Detection and management of depression in adult primary care patients in Hong Kong: a cross-sectional survey conducted by a primary care practice-based research network

Identifying dementia from cognitive footprints in hospital records among Chinese older adults: a machine-learning study

Background

By combining theory-driven and data-driven methods, this study aimed to develop dementia predictive algorithms among Chinese older adults guided by the cognitive footprint theory.

Methods

Electronic medical records from the Clinical Data Analysis and Reporting System in Hong Kong were employed. We included patients with dementia diagnosed at 65+ between 2010 and 2018, and 1:1 matched dementia-free controls. We identified 51 features, comprising exposures to established modifiable factors and other factors before and after 65 years old. The performances of four machine learning models, including LASSO, Multilayer perceptron (MLP), XGBoost, and LightGBM, were compared with logistic regression models, for all patients and subgroups by age.

Findings

A total of 159,920 individuals (40.5% male; mean age [SD]: 83.97 [7.38]) were included. Compared with the model included established modifiable factors only (area under the curve [AUC] 0.689, 95% CI [0.684, 0.694]), the predictive accuracy substantially improved for models with all factors (0.774, [0.770, 0.778]). Machine learning and logistic regression models performed similarly, with AUC ranged between 0.773 (0.768, 0.777) for LASSO and 0.780 (0.776, 0.784) for MLP. Antipsychotics, education, antidepressants, head injury, and stroke were identified as the most important predictors in the total sample. Age-specific models identified different important features, with cardiovascular and infectious diseases becoming prominent in older ages.

Interpretation

The models showed satisfactory performances in identifying dementia. These algorithms can be used in clinical practice to assist decision making and allow timely interventions cost-effectively.

Funding

The Research Grants Council of Hong Kong under the Early Career Scheme 27110519.

Predictive Machine Learning Models for Assessing Lebanese University Students' Depression, Anxiety, and Stress During COVID-19

University students are experiencing a mental health crisis. COVID-19 has exacerbated this situation. We have surveyed students in 2 universities in Lebanon to gauge their mental health challenges. We have constructed a machine learning (ML) approach to predict symptoms of depression, anxiety, and stress based on demographics and self-rated health measures. Our approach involved developing 8 ML predictive models, including Logistic Regression (LR), multi-layer perceptron (MLP) neural network, support vector machine (SVM), random forest (RF) and XGBoost, AdaBoost, Naïve Bayes (NB), and K-Nearest neighbors (KNN). Following their construction, we compared their respective performances. Our evaluation shows that RF (AUC = 78.27%), NB (AUC = 76.37%), and AdaBoost (AUC = 72.96%) have provided the highest-performing AUC scores for depression, anxiety, and stress, respectively. Self-rated health is found to be the top feature in predicting depression, while age was the top feature in predicting anxiety and stress, followed by self-rated health. Future work will focus on using data augmentation approaches and extending to multi-class anxiety predictions.

Effects of the COVID-19 pandemic on mental health and sleep quality in the Chinese general populations during sporadic and outbreak periods

The different coronavirus disease 2019 (COVID-19) outbreak patterns may have different impact on the mental health, but there is no such report at present. This study was aimed to investigate general populations mental health and sleep quality during the sporadic and outbreak of COVID-19 in Tianjin of China. Two cross-sectional studies included 1090 participants during the COVID-19 sporadic period from 28th January to 28th February 2022 and 2036 participants during the COVID-19 outbreak period from 1st January to 1st February 2023. We used the propensity score matching method to match the 2 samples (sporadic and outbreak group) with a ratio of 1:1. Finally, 1087 participants were included in each group. The demographics, Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, Connor-Davidson Resilience Scale, and Pittsburgh Sleep Quality Index were collected from all participants. There was a significant difference between the sporadic and outbreak groups for COVID-19-infected status, anxiety levels, sleep quality, and phycological resilience (all P < .05). Logistic regression analysis showed that female (P < .05) and depression status (P < .05) were the risk factors for the incidence rate of anxiety and poor sleep quality in sporadic group, and outbreak group, while phycological resilience were robust related to the sleep quality (P < .01). Poor sleep quality (P < .01) was related to the incidence of anxiety in sporadic group but not the outbreak group; anxiety levels (P < .01) were related to sleep quality in sporadic group but not the outbreak group. During the COVID-19 pandemic, general populations experienced high anxiety and poor sleep quality incidence rates, especially in the outbreak period. Different risk models for anxiety and sleep quality were found in the different outbreak patterns.

Trust in Medical Professionals Moderates Depression in Hong Kong during COVID-19

Objectives

Given the continuing COVID-19 pandemic and the associated prevention and control measures implemented, the psychological burden brought by the pandemic on citizens is expected to increase. This study is aimed at exploring the predictors of depressive symptoms among Hong Kong people during the epidemic, as well as factors that could potentially alleviate the negative effects of the epidemic.

Methods

The third wave follow-up survey (December 2021 to January 2022) from a longitudinal prospective survey study conducted in Hong Kong was used for a cross-sectional analysis. The participants (n = 803) are adults aged 18 and above in Hong Kong. Logistic and linear regression were performed to test the predictors and moderating effects, respectively, with depression as the outcome variable.

Results

With minimized confounding effects of demographic variables, higher levels of concern about infection, experience with COVID-19 infection and previous epidemics, hassles, and trust in authority increased the odds of being depressed, while a higher level of trust in medical professionals reduced the odds of depression. Moreover, greater trust in medical professionals, as a moderator, lessened the positive associations between the levels of depression and hassles and concern about infection.

Conclusions

Even though the threats of COVID-19 seem to have lowered, this study shows that a few factors associated with the pandemic continue to threaten people's mental health. However, developing greater trust in medical experts may be an effective way to relieve psychological burden.

Psychological Toll of the COVID-19 Pandemic: An In-Depth Exploration of Anxiety, Depression, and Insomnia and the Influence of Quarantine Measures on Daily Life

The COVID-19 pandemic, on a global scale, has prompted multifaceted challenges, including a notable psychological toll on the general population. This study uses mixed-method approach for a nuanced exploration of these experiences. Using a phenomenological strategy, qualitative responses from 999 participants were analyzed regarding their pandemic-induced anxiety and the influence of quarantine measures on their lives. Quantitative measures, including the revised Impact of Event Scale (IES-R), patient health questionnaire-9 (PHQ-9), the seven-item generalized anxiety disorder assessment (GAD-7), and Insomnia Severity Index (ISI), were used to quantify trauma, depression, anxiety, and insomnia attributed to COVID-19. Partial least squares structural equation modeling (PLS-SEM) was utilized for quantitative data analysis. The anxiety-related responses were mainly clustered into four themes: life threats, support shortage, economic consequences, and disruptions to family and social life. Subthemes that addressed the perceived effects encapsulated disruptions to academic and professional lives, familial and social relationships, psychopathological stress, and movement limitations. The findings from quantitative analysis revealed the significant associations between COVID-19-related trauma and symptoms of anxiety, depression, and insomnia, as indicated by coefficients exceeding 0.10 (all z-values > 1.96; p-values < 0.05). In conclusion, the findings underscore COVID-19's role in escalating anxiety, influenced by various factors, and its disruptive effects on daily life due to quarantine measures. The strong associations between the pandemic and the symptoms of depression, anxiety, and insomnia underscore the urgency of comprehensive psychological and public health interventions to alleviate these impacts.

