Building resilience through psychotherapy

Preoperative Depression Screening for Primary Total Knee Arthroplasty: An Evaluation of Its Modifiability on Outcomes in Patients Who Have Depression

BACKGROUND

Few studies have evaluated preoperative depression screenings in patients who have depression. We studied whether depression screenings before total knee arthroplasty (TKA) were associated with lower: 1) medical complications; 2) emergency department (ED) utilizations and readmissions; 3) implant complications; and 4) costs.

METHODS

A nationwide sample from January 1, 2010, to April 30, 2021, was collected using an insurance database. Depression patients were 1:1 propensity-score matched based on those who had (n = 29,009) and did not have (n = 29,009) preoperative depression screenings or psychotherapy visits within 3 months of TKA. A case-matched population who did not have depression was compared (n = 144,994). A 90-day period was used to compare complications and health-care utilization and 2-year follow-up for periprosthetic joint infections (PJIs) and implant survivorship. Costs were 90-day reimbursements. Logistic regression models computed odds ratios (ORs) of depression screening on dependent variables. P values less than .001 were significant.

RESULTS

Patients who did not receive preoperative screening were associated with higher medical complications (18.7 versus 5.2%, OR: 4.15, P < .0001) and ED utilizations (11.5 versus 3.2%, OR: 3.93, P < .0001) than depressed patients who received screening. Patients who had screening had lower medical complications (5.2 versus 5.9%, OR: 0.88, P < .0001) and ED utilizations compared to patients who did not have depression (3.2 versus 3.8%, OR: 0.87, P = .0001). Two-year PJI incidences (3.0 versus 1.3%, OR: 2.63, P < .0001) and TKA revisions (4.3 versus 2.1%, OR: 2.46, P < .0001) were greater in depression patients who were not screened preoperatively versus screened patients. Depression patients who had screening had lower PJIs (1.3 versus 1.8%, OR: 0.74, P < .0001) compared to nondepressed patients. Reimbursements ($13,949 versus $11,982; P < .0001) were higher in depression patients who did not have screening.

CONCLUSIONS

Preoperative screening was associated with improved outcomes in depression patients.

LEVEL OF EVIDENCE

III.

Post-COVID-19 Psychiatric Symptoms in the Elderly: The Role of Gender and Resilience

COVID-19 represents an overwhelming stressor to mental health. Elderly individuals are particularly at risk, but it is still unclear whether the risk is equally distributed among men and women. The aim of this study was to define gender differences in persistent psychiatric symptoms after COVID-19 illness and to test their association with resilience factors. Methods: We assessed 348 individuals aged >65 years at a multidisciplinary post-COVID-19 service. Mood and anxiety symptoms were investigated, as well as psychological distress and resilience, as assessed with the Kessler-10 (K10) Scale and the Connor-Davidson Resilience Scale (CD-RISC), respectively. Multivariate and linear regression analyses were used to test the distribution patterns of psychiatric symptoms and resilience factors. Results: In the total sample, 214 (61.5%) were men (a mean age of 73.25 years ±6.04) and 134 (38.5%) were women (a mean age of 72.69 years ±6.43; p = 0.407). Men and women significantly differed in marital status (χ2 = 25.17; p < 0.001, more men were married), living alone (χ2 = 11.62; p < 0.01, fewer men were living alone), hospitalization during COVID-19 illness (χ2 = 12.35; p < 0.001, more men were hospitalized during COVID-19), and subjective health status before COVID-19 infection (χ2 = 4.32; p < 0.001, men reporting better subjective health than women). Women reported more psychiatric symptoms and fewer resilience factors than men. Low resilience levels significantly predicted psychological distress in both men and women. Conclusions: The female elderly population affected by COVID-19 showed a greater vulnerability to psychiatric symptoms. Our data point to the need to strengthen resilience resources, especially in women.

Medium and long-term efficacy of psychoeducational family intervention for bipolar I disorder: Results from a real-world, multicentric study

OBJECTIVES

This study aims to explore the long-term efficacy of a psychoeducational family intervention (PFI) in bipolar I disorder at one and five years post-intervention in terms of improvement of: (1) patients' symptoms and global functioning and (2) relatives' objective and subjective burden and coping strategies.

METHODS

This is a multicentre, real-world, controlled, outpatient trial. Recruited patients and key-relatives were consecutively allocated to the experimental intervention or treatment as usual. Patients were assessed at baseline, and after one and five years.

RESULTS

One hundred and thirty-seventh number families have been recruited; 70 have been allocated to the experimental intervention, and 67 have been allocated to the control group. We observed an increasing positive effect of the PFI on patients' clinical status, global functioning and objective and subjective burden after one year. We also found a reduction in the levels of relatives' objective and subjective burden and a significant improvement in the levels of perceived professional support and of coping strategies. The efficacy of PFI on patients' clinical status was maintained at five years from the end of the intervention, in terms of relapses, hospitalizations and suicide attempts.

