Beck Depression Inventory For Primary Care Research Articles

Espiritualidade, religiosidade e saúde mental durante a pandemia de COVID-19

Abstract Objective: Depression and anxiety were disorders evidenced during the - Coronavirus disease19 pandemic. In this study, these conditions were evaluated as a function of Spirituality/Religiosity, as well as private prayer practices and attendance at religious spaces. Spirituality and religiosity have been widely investigated as health promoters. Methods: A sample of 1,293 participants completed the Beck Depression Inventory Primary Care, the State-Trait Anxiety Inventory, the Religious Spiritual Coping Brief Scale, and a sociodemographic questionnaire. The group was separated into Spirituality/Religiosity levels, prayer practices, and attendance at religious centers. Results: An ANOVA concluded that those who pray alone daily develop lower anxiety traits (F (8,133) = 7.885, p < 0.001) compared with individuals who pray once or twice a year. Participants who self-declared to be very spiritual exhibited fewer depressive symptoms (M = 2.57, SD = 2.88) compared to non-spiritual participants (M = 4.29, SD = 4.07, p < 0.001). Conclusion: In summary, Spirituality/Religiosity can positively impact mental health.

Longitudinal Impact of Social Restrictions on Sexual Health in the Italian Population

BackgroundSeveral trials have reported on the impact of social restrictions due to SARS-CoV-2 (COVID-19) pandemic on sexual function and psycho-physical well-being. However, data showing modifications of these outcomes over time and at the end of lock-down are scant.AimWe investigated the longitudinal changes in sexual function during social restrictions for COVID-19 pandemic in Italy.MethodsA web-based survey was administered to Italian citizens of legal age via social networks. The Beck Depression Inventory Primary Care, the General Health Survey, Female Sexual Function Index, International Index of Erectile Function, UCLA Loneliness Scale-version 3 questionnaires were used to test mental, physical and sexual well-being. The questionnaires were administered at the beginning of the lockdown (T0), 15 days from the first assessment (T1) and 1 month after the end of the restrictions in 2020 (T2).OutcomesDescriptive statistics and multiple regression analysis were applied to investigate changes in sexual function over and at the end of social restrictions.ResultsData were available for 2543 people (47.2% of men; 43.4% women; 9.4% undefined). Mean age was 48.3 ± 15.1 years for males and 43.9 ± 13.4 for females. Overall, 2.6% reported depressive symptoms according to Beck Depression Inventory Primary Care, 7.4% reported a high level of UCLA loneliness and 19.4% low levels of general mental health. Mild to severe erectile dysfunction was reported by 59.1% of men at T0, while 68.4% of women reported sexual dysfunction. Sexual function levels remain generally unchanged at further follow-up over the social restriction time period (T1), although those who were sexually active at baseline showed a decrease in sexual function scores. At T2, there was an overall improvement in sexual function scores with a rate of severe erectile dysfunction decreasing from 37.1% to 24.1% from T0 to T2 among males and a significant decrease of female sexual dysfunction from 68.4% to 51.2%.Clinical ImplicationsYoung individuals and those with good mental and physical health were more likely to improve sexual function at the end of social restrictions.Strengths & LimitationsValid and reliable questionnaires and longitudinal approach design represent strengths; a large but convenient sample and lack of pre-pandemic baseline data represent limits.ConclusionSocial restrictions due to COVID-19 pandemic led to an increase in sexual dysfunctions in both genders. However, these conditions appeared temporary since an overall improvement was observed at the end of lockdown and especially in younger individuals with higher psycho-physical well-being.Vedovo F, Capogrosso P, Di Blas L, et al. Longitudinal Impact of Social Restrictions on Sexual Health in the Italian Population. J Sex Med 2022;19:923–932.

