Case-finding instruments for depression. Two questions are as good as many

A scoping review to determine themes that represent perceptions of self as mother ('ideal mother' vs 'real mother')

Background: Postnatal depression (PND) is a key cause of maternal morbidity, with current systems of initial recognition in the UK detecting only 50% of cases. In attempts to predict those potentially at risk, this review suggests a novel approach. Aim: Implementing the concept of 'ideal mother' versus 'real mother', and asking the woman to compare their 'ideal self' against 'existent self', the aim of this instrument development review was to determine themes from the literature that relate to women's perceptions of self as a mother, and from this identification develop questions for inclusion within a proposed new measure entitled the Self-Image as Mother Scale (SIMS). Method: A scoping review of the literature was carried out to identify themes considered to affect perception of self as mother, and from this identification, evidence-based questions for inclusion in the SIMS were developed. Findings: Themes identified included (1) marital dissatisfaction, (2) inadequate partner support, (3) lack of family support, (4) socioeconomic status and associated poverty, (5) concern about infant, (6) antenatal/postnatal complications, (7) acceptance of infant gender, (8) history of mental health problems, (9) unplanned pregnancy. Conclusions: From this scoping review 18 questions were developed for inclusion in the SIMS, which will then be evaluated for psychometric properties, scale refinement and validation.

Physical Activity and Its Association with Depression in the Diabetic Hispanic Population

Introduction

Hispanics are the largest ethnic minority group in the United States. The prevalence of depression and co-morbid depression in the Hispanic population is well-recognized. The positive association between physical activity and psychological health improves mood, emotional well-being, and prognostic outcome.

Objectives

There are two aspects of our research paper. First, it critically reviews the available literature showing the correlation between physical exercise and depression. Second, it analyzes the association between exercise and depression in uncontrolled diabetic Hispanics using data collected from the local community intervention program.

Method

A chi-square analysis was conducted to examine whether levels of physical activity reported at the baseline were associated with the frequency of depressed mood and anhedonia self-reported for the previous two weeks. This study utilized the use of the PHQ-2 scale for the assessment of depressive symptoms. The PHQ-2 scale is a useful tool to screen for depression in the integrated care setting. Participants from a local community intervention program were stratified on the basis of their gender and preferred language. Data were collected and represented in tables according to demographic characteristics.

Results

Our study established a statistically significant association between the levels of physical activity and the frequency of depression symptoms among Spanish speaking participants from the local community intervention program. These results provide convincing evidence that biological, developmental, social, and psychological factors facilitate the association between physical activity and depression.

Childhood socioeconomic disadvantage as a determinant of late-life physical function in older Japanese people

BACKGROUND

In this study, we examined the relationship between childhood socioeconomic status and physical function among older Japanese people, and investigated whether there is a sex variation in this association.

METHODS

We administered a cross-sectional questionnaire survey to all independent community-dwelling individuals ≥65 years old, living in Adachi Ward, Tokyo (N = 132,005). Participants self-reported their physical function using the Motor Fitness Scale, and we divided the scores into quartiles for analysis. Childhood socioeconomic status was retrospectively assessed according to a single item.

RESULTS

We analyzed 75,358 questionnaires. The average age of participants was 73.8 ± 6.0 years, and 55.0% were women. An ordered logistic regression analysis showed that lower childhood socioeconomic status was associated with lower physical function, independent of adult sociodemographic factors, health behaviors, and health conditions. This association was stronger in women than in men.

CONCLUSIONS

Our findings indicate that low childhood socioeconomic status might have a long-term influence on physical function in late life and that this influence varies by sex. Assessment of socioeconomic disadvantage in childhood is important for developing strategies to help older people maintain their physical function longer.

Depressive symptoms and quality of life among Chinese medical postgraduates: a national cross-sectional study

High workloads and heavy academic pressure can have significant implications for the risk for depression and poor quality of life (QoL). This study aimed to investigate QoL and depressive symptoms in medical students undergoing postgraduate neurology specialty training in China. The survey covered demographic characteristics, the 8-itemMedical Outcomes Study Short-Formquestionnaire (SF-8), and the 2-itemPrimary Care Evaluation of Mental Disorders depression screening tool. Logistic regression analysis was used to investigate the determinants of QoL and depressive symptoms. Participants were 1,814 postgraduates from 249 hospitals in 27 Chinese provinces. The mean SF-8 physical and mental component summary scores were 78.17 (standard deviation [SD] 15.20) and 68.33 (SD 17.15), respectively. One-third of respondents had depressive symptoms, and those without depressive symptoms had significantly higher QoL scores. The multivariate regression analysis showed that factors independently associated with depressive symptoms were being in the second year of study, a lower household income, and less sleep  time. Although QoL among our sample of Chinese medical students undergoing postgraduate neurology specialty training was favorable relative to other comparable populations, one-third of respondents had depressive symptoms. Accurate measures should be taken to change this situation.

Health status and quality of life in patients with diabetes in Switzerland

AIMS

We aimed to assess the health status and quality of life (QoL) of patients with diabetes and explore the associated factors in a French-speaking region of Switzerland.

METHODS

This cross-sectional study analyzed self-reported data from 585 patients with diabetes. We ran univariate and multivariate regressions analyses on health status (Physical and Mental Component Summary scores (PCS, MCS) of the SF-12) and diabetes-specific QoL (ADDQoL score).

RESULTS

Mean PCS was 43.1±10.4 and mean MCS was 46.7±11.1. The overall ADDQoL score was -1.6±1.6; the life domains of the ADDQoL with the lowest scores were freedom to eat, sex life and freedom to drink. Being older was independently and significantly associated with higher mental health and QoL, while lower income was associated with lower physical health, mental health, and QoL. Having diabetes for over 10 years was associated with lower QoL, while insulin treatment and complications were correlated with lower physical health and QoL.

CONCLUSIONS

This study provides key information on the health status and QoL of patients with diabetes in Switzerland and their associated factors, which can help healthcare providers to identify patients at higher risk of lower health and QoL.

Mood state at the beginning of the pregnancy and its influence on obstetric and perinatal outcomes

Aim: We designed this study to ascertain the prevalence of depressive disorders and anxiety at the beginning of the pregnancy, studying possible associated factors and assessing the influence of mood disorders on perinatal outcomes. Methods: A representative sample of 191 pregnant women at first trimester of their pregnancies completed a questionnaire that included the Whooley´s questions, the Spanish version of the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory and a series of questions related to health status, general mood and sociodemographic variables. Later, we prospectively evaluated the influence of anxiety and depression on the perinatal and obstetric results in 145 of them. Results: More than 20% of pregnant women presented high levels of anxiety. The mean values of the state and trait anxiety scores were 38.7 (SD 9.8) and 34.5 (SD 9.5). The mean BDI score was 5.97 (SD 4.9), with 9.5% of participants achieving scores compatible with depression, (61% mild in, 22.2% moderate, and 16.6% severe). BDI scores were significantly lower in women who became pregnant after assisted reproductive techniques. We observed an association between depression and trait anxiety scores with an infant's low birth weight. The multivariate analysis showed that the feeling of happiness at the beginning of pregnancy was the best predictor of foetal weight. Conclusion: The prevalence of emotional disorders in the first trimester of pregnancy is high, with more than 20% of pregnant women presenting high levels of anxiety, and more than 9.5% presenting depression. During the first trimester, depression and anxiety were associated with low birth weight.

