Baseline Patient Health Questionnaire-9 Scores Research Articles

Effectiveness of a task-sharing collaborative care model for the detection and management of depression among adults receiving antiretroviral therapy in primary care facilities in South Africa: A pragmatic cluster randomised controlled trial

BackgroundHIV is characterised by high rates of comorbidity with mental health conditions including depression, as such, the detection and treatment of comorbid depression is critical to achieve viral load suppression. This study evaluated the effectiveness of a collaborative care intervention for depression among adults with comorbid depression symptoms receiving ART in primary health care (PHC) facilities. MethodsWe conducted a pragmatic cluster-randomised trial in 40 clinics in the North West province of South Africa. PHC clinics were stratified by sub-district and randomised in a 1:1 ratio. Participants were ≥ 18 years, receiving ART, and had depression symptoms indicated by Patient Health Questionnaire-9 (PHQ-9) score ≥ 9. Intervention clinics received: i) supplementary mental health training and clinical communication skills for PHC nurses; ii) workshops for PHC doctors on treating depression; and iii) lay counselling services. Using mixed effects regression models, we assessed co-primary outcomes of PHQ-9 response at 6 months (≥50 % reduction in baseline PHQ-9 score) and viral load suppression at 12 months (viral load<1000 copies/mL). ResultsThe intervention had no effect in PHQ-9 response (49 % vs 57 %, risk difference (RD) = −0.08, 95 % CI = -0.19; 0.03, p = 0.184) or viral load suppression (85 % vs 84 %, RD = 0.02, 95 % CI = −0.01; 0.04, p = 0.125). Nurses referred 4298 clinic patients to counsellors, however, only 66/1008 (7 %) of intervention arm participants were referred to counsellors at any point during the study. LimitationsThe highly pragmatic approach of this trial limited exposure to the counselling component of the intervention and referral to doctors for initiation of antidepressant treatment was extremely low. ConclusionThe trial showed no effect of a district-based intervention to strengthen collaborative care for depression. The trial revealed the extent of the treatment gap in the context of scaling up mental health services. Trial registrationClinicalTrials.gov (NCT02407691); Pan African Clinical Trials Registry (201504001078347).

62 Cognitive Behavioral Therapy Improves Symptoms of Depression in Burn Survivors

Abstract Introduction Burn injury patients can suffer severe trauma as they cope with the events that led to their injuries and their new physical abilities and appearance. Mental health is a component of care that is often overlooked for these patients. The purpose of this prospective study was to evaluate whether burn psychotherapy is effective in reducing depression in burn survivors. Methods Our Burn Center has a full time licensed clinical psychotherapist who uses Cognitive Behavioral Therapy (CBT) to treat patients. Burn clinic nurses administered the Patient Health Questionnaire-9 (PHQ-9) depression screener to n=1842 patients between 2016-2019. Patients were referred to psychotherapy if their total PHQ-9 score met the definition for moderate depression (total score ≥ 10) or they endorsed the question about suicidal thoughts. Patients could also participate through self-referral. Our final sample included n=146 patients (47% female, mean age=41.8) who attended at least one psychotherapy appointment and contributed at least one post-appointment PHQ-9 score. We computed a difference score for each patient by subtracting their baseline PHQ-9 score from their mean post-psychotherapy score. We used a one sample t-test to compare the mean difference score for the group to zero (zero = no change). We also examined how many participants showed a change in PHQ-9 category from pre- to post-psychotherapy. Results The mean baseline score was 11.49 (SD = 6.92) vs. mean post-psychotherapy score 8.54 (SD = 6.45). The mean group difference score was significantly different from zero (mean = -2.95, SD=5.72), t(145)=-6.23, p&amp;lt; 0.001, [95% CI = -3.88 to -2.01]. The negative mean difference indicates a decrease in depressive symptoms. When examining changes in depression category, 50.7% of patients moved to a less severe category of depression after psychotherapy, 13.7% of patients moved to a more severe category, and 35.6% did not change. Conclusions These results support psychotherapy as a measurable benefit to some, but not all individuals undergoing specialized burn care. Burn centers should consider having a full-time burn- and trauma-trained psychotherapist on staff to complete assessments on admission. Continuity of mental health care in burn centers has the potential to positively influence patient outcomes. Applicability of Research to Practice Cognitive behavioral therapy is used in many different populations. Our findings support the practice of specialized psychotherapy intervention in the burn population as effective in decreasing symptoms of depression in some patients.

