Screening Tool For Depression Research Articles

Predictors of anxiety and depression in patients with oral cancer undergoing radical resection with reconstructive surgery

ObjectivesThe reduced survival rate and diminished quality of life (QOL) observed in cancer patients with depression have garnered significant attention in recent years. Oral cancer can cause psychological and social stress because its incidence and treatment not only impair oral functions, such as mastication, swallowing, and articulation, but also disfigure the face. In this study, we investigated the factors that predict worsening psychiatric symptoms, such as anxiety and depression, in patients with oral cancer. Materials and methodsThirty-seven patients with oral cancer who underwent radical resection with reconstructive surgery between 2017 and 2022 were enrolled. The Japanese version of the Hospital Anxiety and Depression Scale (HADS), a screening tool for anxiety and depression, was used to obtain preoperative scores and up to 9-month postoperative scores. ResultsThe number of patients that exceeded the cut-off values for adjustment disorder and depression was 19 (51.4%) preoperative and 20 (54.1%), 13 (35.1%), and 14 (37.8%) at 3, 6, and 9 postoperative months, respectively. The analysis of covariance showed that the primary site (F = 218.267, p = 0.0216) and marital status (F = 105.758, p = 0.0269) were factors that affected the HADS scores. ConclusionThe risk of postoperative anxiety and depression in patients with oral cancer undergoing radical resection with reconstruction may be increased in patients whose tongue is the primary site and in patients who are single.

An empirical comparison of statistical methods for multiple cut-off diagnostic test accuracy meta-analysis of the Edinburgh postnatal depression scale (EPDS) depression screening tool using published results vs individual participant data

BackgroundSelective reporting of results from only well-performing cut-offs leads to biased estimates of accuracy in primary studies of questionnaire-based screening tools and in meta-analyses that synthesize results. Individual participant data meta-analysis (IPDMA) of sensitivity and specificity at each cut-off via bivariate random-effects models (BREMs) can overcome this problem. However, IPDMA is laborious and depends on the ability to successfully obtain primary datasets, and BREMs ignore the correlation between cut-offs within primary studies.MethodsWe compared the performance of three recent multiple cut-off models developed by Steinhauser et al., Jones et al., and Hoyer and Kuss, that account for missing cut-offs when meta-analyzing diagnostic accuracy studies with multiple cut-offs, to BREMs fitted at each cut-off. We used data from 22 studies of the accuracy of the Edinburgh Postnatal Depression Scale (EPDS; 4475 participants, 758 major depression cases). We fitted each of the three multiple cut-off models and BREMs to a dataset with results from only published cut-offs from each study (published data) and an IPD dataset with results for all cut-offs (full IPD data). We estimated pooled sensitivity and specificity with 95% confidence intervals (CIs) for each cut-off and the area under the curve.ResultsCompared to the BREMs fitted to the full IPD data, the Steinhauser et al., Jones et al., and Hoyer and Kuss models fitted to the published data produced similar receiver operating characteristic curves; though, the Hoyer and Kuss model had lower area under the curve, mainly due to estimating slightly lower sensitivity at lower cut-offs. When fitting the three multiple cut-off models to the full IPD data, a similar pattern of results was observed. Importantly, all models had similar 95% CIs for sensitivity and specificity, and the CI width increased with cut-off levels for sensitivity and decreased with an increasing cut-off for specificity, even the BREMs which treat each cut-off separately.ConclusionsMultiple cut-off models appear to be the favorable methods when only published data are available. While collecting IPD is expensive and time consuming, IPD can facilitate subgroup analyses that cannot be conducted with published data only.

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

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

Evaluating the development and well-being assessment (DAWBA) in pediatric anxiety and depression

Enhancing screening practices and developing scalable diagnostic tools are imperative in response to the increasing prevalence of youth mental health challenges. Structured lay psychiatric interviews have emerged as one such promising tool. However, there remains limited research evaluating structured psychiatric interviews, specifically their characterization of internalizing disorders in treatment-seeking youth. This study evaluates the relationship between the Development and Well-Being Assessment (DAWBA), a structured psychiatric interview, and established measures of pediatric anxiety and depression, including the Screen for Child Anxiety Related Disorders (SCARED), the Pediatric Anxiety Rating Scale (PARS), and the Mood and Feelings Questionnaire (MFQ). The study comprised two independent clinical samples of treatment-seeking youth: sample one included 55 youth with anxiety and 29 healthy volunteers (HV), while sample two included 127 youth with Major Depressive Disorder and 73 HVs. We examined the association between the DAWBA band scores, indicating predicted risk for diagnosis, the SCARED and PARS (sample one), and the MFQ (sample two). An exploratory analysis was conducted in a subset of participants to test whether DAWBA band scores predicted the change in anxiety symptoms (SCARED, PARS) across a 12-week course of cognitive behavioral therapy. The results revealed that the DAWBA significantly predicted the SCARED, PARS and MFQ measures at baseline; however, it did not predict changes in anxiety symptoms across treatment. These findings suggest that the DAWBA may be a helpful screening tool for indexing anxiety and depression in treatment-seeking youth but is not especially predictive of longitudinal trajectories in symptomatology across psychotherapy.

