Depression Screening Research Articles

Mental Health and Mobile Communication Profiles of Crowdsourced Participants.

Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) are highly prevalent and burdensome. To increase mental health screening rates, the digital health research community has been exploring the ability to augment self reporting instruments with digital logs. Crowdsourced workers are being increasingly recruited for behavioral health research studies as demographically representative samples are desired for later translational applications. Overshadowed by predictive modeling, descriptive modeling has the ability to expand knowledge and understanding of the clinical generalizability of models trained on data from crowdsourced participants. In this study, we identify mobile communication profiles of a crowdsourced sample. To achieve this, we cluster features derived from time series of call and text logs. The psychiatric, behavioral, and demographic characteristics were notably different across the four identified mobile communication profiles. For example, the profile that had the lowest average depression and anxiety screening scores only shared incoming text logs. This cluster had statistically significantly different depression and anxiety screening scores in comparison to the cluster that shared the most outgoing text logs. These profiles expose important insights regarding the generalizability of crowdsourced samples to more general clinical populations and increase understanding regarding the limitations of crowdsourced samples for translational mental health research.

Establishing mental health friendly pharmacies to assist in the early identification and support of older adults at risk of depression: The EMPATHISE pilot study

BackgroundLate-life depression (LLD) often goes underdiagnosed and undertreated. Community pharmacists are one of the most accessible and trusted healthcare professionals (HCPs) and may play a significant role in LLD screening. ObjectiveThis study aimed to develop and pilot a pharmacist-delivered depression screening and referral service for older adults (≥65 years) at risk of depression, within community pharmacy. MethodsCommunity pharmacists across New South Wales, Australia, were recruited to participate in a prospective pilot study. Pharmacists/pharmacy staff received specialized training before recruiting and screening patients aged ≥65 years using the Geriatric Depression Scale-15 (GDS-15). Patients scoring ≥6 were referred to another HCP, e.g., general practitioner, and followed-up by the pharmacist 1-week postscreening. Patients were also followed-up by a research team member 6-weeks postscreening to explore outcomes of the screening. Semi-structured interviews with pharmacists and patients were undertaken following completion of the pilot study to explore their experiences delivering/receiving the screening service. A thematic inductive analysis approach was used to analyze interview data. ResultsA total of 39 community pharmacies participated in this study. In total, 113 participants attended the training sessions. Pharmacists screened 15 patients from 8 pharmacies, of which 67% were female. Two thirds of patients (67%) received a GDS-15 score of ≥6, indicating possible depression and requiring referral. Pharmacists referred 80% of patients to another HCP. One patient was diagnosed with depression and commenced antidepressant therapy. Five patients and 6 pharmacists participated in semi-structured interviews. Barriers to screening included lack of time and mental illness stigma. Facilitators included pharmacist-patient relationships and training. ConclusionPharmacist-delivered LLD screening was found to be acceptable by both pharmacists and patients, with pharmacists reporting training improved their comfort and confidence with depression screening. These pilot study findings may inform future work into service delivery models to support early identification and treatment of LLD.

Exercise, mental well-being and burnout in Thai medical students in 2020–2021: an online cross-sectional survey

IntroductionWithin the Thai medical curriculum, its rigorous education framework, demanding schedules and high academic standards can contribute to psychological distress. Regular physical activity has consistently shown positive effects on mental health. The aim of the study was to investigate the association between exercise and psychological well-being, including depression, anxiety, and burnout, in Thai medical students, and factors related to insufficient exercise and depression.MethodsThe cross-sectional study was conducted among medical students in the university hospital during 2020–2021. Participants completed self-administered questionnaires consisting of demographic data, Godin-Shephard Leisure-Time Physical Activity Questionnaire, depression screening (9Q), Thai General Health Question-28 (4 domains: somatic symptoms, anxiety and insomnia, social dysfunction, severe depression), and Maslach burnout inventory (Emotional exhaustion (EE), Depersonalization (DP), Reduced Personal Achievement (rPA).ResultsOf the 404 participants, 50.5% were women, the mean age (SD) was 21.06 (1.8) years, and 52% were in clinical years. The prevalence of insufficient exercise was 59.6%, depression (30.2%), somatic symptoms (27.7%), anxiety (30.7%), insomnia (89.4%), social dysfunction (89.4%), high level of EE (32.4%), DP (21%), and rPA (56.7%). Insufficient exercise was associated with moderate to severe depression (OR 2.89, 95% CI 1.16–7.25), anxiety and insomnia (OR 1.56, 95% CI 1.01–2.43), social dysfunction (OR 2.51, 95% CI 1.31–4.78), burnout in part due to high rPA (OR 2.4, 95% CI 1.4–4.13), and study in clinical years (OR 1.91, 95% CI 1.28–2.87). After adjusted significant factors, only studying in the clinical year, social dysfunction, and burnout in part of rPA were related to insufficient exercise.ConclusionsHigh rates of insufficient exercise, psychological challenges, and burnout were prevalent among medical students. To effectively address these issues, medical school should advise students to participate in regular exercise, promoting mental well-being and healthier lifestyles.

