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Published on: June 9, 2018
Prevalence of major depression one year after predictive testing for Huntington's disease
Ann-Marie Codori1, Phillip R Slavney, Adam Rosenblatt
1Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD 21287, USA. acodori@jhmi.edu
Insights
Predictive testing for Huntington's disease (HD) can lead to depression. While not statistically significant, individuals testing positive for HD experienced higher rates of major depression and depressive symptoms within one year post-testing compared to those testing negative.
Area of Science:
- Neurogenetics
- Psychiatry
- Clinical Psychology
Background:
- Predictive testing for Huntington's disease (HD) is available, but its psychological impact, particularly concerning major depression, requires further investigation.
- Previous case studies suggest a link between HD testing and depression, yet prevalence data are limited.
Purpose of the Study:
- To evaluate the prevalence of major depression in individuals during the first year following predictive Huntington's disease (HD) genetic testing.
- To compare the incidence of major depression and clinically significant depressive symptoms between individuals who tested positive and negative for HD.
Main Methods:
- Retrospective chart reviews and data analysis of 153 individuals (50 positive, 103 negative for HD) undergoing predictive testing.
- Systematic assessment for depression every three months post-disclosure using the Schedule for Affective Disorders and Schizophrenia-Change Version and the Beck Depression Inventory, alongside clinical notes review.
Main Results:
- The 1-year prevalence of major depression was 6.0% in HD-positive individuals versus 3.0% in HD-negative individuals (p=0.30), with an estimated population prevalence of 3%.
- Clinically significant depressive symptoms were observed in 20.0% of HD-positive individuals and 12.6% of HD-negative individuals (p=0.17).
- Although not statistically significant, a trend indicated higher frequencies of depressive symptoms and major depression among those testing positive for HD.
Conclusions:
- A positive predictive test for Huntington's disease (HD) is not psychologically benign, despite rare instances of severe psychiatric outcomes.
- Clinical HD testing programs should incorporate routine screening for depressive symptoms post-testing.
- Individuals exhibiting clinically significant depressive complaints warrant referral to mental health professionals for appropriate management.
Abstract:
Psychiatric hospitalizations, completed suicides, and suicide attempts are rare after predictive testing for Huntington's disease (HD). Case studies have shown that major depression can be a consequence of being tested, although no studies have shown how common this is. The present study evaluated the prevalence of major depression during the first year after disclosure. We conducted retrospective data and chart reviews of 153 persons (50 testing positive, 103 testing negative) evaluated every 3 months for depression. There was no significant baseline difference in the percentage of "positives" and "negatives" who had pre-testing major depressive episodes (14% vs. 12%, respectively). A senior psychiatrist reviewed data from the Schedule for Affective Disorders and Schizophrenia-Change Version, from the Beck Depression Inventory, and from clinical notes for every follow-up contact completed. The 1-year prevalence of major depression among positives was 6.0%, compared to 3.0% among negatives (p = 0.30), and an estimated 3% population prevalence. One-year prevalence of clinically significant depressive symptoms, whether or not major depression was diagnosed, was 20.0% in positives and 12.6% in negatives (p = 0.17). Although not statistically significant, depressive symptoms and major depression occurred more frequently among those who tested positive. Despite some evidence to the contrary, including our own studies, a positive predictive test for HD is not psychologically benign. Clinical testing programs should assess patients for depressive symptoms after testing, and patients with clinically significant complaints should be referred to a mental health professional.
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