Risto Antikainen

Correlates of life satisfaction among psychiatric patients

The aim of this study was to examine the sociodemographic and clinical variables associated with life satisfaction in psychiatric patients. The study population consisted of out‐patients and in‐patients (n= 1204) treated at the Department of Psychiatry of Kuopio University Hospital in North Savo, Finland, during May 1993. Sociodemographic, psychosocial and clinical correlates of life satisfaction were examined by means of two different questionnaires, one directed at patients and the other directed at the staff. Life satisfaction was assessed by means of a separate scale based on four questions. Patients with schizophrenia were less dissatisfied than patients with other disorders. The strongest correlates of dissatisfaction were depression and poor social support. Other factors relating to dissatisfaction in multiple regression analysis were self‐rated health and poor financial circumstances. A psychosomatic reaction tendency or degree of psychosocial functioning at the time of the study was not independently related to life satisfaction. Psychiatric patients who are dissatisfied should be evaluated both for depression and for effectiveness of their social network.

Self-reported life satisfaction and treatment factors in patients with schizophrenia, major depression and anxiety disorder

Our aim was to study the associations between life satisfaction and treatment factors and how depression affects these associations among patients with schizophrenia (n=403), major depression (n= 349) and anxiety disorder (n= 139) from a defined area. Treatment satisfaction and compliance were high, but life satisfaction was low regardless of diagnostic group. Patients with schizophrenia recorded better life satisfaction than patients with the other disorders. There were few independent associations between life satisfaction and treatment factors. Fortunately, factors amenable to treatment intervention, such as depression, problem‐solving ability and social support. were independently related to life satisfaction in every diagnostic group. Depression decreased these associations significantly only in patients with schizophrenia. Life satisfaction and treatment satisfaction should be included as separate variables in treatment outcome studies.

Mood improvement reduces memory complaints in depressed patients.

AbstractBackground The aim was to examine associations between memory complaints, cognitive performance and mood in 174 adult, clinically depressed, neurologically healthy patients at baseline and during six months of follow-up. Methods Subjective memory disturbance was assessed using the Memory Complaint Questionnaire (MCQ). Levels of cognitive function, including memory, were assessed using a battery of neuropsychological tests. Mood and personality traits were assessed using rating scales, including the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS) and the 90-item Symptom Check List (SCL-90). Results At baseline, patients complaining of memory disturbances had higher BDI and HDRS scores than patients not complaining of memory problems. They also did less well in objective memory performances but not in other cognitive functions. Complaints of memory problems decreased during the follow-up. This change was associated with mood improvement and with reductions in other mental symptoms but not with changes in cognitive performance. In logistic regression analysis factors independently associated with MCQ change were age (OR 0.96) and BDI change (OR 1.06). Conclusions Subjective memory problems usually decline if depression is alleviated.

Gender differences in the association of adult hopelessness with adverse childhood experiences

Abstract.Background: The impact of childhood traumatic events on long-term psychological development has been widely studied. Nevertheless, little research has been carried out on possible associations between adverse childhood experiences (ACEs) and hopelessness in adulthood, and whether any gender differences exist. Aim: The aim of this study was to examine the association between ACEs (poor relationship between parents, unhappiness of childhood home, hard parenting, physical punishment, domestic violence, alcohol abuse in primary family) and current hopelessness without any mental disorder in a general population sample. Method: 1598 adults (43 % were men), aged 25–64 years, completed self-report measures to assess ACEs and hopelessness by means of the Beck Hopelessness Scale (HS). Logistic regression was used to adjust for the effects of sociodemographic factors on the association between the cumulative number of ACEs and hopelessness. Results: Whereas several bivariate associations were found between ACEs and hopelessness, none of them remained significant in multivariate analysis. However, men who reported three or more ACEs were 2.79 times (95 % CI 1.17–6.63) and women 2.19 times (95 % CI 1.04–4.65) more likely to be hopeless compared with those without any ACEs. In women (OR 2.25, 95 % CI 1.01–5.00), but not in men, this relationship remained significant after adjusting for several current covariates. Conclusion: Clustering of ACEs may have long-lasting effects by increasing the risk of hopelessness in adulthood, especially in women. Increased awareness of the frequency of ACEs and their subsequent consequences, such as hopelessness, may encourage health care professionals to undertake preventive work in primary and mental health care.