Adjunctive Naturopathic Medicine in the Management of Depression and Anxiety Symptoms: A Retrospective Chart Review

Background: Naturopathic medicine uses natural and evidence-based treatments to promote health. The objective of this study was to characterize and evaluate the effectiveness of naturopathic medicine in reducing symptoms of anxiety and depression in patients seeking care from the Mental Health Shift at a Canadian naturopathic teaching clinic. Methods: Charts of 192 consecutive patients who attended appointments between 1 January 2019 and 6 March 2020 were reviewed. Subjects were included if they screened positive on the General Anxiety Disorder 7 (GAD7) or the Patient Health Questionnaire 9 (PHQ9) and attended follow up at least 4 weeks after initial treatment. Results: Of the 22 included subjects, a clinically significant decrease of at least 5 points occurred in 76% of individuals with elevated baseline PHQ9 scores and 59% of individuals with elevated GAD7 scores. Mean PHQ9 and GAD7 scores decreased 7.5 (p&lt;0.0001) and 4.6 (p&lt;0.008) points, respectively. Mild adverse events were reported in 9 charts (41%). No serious adverse events were reported. Most subjects were also in the care of a medical doctor and counsellor. Conclusion: Naturopathic medicine as performed on the Mental Health Shift may be effective in reducing depression and anxiety symptoms as an adjunctive treatment. Further research incorporating comparison groups is warranted.

P1113 Depressive symptoms in ulcerative colitis and Crohn's disease – differences in improvement at 1 year follow-up

Abstract Background Mental health (MH) has been reported to be poorer among patients with inflammatory bowel disease (IBD) than general population. However, it is not known whether MH is more driven by inflammation itself or related to gastrointestinal (GI) symptoms. Also, the dynamics of MH following IBD diagnosis is not well understood. Methods In the Swedish Inception Cohort of IBD (SIC-IBD), patients with Crohn’s disease (CD), ulcerative colitis (UC) and unclassified IBD (IBD-U) as well as symptomatic controls (SC) and healthy controls (HC) filled in Patient Health Questionnaire-9 (PHQ-9), a validated screening tool for depression. Patients completed PHQ-9 at diagnosis and at one year follow-up while the controls completed it once. Disease outcome was defined at one year based on requirement of advanced treatments/ surgery. Results In total, 286 individuals (16 HC, 89 SC, 62 CD, 104 UC, 15 IBD-U) completed the questionnaire at baseline. HC had significantly lower PHQ-9 score, (fewer depressive symptoms), at baseline compared to all the other groups (p&amp;lt;0.01). The baseline PHQ-9 score was not significantly different between SC and CD, UC and IBD-U patients (p=0.06). At one year follow-up, 38 CD and 53 UC patients completed the PHQ-9. Between baseline and follow-up, UC patients had a significant drop in their PHQ-9 score (p&amp;lt;0.0000001), whereas CD patients did not have any significant change in their PHQ-9 score (p=0.06). Furthermore, UC patients had significantly lower PHQ-9 score compared with CD patients at follow-up (p=0.04, Figure 1). Baseline PHQ-9 score was not correlated with calprotectin at baseline neither in UC nor CD patients (p=0.7 and 0.5 respectively). Also, there was no positive correlation between PHQ-9 score change and calprotectin change in either UC or CD patients, and neither baseline nor follow-up PHQ-9 scores were significantly different in patients with poor or good outcome (p&amp;gt;0.05). When analysed separately by sex, there was still no correlation between baseline PHQ-9 score and outcome in neither CD nor UC patients (p&amp;gt;0.05) Conclusion IBD patients have at the time of diagnosis more depressive symptoms than HC, but not different from SC. Depressive symptoms are more related to GI symptoms than IBD specific inflammation or disease outcome. UC patients show more of an improvement in their depressive symptoms one year after diagnosis than CD patients.

Predicting Outcomes of Antidepressant Treatment in Community Practice Settings.

