Antenatal depressive symptoms as a predictor of deterioration in perceived social support across the perinatal period: a four-wave cohort study in Turkey.

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.

Quality of life of Turkish patients with depression in Ankara and in Berlin.

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.

Do sexual dysfunctions get better during dialysis? Results of a six-month prospective follow-up study from Turkey.

Dialysis improves most symptoms of end-stage renal disease (ESRD), yet many patients continue to experience sexual dysfunction (SD) during the dialysis treatment. The aim of this preliminary study was to evaluate the frequency and the course of SD during a 6-month dialysis treatment. Additionally, relationships between the level of depression, cognitive impairment and biochemical parameters of SD were also assessed. The subjects were 43 ESRD (25 male and 18 female) on dialysis treatment for at least 12 months. SD was assessed using the Arizona Sexual Experiences Scale (ASEX); the level of depression and cognitive impairment were assessed using the Hamilton Depression Rating Scale (HDRS) and Mini Mental Status Exam (MMSE). Several biochemical parameters were also assessed. All assessments were carried out at baseline and repeated at 6-month follow-up. Of 43 patients, 20 (47%) and 18 (42%) complained of SD at baseline and at 6-month assessments, respectively. Of 25 males, nine (36%) and seven (28%) patients described SD at baseline and 6-month assessments, respectively; erectile dysfunction was the most frequent complaint. Of 18 females, 11 (61%) and 11 (61%) patients reported SD at baseline and 6-month assessments, respectively; difficulties with arousal and reaching orgasm were the most frequent complaints. Both total and item-by-item comparisons of baseline and 6 months ASEX scores did not reveal any significant changes during 6-month period, indicating that patient's sexual functions do not improve with dialysis treatment. For female patients, HDRS scores were significantly higher in patients with SD at baseline (t = 2.15, P = 0.05) and at 6-month follow-up (t = 2.44, P = 0.03) assessments; after excluding the effects of age and duration of dialysis for females using regression analysis, HDRS still significantly (t = 4.02, P = 0.003) associated with the SD. This preliminary prospective study suggests that SD is frequent in dialysis patients, does not remit with dialysis treatment, associated with depression in female patients, and much clinical attention is indicated.

Panic disorder and memory: does panic disorder result from memory dysfunction?

It is proposed that patients with panic disorder have a defect in fear-relevant episodic memory, and their panic attacks arise from automaticity in recollecting fear-relevant emotional-autonomic cluster. The cluster as a component of fear appears to have been dissociated from cognitive structure (episodic or informative memory trace) or from "information structure". A special method was created for testing this hypothesis where 30 panic disorder patients, 12 healthy controls, and 32 patients with other psychiatric diagnoses were asked to recall and describe a fearful experience. None of the patients in the panic disorder group could recall any fearful event or episode in their past. All but one subject among healthy controls and all the subjects in the non-panic group could recall one or more fearful event or episode. Possible theoretical implications of these results are discussed in the context of some classical concepts.