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Fletcher EKS, Fischer AL, Manocha RHK. Depressive symptoms are highly prevalent and associated with fatigue and pain catastrophizing in the Hypermobility Spectrum Disorders and hypermobile Ehlers Danlos syndrome: a cross-sectional study. Rheumatol Int 2025; 45:128. [PMID: 40293579 DOI: 10.1007/s00296-025-05869-5] [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: 10/23/2024] [Accepted: 04/09/2025] [Indexed: 04/30/2025]
Abstract
Individuals living with Hypermobility Spectrum Disorders and the hypermobile Ehlers-Danlos syndrome (HSD/hEDS) often experience recurrent joint injury, chronic pain, and fatigue. Although generalized anxiety has been recognized as a common comorbidity with HSD/hEDS, minimal research has examined depressive symptoms in this population. The purpose of this investigation was to describe the prevalence, nature, and severity of depressive symptoms in the HSD/hEDS population, and to explore associations with other potential confounding factors. All individuals with HSD/hEDS referred to a specialized connective tissue disorder Physical Medicine & Rehabilitation clinic were asked to self-report demographic data and complete the 9-item Patient Health Questionnaire (PHQ-9), 7-item Generalized Anxiety Disorder Questionnaire (GAD-7), Pain Catastrophizing Symptoms (PCS) questionnaire, and Fatigue Severity Scale (FSS) at their initial clinic visit. Data was prospectively collected between January 2019 and December 2024. Descriptive statistics were performed. A Spearman correlation matrix was used to identify relevant factors associated with depressive symptoms. Relationships emerging as significant (p < 0.001) were further analyzed using independent sample Mann-Whitney U-tests. Fifty-nine individuals (53 female, mean ± SD age: 34.4 ± 11 years) were included, with a mean ± SD PHQ-9 score of 11.2 ± 5.9, indicating moderate depressive symptom severity. 53% of participants (n = 31) met criteria for major depressive disorder (PHQ-9 ≥ 10). Higher pain catastrophizing (ρ = 0.611, p < 0.001) and higher fatigue scores (ρ = 0.593, p < 0.001) were both associated with significantly higher depressive symptoms, but there were no associations with respect to age, working status, and number of alcoholic drinks consumed per week. This research suggests that depression is highly prevalent in patients experiencing HSD/hEDS. There is also a strong association between pain catastrophizing and fatigue in those experiencing depressive symptoms. The interaction between depressive symptoms, pain catastrophizing, and fatigue should be considered in the holistic management of HSD/hEDS.
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Affiliation(s)
| | - Ashley Loren Fischer
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Ranita Harpreet Kaur Manocha
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
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Velescu DR, Marc MS, Traila D, Pescaru CC, Hogea P, Suppini N, Crisan AF, Wellmann N, Oancea C. A Narrative Review of Self-Reported Scales to Evaluate Depression and Anxiety Symptoms in Adult Obstructive Sleep Apnea Patients. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:261. [PMID: 38399548 PMCID: PMC10889932 DOI: 10.3390/medicina60020261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/14/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent chronic condition that has been associated with mental disorders like depression and anxiety. This study intends to provide a practical overview of the most relevant self-reported and self-rating scales that assess depression and anxiety in OSA patients. Materials and Methods: A search for articles was performed using PubMed, Google Scholar, and Semantic Scholar using a combination of words for obstructive sleep apnea, depression, anxiety, and scales. The tools were ordered by type (screening and rating) and arranged chronologically according to the year of publication. Results: Three scales were identified for assessing depression, which were the Center for Epidemiologic Studies Depression Scale (CES-D), the Hospital Anxiety and Depression Scale (HADS-D), and the Patient Health Questionnaire-9 (PHQ-9). For rating depression, two scales were discussed: the Zung Self-Rating Depression Scale (SDS) and the Beck Depression Inventory (BDI), which has three versions (the BDI, the BDI-II, and the Fast Screen (BDI-FS)). For assessing anxiety, the Generalized Anxiety Disorder-7 (GAD-7) scale was identified. Two scales were reviewed for rating anxiety: the State-Trait Anxiety Inventory (STAI) and the Beck Anxiety Inventory (BAI). Each scale is accompanied by a brief description of its practicality and psychometric qualities and an analysis of its strengths and limitations. Conclusions: The findings of this review will contribute to the understanding of the importance of assessing mental health comorbidities in the context of OSA, ultimately guiding clinical practice and future research in this area.
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Affiliation(s)
- Diana Raluca Velescu
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Monica Steluta Marc
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Daniel Traila
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Camelia Corina Pescaru
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Patricia Hogea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Noemi Suppini
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Alexandru Florian Crisan
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Research Center for the Assessment of Human Motion, Functionality and Disability (CEMFD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Norbert Wellmann
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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Gilmore GR, Dyche J. Sleep/wake regularity and cognition in college students using antidepressants. Physiol Behav 2024; 273:114414. [PMID: 37992793 DOI: 10.1016/j.physbeh.2023.114414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/11/2023] [Accepted: 11/18/2023] [Indexed: 11/24/2023]
Abstract
The current project examined sleep, sleep/wake regularity, and cognition in college students diagnosed with depression and using serotonergic antidepressants and in those without a depression diagnosis. Forty participants either using antidepressants (n = 20, 24.75 ± 6.82 years) or without a depression diagnosis (n = 20, 21.70 ± 2.74 years) wore actigraphs for two consecutive weeks (14 days). Cognitive tasks were completed on day 1 (along with demographic surveys) and day 14. Effect sizes indicated that compared to non-clinically depressed peers, participants using antidepressants exhibited slightly greater wake after sleep onset (d = 0.36) and lower sleep efficiency (d = 0.40); however, these differences were likely not noticed by the sleeper. No sleep regularity or cognitive differences were present between groups. Within the antidepressant group, higher dosage predicted greater time in bed (R2 = 0.77), but less total sleep time (R2 = 0.86). The time of day that participants took their antidepressant exhibited differential effects on certain cognitive parameters, such as procedural reaction time and spatial processing, and interactions with years of antidepressant use were found. Self-reported wake episodes also predicted better reaction time and inhibition in the antidepressant group. This study is the first to demonstrate that sleep/wake regularity is comparable between people using antidepressants and non-clinically depressed human samples. For individuals using antidepressants, years of use, dosage, and time of day of use have predictive qualities for reaction times, spatial processing, and inhibition.
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Affiliation(s)
- Gabriel R Gilmore
- Department of Psychology, University of Kentucky, 106-B Kastle Hall, Lexington, KY, 40506, United States.
| | - Jeff Dyche
- Department of Psychology, James Madison University, Miller Hall, MSC 7704, 91 E. Grace Street, Harrisonburg, VA, United States
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Belanger HG, Lee C, Winsberg M. Symptom clustering of major depression in a national telehealth sample. J Affect Disord 2023; 338:129-134. [PMID: 37245550 DOI: 10.1016/j.jad.2023.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 03/30/2023] [Accepted: 05/11/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) is a heterogeneous disorder whose possible symptom combinations have not been well delineated. The aim of this study was to explore the heterogeneity of symptoms experienced by those with MDD to characterize phenotypic presentations. METHODS Cross-sectional data (N = 10,158) from a large telemental health platform were used to identify subtypes of MDD. Symptom data, gathered from both clinically-validated surveys and intake questions, were analyzed via polychoric correlations, principal component analysis, and cluster analysis. RESULTS Principal components analysis (PCA) of baseline symptom data revealed 5 components, including anxious distress, core emotional, agitation/irritability, insomnia, and anergic/apathy components. PCA-based cluster analysis resulted in four MDD phenotypes, the largest of which was characterized by a prominent elevation on the anergic/apathy component, but also core emotional. The four clusters differed on demographic and clinical characteristics. LIMITATIONS The primary limitation of this study is that the phenotypes uncovered are limited by the questions asked. These phenotypes will need to be cross validated with other samples, potentially expanded to include biological/genetic variables, and followed longitudinally. CONCLUSIONS The heterogeneity in MDD, as illustrated by the phenotypes in this sample, may explain the heterogeneity of treatment response in large-scale treatment trials. These phenotypes can be used to study varying rates of recovery following treatment and to develop clinical decision support tools and artificial intelligence algorithms. Strengths of this study include its size, breadth of included symptoms, and novel use of a telehealth platform.
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Affiliation(s)
- Heather G Belanger
- Brightside Health Inc., 5241F Diamond Heights Blvd #3422, San Francisco CA 94131, United States of America; University of South Florida, Department of Psychiatry and Behavioral Neurosciences, 3515 E Fletcher Ave, Tampa, FL 33613, United States of America.
| | - Christine Lee
- Brightside Health Inc., 5241F Diamond Heights Blvd #3422, San Francisco CA 94131, United States of America
| | - Mirène Winsberg
- Brightside Health Inc., 5241F Diamond Heights Blvd #3422, San Francisco CA 94131, United States of America
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Xu Z, Vekaria V, Wang F, Cukor J, Su C, Adekkanattu P, Brandt P, Jiang G, Kiefer RC, Luo Y, Rasmussen LV, Xu J, Xiao Y, Alexopoulos G, Pathak J. Using Machine Learning to Predict Antidepressant Treatment Outcome From Electronic Health Records. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2023; 5:118-125. [PMID: 38077277 PMCID: PMC10698704 DOI: 10.1176/appi.prcp.20220015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/28/2023] Open
Abstract
Objective To evaluate if a machine learning approach can accurately predict antidepressant treatment outcome using electronic health records (EHRs) from patients with depression. Method This study examined 808 patients with depression at a New York City-based outpatient mental health clinic between June 13, 2016 and June 22, 2020. Antidepressant treatment outcome was defined based on trend in depression symptom severity over time and was categorized as either "Recovering" or "Worsening" (i.e., non-Recovering), measured by the slope of individual-level Patient Health Questionnaire-9 (PHQ-9) score trajectory spanning 6 months following treatment initiation. A patient was designated as "Recovering" if the slope is less than 0 and as "Worsening" if the slope was no less than 0. Multiple machine learning (ML) models including L2 norm regularized Logistic Regression, Naive Bayes, Random Forest, and Gradient Boosting Decision Tree (GBDT) were used to predict treatment outcome based on additional data from EHRs, including demographics and diagnoses. Shapley Additive Explanations were applied to identify the most important predictors. Results The GBDT achieved the best results of predicting "Recovering" (AUC: 0.7654 ± 0.0227; precision: 0.6002 ± 0.0215; recall: 0.5131 ± 0.0336). When excluding patients with low PHQ-9 scores (<10) at baseline, the results of predicting "Recovering" (AUC: 0.7254 ± 0.0218; precision: 0.5392 ± 0.0437; recall: 0.4431 ± 0.0513) were obtained. Prior diagnosis of anxiety, psychotherapy, recurrent depression, and baseline depression symptom severity were strong predictors. Conclusions The results demonstrate the potential utility of using ML in longitudinal EHRs to predict antidepressant treatment outcome. Our predictive tool holds the promise to accelerate personalized medical management in patients with psychiatric illnesses.
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Affiliation(s)
| | | | - Fei Wang
- Weill Cornell MedicineNew YorkNew YorkUSA
| | | | - Chang Su
- Temple UniversityPhiladelphiaPennsylvaniaUSA
| | | | | | | | | | - Yuan Luo
- Northwestern UniversityChicagoIllinoisUSA
| | | | - Jie Xu
- University of FloridaGainesvilleFloridaUSA
| | - Yunyu Xiao
- Weill Cornell MedicineNew YorkNew YorkUSA
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Rosario-Hernández E, Rovira-Millán LV, Merino-Soto C, Angulo-Ramos M. Review of the psychometric properties of the Patient Health Questionnaire-9 (PHQ-9) Spanish version in a sample of Puerto Rican workers. Front Psychiatry 2023; 14:1024676. [PMID: 36865076 PMCID: PMC9971011 DOI: 10.3389/fpsyt.2023.1024676] [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: 08/22/2022] [Accepted: 01/03/2023] [Indexed: 02/16/2023] Open
Abstract
Background This study aimed to examine the internal structure and assess the psychometric properties of the Patient Health Questionnaire (PHQ-9) in a Puerto Rican sample of workers. This instrument is a nine-item questionnaire, which was conceptualized as a unidimensional structure; however, there are mixed results regarding this internal structure. This measure is used in the occupational health psychology context in organizations in Puerto Rico; nevertheless, there is little evidence of its psychometric properties with samples of workers. Materials and methods A total of 955 samples from two different study samples were used in this cross-sectional study design in which the PHQ-9 was used. We conducted confirmatory factor analysis, bifactor analysis, and random intercept item factor analysis to examine the internal structure of the PHQ-9. Moreover, a two-factor model was examined by randomly assigning items to the two factors. Measurement invariance across sex and the relationship with other constructs were examined. Results The best-fitted model was the bifactor model followed by the random intercept item factor. The five sets of two-factor models with items randomly assigned obtained acceptable and similar fit indices regardless of the items. Conclusion The results suggest that the PHQ-9 appears to be a reliable and valid instrument to measure depression. The more parsimonious interpretation of its scores, for now, is a unidimensional structure. Comparison across sex appears to be useful in occupational health psychology research settings since the results suggest that the PHQ-9 is invariant regarding this variable.
