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Remigio-Baker RA, Hungerford LD, Bailie JM, Ivins BJ, Lopez J, Ettenhofer ML. The Patient Global Impression of Change as a complementary tool to account for neurobehavioral and mental health symptom improvement for patients with concussion. Disabil Rehabil 2024:1-9. [PMID: 38821113 DOI: 10.1080/09638288.2024.2346233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/17/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE The purpose of this study was to determine the extent to which patient's perspective of symptom improvement, as indexed by the Patient Global Impression of Change (PGIC) survey, is associated with symptom improvement on common measures of neurobehavioral and mental health symptoms following concussion. MATERIALS AND METHODS Data were from 449 US active duty service members receiving treatment in interdisciplinary programs for their concussion. PGIC rating (range = 1-7) was evaluated for compatibility in assessing improvement in or clinically-elevated neurobehavioral (using Neurobehavioral Symptom Inventory [NSI]) and mental health (using Post-traumatic Stress Disorder Checklist, DSM-5 [PCL-5] and Patient Health Questionnaire [PHQ-8]) symptoms. RESULTS Higher PGIC scores were related to a higher prevalence of clinically-relevant decrease in NSI, PCL-5 or PHQ-8 scores. Participants with a PGIC rating of 3+ (vs.<3) were about 2.2 (CI = 1.4-3.5), 1.6 (CI = 1.1-1.3), and 2.7 (CI = 1.4-5.1) times more likely to report clinically-relevant decrease in NSI, PCL-5 and PHQ-8 symptoms, respectively. CONCLUSION PGIC may help providers incorporate patients' perspectives on symptom improvement achieved during rehabilitation. An approach combining PGIC with surveys such as NSI, PCL-5 and PHQ-8 may provide a more comprehensive understanding of symptom improvement and realistic view of expectations for what would be deemed recovery to pre-injury symptom levels.
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Affiliation(s)
- Rosemay A Remigio-Baker
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA
- Compass Government Solutions, Annapolis, MD, USA
| | - Lars D Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Medical Center San Diego, San Diego, CA, USA
| | - Jason M Bailie
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
| | - Brian J Ivins
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
| | - Juan Lopez
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
| | - Mark L Ettenhofer
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Medical Center San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
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Hay BR, Schroder HS. Predictors of psychiatric treatment-seeking attitudes in older adults. Aging Ment Health 2024:1-8. [PMID: 38804059 DOI: 10.1080/13607863.2024.2354347] [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: 02/25/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES Understanding the factors that contribute to treatment-seeking attitudes among older adults-a growing population with frequent mental health concerns-is vital. Although past research has identified some demographic and belief-based predictors of mental health treatment attitudes among this population, previous studies are limited by only evaluating these variables in isolation and not distinguishing between different types of treatment (e.g. medication and psychotherapy). METHODS In a pre-registered online survey of 606 older adults (age 60 years and older), we evaluated stigmatizing attitudes, etiological beliefs about depression, psychological symptoms, and health literacy as well as attitudes about psychotherapy and medication separately. RESULTS Pre-registered linear regression analyses showed that greater stigmatizing attitudes uniquely predicted more negative attitudes for both therapy and medication treatment seeking over and above gender, education, income, extrinsic barriers, health literacy, depression, and anxiety. Additionally, loneliness was a significant predictor of less favorable medication attitudes. Exploratory analysis revealed that attributing depression to a chemical imbalance predicted positive attitudes about medication, but not psychotherapy. CONCLUSION These findings indicate that older adults' treatment-seeking behaviors are separately influenced by stigma, etiological beliefs, and loneliness.
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Affiliation(s)
- Briana R Hay
- Department of Psychology, University of Michigan, Ann Arbor, USA
| | - Hans S Schroder
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, USA
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Remigio-Baker RA, Bailie JM, Ettenhofer ML, Cordero E, Hungerford LD. The Impact of Lifetime Traumatic Brain Injury (TBI) on Mental Health Symptoms among Service Members in Interdisciplinary TBI Programs. Mil Med 2023; 188:199-207. [PMID: 37948227 DOI: 10.1093/milmed/usad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/14/2023] [Accepted: 05/04/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) is highly prevalent among active duty service members (ADSMs) and imposes a significant health burden, particularly on mental health (e.g., post-traumatic stress disorder [PTSD] and depressive symptoms). Little is known about how TBI setting characteristics impact PTSD and depressive symptom expression in service members undergoing interdisciplinary TBI care. MATERIALS AND METHODS The study included 455 patients enrolled in interdisciplinary, outpatient TBI programs within the military health system. Using Poisson regression with robust error variance, TBI injury setting characteristics (i.e., before military service, during military training, and during noncombat/combat deployment) were evaluated against clinically-elevated PTSD (PTSD Checklist, DSM-5 score ≥ 33) and depressive (Patient Health Questionnaire-8 score ≥ 15) symptoms. RESULTS In adjusted models, TBI sustained before military service was associated with less likelihood for clinically-elevated PTSD symptoms at pretreatment (prevalence ratio [PR] = 0.76, confidence interval [CI] = 0.60-0.96) and post-treatment (PR = 0.67, CI = 0.52-0.87). TBI sustained during combat deployment, however, resulted in the greatest impact on clinically-elevated pretreatment PTSD (PR = 1.49, CI = 1.16-1.91) and depressive (PR = 1.47, CI = 1.06-2.03) symptoms. Null results were found between military training/noncombat deployment and mental health symptoms. Regardless of the TBI setting, following TBI treatment, there remained 37.5% (n = 180) and 24.8% (n = 108) with clinically-elevated PTSD and depressive symptoms, respectively. CONCLUSIONS There was a differential impact of TBI settings, particularly between TBI sustained before military service and that from combat deployment among ADSMs enrolled in outpatient TBI programs. This may be indicative of differences in the characteristics of these environments (e.g., injury severity) or the impact of such an event during recovery from current TBIs. The large percentage of ADSMs who present with clinically-elevated mental health symptoms after treatment may suggest the need for additional resources to address mental health needs before, during, and after treatment in TBI programs.
