Negative and positive mental health characteristics of affected family members: Findings from a cross-sectional Australian general population gambling study

Despite the impact of problem gambling on affected family members (AFMs), there are limited large-scale population level studies identifying the negative mental health (NMH) and positive mental health (PMH) characteristics of AFMs. Furthermore, no study has explored whether PMH characteristics are protective in the relationships between AFM status and NMH characteristics. This study involved secondary data analysis from the Third Social and Economic Impact Study of Gambling in Tasmania. Using a subsample of 1,869 adults (48.30 % male; meanage = 48.48; 4.67 % AFMs), this study aimed to explore whether: (1) AFM status is associated with NMH (depression, anxiety, panic, post-traumatic stress disorder, social anxiety, binge drinking, tobacco use, and drug use symptoms) and PMH (quality of life [QOL], personal growth/autonomy, interpersonal/social skills, coping skills) characteristics after separately controlling for sociodemographic, problem gambling severity, and other NMH characteristics; (2) PMH characteristics moderate (buffer) the relationships between AFM status and NMH characteristics; and (3) gender influences these relationships. AFM status, defined as exposure to family member gambling problems, significantly positively predicted NMH characteristics (depression, anxiety, panic, PTSD, and tobacco use symptoms) and negatively predicted QOL (physical, social) and planning coping. The strength of these relationships generally attenuated after controlling for various covariates. Gender did not moderate these relationships. Religious coping exacerbated the relationship between AFM status and panic disorder symptoms. These findings can inform the development of intervention initiatives for family members exposed to gambling problems. Future population-representative research is required using a range of affected other types, longitudinal study designs, and more comprehensive measures.

The Influence of Pandemic-Related Worries During Pregnancy on Child Development at 12 Months

The COVID-19 pandemic has been linked to increased risk for perinatal anxiety and depression among parents, as well as negative consequences for child development. Less is known about how worries arising from the pandemic during pregnancy are related to later child development, nor if resilience factors buffer negative consequences. The current study addresses this question in a prospective longitudinal design. Data was collected from a sub-study (n = 184) of a longitudinal study of pregnant individuals (total n = 1173). During pregnancy (April 17-July 8, 2020) and the early postpartum period (August 11, 2020-March 2, 2021), participants completed online surveys. At 12 months postpartum (June 17, 2021-March 23, 2022), participants completed online surveys and a virtual laboratory visit, which included parent-child interaction tasks. We found more pregnancy-specific pandemic worries were prospectively related to lower levels of child socioemotional development based on parent report (B = - 1.13, SE = .43, p = .007) and observer ratings (B = - 0.13, SE = .07, p = .045), but not to parent-reported general developmental milestones. Parental emotion regulation in the early postpartum period moderated the association between pregnancy-specific pandemic worries and child socioemotional development such that pregnancy-specific pandemic worries did not relate to worse child socioemotional development among parents with high (B = - .02, SE = .10, t = - .14, p = .89) levels of emotion regulation. Findings suggest the negative consequences of parental worry and distress during pregnancy on the early socioemotional development of children in the context of the COVID-19 pandemic. Results highlight that parental emotion regulation may represent a target for intervention to promote parental resilience and support optimized child development.

Investigating the Role of Second Chance Schools and COVID-19 Pandemic on the Mental Health and Self-Image of Greek Adult Students

COVID-19 has globally impacted both physical and mental health. This study aimed to explore the impact of Second Chance Schools (SCS) and the COVID-19 pandemic on the mental health and self-image of Greek SCS students. A total of 251 SCS students from two consecutive study cycles participated, completing the research instruments at the beginning and end of their studies. Participants' anxiety, depressive symptomatology, well-being, self-esteem and self-efficacy were evaluated by means of the GAD-7, PHQ-8, WHO-5 Well-being Index, Rosenberg Self-Esteem Scale and Generalized Self-Efficacy Scale, respectively. The research spanned three years, including a year of universal lockdown, a year with protective measures and a year without anti-COVID-19 measures. Factor analysis, regression analyses and two two-way repeated measures ANOVAs were applied to the collected data. All five psychological dimensions measured by the study's instruments were grouped into two factors, namely mental health and self-image. Well-being positively influenced mental health, while anxiety and depression had a negative impact. On the other hand, self-efficacy and self-esteem positively contributed to self-image. Mental health and self-image were moderately correlated. Pre-SCS values of mental health and self-image predicted a higher percentage of variance in post-SCS values compared to anxiety, depression, well-being, self-efficacy and self-esteem. Moreover, mental health improved after the completion of SCS, but only for participants after the lifting of anti-COVID-19 measures. Conversely, self-image improved for all participants regardless of the presence of anti-COVID-19 measures. Overall, the SCS had a considerable impact on the participants' mental health and self-image, although the effect was influenced by COVID-19.

Factor structure of the patient health questionnaire-4 in adults with attention-deficit/hyperactivity disorder

Background

Persons with attention-deficit/hyperactivity disorder (ADHD) frequently experience symptoms of anxiety and depression. In this population, there is a need for validated brief self-report screening questionnaires to assess the severity of comorbid mental health problems. The Patient Health Questionnaire 4 (PHQ-4) is a self-report questionnaire that may contribute to this purpose as it can screen for both disorders efficiently. However, this will be the first study examining the factor structure of the PHQ-4 in samples of adults with ADHD, and also evaluating the validity of the Norwegian version of the PHQ-4.

Objectives

The aim of the current cross-sectional study was to examine the factor structure and validity of the Norwegian version of the PHQ-4 in a sample of adults who reported having been diagnosed with ADHD.

Methods

Of 496 invited, a total of 326 participants (66%) completed the PHQ-4, The World Health Organization Five Well-Being Index, the Oslo Social Support Scale and the 4-item Perceived Stress Scale electronically in a web-portal between the 9th and 30th of June 2020.

Results

Confirmatory factor analysis of the PHQ-4 supported a two-factor structure [RMSEA = 0.038 (90% CI 0.000-0.159), CFI = 1.00, TLI = 0.999, SRMR = 0.004], consisting of a depression factor and an anxiety factor. Standardized factor loadings were 0.79 to 0.97. The PHQ-4 was negatively correlated with well-being and social support and positively correlated with perceived level of stress.

Conclusion

This study indicates promising psychometric properties of the PHQ-4 as a measure of anxiety and depressive symptoms in adults with self-reported ADHD who are fluent in Norwegian. The questionnaire's brevity makes it a valuable resource in research and clinical settings. However, more studies are needed to test the instrument in a clinical sample.

Two-step screening for depressive symptoms in patients treated with kidney replacement therapies: a cross-sectional analysis

BACKGROUND

Systematic screening for depressive symptoms may identify patients who may benefit from clinical assessment and psychosocial support. Here we assess a two-step screening using ultrabrief pre-screeners [Edmonton Symptom Assessment Survey-revised Depression item (ESASr-D) or Patient Health Questionnaire-2 (PHQ-2)] followed by the Patient-Reported Outcomes Measurement Information System Depression questionnaire (PROMIS-D) to identify depressive symptoms in patients on kidney replacement therapies.

METHODS

We conducted a cross-sectional study of adults (kidney transplant recipients or treated with dialysis) in Toronto, ON, Canada. We simulated various two-step screening scenarios where only patients above a pre-screening cut-off score on the ESASr-D or PHQ-2 would move to step 2 (PROMIS-D). Screening performance was evaluated by sensitivity, specificity and positive and negative predictive values using the Patient Health Questionnaire-9 (PHQ-9) as the referent. The average number of items completed by patients in different scenarios was reported.

