Long-term effectiveness and side-effects of intranasal esketamine in treatment-resistant depression: real-world, single-arm study of over 100 sessions

Impact of pre-transplant anxiety and depression on outcomes of AML patients after allogeneic transplantation

Background Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), can trigger the onset of depressive and anxiety symptoms. The evaluation of mental well-being in patients with a chronic medical condition is considered a good clinical practice and it is strongly recommended by the World Health Organization. Nevertheless, mental health is not routinely investigated in this context for several reasons, including lack of training by healthcare professionals, stigma associated to mental health and gender-relatedstereotypes. The objectives of our study were to assess the presence of depressive and anxiety symptoms inpatients affected by IBD using two simple validated questionnaires and to identify potential related factors, particularly gender differences. Methods We conducted a single center observational study evaluating anxiety and depressive symptoms in patients with IBD treated with biological therapy at the IBD Unit of Ospedale Policlinico of Milan during October 2022. We assessed depressive and anxiety symptoms using respectively the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) that are easy self-administered rating scales. Univariate analyses and regression models were applied for the purpose of the study. Results Among a total of 174 consecutive patients, 158 completed the questionnaires. The prevalence of moderate tosevere depression (PHQ-9 score > 9) in the total sample was 18.4%, and it was higher in CD than in UC (21% vs 9.7%). The prevalence of clinically significant anxiety symptoms (GAD-7 score > 9) was 24% (25.7% in CD and 19.3% in UC). Focusing on gender differences, similar prevalence of significant anxiety anddepression was observed between males (M) and females (F); respectively 18.6% M vs 17.6% F for depression (PHQ-9 > 9) and 22.2% M vs 25.4% F for anxiety (GAD-7 > 9). Of note, a relevant association was observed between younger age and higher GAD-7 (β =-0.639; p=0.021) and PHQ-9 (β =-0.604, p=0.055) scores. Conclusion Both males and females (especially younger) IBD patients in biological therapy are largely affected bysignificant depressive and anxiety symptoms. The administration of simple questionnaires like PHQ-9 andGAD-7 in routine clinical practice can facilitate early identification of patients requiring mental health support, this is crucial as psychiatric conditions can complicate the course of the disease and adherence to treatments.

Mental health of surgeons during the COVID-19 pandemic: An urgent need for intervention

Background Patient diagnosed with Inflammatory Bowel Disease (IBD) experience distressing psychological symptoms and a diminished quality of life (QOL). The efficacy and feasibility of online mindfulness intervention for patients with IBD is unknown.We conducted a mobile-delivered mindfulness intervention among IBD patients to study its feasibility and efficacy in lowering their anxiety or depression level and improving their QOL. Methods We utilized individuals diagnosed with IBD to investigate the correlation between the severity of depression/anxiety and their QOL. The severity of anxiety and depression symptoms was evaluated using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9), respectively. QOL was assessed using the Short Health Scale (SHS). The relationship was analyzed through regression analysis. Additionally, a randomized parallel design was employed to conduct the Online MINdfulness-based stress reduction with Daily EXercise (MINDEX) program, and its effects on QOL and psychological symptoms were studied over a period of 2 months. Results A total of 521 participants initiated the survey and 484 completed and submitted the survey. More than 80% of the patients experienced severe symptoms of anxiety or depression, as indicated by GAD-7 scores ≥ 10 or PHQ-9 scores ≥ 10. The study found that increases in GAD-7 total scores were significantly associated with increases in SHS total scores, with an R2 value of 0.43 and coefficient of 12.6 (95% CI 9.4-15.7) for UC (Ulcerative Colitis) and R2 value of 0.27 and a coefficient of 10.4 (95% CI 8.8-12.1) for CD (Crohn’s Disease). Similarly, increases in PHQ-9 scores also showed significant correlations with increases in SHS total scores, with an R2 value of 0.37 and a coefficient of 9.2 (95% CI 6.5-11.8) for UC and R2 value of 0.22 and a coefficient of 7.2 (95% CI 5.9-8.6) for CD. However, when depression severity was considered, the significant differences between SHS and PHQ-9 scores disappeared in both UC and CD. Yet, the positive correlation between GAD-7 and SHS scores remained significant in UC. Regarding the MINDEX program, the study included 30 MINDEX patients and 22 control patients who completed the program. After 2 months, the scores of GAD-7, PHQ-9, SHS between MINDEX patients and 22 control patients were not statistically significant (.052 < P < .908). Conclusion IBD significantly influenced patients’ anxiety, depression, QOL, and sleep quality. Online mindfulness interventions did not show a significant reduction in anxiety or depression. When formulating personalized treatment plans, it is crucial to take into account the patient’s overall condition to optimize treatment outcomes and enhance the patient’s QOL.