Lower serum insulin-like growth factor 1 concentrations in patients with chronic insomnia disorder

Objectives

Insulin-like growth factor 1 (IGF-1) is a crucial neurotrophin that is produced in the brain and periphery and may play an important role in insomnia and mood disorders. We aimed to analyze its serum concentrations in patients with chronic insomnia disorder (CID).

Methods

Patients with CID were enrolled in this study and divided into the CID group [Generalized Anxiety Disorder-7 (GAD-7) score < 10] and the CID with anxiety group (GAD-7 score ≥ 10). Age-and sex-matched healthy volunteers were recruited as controls. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality and the GAD-7 and the Patient Health Questionnaire-9 to assess emotional status. All subjects were monitored via polysomnography, and the serum IGF-1 concentrations in their peripheral blood were detected via enzyme-linked immunosorbent assays.

Results

We enrolled 65 patients with CID (of whom 35 had anxiety) and 36 controls. The PSQI score and IGF-1 concentration in the CID and CID with anxiety groups were higher than those in the control group. The apparent difference in IGF-1 concentration between the CID and CID with anxiety groups was not statistically significant. The IGF-1 concentration in patients with CID was linearly correlated with the GAD-7 score, PSQI score, and stage 3 non-rapid eye movement (stage N3) time.

Conclusion

The serum IGF-1 concentration in patients with CID was lower than that of participants without CID, negatively correlated with anxiety score and sleep quality, and positively correlated with stage N3 time.

Psychosocial wellbeing and risky health behaviors among Syrian adolescent refugees in South Beirut: a study using the HEEADSSS interviewing framework

Purpose

Adolescent refugees are at risk of mental health disorders and underdiagnosed risky behaviors. Limited research exists in the Middle East and North Africa. This study aims to assess psychosocial wellbeing and risk-taking behaviors among adolescent refugees displaced to South Beirut following a standardized framework.

Methods

A cross-sectional study using face-to-face confidential HEEADSSS (Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Safety and Suicide/Depression) interviews was conducted among 52 Syrian adolescent refugees, between the ages of 14 and 21, in a health center in South Beirut.

Results

The mean age of the interviewees was 17.04 ± 1.77 years, with a male predominance 34 (65.4%). Five (9.6%) were married, 38 (73.1%) were not attending school 27 (52.9%) lived in a place with a crowding index ≥3.5 and 21 (40.4%) were working. Risky health concerns or behaviors detected included no activities or exercise 38 (73.1%), eating one to two meals per day 39 (75%) and smoking 22 (42.3%). Eleven (21.2%) have been ever offered drugs and 22 (42.3%) believed they should carry a weapon for protection. Twenty one out of 32 (65.7%) had major depressive disorders and 33 (63.5%) screened positive for behavioral problems. Exposure to home verbal or physical violence, male gender, smoking, and employment were associated with high scoring in behavioral problems. Smoking and ever been touched in an unwanted way were found to be associated with depression.

Conclusion and practical implications

Implementing the HEEADSSS interviewing assessment within medical encounters with refugee adolescents is one efficient way to detect risky health behaviors and mental health problems. Interventions need to be implemented as early as possible in the refugees' journey to help them cope and gain resilience. Training health care providers to conduct the questionnaire and delivering brief counseling when required is recommended. Establishing a network of referrals to provide multidisciplinary care to adolescents can be helpful. Obtaining a fund to distribute safety helmets for adolescent motorbike drivers can be a way to reduce injuries. More research among adolescent refugees in multiple settings, including teenagers in the host country, is needed to serve this population better.

Community mental health interventions for people with major depressive disorder: A scoping review

People with major depressive disorder continue to be marred by chronically pernicious yet preventable outcomes in the biopsychosocial aspects. With the reallocation of healthcare resources towards the fight against the coronavirus 2019 pandemic, much emphasis has been placed on existing community mental health interventions to ameliorate the disruption of mental health services. Moreover, the recent propulsion of community mental health services by the World Health Organization Mental Health Action Plan 2013-2030 ignited the need to bolster existing community interventions by providing comprehensive, responsive and integrated mental healthcare. The enhanced emphasis on mental healthcare in the community and the heightened demands of people with major depressive disorder underscores the need to explore the current state of community mental health interventions. This scoping review examined 51 primary studies published from year 2010 to 2020 using Arskey & O'Malley's five-stage framework and provided an overview of the impact of existing community mental health interventions for people with major depressive disorder. Findings using thematic analysis have recommended the adoption of person-centred community mental healthcare via the biopsychosocial approach for people with major depressive disorder. Enablers of community mental health interventions were driven by culturally appropriate care and augmented by technology-driven modalities. Challenges and gaps of community mental health interventions include the perpetuation of stigma and misconception, complex demands of persons with major depressive disorder and lack of holistic and long-term outcomes. Given the impact of major depressive disorder on the various biopsychosocial aspects, it is envisioned that our insights into the enablers and barriers of community mental health interventions will guide prospective interdisciplinary and nurse-led interventions in holistically improving the care of persons with major depressive disorder in the community settings.

A cross-sectional study on the impact of the COVID-19 pandemic on psychological outcomes: Multiple indicators and multiple causes modeling

Although the psychological impact of coronavirus disease 2019 (COVID-19) has been evaluated in the literature, further research is needed, particularly on post-traumatic stress disorder (PTSD) and psychological outcomes, is needed. This study aims to investigate the effect of the COVID-19 pandemic on psychological outcomes (depression, anxiety, and insomnia). A cross-sectional study using an online survey was conducted using the following instruments: Impact of Event Scale-Revised (IES-R), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder (GAD-7), and Insomnia Severity Index (ISI). Confirmatory factor analysis (CFA), structural equation model (SEM), multiple indicators and multiple causes (MIMIC) modeling, and differential item functioning (DIF) were performed to analyze the collected data. According to the results, participants with PTSD (n = 360) showed a higher level of depression, anxiety, and insomnia than those without PTSD (n = 639). Among the participants, 36.5% experienced moderate to severe symptoms of depression, and 32.6% had mild depressive symptoms. Moreover, 23.7% of participants experienced moderate to severe anxiety symptoms, and 33.1% had mild anxiety symptoms. In addition, 51.5% of participants experienced symptoms of insomnia. In conclusion, the PTSD caused by COVID-19 is significantly associated with depression, anxiety, and insomnia at the level of latent constructs and observed variables.

Anxiety and depression in the post-pandemic era: concerns about viral mutation and re-outbreak

BACKGROUND

The 2020 coronavirus pandemic (COVID-19) has been raging for more than 20 months, putting significant strain on public health systems around the world. Despite the fact that the pandemic has been effectively managed in certain countries, regional outbreaks and viral mutations continue to pose a threat to people's lives. The likelihood of post-pandemic changes in people's psychological situations warrants more investigation.

