Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement

Emotional stimulated speech-based assisted early diagnosis of depressive disorders using personality-enhanced deep learning

BACKGROUND

Early diagnosis of depression is crucial, and speech-based early diagnosis of depression is promising, but insufficient data and lack of theoretical support make it difficult to be applied. Therefore, it is valuable to combine psychiatric theories, collect speech recognition data for depression, and develop a practicable recognition method for depression.

METHODS

In this study, 24 patients with major depressive disorders (MDDs) and 36 healthy controls (HCs) were recruited to participate in a multi-task speech experiment. Descriptive statistics and tests of variance were used to analyze subjects' personality and speech changes. Subsequently, the speech task with the most depressive cues was explored using the Bidirectional Long - Short Term Memory (Bi-LSTM) algorithm, on which a personality-assisted multitasking deep model, i.e., multi-task attentional temporal convolutional network model (TCN-MTA).

RESULTS

Statistical analyses of speech duration showed that the fable reading, neutral stimulus, and negative stimulus tasks had significant differences on subjects' speech duration, and the negative stimulus task had significant differences between the depressed and control groups (p < 0.001, 0.03, 0.04). Notably, the Big Five personality emotional stability scores were significantly different between the depressed and control groups (0.03). Depression was best identified using Bi-LSTM in negative (Youden index = 0.44) and positive stimulus speech (Youden index = 0.42). Further, the specificity of 0.72 and sensitivity of 0.87 for recognizing depression in negative stimulus speech using our proposed TCN-MTA outperforms existing methods.

LIMITATIONS

The sample size enrolled in this study is higher than the minimum sample size calculated through G-Power 3.1, but the sample size in this study is still small.

CONCLUSION

The proposed deep learning-based personality-assisted multitasking method could accurately recognize major depression, which demonstrated the potential of the method based on the fusion of specialized theories and artificial intelligence.

Depression screening within 3 months of primary shoulder arthroplasty decreases medical complications, implant complications, and costs of care in patients with diagnosed depressive disorder

Background

It is unknown if nonpharmacologic interventions are protective of adverse outcomes in depression patients. We studied whether depression screenings/psychotherapy visits were associated with lower: (a) medical complications, (b) readmission rates, (c) implant-related complications, and (d) healthcare expenditures.

Methods

A nationwide claims database was queried for primary shoulder arthroplasty from 2010 to 2020. Depression patients included those who had (n  =  3566) and did not have (n  =  17,769) a pre-operative depression screen/psychotherapy visit within 3 months of shoulder arthroplasty. A 90-day period was utilized for complications and readmissions. Implant complications were assessed over 2 years. Costs were surgeon reimbursements. Logistic regression models computed odds ratios (OR) of complications and readmissions. P-values less than 0.005 were significant.

Results

Depression patients who did not undergo screening had threefold higher odds of 90-day medical complications (28.08 vs. 7.26%; OR: 3.33, p < 0.0001). Readmissions (3.97 vs. 3.48%; p  =  0.719) were similar between non-screened vs. screened patients. Implant complications were higher among non-screened vs. screened patients (15.89 vs. 8.02%; OR: 1.93, p < 0.0001), including prosthetic joint infections (2.05 vs. 0.93%; OR: 2.04, p < 0.0001). Costs were significantly higher in patients without screening ($10,916 vs $8703; p < 0.0001).

Discussion

Shoulder arthroplasty surgeons may consider counseling their depression patients about the importance of having a recent screening by their physician.Level of Evidence: III.

Incidence of depression in patients with chronic cardiovascular diseases: Case-control study with German health insurance claims data

BACKGROUND

Depression and cardiovascular diseases (CVD) are two common conditions that account for a high proportion of morbidity and mortality worldwide and in Germany. The objective of this study is to examine whether the risk of developing depression in persons with prevalent chronic CVD is elevated compared to persons without CVD and whether it varies by sex and age group.

METHODS

This observational case-control study is based on German statutory health insurance claims data from 2015 to 2019 (N = 2,229,042). The study population comprises persons with a CVD diagnosis in 2016 and without depression or acute major CVD event in 2015-2016 (N = 173,774). A control group was built by 1:1 matching by sex, gender and age. Cox regression models estimated the risk of developing depression during the observation period (2017-2019) while adjusting for several comorbidities. Results are presented stratified by sex and age group.

RESULTS

The presence of chronic CVD increased the risk of developing depression in men and women and in all examined age groups. This relationship between chronic CVD and depression appeared to be particularly pronounced in younger men aged under 55 years (HR = 1.33, 95 %-Confidence Interval (CI) = 1.14-1.54). However, risk of developing depression was much higher in women (with and without CVD) than in men (HR = 1.53, 95 %-CI = 1.46-1.61).

CONCLUSIONS

This study underlines the importance of mental health services for patients with cardiovascular diseases. Given the impact of depression on re-hospitalization, self-care and all-mortality in patients with chronic cardiovascular disorders, a screening for depressive symptoms in this patient group is highly recommended.

Treating obesity in patients with depression: a narrative review and treatment recommendation

The high morbidity of obesity and depression pose significant public health concerns, with the prevalence of obesity doubling in the US between 1990 and 2022 and patients frequently presenting with both. Untreated obesity and depression can greatly impact patient health and well-being, as both obesity and depression are associated with a number of comorbidities including sleep apnea, type 2 diabetes mellitus, metabolic syndrome, metabolic dysfunction-associated steatotic liver disease, and cardiovascular disease. This narrative review aims to provide a comprehensive and current overview of the overlapping etiologies between obesity and depression as well as the available treatment options that may be recommended by primary care professionals to treat these patients with concomitant obesity and depression. With the considerable overlap in the population of patients with obesity and depression, as well as the overlap in the neurobiological, hormonal, and inflammatory pathways underlying both diseases, primary care professionals should consider screening patients presenting with obesity for depression. Holistic treatment options, including lifestyle and behavioral modifications, and pharmacotherapy for both depression and obesity and bariatric surgery for obesity are critical to manage both conditions simultaneously. Therefore, due to the overlapping neurobiological pathways and mechanisms responsible for the incidence and progression of both obesity and depression, a holistic treatment plan including strategies with efficacy for both conditions and any additional comorbidities may improve the clinical approach for patients with concomitant obesity and depression.

Prevalence and Correlates of Clinically Elevated Depressive Symptoms in a Nationwide Sample of Transgender, Nonbinary, and Gender Diverse Young Adults in the United States: Cross-Sectional Survey Study

Background

In the United States, transgender, nonbinary, and gender diverse (TGD) young adults experience a higher risk of depression compared to their cisgender peers. Understanding factors associated with increased risk of depression within the TGD young adult population is important to guide clinical care as well as inform the development of interventions to reduce mental health disparities.

Objective

This exploratory study investigated the prevalence and correlates of positive screening for depressive symptoms among TGD young adults to inform the design, development, and implementation of national interventions aimed at improving mental health in this at-risk population.

Methods

In August 2022, a cross-sectional, nationwide online survey was conducted among TGD young adults aged 18-25 (N=104) in the United States. Measures included sociodemographic variables, family characteristics, mental health care utilization, and the two-item Patient Health Questionnaire-2 (PHQ-2) screener for depression. Poisson regression models with robust variance estimation were fitted to estimate adjusted prevalence ratios (aPR) and 95% CI for correlates of PHQ-2 depression (score ≥3).

Results

The study sample had a mean age of 22 (SD 2) years; 48/104 (46%) individuals identified as Black, Indigenous, or other People of Color, and 69/104 (66%) were nonbinary. Overall, 44 (42%) individuals screened positive for depression using PHQ-2. In a multivariable model adjusted for age, race and ethnicity, US census region, and health insurance status, factors associated with increased depression prevalence using PHQ-2 included low versus high family support (aPR 1.54, 95% CI 1.05-2.27) and identifying with a nonChristian religion versus being unaffiliated (aPR 1.66, 95% CI 1.04-2.63). Factors associated with reduced depression prevalence included living in a rural versus suburban area (aPR 0.48, 95% CI 0.26-0.92) and receiving mental health therapy versus not (aPR 0.71, 95% CI 0.53-0.97).

Conclusions

The high prevalence of depressive symptoms among TGD young adults in this study sample highlights the need for comprehensive mental health evaluation and support in this population. Depression risk is increased among certain subgroups, such as those with low family support. These findings are valuable in informing the development of interventions that aim to improve mental health outcomes among TGD young people.

A mixed-methods study protocol: Perinatal depression screening systems and outcomes in obstetrics clinics

Perinatal depression (PND) is an underrecognized and underdiagnosed public health issue with long-term adverse impacts on birthing parents and their children. While obstetrics practices are increasingly encouraged to use existing evidence-based screening tools, there is little data describing the extent to which screening practices and subsequent referrals to care are implemented in clinical settings. The Screening and Treatment Enhancement for Perinatal Depression (STEPS for PPD) study aims to characterize PND screening and referral procedures and identify areas for system improvements. We describe a protocol for an observational study, guided by implementation science frameworks, examining the role of embedded perinatal social workers in managing PND across Mass General Brigham system obstetrics clinics. Our mixed-methods approach integrates qualitative and quantitative data from a variety of sources, including electronic health records, patient-reported surveys, and qualitative interviews, to capture complex screening and referral practices across a large academic medical system. We aim to characterize nuances within the screening and referral system and identify barriers and facilitators to care to inform future hybrid-implementation effectiveness research and improve patient outcomes.

Screening for Psychotic Experiences and Psychotic Disorders in General Mental Health Treatment Settings: A Systematic Review and Meta-Analysis

BACKGROUND

The absence of systematic psychosis screening within general mental health services contributes to substantial treatment delays and poor long-term outcomes for individuals with psychotic symptoms. We conducted a meta-analysis to estimate rates of subclinical psychotic symptoms for psychotic experiences (PE), clinical high-risk for psychosis syndrome (CHR-P), and psychotic disorders that were identified via studies screening treatment-seeking individuals. These rates can inform implementation recommendations for routine psychosis screening in general mental health settings.

METHODS

PubMed and Web of Science databases were searched to identify empirical studies with information on PE, CHR-P, or psychotic disorder prevalence identified by screening inpatients and outpatients (age < 65 years) receiving general mental health care. PE was identified using threshold scores on validated self-reported questionnaires, and CHR-P and psychotic disorder were identified using gold-standard structured interview assessments. A meta-analysis of each outcome was conducted using the restricted maximum likelihood estimator method to assess effect sizes in a random effects model.

RESULTS

The analyses included 41 independent samples (k = 32 outpatient, k = 2 inpatient, k = 7 combined settings) with a total of 25,751 patients (58% female, mean age: 24.1 years). PE prevalence was 44.3% (95% CI: 35.8-52.8%; 28 samples, n = 21,957); CHR-P prevalence was 26.4% (95% CI: 20.0-32.7%; 28 samples, n = 14,395); and psychotic disorder prevalence was 6.6% (95% CI: 3.3-9.8%; 32 samples, n = 20,371). Rates did not differ by sex, age, or setting type.