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Affiliation(s)
- Rosemay A Remigio-Baker
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring Metro Center I, Silver Spring, MD 20910, USA
- Compass Government Solutions, Annapolis, MD 21401, USA
| | - Jason M Bailie
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring Metro Center I, Silver Spring, MD 20910, USA
- General Dynamics Information Technology, Falls Church, VA 22042, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA 92055, USA
| | - Mark L Ettenhofer
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring Metro Center I, Silver Spring, MD 20910, USA
- General Dynamics Information Technology, Falls Church, VA 22042, USA
- Naval Medical Center of San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA
- University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Evelyn Cordero
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring Metro Center I, Silver Spring, MD 20910, USA
- General Dynamics Information Technology, Falls Church, VA 22042, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA 92055, USA
| | - Lars D Hungerford
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring Metro Center I, Silver Spring, MD 20910, USA
- General Dynamics Information Technology, Falls Church, VA 22042, USA
- Naval Medical Center of San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA
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Mund M, Uhlenbusch N, Rillig F, Weiler-Normann C, Herget T, Kubisch C, Löwe B, Schramm C. Psychological distress of adult patients consulting a center for rare and undiagnosed diseases: a cross-sectional study. Orphanet J Rare Dis 2023; 18:82. [PMID: 37060005 PMCID: PMC10103043 DOI: 10.1186/s13023-023-02669-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/11/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Centers for rare diseases serve as contact points for patients with complex, often undiagnosed complaints and persistent somatic symptoms of heterogeneous origin. Little is known about psychological distress of patients consulting these centers. OBJECTIVES To better understand psychological distress of adult patients presenting at a center for rare diseases by determining the proportion of patients screening positive for depressive, anxiety, and somatic symptom disorders (SSD) and to identify factors associated with increased psychopathology. METHODS Cross-sectional data from the routine care registry of the Martin Zeitz Center for Rare Diseases (MZCSE) at the University Medical Center Hamburg-Eppendorf in Germany was retrieved and analyzed. We included all adult patients presenting between October 01,2020 and September 30,2021, who gave written informed consent. MEASURES Sociodemographic variables, medical history and healthcare utilization, as well as validated measures to screen for a depressive disorder (PHQ-8), an anxiety disorder (GAD-7), and SSD (PHQ-15, SSD-12). RESULTS N = 167 patients were included (age 44.5 ± 14.3 years, 64.7% female). A total of 40.7% of the patients screened positive for a depressive disorder (PHQ-8 ≥ 10), 27.5% for an anxiety disorder (GAD-7 ≥ 10) and 45.0% screened positive for SSD (PHQ-15 ≥ 9 & SSD-12 ≥ 23). Factors associated with increased psychopathology included the number of symptoms, the number of different specialties consulted before and past psychotherapy. CONCLUSIONS Patients presenting at centers for rare diseases are likely to experience high rates of psychological distress. Systematically screening patients with rare and undiagnosed diseases for mental disorders can help to detect those at risk at an early stage and initiate adequate psychological care.
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Affiliation(s)
- Meike Mund
- Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Natalie Uhlenbusch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany
| | - Franziska Rillig
- Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Weiler-Normann
- Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Theresia Herget
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Kubisch
- Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany
| | - Christoph Schramm
- Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Remigio-Baker RA, Hungerford LD, Ettenhofer ML, Barnard LL, Babakhanyan I, Ivins B, Stuessi K, Monasterio CDJ, Bailie JM. Presenting symptoms as prognostic measures of mental health recovery among service members with concussion. Front Neurol 2023; 13:1070676. [PMID: 36712430 PMCID: PMC9880328 DOI: 10.3389/fneur.2022.1070676] [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: 10/15/2022] [Accepted: 12/12/2022] [Indexed: 01/15/2023] Open
Abstract
Background Comorbid mental illness may negatively impact recovery from concussion. This study evaluated whether the level of symptom clusters at clinic intake contribute to poor mental health recovery in concussed patients during treatment, which may in turn serve as a target intervention. Objective The objective of this study is to examine the association between the level of initial symptoms and mental health symptoms among service members with concussion. Methods Data were obtained from 483 active duty service members treated in interdisciplinary treatment programs for traumatic brain injury, all of which were concussions. Pre-treatment symptom clusters included self-reported hyperarousal, dissociation/depression, cognitive dysfunction/headache and neurological symptoms. The outcomes, clinically-relevant decreases in depressive symptoms (assessed by the 8-item Patient Health Questionnaire, PHQ-8) and PTSD symptoms (assessed by the PTSD Checklist for DSM-5, PCL-5), were defined as a decrease in PHQ-8 > 5 and PCL-5 > 7, respectively. Poisson regression with robust error variance was used to evaluate the relationship between the level of each symptom cluster and clinically-relevant decrease in outcomes. Results Participants with higher (vs. lower) levels of pre-treatment hyperarousal and dissociation/depression symptom cluster were less likely to improve in depressive and PTSD symptoms during treatment. The level of cognitive/headache and neurological symptom clusters were not significantly associated with any symptom changes. Conclusion These findings support the need for individualized treatment for symptoms identified and treated after determining concussion history, with particular attention to high levels of hyperarousal and dissociation/depression prior to treatment.
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Affiliation(s)
- Rosemay A. Remigio-Baker
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, United States,General Dynamics Information Technology, Falls Church, VA, United States,*Correspondence: Rosemay A. Remigio-Baker ✉
| | - Lars D. Hungerford
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, United States,General Dynamics Information Technology, Falls Church, VA, United States,Naval Medical Center at San Diego, San Diego, CA, United States
| | - Mark L. Ettenhofer
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, United States,General Dynamics Information Technology, Falls Church, VA, United States,Naval Medical Center at San Diego, San Diego, CA, United States,University of California, San Diego, La Jolla, CA, United States
| | - Lori L. Barnard
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, United States,General Dynamics Information Technology, Falls Church, VA, United States,Naval Hospital Camp Pendleton, Intrepid Spirit 7, Camp Pendleton, CA, United States
| | - Ida Babakhanyan
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, United States,General Dynamics Information Technology, Falls Church, VA, United States,Naval Hospital Camp Pendleton, Intrepid Spirit 7, Camp Pendleton, CA, United States
| | - Brian Ivins
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, United States,General Dynamics Information Technology, Falls Church, VA, United States
| | - Keith Stuessi
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, United States,General Dynamics Information Technology, Falls Church, VA, United States
| | - Carlos Diego J. Monasterio
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, United States,General Dynamics Information Technology, Falls Church, VA, United States,Naval Medical Center at San Diego, San Diego, CA, United States
| | - Jason M. Bailie
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, United States,General Dynamics Information Technology, Falls Church, VA, United States,Naval Hospital Camp Pendleton, Intrepid Spirit 7, Camp Pendleton, CA, United States
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Remigio-Baker RA, Hungerford LD, Lee-Tauler SY, Bailie JM, Caswell M, Babakhanyan I, Ettenhofer ML. Disparities in mental health symptoms recovery across race/ethnicity and education level following mild traumatic brain injury. DIALOGUES IN HEALTH 2022; 1:100048. [PMID: 38515877 PMCID: PMC10953859 DOI: 10.1016/j.dialog.2022.100048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/10/2022] [Accepted: 09/20/2022] [Indexed: 03/23/2024]
Abstract
Purpose The purpose of this study was to investigate the relationship between race/ethnicity and post-concussive mental health (i.e., depressive, post-traumatic stress disorder [PTSD]) and neurobehavioral symptoms among service members, and whether this association differed by education level. Methods The study sample consisted of 524 patients from a multidisciplinary US military outpatient treatment facility for post-concussive symptoms. Poisson regression with robust error variance was utilized to investigate outcome (i.e., clinically-elevated depressive [Patient Health Questionnaire-8 ≥15], PTSD [PTSD Checklist, DSM 5 ≥38] and neurobehavioral [Neurobehavioral Symptom Inventory >75th percentile] symptoms at admission and last follow-up in this cohort study. Modification by education level (low [no college degree] vs. high [associate's degree or higher]) was additionally evaluated. Results The relationship between race/ethnicity and mental health/neurobehavioral symptoms varied by education level (p-interaction: depressive symptoms = 0.002, PTSD symptoms = 0.035, neurobehavioral symptoms = 0.040). Specifically, non-Whites were at a significantly higher prevalence for clinically-elevated depressive symptoms post-treatment than Whites, but only among those with higher education level (PR = 2.22, CI = 1.37-3.59). A similar trend was demonstrated for PTSD and neurobehavioral symptoms. Conclusion Military healthcare may need to increase depression-focused treatment options that are acceptable for racial/ethnic minority patients, particularly those with higher education, while they are recovering from comorbid traumatic brain injury.
