Symptoms of depression and anxiety (MHI) following acute medical/surgical hospitalization and post-discharge psychiatric diagnoses (DSM) in 839 geriatric US veterans

Simplified Screening for Depression in Acutely Hospitalized Geriatric Patients: Comparison of the Two-Item Whooley Questions With the Geriatric Depression Scale-15

OBJECTIVE

The aim of the study is to investigate sensitivity and specificity of the two-item Whooley questions compared to the 15-item Geriatric Depression Scale (GDS-15) for the detection of depressive symptoms in acutely hospitalized geriatric patients.

METHODS

Patients were prospectively recruited. Two-item Whooley questions and GDS-15 were performed within 24 h of admission, the GDS-15 being part of the routine geriatric assessment. Montgomery-Asberg Depression Rating Scale (MADRS) served as gold standard in the form of a structured interview which was performed within 48 h of admission. In addition, all patients were examined for independence (Barthel Index), cognition (mini-mental status examination), vision and hearing (finger rub test) and multimorbidity (Charlson Comorbidity Index).

RESULTS

248 patients were recruited. Median (Q1/3) age was 83 (/3 79/86) years, 157 patients (63%) were female. Whooley questions had a sensitivity of 0.95 (95% CI: 0.81-0.99) and specificity of 0.49 (95% CI: 0.43-0.56) identifying moderate depressive symptoms (MADRS ≥ 20 points) with a negative predictive value (NPV) of 0.99. This is compared to a sensitivity of 0.57 (95% CI: 0.37-0.75) and specificity of 0.62 (95% CI: 0.56-0.68) using GDS-15 to identify moderate depressive symptoms. Both functional impairment and cognitive deficits had an impact on the result of GDS-15, but did not influence the result of Whooley questions.

CONCLUSIONS

Compared to the GDS-15, the two-item Whooley questions are more accurate to screen for symptoms of depression in acutely hospitalized geriatric patients.

Suicide-related mortality in cardiovascular disease in the United States from 1999 to 2019

INTRODUCTION

Research has shown chronic diseases can be associated with suicide but there is limited data on suicide in cardiovascular disease (CVD). Given the substantial psychosocial, financial, quality of life, and health impact of CVD, we aimed to study suicide-related mortality in CVD.

METHODS

We used Center for Disease Control Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access Multiple Cause of Death data from 1999 to 2019. Suicide and CVD related deaths in patients ≥ 25 years were identified. Proportionate suicide-related mortality (PSrM) was calculated as suicide-related deaths (listed with CVD) divided by all CVD-related deaths (irrespective of suicide) and reported as PSrM per 100,000 CVD-related deaths. Joinpoint regression was used to examine trend changes using annual percentage change (APC) overall and by sex, race/ethnicity, disease subtype, and age.

RESULTS

Overall, PSrM in CVD increased from 62.8 in 1999 to 90.5 in 2019. The PSrM increased from 1999 to 2002 with an associated APC of 6.2 (95 % CI, 0.0 to 12.7), remained stable from 2002 to 2005, increased from 2005 to 2013 with an APC of 4.8 (95 % CI, 3.4 to 6.3), and decreased from 2013 to 2019 with an APC of -2.1 (95 % CI, -3.6 to -0.5). Among racial/ethnic groups, PSrM was highest in non-hispanic (NH) White (103.8), then Hispanic or Latino (63.6), and then NH Black or African American individuals (29.2). PSrM was highest in the 25-39 years age group (858), then 40-54 years (382.8), 55-69 years (146.2), 70-84 years (55.9), and then 85+ (17). PSrM initially increased in men with APC (3.1 until 2013), women (4.1 until 2014), NH White individuals (3.9 until 2013), Hispanic or Latino (3.5 until 2014), ages 40-54 years (2.9 until 2013), 55-69 years (6.0 until 2013), then stabilized or decreased. AAMR increased in NH Black or AA individuals APC (1.0) and 25-39 years APC (1.4) from 1999 to 2019.

CONCLUSION

PSrM in CVD peaked in the early 2010s, with varying differences across sex, racial/ethnic, and age groups. Further research is needed to understand disparities and develop preventive strategies.

Adjustment disorder in the Armed Forces: a systematic review

BACKGROUND

In the UK military, adjustment disorder (AjD) is reported as one of the most diagnosed mental disorders, alongside depression, in personnel presenting to mental health services. Despite this, little is understood about what may predict AjD, common treatment or outcomes for this population.

