Adaptation and validation of the Patient Health Questionnaire-9 to evaluate major depression in a primary care sample in Latvia

Self-Esteem and Occupational Factors as Predictors of the Incidence of Anxiety and Depression among Healthcare Workers during the COVID-19 Pandemic in Latvia

The prevalence of depression and anxiety among healthcare workers (HCWs) during the COVID-19 pandemic is high. The aim of the study is to identify the importance of self-esteem and occupational factors in association with the incidence of depression and anxiety among HCWs through a longitudinal cohort study during the COVID-19 pandemic in Latvia. Participants received seven questionnaires during the COVID-19 pandemic on demographic parameters, work-related information, and contact with COVID-19 patients, and three standardized questionnaires that evaluated symptoms of anxiety (GAD-7), depression (PHQ-9), and self-esteem (Rosenberg's self-esteem scale). The Generalized Linear Mixed Model (GLMM) was used to identify factors associated with the incidence of depression and anxiety among HCWs. A total of 322 participants were included in the data analysis for depression and 352 for anxiety. HCWs with low self-esteem were 83% more likely to experience depression and 76% more likely to experience anxiety. Working at a general practitioner practice is associated with twice the risk of developing depression and anxiety. A 31% increase in the odds of depression is observed among HCWs with direct contact with COVID-19 patients. The organizational and government levels must look for opportunities to facilitate the mental health of HCWs to ensure better-quality healthcare.

Mediating effect of physical sub-health in the association of sugar-sweetened beverages consumption with depressive symptoms in Chinese college students: A structural equation model

BACKGROUND

Although previous findings with small samples indicated that sugar-sweetened beverages (SSB) consumption was associated with depressive symptoms in adolescents, the mediating effect of physical sub-health in the association is unknown.

METHODS

A survey was conducted among freshmen from 11 provinces in China. A food frequency questionnaire was used to collect dietary behavior, and patient health questionnaire-9 items was used to assess depressive symptoms. A generalized linear model was used to analyze the association between SSB consumption, physical sub-health and depressive symptoms. The structural equation model was used to analyze the mediating effect of physical sub-health.

RESULTS

Of the 31,856 participants, 36.5 % had positive depressive symptoms. After adjusting for variables, carbonate beverages (β = 0.11; 95%CI: 0.07-0.15; P = 0.000) and milk tea (β = 0.07; 95%CI: 0.01-0.13; P = 0.021) consumption was associated with depressive symptoms in boys. Carbonate beverages (β = 0.09; 95%CI: 0.05-0.13; P = 0.000), tea beverages (β = 0.09; 95%CI: 0.04-0.13; P = 0.000), and milk tea (β = 0.08; 95%CI: 0.04-0.11; P = 0.000) consumption was associated with depressive symptoms in girls. The mediating effect of physical sub-health accounted for 81.3 % of the total effect in the mediating model of SSB associated with depressive symptoms.

LIMITATIONS

Retrospective survey has certain information bias. Association observed in the cross-sectional study is uncertain.

CONCLUSIONS

The present study suggests that the consumption of SSB associated with depressive symptoms in Chinese college students, and physical sub-health plays a complete mediating role in the association.

Exploring the Mediating Role of Parental Anxiety in the Link between Children's Mental Health and Glycemic Control in Type 1 Diabetes

Pediatric diabetes type 1 diabetes mellitus (T1D), as a chronic, incurable disease, is associated with psychoemotional and socioeconomic burden for the whole family. Disease outcomes are determined by the metabolic compensation of diabetes, characterized by the level of glycated hemoglobin (HbA1c). The caregivers play a critical role in the metabolic control of children with T1D. The aim of this study was to investigate which environmental factors may explain the relationship between diabetes compensation and anxiety and depression of a child. The cross-sectional interdisciplinary study recruited dyads from adolescents and their parents (N = 251). Adolescent and parent groups were screened for anxiety and depression. General linear model (GLM) mediation analysis was performed to determine the potential mediating effect of surrounding factors on the relationship between dependent variables (glycated hemoglobin) and independent variables (the child's anxiety and depression symptoms). The study revealed that the relationship between HbA1c and the child's anxiety and depression is fully mediated (B = 0.366, z = 4.31, p < 0.001) by parental anxiety. Diabetes metabolic control in adolescents with T1D is related to adolescents' mental health via parents' anxiety. This means that parents' anxiety plays a more significant role in the level of HbA1c than the anxiety and depression of the adolescent.

