Chronic Physical Health Problems Research Articles

Postpartum recovery after severe maternal morbidity in Kilifi, Kenya: a grounded theory of recovery trajectories beyond 42 days

IntroductionThe burden of severe maternal morbidity is highest in sub-Saharan Africa, and its relative contribution to maternal (ill) health may increase as maternal mortality continues to fall. Women’s perspective of...

Recognition and Management of Depression in Adults With a Chronic Physical Health Problem in the Acute Medical Setting

AimsTo compare current trust practice to NICE clinical guideline 91. To identify patients with a history of depression or chronic physical illness on admission to acute medical services. To assess such patients for evidence of new or ongoing depression and establish prevalence of depressive symptoms in high risk patient groups. To establish appropriate pathways for referral to mental health servicesMethodsCycle one: Eligible adult medical patients were screened for self-reported symptoms of low mood and anhedonia over the 2 weeks prior to admission. Inclusion criteria required patients to have either a past history of a chronic physical health condition or a past history of depression.For those who answered “YES” to depressive symptoms, clinicians were prompted to refer to mental health services.Intervention:Screening questions were added to the adult medical clerking proforma for routine screening of admitted patients.Patients self-identifying as depressed were triaged as requiring either inpatient liaison psychiatry team support or were referred to Improving Access to Psychological Therapies (IAPT) team on discharge with GP follow up.Acute Medical departmental teaching session held on CG91 and new referral pathway created with input from liaison psychiatry team.Cycle two:Audit cycle repeated, including audit of outcomes following identification of patients with depressive symptoms.ResultsIn cycle one, of 123 patients, 90 were eligible for inclusion (PPHx depression n=39; PMHx chronic physical condition n=51).Of those with a past history of depression, 85% reported YES to current symptoms.Of patients with a chronic physical condition, without prior history of depression, 48% reported low mood or anhedonia in the past two weeks.Following introduction of electronic screening questions, completion rate by clinicians was 65% (eligible patients n=102; PPHx depression n=43; PMHx chronic physical condition n=59). 44% of patients with a chronic physical health problem self-reported symptoms of depression.After local educational meeting, 84% of identified patients had a planned referral to primary or secondary care for further mental health assessment and support.ConclusionAround half of patients with chronic physical health conditions self-report high levels of depressive symptoms, without a known mental health diagnosis or support in place.Screening of patients on admission provides an opportunity for appropriate intervention.Establishing clear referral pathways and ongoing education is needed to ensure all identified patients are referred for further assessment.

Enhancing community integration after incarceration: findings from a prospective study of an intensive peer support intervention for veterans with an historical comparison group

BackgroundThe transition to the community after incarceration presents challenges for returning citizens, including the immediate need to secure housing, employment, and income. Additionally, health care is essential for this population due to high rates of chronic physical health and mental health problems and substance use disorders. There is growing recognition of the need for interventions that support returning citizens as they navigate community reintegration while simultaneously tending to physical and behavioral health needs. We developed and pilot tested a peer support intervention designed to provide social, emotional, and logistic support and promote linkage and engagement in healthcare for returning citizens. We tested the intervention with US military veterans in Massachusetts who were being released from prison and jail. Outcomes related to linkage to and engagement in healthcare were evaluated using an historical comparison group. Engagement in peer support, housing status, and reincarceration rates were monitored for the intervention group.ResultsThere were 43 veterans in the intervention group, and 36 in the historical comparison group. For linkage to primary care within 90 days of release, there were no statistically significant differences between the intervention and comparison groups (58% versus 67%). Intervention participants were significantly more likely to receive substance use treatment than the comparison group (86% versus 19%, p < .0001) and the mean monthly substance use visits was greater in the intervention group (0.96 versus 0.34, p < .007). Engagement in mental health services was greater for the intervention group than the comparison group (93% versus 64%, p < .003). There were no significant differences between groups for emergency department use and hospitalization. At the end of the study period, the majority of intervention participants who had been released for over a year were living in permanent housing (84%). Recidivism among the was low, with 7% re-arrested during the study period.ConclusionsAugmenting reentry support through intensive peer support appears to have substantial benefits for veterans in terms of engaging them in health care and contributing to their longer-term stability, including housing and recidivism. Flexible reentry support such as this intervention may be well suited to meet the widely varying needs of returning citizens.