Depression Screening as a Part of the Employees' Annual Checkup Using a Two-Step Approach at King Khalid University Hospital, Riyadh, Saudi Arabia.

Introduction Health professionals experience high levels of work-related stress; hence, the study of depression among healthcare workers(HCWs) is essential to improve patient care, prevent burnout, and retain a skilled workforce as well as reduce stigma, enhance workplace productivity, and promote overall well-being. This study aimed to estimate the prevalence of depression and associated factors among HCWs at King Khalid University Hospital, Riyadh, Saudi Arabia. Methods We conducted a cross-sectional study among HCWs at King Khalid University Hospital. All healthcare workers required to renew their contract annually were given a Patient Health Questionnaire 2 (PHQ2) tool for screening for depression; if their score was three or more, a Patient Health Questionnaire 9 (PHQ9) tool was given along with additional questions including demographic, profession-related factors, and stressor presence in different life dimensions. Results In total, 69 HCWs filled out the screening survey (PHQ9). Most were females (n=57; 82.6%), with 36 (52.2%) aged 35 years or below. Five (7.2%) HCWs reported a family history of mental illness. The prevalence of major depressive disorders among HCWs was 29 (42%). Conclusions Younger HCWs who smoked and had no children were more susceptible to depression. Annual psychological screenings for HCWs could be beneficial for monitoring staff vulnerable to mental health disorders. We need a future multicenter study approach to confirm the prevalence of major depression in our region.

Postpartum Depression Screening in Pediatric Primary Care Clinics and Infant Receipt of Preventive or Acute Care

ObjectiveTo evaluate the association between postpartum depression (PPD) screening results in pediatric primary care and subsequent infant preventive and acute care utilization. MethodsThis was a retrospective cohort analysis of 5341 infants born in 2021 whose mothers were screened for PPD at a well-child visit during the first 6 months. Logistic regression was used to examine that association between a positive PPD screen and 1) adherence to the 12-month well-child visit, and 2) any acute care visits (urgent care or emergency department visits) from 6–15 months. The association between PPD screen and number of acute care visits was examined with negative binomial logistic regression. ResultsThe incidence of positive PPD screens was 15.6% in the first 6 months. There was no significant difference in 12-month well-child visit adherence based on PPD screening (adjusted odds ratio (aOR): 0.91; 95% confidence interval (CI): 0.77–1.06; P-value: 0.206). The odds of having any acute care visit were higher among infants whose mothers screened positive for PPD (aOR: 1.2; 95% CI: 1.0–1.3; P-value: 0.009). There was a significant difference in the incidence rate of acute care visits based on PPD screening results (incidence rate ratio: 1.1; 95% CI: 1.0–1.2; P-value: 0.005). ConclusionsScreening positive for PPD was associated with subsequent acute care utilization but not 12-month preventive care. Primary care providers may need to proactively follow-up after acute care visits to ensure both infant health and maternal needs are met, connecting mothers to resources as needed.