Virtual Round care model in a Covid-19 Geriatric sub intensive unit

Introduction. Telepresence provides clinicians the ability to monitor patients as well to communicate with all the members of the healthcare staff. Covid-19 Units cope with high complexity in providing care and an integration amount the care team and the patients’ relatives should be carried out to obtained successful outcomes and preventing complication. Virtual rounding (VR) has been successfully applied to cope with this task in the last 2000 years in medical units. Covid-19 patients due to safety rules may be prone to isolation and lack of communication with their family.
 Purpose. The aim of our study was to evaluate the effect of structured virtual round protocol in a geriatric Covid-19 unit on anxiety and depression for the patients and their relatives.
 Methodology. All the patients admitted to the geriatric Covid-19 unit from 1 February 2021 to 30 April were studied. Inclusion criteria to the study were the followings: no severe cognitive impairment (MMSE =>24) or neuro sensorial deficits; informed consent to participate to the study. Forty-nine 49 (75% of patients) met the inclusion criteria. All the subject who were found to be eligible to the study underwent a VR standard protocol of care. VR was consisted with: 1) a video call with a tablet device conducted by a psychologist that established a cooperative communication between the health care staff (nurses and MD, their relatives) at the bed sides; 2) a video call with the patient’s relatives in which it was clearly explained the standard care and the role of each healthcare member was also included. Anxiety and depression levels were assessed for the patients at baseline after the end of the protocol by the Hospital Anxiety and Depression Scale (HADS). Patients’ relatives were investigated for depression at baseline and after the end of the protocol by the Beck Depression Inventory- Primary Care (BDI-PC). The Beck Depression Inventory for primary care has seven items with each item rated on a 4-point scale (0–3). It is scored by summing ratings for each item (range 0–21). Items are symptoms of sadness, pessimism, past failure, loss of pleasure, self-dislike, self-criticalness, and suicidal thoughts and wishes. The Hospital Anxiety and Depression Scale (HADS) is a self- assessment scale found to be a reliable instrument for detecting states of depression and anxiety. The anxiety and depressive sub-scales are also valid measures of severity of the emotional disorder. The questionnaire comprises seven questions for anxiety and seven questions for depression, and takes 2–5min to complete. For both scales, scores less than 7 indicate non- cases, 8-10 mild, 11-14 moderate, 15-21 severe. JMP software by SAS (v.16) was used for the statistical analysis.
 Results. The present study included forty-nine 49 patients (67% male), mean age of 69.9 ±14.7 years with one relative for each patient. The average mean of the hospitalization for each patients was 17.6 ± 5.7 days The mean VR duration time was 60±5.5 minutes. VR showed a significant decrease in both Anxiety and depression for patients: (HADS Depression baseline 10.6 ±3.1 vs 6.9 ±2.7 end p<0.01) (HADS Anxiety baseline 10.2 ±3.4 vs 6.8 ±3.0 end p<0.01). VR has also reduced depression in the relatives of patients (BDI-PC 3.6 ±2.4 vs 1.9 ±1.9 p<0.01).
 Discussion. VR has reduced anxiety and depression in patients hospitalized in a sub-intensive COVID 19 unit and it also has been found to be effective in decreasing depression in the relatives of these patients
 Limitation. However, the study has some possible limitations considering its small size and that it was mono centric
 Conclusions. Our data confirm the efficacy of VR in the sub-intensive care setting. This evidence supports the key role of a multidisciplinary team, focusing on the importance of social and psychological support during the hospital stay. 
 More studies will be consequently necessary to better validate the importance of VR as a standard care tool in intensive/sub- intensive care units for the elderly patients

The Prevalence of Pandemic Anxiety, Anxiety and Depression During the COVID-19 Pandemic in Turkey.

This prevalence study involved participants from various cities in Turkey was conducted in April 2020, during the coronavirus pandemic in Turkey, with a view to evaluate the pandemic-related anxiety, generalized anxiety, and depression in the society. The study was conducted with 1267 people in more than 70 cities in Turkey. The study data were obtained by means of online data collection forms, due to the risks posed by the contagious COVID-19 disease in face to face interviews. The Demographic Properties Form, the Utkan Pandemic Anxiety (UPA) scale, the Generalized Anxiety Disorder (GAD-7) scale, and the Beck Depression Inventory for Primary Care (BDI-PC) were utilized as data collection tools. The average value for the UPA scale for the sample was calculated as 10.5 ± 0.257 points, for the GAD-7 scale as 5.5 ± 0.153 points, and for the BDI-PC as 3.8 ± 0.095 points. The cut-off threshold for the UPA scale was exceeded by 34%, for the GAD-7 scale by 25.7%, and for the BDI-PC by 30.9% of the sample. It was concluded that the level of pandemic-related anxiety in the community was high, that the level of generalized anxiety and depression had increased in comparison to pre-pandemic times, and that women had a higher risk of pandemic-related anxiety, generalized anxiety, and depression, because they were a group at risk, and also due to the effect of media surveillance and reports.