A novel tool for improving the accuracy of major depressive disorder screening: A prospective study on andrology with external validation

Patient Health Questionnaire-9 (PHQ-9) is the most widely used tool for screening for major depressive disorder (MDD). Although its reliability and validity have been proven, missed or misjudged cases during MDD screening are often encountered. A nomogram that considers the weights of depressive symptoms was developed using data from premature ejaculation patients to improve screening accuracy. During a 33-month prospective study, a training cohort comprising 605 participants from Xijing Hospital was used to develop and internally validate the nomogram. A validation cohort comprising 461 patients from Xi'an Daxing Hospital was also used to externally test the nomogram. The nomogram was established by integrating the LASSO regression-based optimal predictors of MDD according to their coefficients in a multivariate logistic regression model. The nomogram was well-calibrated during internal and external validations. Moreover, it showed a better discriminatory capacity and yielded more net benefits in both validations than PHQ-9. With better performance, the nomogram may help reduce the number of missed or misjudged cases during MDD screening. This study is the first to weigh the direct indicators of MDD under the DSM-5 criteria, presenting a fresh concept that can be applied to other populations to enhance screening accuracy.

Depression and brain fog as long-COVID mental health consequences: Difficult, complex and partially successful treatment of a 72-year-old patient-A case report

SARS-CoV-2 (COVID-19) infection can result in long-term health consequences i.e., long COVID. The clinical manifestations of long COVID include depression, anxiety, brain fog with cognitive dysfunction, memory issues, and fatigue. These delayed effects of COVID-19 occur in up to 30% of people who have had an acute case of COVID-19. In this case report, a 72-year-old, fully vaccinated patient without pre-existing somatic or mental illnesses, or other relevant risk factors was diagnosed with long COVID. Nine months following an acute COVID-19 infection, the patient's depressive symptoms improved, but memory and concentration difficulties persisted, and the patient remains unable to resume work. These long-term symptoms are possibly linked to micro-hemorrhages detected during examinations of the patient's brain following COVID-19 infection. Patient treatment was complex, and positive results were attained via antidepressants and non-drug therapies e.g., art, music, drama, dance and movement therapy, physiotherapy, occupational therapy, and psychotherapy.

Mobile phone use addiction, insomnia, and depressive symptoms in adolescents from ethnic minority areas in China: A latent variable mediation model

BACKGROUND AND AIMS

Although previous studies have discussed the association between mobile phone use addiction (MPUA) and depressive symptoms in adolescents, studies on Chinese adolescents are limited, with no studies being reported on adolescents from ethnic minority areas within Yunnan. This study aimed to explore the mediating mechanism of insomnia in the association between MPUA and depressive symptoms among Yunnan college students.

METHODS

A sample survey was conducted among 10,121 college students from four colleges in Yunnan province, China, from November to December 2021 via cluster sampling. Insomnia was assessed using the Insomnia Severity Index Scale, MPUA was assessed using the Self-Rating Questionnaire for Adolescent Problematic Mobile Phone Use, and depressive symptoms were assessed using the Patient Health Questionnaire-9 items. A generalized linear model was used to analyze the association between MPUA, insomnia, and depressive symptoms. The structural equation model was used to analyze the mediating effect of insomnia.