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Affiliation(s)
- Ernesto Rosario-Hernández
- Clinical Psychology Programs, School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | | | - César Merino-Soto
- Instituto de Investigación de Psicología, Universidad de San Martín de Porres, Lima, Peru
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Early Response to Antidepressant Medications in Adults With Major Depressive Disorder: A Naturalistic Study and Odds of Remission at 14 Weeks. J Clin Psychopharmacol 2023; 43:46-54. [PMID: 36584249 PMCID: PMC9803387 DOI: 10.1097/jcp.0000000000001638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE/BACKGROUND Early response after 2 to 4 weeks of antidepressant therapy has been shown to predict remission by 8 to 12 weeks. Most of the work to date on early response has been done using data from randomized controlled trials. METHODS/PROCEDURES This naturalistic study uses archival data from a national tele-mental health company. The positive and negative predictive values as well as sensitivity and specificity were calculated using different drops in baseline Patient Health Questionnaire 9 scores at various periods. Demographic and clinical characteristics were compared between early responders versus those lacking early response. Binary logistic regression analyses determined if early response was predictive of remission, response, and greater than minimal improvement at 14 weeks. For those who do not show early improvement, treatments were investigated using binary logistic regression to see if changes predicted later outcomes. FINDINGS/RESULTS Positive predictive values for all endpoints improved with the strength of early response but did not improve much with the time allowed for that response to occur. In contrast, negative predictive values increased substantially with time. Using a definition of 30% drop in Patient Health Questionnaire 9 score at week 4, 56.5% of patients were early responders. Early responders were ~3.2 times more likely to achieve remission than those lacking early response. Of nonresponders by week 4, those prescribed atypical antipsychotics (+SSRI) had significantly reduced odds of response at week 14, whereas those prescribed a norepinephrine and dopamine reuptake inhibitor had increased odds. IMPLICATIONS/CONCLUSIONS Early response may be associated with better outcomes at 14 weeks. In those with lack of response by week 4, patients prescribed a norepinephrine and dopamine reuptake inhibitor may achieve superior outcomes.
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O'Callaghan E, Mahrer N, Belanger HG, Sullivan S, Lee C, Gupta CT, Winsberg M. Telehealth-Supported Decision-making Psychiatric Care for Suicidal Ideation: Longitudinal Observational Study. JMIR Form Res 2022; 6:e37746. [PMID: 36178727 PMCID: PMC9568811 DOI: 10.2196/37746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/16/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background Suicide is a leading cause of death in the United States, and suicidal ideation (SI) is a significant precursor and risk factor for suicide. Objective This study aimed to examine the impact of a telepsychiatric care platform on changes in SI over time and remission, as well as to investigate the relationship between various demographic and medical factors on SI and SI remission. Methods Participants included 8581 US-based adults (8366 in the treatment group and 215 in the control group) seeking treatment for depression, anxiety, or both. The treatment group included patients who had completed at least 12 weeks of treatment and had received a prescription for at least one psychiatric medication during the study period. Providers prescribed psychiatric medications for each patient during their first session and received regular data on participants. They also received decision support at treatment onset via the digital platform, which leveraged an empirically derived proprietary precision-prescribing algorithm to give providers real-time care guidelines. Participants in the control group consisted of individuals who completed the initial enrollment data and completed surveys at baseline and 12 weeks but did not receive care. Results Greater feelings of hopelessness, anhedonia, and feeling bad about oneself were most significantly correlated (r=0.24-0.37) with SI at baseline. Sleep issues and feeling tired or having low energy, although significant, had lower correlations with SI (r=0.13-0.14). In terms of demographic variables, advancing age and education were associated with less SI at baseline (r=−0.16) and 12 weeks (r=−0.10) but less improvement over time (r=−0.12 and −0.11, respectively). Although not different at baseline, the SI expression was evident in 34.4% (74/215) of the participants in the control group and 12.32% (1031/8366) of the participants in the treatment group at 12 weeks. Although the participants in the treatment group improved over time regardless of various demographic variables, participants in the control group with less education worsened over time, after controlling for age and depression severity. A model incorporating the treatment group, age, sex, and 8-item Patient Health Questionnaire scores was 77% accurate in its classification of complete remission. Those in the treatment group were 4.3 times more likely (odds ratio 4.31, 95% CI 2.88-6.44) to have complete SI remission than those in the control group. Female participants and those with advanced education beyond high school were approximately 1.4 times more likely (odds ratio 1.38, 95% CI 1.18-1.62) to remit than their counterparts. Conclusions The results highlight the efficacy of an antidepressant intervention in reducing SI, in this case administered via a telehealth platform and with decision support, as well as the importance of considering covariates, or subpopulations, when considering SI. Further research and refinement, ideally via randomized controlled trials, are needed.
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Affiliation(s)
| | - Nicole Mahrer
- Psychology Department, University of La Verne, La Verne, CA, United States
| | - Heather G Belanger
- Brightside Health Inc, Oakland, CA, United States
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
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O’Callaghan E, Sullivan S, Gupta C, Belanger HG, Winsberg M. Feasibility and acceptability of a novel telepsychiatry-delivered precision prescribing intervention for anxiety and depression. BMC Psychiatry 2022; 22:483. [PMID: 35854281 PMCID: PMC9297585 DOI: 10.1186/s12888-022-04113-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/05/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Major Depressive Disorder and Generalized Anxiety Disorder are pervasive and debilitating conditions, though treatment is often inaccessible and based on trial-and-error prescribing methods. The present observational study seeks to describe the use of a proprietary precision prescribing algorithm piloted during routine clinical practice as part of Brightside's telepsychiatry services. The primary aim is to determine the feasibility and acceptability of implementing this intervention. Secondary aims include exploring remission and symptom improvement rates. METHODS Participants were adult patients enrolled in Brightside who completed at least 12 weeks of treatment for depression and/or anxiety and received a prescription for at least one psychiatric medication. A prescription recommendation was made by Brightside's algorithm at treatment onset and was utilized for clinical decision support. Participants received baseline screening surveys of the PHQ-9 and GAD-7, and at weeks 2,4,6,8,10 and 12. Intent-to-treat (ITT) sensitivity analyses were conducted. Feasibility of the implementation was measured by the platform's ability to enroll and engage participants in timely psychiatric care, as well as offer high touch-point treatment options. Acceptability was measured by patient responses to a 5-star satisfaction rating. RESULTS Brightside accessed and treated 6248 patients from October 2018 to April 2021, treating a majority of patients within 4-days of enrollment. The average plan cost was $115/month. 89% of participants utilized Brightside's core medication plan at a cost of $95/month. 13.4% of patients in the study rated Brightside's services as highly satisfactory, averaging a 4.6-star rating. Furthermore, 90% of 6248 patients experienced a MCID in PHQ-9 or GAD-7 score. Remission rates were 75% (final PHQ-9 or GAD-7 score < 10) for the study sample and 59% for the ITT sample. 69.3% of Brightside patients were treated with the medication initially prescribed at intake. CONCLUSIONS Results suggest that the present intervention may be feasible and acceptable within the assessed population. Exploratory analyses suggest that Brightside's course of treatment, guided by precision recommendations, improved patients' symptoms of anxiety and depression.
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Affiliation(s)
- Erin O’Callaghan
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA 94607-1703 USA
| | - Scott Sullivan
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA 94607-1703 USA
| | - Carina Gupta
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA, 94607-1703, USA.
| | - Heather G. Belanger
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA 94607-1703 USA ,grid.170693.a0000 0001 2353 285XDepartments of Psychology and Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL USA
| | - Mirène Winsberg
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA 94607-1703 USA
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Zhang Y, Liu Y, Ning B, Yan L, Wu L, Zhang D, Li C, Ouyang W, Su S, Jiang S, Zhang G, Xu J, Wang Z, Zheng Z, Zheng D, Chen S, Sun L, Fu W. Efficacy of the Integrative Acupuncture and Moxibustion Treatment in Patients With Major Depressive Disorder: The Study Protocol for a Multicenter, Single-Blinded, Randomized Trial in China. Front Med (Lausanne) 2022; 9:761419. [PMID: 35707522 PMCID: PMC9189311 DOI: 10.3389/fmed.2022.761419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 05/05/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Antidepressants are the front-line treatments for major depressive disorder (MDD), but remain unsatisfactory in outcome. An increasing number of patients are interested in acupuncture and moxibustion treatment as complementary therapies. This study aims to evaluate the efficacy and safety of integrative acupuncture and moxibustion (iAM) treatment in patients with MDD. Methods and Analysis This multicenter, single-blind, 2 × 2 factorial randomized trial will enroll 592 patients with MDD of moderate severity from nine hospitals. All patients will be randomized, in a ratio of 2:2:2:1, through a computerized central randomization system, into four groups (the combined, iAM-only, sertraline-only, and placebo groups). Participants will undergo a 12-week intervention with either 50 mg of sertraline or a placebo once a day and active/sham iAM treatment three times per week. The primary outcome is depression severity, assessed using the Hamilton Depression Scale-17. The secondary outcomes include self-rated depression severity, anxiety, and sleep quality. The primary and secondary outcomes will be measured at weeks 0, 4, 8, 12, and the 8th week posttreatment. Safety will be evaluated through liver and kidney function tests conducted before and after treatment and through monitoring of daily adverse events. An intent-to-treat principle will be followed for the outcome analyses. Conclusion This trial will provide sufficient evidence to ascertain whether iAM is effective and safe for treating MDD and provides a suitable combination strategy for treating MDD. Clinical Trial Registration [www.chictr.org.cn], identifier [ChiCTR2100042841].
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Affiliation(s)
- Yuan Zhang
- Department of Acupuncture and Moxibustion, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yamin Liu
- Shenzhen Bao’an Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Baile Ning
- Department of Acupuncture and Moxibustion, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Luda Yan
- Shenzhen Bao’an Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Lihua Wu
- Shenzhen Bao’an Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Delong Zhang
- School of Psychology, South China Normal University, Guangzhou, China
| | - Changhong Li
- College of Teacher Education, Guangdong University of Education, Guangzhou, China
| | - Wenwei Ouyang
- Key Unit of Methodology in Clinical Research, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shengyong Su
- The First Affiliated Hospital of Guangxi Chinese Medical University, Nanning, China
| | - Shuo Jiang
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Guangcai Zhang
- Hainan Provincial Hospital of Chinese Medicine, Haikou, China
| | - Junfeng Xu
- The First Affiliated Hospital of Tianjin Chinese Medical University, Tianjin, China
| | - Zhen Wang
- The Second Affiliated Hospital of Anhui Chinese Medical University, Hefei, China
| | - Zhong Zheng
- Sleep Medical Center, West China Hospital of Sichuan University, Chengdu, China
| | - Dong Zheng
- Brain Hospital Affiliated Guangzhou Medical University, Guangzhou, China
| | - Shan Chen
- Department of Acupuncture and Moxibustion, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lu Sun
- Department of Psychosomatic Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Lu Sun,
| | - Wenbin Fu
- Department of Acupuncture and Moxibustion, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Wenbin Fu,
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11
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Belanger HG, Winsberg M. Do older adults benefit from telepsychiatric care: Comparison to younger adults. Front Psychiatry 2022; 13:998401. [PMID: 36072453 PMCID: PMC9441623 DOI: 10.3389/fpsyt.2022.998401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Telemental health platforms may increase access to care for older adults. Historically, older adults have tended to adopt new technologies at a slower rate which creates a perception that they may not be able to benefit from them. The purpose of this study was to determine whether or not older adult patients receiving psychiatric care for depression via a telemental health platform achieve the same outcomes as younger adults. METHOD Participant data utilized in the current investigation were obtained from a national mental health telehealth company (i.e., Brightside) and consisted of 12,908 U.S.-based adult patients receiving psychiatric care for depression between October, 2018 and January, 2022. Propensity matching was used to create an older and younger sample (n = 141 in each) using 23 covariates. These samples were then compared using repeated measures ANOVA on Patient Health Questionnaire-9 (PHQ-9) scores at start of treatment, 6 weeks, 8 weeks, 10 weeks, 12 weeks, 14 weeks, and 16 weeks. RESULTS Despite matching, the groups still significantly differed on prior mental health treatment, such that more older adults reported having had prior mental health treatment. There were no other differences between the groups on assessed variables. Both younger and older adults had decreasing scores over time with no significant differences between them. CONCLUSION Older adults have similar improvement in depression symptom severity over time following initiation of psychiatric treatment via a telehealth platform. These findings suggest that age is not a barrier to benefitting from telepsychiatric care.
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Affiliation(s)
- Heather G Belanger
- Brightside Health Inc., Oakland, CA, United States.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
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12
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Belanger HG, Winsberg M. Exploring social determinants of health: Comparing lower and higher income individuals participating in telepsychiatric care for depression. Front Psychiatry 2022; 13:1026361. [PMID: 36683980 PMCID: PMC9849930 DOI: 10.3389/fpsyt.2022.1026361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Telemental health may increase access to care; there has been little research on efficacy with those at the lower end of the income distribution. The purpose of this study was to determine whether lower vs. higher income patients receiving telepsychiatric care for depression achieve: (1) effective symptom reduction and (2) similar outcomes. METHODS Data utilized were obtained from a national mental health telehealth company and consisted of 5,426 U.S.-based patients receiving psychiatric care for moderate to severe depression between October, 2018 and January, 2022. Propensity matching was used to create lower and higher income samples (n = 379 in each) using 22 covariates. These samples were then compared using repeated measures ANOVA on Patient Health Questionnaire-9 (PHQ-9) scores at start of treatment, 6, 8, 10, 12, 14, and 16 weeks. RESULTS Both lower and higher income groups made significant improvement over time, with groups averaging mild symptom severity by week 16. There was a significant group x time interaction, such that the lower income group had significantly greater depression severity at the last two timepoints. CONCLUSION Lower and higher income groups both made significant improvement in depression symptom severity over time following initiation of psychiatric treatment via a telehealth platform, though higher income individuals, all else being equal besides employment, tend to do better. These findings suggest that when lower income individuals do participate in care, good outcomes can be achieved. Further research is needed to better understand the role social determinants of health (SDOH) play in outcome disparities.
