EDITORIAL
Invited Editorial for Special Issue on Affective Disorders Robert M.A. Hirschfeld, MD
T
his special issue of the Journal of Nervous and Mental Disease includes six original articles on mood disorders. The issue includes two epidemiological studies, one on course of illness, one on diagnosis, one on an intervention for depression, and one on the determinants of stigma. The common theme among these studies is that mood disorders (including depression and bipolar disorder) are not simply an altered ‘‘mental state.’’ Rather, these disorders are truly whole-body illnesses that have broad and long-lasting adverse consequences. Our use of the term mental illness may in fact contribute to this undervaluing of the consequences of mood disorders, by reference to the mental, but not general medical, aspects of mood disorders. These articles and this issue may serve as call to arms to take more seriously psychiatric illness, in particular mood disorders, and to put more resources into the prevention, identification, and treatment of mood disorders. Looking at the individual articles, the article by Post et al. (2014) entitled ‘‘More Medical Comorbidities in Patients With Bipolar Disorder From the United States Than From the Netherlands and Germany’’describes findings from cross-national samples of patients followed a number of years by an international group of experts on bipolar disorder, the former Stanley Foundation Bipolar Treatment Outcome Network (now entitled the Bipolar Collaborative Network). Outpatients with bipolar disorder were ascertained from clinics in the United States, the Netherlands, and Germany approximately 15 years ago and have been followed ever since. The American patients were much more likely to be obese and have allergies, head injury, irritable bowel syndrome, migraine, and several other general medical conditions than their European counterparts, who were more likely to have hyperthyroidism. These findings may reflect simply that the American sample was sicker with an earlier age of onset, more prior physical or sexual abuse, more rapid cycling, more psychiatric comorbidities, and more episodes of depression and mania. Nonetheless, the findings do raise questions about whether differences in European versus American life experience may contribute to comorbidities. Of most concern is the possibility that maybe less attention is paid to the general medical illnesses, particularly to obesity and cardiovascular disease, in patients with bipolar disorder in the United States than in Europe. The article by Qu et al. (2014) entitled ‘‘Prevalence and Determinants of Depression Among Survivors 8 Months After the Wenchuan Earthquake’’ describes a staggering rate of depression of nearly 36% among more than 1500 participants living in temporary camp communities near the epicenter of the 2008 Wenchuan earthquake in China. Their analyses revealed several risk factors of depression and others that were not. Severity of depression was significantly associated with being female, perception of loss of livelihood security, loss of a family member, residential damage, and living in a rural area. Being married served as a protector against depressive symptoms. Somewhat surprisingly, age, education, loss of friends or neighbors, and past experiences with bereavement were not associated with depression severity. This study dramatically demonstrates and illustrates the consequences of disaster on communities and population mental health. The article by Zhang et al. (2014) from China is entitled ‘‘Exploratory Quantum Resonance Spectrometer as a Discriminator for Psychiatric Affective Disorders.’’ This article describes a putative biological marker for depression. It involves a handheld biological wave detection unit that measures quantum resonance, a vibration frequency associated with magnetic fields. In this study, there are 1014 schizophrenic patients and 248 patients with mood disorders (including 93 with major depression) and three affective disorder symptoms. Quantum resonance spectrometer scores were able to discriminate three mood disorder symptoms (parathymia, apathy, and irritability) among 93 patients with major depressive disorder. The article by Rubio et al. (2014) entitled ‘‘Effect of First Episode Axis I Disorders on Quality of Life’’ addresses the effect of a new episode of a mental disorder on quality of life in individuals without a history of any mental disorder. This analysis uses data from National Epidemiologic Survey
Department of Psychiatry, The University of Texas Medical Branch, Galveston, TX. Send reprint requests to Robert M.A. Hirschfeld, MD, Department of Psychiatry, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555. E-mail: [email protected]. Copyright * 2014 by Lippincott Williams & Wilkins ISSN: 0022-3018/14/20204Y0263 DOI: 10.1097/NMD.0000000000000115
The Journal of Nervous and Mental Disease
& Volume 202, Number 4, April 2014
