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Wu Y, Yu X, Zhu Y, Shi C, Li X, Jiang R, Niu S, Gao P, Li S, Yan L, Maulik PK, Guo G, Patel A, Gao R, Blumenthal JA. Integrating depression and acute coronary syndrome care in low resource hospitals in China: the I-CARE randomised clinical trial. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 48:101126. [PMID: 39040037 PMCID: PMC11261764 DOI: 10.1016/j.lanwpc.2024.101126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 05/13/2024] [Accepted: 06/11/2024] [Indexed: 07/24/2024]
Abstract
Background Acute coronary syndrome (ACS) often co-occurs with depression, which adversely affects prognosis and increases medical costs, but effective treatment models are lacking, particularly in low-resource settings. This study aims to determine the effectiveness of an ACS and depression integrative care (IC) model compared to usual care (UC) in improving depression symptoms and other health outcomes among patients discharged for ACS in Chinese rural hospitals. Methods A multicentre, randomised controlled trial was conducted in sixteen rural county hospitals in China, from October 2014 to March 2017, to recruit consecutively all ACS patients aged 21 years and older after the disease stablised and before discharge. Patients were randomly assigned in a 1:1 ratio to receive either the IC or UC, stratified by hospital and depression severity. Patients allocated to IC received an ACS secondary prevention program and depression care including case screening, group counselling, and individual problem-solving therapy. Patients allocated to UC received usual care. The primary outcome was change in Patient Health Questionnaire-9 (PHQ-9) from baseline to 6 and 12 months. Main secondary outcomes included major adverse events (MAEs) composed of all-cause death, non-fatal myocardial infarction and stroke, and all-cause re-hospitalisation. Participants were followed up till March 2018. All data were collected in person by trained assessors blinded to treatment group and MAEs were adjudicated centrally. This trial is registered with ClinicalTrials.gov, NCT02195193. Findings Among 4041 eligible patients (IC: 2051; UC: 1990), the mean age was 61 ± 10 years and 63% were men. The mean PHQ-9 score lowered at both 6 and 12 months in both groups but was not lower in IC compared to UC at 6 months (mean difference (MD): -0.04, 95% confidence interval (CI): -0.20, 0.11) or 12 months (MD: -0.06, 95% CI: -0.21, 0.09). There were no treatment group differences for MAEs or other secondary outcomes except for secondary prevention medications at 12 months (45.2% in IC vs 40.8% in UC; relative risk: 1.21, 95% CI: 1.05-1.40). Pre-specified subgroup analyses showed that IC, compared to UC, may be more effective in lowering PHQ-9 scores in women, older patients, and patients with low social support, but less effective in moderately and severely depressed patients (all p for interaction <0.05). Interpretation The study found that the cardiology nurse-led ACS- and depression-integrated care, compared to usual care, did not improve depression symptoms in all patients discharged with ACS. Greater benefits in certain subgroups warrants further studies. Funding R01MH100332 National Institute of Mental Health.