RESULTS

The positive rates of depressive symptoms, MPUA, and insomnia were 39.2 %, 30.8 %, and 22.3 %, respectively. After adjusting for the demographic and confounding variables, MPUA (β = 0.14, 95 % CI: 0.13-0.15, P < 0.01) and insomnia (β = 0.44, 95 % CI: 0.43-0.46, P < 0.01) were associated with depressive symptoms (P < 0.05). The mediating effect of insomnia accounted for 34.7 % of the total effect in the mediating model of MPUA associated with depressive symptoms.

CONCLUSION

Our findings suggest that insomnia partially mediates the association between MPUA and depressive symptoms among Yunnan college students.

Association of Psoriasis With Anxiety and Depression: A Case-Control Study in Chinese Patients

Background: Patients with psoriasis are prone to suffer from anxiety and depression during their lifetime. This study aimed to investigate the association of psoriasis with anxiety and depression in Chinese patients.

Methods: A case-control study in Chinese patients with psoriasis vulgaris and healthy controls was conducted. Clinical information based on patient-reported, clinical information, and reliable structured questionnaires were collected. Multivariable logistic regression was used to investigate the associations, in terms of adjusted odds ratios (AORs).

Results: We continuously selected 1,571 patients who were firstly diagnosed with psoriasis vulgaris, and 1,571 healthy controls, matched by age and sex. The risk of depression in the psoriasis vulgaris group was higher than that in the healthy controls (AOR = 1.30, P = 0.047), while no differences were found in the risk of anxiety between the two groups (AOR = 1.18, P = 0.381). Subgroup analysis by disease onsets showed that late-onset psoriasis (LOP) was significantly associated with a higher risk of anxiety (AOR = 1.47, P = 0.033) and depression symptoms (AOR = 1.85, P = 0.012) but not with early-onset psoriasis (EOP). Subgroup analysis by disease severity indicated that no difference was observed in the associations of mild psoriasis vulgaris, moderate-to-severe psoriasis vulgaris with anxiety and depression.

Conclusion: Patients with psoriasis vulgaris were more likely to develop depression compared with the general population. LOP patients were positively associated with anxiety and depression. We believe the screening of emotional disorders should be included in the daily management of psoriasis patients.

Mental Health and Associated Demographic and Occupational Factors among Health Care Workers during the COVID-19 Pandemic in Latvia

Background and Objectives: The COVID-19 pandemic has negatively impacted the health care system. Front-line health care workers (HCWs) are at a higher risk of mental health adverse outcomes. The aim of this study was to evaluate the frequency of the symptoms of depression and anxiety and associated demographic and occupational factors among front-line HCWs in Latvia. Materials and Methods: A cross-sectional quantitative study was performed in a population of HCWs during the first wave of the COVID-19 pandemic in Latvia. The participants were interviewed between 28 April 2020 and 2 June 2020. Answers from 864 HCWs were obtained. The participants reported their demographics, work-related information, contacts with COVID-19-positive patients and completed two standardised questionnaires that assessed the symptoms of anxiety (GAD-7) and depression (PHQ-9). The gathered data were analysed by a chi-squared test and binary logistic regression. The data analysis was performed using SPSS v25. Results: A total of 209 (24.8%) participants had depression symptoms and 145 (17.2%) had anxiety symptoms. Health care workers older than 50 had a lower risk of both depression (OR 0.422 (95% CI, 0.262-0.680)) and anxiety (OR 0.468 (95% CI, 0.270-0.813)). General practitioners had more frequent symptoms of depression and anxiety than participants who worked at hospitals (32.8% (n = 63) versus 19.4% (n = 73) and 27.1% (n = 52) versus 10.3% (n = 39), respectively (p = 0.037; p < 0.000)). Working more than 48 h during the week was associated with a higher risk of depression (OR 2.222 (95% CI, 1.315-3.753)) and anxiety (OR 2.416 (95% CI, 1.272-4.586)). Conclusions: The vulnerability of the health care system before the COVID-19 pandemic led to significant mental health adverse outcomes of HCWs during the COVID-19 pandemic in Latvia. A further cohort study is needed to evaluate the dynamics of mental health and other predisposing factors of HCWs.