CONCLUSIONS

The study showed that the provision of PFI in real-world settings is associated with a significant improvement of patients' and relatives' mental health and psychosocial functioning in the long term. We found that the clinical efficacy of the intervention, in terms of reduction of patients' relapses, hospitalization and suicide attempts, persists after 5 years. It is advisable that PFI is provided to patients with BD I in routine practice.

A global health model integrating psychological variables involved in cancer through a longitudinal study

Objective

The literature has shown the relevance of certain psychological variables in adjustment to cancer. However, there is a great variability, and these features could be modified through the disease process. The aim of this study is to provide an integrated and global perspective of the importance of variables such as coping, resilience, emotional control, social support, affect, and others in cancer patients through a longitudinal study, with the objective of exploring their associations and underlying interactions.

Methods

The sample was composed of 71 people diagnosed with cancer who were attending psychological support at the Spanish Association Against Cancer (Biscay). We assessed the following variables in two periods of 6 months: perceived stress (PSS), emotional control (CECS), resilience (CD-RISC), coping strategies (CERQ), personality (NEOFFI), social support (MOSS), affect (PANAS), emotional distress (GHQ), quality of life (SF-12) and visual-analogic scales (EVA).

Results

Results showed predictive effects of perceived stress on physical health perception (β = −0.22; t = −3.26; p = 0.002). Mental health perception was influenced by almost all the psychological variables. Consciousness at baseline (βCo = 0.15; p = 0.003), change in Extraversion (βEx = 0.16; p = 0.001) and Resilience (βRe = 0.15; p = 0.002) had significant effects on perceived mental health.

Conclusion

This study provides a global health model that integrates and explores associations between psychological variables related to cancer disease. This information could be useful for guiding personalized psychotherapeutic interventions, with the aim of increasing adjustment to disease.

A Multivariate Analysis of Depression Prevalence in Psoriasis Patients: A Cohort Study

The literature reported higher depression rates in psoriasis patients compared to the general population. Our study aimed to verify whether variability in depression prevalence was due to using different diagnostic tools. We also aimed to determine whether dysfunctional coping strategies might increase the depression burden. We assessed psoriasis severity by the Psoriasis Area Severity Index (PASI) and PSOdisk. We analyzed mental alterations of 120 outpatients by Hamilton Depression and Anxiety Rating Scales (HAM-D and HAM-A), Symptom Checklist-90-Revised (SCL-90-R), plus coping strategies and quality of life by Coping Orientation to Problems Experienced (COPE) Inventory and 36-Item Short Form Health Survey (SF-36). We divided our cohort into five subgroups from minimal to severe psoriasis using the PSOdisk total score. Depression prevalence varied according to the assessment criteria for specificity, frequency, and severity. Different mood disorders other than major depression emerged when we used DSM-IV-TR criteria. Correlation analysis of the criteria we used to diagnose depression or depressed mood indicated that a dysfunctional coping strategy was highly and positively correlated only in patients of the severe subgroup. Differently, a negative correlation emerged between the SF-36 Mental Summary Component (MSC) and behavioral disengagement, thus suggesting that psychopathological distress might induce patients with a marked/severe psoriasis to adopt dysfunctional coping strategies. Dermatologists are fundamental in detecting comorbid depression, referring psoriasis patients to mental health specialists to achieve adequate treatments, and preventing suicide risk.

How Is the History of Early Traumatic Exposure Associated With the Psychopathological Outcomes of COVID-19 Related Lockdown and Subsequent Re-opening in People With Eating Disorders?

The negative impact of COVID-19 pandemic on people with Eating Disorders (EDs) has been documented. The aim of this study was to evaluate whether a history of traumatic experiences during childhood or adolescence was associated with a higher degree of psychopathological worsening during COVID-19 related lockdown and in the following re-opening period in this group of people. People with EDs undergoing a specialist ED treatment in different Italian services before the spreading of COVID-19 pandemic (n = 312) filled in an online survey to retrospectively evaluate ED specific and general psychopathology changes after COVID-19 quarantine. Based on the presence of self-reported traumatic experiences, the participants were split into three groups: patients with EDs and no traumatic experiences, patients with EDs and childhood traumatic experiences, patients with EDs and adolescent traumatic experiences. Both people with or without early traumatic experiences reported retrospectively a worsening of general and ED-specific psychopathology during the COVID 19-induced lockdown and in the following re-opening period. Compared to ED participants without early traumatic experiences, those with a self-reported history of early traumatic experiences reported heightened anxious and post-traumatic stress symptoms, ineffectiveness, body dissatisfaction, and purging behaviors. These differences were seen before COVID-19 related restrictions as well as during the lockdown period and after the easing of COVID-19 related restrictions. In line with the "maltreated ecophenotype" theory, these results may suggest a clinical vulnerability of maltreated people with EDs leading to a greater severity in both general and ED-specific symptomatology experienced during the exposure to the COVID-19 pandemic.