Hypnotic Regression as an Autoethnographic Modality for Exploring Adverse Childhood Experiences as Proposed Effectors of Chronic Adult Obesity - Selected Case Studies

Much has been written about the aetiological role of Adverse Childhood Experiences (ACEs) in the development of chronic adult physical and emotional health problems but current screening methods utilising questionnaires and formal interviewing often fail to show consensus across populations and surveys. This paper proposes that hypnotic regression might provide an alternative approach to ACE screening through its facility in revealing unsuspected and seemingly minor ACEs, which nevertheless can go on to have long term implications for individuals’ adult health. In this study seven female participants with intractable overweight volunteered to participate in a series of hypnosis sessions designed to explore for possible covert childhood or early adulthood traumatic experiences which might have contributed towards their adult obesity problems. During their hypnosis sessions all participants were seemingly able to recall and to recount, narratives of long-forgotten but intensely painful childhood experiences, traumas and family disharmony, which appeared to have provoked life-changing decisions regarding their weight, body image or eating habits, and which may then have contributed to their developing refractory obesity later in their adult life. This study suggests that current decisions limiting the range of what constitutes ACEs may account for the differing results of previous ACEs surveys and that hypnosis might prove to be a useful tool in screening for otherwise unrecognised ACEs, thus helping to improve the specificity and sensitivity of current ACE screening programmes.

Protocol: the complexity of informal caregiving for Alzheimer's disease and related dementias in rural South Africa.

With aging, many people develop Alzheimer's disease or related dementias (ADRD) as well as chronic physical health problems. The consequent care needs can be complicated, with heavy demands on families, households and communities, especially in resource-constrained settings with limited formal care services. However, research on ADRD caregiving is largely limited to primary caregivers and high-income countries. Our objectives are to analyse in a rural setting in South Africa: (1) how extended households provide care to people with ADRD; and (2) how the health and wellbeing of all caregivers are affected by care roles. The study will take place at the Agincourt health and socio-demographic surveillance system site of the MRC/Wits Rural Public Health and Health Transitions Research Unit in Mpumalanga Province, northeast South Africa. We will recruit 100 index individuals predicted to currently have ADRD or cognitive impairment using data from a recent dementia survey. Quantitative surveys will be conducted with each index person's nominated primary caregiver, all other household members aged over 12, and caregiving non-resident kin and non-kin to determine how care and health are patterned across household networks. Qualitative data will be generated through participant observation and in-depth interviews with caregivers, select community health workers and key informants. Combining epidemiological, demographic and anthropological methods, we will build a rich picture of households of people with ADRD, focused on caregiving demands and capacity, and of caregiving's effects on health. Our goal is to identify ways to mitigate the negative impacts of long-term informal caregiving for ADRD when formal supports are largely absent. We expect our findings to inform the development of locally relevant and community-oriented interventions to improve the health of caregivers and recipients, with implications for other resource-constrained settings in both higher- and lower-income countries.

Specialized Biopsychosocial Care in Inpatient Somatic Medicine Units-A Pilot Study.

IntroductionSpecialized biopsychosocial care concepts are necessary to overcome the dualism between physical and psychosocial treatment in acute care hospitals. For patients with complex and chronic comorbid physical and mental health problems, neither standardized psychiatric/psychosomatic nor somatic care units alone are appropriate to their needs. The “Nuremberg Integrated Psychosomatic Acute Unit” (NIPA) has been developed to integrate treatment of both, psychosocial and physical impairments, in an acute somatic care setting.MethodNIPA has been established in inpatient internal medical wards for respiratory medicine, oncology and gastroenterology. One to two patients per ward are regularly enrolled in the NIPA treatment while remaining in the same inpatient bed after completion of the somatic care. In a naturalistic study design, we evaluated treatment effects by assessment of symptom load at admission and at discharge using the Patient Health Questionnaire (PHQ) and the Generalized Anxiety Disorder Scale-7 (GAD-7). Furthermore, we assessed the severity of morbidity using diagnosis data during treatment. At discharge, we measured satisfaction with treatment through the Patient Satisfaction Questionnaire (ZUF-8).ResultsData from 41 NIPA patients were analyzed (18–87 years, 76% female). Seventy-eight percent suffered from at least moderate depression and 49% from anxiety disorders. Other diagnoses were somatoform pain disorder, somatoform autonomic dysfunction, eating disorder and posttraumatic stress disorder. Hypertension, chronic lung diseases and musculoskeletal disorders as well as chronic oncological and cardiac diseases were the most common somatic comorbidities. Treatment resulted in a significant reduction of depressive mood (admission: M = 10.9, SD = 6.1, discharge: M = 7.6, SD = 5.3, d = 0.58, p = 0.001), anxiety (admission: M = 10.6, SD = 4.9, discharge: M = 7.3, SD = 4.1, d = 0.65, p< 0.001) and stress (admission: M = 6.0, SD = 3.6, discharge: M = 4.1, SD = 2.5, d = 0.70, p< 0.001). Somatic symptom burden was reduced by NIPA treatment (admission: M = 10.9, SD = 5.8, discharge: M = 9.6, SD = 5.5, d = 0.30), albeit not statistically significant (p = 0.073) ZUF-8 revealed that 89% reported large or full satisfaction and 11% partial dissatisfaction with treatment.DiscussionNIPA acute care is bridging the gap for patients in need of psychosocial treatment with complex somatic comorbidity. Further long-term evaluation will show whether psychosocial NIPA care is able to reduce the course of physical illness and hospital costs by preventing hospitalization and short-term inpatient re-admissions.