'So, the circle has grown' - Child Health Services nurses' experiences of giving parental interviews with nonbirthing parents

BACKGROUND

Lately, greater focus has been given to the mental health of nonbirthing parents postpartum. However, mothers, but not nonbirthing parents, are routinely screened for postpartum depression, and until recently, nonbirthing parents have not been given the same opportunity as mothers to discuss their parental role without the other parent present. To strengthen the parental role, a separate parental interview with the nonbirthing parent began to be offered as part of the Swedish Child Health Service's (CHS) general programme.

AIM

This study aimed to explore CHS nurses' experiences of performing parental interviews with nonbirthing parents.

METHODS

Content analysis was used when analysing data from six research interviews, of which half were focus group interviews. In total, 11 CHS nurses were interviewed.

RESULTS

Child Health Service nurses reported that although the interview with the nonbirthing parent was a positive experience and that a more family-oriented perspective was something many of them had been longing for, they could also feel that it demanded a lot from them, including things they had perhaps not previously considered. CHS nurses reported difficulties with having such close contact with both parents, and they also described feeling worried about the information that could come up in a standardised conversation and the knowledge provided.

CONCLUSION

There are both possibilities and challenges in widening the responsibilities of the CHS nurse to include the nonbirthing parent by offering a postpartum interview.

IMPLICATIONS

This study provides information to healthcare professionals about the importance of providing proper guidance and education when broadening the duties and responsibilities for CHS nurses to include nonbirthing parents in mental health screening. CHS nurses must be given the resources needed to deal with the challenges they encounter and sufficient time for the interviews to be possible and meaningful.

Transient vs enduring distress in late pregnancy using the EPDS: a brief longitudinal exploratory study

Background and Objective: The Edinburgh Postnatal Depression Scale (EPDS) is widely used to detect perinatal distress in women by one single administration. Recently, research has shown that during early pregnancy around half of the women scoring as 'possibly depressed' on the EPDS only have transient distress, when re-tested after few weeks. This finding may not occur if women are screened later in pregnancy, as their worries then may be more enduring; therefore an exploratory study was conducted to further investigate this issue. Methods: Pregnant women (N = 84) attending a public hospital in Italy completed the EPDS in their third trimester (x = 33 weeks) and again 8-42 days later (while still pregnant). They had not received professional mental health intervention in this time interval. Results: Approximately half of the women who initially scored high on the EPDS in late pregnancy no longer scored high just a few weeks later. Conclusions: Approximately half of women who initially score high on the EPDS when screened in pregnancy only have transient distress in both the second and third trimester. To label these women as being 'possibly depressed', and mixing them with women who show enduring distress, represents a possible weakness in research studies, and may also overburden clinical services. We would therefore recommend, as research and clinical practice, a second administration of the EPDS if a woman initially scores in the distressed range at any stage in pregnancy.

The effects of roux en y gastric bypass surgery on neurobehavioral symptom domains associated with severe obesity

BACKGROUND

Neurobehavioral symptoms and cognitive dysfunction related to mood disorders are present in individuals with severe obesity. We sought to determine acute improvements in these symptoms and relationships with adiposity, inflammation, and insulin sensitivity after roux-en-y gastric bypass (RYGB) surgery.

METHODS

The self-report Zung Depression Rating (ZDRS) and Neurotoxicity Rating (NRS) scales were administered before, and at 6-months after RYGB surgery in severely obese women (body mass index > 35 kg/m²; N = 19). Symptom domains corresponding to depressed mood/suicide ideation, anxiety, cognitive, somatic, and neurovegetative symptoms were assessed. Biologic measures were of adiposity [leptin, abdominal visceral (VAT) and subcutaneous (SAT) adipose tissue], inflammation [IL-6, C-reactive protein (CRP)], and insulin sensitivity (Si). Spearman correlations and linear regression (adjusted for biologic measures) assessed relationships between changes in biologic measures and changes in neurobehavioral domains.

RESULTS

By 6-months after RYGB, VAT, SAT, Si, CRP, and IL-6 had improved (p < .05). Anxiety, somatic, and neurovegetative symptoms domains improved (p < .05), but depressed mood/suicidal ideation and cognitive domains did not. Reductions in VAT were associated with decreases in neurovegetative symptoms (beta = 295 ± 85, p < .01). We also found significant positive longitudinal associations between IL-6 concentrations and minor changes in cognitive symptoms.

CONCLUSION

Anxiety, somatic and neurovegetative symptoms, improved within 6 months after RYGB, but depressed mood/suicidal ideation and cognitive symptoms did not improve. Associations between visceral adiposity, IL-6 concentrations and neurovegetative and cognitive symptoms support links between obesity, inflammation and distinct neurobehavioral symptoms.

Burnout and Quality of Life among Active Member Physicians of the Medical Society of Sedgwick County

INTRODUCTION

The medical literature suggests disturbingly high rates of burnout among US physicians. The objective of this study was to determine the rates of burnout, other forms of distress, and overall quality of life among physicians in Sedgwick County.

METHODS

The study involved a convenience sample of 197 physicians who were active member physicians of the Medical Society of Sedgwick County (MSSC). Between July and August 2018, we surveyed 872 physicians who were active members of the MSSC. The survey assessed manifestations of burnout, symptoms of depression and suicidal ideation, fatigue, and quality of life. The authors used standard descriptive summary statistics, Mann-Whitney U test/independent samples t-Test, Fisher's exact test, and correlations to analyze the data.

RESULTS

The participation rate was 44.6%, with 49.5% of the respondents reporting manifestations of burnout. Although 85% of the participants rated their overall quality of life as good/very good, 45% screened positive for depression, 5% had thoughts of suicide during the past year, and 44% reported excessive fatigue during the past week. Those with manifestations of burnout were 2.13 (100% vs 46.9%, p < 0.01) times more likely to report thoughts of suicidal ideation, 2.43 (72.6% vs 30.4%; p < 0.001) times more likely to screen positive for depression, and 1.89 (67.5% vs 35.8%; p < 0.001) times more likely to have high degrees of fatigue. All of the participants who had suicidal ideation reported manifestations of burnout.

CONCLUSIONS

Burnout was prevalent among active member physicians of the MSSC. Burnout among the participants was associated with symptoms of depression, fatigue, suicidal ideation, and intention of leaving the medical profession via early retirement and/or career change.

Psychometric evaluation of a screening question for persistent depressive disorder

BACKGROUND

About one in five patients with depression experiences a chronic course. Despite the great burden associated with this disease, there is no current screening instrument for Persistent Depressive Disorder (PDD). In the present study, we examine a short screening test, the persistent depression screener (PDS), that we developed for DSM-5 PDD. The PDS is comprised of one question that is administered following an initial self-assessment for depression.

METHODS

Ninety patients from an inpatient clinic/day clinic specialized in treating depression completed the PDS. They were also assessed using a structured clinical interview covering the DSM-5 criteria for PDD. Retest reliability was examined after two weeks (n = 69, 77%).

RESULTS

In this sample, the prevalence of PDD was 64%. Sensitivity of the PDS was 85% with a positive predictive value of 80%. Specificity was 63%. Positive and negative likelihood ratios were 2.3 and .24, respectively. Agreement between the PDS results and the outcome of the clinical interview was moderate (Cohen's Kappa κ = .48 ([95%-CI .28, .68], p < .001, SE = 0.10)). Prevalence-adjusted bias-adjusted Kappa was PABAK = .53. Retest reliability of the PDS was moderate (Cohen's Kappa κ = .52 ([95%-CI .3, .74], p < .001, SE = 0.11)).

