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Beer C, Rae F, Semmler A, Voisey J. Biomarkers in the Diagnosis and Prediction of Medication Response in Depression and the Role of Nutraceuticals. Int J Mol Sci 2024; 25:7992. [PMID: 39063234 PMCID: PMC11277518 DOI: 10.3390/ijms25147992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/28/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
Depression continues to be a significant and growing public health concern. In clinical practice, it involves a clinical diagnosis. There is currently no defined or agreed upon biomarker/s for depression that can be readily tested. A biomarker is defined as a biological indicator of normal physiological processes, pathogenic processes, or pharmacological responses to a therapeutic intervention that can be objectively measured and evaluated. Thus, as there is no such marker for depression, there is no objective measure of depression in clinical practice. The discovery of such a biomarker/s would greatly assist clinical practice and potentially lead to an earlier diagnosis of depression and therefore treatment. A biomarker for depression may also assist in determining response to medication. This is of particular importance as not all patients prescribed with medication will respond, which is referred to as medication resistance. The advent of pharmacogenomics in recent years holds promise to target treatment in depression, particularly in cases of medication resistance. The role of pharmacogenomics in routine depression management within clinical practice remains to be fully established. Equally so, the use of pharmaceutical grade nutrients known as nutraceuticals in the treatment of depression in the clinical practice setting is largely unknown, albeit frequently self-prescribed by patients. Whether nutraceuticals have a role in not only depression treatment but also in potentially modifying the biomarkers of depression has yet to be proven. The aim of this review is to highlight the potential biomarkers for the diagnosis, prediction, and medication response of depression.
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Affiliation(s)
- Cristina Beer
- Centre for Genomics and Personalised Health, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia; (C.B.); (F.R.)
| | - Fiona Rae
- Centre for Genomics and Personalised Health, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia; (C.B.); (F.R.)
| | - Annalese Semmler
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia;
| | - Joanne Voisey
- Centre for Genomics and Personalised Health, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia; (C.B.); (F.R.)
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Qeadan F, McCunn A, Tingey B, Price R, Bobay KL, Saeed AI. Investigating the association between asthma and opioid use disorder with interactions of anxiety and depression among a national sample of the US population. J Asthma 2024; 61:594-607. [PMID: 38088813 DOI: 10.1080/02770903.2023.2294911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/10/2023] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Previous studies have not examined the association between asthma and opioid use disorder (OUD) in a comprehensive national sample of the U.S. population. This study aims to investigate such an association. METHODS This is a matched retrospective cohort study, with a follow-up period of two years, utilizing longitudinal electronic medical records of a comprehensive national healthcare database in the U.S.-Cerner-Real World DataTM. Patients selected for analysis were ≥12 years old with a hospital encounter between January 2000 and June 2020. Adjusted risk ratios (aRRs) of incident OUD for those with asthma compared to those without asthma were calculated using a modified Poisson regressions with robust standard errors via the Huber-White sandwich estimator, and results were stratified by comorbid mental illnesses. RESULTS Individuals with asthma had a greater risk of OUD compared to those without asthma (aRR = 2.12; 95% CI 2.03-2.23). When stratified by anxiety and depression status, individuals with asthma and no anxiety or depression had a greater risk of incident OUD compared to individuals with asthma and either anxiety, depression, or both. Additionally, individuals with asthma medication had 1.29 (95% CI: 1.24, 1.35) greater overall risk for incident OUD compared to those without medication. Independent of comorbid mental illnesses, individuals with asthma medication had greater risk for incident OUD compared to those without medication among individuals without severe/obstructive asthma. CONCLUSIONS Individuals with asthma face a higher OUD risk compared to those without asthma. Comorbid mental illnesses modulate this risk. Caution is advised in opioid prescribing for asthma patients.
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Affiliation(s)
- Fares Qeadan
- Department of Public Health Sciences, Loyola University Chicago, Parkinson School of Health Sciences and Public Health, Maywood, IL, USA
| | - Ashlie McCunn
- Department of Public Health Sciences, Loyola University Chicago, Parkinson School of Health Sciences and Public Health, Maywood, IL, USA
| | - Benjamin Tingey
- Department of Public Health Sciences, Loyola University Chicago, Parkinson School of Health Sciences and Public Health, Maywood, IL, USA
| | - Ron Price
- Department of Public Health Sciences, Loyola University Chicago, Parkinson School of Health Sciences and Public Health, Maywood, IL, USA
| | - Kathleen L Bobay
- Department of Public Health Sciences, Loyola University Chicago, Parkinson School of Health Sciences and Public Health, Maywood, IL, USA
| | - Ali Imran Saeed
- Interventional Pulmonary and Advanced Diagnostics, Dignity Health Norton Thoracic Institute, Phoenix, AZ, USA
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Beer L, Koenig LJ, Tie Y, Yuan X, Fagan J, Buchacz K, Hughes K, Weiser J. Prevalence of Diagnosed and Undiagnosed Depression Among US Adults with Human Immunodeficiency Virus: Data from the Medical Monitoring Project. AIDS Patient Care STDS 2024; 38:206-220. [PMID: 38662470 PMCID: PMC11138357 DOI: 10.1089/apc.2024.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
People with human immunodeficiency virus (PWH) are disproportionately affected by depression, but the recent national estimates for US PWH encompassing both current symptoms and clinical diagnoses to assess missed diagnoses and lack of symptom remission are lacking. We used data from CDC's Medical Monitoring Project (MMP) to report nationally representative estimates of diagnosed and undiagnosed depression among US adult PWH. During June 2021 to May 2022, MMP collected interview data on symptoms consistent with major or other depression and depression diagnoses from medical records of 3928 PWH. We report weighted percentages and prevalence ratios (PRs) to quantify differences between groups on key social and health factors. Overall, 34% of PWH experienced any depression (diagnosis or Patient Health Questionnaire-8); of these, 26% had symptoms but no diagnosis (undiagnosed depression), 19% had both diagnosis and symptoms, and 55% had a diagnosis without symptoms. Among those with depression, persons with a disability (PR: 1.52) and food insecurity (PR: 1.67) were more likely to be undiagnosed. Unemployed persons (PR: 1.62), those experiencing a disability (PR: 2.78), food insecurity (PR: 1.46), or discrimination in human immunodeficiency virus (HIV) care (PR: 1.71) were more likely to have diagnosed depression with symptoms. Those with symptoms (undiagnosed or diagnosed) were less likely to be antiretroviral therapy (ART) dose adherent (PR: 0.88; PR: 0.73) or have sustained viral suppression (PR: 0.62; PR: 0.91) and were more likely to have unmet needs for mental health services (PR: 2.38, PR: 2.03). One-third of PWH experienced depression, of whom nearly half were undiagnosed or still experiencing clinically relevant symptoms. Expanding screening and effective treatment for depression could improve quality of life and HIV outcomes.
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Affiliation(s)
- Linda Beer
- Division of HIV Prevention, CDC, Atlanta, GA
| | | | - Yunfeng Tie
- Division of HIV Prevention, CDC, Atlanta, GA
| | | | | | | | | | - John Weiser
- Division of HIV Prevention, CDC, Atlanta, GA
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Devikrishna NB, Mishra NL, Singh A. Burden of undiagnosed depression among older adults in India: a population based study. BMC Psychiatry 2024; 24:330. [PMID: 38689281 PMCID: PMC11061895 DOI: 10.1186/s12888-024-05684-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/14/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND The study explored the levels and associated factors of undiagnosed depression among community-dwelling older Indian adults. It also identified the socio-demographic predictors of undiagnosed depression among the study population at national and state levels. METHODS The study employed data from the Longitudinal Ageing Study in India wave-I, 2017-18. Based on the data on depression from interviewee's self-reporting and measurement on Composite International Diagnostic Interview- Short Form (CIDI-SF) and Centre for Epidemiological Studies- Depression scale (CES-D) scales, we estimated undiagnosed depression among older adults (age 60+). We estimated multivariable binary logistic regressions to examine the socio-demographic and health-related predictors of undiagnosed depression among older adults. FINDINGS 8% (95% CI: 7.8-8.4) of the total older adults had undiagnosed depression on CIDI-SF scale and 5% (95% CI: 4.8-5.3) on the combined CIDI-SF and CES-D. Undiagnosed depression was higher among those who were widowed, worked in the past and currently not working, scheduled castes, higher educated and the richest. Lack of health insurance coverage, presence of any other physical or mental impairment, family history of Alzheimer's/Parkinson's disease/ psychotic disorder, lower self-rated health and poor life satisfaction were significant predictors of undiagnosed depression on both CIDI-SF and combined scales. CONCLUSION To improve the health of older adults in India, targeted policy efforts integrating mental health screening, awareness campaigns and decentralization of mental healthcare to primary level is needed. Further research could explore the causal factors behind different levels of undiagnosed depression.
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Affiliation(s)
- N B Devikrishna
- International Institute for Population Sciences, 400088, Mumbai, India.
| | - Nand Lal Mishra
- International Institute for Population Sciences, 400088, Mumbai, India
| | - Abhishek Singh
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, 400088, Mumbai, India
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Lee S, Cho Y, Ji Y, Jeon M, Kim A, Ham BJ, Joo YY. Multimodal integration of neuroimaging and genetic data for the diagnosis of mood disorders based on computer vision models. J Psychiatr Res 2024; 172:144-155. [PMID: 38382238 DOI: 10.1016/j.jpsychires.2024.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
Mood disorders, particularly major depressive disorder (MDD) and bipolar disorder (BD), are often underdiagnosed, leading to substantial morbidity. Harnessing the potential of emerging methodologies, we propose a novel multimodal fusion approach that integrates patient-oriented brain structural magnetic resonance imaging (sMRI) scans with DNA whole-exome sequencing (WES) data. Multimodal data fusion aims to improve the detection of mood disorders by employing established deep-learning architectures for computer vision and machine-learning strategies. We analyzed brain imaging genetic data of 321 East Asian individuals, including 147 patients with MDD, 78 patients with BD, and 96 healthy controls. We developed and evaluated six fusion models by leveraging common computer vision models in image classification: Vision Transformer (ViT), Inception-V3, and ResNet50, in conjunction with advanced machine-learning techniques (XGBoost and LightGBM) known for high-dimensional data analysis. Model validation was performed using a 10-fold cross-validation. Our ViT ⊕ XGBoost fusion model with MRI scans, genomic Single Nucleotide polymorphism (SNP) data, and unweighted polygenic risk score (PRS) outperformed baseline models, achieving an incremental area under the curve (AUC) of 0.2162 (32.03% increase) and 0.0675 (+8.19%) and incremental accuracy of 0.1455 (+25.14%) and 0.0849 (+13.28%) compared to SNP-only and image-only baseline models, respectively. Our findings highlight the opportunity to refine mood disorder diagnostics by demonstrating the transformative potential of integrating diverse, yet complementary, data modalities and methodologies.
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Affiliation(s)
- Seungeun Lee
- Department of Mathematics, Korea University, Anamro 145, Seoungbuk-gu, Seoul, 02841, Republic of Korea
| | - Yongwon Cho
- Department of Computer Science and Engineering, Soonchunhyang University, South Korea, Republic of Korea
| | - Yuyoung Ji
- Division of Life Science, Korea University, Anamro 145, Seoungbuk-gu, Seoul, 02841, Republic of Korea
| | - Minhyek Jeon
- Division of Biotechnology, Korea University, Anamro 145, Seoungbuk-gu, Seoul, 02841, Republic of Korea; Computational Biology Department, Carnegie Mellon University, Pittsburgh, PA, 15213, United States
| | - Aram Kim
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Byung-Joo Ham
- Department of Psychiatry, Korea University Anam Hospital, 73, Goryeodae-ro, Seoungbuk-gu, Seoul, 02841, Republic of Korea.
| | - Yoonjung Yoonie Joo
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, 115 Irwon-Ro, Gangnam-Gu, Seoul, 06355, Republic of Korea.
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Lin S(L. Healthy Immigrant Effect or Under-Detection? Examining Undiagnosed and Unrecognized Late-Life Depression for Racialized Immigrants and Nonimmigrants in Canada. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbad104. [PMID: 37498769 PMCID: PMC11036341 DOI: 10.1093/geronb/gbad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVES Immigrants to Canada tend to have a lower incidence of diagnosed depression than nonimmigrants. One theory suggests that this "healthy immigrant effect (HIE)" is due to positive selection. Another school of thought argues that the medical underuse of immigrants may be the underlying reason. This unclear "immigrant paradox" is further confounded by the intersecting race-migration nexus. METHODS This population-based study analyzed data of participants (n = 28,951, age ≥45) from the Canadian Community Health Survey (2015-2018). Multivariable logistic regression was employed to examine associations between race-migration nexus and mental health outcomes, including depressive symptoms (Patient Health Questionnaire [PHQ-9] score ≥10). RESULTS Compared to Canadian-born (CB) Whites, immigrants, regardless of race, were less likely to receive a mood/anxiety disorder diagnosis (M/A-Dx) by health providers in their lifetime. Racialized immigrants were mentally disadvantaged with increased odds of undiagnosed depression (Adjusted odds ratio [AOR] = 1.76, 99% Confidence interval [CI]:1.30-2.37), whereas White immigrants were mentally healthier with decreased odds of PHQ depression (AOR=0.75, 99%CI: 0.58, 0.96) and poor self-rated mental health (AOR=0.56, 99% CI=0.33, 0.95). Among the subpopulation without a previous M/A-Dx (N = 25,203), racialized immigrants had increased odds of PHQ depression (AOR = 1.45, 99% CI: 1.15-1.82) and unrecognized depression (AOR = 1.47, 99% CI: 1.08-2.00) than CB Whites. Other risk factors for undiagnosed depression include the lack of regular care providers, emergency room as the usual source of care, and being home renters. DISCUSSION Despite Canadian universal health coverage, the burden of undiagnosed depression disproportionately affects racialized (but not White) immigrants in mid to late life. Contingent on race-migration nexus, the HIE in mental health may be mainly driven by the healthier profile of White immigrants and partly attributable to the under-detection (by health professionals) and under-recognition of mental health conditions among racialized immigrants. A paradigm shift is needed to estimate late-life depression for medically underserved populations.