Stress Measurement in Primary Care: Conceptual Issues, Barriers, Resources, and Recommendations for Study.

Exposure to stressors in daily life and dysregulated stress responses are associated with increased risk for a variety of chronic mental and physical health problems, including anxiety disorders, depression, asthma, heart disease, certain cancers, and autoimmune and neurodegenerative disorders. Despite this fact, stress exposure and responses are rarely assessed in the primary care setting and infrequently targeted for disease prevention or treatment. In this narrative review, we describe the primary reasons for this striking disjoint between the centrality of stress for promoting disease and how rarely it is assessed by summarizing the main conceptual, measurement, practical, and reimbursement issues that have made stress difficult to routinely measure in primary care. The following issues will be reviewed: a) assessment of stress in primary care, b) biobehavioral pathways linking stress and illness, c) the value of stress measurements for improving outcomes in primary care, d) barriers to measuring and managing stress, and e) key research questions relevant to stress assessment and intervention in primary care. On the basis of our synthesis, we suggest several approaches that can be pursued to advance this work, including feasibility and acceptability studies, cost-benefit studies, and clinical improvement studies. Although stress is recognized as a key contributor to chronic disease risk and mortality, additional research is needed to determine how and when instruments for assessing life stress might be useful in the primary care setting, and how stress-related data could be integrated into disease prevention and treatment strategies to reduce chronic disease burden and improve human health and well-being.

An evaluation of the prevalence of physical health comorbidities in patients with severe and enduring mental illness following admission to the general adult psychiatric inpatient wards in Mersey Care NHS Foundation Trust

AimsThis evaluation aimed to establish the prevalence of physical health comorbidities in SMI patients admitted to the general adult wards in Mersey Care NHS Foundation Trust.BackgroundMean life expectancy in individuals with severe and enduring mental illness (SMI) is 15-20 years shorter than that of the general population. A significant proportion of excess mortality in patients with SMI is due to natural causes, e.g. cardiovascular disease and type II diabetes mellitus. Although SMI patients are at greater risk of developing chronic physical health problems, they often receive worse health care than the general population. SMI patients more likely to engage in unhealthy lifestyle behaviours, such as poor dietary choices, smoking and physical inactivity; Antipsychotic medication prescribed to these patients can cause adverse metabolic side effects.MethodA list of all inpatients on the eight general adult wards in the Trust was obtained in September 2020, producing a sample of 135 inpatients.An audit tool was designed, capturing demographic data – gender, age, ethnicity, and also recording whether the patient had a diagnosis of an SMI (e.g. schizophrenia, bipolar affective disorder). The presence of any physical health comorbidities and whether the inpatient was a smoker was also recorded.ResultOf the 135 inpatients, 10 didn't have any physical health monitoring completed and were excluded from the sample, making the final sample 125 inpatients. 68 of the inpatients were male, 57 were female. 98 had a diagnosis of an SMI, 27 did not. Most inpatients were of “white British” ethnicity. Of the 98 SMI patients, 14 had type II diabetes mellitus, 11 had essential hypertension, 12 had chronic obstructive pulmonary disease and 22 were obese (i.e. a BMI &gt; 30 kg/m2). 70 of the 98 patients with an SMI were smokers.ConclusionAs expected, a significant proportion of patients with SMI admitted to the general adult inpatient wards are smokers. Whilst admission to hospital may not be considered an ideal time to get patients to consider quitting smoking, admission does at least provide an opportunity to educate patients on the negative effects on physical health that smoking has. This evaluation has highlighted that physical health comorbidities are common in this patient group. Admission to the psychiatric ward provides a golden opportunity to provide education to patients on the importance of making healthy lifestyle choices and also to assess any physical health comorbidities and ensure the management of any such comorbidities is optimised prior to discharge.

