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Background Accurately identifying patients at an elevated risk of suicide in minimal time is an important mental health issue. Therefore, we developed the Ultra Brief Checklist for Suicidality (UBCS) and reported its psychometric properties. Methods We studied 544 participants who had completed the UBCS, other self-report measures, and structured clinical interviews by trained interviewers. We explored the psychometric properties of the UBCS's paper-based and online versions by identifying optimal cutoff points, sensitivity, specificity, etc. of all participants. Results The mean score of the UBCS (paper-pencil version) in the no-suicide-risk group was 0.23 (SD = 0.73), while in the Risk-Positive (RP) and the High-Risk (HR) groups it was 3.54 (SD = 3.22) and 6.31 (SD = 3.97), respectively. Optimal cutoff points for the RP and HR groups were 1 (AUC = 0.914) and 3 (AUC = 0.928), respectively. Limitations The current findings apply only to adults, not to children or adolescents. The original MINI was used as the assessment instrument's reference standard rather than MINI 7.0.2 of DSM-5. Predictive validity was not addressed as this was not a longitudinal cohort study. Conclusions The UBCS was rigorously tested and validated. More than half the participants completed the UBCS within a minute. It possesses adequate psychometric properties and can be easily administered with minimal clinician time and effort, via paper or Internet. We believe it can contribute to suicide risk identification and timely interventions.

Background\ud Research and screening of anxiety in the perinatal period is hampered by a lack of psychometric data on self-report anxiety measures used in perinatal populations. This paper aimed to review self-report measures that have been validated with perinatal women.\ud \ud Methods\ud A systematic search was carried out of four electronic databases. Additional papers were obtained through searching identified articles. Thirty studies were identified that reported validation of an anxiety measure with perinatal women.\ud \ud Results\ud Most commonly validated self-report measures were the General Health Questionnaire (GHQ), State Trait Anxiety Inventory (STAI), and Hospital Anxiety and Depression Scales (HADS). Of the 30 studies included, 11 used a clinical interview to provide criterion validity. Remaining studies reported one or more other forms of validity (factorial, discriminant, concurrent and predictive) or reliability. The STAI shows criterion, discriminant and predictive validity and may be most useful for research purposes as a specific measure of anxiety. The Kessler 10 (K-10) may be the best short screening measure due to its ability to differentiate anxiety disorders. The Depression Anxiety Stress Scales 21 (DASS-21) measures multiple types of distress, shows appropriate content, and remains to be validated against clinical interview in perinatal populations.\ud \ud Limitations\ud Nineteen studies did not report sensitivity or specificity data. The early stages of research into perinatal anxiety, the multitude of measures in use, and methodological differences restrict comparison of measures across studies.\ud \ud Conclusion\ud There is a need for further validation of self-report measures of anxiety in the perinatal period to enable accurate screening and detection of anxiety symptoms and disorders.

Background Temperament relates to both emotional dimensions and prevailing mood, but these different views are rarely integrated. Based on a model where temperament works as a system with activation, inhibition and control (inspired in Cloninger's and Rothbart's models), which produce the affective tone (inspired by Akiskal's and Kraepelin's model), we developed and validated the Combined Emotional and Affective Temperament Scale (CEATS). Methods 1007 subjects (28% males) from the general population and university students filled in the instrument either in the Internet or in a pen and paper version. The CEATS has an emotional section (dimensional only), an Affective section (both dimensional and categorical) and an evaluation of problems and benefits related to temperament. The data was analyzed with standard psychometric batteries and different sections were compared. Results In the emotional section, 4 factors with Eingenvalue > 1 explained 46% of the variation. These factors were interpreted as drive, control, disinhibition-fear and anger, had a normal distribution and had satisfactory Chronbach's alphas (0.70–0.82). Anger was particularly associated with problems and drive with benefits. In the Affective section, all 10 categorical affective temperaments were selected, being euthymic and hyperthymic the most prevalent (18–23%), followed by cyclothymic and irritable (11–13%), anxious and depressive (8–9%) and dysphoric, disinhibited, labile and apathetic temperaments (3–7%). The dimensional evaluation of affective temperaments showed 95% of the sample was able to ascribe to at least one affective temperament. Only the euthymic and hyperthymic temperaments were clearly associated with a favorable problem/benefit profile. The comparison between the emotional and affective sections revealed that each affective temperament had a particular emotional configuration. Limitations Both computerized and pen and paper versions were used. The sample was not evaluated for psychiatric symptoms. Quantification of the dimensional assessment of affective temperament is limited. Conclusions The CEATS is a brief and adequate instrument to evaluate emotional and affective aspects of temperament simultaneously.

