Epidemiology of psychotic depression – systematic review and meta-analysis

Jääskeläinen, Erika; Juola, Teija; Korpela, Hanna; Lehtiniemi, Heli; Nietola, Miika; Korkeila, Jyrki; Miettunen, Jouko

doi:10.1017/s0033291717002501

Cited by 117 publications

(113 citation statements)

References 94 publications

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“…Our finding of an added influence of diagnosed psychotic depression on risk of suicide substantiates the so far limited evidence base , but is contrary to the findings of a recent study applying different study methodologies. According to other studies, baseline severity of depression and psychotic features predict future recurrence and persistence of depressive morbidity. Time spent at risk in gradually more severe depressive episodes likely forms a major determinant of suicide risk and provides a meaningful target for prevention .…”

Section: Discussionmentioning

confidence: 92%

Risk factors for suicide in depression in Finland: first‐hospitalized patients followed up to 24 years

Aaltonen

Isometsä

Sund

et al. 2018

Acta Psychiatr Scand

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Risk factors for suicide in depression inFinland: first-hospitalized patients followed up to 24 years Aaltonen KI, Isomets€ a E, Sund R, Pirkola S. Risk factors for suicide in depression in Finland: first-hospitalized patients followed up to 24 years Objective: To examine longitudinally risk factors for suicide in depression, and gender differences in risk factors and suicide methods. Method: We linked data from (i) The Finnish Hospital Discharge Register, (ii) the Census Register of Statistics Finland, and (iii) Statistics Finland's register on causes of deaths. All 56 826 first-hospitalized patients (25 188 men, 31 638 women) in Finland in 1991-2011 with a principal diagnosis of depressive disorder were followed up until death (2587 suicides) or end of the year 2014 (maximum 24 years). Results: Clinical characteristics (severe depression adjusted hazard ratio [AHR] 1.19 [95% CI 1.08-1.30]; psychotic depression AHR 1.45 [1.30-1.62]; and comorbid alcohol dependence AHR 1.26 [1.13-1.41]), male gender (AHR 2.07 [1.91-2.24]), higher socioeconomic status and living alone at first hospitalization were long-term predictors of suicide deaths. Highest risk was associated with previous suicide attempts (cumulative probability 15.4% [13.7-17.3%] in men, 8.5% [7.3-9.7%] in women). Gender differences in risk factors were modest, but in lethal methods prominent. Conclusion: Sociodemographic and clinical characteristics at first hospitalization predict suicide in the long term. Inpatients with previous suicide attempts constitute a high-risk group. Despite some gender differences in risk factors, those in lethal methods may better explain gender disparity in risk. Significant outcomes• This national study of risk factors for suicide in depression is the largest cohort study published thus far in terms of sample size and number of suicide deaths. Of 13 risk factors, male sex, previous suicide attempts, severe or psychotic depression, comorbid alcohol dependence, higher family income, and higher education predicted future suicide.• During the long-term follow-up, a substantial proportion of patients hospitalized for depression with a history of suicide attempt eventually died by suicide.• Some gender differences in risk factors for suicide in depression were found to exist. However, there are marked gender differences in lethal methods used, which more likely explain the gender disparity in risk of suicide. Limitations• The cohort comprised first-hospitalized psychiatric inpatients. Generalizability of findings pertaining to risk factors among psychiatric outpatients or primary care patients remains to be confirmed.• Some risk factors remained uninvestigated in the study.• The study is based on clinical diagnoses. Diagnostic imprecisions likely exist in assessment of severity of depression, in poor recognition of delusional hopelessness of psychotic depression, and missed diagnoses of comorbid alcohol dependence.

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Section: Discussionmentioning

confidence: 92%

Risk factors for suicide in depression in Finland: first‐hospitalized patients followed up to 24 years

Aaltonen

Isometsä

Sund

et al. 2018

Acta Psychiatr Scand

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“…The lifetime prevalence varies between 0.35 and 1%, with higher rates in older age [8]. The hierarchical model we use to distinguish depression subtypes implies that patients with psychotic symptoms also have psychomotor symptoms or melancholia [6].…”

Section: Introductionmentioning

confidence: 99%

Distinguishing Subgroups Based on Psychomotor Functioning among Patients with Major Depressive Disorder

et al. 2017

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Background: Retardation and agitation are symptoms of major depressive disorder (MDD), and their presence could play a role in determining clinically meaningful depressive subtypes such as nonmelancholic depression (NMD) and melancholic depression (MD). In this project, we explored whether three depression subgroups (NMD, MD with psychotic symptoms, and MD without psychotic symptoms) could be distinguished based on objective measures of psychomotor functioning. Methods: Sixty-nine patients with MDD underwent extensive clinical and psychomotor testing prior to treatment with electroconvulsive therapy. Psychomotor functioning was assessed subjectively using the Core Assessment of Psychomotor Change (CORE) and objectively by means of both 24-h actigraphy and performance on a fine motor drawing task. Results: The daytime activity levels measured by actigraphy were significantly lower (F = 7.1, p = 0.0004) in MD patients both with and without psychotic symptoms than in those with NMD. No objective psychomotor variable was able to distinguish between melancholic patients with and those without psychotic symptoms. Conclusions: The depression subtypes NMD, MD with psychotic symptoms, and MD without psychotic symptoms are not marked by increasing psychomotor retardation, possibly because psychomotor disturbance in MD with psychotic symptoms often consists of agitation rather than retardation, or a mixture of the two. However, psychomotor functioning as measured by actigraphy can be used to distinguish between NMD patients and MD patients.

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“…Depression is one of the most common mental disorders. In early 2017, a World Health Organization (WHO) survey showed that there were 322 million people with depression globally [6], of which the prevalence rate of depression in China reached 4.2% [7]. Depression has become one of the most important diseases that endanger human health.…”

Section: Characteristics Of Patients With Mental Disorders In Generalmentioning

confidence: 99%

Strengthening the Ability of General Hospital Neurology Departments to Treat Neuropsychiatric Diseases and Mental Disorders

Zhu

Pan

2018

Integr Med Int

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Due to the “stigma” of neuropsychological and psychogenic disorders in China, patients with psychological and affective disorders mostly prefer to go to general hospitals or integrative medicine hospitals, while the majority of patients with mental disorders in the department of internal medicine are treated in the department of neurology. At present, there are few physicians with the ability to diagnose and treat neuropsychiatric diseases properly in the neurological department of general hospitals in China, and the diagnosis and treatment experience of mental diseases is insufficient. At the same time, the diagnosis and treatment of comorbid patients with internal diseases and mental disorders are more complicated. The psychology departments in general hospitals or mental health centers also have a limited ability to diagnose and treat comorbid diseases relating to internal medicine and mental disorders together. Therefore, this article reviews the current status of diagnosis and treatment of neuropsychiatric and mental disorders in general hospitals or integrative medicine hospitals.

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Epidemiology of psychotic depression – systematic review and meta-analysis

Cited by 117 publications

References 94 publications

Risk factors for suicide in depression in Finland: first‐hospitalized patients followed up to 24 years

Risk factors for suicide in depression in Finland: first‐hospitalized patients followed up to 24 years

Distinguishing Subgroups Based on Psychomotor Functioning among Patients with Major Depressive Disorder

Strengthening the Ability of General Hospital Neurology Departments to Treat Neuropsychiatric Diseases and Mental Disorders

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