Chronic Medical Illness Research Articles

The Relationship Between Emotional Support and Health-Related Self-Efficacy in Older Prisoners.

Objective: To determine whether emotional support, and proportion of emotional support provided by specific sources (e.g., family, other prisoners, clinicians), is associated with health-related self-efficacy among older prisoners. Method: Cross-sectional study of 140 older prisoners age ≥50 with chronic medical illness who completed face-to-face interviews. Logistic regression, controlling for demographic, incarceration, and clinical/behavioral factors evaluated the association between emotional support, operationalized as a score and as a proportion of total emotional support from specific sources, and health-related self-efficacy. Results: Higher emotional support scores, and greater proportion of support from clinicians, were associated with lower likelihood of poor health-related self-efficacy. Those with >50% of their emotional support coming from other prisoners had higher likelihood of poor self-efficacy. Discussion: Among older prisoners with chronic illness, higher emotional support, particularly from clinicians, is associated with lower likelihood of poor self-efficacy; relying on other prisoners for emotional support is associated with poor health-related self-efficacy.

Depression InType2 Diabetic Patients In Al-Diwaniyah Teaching Hospital

Objectives: Depression is commonly found as a comorbid condition in chronic medical illnesses in general, and diabetes mellitus (DM) in particular. Patients with diabetes are twice as likely to suffer from depression as compared to the general population. The aims of the study were to estimate: the prevalence of depression in type 2diabetic patients and its severity, the rate of depression in type 2 diabetes in relation to socio-demographic variables, and to find out the correlation of depression with some diabetes variablesMethods:100 Iraqi patients with type 2 DM compared with 100 persons from general population as control group participated in across sectional study. Participants were interviewed using: a semi-structured interview schedule based on ICD-10, diagnostic criteria for depression ,Beck depression inventory II for severity of depression and socio demographic questionnaire.Results: The prevalence rate of depression in type 2 diabetes was 44%. The rate of depression was higher for females, married, housewife ,those of secondary level education, in age group(50-59),those of poor glycemic control, with long duration of diabetes, in patients on insulin and those with cardiovascular complication.Conclusions: Depression is more common in type2 diabetic patients than in normal individuals. This will necessitate the need for more attention and screening for such conditions, which plays a role in the patients state physically and mentally.Keywords: Depression, Type 2 diabetes mellitus.

Epidemiological and Clinical Characteristics of Streptococcus pneumoniae Infections in a Tertiary Care Center in Bahrain (2010-2014)

Objective: 
 To describe the epidemiology of invasive and non-invasive pneumococcal disease during a 5-year period in a major hospital in Bahrain.
 
 Design and Setting: 
 Retrospective study of cases of pneumococcal diseases among patient ≥ 14 years old during a five-year period (2010-2014), who attended Salmaniya Medical Complex, Bahrain.
 
 Patients and Methods:
 Laboratory data was obtained on Streptococcus pneumoniae isolates. Patients ≥14 years old of age, both inpatient and outpatient with cultures positive for Streptococcus pneumoniae were included. Only samples from blood, cerebrospinal fluid (CSF), pleural fluid, sputum, deep tracheal aspirate (DTA), bronchial wash, eye discharge and middle ear fluid were included. Demographics and clinical records from medical files were then reviewed.
 
 Results:
 A total of 130 culture samples met the inclusion criteria and were analyzed. One-hundred twenty-six patients with pneumococcal disease were identified; with 65% being non-invasive and 35% being invasive pneumococcal disease. Overall, non-bacteremic Pneumonia was the most frequent manifestation, followed by bacteremia. Pneumococcal disease was more common among male patients (62.7%). Mean age was 57.67 (15-95 years). The most common comorbidities were hypertension, Diabetes Mellitus followed by cardiovascular disease. Twenty-seven patients received mechanical ventilation during their admission, 13 patients were admitted to the intensive care unit, and 6 patients developed para-pneumonic effusion as a complication. In-hospital Mortality rate was 13.5%. 
 
 Conclusion: 
 This study supports the current literature where pneumococcal infection is more prevalent in elderly and those with comorbidities. Mortality was related to age, certain chronic medical illness, admission to intensive care unit and need for mechanical ventilation.

