Letters
ous abortion associated with use of antidepressant medication during pregnancy? In conclusion, the reported lack of association between spontaneous abortion and antidepressant use is not supported by the Ross et al data and pregnant women should be educated about the risk of spontaneous abortion associated with use of antidepressant medication during pregnancy. Catalin Tufanaru, MD, MPH Jon Jureidini, MBBS, PhD Author Affiliations: The Joanna Briggs Institute, School of Translational Health Science, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia (Tufanaru); Department of Psychological Medicine, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia (Jureidini). Corresponding Author: Catalin Tufanaru, MD, MPH, The Joanna Briggs Institute, School of Translational Health Science, Faculty of Health Sciences, The University of Adelaide, 5005 Adelaide, South Australia, Australia ([email protected]). Conflict of Interest Disclosures: None reported. 1. Ross LE, Grigoriadis S, Mamisashvili L, et al. Selected pregnancy and delivery outcomes after exposure to antidepressant medication: a systematic review and meta-analysis. JAMA Psychiatry. 2013;70(4):436-443. 2. Cumming G. Understanding the New Statistics: Effect Sizes, Confidence Intervals, and Meta-Analysis. New York, NY: Routledge; 2012. 3. Rothman KJ, Greenland S, Lash TL. Modern Epidemiology. 3rd ed. Philadelphia, PA: Wolters Kluwer Lippincott Williams & Wilkins; 2008. 4. Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJA. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67(10):1012-1024. 5. Hackshaw A, Rodeck C, Boniface S. Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls. Hum Reprod Update. 2011;17(5):589-604.
Developmental Mismatch: Why Some Immigrants Seem Protected From Affective, Personality, and Substance Use Disorders To the Editor In a recently published article about risks of mental disorders associated with various types of foreign migration, Cantor-Graae and Pedersen 1 reported higher risks for schizophrenia-related disorders in all types of migrants, except in children born to expatriates. In addition, which I found particularly interesting, they found lower risks for affective, personality, and substance use disorders in first- and second-generation migrants with 2 foreign-born parents but higher risks in foreign-born adoptees, secondgeneration immigrants with 1 foreign-born parent, and native Danes who resided abroad. The question is, what is the difference between these 2 types of migrants compared with the other types? It is broadly assumed that high psychosocial stress makes immigrants vulnerable to mental disorders.2 Possible causes for psychosocial stress in migrants include discrimination related to different skin color and low socioeconomic 1374
status (SES) due to unemployment or low-paid jobs. Let’s compare the different types of immigrants on these characteristics with native Danes: • Foreign-born adoptees: different skin color, same SES. • First-generation immigrants: different skin color, lower SES. • Second-generation immigrants with 1 foreign-born parent: intermediate skin color, somewhat lower SES. • Second-generation immigrants with 2 foreign-born parents: different skin color, lower SES. • Native Danes who resided abroad: same skin color, same SES. Using this simple comparison, the Cantor-Graae and Pedersen1 results suggest that large differences are protective against affective, personality, and substance use disorders, whereas intermediate and small differences form a risk factor. This seemingly counterintuitive finding might be explained using evolutionary theories. The prenatal and early childhood periods are generally recognized as important programming phases. Environments that signal unpredictability steer individuals in the direction of faster life history strategies.3 Life history strategy should be seen as a coherent pattern of behaviors,4 with insecure attachment, externalizing behavior, earlier maturation, and opportunistic sexual behavior as typical fast life history strategy behaviors, which are adaptive in matched but maladaptive in mismatched situations. 5 It is not unlikely that the early environment contained more cues of unpredictability (eg, prenatal stress, house moves, and parental job changes) in all types of immigrants than in native Danes, predisposing immigrants to faster life history strategies. The Cantor-Graae and Pedersen 1 results suggest that immigrants, who have a relatively fast life history strategy, are at lower risk for affective, personality, and substance use disorders when they experience high psychosocial stress due to different skin color and low SES later in life but at higher risk when these stressors are less prominent. Thus, a match might be protective, whereas a mismatch might be a risk factor.5 Esther Nederhof, PhD
Author Affiliation: Interdisciplinary Center for Psychopathology and Emotion Regulation, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Corresponding Author: Esther Nederhof, PhD, Interdisciplinary Center for Psychopathology and Emotion Regulation, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, PO Box 30001, CC72, 9700 RB Groningen, the Netherlands ([email protected]). Conflict of Interest Disclosures: None reported. 1. Cantor-Graae E, Pedersen CB. Full spectrum of psychiatric disorders related to foreign migration: a Danish population-based cohort study. JAMA Psychiatry. 2013;70(4):427-435. 2. Cantor-Graae E, Selten JP. Schizophrenia and migration: a meta-analysis and review. Am J Psychiatry. 2005;162(1):12-24. 3. Simpson JA, Griskevicius V, Kuo SI, Sung S, Collins WA. Evolution, stress, and sensitive periods: the influence of unpredictability in early versus late childhood on sex and risky behavior. Dev Psychol. 2012;48(3):674-686.