CONCLUSIONS

The present study shows that the PDS - when applied following a self-rating depression scale - might be a valid and reliable way to detect PDD. However, the results of the PDS must be confirmed by a diagnostic interview.

Quality of life profile in three cohorts of community-dwelling Swiss older people

Background

Quality of life (QoL) is a subjective and dynamic concept resulting from an interplay between importance of and satisfaction with different aspects of life. However, it is unclear whether social contexts experienced by individuals born at specific times in history (cohort effects) may influence QoL in old age. This study aimed to compare among older persons born before, during, and at the end of World War II: a) satisfaction with QoL, overall and per domains; b) importance of QoL domains.

Methods

This repeated cross-sectional study included representative samples of community-dwelling adults born in 1934–1938 (pre-war), 1939–1943 (war), and 1944–1948 (baby-boom) from the Lausanne cohort 65+. QoL was assessed overall, and in seven domains in 2011 and 2016. Two-by-two cohort comparisons were performed at ages 68–72 (war versus baby-boom) and 73–77 years (pre-war versus war).

Results

Overall satisfaction with QoL did not differ between cohorts despite increased education level across cohorts and a shift between pre-war and war cohorts towards lower morbidity and higher proportion living alone. However, “Feeling of safety” consistently showed significant improvements from earlier to later-born cohorts. Furthermore, the war cohort reported higher satisfaction than pre-war cohort in “Autonomy”. Conversely, no significant difference was observed between cohorts in importance of QoL domains, except increased importance given to “Health and mobility” in the war compared to pre-war cohort.

Conclusions

Societal changes reflected in the profile of successive elders’ cohorts did not appear to modify the overall satisfaction with QoL.

Electronic supplementary material

The online version of this article (10.1186/s12877-019-1112-4) contains supplementary material, which is available to authorized users.

The effect of the Great East Japan Earthquake on hypertensive disorders during pregnancy: a study from the Fukushima Health Management Survey

Objectives: This study aimed to assess the effects of the Great East Japan Earthquake on hypertensive disorder of pregnancy (HDP) in the Fukushima Prefecture.Methods: We used the results of the Fukushima Health Management Survey which targeted women who gave birth from 2011-2012. Pregnant women were divided into three groups according to their residential area during the disaster (affected, middle, and less-affected area), and four groups according to pregnancy trimester during the disaster (first, second, third trimester, or conception after the disaster). Adjusted odds ratio (aORs) for HDP of each residential area was calculated using logistic regression models, with pregnancy trimester during the disaster as references.Results: Overall, 8323 women participated in the study (affected area: 2207; middle area: 5183; and less-affected area: 933). For women living in the affected and middle areas in the third trimester, the disaster was a significant risk factor for HDP (aOR: 2.61, 1.02-6.66, aOR: 1.93, 1.10-3.40, respectively).Conclusions: To our knowledge, this is the first study to integrate patient residential areas and gestational age during the time of a disaster to estimate the risk of HDP. The third trimester of pregnancy at the time of the disaster was associated with HDP for the women living in the affected and middle areas. The knowledge of the data on disaster-related obstetrical complications can help obstetric care providers in a disaster area provide appropriate medical aid in an emergency.

Postpartum Depressive Disorder - Psychosomatic Aspects

Postpartum depression (PPD) is the most common mental illness in mothers following the birth of a child. Since the symptoms of PPD are similar to the normal stress of healthy women following childbirth, it is often difficult for the attending gynaecologist or midwife to diagnose this illness in a timely manner and thus initiate adequate treatment and comprehensive support for the patient. Even if there are options for a screening using evaluated questionnaires and subsequent psychotherapy and/or drug therapy in the treatment of PPD which has proven effective, it is seen that, in most treatment approaches, little consideration is given to the affect-controlled interaction and the bonding behaviour between mother and child. This article presents diagnostic measures and current therapeutic approaches as well as their integration in practice in order to achieve awareness of this topic in everyday clinical practice and show the pathways of appropriate treatment. Specific multiprofessional treatment approaches which centre on the mother-child relationship demonstrate successes with regard to depression in the mothers and also on the development of a secure mother-child bond and are thus a protective factor in the development of the affected children. The now well-known effects of PPD on the fathers as well as the negative impacts of paternal depression on child development make it clear that the treatment should not focus solely on maternal depression, but also always on the family bond between the mother, child and father in the treatment.

A qualitative study of women's views on the acceptability of being asked about mental health problems at antenatal booking appointments

OBJECTIVE

To explore women's views on the acceptability of being asked about mental health problems at antenatal booking.

DESIGN

Qualitative study.

SETTING

Brief semi-structured qualitative interviews were conducted with women in a private setting at a hospital, or at women's homes. Interview discussions centered around three key questions: "What was it like for you answering the questions about your mood?", "Were there any questions you found upsetting, distressing or confronting?" and "Did the midwife give you some feedback about your answers?"

MEASUREMENTS

Interviews were audio-recorded, transcribed verbatim, and analysed using thematic and framework approaches.

PARTICIPANTS

An ethnically diverse sample [32% white British/Irish, 68% non-white, non-British] of 52 women living in the study area.

FINDINGS

Most women found mental health enquiry acceptable. A smaller proportion reported difficulties and many of these women had a past or current mental health problem and/or a history of abuse. These women reported difficulty due to the emotional responses triggered by the questions and the way disclosures were handled. In general, women wanted to be asked clear questions about mental health problems, to have sufficient time to discuss issues, and to receive responses from midwives which were normalising and well-informed about mental health.

CONCLUSIONS

This study highlights that women want midwives to ask clearly-framed questions about mental health problems [addressing past and current mental health concerns], and value responses from midwives that are normalising, well-informed and allow for discussion.

IMPLICATIONS FOR PRACTICE

Training should be provided to midwives on how to appropriately respond to women's distress during mental health enquiry, and on referral to support services.

Adolescents with same-sex interest: experiences of sexual harassment are more common among boys

Purpose: To explore whether sexual harassment experiences are more common among adolescents reporting romantic and erotic interests in the same sex and both sexes, when sociodemographic and mental health confounding are controlled for, and whether the associations are similar in both sexes and in different phases of adolescence. Methods: A cross-sectional survey among a nationally representative dataset of 25,147 boys and 25,257 girls in comprehensive school, and 33,231 boys and 36,765 girls in upper secondary education. Self-reports of experiences of sexual harassment, and emotional (depression) and behavioral (delinquency) symptoms were used. Results: All associations between sexual minority status and harassment diminished clearly when mental disorder dimensions were controlled for. In the comprehensive school sample (mean age 15.4 years), sexual harassment experiences were 4-7-fold more common among boys, and 1.5-3-fold among girls, with same-sex/both-sexes interest, compared to those interested exclusively in the opposite sex. In the upper secondary education sample (mean age 17.4 years), among boys, sexual harassment was reported 3-6-fold more commonly by those not exclusively heterosexually interested. Among older girls, a slight increase in sexual harassment experiences was seen among those interested in both sexes. Conclusions: Sexual harassment experiences are associated with sexual minority status, particularly among boys. Confounding by mental disorders needs to be accounted for when studying sexual minority status and sexual harassment.

Predicting persistent depressive symptoms in older adults: A machine learning approach to personalised mental healthcare

BACKGROUND

Depression causes significant physical and psychosocial morbidity. Predicting persistence of depressive symptoms could permit targeted prevention, and lessen the burden of depression. Machine learning is a rapidly expanding field, and such approaches offer powerful predictive abilities. We investigated the utility of a machine learning approach to predict the persistence of depressive symptoms in older adults.