An audit to assess physical health monitoring of patients following their admission to the general adult psychiatric inpatient wards in Mersey Care NHS Foundation Trust

AimsThis audit aimed to establish whether patients undergo physical health monitoring within 24 hours of admission to one of the general adult inpatient wards in Mersey Care NHS Foundation Trust, as per Trust policy.BackgroundMean life expectancy in individuals with severe and enduring mental illness (SMI) is 15-20 years shorter than that of the general population. A significant proportion of excess mortality in patients with SMI is due to natural causes, e.g. cardiovascular disease and type II diabetes mellitus. Although SMI patients are at greater risk of developing chronic physical health problems, they often receive worse health care than the general population. Shared care of SMI patients between primary and secondary healthcare professionals causes uncertainty over who is responsible for monitoring the physical health of these patients.MethodA list of all inpatients on the eight general adult wards in the Trust was obtained in September 2020, producing a sample of 135 inpatients.An audit tool was designed, capturing demographic data – gender, age, ethnicity. The patient's psychiatric diagnosis was recorded. The tool captured whether each of the following were measured following admission – body mass index (BMI), blood pressure (B.P), serum cholesterol level, QRISK score and HbA1c level, and, if so, whether this was done within 24 hours of admission. For those patients who were smokers, being offered nicotine replacement therapy was documented.ResultOf the 135 inpatients, 10 didn't have any physical health monitoring completed and were excluded from the sample, making the final sample 125 inpatients. 68 of the inpatients were male, 57 were female. 98 had a diagnosis of an SMI, 27 did not. Most inpatients were of “white British” ethnicity. 91% of the sample had a BMI measured within 24 hours of admission, but only 62% had a B.P done, 59% had a serum cholesterol level done and 58% had an HbA1c level done within 24 hours of admission. 78% of eligible patients had a QRISK score calculated. 97% of inpatients who were smokers were offered nicotine replacement therapy, but only 13% accepted it.ConclusionThe majority of patients admitted to the general adult inpatient wards have an SMI. The audit findings show need for improvement in physical health monitoring following admission. Creation and implementation of a checklist of physical health parameters to be measured within 24 hours of admission could help improve performance. Use of motivational interviewing may help increase uptake of nicotine replacement therapy in smokers.

Physical Health Problems Among People With Severe Mental Illnesses: Race, Gender, and Implications for Practice.

BACKGROUND: Individuals with severe mental illnesses experience high rates of chronic health conditions; however, the extent to which risk of chronic physical health problems varies by race and gender among these individuals is understudied. AIMS: This study examines variations in health problems by race and gender among individuals with severe mental illnesses. METHOD: Administrative data, which included blood pressure, body mass index (BMI), and glycated hemoglobin (HbA1c) values, were obtained from 603 individuals with serious mental illnesses who received integrated health and behavioral health services from a large mental health agency in the Midwest. Bivariate and multivariate statistical models were used to examine variation in physical health problems by race and gender. RESULTS: Compared with men, women with severe mental illnesses were more likely to have BMI levels indicating obesity or morbid obesity (p < .001). Compared with White participants, Black participants were less likely to have high HbA1c levels (p < .001) but were more likely to have high blood pressure (p < .001). Among race and gender groups, Black women were more likely to have high BMI (p < .05), Black men were more likely to have high blood pressure (p < .001), and White men were more likely to have high HbA1c levels (p < .01) when holding constant all other variables. CONCLUSIONS: There is evidence that types and severity of physical health problems among individuals with severe mental illnesses varies by race and gender. Replication of these results and more research is needed to ensure that health-related education and integrated health and behavioral health interventions meet the needs of individuals with serious mental illnesses.