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Affiliation(s)
- Shen (Lamson) Lin
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong Special Administrative Region, China
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Wadle LM, Ebner-Priemer UW, Foo JC, Yamamoto Y, Streit F, Witt SH, Frank J, Zillich L, Limberger MF, Ablimit A, Schultz T, Gilles M, Rietschel M, Sirignano L. Speech Features as Predictors of Momentary Depression Severity in Patients With Depressive Disorder Undergoing Sleep Deprivation Therapy: Ambulatory Assessment Pilot Study. JMIR Ment Health 2024; 11:e49222. [PMID: 38236637 PMCID: PMC10835582 DOI: 10.2196/49222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/21/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The use of mobile devices to continuously monitor objectively extracted parameters of depressive symptomatology is seen as an important step in the understanding and prevention of upcoming depressive episodes. Speech features such as pitch variability, speech pauses, and speech rate are promising indicators, but empirical evidence is limited, given the variability of study designs. OBJECTIVE Previous research studies have found different speech patterns when comparing single speech recordings between patients and healthy controls, but only a few studies have used repeated assessments to compare depressive and nondepressive episodes within the same patient. To our knowledge, no study has used a series of measurements within patients with depression (eg, intensive longitudinal data) to model the dynamic ebb and flow of subjectively reported depression and concomitant speech samples. However, such data are indispensable for detecting and ultimately preventing upcoming episodes. METHODS In this study, we captured voice samples and momentary affect ratings over the course of 3 weeks in a sample of patients (N=30) with an acute depressive episode receiving stationary care. Patients underwent sleep deprivation therapy, a chronotherapeutic intervention that can rapidly improve depression symptomatology. We hypothesized that within-person variability in depressive and affective momentary states would be reflected in the following 3 speech features: pitch variability, speech pauses, and speech rate. We parametrized them using the extended Geneva Minimalistic Acoustic Parameter Set (eGeMAPS) from open-source Speech and Music Interpretation by Large-Space Extraction (openSMILE; audEERING GmbH) and extracted them from a transcript. We analyzed the speech features along with self-reported momentary affect ratings, using multilevel linear regression analysis. We analyzed an average of 32 (SD 19.83) assessments per patient. RESULTS Analyses revealed that pitch variability, speech pauses, and speech rate were associated with depression severity, positive affect, valence, and energetic arousal; furthermore, speech pauses and speech rate were associated with negative affect, and speech pauses were additionally associated with calmness. Specifically, pitch variability was negatively associated with improved momentary states (ie, lower pitch variability was linked to lower depression severity as well as higher positive affect, valence, and energetic arousal). Speech pauses were negatively associated with improved momentary states, whereas speech rate was positively associated with improved momentary states. CONCLUSIONS Pitch variability, speech pauses, and speech rate are promising features for the development of clinical prediction technologies to improve patient care as well as timely diagnosis and monitoring of treatment response. Our research is a step forward on the path to developing an automated depression monitoring system, facilitating individually tailored treatments and increased patient empowerment.
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Affiliation(s)
- Lisa-Marie Wadle
- Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Ulrich W Ebner-Priemer
- Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Jerome C Foo
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
- Institute for Psychopharmacology, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
- Department of Psychiatry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Yoshiharu Yamamoto
- Educational Physiology Laboratory, Graduate School of Education, University of Tokyo, Tokyo, Japan
| | - Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Stephanie H Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Josef Frank
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Lea Zillich
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Matthias F Limberger
- Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | - Tanja Schultz
- Cognitive Systems Lab, University of Bremen, Bremen, Germany
| | - Maria Gilles
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Lea Sirignano
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
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Bridges Hamilton CN, Ylitalo KR, Wende ME, Sharkey JR, Umstattd Meyer MR. Depressive Symptoms and Their Longitudinal Impact on Physical Activity and Sedentary Behaviors Among Mexican-Heritage Youth. FAMILY & COMMUNITY HEALTH 2024; 47:20-31. [PMID: 37747840 DOI: 10.1097/fch.0000000000000388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
The purpose of this study is to examine the longitudinal impact of depressive symptoms on physical activity (PA) levels, sedentary behavior, and screen time among first-generation, Mexican-heritage youth. Mexican-heritage families were recruited by promotoras de salud from colonias in Hidalgo County, Texas. Participants (n = 200 youth, 116 families in final sample) completed at-home, interviewer-administered surveys once during the summer (June-July) and once during the fall (August-December). Youth PA and sedentary behaviors were assessed using a validated 7-day recall instrument. The validated Center for Epidemiology Studies-Depression Child scale was used to assess depression symptoms. Linear mixed-effects models were used to analyze the relationships of PA and sedentary behavior with depressive symptoms. Results showed that those depression symptoms were significantly associated with decreased number of self-reported minutes of sitting and screen time over time in the full sample and among male youth. Depression symptoms also significantly decreased the number of self-reported active and moderate to vigorous PA minutes over time among male youth. Researchers can build on our findings by identifying the mechanisms driving the relationships between depression and PA/sedentary behavior. Public health-programing efforts should intentionally consider the impact that depressive symptoms have on PA.
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Affiliation(s)
- Christina N Bridges Hamilton
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, Kansas (Dr Bridges Hamilton); Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas (Drs Ylitalo, Wende, and Umstattd Meyer); and Professor Emeritus, Texas A&M University, College Station, Texas (Dr Sharkey)
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Pollack LM, Chen J, Cox S, Luo F, Robbins CL, Tevendale H, Li R, Ko JY. Rural/urban differences in health care utilization and costs by perinatal depression status among commercial enrollees. J Rural Health 2024; 40:26-63. [PMID: 37467110 PMCID: PMC10796846 DOI: 10.1111/jrh.12775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/09/2023] [Accepted: 06/13/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE To understand differences in health care utilization and medical expenditures by perinatal depression (PND) status during pregnancy and 1-year postpartum overall and by rural/urban status. METHODS We estimated differences in health care utilization and medical expenditures by PND status for individuals with an inpatient live-birth delivery in 2017, continuously enrolled in commercial insurance from 3 months before pregnancy through 1-year postpartum (study period), using MarketScan Commercial Claims data. Multivariable regression was used to examine differences by rurality. FINDINGS Ten percent of commercially insured individuals had claims with PND. A smaller proportion of rural (8.7%) versus urban residents (10.0%) had a depression diagnosis (p < 0.0001). Of those with PND, a smaller proportion of rural (5.5%) versus urban residents (9.6%) had a depression claim 3 months before pregnancy (p < 0.0001). Compared with urban residents, rural residents had greater differences by PND status in total inpatient days (rural: 0.7, 95% confidence interval [CI]: 0.6-0.9 vs. urban: 0.5, 95% CI: 0.5-0.6) and emergency department (ED) visits (rural: 0.7, 95% CI: 0.6-0.9 vs. urban: 0.5, 95% CI: 0.4-0.5), but a smaller difference by PND status in the number of outpatient visits (rural: 9.2, 95% CI: 8.2-10.2 vs. urban: 13.1, 95% CI: 12.7-13.5). Differences in expenditures for inpatient services by PND status differed by rural/urban status (rural: $2654; 95% CI: $1823-$3485 vs. urban: $1786; 95% CI: $1445-$2127). CONCLUSIONS Commercially insured rural residents had more utilization for inpatient and ED services and less utilization for outpatient services. Rural locations can present barriers to evidence-based care to address PND.
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Affiliation(s)
- Lisa M. Pollack
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jiajia Chen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Feijun Luo
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cheryl L. Robbins
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Heather Tevendale
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rui Li
- Division of Research, Office of Epidemiology and Research, Health Resources and Services Administration, Maternal and Child Health Bureau, US Department of Health and Human Services, Rockville, Maryland, USA
| | - Jean Y. Ko
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Commissioned Corps, United States Public Health Service, United States Department of Health and Human Services, Rockville, Maryland, USA
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Bertl M, Bignoumba N, Ross P, Yahia SB, Draheim D. Evaluation of deep learning-based depression detection using medical claims data. Artif Intell Med 2024; 147:102745. [PMID: 38184352 DOI: 10.1016/j.artmed.2023.102745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 01/08/2024]
Abstract
Human accuracy in diagnosing psychiatric disorders is still low. Even though digitizing health care leads to more and more data, the successful adoption of AI-based digital decision support (DDSS) is rare. One reason is that AI algorithms are often not evaluated based on large, real-world data. This research shows the potential of using deep learning on the medical claims data of 812,853 people between 2018 and 2022, with 26,973,943 ICD-10-coded diseases, to predict depression (F32 and F33 ICD-10 codes). The dataset used represents almost the entire adult population of Estonia. Based on these data, to show the critical importance of the underlying temporal properties of the data for the detection of depression, we evaluate the performance of non-sequential models (LR, FNN), sequential models (LSTM, CNN-LSTM) and the sequential model with a decay factor (GRU-Δt, GRU-decay). Furthermore, since explainability is necessary for the medical domain, we combine a self-attention model with the GRU decay and evaluate its performance. We named this combination Att-GRU-decay. After extensive empirical experimentation, our model (Att-GRU-decay), with an AUC score of 0.990, an AUPRC score of 0.974, a specificity of 0.999 and a sensitivity of 0.944, proved to be the most accurate. The results of our novel Att-GRU-decay model outperform the current state of the art, demonstrating the potential usefulness of deep learning algorithms for DDSS development. We further expand this by describing a possible application scenario of the proposed algorithm for depression screening in a general practitioner (GP) setting-not only to decrease healthcare costs, but also to improve the quality of care and ultimately decrease people's suffering.
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Affiliation(s)
- Markus Bertl
- Department of Health Technologies, Tallinn University of Technology, Akadeemia Tee 15A, Tallinn, 12618, Estonia.
| | - Nzamba Bignoumba
- Department of Software Science, Tallinn University of Technology, Akadeemia Tee 15A, Tallinn, 12618, Estonia
| | - Peeter Ross
- Department of Health Technologies, Tallinn University of Technology, Akadeemia Tee 15A, Tallinn, 12618, Estonia; Department of Research, East-Tallinn Central Hospital, Ravi 18, Tallinn, 10138, Estonia
| | - Sadok Ben Yahia
- Department of Software Science, Tallinn University of Technology, Akadeemia Tee 15A, Tallinn, 12618, Estonia; University of Southern Denmark, Alsion 2, Sønderborg, 6400, Denmark
| | - Dirk Draheim
- Information Systems Group, Tallinn University of Technology, Akadeemia Tee 15A, Tallinn, 12618, Estonia
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11
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Abstract
This article investigates the content and the consequences of the prototypes of people with depression in a multimethod fashion. Fourteen preregistered studies (total N = 5,023, with U.S. American, British, and French adult participants) show that laypeople consider people with depression as having specific psychological, social, and physical features (e.g., unattractive, overweight, unsuccessful, introverted). Target prototypicality influences how much laypeople believe others have depression, how much observers believe that depression-like symptoms cause someone to experience psychological pain, and how much professional mental health care is appropriate for others. This effect was not reduced by instructing people to focus on the symptoms and ignore the target features yet was weakly reduced by informing them of the effect. We discuss theoretical implications for the understanding of prototypes of people with depression and practical implications for alleviating the impact of prototypes.
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Affiliation(s)
- Ignazio Ziano
- Geneva School of Economics and Management, University of Geneva
| | - Yasin Koc
- Faculty of Behavioural and Social Sciences, University of Groningen
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12
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Stanyte A, Fineberg NA, Podlipskyte A, Gecaite-Stonciene J, Macijauskiene J, Steibliene V, Burkauskas J. Validation of the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 in Lithuanian individuals with anxiety and mood disorders. J Psychiatr Res 2023; 164:221-228. [PMID: 37385000 DOI: 10.1016/j.jpsychires.2023.06.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023]
Abstract
The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) are short self-report questionnaires used to screen and assess depression and anxiety severity in medical and community samples. However, little is known about their psychometric properties in individuals with anxiety and mood disorders (AMD) This study evaluated the psychometric properties of the PHQ-9 and GAD-7 in individuals with AMD. Individuals (n = 244, mean age 39.9 ± 12.3 years) with AMD completed the PHQ-9, GAD-7, as well as other measures of depression, anxiety, and a structured diagnostic interview. The PHQ-9 and GAD-7 demonstrated good internal consistency (Cronbach's alpha 0.87 and 0.84, respectively). The PHQ-9 and GAD-7 showed a weak correlation with clinician-rated scales HAM-D and HAM-A (r = 0.316, p < 0.01, r = 0.307, p < 0.01, respectively). For the PHQ-9, a cut score of ≥11 resulted in 72% sensitivity and 72% specificity at recognizing depression symptoms. For the GAD-7, a cut score ≥7 resulted in 73% sensitivity and 54% specificity at recognizing any anxiety disorders. The confirmatory factor analysis suggested a two-factor structure ("cognitive/affectional", "somatic") for both the PHQ-9 and GAD-7. In conclusion, the PHQ-9 and GAD-7 have adequate formal psychometric properties as severity measures for symptoms of anxiety and depression in individuals with AMD. The PHQ-9 performs well as a screener using a cut score of ≥11. However, the clinical utility of the GAD-7 as a diagnostic tool for recognition of anxiety disorders is limited.