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Affiliation(s)
- Yangfeng Wu
- The George Institute for Global Health at Peking University Health Science Centre (PUHSC), Beijing, China
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China
| | - Xin Yu
- Peking University Institute of Mental Health, National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Yidan Zhu
- The George Institute for Global Health at Peking University Health Science Centre (PUHSC), Beijing, China
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China
| | - Chuan Shi
- Peking University Institute of Mental Health, National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Xian Li
- The George Institute for Global Health at Peking University Health Science Centre (PUHSC), Beijing, China
| | - Ronghuan Jiang
- Department of Psychiatry, Chinese PLA (People's Liberation Army) Medical School, Beijing, China
| | - Sheng Niu
- Department of Psychiatry, Chinese PLA (People's Liberation Army) Medical School, Beijing, China
| | - Pei Gao
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China
| | - Shenshen Li
- The George Institute for Global Health at Peking University Health Science Centre (PUHSC), Beijing, China
| | - Lijing Yan
- The Global Health Research Centre, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Pallab K. Maulik
- The George Institute for Global Health, New Delhi, India
- University of New South Wales, Sydney, Australia
| | - Guifang Guo
- Peking University School of Nursing, Beijing, China
| | - Anushka Patel
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Runlin Gao
- The Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Centre, Durham, NC, USA
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Matsuda K, Fujisawa D, Masai K, Miyazaki N, Suzuki S, Okubo Y, Kaseda K, Asakura K, Hishida T, Asamura H. Quality of life, psychological states, and personality traits in patients with pectus excavatum. JTCVS OPEN 2024; 19:355-369. [PMID: 39015465 PMCID: PMC11247226 DOI: 10.1016/j.xjon.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 07/18/2024]
Abstract
Objective The quality of life (QOL) and psychological states of patients with pectus excavatum (PE) have yet to be well understood. This study aimed to evaluate the health-related QOL (HRQOL), psychological states, and personality traits of patients with PE, alongside the associations of these factors with the severity of PE. Methods A cross-sectional evaluation was prospectively performed in patients scheduled to undergo PE repair surgery between July 2019 and April 2021. The primary outcome was the patients' HRQOL, and the secondary outcomes were depression, social anxiety, self-efficacy, and personality traits. Results In total, 129 patients were subjected to analyses. Patients' HRQOL had a lower role component summary score (mean ± standard deviation: 41.8 ± 12.8, P < .001) than the general population controls. Patients' HRQOL had a significantly better physical component summary (54.0 ± 10.4, P < .001) and mental component summary (53.3 ± 8.8, P < .001) than that of the general population. Fourteen patients' (10.9%) and 56 patients' (43.4%) scores indicated the presence of depression and social anxiety disorder, respectively. Patients' self-efficacy (46.1 ± 11.4, P, .001) and level of extraversion (46.5 ± 11.8, P < .001) were lower than those of the general population. No significant correlation was found between the severity of PE and these scores. Conclusions Our study revealed that patients with PE had decreased social-role QOL, depressive tendencies, increased social anxiety, lower self-efficacy, and introversion. No correlation between the severity of PE and the patients' psychological outcomes leads us to conclude that surgical implications of PE should not be decided solely by a physical index.
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Affiliation(s)
- Kohei Matsuda
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Kyohei Masai
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Miyazaki
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Shigeki Suzuki
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan
| | - Yu Okubo
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kaoru Kaseda
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Keisuke Asakura
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomoyuki Hishida
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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Guo X, Qin Z, Meng C, Lv J, Hu Y, Fei J, Liang L, Li J, Yuan T, Mei S, Tong Q. Investigation of the Sleep Quality Among Hospitalized Cardiovascular Patients Using Regression Models and Qualitative Comparative Analysis. Clin Nurs Res 2023; 32:580-588. [PMID: 36633212 DOI: 10.1177/10547738221148150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This study aimed to explore the relationships between modifiable and non-modifiable factors that influence sleep quality in hospitalized patients with cardiovascular disease in China. This study design was cross-sectional and descriptive. This study involved a convenience sample of 242 patients hospitalized for cardiovascular issues. Hierarchical regression model and qualitative comparative analysis model were performed. Regression revealed that age and depression both had statistically significant effects on sleep quality. The combination of conditions with strongest predictive effect on sleep quality was male of younger age, high level of depression, high level of anxiety, and low level of social support. Other combinations with predictive power on sleep quality are as follows: (1) younger male patients (aged 47-63 years) with high level of anxiety, high level of social support, and low level of depression; (2) older male patients (aged 63-79 years) with high level of depression, high level of social support, and low levels of anxiety; and (3) older male patients with high level of anxiety and low level of social support. Nurses may promote primary and secondary prevention of cardiovascular health prior to hospitalization, through routine screening for depressive and anxious symptoms and assessment of the patient's social support network. It is unknown whether these findings are unique to hospitalized patients. Therefore, future work should assess the fit of the model to other more diverse groups of hospitalized patients.