CONCLUSIONS

The high prevalence of psychotic symptoms in general mental health treatment settings underscores the need for early-detection psychosis screening. These base rates can be used to plan training and allocation of resources required to conduct psychosis assessments and build capacity for delivering interventions for CHR-P and early psychosis in non-specialty mental health treatment settings.

The competitive mediating role of basal metabolic rate in the association between polycyclic aromatic hydrocarbon exposure and depression risk

BACKGROUND

The effect of basal metabolic rate (BMR) on depression was unclear. This study investigated the potential role of BMR in the association of polycyclic aromatic hydrocarbons (PAHs) exposure and depression.

METHODS

The study based on the National Health and Nutrition Examination Survey (NHANES). BMR was calculated using both the revised Harris-Benedict equation (BMR1) and the Mifflin-St Jeor equation (BMR2). Generalized linear and logistic regression models were applied to examine the associations between PAH metabolites, BMR, and depression. Weighted Quantile Sum (WQS) regression and Bayesian Kernel Machine Regression (BKMR) were utilized to analyze the combined effects of multiple PAH metabolites. Mediation analysis was conducted to explore the role of BMR.

RESULTS

The study included 8323 participants. A 100 kcal/day increase in BMR1 and BMR2, the depression risk increased by 5 % (95%CI: 1.00, 1.10) and 7 % (95%CI: 1.02, 1.13), respectively. WQS model indicated that mixed PAH metabolites were negatively associated with BMR1 (β: -0.06, P = 0.020) and BMR2 (β: -0.06, P = 0.014). BKMR models showed that when all PAH metabolites were at P75 compared to P50, BMR1 and BMR2 decreased by 20.54 and 20.31 units, respectively, while the depression risk increased by 0.23 units (95 % CI: 0.07, 0.38). Mediation analyses suggested that BMR exerted a competitive mediation effect in the association between 1-NAP, 2-FLU, 1-PHE, 1-PYR, and depression.

CONCLUSION

PAH exposure led to a reduction in BMR and contributed to depression at high levels of exposure. An increase in BMR mitigated the impact of PAH exposure on depression.

Psychometric testing of Chinese version of screening tools (PASS) and GAD among perinatal population: hospital based evidence 2023

BACKGROUND

Anxiety disorders are increasing worldwide, untreated anxiety is linked to maternal and child health outcomes. The purpose of this study is to test psychometric properties of the Perinatal Anxiety Screening Scale (PASS) among Chinese women.

METHODS

The PASS was translated into Chinese following Beaton's intercultural debugging guide. A total of 494 women in the antenatal and postnatal phase participated ( 268 antenatal and 186 postnatal ) were recruited between March 2023 and July 2023 from two hospitals in Sichuan Province, China. The instruments included the demographic characteristics form, PASS, Edinburgh Postnatal Depression Scale (EPDS), and Generalized Anxiety Disorder-7 (GAD-7). The confirmatory factor analysis (CFA), internal consistency reliability and convergent validity were assessed.

RESULTS

The mean age of the participant was 31.67 years (SD = 3.78; range from 23 to 49). The CFA showed that four-factor model of the Chinese-PASS had an excellent fit to the data ( χ2 = 1481.2477; df = 425; χ2/df = 3.485; RMSEA = 0.071; CFI = 0.871; NNFI = 0.828; TLI = 0.859; and IFI = 0.871). The Cronbach's alpha coefficient of total scale was 0.950, and the split-half reliability of total scale was 0.907. The PASS significantly correlated with EPDS (r = 0.732) and GAD-7 (r = 0.763). The area under the ROC curve for PASS scores was 0.91 (SE = 0.01; 95% CI = 0.89-0.94). At cut-off score of ≥ 19.5, the sensitivity was 0.87. The area under the ROC curve for GAD-7 scores was 0.89 (SE = 0.02; 95% CI = 0.86-0.92). At cut-off score of ≥ 3.5, the sensitivity was 0.82.

CONCLUSIONS

The result of this study show that the Chinese-PASS had a reasonably adequate validity and reliability and can be used to screen for anxiety disorder among women during the perinatal period.

Prevalence of Depression and Anxiety Among Adults With Chronic Pain: A Systematic Review and Meta-Analysis

Importance

Depression and anxiety are common among adults with chronic pain, but their prevalence is unclear.

Objectives

To evaluate the prevalence of depression and anxiety among adults with chronic pain and identify factors that moderate prevalence.

Data Sources

A literature search was conducted of MEDLINE, Embase, PsycINFO, and Cochrane Library from January 2013 to October 2023.

Study Selection

Studies reporting the prevalence of depression or anxiety using a validated assessment tool among adults with chronic pain (excluding chronic headache disorders).

Data Extraction and Synthesis

A total of 31 159 initial records were identified, and 5177 full texts were screened. Data were extracted per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline using Covidence. Two independent reviewers completed abstract screening, full-text review, and data extraction and rated risk of bias. Random-effects meta-analyses were applied to pool prevalence, assess moderation, and compare prevalence of depression or anxiety among samples with chronic pain vs control samples.

Main Outcomes and Measures

Prevalence of depression and anxiety based on clinically significant symptoms or diagnosis. The moderators of prevalence identified were pain condition, recruitment setting, continent, age, percentage female, and pain duration.

Results

The search identified 376 studies from 50 countries comprising 347 468 individuals (mean [SD] age, 51.3 [9.5] years; 70.0% female) with chronic pain. Among adults with chronic pain, clinical symptoms of depression were present in 39.3% (95% CI, 37.3%-41.1%; I2 = 98.9%), and clinical symptoms of anxiety were present in 40.2% (95% CI, 38.0%-42.4%; I2 = 99.0%). Prevalence differed by pain condition (highest among samples of people with fibromyalgia [depression, 54.0% (95% CI, 48.5%-59.4%); anxiety, 55.5% (95% CI, 50.4%-60.4%)]; lowest among samples of people with arthritis conditions [eg, osteoarthritis: depression, 29.1% (95% CI, 20.3%-39.7%); anxiety, 17.5% (95% CI, 6.6%-38.8%)]) and was highest among younger people (depression, β = -0.02 [95% CI, -0.03 to -0.01]; anxiety, β = -0.02 [95% CI, -0.03 to -0.01]) and women (depression, β = 0.69 [95% CI, 0.31-1.08]; anxiety, β = 0.90 [95% CI, 0.48-1.33]). With regard to diagnoses, 36.7% (95% CI, 29.0%-45.1%) had a major depressive disorder, and 16.7% (95% CI, 11.8%-23.2%) had generalized anxiety disorder. Women, younger people, and people with nociplastic pain (ie, pain arising from altered nociception without tissue damage) were most likely to have depression and anxiety.

Conclusions and Relevance

In this systematic review and meta-analysis of depression and anxiety among individuals with chronic pain, approximately 40% of adults had clinically significant depression and anxiety. Women, younger people, and people with nociplastic pain were most likely to have depression and anxiety. The co-occurrence of chronic pain with depression and anxiety is a significant public health concern necessitating routine screening in clinical settings, equitable access to specialty care, and innovative treatment development.

Non-traditional risk factors for atrial fibrillation: epidemiology, mechanisms, and strategies

Atrial fibrillation (AF) has become the pre-dominant arrhythmia worldwide and is associated with high morbidity and mortality. Its pathogenesis is intricately linked to the deleterious impact of cardiovascular risk factors, emphasizing the pivotal imperative for early detection and mitigation strategies targeting these factors for the prevention of primary AF. While traditional risk factors are well recognized, an increasing number of novel risk factors have been identified in recent decades. This review explores the emerging non-traditional risk factors for the primary prevention of AF, including unhealthy lifestyle factors in current society (sleep, night shift work, and diet), biomarkers (gut microbiota, hyperuricaemia, and homocysteine), adverse conditions or diseases (depression, epilepsy, clonal haematopoiesis of indeterminate potential, infections, and asthma), and environmental factors (acoustic pollution and other environmental factors). Unlike traditional risk factors, individuals have limited control over many of these non-traditional risk factors, posing challenges to conventional prevention strategies. The purpose of this review is to outline the current evidence on the associations of non-traditional risk factors with new-onset AF and the potential mechanisms related to these risk factors. Furthermore, this review aims to explore potential interventions targeting these risk factors at both the individual and societal levels to mitigate the growing burden of AF, suggesting guideline updates for primary AF prevention.

Gender-Affirming Hormone Therapy and Depressive Symptoms Among Transgender Adults

Importance

In the US, transgender, nonbinary, and gender diverse (TGD) adults have high rates of depression. Gender-affirming hormone therapy (GAHT) is associated with improved mental health outcomes, yet existing US studies have short follow ups and lack sample diversity.

Objective

To evaluate the use of GAHT delivered in primary care as an intervention for moderate-to-severe depressive symptoms in diverse TGD adult patients.

Design, Setting, and Participants

LEGACY was an observational cohort study conducted in federally qualified community health centers in Boston and New York that followed up TGD patients (N = 3592) from calendar years 2016 to 2019 (48 months). Participants included individuals aged 18 years or older, gender identity different from sex at birth, a past 12-month medical visit, and signed patient consent form in the electronic health record (EHR).

Exposures

Prescriptions for GAHT obtained from EHR data, using the date of the first and last GAHT prescription in each calendar year of observation (GAHT within the year vs no GAHT during the year).

Main Outcomes and Measures

A binary outcome of patient-reported moderate-to-severe depressive symptoms was obtained using the validated Patient-Health Questionnaire (PHQ), scoring 10 or greater on the PHQ-9 or scoring 3 or greater on the PHQ-2. Following multiple imputation, generalized estimating equations (GEE) longitudinally modeled GAHT and moderate-to-severe depressive symptoms (n = 20 320 observations) and adjusted for age, gender identity, race and ethnicity, health insurance, federal poverty level, HIV serostatus, number of cohort years, and clinical site.

Results

The median age of the 3592 patients was 28 (IQR, 24-36) years. Race and ethnicity was diverse (1.3% Asian/Pacific Islander, 11.7% Black, 16.1% Hispanic/Latinx, 63.1% White, 6.8% multiracial, and 1.4% other). In addition, 18.9% were nonbinary, 52.1% lived below the federal poverty level, 34.2% were publicly insured, 4.1% were uninsured, and 5.1% were living with HIV. At baseline, 84.5% of the individuals were prescribed GAHT and 15.3% reported moderate-to-severe depressive symptoms. Patients prescribed GAHT had a statistically significantly lower risk of moderate-to-severe depressive symptoms over follow-up compared with those not prescribed GAHT (adjusted risk ratio, 0.85; 95% CI,  0.75-0.98).

Conclusions and Relevance

In this longitudinal observational cohort study, GAHT was associated with lower rates of moderate-to-severe depressive symptoms, highlighting the importance of gender-affirming primary care models for TGD patients.

