OBJECTIVES: Type D personality was originally introduced to study the role of personality in predicting outcomes of heart disease. However, researches showed that other medical conditions are also affected by this personality. The purpose of this study was to evaluate the relationship between type D personality and somatic symptom complaints in depressive patients. METHODS: Eighty-two individuals diagnosed with depressive disorder were included. Type D personality was measured with DS14. Patient Health Questionnaire(PHQ) 9 and 15 were used to measure depression severity and somatization tendencies. For alexithymia, TAS-20 was used. Student T-test and linear regression analysis were performed. The best regression model was determined by stepwise variable selection. RESULTS: More than half of the subjects(56%) complained at least medium degree somatic symptoms according to PHQ-15 criteria. Two-thirds of the subjects were classified as Type D personality(63.4%). The mean PHQ-15 score of the Type D individuals was significantly higher than the remaining subjects(PHQ-15 mean=12.7, p=8.2x10-7). The best regression model included age, PHQ-9 score and NA subscale score as predictor variables. Among these, only the coefficients of age(p=1.5x10(-3)) and NA score(p=1.5x10(-7)) were found to be statistically significant. CONCLUSIONS: The result showed that Type D personality was one of the strong predictors of somatic complaints among depressive individuals. The finding that negative affectivity rather than social inhibition was more closely associated with somatization tendencies does not fully agree with the traditional explanation that inability to express negative emotion predispose the individuals to somatic symptoms. The finding that alexithymia was not shown to be a significant predictors also substantiated this discrepancy. However, it might be possible that the high correlation between NA and SI subscore(r=0.65) and between NA and TAS-20 score(r=0.44) hid the additional effects of social inhibition and alexithymia. Further research with a larger sample would be needed to investigate the effects of the latter two components over and above the effect of negative affectivity on the somatic complaints in depressive patients.
Affective Symptoms ; Depression ; Depressive Disorder ; Heart Diseases ; Humans ; Linear Models

OBJECTIVE: Depression has been associated with alexithymic features. However, few studies have investigated the differences in the general symptoms of patients with depressive disorders according to the presence of alexithymia. Thus, the aim of this study was to evaluate the relationship between alexithymia and symptoms experienced by patients with clinically diagnosed depressive disorders. METHODS: A chart review of patients who were evaluated using the Korean version of the 20-item Toronto Alexithymia Scale (TAS-20) and Symptom Checklist 90-Revised (SCL-90-R) at the same time between the years 2003 and 2007 was conducted. A total of 104 patients with depressive disorders were included and divided into two groups: alexithymia (n=52) and non-alexithymia (n=52). A direct comparison between the two groups was carried out. Regression analysis was also carried out for the TAS-20 total and subset scores in order to model the relationship between alexithymia and symptoms. RESULTS: The presence of alexithymia was confirmed in 50% of the patients with depressive disorders, and the symptoms of depressive patients with alexithymia were more severe than those of their non-alexithymic counterparts on all 9 symptom domains of the SCL-90-R. Furthermore, regression analysis revealed that the presence of alexithymia was positively associated with depression, phobic anxiety, and psychoticism but inversely associated with anxiety. CONCLUSION: These results suggest that the clinical features of depression are partially dependent on the presence of alexithymia. Alexithymic patients with depressive disorders are likely to show more severe depressive, psychotic, and phobic symptoms. In other words, clinicians should suspect the presence of alexithymic tendencies if these symptoms coexist in patients with depressive disorders and address their difficulties in effective communication.
Affective Symptoms* ; Anxiety ; Checklist ; Depression ; Depressive Disorder* ; Humans

Introduction: Depressive symptoms are major public health issues with significantly increasing rates during adolescence. Specific factors and mechanisms associated with depressive symptoms still need to be identified. The present study aimed to examine direct relationships between paternal attachment and negative life events (NLE) to depressive symptoms. Indirect effect of automatic thoughts on the relationships was also examined. Methods: A sample of 1030 adolescents aged between 13 and 19 years (mean=15.36) was recruited using probability proportional to size cluster sampling from selected states in Peninsular Malaysia to complete self-report measures on the study variables. Results: Structural equation modelling indicated that paternal attachment in terms of secure, approachability and anxious fearful were directly associated to depressive symptoms. Broadly, increases in secure and approachability attachments followed by decreases in depressive symptoms. Adolescents who experienced anxious fearful attachment seemed to be more vulnerable to depressive symptoms. Moreover, results from mediation analyses revealed that automatic thoughts mediated the effect of two attachment variables (i.e., anxious fearful and responsiveness) and NLE to depressive symptoms. Conclusion: These findings shed light on the concurrent effects of attachment and life events on depressive symptoms, providing evidence on how to reduce depressive symptoms among adolescents. The current study also expands knowledge on the role of automatic thoughts as potentially relevant mediator. Intervention and prevention programs aimed at preventing adolescents from the deleterious effects of depressive symptoms should involve both parents and adolescents in order to promote optimal attachment relationships and minimize depressive cognitions in adolescents
depressive symptoms

