Screening For Depression In Patients Research Articles

Long-term cardiac outcomes of depression screening, diagnosis and treatment in patients with acute coronary syndrome: the DEPACS study.

To investigate the impacts of depression screening, diagnosis and treatment on major adverse cardiac events (MACEs) in acute coronary syndrome (ACS). Prospective cohort study including a nested 24-week randomised clinical trial for treating depression was performed with 5-12 years after the index ACS. A total of 1152 patients recently hospitalised with ACS were recruited from 2006 to 2012, and were divided by depression screening and diagnosis at baseline and 24-week treatment allocation into five groups: 651 screening negative (N), 55 screening positive but no depressive disorder (S), 149 depressive disorder randomised to escitalopram (E), 151 depressive disorder randomised to placebo (P) and 146 depressive disorder receiving medical treatment only (M). Cumulative MACE incidences over a median 8.4-year follow-up period were 29.6% in N, 43.6% in S, 40.9% in E, 53.6% in P and 59.6% in M. Compared to N, screening positive was associated with higher incidence of MACE [adjusted hazards ratio 2.15 (95% confidence interval 1.63-2.83)]. No differences were found between screening positive with and without a formal depressive disorder diagnosis. Of those screening positive, E was associated with a lower incidence of MACE than P and M. M had the worst outcomes even compared to P, despite significantly milder depressive symptoms at baseline. Routine depression screening in patients with recent ACS and subsequent appropriate treatment of depression could improve long-term cardiac outcomes.

Implementation and evaluation of depression screening in patients with recently diagnosed coronary artery disease.

IntroductionPatients with coronary artery disease (CAD) are at an increased risk for depression. Additionally, comorbid depression in patients with CAD is associated with increased mortality and worse cardiac outcomes. Screening this patient population for depression is recommended but is not routinely done in practice. The purpose of this quality improvement initiative was to implement a protocol to screen patients with CAD for depression using the Patient Health Questionnaire (PHQ-9). Primary objectives were to determine the frequency of positive depression screens and the frequency of acceptance of mental health (MH) service referral.MethodsPatients with CAD were screened for depression using the PHQ-9 during a hospital admission to the inpatient cardiology unit at the Clement J. Zablocki Veterans Affairs Medical Center. All patients were rescreened for depression at 4 and 8 weeks after discharge. Patients with positive screens for depression were offered referral for MH services, and reasons for decline were documented.ResultsOf the 36 patients screened for depression, 14 (39%) screened positive for depression, including 10 patients at baseline (28%), 3 additional patients (8%) at week 4 after discharge, and 1 additional patient (3%) at week 8 after discharge. Of the 14 patients who screened positive for depression, 3 patients (21%) accepted MH service referral. The most commonly reported reason for declining referral was no perceived benefit.DiscussionThe results of this initiative support the utility of using the PHQ-9 for depression screening in patients with recently diagnosed CAD and offering MH service referral for treatment of comorbid depression.

Different Depression Treatment Recommendations and Adherence for Spanish- and English-Speaking Patients.

National guidelines recommend primary care providers (PCPs) screen patients for depression with a standardized tool and address positive screenings. However, depression prevalence is lower in Latinos (8% to 15%, with Spanish speakers at 8%) than non-Latino whites (22%). As a result of these prevalence differences, PCPs may use ethnicity and language of the patient to determine depression screening behaviors. This study examined standard of care (SoC) depression treatment recommendations by ethnicity and language for patients who screened positive for major depression during a medical visit. 275 patients scored ≥10 on the Patient Health Questionnaire-9 screening; a chart review assessed treatment referrals, followed by semistructured interviews with 18 patients and 7 PCPs regarding depression treatment behaviors. 138 patients (50%) received SoC treatment recommendations. After controlling for age, gender, and race, a binary logistic regression was performed to determine language and ethnicity effects on SoC depression treatment recommendations (psychotherapy/pharmacotherapy vs other). Spanish-speaking Latinos were 72% less likely to receive SoC recommendations than English speakers (odds ratio [OR] = 0.39). Interviews with Spanish-speaking patients confirmed that negative perceptions about medications, patient noncompliance, and a shortage of bilingual behavioral health providers within the clinic impacted SoC recommendations and uptake. Spanish-speaking Latinos did not receive or follow through with SoC recommendations as often as English speakers regardless of ethnicity. Future studies should explore reasons why language is a barrier to SoC recommendations for Latinos and explore culturally and linguistically sensitive methods to effectively treat Spanish speakers for depression during a medical visit.