Association of Thyroid Function With Depression: A Historical Cohort Study

BACKGROUND

There is inconsistent evidence concerning the association between thyroid dysfunctions and depression. Therefore, we conducted this population-based study to investigate the relationship between thyroid-stimulating hormone (TSH) and depression using the Patient Health Questionnaire-9 (PHQ-9).

METHOD

We included patients (≥18 y) who received care at the Marshfield Clinic Health System and completed a TSH level and a PHQ-9 within 2 weeks, between 2015 and 2020. We used a logistic regression model adjusted for covariates to estimate the effect of TSH level on clinically relevant depression (PHQ-9 score ≥10).

RESULTS

Our cohort included 31,099 patients, mean age 50.9±19.5 years, 73.5% females, and 96.3% White, 39.7% of whom had clinically relevant depression. The patients with clinically relevant depression had higher TSH levels compared with those without such depression (P=0.01). In this cohort, we found that low TSH levels (<0.5 mIU/L) and very elevated TSH levels (≥10 mIU/L) both had increased odds of being associated with clinically relevant depression: [1.30 (95% CI: 1.15-1.46) and OR 1.50 (95% CI: 1.25-1.81), respectively]. Subgroup analysis showed similar findings in patients with mood disorders, females, younger adults (<65 y), and those with untreated thyroid disorders. In males, only low TSH was associated with clinically relevant depression, whereas in patients with treated thyroid disorders, only very elevated TSH was associated with clinically relevant depression.

CONCLUSIONS

In this large cross-sectional study, we found that low TSH and very elevated TSH levels were both associated with higher odds of depression. Similar trends were observed in patients with mood disorders, females, younger adults (<65 y), and those with untreated thyroid disorders. Large prospective population-based studies are needed to further investigate the relationship between TSH levels and clinical depression.

Ethical Issues and Challenges Regarding the Use of Mental Health Questionnaires in Public Health Nutrition Research

BACKGROUND

The use of mental health questionnaires is common in desk-based public health epidemiological research; however, the burden this might put on participants and researchers has been questioned and has not been previously addressed. This paper delves into the ethical issues and challenges of using such scales and questionnaires, providing a real-life case study where the Beck's Depression Inventory-II was used.

METHODS/RESULTS

The ethical considerations raised by using mental health questionnaires in public health epidemiological research include incorrectly identifying participants as depressed or non-depressed; inability to identify participants for referral procedures due to the anonymous nature of some research studies; an increased burden on participants through depression and suicidal questions; and the high expectation of participants towards the researcher. Preventative measures to reduce these challenges include choosing appropriate cut-off scores for correctly identifying participants; highlighting whether the mental health questionnaires used may elicit negative emotional or psychological reactions related to suicidality; specifying the criteria for referral to clinical services; detailing the intended referral processes; including approaches where the researcher directly connects participants with a psychological service provider; and including a passive referral method such as contact details for participants to initiate their own referrals to clinical care.

CONCLUSIONS

This paper serves as a guide for researchers aiming to collect data on mental health through questionnaires. The ethical challenges discussed in this paper should be considered and reviewed at all stages of the research project.

The Development and Psychometric Validation of the Fainareti Screening Tool for Perinatal Mental Health in Greek Pregnant Women

Background/Objectives: It would be helpful for primary healthcare professionals to have access to a brief, general screening tool allowing them to detect patients suffering from major mental illness. This also holds for organizations and institutions at which pregnant women ask for support during the perinatal period. An evaluation of the psychometric properties, validity, and reliability of the Fainareti mental health screening tool was carried out in Greek women in this study. Methods: The study participants consisted of 518 women retrospectively followed from pregnancy to their first year postpartum as part of a health intervention at the Day Center for Women's Mental Health Care (Perinatal Mental Health Disorders), operated by the non-profit organization Fainareti. Alongside the newly developed screening tool, this study utilized the Perinatal Anxiety Screening Scale (PASS), the Patient Health Questionnaire (PHQ-9), and the Edinburgh Postnatal Depression Scale (EPDS). Results: The assessment of the tool's internal reliability included computing two separate internal consistency indices, with both indicating its significant level of reliability. The correlation analysis between the tool and the scales included in this study demonstrated the tool's strong convergent validity, while factor analyses confirmed its satisfactory construct validity. Conclusions: Overall, these findings suggest that the one-factor Fainareti mental health screening tool is suitable for initial assessments of the mental health of Greek women.

An Analysis of Primary Hyperparathyroidism in Association with Depression or Anxiety

BACKGROUND

Non-classical manifestations such as neuropsychiatric manifestations in primary hyperparathyroidism (PHPT) have long been documented as symptoms of PHPT and are commonly reported by these patients, despite this connection still being a matter of debate, and they (per se) do not represent an indication of parathyroidectomy.

OBJECTIVE

We aimed to overview the most recent findings regarding the link between depression and/or anxiety (D/A) in subjects confirmed with PHPT, including the impact of the surgery in improving their outcome.

METHODS

This was a comprehensive review of English-based original studies published between January 2020 and October 2024.

RESULTS

The studies (n = 16) included a total of 10,325 patients and an additional 152,525 patients with hypercalcemia (out of whom 13,136 had a PHPT diagnosis and 45,081 were at risk of PHPT diagnosis). Out of these subjects with PHPT, 10,068 underwent parathyroidectomy. Female prevalence was between 62.5 and 92%. Most individuals were over 50, with the youngest studied population having a mean age of 52.7 ± 13.8 years, and the oldest had a median of 71. Depression was documented based on ICD-10 codes (n = 3) and patients' records (n = 2), Depression Anxiety Stress Scales (DASS) (n = 2), Beck Depression Inventory (BDI) (n = 3), BDI-II (n = 3), Symptom Check List 90-revised (SCL) (n = 1), Hamilton Depression Rating Scale (HAM-D) (n = 2), HADS (n = 2), Patient Health Questionnaire-9 (n = 1), and European Quality of Life 5 Dimensions 3-Level Version (EuroQOL-5D-3L) (n = 1). Patient records' (n = 1) and ICD-10 codes (n = 2) were also used for anxiety. Most studies used questionnaires to identify anxiety in PHPT: DASS (n = 2), SCL90R (n = 1), Generalized Anxiety Disorder-7 (n = 1), HADS (n = 2), EuroQOL-5D-3L (n = 1), and State-Trait Anxiety Inventory (n = 1). Depression prevalence varied from 20-36.6% to 65.7% (scale-based assessment) and to 10.5% upon ICD-10. A rate of newly onset depression was reported of 10.7% and of 0.2% with concern to the prevalent suicidal ideation (an incidental rate of 0.4% after a median follow-up of 4.2 years). Most studies identified a moderate depression (when assessing its severity), affecting approximately one third of the surgery candidates. The prevalence of anxiety in PHPT varied between 10.4% and 38.6% (n = 8). Discordant results were generated when applying distinct questionnaires for the same population, and this might come as a potential bias. Other confounding factors are generated by the sub-population referred for surgery that typically displays a more severe parathyroid condition or non-endocrine overlapping conditions (e.g., related to the social or familial status).

CONCLUSION

The modern approach of the patient with PHPT should be complex and go beyond the traditional frame. D/A had a high prevalence in the mentioned studies, associated with increased medication use. Yet, the underlying pathogenic mechanisms remain incompletely elucidated. No correlations between D/A and serum calcium levels were confirmed, while PTH had a slight positive correlation with depression. Parathyroid surgery appears to be beneficial for D/A as it improves the scores, prevalence, and severity. Cinacalcet might reduce depression scores, although more evidence is needed. Women are prone to both PHPT and D/A. The optimal method of D/A screening in PHPT remains to be determined, and the current scales need validation and perhaps adjustment for this specific population sub-group, while PHPT management should be refined upon D/A identification.

Screening for depression, anxiety, and psychological distress associated with low back pain by musculoskeletal and spinal clinicians. A scoping review

PURPOSE

A biopsychosocial assessment of a person with low back pain (LBP) should include the detection of psychological risk factors. Pragmatically, clinicians often use their clinical impression rather than questionnaires to screen for psychological risk factors. This scoping review explores how accurately depression, anxiety, and psychological distress can be identified by musculoskeletal (MSK) or spinal clinicians using clinical impression alone.

METHODS

The study protocol was pre-registered on Open Science Framework (OSF) https://osf.io/pt3a6/ . A comprehensive search strategy using five databases (MEDLINE, CINAHL, Academic Search Complete, APA PsycInfo, APA PsycArticles) was conducted by two independent reviewers, with additional searching of references. Studies must have included adults with LBP, who were assessed by MSK or spinal clinician for depression, anxiety or psychological distress using their clinical impression as well as a reference standard questionnaire. Data were synthesised descriptively and thematically for each psychological factor separately.

RESULTS

Eight studies involving MSK clinicians (n = 4) and spinal clinicians (n = 4) were eligible. Four different reference standard questionnaires were used. Overall MSK and spinal clinicians were not accurate at identifying depression, anxiety or psychological distress in adults with LBP using only clinical impression. Mean sensitivity for accurate identification of high reference standard questionnaire scores for depression, anxiety, and psychological distress ranged between 12.0% and 40.0%. Mean sensitivity was marginally higher when the threshold was reduced to analyse clinician ability to accurately capture any abnormal psychological state (34.0% to 54.1%). Mean specificity values across higher thresholds ranged from 88.7% to 93.6%.

CONCLUSION

Overall, clinician impression alone is insufficient for MSK and spinal clinicians to accurately identify depression, anxiety and psychological distress in adults with LBP. The general tendency of the clinicians was to underestimate their presence. Without formal assessment of the psychological status of patients with LBP, clinicians will have an incomplete understanding of concordant psychological factors, and may fail to notice the requirement to refer on for appropriate psychological management.

Hypothalamus-pituitary-adrenal and gut-brain axes in biological interaction pathway of the depression

The hypothalamus-pituitary-adrenal (HPA) and gut-brain axes are vital biological pathways in depression. The HPA axis regulates the body's stress response, and chronic stress can lead to overactivation of the HPA axis, resulting in elevated cortisol levels that contribute to neuronal damage, particularly in regions such as the hippocampus and prefrontal cortex, both of which are involved in mood regulation and mental disorders. In parallel, the gut-brain axis, a bidirectional communication network between the gut microbiota and the central nervous system, influences emotional and cognitive functions. Imbalances in gut microbiota can affect the HPA axis, promoting inflammation and increasing gut permeability. This allows endotoxins to enter the bloodstream, contributing to neuroinflammation and altering neurotransmitter production, including serotonin. Since the majority of serotonin is produced in the gut, disruptions in this pathway may be linked to depressive symptoms. This review explores the interplay between the HPA axis and the gut-brain axis in the context of depression.

Frequency of depression and anxiety symptoms among adults with childhood- versus adult-onset disability

BACKGROUND

Individuals with disabilities experience high rates of depression and anxiety. Potential differences between those with childhood- versus adult-onset disability have not been adequately explored.