The authors examined whether machine-learning models could be used to analyze data from electronic health records (EHRs) to predict patients' responses to antidepressant medications. EHR data from a Washington State health system identified patients ages ≥13 years who started an antidepressant medication in 2016 in a community practice setting and had a baseline Patient Health Questionnaire-9 (PHQ-9) score of ≥10 and at least one PHQ-9 score recorded 14-180 days later. Potential predictors of a response to antidepressants were extracted from the EHR and included demographic characteristics, psychiatric and substance use diagnoses, past psychiatric medication use, mental health service use, and past PHQ-9 scores. Random-forest and penalized regression analyses were used to build models predicting follow-up PHQ-9 score and a favorable treatment response (≥50% improvement in score). Among 2,469 patients starting antidepressant medication treatment, the mean±SD baseline PHQ-9 score was 17.3±4.5, and the mean lowest follow-up score was 9.2±5.9. Outcome data were available for 72% of the patients. About 48% of the patients had a favorable treatment response. The best-fitting random-forest models yielded a correlation between predicted and observed follow-up scores of 0.38 (95% CI=0.32-0.45) and an area under the receiver operating characteristic curve for a favorable response of 0.57 (95% CI=0.52-0.61). Results were similar for penalized regression models and for models predicting last PHQ-9 score during follow-up. Prediction models using EHR data were not accurate enough to inform recommendations for or against starting antidepressant medication. Personalization of depression treatment should instead rely on systematic assessment of early outcomes.

The effect of cognitive behavioral therapy on depression of people with epilepsy

BackgroundDepression, a common mental problem frequently detected in people with epilepsy (PWE), is a major factor that decreases the quality of life of PWE. The cognitive behavioral therapy (CBT) is the most commonly used non-pharmacological treatment for depressive disorders. The CBT for PWE with depression has not yet been studied in Korea. This study aimed to evaluate the effects of the CBT on depression in PWE in Korea. MethodThis study included 16 PWE with depression who received CBT and 30 control PWE with depression who did not receive CBT. The mean number of CBT sessions per patient was 7.2 in the CBT group. The Beck Depression Inventory-II (BDI-II) and Patient Health Questionnaire-9 (PHQ-9) were administered before and after CBT sessions in the CBT group, whereas PHQ-9 was performed at baseline and follow-up in the control group. The difference in PHQ-9 and BDI-II scores were analyzed between the pre- and post-CBT periods in the CBT group. The difference between baseline and follow-up PHQ-9 scores was compared in the control group. ResultsThere was no significant difference in baseline variables between the CBT and control groups. The PHQ-9 score significantly decreased after the CBT sessions in the CBT group (pre-CBT PHQ-9 = 13.56 vs. post-CBT PHQ-9 = 8.56) but it did not change in the control group (Baseline PHQ-9 = 13.83 vs. follow-up PHQ-9 = 14.67). Twelve PWE had undergone four or more CBT sessions with pre-CBT and post-CBT BDI-II. The BDI-II score significantly decreased after CBT sessions (pre-CBT BDI-II = 30.75 vs. post-CBT BDI-II = 21.5). The CBT decreased the sub-field scores of cognitive and physical-emotional factors as well as suicidal ideation, but the score of sleep problems did not significantly improve. The CBT did not significantly change the seizure frequency. ConclusionThe CBT significantly improved depression in Korean PWE. Therefore, it can be considered a treatment tool for depression in PWE. However, a study with more patients and a fixed number of CBT sessions is recommended to generalize this effect.

Help-seeking during 1-year follow-up in Chinese patients diagnosed with type 2 diabetes mellitus comorbid major depressive disorder.