JAMA Psychiatry December 2013 Volume 70, Number 12
Copyright 2013 American Medical Association. All rights reserved.
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Letters
4. Belsky J, Steinberg L, Draper P. Childhood experience, interpersonal development, and reproductive strategy: and evolutionary theory of socialization. Child Dev. 1991;62(4):647-670. 5. Nederhof E, Schmidt MV. Mismatch or cumulative stress: toward an integrated hypothesis of programming effects. Physiol Behav. 2012;106(5):691-700.
Toward a Genuinely Patient-Centered Metric of Depression Recovery: One Step Further To the Editor Although remission from major depressive disorder implies both symptom resolution and return to normal levels of functionality, it is usually merely assessed with symptomatic rating scales. 1 In line with other efforts of going beyond this prevailing, nearly exclusive focus on symptom resolution, Cohen and colleagues 2 have developed a more accurate, holistic, and patient-reported metric of recovery, which encompasses depressive symptom severity, functioning, and quality of life. Cohen and colleagues have elegantly demonstrated that the Individual Burden of Illness Index for Depression (IBI-D) 3 is a useful index in evaluating treatment efficacy and recovery in major depressive disorder.2 However, in our opinion, the statement by Cohen and colleagues that their investigation “is in line with the latest emphasis on patient-reported outcomes”2(p349) does not reflect the state of the art of research on patient-reported outcome measures. Nowadays, there is a wide and growing consensus that patient-reported outcome instruments should be developed with input from patients. 4 , 5 Therefore, patientcenteredness of the commonly used instruments is not necessarily guaranteed. 6 In fact, patient-reported outcome instruments can be similar to clinician-rated measures unless their development process incorporates patients’ perspectives.6 That is precisely the main limitation of the 3 selfreport measures on which the IBI-D is based (the Quick Inventory of Depressive Symptomatology–Self-report, the Work and Social Adjustment Scale, and the Quality of Life Enjoyment and Satisfaction Questionnaire–Short Form): they were developed without direct patient participation. A potential alternative to the current IBI-D is the Remission From Depression Questionnaire (RDQ),7 which could become a genuinely patient-centered index of illness burden. The RDQ has been designed to assess those domains considered by depressed patients to be relevant in defining remission. In addition to the 3 facets captured by the IBI-D (ie, symptoms of depression, functioning, and quality of life), other domains prioritized by patients and assessed by the RDQ are additional symptoms often present in depressed patients such as anxiety and irritability, features of positive mental health, coping ability, and a general sense of well-being. 7 Moreover, the use of only 1 instrument instead of 3 separate self-reports will substantially be less time-consuming for respondents. In fact, answering just the Quick Inventory of Depressive Symptomatology–Self-report takes a similar amount of time to completing the RDQ.8 The