Screening for depression in primary care with Patient Health Questionnaire-9 (PHQ-9): A systematic review

BACKGROUND

Depression is a leading cause of disability. International guidelines recommend screening for depression and the Patient Health Questionnaire 9 (PHQ-9) has been identified as the most reliable screening tool. We reviewed the evidence for using it within the primary care setting.

METHODS

We retrieved studies from MEDLINE, Embase, PsycINFO, CINAHL and the Cochrane Library that carried out primary care-based depression screening using PHQ-9 in populations older than 12, from 1995 to 2018.

RESULTS

Forty-two studies were included in the systematic review. Most of the studies were cross-sectional (N=40, 95%), conducted in high-income countries (N=27, 71%) and recruited adult populations (N=38, 90%). The accuracy of the PHQ-9 was evaluated in 31 (74%) studies with a two-stage screening system, with structured interview most often carried out by primary care and mental health professionals. Most of the studies employed a cut-off score of 10 (N=24, 57%, total range 5 - 15). The overall sensitivity of PHQ-9 ranged from 0.37 to 0.98, specificity from 0.42 to 0.99, positive predictive value from 0.09 to 0.92, and negative predictive value from 0.8 to 1.

LIMITATIONS

Lack of longitudinal studies, small sample size, and the heterogeneity of primary-care settings limited the generalizability of our results.

CONCLUSIONS

PHQ-9 has been widely validated and is recommended in a two-stage screening process. Longitudinal studies are necessary to provide evidence of long-term screening effectiveness.

Measuring mental health burden in humanitarian settings: a critical review of assessment tools

BACKGROUND

The effects of disasters and conflicts are widespread and heavily studied. While attention to disasters' impacts on mental health is growing, mental health effects are not well understood due to inconsistencies in measurement.

OBJECTIVE

The purpose of this study is to review mental health assessment tools and their use in populations affected by disasters and conflicts.

METHOD

Tools that assess posttraumatic stress disorder, depression, substance use disorder, and general mental health were examined. This review began with a search for assessment tools in PubMed, PsycINFO, and Google Scholar. Next, validation studies for the tools were obtained through snowball sampling. A final search was conducted for scientific studies using the selected tools in humanitarian settings to collect the data for analysis. The benefits and limitations described for each tool were compiled into a complete table.

RESULTS

Twelve assessment tools were included, with 88 studies using them. The primary findings indicate that half of the studies used the Impact of Events Scale-Revised. The most common limitation discussed is that self-report tools inaccurately estimate the prevalence of mental health problems. This inaccuracy is further exacerbated by a lack of cultural appropriateness of the tools, as many are developed for Western contexts.

CONCLUSION

It is recommended that researchers and humanitarian workers reflect on the effectiveness of the mental health assessment tool they use to accurately represent the populations under study in emergency settings. In addition, mental health assessment should be coupled with action.

Using Generalized Anxiety Disorder-2 (GAD-2) and GAD-7 in a Primary Care Setting

Anxiety disorders are highly prevalent in the primary care setting and are responsible for significant morbidity as well as a loss of productivity. Evaluation by mental health specialists and behavioral specialists can sometimes be confounded with problems of availability, accessibility, and the patient's hesitancy to talk to new providers due to lack of prior relationship and trust. Primary care providers already have the advantage of being available for their patients, and have built years of trust behind them to strengthen this relationship. The biggest problems which confront primary care are the time constraints as well as the presence of multiple medical demands. This leads to a constant need for tools that facilitate early recognition and diagnosis of mental health disorders while also providing judicious utilization of clinic time. This article attempts to review the use of two of these popular tools: Generalized Anxiety Disorder scale-2 (GAD-2) and GAD-7 in the primary care setting.

Changes in Cognition, Depression and Quality of Life after Carotid Stenosis Treatment

BACKGROUND

Although several studies have evaluated the change of cognitive performance after severe carotid artery stenosis, the results still remain elusive. The objective of this study was to assess changes in cognitive function, depressive symptoms and Health Related Quality of Life (HRQoL) after carotid stenosis revascularisation and Best Medical Treatment (BMT).