Previous research has revealed a bidirectional relationship between type 2 diabetes mellitus (T2DM) and major depressive disorder (MDD). A very limited proportion of patients with T2DM comorbid MDD received adequate psychiatric intervention. This study investigated the help-seeking behaviors of patients with T2DM comorbid with MDD during one-year follow-up. At a medical center in China, a cohort of outpatients with T2DM were assessed and diagnosed for comorbid depression at baseline and after one year. The Mini International Neuropsychiatric Interview was used to diagnose MDD, while The Patient Health Questionnaire-9 (PHQ-9) and The Hamilton Depression Scale 17-item (HAMD-17) were used for depression assessment. Mental health help-seeking behaviors of patients during follow-up period were also evaluated. Out of the 203 patients with T2DM at baseline, 114 (56.2%) completed the follow-up. The prevalence of MDD in participants with T2DM was 12.8% at baseline and 22.8% at follow-up. Patients who completed the follow-up had a lower baseline PHQ-9 score (test statistic -2.068, p=0.039), HAMD-17 score (test statistic -2.285, p=0.022) than those who did not complete the follow-up. A total of 26 patients had comorbid MDD during the follow-up period, among which 8 patients (30.8%) voluntarily visited psychiatric clinics, while others did not seek assistance. The level of HbA1c at follow-up was higher in patients who sought help than in those who did not (8.1 ± 1.8% vs. 7.0 ± 0.7%), although the difference was not statistically significant. Voluntary psychiatric help-seeking for Chinese patients with comorbid T2DM and MDD is uncommon. It is crucial to increase awareness of depression among patients and healthcare professionals alike.

Association between depression and risk of type 2 diabetes and its sociodemographic factors modifications: A prospective cohort study in southwest China.

Depression may be associated with the risk of developing type 2 diabetes. The goal of this study was to explore the association of severe of depression with the risk of type 2 diabetes in adults in Guizhou, China. A 10-year prospective cohort study of 7158 nondiabetes adults aged 18 years or older was conducted in Guizhou, southwest China from 2010 to 2020. The Patient Health Questionnaire-9 (PHQ-9) was used to measure the prevalence of depression. Cox proportional hazard models were used to estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) of depression and incident type 2 diabetes. A quantile regression (QR) analytical approach were applied to evaluate the associations of PHQ-9 score with plasma glucose values. A total of 739 type 2 diabetes cases were identified during a median follow-up of 6.59 years. The HR (95% CI) per 1-SD increase for baseline PHQ-9 score was 1.051 (1.021, 1.082) after multivariable adjustment. Compared with participants without depression, those with mild or more advanced depression had a higher risk of incident type 2 diabetes (HR:1.440 [95% CI, 1.095, 1.894]). Associations between depression with type 2 diabetes were suggested to be even stronger among women or participants aged ≥45 years (p < .05). There are significant positive associations of PHQ-9 score with 2-h oral glucose tolerance test blood glucose levels. Depression significantly increased the risk of incident type 2 diabetes, especially in women, participants aged ≥45 years, Han ethnicity, and urban residents. These findings highlighted the importance and urgency of depression health care.

The Impact of Social Determinants of Health on the Identification and Outcomes of Depression in Primary Care

Social determinants of health (SDOH) may significantly impact treatment outcomes for depression in primary care. An analysis of patients in collaborative care was conducted to explore the association between SDOH and depression baseline scores and treatment outcomes as assessed by the Patient Health Questionnaire-9 (PHQ9). Although individuals’ baseline PHQ9 scores did not differ by SDOH flag, there was a direct effect of SDOH on PHQ9 reduction rates. SDOH did not significantly moderate the association between collaborative care treatment and depression outcomes. Individuals flagged with SDOH showed higher depression scores at the end of the treatment despite a higher clinical dosage. Routine screening for SDOH in collaborative care and primary care should be further explored.

Exercise for geriatric psychiatry outpatients: Results from a clinic intervention

BackgroundExercise is a non-pharmacological intervention that may benefit elderly patients with depression, but the effects of an exercise intervention in geriatric psychiatry outpatients have yet to be tested. MethodOutpatients in a geriatric psychiatry clinic participated in a structured exercise intervention of 50 minutes, twice-weekly, over twelve weeks. Depressive symptoms were assessed at baseline and post-intervention using the Patient Health Questionnaire-9 (PHQ-9). ResultsNine participants had baseline and post-intervention PHQ-9 scores. Mean scores were 5.9 and 2.8 at baseline and post-intervention, respectively (p = 0.03). ConclusionsExercise intervention for geriatric psychiatry outpatients may improve depressive symptoms. Evidence from controlled interventions is warranted.

Association Between Depression and Risk of Incident Cardiovascular Diseases and Its Sex and Age Modifications: A Prospective Cohort Study in Southwest China.