AIM

The systematic review aimed to summarise existing research for AjD in Armed Forces (AF) populations, including prevalence and risk factors, and to outline clinical and occupational outcomes.

METHOD

A literature search was conducted in December 2020 to identify research that investigated AjD within an AF population (serving or veteran) following the PRISMA guidelines.

RESULTS

Eighty-three studies were included in the review. The AjD prevalence estimates in AF populations with a mental disorder was considerably higher for serving AF personnel (34.9%) compared to veterans (12.8%). Childhood adversities were identified as a risk factor for AjD. AjD was found to increase the risk of suicidal ideation, with one study reporting a risk ratio of 4.70 (95% Confidence Interval: 3.50-6.20). Talking therapies were the most common treatment for AjD, however none reported on treatment effectiveness.

CONCLUSION

This review found that AjD was commonly reported across international AF. Despite heterogeneity in the results, the review identifies several literature gaps.

Frequency of Depression and Anxiety Symptoms in Surgical Hospitalized Patients

Background Patients hospitalized for surgeries and those with chronic remitting health conditions develop hospital-induced anxiety and depression. Unfamiliar hospital environment, insufficient privacy, exposure to strange instruments, financial concerns, disease stress, and prolonged hospital stay contribute to this anxiety. The aim of this study was to assess the frequency of depression and anxiety in surgical patients. Material and methods This observational study was conducted among 50 patients hospitalized for 10 days or more in the surgical unit. All patients completed the Hospital Anxiety and Depression Scale (HADS). It has seven items for anxiety and depression each. Each item scores 0-3. A subscale score >8 denotes anxiety or depression. Data were entered and analyzed using SPSS v.20. Mean and standard deviation (SD) were calculated for descriptive data, and frequencies and percentages were calculated for categorical data. Results On the HADS, the mean ± SD score of anxiety was 11.84 ± 4.16 and that of depression was 12.78 ± 4.16. There were 64% severely anxious and 74% severely depressed hospitalized patients. More patients with less than two weeks of hospital stay were severely depressed than severely anxious (72.7% vs. 36.3%). There were 20% patients with moderate anxiety and depression with hospital stay longer than three weeks and 80% with severe anxiety and depression. Conclusion There is a high incidence of anxiety and depression in surgical patients. Patients at risk of developing these symptoms must be identified and psychological care should be provided to them.

Suicide death rates in patients with cardiovascular diseases - A 15-year nationwide cohort study in Taiwan

BACKGROUND

The literature on suicide mortality rates in patients with cardiovascular diseases (CVDs) is limited.

METHODS

Taiwan National Health Insurance Research Database and Taiwan Death Registry were retrieved for patients with the 5 CVDs: congestive heart failure (CHF), acute myocardial infarction (AMI), ischemic stroke (IS), hemorrhagic stroke (HS), and pacemaker implantation (PMI) between January 1, 2001, and December 31, 2015. We excluded patients younger than 15 years old. The primary outcome was suicidal death. The standardized mortality ratio (SMR) was used to compare the risk of suicidal death in the 5 CVDs to the general population.

RESULTS

From 2001 to 2015, there were 212,206 patients with CHF, 178,894 patients with AMI, 475,359 patients with IS, 189,555 patients with HS, and 64,173 patients with PMI. The suicide death rate per 100,000 person-year, 95% CI was 59.6 (54.5-64.8) for those with CHF, 44.6 (40.1-49.1) for AMI, 57.6 (54.7-60.5) for IS, 44.6 (40.2-49.0) for HS, 54.0 (45.9-62.0) for PMI, and 20.3 (20.1-20.4) for the general population. Patients with CHF patients had the highest SMR (2.10), followed by IS (1.96), PMI (1.86), HS (1.65), and AMI (1.46). The SMRs for patients with CVDs peaked at year 2 after the diagnosis, declined for patients with AMI, IS, and HS, increased and decreased for PMI alternately, and reached very similar values all five CVDs after 10th year after the diagnosis.

CONCLUSIONS

Patients with acute CVD with AMI, IS, and HS had suicide death rates peaked early after diagnosis, but patients with chronic CVD with CHF and PMI had suicide death rates that increased progressively. In addition, patients with PMI, CHF, IS had highest association with psychiatric illness and patients with PMI who were of young to middle age had highest suicide death rate.