METHOD

Baseline demographic and psychometric data from 284 patients were used to predict the likelihood of older adults having persistent depressive symptoms after 12 months, using a machine learning approach ('extreme gradient boosting'). Predictive performance was compared to a conventional statistical approach (logistic regression). Data were drawn from the 'treatment-as-usual' arm of the CASPER (CollAborative care and active surveillance for Screen-Positive EldeRs with subthreshold depression) trial.

RESULTS

Predictive performance was superior using machine learning compared to logistic regression (mean AUC 0.72 vs. 0.67, p < 0.0001). Using machine learning, an average of 89% of those predicted to have PHQ-9 scores above threshold at 12 months actually did, compared to 78% using logistic regression. However, mean negative predictive values were somewhat lower for the machine learning approach (45% vs. 35%).

LIMITATIONS

A relatively small sample size potentially limited the predictive power of the algorithm. In addition, PHQ-9 scores were used as an indicator of persistent depressive symptoms, and whilst well validated, a clinical interview would have been preferable.

CONCLUSIONS

Overall, our findings support the potential application of machine learning in personalised mental healthcare.

Do baby boomers feel healthier than earlier cohorts after retirement age? The Lausanne cohort Lc65+ study

OBJECTIVE

Despite the popular belief that baby boomers are ageing in better health than previous generations, limited scientific evidence is available since baby boomers have turned retirement age only recently. This study aimed to compare self-reported health status at ages 65-70 years among three cohorts of older people born before, during and at the end (baby boomers) of the Second World War.

DESIGN

Repeated cross-sectional population-based study.

SETTING

Community in a region of French-speaking Switzerland.

PARTICIPANTS

Community-dwelling older adults who enrolled in the Lausanne cohort 65+ study at ages 65-70 years in 2004 (n=1561), 2009 (n=1489) or 2014 (n=1678).

OUTCOMES

Number of self-reported chronic conditions (from a list of 11) and chronic symptoms (from a list of 11); depressive symptoms; self-rated health (very good, good, average, poor or very poor); fear of disease (not afraid at all, barely afraid, a bit afraid, quite afraid or very afraid); self-perception of ageing; disability in basic and instrumental activities of daily living.

RESULTS

There was no significant difference between cohorts in the number of self-reported chronic conditions and chronic symptoms as well as the presence of difficulty in basic activities of daily living, depressive symptoms, fear of disease and negative self-perception of ageing. In women only, significant differences between cohorts were observed in self-rated health (p=0.005) and disability in instrumental activities of daily living (p=0.003), but these associations did not remain significant in logistic regression models adjusted for sociodemographic characteristics and unhealthy behaviours.

CONCLUSIONS

Despite important sociodemographic differences between older baby boomers and earlier cohorts, most health indicators did not suggest any trend towards a compression of morbidity. Future studies comparing these three cohorts at more advanced age are required to further investigate whether differences emerge later in life.

Patterns of tobacco use, quit attempts, readiness to quit and self-efficacy among smokers with anxiety or depression: Findings among six countries of the EUREST-PLUS ITC Europe Surveys

INTRODUCTION

We compared smoking behaviors, past quit attempts, readiness to quit and beliefs about quitting among current cigarette smokers with probable anxiety or depression (PAD) to those without PAD, from six European Union (EU) Member States (MS).

METHODS

A nationally representative cross-sectional sample of 6011 adult cigarette smokers from six EU MS (Germany, Greece, Hungary, Poland, Romania, Spain) was randomly selected through a multistage cluster sampling design in 2016. Respondents were classified as having PAD based on self-reported current diagnosis or treatment for anxiety or depression, or a positive screen for major depression, according to a validated two-item instrument. Sociodemographic characteristics, patterns of tobacco use, past quitting, readiness to quit, self-efficacy and beliefs about quitting were assessed for patients with and without PAD. Logistic regression was used to examine predictors of PAD. All analyses were conducted using the complex samples package of SPSS.

RESULTS

Among smokers sampled, 21.0% (95% CI: 19.3-22.9) were identified as having PAD. Logistic regression analyses controlling for socioeconomic variables and cigarettes smoked per day found smokers with PAD were more likely to have made an attempt to quit smoking in the past (AOR=1.48; 95% CI: 1.25-1.74), made a quit attempt in the last 12 months (AOR=1.75; 95% CI: 1.45-2.11), and report lower self-efficacy with quitting (AOR=1.83; 95% CI: 1.44-2.32) compared to smokers without PAD. Additionally, it was found that individuals with PAD were more likely to report having received advice to quit from a doctor or health professional and having used quitline support as part of their last quit attempt.

CONCLUSIONS

Smokers with PAD report a greater interest in quitting in the future and more frequent failed quit attempts than smokers without PAD; however, the high rates of untreated anxiety or depression, nicotine dependence, low confidence in the ability to quit, infrequent use of cessation methods, as well as socioeconomic factors may make quitting difficult.

Psychometric properties of the 7-item Generalized Anxiety Disorder Scale (GAD-7) in a large representative sample of Finnish adolescents

Symptoms of generalized anxiety disorder (GAD) are common among adolescents and can lead to severe psychosocial impairment, yet there is a lack of a good quality scale to measure symptoms of generalized anxiety in young people. The 7-item Generalized Anxiety Disorder Scale (GAD-7) is a self-report scale used to measure GAD symptoms and has been validated in adult populations, but the measure's psychometric properties regarding adolescents are unknown. The aim of this study was to investigate the reliability, factorial validity, and construct validity of the GAD-7 in adolescents in a nationally representative sample from a general population. Our study was based on Finnish survey data on 111,171 adolescents aged 14-18 years. Our results show that the GAD-7 demonstrates good psychometric properties in adolescents. The internal consistency of the GAD-7 was good (Cronbach's α = 0.91) and the instrument's unidimensional factor structure was supported. The associations of GAD-7 sum scores with self-report measures of depression and social anxiety supported construct validity. The psychometric properties of the GAD-7 in this sample of adolescents were similar to those reported among adults. However, studies in which diagnostic interviews are performed are needed to demonstrate the diagnostic efficacy of the measure in this age group.

Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

BACKGROUND

Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects.

METHODS

FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762.

FINDINGS

Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839-1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26-6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38-2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months.

INTERPRETATION

Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function.

FUNDING

UK Stroke Association and NIHR Health Technology Assessment Programme.

Performance of the 3-item screener, the Edinburgh Postnatal Depression Scale, the Hopkins Symptoms Checklist-15 and the Self-Reporting Questionnaire and Pregnancy Risk Questionnaire, in screening of depression in antenatal clinics in the Blantyre district of Malawi

Background

Screening instruments for antenatal depression vary in performance. This study aimed at assessing the performance of a range of screening instruments in detecting depressive symptoms in antenatal clinics in Blantyre district, Malawi.

Methods

A cross-sectional study was conducted to screen for depression among women attending 8 selected antenatal clinics in Blantyre district using 3-item screener, Edinburgh Postnatal Depression Scale (EPDS), Hopkins Symptoms Checklist-15 (HSCL-15), Self-Reporting Questionnaire (SRQ) and Pregnancy Risk Questionnaire (PRQ). The instruments were administered to a random sample of 480 pregnant women. Data were analysed using SPSS 22.0 testing for performance differences in proportions of screen positives and how screen positive results might differ by particular variables.