Mental Health Assessments in Emergency Department Patients: Assessing Longitudinal Follow-up and Retest Reliability (MCAT-2) [Provisional Baseline Analysis

Background/Objective:The prevalence of anxiety and depression in adults in the United States is high with many experiencing ≥1 episode of anxiety or depression over a given year. Despite this, diagnoses of anxiety and depression in patients presenting to the ED for somatic complaints are seldom, relative to the population prevalence. Current fixed-item anxiety and depression screening tools have variable specificity and sensitivity, but adaptive screening tools such as the Computerized Adaptive Testing-Mental Health tool (CAT-MH) are thought to provide improved diagnostic characteristics and precision over fixed item tools. Our objective is to establish the reliability ofits depression and anxiety severity assessments in patients initially screened in an ED setting and reassessed over 30 days.
 Methods:We are conducting a longitudinal observational study among adult ED patients presenting with somatic, non-mental health complaints. The CAT-MH, Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-8 (PHQ-8), are administered to randomly selected patients meeting enrollment criteria after informed consent. Participants are reassessed at 1-, 2-, and 4 weeks after ED discharge and analyzed for longitudinal test-retest reliability and sensitivity to change in score severity over time.
 Results:In this ongoing study, we present baseline anxiety and depression severity assessments for the first 49 enrolled patients (Mean age of 37, 73% female, 49% white, 47% black). Fixed item tools (GAD-7 and PHQ-8) categorized 16% and 6% of patients as moderate and severe anxiety respectively vs 19% and 15% as moderate, and moderately-severe/severe depression. In comparison, CAT-MH categorized 8% and 10% as moderate and severe anxiety.10% and 6% were categorized as moderate and severe depression.
 Conclusion:In this longitudinal observational study, we present baseline data for the first 49 out of 100 planned patients. Upon completion of the study, we hope to find that the severity assessments from CAT-MH remain stable over 30 days.

The Impact of COVID-19 Pandemic on Mental Health of Adolescents With Chronic Medical Conditions: Findings From a German Pediatric Outpatient Clinic

PurposeThe impact of the COVID-19 pandemic on the mental health of adolescents is of great concern, especially in the vulnerable group of adolescents with chronic medical conditions. The aim of this study was to examine this impact on the mental health of adolescents with chronic medical conditions treated in a German pediatric outpatient clinic. MethodsChanges in the mental health status of adolescents with chronic medical conditions treated in a German pediatric outpatient clinic during the COVID-19 pandemic were explored via validated screening tools for anxiety and depression. ResultsThe relative risk for adolescents with chronic medical conditions to develop clinically relevant symptoms of anxiety or depression was significantly higher (odds ratio 1,78 [confidence interval 1.06–3.04]) during the pandemic. DiscussionThis study identifies the COVID-19 pandemic as a potential additional risk for adolescents with chronic medical conditions to develop clinically relevant signs of anxiety or depression.

Age matters: association between age and depression severity at the time of OSA diagnosis and PAP adherence in adult patients.