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Affiliation(s)
- Heather G Belanger
- Brightside Health Inc., Oakland, CA, United States.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
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13
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Rosario-Hernández E, Rovira-Millán LV, Merino-Soto C. Review of the Internal Structure, Psychometric Properties, and Measurement Invariance of the Work-Related Rumination Scale - Spanish Version. Front Psychol 2021; 12:774472. [PMID: 34899526 PMCID: PMC8656259 DOI: 10.3389/fpsyg.2021.774472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The aim of the current study was to examine the internal structure and assess the psychometric properties of the Work-Related Rumination Scale (WRRS) – Spanish version in a Puerto Rican sample of workers. This instrument is a 15-item questionnaire, which has three factors, affective rumination, problem-solving pondering, and detachment. This measure is used in the occupational health psychology context; however, there is little evidence of its psychometric properties. Materials and Methods: A total sample of 4,100 from five different study samples was used in this cross-sectional study design in which the WRRS was used. We conducted confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) to examine the internal structure of the Work-Related Rumination Scale. Measurement invariance across sex and age was examined. Results: The three-factor model was supported; however, four items were eliminated due to their cross-loadings and factorial complexity. This 11-item Spanish version of the WRRS was invariant across sex and age. Reliability of the three-factors of WRRS were within the range of 0.74 to 0.87 using Cronbach’s alpha and McDonald’s omega. Correlations between the three factors were as expected as well as with other established measures. Conclusion: The results suggest that the WRRS-Spanish version appears to be a reliable and valid instrument to measure work-related rumination using its three factors. Comparison across sex and age appear to be useful in occupational health psychology research setting since results suggest that the WRRS is invariant regarding those variables.
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Affiliation(s)
- Ernesto Rosario-Hernández
- Clinical Psychology Programs, School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, PR, United States.,Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, United States
| | - Lillian V Rovira-Millán
- Psychology Program, Department of Social Sciences, University of Puerto Rico, Cayey, PR, United States
| | - César Merino-Soto
- Psychology Research Institute, School of Psychology, University of San Martín de Porres, Lima, Peru
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14
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Falkenström F, Holmqvist R. Therapist in-session feelings predict change in depressive symptoms in interpersonal and brief relational psychotherapy. Psychother Res 2021; 32:571-584. [PMID: 34763615 DOI: 10.1080/10503307.2021.1998700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Objective: Brief Relational Therapy (BRT) includes the idea that the therapists use their in-session feelings in meta-communications about the therapy relationship to facilitate resolution of alliance ruptures. The current study aimed to explore the effect of therapist feelings on patient depressive symptoms in BRT compared to Interpersonal Psychotherapy (IPT).Methods: The effects of therapist feelings were studied in 40 patients randomized to 16 sessions of IPT or BRT, using the Feeling Word Checklist-24, the Patient Health Questionnaire-9 and the Working Alliance Inventory. Data was analyzed using dynamic structural equation modeling.Results: Negative therapist feelings predicted increase and positive feelings decrease in next-session PHQ-9 via the alliance and the patients' engaged feelings, in both treatments. The direct effect of negative therapist feelings on PHQ-9 differed significantly between BRT and IPT, with more negative feelings predicting a decrease in PHQ-9 in BRT but not in IPT.Conclusion: Negative therapist feelings may cause increase/less decrease and positive feelings more decrease in depressive symptoms via disruptions in the alliance. In BRT, if the alliance is unaffected by negative therapist feelings, the patient's depressive symptoms may improve. Findings need replication in a larger sample.
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Affiliation(s)
- Fredrik Falkenström
- Department of Psychology, Linnaeus University, Växjö, Sweden.,Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Rolf Holmqvist
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
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15
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Mulvaney SA, Mara CA, Kichler JC, Majidi S, Driscoll KA, Westen SC, Rawlinson A, Jacobsen LM, Adams RN, Hood KK, Monaghan M. A retrospective multisite examination of depression screening practices, scores, and correlates in pediatric diabetes care. Transl Behav Med 2021; 11:122-131. [PMID: 31764981 DOI: 10.1093/tbm/ibz171] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Psychosocial guidelines recommend routine screening of depressive symptoms in adolescents and young adults (AYA) with diabetes. Best practices for screening in routine care and patient characteristics associated with depressive symptoms require further investigation. The purpose of this study was to examine psychometric properties of the Patient Health Questionnaire (PHQ-2 and PHQ-9); document rates of depressive symptoms and related clinical actions; and evaluate associations with patient characteristics. The Patient Health Questionnaire (PHQ-2 or PHQ-9) was administered at five pediatric academic medical centers with 2,138 youth with type 1 diabetes. Screening was part of routine clinical care; retrospective data from electronic health records were collected for the first screening date as well as 12 months prior. The PHQ demonstrated good psychometric properties. Evaluation of item-level PHQ-9 data identified 5.0% of AYA with at least moderate depressive symptoms who would not have been flagged for further screening using the PHQ-2 only. On the PHQ-9, 10.0% of AYA with type 1 diabetes endorsed elevated depressive symptoms and 7.0% endorsed thoughts of self-harm. Patients with moderate or greater depressive symptoms had a 43.9% documented referral rate for mental health treatment. Higher BMI, older age, public insurance, shorter diabetes duration, higher HbA1C, and a diabetic ketoacidosis (DKA) event in the past year were associated with depressive symptoms. The PHQ-9 identified AYA with elevated depressive symptoms that would not have been identified using the PHQ-2. Depressive symptoms were associated with negative diabetes indicators. To improve referral rates, standardized methods for provision and documentation of referrals are needed.
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Affiliation(s)
| | - Constance A Mara
- Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jessica C Kichler
- Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | | | | | | | | | - Korey K Hood
- Stanford University School of Medicine, Palo Alto, CA, USA
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16
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Factors associated with response and remission from depression at 6-months of treatment in a retrospective cohort treated within an integrated care program. BMC Health Serv Res 2021; 21:703. [PMID: 34271912 PMCID: PMC8285801 DOI: 10.1186/s12913-021-06729-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/25/2021] [Indexed: 12/03/2022] Open
Abstract
Background Depression causes significant morbidity, which impacts mental health, overall general health outcomes, everyday functioning and quality of life. This study aims to contribute to knowledge in the field through enhanced understanding of factors that influence depression response and remission, with consideration for design of treatment services to optimize depression outcomes within integrated care programs. Methods Using routine behavioral health screening and electronic health record data, we identified a retrospective cohort consisting of 615 adult patients receiving depression treatment within an integrated care program. Cohort member Patient Health Questionnaire (PHQ-9) data was analyzed for the 6 months following initiation of treatment. Multinomial regression models were estimated to identify factors associated with depression treatment response (PHQ-9 < 10) and remission (PHQ-9 < 5). Results At 6 months, 47% of patients demonstrated treatment response and 16% demonstrated remission. Baseline trauma symptoms and suicidal ideation were significantly associated with decreased odds of achieving remission (Odds Ratio (95% CI) [OR] = 0.45 (0.23, 0.88) and OR = 0.49 (0.29, 0.82), respectively). In fully adjusted models, baseline suicidal ideation remained significant (OR = 0.53 (0.31, 0.89)) and some evidence of an association persisted for baseline trauma symptoms (OR = 0.51 (0.25, 1.01)). Conclusions After controlling for baseline depression symptoms, the presence of suicidal ideation is associated with reduced likelihood of remission. Increased understanding of factors associated with depression treatment outcomes may be employed to help guide the delivery and design of clinical services. Alongside routine screening for co-morbid anxiety, suicidal ideation and traumatic stress should be assessed and considered when designing depression treatment services.
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17
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Monaghan M, Mara CA, Kichler JC, Westen SC, Rawlinson A, Jacobsen LM, Adams RN, Stone JY, Hood KK, Mulvaney SA. Multisite Examination of Depression Screening Scores and Correlates Among Adolescents and Young Adults With Type 2 Diabetes. Can J Diabetes 2021; 45:411-416. [PMID: 33722492 DOI: 10.1016/j.jcjd.2021.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/06/2021] [Accepted: 01/16/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Our aim was to evaluate self-reported depressive symptoms and clinical outcomes during routine screening for adolescents and young adults with type 2 diabetes (T2D), and examine associations among depressive symptoms and demographic and clinical characteristics. METHODS The Patient Health Questionnaire (PHQ) was administered to 197 adolescents and young adults with T2D using the PHQ-2 or PHQ-9 in routine pediatric diabetes care at 4 academic medical centres. Data from electronic health records were extracted from the screening date and 12 months earlier. RESULTS Adolescents and young adults with T2D (mean age, 16.85 years; 57% male; 77.2% non-Caucasian) completed the PHQ as part of routine diabetes care. On the PHQ, 19.3% of adolescents and young adults endorsed elevated depressive symptoms (PHQ score ≥10) and, among a subsample with item-level data (n=53), 18.9% endorsed thoughts of self-harm. Subsequently, 50.0% of those with depressive symptoms had a documented referral for mental health treatment in the electronic health record after the positive screening outcome. Older age, shorter diabetes duration, higher glycated hemoglobin level, being non-Hispanic white, more blood glucose checks per day and being prescribed oral medications were significantly associated with more depressive symptoms. CONCLUSIONS Screening for depressive symptoms identifies individuals in need of referral for mental health treatment. A focus on self-harm assessment, standardized methods for documentation of symptoms and mental health referrals and increased referral resources are needed.
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Affiliation(s)
- Maureen Monaghan
- Center for Translational Research, Children's National Hospital, Washington, District of Columbia, United States.
| | - Constance A Mara
- Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Jessica C Kichler
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | - Sarah C Westen
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, United States
| | - Alana Rawlinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, United States
| | - Laura M Jacobsen
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, Florida, United States
| | - Rebecca N Adams
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - Jenine Y Stone
- School of Nursing, Vanderbilt University and Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - Shelagh A Mulvaney
- School of Nursing, Vanderbilt University and Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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18
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Kim S, Lee K. Screening for Depression in Mobile Devices Using Patient Health Questionnaire-9 (PHQ-9) Data: A Diagnostic Meta-Analysis via Machine Learning Methods. Neuropsychiatr Dis Treat 2021; 17:3415-3430. [PMID: 34848962 PMCID: PMC8612669 DOI: 10.2147/ndt.s339412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/02/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Depression is a symptom commonly encountered in primary care; however, it is often not detected by doctors. Recently, disease diagnosis and treatment approaches have been attempted using smart devices. In this study, instrumental effectiveness was confirmed with the diagnostic meta-analysis of studies that demonstrated the diagnostic effectiveness of PHQ-9 for depression using mobile devices. PATIENTS AND METHODS We found all published and unpublished studies through EMBASE, MEDLINE, MEDLINE In-Process, and PsychINFO up to March 26, 2021. We performed a meta-analysis by including 1099 subjects in four studies. We performed a diagnostic meta-analysis according to the PHQ-9 cut-off score and machine learning algorithm techniques. Quality assessment was conducted using the QUADAS-2 tool. Data on the sensitivity and specificity of the studies included in the meta-analysis were extracted in a standardized format. Bivariate and summary receiver operating characteristic (SROC) curve were constructed using the metandi, midas, metabias, and metareg functions of the Stata algorithm meta-analysis words. RESULTS Using four studies out of the 5476 papers searched, a diagnostic meta-analysis of the PHQ-9 scores of 1099 people diagnosed with depression was performed. The pooled sensitivity and specificity were 0.797 (95% CI = 0.642-0.895) and 0.85 (95% CI = 0.780-0.900), respectively. The diagnostic odds ratio was 22.16 (95% CI = 7.273-67.499). Overall, a good balance was maintained, and no heterogeneity or publication bias was presented. CONCLUSION Through various machine learning algorithm techniques, it was possible to confirm that PHQ-9 depression screening in mobiles is an effective diagnostic tool when integrated into a diagnostic meta-analysis.
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Affiliation(s)
- Sunhae Kim
- Department of Psychiatry, Hanyang University Medical Center, Seoul, Korea
| | - Kounseok Lee
- Department of Psychiatry, Hanyang University Medical Center, Seoul, Korea
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19
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Smarr KL, Keefer AL. Measures of Depression and Depressive Symptoms. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:608-629. [PMID: 33091258 DOI: 10.1002/acr.24191] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/17/2020] [Indexed: 01/27/2023]
Affiliation(s)
- Karen L Smarr
- Harry S. Truman Memorial Veterans' Hospital and University of Missouri School of Medicine, Columbia
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20
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Cox CE, Olsen MK, Gallis JA, Porter LS, Greeson JM, Gremore T, Frear A, Ungar A, McKeehan J, McDowell B, McDaniel H, Moss M, Hough CL. Optimizing a self-directed mobile mindfulness intervention for improving cardiorespiratory failure survivors' psychological distress (LIFT2): Design and rationale of a randomized factorial experimental clinical trial. Contemp Clin Trials 2020; 96:106119. [PMID: 32805434 PMCID: PMC7428440 DOI: 10.1016/j.cct.2020.106119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Although as many as 75% of the >2 million annual intensive care unit (ICU) survivors experience symptoms of psychological distress that persist for months to years, few therapies exist that target their symptoms and accommodate their unique needs. In response, we developed LIFT, a mobile app-based mindfulness intervention. LIFT reduced distress symptoms more than either a telephone-based mindfulness program or education control in a pilot randomized clinical trial (LIFT1). OBJECTIVE To describe the methods of a factorial experimental clinical trial (LIFT2) being conducted to aid in the development and implementation of the version of the LIFT intervention that is optimized across domains of effect, feasibility, scalability, and costs. METHODS AND ANALYSIS The LIFT2 study is an optimization trial conceptualized as a component of a larger multiphase optimization strategy (MOST) project. The goal of LIFT2 is to use a 2 × 2 × 2 factorial experimental trial involving 152 patients to determine the ideal components of the LIFT mobile mindfulness program for ICU survivors across factors including (1) study introduction by call from a therapist vs. app only, (2) response to persistent or worsening symptoms over time by therapist vs. app only, and (3) high dose vs. low dose. The primary trial outcome is change in depression symptoms 1 month from randomization measured by the PHQ-9 instrument. Secondary outcomes include anxiety, post-traumatic stress disorder, and physical symptoms; measures of feasibility, acceptability, and usability; as well as themes assessed through qualitative analysis of semi-structured interviews with study participants conducted after follow up completion. We will use general linear models to compare outcomes across the main effects and interactions of the factors.