Results

The prevalence estimates yielded by screening instruments ranged from 12.9% (SRQ) to 42.1% (3-item screener). There were no significant differences in prevalence estimates for EPDS, HSCL-15, PRQ and SRQ. There were performance differences in the proportions of screen positives with significant systematic differences between proportions of screen positives of PRQ and SRQ (p<.001), EPDS and HSCL-15 (p=.001), HSCL and PRQ (p<.001), and EPDS and SRQ (p<.001). Screen positive results on HSCL-15, PRQ, 3-item screener and EPDS were found to differ by variables such as “not being supported by partner” which resulted in respondents having ≥3 times chances to screen positive on these four instruments. The screen positive results on SRQ were found not to differ by age, education, employment status, marital status, setting, gestation and number of pregnancies.

Conclusions

There were minimal variations in the performance of the EPDS, SRQ and HSCL-15 as standard public health screening instruments. However, systematic differences between proportions of screen positives exist and screen positive results from these instruments differed by demographics. It is important to validate screening instruments against a gold standard to ensure relevant clinical outcomes for pregnant women with depression.

Comparison of the Edinburgh Postnatal Depression Scale and the Whooley questions in screening for postpartum depression in Japan

Objective: We examined the clinical utility of the Whooley questions in comparison with that of the Edinburgh Postnatal Depression Scale (EPDS) in Japan.Methods: We carried out mental health screening of all postnatal mothers (n = 258) who gave birth to singleton babies at term attending our hospital using the EPDS and the Whooley questions. For the EPDS, scores were calculated, and a score of nine points or more was regarded as "positive screening" according to the results of previous observations in Japan. For the Whooley questions, if at least one question was answered "yes," we diagnosed it as "positive screen."Results: The positive rate of the Whooley questions was 16.7%, while that of the EPDS (≥ 9 points) was 14.8% (p = .55). The incidence of postpartum depression was 5.4%. The difference in the sensitivity and positive predictive value of the two tools did not reach significance (p = .09 and .45, respectively).Conclusions: There were no significant differences in accuracy on comparing the two screening tools. We should examine how to use the two tools according to the regional support systems.

Validity and reliability of anti-diabetic medication adherence scale among patients with diabetes in Baghdad, Iraq: a pilot study

BACKGROUND

Medication non-adherence is a common problem among patients with diabetes. Patient-reported medication adherence scales are the most commonly used method to assess patient medication adherence, but up to today there is no specific tool for assessing medication adherence among patients with diabetes in Arab countries. This study aimed to develop and validate a new tool for assessment of adherence to antidiabetic medications among Iraqi patients with diabetes.

METHODS

The Iraqi Anti-Diabetic Medication Adherence Scale (IADMAS) consists of eight items. The face and content validity of the IADMAS were established via an expert panel. For convergent validity, the IADMAS was compared with the Medication Adherence Questionnaire (MAQ). For concurrent validity, the IADMAS was compared with glycosylated hemoglobin. A total of 84 patients with types 2 diabetes were recruited from a diabetes center in Baghdad, Iraq. Test-retest reliability was measured by readministering the IADMAS to the same patients 4 weeks later.

RESULTS

Only 80 patients completed the study (response rate: 95%). Reliability analysis of the IADMAS showed a Cronbach's alpha value of 0.712, whereas that of the MAQ was 0.649. All items in the IADMAS showed no significant difference in the test-retest analysis, indicating that the IADMAS has stable reliability. There was no difference in the psychometric properties of the IADMAS and the MAQ. The sensitivity and specificity of the IADMAS were higher than that of the MAQ (100% vs 87.5% and 33.9% vs 29.7%, respectively).

CONCLUSION

The IADMAS developed in this study is a reliable and valid instrument for assessing antidiabetic medication adherence among Iraqi patients.

Cost-Utility Analysis of Routine Anxiety and Depression Screening in Patients Consulting for Osteoarthritis: Results From a Clinical, Randomized Controlled Trial

OBJECTIVE

To investigate the cost-effectiveness (cost-utility) of introducing general practitioner screening for anxiety and depression in patients consulting for osteoarthritis (OA).

METHODS

A cluster-randomized trial-based economic evaluation to assess general practitioners screening for anxiety and depression symptoms in patients consulting for OA compared to usual care (screening for pain intensity) was undertaken over a 12-month period from a UK National Health Service and societal perspective. Patient-level mean costs and mean quality-adjusted life years (QALYs) were estimated, and cost-effectiveness acceptability curves controlling for cluster-level data were constructed. The base-case analysis used the net benefit regressions approach. The 2-stage nonparametric sampling technique was explored in a sensitivity analysis.

RESULTS

The base-case analysis demonstrated that the intervention was as costly as, and less effective than, the control (QALY differential -0.029 [95% confidence interval -0.062, 0.003]). In the base-case analyses, general practitioner screening for anxiety and depression was unlikely to be a cost-effective option (probability <5% at £20,000/QALY). Similar results were observed in all sensitivity analyses.

CONCLUSION

Prompting general practitioners to routinely screen and manage comorbid anxiety and depression in patients presenting with OA is unlikely to be cost-effective. Further research is needed to explore clinically effective and cost-effective models of managing anxiety and depression in patients presenting with clinical OA.

The clinical application of pain neuroscience, graded motor imagery, and graded activity with complex regional pain syndrome-A case report

BACKGROUND

Chronic Regional Pain Syndrome (CRPS) is a condition that physical therapists may encounter in an outpatient orthopedic setting. In physical therapy (PT) treatment of CRPS addresses pain and the changes observed in the brain through the use of graded motor imagery (GMI).

CASE DESCRIPTION

A 57-year-old female presented to an outpatient PT clinic with CRPS type 1. Complicating psychosocial factors such as kinesiophobia and catastrophization were present. The patient engaged in a treatment plan including GMI: pain neuroscience education (PNE), laterality training, motor imagery, and mirror training. As symptoms improved, graded functional exposure and functional restoration occurred.

OUTCOMES

The patient was seen for a total of 26 visits over a 9-month period. FAAM measures exceeded reported clinically important change that was sustained at two-year follow-up. Long term outcomes showed no functional deficits related to her foot or ankle and minimal to no catastrophizing and fear avoidance behaviors.

DISCUSSION

This case report showcases the use of GMI with a patient with CRPS type 1 in an outpatient orthopedic clinic. Clinicians may consider the use of GMI to progress a patient toward maximal functional gains.

A cross-sectional study of depression among women attending antenatal clinics in Blantyre district, Malawi

Background

Pregnancy is a period associated with major psychological and social changes in the life of a woman and can be associated with anxiety and depression.

Aim

To describe demographic, clinical and risk profile of antenatal depression among pregnant women attending antenatal clinics in Blantyre district, Malawi.

Setting

The study was conducted in eight antenatal clinics in Blantyre district, Malawi.

Methods

A cross-sectional study of 480 randomly selected pregnant women attending antenatal clinics was conducted. Prevalence was determined using the Edinburgh Postnatal Depression Scale (EPDS) which was validated against a sub-sample using the Mini International Neuropsychiatric Interview. The risk factors of depression were assessed using the Pregnancy Risk Questionnaire. Data were analysed using descriptive statistics, Pearson chi-square test and binary logistic regression.