Numerous studies have shown an association and symptom overlaps between obstructive sleep apnea (OSA) and depression. However, data are limited on the association between age, sex, the severity of depression at the time of OSA diagnosis, and its impact on positive airway pressure (PAP) adherence. The Patient Health Questionnaire (PHQ-9) is a validated depression screening and severity scoring tool recommended by the Diagnostic and Statistical Manual of Mental Disorders (fifth edition). In this retrospective observational study, we evaluate the interrelationship between age at OSA diagnosis, depression severity, and PAP adherence. Patients with new OSA diagnosis, seen at the University of California San Francisco-Fresno Sleep Center between February and October of 2022, were evaluated. PHQ-9 scores for depression severity uses a 1 to 5 scale (1 = none, 2 = mild, 3 = moderate, 4 moderately severe, 5 = severe). The PHQ-9 was administered at the time of OSA diagnosis and follow-up. Average daily PAP usage hours were obtained from PAP devices between 1 to 3 months after therapy initiation. IBM SPSS version 29.0.0 was used to calculate descriptive statistics, Pearson correlation, and Mann-Whitney test. Seventy-seven patients fit the inclusion criteria, of which 28 were women (36.4%). The average baseline apnea-hypopnea index was 34.5 (standard deviation 31.8), with a PHQ-9 mean of 8.3 with standard deviation ± 5.9. A Mann-Whitney comparison between the group with normal PHQ-9 scores and the group with PHQ-9 scores consistent with depression (score of 5 or greater) showed no statistically significant differences in apnea-hypopnea index (P = .470) or average night hour use (P = .195). There was a statistically significant difference in age between both groups (P = .031). Spearman correlation confirmed a negative, statistically significant correlation between PHQ-9 scores and age in patients with OSA. This study showed that PHQ-9 scores at the time of OSA diagnosis are moderately correlated with younger age, with those patients younger than 50 years old having more moderate to severe depression scores than older patients. We did not find a correlation between age and PAP adherence or between PHQ-9 scores and PAP adherence. Our findings can help identify high-risk depression patients early in the diagnosis of OSA and bring awareness that the young adult population can be particularly vulnerable. Niraula R, Singh A, DelRosso LM, Meghpara S, Keenan L. Age matters: association between age and depression severity at the time of OSA diagnosis and PAP adherence in adult patients. J Clin Sleep Med. 2024;20(6):859-862.

Cluster Analysis of the Positive and Negative Indicators of Complete Mental Health State Model

<p>本研究目的在了解正負向指標篩檢心理健康型態集群分佈情形，是否符合Keyes主張以主觀幸福感與憂鬱症狀雙指標區分的完整心理健康模式。研究設計以心理健康BMI幸福感問卷、病人健康狀況憂鬱問卷，做為正負向指標篩檢工具，架構完整心理健康模式；以問卷調查法立意取樣739份樣本，經群集分析法作統計分群。結果能區分出有意義的四群集，包括擁有高幸福低憂鬱之完整圓滿心理健康型態的「心盛型」群集（46.28%）、不完整心理健康型態三個群集:「冷靜型」（低幸福低憂鬱之不完整心理亞健康型態，31.94%）、「奮戰型」（高幸福高憂鬱之不完整心理健康型態，11.10%）、「混沌型」（低幸福高憂鬱之不完整心理健康型態，10.69%）。低憂鬱者佔全體 78.22%，其中59.17%擁有高幸福而處於完整圓滿心理健康型態；高憂鬱者佔全體21.78%，其中50.93%擁有高幸福感。驗證了幸福感、憂鬱傾向作為正負向心理健康指標，篩檢完整或不完整心理健康型態。建議:（1）高憂鬱者參照「奮戰型」這群人高幸福感來源，藉由參與社團獲得人際支持、找到工作及收入來增加自我價值感；（2）「冷靜型」不能單看低憂鬱的心理健康篩檢，需提升「友善人際支持 正念情緒平穩 認同自我價值意義」之正向心理健康BMI幸福感，以獲得完整心理健康；（3）未來研究可依據正負向心理健康指標去發展心理健康素養能力，作為心理健檢與自主管理完整心理健康之用。</p> <p> </p><p>This study aimed to understand the cluster distribution of positive and negative indicators for screening mental health patterns and whether they conform to Keyes’ claim that positive and negative indicators should be included in the complete mental health state model. The positive mental health indicators included social, emotional, and psychological well-being, which should be measured using the Mental Health Continuum Short Form (MHC-SF). Negative indicators measure the level of symptoms of mental illness concurrently, serving as a complete assessment of whether the individual is in a healthy state of positive and negative mental health indicators. Keyes employed these to distinguish four clusters of people with four mental health modes, of which the incomplete mental health cluster was in the state. Even if they have a negative mental illness, they could have positive mental health and well-being. Although some people do not have negative mental illness, they cannot have positive mental health and well-being. Therefore, Taiwanese scholar Li corresponded to these three well-being developments and selected three operational mental health skills: ""Befriend-Mindfulness-Identity"" as the Mental Health BMI Well-Being Index questionnaire (mBMI). After using them to evaluate 739 people, it was evident that the scores of the above two questionnaires were significantly correlated, and the mBMI questionnaire total score and Questions B, M, and I could effectively predict the total score, social, emotional, and psychological well-being of the MHC-SF, with a total explanatory power of 30.3%. This test should be used as a simple screening for well-being and as a positive mental health screening tool. Additionally, a Depression Scale Screening Tool for Negative Mental Health Depression was combined to explore the complete mental health state model of Taiwanese people. </p> <p> Therefore, in this study, the mBMI questionnaire was selected as a simple tool to measure positive mental health well-being, and the patients’ health questionnaire for depression was used as a screening tool for negative mental health indicators. These are used as positive and negative indicators to test whether a complete or incomplete mental health state model fits. The questionnaire survey method was used to deliberately sample the data from 739 valid samples, and the cluster analysis method was used for statistical grouping to verify its suitability. According to the results of the aforementioned positive and negative indicators, four meaningful clusters were distinguished, including one complete and three incomplete mental health models. One cluster was ""Flourishing type""(46.28%) of high well-being and low depression, which belonged to the complete mental health state model. The other three clusters were incomplete mental health state models. ""Fighting type"" (31.94%) of high well-being and high depression, ""Calm type"" (11.10%) of low well-being and low depression, and ""Chaos type"" (10.69%) of low well-being and high depression could fight for high well-being. It was verified that well-being and depression could be used as positive and negative mental health indicators to screen for complete or incomplete mental health state models. When we identified people with high depression, we encouraged them to refer to the source of high well-being of the ""fighting type"" group and increase their sense of self-worth by participating in clubs to obtain interpersonal support, find jobs, and earn income. We reminded the ""calm type"" people with low depression to promote their high well-being to have a complete mental health state. Finally, we monitored positive and negative indicators of mental health using screening tools of the Mental Health BMI Well-Being Index and the Patient Health Questionnaire (PHQ-9) to screen for complete or incomplete mental health states as a reference for promoting positive and negative mental health. The befriend-mindfulness-identity skills should be improved to promote well-being and adjust depression to achieve complete mental health.</p> <p> </p>

