Monitoring Depression Treatment Outcomes With the Patient Health Questionnaire-9

Can an app designed to reduce repetitive negative thinking decrease depression and anxiety in young people? Results from a randomized controlled prevention trial

BACKGROUND AND OBJECTIVES

Rates of mental health disorders are rising among adolescents and young adults. Therefore, scalable methods for preventing psychopathology in these age groups are needed. As repetitive negative thinking (RNT) is a risk factor for depression and anxiety disorders, targeting RNT via smartphone app promises to be an effective, scalable strategy. The current three-arm, parallel group, randomized controlled trial tested whether a self-help app designed to reduce RNT decreased psychopathological symptoms and RNT in adolescents and young adults at risk for mental disorders.

METHOD

A sample of 16-22-year-olds with elevated levels of RNT (N = 365) were randomly allocated to either use a one of two self-help apps designed to reduce RNT for 6 weeks or to a waitlist. The full RNT-focused intervention app encompassed a variety of RNT-reducing strategies, whereas the concreteness training app focused on one of these strategies, namely, concrete thinking.

RESULTS

The apps did not decrease depressive symptoms, anxiety symptoms and RNT relative to the waitlist. However, exploratory analyses using a minimum dose criterion showed that participants who used the full-RNT-focused intervention app more often, reported greater baseline to follow-up decreases in depressive symptoms compared to waitlist.

LIMITATIONS

Include decreased power due to slightly more dropout than expected and limited generalizability due to the mostly female and highly educated sample.

CONCLUSIONS

RNT-focused prevention via a self-help app did not decrease depression and anxiety, presumably due to too little engagement with the app content provided.

Morbidity-bridging metabolic pathways: linking early cardiovascular disease risk and depression symptoms using a multi-modal approach

Aims

Prevalence of cardiovascular diseases (CVDs) and depression is rising globally. Their co-occurrence associates with poorer outcomes, potentially due to shared metabolic pathways. This study aimed to identify metabolic pathways linking depression symptoms and CVD risk factors.

Methods and results

Data from the Young Finns Study (YFS, n = 1,599, mean age 37 ± 5, 54% female) served as input for a network (mixed graphical models). Confirmatory analysis through covariate-adjusted regression was done with UK Biobank (UKB, n = 69,513, mean age 63 ± 7, 64% female). Mendelian randomization assessed causality using genome-wide association studies data. The study examined 52 plasma metabolites measured by nuclear magnetic resonance spectroscopy. Outcomes included depression symptoms (BDI in YFS, PHQ-9 in UKB) and CVD risk factors [systolic/diastolic blood pressure, carotid intima-media thickness (cIMT)]. Mendelian randomization inferred causal links between metabolites and depression or (intermediate markers of) CVD. Two bridge metabolites were identified: glucose linked to sleep pattern (P = 0.034); omega-3 fatty acids (FAs) linked to appetite change (P < 0.001); and both connected to cIMT (both P = 0.002). Mendelian randomization suggested glucose as causal in coronary artery disease (CAD) risk, while omega-3 FAs showed potential causal links to CAD, coronary artery calcification, and cIMT.

Conclusion

This study integrated three statistical techniques and identified two metabolic markers (glucose, omega-3 FAs) connecting depression and CVD on a symptom and risk factor level. The associations, established in a relatively young cohort, were replicated in a predominantly middle-aged cohort and emphasize both the generalizability of the findings across different populations and value of symptom-level analysis in depression and CVD comorbidity research.

Question-based computational language approach outperform ratings scale in discriminating between anxiety and depression

Major Depression (MD) and General Anxiety Disorder (GAD) are the most common mental health disorders, which typically are assessed quantitatively by rating scales such as PHQ-9 and GAD-7. However, recent advances in natural language processing (NLP) and machine learning (ML) have opened up the possibility of question-based computational language assessment (QCLA). Here we investigate how accurate open-ended questions, using descriptive keywords or autobiographical narratives, can discriminate between participants that self-reported diagnosis of depression and anxiety, or health control. The results show that both language and rating scale measures can discriminate well, however, autobiographical narratives discriminate best between healthy and anxiety (ϕ = 1.58), as well as healthy and depression (ϕ = 1.38). Descriptive keywords, and to a certain extent autobiographical narratives, also discriminate better than summed scores of GAD-7 and PHQ-9 (ϕ=0.80 in discrimination between anxiety and depression), but not when individual items of these scales were analyzed by ML (ϕ=0.86 and ϕ=0.91 in item-level analysis of PHQ-9 and GAD-7, respectively). Combining the scales consistently elevated the discrimination even more (ϕ=1.39 in comparison between depression and anxiety), both in item-level and sum-scores analyses. These results indicate that QCLA measures often, but not in all cases, are better than standardized rating scales for assessment of depression and anxiety. Implication of these findings for mental health assessments are discussed.

Innovating Care for Postmenopausal Women Using a Digital Approach for Pelvic Floor Dysfunctions: Prospective Longitudinal Cohort Study

Background

The menopause transition is a significant life milestone that impacts quality of life and work performance. Among menopause-related conditions, pelvic floor dysfunctions (PFDs) affect ∼40%-50% of postmenopausal women, including urinary or fecal incontinence, genito-pelvic pain, and pelvic organ prolapse. While pelvic floor muscle training (PFMT) is the primary treatment, access barriers leave many untreated, advocating for new care delivery models.

Objective

This study aims to assess the outcomes of a digital pelvic program, combining PFMT and education, in postmenopausal women with PFDs.

Methods

This prospective, longitudinal study evaluated engagement, safety, and clinical outcomes of a remote digital pelvic program among postmenopausal women (n=3051) with PFDs. Education and real-time biofeedback PFMT sessions were delivered through a mobile app. The intervention was asynchronously monitored and tailored by a physical therapist specializing in pelvic health. Clinical measures assessed pelvic floor symptoms and their impact on daily life (Pelvic Floor Impact Questionnaire-short form 7, Urinary Impact Questionnaire-short form 7, Colorectal-Anal Impact Questionnaire-short form 7, and Pelvic Organ Prolapse Impact Questionnaire-short form 7), mental health, and work productivity and activity impairment. Structural equation modeling and minimal clinically important change response rates were used for analysis.

Results

The digital pelvic program had a high completion rate of 77.6% (2367/3051), as well as a high engagement and satisfaction level (8.6 out of 10). The safety of the intervention was supported by the low number of adverse events reported (21/3051, 0.69%). The overall impact of pelvic floor symptoms in participants' daily lives decreased significantly (-19.55 points, 95% CI -22.22 to -16.88; P<.001; response rate of 59.5%, 95% CI 54.9%-63.9%), regardless of condition. Notably, nonwork-related activities and productivity impairment were reduced by around half at the intervention-end (-18.09, 95% CI -19.99 to -16.20 and -15.08, 95% CI -17.52 to -12.64, respectively; P<.001). Mental health also improved, with 76.1% (95% CI 60.7%-84.9%; unadjusted: 97/149, 65.1%) and 54.1% (95% CI 39%-68.5%; unadjusted: 70/155, 45.2%) of participants with moderate to severe symptomatology achieving the minimal clinically important change for anxiety and depression, respectively. Recovery was generally not influenced by the higher baseline symptoms' burden in individuals with younger age, high BMI, social deprivation, and residence in urban areas, except for pelvic health symptoms where lower BMI levels (P=.02) and higher social deprivation (P=.04) were associated with a steeper recovery.

Conclusions

This study demonstrates the feasibility, safety, and positive clinical outcomes of a fully remote digital pelvic program to significantly improve PFD symptoms, mental health, and work productivity in postmenopausal women while enhancing equitable access to personalized interventions that empower women to manage their condition and improve their quality of life.

Identifying impaired mental health in patients with type 2 diabetes: a cross-sectional study in general practice

BACKGROUND

Type two diabetes (T2D) is linked to impaired mental health. International guidelines emphasise the importance of including psychological aspects in diabetes care. Yet, no systematic approach has been implemented to assess mental health in patients with T2D in general practice.

AIM

To evaluate the mental health of patients with T2D in general practice, and to investigate the effectiveness of asking patients about their wellbeing by using a single-item question compared with the five-item World Health Organization-Five Wellbeing Index (WHO-5).

DESIGN & SETTING

A cross-sectional study was undertaken, which included 230 patients with T2D in Danish general practice, from 1 May 2023-31 January 2024.

METHOD

Eligible patients were recruited at the annual chronic care consultation. They answered a single-item question on wellbeing and four validated measures of general wellbeing (WHO-5), depression (Patient Health Questionnaire-9; PHQ-9), anxiety (Generalised Anxiety Disorder-7; GAD-7), and diabetes distress (Problem Areas in Diabetes-5; PAID-5).

RESULTS

Overall, 32% of patients expressed symptoms of impaired mental health. Notably, the WHO-5 identified 53% of these patients, whereas only 12% of patients were identified through the single-item question. Importantly, among the patients exhibiting symptoms of impaired mental health, those identified by the WHO-5 displayed statistically significantly lower mental health scores across all measures (except PAID-5) compared with those not identified by the WHO-5.

CONCLUSION

A significant proportion of patients with T2D in general practice are affected by mental health issues. Our findings indicate that a single-item question may not sufficiently detect these issues, highlighting the importance of incorporating tools, such as the WHO-5, to offer a more comprehensive approach in diabetes care.

Mental Health, Substance Use, Trauma Exposure, and Experiences of Discrimination Among Caregivers of Youth With Juvenile Legal System Involvement

Family-focused interventions for youth with juvenile legal system involvement place emphasis on improving caregiver wellbeing. However, there is limited work to date characterizing the prevalence and determinants of behavioral health concerns among these caregivers. The present study sought to examine among 100 caregivers of youth with juvenile legal system involvement: (a) rates of depression, anxiety, PTSD, and cannabis and alcohol use; (b) frequency of exposure to traumatic events and discrimination; and (c) the association between experiences of traumatic events and discrimination and behavioral health concerns. The results indicated a variety of behavioral health concerns were experienced by caregivers, with an alarming number of caregivers having been exposed to traumatic events and discrimination. Discrimination was most frequently associated with mental health concerns. Our findings indicated that family-based interventions targeting youth with juvenile legal system involvement should continue to focus on caregiver wellbeing and emphasize reducing the impact of experiences of discrimination.

The Johns Hopkins Hope at Hopkins Clinic: supporting the comprehensive needs of individuals with metastatic breast cancer

PURPOSE

Individuals with metastatic breast cancer (MBC) may live with their disease for many years. We initiated the Johns Hopkins Hope at Hopkins Clinic to assess the needs and optimize the care of these patients.

