alpha (C-α) and Hierarchical McDonald Omega for polychoric variables (MD-Ω) were estimated; and receiver operating characteristics (ROC) analysis performed. For the CES-D and ZSDS scales, C-α was 0.93 and 0.89 respectively, while MD-Ω was 0.90 and 0.75 respectively. The area under the ROC curve in MDE+OPD was 0.83 for CES-D and 0.84 for ZSDS; and in MDE+NEP was 0.98 for CES-D and 0.96 for ZSDS. Cut-off scores (co) for the highest proportions of correctly classified (cc) individuals among MDE+OPD were ≥29 for CES-D (sensitivity (ss) = 77.1/specificity (sp) = 79.4%/(cc) = 78.2%) and ≥47 for ZSDS (ss = 85.7%/sp = 71.4%/cc = 78.9%). In the MDE+NEP, co were ≥24 for the CES-D (ss = 91.4%/sp = 96.7%/cc = 93.9%) and ≥45 for the ZSDS (ss = 91.4%/sp = 91.8%/cc = 91.6%).

Conclusion

Spanish versions of the CES-D and ZSDS are valid instruments to detect depression in clinical settings and could be useful for both epidemiological research and primary clinical settings in settings similar as those of public hospitals in Lima, Peru.     

The mid-domain effect revisited

We revisit the proposition that boundary constraints on species' ranges cause species richness gradients (the mid-domain effect [MDE] hypothesis). In the absence of environmental gradients, species should not retain their observed range sizes as assumed by MDE models. Debate remains regarding the definition of domain limits, valid predictions for testing the models, and their statistical assessment. Empirical support for the MDE is varied but often weak, suggesting that geometric constraints on species' ranges do not provide a general explanation for richness gradients. Criticism of MDE model assumptions does not, however, imply opposition to the use of null models in ecology.     

Causality,menopause, and depression: a critical review of the literature.

OBJECTIVE: To assess whether causal criteria can be used to find out whether there is support in published research for maintaining that menopause causes depression. DESIGN: Ninety four articles from 30 years of research examining the relation of natural menopause to depression were traced by using Medline and systematic follow up of reference lists. Specified exclusion and inclusion criteria were applied, and the resulting 43 epidemiological primary research articles were classified and tabulated according to sample and measures used and the researchers'' own conclusion as to whether or not an association had been established. This material was qualitatively evaluated with Hill''s nine criteria for causality. RESULT: There is insufficient evidence at present to maintain that menopause causes depression. In addition to methodological and statistical problems, a temporal problem in the menopause concept hinders research in this area. CONCLUSION: Causal criteria can usefully be used to structure a literature review. Further theoretical work is required to integrate standard clinical epidemiological concepts.     

Development of the Pet Bereavement Questionnaire

Abstract

The death of a pet can be a significant stressor for some people and is a known risk factor for depression. The Pet Bereavement Questionnaire (PBQ) was developed to fill the need for a brief, acceptable, well-validated instrument for use in studies of the psychological impact of losing a pet. Initial results suggest that the PBQ has good internal reliability (Cronbach's α = 0.87), as well as good construct validity, with three distinct factors reflecting grief, anger and guilt. Grief was found to correlate strongly with pet attachment. The anger and guilt scales, however, correlated with depressive symptoms. The PBQ discriminated between individuals seeking support after pet loss (who would be expected to show higher levels of bereavement) and those who simply acknowledge the recent loss of a pet. We suggest that future research into pet bereavement use this new questionnaire so that the results of different studies can be compared, normative scores can be developed and researchers in this area can use a single instrument with established construct validity. In particular, we hope the PBQ will be used in treatment outcome research to identify high-risk individuals and test the effectiveness of both existing and novel interventions. Moreover, the PBQ could also be used in clinical settings, such as tertiary care veterinary hospitals, to identify pet owners in need of clinical support services.     