RESULTS

Of 480 participants, 60% were male with a mean age of 55 years. Based on PHQ-9, 19% of patients had moderate or severe depressive symptoms. Pre-screening with a PHQ-2 score ≥1 combined with a PROMIS-D score of ≥53 provided the best two-step results (sensitivity 0.81, specificity 0.84, NPV 0.95). Two-step screening also reduces question burden.

CONCLUSIONS

A two-step screening using a PHQ-2 score ≥1 followed by a PROMIS-D score ≥53 has good sensitivity and specificity for identifying potentially significant depressive symptoms among patients on kidney replacement therapies. This approach has lower question burden. Screened-in patients will need further clinical assessment to establish a diagnosis.

The mental health of international university students from China during the COVID-19 pandemic and the protective effect of social support: A longitudinal study

BACKGROUND

During the COVID-19 pandemic Chinese international students were reported to experience racism, food security issues and social isolation. However, no study has investigated the prevalence of these issues and the potential for worsening mental health in this population group during the pandemic. Therefore, this study aimed to examine the effect of this pandemic on the mental health of Chinese international students living in Australia and China, and the protective effect of social support.

METHODS

Data were extracted from a survey of Australian university students (April-June 2019) and follow-up during the pandemic (Sept-Oct 2020). The prevalence of anxiety, major depression and pandemic-related stressors was reported. Multivariable logistic regression was used to assess the association between country of residence, social support (baseline/follow-up), and follow-up self-reported mental health.

RESULTS

With the pandemic, there was a substantial increase in the prevalence of anxiety (24.7 % vs 45.7 %) and major depression (22.1 % vs 43.8 %). Major depression was less likely to be reported by international students in China (34.8 %) than in Australia (46.3 %). Students with high social support during the pandemic were less likely to report major depression (Adjusted OR:0.15 [95 % CI 0.06,0.34]), although this effect was not observed longitudinally (Adjusted OR:1.03 [95 % CI 0.58,1.83]).

LIMITATION

Post pandemic improvement in mental health cannot be assessed.

CONCLUSION

The pandemic appeared to have had a strong negative effect on Chinese international university students' mental health. Those living in Australia were more likely to experience poorer mental health, highlighting the need for increased support to this group.

Informing Use of the Patient Health Questionnaire-2 to Detect Moderate or Greater Depression Symptoms in Adolescents and Young Adults in Outpatient Primary Care

OBJECTIVE

We compared the Patient Health Questionnaire (PHQ)-2 to the PHQ-9 and examined the implications of using various cutoff scores on the PHQ-2 to detect moderate or greater depressive symptoms on the PHQ-9. We hypothesized that a cutoff score of ≥2 would be optimal for detecting scores of ≥10 on the PHQ-9.

METHODS

Demographic and depression screening data from 3,256 routine preventive visits for patients aged 12-25 years at the adolescent and young adult clinic at Children's Hospital Colorado between March 2017 and July 2019 were collected retrospectively. Patients completed routine depression screening at 2,183 visits which were included for analysis. PHQ-2 scores and PHQ-9 scores were calculated for each included patient visit. Associations between different PHQ-2 cutoff scores and moderate or greater depressive symptoms on the PHQ-9 (≥10) were evaluated.

RESULTS

A PHQ-2 score ≥2 had a sensitivity of 89% and specificity of 83% for detecting patients with moderate or greater depressive symptoms on the PHQ-9. On a receiver operating characteristic curve, a PHQ-2 cutoff of ≥2 optimized sensitivity and specificity. Analysis of gender and ethnic/racial subgroups demonstrated the same optimal cutoff score for each group studied. For patients aged 21 years and older a PHQ-2 cutoff of ≥3 was most accurate.

DISCUSSION

Lowering the positive PHQ-2 cutoff to ≥2 has several clinical advantages, including increased detection of moderate or greater depressive symptoms and depressive disorders. Providers may increase identification of depression by making this change particularly if they follow a positive PHQ-2 with a full PHQ-9.

The Influence of Pandemic-Related Worries During Pregnancy on Child Development at 12 Months

The COVID-19 pandemic has been linked to increased risk for perinatal anxiety and depression among parents, as well as negative consequences for child development. Less is known about how worries arising from the pandemic during pregnancy are related to later child development, nor if resilience factors buffer negative consequences. The current study addresses this question in a prospective longitudinal design. Data was collected from a sub-study ( n  = 184) of a longitudinal study of pregnant individuals (total n  = 1,173). During pregnancy (April 17-July 8, 2020) and the early postpartum period (August 11, 2020-March 2, 2021), participants completed online surveys. At 12 months postpartum (June 17, 2021-March 23, 2022), participants completed online surveys and a virtual laboratory visit, which included parent-child interaction tasks. We found more pregnancy-specific pandemic worries were prospectively related to lower levels of child socioemotional development based on parent report (B=-1.13, SE = .43, p  = .007) and observer ratings (B=-0.13, SE = .07, p  = .045), but not to parent-reported general developmental milestones. Parental emotion regulation in the early postpartum period moderated the association between pregnancy-specific pandemic worries and child socioemotional development such that pregnancy-specific pandemic worries did not related to worse child socioemotional development among parents with high (B=-.02, SE = .10, t=-.14, p = .89) levels of emotion regulation. Findings suggest the negative consequences of parental worry and distress during pregnancy on the early socioemotional development of children in the context of the COVID-19 pandemic. Results highlight that parental emotion regulation may represent a target for intervention to promote parental resilience and support optimized child development.

A novel electronic patient-reported outcome delivery system to implement health-related quality of life measures in routine clinical care: An analysis of 5 years of experience

Objective

To develop a simple and secure technological solution to incorporate electronic patient-reported outcomes (ePROs) into routine clinical care.

Methods

A novel ePRO questionnaire delivery system was developed by Software for Specialists (S4S) in partnership with OPAL Rheumatology Australia. Validated questionnaires were sent from the electronic medical record (EMR) (Audit4) of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), lupus or giant cell arteritis (GCA) and delivered to the patient's email address or completed in the clinic waiting room using a smart device (in-practice). Completed questionnaires were encrypted and returned to the patient's Audit4. Deidentified clinical data was extracted and aggregated across all sites. Data collected between April 2016-Dec 2020 were analysed descriptively.

Results

Between April 2016 to Dec 2020, 221,352 Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F), Patient Health Questionnaire-2 (PHQ-2) and/or HealthCare Resource Utilization (HCRU) questionnaires were sent from 39 of 42 contributing clinics (93%). 85% of questionnaires were delivered via email and 15% in-practice. Overall, 85% of patients completed at least one questionnaire, and of all questionnaires sent, 73% were completed. Females were more likely to engage with the questionnaires than males (87% vs. 81%), and older patients were slightly more likely to complete all questionnaires delivered.

Conclusions

The novel Audit4 ePRO delivery system is an effective tool for incorporating PROs into routine clinical care. The data generated provides a unique opportunity to understand the full burden of disease for patients in the real-world setting and the impact of interventions.

The impact of fatigue on mortality of patients with non-alcoholic fatty liver disease: Data from National Health and nutrition examination survey 2005-2010 and 2017-2018

OBJECTIVE

Fatigue among patients with NAFLD may negatively impact their health-related quality of life and clinical outcomes (mortality). We determined fatigue prevalence and its association with all-cause mortality among patients with NAFLD.

DESIGN

NHANES 2005-2010 and 2017-2018 data were used with linked mortality data. NAFLD was defined by fatty liver index for NHANES 2005-2010 and by transient elastography for NHANES 2017-2018. Fatigue was assessed by Patient Health Questionnaire.