PATIENTS AND METHODS

Patients with MBC who agreed to participate in the Clinic in addition to usual care completed patient-reported outcome (PRO) surveys. They met with a navigator and underwent core consults (cancer rehabilitation, integrative medicine, supportive and palliative care, social work, and nutrition), clinical trial eligibility assessment, and optional services based on PRO responses and selection from a Clinic Menu. A medical oncologist provided a Care Plan during a final consult. Participants were asked to complete 3- and 6-month follow-up PRO surveys. We report on initial Clinic implementation, participant characteristics, and baseline PROs.

RESULTS

From 11/2020 to 6/2022, 45 patients completed baseline surveys and participated in the Clinic. Median age was 58 (32-86); the majority (71%) were white and had estrogen receptor-positive (84%) tumors. Baseline physical and mental health were not good for ≥ 14 days of the past month for 22 and 10%, respectively. PROMIS measure scores were > 1 standard deviation worse than average for 32% for Physical Health, 16% for Mental Health, and 23% for Physical Function. PHQ-8 and GAD-7 scores suggested depression and anxiety for 22 and 7%, respectively. More than 80% of participants received specific recommendations from the core consultants. Only 20% of participants completed follow-up surveys.

CONCLUSION

Patients living with MBC have multiple needs. We used our results to implement routine PRO assessments and to expand services for patients with MBC. Our experience can serve as a model for coordinated care in other systems.

The Accuracy of the PHQ-2 Alone and Combined With the PHQ-9 to Identify Major Depression in Traumatic Brain Injury

OBJECTIVE

To assess the reliability, construct validity, and screening accuracy of the Patient Health Questionnaire-2 (PHQ-2) and the combined PHQ-2/PHQ-9 to detect major depressive disorder (MDD) in persons with traumatic brain injury (TBI).

SETTING

Level 1 trauma center.

PARTICIPANTS

Participants were 135 adults within 1 year of sustaining complicated mild, moderate, or severe TBI, initially recruited for a depression treatment trial.

DESIGN

Screening validity study relative to structured diagnostic assessment.

INTERVENTIONS

Not applicable.

MAIN MEASURES

PHQ-2 and PHQ-9 depression scales, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

RESULTS

The optimal cutoff for the PHQ-2 alone is a score of 2 or more which results in a sensitivity of .86 and a specificity of .83. When the PHQ-2 and PHQ-9 are combined in a 2-step process, the optimal cutoffs are 1 or more on the PHQ-2 and a total of 5 or more of the 9 PHQ-9 symptoms endorsed at least several days in the past 2 weeks. This resulted in a sensitivity of .93 and a specificity of .89 and only 53.6% of patients needed to be administered the entire PHQ-9.

CONCLUSION

The 2-step PHQ-2/PHQ-9 screening process described here represents an efficient, reliable, and valid means of detecting MDD in people with TBI. Results suggest that the generic PHQ-2/PHQ-9 depression screening parameters adopted within large U.S. federal entities may disadvantage people with TBI.

Efficacy of Nortriptyline-Topiramate and Verapamil-Paroxetine in Tinnitus Management: A Randomized Placebo-Controlled Trial

OBJECTIVE

To evaluate the efficacy of 2 drug combinations on tinnitus severity and associated stress, depression, sleep, and anxiety.

STUDY DESIGN

A randomized, double-blind, placebo-controlled clinical trial conducted between 2019 and 2023 for an 8-week duration.

SETTING

Single institution tertiary care center.

METHODS

The study recruited adult patients with moderate to severe tinnitus for 6 months or more. In total, 81 patients were assessed for eligibility, 78 were enrolled and randomized, and 67 were included in the per-protocol analysis. Patients were randomized into 3 groups (1:1:1). Group NT received nortriptyline-topiramate, group VP received verapamil-paroxetine, and group P received placebo.

RESULTS

A total of 19 patients in group NT, 22 in group VP, and 26 patients in group P were included in the per-protocol analysis. In group NT, the Tinnitus Functional Index (TFI) score decreased from 58.4 ± 13.9 (baseline) to 46.3 ± 17.5 (end-of-trial) (P < .001). Similarly, in group VP, the TFI score decreased from 54.6 ± 17.5 to 42.2 ± 16.1 (P = .004). However, group P did not demonstrate any significant decrease in the TFI score from 51.2 ± 18.6 to 45.2 ± 20.1 (P = .086). The between-arm analysis did not yield any statistical significance decrease in the TFI score (analysis of variance, P = .265).

CONCLUSION

Both combinations of drugs were promising in improving tinnitus severity. However, larger-scale trials with longer follow-up periods are warranted to validate our findings between groups.

Videoconference-Delivered Acceptance and Commitment Therapy for Family Caregivers of People With Dementia: Pilot Randomized Controlled Trial

BACKGROUND

Family caregivers of individuals with dementia face significant mental health challenges. Acceptance and commitment therapy (ACT) has emerged as a promising intervention for improving these caregivers' mental health. While various delivery modes of ACT have been explored, there is a need for evidence on the efficacy of videoconference-delivered ACT programs for this population.

OBJECTIVE

This pilot randomized controlled trial, conducted in the United States, aims to assess the effects of a videoconference-delivered, therapist-guided ACT program on reducing depressive symptoms and improving other mental health outcomes among family caregivers with depression who give care to individuals with dementia, compared to a control group that received psychoeducation materials only.

METHODS

This 2-arm, parallel-group pilot randomized controlled trial randomly assigned 33 family caregivers to either a 10-week videoconference-delivered ACT program (n=16, 48%) or a control group that received psychoeducation materials alone (n=17, 52%). Depressive symptoms (primary outcome) were measured using the Patient Health Questionnaire-9. Secondary outcomes included anxiety, stress, psychological quality of life (QoL), caregiver burden, predeath grief, guilt, and ACT process measures. Outcomes were assessed in the pretest, posttest (10-12 weeks after pretest), and a 3-month follow-up (3 months after posttest, approximately 5-6 months after pretest). An intent-to-treat approach was used for all outcome analyses. Linear mixed-effects models for repeated measures were used to analyze outcomes.

RESULTS

The ACT group reported significantly greater improvements in stress (P=.043) and psychological QoL (P=.014) in the posttest compared to the control group. Within the ACT group, participants experienced a significant decrease in depressive symptoms, with a mean (SE) change of -6.09 (1.16) points (95% CI -8.42 to -3.76; P<.001) in the posttest and -6.71 (1.45) points (95% CI -9.63 to -3.81; P<.001) in the 3-month follow-up. These changes exceed the estimated minimal clinically important difference on the Patient Health Questionnaire-9. In addition, the ACT group reported significant improvements in anxiety, stress, psychological QoL, caregiver burden, predeath grief, guilt, values-driven action, and experiential avoidance at both posttest and 3-month follow-up. A sensitivity analysis, excluding 1 participant with near-outlier data, revealed statistically significant between-group differences in depressive symptoms at posttest (P=.037); stress at posttest (P<.001) and in 3-month follow-up (P=.001); psychological QoL at posttest (P<.001); caregiver burden at posttest (P=.003) and in 3-month follow-up (P=.003); predeath grief in 3-month follow-up (P=.031); and values-driven action at posttest (P=.032).

CONCLUSIONS

The videoconference-delivered ACT program showed promise in improving mental health outcomes and ACT processes among family caregivers with depression who give care to individuals with dementia. Future studies should aim to replicate these findings with larger, more diverse caregiver populations and explore the long-term efficacy of videoconference-delivered ACT programs.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05043441; https://clinicaltrials.gov/study/NCT05043441.

Outcomes and motivations in unspecified (nondirected altruistic) kidney donation: Results from a United Kingdom prospective cohort study

Unspecified kidney donors (UKDs) increase the number of high-quality kidneys available for transplantation. This study aimed to determine whether the practice was acceptable, based on the noninferiority of donor physical and psychosocial outcomes when compared to specified kidney donors (SKDs). This longitudinal, prospective cohort study investigated potential living kidney donors from across all 23 UK adult kidney transplant centers. Participants completed validated questionnaires at 4 time points (recruitment, 2-4 weeks predonation, 3- and 12-months postdonation). Clinical outcome data were collected from National Health Service Blood and Transplant. Three hundred seventy-three (of 837 recruited; 45.7%) went on to donate (November 2016 to January 2021). There were no differences in donation rates (204 SKDs [54.7%] vs 169 UKDs [45.3%]; P = .944). Both groups reported being motivated by the desire to help someone (P = .157). Tests for noninferiority indicated that UKDs do no worse than SKDs on psychosocial or clinical outcomes over 12 months, and costs are similar (P > .05). This is the world's largest prospective observational study comparing SKDs and UKDs. It demonstrates no differences in primary motivation, donation rates, regret, cost, or psychosocial and physical outcomes. These data should reassure transplant professionals and potential donors and can bolster confidence in the practice around the world.

Dyadic coping after cancer diagnosis - a longitudinal cluster analysis

BACKGROUND AND PURPOSE

Dyadic coping (DC) considers the perception of both the individual and their partner's coping behavior and influences various health outcomes. Given the paucity of research investigating the course of DC after a cancer diagnosis, we explored longitudinal data to find statistically distinct trajectories of DC and to characterize and predict those based on medical, psychological and sociodemographic characteristics.

MATERIALS AND METHODS

In this prospective, multicenter study, we assessed patients with primary solid tumors at four measurement points using validated self-report questionnaires: first within 8 weeks of diagnosis, then at 6-month intervals. We measured DC using the Dyadic Coping Inventory (DCI). Clusters were identified via a feature-based clustering approach, characterized with t-tests and chi-squared tests and predicted with multinomial logistic regression.

RESULTS AND INTERPRETATION

We analyzed data from 418 patients in a partnership (mean age 61 years, 55.3% men, 84.8% married). Most prevalent cancers were prostate cancer (25.6%), skin cancer (17.5%) and breast cancer (16.3%). One cluster (33.5%) reported a stable high trajectory of coping behavior, indicating good coping behavior. It had the following characteristics: male (62.9%), regularly employed (57.9%), prostate cancer (34.3%) and childless (27.1%). The remaining sample contained a cluster with increasing coping behavior (34.7%) and another with decreasing coping behavior (31.8%). Lack of regular employment, having children and generalized anxiety are significantly associated with worsening coping behavior. This study is one of the first to examine DC trajectories in a large sample of cancer patients in the early phase after diagnosis. It is essential to understand markers such as psychological stress or family and work-related issues to optimize clinical and psycho-oncological outcomes and facilitate the support or maintenance of couple-related disease management in the long term.

Health System, Community-Based, or Usual Dementia Care for Persons With Dementia and Caregivers: The D-CARE Randomized Clinical Trial

Importance

The effectiveness of different approaches to dementia care is unknown.

Objective

To determine the effectiveness of health system-based, community-based dementia care, and usual care for persons with dementia and for caregiver outcomes.

Design, Setting, and Participants

Randomized clinical trial of community-dwelling persons living with dementia and their caregivers conducted at 4 sites in the US (enrollment June 2019-January 2023; final follow-up, August 2023).

