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Biomedical subjects

T A Furukawa

Publications and source records attributed to T A Furukawa.

At least 19 recordsLinked to original sources
PubMed2005

Cross-cultural equivalence in depression assessment: Japan-Europe-North American study.

OBJECTIVE: Worldwide use of the Hamilton Rating Scale for Depression (HRSD) presupposes that depression symptomatology can be measured the same way across countries but no empirical study has yet examined this issue. We therefore examined cross-cultural consistency of factor structure of HRSD. METHOD: A 17-item HRSD data were sought for 5,185 individuals diagnosed with major depression in Japan, Europe and North America. Candidate factor structures were obtained with simultaneous component analysis (SCA) across the three cultures. They were then submitted to multiple-group confirmatory factor analysis (CFA). RESULTS: According to SCA, 3-, 4- or 5-factor solutions were found to optimally and adequately summarize the variables for all the three populations. When submitted to CFA, the 5-factor solution was the best fitting and the most parsimonious: they were 'anhedonia/retardation,''guilt/agitation,''bodily symptoms,''insomnia' and 'appetite.' CONCLUSION: Common underlying factors exist for HRSD among Japanese, European and American patients with major depression.

Adult↗
PubMed2004

Psychosocial predictors of successful delivery after unexplained recurrent spontaneous abortions: a cohort study.

OBJECTIVE: To examine psychosocial predictors of successful pregnancy after recurrent spontaneous abortions (RSA). METHOD: We administered two waves of semi-structured interview and self-report questionnaire battery to a consecutive series of 46 couples who had had two RSAs (baseline before third pregnancy, and immediately after third pregnancy was ascertained), and followed them through their third pregnancy. RESULTS: Of the 46 couples, four miscarried for karyotypal abnormalities and six without any known cause. When the latter six were compared with the remaining 36 women, they reported less social support satisfaction, a more stable attribution for the causes of past abortions, and more depressed mood in the preceding year. Taken altogether, this psychosocial model was able to predict 93% of the pregnancy outcomes correctly. CONCLUSION: Psychosocial variables (depression, attribution and social support) are robust predictors of the prospective pregnancy and suggest possible points of intervention in couples with RSA.

Abortion, Spontaneous↗
PubMed2003

The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being.

BACKGROUND: Two new screening scales for psychological distress, the K6 and K10, have been developed but their relative efficiency has not been evaluated in comparison with existing scales. METHOD: The Australian National Survey of Mental Health and Well-Being, a nationally representative household survey, administered the WHO Composite International Diagnostic Interview (CIDI) to assess 30-day DSM-IV disorders. The K6 and K10 were also administered along with the General Health Questionnaire (GHQ-12), the current de facto standard of mental health screening. Performance of the three screening scales in detecting CIDI/DSM-IV mood and anxiety disorders was assessed by calculating the areas under receiver operating characteristic curves (AUCs). Stratum-Specific Likelihood Ratios (SSLRs) were computed to help produce individual-level predicted probabilities of being a case from screening scale scores in other samples. RESULTS: The K10 was marginally better than the K6 in screening for CIDI/DSM-IV mood and anxiety disorders (K10 AUC: 0.90, 95%CI: 0.89-0.91 versus K6 AUC: 0.89, 95%CI: 0.88-0.90), while both were significantly better than the GHQ-12 (AUC: 0.80, 95%CI: 0.78-0.82). The SSLRs of the K10 and K6 were more informative in ruling in or out the target disorders than those of the GHQ-12 at both ends of the population spectrum. The K6 was more robust than the K10 to subsample variation. CONCLUSIONS: While the K10 might outperform the K6 in screening for severe disorders, the K6 is preferred in screening for any DSM-IV mood or anxiety disorder because of its brevity and consistency across subsamples. Precision of individual-level prediction is greatly improved by using polychotomous rather than dichotomous classification.

Adolescent↗
PubMed2003

Time to recurrence after recovery from major depressive episodes and its predictors.