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Affiliation(s)
- Rosemay A. Remigio-Baker
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
| | - Lars D. Hungerford
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Medical Center San Diego, San Diego, CA, USA
| | - Su Yeon Lee-Tauler
- Henry M. Jackson Foundation, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jason M. Bailie
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
| | - Melissa Caswell
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
| | - Ida Babakhanyan
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
| | - Mark L. Ettenhofer
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Medical Center San Diego, San Diego, CA, USA
- University of California, San Diego, La Jolla, CA, USA
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Geographic Region, Racial/Ethnic Disparities, and Late-Life Depression: Results From a Large US Cohort of Older Adults. Am J Geriatr Psychiatry 2022; 30:703-716. [PMID: 34969584 PMCID: PMC9106835 DOI: 10.1016/j.jagp.2021.11.010] [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: 03/29/2021] [Revised: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine associations between geographic region and late-life depression (LLD) severity, item-level symptom burden, and treatment; to evaluate whether racial/ethnic disparities in LLD, previously observed in the overall sample, vary by region. METHODS We included 25,502 VITAL (Vitamin D and Omega-3 Trial) participants and administered the Patient Health Questionnaire-8 for depressive symptoms; participants also reported medication and/or counseling care for depression. Multivariable regression analyses were performed. RESULTS Despite overall lower LLD severity and item-level symptom burden in the Midwest versus Northeast, higher LLD severity and item-level burden were observed among minorities, especially Black and Hispanic adults, compared to non-Hispanic whites in this region. Racial/ethnic disparities in item-level symptoms (e.g., anhedonia, sadness, psychomotor changes) varied by region. There were no significant differences in depression care by region; furthermore, regional variation was not observed in racial disparities in care: e.g., among those with clinician/physician-diagnosed depression, Blacks versus non-Hispanic whites had greater than 50% lower odds of treatment in all regions. CONCLUSION LLD varied by geographic region. Furthermore, magnitudes of racial/ethnic disparities in LLD severity and item-level symptom burden, but not depression care, differed by region.
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Cultural attributes of suicidal ideation among older immigrants: a qualitative study. BMC Geriatr 2022; 22:678. [PMID: 35172754 PMCID: PMC8851697 DOI: 10.1186/s12877-021-02628-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/24/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Suicide is a large and growing public health problem. Little is known about the attributes of suicidal ideation (SI) in the contexts of immigration. This qualitative study aims to explore immigration- and acculturation-related attributes of SI among older immigrants. METHODS A qualitative semi-structured interview design. Interview were conducted with 57 older Chinese immigrants in Chicago with self-reported SI in the past month. RESULTS In addition to attributes of SI which have been well documented in the literature, we identified immigration- and acculturation-related attributes, including linguistic and cultural barriers of being integrated to the receiving communities, acculturation gaps in intergenerational support, and uselessness. CONCLUSIONS Findings of the study highlight the intersectionality of race, culture, and aging regarding SI, which are essential to improve recognition and understanding of SI among immigrant populations.
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Ravona-Springer R, Lutski M, Schnaider Beeri M, Goldbourt U, Tanne D. C-reactive protein in midlife is associated with depressive symptoms two decades later among men with coronary heart disease. Nord J Psychiatry 2020; 74:226-233. [PMID: 31769325 DOI: 10.1080/08039488.2019.1695284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Aim: We investigated the relationship between midlife C-reactive protein (CRP) levels in men with coronary heart disease (CHD) and depressive symptoms at old age. CRP levels were measured in a subset of patients with CHD, who previously participated in a secondary prevention trial.Methods: Depressive symptoms were evaluated in survivors of the original cohort 15.0 ± 3 and 19.9 ± 1 years later (T1, n = 463 and T2, n = 314 respectively) using the Geriatric Depression Scale (GDS), 15-item version. Logistic regression was used to estimate ORs and 95%CIs for presence of potentially clinically significant depressive symptoms (GDS ≥5) at T1 and T2.Results: Adjusting for demographic and health-related variables, the OR (95%CI) for GDS ≥5 was 1.23 (0.65-2.33); p = .53 at T1 and 2.36 (1.16-4.83); p = .018 at T2 in the top CRP tertile compared to the others. Similarly, consistently high CRP levels in the top tertile at baseline and 2 years later, were associated with OR of 2.85 (95%CI 1.29-6.30); p = .01 for GDS ≥5 at T2.Conclusions: Presence and persistence of low-grade inflammation in men with CHD during midlife are associated with increased risk of depressive symptoms twenty years later. Among middle aged men with CHD, low-grade inflammation may provide an important added value for prediction of depression in old age.