986 The Risk of Depression in Patients With Nonalcoholic Fatty Liver Disease

INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States. The association of depression with chronic liver disease is reported in the literature, but the previous studies that established this association were limited in size. Therefore, we aimed in this study is to evaluate the association between NAFLD and depression using very large database. METHODS: Using data from the National Inpatient Sample (NIS) database between 2002 and 2014, we identified all patients who were diagnosed with NAFLD using appropriate ICD 9 coding. The control group was the patients who did not have a diagnosis of NAFLD. We then performed multivariate logistic regression analysis for the association between NAFLD and depression. RESULTS: The total population was comprised of 101,231,036 patients, of which 365,701 (0.36%) were diagnosed with NAFLD. Patients in the NAFLD group were older (53 vs 48), less likely to be females (57.7% vs 58.4%) and African American (9.3% vs 14.3%) (P < 0.001 for all). In addition, NAFLD patients had more obesity (26.2% vs 6.9%), smoking (13.9% vs 9.5%), hypothyroidism (12.2% vs 7.8%) and diabetes mellitus (DM) with or without complications (5.6% vs 3.2%) and (30.7% vs 14.1%) respectively, (P < 0.001 for all). Using Multivariate logistic regression, and after adjusting for potential cofounding factors including: (age, gender, race, obesity, smoking, DM and hypothyroidism), NAFLD group had a statistically significant higher rate of depression (Odds Ratio [OR] 1.75, 95% confidence interval [CI] 1.73–1.77, P < 0.0001) compared with the non-NAFLD group. CONCLUSION: Our analysis of very large nationwide database showed that patients with NAFLD were more likely to have depression compared to patients without NAFLD. This finding highlights the importance of depression screening in patients with NAFLD which can help improve their quality of life.

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.

Evaluation of reliability and validity of the patient health questionnaire-9 in patients with acne

Objective To evaluate the reliability and validity of the patient health questionnaire-9 (PHQ-9) in patients with acne. Methods A total of 300 patients with acne were enrolled from the Department of Dermatology, Affiliated Hospital of Southwestern Medical University from January 2017 to June 2018. Questionnaire survey was conducted among these patients to evaluate their depression status with the PHQ-9 and Hamilton depression scale (HAMD) , and the questionnaire completion time was recorded. The structured clinical interview (SCID) for American Diagnostic and Statistical Manual of Mental Disorders (4th Version) (DSM-Ⅳ) served as the for diagnosis of depression. Reliability analysis of the PHQ-9 was performed using the Cronbach′s α coefficient and one-week test-retest reliability. Factor analysis, Spearman correlation analysis and receiver operating characteristic (ROC) curve were used for validity analysis of the PHQ-9, and the screening validity was also analyzed in different subgroups. Results A total of 258 patients with acne completed all the survey, and 47 were diagnosed with depressive disorder according to the diagnostic gold standard SCID. An optimal cutoff score of 9 was determined for the diagnosis of depression using the PHQ-9, with a sensitivity of 95.7%, a specificity of 88.6%, and an area under the ROC curve (AUC) of 0.973 (95% CI: 0.956-0.990) . In different groups of people, the AUC ranged from 0.886 to 0.955. Validity analysis showed that the correlation coefficient between the total score of PHQ-9 and HAMD was 0.766, and the kappa value was 0.530. Factor analysis revealed that there were two common factors (cognitive-emotion factor and somatic symptom factor) , which explained 65.52% of the total variances. As reliability analysis showed, the Cronbach′s α coefficient of the PHQ-9 was 0.851, the correlation coefficients of the 9 items with the total scale score ranged from 0.550 to 0.709, the inter-item correlation coefficients ranged from 0.224 to 0.654, and the test-retest reliability value of the PHQ-9 was 0.824. The time to complete the PHQ-9 (4.9 ± 1.2 minutes) was significantly less than the time to complete HAMD (44.2 ± 5.9 minutes; t=108.787, P < 0.001) . Conclusions The PHQ-9 shows good reliability and validity for the diagnosis of depression in patients with acne, and can be used for preliminary screening of depression in patients with acne. Compared with the HAMD, the PHQ-9 has obvious advantages of being more timesaving and manpower-saving to make it easier to implement in clinic. Key words: Acne vulgaris; Depression; Questionnaires; Evaluation studies; Patient health questionnaire-9; Reliability; Validity

Depression Rates After Facial Paralysis.