BACKGROUND: Depression is a remitting but recurring disease. However, there is a paucity of prospectively recorded data on the course of depression after recovery. METHOD: A multi-centre prospective serial follow-up study of an inception cohort of hitherto untreated unipolar major depression (N = 95) for 6 years. We report the time to recurrence after recovery from the index depressive episode and their predictors. RESULTS: The cumulative probability of remaining well without subthreshold symptoms was 57% (95% CI, 46 to 68%) at 1 year, 47% (95% CI, 36 to 58%) at 2 years and 35% (95% CI, 23 to 47%) at 5 years. The same without full relapse was 79% (95% CI, 70 to 88%) at 1 year, 70% (95% CI, 60 to 80%) at 2 years and 58% (95% CI, 46 to 70%) at 5 years. The median duration of well-interval from the end of the index episode to the beginning of the subthreshold episode was 19-0 months (95% CI, 2-4 to 35-7), and that to the end of the full episode was over 6 years. Residual symptoms at time of recovery predicted earlier recurrence. CONCLUSIONS: The median length of the well-interval was much longer than previously reported in studies employing similar definitions but dealing with a more severe spectrum of patients. However, the sobering fact remains that less than half of the patients can expect to remain virtually symptom-free for 2 years or more after recovery from the depressive episode.

Adolescent↗
PubMed2002

Stratum-specific likelihood ratios of the general health questionnaire in the community: help-seeking and physical co-morbidity affect the test characteristics.

BACKGROUND: In evidence-based medicine, stratum-specific likelihood ratios (SSLRs) are now being increasingly recognized as a more convenient and generalizable method to interpret diagnostic information than an optimal cut-off and its associated sensitivity and specificity. We previously examined the SSLRs of the General Health Questionnaire (GHQ) in primary care settings. The present paper aims to examine if these SSLRs are generalizable to the community settings. METHODS: The Composite International Diagnostic Interview (CIDI) and the GHQ were administered on a representative sample of the Australian population in the Australian National Survey of Mental Health and Well-Being. We first compared the SSLRs of GHQ in urban Australia with the estimates that we had previously obtained from the developed urban centres in the WHO Psychological Problems in General Health Care study. If the SSLRs in the community were found to differ significantly from those in the primary care, we sought for explanatory variables. RESULTS: The SSLRs in urban Australia and in the urban centres in the WHO study were significantly different for three out of the six strata. When we limited the sample to those with physical problems who visited a health professional, however, the SSLRs in the Australian study were strikingly close to those observed for primary care settings. CONCLUSIONS: Different sets of SSLRs apply to primary care and general population samples. For general population surveys in developed countries, the results of the Australian National Survey represent the currently available best estimates. For developing countries or rural areas, the results are less definitive and an investigator may wish to conduct a pilot study.

Adolescent↗
PubMed2002

Personality, social support, coping and emotional distress after repeated spontaneous abortions.

Systematic investigations on the emotional impacts of repeated spontaneous abortions have been few. We mounted a prospective study of a cohort of couples who had experienced two consecutive first trimester spontaneous abortions and for whom no clearly identifiable causes were found. The present report is based on the first part of the study and examines: (1) emotional distress reported by the miscarrying women at six months (median, range 1-12 months) after two abortions; and (2) psychosocial predictors influencing such distress. The mean score of the women on the Symptom Checklist 90-Revised--one of the most popular self-report scales for psychopathology--was 0.38, whereas that for the general population is reported to be 0.26 (the higher the score, the more psychopathology). Fourteen percent of the cohort scored above the cutoff point for mental disorders screening. Factors examined and found non-influential upon the level of emotional distress include: the maternal age; whether the last pregnancy was planned and wished for or not; and coping styles of the women after the abortions. Control by the husbands over the marital relationship and neurotic personality traits of the women increased the emotional distress, whereas the social support the women perceive decreased it. These findings suggest that martial and social support are important in determining the level of psychiatric morbidity after repeated abortions.

Abortion, Spontaneous↗
PubMed2001

Is antidepressant-benzodiazepine combination therapy clinically more useful? A meta-analytic study.

