Screening and case finding for major depressive disorder using the Patient Health Questionnaire (PHQ-9): a meta-analysis

The association between outdoor ambient temperature and depression and mania: An ecological momentary assessment study

BACKGROUND

Environmental heat exposure can negatively impact mental health. Evidence for its effect on mood disorder symptoms is inconsistent. Current studies are limited by poor temporal and geographical resolution.

METHODS

We used ecological momentary assessment (EMA) data from the smartphone app juli to investigate the association between real-time mean and maximum ambient temperature collected from smartphone geolocation, and depressive and manic symptom scales, every two weeks, in adults with depression and bipolar disorder. We used negative binomial mixed-effects regression models, controlled for demographic and weather variables, and stratified by season.

RESULTS

We analysed data from 4000 participants with depressive symptom scores and 2132 with manic symptom scores, between 2021 and 2023. We found that each 1 °C increase in mean daily temperature in the preceding two weeks was associated with a 0.2 % reduction in depressive symptom scores (coeff 0.998, 95%CI 0.997-0.999) and a 0.4 % increase in manic symptom scores (coeff 1.004, 95%CI 1.001-1.007). Associations between maximum temperature and symptom scores followed a similar pattern. These findings were context dependent, based on season and individual's normal heat exposure.

LIMITATIONS

We were unable to capture several socio-demographic covariates, had limited geographical information due to privacy regulations, and included a non-random sample.

CONCLUSIONS

We found evidence that higher temperatures were associated with increased manic symptoms and decreased depressive symptoms, indicating an important relationship between temperature and the mood disorder continuum. With global heating, there is a need to understand the impact of temperature on mood symptoms, to provide targeted clinical prevention and support. This study demonstrates potential for EMA methods to inform our understanding of these links.

New-onset mental disorders increase among patients with metabolic diseases after the COVID-19 pandemic

There is limited information on new-onset mental disorders in adults with metabolic diseases following the COVID-19 pandemic. Here, we aimed to examine the changes in mental health following the COVID-19 pandemic and identify factors associated with the development of new-onset mental disorders. Among 90,580 UK Biobank participants diagnosed with COVID-19 between Jan 31, 2020 and Oct 31, 2022, those who completed both baseline and follow-up mental health questionnaires in 2016-2017 and 2022-2023 were included in the analysis. New-onset depression, anxiety, and alcohol use disorder following the COVID-19 pandemic, as well as changes in mental health scores, were assessed. Furthermore, their association with sociodemographic, clinical, and self-perceived emotional state-related exposures was examined. Prevalent metabolic diseases were significantly associated with a higher risk of new-onset depression (hypertension: odds ratio [OR], 1.22; 95% CI 1.01-1.47; diabetes: OR 1.8; 95% CI 1.25-2.6; obesity: OR 1.66; 95% CI 1.43-1.95) and anxiety (hypertension: OR 1.32; 95% CI 1.06-1.63; diabetes: OR 1.66; 95% CI 1.06-2.62; obesity: OR 1.2; 95% CI 0.99-1.44) following COVID-19 pandemic. There was a significant increase of Patient Health Questionnaire-9 (PHQ-9; beta, 0.32; 95% CI 0.29-0.35) and Generalized Anxiety Disorder-7 (GAD-7; beta, 0.10; 95% CI 0.06-0.13) scores throughout the COVID-19 pandemic, while Alcohol Use Disorder Identification Test (AUDIT) score decreased over time (beta, - 0.24; 95% CI - 0.30 to - 0.18). Preexisting metabolic diseases were associated with the accelerated increase in the PHQ-9 and GAD-7 scores following the pandemic. Adults with metabolic diseases are associated with an increased risk of new-onset depression, anxiety, and alcohol use disorders following the COVID-19 pandemic.

Understanding the dual role of individual position in multidimensional social support networks and depression levels: Insights from a nomination-driven framework

This study aims to investigate the relationship between the structural characteristics (e.g., single dimension friendship networks) and functional characteristics (multi-dimension) of social support networks and depressive symptoms among college students. Data were collected from 1784 students across six Chinese universities using questionnaire surveys and a nomination-based social network analysis approach. Friendship and social support networks (including four dimensions of support: appraisal, belonging, tangible, and self-esteem), were constructed to exploring relationships between network characteristics and depressive symptoms at both individual and class levels. The results indicate that greater integration and active participation in these networks are significantly linked to lower depression risks at both individual and class levels, underscoring the protective role of social connections. Yet, individuals with high betweenness centrality in networks demanding high support face increased depression risks, attributed to the stress of maintaining social cohesion and identity. Multilevel analysis further reveals that class network modularity is positively correlated with depressive symptoms and moderates the relationship between local clustering and depressive symptoms in high-burden social support networks, indicating that individuals in bridge positions or on the periphery of high-modularity networks may face increased risk of depression, potentially due to the lack of strong emotional support and social validation. These findings, by focusing on the characteristics of networks at both individual and group levels, lay a foundation for targeted intervention measures designed to optimize social support systems. They offer insights into mental health policies and practices among college students.

A comparison of objective and subjective measures of physical activity, sedentary and sleep behaviors between persons with and without depressive symptoms

BACKGROUND

Major Depressive Disorder (MDD) is characterized by negative recall biases, which may impact how individuals with depressive symptoms report physical activity (PA), sedentary, and sleep behaviors. Additionally, there are discrepancies between subjective and objective behaviors in MDD. Thus, the current study investigated whether individuals with depressive symptoms differ in their subjective and objective PA, sedentary, and sleep behaviors, and whether the magnitude of these discrepancies differ from those in individuals without depressive symptoms.

METHODS

Participants from the 2011-2014 National Health and Nutrition Examination Survey (N = 8367; Ndepressed = 762) with one-week of passively-collected, wrist worn actigraphy data and self-reported questionnaires assessing PA, sedentary, and sleep behaviors were analyzed.

RESULTS

Three negative binomial models investigated the effects of group, measurement type, and their interaction on PA, sedentary, and sleep behaviors. Individuals with depressive symptoms exhibited lower PA and sleep than individuals without depressive symptoms but did not differ in sedentary behaviors. Measurement type differed across all models: self-reported PA and sleep were lower, and self-reported sedentary behaviors were greater, than objective measurements. The interaction was significant only for PA; whereas objective PA was greater than subjective measurements for all individuals, the difference was far greater for individuals with depressive symptoms.

LIMITATIONS

The absence of a clinically depressed sample and current manner of assessing subjective and objective measures may limit our generalizability and conclusions.

CONCLUSION

Our study highlights discrepancies in objective and subjective reports across domains and emphasizes the importance of incorporating objective measurements to improve psychopathology assessment.

Prevalence of premenstrual syndrome and its relationship to depression among Korean adolescents: A nationwide cross-sectional study

OBJECTIVE

To investigate the prevalence of PMS and depressive symptoms and to determine their association among Korean adolescent girls using a nationally representative cross-sectional survey.

MATERIALS AND METHODS

The Korean Study of Women's Health Related Issues (K-Stori)was used. Of the 3000 adolescent girls aged 14-17 years, the study subjects were 2970 girls after menarche. Depressive symptom was assessed with the PHQ-9. Multivariable logistic regression analysis was used to investigate factors associated with depressive symptom.

RESULTS

The prevalence of PMS was 70.5 %. Irritability (43.8 %), abdominal bloating (32.8 %), and breast tenderness (27.5 %) were the most predominant symptoms. The prevalence of depressive symptom was 15.5 %. Girls with PMS were more likely to be depressed than those who did not experience PMS (OR, 1.70; CI, 1.31-2.20). BMI was not associated with depressive symptom. However, a significant association was noted between satisfaction with one's body image and depressive symptom. Ever-smokers were more likely to be depressed than never-smokers (OR, 1.64; CI, 1.10-2.45).

CONCLUSIONS

PMS were significantly associated with depressive symptom. PMS should be taken into account in the management of depression. Our study emphasized the significance of a multidisciplinary approach.

Comparison of Logistic Regression and Machine Learning Approaches in Predicting Depressive Symptoms: A National-Based Study

OBJECTIVE

Machine learning (ML) has been reported to have better predictive capability than traditional statistical techniques. The aim of this study was to assess the efficacy of ML algorithms and logistic regression (LR) for predicting depressive symptoms during the COVID-19 pandemic.

METHODS

Analyses were carried out in a national cross-sectional study involving 21,916 participants. The ML algorithms in this study included random forest (RF), support vector machine (SVM), neural network (NN), and gradient boosting machine (GBM) methods. The performance indices were sensitivity, specificity, accuracy, precision, F1-score, and area under the receiver operating characteristic curve (AUC).

RESULTS

LR and NN had the best performance in terms of AUCs. The risk of overfitting was found to be negligible for most ML models except for RF, and GBM obtained the highest sensitivity, specificity, accuracy, precision, and F1-score. Therefore, LR, NN, and GBM models ranked among the best models.

CONCLUSION

Compared with ML models, LR model performed comparably to ML models in predicting depressive symptoms and identifying potential risk factors while also exhibiting a lower risk of overfitting.

Dark Triad Personality Traits and Cyberbullying: The Mediating Role of Emotional Empathy

Nowadays, with the widespread use of the Internet, cyberbullying has become a pervasive threat to people. This study aimed to create a structural model of cyberbullying based on dark personality traits, with empathy as a mediating factor among students. A total of 360 students of the Mohaghegh Ardabili University were included using the multistage random sampling method. Data were collected using the Cyber-Bullying/Victimization Experiences Questionnaire, Dark Triad Personality Scale, and Questionnaire Measure of Emotional Empathy. Collected data were analyzed using Pearson's correlation test and structural equation modeling in SPSS and AMOS 24. The direct route of Machiavellianism and psychopathy was positively significant for cyberbullying and negatively significant for empathy. Empathy also has a direct negative effect on cyberbullying. Furthermore, there was an indirect effect of Machiavellianism and psychopathy on cyberbullying through empathy. Dark personality traits including Machiavellianism and psychopathy are significant risk factors for cyberbullying, with these traits indirectly contributing to cyberbullying through empathy deficits.

