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Kleet AC, Regan M, Siceloff BA, Alvarez C, Farr M. Psychosocial readiness assessment for heart transplant candidates. Heart Lung 2024; 67:19-25. [PMID: 38631109 DOI: 10.1016/j.hrtlng.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Psychosocial evaluation for transplant suitability is required by the Centers for Medicare and Medicaid Services (CMS) as a condition of participation for transplant programs. There are no regulations regarding follow-up reassessment for transplant readiness after waitlisting. OBJECTIVES An evidence-based pilot project was developed and implemented to evaluate the feasibility of psychosocial readiness assessments for waitlisted heart transplantation candidates. The primary aim was to test the feasibility of these assessments in practice from a patient and programmatic perspective. METHODS During a 12-week period, waitlisted outpatients underwent one assessment each. Socioeconomic elements of caregiver support, housing, transportation, and insurance coverage status were assessed by simple using "yes/no" questions. To assess mental health needs, the General Anxiety Disorder-7 questionnaire (GAD-7) and the Patient Health Questionnaire-8 (PHQ-8) tools were utilized. Rescheduled readiness visits and no-show rates were measured. A post-implementation Qualtrics survey was administered to measure team member perceptions of feasibility. RESULTS A total of 57 patients were assessed during the 12-week period. The primary aim of feasibility was achieved with 93 % of visits performed with freedom from rescheduling or patient no-show to the visit. Additionally, 75 % of team members reported the readiness assessments were feasible to complete in practice. CONCLUSIONS Addressing the non-medical and mental health needs of waitlisted heart transplant patients allows transplant programs to maintain candidates with necessary resources and care. The readiness assessments are feasible in practice and may serve to reduce untoward outcomes in the post-transplant phase by providing targeted care prior to the time of transplant.
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Affiliation(s)
- Audrey C Kleet
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA.
| | - Mathew Regan
- New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Birgit A Siceloff
- Médecins Sans Frontières 140, Route de Ferney, 1202 Geneva, Switzerland
| | - Carmen Alvarez
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Maryjane Farr
- Division of Cardiology, University of Texas Southwestern Medical Center, USA
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Pfeifer K, Ates G, Pogorzelski M, Zaun G, Rötger A, Schuler M, Schöbel C, Tewes M. Investigation of screening questions to identify insomnia in cancer patients. Sci Rep 2024; 14:18343. [PMID: 39112537 PMCID: PMC11306326 DOI: 10.1038/s41598-024-69086-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 07/31/2024] [Indexed: 08/10/2024] Open
Abstract
The high prevalence of insomnia in cancer patients leads to a significant reduction in the quality of life of those affected. A detailed record of symptoms therefore plays an essential role for further course of treatment. Which screening instruments enable identification of cancer patients with insomnia is the subject of this single-arm nonrandomized study. During the data collection period, cancer patients meeting the following criteria: self-reported tiredness and/or trouble falling or staying asleep or sleeping too much in an electronic patient-reported outcome measurement were enrolled. For further analysis, focus was placed on the Patient Health Questionnaire Depression Scale (PHQ-8), the Minimal Documentation System (MIDOS2) and the Insomnia Severity Index (ISI). Frequency, correlation, and variance analyses were conducted to identify likely predictors of insomnia. Our findings indicate a closer correlation between the screening question pertaining to sleep disorders and the ISI, compared to the question on tiredness and the ISI. The initial recording of sleep-related parameters plays an essential role for cancer patients in order to identify and treat modifiable factors as promptly as possible. For an initial assessment, we recommend asking about trouble falling or staying asleep or sleeping too much.
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Affiliation(s)
- K Pfeifer
- Department of Palliative Medicine, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - G Ates
- Institute for Digitalization and General Medicine, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - M Pogorzelski
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - G Zaun
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | | | - M Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, 45147, Essen, Germany
| | - C Schöbel
- Center for Sleep- and Telemedicine, West German-Lung-Center at University Hospital Essen, Ruhrlandklinik, 45239, Essen, Germany
| | - M Tewes
- Department of Palliative Medicine, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany.
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Wong RJ, Loeb R, Seal KH, Barry F, Stark Kent D, Seetharaman S, Sharma A, Lai JC, Rubin JB. The Complex Relationship Between Pain, Mental Health, and Quality-of-Life in Patients With Cirrhosis Undergoing Liver Transplant Evaluation. J Clin Gastroenterol 2024:00004836-990000000-00313. [PMID: 39008614 DOI: 10.1097/mcg.0000000000002028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 05/05/2024] [Indexed: 07/17/2024]
Abstract
GOALS AND BACKGROUND Patients with cirrhosis undergoing liver transplant evaluation have high rates of pain and mental health comorbidities; both may significantly impair health-related quality of life (HRQL). We investigated the association between pain, anxiety/depression, and HRQL in this population. STUDY In 62 patients with cirrhosis undergoing liver transplant evaluation, we performed 4 validated assessments to characterize: pain (Brief Pain Inventory-Short Form, BPI-SF), anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-8), and liver-specific HRQL (Chronic Liver Disease Questionnaire). The presence of pain was determined using the BPI-SF screening question. Linear regression was used to identify demographic or clinical factors predictive of pain severity (PS) and interference (PI) and to evaluate the association between pain, anxiety/depression, and HRQL. RESULTS Seventy-one percent of patients reported pain, 26% had clinical depression, and 24% had moderate-severe anxiety. Neither liver disease severity, nor its complications were associated with pain (PS or PI), but anxiety and depression were predictors of pain on bivariate analysis. Only depression remained a significant predictor of PS (b=0.28, P<0.05) and PI (b=0.30, P<0.05) in multivariable models. HRQL was inversely associated with PS, PI, depression, and anxiety, but only anxiety (b=-0.14, P=0.003) remained associated with HRQL in the adjusted model. CONCLUSIONS Pain is present in over 70% of patients with cirrhosis undergoing liver transplant evaluation. Anxiety and depression were highly correlated with pain and appeared to be key drivers in predicting poor HRQL. Evaluating and managing mental health comorbidities should be explored as a strategy to improve HRQL in patients with cirrhosis and pain.
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Affiliation(s)
- Randi J Wong
- University of California, San Francisco , Department of Medicine San Francisco, CA
- University of South Florida Morsani College of Medicine, Department of Medicine Tampa, FL
| | - Rebecca Loeb
- University of California, San Francisco , Department of Medicine San Francisco, CA
| | - Karen H Seal
- University of California, San Francisco , Department of Medicine San Francisco, CA
- San Francisco VA Medical Center Department of Medicine, San Francisco, CA
| | - Fawzy Barry
- University of California, San Francisco , Department of Medicine San Francisco, CA
| | - Dorothea Stark Kent
- University of California, San Francisco , Department of Medicine San Francisco, CA
| | - Sri Seetharaman
- University of California, San Francisco , Department of Medicine San Francisco, CA
| | - Arjun Sharma
- University of California, San Francisco , Department of Medicine San Francisco, CA
| | - Jennifer C Lai
- University of California, San Francisco , Department of Medicine San Francisco, CA
| | - Jessica B Rubin
- University of California, San Francisco , Department of Medicine San Francisco, CA
- San Francisco VA Medical Center Department of Medicine, San Francisco, CA
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Ong LE, Speicher S, Villasenor D, Kim J, Jacobs A, Macia KS, Cloitre M. Brief Peer-Supported webSTAIR for Trauma-Exposed Veterans in the Community: Randomized Controlled Trial. J Med Internet Res 2024. [PMID: 39012722 DOI: 10.2196/52130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Peer-supported mobile health (mhealth) programs hold the promise of providing a low-burden approach to increasing access to care and improving mental health. While peer support has been shown to improve engagement into care, there is limited investigation about the impact of peers on symptom outcome. Trauma-exposed populations frequently suffer from co-occurring posttraumatic stress and depressive symptoms as well as difficulties in day-to-day functioning. This study evaluated the potential benefits of a peer-supported transdiagnostic mhealth program on symptom outcomes and functioning. OBJECTIVE This randomized controlled trial tested the effectiveness of Brief Peer-Supported (BPS) webSTAIR, a 6-module transdiagnostic online program derived from Skills Training in Affective and Interpersonal Regulation (STAIR) compared to waitlist control (WL) in a community sample of Veterans who screened positive for either post-traumatic stress disorder (PTSD) and/or depression. METHODS A total of 178 eligible Veterans were enrolled in the study using a 2:1 randomization scheme with 117 assigned to BPS webSTAIR and 61 assigned to WL. PTSD and depressive symptoms as well as emotion regulation, and psychosocial functioning were assessed via phone at pretreatment, posttreatment, and 8-week follow-up. Mixed-effects models were used to assess change in outcome measures across timepoints and evaluate the impact of module completion on outcomes. Exploratory analyses were conducted to determine whether the type and number of peer interactions influenced outcomes. RESULTS Significant interaction effects were observed for all outcomes such that participants randomized to BPS webSTAIR reported significantly greater improvement at posttreatment compared to WL with moderate effect sizes for PTSD (PCL-5 d = -0.48) depression (PHQ- 8 d = -0.64), emotion regulation (DERS-16 d = 0.61) and functional impairment (WSAS d = 0.61); gains were maintained at 8-week follow-up. Those who completed more modules reported greater improvement on all outcomes. An initial cohort of participants who were required to engage with a peer coach to progress through the modules interacted more frequently with peers but completed fewer modules compared to a later cohort for whom peer engagement was optional. CONCLUSIONS BPS webSTAIR was effective in improving PTSD and depression symptoms, emotion regulation, and psychosocial functioning in community Veterans. Peer-supported transdiagnostic mhealth programs may be a particularly efficient, effective, and low-burden approach to improving mental health among trauma-exposed populations. Investigation of peer-supported programs among other populations is necessary to evaluate the generalizability of the findings. Analyses comparing peer support that was required versus optional indicated that some veterans may not need or want peer support. Future research should evaluate how best to deliver peer support and for whom it is most beneficial. If successful, peer-supported tech programs may increase the VA workforce as well as improve veteran mental health services and outcomes. CLINICALTRIAL ClinicalTrials.gov NCT04286165.
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Affiliation(s)
- Laura E Ong
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, US
| | - Sarah Speicher
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, US
| | - Diana Villasenor
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, US
| | - Jamie Kim
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, US
| | - Adam Jacobs
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, US
| | - Kathryn S Macia
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, US
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, US
- HSR&D Center for Innovation to Implementation (Ci2i), Veterans Affairs Palo Alto Health Care System, Palo Alto, US
| | - Marylene Cloitre
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, US
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Hietamies TM, Smith AE, Lii TR, Muzzall E, Flohr J, Okada RL, Andriella ZG, Nyongesa CA, Cianfichi LJ, Hack LM, Heifets BD. Prevalence and characteristics of preoperative patients with depression. Br J Anaesth 2024; 133:77-85. [PMID: 38782617 DOI: 10.1016/j.bja.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Within the perioperative period, depression-related diagnoses are associated with postoperative complications. We developed a perioperative depression screening programme to assess disease prevalence and feasibility for intervention. METHODS Adult patients in multiple surgical departments at a single academic centre were screened for depression via the electronic health record patient portal or preoperative anaesthesia clinic before surgery, using the Patient Health Questionnaire (PHQ)-2 and -8. We utilised a broad method, screening all patients, and a focused method, only screening patients with a history of depression. Logistic regression was used to identify characteristics associated with clinically significant depression (PHQ-8 ≥10). Symptomatic patients were administered a brief psychoeducational intervention and referred for mental health services. RESULTS A total of 3735 patients were identified by the broad and focused screens, of whom 2940 (79%) returned PHQ-2 data and were included in analysis. The broad screen (N=1216) found 46 (4%) patients who reported symptoms of moderate or greater severity. The focused screen (N=1724) found 242 (14%) patients with symptoms of moderate or greater severity and over all higher rates of depression across the symptom severity scale. Using the total screened pool, logistic regression identified a history of depression as the strongest associated patient characteristic variable but this did not capture most cases. Finally, we found that 66% of patients who were contacted about mental health services accepted referrals or sought outside care. CONCLUSIONS At least 4% of preoperative patients have clinically significant symptoms of depression, most of whom do not have a chart history of depression.
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Affiliation(s)
- Tuuli M Hietamies
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ashleigh E Smith
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Theresa R Lii
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Evan Muzzall
- Software and Services for Data Science, Stanford Libraries, Stanford, CA, USA
| | - Josephine Flohr
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Robin L Okada
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Zachary G Andriella
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Cynthia A Nyongesa
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Lisa J Cianfichi
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Laura M Hack
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, CA, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Boris D Heifets
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, CA, USA.
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Leng QL, Lyons KS, Winters-Stone KM, Medysky ME, Dieckmann NF, Denfeld QE, Sullivan DR. Preliminary effects of a yoga intervention for lung cancer dyads: benefits for care partners. Support Care Cancer 2024; 32:447. [PMID: 38902487 DOI: 10.1007/s00520-024-08638-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/07/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE Lung cancer is a disease with high mortality and morbidity, impacting both the patient and their closest contact, referred to in this paper as their care partner. There is limited evidence on how to support mental health and quality of life (QOL) for patient-care partner dyads during cancer treatment. This pilot study examines yoga as an intervention to improve well-being for the dyad. METHODS A single-group, 12-week pilot trial of yoga for patients and their care partners recruited from two hospitals during cancer treatment (N = 23 patient-partner dyads or 46 individuals). Most care partners were spouses (70%), with the remainder being adult children (22%), a sibling (4%), or a friend (4%). Descriptive statistics, Cohen's d effect sizes, and paired t-tests for validated psychosocial measures were calculated at baseline and 12 weeks. RESULTS Sixty-five percent of dyads (N = 13) completed the study, with withdrawals mostly due to disease progression. Among care partners, there was a decrease in depression symptomology on the PHQ-8 (p = 0.015, Cohen's d = 0.96) and improvement in QOL on the Caregiver QOL-Cancer scale (p = 0.001, Cohen's d = 0.61). Fifty percent of dyads experienced concordant improvement in depressive symptoms and 77% in QOL. CONCLUSION Patient-partner yoga is a promising intervention for improving mental health and QOL for patient-partner dyads among lung cancer survivors. This study demonstrates yoga to be acceptable, feasible, and with high concordance within patient-partner dyads for improvements in QOL. Yoga shows promise for patients and care partners to alleviate the negative psychosocial impacts of lung cancer, though more research is needed to confirm effects. TRIAL REGISTRATION ClinicalTrials.gov, NCT03649737, 12/9/2020.