BACKGROUND: Anxiety frequently coexists with depression, and benzodiazepines are often prescribed together with antidepressants. However, benzodiazepines themselves have little or no antidepressive effects and we lack firm evidence for or against this combination therapy. We therefore conducted a meta-analysis of relevant randomized controlled trials to date. METHODS: All randomized controlled trials that compared antidepressant-benzodiazepine treatment with antidepressant alone for adult patients with major depression were sought by electronic searches of Medline and several other databases (January 1972 to December 1998), combined with hand searching, reference searching and SciSearch. Two reviewers independently assessed the eligibility and quality of the studies. Relative risks were estimated with random effects model. RESULTS: Aggregating nine studies with a total of 679 patients, the combination therapy group was 37% (95%CI: 19-51%) less likely to drop out than the antidepressant alone group. The intention-to-treat analysis showed that the former were 63% (18-127%) to 38% (15-66%) more likely to show response (defined as 50% or greater reduction in the depression scale from baseline) up to 4 weeks. LIMITATIONS: None of the included RCTs followed the patients beyond 8 weeks. CONCLUSIONS: The potential benefits of adding a benzodiazepine to an antidepressant must be balanced judiciously against possible harm, including development of dependence and accident proneness, on the one hand, and against continued suffering following no response and drop-out, on the other.

Adult↗
PubMed2001

Stratum-specific likelihood ratios of two versions of the general health questionnaire.

BACKGROUND: In other branches of epidemiology, stratum specific likelihood ratios (SSLRs) have been found to be preferable to fixed best threshold approaches to screening instruments. This paper presents SSLRs of GHQ-12 and GHQ-28 and compares the SSLR method with the traditional optimal threshold approach. METHODS: Random effects meta-analysis and meta-regression were used to obtain pooled estimates of SSLRs of the two questionnaires for the 15 centres participating in the WHO study of Psychological Problems in General Health Care. We illustrated the use of SSLRs by applying them to random samples of patients from centres with different backgrounds. RESULTS: For developed and urban centres, the estimates of SSLRs were homogeneous for 10 out of 12 strata of the GHQ-12 and GHQ-28. For other centres, the overall results, which were heterogeneous for six out of 12 strata, were deemed the currently available best estimates. When we applied these results to centres with different prevalences of mental disorders and backgrounds, the estimates matched the actually observed closely. These examples showed how the SSLR approach is more informative than the traditional threshold approach. CONCLUSIONS: Those working in developed urban settings can use the corresponding SSLRs with reasonable confidence. Those working in non-urban or developing areas may wish to use the overall results, while acknowledging that they must remain less certain until further research can explicate heterogeneity. These SSLRs have been incorporated into nomograms and spreadsheet programmes so that future researchers can swiftly derive the post-test probability for a patient or a group of patients from a pre-test probability and GHQ score.

Adolescent↗
PubMed2001

Symptomatic recovery and social functioning in major depression.

OBJECTIVE: To determine whether social functional recovery precedes, runs in parallel with, or lags behind symptomatic recovery from major depressive episodes. METHOD: Psychiatric out-patients or in-patients aged 18 years or over, diagnosed with unipolar major depressive disorder according to DSM-IV, and who had received no antidepressant medication in the preceding 3 months were identified at 23 collaborating centres from all over Japan (n=95). They were rated with the 17-item Hamilton Rating Scale for Depression (HRSD) and the Global Assessment Scale (GAS) monthly, and with the Social Adjustment Scale-Self Report (SAS-SR) 6-monthly. Remission was defined as 7 or less on the HRSD and recovery as 2 or more consecutive months of remission. RESULTS: The GAS ratings showed continuous amelioration from baseline to remission, remission to recovery, and after sustained recovery. The same trends were observed for SAS-SR scores. CONCLUSION: We can expect further amelioration in social adjustment after symptomatic remission and recovery of major depressive episodes.

Major Depressive Disorder↗
PubMed2000

Course and outcome of depressive episodes: comparison between bipolar, unipolar and subthreshold depression.