OBJECTIVE

To examine the relationship between age of disability onset and frequency of reported depression and anxiety symptoms.

DESIGN

Secondary data analysis.

SETTING

2020-2021 National Health Interview Survey (NHIS), a nationally representative survey of adults on illness and disability in the United States.

PARTICIPANTS

NHIS respondents aged 22-80 years with mobility, cognitive, or mobility + cognitive disability (n = 6386).

INTERVENTIONS

Age of disability onset (childhood onset, defined as onset before age 22, per NHIS question, vs. adult onset) was our independent variable.

MAIN OUTCOME MEASURES

We calculated frequency of reported current depression and anxiety symptoms among those with childhood- versus adult-onset disability. Logistic regression was used to calculate the odds ratios (OR) of frequent versus infrequent depression and anxiety symptoms for childhood- versus adult-onset disability, adjusted for demographic factors.

RESULTS

A higher percentage of participants with childhood- compared to adult-onset disability reported frequent depression symptoms (mobility: 32.7% vs. 21.9%, p < .01; cognitive: 55.6% vs. 44.5%, p < .01; mobility + cognitive: 71.4% vs. 52.8%, p < .01) and anxiety symptoms (mobility: 44.3% vs. 35.5%, p < .01; cognitive: 83.5% vs. 63.1%, p < .01; mobility + cognitive: 82.8% vs. 70.3%, p < .01). Participants with childhood-onset disability had higher adjusted odds of frequent depression symptoms for all disability types (mobility adjusted odds ratio [aOR], 1.58 [95% confidence interval (CI), 1.15-2.16]; cognitive aOR, 1.84 [95% CI, 1.12-3.02]; mobility + cognitive aOR, 2.06 [95% CI, 1.16-3.67]), and frequent anxiety symptoms for cognitive (aOR, 3.28 [95% CI, 1.92-5.60]) and mobility + cognitive disabilities (aOR, 2.01 [95% CI, 1.07-3.75]) compared to those with adult-onset disability.

CONCLUSION

Individuals with childhood-onset disabilities may be at uniquely higher risk for mental health symptoms than their peers with adult-onset disabilities, warranting specific attention to their health care and outcomes.

Depression and Its Effect on Geriatric Rehabilitation Outcomes in Switzerland's Aging Population

Background and Objectives: Depression is a common mental problem in the older population and has a significant impact on recovery and general well-being. A comprehensive understanding of the prevalence of depressive symptoms and their effects on functional outcomes is essential for improving care strategies. The primary aim of this study was to determine the prevalence of depressive symptoms in older patients undergoing geriatric rehabilitation and to assess their specific impact on their functional abilities. Materials and Methods: A retrospective study was conducted at the Lucerne Cantonal Hospital in Wolhusen, Switzerland, spanning from 2015 to 2020 and including 1159 individuals aged 65 years and older. The presence of depressive symptoms was assessed using the Geriatric Depression Scale (GDS) Short Form, while functional abilities were evaluated using the Functional Independence Measure (FIM) and the Tinetti test. Data analysis was performed using TIBCO Statistica 13.3, with statistical significance set at p < 0.05. Results: Of the participants, 22.9% (N = 266) exhibited depressive symptoms, with no notable differences between genders. Although all patients showed functional improvements, the duration of rehabilitation was prolonged by two days (p = 0.012, d = 0.34) in those with depressive symptoms. Alarmingly, 76% of participants were classified as at risk of falling based on the Tinetti score. However, no significant correlation was found between the GDS and Tinetti scores at admission (p = 0.835, r = 0.211) or discharge (p = 0.336, r = 0.184). The results from the non-parametric Wilcoxon matched-pairs test provide compelling evidence of significant changes in FIM scores when comparing admission scores to those at discharge across all FIM categories. Conclusions: Depressive symptoms are particularly common in geriatric rehabilitation patients, leading to prolonged recovery time and increased healthcare costs. While depressive symptoms showed no correlation with mobility impairments, improvements in functional status were directly associated with reduced GDS scores. Considering mental health during admission and planning is critical in optimizing rehabilitation outcomes.

Depression Treatment After a Positive Depression Screen Result

Importance

As primary care practices increase depression screening, it is unknown whether screening is associated with appropriate and equitable treatment.

Objective

To investigate factors associated with initial treatment among patients who screen positive for depression and/or suicidal ideation (SI).

Design, Setting, and Participants

Cohort study using electronic health record data from September 2017 to September 2021, from a large US academic health system. Participants were adult primary care patients with elevated depressive symptoms (Patient Health Questionnaire-9 score ≥10) and/or SI, excluding patients with baseline depression, bipolar disorder, schizophrenia, schizoaffective disorder, or dementia. Data were analyzed from December 30, 2022, to February 17, 2024.

Exposure

Patient characteristics including gender, age, preferred language, and race and ethnicity.

Main Outcomes and Measures

Primary outcome was antidepressant or mental health referral ordered at screening. Secondary outcomes were antidepressant/referral and antidepressant/referral or follow-up visit within 8 weeks.

Results

Of 60 062 patients screened, 3980 (7%) reported elevated depressive symptoms or SI. The cohort was 68.1% women (2711), and the mean (SD) age was 46.5 (17.6) years; 0.8% were 12.4% African American or Black (493), American Indian or Alaska Native (30), 24.8% Asian (988), 14.6% Latino/Latina/Latinx (582), 1.5% Pacific Islander (58), and 36.9% White (1470), and 9.0% other/unknown (359); 5.6% preferred a non-English language (223). Approximately 38% (1518) received antidepressants/referrals when screened (including 44% of 461 patients [203] with SI). By 8 weeks, 2785 patients (70%) received antidepressant/referral and/or follow-up (including 75% of 783 patients with SI). In multivariable logistic regression models adjusting for site and clustered on primary care physician, there were no statistically significant differences in the primary outcome by gender, preferred language, or health insurance. African American or Black and Asian patients had lower estimated probabilities of treatment ordered when screened (34.0% [95% CI, 28.4%-39.6%] for Black patients and 35.4% [95% CI, 31.5%-39.4%] for Asian patients) than White patients (40.5% [95% CI 37.4%-43.5%]). Estimated treatment decreased with increasing age (46.4% [95% CI, 41.2%-51.5%] for patients aged 18-30 years and 17.5% [95% CI, 12.1%-22.9%] for patients aged ≥75 years). Patients with SI had greater estimated treatment than those without SI (43.5% [95% CI, 39.9%-47.1%] vs 35.2% [95% CI, 33.0%-37.5%]), although treatment was overall low for this high-risk group. Secondary outcomes were consistent, although there were no statistically significant differences in follow-up visits for African American or Black and Asian patients compared with White patients.

Conclusions and Relevance

In this cohort study, moderate rates of initial treatment among patients with elevated depressive symptoms and/or SI were found. Targeted interventions are needed for patients at risk of undertreatment, including patients with SI, African American or Black and Asian patients, and older adults.

Outcomes of a Depression Screening and Postscreen Intervention Pilot Program in Specialty Clinics

OBJECTIVE

The authors evaluated the feasibility of automated depression screening and a follow-up postscreening protocol.

METHODS

Patient Health Questionnaire-2 (PHQ-2) and PHQ-9 screeners were sent to 20 specialty clinics and administered to patients who were ages ≥18 years, had not completed a PHQ-2 or PHQ-9 within the past 9 months, had no psychiatric diagnosis within the past 2 years, and had no behavioral health appointment within the previous year or an upcoming behavioral health appointment. In a two-pronged approach, patients with scores indicating moderate or moderately severe depression but with no indication of possible suicidal ideation were offered behavioral health resources (first prong), or patients with scores indicating severe depression or with possible suicidal ideation were contacted via telephone and requested to schedule a behavioral health appointment (second prong).

RESULTS

The PHQ-2 was offered to 21,674 patients, with 38.1% (N=8,247) completing the screening; 13.1% (N=1,084) of those with completed screens had a positive depression score. Of patients who completed the PHQ-9, 44.5% (N=650) were eligible for the first prong of the intervention and 31.1% (N=455) for the second prong. Depression screening completion rates differed significantly by multiple sociodemographic factors. Mean±SD lag times from screening completion to successful contact and from contact to appointment completion were 7±6 and 5±4 days, respectively.

CONCLUSIONS

Automated depression screening with outreach based on depression severity is feasible and provides potentially efficient use of scarce resources. More research is needed on the mechanisms for automated screening and follow-up to examine factors such as patient engagement after a positive screening.

Geography and risk of suicidal ideation and attempts post outpatient psychiatric visit in commercially insured US adults

OBJECTIVE

This study sought to determine whether demographic and clinical factors for suicidal ideation (SI) and suicide attempts (SA) in adults vary across different census divisions in the US.

METHODS

A nationwide cohort was constructed using commercial health insurance claims data of adults aged 25-64 years with at least one mental health or substance use disorder-related outpatient visit between 2014 and 2015. Survival analysis was used to study how the association of demographic and clinical factors on SI and SA vary by geographic divisions.

RESULTS

The Mountain Division had the highest rates of SI and SA in almost all observed time intervals after the index visit. The Northeast region and the West coast had the lowest rates. For both SI and SA, we observed strong interaction effects between geographic division and urbanicity (χ2(152) = 188.14, p = 0.02; χ2(152) = 196.20, p = 0.01, respectively). In particular, urbanicity was a risk factor for SI in the West North Central (HR = 0.71, 95% CI: [0.50, 0.99]) and the Pacific (HR = 0.54, 95% CI: [0.40, 0.74]) Divisions. Urbanicity was also a risk factor for SA in the West North Central Division (HR = 0.39, 95% CI: [0.16, 0.95]), but a protective factor for SA in the Mountain Division (HR = 1.71, 95% CI: [1.11, 2.63]).

CONCLUSIONS

The association between urbanicity and SI and SA varied by US geography. Future suicide prevention efforts should include a focus on urban adults in the West North Central and the Pacific Divisions, and rural adults in the Mountain Division.

Developing a simplified measure to predict the risk of autism spectrum disorders: Abbreviating the M-CHAT-R using a machine learning approach in China

BACKGROUND

Early screening for autism spectrum disorder (ASD) is crucial, yet current assessment tools in Chinese primary child care are limited in efficacy.

OBJECTIVE

This study aims to employ machine learning algorithms to identify key indicators from the 20-item Modified Checklist for Autism in Toddlers, revised (M-CHAT-R) combining with ASD-related sociodemographic and environmental factors, to distinguish ASD from typically developing children.

METHODS

Data from our prior validation study of the Chinese M-CHAT-R (August 2016-March 2017, n = 6,049 toddlers) were reviewed. We extracted the 20-item M-CHAT-R data and integrated 17 sociodemographic and environmental risk factors associated with ASD development to strengthen M-CHAT-R's machine learning screening. Five feature selection methods were used to extract subsets from the original set. Six machine learning algorithms were applied to identify the optimal subset distinguishing clinically diagnosed ASD toddlers from typically developing toddlers.