Associations Between Cognitive Impairment, Depressive Symptoms, and Work Productivity Loss in Patients With Bipolar Disorder: A Cross-Sectional Analysis

AIM

To evaluate the relationship between cognitive impairment and work productivity loss in patients with bipolar disorder.

METHODS

We enrolled outpatients with bipolar disorder aged 18-59 years undergoing treatment and actively employed or on sick leave. Baseline demographic, medical resource use, and employment data were collected. We evaluated work productivity, cognitive impairment, quality of life (QOL), depressive symptoms (defined as a Patient Health Questionnaire-9 [PHQ-9] score of ≥ 10), and sleep disturbance. This interim analysis examined correlations among baseline symptom scores and correlations of each symptom score with work productivity loss and QOL.

RESULTS

Among 211 participants, cognitive impairment was moderately correlated with depressive symptoms (r = 0.595) and insomnia (r = 0.481), and depressive symptoms and insomnia were highly correlated (r = 0.719) (all p < 0.001). Work productivity loss (presenteeism) was moderately correlated with cognitive impairment (r = 0.474), depression (r = 0.577), and insomnia (r = 0.547) (all p < 0.001). Depression had the strongest influence on presenteeism (multiple regression analysis, regression coefficient: 22.98; p < 0.001). Among participants without severe depressive symptoms (PHQ-9 ≤ 19), cognitive impairment (13.91, p = 0.007) and insomnia (13.80, p = 0.016) strongly affected presenteeism. Among participants without moderately severe or severe depressive symptoms (PHQ-9 ≤ 14), insomnia affected presenteeism (23.14, p = 0.011). QOL was moderately negatively associated with cognitive impairment (r = -0.653), depression (r = -0.699), and insomnia (r = -0.559) (all p < 0.001). In multiple regression analysis, cognitive impairment (-0.12, p < 0.001), depression (-0.12, p = 0.010), and insomnia (-0.16, p < 0.001) were significantly associated with QOL.

CONCLUSIONS

Treatment should focus on improving the core symptoms of bipolar disorder, insomnia, and cognitive impairment.

TRIAL REGISTRATION

UMIN Clinical Trials Registry (UMIN000051519).

Feasibility and acceptability of implementing the Global Scales for Early Development (GSED) package for children 0-3 years across three countries

BACKGROUND

To assess the neurodevelopment of children under three years, a multinational team of subject matter experts (SMEs) led by the World Health Organization (WHO) developed the Global Scales for Early Development (GSED). The measures include (1) a caregiver-reported short form (SF), (2) a directly administered long form (LF), and (3) a caregiver-reported psychosocial form (PF). The feasibility objectives of this study in Bangladesh, Pakistan, and the United Republic of Tanzania were to assess (1) the study implementation processes, including translation, training, reliability testing, and scheduling of visits and (2) the comprehensibility, cultural relevance, and acceptability of the GSED measures and the related GSED tablet-based application (app) for data collection for caregivers, children, and assessors.

METHODS

In preparation for a large-scale validation study, we implemented several procedures to ensure that study processes were feasible during the main data collection and that the GSED was culturally appropriate, including translation and back translation of the GSED measures and country-specific training packages on study measures and procedures. Data were collected from at least 32 child-caregiver dyads, stratified by age and sex, in each country. Two methods of collecting inter-rater reliability data were tested: live in-person versus video-based assessment. Each country planned two participant visits: the first to gain consent, assess eligibility, and begin administration of the caregiver-reported GSED SF, PF, and other study measures and the second to administer the GSED LF directly to the child. Feedback on the implementation processes was evaluated by in-country assessors through focus group discussions (FGDs). Feedback on the comprehensibility, relevance, and acceptability of the GSED measures from caregivers was obtained through exit interviews in addition to the FGD of assessors. Additional cognitive interviews were conducted during administration to ensure comprehension and cultural relevance for several GSED PF items.

RESULTS

The translation-back translation process identified items with words and phrases that were either mistranslated or did not have a literal matching translation in the local languages, requiring rewording or rephrasing. Implementation challenges reiterated the need to develop a more comprehensive training module covering GSED administration and other topics, including the consent process, rapport building, techniques for maintaining privacy and preventing distraction, and using didactic and interactive learning modes. Additionally, it suggested some modifications in the order of administration of measures. Assessor/supervisor concurrent scoring of assessments proved to be the most cost-effective and straightforward method for evaluating inter-rater reliability. Administration of measures using the app was considered culturally acceptable and easy to understand by most caregivers and assessors. Some mothers felt anxious about a few GSED LF items assessing motor skills. Additionally, some objects from the GSED LF kit (a set of props to test specific skills and behaviors) were unfamiliar to the children, and hence, it took extra time for them to familiarize themselves with the materials and understand the task.

CONCLUSION

This study generated invaluable information regarding the implementation of the GSED, including where improvements should be made and where the administered measures' comprehensibility, relevance, and acceptability needed revisions. These results have implications both for the main GSED validation study and the broader assessment of children's development in global settings, providing insights into the opportunities and challenges of assessing young children in diverse cultural settings.

Prevalence of depressive symptoms and associated factors in Brazilian older adults: 2019 Brazilian National Health Survey

This study aimed to describe the prevalence of depressive symptoms and associated factors among older adults. A cross-sectional population-based study using data from the 2019 Brazilian National Health Survey was carried out. The prevalence of depressive symptoms was determined using the 9-item Patient Health Questionnaire (PHQ-9), and associations were tested according to sociodemographic, health and behavioral variables. Crude and adjusted prevalence ratios (PR) with 95% confidence intervals (95%CI) were calculated using Poisson's regression. The overall prevalence of depressive symptoms was 10.7% (95%CI: 9.9; 11.5). Higher PHQ-9 scores were associated with female gender (PR = 2.11, 95%CI: 1.82; 2.44), lack of participation in religious activities (PR = 1.20, 95%CI: 1.07; 1.35), nonsmoking status (PR = 1.55, 95%CI: 1.32; 1.83), poor or very poor self-perceived health (PR = 7.55, 95%CI: 5.82; 9.80), and multimorbidity (PR = 2.26, 95%CI: 1.85; 2.75). Higher education (PR = 0.55, 95%CI: 0.42; 0.73), income (PR = 0.68, 95%CI: 0.54; 0.85), and physical activity (PR = 0.72, 95%CI: 0.57; 0.90) were found to be negatively associated with the outcome. The most prevalent depressive symptoms were: sleeping problems (24.8%, 95%CI: 23.8; 25.8), not feeling rested or willing/feeling without energy (14.5%, 95%CI: 13.7; 15.4), and being depressed/down/without perspective (10.5%, 95%CI: 9.7; 11.2). These findings highlight the importance of prioritizing the identification and treatment of depressive symptoms in older Brazilian populations, particularly given that one in ten older Brazilians experience depressive symptoms.

Prevalence and factors associated with dementia in Lesotho: A cross-sectional, population-based study

INTRODUCTION

Limited research has examined dementia prevalence and associated factors in Lesotho. This study investigates dementia prevalence and the associated factors in Lesotho.

METHODS

A survey in Lesotho included 1738 participants screened for dementia and potential associated factors with a focus on modifiable factors. Associations were evaluated using logistic regression models.

RESULTS

The median age was 66 years, with 54.83% women. The prevalence of dementia was 4.89%. Those with depressive symptoms (adjusted odds ratio [aOR]: 3.97, 95% confidence interval [CI]: 1.39-11.30), age ≥ 75 (aOR: 2.68, 95% CI: 1.42-5.04), and underweight (aOR 2.30, 95% CI: 1.23-4.29) had increased odds of dementia. Those with moderate (aOR: 0.32, 95% CI: 0.17-0.58) to high (aOR: 0.35, 95% CI: 0.16-0.77) physical activity and obesity (aOR: 0.30, 95% CI: 0.11-0.80) presented lower odds for dementia.

DISCUSSION

This study provides a contemporary estimate of dementia prevalence in Lesotho, highlighting an association with modifiable factors.

HIGHLIGHTS

In Lesotho there is a probable dementia prevalence of 4.89%, aligning with regional estimates for Africa. Depression, older age, being underweight, and low physical activity were associated with increased odds of dementia. Moderate to high physical activity and obesity were associated with lower dementia odds. Further study of the association of dementia with potentially modifiable factors in low- and middle-income countries is warranted.

On the pursuit of reproducibility: the importance of large sample sizes in psychoimmunology

Peripheral inflammatory markers (PIMs), such as C-reactive protein (CRP) or white blood cell count (WBC), have been associated with depression severity in meta-analyses and large cohort studies. However, in typically-sized psychoimmunology studies (N < 200) that explore associations between PIMs and neurobiological/psychosocial constructs related to depression and studies that examine less-studied PIMs (e.g., interferon gamma), significant concerns about reproducibility of results exist. For the well-characterized association between PIMs (CRP/WBC) and depression severity, we examined statistical errors as a function of sample size in a large community cohort (n = 24,550). We further assessed how statistical errors varied as related to analytic decisions (e.g., number of covariates) and characteristics related to study design (e.g., relationships within subgroups of patients). Only large samples (e.g., n = 1000 to n = 10,000) were sufficiently powered to detect PIM-depression associations and minimized overestimation of effect sizes (e.g., effect size inflation), and greater sample sizes were required as more covariates were included in analytic models. Moderately sized samples (n > 500) generally ensured the correct directionality of effect sizes (e.g., low rates of sign reversal). Sample sizes required for 80% power also varied widely depending on study design characteristics (e.g., N = 350 to N = 10,000+). Typically-sized psychoimmunology studies examining PIM-depression associations (N < 200) are likely underpowered and at high risk of overestimation of effect sizes. Study design characteristics also notably influence power and statistical error rates. Use of large sample sizes (e.g., N > 7000) and consideration of analytic decisions (e.g., number/choice of covariates) will maximize reproducibility of psychoimmunology studies related to depression to enhance development of treatments for depression or to help understand pathophysiological mechanisms of depression.