RESULTS

NHANES 2005-2010 cohort (n = 5429, mean age 47.1 years, 49.7% male, 69.9% white), 37.6% had NAFLD. Compared to non-NAFLD controls, fatigue was more common in NAFLD (8.35% vs 6.0%, p = .002). Among NHANES 2017-2018 cohort (n = 3830, mean age 48.3 years, 48.6% male, 62.3% white), 36.9% had NAFLD. Compared to non-NAFLD controls, fatigue was more common among NAFLD (8.7% vs 6.2%). NAFLD had more sleep disturbance (34.0% vs 26.7%), cardiovascular disease (CVD) (10.7% vs. 6.3%), significant hepatic fibrosis (liver stiffness>8.0 kPa, 17.9% vs 3.5%) and advanced hepatic fibrosis (>13.1 kPa, 5.4% vs 0.9%; all p < .003). The presence of depression (OR: 11.52, 95% CI: 4.45-29.80, p < .0001), CVD (OR: 3.41, 95% CI: 1.02-11.34, p = .0462) and sleep disturbance (OR: 2.00, 95% CI: 1.00-3.98, p = .0491) was independently associated with fatigue; good sleep quality (OR: 0.58, 95% CI: 0.35-0.96, p = .0366) had an inverse association. By multivariable Cox model, NAFLD adults with fatigue experienced 2.3-fold higher mortality than NAFLD without fatigue (HR: 2.31, 95% CI: 1.37-3.89, p = .002).

CONCLUSIONS

Fatigue among those with NAFLD is associated with increased risk for mortality and is mainly driven by depression, sleep disturbance and CVD. These findings have important clinical implications.

Pre- and intraoperative cerebral near-infrared spectroscopy and postoperative delirium: Results of a prospective cross-sectional trial

Postoperative delirium (PODE) is a serious complication that can occur during the first few days after surgery. A number of causes can make delirium more likely; one factor to consider is hypoxia during anesthesia. In this study, the pre- and intraoperative cerebral regional oxygen saturation (rSO2) as measured by near-infrared spectroscopy (NIRS) was to be examined with regard to an association with the occurrence of PODE in patients undergoing major abdominal procedures. Data from 80 patients (33 women, 47 men) was examined. The mean age was 66.31 ± 10.55 years (between 42 and 84 years). Thirteen patients developed PODE. The preoperative rSO2 values (P = .10) and the rSO2 values during the steady state of anesthesia (P = .06) tended to be lower in the delirium group than in the non-delirium group. There was a significant correlation between the preoperative rSO2 and the preoperative hemoglobin values (P < .001). The variance of rSO2 during the steady state of anesthesia was significantly greater in the delirium group compared to the non-delirium group (P = .03). In two patients from the delirium group, rSO2 dropped below 50%; they also had a minimum mean arterial pressure below 50 mm Hg, which could have disturbed cerebral autoregulation. The duration of rSO2 decreases (>10%, >15%, >20%) and increases (>10%) compared to the preoperative values was not significantly different between patients with and without PODE. The results suggest that NIRS could be a useful monitoring method for patients undergoing abdominal surgical procedures, on the one hand to recognize patients with low pre- or intraoperative rSO2 values, and on the other hand to detect changes in rSO2 values during anesthesia.

Status of Cardiovascular Health in US Adults and Children Using the American Heart Association's New "Life's Essential 8" Metrics: Prevalence Estimates From the National Health and Nutrition Examination Survey (NHANES), 2013 Through 2018

BACKGROUND

The American Heart Association recently published an updated algorithm for quantifying cardiovascular health (CVH)-the Life's Essential 8 score. We quantified US levels of CVH using the new score.

METHODS

We included individuals ages 2 through 79 years (not pregnant or institutionalized) who were free of cardiovascular disease from the National Health and Nutrition Examination Surveys in 2013 through 2018. For all participants, we calculated the overall CVH score (range, 0 [lowest] to 100 [highest]), as well as the score for each component of diet, physical activity, nicotine exposure, sleep duration, body mass index, blood lipids, blood glucose, and blood pressure, using published American Heart Association definitions. Sample weights and design were incorporated in calculating prevalence estimates and standard errors using standard survey procedures. CVH scores were assessed across strata of age, sex, race and ethnicity, family income, and depression.

RESULTS

There were 23 409 participants, representing 201 728 000 adults and 74 435 000 children. The overall mean CVH score was 64.7 (95% CI, 63.9-65.6) among adults using all 8 metrics and 65.5 (95% CI, 64.4-66.6) for the 3 metrics available (diet, physical activity, and body mass index) among children and adolescents ages 2 through 19 years. For adults, there were significant differences in mean overall CVH scores by sex (women, 67.0; men, 62.5), age (range of mean values, 62.2-68.7), and racial and ethnic group (range, 59.7-68.5). Mean scores were lowest for diet, physical activity, and body mass index metrics. There were large differences in mean scores across demographic groups for diet (range, 23.8-47.7), nicotine exposure (range, 63.1-85.0), blood glucose (range, 65.7-88.1), and blood pressure (range, 49.5-84.0). In children, diet scores were low (mean 40.6) and were progressively lower in higher age groups (from 61.1 at ages 2 through 5 to 28.5 at ages 12 through 19); large differences were also noted in mean physical activity (range, 63.1-88.3) and body mass index (range, 74.4-89.4) scores by sociodemographic group.

CONCLUSIONS

The new Life's Essential 8 score helps identify large group and individual differences in CVH. Overall CVH in the US population remains well below optimal levels and there are both broad and targeted opportunities to monitor, preserve, and improve CVH across the life course in individuals and the population.

Update of the standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population

INTRODUCTION

PHQ-4, consisting of PHQ-2 and GAD-2, is a widely used screening instrument for depressive and anxiety symptoms in clinical settings and in epidemiological studies. In the present study we provide an update of normative data from the German general population.

METHODS

Data was collected in two randomly selected samples representative of the German general population in 2020 (N = 2503) and 2021 (N = 2519). We computed percentile norm values for the total sample (N = 5022) and for different age groups, stratified by gender.

RESULTS

Compared to previous data, only minor changes in normative values were observed. 95 %-thresholds were at a score of 6-7 for the PHQ-4, and 3-4 for PHQ-2 and GAD-2 respectively. The scales showed acceptable reliability with McDonald's omega of ω = 0.77 for PHQ-2, ω = 0.78 for GAD-2, and ω = 0.85 for PHQ-4.

LIMITATIONS

Lack of a diagnostic gold standard and suboptimal response proportion (44.2 %) are limitations of this study.

CONCLUSION

This update supports the continued use of PHQ-4 scales as reliable instruments. For psychometric application, the reported normative data for PHQ-2, GAD-2 and PHQ-4 facilitates more up-to-date comparisons.

Diagnostic accuracy of the Patient Health Questionnaire 2 (PHQ-2) in Qatar’s primary care settings

This cross-sectional study was designed to establish diagnostic accuracy of the Patient Health Questionnaire 2 in Qatar’s primary care population. The data required for the study were anonymously extracted from Qatar’s primary care electronic medical record system. The sensitivity, specificity, predictive values, negative values and optimal cut-off points were calculated for the tool. A total of 6921 individuals met the study’s inclusion criteria. The diagnostic accuracy of cut-off values was calculated for scores 1–6. Based on the Youden’s index (0.58), a score of 2 was identified as the most optimal cut-off. It offers a sensitivity of 88.73% and specificity of 69.31%. Further studies should aim to confirm the results using alternative study designs and to report them in accordance to population characteristics both in Qatar and internationally.