Depression and anxiety are highly prevalent conditions in the United States. Despite the availability of suitable therapeutic options, limited access to high-quality psychiatrists represents a major barrier to treatment. Although telepsychiatry has the potential to improve access to psychiatrists, treatment efficacy in the telepsychiatry model remains unclear. Our primary objective was to determine whether there was a clinically meaningful change in 1 of 2 validated outcome measures of depression and anxiety-the Patient Health Questionnaire-8 (PHQ-8) or the Generalized Anxiety Disorder-7 (GAD-7)-after receiving at least 8 weeks of treatment in an outpatient telepsychiatry setting. We included treatment-seeking patients enrolled in a large outpatient telepsychiatry service that accepts commercial insurance. All analyzed patients completed the GAD-7 and PHQ-8 prior to their first appointment and at least once after 8 weeks of treatment. Treatments included comprehensive diagnostic evaluation, supportive psychotherapy, and medication management. In total, 1826 treatment-seeking patients were evaluated for clinically meaningful changes in GAD-7 and PHQ-8 scores during treatment. Mean treatment duration was 103 (SD 34) days. At baseline, 58.8% (1074/1826) and 60.1% (1097/1826) of patients exhibited at least moderate anxiety and depression, respectively. In response to treatment, mean change for GAD-7 was -6.71 (95% CI -7.03 to -6.40) and for PHQ-8 was -6.85 (95% CI -7.18 to -6.52). Patients with at least moderate symptoms at baseline showed a 45.7% reduction in GAD-7 scores and a 43.1% reduction in PHQ-8 scores. Effect sizes for GAD-7 and PHQ-8, as measured by Cohen d for paired samples, were d=1.30 (P<.001) and d=1.23 (P<.001), respectively. Changes in GAD-7 and PHQ-8 scores correlated with the type of insurance held by the patients. Greatest reductions in scores were observed among patients with commercial insurance (45% and 43.9% reductions in GAD-7 and PHQ-8 scores, respectively). Although patients with Medicare did exhibit statistically significant reductions in GAD-7 and PHQ-8 scores from baseline (P<.001), these improvements were attenuated compared to those in patients with commercial insurance (29.2% and 27.6% reduction in GAD-7 and PHQ-8 scores, respectively). Pairwise comparison tests revealed significant differences in treatment responses in patients with Medicare versus commercial insurance (P<.001). Responses were independent of patient geographic classification (urban vs rural; P=.48 for GAD-7 and P=.07 for PHQ-8). The finding that treatment efficacy was comparable among rural and urban patients indicated that telepsychiatry is a promising approach to overcome treatment disparities that stem from geographical constraints. In this large retrospective data analysis of treatment-seeking patients using a telepsychiatry platform, we found robust and clinically significant improvement in depression and anxiety symptoms during treatment. The results provide further evidence that telepsychiatry is highly effective and has the potential to improve access to psychiatric care.

Effects of Depression and Anxiety Improvement on Adherence to Medication and Health Behaviors in Recently Hospitalized Cardiac Patients

Assessment of anxiety and depression symptoms severity among polish adult patients with cystic fibrosis: impact of selected sociodemographic and health variables.

