The etiology of depression has long been thought to include social environmental factors. To quantitatively explore the novel possibility of person-to-person spread and network-level determination of depressive symptoms, analyses were performed on a densely interconnected social network of 12 067 people assessed repeatedly over 32 years as part of the Framingham Heart Study. Longitudinal statistical models were used to examine whether depressive symptoms in one person were associated with similar scores in friends, co-workers, siblings, spouses and neighbors. Depressive symptoms were assessed using CES-D scores that were available for subjects in three waves measured between 1983 and 2001. Results showed both low and high CES-D scores (and classification as being depressed) in a given period were strongly correlated with such scores in one's friends and neighbors. This association extended up to three degrees of separation (to one's friends’ friends’ friends). Female friends appear to be especially influential in the spread of depression from one person to another. The results are robust to multiple network simulation and estimation methods, suggesting that network phenomena appear relevant to the epidemiology of depression and would benefit from further study.

We used complete Centers for Disease Control death certificate records and the Centers for Medicare and Medicaid Services 100% Standard Analytic File for hospice claims for 2002 to examine differences in hospice utilization between African-American and white decedents living in the United States. White decedents were more likely to use hospice in the year before their death than African-American decedents (29% vs 22%). Cause-specific hospice utilization rates among women were consistently higher than among men within a given race. African-American decedents were consistently less likely to use hospice than white decedents for almost all conditions. Hospice utilization was lower among African-American than among white decedents in 31 of 40 states. The higher the overall hospice utilization in a state, the less the positive difference between white and African-American usage rates; that is, the more accepted hospice is, as measured by 'market share', the lower the racial disparity in its use.

PURPOSE: Psychiatric disorders and abnormal personality traits are commonly identified in patients complaining of fatigue, most of whom can be diagnosed to have depressive (D), anxiety (A), somatoform (S) or eating (E) disorders. This study was designed to determine the relationship between the prevalence of severe fatigue and the presence of personality pathology in individuals with these psychiatric disorders. METHODS: We analyzed 1197 referrals to an academic psychosomatic medicine outpatient unit. All patients underwent highly structured standardized psychometric and clinical assessments which allowed the categorical classification into D, A, S, and E groups. Within each group, the self-scored severity of fatigue experienced during the week preceding the evaluation was compared for patients with and without personality disorders (P). RESULTS: The one-week prevalence of severe fatigue was 38% in D (N ϭ 324) and 45% in D ϩ P (N ϭ 139), p ϭ NS; 29% in A (N ϭ 216) and 29% in A ϩ P (N ϭ 79), p ϭ NS; 33% in E (N ϭ 99) and 32% in E ϩ P (N ϭ 53), p ϭ NS; and 20% in S (N ϭ 209) and 34% in S ϩ P (N ϭ 78), p Ͻ .01. The difference in fatigue severity was ϩ 5% for D ϩ P vs D (p ϭ NS), ϩ 1% for A ϩ P vs A (p ϭ NS), Ϫ 2% for E ϩ P vs E (p ϭ NS) and 32% for S ϩ P vs S (p Ͻ .01). The greater severity of fatigue had a significant contribution to the difference in the 14-item index of somatic distress only for S vs S ϩ P (p ϭ .03) CONCLUSION: Severe fatigue may be a marker of personality pathology in patients with unexplained somatic complaints who do not suffer from depressive, anxiety or eating disorders. SOMATIC DISTRESS OF THE MENTALLY ILL AND ITS RELATIONSHIP TO PERSONALITY DISORDERS.N Schmitz, N Hartkamp, W Tress, M Franz, P Manu, Department of Psychosomatics and Psychoterapy, Heinrich-Heine-University, Duesseldorf, Germany; Department of Medicine and Department of Psychiatry, Long Island Jewish Medical Center, Glen Oaks, NY PURPOSE: Personality disorders are often invoked by clinicians as a contributing factor to the severity of physical complaints of psychiatric patiens, but the scientific support for this asociation is scant. This study was designed to determine the relationship between somatic distress and the presence of personality pathology in individuals with well-defined psychiatric disorders. METHODS: We analyzed 1437 consective referrals to an academic psychosomatic outpatient unit. Standardized psychometric and clinical evaluations were used to diagnose personality (P), depressive (D), anxiety (A), and somatoform (S) disorders. The assessment of somatic distress was based on the self-rating of the severity of 14 somatic experiences (SE) during the week preceding the evaluation. RESULTS: Compared with D (N ϭ 324), A (N ϭ 216) and S (N ϭ 209), patients with P (N ϭ 392) indicated the lowest severity of somatic distress (p ϭ .001). Patients with the comorbid associations D ϩ P (N ϭ 139) and A ϩ P (N ϭ 79) had experienced milder somatic distress than those with D or A alone (p ϭ .007). In contrast, patients with S...

for the expert assistance given to build the analytical data. We thank Maurizio Fava for helpful comments regarding the article.