It is pragmatically important to know the comparative prognoses of bipolar, unipolar and subthreshold depressions after they present to clinical attention. Previous studies focusing on bipolar and/or unipolar depressions have questionable generalizability because of overrepresentation of inpatients and/or refractory patients, and no study has yet focused on the length of subthreshold depression. The Group for Longitudinal Affective Disorders Study (GLADS) in Japan is conducting a prospective, serial follow-up study of broadly defined mood disorder patients, who had not received treatment for their index episode before study entry. The median time to recovery for bipolar depression was 2.0 months (95%CI: 0.9-3.1), that for unipolar depression 3.0 (2.5-3.6), and that for subthreshold depression 3.2 (0-12.3). Survival analyses revealed no statistically significant difference among the three. Neither was the total time unwell significantly different among the three: on average, these patients were symptomatic with two or more significant affective symptoms for 9.5 (8.0-10.9) months out of the initial 24 months of follow-up. The bipolar depressed patients tended to present with graver functional impairment at intake, but thereafter there was no statistically significant difference in the global functioning of these three diagnostic subgroups. In our sample, patients with depressive disorder not otherwise specified appeared to suffer both symptomatologically and functionally as much as patients with major mood disorders.

Acute Disease↗
PubMed2000

Antidepressant plus benzodiazepine for major depression.

BACKGROUND: Anxiety frequently coexists with depression. There is no systematic review to show if adding benzodiazepines to antidepressants can bring about any advantage over antidepressants alone in the treatment of depression, although such a combination prescription appears to be widely practiced worldwide OBJECTIVES: To determine whether, among adult patients with major depression, adding benzodiazepines to antidepressants brings about any benefit in terms of symptomatic recovery or side-effects in the short term (less than 8 weeks) and long term (more than 2 months), in comparison with treatment by antidepressants alone. SEARCH STRATEGY: Electronic searches of MEDLINE, EMBASE, International Pharmaceutical Abstracts, Biological Abstracts, LILACS, PsycLit, the Cochrane Library and the trial register of the Cochrane Depression, Anxiety and Neurosis Group (January 1972 to December 1998), combined with hand searching, reference searching, SciSearch and personal contacts. SELECTION CRITERIA: All randomized controlled trials that compared combined antidepressant-benzodiazepine treatment with antidepressant alone for adult patients with major depression (Feighner criteria, RDC, DSM-III, DSM-III-R, DSM-IV or ICD-10). Exclusion criteria are: antidepressant dosage lower than 100 mg of imipramine or its equivalent daily and duration of trial shorter than 4 weeks. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the eligibility and quality of the studies. Two reviewers independently extracted the data. Standardized weighted mean differences and relative risks were estimated with random effects model. The dropouts were assigned the least favorable outcome. Two sensitivity analyses examined the effect of this assumption as well as the effect of including medium quality studies. Three a priori subgroup analyses were performed with regard to the patients with or without comorbid anxiety and with regard to the types of benzodiazepines tested. MAIN RESULTS: Aggregating nine studies with a total of 679 patients, the combination therapy group was 37% (95%CI: 19 to 51%) less likely to drop out than the antidepressant alone group. The intention-to-treat analysis showed that the former were 63% (18 to 127%) to 38% (15 to 66%) more likely to show response (defined as 50% or greater reduction in the depression scale from baseline) up to 4 weeks. REVIEWER'S CONCLUSIONS: The potential benefits of adding a benzodiazepine to an antidepressant must be balanced judiciously against possible harms including development of dependence and accident proneness, on the one hand, and against continued suffering following no response and drop-out, on the other.

Adult↗
PubMed2000

Treatment received by depressed patients in Japan and its determinants: naturalistic observation from a multi-center collaborative follow-up study.