The Winding Path of Depression in Argentina from Awareness to Functional Recovery

Background: Despite the huge global socioeconomic burden of depressive disorders, depression is often underreported and undertreated due to a lower level of awareness from both healthcare providers and payers in many countries. The lack of an evidence-based approach to care delivery has resulted in the inequitable allocation of health resources, causing resource scarcity issues in Argentina. Objective: The aim of this paper is to identify the gaps in evidence related to patients’ journeys and barriers in the existing care ecosystem contributing to poor access to quality care for depression in an Argentine context. Methods: A semi-systematic review of the literature was performed from 2012 to 2021 using Medline, Embase and Biosis and other unstructured sources (Google Scholar, the World Health Organization (WHO) website, Argentina Ministry of Health website, and Incidence and Prevalence Database (IPD) on awareness, screening, diagnosis, treatment, adherence and/or control of depression amongst adults (≥18 years). Any identified data gaps were supplemented with anecdotal data from local experts. Results: Low percentages of adult patients with depression awareness (<25%), screening (<10%), diagnosis (37.5%), received treatment (41.9%), adherence to treatment (37.5%), and control (37.5%) were observed. Conclusion: Ensuring a care continuum while considering full clinical remission with functional recovery as a therapeutic goal and advocacy for patient-centric adjustments in existing mental health policies would be key drivers for improving the depression care scenario.

Anesthesia for cesarean delivery and subsequent depression: A nationwide retrospective cohort study

BackgroundPostpartum depression is a major psychiatric disorder associated with maternal suicide and child developmental disturbances. In this study, we aimed to investigate whether general anesthesia for cesarean delivery is associated with a higher rate of new-onset depression after delivery than neuraxial anesthesia. MethodsThis is a nationwide retrospective cohort study using data retrieved from the National Health Insurance Research Database between 2014 and 2018. Women who had cesarean delivery under general or neuraxial anesthesia were enrolled. After 1:4 propensity score matching, there were 4544 and 18,176 women under the general and neuraxial anesthesia groups, respectively. The primary outcome was new-onset depression diagnosed after delivery in a time-to-event analysis setting. ResultsAfter propensity-score matching, the rate of new-onset depression diagnosed within 1 year was 1.10 % (50/4488) and 0.86 % (157/18176) after cesarean delivery under general and neuraxial anesthesia, respectively. For depression diagnosed within 90 days of delivery, significant difference between the two groups was noted (0.51 % vs. 0.30 %, P = 0.031). In the time-to-event analysis with Cox regression model, women who delivered under general anesthesia were associated with significantly higher risk of postpartum depression within 90 days (Hazard ratio [HR], 1.71; 95 % CI, 1.05–2.79) compared with those under neuraxial anesthesia. LimitationsThe observational design only allows asserting association, rather than establishing causality between exposure and outcomes. ConclusionsWomen who underwent cesarean delivery under general anesthesia had a higher risk of subsequent depression within 90 days than those under neuraxial anesthesia. Early screening for depressive disorders might facilitate timely management.

Ethno-racial differences in depressive symptom endorsement: Evaluation of brief forms of the Geriatric Depression Scale in older adults.

Depression among older adults is a pressing public health concern, necessitating accurate assessment tools. The Geriatric Depression Scale (GDS) offers a brief and efficient means of screening depressive symptoms, yet its performance across ethno-racial groups remains understudied. This study aimed to compare the ability of various brief forms of the GDS to detect depressive symptoms and to assess potential ethno-racial differences in symptom endorsement among White, Black/African-American, and American Indian/Alaska Native older adults. Data were obtained from the Wisconsin Alzheimer's Disease Research Center (ADRC) clinical cohort, comprising 555 cognitively healthy individuals at risk for dementia. We used participants' baseline data for this cross-sectional analysis. Depressive symptoms were assessed using multiple brief forms of the GDS, derived from a systematic review and meta-analysis. We examined internal consistency and correlations with global Clinical Dementia Rating (CDR) scores. We conducted Kruskal-Wallis tests and post hoc pairwise comparisons to assess ethno-racial group differences in symptom endorsement. Descriptive statistics revealed a predominance of female and White participants, with notable representation from Black and American Indian/Alaska Native groups. All GDS versions demonstrated moderate to high internal consistency. Significant positive correlations were observed between GDS scores and global CDR scores. Ethno-racial group differences in depressive symptom endorsement were evident, with Black participants consistently reporting higher levels of symptoms across most GDS versions. However, American Indian/Alaska Native participants endorsed significantly fewer symptoms than Black participants in one GDS version. The study highlights the importance of considering ethno-racial differences in depressive symptomatology when assessing older adults. While the GDS demonstrates overall reliability, variations in symptom endorsement across different ethno-racial groups underscore the need for culturally sensitive assessment tools and interventions. Future research should further explore these group differences and develop tailored approaches to depression screening and treatment in diverse older adult populations.