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Affiliation(s)
- Qian L Leng
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.
| | - Karen S Lyons
- School of Nursing, Oregon Health and Science University, Portland, OR, USA
| | - Kerri M Winters-Stone
- School of Nursing, Oregon Health and Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Mary E Medysky
- School of Nursing, Oregon Health and Science University, Portland, OR, USA
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health and Science University, Portland, OR, USA
| | - Quin E Denfeld
- School of Nursing, Oregon Health and Science University, Portland, OR, USA
- Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Donald R Sullivan
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Division of Pulmonary, Allergy and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
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Rheingold AA, Williams JL, Bottomley JS. Prevalence and Co-Occurrence of Psychiatric Conditions Among Bereaved Adults. JAMA Netw Open 2024; 7:e2415325. [PMID: 38842805 PMCID: PMC11157353 DOI: 10.1001/jamanetworkopen.2024.15325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/05/2024] [Indexed: 06/07/2024] Open
Abstract
Importance Rates of grief-related psychiatric conditions, such as prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD), among bereaved adults in the US are largely unknown due to limited studies that leverage national samples. Objective To assess risk factors for and prevalence rates and co-occurrence of PGD, PTSD, and MDD among bereaved adults in the US. Design, Setting, and Participants Data for this survey study were collected from a large US panel sample between October 10 and 28, 2022, using a web-based survey. Participants were aged 18 years or older and were proficient in English. Data analysis was conducted between March and June 2023. Main Outcomes and Measures Probable psychiatric conditions were assessed with validated measures that used conservative cutoff scores, duration, and impairment criteria. These measures included the revised Prolonged Grief Disorder scale for PGD, the PTSD Checklist for DSM-5 for PTSD, and the Patient Health Questionnaire-9 for MDD. Data were analyzed using basic descriptives and logistic regression. Results A total of 2034 adults (n = 1529 and 505 in the bereaved and comparison groups, respectively) completed the study. Respondents had a mean (SD) age of 40.7 (15.9) years; the majority were women (1314 [64.6%]) and had at least some college experience (1394 [68.5%]). With regard to race and ethnicity, 392 respondents (19.3%) were Black, 138 (6.8%) were Hispanic, and 1357 (66.7%) were White. Among bereaved adults, 312 (20.4%), 518 (33.9%), and 461 (30.2%) met criteria for a presumptive diagnosis of PGD, PTSD, and MDD, respectively. Comorbidities were common, with 441 participants (28.8%) meeting criteria for at least 2 co-occurring disorders. Comorbid PGD, PTSD, and MDD were more common than any 2 co-occurring or isolated disorders; the presence of co-occurring conditions was more likely among respondents who reported a traumatic loss. Age and educational attainment were associated with the risk of psychiatric conditions; less time since the index death, loss of a psychologically close other, and a traumatic loss experience were associated with increased risk of PGD, PTSD, and MDD or their co-occurrence. Conclusions and Relevance In this study, the majority of bereaved adults did not meet presumptive criteria for PGD, PTSD, or MDD. Nevertheless, PGD, PTSD, and MDD were highly prevalent and comorbid, particularly among those who experienced traumatic loss. These findings underscore the need for integrated psychological care that leverages transdiagnostic mechanisms of evidence-based practice.
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Affiliation(s)
- Alyssa A. Rheingold
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Joah L. Williams
- Department of Psychology, University of Memphis, Memphis, Tennessee
| | - Jamison S. Bottomley
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
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8
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Dörner M, von Känel R, König N, Pazhenkottil AP, Altwegg R, Nager L, Attanasio V, Guth L, Zirngast S, Menzi A, Zuccarella-Hackl C, Princip M. Mindfulness Is Associated with Lower Depression, Anxiety, and Post-Traumatic Stress Disorder Symptoms and Higher Quality of Life in Patients with an Implantable Cardioverter-Defibrillator-A Cross-Sectional Study. Healthcare (Basel) 2024; 12:1118. [PMID: 38891193 PMCID: PMC11172204 DOI: 10.3390/healthcare12111118] [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: 05/09/2024] [Revised: 05/25/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Several studies suggested the efficacy of dispositional mindfulness and mindfulness-based interventions in reducing anxiety and depression in cardiovascular diseases. However, data on the impact of mindfulness on the psychological well-being of patients with an implantable cardioverter-defibrillator (ICD) are scarce. In this study, 422 patients with an ICD were prospectively recruited. Logistic regression was applied to determine associations between dispositional mindfulness (Freiburg Mindfulness Inventory), depression (Patient Health Questionnaire-8), anxiety (Generalized Anxiety Disorder-7 scale), and post-traumatic stress disorder (PTSD) symptoms (Post-Traumatic Stress Diagnostic Scale), adjusting for age, sex, educational status, number of ICD shocks after ICD implantation, and physical activity. The PROCESS regression path analysis modelling tool was used to identify indirect mediating effects of dispositional mindfulness on depression, anxiety, and PTSD symptoms and quality of life (QoL; EuroQol group 5-dimension questionnaire). Participants presented high baseline QoL (mean 1.06 to 1.72) and medium-high mindfulness scores (mean 40.85 points). Higher mindfulness scores were associated with lower levels of anxiety (OR 0.90, 95% CI 0.86 to 0.95, 0.001), depression (OR 0.93, 95% CI 0.88 to 0.98, p = 0.006), and PTSD symptoms (OR 0.94, 95% CI 0.89 to 0.98, p = 0.011). Furthermore, greater mindfulness partially mediated the relationship between anxiety (indirect effect 0.10, 95% CI 0.02 to 0.21), depression (indirect effect 0.08, 95% CI 0.01 to 0.17), or PTSD (indirect effect 0.04, 95% CI 0.01 to 0.17) as independent variables and the QoL as the dependent variable. This study suggests that greater dispositional mindfulness is associated with less anxiety, depression, and PTSD symptoms. Mindfulness might also increase the QoL in ICD patients by mitigating the impact of those with psychological distress.
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Affiliation(s)
- Marc Dörner
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
| | - Roland von Känel
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Noelle König
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Aju P. Pazhenkottil
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Rahel Altwegg
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Ladina Nager
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Veronica Attanasio
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Lisa Guth
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Sina Zirngast
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Anna Menzi
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Claudia Zuccarella-Hackl
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Mary Princip
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
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Villalba K, Latorre-Garcia W, Attonito J. The Relationship Between Intimate Partner Violence, Depression, Alcohol Abuse in Black and Hispanic Women. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241253574. [PMID: 38769893 DOI: 10.1177/08862605241253574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
The relationship between intimate partner violence (IPV), depression, and risky alcohol use is complex and multi-dimensional. Depression has been documented as a common consequence of experiencing IPV, where depressed individuals might turn to substances like alcohol as a coping mechanism. Thus, assessing the indirect effect of depression in the relationship between IPV and alcohol abuse in African American and Hispanic women is warranted. Cross-sectional data was collected from 152 African American and Hispanic women living in Miami, Florida. Descriptive statistics, correlation analysis, and Hayes' direct and indirect mediation analyses were conducted. A total of 77% reported IPV. The mean age was 42.84 (SD = 10.69). About 57% of participants identified as African American, and 62% identified as Hispanic/Latino. On average, participant depression scores (8.6, SD = 5.7) showed mild-to-moderate severity, and the average alcohol abuse score was 15.5 (±8.9), suggesting risky alcohol use. IPV was directly associated with alcohol abuse (β = .50, 95% CI [.18, .82]; [R2 = .059, F(1, 150) = 9.37, p < .001), and with depression (β = .48, 95% CI [.27, .69]; [R2 = .119, F(1, 150) = 20.43, p < .001). Depression modified the effect of IPV on alcohol abuse by about 19% (β = .56, 95% CI [.33, .80]; [R2 = .185, F(2, 149) = 16.87, p < .0026). Results of this study suggest that depression is an important component to be considered when addressing alcohol abuse among women with experiences of IPV. This study highlights the importance of assessing women who report IPV for depressive symptoms when treating alcohol use disorders.
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Affiliation(s)
- Karina Villalba
- College of Medicine, Population Health Sciences, University of Central Florida, Orlando, USA
| | | | - Jennifer Attonito
- College of Business, Health Administration, Florida Atlantic University, Boca Raton, USA
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10
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Dymm B, Goldstein LB, Unnithan S, Al-Khalidi HR, Koltai D, Bushnell C, Husseini NE. Depression following small vessel stroke is common and more prevalent in women. J Stroke Cerebrovasc Dis 2024; 33:107646. [PMID: 38395097 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 01/19/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES We sought to examine the frequency of depression after small vessel-type stroke (SVS) and associated risk factors. MATERIALS AND METHODS We conducted a retrospective analysis of a prospective cohort of patients enrolled in the American Stroke Association-Bugher SVS Study, which included 200 participants within 2-years of SVS and 79 controls without a history of stroke from 2007 to 2012 at four sites. The primary outcome was PHQ-8, with scores ≥10 consistent with post-stroke depression (PSD). A logistic regression adjusted for age, race, sex, history of diabetes and Short-Form Montreal Cognitive Assessment score (SF-MoCA) was used to compare the risk of having depression after SVS compared to controls. Another logistic regression, adjusted for age, sex, race, level of education, SF-MoCA, white matter disease (WMD) burden, stroke severity (NIHSS), time between stroke and depression screen, history of diabetes, and history of hypertension was used to identify factors independently associated with depression in participants with SVS. RESULTS The cohort included 161 participants with SVS (39 excluded due to missing data) and 79 controls. The mean interval between stroke and depression screening was 74 days. Among participants with SVS, 31.7% (n = 51) had PSD compared to 6.3% (n = 5) of controls (RR = 5.44, 95% CI = 2.21-13.38, p = 0.0002). The only two variables independently associated with PSD in participants with SVS were female sex (RR = 1.84, 95% CI = 1.09-3.09, p = 0.020) and diabetes (RR 1.69, 95% CI 1.03-2.79). CONCLUSIONS After adjusting for several demographic and clinical variables, having a SVS was associated with an approximate 5-fold increased risk of depression and was more frequent in women and in those with diabetes. The extent of WMD was not independently associated with PSD, suggesting that small vessel disease in the setting of an overt SVS may not account for the increased prevalence of depression.
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Affiliation(s)
- Braydon Dymm
- Duke University Hospital, Department of Neurology, 2301 Erwin Rd, Durham, NC 27705, United States.
| | | | - Shakthi Unnithan
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, United States
| | - Hussein R Al-Khalidi
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, United States
| | - Deborah Koltai
- Duke University Hospital, Department of Neurology, 2301 Erwin Rd, Durham, NC 27705, United States
| | - Cheryl Bushnell
- Wake Forest Atrium Health, Department of Neurology, United States
| | - Nada El Husseini
- Duke University Hospital, Department of Neurology, 2301 Erwin Rd, Durham, NC 27705, United States
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11
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Son HE, Hong YS, Son H. Association between Changes in Daily Life Due to COVID-19 and Depressive Symptoms in South Korea. Healthcare (Basel) 2024; 12:840. [PMID: 38667602 PMCID: PMC11050245 DOI: 10.3390/healthcare12080840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/07/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
We aimed to examine changes in daily life due to coronavirus disease 2019 (COVID-19) among younger (≤64 years) and older (≥65 years) individuals and to analyze their association with depressive symptoms. Raw data from the 2020 Korean Community Health Survey were used to analyze 228,485 individuals. Changes in daily life due to COVID-19 were measured using a questionnaire that evaluated changes in physical activity, sleep duration, instant food intake, and drinking and smoking status. Depressive symptoms were assessed using the Patient Health Questionnaire 9 scale, and logistic regression analysis was performed to explore the association between the two variables. This study confirmed a significant association between the two variables and found that the intake of instant food showed the largest difference in odds ratios between the younger (OR: 1.851; 95% CI: 1.720-1.992) and older groups (OR: 1.239; 95% CI: 1.060-1.447). A major finding of this study is that the analysis of the association between the two variables revealed a stronger correlation in more variables in the younger population compared to the older population. To address COVID-19-related depression and prepare for potential mental health crises, countries should expand response measures.
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Affiliation(s)
| | | | - Hyunjin Son
- Department of Preventive Medicine, College of Medicine, Dong-A University, Busan 49201, Republic of Korea; (H.-E.S.); (Y.-S.H.)
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12
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Ahuvia IL, Schleider JL, Kneeland ET, Moser JS, Schroder HS. Depression self-labeling in U.S. college students: Associations with perceived control and coping strategies. J Affect Disord 2024; 351:202-210. [PMID: 38286232 DOI: 10.1016/j.jad.2024.01.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/20/2024] [Accepted: 01/26/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Research on mental illness labeling has demonstrated that self-labeling (identifying with a mental illness label, e.g., "I have depression") is associated with internalized stigma, maladaptive responses to that stigma, and lower quality of life. However, research has not yet examined the link between self-labeling and how individuals cope with emotional distress. It is important to understand this relationship because adaptive and maladaptive methods of coping can lead to positive and negative mental illness outcomes. METHODS This cross-sectional study examined the link between depression self-labeling, depression symptoms, and three constructs related to depression self-management (perceived control over depression, cognitive emotion regulation strategies, and help-seeking beliefs) in a large (N = 1423) sample of U.S. college students. RESULTS Approximately one-fifth of students (22.2 %) self-labeled as having depression, while 39.0 % were estimated to meet diagnostic criteria for MDD. After controlling for depression symptom severity, self-labeling was associated with lower levels of perceived control over depression (p = .002), more catastrophizing (p = .013), less perspective taking, refocusing, reappraisal, and planning (ps < 0.05), and more positive help-seeking attitudes towards medication (p < .001) but not therapy. LIMITATIONS Results are non-causal and may not generalize to non-college populations. CONCLUSIONS Self-labeling may inform how individuals cope with emotional distress, with the potential for positive and negative effects on clinical outcomes. This is consistent with well-established research on self-labeling with regards to stigma, but extends this research in important new directions.
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Affiliation(s)
| | - Jessica L Schleider
- Northwestern University Feinberg School of Medicine, United States of America
| | | | | | - Hans S Schroder
- University of Michigan Medical School, United States of America
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13
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Naik H, Tran KC, Staples JA, Perlis RH, Levin A. Psychiatric Symptoms, Treatment Uptake, and Barriers to Mental Health Care Among US Adults With Post-COVID-19 Condition. JAMA Netw Open 2024; 7:e248481. [PMID: 38662370 PMCID: PMC11046346 DOI: 10.1001/jamanetworkopen.2024.8481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/27/2024] [Indexed: 04/26/2024] Open
Abstract
Importance Psychiatric symptoms are reportedly common among adults with post-COVID-19 condition (PCC). However, nationally representative data regarding symptom prevalence, treatment uptake, and barriers to care are needed to inform the development of care models. Objectives To evaluate the prevalence of psychiatric symptoms in US adults with PCC compared with those without PCC and assess treatment uptake and cost-related barriers to treatment. Design, Setting, and Participants Data from the 2022 National Health Interview Survey (NHIS), a nationally representative US cross-sectional survey, were analyzed between October 2023 and February 2024. Exposure Current PCC, defined as new symptoms following SARS-CoV-2 infection lasting more than 3 months and ongoing at the time of interview. Main Outcomes and Measures Depression symptoms were evaluated by the Patient Health Questionnaire-8 and anxiety symptoms were assessed using the General Anxiety Disorder-7 instrument. Participants were classified as having received treatment if they received mental health counseling or therapy or medications for mental health. Sleep difficulties, cognitive difficulties, disabling fatigue, and cost-related barriers were assessed from additional NHIS questions. Results Of the 25 122 participants representing approximately 231 million US adults (median [IQR] age, 46 [32-61] years; 49.8% male and 50.2% female participants), a weighted prevalence (wPr) of 3.4% (95% CI, 3.1%-3.6%) had current PCC. Compared with other US adults, participants with current PCC were more likely to have depression symptoms (wPr, 16.8% vs 7.1%; adjusted odds ratio [AOR], 1.96; 95% CI, 1.51-2.55), anxiety symptoms (wPr, 16.7% vs 6.3%; AOR, 2.21; 95% CI, 1.53-3.19), sleep difficulties (wPr, 41.5% vs 22.7%; AOR 1.95; 95% CI, 1.65-2.29), cognitive difficulties (wPr, 35.0% vs 19.5%; AOR, 2.04; 95% CI, 1.66-2.50), and disabling fatigue (wPr, 4.0% vs 1.6%; AOR, 1.85; 95% CI, 1.20-2.86). Among participants who had depression or anxiety symptoms, those with PCC had a similar likelihood of not having received treatment (wPr, 28.2% vs 34.9%; AOR, 1.02; 95% CI, 0.66-1.57). However, participants with current PCC were more likely to report a cost-related barrier to accessing mental health counseling or therapy (wPr, 37.2% vs 23.3%; AOR, 2.05; 95% CI, 1.40-2.98). Conclusions and Relevance The findings of this study suggest that people with PCC have a higher prevalence of psychiatric symptoms than other adults but are more likely to experience cost-related barriers to accessing therapy. Care pathways for PCC should consider prioritizing mental health screening and affordable treatment.