The Neighborhood Built Environment and Cognitive Function of Older Persons: Results from the Singapore Longitudinal Ageing Study

Background: We investigated the association of subjective (perceived) and objective (geographical information system [GIS]-based) measures of the neighborhood built environment (BE) attributes with cognitive function among older persons, and the mediating effect of transportation physical activity (TPA) and leisure time (physical, social and productive) activities (LTA). Method: A cross-sectional study of 402 residents aged 55 years and above in the Singapore Longitudinal Ageing Study. Perceived neighborhood BE attributes (residential density, street connectivity, land use mix - diversity, land use mix - access, infrastructure for walking or cycling, aesthetics, traffic safety, and crime safety) and objective GIS measures of walkability and accessibility were related to participants' cognitive global and domain-specific performance measured by Repeatable Battery for the Assessment of Neurocognitive Status (RBANS). Results: Controlling for age, sex, education, race, chronic medical illnesses, self-rated health, Geriatric Depression Scale depression score, POMA measures of balance and gait, and other BE attributes, the subjective measure of land use mix-diversity (standardized coefficient β = 0.161, p = 0.008) and GIS measure of walkability (β = 0.163, p = 0.002) were positively and significantly associated with RBANS global z-score, and immediate and delayed memory recall, visuospatial/ constructional ability and language, except attention. In hierarchical modeling, TPA and LTA attenuated the effect estimates, but the associations remained significant. Conclusion: BE features which increase opportunities and easy access to a diversity of destinations for services and facilities that promote physical, social and cognitively stimulating activities is associated with better cognitive functioning in older people.

End-of-life services for older people in residential care homes in Hong Kong.

Good end-of-life care is needed for older people living in residential care homes with advanced irreversible chronic medical illnesses and cancers. At present, the usual practice of residential care homes is to send older residents to acute care hospitals when they are unwell, and some residents will die in hospital. Dying in hospital without choice for older people may not be in alignment with the principle of 'good death'. There are many barriers for older people to die in the place of their choice, particularly in a residential care home. In the community, to enhance end-of-life care for elderly people living in residential care homes, pilot end-of-life programmes have been organised by community geriatric assessment teams. In 2015, the Hong Kong Hospital Authority started the 'Enhance community geriatric assessment team support to end-of-life patients in residential care homes for the elderly' programme in four clusters. In the hospital setting, an end-of-life clinical plan and end-of-life ward in geriatric step-down hospitals may improve the quality of death of elderly people. In September 2015, the Hospital Authority guideline on life-sustaining treatment for terminally ill people was updated. Among other key end-of-life issues, careful (comfort) hand feeding was first mentioned in the guideline. The possible establishment of enduring powers of attorney for health care decision-making and enhancement of careful (comfort) hand feeding are new developments in the coming years.

The predictive effect of medical illnesses for mental health care in adolescence: a register-based study.

BackgroundAdolescence is a developmentally sensitive stage, during which a medical illness may have an effect on individual development, and vice versa. Chronic medical illnesses in adolescents have been associated with psychiatric symptoms. The aim of the present register-based pilot study was to assess whether, and to what extent, different medical diagnoses predict subsequent use of mental health services among adolescents.MethodsThe study material comprised data on visits to a pediatric clinic by 12- to 16-year-old adolescent patients over a period of 5 years. Altogether, 10,154 visits by 1,781 patients were identified. The associations of the medical diagnoses with a subsequent visit to the adolescent psychiatry clinic were analyzed using logistic regression.ResultsDuring the follow-up period, 299 patients (16.8%) visited or contacted the adolescent psychiatry clinic at least once. Of various diagnoses, the highest odds ratios (ORs) were observed for diabetes mellitus (OR=4.07, p<0.001) and neoplasms (OR=3.29, p=0.047). An association was found between adolescent psychiatry clinic visits and female gender.ConclusionMedical symptoms and illnesses that require a referral to a pediatrician are a marked risk factor for later use of mental health services. The results call for screening for psychological distress among patients with somatic illnesses and prompt referrals to mental health services if required.

Association between oral intake of dydrogesterone during early pregnancy and congenital heart disease: a case-control study

