Haroutune K. Armenian

Depression, Psychotropic Medication, and Risk of Myocardial Infarction Prospective Data From the Baltimore ECA Follow-up

BACKGROUND There is suggestive evidence that depression increases risk of myocardial infarction (MI), but there are no prospective studies in which the measure of depression corresponds to clinical criteria. This study examines prospectively whether a major depressive episode increases the risk of incident MI and evaluates the role of psychotropic medication use in this relationship. METHODS AND RESULTS The study is based on a follow-up of the Baltimore cohort of the Epidemiologic Catchment Area Study, a survey of psychiatric disorders in the general population. A history of major depressive episode, dysphoria (2 weeks of sadness), and psychotropic medication use were assessed in 1981, and self-reported MI was assessed in 1994. Sixty-four MIs were reported among 1551 respondents free of heart trouble in 1981. Compared with respondents with no history of dysphoria, the odds ratio for MI associated with a history of dysphoria was 2.07 (95% CI, 1.16 to 3.71), and the odds ratio associated with a history of major depressive episode was 4.54 (95% CI, 1.65 to 12.44), independent of coronary risk factors. In multivariate models, use of barbiturates, meprobamates, phenothiazines, and lithium was associated with an increased risk of MI, whereas use of tricyclic antidepressants and benzodiazepines was not. Among individuals with no history of dysphoria, only lithium use was significantly associated with MI. CONCLUSIONS These data suggest that a history of dysphoria and a major depressive episode increase the risk of MI. The association between psychotropic medication use and MI is probably a reflection of the primary relationship between depression and MI.

Depression and Risk for Onset of Type II Diabetes: A prospective population-based study

OBJECTIVE To determine whether depression is associated with an increased risk for onset of diabetes. RESEARCH DESIGN AND METHODS In 1981, a total of 3,481 household-residing adults participated in the Epidemiologic Catchment Area (ECA) Program survey at the East Baltimore site. A follow-up of that cohort after 13 years completed 1,897 interviews, amounting to >72% of survivors. In 1981, depression was assessed with the National Institutes of Mental Health (NIMH) Diagnostic Interview Schedule and diabetes, by self-report. This prospective analysis focused on subjects at risk for onset of diabetes by removing from the analysis individuals with diabetes in 1981. RESULTS There were 89 new cases of diabetes among 1,715 individuals at risk, yielding a 13-year cumulative incidence of diabetes of 5.2%. In logistic models, major depressive disorder, but not milder forms of depression or other forms of psychiatric disorder, predicted the onset of diabetes (estimated relative risk, 2.23; 95% CI 0.90–5.55). Controlling for age, race, sex, socioeconomic status, education, use of health services, other psychiatric disorders, and body weight did not weaken the relationship. CONCLUSIONS Major depressive disorder signals increased risk for onset of type II diabetes. Limitations of the findings arise from the difficulty in determining temporal order with two chronic conditions, even when the temporal order of measurement is clear. In addition, even though control variables were introduced for the use of health services, it is possible that the treatment for depression led to an earlier diagnosis of diabetes in this sample.

Loss as a determinant of PTSD in a cohort of adult survivors of the 1988 earthquake in Armenia: implications for policy

Objective: To study the relationship of post‐traumatic stress disorder (PTSD) to severity of the disaster experience.

The 1988 earthquake in Soviet Armenia: A case study

A major earthquake devastated the Armenian Republic of the Soviet Union on December 7, 1988, resulting in thousands of deaths and injuries. In a postearthquake investigation of three towns seriously affected by the earthquake, we studied earthquake-related injury patterns, made observations on rescue and medical efforts, and postulated certain factors associated with increased morbidity and mortality. Information was obtained from official Soviet documents, interviews with survivors of the earthquake, and interviews with local, regional, and national government officials. Figures were based on assessments made by these officials in the field in the immediate postearthquake period. Out of a population of 8,500, there were 4,202 (49.4%) deaths and 1,244 (14.6%) injured (casualty rate, 64.0%). Deaths and injuries were 67 and 11 times higher, respectively, among trapped than nontrapped victims. Being outside at the time of the earthquake or having escaped to the outside from the collapsing structure was crucial for survival. Among persons found alive, 89% were rescued during the first 24 hours, mostly without the use of heavy equipment. This observation underscores the importance of swift rescuer response. As with all field surveys after disasters, there were methodological limitations to this study due to chaotic postearthquake conditions. Accordingly, results must be approached with caution. Nonetheless, these preliminary observations are striking and have generated several new hypotheses for further investigations using more sophisticated analytic methods.

Reductions in high-risk drug use behaviors among participants in the Baltimore Needle Exchange Program

OBJECTIVE To determine whether enrollment in the Baltimore Needle Exchange Program (NEP) was associated with short-term reduction in risky injection practices. METHODS Demographic information was collected on NEP participants upon enrollment. A systematic sample of enrollees was interviewed at program entry, 2 weeks, and 6 months later on recent drug-related behaviors. Comparisons were performed using paired t-tests. RESULTS Among 221 NEP participants who completed baseline, 2-week and 6-month follow-up visits, significant reductions (p < .01) were reported in using a previously used syringe (21.6%, 11.0%, 7.8%, respectively), lending ones used syringe to a friend (26.7%, 18.4%, 12%, respectively), and several indirect sharing activities. Reductions were reported in the mean number of injections per syringe and the mean number of injections per day (p < .001). CONCLUSIONS These results show rapid and mostly large reductions in a variety of risky injection drug use behaviors. Study findings are consistent with earlier reports showing an association between behavioral risk reduction and participation in a needle exchange program.

Interaction of human immunodeficiency virus type 1 and human herpesvirus type 8 infections on the incidence of Kaposi's sarcoma.

