Prevalence of Depression in Patients with Pituitary Tumors: Association of Depression with Perceived Social Capital

Purpose:

The relationship between the pituitary gland to the limbic system has been implicated in the development of psychological and psychiatric symptoms found in patients with pituitary tumors (PT) and disorders. Brain-Derived Neurotrophic Factor (BDNF) produced in response to neuroendocrine effectors has been linked to depression. In turn, a direct relationship has been demonstrated between psychological health and social capital in numerous chronic illnesses.

The purpose of this study was to investigate the prevalence of depression in patients who were newly diagnosed with pituitary adenomas and to evaluate the impact of perceived interpersonal and social support on depression severity. Secondary analysis was performed to evaluate the prevalence of depression by tumor hormonal expression, including non-functional adenomas (NF), prolactinomas (P), growth hormone (GH) secreting adenomas and adrenocorticotrophin (ACTH) secreting adenomas.

Methods:

 

Prospective review was conducted of 104 patients (32 male/71 Female) with MRI confirmed pituitary tumors at one institution from 2011-2013 ( NF 44, P28, GH9, ACTH 6, other 17). All patients completed the 21 question Beck Depression Inventory II (BDI-II) and 6 questions designed to solicit the patient’s perception of social support from family member, spouse/partner and friends (Crohnbach’s alpha .952). All patients were newly diagnosed and were asked to complete the questionnaire at initial presentation. Comparison of means was performed using Pearson’s 2 tailed ANOVA and bivariate analysis and descriptive analysis was performed. All analysis was performed using PASW 18.

Results:

 

Mood disturbance was reported by all patients. 27.8% of patients reported mild mood disturbance and 65.4% qualified as borderline to moderate clinical depression. Only 7 (6.7%) patients reported severe depressive symptoms and 5/7 of these patients reported high levels of social capital/support. However, overall there was no correlation between the severity of depression and social support (r=-.15, p=0.13). 76% of patients perceived moderate to high levels of support. There was no correlation between gender and depression or perceptions of social support. Perception of support was similar with respect to both family and friends. Tumors were classified by diagnosis, analyzed for the prevalence of depression for each diagnosis and correlated with social support. There was no significant difference in prevalence of depression (p=0.3) or perception of social support (p=0.21) based on diagnosis. Nor were higher levels of depression correlated with poor social capital/support. Depression and social support were positively correlated (r=.409, p=0.000).

Conclusion:

Although depression is common to patients with pituitary tumors, most reported high levels of social support. While mild mood disturbance may be associated with a recent brain tumor diagnosis, more severe levels of clinical depression warrant further evaluation. The use of tools for early identification of at risk patients provides for timely intervention and improved outcomes. Treatment protocols differ according to pituitary hormonal activity and tumor size symptoms such as visual field disturbance. Further evaluation of the impact of specific interventions on both depression and any changes in social capital over time is required.

References:

Haines, V, A., Beggs,J.J., & Hurlbert.J.S. (2002). Exploring the Structural Contexts of the Support Process: Social Networks, Social Statuses, Social Support, and Psychological Distress. Advances in Medical Sociology, 8:269–92.

Zea,M.C., Belgrave,F.C.,Townsend,T.G.,Jarama,S.L., Banks,S.L. (1996) The Influence of Social Support and Active Coping on Depression Among African Americans and Latinos With Disabilities Rehabilitation Psychology,

41 (3) 225-242.

van der Klaauw,A.A., Kars,M., Biermasz,N.R., Roelfsema,R., Dekkers,O.M.,Corssmit,E.P., van Aken, M.O.,Havekes,B., Pereira,A.M., Pijl,H., Smit ,J.W. & Romijn,J.A. (2008).Disease-specific impairments in quality of life during long-term follow-up of patients with different pituitary adenomas. Clinical Endocrinology, 69, 775–784. doi: 10.1111/j.1365-2265.2008.03288.x

Berry, A.,Bellisario,V., Capoccia, S.,Tirassa,P.,Calza,A.,Alleva, E.,Cirulli,F., (2012). Social deprivation stress is a triggering factor for the emergence of anxiety- and depression-like behaviours and leads to reduced brain BDNF levels in C57BL/6J mice. Psychoneuroendocrinology ,37, 762—772

Wetterberg.L. (1986). The Relationship Between The Pineal Gland And The Pituitary-Adrenal Axis In Health, Endocrine And Psychiatric Conditions. Psychoneuroendocrinoogy, 8 (1) 75-80.

Liu,L.,Ran Pang,R.,Sun,W.,Wu, M.,Qu,P., Lu,C. &Wang,L. (2013).Functional social support, psychological capital, and depressive and anxiety symptoms among people living with HIV/AIDS employed full-time BMC Psychiatry, 13:324 doi:10.1186/1471-244X-13-324

Jaremka,L.M., Fagundes,C.P., Glaser,R., Bennett e,J.M., Malarkey,W.B.& Kiecolt-Glaser,J.K.(2013). Loneliness predicts pain, depression, and fatigue: Understanding the role of immune dysregulation Psychoneuroendocrinology, 38, 1310—1317.

Bassett,E.& Moore,S. (2013). Gender Differences in the Social Pathways Linking Neighborhood Disadvantage and Depressive Symptoms PLOS ONE,8:10 e76554.

Grynderup,M,B.,, Kolstad,H.A., Mikkelsen,S.,Andersen, J.H.,Bonde, J.P.,Buttenschøn,H.N.,Kærgaard, A.,Kærlev,L.,Rugulies,R., Thomsen ,J.F.,Vammen,M.A.,Mors, O.&Hansen,M( 2013). A two-year follow-up study of salivary cortisol concentration and the risk of depression. Psychoneuroendocrinology, 38, 2042—2050.

Irwin,J.,LaGory,M.,Ritchey, F. & Fitzpatrick,K. (2008) Social assets and mental distress among the homeless: Exploring the roles of social support and other forms of social capital on depression. Social Science & Medicine. 67. 1935–1943

Sharp, L,K. & Lipsky, M.S (2002). Screening for Depression Across the Lifespan:

A Review of Measures for Use in Primary Care Settings. American Family Physician., 66(6)1001-1008.

Beck, A.T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571

Beck, A. T., Steer, R.A., & Garbin, M.G. (1988) Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8(1), 77-100