To examine possible associations between depression and cardiovascular disease (CVD) incidence and whether demographic factors modified those associations in the Chinese population. This prospective cohort study comprised 7,735 adults aged 18 years or older in Guizhou, China from 2010 to 2020. The Patient Health Questionnaire-9 (PHQ-9) was used to measure the prevalence of depression. Cox proportional hazard models were used to estimated hazard ratios (HRs) and 95% confidence intervals (95%CIs) of depression and incident CVD. We identified 215 CVD cases (including 28 acute myocardial infarction (AMI) and 197 stroke cases) during an average follow-up of 7.07 years. In the multivariable-adjusted model, baseline PHQ-9 score was associated with incident CVD, AMI, and stroke. The HR per 1-SD increase for PHQ-9 score was 1.14 (95%CI: 1.03, 1.26) for CVD, 1.26 (95%CI: 1.01, 1.57) for AMI, and 1.12 (95%CI: 1.01, 1.25) for stroke. Compared with participants without depression, those with any mild or more advanced depression had a higher risk of incident CVD (HR: 1.69, 95%CI: 1.08, 2.64) and AMI (HR: 3.36, 95%CI: 1.17, 10.56). Associations between depression with CVD and stroke were suggested to be even stronger among women and participants aged <65 years (P for interaction <0.05). The effect of depression on stroke tended to be preserved in non-smokers. Depression was associated with a higher risk of incident CVD, AMI, and stroke in adults of Southwest, China, particularly in women, participants aged <65 years, and non-smokers. These findings highlighted the importance and urgency of depression healthcare.

Depression and Perceived Stress After Spontaneous Coronary Artery Dissection and Comparison With Other Acute Myocardial Infarction (the VIRGO Experience)

Data on depression and stress among patients with spontaneous coronary artery dissection (SCAD) are limited. Using data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study, which prospectively enrolled 3,572 acute myocardial infarction (AMI) patients between 18 and 55years of age, we identified 67 SCAD cases. We compared Patient Health Questionnaire-9 (PHQ-9) and 14-item Perceived Stress Scale (PSS-14) scores obtained at baseline, 1 month, and 12months between SCAD and AMI of all other causes. Using longitudinal linear mixed-effects analysis, we compared depression and stress scores between SCAD and other AMI, adjusting for time and selected covariates. Patients with SCAD had lower baseline PHQ-9 scores (6.1 ± 6.0 vs 7.7 ± 6.4 for other patients with AMI, p=0.03), similar 1-month scores, and lower 12-month scores (3.2 ± 4.3 vs 4.9 ± 5.5, p=0.004). At baseline and 1month, patients with SCAD had similar PSS-14 scores to those of other patients with AMI. At 12months, patients with SCAD had lower scores (18.4 ± 8.8 vs 21.5 ± 9.3 for other patients with AMI, p=0.009). After adjustment for cardiovascular risk factors, co-morbidities, and clinical acuity, no differences in PHQ-9 or PSS-14 scores remained between SCAD and other AMI. Similar results were obtained in a subgroup analysis of only women with SCAD and other AMI. In conclusion, patients with SCAD had a relatively lower burden of depression and perceived stress than other patients with AMI, potentially because of fewer co-morbidities and favorable socioeconomic factors. However, given high depression and stress burden in both SCAD and other patients with AMI, routine screening can help identify and treat these patients.

Response to TMS treatment for depression associated with higher levels of psychological well-being

Treatment resistant depression (TRD) is a complex condition associated with a great deal of disability and suffering. The relationship between TRD and psychological well-being (PWB) appears to be more complex than a simple antithesis. Transcranial magnetic stimulation (TMS) is a well-tolerated treatment for TRD. However successful, a drawback for TMS is that it has a lack of predictive biomarkers for treatment response. Our study focuses on the relationship between PWB and treatment resistant depression, and how PWB relates to TMS treatment response. We hypothesized that TMS treatment responders would have higher levels of PWB at baseline. In this study of 21 patients with TRD, we used the Ryff Scales of Psychological Well-Being and Patient Health Questionnaire-9 (PHQ-9). We found a significant relationship between environmental mastery, purpose in life, self-acceptance, and total PWB with baseline depression but no significant correlation between autonomy, personal growth, and positive relations with others and baseline PHQ-9 scores. No Ryff domain of PWB significantly predicted change in PHQ-9 score. Interestingly, however, we found that TMS responders had higher levels of autonomy (M(SD) = 62.10(10.46), p = 0.022) and personal growth (M(SD) = 65.00(11.04), p = 0.007) than non-responders at baseline. These specific aspects of well-being appear to be distinct from depression and particularly important in treatment response. This discovery suggests that assessing PWB might prove clinically useful when assessing future candidates for TMS treatment of TRD. Further research is necessary to evaluate the effects of TMS on PWB since these may be distinct from its effect on depression symptomology.