METHODS

Study involved 213 patients with ≥70% carotid stenosis who underwent assessment of cognitive function using Montreal Cognitive Assessment scale (MoCA), depressive symptoms - using Patient Health Questionnaire-9 (PHQ-9) and HRQoL - using Medical Outcome Survey Short Form version 2 (SF-36v2). The assessment was performed before and at 6 and 12 months followup periods in patients who had Carotid Endarterectomy (CEA), Carotid Artery Stenting (CAS) or received BMT only.

RESULTS

Improvement in the total MoCA scores was observed after 6 and 12 months (p<0.001, Kendall's W=0.28) in the CEA group. In the CAS group - after 12 months (p=0.01, Kendall's W=0.261) whereas in the BMT group - no significant changes (p=0.295, Kendall's W=0.081) were observed. Reduction of depressive symptoms was not found in any of the study groups. Comparing mean SF-36v2 scores in the CEA group, there was no significant difference in any of 10 subscales. Likewise in the CAS group - no significant difference in 9 of 10 subscales (p=0.028, η2=0.343) was observed. Three subscales worsened in the BMT group during the 1-year follow-up period.

CONCLUSION

Patients with severe carotid stenosis who underwent revascularisation enhanced their cognitive performance without exerting significant change of depressive symptoms. Preoperative HRQoL may be maintained for at least one year in the CEA group.

Prevalence of major depression and associated correlates in Latvian primary care population: results from the National Research Program BIOMEDICINE 2014-2017

Purpose and aim. In Latvia, the 12-month prevalence of depression in the general population has been estimated at 7.9%, but the data of the National Health Service show that general practitioners (GP's) saw only 3514 unique patients with a diagnosis of mood disorders in 2014. This is the first study conducted at the national level that was aimed to estimate the point and lifetime prevalence of depression and associated factors in primary care settings in Latvia.Materials and methods. This study was conducted at 24 primary care facilities in 2015. During a 1-week period, all consecutive adult patients were invited to complete the study questionnaires. Within a period of 2 weeks, the respondents were interviewed over the phone using the Mini International Neuropsychiatric Interview (M.I.N.I.), Version 6.0.0. A hierarchical multivariate data analysis was performed.Results. The study population consisted of 1485 patients. According to the M.I.N.I., 28.1% (95% CI 25.9-30.4) of the patients had at least one depressive episode in the past, and 10.2% (95% CI 8.7-11.8) had current depression. In the final multivariate analysis model, current major depression was associated with the female gender (OR 2.01), basic or unfinished basic education (OR 1.86), loss of marital ties (OR 1.86), and gastrointestinal (OR 3.46) and oncological (OR 2.26) diseases as a reason for visiting the GP.Conclusions. The prevalence of major depression in primary care is consistent with that in other European countries but is significantly underdiagnosed. Enhanced training in Latvian primary care settings may improve clinical outcomes.

Setting-Specific and Symptom-Specific Association between Secondhand Smoke Exposure and Depressive Symptoms

Few studies have focused on the potential relationship between secondhand smoke (SHS) exposure and depressive symptoms. This study aimed to explore the potential association between SHS exposure and depressive symptoms and differentiate this association in setting-specific exposure and symptom-specific outcomes. A cross-sectional study was conducted in Guangdong province of China from September to December 2010 using a multistage sampling method to randomly sample adults aged 18 years and older. SHS exposure was defined as inhalation by non-smokers of the smoke exhaled from smokers for at least 1 day a week in the past 30 days. Depressive symptoms were measured using the nine-item Patient Health Questionnaire. The zero-inflate negative binomial regression models were used to explore the associations between SHS exposure and depressive symptoms. A total of 2771 non-smokers were included in this study, with mean age of 49.6 ± 14.0 years and 70.3% of females. The prevalence of depressive symptoms was significantly higher in participants with SHS exposure than in those without exposure (incidence rate ratio (IRR) = 1.32, 95% confidence interval (CI) 1.16⁻1.51), and there were similar positive associations for SHS exposure in medical facilities (IRR = 1.37, 95% CI 1.17⁻1.61) and in schools (IRR = 1.46, 95% CI 1.20⁻1.77). Notably, there was a monotonically increasing dose-response relationship between frequency of SHS exposure and depressive symptoms. When differentiating this relationship by the dimensions of depressive symptoms, there were similar dose-response relationships for cognitive-affective and somatic symptoms. When differentiating this relationship by sex, only females showed a significant dose-response relationship. Our findings suggest dose-response relationships between SHS exposure and depressive symptoms in sex-specific and symptom-specific manners. Future longitudinal studies are needed to establish the biological mechanisms of the impact of SHS exposure.

