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Liu Z, Wang Z, Cao B, Li F. Pupillary response to cognitive control in depression-prone individuals. Int J Psychophysiol 2024; 205:112426. [PMID: 39214257 DOI: 10.1016/j.ijpsycho.2024.112426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 08/18/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
Revealing the pupillary correlates of depression-prone individuals is conducive to the early intervention and treatment of depression. This study recruited 31 depression-prone and 31 healthy individuals. They completed an emotional task-switching task combined with a go/no-go task, and task-evoked pupillary responses (TEPR) were recorded. Behavioral results showed no significant differences in behavioral performance in terms of cognitive flexibility and inhibition between the depression-prone group and the healthy control group. The pupillary results revealed that (1) the depression-prone group showed slightly lower TEPRs to positive stimuli than the healthy controls during cue presentation; (2) during target presentation, the depression-prone group did not show an effect of emotional valence on the pupillary response in the task-repeat trials; and (3) compared to the healthy controls, the depression-prone group showed significantly smaller TEPRs to negative no-go stimuli and had a longer latency of the second peak of pupil dilation in no-go trials. These results imply that depression-prone individuals may have slower neural responses in cognitive control tasks and emotion-specific weakened cognitive control than healthy individuals.
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Affiliation(s)
- Zhihong Liu
- School of Psychology, Jiangxi Normal University, China; School of Psychology, Shaanxi Normal University, China
| | - Zhijing Wang
- School of Psychology, Jiangxi Normal University, China; School of Humanities and Management, Yunnan University of Chinese Medicine, China
| | - Bihua Cao
- School of Psychology, Jiangxi Normal University, China
| | - Fuhong Li
- School of Psychology, Jiangxi Normal University, China.
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N S Gendy M, Taisir R, Sousa S, Costello J, Rush B, Busse JW, Mackillop J. Prevalence of cannabis use disorder among individuals using medical cannabis at admission to inpatient treatment for substance use disorders. Addict Behav 2023; 142:107667. [PMID: 36893511 DOI: 10.1016/j.addbeh.2023.107667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/28/2022] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Cannabis is used for medical and recreational purposes and may result in cannabis use disorder (CUD). This study explored the prevalence of cannabis use disorder and other psychiatric comorbidities among inpatients undergoing treatment for substance use disorder who reported medical cannabis use at admission. METHODS We assessed CUD and other substance use disorders based on DSM-5 symptoms, anxiety with the Generalized Anxiety Disorder scale (GAD-7), depression with the Patient Health Questionnaire (PHQ-9), and post-traumatic stress disorder with the PTSD Checklist for DSM-5 (PCL-5). We compared the prevalence of CUD and other psychiatric comorbidities between inpatients who endorsed the use of cannabis for medical purposes only vs those endorsing use for medical and recreational purposes. RESULTS Among 125 inpatients, 42% reported medical use only, and 58% reported medical and recreational use (dual motives). For CUD, 28% of Medical-Only and 51% of Dual-Use motives patients met the diagnostic criteria for CUD (p = 0.016). High psychiatric comorbidities were present: 79% and 81% screened positive for an anxiety disorder, 60% and 61% screened positive for depression, and 66% and 57% screened positive for PTSD for the Medical-Only and Dual-Use inpatients, respectively. CONCLUSIONS Many treatment-seeking individuals with substance use disorder who report medical cannabis use meet criteria for CUD, particularly those reporting concurrent recreational use.
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Affiliation(s)
- Marie N S Gendy
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada; Homewood Research Institute, Guelph, ON, Canada
| | | | - Sarah Sousa
- Homewood Research Institute, Guelph, ON, Canada
| | | | - Brian Rush
- Homewood Research Institute, Guelph, ON, Canada; Center for Addiction and Mental Health, Toronto, ON, Canada
| | - Jason W Busse
- Department of Anesthesia, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, Canada
| | - James Mackillop
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada; Homewood Research Institute, Guelph, ON, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, Canada; Department of Psychology, Neuroscience, and Behavior, McMaster University, Hamilton, Canada.
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Alhabeeb AA, Al-Duraihem RA, Alasmary S, Alkhamaali Z, Althumiri NA, BinDhim NF. National screening for anxiety and depression in Saudi Arabia 2022. Front Public Health 2023; 11:1213851. [PMID: 37441650 PMCID: PMC10333514 DOI: 10.3389/fpubh.2023.1213851] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
Background Mental health disorders, such as major depressive disorder (MDD) and generalized anxiety disorder (GAD), represent a significant public health concern in Saudi Arabia. This study aims to provide a recent mental health screening prevalence, including anxiety and depression screening in the general public and to explore the associated risk factors. Methods A cross-sectional study was conducted, employing a phone interview survey with 6,015 participants, using a quota sampling strategy to ensure equal representation of both sexes and administrative regions. The study assessed the prevalence of MDD and GAD risk and examined demographic, socioeconomic, and lifestyle factors associated with these mental health disorders. Results The national prevalence of people at risk of MDD and GAD were found to be 12.7 and 12.4%, respectively. Low diagnosis and treatment rates were observed, with only 1.5 and 0.5% of participants currently diagnosed and treated for depression and anxiety, respectively. Risk factors for MDD and GAD included female sex, lower education and income levels, smoking, and waterpipe use. Protective factors included physical activity, participation in volunteering activities and the practice of daily hobbies in the last 30 days. Conclusion The relatively high prevalence of MDD and GAD risk and low diagnosis and treatment rates in Saudi Arabia emphasize the need for increased mental health promotion, early detection, and treatment accessibility. The study highlights the importance of addressing modifiable risk factors and fostering protective factors through targeted interventions. Future research should focus on longitudinal associations, potential mediators and moderators, and the development of culturally appropriate and evidence-based interventions to enhance mental health outcomes in the region.
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Affiliation(s)
| | | | - Saeed Alasmary
- National Centre for Mental Health Promotion, Riyadh, Saudi Arabia
| | | | - Nora A. Althumiri
- Informed Decision-Making for Research and Studies, Riyadh, Saudi Arabia
| | - Nasser F. BinDhim
- Informed Decision-Making for Research and Studies, Riyadh, Saudi Arabia
- College of medicine, Alfaisal University, Riyadh, Saudi Arabia
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Cheung BS, Murphy JK, Michalak EE, Liu J, Yang X, Wang X, Chen J, Lam RW. Barriers and facilitators to technology-enhanced measurement based care for depression among Canadian clinicians and patients: Results of an online survey. J Affect Disord 2023; 320:1-6. [PMID: 36162664 DOI: 10.1016/j.jad.2022.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/12/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Measurement-based care (MBC) is an evidence-based approach that can improve management of depression, but its use in clinical settings remains low. The use of digital technology, or technology-enhanced MBC (eMBC), may address some of the barriers to implementation of MBC by enabling patients to easily complete outcome assessments. This study aims to identify the perceived facilitators and barriers to MBC and eMBC from both patient and provider perspectives in Canada. METHODS The study recruited 108 clinicians and 131 patients with a self-reported diagnosis of depression to participate in an online survey about the acceptability of both MBC and eMBC. RESULTS Most clinicians (90/108, 83.3 %) agreed that MBC is important for clinical judgement, and felt trained to interpret their scores; however, only 43/108 (39.8 %) use MBC routinely. Clinicians (95/108, 88.0 %) felt they would be more likely to use MBC if it was automated and available to use electronically. Most patients (117/131, 89.3 %) felt MBC would be helpful for their treatment and were willing to use a mobile app to track their symptoms. LIMITATIONS Recruitment was done online and, hence, this study may not capture the perspective of patients who are not already familiar with using online programs to complete questionnaires. CONCLUSIONS Clinicians and patients in Canada would be willing to utilize MBC and eMBC in their psychiatric care, but barriers to implementation include perceptions about efficiency, ease of use, and accessibility. These results highlight the importance of engaging both clinicians and patients to effectively implement MBC and eMBC for depression.
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Affiliation(s)
- Bennett Sw Cheung
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jill K Murphy
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jing Liu
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xiaorui Yang
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xing Wang
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Chen
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
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Berchuck SI, Jammal AA, Page D, Somers TJ, Medeiros FA. A Framework for Automating Psychiatric Distress Screening in Ophthalmology Clinics Using an EHR-Derived AI Algorithm. Transl Vis Sci Technol 2022; 11:6. [PMID: 36180026 PMCID: PMC9547354 DOI: 10.1167/tvst.11.10.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose In patients with ophthalmic disorders, psychosocial risk factors play an important role in morbidity and mortality. Proper and early psychiatric screening can result in prompt intervention and mitigate its impact. Because screening is resource intensive, we developed a framework for automating screening using an electronic health record (EHR)-derived artificial intelligence (AI) algorithm. Methods Subjects came from the Duke Ophthalmic Registry, a retrospective EHR database for the Duke Eye Center. Inclusion criteria included at least two encounters and a minimum of 1 year of follow-up. Presence of distress was defined at the encounter level using a computable phenotype. Risk factors included available EHR history. At each encounter, risk factors were used to discriminate psychiatric status. Model performance was evaluated using area under the receiver operating characteristic (ROC) curve and area under the precision-recall curve (PR AUC). Variable importance was presented using odds ratios (ORs). Results Our cohort included 358,135 encounters from 40,326 patients with an average of nine encounters per patient over 4 years. The ROC and PR AUC were 0.91 and 0.55, respectively. Of the top 25 predictors, the majority were related to existing distress, but some indicated stressful conditions, including chemotherapy (OR = 1.36), esophageal disorders (OR = 1.31), central pain syndrome (OR = 1.25), and headaches (OR = 1.24). Conclusions Psychiatric distress in ophthalmology patients can be monitored passively using an AI algorithm trained on existing EHR data. Translational Relevance When paired with an effective referral and treatment program, such algorithms may improve health outcomes in ophthalmology.
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Affiliation(s)
| | - Alessandro A. Jammal
- Duke Eye Center and Department of Ophthalmology, Duke University, Durham, NC, USA
| | - David Page
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Tamara J. Somers
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Felipe A. Medeiros
- Duke Eye Center and Department of Ophthalmology, Duke University, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
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Development of computer adaptive testing for measuring depression in patients with cancer. Sci Rep 2022; 12:8247. [PMID: 35581321 PMCID: PMC9114408 DOI: 10.1038/s41598-022-12318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
The usefulness of depression scales for patients with cancer based on item response theory (IRT) and computer adaptive testing (CAT) has not yet been fully explored. This study thus aimed to develop an IRT-based tool for measuring depression in patients with cancer. We analyzed data from 393 patients with cancer from four tertiary centers in Japan who had not received psychiatric treatment. They answered 62 questions across five categories regarding their psychiatric status over the previous week. We selected 28 items that satisfied the assumptions of IRT, fitted a graded response model to these items, and performed CAT simulations. The CAT simulation used an average of 6.96 items and showed a Pearson’s correlation coefficient of 0.916 (95% confidence interval, 0.899–0.931) between the degree of depression estimated by simulation and that estimated using all 28 items. The measurement precision of CAT with only four items was superior to that of the estimation using the calibrated Patient Health Questionnaire-9. These results imply that this scale is useful and accurate for measuring depression in patients with cancer.
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eHealth generated patient data in an outpatient setting after stem cell transplantation: a scoping review. Transplant Cell Ther 2022; 28:463-471. [DOI: 10.1016/j.jtct.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022]
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Cooley ME, Mazzola E, Xiong N, Hong F, Lobach DF, Braun IM, Halpenny B, Rabin MS, Johns E, Finn K, Berry D, McCorkle R, Abrahm JL. Clinical Decision Support for Symptom Management in Lung Cancer Patients: A Group RCT. J Pain Symptom Manage 2022; 63:572-580. [PMID: 34921934 PMCID: PMC9194912 DOI: 10.1016/j.jpainsymman.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/19/2021] [Accepted: 12/07/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT Clinical guidelines are available to enhance symptom management during cancer treatment but often are not used in the practice setting. Clinical decision support can facilitate the implementation and adherence to clinical guidelines. and improve the quality of cancer care. OBJECTIVES Clinical decision support offers an innovative approach to integrate guideline-based symptom management into oncology care. This study evaluated the effect of clinical decision support-based recommendations on clinical management of symptoms and health-related quality of life (HR-QOL) among outpatients with lung cancer. METHODS Twenty providers and 179 patients were allotted in group randomization to attention control (AC) or Symptom Assessment and Management Intervention (SAMI) arms. SAMI entailed patient-report of symptoms and delivery of recommendations to manage pain, fatigue, dyspnea, depression, and anxiety; AC entailed symptom reporting prior to the visit. Outcomes were collected at baseline, two, four and six-months. Adherence to recommendations was assessed through masked chart review. HR-QOL was measured by the Functional Assessment of Cancer Therapy-Lung questionnaire. Descriptive statistics with linear and logistic regression accounting for the clustering structure of the design and a modified chi-square test were used for analyses. RESULTS Median age of patients was 63 years, 58% female, 88% white, and 32% ≤high school education. Significant differences in clinical management were evident in SAMI vs. AC for all target symptoms that passed threshold. Patients in SAMI were more likely to receive sustained-release opioids for constant pain, adjuvant medications for neuropathic pain, opioids for dyspnea, stimulants for fatigue and mental health referrals for anxiety. However, there were no statistically significant differences in HR-QOL at any time point. CONCLUSION SAMI improved clinical management for all target symptoms but did not improve patient outcomes. A larger study is warranted to evaluate effectiveness.