Physical, Mental and Sexual Health Among Transgender Women: A Comparative Study Among Operated Transgender and Cisgender Women in a National Tertiary Referral Network

Few studies have investigated how physical, mental and sexual function are associated with each other in operated transgender women (oTW). To provide information on the physical, mental and sexual health of oTW in comparison with a group of cisgender women (cisW). An age-matched control study was carried out, recruiting 125 oTW in 7 national referral centers and 80 volunteer women. Beck Depression Inventory Primary Care (BDI-PC), General Health Survey (SF-36), Female Sexual Function Index (FSFI) and operated Male to Female Sexual Function Index (oMtFSI) questionnaires were web-based administered. Data included: age, area of origin, educational level, sexual orientation, years since surgery and hormone therapy. T-test was applied to inspect mean score differences between oTW and cisW, in mental, sexual and physical health; simple correlations and multiple regression analysis revealed how mental, sexual and physical health were concurrently associated in the two groups RESULTS: Response rate 60% (52% oTW, 71% cisW). oTW mean age 38.5 years (SD=9.3), cisW 37.7 years (SD=11.5). Both cisW and oTW reported average values in the range of mental, physical and sexual health. Statistical comparisons revealed no significant group differences in mental and physical health. oTW who referred a worse sexual function also reported worse overall mental well-being and higher levels of depressive symptoms. FSFI scores were negatively associated with years since surgery, but not with age. Multiple regression analysis showed that FSFI Pain accounted for a significant unique variance proportion of risk of depression in oTW. FSFI Sexual Pain was the strongest estimator of inter-individual differences in BDI-PC among oTW (P < .01). No significant differences in the levels of depressive symptoms, physical and mental well- being were found in oTW and cis-W. The relation between depressive symptoms and sexual function in oTW is stronger than in cisW, and sexual pain substantially predicts risk of depression in oTW. The evaluation of outcomes using validated questionnaires and the relatively large sample size. The convenience control group reported mental, physical and sexual health levels within the range of Italian normative data. Since this is a cross-sectional study, we must be careful in drawing conclusions from our results. Sexual pain and lubrication difficulties are the main causes of worse sexual function in oTW, highlighting the importance of perioperative counseling to make surgical expectations realistic and to educate to a proper neovagina management. Vedovo F, Di Blas L, Aretusi F, etal. Physical, Mental and Sexual Health Among Transgender Women. A comparative Study Among Operated Transgender and Cisgender Women in a National Tertiary Referral Network. J Sex Med Rev 2021;18:982-989.

High Health-Related Quality of Life During Dendritic Cell Vaccination Therapy in Patients With Castration-Resistant Prostate Cancer.

BackgroundMaintaining health-related quality of life (HRQoL) is highly desirable during systemic therapies for patients with castration-resistant prostate cancer (CRPC). Patient-reported outcome measures (PROs) were studied in our phase IIa trial on cellular-based immunotherapy with dendritic cells (DC).MethodsWe treated 21 chemo-naive asymptomatic or minimally symptomatic patients with CRPC with maximally three cycles of DC vaccinations (ClinicalTrials.gov, NCT02692976). Here, we report the impact of DC vaccination on HRQoL. PROs were assessed using the EORTC-QLQ-C30, the EORTC-QLQ-PR25, Checklist Individual Strength (CIS20-R), and Beck Depression Inventory Primary Care questionnaires. Short-term and long-term vaccine-related effects on HRQoL were studied.ResultsQuestionnaires were collected at baseline (n=20), week 6 (n=19), week 12 (n=18), week 24 (n=13), week 50 (n=8) and week 100 (n=2). No clinically relevant differences in symptom-related outcome, functioning-related outcome, and Global Health Status were observed directly after the first cycle of DC vaccinations (week 6) and at follow-up (week 12) compared to baseline. HRQoL remained high throughout the vaccination cycle and six weeks afterward. In radiographic non-progressive patients, who continued DC vaccination, high HRQoL scores were observed up to one and two years after study enrolment.ConclusionsPatients with asymptomatic or minimally symptomatic CRPC show high HRQoL throughout DC-based immunotherapy. This is a clinically relevant finding in this older-aged patient population with advanced prostate cancer.