use of genuinely patient-centered, patient-reported outcome instruments such as the RDQ will surely contribute to the development of a more accurate, patient-centered metric of depression recovery. Joan Trujols, MA, MSc Maria J. Portella, PhD Víctor Pérez, MD, PhD Author Affiliations: Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain. Corresponding Author: Joan Trujols, MA, MSc, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret 167, 08025 Barcelona, Spain ( [email protected]). Conflict of Interest Disclosures: Mr Trujols has served as a consultant for Roche Pharmaceuticals. Dr Pérez has received research support from Eli Lilly, Lundbeck, Boehringer Ingelheim, Pfizer, AstraZeneca, and GlaxoSmithKline; received speaker’s honoraria from Servier, Eli Lilly, Bristol-Myers Squibb–Otsuka, GlaxoSmithKline, AstraZeneca, and Boehringer Ingelheim; and served as a consultant for and/or on advisory boards for Eli Lilly, Bristol-Myers Squibb, and AstraZeneca. 1. Romera I, Pérez V, Menchón JM, Polavieja P, Gilaberte I. Optimal cutoff point of the Hamilton Rating Scale for Depression according to normal levels of social and occupational functioning. Psychiatry Res. 2011;186(1):133-137. 2. Cohen RM, Greenberg JM, IsHak WW. Incorporating multidimensional patient-reported outcomes of symptom severity, functioning, and quality of life in the Individual Burden of Illness Index for Depression to measure treatment impact and recovery in MDD. JAMA Psychiatry. 2013;70(3):343-350. 3. Ishak WW, Greenberg JM, Saah T, et al. Development and validation of the Individual Burden of Illness Index for Major Depressive Disorder (IBI-D). Adm Policy Ment Health. 2013;40(2):76-86. 4. Patrick DL, Burke LB, Gwaltney CJ, et al. Content validity—establishing and reporting the evidence in newly developed patient-reported outcomes (PRO) instruments for medical product evaluation: ISPOR PRO good research practices task force report, part 1: eliciting concepts for a new PRO instrument. Value Health. 2011;14(8):967-977. 5. Reeve BB, Wyrwich KW, Wu AW, et al. ISOQOL recommends minimum standards for patient-reported outcome measures used in patient-centered outcomes and comparative effectiveness research [published online January 4, 2013]. Qual Life Res. doi:10.1007/s11136-012-0344-y. 6. Trujols J, Portella MJ, Iraurgi I, Campins MJ, Siñol N, Pérez de los Cobos J. Patient-reported outcome measures: are they patient-generated, patient-centred or patient-valued? [published online January 16, 2013]. J Ment Health. doi:10.3109/09638237.2012.734653. 7. Zimmerman M, Martinez JH, Attiullah N, et al. A new type of scale for determining remission from depression: the Remission From Depression Questionnaire. J Psychiatr Res. 2013;47(1):78-82. 8. Zimmerman M, Galione JN, Attiullah N, et al. Depressed patients’ perspectives of 2 measures of outcome: the Quick Inventory of Depressive Symptomatology (QIDS) and the Remission From Depression Questionnaire (RDQ). Ann Clin Psychiatry. 2011;23(3):208-212.
CORRECTION Error in Author Name: In the original article titled “Heritable Variations in Gray Matter Concentration as a Potential Endophenotype for Psychopathic Traits” published in the April 2010 issue of JAMA Psychiatry, then Archives of General Psychiatry (2010;67[4]:406-413. doi:10.1001/archgenpsychiatry.2010.20), the first author’s name was misspelled. The correct spelling is Fruhling V. Rijsdijk, not Rijsdijsk. This article was corrected online.
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JAMA Psychiatry December 2013 Volume 70, Number 12
Copyright 2013 American Medical Association. All rights reserved.