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Affiliation(s)
- Mary E Cooley
- Research in Nursing and Patient Care (M.E.C, B.H.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
| | - Emanuele Mazzola
- Data Sciences (E.M., N.X., F.H.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Niya Xiong
- Data Sciences (E.M., N.X., F.H.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Fangxin Hong
- Data Sciences (E.M., N.X., F.H.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Ilana M Braun
- Psychosocial Oncology and Palliative Care (I.M.B., J.L.A.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Barbara Halpenny
- Research in Nursing and Patient Care (M.E.C, B.H.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Michael S Rabin
- Lowe Center for Thoracic Oncology (M.S.R.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ellis Johns
- Family Medicine (E.J.), Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kathleen Finn
- Clinical Research (K.F.), City of Hope, Duarte, California, USA
| | - Donna Berry
- Biobehavioral Nursing and Health Informatics (D.B.), University of Washington, Seattle, Washington, USA
| | - Ruth McCorkle
- School of Nursing (R.M.), Yale University, New Haven, Connecticut, USA
| | - Janet L Abrahm
- Psychosocial Oncology and Palliative Care (I.M.B., J.L.A.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Gupta M, Malik T, Sinha C. Delivery of a Mental Health Intervention for Chronic Pain Through an Artificial Intelligence-Enabled App (Wysa): Protocol for a Prospective Pilot Study. JMIR Res Protoc 2022; 11:e36910. [PMID: 35314423 PMCID: PMC9015778 DOI: 10.2196/36910] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with chronic pain often suffer from coexisting, long-term and debilitating mental health comorbidities such as depression and anxiety. Artificial Intelligence Supported Cognitive Behavioral Therapy or AI-CBT interventions could offer cost-effective, accessible, and potentially effective resources to tackle this problem. However, there is not enough research conducted about the efficacy of AI-CBT interventions for chronic pain. OBJECTIVE This prospective cohort study aims to examine the efficacy and usage of an AI-CBT intervention for chronic pain (Wysa for Chronic Pain app), using a conversational agent (with no human intervention). To the best of our knowledge, this is the first such study for chronic pain using a fully-automated, free-text-based conversational agent (CA). METHODS Participants with self-reported chronic pain (N = 500) will be recruited online on a rolling basis from April 2022 through posts on US-based internet communities within this prospective cohort. Informed consent is taken from the participants within the app and the Wysa intervention is delivered remotely for 8 weeks. Outcome measures including NPRS (Numeric Pain Rating Scale), PROMIS PI (Patient-Reported Outcomes Measurement Information System Pain Interference), GAD-7 (Generalized Anxiety Disorder), and PHQ-9 (Patient Health Questionnaire) questionnaires will be administered to test the effectiveness of the intervention on reducing levels of pain interference, depression, and anxiety. The therapeutic alliance created with the conversational agent will be assessed through the WAI-SR (Working Alliance Inventory-Short Revised). Retention and usage statistics will be observed for adherence and engagement. RESULTS The study will open for recruitment in April 2022 and data collection is expected to be completed by August 2022. The results for the primary outcomes are expected to be published by late-2022. CONCLUSIONS Mental health conversational agents driven by artificial intelligence (AI) could be effective in helping patients with chronic pain learn to self-manage their pain and deal with common comorbidities like depression and anxiety. The Wysa for Chronic Pain app is one such digital intervention that can potentially serve as a solution to the problems of affordability and scalability associated with interventions with a human therapist in loop. This prospective study examines the efficacy of the app as a treatment solution for chronic pain. It aims to inform future practices and digital mental health interventions for individuals with chronic pain. CLINICALTRIAL
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Liu W, Yu F, Geldsetzer P, Yang J, Wang Z, Golden T, Jiao L, Chen Q, Liu H, Wu P, Wang C, Bärnighausen T, Chen S. Prevalence of depression in China during the early stage of the COVID-19 pandemic: a cross-sectional study in an online survey sample. BMJ Open 2022; 12:e056667. [PMID: 35264364 PMCID: PMC8914405 DOI: 10.1136/bmjopen-2021-056667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES We aimed to determine (1) the prevalence of depression during the COVID-19 pandemic among Chinese adults and (2) how depression prevalence varied by province and sociodemographic characteristics. DESIGN Cross-sectional study. SETTING National online survey in China. PARTICIPANTS We conducted a cross-sectional online survey among adults registered with the survey company KuRunData from 8 May 2020 to 8 June 2020. We aimed to recruit 300-360 adults per province (n=14 493), with a similar distribution by sex and rural-urban residency as the general population within each of these provinces. PRIMARY OUTCOME Participants completed the Patient Health Questionaire-9 (PHQ-9). We calculated the prevalence of depression (defined as a PHQ-9 score ≥10) nationally and separately for each province. ANALYSIS Covariate-unadjusted and covariate-adjusted logistic regression models were used to examine how the prevalence of depression varied by adults' sociodemographic characteristics. All analyses used survey sampling weights. RESULTS The survey was initiated by 14 493 participants, with 10 000 completing all survey questions and included in the analysis. The prevalence of depression in the national sample was 6.3% (95% CI 5.7% to 6.8%). A higher odds of depression was associated with living in an urban area (OR 1.50; 95% CI 1.18 to 1.90) and working as a nurse (OR 3.06; 95% CI 1.41 to 6.66). A lower odds of depression was associated with participants who had accurate knowledge of COVID-19 transmission prevention actions (OR 0.71; 95% CI 0.51 to 0.98), the knowledge that saliva is a main transmission route (OR 0.80; 95% CI 0.64 to 0.99) and awareness of COVID-19 symptoms (OR, 0.82; 95% CI 0.68 to 1.00). CONCLUSION Around one in 20 adults in our online survey sample had a PHQ-9 score suggestive of depression. Interventions and policies to prevent and treat depression during the COVID-19 pandemic in China may be particularly needed for nurses and those living in urban areas.
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Affiliation(s)
- Weina Liu
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Children and Adolescents Health Promotion, Jiangsu Provincial CDC, Nanjing, Jiangsu, China
| | - Fengyun Yu
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Pascal Geldsetzer
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Division of Primary Care and Population Health,Department of Medicine, Stanford University, Stanford, California, USA
| | - Juntao Yang
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhuoran Wang
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Todd Golden
- National Cancer Institute Division of Cancer Control and Population Sciences, Rockville, Maryland, USA
| | - Lirui Jiao
- Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Qiushi Chen
- Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Haitao Liu
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Peixin Wu
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chen Wang
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Pulmonary and Critical Care Medicine of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Till Bärnighausen
- Institute of Public Health, Universitatsklinikum Heidelberg Institut fur Global Health, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Simiao Chen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Dosovitsky G, Kim E, Bunge EL. Psychometric Properties of a Chatbot Version of the PHQ-9 With Adults and Older Adults. Front Digit Health 2021; 3:645805. [PMID: 34713116 PMCID: PMC8522018 DOI: 10.3389/fdgth.2021.645805] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/06/2021] [Indexed: 12/20/2022] Open
Abstract
Background: The Patient Health Questionnaire-9 (PHQ-9) is a brief depression measure that has been validated. A chatbot version of the PHQ-9 would allow the assessment of depressive symptoms remotely, at a large scale and low cost. Objective: The current study aims to: Assess the feasibility of administering the PHQ-9 in a sample of adults and older adults via chatbot, report the psychometric properties of and identify the relationship between demographic variables and PHQ-9 total scores. Methods: A sample of 3,902 adults and older adults in the US and Canada were recruited through Facebook from August 2019 to February 2020 to complete the PHQ-9 using a chatbot. Results: A total of 3,895 (99.82%) completed the PHQ-9 successfully. The internal consistency of the PHQ-9 was 0.896 (p < 0.05). A one factor structure was found to have good model fit [X2 (27, N = 1,948) = 365.396, p < 0.001; RMSEA = 0.080 (90% CI: 0.073, 0.088); CFI and TLI were 0.925 and 0.900, respectively, and SRMR was 0.039]. All of the demographic characteristics in this study were found to significantly predict PHQ-9 total score, however; their effect was negligible to weak. Conclusions: There was a large sample of adults and older adults were open to completing assessments via chatbot including those over 75. The psychometric properties of the chatbot version of the PHQ-9 provide initial support to the utilization of this assessment method.
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Affiliation(s)
- Gilly Dosovitsky
- Psychology Department, Palo Alto University, Palo Alto, CA, United States
| | - Erick Kim
- Psychology Department, Palo Alto University, Palo Alto, CA, United States
| | - Eduardo L Bunge
- Psychology Department, Palo Alto University, Palo Alto, CA, United States
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Nielsen SW, Ruhlmann CH, Eckhoff L, Brønnum D, Herrstedt J, Dalton SO. Cannabis use among Danish patients with cancer: a cross-sectional survey of sociodemographic traits, quality of life, and patient experiences. Support Care Cancer 2021; 30:1181-1190. [PMID: 34453567 DOI: 10.1007/s00520-021-06515-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Patients with cancer are using cannabis for self-treatment. The reasons, experienced effects, and prevalence of use are unknown in the European general oncological population. METHODS Adult patients with cancer attending outpatient oncology clinics were invited to participate in a cross-sectional survey. The questionnaire consisted of sociodemographic questions, validated scales on quality of life, neuropathy, anxiety and depression as well as questions regarding use of cannabis. RESULTS The overall response rate was 83% (2839 patients) and 13% of patients were using or had used cannabis during their treatment. Rate of use was higher in smokers (19% vs 11%, p adjusted 0.002), in patients in active cancer treatment (14% vs 10%, p adjusted = 0.02), and in patients with depression (19% vs 11%, adjusted p = 0.002). Cannabis use was also correlated with lower quality of life (EORTC C30 SumScore mean diff. = - 7.61, 95% CI = [- 9.69; - 5.53]). In total, 77% of users experienced at least one positive effect of cannabis, 18% experienced no effect, and 5% experienced other effects. At least one side effect was experienced by 33% of users. Management of pain and nausea were the primary reasons for initiating cannabis use (39% for both). Less nausea and better sleep were the most common effects experienced (26% for both). Oils for oral use were the most common route of administration (88%). CONCLUSION Cannabis use among patients with cancer is prevalent and correlated with worse quality of life. Patients report using cannabis for symptom management and many experience relief of their symptoms. However, one third of patients experienced side effects.
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Affiliation(s)
- Sebastian W Nielsen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 9, 4000, Roskilde, Denmark.
| | - Christina H Ruhlmann
- Department of Clinical Research, University of Southern Denmark, 5000, Odense C, Denmark.,Department of Oncology R, Odense University Hospital, 5000, Odense C, Denmark
| | - Lise Eckhoff
- Department of Oncology R, Odense University Hospital, 5000, Odense C, Denmark
| | - Dorthe Brønnum
- Centre for Clinical Research, North Denmark Regional Hospital, 9800, Hjoerring, Denmark
| | - Jørn Herrstedt
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 9, 4000, Roskilde, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1165, Copenhagen, Denmark
| | - Susanne O Dalton
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1165, Copenhagen, Denmark.,Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, 2100, Copenhagen, Denmark
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13
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Shimony O, Einav N, Bonne O, Jordan JT, Van Vleet TM, Nahum M. The association between implicit and explicit affective inhibitory control, rumination and depressive symptoms. Sci Rep 2021; 11:11490. [PMID: 34075112 PMCID: PMC8169859 DOI: 10.1038/s41598-021-90875-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 05/19/2021] [Indexed: 11/09/2022] Open
Abstract
Inhibitory control underlies one's ability to maintain goal-directed behavior by inhibiting prepotent responses or ignoring irrelevant information. Recent models suggest that impaired inhibition of negative information may contribute to depressive symptoms, and that this association is mediated by rumination. However, the exact nature of this association, particularly in non-clinical samples, is unclear. The current study assessed the relationship between inhibitory control over emotional vs. non-emotional information, rumination and depressive symptoms. A non-clinical sample of 119 participants (mean age: 36.44 ± 11.74) with various levels of depressive symptoms completed three variations of a Go/No-Go task online; two of the task variations required either explicit or implicit processing of emotional expressions, and a third variation contained no emotional expressions (i.e., neutral condition). We found reductions in inhibitory control for participants reporting elevated symptoms of depression on all three task variations, relative to less depressed participants. However, for the task variation that required implicit emotion processing, depressive symptoms were associated with inhibitory deficits for sad and neutral, but not for happy expressions. An exploratory analysis showed that the relationship between inhibition and depressive symptoms occurs in part through trait rumination for all three tasks, regardless of emotional content. Collectively, these results indicate that elevated depressive symptoms are associated with both a general inhibitory control deficit, as well as affective interference from negative emotions, with implications for the assessment and treatment of mood disorders.