Interventions

Participants were randomized 7:7:1 to health system-based care provided by an advanced practice dementia care specialist (n = 1016); community-based care provided by a social worker, nurse, or licensed therapist care consultant (n = 1016); or usual care (n = 144).

Main Outcomes and Measures

Primary outcomes were caregiver-reported Neuropsychiatric Inventory Questionnaire (NPI-Q) severity score for persons living with dementia (range, 0-36; higher scores, greater behavioral symptoms severity; minimal clinically important difference [MCID], 2.8-3.2) and Modified Caregiver Strain Index for caregivers (range, 0-26; higher scores, greater strain; MCID, 1.5-2.3). Three secondary outcomes included caregiver self-efficacy (range, 4-20; higher scores, more self-efficacy).

Results

Among 2176 dyads (individuals with dementia, mean age, 80.6 years; 58.4%, female; and 20.6%, Black or Hispanic; caregivers, mean age, 65.2 years; 75.8%, female; and 20.8% Black or Hispanic), primary outcomes were assessed for more than 99% of participants, and 1343 participants (62% of those enrolled and 91% still alive and had not withdrawn) completed the study through 18 months. No significant differences existed between the 2 treatments or between treatments vs usual care for the primary outcomes. Overall, the least squares means (LSMs) for NPI-Q scores were 9.8 for health system, 9.5 for community-based, and 10.1 for usual care. The difference between health system vs community-based care was 0.30 (97.5% CI, -0.18 to 0.78); health system vs usual care, -0.33 (97.5% CI, -1.32 to 0.67); and community-based vs usual care, -0.62 (97.5% CI, -1.61 to 0.37). The LSMs for the Modified Caregiver Strain Index were 10.7 for health system, 10.5 for community-based, and 10.6 for usual care. The difference between health system vs community-based care was 0.25 (97.5% CI, -0.16 to 0.66); health system vs usual care, 0.14 (97.5% CI, -0.70 to 0.99); and community-based vs usual care, -0.10 (97.5% CI, -0.94 to 0.74). Only the secondary outcome of caregiver self-efficacy was significantly higher for both treatments vs usual care but not between treatments: LSMs were 15.1 for health system, 15.2 for community-based, and 14.4 for usual care. The difference between health system vs community-based care was -0.16 (95% CI, -0.37 to 0.06); health system vs usual care, 0.70 (95% CI, 0.26-1.14); and community-based vs usual care, 0.85 (95% CI, 0.42 to 1.29).

Conclusions and Relevance

In this randomized trial of dementia care programs, no significant differences existed between health system-based and community-based care interventions nor between either active intervention or usual care regarding patient behavioral symptoms and caregiver strain.

Trial Registration

ClinicalTrials.gov Identifier: NCT03786471.

Improving access to help with poor sleep across youth mental health services: Interim implementation and clinical outcomes

OBJECTIVES

There is a high, unmet sleep need in young people with mental health difficulties. We took a whole-system approach to improving access to sleep support across a youth mental health system (14-25 years).

METHODS

We used the Exploration, Preparation, Implementation and Sustainment (EPIS) framework to develop an implementation programme (The Better Sleep Programme) incorporating two levels of training: (i) therapeutic practitioners received training and supervision in CBT for insomnia (CBTi) adapted for young people with mental health difficulties, (ii) non-therapeutic practitioners received knowledge and skills workshops. Implementation and clinical outcome measures were collected.

DESIGN

Implementation outcomes of acceptability, adoption, appropriateness, accessibility and fidelity were considered for the programme and CBTi intervention within it. Clinical outcomes for the CBTi intervention covered sleep, wellbeing and personal goals and were evaluated using a pre-post comparison within-subject design.

RESULTS

High levels of attendance and uptake were seen for CBTi training (210 therapeutic practitioners from 18 services) and workshops (270 attendees from 29 services). Five of the six core service areas trained were routinely offering the CBTi intervention. Significant improvements were seen across all clinical outcome measures (n = 83, p ≤ 0.001 to p ≤ 0.05) with moderate to large effect sizes observed across measures of sleep (d = 0.61-1.35), mental health (d = 0.57-1.26) and personal goals (d = 1.77).

CONCLUSIONS

This centrally-funded, system-wide implementation programme shows significant promise as a means of improving sleep in young people with mental health difficulties. High uptake with encouraging clinical outcomes was seen across services. Further evaluation is required to establish sustainability and generalizability.

Understanding the Impact of Intimate Partner Violence on Mental Health in Migrant Spanish Women: A Network Analysis Approach

The main aim of this paper was to perform a secondary analysis of a dataset of migrant women in Spain to determine relationships between different types of intimate partner violence (IPV) and psychiatric symptoms, as well as core symptoms within IPV dimensions. The Cyber Aggression item "Sent messages that were threatening or harassing" (Cyber.10) was centrally situated across many measures, having a betweenness of 2.607, a closeness of 2.464, and a strength of 1.513. The research demonstrated how the relationship between multiple IPV and mental health disorders among Spanish migrant women is very multifactorial.

Evaluating the Impact of Buprenorphine on Depressive Symptoms Among Veterans with Chronic Pain

Buprenorphine has demonstrated benefit for acute and chronic pain and various psychiatric disorders. However, many studies evaluating buprenorphine's effect on psychiatric conditions are not specific to the chronic pain population. This retrospective study was conducted to assess the impact of buprenorphine on depressive symptoms in patients with chronic pain at a Veterans Affairs healthcare facility. Adults with chronic pain started on any formulation of buprenorphine or traditional opioid (non-buprenorphine opioid) with at least two depression screenings between May 1, 2016 and November 1, 2021 were included. The primary outcome was change in depressive symptoms, measured by Patient Health Questionnaire-9 (PHQ-9), from baseline to 6-18 months after starting therapy. Secondary outcomes included changes in Columbia-Suicide Severity Rating Scale and mental health services utilization. Twenty-one patients were included. Median baseline PHQ-9 in the buprenorphine and traditional opioid groups were 14 and 13, respectively. Median change in PHQ-9 was -5 in the buprenorphine group and -1.5 in the traditional opioid group. Compared to traditional opioids, buprenorphine was associated with a greater reduction in depressive symptoms among Veterans with chronic pain. Although this reduction met the threshold for clinically significant improvement, further investigation is needed to evaluate the clinical relevance of these findings.

Therapeutic Effectiveness of Lumbar Medial Branch Block and Lumbar Intra-Articular Facet Injections: A Propensity-Matched Cohort Study

BACKGROUND

Chronic low back pain is a prevalent condition that is treated commonly with radiofrequency neurotomy (RFN) after diagnostic targeting with medial branch blocks (MBB) or intra-articular (IA) injection.

PURPOSE

We evaluated the long-term therapeutic value of MBB and IA injection of steroids for relief from chronic low back pain beyond the current diagnostic utility.

METHODS AND OUTCOME MEASURES

This was a retrospective propensity-matched cohort study from a single physician injection census at a tertiary care hospital. A total of 460 patients receiving MBB (n=383) or IA injection (n=77) in 2013-2020 were included. Primary outcome measures were patient-reported outcomes (PROs) at the time of injection, and follow-up at three and six months with the Numerical Rating Scale (NRS), PRO Measurement Information System (PROMIS)-Mental Health (MH), PROMIS-Physical Health (PH), and the Patient Health Questionnaire (PHQ)-9 scores. The same PROs at the one-year follow-up were the secondary outcome measures. Propensity weighting was performed to balance MBB and IA injection groups over several demographic and clinical categories.

RESULTS

Significant improvements in NRS (p=<0.001) were reported at the three-month, six-month, and one-year follow-ups, while significant improvements in PROMIS-PH scores (p=0.015) were identified at three and six months post injection.

CONCLUSIONS

Our results suggest that MBB and IA injection have potential therapeutic benefits for chronic low back pain for at least six months post injection. These results suggest that there is value in these diagnostic modalities therapeutically beyond the acute time frame. These results lay the groundwork for additional investigations into treatment options for patients affected by chronic low back pain.

Coping and learning to Manage Stress with cystic fibrosis (CALM): A multisite telehealth randomized controlled trial to reduce depression and anxiety symptoms in adults with cystic fibrosis

BACKGROUND

Adults with cystic fibrosis (AWCF) have higher rates of depression and anxiety than comparable community members. This multisite randomized waitlist-controlled trial tested the efficacy of "Coping and Learning to Manage Stress with CF" (CALM), a 6-session+booster telehealth intervention to improve depression and anxiety symptoms (primary outcomes) and perceived stress, coping self-efficacy, and key health-related quality of life domains (secondary outcomes).

METHODS

AWCF reporting mild to severe symptoms of depression and/or anxiety were randomized to receive CALM immediately (immediate, n = 66) or after a 13-week delay (waitlist, n = 66). Group differences post-intervention and at 1-month were examined via linear mixed models. Maintenance of treatment gains from baseline to 3-month follow-up was examined using combined data from both groups. Effect size calculations using Cohen's d assessed treatment effect magnitude.

RESULTS

Compared to the waitlist group, those that received CALM immediately reported lower depression and anxiety symptoms post-intervention and at 1-month follow-up (ps<0.001). For depression there was a large effect size post-intervention (d = 0.85) and a medium effect size at 1-month follow-up (d = 0.70); anxiety had a medium effect size post-intervention (d = 0.65) and at 1-month follow-up (d = 0.66). The immediate group also reported significantly higher coping self-efficacy, less stress, and increased vitality post-CALM and at 1-month follow-up (ps<0.01). Treatment gains were maintained at 3-month follow-up for all outcomes.

CONCLUSIONS

CALM was efficacious for AWCF in reducing symptoms of depression, anxiety, and perceived stress while improving coping self-efficacy and vitality with evidence of treatment sustainability. Next steps are dissemination and implementation to CF psychosocial clinicians.

Economic Insecurities and Mental Health Among Low-Income Pregnant People in the Central Valley Region of California

BACKGROUND

The association between economic insecurity and mental health among low-income pregnant people is understudied. We examined the relationship between economic insecurity and perinatal stress, anxiety, and depressive symptoms among a low-income, racially/ethnically diverse study population, and differentiated associations by nativity status.

METHODS

We used cross-sectional data from the EMBRACE Study that enrolled Medi-Cal (California's Medicaid program) eligible pregnant people in the Central Valley region of California. Economic insecurity was assessed through measures of food insecurity, low financial well-being, inability to pay an emergency expense, inability to pay bills, fear of eviction, and history of homelessness. We examined the association of these measures with perceived stress (Perceived Stress Scale), generalized anxiety symptoms (Generalized Anxiety Disorder-7), and depressive symptoms (Patient Health Questionnaire-9), adjusting for age, relationship status, and education level. We also examined effect measure modification by nativity among the Latinx population. We report the estimated differences and 95% confidence intervals for each exposure and outcome.