Background: This paper examines the distribution of the temperamental characteristics and gender effects of a new autoquestionnaire developed by Akiskal et al. (TEMPS-A) in its German briefTEMPS-M version. Methods: As described in a companion article [J. Affect. Disord. 85 (2005), 53, this issue], based on a study population of 1056 students of the Westfalische-Wilhelms-Universitat in Munster, Germany, we constructed the briefTEMPS-M. In the present paper we report on the basic descriptive statistics of the five subscales of the briefTEMPS (depressive, cyclothymic, hyperthymic, irritable, and anxious), as well as gender differences. Results: Except for the hyperthymic, these subscales are capable of representing the full range of temperament in a sample of German students. Characteristics of the distribution (skewness, kurtosis) of the subscales are well in acceptable limits. We found higher depressive, cyclothymic, and anxious, as well as lower hyperthymic, temperament values in women as compared to men. Cut-off scores to determine extreme groups are provided. To render our results comparable to a similar study using the interview version of the TEMPS-I in an Italian student population [J. Affect. Disord. 47 (1998) 1; J. Affect. Disord. 51 (1998) 7], we computed the rates for dominant temperaments based on the z scores +2 S.D., and obtained the following: depressive, 4.7%; cyclothymic, 4.7%; hyperthymic, 2.1%; irritable, 4.0%; and anxious, 4.2%. Conclusions: The briefTEMPS-M is a potentially valuable scale to quickly assess temperament in research, clinical and normal samples.

BACKGROUND: Childhood maltreatment among women is related to risk of adult depression and particularly an episode taking a chronic course. This paper explores the aspects of parental behaviour involved. METHODS: An expanded version of CECA (Childhood Experiences of Care and Abuse), a retrospective interview-based instrument covering neglect as well as various forms of abuse is used to develop a new index of parental maltreatment. Data are derived from an enquiry of sister pairs between early 20s and 50s, comprising a high-risk series (n=118) where the first sister was selected as likely to have experienced childhood abuse or neglect, and a comparison series (n=80) where she was selected at random. RESULTS: Adverse maternal behaviour emerges as of critical importance for the link with adult chronic depression. Maternal lack of affection ('neglect') and maternal rejection ('emotional abuse') form the core of an index of parental maltreatment, and it is concluded that persistent rejection, particularly from a mother, appears to be the core experience of importance. The findings of behavioural genetics that the experience of siblings of parents in ordinary families often differs have been found to hold for the more extreme behaviour involved in maltreatment. Difference between siblings in risk of later chronic depression is entirely related to such experience. LIMITATIONS: The study is based on retrospective questioning of adult women. Our next paper considers the possible threats to validity involved [Brown, G.W., Craig, T.K.J., Harris, T.O., Handley, R.V., Harvey, A.L., 2007a. Validity of retrospective measures of early maltreatment and depressive episodes using CECA (Childhood Experience of Care and Abuse) - a life-course study of adult chronic depression - 2. J. Affect. Disord. doi:10.1016/j.jad.2007.06.003]. CONCLUSIONS: Parental maltreatment emerges as a critical determinant of later chronic depressive episodes among adult women. Language: en

Background An earlier paper [Brown, G.W., Craig, T.K.J., Harris, T.O., Handley, R.V., Harvey, A.L., 2007a-this issue. Development of a retrospective interview measure of parental maltreatment using the Childhood Experience of Care & Abuse (CECA) instrument — a life-course study of adult chronic depression — 1. J. Affect. Disord. doi:10.1016/j.jad.2007.05.022] documented an association between parental maltreatment and risk of adult chronic depression. This paper explores the contribution of other child-specific factors (e.g. conduct problems) and family-wide factors (e.g. parental discord). Methods Data are derived from an enquiry of 198 women largely comprising of adult sister pairs. Data was collected by semi-structured interviews covering a wide range of parental behaviour and childhood behaviour. Results Parental maltreatment emerged as channelling the effect of family-wide factors on risk of adult chronic depression, but with a child's conduct problems and shame-withdrawal partly mediating this link. A child's depression before 17, although correlated with parental maltreatment, did not appear to play a significant role in adult depression. This core model is supplemented by analyses exploring the mechanisms involved. A mother's rejection/physical abuse and her depression via her lax control, for example, account for the link of parental maltreatment with conduct problems. Also ‘rebelliousness’ of a child relates to the chances of her low affection moving to rejection. “Rebelliousness” also appears to play a role in why the paired sisters so often had a different experience of maltreatment. Limitations The data is collected retrospectively — but see [Brown, G.W., Craig, T.K.J., Harris, T.O., Handley, R.V., Harvey, A.L., 2007b-this issue. Validity of retrospective measures of early maltreatment and depressive episodes using the Childhood Experience of Care and Abuse (CECA) instrument — A life-course study of adult chronic depression — 2. J. Affect. Disord. doi:10.1016/j.jad.2007.06.003]. Conclusions Child-specific factors play a major role in the origins of adult chronic depressive episodes. This, however, is fully consistent with an equally significant contribution from family-wide factors. The crucial point is that the link of the latter with such depression appears to be indirect and mediated very largely by parental maltreatment.