Introduction: Negative automatic thoughts refer to subconscious thinking patterns in response to irrational and self-defeating stimuli. Individuals who are depressed tend to have biased negative automatic thoughts. Therefore, there is a need to refine our understanding of what contributes to the development of adolescent depressive symptoms. The current study examined the mediating role of negative automatic thoughts in the link between maternal attachment and depressive symptoms among late adolescents in Pakistan. Methods: This cross-sectional study focused on 936 (males=423, females=513) students aged 17 to 19 years old, who were selected through multistage cluster sampling technique. Respondents answered self-report questionnaires which assessed maternal attachment, depressive symptoms, and negative automatic thoughts. Structural equation modelling was utilised to analyse the relationships among the research variables. Results: The findings indicated that 39.3% had negative automatic thoughts; whereas, 5.6% experienced severe depressive symptoms. Correlational analysis showed that maternal attachment had a negative association with depressive symptoms and negative automatic thoughts. In contrast, depressive symptoms were positively related to negative automatic thoughts. Structural analysis revealed that negative automatic thoughts partially mediated the association of maternal attachment with depressive symptoms among late adolescents. Findings specifically demonstrated that those with insecure maternal attachment tend to have negative automatic thoughts, which subsequently lead to depressive symptoms. Conclusion: In conclusion, findings highlight the importance of secure attachment to the mother and positive automatic thoughts in combating depressive symptoms; thus ensuring a healthy psychological development for adolescents.
Depressive symptoms

OBJECTIVE: Alexithymic characteristics may represent cognitive and affective mediators between stressors and stress responses among those with depressive disorders. This study evaluated how alexithymic characteristics, as measured by the Korean version of the Toronto Alexithymia Scale-20 (TAS-20K), could be related to stress response patterns, as measured by the Stress Response Inventory (SRI), within a sample composed of individuals diagnosed with depressive disorders. METHODS: Participants comprised a cross section of patients diagnosed with depressive disorders (n=98). Data on demographic and psychosocial factors (i.e., sex, age, and level of education), clinical profiles {i.e., primary and comorbid psychiatric conditions meeting the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria at the time of the evaluation}, duration of illness, medications, and Clinical Global Impression (CGI) scores, and the results of psychological assessments (TAS-20K, SRI) were analyzed. RESULTS: Patients having depressive disorders with alexithymia obtained significantly higher scores in terms of all seven subscales of the SRI, as compared to those without alexithymia, a logistic regression model was used to assess possible predictors for the presence of alexithymia in patients with depressive disorders, including the seven subscales of the SRI, gender, age, and duration of illness. We found that aggressive and somatizing responses to stress were significantly associated with the presence of alexithymia among patients with depression. CONCLUSION: These findings suggest that patients having depression with alexithymia were more susceptible to stress than those without alexithymia. Clinicians might improve their treatment of depression by identifying the clinical predictors for alexithymia and by helping those individuals demonstrating such symptoms in coping with emotionally stressful situations.
Affective Symptoms ; Depression ; Depressive Disorder ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Korea ; Logistic Models

OBJECTIVE: This study was performed to elucidate relationships between alexithymia, suicide ideation and homocysteine levels in drug-naïve outpatients with major depressive disorder (MDD). METHODS: Sixty seven outpatients with MDD with melancholic features were evaluated by the means of the Hamilton Depression Rating Scale, the Toronto Alexithymia Scale (TAS–20), the Scale of Suicide Ideation, and homocysteine levels. RESULTS: Alexithymic subjects showed higher scores on all scales and higher homocysteine levels. Regression analysis shown higher homocysteine levels and TAS-20’ “Difficulty in Describing Feelings” dimension, in turn being associated with higher suicide ideation. CONCLUSION: In conclusion, alexithymic MDD outpatients may characterize for homocysteine dysregulation that may be linked to suicide ideation, regardless depression’ severity. However, study limitations are discussed and must be considered.
Affective Symptoms ; Depression ; Depressive Disorder, Major ; Homocysteine ; Humans ; Outpatients ; Suicidal Ideation ; Suicide ; Weights and Measures

The increasing number of patients with depression is a serious social issue in contemporary Korean society. To fully understand the pathophysiology of depression, this paper reviewed how depression affects the decision making process of humans. Various recent studies in behavioral economics, mathematics, medicine, and neurobiology have shown how humans make decisions and how emotional disturbances, such as depressive disorder, affect this process. There has been great progress in behavioral economics during this decade, and numerous experiments have been designed to evaluate decision making process in humans. In general, economic decision making is evaluated using the Iowa Gambling Task, and social decision making is assessed using the ultimatum game. Numerous research studies have analyzed the performance and reaction of patients with depression in these games. As a result of the advancement of neurophysiology, research has successfully identified the part of the brain that causes the specific results of tests being conducted on patients with depression. Meanwhile, computational neuroscientists have established decision making models based on bayesian framework. These models also match with the neuroanatomy. Although a large part remains unclear, researchers look forward to achieving a better understanding in depression by analyzing the distinct patterns of responses that patients under depression show in the experiment of behavioral economics.
Affective Symptoms ; Brain ; Decision Making* ; Depression* ; Depressive Disorder ; Economics, Behavioral ; Gambling ; Humans ; Interdisciplinary Studies ; Iowa ; Mathematics ; Neuroanatomy ; Neurobiology ; Neurophysiology

