The impact of a mental health service on chronic disease management in primary care

Evaluation of the Effect of Psychological Resilience on Anxiety in Patients with Diabetic Retinopathy Through the Mediating Effect of Perceived Stress: A Moderated Mediation Model

Objective

To investigate the anxiety status of Chinese patients with diabetic retinopathy (DR) and its relationship with psychological resilience and perceived stress.

Methods

A sampling method was used to select 606 DR patients, and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), Perceived Stress Scale short-form (PSS-10), and General Anxiety Disorder-7 (GAD-7) were used for the survey. We used SPSS 26.0 to analyse the data and employed PROCESS v4.1 for the mediating effect test.

Results

The incidence of anxiety in DR patients was approximately 53.63%, with psychological resilience (CD-RISC-10 average=27.51±8.32) and perceived stress (PSS-10 average=15.97±6.54). Anxiety was negatively correlated with psychological resilience (r=-0.569, P<0.01) and positively correlated with perceived stress (r=0.638, P<0.01). Additionally, psychological resilience was negatively correlated with perceived stress (r=-0.681, P<0.01). Perceived stress had a positive predictive effect on anxiety (total effect = -0.327, 95% bootstrap CI = -0.363 to -0.291), and it played a mediating role in the relationship between psychological resilience and anxiety, with a mediating effect size of 54.13%.

Conclusion

Psychological resilience and perceived stress directly or indirectly affect anxiety, Perceived stress moderates the relationship between psychological resilience and anxiety as a mediating variable. By analyzing this psychological mechanism, this study provides a new perspective for applying psychology to chronic diseases and a scientific basis for medical staff to develop targeted psychological intervention measures.

Digital acceptance and commitment therapy for adults with chronic health conditions: Results from a waitlist-controlled trial

Digital mental health interventions (DMHIs) provide a promising avenue for addressing the mental health needs of adults with chronic health conditions (CHCs). Transdiagnostic DMHIs, which apply to a range of conditions by focusing on common core processes of change (e.g., acceptance and commitment therapy; ACT), are particularly needed to address the various ways a wide range of CHCs impact quality of life. The present study evaluated an ACT DMHI designed to improve quality of life and mental health transdiagnostically for adults with CHCs. A sample of 100 adults with CHCs were randomized to ACT or waitlist, with baseline, 6-week, and 10-week assessment points. Recruitment (100 participants in 3 months with a wide range of CHCs), retention (84% at follow-up), and adherence rates (M = 4 of 6 sessions) indicated feasibility, with high program satisfaction ratings for acceptability. Only psychological flexibility improved more in ACT versus waitlist at post-intervention (6-week follow-up), with no differences on other outcomes until 10-week follow-up. Participants in ACT improved significantly more than waitlist at 10-week follow-up on the primary outcome of quality of life as well as functional impairment from CHCs and psychological flexibility. An exploratory moderation test suggested participants with elevated mental health symptoms at baseline improved more on these symptoms in ACT relative to waitlist at 10-week follow-up. Overall, results support the feasibility, acceptability, and efficacy of a transdiagnostic ACT DMHI to improve quality of life and mental health for adults with a wide range of CHCs. CLINICALTRIALSGOV IDENTIFIER: NCT06179264.

The burden of mental disorders and substance abuse in the Middle East and North Africa (MENA) region: findings from the Global Burden of Disease Study

BACKGROUND

Mental disorders pose significant morbidity and mortality risks globally. Despite this, research on mental health in the Middle East and North Africa (MENA) region is scarce, hindered by social stigmas and limited healthcare expenditure. This study, utilizing the Global Burden of Disease (GBD) database, aims to address this gap by examining the prevalence, incidence, and demographic patterns of mental disorders in MENA.

METHODS

This ecological study draws on the GBD data to assess the prevalence and burden of mental disorders and substance abuse across the MENA region from 1990 to 2019. Utilizing age-standardized rates of prevalence and Disability-Adjusted Life Years (DALYs), we examine the evolving burden of mental disorders, variations among MENA countries, and trends in associated risk factors by age and gender.