Clinician-reported childbirth outcomes, patient-reported childbirth trauma, and risk for postpartum depression

Childbirth trauma is common and increases risk for postpartum depression (PPD). However, we lack brief measures to reliably identify individuals who experience childbirth trauma and who may be at greater prospective risk for PPD. To address this gap, we used data from a racially diverse prospective cohort (n=1082). We collected survey data during pregnancy and at 12 weeks postpartum, as well as clinician-reported data from medical records. A new three-item measure of patient-reported childbirth trauma was a robust and independent risk factor for PPD, above and beyond other known risk factors for PPD, including prenatal anxiety and depression. Cesarean birth, greater blood loss, and preterm birth were each associated with greater patient-reported childbirth trauma. Finally, there were prospective indirect pathways whereby cesarean birth and higher blood loss were related to higher patient-reported childbirth trauma, in turn predicting greater risk for PPD. Early universal postpartum screening for childbirth trauma, targeted attention to individuals with childbirth complications, and continued screening for depression and anxiety can identify individuals at risk for PPD. Such efforts can inform targeted interventions to improve maternal mental health, which plays a vital role in infant development.

Factor Structures of Patient Health Questionnaire-9 Instruments in Exploring Depressive Symptoms of Suburban Population

BACKGROUND

This study aims to examine the psychometric properties of the nine-item Patient Health Questionnaire (PHQ-9) and assess the relationship between the PHQ-9 domain and demographics and health behaviors in Vietnamese people.

MATERIALS AND METHODS

The PHQ9 was administered to 899 participants. Exploratory factor and reliability analyses were performed. Tobit regression and Ordered logistic regression were further performed to determine factors associated with the PHQ-9 score and characteristics of depression.

RESULTS

The 2-factor model of PHQ-9, including factor 1 "Somatic" and factor 2 "Cognitive/Affective," showed good psychometric properties. The Cronbach's alpha value showed high internal consistency in two factors (0.84 and 0.80, respectively). Gender, health behavior exercising, drinking, and health status had associations with both factors of the PHQ-9 model.

CONCLUSION

The PHQ-9 scale is a valid and reliable instrument to assess depression in the Vietnam population. This scale can be a useful screening tool for depression; however, further validation studies in other populations are required.

Sexual Desire, Depressive Symptoms and Medication Use Among Women With Fibromyalgia in Flanders

Background

Fibromyalgia (FM) is associated with sexual dysfunction, though much less is known about the sexual desire, and especially dyadic and solitary sexual desire, among women with fibromyalgia.

Aim

To investigate on the one hand the global sexual desire, the dyadic sexual and solitary sexual desire, and on the other hand the association with depressive symptoms, fibromyalgia symptoms and medication use among women with fibromyalgia in Flanders, Belgium.

Methods

An online survey was spread through the Flemish league for Fibromyalgia Patients to be completed by women with fibromyalgia. The sexual desire inventory-2 (SDI-2) was used to measure sexual desire (global, dyadic, solitary), the VASFIQ for fibromyalgia symptoms, and the PHQ-2 for depressive symptoms, while also including questions on demographic factors (time since FM, age) and medication usage (antidepressants, pain medication, sleeping medication).

Main Outcome Measure

Global sexual desire, dyadic sexual desire and solitary sexual desire were studied in relation to depressive symptoms, medication use and fibromyalgia symptoms.

Results

One hundred and three women with FM answered the survey. Depressive symptoms were significantly associated with a lower global, dyadic and solitary sexual desire, as was the use of antidepressant medication. The association between solitary sexual desire and depressive symptoms disappeared when controlled for antidepressant medication. Age, fibromyalgia symptoms nor time since diagnosis were significantly associated with any form of sexual desire.

Conclusion

Depressive symptoms and antidepressant medication, and not fibromyalgia symptoms, were associated with decreased sexual desire of women with FM. As antidepressant medication and depressive symptoms are associated with a decreased sexual desire, more attention should be paid towards the mental health issues associated with fibromyalgia, as well as the prescription of antidepressant medication. This study is the first to investigate sexual desire among women with fibromyalgia in Flanders, and one of the few internationally to have done so. It is limited by its cross-sectional design, and for not providing information on men with FM.

Van Overmeire R, Vesentini L, Vanclooster S, et al. Sexual Desire, Depressive Symptoms and Medication Use Among Women With Fibromyalgia in Flanders. Sex Med 2022;10:100457.

A retrospective multisite examination of depression screening practices, scores, and correlates in pediatric diabetes care

Psychosocial guidelines recommend routine screening of depressive symptoms in adolescents and young adults (AYA) with diabetes. Best practices for screening in routine care and patient characteristics associated with depressive symptoms require further investigation. The purpose of this study was to examine psychometric properties of the Patient Health Questionnaire (PHQ-2 and PHQ-9); document rates of depressive symptoms and related clinical actions; and evaluate associations with patient characteristics. The Patient Health Questionnaire (PHQ-2 or PHQ-9) was administered at five pediatric academic medical centers with 2,138 youth with type 1 diabetes. Screening was part of routine clinical care; retrospective data from electronic health records were collected for the first screening date as well as 12 months prior. The PHQ demonstrated good psychometric properties. Evaluation of item-level PHQ-9 data identified 5.0% of AYA with at least moderate depressive symptoms who would not have been flagged for further screening using the PHQ-2 only. On the PHQ-9, 10.0% of AYA with type 1 diabetes endorsed elevated depressive symptoms and 7.0% endorsed thoughts of self-harm. Patients with moderate or greater depressive symptoms had a 43.9% documented referral rate for mental health treatment. Higher BMI, older age, public insurance, shorter diabetes duration, higher HbA1C, and a diabetic ketoacidosis (DKA) event in the past year were associated with depressive symptoms. The PHQ-9 identified AYA with elevated depressive symptoms that would not have been identified using the PHQ-2. Depressive symptoms were associated with negative diabetes indicators. To improve referral rates, standardized methods for provision and documentation of referrals are needed.

Burnout and presenteeism among healthcare workers in Nigeria: Implications for patient care, occupational health and workforce productivity

Background: Burnout and presenteeism are two emerging occupational health challenges which share same locus among healthcare workers, and the trend is rising. We aim to define the magnitude of burnout and presenteeism among frontline members of the health workforce and explore any correlation between the two in order to provide empirical data from our socioeconomic and geographical background.

Design and Methods: We used self-administered questionnaire to conduct a cross-sectional study among the physicians and nurses in a regional trauma centre in Enugu, Eastern Nigeria; with the respondents selected by stratified random sampling. The Oldenburg burnout inventory and Stanford presenteeism scale were used to measure burnout and presenteeism respectively, while the 2-item patient-health questionnaire (PHQ-2) was used to screen for depression. The level of statistical significance was determined by a p value of <0.05.

Results: Among the healthcare workers surveyed (n=155); 34 (21.9%) were physicians, while 121 (78.1%) were nurses. Burnout prevalence was 69%. Burnout was associated with self-rated health status and length of years in professional service but not the occupation or depression screen status of the worker. Sixty-two healthcare workers (40%) screened positive for depression. A positive screen for depression was the only factor that had significant association with lower presenteeism scores (p=0.002). The mean presenteeism scores had strong negative correlation with both the exhaustion (p<0.001) and disengagement (p<0.001) domains of burnout.

Conclusion: Burnout is high among the healthcare workers and correlates with presenteeism scores. The mental health of the workforce greatly impaired their productivity.