Mental health and help-seeking behaviors among Mozambican youth: insights from a post-pandemic National Survey Amidst Internal Conflict

PURPOSE

This study aimed to investigate the prevalence and sociodemographic determinants of major depressive disorder (MDD) and generalized anxiety disorder (GAD) among Mozambican youth aged 15-24 years, as well as their help-seeking behaviors.

METHODS

Data from 8,154 youth participants in the 2022-23 Mozambique Demographic Health Survey were analyzed. MDD and GAD were assessed using the PHQ-9 and GAD-7 scales, respectively. Univariate and multivariate logistic regression analyses were conducted to examine associations between sociodemographic factors and mental health outcomes and health-seeking behaviors.

RESULTS

The prevalence of MDD and GAD among Mozambican youth was 7.5% for each condition. However, only 9.3% of those with either MDD or GAD sought help for their symptoms, primarily from family and friends. Females had significantly higher odds of experiencing both MDD and GAD but lower help-seeking behavior as compared to males. Unemployment, lower household wealth, and being single were associated with higher odds of both disorders and lower odds of help-seeking behaviors. Higher education increased the odds of GAD and help-seeking behaviors. Significant regional variations were observed, with conflict-affected regions including Cabo Delgado, Nampula, and Zambezia showing the highest prevalence of MDD and GAD.

CONCLUSION

This study reveals substantial mental health challenges among Mozambican youth, with notable disparities across sociodemographic groups and regions. The low rates of help-seeking behavior underscore the need for targeted interventions to improve mental health awareness and access to services for socio-demographically vulnerable youth.

Adverse childhood experiences and suicidal ideation in patients with major depressive disorder: investigating the mediating role of emotional reactivity and probabilistic and reinforcement learning

OBJECTIVES

Major Depressive Disorder (MDD) is a severe and widespread psychiatric condition that affects individuals globally. Suicidal ideation is one of the key symptoms associated with this disorder. Numerous studies have explored the impact of adverse childhood experiences on the development of suicidal thoughts in adulthood. However, limited research focuses on the underlying mechanisms that mediate this relationship. Therefore, the present study aimed to investigate whether emotional reactivity, along with probabilistic and reinforcement learning (PRL), serves as a mediator in the relationship between adverse childhood experiences and suicidal ideation in Iranian patients with MDD.

METHOD

The study included 201 inpatients diagnosed with MDD hospitalized in various psychiatric wards across Shiraz, Iran. Participants were selected using a convenient sampling method. Data were collected through the Probabilistic Reward Task, the Emotional Reactivity Scale, the Beck Scale of Suicidal Ideation, and the Modified Adverse Childhood Experiences - International Questionnaire. The collected data were analyzed using Pearson's correlation test and structural equation modeling with SPSS and AMOS 26.

RESULTS

Adverse childhood experiences were found to have a direct and significant relationship with suicidal ideation (p < .001). Additionally, emotional reactivity and PRL served as significant mediators in the relationship between adverse childhood experiences and suicidal ideation.

CONCLUSION

Our findings indicate that various factors-including adverse childhood experiences, emotional reactivity, and PRL-contribute to the development of suicidal ideation in patients with major depressive disorder (MDD). Therefore, it is essential to consider these factors when developing therapeutic plans.

Service Attributes and Acceptability of Digital and Nondigital Depression Management Methods Among Individuals With Depressive Symptoms: Survey Study

BACKGROUND

Academic research on digital mental health tends to focus on its efficacy and effectiveness, with much less attention paid to user preferences and experiences in real-world settings.

OBJECTIVE

This study aims to analyze service characteristics that service users value and compare the extent to which various digital and nondigital mental health treatments and management methods fulfill users' expectations.

METHODS

A total of 114 people with at least moderate levels of depressive symptoms (as measured by Patient Health Questionnaire-9 score ≥10) completed a web-based questionnaire measuring their awareness and adoption of digital mental health services and their valuation of 15 psychological service attributes, including effectiveness, credibility, waiting time, and more. They were also assessed on their expectations toward seven common mental health treatments and management methods, including (1) face-to-face psychological intervention, (2) medication, (3) guided internet-based psychological intervention, (4) face-to-face counseling service, (5) self-guided mental health apps for depression, (6) self-help bibliotherapy, and (7) psychological intervention via videoconferencing.

RESULTS

A Friedman test with a Dunn posttest showed the average importance rank of "effectiveness" was significantly higher than all other measured attributes. "Privacy," "credibility," and "cost" were ranked as equally important. Participants rated face-to-face psychological intervention the most effective management method, while other digital management methods were perceived as less effective. Medication was perceived as the least appealing method, while other methods were deemed equally appealing. Face-to-face psychological intervention, medication, and counseling were considered less satisfactory due to their higher costs and longer waiting times when compared to digital services. Repeated measures ANOVA showed some forms of management method were more likely to be adopted, including guided internet-based psychological intervention, psychological intervention via videoconferencing, face-to-face psychological intervention, and face-to-face counseling services provided by a counselor as compared to self-guided mobile apps, self-help bibliotherapy, and medication.

CONCLUSIONS

The study highlights the importance of considering multiple service attributes beyond effectiveness in depression management methods, despite effectiveness being regarded as the most crucial factor using the rank method. Compared to nondigital services, digital services were identified as having specific strengths as perceived by users. Future dissemination and promotion efforts may focus on debunking myths of guided internet-based psychological intervention as a less effective option and promoting the particular service strengths of digital services.

Adolescent Emotional Reactivity in Family and School Contexts: Prospective Links to Adolescent Psychopathology

Emotional reactivity has been linked to adolescent psychopathology and mental health problems. However, limited research has investigated the distinct associations between emotional reactivity in multiple interpersonal contexts and the development of adolescent psychopathology. The current study examined emotional reactivity to interparental conflict, parent-adolescent conflict, and school problems as predictors of adolescent internalizing problems, depressive symptoms, and anxiety symptoms six months later. The sample included 139 adolescents (54% girls; Mage = 13.30, SDage = 0.73) and their parents who completed 10-day daily reports and 6-month follow-up assessments in Taiwan. Results showed that negative emotional reactivity to interparental conflict was associated with increased internalizing problems, depressive symptoms, and anxiety symptoms, after controlling for emotional reactivity to parent-adolescent conflict and school problems, outcomes at baseline, mean negative emotions, and sex. Furthermore, the associations between both positive and negative emotional reactivity to interparental conflict and adolescent anxiety symptoms was stronger for girls than boys. Findings suggested that heightened emotional reactivity to interparental conflict is a risk factor for predicting adolescent psychopathology, especially for girls' anxiety symptoms. Results highlight the importance of emotional reactivity across multiple interpersonal contexts in adolescence.

Association of physical activity and sedentary behaviour with depressive symptoms in Chinese adults

This study aims to examine the independent and joint associations of physical activity (PA) and sedentary behaviour with depressive symptoms. A population-based cross-sectional study conducted in China included 17,861 adults. PA and sedentary behaviour were assessed using the International Physical Activity Questionnaire. Depressive symptoms were determined by the 9-item Patient Health Questionnaire score ≥10. Logistic regression models were used to calculate the odds ratios (ORs) and corresponding 95% confidence intervals (CIs). The prevalence of depressive symptoms among all participants was 20.6% (3679/17861). Higher levels of PA were inversely associated with depressive symptoms, whereas prolonged sedentary behaviour was associated with increased odds of depressive symptoms. The positive associations between sedentary behaviour and depressive symptoms remained significant, regardless of PA levels. In joint analyses, the depressive symptoms OR comparing adults who reported low level of PA with the highest tertile of sedentary behaviour to those reporting high level of PA with the lowest tertile of sedentary behaviour was 1.99 (95% CI 1.64 to 2.40). This study indicated that high level of PA may not offset the increased risk of depressive symptoms associated with high amounts of sedentary behaviour, and therefore these behaviours should be considered jointly to obtain optimal prevention effects.

Depression, anxiety, and help-seeking among Slovenian postsecondary students during the COVID-19 pandemic

Introduction

The COVID-19 pandemic has faced students with many challenges, contributing to their mental distress. This article explores the role of demographic characteristics, psychological status, year of study, and social support during the COVID-19 pandemic in explaining Slovenian university students' mental health problems and help-seeking behavior.

Methods

In February and March 2021, data were collected on 5,234 full-time Slovenian postsecondary students who were enrolled in public and concessionary independent higher education institutions. Participants completed a questionnaire, which included The Patient Health Questionnaire (PHQ-9), General Anxiety Disorder questionnaire (GAD-7), Oslo Social Support Scale (OSSS-3), and items measuring psychological status, help-seeking behavior and demographics. Data were analyzed using multiple linear regression and hypothesis testing for differences.

Results

Factors, such as gender, age, psychological status and social support, contributed to experiencing anxiety and depression among Slovenian students during the COVID-19 pandemic, with year of study additionally contributing to experiencing depression. Similarly, gender, age, psychological status and social support contributed to help-seeking behavior. Higher levels of depression and anxiety were reported by female students, students with prior mental disorders, and students with lower social support levels. Female students and students with lower social support levels reported more frequent help-seeking behaviors.

Conclusion

The results provide insight into the mental state of the Slovenian student population in the context of imposed public health measures at the end of the second COVID-19 wave in Slovenia. The findings can help identify vulnerable groups within the student population to whom we must be particularly attentive in times of crisis.

Association between bullying victimization and mental health problems among Chinese left-behind children: a cross-sectional study from the adolescence mental health promotion cohort

Background

Left-behind children (LBC) refer to those who have been separated from at least one parent for six months or more due to parental migration for work. This phenomenon poses a significant threat to the mental health of over 61 million LBC in China. This study aims to compare the prevalence of mental health symptoms between LBC and non-left-behind children (non-LBC) and to explore the predictive effect of bullying victimization on adolescent mental health problems.