A Comparative Evaluation of Measurement-Based Psychiatric Care Delivered via Specialized Telemental Health Platform Versus Treatment As Usual: A Retrospective Analysis.

Background and objectiveA significant proportion of the adult population in the United States (US) live with some form of mental illness. The more prevalent conditions of depression and anxiety are typically managed in primary care settings rather than specialty care. The aim of this study was to determine the efficacy of a novel, measurement-driven psychiatric treatment platform delivered via an online telemental health platform as compared to treatment as usual (TAU).MethodsThe TAU dataset and the telemental health platform (Brightside) dataset were constructed based on the total populations of adult patients receiving care for depression from January 2018 through December 2020 (November 2018 through March 2021 for the Brightside group). Patients in both groups had a primary mental health diagnosis of depression and the presence of a positive screen for depression as measured by the Patient Health Questionnaire-9 (PHQ-9) upon initiation of treatment. HITLAB, an independent digital health verification and testing lab, conducted comparative analyses of the two groups using the Chi-square test of independence.ResultsClose to 80% of telemental health platform patients experienced a reduction of 5 or more points from their baseline PHQ-9 score as compared to 52% of TAU patients. The mean reduction in PHQ-9 score was slightly higher in the Brightside group (-11.5) versus the TAU group (-10.1). Chi-square tests of independence [x2 (1, n=6281) = 256.75, p≤0.001] for meaningful reduction and for remission [x2 (1, n=6281) = 105.50 p≤0.001] were highly significant.ConclusionThe telemental health platform patients performed significantly better than those under psychiatric TAU in terms of reduction in symptoms of depression in adults.

Effects of transcranial magnetic stimulation on sleep quality and mood in patients with major depressive disorder.

It is unknown whether sleep quality improvements after repetitive transcranial magnetic stimulation (rTMS) are inherent to the intervention or related to improvements in depressive symptoms. This retrospective study examined sleep quality in patients with major depressive disorder before and after treatment with rTMS, adjusting for age, sex, sedative-hypnotic use, number of rTMS treatments, depression severity, and changes in depressive symptoms. Adults with major depressive disorder underwent a 6-week course of 10 Hz rTMS over the left dorsolateral prefrontal cortex. Patients completed the Patient Health Questionnaire-9 depression rating scale and the Pittsburgh Sleep Quality Index before and after treatment. To limit confounding, analysis of depressive symptoms occurred without item 3 (the sleep item) of the Patient Health Questionnaire-9. Twenty-one patients completed the study, with a mean (± standard deviation) baseline Pittsburgh Sleep Quality Index score of 12.0 (± 3.8), compared to 10.5 (± 4.3) posttreatment (P = .01). The mean baseline Patient Health Questionnaire-9 score without item 3 was 17.3 (± 3.0), compared to 12.2 (± 4.9) posttreatment (P = .0001). Pittsburgh Sleep Quality Index and modified Patient Health Questionnaire-9 changes were uncorrelated in nonadjusted and adjusted linear regression models and in the Spearman rank-order correlation. Mood and sleep quality improved independently after rTMS treatment, even after adjusting for age, sex, sedative-hypnotic use, number of rTMS treatments, and depression severity. These findings suggest that rTMS exerts direct effects on both mood and sleep in patients with major depressive disorder. Collins AR, Cheung J, Croarkin PA, Kolla BP, Kung S. Effects of transcranial magnetic stimulation on sleep quality and mood in patients with major depressive disorder. J Clin Sleep Med. 2022;18(5):1297-1305.

