title: Detection of subclinical depression in bipolar disorder: a cross-sectional, 4-month prospective follow-up study at community mental health services (SIN-DEPRES).
abstract: OBJECTIVE
  The aim of this study was to assess the prevalence and the impact of depressive symptoms on the functional outcome of bipolar disorder outpatients in remission.
  
  
  METHODS
  A cross-sectional, prospective 16-week study of a cohort of 739 euthymic bipolar disorder patients (DSM-IV-TR criteria) recruited by 94 investigators was conducted. Clinical stability was assessed at baseline and at week 16 with the modified Clinical Global Impressions Scale-Bipolar Version, and depressive symptoms were assessed at baseline with the 17-item Hamilton Depression Rating Scale (HDRS-17 [primary endpoint measure]), the Montgomery-Asberg Depression Rating Scale (MADRS), and the self-applied Center for Epidemiologic Studies-Depression Scale (CES-D). Functional status was evaluated with the Social and Occupational Functioning Assessment Scale (SOFAS) and Social Adaptation Self-evaluation Scale (SASS). The study was conducted from April 2006 to March 2007.
  
  
  RESULTS
  Subclinical depressive symptoms (SDS) were detected on the HDRS-17 in 16.9% of the sample. In symptom-free patients, the incidence of new SDS after 16 weeks was 20% (MADRS score > 7). At baseline, SDS patients compared to non-SDS patients presented with poorer social-occupational performance (SOFAS score mean difference, -11.9; 95% CI, -14.2 to -9.6) and poorer social adjustment (SASS score mean difference, -5.6; 95% CI, -7.1 to -4.1). Depressive symptoms were inversely related to functional status and social adjustment: MADRS-SOFAS correlation coefficients, r = -0.54 (P < .0001), and MADRS-SASS correlation coefficients, r = -0.42 (P < .0001). The self-applied survey identified additional cases with depressive symptoms, showing an SDS total prevalence of 44.9%.
  
  
  CONCLUSIONS
  Depressive symptoms in apparently remitted bipolar disorder outpatients are not rare and result in a decline in occupational outcome and social maladjustment.
authors.affiliation: Bipolar Disorder Programme, Institut Clínic de Neurosciences, Hospital Clinic, IDIBAPS, University of Barcelona, CIBERSAM , Spain. evieta@clinic.ub.es
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
authors.forename: Rosario
authors.initials: R
authors.lastname: de Arce
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Jiménez-Arriero
authors.forename: Alfonso
authors.initials: A
authors.lastname: Rodriguez
authors.forename: Vicent
authors.initials: V
authors.lastname: Balanzá
authors.forename: Silvia
authors.initials: S
authors.lastname: Cobaleda
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D016009:Chi-Square Distribution; D003156:Community Mental Health Services / Q000706:statistics & numerical data; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012917:Social Adjustment