Context Depression, fatigue, and sleep disturbances have been identified as a symptom cluster among breast cancer patients. However, few longitudinal studies have examined the temporal relations between these symptoms surrounding diagnosis and treatment. Objectives The current study investigated the co-occurrence of and interrelations between non-somatic depressive symptoms, fatigue, and sleep disturbances in breast cancer patients at three time points: prior to, after, and six to eight months following adjuvant chemotherapy treatment. Methods Separate samples of premenopausal (N = 67) and postmenopausal (N = 67) breast cancer patients completed self-report measures of depression, fatigue, and sleep disturbances at all three time points. Path analysis was used to explore within- and cross-symptom paths across time. Results Depression, fatigue, and sleep disturbances were correlated within each time point. Continuity paths, whereby prior levels of symptom severity tended to predict subsequent severity of the same symptom at the subsequent time point, were significant in both samples, except for depression in the premenopausal sample. Instead, significant cross-symptom paths emerged whereby baseline fatigue predicted post-chemotherapy depression, and post-chemotherapy fatigue predicted depression at follow-up in the premenopausal patients. No significant cross-symptom paths emerged for the postmenopausal sample. Conclusion Findings supported the notion that depression, fatigue, and sleep disturbances manifest as a symptom cluster. Fatigue may precede non-somatic symptoms of depression among premenopausal breast cancer patients and represents a potential intervention target.

Background We present a fully articulated protocol for the Hamilton Rating Scale for Depression (HAM-D), including item scoring rules, rater training procedures, and a data management algorithm to increase accuracy of scores prior to outcome analyses. The latter involves identifying potentially inaccurate scores as interviews with discrepancies between two independent raters on the basis of either scores (≥ 5-point difference) or meeting threshold for depression recurrence status, a long-term treatment outcome with public health significance. Discrepancies are resolved by assigning two new raters, identifying items with disagreement per an algorithm, and reaching consensus on the most accurate scores for those items. Methods These methods were applied in a clinical trial where the primary outcome was the Structured Interview Guide for the Hamilton Rating Scale for Depression—Seasonal Affective Disorder version (SIGH-SAD), which includes the 21-item HAM-D and 8 items assessing atypical symptoms. 177 seasonally depressed adult patients were enrolled and interviewed at 10 time points across treatment and the 2-year followup interval for a total of 1,589 completed interviews with 1,535 (96.6%) archived. Results Inter-rater reliability ranged from ICCs of .923 to .967. Only 86 (5.6%) interviews met criteria for a between-rater discrepancy. HAM-D items “Depressed Mood,” “Work and Activities,” “Middle Insomnia,” and “Hypochondriasis” and Atypical items “Fatigability” and “Hypersomnia” contributed most to discrepancies. Limitations Generalizability beyond well-trained, experienced raters in a clinical trial is unknown. Conclusions Researchers might want to consider adopting this protocol in part or full. Clinicians might want to tailor it to their needs.

CBT-SAD and light therapy are comparably effective for SAD during an acute episode, and both may be considered as treatment options.

Objective The central public health challenge for winter seasonal affective disorder (SAD) is recurrence prevention. Preliminary studies suggest better long-term outcomes following cognitive-behavioral therapy (CBT-SAD) than light therapy. This study is a large randomized head-to-head comparison of these treatments on outcomes one and two winters after acute treatment. Method Community adults with Major Depression, Recurrent with Seasonal Pattern (N=177) were followed one and two winters after a randomized trial of 6-weeks of CBT-SAD (n=88) or light therapy (n=89). Prospective followup visits occurred in January or February of each year, and major depression status was assessed by phone in October and December of the first year. The primary outcome was winter depression recurrence status on the Structured Interview Guide for the Hamilton Rating Scale for Depression-SAD Version (SIGH-SAD). Other outcomes were depression severity on the SIGH-SAD and the Beck Depression Inventory-Second Edition (BDI-II), remission status based on severity cutpoints, and major depression status from tracking calls. Results The treatments did not differ on any outcome during the first year of followup. The second winter, CBT-SAD was associated with a smaller proportion of SIGH-SAD recurrences (27.3% vs. 45.6%), less severe symptoms on both measures, and a larger proportion of remissions defined as BDI-II≤8 (63.3% vs. 43.9%) than light therapy. Non-recurrence at next winter was more highly associated with non-recurrence the second winter among CBT-SAD (RR=5.12) than light therapy (RR=1.92) subjects. Conclusions CBT-SAD was superior to light therapy two winters following acute treatment, suggesting greater durability for CBT-SAD.