www.jonmd.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
263
The Journal of Nervous and Mental Disease
Editorial
on Alcohol and Related Conditions, a population survey ascertained in 2001 and 2002 and reassessed in 2004 and 2005. The analysis focused on individuals who experienced the first episode of any mental disorder after their original evaluation, looking at quality of life. They found a substantial decrease in quality of life in patients with first episode of major depressive disorder or generalized anxiety disorder. These findings dramatically demonstrate the impact of depression and anxiety on quality of life, more so than other psychiatric illnesses. The article by Oyama and Sakashita (2014) is entitled ‘‘Effects of Universal Screening for Depression Among Middle-Aged Adults in a Community With a High Suicide Rate.’’ This study focused on the value of a depression screening program and modest subsequent care support in adults aged 40 to 64 years in Japan. The study compared individuals involved in this program with individuals who were not, although both groups of people in the general population received ongoing dissemination of educational information about depression. The outcome was prevalence of depressive symptoms before and after the program as assessed by the Center for Epidemiological Studies Depression Scale. The intervention involved telephone or face-to-face interviews conducted by public health nurses or psychiatric social workers who made referrals to treatment for appropriate individuals. Some treatment support was provided when indicated. The resultant sample was relatively smallV79 people who participated in the second phase of screening, with 16 actually receiving a diagnosis of depression. Each of these 16 received some treatment. This led to a substantial reduction in the prevalence of moderate-to-severe depressive symptoms and overall depressive symptoms in the intervention group. There was no difference in this prevalence in the control group. These findings suggest that even a very moderate intervention for depression may have very significant cognitive consequences. The final article in the special issue is by Henshaw (2014) and is entitled ‘‘Too Sick, Not Sick Enough? Effects of Treatment Type and Timing on Depression Stigma.’’ This study involved a survey of reactions to a case vignette of a 27-year-old man who becomes depressed. There are several action options for him, including early treatment psychotherapy, early treatment pharmacotherapy, delayed treatment psychotherapy, delayed treatment pharmacotherapy, and extended delay without treatment. The study assessed 116 undergraduates and 301 participants from an online survey participation service. The study focused on how these choices by the individuals
264
www.jonmd.com
& Volume 202, Number 4, April 2014
with depression affected the stigma associated with depression. The results were that extended untreated symptoms were associated with a desire for other people to distance themselves from the affected person and to have negative feelings about the individual’s character. Interestingly, those seeking pharmacotherapy were viewed as less responsible for their illness than those seeking psychotherapy. These articles from around the world underscore the universality of depression and its adverse consequences. Our hope is that early recognition and intervention may have a profoundly positive effect on the course of depression.
DISCLOSURE Dr Hirschfeld receives or has received royalties from Jones and Bartlett. He is or has been a consultant for Grey Healthcare, Biostrategies, Merck Manual Editorial Board, and Equinox Group. He has received honorarium from Physicians Post Graduate Press, Health and Wellness Partners, Merck Manual Editorial Board, CME Outfitters, Letters & Sciences, Nevada Psychiatric Association, and CMEology.
REFERENCES Henshaw EJ (2014) Too Sick, Not Sick Enough?: Effects of Treatment Type and Timing on Depression Stigma. J Nerv Ment Dis 202:292Y299. Oyama H, Sakashita T (2014) Effects of Universal Screening for Depression Among Middle-Aged Adults in a Community With a High Suicide Rate. J Nerv Ment Dis 202:280Y286. Post RM, Altshuler LL, Leverich GS, Frye MA, Suppes T, McElroy SL, Keck PE Jr, Nolen WA, Kupka RW, Grunze H, Rowe M (2014) More Medical Comorbidities in Patients With Bipolar Disorder From the United States Than From the Netherlands and Germany. J Nerv Ment Dis 202:265Y270. Qu Z, Wang C-W, Zhang X, Ho AHY, Wang X, Chan CLW (2014) Prevalence and Determinants of Depression Among Survivors 8 Months After the Wenchuan Earthquake. J Nerv Ment Dis 202:275Y279. Rubio JM, Olfson M, Pe´rez-Fuentes G, Garcia-Toro M, Wang S, Blanco C (2014) Effect of First Episode Axis I Disorders on Quality of Life. J Nerv Ment Dis 202:271Y274. Zhang Y, Liu F, Shi J, Yue X, Zhang H, Du X, Sun L, Yuan J (2014) Exploratory Quantum Resonance Spectrometer as a Discriminator for Psychiatric Affective Disorders. J Nerv Ment Dis 202:287Y291.