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Affiliation(s)
- Agne Stanyte
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga-Kaunas, Lithuania.
| | - Naomi A Fineberg
- University of Hertfordshire, Hatfield, UK; Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK; University of Cambridge Clinical Medical School, Cambridge, UK
| | - Aurelija Podlipskyte
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga-Kaunas, Lithuania
| | - Julija Gecaite-Stonciene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga-Kaunas, Lithuania
| | - Jurate Macijauskiene
- Department of Geriatrics, Faculty of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vesta Steibliene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga-Kaunas, Lithuania
| | - Julius Burkauskas
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga-Kaunas, Lithuania
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13
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Smith ML, Steinman LE, Montoya CN, Thompson M, Zhong L, Merianos AL. Effectiveness of the Program to Encourage Active, Rewarding Lives (PEARLS) to reduce depression: a multi-state evaluation. Front Public Health 2023; 11:1169257. [PMID: 37361168 PMCID: PMC10289834 DOI: 10.3389/fpubh.2023.1169257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/15/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction An estimated 15% of community-dwelling older adults have depressive symptoms in the U.S. The Program to Encourage Active, Rewarding Lives (PEARLS) is an evidence-based program for managing late-life depression. PEARLS is a home/community-based collaborative care model delivered by community-based organizations to improve access to quality depression care. Trained staff actively screen for depression to improve recognition, teach problem-solving and activity planning skills for self-management, and connect participants to other supports and services as needed. Methods This study examined 2015-2021 data from 1,155 PEARLS participants across four states to assess PEARLS effectiveness to reduce depressive symptoms. The clinical outcomes were measured by the self-reported PHQ-9 instrument to assess changes in depressive symptoms scored as depression-related severity, clinical remission, and clinical response. A generalized estimating equation (GEE) model was fitted to examine changes in composite PHQ-9 scores from baseline to the final session. The model adjusted for participants' age, gender, race/ethnicity, education level, income level, marital status, number of chronic conditions, and number of PEARLS sessions attended. Cox proportional hazards regression models were conducted to estimate the hazard ratio for improvement of depressive symptoms (i.e., remission or response), while adjusting for the covariates. Results PHQ-9 scale scores significantly improved from baseline to their final sessions (mean difference = -5.67, SEM = 0.16, p < 0.001). About 35% of participants achieved remission with PHQ-9 score < 5. Compared to participants with mild depression, patients with moderate depression (HR = 0.43, 95%CI = 0.35-0.55), moderately severe depression (HR = 0.28, 95%CI = 0.21-0.38), and severe depression (HR = 0.22 95%CI = 0.14-0.34) were less likely to experience clinical remission with PHQ-9 score < 5, while adjusting for the covariates. About 73% achieved remission based on no longer having one or both cardinal symptoms. Compared to participants with mild depression, patients with moderate depression (HR = 0.66, 95%CI = 0.56-0.78), moderately severe depression (HR = 0.46, 95%CI = 0.38-0.56), and severe depression (HR = 0.38, 95%CI = 0.29-0.51) were less likely to experience clinical remission, while adjusting for the covariates. Nearly 49% of participants had a clinical response or a ≥ 50% decrease in PHQ-9 scores over time. There were no differences between the severity of depression groups based on the time to clinical response. Discussion Findings confirm that PEARLS is an effective program to improve depressive symptoms among older adults in diverse real-world community settings and can be a more accessible option for depressive older adults who are traditionally underserved by clinical care.
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Affiliation(s)
- Matthew Lee Smith
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, United States
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States
- Center for Health Equity and Evaluation Research, Texas A&M University, College Station, TX, United States
| | - Lesley E. Steinman
- Department of Health Systems and Population Health, Health Promotion Research Center, School of Public Health, University of Washington, Seattle, WA, United States
| | | | | | - Lixian Zhong
- School of Pharmacy, Texas A&M University, College Station, TX, United States
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, United States
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14
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Bramhankar M, Kundu S, Pandey M, Mishra NL, Adarsh A. An assessment of self-rated life satisfaction and its correlates with physical, mental and social health status among older adults in India. Sci Rep 2023; 13:9117. [PMID: 37277415 PMCID: PMC10241830 DOI: 10.1038/s41598-023-36041-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 05/28/2023] [Indexed: 06/07/2023] Open
Abstract
Life satisfaction refers to the assessment of one's own life in terms of self-perceived favourable qualities. It is an integral part of healthy and successful course of ageing. It is widely associated with the health status and social well-being. The present study attempted to determine the constructing factors of self-rated life satisfaction, such as socio-demographic, physical, social, and mental well-being of older adults. We analysed information from the Longitudinal Ageing Study in India (LASI-1), the initial phase conducted during 2017-18 for the population of older adults in India. We applied descriptive statistics for prevalence assessment and association was checked using chi-square test. Further, to determine the adjusted outcome of predictor covariates on the likelihood of an individual being satisfied from life estimated by applying hierarchical multiple logistic regression models. Several noteworthy affirmations on the relationship between the socio-demographic variables and health risk behaviours with life satisfaction were observed. The results were consistent with studies showing change in life satisfaction subject to the state of physical and mental health, presence of chronic diseases, friends and family relations, dependency, and events of trauma or abuse. While comparing respondents, we found varying degrees of life satisfaction by gender, education, marital status, expenditure and other socio-economic features. We also found that besides physical and mental health, social support and well-being play a pivotal role in achieving higher life satisfaction among older adults. Overall, this work contributes to the study of the subjective well-being of older adults in India based on self-reported levels of life satisfaction and further narrows the gap in knowledge about associated behaviour. Hence, with on-going ageing scenario, there is need for multi-sectorial policy-oriented approaches at individual, family, and community level, which helps to take care of older-adults' physical, social, and mental health for the betterment of healthy ageing.
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Affiliation(s)
- Mahadev Bramhankar
- Department of Bio-Statistics and Demography, International Institute for Population Sciences, Mumbai, India.
| | - Sampurna Kundu
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
| | - Mohit Pandey
- Department of Bio-Statistics and Demography, International Institute for Population Sciences, Mumbai, India
| | - Nand Lal Mishra
- Department of Bio-Statistics and Demography, International Institute for Population Sciences, Mumbai, India
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, India
| | - Adarsh Adarsh
- Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany
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15
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Pizzicato LN, Xie RZ, Yang Y, Grabner M, Chapman RH. Real-world treatment modalities, health care resource utilization, and costs among commercially insured patients with newly diagnosed major depressive disorder in the United States. J Manag Care Spec Pharm 2023; 29:614-625. [PMID: 37276037 PMCID: PMC10387971 DOI: 10.18553/jmcp.2023.29.6.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND: In the United States, major depressive disorder (MDD) is one of the most prevalent mental health disorders. Treatment guidelines for MDD recommend pharmacologic and nonpharmacologic therapies tailored to the patient's disease severity, level of function, and comorbid health conditions. While previous studies examined real-world pharmacologic treatment patterns and costs among patients with MDD, few have examined the use of nonpharmacologic treatments and their association with health care resource utilization (HCRU) and cost. OBJECTIVE: To describe prevalence and associations between patient/provider characteristics and treatment modality and characterize HCRU and cost by treatment modality for patients with newly diagnosed MDD. METHODS: Commercially insured US patients, aged 18-62 years with newly diagnosed MDD between January 1, 2017, and September 30, 2019, were retrospectively identified from the Healthcare Integrated Research Database. Eligible patients were continuously enrolled in the health plan for 1 year before and 2 years after the first MDD diagnosis (index date). Those with co-occurring schizophrenia, bipolar disorder, postpartum depression, substance use disorder, and any prior MDD treatments were excluded. Treatment modalities assessed in the 2-year post-index period included antidepressant only (Rx-only), nonpharmacologic only (non-Rx-only), both antidepressant and nonpharmacologic (combination), and no treatment. HCRU and costs were assessed in the 2-year post-index period by treatment modality. Regression models identified associations between patient/provider characteristics and treatment modality, and the relationship between treatment modality and MDD severity changes. RESULTS: In total, 12,657 patients were included (mean age: 36 years; 60% female). During follow-up, 34% of patients received Rx-only, 25% received non-Rx-only, 28% received combination, and 13% received no treatment. MDD severity at diagnosis (26% mild, 54% moderate, 20% severe) was available for 51% of patients. Post-index inpatient hospitalizations were 11% for those with Rx-only, 10% for non-Rx-only, 16% for combination, and 29% for no treatment, whereas all-cause mean monthly total costs were $792, $633, $786, and $1,292, respectively. In multinomial logistic regression, age, sex, geographic region and urbanicity of patient residence, socioeconomic status, diagnosing provider specialty, and initial diagnosis location were significantly associated (P < 0.05) with treatment modality. In multivariable logistic regression, recipients of Rx-only (odds ratio = 2.03, P < 0.01) or combination (odds ratio = 3.26, P < 0.01) had higher odds of improving MDD severity than patients who received no treatment. CONCLUSIONS: In this real-world sample of commercially insured patients, we observed variations in outcomes by treatment modality and an association between treatment modality and disease severity. Further research is needed to explore the underlying causal relationships between treatment modality and patient outcomes. Study Registration: https://doi.org/10.17605/OSF.IO/YQ6B3 DISCLOSURES: Dr Grabner is an employee of Carelon Research, which received funding from the Innovation and Value Initiative for the conduct of the study on which this manuscript is based. Ms Pizzicato and Mr Yang were employees of Carelon Research at the time the study was conducted. Dr Grabner is a shareholder of Elevance Health. Drs Xie and Chapman are employees of the Innovation and Value Initiative.
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16
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Chang CM. What Do Patients Want in the Treatment of Major Depressive Disorder? Taiwan's TAILOR Survey. Neurol Ther 2023; 12:21-29. [PMID: 37115461 PMCID: PMC10147885 DOI: 10.1007/s40120-023-00471-y] [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: 12/20/2022] [Accepted: 03/15/2023] [Indexed: 04/29/2023] Open
Abstract
In Taiwan, the number of patients being treated for depression has been increasing over recent decades, but there remain some key unmet needs for these patients. One issue is the low rate of help-seeking, which may be at least partially attributable to the stigma of depression in Asian societies. Stigma also contributes to underdiagnosis, because stigmatised patients may emphasise somatic symptoms (e.g. lethargy/fatigue, sleep disorders or changes in appetite), fearing how they will be perceived if they discuss psychological symptoms with their physician. Underdiagnosis may also result from cross-cultural differences, because assessment scales and screening tools are usually developed in Western populations and may not have the same validity in Asian patients. Depression in Taiwan appears to be undertreated, with a high rate of suboptimal antidepressant dosages and inadequate duration of therapy. Patients may discontinue treatment earlier than recommended for a number of reasons related to their own beliefs about treatment, their relationship with their physicians, or the effects of the medication (adverse effects, slow onset of effect, or lack of effect on comorbid symptoms). Moreover, frequently there is discordance between how patients and physicians define treatment success in depression. Patients are more likely to achieve a benefit from treatment which remains persistent when physicians and patients are closely aligned on treatment goals. To better understand the experiences, preferences and attitudes of patients with depression in Taiwan, the Target Antidepressant Initiation choice to unLock positive patient Outcomes and Response (TAILOR) survey was conducted in 340 adult outpatients receiving treatment for major depressive disorder (MDD). The results of the TAILOR survey highlight the personal and perceived stigma of depression, current barriers to seeking help and maintaining treatment, and opportunities to improve shared decision-making, medication adherence and clinical outcomes for Taiwanese patients with MDD.
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Affiliation(s)
- Chia-Ming Chang
- Department of Psychiatry, Chang Gung Memorial Hospital at Linko, Taoyuan, 333, Taiwan.
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17
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Meng YH, Hsieh MS, Chi YC, How CK, Chen PC, Chang CM. Effect of Carbon Monoxide Poisoning on Epilepsy Development: A Nationwide Population-Based Cohort Study. Ann Emerg Med 2023:S0196-0644(22)01315-4. [PMID: 36797130 DOI: 10.1016/j.annemergmed.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/10/2022] [Accepted: 11/22/2022] [Indexed: 02/17/2023]
Abstract
STUDY OBJECTIVE Carbon monoxide (CO) poisoning causes central nervous system toxicity resulting in delayed neurologic sequelae. This study aims to evaluate the risk of epilepsy in patients with a history of CO intoxication. METHODS We conducted a retrospective population-based cohort study using the Taiwan National Health Insurance Research Database and enrolled patients with and without CO poisoning matched for age, sex, and index year in a 1:5 ratio, between 2000 and 2010. Multivariable survival models were used to assess the risk of epilepsy. The primary outcome was newly developed epilepsy after the index date. All patients were followed until a new diagnosis of epilepsy, death, or December 31, 2013. Stratification analyses by age and sex were also conducted. RESULTS This study included 8,264 patients with CO poisoning and 41,320 without. Patients with a history of CO poisoning were strongly associated with subsequent epilepsy (adjusted hazard ratio [HR] 8.40; 95% confidence interval [CI], 6.48 to 10.88). In the age-stratified analysis, intoxicated patients aged 20 to 39 years had the highest HR (adjusted HR 11.06; 95% CI, 7.17 to 17.08). In the sex-stratified analysis, adjusted HRs for male and female patients were 8.00 (95% CI, 5.86 to 10.92) and 9.53 (95% CI, 5.95 to 15.26), respectively. CONCLUSION Patients with CO poisoning were associated with an increased risk of developing epilepsy compared with those without CO poisoning. This association was more prominent in the young population.
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Affiliation(s)
- Yu-Hsiang Meng
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Shun Hsieh
- Department of Emergency Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan
| | - Yu-Chi Chi
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chorng-Kuang How
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Pau-Chung Chen
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chia-Ming Chang
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.
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18
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McConaghy K, Rullan P, Murray T, Molloy R, Heinberg LJ, Piuzzi NS. Team Approach: Management of Mental Health in Orthopaedic Patients. JBJS Rev 2023; 11:01874474-202302000-00003. [PMID: 36763707 DOI: 10.2106/jbjs.rvw.22.00167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
» Mental health evaluation should be considered an essential part of the routine preoperative assessment and should be managed by a multidisciplinary team composed of the primary care physician, orthopaedic provider, and behavioral health specialist. » The scientific literature indicates that patients without comorbid psychiatric symptoms and adaptive coping strategies, resilience, and well-managed expectations have improved functional outcomes and satisfaction after orthopaedic procedures. » Psychological issues are multifaceted and require treatment tailored to each individual patient. Therefore, close communication between all members of the care team is required to create and execute the perioperative plan.