FINDINGS

Nine features were grouped into three subsets: subset 1 contained unanimously recommended items (A1 [Follows point], A3 [Pretend play], A9 [Brings objects to show], A10 [Response to name] and A16 [Gazing following]). Subset 2 added two items (A17 [Gaining parent's attention] and A18 [Understands what is said]), and subset 3 included two more items (A8 [Interest in other children] and child's age). The top-performing algorithm resulted in a seven-item classifier of subset 2 with 92.5 % sensitivity, 90.1 % specificity, and 10.0 % positive predictive value.

CONCLUSIONS

Machine learning classifiers effectively differentiate ASD toddlers from typically developing toddlers using a reduced M-CHAT-R item set.

CLINICAL IMPLICATIONS

This highlights the clinical significance of machine learning-optimized models for ASD screening in primary health care centers and broader applications.

Addressing perinatal mood and anxiety disorders in obstetric settings: results of a cluster randomized controlled trial of two approaches

BACKGROUND

Mood and anxiety disorders affect one in 5 perinatal individuals and are undertreated. While professional organizations and policy makers recommend that obstetric practices screen for, assess and treat mood and anxiety disorders, multi-level barriers to doing so exist. To help obstetric practices implement the recommended standard of care, we developed implementation assistance, an approach to guide practices on how to integrate screening, assessment, and treatment of mood and anxiety disorders into the obstetric practice workflow. To teach obstetric care clinicians how to treat perinatal mood and anxiety disorders, we also developed an e-learning course and toolkit.

OBJECTIVE

Evaluate the extent to which 1) implementation assistance + e-learning/toolkit, and 2) e-learning/toolkit alone improved the rates and quality of care for perinatal mood and anxiety disorders in obstetric practices, as compared to usual care.

STUDY DESIGN

We conducted a cluster randomized controlled trial involving 13 obstetric practices across the United States (US). Using 2:2:1 randomization, 13 obstetric practices were assigned to 1) implementation assistance + e-learning/toolkit (n=5), 2) e-learning/toolkit alone (n=5), or 3) usual care (n=3). We measured obstetric care clinicians' quality of care for perinatal mood and anxiety disorders (as measured by medical record documentation of screening, assessment, treatment initiation, and monitoring) documented in patient charts (n=1040). Effectiveness was assessed using multilevel generalized linear mixed models, accounting for clustering of repeated measurements (n=2, i.e., pre and post) within obstetric care clinicians' patient charts (n=40) nested within practices (n=13). Intention-to-treat and per-protocol analyses were conducted.

RESULTS

At baseline, no significant differences were observed among the 3 groups regarding documented mental health screening. Chart abstraction at 8 months post-training revealed a significant increase in recommended bipolar disorder screening only among the practices that received the implementation plus e-learning/toolkit (from 0.0% to 30.0%; p=.017). Practices receiving the e-learning/toolkit alone or usual care continued to not screen for bipolar disorder. Documented screening for anxiety also increased in the implementation + e-learning/toolkit group (from 0.5% to 40.2%), however, it did not reach statistical significance when compared to the other groups (P=.09). A significant increase in documented post-traumatic stress disorder (PTSD) screening was observed among practices receiving the implementation plus e-learning/toolkit (0.0% to 30.0%; P=.018). The quality-of-care score in the implementation + e-learning toolkit group increased from 20.5 at baseline to 42.8 at follow-up and was significantly different from both the e-learning/toolkit alone group (P=.02) and the usual care group (P=.03). At 8 months post-training, the implementation + e-learning/toolkit group had higher mean provider readiness scores than the other 2 groups for documentation of screening, assessment, and monitoring. However, documentation of treatment was the only component that reached statistical significance (P=.025).

CONCLUSION

Among the practices that followed the implementation protocols, implementation assistance + e-learning/toolkit was effective in improving rates of screening for bipolar disorder, anxiety, and PTSD. However, 3 of the 5 practices did not follow the implementation protocols, suggesting that the intensity of the implementation needs to be tailored based on practice readiness for implementation.

Adult Diagnosis of ADHD in Women: A Mixed Methods Investigation

OBJECTIVE

The goal of this study was to examine the experiences of women diagnosed with ADHD in adulthood.

METHODS

Benefits and costs associated with obtaining the diagnosis were examined in two focus groups conducted virtually. Factors hindering and facilitating the identification, assessment, and subsequent treatment of ADHD were also explored. Focus groups were conducted virtually and together included 14 women (Mage = 39.43, SD = 6.37) who were diagnosed with ADHD in adulthood.

RESULTS

The majority of women described numerous benefits of receiving a diagnosis of ADHD, including validation/self-compassion, adaptive coping, and social support. Negative aspects of the diagnosis, including difficulties accessing care, the burden of care, limitations to existing evidence-based treatments, and stigma were also identified by some women. Furthermore, women described variable diagnostic experiences, with many indicating that they had not recognized their own symptoms of ADHD, as well as diagnostic complexity and other factors that masked identification of ADHD. Women described a range of diagnostic assessment procedures, as well as considerable self-advocacy to convince their providers to consider the diagnosis of ADHD.

CONCLUSION

These lived experiences of women diagnosed with ADHD provide critical insight into improving clinical care for ADHD in women. Recommendations to increase accurate and timely identification of ADHD in women and advance efforts toward effective and equitable care are discussed.

Who decides to follow the referral advice after a positive postpartum depression screening result? Reflections about the role of sociodemographic, health, and psychological factors from psychological consultations - a cross-sectional study

BACKGROUND/OBJECTIVE

Postpartum depression (PPD), a common and severe mental health problem, affects about 13-20 % of new mothers. Despite the psychological intervention's effectiveness, referral uptake rates among affected women are low. In the article, we aim to characterise those new mothers who adhered to referral advice after a positive PPD screening result.

METHOD

9161 women had taken part in a midwife-led PPD screening. Those who scored equal to or more than ten points on the Edinburgh Postnatal Depression Scale (EPDS) were referred for psychological consultations (12 %, n = 1109). We used data gathered during the realization of a PPD prevention programme. The following measures were used: EPDS, a sociodemographic and health data survey, and psychological consultation cards.

RESULTS

We found that only 85 (8 %) of referred mothers later enrolled in psychological consultations. Those mothers who adhered to the referral advice had higher EPDS (total score) and EPDS - 3A anxiety scores than mothers who did not contact a psychologist. Moreover, they had a higher gestational age at birth and, on average, fewer children. More PPD symptoms, C-section experience, self-assessed good financial situation and a postgraduate higher education degree were predictors of seeking help.

CONCLUSION

A mother's decision to follow the referral advice is crucial in mental health prevention and should be treated as an addition to a separate step 2: referral in a 3-step PDD management process, with identification constituting a step 1, and intervention - a step 3.

Patient and provider factors associated with follow-up for positive depression screens in adults: a retrospective review of University of Utah primary and specialty care clinics

OBJECTIVE

To identify patient and provider factors associated with lower rates of follow-up for positive depression screens in outpatient settings.

DESIGN

Retrospective cohort study with electronic health record analysis investigating factors associated with follow-up care for patients with moderate-to-severe depressive symptoms. Patient and provider variables were associated with rates of follow-up for positive depression screens.

SETTING

University of Utah and University of Utah Health-affiliated primary care and specialty clinics.

PARTICIPANTS

Adults who screened positive for depressive symptoms (score≥10) on the Patient Health Questionnaire (PHQ-9) at an ambulatory visit between 1 January 2021 and 31 January 2022. A total of 17 651 patients were included in the study.

OUTCOME MEASURES

Follow-up for positive depression screens was defined as a new antidepressant prescription or completed mental health visit. Variables associated with follow-up included patient demographic data, anthropometric measures, geographical classification, primary language, comorbidities and socioeconomic factors as well as provider demographics, level of training and clinic type.

RESULTS

5396 patients (30.6%) did not receive follow-up care for a positive PHQ-9 screen. Factors associated with lower rates of follow-up included male patients (gender; p=0.013), older patients (age group; p=0.016), non-White patients (ethnicity; p<0.0001), non-English (primary language; p<0.0001), lack of insurance (p<0.0001), older providers (p=0.027), male providers (p=0.0037) and attending-level providers (p<0.0001).

CONCLUSIONS

Significant discrepancies in follow-up for positive depression screens in the ambulatory setting exist, particularly among racial/ethnic minority groups and patients who are non-native English speakers. Older providers and attending-level providers were less likely to facilitate follow-up for positive depression screens in their clinics.

Mental Health Utilization Among Transgender Veterans

Importance

Compared with cisgender (CG) individuals, transgender and gender-diverse (TGD) individuals experience substantial social and economic disparities that can result in adverse mental health consequences. It is critical to understand potential barriers to care and to address the causes of the disparities in the future.

Objective

To characterize mental health care utilization among TGD veterans with depression.

Design, Setting, and Participants

This cohort study used electronic health record data from the US Department of Veterans Affairs (VA) to create a 1:3 age group-matched and VA facility-matched nationwide cohort of TGD and CG veterans with documentation of depression during 2018 to 2020. Data analysis was performed from January to November 2023.

Exposure

TGD identity was ascertained by diagnosis of a gender identity disorder.

Main Outcomes and Measures

The primary outcome was mental health care utilization, including counts of outpatient (in specialty care and primary care settings), telehealth, emergency department, and inpatient visits in this cohort. Descriptive statistics were used to characterize counts of mental health utilization, and statistically significant differences between TGD and CG veterans were tested using χ2 and Fisher exact tests. Wilcoxon rank-sum tests were used to test for differences in utilization between the 2 groups. Adjusted logistic regression, controlling for age group, administrative sex, race, Charlson Comorbidity Index, and number of mental health medications (eg, antidepressant, antipsychotic, and anxiolytic medications), was also used to compare utilization between TGD and CG veterans.

Results

Among 10 564 veterans with depression (mean [SD] age, 46.4 [15.2] years; 8050 male [76.2%]), 2643 TGD veterans were matched with 7921 CG veterans. TGD veterans had 6 more specialty mental health visits per year than CG veterans (mean [SD], 13.93 [20.08] vs 8.46 [14.96] visits a year; median [range], 7.14 [0.00-246.30] vs 3.76 [0.00-202.38] visits per year). In adjusted models, compared with CG veterans, TGD veterans were 2.6 times more likely to have an outpatient mental-health visit (odds ratio, 2.60; 95% CI, 2.16-3.15).

Conclusions and Relevance

In this cohort study of veterans with depression, TGD veterans had significantly higher utilization of mental health services compared with CG veterans, even after adjusting for several relevant health factors. Different health system resources may be required to meet the needs of this population. Further studies are needed to understand the determinants of these disparities and subsequently how to address them.

Peripartum Depression: What's New?