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Affiliation(s)
- Xinmeng Guo
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Zeying Qin
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Cuicui Meng
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Jianping Lv
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Yueyang Hu
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Junsong Fei
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Leilei Liang
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Jingyang Li
- First Hospital, Jilin University, Changchun, Jilin Province, China
| | - Tongshuang Yuan
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Songli Mei
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Qian Tong
- First Hospital, Jilin University, Changchun, Jilin Province, China
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Takahara M, Iida O, Ohura N, Soga Y, Yamaoka T, Azuma N. Social isolation in patients with chronic limb-threatening ischemia: a cross-sectional study. Sci Rep 2023; 13:1933. [PMID: 36732613 PMCID: PMC9894975 DOI: 10.1038/s41598-023-29197-5] [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: 11/11/2022] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Assistance by family members or friends plays important roles in the course of treating patients with chronic limb-threatening ischemia (CLTI), both during hospitalization and after discharge. The aim of this study was to reveal the prevalence of social isolation and to explore relevant clinical backgrounds in patients with CLTI presenting with tissue loss and requiring revascularization. We analyzed 413 patients registered in a multicenter study in whom revascularization were scheduled for CLTI with tissue loss. Social isolation was analyzed by assessing the residence status of the patients and the involvement of a trusted family member or friend in their daily lives and during hospitalization. Patients living alone accounted for 24.5% (95% confidence interval [CI] 20.1-28.8%) of the study population. Patients receiving welfare were more likely to live alone (P < 0.001). For patients living alone, 21.8% (95% CI 12.8-30.8%) met a trusted family member or friend in their daily lives less than once per year. Younger age and receiving welfare were independently associated with lower frequency of meeting the trusted person in their daily lives (both P < 0.05). The adjusted odds ratio of age and receiving welfare was 0.44 (95% CI 0.29-0.67) per 10-year increase and 3.47 (95% CI 1.43-8.44), respectively. During hospitalization, 9.9% (95% CI 6.8-13.0%) of the patients had no hospital visits by a trusted family member or friend on three key occasions: the patient's first hospital visit, the preoperative explanation regarding the planned operation, and the day of the operation. Younger age and receiving welfare were independently associated with lower frequency of hospital visits by a family member or friend (both P < 0.05). The adjusted odds ratio of age and receiving welfare for no visit versus ≥ 1 visit was 0.51 (0.36-0.74) per 10-year increase and 5.29 (2.46-11.4), respectively. In conclusion, social isolation is common among patients with CLTI, especially younger patients and those on welfare. Practical countermeasures against social isolation are warranted in the management of CLTI.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Norihiko Ohura
- Department of Plastic, Reconstructive Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0001, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, 1 Bunkyo-Cho, Matsuyama, Ehime, 790-8524, Japan
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University, 2-1 Midorigaoka-Higashi, Asahikawa, 078-8510, Japan
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Abstract
Depression is a well-known risk factor for adverse cardiovascular outcomes in patients with cardiovascular diseases. The prevalence of depression in patients with cardiovascular diseases has been reported to be approximately 20 %. A two-step depression screening protocol using the 2-item Patient Health Questionnaire (PHQ-2) and the 9-item Patient Health Questionnaire (PHQ-9) is recommended for patients with cardiovascular diseases. Cardiovascular diseases and depression share a common pathology, including increased activity of the sympathetic nervous system, hyperactivity of hypothalamic-pituitary-adrenal axis, and inflammation. Psychosocial and environmental factors are also associated with depression and cardiovascular outcomes. Randomized controlled trials of antidepressant treatment for patients with depression and cardiovascular diseases have shown no advantage regarding cardiovascular outcomes. However, improvement in depressive symptoms, regardless of the method, may lead to a reduction in subsequent cardiovascular events. A collaborative approach between cardiologists and psychiatrists is recommended to manage depression in patients with cardiovascular diseases. Future research should identify more specific targets for treating patients with cardiovascular diseases, involve collaboration with professionals across fields, and establish community support systems.
