Men with borderline testosterone levels have higher rates of depression and

depressive symptoms than the general population, new research finds. The
results will be presented Saturday, March 7, at ENDO 2015, the annual
meeting of the Endocrine Society in San Diego.

"Over half of men referred for borderline testosterone levels have depression. This study found
that men seeking management for borderline testosterone have a very high rate of depression,
depressive symptoms, obesity and physical inactivity," said principal study author Michael S.
Irwig, MD, FACE, associate professor of medicine and director of the Center for Andrology in the
Division of Endocrinology at George Washington University in Washington, DC. "Clinicians need
to be aware of the clinical characteristics of this sample population and manage their
comorbidities such as depression and obesity."

The number of men having their testosterone levels checked has increased dramatically. Studies
of the possible association between depression and serum testosterone show inconsistent results,
and few studies have been published about adult men referred for the management of borderline
testosterone.

Dr. Irwig and his colleagues studied 200 adult men between 20 and 77 years of age whose
testosterone levels were borderline (between 200 and 350 nanograms per deciliter).

The researchers collected the men's demographic information, medical histories, medication use,
and signs and symptoms of hypogonadism.

They remeasured the men's total testosterone and assessed depression from their medical history
and depressive symptoms with the validated Patient Health Questionnaire 9 (PHQ-9).

Using a score of 10 or higher on the PHQ-9, 56% of the study participants had significant
depressive symptoms, known diagnosis of depression and/or use of an antidepressant. Their
rates of depressive symptoms were markedly higher than the 15 to 22% in an ethnically diverse
sample of primary care patients and the 5.6% among overweight and obese US adults.

The population also had a high prevalence of overweight (39%), obesity (40%) and physical
inactivity; other than walking, 51% of the men did not engage in regular exercise. The most
common symptoms reported were erectile dysfunction (78%), low libido (69%) and low energy
(52%).
"This study underscores the utility of a validated instrument to screen for depression, especially as
some subjects may deny signs and symptoms during the interview. Appropriate referrals should
be made for formal evaluation and treatment of depression," Dr. Irwig said.

A new study published in the current issue of Psychotherapy and

Psychosomatics has analyzed the long-term effects of psychotherapy on
borderline personality disorder. Authors report the effect of DBT compared
to TAU on inpatient service use, and a follow-up 6 months after the end of
treatment.

Data on psychiatric hospitalisation were collected by interviewing patients at two monthly intervals
using the Client Service Receipt Inventory, which was then triangulated with data from electronic
patient records. In the year prior to treatment, 24 patients had been hospitalised with the number
of inpatient days ranging from 0 to 365 (mean 20.5, SD 63.1).

The number of inpatient days in the year prior to treatment did not differ between conditions.
During the 12-month intervention period, 2 patients allocated to DBT and 11 allocated to TAU
were hospitalised. For the 2 patients hospitalised in the DBT condition, 1 was hospitalised
following dropping out of DBT, whilst the other was a long-term inpatient when beginning DBT,
and remained so for the first 3 months of treatment.

A logistic regression showed that the odds of hospitalisation during the intervention period were
significantly higher in patients allocated to the TAU condition. This difference remained significant
after adjusting for whether patients had been hospitalised in the year prior to treatment.

A standardised self-harm interview was also used to assess self-harm frequency during the
follow-up period. The mean number of days with self-harm in the last 2 months of treatment for
DBT completers was 1.79 (SD 3.68) whilst the mean number of days with self-harm during the 6
months after treatment was 1 (SD 1.80), i.e. a rate of 0.33 days per 2-month period. A Wilcoxon
signed-rank test showed that this was not a significant difference (z = 1.42, p = 0.16). No DBT
completers had any inpatient hospitalisations during the 6-month follow-up period. For treatment
dropouts, the rate of follow-up was too low (8 of 21 participants) to render statistical comparison
valid.

These findings on hospitalisation concur with international RCTs that have shown DBT can reduce
hospitalisation, but are in contrast with another UK RCT which found hospitalisation days did not
differ between DBT and TAU. Treatments which reduce the use of inpatient resources are
particularly important, given that patients with BPD have been found in several studies to make
greater use of inpatient psychiatric services than patients with major depressive disorder or other
personality disorders.
 The high healthcare costs (and presumably patient distress) resulting from such frequent
hospitalisation render the implementation of interventions that can reduce hospitalisation an
important priority for this patient group. Thus, DBT should be considered an effective intervention
for keeping self-harming patients with BPD out of hospital, and that positive effects on self-harm
and hospitalisation are sustained once treatment is over.

Story Source:

Materials provided by Journal of Psychotherapy and Psychosomatics. Note: Content may be

edited for style and length.

Journal Reference:

1. K. Barnicot, M. Savill, N. Bhatti, S. Priebe. A Pragmatic Randomised Controlled Trial of

Dialectical Behaviour Therapy: Effects on Hospitalisation and Post-Treatment Follow-
Up. Psychotherapy and Psychosomatics, 2014; 83 (3): 192 DOI: 10.1159/000357365