* 2014 Lippincott Williams & Wilkins
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Invited Editorial for Special Issue on Affective Disorders Robert M.A. Hirschfeld, MD
T
his special issue of the Journal of Nervous and Mental Disease includes six original articles on mood disorders. The issue includes two epidemiological studies, one on course of illness, one on diagnosis, one on an intervention for depression, and one on the determinants of stigma. The common theme among these studies is that mood disorders (including depression and bipolar disorder) are not simply an altered ‘‘mental state.’’ Rather, these disorders are truly whole-body illnesses that have broad and long-lasting adverse consequences. Our use of the term mental illness may in fact contribute to this undervaluing of the consequences of mood disorders, by reference to the mental, but not general medical, aspects of mood disorders. These articles and this issue may serve as call to arms to take more seriously psychiatric illness, in particular mood disorders, and to put more resources into the prevention, identification, and treatment of mood disorders. Looking at the individual articles, the article by Post et al. (2014) entitled ‘‘More Medical Comorbidities in Patients With Bipolar Disorder From the United States Than From the Netherlands and Germany’’describes findings from cross-national samples of patients followed a number of years by an international group of experts on bipolar disorder, the former Stanley Foundation Bipolar Treatment Outcome Network (now entitled the Bipolar Collaborative Network). Outpatients with bipolar disorder were ascertained from clinics in the United States, the Netherlands, and Germany approximately 15 years ago and have been followed ever since. The American patients were much more likely to be obese and have allergies, head injury, irritable bowel syndrome, migraine, and several other general medical conditions than their European counterparts, who were more likely to have hyperthyroidism. These findings may reflect simply that the American sample was sicker with an earlier age of onset, more prior physical or sexual abuse, more rapid cycling, more psychiatric comorbidities, and more episodes of depression and mania. Nonetheless, the findings do raise questions about whether differences in European versus American life experience may contribute to comorbidities. Of most concern is the possibility that maybe less attention is paid to the general medical illnesses, particularly to obesity and cardiovascular disease, in patients with bipolar disorder in the United States than in Europe. The article by Qu et al. (2014) entitled ‘‘Prevalence and Determinants of Depression Among Survivors 8 Months After the Wenchuan Earthquake’’ describes a staggering rate of depression of nearly 36% among more than 1500 participants living in temporary camp communities near the epicenter of the 2008 Wenchuan earthquake in China. Their analyses revealed several risk factors of depression and others that were not. Severity of depression was significantly associated with being female, perception of loss of livelihood security, loss of a family member, residential damage, and living in a rural area. Being married served as a protector against depressive symptoms. Somewhat surprisingly, age, education, loss of friends or neighbors, and past experiences with bereavement were not associated with depression severity. This study dramatically demonstrates and illustrates the consequences of disaster on communities and population mental health. The article by Zhang et al. (2014) from China is entitled ‘‘Exploratory Quantum Resonance Spectrometer as a Discriminator for Psychiatric Affective Disorders.’’ This article describes a putative biological marker for depression. It involves a handheld biological wave detection unit that measures quantum resonance, a vibration frequency associated with magnetic fields. In this study, there are 1014 schizophrenic patients and 248 patients with mood disorders (including 93 with major depression) and three affective disorder symptoms. Quantum resonance spectrometer scores were able to discriminate three mood disorder symptoms (parathymia, apathy, and irritability) among 93 patients with major depressive disorder. The article by Rubio et al. (2014) entitled ‘‘Effect of First Episode Axis I Disorders on Quality of Life’’ addresses the effect of a new episode of a mental disorder on quality of life in individuals without a history of any mental disorder. This analysis uses data from National Epidemiologic Survey
Department of Psychiatry, The University of Texas Medical Branch, Galveston, TX. Send reprint requests to Robert M.A. Hirschfeld, MD, Department of Psychiatry, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555. E-mail: [email protected]. Copyright * 2014 by Lippincott Williams & Wilkins ISSN: 0022-3018/14/20204Y0263 DOI: 10.1097/NMD.0000000000000115
The Journal of Nervous and Mental Disease
& Volume 202, Number 4, April 2014
www.jonmd.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
