Depressive disorders risk factors

Assess for the safety of others and potential for violence. If accompanied by friends or family with whom the patient is living, ask them to remove from the home all guns, caustic chemicals, medications, and objects the person might use to harm self or others. Risk factors for suicide include severity of depression, feelings of hopelessness, comorbid personality disorder, and a history of a previous suicide attempt.19... 

Disturbances of sleep are typical of mood disorders, and belong to the core symptoms of major depression. More than 90% of depressed patients complain of impaired sleep quality [60], Typically, patients suffer from difficulties in falling asleep, frequent nocturnal awakenings, and early morning awakening. Not only is insomnia a typical symptom of depression but, studies suggest, conversely, insomnia may be an independent risk factor for depression. In bipolar disorders sleep loss may also be a risk factor for the development of mania. Hypersomnia is less typical for depression [61] and, in contrast to insomnia, may be related to certain subtypes of depression, such as seasonal affective disorder (SAD). 

Samuelsson G, McCamish-Svensson C, Hagberg B et al. (2005) Incidence and risk factors for depression and anxiety disorders results from a 34-year longitudinal Swedish cohort study. Aging Ment Health 9 (6) 571-575... 

Major depressive disorder is among the most common psychiatric syndromes affecting approximately one in four American women and one in ten American men during their lifetimes. Although the overall prevalence rates have stabilized, the average age of onset for the disorder has decidedly decreased. Numerous risk factors for depression have been identified and are listed in Table 3.3. 

The risk factors for dysthymia include a family history of depression and the coexistence of a personality disorder. In addition, dysthymic patients often have major depression, anxiety disorders, or substance abuse disorders as well. 

From our clinical experience, we have found that youth with more severe and chronic depressions and those with significant comorbid disorders or who experience parental conflict often fail to respond to either monotherapy alone (Clarke et ah, 1992 Brent et ah, 1998 Emslie et ah, 1998). Therefore, severe and chronic depressions should be treated with both antidepressants and psychotherapy, and other risk factors for poor outcome (e.g., parent depression, ADHD) should be addressed with additional psychosocial and/or pharmacological interventions. 

Psychiatr Chn North Am 19 179-200, 1996 Fava M, Rosenbaum JF, McGrath PJ, et al Dthium and tricyclic augmentation of fluoxetine treatment for resistant major depression a double-blind, controlled study. Am J Psychiatry 151 1372-1374, 1994 Fawcett J Suicide risk factors in depressive disorders and panic disorder. J Clin Psychiatry 53 [suppl 3) 9-13, 1992... 

Klein E, Bental E, Lerer B, et al Carbamazepine and halopeiidol vs. placebo and haloperidol in excited psychoses. Arch Gen Psychiatry 41 165-170, 1984a Klein E, Hefez A, Lavie P Effects of clomipramine infusion on sleep in depressed patients. Neuropsychobiology 1 85-88, 1984b Klein E, Lavie P, Meiraz R, et al Increased motor activity and recurrent manic episodes risk factors that predict rapid relapse in remitted bipolar disorder patients after lithium discontinuation—a double blind study. Biol Psychiatry 31 279-284, 1992... 

Major depression is a significant risk factor for suicide. The presence of suicidal ideation should be assessed initially and repeatedly over the course of treatment. In this respect, depressive disorders are a major health care problem, contributing to 70% of suicide-related deaths (with a 15% mortality risk associated with suicide in untreated recurrent major episodes). 

Beck et al. (38) reported that hopelessness in the context of major depression was the MDD symptom most often associated with suicide. This finding was replicated by Fawcett et al. (39), who found that hopelessness with anhedonia, mood cycling within an episode, loss of mood reactivity, and psychotic delusions were high-risk factors for a subsequent suicide. Soloff and associates ( 40) also found that hopelessness and impulse aggression independently increased the risk of suicidal behavior in patients with borderline personality disorder and in patients with major depression. Negative life events (e.g., the death of a loved one or humiliating events such as financial ruin) often precede suicide. 

Middle-aged or older individuals who complete suicide tend to suffer from a depressive disorder. Younger individuals who complete suicide usually suffer from schizophrenia or a bipolar disorder. The risk factors for suicide attempts versus completions are the following ... 

The relationship between alcohol abuse and suicide has been recognized for many years, with at least one in five suicide victims being intoxicated at the time of their death. Alcohol may lower inhibitions, serving as a precipitant to the act, or the disease of alcoholism itself could be a risk factor. Alcohol also induces biochemical changes (e.g., lowers CSF 5-HIAA and decreases 5-HT2 receptors in the neocortex), similar to changes observed in at least a subset of depressive disorders. Thus, alcohol may aggravate or contribute to the pathophysiology that mediates the depressive syndrome and leads to suicide completions. 

Fawcett J. Suicide risk factors in depressive disorders and in panic disorder. J din Psychiatry 1992 5[3, Suppl] 9-13. 

There is no major difference in outcome or risk factors for major depressive disorder with anxiety versus major depressive disorder without anxiety. 

Depression and Diabetes Mellitus. Patients with chronic medical illness have a high prevalence of major depressive disorder [59], Depression may be three times more prevalent in the diabetic population when compared with its occurrence in nondiabetic individuals [60], In addition, microalbuminuria, hypertension, and hyperinsulinemia are another three independent risk factors for cardiac disease in non-insulin-dependent diabetes mellitus (NIDDM) [61], Nosadini et al. showed that peripheral insulin resistance, hypertension, microalbuminuria, and lipid abnormalities are associated with NIDDM [61], Further, Helkala et al. determined that cognitive and memory dysfunction are associated with NIDDM and explored the disease s relationship with depression, metabolic control, and serum lipids. The results showed that the NIDDM patients had impaired control of their learning processes [62], Obviously, future research examining the causal relationship of depression to the onset on diabetes and the effect of depression on the natural course of diabetes is needed [60]. 

As regular psychiatric assessment is not always possible, the identification of easily detectable predictive factors of severe psychiatric disorders may help select which patients should undergo close psychiatric assessment. In 71 patients treated with interferon alfa alone or combined with ribavirin for chronic hepatitis C, female sex, scores on the MADRS at 4 months of treatment, sleep disorders, and prior antidepressant use were independent risk factors of suicidal behavior or depression (349). This study also suggested that prolonged follow-up is required, as 8% of patients still had suicidal behavior 6 months after the end of treatment. 

It is well known that acute and chronic stress can impact certain psychiah ic disorders here we focus on two disorders where the evidence for a role of stress and the activation of the HPA axis is particularly sh ong. Many lines of evidence suggest that chronic sbress is a major risk factor for major depression (MD), and the onset of schizophrenia is often associated with stressful life events. 

Other psychiatric illnesses, particularly the anxiety disorder, are also risk factors for development of major depressive disorder. Persons with anxiety disorders (panic disorder, obsessive compulsive cUsorder, social phobia, generalized anxiety disorder, and posttrauma tic stress disorder) go on to develop major depressive cUsorder over the course of 5-20 years in over 50% of cases. 

Nevertheless, this is an area of intensive research, with the potential for improved diagnosis and heatment. The best estimates are that several genes are involved (5-15). The environmental influence in bipolar disorder is less than that for major depressive disorder. Some risk factors have been identified, including negative stressful life events. 

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