Background To validate the reliability and validity of the Chinese version of the THINC-it tool in adults with major depressive disorder (MDD). Methods Subjects aged 18 to 65 years (n=117) with MDD were evaluated and compared to age- and sex-matched healthy controls (n=124). Subjects completed the THINC-it, four criteria-related objective cognitive subtests, and the paper version of Perceived Deficits Questionnaire for Depression-5-item (PDQ-5-D). Results There were significant differences in Spotter [Mean difference (MD) Standard errors (SE)=-0.40 (0.17), P=0.018; 95% Confidence intervals (CI) (-0.73 to -0.07)]; Codebreaker [MD (SE)=-0.39 (0.14), P=0.006; 95% CI(-0.67 to -0.11)]; and the overall performance of four objective tests (including variants of IDN, OBK, DSST, and TMT-B) [MD (SE)=-0.30 (0.12), P=0.013; 95% CI (-0.53 to -0.06]) between the two groups. In the HC group, PDQ-5-D retest reliability was good (ICC = 0.841), and the test-retest reliability of the objective cognitive test was relatively low (ICC ranging from 0.123 to 0.545). In the MDD group: Cronbach's α of PDQ-5-D=0.704; all the THINC-it subtests had good concurrent validity (r ranging from 0.343 to 0.835, all P Limitation The test-retest sample size was relatively small, the educational level and IQ of the control and MDD groups were not completely matched. Conclusion The Chinese version of the THINC-it tool exhibits good reliability and validity in adults with MDD. There is a need to incorporate cognitive assessment of adults with MDD broadly. The THINC-it tool is the first tool validated to assess cognition of MDD in a Chinese population.

Background : Depression and suicide are prominent and increasing U.S. public health issues, which suggests novel assessment and treatment approaches are needed. Reiss’ Expectancy Model of Fear, Anxiety, and Panic states that fear is based on two classes of variables, expectations and sensitivities, which has led to much research on anxiety sensitivity as a significant risk factor for later anxiety psychopathology. Major depressive disorder also includes biased expectations and sensitivities; however, a depression sensitivity rooted in Expectancy Theory has never been formalized. Uncovering depression-related sensitivities may lead to earlier risk detection and prevention before mood disorders develop. Method : The goal of the paper was to create a Depression Sensitivity Index using exploratory factor analysis and item response theory and then conduct tests of convergent and construct validity using structural equation modeling using three independent samples. Results : indicated two lower order factors: 1) physical and cognitive concerns (DSPCC) and 2) social concerns (DSSC). Factors showed incremental associations with depression (DSPCC), social anxiety (both) and suicidal thoughts and behaviors (DSPCC), above and beyond anxiety sensitivity cognitive concerns. Both factors together predicted depressive disorder diagnoses Limitations : Mostly self-report data, large percentage of non-Hispanic White participants in Study 1. Conclusions : The results offer initial evidence that expectancy theory applies beyond “fear, anxiety, and panic” and that with further development depression sensitivity could be an important intervention target for prevention of major depressive disorder and suicidal thoughts and behaviors.

Background Suicide is the second leading cause of death in adolescents. Screening for persons at risk usually includes asking about suicidal ideation, which is considered inappropriate in some societies and situations. To avoid directly addressing suicide, this paper investigates whether the Health Behaviour in School-aged Children Symptom Checklist (HBSC-SCL), a validated non-clinical measure of eight subjective health complaints (e.g. headache, feeling low), could be used as a tool for screening suicidal ideation and behavior in adolescents. Methods 5262 secondary school students aged 12–18 answered the Luxembourgish HBSC 2014 survey, including the HBSC-SCL items and suicidal ideation and behavior questions. Results Each HBSC-SCL item correlates with suicidal ideation and behavior. A sum score was calculated ranging from zero to eight health complaints to predict respondents who considered suicide (area under the ROC curve = 0.770). The ideal cut-off for screening students who consider suicide is three or more health complaints: sensitivity is 66.3%, specificity is 75.9% and positive predictive value is 32.9%. Limitations One limitation is HBSC-SCL's low positive predictive value. This is a general problem of screening rare events: the lower the prevalence, the lower the positive predictive value. Sensitivity and specificity could be improved by taking age-, gender- and country-specific cut-off values, but such refinements would make the score calculation more complicated. Conclusions The HBSC-SCL is short, easy to use, with satisfactory screening properties. The checklist can be used when suicide cannot be addressed directly, and also in a more general context, e.g. by school nurses when screening adolescents.