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Affiliation(s)
- Orly Shimony
- School of Occupational Therapy, Faculty of Medicine, The Hebrew University, Mount Scopus, PO Box 24026, 9124001, Jerusalem, Israel
| | - Noam Einav
- School of Occupational Therapy, Faculty of Medicine, The Hebrew University, Mount Scopus, PO Box 24026, 9124001, Jerusalem, Israel
| | - Omer Bonne
- Department of Psychiatry, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Joshua T Jordan
- Department of Psychology, Dominican University of California, San Rafael, CA, USA
| | - Thomas M Van Vleet
- Department of Research & Development, Posit Science Corporation, San Francisco, CA, USA
| | - Mor Nahum
- School of Occupational Therapy, Faculty of Medicine, The Hebrew University, Mount Scopus, PO Box 24026, 9124001, Jerusalem, Israel.
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14
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Supporting Medical Staff from Psycho-Oncology with Smart Mobile Devices: Insights into the Development Process and First Results. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105092. [PMID: 34064987 PMCID: PMC8150950 DOI: 10.3390/ijerph18105092] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 12/11/2022]
Abstract
Cancer is a very distressing disease, not only for the patients themselves, but also for their family members and relatives. Therefore, patients are regularly monitored to decide whether psychological treatment is necessary and applicable. However, such monitoring processes are costly in terms of required staff and time. Mobile data collection is an emerging trend in various domains. The medical and psychological field benefits from such an approach, which enables experts to quickly collect a large amount of individual health data. Mobile data collection applications enable a more holistic view of patients and assist psychologists in taking proper actions. We developed a mobile application, FeelBack, which is designed to support data collection that is based on well-known and approved psychological instruments. A controlled pilot evaluation with 60 participants provides insights into the feasibility of the developed platform and it shows the initial results. 31 of these participants received paper-based questionnaire and 29 followed the digital approach. The results reveal an increase of the overall acceptance by 58.5% in the mean when using a digital screening as compared to the paper-based. We believe that such a platform may significantly improve cancer patients’ and relatives’ psychological treatment, as available data can be used to optimize treatment.
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15
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Hungerbuehler I, Daley K, Cavanagh K, Garcia Claro H, Kapps M. Chatbot-Based Assessment of Employees' Mental Health: Design Process and Pilot Implementation. JMIR Form Res 2021; 5:e21678. [PMID: 33881403 PMCID: PMC8100879 DOI: 10.2196/21678] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/10/2020] [Accepted: 03/17/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Stress, burnout, and mental health problems such as depression and anxiety are common, and can significantly impact workplaces through absenteeism and reduced productivity. To address this issue, organizations must first understand the extent of the difficulties by mapping the mental health of their workforce. Online surveys are a cost-effective and scalable approach to achieve this but typically have low response rates, in part due to a lack of interactivity. Chatbots offer one potential solution, enhancing engagement through simulated natural human conversation and use of interactive features. OBJECTIVE The aim of this study was to explore if a text-based chatbot is a feasible approach to engage and motivate employees to complete a workplace mental health assessment. This paper describes the design process and results of a pilot implementation. METHODS A fully automated chatbot ("Viki") was developed to evaluate employee risks of suffering from depression, anxiety, stress, insomnia, burnout, and work-related stress. Viki uses a conversation style and gamification features to enhance engagement. A cross-sectional analysis was performed to gain first insights of a pilot implementation within a small to medium-sized enterprise (120 employees). RESULTS The response rate was 64.2% (77/120). In total, 98 employees started the assessment, 77 of whom (79%) completed it. The majority of participants scored in the mild range for anxiety (20/40, 50%) and depression (16/28, 57%), in the moderate range for stress (10/22, 46%), and at the subthreshold level for insomnia (14/20, 70%) as defined by their questionnaire scores. CONCLUSIONS A chatbot-based workplace mental health assessment seems to be a highly engaging and effective way to collect anonymized mental health data among employees with response rates comparable to those of face-to-face interviews.
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Affiliation(s)
| | | | - Kate Cavanagh
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Heloísa Garcia Claro
- School of Nursing, University of Campinas, Campinas, Brazil.,Department of Preventive Medicine, University of São Paulo, São Paulo, Brazil
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16
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BinDhim NF, Althumiri NA, Basyouni MH, Alageel AA, Alghnam S, Al-Qunaibet AM, Almubarak RA, Aldhukair S, Ad-Dab’bagh Y. Saudi Arabia Mental Health Surveillance System (MHSS): mental health trends amid COVID-19 and comparison with pre-COVID-19 trends. Eur J Psychotraumatol 2021; 12:1875642. [PMID: 34025918 PMCID: PMC8128114 DOI: 10.1080/20008198.2021.1875642] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/01/2021] [Indexed: 12/04/2022] Open
Abstract
Background: The impact of the COVID-19 pandemic on populations' mental health has started to emerge. Objectives: To describe the mental health trends of the risk of major depressive disorder (MDD) and generalized anxiety disorder (GAD) between May and August 2020. It also compares the results with pre-COVID-19 results and identifies risk factors associated with increased likelihood of being at risk of MDD and GAD. Method: This study utilizes repeated cross-sectional design, at national-level coverage of mental health screenings via computer-assisted phone interviews conducted in four waves monthly (between May and August 2020). Arabic-speaking adults from Saudi Arabia were recruited via a random phone list. The questionnaire includes the Arabic version of the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder-7 (GAD-7). Pre-COVID-19 comparison was done using the PHQ-2 score to allow for comparison with a previous and similar national study conducted in 2018. Results: Across the four waves, 16,513 participants completed the interviews, with an overall response rate of 81.3%. The weighted national prevalence of people at risk of MDD was 14.9% overall, and 13.8%, 13.6%, 16.8%, and 15.3% in Waves 1, 2, 3, and 4, respectively. The weighted national prevalence of people at risk of GAD was 11.4%, overall, and 10.9%, 10.7%, 12.4%, and 11.7% in Waves 1, 2, 3, and 4, respectively. The weighted national proportion of individuals who were at risk of MDD and GAD at the same time was 7.4% overall. The risk of MDD on PHQ-2 increased by 71.2%, from 12.5% in 2018 to 21.4% in 2020. Conclusions: The risks of MDD and GAD in this study are relatively high. These results can help decision makers to understand the impact of the COVID-19 pandemic on the population's mental health and the most-impacted subgroups.
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Affiliation(s)
- Nasser F. BinDhim
- Scientific Affairs Department, Sharik Association for Health Research, Riyadh, Saudi Arabia
- CEO Office, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
- Public Health Department, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Nora A. Althumiri
- Scientific Affairs Department, Sharik Association for Health Research, Riyadh, Saudi Arabia
| | - Mada H. Basyouni
- Scientific Affairs Department, Sharik Association for Health Research, Riyadh, Saudi Arabia
- Small and medium enterprises Department, Ministry of Health, Riyadh, Saudi Arabia
| | - Asem A. Alageel
- Department of Clinical Neurosciences, College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Suliman Alghnam
- Population Health Department, King Abdulah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Ada M. Al-Qunaibet
- Public Health Research and Health Statistics Department, The National Center for Disease Prevention and Control (Weqaya), Riyadh, Saudi Arabia
| | - Rasha A. Almubarak
- Scientific Affairs Department, Sharik Association for Health Research, Riyadh, Saudi Arabia
| | - Shahla Aldhukair
- Research and Studies Department, Saudi Health Council, Riyadh, Saudi Arabia
| | - Yasser Ad-Dab’bagh
- Small and medium enterprises Department, Ministry of Health, Riyadh, Saudi Arabia
- Mental Health Department, King Fahd Specialist Hospital, Dammam, Saudi Arabia
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17
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Kim S, Lee K. Screening for Depression in Mobile Devices Using Patient Health Questionnaire-9 (PHQ-9) Data: A Diagnostic Meta-Analysis via Machine Learning Methods. Neuropsychiatr Dis Treat 2021; 17:3415-3430. [PMID: 34848962 PMCID: PMC8612669 DOI: 10.2147/ndt.s339412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/02/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Depression is a symptom commonly encountered in primary care; however, it is often not detected by doctors. Recently, disease diagnosis and treatment approaches have been attempted using smart devices. In this study, instrumental effectiveness was confirmed with the diagnostic meta-analysis of studies that demonstrated the diagnostic effectiveness of PHQ-9 for depression using mobile devices. PATIENTS AND METHODS We found all published and unpublished studies through EMBASE, MEDLINE, MEDLINE In-Process, and PsychINFO up to March 26, 2021. We performed a meta-analysis by including 1099 subjects in four studies. We performed a diagnostic meta-analysis according to the PHQ-9 cut-off score and machine learning algorithm techniques. Quality assessment was conducted using the QUADAS-2 tool. Data on the sensitivity and specificity of the studies included in the meta-analysis were extracted in a standardized format. Bivariate and summary receiver operating characteristic (SROC) curve were constructed using the metandi, midas, metabias, and metareg functions of the Stata algorithm meta-analysis words. RESULTS Using four studies out of the 5476 papers searched, a diagnostic meta-analysis of the PHQ-9 scores of 1099 people diagnosed with depression was performed. The pooled sensitivity and specificity were 0.797 (95% CI = 0.642-0.895) and 0.85 (95% CI = 0.780-0.900), respectively. The diagnostic odds ratio was 22.16 (95% CI = 7.273-67.499). Overall, a good balance was maintained, and no heterogeneity or publication bias was presented. CONCLUSION Through various machine learning algorithm techniques, it was possible to confirm that PHQ-9 depression screening in mobiles is an effective diagnostic tool when integrated into a diagnostic meta-analysis.
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Affiliation(s)
- Sunhae Kim
- Department of Psychiatry, Hanyang University Medical Center, Seoul, Korea
| | - Kounseok Lee
- Department of Psychiatry, Hanyang University Medical Center, Seoul, Korea
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18
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Shrestha SK, Joshi S, Bhattarai RB, Joshi LR, Adhikari N, Shrestha SK, Basnet R, Kc KN. Prevalence and risk factors of depression in patients with drug-resistant tuberculosis in Nepal: A cross-sectional study. J Clin Tuberc Other Mycobact Dis 2020; 21:100200. [PMID: 33204854 PMCID: PMC7649626 DOI: 10.1016/j.jctube.2020.100200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Patients with drug-resistant tuberculosis (DR TB) are at high risk for depression. DR TB patients in Nepal were screened with Health Questionnaire 9 for depression. 81 out of 129 patients (62.7%) were found to have possible depressive disorder. Duration of illness was a significant risk factor for depression (p < 0.001).
Background Patients with drug-resistant tuberculosis (DR TB) have a protracted course of illness and the available treatment has a low success rate. These factors combined with the associated stigma and financial implications put the patients with DR TB at an increased risk of depression. The psychiatric side effects of anti-tuberculosis drugs further aggravate the problem. This study aimed to estimate the prevalence of depression among patients with DR TB in Nepal and identify risk factors. Methods We conducted this cross-sectional study in April 2018 at all the functioning 11 programmatic DR TB treatment centers across Nepal. We selected 129 patients aged ≥ 16 years receiving treatment for DR TB by non-probability quota sampling. Six trained data collectors conducted face-to-face interviews and administered the Nepali language version of Patient Health Questionnaire 9 (PHQ-9) to screen for depression. We summarized sociodemographic and treatment characteristics with median (Interquartile Range [IQR]) and proportions as appropriate. We performed univariate analysis for the variables hypothesized as risk factors for depression. We fitted a multivariable binary logistic regression model with depression as the outcome variable and the variables with a significance level of < 0.25 as explanatory variables. We regarded a p-value of < 0.05 as significant for individual variables in the logistic regression model. Results Of the 129 patients studied, 92 (71.3%) were male and the median age was 36 years (IQR 25–48). The majority (109, 84.4%) had multi-drug resistant tuberculosis (MDR TB). We identified 81 patients (62.7%, 95% Confidence Interval [CI] 53.7–71) with the PHQ-9 score of 10 or more signifying probable depressive disorder. In univariate analyses, age, treatment center location, DR TB treatment duration, and duration of current illness had a p-value lower than the pre-specified cut-off of 0.25. In the multivariable logistic regression model, we found a statistically significant association of depression with the duration of illness (adjusted Odds Ratio 1.15, 95% CI 1.07–1.26, p < 0.001). Conclusion This study has found that a large proportion of the patients with DR TB screened have depression suggesting the need for screening and management of comorbid depression within the National TB Control Program.