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Mechili EA, Sifaki-Pistolla D, Meliqi A, Gallos P, Chatzea VE. Screening for Depression in Cardiovascular Patients in Albania: Findings from the Country Check-Up Program. J Clin Psychol Med Settings 2022; 29:578-585. [PMID: 35960399 DOI: 10.1007/s10880-022-09904-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 10/15/2022]
Abstract
This is a retrospective study conducted in Vlora from January 2016 to April 2017 and the aim was to report the prevalence of depression in cardiovascular (CVD) patients. Depression assessment was done using the Patient Health Questionnaire (PHQ)-9 (PHQ-9). Data were derived from the patient records and the standard recommended cut-off point of PHQ-9 ≥ 10 was used. In total, data of 300 patients were analyzed. Depressive symptoms (PHQ-9 ≥ 10) were observed at 6% of the participants. Trouble falling asleep or staying asleep or sleeping too much, feeling tired or having little energy and having little interest or pleasure in doing things were the most common symptoms reported. In multivariate analysis, only family status showed statistical significance. Unmarried (mean rank = 207.22) are more likely to have moderate or severe depression level (OR 3.529; C.I. 95% 1.017-12.238). Future research should focus on the needed actions after depression screening (i.e. referral, treatment etc.).
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Affiliation(s)
- Enkeleint A Mechili
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Crete, Greece.
- Department of Healthcare, Faculty of Health, University of Vlora, Kosova Street, P. Box 9401, Vlora, Albania.
| | - Dimitra Sifaki-Pistolla
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Crete, Greece
- School of Health Sciences, Department of Nursing, Frederick University, Nicosia, Cyprus
| | | | - Parisis Gallos
- Health Informatics Laboratory, School of Health Science, National and Kapodistrian University of Athens, Athens, Greece
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Zhou Y, Sun W, Zhang G, Wang A, Lin S, Chan MTV, Peng Y, Wang G, Han R. Ketamine Alleviates Depressive Symptoms in Patients Undergoing Intracranial Tumor Resection: A Randomized Controlled Trial. Anesth Analg 2021; 133:1588-1597. [PMID: 34633992 DOI: 10.1213/ane.0000000000005752] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Depressive symptoms occur in over 40% of neurosurgical patients during the perioperative period. However, no measure has been suggested to have a rapid effect on depressive surgical patients during increasingly shorter stays in the hospital. This study aimed to determine whether ketamine could improve depressive symptoms rapidly and safely during the hospital stay. METHODS This was a randomized, placebo-controlled, and double-blinded trial. Patients with moderate-to-severe depressive symptoms undergoing elective supratentorial brain tumor resection were randomized to intravenously receive either (1) 0.5 mg·kg-1 ketamine for 40 minutes or (2) an identical volume of normal saline. The primary outcome was treatment response on postoperative day 3, defined as a ≥50% reduction from the baseline depressive score. The secondary outcomes included the rate of remission and safety outcomes. The Montgomery-Åsberg Depression Rating Scale was applied by trained psychiatrists to evaluate depressive symptoms. RESULTS A total of 84 neurosurgical patients were enrolled in the trial. The response rate was increased by the administration of ketamine (41.5% [17/41] vs 16.3% [7/43]; relative risk [RR]: 2.51, 95% confidence interval [CI], 1.18-5.50) relative to the administration of placebo at 3 days. Furthermore, the remission rate at discharge (29.3% [12/41] vs 7.0% [3/43]; RR: 4.20, 95% CI, 1.28-13.80) was also improved by ketamine. No psychotic symptoms or adverse events were reported to be substantially higher in the ketamine group. CONCLUSIONS The trial indicates that the intraoperative administration of ketamine could alleviate moderate-to-severe depressive symptoms in neurosurgical patients without worsening safety.