Background The Saving Inventory – Revised (SI-R) is the most widely used self-report measure of hoarding symptom severity. The goal of this study is to establish a firm empirical basis for a cutoff score on the SI-R and to examine the functioning of the SI-R as a screening tool and indicator of hoarding symptom severity across the lifespan. Methods This study used archival data from 1,116 participants diagnosed with a clinical interview in 14 studies conducted by research groups who focus on hoarding. We used receiver operating characteristic (ROC) analysis and the Youden's J statistic to determine optimal cutoff scores for classifying participants who would be likely to receive a hoarding diagnosis. Results Overall, the discriminant performance of the SI-R Total score and each of the three subscales was high, confirming the status of the SI-R is an excellent screening tool for differentiating hoarding from non-hoarding cases. The optimal SI-R Total cutoff score is 39, although analyses suggested that older adults require a significantly lower cutoff and adults younger than 40 years require a significantly higher cutoff score. Limitations The confidence interval around the optimal cutoff for the SI-R Total score for oldest age group was wide in comparison to those reported for the younger groups, creating more uncertainty around the optimal cutoff score for this group. Conclusions This paper provides investigators and clinicians with the data necessary to select evidence-based cutoff scores on the SI-R that optimally suit their relative need for sensitivity and specificity in different age groups.

Background The Youth Anxiety Measure-I for DSM-5 has recently been developed to assess youth's anxiety symptomatology. As social anxiety is one of the most common disorders in adolescence, this scale includes a subscale measuring social anxiety. However, psychometric properties of the YAM-5-I social anxiety subscale (YAM-5-I-SAD) in clinical samples are lacking. This paper aims to bridge the gap. Methods The sample comprised 24 clinically diagnosed and 24 healthy control Spanish-speaking adolescents aged 14–17 years. Results Data revealed that the YAM-5- I-SAD yielded excellent sensitivity, which makes it particularly useful as a screening tool to early detect socially anxious adolescents. In addition, the YAM-5-I-SAD evidenced good internal consistency and construct validity. Limitations Data are limited to the social anxiety subscale. Conclusions The YAM-5-I-SAD is a sensitive and specific measure to screen for adolescents with social anxiety.

Background In this field study of WHO's revised classification of mental disorders for primary care settings, the ICD-11 PHC, we tested the usefulness of two five-item screening scales for anxiety and depression to be administered in primary care settings. Methods The study was conducted in primary care settings in four large middle-income countries. Primary care physicians (PCPs) referred individuals who they suspected might be psychologically distressed to the study. Screening scales as well as a structured diagnostic interview, the revised Clinical Interview Schedule (CIS-R), adapted for proposed decision rules in ICD-11 PHC, were administered to 1488 participants. Results A score of 3 or more on one or both screening scale predicted 89.6% of above-threshold mood or anxiety disorder diagnoses on the CIS-R. Anxious depression was the most common CIS-R diagnosis among referred patients. However, there was an exact diagnostic match between the screening scales and the CIS-R in only 62.9% of those with high scores. Limitations This study was confined to those in whom the PCP suspected psychological distress, so does not provide information about the prevalence of mental disorders in primary care settings. Conclusions The two five-item screening scales for anxiety and depression provide a practical way for PCPs to evaluate the likelihood of mood and anxiety disorders without paper and pencil measures that are not feasible in many settings. These scales may provide substantially improved case detection as compared to current primary care practice and a realistic alternative to complex diagnostic algorithms used by specialist mental health professionals.

Cognitive therapy (CT) has been shown to be efficacious in the treatment of depression in numerous randomized controlled trials (RCTs). However, little evidence is available that speaks to the effectiveness of this treatment under routine clinical conditions.This paper examines outcomes of depressed individuals seeking cognitive therapy at an outpatient clinic (N=217, Center for Cognitive Therapy; CCT). Outcomes were then compared to those of participants in a large NIMH-funded RCT of cognitive therapy and medications as treatments for depression.The CCT is shown to be a clinically representative setting, and 61% of participants experienced reliable change in symptoms over the course of treatment; of those, 45% (36% of the total sample) met criteria for recovery by the end of treatment. Participants at CCT had similar outcomes to participants treated in the RCT, but there was some evidence that those with more severe symptoms at intake demonstrated greater improvement in the RCT than their counterparts at CCT.The CCT may not be representative of all outpatient settings, and the structure of treatment there was considerably different from that in the RCT. Treatment fidelity was not assessed at CCT.Depressed individuals treated with cognitive therapy in a routine clinical care setting showed a significant improvement in symptoms. When compared with outcomes evidenced in RCTs, there was little evidence of superior outcomes in either setting. However, for more severe participants, outcomes were found to be superior when treatment was delivered within an RCT than in an outpatient setting. Clinicians treating such patients in non-research settings may thus benefit from making modifications to treatment protocols to more closely resemble research settings.