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Affiliation(s)
- Hiten Naik
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Post–COVID-19 Interdisciplinary Clinical Care Network, Vancouver, British Columbia, Canada
| | - Karen C. Tran
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Post–COVID-19 Interdisciplinary Clinical Care Network, Vancouver, British Columbia, Canada
- Centre for Clinical Epidemiology & Evaluation, Vancouver, British Columbia, Canada
| | - John A. Staples
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Clinical Epidemiology & Evaluation, Vancouver, British Columbia, Canada
| | - Roy H. Perlis
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Adeera Levin
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Post–COVID-19 Interdisciplinary Clinical Care Network, Vancouver, British Columbia, Canada
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Forbes D, LeardMann CA, Lawrence-Wood E, Villalobos J, Madden K, Gutierrez IA, Cowlishaw S, Baur J, Adler AB. Three-Item Dimensions of Anger Reactions Scale. JAMA Netw Open 2024; 7:e2354741. [PMID: 38315485 PMCID: PMC10844994 DOI: 10.1001/jamanetworkopen.2023.54741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/13/2023] [Indexed: 02/07/2024] Open
Abstract
Importance Problematic anger is prevalent and associated with adjustment difficulties in military populations. To facilitate measurement of problematic anger, a very brief valid measure is needed. Objective To reduce the Dimensions of Anger Reactions 5-item (DAR-5) scale to a very brief measure. Design, Setting, and Participants This cross-sectional study used survey data collected between 2014 and 2016 in the Australian Transition and Well-Being Research Programme and US Millennium Cohort Study. Participants were service members who were actively serving or had transitioned out of the military (separated). Statistical analyses were performed from September 2021 to June 2023. Main Outcomes and Measures The DAR-5 was reduced to the 3 experiential items: frequency, intensity, and duration (the DAR-3). Psychometrics for the DAR-3 and DAR-5 were compared in terms of standardized Cronbach α, positive screening result, mean, and SD. Analyses were stratified by Australian and US military service status cohorts (active duty and separated). Results A total of 71 010 participants were included from Australia and the US. Of 10 900 Australian participants (8145 active duty participants [74.7%]; 2755 separated participants [25.3%]), 5893 (55.2%) were aged 40 years or older and 8774 (80.5%) were male; of 60 110 US participants (24 706 active duty participants [41.1%]; 35 404 separated participants [58.9%]), 28 804 (47.9%) were aged 30 to 39 years and 43 475 (72.3%) were male. The DAR-3 demonstrated good internal consistency in the active duty (Australia: mean [SD] score, 4.97 [2.5]; α = 0.90; US: mean [SD] score, 5.04 [2.6]; α = 0.87) and separated (Australia: mean [SD] score, 6.53 [3.4]; α = 0.92; US: mean [SD] score, 6.05 [3.2]; α = 0.91) samples. The cutoff score of 8 or greater on the DAR-3 had optimal sensitivity and specificity across all samples. DAR-3 and DAR-5 were associated with posttraumatic stress disorder (PTSD), depression, aggression, and relationship conflict. While the scales did not significantly differ in their associations with PTSD, depression, and relationship conflict, the magnitude of association for aggression was significantly lower in US samples using the DAR-3 (eg, US active duty sample: DAR-5 OR, 9.96; 95% CI, 9.01-11.00; DAR-3 OR, 8.36; 95% CI, 7.58-9.22). Conclusions and Relevance In this cross-sectional study of a very brief measure of anger, each item contributed to the overall strength of the measure without losing psychometric strength compared with the DAR-5. The consistency of these findings across military and veteran samples in Australian and US populations demonstrated the psychometric robustness of the DAR-3.
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Affiliation(s)
- David Forbes
- Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia
| | - Cynthia A. LeardMann
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Leidos, San Diego, California
| | - Ellie Lawrence-Wood
- Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia
| | - Javier Villalobos
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Leidos, San Diego, California
| | - Kelsey Madden
- Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia
| | - Ian A. Gutierrez
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Sean Cowlishaw
- Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia
| | - Jenelle Baur
- Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia
| | - Amy B. Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
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15
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Qin A, Xu L, Hu F, Qin W, Zhang X, Pei Z, Zhao Y, Fu J. Association between cognitive functioning and lifetime suicidal ideation among Chinese older adults: the mediating effect of depression. Eur Geriatr Med 2024; 15:225-234. [PMID: 38165610 DOI: 10.1007/s41999-023-00912-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/28/2023] [Indexed: 01/04/2024]
Abstract
PURPOSE Existing evidence indicates an association between cognitive functioning and both geriatric depression and suicidality, with mixed evidence regarding the direction of the relationship between cognitive functioning and aspects of geriatric lifetime suicidal ideation. This study aims to examine the relationship between cognitive functioning, depression, and suicide ideation and to explore the intermediary role of depression between cognitive functioning and suicidal ideation in the older adults. METHODS A multi-stage random cluster sampling method was used to collect a sample of 3896 individuals aged 60 and above. Descriptive statistics of the sample data were analyzed using one-way ANOVA, and then the correlation between variables was obtained by binary logistic regression analysis. SPSS macro program PROCESS V3.5 was used to test the mediating role of depression in the relationship between cognitive function and lifetime suicidal ideation. RESULTS The prevalence of lifetime suicidal ideation among older adults was 3.9%. Lifetime suicidal ideation was associated with depression (OR = 1.308, P < 0.001) but was not significantly correlated with cognitive function (OR = 0.972, P > 0.05). The relationship between cognitive function and depression was also supported in this study (β = - 0.0841, P < 0.001). Depression completely mediated the relationship between cognitive function and lifetime suicidal ideation. CONCLUSION There was no significant correlation between cognitive impairment in older adults and a heightened risk of lifetime suicidal ideation. However, this relationship was completely mediated by depression. It is crucial to prevent the onset of depression among older adults with cognitive impairment, as depression is strongly linked to lifetime suicidal ideation.
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Affiliation(s)
- Afei Qin
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, Shandong, China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012, Shandong, China
| | - Lingzhong Xu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, Shandong, China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012, Shandong, China
| | - Fangfang Hu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, Shandong, China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012, Shandong, China
| | - Wenzhe Qin
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, Shandong, China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012, Shandong, China
| | - Xiaohong Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, Shandong, China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012, Shandong, China
| | - Zhongfei Pei
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, Shandong, China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012, Shandong, China
| | - Yan Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, Shandong, China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012, Shandong, China
| | - Jing Fu
- Nursing Department of Qilu Hospital, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, China.
- Blood Purification Center of Qilu Hospital, Shandong University, Jinan, Shandong, China.
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16
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Tong M, Hurtado A, Deshpande R, Pietrzak RH, He C, Kaplan C, Kaplan S, Akhtar S, Feder A, Feingold JH, Ripp JA, Peccoralo LA. Psychological Burden of Systemic Racism-Related Distress in New York City Healthcare Workers During the COVID-19 Pandemic. J Gen Intern Med 2024; 39:450-459. [PMID: 37845586 PMCID: PMC10897117 DOI: 10.1007/s11606-023-08422-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/07/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Little is known about the relationship among systemic racism, psychological symptoms (depression, anxiety, and/or post-traumatic stress disorders), and burnout in healthcare workers (HCWs). OBJECTIVE To determine whether distress related to awareness of systemic racism contributes to psychological symptoms and/or burnout in HCWs. We explored whether this form of racism-related distress may moderate the relationship between race, ethnicity, psychological symptoms, and burnout. DESIGN A cross-sectional survey was conducted from November 19, 2020, through January 11, 2021. Statistical analysis was conducted from May 3, 2022, to June 15, 2022. PARTICIPANTS Frontline HCWs at an urban tertiary care hospital in New York City. MAIN MEASURES Distress related to awareness of systemic racism (SR) and racial disparities in COVID-19 outcomes (RD), psychological symptoms, and burnout. KEY RESULTS Two thousand one of 4654 HCWs completed the survey (response rate 43.0%). Most HCWs reported experiencing distress related to awareness of systemic racism (1329 [66.4%]) and to racial disparities in COVID-19 outcomes (1137 [56.8%]). Non-Hispanic Black participants (SR odds ratio (OR) 2.84, p < .001; RD OR 2.34, p < .001), women (SR OR 1.35, p = .01; RD OR 1.67, p < .001), and those with history of mental illness (SR OR 2.13, p < .001; RD OR 1.66, p < .001) were more likely to report SR- and RD-related distress, respectively. HCWs who experienced "quite-a-bit to extreme" SR-related distress were more likely to screen positive for psychological symptoms (OR 5.90, p < .001) and burnout (OR 2.26, p < .001). CONCLUSIONS Our findings suggest that distress related to awareness of systemic racism, not race/ethnicity, was associated with experiencing psychological symptoms and burnout in HCWs. As the medical community continues to critically examine the role of systemic racism in healthcare, our work is a first step in characterizing its toll on the psychological well-being of HCWs.
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Affiliation(s)
- Michelle Tong
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Alicia Hurtado
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Richa Deshpande
- Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Celestine He
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Carly Kaplan
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Sabrina Kaplan
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Saadia Akhtar
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jordyn H Feingold
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan A Ripp
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren A Peccoralo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA.
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Coopersmith AS, Berler MH, Johnston B, Knutilla L, Edwards AL, Lebares CC. Investigating influential factors and mechanisms of surgical resident well-being using social network analysis. Am J Surg 2024; 228:45-51. [PMID: 37722938 DOI: 10.1016/j.amjsurg.2023.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/09/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Burnout and depression in General Surgery residents affect patient care and drive attrition. Few impactful interventions exist, in part because little is known about influential drivers and mechanistic relationships. METHODS Residents from 16 general surgery programs completed published well-being scales in January 2021. Social network analysis demonstrated influential relationships between factors, and path analysis revealed drivers of burnout and depression. RESULTS 300 residents completed the survey (34% response rate). Workplace demand and mindfulness influenced depressive symptoms and emotional exhaustion, mediated by perceived stress. Mindfulness increased personal accomplishment, mediated by psychological well-being (p < 0.05 for all results). All mediated effects were greater than direct effects. CONCLUSIONS This study yielded a quantitative conceptual model of mechanistic relationships affecting well-being in surgical residency, identifying stress and psychological well-being (measuring sense of purpose) as central mediators, and triangulating workplace demand and mindfulness as potentially high-yield interventional targets for reducing burnout and depression in surgical residency.
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Affiliation(s)
- Ari S Coopersmith
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Michael H Berler
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Brianna Johnston
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Lillian Knutilla
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Anya L Edwards
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Carter C Lebares
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
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18
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Lozano P, Peters A, Southworth A, Mo Y, Lam H, Randal FT, Kim KE. Smoking behavior among Asian Americans during the initial phase of the COVID-19 pandemic: The influence of pandemic stressors and depression. Tob Induc Dis 2024; 22:TID-22-28. [PMID: 38274001 PMCID: PMC10809060 DOI: 10.18332/tid/176923] [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: 10/20/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Heightened levels of distress among Asian Americans during the initial phases of the pandemic may be associated with current smoking behavior. In this study, we examine differences in current smoking among Asian Americans from two different ethnic backgrounds before and during the COVID-19 pandemic. METHODS We analyzed cross-sectional survey data (n=202) from Chinese and South Asian adults in Chicago, collected between February and May 2020. We conducted logistic regression models to estimate the relationship between exposure to the COVID-19 pandemic and current smoking. We tested whether the association varied by Asian American ethnic group, unemployment, racial discrimination, and depression symptoms. RESULTS We found that current smoking increased from 28% to 48% among Asian Americans (i.e. Chinese and South Asians) during the pandemic. We found a statistically significant interaction between the COVID-19 period indicator variable and current smoking by Asian American ethnic groups (p=0.014), such that current smoking was lower for Chinese compared to South Asians before COVID-19, but was comparable for both groups during the pandemic. We also found a statistically significant interaction between the period indicator variable and current smoking by racial discrimination (p=0.047) and depression symptoms (p=0.02). Results from these interactions suggest that Asian Americans who experienced racial discrimination and depression during the pandemic may be more likely to be current smokers compared to their pre-pandemic counterparts. CONCLUSIONS The findings of the study highlight the need for culturally tailored smoking cessation interventions for Asian American communities that address pandemic-related stressors such as discrimination that may trigger cigarette use.