DESIGN AND PARTICIPANTS

This study was conducted in the context of another outbreak in Zhangjiajie, China, respondents (infected patients, healthy population) were required to complete self-administered questions and standardized questionnaires, including the patient health questionnaire-9 (PHQ-9), the generalized anxiety disorder-7 (GAD-7), and the Brief Illness Perception Questionnaire (BIPQ).

MEASURES

We conducted an anonymous questionnaire survey of infected patients (excluding critically ill patients) in the confirmed COVID-19 ward of Zhangjiajie City People's Hospital's East Hospital from August 14 to 24, 2021, and used convenience sampling to survey medical staff and the general public to assess the psychological reactions of different populations during the delta variant outbreak pandemic. Differences in anxiety and depression severity were compared between groups, with logistic regression models constructed to explore potential factors associated with scoring clinical significant levels of depression and/or anxiety.

RESULTS

There is no significant difference (p value = 0.228) between anxiety and depression in patients (n = 53), general public (n = 97), medical personnel (n = 103), and support workers (n = 65). Females reported higher scores on the GAD-7 and the BIPQ, reduced communication with family and friends appeared to be a risk factor for clinically significant anxiety and depression.

CONCLUSIONS

There were no significant differences in anxiety and depression across populations explored in this study, but females had higher anxiety and illness perception than males, and effective communication may help improve mental health.

Depression rates and health-seeking behavior in primary care: Andersen model of health- care utilization

Depression imposes a tremendous burden on the health-care systems. Many patients prefer informal (family & friends) over formal mental health services (MHS) provided by professionals. We aimed to investigate the prevalence of depression among primary care patients and to examine the factors predicting seeking MHS using the Andersen Health Care Utilization Model. We interviewed 300 primary care patients in Jordan. The mean age was 39.85 ± 14.45, and 80% were women. 35.7% had depression, and 28.7% had significant depression impairing daily function. The most commonly reported source of help was family members and less than one-third had the intention to seek formal MHS. The predisposing-factors domain was the only predictive of seeking MHS in depression and suicide, whereas the 'enabling' and 'need' domains were not. Knowledge, stigma and life satisfaction were predictive of seeking formal MHS. Raising awareness and empowering doctors to screen for depression is needed as less than a third would seek formal MHS.

Mental Health Survey of Social Entrepreneurs During COVID-19: A Study From Pakistan

Background

COVID-19 is widely considered one of the worst pandemics in history, resulting in worldwide lockdowns, social isolation, unemployment, and economic recession. With the prolongation of COVID-19, numerous people experience stress, depression, and other mental health challenges. Recently, several studies have been documented in the literature on mental health issues among students (related to medical or other fields), teachers, medical personnel, and nurses in the wake of the COVID-19 pandemic. However, social entrepreneurs (SEs) have received insufficient attention. This study aims to conduct an online survey in Pakistan's five major cities to investigate more about the mental health status of social entrepreneurs.

Materials and Methods

An online survey which included the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) was employed to collect data. The data analyses were carried out employing descriptive statistics, chi-square test, and multiple regression analyses.

Results

A total of 840 social entrepreneurs from Pakistan participated in the survey. Among these, 366 (43.6%) were female and 474 (56.4%) were male. The findings revealed that 709 (84%) social entrepreneurs were suffering from depression symptoms, and 600 (80%) were suffering from anxiety symptoms. The majority of social entrepreneurs with depression (N = 546) and anxiety (N = 567) had mild and moderate stages. In addition, optional open-ended questions were asked from SE participants that help to understand their perception and response to the COVID-19 pandemic.

Conclusion

The study concluded that several SEs in major cities of Pakistan were experiencing depression and anxiety symptoms. Based on data analysis, male SEs were highly suffering from depression and anxiety than female SEs. Limited resources and changes in customers' behavior were one of the major problems that lead SEs to depression and anxiety during the COVID-19 epidemic. In addition, SEs revealed that the lack of a social business execution policy is the most distressing factor for them. Therefore, a local government must take rigorous precautionary measures to prevent mental health issues among social entrepreneurs. Moreover, the Government of Pakistan needs to adopt supportive policies to assist social entrepreneurs in stressful circumstances.

Under detection of depression in primary care settings in low and middle-income countries: a systematic review and meta-analysis

BACKGROUND

Depression is one of the commonest mental disorders in primary care but is poorly identified. The objective of this review was to determine the level of detection of depression by primary care clinicians and its determinants in studies from low- to middle-income countries (LMICs).

METHODS

A systematic review and meta-analysis was conducted using PubMed, PsycINFO, MEDLINE, EMBASE, LILAC, and AJOL with no restriction of year of publication. Risk of bias within studies was evaluated with the Effective Public Health Practice Project (EPHPP). "Gold standard" diagnosis for the purposes of this review was based on the 9-item Patient Health Questionnaire (PHQ-9; cutoff scores of 5 and 10), other standard questionnaires and interview scales or expert diagnosis. Meta-analysis was conducted excluding studies on special populations. Analyses of pooled data were stratified by diagnostic approaches.

RESULTS

A total of 3159 non-duplicate publications were screened. Nine publications, 2 multi-country studies, and 7 single-country studies, making 12 country-level reports, were included. Overall methodological quality of the studies was good. Depression detection was 0.0% in four of the twelve reports and < 12% in another five. PHQ-9 was the main tool used: the pooled detection in two reports that used PHQ-9 at a cutoff point of 5 (combined sample size = 1426) was 3.9% (95% CI = 2.3%, 5.5%); in four reports that used PHQ-9 cutoff score of 10 (combined sample size = 5481), the pooled detection was 7.0% (95% CI = 3.9%, 10.2%). Severity of depression and suicidality were significantly associated with detection.

CONCLUSIONS

While the use of screening tools is an important limitation, the extremely low detection of depression by primary care clinicians poses a serious threat to scaling up mental healthcare in LMICs. Interventions to improve detection should be prioritized.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42016039704 .

The relationship between childhood trauma and depressive symptom among Zhuang adolescents: Mediating and moderating effects of cognitive emotion regulation strategies

BACKGROUND

Not all adolescents who have endured childhood trauma will develop depressive symptom, nor will they all experience the same level of depressive symptom. According to previous research, cognitive emotion regulation strategies may explain a portion of the variance. Observe the connection between childhood trauma and depressive symptom and investigate whether cognitive emotion regulation strategies mediate or moderate this association.

METHODS

In October 2019, a cross-sectional study measuring childhood trauma, cognitive emotion regulation strategies, and depressive symptom among Zhuang adolescents was done in one senior high school and two junior highs in Chongzuo, Guangxi, China, using a self-report questionnaire. To examine the hypothesis of mediating and moderating effects, SPSS PROCESS was utilized.

RESULTS

In this study, there was a positive relationship between childhood trauma and depressive symptom, whereas there were positive correlations between expressive suppression and childhood trauma and depressive symptom (r = 0.380, 0.246, and 0.089, respectively, p < 0.01). The 5,000-sample bootstrap procedure revealed that the indirect relationship between the independent variable (childhood trauma or emotional abuse) and the dependent variable (depressive symptom) was statistically significant (β = 0.0154 95% CI: 0.0019, 0.0165, β = 0.0442 95% CI: 0.0008, 0.0117). The statistical significance of the interaction effect enhanced the R-square value of the moderating effect when the independent variable was the total childhood trauma score (ΔR2 = 0.0044, 0.0089).

