Gender Differences in the Clinical Characteristics of Psychotic Depression: Results from the CRESCEND Study

Abstract

ObjectiveTo test whether there are gender differences in the clinical characteristics of patients with psychotic depression (PD).MethodsUsing data from the Clinical Research Center for Depression (CRESCEND) study in South Korea, we tested for potential gender differences in clinical characteristics among 53 patients with PD. The Psychotic Depression Assessment Scale (PDAS) and other psychometric scales were used to evaluate various clinical features of the study subjects. Independent t-tests were performed for normally distributed variables, Mann-Whitney U-tests for non-normally distributed variables, and χ2 tests for discrete variables. In addition, to exclude the effects of confounding variables, we carried out an analysis of covariance (ANCOVA) for the normally distributed variables and binary logistic regression analyses for discrete variables, after adjusting the effects of marital status.ResultsWe identified more prevalent suicidal ideation (adjusted odds ratio [aOR]=10.316, p=0.036) and hallucinatory behavior (aOR=8.332, p=0.016), as well as more severe anxiety symptoms (degrees of freedom [df]=1, F=6.123, p=0.017), and poorer social and occupational functioning (df=1, F=6.265, p=0.016) in the male patients compared to the female patients.ConclusionOur findings suggest that in South Korean patients with PD, suicidal ideation, hallucinatory behavior, and anxiety is more pronounced among males than females. This should be taken into consideration in clinical practice.

Clinical Validation of the Psychotic Depression Assessment Scale, Hamilton Depression Rating Scale-6, and Brief Psychiatric Rating Scale-5: Results from the Clinical Research Center for Depression Study

“… 42 Although one study has shown that gender is not significantly associated with treatment outcome in 259 patients with MDD with psychotic features, 43 another study has shown that men with PD have more severe anxiety symptoms, more prevalent suicidal ideation, and more hallucinatory behavior than women with PD. 28 Hence, age, gender, and other baseline characteristics might be associated with a greater proportion of mild PD at baseline in the present study. In the current study, the baseline mean scores of the PDAS, HAMD-6, and BPRS-5 assessments were 14.0 (SD=3.2), 11.4 (SD=3.2), and 2.6 (SD=2.6), respectively, whereas in a previous validation study 38 the scores were 29.5 (SD=11.3), 18.9 (SD= 6.0), and 10.6 (SD=5.8), respectively.…”

“… 21 In addition, the PDAS has been proposed as a promising diagnostic tool for PD. 27 28 Østergaard et al 25 proposed the following severity classification: mild PD (a PDAS score of 8–15), moderate PD (a PDAS score of 16–23), and severe PD (a PDAS score >23).…”

“… 24 The PDAS can be used to evaluate the outcome measures from randomized clinical trials, and identify the patients with PD from those with non-PD. 25 26 27 28 The reasons for employing the composite scale of the HAMD-6 and BPRS-5 were as follows: since the HAMD-6 is superior to the HAMD in terms of clinical validity and unidimensionality, it was used as a subscale in the PDAS to measure the severity of depressive symptoms. In addition, the combination of the HAMD-6 and BPRS-5 has shown the greatest clinical validity and responsiveness of the various composite scales of the HAMD-6 and BPRS-X (X=1-7).…”

“…Hence, the current study aims to validate the PDAS for a follow-up period of 52 weeks, using data from the Clinical Research Center for Depression (CRESCEND) study, which is the first large, prospective, naturalistic study of patients with depressive disorders in South Korea. 26 27 28 29 30 31 32 Thus, for the current study, we identified patients with PD from the CRESCEND study, and then evaluated the clinical validity and responsiveness of the PDAS, including HAMD-6 and BPRS-5, by comparing the results against several assessment scales including the clinical global impression (CGI) scales, 33 HAMD, 23 the positive symptom subscale (PSS), 34 and the negative symptom subscale (NSS). 34 …”