Dana C. Hughes

Post-traumatic stress disorder in the community: an epidemiological study

Post-traumatic stress disorder (PTSD) was studied in the Piedmont region of North Carolina. Among 2985 subjects, the lifetime and six month prevalence figures for PTSD were 1.30 and 0.44% respectively. In comparison to non-PTSD subjects, those with PTSD had significantly greater job instability, family history of psychiatric illness, parental poverty, child abuse, and separation or divorce of parents prior to age 10. PTSD was associated with greater psychiatric comorbidity and attempted suicide, increased frequency of bronchial asthma, hypertension, peptic ulcer and with impaired social support. Differences were noted between chronic and acute PTSD on a number of measures, with chronic PTSD being accompanied by more frequent social phobia, reduced social support and greater avoidance symptoms.

Abbreviating the Duke Social Support Index for Use in Chronically Ill Elderly Individuals

The 35-item Duke Social Support Index (DSSI) measures multiple dimensions of social support and has been used extensively in cross-sectional and longitudinal studies of aging. Epidemiological studies of chronically ill, frail elderly individuals often wish to include a measure of social support. However, most multidimensional measures (including the DSSI) are long and may exhaust the patient, especially when included in an often already congested interview schedule. The authors have developed two abbreviated versions of the DSSI (23-item and 11-item) that capture the essential components of social support related to mental health outcomes and use of health services in treating elderly individuals with nonpsychiatric medical illness.

Relationship of health and demographic characteristics to Mini-Mental State Examination score among community residents

Mini-Mental State findings from an age 60+ random community sample (N = 1681) indicate that score is related to education, age and race (but not sex) and to functional status, but not to selected aspects of physical or mental health. Adjustment for demographic characteristics, particularly education, is recommended lest cognitive impairment be overestimated.

Predisposition locus for major depression at chromosome 12q22-12q23.2

Major depression disorder is a common psychiatric disease with a major economic impact on society. In many cases, no effective treatment is available. The etiology of major depression is complex, but it is clear that the disease is, to a large extent, determined genetically, especially among individuals with a familial history of major depression, presumably through the involvement of multiple predisposition genes in addition to an environmental component. As a first step toward identification of chromosomal loci contributing to genetic predisposition to major depression, we have conducted a genomewide scan by using 628 microsatellite markers on 1,890 individuals from 110 Utah pedigrees with a strong family history of major depression. We identified significant linkage to major depression in males at marker D12S1300 (multipoint heterogeneity LOD score 4.6; P=.00003 after adjustment for multiple testing). With additional markers, the linkage evidence became highly significant, with the multipoint heterogeneity LOD score at marker D12S1706 increasing to 6.1 (P=.0000007 after adjustment for multiple testing). This study confirms the presence of one or more genes involved in psychiatric diseases on the q arm of chromosome 12 and provides strong evidence for the existence of a sex-specific predisposition gene to major depression at 12q22-q23.2.

Functional Impairment and Utilization of Services Associated With Posttraumatic Stress in the Community

This study describes social functioning and service utilization patterns associated with posttraumatic stress symptoms relative to nonpsychiatric controls and depressive disorder controls in a cross-sectional epidemiological survey. Data from 49 cases and 147 controls who participated in the North Carolina component of the Epidemiologic Catchment Area study were examined. Results indicate that symptoms of posttraumatic stress were associated with impairment along several domains of functioning: social, financial, physical, and psychological. Individuals with posttraumatic stress were found to have more socioeconomic disadvantages and impaired functioning. Despite this, individuals with posttraumatic stress are receiving relatively few mental health services. Further research assessing service use, treatment, and functional outcomes are indicated.

Genome-wide linkage analyses of extended Utah pedigrees identifies loci that influence recurrent, early-onset major depression and anxiety disorders