Results

Prevalence of antenatal depression using the EPDS was 19% (95% CI 15.5% – 22.5%, n = 91) and was comparable to the Mini International Neuropsychiatric Interview (25.8% [95% CI = 17.5–34], n = 25). The key risk factors that predicted antenatal depression were: ‘being distressed by anxiety or depression for more than 2 weeks during this pregnancy’ (OR = 4.1 [2.1–7.9], p ≤ 0.001); ‘feeling that a relationship with partner is not an emotionally supportive one’ (OR = 3.5 [1.4–8.4], p = 0.01); ‘having major stresses, changes or losses in the course of this pregnancy’ (OR = 3.2 [1.7–6.2], p = 0.01); ‘feeling that father was critical of her when growing up’ (OR = 3.2 [1.4–7.6], p = 0.01); and ‘having history of feeling miserable or depressed for ≥2 weeks before this pregnancy’ (OR = 2.4 [1.3–4.4], p = 0.01).

Conclusion

This study confirmed the high-prevalence rate of depression in this group and illustrated that antenatal depression was associated with being distressed by anxiety or depression; support from partner; major stresses during pregnancy; and history of feeling miserable or depressed before pregnancy. This study also found a history of poor relationship between pregnant women and their fathers during childhood.

Facilitators and Barriers to Pre-Exposure Prophylaxis (PrEP) Use Among Black Individuals in the United States: Results from the National Survey on HIV in the Black Community (NSHBC)

This study explores willingness to use PrEP among Black individuals in the US. From February to April 2016, an online survey was administered to a nationally representative sample of Black individuals. 855 individuals who were HIV negative by self-report participated [mean age: 33.6 (SD 9.2); 45.5% male]. Among all respondents, 14.5% were aware of, and 26.0% would be willing to use PrEP. Among high-risk individuals (N = 327), 19.8% knew about and 35.1% would be willing to use PrEP. The most common reason for lack of willingness among high-risk individuals was low self-perceived risk (65.1%). In multivariate analysis, individuals reporting single marital status [OR 1.8 (1.2, 2.5), p = 0.002], depressive symptoms [OR 1.6 (1.2, 2.2), p = 0.0054], arrest history [OR 1.7(1.2, 2.4), p = 0.0003], PrEP knowledge [OR 1.5 (1.0, 2.3), p = 0.0247] and belief in HIV conspiracies [OR 1.3 (1.1, 1.5), p = 0.0075] were more willing to use PrEP. Participants who saw a health care provider less frequently were less willing to use PrEP [OR 0.5 (0.4, 0.8), p = 0.0044]. Among a nationally representative sample of Black individuals, few high risk individuals were willing to use PrEP. Interventions to increase risk awareness, PrEP knowledge and access to care are necessary to improve PrEP uptake.

Alzheimers' disease and caregiving: a meta-analytic review comparing the mental health of primary carers to controls

OBJECTIVES

To quantitatively review the literature comparing depressed mood, anxiety and psychological distress in caregivers (CGs) of older adults with Alzheimer's disease (AD) with non-caregivers (NCGs) Methods: Eighteen independent studies comparing AD CGs (N = 2378) with NCGs (N = 70,035) were evaluated in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Standardised mean differences (Hedges' g) with associated 95% confidence intervals and p-values were calculated using a random-effects model.

RESULTS

Studies generally conformed to STROBE criteria in terms of their methodological and procedural detail, although data management issues that may contribute to methodological bias were identified. Pooled effect estimates revealed medium to large group differences in depression (g_w = 1.01 [CI: 0.73, 1.29] p < 0.01) and anxiety (g_w = 0.64 [CI: 0.39, 0.89] p < 0.01): AD caregivers reported higher symptom severity. Gender was a significant moderator: female caregivers experienced poor self-reported mood (g_w = 1.58 [CI: 1.11, 2.05], p < 0.01), although this analysis was limited in power given the small number of contributing studies.

DISCUSSION

Caregivers of patients with AD experience poor mental health in comparison to the general population, with female caregivers being disproportionately affected. Further exploration of the psychosocial variables that contribute to these group differences is needed to inform effective support services and, in turn, help caregivers manage the emotional demands of AD.

Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors

OBJECTIVE

To evaluate physician burnout, well-being, and work unit safety grades in relationship to perceived major medical errors.

PARTICIPANTS AND METHODS

From August 28, 2014, to October 6, 2014, we conducted a population-based survey of US physicians in active practice regarding burnout, fatigue, suicidal ideation, work unit safety grade, and recent medical errors. Multivariate logistic regression and mixed-effects hierarchical models evaluated the associations among burnout, well-being measures, work unit safety grades, and medical errors.

RESULTS

Of 6695 responding physicians in active practice, 6586 provided information on the areas of interest: 3574 (54.3%) reported symptoms of burnout, 2163 (32.8%) reported excessive fatigue, and 427 (6.5%) reported recent suicidal ideation, with 255 of 6563 (3.9%) reporting a poor or failing patient safety grade in their primary work area and 691 of 6586 (10.5%) reporting a major medical error in the prior 3 months. Physicians reporting errors were more likely to have symptoms of burnout (77.6% vs 51.5%; P<.001), fatigue (46.6% vs 31.2%; P<.001), and recent suicidal ideation (12.7% vs 5.8%; P<.001). In multivariate modeling, perceived errors were independently more likely to be reported by physicians with burnout (odds ratio [OR], 2.22; 95% CI, 1.79-2.76) or fatigue (OR, 1.38; 95% CI, 1.15-1.65) and those with incrementally worse work unit safety grades (OR, 1.70; 95% CI, 1.36-2.12; OR, 1.92; 95% CI, 1.48-2.49; OR, 3.12; 95% CI, 2.13-4.58; and OR, 4.37; 95% CI, 2.06-9.28 for grades of B, C, D, and F, respectively), adjusted for demographic and clinical characteristics.

CONCLUSION

In this large national study, physician burnout, fatigue, and work unit safety grades were independently associated with major medical errors. Interventions to reduce rates of medical errors must address both physician well-being and work unit safety.

The Differential Effects of Age on the Association Between Childhood Socioeconomic Disadvantage and Subjective Symptoms of Dementia Among Older Japanese People

Background

Despite increasing evidence of an association between childhood socioeconomic disadvantage and cognitive outcomes, such as dementia and cognitive decline, in Western countries, there are no studies on this association from non-Western societies. We investigated the relationship between childhood socioeconomic status (SES) and subjective symptoms of dementia among community-dwelling older Japanese people and examined age and sex variations in this association.

Methods

Data were derived from a cross-sectional survey for all community-dwelling individuals aged 65 years and over in Adachi, Tokyo (n = 132,005). We assessed subjective dementia symptoms using a self-administered dementia checklist, which was validated by comparison with the Clinical Dementia Rating scale.

Results

Data from 75,358 questionnaires were analyzed. After adjusting for potential covariates, lower childhood SES was associated with greater likelihood of subjective dementia symptoms. We found a significant interaction between childhood SES and age on subjective dementia symptoms but no interaction between childhood SES and sex. Age-stratified analysis indicated that the association between lower childhood SES and subjective dementia symptoms was stronger in the ≥75 years subgroup than in the 65–74 years subgroup, indicating an effect modification of age on this association.

Conclusions

Our findings suggested that low SES in childhood might have a long-term influence on dementia symptoms in late life and that this influence varied by age. This differential association might be explained by the social and historical context in Japan (ie, World War II, postwar chaos, and high economic growth) that has shaped participants’ early experiences.