Resistance to Brown Ring Disease in the Manila clam, Ruditapes philippinarum: A study of selected stocks showing a recovery process by shell repair

European stocks of the Manila clam Ruditapes philippinarum are affected by the Brown Ring Disease (BRD), which is caused by Vibrio tapetis. BRD is characterized by an accumulation of a brown organic matrix on the inner face of the shell. Clams that recover from BRD develop a white mineralized layer covering the brown matrix. Stocks of clams that showed resistance to BRD development, as enhanced recovery, have been monitored since 2000. We have examined two selected stocks: a Low Susceptibility (LS) stock and a High Susceptibility stock (HS), over three generations. The LS stock showed less evidence of the BRD symptoms, and more evidence of total shell repair, both in the field and following experimental challenge with V. tapetis, indicating that some clams may be less vulnerable to a V. tapetis attack than others. The inner face of the valves of the LS and HS clams of the two last generations were analysed with scanning electron microscopy. Examination of shells from BRD-affected clams showed that during the repair process, calcium crystals were progressively laid down until the affected zone was entirely covered. By the end of the shell repair process, a final organic layer covered the calcium crystal mounds. This layer seemed essential in the recovery process. The results indicate that the shell repair capability of the clams is the principal mechanism implicated in the development of BRD resistance in the Manila clam stocks. However, this resistance did not increase with generation because the broodstock was maintained at a site where selection pressure was low, due to a low prevalence of V. tapetis.     

Is ADHD a valid diagnosis in older adults?

ADHD is a neurodevelopmental syndrome that often persists into adulthood. It is possible that different criteria are necessary for older adults than younger adults: the manifestations of ADHD could change with age; other conditions with onset in later life share presenting symptoms with ADHD; different contextual challenges and patterns of compensatory support may exist. For these reasons, we reviewed evidence for the validity of DSM ADHD criteria in adulthood for individuals over the age of 50. Specifically, we evaluated evidence that the DSM criteria for ADHD identify a valid syndrome in older adults based on clinical presentation, laboratory or testing findings, absence of alternate diagnosis to explain symptoms, course of the syndrome, or familial presence of the condition. We found evidence that various ADHD criteria identify subjects with clinical presentations similar to that seen in younger adults, but only 92 well-described cases have been reported in the literature. ADHD traits also may be less common in the general population of older adults than in younger adults, suggesting that the threshold for an atypical burden of ADHD traits may be lower in older populations. Future research can establish a richer basis for validity of diagnostic criteria for ADHD in older adults.     

The impact of spousal bereavement on subjective wellbeing: Evidence from the Taiwanese elderly population

Bereavement is an inevitable event in our life. This paper employs the Taiwanese panel Survey of Health and Living Status of the Elderly (SHLSE) to evaluate the impact of losing a spouse on self-assessed health and subjective well-being measured by depression and life satisfaction. Propensity score matching methods are used to generate a hypothetical bereavement date and a weight for the non-bereaved to create a comparable non-bereaved cohort and a difference-in-differences (DiD) approach is used to estimate the impact of spousal bereavement.The results show that spousal bereavement increases depression scale by 1.81 points but this increment decreases by 0.43 points every year after bereavement. It takes approximate 4 years to restore to the level prior to bereavement. We also examine the demographic and socioeconomic differences in the spousal bereavement impact and find that the spousal bereavement impact is greater on the bereaved in the higher income group in terms of self-assessed health and depression. Our results only represent a lower boundary of the possible impact of spousal bereavement on self-assessed health and subjective wellbeing due to data restrictions.     

The Real World Mental Health Needs of Heart Failure Patients Are Not Reflected by the Depression Randomized Controlled Trial Evidence

Introduction

International depression screening guidelines in heart failure (HF) are partly based on depression treatment efficacy from randomized controlled trials (RCTs). Our aim was to test the external validity of depression RCT criteria in a sample of real-world HF patients.