Stress, Depression, and Anxiety Symptoms in Older Adults: Temporal Trend and Relationship with COVID-19

Introduction. Although studies have demonstrated the impact of the COVID-19 pandemic on mental health, those correlating COVID-19 statistics with the psychosocial repercussions in older adults are as yet incipient. Objective. Evaluate the screening of stress, depression, and anxiety symptoms in older adults throughout the pandemic and their relationship with the occurrence and severity metrics of COVID-19. Method. An ecological, time-series, web-based survey study was conducted in the population aged 60 and over who use digital media. Data collection was undertaken between July 2020 and January 2021 in eight Brazilian cities and included 2,712 older adults. Results. There was an upward trend in anxiety and depression symptoms in Brasília-DF, and a downward trend in these symptoms in Divinópolis-MG. It was also possible to identify correlations between mental disorder symptom scores and COVID-19 occurrence and severity metrics in two of the cities evaluated. Discussion and conclusion. This study is one of the first to explore the relationship between COVID-19 indicators and mental health variables in older adults, showing that changes in the occurrence and severity metrics of the Novel Coronavirus may be followed by changes in the frequency of mental health problems in this population.

EFFECTIVENESS OF HORTICULTURAL ACTIVITY ON DEPRESSIVE SYMPTOMS AMONG OLDER ADULTS

Background: Mental disorders such as depressive symptoms are widespread, often underdiagnosed, and usually inappropriately treated. The early recognition of factors that may promote depressive symptoms with the help of depression screening aid can help to plan better care for the patient. Therefore, this study aimed to assess the depressive symptoms and the effectiveness of horticulture activity to reduce depressive symptoms among older adults in selected old age homes, Dehradun Uttarakhand. Objectives: To determine the effectiveness of horticulture Activity on depressive symptoms among older adults in the experimental group. Methodology: Quasi-experimental approach with a non-randomized control group design was used in the study Non-probabilitypurposive sampling technique was used to collect data, 60 older adults in the age group 60 or above were selected for the study. The subjects were given horticulture activity for approximately 45 minutes once a day for 14 days. Pre-test and Post-test were conducted by using Socio-Demographic Data, and Geriatric Depression Scale. Both descriptive and inferential statistics were used to assess the data. Result: The result revealed that horticulture activity are effective in reduced the depressive symptoms. In experimental group the outcome t value was 18.41 (significant at p≤0.05) and control group t value was 3.15 (Significant at p≤0.05). No significant association between the score of Geriatric Depression Scale in experimental group and control group. Conclusion: This study concluded that pranayama is effective in reducing depressive symptoms among older adults.

Associations between antenatal depressive symptoms in different trimesters and perinatal outcomes: A prospective multicenter cohort study in China

BackgroundEvidence exists that maternal antenatal depression may have adverse impacts on perinatal outcomes. However, the results of those studies are inconsistent and mainly focus on maternal depressive symptoms in the second or third trimester. MethodsThis prospective cohort study used a sub-sample of participants from the Sino-Canadian Healthy Life Trajectories Initiative trial. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for depressive symptoms in the first, second, and third trimesters, respectively. Infant growth indicator measurements were conducted in the first year of life. Logistic regression, Spearman correlation analyses and Generalized estimation equation (GEE) models were used to test the hypotheses. Results2053 participants were recruited in this study, 326 of whom had at least one EPDS score ≥ 10 during pregnancy. A higher EPDS score in the first (aOR=1.053, 95 % CI: 1.004–1.103) or in the second trimester (aOR=1.060, 95 % CI: 1.007–1.115) was associated with greater risk of macrosomia. A higher EPDS score in the third trimester was associated with higher risks of preterm birth (aOR=1.079, 95 % CI: 1.006–1.157) and the infant being small for gestational age (aOR=1.097, 95 % CI: 1.015–1.185). GEE models showed that a greater EPDS score in the third trimester was associated with higher infant subscapular skinfold thickness (adjusted β=0.026, 95 % CI: 0.003–0.050). ConclusionMaternal depressive symptoms in different trimesters were differentially associated with infant weight and growth parameters at birth and postnatally. The present study further highlights the importance of depression screening in all trimesters of pregnancy, including the first trimester.