Validity of the PHQ-9 and PHQ-2 to screen for depression in nationwide primary care population in Latvia

BACKGROUND

Depression is highly underdiagnosed in primary care settings in Latvia. Screening for depression in primary care is potentially an efficient way to find undetected case s and improve diagnostics. We aimed to validate both a nine-item and two-item Patient Health Questionnaire (PHQ-9 and PHQ-2) in the Latvian and Russian languages in primary care settings using a representative sample in Latvia.

MATERIALS AND METHODS

The study was carried out within the framework of the National Research Program BIOMEDICINE to assess the prevalence of mental disorders at 24 primary care facilities. During a 1-week period, all consecutive adult patients were invited to complete the PHQ-9 and PHQ-2. Criterion validity was assessed against the Mini International Neuropsychiatric Interview (MINI).

RESULTS

There were 1467 patients who completed the PHQ-9 and the MINI. Overall, the PHQ-9 items showed good internal reliability (Cronbach's alpha 0.81 for Latvian version and 0.79 for Russian version of the PHQ-9). A cut-off score of 8 or greater was established for the PHQ-9 (sensitivity 0.75 and 0.79, specificity 0.84 and 0.80 for Latvian and Russian languages, respectively). For the PHQ-2, a score of 2 or higher (sensitivity 0.79 and 0.79, specificity 0.65 and 0.67 for Latvian and Russian languages) detected more cases of depression than a score of 3 or higher.

CONCLUSIONS

We suggest GPs ask patients to respond to the first 2 questions of the PHQ-9. If their score is positive, the patients should then complete the PHQ-9.

Untreated depression among persons living with human immunodeficiency virus in Kazakhstan: A cross-sectional study

Background

In Kazakhstan, scarce official prevalence data exists for mood disorders. This study investigates the occurrence of depressive symptoms among people living with HIV/AIDS (PLWHA), and the relationship between depressive symptoms, HIV treatment initiation and antiretroviral treatment (ART) adherence.

Methods

A cross-sectional study was conducted among patients seen at the Almaty AIDS Center between April and December 2013. Two data sources were used: 1) self-administered survey that included the Patient Health Questionnaire (PHQ-9) to capture depression symptoms and 2) medical record review. Two primary outcomes were evaluated with log-binomial models and Fisher’s exact test: the relationship between depression symptoms and 1) HIV treatment group, and 2) HIV adherence.

Results

Of the 564 participants, 9.9% reported symptoms consistent with a depressive disorder. None had received treatment for depression. Among those not on ART, a relationship between depressive symptoms and low CD4 counts (≤ 350 cells/mm³) was evident (7.1% for CD4 ≤ 350 cells/mm³ vs. 0.9% for CD4 > 350 cells/mm³, p = 0.029). In multivariable analysis, a higher prevalence of depressive symptoms was statistically associated with ART treatment, positive hepatitis C virus (HCV) status, and being unmarried. For those taking ART, treatment adherence was not statistically associated with a lower prevalence of depressive symptoms (12.5% vs 20.0%, p = 0.176); limited power may have impacted statistical significance.

