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The role of Melancholia in prostate cancer patients' depression.

Sharpley CF, Bitsika V, Christie DR - BMC Psychiatry (2011)

Bottom Line: Although it is well established that prostate cancer (PCa) patients are more likely to experience clinical depression than their age-matched non-prostate cancer peers, and that such depression can have negative effects upon survival, little is known about the underlying nature of the depressive symptomatology that these men experience.In particular, the incidence of melancholic symptoms of depression, which are signs of increased risk of suicide and resistance to treatment, has not previously been reported in PCa patients.Psychometric data were satisfactory.

View Article: PubMed Central - HTML - PubMed

Affiliation: Brain-Behaviour Research Group, University of New England, Armidale, New South Wales 2351, Australia. csharpley@onthenet.com.au

ABSTRACT

Background: Although it is well established that prostate cancer (PCa) patients are more likely to experience clinical depression than their age-matched non-prostate cancer peers, and that such depression can have negative effects upon survival, little is known about the underlying nature of the depressive symptomatology that these men experience. In particular, the incidence of melancholic symptoms of depression, which are signs of increased risk of suicide and resistance to treatment, has not previously been reported in PCa patients. The present study aimed to measure the incidence and nature of Melancholia in PCa depression.

Method: A sample of 507 PCa patients in Queensland, Australia, completed anonymous and confidential questionnaires about their background, treatment status, and depression. Data were analysed to select depressive symptoms that were part of the definition of Melancholia vs those which were not. Regression was used to determine the links between Melancholia and overall depressive status, and factor analysis revealed the underlying components of Melancholia, which were mapped over time since diagnosis for 3 years.

Results: Psychometric data were satisfactory. Melancholia significantly predicted depressive status for the most depressed subset of patients, but not for the total sample. Melancholia was factored into its components of Anhedonia and Agitation, and the first of these was more powerful in predicting Melancholia. Variability over the 3 years following diagnosis was noted for each of these two components of Melancholia.

Conclusions: The strong presence of Melancholia in the depressive symptomatology of this sample of PCa patients suggests that some forms of treatment for depression may be more likely to succeed than others. The dominance of Anhedonia and Agitation over other symptoms of Melancholia also holds implications for treatment options when assisting these men to cope with their depression.

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Total Melancholia, Factor 1 (Anhedonia) and Factor 2 (Agitation): (a) incidence over 3-month cohorts, and (b) comparative weighting of Melancholia by Factors 1 and 2 over 3-month cohorts.
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Figure 1: Total Melancholia, Factor 1 (Anhedonia) and Factor 2 (Agitation): (a) incidence over 3-month cohorts, and (b) comparative weighting of Melancholia by Factors 1 and 2 over 3-month cohorts.

Mentions: The second analysis was performed to determine the presence of any variability in Melancholia, Anhedonia and Agitation over time. The sample was identified according to time since diagnosis, and classified into 3-month cohorts, ranging in subsample size from 10 for cohort 9 (i.e., 25 to 27 months after diagnosis) to 95 for cohort 2 (4 to 6 months after diagnosis). Although there were no significant correlations between time since diagnosis and SDS total score, the variabilities in total Melancholia scores (i.e., the mean of the 11 SDS items that comprise the Melancholia subset), the Anhedonia score (i.e., mean of items 2, 5, 17, 18, 20) and the Agitation score (mean of items 9, 13,15, 19) are shown in Figure 1(a) and 1(b). From Figure 1(a), it is apparent that Melancholia scores were relatively stable, although with a peak during the initial 3 months, and again at between 25 and 27 months after diagnosis. Anhedonia was highest immediately after diagnosis, then dropped for 12 months and increased during the period between 15 and 24 months after diagnosis. Agitation was fairly stable during the first 12 months after diagnosis but then increased dramatically at 15 months, decreased after that, and increased again at 27 months after diagnosis. Because these changes may have been due to current disease status (i.e., cancer still present, cancer in remission, cancer re-occurred after previous treatment) for various 3-monthly cohorts, MANOVA was conducted using current disease status over the 3-monthly cohorts as the Independent Variable and Melancholia, Anhedonia and Agitation as the Dependent Variables. There was no significant main effect (F(6,966) = 1.542, p = .161, Wilks Lambda, partial eta square = .009), nor any significant univariate effects. As noted by Stevens [38], with a sample size of over 100, "power is not an issue" (p. 6), and the β for this analysis was .600, also arguing that this nonsignificant outcome is not a result of a Type II error and it may be accepted that the lack of significant effects was not due to some of the sample having had unsuccessful treatment for their PCa. Figure 1(b) shows the relative distribution of the two Melancholia factors over the period examined, and reflects a consistent (although only slightly) higher incidence of Anhedonia over Agitation, with some variability during the 36-month period, and (most importantly for intervention planning) different peaks for the two factors of Melancholia at different times after diagnosis.


The role of Melancholia in prostate cancer patients' depression.