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Affiliation(s)
- Christopher E Cox
- Department of Medicine, Division of Pulmonary & Critical Care Medicine and the Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC, United States of America.
| | - Maren K Olsen
- Department of Biostatistics and Bioinformatics, Duke University Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, NC, United States of America.
| | - John A Gallis
- Department of Biostatistics & Bioinformatics, Duke Global Health Institute, Duke University, Durham, NC, United States of America.
| | - Laura S Porter
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, United States of America.
| | - Jeffrey M Greeson
- Department of Psychology, College of Science and Mathematics, Rowan University, Glassboro, NJ, United States of America.
| | - Tina Gremore
- Department of Psychology, College of Science and Mathematics, Rowan University, Glassboro, NJ, United States of America.
| | - Allie Frear
- Department of Medicine, Division of Pulmonary & Critical Care Medicine and the Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC, United States of America.
| | - Anna Ungar
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of Washington, Seattle, WA, United States of America.
| | - Jeffrey McKeehan
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of Colorado, Denver, CO, United States of America.
| | - Brittany McDowell
- Department of Medicine, Division of Pulmonary & Critical Care Medicine and the Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC, United States of America.
| | - Hannah McDaniel
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of Colorado, Denver, CO, United States of America.
| | - Marc Moss
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of Colorado, Denver, CO, United States of America.
| | - Catherine L Hough
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of Washington, Seattle, WA, United States of America.
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21
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Yao HM, Xiao RS, Cao PL, Wang XL, Zuo W, Zhang W. Risk factors for depression in patients with chronic obstructive pulmonary disease. World J Psychiatry 2020; 10:59-70. [PMID: 32399399 PMCID: PMC7203084 DOI: 10.5498/wjp.v10.i4.59] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/26/2020] [Accepted: 03/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prevalence of depression in patients with chronic obstructive pulmonary disease (COPD) ranges from 10% to 42%, but the diagnosis of depression in patients with COPD is often unrecognized and untreated. Unrecognized depression has major implications for compliance with medical treatment, prolonged lengths of stay, increased frequency of hospital admissions, and increased consultations with primary care physicians. Many studies have attempted to identify risk factors for progression, prognosis and response to therapy in patients with depression. However, few studies have examined the risk factors for depression in patients with COPD, and some results remain controversial. AIM To identify the potential risk factors to define patients with COPD who are at "high risk" of depression. METHODS The clinical data of 293 patients with COPD were reviewed from January 2017 to December 2018. The correlations between demographics, clinical characteristics and depression were analyzed. The risk factors for depression in patients with COPD were identified by multivariate logistic regression analysis. The cutoff value, sensitivity and specificity of the independent correlation factors were calculated with a receiver operating characteristic curve. RESULTS Of the 293 patients included, 65 (22.18%) individuals were identified to have depression. Significant differences were detected between patients with and without depression in terms of body mass index (BMI), forced expiratory volume in 1 s (FEV1), and COPD assessment test (CAT) score (all P < 0.05). Low BMI, low FEV1, and high CAT were independent risk factors for depression in patients with COPD and the cutoff values of BMI, FEV1, and CAT scores were 21.373 kg/m2, 0.855 L and 12.5, respectively. CONCLUSION Low BMI, low FEV1, and high CAT score were identified as independent risk factors for depression in patients with COPD.
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Affiliation(s)
- Hui-Ming Yao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Ren-Sen Xiao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Ping-Liang Cao
- Second Department of Cardiovascular Medicine, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Xiao-Lei Wang
- Second Department of Cardiovascular Medicine, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Wei Zuo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Wei Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Mercier LJ, Fung TS, Harris AD, Dukelow SP, Debert CT. Improving symptom burden in adults with persistent post-concussive symptoms: a randomized aerobic exercise trial protocol. BMC Neurol 2020; 20:46. [PMID: 32024486 PMCID: PMC7003424 DOI: 10.1186/s12883-020-1622-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 01/21/2020] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Persistent post-concussive symptoms (PPCS) affect up to 30% of individuals following mild traumatic brain injury. PPCS frequently includes exercise intolerance. Sub-symptom threshold aerobic exercise has been proposed as a treatment option for symptom burden and exercise intolerance in this population. The primary aim of this study is to evaluate whether a progressive, sub-symptom threshold aerobic exercise program can alleviate symptom burden in adults with PPCS. METHODS Fifty-six adults (18-65) with PPCS (>3mos-5 yrs) will be randomized into two groups: an immediate start 12-week aerobic exercise protocol (AEP) or delayed start 6-week placebo-like stretching protocol (SP), followed by AEP. Aerobic or stretching activities will be completed 5x/week for 30 mins during the intervention. Online daily activity logs will be submitted. Exercise prescriptions for the AEP will be 70-80% of heart rate at the point of symptom exacerbation achieved on a treadmill test with heart rate monitoring. Exercise prescription will be updated every 3-weeks with a repeat treadmill test. The Rivermead Post-concussion Symptom Questionnaire will be the primary outcome measure at 6 and 12-weeks of intervention. Secondary outcomes include assessments of specific symptoms (headache, quality of life, mood, anxiety, fatigue, dizziness, sleep parameters, daytime sleepiness) in addition to blood biomarkers and magnetic resonance imaging and spectroscopy data for quantification of brain metabolites including γ-aminobutyric acid (GABA), glutathione, glutamate and N-acetyl aspartate (NAA) all measured at 6 and 12-weeks of intervention. DISCUSSION This trial will evaluate the use of aerobic exercise as an intervention for adults with PPCS, thus expanding our knowledge of this treatment option previously studied predominantly for adolescent sport-related concussion. TRIAL REGISTRATION ClinicalTrials.gov - NCT03895450 (registered 2019-Feb-11).
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Affiliation(s)
- Leah J Mercier
- Department of Clinical Neurosciences, Division of Physical Medicine and Rehabilitation, University of Calgary, Calgary, AB, Canada.
| | - Tak S Fung
- Information Technologies, University of Calgary, Calgary, AB, Canada
| | - Ashley D Harris
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Division of Physical Medicine and Rehabilitation, University of Calgary, Calgary, AB, Canada
| | - Chantel T Debert
- Department of Clinical Neurosciences, Division of Physical Medicine and Rehabilitation, University of Calgary, Calgary, AB, Canada
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Aslan J, Cova F, Saldivia S, Bustos C, Inostroza C, Rincón P, Ortiz C, Bühring V. Psychometric Properties of the Patient Health Questionnaire-9 in Elderly Chilean Primary Care Users. Front Psychiatry 2020; 11:555011. [PMID: 33312135 PMCID: PMC7704434 DOI: 10.3389/fpsyt.2020.555011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background: This study aimed to assess the measurement properties (reliability, factor structure, and criterion validity) of the Patient Health Questionnaire (PHQ-9) as an instrument for screening major depressive disorder (MDD) in elderly primary care users in Chile. Method: About 582 participants aged between 65 and 80 years were enrolled from primary care centers. They completed the Composite International Diagnostic Interview (CIDI), a survey with sociodemographic characteristics and the PHQ-9. Results: The PHQ-9 revealed an acceptable internal consistency (ω = 0.79 [95% CI: 0.75-0.80] and α = 0.78 [95% CI: 0.75-0.81]); confirmatory factor analysis demonstrated a good fit for both 1- and 2-factor solutions. The chi-square difference test (χ2 = 0.61, gl = 1, p = 0.43) and correlation between the somatic and the cognitive-effective latent factors were very high (r = 0.97, p < 0.001), indicating that the 1 factor model was more parsimonious. Utilizing the CIDI as the gold standard, the area under the curve (AUC) was 0.88 (SE = 0.04, 95% CI: 0.84-0.90). The optimal cut-off score of ≥ 6 yielded good sensitivity and specificity for detecting MDD (0.95 and 0.76, respectively). However, considering the clinical utility index, the cut-off score of ≥9 proved to be a more effective marker for discarding cases of MDD. Conclusion: The PHQ-9 has adequate psychometric properties for elderly primary care users. In clinical settings, it showed its greatest utility in ruling out the presence of an MDD, however, its clinical value for identifying possible cases of MDD is limited. In cases above the cut-off point, it is recommended to perform a more thorough evaluation.
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Affiliation(s)
- Joseph Aslan
- Doctoral Program in Psychology, Universidad de Concepción, Concepción, Chile
| | - Félix Cova
- Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
| | - Sandra Saldivia
- Department of Psychiatry and Mental Health, Faculty of Medicine, Universidad de Concepción, Concepción, Chile
| | - Claudio Bustos
- Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
| | - Carolina Inostroza
- Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
| | - Paulina Rincón
- Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
| | - Camila Ortiz
- Master Program in Politics and Government, Universidad de Concepción, Concepción, Chile
| | - Vasily Bühring
- Master Program in Psychology, Universidad de Concepción, Concepción, Chile
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Chavanon ML, Meyer T, Belnap BH, Huang Y, Abebe KZ, Rollman BL, Herrmann-Lingen C. Emotion regulation in patients with heart failure: Its relationship with depressive symptoms and rehospitalization. J Psychosom Res 2019; 125:109811. [PMID: 31450124 PMCID: PMC6752733 DOI: 10.1016/j.jpsychores.2019.109811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the role of emotion regulation and its relationship to mental and physical health in patients with heart failure (HF). METHODS Patients hospitalized with HF were screened for depressive symptoms with the two-item Patient Health Questionnaire (PHQ-2) and classified as screen-positive if endorsing ≥1 item and otherwise as screen-negative. One month after hospital discharge, the Emotion Regulation Questionnaire (ERQ) was administered to assess suppression and reappraisal as emotion regulation strategies. In all participants who completed the ERQ (N = 394), all-cause rehospitalization and depressive symptoms using the PHQ-9 were assessed at 1-, 3-, and 6-months after hospital discharge. RESULTS Overall, PHQ-9 scores decreased by 6-months (-0.13 points/month, p = .003), and although suppression showed a small association with depression, neither strategy modulated the slope of the decline in depressive symptoms. Multivariable-adjusted Cox models showed that reappraisal and suppression were not related to all-cause rehospitalization in the entire cohort. However, increasing reappraisal reduced rehospitalization risk by 24% for screen-positive patients (N = 311, HR = 0.76, p = .02), but increased it by 94% in screen-negative patients (N = 83, HR = 1.94, p = .009). CONCLUSION Suppression and reappraisal showed specific and divergent associations in patients with HF: Suppression may relate to depressive symptoms. Reappraisal was associated with rehospitalization, but differently for patients with a positive vs. negative depression screen. Further studies are needed to examine whether emotion-regulation skill training can improve mental and physical health in depressed patients with HF or ameliorate depression in those at-risk.
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Affiliation(s)
- Mira-Lynn Chavanon
- Philipps-Universität Marburg, Department of Psychology, Marburg, Germany; Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany; German Center for Cardiovascular Research, Göttingen, Germany
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany; German Center for Cardiovascular Research, Göttingen, Germany
| | - Birgit Herbeck Belnap
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany; Center for Behavioral Health and Smart Technology, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yan Huang
- Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kaleab Z Abebe
- Center for Clinical Trials and Data Coordination, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Bruce L Rollman
- Center for Behavioral Health and Smart Technology, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany; German Center for Cardiovascular Research, Göttingen, Germany.
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Russoniello CV, Fish MT, O'Brien K. The Efficacy of Playing Videogames Compared with Antidepressants in Reducing Treatment-Resistant Symptoms of Depression. Games Health J 2019; 8:332-338. [PMID: 31216188 DOI: 10.1089/g4h.2019.0032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: The goal of this month-long controlled study was to compare the efficacy of a second antidepressant (sAD) medication with a prescribed regimen of Plants vs. Zombies™ (PvZ), a casual videogame, in reducing treatment-resistant depression symptoms (TRDS) and improving heart rate variability (HRV). Materials and Methods: Approximately ∼8 weeks after beginning antidepressant therapy, participants returned to psychiatrists for evaluation and complained of TRDS. The psychiatrist gave them a choice of self-selecting a sAD medication or playing a prescribed regimen of PvZ as part of a research study. Those who agreed were referred to researchers who then screened them for major depression, the criteria for inclusion. PvZ was prescribed four times per week for 30-45 minutes over 4 weeks. Self-reported data were collected at four different times utilizing the Patient Health Questionnaire-9. HRV, an indicator of autonomic nervous system (ANS) functioning, was also recorded each time. Results: The sAD group's TRDS significantly improved. Remarkably, the PvZ group's TRDS improved significantly beyond the control group at all measurement times except for time 1 or baseline. In addition, a single 30-minute session of playing PvZ was significantly more effective in acutely reducing TRDS when compared with the sAD group that surfed the NIHM website on depression. Changes in HRV parameters indicated increased parasympathetic engagement and ANS balance in the PvZ group compared with the sAD group. Discussion: The findings illustrate the potential of PvZ as an acute and chronic intervention for reducing TRDS. Health care practitioners such as physicians and recreational therapists can consider recommending a regimen of prescribed PvZ play as a method to ameliorate symptoms of depression for those clients who self-select this option. Finally, a psychophysiological method for measuring the efficacy of videogames in reducing TRDS and a means to quantify ANS changes during gameplay are presented.