Methods

HF patients admitted to 3 hospitals in South Australia were referred to a HF psychologist if not already receiving current psychiatric management by psychologist or psychiatrist elsewhere. Screening and referral protocol consisted of the following; (a). Patient Health Questionnaire ≥10; (b). Generalized Anxiety Disorder Questionnaire ≥7); (c). positive response to 1 item panic attack screener; (d). evidence of suicidality. Patients were evaluated against the most common RCT exclusion criteria personality disorder, high suicide risk, cognitive impairment, psychosis, alcohol or substance abuse or dependency, bi-polar depression.

Results

Total 81 HF patients were referred from 404 HF admissions, and 73 were assessed (age 60.6±13.4, 47.9% female). Nearly half (47%) met at least 1 RCT exclusion criterion, most commonly personality disorder (28.5%), alcohol/substance abuse (17.8%) and high suicide risk (11.0%). RCT ineligibility criteria was more frequent among patients with major depression (76.5% vs. 46.2%, p<.01) and dysthymia (26.5% vs. 7.7%, p = .03) but not significantly associated with anxiety disorders. RCT ineligible patients reported greater severity of depression (M = 16.6±5.0 vs. M = 12.9±7.2, p = .02) and were higher consumers of HF psychotherapy services (M = 11.5±4.7 vs. M = 8.5±4.8, p = .01).

Conclusion

In this real-world sample comparable in size to recent RCT intervention arms, patients with depression disorders presented with complex psychiatric needs including comorbid personality disorders, alcohol/substance use and suicide risk. These findings suggest external validity of depression screening and RCTs could serve as a basis for level A guideline recommendations in cardiovascular diseases.     

Psychobiological and evolutionary perspectives on coping and health characteristics following loss: a twin study.

An analysis of coping, grief and health characteristics is reported for a bereaved monozygotic (MZ) and dizygotic (DZ) same-sex twin sample. The data were examined with reference to psychobiological and evolutionary perspectives on behavior. A Coping Scale, included as part of a comprehensive Twin Loss Survey (TLS), assessed coping with daily responsibilities and activities 1-2 months before the co-twin's death, 1-2 months following the co-twin's death and currently. A Grief Intensity Scale obtained judgments of grief 1-2 months following the loss, and currently. Information on physical symptoms was available from the Somatization Scale of the Grief Experience Inventory. Psychobiological and evolutionary perspectives specified hypotheses for two twin groups: one model was specified to reflect bereavement experiences immediately following loss of the co-twin (retrospective twin group); a second model represented present bereavement response (current twin group). Consistent with psychobiological theory, twins' social closeness showed a positive association with grief intensity which, in turn, affected somatic symptoms and coping efficacy in predicted directions. With respect to evolutionary psychological theory, the effect of zygosity on current grief implicated correlates of genetic relatedness as factors in the bereavement process.     

State and Trait Olfactory Markers of Major Depression

Nowadays, depression is a major issue in public health. Because of the partial overlap between the brain structures involved in depression, olfaction and emotion, the study of olfactory function could be a relevant way to find specific cognitive markers of depression. This study aims at determining whether the olfactory impairments are state or trait markers of major depressive episode (MDE) through the study of the olfactory parameters involving the central olfactory pathway. In a pilot study, we evaluated prospectively 18 depressed patients during acute episodes of depression and 6 weeks after antidepressant treatment (escitalopram) against 54 healthy volunteers, matched by age, gender and smoking status. We investigated the participants’ abilities to identify odors (single odors and in binary mixture), to evaluate and discriminate the odors’ intensity, and determine the hedonic valence of odors. The results revealed an “olfactory anhedonia” expressed by decrease of hedonic score for high emotional odorant as potential state marker of MDE. Moreover, these patients experienced an “olfactory negative alliesthesia”, during the odor intensity evaluation, and failed to identify correctly two odorants with opposite valences in a binary iso-mixture, which constitute potential trait markers of the disease. This study provides preliminary evidence for olfactory impairments associated with MDE (state marker) that are persistent after the clinical improvement of depressive symptoms (trait marker). These results could be explained by the chronicity of depression and/or by the impact of therapeutic means used (antidepressant treatment). They need to be confirmed particularly the ones obtained in complex olfactory environment which corresponds a more objective daily life situation.     