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Affiliation(s)
| | - Sulochana Joshi
- Department of Psychiatry, Patan Academy of Health Sciences, 44700 Lalitpur, Nepal
| | | | - Lok Raj Joshi
- National Tuberculosis Control Center, 44811 Thimi, Bhaktapur, Nepal
| | | | | | - Rajendra Basnet
- National Tuberculosis Control Center, 44811 Thimi, Bhaktapur, Nepal
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19
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Turna J, Balodis I, Munn C, Van Ameringen M, Busse J, MacKillop J. Overlapping patterns of recreational and medical cannabis use in a large community sample of cannabis users. Compr Psychiatry 2020; 102:152188. [PMID: 32653594 DOI: 10.1016/j.comppsych.2020.152188] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/11/2020] [Accepted: 05/28/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Regulatory changes are increasing access to both medical cannabis and cannabis in general. As such, understanding patterns of recreational and medical cannabis use is a high public health priority. OBJECTIVES Patterns of cannabis use (recreational and medical), other substance use, and psychiatric symptoms were characterized in a large sample of community adult cannabis users in Canada, prior to federal cannabis legalization. METHODS This was a self-report assessment of 709 cannabis users (Mean age = 30.19 (11.82) years; 55.01% female). Patterns of overall substance use and psychiatric symptomatology were compared based on recreational/medical cannabis status. RESULTS Overall, 61.4% of participants endorsed exclusively recreational use, while 38.6% reported some level of medical use. Of all medical users, only 23.4% reported authorization from a health professional. Recreational cannabis users typically reported infrequent use (less than weekly), whereas medical users modally reported daily use. Compared to recreational users, medical users reported more problematic cannabis use in addition to greater psychiatric symptomatology (anxiety, depression and trauma). Interestingly, a large majority of medical users also reported using recreationally (80.6%), while exclusive medical use was less common (19.3%). This dual motives group reported more daily cannabis use and more alcohol and tobacco use. Compared to medical-only users, individuals using cannabis for both medical and recreational purposes more often used cannabis to treat psychiatric conditions. CONCLUSIONS These findings reveal the differences in cannabis use patterns and preferences between recreational and medical users, and even within medical users. In particular, dual motives individuals, who use cannabis for both positively and negatively reinforcing purposes, may warrant special attention as a subpopulation.
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Affiliation(s)
- Jasmine Turna
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Iris Balodis
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Catharine Munn
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Michael Van Ameringen
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; MacAnxiety Research Centre, McMaster University, Hamilton, ON, Canada
| | - Jason Busse
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Department of Health, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - James MacKillop
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Homewood Research Institute, Guelph, ON, Canada.
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20
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Evaluation of an electronic clinical algorithm to improve screening and evaluation of college students for depressive symptoms. J Am Assoc Nurse Pract 2020; 33:754-759. [DOI: 10.1097/jxx.0000000000000493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 06/22/2020] [Indexed: 11/27/2022]
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21
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Suh J, Williams S, Fann JR, Fogarty J, Bauer AM, Hsieh G. Parallel Journeys of Patients with Cancer and Depression: Challenges and Opportunities for Technology-Enabled Collaborative Care. ACTA ACUST UNITED AC 2020; 4. [PMID: 32656502 DOI: 10.1145/3392843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Depression is common but under-treated in patients with cancer, despite being a major modifiable contributor to morbidity and early mortality. Integrating psychosocial care into cancer services through the team-based Collaborative Care Management (CoCM) model has been proven to be effective in improving patient outcomes in cancer centers. However, there is currently a gap in understanding the challenges that patients and their care team encounter in managing co-morbid cancer and depression in integrated psycho-oncology care settings. Our formative study examines the challenges and needs of CoCM in cancer settings with perspectives from patients, care managers, oncologists, psychiatrists, and administrators, with a focus on technology opportunities to support CoCM. We find that: (1) patients with co-morbid cancer and depression struggle to navigate between their cancer and psychosocial care journeys, and (2) conceptualizing co-morbidities as separate and independent care journeys is insufficient for characterizing this complex care context. We then propose the parallel journeys framework as a conceptual design framework for characterizing challenges that patients and their care team encounter when cancer and psychosocial care journeys interact. We use the challenges discovered through the lens of this framework to highlight and prioritize technology design opportunities for supporting whole-person care for patients with co-morbid cancer and depression.
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Affiliation(s)
- Jina Suh
- University of Washington, USA and Microsoft Research, USA
| | | | - Jesse R Fann
- University of Washington, USA and Seattle Cancer Care Alliance, USA
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22
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Implementation of a tablet-based suicide screening tool in an emergency department. Am J Emerg Med 2020; 42:256-257. [PMID: 32641267 DOI: 10.1016/j.ajem.2020.06.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/20/2022] Open
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Gandré C, Le Jeannic A, Vinet MA, Turmaine K, Courtet P, Roelandt JL, Vaiva G, Giraudeau B, Alberti C, Chevreul K. The PRINTEMPS study: protocol of a cluster-randomized controlled trial of the local promotion of a smartphone application and associated website for the prevention of suicidal behaviors in the adult general population in France. Trials 2020; 21:553. [PMID: 32571432 PMCID: PMC7309990 DOI: 10.1186/s13063-020-04464-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide constitutes a cause of death which could be prevented by e-health programs accessible to the general population. Effective promotion has the potential to maximize the uptake of such programs. However, few e-health programs have been combined with promotion campaigns. The primary objective of this trial is to assess the effectiveness of a tailored promotion, at a local level, of a mobile application and website offering evidence-based content for suicide prevention (the StopBlues program), and to compare the effectiveness of two types of local promotion in terms of their impact on suicidal acts. Secondary objectives focus on the effectiveness of the promotion in terms of the intensity of utilization of the StopBlues program, help-seeking behaviors and the level of psychological impairment of program users. METHODS/DESIGN This is a three-arm, parallel-group, cluster-randomized controlled trial, with before-and-after observation. Thirty-four clusters, corresponding to geographical areas sharing a common local authority in France, will be included. They will be randomly assigned to one of the following arms with a ratio of 1:1:1: a control group; a basic promotion group in which promotion of the StopBlues program will be done by local authorities; and an intensified promotion group in which basic promotion will be supplemented by an additional one in a general practitioner's waiting room. The primary outcome measure will be the number of suicidal acts within each cluster over a 12-month period following the launch of the intervention. Baseline data will be collected for each cluster over the 12-month period prior to the trial. Secondary outcomes will include length of use of the StopBlues program, measures of help-seeking behaviors and level of psychological distress among users of the program, as well as the cost-effectiveness and budgetary impact of its promotion. A more sustained promotion by local authorities will also be implemented after 12 months in the control group and assessed using the same outcome measures. DISCUSSION This research should contribute to the sparse evidence base regarding the promotion of e-health programs and will support the wider delivery of the intervention evaluated if proven effective. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03565562. Registered on 11 June 2018.
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Affiliation(s)
- Coralie Gandré
- Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France
| | - Anaïs Le Jeannic
- Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France
- Health Economics Clinical Research Platform (URC Eco), AP-HP, 1 Place du Parvis Notre-Dame, 75004, Paris, France
| | - Marie-Amélie Vinet
- Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France
- Health Economics Clinical Research Platform (URC Eco), AP-HP, 1 Place du Parvis Notre-Dame, 75004, Paris, France
| | | | - Philippe Courtet
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- Neuropsychiatry, Epidemiological and Clinical Research, INSERM, University of Montpellier, Montpellier, France
| | - Jean-Luc Roelandt
- Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France
- World Health Organization Collaborating Centre for Research and Training in Mental Health, Établissement Public de Santé Mentale Lille Metropole, Lille, Hellemmes, France
| | - Guillaume Vaiva
- Department of Adult Psychiatry, CHU Lille, Lille, France
- Centre National de Ressources et Résilience pour le Psychotraumatisme (Cn2r Lille Paris), Lille, France
| | - Bruno Giraudeau
- INSERM CIC 1415, CHRU de Tours, Tours, France
- Tours University, Nantes University, INSERM SPHERE, U1246, Tours, France
| | - Corinne Alberti
- Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France
- Hôpital Robert Debré, CIC-EC, Unité INSERM CIC 1426, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Karine Chevreul
- Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France.
- Health Economics Clinical Research Platform (URC Eco), AP-HP, 1 Place du Parvis Notre-Dame, 75004, Paris, France.
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Henson P, Torous J. Feasibility and correlations of smartphone meta-data toward dynamic understanding of depression and suicide risk in schizophrenia. Int J Methods Psychiatr Res 2020; 29:e1825. [PMID: 32333471 PMCID: PMC7301285 DOI: 10.1002/mpr.1825] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/17/2020] [Accepted: 03/29/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES We investigate whether meta-data, specifically duration of responses to smartphone-delivered surveys, is correlated to elevated scores on the depression assessment PHQ-9 as well as the specific item around self-harm (item 9). METHODS In this observational study, we recruited 92 smartphone-owning adults (≥ 18) with schizophrenia (45) and healthy controls (43). We installed an open-source smartphone app called mindLAMP to collect survey results and latencies (response times) over a period of 3 months. Surveys were scheduled for twice a week, but participants were instructed to take the surveys naturally as much or as little as they wanted. A total of 1,218 PHQ-9 surveys were completed across all participants over 3 months. RESULTS A total of 75 participants (39 with schizophrenia and 36 healthy controls) completed both the initial visit and follow-up, as well as provided at least one self-reported PHQ-9 survey through the app. We found that depression symptom severity and response latencies were correlated for both individuals with schizophrenia (Spearman's ρ = .22, p = .037) and healthy controls (Spearman's ρ = .58, p < .001). Participants with schizophrenia scored higher (more severe) and took longer for every item of the PHQ-9 when compared to controls (p < .05 for each item). Item 9 response value and latency was slightly correlated for participants with schizophrenia (Spearman's ρ = .086, p = .035) but was not significant for controls (Spearman's ρ = .036, p = .37). CONCLUSIONS Meta-data revealed group differences between individuals with schizophrenia and healthy controls based on individual depression symptoms completed on a smartphone. Correlation between suicide specific question latency and severity for participants with schizophrenia but not for controls indicates the clinical potential and need for further research.
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Affiliation(s)
- Philip Henson
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Yu YL, Yeo H, Kang S. The impact of depressive symptoms on health value in patients with gynecologic cancer: A comparison with physical symptoms and performance status. Gynecol Oncol 2020; 157:733-739. [PMID: 32307127 DOI: 10.1016/j.ygyno.2020.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/03/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The importance of managing depressive symptoms is frequently underestimated in the clinic. In this study, the effects of depressive symptoms on health utility value (HUV) in gynecologic cancer patients are evaluated. In addition, the effects were compared with those of performance status and physical symptoms. METHODS Patient-reported outcome data from 274 gynecologic cancer patients were prospectively collected. HUV was measured using the 3-level version of the EuroQoL 5-dimension descriptive system (EQ-5D-3L) and the EuroQoL visual analog scale (EQ-VAS). The Patient Health Questionnaire-9 (PHQ-9) was used to measure the severity of depressive symptoms. The impact of depressive symptoms on HUV was analyzed using the generalized linear model. RESULTS Moderate-severe depressive symptoms were significantly associated with a decrease in HUV in gynecologic cancer patients (p < 0.0001 for the EQ-5D-3L and EQ-VAS). Severe fatigue and severe pain were also associated with a decrease in HUV (p = 0.018 and p < 0.0001 for the EQ-5D-3L and EQ-VAS; p < 0.0001 for the EQ-5D-3L, respectively), and the effect sizes were comparable to that of moderate-severe depressive symptoms. In addition to the patients with moderate-severe depressive symptoms, the patients with mild depressive symptoms also experienced a significant decrease in HUV (p < 0.0001 for the EQ-5D-3L and EQ-VAS). The effect size for mild depressive symptoms was comparable to those for mild fatigue or mild pain. CONCLUSIONS Even mild depressive symptoms may significantly compromise HUV in gynecologic cancer patients, and the effect is comparable to that of performance status or physical symptoms. Gynecologic oncologists should put more effort into properly preventing, detecting, and managing depressive symptoms.