263
The Journal of Nervous and Mental Disease
Editorial
on Alcohol and Related Conditions, a population survey ascertained in 2001 and 2002 and reassessed in 2004 and 2005. The analysis focused on individuals who experienced the first episode of any mental disorder after their original evaluation, looking at quality of life. They found a substantial decrease in quality of life in patients with first episode of major depressive disorder or generalized anxiety disorder. These findings dramatically demonstrate the impact of depression and anxiety on quality of life, more so than other psychiatric illnesses. The article by Oyama and Sakashita (2014) is entitled ‘‘Effects of Universal Screening for Depression Among Middle-Aged Adults in a Community With a High Suicide Rate.’’ This study focused on the value of a depression screening program and modest subsequent care support in adults aged 40 to 64 years in Japan. The study compared individuals involved in this program with individuals who were not, although both groups of people in the general population received ongoing dissemination of educational information about depression. The outcome was prevalence of depressive symptoms before and after the program as assessed by the Center for Epidemiological Studies Depression Scale. The intervention involved telephone or face-to-face interviews conducted by public health nurses or psychiatric social workers who made referrals to treatment for appropriate individuals. Some treatment support was provided when indicated. The resultant sample was relatively smallV79 people who participated in the second phase of screening, with 16 actually receiving a diagnosis of depression. Each of these 16 received some treatment. This led to a substantial reduction in the prevalence of moderate-to-severe depressive symptoms and overall depressive symptoms in the intervention group. There was no difference in this prevalence in the control group. These findings suggest that even a very moderate intervention for depression may have very significant cognitive consequences. The final article in the special issue is by Henshaw (2014) and is entitled ‘‘Too Sick, Not Sick Enough? Effects of Treatment Type and Timing on Depression Stigma.’’ This study involved a survey of reactions to a case vignette of a 27-year-old man who becomes depressed. There are several action options for him, including early treatment psychotherapy, early treatment pharmacotherapy, delayed treatment psychotherapy, delayed treatment pharmacotherapy, and extended delay without treatment. The study assessed 116 undergraduates and 301 participants from an online survey participation service. The study focused on how these choices by the individuals
264
www.jonmd.com
& Volume 202, Number 4, April 2014
with depression affected the stigma associated with depression. The results were that extended untreated symptoms were associated with a desire for other people to distance themselves from the affected person and to have negative feelings about the individual’s character. Interestingly, those seeking pharmacotherapy were viewed as less responsible for their illness than those seeking psychotherapy. These articles from around the world underscore the universality of depression and its adverse consequences. Our hope is that early recognition and intervention may have a profoundly positive effect on the course of depression.
DISCLOSURE Dr Hirschfeld receives or has received royalties from Jones and Bartlett. He is or has been a consultant for Grey Healthcare, Biostrategies, Merck Manual Editorial Board, and Equinox Group. He has received honorarium from Physicians Post Graduate Press, Health and Wellness Partners, Merck Manual Editorial Board, CME Outfitters, Letters & Sciences, Nevada Psychiatric Association, and CMEology.
REFERENCES Henshaw EJ (2014) Too Sick, Not Sick Enough?: Effects of Treatment Type and Timing on Depression Stigma. J Nerv Ment Dis 202:292Y299. Oyama H, Sakashita T (2014) Effects of Universal Screening for Depression Among Middle-Aged Adults in a Community With a High Suicide Rate. J Nerv Ment Dis 202:280Y286. Post RM, Altshuler LL, Leverich GS, Frye MA, Suppes T, McElroy SL, Keck PE Jr, Nolen WA, Kupka RW, Grunze H, Rowe M (2014) More Medical Comorbidities in Patients With Bipolar Disorder From the United States Than From the Netherlands and Germany. J Nerv Ment Dis 202:265Y270. Qu Z, Wang C-W, Zhang X, Ho AHY, Wang X, Chan CLW (2014) Prevalence and Determinants of Depression Among Survivors 8 Months After the Wenchuan Earthquake. J Nerv Ment Dis 202:275Y279. Rubio JM, Olfson M, Pe´rez-Fuentes G, Garcia-Toro M, Wang S, Blanco C (2014) Effect of First Episode Axis I Disorders on Quality of Life. J Nerv Ment Dis 202:271Y274. Zhang Y, Liu F, Shi J, Yue X, Zhang H, Du X, Sun L, Yuan J (2014) Exploratory Quantum Resonance Spectrometer as a Discriminator for Psychiatric Affective Disorders. J Nerv Ment Dis 202:287Y291.
* 2014 Lippincott Williams & Wilkins
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