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Affiliation(s)
- Carmen V Russoniello
- Department of Recreation Sciences, Center for Applied Psychophysiology, East Carolina University, Greenville, North Carolina
| | - Matthew T Fish
- Department of Recreation Sciences, Center for Applied Psychophysiology, East Carolina University, Greenville, North Carolina
| | - Kevin O'Brien
- Department of Biostatistics, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina
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Stilling JM, Duszynski CC, Oni I, Paxman E, Dunn JF, Debert CT. Using Functional Near-Infrared Spectroscopy to Study the Effect of Repetitive Transcranial Magnetic Stimulation in Concussion: A Two-Patient Case Study. Front Neurol 2019; 10:476. [PMID: 31139136 PMCID: PMC6518445 DOI: 10.3389/fneur.2019.00476] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/23/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Approximately 25% of concussion patients experience persistent post-concussion symptoms (PPCS). Repetitive transcranial magnetic stimulation (rTMS) has been explored as a treatment, and functional near-infrared spectroscopy (fNIRS) may be a cost-effective method for assessing response. Objectives: Evaluate rTMS for the treatment of PPCS and introduce fNIRS as a method of assessing treatment response. Methods: Design: Two-patient case study. Setting: Calgary Brain Injury Program. Participants: 47 and 49 years. male, with PPCS for 1-2 years (headache, cognitive difficulties, nausea, visual difficulties, irritability, anxiety, poor mood, sleep, and fatigue). Intervention: 10 sessions of rTMS therapy to the left dorsolateral prefrontal cortex (DLPFC), at 10 Hz (600 pulses) and 70% of resting motor threshold amplitude. Participants completed an 8-week headache diary and a battery of clinical questionnaires prior to each fNIRS session. fNIRS: Hemodynamic changes were recorded over the frontoparietal cortex during rest, finger tapping, and a graded working memory test. fNIRS was completed pre-rTMS, following rTMS (day 14), and at 1-month post-rTMS (day 45). For comparison, two healthy, sex-matched controls were scanned with fNIRS once daily for five consecutive days. Results: Clinical scores improved (headache severity, MoCA, HIT-6, PHQ-9, GAD-7, QOLIBRI, RPSQ, BCPSI) or remained stable (PCL-5, headache frequency) post-rTMS, for both participants. Participant 1 reported moderate symptom burden, and a fNIRS task-evoked hemodynamic response showing increased oxyhemoglobin was observed following a working memory task, as expected. Participant 2 exhibited a high symptom burden pre-treatment, with abnormal fNIRS hemodynamic response where oxyhemoglobin declined, in response to task. One month following rTMS treatment, participant 2 had a normal fNIRS hemodynamic response to task, corresponding to significant improvements in clinical outcomes. Conclusion: This case study suggests fNIRS may be sensitive to physiological changes that accompany rTMS treatment. Further studies exploring fNIRS as a cost-effective technology for monitoring rTMS response in patients with PPCS are suggested.
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Affiliation(s)
- Joan M. Stilling
- Hotchkiss Brain Institute, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Chris C. Duszynski
- Hotchkiss Brain Institute, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ibukunoluwa Oni
- Hotchkiss Brain Institute, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Eric Paxman
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jeff F. Dunn
- Hotchkiss Brain Institute, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Chantel T. Debert
- Hotchkiss Brain Institute, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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von Siemens SM, Jörres RA, Behr J, Alter P, Lutter J, Lucke T, Söhler S, Welte T, Watz H, Vogelmeier CF, Trudzinski F, Rief W, Herbig B, Kahnert K. Effect of COPD severity and comorbidities on the result of the PHQ-9 tool for the diagnosis of depression: results from the COSYCONET cohort study. Respir Res 2019; 20:30. [PMID: 30744630 PMCID: PMC6371561 DOI: 10.1186/s12931-019-0997-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/04/2019] [Indexed: 01/01/2023] Open
Abstract
The diagnosis of depression, a frequent comorbidity of chronic obstructive pulmonary disease (COPD), is often supported by questionnaires, such as the Patient Health Questionnaire 9 (PHQ-9). It is unknown to which extent its single questions are affected by the clinical characteristics of COPD patients. We addressed this question in 2255 GOLD grade 1–4 patients from the COSYCONET (COPD and Systemic Consequences - Comorbidities Network) COPD cohort. The dependence on COPD severity was assessed using symptoms, exacerbation risk (GOLD A-D; modified Medical Research Council dyspnoea scale (mMRC)), and frequent comorbidities as predictors of PHQ-9 results, while including age, gender, body mass index (BMI) and smoking habits as covariates. Symptoms and exacerbation risk were associated with depression in an additive manner, with mean elevations in the PHQ-9 sum score by 2.75 and 1.44 points, respectively. Asthma, sleep apnoea, gastrointestinal disorders, osteoporosis and arthritis were linked to increases by 0.8 to 1.3 points. Overall, the COPD characteristics contributed to the mean PHQ-9 score by increases from 4.5 or 5.2 to 6.3 points, respectively, when either taking GOLD A as reference or the absence of comorbidities. This finding was independent of the diagnosis of mental disorder or the intake of antidepressants. The presence of COPD led to an increase in the proportion of scores indicating depression from 12 to 22%. Single item analysis revealed homogenous effects regarding GOLD groups, but heterogeneous effects regarding GOLD grades. These findings indicate specific effects of COPD severity on the PHQ-9 depression score, especially symptoms and exacerbation risk, explaining the high prevalence of depression in COPD. Alternative explanations like an overlap of COPD severity and PHQ-9 items are discussed. Of note, we also found COPD treatment effects on depression scores.
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Affiliation(s)
- Sarah Marietta von Siemens
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, University of Munich (LMU), Ziemssenstr. 1, 80336, Munich, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany, Member of the German Center for Lung Research (DZL), Baldingerstrasse, 35043, Marburg, Germany
| | - Johanna Lutter
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Ingolstädter Landstr. 1, 85764, Munich, Germany
| | - Tanja Lucke
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany
| | - Sandra Söhler
- ASCONET Study Coordination Office, University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Tobias Welte
- Department of Pneumology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Woehrendamm 80, 22927, Grosshansdorf, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany, Member of the German Center for Lung Research (DZL), Baldingerstrasse, 35043, Marburg, Germany
| | - Franziska Trudzinski
- Department of Internal Medicine V - Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Kirrberger Straße 1, 66424, Homburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Germany, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Britta Herbig
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany
| | - Kathrin Kahnert
- Department of Internal Medicine V, University of Munich (LMU), Ziemssenstr. 1, 80336, Munich, Germany.
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Lauria-Horner B, Beaulieu T, Knaak S, Weinerman R, Campbell H, Patten S. Controlled trial of the impact of a BC adult mental health practice support program (AMHPSP) on primary health care professionals' management of depression. BMC FAMILY PRACTICE 2018; 19:183. [PMID: 30486799 PMCID: PMC6262957 DOI: 10.1186/s12875-018-0862-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 11/05/2018] [Indexed: 01/15/2023]
Abstract
Background Depression affects over 400 million people globally. The majority are seen in primary care. Barriers in providing adequate care are not solely related to physicians’ knowledge/skills deficits, but also time constraints, lack of confidence/avoidance, which need to be addressed in mental health-care redesign. We hypothesized that family physician (FP) training in the Adult Mental Health Practice Support Program (AMHPSP) would lead to greater improvements in patient depressive symptom ratings (a priori primary outcome) compared to treatment as usual. Methods From October 2013 to May 2015, in a controlled trial 77 FP practices were stratified on the total number of physicians/practice as well as urban/rural setting, and randomized to the British Columbia AMHPSP⎯a multi-component contact-based training to enhance FPs’ comfort/skills in treating mild-moderate depression (intervention), or no training (control) by an investigator not operationally involved in the trial. FPs with a valid license to practice in NS were eligible. FPs from both groups were asked to identify 3–4 consecutive patients > 18 years old, diagnosis of depression, Patient Health Questionnaire (PHQ-9) score ≥ 10, able to read English, intact cognitive functioning. Exclusion criteria: antidepressants within 5 weeks and psychotherapy within 3 months of enrollment, and clinically judged urgent/emergent medical/psychiatric condition. Patients were assigned to the same arm as their physician. Thirty-six practices recruited patients (intervention n = 23; control n = 13). The study was prematurely terminated at 6 months of enrollment start-date due to concomitant primary health-care transformation by health-system leaders which resulted in increased in-office demands, and recruitment failure. We used the PHQ-9 to assess between-group differences at baseline, 1, 2, 3, and 6 months follow-up. Outcome collectors and assessors were blind to group assignment. Results One hundred-and-twenty-nine patients (intervention n = 72; control n = 57) were analysed. A significant improvement in depression scores among intervention group patients emerged between 3 and 6 months, time by treatment interaction, likelihood ratio test (LR) chi2(3) = 7.96, p = .047. Conclusions This novel skill-based program shows promise in translating increased FP comfort and skills managing depressed patients into improved patient clinical outcomes⎯even in absence of mental health specialists availability. Trial registration #NCT01975948. Electronic supplementary material The online version of this article (10.1186/s12875-018-0862-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Tara Beaulieu
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephanie Knaak
- Opening Minds Anti-Stigma Initiative, Mental Health Commission of Canada, Ottawa, ON, Canada.,University of Calgary, Calgary, Alberta, Canada
| | - Rivian Weinerman
- University of Bristish Columbia, Medical Staff Honorary Status Island Health Authority, Victoria, Canada
| | - Helen Campbell
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
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Rodríguez-Rabassa M, López P, Rodríguez-Santiago RE, Cases A, Felici M, Sánchez R, Yamamura Y, Rivera-Amill V. Cigarette Smoking Modulation of Saliva Microbial Composition and Cytokine Levels. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2479. [PMID: 30405010 PMCID: PMC6266915 DOI: 10.3390/ijerph15112479] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/26/2018] [Accepted: 11/03/2018] [Indexed: 12/18/2022]
Abstract
Tobacco use has been implicated as an immunomodulator in the oral cavity and contributes to the development of oral cancer. In the present study, we investigated the effects of cigarette smoking on bacterial diversity and host responses compared to healthy nonsmoking controls. Saliva samples were collected from eighteen smokers and sixteen nonsmoking individuals by passive drool. The 16S rRNA gene was used to characterize the salivary microbiome by using the Illumina MiSeq platform. Cytokine and chemokine expression analyses were performed to evaluate the host response. Significant differences in cytokine and chemokine expression levels of MDC, IL-10, IL-5, IL-2, IL-4, IL-7, adrenocorticotropic hormone (ACTH), insulin, and leptin were observed between smokers and nonsmokers. Taxonomic analyses revealed differences between the two groups, and some bacterial genera associated with the smokers group had correlations with hormones and cytokines identified as statistically different between smokers and nonsmokers. These factors have been associated with inflammation and carcinogenesis in the oral cavity. The data obtained may aid in the identification of the interactions between the salivary microbiome, host inflammatory responses, and metabolism in smokers.
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Affiliation(s)
- Mary Rodríguez-Rabassa
- AIDS Research Infrastructure Program, Ponce Research Institute, Ponce Health Sciences University, 395 Dr. Luis F. Sala Street, Ponce, PR 00716-2348, USA.
- Clinical Psychology Program, School of Behavioral & Brain Science, Ponce Health Sciences University, Ponce, PR 00716-2348, USA.
| | - Pablo López
- AIDS Research Infrastructure Program, Ponce Research Institute, Ponce Health Sciences University, 395 Dr. Luis F. Sala Street, Ponce, PR 00716-2348, USA.
| | - Ronald E Rodríguez-Santiago
- AIDS Research Infrastructure Program, Ponce Research Institute, Ponce Health Sciences University, 395 Dr. Luis F. Sala Street, Ponce, PR 00716-2348, USA.
| | - Antonio Cases
- Tobacco Control and Oral Health Division, Department of Health, Commonwealth of Puerto Rico, San Juan, PR 00716-2348, USA.
| | - Marcos Felici
- Tobacco Control and Oral Health Division, Department of Health, Commonwealth of Puerto Rico, San Juan, PR 00716-2348, USA.
| | - Raphael Sánchez
- AIDS Research Infrastructure Program, Ponce Research Institute, Ponce Health Sciences University, 395 Dr. Luis F. Sala Street, Ponce, PR 00716-2348, USA.
| | - Yasuhiro Yamamura
- AIDS Research Infrastructure Program, Ponce Research Institute, Ponce Health Sciences University, 395 Dr. Luis F. Sala Street, Ponce, PR 00716-2348, USA.
| | - Vanessa Rivera-Amill
- AIDS Research Infrastructure Program, Ponce Research Institute, Ponce Health Sciences University, 395 Dr. Luis F. Sala Street, Ponce, PR 00716-2348, USA.
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Rief W, Burton C, Frostholm L, Henningsen P, Kleinstäuber M, Kop WJ, Löwe B, Martin A, Malt U, Rosmalen J, Schröder A, Shedden-Mora M, Toussaint A, van der Feltz-Cornelis C. Core Outcome Domains for Clinical Trials on Somatic Symptom Disorder, Bodily Distress Disorder, and Functional Somatic Syndromes: European Network on Somatic Symptom Disorders Recommendations. Psychosom Med 2018; 79:1008-1015. [PMID: 28691994 DOI: 10.1097/psy.0000000000000502] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The harmonization of core outcome domains in clinical trials facilitates comparison and pooling of data, and simplifies the preparation and review of research projects and comparison of risks and benefits of treatments. Therefore, we provide recommendations for the core outcome domains that should be considered in clinical trials on the efficacy and effectiveness of interventions for somatic symptom disorder, bodily distress disorder, and functional somatic syndromes. METHODS The European Network on Somatic Symptom Disorders group of more than 20 experts in the field met twice in Hamburg to discuss issues of assessment and intervention research in somatic symptom disorder, bodily distress disorder, and functional somatic syndromes. The consensus meetings identified core outcome domains that should be considered in clinical trials evaluating treatments for somatic symptom disorder and associated functional somatic syndromes. RESULTS The following core domains should be considered when defining ascertainment methods in clinical trials: a) classification of somatic symptom disorder/bodily distress disorder, associated functional somatic syndromes, and comorbid mental disorders (using structured clinical interviews), duration of symptoms, medical morbidity, and prior treatments; b) location, intensity, and interference of somatic symptoms; c) associated psychobehavioral features and biological markers; d) illness consequences (quality of life, disability, health care utilization, health care costs; e) global improvement and treatment satisfaction; and f) unwanted negative effects. CONCLUSIONS The proposed criteria are intended to improve synergies of clinical trials and to facilitate decision making when comparing different treatment approaches. These recommendations should not result in inflexible guidelines, but increase consistency across investigations in this field.