Introduction: Previous studies have shown anxiety and depression can contribute to poorer outcomes in asthma. Outpatients are monitored via the Asthma Control Questionnaire (ACQ-6) and the Asthma Quality of Life Questionnaire (mini-AQLQ). These do not specifically address anxiety or depression but anecdotal evidence suggests correlation between asthma control and these comorbidities. Aim: GAD and PHQ-9 seek to identify anxiety and depression respectively. We aimed to discover if the added use of these questionnaires would provide further information on the presence of these comorbidities. We hypothesised that ACQ-6 and AQLQ are predictive of GAD and PHQ-9 scores. Method: 300 patients attending asthma clinic completed ACQ-6, AQLQ, GAD and PHQ-9 questionnaires and scores were recorded. Data were analysed for correlation between ACQ-6 and AQLQ with PHQ-9 and GAD scores. ROC curves were generated comparing AQLQ and ACQ-6 with GAD to assess the sensitivity of this relationship. Results: Average ACQ-6 was 2.9 and AQLQ was 3.5. Average GAD score was 9.3 approaching the threshold for moderate anxiety. Average PHQ-9 was 10.8, over the limit for significant depression. This highlights the presence of these comorbidities in our asthmatics. Poorer ACQ-6 and AQLQ were associated with worse PHQ-9 (p Conclusions: Anxiety and depression are prevalent in our asthma patients. Adverse ACQ-6 and AQLQ scores are associated with the presence of anxiety and depression. This nullifies the need to burden patients with additional questionnaires to identify these conditions.

Objective This service evaluation aimed to determine the prevalence of anxiety and depression and the severity of anxiety and depression symptoms experienced in irritable bowel syndrome (IBS) patients crossing the primary-secondary care interface. It also aimed to assess how routinely collected symptom scores for anxiety and depression influence clinician recognition and response in the IBS clinic. Method A retrospective review of online medical records was conducted for new patients referred to a specialist IBS clinic at a large National Health Service Teaching Hospital over 12 months. Baseline clinicodemographic data, IBS subtype and pre-existing diagnoses of anxiety and/or depression were extracted. All patients completed Generalised Anxiety Disorder-7 (GAD-7), which measures anxiety symptoms, and Patient Health Questionnaire-9 (PHQ-9), which measures depression symptoms, forms prior to clinic review. Severity scores were compared using non-parametric statistical tests (p&lt;0.05) Results A total of 103 patients were included. Overall, 63.1% had a diagnosis of anxiety and/or depression, and most reported moderate-to-severe anxiety and depression symptoms when crossing the primary-secondary care interface. Patients with pre-existing mental health diagnoses had significantly higher GAD-7 and PHQ-9 scores (p&lt;0.01 and p&lt;0.001, respectively) than those without; however, there were no significant differences in symptom burden between groups (anxiety, depression or mixed disorder) on GAD-7 or PHQ-9. Elevated preclinic GAD-7 and PHQ-9 scores were acknowledged in over 80% of consultations and frequently resulted in mental-health-specific management recommendations. Conclusion Introducing preclinic screening enhances the visibility of anxiety and depression symptoms as patients cross the primary-secondary care interface, providing early insight into symptom severity.