BackgroundCongenital heart disease is the most frequent form of congenital anomaly in newborn infants and accounts for more than a quarter of all serious congenital abnormalities worldwide. A genetic cause is identified in less than 20% of cases of congenital heart disease and in most cases the cause remains unknown. In the context of the health burden of congenital heart disease, the contribution of non-inherited risk factors is important, especially if the disease is caused by a drug that can be avoided during pregnancy. We sought to determine whether maternal dydrogesterone treatment in early pregnancy is associated with congenital heart disease in the infant. MethodsA retrospective case-control study of birth defects and associated risk factors was conducted at Al Rantisi Specialist Paediatric Hospital in the Gaza Strip. Data were obtained and compared between 202 children born with congenital heart disease and a control group of 200 childrenwho did not have congenital heart disease and were randomly selected from the same geographical populations during their admission due to different medical reasons. All children were born in the period of 2010–2013. Data were collected from June, 2013, to December, 2013, by interview with mothers. Dydrogesterone exposure was defined as any reported use during the first trimester of pregnancy. Exclusion criteria included stillbirth, chromosomal abnormalities in the child, and maternal chronic medical illnesses such as diabetes. Binary logistic regression analyses were used to identify any association between drug exposure and congenital heart disease. The study was approved by the human research ethics committee, Ministry of Health, Gaza Strip. Verbal informed consent was obtained from the children's parents. FindingsExposure to dydrogesterone during the first trimester of pregnancy was more frequent among mothers of children born with congenital heart disease (75 of 202) than in mothers of children in the control group (36 of 200; adjusted odds ratio 2·71, 95% CI 1·54–4·24, p<0.001]. InterpretationWe identified a positive association between dydrogesterone use during early pregnancy and congenital heart disease in the offspring. Further studies are needed to confirm these findings. FundingNone.

Advances in Psychotherapy for Depressed Older Adults.

We review recent advances in psychotherapies for depressed older adults, in particular those developed for special populations characterized by chronic medical illness, acute medical illness, cognitive impairment, and suicide risk factors. We review adaptations for psychotherapy to overcome barriers to its accessibility in non-specialty settings such as primary care, homebound or hard-to-reach older adults, and social service settings. Recent evidence supports the effectiveness of psychotherapies that target late-life depression in the context of specific comorbid conditions including COPD, heart failure, Parkinson's disease, stroke and other acute conditions, cognitive impairment, and suicide risk. Growing evidence supports the feasibility, acceptability, and effectiveness of psychotherapy modified for a variety of health care and social service settings. Research supports the benefits of selecting the type of psychotherapy based on a comprehensive assessment of the older adult's psychiatric, medical, functional, and cognitive status, and tailoring psychotherapy to the settings in which older depressed adults are most likely to present.

Tobacco Use Disorder Among Patients With Smoking-related Chronic Medical Disease: Association With Comorbid Substance Use Disorders.

Very little is known of the behavioral vulnerabilities of patients diagnosed with smoking-related chronic medical illness who continue to smoke, potentially worsening morbidity and mortality risks. This study explores the association of tobacco use disorder (TUD) among those with smoking-related chronic medical illnesses with other substance use disorders (SUDs) and risk factors. Among veterans with smoking-related chronic medical illnesses identified from the National Veterans Health Administration administrative records from fiscal year 2012, we compared the characteristics of those with a diagnosis of TUD (International Classification of Diseases, 9th edition code 305.xx; n = 519,918), and those without such a diagnosis (n = 2,691,840). Using multiple logistic regression, we further explored the independent association of factors associated with TUD. SUD prevalence was markedly higher among those with TUD (24.9% vs 5.44%), including alcohol use disorder (20.4% vs 4.3%) and drug use disorder (13.5% vs 2.6%), compared with nonsmokers. On multiple logistic regression analyses, alcohol use disorder (odds ratio [OR] 2.94, 95% confidence interval [CI] 2.90-2.97) and drug use disorder (OR 1.97, 95% CI 1.94-1.99) were independently associated with current TUD diagnosis. Having any single SUD was associated with considerably high odds of having TUD (OR 3.32, 95% CI 3.29-2.36), and having multiple SUDs with even further increased risk (OR 4.09, 95% CI 4.02-4.16). A substantial proportion of people with TUD diagnosis despite concurrent smoking-related medical illnesses are also likely to have other comorbid SUDs, complicating efforts at smoking cessation, and requiring a broader approach than standard nicotine-dependence interventions.

