501. Head Injury, Race, and Substance Abuse in
Psychiatric Patients
William B. Lawson1, Steve Arndt2, Steve Fleck3, Steve
Strakowski3, Tanya Seaward1, Patient Characteristics
Study Group, Shanique Cartwright1
1Psychiatry and Behavioral Sciences, Howard University, Washington,
DC, 2Psychology, University of Iowa, Iowa City, IA, 3Psychiatry,
University of Cincinnati, Cincinnati, OH
Background: Head injury (HI) has been associated with neuropsychiatric
disorders including affective disorders and psychosis. HI is believed to be more
common in ethnic minorities and/or those from a low socioeconomic class. HI
may contribute to ethnic differences in prevalence and misdiagnosis of mental
disorders.
Methods: We examined HI in a study assessing ethnic differences in treatment
seeking psychiatric patients with an affective disorder, psychotic disorder, or
both. Any reports of ethnic differences in head injury may be a consequence
of ethnic differences in substance abuse and dependence and its relation to
head trauma.
Results: 532 patients were evaluated and 136 (26%) had HI present. 217
(41%) were African American, 127 (24%) were Latino, and 188 (35%) were
White. Latino subjects reported the highest occurrence of HI (39%), followed
by Whites (28%) and African Americans (16%).African Americans had
significantly fewer head injuries then either Latinos or Whites which did not
differ significantly from each other. With logistic regression adjusting for race/
ethnic group, age, and the presence or absence of substance abuse, the ethnicity
differences in HI disappeared, However the race by substance abuse interaction
attained significance.
Conclusions: Any reports of ethnic differences in head injury may be a
consequence of ethnic differences in substance abuse and dependence and its
relation to head trauma.
Supported by RO1MH68797-01A2.
751. Major Depressive Disorders and Serum
Cortisol Secretion: A Random Effect Meta-Analysis
Malena A. Banks, William B. Lawson, Evaristus A.
Nwulia
Department of Psychiatry, Howard University Hospital, Washington, DC
Background: Although subtypes of Major Depressive Disorders (MDD) have
been associated with HPA axis activity, the literature on utility of cortisol
measures as biomarkers of MDD has been mixed. We combined published
comparative studies of serum cortisol concentrations between depressed and
non-depressed subjects, using random effects meta-analysis, which accounts
for observed and un-observed heterogeneity to obtain an overall estimate of the
association between MDD and serum cortisol.
Methods: We searched major databases (MEDLINE, PsycINFO and
Cochrane) for comparative studies published from January 1, 1988 - September
10, 2008; manual journal searches; reference list reviews; and citation tracking
of included articles. We included studies written in English, restricted to
human populations, which obtained any measure of serum cortisol level in
depressed subjects and either healthy or non-depressed psychiatric controls.
Results: We have identified 58 studies meeting our research criteria; these
included a total of 2735 individuals. The mean cortisol concentration (± S.D.)
for the total study sample is 81.22 (± 6.72) μg/l; the mean effect of depression
(± S.D) = 19.6 (± 4.6) μg/l (P < 0.00001). Depression accounted for 76% of the
variance in serum cortisol level across studies.
Conclusions: This study reveals strong association between serum cortisol and
MDD, and provides further support for the incorporation of cortisol measure
or other more specific measures of HPA activity as a biomarker of MDD. Our
discussion focuses on subtypes of depression with the strongest association
with hypercortisolism as well as other factors accounting for heterogeneity in
reviewed studies.