Intraoperative monitoring parameters and postoperative delirium: Results of a prospective cross-sectional trial

Postoperative delirium (PODE) can be associated with severe clinical complications; therefore, preventive measures are important. The objective of this trial was to elucidate whether haemodynamic or electroencephalographic (EEG) monitoring parameters during general anaesthesia or sevoflurane dosage correlate with the incidence of PODE. In addition, sevoflurane dosages and EEG stages during the steady state of anaesthesia were analyzed in patients of different ages.Eighty adult patients undergoing elective abdominal surgery received anaesthesia with sevoflurane and sufentanil according to the clinical routine. Anaesthesiologists were blinded to the EEG. Haemodynamic parameters, EEG parameters, sevoflurane dosage, and occurrence of PODE were analyzed.Thirteen patients (4 out of 33 women, 9 out of 47 men) developed PODE. Patients with PODE had a greater mean arterial pressure (MAP) variance (267.26 (139.40) vs 192.56 (99.64) mmHg2, P = .04), had a longer duration of EEG burst suppression or suppression (27.09 (45.32) vs 5.23 (10.80) minutes, P = .03), and received higher minimum alveolar sevoflurane concentrations (MAC) (1.22 (0.22) vs 1.09 (0.17), P = .03) than patients without PODE. MAC values were associated with wide ranges of EEG index values representing different levels of hypnosis.The results suggest that, in order to prevent PODE, a great variance of MAP, higher doses of sevoflurane, and deep levels of anaesthesia should be avoided. Titrating sevoflurane according to end-tidal gas monitoring and vital signs can lead to unnecessarily deep or light hypnosis. Intraoperative EEG monitoring may help to prevent PODE.

Depression reported by US adults in 2017-2018 and March and April 2020

BACKGROUND

Coronavirus disease 2019 (COVID-19) and the associated social distancing and lockdown restrictions are expected to have substantial and enduring mental health effects. In this study, we aimed to assess depression levels before and during the COVID-19 pandemic in the United States.

METHODS

We used the Patient Health Questionnaire-2 (PHQ-2) brief screening instrument to detect probable depression in two nationally representative surveys of US adults. Pre-pandemic levels of depression were assessed in a sample of 5,075 adults from the 2017-2018 National Health and Nutrition Examination Survey (NHANES). Depression was assessed in March (N = 6,819) and April 2020 (N = 5,428) in the Understanding America Study, a representative sample of the US population.

RESULTS

The percentage of US adults with depression increased significantly from 8.7% (95% CI[7.6%-9.8%]) in 2017-2018 to 10.6% (95% CI[9.6%-11.6%) in March 2020 and 14.4% (95% CI[13.1%-15.7%]) in April 2020. Statistically significant increases in depression levels were observed for all population subgroups examined with the exception of those aged 65+ years and Black participants. Young adults (aged 18-34) experienced a marked increase in depression of 13.4 percentage points (95% CI [9.5%-17.2%]) that was larger than any other age group. Additional analyses of depression trends in NHANES from 2007/2008-2017/2018 showed that the substantial increase in depression in April 2020 was unlikely to be due to typical year-to-year variation.

CONCLUSIONS

Our findings suggest that depression levels have risen substantially during the COVID-19 pandemic and reinforce recent findings indicating that young adults may be particularly vulnerable to the mental health effects of the pandemic.

Validity and Reliability of the Computer-Administered Routine Opioid Outcome Monitoring (ROOM) Tool

OBJECTIVE

The Routine Opioid Outcome Monitoring (ROOM) tool measures outcomes with opioids using an established framework which includes domains such as pain, mood, opioid use disorder, alcohol use, and constipation. This study aims to validate and establish the test-retest reliability of the computer-administered ROOM tool.

DESIGN AND SETTING

Cross-sectional analysis of an online sample.

SUBJECTS

Participants comprised those with chronic noncancer pain who regularly used prescription opioids.

METHODS

Participants self-completed the online ROOM tool along with other validated measures (validation questionnaire), and those who were agreeable also completed the online test-retest questionnaire approximately two weeks later. Subcomponents of the ROOM tool (i.e., pain, mood, alcohol use, opioid use disorder, and constipation) were validated against longer measures of the same construct using Pearson correlation coefficients. Intraclass correlation coefficients were used to assess the stability of the ROOM tool over time.

RESULTS

A total of 324 participants completed the validation questionnaire, of whom 260 also completed the test-retest questionnaire. The opioid use disorder domain showed good sensitivity (73.6) and specificity (75.8) against the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, any opioid use disorder. All ROOM components showed moderate correlation (r = 0.55-0.73) with their longer counterparts. Test-retest reliability was fair (0.58-0.75), indicating that responses were relatively stable over time. Reliability did vary, however, based on the components being measured and how certain tools were scored.

CONCLUSION

The computer-administered ROOM tool is a valid approach for brief monitoring of outcomes with prescribed opioids in primary care settings and appears to be acceptable to people who are using prescribed opioids for chronic pain.

Validation of the Patient Health Questionnaire-2 to screen for depression in Canadian Armed Forces personnel

Post-deployment screening within the Canadian Armed Forces (CAF) aims to capture those with mental health issues so that appropriate and timely treatment can be provided. However, the process is lengthy and places considerable burden on CAF members and clinicians. Evaluation of shorter measures of mental health is an important step toward reducing the length of the process while still capturing those in need of care. This study evaluated the 2-item Patient Health Questionnaire (PHQ-2) as a potential brief measure of depression to be included in screening. Operating characteristics of the PHQ-2 were assessed against the full scale using existing recommended cutoffs, as well as clinician impressions of depression being of major concern. Correlations of the PHQ-2 with other measures of health were also examined. The PHQ-2 demonstrated good sensitivity and specificity for detecting depression compared to the full scale and to clinician impressions, at cutoffs similar to those found in past research. As well, it exhibited high correlations with other measures of mental health. This study provides evidence for the validity of the PHQ-2 as a brief screening tool for depression in CAF members following deployment.

Symptoms of Burnout Among Surgeons Are Correlated with a Higher Incidence of Perceived Medical Errors

BACKGROUND

Nearly 44% of practicing physicians in the USA report symptoms of burnout. Psychological distress and loss of joy in medicine are associated with malpractice lawsuits and attrition from medical practice and may correlate with the rate of perceived medical errors.

QUESTIONS/PURPOSES

We sought to answer two questions: (1) What physician factors are associated with the number of perceived medical errors among practicing surgeons in the prior 3 months? (2) What characteristics are associated with symptoms of burnout among practicing surgeons?

METHODS

We created a cross-sectional survey and invited members of the Science of Variation Group to respond between December 2018 and January 2019. Participating surgeons completed the Abbreviated Maslach Burnout Inventory, the two-item Patient Health Questionnaire (PHQ-2), and information about practice characteristics and demographics. We created a negative binomial and a multivariable linear regression model to seek factors independently associated with the number of perceived medical errors and symptoms of burnout.

RESULTS

A greater level of emotional exhaustion was associated with a greater number of perceived medical errors, while practice location in Europe was associated with fewer perceived errors. A higher PHQ-2 score was independently associated with symptoms of burnout.

CONCLUSION

It is possible that symptoms of burnout cause surgeons to be more likely to perceive an imperfection as an error or that burnout distracts surgeons, contributing to a greater likelihood of a verifiable error. Additional studies are merited to investigate a potential causal relationship between symptoms of burnout and medical errors.

The Disproportionate Burden of the COVID-19 Pandemic Among Pregnant Black Women

The COVID-19 pandemic has disproportionately impacted the well-being of vulnerable populations in the US, including Black people. The impact on pregnant women is of special concern for the intrauterine and post-natal development of their offspring. We evaluated in an online survey a sample of 913 pregnant women, 216 Black, 571 White, 126 Other, during a 2-week stay-at-home mandate in the Philadelphia region. We applied logistic regression models and analysis of covariance to examine general and pregnancy-specific worries and negative consequences arising from the COVID-19 pandemic, symptoms of anxiety and depression, and resilience. Black pregnant women reported greater likelihood of having their employment negatively impacted, more concerns about a lasting economic burden, and more worries about their prenatal care, birth experience, and post-natal needs. In the full sample, 11.1% of women met screening criteria for anxiety and 9.9% met criteria for depression. Black women were more likely to meet criteria for depression than White women, but this difference was not significant accounting for covariates. Resilience factors including self-reliance and emotion regulation were higher in Black women. Racial disparities related to COVID-19 in pregnant women can advance the understanding of pregnancy related stressors and improve early identification of mental health needs.