Conclusions

Untreated depression was found among PLWHA suggesting the need to evaluate access to psychiatric treatment. A collaborative strategy may be helpful to optimize HIV treatment outcomes.

Association of depression and anxiety with cardiovascular co-morbidity in a primary care population in Latvia: a cross-sectional study

BACKGROUND

Cardiovascular (CV) diseases (CVDs) are the leading cause of mortality worldwide. Globally, there is a growing interest in understanding and addressing modifiable psychosocial risk factors, particularly depression and anxiety, to prevent CVDs and to reduce morbidity and mortality. Despite the high premature mortality rate from CVDs in Latvia, this is the first Latvian study to examine the association of depression and anxiety with CVD morbidity in a primary care population.

METHODS

This cross-sectional study was carried out in 2015 within the framework of the National Research Program BIOMEDICINE at 24 primary care facilities throughout Latvia. Consecutive adult patients during a one-week time period at each facility were invited to join the study. Assessments onsite included a 9-item Patient Health Questionnaire (PHQ-9) and a 7-item Generalized Anxiety Disorder scale (GAD-7) followed by a socio-demographic questionnaire and measurements of height, weight, waist circumference, blood pressure, and total cholesterol. The diagnostic Mini International Neuropsychiatric Interview (MINI) was conducted over the telephone within 2 weeks after the visit to the general practitioner. A multivariate model was developed using binary logistic regression.

RESULTS

From the 1565 subjects (31.2% male), CVD was detected in 17.1%. Depression screening was positive (PHQ-9 ≥ 10) for 14.7%, and anxiety screening was positive (GAD-7 ≥ 10) for 10.1% of the study subjects. According to the MINI, 10.3% had current and 28.1% had lifetime depressive episode, and 16.1% had an anxiety disorder. Depression, not anxiety, was statistically significantly related to CVDs with an odds ratio (OR) of 1.52 (p = 0.04) for current depressive symptoms (PHQ-9 ≥ 10) and 2.08 (p = 0.002) for lifetime depressive episode (MINI).

CONCLUSIONS

Current depressive symptoms (PHQ-9 ≥ 10) and a lifetime depressive episode (according to the MINI) were significantly associated with increased risk of CV morbidity. Therefore, CV patients should be screened and treated for depression to potentially improve the prognosis of CVDs. Enhanced training and integration of mental health treatment in Latvian primary care settings may improve clinical outcomes.

Association of Depression and Anxiety With the 10-Year Risk of Cardiovascular Mortality in a Primary Care Population of Latvia Using the SCORE System

Background: Depression and anxiety have been recognized as independent risk factors for both the development and prognosis of cardiovascular (CV) diseases (CVD). The Systematic Coronary Risk Evaluation (SCORE) function measures the 10-year risk of a fatal CVD and is a crucial tool for guiding CV patient management. This study is the first in Latvia to investigate the association of depression and anxiety with the 10-year CV mortality risk in a primary care population. Methods: This cross-sectional study was conducted at 24 primary care facilities. During a 1-week period in 2015, all consecutive adult patients were invited to complete a nine-item Patient Health Questionnaire (PHQ-9) and a seven-item Generalized Anxiety Disorder scale (GAD-7) followed by sociodemographic questionnaire and physical measurements. The diagnostic Mini International Neuropsychiatric Interview (M.I.N.I.) was administered by telephone in the period of 2 weeks after the first contact at the primary care facility. A hierarchical multivariate analysis was performed. Results: The study population consisted of 1,569 subjects. Depressive symptoms (PHQ-9 ≥10) were associated with a 1.57 (95% confidence interval (CI): 1.06-2.33) times higher odds of a very high CV mortality risk (SCORE ≥10%), but current anxiety disorder (M.I.N.I.) reduced the CV mortality risk with an odds ratio of 0.58 (95% CI: 0.38-0.90). Conclusions: Our findings suggest that individuals with SCORE ≥10% should be screened and treated for depression to potentially delay the development and improve the prognosis of CVD. Anxiety could possibly have a protective influence on CV prognosis.