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Affiliation(s)
- Ramit Ravona-Springer
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel.,Psychiatric Division, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Miri Lutski
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Israel
| | - Michal Schnaider Beeri
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Uri Goldbourt
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Tanne
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Stroke and Cognition Institute, Rambam Health Care Campus, Haifa, Israel
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Vyas CM, Donneyong M, Mischoulon D, Chang G, Gibson H, Cook NR, Manson JE, Reynolds CF, Okereke OI. Association of Race and Ethnicity With Late-Life Depression Severity, Symptom Burden, and Care. JAMA Netw Open 2020; 3:e201606. [PMID: 32215634 PMCID: PMC7325738 DOI: 10.1001/jamanetworkopen.2020.1606] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Importance Knowledge gaps persist regarding racial and ethnic variation in late-life depression, including differences in specific depressive symptoms and disparities in care. Objective To examine racial/ethnic differences in depression severity, symptom burden, and care. Design, Setting, and Participants This cross-sectional study included 25 503 of 25 871 community-dwelling older adults who participated in the Vitamin D and Omega-3 Trial (VITAL), a randomized trial of cancer and cardiovascular disease prevention conducted from November 2011 to December 2017. Data analysis was conducted from June to September 2018. Exposure Racial/ethnic group (ie, non-Hispanic white; black; Hispanic; Asian; and other, multiple, or unspecified race). Main Outcomes and Measures Depressive symptoms, assessed using the Patient Health Questionnaire-8 (PHQ-8); participant-reported diagnosis, medication, and/or counseling for depression. Differences across racial/ethnic groups were evaluated using multivariable zero-inflated negative binomial regression to compare PHQ-8 scores and multivariable logistic regression to estimate odds of item-level symptom burden and odds of depression treatment among those with diagnosed depression. Results There were 25 503 VITAL participants with adequate depression data (mean [SD] age, 67.1 [7.1] years) including 12 888 [50.5%] women, 17 828 [69.9%] non-Hispanic white participants, 5004 [19.6%] black participants, 1001 [3.9%] Hispanic participants, 377 [1.5%] Asian participants, and 1293 participants [5.1%] who were categorized in the other, multiple, or unspecified race group. After adjustment for sociodemographic, lifestyle, and health confounders, black participants had a 10% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (rate ratio [RR], 1.10; 95% CI, 1.04-1.17; P < .001); Hispanic participants had a 23% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (RR, 1.23; 95% CI, 1.10-1.38; P < .001); and participants in the other, multiple, or unspecified group had a 14% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (RR, 1.14; 95% CI, 1.04-1.25; P = .007). Compared with non-Hispanic white participants, participants belonging to minority groups had 1.5-fold to 2-fold significantly higher fully adjusted odds of anhedonia (among black participants: odds ratio [OR], 1.76; 95% CI, 1.47-2.11; among Hispanic participants: OR, 1.96; 95% CI, 1.43-2.69), sadness (among black participants: OR, 1.31; 95% CI, 1.07-1.60; among Hispanic participants: OR, 2.09; 95% CI, 1.51-2.88), and psychomotor symptoms (among black participants: OR, 1.77; 95% CI, 1.31-2.39; among Hispanic participants: OR, 2.12; 95% CI, 1.28-3.50); multivariable-adjusted odds of sleep problems and guilt appeared higher among Hispanic vs non-Hispanic white participants (sleep: OR, 1.24; 95% CI, 1.01-1.52; guilt: 1.84; 95% CI, 1.31-2.59). Among those with clinically significant depressive symptoms (ie, PHQ-8 score ≥10) and/or those with diagnosed depression, black participants were 61% less likely to report any treatment (ie, medications and/or counseling) than non-Hispanic white participants after adjusting for confounders (adjusted OR, 0.39; 95% CI, 0.27-0.56). Conclusions and Relevance In this cross-sectional study, significant racial and ethnic differences in late-life depression severity, item-level symptom burden, and depression care were observed after adjustment for numerous confounders. These findings suggest a need for further examination of novel patient-level and clinician-level factors underlying these associations.
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Affiliation(s)
- Chirag M. Vyas
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Grace Chang
- Department of Psychiatry, VA Boston Healthcare System, Brockton, MA, USA
| | - Heike Gibson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Nancy R. Cook
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - JoAnn E. Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Charles F. Reynolds
- Department of Psychiatry, UPMC and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Olivia I. Okereke
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
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Donneyong M, Reynolds C, Mischoulon D, Chang G, Luttmann-Gibson H, Bubes V, Guilds M, Manson J, Okereke O. Protocol for studying racial/ethnic disparities in depression care using joint information from participant surveys and administrative claims databases: an observational cohort study. BMJ Open 2020; 10:e033173. [PMID: 31915172 PMCID: PMC6955513 DOI: 10.1136/bmjopen-2019-033173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Current evidence indicates that older racial/ethnic minorities encounter disparities in depression care. Because late-life depression is common and confers major adverse health consequences, it is imperative to reduce disparities in depression care. Thus, the primary objectives of this protocol are to: (1) quantify racial/ethnic disparities in depression treatment and (2) identify and quantify the magnitude of these disparities accountable for by a multifactorial combination of patient, provider and healthcare system factors. METHODS AND ANALYSIS Data will be derived from the Vitamin D and Omega-3 Trial-Depression Endpoint Prevention (VITAL-DEP) study, a late-life depression prevention ancillary study to the VITAL trial. A total of 25 871 men and women, aged 50+ and 55+ years, respectively, were randomised in a 2×2 factorial randomised trial of heart disease and cancer prevention to receive vitamin D and/or fish oil for 5 years starting from 2011. Most participants were aged 65+ years old at randomisation. Medicare claims data for over 19 000 VITAL/VITAL-DEP participants were linked to conduct our study.The major study outcomes are depression treatment (antidepressant use and/or receipt of psychotherapy services) and adherence to medication treatment (antidepressant adherence and acceptability). The National Academy of Medicine framework for studying racial disparities was leveraged to select patient-level, provider-level and healthcare system-level variables and to address their potential roles in depression care disparities. Blinder-Oaxaca regression decomposition methods will be implemented to quantify and identify correlates of racial/ethnic disparities in depression treatment and adherence. ETHICS AND DISSEMINATION This study received Institutional Review Board (IRB) approval from the Partners Healthcare (PHS) IRB, protocol# 2010P001881. We plan to disseminate our results through publication of manuscripts patient engagement activities, such as study newsletters regularly sent out to VITAL participants, and presentations at scientific meetings. TRIAL REGISTRATION NUMBER NCT01696435.