OPPORTUNITIES FOR IMPROVING THE LONG-TERM MANAGEMENT OF KERATOCONUS PATIENTS

Background and Objective: This study determined whether practitioners specializing in keratoconus (KC) adhere to published guidelines for disease management and to what extent comorbid conditions of dry eye, contact lens tolerance, and psychological consequences of KC are formally assessed as part oflong-term management. Materials and Methods: This cross-sectional study used an IRB-approved, Internet-based, REDCap platform. Descriptive statistics are presented. Results: A total of 222 participants qualified for participation. Most 134 (60%) followed young and unstable patients every 6 months and less frequent follow-up examinations for patients with stable findings, with 142 (64%) recommending annual examinations. Scleral lenses were the preferred optical correction method (36%), followed by corneal gas-permeable lenses (21%). A total of 118 (55%, n=216) participants recommend crosslinking to any patient with documented disease progression regardless of age. Fewer than 25% of patients were referred for surgical correction of KC. Half of respondents, 114 (51%), reported testing for tear film dysfunction, while 108 (49%) never tested. No participants used a depression screening instrument. Conclusion: Practitioners managing patients with KC largely adhere to current consensus recommendations. This survey identified several potentially high-impact, low-cost improvements to current practice patterns, including screening for dry eye and depression.

The Relationship Between Screen Time, Social Network Usage, and Physical Activity with Depression in Students at Qazvin University

Background: Depression and its related variables are especially interesting and important to study in the context of the virtual world. Objectives: The purpose of the present study was to investigate the relationship between screen time, the amount of social network usage, and physical activity with depression in students. Methods: The research method was a descriptive correlation study. One hundred sixty undergraduate students from Qazvin Universities were selected as a sample in the spring of 2022 using multi-stage cluster sampling. After dropping some subjects, the sample size was reduced to 146. The participants completed questionnaires about screen time, social network usage, physical activity, and depression. The obtained data were analyzed using Pearson's correlation coefficient and simultaneous regression. Results: The results showed a significant relationship between screen time and depression (r = 0.35, P < 0.01). There was also a significant relationship between the use of social networks and depression (r = 0.17, P < 0.05), but no relationship was observed between physical activity and depression (r = 0.08, P > 0.05). Additionally, it was found that the predictor variables could explain 13% of the variance in the depression variable. Conclusions: The contribution of the screen time variable in explaining depression symptoms was higher than that of the other variables.

Life changes and symptoms of depression and anxiety among Chinese children and adolescents before, during, and after the COVID-19 pandemic lockdown: a combination of cross-sectional, longitudinal, and clustering studies.

The measures to prevent COVID-19 pandemic had caused significant life changes, which may have caused stress on the mental health of children and adolescents. We aimed to evaluate the short- and long-term effects of life changes on children's mental health in a large Chinese cohort. Survey-based life changes during COVID-19 lockdown were measured among 7,829 Chinese students at Grade 1-9, including social contacts, lifestyles and family financial status. Clustering analysis was applied to identify potential patterns of these changes. Depressive and anxiety symptoms were measured using the Center for Epidemiologic Studies Depression Scale and Screen for Child Anxiety Related Emotional Disorders. Logistic regression models were used to investigate the associations between these changes, their patterns and the presence of depression/anxiety symptoms using both cross-sectional and longitudinal designs. We found that the prevalence of depression and anxiety symptoms decreased during pandemic (34.6-32.6%). However, during and shortly after lockdown, students who reported negative impacts on their study, social and outside activities, and diet had increased risks of depressive/anxiety symptoms. Decreased electronic time and sugar-sweetened consumption, as well as family income decline and unemployment, were also associated with higher risks of these symptoms. Additionally, students with changed sleep time had increased depressive symptoms. These associations attenuated or disappeared one year later. Similar patterns were observed in clustering analysis, while only the group with severe impact on family financial status showed a sustained increase in depression symptoms. In summary, restrictive measures that changed children and adolescents' daily life during COVID-19 lockdown showed negative effects on their mental health, with some commonalities and distinctions patterns in the manifestation of depression and anxiety symptoms.

Disparities in Screening and Treatment Patterns for Depression and Anxiety During Pregnancy: An Integrative Review.