Life events are important in the course of hopelessness—a 2-year follow-up study in a general population

Abstract. Background: The association between life events and hopelessness in a general population is unknown. Aim: The aim of this study was to examine the course of hopelessness and how positive and negative life events are associated with it. Method: This was a 2- year follow-up study among general population adults, excluding any with a mental disorder. The impact of 15 occasional life events during the follow-up was assessed and the course of hopelessness measured with the Beck Hopelessness Scale (HS). Results: Four percent of the study subjects with no hopelessness at baseline and 56% of those with hopelessness at baseline reported hopelessness on follow-up. In multiple logistic regression analyses, a notable worsening of the subjective financial situation was revealed as the most important life event, both in becoming hopeless during the follow-up (OR 5.07; 95% CI 2.20–11.7) and in continued hopelessness (OR 7.51, 95% CI 2.19–25.8). Moreover, considerable interpersonal conflicts at work (OR 3.29, 95% CI 1.17–9.27) were associated with becoming hopeless. However, a notable positive change in common living conditions (OR 0.16, 95% CI 0.04–0.74) was found to be a protective factor against becoming hopeless. All these variables remained significant even when adjusted for change in depression scores (BDI). Conclusion: Hopelessness may be persistent in a general population. The impact of life events, especially a notable worsening of the subjective financial situation, is important in becoming or remaining hopeless.

Cluster C personality disorder impedes alleviation of symptoms in major depression

BACKGROUND We investigated whether cluster C personality disorder (CPD) is associated with recovery from depression. METHODS The study design was observational. Diagnoses of major depression (MD) and CPD were confirmed by means of the Structured Clinical Interview for DSM-III-R (SCID-I, -II). Changes in symptom scales in 52 patients with MD and CPD were compared with changes in 65 patients with MD alone over a 6-month follow-up period. RESULTS On the Hamilton Depression Rating Scale and Beck Depression Inventory (BDI) scales, recovery of patients with MD and comorbid CPD was inferior to recovery of patients with MD alone. Findings were similar in relation to several other symptom scales. Of those with MD alone 54% had recovered from their depression, but only 16% of those with CPD and MD (BDI score <10 on follow-up). Logistic regression analysis revealed an independent association between lack of recovery and presence of CPD (OR 7.5, 95% CI 2.6-22.2). LIMITATIONS Study design was observational. CONCLUSION The presence of CPD hinders alleviation of depressive symptoms in major depression.

A prospective three‐year follow‐up study of borderline personality disorder inpatients

Prospective long‐term follow‐up studies on patients with borderline personality disorder (BPD) have been uncommon. Clinical data suggest that their treatment is highly demanding and that short‐term results are sometimes limited. In this study, changes in symptoms and social management were monitored during a hospitalization period of 91 days (mean, range 21–296 days) and during a 3‐year follow‐up period in 62 patients admitted during 1989 to an open ward specializing in the psychotherapeutic treatment of BPD. The patients were thoroughly evaluated, using various rating scales, at the beginning and at the end of the index admission and after the follow‐up period. Forty‐two patients (70%) participated in the follow‐up evaluation. Most patients suffered from overt anxiety and depressive symptoms at the beginning of hospitalization, and these declined significantly during hospital treatment. At the end of the follow‐up period, depressive and anxiety symptoms were at the same level as on discharge, as assessed by the Beck Depression Inventory and Hamilton Depression Rating Scale. Although treatment response was otherwise maintained, the patients often showed suicidal behavior. During the follow‐up period the sample clearly differentiated in two groups: those continually fit for work (33%) and those chronically incapable of working (46%).