CONCLUSIONS

Our findings corroborated the conclusion of prior research that cognitive emotion regulation strategies mediate and moderate the development of depressive symptom. Although we demonstrate that cognitive emotion regulation strategies play a mediating and moderating role in the relationships between childhood trauma and depressive symptom, the mediating effects on the relationships between the other types of childhood traumas, including physical abuse and neglect, sexual abuse, emotional neglect, and depressive symptom, did not emerge.

Prevalence of unrecognized depression and associated factors among medical outpatient department attendees; a cross sectional study

OBJECTIVES

To determine the prevalence and associated factors of unrecognized depression among patients who visit non-psychiatric outpatient departments in the University of Gondar specialized teaching hospital. North West Ethiopia.

METHODS

An institution-based cross-sectional study was conducted among Medical outpatient departments in the University of Gondar specialized referral hospital from March to April 2019. We collected data through face-to-face interviews. We recruited 314 participants for face-to-face interviews using the systematic random sampling technique. The patient health questionnaire (PHQ-9) was used to measure depression. Coded variables were entered into Epi Info version 7 and exported to SPSS version 20 for analysis. Descriptive statistics and multivariable logistic regression analysis were used. Adjusted odds ratios (AOR) with a 95% confidence interval were used to calculate significance.

RESULTS

A total of 314 participants were interviewed with a response rate of 100%. The prevalence of depression was 15.9% with (95% CI (12.1-20.1)). In the multivariate logistic regression revealed that, able to read and write (AOR = 0.24, 95% CI (0.67-0.84)), secondary education (AOR = 0.34, 95% CI (0.12-0.91)), education in college and university level (AOR = 0.32, 95% CI (0.13-0.78)), poor social support (AOR = 7.78, 95% CI (2.74-22.09)), current cigarette smokers(AOR = 12.65, 95% CI (1.79-89.14)) were associated with depression.

CONCLUSION

The prevalence of depression among outpatient attendees was high. We recommend an early depression screening be carried out by health professionals.

Prevalence of depression and suicide ideation in Hong Kong doctors: a cross-sectional study

Depression amongst physicians can lead to poor individual and institutional outcomes. This study examined the prevalence and factors associated with depression and suicidal ideation amongst doctors in Hong Kong. Doctors who graduated from medical school at the University of Hong Kong between 1995 and 2014 were invited to participate in a survey measuring depressive symptoms, suicidal ideation and thoughts of self-harm, lifestyle behaviours, career satisfaction and socio-demographic characteristics. Data collection occurred between January and April 2016. The prevalence of screened-positive depression was 16.0% and 15.3% of respondents reported having suicidal ideation. Amongst those with positive depression screening scores, less than half reported having a diagnosed mood disorder. Sleeping fewer hours was associated with higher depression scores (P < 0.001) and an increased odds of meeting the cut-off for depression (P < 0.001). Factors associated with suicidal ideation included being unmarried (P = 0.012) and sleeping fewer hours (P = 0.022). Hong Kong doctors appear to have high rates of undiagnosed depression, and high levels of depressive symptoms and suicidal ideations. There is a need for greater awareness of the morbidity due to depression and to promote better mental health help-seeking among physicians. Barriers to mental health help-seeking need to be addressed and appropriate resources allocated to reduce suffering.

COVID-19 pandemic related long-term chronic stress on the prevalence of depression and anxiety in the general population

BACKGROUND

The COVID-19 pandemic has lasted for more than 1 year, causing far-reaching and unprecedented changes in almost all aspects of society. This study aimed to evaluate the long-term consequences of the COVID-19 pandemic on depression and anxiety, and explore the factors associated with it.

METHODS

A cross-sectional study using an online survey was conducted to assess mental health problems from February 2 to February 9, 2021 by using patient health questionnaire-9 (PHQ-9) and generalized anxiety disorder-7 (GAD-7). The insomnia severity index (ISI), demographic data and COVID-19 related variables were measured by a self-designed questionnaire. The factors associated with depressive and anxiety symptoms were identified by Pearson chi-square test and binary logistic regression analysis.

RESULTS

In the study that 1171 participants enrolled, the overall prevalence of depressive and anxiety symptoms among general people was 22.6 and 21.4% respectively in the present study. Living alone was a potential risk factor for depressive symptoms, while regular exercises was a potential protective factor. The prevalence of depressive and anxiety symptoms was significantly associated with the severity of insomnia symptoms and the negative feelings about pandemic.

CONCLUSION

COVID-19 pandemic- related chronic stress has brought about profound impacts on long-term mental health in the general population. The level of insomnia and a negative attitude towards the pandemic are significantly correlated with unfavorable mental health. However, we failed to found a significant association of age and gender with the mental health symptoms, although they were recognized as well-established risk factors during the outbreak by some other studies. This discrepancy may be because the acute and chronic effects of the pandemic are influenced by different factors, which reminds that more attention should be paid to the intrinsic psychological factors and physical reactions towards COVID-19.

Prevalence of mental health problems and associated factors among front-line public health workers during the COVID-19 pandemic in China: an effort-reward imbalance model-informed study

BACKGROUND

Poor mental health status and associated risk factors of public health workers have been overlooked during the COVID-19 pandemic. This study used the effort-reward imbalance model to investigate the association between work-stress characteristics (effort, over-commitment, reward) and mental health problems (anxiety and depression) among front-line public health workers during the COVID-19 pandemic in China.

METHODS

A total of 4850 valid online questionnaires were collected through a self- constructed sociodemographic questionnaire, the adapted ERI questionnaire, the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item General Anxiety Disorder Scale (GAD-7). Hierarchical logistic regression analysis was conducted to investigate the association between ERI factors and mental health problems (i.e., depression and anxiety), with reward treated as a potential moderator in such associations.

RESULTS

The data showed that effort and over-commitment were positively associated with depression and anxiety, while reward was negatively associated with depression and anxiety. Development and job acceptance were the two dimensions of reward buffered the harmful effect of effort/over-commitment on depression and anxiety, whereas esteem was non-significant.

CONCLUSIONS

This study confirmed the harmful effects of effort and over-commitment on mental health among public health workers during the COVID-19 pandemic in China. Such effects could be alleviated through an appropriate reward system, especially the development and job acceptance dimensions of such a system. These findings highlight the importance of establishing an emergency reward system, comprising reasonable work-allocation mechanism, bonuses and honorary titles, a continuous education system and better career-development opportunities.

Relationship between subjective quality of life and perceptions of recovery orientation of treatment service in patients with schizophrenia and major depressive disorder

OBJECTIVE

This study aimed to investigate the relationship between subjective quality of life (QOL) and the specific domains of perceptions of recovery orientation of treatment services in patients with schizophrenia and major depressive disorder (MDD).