Being and doing in the outdoors brings something extra! Evaluating the Danish Healthy in Nature Project

ABSTRACT Purpose Little is known of the potential of using nature and outdoor activities in relation to community-based health promotion programmes. This study seeks a better understanding of how people with mental or chronic physical health problems experience a local outdoor health promotion or rehabilitation programmes and a better understanding of how these programs contribute to the participant’s health and well-being. Methods The study is based on data from the Healthy in Nature project targeting adults with chronic physical health problems and adults with mental health problems. Data was collected using a qualitative multiple case study design involving five selected cases with both qualitative interviews and observation. Data was analysed using Braun et al.’s 6-phase guide to qualitative reflexive thematic analysis, employing Self-DeterminationTheory as a theoretical framework. Results: Overall, the participants in the two groups experienced increased competence, autonomy, and relatedness, and the participants expressed the importance of both being in a natural environment and doing outdoor activities (friluftsliv). Conclusions The study makes a valuable contribution to the field of health promotion and rehabilitation pointing tonature and friluftsliv as important elements that offer great potential tocommunity-based health promotion.

Health Status of Elderly People Living in Old Aged Homes in Pokhara

Background: Health is serious matter for the elderly people especially living in old aged homes. In this context, this study has tried to explore the health status of elderly people living in old aged homes.&#x0D; Methods: Information were collected from fifty seven elderly people living in purposively selected three major old aged homes of Pokhara by using structured questionnaire through interview techniques. The elderly people, who were unable to speak, hear, complete the interview process, have severe psychiatric disorder, did not have verbal consent to participate were excluded from the study. Descriptive analysis was carried out for this research.&#x0D; Results: Majority (87.7%) of the respondents had chronic physical health problem like back pain problem as major followed by other musculoskeletal problems, gastrointestinal disease, hypertension, respiratory problem, diabetes mellitus, heart disease, eyes and ears problem. The proportion of female was higher than male regarding their chronic physical health problem. Majority went to hospital when they were sick. Half of the respondents were worried about economic insecurity followed by lack of social relation, lack of treatment during illness, fear of future, lack of recreational activities, food management of old age homes, environment of elderly official, sitting and sleeping environment of elderly home and others respectively. All the respondents prayed god to cope with these stress followed by listening to religious hymns, go to religious places, solitary living, crying alone, and take cigarettes/alcohols.&#x0D; Conclusions: Health status of elderly people living in old aged home was not good since most of the elderly were suffered from chronic physical health problem. Females are more vulnerable.

Positive Mental Health and Self-Care in Patients with Chronic Physical Health Problems: Implications for Evidence-based Practice.

The capacity for self-care and positive mental health (PMH) has an influence on well-being and on one's approach to chronic illness. The aim was to determine the level of PMH and self-care agency as well as the relations among sociodemographic variables, PMH, and the level of self-care among patients with chronic physical health problems. We also examined correlations between PMH and self-care agency. A descriptive, cross-sectional correlational study was conducted with a sample of 209 patients at a primary care center. The instruments used were the Positive Mental Health Questionnaire and the Appraisal of Self-Care Agency scale. The STROBE statement was used. Significant differences were found in the PMH factors in relation to sociodemographic variables and health conditions. Suffering one or more chronic diseases was associated negatively, and significantly, with the capacity for self-care. The four most prevalent chronic health problems in the sample were hypertension, hypercholesterolemia, obesity, and diabetes mellitus. In people with chronic physical health problems, there is a positive relationship between PMH and self-care capacity. An increase in the possibility of caring for oneself saw an increase in PMH; conversely, an increase in PMH brought with it an increased capacity for self-care as well. Therefore, if actions are taken to increase PMH, the capacity for self-care will also increase.

Quality of life and its predictors among aging people in urban and rural Nepal.

We studied the quality of life (QoL) of the elderly in Nepal and their special needs. Nepal is a low- and middle-income country where the elderly population is growing significantly. A random selection of informants from the Kavre district was carried out in this cross-sectional, population-based, door-to-door survey. The district has a mixture of urban and rural communities. In Nepal, families generally take care of their elderly. Hardly any placement is made in institutions. A validated Nepali version of World Health Organization Quality of Life 8-question scale (WHOQoL-8) estimated QoL among the elderly (≥ 60years; N = 439). Other variables of interest were socio-demographics, substance use, physical and psychological health, and family support. Depression was measured by Geriatric Depression Scale short form [GDS-15]. Due to a high illiteracy rate, a structured and culturally adapted questionnaire was presented in an interview format. The relationships between the variables and QoL were analyzed using independent sample t tests, linear regression and Pearson's correlations. The mean QoL score was 25.7 (± 4.2); 49.2% rated their QoL as good. Positive predictors of QoL were: urban residence (p = 0.03); employment (p = 0.02); absence of chronic physical health problems (p = 0.02); absence of depression (p < 0.001); adequate time given by family (p = 0.001), and reports of non-abusive family relationships (p < 0.001). A negative correlation was found between geriatric depression and the QoL score (r = - 0.697; p < 0.001). QoL of the elderly in Nepal may potentially improve by care directed towards their physical and psychological health, by strengthening family relations, and by financial independence.