Associations of Physician Empathy with Patient Anxiety and Ratings of Communication in Hospital Admission Encounters

OBJECTIVE

To assess the association between the frequency of empathic physician responses with patient anxiety, ratings of communication, and encounter length during hospital admission encounters.

DESIGN

Analysis of coded audio-recorded hospital admission encounters and pre- and postencounter patient survey data.

SETTING

Two academic hospitals.

PATIENTS

Seventy-six patients admitted by 27 attending hospitalist physicians.

MEASUREMENTS

Recordings were transcribed and analyzed by trained coders, who counted the number of empathic, neutral, and nonempathic verbal responses by hospitalists to their patients' expressions of negative emotion. We developed multivariable linear regression models to test the association between the number of these responses and the change in patients' State Anxiety Scale (STAI-S) score pre- and postencounter and encounter length. We used Poisson regression models to examine the association between empathic response frequency and patient ratings of the encounter.

RESULTS

Each additional empathic response from a physician was associated with a 1.65-point decline in the STAI-S anxiety scale (95% confidence interval [CI], 0.48-2.82). Frequency of empathic responses was associated with improved patient ratings for covering points of interest, feeling listened to and cared about, and trusting the doctor. The number of empathic responses was not associated with encounter length (percent change in encounter length per response 1%; 95% CI, -8%-10%).

CONCLUSIONS

Responding empathically when patients express negative emotion was associated with less patient anxiety and higher ratings of communication but not longer encounter length.

Differences in prescribing psychotropic drugs for elderly with depression

OBJECTIVE

The escalating tendency of elderly population aged 65 and over, which grown up to 9% since 2001 in Taiwan, remarks the important issue of mental health among ageing population. Depression in the elderly is frequently undetected or inadequately treated. This study aimed to investigate the pharmacotherapy of elderly patients with depression by comparing the patterns of prescribing psychotropic drugs (psychotropics) of psychiatrists and non-psychiatrists.

METHODS

A random sampling of 5% of inpatients from the National Health Insurance (NHI) database in Taiwan from 2001 to 2003 was selected. In all, 1058 (0.9%) inpatients aged 65 and older with a diagnosis of any depressive disorder were included. The psychotropic prescribing pattern and the dosages used were analysed and compared. Physician specialties were based on the record of NHI database. Non-psychiatrists were defined by physicians other than psychiatry.

RESULTS

A total of 88% of elderly depressed inpatients had two or more comorbid physical illnesses. The most commonly prescribed psychotropics were: antidepressants (71.4%), anxiolytics (62.6%) and hypnotics (51.4%). Psychiatrists had a higher rate of prescribing psychotropics, except anxiolytics, than non-psychiatrists. Although selective serotonin reuptake inhibitors were commonly prescribed, non-psychiatrists preferred the use of tricyclic antidepressants and moclobemide. Trazodone was the most preferred antidepressant, but was generally used in low dosages.

CONCLUSION

Psychiatrists generally utilised higher dosages of newer antidepressants than non-psychiatrists. Differences in the prescribing pattern of psychotropics existed between physician specialties. Further investigations are warranted to determine how the selection and dosing of drugs influence the outcome of depression on the elderly.

Need, Awareness, and Use of Career Services for College Students

This study examined whether university students were psychologically distressed or had difficulties with career decisions to indicate whether they needed career services, whether they were aware of the services offered by the campus counseling and career services, and finally, whether they had used the services. Findings indicated that students indicated difficulties with career decisions, high levels of psychological distress, and low levels of psychological well-being and that about half of students were aware of career services but much fewer had used those services. There were relationships among psychological distress and career-related variables for undecided students. Results are discussed with implications for career services on university campuses.

Prevalence and Determinants of Depression and Anxiety Symptoms in Surgical Patients

OBJECTIVES

Mood disorders are prevalent in hospitalized patients. However, risk factors for early diagnosis have not been studied exclusively in surgical patients. Our study aimed to investigate the prevalence and determinants of depression and anxiety symptoms in surgical patients.