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Affiliation(s)
- Kara McConaghy
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Pedro Rullan
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Trevor Murray
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Robert Molloy
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Leslie J Heinberg
- Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio.,Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio.,Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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19
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Fragala MS, Tong CH, Hunter JL, Jelovic NA, Hayward JI, Carr S, Kim PM, Peters ME, Birse CE. Facilitating Mental Health Treatment Through Proactive Screening and Concierge Services in the Workplace. J Occup Environ Med 2023; 65:160-166. [PMID: 36190912 PMCID: PMC9897277 DOI: 10.1097/jom.0000000000002707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study is to determine if a proactive employer-sponsored mental health program closed gaps in detection and treatment of mental health conditions. METHODS Of n = 56,442 eligible, n = 8170 (14.5%) participated in the optional screening. Participants with mental health risk were offered care concierge services including support, care planning, and connection to care. Difference in behavioral health care utilization, diagnoses, and prescriptions were evaluated postintervention through claims analysis. RESULTS Compared with controls (n = 2433), those receiving concierge services (n = 369) were more likely to fill mental health prescriptions (adjusted hazards ratio [HR], 1.2; 1.0-1.5; P = 0.042), use professional mental health services (adjusted HR, 1.4; 1.1-1.8; P = 0.02), and use new mental health services (adjusted HR, 1.9; 1.2-2.8; P = 0.004) in the following 6 months. CONCLUSIONS This proactive mental health program with care concierge services identified risk, connected individuals to mental health care, and facilitated mental health treatment, among program participants.
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20
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James TA, Duarte A. Depressive symptoms are associated with reduced positivity preferences in episodic memory in aging. Neurobiol Aging 2023; 121:38-51. [PMID: 36371815 PMCID: PMC11212072 DOI: 10.1016/j.neurobiolaging.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022]
Abstract
Age-related positivity preferences are represented as greater memory benefits for positive and/or reduced benefits for negative material with age. It is unknown if positivity preferences are limited to older adults without depressive symptoms. In this fMRI study, adults across the lifespan with a range of depressive symptoms were scanned as they rated emotional intensity of images and subsequently completed a recognition memory task. Behavioral, univariate, and functional connectivity analyses provided evidence for interactive effects between age and depressive symptoms. With low depressive symptoms, typical age-related emotional preferences emerged: younger age was associated with better memory for negative images, and this benefit was reduced with older age. With increasing depressive symptoms in older age, positivity preferences were reduced, manifesting as improvements in negative memory. The neural data highlighted potential underlying mechanisms, including reductions in prefrontal cortex connectivity reflecting diminished ability to engage regulatory processes to reduce negative affect in older participants with higher depressive symptoms. These findings suggest that depressive symptoms in older adulthood reduce positivity preferences through alterations in neural networks underlying emotion regulation.
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Affiliation(s)
- Taylor A James
- School of Psychology, Georgia Institute of Technology, Atlanta, GA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Audrey Duarte
- School of Psychology, Georgia Institute of Technology, Atlanta, GA, USA; Department of Psychology, University of Texas at Austin, Austin, TX, USA
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21
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Császár-Nagy N, Bókkon I. Hypnotherapy and IBS: Implicit, long-term stress memory in the ENS? Heliyon 2022; 9:e12751. [PMID: 36685398 PMCID: PMC9849985 DOI: 10.1016/j.heliyon.2022.e12751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/20/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023] Open
Abstract
The association between irritable bowel syndrome (IBS) and psychiatric and mood disorders may be more fundamental than was previously believed. Prenatal, perinatal, postnatal, and early-age conditions can have a key role in the development of IBS. Subthreshold mental disorders (SMDs) could also be a significant source of countless diverse diseases and may be a cause of IBS development. We hypothesize that stress-induced implicit memories may persist throughout life by epigenetic processes in the enteric nervous system (ENS). These stress-induced implicit memories may play an essential role in the emergence and maintenance of IBS. In recent decades, numerous studies have proven that hypnosis can improve the primary symptoms of IBS and also reduce noncolonic symptoms such as anxiety and depression and improve quality of life and cognitive function. These significant beneficial effects of hypnosis on IBS may be because hypnosis allows access to unconscious brain processes.
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Affiliation(s)
- N. Császár-Nagy
- National University of Public Services, Budapest, Hungary,Psychosomatic Outpatient Clinics, Budapest, Hungary
| | - I. Bókkon
- Psychosomatic Outpatient Clinics, Budapest, Hungary,Vision Research Institute, Neuroscience and Consciousness Research Department, Lowell, MA, USA,Corresponding author. H-1238, Budapest, Láng Endre 68, Hungary.
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22
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Williams SZ, Lewis CF, Muennig P, Martino D, Pahl K. Self-reported anxiety and depression problems and suicide ideation among black and latinx adults and the moderating role of social support. J Community Health 2022; 47:914-923. [PMID: 35921053 DOI: 10.1007/s10900-022-01127-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 01/09/2023]
Abstract
Suicide is a critical public health problem. Over the past decade, suicide rates have increased among Black and Latinx adults in the U.S. Though depression is the most prevalent psychiatric contributor to suicide risk, Black and Latinx Americans uniquely experience distress and stress (e.g., structural adversity) that can independently operate to worsen suicide risk. This makes it important to investigate non-clinical, subjective assessment of mental health as a predictor of suicide ideation. We also investigate whether social support can buffer the deleterious impact of poor mental health on suicide ideation.We analyzed data from 1,503 Black and Latinx participants of the Washington Heights Community Survey, a 2015 survey of residents of a NYC neighborhood. Multivariable logistic regression was conducted to examine the effect of subjectively experienced problems with anxiety and depression on suicide ideation independent of depression diagnosis, and the role of social support as a moderator.Estimated prevalence of past two-week suicide ideation was 5.8%. Regression estimates showed significantly increased odds of suicide ideation among participants reporting moderate (OR = 8.54,95% CI = 2.44-29.93) and severe (OR = 16.84,95% CI = 2.88-98.46) versus no problems with anxiety and depression, after adjustment for depression diagnosis. Informational support, i.e., having someone to provide good advice in a crisis, reduced the negative impact of moderate levels of anxiety and depression problems on suicide ideation.Findings suggest that among Black and Latinx Americans, subjective feelings of anxiety and depression account for a significant portion of the suicide ideation risk related to poor mental health. Further, social support, particularly informational support, may provide protection against suicide ideation.
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Affiliation(s)
- Sharifa Z Williams
- Center for Research on Cultural and Structural Equity in Behavioral Health, Division of Social Solutions & Services Research, Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Bldg. 35, 10962-1159, Orangeburg, NY, USA. .,Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA.
| | - Crystal Fuller Lewis
- Center for Research on Cultural and Structural Equity in Behavioral Health, Division of Social Solutions & Services Research, Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Bldg. 35, 10962-1159, Orangeburg, NY, USA.,Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Peter Muennig
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniele Martino
- Center for Research on Cultural and Structural Equity in Behavioral Health, Division of Social Solutions & Services Research, Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Bldg. 35, 10962-1159, Orangeburg, NY, USA
| | - Kerstin Pahl
- Center for Research on Cultural and Structural Equity in Behavioral Health, Division of Social Solutions & Services Research, Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Bldg. 35, 10962-1159, Orangeburg, NY, USA.,Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
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23
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Milić J. How to design a reliable and practical biomarker: the electrophysiologic coefficient of depressiveness - δEPCD. Biomarkers 2022; 27:711-714. [PMID: 36196689 DOI: 10.1080/1354750x.2022.2122565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Jelena Milić
- Institute of Public Health of Serbia, Dr Milan Jovanovic Batut", Centar for Informatics and Biostatistics in Health Care
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24
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Rogers NB, Grits D, Emara AK, Higuera CA, Molloy RM, Klika AK, Piuzzi NS. Preoperative Veterans Rand-12 Mental Composite Score of < 40 Leads to Increased Healthcare Utilization and Diminished Improvement After Primary Knee Arthroplasty. J Arthroplasty 2022; 37:2178-2185. [PMID: 35598758 DOI: 10.1016/j.arth.2022.05.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/04/2022] [Accepted: 05/16/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Adverse outcomes after total knee arthroplasty (TKA) have been associated with preoperative psychological disorders and poor mental health. We aimed to investigate and quantify the association between preoperative mental health and 1) postoperative 90-day health care utilization; and 2) 1-year patient-reported outcomes after primary TKA. METHODS Retrospective review of prospectively collected data of patients who underwent primary elective TKA (n = 7,476) was performed. Preoperative mental health was evaluated using Veterans Rand-12 Mental Composite Scores (VR-12 MCS). Outcomes included prolonged length of stay (>2-days), nonhome discharge, 90-day readmissions, emergency department visits, and reoperation. Improvement in Knee Injury and Osteoarthritis Outcome Score (KOOS) and Patient Acceptable Symptom State (PASS) achievement were evaluated at 1-year. Multivariable regression was implemented to explore associations between preoperative VR-12 MCS and outcomes of interest. RESULTS A total of 5,402 (72.3%) completed 1-year follow-up. Lower preoperative VR-12 MCS was associated with higher odds of prolonged length of stay (MCS 20-39: odds ratio (OR): 1.46;P < .001), and nonhome discharge disposition (MCS 20-39: OR: 1.92;P < .001), but not 90-day readmission or reoperation (MCS20-39; P = .12 and P = .64). At 1-year, patients with a lower MCS were less likely to attain a substantial clinical benefit in KOOS-pain (MCS 0-19; OR: 0.25; P < .001) and less likely to achieve PASS (MCS20-39; OR: 0.74; P = .002). Patients with an MCS >60 were more likely to be discharged home (OR: 1.42; P = .008), achieve substantial clinical benefit in their KOOS-JR (OR: 1.16; P = .027),-Pain (OR: 1.220; P = .007) and PASS at 1-year (OR: 1.28; P = .008). CONCLUSIONS Lower VR-12 MCS is associated with increased postoperative health care utilization and worse patient-reported outcome measures at 1-year post-TKA. These findings suggest that a VR-12 MCS ≤40 could be used to designate increased risk, guide the preoperative discussion and potential interventions.
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Affiliation(s)
- Nathan B Rogers
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Daniel Grits
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Carlos A Higuera
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Robert M Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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25
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Galiatsatos P, Oluyinka M, Min J, Schreiber R, Lansey DG, Ikpe R, Pacheco MC, DeJaco V, Ellison-Barnes A, Neptune E, Kanarek NF, Cudjoe TKM. Prevalence of Mental Health and Social Connection among Patients Seeking Tobacco Dependence Management: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11755. [PMID: 36142029 PMCID: PMC9517384 DOI: 10.3390/ijerph191811755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION with regards to tobacco dependence management, there are certain barriers to successful smoking cessation for patients, such as untreated anxiety and depression. Complicating the impact of mental health morbidities on tobacco dependence may be the significant portion of patients whose mental health issues and limited social connections are undiagnosed and unaddressed. We hypothesize that patients with no prior mental health diagnoses who are treated for tobacco dependence have high rates of undiagnosed mental health morbidities. METHODS patients were recruited from a tobacco treatment clinic in 2021. Every patient who came for an inaugural visit without a prior diagnosis of mental health disease was screened for depression, anxiety, social isolation and loneliness. Sociodemographic variables were collected. RESULTS over a 12-month period, 114 patients were seen at the tobacco treatment clinic. Of these 114 patients, 77 (67.5%) did not have a prior diagnosis of a mental health disease. The mean age was 54.3 ± 11.2 years, 52 (67.5%) were females, and 64 (83.1%) were Black/African American. The mean age of starting smoking was 19.3 ± 5.2 years, and 43 (55.8%) had never attempted to quit smoking in the past. With regards to mental health screening, 32 (41.6%) patients had a score of 9 or greater on the Patient Health Questionnaire (PHQ) 9, 59 (76.6%) had a score of 7 or greater on the Generalized Anxiety Disorder (GAD) 7, 67 (87.0%) were identified with social isolation and 70 (90.1%) for loneliness on screening. CONCLUSION there was a high prevalence of undiagnosed mental health morbidities and social disconnection in patients who were actively smoking and were struggling to achieve smoking cessation. While a larger scale study is necessary to reaffirm these results, screening for mental health morbidities and social disconnection may be warranted in order to provide effective tobacco dependence management.