PURPOSE OF THE REVIEW

Peripartum depression (PPD), including both depression during pregnancy and postpartum, is the most frequent health disorder during the perinatal period. It is a significant public health issue in many countries due to its prevalence and its impact on women, as well as on their partners and offspring. Here, we will attempt to untangle the most recent studies and publications, considering what it is essential to know in 2024 about PPD as a specific perinatal issue.

RECENT FINDINGS

PPD appears to be a very heterogeneous disorder in which a complex interplay between different factors contributes to its pathophysiology. Thus, the need to enhance diagnosis and referral through a better understanding of its severity and co-morbidities has emerged as a major public health issue. Indeed, research has consistently shown that PPD negatively impacts parent-infant interactions and infants' cognitive, social, and emotional development. Evidence underlining its global risk has accumulated over the past three decades, but many questions remain, including how these vulnerable offspring developmental trajectories unfold.

Cost-Effectiveness of Perinatal Depression Screening: A Scoping Review

OBJECTIVE

Perinatal depression (PND) has emerged as a significant public health concern. There is no consensus among countries or organizations on whether to screen for PND. Despite the growing body of evidence regarding the economic value of PND screening, its cost-effectiveness remains inadequately understood due to the heterogeneity of existing studies. This study aims to synthesize the available global evidence on the cost-effectiveness of PND screening compared to routine or usual care to provide a clearer understanding of its economic value.

METHODS

A detailed search strategy was predetermined to identify peer-reviewed publications that evaluated the cost-effectiveness of PND screening. We designed a scoping literature review protocol and searched electronic databases, including MEDLINE, EMBASE, and Web of Science, for studies published from inception to 10 December 2023. We included studies that conducted full economic evaluations comparing PND screening with usual care or other comparators and excluded studies that were not in English or lacked full texts. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to evaluate the reporting quality of the studies. Then, the data regarding costs and effectiveness were extracted and summarized narratively.

RESULTS

A total of ten eligible studies were included, all of which were evaluated as being of high reporting quality. Nine of these studies compared the economic value of PND screening with usual care without screening, with eight finding that PND screening was generally more cost-effective. The remaining study evaluated the cost-effectiveness of two psychosocial assessment models and indicated that both effectively identified women "at risk". Across studies, PND screening ranged from being dominant (cheaper and more effective than usual care without screening) to costing USD 17,644 per quality adjusted life year (QALY) gained. Most included studies used decision trees or Markov models to test if PND screening was cost-effective. Although current economic evaluation studies have mostly suggested PND screening could be more cost-effective than usual care without screening, there is high heterogeneity in terms of participants, screening strategies, screening settings, and perspectives across studies.

CONCLUSIONS

Despite varied settings and designs, most studies consistently indicate PND screening as cost-effective. Further evidence is also required from low- and middle-income countries (LMIC), non-Western countries, and randomized controlled trials (RCTs) to draw a more robust conclusion.

Comparative Safety of Antipsychotic Medications and Mood Stabilizers During Pregnancy: A Systematic Review and Network Meta-analysis of Congenital Malformations and Prenatal Outcomes

BACKGROUND

A network meta-analysis was performed to evaluate the risk of congenital malformations and other prenatal outcomes in fetuses after exposure to antipsychotic medications and mood stabilizers during pregnancy.

METHODS

We searched the PubMed, EMBASE, and Cochrane CENTRAL databases up to 15 December 2023, to identify experimental and observational studies comparing antipsychotic and mood stabilizer treatments with control treatments (no exposure). The primary outcome of the study was the incidence of congenital malformations and the secondary outcomes were preterm birth and spontaneous abortion. Additionally, two authors independently assessed the risk of bias in each domain of the included studies using the ROBINS-I tool and evaluated the quality of evidence using the CINeMA rating tool.

RESULTS

The literature search identified 18,334 potential records, and 22 studies involving 3,042,997 pregnant women were ultimately included. Compared with the unexposed group, quetiapine [odds ratio (OR), 1.19; 95% credible interval (CrI), 1.01-1.39], aripiprazole (OR, 1.30; 95% CrI 1.10-1.65), olanzapine (OR, 1.33; 95% CrI 1.11-1.64), risperidone (OR, 1.43; 95% CrI 1.18-1.77), and lithium (OR, 1.61; 95% CrI 1.07-2.30) were associated with a slightly increased risk of congenital malformations. In contrast, lamotrigine (OR, 1.21; 95% CrI 0.86-1.64), ziprasidone (OR, 1.14; 95% CrI 0.73-1.72), and haloperidol (OR, 1.26; 95% CrI 0.90-1.75) did not show significant differences compared with the unexposed group, with narrower credible intervals.

CONCLUSIONS

The evidence from this analysis suggests that, overall, quetiapine has the lowest teratogenic risk when used during pregnancy, making it the safer option for pregnant women. Lamotrigine and haloperidol follow closely behind. At the same time, the use of lurasidone and ziprasidone should be approached with caution, and further clinical studies are necessary to better assess their safety.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD4201811373.

Depression prevalence, screening, and treatment in adult outpatients with type 1 and type 2 diabetes: A nationally representative cross-sectional study (National Ambulatory Medical Care Survey 2014-2019)

BACKGROUND

Studies have shown that the presence of diabetes or depression may increase the risk for developing the other. The primary objective of this study is to describe the current prevalence of comorbid depression and the rate of screening and treatment for comorbid depression in US adult outpatients with diabetes compared to those without diabetes.

METHODS

We analyzed data from the 2014-2019 National Ambulatory Medical Care Survey. Descriptive statistics, univariate analyses, and multivariable regression models were developed with weighting factors applied.

RESULTS

Depression prevalence is higher in those with diabetes than without diabetes. Females with diabetes have higher rates of depression (15.4%) compared to females without diabetes (13.7%) or males with diabetes (9.1%). Screening rates for depression are extremely low (<6%) in patients with diabetes and without diabetes. Patients with diabetes and depression are less likely to be screened than those with depression alone.

LIMITATIONS

The cross-sectional design of the study cannot establish causality and has inherent limitations in capturing temporal relationships. The reliance on ICD codes limits the scope of diagnosis and underestimates rates of comorbidity if depression is not formally diagnosed. The NAMCS cohort only includes ambulatory visits to office-based physicians, so depression diagnoses and screening rates among patients who visit other health care settings or are not seeing physicians would be underestimated.

CONCLUSIONS

Depression is prevalent in people with diabetes. Screening rates are unacceptably low, indicating a gap in recommended care and underreporting of depression. More routine screening and treatment are necessary to align with guideline-recommended care.

A mobile-based randomized controlled trial on the feasibility and effectiveness of screening for major depressive disorder: study protocol

BACKGROUND

Mobile-based screening interventions to detect and treat Major Depressive Disorder (MDD) at an early stage might be a promising approach for reducing its societal burden. In the present study, we will evaluate the feasibility and effectiveness of screening for MDD using a mobile-based screening protocol.

METHODS

This study will be a three-arm, parallel randomized control trial (RCT) performed in a multi-ethnic population within the municipality of Rotterdam (the Netherlands). The trial includes two intervention groups that will be screened 4-weekly for MDD for 12 months using the Patient Health Questionnaire (PHQ-9) and a control group who does not receive mobile-based screening for MDD. Participants in the one-test intervention arm will be referred for further diagnosis and treatment, if necessary, after a single positive test score for moderate-severe major depression symptoms (PHQ-9 > 10). Participants in the multiple-test intervention arm will only be referred after three consecutive positive test scores. 1786 eligible participants will be included in the RCT, with 446 and 447 in the one-test and multiple-test referral arms, respectively, and 893 in the control arm. Primary outcome is participants' QoL after 12 months (EQ-5D-5L). Secondary outcomes include participants' QoL after 24 months (EQ-5D-5L), evaluating the occurrence and severity of MDD symptoms (PHQ-9), intervention engagement, and identifying public mental health differences based on sociodemographic characteristics, including age, gender, ethnicity, financial situation, educational background, and living area. Long-term results of the RCT will be incorporated into a microsimulation model to determine the long-term benefits, harms, and costs of MDD screening.

DISCUSSION

The information gained from examining the feasibility and (cost-) effectiveness of mobile-based screening for MDD could be of guidance for mental health policy implementations and support the introduction of mobile-based screening for MDD in the Netherlands and/or other nations.

TRIAL REGISTRATION

ClinicalTrials.gov: NL84280.078.23, NCT05989412 , August 8, 2024.

Improving perinatal depression screening uptake: The impact of Medicaid reimbursement policy in Massachusetts

OBJECTIVE

To evaluate the impact of the Massachusetts Medicaid program's reimbursement policy change for perinatal depression screening on utilization rates.

STUDY SETTING AND DESIGN

This study employed a difference-in-differences design to compare insurance-paid prenatal and postpartum depression screening rates as well as postpartum antidepressant receipt rates between Medicaid and privately insured individuals before and after policy implementation in May 2016.

DATA SOURCES AND ANALYTIC SAMPLE

Data are from the 2014-2020 Massachusetts All-Payer Claims Database. The study included individuals with a live birth from October 10, 2014, to December 31, 2019, who were continuously insured either by Medicaid or private insurance.

PRINCIPAL FINDINGS

Among 141,085 births, 42.6% were covered by Medicaid. Among those with Medicaid, 1.9% had a paid postpartum depression screening prior to the policy and 16.9% after (1.5% vs. 12.3% for prenatal screening); among privately insured, 3.8% had a paid postpartum screening prior to the policy and 10.6% after (0.9% vs. 6.7% for prenatal screening). Antidepressant receipt rose from 6.9% to 8.3% among Medicaid enrollees and from 3.3% to 4.9% among privately insured individuals after the policy. After regression adjustment, implementation of the Massachusetts Medicaid reimbursement policy was positively associated with perinatal depression screening rates with a differential increase of 10.0 percentage points (p < 0.001) for postpartum screening and 3.5 percentage points (p < 0.001) for prenatal screening among Medicaid enrollees versus privately insured. Despite increased depression screening, the policy was not associated with a statistically significant change in antidepressant receipt among Medicaid enrollees compared to privately insured individuals.

CONCLUSIONS

Separate payment for perinatal depression screening significantly improved screening rates among Medicaid beneficiaries, highlighting Medicaid's critical role in identifying mental health needs for vulnerable populations. However, the persistence of sub-optimal screening rates among perinatal individuals underscores the need for a comprehensive approach to ensure universal screening and effective treatment for perinatal depression.

Evaluating Bias-Mitigated Predictive Models of Perinatal Mood and Anxiety Disorders

Importance

Machine learning for augmented screening of perinatal mood and anxiety disorders (PMADs) requires thorough consideration of clinical biases embedded in electronic health records (EHRs) and rigorous evaluations of model performance.

Objective

To mitigate bias in predictive models of PMADs trained on commonly available EHRs.

Design, Setting, and Participants

This diagnostic study collected data as part of a quality improvement initiative from 2020 to 2023 at Cedars-Sinai Medical Center in Los Angeles, California. The study inclusion criteria were birthing patients aged 14 to 59 years with live birth records and admission to the postpartum unit or the maternal-fetal care unit after delivery.