METHODS

One hundred and seventy-nine patients with schizophrenia spectrum disorders and fifty-seven patients with MDD were recruited. Patients were assessed on subjective QOL, self-reported depressive symptoms, illness severity, functioning, and perception of recovery orientation of the service environment (RSA). A multiple linear regression model was used to assess the relationship between QOL and RSA score, controlling for all other factors. Spearman correlation analysis was used to examine the relationship between RSA domains and total QOL in each diagnostic group separately.

RESULTS

The regression model explained 47.4 % of the variance observed in total QOL. Depressive symptoms, functioning and RSA were significantly associated with total QOL in the model. Domains one (life goals) and five (individually tailored services) of the RSA were associated with QOL in both groups. Domains two (patient involvement) and three (diversity of treatment options) were associated with total QOL only in patients with schizophrenia.

CONCLUSION

Our findings highlight that perceptions of recovery orientation of service, depressive symptoms and functioning significantly affected the subjective QOL of patients with serious mental illness. The differential relationship observed between QOL and domains of RSA in patients with MDD and schizophrenia suggests that targeted interventions meeting the needs of different patient groups may be crucial to improve QOL of patients.

Face Mask Wearing Behaviors, Depressive Symptoms, and Health Beliefs Among Older People During the COVID-19 Pandemic

The COVID-19 pandemic has affected more than 100 countries. Despite the global shortage of face masks, the public has adopted universal mask wearing as a preventive measure in many Asian countries. The COVID-19 mortality rate is higher among older people, who may find that wearing a face mask protects their physical health but jeopardizes their mental health. This study aimed to explore the associations between depressive symptoms, health beliefs, and face mask wearing behaviors among older people. By means of an online survey conducted between March and April 2020, we assessed depressive symptoms, health beliefs regarding COVID-19, and face mask use and reuse among community-dwelling older people. General linear models were employed to explore the associations among these variables. Of the 355 valid participants, 25.6% experienced depressive symptoms. Health beliefs regarding the perceived severity of disease (p = 0.001) and perceived efficacy of practicing preventive measures (p = 0.005) were positively associated with face mask use. Those who reused face masks (p = 0.008) had a stronger belief in disease severity (p < 0.001), had poorer cues to preventive measures (p = 0.002), and were more likely to experience depressive symptoms. Mask reuse was significantly associated with depression only among those who perceived the disease as serious (p = 0.025) and those who had poorer cues to preventive measures (p = 0.004). In conclusion, health beliefs regarding perceived severity and efficacy contributed to more frequent face mask use, which was unrelated to depressive symptoms. Older people who had a stronger belief in disease severity had less adequate cues to preventive measures and reused face masks experienced greater depressive symptoms. A moderation effect of health beliefs (i.e., disease severity and cues to preventive measures) on face mask reuse and depression was observed.

Comparison of prevalence of depression among medical, dental, and engineering students in Patna using Beck's Depression Inventory II: A cross-sectional study

Background:

Depression, a multi-dimensional disorder adversely affects the interpersonal, social and occupational spheres of students’ life. It is the 11^th leading cause of global disease burden.

Aims and Objectives:

To assess the prevalence of depressive symptoms among various professional course students including medical, dental, and engineering students in Patna, Bihar.

Materials and Methods:

The present investigation was a questionnaire-based cross-sectional descriptive study. A total of 3,100 students attending government and private medical, dental, and engineering colleges in Patna were approached during the course of this study. Students were briefed about the study and questionnaire. BDI-II (Beck's Depression Inventory-II) was administered to the students and they were instructed to fill it. Beck's scores were recorded and a descriptive analysis performed.

Results:

2798 students out of 3,100 responded positively to the survey by completely filling out the form. The overall response rate was 90.25%. The overall prevalence of depressive symptoms was found to be 47.78%. Of the three streams, students belonging to the engineering stream (40.28%) showed a maximum prevalence of depressive symptoms followed by dental (38.50%) and medical students (34.74%).

Conclusion:

Our study showed an alarming prevalence of depression among professional course seeking students. This multi-dimensional disorder continues to affect student's performance and professionalism, thus, extending its negative impact to the community at large. This may carry out later in their lives, thus leaving a long-term negative impact. Considering the high rate of depressive symptoms, establishing a unit or facility to identify or diagnose it at an early stage and providing psychological support to students is recommended.

Depression and Anxiety in Hong Kong during COVID-19

It has been three months since the first confirmed case of coronavirus disease 2019 (COVID-19) in Hong Kong, and people now have a more complete picture of the extent of the pandemic. Therefore, it is time to evaluate the impacts of COVID-19 on mental health. The current population-based study aimed to evaluate the depression and anxiety of people in Hong Kong during the COVID-19 pandemic. Respondents were randomly recruited and asked to complete a structured questionnaire, including the patient health questionnaire-9 (PHQ-9), the generalized anxiety disorder-7 (GAD-7), the global rating of change scale and items related to COVID-19. Of the 500 respondents included in the study, 19% had depression (PHQ-9 score ≥ 10) and 14% had anxiety (GAD score ≥ 10). In addition, 25.4% reported that their mental health had deteriorated since the pandemic. Multiple logistic regression analysis found that not experiencing the SARS outbreak in 2003, being worried about being infected by COVID-19, being bothered by having not enough surgical masks and being bothered by not being able to work from home were associated with a poorer mental health status. Psychological support, such as brief, home-based psychological interventions, should be provided to citizens during the pandemic.

Association Between Depression, Health Beliefs, and Face Mask Use During the COVID-19 Pandemic

The 2019 novel coronavirus (COVID-19) pandemic is associated with increases in psychiatric morbidity, including depression. It is unclear if people with depressive symptoms understand or apply COVID-19 information differently to the general population. Therefore, this study aimed to examine associations between depression, health beliefs, and face mask use during the COVID-19 pandemic among the general population in Hong Kong. This study gathered data from 11,072 Hong Kong adults via an online survey. Respondents self-reported their demographic characteristics, depressive symptoms (PHQ-9), face mask use, and health beliefs about COVID-19. Hierarchical logistic regression was used to identify independent variables associated with depression. The point-prevalence of probable depression was 46.5% (n = 5,150). Respondents reporting higher mask reuse (OR = 1.24, 95%CI 1.17-1.34), wearing masks for self-protection (OR = 1.03 95%CI 1.01-1.06), perceived high susceptibility (OR = 1.15, 95%CI 1.09-1.23), and high severity (OR = 1.33, 95%CI 1.28-1.37) were more likely to report depression. Depression was less likely in those with higher scores for cues to action (OR = 0.82, 95%CI 0.80-0.84), knowledge of COVID-19 (OR = 0.95, 95%CI 0.91-0.99), and self-efficacy to wear mask properly (OR = 0.90 95%CI 0.83-0.98). We identified a high point-prevalence of probable major depression and suicidal ideation during the COVID-19 outbreak in Hong Kong, but this should be viewed with caution due to the convenience sampling method employed. Future studies should recruit a representative probability sample in order to draw more reliable conclusions. The findings highlight that COVID-19 health information may be a protective factor of probable depression and suicidal ideation during the pandemic. Accurate and up-to-date health information should be disseminated to distressed and vulnerable subpopulations, perhaps using digital health technology, and social media platforms to prompt professional help-seeking behavior.