Duration of untreated illness predicts 3-year outcome in patients with obsessive-compulsive disorder: A real-world, naturalistic, follow-up study

Duration of untreated illness (DUI) is a predictor of outcome in psychotic and affective disorders. The few available data on the effect of DUI in obsessive-compulsive disorder (OCD) suggest an association between longer DUI and poorer response to treatments. This is a real-world, naturalistic, follow-up study evaluating the impact of DUI on long-term clinical outcomes. The sample consists of 83 outpatients with OCD with a mean DUI of 7.3 (5.8) years. Patients with symmetry/ordering cluster symptoms were younger at onset of the disease (20.4 ± 7.9 vs. 27.8 ± 10.6; p<.05, d = 0.79), had a longer duration of the illness (10.1 ± 4.6 vs. 6.8 ± 4.6, p<.05; d = 0.53) and a longer DUI (7.9 ± 6.5 vs. 5.4 ± 3.6, p<.05, d = 0.49) compared to patients not presenting with those symptoms. Fifty-nine patients completed the follow-up, and 33.9% (N = 20) met the criteria for partial remission, scoring <15 at the Y-BOCS for at least eight weeks. Patients in partial remission for more than 40% of the follow-up were defined as "good outcome" and they had a significantly shorter DUI compared to patients with "poor outcome". Access to adequate treatments is highly delayed in patients with OCD. DUI is strongly associated with poor treatment outcomes. Therefore, strategies to ensure an early diagnosis and treatment are needed.

Loneliness in Young Adults During the First Wave of COVID-19 Lockdown: Results From the Multicentric COMET Study

The COVID-19 pandemic has affected the mental and physical health of the general population at any age, but it is expected to have a protracted and severe consequences for younger populations. The pandemic has had several consequences on mental health including anger and irritability, depressive symptoms and somatic complaints, insomnia, lack of motivation, and loneliness. In particular, loneliness and its related negative feelings are thought to be particularly pronounced during young adulthood because of the many social changes that young people deal with during this period of life. Therefore, it is essential to evaluate the type of impact of the pandemic on the mental health of young people and their levels of loneliness experienced during the first phase of the lockdown. Based on the largest Italian study on the effects of the COVID-19 pandemic on the mental health of general population, in this paper we aim to: (1) describe the levels of loneliness in a national sample of Italian young adults aged 18-34 years, during the first wave of lockdown in 2020; (2) evaluate the clinical and socio-demographic differences in young adults reporting low vs. high levels of loneliness; (3) assess the role of clinical symptomatology, coping strategies, levels of resilience, and duration of lockdown as possible predictors of loneliness. The final sample consists of 8,584 people, mainly female (72.6%), single, with a mean age of 26.4 (±4.4) years. The mean score at the UCLA was 47.5 (±13.6), with 27% (N = 2,311) of respondents exceeding the cut-off for high levels of loneliness. High levels of loneliness were predicted by the presence of avoidant coping strategies, such as self-distraction (Beta coefficient, B = 0.369, 95% Confidence Interval, CI = 0.328-0.411), venting (B = 0.245, 95% CI = 0.197-0.293), denial (B = 0.110, 95% CI = 0.061-0.159), and emotional disengagement (B = 0.133, 95% CI = 0.080-0.185). Weeks of exposure to the pandemic were significantly associated with worsening of loneliness (p < 0.000). There is currently considerable interest in trying to reduce loneliness, both within the context of COVID-19 and more generally. Our results highlight that young people are at a higher risk of developing loneliness and suggest that more interventions and practical guidelines are needed.

The clinical characterization of the adult patient with depression aimed at personalization of management

Depression is widely acknowledged to be a heterogeneous entity, and the need to further characterize the individual patient who has received this diagnosis in order to personalize the management plan has been repeatedly emphasized. However, the research evidence that should guide this personalization is at present fragmentary, and the selection of treatment is usually based on the clinician's and/or the patient's preference and on safety issues, in a trial-and-error fashion, paying little attention to the particular features of the specific case. This may be one of the reasons why the majority of patients with a diagnosis of depression do not achieve remission with the first treatment they receive. The predominant pessimism about the actual feasibility of the personalization of treatment of depression in routine clinical practice has recently been tempered by some secondary analyses of databases from clinical trials, using approaches such as individual patient data meta-analysis and machine learning, which indicate that some variables may indeed contribute to the identification of patients who are likely to respond differently to various antidepressant drugs or to antidepressant medication vs. specific psychotherapies. The need to develop decision support tools guiding the personalization of treatment of depression has been recently reaffirmed, and the point made that these tools should be developed through large observational studies using a comprehensive battery of self-report and clinical measures. The present paper aims to describe systematically the salient domains that should be considered in this effort to personalize depression treatment. For each domain, the available research evidence is summarized, and the relevant assessment instruments are reviewed, with special attention to their suitability for use in routine clinical practice, also in view of their possible inclusion in the above-mentioned comprehensive battery of measures. The main unmet needs that research should address in this area are emphasized. Where the available evidence allows providing the clinician with specific advice that can already be used today to make the management of depression more personalized, this advice is highlighted. Indeed, some sections of the paper, such as those on neurocognition and on physical comorbidities, indicate that the modern management of depression is becoming increasingly complex, with several components other than simply the choice of an antidepressant and/or a psychotherapy, some of which can already be reliably personalized.