Dispositional pain catastrophising in non-clinical sample: The role of depression, perceived stress and social support

The pain literature highlights the importance of pain catastrophising in understating pain related experiences. Clarifying the pain catastrophising may contribute to better understanding of the pain. This study aimed to understand the relationship between dispositional pain catastrophising and psychosocial variables (i.e., depressive symptoms, perceived stress and social support). Unlike most research, the current study considered pain catastrophising as an outcome. To improve the predictability of dispositional pain catastrophising, participants were asked to complete questionnaires according to their retrospective painful experience (i.e. dental, back pain, etc). A cross-sectional study was conducted among 202 young adults who do not suffer from chronic pain. Outcome measures include the Pain Catastrophizing Scale (PCS), Perceived Stress Scale (PSS), Beck Depression Inventory for Primary Care (BDI-PC), and Multidimensional Scale of Perceived Social Support (MSPSS). Dispositional pain catastrophizing was found to be positively related to depressive symptoms and perceived stress, yet negatively related to perceived social support. When these psychosocial variables were included in the same regression model, perceived social support was no longer a significant factor for pain catastrophizing. Depression was the most important predictor in the model. The findings showed that psychosocial factors may contribute to pain catastrophizing.

Development and validation of a quality of life scale in Familial Mediterranean Fever (FMFQoL)

Objective To develop a valid and reliable quality-of-life (QoL) scale in familial Mediterranean fever (FMF). Methods After producing question pool by using psychometric methods, high-performance questions were obtained according to expert panel. The principal component analysis (PCA) was done with varimax rotation for factor analysis. The final version of the scale (FMF-QoL) was examined for reliability and validity. Internal consistency with Cronbach alpha was calculated. The face, content, convergent and discriminant validity were analyzed. PRAS score used to assess the disease activity. Spearman correlation coefficient (rho) was used to assess the convergent and discriminant validity. Results In our study, 123 FMF patients were recruited. According to the factor analysis the FMF-QoL were represented by 4 factor groups (eigenvalues >1) which were physical impact, social and recreational impact, psychological impact, and impact of sleep. All questions’ factor loadings after Varimax rotation were bigger than 0.5 and the cumulative variance of the scale was 68.11%. The strongest correlation of the FMF-QoL was found with other QoL scales like EUROHIS (rho: −0.64, p < .0005) and Short Form 36 physical functioning subscale (rho: −0.63, p < .0005). The correlations between the FMF-QoL and functional parameters were found to be moderate [Beck Depression Inventory-Primary Care (rho: 0.46, p < .0005), Jenkins Sleep Scale (rho: 0.44, p < .0005), Health Assessment Questionnaire (rho: 0.44, p < .0005)]. FMF-QoL was also correlated with the disease specific measures [PRAS (rho: 0.42, p < .0005), number of attacks in the previous year (rho: 0.44, p < .0005)]. Conclusion A valid, reliable, practical, not time-consuming FMF-specific QoL scale that can be used in the clinical follow-up and treatment of these patients was developed and validated.

P-04-10 Italian Residents in Urology Sexual Health: A Multicentric Study

Several trials have dealt with residents well-being and burn-out, few data are available on residents Sexual Health. We aim to investigate Sexual Health among Italian residents in urology. Female Sexual Function Index (FSFI), Brief Index of Sexual Functioning Male (BISF-M), General Health Survey (SF-36) and Beck Depression Inventory Primary Care (BDI-PC) questionnaires were web-based administered to 299 residents from all of the 25 Italian Residency Programs. Data included: year of training (PGY), location, age, gender, sexual orientation, marital status, children, duty hours. Mean level differences in BDI-PC, FSFI and BISF-M levels for between-people variables such as gender, day/night shifts and children were inspected via ANOVA; correlations between depression and sexual functioning were investigated. Responding rate 49%. Mean age 30.4 (SD 2.2), 83% M, 86% F had stable relationship, 33% engaged to a colleague, 6% had children. 97% heterosexual, 2% bisexual, 1% homosexual. 19% F reported FSFI total score < 26, indicating a possible sexual dysfunction. 33% F, 11% M had a BMI-PC >3, indicating a mild to severe depression level. 64% did night shifts, ANOVAs revealed a significant interaction effect (p < 0.05, eta square =.06) between sexual function and night shifts on BDI-PC levels; F with night shifts reaching a critical mean BDI-PC score of 4.21. Higher BDI scores were associated with lower FSFI Arousal (p< 0.001), higher FSFI Dyspareunia (p< 0.05), lower FSFI total scores (p< 0.05). No correlations between BDI-PC and BISF-M or between sexual satisfaction and PGY, stable relationship and workload.

Pulmonary Rehabilitation Reduces Subjective Fatigue in COPD: A Responder Analysis.