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Affiliation(s)
- Yang Zhou
- From the Department of Anesthesiology, Beijing Tiantan Hospital Capital Medical University, Beijing, People's Republic of China
| | - Wanchen Sun
- From the Department of Anesthesiology, Beijing Tiantan Hospital Capital Medical University, Beijing, People's Republic of China
| | - Guofu Zhang
- China & Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Psychiatry, Capital Medical University, China & Center of Depression, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Anxin Wang
- Department of Statistics, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Song Lin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Matthew T V Chan
- Department of Anesthesia and Intensive Care, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, People's Republic of China
| | - Yuming Peng
- From the Department of Anesthesiology, Beijing Tiantan Hospital Capital Medical University, Beijing, People's Republic of China
| | - Gang Wang
- China & Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Psychiatry, Capital Medical University, China & Center of Depression, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Ruquan Han
- From the Department of Anesthesiology, Beijing Tiantan Hospital Capital Medical University, Beijing, People's Republic of China
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Qin Z, Mei S, Gao T, Liang L, Li C, Hu Y, Guo X, Meng C, Lv J, Yuan T, Fei J, Tong Q, Yang Y. Self-Esteem as a Mediator between Life Satisfaction and Depression among Cardiovascular Disease Patients. Clin Nurs Res 2021; 31:115-121. [PMID: 34259087 DOI: 10.1177/10547738211030002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study explores the association between life satisfaction and depression among patients with cardiovascular diseases and whether this association is mediated by self-esteem. A cross-sectional study was conducted in a third-grade hospital. We examined 300 patients with cardiovascular diseases with a mean age of 62.00 years (females, 133). Life satisfaction was associated with depression. Adding self-esteem to the model weakened the strength of the association between the two. Moreover, 34.2% of the effect of life satisfaction on depression could be explained by self-esteem. We found that self-esteem could totally explain the effect of life satisfaction on depression among patients with cardiovascular diseases.
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Suzuki T, Shiga T, Nishimura K, Omori H, Tatsumi F, Hagiwara N. Patient Health Questionnaire-2 Screening for Depressive Symptoms in Japanese Outpatients with Heart Failure. Intern Med 2019; 58:1689-1694. [PMID: 30799347 PMCID: PMC6630118 DOI: 10.2169/internalmedicine.2034-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective Depression is common in patients with heart failure (HF) and is a possible risk factor for adverse outcomes. The aim of this study was to determine the prevalence of depression assessed by the 2-item Patient Health Questionnaire (PHQ-2) and the effect of depression on outcomes in Japanese outpatients with HF. Methods This sub-analysis of a prospective observational study assessed 976 patients with HF (mean age 66±13 years; 26.7% female; 42.7% with an ischemic etiology). Depression was defined as a PHQ-2 score ≥3. The main composite outcome was death from any cause or hospitalization due to worsening HF. PHQ-2 items were extracted from the PHQ-9 results. To evaluate the association of PHQ-2 scores with outcomes, Cox proportional hazards models were evaluated. Results Fifty-seven (5.8%) patients were diagnosed with depression. During a median follow-up of 21 months, the incidence rates for death from any cause and hospitalization due to worsening HF in patients with and without depression were 2.2 vs. 0.9 per 100 person-years and 6.7 vs. 1.6, p<0.001, respectively. There was a higher incidence of the main outcome in patients with depression than in those without depression (p<0.001). After adjustment for conventional risk factors, depression (PHQ-2 ≥3) was an independent predictor of the main outcome (hazard ratio 2.41, 95% confidence interval 1.14-4.67, p=0.022), and a score for item 1 of the PHQ-2 (loss of interest or pleasure) ≥2 was also an independent risk factor (hazard ratio 3.57, 95% confidence interval 1.85-6.46, p<0.001). Conclusion Depression as assessed by the PHQ-2 was identified in 5.8% of Japanese outpatients with HF and was associated with outcomes.
