Differential impact of isolated psychotic symptoms on treatment outcome of major depressive disorder in the STARD cohort of Whites, Blacks and Latinos

• Published in: Journal of affective disorders Vol. 150; no. 2; pp. 578 - 584
• Main Authors: Cassano, Paolo, Chang, Trina, Trinh, Nhi-Ha, Baer, Lee, Fava, Maurizio, Mischoulon, David
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier B.V 05.09.2013; Elsevier
• Subjects: Adult; Adult and adolescent clinical studies; Affective disorders; Antidepressants; Attitude to Health - ethnology; Biological and medical sciences; Black People - psychology; Black People - statistics & numerical data; Cohort Studies; Depression; Depressive Disorder, Major - complications; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - ethnology; Depressive Disorder, Major - psychology; Female; Hallucinations; Hallucinations - drug therapy; Hallucinations - ethnology; Hallucinations - etiology; Hispanic; Hispanic or Latino - psychology; Hispanic or Latino - statistics & numerical data; Humans; Latin American people; Latinos; Major depressive disorder; Male; Medical sciences; Middle Aged; Mood disorders; Neuropharmacology; Pharmacology. Drug treatments; Prevalence; Psychiatry; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Psychosis-like symptoms; Psychotic Disorders - diagnosis; Psychotic Disorders - epidemiology; Psychotic Disorders - psychology; Psychotic symptoms; Remission; Symptoms; Treatment Outcome; White People - psychology; White People - statistics & numerical data; Remission; Latinos; Antidepressants; Hispanic; Psychosis-like symptoms; Major depressive disorder; Mood disorder; Psychotropic; Treatment efficiency; Depression; Ethnic group; Psychosis; Symptomatology; Antidepressant agent
• ISSN: 0165-0327; 1573-2517; 1573-2517
• DOI: 10.1016/j.jad.2013.02.012

To determine whether isolated psychotic symptoms are more likely to be endorsed by depressed Latinos as opposed to other ethnic–racial groups; whether these symptoms affect Latinos similarly to other ethnic–racial groups in terms of treatment response; and whether they are more likely to be associated with anxiety disorders in depressed Latinos. We analyzed data from STAR⁎D subjects who self identified as White, Black, or Latino. Rates of isolated psychotic symptoms were assessed by the self-rated Psychiatric Diagnostic Screening Questionnaire (PDSQ) and compared between ethnic–racial groups. Depressive remission outcomes were compared within each ethnic–racial group between subjects who endorsed psychotic symptoms versus no psychotic symptoms. Associations between isolated psychotic symptoms and anxiety disorders were also examined. Among 2597 eligible subjects with at least one post-baseline assessment and available PDSQ data excluding first-rank symptoms, the prevalence of auditory–visual hallucination was 2.5% in Whites (n=49/1928), 11.3% in Blacks (n=45/398) 6.3% in Latinos (n=17/270) (χ2=64.9; df=2; p<0.001). Prevalence of paranoid ideation was 15.5% in Whites (n=299/1927), 31.5% in Blacks (n=126/400), and 21.1% in Latinos (n=57/270) (χ2=57.3; df=2; p<0.001). Among Whites and Blacks but not Latinos, depressive remission rates were worse in subjects with auditory–visual hallucinations compared to those without them. Paranoid ideation had a significant negative impact on remission in Whites only. In all ethnic–racial groups, a significant association was found between auditory–visual hallucinations and PTSD and panic disorder. The STAR*D study did not include any structured clinician-based assessment of psychotic symptoms. Latinos do not appear to have worse outcomes when treated for MDD with auditory–visual hallucinations, differently from Whites and Blacks.