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Affiliation(s)
- Ye Lee Yu
- Division of Precision Medicine, National Cancer Center Korea, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea.
| | - Hyemin Yeo
- Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
| | - Sokbom Kang
- Division of Precision Medicine, National Cancer Center Korea, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea.
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Abstract
Patients with a current diagnosis of breast cancer are enjoying dramatic cure rates and survivorship secondary to an increase in awareness, earlier detection, and more effective therapies. Although strategies such as Breast Cancer Awareness Month in October focus on early detection, lifestyle changes are seldom discussed other than dietary concerns and physical activity. Lifestyle modifications centered on diet and exercise have been demonstrated to affect overall disease-free survival in breast cancer. Since the early 2000s, the role of the human gut microbiota and its relation to breast cancer has become a major area of interest in the scientific and medical community. We live and survive owing to the symbiotic relationship with the microorganisms within us: the human microbiota. Scientific advances have identified a subset of the gut microbiota: the estrobolome, those bacteria that have the genetic capability to metabolize estrogen, which plays a key role in most breast cancers. Recent research provides evidence that the gut microbiome plays a substantial role in estrogen regulation. Gut microbiota diversity appears to be an essential component of overall health, including breast health. Future research attention should include a more extensive focus on the role of the human gut microbiota in breast cancer.
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Affiliation(s)
- Balazs I Bodai
- The Breast Cancer Survivorship Institute, Kaiser Permanente, Sacramento, CA
| | - Therese E Nakata
- The Breast Cancer Survivorship Institute, Kaiser Permanente, Sacramento, CA
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Jungmann SM, Klan T, Kuhn S, Jungmann F. Accuracy of a Chatbot (Ada) in the Diagnosis of Mental Disorders: Comparative Case Study With Lay and Expert Users. JMIR Form Res 2019; 3:e13863. [PMID: 31663858 PMCID: PMC6914276 DOI: 10.2196/13863] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/26/2019] [Accepted: 08/31/2019] [Indexed: 12/28/2022] Open
Abstract
Background Health apps for the screening and diagnosis of mental disorders have emerged in recent years on various levels (eg, patients, practitioners, and public health system). However, the diagnostic quality of these apps has not been (sufficiently) tested so far. Objective The objective of this pilot study was to investigate the diagnostic quality of a health app for a broad spectrum of mental disorders and its dependency on expert knowledge. Methods Two psychotherapists, two psychology students, and two laypersons each read 20 case vignettes with a broad spectrum of mental disorders. They used a health app (Ada—Your Health Guide) to get a diagnosis by entering the symptoms. Interrater reliabilities were computed between the diagnoses of the case vignettes and the results of the app for each user group. Results Overall, there was a moderate diagnostic agreement (kappa=0.64) between the results of the app and the case vignettes for mental disorders in adulthood and a low diagnostic agreement (kappa=0.40) for mental disorders in childhood and adolescence. When psychotherapists applied the app, there was a good diagnostic agreement (kappa=0.78) regarding mental disorders in adulthood. The diagnostic agreement was moderate (kappa=0.55/0.60) for students and laypersons. For mental disorders in childhood and adolescence, a moderate diagnostic quality was found when psychotherapists (kappa=0.53) and students (kappa=0.41) used the app, whereas the quality was low for laypersons (kappa=0.29). On average, the app required 34 questions to be answered and 7 min to complete. Conclusions The health app investigated here can represent an efficient diagnostic screening or help function for mental disorders in adulthood and has the potential to support especially diagnosticians in their work in various ways. The results of this pilot study provide a first indication that the diagnostic accuracy is user dependent and improvements in the app are needed especially for mental disorders in childhood and adolescence.
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Affiliation(s)
| | - Timo Klan
- Department of Psychology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sebastian Kuhn
- University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Florian Jungmann
- University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
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Zhu L, Yao J, Wu L, Wang J, Qiu M, Zhang C, Zhang H, Xie J, Liu A, Ranchor A, Schroevers M. Psychometric properties of the Depression Stigma Scale (DSS) in Chinese cancer patients: a cross-sectional study. BMJ Open 2019; 9:e028429. [PMID: 31340966 PMCID: PMC6661685 DOI: 10.1136/bmjopen-2018-028429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES The Depression Stigma Scale (DSS) is commonly used to assess depression stigma in the general population and in people with depression. The DSS includes two 9-item subscales assumed to measure personal depression stigma (ie, personal perceptions of depression) and perceived depression stigma (ie, perceptions of how others perceive depression). The aim of the present study was to examine its psychometric properties in terms of validity and reliability in Chinese cancer patients. DESIGN A cross-sectional study design. PARTICIPANTS AND SETTINGS This study focused on 301 Chinese cancer patients recruited from two hospitals in Xi'an, China. METHODS Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to assess the factor structure. Internal consistency was assessed using Cronbach's alpha. To examine concurrent validity, symptoms of depression were used as the criterion. RESULTS For each subscale of the DSS (ie, personal and perceived depression stigma), the EFA and CFA confirmed a two-factor structure: weak-not-sick (ie, perceiving that depression is not a real illness, but rather a sign of weakness) and discrimination (ie, perceiving that depressed people are discriminated against). The Cronbach's alphas were adequate, ranging from 0.70 to 0.80. Symptoms of depression were positively but weakly correlated to personal and perceived depression stigma. CONCLUSIONS The DSS appeared to show satisfactory psychometric properties in our sample of cancer patients. Both personal depression stigma and perceived depression stigma subscales consisted of two underlying aspects.
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Affiliation(s)
- Lei Zhu
- School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Juntao Yao
- Shaanxi Provincial Tumor Hospital, Xi'an, China
| | - Liyang Wu
- School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Jun Wang
- School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Mengting Qiu
- School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Chunyu Zhang
- School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Hongmei Zhang
- Department of Oncology, Xijing Hospital attached to the Medical University of the Air Force, Xi'an, China
| | - Juan Xie
- Shaanxi Provincial Tumor Hospital, Xi'an, China
| | - Ailan Liu
- Shaanxi Provincial Tumor Hospital, Xi'an, China
| | - Adelita Ranchor
- Department of Health Psychology, University Medical Center Groningen, Groningen, The Netherlands
| | - Maya Schroevers
- Department of Health Psychology, University Medical Center Groningen, Groningen, The Netherlands
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Biases in processing of mood-congruent facial expressions in depression. Psychiatry Res 2019; 275:143-148. [PMID: 30908978 PMCID: PMC6504610 DOI: 10.1016/j.psychres.2019.02.076] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 01/17/2023]
Abstract
Cognitive models of depression suggest that depressed individuals exhibit a tendency to attribute negative meaning to neutral stimuli, and enhanced processing of mood-congruent stimuli. However, evidence thus far has been inconsistent. In this study, we sought to identify both differential interpretation of neutral information as well as emotion processing biases associated with depression. Fifty adult participants completed standardized mood-related questionnaires, a novel immediate mood scale questionnaire (IMS-12), and a novel task, Emotion Matcher, in which they were required to indicate whether pairs of emotional faces show the same expression or not. We found that overall success rate and reaction time on the Emotion Matcher task did not differ as a function of severity of depression. However, more depressed participants had significantly worse performance when presented with sad-neutral face pairs, as well as increased reaction times to happy-happy pairs. In addition, accuracy of the sad-neutral pairs was found to be significantly associated with depression severity in a regression model. Our study provides partial support for the mood-congruent hypothesis, revealing only a potential bias in interpretation of sad and neutral expressions, but not a general deficit in processing of facial expressions. The potential of such bias in serving as a predictor for depression should be further examined in future studies.
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Magee JC, Adut S, Brazill K, Warnick S. Mobile App Tools for Identifying and Managing Mental Health Disorders in Primary Care. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2018; 5:345-362. [PMID: 30397577 PMCID: PMC6214367 DOI: 10.1007/s40501-018-0154-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Mental health apps are intriguing yet challenging tools for addressing barriers to treatment in primary care. In the current review, we seek to assist primary care professionals with evaluating and integrating mental health apps into practice. We briefly summarize two leading frameworks for evaluating mental health apps and conduct a systematic review of mental health apps across a variety of areas commonly encountered in primary care. RECENT FINDINGS Existing frameworks can guide professionals and patients through the process of identifying apps and evaluating dimensions such as privacy and security, credibility, and user experience. For specific apps, several problem areas appear to have relatively more scientific evaluation in the current app landscape, including PTSD, smoking, and alcohol use. Other areas such as eating disorders not only lack evaluation, but contain a significant subset of apps providing potentially harmful advice. SUMMARY Overall, individuals seeking mental health apps will likely encounter strengths such as symptom tracking and psychoeducational components, while encountering common weaknesses such as insufficient privacy settings and little integration of empirically-supported techniques. While mental health apps may have more promise than ever, significant barriers to finding functional, usable, effective apps remain for health professionals and patients alike.
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Affiliation(s)
- Joshua C Magee
- Miami University, Department of Psychology, 90 North Patterson Ave., Oxford, OH 45056
| | - Sarah Adut
- Miami University, Department of Psychology, 90 North Patterson Ave., Oxford, OH 45056
| | - Kevin Brazill
- University of Illinois College of Medicine at Urbana-Champaign/Carle Physician Group, Department of Family Medicine and Department of Psychiatry, 611 West Park St., Urbana, IL 61801
| | - Stephen Warnick
- University of Michigan Medical School, Department of Family Medicine and Department of Psychiatry, 1150 W. Medical Center Dr., M7300 Med Sci I, SPC 5625, Ann Arbor, MI 48109-5625
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Niazi S, Frank RD, Sharma M, Roy V, Ames S, Rummans T, Spaulding A, Sher T, Ailawadhi M, Bhatia K, Ahmed S, Tan W, Chanan-Khan A, Ailawadhi S. Impact of psychiatric comorbidities on health care utilization and cost of care in multiple myeloma. Blood Adv 2018; 2:1120-1128. [PMID: 29776984 PMCID: PMC5965054 DOI: 10.1182/bloodadvances.2018016717] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/16/2018] [Indexed: 12/13/2022] Open
Abstract
Approximately one third of cancer patients suffer from comorbid mood disorders that are associated with increased cost and poorer outcomes. The majority of patients with multiple myeloma (MM) are treated with corticosteroids; as many as three fourths of those taking corticosteroids develop neuropsychiatric complications, likely increasing morbidity and cost of care. MM patients diagnosed between 1991 and 2010 and reported in the Surveillance Epidemiology, and End Results-Medicare database were characterized as MM-Only, MM+Psychiatric (any psychiatric condition, preexisting or post-MM), or MM+Depression (depression as the only psychiatric diagnosis, preexisting or post-MM). Differences in demographic characteristics, occurrence of clinical myeloma-defining events (MDEs), health care utilization (inpatient, outpatient, ambulatory claims), and cost of care during the first 6 months of MM diagnosis were analyzed. Psychiatric comorbidities were reported more frequently in females, and racial minorities had lower rates of psychiatric comorbidities. All clinical MDEs were more common in the MM+Psychiatric and MM+Depression groups; within them, the majority were more common in patients diagnosed with the psychiatric condition or depression after MM compared with it being a preexisting condition. Health care utilization in all treatment settings was higher in those with psychiatric comorbidities. Cost of care within the first 6 months after MM diagnosis was significantly higher in the MM+Psychiatric and MM+Depression groups. This increase in cost was more pronounced for patients from racial minorities diagnosed with a psychiatric condition, including depression. Psychiatric comorbidities significantly impact the clinical presentations, health care utilization, and cost among patients with MM. These findings need to be addressed for improved survivorship of MM patients.