BACKGROUND: Undertreatment of depression appears widespread but the available literature is limited to North American and European countries. We aimed to examine the treatment received by patients with major depression in Japan and to elucidate any predictor of their treatment level. METHODS: A naturalistic, prospective follow-up study of an inception cohort of subjects with mood disorders was undertaken in psychiatric departments of 13 university hospitals, those of six general hospitals, three mental hospitals and one community mental health center from all over Japan. A total of 95 patients without any prior antidepressant treatment were diagnosed with major depression according to DSM-IV and were followed up every month until treatment termination and every 6 months thereafter. RESULTS: The follow-up information was available in 98 to 97% of the cohort. The proportion of patients receiving less than 125 mg/day of imipramine or equivalent reached 69% (95% CI: 58-78%) at 1 month and 67% (95% CI: 54-77%) at 6 months. A few clinical variables were significantly associated with inadequate antidepressant prescription but altogether they explained only 5 to 14% of the variance observed. CONCLUSIONS: Japan was no exception to the other industrialized countries in its less than optimal provision of treatment to major depression and its lack of explanatory predictors for this common practice.

Adult↗
PubMed2000

Discrepancies among megatrials.

The validity of meta-analyses has recently been examined by comparing their results with those of megatrials on the same topic. We investigated the reliability of this gold standard by identifying megatrials, defined as ones involving more than 1000 subjects, in the recent issue of the Cochrane Library and in the article by LeLorier et al. (N Engl J Med 1997;337:536-42). In the former set, 289 pairs of megatrials were identified which studied the same patient-intervention-outcome combinations. Of these, 210 (73%, 95% CI: 67-77%) reported odds ratios or weighted mean differences that were not statistically significantly different from each other. The agreement of statistical conclusions regarding outcomes was a quadratic weighted kappa of 0.40 (95% CI: 0.29-0.51). The article by LeLorier et al. yielded 133 comparisons, of which 97 (73%, 95% CI: 64-79%) reported mutually compatible odds ratios. The agreement of statistical conclusions was a kappa of 0.33 (95% CI: 0.18-0.47). Agreement among megatrials was approximately as large as that reported between meta-analyses and megatrials. These findings suggest that taking megatrials as the gold standard can be problematic and that there is no substitute for clear and hard thinking for any study, be it a meta-analysis or a megatrial.

Humans↗
PubMed2000

Validity of brief intelligence tests for patients with Alzheimer's disease.

The validity of two kinds of brief intelligence tests for patients with Alzheimer's disease (AD) was investigated. In study 1, five short forms of the Japanese Wechsler Adult Intelligence Scale-Revised (JWAIS-R) were administered to 102 AD patients. The results showed that the intra-class correlation coefficients (ICC) between IQ estimated with the short forms and those obtained by administration of the full JWAIS-R were satisfactory, ranging from 0.82 to 0.98, and that the abbreviated forms took a shorter time to execute. In study 2, the Raven's Coloured Progressive Matrices (RCPM) and the Mini-Mental State Examination (MMSE) were administered to 67 AD patients. The ICC between the IQ estimated with these tests and the full-scale IQ of the JWAIS-R were both acceptable at 0.57, and each test could be carried out in a very short time. It was concluded that these brief tests, particularly the WAIS-R short forms, are highly practical for quick measurement of intelligence in AD patients, although they have their respective limitations.

Aged↗
PubMed2000

Psychosocial factors regulating natural-killer cell activity in recurrent spontaneous abortions.

PROBLEM: The preconceptional natural-killer cell (NK) activity predicts subsequent miscarriage among women with unexplained recurrent spontaneous abortion (RSA). Psycho-neuro-immuno-endocrine network has recently been proposed as a mechanism for abortions. We therefore examined which psychosocial factors influenced the NK activity among women with RSA. METHOD OF STUDY: We measured the preconceptional NK activity of 61 women with a history two consecutive unexplained first-trimester miscarriages and no live births. We also administered semi-structured interviews and a battery of self-report questionnaires to assess their social support, personality, self-esteem and psychiatric symptoms. RESULTS: The preconceptional NK activity was negatively correlated with the women's neuroticism personality trait (r= -0.32, P = 0.01) and current depressive symptoms (r = -0.26, P= 0.05), and positively correlated with their self-esteem (r = 0.34, P = 0.01). CONCLUSIONS: In addition to several substances such as transforming-growth-factor beta and granulocyte-macrophase colony-stimulating factor, we found that low neuroticism, low depression scale score and high self-esteem contributed to high NK activity among women with RSA.

Abortion, Habitual↗