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Affiliation(s)
- Paula Lozano
- Department of Biomedical Sciences, Center for Asian Health Equity - University of Chicago Medicine, Chicago, United States
| | - Aven Peters
- Department of Biomedical Sciences, Center for Asian Health Equity - University of Chicago Medicine, Chicago, United States
| | | | - Yicklun Mo
- Asian Health Coalition, Chicago, United States
| | - Helen Lam
- Department of Biomedical Sciences, Center for Asian Health Equity - University of Chicago Medicine, Chicago, United States
| | | | - Karen E. Kim
- Department of Biomedical Sciences, Center for Asian Health Equity - University of Chicago Medicine, Chicago, United States
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19
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Imel ZE, Tanana MJ, Soma CS, Hull TD, Pace BT, Stanco SC, Creed TA, Moyers TB, Atkins DC. Mental Health Counseling From Conversational Content With Transformer-Based Machine Learning. JAMA Netw Open 2024; 7:e2352590. [PMID: 38252437 PMCID: PMC10804269 DOI: 10.1001/jamanetworkopen.2023.52590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/28/2023] [Indexed: 01/23/2024] Open
Abstract
Importance Use of asynchronous text-based counseling is rapidly growing as an easy-to-access approach to behavioral health care. Similar to in-person treatment, it is challenging to reliably assess as measures of process and content do not scale. Objective To use machine learning to evaluate clinical content and client-reported outcomes in a large sample of text-based counseling episodes of care. Design, Setting, and Participants In this quality improvement study, participants received text-based counseling between 2014 and 2019; data analysis was conducted from September 22, 2022, to November 28, 2023. The deidentified content of messages was retained as a part of ongoing quality assurance. Treatment was asynchronous text-based counseling via an online and mobile therapy app (Talkspace). Therapists were licensed to provide mental health treatment and were either independent contractors or employees of the product company. Participants were self-referred via online sign-up and received services via their insurance or self-pay and were assigned a diagnosis from their health care professional. Exposure All clients received counseling services from a licensed mental health clinician. Main Outcomes and Measures The primary outcomes were client engagement in counseling (number of weeks), treatment satisfaction, and changes in client symptoms, measured via the 8-item version of Patient Health Questionnaire (PHQ-8). A previously trained, transformer-based, deep learning model automatically categorized messages into types of therapist interventions and summaries of clinical content. Results The total sample included 166 644 clients treated by 4973 therapists (20 600 274 messages). Participating clients were predominantly female (75.23%), aged 26 to 35 years (55.4%), single (37.88%), earned a bachelor's degree (59.13%), and were White (61.8%). There was substantial variability in intervention use and treatment content across therapists. A series of mixed-effects regressions indicated that collectively, interventions and clinical content were associated with key outcomes: engagement (multiple R = 0.43), satisfaction (multiple R = 0.46), and change in PHQ-8 score (multiple R = 0.13). Conclusions and Relevance This quality improvement study found associations between therapist interventions, clinical content, and client-reported outcomes. Consistent with traditional forms of counseling, higher amounts of supportive counseling were associated with improved outcomes. These findings suggest that machine learning-based evaluations of content may increase the scale and specificity of psychotherapy research.
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Affiliation(s)
| | | | | | | | | | | | - Torrey A. Creed
- Beck Community Initiative, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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20
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Kandola A, Edwards K, Muller MAE, Dührkoop B, Hein B, Straatman J, Hayes JF. Digitally managing depression: A fully remote randomised attention-placebo controlled trial. Digit Health 2024; 10:20552076241260409. [PMID: 38854919 PMCID: PMC11162123 DOI: 10.1177/20552076241260409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/11/2024] Open
Abstract
Background Depression is a common and disabling condition. Digital apps may augment or facilitate care, particularly in under-served populations. We tested the efficacy of juli, a digital self-management app for depression in a fully remote randomised controlled trial. Methods A pragmatic randomised controlled trial that included participants aged > 18 who self-identified as having depression and scored > 5 on the Patient Health Questionnaire-8. Participants were randomly assigned (1:1) to receive juli for 8 weeks or a limited attention-placebo control app. Our primary outcome was the difference in Patient Health Questionnaire-8 scores at 8 weeks. Secondary outcomes were remission, minimal clinically important difference, worsening of depression, and health-related quality of life. Analyses were per-protocol (primary), and modified and full intention-to-treat (secondary). The trial was registered at ISRCTN (ISRCTN12329547). Results Between May 2021 and January 2023, we randomised 908 participants. 662 completed the week 2 outcome assessment and were included in the modified intention-to-treat analysis, and 456 completed the week 8 outcome assessments (per-protocol). In the per-protocol analysis, the juli group had a greater reduction in Patient Health Questionnaire-8 score (10.78, standard deviation 6.26) than the control group (11.88, standard deviation 5.73) by week 8 (baseline adjusted β-coefficient -0.94, 95% CI: -1.87 to -0.22, p = 0.045). Achieving remission and a minimal clinically important difference was more likely in the juli group at 8 weeks (adjusted odds ratios 2.22, 95% CI: 1.45-3.39, p < 0.001 and 1.56, 95% CI: 1.08-2.27, p = 0.018, respectively). There were no between-group differences in health-related quality of life or worsening of depression. Modified and full intention-to-treat analyses found similar results, but the primary outcome was non-significant. Conclusion The use of juli for 8 weeks resulted in a small reduction in symptoms of depression compared with an attention-placebo control. The juli app is a digital self-management tool that could increase the accessibility of evidence-based depression treatments.
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Affiliation(s)
- Aaron Kandola
- MRC Unit of Lifelong Health and Aging, University College London - UCL, UK
- juli Health, Hull, MA, USA
| | - Kyra Edwards
- Division of Psychiatry, University College London - UCL, UK
| | | | | | | | | | - Joseph F Hayes
- juli Health, Hull, MA, USA
- Division of Psychiatry, University College London - UCL, UK
- Camden and Islington NHS Foundation Trust, London, UK
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21
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Shirasaki K, Hifumi T, Nakanishi N, Nosaka N, Miyamoto K, Komachi MH, Haruna J, Inoue S, Otani N. Postintensive care syndrome family: A comprehensive review. Acute Med Surg 2024; 11:e939. [PMID: 38476451 PMCID: PMC10928249 DOI: 10.1002/ams2.939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
Families of critically ill patients are predisposed to tremendous burdens when their relatives are admitted to the intensive care unit (ICU). Postintensive care syndrome family (PICS-F) can be described as a devastated life, encompassing psychological, physical, and socioeconomical burdens that begin with the emotional impact experienced by the family when the patient is admitted to the ICU. PICS-F was primarily proposed as a clinically significant psychological impairment, but it needs to be extended beyond the psychological impairment of the family to include physical and socioeconomical impairments in the future. The prevalence of physiological problems including depression, anxiety and post-traumatic syndrome is 20-40%, and that of non-physiological problems including fatigue is 15% at 6 months after the ICU stay. Assessment of PICS-F was frequently conducted at 3- or 6-month points, although the beginning of the evaluation was based on different assessment points among each of the studies. Families of ICU patients need to be given and understand accurate information, such as the patient's diagnosis, planned care, and prognosis. Prevention of PICS-F requires a continuous bundle of multifaceted and/or multidisciplinary interventions including providing a family information leaflet, ICU diary, communication facilitators, supportive grief care, and follow-up, for the patient and families from during the ICU stay to after discharge from the ICU. This is the first comprehensive review of PICS-F to address the concept, risk factors, assessment tools, prevalence, and management to prevent PICS-F to facilitate acute care physicians' understanding of PICS-F.
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Affiliation(s)
- Kasumi Shirasaki
- Department of Emergency and Critical Care MedicineSt. Luke's International HospitalTokyoJapan
| | - Toru Hifumi
- Department of Emergency and Critical Care MedicineSt. Luke's International HospitalTokyoJapan
| | - Nobuto Nakanishi
- Division of Disaster and Emergency Medicine, Department of Surgery RelatedKobe University Graduate School of MedicineKobeJapan
| | - Nobuyuki Nosaka
- Department of Intensive Care MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Kyohei Miyamoto
- Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayamaJapan
| | - Miyuki H. Komachi
- School of Clinical Medicine, Department of Psychiatry, Child and Adolescent Resilience and Mental HealthUniversity of CambridgeCambridgeUK
| | - Junpei Haruna
- Department of Intensive Care Medicine, School of MedicineSapporo Medical UniversityHokkaidoJapan
| | - Shigeaki Inoue
- Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayamaJapan
| | - Norio Otani
- Department of Emergency and Critical Care MedicineSt. Luke's International HospitalTokyoJapan
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22
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Cuauro SE, Santos N, Andrade E, Dani AW, Sanchious SN, Hooper SC, Becker CB. Internalized Weight Stigma and Weight Discrimination: Associations with Quality of Life and Psychosocial Impairment in a Sample Living with Food Insecurity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7147. [PMID: 38131699 PMCID: PMC10742389 DOI: 10.3390/ijerph20247147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/26/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Abstract
Research suggests that experiencing weight discrimination is associated with a lower quality of life and poor psychological and physical health. However, much of the existing weight discrimination literature has neglected under-represented groups. Little is known about how the experience of weight discrimination affects quality of life and eating/weight-related psychosocial impairment in those living with food insecurity. The present study investigated the associations of weight discrimination and eating/weight-related psychosocial impairment and quality of life. We examined internalized weight stigma and several psychological indicators as potential mediators. Participants (N = 1085) who were recruited from a local food bank completed a questionnaire assessing food insecurity, weight discrimination, internalized weight stigma, eating disorder pathology, anxiety, depression, eating/weight-related psychosocial impairment, and quality of life. Overall, almost one in four participants reported experiencing weight discrimination. Our serial mediation models indicated that increased experiences of weight discrimination were associated with greater internalized weight stigma and psychopathology, which were in turn associated with lower quality of life and greater eating/weight-related psychosocial impairment. Thus, experiencing weight discrimination may negatively impact quality of life and eating/weight-related psychosocial impairment through its effect on mental health. It is imperative to address the negative effects of the widespread discrimination of people based on their weight.
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Affiliation(s)
- Sabrina E. Cuauro
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
- Department of Psychological Sciences, Rice University, Houston, TX 77005, USA
| | - Natalia Santos
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
| | - Estefania Andrade
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
| | - Anoushka W. Dani
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
| | - Saivone N. Sanchious
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI 02912, USA
| | - Savannah C. Hooper
- Department of Psychological and Brain Science, University of Louisville, Louisville, KY 40292, USA;
| | - Carolyn Black Becker
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
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23
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Swirsky ES, Boyd AD, Gu C, Burke LA, Doorenbos AZ, Ezenwa MO, Knisely MR, Leigh JW, Li H, Mandernach MW, Molokie RE, Patil CL, Steffen AD, Shah N, deMartelly VA, Staman KL, Schlaeger JM. Monitoring and responding to signals of suicidal ideation in pragmatic clinical trials: Lessons from the GRACE trial for Chronic Sickle Cell Disease Pain. Contemp Clin Trials Commun 2023; 36:101218. [PMID: 37842321 PMCID: PMC10569945 DOI: 10.1016/j.conctc.2023.101218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/11/2023] [Accepted: 10/01/2023] [Indexed: 10/17/2023] Open
Abstract
Sickle cell disease (SCD) is a hemoglobin disorder and the most common genetic disorder that affects 100,000 Americans and millions worldwide. Adults living with SCD have pain so severe that it often requires opioids to keep it in control. Depression is a major global public health concern associated with an increased risk in chronic medical disorders, including in adults living with sickle cell disease (SCD). A strong relationship exists between suicidal ideation, suicide attempts, and depression. Researchers enrolling adults living with SCD in pragmatic clinical trials are obligated to design their methods to deliberately monitor and respond to symptoms related to depression and suicidal ideation. This will offer increased protection for their participants and help clinical investigators meet their fiduciary duties. This article presents a review of this sociotechnical milieu that highlights, analyzes, and offers recommendations to address ethical considerations in the development of protocols, procedures, and monitoring activities related to suicidality in depressed patients in a pragmatic clinical trial.
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Affiliation(s)
| | | | - Carol Gu
- University of Illinois Chicago, Chicago, IL, USA
| | | | | | | | | | | | - Hongjin Li
- University of Illinois Chicago, Chicago, IL, USA
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24
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Cheng DK, Ullah MH, Gage H, Moineddin R, Sud A. Chronic pain trials often exclude people with comorbid depressive symptoms: A secondary analysis of 346 randomized controlled trials. Clin Trials 2023; 20:632-641. [PMID: 37345528 PMCID: PMC10638851 DOI: 10.1177/17407745231182010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Chronic pain and depression are common comorbid conditions, but there is limited evidence-based guidance for management of the two conditions together. In recent years, there has been an increase in the number of chronic pain randomized controlled trials that collect depression outcomes, but it is unknown how often these trials include people with depression or significant depressive symptoms. If trials do not include participants representative of real-world populations, evidence and guidance generated from these trials risk being inapplicable for large proportions of the target population, or worse, risk harm. Thus, in order to identify pathways to improve the conduct of clinical trials, the aims of this study were to (1) estimate the proportion of randomized controlled trials evaluating chronic pain interventions and reporting depression outcomes that include participants with significant depressive symptoms; and (2) assess the variability of inclusion proportions by pain type, intervention type, gender, country of origin, and publication year. METHODS Studies were extracted from an umbrella review of interventions for chronic pain that reported depression outcomes. Screening and data extraction were completed in duplicate and conflicts were resolved by a third author. Randomized controlled trials with at least 50% adult participants and validated depression scales were included, and randomized controlled trials with populations whose mean scores were at or above depression thresholds at baseline were considered to have included participants with depression. RESULTS Of the 346 randomized controlled trials analyzed, 142 (41%) included participants with depression. Eight pain-type groups and nine intervention types were identified. Randomized controlled trials investigating fibromyalgia and mixed chronic pain had the highest proportion of participants with depression, whereas studies of arthritis and axial pain had among the lowest. Randomized controlled trials from the United States had a significantly lower inclusion proportion compared with non-US studies, especially for studies on arthritis. The increase in inclusion proportion by publication year was driven by the increase in fibromyalgia studies. DISCUSSION AND CONCLUSION This study highlights opportunities to improve the conduct of chronic pain clinical trials. The majority of randomized controlled trials s analyzed evaluated participants without significant depressive symptoms at baseline, thus the findings synthesized in systematic reviews and subsequent guidelines are most applicable to the subset of real-world populations that do not have significant depressive symptoms. As well, systemic biases around psychological conditions and gender may be important contributors to differences in the study of depression in fibromyalgia compared with common conditions such as arthritis and axial pain. In order to better inform clinical practice, future research must intentionally include individuals with comorbid depression in trials of common chronic pain conditions, and consider methods to mitigate biases that may distort study design.
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Affiliation(s)
- Darren K Cheng
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Maarij Hannan Ullah
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Henry Gage
- Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Rahim Moineddin
- Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Abhimanyu Sud
- Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Humber River Hospital, Toronto, ON, Canada
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25
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Ramirez JL, Kim E, Fregenal AC, Vigran HJ, Hughes SE, Reynolds CW, Varban OA, Carlin AM, Ehlers AP, Bonham AJ, Finks JF. Depression as a risk factor for adverse outcomes and increased healthcare utilization in bariatric surgery patients. Surg Endosc 2023; 37:9582-9590. [PMID: 37735218 DOI: 10.1007/s00464-023-10353-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/30/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Depression is strongly associated with obesity and is common among patients undergoing bariatric surgery. Little is known about the impact of depression on early postoperative outcomes or its association with substance use. METHODS The Michigan Bariatric Surgery Collaborative is a statewide quality improvement program that maintains a large clinical registry. We evaluated patients undergoing primary Roux-en-Y gastric bypass or sleeve gastrectomy between 2017 and 2022. Patients self-reported symptoms of depression (PHQ-8) and use of alcohol (AUDIT-C), smoking, prescription opiates, and marijuana at baseline. Preoperative PHQ-8 scores stratified patients based on severity: no depression (0-4), mild (5-9), moderate (10-14), or severe (15-24). We compared 30-day outcomes and substance use between patients with and without depression. RESULTS Among 44,301 patients, 30.8% had some level of depression, with 19.8% mild, 7.5% moderate, and 3.5% severe. Patients with depression were more likely to have an extended length of stay (LOS) (> 3 days) than those without depression (no depression 2.1% vs. severe depression 3.0%, p = 0.0452). There were no significant differences between no depression and severe depression groups in rates of complications (5.7% vs. 5.2%, p = 0.1564), reoperations (0.9%, vs. 0.8%, p = 0.7394), ED visits (7.7% vs. 7.8%, p = 0.5353), or readmissions (3.2% vs. 3.9%, p = 0.3034). Patients with severe depression had significantly higher rates of smoking (9.7% vs. 12.5%, p < 0.0001), alcohol use disorder (8.6% vs. 14.0%, p < 0.0001), opiate use (14.5% vs. 22.4%, p < 0.0001) and marijuana use (8.4%, vs. 15.5%, p = 0.0008). CONCLUSIONS This study demonstrated that nearly one-third of patients undergoing bariatric surgery have depression, with over 10% in the moderate to severe range. There was a significant association between preoperative depressive symptoms and extended LOS after bariatric surgery, as well as higher rates of smoking and use of marijuana, prescription opiates and alcohol. There was no significant effect on adverse events or other measures of healthcare utilization.