Evaluation of the impacts of a district-level mental health care plan on contact coverage, detection and individual outcomes in rural Uganda: a mixed methods approach

Background

The burden of mental disorders in low- and middle-income countries is large. Yet there is a major treatment gap for these disorders which can be reduced by integrating the care of mental disorders in primary care.

Aim

We aimed to evaluate the impact of a district mental health care plan (MHCP) on contact coverage for and detection of mental disorders, as well as impact on mental health symptom severity and individual functioning in rural Uganda.

Results

For adults who attended primary care facilities, there was an immediate positive effect of the MHCP on clinical detection at 3 months although this was not sustained at 12 months. Those who were treated in primary care experienced significant reductions in symptom severity and functional impairment over 12 months. There was negligible change in population-level contact coverage for depression and alcohol use disorder.

Conclusion

The study found that it is possible to integrate mental health care into primary care in rural Uganda. Treatment by trained primary care workers improves clinical and functioning outcomes for depression, psychosis and epilepsy. Challenges remain in accessing the men for care, sustaining the improvement in detection over time, and creating demand for services among those with presumed need.

[How frequently are depressive disorders recognized in primary care patients? : A cross-sectional epidemiological study in Germany]

BACKGROUND

Primary care physicians (PCPs) play a crucial role for guideline-oriented intervention in patients with depression.

OBJECTIVES

Based on a diagnostic screening questionnaire, this study investigates the sensitivity of PCPs to recognize patients with depression as well as the factors facilitating recognition and concordant diagnostic decisions.

METHOD

In a cross-sectional epidemiological study in six regions of Germany, 3563 unselected patients filled in questionnaires on mental and physical complaints and were diagnostically evaluated by their PCP (N = 253). The patient reports on an established Depression-Screening-Questionnaire (DSQ), which allows the approximate derivation of an ICD-10 depression diagnosis, were compared with the physician diagnosis (N = 3211). In a subsample of discordant cases a comprehensive standardized clinical-diagnostic interview (DIA-X/CIDI) was applied.

RESULTS

On the study day, the prevalence of ICD-10 depression was 14.3% according to the DSQ and 10.7% according to the physician diagnosis. Half of the patients identified by DSQ were diagnosed with depression by their physician and two thirds were recognized as mental disorder cases. More severe depression symptomatology and the persistent presence of main depression symptoms were related to better recognition and concordant diagnostic decisions. Diagnostic validation interviews confirmed the DSQ diagnosis in the majority of the false-negative cases. Indications for at least a previous history of depression were found in up to 70% of false-positive cases.

CONCLUSION

Given the high prevalence of depression in primary care patients, there is continued need to improve the recognition and diagnosis of these patients to assure guideline-oriented treatment.

Tree analysis modeling of the associations between PHQ-9 depressive symptoms and doctor diagnosis of depression in primary care

BACKGROUND

The aim of this study was to explore the relationship between patient self-reported Patient Health Questionnaire-9 (PHQ-9) symptoms and doctor diagnosis of depression using a tree analysis approach.

METHODS

This was a secondary analysis on a dataset obtained from 10 179 adult primary care patients and 59 primary care physicians (PCPs) across Hong Kong. Patients completed a waiting room survey collecting data on socio-demographics and the PHQ-9. Blinded doctors documented whether they thought the patient had depression. Data were analyzed using multiple logistic regression and conditional inference decision tree modeling.

RESULTS

PCPs diagnosed 594 patients with depression. Logistic regression identified gender, age, employment status, past history of depression, family history of mental illness and recent doctor visit as factors associated with a depression diagnosis. Tree analyses revealed different pathways of association between PHQ-9 symptoms and depression diagnosis for patients with and without past depression. The PHQ-9 symptom model revealed low mood, sense of worthlessness, fatigue, sleep disturbance and functional impairment as early classifiers. The PHQ-9 total score model revealed cut-off scores of &gt;12 and &gt;15 were most frequently associated with depression diagnoses in patients with and without past depression.

CONCLUSIONS

A past history of depression is the most significant factor associated with the diagnosis of depression. PCPs appear to utilize a hypothetical-deductive problem-solving approach incorporating pre-test probability, with different associated factors for patients with and without past depression. Diagnostic thresholds may be too low for patients with past depression and too high for those without, potentially leading to over and under diagnosis of depression.

Non-disclosure of symptoms in primary care: an observational study

BACKGROUND

Symptoms form a major component of patient agendas, with the need for an explanation of symptoms being a prominent reason for consultation.

OBJECTIVES

To estimate the prevalence of different symptoms pre-consultation, to investigate whether intention to mention a symptom in the consultation varied between patients and across symptoms, and to determine how patients' intended agendas for mentioning symptoms compared with what was discussed.

METHOD

We videorecorded consultations of an unselected sample of people aged 45 and over consulting their GP in seven different practices in UK primary care. A pre-consultation questionnaire recorded the patient's agenda for the consultation, current symptoms and symptoms the patient intended to discuss with their GP. The videorecorded consultation was viewed and all patient agendas and 'symptoms with intention to discuss' were compared with the actual topics of discussion.

RESULTS

Totally, 190 patients participated. Eighty-one (42.6%) were female and the mean age was 68 (range 46-93). Joint pain was the most commonly reported symptom. One hundred thirty-nine (81.8% of those reporting symptoms) patients reported intention to discuss a symptom. In 43 (22.6%) consultations, 67 symptoms (27.2%), where an intention to discuss had been expressed, remained undisclosed. Tiredness and sleeping difficulty were more likely to be withheld than other symptoms after an intention to discuss had been expressed. Of the more physically located symptoms, joint pain was the most likely to remain undisclosed.

CONCLUSION

This study suggests that the extent of symptom non-disclosure varies between patients, physicians and symptoms. Further work needs to explore the consequences of non-disclosure.

Chinese perspectives on primary care for common mental disorders: Barriers and policy implications

BACKGROUND

The World Health Organization (WHO) has called for integration of mental health into primary care for a decade. In Western countries, around 15% to 25% of patients with common mental disorders including mood and anxiety disorders seek help from primary care physicians (PCPs). The rate is only about 5% in China.

AIMS

This article reviews the Chinese findings on the barriers to primary care for common mental disorders and how they compared with Western findings.

METHODS

A narrative literature review was conducted, focusing on literature published from mid-1990s in English or Chinese. Patient, PCP and health system factors were reviewed.

RESULTS

Although Chinese and Western findings show similar themes of barriers, the Chinese have stronger barriers in most aspects, including under-recognition of the need for treatment, stigma on mental illness, somatization, worries about taking psychiatric drugs, uncertainties in the role, competency and legitimacy of PCPs in mental health care and short consultation time.

CONCLUSION

Current policies in China emphasize enhancement of mental health facilities and workforce in the community. Our review suggests that patients' intention to seek help and PCPs' competency in mental health care are other fundamental factors to be addressed.

Factors contributing to the recognition of anxiety and depression in general practice

Background

Adequate recognition of anxiety and depression by general practitioners (GPs) can be improved. Research on factors that are associated with recognition is limited and shows mixed results. The aim of this study was to explore which patient and GP characteristics are associated with recognition of anxiety and depression.