Background Mental health disorder (MHD) prevalence is high among people with HIV (PWH) and linked to poor health outcomes, including HIV non-suppression. Despite recommendations for routine mental health screening in HIV care settings, screening uptake remains low. The brief Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2) are validated screeners for depression and anxiety symptoms with potential for integration into HIV care. This study evaluates the accuracy of the PHQ-2 and GAD-2 in detecting depression and anxiety among PWH and co-occurring MHD or substance use disorders (SUD). Methods Routine screening using the PHQ-2, GAD-2, and NIDA Quick Screen for SUD was implemented in an HIV care setting in Baltimore in April 2022. Patients who screened positive on any screener and enrolled in a study evaluating an intervention for SUD and MHD care were included in the analysis. Participants completed the longer PHQ-8 and GAD-7 screeners at enrollment, which served as reference standards using recommended cut points of ≥10 to indicate moderate or severe depression or anxiety, respectively. PHQ-2 and GAD-2 scores are derived from the first two questions of their corresponding longer measure. Area under the curve (AUC), sensitivity, and specificity were obtained for the PHQ-2 and GAD-2 at various cut points against their corresponding longer measure. Results Of the 204 patients included in this study, 68% were male, 80% were Black, and mean age was 51 years. Compared to the PHQ-8 using a cut point of ≥10, the PHQ-2 at the cut point of ≥3 demonstrated high accuracy in detecting depression at a cut point of ≥3 (AUC = 0.86; 95% CI: 0.81, 0.91) with a sensitivity of 0.82 (95% CI: 0.72, 0.89) and specificity of 0.90 (95% CI: 0.83, 0.95). Compared to the GAD-7 using a cut point of ≥10, the GAD-2 was highly accurate in identifying anxiety at a cut point of ≥3 (AUC = 0.90; 95% CI: 0.86, 0.94), achieving a high sensitivity (0.89; 95% CI: 0.81, 0.95) and specificity (0.91; 95% CI: 0.84, 0.95). Conclusion In the context of HIV care in busy clinical settings, our findings indicate that implementation of the PHQ-2 and GAD-2 screeners accurately detect depression and anxiety symptoms at the optimal cut point of ≥3. Simplified identification and treatment of comorbid MHD may improve HIV outcomes. Disclosures Oluwaseun Falade-Nwulia, MBBS ,MPH, Abbvie Inc: Grant/Research Support|Gilead Sciences: Advisor/Consultant

Background: We sought to assess the anxiety and depression scores of pregnant women in Hong Kong during the COVID-19 pandemic and to evaluate the impact of demographic, economic and social factors on these scores. Methods: This was part of an ongoing worldwide cross-sectional study conducted from 22 May 2020 to 28 February 2021. Data were collected through an anonymous web-based survey. The severity of depression and anxiety was assessed using the Patient Health Questionnaire-9 (PHQ-9) score and the General Anxiety Disorder-7 (GAD-7) score, respectively. Results: A total of 361 participants completed both the GAD-7 and PHQ-9 questionnaires. Participants with psychiatric illness reported a significant higher median GAD-7 score (6.00, interquartile range [IQR] 3.00–7.75 vs. 2.00, IQR 0.00–6.00, p = 0.001), while the median PHQ-9 score was also higher but was not statistically significant (6.50, IQR 3.00–11.00 vs. 5.00, IQR 3.00–8.00, p = 0.066). A higher proportion of participants with psychiatric illness reported moderate-severe depression and anxiety (35.7% vs. 16.5%, p = 0.002, 17.8% vs. 3.6%, p &lt; 0.001 respectively). Multivariate regression analysis demonstrated that financial difficulty, in education and pregnancy by in-vitro fertilization were associated with a higher PHQ-9 score in pregnant women during the COVID-19 pandemic, while underlying psychiatric illness was associated with a higher GAD-7 score. Support from a partner was demonstrated to be associated with a reduced level of depression and anxiety in pregnancy. Conclusions: Pregnant women with underlying psychiatric illness were more vulnerable during the COVID-19 pandemics than the non-psychiatric counterparts. Partner support is important for alleviating depression and anxiety in pregnancy during the COVID-19 pandemic. Clinical Trial Registration: The study was registered at http://www.clinicaltrials.gov, registration number NCT04377412.