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Affiliation(s)
| | - Erin Kim
- University of Michigan Medical School, Ann Arbor, MI, USA.
| | | | | | - Sarah E Hughes
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Oliver A Varban
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Anne P Ehlers
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Aaron J Bonham
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan F Finks
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
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26
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Bryan CJ, Allen MH, Bryan AO, Thomsen CJ, Baker JC, May AM. Does Suicide Risk Screening Improve the Identification of Primary Care Patients Who Will Attempt Suicide Versus Depression Screening Alone? Jt Comm J Qual Patient Saf 2023; 49:680-688. [PMID: 37739828 DOI: 10.1016/j.jcjq.2023.08.008] [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: 02/28/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE The effectiveness of suicide risk screening relative to depression screening alone among primary care patients has not been tested rigorously. This study compared the performance of multiple depression screening methods (Patient Health Questionnaire [PHQ]-2, PHQ-8, and PHQ-9) and multiple suicide risk screening methods (PHQ-9 item 9 and suicide-focused screening of "thoughts of killing yourself" during the entire lifespan, within the past month, and within the past week) in a convenience sample of primary care patients. METHODS A total of 2,744 patients (military personnel, family members, and retirees) from six military primary care clinics completed the PHQ-9 and screening for suicidal ideation (SI) during routine clinic visits. Follow-up phone interviews were conducted for one year post-baseline to assess the incidence of suicide attempts, the study's primary outcome. Sensitivity, specificity, accuracy, and F1 statistics were calculated for each screening method for identifying patients who attempted suicide. RESULTS More than 65% of patients who screened positive for SI also screened positive for depression on the PHQ-9. Depression screening with the PHQ-9 correctly identified more patients who attempted suicide during follow-up than the PHQ-2, past week SI, and past month SI. The PHQ-9 correctly identified more patients who attempted suicide within 3 months than lifetime SI, but lifetime SI correctly identified more patients who attempted suicide within 6 and 12 months. CONCLUSION Depression screening with the PHQ-9 was the most effective strategy for identifying patients who attempted suicide in the near term. Universal suicide risk screening is unlikely to meaningfully improve identification of higher-risk patients beyond PHQ-9 depression screening.
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27
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van Loggerenberg F, Akena D, Alinaitwe R, Birabwa-Oketcho H, Méndez CAC, Gómez-Restrepo C, Kulenović AD, Selak N, Kiseljaković M, Musisi S, Nakasujja N, Sewankambo NK, Priebe S. Feasibility and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with long-term physical conditions: an exploratory non-controlled study in Bosnia and Herzegovina, Colombia and Uganda. BMC PRIMARY CARE 2023; 24:241. [PMID: 37968592 PMCID: PMC10652546 DOI: 10.1186/s12875-023-02197-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION The management of long-term physical conditions is a challenge worldwide, absorbing a majority resources despite the importance of acute care. The management of these conditions is done largely in primary care and so interventions to improve primary care could have an enormous impact. However, very little data exist on how to do this. Mental distress is frequently comorbid with long term physical conditions, and can impact on health behaviour and adherence, leading to poorer outcomes. DIALOG+ is a low-cost, patient-centred and solution-focused intervention, which is used in routine patient-clinician meetings and has been shown to improve outcomes in mental health care. The question arises as to whether it could also be used in primary care to improve the quality of life and mental health of patients with long-term physical conditions. This is particularly important for low- and middle-income countries with limited health care resources. METHODS An exploratory non-controlled multi-site trial was conducted in Bosnia and Herzegovina, Colombia, and Uganda. Feasibility was determined by recruitment, retention, and session completion. Patient outcomes (quality of life, anxiety and depression symptoms, objective social situation) were assessed at baseline and after three approximately monthly DIALOG+ sessions. RESULTS A total of 117 patients were enrolled in the study, 25 in Bosnia and Herzegovina, 32 in Colombia, and 60 in Uganda. In each country, more than 75% of anticipated participants were recruited, with retention rates over 90% and completion of the intervention exceeding 92%. Patients had significantly higher quality of life and fewer anxiety and depression symptoms at post-intervention follow-up, with moderate to large effect sizes. There were no significant improvements in objective social situation. CONCLUSION The findings from this exploratory trial suggest that DIALOG+ is feasible in primary care settings for patients with long-term physical conditions and may substantially improve patient outcomes. Future research may test implementation and effectiveness of DIALOG+ in randomized controlled trials in wider primary care settings in low- and middle-income countries. TRIAL REGISTRATION All studies were registered prospectively within the ISRCTN Registry. ISRCTN17003451, 02/12/2020 (Bosnia and Herzegovina), ISRCTN14018729, 01/12/2020 (Colombia) and ISRCTN50335796, 02/12/2020 (Uganda).
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Affiliation(s)
- Francois van Loggerenberg
- Youth Resilience Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Dickens Akena
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Racheal Alinaitwe
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Carlos Gómez-Restrepo
- Departments of Clinical Epidemiology and Biostatistics and Psychiatry and Mental Health, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Nejra Selak
- Primary Care Center Zenica, Zenica, Bosnia and Herzegovina
| | - Meliha Kiseljaković
- Emergency Medical Center of Canton Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Seggane Musisi
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Nelson K Sewankambo
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, East London NHS Foundation Trust, London, UK
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He C, Igwe N, Damian C, Feder A, Feingold J, Ripp J, Pietrzak R, Peccoralo L, Hurtado A, Chan C. Racial & ethnic differences in mental health outcomes and risk factors among frontline healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry 2023; 85:1-7. [PMID: 37716020 DOI: 10.1016/j.genhosppsych.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/06/2023] [Accepted: 09/07/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE To examine racial/ethnic differences in mental health outcomes and risk factors during the COVID-19 pandemic among frontline healthcare workers (FHCWs). METHODS A survey was conducted on FHCWs at a large metropolitan hospital during winter 2021. Depression, anxiety, and post-traumatic stress symptoms, demographic characteristics, and COVID-19-related occupational factors were assessed. Multivariable logistic regression examined factors associated with screening positive for psychiatric symptoms and their interactions with race/ethnicity. RESULTS Of 1437 FHCWs, 762 (53.0%) self-identified as white, 451 (31.4%) as Asian, 118 (8.2%) as Black, and 106 (7.4%) as Latinx. Black FHCWs had a higher prevalence of screening positive for depression (18.6%) than other groups (6.6%-11.7%, p < .05). Significant risk factors by race/ethnicity interactions indicated that having cared for patients who died from COVID-19 increased risk of psychiatric symptoms among white and Black individuals, having to make difficult decisions prioritizing patients increased risk most significantly among white and Asian individuals, and working more hours increased risk most significantly among Latinx individuals. CONCLUSION Results suggest that occupational stressors may have differential impacts on mental health among racial/ethnic groups of FHCWs. Findings provide insight on subgroups with increased vulnerability to certain risk factors and inform interventions to improve mental health in diverse FHCWs.
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Affiliation(s)
- Celestine He
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, NY, NY 10029, USA.
| | - Nnamdi Igwe
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, NY, NY 10029, USA
| | - Candida Damian
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, NY, NY 10029, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1230, NY, NY 10029, USA
| | - Jordyn Feingold
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1230, NY, NY 10029, USA
| | - Jonathan Ripp
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, NY, NY 10029, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1087, NY, NY 10029, USA
| | - Robert Pietrzak
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1230, NY, NY 10029, USA
| | - Lauren Peccoralo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, NY, NY 10029, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1087, NY, NY 10029, USA
| | - Alicia Hurtado
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, NY, NY 10029, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1230, NY, NY 10029, USA
| | - Chi Chan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1230, NY, NY 10029, USA
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Rausch R, Bäuerle A, Rentrop V, Jansen C, Nensa F, Palm S, Tewes M, Schadendorf D, Skoda EM, Teufel M. Falling off the screening grid-Predictors for postponed utilization of psycho-oncological support in cancer patients and its implications for distress assessment and management. Psychooncology 2023; 32:1727-1735. [PMID: 37789593 DOI: 10.1002/pon.6226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Distress assessment of cancer patients is considered state-of-the-art. In addition to distress scores, individual care needs are an important factor for the initiation of psycho-oncological interventions. In a mono-centric, observational study, we aimed for characterization of patients indicating a subjective need but declining to utilize support services immediately to facilitate implementation of adapted screenings. METHODS This study analyzed retrospective data from routine distress screening and associated data from hospital records. Descriptive, variance and regression analyses were used to assess characteristics of postponed support utilization in patients with mixed cancer diagnoses in different treatment settings. RESULTS Of the total sample (N = 1863), 13% indicated a subjective need but postponed support utilization. This subgroup presented as being as burdened by symptoms of depression (p < 0.001), anxiety (p < 0.001) and distress (p < 0.001) as subjectively distressed patients with intent to directly utilize support. Time periods since diagnosis were shorter (p = 0.007) and patients were more often inpatients (p = 0.045). CONCLUSIONS Despite high heterogeneity among the subgroups, this study identified distress-related factors and time since diagnosis as possible predictors for postponed utilization of psycho-oncological interventions. Results suggest the necessity for time-individualized support which may improve utilization by distressed patients.
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Affiliation(s)
- Raya Rausch
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Vanessa Rentrop
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Christoph Jansen
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Felix Nensa
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Stefan Palm
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Mitra Tewes
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Palliative Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Dirk Schadendorf
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Dermatology, University Hospital Essen, NCT West and West German Cancer Center Consortium, Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
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Drazich BF, Anokye D, Zhu S, Teleb J, Galik E, Colloca L, Resnick B. Motivating older adults through immersive virtual exercise (MOTIVE): A randomized pilot study. Geriatr Nurs 2023; 54:229-236. [PMID: 37844539 DOI: 10.1016/j.gerinurse.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND This study aimed to: 1) determine the feasibility of a virtual reality physical activity intervention among older adults and 2) test the preliminary effectiveness of the intervention at increasing physical activity and 3) decreasing depressive symptoms. METHODS We included 10 older adults randomized into the Motivating Older Adults Through Immersive Virtual Exercise (MOTIVE) intervention group and 10 randomized into the physical activity education only control group. We analyzed the data using descriptive statistics and linear mixed models, testing the interaction of time and the treatment condition. RESULTS Participants in the intervention group attended an average of 15 out of the 16 sessions. A total of 90% of MOTIVE intervention group participants "completely agreed" that the intervention was acceptable, (compared to 30% of education control group participants). CONCLUSION This study supports testing the effectiveness of the intervention at improving physical activity and depressive symptoms in a larger sample of older adults.
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Affiliation(s)
- Brittany F Drazich
- School of Nursing, University of Maryland Baltimore, 655 W Lombard St. Baltimore, MD 21201, USA.
| | - Debora Anokye
- School of Nursing, University of Maryland Baltimore, 655 W Lombard St. Baltimore, MD 21201, USA
| | - Shijun Zhu
- School of Nursing, University of Maryland Baltimore, 655 W Lombard St. Baltimore, MD 21201, USA
| | - Jejomar Teleb
- School of Nursing, University of Maryland Baltimore, 655 W Lombard St. Baltimore, MD 21201, USA
| | - Elizabeth Galik
- School of Nursing, University of Maryland Baltimore, 655 W Lombard St. Baltimore, MD 21201, USA
| | - Luana Colloca
- School of Nursing, University of Maryland Baltimore, 655 W Lombard St. Baltimore, MD 21201, USA
| | - Barbara Resnick
- School of Nursing, University of Maryland Baltimore, 655 W Lombard St. Baltimore, MD 21201, USA
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Dörner M, von Känel R, Pazhenkottil AP, Altwegg R, Nager L, Attanasio V, Guth L, Zirngast S, Menzi A, Princip M, Hackl-Zuccarella C. Fear of COVID-19 Predicts Depression, Anxiety and Post-Traumatic Stress Disorders in Patients with Implantable Cardioverter Defibrillators and Is Mediated by Positive and Negative Affects-A Cross-Sectional Study. J Clin Med 2023; 12:6884. [PMID: 37959349 PMCID: PMC10648893 DOI: 10.3390/jcm12216884] [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: 10/09/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
The COVID-19 pandemic affected both the physical and mental health of the general population. People with cardiac diseases seem to be particularly vulnerable to the implications of the pandemic. However, studies on the mental health impact of the COVID-19 pandemic on people with implantable cardioverter defibrillator (ICDs) are lacking. Thus, we aimed to explore the level of fear of COVID-19 and the prevalence of anxiety, depression and post-traumatic stress disorder (PTSD) in ICD patients. Furthermore, we aimed to identify novel predictors for anxiety, depression and PTSD, including COVID-19-related variables, and to assess whether positive affects (PAs) and negative affects (NAs) mediate the relationship between the level of fear of COVID-19 and anxiety, depression and PTSD, respectively. The data of 363 patients with ICDS who had been prospectively included in this study between 2020 and 2023, were analyzed. Potential predictors for anxiety, depression, and PTSD were identified using logistic regression. To identify indirect mediating effects of PAs and NAs, we applied the PROCESS regression path analysis modeling tool. The prevalence of anxiety was 9.19%, of depression 10.85%, and of PTSD 12.99%. Being unemployed was the strongest predictor for anxiety (OR = 10.39) and depression (OR = 6.54). Younger age predicted anxiety (OR = 0.95) and PTSD (OR = 0.92). Receiving low social support was associated with anxiety (OR = 0.91), depression (OR = 0.88) and PTSD (OR = 0.91). Patients with a history of COVID-19 (OR = 3.58) and those who did not feel well-informed about COVID-19 (OR = 0.29) were more likely to be depressed. Higher levels of fear of COVID-19 predicted anxiety (OR = 1.10), depression (OR = 1.12) and PTSD (OR = 1.14). The relationship between fear of COVID-19 and anxiety or depression was fully mediated by PAs and NAs, while NAs partially mediated the relationship between fear of COVID-19 and PTSD. Vulnerable subgroups of ICD patients may need additional psychological and educational interventions due to fear of COVID-19, anxiety, depression and PTSD during the pandemic.
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Affiliation(s)
- Marc Dörner
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (M.P.); (C.H.-Z.)