RESULTS

From 1990 to 2019, the MENA region witnessed varying trends in mental disorders. The age-standardized prevalence rate in 2019 was 14,938 per 100,000 individuals, experiencing a 2.1% decrease overall. However, all-age prevalence surged by 86.2%. Disorders like schizophrenia and depressive disorders exhibited substantial increases, contrasting with a 128.1% rise in substance use disorders. Temporal analysis revealed fluctuations in DALY trends, capturing the dynamic nature of mental health burdens over time. Risk factors, including bullying victimization and intimate partner violence, underwent shifts, reflecting changing contributors to mental health burden.

CONCLUSION(S)

Despite a decrease in age-standardized prevalence rates in 2019, the substantial all-age prevalence rise demands attention. Temporal analysis unraveled nuanced trends, emphasizing the complex interplay of sociocultural factors. The shifting prominence of risk factors underscores the dynamic nature of mental health burdens, necessitating region-specific interventions that address both prevalence patterns and contributing factors. Future research should delve into the specific sociocultural determinants influencing the observed trends, allowing for tailored interventions to mitigate the burden of mental health disorders in the MENA region.

Adherence to prescribed antihypertensive medication among patients with depression in the United States

BACKGROUND

Hypertensive patients with depression have a higher mortality rate and a worse prognosis compared with hypertensive only. Depression may reduce medication adherence in hypertension patients.

METHODS

This study includes respondents in the National Health and Nutritional Examination Survey (NHANES) database from 2005 to 2018 who had previously been diagnosed with hypertension. Medication adherence was defined as taking medication as recommended by a physician. The depressive state was assessed using the patient health questionnaire (PHQ)-9.

RESULTS

Nine thousand one hundred eighty-six respondents were included in the analysis. Medication adherence was associated with depression (odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.26 to1.75) and depression score (OR: 1.04 per each point increase, 1.03 to 1.05) in the unadjusted analyses. After adjusting for clinical and socioeconomic/demographic factors, there were significant statistical correlations between depression score and medication adherence (aOR: 1.02 per each point increase, 1.00 to 1.03, p < 0.05), but there was no significant statistical correlation between depression and medication adherence (p > 0.05). It was still statistically significant relationships between sex, age, body mass index (BMI), race, marital status, and health insurance with medication adherence after adjusted socioeconomic/demographic factors.

CONCLUSION

Depression was marginally associated with poor medication adherence in hypertensive patients, and the correlation increased with depression degree. Moreover, socioeconomic/demographic factors have an independent impact on medication adherence including sex, age, BMI, race, marital status, and health insurance.

The Economic Burden Associated with Depressive Symptoms among Middle-Aged and Elderly People with Chronic Diseases in China

Coexisting physical diseases and depressive symptoms exacerbate morbidity and disability, but their incremental economic burden remains unclear. We used cross-sectional data from the China Health and Retirement Longitudinal Study (CHARLS) survey in 2018 to estimate the economic burden associated with depressive symptoms among middle-aged and elderly people with chronic diseases. A multivariable regression model was used to assess the annual health care utilization, expenditures, and productivity loss of depressive symptoms among people with 12 common chronic diseases. We found that depressive symptoms were associated with higher incremental economic burdens, as the total health care costs increased by 3.1% to 85.0% and annual productivity loss increased by 1.6% to 90.1%. Those with cancer or malignant tumors had the largest economic burden associated with depressive symptoms, with CNY 17,273.7 additional annual health care costs and a loss of CNY 2196.2 due to additional annual productivity loss. The effect of depressive symptoms on the economic burden of patients with chronic conditions did not increase by the number of chronic conditions. Considering the high economic burden associated with depressive symptoms among patients with chronic conditions, it is important to consider the mental health of patients in chronic disease treatment and management.