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Affiliation(s)
- Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
- The Tobacco Treatment and Cancer Screening Clinic, Baltimore, MD 21224, USA
- Medicine for the Greater Good, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
| | - MopeninuJesu Oluyinka
- The Tobacco Treatment and Cancer Screening Clinic, Baltimore, MD 21224, USA
- Medicine for the Greater Good, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
| | - Jihyun Min
- The Tobacco Treatment and Cancer Screening Clinic, Baltimore, MD 21224, USA
| | - Raiza Schreiber
- The Tobacco Treatment and Cancer Screening Clinic, Baltimore, MD 21224, USA
| | - Dina G. Lansey
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
| | - Ruth Ikpe
- Medicine for the Greater Good, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
| | - Manuel C. Pacheco
- Univeridad Tecnológica de Pereira, Universidad Visión de las Americas, Pereira 660003, Colombia
| | - Victoria DeJaco
- The Tobacco Treatment and Cancer Screening Clinic, Baltimore, MD 21224, USA
| | | | - Enid Neptune
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
- The Tobacco Treatment and Cancer Screening Clinic, Baltimore, MD 21224, USA
| | - Norma F. Kanarek
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
- Environmental Health and Engineering, Johns Hopkins School of Public Health, Baltimore, MD 21224, USA
| | - Thomas K. M. Cudjoe
- Medicine for the Greater Good, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
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26
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Nanayakkara GL, Krincic L, Lightfoot R, Reinhardt W, De Silva K, Senaratne JM, Senaratne MPJ. Demographics and risk factors that influence the prevalence of depression in patients attending cardiac rehabilitation. Medicine (Baltimore) 2022; 101:e30470. [PMID: 36086695 PMCID: PMC10980405 DOI: 10.1097/md.0000000000030470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022] Open
Abstract
Depression has been associated with adverse outcomes in patients with cardiac disease. Data on its prevalence and the factors influencing it are limited in the cardiac rehabilitation program (CRP) setting. To elucidate the prevalence of and the factors that influence depression in patients attending CRP. Patients attending the CRP from 2003 to 2016 were included in the study. All patients had a Beck Depression Inventory-II (BDI-II) performed prior to commencement in CRP and were followed longitudinally. The BDI-II for the 4989 patients were as follows: 0 to 13 (normal) = 3623 (72%); 14 to 19 (mild depression) = 982 (20%); 20 to 28 (moderate depression) = 299 (6%); 29 to 63 (severe depression) = 85 (2%). The BDI-II (mean ± SEM) for males (mean age: 60.8 ± 0.1 years) and females (mean age: 63.4 ± 0.3 years, P < .001) were 7.0 ± 0.1 and 8.5 ± 0.2 (P < .001), respectively. Elevated BDI-II scores (14-63) were more common in type 1 (41.1%) and type 2 (30.5%) diabetics than nondiabetics (25.7%). Similarly, elevated scores were more common in smokers (36.1%) than never-smokers (24.7%). The BDI-II scores for Caucasians, South Asians, and East Asians were 7.3 ± 0.1, 8.0 ± 0.3, and 7.0 ± 0.3 respectively (P = .01 for CA vs SA by 1-way ANOVA and least significant difference test). The prevalence of depression is high in patients attending CRP affecting 28% of the population. BDI-II is a simple validated screening tool that can be applied to patients attending CRP. Diabetics, current smokers, and South Asians all had a higher prevalence of depression.
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Affiliation(s)
| | - Lena Krincic
- Grey Nuns Community Hospital, Edmonton, AB, Canada
| | | | | | | | - Janek M. Senaratne
- Grey Nuns Community Hospital, Edmonton, AB, Canada
- Division of Cardiology, University of Alberta, Edmonton, AB, Canada
| | - Manohara P. J. Senaratne
- Grey Nuns Community Hospital, Edmonton, AB, Canada
- Division of Cardiology, University of Alberta, Edmonton, AB, Canada
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Handy A, Mangal R, Stead TS, Coffee RL, Ganti L. Prevalence and Impact of Diagnosed and Undiagnosed Depression in the United States. Cureus 2022; 14:e28011. [PMID: 36134073 PMCID: PMC9470500 DOI: 10.7759/cureus.28011] [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] [Accepted: 08/13/2022] [Indexed: 11/09/2022] Open
Abstract
Background: The objectives of this study were: 1) estimate the impact and severity of both diagnosed and undiagnosed depression in the general US population 2) explore the demographics of depression based on its common symptoms 3) interpret Patient Health Questionnaire-9 (PHQ-9) scores to improve accuracy in identifying individuals with depression. Methods: A random sample of 200 individuals was selected from a general US adult population to complete the Patient Health Questionnaire-9 (PHQ-9). Results: Only 39.4% of respondents indicated that they had a formal diagnosis of depression. In contrast, 53% of participants have considered seeking help from a mental health professional. More importantly, 31.45% of respondents without a formal diagnosis had a PHQ-9 score of over 10 (moderate to severe depression). Conclusions: The results indicate that undiagnosed depression exists in the US population and suggest that access to mental health services needs to expand across the nation.
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Faisal-Cury A, Ziebold C, Rodrigues DMDO, Matijasevich A. Depression underdiagnosis: Prevalence and associated factors. A population-based study. J Psychiatr Res 2022; 151:157-165. [PMID: 35486997 DOI: 10.1016/j.jpsychires.2022.04.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/01/2022] [Accepted: 04/20/2022] [Indexed: 12/14/2022]
Abstract
UNLABELLED Despite its high prevalence and negative consequences, depression is often underdiagnosed. We aimed to estimate the prevalence and sociodemographic and health related factors associated with depression underdiagnosis among a nationally representative population-based sample in Brazil. METHOD We used data from 70,806 participants (15-107 years old) of the Brazilian National Survey (PNS 2019). Depression underdiagnosis was considered for participants with a Patient Health Questionnaire-9 (PHQ-9) score >9 and with no diagnosis made by a health provider. Logistic regression models were performed to assess the crude and adjusted association between depression underdiagnosis and sociodemographic and health related factors. Population attributable risk fractions were calculated for significant predictors. RESULTS The prevalence of depression (according the PHQ-9) was 11.2% (IC95% 10.8:11.7). Depression underdiagnosis prevalence was 63.6% (IC95% 62.0%:65.2%) and was more frequent among male, elderly population, those with lower income, lower schooling, living in the North/Central region of the country, with best health perception, lower number of chronic disease and medical appointments. A significant percentage of depression underdiagnosed cases in Brazil in 2019 would be prevent by improving education (10.18%), income (3.99%), access to health visits (5.59%) and addressing barriers for depression diagnosis among males (5.44%), elderlies (3.32%), and population from the North region (8.29%). CONCLUSION(S) depression underdiagnosis is common in Brazil. Preventive measures should target the sociodemographic and health related factors associated with depression underdiagnosis.
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Affiliation(s)
- Alexandre Faisal-Cury
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Carolina Ziebold
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
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Zhong X, Zhou Z, Li G, Kwizera MH, Muennig P, Chen Q. Neighborhood disparities in COVID-19 outcomes in New York city over the first two waves of the outbreak. Ann Epidemiol 2022; 70:45-52. [PMID: 35487451 PMCID: PMC9042413 DOI: 10.1016/j.annepidem.2022.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 01/25/2022] [Accepted: 04/18/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE To assess the association of neighborhood demographic and socioeconomic characteristics with COVID-19 incidence and mortality in New York City (NYC) over the first two waves of outbreak. METHODS This retrospective study used neighborhood-level data from 177 modified ZIP code tabulation areas in NYC between March 01, 2020 and April 30, 2021. RESULTS Neighborhoods that were most severely impacted in wave 1 were also more affected in wave 2. Neighborhoods with a higher percentage of seniors (≥75 years), males, Black and Hispanic population, and large-size households had higher incidence rates of COVID-19 in wave 1 but not in wave 2. Neighborhoods with higher percentage of Black and Hispanic population and lower insurance coverage had higher death rate per capita and case fatality ratio in wave 1, and neighborhoods with higher percentage of Black and Asian population had elevated case fatality ratio in wave 2. Median household income was negatively associated with incidence rate and death rate per capita but not associated with case fatality ratio in both waves. Neighborhoods with more seniors had higher death rate and case fatality ratio in both waves. CONCLUSIONS Neighborhood disparities in COVID-19 incidence and mortality across NYC neighborhoods were dynamic during the first two waves of outbreak.
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Affiliation(s)
- Xiaobo Zhong
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ziqi Zhou
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Guohua Li
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Muhire H Kwizera
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Peter Muennig
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY
| | - Qixuan Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY.
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Eltokhi A, Sommer IE. A Reciprocal Link Between Gut Microbiota, Inflammation and Depression: A Place for Probiotics? Front Neurosci 2022; 16:852506. [PMID: 35546876 PMCID: PMC9081810 DOI: 10.3389/fnins.2022.852506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/18/2022] [Indexed: 12/12/2022] Open
Abstract
Depression is a severe mental disorder that places a significant economic burden on public health. The reciprocal link between the trillions of bacteria in the gut, the microbiota, and depression is a controversial topic in neuroscience research and has drawn the attention of public interest and press coverage in recent years. Mounting pieces of evidence shed light on the role of the gut microbiota in depression, which is suggested to involve immune, endocrine, and neural pathways that are the main components of the microbiota-gut-brain axis. The gut microbiota play major roles in brain development and physiology and ultimately behavior. The bidirectional communication between the gut microbiota and brain function has been extensively explored in animal models of depression and clinical research in humans. Certain gut microbiota strains have been associated with the pathophysiology of depression. Therefore, oral intake of probiotics, the beneficial living bacteria and yeast, may represent a therapeutic approach for depression treatment. In this review, we summarize the findings describing the possible links between the gut microbiota and depression, focusing mainly on the inflammatory markers and sex hormones. By discussing preclinical and clinical studies on probiotics as a supplementary therapy for depression, we suggest that probiotics may be beneficial in alleviating depressive symptoms, possibly through immune modulation. Still, further comprehensive studies are required to draw a more solid conclusion regarding the efficacy of probiotics and their mechanisms of action.
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Affiliation(s)
- Ahmed Eltokhi
- Department of Pharmacology, University of Washington, Seattle, WA, United States
| | - Iris E Sommer
- Department of Biomedical Sciences of Cells & Systems, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
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31
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Acharya S, Satpathy A, Beura R, Datta P, Das U, Mahapatra P. Assessment of clinical depression in abdominally obese subjects with periodontal disease. Indian J Dent Res 2022; 33:120-125. [PMID: 36254945 DOI: 10.4103/ijdr.ijdr_780_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Depression is a commonly prevailing condition that goes undetected in clinical settings. Both abdominal obesity and periodontal disease have a bearing on mental health and have an impact on the quality of life. OBJECTIVE To assess the level of clinical depression in abdominally obese subjects with periodontal disease. METHODS Two hundred and ten subjects with a mean age of 37.45 ± 9.59 years (males = 117; females = 93) were grouped as per their abdominal obesity and periodontal status and assessed for their clinical depression levels (mental health) using the Centre for Epidemiologic Studies-Depression Scale (CES-D). Collected data were analysed. RESULTS The clinical depression score significantly varied in subjects with different periodontal status in both non-obese (F (2,102) = 113.66, P < 0.0001) and abdominally obese subjects (F (2,102) = 132.04, P < 0.001). Significantly higher depression score was demonstrated in healthy (P < 0.001), gingivitis (P < 0.001), and periodontitis (P < 0.001) groups in abdominally obese subjects. CONCLUSION Clinical depression is significantly associated with abdominal obesity and periodontal disease in subjects with abdominal obesity and severe periodontal disease demonstrating higher depression scores.
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Affiliation(s)
- Sheetal Acharya
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | - Anurag Satpathy
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | - Rajdeep Beura
- Department of Periodontics, Hi Tech Dental College and Hospital, Bhubaneswar, Odisha, India
| | - Pratiti Datta
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | - Utkalika Das
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | - Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, KIIT (Deemed to be University), Bhubaneswar, Odisha, India
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Kurtzman ET, Greene J. Is Adversity in Childhood Linked to Marijuana Use in Adulthood?: Findings from the Behavioral Risk Factor Surveillance System. Subst Use Misuse 2022; 57:273-286. [PMID: 34812106 DOI: 10.1080/10826084.2021.2002905] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background: Adverse childhood experiences (ACEs) are potentially traumatic events, which can have long-term, negative consequences. Few studies have examined ACEs' relationship to marijuana use. Objectives: We examined the association between ACEs and past-month marijuana use among adults and the pathways between childhood adversity and marijuana use. Methods: Adults from five states (n = 22,991) who responded to the 2019 Behavioral Risk Factors Surveillance System were included. We examined the prevalence of ACEs and marijuana use. We employed generalized structural equation modeling to assess the relationship between ACEs and marijuana use and the role of depression and poor mental and physical health as possible mediators. Results: Overall, 65.0% of the population reported 1+ ACE. Heavy marijuana use and past-month marijuana use prevalence rates were 10.3% and 5.0%, respectively. We found mediation effects for depression and poor mental health but not poor physical health. The number of ACEs was associated with a statistically significant increase in any past-month marijuana use-indirect effects ranged from 1.0 (95% CI, 1.0-1.0) to 1.4 (95% CI, 1.2-1.7), direct effects ranged from 1.1 (95% CI, 07-1.7) to 5.3 (95% CI 3.2-8.8), and total effects ranged from 1.1 (95% CI, 0.7-1.7) to 5.9 (95% CI, 3.6-9.8). Women, married persons, and middle aged and older adults had a lower odds of marijuana use. Reporting at least one HIV risk behavior was associated with an increased odds of marijuana use. Conclusion: ACE exposure was positively associated with marijuana use. Depression and poor mental health separately mediated this relationship.
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Affiliation(s)
- Ellen T Kurtzman
- School of Nursing, The George Washington University, Washington, DC, USA
| | - Jessica Greene
- Marxe School of Public and International Affairs, Baruch College, City University of New York, New York, New York, USA
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Pabayo R, Benny C, Liu SY, Grinshteyn E, Muennig P. Financial Barriers to Mental Healthcare Services and Depressive Symptoms among Residents of Washington Heights, New York City. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:184-194. [PMID: 34894792 PMCID: PMC9315193 DOI: 10.1177/15404153211057563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives: In the United States, Hispanics are more likely to
experience financial barriers to mental health care than non-Hispanics. We used
a unique survey to study the effect of these financial barriers on the severity
of depressive symptoms among Hispanics who had previously been diagnosed as
having depression. Methods: This cross-sectional study used data
from the 2015 Washington Heights Community Survey, administered to 2,489
households in Manhattan, New York City. Multiple regression models and
propensity score matching were used to estimate the association between
financial barriers to mental health care and depressive symptoms and the
likelihood of being clinically depressed. Results: Among those
diagnosed with depression, those with financial barriers to mental health
services or counseling had significantly higher (β = 0.36, 95% CI = 0.03, 0.70)
depressive symptoms. When propensity score matching was utilized, those with
financial barriers to mental health services had significantly greater
depressive symptoms (β = 0.63, 95% CI = 0.37, 0.89) and were significantly more
likely to be currently depressed (OR = 2.38, 95% CI = 1.46, 3.89), in comparison
to those who had access. Conclusions: Making mental health care
more affordable and therefore more accessible to Hispanics is one step toward
mitigating the burden on mental illness and decreasing health disparities.