To date, it remains unknown which patients report a clinically-relevant improvement in fatigue following pulmonary rehabilitation (PR). The purpose of this study was to identify and characterize these responders. Demographics, lung function, anxiety (anxiety subscale of the 90-item symptom checklist (SCL-90-A)), depression (Beck depression inventory for primary care (BDI-PC)), exercise tolerance (six-minute walking distance test (6MWD)), and health status (Nijmegen clinical screening instrument (NCSI)) were assessed before and after a 12-week PR programme. Fatigue was assessed using the checklist individual strength (CIS)-Fatigue. Patients with a decline ≥ 10 points (minimally clinically important difference, MCID) on the CIS-Fatigue were defined as responders. Chronic obstructive pulmonary disease (COPD) patients (n = 446, 61 ± 9 years, 53% male, forced expiratory volume in 1 s (FEV1) 43% ± 18% predicted, 75% severe fatigue) were included. Mean change in fatigue after PR was 10 ± 12 points (p < 0.01) and exceeded the MCID. In total, 56% were identified as fatigue responders. Baseline CIS-Fatigue (45 ± 7 vs. 38 ± 9 points, respectively, p < 0.001) and health-related quality-of-life (HRQoL; p < 0.001) were different between responders and non-responders. No differences were found in demographics, baseline anxiety, depression, lung function, 6MWD, and dyspnoea (p-values > 0.01). Responders on fatigue reported a greater improvement in anxiety, depression, 6MWD, dyspnoea (all p-values < 0.001), and most health status parameters. PR reduces fatigue in COPD. Responders on fatigue have worse fatigue and HRQoL scores at baseline, and are also likely to be responders on other outcomes of PR.

Obesity, depression and hip pain.

Up to 64% of the general population reports experiencing chronic pain, with the hip being one of the most frequent sites. An association has been shown between chronic back pain, obesity and depression. To date, a similar association has not been investigated with chronic hip pain. A total of 2,515 subjects were chosen as a representative cross-section of the German population. Each was provided with a questionnaire that included the Regional Pain Scale, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), Beck Depression Inventory-Primary Care and Winkler social class index. Participant height and weight values were obtained from self-reports. Using logistic regression methodology, we analysed the association between hip pain, obesity and increased depression scores. A total of 124 (4.9%) subjects reported chronic hip pain and an additional 39 (1.5%) reported chronic hip pain that was disabling. Hip pain affected 1-5 sites (oligolocular) in 47% of cases, and was widespread (6-19 sites) in 50%. Obesity and increased values on the depression scale were associated with an increased likelihood of chronic hip pain (odds ratio [OR] 2.55 and 8.53, respectively) compared with subjects without pain. Increased values on the depression scale (OR 28.22) increased the likelihood of experiencing disabling chronic hip pain in comparison with pain free individuals. Hip pain is rarely the sole site of pain. Obesity and increased values on the depression scale are associated with chronic hip pain. Increased values on the depression scale are associated with disabling chronic hip pain.

Postpartum depression and affecting factors in primary care.

The aim of this study was to determine the frequency and affecting factors of postpartum depression (PPD) in Edirne city center. This cross-sectional study was conducted among 111 pregnant women in their third trimester in Family Health Centers in Edirne, Turkey. The participants filled out a questionnaire on sociodemographic factors developed by the researchers along with the Beck Depression Inventory for Primary Care (BDI-PC) before childbirth. Women with a probability of depression, determined with the BDI-PC, were excluded, and the remaining 100 participants were applied the Edinburgh postpartum depression scale (EPDS) in the first and second months after childbirth. The frequency of PPD was 14% (n = 14) in the first month and 17% (n = 17) in the second month of delivery. Thus, 24 different mothers out of 100 were determined to have PPD in the first two months after childbirth. The probability of PPD, measured with EPDS, was significantly higher among younger mothers, mothers with unemployed husbands, mothers with lower income, mothers with a health problem of the child, and mothers who do not breastfeed. There was no significant relationship between PPD and mother's education status, marriage age, the age of first labor, PPD after previous childbirth, psychiatric disorders in first-degree relatives, higher number of children, method of delivery, and unwanted pregnancies. PPD is an important community problem. Thus, it is useful to monitor the risky mothers in primary care and screen them with the practical EPDS in order to prevent the negative effects on the baby and the mother.