Broken Heart: A Statistical Study of Increased Mortality among Widowers

A total of 4,486 widowers of 55 years of age and older have been followed up for nine years since the death of their wives in 1957. Of these 213 died during the first six months of bereavement, 40% above the expected rate for married men of the same age. Thereafter the mortality rate fell gradually to that of married men and remained at about the same leveLThe greatest increase in mortality during the first six months was found in the widowers dying from coronary thrombosis and other arteriosclerotic and degenerative heart disease. There was also evidence of a true increase in mortality from other diseases, though the numbers in individual categories were too small for statistical analysis.In the first six months 22·5% of the deaths were from the same diagnostic group as the wife''s death. Some evidence suggests that this may be a larger proportion than would be expected by chance association, but there is no evidence suggesting that the proportion is any different among widows and widowers who have been bereaved for more than six months.     

Computational study on the selective inhibition mechanism of MS402 to the first and second bromodomains of BRD4

As a member of the bromodomain and extraterminal domain (BET) family, BRD4 is considered as a potential target for cancer treatment. However, because of the highly conservation of its two homologous bromodomains (BD1/BD2), selective inhibition of each bromodomain remains a challenge. MS402 is a domain-selective inhibitor of BRD4-BD1 over BRD4-BD2 reported recently. Understanding the selectivity mechanism would be very useful for the further design of more potent BD1-selectivity inhibitors. Molecular dynamics simulation, adaptive biasing force and multiple-walker adaptive biasing force were performed to study the inhibition and domain-selective mechanism of MS402 toward BRD4-BD1 over BRD4-BD2 here. Results demonstrate BRD4-BD1 binds to MS402 with lower binding free energy than BRD4-BD2. Residues Gln85, Pro86, Asn140, and Ile146 are crucial for MS402's selectively binding to BRD4-BD1. MS402 needs to overcome more energy barrier to dissociate from BD1 than from BD2 pocket. These findings will be helpful for rational structural modification of existing inhibitors to increase their BD1-selectivity.     

When is pneumonia not pneumonia: a clinicopathologic study of the utility of lung tissue biopsies in determining the suitability of cadaveric tissue for donation

Healthcare-associated pneumonia (HCAP) represents a major diagnostic challenge because of the relatively low sensitivity and specificity of clinical criteria, radiological findings, and microbiologic culture results. It is often difficult to distinguish between pneumonia, underlying pulmonary disease, or conditions with pulmonary complications; this is compounded by the often-subjective clinical diagnosis of pneumonia. We conducted this study to determine the utility of post-mortem lung biopsies for diagnosing pneumonia in tissue donors diagnosed with pneumonia prior to death. Subjects were deceased patients who had been hospitalized at death and diagnosed with pneumonia. Post-mortem lung biopsies were obtained from the anatomic portion of the cadaveric lung corresponding to chest radiograph abnormalities. Specimens were fixed, stained with hematoxylin and eosin, and read by a single board-certified pathologist. Histological criteria for acute pneumonia included intense neutrophilic infiltration, fibrinous exudates, cellular debris, necrosis, or bacteria in the interstitium and intra-alveolar spaces. Of 143 subjects with a diagnosis of pneumonia at time of death, 14 (9.8 %) had histological evidence consistent with acute pneumonia. The most common histological diagnoses were emphysema (53 %), interstitial fibrosis (40 %), chronic atelectasis (36 %), acute and chronic passive congestion consistent with underlying cardiomyopathy (25 %), fibro-bullous disease (12 %), and acute bronchitis (11 %). HCAP represents a major diagnostic challenge because of the relatively low sensitivity and specificity of clinical criteria, radiological findings, and microbiologic testing. We found that attending physician-diagnosed pneumonia did not correlate with post-mortem pathological diagnosis. We conclude that histological examination of cadaveric lung tissue biopsies enables ascertainment or rule out of underlying pneumonia and prevents erroneous donor deferrals.