Methods

In 2019, we conducted a cross-sectional analysis involving 28,036 children and adolescents in Mianyang City, Sichuan Province, China, with ages ranging from 8 to 19 years. Mental health symptoms were assessed using the 7-item Generalized Anxiety Disorder (GAD-7) scale and the 9-item Patient Health Questionnaire (PHQ-9). The Delaware Bullying Victimization Scale-Student (DBVS-S) was employed to gather data on experiences of bullying victimization. Information on self-injury was collected by inquiring whether participants had engaged in self-injurious behavior and the reasons for such behavior. Multivariable logistic regression was utilized to analyze the risk and protective factors associated with mental health symptoms, with a particular focus on different types of bullying victimization.

Results

Compared to non-left-behind children (non-LBC), left-behind children (LBC) exhibited a higher prevalence of mental health issues: anxiety symptoms (24.0% vs. 18.0%, p<0.001), depressive symptoms (27.9% vs. 19.4%, p<0.001), and self-injurious behavior (17.7% vs. 12.2%, p<0.001). Among LBC, physical bullying was identified as the most significant predictor of anxiety symptoms (OR = 1.62). Additionally, LBC who experienced verbal bullying had a higher risk of depressive symptoms (OR = 2.23) and self-injurious behaviors (OR = 1.54). Enhanced family functioning, positive teacher-student relationships, and strong peer relationships were found to offer protective effects against mental health problems.

Conclusion

Our results suggested that LBC experienced a higher incidence of mental health symptoms, particularly among those who had been victims of bullying. This underscores the urgent need for supportive strategies focused on the school environment and interpersonal relationships to mitigate negative mental health outcomes for LBC.

Association of pre-existing depression and anxiety with Omicron variant infection

Pre-existing psychiatric disorders were linked to an increased susceptibility to COVID-19 during the initial outbreak of the pandemic, while evidence during Omicron prevalence is lacking. Leveraging data from two prospective cohorts in China, we identified incident Omicron infections between January 2023 and April 2023. Participants with a self-reported history or self-rated symptoms of depression or anxiety before the Omicron pandemic were considered the exposed group, whereas the others were considered unexposed. We employed multivariate logistic regression models to examine the association of pre-existing depression or anxiety with the risk of any or severe Omicron infection indexed by medical interventions or severe symptoms. Further, we stratified the analyses by polygenic risk scores (PRSs) for COVID-19 and repeated the analyses using the UK Biobank data. We included 10,802 individuals from the Chinese cohorts (mean age = 51.1 years, 45.6% male), among whom 7841 (72.6%) were identified as cases of Omicron infection. No association was found between any pre-existing depression or anxiety and the overall risk of Omicron infection (odds ratio [OR] =1.04, 95% confidence interval [CI] 0.95-1.14). However, positive associations were noted for severe Omicron infection, either as infections requiring medical interventions (1.26, 1.02-1.54) or with severe symptoms (≥3: 1.73, 1.51-1.97). We obtained comparable estimates when stratified by COVID-19 PRS level. Additionally, using clustering method, we identified eight distinct symptom patterns and found associations between pre-existing depression or anxiety and the patterns characterized by multiple or complex severe symptoms including cough and taste and smell decline (ORs = 1.42-2.35). The results of the UK Biobank analyses corroborated findings of the Chinese cohorts. In conclusion, pre-existing depression and anxiety was not associated with the risk of Omicron infection overall but an elevated risk of severe Omicron infection, supporting the continued efforts on monitoring and possible early intervention in this high-risk population during Omicron prevalence.

The performance relationship between the EQ-5D-5L composite "Anxiety/Depression" dimension and anxiety and depression symptoms in a large, general population sample

PURPOSE

This cross-sectional study aims to understand the relationship between responses on the Anxiety/Depression (A/D) dimension of the EQ-5D-5L and symptoms of anxiety and depression on the GAD-7 and PHQ-9 instruments. In doing so, we investigate the comparative performance of the dimension between diagnostic groups (i.e. anxiety (GAD-7); depression (PHQ-9); anxiety & depression versus none). We additionally investigate the discriminatory performance between sub-populations based on gender, age, education and self-reported chronic conditions.

METHODS

19,902 general population participants completed a health survey in May/June 2020, from five European countries and the United States. Performance of A/D was calculated using the Area Under the Receiver Operating Characteristic curve (AUROC), and was compared to having anxiety (GAD-7 ≥ 8), depression (PHQ-9 ≥ 10) and both versus none for the total population and sub-populations. Several additional sensitivity analyses were conducted, including calculations of the optimal A/D cut-off.

RESULTS

The performance in the total sample was good (AUROC > 0.8) and did not differ significantly between diagnostic groups. The performance differed significantly between the age groups, with worse performance in the younger groups, and differed between those with a singular chronic condition, with worse performance in those indicating having an anxiety or depression disorder. The performance did not differ significantly by gender, education, nor total chronic conditions.

CONCLUSION

The A/D dimension captures symptoms of anxiety, depression or both equally well. Performance is worse in the younger population. Interpretation in those with a self-reported anxiety or depression disorder should be further investigated. This is the first-of-its-kind large population sample performance analysis, where we present evidence that the performance of the A/D dimension differs between ages, and thus intra-age comparative results may be flawed.

Pleasurable emotions and internalizing psychopathology: A multi-study examination of specificity and alternative explanations

OBJECTIVES

Past research has been inconclusive regarding the specificity of associations between discrete pleasurable emotions and internalizing symptoms. Contentment may be especially relevant to depression, whereas tranquillity may be especially relevant to worry. The goal of the current research was to clarify the mixed findings regarding the relation between pleasure deficits and internalizing psychopathology.

METHODS

Participants from three samples (Total N = 757) completed alternative measures of depression and pleasurable emotions. Participants in Study 1 also completed a measure of anticipatory and consummatory pleasure, and close peers to a subset of participants (N = 64) reported their perceptions of participants' depression severity. Participants in Studies 2 and 3 also completed a measure of worry.

RESULTS

Across the three samples, contentment was significantly negatively associated with self-reported depression. This association could not be accounted for by tranquillity, cheerfulness, anticipatory pleasure, or consummatory pleasure. Contentment was also strongly negatively associated with peer-reported depression. Contentment was more strongly associated with depression than was cheerfulness. However, the strength of the association between contentment and depression relative to the strength of the association between tranquillity and depression depended on how contentment and depression were measured. Conversely, tranquillity was more strongly associated with worry than were contentment or cheerfulness.

CONCLUSIONS

This study provides further evidence of the potential importance of the role of contentment in depression and tranquillity in worry. It may be useful to attend to contentment when assessing and treating depression and to attend to tranquillity when assessing and treating elevated worry.

Joint association of sedentary behavior and physical activity domains with depression in Korean adults: Cross-sectional study combining four biennial surveys (2016-2022)

Although the increased prevalence of sedentary behavior and insufficient physical activity constitutes a global public health concern, there is limited research on their effects on mental health. We investigated the combined association of sedentary behavior (daily sitting or reclining ≥10 h/day) and physical activity domains (evaluated using the Global Physical Activity Questionnaire, including occupational physical activity, leisure-time physical activity, and transportation-related physical activity) with depression (Patient Health Questionnaire-9, cutoff score: 10). This cross-sectional study utilized biennial data of 21,416 adults (age >20 years) from the Korea National Health and Nutrition Examination Survey waves 7-9 (2016-2022). Joint associations were explored by combining sedentary behavior and each physical activity domain into four levels. Sedentary behavior and occupational physical activity increased the risk of depression, leisure-time physical activity decreased the risk only in men, and transportation-related physical activity showed no significant association. Logistic regression each physical activity domain revealed, for men and women, a significantly higher risk of depression in the sedentary behavior (+)/occupational physical activity (+) group than in the sedentary behavior (-)/occupational physical activity (-) group (odds ratio: 3.05 and 2.66, respectively). The sedentary-behavior (+)/leisure-time physical-activity (-) group showed a significantly higher risk of depression than the sedentary behavior (-)/leisure-time physical activity (+) group (odds ratio: 2.50 and 2.14), and sedentary behavior (+)/transportation-related physical activity (-) group also showed a significantly higher risk of depression compared to the sedentary behavior (-)/transportation-related physical activity (+) group (odds ratio: 1.83 and 1.61). With concurrent exposure to sedentary behavior, the occupational physical activity and lack of leisure time and transportation-related physical activity synergistically increased the risk of depression. Encouraging leisure-time physical activity, minimizing rigorous occupational physical activity, and reducing sedentary behavior may reduce depressive symptoms, and research into specific domains of sedentary behavior and the quantity and quality of transportation-related physical activity is needed.

Predictive Value of Life's Crucial 9 for Cardiovascular and All-Cause Mortality: A Prospective Cohort Study From the NHANES 2007 to 2018

BACKGROUND

The predictive value of Life's Crucial 9 (LC9), a recently proposed cardiovascular health risk score combining psychological health and Life's Essential 8 (LE8), remains unclear.

METHODS AND RESULTS

In this cohort study, we included 16 290 adults without cardiovascular disease from the 2007 to 2018 cycles of NHANES (National Health and Nutrition Examination Survey). The LC9 was the mean of the LE8 score and the depression score, which represented a dimension of psychological health. The study outcomes were cardiovascular and all-cause mortality. Cox proportional hazard models were fitted to estimate the association of LC9 and LE8 scores with outcomes. The differences in Harrell's concordance index, net reclassification improvement index, and integrated discrimination improvement were calculated to assess the predictive ability of the depression score in addition to the LE8 score. During a median follow-up of 7.08 years, 879 (5.40%) participants died, and 242 (1.49%) died from cardiovascular disease. The adjusted hazard ratio (HR) of per LE8 10-score increase for cardiovascular mortality was 0.80 (95% CI, 0.72-0.88; P<0.001) and the adjusted HR of per LC9 10-score increase was 0.77 (95% CI, 0.69-0.86; P<0.001). Adding the depression score to the LE8 score, the improvement in concordance index for cardiovascular mortality was 0.001 (95% CI, -0.001 to 0.003; P=0.30), the net reclassification improvement index was 10.6% (95% CI, -7.6% to 18.9%; P=0.073), and the IDI was 0.002 (95% CI, 0.000-0.007; P=0.033). The results for all-cause mortality showed similar patterns.

CONCLUSIONS

Compared with the LE8, the improvement in the predictive value of LC9 was negligible. It may not be necessary to add a depression score to the current cardiovascular health score.