A prospective research on depression among chronic obstructive pulmonary disease patients in a tertiary care hospital

Background: Chronic obstructive pulmonary disease (COPD) indicates chronic lung disorders presented by a gradually progressive irrevocable bronchial obstruction (progressive restriction of the enforced expiratory capacity in 1 s forced expiratory volume-1) and manifestation compound of recurring bronchial cough and breathlessness. The patient’s life enters into a vicious cycle due to the complications of concurrent depressive disorder. Aims and Objectives: This research was conducted to evaluate the occurrence of despair among COPD patients in an advanced care hospital using a patient health questionnaire (PHQ-9) scale. Materials and Methods: This research was led subsequently receiving authorization from Institutional Ethical Board and inscribed well-versed agreement from the patients in the department of respiratory medicine. The PHQ-9 scale was employed for screening and assessment of despair yielding relevant details. No intervention was administered for the research. The analysis was based on the information obtained from the investigation reports. Results: Reddy et al. suggested the arbitrary classification of PHQ-9 scores: 0–4 indicates negligible misery, 5–9 minor misery, 10 and higher than indicates reasonable to acute misery. In our research, 39 patients scored PHQ-9 score between 0 and 4, 46 patients scored PHQ-9 score between 5 and 9, and 15 patients scored PHQ-9 score 10 and above. Conclusion: The occurrence of depression among COPD patients is significantly excessive so validated screening tool for depression is required in COPD management.

Psychometric Properties of the Patient Health Questionnaire-9 for Saudi Caregivers: A Cross-Sectional Study in Saudi Arabia.

To evaluate the psychometric properties of the Arabic-language Patient Health Questionnaire-9 (PHQ-9) among Saudi caregivers of patients with chronic diseases. Using a cross-sectional design, 94 Saudi caregivers (37 male and 57 female) in the medical city participated in the study. A comparative assessment was conducted on 4 models proposed in the existing PHQ-9 literature to gauge their compatibility through confirmatory factor analyses. This study evaluates convergent validity through a correlation analysis, examining the relationship between the PHQ-9 and the Depression, Anxiety, and Stress Scale-21 (DASS-21). Among the various models we examined, the single-factor structure of the PHQ-9 displayed the best fit with the data we gathered. Notably, the Cronbach alpha coefficient for the PHQ-9 registered at .81, indicating a high level of internal consistency. Factor loadings spanned a range from .39 to .76. The convergent validity of the PHQ-9 and DASS-21 was deemed satisfactory. It is established that the PHQ-9 serves as an effective tool for depression screening among Saudi caregivers in Saudi Arabia. Its strengths lie in its demonstrated validity, dependability, brevity, and convenience of administration, positioning it as a valuable resource for preventative measures and performance assessment within mental health settings.