Background The Achenbach child behaviour checklist (CBCL/YSR) is a widely used screening tool for affective problems. Several studies report good association between the checklists and psychiatric diagnoses; although with varying degrees of agreement. Most are cross-sectional studies involving adolescents referred to mental health services. This paper aims to evaluate the performance of the youth self report (YSR) empirical and DSM-oriented internalising scales in predicting later depressive disorders in young adults. Methods Sample was 2431 young adults from an Australian birth cohort study. The strength of association between the empirical and DSM-oriented scales assessed at 14 and 21 years and structured-interview derived depression in young adulthood (18 to 22 years) were tested using odds ratios, ROC analyses and related diagnostic efficiency tests (sensitivity, specificity, positive and negative predictive values). Results Adolescents with internalising symptoms were twice (OR 2.3, 95%CI 1.7 to 3.1) as likely to be diagnosed with DSM-IV depression by age 21. Use of DSM-oriented depressive scales did not improve the concordance between the internalising behaviour and DSM-IV diagnosed depression at age 14 (ORs ranged from 1.9 to 2.5). Limitations Some loss to follow-up over the 7-year gap between the two waves of follow-up. Conclusion DSM-oriented scales perform no better than the standard internalising or anxious/depressed scales in identifying young adults with later DSM-IV depressive disorder.

Diagnosing past hypomania is a difficult task. Current structured interviews (e.g. CIDI, SCID) limit the ability to probe for hypomania. A modified SCID Hypomania Module was published by us (Benazzi and Akiskal, J Affect Disord 2003; Akiskal and Benazzi, J Clin Psychiatry 2005) in order to overcome the limitations of structured interviewing. Our papers outlined the framework of the modified SCID. In response to requests from many readers of this journal and other clinicians and investigators, we are hereby providing a more explicit step-by-step phenomenologic probing interview. DSM-IV criteria have to be met, but the probing for hypomania is very different from that of the SCID. All past hypomanic symptoms are assessed. No negative meaning is given to symptoms, as hypomania often improves functioning and it is seen by patients as a state of well being. The first step is probing for overactivity (increase in goal-directed activity), because observable behaviors are easier to remember by patients and key informants. There is no gold-standard for overactivity: each person becomes his/her own standard to ‘measure’ a clear-cut departure form the usual behavior. Questions, correspondingly, can change from patient to patient. The emotions associated with behavioral change are easier to be remembered than asking them first, as in the structured interviews. Structured interviews have mood change (elation, irritability) as stem question (corresponding to the criterion A of DSM-IV, which postulates that it must always be present). However, apart from a likely recall bias of past emotions, the description of mood change appears more or less negative in structured interviews (to increase specificity but by much reducing sensitivity, i.e. the false-negatives). Presenting mood change as simply having been more elated/irritable than usual can easily be interpreted as normal mood fluctuations, while presenting mood change as much more than usual could be understood as a severe mental disorder. Both ways are likely to lead to a negative response, moving the interviewers to unipolar disorders (the skip-out instruction). Our modified SCID is a fully semi-structured interview: many questions are asked about each symptom to make the question understandable according to each patient, and, very importantly, examples of the ‘events’ are systematically asked to check understanding and clinical relevance. Our interview follows DSM-IV criteria (apart from the minimum duration, 2 days versus DSM-IV 4 days), i.e. mood change must always been present, but our probing detects more hypomanic episodes than the SCID.

Background The development of a brief valid tool to screen for depression in patients with advanced cancer is important. This paper reports data on the psychometric properties of the Brief Edinburgh Depression Scale. Method Two hundred and forty six patients who fulfilled the inclusion criteria completed the 10-item EDS and Present State Examination. Results Factor extraction revealed 6 items from the ten item EDS. The most valid cut off for defining a case, using the PSE diagnosis as the “gold-standard”, was a score of 6 out of 18 on the Brief Edinburgh Depression Scale which gave a sensitivity of 72% and specificity of 83% with a PPV of 65.1% and NPV of 87.1%. Conclusions The six item EDS is a brief and sensitive method of screening for depression in advanced cancer patients — this novel use of the Edinburgh depression scale may have a significant impact on the assessment and thus management of this distressing symptom.