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
| | - Roland von Känel
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (M.P.); (C.H.-Z.)
| | - Aju P. Pazhenkottil
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (M.P.); (C.H.-Z.)
| | - Rahel Altwegg
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (M.P.); (C.H.-Z.)
| | - Ladina Nager
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (M.P.); (C.H.-Z.)
| | - Veronica Attanasio
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (M.P.); (C.H.-Z.)
| | - Lisa Guth
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (M.P.); (C.H.-Z.)
| | - Sina Zirngast
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (M.P.); (C.H.-Z.)
| | - Anna Menzi
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (M.P.); (C.H.-Z.)
| | - Mary Princip
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (M.P.); (C.H.-Z.)
| | - Claudia Hackl-Zuccarella
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (M.P.); (C.H.-Z.)
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Gómez-Restrepo C, Sarmiento-Suárez MJ, Alba-Saavedra M, Calvo-Valderrama MG, Rincón-Rodríguez CJ, Bird VJ, Priebe S, van Loggerenberg F. Development and Implementation of DIALOG+S in the School Setting as a Tool for Promoting Adolescent Mental Well-Being and Resilience in a Post-Armed Conflict Area in Colombia: Exploratory Cluster Randomized Controlled Trial. JMIR Form Res 2023; 7:e46757. [PMID: 37792465 PMCID: PMC10585436 DOI: 10.2196/46757] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/13/2023] [Accepted: 08/07/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Educational settings are ideal for promoting mental well-being and resilience in children. The challenges of the COVID-19 pandemic made evident the important role that teachers and school counselors play in the mental health of their students. Therefore, it is imperative to develop and implement cost-effective interventions that allow them to identify and address mental health problems early, especially in post-armed conflict areas, to reduce the burden of mental disorders in this population. OBJECTIVE This study aimed to adapt an existing patient-focused digital intervention called DIALOG+ from an adult clinical setting to an adolescent educational setting and to assess the feasibility, acceptability, and estimated effect of implementing this intervention as a tool for promoting quality of life, mental well-being, and resilience. METHODS We conducted an exploratory mixed methods study in 2 public schools in postconflict areas in Tolima, Colombia. This study was conducted in 3 phases. In the adaptation phase, focus groups were conducted with students and teachers to identify changes required in DIALOG+ for it to be used in the school setting. The exploration phase consisted of an exploratory cluster randomized controlled trial. A total of 14 clusters, each with 1 teacher and 5 students, were randomly allocated to either the experimental (DIALOG+S) group or to an active control group (counseling as usual). Teachers in both groups delivered the intervention once a month for 6 months. Through screening scales, information was collected on mental health symptoms, quality of life, self-esteem, resilience, and family functionality before and after the intervention. Finally, the consolidation phase explored the experiences of teachers and students with DIALOG+S using focus group discussions. RESULTS The changes suggested by participants in the adaptation phase highlighted the central importance of the school setting in the mental health of adolescents. In the exploratory phase, 70 participants with a mean age of 14.69 (SD 2.13) years were included. Changes observed in the screening scale scores of the intervention group suggest that the DIALOG+S intervention has the potential to improve aspects of mental health, especially quality of life, resilience, and emotional symptoms. The consolidation phase showed that stakeholders felt that using this intervention in the school setting was feasible, acceptable, and an enriching experience that generated changes in the perceived mental health and behavior of participants. CONCLUSIONS Our results are encouraging and show that the DIALOG+S intervention is feasible and acceptable as a promising opportunity to promote well-being and prevent and identify mental health problems in the school context in a postconflict area in Colombia. Larger, fully powered studies are warranted to properly assess the efficacy and potential impact of the intervention and to refine implementation plans. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number (ISRCTN) registry ISRCTN14396374; https://www.isrctn.com/ISRCTN14396374. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/40286.
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Affiliation(s)
- Carlos Gómez-Restrepo
- Departamento de Epidemiologia Clínica y Bioestadistica, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
- Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | | | | | - Carlos Javier Rincón-Rodríguez
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Victoria Jane Bird
- Unit for Social and Community Psychiatry, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, East London NHS Foundation Trust, London, United Kingdom
| | - Francois van Loggerenberg
- Unit for Social and Community Psychiatry, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- Youth Resilience Unit, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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Giovanelli A, Sanchez Karver T, Roundfield KD, Woodruff S, Wierzba C, Wolny J, Kaufman MR. The Appa Health App for Youth Mental Health: Development and Usability Study. JMIR Form Res 2023; 7:e49998. [PMID: 37792468 PMCID: PMC10585433 DOI: 10.2196/49998] [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: 06/15/2023] [Accepted: 08/24/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Demand for adolescent mental health services has surged in the aftermath of the COVID-19 pandemic, and traditional models of care entailing in-person services with licensed mental health providers are inadequate to meet demand. However, research has shown that with proper training and supervision mentors can work with youth with mental health challenges like depression and anxiety and can even support the use of evidence-based strategies like cognitive behavioral therapy (CBT). In our increasingly connected world, youth mentors can meet with young people on a web-based platform at their convenience, reducing barriers to care. Moreover, the internet has made evidence-based CBT skills for addressing depression and anxiety more accessible than ever. As such, when trained and supervised by licensed clinicians, mentors are an untapped resource to support youth with mental health challenges. OBJECTIVE The objective of this study was to develop and assess the feasibility and acceptability of Appa Health (Appa), an evidence-based mental health mentoring program for youth experiencing symptoms of depression and anxiety. This paper describes the development, pilot testing process, and preliminary quantitative and qualitative outcomes of Appa's 12-week smartphone app program which combines web-based near-peer mentorship with short-form TikTok-style videos teaching CBT skills created by licensed mental health professionals who are also social media influencers. METHODS The development and testing processes were executed through collaboration with key stakeholders, including young people and clinical and research advisory boards. In the pilot study, young people were assessed for symptoms of depression or anxiety using standard self-report clinical measures: the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 scales. Teenagers endorsing symptoms of depression or anxiety (n=14) were paired with a mentor (n=10) based on preferred characteristics such as gender, race or ethnicity, and lesbian, gay, bisexual, transgender, queer (LGBTQ) status. Quantitative survey data about the teenagers' characteristics, mental health, and feasibility and acceptability were combined with qualitative data assessing youth perspectives on the program, their mentors, and the CBT content. RESULTS Participants reported finding Appa helpful, with 100% (n=14) of teenagers expressing that they felt better after the 12-week program. Over 85% (n=12) said they would strongly recommend the program to a friend. The teenagers were engaged, video chatting with mentors consistently over the 12 weeks. Metrics of anxiety and depressive symptoms reduced consistently from week 1 to week 12, supporting qualitative data suggesting that mentoring combined with CBT strategies has the potential to positively impact youth mental health and warrants further study. CONCLUSIONS Appa Health is a novel smartphone app aiming to improve the well-being of youth and reduce anxiety and depressive symptoms through web-based mentoring and engaging CBT video content. This formative research sets the stage for a large-scale randomized controlled trial recently funded by the National Institutes of Health Small Business Innovation Research program.
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Affiliation(s)
- Alison Giovanelli
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
- Appa Health, Oakland, CA, United States
| | - Tahilin Sanchez Karver
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Katrina D Roundfield
- Appa Health, Oakland, CA, United States
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | | | | | - J Wolny
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States
| | - Michelle R Kaufman
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Winsor AA, Ebelthite C, Onih J, Nicholson TR, Pal DK, Richardson M. Study protocol for a case series: implementation and evaluation of an integrated mental and physical healthcare programme to screen for mental health symptoms in people with epilepsy. BMJ Open 2023; 13:e075043. [PMID: 37788926 PMCID: PMC10551954 DOI: 10.1136/bmjopen-2023-075043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/12/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION The prevalence of mental health symptoms in people with epilepsy (PWE) is elevated compared with that of the general population. These symptoms can negatively impact epilepsy management and patient outcomes but can be treated once recognised. It is, therefore, important to screen for these symptoms to identify needs and put in place appropriate support. Unfortunately, mental health symptoms are rarely addressed in epilepsy services due to time constraints, lack of resources and communication between psychological and medical professionals. These barriers can result in diagnostic overshadowing, where symptoms may be attributed to the disease and reduce the level of support PWE receive. Implementing an online screening tool embedded in the electronic health record (EHR) platform with supported referral pathways may remove some of these barriers. METHODS AND ANALYSIS We will follow the Integrating Mental and Physical Healthcare: Research Training and Services framework, which is a routine clinical data collection tool used by clinical teams to electronically screen psychological symptoms among patients with long-term physical health conditions. Patient outcomes including mental health, physical health and psychosocial outcomes will be collected and uploaded to the EHR platform in real-time. An appropriate referral pathway will be recommended depending on severity of the outcome scores. We will initially pilot the tool for individuals aged 13 years and above through epilepsy clinics at King's College Hospital. Following this, the acceptability and feasibility of the tool will be assessed at baseline, 6 and 12 months. ETHICS AND DISSEMINATION Ethics approval was obtained from the National Health Service Research Ethics Committee of South Central-Oxford C, reference: 21/EM/0205. This study is expected to inform the use of integrated electronic mental health screening for youth in epilepsy clinics and improve access to psychological support. The findings will be disseminated through academic peer-reviewed journals, poster presentations and scientific meetings.
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Affiliation(s)
- Alice Afua Winsor
- School of Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, King's College london, London, UK
| | | | - Jemima Onih
- King's Health Partners, Mind & Body Programme, London, UK
| | - Timothy R Nicholson
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Deb K Pal
- School of Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, King's College london, London, UK
| | - Mark Richardson
- School of Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, King's College london, London, UK
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Halim I, Stemmet L, Hach S, Porter R, Liang HN, Vaezipour A, Henry JD, Baghaei N. Individualized Virtual Reality for Increasing Self-Compassion: Evaluation Study. JMIR Ment Health 2023; 10:e47617. [PMID: 37782537 PMCID: PMC10580135 DOI: 10.2196/47617] [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: 03/27/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Depression and anxiety are common and debilitating mental disorders with severe negative repercussions at both individual and societal levels. Although virtual reality (VR) has emerged as a safe and effective tool for the treatment of anxiety disorders, studies of the therapeutic application of VR to treat depression are more limited. OBJECTIVE The purpose of this study was to test whether a novel type of individualized VR (iVR) can be used to improve self-compassion and decrease depressive symptoms and to evaluate the usability and acceptability of this approach, as rated by participants. The iVR system was designed and developed based on the feedback obtained from a previous study, with improved appearance and feel of the avatar and enhanced graphical quality. METHODS A total of 36 young adult participants were recruited from a university community social media site. Participants were aware that the study was investigating a treatment for depression but were not recruited based on depression diagnosis. Participants were asked to complete 2 iVR sessions, spaced 2 weeks apart. At baseline and upon completion of each iVR session, participants were asked to complete validated measures of self-compassion and depression. Upon completion of both iVR sessions, additional measures were administered to assess participants' perceptions about the perceived usability and system acceptability of the iVR approach. RESULTS Self-compassion was assessed at the beginning of session 1 (preintervention baseline) and at the end of session 1 (postintervention assessment). Owing to COVID-19 constraints, 36% (13/36) of the participants were unable to complete the follow-up iVR session. Self-compassion was assessed again for the remaining 64% (23/36) of the participants at the end of session 2 (postintervention assessment). Within-group analyses revealed that self-compassion was significantly increased at the end of both session 1 (P=.01) and session 2 (P=.03) relative to baseline. There was also a nonsignificant trend for depressive symptoms to be low at the end of session 2 relative to baseline. Both quantitative and qualitative participant data supported the iVR approach as being acceptable and usable. CONCLUSIONS Although these data must be treated as preliminary owing to the small sample size and potential selection bias, the data provide encouraging initial evidence that iVR might be a useful tool to enhance self-compassion and reduce depressive symptoms, highlighting the need for randomized controlled trials in the future.
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Affiliation(s)
- Ilona Halim
- School of Mathematical and Computational Sciences, Massey University, Auckland, New Zealand
| | - Lehan Stemmet
- Auckland Institute of Studies, Auckland, New Zealand
| | | | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Hai-Ning Liang
- Department of Computing, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Atiyeh Vaezipour
- Recover Injury Research Centre, The University of Queensland, St Lucia, Australia
| | - Julie D Henry
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - Nilufar Baghaei
- School of Electrical Engineering and Computer Science, The University of Queensland, St Lucia, Australia
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Ruehlman L, Karoly P. A pilot test of Internet-delivered brief interactive training sessions for depression: Evaluating dropout, uptake, adherence, and outcome. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2131-2139. [PMID: 34469262 DOI: 10.1080/07448481.2021.1961781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 05/31/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Uptake, adherence, and dropout rates for Internet-based programs for depression are in need of improvement. Excessive user burden (eg, heavy content, extended duration) may undermine engagement and precipitate dropout. To address this problem, an alternative format was proposed: Brief Interactive Training Sessions (BITS). BITS target a narrow behavioral health skill and require 3-4 hours to complete. A depression-focused version of BITS that provides training in cognitive distortion/restructuring was tested. PARTICIPANTS Fifty-two depressed college students were randomly assigned to BITS or to a wait-list. METHODS Students competed pre-and post-test (7 week) assessments of depression and cognitive distortions. RESULTS Uptake rate was 83%. Among study completers, adherence was 96%. The dropout rate did not improve. Compared to the control group, the experimental group reported a significant reduction in depression and in cognitive distortions. CONCLUSIONS The BITS format is a promising vehicle for improving uptake and adherence while achieving positive clinical outcomes.
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Affiliation(s)
| | - Paul Karoly
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
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37
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Macia KS, Carlson EB, Palmieri PA, Smith SR, Anglin DM, Ghosh Ippen C, Lieberman AF, Wong EC, Schell TL, Waelde LC. Development of a Brief Version of the Dissociative Symptoms Scale and the Reliability and Validity of DSS-B Scores in Diverse Clinical and Community Samples. Assessment 2023; 30:2058-2073. [PMID: 37653563 PMCID: PMC10478338 DOI: 10.1177/10731911221133317] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The Dissociative Symptoms Scale (DSS) was developed to assess moderately severe types of dissociation (depersonalization, derealization, gaps in awareness and memory, and dissociative reexperiencing) that would be relevant to a range of clinical populations, including those experiencing trauma-related dissociation. The current study used data from 10 ethnically and racially diverse clinical and community samples (N = 3,879) to develop a brief version of the DSS (DSS-B). Item information curves were examined to identify items with the most precision in measuring above average levels of the latent trait within each subscale. Analyses revealed that the DSS-B preserved the factor structure and content domains of the full scale, and its scores had strong reliability and validity that were comparable to those of scores on the full measure. DSS-B scores showed high levels of measurement invariance across ethnoracial groups. Results indicate that DSS-B scores are reliable and valid in the populations studied.