RESULTS

In our sample of 674 participants, we observed associations between economic insecurity and mental health. Among the 24 models, 15 showed medium to large effects (>0.35 standard deviation differences) and only three showed negligible effect sizes. Across all outcomes, we observed a stronger relationship between economic insecurity and mental health for U.S.-born Latinx people compared with their foreign-born (93% Mexico-born) counterparts.

CONCLUSION

We found low-income pregnant people experience significant economic insecurities that may impact mental health adversely. Programs that increase economic supports during pregnancy may serve as important maternal mental health interventions, especially among racial/ethnic minoritized groups.

Mathematical modeling and optimal control of depression dynamics influenced by saboteurs

Depression disorder affects millions globally, characterized by symptoms such as profound sadness, loss of interest in activities, and disruptions in eating and sleeping patterns. Understanding depression within the context of chronic pain is essential for developing effective management and intervention strategies. This study utilizes mathematical modeling to analyze depression trends using empirical data from Spain spanning from 2011 to 2022. Our depression model incorporates distinct compartments for primary and secondary depressed populations, along with a category for individuals categorized as saboteurs, who may actively influence the depression prevalence. We calculated the basic reproduction number [Formula: see text] and identified four equilibrium points and evaluated their stability. Additionally, sensitivity analysis was conducted to assess the impact of [Formula: see text] on depression prevalence. Furthermore, optimal control strategies were explored for the model. These strategies aim to improve treatment adherence, encourage doctor consultations, promote self-medication practices, and enhance recovery rates, ultimately aiming to reduce spread of depressive disorders and associated mortality. Data fitting was conducted using Python, and simulations were carried out in MATLAB to ensure rigorous validation of the model.

Investigating mental health disparities in rural sexual and gender minority adults: protocol for the rural exploration and approaches to LGBTQ + Mental Health (REALM) prospective cohort study

BACKGROUND

Sexual and gender minority (SGM) persons experience substantial mental health disparities throughout the life course, including increased vulnerability to depression and suicide. Few existing studies, however, have explored how pervasive experiences of SGM-related stigma, discrimination, and trauma (i.e., minority stress) contribute to adverse mental health outcomes among diverse sub-populations of SGM adults living in rural areas of the United States. This paper describes the protocol for a prospective cohort study, "Rural Exploration and Approaches for LGBTQ + Mental Health (REALM)," that will explore minority stress in relation to mental health conditions and suicidal behaviors among rural SGM adults.

METHODS

Online processes will be used to recruit and enroll a diverse sample of up to 2,500 SGM adults aged 18 + living in rural counties and small metropolitan areas in the United States to complete an online baseline survey. This will include: up to 1,000 cisgender sexual minority persons (up to n = 500 each cisgender women and cisgender men); and up to 1,500 gender minority persons (up to n = 500 persons who were assigned male at birth and identify as a woman, female, and/or transfeminine; up to n = 500 persons who were assigned female at birth and identify as a man, male, and/or transmasculine; and up to n = 500 persons who identify as some other gender, including non-binary, gender non-conforming, and/or agender regardless of sex assigned at birth). All enrolled participants will subsequently be followed over a 12-month period, with repeated surveys at three-month intervals. Included survey measures will focus on sociodemographic information, mental health, substance use, suicidal behaviors, minority stressors, psychological processes, and other related risk and protective factors.

DISCUSSION

This study presents a critical opportunity to better understand how minority stress contributes to adverse mental health outcomes among populations that remain underrepresented in research and programs in 2024. Results will be used to create more targeted, acceptable, and impactful intervention content and strategies that mitigate stigma, promote mental health, and prevent suicidal behaviors among rural SGM adults.

Self-Guided Smartphone App (Vimbo) for the Reduction of Symptoms of Depression and Anxiety in South African Adults: Pilot Quantitative Single-Arm Study

BACKGROUND

Barriers to mental health assessment and intervention have been well documented within South Africa, in both urban and rural settings. Internationally, evidence has emerged for the effectiveness of technology and, specifically, app-based mental health tools and interventions to help overcome some of these barriers. However, research on digital interventions specific to the South African context and mental health is limited.

OBJECTIVE

This pilot study investigated the feasibility of using an app (Vimbo) to treat symptoms of anxiety and depression in South African adults recruited from a community sample. The Vimbo app is a self-guided, cognitive behavioral therapy-based digital intervention for common mental health difficulties developed for the South African context.

METHODS

This pilot study used a naturalistic, single-arm design testing the Vimbo app over 12 weeks, from October 2020 to February 2021. Participants were recruited through the South African Depression and Anxiety Group and social media advertisements online. A 2-week retention period was used to allow for a minimum of 2 datasets. App usage and engagement metrics were extracted directly from the back end of the app. Based on the model, researchers expected many users to discontinue usage when their symptom levels entered a healthy range. Pre-post review of symptom levels was used to reflect on clinical recovery status at discontinuation after the retention period.

RESULTS

A total of 218 applicants met study eligibility criteria and were invited to download the Vimbo app. Of these, 52% (114/218) of the participants registered with the app, who indicated multiple variances of depression and anxiety symptoms ranging in severity from mild to severe. Two participants users withdrew from the study. Moreover, 69% (77/112) of users were retained, including 8 who had technical issues with their treatment. When comparing broad uptake across all interested participants, chi-square analysis indicated significantly reduced uptake in participants identifying as "unemployed but seeking employment" (χ24=10.47; N=251; P=.03). When considering app usage for the entire cohort (n=69, excluding participants with technical issues), there was a mean of 72.87 (SD 71.425) total module pages read, a mean of 30% (SD 29.473%) of prescribed content completed, and a mean of 19.93 (SD 27.517) times engaging with tools and skills.

CONCLUSIONS

Our findings support the case for continued exploration of app-based interventions for treating depression and anxiety in South Africa. Developing strategies to increase access and improve intervention uptake may prove essential to helping mobile health interventions make as significant an impact as possible. Future research should include a randomized controlled trial with a larger sample to further assess the efficacy of app-based interventions in treating mental health difficulties in South Africa.

A multi-site feasibility study of a stepped-care telehealth intervention for depression and anxiety in post-treatment cancer survivors at community cancer clinics (WF-30917CD)

PURPOSE

This feasibility study estimated accrual, retention, adherence, and summarized preliminary efficacy data from a stepped-care telehealth intervention for cancer survivors with moderate or severe levels of anxiety and/or depressive symptoms.

METHODS

Participants were randomized to intervention or enhanced usual care (stratified by symptom severity). In the intervention group, those with moderate symptoms received a cognitive-behavioral therapy (CBT) workbook/6 bi-weekly check-in calls (low intensity) and severe symptoms received the workbook/12 weekly therapy sessions (high intensity). Depression, anxiety, insomnia, fatigue, quality of life (QOL), fear of recurrence, and cancer-related distress were assessed pre- and post-intervention.

RESULTS

Participants (N = 68; ages 36-82; 88% White) were randomized to telehealth (n = 34) or enhanced usual care (EUC, n = 34), stratified by symptoms (moderate, n = 38; severe, n = 30). Accrual was 1.8/month with 88% retention and > 75% adherence. For those with moderate symptoms, the low-intensity intervention was associated with better cancer-related distress post-intervention but worse fatigue, insomnia, and physical QOL and and minimal differences for anxiety, depression, fear of recurrence, and mental QOL compared with EUC using clinically meaningful values to assess differences. For those with severe symptoms, the high-intensity intervention was associated with better fatigue, fear of recurrence, cancer-related distress, and physical/mental QOL.

CONCLUSIONS

Accrual to a stepped-care telehealth intervention for distressed cancer survivors was lower than expected, but retention and adherence were strong. Data suggest potential impact of the high-intensity intervention.

IMPLICATIONS FOR CANCER SURVIVORS

A telephone-based CBT intervention where cancer survivors worked with a therapist yielded improvements in fatigue, fear of recurrence, distress, and quality of life.

Considering Comorbidities and Individual Differences in Testing a Gaming Behavioral Activation App for Perinatal Depression and Anxiety: Open Trial Pilot Intervention Study

Background

There is increasing interest in the development of scalable digital mental health interventions for perinatal populations to increase accessibility. Mobile behavioral activation (BA) is efficacious for the treatment of perinatal depression; however, the effect of comorbid anxiety and depression (CAD) on symptom trajectories remains underexplored. This is important given that at least 10% of women in the perinatal period experience CAD.

Objective

We assessed whether there were differences in symptom trajectories in pregnant participants with CAD as compared to those with depression only (ie, major depressive disorder [MDD]) during intervention with a BA mobile gaming app.

Methods

Pregnant adults with either CAD (n=10) or MDD (n=7) used a BA app for 10 weeks and completed biweekly symptom severity questionnaires for depression and anxiety. We assessed whether baseline diagnoses were associated with differential symptom trajectories across the study with mixed effects longitudinal models.

Results

When controlling for baseline symptoms, results revealed a significant interaction between baseline diagnosis and the quadratic component of study week on anxiety (β=.18, SE 0.07; t62=2.61; P=.01), revealing a tendency for anxiety in the CAD group to increase initially and then decrease at an accelerated rate, whereas MDD symptoms were relatively stable across time. There was a significant effect of linear time on depression (β=-.39, SE 0.11; t68=-3.51; P=.001), showing that depression declined steadily across time for both groups. There was a significant effect of baseline diagnosis on depression (β=-8.53, SE 3.93; t13=-2.17; P=.05), suggesting that those with MDD had higher follow-up depression compared to those with CAD when holding other predictors constant.

Conclusions

The app was beneficial in reducing depression symptoms in perinatal individuals with different comorbidity profiles. With respect to anxiety symptom trajectories, however, there was more variability. The app may be especially effective for the treatment of anxiety symptoms among individuals with CAD, as it encourages in-the-moment ecologically relevant exposure to anxiety-provoking stimuli. Despite no significant group difference in baseline anxiety symptoms, the MDD group did not have a significant reduction in their anxiety symptoms across the study period, and some individuals had an increase in anxiety. Findings may point to opportunities for the augmentation of BA gaming apps for those with MDD to more effectively target anxiety symptoms. Overall, findings suggest there may be value in considering comorbidities and individual variations in participants when developing scalable mobile interventions for perinatal populations.

Investigating the impact of shift work on depression: Insights from sleep duration and physical activity

BACKGROUND

Shift work has been associated to a higher risk of depression and other health problems.

OBJECTIVE

This study aims to explore the connection between shift work and depression using NHANES data, with a focus on the roles of sleep duration and physical activity.

METHODS

NHANES data from 2007 to 2025 were examined using weighted multivariable logistic regression and stratified analysis, adjusting for demographic, chronic disease, and lifestyle factors. The impact of sleep duration and physical activity on depression among shift workers was examined using generalized additive models.