Methods

We performed a secondary analysis on data from 444 patients who were recruited for a randomized trial. Recognition of anxiety and depression was defined in terms of information in the medical records, in patients who screened positive on the extended Kessler 10 (EK-10). A total of 10 patient and GP characteristics, measured at baseline, were tested and included in a multilevel regression model to examine their impact on recognition.

Results

Patients who reported a perceived need for psychological care (OR = 2.54, 95% CI 1.60–4.03) and those with higher 4DSQ distress scores (OR = 1.03; 95% CI 1.00–1.07) were more likely to be recognized. In addition, patients’ anxiety or depression was less likely to be recognized when GPs were less confident in their abilities to identify depression (OR = 0.97; 95% CI 0.95–0.99). Patients’ age, chronic medical condition, somatisation, severity of anxiety and depression, and functional status were not associated with the recognition of anxiety and depression.

Conclusions

There is room for improvement of the recognition of anxiety and depression. Quality improvement activities that focus on increasing GPs’ confidence in the ability to identify symptoms of distress, anxiety and depression, as part of care according to guidelines, may improve recognition.

Electronic supplementary material

The online version of this article (10.1186/s12875-018-0784-8) contains supplementary material, which is available to authorized users.

Poverty and health-related quality of life of people living in Hong Kong: comparison of individuals from low-income families and the general population

Background

To assess health-related quality of life (HRQOL) among Chinese adults from low-income households in Hong Kong, and to explore any threshold of household income that impaired HRQOL.

Methods

A cross-sectional analysis was conducted on 298 adults from low-income families when they enrolled into a cohort study between 2012 and 2014. HRQOL was measured by the 12-item Short-Form Health Survey-version 2 (SF-12v2). Their mean SF-12v2 subscale and summary scores were compared with those of 596 age-sex-matched subjects randomly selected from a database of 2763 adults from the Hong Kong general population (ratio = 1:2). Multiple linear regressions were conducted to determine any association between monthly household income and HRQOL.

Results

Subjects from low-income households had significantly lower SF-12v2 bodily pain, general health, vitality and physical component summary (PCS) scores than the age-sex matched subjects from the general population. Subgroup analysis showed that a household income <50% of the median monthly household income in Hong Kong (HK$10 000 ≈ US$1290, i.e. poverty line in Hong Kong) was independently associated with poorer PCS and mental component summary (MCS) scores after adjustment for socio-demographics and co-morbidities.

Conclusion

Chinese adults from low-income households had poorer HRQOL, and <50% of the median monthly household income seems to be the threshold for impairment of both physical and mental HRQOL. The findings support the current definition of the poverty line.

Depression and unemployment incidence rate evolution in Portugal, 1995-2013: General Practitioner Sentinel Network data

OBJECTIVE

Quantify, for both genders, the correlation between the depression incidence rate and the unemployment rate in Portugal between 1995 and 2013.

METHODS

An ecological study was developed to correlate the evolution of the depression incidence rates estimated by the General Practitioner Sentinel Network and the annual unemployment rates provided by the National Statistical Institute in official publications.

RESULTS

There was a positive correlation between the depression incidence rate and the unemployment rate in Portugal, which was significant only for males (R² = 0.83, p = 0.04). For this gender, an increase of 37 new cases of depression per 100,000 inhabitants was estimated for each 1% increase in the unemployment rate between 1995 and 2013.

CONCLUSIONS

Although the study design does not allow the establishment of a causal association between unemployment and depression, the results suggest that the evolution of unemployment in Portugal may have had a significant impact on the level of mental health of the Portuguese, especially among men.

Mental health of African asylum-seekers and refugees in Hong Kong: using the social determinants of health framework

Background

Hong Kong is non-signatory to the 1951 Refugee Convention and its 1967 Protocol, and has no systematic domestic policies committed to the rights of asylum-seekers and refugees (ASRs). This creates a tenuous setting for African ASRs there. This study explored how mapped social determinates of health has impacted the mental health and wellbeing of African ASR’s in Hong Kong.

Methods

A cross-sectional survey was carried out with 374 African ASRs. The survey comprised of: (a) socio-demographics; (b) health status; (c) health behaviours; and, (d) social experiences. Associations between social determinants of health and depression screen were explored and multivariable regression analysis was conducted.

Results

Majority of participants were 18–37 years old (79.7%), male (77.2%), single (66.4%) and educated (60.9% high school and above). Over a third (36.1%) screened positive for depression. Analyses revealed that living with family reduced the odds of a positive depression screen (OR = 0.25, 95%CI = 0.07–0.88). Those perceiving their health to be “Poor” were 5.78 times as likely to be screened for depression. Additionally, those with higher scores on the discrimination scale were more likely to have positive depression screen (OR = 1.17, 95%CI = 1.10–1.24).

Conclusion

A significant proportion of African ASRs in Hong Kong exhibits depressive symptoms. A complex interaction combining both social and perceptions of health and discrimination in the host society is likely exacerbated by their ASR status. The use of community support groups or even re-examination of the family reunification laws could improve the mental health and wellbeing of African ASRs in Hong Kong.

Trajectory Pathways for Depressive Symptoms and Their Associated Factors in a Chinese Primary Care Cohort by Growth Mixture Modelling

Background

The naturalistic course for patients suffering from depressive disorders can be quite varied. Whilst some remit with little or no intervention, others may suffer a more prolonged course of symptoms. The aim of this study was to identify trajectory patterns for depressive symptoms in a Chinese primary care cohort and their associated factors.

Methods and Results

A 12-month cohort study was conducted. Patients recruited from 59 primary care clinics across Hong Kong were screened for depressive symptoms using the Centre for Epidemiologic Studies Depression Scale (CES-D) and monitored over 12 months using the Patient Health Questionnaire-9 items (PHQ-9) administered at 12, 26 and 52 weeks. 721 subjects were included for growth mixture modelling analysis. Using Akaike Information Criterion, Bayesian Information Criterion, Entropy and Lo-Mendell-Rubin adjusted likelihood ratio test, a seven-class trajectory path model was identified. Over 12 months, three trajectory groups showed improvement in depressive symptoms, three remained static, whilst one deteriorated. A mild severity of depressive symptoms with gradual improvement was the most prevalent trajectory identified. Multivariate, multinomial regression analysis was used to identify factors associated with each trajectory. Risk factors associated with chronicity included: female gender; not married; not in active employment; presence of multiple chronic disease co-morbidities; poor self-rated general health; and infrequent health service use.

Conclusions

Whilst many primary care patients may initially present with a similar severity of depressive symptoms, their course over 12 months can be quite heterogeneous. Although most primary care patients improve naturalistically over 12 months, many do not remit and it is important for doctors to be able to identify those who are at risk of chronicity. Regular follow-up and greater treatment attention is recommended for patients at risk of chronicity.

Health-related quality of life mediates associations between multi-morbidity and depressive symptoms in Chinese primary care patients

BACKGROUND

Qualifying the relationship between multi-morbidity, health-related quality of life (HRQOL) and depressive symptoms in primary care can help to inform the development of appropriate interventions and services which can help to enhance HRQOL in patients with chronic disease.