OBJECTIVE: The aim of this study was to evaluate the relationship between quality of life (QoL) and alexithymia in patients with depressive disorders receiving antidepressant medication. METHODS: The sample consisted of patients visiting the outpatient psychiatric unit of a university hospital between January 2007 and June 9. Participants completed the Symptom Checklist-90-R (SCL-90-R), the Beck Depression Inventory (BDI), the Toronto Alexithymia Scale-20-K (TAS-20-K), and the 36-item Short Form Health Survey of the Medical Outcomes Study (SF-36). A total of 75 patients diagnosed with depressive disorder according to DSM-IV criteria were included in this study. Student t-tests and regression analyses were conducted on the data. RESULTS: Patients with alexithymia obtained lower QoL scores than did patients without alexithymia on eight dimensions of the SF-36. The regression analysis showed that alexithymia was positively associated with hostility and inversely associated with paranoid ideation. CONCLUSION: Patients with alexithymia emerged as more symptomatic on the SCL-90-R and obtained lower QoL scores on eight dimensions of the SF-36 than did patients without alexithymia. It is important that clinicians identify alexithymic characteristics in patients with depressive disorders to help them improve their QoL.
Affective Symptoms ; Depression ; Depressive Disorder ; Diagnostic and Statistical Manual of Mental Disorders ; Health Surveys ; Hostility ; Humans ; Outpatients ; Quality of Life

PURPOSE: To evaluate the association of a specific type of lower urinary tract symptom (LUTS) and the depression in community-dwelling elderly Korean men. MATERIALS AND METHODS: A total of 392 men aged 65 years or older, who completed urological and psychiatric evaluations as a participant of the Korean Longitudinal Study on Health and Aging, were included. From each subject, an interview on the demographic characteristics and medical history, IPSS, and psychiatric questionnaire were taken. Subjects were divided into two groups; depression and euthymic. Subjects with IPSS subscore more than 3 points was considered 'high' subscore. IPSS subscores were compared between the two groups, and the relationship between depression and LUTS severity was assessed. RESULTS: The mean age of the subjects was 75, and 6.4% of the subjects were diagnosed to have major depressive disorders. The depression group showed higher IPSS scores than the euthymic group (16.1+/-9.9 vs. 11.6+/-8.6, p=0.01). IPSS subscores of question 1 (incomplete empty), question 3 (intermittency), question 4 (urgency) and question 6 (straining to void) were higher in the depression group compared with the euthymic group. Chi-square test revealed subjects with high IPSS 1, 3, 4, and 6 score were associated with depression, but multivariate analysis identified only high IPSS question 4 as a significant prognostic factor for depression. CONCLUSIONS: Elderly population with depression is more likely to have more severe LUTS than population without depression. Among the urinary symptoms, urgency was strongly associated with depression. Patients with moderate to severe LUTS and especially urgency may need their mental health status evaluation.
Aging ; Depression* ; Depressive Disorder, Major ; Humans ; Longitudinal Studies ; Lower Urinary Tract Symptoms ; Male ; Mental Health ; Multivariate Analysis ; Urinary Tract

OBJECTIVE: Recent neuroimaging studies have suggested that brain changes occur in subjects at ultra-high risk (UHR) for psychosis while experiencing prodromal symptoms, among which depression may increase the risk of developing a psychotic disorder. The goal of this study is to examine brain metabolite levels in the anterior cingulate cortex, the left dorsolateral prefrontal cortex and the left thalamus in subjects at UHR for psychosis and to compare brain metabolite levels between the UHR subjects with comorbid major depressive disorder and healthy controls. METHODS: Proton magnetic resonance spectroscopy was used to examine brain metabolite levels. Twenty UHR subjects and 20 age- and intelligence quotient (IQ)-matched healthy controls were included in this study. RESULTS: Overall, no significant differences were observed in any metabolite between the UHR and healthy control group. However, UHR subjects with major depressive disorder showed significantly higher myo-inositol (Ins) levels in the left thalamus, compared to the healthy control. CONCLUSION: Our results demonstrate that increased thalamic Ins level is associated with prodromal depressive symptoms. Further longitudinal follow-up studies with larger UHR sample sizes are required to investigate the function of Ins concentrations as a biomarker of vulnerability to psychosis.
Brain ; Depression ; Depressive Disorder, Major ; Gyrus Cinguli ; Intelligence ; Magnetic Resonance Spectroscopy ; Neuroimaging ; Prefrontal Cortex ; Prodromal Symptoms ; Protons ; Psychotic Disorders ; Sample Size ; Schizophrenia ; Thalamus