Prevalence of depressive symptoms among young adults in Brazil: Results of the 2013 and 2019 editions of the National Health Survey

OBJECTIVE

To estimate the prevalence of depressive symptoms in the population aged 18 to 24, according to socioeconomic and demographic aspects in Brazil, comparing its evolution between 2013 and 2019.

METHODS

Cross-sectional study carried out with secondary data obtained from National Health Survey 2013 and 2019. It were included 7,823 young adulthood (aged 18 to 24) from 2013 and 8,047 from 2019. The instrument used to assess depression was the Patient Health Questionnaire-9 (PHQ-9). All estimates included population weights and complex sampling.

RESULTS

The prevalence of depression almost doubled: 10.9% (95%CI 9.6-12.2) in 2019, compared to 5.6% (95%CI 4.8-6.4) in 2013, an absolute difference of 5.3% (4.5-6.0) greater. Women were the most affected in both surveys, with an increase between 2013 (8.3%; 95%CI 6.9-9.6) and 2019 (15.6%; 95%CI 13.5-17.6) higher than that of men (2013: 2.9%; 95%CI 2.0-3.8 and 2019: 6.2%; 95%CI 4.7-7.7). In both sexes, the pattern of increase was greater for the groups aged 18 to 20, not participating in religious activities, who were at the lowest levels of education and income, who lived with two or three or more people, who lived in the Northeast, Southeast, capitals and metropolitan areas of the country.

CONCLUSION

There was a significant increase in the prevalence of depressive symptoms over the six years between the two surveys. However, this increase did not occur homogeneously among the characteristics analyzed, indicating population groups and locations in Brazil where the presence of these symptoms increased most in the period.

Using Large Language Models to Detect Depression From User-Generated Diary Text Data as a Novel Approach in Digital Mental Health Screening: Instrument Validation Study

BACKGROUND

Depressive disorders have substantial global implications, leading to various social consequences, including decreased occupational productivity and a high disability burden. Early detection and intervention for clinically significant depression have gained attention; however, the existing depression screening tools, such as the Center for Epidemiologic Studies Depression Scale, have limitations in objectivity and accuracy. Therefore, researchers are identifying objective indicators of depression, including image analysis, blood biomarkers, and ecological momentary assessments (EMAs). Among EMAs, user-generated text data, particularly from diary writing, have emerged as a clinically significant and analyzable source for detecting or diagnosing depression, leveraging advancements in large language models such as ChatGPT.

OBJECTIVE

We aimed to detect depression based on user-generated diary text through an emotional diary writing app using a large language model (LLM). We aimed to validate the value of the semistructured diary text data as an EMA data source.

METHODS

Participants were assessed for depression using the Patient Health Questionnaire and suicide risk was evaluated using the Beck Scale for Suicide Ideation before starting and after completing the 2-week diary writing period. The text data from the daily diaries were also used in the analysis. The performance of leading LLMs, such as ChatGPT with GPT-3.5 and GPT-4, was assessed with and without GPT-3.5 fine-tuning on the training data set. The model performance comparison involved the use of chain-of-thought and zero-shot prompting to analyze the text structure and content.

RESULTS

We used 428 diaries from 91 participants; GPT-3.5 fine-tuning demonstrated superior performance in depression detection, achieving an accuracy of 0.902 and a specificity of 0.955. However, the balanced accuracy was the highest (0.844) for GPT-3.5 without fine-tuning and prompt techniques; it displayed a recall of 0.929.

CONCLUSIONS

Both GPT-3.5 and GPT-4.0 demonstrated relatively reasonable performance in recognizing the risk of depression based on diaries. Our findings highlight the potential clinical usefulness of user-generated text data for detecting depression. In addition to measurable indicators, such as step count and physical activity, future research should increasingly emphasize qualitative digital expression.

Isotemporal substitution of sedentary behavior with physical activity and its influence on depressive symptoms among adults with overweight/obesity in the United States: A cross-sectional study

Objective

This cross-sectional study examined the influence of sedentary behavior (SB) time substitution with physical activity (PA) on depressive symptoms among adults with overweight/obesity. SB time was replaced with equal amount of walking/bicycling or leisure-time moderate-to-vigorous PA (MVPA).

Methods

Data of the 18344 adults, who were overweight and obesity was obtained from the National Health and Nutrition Examination Survey 2006-2018. PA of participants was measured by the Global Physical Activity Questionnaire. Depressive symptoms, including overall, somatic, and cognitive depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ-9). Isotemporal substitution model based on weighted multiple linear regression was used to assess the association of SB time substitution with PA on depressive symptoms.

Results

Independent model analysis showed that 30 min/day SB time was significantly associated with higher PHQ-9 depressive symptoms, while engage in walking/bicycling or leisure-time MVPA for 30 min/day was associated with lower depressive symptoms. Isotemporal substitution analyses revealed that replacing 30 min/day SB time with equal amount of walking/bicycling or leisure-time MVPA was associated with significant lower PHQ-9 total scores (walking/bicycling: β = -0.088, 95%CI = -0.129, -0.047, P < 0.01; MVPA: β = -0.160, 95%CI = -0.185, -0.134, P < 0.01). Moreover, cognitive depressive symptoms (walking/bicycling: β = -0.035, 95%CI = -0.058, -0.013, P < 0.01; MVPA: β = -0.074, 95%CI = -0.088, -0.060, P < 0.01), and somatic depressive symptoms (walking/bicycling: β = -0.053, 95%CI = -0.075, -0.030, P < 0.01; MVPA: β = -0.085, 95%CI = -0.100, -0.071, P < 0.01) were also significantly lower after replacing SB time with either walking/bicycling or MVPA. However, replacing 30 min/day PA with SB time represented with higher depressive symptoms.

Conclusions

Replacing SB time with walking/bicycling or MVPA is beneficial in lowering the depressive symptoms among overweight/obese adults. Owing to the benefits of PA on depression, strategies promoting PA participation, are necessary for better social/mental well-being and healthy society.

Factors Influencing Health-Related Quality of Life of Patients with Spinocerebellar Ataxia

BACKGROUND

Little is known about the progression of health-related quality of life (HRQoL) and predicting factors in spinocerebellar ataxia (SCA). Such knowledge is crucial to identify modifiable factors promoting everyday life with SCA and attenuating HRQoL decline.

OBJECTIVES

This study is to assess HRQoL progression and identify factors affecting SCA patients' HRQoL.

METHODS

Longitudinal data (three-year follow-up) of 310 SCA patients of the European SCA3/Machado-Joseph-Disease Initiative (ESMI) (2016-2022) and 525 SCA patients (SCA1, SCA2, SCA3 or SCA6) of the EUROSCA natural history study cohort (2006-2015) were assessed. Both large cohort studies share standardized assessments of clinical measures, SARA, INAS, PHQ-9, and HRQoL (EQ-5D-3L). The association between HRQoL and clinical measures was assessed by Spearman Correlation (rs). Multivariable panel regression models were performed to evaluate the impact of patients' socio-demographics, age of onset, SCA type and body mass index (BMI), and clinical measures on HRQoL progression.

RESULTS

HRQoL significantly decreased over one (- 0.014, p = 0.095), two (- 0.028, p = 0.003), and three years (- 0.032, p = 0.002). Ataxia severity and mental health strongly correlated with HRQoL (rsSARA = - 0.589; rsPHQ-9 = - 0.507). HRQoL more intensively declined in male (ß = - 0.024, p = 0.038) patients with an earlier age of onset (ß = 0.002, p = 0.058). Higher progression of ataxia severity (ß = - 0.010, p ≤ 0.001), mental health problems (ß = - 0.012, p < 0.001), and higher BMI (ß = - 0.003, p = 0.029) caused more severe decline of patients' HRQoL over time.

DISCUSSION

In absence of curative treatments, stronger focus on mental health and weight influence could help clinical evaluation and accompany treatment improving SCA patients' HRQoL, especially in male patients with early disease onset.

Perceived social support and longitudinal trajectories of depression and anxiety in World Trade Center responders

PURPOSE

While severely distressing events are known to affect mental health adversely, some survivors develop only short-lived or no psychiatric symptoms in the aftermath of a disaster. In the WTC Health Program General Responder Cohort (WTCHP GRC) we examined whether social support was protective against the development of depression or anxiety symptoms after the 9/11 WTC attacks and explored in a subsample whether trait resilience moderated this relationship.

METHODS

We analyzed data from 14,033 traditional and 13,478 non-traditional responders who attended at least three periodic health monitoring visits between 2002 and 2019. Linear mixed-effects models were used to examine depression (Patient Health Questionnaire-9; PHQ-9) and anxiety (Generalized Anxiety Disorder screener; GAD-7) scores. In a subsample of 812 participants, we also assessed if the association between social support and symptoms was moderated by an individual's trait resilience level (Connor-Davidson Resilience Scale, CD-RISC).

RESULTS

For both traditional and non-traditional responders, perceived social support around 9/11 was associated with lower levels of depressive (β = - 0.24, S.E. = 0.017, z = - 14.29, p < 0.001) and anxiety symptoms (β = - 0.17, S. E. = 0.016, z = - 10.48, p < 0.001). Trait resilience scores were higher in responders with at least one source of social support during the aftermath of 9/11 compared to those without (mean 71.56, SD 21.58 vs mean 76.64, SD 17.06; β = 5.08, S.E. = 0.36, p < 0.001). Trait resilience moderated the association between social support and depressive (p < 0.001) and anxiety trajectories (p < 0.001) for traditional responders.

CONCLUSION

Our findings suggest that perceived social support around a severely distressing event may have long-term protective effects on symptoms of depression and anxiety.

Mental health symptoms among Dutch elite athletes and their coaches: a cross-sectional study

A bstract

Objective

To establish the prevalence of mental health symptoms (MHSs ) among Dutch elite athletes and their coaches, to examine the association between potential contributing factors and MHS among Dutch elite athletes and their coaches and to explore the view and needs of Dutch elite athletes and their coaches regarding mental health resources and support.