Changes in PHQ-9 depression scores in acute stroke patients shortly after returning home.

Post-stroke depression is a disabling condition that occurs in approximately one-third of stroke survivors. There is limited information on changes in depressive symptoms shortly after stroke survivors return home. To identify factors associated with changes in post-stroke depressive symptoms during the early recovery period, we conducted a secondary analysis of patients enrolled in a clinical trial conducted during the transition period shortly after patients returned home (MISTT). The Michigan Stroke Transitions Trial (MISTT) tested the efficacy of social worker case management and access to online information to improve patient-reported outcomes following an acute stroke. Patient Health Questionnaire-9 (PHQ-9) scores were collected via telephone interviews conducted at 7 and 90 days post-discharge; higher scores indicate more depressive symptoms. Generalized estimating equations were used to identify independent predictors of baseline PHQ-9 score at 7 days and of changes over time to 90 days. Of 265 patients, 193 and 185 completed the PHQ-9 survey at 7 and 90 days, respectively. The mean PHQ-9 score was 5.9 at 7 days and 5.1 at 90 days. Older age, being unmarried, and having moderate stroke severity (versus mild) were significantly associated with lower 7-day PHQ-9 scores (indicating fewer depressive symptoms). However, at 90 days, both unmarried patients and those with moderate or high stroke severity had significant increases in depressive symptoms over time. In stroke patients who recently returned home, both marital status and stroke severity were associated with depressive symptom scores; however, the relationships were complex. Being unmarried and having higher stroke severity was associated with fewer depressive symptoms at baseline, but both factors were associated with worsening depressive symptoms over time. Identifying risk factors for changes in depressive symptoms may help guide effective management strategies during the early recovery period.

Assessment of Computer Assisted Rehabilitation Environment (CAREN) System Use and Mood in Patients With Multiple Sclerosis.

Depression is a common comorbidity in patients with multiple sclerosis (MS) and is associated with decreased quality of life. Identifying treatments that aid psychological and physical rehabilitation in patients with MS provides valuable information for interdisciplinary teams. Seventy-five adults with MS who completed the Patient Health Questionnaire-9 (PHQ-9) and Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health scale during routine physical therapy appointments where the (CAREN) system was used were studied. Data were retrospective and collected via patient-reported outcomes. Group comparisons used 2-sample t tests or Mann-Whitney U tests for continuous variables and Fisher exact tests for categorical variables. To examine self-reported depression, mean ± SD baseline scores were computed and stratified by number of CAREN sessions. Patients with 5 or more sessions seemed to have lower baseline PHQ-9 and PROMIS Mental Health scores; however, no significant differences were found at the univariate level. There were no statistically significant differences in follow-up scores for the outcome measures. Current research evaluating the rehabilitation of patients with MS using the CAREN system is scarce. This pilot study is important to inform prospective studies exploring use of the CAREN system for psychological rehabilitation. Patients with 5 or more CAREN sessions had lower baseline PHQ-9 scores, which may suggest that mood plays a role in the selection of patients for CAREN system use. This study shows that mood is not affected by the CAREN system. More specific research needs to be completed with a more robust sample.

Long-Term Outcomes of Inferior Meatus Augmentation Procedure to Treat Empty Nose Syndrome.