Facial paralysis (FP) has many functional consequences with a large impact on daily life. Although an association with FP and depression has been observed and described in the literature, there are currently no large-scale studies to further validate this correlation. Our goal was to determine whether patients with FP become depressed at a higher rate compared with matched controls. We performed a retrospective cohort study using MarketScan Commercial Claims and Encounters Database by Truven Health. From the database, all inpatient and outpatient claims with International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for FP and depression between 2005 and 2013 were extracted. Patients younger than 18 years were categorized as children and those 18 years or older as adults. Patients were subcategorized as having a history of depression if a diagnosis of depression preceding a diagnosis of FP was noted. We matched each patient to a control in the MarketScan database based on age, sex, and state of residence. We compared rates of depression between these patients and matched controls using conditional logistic regression. The method of Kaplan and Meier was used to estimate cumulative incidence curves of depression by each group. Approximately 57,941 patients were identified with International Classification of Diseases, Ninth Revision, codes for FP. Among children and adult patients without a diagnosis of depression before the index date for FP, 6.4% (285) and 9.7% (4733), respectively, had a diagnosis of depression within 2 years of the diagnosis of FP. Matched controls showed depression rates within 2 years of 3.9% for children (P < 0.001) and 6.1% for adults (P < 0.001). The present study adds to the current body of knowledge on FP and depression given its large sample size and analysis of adult and pediatric populations over 2 years. Indeed, we found that depression rates were significantly increased in both adults and children as compared with matched controls. Our results suggest a need for long-term depression screening in patients with FP.

Abstract TP344: Adding Depression Screening at 90-Days Post-Stroke Increases the Number of Positive Screens

Background: Comprehensive Stroke Centers are required by The Joint Commission to screen stroke patients with stroke for depression prior to discharge. Stroke related depression, however, may occur weeks or months after the acute event. Adding a 90-day screen may help identify additional patients with depression after discharge from the acute hospital setting. Purpose: To evaluate the impact of having a registered nurse (RN) perform 90-day post-discharge depression screening by telephone for patients with recent stroke. Methods: A team of RNs were trained on the Patient Health Questionnaires (PHQ2 and PHQ9). Both tools have been validated for telephone use. All ischemic and hemorrhagic stroke patients discharged home were included. Patients were called 90 days +/- 15 days post-discharge. Patients scoring positive on the PHQ2 (a score of &amp;gt; or equal to 3) were further evaluated by the RN using the PHQ9. Nurses referred patients scoring &amp;gt; or equal to 9 on the PHQ9 to the Stroke Medical Director for further evaluation. See graphic below. Results: Between August 2017 and July 2018, 297 patients were screened (56% of total stroke discharges, 297/527), of whom 8.8% (26/297) scored &amp;gt; or equal to 3 on the PHQ2. Of these, 73% had a PHQ9 score &amp;gt; or equal to 9 (19/26). All patients with a positive PHQ9 screen (19/19) were referred to the Stroke Medical Director and received appropriate triage and referral for ongoing care. This yielded a 6.4% rate (19/297) of stroke patients with symptoms of depression 90-days post-discharge. While some patients had a history of depression, most had no history or risk factors for depression. Conclusion: Conducting RN-facilitated 90-day post-hospital discharge telephone depression screening in patients with recent stroke appears to be an effective method to identify additional patients with stroke related depression who would not have been identified otherwise.

Depression in cirrhosis - a prospective evaluation of the prevalence, predictors and development of a screening nomogram.