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Affiliation(s)
- Roman Pabayo
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Claire Benny
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Sze Yan Liu
- 8087Montclair State University, Public Health Department, Montclair, NJ, USA
| | - Erin Grinshteyn
- 16152University of San Francisco, Health Professions Department, San Francisco, CA, USA
| | - Peter Muennig
- 33638Columbia Mailman School of Public Health, New York City, NY, USA
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Safarini OA, Taya H, Abu Elhija Y, Qadous M, Farhoud A, Thabaleh A, Khayyat A, Nazzal Z, Abuhassan AM, Ghanim N, Mahamid F, Al Ali R, Damiri B. Assessment of the Relationship of Depression With Tobacco and Caffeine Use Among University Students: A Cross-Sectional Study. Cureus 2021; 13:e19098. [PMID: 34868751 PMCID: PMC8627153 DOI: 10.7759/cureus.19098] [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] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background University students are at a higher risk of using cognitive enhancers and psychoactive substances. Depression is associated with a noticeable decline in academic performance and can increase the risk of substance use. Due to sociopolitical issues, the use of cognitive enhancers and psychoactive substances among Palestinians has spread in the last decade. However, depression among tobacco and caffeine users remains underrecognized and neglected. Methodology A self-administrated questionnaire and the Beck Depression Inventory were used to assess the association of depression and the use of cognitive enhancers and psychoactive substances among university students at An-Najah National University in 2020. Results The response rate to the questionnaires was 78.8% (n = 1,051; 38.8% males, 61.2% females). The overall prevalence of depression was high (30.6% males, 34.7% females). The prevalence of cigarette smoking (39.2% males, 3.9% females), waterpipe smoking (43.1% males, 21.6% females), energy drink consumption (59.6% males, 29.7% females), coffee consumption (85.5% for each gender), tea consumption, and chocolate consumption was high, with significant differences in accordance to gender and academic fields. The multinomial logistic regression results revealed that cigarette smokers were more likely to have a higher risk of severe (odds ratio [OR] = 4.5, p = 0.001), moderate (OR = 3.27, p < 0.001), and mild depression (OR = 2.24, p = 0.002) than non-smokers. Severe depression was less prevalent among medical students than health sciences and non-medical students (OR = 0.215, p = 0.015). Moreover, males were less likely to have moderate (OR = 0.5, p = 0.012) and mild (OR = 0.48, p = 0.001) depression than females. Conclusions Overall, the results of this study revealed the high prevalence of depression and the detrimental effects of smoking on students. Moreover, the findings suggest the urgent need to address depression and risk factors among Palestinian university students by educating them about mental health, identifying high-risk students, and offering easily accessible psychological help. Further, it is crucial to broaden the focus of studies to include students from various academic fields instead of focusing on medical students.
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Affiliation(s)
| | | | | | - Marah Qadous
- Medicine, An-Najah National University, Nablus, PSE
| | | | | | | | - Zaher Nazzal
- Community and Family Medicine, An-Najah National University, Nablus, PSE
| | | | - Nesma Ghanim
- Medicine, An-Najah National University, Nablus, PSE
| | - Fayez Mahamid
- Clinical Psychology, An-Najah National University, Nablus, PSE
| | - Rayyan Al Ali
- Forensic Medicine, An-Najah National University, Nablus, PSE
| | - Basma Damiri
- Medicine and Health Sciences, An-Najah National University, Nablus, PSE
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Singh SP, Menon S, Singh S, Nadeau AJ, Jiao J. Perceived Depression, Anxiety, and Stress Outcomes Among Students of Early Entrance College Programs. Cureus 2021; 13:e20360. [PMID: 35028236 PMCID: PMC8751760 DOI: 10.7759/cureus.20360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Mental health disorders affect adolescents and children and have resulted in many academic institutions now recognizing and taking steps to reduce the pressure they place on students. Early Entrance to College Programs (EECP) is a small subset of academic institutions focused on providing an accelerated higher education path, and these students are held to high academic standards. It is important to research the effects of these programs on the students' mental health, as younger children are extremely susceptible to mental disorders that may last into adulthood. Methods This study analyzed a three-part survey given to alumni of various EECPs. The survey is a combination of Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and yes/no questions regarding the participants' demographics. A longitudinal study was also conducted on current students in EECPs. These students were given a survey consisting of the 21-item Depression, Anxiety, and Stress Scale (DASS-21) questionnaire, which was completed two times throughout the academic year, three months later. Results The results displayed that there was a significant impact of academic rigor on the mental health of these students. In both the one-time and longitudinal studies, a majority of participants recorded having higher levels of anxiety and depression than before they were in the program. Conclusions The association between mental health and academic rigor is similar to what is seen among both high school and college cohort students with a greater emphasis on the social environment as a modulating factor.
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Affiliation(s)
- Som P Singh
- Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Shreya Menon
- Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Shipra Singh
- Department of Psychiatry, Central Michigan University College of Medicine, Saginaw, USA
| | - Alexander J Nadeau
- Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Jianwei Jiao
- Department of Psychiatry, University of Missouri-Kansas City, Kansas City, USA
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Tan JK, Khoo CS, Beh HC, Hod R, Baharudin A, Yahya WNNW, Tan HJ. Prevalence and associated risk factors of undiagnosed depression among people with epilepsy in a multiethnic society. Epilepsy Res 2021; 178:106772. [PMID: 34763265 DOI: 10.1016/j.eplepsyres.2021.106772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/17/2021] [Accepted: 09/19/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Depression is the most frequent psychiatric comorbidity of epilepsy. However, clinicians often neglect to screen for depressive symptoms among patients with epilepsy and, therefore, fail to detect depression. Many studies have described the risks associated with depression in patients with epilepsy, but few studies have elaborated whether these risks are similar in those with undiagnosed depression, especially in a multiethnic community. METHODS In the present cross-sectional study conducted at a tertiary teaching hospital, we aimed to investigate the prevalence and associated risk factors of undiagnosed depression in patients with epilepsy. We recruited patients with epilepsy aged 18-65 years after excluding those with background illnesses that may have contributed to the depressive symptoms. In total, 129 participants were recruited. We collected their demographic and clinical details before interviewing them using two questionnaires-the Neurological Disorders Depression Inventory for Epilepsy and Beck's Depression Inventory-II. Subsequently, if a participant screened positive for depression, the diagnosis was confirmed using the Diagnostic and Statistical Manual of Mental Disorders questionnaire, and a psychiatric clinic referral was offered. RESULTS Among the 129 participants, 9.3 % had undiagnosed major depressive disorder, and there was a female preponderance (66.7 %). The risk factors for undiagnosed depression among patients with epilepsy included low socioeconomic background (p = 0.026), generalized epilepsy (p = 0.036), and temporal lobe epilepsy (p = 0.010). Other variables such as being underweight and unmarried were more common among patients diagnosed with depression than without but no statistically significant relationship was found. CONCLUSION The prevalence of undiagnosed depression among patients with epilepsy was higher than that in population-based studies conducted in Western countries. Although questionnaires to screen for depression are widely available, some clinicians rarely use them and, therefore, fail to identify patients who may benefit from psychosocial support and treatment that would improve their disease outcomes and quality of life. The present study indicated that clinicians should use screening questionnaires to identify undiagnosed depression in people with epilepsy.
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Affiliation(s)
- Juen Kiem Tan
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Ching Soong Khoo
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hui Chien Beh
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Rozita Hod
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Azlin Baharudin
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Wan Nur Nafisah Wan Yahya
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hui Jan Tan
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
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McGrath N, O Neill K, McHugh SM, Toomey E, Kearney PM. Epidemiology of undiagnosed depression in people with diabetes mellitus: a comparative analysis of Ireland, England and the USA. BMJ Open 2021; 11:e049155. [PMID: 34645663 PMCID: PMC8515475 DOI: 10.1136/bmjopen-2021-049155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Improving detection of depression in people with diabetes is recommended. However, little is known about how different health systems compare in depression detection. We estimated and compared the (1) prevalence of depression detection in people with and without diabetes, and (2) association between diabetes and undiagnosed depression across three health systems. DESIGN Cross-sectional analysis of three nationally representative studies: The Irish Longitudinal Study on Ageing, the English Longitudinal Study on Ageing and the Health and Retirement Study. SETTING Community-dwelling adults in Ireland, England and the USA. PARTICIPANTS Adults aged ≥50 years. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was depression diagnosis. The secondary outcome was any depression. Any depression was defined by the presence of self-reported doctor-diagnosed depression or current depression symptoms on the Centre for Epidemiological Studies-Depression scale. Depression diagnosis was categorised as: undiagnosed, symptomatic and diagnosed, and asymptomatic and diagnosed. We estimated age-standardised prevalence of depression diagnosis by country and diabetes status. Anyone who self-reported having ever received a doctor diagnosis of diabetes was classified as having diabetes. Among respondents with depression, we estimated the association between diabetes and undiagnosed depression by country using multivariable logistic regression. RESULTS The prevalence of depression (diagnosed and undiagnosed) was higher in people with diabetes in each country with absolute rates varying by country; undiagnosed prevalence (Ireland: diabetes 10.1% (95% CI 7.5% to 12.8%) vs no diabetes 7.5% (95% CI 6.8% to 8.2%), England: diabetes 19.3% (95% CI 16.5% to 22.2%) vs no diabetes 11.8% (95% CI 11.0% to 12.6%), USA: diabetes 7.4% (95% CI 6.4% to 8.4%) vs no diabetes 6.1% (95% CI 5.7% to 6.6%)). In the fully adjusted model, there was no clear pattern of association between diabetes status and undiagnosed depression; Ireland: OR=0.82 (95% CI 0.5 to 1.3), England: OR=1.47 (95% CI 1.0 to 2.1), USA: OR=0.80 (95% CI 0.7 to 1.0). CONCLUSIONS Although undiagnosed depression was more prevalent among people with diabetes, the relationship between diabetes and undiagnosed depression differed by country. Targeted efforts are needed to improve depression detection among community-dwelling older adults, particularly those with diabetes.
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Affiliation(s)
- Niamh McGrath
- School of Public Health, University College Cork-National University of Ireland, Cork, Ireland
| | - Kate O Neill
- School of Public Health, University College Cork-National University of Ireland, Cork, Ireland
| | - Sheena M McHugh
- School of Public Health, University College Cork-National University of Ireland, Cork, Ireland
| | - Elaine Toomey
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Patricia M Kearney
- School of Public Health, University College Cork-National University of Ireland, Cork, Ireland
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Richardson MES, Brown D, Honore D, Labossiere A. Fragmented day-night cycle induces period lengthening, lowered anxiety, and anhedonia in male mice. Behav Brain Res 2021; 413:113453. [PMID: 34252503 DOI: 10.1016/j.bbr.2021.113453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 12/20/2022]
Abstract
Light exposure at night disrupts circadian-regulated biological functions, including mood. However, the consequence of fragmenting the night period and distributing it across the 24-hr period is less understood. Here we show that fragmenting an 8 -h and 6 -h night into equally distributed 2 -h periods throughout the 24-hr day results in period lengthening of the circadian rhythm in mice. Furthermore, mice exhibited less anxiety, which indicates increased risk-taking behavior, and a lack of pleasure-seeking, known as anhedonia. The successive alley and open field tests were used to assess anxiety, while the sucrose preference test was used to assess anhedonia. Analysis of depressive-like behaviors with the forced swim and tail suspension tests were not observed. After two weeks in 12 h light - 12 h dark, mice exposed to the fragmented night recovered and exhibited normal behaviors for both anxiety and anhedonia. Our results are congruent with published studies that describe the detrimental effects of constant light conditions on circadian rhythms and mood. These findings unveil the negative impact that fragmenting the day-night cycle has on circadian rhythms and mood.
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Affiliation(s)
- Melissa E S Richardson
- Department of Biological Sciences, Oakwood University, United States(1); Department of Biology, Johns Hopkins University, United States.
| | - Desiree Brown
- Department of Biological Sciences, Oakwood University, United States(1)
| | - Danielle Honore
- Department of Biological Sciences, Oakwood University, United States(1)
| | - Andisa Labossiere
- Department of Biological Sciences, Oakwood University, United States(1)
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Müller SR, Chen XL, Peters H, Chaintreau A, Matz SC. Depression predictions from GPS-based mobility do not generalize well to large demographically heterogeneous samples. Sci Rep 2021; 11:14007. [PMID: 34234186 PMCID: PMC8263566 DOI: 10.1038/s41598-021-93087-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/21/2021] [Indexed: 11/25/2022] Open
Abstract
Depression is one of the most common mental health issues in the United States, affecting the lives of millions of people suffering from it as well as those close to them. Recent advances in research on mobile sensing technologies and machine learning have suggested that a person's depression can be passively measured by observing patterns in people's mobility behaviors. However, the majority of work in this area has relied on highly homogeneous samples, most frequently college students. In this study, we analyse over 57 million GPS data points to show that the same procedure that leads to high prediction accuracy in a homogeneous student sample (N = 57; AUC = 0.82), leads to accuracies only slightly higher than chance in a U.S.-wide sample that is heterogeneous in its socio-demographic composition as well as mobility patterns (N = 5,262; AUC = 0.57). This pattern holds across three different modelling approaches which consider both linear and non-linear relationships. Further analyses suggest that the prediction accuracy is low across different socio-demographic groups, and that training the models on more homogeneous subsamples does not substantially improve prediction accuracy. Overall, the findings highlight the challenge of applying mobility-based predictions of depression at scale.
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Affiliation(s)
- Sandrine R Müller
- Data Science Institute, Columbia University, New York, USA.