Exposure

Patient-reported race and ethnicity (7 levels) obtained through EHRs.

Main Outcomes and Measures

Logistic regression, random forest, and extreme gradient boosting models were trained to predict 2 binary outcomes: moderate to high-risk (positive) screen assessed using the 9-item Patient Health Questionnaire (PHQ-9), and the Edinburgh Postnatal Depression Scale (EPDS). Each model was fitted with or without reweighing data during preprocessing and evaluated through repeated K-fold cross validation. In every iteration, each model was evaluated on its area under the receiver operating curve (AUROC) and on 2 fairness metrics: demographic parity (DP), and difference in false negatives between races and ethnicities (relative to non-Hispanic White patients).

Results

Among 19 430 patients in this study, 1402 (7%) identified as African American or Black, 2371 (12%) as Asian American and Pacific Islander; 1842 (10%) as Hispanic White, 10 942 (56.3%) as non-Hispanic White, 606 (3%) as multiple races, 2146 (11%) as other (not further specified), and 121 (<1%) did not provide this information. The mean (SD) age was 34.1 (4.9) years, and all patients identified as female. Racial and ethnic minority patients were significantly more likely than non-Hispanic White patients to screen positive on both the PHQ-9 (odds ratio, 1.47 [95% CI, 1.23-1.77]) and the EPDS (odds ratio, 1.38 [95% CI, 1.20-1.57]). Mean AUROCs ranged from 0.610 to 0.635 without reweighing (baseline), and from 0.602 to 0.622 with reweighing. Baseline models predicted significantly greater prevalence of postpartum depression for patients who were not non-Hispanic White relative to those who were (mean DP, 0.238 [95% CI, 0.231-0.244]; P < .001) and displayed significantly lower false-negative rates (mean difference, -0.184 [95% CI, -0.195 to -0.174]; P < .001). Reweighing significantly reduced differences in DP (mean DP with reweighing, 0.022 [95% CI, 0.017-0.026]; P < .001) and false-negative rates (mean difference with reweighing, 0.018 [95% CI, 0.008-0.028]; P < .001) between racial and ethnic groups.

Conclusions and Relevance

In this diagnostic study of predictive models of postpartum depression, clinical prediction models trained to predict psychometric screening results from commonly available EHRs achieved modest performance and were less likely to widen existing health disparities in PMAD diagnosis and potentially treatment. These findings suggest that is critical for researchers and physicians to consider their model design (eg, desired target and predictor variables) and evaluate model bias to minimize health disparities.

Mental Health and Mobile Communication Profiles of Crowdsourced Participants

Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) are highly prevalent and burdensome. To increase mental health screening rates, the digital health research community has been exploring the ability to augment self reporting instruments with digital logs. Crowdsourced workers are being increasingly recruited for behavioral health research studies as demographically representative samples are desired for later translational applications. Overshadowed by predictive modeling, descriptive modeling has the ability to expand knowledge and understanding of the clinical generalizability of models trained on data from crowdsourced participants. In this study, we identify mobile communication profiles of a crowdsourced sample. To achieve this, we cluster features derived from time series of call and text logs. The psychiatric, behavioral, and demographic characteristics were notably different across the four identified mobile communication profiles. For example, the profile that had the lowest average depression and anxiety screening scores only shared incoming text logs. This cluster had statistically significantly different depression and anxiety screening scores in comparison to the cluster that shared the most outgoing text logs. These profiles expose important insights regarding the generalizability of crowdsourced samples to more general clinical populations and increase understanding regarding the limitations of crowdsourced samples for translational mental health research.

The screening accuracy of the Edinburgh Postnatal Depression Scale (EPDS) to detect perinatal depression with and without the self-harm item in pregnant and postpartum women

BACKGROUND

This study aims to examine whether the Edinburgh Postnatal Depression Scale (EPDS), excluding the self-harm item (EPDS-9), performs as effectively as the full EPDS in identifying depression among perinatal women.

METHODS

A total of 3571 pregnant women and 3850 postpartum women participated in this observational study. Participants who scored ≥ 9 on the EPDS underwent further diagnostic evaluations by a clinical psychologist and/or psychiatrist.

RESULTS

The EPDS-9 and full EPDS demonstrated a near-perfect correlation in both the antepartum (r = 0.996) and postpartum (r = 0.998) cohorts. EPDS-9 showed exceptional precision in identifying depression as screened by the full EPDS at cutoff points ranging 9-14, with areas under the curve ≥0.998. The sensitivity of EPDS-9 and full EPDS to detect depression that requires psychotropic medications was poor. The highest accuracy for both versions was at a cutoff score of 9: sensitivity of 0.579 for the full EPDS and 0.526 for the EPDS-9. At the cutoff point of 9, EPDS-9 performed adequately in predicting the response of the participants to the self-harm item.

CONCLUSION

The EPDS-9 represents a solid and effective replacement for the full EPDS in clinical settings. If the presence of suicidal thoughts needs to be assessed, specialized scales should be used.

Primary care mental health integration to improve early treatment engagement for veterans who screen positive for depression

OBJECTIVE

To examine the relationship between the penetration (or reach) of a national program aiming to integrate mental health clinicians into all primary care clinics (PC-MHI) and rates of guideline-concordant follow-up and treatment among clinic patients newly identified with depression in the Veterans Health Administration (VA).

DATA SOURCES/STUDY SETTING

15,155 screen-positive patients 607,730 patients with 2-item Patient Health Questionnaire scores in 82 primary care clinics, 2015-2019.

STUDY DESIGN

In this retrospective cohort study, we used established depression care quality measures to assess primary care patients who (a) newly screened positive (score ≥3) and (b) were identified with depression by clinicians via diagnosis and/or medication (n = 15,155; 15,650 patient-years). Timely follow-up included ≥3 mental health, ≥3 psychotherapy, or ≥3 primary care visits for depression. Minimally appropriate treatment included ≥4 mental health visits, ≥3 psychotherapy, or ≥60 days of medication. In multivariate regressions, we examined whether higher rates of PC-MHI penetration in clinic (proportion of total primary care patients in a clinic who saw any PC-MHI clinician) were associated with greater depression care quality among cohort patients, adjusting for year, healthcare system, and patient and clinic characteristics.

DATA COLLECTION/EXTRACTION METHODS

Electronic health record data from 82 VA clinics across three states.

PRINCIPAL FINDINGS

A median of 9% of all primary care patients were seen by any PC-MHI clinician annually. In fully adjusted models, greater PC-MHI penetration was associated with timely depression follow-up within 84 days (∆P = 0.5; SE = 0.1; p < 0.001) and 180 days (∆P = 0.3; SE = 0.1; p = 0.01) of a positive depression screen. Completion of at least minimal treatment within 12 months was high (77%), on average, and not associated with PC-MHI penetration.

CONCLUSIONS

Greater PC-MHI program penetration was associated with early depression treatment engagement at 84-/180-days among clinic patients newly identified with depression, with no effect on already high rates of completion of minimally sufficient treatment within the year.

The importance of the cumulation of risk factors for antepartum depression

OBJECTIVES

Pregnancy is a period of heightened vulnerability to mental health problems. This pilot study aims to investigate the association between psychosocial and obstetric risk factors and the onset of depressive and anxious symptoms during pregnancy, with a focus on cumulative risks.

METHOD

Conducted at Ghent University Hospital in Belgium, this prospective observational study involved 378 pregnant women. Participants received a semi-standardized psychosocial assessment at 16 weeks to evaluate potential risk factors, followed by stepped screening protocol for depressive and anxious symptoms at 20 weeks. Due to significant overlap, the analysis focused solely on depressive symptoms.

RESULTS

Depressive symptoms were identified in 5.5% of participants with a score ≥ 13 on the Edinburgh Depression Scale. Key psychosocial risk factors that increase the risk of antepartum depression include a history of mental health issues, especially depression (Fisher's exact test (FET), p = .018), experiences of physical (FET, p = .007) or emotional (FET, p = .008) violence, lack of social support (FET, p = .014), and unplanned pregnancy (FET, p = .008). No significant association was found between obstetric factors and depressive symptoms. The study highlights that the accumulation of psychosocial risk factors significantly elevates the risk of depression (Kendall's τ = 0.22, p < .001).

CONCLUSION

These findings underscore the necessity of comprehensive psychosocial assessments in pregnant women, offering deeper insights than mere screenings for depression and anxiety. Recognizing and quantifying these risk factors facilitates targeted interventions. Employing a cumulative risk index effectively identifies women at heightened risk of mental health problems.

Patient With Chronic Heart Failure as a Participant in the Treatment Process: the Role of Structured Training And Outpatient Observation (on the Anniversary of the Study Chance)

Aim      The article presents the principal results and conclusions of the study "SCHool and outpAtient moNitoring of patients with Cardiac failurE (CHANCE)", organized by the Society of Experts in Heart Failure.Material and methods  CHANCE was a multicenter randomized study. Patients in the intervention group (IG) received the Structured Education and Flexible Outpatient Control Model, that included telephone contacts plus an additional visit if necessary. The planned visits for the IG and control group (CG) were scheduled at 3, 6, and 12 months. 360 IG patients and 385 CG patients were included in the analysis. In the main analysis of the CHANCE study, the efficacy was assessed by the impact on the hard endpoints (mortality and rehospitalizations), clinical condition, functional capabilities, quality of life, anxiety and depressive symptoms, and cost-effectiveness. Also, a comprehensive assessment was performed of the prevalence, structure, and dynamics of anxiety and depressive symptoms depending on the changes in the clinical condition.Results Mortality significantly differed between the groups: 30 (8.3%) patients died in the IG and 50 (13.0%) in the CG. The relative risk of death was 0.68, 95% confidence interval 0.42-0.99, p = 0.044. To prevent one death, it was necessary to educate and monitor 21 patients with clinically evident chronic heart failure (CHF) according to the principles of the CHANCE program. According to the dynamics of the Clinical Condition Assessment Scale (SCAS), the score difference between the groups was 1.7 (p<0.001) after 12 months of follow-up in favor of the IG group. In 12 months, the increase in the 6-minute walk test distance was 98.7 m in the IG and 42.9 m in the CG (p<0.001). The change from baseline in the Minnesota questionnaire total score was 15.3 ± 16.3 in the IG (p<0.001) and 6.2 ± 15.3 in the CG (p<0.001). The odds of developing depressive symptoms increased with each SCAS point by 19% (p = 0.0002). The odds of developing anxiety symptoms increased with each SCAS point by 12% (p = 0.02). The odds of developing the most unfavorable combination of anxiety and depressive symptoms increased with each SCAS point by 41% (p = 0.000002). The participation of patients in the study increased the odds of reducing the anxiety and depressive symptoms in patients with CHF by 2.35 times (p<0.0001), to a greater extent in women.Conclusion      The CHANCE study that included 42 centers in 23 cities of Russia became the forerunner of the first initiatives in organizing the outpatient follow-up of patients in real clinical practice and serves as a vivid example of the importance of national research programs. Their implementation allows obtaining results that can be scaled up throughout the country to make an important contribution to the improvement of medical care for patients with CHF.