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Affiliation(s)
- Tsuyoshi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, Japan
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University, Japan
| | | | - Hisako Omori
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Japan
| | - Fujio Tatsumi
- Department of Cardiology, Institute of Geriatrics, Women's Medical University, Japan
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10
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Zhou Y, Peng Y, Fang J, Sun W, Zhang G, Zhen L, Wang G, Han R. Effect of low-dose ketamine on PerioperAtive depreSsive Symptoms in patients undergoing Intracranial tumOr resectioN (PASSION): study protocol for a randomized controlled trial. Trials 2018; 19:463. [PMID: 30157913 PMCID: PMC6114290 DOI: 10.1186/s13063-018-2831-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perioperative depressive symptoms (PDS) are common mental comorbidities that influence clinical outcomes and prognosis. However, there is no rapid-acting treatment to address these symptoms during a limited hospital stay. METHODS/DESIGN This is a single-center, randomized, placebo-controlled, and double-blind trial. Randomization will be applied and stratified by the severity of PDS (moderate versus severe). Eighty patients who are scheduled for elective supratentorial brain tumor resection with PDS will be randomly allocated to the ketamine or placebo group with a ratio of 1 to 1. Patients in the ketamine group will be administered low-dose ketamine (0.5 mg/kg) intravenously for 40 min while the dural mater is being cut into, whereas patients in the placebo group will receive the same volume of normal saline at the same infusion rate at the same time points. The primary endpoint is the rate of PDS response at 3 days after surgery. Secondary outcomes include efficacy parameters such as the rate of PDS remission and safety outcomes such as the incidence of postoperative delirium, quality of recovery, and psychiatric side effects. DISCUSSION This study aims to determine whether ketamine could improve the depressive symptoms of perioperative patients undergoing supratentorial brain tumor resection. It will also examine the safety of administering ketamine as an intraoperative anti-depressant. TRIAL REGISTRATION ClinicalTrials.gov, NCT03086148 . Registered on 22 March 2017.
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Affiliation(s)
- Yang Zhou
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China
| | - Yuming Peng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China
| | - Jinghan Fang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China
| | - Wanchen Sun
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China
| | - Guofu Zhang
- China and Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Psychiatry, Capital Medical University, China and Center of Depression, Beijing Institute for Brain Disorders, Beijing, China
| | - Long Zhen
- China and Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Psychiatry, Capital Medical University, China and Center of Depression, Beijing Institute for Brain Disorders, Beijing, China
| | - Gang Wang
- China and Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Psychiatry, Capital Medical University, China and Center of Depression, Beijing Institute for Brain Disorders, Beijing, China
| | - Ruquan Han
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China.
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11
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Suzuki T, Shiga T, Omori H, Tatsumi F, Nishimura K, Hagiwara N. Self-Reported Non-adherence to Medication in Japanese Patients with Cardiovascular Diseases. Am J Cardiovasc Drugs 2018; 18:311-316. [PMID: 29748918 DOI: 10.1007/s40256-018-0278-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Non-adherence to medication is an important problem in cardiovascular treatment. The aim of this study was to assess self-reported non-adherence in Japanese patients with cardiovascular disease. METHODS A total of 1372 outpatients at three university hospitals who completed self-reported questionnaires were analyzed in this prospective study (mean age 67 ± 12 years; 31% female). Self-reported adherence to cardiovascular drugs was measured with a modified Siegal scale. Depressive symptoms were defined as a Patient Health Questionnaire-9 score of ≥ 10. RESULTS A total of 227 patients (17%) were defined as non-adherent. Multiple logistic regression analysis showed that ≥ 2 times daily dosing frequency, age < 65 years and active employment were significantly associated with non-adherence, with odds ratios of 4.42 [95% confidence interval (CI) 3.02-6.48], 1.70 (95% CI 1.23-2.35) and 1.43 (95% CI 1.03-1.99), respectively. However, depression was not a significant factor in non-adherence. CONCLUSIONS Our study showed that self-reported non-adherence to medications was 17% in Japanese patients with cardiovascular disease in the university hospital setting. Daily dosing frequency, younger age and employment were significantly associated with non-adherence. TRIAL REGISTRATION University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) no. UMIN 000023514.
