Maria Efisia Lecca

The Use of Antidepressant Drugs and the Lifetime Prevalence of Major Depressive Disorders in Italy

Background: The increased use of antidepressant drugs (ADs) improved the response to the needs of care although some community surveys have shown that subjects without lifetime psychiatric diagnosis (anxiety/depression) used ADs. Objectives: To evaluate the appropriateness and amount of prescription of psychotropic drugs in people with lifetime diagnosis of Major Depressive Disorder (MDD) by means of community survey with a semi-structured interview as a diagnostic instrument, administered by clinicians. Methods: Study design: community survey. Study population: samples randomly drawn, after stratification from the adult population of municipal records. Sample size: 4.999 people were drawn in 7 centres of 6 Italian regions. Tools: questionnaire on psychotropic drug consumption, prescription, health services utilization; Structured Clinical Interview for DSM-IV modified (ANTAS); Training: interviewers were trained psychologists or medical doctors. Results: 3.398 subjects were interviewed (68% of the recruited sample). The lifetime prevalence of DSM-IV MDD was 4.3% in males and 11.5% in females; antidepressant drugs were taken by 4.7% of subjects, 2.9% male and 5.9% female. 38% of males and 57% of females with lifetime diagnosis of MDD were taking ADs. Conclusions: Compared with studies using lay interviewers and structured tools the prevalence of the MDD was quite lower; ADs use was higher and tallied well with the data regarding antidepressant sales in Italy; the correspondence between lifetime diagnosis of MDD and ADs use was closer.

The lifetime prevalence of bipolar disorders and the use of antidepressant drugs in bipolar depression in Italy

BACKGROUND The prevalence of bipolar spectrum disorders in the community is under debate and the prescription of antidepressant drugs (ADs) in bipolar depression appears to be an underestimated problem. OBJECTIVES To evaluate the prevalence of bipolar disorders by means of a screening instrument in seven communities within six regions of Italy and evaluate the appropriateness and number of prescriptions for ADs in bipolar depression. METHODS STUDY DESIGN community survey. STUDY POPULATION samples randomly drawn, after stratification from the adult population of municipal records. SAMPLE SIZE 4999 people from seven communities within six regions of Italy. Tools: questionnaire on psychotropic drug consumption, prescription, health services utilization; Structured Clinical Interview NP for DSM-IV modified (ANTAS); Mood Disorder Questionnaire (MDQ). Training: interviewers were trained psychologists or medical doctors. STUDY LIMITATIONS the population studied did not represent a nationally representative multistage clustered area probability sample of households. RESULTS 3398 subjects were interviewed (68% of recruited sample). Positivity at MDQ (MDQ+) was higher in males (3.4% vs. 2.8%) but the difference was not significant (OR=1.2, P=0.37). The association between MDQ+ and Major Depressive Disorder (MDD) was statistically significant for both males (OR=14.9, P<0.0001) and females (OR=8.3, P<0.001); 30% of subjects with MDQ+ and MDD lifetime diagnosis were taking ADs. CONCLUSIONS These overall rates of being MDQ+ are similar to community surveys conducted within USA and the use of ADs in people with MDQ+ and MDD diagnoses are.

Quality of Life and Urban / Rural Living: Preliminary Results of a Community Survey in Italy

Background: The purpose of this population-based study is to examine the association between subjective quality of life and rural/urban residence in six Italian regions, including age and gender into the analysis. Methods: Study design: community survey. Study population: Samples stratified according to sex and age, drawn from municipal records. Sample size: 4999 people 18 years and older, from seven communities within six regions of Italy. Tools: Ad-hoc form to assess basic demographic data; SF-12. Interviewers were trained psychologists or medical doctors. Results: 3398 subjects were interviewed (68% of recruited sample). The mean score of SF-12 in the overall sample was 38.4±6.1, SF-12 was higher in men than in in women (38.4±6.1 vs 37.5±5.9 F=99.18, df 1, 3396, 3397, p<0.0001); SF-12 score decreased from the youngest to the oldest age group, with significant differences between all ages groups; men showed higher scores in all age groups. The urban/rural difference of mean scores of SF-12 did not achieve statistical significance in women. Young men with urban residence had higher SF-12 scores than their counterparts with rural residence. Maen aged 65 years and older with rural residence showed, by contrast, higher scores than men from the same age group with urban residence. Conclusions: Men show a higher subjective quality of life than women. Subjective quality of life decreases with age in both genders. Men are more sensitive to urban/rural residence than women. Young men live better in cities, elderly men better in rural areas.BACKGROUND The purpose of this population-based study is to examine the association between subjective quality of life and rural/urban residence in six Italian regions, including age and gender into the analysis. METHODS STUDY DESIGN community survey. STUDY POPULATION Samples stratified according to sex and age, drawn from municipal records. SAMPLE SIZE 4999 people 18 years and older, from seven communities within six regions of Italy. TOOLS Ad-hoc form to assess basic demographic data; SF-12. Interviewers were trained psychologists or medical doctors. RESULTS 3398 subjects were interviewed (68% of recruited sample). The mean score of SF-12 in the overall sample was 38.4±6.1, SF-12 was higher in men than in in women (38.4±6.1 vs 37.5±5.9 F=99.18, df 1, 3396, 3397, p<0.0001); SF-12 score decreased from the youngest to the oldest age group, with significant differences between all ages groups; men showed higher scores in all age groups. The urban/rural difference of mean scores of SF-12 did not achieve statistical significance in women. Young men with urban residence had higher SF-12 scores than their counterparts with rural residence. Maen aged 65 years and older with rural residence showed, by contrast, higher scores than men from the same age group with urban residence. CONCLUSIONS Men show a higher subjective quality of life than women. Subjective quality of life decreases with age in both genders.Men are more sensitive to urban/rural residence than women.Young men live better in cities, elderly men better in rural areas.