A prospective study of antenatal anxiety and depression in pregnant women with polycystic ovary syndrome

BACKGROUND

Women with polycystic ovary syndrome (PCOS) experience higher rates of depression and anxiety. There is limited research relating to perinatal mental health in women with PCOS. Studies suggest PCOS is associated with a higher prevalence of perinatal mental health disorders. Perinatal guidelines currently do not recognise PCOS as a risk factor for perinatal mental health disorders. We aimed to prospectively assess the prevalence of mental health disorders in pregnant women with PCOS.

METHODS

Consenting pregnant women, with and without PCOS, were invited to participate. Standardised validated questionnaires were carried out including Generalised Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9) and Edinburgh Postnatal Depression Scale (EPDS).

RESULTS

Fifty-one with PCOS and 49 without PCOS responded. Pregnant women with PCOS had a higher mean (SD) anxiety score (GAD-7) than those without PCOS (8.2 [6.7] vs. 5.89 [4.7], p = 0.04). Pregnant women with PCOS had higher mean (SD) depression scores than those without PCOS on EPDS (9.1 [6.4] vs. 6.4 [4.5], p = 0.02) but not PHQ-9 score (median (IQR) 4 (3-9) vs. 4 (2-7.5), p = 0.25). Women with PCOS were more likely to experience moderate/severe anxiety (PCOS 34%, control 20%) and moderate/severe depression (PCOS 34%, control 20%) symptoms than women without PCOS. Twenty-nine percent of pregnant women with PCOS had an EPDS score >13 showing significantly higher rates of severe depression (PCOS 29%, control 12%, p = 0.03).

CONCLUSION

Our findings suggest a higher prevalence of perinatal depression and anxiety in women with PCOS. Our findings may suggest increased need for screening for mental health disorders in women with PCOS.

Primary care physicians' attitudes, practices, and perceived barriers toward depression screening in older people in the Kingdom of Bahrain

Purpose

This study aimed to explore attitudes, practices, and perceived barriers of primary care physicians (PCPs) toward depression screening in older people.

Methods

This cross-sectional study enrolled PCPs from randomly selected representative primary care centers in Bahrain. A self-administered piloted semi-structured questionnaire was used for data collection.

Results

We enrolled 248 PCPs in the study (82.3% females, and the mean age = 40 ± 8.7 years). More than half of the participants (54.4%) had a positive attitude toward depression screening in older people. However, only 10.9% of the participants reported systematically screening for this condition without using specific tools for screening in 45.5%. The most reported barriers toward this service are short consultation time (95%), the presence of multiple co-morbidities in this age group (90%), and the absence of guidelines or appropriate training in around 30%. Positive attitudes were significantly higher among older PCPs (p = 0.039), family physician consultants (p = 0.008), those with more than 10 years of work experience (p = 0.024), and those who participated in related educational activities (p = 0.007). Under-screening practice is associated with perceived short consultation time (p = 0.002), insufficient continuous medical education (CME) activities attendance in older people's mental health (p = 0.048) as well as having a general physician's title (p = 0.049). Only the PCPs' job title, Adjusted Odds Ratio (OR) = 3.513, 95 C.I [1.225-10.074] and attendance of CME activities, OR = 1.278, 95 C.I [1.098 - 3.192] remained significant when controlled for age and experience.

Conclusion

More training on older people's mental health and provision of screening and management guidelines are priorities to promote older people's mental health in primary care settings.

Trends in Postpartum Depression by Race, Ethnicity, and Prepregnancy Body Mass Index

Importance

Postpartum depression (PPD) poses significant risks to maternal and child health. Understanding temporal trends is crucial for evaluating prevalence and identifying populations at risk.

Objective

To evaluate recent trends in PPD and assess how these trends are associated with race, ethnicity, and prepregnancy body mass index (BMI).

Design, Setting, and Participants

A serial, cross-sectional analysis using data from the Kaiser Permanente Southern California (KPSC) electronic health records (EHRs), with live and stillbirths at 20 or more weeks of gestation who were KPSC members at the time of delivery between 2010 and 2021. Data were analyzed from July 2022 to August 2023.

Exposures

Self-reported race, ethnicity, and recorded prepregnancy BMI.

Main outcome measures

PPD cases were identified using validated diagnostic codes and prescription records within 12 months postpartum in the KPSC EHRs. Patients with an Edinburgh Postnatal Depression Scale score of 10 or more within 6 months postpartum were further evaluated by a mental health specialist for formal PPD diagnosis.

Results

In this study of 442 308 pregnancies, the median (IQR) maternal age at delivery was 31 (27-34) years. The cohort was racially and ethnically diverse, with 62 860 individuals (14.2%) identifying as Asian/Pacific Islander, 231 837 (52.4%) as Hispanic, 33 207 (7.5%) as non-Hispanic Black, 108 201 (24.5%) as non-Hispanic White, 5903 (1.3%) as multiple or other, and 300 (0.1%) unknown. PPD prevalence doubled over the study period, increasing from 9.4% in 2010 to 19.0% in 2021. The largest increases were observed among Asian and Pacific Islander participants (280% increase) and non-Hispanic Black participants (140% increase). PPD rates increased across all BMI categories, particularly among individuals with obesity (class I) and morbid obesity (class II/III).

Conclusions and Relevance

In this cross-sectional study, PPD diagnosis increased significantly across all racial and ethnic groups and BMI categories over the past decade. While rising PPD may reflect improved screening and diagnosis practices, the persistently high rates highlight the need to develop and implement interventions to prevent the condition while expanding efforts to mitigate the impact of PPD on maternal and child health.

Mental health screenings in dental settings: Feasibility and outcomes from a study by The National Dental Practice-Based Research Network

BACKGROUND

With the rising importance of mental health screenings in nontraditional settings, dental offices offer an important opportunity to provide these services. This feasibility study examined mental health screenings and referral to treatment procedures in dental practices.

METHODS

A total of 17 dentists, dental hygienists, and dental office staff members (dental office personnel [DOP]) from 5 dental practices enrolled 36 patients in the study. Patients completed 4 validated mental health screening instruments. In addition to training in study procedures, DOP also were trained on how to review patient screening measures and provide appropriate mental health follow-up (ie, provide a list of area mental health resources) when necessary.

RESULTS

Twenty-two patients (61.1%) met the study threshold for follow-up on any mental health screening form. DOP provided appropriate follow-up for all 22 patients, which included providing a list of area mental health resources. DOP reported that the mental health screening procedures did not disrupt the workflow in 93% of patient encounters.

CONCLUSIONS

Overall, DOP reported minimal disruption in their workflow. The findings suggest the viability of incorporating regular mental health screenings as part of the regular dental patient workflow. This study also highlights the potential for the scalability and impact of screening procedures in dental practices.

PRACTICAL IMPLICATIONS

This feasibility study highlights the potential of dental offices becoming an avenue for screening patient mental health concerns and providing area resources, thus enhancing comprehensive patient care and overall patient well-being.

Implementing the evidence: Routine screening for depression and anxiety in primary care

Background: Primary care providers are qualified to treat, diagnose, and manage common mental health issues like anxiety and depression. Anxiety and depression are common among college age students, with the average age of onset occurring in one's late teens to early 20s. Screening tools are commonly used to recognize patients who may be at risk for anxiety and depression. Purpose: The purpose of this evidence-based practice project was to (a) implement evidence-based guidelines for screening and management of college-aged patients with anxiety and/or depression and (b) to develop an algorithm that describes evidence-based management to guide providers at two student health centers. Methods: All patients who registered for a sick visit or other appointment at the project site were screened for anxiety and depression using two validated tools. An algorithm to help healthcare providers properly assess and better treat anxiety and depression was developed and implemented for this project. Results: A total of 366 patients were screened for depression and anxiety over a 3-month period. Using the created algorithm, patients received education on anxiety and/or depression and a counseling referral. If warranted, patients were prescribed medication therapy for depression and/or anxiety. Conclusion: Screening for anxiety and depression has become the standard of care in primary care clinics. Routine screening tools help healthcare providers identify patients with anxiety and depression. Early identification and diagnosis of anxiety and depression leads to better outcomes in treatment.

Stakeholders and their perspectives on perinatal depression screening: a systematic review

BACKGROUND

Untreated perinatal depression significantly affects the health outcomes of both mothers and infants and increases the economic burden on families and society. Early depression screening to identify at-risk women is essential, and involving key stakeholders ensures the successful integration of best practices within healthcare settings.

OBJECTIVES

This study aims are: 1) to identify stakeholders from guidelines and studies that influence the implementation of perinatal depression screening; and 2) to provide a thematic summary of stakeholders' perspectives on the opportunities and challenges for scaling perinatal depression screening.

METHODS

A total of 10 databases were comprehensively searched from their inception until July 28 in 2024, encompassing both Chinese and English literature. Websites of academic organizations were also explored to obtain guidelines pertaining to perinatal depression screening. This study followed the PRISMA guidelines for systematic reviews. Stakeholders' perspectives were analyzed using second-order thematic qualitative analysis.

RESULTS

A total of 3268 original articles and 104 guidelines were retrieved. Titles, abstracts, and full texts were screened, resulting in the inclusion of 57 original studies and 9 guidelines for data analysis. The most commonly mentioned stakeholders in perinatal depression screening were health care workers (n = 48) and perinatal women (n = 32), followed by healthcare leaders/managers (n = 16) and policymakers (n = 15). A total 23 articles reported stakeholders' perspectives, from which 291 quotes were extracted. Thematic synthesis identified 12 initial codes, which were summarized into three themes: perinatal depression screening practices, challenges in implementing screening, facilitating factors and opportunities for screening services.

CONCLUSIONS

This study identified 17 types of stakeholders, with health care workers and perinatal women being the primary groups. Additionally, key challenges in perinatal depression screening were identified, highlighting the need for future research to focus cost, quality, and reimbursement structures to ensure the sustainable and scalable implementation of screening initiatives.

Screening for Perinatal Depression: Barriers, Guidelines, and Measurement Scales

Background: Screening for perinatal depression can lower its prevalence and ensure that mothers receive adequate treatment and support. Yet, few practitioners screen for it. The present article is a brief review of barriers to screening, and two screening scales are validated for perinatal women. Findings: Even though health organizations recommend screening, most new mothers are not screened. Providers cite a lack of time, opening "Pandora's box," and a lack of resources for mothers who screen positive as the reasons why they do not screen for this condition. The Edinburgh Postnatal Depression Scale and the Patient Health Questionnaires are brief screening scales validated for new mothers and widely available. Conclusions: Screening is necessary to identify depression in pregnant and postpartum women. Practitioners who screen for this condition need a clear plan and knowledge of how to access available community resources so that they know what to do when a mother screens positive.