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Affiliation(s)
- Macarius Donneyong
- Pharmacy Practice and Science, College of Pharmacy, The Ohio University State University, Columbus, Ohio, USA
| | - Charles Reynolds
- Psychiatry, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Grace Chang
- Psychiatry, Harvard University, Cambridge, Massachusetts, USA
- Psychiatry, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - Heike Luttmann-Gibson
- Psychiatry, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Vadim Bubes
- Psychiatry, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Joann Manson
- Psychiatry, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Olivia Okereke
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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12
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Cheruvu VK, Chiyaka ET. Prevalence of depressive symptoms among older adults who reported medical cost as a barrier to seeking health care: findings from a nationally representative sample. BMC Geriatr 2019; 19:192. [PMID: 31319807 PMCID: PMC6639933 DOI: 10.1186/s12877-019-1203-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 07/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older adults aged 65 and over will make up more than 20% of U.S. residents by 2030, and in 2050, this population will reach 83.7 million. Depression among older adults is a major public health concern projected to be the second leading cause of disease burden. Despite having Medicare, and other employer supplements, the burden of out of pocket healthcare expenses may be an important predictor of depression. The current study aims to investigate whether delay in seeing a doctor when needed but could not because of medical cost is significantly associated with symptoms of current depression in older adults. METHODS Cross-sectional data from the 2011 Behavioral Risk Factor Surveillance System (BFRSS) from 12 states and Puerto Rico were used for this study (n = 24,018). RESULTS The prevalence of symptoms of current depression among older adults who reported medical cost as a barrier to seeking health care was significantly higher (17.8%) when compared to older adults who reported medical cost not being a barrier to seeking health care (5.5%). Older adults who reported medical cost as a barrier to seeking health care were more likely to report current depressive symptoms compared to their counterparts [Adjusted Odds Ratio (AOR): 2.2 [95% CI: 1.5-3.3]). CONCLUSIONS Older adults (≥ 65 years of age) who experience the burden of medical cost for health care are significantly more likely to report symptoms of depression. Health care professionals and policymakers should consider effective interventions to improve access to health care among older adults.
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Affiliation(s)
- Vinay K Cheruvu
- College of Public Health, Kent State University, 320 Lowry Hall, 750 Hilltop Drive, Kent, OH, 44242, USA.
| | - Edward T Chiyaka
- College of Public Health, Kent State University, 320 Lowry Hall, 750 Hilltop Drive, Kent, OH, 44242, USA
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13
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Shin C, Lee SH, Han KM, Yoon HK, Han C. Comparison of the Usefulness of the PHQ-8 and PHQ-9 for Screening for Major Depressive Disorder: Analysis of Psychiatric Outpatient Data. Psychiatry Investig 2019; 16:300-305. [PMID: 31042692 PMCID: PMC6504773 DOI: 10.30773/pi.2019.02.01] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/01/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to demonstrate that the Patient Health Questionnaire (PHQ)-8 is not less useful than the PHQ-9 as a screening test for major depressive disorder (MDD). METHODS We performed a retrospective analysis of 567 patients in psychiatric outpatient units. The Mini International Neuropsychiatric Interview was used to diagnose MDD. We derived the validity and reliability of the PHQ-8 and PHQ-9. To evaluate the ability of the PHQ-8 and PHQ-9 to discriminate MDD, we drew receiver operating characteristic (ROC) curves and compared the areas under the curves (AUCs). RESULTS Of the 567 participants, 207 (36.5%) were diagnosed with MDD. Cronbach's αs for the PHQ-8 and PHQ-9 were 0.892 and 0.876, respectively. Similar to the PHQ-9, the PHQ-8 was also associated with scores on the Hamilton Depression Rating Scale in a correlation analysis. When we drew ROC curves for the PHQ-8 and PHQ-9, there was no statistically significant difference in the AUCs. With a cutoff score of 10, the PHQ-8 showed a sensitivity of 58.3%, specificity of 83.1%, positive predictive value of 53.4%, and negative predictive value of 85.7%. CONCLUSION In a psychiatric outpatient sample, the PHQ-8 was as useful as the PHQ-9 for MDD screening.
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Affiliation(s)
- Cheolmin Shin
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung-Hoon Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyu-Man Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ho-Kyoung Yoon
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
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Okereke OI, Reynolds CF, Mischoulon D, Chang G, Cook NR, Copeland T, Friedenberg G, Buring JE, Manson JE. The VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention (VITAL-DEP): Rationale and design of a large-scale ancillary study evaluating vitamin D and marine omega-3 fatty acid supplements for prevention of late-life depression. Contemp Clin Trials 2018; 68:133-145. [PMID: 29526608 PMCID: PMC5899680 DOI: 10.1016/j.cct.2018.02.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/19/2018] [Accepted: 02/27/2018] [Indexed: 02/07/2023]
Abstract
RATIONALE Depression is a leading cause of disease burden and disability for older adults; thus, prevention is a priority. Biologic and observational data support potential mental health benefits of vitamin D and omega-3 fatty acids; however, it is unclear whether these supplements can prevent late-life depression. DESIGN We describe the novel methodology of a large-scale study: VITAL-DEP (VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention), an ancillary to the VITAL trial. Primary Aims of VITAL-DEP are to determine effects on prevention of depression and on trajectory of mood symptoms of long-term (mean=5years) supplementation with vitamin D (vitamin D3 [cholecalciferol], 2000IU/day) and marine omega-3 fatty-acids (eicosapentaenoic acid + docosahexaenoic acid, 1g/day), in a 2×2 factorial design, among 25,874 older adults. Secondary Aims will evaluate: vitamin D's effects among African-Americans (an at-risk group for vitamin D deficiency); both agents' effects among those with high-risk factors or sub-syndromal depression in a sub-set of ~1000 participants with detailed examinations at baseline and 2-year follow-up; whether baseline nutrient levels influence depression risk and/or modify agents' effects. Additional planned analyses will use pre-randomization blood samples available in ~17,000 participants to address whether key biomarkers and factors influence long-term mood and depression risk and/or the agents' effects. CONCLUSION VITAL-DEP applies all modalities of state-of-the-art prevention research - universal, selective and indicated. VITAL-DEP will clarify effects of supplemental vitamin D and/or omega-3 on mood, and inform clinical care and public health guidelines on the use of these agents for prevention of depression in mid-life and older adults.
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Affiliation(s)
- Olivia I Okereke
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Charles F Reynolds
- Department of Psychiatry, UPMC and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Grace Chang
- VA Boston Healthcare System, Brockton, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Nancy R Cook
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Trisha Copeland
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Georgina Friedenberg
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Julie E Buring
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Pynnönen K, Törmäkangas T, Rantanen T, Tiikkainen P, Kallinen M. Effect of a social intervention of choice vs. control on depressive symptoms, melancholy, feeling of loneliness, and perceived togetherness in older Finnish people: a randomized controlled trial. Aging Ment Health 2018; 22:77-84. [PMID: 27657351 DOI: 10.1080/13607863.2016.1232367] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study examined effects of a social intervention on depressive symptoms, melancholy, loneliness, and perceived togetherness in community-dwelling Finnish older people. METHOD Promotion of mental well-being in older people (GoodMood; ISRCTN78426775) was a single-blinded randomized control trial lasting 1.5 years. Two hundred and twenty-three persons aged 75-79 years reporting symptoms of loneliness or melancholy were randomized into intervention and control groups. The intervention group was allowed to choose among supervised exercise, social activity, or personal counseling. Follow-up measurements were conducted at the end of 6-month intervention, and at 3, 6, and 12 months post intervention. RESULTS Number of depressive symptoms remained unchanged, while loneliness and melancholy decreased in both the intervention and control groups during the study (p < 0.001). Social integration increased in the intervention group but not in controls (p = 0.041). Attachment and guidance increased in both groups (p < 0.001). CONCLUSION The intervention did not alleviate depressed mood. Positive changes over time were observed in loneliness, feelings of melancholy, attachment, and guidance but these occurred independently of the intervention. Our secondary analysis suggests that the intervention increased perceived social integration. In sum, the effects of the intervention were moderate only and did not expedite further overcoming depressive mood or loneliness.