Background: Although generalized anxiety disorder (GAD) is currently described as a time-limited state mental disorder, emerging evidence suggests that it is best considered as an exaggeration of a putative “anxious temperament” (AT). It is presently unknown whether it is a distinct or unitary construct of a melange of anxious traits related to Cluster-C personality disorders. Methods: As part of a Franco-American collaborative study, we developed the 15-item Operational Criteria for Anxious Personality (OCAP), expanding criteria sets developed earlier by one of us (H.S.A.). The study, which was conducted in the French primary care medical sector, included 1112 young adults (18–40 years), seeking help for isolated anxious complaints, never treated before—and without any diagnosable disorder on the axis I of DSM-IV. As previous papers have reported the preliminary validity of OCAP, especially concurrent validity with the State–Trait Anxiety Inventory (STAI) (Speilberger), in this report, we focus on its full psychometric properties. Results: The present data indicate a normal distribution of AT items, a satisfactory Chronbach's coefficient (0.64), and the presence at intake of three different subtypes of AT: “anxious-avoidant,” “anxious-phobic,” and “anxious-sensitive.” After a prospective 6-month follow-up, the major criteria of AT were stable in 80% of cases, and for specific AT items, the stability rate varied between 65% and 80%; much of the unstable items were accounted by improvement during naturalistic treatment. The latter could explain the different factor structure obtained at follow-up, which tended to be less heterogeneous, and represented by one global factor. Limitation: We used a categorical (yes/no) rather than a Likert-type gradation of frequency and intensity of anxiousness items and relatively low number of items, especially for those involving worrying about one's own health or that of one's loved ones. Conclusions: Anxiousness as a temperamental dimension appears to involve putative subtypes along “worrying,” “phobic,” “sensitive” (and “avoidant”) dimensions.

Background Since 1977, the work of the author has shown the primacy of behavioral activation, flamboyance, and extravagance in detecting hypomania, the historical hallmark of cyclothymic and the broader spectrum of bipolar II (BP-II) disorders. In other words, the soft spectrum is more likely to declare itself in behavioral rather than mood disturbances. The obligatory search for elation and related mood changes a la DSM-IV (and its interview form, the SCID) during the clinical interview is often doomed to failure, thereby “condemning” the patient to a unipolar diagnosis, and hence to sequential and often tragic failures with antidepressants or combinations thereof. Methods To characterize behavioral signs of good specificity, though individually of low sensitivity for BP-II in patents presenting with major depression, the author undertook a chart review of over 1000 depressive patients he had examined extending over a period of nearly three decades. The Mood Clinic Data Questionnaire (MCDQ) used in the author's Memphis mood clinic permitted systematization of unstructured observations . BP-II had been independently confirmed by hypomania of ≥2 days and/or cyclothymia over the course of the index illness (both of which were validated by family history for bipolarity in earlier research in our clinic). Results Triads of behavior or traits in the patients' biographical history—as well as in the biologic kin—involving polyglottism, eminence, creative achievement, professional instability, multiple substance/alcohol use, multiple comorbidity (axis I and axis II), multiple marriages, a broad repertoire of sexual behavior (including brief interludes of homosexuality), impulse control disorders, as well as ornamentation and flamboyance (with red and other bright colors dominating) were specific for BP-II. Temperamentally, many of these individuals thrive on activity—they are indeed “activity junkies.” Limitation The reported findings pertain primarily to the differential diagnosis between BP-II and unipolar depression. Replication of the approach espoused herein will require quantification of the operational definitions of the observed phenomenology. Conclusion The findings, which make sense in an evolutionary model of the advantage that “dilute” bipolar traits confer to human biography and erotic life, suggest that such behavioral traits can be useful provisionally in assigning a depressive episode to the realm of the bipolar II spectrum. Overall, the perspective espoused in this paper indicates that temperamental excesses and, more generally, a biographical approach, represent a more coherent approach than hypomanic episodes in the diagnosis of BP-II patients. Finally, such a diagnostic approach underscores the importance of incorporating evolutionary considerations and principles in understanding the origin of affective disorders.

This paper describes the relationship between entry criteria and eligible population for inclusion in Major Depression (MD) clinical trials. Inclusion criteria for a MD study typically require patients to pass a threshold score on a depression rating scale, most commonly the HAM-D or MADRS. A Score To Enter (STE) ofor = 17 on the HAM-D 17-item scale is a typical value, although higher values (i.e.or = 22 or evenor = 25 points) are often used. It is commonly supposed that patients with higher baseline scores form a more sensitive sample for discriminating active drug from placebo.We present data from a sample of depressed hospital outpatients and describe their general characteristics. We then introduce a model, based upon this sample, which predicts the impact of STE on eligible trial population.A small increase in STE has a marked effect on eligible population: an increase in HAM-D (17 item) STE from 17 to 21 and 25 reduces the eligible population by 42 and 76%, respectively. These predictions are reasonably robust when our model is validated with known clinical trial data.Our findings have major implications for planning and managing Major Depression trials as higher STEs substantially restrict the proportion of patient eligible for study.