Depression is associated with substantial morbidity and mortality in cirrhosis, but is underdiagnosed and undertreated. Using the Mini International Neuropsychiatric Interview (MINI) as a gold-standard, to determine prevalence, predictors, and outcomes of depression, and to develop a screening nomogram for use in cirrhosis patients. Cirrhotic outpatients 18-80years of age, not on anti-depressants, were consecutively recruited from liver clinics at three tertiary care hospitals. Baseline health-related quality of life (HRQoL) and frailty were determined by the chronic liver disease questionnaire, EQ-VAS, Clinical Frailty Scale and Fried Frailty Criteria. Depression was identified using the MINI and participants were followed up to 6months to determine unplanned hospitalization/death. Of 305 patients, 62% were male; mean age 55(10) years; mean MELD 12.5(5), 61% Child Pugh B/C. Prevalence of depression 18% by MINI. Patients with depression had lower baseline HRQoL and higher frailty scores. Five independently predictive factors were used to develop a clinical nomogram for the diagnosis of clinical depression. These included three Hospital Anxiety and Depression Screening tool variables: "I have lost interest in my appearance" (adjusted odds ratio [aOR] 2.2, P=0.006), "I look forward with enjoyment to things" (aOR 2.0, P=0.02), "I feel cheerful" (aOR 2.8, P=0.002), and two demographic variables: younger age (aOR 0.92, P=0.001) and not being married or in a common-law relationship (aOR 0.30, P=0.008). Depression is common in patients with cirrhosis. It has a significant impact on HRQoL and functional status. The developed clinical nomogram is promising for the rapid screening of depression in patients with cirrhosis.

Cost-Utility Analysis of Routine Anxiety and Depression Screening in Patients Consulting for Osteoarthritis: Results From a Clinical, Randomized Controlled Trial.

ObjectiveTo investigate the cost‐effectiveness (cost‐utility) of introducing general practitioner screening for anxiety and depression in patients consulting for osteoarthritis (OA).MethodsA cluster‐randomized trial‐based economic evaluation to assess general practitioners screening for anxiety and depression symptoms in patients consulting for OA compared to usual care (screening for pain intensity) was undertaken over a 12‐month period from a UK National Health Service and societal perspective. Patient‐level mean costs and mean quality‐adjusted life years (QALYs) were estimated, and cost‐effectiveness acceptability curves controlling for cluster‐level data were constructed. The base‐case analysis used the net benefit regressions approach. The 2‐stage nonparametric sampling technique was explored in a sensitivity analysis.ResultsThe base‐case analysis demonstrated that the intervention was as costly as, and less effective than, the control (QALY differential −0.029 [95% confidence interval −0.062, 0.003]). In the base‐case analyses, general practitioner screening for anxiety and depression was unlikely to be a cost‐effective option (probability <5% at £20,000/QALY). Similar results were observed in all sensitivity analyses.ConclusionPrompting general practitioners to routinely screen and manage comorbid anxiety and depression in patients presenting with OA is unlikely to be cost‐effective. Further research is needed to explore clinically effective and cost‐effective models of managing anxiety and depression in patients presenting with clinical OA.

Screening for depression in patients with cognitive impairment: a local audit

Depression is highly prevalent in cognitive impairment and is considered one of the most common comorbid conditions in dementia.1 Despite this, underlying depressive symptoms can easily be missed2 by health care providers, mainly due to lack of awareness and lack of routine screening for depressive symptoms. Here, the authors examine the results of their local audit in Oxleas NHS Foundation Trust screening for depression in those diagnosed with dementia and discuss what their recommendations are for improving this aspect of clinical care in the future.