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Affiliation(s)
- Winfried Rief
- From the Department of Psychology (Rief), Philipps University, Marburg, Germany; University of Aberdeen (Burton), Aberdeen, UK; University of Aarhus (Frostholm, Schröder), Aarhus, Denmark; Technical University of Munich (Henningsen), München, Germany; University of Marburg (Kleinstäuber), Marburg, Germany; Tilburg University (Kop, van der Feltz-Cornelis), Tilburg, the Netherlands; University Medical Center, Hamburg-Eppendorf (Löwe, Shedden-Mora, Toussaint), Hamburg, Germany; University of Wuppertal (Martin), Wuppertal, Germany; University of Oslo (Malt), Oslo, Norway; and University of Groningen (Rosmalen), Groningen, the Netherlands
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Abstract
Avoidable disability associated with depression, anxiety, and impaired cognition among older adults is pervasive. Incentives for detection of mental disorders in late life include increased reimbursement, reduced cost, and less burden for patients and families. However, screening not aligned with diagnosis, intervention, and outcome assessment has questionable utility. The link between screening, treatment, and outcomes is well established for depression, less so for anxiety and impaired cognition. This article details the use of common instruments to screen and assess depression, anxiety, and cognitive impairment.
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Affiliation(s)
- Gary J Kennedy
- Division of Geriatric Psychiatry, Department of Psychiatry and Behavioral Science, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
| | - Mirnova E Ceïde
- Division of Geriatric Psychiatry, Department of Psychiatry and Behavioral Science, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA; Division of Geriatric Medicine, Department of Psychiatry and Behavioral Science, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA; Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
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Gierk B, Kohlmann S, Hagemann-Goebel M, Löwe B, Nestoriuc Y. Monitoring somatic symptoms in patients with mental disorders: Sensitivity to change and minimal clinically important difference of the Somatic Symptom Scale - 8 (SSS-8). Gen Hosp Psychiatry 2017; 48:51-55. [PMID: 28917395 DOI: 10.1016/j.genhosppsych.2017.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/14/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The SSS-8 is a brief questionnaire for the assessment of somatic symptom burden. This study examines its sensitivity to change and the minimal clinically important difference (MCID) in patients with mental disorders. METHOD 55 outpatients with mental disorders completed the SSS-8 and measures of anxiety, depression, and disability before and after receiving treatment. Effect sizes and correlations between the change scores were calculated. The MCID was estimated using a one standard error of measurement threshold and the change in disability as an external criterion. RESULTS There was a medium decline in somatic symptom burden for the complete sample (n=55, dz=0.53) and a large decline in a subgroup with very high somatic symptom burden at baseline (n=11, dz=0.94). Decreases in somatic symptom burden were associated with decreases in anxiety (r=0.68, p<0.001), depression (r=0.62, p<0.001) and disability (r=0.51, p<0.001). The MCID was estimated as a 3-point decrease. CONCLUSION The SSS-8 is sensitive to change. A 3-point decrease reflects a clinically important improvement. Due to its brevity and sound psychometric properties, the SSS-8 is useful for monitoring somatic symptom burden.
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Affiliation(s)
- Benjamin Gierk
- Department of Psychiatry and Psychotherapy, Asklepios Clinic North, Hamburg, Germany.
| | - Sebastian Kohlmann
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Schön Clinic Hamburg Eilbek, Hamburg, Germany
| | | | - Bernd Löwe
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Schön Clinic Hamburg Eilbek, Hamburg, Germany
| | - Yvonne Nestoriuc
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Schön Clinic Hamburg Eilbek, Hamburg, Germany
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Evaluation of a Pilot Implementation to Integrate Alcohol-Related Care within Primary Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14091030. [PMID: 28885557 PMCID: PMC5615567 DOI: 10.3390/ijerph14091030] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/22/2017] [Accepted: 08/30/2017] [Indexed: 02/08/2023]
Abstract
Alcohol use is a major cause of disability and death worldwide. To improve prevention and treatment addressing unhealthy alcohol use, experts recommend that alcohol-related care be integrated into primary care (PC). However, few healthcare systems do so. To address this gap, implementation researchers and clinical leaders at Kaiser Permanente Washington partnered to design a high-quality Program of Sustained Patient-centered Alcohol-related Care (SPARC). Here, we describe the SPARC pilot implementation, evaluate its effectiveness within three large pilot sites, and describe the qualitative findings on barriers and facilitators. Across the three sites (N = 74,225 PC patients), alcohol screening increased from 8.9% of patients pre-implementation to 62% post-implementation (p < 0.0001), with a corresponding increase in assessment for alcohol use disorders (AUD) from 1.2 to 75 patients per 10,000 seen (p < 0.0001). Increases were sustained over a year later, with screening at 84.5% and an assessment rate of 81 patients per 10,000 seen across all sites. In addition, there was a 50% increase in the number of new AUD diagnoses (p = 0.0002), and a non-statistically significant 54% increase in treatment within 14 days of new diagnoses (p = 0.083). The pilot informed an ongoing stepped-wedge trial in the remaining 22 PC sites.
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Zwerenz R, Becker J, Gerzymisch K, Siepmann M, Holme M, Kiwus U, Spörl-Dönch S, Beutel ME. Evaluation of a transdiagnostic psychodynamic online intervention to support return to work: A randomized controlled trial. PLoS One 2017; 12:e0176513. [PMID: 28481893 PMCID: PMC5421767 DOI: 10.1371/journal.pone.0176513] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 04/08/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives Given their flexibility, online interventions may be useful as an outpatient treatment option to support vocational reintegration after inpatient rehabilitation. To that purpose we devised a transdiagnostic psychodynamic online intervention to facilitate return to work, focusing on interpersonal conflicts at the workplace often responsible for work-related stress. Research design and methods In a randomized controlled trial, we included employed patients from cardiologic, psychosomatic and orthopedic rehabilitation with work-related stress or need for support at intake to inpatient rehabilitation after they had given written consent to take part in the study. Following discharge, maladaptive interpersonal interactions at the workplace were identified via weekly blogs and processed by written therapeutic comments over 12 weeks in the intervention group (IG). The control group (CG) received an augmented treatment as usual condition. The main outcome, subjective prognosis of gainful employment (SPE), and secondary outcomes (psychological complaints) were assessed by means of online questionnaires before, at the end of aftercare (3 months) and at follow-up (12 months). We used ITT analyses controlling for baseline scores and medical group. Results N = 319 patients were enrolled into IG and N = 345 into CG. 77% of the IG logged in to the webpage (CG 74%) and 65% of the IG wrote blogs. Compared to the CG, the IG reported a significantly more positive SPE at follow-up. Measures of depression, anxiety and psychosocial stressors decreased from baseline to follow-up, whereas the corresponding scores increased in the CG. Correspondingly, somatization and psychological quality of life improved in the IG. Conclusions Psychodynamic online aftercare was effective to enhance subjective prognosis of future employment and improved psychological complaints across a variety of chronic physical and psychological conditions, albeit with small effect sizes.
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Affiliation(s)
- Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jan Becker
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Katharina Gerzymisch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Martin Siepmann
- University Medical Center of the Carl Gustav Carus Technical University, Department of Psychosomatic Medicine and Psychotherapy, Dresden, Germany
| | - Martin Holme
- German Statutory Pension Insurance Rehabilitation Center for Orthopedic Diseases, Clinic Weser, Bad Pyrmont, Germany
| | - Ulrich Kiwus
- German Statutory Pension Insurance Rehabilitation Center for Cardiovascular Diseases, Clinic Wetterau, Bad Nauheim, Germany
| | - Sieglinde Spörl-Dönch
- Clinic for Prevention and Rehabilitation of Cardiovascular Diseases 'Haus Franken' GmbH, Bad Neustadt/ Saale, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Taylor SF, Bhati MT, Dubin MJ, Hawkins JM, Lisanby SH, Morales O, Reti IM, Sampson S, Short EB, Spino C, Watcharotone K, Wright J. A naturalistic, multi-site study of repetitive transcranial magnetic stimulation therapy for depression. J Affect Disord 2017; 208:284-290. [PMID: 27794252 PMCID: PMC5550826 DOI: 10.1016/j.jad.2016.08.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 07/21/2016] [Accepted: 08/24/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) was approved in 2008 in the United States, and there are relatively few studies describing its use in regular clinical practice since approval. METHODS From April 2011 to October 2014, ten sites within the National Network of Depression Centers (NNDC) provided data on 62 evaluable patients with a depressive episode. Treatment was determined naturalistically. Response was assessed by the Quick Inventory of Depressive Symptoms, Self-Report (QIDS-SR) as the primary outcome, and the Patient Health Questionnaire-9 (PHQ-9) and the clinician-rated Clinical Global Impression (CGI) as secondary depression measures. RESULTS Enrolled patients exhibited significant treatment resistance, with 70.2% reporting more than 4 prior depressive episodes. Most patients received treatment with standard parameters (10Hz over the left dorsolateral prefrontal cortex), although 22.6% of the patients received 1 or 5Hz stimulation at some point. Over 6 weeks of treatment, response and remission rates were 29.4% and 5.9%, respectively, for the QIDS-SR; 39.2% and 15.7%, respectively, for the PHQ-9; and 50.9% and 17.9%, respectively, for the CGI. Moderator analyses revealed no effect of prior depressive episodes, history of ECT or gender, although early life stress predicted a better response to rTMS therapy. LIMITATIONS The study was an open-label, registry trial, with relatively coarse clinical data, reflecting practice only in academic, depression-specialty centers. Because of the relatively small size and heterogeneity of the sample, type 2 errors are possible and positive findings are in need of replication. CONCLUSION rTMS demonstrates effectiveness in clinical practice within the NNDC, although remission rates appear slightly lower in comparison with other recent naturalistic studies.
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Affiliation(s)
- Stephan F. Taylor
- University of Michigan, Ann Arbor, Michigan,To whom correspondence should be addressed: Department of Psychiatry, Rachel Upjohn Building 4250 Plymouth Rd, Ann Arbor MI 48109-2700, Phone: (734) 936-4955, Fax: (734) 936-7868,
| | | | | | | | - Sarah H. Lisanby
- Duke University, Durham, North Carolina and National Institute of Mental Health
| | - Oscar Morales
- McLean Hospital, Harvard University, Cambridge, Massachusetts
| | | | | | - E. Baron Short
- Medical University of South Carolina, Charleston, South Carolina
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Curtis JR, Treece PD, Nielsen EL, Gold J, Ciechanowski PS, Shannon SE, Khandelwal N, Young JP, Engelberg RA. Randomized Trial of Communication Facilitators to Reduce Family Distress and Intensity of End-of-Life Care. Am J Respir Crit Care Med 2016; 193:154-62. [PMID: 26378963 DOI: 10.1164/rccm.201505-0900oc] [Citation(s) in RCA: 270] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
RATIONALE Communication with family of critically ill patients is often poor and associated with family distress. OBJECTIVES To determine if an intensive care unit (ICU) communication facilitator reduces family distress and intensity of end-of-life care. METHODS We conducted a randomized trial at two hospitals. Eligible patients had a predicted mortality greater than or equal to 30% and a surrogate decision maker. Facilitators supported communication between clinicians and families, adapted communication to family needs, and mediated conflict. MEASUREMENTS AND MAIN RESULTS Outcomes included depression, anxiety, and post-traumatic stress disorder (PTSD) among family 3 and 6 months after ICU and resource use. We identified 488 eligible patients and randomized 168. Of 352 eligible family members, 268 participated (76%). Family follow-up at 3 and 6 months ranged from 42 to 47%. The intervention was associated with decreased depressive symptoms at 6 months (P = 0.017), but there were no significant differences in psychological symptoms at 3 months or anxiety or PTSD at 6 months. The intervention was not associated with ICU mortality (25% control vs. 21% intervention; P = 0.615) but decreased ICU costs among all patients (per patient: $75,850 control, $51,060 intervention; P = 0.042) and particularly among decedents ($98,220 control, $22,690 intervention; P = 0.028). Among decedents, the intervention reduced ICU and hospital length of stay (28.5 vs. 7.7 d and 31.8 vs. 8.0 d, respectively; P < 0.001). CONCLUSIONS Communication facilitators may be associated with decreased family depressive symptoms at 6 months, but we found no significant difference at 3 months or in anxiety or PTSD. The intervention reduced costs and length of stay, especially among decedents. This is the first study to find a reduction in intensity of end-of-life care with similar or improved family distress. Clinical trial registered with www.clinicaltrials.gov (NCT 00720200).