Methods

A cross-sectional study was conducted by distributing an electronic questionnaire based on validated screening questionnaires for the assessment of MHS.

Results

In total, 156 athletes (55 % female) and 95 coaches (79 % male) across various sports participated in this study. The most prevalent MHS among athletes and coaches were distress (73 % and 41 %) and alcohol misuse (52 % and 53 %). Adverse life events showed an association with anxiety, depression, sleep disturbance, alcohol misuse and disordered eating while severe injuries showed an association with distress and sleep disturbance in elite athletes. Among coaches, no significant associations were found between potential contributing factors and MHS. 60 % of the athletes and 60 % of the coaches (totally) agreed that they could openly address their mental health issues within their sport while 53 % of the athletes and 41 % of the coaches (totally) agreed a need for increased attention regarding mental health/guidance in their sport.

Conclusions

MHSs are prevalent among Dutch elite athletes and coaches. Recent adverse life events and severe injuries have a potential intersection with MHS in elite athletes. There is a need for increased attention regarding mental health/guidance among Dutch elite athletes and coaches within their sport so that subsequent treatment/support can be provided.

Quantifying the Importance of Non-Suicidal Self-Injury Characteristics in Predicting Different Clinical Outcomes: Using Random Forest Model

Existing research on non-suicidal self-injury (NSSI) among adolescents has primarily concentrated on general risk factors, leaving a significant gap in understanding the specific NSSI characteristics that predict diverse psychopathological outcomes. This study aims to address this gap by using Random Forests to discern the significant predictors of different clinical outcomes. The study tracked 348 adolescents (64.7% girls; mean age = 13.31, SD = 0.91) over 6 months. Initially, 46 characteristics of NSSI were evaluated for their potential to predict the repetition of NSSI, as well as depression, anxiety, and suicidal risks at a follow-up (T2). The findings revealed distinct predictors for each psychopathology. Specifically, psychological pain was identified as a significant predictor for depression, anxiety, and suicidal risks, while the perceived effectiveness of NSSI was crucial in forecasting its repetition. These findings imply that it is feasible to identify high-risk individuals by assessing key NSSI characteristics, and also highlight the importance of considering diverse NSSI characteristics when working with self-injurers.

Association of METS-IR index with depressive symptoms in US adults: A cross-sectional study

BACKGROUND

An association between insulin resistance (IR) and depression has been identified in recent years. The purpose of this study was to examine the relationship between IR and depression in the general population.

METHODS

The population for this cross-sectional study consisted of adults participating in the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. Insulin sensitivity was assessed using the Metabolic Score for IR (METS-IR) index, while depression was evaluated using the Patient Health Questionnaire (PHQ)-9. Logistic regression analyses, subgroup analyses, and dose-response curves were conducted to assess the association between the METS-IR index and depression.

RESULTS

A total of 13,157 adults aged over 20 years were included in this study. After adjusting for potential confounders, it was observed that each unit increase in the METS-IR index was associated with a 1.1 percentage point increase in the prevalence of depression (OR = 1.011; 95 % CI: 1.008, 1.014). Patients in the 4th quartile of the METS-IR index had a higher likelihood of depression compared to those in the 1st quartile (OR = 1.386, 95 % CI: 1.239, 1.549). Stratified analyses demonstrated consistent results in all subgroups, except for men, patients under 40 years of age, and those with a history of cancer. Dose-response curves indicated a nonlinear relationship between the METS-IR index and the risk of depression, with an inflection point value of 32.443 according to threshold effect analysis.

CONCLUSIONS

Our findings suggest that higher METS-IR scores are associated with an increased likelihood of experiencing depressive symptoms among U.S. adults.

Heterogeneous trajectories of depression and resilience following limb amputation

OBJECTIVE

To identify longitudinal trajectories of depression in the first 6 months following limb loss and to explore baseline predictors of trajectories, including pain and demographic factors. A secondary aim was to evaluate whether trajectories of depression were associated with elevated symptoms of posttraumatic stress (PTS) at 6 months.

DESIGN

Secondary longitudinal data analysis of an inception cohort study of persons with new-onset limb loss. Participants completed assessments at three intervals (initial, 3 months, and 6 months).

SETTING

Hospitalized care, acute rehabilitation, ambulatory care, and community.

PARTICIPANTS

Participants were recruited from consecutive cases of amputation surgery in a metropolitan hospital system over a period of 4 years (2002-2007). The final sample (n = 203) was predominantly White (79.3%) and male (78.8%) with an average age of 49.4 years (standard deviation [SD] = 14.6).

MAIN OUTCOME MEASURE(S)

Depression was assessed via the Patient Health Questionnaire-9 (PHQ-9); posttraumatic stress symptoms were measured via the PTSD checklist- Civilian Version (PCL-C).

RESULTS

Four trajectories of depression were identified via Latent Growth Mixture Modeling: Resilience (73.2%), Chronic Depression (11.2%), Emerging Depression (8.9%), and Recovery (6.7%). Average pain intensity significantly predicted trajectory membership. Membership in the Chronic Depression class predicted elevated 6-month PTS compared to all other classes; membership in the Resilience class predicted lower PTS than in the Chronic and Emerging Depression classes but did not differentiate from the Recovery trajectory.

CONCLUSIONS

Findings reveal that the course of depression post-amputation is heterogenous, with varying profiles of symptom development, maintenance, and remission. A majority of individuals were classified as Resilient, whereas a substantial minority of individuals developed clinically significant depression between 3 and 6 months (Emerging Depression), suggesting that early screening during acute care may be insufficient. We detected a significant prospective relation between depression trajectories and distal PTS, advancing the potential clinical utility of trajectory modeling as a risk surveillance tool.

Substance use and mental health factors associated with self-reported higher risk cannabis use among people with HIV screened in primary care

Background

While cannabis use is prevalent among people with HIV (PWH), factors associated with higher-risk use require further study. We examined factors associated with indicators risk for cannabis use disorder (CUD) among PWH who used cannabis.

Methods

Participants included adult (≥18 years old) PWH from 3 HIV primary care clinics in Kaiser Permanente Northern California who reported past three-month cannabis use through the computerized Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) screening. Primary outcome was TAPS cannabis score (range 1-3), categorized as any use (1) and higher risk for CUD (≥2). Measures included sociodemographics (age, sex, race, neighborhood deprivation index [NDI]), Charlson Comorbidity Index (CCI), HIV RNA, CD4 cell counts, higher risk tobacco use (TAPS tobacco score≥2), depression, and anxiety symptoms. Unadjusted and multivariable logistic regression examined factors associated with higher risk for CUD.

Results

Of the complete sample (N=978; 94.1% Male; 58.3% White; Age Mode=51-60), 35.8% reported higher risk for CUD. Unadjusted models indicated younger age, Black race, higher CCI, depression, anxiety, and higher risk tobacco use were associated with higher risk, while only Black race (OR=1.84, 95% CI[1.29, 2.63]), anxiety (OR=1.91, 95% CI[1.22, 2.98]), and higher risk tobacco use (OR=2.27, 95% CI[1.47, 3.51]) remained significant in the multivariable model.

Conclusions

Black race, anxiety and tobacco use, but not HIV clinical markers, were associated with higher risk for CUD among PWH. Clinical efforts to screen and provide interventions for preventing CUD alongside anxiety and tobacco use among PWH should be evaluated.

Comorbid depression among adults with heart failure in Ethiopia: a hospital-based cross-sectional study

BACKGROUND

Depression is a common comorbidity in adults with heart failure. It is associated with poor clinical outcomes, including decreased health-related quality of life and increased morbidity and mortality. There is a lack of data concerning the extent of this issue in Ethiopia. Consequently, this study aimed to assess the prevalence of comorbid depression and associated factors among adults living with heart failure in Ethiopia.

METHODS

A hospital-based cross-sectional study was conducted at the cardiac outpatient clinics of two selected specialist public hospitals in Addis Ababa, Ethiopia: St. Paul's Hospital Millennium Medical College and St. Peter Specialized Hospital. An interviewer-administered questionnaire was used to collect data from 383 adults with heart failure who attended the clinics and met the inclusion criteria. Depression was measured using the Patient Health Questionnaire (PHQ-9). A binary logistic regression model was fitted to identify factors associated with depression. All statistical analyses were conducted using STATA version 17 software.

RESULTS

The mean age of the participants was 55 years. On average, participants had moderate depression, as indicated by the mean PHQ-9 score of 11.02 ± 6.14, and 217 (56.6%, 95%CI 51.53-61.68) had comorbid depression. Significant associations with depression were observed among participants who were female (AOR: 2.31, 95%CI:1.30-4.08), had comorbid diabetes mellitus (AOR: 3.16, 95%CI: 1.47-6.82), were classified as New York Heart Association (NYHA) class IV (AOR: 3.59, 95%CI: 1.05-12.30), reported poor levels of social support (AOR: 6.04, 95%CI: 2.97-12.32), and took more than five medications per day (AOR: 5.26, 95%CI: 2.72-10.18).

CONCLUSIONS

This study indicates that over half of all adults with heart failure in Ethiopia have comorbid depression, influenced by several factors. The findings have significant implications in terms of treatment outcomes and quality of life. More research in the area, including interventional and qualitative studies, and consideration of multifaceted approaches, such as psychosocial interventions, are needed to reduce the burden of comorbid depression in this population.

Prevalence and associated factors of common mental disorders among internally displaced people by armed conflict in Cabo Delgado, Mozambique: a cross-sectional community-based study

Background

Humanitarian emergencies are a major global health challenge with the potential to have a profound impact on people's mental and psychological health. Displacement is a traumatic event that disrupts families and affects physical and psychological health at all ages. A person may endure or witness a traumatic incident, such as being exposed to war, and, as a result, develop post-traumatic stress disorder (PTSD). There is a lack of information about post-traumatic stress disorder, depression, and anxiety disorder in low and middle-income countries in humanitarian emergency contexts such as Mozambique. This study aimed to assess the prevalence of PTSD, depression, and anxiety, and associated factors among armed conflict survivors in Cabo Delgado, north region of Mozambique in 2023.

