Impact of depression and social support on nonadherence to antipsychotic drugs in persons with schizophrenia in Thailand

Sirijit Suttajit, Sutrak PilakantaDepartment of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, ThailandBackground: Little is known about the effect of social support on nonadherence in persons with schizophrenia, especially in developing Asian countries where social support is considered to be imperative. Additionally, the role of depression as a mediator in the association between social support deficits and nonadherence has not been evaluated.Methods: This was a cross-sectional study conducted in 75 participants at a university hospital in Thailand. Logistic regression was used to determine whether depression and a deficit in social support were associated with nonadherence, and whether depression mediated this association.Results: There were strong relationships between nonadherence and major depressive episodes (odds ratio [OR] 9.5, confidence interval [CI] 2.3–38.9), living alone (OR 21.8, CI 3.5–143.0), and dissatisfaction with support from family (OR 10.0, CI 1.9–53.1). The OR of the association between social support deficits and nonadherence decreased by nearly one half after adjusting for depression.Discussion: Depression and social support deficits were significantly associated with nonadherence in persons with schizophrenia. Depression is important in mediating the association between social support deficits and nonadherence. Enhancing social support, as well as early detection and effective intervention for depression should be emphasized in interventions to improve adherence in persons with schizophrenia.Keywords: nonadherence, schizophrenia, depression, social support, antipsychotic drug

Prevalence of metabolic syndrome and its association with depression in patients with schizophrenia

Sirijit Suttajit, Sutrak PilakantaDepartment of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, ThailandPurpose: To identify the point prevalence of metabolic syndrome in patients with schizophrenia and to evaluate the association between depressive symptoms and metabolic syndrome in patients with schizophrenia.Patients and methods: Metabolic syndrome was assessed based on an updated definition derived from the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) and the International Diabetes Federation criteria. The 17-item Hamilton Depression Rating Scale (HDRS-17) was used to measure depressive symptoms in 80 patients with schizophrenia. Odds ratios and 95% confidence intervals were calculated using logistic regression for the association between each depressive symptom and metabolic syndrome.Results: The point prevalence rates of metabolic syndrome according to the modified NCEP-ATP III and International Diabetes Federation criteria were 37% and 35%, respectively. The risk of having metabolic syndrome significantly increased in those who were widowed or separated, or had longer duration of illness. Central obesity was the metabolic feature with the highest odds ratios for metabolic syndrome at 19.3. Three out of 17 items of HDRS subscales were found to be significantly associated with metabolic syndrome, including depressed mood, middle insomnia, and retardation with the odds ratios of 3.0, 3.4, and 3.6, respectively.Conclusion: This study showed that the prevalence of metabolic syndrome in patients with schizophrenia was higher than the overall rate but was slightly lower than in the general population in the USA. Central obesity, measured by waist circumference, was found to be highly correlated with metabolic syndrome. Depressed mood, middle insomnia, and retardation were significantly associated with metabolic syndrome in patients with schizophrenia. Waist circumference and screening for depression should be done at the clinics during patient follow-up.Keywords: mood symptoms, hypertension, dyslipidemia, hyperglycemia, central obesit

Prevalence Of Thyroid Dysfunction And Its Relationship With The Severity Of Major Depressive Disorder (MDD)

Objective: The objective of this study is to determine the prevalence of thyroid dysfunction in Major Depressive Disorder and the factors that were associated with the severity of MDD. Methods: A total of 140 major depressive disorder patients researched are subjected for blood sampling to determine the blood thyroid abnormalities. The severity of illness of MDD was determined by the duration of illness, frequency of admission/ suicidal attempts, and the Hamilton rating scale for depression (HAM-D). Results: Thirty-one of the 140 patients had thyroid dysfunction. There was no significant difference in the severity of illness among patients with MDD between thyroid dysfunction and normal function group (p=0.024). Conclusion: Patients with MDD had high prevalence of thyroid dysfunction; however, the former had no correlation with later.Please click PDF below to download the full paper...Â

Predictors of quality of life among individuals with schizophrenia

Sirijit Suttajit, Sutrak Pilakanta Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Purpose: The study reported here aimed to evaluate both biological and psychosocial factors as predictors for quality of life as well as to examine the associations between the factors and quality of life in individuals with schizophrenia. Methods: Eighty individuals with schizophrenia were recruited to the study. The Thai version of the World Health Organization Quality of Life-BREF was utilized to measure the quality of life. The five Marder subscales of the Positive and Negative Syndrome Scale were applied. Other tools for measurement included the Calgary Depression Scale for Schizophrenia and six social support deficits (SSDs). Pearson/Spearman correlation coefficients and the independent t-test were used for the statistical analysis to determine the associations of variables and the overall quality of life and the four domain scores. A multiple linear regression analysis of the overall quality of life and four domain scores was applied to determine their predictors. Results: The Positive and Negative Syndrome Scale total score, positive symptoms, negative symptoms, disorganized thought, and anxiety/depression showed a significant correlation with the overall quality of life and most of the four domain scores. Depression, SSDs, and adverse drug events showed a significant correlation with a poorer overall quality of life. The multiple linear regression model revealed that negative symptoms, depression, and seeing a relative less often than once per week were predictors for the overall quality of life (adjusted R2=0.472). Negative symptoms were also found to be the main factors predicting a decrease in the four domains of quality of life – physical health, psychological, social relationships, and environment. Conclusion: Negative symptoms, depression, and poor contact with relatives were the foremost predictors of poor quality of life in individuals with schizophrenia. Positive symptoms, negative symptoms, disorganized thought, anxiety/depression, SSDs, and adverse events were also found to be correlated with quality of life. Keywords: adverse events, depression, negative symptoms, positive symptoms, social suppor

Prevalence of and factors associated with depression in patients with schizophrenia in Thailand: a post-hoc analysis

Abstract Objectives This study was aimed to assess the prevalence of depression and identify factors associated with depression in patients with schizophrenia in a university hospital. Methods This was a post-hoc analysis of a cross-sectional study conducted in 75 patients with schizophrenia. Major depressive episodes were diagnosed according to DSM-IV-TR. The six social support defi cits (SSDs) scale was used to identify social support defi cits. Chisquare and logistic regression were used to determine factors associated with depression. Results The prevalence of depression was 16.0%, with only 25.0% of them previously being recognized and treated with antidepressants. Age, sex, marital status, income, duration of illness, type of antipsychotic drugs and number of side effects were not signifi cantly associated with depression. Three out of six social support defi cits were associated signifi cantly with depression, including living alone, reciprocity in the family, and dissatisfaction with family support, with odds ratios of 10.0, 4.9 and 8.6, respectively. Those with at least one social support defi cit were 9.3 times more likely to be depressed than those without one (p=0.002). Conclusion This study suggested that depression in patients with schizophrenia was still under recognized by Thai psychiatrists. The fi ndings do not support the hypothesis that depression is more common in patients receiving typical antipsychotic drugs. Psychosocial factors such as social support defi cits were found to have a higher impact on depression than biological ones in Thai patients with schizophrenia. Chiang Mai Medical Journal 2011;50(4):115-121