Turkish adaptation of Kessler Psychological Distress Scale: validity and reliability study

Objective: Psychological distress is defined as emotional damage characterized by symptoms of depression and anxiety. Aim of study is to adapt Kessler Psychological Distress Scale (K10-PDS) to Turkish and to determine its validity and reliability and use it in psychological distress screenings. Methods: K10-PDS was translated into Turkish according to WHO World Mental Health Initiative Interview Translation Guidelines. A Sociodemographic Information Questionnaire, Beck Depression Inventory for Primary Care (BDI-PC) and Turkish K10-PDS were applied to 200 volunteers between 18-77 years old in Family Medicine and Psychiatry polyclinics of Antalya Training and Research Hospital. Turkish K10-PDS were given again to 55 participants for reliability study four days later. Results: Mean of participants' Turkish K10-PDS score was 21.8±10.7. Reliability (Cronbach's alpha) of the Turkish K10-PDS was 0.95. Based on ROC analysis, the area under the curve was found to be 0.958. Spearman-Brown two-quartile test reliability was 0.93, and test-retest correlation coefficient was 0.89. Item-total score correlations ranged between 0.720 and 0.887. At the cut-off point of >20, the sensitivity was 92.0% and specificity was 90.4%. Conclusion: It has been shown that Turkish K10-PDS can be used as a valid and reliable scale for the detection, screening and treatment of depression and anxiety disorders, especially for psychological distress.

Intimate Partner Violence Victimization and Associated Implications for Health and Functioning Among Male and Female Post-9/11 Veterans.

There is increased emphasis on identifying patients who experience intimate partner violence (IPV) in Department of Veterans Affairs and other health care settings. A better understanding of IPV's implications for health and functioning is needed among post-911 Veterans, and especially male Veterans, to inform IPV screening and response. To identify past 6-month IPV experienced among partnered post-9/11 Veterans and examine sex-based associations between IPV and health. A national sample of Veterans completed a survey that included measures of IPV victimization and health. Types of IPV and relationships with health and functioning were examined separately for male and female Veterans. In total, 407 post-9/11 Veterans (52% women) in intimate relationships. IPV victimization was assessed with the Conflict Tactics Scales-Revised. Health and functioning indicators included posttraumatic stress disorder (PCL-5) and depression (Beck Depression Inventory-Primary Care) symptoms, physical health-related quality of life (Short-Form 12-item Health Survey), and occupational functioning (Inventory of Psychosocial Functioning). Nearly two thirds of both men and women reported past 6-month IPV, with greatest endorsement of psychological aggression (65% of men, 59% of women). A total of 8% of men and 7% of women reported physical IPV and 4% of men and 7% of women reported sexual IPV. Psychological aggression was strongly linked with mental health for both sexes and greater occupational impairment for men. Physical and sexual IPV were associated with more severe mental health symptoms for women while physical IPV was negatively associated with physical health-related quality of life for men. Recent IPV victimization, especially psychological aggression, is a key health issue for partnered male and female post-9/11 Veterans. Practice and research implications are discussed.

Prevalence and correlates of pain in fatigued patients with type 1 diabetes

ObjectiveTo investigate the prevalence, location and severity of pain, as well as its association with psychosocial and clinical variables and its impact on functional impairment in fatigued patients with type 1 diabetes. Methods120 severely fatigued patients with type 1 diabetes completed questionnaires on pain (McGill Pain Questionnaire, MPQ; Short Form Health Survey subscale bodily pain, SF-36), fatigue severity (Checklist Individual Strength subscale fatigue severity, CIS), depressive symptoms (Beck Depression Inventory Primary Care, BDI-PC) and functional impairment (Sickness Impact Profile-8, SIP-8). HbA1c and diabetes-related complications were assessed, and physical activity was measured using actigraphy. Results72% of patients reported pain. Muscle, joint and back pain, and headache were most common. Patients with pain were more often female (69 vs. 44%, p=0.013), reported more complications (mean number: 0.7 vs. 0.3, p=0.009) and scored higher on the BDI-PC measuring depressive symptoms (mean score: 3.8 vs. 2.3, p=0.002), compared to patients without pain. Pain was associated with diabetes duration, the number of complications, fatigue severity, depressive symptoms and functional impairment, but not with HbA1c or physical activity. Of patients with pain, 26% reported a high impact of pain. Both pain (β=−0.31, t(117)=−3.39, p=0.001) and fatigue severity (β=0.18, t(117)=2.04, p=0.044) contributed to functional impairment. ConclusionPain was highly prevalent in fatigued patients with type 1 diabetes, although pain impact and severity were relatively low, and the location of some pain symptoms was similar to the location of those in the general population. As pain is related to fatigue and contributes independently to functional impairment, fatigue interventions should address pain.

Reliability and validity of the Italian version of the 14-item Resilience Scale.