To determine Kaposis sarcoma (KS) risk related to timing of human immunodeficiency virus type 1 (HIV-1) and human herpesvirus type 8 (HHV-8) infections, stored longitudinal sera from 400 homosexual men with known dates of HIV-1 seroconversion (+/-4.5 months) were tested for HHV-8 antibody. Times from HHV-8 seroconversion to KS were compared for the 69 men who became infected with HHV-8 after acquiring HIV-1 to the 182 men who were HHV-8 seropositive before their HIV-1 infection. None developed KS before coinfection. HHV-8 seroconversion after HIV-1 infection increased the risk of KS (risk ratio, 2.55; 95% confidence interval, 1.06-6.10) compared with those infected with HHV-8 before HIV-1. The KS hazards in HHV-8-infected men increased by 60% (P<.001) for each year of HIV-1 infection. Faster CD4 cell loss and higher HIV-1 RNA levels significantly predicted KS. The quicker development of KS in men acquiring HHV-8 after HIV-1 and its association with CD4 slope argues that KS is more likely if HHV-8 infection occurs in an immunocompromised person.

Risk Factors for Depression in the Survivors of the 1988 Earthquake in Armenia

Most studies of psychopathology following disasters are concerned with posttraumatic stress disorder (PTSD). The present analyses sought to assess the rate and determinants of depression in adult survivors of the 1988 earthquake in Armenia. Unlike previous studies of earthquakes, the present analyses derive from a well-defined cohort of survivors who undenvent diagnostic interviewing to characterize psychiatric morbidity. As part of a cohort study of 32,743 survivors of the 1988 earthquake in Armenia, a stratified population sample of 1,785 persons was interviewed about 2 years following the disaster using a special questionnaire based on the National Institute of Mental Health (NIMH) Disaster Interview Schedule/Disaster Supplement. 52% met the criteria for major depression. Of these, a total of 177 cases of depression with no other psychiatric diagnosis or comorbidity were compared with 583 controls from the same interviewed group who did not fulfill the criteria for any psychiatric disorder. Cases and controls were compared as to data obtained independently at the aftermath of the disaster on a number of exposures and characteristics related to the earthquake. More of the cases involved females (odds ratio [OR] for males 0.7 [95% confidence interval [CI] 0.5–0.9]) and from the city of Gumri, which had some of the worst destruction (OR for residents of Gumri 5.9 [95% CI 4.0–8.8]). Being with someone in the same building at the moment of the earthquake was protective for depression (OR for presence of other people 0.5 [95% CI 0.3–0.6]), and the risk of depression increased with the amount of loss that the family sustained as a result of the earthquake (OR for highest level of loss 2.5 [95% CI 1.3–4.8]). The use of alcohol was protective for depression (OR for those who drink 0.5 [95% CI 0.3–0.8]). In various models of multivariate adjustment and analysis, the increased risk of depression with loss, geographic location, and female gender was maintained. Also, being with someone during the disaster, receiving assistance and support after the earthquake, and alcohol use were protective for depression in these multivariate analyses. Depression is a common sequel to an earthquake. As with our previous study of PTSD, we were able to relate intensity of the disaster and loss to the risk of depression in a general population sample. The role of social support during and after the disaster as a protective mechanism against adverse psychological outcome was highlighted againt.

Urinary Incontinence and Psychological Distress in Community-Dwelling Older Adults

OBJECTIVES: To examine the relationship between urinary incontinence (UI) and psychological distress in older adults. We hypothesized that persons with UI associated with condition‐specific functional loss would be most likely to report psychological distress.

Major depression and cancer: the 13-year follow-up of the Baltimore Epidemiologic Catchment Area sample (United States)

AbstractObjective: The relationship between depression and development of cancer is not well understood, with some studies finding a significant but small increase in risk for cancer among persons with depression. No studies have employed standardized interviews keyed to the diagnostic criteria for Major Depression. Our objective was to evaluate the relationship between Major Depression at baseline and new onset of cancer at follow-up. Method: The study was based on a population-based 13-year follow-up survey of community-dwelling adults living in East Baltimore in 1981. After excluding 372 persons with a history of cancer or those whom reported their health as poor at the baseline interview, 3109 adults remained. Information on baseline depression status and cancer at follow-up was available for 2017 persons. A diagnosis of cancer was ascertained at follow-up through interview of survivors and from death certificates. Results: There were 203 new cases of cancer among 2017 persons at risk. Neither Major Depression (relative risk (RR) = 1.0, 95% confidence interval (CI) 0.5–2.1) nor dysphoric episode (RR = 1.3, 95% CI 0.9–1.9) were significantly associated with increased risk of cancer at follow-up. However, among women with Major Depression, the risk of breast cancer was increased (adjusted RR = 3.8, 95% CI 1.0–14.2). Conclusions: We found no overall association of depression with cancer. However, among women, Major Depression (but not dysphoric episode alone) was associated with the onset of breast cancer.

The relation between Chlamydia pneumoniae infection and abdominal aortic aneurysm: case-control study.

Due to recent interest in the role of Chlamydia pneumoniae as a pathogen of the vascular system, a case-control study was conducted to investigate the association between serological evidence of infection with C. pneumoniae and the occurrence of abdominal aortic aneurysm. Detectable IgG antibody to C. pneumoniae was more common among abdominal aortic aneurysm cases than among control patients (adjusted odds ratio, 5.97; P = .08), as was detectable IgM antibody (10% vs. 0%; P = .02). These findings suggest that infection with C. pneumoniae may play a role in the pathogenesis of abdominal aortic aneurysm; therefore, further research in this area is warranted.