Major depressive disorder (MDD) is a common, clinically heterogeneous disorder often found comorbid with other disorders. We studied recurrent, early‐onset MDD (MDD‐RE) and anxiety disorders in combination to define powerful phenotypes for genetic study. We used 87 large, extended Utah pedigrees to investigate linkage to 3 phenotypes: “MDD‐RE;” “MDD‐RE or anxiety;” and “MDD‐RE and anxiety;” where in the latter definition the disorders must appear comorbid within an individual. Pedigrees ranged in size from 2 to 6 generations and contained 3 to 42 individuals affected with MDD or anxiety (718 total). In primary analyses, we identified three regions with at least suggestive genome‐wide evidence for linkage on chromosomes 3centr, 7p, and 18q. Both 7p and 18q are replication findings for related phenotypes. The best linkage evidence was for a novel locus at 3p12.3‐q12.3 (LOD = 3.88, “MDD‐RE or anxiety”) and 18q21.33‐q22.2 (LOD = 3.75, “MDD‐RE and anxiety”), a well‐established susceptibility locus for bipolar disorder. In our secondary sex‐specific analyses, we identified two further regions of interest on chromosomes 4q and 15q. Using linked pedigrees, we localized 3centr and 18q to 9.8 and 12.2 cM, respectively, with potential for further localization with the addition of markers in specific pedigrees. Our success in replication and novel locus identification illustrates the utility of large extended pedigrees for common disorders, such as MDD. Further, it supports the hypothesis that MDD and anxiety disorders have over‐lapping genetic etiologies and suggests that comorbid diagnoses may be useful in defining more genetically homogeneous forms of MDD for linkage mapping.

Major Depression with Melancholia: A Comparison of Middle‐Aged and Elderly Adults

Patients admitted to an inpatient psychiatric service were screened to identify middle‐aged (35 to 50 years of age) and elderly (60 years of age and over) patients suffering from a major depressive episode with melancholia. Thirty‐seven subjects (18 middle‐aged and 19 elderly) were identified. Criteria symptoms for depression and symptoms specifically associated with melancholic or endogenous depression did not differ across age groups, with few exceptions. Major depression with melancholia in this hospitalized population was symptomatically similar in the middle‐aged and elderly. The syndrome is therefore relatively common on this inpatient service and should be easily recognized. J Am Geriatr Soc 35:927–932, 1987

Developing a screening index for community studies of somatization disorder

Despite the low prevalence of somatization disorder in the community, the section of the Diagnostic Interview Schedule used to make the diagnosis--as well as previous diagnostic interviews for the related diagnoses of hysteria, and Briquets syndrome--is quite lengthy. This study evaluates a somatization disorder screening index derived from completed interviews from the NIMH sponsored Epidemiologic Catchment Area program. A screening index comprised of 11 symptoms of somatization was derived at the Duke ECA site and replicated across the Johns Hopkins, Yale, and Washington University sites. Across ECA sites a screening threshold of five of 11 symptoms correctly identified 41 of 42 respondents with DIS/DSM-III somatization disorder (97.6%) while correctly classifying 14,600 of 14,750 (99.0%) without the disorder. The screening index offers promise as a screening device for clinical and community studies of somatization disorder.

Age and impaired subjective support. Predictors of depressive symptoms at one-year follow-up.

We followed a cohort of subjects (predominantly inpatients) suffering a major depressive episode in midlife and late-life for 1 year (N = 118). In this follow-up study, we examined three hypotheses. a) Elder subjects suffering major depression, compared with middle-aged subjects, will more likely report endogenous symptoms and less likely report decreased life satisfaction symptoms at 1-year follow-up. b) Impaired social support during the index episode will predict poor life satisfaction, but not endogenous symptoms at 1-year follow-up, regardless of age. c) Impaired social support during the index episode will be more predictive of decreased life satisfaction symptoms in midlife, compared with late life, at 12-month follow-up. The first two hypotheses were not supported, but the third hypothesis was. Both decreased life satisfaction and endogenous symptoms at outcome were significantly predicted by impaired social support during the index episode. Impaired social support predicted a poor outcome from an episode of major depression in both middle life and late life in controlled analyses. However, the effect of impaired subjective social support was conditional on age. Subjective social support appears to have a decreasing influence on the report of both endogenous and decreased life satisfaction symptoms for older individuals.

Age Differences in Life Events: A Multivariate Controlled Analysis

Effects of age on the distribution of specific life events experienced during the past year by community-based adults were examined controlling for sex, race, education, marital status, and place of residence. The controlled analyses were done using logistic regression. Data were gathered via personal interview from 3,798 respondents ages eighteen years and over who participated in the Epidemiologic Catchment Area (ECA), community survey from North Carolina. Respondents were placed in one of four age groups. The percentage of respondents reporting each of the nineteen events examined ranged from 0.5 percent for death of spouse to 19.1 percent for death of loved one. Age was an important predictor in the controlled analysis for thirteen of the seventeen life events examined. A majority of differences occurred between the youngest and oldest age groups. Age differences were not found for illness of one week or more involving activity limitation.