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Affiliation(s)
- Katja Pynnönen
- a Gerontology Research Center and Department of Health Sciences , University of Jyväskylä , Jyväskylä , Finland
| | - Timo Törmäkangas
- a Gerontology Research Center and Department of Health Sciences , University of Jyväskylä , Jyväskylä , Finland
| | - Taina Rantanen
- a Gerontology Research Center and Department of Health Sciences , University of Jyväskylä , Jyväskylä , Finland
| | - Pirjo Tiikkainen
- b School of Health and Social Studies, JAMK University of Applied Sciences , Jyväskylä , Finland
| | - Mauri Kallinen
- c Department of Medical Rehabilitation , Oulu University Hospital , Oulu , Finland.,d Center for Life Course Epidemiology Research , Faculty of Medicine, University of Oulu , Oulu , Finland
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16
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How common is depression in patients with polymyalgia rheumatica? Clin Rheumatol 2017; 37:1633-1638. [DOI: 10.1007/s10067-017-3691-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/25/2017] [Accepted: 05/18/2017] [Indexed: 11/26/2022]
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Kim MT, Kim KB, Han HR, Huh B, Nguyen T, Lee HB. Prevalence and Predictors of Depression in Korean American Elderly: Findings from the Memory and Aging Study of Koreans (MASK). Am J Geriatr Psychiatry 2015; 23:671-83. [PMID: 25554484 PMCID: PMC4442756 DOI: 10.1016/j.jagp.2014.11.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 11/16/2014] [Accepted: 11/20/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To estimate the prevalence and identify the predictors of depression among community-dwelling Korean American elderly (KAE). DESIGN A cross-sectional descriptive epidemiological survey using a two-step sampling strategy to obtain a representative community sample. SETTING The authors recruited study participants at religious, service, and business establishments in the KA community (26 churches, 6 senior centers, 2 medical daycare centers, 1 supermarket). PARTICIPANTS Community-dwelling first-generation KAE (N = 1,118; mean age ± SD: 70.5 ± 7.0 years; female: 67.2%). MEASUREMENTS Trained bilingual nurses and community health workers interviewed participants face-to-face for demographic information, chronic conditions, and depression using the Korean versions of the Patient Health Questionnaire (PHQ-9K). RESULTS 30.3% of KAEs were classified as having either mild (PHQ-9K score 5-9; N = 218, 19.5%) or clinical depression (PHQ-9K score ≥10; N = 120, 10.8%), respectively. One of seven KAE (N = 164, 14.7%) endorsed thoughts of death or self-injury, but only 63 (5.7%) reported utilizing mental health services. The authors also identified several predictors of depression, including living arrangement (living alone versus living with family/spouse); having chronic conditions such as diabetes, arthritis, digestive disorders, or chronic bronchitis; years of education; and cognitive impairment. CONCLUSIONS The authors' findings reveal a high prevalence of depression among KAE and a low level of mental health service utilization. Because there are urgent needs for culturally and contextually relevant interventions, the authors also discuss the feasibility of community-based interventions to reduce the burden of depression, which should be incorporated into a management system for multiple chronic conditions.
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Affiliation(s)
- Miyong T. Kim
- School of Nursing, University of Texas at Austin, Austin, Texas
| | - Kim B. Kim
- Korean Resource Center, Ellicott City, Maryland
| | - Hae-Ra Han
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Boyun Huh
- School of Nursing, University of California at San Francisco, San Francisco, California
| | - Tam Nguyen
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
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Iglesias-Rios L, Harlow SD, Reed BD. Depression and posttraumatic stress disorder among women with vulvodynia: evidence from the population-based woman to woman health study. J Womens Health (Larchmt) 2015; 24:557-62. [PMID: 25950702 DOI: 10.1089/jwh.2014.5001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Psychological disorders may affect the pain experience of women with vulvodynia, but evidence remains limited. The present study aimed to describe the magnitude of the association of depression and posttraumautic stress disorder (PTSD) with the presence of vulvodynia in a nonclinical population from southeastern Michigan. METHODS Baseline data from 1,795 women participating in the Woman to Woman Health Study, a multiethnic population-based study, was used for this analysis. Validated screening questionnaires were conducted to assess vulvodynia, depression, and PTSD. Modified Poisson regression models with a robust variance estimation were used to estimate prevalence ratios (PR) and their 95% confidence intervals (CI) for the association between vulvodynia status and two mental health conditions, depression and PTSD. RESULTS In the adjusted models, women who screened positive for depression had a 53% higher prevalence of having vulvodynia (PR=1.53; 95% CI: 1.12, 2.10) compared with women who screened negative for depression. Women who screened positive for PTSD had more than a two-fold increase in the prevalence of having vulvodynia (PR=2.37; 95% CI: 1.07, 5.25) compared with women who screened negative for PTSD. CONCLUSIONS The increased prevalence of vulvodynia among those screening positive for depression or PTSD suggests that these disorders may contribute to the likelihood of reporting vulvodynia. Alternatively, vulvodynia, depression, and PTSD may have a common pathophysiological and risk profile. Prospective studies are needed to improve our understanding of the temporal relation between mental health conditions and vulvar pain.
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Affiliation(s)
- Lisbeth Iglesias-Rios
- 1 Department of Epidemiology, School of Public Health, University of Michigan , Ann Arbor, Michigan
| | - Siobán D Harlow
- 1 Department of Epidemiology, School of Public Health, University of Michigan , Ann Arbor, Michigan
| | - Barbara D Reed
- 2 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan
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Garcia EFY, Joseph J, Wilson MD, Hinton L, Simon G, Ludman E, Scott F, Kravitz RL. Pediatric-based intervention to motivate mothers to seek follow-up for depression screens: The Motivating Our Mothers (MOM) trial. Acad Pediatr 2015; 15:311-8. [PMID: 25906700 PMCID: PMC4409654 DOI: 10.1016/j.acap.2014.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 10/08/2014] [Accepted: 11/25/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the initial effectiveness of a novel, pediatric office-based intervention in motivating mothers to seek further assessment of positive depression screens. METHODS In this pilot randomized controlled trial, English-speaking mothers (n = 104) with positive 2-question depression screens and presenting with children 0 to 12 years old for well-child care to a general pediatric training clinic received interventions from a trained research assistant. The Motivating Our Mothers (MOM) intervention included office-based written and verbal targeted depression education and motivational messages encouraging further depression assessment and a semistructured telephone booster delivered 2 days later. The control intervention included nontargeted written and verbal messages and 2 days later, an attention control telephone survey. Both groups received a list of depression care resources. The primary outcome was the proportion of mothers in each group who reported trying to contact any of 6 types of resources to discuss the positive screen at 2 weeks after intervention (ClinicalTrials.gov NCT01453790). RESULTS Despite 6 contact attempts, 10 MOM and 9 control mothers were lost to follow-up. More mothers in the MOM intervention tried to contact a resource compared to control (73.8% vs 53.5%, difference 20.3%, 95% confidence interval for difference -0.1 to 38.5, P = .052). CONCLUSIONS Mothers receiving the MOM intervention made more attempts to contact a resource for follow-up of positive depression screens. If found effective in larger studies, MOM may prove a promising approach for motivating depression screen-positive mothers identified in general pediatric settings within and beyond the postpartum period to seek further depression assessment and support.