Sharpley CF, Bitsika V, Christie DR - BMC Psychiatry (2011)

Total Melancholia, Factor 1 (Anhedonia) and Factor 2 (Agitation): (a) incidence over 3-month cohorts, and (b) comparative weighting of Melancholia by Factors 1 and 2 over 3-month cohorts.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3278360&req=5

Figure 1: Total Melancholia, Factor 1 (Anhedonia) and Factor 2 (Agitation): (a) incidence over 3-month cohorts, and (b) comparative weighting of Melancholia by Factors 1 and 2 over 3-month cohorts.
Mentions: The second analysis was performed to determine the presence of any variability in Melancholia, Anhedonia and Agitation over time. The sample was identified according to time since diagnosis, and classified into 3-month cohorts, ranging in subsample size from 10 for cohort 9 (i.e., 25 to 27 months after diagnosis) to 95 for cohort 2 (4 to 6 months after diagnosis). Although there were no significant correlations between time since diagnosis and SDS total score, the variabilities in total Melancholia scores (i.e., the mean of the 11 SDS items that comprise the Melancholia subset), the Anhedonia score (i.e., mean of items 2, 5, 17, 18, 20) and the Agitation score (mean of items 9, 13,15, 19) are shown in Figure 1(a) and 1(b). From Figure 1(a), it is apparent that Melancholia scores were relatively stable, although with a peak during the initial 3 months, and again at between 25 and 27 months after diagnosis. Anhedonia was highest immediately after diagnosis, then dropped for 12 months and increased during the period between 15 and 24 months after diagnosis. Agitation was fairly stable during the first 12 months after diagnosis but then increased dramatically at 15 months, decreased after that, and increased again at 27 months after diagnosis. Because these changes may have been due to current disease status (i.e., cancer still present, cancer in remission, cancer re-occurred after previous treatment) for various 3-monthly cohorts, MANOVA was conducted using current disease status over the 3-monthly cohorts as the Independent Variable and Melancholia, Anhedonia and Agitation as the Dependent Variables. There was no significant main effect (F(6,966) = 1.542, p = .161, Wilks Lambda, partial eta square = .009), nor any significant univariate effects. As noted by Stevens [38], with a sample size of over 100, "power is not an issue" (p. 6), and the β for this analysis was .600, also arguing that this nonsignificant outcome is not a result of a Type II error and it may be accepted that the lack of significant effects was not due to some of the sample having had unsuccessful treatment for their PCa. Figure 1(b) shows the relative distribution of the two Melancholia factors over the period examined, and reflects a consistent (although only slightly) higher incidence of Anhedonia over Agitation, with some variability during the 36-month period, and (most importantly for intervention planning) different peaks for the two factors of Melancholia at different times after diagnosis.

Bottom Line: Although it is well established that prostate cancer (PCa) patients are more likely to experience clinical depression than their age-matched non-prostate cancer peers, and that such depression can have negative effects upon survival, little is known about the underlying nature of the depressive symptomatology that these men experience.In particular, the incidence of melancholic symptoms of depression, which are signs of increased risk of suicide and resistance to treatment, has not previously been reported in PCa patients.Psychometric data were satisfactory.

View Article: PubMed Central - HTML - PubMed

Affiliation: Brain-Behaviour Research Group, University of New England, Armidale, New South Wales 2351, Australia. csharpley@onthenet.com.au

ABSTRACT

Background: Although it is well established that prostate cancer (PCa) patients are more likely to experience clinical depression than their age-matched non-prostate cancer peers, and that such depression can have negative effects upon survival, little is known about the underlying nature of the depressive symptomatology that these men experience. In particular, the incidence of melancholic symptoms of depression, which are signs of increased risk of suicide and resistance to treatment, has not previously been reported in PCa patients. The present study aimed to measure the incidence and nature of Melancholia in PCa depression.

Method: A sample of 507 PCa patients in Queensland, Australia, completed anonymous and confidential questionnaires about their background, treatment status, and depression. Data were analysed to select depressive symptoms that were part of the definition of Melancholia vs those which were not. Regression was used to determine the links between Melancholia and overall depressive status, and factor analysis revealed the underlying components of Melancholia, which were mapped over time since diagnosis for 3 years.

Results: Psychometric data were satisfactory. Melancholia significantly predicted depressive status for the most depressed subset of patients, but not for the total sample. Melancholia was factored into its components of Anhedonia and Agitation, and the first of these was more powerful in predicting Melancholia. Variability over the 3 years following diagnosis was noted for each of these two components of Melancholia.

Conclusions: The strong presence of Melancholia in the depressive symptomatology of this sample of PCa patients suggests that some forms of treatment for depression may be more likely to succeed than others. The dominance of Anhedonia and Agitation over other symptoms of Melancholia also holds implications for treatment options when assisting these men to cope with their depression.

Show MeSH
Related in: MedlinePlus