BackgroundIn recent years resilience has gained clinical relevance in sociological, psychological, and medical disciplines, and a lot of scales measuring resilience have been developed and have been utilized in the western countries. The aim of the study was to assess the psychometric properties of the Italian version of the 14-item Resilience Scale (RS-14), by describing its validity and reliability. As agreed with the authors of the original English version of the RS-14, it was translated into Italian. Then the standard procedure for back-translation was followed.MethodsIn total, 150 participants among the nursing and professional education students of the University of Insubria of Varese and health workers of the “ASST dei Sette Laghi-Ospedale di Circolo” of Varese were enrolled. The responses to the questionnaires were collected only from the students and the health workers between the ages of 18 and 65 years who gave their consent to participate in the study from April to September 2015. A subsample of 26 students and health workers was retested on the RS-14, 5 weeks after the first assessment. The questionnaires were handed out to 214 people, and 150 sets of questionnaires (70%) were returned, of which eight were subsequently removed because >60% of the answers were missing. In order to ensure anonymity, every completed questionnaire was identified only via a code.ResultsNo significant differences were found between the mean values of the resilience scores between women (76.1) and men (76.3), with unpaired t-test = −0.08 and P=0.93. Similarly, no difference between resilience scores were found between mean age group of 18–25 years (75.3) and 26–65 years (78.7), with t-test = 1.6. The overall Cronbach’s alpha of the RS-14 is 0.88, P=0.10. The RS-14 is negatively correlated with the Beck Depression Inventory-Primary Care Version and the 12-item General Health Questionnaire and positively correlated with the World Health Organization Quality of Life-Brief Version. The test-retest reliability, assessed on the 26 subjects 5 weeks after the first evaluation, highlighted an intraclass correlation coefficient value equal to 0.65. Factor analysis retains three factors, and it considers the factor loadings >0.40: RS-14-06 (‘I am determined’) is loaded on all the factors and RS-14-12 (‘In an emergency, I am someone people can generally rely on’) is not loaded on any factor.ConclusionThis study demonstrates that the Italian RS-14 has psychometric properties with a good level of internal consistency (Cronbach’s alpha = 0.88), an adequate concurrent validity, verified by relationships with the other scales and as it was expected from literature, and an acceptable test-retest reliability.

Perception of community tolerance and prevalence of depression among transgender persons

ABSTRACTThe goal of the study was to examine the association between depression and perceived community tolerance after controlling for various demographic and personal characteristics, treatment receipt, and past experiences with abuse or discrimination. An online survey assessed depressive symptoms among transgender and gender nonconforming individuals. Depression was assessed using the 7-item Beck Depression Inventory for Primary Care (BDI-PC) and the 10-item Center for Epidemiologic Studies Depression (CESD-10) scale. The prevalence ratios (95% confidence intervals) comparing depression in persons who did and did not perceive their area as tolerant were 0.33 (0.20–0.54) for BD-PC and 0.66 (0.49–0.89) for CESD-10. Other factors associated with depression were experience with abuse or discrimination, lower education, and unfulfilled desire to receive hormonal therapy. Depression was common in this sample of transgender and gender nonconforming individuals and was strongly and consistently associated with participants’ perceptions of community tolerance, even after adjusting for possible confounding. The association between desire to receive hormonal therapy and depression is a finding that warrants further exploration. Future research should also assess depression and changes in perception of community tolerance in transgender individuals before and after initiation of gender confirmation treatment.

The impact of body weight and depression on low back pain in a representative population sample.

Low back pain (LBP), obesity, and depression are highly prevalent health conditions. We assessed the relative impact of body weight and depression on different types of LBP in a representative population sample. This is a cross-sectional study. Two thousand five hundred ten subjects aged 14-90 years were randomly selected from the German general population in 2012. Pain sites and duration of pain were assessed by the Widespread Pain Index( WPI), depression by the Beck Depression Inventory Primary Care Questionnaire, disability by the European Organization for Research and Treatment of Cancer questionnaire, and current body mass index (BMI, kg/m(2) ) by self-reported body weight and height. Widespread pain was defined by ≥7/19 pain sites in the WPI. Hierarchical logistic regression analyses were performed with different types of LBP as the dependent variable, and age, gender, lifetime employment status as a worker, number of pain sites, BMI, and depression as independent variables. One thousand six hundred eighty-seven (67.1%) of participants reported no pain. Five hundred six (20.2%) reported chronic LBP and 84 (3.3%) reported disabling chronic LBP. Age (odds ratio [OR] 1.05 [95% confidence interval {CI} 1.04-1.06]), BMI (OR 1.08 [95% CI 1.05.-1.11]), and depression (OR 1.38 [95% CI 1.30-1.49]) independently predicted chronic LPB compared with persons without pain. Age (OR 1.07 [95% CI 1.05-1.09]), BMI (OR 1.07 [95% CI 1.03-1.13]), and depression (OR 1.71 [95% CI 1.55-1.88]) independently predicted disabling chronic LPB compared with persons without pain. Age (OR 1.03 [95% CI 1.01-1.05]), widespread pain (OR 5.23 [95% CI 3.04-9.00), and depression (OR 1.34 [95% CI 1.16-1.55]) independently predicted disabling chronic LPB compared with persons with nondisabling chronic LBP. BMI and depression are modifiable risk indicators for chronic disabling LBP.