RESULTS

The study included 4965 participants. Adjusting for all covariates, shift work was significantly linked to increased depression risk (OR = 1.25, 95% CI: 1.05-1.48, p = 0.0127). For shift workers, each additional hour of sleep reduced depression risk by 19% (OR = 0.81, 95% CI: 0.72-0.91, p = 0.0007), and those with adequate sleep had a 40% lower depression risk compared to those with insufficient sleep (OR = 0.60, 95% CI: 0.42-0.87, p = 0.0072). Regular physical activity reduced depression risk by 44% (OR = 0.56, 95% CI: 0.36-0.87, p = 0.0104), whereas insufficient activity showed no significant impact (OR = 0.83, 95% CI: 0.50-1.38, p = 0.4731).

CONCLUSIONS

Shift work increases depression risk, while sufficient sleep and physical activity are protective. These findings underscore the importance of improving conditions for shift workers and developing preventive strategies.

Effects of Social Determinants of Health and Social Support on Surgical Outcomes Among Patients Undergoing Hysterectomy

OBJECTIVE

To describe composite 30-day postoperative complication rates among patients undergoing hysterectomy during the coronavirus disease 2019 (COVID-19) pandemic and to determine baseline and postoperative mental health symptoms, levels of social support, and socioeconomic status and their association with hysterectomy outcomes.

METHODS

This multicenter prospective cohort study at eight centers across the United States enrolled patients who underwent minimally invasive hysterectomy for benign indications during the COVID-19 pandemic. Patients completed preoperative and postoperative surveys assessing mental health (PHQ-9 [Patient Health Questionnaire]), social support (MOS-SS [Medical Outcomes Study Social Support Survey]), and socioeconomic status (Hollingshead Index [Hollingshead Four Factor Index of Socioeconomic Status]). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates and 30-day composite complication rates were measured and categorized by Clavien-Dindo Grade. Bivariate associations of survey data on complications were assessed. Logistic regression analyses were used to identify independent predictors of 30-day complications and complication severity.

RESULTS

Postoperative complications within 30 days occurred in 67 of 273 (24.5%) patients. Most (88.1%) complications were mild, but eight (11.9%) experienced severe complications. Only three patients (1.1%) tested positive for SARS-CoV-2 infection. There were no differences in complication rates when comparing race and ethnicity, age, or socioeconomic status. Survey responses that indicated more depression and worse support from preoperative to postoperative were seen in patients with severe complications ( P =.008 and P =.09, respectively). Multivariate analysis demonstrated that an increase in support scores was protective against severe complications ( P =.02). Worsening depression scores were associated with more severe complications ( P =.03).

CONCLUSION

This study showed a high rate of complications (24.5%) among patients who underwent hysterectomy during the COVID-19 pandemic. Lower social support and worse mental health status are associated with worse postoperative outcomes after hysterectomy.

Proinflammatory Cytokine Profiles in Menière's Disease and Vestibular Migraine

OBJECTIVE

To evaluate the levels of inflammatory cytokines and symptom survey scores in patients diagnosed with Menière's disease or vestibular migraine from a single center by a single neurotologist compared to control subjects with no history of dizziness or migraine.

STUDY DESIGN

Cross-sectional pilot study.

SETTING

Single-center tertiary referral center in Charleston, SC.

PATIENTS

Patients were recruited from the neurotology clinic at a tertiary referral center. Patients with definite Menière's disease or definite vestibular migraine as defined by the Barany consensus criteria were eligible. Control subjects presented to clinic without dizziness, vertigo, fluctuating hearing loss, or a history of migraine.

MAIN OUTCOME MEASURES

Questionnaire scores include DHI, SF-20, CFQ, PHQ-9, PSWQ, GAD-7, NVI, DCS, VM-PATHI, and MD-POSI. Circulating and in vitro levels of cytokines include ENA-78, GROα, IFN-α2a, IFN-γ, IL-10, IL-1α, IL-1β, IL-1RA, IL-2, IL-4, IL-5, IL-6, IL-8, MCP-1, MCP-2, MDC, MIP-1α, MIP-1β, and TNF-α. Cytokine levels were compared with effect size analysis.

RESULTS

There were 20 Menière's disease, 20 vestibular migraine, and 10 control patients enrolled in this study. Episode frequencies ranged from three per week to two to five per year in the MD group and daily to 1 every 2 to 3 months in the VM group. When patient-derived PBMC samples were compared to vestibular migraine, TNF-α ( d = -0.427 [-0.879, 0.025]) and IFN-γ ( d = -0.818 [-1.313, -0.323]) were found to be higher in Menière's disease, whereas ENA-78 ( d = -0.652 [-1.361, 0.056]) was found to be lower. No differences were found when cytokines were measured following stimulation with LPS.

CONCLUSIONS

This pilot study suggests Menière's disease patients may have higher levels of TNF-α and IFN-γ and lower levels of ENA-78 than vestibular migraine patients when measured following in vitro release from patient-derived PBMC. Increased sample size, optimized blood draw timing, and more specific PBMC stimulation may help us further elucidate inflammatory pathways implicated in these disorders.

Naturalistic use of a digital mental health intervention for depression and anxiety: A randomized clinical trial

BACKGROUND

Digital mental health interventions (DMHI) may offer scalable treatment for common mental health conditions. However, many commercially available apps have not been subjected to rigorous evaluation of effectiveness, particularly among users experiencing clinically significant symptomatology. We examined depression and anxiety symptom outcomes associated with a top-rated, commercially available self-guided DMHI based on cognitive behavioral therapy ("Sanvello") relative to waitlist control.

METHODS

This preregistered web-based, 2-arm, parallel-group randomized trial enrolled U.S. adults with self-reported elevated symptoms of depression and/or anxiety. Those assigned to the treatment condition were provided 8 weeks of access to Sanvello. Co-primary outcomes of depression (Patient Health Questionnaire [PHQ-9]) and anxiety (Generalized Anxiety Disorder 7-item scale [GAD-7]) severity were assessed at baseline and 2, 4, 6, and 8 weeks.

RESULTS

Intention-to-treat analyses included 280 participants (mean age 32.47 ± 9.32 years; 86.1 % women). Generalized linear mixed models showed a significant improvement in depression (F(4,779) = 6.51, p < .001) and anxiety (F(4,907) = 3.28, p = .01) associated with the DMHI over time. The intervention was also associated with a greater proportion of participants exhibiting depression response (25 [45.5 %] vs 26 [16.9 %]) and remission (10 [18.2 %] vs 7 [4.5 %]) on the PHQ-9, and anxiety response (31 [44.9 %] vs 39 [22.8 %]) and remission (20 [29.0 %] vs 27 [15.8 %]) on the GAD-7, relative to waitlist.

LIMITATIONS

Findings may not represent people with serious mental illness, suicidality, or the broader population of DMHI users.

CONCLUSIONS

A commercially available, self-guided DMHI was effective at improving symptoms in individuals experiencing depression or anxiety.

TRIAL REGISTRATION

ClinicalTrials.gov [NCT05373329].

Feasibility of implementing a culturally and linguistically adapted telephone-based cognitive-behavioral therapy (CBT) intervention for depression and anxiety with Hispanic and Latino cancer survivors

PURPOSE/OBJECTIVES

Hispanic and Latino (hereafter 'H/L') cancer survivors report higher rates of anxiety/depression and are less likely to receive psychosocial services than other survivors. We field-tested a culturally and linguistically adapted cognitive-behavioral therapy intervention with H/L post-treatment cancer survivors. Goals were to: (1) assess feasibility; (2) describe future efficacy outcomes; and (3) examine feedback for refinements.

DESIGN/RESEARCH APPROACH

Single-arm feasibility study.

SAMPLE/PARTICIPANTS

H/L cancer survivors (N = 8).

METHODS

Participants completed the 12-week CBT intervention, pre- and post-intervention measures, brief weekly feedback, and an in-depth interview. Recruitment, retention, and adherence, and changes in anxiety, depression, and fear of recurrence were summarized using descriptive statistics and 95% confidence intervals.

FINDINGS

Of 44 H/L survivors approached, 18 agreed to screening, and 9 met criteria; 8 enrolled over 7.4 months. Although we did not perform formal hypothesis testing, we observed clinically meaningful decreases in anxiety and depression. All who completed the intervention (n = 7) recommended the intervention.

CONCLUSION

While recruitment was challenging, participants reported robust decreases in depression and/or anxiety and high intervention satisfaction.

IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS OR POLICY

Future work should explore ways to decrease stigma and enhance recruitment to fully evaluate the adapted intervention among H/L survivors.

A study on anxiety and depression symptoms among menopausal women: a web based cross sectional survey

Background

An essential part of aging is menopause, which indicates the final phase of the female reproductive cycle. The objective of this research was to assess anxiety and depressive symptoms among menopausal women in Asir region, Saudi Arabia.

Methods

The cross-sectional survey was carried out in February to June 2024, using a random sampling procedure, study participants were selected. All menopausal women including <50 and ≥60 years old, were included, and symptoms of depression and anxiety were collected using Patient Health Questionnaire-9 (PHQ-9) Generalized Anxiety Disorder-7 (GAD-7) respectively.

Results

Of the 396 menopausal women, the majority 170 (42.9%) were <50 years old and 92 (23.2%) were between 50 and 54 years old. Two hundred eighty-one were married (71%) and 273 (68.9%) were literate. Most of them, 229 (57.8%) got married at <18 years and 196 (49.5%) have a parity of 3-5 and 189 (47.7%) women attained menopause at <50 years old. In terms of menopausal symptoms, 268 (67.7%) women experienced hot flushes; 252 (63.6%) had night sweats and were more irritable 256 (64.6%) followed by 244 (61.6%) had decreased sexual desire. In general, 258 (65.2%) and 206 (52.02%) menopausal women reported having depression and anxiety symptoms, respectively. Married (OR = 0.317; 95% CI = 0.182-0.551, p = 0.000) and literate (OR = 0.518; 95% CI = 0.309-0.868, p = 0.013) are less likely to be in depression compared to widowed/separated individuals. Literates (OR = 0.271; 95% CI = 0.165-0.443, p = 0.000), are less likely to have anxiety compared to illiterates.

Conclusion

The study found that a significant percentage of menopausal women had depression and anxiety symptoms. These results emphasize the significance of screening and assessing women experiencing anxiety and depression symptoms throughout the menopausal transition. To alleviate menopausal symptoms, it is also suggested to conduct activities to educate menopausal women, such as a health awareness program in shopping centers and other public places, etc.

Mental health symptoms and burdens after a SARS-CoV-2 infection

BACKGROUND

Previous studies have found adverse effects on mental health following infection with SARS-CoV-2. This study investigates whether mental health is also impaired in unknowingly infected individuals. In addition, the relevance of the severity of the infection and the time since the onset of infection were analyzed.