Prevalence of and optimal screening tool for postpartum depression in a community-based population in China

BackgroundPostpartum depression (PPD) is an important public health problem worldwide. China is planning to launch PPD screening in community settings, but there are questions on the community prevalence of PPD and validated screening tools. MethodsWe sought to recruit all eligible new mothers during postnatal home visits in two districts of Changsha, China, and after informed consent, screened them for PPD using three self-administered questionnaires—the Edinburgh Postpartum Depression Scale (EPDS), the Patient Health Questionnaire (PHQ-9), and Whooley Questions for Depression Screening. Video structured diagnostic interviews were performed online according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) by qualified specialists who were blinded to screening results. Optimal screening was determined based on the acceptability of scales and diagnostic accuracy metrics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). ResultsOut of 3004 eligible women, 2730 (90.9 %) completed the screening questionnaires. Among those screened, the video structured diagnostic interview was administered to 1862 (68.2 %) and 62 (3.3 %) were diagnosed with a current depressive condition. The optimal screening approach involved combining Whooley Questions (at least one “yes”) with EPDS (cutoff >10) in series, with sensitivity of 0.76 (95 % CI 0.63 to 0.85), specificity of 0.93 (0.92 to 0.94), PPV of 0.28 (0.21 to 0.36) and NPV of 0.99 (0.98 to 1.00). LimitationsDue to the regional sample and exclusion of mothers with telephone contact rather than home visits, our findings may not be fully generalizable to the entire population. ConclusionsThe prevalence of PPD among women in this sample was substantially lower than those reported in previous studies in China, the majority of which used screen positivity in measuring prevalence. Combining Whooley Questions with EPDS in series is the most optimal screening approach in this population, though this would still result in a high number of false positives at current prevalence.

Optimal cut-offs of depression screening tools during the COVID-19 pandemic: a systematic review

BackgroundStudies have reported an increase in the prevalence of depression during the COVID-19 pandemic. The accuracy of screening tools may change with the prevalence and distribution of a disease in a population or sample: the “Spectrum Effect”.MethodsFirst, we selected commonly used screening tools and developed search strategies for the inclusion of original studies during the pandemic. Second, we searched PsycINFO, EMBASE, and MEDLINE from March 2020 to September 2022 to obtain original studies that investigated the accuracy of depression screening tools during the pandemic. We then searched these databases to identify meta-analyses summarizing the accuracy of these tools conducted before the pandemic and compared the optimal cut-offs for depression screening tools during the pandemic with those before.ResultFour original studies evaluating the optimal cut-offs for four screening tools (Beck Depression Inventory [BDI-II], Hospital Anxiety and Depression Scale-Depression [HADS-D], Patient Health Questionnaire-9 [PHQ-9], and Geriatric Depression Scale-4 [GDS-4]) were published during the pandemic. Four meta-analyses summarizing these tools before the pandemic. We found that the optimal cut-off of BDI-II was 14 during the pandemic (23.8% depression prevalence, screening patients with Type 2 diabetes) and 14.5 before the pandemic (17.6% depression prevalence, screening psychiatric, primary care, and healthy populations); HADS-D was 10 during the pandemic (23.8% depression prevalence, screening patients with type 2 diabetes) and 7 before the pandemic (15.0% depression prevalence, screening medically ill patients); PHQ-9 was 11 during the pandemic (14.5% depression prevalence, screening university students) and 8 before the pandemic (10.9% depression prevalence, screening the unrestricted population), and GDS-4 was 1.8 during the pandemic (29.0% depression prevalence, screening adults seen in a memory clinic setting) and 3 before the pandemic (18.5% depression prevalence, screening older adults).ConclusionThe optimal cut-off for different screening tools may be sensitive to changes in study populations and reference standards. And potential spectrum effects that should be considered in post-COVID time which aiming to improve diagnostic accuracy.

Validation of the anxiety subscale of the Spanish version of the Edinburgh Postnatal Depression Scale (EPDS-A).