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Affiliation(s)
- J Randall Curtis
- 1 Cambia Palliative Care Center of Excellence and Division of Pulmonary and Critical Care.,2 Department of Biobehavioral Nursing and Health Systems, School of Nursing
| | - Patsy D Treece
- 1 Cambia Palliative Care Center of Excellence and Division of Pulmonary and Critical Care
| | - Elizabeth L Nielsen
- 1 Cambia Palliative Care Center of Excellence and Division of Pulmonary and Critical Care
| | | | | | - Sarah E Shannon
- 2 Department of Biobehavioral Nursing and Health Systems, School of Nursing
| | - Nita Khandelwal
- 5 Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Jessica P Young
- 1 Cambia Palliative Care Center of Excellence and Division of Pulmonary and Critical Care
| | - Ruth A Engelberg
- 1 Cambia Palliative Care Center of Excellence and Division of Pulmonary and Critical Care
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Doyle C, Dunt D, Ames D, Fearn M, You E(C, Bhar S. Study protocol for a randomized controlled trial of telephone-delivered cognitive behavior therapy compared with befriending for treating depression and anxiety in older adults with COPD. Int J Chron Obstruct Pulmon Dis 2016; 11:327-34. [PMID: 26929616 PMCID: PMC4760208 DOI: 10.2147/copd.s100859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND COPD is an umbrella term to describe chronic lung diseases that cause limitations in lung airflow, including emphysema and chronic bronchitis. The prevalence of depression and anxiety in people with COPD is high, although these comorbidities are often undiagnosed, untreated, or undertreated. There is a need to identify efficacious treatments for depression and anxiety in people with COPD. Cognitive behavior therapy (CBT) for the treatment of anxiety and depression has a strong evidence base. There has been some success delivering this treatment over the telephone in limited studies. The aim of this study is to evaluate the efficacy of both telephone-administered CBT and befriending on outcomes for patients with diagnosed COPD who have at least mild levels of depression and/or anxiety. METHODS The protocol described in this paper is of a pragmatic randomized controlled trial comparing eight sessions of telephone CBT to an active social control, referred to as befriending. Primary outcome measures will include depression and anxiety symptoms, and secondary outcome measures will include quality of life, self-efficacy, and COPD symptom severity. Participants' satisfaction with the intervention and therapeutic alliance will also be assessed. Measures will be taken pre- and postdelivery of the intervention and again at 8 weeks following the intervention. CONCLUSION People with COPD often have limitations to their mobility because of their breathlessness. They are often already attending many medical appointments and could be reluctant to attend for face-to-face psychological treatment. The results of this study should identify the relative efficacy of CBT delivered over the telephone to this population, which, if successful, may be a cost-effective and more palatable alternative to face-to-face treatment of depression or anxiety for this population.
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Affiliation(s)
- Colleen Doyle
- Australian Catholic University, Melbourne, VIC, Australia
| | - David Dunt
- Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia
| | - David Ames
- National Ageing Research Institute, Melbourne, VIC, Australia
| | - Marcia Fearn
- National Ageing Research Institute, Melbourne, VIC, Australia
| | | | - Sunil Bhar
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
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Williams RT, Heinemann AW, Neumann HD, Fann JR, Forchheimer M, Richardson EJ, Bombardier CH. Evaluating the Psychometric Properties and Responsiveness to Change of 3 Depression Measures in a Sample of Persons With Traumatic Spinal Cord Injury and Major Depressive Disorder. Arch Phys Med Rehabil 2016; 97:929-37. [PMID: 26859610 DOI: 10.1016/j.apmr.2016.01.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 01/09/2016] [Accepted: 01/12/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To compare the measurement properties and responsiveness to change of the Patient Health Questionnaire-9 (PHQ-9), the Hopkins Symptom Checklist-20 (HSCL-20), and the Hamilton Depression Rating Scale (HAM-D) in people with spinal cord injury (SCI) diagnosed with major depressive disorder (MDD). DESIGN Secondary analysis of depression symptoms measured at 6 occasions over 12 weeks as part of a randomized controlled trial of venlafaxine XR for MDD in persons with SCI. SETTING Outpatient and community settings. PARTICIPANTS Individuals (N=133) consented and completed the drug trial. Eligibility criteria were age at least 18 years, traumatic SCI, and diagnosis of MDD. INTERVENTIONS Venlafaxine XR. MAIN OUTCOME MEASURES Patients completed the PHQ-9 and the HSCL-20 depression scales; clinical investigators completed the HAM-D and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) Dissociative Disorders, which was used as a diagnostic criterion measure. RESULTS All 3 instruments were improved with rating scale analysis. The HSCL-20 and the HAM-D contained items that misfit the underlying construct and that correlated weakly with the total scores. Removing these items improved the internal consistency, with floor effects increasing slightly. The HAM-D correlated most strongly with Structured Clinical Interview for DSM-IV Dissociative Disorders diagnoses. Improvement in depression was similar on all outcome measures in both treatment and control groups. CONCLUSIONS The psychometric properties of the revised depression instruments are more than adequate for routine use in adults with SCI and are responsive to clinical improvement. The PHQ-9 is the simplest instrument with measurement properties as good as or better than those of the other instruments and required the fewest modifications.
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Affiliation(s)
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Jesse R Fann
- University of Washington School of Medicine, Seattle, WA
| | | | - Elizabeth J Richardson
- Department of Physical Medicine and Rehabilitation, The University of Alabama at Birmingham, Birmingham, AL
| | - Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
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Psycholosocial factors associated with psychological insulin resistance in primary care patients in Hong Kong. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2015; 2:157-162. [PMID: 29159120 PMCID: PMC5685026 DOI: 10.1016/j.jcte.2015.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/21/2015] [Accepted: 10/23/2015] [Indexed: 11/22/2022]
Abstract
No relationship was found between depression and PIR. Prevalence of PIR was 47.2% in insulin-naïve patients and 8.7% in insulin users. PIR etiology is likely multifactorial in Hong Kong primary care population. PIR was associated with multiple social factors. Aim Patients with diabetes mellitus (DM) often delay the initiation of insulin treatment and titration due to psychological factors. This phenomenon is called psychological insulin resistance (PIR). The insulin treatment appraisal scale (ITAS) that was initially developed for Western populations has been translated and validated to measure PIR in Taiwanese populations (C-ITAS). This study aims to estimate the prevalence of PIR in primary care patients with DM in Hong Kong and to examine the relationship between PIR and psychosocial factors. Method 402 DM patients from a government-funded general outpatient clinic completed the C-ITAS and a health questionnaire (the Patient Health Questionnaire-9, PHQ-9). Patient demographics were recorded and associations among C-ITAS scores, PHQ-9 scores and demographic data were evaluated. Results There was no relationship between the presence of depression and PIR. Furthermore, the prevalence of PIR was 47.2% in insulin-naive patients but only 8.7% in current insulin users. Tools such as the C-ITAS may help clinicians understand the etiology of PIR, which this study suggests is likely the result of multiple risk factors. Factors associated with a lower prevalence of PIR included current insulin use, a family history of insulin use, a high education level, male sex, and having received counseling from a physician about insulin within the previous 6 months.
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40
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Fowler JC, Patriquin M, Madan A, Allen JG, Frueh BC, Oldham JM. Early identification of treatment non-response utilizing the Patient Health Questionnaire (PHQ-9). J Psychiatr Res 2015; 68:114-9. [PMID: 26228409 DOI: 10.1016/j.jpsychires.2015.06.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/19/2015] [Accepted: 06/20/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Treatment non-response among high-risk, psychiatric patients exposes those suffering to suicidal risk as well as persistent social and occupational difficulties. Strategies for identification of treatment non-response are limited. AIMS Diagnostic efficiency of a self-report, cross-cutting symptom measure was assessed as a marker of treatment non-response. METHOD 835 inpatients at a specialist psychiatric hospital completed the Patient Health Questionnaire - Depression (PHQ-9) at admission and every two weeks during hospitalization. RESULTS For patients admitted with severe depression (PHQ-9 ≥ 20), results indicated good accuracy of 2-week PHQ-9 change score in identifying treatment non-response (AUC = 0.80, SE = 0.04, p < .0001; sensitivity = 85%; specificity = 73%; OR = 14.91). CONCLUSIONS The search for predictors of non-response to psychiatric treatment has a long and generally unfulfilled history. The PHQ-9 change score holds promise as a cost-effective test with comparable diagnostic characteristics to other medical tests.
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Affiliation(s)
- J Christopher Fowler
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Michelle Patriquin
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Alok Madan
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Jon G Allen
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - B Christopher Frueh
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; University of Hawaii, Department of Psychology, 200 West Kawili St., Hilo, HI 96720, USA
| | - John M Oldham
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
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Chin WY, Choi EPH, Chan KTY, Wong CKH. The Psychometric Properties of the Center for Epidemiologic Studies Depression Scale in Chinese Primary Care Patients: Factor Structure, Construct Validity, Reliability, Sensitivity and Responsiveness. PLoS One 2015; 10:e0135131. [PMID: 26252739 PMCID: PMC4529142 DOI: 10.1371/journal.pone.0135131] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/17/2015] [Indexed: 12/25/2022] Open
Abstract
Background The Center for Epidemiologic Studies Depression Scale (CES-D) is a commonly used instrument to measure depressive symptomatology. Despite this, the evidence for its psychometric properties remains poorly established in Chinese populations. The aim of this study was to validate the use of the CES-D in Chinese primary care patients by examining factor structure, construct validity, reliability, sensitivity and responsiveness. Methods and Results The psychometric properties were assessed amongst a sample of 3686 Chinese adult primary care patients in Hong Kong. Three competing factor structure models were examined using confirmatory factor analysis. The original CES-D four-structure model had adequate fit, however the data was better fit into a bi-factor model. For the internal construct validity, corrected item-total correlations were 0.4 for most items. The convergent validity was assessed by examining the correlations between the CES-D, the Patient Health Questionnaire 9 (PHQ-9) and the Short Form-12 Health Survey (version 2) Mental Component Summary (SF-12 v2 MCS). The CES-D had a strong correlation with the PHQ-9 (coefficient: 0.78) and SF-12 v2 MCS (coefficient: -0.75). Internal consistency was assessed by McDonald’s omega hierarchical (ωH). The ωH value for the general depression factor was 0.855. The ωH values for “somatic”, “depressed affect”, “positive affect” and “interpersonal problems” were 0.434, 0.038, 0.738 and 0.730, respectively. For the two-week test-retest reliability, the intraclass correlation coefficient was 0.91. The CES-D was sensitive in detecting differences between known groups, with the AUC >0.7. Internal responsiveness of the CES-D to detect positive and negative changes was satisfactory (with p value <0.01 and all effect size statistics >0.2). The CES-D was externally responsive, with the AUC>0.7. Conclusions The CES-D appears to be a valid, reliable, sensitive and responsive instrument for screening and monitoring depressive symptoms in adult Chinese primary care patients. In its original four-factor and bi-factor structure, the CES-D is supported for cross-cultural comparisons of depression in multi-center studies.
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Affiliation(s)
- Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, 161 Main Street, Ap Lei Chau Clinic, Ap Lei Chau, Hong Kong
- * E-mail:
| | - Edmond P. H. Choi
- School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pok Fu Lam, Hong Kong
| | - Kit T. Y. Chan
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, 161 Main Street, Ap Lei Chau Clinic, Ap Lei Chau, Hong Kong
| | - Carlos K. H. Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, 161 Main Street, Ap Lei Chau Clinic, Ap Lei Chau, Hong Kong
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Impact of identification and treatment of depression in heart transplant patients. Cardiovasc Psychiatry Neurol 2014; 2014:747293. [PMID: 25295180 PMCID: PMC4177779 DOI: 10.1155/2014/747293] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 08/23/2014] [Accepted: 08/29/2014] [Indexed: 01/30/2023] Open
Abstract
Background. The effects of clinical depression after orthotopic heart transplantation (OHT) are relatively unknown. The purpose of this study was to evaluate the impact of depression on outcomes after OHT. Methods. We performed a single center retrospective review of 102 consecutive patients who underwent OHT at Northwestern Memorial Hospital from June 2005 to October 2009. The diagnosis of depression was obtained from attending physician documentation. The primary endpoints were all-cause mortality (ACM), hospitalizations, and rejection. Results. Of 102 OHT patients, 26 (26%) had depression. Depressed patients were similar in age to nondepressed patients (57.6 years versus 56.9, P = 0.79). There was no statistical difference in survival between groups at 5 years after OHT (P = 0.94). All-cause hospitalizations were higher in depressed versus nondepressed patients (4.3 versus 2.6 hospitalizations P = 0.05). There were no significant differences in hospitalizations between the two groups for the following complications: cardiac (heart failure, edema, arrhythmias, and acute rejection) and infections. There was no significant difference in episodes of 2R and 3R rejection. Conclusion. Early identification and treatment of depression in OHT patients result in outcomes similar to nondepressed patients.
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Rathore JS, Jehi LE, Fan Y, Patel SI, Foldvary-Schaefer N, Ramirez MJ, Busch RM, Obuchowski NA, Tesar GE. Validation of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adults with epilepsy. Epilepsy Behav 2014; 37:215-20. [PMID: 25064739 PMCID: PMC4427235 DOI: 10.1016/j.yebeh.2014.06.030] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to assess the accuracy and operating characteristics of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adults with epilepsy. METHODS Tertiary epilepsy center patients served as the study population, with 237 agreeing to structured interview using the Mini-International Neuropsychiatric Interview (MINI), a "gold standard" instrument developed for rapid diagnosis of neuropsychiatric disorders, including major depressive disorder (MDD); 172 also completed the PHQ-9, and 127 completed both the PHQ-9 and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) within two days of the MINI. Sensitivity, specificity, positive and negative predictive values, and areas under the ROC curves for each instrument were determined. Cut-points of 10 for the PHQ-9 and 15 for the NDDI-E were used, and ratings at or above the cut-points were considered screen-positive. The PHQ-9 was divided into cognitive/affective (PHQ-9/CA) and somatic (PHQ-9/S) subscales to determine comparative depression screening accuracy. RESULTS The calculated areas under the ROC curves for the PHQ-9 (n=172) and the PHQ-9/CA and PHQ-9/S subscales were 0.914, 0.924, and 0.846, respectively, with the PHQ-9 more accurate than the PHQ-9/S (p=0.002) but not different from the PHQ-9/CA (p=0.378). At cut-points of 10 and 15, respectively, the PHQ-9 had higher sensitivity (0.92 vs 0.87) but lower specificity (0.74 vs 0.89) compared with the NDDI-E. The areas under the ROC curves of the PHQ-9 and the NDDI-E showed similar accuracy (n=127; 0.930 vs 0.934; p=0.864). SIGNIFICANCE The PHQ-9 is an efficient and nonproprietary depression screening instrument with excellent accuracy validated for use in adult patients with epilepsy as well as multiple other medical populations.