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Affiliation(s)
- Tsuyoshi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Hisako Omori
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Fujio Tatsumi
- Department of Cardiology, Institute of Geriatrics, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Finnell JE, Lombard CM, Padi AR, Moffitt CM, Wilson LB, Wood CS, Wood SK. Physical versus psychological social stress in male rats reveals distinct cardiovascular, inflammatory and behavioral consequences. PLoS One 2017; 12:e0172868. [PMID: 28241050 PMCID: PMC5328366 DOI: 10.1371/journal.pone.0172868] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/12/2017] [Indexed: 01/22/2023] Open
Abstract
Repeated exposure to social stress can precipitate the development of psychosocial disorders including depression and comorbid cardiovascular disease. While a major component of social stress often encompasses physical interactions, purely psychological stressors (i.e. witnessing a traumatic event) also fall under the scope of social stress. The current study determined whether the acute stress response and susceptibility to stress-related consequences differed based on whether the stressor consisted of physical versus purely psychological social stress. Using a modified resident-intruder paradigm, male rats were either directly exposed to repeated social defeat stress (intruder) or witnessed a male rat being defeated. Cardiovascular parameters, behavioral anhedonia, and inflammatory cytokines in plasma and the stress-sensitive locus coeruleus were compared between intruder, witness, and control rats. Surprisingly intruders and witnesses exhibited nearly identical increases in mean arterial pressure and heart rate during acute and repeated stress exposures, yet only intruders exhibited stress-induced arrhythmias. Furthermore, re-exposure to the stress environment in the absence of the resident produced robust pressor and tachycardic responses in both stress conditions indicating the robust and enduring nature of social stress. In contrast, the long-term consequences of these stressors were distinct. Intruders were characterized by enhanced inflammatory sensitivity in plasma, while witnesses were characterized by the emergence of depressive-like anhedonia, transient increases in systolic blood pressure and plasma levels of tissue inhibitor of metalloproteinase. The current study highlights that while the acute cardiovascular responses to stress were identical between intruders and witnesses, these stressors produced distinct differences in the enduring consequences to stress, suggesting that witness stress may be more likely to produce long-term cardiovascular dysfunction and comorbid behavioral anhedonia while exposure to physical stressors may bias the system towards sensitivity to inflammatory disorders.
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Affiliation(s)
- Julie E Finnell
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, South Carolina, United States of America
| | - Calliandra M Lombard
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, South Carolina, United States of America
| | - Akhila R Padi
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, South Carolina, United States of America
| | - Casey M Moffitt
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, South Carolina, United States of America
| | - L Britt Wilson
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, South Carolina, United States of America
| | - Christopher S Wood
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, South Carolina, United States of America
| | - Susan K Wood
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, South Carolina, United States of America
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Suzuki T, Shiga T, Omori H, Tatsumi F, Nishimura K, Hagiwara N. Adherence to medication and characteristics of Japanese patients with non-valvular atrial fibrillation. J Cardiol 2016; 70:238-243. [PMID: 28007412 DOI: 10.1016/j.jjcc.2016.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 11/07/2016] [Accepted: 11/21/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Adherence to medication plays an important role in the prevention of morbidity and mortality in non-valvular atrial fibrillation (NVAF) patients. The aim of this study is to assess adherence to medication and risk factors for non-adherence in Japanese NVAF patients who are prescribed anticoagulants. METHODS A total of 378 outpatients with NVAF who completed self-reported questionnaires were analyzed in this prospective study (mean age 69±12 years; 26% female). Self-reported adherence to cardiovascular drugs including anticoagulants was measured with a modified Siegal scale. Depression was defined as a Patient Health Questionnaire-9 score of ≥10. Univariate and multivariate analyses were performed on several variables to analyze factors affecting non-adherence. RESULTS In total, 291 (77%) of our patients received warfarin, and the remainder received direct oral anticoagulants. Fifty-two (14%) patients were defined as non-adherent. Univariate analyses showed that age <65 years, ≥2 times daily dosing of cardiovascular drugs and employment, but not depression, were significantly associated with non-adherence, 1.87 (95% CI: 1.01-3.42, p=0.04), 2.97 (95% CI: 1.64-5.49, p<0.01), 2.11 (95% CI: 1.16-3.93, p=0.01), and 0.74 (95% CI: 0.26-2.64), respectively. Multivariate analysis showed that only ≥2 times daily dosing was a significant independent risk factor (HR 3.06, 95% CI: 1.67-5.69, p<0.01). CONCLUSIONS Our study showed that the prevalence of non-adherence to medications was 14% in NVAF patients. Frequent daily dosing was an independent risk factor for non-adherence to medication (UMIN-CTR No. UMIN 000023514).
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Affiliation(s)
- Tsuyoshi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Hisako Omori
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Fujio Tatsumi
- Department of Cardiology, Tokyo Women's Medical University Aoyama Hospital, Tokyo, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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