Examination of the best cut-off points of PHQ-2 and GAD-2 for detecting depression and anxiety in Italian cardiovascular inpatients

OBJECTIVE

Despite the frequent association between anxiety, depression and cardiovascular diseases (CVD), cardiovascular inpatients are not usually screened for these psychopathological conditions. To fill this gap, especially in hospital environments, there is the need of brief screening instruments that provide reliable information in a very short time. According to this need, the aim of this study was to examine the best cut-off points of two brief and easy-to-use questionnaires in a sample of Italian cardiovascular inpatients: the 2-item Patient Health Questionnaire (PHQ-2) and the 2-item Generalized Anxiety Disorder (GAD-2).

DESIGN

3500 cardiovascular inpatients were recruited and completed both the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Disorder (GAD-7). PHQ-2 and GAD-2 were then obtained extracting the first two item from PHQ-9 and GAD-7.

MAIN OUTCOME MEASURES

The PHQ-2 and GAD-2 psychometric properties were calculated comparing them with PHQ-9 and GAD-7, respectively.

RESULTS

The PHQ-2 threshold of ≥ 2 and the GAD-2 threshold of ≥ 3 are the best solutions in balancing between sensitivity and specificity, also providing acceptable rates of false positives and false negatives.

CONCLUSIONS

the PHQ-2 and GAD-2 Italian versions showed good diagnostic features for measuring depression and anxiety in CVD patients.

Evaluating resilience as a predictor of outcomes in lung transplant candidates

BACKGROUND

Resilience represents the capacity to adapt to adversity. Resilience can improve following behavioral interventions. We examined lung transplant candidates' resilience as a novel predictor using the Connor-Davidson Resilience Scale (RISC-10).

METHODS

Waitlisted candidates at six centers were mailed questionnaires from 9/16/2015 to 10/1/2019. Follow-up surveys were collected annually and post-transplant. Outcomes were recorded through February 17, 2020. Primary outcome was pre-transplant death/delisting. Analyses included t test or chi-square for group comparisons, Pearson's correlation coefficients for strength of relationships, and Cox proportional-hazard models to evaluate associations with outcomes, adjusting for age, sex, and mood.

RESULTS

Participation was 55.3% (N = 199). Baseline RISC-10 averaged 32.0 ± 5.6 and did not differ by demographics, primary transplant diagnosis, or disease severity markers. RISC-10 did not correlate to the commonly utilized Psychosocial Assessment of Candidates for Transplant [PACT] or Stanford Integrated Psychosocial Assessment for Transplantation [SIPAT] tools. Scores < 26.3 (representing > 1 standard deviation below population average) occurred in 16% and were associated with pre-transplant death or delisting, adjusted Hazard Ratio of 2.60 (95% Confidence Interval 1.23-5.77; P = .01).

CONCLUSION

One in six lung candidates had low resilience, predicting increased pre-transplant death/delisting. RISC-10 did not correlate with PACT or SIPAT; resilience may represent a novel risk factor.

Resilience, COVID-19-related stress, anxiety and depression during the pandemic in a large population enriched for healthcare providers

COVID-19 pandemic is a global calamity posing an unprecedented opportunity to study resilience. We developed a brief resilience survey probing self-reliance, emotion-regulation, interpersonal-relationship patterns and neighborhood-environment, and applied it online during the acute COVID-19 outbreak (April 6-15, 2020), on a crowdsourcing research website ( www.covid19resilience.org ) advertised through social media. We evaluated level of stress (worries) regarding COVID-19: (1) contracting, (2) dying from, (3) currently having, (4) family member contracting, (5) unknowingly infecting others with (6) experiencing significant financial burden following. Anxiety (GAD7) and depression (PHQ2) were measured. Totally, 3042 participants (n = 1964 females, age range 18-79, mean age = 39) completed the resilience and COVID-19-related stress survey and 1350 of them (mean age = 41, SD = 13; n = 997 females) completed GAD7 and PHQ2. Participants significantly endorsed more distress about family contracting COVID-19 (48.5%) and unknowingly infecting others (36%), than getting COVID-19 themselves (19.9%), p < 0.0005 covarying for demographics and proxy COVID-19 exposures like getting tested and knowing infected individuals. Patterns of COVID-19 related worries, rates of anxiety (GAD7 > 10, 22.2%) and depression (PHQ2 > 2, 16.1%) did not differ between healthcare providers and non-healthcare providers. Higher resilience scores were associated with lower COVID-19 related worries (main effect F1,3054 = 134.9; p < 0.00001, covarying for confounders). Increase in 1 SD on resilience score was associated with reduced rate of anxiety (65%) and depression (69%), across healthcare and non-healthcare professionals. Findings provide empirical evidence on mental health associated with COVID-19 outbreak in a large convenience sample, setting a stage for longitudinal studies evaluating mental health trajectories following COVID-19 pandemic.

The Unmet Supportive Care Needs of Arab Australian and Arab Jordanian Cancer Survivors: An International Comparative Survey

BACKGROUND

Research exploring the unmet supportive care needs of Arab cancer survivors is limited, with most conducted with immigrant groups. No study has compared the unmet supportive care needs of immigrant Arab cancer survivors with Arab cancer survivors living in their native country.

OBJECTIVE

To explore the unmet supportive care needs of both Arab Australian and Arab Jordanian cancer survivors.

METHODS

Arab people living in Sydney, Australia, and Amman, Jordan, and diagnosed with cancer within the last 5 years were invited to complete a questionnaire that measured unmet supportive care needs, depression, and language acculturation. Multiple regression analysis was performed to identify predictors of unmet supportive care needs.

RESULTS

Seventy-seven Arab Jordanian and 66 Arab Australian cancer survivors were recruited. Australian participants were older than their Jordanian counterparts (61.5 vs 52.3 years; P < .001) and reported higher levels of overall unmet needs (44.9 vs 36.1; P = .012). Controlling for age and stage of cancer diagnosis, higher levels of depression (β = .34) and living in Australia (β = .26) were significant predictors of unmet needs and explained almost 17% of the variance.

CONCLUSIONS

These findings have extended our understanding of the unmet supportive care needs of Arab cancer survivors and confirm disparities in unmet needs in immigrant populations.

IMPLICATIONS FOR PRACTICE

Greater attention is needed to ensure the supportive care needs are met for immigrant patients with cancer. Additional strategies to address physical and psychological needs are particularly needed in this group.

Swipe-based dating applications use and its association with mental health outcomes: a cross-sectional study

Background

Swipe-Based Dating Applications (SBDAs) function similarly to other social media and online dating platforms but have the unique feature of “swiping” the screen to either like or dislike another user’s profile. There is a lack of research into the relationship between SBDAs and mental health outcomes.

The aim of this study was to study whether adult SBDA users report higher levels of psychological distress, anxiety, depression, and lower self-esteem, compared to people who do not use SBDAs.

Methods

A cross-sectional online survey was completed by 437 participants. Mental health (MH) outcomes included the Kessler Psychological Distress Scale, Generalised Anxiety Disorder-2 scale, Patient Health Questionnaire-2, and Rosenberg Self-Esteem Scale. Logistic regressions were used to estimate odds ratios of having a MH condition. A repeated measures analysis of variance was used with an apriori model which considered all four mental health scores together in a single analysis. The apriori model included user status, age and gender.