The prevalence of depression and insomnia symptoms among patients with rheumatoid arthritis and osteoarthritis in Poland: a case control study

The objective of the study was to assess the prevalence of symptoms of depression and insomnia among patients with rheumatoid arthritis and osteoarthritis in comparison with individuals without chronic diseases. The study was carried out at National Institute of Geriatrics, Rheumatology and Rehabilitation, included 229 persons. The participants were divided into the following groups: group I - 120 patients with rheumatoid arthritis, group II - 58 patients with osteoarthritis, group III - 51 healthy individuals no confirmed depression (control group). Symptoms of depression were confirmed by a multiple-choice self-reported Beck Depression Inventory questionnaire. Symptoms of depression confirmed with depression inventory≥ 10 occurred as follows: patients with rheumatoid arthritis - 75.83%, patients with osteoarthritis - 50%, control group - 23.53% (p<0.0001), with the prevalence of insomnia (AIS≥6) at: 71%, 32% and 33%, respectively (p<0.001). In group I mean values of FIRST and AIS were 23.06 and 8.36 respectively, with group II: 21.71 and 7.84, respectively. In all subjects with AIS≥6, the depression inventory was statistically significantly (p<0.005) higher than in the subjects with AIS<6 (respectively: 17.02 vs 12.13; 15.6 vs 8.05; 5.45 vs 1.81). Patients with rheumatoid arthritis find it difficult to cope with stress. Insomnia as a reaction to stress occurs more often in this group.

Comparing the Maslach Burnout Inventory to Other Well-Being Instruments in Emergency Medicine Residents

BACKGROUND

The Maslach Burnout Inventory (MBI) is considered the "gold standard" for measuring burnout, encompassing 3 scales: emotional exhaustion, depersonalization, and personal accomplishment. Other well-being instruments have shown utility in various settings, and correlations between MBI and these instruments could provide evidence of relationships among key variables to guide well-being efforts.

OBJECTIVE

We explored correlations between the MBI and other well-being instruments.

METHODS

We fielded a multicenter survey of 9 emergency medicine (EM) residencies, administering the MBI and 4 published well-being instruments: a quality-of-life assessment, a work-life balance rating, an appraisal of career satisfaction, and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire 2 question screen. Consistent with the Maslach definition, burnout was defined by high emotional exhaustion (> 26) and high depersonalization (> 12).

RESULTS

Of 334 residents, 261 (78%) responded. Residents who reported lower quality of life had higher emotional exhaustion (ρ = -0.437, P < .0001), higher depersonalization (ρ = -0.18, P < .005), and lower personal accomplishment (ρ = 0.347, P < .001). Residents who reported a negative work-life balance had emotional exhaustion (P < .001) and depersonalization (P < .009). Positive career satisfaction was associated with lower emotional exhaustion (P < .0001), lower depersonalization (P < .005), and higher personal accomplishment (P < .05). A positive depression screen was associated with higher emotional exhaustion, higher depersonalization, and lower personal achievement (all P < .0001).

CONCLUSIONS

Our multicenter study of EM residents demonstrated that assessments using the MBI correlate with other well-being instruments.

Is community social capital associated with subjective symptoms of dementia among older people? A cross-sectional study in Japan

AIM

Many studies have reported the preventive effects of community social capital on health outcomes, such as mortality and incidence of diseases. However, evidence on the association between community social capital and dementia-related outcomes remains sparse. The present study examined the contextual association of social capital with subjective symptoms of dementia among community-dwelling older adults in Japan, using a population-based, large-scale questionnaire survey.

METHODS

Data were used from a cross-sectional survey for all community-dwelling individuals aged ≥65 years in Adachi Ward, Tokyo (n = 132 005). Subjective dementia symptoms were assessed using a self-administered dementia checklist, which was validated by the Clinical Dementia Rating Scale. Social capital was assessed by neighborhood cohesion (neighborhood trust, neighborhood attachment and sense of belonging to the neighborhood) and neighborhood network (i.e. social relationships with neighbors). Individual responses from each district were aggregated to create indicators of district-level social capital.

RESULTS

A total of 75 338 questionnaires were analyzed (covering 260 districts). The average age of participants was 73.8 ± 6.0 years (45.0% men). A multilevel binomial logistic regression analysis by sex showed that a denser neighborhood network in a district was associated with a lower likelihood of subjective dementia symptoms (odds ratio 0.89, 95% confidence interval 0.83-0.96) among women. No association was found for men between district-level social capital and subjective dementia symptoms.

CONCLUSIONS

Fostering structural aspects of social capital in a community is a potential dementia-prevention strategy, and policymakers should focus on such community-based approaches as well as on approaches that target individuals. Geriatr Gerontol Int 2018; 18: 1537-1542.

Measures for concordance and discordance with applications in disease control and prevention

Bivariate binary response data appear in many applications. Interest goes most often to a parameterization of the joint probabilities in terms of the marginal success probabilities in combination with a measure for association, most often being the odds ratio. Using, for example, the bivariate Dale model, these parameters can be modelled as function of covariates. But the odds ratio and other measures for association are not always measuring the (joint) characteristic of interest. Agreement, concordance, and synchrony are in general facets of the joint distribution distinct from association, and the odds ratio as in the bivariate Dale model can be replaced by such an alternative measure. Here, we focus on the so-called conditional synchrony measure. But, as indicated by several authors, such a switch of parameter might lead to a parameterization that does not always lead to a permissible joint bivariate distribution. In this contribution, we propose a new parameterization in which the marginal success probabilities are replaced by other conditional probabilities as well. The new parameters, one homogeneity parameter and two synchrony/discordance parameters, guarantee that the joint distribution is always permissible. Moreover, having a very natural interpretation, they are of interest on their own. The applicability and interpretation of the new parameterization is shown for three interesting settings: quantifying HIV serodiscordance among couples in Mozambique, concordance in the infection status of two related viruses, and the diagnostic performance of an index test in the field of major depression disorders.

Changes in the burnout profile of chairs of academic departments of obstetrics and gynecology over the past 15 years

BACKGROUND

While many studies have documented the high prevalence of burnout in practicing physicians and medical trainees, fewer reports describe burnout in academic leaders. In 2002, we observed a moderate-high to high level of burnout in 41.4% of chairs of academic departments of obstetrics and gynecology.

OBJECTIVE

The purpose of this study was to identify trends in burnout and associated factors in today's obstetrics and gynecology chairs as they face complex changes to the current health care environment.

STUDY DESIGN

This was a cross-sectional study. A survey was developed based on the questionnaire used in our first investigation and sent electronically to all members of the Council of University Chairs of Obstetrics and Gynecology. Burnout was measured using an abbreviated Maslach Burnout Inventory-Human Sciences Survey. In addition to demographic data, we assessed perceived stressors, job satisfaction, spousal/partner support, self-efficacy, depression, suicidal ideation, and stress management.

RESULTS

The response rate was 60% (84/139). Almost 30% of chairs were women, increased from 7.6% in 2002. Hospital and department budget deficits and loss of key faculty remain major stressors noted by participants. The Maslach Burnout Inventory results have changed dramatically over the past 15 years. Today's chairs demonstrated less burnout but with an "ineffective" profile. Subscale scores for emotional exhaustion and depersonalization were reduced but >50% reported low personal accomplishment. Spousal support remained important in preventing burnout.

CONCLUSION

Chairs of academic departments of obstetrics and gynecology continue to face significant job-related stress. Burnout has decreased; however, personal accomplishment scores have also declined most likely due to administrative factors that are beyond the chairs' perceived control.