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Affiliation(s)
- Shehzad Niazi
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | - Ryan D Frank
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN; and
| | | | | | - Steve Ames
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | - Teresa Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | - Aaron Spaulding
- Division of Healthcare Policy and Research, Mayo Clinic, Jacksonville, FL
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Ogawa A, Kondo K, Takei H, Fujisawa D, Ohe Y, Akechi T. Decision-Making Capacity for Chemotherapy and Associated Factors in Newly Diagnosed Patients with Lung Cancer. Oncologist 2017; 23:489-495. [PMID: 29212735 DOI: 10.1634/theoncologist.2017-0187] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 10/24/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The objective of this study was to assess decision-making capacity in patients newly diagnosed with lung cancer, clinical factors associated with impaired capacity, and physicians' perceptions of patients' decision-making capacity. MATERIALS AND METHODS We recruited 122 patients newly diagnosed with lung cancer. One hundred fourteen completed the assessment. All patients were receiving a combination of treatments (e.g., chemotherapy, chemo-radiotherapy, or targeted therapy). Decision-making capacity was assessed using the MacArthur Competence Tool for Treatment. Cognitive impairment, depressive symptoms, and frailty were also evaluated. Physicians' perceptions were compared with the ascertainments. RESULTS Twenty-seven (24%, 95% confidence interval [CI], 16-31) patients were judged to have incapacity. Clinical teams had difficulty in judging six (22.2%) patients for incapacity. Logistic regression identified frailty (odds ratio, 3.51; 95% CI, 1.13-10.8) and cognitive impairment (odds ratio, 5.45; 95% CI, 1.26-23.6) as the factors associated with decision-making incapacity. Brain metastasis, emphysema, and depression were not associated with decision-making incapacity. CONCLUSION A substantial proportion of patients diagnosed with lung cancer show impairments in their capacity to make a medical decision. Assessment of cognitive impairment and frailty may provide appropriate decision-making frameworks to act in the best interest of patients. IMPLICATIONS FOR PRACTICE Decision-making capacity is the cornerstone of clinical practice. A substantial proportion of patients with cancer show impairments in their capacity to make a medical decision. Assessment of cognitive impairment and frailty may provide appropriate decision-making frameworks to act in the best interest of patients.
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Affiliation(s)
- Asao Ogawa
- Division of Psycho-Oncology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan
| | - Kyoko Kondo
- Division of Psycho-Oncology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan
- Department of Pulmonary Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroyuki Takei
- Division of Psycho-Oncology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan
| | - Daisuke Fujisawa
- Division of Psycho-Oncology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Yuichiro Ohe
- Thoracic Oncology Division, National Cancer Center Hospital, Chuo-ku, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City Graduate School of Medical Science, Nagoya, Aichi, Japan
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Correlation of sociodemographic and clinical parameters with depression and distress in patients with hematologic malignancies. Ann Hematol 2017; 97:519-528. [DOI: 10.1007/s00277-017-3198-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
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Crane HM, Crane PK, Tufano JT, Ralston JD, Wilson IB, Brown TD, Davis TE, Smith LF, Lober WB, McReynolds J, Dhanireddy S, Harrington RD, Rodriguez CV, Nance RM, Delaney JAC, Safren SA, Kitahata MM, Fredericksen RJ. HIV Provider Documentation and Actions Following Patient Reports of At-risk Behaviors and Conditions When Identified by a Web-Based Point-of-Care Assessment. AIDS Behav 2017; 21:3111-3121. [PMID: 28205041 DOI: 10.1007/s10461-017-1718-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We compared same-day provider medical record documentation and interventions addressing depression and risk behaviors before and after delivering point-of-care patient-reported outcomes (PROs) feedback for patients who self-reported clinically relevant levels of depression or risk behaviors. During the study period (1 January 2006-15 October 2010), 2289 PRO assessments were completed by HIV-infected patients. Comparing the 8 months before versus after feedback implementation, providers were more likely to document depression (74% before vs. 87% after feedback, p = 0.02) in patients with moderate-to-severe depression (n = 317 assessments), at-risk alcohol use (41 vs. 64%, p = 0.04, n = 155) and substance use (60 vs. 80%, p = 0.004, n = 212). Providers were less likely to incorrectly document good adherence among patients with inadequate adherence after feedback (42 vs. 24%, p = 0.02, n = 205). While PRO feedback of depression and adherence were followed by increased provider intervention, other domains were not. Further investigation of factors associated with the gap between awareness and intervention are needed in order to bridge this divide.
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Danial-Saad A, Chiari L. A multidisciplinary approach for developing an assessment tool for touch screen devices. Disabil Rehabil Assist Technol 2017; 13:745-753. [PMID: 28903629 DOI: 10.1080/17483107.2017.1370500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM The aim of this study was to describe the processes of reaching consensus regarding the assessment of the user's skills required to operate various touch screen devices. A five-step procedure was used to collect and validate the required skills by a multidisciplinary team of 52 experts. Content validity was calculated to determine the agreement levels between the experts. A comparison was made between the discipline groups in order to test correlation between each group and their choice of specific clusters of tasks. METHODS The final consensus set by the experts' recommendations included 15 domains and 50 skills/measurements. The result of Cronbach's α test for the final assessment questionnaire (50 skills/measurements) was 0.94, which indicates a high degree of internal consistency. The results of Kruskal-Wallis's test showed the lack of any significant difference between agreements of the clinicians and the technicians groups, but significant differences were found between the educators and the clinicians groups. CONCLUSION The assessment questionnaire, in its current form, can be used by clinicians and it is expected to help in developing an objective assessment tool to quantify the performance and touch characteristics of individuals with varying abilities and disabilities, in order to enhance accessibility of touch screen technology. Implications for Rehabilitation Collecting and creating the required knowledge needed for assessing the user's skills for operating touch screen devices. The created knowledge helps clinicians to focus on the essential skills and measurements needed for a comprehensive assessment of the individual's abilities and disabilities while operating touch screen devices. The results of the assessment can be used as recommendations for enhancing accessibility of touch screen devices for various disabilities. This knowledge is expected to help in developing an application that provides an objective assessment tool. The study emphasizes the importance of close collaboration with multidisciplinary teams for creating a valid assessment tool.
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Affiliation(s)
- Alexandra Danial-Saad
- a Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences , The University of Haifa , Haifa , Israel.,b The Academic Arab College for Education in Israel , Haifa , Israel
| | - Lorenzo Chiari
- c Department of Electrical, Electronic, and Information Engineering - Guglielmo Marconi (DEI) and Health Sciences and Technologies - Interdepartmental Center for Industrial Research (HST-ICIR) , University of Bologna , Bologna , Italy
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Du N, Yu K, Ye Y, Chen S. Validity study of Patient Health Questionnaire-9 items for Internet screening in depression among Chinese university students. Asia Pac Psychiatry 2017; 9:10.1111/appy.12266. [PMID: 28856843 PMCID: PMC5580087 DOI: 10.1111/appy.12266] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/27/2016] [Accepted: 09/16/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Internet intervention in Chinese university students would be a possible approach to overcome the gap between high rate of depression and high rates of underdiagnosis and undertreatment. As a popular measure of screening, the feasibility and user satisfaction of Patient Health Questionnaire-9 items for online program were tested. METHODS The subjects were enrolled based on an email list from the students' office of a Chinese university, and 300 undergraduate students were randomly invited of which 230 (76.7%) students were willing to participate in the study and completed the first test. After 2 weeks, a subsample of 150 (65.2%) subjects were randomly chosen to retake the test for the test-retest reliability. And 81 (35.2%) among the 230 subjects were randomly selected to undergo the Mini International Neuropsychiatric Interview within 48 hours. Among 150 subjects, 120 (52.2%) completed client satisfaction questionnaire about this online screening program. RESULTS (1) The Cronbach alpha was 0.80 and the test-retest reliability was 0.78. (2) The optimal cutoff score of 10 revealed a sensitivity of 0.74 and specificity of 0.85, with an area under the curve of 0.897 (95% confidence interval, 0.823-0.970). (3) The mean duration of administration was 3.5 minutes. (4) Satisfaction with the online screening program was highly appreciated. CONCLUSIONS The results indicated potential value of the online screening program for further Internet-administrated programs of depression among Chinese university students.
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Affiliation(s)
- Na Du
- Department of Psychology, Zhejiang University, Zhejiang, China
| | - Kexin Yu
- Department of Psychology, Zhejiang University, Zhejiang, China
| | - Yan Ye
- Department of Psychology, Zhejiang University, Zhejiang, China
| | - Shulin Chen
- Department of Psychology, Zhejiang University, Zhejiang, China
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Späth C, Hapke U, Maske U, Schröder J, Moritz S, Berger T, Meyer B, Rose M, Nolte S, Klein JP. Characteristics of participants in a randomized trial of an Internet intervention for depression (EVIDENT) in comparison to a national sample (DEGS1). Internet Interv 2017; 9:46-50. [PMID: 30135836 PMCID: PMC6096289 DOI: 10.1016/j.invent.2017.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/18/2017] [Accepted: 05/31/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND While the efficacy of Internet interventions for depression has been demonstrated in numerous studies, there is concern that the participants in these studies may systematically differ from depressed subjects in the general population. The goal of this study was to compare participants in a large trial of an Internet intervention for depression with a population-based sample that reported depressive symptomatology in the same range of severity. METHODOLOGY The analysis is based on a sample of participants of a randomized controlled trial testing the effectiveness of an Internet intervention for depression in mild to moderate depression (EVIDENT, N = 1013) and a subsample of participants in a representative population-based sample (DEGS1, n = 1978). The DEGS1 subsample was chosen based on the score in the Patient Health Questionnaire-9 (PHQ-9, score 5-14) as this was the main inclusion criterion for the EVIDENT study. Both samples were compared with respect to a range of demographic and clinical variables. RESULTS Compared with the DEGS1 subsample, participants in the EVIDENT sample were significantly more often female (68.6% vs. 56.3%), slightly older (mean age 42.9 vs. 40.4 years), had more often completed highest secondary education (51.3% vs. 22.4%), were clinically more severely affected (moderate depressive symptoms in 62.6% vs. 18.3%) and reported a lower quality of life. CONCLUSION These findings indicate that participants in this Internet trial were not just internet savvy young males without significant impairment. Future studies should aim to recruit participants with lower educational status to increase the reach of Internet interventions.
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Affiliation(s)
- Christina Späth
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | | | | | - Johanna Schröder
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Björn Meyer
- Research Department, Gaia AG, Hamburg, Germany
| | - Matthias Rose
- Department of Psychosomatic Medicine, Charité University Medical Center, Berlin, Germany
- Quantitative Health Sciences, Outcomes Measurement Science, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sandra Nolte
- Department of Psychosomatic Medicine, Charité University Medical Center, Berlin, Germany
- Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Melbourne, Australia
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
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Saeb S, Lattie EG, Kording KP, Mohr DC. Mobile Phone Detection of Semantic Location and Its Relationship to Depression and Anxiety. JMIR Mhealth Uhealth 2017; 5:e112. [PMID: 28798010 PMCID: PMC5571235 DOI: 10.2196/mhealth.7297] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/09/2017] [Accepted: 06/17/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Is someone at home, at their friend's place, at a restaurant, or enjoying the outdoors? Knowing the semantic location of an individual matters for delivering medical interventions, recommendations, and other context-aware services. This knowledge is particularly useful in mental health care for monitoring relevant behavioral indicators to improve treatment delivery. Local search-and-discovery services such as Foursquare can be used to detect semantic locations based on the global positioning system (GPS) coordinates, but GPS alone is often inaccurate. Mobile phones can also sense other signals (such as movement, light, and sound), and the use of these signals promises to lead to a better estimation of an individual's semantic location. OBJECTIVE We aimed to examine the ability of mobile phone sensors to estimate semantic locations, and to evaluate the relationship between semantic location visit patterns and depression and anxiety. METHODS A total of 208 participants across the United States were asked to log the type of locations they visited daily, using their mobile phones for a period of 6 weeks, while their phone sensor data was recorded. Using the sensor data and Foursquare queries based on GPS coordinates, we trained models to predict these logged locations, and evaluated their prediction accuracy on participants that models had not seen during training. We also evaluated the relationship between the amount of time spent in each semantic location and depression and anxiety assessed at baseline, in the middle, and at the end of the study. RESULTS While Foursquare queries detected true semantic locations with an average area under the curve (AUC) of 0.62, using phone sensor data alone increased the AUC to 0.84. When we used Foursquare and sensor data together, the AUC further increased to 0.88. We found some significant relationships between the time spent in certain locations and depression and anxiety, although these relationships were not consistent. CONCLUSIONS The accuracy of location services such as Foursquare can significantly benefit from using phone sensor data. However, our results suggest that the nature of the places people visit explains only a small part of the variation in their anxiety and depression symptoms.