There is a need to implement routine perinatal mental health screening in Spain. Therefore, it is necessary to systematise the detection of depressive and anxious symptoms in pregnancy and postpartum using the same instrument. The Edinburgh Postnatal Stress Depression Scale (EPDS) is frequently used as a rapid, effective and cross-culturally validated screening tool for perinatal depression. In several countries, an Anxiety subscale, the EPDS-A, was identified within the EPDS. Although the factorial structure of the EPDS has been investigated in Spanish population, the EPDS-A has not yet been validated. This study aimed to validate the EPDS-A as a measure of perinatal anxiety in Spanish population. 161 women were evaluated with the EPDS and the State-Trait Anxiety Inventory (STAI) during pregnancy and postpartum. Confirmatory factor analysis (CFA) was used to confirm the trifactorial structure of the EPDS, comprising the dimensions of Depression, Anhedonia and Anxiety. Likewise, the invariance of the trifactorial model between pregnancy and postpartum was tested. Finally, the correlations between the EPDS-A and the STAI subscales (State Anxiety and Trait Anxiety) were calculated. The Exploratory factor analysis (EFA) driven three-factor structure of the EPDS, consisting of an Anhedonia factor (Items 1, 2, and 10), an Anxiety factor (Items 3, 4, 5, and 6) and a Depression factor (Items 7, 8, and 9), was the best measurement model for the current data compared to the alternative model tested [χ2 = 34.592, df = 32, p = 0.34; χ2/df = 1.08; RMSEA = 0.023, 90% Confidence Interval [CI] [0.000, 0.064], CFI = 0.996, GFI = 0.960]. The model's invariance between pregnant and postpartum women was confirmed. The existence of an Anxiety subscale within the EPDS was also confirmed. The scores obtained with the EPDS-A correlated moderately with scores on both subscales of the STAI during pregnancy and after delivery. Using the STAI as a criterion and prioritising the instrument's sensitivity, a cut-off point of 4 points was established for the EPDS-A. Our results confirm the trifactorial structure of the EPDS in Spanish population. The Anxiety subscale was validated for routine perinatal mental health screening.

Developing an appropriate depression and anxiety screening tool for use with Australian First Nations peoples living in the Torres Strait and Northern Peninsula Area of Australia: Protocol for a Delphi study.

Tools that screen for depression and anxiety developed using the Western biomedical paradigm are still used with First Nations peoples globally, despite calls for cross-cultural adaption. Recent work by the research team found that tools used to screen for depression and anxiety were not appropriate for use with Australian First Nations peoples living in the Torres Strait and Northern Peninsula Area (NPA). of Australia. Consequently, the objective of this Delphi study is to gain consensus from an expert mental health panel to inform the development of an appropriate depression and anxiety screening tool(s). A Delphi study with Australian expert panellists will be used to reach consensus about whether an existing screening tool should be used or whether adaption or new tool development should take place. Three sequential rounds of anonymous online surveys will be used to reach consensus. The first round will seek consensus about the tool(s). Subsequent rounds will seek consensus on the development of the tool(s) identified in round one. Panellists will be identified using a combination of authorship of related publications, established national clinical or research profile in First Nations mental health, and/or by peer referral. Consensus will be reached when 75% of the panel agree. When agreement is not reached suggestions will be taken to the next round. If agreement is not achieved by the third round, the Steering Committee will make any outstanding decisions. Dissemination of the findings through continuing community engagement, conference presentations and publications will be led by Torres Strait Islander members of the research team.

Increasing postpartum depression screening and resources in pediatric primary care: A quality improvement project to enhance provider confidence

BackgroundUnidentified and untreated postpartum depression (PPD) can have a negative impact on children. This Quality Improvement (QI) project aimed to increase PPD screening through provider education and enhancing pediatric primary care provider (PCP) confidence in using the Edinburg Postnatal Depression Screening (EPDS) tool, discussing PPD with mothers, and providing resources. Design and methodsPCPs and staff were educated on the project. Providers were surveyed prior to and after implementation to assess confidence with screening for and addressing PPD. Mothers of infants 0–6 months were screened using the EPDS at well-care visits. Discussion of PPD and resource support was provided if needed. ResultsA total of 273 mothers met criteria for screening, and of those 65% (n = 178) had a documented score. 12.4% of mothers had a score of 10 or greater, indicating high risk for PPD. Results from PCPs were compared both pre- and post-project. Screening for PPD increased from 3 to 4.5, using the EPDS tool from 2.25 to 4.75, discussing PPD with mothers from 2.75 to 4.25, and providing resources from 2.25 to 4.25. ConclusionsPPD screening increased, and provider confidence with using the EPDS, discussing PPD with mothers, and providing resources in pediatric primary care increased.Practice Implications: Educating PCPs on the importance of PPD screening and providing resources for at-risk mothers can increase identification of PPD in the primary care setting. Enhancing the confidence of providers to discuss PPD with mothers and offer resources to those in need can lead to better outcomes for pediatric patients and their families.