We sought to report the long-term, symptom-focused, prospective outcomes in empty nose syndrome (ENS) patients after undergoing inferior meatus augmentation procedure (IMAP) through use of four validated questionnaires: Empty Nose Syndrome 6-Item Questionnaire (ENS6Q), 22-item Sino-Nasal Outcome Test (SNOT-22), Generalized Anxiety Disorder 7-Item Scale (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). Prospective case series. A single-center prospective case series was performed for patients diagnosed with ENS who underwent IMAP between July 2017 and February 2020. Diagnosis of ENS was based on the following criteria: 1) reported discomfort with nasal breathing and/or paradoxical nasal obstruction after inferior turbinate reduction, 2) a positive ENS6Q score of at least 11, and 3) a positive cotton test. Questionnaire responses were recorded prior to surgery as well as 1, 3, 6, and 12 months postoperatively. Seventeen eligible patients were included. Mean ENS6Q scores were significantly reduced at all postoperative time points (p < .0001, p < .0001, p < .0001, p=.0003). Of the six ENS6Q subdomains, five (suffocation, dryness, sense of diminished airflow, nasal crusting, and nasal burning) were significantly reduced 1-year postoperatively (p < .0001, p=.0004, p=.0136, p=.0114, p=.0080, respectively). SNOT-22 scores were significantly reduced at all time points (p=.0021, p=.0227, p=.0004, and p=.0025). Of the SNOT-22 subdomains, the sleep subdomain was significantly reduced 1-year postoperatively (p=.0432). Low baseline GAD-7 and PHQ-9 scores were recorded at 7 and 9.4, respectively, and although scores at all postoperative time points were reduced, there was no statistical significance. IMAP via implant of cadaveric rib cartilage provides significant, long-term improvements in ENS-specific and general sinonasal symptoms. 4 Laryngoscope, 131:E2736-E2741, 2021.

A non-specialist depression care pathway for adolescents living with HIV and transitioning into adult care in Peru: a nested, proof of concept pilot study.

Adolescents living with HIV (ALWH) are disproportionally impacted by depression, experiencing worse HIV outcomes. Integrated depression and HIV care may support antiretroviral adherence. This study pilot tested for proof of concept a basic depression care pathway for ALWH to inform depression care integration with HIV services in Peru. ALWH were screened for depression with the Patient Health Questionnaire-9 (PHQ-9). Participants with PHQ-9 scores of ⩾10 or suicidal ideation (SI) were eligible for Psychological First Aid (PFA) delivered by non-mental health specialists. Participants with PHQ-9 re-assessments of ⩾20 or SI were referred to specialized services. Twenty-eight (11 female, 17 male) ALWH aged 15-21 years participated; n = 20 (71%) identified as heterosexual. Most (18/28) acquired HIV at birth. Baseline PHQ-9 scores were 0-4, n = 3 (11%); 5-9, n = 9 (32%); 10-14, n = 10 (36%); 15-19, n = 4 (14%); and 20-27, n = 2 (7%). Eleven participants (40%) reported SI. Among participants with PHQ-9 > 4, 92% (23/25) were not severe. Of the 21 (75%) of participants eligible for PFA, n = 9 (32%) accepted at least one session, of which n = 3 (33%) were linked to specialized care. A simple care pathway operationalizing depression screening and non-specialist delivered emotional support is a first step toward integrated depression and HIV care for ALWH.

The relationship between depression and metabolic control parameters in type 2 diabetic patients: A cross-sectional and feasibility interventional study.

Substantial evidence supports a bidirectional relationship between diabetes and clinical depression. However, little is known about the effect of treating one condition on the control of the other. Thus, this study aimed to determine the prevalence of depression among Type II diabetes mellitus (T2DM) patients and to assess the efficacy and feasibility of escitalopram treatment of depression on their metabolic control parameters. T2DM patients attending primary care clinics in the North of Jordan were enrolled in a cross-sectional study during the period from February to December 2019 (n=157). Depressive symptoms were screened utilising the patient health questionnaire-9 (PHQ-9) tool. Metabolic control was assessed by measurement of glycated haemoglobin (HbA1c), triglycerides, cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Patients with moderate to severe depressive symptoms by PHQ-9 (n=58) were interviewed by a psychiatrist to confirm a clinical diagnosis of depression. Eligible depressed patients were administered escitalopram 10mg orally once daily for 3months (n=12). Thereafter, depressive symptoms and metabolic control measures were reassessed. The prevalence of moderate to severe depressive symptoms among T2DM patients, according to PHQ-9, was 36.94%, while the prevalence of clinical depression based on interview was 7.64%. Baseline PHQ-9 scores correlated significantly with baseline levels of HbA1c, HDL, cholesterol and triglycerides. Escitalopram treatment intervention resulted in significant improvement of PHQ-9 scores without significantly improving any of the metabolic control measures. The relationship between depression and T2DM in the context of metabolic syndrome is plausible. However, our results show that escitalopram treatment may not be associated with significant improvement in metabolic control parameters among these patients. Our study has laid the groundwork for future randomised clinical trials with larger sample size and longer follow-up.