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Affiliation(s)
- Jaivir S. Rathore
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Department of Neurology and Rehabilitation, Neuropsychiatric Institute, University of Illinois Medical Center at Chicago (UIC), Illinois, U.S.A,Corresponding Author: Jaivir S. Rathore, M.D. 912 S. Wood St. 855N (M/C 769) UIC Chicago, IL 60612, U.S.A, Phone: +1-216-925-2499,
| | - Lara E. Jehi
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Youran Fan
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Sima I. Patel
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,MINCEP Epilepsy Care, University of Minnesota Medical Center, Minneapolis, Minnesota, U.S.A
| | - Nancy Foldvary-Schaefer
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Maya J. Ramirez
- Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Psychology Services, Tampa General Hospital, Tampa, Florida, U.S.A
| | - Robyn M. Busch
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Nancy A. Obuchowski
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - George E. Tesar
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
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Williams L, Gorman R, Hankerson S. Implementing a mental health ministry committee in faith-based organizations: the promoting emotional wellness and spirituality program. SOCIAL WORK IN HEALTH CARE 2014; 53:414-34. [PMID: 24717187 PMCID: PMC4000587 DOI: 10.1080/00981389.2014.880391] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Social workers have successfully collaborated with African-American faith-based organizations to improve health outcomes for numerous medical conditions. However, the literature on Faith-Based Health Promotion for major depression is sparse. Thus, the authors describe a program used to implement a Mental Health Ministry Committee in African-American churches. Program goals are to educate clergy, reduce stigma, and promote treatment seeking for depression. Key lessons learned are to initially form partnerships with church staff if there is not a preexisting relationship with the lead pastor, to utilize a community-based participatory approach, and to have flexibility in program implementation.
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Affiliation(s)
- Laverne Williams
- a Mental Health Association in New Jersey , Verona , New Jersey , USA
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Lin JD, Lin LP, Kuo MT, Hsu SW, Lee TN, Lai CI, Wu JL. Assessment of the 9-item Patient Health Questionnaire (PHQ-9) as a screen tool for symptoms of depression in community caregivers for adults with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:178-184. [PMID: 24183645 DOI: 10.1016/j.ridd.2013.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 10/03/2013] [Indexed: 06/02/2023]
Abstract
The study aim was to determine the extent and determinants of reporting depressive symptoms in caregivers for persons with intellectual disabilities based on assessment of the 9-item Patient Health Questionnaire (PHQ-9). A cross-sectional study was conducted, recruiting 455 caregivers for adults with ID who were providing care in community residences, with complete PHQ-9 data being analyzed. The results indicated that the mean of each item scored on the PHQ-9 varied from 0.3 (Q9) to 1.1 (Q4). For two items (Q3 - "sleeping difficulties" and Q4 - "fatigue"), the respondents reported occurrence during several days in the previous two weeks. However, after scrutinizing the distribution of each item in the PHQ-9, 3.3-14.5% respondents reported that each item happened nearly every day, and 4.0-17.8% expressed that each happened more than half of the days in the previous two weeks. With respect to difficulties examined on the PHQ, 47% of cases expressed that it was somewhat difficult, 8.2% expressed that it was very difficult, and 4.5% felt that it was extremely difficult to work, care for things at home, or get along with others. Finally, a logistic regression model revealed that only one factor of self-perceived health status (fair/poor vs. excellent/very good, OR=7.519, 95% CI=3.03-18.68, p<0.001) exhibited a statistically significant correlation with depressive symptom occurrence (PHQ-9 score ≥ 10) among the caregivers. The study highlights the need to strengthen appropriate health initiatives for monitoring mental health status and to provide necessary services for community caregivers for adults with ID.
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Affiliation(s)
- Jin-Ding Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan; Chung-Hua Foundation for Persons with Intellectual Disabilities, New Taipei City, Taiwan.
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Rivera-Rivera Y, García Y, Toro V, Cappas N, López P, Yamamura Y, Rivera-Amill V. Depression Correlates with Increased Plasma Levels of Inflammatory Cytokines and a Dysregulated Oxidant/Antioxidant Balance in HIV-1-Infected Subjects Undergoing Antiretroviral Therapy. ACTA ACUST UNITED AC 2014; 5. [PMID: 25674354 DOI: 10.4172/2155-9899.1000276] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Depression is the most common psychiatric diagnosis in the HIV/AIDS population and represents a risk factor for disease progression. Since HIV-1 infection is characterized by immunologic and metabolic disturbances, we want to study the effects of depression on different components related to pro-inflammatory and oxidative stress markers. We hypothesize that depression will lead to increased pro-inflammatory cytokine levels and altered antioxidant/oxidant balance. METHODS We included males and females who were ≥21 years of age, whose HIV-1 sero-status was confirmed by Western Blot, and who were currently undergoing antiretroviral treatment. Patients completed the participation consent form, a socio-demographic survey, and the Patient Health Questionnaire-9 (PHQ-9) for depression assessment. We isolated the plasma from participants' blood samples for viral load analysis (RT-PCR), T-cell counts (flow cytometry), and hematological parameters. A cytokine magnetic bead panel was used to measure interleukin-15 (IL-15), interferon gamma-induced protein 10 (IP-10), IL-12 and granulocyte colony-stimulating factor (G-CSF) levels. We also performed assays to determine the antioxidant activity of superoxide dismutase (SOD) and catalase and to measure the lipid peroxidation levels using malondialdehyde (MDA) and 8-isoprostane assays. Statistical comparisons and correlations at 5% level of significance were determined. RESULTS Our results show that subjects with mild/moderate to severe depression as assessed by PHQ-9 had a significantly decreased adherence to anti-retroviral treatment. Subjects with depression also had significantly lower levels of white blood cells (WBC) and platelets (PLT) than did the non-depressed group. The HIV+ subjects with depression had increased levels of IL-15, IP-10, IL-12 p40/p70 and G-CSF compared to their non-depressed counterparts. The latter had increased MDA and 8-isoprostane levels. CONCLUSIONS Our results suggest that HIV+ subjects with depressive symptoms have higher levels of inflammation and altered oxidant/antioxidant balance. Although the groups were small, this study strengthens the hypothesis that alterations in cytokines are associated with the mechanisms underlying depression symptoms.
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Affiliation(s)
- Yainyrette Rivera-Rivera
- Department of Microbiology, Ponce Health Sciences University-School of Medicine/ Ponce Research Institute, USA
| | - Yashira García
- Department of Microbiology, Ponce Health Sciences University-School of Medicine/ Ponce Research Institute, USA
| | - Valerie Toro
- Department of Clinical Psychology, Ponce Health Sciences University-School of Medicine/ Ponce Research Institute, USA
| | - Nydia Cappas
- Department of Clinical Psychology, Ponce Health Sciences University-School of Medicine/ Ponce Research Institute, USA
| | - Pablo López
- AIDS Research Program, Ponce Health Sciences University-School of Medicine/ Ponce Research Institute, USA
| | - Yasuhiro Yamamura
- AIDS Research Program, Ponce Health Sciences University-School of Medicine/ Ponce Research Institute, USA
| | - Vanessa Rivera-Amill
- Department of Microbiology, Ponce Health Sciences University-School of Medicine/ Ponce Research Institute, USA
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Russoniello CV, Fish M, O'Brien K. The Efficacy of Casual Videogame Play in Reducing Clinical Depression: A Randomized Controlled Study. Games Health J 2013. [PMID: 26197075 DOI: 10.1089/g4h.2013.0010] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Depression is a debilitating illness that is estimated to affect more than 300 million people worldwide. Although there has been some success in treatment of this illness with pharmaceuticals and behavioral techniques like cognitive behavioral therapy, these are often costly and have stigma associated with them. The purpose of this study was to test whether a prescribed regimen of casual videogame (CVG) play could reduce symptoms associated with depression. SUBJECTS AND METHODS Participants were screened for depression using the Patient Health Questionnaire-9 (PHQ-9). They were then randomized into the control (n=29) or experimental (n=30) group. Experimental participants were prescribed to play CVGs three times per week (with 24 hours between each session), for 30 minutes, over a 1-month period. Control participants surfed the National Institute of Mental Health's Web page on depression. The instrument used to test the hypothesis was the PHQ-9. RESULTS Repeated-measures statistical analyses revealed there was a significant interaction of group and time, supporting the hypothesis that the groups would be different after the intervention. Moreover, when data were compared using tests of within-subjects contrasts between baseline (Time 1) and the end of the 1-month study (Time 3), we found significant decreases in depression symptoms in the experimental group. When this was compared with the control group changes, the results were still significant. CONCLUSIONS We found that a prescribed regimen of playing CVGs significantly reduced symptoms of clinical depression as measured by the PHQ-9. Clinicians should consider these low-cost CVGs as a possible intervention to address psychological and somatic symptoms associated with depression.
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Affiliation(s)
- Carmen V Russoniello
- 1 Psychophysiology and Biofeedback Lab, East Carolina University , Greenville, North Carolina
| | - Matthew Fish
- 1 Psychophysiology and Biofeedback Lab, East Carolina University , Greenville, North Carolina
| | - Kevin O'Brien
- 2 Department of Biostatistics, East Carolina University , Greenville, North Carolina
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Schumacher JE, McCullumsmith C, Mugavero MJ, Ingle-Pang PE, Raper JL, Willig JH, You Z, Batey DS, Crane H, Lawrence ST, Wright C, Treisman G, Saag MS. Routine depression screening in an HIV clinic cohort identifies patients with complex psychiatric co-morbidities who show significant response to treatment. AIDS Behav 2013; 17:2781-91. [PMID: 23086427 DOI: 10.1007/s10461-012-0342-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study described characteristics, psychiatric diagnoses and response to treatment among patients in an outpatient HIV clinic who screened positive for depression. Depressed (25 %) were less likely to have private insurance, less likely to have suppressed HIV viral loads, had more anxiety symptoms, and were more likely to report current substance abuse than not depressed. Among depressed, 81.2 % met diagnostic criteria for a depressive disorder; 78 % for an anxiety disorder; 61 % for a substance use disorder; and 30 % for co-morbid anxiety, depression, and substance use disorders. Depressed received significantly more treatment for depression and less HIV primary care than not depressed patients. PHQ-9 total depression scores decreased by 0.63 from baseline to 6-month follow-up for every additional attended depression treatment visit. HIV clinics can routinely screen and treat depressive symptoms, but should consider accurate psychiatric diagnosis as well as co-occurring mental disorders.
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Affiliation(s)
- Joseph E Schumacher
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA,
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Klein JP, Berger T, Schröder J, Späth C, Meyer B, Caspar F, Lutz W, Greiner W, Hautzinger M, Rose M, Gräfe V, Hohagen F, Andersson G, Vettorazzi E, Moritz S. The EVIDENT-trial: protocol and rationale of a multicenter randomized controlled trial testing the effectiveness of an online-based psychological intervention. BMC Psychiatry 2013; 13:239. [PMID: 24074299 PMCID: PMC3850933 DOI: 10.1186/1471-244x-13-239] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 09/24/2013] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Depressive disorders are among the leading causes of worldwide disability with mild to moderate forms of depression being particularly common. Low-intensity treatments such as online psychological treatments may be an effective way to treat mild to moderate depressive symptoms and prevent the emergence or relapse of major depression. METHODS/DESIGN This study is a currently recruiting multicentre parallel-groups pragmatic randomized-controlled single-blind trial. A total of 1000 participants with mild to moderate symptoms of depression from various settings including in- and outpatient services will be randomized to an online psychological treatment or care as usual (CAU). We hypothesize that the intervention will be superior to CAU in reducing depressive symptoms assessed with the Personal Health Questionnaire (PHQ-9, primary outcome measure) following the intervention (12 wks) and at follow-up (24 and 48 wks). Further outcome parameters include quality of life, use of health care resources and attitude towards online psychological treatments. DISCUSSION The study will yield meaningful answers to the question of whether online psychological treatment can contribute to the effective and efficient prevention and treatment of mild to moderate depression on a population level with a low barrier to entry. TRIAL REGISTRATION NUMBER NCT01636752.
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Affiliation(s)
- Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Luebeck University, Luebeck, Germany.
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Johanna Schröder
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Späth
- Department of Psychiatry and Psychotherapy, Luebeck University, Luebeck, Germany
| | - Björn Meyer
- GAIA AG, Hamburg, Germany,Department of Psychology, City University London, London, United Kingdom
| | - Franz Caspar
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, Bielefeld University, Bielefeld, Germany
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Matthias Rose
- Department of Psychosomatic Medicine, Charité University Medical Center, Berlin, Germany
| | - Viola Gräfe
- Department of Health Economics and Health Care Management, Bielefeld University, Bielefeld, Germany
| | - Fritz Hohagen
- Department of Psychiatry and Psychotherapy, Luebeck University, Luebeck, Germany
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Stockholm, Sweden,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
African Americans, compared with white Americans, underutilize mental health services for major depressive disorder. Church-based programs are effective in reducing racial disparities in health; however, the literature on church-based programs for depression is limited. The purpose of this study was to explore ministers' perceptions about depression and the feasibility of utilizing the church to implement evidence-based assessments and psychotherapy for depression. From August 2011 to March 2012, data were collected from three focus groups conducted with adult ministers (n = 21) from a black mega-church in New York City. Using consensual qualitative research to analyze data, eight main domains emerged: definition of depression, identification of depression, causal factors, perceived responsibilities, limitations, assessment, group interpersonal psychotherapy, and stigma. A major finding was that ministers described depression within a context of vast suffering due to socioeconomic inequalities (e.g., financial strain and unstable housing) in many African American communities. Implementing evidence-based assessments and psychotherapy in a church was deemed feasible if principles of community-based participatory research were utilized and safeguards to protect participants' confidentiality were employed. In conclusion, ministers were enthusiastic about the possibility of implementing church-based programs for depression care and emphasized partnering with academic researchers throughout the implementation process. More research is needed to identify effective, multidisciplinary interventions that address social inequalities which contribute to racial disparities in depression treatment.
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