Results

Thirty percent were current SBDA users. The majority of users and past users had met people face-to-face, with 26.1%(60/230) having met > 5 people, and only 22.6%(52/230) having never arranged a meeting. Almost 40%(39.1%; 90/230) had previously entered into a serious relationship with someone they had met on a SBDA. More participants reported a positive impact on self-esteem as a result of SBDA use (40.4%; 93/230), than a negative impact (28.7%;66/230).

Being a SBDA user was significantly associated with having psychological distress (OR = 2.51,95%CI (1.32–4.77)), p = 0.001), and depression (OR = 1.91,95%CI (1.04–3.52), p = 0.037) in the multivariable logistic regression models, adjusting for age, gender and sexual orientation. When the four MH scores were analysed together there was a significant difference (p = 0.037) between being a user or non-user, with SDBA users having significantly higher mean scores for distress (p = 0.001), anxiety (p = 0.015) and depression (p = 0.005). Increased frequency of use and longer duration of use were both associated with greater psychological distress and depression (p < 0.05).

Conclusion

SBDA use is common and users report higher levels of depression, anxiety and distress compared to those who do not use the applications. Further studies are needed to determine causality and investigate specific patterns of SBDA use that are detrimental to mental health.

Sequential screening for depression in humanitarian emergencies: a validation study of the Patient Health Questionnaire among Syrian refugees

BACKGROUND

Despite the need for mental health surveillance in humanitarian emergencies, there is a lack of validated instruments. This study evaluated a sequential screening process for major depressive disorder (MDD) using the two- and eight-item Patient Health Questionnaires (PHQ-2 and PHQ-8, respectively).

METHODS

This study analyzed data collected during a cross-sectional survey in a Syrian refugee camp in Greece (n = 135). The response rate for each instrument was assessed, and response burden was calculated as the number of items completed. The sequential screening process was simulated to replicate the MDD classifications captured if the PHQ-2 was used to narrow the population receiving the full PHQ-8 assessment. All respondents were screened using the PHQ-2. Only respondents scoring ≥ 2 are considered at risk for symptoms of MDD and complete the remaining six items. The positive and negative percent agreement of this sequential screening process were evaluated.

RESULTS

The PHQ-2, PHQ-2/8 sequential screening process, and PHQ-8 were completed by 91%, 87%, and 84% of respondents, respectively. The sequential screening process had a positive percent agreement of 89% and a negative percent agreement of 100%, and eliminated the need to complete the full PHQ-8 scale for 34 (25%) respondents.

CONCLUSIONS

The benefits of the sequential screening approach for the classification of MDD presented here are twofold: preserving classification accuracy relative to the PHQ-2 alone while reducing the response burden of the PHQ-8. This sequential screening approach is a pragmatic strategy for streamlining MDD surveillance in humanitarian emergencies.

Heart Transplant Recipients Prefer a Telemental Health Cognitive-Behavioral Therapy Intervention Delivered by Telephone

Background: Depression and anxiety are common after heart transplant, and in a regional heart transplant center servicing northern California, willingness to participate in treatment can be a major barrier. Introduction: Our primary aim is to design a remote cognitive-behavioral therapy (CBT) intervention. This study is the first step in the process. Through a survey to the cohort of heart transplant recipients (N = 230), managed within the Kaiser Permanente Northern California's Heart Transplant Service, we aimed to assess symptoms of stress, depression, and anxiety, patient willingness to participate in a CBT intervention, and preference between video and telephone. We proposed to patients a five-visit intervention, with the first and last visits in person and the three middle visits by video. Materials and Methods: One hundred twenty of 230 heart transplant recipients returned the 12-question Likert-like survey. Statistical tests included chi-square, fisher exact test, t-tests, and a logistic regression model. Results: Patients who reported two or more symptoms of stress, depression, and anxiety were 5.67 times more likely to engage in a remote CBT intervention (odds ratio = 5.67; 95% confidence interval 1.63-19.78; p = 0.006). Patients experiencing stress with depression were the most willing group to participate in a CBT intervention. The 12 patients who met the study criteria of 3 years post-transplant and experiencing at least one mental health symptom were invited to participate in the CBT intervention. All patients (12) who met the CBT intervention criteria were not willing to participate in the two in-person visits. All were willing to participate in a telephone-only CBT intervention. Discussion: Among the heart transplant recipients in this cohort, there is more willingness to participate in a CBT intervention when distress is higher and there is a preference for telephone visits as the modality for treatment delivery. Conclusions: Based on the findings, the CBT intervention will be shorter in duration; instead of five visits, there will be four visits; and it will be conducted by telephone only. The new intervention will be tested with 8 to 10 patients, changed, and then it will need to be empirically tested.

A computerized version of the Patient Health Questionnaire-4 as an ultra-brief screening tool to detect emotional disorders in primary care

BACKGROUND

The Patient Health Questionnaire-4 (PHQ-4) is an ultra-brief self-report consisting of a 2-item depression scale (PHQ-2) and a 2-item anxiety scale (GAD-2). The aim of the present study is to determine the psychometric properties of a computerized version of the PHQ-4 used to detect emotional disorders (anxiety and depression) in the primary care setting.

METHOD

A total of 1052 patients with suspected anxiety, depression, or somatic symptoms were recruited from 28 primary care centres participating in the PsicAP trial and completed the full version of the computerized PHQ. In addition, 178 of these patients also underwent in clinical interviews as a gold standard.

RESULTS

Confirmatory factor analyses showed very good fit indices for a two-factor solution. This model was structurally invariant among the various age and gender groups and internal consistency was acceptable (PHQ-4; α = .83, PHQ-2; α = .86, and GAD-2; α = .76). The best cut-off points to obtain high sensitivity values was 3, on both the PHQ-2 (major depressive disorder) and the GAD-2 (generalized anxiety disorder). The criterion validity (sensitivity and specificity) for the PHQ-2 were .90 and .61 and for the GAD-2, .88 and 0.61.

LIMITATIONS

The study was not designed as a prevalence study. Therefore, does not contain information on patients whose general practitioners do not consider them to suffer emotional disorders.

CONCLUSION

This is the first study to provide evidence for the reliability and validity of a computerized version of the PHQ-4. This computerized tool can be used to detect depression and anxiety in a primary care setting.

The Patient Health Questionnaire depression screener in spinal cord injury

CONTEXT

Although depression is not inevitable following spinal cord injury/dysfunction (SCI/D), it can have a negative impact on rehabilitation. Evidence-based assessment of depression utilizing self-report instruments, such as the Patient Health Questionnaire-9 (PHQ-9), is considered good clinical practice. Although the PHQ-9 has been studied in individuals with SCI/D, little is known about the clinical utility of the Patient Health Questionnaire-2 (PHQ-2). Traditional cutoff scores for the PHQ-2 were examined to explore their operating characteristics as related to PHQ-9 results.

METHODS

Archival data were collected for 116 Veterans with SCI/D who completed the PHQ-2 and PHQ-9 as one component of their routine, comprehensive SCI annual evaluation at a Veterans Affairs Medical Center. Logistic regressions were performed to determine the impact of different cutoff scores for the PHQ-2 on the likelihood that participants would endorse clinically significant levels of depressive symptoms on the PHQ-9 (≥10).

RESULTS

Using a cutoff score of 3 or greater correctly classified 94.8% of the cases, outperforming the other cutoff scores. A cutoff score of 3 or greater had a sensitivity of 83.3% and specificity of 97.8%, and yielded a positive predictive value of 90.9% and a negative predictive value of 95.7%.

CONCLUSION

The PHQ-2 shows promise as a clinically useful screener in the community-residing SCI/D population. Findings regarding the presence of suicidal ideation emphasize the importance of routine screening for depressive symptomatology in the SCI/D population. Future research should investigate the role of the PHQ-2 in clinical decision-making and treatment monitoring.