- Department of Psychology, Bielefeld University, Bielefeld, Germany.
| | - Xi Leslie Chen
- Computer Science Department, Columbia University, New York, USA
| | - Heinrich Peters
- Columbia Business School, Columbia University, New York, USA
| | | | - Sandra C Matz
- Columbia Business School, Columbia University, New York, USA
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Gilbert CS, Earleywine M, Mian MN, Altman BR. Symptom specificity of ayahuasca's effect on depressive symptoms. JOURNAL OF PSYCHEDELIC STUDIES 2021. [DOI: 10.1556/2054.2021.00165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AbstractBackgroundAyahuasca's effects on symptoms of depression have generated considerable optimism. Clients frequently report more concern about some symptoms than others, and available treatments alter symptoms differentially. Few studies address the symptom specificity of this psychoactive brew.AimsWe examined self-reported effects of ayahuasca on the individual symptoms of depression assessed by the 10-item short-form of Center for Epidemiological Studies of Depression (CESD-10).MethodsWe asked over 120 participants to complete a retrospective assessment of CESD-10 symptoms one month before and one month after using ayahuasca.ResultsParticipants indicated that ayahuasca had a larger influence on affective symptoms like hope, depressed mood, and happiness, than cognitive, interpersonal, and somatic symptoms like restless sleep, loneliness, and difficulty focusing.ConclusionsPotential clients might appreciate identifying if different treatments provide more relief for some depressive symptoms than others. We examined retrospective reports of ayahuasca's potential for differential impact. Those eager to alter hope, happiness, and other affective symptoms will likely find ayahuasca more helpful than those who want an intervention for restless sleep, loneliness, or trouble focusing. This symptom specificity parallels the effects of serotonergic antidepressant medications, suggesting that psychedelic-assisted psychotherapy using ayahuasca might have considerable appeal for those who seek comparable relief but would rather not use prescription serotonergic medications. Jumpstarting psychotherapy with the rapid onset of ayahuasca-induced relief also appears to have potential.
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Affiliation(s)
- Cody Sykes Gilbert
- Department of Psychology, University at Albany, SUNY Albany, NY, 12203, United States
| | - Mitch Earleywine
- Department of Psychology, University at Albany, SUNY Albany, NY, 12203, United States
| | - Maha N. Mian
- Department of Psychology, University at Albany, SUNY Albany, NY, 12203, United States
| | - Brianna R. Altman
- Department of Psychology, University at Albany, SUNY Albany, NY, 12203, United States
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Punjani N, Nascimento B, Salter C, Miranda E, Terrier J, Taniguchi H, Jenkins L, Mulhall JP. Predictors of Depression in Men With Peyronie's Disease Seeking Evaluation. J Sex Med 2021; 18:783-788. [PMID: 33712403 PMCID: PMC9087901 DOI: 10.1016/j.jsxm.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Peyronie's disease (PD) has negative impacts on the psychosocial status of men including depression warranting clinical evaluation in up to 50% of men. AIM To examine predictors of depression in patients with early PD seeking evaluation. METHODS All PD patients at a high-volume PD practice underwent screening and curvature assessment after intracavernosal injection. Complex deformity was defined as any degree of multiplanar curvature, curvature >60 degrees, or presence of hourglass deformity. Men completed the PD questionnaire (PDQ), a validated depression questionnaire (CES-D) as well as the Self-Esteem and Relationship (SEAR) questionnaire. Scores of ≥16 on CES-D were considered indicative of moderate/severe depression. Predictors of the presence of depression were defined using univariable and multivariable logistic regression. OUTCOMES Demographic, bother and curve related predictors of depression in men with PD. RESULTS 408 men completed all questionnaires. Mean age was similar between depressed and nondepressed groups (57 ± 10 years overall, P = .60 between groups). Proportions of erectile dysfunction were similar between groups (P = .96). Mean PD duration was similar between groups (19 ± 35 months overall, P = .46 between groups). Mean degree of curvature was 38 ± 2 degrees in the depressed vs 33 ± 1 degrees in the nondepressed groups (P = .03). A complex deformity was seen in 64.5% in the depressed vs 61.5% in the nondepressed (P = .56). A total of 110 (27%) patients had CESD scores ≥16. 74% depressed men were in relationships compared to 84% nondepressed men (P < .01). Other characteristics including bother, pain, duration of disease, curve complexity and instability were similar between the two groups. On univariable analysis, factors protective against depression included being partnered (OR 0.42, 95%CI 0.24-0.75, P < .01) and higher total SEAR scores (OR 0.95, 95%CI 0.94-0.97, P < .01). Elevated PDQ domain scores were associated with depression (Psychologic Symptoms 1.05, 95%CI 1.02-1.10, P < .01; Pain 1.08, 95%CI 1.03-1.12, P < .01; Bother 1.11, 95% CI 1.05-1.68, P < .01) as well as baseline history of depression (OR 2.93, 95%CI 1.67-5.14, P < .001). On multivariable analysis, only total SEAR score remained protective against depression (OR 0.96, 95%CI 0.94-0.97, P < .001). CLINICAL IMPLICATIONS Providers must recognize that men with PD seeking evaluation have meaningful rates of depression for which early recognition is necessary. STRENGTHS AND LIMITATIONS Retrospective review of a large prospectively collected dataset from a single center of men with PD utilizing a validated screening tool for depression. CONCLUSION While no significant demographic, bother or curve related factors predicted depression in early PD men seeking evaluation, it remains a significant problem warranting further prospective evaluation. P. Nahid, N. Bruno, S. Carolyn, et al. Predictors of Depression in Men With Peyronie's Disease Seeking Evaluation. J Sex Med 2021;18:783-788.
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Affiliation(s)
- Nahid Punjani
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Urology, Center for Male Reproductive Medicine and Microsurgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Bruno Nascimento
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas, Urology, Sao Paulo, Brazil
| | - Carolyn Salter
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eduardo Miranda
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Universidade Federal do Ceara, Division of Urology, Fortaleza, Brazil
| | - Jean Terrier
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hisanori Taniguchi
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lawrence Jenkins
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John P Mulhall
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Di Matteo D, Wang W, Fotinos K, Lokuge S, Yu J, Sternat T, Katzman MA, Rose J. Smartphone-Detected Ambient Speech and Self-Reported Measures of Anxiety and Depression: Exploratory Observational Study. JMIR Form Res 2021; 5:e22723. [PMID: 33512325 PMCID: PMC7880807 DOI: 10.2196/22723] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/13/2020] [Accepted: 12/24/2020] [Indexed: 12/14/2022] Open
Abstract
Background The ability to objectively measure the severity of depression and anxiety disorders in a passive manner could have a profound impact on the way in which these disorders are diagnosed, assessed, and treated. Existing studies have demonstrated links between both depression and anxiety and the linguistic properties of words that people use to communicate. Smartphones offer the ability to passively and continuously detect spoken words to monitor and analyze the linguistic properties of speech produced by the speaker and other sources of ambient speech in their environment. The linguistic properties of automatically detected and recognized speech may be used to build objective severity measures of depression and anxiety. Objective The aim of this study was to determine if the linguistic properties of words passively detected from environmental audio recorded using a participant’s smartphone can be used to find correlates of symptom severity of social anxiety disorder, generalized anxiety disorder, depression, and general impairment. Methods An Android app was designed to collect periodic audiorecordings of participants’ environments and to detect English words using automatic speech recognition. Participants were recruited into a 2-week observational study. The app was installed on the participants’ personal smartphones to record and analyze audio. The participants also completed self-report severity measures of social anxiety disorder, generalized anxiety disorder, depression, and functional impairment. Words detected from audiorecordings were categorized, and correlations were measured between words counts in each category and the 4 self-report measures to determine if any categories could serve as correlates of social anxiety disorder, generalized anxiety disorder, depression, or general impairment. Results The participants were 112 adults who resided in Canada from a nonclinical population; 86 participants yielded sufficient data for analysis. Correlations between word counts in 67 word categories and each of the 4 self-report measures revealed a strong relationship between the usage rates of death-related words and depressive symptoms (r=0.41, P<.001). There were also interesting correlations between rates of word usage in the categories of reward-related words with depression (r=–0.22, P=.04) and generalized anxiety (r=–0.29, P=.007), and vision-related words with social anxiety (r=0.31, P=.003). Conclusions In this study, words automatically recognized from environmental audio were shown to contain a number of potential associations with severity of depression and anxiety. This work suggests that sparsely sampled audio could provide relevant insight into individuals’ mental health.
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Affiliation(s)
- Daniel Di Matteo
- The Centre for Automation of Medicine, The Edward S Rogers Sr Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - Wendy Wang
- The Centre for Automation of Medicine, The Edward S Rogers Sr Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - Kathryn Fotinos
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
| | | | - Julia Yu
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
| | - Tia Sternat
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada.,Department of Psychology, Adler Graduate Professional School, Toronto, ON, Canada
| | - Martin A Katzman
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada.,Department of Psychology, Adler Graduate Professional School, Toronto, ON, Canada.,Department of Psychology, Lakehead University, Thunder Bay, ON, Canada.,The Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Jonathan Rose
- The Centre for Automation of Medicine, The Edward S Rogers Sr Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
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Gialluisi A, Costanzo S, Castelnuovo AD, Bonaccio M, Bracone F, Magnacca S, De Curtis A, Cerletti C, Donati MB, de Gaetano G, Iacoviello L. Combined influence of depression severity and low-grade inflammation on incident hospitalization and mortality risk in Italian adults. J Affect Disord 2021; 279:173-182. [PMID: 33059220 DOI: 10.1016/j.jad.2020.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/27/2020] [Accepted: 10/04/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Depression and low-grade systemic inflammation are associated risk factors for hospitalizations and mortality, although the nature of this relationship is under-investigated. METHODS We performed multivariable Cox regressions of first hospitalization/mortality for all and specific causes vs depression severity, in an Italian population cohort (N=13,176; age≥35 years; 49.4% men), incrementally adjusting for sociodemographic, health and lifestyle factors. We tested potential mediation, additive and interactive effects of INFLA-score, a composite circulating inflammation index, and potential concurrent mediations of main lifestyles and chronic conditions. RESULTS Over 4,856 hospitalizations (median follow-up 7.28 years), we observed an increased incident risk of events by 24% (CI=17-32%) and 59% (30-90%) for moderate and severe depression, which also showed a 125% (33-281%) increased risk of all-cause mortality (over 471 deaths, 8.24 years). These remained stable after adjustment for lifestyles, health conditions and INFLA-score, which explained 2.1%, 7.6%, 16.3% and 8%, 14.9% and 12% of depression influence on hospitalizations and mortality risk, respectively. These proportions remained substantially stable after reciprocal adjustments. INFLA-score showed significant additive (but not interactive) effects on both hospitalizations and mortality risk. LIMITATIONS Depression severity was defined using a sub-version of Patient Health Questionnaire 9, which was validated here. Directionality links among exposures could not be established since they were collected simultaneously. CONCLUSIONS These findings suggest a combined influence of depression and low-grade inflammation on health, which is partly intertwined and dependent on lifestyles and chronic conditions. This suggests the existence of pathways other than inflammation through which depression may play its detrimental effect.
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Affiliation(s)
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | | | | | - Francesca Bracone
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | | | - Amalia De Curtis
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Chiara Cerletti
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | | | | | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy; Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Benrimoh D, Tanguay-Sela M, Perlman K, Israel S, Mehltretter J, Armstrong C, Fratila R, Parikh SV, Karp JF, Heller K, Vahia IV, Blumberger DM, Karama S, Vigod SN, Myhr G, Martins R, Rollins C, Popescu C, Lundrigan E, Snook E, Wakid M, Williams J, Soufi G, Perez T, Tunteng JF, Rosenfeld K, Miresco M, Turecki G, Gomez Cardona L, Linnaranta O, Margolese HC. Using a simulation centre to evaluate preliminary acceptability and impact of an artificial intelligence-powered clinical decision support system for depression treatment on the physician-patient interaction. BJPsych Open 2021; 7:e22. [PMID: 33403948 PMCID: PMC8058891 DOI: 10.1192/bjo.2020.127] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recently, artificial intelligence-powered devices have been put forward as potentially powerful tools for the improvement of mental healthcare. An important question is how these devices impact the physician-patient interaction. AIMS Aifred is an artificial intelligence-powered clinical decision support system (CDSS) for the treatment of major depression. Here, we explore the use of a simulation centre environment in evaluating the usability of Aifred, particularly its impact on the physician-patient interaction. METHOD Twenty psychiatry and family medicine attending staff and residents were recruited to complete a 2.5-h study at a clinical interaction simulation centre with standardised patients. Each physician had the option of using the CDSS to inform their treatment choice in three 10-min clinical scenarios with standardised patients portraying mild, moderate and severe episodes of major depression. Feasibility and acceptability data were collected through self-report questionnaires, scenario observations, interviews and standardised patient feedback. RESULTS All 20 participants completed the study. Initial results indicate that the tool was acceptable to clinicians and feasible for use during clinical encounters. Clinicians indicated a willingness to use the tool in real clinical practice, a significant degree of trust in the system's predictions to assist with treatment selection, and reported that the tool helped increase patient understanding of and trust in treatment. The simulation environment allowed for the evaluation of the tool's impact on the physician-patient interaction. CONCLUSIONS The simulation centre allowed for direct observations of clinician use and impact of the tool on the clinician-patient interaction before clinical studies. It may therefore offer a useful and important environment in the early testing of new technological tools. The present results will inform further tool development and clinician training materials.