UTILITY OF DEPRESSION SCREENING DURING TOBACCO CESSATION

SESSION TITLE: Tobacco Cessation and Prevention SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Prior studies have shown a significant incidence of depression in individuals with nicotine dependence. The question remains whether coexisting depression influences outcomes in patients undergoing tobacco cessation. The Pulmonary Tobacco Cessation Program at Brooke Army Medical Center currently performs screening for depression in patients enrolled in the Tobacco Cessation Program. We will perform a retrospective chart review to determine whether the presence of depression affects the outcomes in the patients enrolled in our tobacco cessation program. METHODS: This study is a retrospective chart review of the Clinic Tobacco Cessation database and electronic health records to identify patients undergoing depression screening prior to and during the tobacco cessation process. Those patients undergoing depression screening using the PHQ-2 and PHQ-9 screening tool will be evaluated for a positive or negative screen on PHQ-2 and if positive the PHQ-9 score will be recorded. We will review the electronic health records of up to 500 individuals to identify the results of depression screening, pharmacologic therapy choices for tobacco cessation, medication adverse effects and tolerance, number of sessions attended, and tobacco cessation rates at 4 weeks, 12 weeks, 6 months, and 12 months. RESULTS: An initial cohort of records reviewed found that 12 of 36 (33%) of individuals enrolled in the tobacco cessation program had a positive PHQ2 screen for depression. The subjects with a positive PHQ2 screen completed a PHQ9 screen and the mean score was 12.08 (range 3 - 23). Tobacco cessation rates for subjects with a positive screen for depression were 8.3% at 1 month, 0% at 3 months, 0% at 6 months and 8.3% at 12 months. Tobacco cessation rates in subjects with a negative screen for depression were 25% at 1 month, 25% at 3 months, 12.5% at 6 months, and 12.5% at 12 months. There was no difference in program completion rates among the two groups as defined as > 50% class attendance with 91.6% of both groups completing the program. In the group with a negative depression screen, 54.2% received varenicline, 33.3% received bupropion, 16.6% received nicotine replacement therapy, and 8.3% received no pharmacologic treatment. In the group with a positive depression screen, 58.3% received varenicline, 8.3% received bupropion, 25% received nicotine replacement therapy, and 8.3% received no pharmacologic treatment. CONCLUSIONS: The course completion rate defined by attending more than half of scheduled classes did not differ between patients with and without a positive screen for depression. Patient's with a negative depression screen were more likely to be abstinent from tobacco use at 1 month, 3 months, 6 months, and 9 months. CLINICAL IMPLICATIONS: Screening for depression with a simple screening tool may help predict success during attempts at tobacco cessation. DISCLOSURES: No relevant relationships by Deborah Bray, source=Web Response No relevant relationships by Jackie Hayes, source=Web Response No relevant relationships by Chinyere Mbagwu, source=Web Response No relevant relationships by John Untisz, source=Web Response

Anxiety and Depression among Patients with Uveitis and Ocular Inflammatory Disease at a Tertiary Center in Southern Thailand: Vision-Related Quality of Life, Sociodemographics, and Clinical Characteristics Associated

ABSTRACTPurpose: To estimate the prevalence of positive anxiety and depression screening in patients with ocular inflammatory disease (OID). The predictors associated with anxiety and depressive symptoms were investigated.Methods: A cross-sectional study was conducted. The Thai Hospital Anxiety and Depression Scale (HADS), a sociodemographic questionnaire, and the Thai Visual Functioning Questionnaire 28 were administered to all participants. Associations were estimated using the Cox regression.Results: Of the 86 participants, 12.8% and 8.1% screened positive for anxiety and depression, respectively. Predictors of an increase in both HADS-Anxiety and HADS-Depression scores comprised poor understanding of OIDs [adjusted relative probability (aRP) = 1.56; p = 0.021 and 1.59; p = 0.012, respectively], and low overall composite score (aRP = 1.45; p = 0.022 and 1.6; p = 0.002, respectively).Conclusions: Approximately one-tenth of our patients screened positive for anxiety and depression. Patients with poor understanding of their OID and poor self-reported visual function were at an increased risk.

The need for depression screening in patients with adrenal incidentalomas and (possible) autonomous cortisol secretion - the role of integrated care

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Sensitivity and specificity of the Akena Visual Depression Inventory (AViDI-18) in Kampala (Uganda) and Cape Town (South Africa).

Visual scales may be particularly useful in screening for depression in patients with low literacy. However, few have been validated and none are in common use.AimModification and validation of a visual scale to screen for depression in low literacy settings. We assessed the validity, reliability and factor loading of a 28-item visual depression inventory using pictorial items depicting depression signs and symptoms. We validated a revised scale comprised of 18 items known as the Akena Visual Depression Inventory (AViDI-18) against a structured diagnostic interview (Mini-International Neuropsychiatric Inventory) in 343 patients in Kampala (Uganda) and Cape Town (South Africa). The 18 pictorial items had acceptable validity and reliability. The area under the curve (AUC) score of the AViDI-18 was 0.9. AUC scores were not significantly associated with sociodemographic variables. The AViDI-18 is a valid screen for depression in patients with low literacy.Declaration of interestNone.