A call to action to address COVID-19-induced global food insecurity to prevent hunger, malnutrition, and eating pathology.

The coronavirus 2019 disease (COVID-19) pandemic has led to food shortages, increased food prices, and loss of income. As a result, global food insecurity alerts have been issued. The pandemic threatens millions of children and adolescents and their families currently living with or at risk for development of food insecurity. The lack of consistent access to nutritious food sources is associated with chronic physical and mental health problems and death. Studies on food insecurity and eating pathology have heightened our concern about the impact the added effect of the pandemic may have on eating behaviors of children and adolescents. Here, we want to draw attention to the need for making food security and healthy eating attitudes and behaviors a global priority during the COVID-19 pandemic to guarantee the current and future health and well-being of our children and adolescents.

Effectiveness of autogenic training on psychological well-being and quality of life in adults living with chronic physical health problems: a protocol for a systematic review of RCT

BackgroundAutogenic training is a relaxation technique that uses systematic exercises to induce a general disconnection of the organism. It is used in conjunction with conventional medical care as part of disease management to relieve symptoms associated with chronic health problems and to improve well-being. The purpose of this systematic review is to evaluate the efficacy of autogenic training on psychological well-being, quality of life, and adverse effects in people living with chronic physical health problems.MethodsThe methodology used follows the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Studies, published up to December 31, 2019, will be identified through searches in the following databases: MEDLINE, Web of Science, EMBASE, SCOPUS, PsychINFO, CINAHL, EBM Reviews, Google Scholar, Dissertations & Theses Global, Open Access Theses and Dissertations, OpenGrey, E-Theses Online Service, Grey Literature Report, eScholarship@McGill, Papyrus, and CorpusUL. All studies of randomized controlled trials that assess autogenic training as an intervention to improve psychological well-being and quality of life in adults aged 18 and older living with one or more chronic physical health problem will be considered eligible. The study selection, the data collection, and the evaluation of the risk of bias will be conducted independently and in duplicate by two reviewers. RoB 2 tool will be used to assess the risk of bias. Discrepancies will be resolved through discussion. A tabular and narrative synthesis of data is planned, and a meta-analysis will be done according to the quality of data. The primary outcomes will be general psychological distress, depression, and anxiety, and the secondary outcomes will be quality of life and adverse effects. The present protocol of systematic review is reporting following MECIR standards for the reporting of protocols and the PRISMA-P recommendations.DiscussionAutogenic training appears to be a promising therapy to improve psychological well-being and quality of life in people living with chronic physical health problems, but no recent reports have synthesized the available evidence in this population. The results of this review will examine and synthesize the evidence on the benefits and harms of autogenic training on psychological well-being and quality of life in people living with chronic physical health problems, thus supporting the development of best practices for complementary approaches.Systematic review registrationPROSPERO CRD42018105347.

Prevalence, 12-Month Prognosis, and Clinical Management Need of Depression in Coronary Heart Disease Patients: A Prospective Cohort Study

Background: Screening for depression in patients with coronary heart disease (CHD) remains controversial. There is limited data on the actual depression management need in routine care. The aim of this study was to examine the prevalence, treatment rates, prognosis, and management need of clinical and subclinical depression in CHD patients according to the American Heart Association recommendations and the National Institute for Health and Care Excellence (NICE) guideline “Depression in Adults with a Chronic Physical Health Problem”. Methods: Patients were recruited at 2 German university clinics between 2012 and 2014. Depressive disorders were assessed according to the DSM-IV and depressive symptom severity at baseline and during follow-up was evaluated with the Patient Health Questionnaire (PHQ-9). Depression management need was determined by the severity and longitudinal course of depression symptoms. Results: Of 1,024 patients (19% women), 12% had clinical depression (depressive disorder) and 45% had subclinical depression (PHQ-9 score ≥5) at baseline. Among those with clinical depression, 46% were in treatment at least once during 12 months; 26% were continuously in treatment during follow-up. Depressive disorder and depressive symptoms were significant risk factor-adjusted predictors of the 12-months mortality (adjusted HR = 3.19; 95% CI 1.32–7.69, and adjusted HR = 1.09; 95% CI 1.02–1.16, respectively). Depressive symptoms persisted in 85% of the clinically depressed and in 47% of the subclinically depressed patients. According to current recommendations, 29% of all CHD patients would require depression management within 1 year. Conclusions: There is a need for enhanced recognition, referral, and continuous and improved clinical management of depression in CHD patients.