Actigraphy scoring for sleep outcome measures in chronic obstructive pulmonary disease

BackgroundActigraphy is commonly used to measure sleep outcomes so that sleep can be measured conveniently at home over multiple nights. Actigraphy has been validated in people with sleep disturbances; however, the validity of scoring settings in people with chronic medical illnesses such as chronic obstructive pulmonary disease remains unclear. The purpose of this secondary analysis was to compare actigraphy-customized scoring settings with polysomnography (PSG) for the measurement of sleep outcomes in people with chronic obstructive pulmonary disease who have insomnia. MethodsParticipants underwent overnight sleep assessment simultaneously by PSG and actigraphy at the University of Illinois of Chicago Sleep Science Center. Fifty participants (35 men and 15 women) with mild-to-severe chronic obstructive pulmonary disease and co-existing insomnia were included in the analysis. Sleep onset latency, total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE) were calculated independently from data derived from PSG and actigraphy. Actigraphy sleep outcome scores obtained at the default setting and several customized actigraphy settings were compared to the scored PSG results. ResultsAlthough no single setting was optimal for all sleep outcomes, the combination of 10 consecutive immobile minutes for sleep onset or end and an activity threshold of 10 worked well. Actigraphy overestimated TST and SE and underestimated WASO, but there was no difference in variance between PSG and actigraphy in TST and SE when the 10 × 10 combination was used. As the average TST and SE increased, the agreement between PSG and actigraphy appeared to increase, and as the average WASO decreased, the agreement between PSG and actigraphy appeared to increase. ConclusionResults support the conclusion that the default actigraphy settings may not be optimal for people with chronic obstructive pulmonary disease and co-existing insomnia.

Evidence base for Multiple Family Therapy (MFT) in non‐psychiatric conditions and problems: a review (part 2)

AbstractThis article provides an updated overview of the empirical literature regarding Multiple Family Therapy's (MFT) applications to non‐psychiatric conditions and problems. Although the evidence is not as strong for these disorders as for psychiatric disorders, the benefits of MFT approaches are apparent in the following areas: family management of several severe chronic medical illnesses; prevention of educational failure and exclusion; and treatment of marital distress. MFT research in non‐psychiatric settings has been faced with unique challenges that have mitigated the quality and quantity of outcome and process research produced over the past decade. Future research efforts should focus on: (1) stronger commitment to the evaluation of ongoing MFT programmes; (2) identification and manualization of major MFT programmes; (3) more Randomized Clinical Trials (RCTs) on the effectiveness of MFT programmes in community settings; and (4) higher priority for research on MFT's change processes and patterns of interaction.Practitioner points The treatment of chronic physical diseases is optimized by involving family members, and MFT is a valuable way of doing so: workshops delivered in brief formats are most feasible MFT should be considered for non‐psychiatric problems with the risk of isolation and stigmatization. The presence of other families sharing the same challenges is very useful MFT practitioners should attempt to operationalize their MFT model and include an evaluation component in their therapeutic implementation as routine practice

Pre-existing medical comorbidity is not associated with neurological outcomes in patients undergoing targeted temperature management following cardiac arrest.

The prognostic significance of chronic medical illness in comatose survivors of cardiac arrest who undergo targeted temperature management (TTM) remains largely unknown. We sought to assess the association between overall burden of pre-existing medical comorbidity and neurological outcomes in survivors of cardiac arrest undergoing TTM. We analyzed a prospectively collected cohort of 314 patients treated with TTM following cardiac arrest at a tertiary care hospital between 2007 and 2014. Overall burden of medical comorbidity was approximated with the use of the Charlson Comorbidity Index (CCI). Poor neurological outcome at hospital discharge, defined as a cerebral performance category (CPC) score >2, was the primary outcome. Secondary outcomes included death prior to hospital discharge and at 1year following cardiac arrest. Multivariable logistic regression was used to assess the association between CCI scores and outcomes. A poor neurological outcome at hospital discharge was observed in 193 (61%) patients. One hundred and seventy-nine (57%) patients died prior to hospital discharge and a total of 195 (62%) patients had died at 1-year post-arrest. In multivariable logistic regression, elevated CCI scores were not associated with increased odds of poor neurological outcomes (OR 1.04, 95% CI 0.90-1.19, p=0.608) or death (OR 0.99, 95% CI 0.86-1.13, p=0.816) at hospital discharge. No association was seen between CCI scores and death at 1-year post-arrest (OR 1.09, 95% CI 0.95-1.26, p=0.220). Increasing burden of medical comorbidity, as defined by CCI scores, is not associated with neurological outcomes or survival in patients treated with TTM.

Psychosocial aspects of diabetes in pregnancy

AbstractAs treating physicians, we usually focus on the patient's medical condition, forgetting the impact of the illness on the psychosocial aspects of the patient's life. Patients with chronic medical illnesses usually suffer from a lot of psychosocial stress. Diabetes is one such medical condition where numerous studies focus on the physical and medical aspects, but fewer are concerned with the psychosocial experiences and needs of the patients. Transition to motherhood is a major life-changing event for all women. It brings in a big psychological impact on the woman who has to go through this transition with an added medical condition which can affect her pregnancy and also the health and well-being of the unborn child. In this article, we discuss the psychosocial issues faced by a diabetic woman going through the transition from pregnancy to motherhood.