Pharmacologic Treatment for Depression at Injury Is Associated With Fewer Clinician Visits for Persistent Symptoms After Mild Traumatic Brain Injury: A Medical Record Review Study

BackgroundDepression and traumatic brain injury (TBI) substantially contribute to the U.S. health care burden. Depression is a known risk factor for prolonged recovery after TBI. However, the effect of depression treatment on health care utilization has yet to be studied. ObjectiveTo examine whether an association exists between pharmacologic treatment of depression at the time of mild or concussive TBI and the number of subsequent clinician visits for persistent injury-related symptoms. DesignRetrospective medical record review. SettingTertiary care medical center. ParticipantsA total of 120 patients (mean age 45.6 years) with a history of depression who subsequently experienced a mild or concussive TBI were included. MethodsIndividuals were identified with co-occurring diagnoses of depression and mild or concussive TBI by retrospective electronic medical record review. The diagnosis of depression must have preceded the diagnosis of TBI. Main OutcomeThe number of clinician visits for postinjury symptoms were counted at 3, 6, and 12 months postinjury. ResultsClinician visits for persistent injury-related symptoms were significantly fewer at all 3 time points for the group treated for depression at time of injury. ConclusionsDepressed individuals who were pharmacologically treated for depression at the time of TBI had significantly fewer clinician visits for persistent postinjury symptoms than those not pharmacologically treated for depression at the time of injury. Routine depression screening in patients with a high risk for TBI may identify a mood disorder that could contribute to persistent symptoms if left untreated, with its effective management potentially reducing health-related costs. Level of EvidenceIII

Prevalence and predictors of depressive symptoms among attendees of a tertiary care dermatology clinic in Muscat, Oman.

Various studies have suggested that depression is more prevalent among patients with skin disorders than in the general population. Most of the studies addressing this subject involve Euro-American populations. The present study aimed to estimate the prevalence of depressive symptoms among patients with dermatological disorders and, then, to decipher the clinical-demographic factors associated with depressive symptoms. A cross-sectional analytical study was conducted among a random sample of patients attending a dermatology clinic in Muscat. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for depressive symptoms. A logistic regression model was used to find the adjusted and unadjusted odds ratios (ORs). A total of 260 patients participated in this study, with a response rate of 81%. The prevalence of depression symptoms was 24%. According to regression analysis, family history of depression, comorbid medical disorders, and treatment with topicals or isotretinoin were significant predictors of depression (OR=9.41, 95% confidence interval [CI]: 2.27-39.05, P=0.002; OR=2.0, 95% CI: 1.2-3.21, P=0.05; OR=2.28, 95% CI: 1.09-4.76, P=0.028; and OR=2.78; 95% CI: 1.08-7.19, P=0.035, respectively). This study indicates that depressive symptoms are common among patients with dermatological disorders in Oman, particularly in those with a family history of depression and medical comorbidities, and those who use a specific dermatological medication. Screening for depression in patients attending dermatology clinics is essential in order to detect and promptly treat patients suffering from depression.

Screening for Psychological Conditions in Infertile Women: Provider Perspectives.

To determine if reproductive specialists are screening new patients for depression or anxiety, explore possible reasons why providers are not screening, and assess physician's views about the impact of mental health disorders on fertility. Cross-sectional exploratory study in which 86 practicing reproductive physicians filled out a 20-question survey regarding mental health screening and perception of psychological disorders on reproduction. The majority of infertility providers believe psychological conditions negatively impact pregnancy success (75%); however, most providers are not formally screening patients for depression or anxiety (28%). Providers who did not screen for depression were more likely to be uncomfortable assessing patients for mental health disorders and to work in a private practice setting. This study finds that most infertility specialist respondents believe that mental health conditions negatively impact reproductive outcomes; however, few of these providers are screening for psychological disorders in infertile women. Reasons why providers are not screening infertility patients for psychological disorders include lack of time and unfamiliarity with recommendations for treatment of mental health conditions. Implementing a rapid screen for anxiety and depression and providing easily assessable succinct educational updates to fertility providers on current treatment options for mental health disorders may allow affected patients to be treated sooner, and ultimately, may improve fertility outcomes.

The effects of implementing a point-of-care electronic template to prompt routine anxiety and depression screening in patients consulting for osteoarthritis (the Primary Care Osteoarthritis Trial): A cluster randomised trial in primary care.