The acceptability of an online intervention using positive psychology for depression: A qualitative study

BACKGROUND

Positive psychology interventions may usefully treat depression and can be delivered online to reduce the treatment gap. However, little is known about how acceptable patients find this approach. To address this, the present study interviewed recent users of a positive psychology self-help website.

METHODS

In-depth semi-structured interviews explored the experiences of twenty-three participants from a larger feasibility study. A stratified purposive sampling strategy selected participants with varying intervention experience according to their intervention logins, as well as varying age, gender and depressive symptoms. Framework analysis was used to explore patterns and linkages within and between participants' accounts.

RESULTS

Acceptability varied between participants. Those who found it more acceptable felt it was relevant to their depression and reported feeling empowered by a self-help approach. Conversely, participants for whom it was less acceptable perceived the positive focus irrelevant to their depression and found the emphasis on self-action unsupportive.

CONCLUSIONS

The acceptability of an online positive psychology intervention may be facilitated by a patients' preference for a psychological focus on the positive. However, patients may also have distinct preferences for online self-help. Future research should investigate the importance of the therapeutic orientation of online self-help interventions and whether patients' preferences for these can be reliably identified. This could help to target online self-help in clinical practice.

Correlates of Validity of Self-Reported Methamphetamine Use among a Sample of Dependent Adults

BACKGROUND

Self-reported data are widely used in substance-use research, yet few studies have assessed the validity of self-reported methamphetamine use compared to biological assays.

OBJECTIVES

We sought to assess the validity and correlates of validity of self-reported methamphetamine use compared to urine toxicology (UTOX).

METHODS

Using a sample of methamphetamine-dependent individuals enrolled in a randomized controlled pharmacotherapy trial in the United States (n = 327 visits among 90 participants), we calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the kappa coefficient of self-reported methamphetamine use in the past 3 days compared to UTOX, as well as the NPV of self-reported methamphetamine use over an extended recall period of 1 month. We used multivariable logistic regression models to assess correlates of concordance between self-reported methamphetamine use and UTOX.

RESULTS

The sensitivity of self-reported methamphetamine use in the past 3 days was 86.7% (95% confidence intervals (95%CI): 81.4%-91.4%), the specificity was 85.3% (77.7-91.3), the PPV was 91.5% (86.9-94.8), and the NPV was 78.0% (69.4-86.1), compared to UTOX (kappa = 0.71). The NPV over the extended recall period was 70.6% (48.0-85.7). In multivariable analyses, validity of self-reported methamphetamine use was higher for older participants but lower during follow-up compared to baseline and when polysubstance use or depressive symptoms were reported. Conclusions/Importance: Our sample of methamphetamine-dependent adults reported recent methamphetamine use with high validity compared to UTOX. Validity increased with age but decreased when participants reported depressive symptoms or polysubstance use as well as later in the study timeline and during longer recall periods.

S2k Guidelines for the diagnosis and treatment of chronic pruritus - update - short version

Associated with a host of different diseases, pruritus is a cardinal symptom that poses an interdisciplinary diagnostic and therapeutic challenge. Over time, that symptom may progress independently of the initial cause, thus losing its function as a warning sign and turning into a clinically relevant disease of its own. In Germany, approximately 13.5 % of the general population are affected by chronic pruritus, with an incidence of 7 %. All forms of chronic pruritus require targeted treatment consisting of (a) diagnosis and management of the underlying disease, (b) dermatological treatment of primary or secondary (for example, dry skin, scratch lesions) symptoms, (c) symptomatic antipruritic treatment, and (d) psychological/psychotherapeutic treatment in case of an underlying or associated psychological or psychosomatic condition. Medical care of patients with chronic pruritus should therefore include an interdisciplinary approach, in particular with respect to diagnosis and therapy of the underlying disease as well as in terms of the management of treatment and adverse events. The objective of the present interdisciplinary guidelines is to define and standardize diagnostic and therapeutic procedures in patients with chronic pruritus. This is a short version of the current S2 guidelines on chronic pruritus. The long version may be found at www.awmf.org.

Women's views and experiences of having their mental health needs considered in the perinatal period

OBJECTIVE

To explore women's views and experiences of having their mental health needs considered in the perinatal period in an Irish maternity hospital setting.

DESIGN

A qualitative design using semi-structured interviews was used to explore women's views and experiences. Data were analysed using Thematic Analysis (Braun and Clarke, 2006).

SETTING

A voluntary maternity hospital in Dublin, Ireland which had access to a perinatal mental health team.

PARTICIPANTS

In total 8 women who met the inclusion criteria were recruited and participated in this study. The women were interviewed in the early postpartum period.

FINDINGS

The study offers important insights into how women feel about having their mental health needs considered in the perinatal period. Women reported pregnancy was an emotional time, feeling expected to be happy, and women with significant mental health histories preferred not to be referred to available services unless they asked for help. Women reported barriers to disclosure including stigma/shame, lack of time. Screening tools were viewed with mixed opinions. In getting help, the baby was a motivator for some women, attitudes of healthcare professionals and lack of time affected this.

KEY CONCLUSIONS

Women appreciated all methods of enquiry about their mental health and being given time to discuss concerns with healthcare professionals. Perceived busy staff workloads was a barrier in asking for help, as was lack of continuity of care. Screening tools were viewed as a tick box exercise, but also as a 'modality' to assist detection of women at risk. Mental health enquiry focused on depression and anxiety, with little or no enquiry about less common disorders. Women with significant histories were less likely to engage or accept referral to perinatal mental health services, preferring to access help if they felt they needed to.

IMPLICATIONS FOR PRACTICE

HCPs should enquire regularly about women's emotional wellbeing at every antenatal and postnatal contact, offering support where required. Detailed enquiry about mental health should encompass the broad spectrum of perinatal mental health problems, including but not limited to depression and anxiety. Screening tools can assist in the identification of women at risk of developing perinatal mental health problems. A specialist mental health midwife should link with high-risk women at the first antenatal booking visit and provide information on early intervention and access to services.

'Teabacco': Smoking of nicotine-infused tea as an unintended consequence of prison smoking bans

INTRODUCTION AND AIMS

Following the introduction of smoke-free policies in prisons in several countries, there have been anecdotal reports of prisoners creating cigarettes by mixing nicotine patches or lozenges with tea leaves ('teabacco'). Among a sample of people recently released from smoke-free prisons in Queensland, Australia, the aims of this study were to explore the perceived popularity of teabacco use, motivations for its use and describe the process of creating teabacco to identify potential associated health risks.

DESIGN AND METHODS

This study used a mixed-methods design. Eighty-two people recently released from prison in Queensland, Australia completed surveys at parole offices measuring teabacco use while incarcerated. Twenty-one teabacco smokers took part in follow-up, qualitative interviews to explore survey responses in greater depth.

RESULTS

The majority of survey participants (57%) reported smoking teabacco while incarcerated, with 37% smoking teabacco frequently (> once per week). Teabacco use was primarily motivated by cigarette cravings. Participants described the perceived inevitability of prisoners finding substitutes for tobacco. Multivariate analyses found that self-rated poor physical health, having been incarcerated five or more times, experiencing cigarette cravings while incarcerated, and use of illicit drugs while incarcerated were positively associated with frequent teabacco use in prison.

DISCUSSION AND CONCLUSIONS

Our findings suggest that teabacco use has become common practice in Queensland's smoke-free prisons. Correctional smoking bans are an important public health initiative but should be complemented with demand and harm reduction measures cognisant of the risk environment.