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ous abortion associated with use of antidepressant medication during pregnancy? In conclusion, the reported lack of association between spontaneous abortion and antidepressant use is not supported by the Ross et al data and pregnant women should be educated about the risk of spontaneous abortion associated with use of antidepressant medication during pregnancy. Catalin Tufanaru, MD, MPH Jon Jureidini, MBBS, PhD Author Affiliations: The Joanna Briggs Institute, School of Translational Health Science, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia (Tufanaru); Department of Psychological Medicine, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia (Jureidini). Corresponding Author: Catalin Tufanaru, MD, MPH, The Joanna Briggs Institute, School of Translational Health Science, Faculty of Health Sciences, The University of Adelaide, 5005 Adelaide, South Australia, Australia ([email protected]). Conflict of Interest Disclosures: None reported. 1. Ross LE, Grigoriadis S, Mamisashvili L, et al. Selected pregnancy and delivery outcomes after exposure to antidepressant medication: a systematic review and meta-analysis. JAMA Psychiatry. 2013;70(4):436-443. 2. Cumming G. Understanding the New Statistics: Effect Sizes, Confidence Intervals, and Meta-Analysis. New York, NY: Routledge; 2012. 3. Rothman KJ, Greenland S, Lash TL. Modern Epidemiology. 3rd ed. Philadelphia, PA: Wolters Kluwer Lippincott Williams & Wilkins; 2008. 4. Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJA. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67(10):1012-1024. 5. Hackshaw A, Rodeck C, Boniface S. Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls. Hum Reprod Update. 2011;17(5):589-604.
Developmental Mismatch: Why Some Immigrants Seem Protected From Affective, Personality, and Substance Use Disorders To the Editor In a recently published article about risks of mental disorders associated with various types of foreign migration, Cantor-Graae and Pedersen 1 reported higher risks for schizophrenia-related disorders in all types of migrants, except in children born to expatriates. In addition, which I found particularly interesting, they found lower risks for affective, personality, and substance use disorders in first- and second-generation migrants with 2 foreign-born parents but higher risks in foreign-born adoptees, secondgeneration immigrants with 1 foreign-born parent, and native Danes who resided abroad. The question is, what is the difference between these 2 types of migrants compared with the other types? It is broadly assumed that high psychosocial stress makes immigrants vulnerable to mental disorders.2 Possible causes for psychosocial stress in migrants include discrimination related to different skin color and low socioeconomic 1374
status (SES) due to unemployment or low-paid jobs. Let’s compare the different types of immigrants on these characteristics with native Danes: • Foreign-born adoptees: different skin color, same SES. • First-generation immigrants: different skin color, lower SES. • Second-generation immigrants with 1 foreign-born parent: intermediate skin color, somewhat lower SES. • Second-generation immigrants with 2 foreign-born parents: different skin color, lower SES. • Native Danes who resided abroad: same skin color, same SES. Using this simple comparison, the Cantor-Graae and Pedersen1 results suggest that large differences are protective against affective, personality, and substance use disorders, whereas intermediate and small differences form a risk factor. This seemingly counterintuitive finding might be explained using evolutionary theories. The prenatal and early childhood periods are generally recognized as important programming phases. Environments that signal unpredictability steer individuals in the direction of faster life history strategies.3 Life history strategy should be seen as a coherent pattern of behaviors,4 with insecure attachment, externalizing behavior, earlier maturation, and opportunistic sexual behavior as typical fast life history strategy behaviors, which are adaptive in matched but maladaptive in mismatched situations. 5 It is not unlikely that the early environment contained more cues of unpredictability (eg, prenatal stress, house moves, and parental job changes) in all types of immigrants than in native Danes, predisposing immigrants to faster life history strategies. The Cantor-Graae and Pedersen 1 results suggest that immigrants, who have a relatively fast life history strategy, are at lower risk for affective, personality, and substance use disorders when they experience high psychosocial stress due to different skin color and low SES later in life but at higher risk when these stressors are less prominent. Thus, a match might be protective, whereas a mismatch might be a risk factor.5 Esther Nederhof, PhD
Author Affiliation: Interdisciplinary Center for Psychopathology and Emotion Regulation, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Corresponding Author: Esther Nederhof, PhD, Interdisciplinary Center for Psychopathology and Emotion Regulation, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, PO Box 30001, CC72, 9700 RB Groningen, the Netherlands ([email protected]). Conflict of Interest Disclosures: None reported. 1. Cantor-Graae E, Pedersen CB. Full spectrum of psychiatric disorders related to foreign migration: a Danish population-based cohort study. JAMA Psychiatry. 2013;70(4):427-435. 2. Cantor-Graae E, Selten JP. Schizophrenia and migration: a meta-analysis and review. Am J Psychiatry. 2005;162(1):12-24. 3. Simpson JA, Griskevicius V, Kuo SI, Sung S, Collins WA. Evolution, stress, and sensitive periods: the influence of unpredictability in early versus late childhood on sex and risky behavior. Dev Psychol. 2012;48(3):674-686.