Early-Life Socioeconomic Disadvantage and Metabolic Health Disparities

A quarter of the world's population have metabolic syndrome (MetS). MetS prevalence is stratified by socioeconomic status (SES), such that low SES is associated with higher MetS risk. The present study examined the relative roles of early-life SES and current SES in explaining MetS risk. Participants (N = 354; ages = 15-55 years, M [SD] = 36.5 [10.7] years; 55% female; 72.9% white, 16.9% Asian, 10.2% others) were evaluated for SES and MetS. All were in good health, defined as free of chronic medical illness and acute infectious disease. Using occupational status as a proxy for SES, we recruited roughly equal numbers of participants with low-low, low-high, high-low, and high-high combinations of early-life and current SES. We used the International Diabetes Federation definition for MetS using race- and sex-specific cutoffs for waist circumference, triglyceride levels, high-density lipoprotein cholesterol, blood pressure, and glycosylated hemoglobin levels. Analyses revealed a main effect of low early-life SES on increased MetS risk according to the three separate definitions. They included the traditional MetS diagnosis (odds ratio [OR] = 1.53, confidence interval [CI] = 1.01-2.33, p = .044), the number of MetS components for which diagnostic thresholds were met (OR = 1.61, CI = 1.10-2.38, p = .015), and a continuous indicator of metabolic risk based on factor analysis (F(1,350) = 6.71, p = .010, partial η = .019). There was also a significant interaction of early-life SES and current SES in predicting MetS diagnosis (OR = 1.54, CI = 1.02-2.34). The main effects of current SES were nonsignificant in all analyses. These findings suggest that MetS health disparities originate in childhood, which may be an opportune period for interventions.

Death by Insulin: Management of Self-Harm and Suicide in Diabetes Management.

Suicide is the tenth leading cause of death in Americans of all ages. Presence of a chronic medical illness (e.g. Diabetes mellitus) increases the risk of suicide. The goal of this review is to examine the relationship between diabetes and depression, as well as diabetes and suicide. Earlier this year, the U.S. Preventive Task Force (USPTF) escalated their recommendation for depression to include not only routine screening for depression but additional focus on active follow up that requires measurement based care. As a result, it is important that persons with diabetes are also screened for suicidal ideation in the presence of a mood disorder. Due to the higher risk and access to potentially lethal medications in persons with diabetes, risk mitigation procedures should be in place that includes not only depression and suicide screening but also the use of inter-disciplinary teams. Appropriate medical monitoring is essential following a suicide attempt to avoid death particularly because these patients are prone to repeat attempts.

Effect of Psychiatric Illness on Acute Care Utilization at End of Life From Serious Medical Illness

ContextLittle is known about psychiatric illness and utilization of end-of-life care. ObjectivesWe hypothesized that preexisting psychiatric illness would increase hospital utilization at end of life among patients with chronic medical illness due to increased severity of illness and care fragmentation. MethodsWe reviewed electronic health records to identify decedents with one or more of eight chronic medical conditions based on International Classification of Diseases–9 codes. We used International Classification of Diseases–9 codes and prescription information to identify preexisting psychiatric illness. Regression models compared hospital utilization among patients with and without psychiatric illness. Path analyses examined the effect of severity of illness and care fragmentation. ResultsEleven percent of 16,214 patients with medical illness had preexisting psychiatric illness, which was associated with increased risk of death in nursing homes (P = 0.002) and decreased risk of death in hospitals (P < 0.001). In the last 30 days of life, psychiatric illness was associated with reduced inpatient and intensive care unit utilization but increased emergency department utilization. Path analyses confirmed an association between psychiatric illness and increased hospital utilization mediated by severity of illness and care fragmentation, but a stronger direct effect of psychiatric illness decreasing hospitalizations. ConclusionOur findings differ from the increased hospital utilization for patients with psychiatric illness in circumstances other than end-of-life care. Path analyses confirmed hypothesized associations between psychiatric illness and increased utilization mediated by severity of illness and care fragmentation but identified more powerful direct effects decreasing hospital use. Further investigation should examine whether this effect represents a disparity in access to preferred care.

Improved Sleep, Diet, and Exercise in Adults with Serious Mental Illness: Results from a Pilot Self-Management Intervention.