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Affiliation(s)
- Erik Fernandez y Garcia
- Department of Pediatrics, School of Medicine, University of California, Davis, Sacramento, CA
| | - Jill Joseph
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA
| | - Machelle D. Wilson
- University of California, Davis, Clinical and Translational Science Center, Department Public Health Sciences, University of California, Davis, Sacramento, CA
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, School of Medicine University of California, Davis, Sacramento, CA
| | | | | | - Fiona Scott
- School of Medicine, University of California, Davis, Sacramento, CA
| | - Richard L. Kravitz
- Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA
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Rogers ES, Fu SS, Krebs P, Noorbaloochi S, Nugent SM, Rao R, Schlede C, Sherman SE. Proactive outreach for smokers using VHA mental health clinics: protocol for a patient-randomized clinical trial. BMC Public Health 2014; 14:1294. [PMID: 25518878 PMCID: PMC4301886 DOI: 10.1186/1471-2458-14-1294] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 12/01/2014] [Indexed: 12/03/2022] Open
Abstract
Background Persons with a mental health diagnosis have high rates of tobacco use and face numerous barriers to cessation including high levels of nicotine dependence, low rates of tobacco treatment referrals from mental health providers, and limited availability of tobacco treatment targeted to their needs. This manuscript describes the rationale and methods of a clinical trial with the following aims: 1) Compare the reach and efficacy of a proactive telephone-based tobacco cessation program for Veterans Health Administration (VHA) mental health clinic patients to VHA usual care and 2) Model longitudinal associations between baseline patient characteristics and long-term abstinence. Methods/design We will use the electronic medical record to identify patients across four VHA healthcare facilities who have a clinical reminder code indicating current tobacco use in the past six months and who have had a mental health clinic visit in the past 12 months. We will send each patient an introductory letter and baseline survey. Survey respondents (N = 3840) will be randomized in a 1:1 fashion to intervention or control. Control participants will receive VHA usual care. Intervention participants will receive proactive motivational telephone outreach to offer tobacco treatment. Intervention participants interested in treatment will receive eight weeks of nicotine replacement therapy plus eight sessions of specialized telephone counseling over two months, followed by monthly maintenance counseling for four months. We will conduct telephone surveys with participants at six and 12 months to assess study outcomes. We will collect a mailed saliva sample from patients reporting 7-day abstinence on the telephone surveys. The primary outcome will be cotinine-validated abstinence at 12-month follow-up. Discussion Mental health patients are a high-risk smoking population with significant barriers to cessation. This study will evaluate the efficacy of a program that proactively reaches out to smokers with a mental health treatment history to engage them into telephone cessation counseling targeted to the needs of mental health patients. Trial registration Clinicaltrials.gov: NCT01737281 (registered November 5, 2012).
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Affiliation(s)
- Erin S Rogers
- VA New York Harbor Healthcare System, 423 East 23rd Street, New York, NY 10010, USA.
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Dong X, Chen R, Li C, Simon MA. Understanding depressive symptoms among community-dwelling Chinese older adults in the Greater Chicago area. J Aging Health 2014; 26:1155-71. [PMID: 25239971 PMCID: PMC9944289 DOI: 10.1177/0898264314527611] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This study aimed to examine the prevalence of depressive symptoms among U.S. Chinese older adults. METHOD Data were from the Population Study of Chinese Elderly in Chicago (PINE) study, a population-based survey of U.S. Chinese older adults aged 60 years and above. The Patient Health Questionnaire (PHQ-9) was used to examine depressive symptoms. RESULTS Of the 3,159 community-dwelling Chinese older adults, 1,717 (54.4%) reported having any depressive symptoms in the last 2 weeks. Older age (r = .09), being female (r = .10), lower income (r = .09), not being married (r = .07), having fewer years in the United States (r = .05), lower overall health status (r = .32), poorer quality of life (r = .14), and worsening health over the past year (r = .24) were significantly and positively correlated with any depressive symptoms. DISCUSSION Depressive symptoms are common among U.S. Chinese older adults in the Greater Chicago area. Further longitudinal studies should be conducted to better understand risk factors and outcomes of depressive symptoms among U.S. Chinese older adults.
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Affiliation(s)
- XinQi Dong
- Rush University Medical Center, Chicago, IL, USA
| | - Ruijia Chen
- Rush University Medical Center, Chicago, IL, USA
| | - Chengyue Li
- Rush University Medical Center, Chicago, IL, USA
| | - Melissa A. Simon
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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Rayens MK, Reed DB. Predictors of depressive symptoms in older rural couples: the impact of work, stress and health. J Rural Health 2013; 30:59-68. [PMID: 24383485 DOI: 10.1111/jrh.12028] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Older farmers experience a high rate of suicide, and depression is closely aligned with suicide among agricultural workers. Depressive symptoms may be influenced by work patterns, work satisfaction, stress, and health status. In addition, members of a couple may affect each other's depressive symptoms. The purpose was to determine whether depressive symptoms score is predicted by hours worked on the farm, satisfaction with work, number of health conditions, perceived stress, and demographics in a sample of older farm couples, and to assess the degree of influence on depressive symptoms spouses have on each other. METHODS A total of 494 couples participated in the initial interview for a longitudinal study of farmers aged 50 and above. Data from husbands and wives were used together in a multilevel, dyad-based regression model to determine predictors of depressive symptoms. FINDINGS Men's depressive symptoms scores were predicted by their own number of health conditions and stress and by their wives' stress and health conditions. Women's depressive symptoms scores were predicted by their own work satisfaction, stress, and number of health conditions and their husbands' time spent working on the farm and stress. CONCLUSIONS Stress management may be particularly important in older farm couples, since perceived duress of 1 member of the dyad impacts both. Work factors and health conditions also affect depressive symptoms in older rural couples, but these may be less easily modified.