JAMA Psychiatry December 2013 Volume 70, Number 12
Copyright 2013 American Medical Association. All rights reserved.
Downloaded From: http://archpsyc.jamanetwork.com/ by a Gazi Universitesi User on 09/10/2017
jamapsychiatry.com
Letters
4. Belsky J, Steinberg L, Draper P. Childhood experience, interpersonal development, and reproductive strategy: and evolutionary theory of socialization. Child Dev. 1991;62(4):647-670. 5. Nederhof E, Schmidt MV. Mismatch or cumulative stress: toward an integrated hypothesis of programming effects. Physiol Behav. 2012;106(5):691-700.
Toward a Genuinely Patient-Centered Metric of Depression Recovery: One Step Further To the Editor Although remission from major depressive disorder implies both symptom resolution and return to normal levels of functionality, it is usually merely assessed with symptomatic rating scales. 1 In line with other efforts of going beyond this prevailing, nearly exclusive focus on symptom resolution, Cohen and colleagues 2 have developed a more accurate, holistic, and patient-reported metric of recovery, which encompasses depressive symptom severity, functioning, and quality of life. Cohen and colleagues have elegantly demonstrated that the Individual Burden of Illness Index for Depression (IBI-D) 3 is a useful index in evaluating treatment efficacy and recovery in major depressive disorder.2 However, in our opinion, the statement by Cohen and colleagues that their investigation “is in line with the latest emphasis on patient-reported outcomes”2(p349) does not reflect the state of the art of research on patient-reported outcome measures. Nowadays, there is a wide and growing consensus that patient-reported outcome instruments should be developed with input from patients. 4 , 5 Therefore, patientcenteredness of the commonly used instruments is not necessarily guaranteed. 6 In fact, patient-reported outcome instruments can be similar to clinician-rated measures unless their development process incorporates patients’ perspectives.6 That is precisely the main limitation of the 3 selfreport measures on which the IBI-D is based (the Quick Inventory of Depressive Symptomatology–Self-report, the Work and Social Adjustment Scale, and the Quality of Life Enjoyment and Satisfaction Questionnaire–Short Form): they were developed without direct patient participation. A potential alternative to the current IBI-D is the Remission From Depression Questionnaire (RDQ),7 which could become a genuinely patient-centered index of illness burden. The RDQ has been designed to assess those domains considered by depressed patients to be relevant in defining remission. In addition to the 3 facets captured by the IBI-D (ie, symptoms of depression, functioning, and quality of life), other domains prioritized by patients and assessed by the RDQ are additional symptoms often present in depressed patients such as anxiety and irritability, features of positive mental health, coping ability, and a general sense of well-being. 7 Moreover, the use of only 1 instrument instead of 3 separate self-reports will substantially be less time-consuming for respondents. In fact, answering just the Quick Inventory of Depressive Symptomatology–Self-report takes a similar amount of time to completing the RDQ.8 The