Managing Your Own Wellness (MYOW): Intervention for improving wellness through dementia care partner’s self‐care

AbstractBackgroundCaring for a person living with dementia (PLWD) can be a stressful and straining experience for family/friend care partners (CP), often leading to an increased risk for adverse psychosocial and health outcomes (e.g., depression, anxiety, mortality). Engaging in self‐care can reduce these risks and improve health. Yet, comprehensive tools that measure self‐care as a dynamic concept in the context of dementia caregiving do not exist. “Managing Your Own Wellness” [MYOW] checklist was created and validated to capture dementia CP self‐care behaviors and to inform the development of a brief, tailored person‐centered intervention. The study’s objective was to pilot test this intervention, with the ultimate goal of informing a new generation of CP interventions that address the complex and wide range of self‐care needs.MethodNineteen primary dementia CPs completed the study and participated in the baseline visit to establish a self‐care goal, three weekly check‐in coaching visits with the interventionist, and a final exit interview at week four. Measures at baseline, week four, and week 12 included MYOW, well‐being scale, single item tool for perceived strain and stress, and screening tools for depression and anxiety. Participants completed daily tracking forms to report their engagement and perception of progress in their selected self‐care activity. All interviews were transcribed and coded using thematic content analysis. Study measures were evaluated using correlation analyses.ResultsCP’s increased engagement in self‐care activities and improved sense of well‐being were captured by quantitative measures. Qualitative analysis revealed themes involving a change in relationship dynamics, evolution of the sense of self, shift in internal personal perspective (acceptance) and its effects on CP behaviors (increased patience, less frustration), and perception of PLWD interactions (more cooperative).ConclusionMYOW intervention had high acceptability and demonstrated high potential for broad dissemination. CP engaged in developing and following through on personalized self‐care goals and in tracking their progress. The impact of self‐care is dynamic and multi‐faceted. Focusing on brief daily wellness‐related activities has mutual benefits for CP and PLWD. Future research should be focused on further simplifying intervention protocols and measures and evaluating the intervention with a larger diverse sample of CP.

Early Detection of Depression in Parkinson's Disease: Psychometrics and Diagnostics of the Spanish Version of the Beck Depression Inventory.

Depression is one of the most disabling non-motor symptoms in Parkinson's disease (PD) and requires proper diagnosis as it negatively impacts patients' and their relatives quality of life. The present study aimed to examine the psychometric and diagnostic properties of the Beck Depression Inventory-I (BDI-I) in a Spanish PD cohort. Consecutive PD outpatients completed the Spanish version of the BDI-I and other questionnaires assessing anxiety and apathy. Patients' caregivers completed the depression/dysphoria domain of the Neuropsychiatric Inventory (NPI-D). The internal consistency, convergent and divergent validity and the factorial structure of BDI-I were evaluated, and an optimal cut-off was defined by means of the Youden index. The BDI-I proved to have a good internal consistency and was underpinned by a mono-component structure. Regarding construct validity, the BDI-I was substantially related to anxiety and apathy measures in PD. Furthermore, the BDI-I overall showed good accuracy with adequate sensitivity and specificity. The optimal cut-off point was defined at 10. We provided evidence of the psychometric and diagnostic properties of the Spanish version of the BDI-I as a screening tool for depression in Spanish speaking PD patients, suggesting its usefulness in clinical research and practice.

Identification of central symptoms of children depression and development of two short version of Children's Depression Inventory: Based on network analysis and machine learning