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Affiliation(s)
- Kathryn S. Macia
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Eve B. Carlson
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | | | | | | | | | | | - Lynn C. Waelde
- Stanford University School of Medicine, Palo Alto, CA, USA
- Palo Alto University, CA, USA
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Villarreal-Zegarra D, Barrera-Begazo J, Otazú-Alfaro S, Mayo-Puchoc N, Bazo-Alvarez JC, Huarcaya-Victoria J. Sensitivity and specificity of the Patient Health Questionnaire (PHQ-9, PHQ-8, PHQ-2) and General Anxiety Disorder scale (GAD-7, GAD-2) for depression and anxiety diagnosis: a cross-sectional study in a Peruvian hospital population. BMJ Open 2023; 13:e076193. [PMID: 37714674 PMCID: PMC10510859 DOI: 10.1136/bmjopen-2023-076193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/21/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVES The Patient Health Questionnaire (PHQ) and Generalised Anxiety Disorder Scale (GAD) are widely used screening tools, but their sensitivity and specificity in low-income and middle-income countries are lower than in high-income countries. We conducted a study to determine the sensitivity and specificity of different versions of these scales in a Peruvian hospital population. DESIGN Our study has a cross-sectional design. SETTING Our participants are hospitalised patients in a Peruvian hospital. The gold standard was a clinical psychiatric interview following ICD-10 criteria for depression (F32.0, F32.1, F32.2 and F32.3) and anxiety (F41.0 and F41.1). PARTICIPANTS The sample included 1347 participants. A total of 334 participants (24.8%) were diagnosed with depression, and 28 participants (2.1%) were diagnosed with anxiety. RESULTS The PHQ-9's≥7 cut-off point showed the highest simultaneous sensitivity and specificity when contrasted against a psychiatric diagnosis of depression. For a similar contrast against the gold standard, the other optimal cut-off points were: ≥7 for the PHQ-8 and ≥2 for the PHQ-2. In particular, the cut-off point ≥8 had good performance for GAD-7 with sensitivity and specificity, and cut-off point ≥10 had lower levels of sensitivity, but higher levels of specificity, compared with the cut-off point of ≥8. Also, we present the sensitivity and specificity values of each cut-off point in PHQ-9, PHQ-8, PHQ-2, GAD-7 and GAD-2. We confirmed the adequacy of a one-dimensional model for the PHQ-9, PHQ-8 and GAD-7, while all PHQ and GAD scales showed good reliability. CONCLUSIONS The PHQ and GAD have adequate measurement properties in their different versions. We present specific cut-offs for each version.
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Affiliation(s)
- David Villarreal-Zegarra
- Escuela de Medicina, Universidad César Vallejo, Trujillo, Peru
- Instituto Peruano de Orientación Psicológica, Lima, Peru
| | | | | | | | - Juan Carlos Bazo-Alvarez
- Research Department of Primary Care and Population Health, University College London (UCL), London, UK
| | - Jeff Huarcaya-Victoria
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Ica, Peru
- Unidad de Psiquiatría de Enlace, Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
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Kim M, Jung S, Park JE, Sohn JH, Seong SJ, Kim BS, Chang SM, Hong JP, Hahm BJ, Yeom CW. Validation of the Patient Health Questionnaire-9 and Patient Health Questionnaire-2 in the General Korean Population. Psychiatry Investig 2023; 20:853-860. [PMID: 37794667 PMCID: PMC10555509 DOI: 10.30773/pi.2023.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/26/2023] [Accepted: 06/30/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE The Patient Health Questionnaire-9 (PHQ-9) and PHQ-2 have not been validated in the general Korean population. This study aimed to validate and identify the optimal cutoff scores of the PHQ-9 and PHQ-2 in screening for major depression in the general Korean population. METHODS We used data from 6,022 participants of the Korean Epidemiological Catchment Area Study for Psychiatric Disorders in 2011. Major depression was diagnosed according to the Korean Composite International Diagnostic Interview. Validity, reliability, and receiver operating characteristic curve analyses were performed using the results of the PHQ-9 and Euro Quality of life-5 dimension (EQ-5d). RESULTS Of the 6,022 participants, 150 were diagnosed with major depression (2.5%). Both PHQ-9 and PHQ-2 demonstrated relatively high reliability and their scores were highly correlated with the "anxiety/depression" score of the EQ-5d. The optimal cutoff score of the PHQ-9 was 5, with a sensitivity of 89.9%, specificity of 84.1%, positive predictive value (PPV) of 12.6%, negative predictive value (NPV) of 99.7%, positive likelihood ratio (LR+) of 5.6, and negative likelihood ratio (LR-) of 0.12. The optimal cutoff score of the PHQ-2 was 2, with a sensitivity of 85.3%, specificity of 83.2%, PPV of 11.6%, NPV of 99.5%, LR+ of 5.1, and LR- of 0.18. CONCLUSION The PHQ-9 and PHQ-2 are valid tools for screening major depression in the general Korean population, with suggested cutoff values of 5 and 2 points, respectively.
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Affiliation(s)
- Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sanghyup Jung
- Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jee Eun Park
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jee Hoon Sohn
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Su Jeong Seong
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Byung-Soo Kim
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sung Man Chang
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Bong-Jin Hahm
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Human Behavioral Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Chan-Woo Yeom
- Department of Psychiatry, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeonbu, Republic of Korea
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Tarchi L, Crescenzo P, Talamonti K. Prevalence and predictors of mental distress among Italian Red Cross auxiliary corps: A cross-sectional evaluation after deployment in anti-COVID-19 operations. MILITARY PSYCHOLOGY 2023; 35:394-407. [PMID: 37615558 PMCID: PMC10453978 DOI: 10.1080/08995605.2022.2069983] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/20/2022] [Indexed: 12/23/2022]
Abstract
The aim of the present study is to describe the prevalence and individual predictors of mental distress (anxiety, depression, and burnout) in a sample of volunteers engaged in emergency services. A total of 823 volunteers enrolled in the Red Cross auxiliary corps were surveyed between 28 June 2021 and 28 August 2021 (299 men and 524 women). After deployment in anti-COVID-19 operations, participants completed the Patient Health Questionnaire, Generalized Anxiety Disorder Questionnaire, Maslach Burnout Inventory, and Big Five Inventory through an online platform. A moderately severe risk of depression was found in 1.70% of the sample. A severe risk for anxiety disorders was found in 1.82%. A high risk for emotional exhaustion was found in 3.40%, depersonalization in 12.88%, and low personal accomplishment in 7.53%. Women showed a higher risk of both depression and anxiety in comparison to males. Personality factors were significant predictors for all dimensions. In contrast to the current literature, openness was found to be a predisposing personality factor in developing burnout dimensions. The relevance of the current findings for the development of effective screening tools before the deployment of reserve forces during medical crises is discussed.
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Affiliation(s)
- Livio Tarchi
- Psychological Activities Unit (NAP), Italian Red Cross Voluntary Military Corps, Ministry of Defense, Rome, Italy
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Pietro Crescenzo
- Psychological Activities Unit (NAP), Italian Red Cross Voluntary Military Corps, Ministry of Defense, Rome, Italy
| | - Kristian Talamonti
- Psychological Activities Unit (NAP), Italian Red Cross Voluntary Military Corps, Ministry of Defense, Rome, Italy
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Nielsen MS, Steinsbekk A, Nøst TH. Interest in using patient portals among adolescents in mental health care - a cross-sectional study. BMC Health Serv Res 2023; 23:841. [PMID: 37559093 PMCID: PMC10410786 DOI: 10.1186/s12913-023-09823-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/17/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Adolescents in mental health care may benefit from using patient portals to access personalised information about their health and treatment. While no studies have considered the interest in using patient portals among adolescents in mental health care, factors such as patient activation, self-reported health, depressive symptoms, diagnosis, healthcare utilisation, and eHealth literacy have been found to be associated with interest in and use of patient portals in other patient groups. Therefore, the aim was to explore the associations between interest in using patient portals and patient activation, self-reported health, depressive symptoms, diagnosis, healthcare utilisation and eHealth literacy among adolescents in specialist mental health care. METHODS A cross-sectional study among adolescents between 12 and 18 years of age receiving or having received treatment at four different specialist child and adolescent mental healthcare services across Norway. The adolescents´ answers to the questionnaire were linked to data on their healthcare utilisation and ICD-10 diagnoses from the Norwegian Patient Registry. The data were analysed using descriptive statistics and bivariate tests. RESULTS The 53 adolescents who participated, had a mean age of 15 years and 68% of them identified as female. Two out of three (64%) were interested in using patient portals. Most of the factors were not associated with interest in using patient portals. However, adolescents with mental and behavioural disorders (F diagnoses, 75% interested) were more interested in using patient portals compared to those with symptoms and signs involving cognition, perception, emotional state, and behaviour (R diagnoses, 31% interested). CONCLUSION Except for mental health diagnosis, this study did not identify any specific factors likely to impact patient portal interest among adolescents in specialist mental health care.
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Affiliation(s)
- Martine Stecher Nielsen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, 7491, Norway.
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Centre for E-health Research, Tromsø, Norway
| | - Torunn Hatlen Nøst
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, 7491, Norway
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
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Hou G, Zhang S, Gao M, Zheng Y, Liu N, Zhang G, Meng P, Hou N, Wang F, Yuan J. A novel tool for improving the accuracy of major depressive disorder screening: A prospective study on andrology with external validation. Psychiatry Res 2023; 326:115277. [PMID: 37301023 DOI: 10.1016/j.psychres.2023.115277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
Patient Health Questionnaire-9 (PHQ-9) is the most widely used tool for screening for major depressive disorder (MDD). Although its reliability and validity have been proven, missed or misjudged cases during MDD screening are often encountered. A nomogram that considers the weights of depressive symptoms was developed using data from premature ejaculation patients to improve screening accuracy. During a 33-month prospective study, a training cohort comprising 605 participants from Xijing Hospital was used to develop and internally validate the nomogram. A validation cohort comprising 461 patients from Xi'an Daxing Hospital was also used to externally test the nomogram. The nomogram was established by integrating the LASSO regression-based optimal predictors of MDD according to their coefficients in a multivariate logistic regression model. The nomogram was well-calibrated during internal and external validations. Moreover, it showed a better discriminatory capacity and yielded more net benefits in both validations than PHQ-9. With better performance, the nomogram may help reduce the number of missed or misjudged cases during MDD screening. This study is the first to weigh the direct indicators of MDD under the DSM-5 criteria, presenting a fresh concept that can be applied to other populations to enhance screening accuracy.
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Affiliation(s)
- Guangdong Hou
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Siyan Zhang
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Ming Gao
- Department of Andrology, Xi'an Daxing Hospital affiliated to Yan'an University, Xi'an 710016, China
| | - Yu Zheng
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.
| | - Nian Liu
- Deptartment of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Geng Zhang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China; Department of Urology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Ping Meng
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Niuniu Hou
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China; Department of General Surgery, Eastern Theater Air Force Hospital of PLA, Nanjing 210001, China
| | - Fuli Wang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.
| | - Jianlin Yuan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.
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Yang W, Liu J, Cao P, Zhu R, Wang Y, Liu JK, Wang F, Zhang X. Attention guided learnable time-domain filterbanks for speech depression detection. Neural Netw 2023; 165:135-149. [PMID: 37285730 DOI: 10.1016/j.neunet.2023.05.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 05/13/2023] [Accepted: 05/20/2023] [Indexed: 06/09/2023]
Abstract
Depression, as a global mental health problem, is lacking effective screening methods that can help with early detection and treatment. This paper aims to facilitate the large-scale screening of depression by focusing on the speech depression detection (SDD) task. Currently, direct modeling on the raw signal yields a large number of parameters, and the existing deep learning-based SDD models mainly use the fixed Mel-scale spectral features as input. However, these features are not designed for depression detection, and the manual settings limit the exploration of fine-grained feature representations. In this paper, we learn the effective representations of the raw signals from an interpretable perspective. Specifically, we present a joint learning framework with attention-guided learnable time-domain filterbanks for depression classification (DALF), which collaborates with the depression filterbanks features learning (DFBL) module and multi-scale spectral attention learning (MSSA) module. DFBL is capable of producing biologically meaningful acoustic features by employing learnable time-domain filters, and MSSA is used to guide the learnable filters to better retain the useful frequency sub-bands. We collect a new dataset, the Neutral Reading-based Audio Corpus (NRAC), to facilitate the research in depression analysis, and we evaluate the performance of DALF on the NRAC and the public DAIC-woz datasets. The experimental results demonstrate that our method outperforms the state-of-the-art SDD methods with an F1 of 78.4% on the DAIC-woz dataset. In particular, DALF achieves F1 scores of 87.3% and 81.7% on two parts of the NRAC dataset. By analyzing the filter coefficients, we find that the most important frequency range identified by our method is 600-700Hz, which corresponds to the Mandarin vowels /e/ and /eˆ/ and can be considered as an effective biomarker for the SDD task. Taken together, our DALF model provides a promising approach to depression detection.
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Affiliation(s)
- Wenju Yang
- College of Computer Science and Engineering, Northeastern University, Shenyang, 110819, Liaoning, China; Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, 110819, Liaoning, China
| | - Jiankang Liu
- College of Computer Science and Engineering, Northeastern University, Shenyang, 110819, Liaoning, China; Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, 110819, Liaoning, China
| | - Peng Cao
- College of Computer Science and Engineering, Northeastern University, Shenyang, 110819, Liaoning, China; Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, 110819, Liaoning, China.
| | - Rongxin Zhu
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210096, China
| | - Yang Wang
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210096, China
| | - Jian K Liu
- School of Computing, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - Fei Wang
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210096, China.
| | - Xizhe Zhang
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, 211166, China.