use of genuinely patient-centered, patient-reported outcome instruments such as the RDQ will surely contribute to the development of a more accurate, patient-centered metric of depression recovery. Joan Trujols, MA, MSc Maria J. Portella, PhD Víctor Pérez, MD, PhD Author Affiliations: Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain. Corresponding Author: Joan Trujols, MA, MSc, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret 167, 08025 Barcelona, Spain ( [email protected]). Conflict of Interest Disclosures: Mr Trujols has served as a consultant for Roche Pharmaceuticals. Dr Pérez has received research support from Eli Lilly, Lundbeck, Boehringer Ingelheim, Pfizer, AstraZeneca, and GlaxoSmithKline; received speaker’s honoraria from Servier, Eli Lilly, Bristol-Myers Squibb–Otsuka, GlaxoSmithKline, AstraZeneca, and Boehringer Ingelheim; and served as a consultant for and/or on advisory boards for Eli Lilly, Bristol-Myers Squibb, and AstraZeneca. 1. Romera I, Pérez V, Menchón JM, Polavieja P, Gilaberte I. Optimal cutoff point of the Hamilton Rating Scale for Depression according to normal levels of social and occupational functioning. Psychiatry Res. 2011;186(1):133-137. 2. Cohen RM, Greenberg JM, IsHak WW. Incorporating multidimensional patient-reported outcomes of symptom severity, functioning, and quality of life in the Individual Burden of Illness Index for Depression to measure treatment impact and recovery in MDD. JAMA Psychiatry. 2013;70(3):343-350. 3. Ishak WW, Greenberg JM, Saah T, et al. Development and validation of the Individual Burden of Illness Index for Major Depressive Disorder (IBI-D). Adm Policy Ment Health. 2013;40(2):76-86. 4. Patrick DL, Burke LB, Gwaltney CJ, et al. Content validity—establishing and reporting the evidence in newly developed patient-reported outcomes (PRO) instruments for medical product evaluation: ISPOR PRO good research practices task force report, part 1: eliciting concepts for a new PRO instrument. Value Health. 2011;14(8):967-977. 5. Reeve BB, Wyrwich KW, Wu AW, et al. ISOQOL recommends minimum standards for patient-reported outcome measures used in patient-centered outcomes and comparative effectiveness research [published online January 4, 2013]. Qual Life Res. doi:10.1007/s11136-012-0344-y. 6. Trujols J, Portella MJ, Iraurgi I, Campins MJ, Siñol N, Pérez de los Cobos J. Patient-reported outcome measures: are they patient-generated, patient-centred or patient-valued? [published online January 16, 2013]. J Ment Health. doi:10.3109/09638237.2012.734653. 7. Zimmerman M, Martinez JH, Attiullah N, et al. A new type of scale for determining remission from depression: the Remission From Depression Questionnaire. J Psychiatr Res. 2013;47(1):78-82. 8. Zimmerman M, Galione JN, Attiullah N, et al. Depressed patients’ perspectives of 2 measures of outcome: the Quick Inventory of Depressive Symptomatology (QIDS) and the Remission From Depression Questionnaire (RDQ). Ann Clin Psychiatry. 2011;23(3):208-212.
CORRECTION Error in Author Name: In the original article titled “Heritable Variations in Gray Matter Concentration as a Potential Endophenotype for Psychopathic Traits” published in the April 2010 issue of JAMA Psychiatry, then Archives of General Psychiatry (2010;67[4]:406-413. doi:10.1001/archgenpsychiatry.2010.20), the first author’s name was misspelled. The correct spelling is Fruhling V. Rijsdijk, not Rijsdijsk. This article was corrected online.
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JAMA Psychiatry December 2013 Volume 70, Number 12
Copyright 2013 American Medical Association. All rights reserved.
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![[Affective disorders and personality disorders].](/assets/img/hold.png)