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Affiliation(s)
- Sohrab Saeb
- Center for Behavioral Intervention Technologies (CBITs), Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
- Rehabilitation Institute of Chicago, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Emily G Lattie
- Center for Behavioral Intervention Technologies (CBITs), Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Konrad P Kording
- Rehabilitation Institute of Chicago, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - David C Mohr
- Center for Behavioral Intervention Technologies (CBITs), Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
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Jacobs JM, Traeger L, Eusebio J, Simon NM, Sequist LV, Greer JA, Temel JS, Pirl WF. Depression, inflammation, and epidermal growth factor receptor (EGFR) status in metastatic non-small cell lung cancer: A pilot study. J Psychosom Res 2017; 99:28-33. [PMID: 28712427 DOI: 10.1016/j.jpsychores.2017.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/06/2017] [Accepted: 05/11/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Patients with stage IV non-small cell lung cancer (NSCLC) have high risk for depressive symptoms and major depressive disorder (MDD); however, those with epidermal growth factor receptor (EGFR) mutations may have decreased risk. The biological underpinning of this relationship is unknown. We examined differences in depression severity and MDD in patients with newly diagnosed stage IV NSCLC based on EGFR mutation status, and examined proinflammatory cytokines and growth factors known to play a role in cancer progression and depression. METHODS Fifty-five patients with newly diagnosed stage IV NSCLC completed self-report and clinician-administered depression assessments prior to receiving results of tumor genotyping. We measured serum levels of circulating biological markers of inflammation: IL-1β, IL-6, TGF-α, and TNF-α. We examined differences in depression severity, MDD, and inflammatory biomarkers in patients with and without EGFR mutations. RESULTS Patients with EGFR mutations (n=10) had lower depression severity (t[43]=2.38, p=0.03) than those without EGFR mutations (n=38) and fewer patients with EGFR mutations had concurrent MDD (2.08%) relative to those without mutations (27.08%). Patients with MDD had higher levels of TNF-α than those without MDD (t[40]=2.95, p=0.005). Those with EGFR mutations exhibited higher levels of TNF-α relative to those without EGFR mutations (t[35]=2.17, p=0.04). CONCLUSIONS Patients with stage IV NSCLC harboring an EGFR mutation exhibited elevated proinflammatory marker TNF-α, yet had lower depression severity than patients without EGFR mutations. More work is warranted to examine the interaction between tumor genotyping and inflammatory cytokines in the context of depression.
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Affiliation(s)
- Jamie M Jacobs
- Center for Psychiatric Oncology and Behavioral Sciences, Department of Psychiatry, Massachusetts General Hospital Cancer Center/Harvard Medical School, 55 Fruit St., Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States.
| | - Lara Traeger
- Center for Psychiatric Oncology and Behavioral Sciences, Department of Psychiatry, Massachusetts General Hospital Cancer Center/Harvard Medical School, 55 Fruit St., Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States
| | - Justin Eusebio
- Center for Psychiatric Oncology and Behavioral Sciences, Department of Psychiatry, Massachusetts General Hospital Cancer Center/Harvard Medical School, 55 Fruit St., Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States
| | - Naomi M Simon
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 6th floor, Boston, MA 02114, United States
| | - Lecia V Sequist
- Massachusetts General Hospital Cancer Center/Harvard Medical School, 55 Fruit St., Yawkey Center for Outpatient Care, Suite 7B, Boston, MA 02114, United States
| | - Joseph A Greer
- Center for Psychiatric Oncology and Behavioral Sciences, Department of Psychiatry, Massachusetts General Hospital Cancer Center/Harvard Medical School, 55 Fruit St., Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States
| | - Jennifer S Temel
- Massachusetts General Hospital Cancer Center/Harvard Medical School, 55 Fruit St., Yawkey Center for Outpatient Care, Suite 7B, Boston, MA 02114, United States
| | - William F Pirl
- Center for Psychiatric Oncology and Behavioral Sciences, Department of Psychiatry, Massachusetts General Hospital Cancer Center/Harvard Medical School, 55 Fruit St., Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States
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Van Ameringen M, Turna J, Khalesi Z, Pullia K, Patterson B. There is an app for that! The current state of mobile applications (apps) for DSM-5 obsessive-compulsive disorder, posttraumatic stress disorder, anxiety and mood disorders. Depress Anxiety 2017; 34:526-539. [PMID: 28569409 DOI: 10.1002/da.22657] [Citation(s) in RCA: 174] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/04/2017] [Accepted: 04/09/2017] [Indexed: 02/06/2023] Open
Abstract
Mental health apps are viewed as a promising modality to extend the reach of mental health care beyond the clinic. They do so by providing a means of assessment, tracking, and treatment through a smartphone. Given that nearly 2/3 of the American population owns a smartphone, mental health apps offer the possibility of overcoming treatment barriers such as geographic location or financial barriers. Unfortunately, the excitement surrounding mental health apps may be premature as the current supporting literature regarding their efficacy is limited. The app marketplace is littered with apps claiming to treat or assess symptoms, but even those created by reputable organizations or those incorporating components of evidence-based treatments have not yet been validated in terms of their efficacy. This review aims to provide a comprehensive review of the current state of the mental health app literature by examining published reports of apps designed for DSM-5 anxiety and mood disorders, OCD, and PTSD. The breadth of apps reviewed includes those oriented around assessment, symptom tracking, and treatment as well as "multipurpose" apps, which incorporate several of these components. This review will also present some of the most popular mental health apps which may have clinical utility and could be prescribed to clients. While we discuss many potential benefits of mental health apps, we focus on a number of issues that the current state of the app literature presents. Overall there is a significant disconnect between app developers, the scientific community and health care, leaving the utility of existing apps questionable.
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Affiliation(s)
- Michael Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,MacAnxiety Research Centre, McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada
| | - Jasmine Turna
- MacAnxiety Research Centre, McMaster University, Hamilton, ON, Canada.,MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Zahra Khalesi
- MacAnxiety Research Centre, McMaster University, Hamilton, ON, Canada
| | - Katrina Pullia
- MacAnxiety Research Centre, McMaster University, Hamilton, ON, Canada
| | - Beth Patterson
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,MacAnxiety Research Centre, McMaster University, Hamilton, ON, Canada
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Schrom K, Nagy T, Mostow E. Depression screening using health questionnaires in patients receiving oral isotretinoin for acne vulgaris. J Am Acad Dermatol 2017; 75:237-9. [PMID: 27317530 DOI: 10.1016/j.jaad.2016.02.1148] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 02/04/2016] [Accepted: 02/07/2016] [Indexed: 12/25/2022]
Abstract
Isotretinoin is used to treat severe and recalcitrant acne. Possible side effects include depression, suicide, and suicidal ideation; however, other studies suggest isotretinoin may improve mood and quality of life. Although iPLEDGE consenting warns about the risk of depression and suicidal ideation, there is no recommendation for screening tools. The patient health questionnaire-2 and the patient health questionnaire-9 are validated instruments that enable dermatologists to efficiently screen for depression before and after isotretinoin is initiated.
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Affiliation(s)
- Kory Schrom
- Northeast Ohio Medical University, Rootstown, Ohio.
| | | | - Eliot Mostow
- Northeast Ohio Medical University, Rootstown, Ohio; Akron Dermatology, Akron, Ohio
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Nahum M, Van Vleet TM, Sohal VS, Mirzabekov JJ, Rao VR, Wallace DL, Lee MB, Dawes H, Stark-Inbar A, Jordan JT, Biagianti B, Merzenich M, Chang EF. Immediate Mood Scaler: Tracking Symptoms of Depression and Anxiety Using a Novel Mobile Mood Scale. JMIR Mhealth Uhealth 2017; 5:e44. [PMID: 28404542 PMCID: PMC5406620 DOI: 10.2196/mhealth.6544] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/24/2016] [Accepted: 02/11/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Mood disorders are dynamic disorders characterized by multimodal symptoms. Clinical assessment of symptoms is currently limited to relatively sparse, routine clinic visits, requiring retrospective recollection of symptoms present in the weeks preceding the visit. Novel advances in mobile tools now support ecological momentary assessment of mood, conducted frequently using mobile devices, outside the clinical setting. Such mood assessment may help circumvent problems associated with infrequent reporting and better characterize the dynamic presentation of mood symptoms, informing the delivery of novel treatment options. OBJECTIVES The aim of our study was to validate the Immediate Mood Scaler (IMS), a newly developed, iPad-deliverable 22-item self-report tool designed to capture current mood states. METHODS A total of 110 individuals completed standardized questionnaires (Patient Health Questionnaire, 9-item [PHQ-9]; generalized anxiety disorder, 7-Item [GAD-7]; and rumination scale) and IMS at baseline. Of the total, 56 completed at least one additional session of IMS, and 17 completed one additional administration of PHQ-9 and GAD-7. We conducted exploratory Principal Axis Factor Analysis to assess dimensionality of IMS, and computed zero-order correlations to investigate associations between IMS and standardized scales. Linear Mixed Model (LMM) was used to assess IMS stability across time and to test predictability of PHQ-9 and GAD-7 score by IMS. RESULTS Strong correlations were found between standard mood scales and the IMS at baseline (r=.57-.59, P<.001). A factor analysis revealed a 12-item IMS ("IMS-12") with two factors: a "depression" factor and an "anxiety" factor. IMS-12 depression subscale was more strongly correlated with PHQ-9 than with GAD-7 (z=1.88, P=.03), but the reverse pattern was not found for IMS-12 anxiety subscale. IMS-12 showed less stability over time compared with PHQ-9 and GAD-7 (.65 vs .91), potentially reflecting more sensitivity to mood dynamics. In addition, IMS-12 ratings indicated that individuals with mild to moderate depression had greater mood fluctuations compared with individuals with severe depression (.42 vs .79; P=.04). Finally, IMS-12 significantly contributed to the prediction of subsequent PHQ-9 (beta=1.03, P=.02) and GAD-7 scores (beta =.93, P=.01). CONCLUSIONS Collectively, these data suggest that the 12-item IMS (IMS-12) is a valid tool to assess momentary mood symptoms related to anxiety and depression. Although IMS-12 shows good correlation with standardized scales, it further captures mood fluctuations better and significantly adds to the prediction of the scales. Results are discussed in the context of providing continuous symptom quantification that may inform novel treatment options and support personalized treatment plans.
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Affiliation(s)
- Mor Nahum
- School of OT, Faculty of Medicine, Hebrew University, Jerusalem, Israel.,Posit Science Corporation, San Francisco, CA, United States
| | | | - Vikaas S Sohal
- Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Julie J Mirzabekov
- UC Berkeley- UCSF Joint Medical Program, University of California, Berkeley, CA, United States.,School of Medicine, University of California, San Francisco, CA, United States
| | - Vikram R Rao
- Department of Neurology, University of California, San Francisco, CA, United States
| | - Deanna L Wallace
- Department of Neurosurgery, University of California, San Francisco, CA, United States
| | - Morgan B Lee
- Department of Neurosurgery, University of California, San Francisco, CA, United States
| | - Heather Dawes
- Department of Neurosurgery, University of California, San Francisco, CA, United States
| | - Alit Stark-Inbar
- Posit Science Corporation, San Francisco, CA, United States.,Department of Psychology, University of California, Berkeley, CA, United States
| | - Joshua Thomas Jordan
- California School of Professional Psychology, Alliant International University, San Francisco, CA, United States
| | - Bruno Biagianti
- Posit Science Corporation, San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, CA, United States
| | | | - Edward F Chang
- Department of Neurosurgery, University of California, San Francisco, CA, United States
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A Correlational Study of Spiritual Well-being and Depression in the Adult Cancer Patient. Health Care Manag (Frederick) 2017; 36:164-172. [PMID: 28346295 DOI: 10.1097/hcm.0000000000000153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Depression in adult cancer patients has been widely studied, along with spiritual effects of traumatic events and even spiritual growth after a diagnosis of cancer. There has been limited research determining a direct correlation between spiritual well-being and depression in adult cancer patients. The purpose of this research study was to examine the relationship between spiritual well-being and depression in adult cancer patients. This was a descriptive correlational study using 59 patients older than 18 years from an outpatient cancer center. The researchers hypothesized that patients with a low spiritual well-being score would be more likely to have a high depressive symptom score, thus providing support for a correlation between cancer patient's spiritual well-being and risk of depression. Implications of this study lead to evidence for better screening processes for cancer patients regarding spiritual well-being.
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44
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Adult Co-morbidity Evaluation 27 scores of head and neck cancer patients using touch-screen technology: patient satisfaction and clinical verification. The Journal of Laryngology & Otology 2017; 131:442-446. [PMID: 28249627 DOI: 10.1017/s0022215116009397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This study aimed to assess head and neck cancer patient satisfaction with the use of a touch-screen computer patient-completed questionnaire for assessing Adult Co-morbidity Evaluation 27 co-morbidity scores prior to treatment, along with its clinical reliability. METHODS A total of 96 head and neck cancer patients were included in the audit. An accurate Adult Co-morbidity Evaluation 27 co-morbidity score was achieved via patient-completed questionnaire assessment for 97 per cent of participants. RESULTS In all, 96 per cent of patients found the use of a touch-screen computer acceptable and would be willing to use one again, and 62 per cent would be willing to do so without help. Patients were more likely to be willing to use the computer again without help if they were aged 65 years or younger (χ2 test; p = 0.0054) or had a performance status of 0 or 1 (χ2 test; p = 0.00034). CONCLUSION Use of a touch-screen computer is an acceptable approach for assessing Adult Co-morbidity Evaluation 27 scores at pre-treatment assessment in a multidisciplinary joint surgical-oncology clinic.