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Affiliation(s)
- Mary Kay Rayens
- College of Nursing, University of Kentucky, Lexington, Kentucky; College of Public Health, University of Kentucky, Lexington, Kentucky
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Maciuba SA, Westneat SC, Reed DB. Active coping, personal satisfaction, and attachment to land in older African-American farmers. Issues Ment Health Nurs 2013; 34:335-43. [PMID: 23663020 DOI: 10.3109/01612840.2012.753560] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Elevated suicide mortality rates have been reported for farmers and for the elderly. Very little literature exists that looks at the health of older minority farmers. This mixed-method study describes older African-American farmers (N = 156) in the contexts of active coping, personal satisfaction from farm work, and attachment to their farmland to provide insight into the psychosocial dimensions of their mental health. Findings show that the farmers have positive perspectives on work and farm future, and strong attachment to the land. Differences were noted by gender. Nurses can use these findings to frame culturally appropriate strategies for aging farmers to maximize positive outcomes.
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Affiliation(s)
- Sandra A Maciuba
- University of Kentucky, College of Nursing, Lexington, Kentucky 40536-0232, USA
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Luppa M, Sikorski C, Luck T, Ehreke L, Konnopka A, Wiese B, Weyerer S, König HH, Riedel-Heller SG. Age- and gender-specific prevalence of depression in latest-life--systematic review and meta-analysis. J Affect Disord 2012; 136:212-21. [PMID: 21194754 DOI: 10.1016/j.jad.2010.11.033] [Citation(s) in RCA: 484] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 11/09/2010] [Accepted: 11/30/2010] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of the study is to systematically analyze the prevalence of depression in latest life (75+), particularly focusing on age- and gender-specific rates across the latest-life age groups. DESIGN Relevant articles were identified by systematically searching the databases MEDLINE, Web of Science, Cochrane Library and Psycinfo and relevant literature from 1999 onwards was reviewed. Studies based on the community-based elderly population aged 75 years and older were included. Quality of studies was assessed. Meta-analysis was performed using random effects model. RESULTS 24 studies reporting age- and gender-specific prevalence of depression were found. 13 studies had a high to moderate methodical quality. The prevalence of major depression ranged from 4.6% to 9.3%, and that of depressive disorders from 4.5% to 37.4%. Pooled prevalence was 7.2% (95% CI 4.4-10.6%) for major depression and 17.1% (95% CI 9.7-26.1%) for depressive disorders. Potential sources of high heterogeneity of prevalence were study design, sampling strategy, study quality and applied diagnostics of latest life depression. CONCLUSIONS Despite the wide variation in estimates, it is evident that latest life depression is common. To reduce variability of study results, particularly sampling strategies (inclusion of nursing home residents and severe cognitively impaired individuals) for the old age study populations should be addressed more thoroughly in future research.
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Affiliation(s)
- M Luppa
- Institute of Social Medicine, Occupational Health and Public Health, Public Health Research Unit, University of Leipzig, Leipzig, Germany.
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Depressive symptoms in men aged 50 years and older and their relationship to genetic androgen receptor polymorphism and sex hormone levels in three different samples. Am J Geriatr Psychiatry 2011; 19:274-83. [PMID: 20808127 DOI: 10.1097/jgp.0b013e3181e70c22] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Depression in aging men has been related to low sex hormone concentrations; the putatively modulating effects of the genetically determined androgen receptor (AR) cytosine-adenosine-guanine (CAG) repeat polymorphism are often not taken into account. The aim of this study was to determine how sex hormone levels and the AR polymorphism relate to depressive symptoms in aging men. METHODS This cross-sectional study of men aged 50 years and older included 120 consecutive patients of the Department of Psychosomatics and Psychotherapy, 76 consecutive patients of the Andrologic Clinic, and 100 participants from the community sample (CS); all participants completed the Patient Health Questionnaire. Morning blood samples were analyzed for total and free testosterone, estradiol, and the AR CAG polymorphism. Patients on hormone substitution or other medication known to influence testosterone levels were excluded. RESULTS The two clinical samples had significantly longer AR CAG repeats and higher depression levels compared with the CS. When controlling for possible confounders, depression scores were positively correlated with CAGn (r = 0.20, df: 107, p ≤ 0.038) in psychosomatic patients and with CAGn (r = 0.27, df: 55, p ≤ 0.043) and estradiol (r = 0.31, df: 55, p ≤ 0.019) in andrologic patients, whereas the CS showed no significant correlations between depression scores, CAGn, and sex hormones. CAGn did not correlate significantly with testosterone in the three samples. Regression analysis confirmed association of CAGn with depression. CONCLUSIONS Conclusions from these data must be considered to be preliminary and need to be replicated. However, our results point to associations between the genetic AR polymorphism and vulnerability to depressive symptomatology.
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Do the PHQ-8 and the PHQ-2 accurately screen for depressive disorders in a sample of pregnant women? Gen Hosp Psychiatry 2010; 32:544-8. [PMID: 20851275 PMCID: PMC2943487 DOI: 10.1016/j.genhosppsych.2010.04.011] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 04/29/2010] [Accepted: 04/30/2010] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The aim of this study was to assess the psychometric properties of the Patient Health Questionnaire (PHQ)-8, and the PHQ-2, a two-item version of the PHQ, respectively, in pregnancy. These screeners were compared to a structured diagnostic interview in a cohort of pregnant women attending prenatal care. Based upon studies documenting high sensitivity and specificity on the PHQ-8 and PHQ-2 in the general adult population, we hypothesized that both instruments would be effective in this population. METHODS Two hundred eighteen women, 13 of them depressed, were given the Composite International Diagnostic Interview and the PHQ-8 before 17 weeks of pregnancy. Receiver Operating Characteristic curves determined optimal thresholds and sensitivity and specificity were calculated using both dimensional and categorical approaches. Agreement between the PHQ-2 and PHQ-8 was measured using Cohen's kappa. RESULTS Optimal cutoffs for the PHQ-8 and PHQ-2 were 11 and 4, respectively. Using these cutoffs, the PHQ-8 had a sensitivity of 77% and a specificity of 62% while the PHQ-2 had a sensitivity of 62% and a specificity of 79%. The categorical method of scoring the PHQ-8 yielded a sensitivity of 54% and a specificity of 84%. CONCLUSIONS In our sample, the PHQ-8 and PHQ-2 performed almost equally in detecting probable major depressive disorder in a sample of pregnant women. The categorical scoring method for the PHQ-8 had lower sensitivity but slightly higher specificity than the dimensional version. We found the PHQ-8 and PHQ-2 to have lower sensitivity and specificity in our pregnant population as compared to findings in nonpregnant populations; however, characteristics of our sample and choice of diagnostics instrument could explain these discrepant findings.
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