ABSTRACT
BACKGROUND: In a perinatal cohort of women in urban and rural Turkey, we investigated associations between antenatal depressive symptoms and subsequent changes in perceived quality of key family relationships. METHOD: Of 730 women recruited in their third trimester (94.6% participation), 578 (79.2%) were reassessed at a mean of 4.1 (s.d. = 3.3) months after childbirth, 488 (66.8%) were reassessed at 13.7 (s.d. = 2.9) months, and 448 (61.4%) at 20.8 (s.d. = 2.7) months. At all four examinations, self-reported quality of relationship with the husband, mother and mother-in-law was ascertained using the Close Persons Questionnaire with respect to emotional support, practical support and negative aspects of the relationship. Antenatal depressive symptoms were defined using the Edinburgh Postnatal Depression Scale. A range of covariates in mixed models was considered including age, education, number of children, family structure, physical health, past emotional problems and stressful life events. RESULTS: Key findings were as follows: (i) reported emotional and practical support from all three relationships declined over time in the cohort overall; (ii) reported emotional support from the husband, and emotional and practical support from the mother-in-law, declined more strongly in women with antenatal depressive symptoms; (iii) associations between depressive symptoms and worsening spouse relationship were more pronounced in traditional compared with nuclear families. CONCLUSIONS: Antenatal depressive symptoms predicted marked decline in the quality of key relationships over the postnatal period. This may account for some of the contemporaneous associations between depression and worse social support, and may compound the risk of perinatal depression in subsequent pregnancies.
Subject(s)
Depressive Disorder/psychology , Family Relations/psychology , Pregnancy Complications/psychology , Social Support , Adolescent , Adult , Cohort Studies , Depression, Postpartum/ethnology , Depression, Postpartum/psychology , Depressive Disorder/ethnology , Family Relations/ethnology , Female , Follow-Up Studies , Humans , Pregnancy , Pregnancy Complications/ethnology , Turkey/ethnology , Young AdultABSTRACT
OBJECTIVE: An association between bipolar disorder and cognitive impairment has repeatedly been described, even for euthymic patients. Findings are inconsistent both across primary studies and previous meta-analyses. This study reanalysed 31 primary data sets as a single large sample (N = 2876) to provide a more definitive view. METHOD: Individual patient and control data were obtained from original authors for 11 measures from four common neuropsychological tests: California or Rey Verbal Learning Task (VLT), Trail Making Test (TMT), Digit Span and/or Wisconsin Card Sorting Task. RESULTS: Impairments were found for all 11 test-measures in the bipolar group after controlling for age, IQ and gender (Ps ≤ 0.001, E.S. = 0.26-0.63). Residual mood symptoms confound this result but cannot account for the effect sizes found. Impairments also seem unrelated to drug treatment. Some test-measures were weakly correlated with illness severity measures suggesting that some impairments may track illness progression. CONCLUSION: This reanalysis supports VLT, Digit Span and TMT as robust measures of cognitive impairments in bipolar disorder patients. The heterogeneity of some test results explains previous differences in meta-analyses. Better controlling for confounds suggests deficits may be smaller than previously reported but should be tracked longitudinally across illness progression and treatment.
Subject(s)
Affective Symptoms , Bipolar Disorder , Cognition Disorders , Mental Competency , Neuropsychological Tests , Psychotropic Drugs/adverse effects , Adult , Affect , Affective Symptoms/psychology , Age of Onset , Bipolar Disorder/complications , Bipolar Disorder/diagnosis , Bipolar Disorder/drug therapy , Bipolar Disorder/epidemiology , Cognition Disorders/diagnosis , Cognition Disorders/drug therapy , Cognition Disorders/epidemiology , Cognition Disorders/etiology , Confounding Factors, Epidemiologic , Female , Humans , Male , Mental Processes/drug effects , Middle Aged , Psychiatric Status Rating Scales , Psychotropic Drugs/administration & dosage , Risk FactorsABSTRACT
BACKGROUND AND OBJECTIVES: Quality of life (QOL) of immigrant groups with mental disorders should be compared with similar patients in the country of origin. Therefore, this study evaluated the QOL in Turkish patients who were in treatment because of depressive disorders in Ankara and Berlin. SUBJECTS AND METHODS: Patients with depressive disorders were recruited from services in Ankara and Berlin. The same researcher interviewed all patients and assessed socio-demographic characteristics, symptomatology, psychiatric diagnosis and QOL. RESULTS: QOL of patients in Ankara was significantly higher than that of patients in Berlin. Satisfaction with specific life domains also showed significant differences between the two groups. Factors positively associated with QOL in Berlin were marital status, shorter duration of marriage, fewer occupants per household, a relaxed religious attitude, being informed about the illness by the physician, and lower levels of symptoms. In Ankara, only initial help seeking behavior and level of depressive symptoms were associated with QOL. CONCLUSION: QOL of Turkish patients with depression in Berlin appears lower than that of similar patients in Ankara. Different factors may influence QOL of Turkish patients with depression living in the place of origin and having emigrated to Germany.