Methods

A community-based cross-sectional study was conducted between January and April 2023 among 750 participants, who were selected by convenience. A face-to-face interview used the Primary Care Post-Traumatic Stress Disorder Checklist (PC-PTSD-5) to evaluate PTSD, the Generalized Anxiety Disorder Scale (GAD-7) to evaluate anxiety and the Patient Health Questionnaire - Mozambique (PHQ-9 MZ) to evaluate depression. The association between PTSD and demographic and psychosocial characteristics was analyzed using bivariate and multivariable binary logistic regression. We used a 5% significance level.

Results

The three mental disorders assessed were highly prevalent in our sample with 74.3% PTSD, 63.8% depression, and 40.0% anxiety. The chance of developing PTSD was higher in females (AOR = 2.30, 95% CI 1.50-3.51), in patients with depression symptoms (AOR = 8.27, 95% CI = 4.97-13.74) and anxiety symptoms (AOR = 1.45, 95% CI = 0.84-2.50).

Conclusion

This study reported that the prevalence of PTSD, depression, and anxiety were high. Patients having depressive symptoms, anxiety symptoms, and being female are more at risk of developing PTSD. There is a need to integrate screening for common mental disorders in the context of humanitarian emergencies and its adapted integration of psychosocial interventions.

Unraveling the associations between unhealthy lifestyle behaviors and mental health in the general adult Chinese population: A cross-sectional study

BACKGROUND

This study examined the cumulative risk of unhealthy lifestyle behaviors and the associations between overall lifestyle and common mental disorders (CMDs), insomnia, stress, health-related quality of life (HRQOL), and functional impairment. Additionally, the treatment preferences for managing CMDs and insomnia were examined.

METHODS

A survey was conducted on 1487 Chinese Hong Kong adults, assessing their lifestyle behaviors (i.e., diet and nutrition, substance use, physical activity, stress management, restorative sleep, social support, and environmental exposures), mental health-related outcomes, and treatment preferences via a vignette.

RESULTS

The findings revealed significant additive relationships between the number of 'worse' lifestyle domains and the risk of all outcomes. A healthier overall lifestyle was significantly associated with reduced risks of all outcomes (AORs = 0.88 to 0.93). Having healthier practices in diet and nutrition, substance use, stress management, restorative sleep, and social support domains were significantly associated with lower risks of all outcomes (AORs = 0.93 to 0.98), except that substance use was not significantly associated with stress. Physical activity was inversely associated with only depressive symptoms (AOR = 0.98), anxiety symptoms (AOR = 0.99), and stress (AOR = 0.99). Environmental exposures were not significantly associated with functional impairment but with all other outcomes (AORs = 0.98 to 0.99). Besides, lifestyle interventions (55 %) were significantly more preferred for managing CMDs and insomnia relative to psychotherapy (35.4 %) and pharmacotherapy (9.6 %).

CONCLUSIONS

Our findings underscore the importance of considering lifestyle factors when managing CMDs, insomnia, stress, HRQOL, and functional impairment, with a particular emphasis on adopting a multicomponent treatment approach.

Mental health effects associated with COVID-19 financial assistance in South Korea: a comparison of employment status

BACKGROUND

COVID-19 has created tensions across different sectors of the society, but the impact has been unequal. Vulnerable people have been most affected, especially those with insecure employment and who have experienced economic hardships due to unemployment and lost wages. The combination of social change and economic hardships due to the pandemic increases the risk of poor mental health. Some countries have utilized financial assistance to alleviate economic hardships caused by COVID-19, and in South Korea, the central and local governments have implemented COVID-19 financial assistance. This study analysed the impact of financial assistance on mental health associated with working status during the COVID-19 pandemic in South Korea.

METHODS

The participants of this study were randomly selected from residents of Gyeonggi-do after being proportionally allocated by resident registration population status. A total of 1,000 adult males and females aged 19 years or older in Gyeonggi-do who received financial assistance from the central and local governments were selected. A retrospective pre-post-study design was applied, and mental health surveys including the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-item scale (GAD-7) were applied.

RESULTS

The results show that depression scores averaged 5.5 and anxiety scores averaged 4.4 before COVID-19 Financial Assistance. It is similar to the national average of 5.1 and 4.5 respectively at that time. After the assistance, depression scores dropped to 4.5, and anxiety scores dropped to 3.2. Before the assistance, depression and anxiety were higher among temporary day labourers with less job security, and they showed the most significant improvement in mental health. For full-time workers, there was no significant change in anxiety or depression after receiving the assistance.

CONCLUSIONS

Financial assistance can provide material resources and also positively affect mental health. In particular, it had a greater impact on the relatively vulnerable groups, such as those in unstable employment.

Depression and anxiety among cancer patients visiting a tertiary care cancer hospital

BACKGROUND

Cancer patients frequently experience psychological problems related to reactions to cancer diagnosis, cancer type and stage, treatment effects, recurrence, fear of end-of-life, survivorship, and financial burden. Depression and anxiety are both psychological and physiological disturbances among cancer patients.

AIM

To assess the prevalence of depression and anxiety among cancer patients attending a tertiary care cancer hospital.

METHODS

A cross-sectional study was conducted at Bhaktapur Cancer Hospital in Kathmandu Valley among 220 cancer patients aged from 18 years to 70 years. Ethical approval was taken from the Institutional Review Committee of CiST College. Convenient sampling was used to interview patients with the standardized Patient-Health Questionnaire (PHQ-9) for Depression and Hospital Anxiety and Depression sub-scale (HADS-A) for anxiety. Epi-Data was used for data entry and transferred to SPSS Version 25 for analysis.

RESULTS

The study revealed that of 220 patients, most of the respondents belonged to the age group 51-60 years. More than half 131 (59.6%) of the respondents were female, most of them had depression, and one-third had anxiety. Among the respondents, 124 (56.4%) had mild depression, 70 (31.8%) had moderate depression, and 3 (1.3%) had severe depression; 79 (35.9%) had mild anxiety, 64 (29.1%) had moderate anxiety, and 4 (1.8%) had severe anxiety.

CONCLUSION

Most respondents were depressed and one-third had anxiety. More than half and nearly one-third had mild and moderate depression, respectively, and nearly one-third had mild and moderate anxiety, which is higher than other studies.

A Narrative Review of Self-Reported Scales to Evaluate Depression and Anxiety Symptoms in Adult Obstructive Sleep Apnea Patients

Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent chronic condition that has been associated with mental disorders like depression and anxiety. This study intends to provide a practical overview of the most relevant self-reported and self-rating scales that assess depression and anxiety in OSA patients. Materials and Methods: A search for articles was performed using PubMed, Google Scholar, and Semantic Scholar using a combination of words for obstructive sleep apnea, depression, anxiety, and scales. The tools were ordered by type (screening and rating) and arranged chronologically according to the year of publication. Results: Three scales were identified for assessing depression, which were the Center for Epidemiologic Studies Depression Scale (CES-D), the Hospital Anxiety and Depression Scale (HADS-D), and the Patient Health Questionnaire-9 (PHQ-9). For rating depression, two scales were discussed: the Zung Self-Rating Depression Scale (SDS) and the Beck Depression Inventory (BDI), which has three versions (the BDI, the BDI-II, and the Fast Screen (BDI-FS)). For assessing anxiety, the Generalized Anxiety Disorder-7 (GAD-7) scale was identified. Two scales were reviewed for rating anxiety: the State-Trait Anxiety Inventory (STAI) and the Beck Anxiety Inventory (BAI). Each scale is accompanied by a brief description of its practicality and psychometric qualities and an analysis of its strengths and limitations. Conclusions: The findings of this review will contribute to the understanding of the importance of assessing mental health comorbidities in the context of OSA, ultimately guiding clinical practice and future research in this area.

Detecting major depressive disorder presence using passively-collected wearable movement data in a nationally-representative sample

Major Depressive Disorder (MDD) is a heterogeneous disorder, resulting in challenges with early detection. However, changes in sleep and movement patterns may help improve detection. Thus, this study aimed to explore the utility of wrist-worn actigraphy data in combination with machine learning (ML) and deep learning techniques to detect MDD using a commonly used screening method: Patient Health Questionnaire-9 (PHQ-9). Participants (N = 8,378; MDD Screening = 766 participants) completed the and wore Actigraph GT3X+ for one week as part of the National Health and Nutrition Examination Survey (NHANES). Leveraging minute-level, actigraphy data, we evaluated the efficacy of two commonly used ML approaches and identified actigraphy-derived biomarkers indicative of MDD. We employed two ML modeling strategies: (1) a traditional ML approach with theory-driven feature derivation, and (2) a deep learning Convolutional Neural Network (CNN) approach, coupled with gramian angular field transformation. Findings revealed movement-related features to be the most influential in the traditional ML approach and nighttime movement to be the most influential in the CNN approach for detecting MDD. Using a large, nationally-representative sample, this study highlights the potential of using passively-collected, actigraphy data for understanding MDD to better improve diagnosing and treating MDD.

An empirical comparison of statistical methods for multiple cut-off diagnostic test accuracy meta-analysis of the Edinburgh postnatal depression scale (EPDS) depression screening tool using published results vs individual participant data

BACKGROUND

Selective reporting of results from only well-performing cut-offs leads to biased estimates of accuracy in primary studies of questionnaire-based screening tools and in meta-analyses that synthesize results. Individual participant data meta-analysis (IPDMA) of sensitivity and specificity at each cut-off via bivariate random-effects models (BREMs) can overcome this problem. However, IPDMA is laborious and depends on the ability to successfully obtain primary datasets, and BREMs ignore the correlation between cut-offs within primary studies.

METHODS

We compared the performance of three recent multiple cut-off models developed by Steinhauser et al., Jones et al., and Hoyer and Kuss, that account for missing cut-offs when meta-analyzing diagnostic accuracy studies with multiple cut-offs, to BREMs fitted at each cut-off. We used data from 22 studies of the accuracy of the Edinburgh Postnatal Depression Scale (EPDS; 4475 participants, 758 major depression cases). We fitted each of the three multiple cut-off models and BREMs to a dataset with results from only published cut-offs from each study (published data) and an IPD dataset with results for all cut-offs (full IPD data). We estimated pooled sensitivity and specificity with 95% confidence intervals (CIs) for each cut-off and the area under the curve.