METHODS

Data from the population-representative Gutenberg COVID-19 Study (GCS) were used (N = 2,267). SARS-CoV-2 infection was determined multimodally by self-report, throat swabs (acute infections) and antibody measurements (previous infections). Participants completed self-report questionnaires on mental health.

RESULTS

Neither unknowing nor knowing SARS-CoV-2 infection had an impact on mental health. However, symptom severity and previous depression or anxiety predicted higher levels of depressiveness, anxiety and somatic complaints. Our results confirm findings suggesting that the severity of the initial infection and previous mental illness, but not knowledge of the infection, are the most important predictors of negative mental health outcomes following SARS-CoV-2 infection.

CONCLUSION

The results suggest that mental health care should focus on individuals who suffer from a severe acute COVID-19 infection or have a history of mental illness.

Emotional competence self-help app versus cognitive behavioural self-help app versus self-monitoring app to prevent depression in young adults with elevated risk (ECoWeB PREVENT): an international, multicentre, parallel, open-label, randomised controlled trial

BACKGROUND

Effective, scalable interventions are needed to prevent poor mental health in young people. Although mental health apps can provide scalable prevention, few have been rigorously tested in high-powered trials built on models of healthy emotional functioning or tailored to individual profiles. We aimed to test a personalised emotional competence app versus a cognitive behavioural therapy (CBT) self-help app versus a self-monitoring app to prevent an increase in depression symptoms in young people.

METHODS

This multicentre, parallel, open-label, randomised controlled trial, within a cohort multiple randomised trial (including a parallel trial of wellbeing promotion) was done at four university trial sites in the UK, Germany, Spain, and Belgium. Participants were recruited from schools, universities, and social media from the four respective countries. Eligible participants were aged 16-22 years with increased vulnerability indexed by baseline emotional competence profile, without current or past diagnosis of major depression. Participants were randomly assigned (1:1:1) to usual practice plus either the personalised emotional competence self-help app, the generic CBT self-help app, or the self-monitoring app by an independent computerised system, minimised by country, age, and self-reported gender, and followed up for 12 months post-randomisation. Outcome assessors were masked to group allocation. The primary outcome was depression symptoms (according to Patient Health Questionnaire-9 [PHQ-9]) at 3-month follow-up, analysed in participants who completed the 3-month follow-up assessment. The study is registered with ClinicalTrials.gov, NCT04148508, and is closed.

FINDINGS

Between Oct 15, 2020, and Aug 3, 2021, 1262 participants were enrolled, including 417 to the emotional competence app, 423 to the CBT app, and 422 to the self-monitoring app. Mean age was 18·8 years (SD 2·0). Of 1262 participants self-reporting gender, 984 (78·0%) were female, 253 (20·0%) were male, 15 (1·2%) were neither, and ten (0·8%) were both. 178 participants in the emotional competence app group, 191 in the CBT app group, and 199 in the self-monitoring app group completed the follow-up assessment at 3 months. At 3 months, depression symptoms were lower with the CBT app than the self-monitoring app (mean difference in PHQ-9 -1·18 [95% CI -2·01 to -0·34]; p=0·006), but depression symptoms did not differ between the emotional competence app and the CBT app (0·63 [-0·22 to 1·49]; p=0·15) or the self-monitoring app and emotional competence app (-0·54 [-1·39 to 0·31]; p=0·21). 31 of the 541 participants who completed any of the follow-up assessments received treatment in hospital or were admitted to hospital for mental health-related reasons considered unrelated to interventions (eight in the emotional competence app group, 15 in the CBT app group, and eight in the self-monitoring app group). No deaths occurred.

INTERPRETATION

The CBT app delayed increases in depression symptoms in at-risk young people relative to the self-monitoring app, although this benefit faded by 12 months. Against hypotheses, the emotional competence app was not more effective at reducing depression symptoms than the self-monitoring app. CBT self-help apps might be valuable public mental health interventions for young people given their scalability, non-consumable nature, and affordability.

FUNDING

European Commission.

Identifying trajectories of change in sleep disturbance during psychological treatment for depression

BACKGROUND

Sleep disturbance may impact response to psychological treatment for depression. Understanding how sleep disturbance changes during the course of psychological treatment, and identifying the risk factors for sleep disturbance response may inform clinical decision-making.

METHOD

This analysis included 18,915 patients receiving high-intensity psychological therapy for depression from one of eight London-based Improving Access to Psychological Therapies (IAPT) services between 2011 and 2020. Distinct trajectories of change in sleep disturbance were identified using growth mixture modelling. The study also investigated associations between identified trajectory classes, pre-treatment patient characteristics, and eventual treatment outcomes from combined PHQ-9 and GAD-7 metrics used by the services.

RESULTS

Six distinct trajectories of sleep disturbance were identified: two demonstrated improvement, while one showed initial deterioration and the other three groups displayed only limited change in sleep disturbance, each with varying baseline sleep disturbance. Associations with trajectory class membership were found based on: gender, ethnicity, employment status, psychotropic medication use, long-term health condition status, severity of depressive symptoms, and functional impairment. Groups that showed improvement in sleep had the best eventual outcomes from depression treatment, followed by groups that consistently slept well.

LIMITATION

Single item on sleep disturbance used, no data on treatment adherence.

CONCLUSIONS

These findings reveal heterogeneity in the course of sleep disturbance during psychological treatment for depression. Closer monitoring of changes in sleep disturbance during treatment might inform treatment planning. This includes decisions about when to incorporate sleep management interventions, and whether to change or augment therapy with interventions to reduce sleep disturbance.

Mental health disparities among sexual and gender minority students in higher education

Objective: There has been an ongoing mental health crisis among sexual and gender minority (SGM) populations. This continues amidst rising population-level depression and suicide rates, especially among students in higher education. This work aims to understand changes in SGM student mental health over time. Participants: N = 483,574 responses to the Healthy Minds Study (2007C2022) were examined from 18 to 35-year-old U.S. college and university students. Methods: Linear and logistic regressions were used to examine associations between SGM identity and mental health. Mediation and structural equation modeling were used to examine potential links among risk factors. Results: On average, ∼18% of students identified as SGM, which included a 6-fold increase in SGM self-identification across this 15-year period. Depression rates increased over time; ∼12% of students reported major depression. SGM students were 3.18 times (z = 111.16, p < .001) more likely to report depression than non-SGM students (26.85% vs. 8.53%). Disproportionate discrimination and lack of school belonging partially explained SGM disparities in depression. SGM students were twice as likely to utilize therapy (z = 115.42, p < .001) but half as likely seek help from family (z = 55.48, p ≤ .001). Conclusions: Academic institutions must take concrete steps to reduce barriers mental health care, combat discrimination, and bolster community belonging and interpersonal support for SGM students.

A qualitative study of the mental health outcomes in people being treated for obesity and type 2 diabetes with glucagon-like peptide-1 receptor agonists

OBJECTIVE

Obesity and type 2 diabetes (T2D) are associated with increased rates of mental disorders, particularly depression, anxiety and binge-eating disorder. GLP-1 receptor agonists are a novel class of pharmacological agents for obesity and T2D. We aimed to describe participants' experiences of GLP-1 receptor agonists on their mental health.

METHODS

Qualitative, individual, semi-structured interviews were conducted in nine participants who were prescribed GLP-1 receptor agonists for the treatment of obesity and/or T2D. Mental health status was measured at time of GLP-1 receptor agonist initiation and assessed again at 12-16 weeks when the semi-structured interview took place. Data were analysed using reflexive thematic analysis.

RESULTS

Three main themes were generated from the analysis: (1) acceptance of negative side effects for long term physical health benefits; (2) reflections on the diverse impact on mental health; (3) reduced appetite and increased control of eating behaviours.

DISCUSSION

Overall, participants with obesity and/or T2D described a positive impact of GLP-1 receptor agonists on their mental health, especially perception of improved control of eating behaviours. This suggests GLP-1 receptor agonists should be further studied for their potential effectiveness for treatment of binge-eating disorder.

The Impact of Changes in Depression on Cardiovascular Outcomes in Patients With Coronary Heart Disease

Background

Depression is associated with major adverse cardiovascular events (MACE). Whether longitudinal changes in depression affect MACE in patients with coronary heart disease (CHD) remains unknown.

Objectives

The authors evaluated the hypothesis that increasing or persistent depression predicts MACE in patients with CHD.

Methods

At baseline, 3,483 Emory Cardiovascular Biobank participants (median age 65.5 years, 31.6% female) completed the Patient Health Questionnaire 8 (PHQ8) for depression evaluation. At 1 year, 2,639 of these event-free participants repeated the questionnaire. Depression was defined as a PHQ8 score >9 and change in depressive symptoms ( Δ PHQ8) was year 1 score minus baseline PHQ8 scores. We categorized participants into never depression (both PHQ8 <10), new depression (baseline PHQ8 <10; 1-year PHQ8 >9), remitted depression (baseline PHQ8 >9; year 1 PHQ8 <10), and persistent depression (both PHQ8 >9) groups. Fine-Gray models with noncardiovascular death as the competing event and adjusted for demographics, CHD, and depression related factors evaluated how changes in depression affect MACE (cardiovascular death and MI).

Results

Overall, the incidence of MACE was 14%, with 8.7% of those with follow-up PHQ8 having MACE. 2.9% had persistent depression, 4.5% had new depression, 10.8% had remitted depression, and 81.8% never had depression. Increasing depressive symptoms independently predicted MACE ( Δ PHQ8 subdistribution HR: 1.06 [95% CI: 1.02-1.09], P < 0.001). Correspondingly, the incidence of MACE was higher in those with persistent (20.8%) or new depression (11.9%) than in those with remitted (9.4%) or never depression (8%) (P < 0.001). Compared to never depression, persistent depression independently predicted MACE (subdistribution HR: 2.78 [95% CI: 1.2-6.5], P = 0.017).

Conclusions

Increasing or persistent depression predicts MACE in individuals with CHD.

Minimal Detectable Changes of the Health Assessment Questionnaire-Disability Index, Patient-Reported Outcomes Measurement Information System-29 Profile Version 2.0 Domains, and Patient Health Questionnaire-8 in People With Systemic Sclerosis: A Scleroderma Patient-Centered Intervention Network Cohort Cross-Sectional Study

OBJECTIVE

Systemic sclerosis (SSc) is a rare, chronic autoimmune disorder associated with disability, diminished physical function, fatigue, pain, and mental health concerns. We assessed minimal detectable changes (MDCs) of the Health Assessment Questionnaire-Disability Index (HAQ-DI), Patient-Reported Outcomes Measurement Information System-29 Profile version 2.0 (PROMIS-29v2.0) domains, and Patient Health Questionnaire (PHQ)-8 in people with SSc.