METHODS

We included 392 surgical patients in this prospective cross-sectional study, which took place between June 2011 and June 2012. The Hospital Anxiety and Depression Scale (HADS) was used to screen for symptoms of depression and anxiety at weekly interviews. Regression analysis was performed to identify risk factors for early (the day after admission) and late (one week or more) in-hospital psychiatry symptoms.

RESULTS

Depression and anxiety symptoms increased from the time of admission toward longer hospital stay. Scores obtained in the second and third weeks of admission were associated with the need for surgery while HADS in the third week was associated with lack of familial support and being under the poverty line (p < 0.050). Regression model analysis showed that early depression was associated with female gender, and early anxiety was inversely affected by female gender and protected by higher education level. A history of mood disorder was a risk factor. Later anxiety was also associated with longer hospital stay.

CONCLUSIONS

Depression and anxiety symptoms are a major concern in surgical patients especially in females and those with a history of mood disorders or lower educational level. Patients with a longer hospital stay, in particular, those with underlying diseases, postoperative complications, lack of familial support, and the need for reoperation were also at increased risk.

Depressive symptoms among the medically hospitalized older individuals -- a 1-year follow-up study

AIM

The present follow-up study of older medically hospitalized patients from a rural area in Norway assessed the prevalence of depressive symptoms at 1-year follow-up and furthermore explored whether depressive symptoms at follow-up was associated with change in the medical, functional or emotional situation between baseline and follow-up.

METHODS

A 1-year follow-up study included 363 (175 men) older medical inpatients with age range 65-98 (mean = 80.2; standard deviation (SD) = 7.5) years. Information was collected at baseline and follow-up using the Hospital Anxiety and Depression scale (HAD), the Mini-Mental State Examination, Lawton and Brody's scales for physical self-maintenance and performance of the instrumental activities of daily living.

RESULTS

The prevalence of depressive symptoms, as defined by a score ≥ 8 at HAD-D, was 10% at baseline and 7% at follow-up. Of those with depressive symptoms at baseline, 78% had experienced remission. The incidence of depressive symptoms at follow-up was 5%. In logistic regression analyses adjusted for age, gender, and depressive symptoms at baseline, becoming or being in need of assistance from nursing or social services (odds ratio (OR) = 8.1, 95% CI: 1.9-34.2 and OR = 4.4, 95% CI: 1.1-17.4, respectively), having a cognitive decline (OR = 1.1, 95% CI: 1.0-1.3), and exhibiting poorer physical self-maintenance (OR = 1.2, 95% CI: 1.0-1.3), becoming vision impaired (OR = 8.3, 95% CI: 2.8-25.0), and with increased anxiety (OR = 1.2, 95% CI: 1.0-1.3) during follow-up was associated with depressive symptoms at follow-up.

CONCLUSION

The 1-year follow-up study of older medical inpatients contributes to the research body regarding risk factors of depression in older people.

Survival in the community of the very old depressed, discharged from medical inpatient care

OBJECTIVES

To examine the prevalence and associated risk factors of depression in older patients discharged home from acute medical care and their influence on duration of survival in the community.

DESIGN

A cross-sectional, prevalence study of depression in recently discharged patients and a prospective, case-controlled study of depressed and psychiatrically asymptomatic sub groups, exploring the relationship between depression, associated risk factors, and duration of survival in the community.

SETTING

A community study of patients aged 75 and older discharged from the Countess of Chester Hospital and Wirral Hospitals Trust serving Wirral and West Cheshire, England.

PARTICIPANTS

Three hundred and eleven patients were entered into the prevalence study. One hundred and fifty-eight patients (54 depressed and 104 asymptomatic) were entered into the prospective case controlled study and followed up for up to two years.

MEASUREMENTS

Depression was defined by GMS/AGECAT criteria. Demographic details, handicap, pain, forced expiratory volume and social network were measured as dependent variables in the prevalence study and included in the analysis of risk factors potentially associated with duration of survival in the community.

RESULTS

A depression prevalence rate of 17.4% was found. Age (p = 0.049, CI; 0.813, 0.999), forced expiratory volume (p = 0.034, CI; 0.991, 1.000) and handicap (p = 0.000, CI; 1.268, 1.723) were associated with depression but depression (p = 0.040, CI; 1.039, 4.915) was the only base-line variable associated with reduced survival in the community as defined by mortality and re-admission.

CONCLUSIONS

Depression is common in older people discharged from acute medical care and is a major risk factor for reduced duration of community survival.