RESULTS

Compared to the BREMs fitted to the full IPD data, the Steinhauser et al., Jones et al., and Hoyer and Kuss models fitted to the published data produced similar receiver operating characteristic curves; though, the Hoyer and Kuss model had lower area under the curve, mainly due to estimating slightly lower sensitivity at lower cut-offs. When fitting the three multiple cut-off models to the full IPD data, a similar pattern of results was observed. Importantly, all models had similar 95% CIs for sensitivity and specificity, and the CI width increased with cut-off levels for sensitivity and decreased with an increasing cut-off for specificity, even the BREMs which treat each cut-off separately.

CONCLUSIONS

Multiple cut-off models appear to be the favorable methods when only published data are available. While collecting IPD is expensive and time consuming, IPD can facilitate subgroup analyses that cannot be conducted with published data only.

Risk and Preventive Factors for Depressive Symptoms Among Older Chilean Adults During the SARS-CoV-2 Outbreak: A Longitudinal Study

OBJECTIVE

To specifically examine the multiple factors related to the increase in depressive symptoms during the COVID-19 outbreak in older adults in Chile.

METHOD

A longitudinal study was conducted using a dataset from a nationally representative survey cohort of Chilean older adults followed at three time points during the COVID-19 outbreak. The main outcome was depressive symptoms (Patient Health Questionnaire scale). The independent variables included: age, sex, educational level, geographic area, living alone, self-perceived health, self-reported resilience, loneliness, and social isolation.

RESULTS

A total of 424 older adults were included. Female sex (β = 0.95, 95% CI: 0.22 to 1.68) and loneliness (β = 1.21, 95% CI: 1.05 to 1.37) were the main risk factors for an increase in depressive symptoms in older adults. In contrast, living outside the metropolitan region (β=-0.70, 95% CI: -1.39 to -0.02), living in company (β=-0.34, 95% CI:-1.24 to 0.56), having better self-perceived health (β=-5.04, 95% CI:-6.33 to -3.75) and greater resilience (β=-0.30, 95% CI: -0.38 to -0.23) were preventive factors.

CONCLUSION

These results provide useful evidence to develop mental health prevention or control strategies for older adults.

CLINICAL IMPLICATIONS

The findings highlight the importance of a holistic approach to health care for older adults that integrates strategies to address loneliness, foster resilience, and promote an active social life.

Exploring the association between depression and diabetes among type 1 and type 2 diabetic mellitus patients: A cross-sectional study in Gujarat, India

Background

Depression and anxiety are common among patients with diabetes mellitus and it affects the control of diabetes negatively. Depression is the third leading reason for the most disability-adjusted life years. Once depression coexists with diabetes mellitus, it is related to major health consequences and ends up in poor health outcomes.

Aim

The study aimed to estimate the prevalence of depression in diabetes mellitus people and to find an association of depressive symptoms with sociodemographic and clinical predictors among patients with diabetes mellitus attending follow-ups at the general public hospital, in western Gujarat.

Materials and Methods

It is an institutional-based cross-sectional study conducted among people living with diabetes mellitus at Tertiary Hospitals, Urban Health Training Center, and Rural Health Training Center. The study period was from January 2023 to May 2023. Data were collected using a structured questionnaire. Depression was assessed by the Patient Health Questionnaire 9. The collected data were cleaned, edited, entered into MS Excel (2006), and analyzed using SPSS software (version 26). A P value of <0.05 was considered statistically significant.

Results

A total of 380 study participants were included in this study. Among 380 participants, 282 (74%) were having depressive symptoms. Of 282, 61 (21.6%) have mild depressive symptoms, 106 (37.5%) have moderate symptoms, 111 (39%) have moderately severe symptoms, and four (1.4%) have severe symptoms. Of 380 participants, 221 (58%) have clinical depression (moderate, moderately severe, and severe symptoms). Variables significantly associated with depression were marital status, number of family members, socio-economic status, type of diabetes mellitus, treatment given, presence of comorbidities, and duration of diabetes more than 5 years.

Conclusion

The present study has shown a considerably higher amount of depression in diabetic participants. So, healthcare professionals should consider screening for depression using the Patient Health Questionnaire 9 or other validated tools in all diabetic patients, especially in those who are at a higher risk.

Comparison of Delivery of Care Before and During COVID-19 Within an Academic Outpatient Psychiatry Practice

Introduction: The COVID-19 pandemic has challenged outpatient mental health clinics. This article compares care delivery and patient characteristics before and during the COVID-19 pandemic in outpatient mental health clinics within an academic health system. Methods: A retrospective cohort study was conducted in patients who received outpatient psychiatric services at two clinics (A and B). The investigators compared care delivery with patients with mental health conditions prepandemic (January 1-December 31, 2019) and midpandemic (January 1-December 31, 2020) periods. Care delivery was defined as the number and type of new and return visits (telehealth and face-to-face visits), patients with recorded measurement-based care (MBC) outcomes, and communication capability between patients and providers. Results: During the prepandemic period, 6,984 patients were seen in Clinics A and B, resulting in 57,629 visits. In the midpandemic period, 7,110 patients were served, resulting in 61,766 total visits. Medication management visits increased from 2019 to 2020; number of visits with documented outcome measures increased by 90% in Clinic A and 15% in Clinic B. The number of MyChart messages per patient increased more than twofold during the midpandemic period. The number of new visits with primary diagnosis of anxiety disorders increased in CY2020 and the number of visits with primary diagnosis of major depressive/mood disorders decreased in CY2020. Payor mix did not vary between the two periods although there was variability between payor mix at the two primary clinic locations. Discussion: The study suggests that there was no detrimental impact on access to care between the prepandemic and midpandemic periods within the health system. Mental health visits while pivoting to telehealth increased during the midpandemic period. Transition to telepsychiatry improved the ability to administer and document MBC.

Lifetime and current depression in the German National Cohort (NAKO)

OBJECTIVES

The present study introduces the assessment of depression and depressive symptoms in the German National Cohort (NAKO), a population-based mega cohort. Distribution of core measures, and associations with sociodemographic factors are examined.

METHODS

The current analysis includes data from the first 101,667 participants (NAKO data freeze 100,000). Depression and depressive symptoms were assessed using a modified version of the depression section of the Mini-International Neuropsychiatric Interview (MINI), self-reported physician's diagnosis of depression, and the depression scale of the Patient Health Questionnaire (PHQ-9).

RESULTS

A lifetime physician's diagnosis of depression was reported by 15.0% of participants. Of those, 47.6% reported having received treatment for depression within the last 12 months. Of the subset of 26,342 participants undergoing the full depression section of the modified MINI, 15.9% were classified by the MINI with a lifetime depressive episode. Based on the PHQ-9, 5.8% of the participants were classified as currently having a major or other depression by the diagnostic algorithm, and 7.8% according to the dimensional assessment (score ≥ 10). Increased frequency of depression measures and higher depression scores were observed in women and participants with lower education level or a family history of depression.

CONCLUSIONS

The observed distributions of all depression measures and their associations with sociodemographic variables are consistent with the literature on depression. The NAKO represents a valuable epidemiologic resource to investigate depression, and the range of measures for lifetime and current depression allows users to select the most suitable instrument for their specific research question.

Racial, ethnic, and age disparities in the association of mental health symptoms and polysubstance use among persons in HIV care

We characterized polysubstance use burden and associations with mental health problems across demographic subgroups of PWH. In 2018-2020, as part of a primary care-based intervention study, PWH in care at three medical centers in Kaiser Permanente Northern California were screened for depression (PHQ-9≥10), anxiety (GAD-2≥3), and substance use (Tobacco, Alcohol, Prescription medication, and other Substance use [TAPS]≥1 per substance). We used Poisson regression to estimate prevalence ratios (PRs) comparing polysubstance use prevalence (TAPS≥1 for ≥2 substances) between PWH with positive screens for depression or anxiety vs. neither, among all PWH, and stratified by race/ethnicity and age (restricted to men), adjusting for sociodemographics, CD4, and HIV load. Screened PWH (N = 2865) included 92% men, 56% White, 19% Black, and 15% Hispanic PWH, with a median age of 55 years. Overall, polysubstance use prevalence was 26.4% (95% CI 24.9%-28.1%). PWH with depression or anxiety (n = 515) had an adjusted polysubstance use PR of 1.26 (1.09-1.46) vs. PWH with neither (n = 2350). Adjusted PRs were 1.47 (1.11-1.96), 1.07 (0.74-1.54), and 1.10 (0.85-1.41) among Black, Hispanic, and White men, respectively. Adjusted PRs did not differ by age group. Interventions should consider jointly addressing mental health and substance use problems and potential drivers, e.g. stigma or socioeconomic factors.

Screening for Psychological Distress in Healthcare Workers Using Machine Learning: A Proof of Concept

The purpose of this study was to train and test preliminary models using two machine learning algorithms to identify healthcare workers at risk of developing anxiety, depression, and post-traumatic stress disorder. The study included data from a prospective cohort study of 816 healthcare workers collected using a mobile application during the first two waves of COVID-19. Each week, the participants responded to 11 questions and completed three screening questionnaires (one for anxiety, one for depression, and one for post-traumatic stress disorder). Then, the research team selected two questions (out of the 11), which were used with biological sex to identify whether scores on each screening questionnaire would be positive or negative. The analyses involved a fivefold cross-validation to test the accuracy of models based on logistic regression and support vector machines using cross-sectional and cumulative measures. The findings indicated that the models derived from the two questions and biological sex accurately identified screening scores for anxiety, depression, and post-traumatic stress disorders in 70% to 80% of cases. However, the positive predictive value never exceeded 50%, underlining the importance of collecting more data to train better models. Our proof of concept demonstrates the feasibility of using machine learning to develop novel models to screen for psychological distress in at-risk healthcare workers. Developing models with fewer questions may reduce burdens of active monitoring in practical settings by decreasing the weekly assessment duration.