OBJECTIVE

The objective of this study was to determine whether the physical aspect of HRQOL mediates the relationship between chronic disease multi-morbidity and depressive symptoms in Chinese primary care patients.

METHODS

A cross-sectional survey was conducted on patients recruited from the waiting rooms of 59 primary care clinics distributed across Hong Kong. About 9259 subjects were included for the mediation model analysis. The primary outcome was level of depressive symptoms as measured by the Patient Health Questionniare 9. The mediation model was tested using a bootstrapping method.

RESULTS

The prevalence of chronic disease was 50.4%, with 25.4% having two or more co-morbidities. The relationship between multi-morbidity and depressive symptoms was found to be mediated by the Physical Component Summary score of the SF-12 v2. Further analysis found the general health (GH) and role physical domains of the SF-12 were the strongest mediators, followed by bodily pain and physical functioning (PF).

CONCLUSION

To enhance the functional capacity of primary care patients with co-existing chronic disease and depressive symptoms, health care interventions should be directed at improving the physical aspects of HRQOL, in particular enhancing patients' GH perception, role functioning and PF, and to better manage chronic pain.

The 12-Month Incidence and Predictors of PHQ-9-Screened Depressive Symptoms in Chinese Primary Care Patients

PURPOSE

Evidence regarding the onset of depressive symptoms in primary care is rarely available but can help inform policy development, service planning, and clinical decision making. The objective of this study was to estimate the 12-month cumulative incidence and predictors of a positive screen for depressive symptoms on the 9-item Patient Health Questionnare-9 (PHQ-9) among primary care patients with no history of physician-diagnosed depression.

METHODS

We monitored a cohort of 2,929 adult primary care patients with no past history of physician-diagnosed depression and with baseline PHQ-9 scores of 9 or lower by telephone interview at 3, 6, and 12 months. A generalized linear mixed effects Poisson Model was used to explore factors associated with the incidence of PHQ-positive symptoms.

RESULTS

The cumulative incidence of positive screening on the PHQ-9 over 12 months was 5.23% (95% CI, 3.83%-6.64%). Positive predictors included being female, coming from a lower-income household, being a smoker, having at least 2 comorbidities, having a family history of depression, and having consulted a physician at least twice in the past 4 weeks. Consulting a physician with qualifications in both family medicine and psychological medicine was a negative predictor.

CONCLUSIONS

The cumulative incidence of PHQ-9-screened depressive symptoms in this study population was higher than those reported for depressive disorders in earlier systematic reviews. Groups who may warrant greater treatment attention include women, patients with multimorbidity, smokers, patients with recent high rates of medical consultations, and those who are from lower-income households or who have a family history of depression. Greater physician training may have a protective effect.

12-Month naturalistic outcomes of depressive disorders in Hong Kong's primary care

BACKGROUND

In Asia, the role of primary care physicians (PCPs) in mental health delivery is not clearly defined and what happens to patients following a depressive episode remains poorly understood.

OBJECTIVE

To examine the 12-month naturalistic outcomes of depression in primary care and the impact of PCP identification.

METHODS

A cohort study was conducted. A total of 10179 adults were consecutively recruited from the waiting rooms of 59 PCPs across Hong Kong to complete a survey which screened for depression. Blinded doctors provided data on their diagnosis and management; 539 screened-positive and 3819 screened-negative subjects consented to telephone follow-up at 3, 6 and 12 months. Study instruments included Patient Health Questionnaire-9, Centre for Epidemiologic Studies Depression Scale 20 and Short-Form Health Survey Version 2.0 (SF-12v2) and self-reported mental health and primary care service use.

RESULTS

12-month remission rate was 60.31%. PCP detection had no association with remission. Identified patients had poorer health-related quality of life (HRQOL) at baseline but a faster rate of recovery in SF-12v2 mental component scores. PCP detection was associated with greater mental health service use at 12, 26 and 52 weeks, while GP consultation rates were only increased at 12 weeks.

CONCLUSIONS

Over 1 year, ~60% of depressed patients experience symptom resolution, while 40% continue to suffer a chronic or remitting course of illness. Identification of depression by a PCP does not appear to affect remission of mood symptoms at 12 months, but is associated with a faster rate of recovery of HRQOL. PCP detection raises GP consultation rates temporarily however appears to enable more patients to access mental health services over 12 months.

Mental health of Chinese primary care patients with lower urinary tract symptoms

The aim of this study was to evaluate the mental health of Chinese primary care patients with lower urinary tract symptoms (LUTS). This was a cross-sectional observational study. Five hundred and nineteen subjects with LUTS completed a structured questionnaire containing the Depression, Anxiety, and Stress Scale-Short Form, the International Prostate Symptom Score, the adapted International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and questions about socio-demographics. Overall, 17.7% of subjects reported depressive symptoms, 24.3% anxiety symptoms and 9.6% stress symptoms. In males, demographic factors associated with poorer mental health included being not married; clinical factors included higher LUTS severity, weak stream, straining and mixed urinary incontinence. In females, demographic factors associated with poorer mental health included being younger, not married and lower household income; clinical factors included higher LUTS severity, incomplete bladder emptying, urgency and weak stream. Chinese primary care patients with LUTS appear to be an at-risk group for poorer mental health with increased prevalence of anxiety and depressive symptoms and may require routine screening to identify those who may require more tailored interventions to address both their urinary symptoms and psychological distress.

Help-seeking intentions and subsequent 12-month mental health service use in Chinese primary care patients with depressive symptoms

OBJECTIVE

To identify the factors associated with 12-month mental health service use in primary care patients with depressive symptoms.

DESIGN

Cross-sectional followed by 12-month cohort study.

SETTING AND PARTICIPANTS

10 179 adult patients were recruited from the waiting rooms of 59 primary care clinics across Hong Kong to complete a questionnaire which screened for depression. 518 screened-positive participants formed the cohort and were telephoned at 3, 6 and 12 months to monitor mental health service use.

PRIMARY AND SECONDARY OUTCOMES

▸ Help-seeking preferences; ▸ Intention to seek help from a healthcare professional; ▸ 12-month mental health service use.

RESULTS

At baseline, when asked who they would seek help from if they thought they were depressed, respondents preferred using friends and family (46.5%) over a psychiatrist (24.9%), psychologist (22.8%) or general practitioner (GP; 19.9%). The presence of depressive symptoms was associated with a lower intention to seek help from family and friends but had no effect on intention to seek help from a healthcare professional. Over 12 months, 24.3% of the screened-positive cohort reported receiving services from a mental health professional. Factors associated with service use included identification of depression by the GP at baseline, having a past history of depression or other mental illness, and being a public sector patient. Having a positive intention to seek professional help or more severe depressive symptoms at baseline was not associated with a greater likelihood of receiving treatment.

CONCLUSIONS

Mental health service use appears to be very low in this setting with only one in four primary care patients with depressive symptoms receiving treatment from a psychiatrist, GP or psychologist over a year. To help reduce the burden of illness, better detection of depressive disorders is needed especially for patients who may be undertreated such as those with no prior diagnosis of depression and those with more severe symptoms.