BackgroundThis study aimed to evaluate whether prompting general practitioners (GPs) to routinely assess and manage anxiety and depression in patients consulting with osteoarthritis (OA) improves pain outcomes.Methods and findingsWe conducted a cluster randomised controlled trial involving 45 English general practices. In intervention practices, patients aged ≥45 y consulting with OA received point-of-care anxiety and depression screening by the GP, prompted by an automated electronic template comprising five questions (a two-item Patient Health Questionnaire–2 for depression, a two-item Generalized Anxiety Disorder–2 questionnaire for anxiety, and a question about current pain intensity [0–10 numerical rating scale]). The template signposted GPs to follow National Institute for Health and Care Excellence clinical guidelines for anxiety, depression, and OA and was supported by a brief training package. The template in control practices prompted GPs to ask the pain intensity question only. The primary outcome was patient-reported current pain intensity post-consultation and at 3-, 6-, and 12-mo follow-up. Secondary outcomes included pain-related disability, anxiety, depression, and general health.During the trial period, 7,279 patients aged ≥45 y consulted with a relevant OA-related code, and 4,240 patients were deemed potentially eligible by participating GPs. Templates were completed for 2,042 patients (1,339 [31.6%] in the control arm and 703 [23.1%] in the intervention arm). Of these 2,042 patients, 1,412 returned questionnaires (501 [71.3%] from 20 intervention practices, 911 [68.0%] from 24 control practices). Follow-up rates were similar in both arms, totalling 1,093 (77.4%) at 3 mo, 1,064 (75.4%) at 6 mo, and 1,017 (72.0%) at 12 mo. For the primary endpoint, multilevel modelling yielded significantly higher average pain intensity across follow-up to 12 mo in the intervention group than the control group (adjusted mean difference 0.31; 95% CI 0.04, 0.59). Secondary outcomes were consistent with the primary outcome measure in reflecting better outcomes as a whole for the control group than the intervention group. Anxiety and depression scores did not reduce following the intervention. The main limitations of this study are two potential sources of bias: an imbalance in cluster size (mean practice size 7,397 [intervention] versus 5,850 [control]) and a difference in the proportion of patients for whom the GP deactivated the template (33.6% [intervention] versus 27.8% [control]).ConclusionsIn this study, we observed no beneficial effect on pain outcomes of prompting GPs to routinely screen for and manage comorbid anxiety and depression in patients presenting with symptoms due to OA, with those in the intervention group reporting statistically significantly higher average pain scores over the four follow-up time points than those in the control group.Trial registrationISRCTN registry ISRCTN40721988

Depression Outcomes in Adults Attending Family Practice Were Not Improved by Screening, Stepped-Care, or Online CBT during a 12-Week Study when Compared to Controls in a Randomized Trial.

There is uncertainty regarding possible benefits of screening for depression in family practice, as well as the most effective treatment approach when depression is identified. Here, we examined whether screening patients for depression in primary care, and then treating them with different modalities, was better than treatment-as-usual (TAU) alone. Screening was carried out for depression using the 9-item Patient Health Questionnaire (PHQ-9), with a score of ≥10 indicating significant depressive symptoms. PHQ-9 scores were given to family physicians prior to patients being seen (except for the Control group). Patients (n = 1,489) were randomized to one of four groups. Group #1 were controls (n = 432) in which PHQ-9 was administered, but results were not shared. Group #2 was screening followed by TAU (n = 426). Group #3 was screening followed by both TAU and the opportunity to use an online cognitive behavioral therapy (CBT) treatment program (n = 440). Group #4 utilized an evidence-based Stepped-care pathway for depression (n = 191, note that this was not available at all clinics). Of the study sample 889 (60%) completed a second PHQ-9 rating at 12 weeks. There were no statistically significant differences in baseline PHQ-9 scores between these groups. Compared to baseline, mean PHQ-9 scores decreased significantly in the depressed patients over 12 weeks, but there were no statistically significant differences between any groups at 12 weeks. Thus, for those who were depressed at baseline Control group (Group #1) scores decreased from 15.3 ± 4.2 to 4.0 ± 2.6 (p < 0.001), Screening group (Group #2) scores decreased from 15.5 ± 3.9 to 4.6 ± 3.0 (p < 0.001), Online CBT group (Group #3) scores decreased from 15.4 ± 3.8 to 3.4 ± 2.7 (p < 0.01), and the Stepped-care pathway group (Group #4) scores decreased from 15.3 ± 3.6 to 5.4 ± 2.8 (p < 0.05). In conclusion, these findings from this controlled randomized study do not suggest that using depression screening tools in family practice improves outcomes. They also suggest that much of the depression seen in primary care spontaneously resolves and do not support suggestions that more complex treatment programs or pathways improve depression outcomes in primary care. Replication studies are required due to study limitations.