Partial remission in major depression: A two-phase, 12-month prospective study

We conducted an interview-based survey to predict the clinical course of major depressive disorder during a follow-up period of 12 months. Altogether 86 patients were investigated. A SCID I interview for DSM-III-R axis-I diagnosis was conducted at baseline and a SCID II interview for personality disorders at the 6-month follow-up. Beck Depression Inventory scores indicated the level of depression and were compiled at baseline and at 6 and 12 months. A BDI score between 9 and 14 was considered to indicate partial remission, and score of 0-8 indicated remission. At the 6-month assessment 33% of the patients had remission, 20% were in partial remission, and 47% were in the depressive phase. Older age, personality disorder, and alexithymia were associated with poor response at 6 months. At 12 months 37% had remission, 28% were in partial remission, and 35% were still in the depressive phase. Treatment at the early stage should be effective enough to achieve remission. If the response is not satisfactory within 6 months, a renewed search should be conducted for factors hindering recovery. Comorbid personality disorder is the main factor predicting a poor short-term response in major depressive disorder.

Long-term alexithymic features indicate poor recovery from depression and psychopathology. A six-year follow-up.

312 Disclosure Statement The author discloses the following potential conflicts of interest. Research Support: Abbott Laboratories, Alkermes, Aspect Medical Systems, Astra-Zeneca, Bristol-Myers Squibb Co., Cephalon, Eli Lilly & Co., Forest Pharmaceuticals Inc., GlaxoSmithKline, J & J Pharmaceuticals, Lichtwer Pharma GmbH, Lorex Pharmaceuticals, Novartis, Organon Inc., Pamlab LLC, Pfizer Inc., Pharmavite, Roche, Sanofi/Synthelabo, Solvay Pharmaceuticals Inc., Wyeth-Ayerst Laboratories. Advisory/Consulting: Aspect Medical Systems, Astra-Zeneca, Bayer AG, Best Practice Project Management Inc., Biovail Pharmaceuticals Inc., Brain Cells Inc., Bristol-Myers Squibb Co., Cephalon, Compellis, Cypress Pharmaceuticals, Dov Pharmaceuticals, Eli Lilly & Co., Epix Pharmaceuticals, Fabre-Kramer Pharmaceuticals Inc., Forest Pharmaceuticals Inc., GlaxoSmithKline, Grunenthal GmbH, Janssen Pharmaceutica, Jazz Pharmaceuticals, J & J Pharmaceuticals, Knoll Pharmaceutical Co., Lundbeck, MedAvante Inc., Merck, Neuronetics, Novartis, Nutrition 21, Organon Inc., Pamlab LLC, Pfizer Inc., Pharmastar, Pharmavite, Roche, Sanofi/Synthelabo, Sepracor, Solvay Pharmaceuticals Inc., Somaxon, Somerset Pharmaceuticals, Takeda, WyethAyerst Laboratories. Speaking: Astra-Zeneca, Boehringer-Ingelheim, Bristol-Myers Squibb Co., Cephalon, Eli Lilly & Co., Forest Pharmaceuticals Inc., GlaxoSmithKline, Novartis, Organon Inc., Pfizer Inc., Pharmastar, Wyeth-Ayerst Laboratories. Equity Holdings: Compellis, MedAvante.

Which factors are important predictors of non-recovery from major depression? A 2-year prospective observational study

Our aim was to study factors associated with long-term non-recovery from major depression. A total of 109 patients with major depression were followed prospectively for 2 years. A diagnosis of major depression based on SCID interviews at follow-up indicated non-recovery. The effect of several established risk factors was assessed. A third (30%) of the patients did not recover. Severity of initial depression were associated with poor outcome according to univariate analysis. Nevertheless, personality disorder and rural area of residence were associated with non-recovery in final multivariate analysis. Major depression in patients with personality disorder should be treated as effectively as possible. Moreover, service planning in rural areas needs attention.