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Bajracharya P, Summers L, Amatya AK, DeBlieck C. Implementation of a Depression Screening Protocol and Tools to Improve Screening for Depression in Patients With Diabetes in the Primary Care Setting. J Nurse Pract 2016. [DOI: 10.1016/j.nurpra.2016.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Crane HM, Fredericksen RJ, Church A, Harrington A, Ciechanowski P, Magnani J, Nasby K, Brown T, Dhanireddy S, Harrington RD, Lober WB, Simoni J, Safren SA, Edwards TC, Patrick DL, Saag MS, Crane PK, Kitahata MM. A Randomized Controlled Trial Protocol to Evaluate the Effectiveness of an Integrated Care Management Approach to Improve Adherence Among HIV-Infected Patients in Routine Clinical Care: Rationale and Design. JMIR Res Protoc 2016; 5:e156. [PMID: 27707688 PMCID: PMC5071617 DOI: 10.2196/resprot.5492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/28/2016] [Accepted: 05/30/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adherence to antiretroviral medications is a key determinant of clinical outcomes. Many adherence intervention trials investigated the effects of time-intensive or costly interventions that are not feasible in most clinical care settings. OBJECTIVE We set out to evaluate a collaborative care approach as a feasible intervention applicable to patients in clinical care including those with mental illness and/or substance use issues. METHODS We developed a randomized controlled trial (RCT) investigating an integrated, clinic-based care management approach to improve clinical outcomes that could be integrated into the clinical care setting. This is based on the routine integration and systematic follow-up of a clinical assessment of patient-reported outcomes targeting adherence, depression, and substance use, and adapts previously developed and tested care management approaches. The primary health coach or care management role is provided by clinic case managers allowing the intervention to be generalized to other human immunodeficiency virus (HIV) clinics that have case managers. We used a stepped-care approach to target interventions to those at greatest need who are most likely to benefit rather than to everyone to maintain feasibility in a busy clinical care setting. RESULTS The National Institutes of Health funded this study and had no role in study design, data collection, or decisions regarding whether or not to submit manuscripts for publication. This trial is currently underway, enrollment was completed in 2015, and follow-up time still accruing. First results are expected to be ready for publication in early 2017. DISCUSSION This paper describes the protocol for an ongoing clinical trial including the design and the rationale for key methodological decisions. There is a need to identify best practices for implementing evidence-based collaborative care models that are effective and feasible in clinical care. Adherence efficacy trials have not led to sufficient improvements, and there remains little guidance regarding how adherence interventions should be implemented into clinical care. By focusing on improving adherence within care settings using existing staff, routine assessment of key domains, such as depression, adherence, and substance use, and feasible interventions, we propose to evaluate this innovative way to improve clinical outcomes. TRIAL REGISTRATION Clinicaltrials.gov NCT01505660; http://clinicaltrials.gov/ct2/show/NCT01505660 (Archived by WebCite at http://www.webcitation/ 6ktOq6Xj7).
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Affiliation(s)
- Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA, United States.
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Ferrari M, Ahmad F, Shakya Y, Ledwos C, McKenzie K. Computer-assisted client assessment survey for mental health: patient and health provider perspectives. BMC Health Serv Res 2016; 16:516. [PMID: 27663508 PMCID: PMC5035495 DOI: 10.1186/s12913-016-1756-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 09/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The worldwide rise in common mental disorders (CMDs) is posing challenges in the provision of and access to care, particularly for immigrant, refugee and racialized groups from low-income backgrounds. eHealth tools, such as the Interactive Computer-Assisted Client Assessment Survey (iCCAS) may reduce some barriers to access. iCCAS is a tablet-based, touch-screen self-assessment completed by clients while waiting to see their family physician (FP) or nurse practitioner (NP). In an academic-community initiative, iCCAS was made available in English and Spanish at a Community Health Centre in Toronto through a mixed-method trial. METHODS This paper reports the perspectives of clients in the iCCAS group (n = 74) collected through an exit survey, and the perspectives of 9 providers (four FP and five NP) gathered through qualitative interviews. Client acceptance of the tool was assessed for cognitive and technical dimensions of their experience. They rated twelve items for perceived Benefits and Barriers and four questions for the technical quality. RESULTS Most clients reported that the iCCAS completion time was acceptable (94.5 %), the touch-screen was easy to use (97.3 %), and the instructions (93.2 %) and questions (94.6 %) were clear. Clients endorsed the tool's Benefits, but were unsure about Barriers to information privacy and provider interaction (mean 4.1, 2.6 and 2.8, respectively on a five-point scale). Qualitative analysis of the provider interviews identified five themes: challenges in Assessing Mental Health Services, such as case complexity, time, language and stigma; the Tool's Benefits, including non-intrusive prompting of clients to discuss mental health, and facilitation of providers' assessment and care plans; the Tool's Integration into everyday practice; Challenges for Use (e.g. time); and Promoting Integration Effectively, centered on the timing of screening, setting readiness, language diversity, and technological advances. CONCLUSIONS Participant clients and providers perceived iCCAS as an easy and useful tool for mental health assessments at the Community Health Centre and similar settings. The findings are anticipated to inform further work in this area. TRIAL REGISTRATION ClinicalTrials.gov; NCT02023957 ; Registered retrospectively 12 Dec. 2013.
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Affiliation(s)
- Manuela Ferrari
- School of Health Policy and Management, York University, 4700 Keele Street, HNES Building, Rm 414, Toronto, ON M3J1P3 Canada
| | - Farah Ahmad
- School of Health Policy and Management, York University, 4700 Keele Street, HNES Building, Rm 414, Toronto, ON M3J1P3 Canada
| | - Yogendra Shakya
- Access Alliance Multicultural Health and Community Services, 340 College Street, Suite 500, Toronto, ON M5T3A9 Canada
| | - Cliff Ledwos
- Access Alliance Multicultural Health and Community Services, 340 College Street, Suite 500, Toronto, ON M5T3A9 Canada
| | - Kwame McKenzie
- Wellesley Institute, Centre for Addiction & Mental Health, 33 Russell Street, Toronto, ON M5S2S1 Canada
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Fann JR, Hong F, Halpenny B, Blonquist TM, Berry DL. Psychosocial outcomes of an electronic self-report assessment and self-care intervention for patients with cancer: a randomized controlled trial. Psychooncology 2016; 26:1866-1871. [PMID: 27530529 DOI: 10.1002/pon.4250] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 07/11/2016] [Accepted: 08/12/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND The use of Web-based technology to facilitate self-care and communication with health care providers has the potential to improve psychosocial outcomes for patients undergoing cancer treatment. This study reports an analysis of psychosocial outcomes of the electronic self-report assessment for cancer study. METHODS Adult patients starting cancer therapy were randomized to receive usual education about symptoms and quality of life topics (control) or usual education plus self-care instruction for symptoms and quality of life issues, communication coaching, and the opportunity to track symptoms and quality of life between clinic visits (intervention). Depression (Patient Health Questionnaire-9) and social, emotional, and role functioning (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 subscales) were measured before treatment (T1), 3 to 6 weeks after starting treatment (T2), 2 weeks later (T3), and 2 to 4 weeks after treatment ended or at the next restaging visit for participants who continued to receive treatment (T4). Clinicians received summaries of participant reports at each time point in both groups. RESULTS In multivariable analysis, the depression scores were significantly lower (P = .04) and there was a trend to higher social and role functioning (P = .07) in the intervention group compared with the control. Working status was significantly associated with lower depression and better social and role functioning. CONCLUSIONS A patient-centered, Web-based intervention that facilitates self-care and communication can improve psychosocial outcomes in the cancer setting.
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Affiliation(s)
- Jesse R Fann
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA.,Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Fangxin Hong
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Chan School of Public Health, Boston, MA, USA
| | - Barbara Halpenny
- Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Traci M Blonquist
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Donna L Berry
- Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
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Erbe D, Eichert HC, Rietz C, Ebert D. Interformat reliability of the patient health questionnaire: Validation of the computerized version of the PHQ-9. Internet Interv 2016; 5:1-4. [PMID: 30135800 PMCID: PMC6096192 DOI: 10.1016/j.invent.2016.06.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/03/2016] [Accepted: 06/21/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Computerized versions of well-established measurements such as the PHQ-9 are widely used, but data on the comparability of psychometric properties are scarce. OBJECTIVE Our objective was to compare the interformat reliability of the paper-and-pen version with a computerized version of the PHQ-9 in a clinical sample. METHODS 130 participants with mental health disorders were recruited during psychotherapeutic treatment in a mental health clinic. In a crossover design, they all completed the PHQ-9 in both the computerized and paper-and-pen versions in randomized order. RESULTS The internal consistency was comparable for the computer (α = 0.88) and paper versions (α = 0.89), and highly significant correlations were found between the formats (r = 0.92). PHQ-9 total scores were not significantly different between the paper and the computer delivered versions. There was a significant interaction effect between format and order of administration for the PHQ-9, indicating that the first administration delivered slightly higher scores. LIMITATIONS In order to reduce the required effort for the participants, we did not ask them to fill out anything but the PHQ-9 once in paper and once in computer version. CONCLUSIONS Our findings suggest that the PHQ-9 can be transferred to computerized use without affecting psychometric properties in a clinically meaningful way.
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LeBaron VT, Blonquist TM, Hong F, Halpenny B, Berry DL. Screening for Pain in the Ambulatory Cancer Setting: Is 0-10 Enough? J Oncol Pract 2015; 11:435-41. [PMID: 26306620 PMCID: PMC4647066 DOI: 10.1200/jop.2015.004077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The purpose of this study was to explore concordance between patient self-reports of pain on validated questionnaires and discussions of pain in the ambulatory oncology setting. METHODS Adult, ambulatory patients (N = 452) with all stages of cancer were included. Three pain measures were evaluated: two items from the Symptom Distress Scale (frequency [SDSF] and intensity [SDSI]) and the Pain Intensity Numeric Scale (PINS). Relevant pain was defined as: (1) scores 3 of 5 on SDSF or SDSI or 5 of 10 on the (PINS); or (2) discussion of existing pain in an audio-recorded clinic visit. For each scale, McNemar's test assessed concordance of patient self-reports of relevant pain with discussions of relevant pain in the audio-recorded clinic visit. Sensitivity, specificity, and accuracy were calculated and a receiver operating characteristic analysis evaluated thresholds on self-report pain questionnaires to best identify relevant pain discussed in clinic. RESULTS Identification of relevant pain by self-report was discordant (P < .001) with discussed pain coded in audio-recorded visits for all three measures. Specificity was higher for intensity (SDSI, 0.94; PINS, 0.97) than frequency (SDSF, 0.87); sensitivity was higher for frequency (SDSF, 0.35) than intensity (SDSI, 0.24; PINS, 0.12). Accuracy was higher for the SDS pain items (SDSF, 0.57; SDSI, 0.54) than for PINS (0.48). Receiver operating characteristic analysis curves suggest that lower threshold scores may improve the identification of relevant pain. CONCLUSION Self-report pain screening measures favored specificity over sensitivity. Asking about pain frequency (in addition to intensity) and reconsidering threshold scores on pain intensity scales may be practical strategies to more accurately identify patients with cancer who have relevant pain.
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Affiliation(s)
- Virginia T LeBaron
- University of Virginia School of Nursing, Charlottesville, VA; Dana-Farber Cancer Institute; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services; and Harvard Medical School, Boston, MA
| | - Traci M Blonquist
- University of Virginia School of Nursing, Charlottesville, VA; Dana-Farber Cancer Institute; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services; and Harvard Medical School, Boston, MA
| | - Fangxin Hong
- University of Virginia School of Nursing, Charlottesville, VA; Dana-Farber Cancer Institute; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services; and Harvard Medical School, Boston, MA
| | - Barbara Halpenny
- University of Virginia School of Nursing, Charlottesville, VA; Dana-Farber Cancer Institute; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services; and Harvard Medical School, Boston, MA
| | - Donna L Berry
- University of Virginia School of Nursing, Charlottesville, VA; Dana-Farber Cancer Institute; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services; and Harvard Medical School, Boston, MA
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