Toward Development of a Tinnitus Magnitude Index

The aim of the study was to provide preliminary evidence of a unique "tinnitus magnitude" domain describing intensity of tinnitus perception that will assist in the development of a cognitive-behavioral mediation model of psychological distress associated with tinnitus. A sample of 347 participants with tinnitus was previously recruited from four audiology clinics for the purpose of developing a tinnitus distress measure, the Tinnitus Functional Index (TFI). From the questions used for TFI development, potential tinnitus magnitude items were selected by including those that minimally overlapped with tinnitus reactions. The three items having the least overlap were analyzed retrospectively to assess internal consistency, test-retest reliability, group differences using demographics and tinnitus-relevant descriptive variables, and discriminant validity. The three-item scale was developed in an effort to establish a model for prospective development of a Tinnitus Magnitude Index (TMI) that would assess the magnitude of tinnitus variables independent of reactions to tinnitus. Internal consistency (α = 0.86) and repeated measures tests (r = 0.74, df = 29, p < 0.001) indicate the three-item scale is reliable. Discriminant validity was supported by only moderate correlations (r≥ 0.30 and r ≤ 0.69) of the scale with the Tinnitus Handicap Inventory (r = 0.62), the Beck Depression Inventory for Primary Care (r = 0.38), and the seven independent domains of tinnitus reactions measured using subscales of the TFI (r = 0.49 to 0.72). Correlations between the scale and two tinnitus reactions (distress) subscales were high (r > 0.70) as compared with moderate correlations. This study involved a retrospective analysis of data from questions that were originally evaluated for use in a tinnitus outcome questionnaire. The analysis was conducted to establish a model for prospective development of a TMI. Results of this analysis suggest that a TMI can be developed that would provide a reliable and valid measure of tinnitus magnitude that overlaps minimally in content with measures of cognitive, behavioral, and emotional tinnitus reactions. A fully validated TMI would provide a measure of tinnitus magnitude that is not confounded by emotional reactions to tinnitus or general depressive symptoms and would be useful in developing a testable model of psychological distress due to tinnitus. Although the primary goal is to develop a measure of tinnitus magnitude that predicts cognitive, behavioral, and emotional reactions to tinnitus, a TMI may also have utility in assessing this construct in clinical settings.

Depression screening in uninsured patients in a primary care setting

There is a strong correlation between chronic disease and depression; however, screening patients for depression is not typical in the primary care setting due to factors such as time constraints and the provider's ability to diagnose and manage depression. This study sought to: (1) determine the prevalence of depression in uninsured or underinsured patients with chronic diseases using a screening instrument validated for use in the primary care setting, (2) provide a referral to the patient's primary care provider (PCP) for depression management prior to disease management as needed, and (3) enroll patients for chronic disease management services. The study utilized a cross-sectional design consisting of a self-administered survey and medical record review after physician and nursing appointments. Patients completed the Beck Depression Inventory for Primary Care (BDI-PC) upon program enrollment. Patients that screened positively for depression were referred to the PCP for follow-up services prior to entry into one of the disease management programs. After PCP appointments took place, medical records were reviewed to obtain medical and depression diagnoses, along with mediation recommendations. Forty-one patients were enrolled in the clinic program and completed the depression screening. Eight patients were found to have mild depression and two patients had moderate depression as determined by the BDI-PC, which accounted for 24% of the clinic patients. Four of the patients with mild depression and both patients with moderate depression initiated antidepressant therapy. Additionally, three patients with minimal scores on the screening began medication therapy based on symptoms reported to the PCP. The results of this study suggest that it is feasible to incorporate a depression-screening tool in a primary care setting with further evaluation and follow-up by primary care providers.