Sub-threshold depression and antidepressants use in a community sample: searching anxiety and finding bipolar disorder

BackgroundTo determine the use of antidepressants (ADs) in people with sub-threshold depression (SD); the lifetime prevalence of mania and hypomania in SD and the link between ADs use, bipolarity and anxiety disorders in SD.MethodsStudy design: community survey. Study population: samples randomly drawn, after stratification from the adult population of municipal records. Sample size: 4999 people from seven areas within six Italian regions. Tools: Questionnaire on psychotropic drug consumption, prescription; Structured Clinical Interview NP for DSM-IV modified (ANTAS); Hamilton Depression Rating Scale (HAM-D); Mood Disorder Questionnaire (MDQ); Short Form Health Survey (SF-12). SD definition: HAM-D > 10 without lifetime diagnosis of Depressive Episode (DE).ResultsSD point prevalence is 5.0%. The lifetime prevalence of mania and hypomania episodes in SD is 7.3%. Benzodiazepines (BDZ) consumption in SD is 24.1%, followed by ADs (19.7%). In SD, positive for MDQ and comorbidity with Panic Disorder (PD) or Generalized Anxiety Disorders (GAD) are associated with ADs use, whereas the association between a positive MDQ and ADs use, without a diagnosis of PD or GAD, is not significant. Only in people with DE the well-being (SF-12) is higher among those using first-line antidepressants compared to those not using any medication. In people with SD no significant differences were found in terms of SF-12 score according to drug use.ConclusionsThis study suggests caution in prescribing ADs to people with SD. In people with concomitant anxiety disorders and SD, it should be mandatory to perform a well-designed assessment and evaluate the presence of previous manic or hypomanic symptoms prior to prescribing ADs.

Outcomes of discharged females versus those waiting for discharge from Vlore Psychiatric Hospital (Albania)

Background: This study examines the psychosocial outcomes of women discharged from the Vlore Psychiatric Hospital in Albania. Methods: The study was designed as a controlled, not randomized, follow-up study. It included 16 women diagnosed with psychosis who were discharged from a psychiatric hospital to live in group homes in the community. The control group included 20 women diagnosed with psychosis who lived at the psychiatric hospital while awaiting discharge. All subjects were assessed twice using the HoNOS-Rome tool, at the start of the study (T0) and 12 months later (T1). Results: Both groups showed an improvement in the HoNOS total score between T0 and T1 (p < .001). This improvement was significantly larger in the Home group compared to the Hospital group (p = .014). An item-level analysis indicated a significantly greater improvement in the Home group on items 11 (autonomy), 12 (work), 16 (family) and 18 (goals). Conclusions: Projects for social inclusion of people suffering from psychosis must design living spaces that offer viable alternatives to psychiatric hospitals. This study also documents the efforts in the Vlore region of Albania to follow European standards of mental health care.

Counseling in Primary Care Improves Depression and Quality of Life

Introduction: To measure the effectiveness on Quality of Life of adjunctive cognitive behavioral counseling in the setting of General Practitioners (GPs) along with the treatment as usual (TAU;) for the treatment of depression. Methods: Six month-controlled trial of patients who were referred to randomly assigned GPs (four for experimental group of patients and ten for the control) was done. Experimental sample had 34 patients with DSM-IV diagnosis of Depression (Depressed Episode, Dysthymia, or Adjustment Disorder with Depressed Mood) receiving the TAU supplemented with counseling. Control group had 30 patients with diagnosis of Depression receiving only the TAU. Results: The Beck Depression Inventory (BDI) score improved in both groups. Patients in the experimental group showed greater improvement compared to the control group at T2. The World Health Organization Quality OF Life Questionnaire (WHOQOL) score also improved in the experimental group but not in the control group. The improvement in the experimental group was statistically significant in terms of both BDI and WHOQOL scores. Conclusions: Adding counseling to TAU in general medical practice settings is more effective in controlling the symptoms of depression and improving the quality of life as measured over a period of six months, than TAU alone. These results while encouraging, also calls for a larger study involving a largersample size and a longer period of time.

Quality of Life in Carotid Atherosclerosis: The Role of Co-morbid Mood Disorders

Introduction/Objective: To study in severe carotid atherosclerosis (CA): the frequency of mood disorders (MD); the impairment of quality of life (QoL); the role of co-morbid MD in such impairment. Methods: Case-control study. Cases: consecutive in-patients with CA (stenosis ≥ 50%). Controls: subjects with no diagnosis of CA randomized from a database of a community survey. Psychiatric diagnosis according to DSM-IV made by clinicians and semi-structured interview, QoL measured by the Short Form Health Survey (SF-12). Results: This is the first study on comorbidity on CA disease and MD in which psychiatric diagnoses are conducted by clinicians according to DSM-IV diagnostic criteria. Major Depressive Disorder (MDD) (17.4% vs 2.72%, P <0.0001) but not Bipolar Disorders (BD) (4.3% vs 0.5%, P = 0.99) was higher in cases (N=46) than in controls (N= 184). SF-12 scores in cases were lower than in controls (30.56±8.12 vs 36.81±6:40; p <0.001) with QoL comparable to serious chronic diseases of the central nervous system. The burden of a concomitant MDD or BD amplifies QoL impairment. Conclusion: Comorbid MD aggravates the impairment of QoL in CA. Unlike autoimmune diseases or degenerative diseases of the Central Nervous System, CA shows a strong risk of MDD than BD.