BackgroundThe objective of this study was to examine the relationship of mental health status between self-poisoning suicide patients and their family members, and it also sought to identify potential patient’s risk and parental factors for the prediction of suicide attempt, anxiety, and depression.MethodsIn this study, 151 poisoned patients were prospectively included, and they were matched 1:1 with 151 family members. We gathered information on patient’s and their matched family member’s demographics, lifestyle choices, mental health status, level of intimacy, and history of psychiatry disease. The relationship of patient’s and their family member’s mental health state was investigated using a correlation matrix. Multivariable analyses (multiple logistic regression) were conducted among patients and their matched family members, to identify potential risk factors for self-poisoning suicide, anxiety, and depression.ResultsOf the total patients, 67.55% (102/151) attempted self-poisoning suicide. Poisoned patients had more severe anxiety and depression symptoms than their matched family members, and this difference was even more pronounced among patients with self-poisoning suicide. Generalized anxiety disorder-7 (GAD-7) score for family members was significantly and favorably correlated with patient’s GAD-7 score after eliminating non-suicide patients and their matched family members. The patient health questionnaire-9 (PHQ-9) score showed a similar pattern, and the family member’s PHQ-9 score was strongly and favorably associated with patient’s PHQ-9 and Beck hopelessness scale-20 (BHS-20) score. Multivariable analysis showed that married marital status (P = 0.038), quitting smoking (P = 0.003), sedentary time of 1 to 6 h (P = 0.013), and participation in a sports more than five times per week (P = 0.046) were all significantly associated with a lower risk of suicide by self-poisoning, while a more serious anxiety state (P = 0.001) was significantly associated with a higher risk of self-poisoning suicide. Multivariable analysis demonstrated that, specifically among self-poisoning suicide patients, married marital status (P = 0.011) and no history of psychiatry disease (P < 0.001) were protective factors for anxiety, while divorced or widowed marital status (P = 0.004), a sedentary time of 1 to 3 h (P = 0.022), and a higher monthly income (P = 0.027) were significant contributors to anxiety. The propensity of additional family-matched characteristics to predict patient’s suicidality, anxiety, and depression was also examined.ConclusionsSelf-poisoning suicide patients have severe mental health issues. Patients who self-poison have a close connection to their family member’s mental health, particularly their levels of anxiety and depression. According to the findings, being married and adopting healthy lifestyle habits, such as quitting smoking and drinking, increasing their physical activity levels, and managing their idle time, are able to help patients with mental health concerns and even suicidal thoughts.

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Prevalence of Symptoms of Depression and Anxiety in Adults With Cystic Fibrosis Based on the PHQ-9 and GAD-7 Screening Questionnaires

BackgroundThis study investigates outcomes from two federal grant programs: the Evidence-Based Tele-Behavioral Health Network Program (EB THNP) funded from September 2018 to August 2021 and the Substance Abuse Treatment Telehealth Network Grant Program (SAT TNGP) funded from September 2017 to August 2020. As part of the health services implementation program, the aims of this study were to evaluate outcomes in patient symptoms of depression and anxiety across the programs’ 17 grantees and 95 associated sites, with each grantee having data from telehealth patients and from an in-person comparison group.MethodsThe research design is a prospective multi-site observational study. Each grantee provided data on a nonrandomized convenience sample of telehealth patients and an in-person comparison group from sites with similar rural characteristics and during the same time period. Patient characteristics were collected at treatment initiation, and clinical outcome measures were collected at baseline and monthly. The validated clinical outcome measure instruments included the Patient Health Questionnaire-9 (PHQ-9) for depression symptoms and the Generalized Anxiety Disorder-7 (GAD-7) scale for anxiety-related symptoms. Linear mixed models, with grantee as the random effect, were used to determine the association of behavioral health delivery (telehealth versus in-person) on the one-month change in PHQ-9 and GAD-7 while adjusting for covariates.ResultsAcross a total of 1,514 patients, one-month change scores were improved indicating that PHQ-9 and GAD-7 scores decreased from baseline to the one-month follow-up at similar rates in both the in-person and telehealth groups. Reduction in scores averaged 2.8 for the telehealth treatment group and 2.9 for the in-person treatment group in the PHQ-9 subsample and 2.0 for the telehealth treatment group and 2.4 for the in-person treatment group in the GAD-7 subsample. There was no statistically significant association between the modality of care (telehealth treatment group versus in-person comparison group) and the one-month change scores for either PHQ-9 or GAD-7. Individuals with higher baseline scores demonstrated the greatest decrease in scores for both measures. Upon adjusting for baseline scores and grantee program, patient demographics were not found to be significantly associated with change in anxiety or depression symptoms.ConclusionIn our very large pragmatic study comparing behavioral health treatment delivered to a population of patients in rural, underserved communities, we found no clinical or statistical differences in improvements in depression or anxiety symptoms as measured by the PHQ-9 and GAD-7 between patients treated via telehealth or in-person.