Compared to the general population, adults with serious mental illnesses have elevated rates of medical morbidity resulting in a reduced life expectancy of approximately 15years. Chronic disease self-management programs for adults with serious mental and chronic medical illnesses show some promise in improving physical health-related outcomes, yet none of them address sleep quality. Poor sleep affects a majority of adults with serious mental illness and is robust risk factor for physical morbidity and premature mortality. This pilot project examined the impact of a 14-week educational and support group that included sleep quality as a cornerstone in promoting wellness and self-management in 78 adults with serious mental illness and poor health. Results provide preliminary data that the self-management program was associated with significant improvements in self-reported sleep quality at post-intervention. At 3-month follow-up, participants reported additional increases in sleep quality as well as in healthy diet and exercise frequency. Addressing sleep quality as part of self-management and wellness programs may be a viable approach to assist adults with chronic mental and physical illnesses to adopt health-promoting changes.

Depression in the elderly with chronic medical illness

BackgroundThere is a bi-directional relationship between depression and chronic medical disorders.AimsThe objectives of our study were to measure the prevalence of depression in the elderly with chronic medical illness in primary care and to determine the socio-demographic and clinical factors related to depression.MethodsWe conducted a descriptive and analytical cross-sectional study of patients aged over 65, followed at the outpatient chronic diseases in Oudhref's district hospital (south of Tunisia) during the month of September 2014. We used two instruments: the activity of daily living (ADL) to determine the degree of autonomy and the geriatric depression scale (GDS) validated in Tunisia.ResultsAt the end of our investigation, 100 chronic disease patients met inclusion criteria. The average age of our population was 75 years. Prevalence of depression was 48%. The most frequent chronic pathology was hypertension (79%), followed by diabetes (70%). In analytical study, we noted no correlation between depression and socio-demographic variables such as age, sex and marital status. Regarding clinical variables, depression was significantly more frequent in patients with sensory impairments (82% vs 18%, P = 0.017), dependent (80% vs 20%, P = 0.002). Regarding chronic disease, depression was significantly more frequent in patients with respiratory disease (80% vs 20%, P = 0.033), a higher number of comorbidities (P = 0.005), who were hospitalised at least once (P = 0.015).ConclusionDepression is common in elderly with a chronic disease. Using screening instruments for major depression by primary care clinicians will help to detect depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Depression screening in primary care patients

IntroductionDepression is a common mental disorder that can be associated with more functional disability than most chronic medical illnesses and the increased reporting of medically unexplained somatic symptoms.AimTo assess the prevalence of depression in a Tunisian population, as well as the associated factors.MethodsWe conducted a cross-sectional, descriptive and analytic study, among 707 subjects consulting in 20 primary care units in Sfax and Tunis, Tunisia. These participants, randomly chosen, were asked to answer a questionnaire after their consent. Depressive symptoms were evaluated using the “Beck Depression Inventory” (BDI).ResultsThe mean age of participants was 39.84 years. Among them, 38.6% had a low educational level (illiterate or primary school level); 45.3% were professionally inactive and 92.9% had a low to medium socio economic level. Medical, psychiatric and suicide attempt histories were reported respectively in 51.2%, 7.6% and 1.8% of cases. According to BDI, a mild depression was noted in 22.9%; moderate 16.1%; severe 4.1%. Among those presenting a moderate to severe depression (MSD), only 16.8% were followed up in psychiatry, 4.2% were receiving antidepressant and 9.8% benzodiazepine. MSD was associated with low educational level (P &lt; 0.001); low to medium socio economic level (P &lt; 0.001); psychiatric histories (P &lt; 0.001); suicide attempt histories (P &lt; 0.001); somatic histories (P &lt; 0.001).ConclusionOur study highlighted a high prevalence of depression that is still under diagnosed and therefore poorly managed. General practitioners should be made aware of the importance of screening for depression in medical patients because it not only complicates their overall medical treatments, but also impedes their physical and social functioning.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Transition to Adult Health Care Services for Young Adults with Chronic Medical Illness and Psychiatric Comorbidity.

This article provides national data on the lack of transition preparation among youth with special health care needs, including those with emotional, behavioral, and developmental conditions. Consumer and provider transition barriers pertaining to inadequate transition support are summarized. In addition, current US transition goals are presented along with health professional recommendations on transition. The Six Core Elements of Health Care Transition, which are aligned with professional recommendations, are reviewed with practice-based lessons learned from quality improvement efforts. The article concludes with a discussion of transition evaluation needs and opportunities.