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Affiliation(s)
- David Benrimoh
- Department of Psychiatry, McGill University, Canada; Aifred Heath Inc., Montreal, Canada; and Faculty of Medicine, McGill University, Canada
| | - Myriam Tanguay-Sela
- Montreal Neurological Institute, McGill University, Canada; and Aifred Health Inc., Montreal, Canada
| | - Kelly Perlman
- Douglas Mental Health University Institute, Montreal, Canada; and Aifred Health Inc., Montreal, Canada
| | | | - Joseph Mehltretter
- Department of Computer Science, University of Southern California, Los Angeles, USA; and Aifred Health Inc., Montreal, Canada
| | - Caitrin Armstrong
- School of Computer Science, McGill University, Canada; and Aifred Health Inc., Montreal, Canada
| | | | | | - Jordan F Karp
- Department of Psychiatry, University of Pittsburgh, USA
| | | | - Ipsit V Vahia
- Department of Psychiatry, McLean Hospital/Harvard University, USA
| | | | | | | | - Gail Myhr
- Department of Psychiatry, McGill University, Canada
| | - Ruben Martins
- Douglas Mental Health University Institute, Montreal, Canada; and Department of Psychiatry, McGill University, Canada
| | - Colleen Rollins
- Department of Psychiatry, University of Cambridge, UK; and Aifred Health Inc., Montreal, Canada
| | - Christina Popescu
- Douglas Mental Health University Institute, Montreal, Canada; and Aifred Health Inc., Montreal, Canada
| | - Eryn Lundrigan
- Department of Anatomy and Cell Biology, McGill University, Canada
| | - Emily Snook
- Faculty of Medicine, University of Toronto, Canada
| | - Marina Wakid
- Douglas Mental Health University Institute, Montreal, Canada
| | | | | | - Tamara Perez
- Department of Experimental Medicine, McGill University, Canada
| | | | | | - Marc Miresco
- Department of Psychiatry, McGill University, Canada
| | - Gustavo Turecki
- Douglas Mental Health University Institute, Montreal, Canada; and Department of Psychiatry, McGill University, Canada
| | - Liliana Gomez Cardona
- Douglas Mental Health University Institute, Montreal, Canada; and Department of Psychiatry, McGill University, Canada
| | - Outi Linnaranta
- Douglas Mental Health University Institute, Montreal, Canada; and Department of Psychiatry, McGill University, Canada
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The Cost of Poor Mental Health in Total Joint Arthroplasty. J Arthroplasty 2020; 35:3432-3436. [PMID: 32709561 DOI: 10.1016/j.arth.2020.06.083] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this analysis was to evaluate (1) the impact of depression on resource utilization and financial outcomes in bundled total joint arthroplasty (TJA) and (2) whether similar effects are seen using baseline patient-reported outcome scores. METHODS All elective bundled TJA cases from 2017 to 2018 at an academic system in the New York City area were included. We analyzed variables associated with cost differences seen between patients with and without depression, and between patients with low (<40th percentile) and high baseline (>60th percentile) Veterans RAND 12-Item Health Survey mental component scores (MCSs). We also analyzed whether depression or low MCS could predict worse financial outcomes. RESULTS Our population included 825 patients, 418 with patient-reported outcome scores data. Depression was associated with higher rates of skilled nursing facility (SNF) discharge (42.7% vs 36.5%, P = .04), SNF payments ($16,200 vs $12,100, P = .0002), and average total episode costs ($31,000 vs $27,000, P = .04). Depression predicted bundle cost to be greater than target price (OR 1.82, 95% CI: 1.04-.16; P = .04) and SNF payment greater than 75th percentile (OR: 1.91; 95% CI: 1.00-3.65; P < .05). Similar effects were not seen using MCS. CONCLUSION This is the first study to determine that depression predicts bundle cost greater than target price and SNF payment greater than 75th percentile. Our results emphasize the importance of accurate preoperative assessment of mental health in optimization of care, focusing on attenuating the increased SNF payments associated with depression. As similar effects were not seen using MCS, future studies should analyze the use of validated screening tools for depression, such as the PHQ-9, for more accurate assessments of patient mental health in TJA.
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Towards a Personalized Multi-Domain Digital Neurophenotyping Model for the Detection and Treatment of Mood Trajectories. SENSORS 2020; 20:s20205781. [PMID: 33053889 PMCID: PMC7601670 DOI: 10.3390/s20205781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/02/2020] [Accepted: 10/08/2020] [Indexed: 12/23/2022]
Abstract
The commercial availability of many real-life smart sensors, wearables, and mobile apps provides a valuable source of information about a wide range of human behavioral, physiological, and social markers that can be used to infer the user's mental state and mood. However, there are currently no commercial digital products that integrate these psychosocial metrics with the real-time measurement of neural activity. In particular, electroencephalography (EEG) is a well-validated and highly sensitive neuroimaging method that yields robust markers of mood and affective processing, and has been widely used in mental health research for decades. The integration of wearable neuro-sensors into existing multimodal sensor arrays could hold great promise for deep digital neurophenotyping in the detection and personalized treatment of mood disorders. In this paper, we propose a multi-domain digital neurophenotyping model based on the socioecological model of health. The proposed model presents a holistic approach to digital mental health, leveraging recent neuroscientific advances, and could deliver highly personalized diagnoses and treatments. The technological and ethical challenges of this model are discussed.
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Abdel-Rahman O, Salas AS, Watanabe SM, Li X. Burden of depression among Canadian adults with cancer; results from a national survey. Expert Rev Pharmacoecon Outcomes Res 2020; 21:667-672. [PMID: 32885693 DOI: 10.1080/14737167.2020.1819794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To assess the prevalence and association of depression among Canadian adults with cancer in a population-based context. METHODS The Canadian Community Health Survey (CCHS) (2015-2016) was accessed and adult participants with cancer who completed the Personal Health Questionnaire (PHQ9) were included in the current analysis. Multivariable logistic regression was conducted to elucidate the factors associated with the development of depression. An additional multivariable logistic regression analysis was conducted to evaluate the association of depression with ever contemplating suicide (suicidal ideation). RESULTS A total of 867 participants with cancer have completed PHQ9 were included in the current analysis (including 603 participants (69.6%) without depression (PHQ9 ≤ 4) and 264 participants (30.4%) with depression (PHQ9 > 4)). Moreover, 92 participants (10.6%) fulfill the criteria for moderate/severe depression (PHQ9 > 9). The following factors were associated with the presence of depression (PHQ9 > 4), female sex (OR for males versus females: 0.56; 95% CI: 0.34-0.93; P = 0.02); poor self-perceived health (OR for excellent health versus poor health: 0.12; 95% CI: 0.02-0.62; P = 0.01) and poor self-perceived mental health (OR for excellent mental health versus poor mental health: 0.02; 95% CI: <0.01-0.24; P < 0.01). Additional multivariable logistic regression analysis showed that depression (PHQ9 > 4) was associated with a higher probability of suicidal ideation (OR for no depression versus depression: 0.43; 95% CI: 0.21-0.91; P = 0.02). CONCLUSIONS Depression seems to be an underdiagnosed and possibly undertreated comorbid condition among Canadian adults with cancer.
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Affiliation(s)
- Omar Abdel-Rahman
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Anna Santos Salas
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sharon M Watanabe
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Xinmin Li
- Department of Psychiatry, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada
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Armbrecht E, Shah A, Schepman P, Shah R, Pappadopulos E, Chambers R, Stephens J, Haider S, McIntyre RS. Economic and humanistic burden associated with noncommunicable diseases among adults with depression and anxiety in the United States. J Med Econ 2020; 23:1032-1042. [PMID: 32468879 DOI: 10.1080/13696998.2020.1776297] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aims: This study estimated the economic and humanistic burden associated with chronic non-communicable diseases (NCCDs) among adults with comorbid major depressive and/or any anxiety disorders (MDD and/or AAD).Materials and methods: A retrospective analysis was conducted using the Medical Expenditure Panel Survey data (2010-2015). The analytic cohort included adults (≥18 years) with MDD only (C1), AAD only (C2), or both (C3). The presence of either of 6 NCCDs (cardiovascular diseases [CVD], pulmonary disorders [PD], pain, high cholesterol, diabetes, and obesity) were assessed. Study outcomes included healthcare costs, activity limitations, and quality of life. Multivariate regressions were conducted in each of the 3 cohorts to evaluate the association between the presence of NCCDs and outcomes.Results: The analytic sample included 9,160,465 patients: C1 (4,391,738), C2 (3,648,436), C3 (1,120,292). Pain (59%) was the most common condition, followed by CVD (55%), high cholesterol (50%), obesity (42%), PD (17%), and diabetes (14%). Mean annual healthcare costs were the greatest for C3 ($14,317), followed by C1 ($10,490) and C2 ($7,906). For C1, CVD was associated with the highest increment in annual costs ($3,966) followed by pain ($3,617). For C2, diabetes was associated with the highest incremental annual costs ($4,281) followed by PD ($2,997). For C3, cost trends were similar to those seen in C2. NCCDs resulted in a significant decrease in physical quality of life across all cohorts. Pain was associated with a significantly higher likelihood of self-reported physical, social, cognitive, and activity limitations compared to those without pain.Conclusions: 60% of patients with MDD and/or AAD had at least one additional NCCD, which significantly increased the economic and humanistic burden. These findings are important for payers and clinicians in making treatment decisions. These results underscore the need for development of multi-pronged interventions which aim to improve quality of life and reduce activity limitations among patients with mental health disorders and NCCDs.
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Affiliation(s)
- Eric Armbrecht
- Saint Louis University Center for Health Outcomes Research, St. Louis, MO, USA
| | - Anuj Shah
- Pharmerit International, Bethesda, MD, USA
| | | | | | | | | | | | | | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University of Toronto, Toronto, ON, Canada
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Mausbach BT, Decastro G, Schwab RB, Tiamson-Kassab M, Irwin SA. Healthcare use and costs in adult cancer patients with anxiety and depression. Depress Anxiety 2020; 37:908-915. [PMID: 32485033 PMCID: PMC7484454 DOI: 10.1002/da.23059] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/07/2020] [Accepted: 05/20/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Anxiety and depression are common in individuals with cancer and may impact healthcare service use and costs in this population. This study examined the effects of anxiety alone, depression alone, and comorbid anxiety and depressive disorder on healthcare use and costs among patients with cancer. METHOD This was a retrospective cohort analysis of administrative data of patients aged 18 or older with an International Classification of Diseases, Ninth Revision diagnosis of cancer. Key outcomes were any visit to emergency department (ED), any inpatient hospitalization, length of hospital stays, and annual healthcare costs 1 year from cancer diagnosis. RESULTS A total of 13,426 patients were included. Relative to patients with neither anxiety nor depression, those with anxiety alone, depression alone, or comorbid anxiety and depression were more likely to experience an ED visit and be hospitalized. Length of hospital stays were also longer and annual healthcare costs were significantly higher in all three clinical groups. CONCLUSIONS Cancer patients with anxiety and depression were at greater risk for ED visits and hospitalizations, experienced longer hospital stays, and accrued higher healthcare costs. Future researchers should determine whether screening and treating comorbid anxiety and depression may decrease healthcare utilization and improve turnover wellbeing among cancer patients.
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Affiliation(s)
- Brent T Mausbach
- Department of Psychiatry, University of California San Diego, La Jolla, CA,Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Gabrielle Decastro
- Departments of Psychology, Ohio University, Athens, OH and San Diego State University, San Diego, CA
| | - Richard B Schwab
- Moores Cancer Center, University of California San Diego, La Jolla, CA,Division of Hematology/Oncology, Department of Medicine, University of California San Diego, La Jolla, CA
| | - Maria Tiamson-Kassab
- Department of Psychiatry, University of California San Diego, La Jolla, CA,Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Scott A Irwin
- Cedars-Sinai Cancer & Department of Psychiatry and Behavioral Neurosciences, Cedars Sinai Health System, Los Angeles CA
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50
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Farid D, Li P, Da Costa D, Afif W, Szabo J, Dasgupta K, Rahme E. Undiagnosed depression, persistent depressive symptoms and seeking mental health care: analysis of immigrant and non-immigrant participants of the Canadian Longitudinal Study of Aging. Epidemiol Psychiatr Sci 2020; 29:e158. [PMID: 32792036 PMCID: PMC7443777 DOI: 10.1017/s2045796020000670] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/04/2020] [Accepted: 07/14/2020] [Indexed: 12/19/2022] Open
Abstract
AIMS Early diagnosis and treatment of depression are associated with better prognosis. We used baseline data of the Canadian Longitudinal Study on Aging (2012-2015; ages 45-85 years) to examine differences in prevalence and predictors of undiagnosed depression (UD) between immigrants and non-immigrants at baseline and persistent and/or emerging depressive symptoms (DS) 18 months later. At this second time point, we also examined if a mental health care professional (MHCP) had been consulted. METHODS We excluded individuals with any prior mood disorder and/or current anti-depressive medication use at baseline. UD was defined as the Center for Epidemiological Studies Depression 10 score ⩾10. DS at 18 months were defined as Kessler 10 score ⩾19. The associations of interest were examined in multivariate logistic regression models. RESULTS Our study included 4382 immigrants and 18 620 non-immigrants. The mean age (standard deviation) in immigrants was 63 (10.3) years v. 65 (10.7) years in non-immigrants and 52.1% v. 57.1% were male. Among immigrants, 12.2% had UD at baseline of whom 34.2% had persistent DS 18 months later v. 10.6% and 31.4%, respectively, among non-immigrants. Female immigrants were more likely to have UD than female non-immigrants (odds ratio 1.50, 95% confidence interval 1.25-1.80) but no difference observed for men. The risk of persistent DS and consulting an MHCP at 18 months did not differ between immigrants and non-immigrants. CONCLUSIONS Female immigrants may particularly benefit from depression screening. Seeking mental health care in the context of DS should be encouraged.
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Affiliation(s)
- D. Farid
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - P. Li
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - D. Da Costa
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada
| | - W. Afif
- Department of Medicine, Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada
| | - J. Szabo
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- Chronic Viral Illnesses Service, McGill University Health Center, Montreal, Quebec, Canada
| | - K. Dasgupta
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, Division of General Internal Medicine, McGill University, Montreal, Quebec, Canada
| | - E. Rahme
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada
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