METHODS

Scleroderma Patient-Centered Intervention Network Cohort participants completed the HAQ-DI, PROMIS-29v2.0 domains, and PHQ-8 at baseline assessments from April 2014 until August 2023. We estimated MDC95 (smallest change that can be detected with 95% certainty) and MDC90 (smallest change that can be detected with 90% certainty) with 95% confidence intervals (CIs) generated via the percentile bootstrapping method resampling 1,000 times. We compared MDC estimates by age, sex, and SSc subtype.

RESULTS

A total of 2,571 participants were included. Most were female (n = 2,241; 87%), and 38% (n = 976) had diffuse SSc. Mean (±SD) age was 54.9 (±12.7) years and duration since onset of first non-Raynaud phenomenon symptom was 10.8 (±8.7) years. MDC95 estimate was 0.41 points (95% CI 0.40-0.42) for the HAQ-DI, between 4.88 points (95% CI 4.72-5.05) and 9.02 points (95% CI 8.80-9.23) for the seven PROMIS-29v2.0 domains, and 5.16 points (95% CI 5.06-5.26) for the PHQ-8. MDC95 estimates were not materially different across subgroups.

CONCLUSION

MDC95 and MDC90 estimates were precise and similar across age, sex, and SSc subtype groups. HAQ-DI MDC95 and MDC90 were substantially larger than previous estimates of HAQ-DI minimal important difference from several small studies. Minimally important differences of all measures should be evaluated in large studies using anchor-based methods.

Treatment Readiness in Psychiatric Residential Care for Adolescents

There are many factors to consider when treating adolescents with psychiatric challenges, including whether they are willing and interested in participating in treatment. This study aimed to explore how treatment readiness impacts treatment experience for adolescents in psychiatric residential care who came into treatment with moderate to severe depression. All participants (N = 1,624; Mage = 15.58, SD = 1.46) were admitted to a large, multi-state psychiatric residential system between January 2020 and March 2022. Patients were 95.6% White, 99% non-Hispanic, and 64.7% identified as female. At intake, all patients were administered an assessment which includes the multi-dimensional Behavioral Health Screen (BHS) that assesses psychopathology and risk factors, a working alliance scale, depression, and well-being measures. Patients were also asked how they were admitted to the program, using a single item, multiple choice question as an informal treatment readiness measure, yielding three readiness groups: precontemplation, contemplation, or preparation. Regression analysis results indicated that patients' readiness level was associated with different baseline characteristics (e.g., age, gender, psychopathology symptoms, risk factors) and week 3 outcomes (e.g., decreased symptoms, well-being, alliance, satisfaction). The clinical implications, as well as limitations and future directions, will be discussed.

Evidence of symptom specificity for depression in multiple sclerosis: A two sample Mendelian randomization study

BACKGROUND

Depression is common and phenotypically heterogenous in multiple sclerosis (MS). MS may increase risk of some but not all affective symptoms or certain symptoms may predispose individuals to higher MS risk.

OBJECTIVE

To assess the existence and direction of causality between distinct depressive symptoms and MS using two-sample Mendelian randomization (MR).

METHODS

Using summary data from genome-wide association studies, we selected genetic instrument variables (IV) for MS (n = 115,776) and IVs for depressive symptoms (average n = 117,713): anhedonia, altered appetite, concentration, depressed mood, fatigue, inadequacy, psychomotor changes, sleeping problems and suicidality. We performed two-sample MR in either direction using inverse-variance models. Sensitivity analyses included weighted-median and MR-Egger regression. Obesity is a known risk factor for MS and depression; we adjusted for body mass index in multivariable-MR.

RESULTS

Genetic liability to MS was associated with anhedonia (IVW estimate per 102: 0.69; 95 % CI: 0.24-1.13; p = 0.002), concentration difficulty (0.66; 0.19-1.13; p = 0.006) and psychomotor changes (0.37; 0.08-0.65; p = 0.01). Results were similar in sensitivity analyses. In the opposite direction, we found no evidence of a causal relationship for any affective symptom on MS risk.

CONCLUSIONS

Genetic susceptibility to MS was associated with anhedonia, concentration, and psychomotor-related symptoms, suggesting a specific phenotype of depression in MS.

Exploring the Importance of Race and Gender Concordance Between Patients and Physical Therapists in Digital Rehabilitation for Musculoskeletal Conditions: Observational, Longitudinal Study

BACKGROUND

Race/ethnicity and gender concordance between patients and providers is a potential strategy to improve health care interventions. In digital health, where human interactions occur both synchronously and asynchronously, the effect of concordance between patients and providers is unknown.

OBJECTIVE

This study aimed to evaluate the impact of race/ethnicity or gender concordance between patients and physical therapists (PTs) in engagement and the clinical outcomes following a digital care program (DCP) in patients with musculoskeletal (MSK) conditions.

METHODS

This secondary analysis of 2 prospective longitudinal studies (originally focused on assessing the acceptance, engagement, and clinical outcomes after a remote DCP) examined the impact of both race/ethnicity concordance and gender concordance between patients and PTs on outcomes for a digital intervention for MSK conditions. Outcomes included engagement (measured by the completion rate and communication, assessed by text interactions), satisfaction, and clinical outcomes (response rate, ie, percentage of patients achieving at least a minimal clinically important change in pain, measured by the Numerical Pain Rating Scale [NPRS]; anxiety, measured by the Generalized Anxiety Disorder 7-item scale [GAD-7]; depression, measured by the Patient Health Questionnaire 9-item [PHQ-9]; and daily activity impairment, measured by the Work Productivity and Activity Impairment [WPAI] questionnaire).

RESULTS

Of 71,201 patients, 63.9% (n=45,507) were matched with their PT in terms of race/ethnicity, while 61.2% (n=43,560) were matched for gender. Concordant dyads showed a higher completion rate among White (adjusted odds ratio [aOR] 1.11, 95% CI 1.05-1.19, P<.001) and Hispanic (aOR 1.27, 95% CI 1.08-1.54, P=.009) groups, as well as women (aOR 1.10, 95% CI 1.06-1.18, P<.001), when compared to discordant dyads. High and similar levels of interaction between patients and PTs were observed across race/ethnicity and gender dyads, except for Asian concordant dyads (adjusted β coefficient 5.32, 95% CI 3.28-7.36, P<.001). Concordance did not affect satisfaction, with high values (>8.52, 95% CI 8.27-8.77) reported across all dyads. Response rates for pain, anxiety, and daily activity impairment were unaffected by race/ethnicity concordance. An exception was observed for depression, with White patients reporting a higher response rate when matched with PTs from other races/ethnicities (aOR 1.20, 95% CI 1.02-1.39, P=.02). In terms of gender, men had a slightly higher pain response rate in discordant dyads (aOR 1.08, 95% CI 1.01-1.15, P=.03) and a higher depression response rate in concordant dyads (aOR 1.23, 95% CI 1.05-1.47, P=.01).

CONCLUSIONS

Race/ethnicity and gender concordance between patients and PTs does not translate into higher satisfaction or improvement for most clinical outcomes, aside from a positive effect on treatment completion. These results highlight the importance of other PT characteristics, in addition to race/ethnicity or gender concordance, suggesting the potential benefit of experience, languages spoken, and cultural safety training as ways to optimize care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04092946, NCT05417685; https://clinicaltrials.gov/study/NCT05417685, https://clinicaltrials.gov/study/NCT04092946.

Health-related quality of life of people with depression: pre-post intervention compared with age-matched general population in Vietnam

BACKGROUND

In Vietnam, there is a paucity of health-related quality of life (HRQoL) research on people with depression as well as a lack of evidence on supported self-management (SSM) intervention for depression on HRQoL. This study aimed to compare the HRQoL of people with depression and age-matched people in the Vietnamese population, evaluate the effects of Tele-SSM intervention on HRQoL, and examine the association between the changes in HRQoL score and mental health well-being (depression, anxiety, and stress).

METHODS

This study was a pre- and post-study involving Vietnamese adults aged 18-64 who had depression symptoms (score ≥ 5 points in the PHQ-9). Participants (N = 58) completed Tele-SSM-a supported self-management intervention incorporating cognitive behavioral therapy and non-violent communication and using a task-shifting approach. To compare with the general population, we conducted a 1-to-1 matching by age with an EQ-5D-5L valuation study with a nationally representative sample of the Vietnamese general population.

RESULTS

HRQoL was significantly impaired in people with depression compared to the age-matched general population. Regarding health profile, participants reported the most difficulties in usual activities, pain/discomfort, and anxiety/depression dimensions. Significant improvements were observed in HRQoL scores post-intervention compared to pre-intervention in both EQ-VAS scores (from 59.84 to 79.48) and utility scores (from 0.79 to 0.90). These results remained lower than the age-matched general population (EQ-VAS score = 83.28, utility score = 0.96). Depression was associated with lower HRQoL while controlling for stress, anxiety symptoms and sociodemographic characteristics.

CONCLUSIONS

These results indicate that HRQoL is significantly impaired in people with depression and contribute to providing empirical evidence of Tele-SSM intervention in improving HRQoL. Further randomized controlled trials should be conducted to evaluate the effectiveness and cost-effectiveness of the Tele-SSM intervention.

Unveiling Post-COVID-19 syndrome: incidence, biomarkers, and clinical phenotypes in a Thai population

BACKGROUND

Post-COVID- 19 syndrome (PCS) significantly impacts the quality of life of survivors. There is, however, a lack of a standardized approach to PCS diagnosis and management. Our bidirectional cohort study aimed to estimate PCS incidence, identify risk factors and biomarkers, and classify clinical phenotypes for enhanced management to improve patient outcomes.

METHODS

A bidirectional prospective cohort study was conducted at five medical sites in Hatyai district in Songkhla Province, Thailand. Participants were randomly selected from among the survivors of COVID-19 aged≥18 years between May 15, 2022, and January 31, 2023. The selected participants underwent a scheduled outpatient visit for symptom and health assessments 12 to 16 weeks after the acute onset of infection, during which PCS was diagnosed and blood samples were collected for hematological, inflammatory, and serological tests. PCS was defined according to the World Health Organization criteria. Univariate and multiple logistic regression analyses were used to identify biomarkers associated with PCS. Moreover, three clustering methods (agglomerative hierarchical, divisive hierarchical, and K-means clustering) were applied, and internal validation metrics were used to determine clustering and similarities in phenotypes.