Associations between social capital and depression: A study of adult twins

Social capital is associated with depression independently of individual-level risk factors. We used a sample of 1586 same-sex twin pairs to test the association between seven measures of social capital and two related measures of neighborhood characteristics with depressive symptoms accounting for uncontrolled selection factors (i.e., genetics and shared environment). All measures of cognitive social capital and neighborhood characteristics were associated with less depressive symptoms in between-twin analysis. However, only measures of cognitive social capital were significantly associated with less depressive symptoms within-pairs. These results demonstrate that cognitive social capital is associated with depressive symptoms free of confounding from genetic and environmental factors shared within twins.

Associations between neighbourhood characteristics and depression: a twin study

BACKGROUND

Depression is an important contributor to the global burden of disease. Besides several known individual-level factors that contribute to depression, there is a growing recognition that neighbourhood environment can also profoundly affect mental health. This study assessed associations between three neighbourhood constructs-socioeconomic deprivation, residential instability and income inequality-and depression among adult twin pairs. The twin design is used to examine the association between neighbourhood constructs and depression, controlling for selection factors (ie, genetic and shared environmental factors) that have confounded purported associations.

METHODS

We used multilevel random-intercept Poisson regression among 3738 same-sex twin pairs from a community-based twin registry to examine the association between neighbourhood constructs and depression. The within-pair association controls for confounding by genetic and environmental factors shared between twins within a pair, and is the main parameter of interest. Models were adjusted for individual-level income, education and marital status, and further by neighbourhood-level population density.

RESULTS

When twins were analysed as individuals (phenotypic model), all neighbourhood constructs were significantly associated with depression. However, only neighbourhood socioeconomic deprivation showed a significant within-pair association with depression. A 10-unit within-pair difference in neighbourhood socioeconomic deprivation was associated with 6% greater depressive symptoms (1.06, 95% CI 1.01 to 1.11); the association did not substantially change in adjusted models.

CONCLUSION

This study provides new evidence linking neighbourhood socioeconomic deprivation with greater depression. Future studies should employ longitudinal designs to better test social causation versus social selection.

Psychometric properties and correlates of the PHQ-2 and PHQ-9 after traumatic brain injury

PRIMARY OBJECTIVE

To determine the predictive accuracy of the Patient Health Questionnaire (PHQ)-2 in predicting PHQ-9 findings and to examine demographic, historical, and injury correlates of PHQ-9 ratings.

RESEARCH DESIGN

Retrospective analysis of data collected as part of routine clinical outpatient care over a period of 30 months on 168 persons with mild to severe traumatic brain injury, who were referred for neuropsychological evaluation within 1-12 months after injury.

MAIN OUTCOMES AND RESULTS

PHQ-2 scores ≥2 had a sensitivity of 0.90 in predicting PHQ-9 scores ≥10, and a sensitivity of 0.95 in predicting endorsement of any passive or active suicidal thoughts on the PHQ-9. Premorbid history of having experienced personal abuse was the strongest predictor of post-injury PHQ-9 ratings.

CONCLUSIONS

The PHQ-2 has adequate sensitivity in predicting PHQ-9 findings and can be used as a screener in clinical practice in persons with traumatic brain injury, as long as formal psychometric assessment is supplemented with a comprehensive review of premorbid history.

Examining Burnout, Depression, and Self-Compassion in Veterans Affairs Mental Health Staff

OBJECTIVES

Burnout, a state of emotional exhaustion associated with negative personal and occupational outcomes, is prevalent among healthcare providers. A better understanding of the psychological factors that may be associated with resilience to burnout is essential to develop effective interventions. Self-compassion, which includes kindness toward oneself, recognition of suffering as part of shared human experience, mindfulness, and nonjudgment toward inadequacies and failures, may be one such factor. The purpose of this study was to examine the relationships between burnout, depression, and self-compassion in Veterans Affairs (VA) mental health staff.

DESIGN

Cross-sectional study.

SETTING

VA medical center and affiliated community-based clinics.

PARTICIPANTS

VA mental health staff.

OUTCOME MEASURES

The 19-item Copenhagen Burnout Inventory, the 26-item Self-Compassion Scale, and the Patient Health Questionnaire 2-item depression screen. Demographic information included age, sex, years worked in current position, and number of staff supervised.

RESULTS

One hundred and twenty-eight of a potential 379 individuals (33.8%) responded. Clerical support, nursing, social work, psychology, and psychiatry were the major professions represented. Self-compassion was inversely correlated with burnout (r = -0.41, p < 0.001), and inversely correlated with depression (r_pb = -0.39, p < 0.001). The inverse relationship between self-compassion and burnout remained significant even after accounting for depressive symptoms and demographic variables in a multiple linear regression model. Of all the variables examined, self-compassion was the strongest predictor of burnout.

CONCLUSIONS

The results of this study support the hypothesis that self-compassion may be associated with resilience to burnout. Alternatively, decreased self-compassion may be a downstream effect of increased burnout. Prospective, longitudinal studies are needed to determine the directional relationship between these factors, and whether interventions that cultivate self-compassion may decrease burnout and/or protect against its negative personal and professional outcomes.

Depression-Specific Outcomes After Treatment of Chronic Rhinosinusitis

IMPORTANCE

Depression is frequently undiagnosed in patients with chronic rhinosinusitis (CRS) and affects quality of life, productivity, and health care use.

OBJECTIVE

To examine depression-specific outcomes after medical or surgical treatment of CRS.

DESIGN, SETTING, AND PARTICIPANTS

A multi-institutional, prospective study of patients with refractory CRS treated at tertiary academic rhinology centers was performed from March 1, 2011, to November 1, 2015. Data analysis was performed from October 1, 2015, to November 1, 2015.

INTERVENTIONS

Patients self-selected to undergo continued medical management or endoscopic sinus surgery for refractory CRS.

MAIN OUTCOMES AND MEASURES

Patients completed the 22-item Sinonasal Outcome Test (SNOT22), Rhinosinusitis Disability Index (RSDI), Pittsburgh Sleep Quality Index (PSQI), and missed productivity and medication use questionnaires before and at least 6 months after treatment. Computed tomography and endoscopy scoring were performed with reviewers masked to patient-reported data. Depression-specific outcomes were recorded using the 2-item Patient Health Questionnaire (PHQ2).

RESULTS

Baseline data were available on 685 patients, with 167 (24.4%) having depression according to the PHQ2 scores. The mean (SD) age of the patients was 50.5 (15.0) years, and 332 (48.4%) were male. Revision surgery status was the only baseline factor associated with depression (53.9% vs 38.0%, P < .001). Patients with depression had worse baseline SNOT22 (mean, 64.5 vs 47.6), PSQI (mean, 12.8 vs 8.4), productivity (mean, 22.8 vs 5.2 days missed), and medication use scores for oral antibiotics (mean, 23.8 vs 14.8) and oral corticosteroids (mean, 17.8 vs 9.9) (P < .001 for all). Medical and surgical treatments had similar outcomes for patients with depression with mean improvement in the PHQ2 scores from 3.96 to 1.91 (P < .001), and 110 of 167 patients (65.9%) categorized as having depression at baseline were categorized as not having depression after treatment. Improvements in the PHQ2 scores were associated with improvements in the SNOT22, PSQI, oral antibiotic use, and productivity scores (P ≤ .001 for all).

CONCLUSIONS AND RELEVANCE

Depression is a common comorbidity in patients with CRS and affects numerous quality-of-life and health care outcomes. There are few objective baseline factors to aid physicians in identifying depression in patients with CRS. Medical and surgical treatments for CRS improve depression and related clinical outcomes.