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Drebing CE, Mamon D, Calixte RM, Tuval-Mashiach R, Patton B, Scoglio AAJ, Girouard C, Fukuda S, Gao W, Penk WE. Pilot outcomes of a filmmaking intervention designed to enhance treatment entry and social reintegration of veterans. Psychol Serv 2023; 20:585-595. [PMID: 35191722 PMCID: PMC10198373 DOI: 10.1037/ser0000618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Military personnel transitioning to civilian life have reported significant challenges in reintegrating into civilian culture. Filmmaking has been used as a therapeutic intervention to enhance the community reintegration of veterans, but there are no published quantitative data documenting its impact. The present study provides outcome data on 40 veterans who participated in the I Was There (IWT) filmmaking workshop. This 3-day (20-hr) group intervention involved veterans working in small teams with a film coach, making short films designed to communicate some aspect of their experience during or after military service, and then creating a screening event to show their films to community members. The sample consisted of community-dwelling veterans who reported at least some mental health symptoms and who were not engaged in mental health treatment for those symptoms. Targeted outcomes included engagement in mental health care, symptoms of posttraumatic stress disorder (PTSD) and depression, and reported perception of community interest in their experience as veterans. Fifty-six percent of participants entered treatment within 4 months of participation. Significant decreases were noted in symptoms of PTSD at 1-month follow-up but not at the 4-month follow-up, while changes in depression were not statistically significant. Participation was related to increased perception of community interest in veterans' experience, and increased interest among community members who viewed the films. These data provide initial support for the conclusion that the IWT film workshop is a potentially effective tool for treatment engagement and for community reintegration among veterans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Charles E. Drebing
- The Social and Community Reintegration Research Program, Bedford VA Hospital
| | - Daria Mamon
- The Social and Community Reintegration Research Program, Bedford VA Hospital
| | - Rachelle M. Calixte
- The Social and Community Reintegration Research Program, Bedford VA Hospital
| | | | | | | | - Caitlin Girouard
- The Social and Community Reintegration Research Program, Bedford VA Hospital
| | - Seiya Fukuda
- The Social and Community Reintegration Research Program, Bedford VA Hospital
| | - Wenwu Gao
- The Social and Community Reintegration Research Program, Bedford VA Hospital
| | - Walter E. Penk
- The Social and Community Reintegration Research Program, Bedford VA Hospital
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Tran DD, Davis JP, Tucker JS, Bricker JB, Lee DS, Fitzke RE, Pedersen ER. Cigarette Smoking and Depression Among U.S. Veterans: Longitudinal Associations With Posttraumatic Stress Disorder. Nicotine Tob Res 2023; 25:1496-1504. [PMID: 37094359 PMCID: PMC10347971 DOI: 10.1093/ntr/ntad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 03/09/2023] [Accepted: 04/21/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Cigarette smoking and depression are associated with morbidity and mortality. Among veterans, approximately 22% are current smokers and 11%-15% have been diagnosed with depression. Although prior research suggests a strong association between smoking and depression among veterans, little research has examined trajectories of smoking and depressive symptoms and their correlates over time in this population. AIMS AND METHODS Using parallel process growth curve modeling, we examined the longitudinal relationship between smoking and depression and tested whether posttraumatic stress disorder (PTSD) symptoms predict smoking and depression trajectories over 18 months (February 2020-August 2021). Veterans were recruited for an online, longitudinal study and responded to surveys across five-time points (baseline N = 1230; retention = 79.3%-83.3% across waves). RESULTS Associations indicated that more frequent smoking at baseline was associated with steeper increases in depression symptom severity, and greater depression severity at baseline was associated with a less steep decrease in smoking frequency over time. PTSD was associated with less smoking at time 1 but more frequent smoking at times 3-5 as well as greater depression across all time points. CONCLUSIONS Findings provide support that the growth trajectories of smoking and depression are linked, and PTSD symptoms are associated with these trajectories among veterans. Addressing these factors simultaneously in veteran treatment centers or through tobacco cessation efforts may be beneficial. IMPLICATIONS This study offers strong evidence that the growth trajectories of smoking and depression are linked, and PTSD symptoms affect these trajectories among veterans, who represent a largely understudied population despite high rates of substance use and mental health problems. Results of this study strengthen the case for a more integrated treatment approach in which both smoking and mental health concerns are simultaneously addressed, which may yield more beneficial physical health and clinical outcomes for post-9/11 veterans.
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Affiliation(s)
- Denise D Tran
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CAUSA
| | - Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CAUSA
| | | | - Jonathan B Bricker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA USA
- Department of Psychology, University of Washington, Seattle, WA USA
| | - Daniel S Lee
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CAUSA
| | - Reagan E Fitzke
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CAUSA
| | - Eric R Pedersen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CAUSA
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Hungerford L, Agtarap S, Ettenhofer M. Impact of depression and post-traumatic stress on manual and oculomotor performance in service members with a history of mild TBI. Brain Inj 2023; 37:680-688. [PMID: 37204183 DOI: 10.1080/02699052.2023.2210293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 03/03/2023] [Accepted: 05/01/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To determine the impact of depression and post-traumatic stress on an automated oculomotor and manual measure of visual attention, compared to conventional neuropsychological assessment. Setting: Military traumatic brain injury (TBI) rehabilitation program. PARTICIPANTS 188 Active Duty Service Members (ADSM) with a history of mild TBI. DESIGN A cross-sectional and correlational study with data obtained through an IRB-approved data registry study. Main measures: Bethesda Eye & Attention Measure (BEAM); brief neuropsychological battery; self-reported symptom surveys including Neurobehavioral Symptom Inventory (NSI), Patient Health Questionnaire-8 (PHQ-8), and PTSD Checklist-5 (PCL-5). RESULTS Small effect sizes were found for partial correlations between both depression and post-traumatic stress and key BEAM metrics. In contrast, small-to-medium effects sizes were found across all traditional neuropsychological test measures. CONCLUSION This study illustrates the profile of impairments associated with depression and post-traumatic stress on saccadic eye movements and manual responses to BEAM relative to conventional neuropsychological tests. Results demonstrated that among ADSM seen for mTBI, depression and PTS exert a significant negative impact on measures of processing speed, attention, executive function, and memory across saccadic, manual, and conventional neuropsychological tests. However, the unique psychometric features of each of these assessment approaches may assist in distinguishing the effects of psychiatric comorbidities within this population.
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Affiliation(s)
- Lars Hungerford
- Traumatic Brain Injury Center of Excellence TBICoE, Bethesda, MD, USA
- Department of Clinical Support Services, Naval Medical Center San Diego, San Diego, CA, USA
| | - Stephanie Agtarap
- Traumatic Brain Injury Center of Excellence TBICoE, Bethesda, MD, USA
- Department of Clinical Support Services, Naval Medical Center San Diego, San Diego, CA, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Lyda Hill Institute for Human Resilience, Craig Hospital, Englewood, Colorado, USA
| | - Mark Ettenhofer
- Traumatic Brain Injury Center of Excellence TBICoE, Bethesda, MD, USA
- Department of Clinical Support Services, Naval Medical Center San Diego, San Diego, CA, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Department of Psychiatry, University of California, San Diego,CA, USA
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Amirkhanzadeh Barandouzi Z, Bruner DW, Miller AH, Paul S, Felger JC, Wommack EC, Higgins KA, Shin DM, Saba NF, Xiao C. Associations of inflammation with neuropsychological symptom cluster in patients with Head and neck cancer: A longitudinal study. Brain Behav Immun Health 2023; 30:100649. [PMID: 37396338 PMCID: PMC10308212 DOI: 10.1016/j.bbih.2023.100649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/17/2023] [Accepted: 06/03/2023] [Indexed: 07/04/2023] Open
Abstract
Purpose Head and neck cancer (HNC) patients may experience multiple co-occurring neuropsychological symptoms (NPS) cluster, including fatigue, depression, pain, sleep disturbance, and cognitive impairment. While inflammation has been attributed as a key mechanism for some of these symptoms, its association with the NPS as a cluster of symptoms is unknown. Thus, the aim of this study was to examine the association between peripheral inflammation and NPS cluster among HNC patients over cancer treatment (radiotherapy with or without chemotherapy). Methods HNC patients were recruited and followed at pre-treatment, end of treatment, three months and one-year post-treatment. Plasma inflammatory markers, including C-reactive protein (CRP), tumor necrosis factor-alpha (TNFA), soluble tumor necrosis factor receptor-2 (sTNFR2), interleukin-1 beta (IL1-β), interleukin-6 (IL-6), interleukin-10 (IL-10), monocyte chemotactic protein-1 (MCP-1), and interleukin-1 receptor antagonist (IL-1RA) and patient-reported NPS cluster were collected at the 4 time points. Associations between inflammatory markers and the NPS cluster were analyzed using linear mixed-effects models and generalized estimating equations (GEE) models controlling covariates. Results 147 HNC patients were eligible for analysis. 56% of the patients received chemoradiotherapy as treatment. The highest NPS cluster score was reported at the end of treatment, which gradually decreased over time. An increase in inflammatory markers including CRP, sTNFR2, IL-6 and IL-1RA was associated with higher continuous NPS cluster scores (p<0.001, p = 0.003, p<0.001, p<0.001; respectively). GEE further confirmed that patients with at least two moderate symptoms had elevated sTNFR2, IL-6, and IL-1RA (p = 0.017, p = 0.038, p = 0.008; respectively). Notably, this positive association between NPS cluster and inflammatory markers was still significant at one-year post-treatment for CRP (p = 0.001), sTNFR2 (p = 0.006), and IL-1RA (p = 0.043). Conclusions Most HNC patients experienced NPS clusters over time, especially immediately after the end of treatment. Elevated inflammation, as represented by inflammatory markers, was strongly associated with worse NPS cluster over time; this trend was also notable at one-year post-treatment. Our findings suggest that peripheral inflammation plays a pivotal role in the NPS cluster over cancer treatment, including long-term follow-ups. Interventions on reducing peripheral inflammation may contribute to alleviating the NPS cluster in cancer patients.
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Affiliation(s)
| | - Deborah W. Bruner
- School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Andrew H. Miller
- School of Medicine, Emory University, 201 Dowman Dr, Atlanta, GA, 30322, USA
| | - Sudeshna Paul
- School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Jennifer C. Felger
- School of Medicine, Emory University, 201 Dowman Dr, Atlanta, GA, 30322, USA
| | - Evanthia C. Wommack
- School of Medicine, Emory University, 201 Dowman Dr, Atlanta, GA, 30322, USA
| | - Kristin A. Higgins
- School of Medicine, Emory University, 201 Dowman Dr, Atlanta, GA, 30322, USA
| | - Dong M. Shin
- School of Medicine, Emory University, 201 Dowman Dr, Atlanta, GA, 30322, USA
| | - Nabil F. Saba
- School of Medicine, Emory University, 201 Dowman Dr, Atlanta, GA, 30322, USA
| | - Canhua Xiao
- School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA, 30322, USA
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Liu Y, O’Grady MA. A cross-sectional study of the relationship between depression status, health care coverage, and sexual orientation. DISCOVER MENTAL HEALTH 2023; 3:13. [PMID: 37861944 PMCID: PMC10501004 DOI: 10.1007/s44192-023-00039-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/22/2023] [Indexed: 10/21/2023]
Abstract
Health care coverage is an important factor in receipt of behavioral healthcare. This study uses data from the New York City Community Health Survey to examine how sexual minority status impacts the relationship between depression status and having health care coverage. Approximately 10% of the sample (n = 9571; 47% 45+ years old; 35% White Non-Hispanic; 7% sexual minority) reported probable depression and low health care coverage. Compared to heterosexual participants, a greater proportion of sexual minority participants had low health care coverage (17% vs. 9%) and probable depression (19% vs. 9%). Logistic regression examining the association between probable depression status and health care coverage showed that those with probable depression have odds of low health care coverage that are were 3.08 times those who did not have probable depression; this relationship was not modified by sexual orientation. Continued research to understand the interplay of health care coverage, mental health, and sexual orientation is needed.
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Affiliation(s)
- Yang Liu
- Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, USA
| | - Megan A. O’Grady
- Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, USA
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Stanyte A, Fineberg NA, Podlipskyte A, Gecaite-Stonciene J, Macijauskiene J, Steibliene V, Burkauskas J. Validation of the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 in Lithuanian individuals with anxiety and mood disorders. J Psychiatr Res 2023; 164:221-228. [PMID: 37385000 DOI: 10.1016/j.jpsychires.2023.06.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023]
Abstract
The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) are short self-report questionnaires used to screen and assess depression and anxiety severity in medical and community samples. However, little is known about their psychometric properties in individuals with anxiety and mood disorders (AMD) This study evaluated the psychometric properties of the PHQ-9 and GAD-7 in individuals with AMD. Individuals (n = 244, mean age 39.9 ± 12.3 years) with AMD completed the PHQ-9, GAD-7, as well as other measures of depression, anxiety, and a structured diagnostic interview. The PHQ-9 and GAD-7 demonstrated good internal consistency (Cronbach's alpha 0.87 and 0.84, respectively). The PHQ-9 and GAD-7 showed a weak correlation with clinician-rated scales HAM-D and HAM-A (r = 0.316, p < 0.01, r = 0.307, p < 0.01, respectively). For the PHQ-9, a cut score of ≥11 resulted in 72% sensitivity and 72% specificity at recognizing depression symptoms. For the GAD-7, a cut score ≥7 resulted in 73% sensitivity and 54% specificity at recognizing any anxiety disorders. The confirmatory factor analysis suggested a two-factor structure ("cognitive/affectional", "somatic") for both the PHQ-9 and GAD-7. In conclusion, the PHQ-9 and GAD-7 have adequate formal psychometric properties as severity measures for symptoms of anxiety and depression in individuals with AMD. The PHQ-9 performs well as a screener using a cut score of ≥11. However, the clinical utility of the GAD-7 as a diagnostic tool for recognition of anxiety disorders is limited.
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Affiliation(s)
- Agne Stanyte
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga-Kaunas, Lithuania.
| | - Naomi A Fineberg
- University of Hertfordshire, Hatfield, UK; Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK; University of Cambridge Clinical Medical School, Cambridge, UK
| | - Aurelija Podlipskyte
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga-Kaunas, Lithuania
| | - Julija Gecaite-Stonciene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga-Kaunas, Lithuania
| | - Jurate Macijauskiene
- Department of Geriatrics, Faculty of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vesta Steibliene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga-Kaunas, Lithuania
| | - Julius Burkauskas
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga-Kaunas, Lithuania
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50
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Gómez-Restrepo C, Sarmiento-Suárez MJ, Alba-Saavedra M, Calvo-Valderrama MG, Rincón-Rodríguez CJ, González-Ballesteros LM, Bird V, Priebe S, van Loggerenberg F. Mental health problems and resilience in adolescents during the COVID-19 pandemic in a post-armed conflict area in Colombia. Sci Rep 2023; 13:9743. [PMID: 37328494 PMCID: PMC10276040 DOI: 10.1038/s41598-023-35789-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/24/2023] [Indexed: 06/18/2023] Open
Abstract
The impact of COVID-19 pandemic on mental health of adolescents are emerging and require particular attention in settings where challenges like armed conflict, poverty and internal displacement have previously affected their mental wellbeing. This study aimed to determine the prevalence of anxiety symptoms, depressive symptomatology, probable post-traumatic stress disorder and resilience in school-attending adolescents in a post-conflict area of Tolima, Colombia during the COVID-19. A cross-sectional study was carried out with 657 adolescents from 12 to 18 years old, recruited by convenience sampling in 8 public schools in the south of Tolima, Colombia, who completed a self-administered questionnaire. Mental health information was obtained through screening scales for anxiety symptoms (GAD-7), depressive symptomatology (PHQ-8), probable post-traumatic stress disorder (PCL-5) and resilience (CD-RISC-25). The prevalence observed for moderate to severe anxiety symptoms was 18.9% (95% CI 16.0-22.1) and for moderate to severe depressive symptomatology was 30.0% (95% CI 26.5-33.7). A prevalence of probable post-traumatic stress disorder (PTSD) of 22.3% (95% CI 18.1-27.2) was found. The CD-RISC-25 results for resilience had a median score of 54 [IQR 30]. These results suggest that approximately two-thirds of school-attending adolescents in this post-conflict area experienced at least one mental health problem such as anxiety symptoms, depressive symptomatology or probable PTSD during the COVID-19 pandemic. Future studies are of interest to establish the causal relationship between these findings and the impact of the pandemic. These findings highlight the challenge that schools have after pandemic to address the mental health of their students in order to promoting adequate coping strategies and implement prompt multidisciplinary interventions to reduce the burden of mental health problems in adolescents.
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Affiliation(s)
| | | | | | | | | | | | - Victoria Bird
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
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