Sleep quality and perceived health in college undergraduates with adverse childhood experiences

BackgroundResearch demonstrates that poor sleep quality is a predictor of chronic mental and physical health problems. The link between adverse childhood experiences (ACEs) and poor health outcomes is also well established; however, few studies have examined the relationships between ACEs, sleep quality, and physical and mental health. MethodsThe current study used structural equation modeling to assess the direct and indirect relationships between ACEs, sleep quality, symptoms of depression and anxiety, and general health perception in a sample of college undergraduates (N = 399), a group of individuals whose age is notable for only recently transitioning out of childhood. ResultsIndirect (ie, mediation) effects indicated with 95% confidence that sleep quality mediated the relationship between ACEs and general health perception, depressive symptoms, and symptoms of anxiety. Sleep quality did not account for the entire relationship between ACE score and these health outcomes, indicating partial mediation. When reversing the mediator and outcome variables, depression and anxiety fully mediated the relationship between ACE score and sleep quality. ConclusionThe results of this study suggest that sleep quality may be an important intermediary mechanism by which ACEs might contribute to poor health outcomes and especially poor general health perception. Prospective longitudinal research is needed to examine the directionality of the relationships between ACEs, sleep quality, and physical and mental health outcomes over time.

The Impact of Individual and Parental American Indian Boarding School Attendance on Chronic Physical Health of Northern Plains Tribes.

This study investigated the relationship of American Indian boarding school attendance and chronic physical health. We hypothesized boarding school attendance would be associated with an increased number of chronic physical health problems. We also examined the relationship between boarding school attendance and the 15 chronic health problems that formed the count of the chronic health conditions. American Indian attendees had a greater count of chronic physical health problems compared with nonattendees. Father's attendance was independently associated with chronic physical health problems. Attendees were more likely to have tuberculosis, arthritis, diabetes, anemia, high cholesterol, gall bladder disease, and cancer than nonattendees.

Multicentre cross-sectional clinical evaluation study about quality of life in adults with disorders/differences of sex development (DSD) compared to country specific reference populations (dsd-LIFE)

BackgroundPrevious studies in quality of life (QOL) in individuals with disorders/differences of sex development (DSD) have been restricted to subpopulations of the condition. We describe QOL in adult persons with DSD compared to country specific references and assess the impact of diagnosis.MethodsThe multicentre cross-sectional clinical evaluation (dsd-LIFE) took place in 14 specialized clinics in six European countries. Adolescents (≥16 years) and adults having a DSD condition were included from 02/2014 to 09/2015. The main outcome QOL was measured by the WHOQOL-BREF (domains of physical health, psychological, social relationships, and environment). QOL was compared to country specific reference populations by using unpaired t-tests. Linear regression models explained the additional variance of the diagnosis on QOL.ResultsThree hundred one individuals with Turner Syndrome, 219 with Klinefelter Syndrome (including XYY), 226 with 46,XX CAH and 294 with rare DSD conditions (gonadal dysgenesis, androgen insensitivity syndrome, severe hypospadias, and androgen synthesis errors or other diagnosis) took part. Compared to healthy European populations, QOL was similar in psychological, slightly worse in physical health, and slightly better in environment. In social relationships, QOL was significantly poorer compared to healthy and non-healthy reference populations. In linear regression models health status was the most important predictor of QOL; additional variance was explained by feelings about household’s income in all domains, and the relationship status in social relationships. Diagnosis explained nearly no additional variance.ConclusionsExcept for social relationships, most people with DSD adapt well to their life circumstances and report a good QOL. Not diagnosis, but the individual’s health status is much more important than previously thought. Therefore care for people with DSD should focus more on chronic physical or mental health problems both related and unrelated to the diagnosis itself.Trial registrationGerman Clinical Trials Register DRKS00006072.