FINDINGS

A total of 300 survivors were enrolled in the study, 47% of whom developed PCS according to the World Health Organization (WHO) definition. In the sampled cohort, 66.3% were females, and 79.4% of them developed PCS (as compared to 54.7% of males, p-value <0.001). Comorbidities were present in 19% (57/300) of all patients, with 11% (18/159) in the group without PCS and 27.7% (39/141) in the group with PCS. The incidence of PCS varied depending on the criteria used and reached 13% when a quality of life indicator was added to the WHO definition. Common PCS symptoms were hair loss (22%) and fatigue (21%), while mental health symptoms were less frequent (insomnia 3%, depression 3%, anxiety 2%). According to our univariate analysis, we found significantly lower hematocrit and IgG levels and greater ALP levels in PCS patients than in patients who did not develop PCS (p-value < 0.05). According to our multivariable analysis, adjusted ALP levels remained a significant predictor of PCS (OR 1.02, p-value= 0.005). Clustering analysis revealed four groups characterized by severe clinical symptoms and mental health concerns (Cluster 1, 4%), moderate physical symptoms with predominant mental health issues (Cluster 2, 9%), moderate mental health issues with predominant physical symptoms (Cluster 3, 14%), and mild to no PCS (Cluster 4, 77%). The quality of life and ALP levels varied across the clusters.

INTERPRETATION

This study challenges the prevailing diagnostic criteria for PCS, emphasizing the need for a holistic approach that considers quality of life. The identification of ALP as a biomarker associated with PCS suggests that its monitoring could be used for early detection of the onset of PCS. Cluster analysis revealed four distinct clinical phenotypes characterized by different clinical symptoms and mental health concerns that 'exhibited varying impacts on quality of life. This finding suggested that accounting for the reduced quality of life in the definition of PCS could enhance its diagnosis and management and that moving toward personalized interventions could both improve patient outcomes and help reduce medicalization and optimally target the available resources.

FUNDING

The research publication received funding support from Medical Council of Thailand (Police General Dr. Jongjate Aojanepong Foundation), Hatyai Hospital Charity and Wellcome Trust.

More than a headache-somatic and mental symptom burden in spontaneous intracranial hypotension before and after surgical treatment

Introduction

Patients with spontaneous intracranial hypotension (SIH) frequently present with several symptoms and impaired mental health. This study systematically investigates the somatic and mental symptom burden of SIH and the effect of surgical treatment.

Methods

In this single-center retrospective study, patients with surgical closure of a spinal cerebrospinal fluid leak between September 2022 and July 2023 completed the Somatic Symptom Scale (SSS-8), the Somatic Symptom Disorder - B Criteria Scale (SSD-12), and the Patient Health Questionnaire (PHQ-8) preoperatively and three and 6 months postoperatively.

Results

Fifty-seven patients were included. All three scores showed clearly pathological values before surgery (SSS-8: 12 [IQR 6.5-16], SSD-12: 26 [IQR 19.5-33.5], PHQ-8: 11 [IQR 6.5-15]) representing a high somatic symptom burden and relevant current depression. After surgery, there was a significant and sustainable improvement (SSS-8: 8 [IQR 3-11.75], SSD-12: 12.5 [IQR 5-21.75], PHQ-8: 4.5 [IQR 2-9], p < 0.001, respectively) that exceeded the minimal clinically important difference for every score.

Conclusion

SIH presents with high somatic and mental symptom burden. Surgical treatment leads to a relevant improvement of somatic and depressive symptoms. However, even after surgical success some patients still exhibit elevated depressive scores. Depressive symptoms might be added to the typical symptomatology of SIH.

Patterns of Alcohol, Cannabis, and E-Cigarette Use/Co-Use and Mental Health Among U.S. College Students

Substance use and mental health are highly correlated, though few studies assess the risk for depression and anxiety associated with dual and polysubstance use among college students. The purpose of this study was to characterize the relationship between alcohol, cannabis, and e-cigarette exclusive, dual, and polysubstance use and depression and anxiety among U.S. college students by racial and ethnic subgroup and stratified by sex.

Data from 83,467 undergraduate students participating in the 2020-2021 Health Minds Survey, a multi-campus, web-based survey, were used. Sex-stratified logistic regression models examined the effects of exclusive (past 30-day cannabis use, past 30-day e-cigarette use, past 2-week heavy alcohol use), dual (two among cannabis, e-cigarette, or alcohol use), and polysubstance (all three substances) use on anxiety (≥10 GAD-7 score) and depression (≥15 PHQ-9 score).

The study included 60,746 females and 22,721 males. Among females, compared to those who exclusively used alcohol, dual users of cannabis and e-cigarette had the largest odds for depression (adjusted odds ratio (aOR) = 1.92) and anxiety (aOR = 1.69) followed by polysubstance users (aORs = 1.85 and 1.53, respectively). Among males, compared to those who exclusively used alcohol, dual users of cannabis and e-cigarette had the largest odds for depression (aOR = 2.72) and anxiety (aOR = 2.23) followed by polysubstance users (aOR = 1.71 and 1.85, respectively). African American female and male students had lower odds of anxiety and depression compared to White students.

The results suggest that single, dual, and polysubstance use are associated with anxiety and depression among U.S. college students, though not necessarily in additive ways.

Patients With Nonobstructive Coronary Artery Disease and Chest Pain: Impact of Obesity and Depressive Symptoms

BACKGROUND

Chest pain (CP) in patients with nonobstructive coronary artery disease is a therapeutic challenge affecting morbidity and mortality. We aimed to identify clinical factors associated with CP in this population, hypothesizing that obesity and depressive symptoms are associated with CP.

METHODS AND RESULTS

In 814 patients with angiographically confirmed nonobstructive coronary artery disease, we measured sociodemographic variables, clinical risk factors, medications, and Patient Health Questionnaire 9 scores for depressive symptoms. We assessed CP frequency and prevalence by using all items from the Seattle Angina Questionnaire angina frequency domain to generate an angina frequency composite score. In the overall sample (58.8±11.7 years old, 52.6% female), 42.8% had obesity, and 71.5% had CP, with an angina frequency composite score (SD) score of 76.4 (22.1). Compared with individuals without obesity, individuals with obesity had a higher prevalence (77.6% versus 67%, P<0.001) and more frequent CP (angina frequency composite score, 74.9 [SD, 22.2] versus 78.3 [SD, 21.9], P=0.02). Obesity was independently associated with CP occurrence (odds ratio [OR], 1.7 [95% CI, 1-2.9], P=0.04). Obesity's connection with CP was only in men: men with obesity had more frequent CP (angina frequency composite score, 75.8 [SD, 20.1] versus 82.1 [SD, 19.9], P=0.002) and more prevalent CP (79.5% versus 58.2%, P<0.001) than their counterparts insofar as men with obesity had similar CP to women. Patient Health Questionnaire 9 score (OR, 1.07 [95% CI, 1.01-1.13], P=0.03) was independently associated with CP and partly mediated the association between obesity and CP.

CONCLUSIONS

Obesity and depressive symptoms were independently associated with CP in individuals with nonobstructive coronary artery disease, particularly in men, and depressive symptoms partly mediated this association.

Relationship between Patient Health Questionnaire (PHQ-9) and Montgomery-Asberg Depression Rating Scale (MADRS) total scores in older adults with major depressive disorder: An analysis of the OPTIMUM clinical trial

BACKGROUND

The Patient Health Questionnaire (PHQ-9) and Montgomery-Asberg Depression Rating Scale (MADRS) are commonly used scales to measure depression severity in older adults.

METHODS

We utilized data from the Optimizing Outcomes of Treatment-Resistant Depression in Older Adults (OPTIMUM) clinical trial to produce conversion tables relating PHQ-9 and MADRS total scores. We split the sample into training (N = 555) and validation samples (N = 187). Equipercentile linking was performed on the training sample to produce conversion tables for PHQ-9 and MADRS. We compared the original and estimated scores in the validation sample with Bland-Altman analysis. We compared the depression severity level using the original and estimated scores with Chi-square tests.

RESULTS

The Bland-Altman analysis confirmed that differences between the original and estimated scores for at least 95 % of the sample fit within 1.96 standard deviations of the mean difference. Chi-square tests showed a significant difference in the proportion of participants at each depression severity category determined using the original and estimated scores.

LIMITATIONS

The conversion tables should be used with caution when comparing depression severity at the individual level.

CONCLUSIONS

Our conversion tables relating PHQ-9 and MADRS scores can be used to compare treatment outcomes using aggregate data in studies that only used one of these scales.

Efficacy of a cognitive-behavioral digital therapeutic on psychosocial outcomes in rheumatoid arthritis: randomized controlled trial

Cognitive behavioral therapy improves psychosocial outcomes in rheumatoid arthritis (RA), but access is limited. We conducted a randomized controlled trial to evaluate the efficacy of a cognitive-behavioral digital therapeutic, reclarit, on psychosocial outcomes in adult RA patients with impaired health-related quality of life. Participants were randomized to reclarit plus treatment as usual (TAU) or TAU plus educational and informational material (active control). The primary outcome was SF-36 mental (MCS) and physical (PCS) component summary scores at 3 months, with additional assessments at 6 months. reclarit significantly improved SF-36 MCS scores compared to control (mean difference 3.3 [95% CI 0.7, 5.9]; p = 0.014), with high user satisfaction and sustained improvements at 6 months. Depression, anxiety, fatigue, and social/work functioning also improved significantly, while SF-36 PCS, pain, and disability scores did not differ. In conclusion, reclarit offers immediate, effective, evidence-based and personalized psychological support for RA patients.

Lack of Acute Agomelatine Effect in a Model of Social Anxiety in Healthy Volunteers: A Double-Blind, Placebo-Controlled Trial

BACKGROUND

Agomelatine is an antidepressant drug that acts as an agonist of melatoninergic MT1/2 receptors and an antagonist of serotonergic 5-HT2C receptors. Studies suggest that agomelatine has anxiolytic properties in social anxiety, but there are no studies that assessed the effects of this compound in human experimental anxiety induced by a public speaking test. The objective of our investigation was to assess the effects of agomelatine on human experimental anxiety using the Simulation Public Speaking Test (SPST).

METHODS

Agomelatine (25 mg, n = 14), citalopram (20 mg, n = 14), venlafaxine (75 mg, n = 14), or placebo (n = 14) were administered in single doses to healthy volunteers in a double-blind study. Subjective anxiety was assessed with the Visual Analogue Mood Scale. Arterial blood pressure, heart rate, and blood levels of prolactin and cortisol were also recorded, as well as plasma levels of the 3 drugs.

RESULTS

The SPST induced significant subjective, physiological, and hormonal effects in all groups. The SPST also increased the anxiety and decreased mental sedation Visual Analogue Mood Scale factors during the anticipatory and performance phases of the test. Citalopram increased anxiety during the test in females, whereas agomelatine and venlafaxine were not different from placebo.

CONCLUSIONS

Confirming previous results, a serotonin selective reuptake inhibitor, citalopram, caused an anxiogenic effect in the SPST only in females. Acute administration of a low dose of agomelatine failed to modify the behavioral and physiological changes caused by this test. Future studies using higher doses and repeated administration should investigate if agomelatine behavioral and physiological effects could be detected in human experimental anxiety models.