Poor mental health among is a major contributor to the burden of disease among adolescents. For this paper we use cross sectional survey data among a sample of 2,768 adolescent (aged 15-19) and 2,027 young adults (aged 20-24) living in Manicaland Province, Zimbabwe to calibrate the Shona Symptom Questionnaire (SSQ) against the Self Report Questionnaire (SRQ-20) and examined the performance indices of the SSQ based on various cut points for classification. The SSQ depression screening tool performed best with a cut point of five or more positive responses out of 14 questions, resulting in the following validation coefficients for adolescents and young adults respectively: AUC (0.83, 088); kappa statistic (0.64, 0.66); sensitivity (0.89, 0.95); specificity (0.94, 0.92); PPV (0.45, 0.55); NVP (0.99, 1.00). The modified SSQ cut point of five or more substantially increase the depression estimates for both age groups to align more closely with the SRQ-20 estimates. The prevalence of depression increased from 3.5% to 13.2% among adolescents and from 5.1% to 16.2% among young adults based on these revisions to the SSQ. Using a multivariate logistic regression model we isolated particular characteristics to test their association with the odds of being misclassified as non-depressed based on the conventional SSQ cut point. Findings suggest that adolescents who were orphaned (OR 1.48) or ever had sex (2.13) were at a significantly greater odds of being a false negative than their counterparts. Secondary education was significantly associated with false negative misclassification among young adults (OR 2.11). When retested using the modified cut point of five or greater, associations with misclassification disappeared. This study highlight that not all depression scales are appropriate for use among adolescents given their unique developmental stage. While using culturally-appropriate scales such as the SSQ is important, we strongly recommend modification to the cut point in order to improve adolescent depression detection. Alternatively we recommend continued use of the standardized cross-cultural SRQ given it continued success at classify cases of depression across age groups.

Background: The Quality of Life in Depression Scale (QLDS) employs the needs-based model of quality of life (QoL) and was developed in the UK and The Netherlands as an outcome measure for clinical trials. This paper describes the production and psychometric assessment of nine new language versions for Canada (French and English), Denmark, France, Germany, Italy, Morocco, Spain and the US. Methods: Three adaptation stages were employed; production of conceptually equivalent translations, field-test interviews and assessment of reliability and construct validity by survey of patients with major depression. Results: Few problems were experienced with producing conceptually equivalent translations, except in Morocco. Patients in the field-test interviews found the instrument to have appropriate content and to be easy to complete. Internal consistency and test–retest reliability were excellent for all language versions and scores were found to relate appropriately to measures of depression severity and health status. Limitations: Further investigation is required of the ability of the measure to assess individuals at the extremes of the QoL continuum. Data collected with the Arabic QLDS should not be combined with those from other countries. Conclusions: The QLDS is the first instrument designed to assess QoL in depression based on a coherent model of the construct. Each language version has been shown to be well accepted by respondents and to have excellent psychometric properties. As the instrument is now available in a large number of languages, the QLDS is the QoL instrument of choice for inclusion in clinical trials of interventions for depression.

This paper presents a phenomenological study of three false negative cases according to the Edinburgh Postnatal Depression Scale (EPDS) of major depressive disorder identified by a semi-structured clinical interview. In a study of 87 unselected women with 23 of them suffering from a major depressive disorder (according to the Research Diagnostic Criteria), three cases of major depressive disorders were not identified as potential cases by the EPDS. The symptomatology of these three false negative cases was also assessed by a semi-structured interview (Present State Examination). Comparisons between EPDS scores and the scores of two other self report questionnaires (the General Health Questionnaire-28 and the Center for Epidemiologic Studies-Depression Scale) suggest that EPDS is better at identifying depressed postnatal women with anhedonic and anxious symptomatology rather than those whose depression presents mainly with psychomotor retardation.

This paper reports the validation of the EPDS against a Research Diagnostic Criteria diagnosis of Major and Minor depression. The EPDS was administered to non-postnatal women with older children (mean age of youngest child 3 years 9 months) and to postnatal women (baby aged 6 months). All who scored 9 or above and one third of low scorers were interviewed, using Goldberg's Clinical Interview Schedule. The study confirmed good user acceptability of the EPDS when administered as a postal questionnaire (92% response rate). The EPDS was found to have satisfactory sensitivity (79%) and specificity (85%). Our findings suggest that the EPDS take a place alongside other screening scales for depression in Community samples. It is proposed that when used in these settings it is referred to as the Edinburgh Depression Scale.