BackgroundUsing network analysis to study the central symptoms is important for understanding the mechanism of depression symptoms and selecting items for the short version depression screening scale. This study aimed to identify the central symptoms of depression and develop the short and effective depression screening tools for Chinese rural children. MethodsFirstly, the 2458 individuals (Mage = 10.74; SDage = 1.64; 51.2 % were female) were recruited from the rural children's mental health database. Children's Depression Inventory (CDI) was used to assess depression symptoms. Then, network analysis was used to identify the central symptoms of depression. The accuracy, stability, and gender invariance of the depression symptoms network were tested. Finally, a short version of CDI with central symptoms (CDI-SC) and a new CDI-10 (CDI-10-N) were developed by network analysis and feature selection techniques to optimize the existing CDI-10. Their performances in screening depression symptoms were validated by the cutoff threshold and machine learning. ResultsThe central symptoms of Chinese rural children's depression were sadness, self-hatred, loneliness and self-deprecation. This result was accurate and stable and depression symptoms network has gender invariance. The AUC values of CDI-10-N and CDI-SC are over 0.9. The CDI-10-N has a higher AUC than CDI-10. The optimal cutoff thresholds for CDI-10-N and CDI-SC are 6 and 1. The performance of machine learning on AUC generally outperforms those of cutoff threshold. ConclusionsThe central symptoms identified in this study should be highlighted in screening depression symptoms, and CDI-10-N and CDI-SC are effective tools for screening depression symptoms in Chinese rural children.

Help us help you using technology to maximize resource response to patient reported SDoH and depression screening.

576 Background: Social determinants of health (SDoH) are associated with inferior health outcomes, morbidity, life expectancy, and healthcare expenses. Screening for SDoH is increasingly incorporated into routine clinical practice, however clinical decision support and resources addressing positive SDoH screening are less robust. As part of the ASCO PC4, we developed an electronic workflow that utilizes SDoH and depression screening tools with prepopulated referrals to assist the clinician in directing the referral to the most appropriate supportive service. Methods: Smilow Cancer Hospital ASCO Patient Centered Care Certification Implementation Team collaborated with our social work, psycho oncology, and Community Health Worker (CHW) to optimally screen and respond to patients who screened positive for SDoH or depression. A workflow was established using Welcome Web software in combination with Epic to transfer patient results collected in the waiting room via iPad to the patient’s medical record. Positive screening results trigger a best practice advisory when clinician opens chart. The alert links to a Smartset prepopulating an order to the appropriate resource for the reported need. Patients with transportation, food insecurity, or housing concerns were referred to Community Healthcare Worker. Social workers received referrals for patients with social connection concerns and PHQ-9 scores between 9-14. Patients with a PHQ-9 score of 15 and above were referred to the psycho-oncology team. A specialized workflow was created for any patient who responded positively to thoughts of self-harm. These patients received an immediate intervention and were screened using the Columbia Suicide Severity Screening Tool. Results: See table. Conclusions: Incorporating SDoH screening alongside clinical decision support and automated referrals was feasible. Technology enabled screening enhances efficiency and assists clinicians with direct referrals to the appropriate resource, while allowing resources to operate at the top of their licensure and enhance efficiency. Future Directions for Research: 1. Monitor emergency room utilization, admissions, and unplanned visits for patients receiving services from CHW, Social Work, and Psycho-oncology services. 2. Monitor work queue volumes to assess if directed referrals expedite response.[Table: see text]

Validating the Edinburgh Postnatal Depression Scale Against the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition for Use in Uganda.

The Edinburgh Postnatal Depression Scale (EPDS) is a widely acknowledged screening tool for postpartum depression (PPD) globally, but its validation in Uganda has been lacking. This study aimed to assess the EPDS's accuracy as a PPD screening tool in Uganda compared to the Mini-International Neuropsychiatric Interview (MINI 7.0.2) based on the DSM-5. This was a descriptive cross-sectional study conducted at a referral hospital and two peri-urban primary care postpartum clinics in rural southwestern Uganda. We enrolled 287 mothers aged 18 to 49 at their six-week postpartum visit. The EPDS was used for initial screening, and the MINI 7.0.2 was employed for clinical diagnosis. The study used the Runyankore-Rukiga language version of the EPDS and collected data from November 11, 2019, to June 10, 2020, with the MINI 7.0.2 as the reference standard. The overall PPD prevalence was 29.5%, as opposed to 26.5% with EPDS and MINI 7.0.2 DSM-5 criteria (p = 0.239). The EPDS demonstrated a sensitivity of 86.8%, specificity of 92.1%, positive predictive value of 80.5%, and negative predictive value of 94.9%. A cutoff score of ≥10 was found to be the most effective acceptable point after drawing the AUC of ROC and determining the most appropriate point using Youden's index. The area under the ROC curve, indicating the scale's overall performance against MINI 7.0.2, was 0.89 for Bwizibwera HCIV, 0.97 for Kinoni HCIV, and 0.84 for MRRH. In conclusion, the EPDS can effectively screen for postpartum depression in southwestern Uganda using a cutoff score of ≥10. It exhibits strong diagnostic performance in correctly identifying PPD in postpartum mothers.