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

J Affect Disord. 2013 Sep 5;150(2):578-84. doi: 10.1016/j.jad.2013.02.012. Epub 2013 Mar 13.

Abstract

Objective: 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.

Methods: 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.

Results: 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) (χ(2)=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) (χ(2)=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.

Limitations: The STAR*D study did not include any structured clinician-based assessment of psychotic symptoms.

Conclusion: Latinos do not appear to have worse outcomes when treated for MDD with auditory-visual hallucinations, differently from Whites and Blacks.

Keywords: Antidepressants; Hispanic; Latinos; Major depressive disorder; Psychosis-like symptoms; Remission.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Attitude to Health / ethnology
  • Black People / psychology
  • Black People / statistics & numerical data
  • Cohort Studies
  • Depressive Disorder, Major / complications
  • Depressive Disorder, Major / drug therapy*
  • Depressive Disorder, Major / ethnology*
  • Depressive Disorder, Major / psychology
  • Female
  • Hallucinations / drug therapy
  • Hallucinations / ethnology*
  • Hallucinations / etiology
  • Hispanic or Latino / psychology*
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Psychotic Disorders / diagnosis
  • Psychotic Disorders / epidemiology
  • Psychotic Disorders / psychology
  • Treatment Outcome
  • White People / psychology
  • White People / statistics & numerical data