Background: The importance of personal recovery in mental health is increasing widely recognised. However, there is no measure available to assess recovery experiences in individuals with a diagnosis of bipolar disorder. This paper reports on the development of the Bipolar Recovery Questionnaire (BRQ) to aid recovery informed developments in research and clinical practice. Methods: A draft 45 item BRQ was developed based on prior literature review and qualitative research. In the current study a panel of clinicians, academics and consumers rated draft items on recovery relevance and comprehensibility leading to the 36 item questionnaire subjected to psychometric evaluation. 60 participants with bipolar disorder completed BRQ along with measures of mood, quality of life, functioning and personal growth. Results: BRQ was internally consistent and reliable over a month long test–retest period. BRQ scores were significantly associated with lower depression and mania scores and with higher wellbeing. BRQ was also significantly associated with better functioning, better mental health quality of life and personal growth. Regression analysis indicated that depression, wellbeing and personal growth were all uniquely associated with BRQ. Limitations: Sample size did not permit exploration of the factor structure of BRQ. The sample is drawn from the North West of England thus it is not clear how these findings might generalise beyond this group. Conclusions: BRQ is designed to assess personal experiences of recovery in bipolar disorder. The present study indicates that it is reliable and valid, being associated with both symptomatic and functional outcomes consistent with established definitions of recovery.

Background It is unclear whether cognitive impairment is prevalent in the remitted state of unipolar disorder. Aim To evaluate whether cognitive function is impaired in the remitted state in patients with unipolar depression compared with healthy control individuals, and to investigate the association to prior course of illness, i.e. the number, duration and severity of prior depressive episodes. Method Systematic search on existing on-line databases and hand-search of original published papers. Results A total of 11 studies fulfilled the selection criteria and were included in the review, including a total of 500 patients remitted from unipolar depression and 471 healthy control individuals. In nine of the eleven studies performance on neuropsychological tests was found to be decreased in patients compared to healthy control individuals in at least one of the tests. Methodological drawbacks were prevalent including non-stringent definition of remission and non-correction for multiple testing. Only few studies investigated the association between cognition and prior course of illness and the results were divergent. Limitations Stringent criteria were used in the assessment of eligibility of studies. The studies were first and foremost selected according to the criteria for remission used. Conclusion Cognitive dysfunction seems to be present in individuals suffering from unipolar disorder in the remitted state. We recommend that future studies should focus on disentangling the state and trait characteristics of cognitive dysfunction in unipolar disorder and further clarify the associations with clinical phenotype, course of illness and subsyndromal psychopathology. Furthermore, there is a need to identify the cognitive difficulties in individuals suffering from unipolar disorder in relation to psychosocial function, quality of life and risk of recurrence and to assess the effect of treatment intervention on cognitive function.

Background Rates of PTSD and depression are high in Korean War veterans. The prevalence and impact of the two disorders occurring comorbidly, however, has not been investigated. This paper aims to investigate the extent to which PTSD and depression co-occur in Australian veterans of the Korean War, the symptom severity characteristics of comorbidity, the impact on life satisfaction and quality, and the association with war-related predictors. Methods Veterans ( N = 5352 ) completed self-report questionnaires including the Posttraumatic Stress Disorder Checklist, the Hospital Anxiety and Depression Scale, the Life Satisfaction Scale, the brief World Health Organisation Quality of Life questionnaire and the Combat Exposure Scale. Results Seventeen percent of veterans met criteria for comorbid PTSD and depression, 15% had PTSD without depression, and a further 6% had depression without PTSD. Compared with either disorder alone, comorbidity was associated with impaired life satisfaction, reduced quality of life, and greater symptom severity. Several war-related factors were associated with comorbidity and with PTSD alone, but not with depression alone. Limitations The reliance on self-reported measures and the necessity for retrospective assessment of some deployment-related factors renders some study data vulnerable to recall bias. Conclusions Comorbid PTSD and depression, and PTSD alone, are prevalent among Korean War veterans, are both associated with war-related factors 50 years after the Korean War, and may represent a single traumatic stress construct. The results have important implications for understanding complex psychopathology following trauma.

Background This paper extends previous work describing course in depression using a recommended operational model that defines remission onset and relapse. We test whether a similar course pattern would emerge using this model in a new cohort of depressed participants. Methods We recruited a cohort of 86 participants, first-time inpatients, with DSM-IV major depression. Outcome was assessed prospectively over a 13-month minimum follow-up period. Remission onset was defined as a Ham-D score 16 for two consecutive weeks and meeting DSM-IV criteria for major depressive disorder. Results The cumulative probability of remission onset was 0.62 (SE = 0.05) and 0.80 (SE = 0.05) at 3 and 6 months following study entry. The relapse risk was 0.28 (SE = 0.05) at 6 months post remission onset; 53% of those relapsing did so in the first 2 months post remission onset. Predictors of longer times to remission onset included: longer illness length, higher anxiety scores and unemployment; higher anxiety scores predicted relapse. The course pattern is similar to that reported previously. Limitations These findings apply to inpatients only. Course was not rated blind to all of the participants' baseline data. Conclusions Defining remission onset and relapse using this model is associated with a replicable course pattern. A singular clinical advantage of the model is the identification of those participants at highest risk of relapse 2 months post remission onset.