Stresses and Disability in Depression across Gender.

Depression, though generally episodic, results in lasting disability, distress, and burden. Rising prevalence of depression and suicide in the context of epidemiological transition demands more attention to social dimensions like gender related stresses, dysfunction, and their role in outcome of depression. Cross-sectional and follow-up assessment of men and women with depression at a psychiatric tertiary centre was undertaken to compare their illness characteristics including suicidal ideation, stresses, and functioning on GAF, SOFAS, and GARF scales (N = 107). We reassessed the patients on HDRS-17 after 6 weeks of treatment. Paired t-test and chi-square test of significance were used to compare the two groups, both before and after treatment. Interpersonal and marital stresses were reported more commonly by women (P < 0.001) and financial stresses by men (P < 0.001) though relational functioning was equally impaired in both. Women had suffered stresses for significantly longer duration (P = 0.0038). Men had more impairment in social and occupational functioning compared to females (P = 0.0062). History of suicide attempts was significantly associated with more severe depression and lower levels of functioning in case of females with untreated depression. Significant cross-gender differences in stresses, their duration, and types of dysfunction mandate focusing on these aspects over and above the criterion-based diagnosis.

Untreated major depressive disorder with and without atypical features: a clinical comparative study.

AIMS AND METHOD: A comparative study of major depression with and without atypical features (as per DSM IV TR criteria) was planned to assess illness characteristics, resulting dysfunction and co-morbidities, which can have important implications in its management. Serially, 107 newly registered patients with depression not taking any treatment for at least a month were included. Patients with psychotic features in present or past, known bipolar disorder and likely organic aetiology were excluded. They were interviewed using SCID I (Structured clinical interview for DSM IV axis I disorders). Impulsiveness, suicidal ideation and functioning in various spheres was also assessed and compared between those with and without atypical features. RESULTS: Atypical features were seen in a significant number (55.14%) of patients especially from urban and semi-urban areas. Interpersonal sensitivity and leaden paralysis were the commonest atypical features apart from mood reactivity. Presence of hypersomnia and/or hyperphagia documented in 36 (33.65%) of 107 patients. Comparison of patients with and without atypical features revealed no significant difference in illness characteristics including suicidal ideation. However, they differed in level of impulsiveness and associated psychiatric co-morbidities. Also, deterioration of functioning with rising HDRS was more significant in patients without atypical features. CLINICAL IMPLICATIONS: Presence of atypical features is common in patients with major depressive disorder. These patients should be vigilantly assessed and managed in view of equal morbidity but different co-morbidities like anxiety and soft bipolar disorders than those without atypical features.