Symptoms of untreated depression and anxiety during pregnancy are associated with serious adverse effects for the pregnant person, birth outcomes, and child development. However, pregnant persons are less likely to be screened and treated compared with nonpregnant people. In this systematic review, we aimed to explore individual, provider, and systems factors that impact screening, identification, and treatment patterns for depression and anxiety during pregnancy. Studies were eligible for inclusion if they were conducted within the United States and published in English between January 2012 and January 2023. Each study included analysis that compared rates of screening, identification, or treatment engagement and explicitly discussed disparities or health equity in marginalized groups. Fifteen articles met full inclusion criteria. Results demonstrated variation in the screening, identification, and treatment of depression and anxiety during pregnancy among diverse groups of patients. Screening rates ranged from 51.3% in Puerto Rico to 90.7% in Alaska. Among specific clinical populations, rates were as low as 2.0%. Fewer than half of patients were referred to treatment when indicated by screening or diagnoses. Patient characteristics such as age, race, ethnicity, socioeconomic and health factors, mental health history, and obesity were associated with variation in the rates of screening, diagnoses, or treatment engagement. Language factors were the most common factor associated with lower rates of screening and treatment access. Results suggest that many pregnant people are being overlooked and lack appropriate referrals or resources to access treatment. Results are consistent with previous findings that role confusion and lack of time, provider training, and interest contribute to low rates of screening and treatment. Future research must focus on system level factors to address perceived barriers to screening and treating depression and anxiety during pregnancy in a systematic and equitable way.

Prevalence of anxiety and depression and their associated risk factors throughout pregnancy and postpartum: a prospective cross-sectional descriptive multicentred study

ObjectiveTo assess the prevalence of anxiety and depression and their associated risk factors throughout the pregnancy and postpartum process using a new screening for the early detection of mental health problems.DesignA prospective cross-sectional descriptive multicentred study. Participants were consecutively enrolled at ≥ 12 weeks’ gestation and followed at three different time points: at 12–14 weeks of pregnancy, at 29–30 weeks of pregnancy, and 4–6 weeks postpartum. All women completed a mental screening at week 12–14 of pregnancy consisting of two questions from the Generalised Anxiety Disorder Scale (GAD-2) and the two Whooley questions. If this screening was positive, the woman completed the Edinburgh Postnatal Depression Scale (EPDS).SettingSeven primary care centres coordinated by a Gynaecology and Obstetrics Department in the city of Terrassa (Barcelona) in northern Spain.ParticipantsPregnant women (N = 335, age 18–45 years), in their first trimester of pregnancy, and receiving prenatal care in the public health system between July 2018 and July 2020.FindingsThe most relevant factors associated with positive screening for antenatal depression or anxiety during pregnancy, that appear after the first trimester of pregnancy, are systematically repeated throughout the pregnancy, and are maintained in the postpartum period were: a history of previous depression, previous anxiety, abuse, and marital problems. In weeks 12–14 early risk factors for positive depression and anxiety screening and positive EPDS were: age, smoking, educational level, employment status, previous psychological/psychiatric history and treatment, suicide in the family environment, voluntary termination of pregnancy and current planned pregnancy, living with a partner and partner’s income. In weeks 29–30 risk factors were: being a skilled worker, a history of previous depression or anxiety, and marital problems. In weeks 4–6 postpartum, risk factors were: age, a history of previous depression or anxiety or psychological/psychiatric treatment, type of treatment, having been mistreated, and marital problems.ConclusionsEarly screening for anxiety and depression in pregnancy may enable the creation of more effective healthcare pathways, by acting long before mental health problems in pregnant women worsen or by preventing their onset. Assessment of anxiety and depression symptoms before and after childbirth and emotional support needs to be incorporated into routine practice.

Using Multimodal Assessments to Reevaluate Depression Designations for Spine Surgery Candidates.

Depression is common in spine surgery candidates and may influence postoperative outcomes. Ecological momentary assessments (EMAs) can overcome limitations of existing depression screening methods (e.g., recall bias, inaccuracy of historical diagnoses) by longitudinally monitoring depression symptoms in daily life. In this study, we compared EMA-based depression assessment with retrospective self-report (a 9-item Patient Health Questionnaire [PHQ-9]) and chart-based depression diagnosis in lumbar spine surgery candidates. We further examined the associations of each depression assessment method with surgical outcomes. Adult patients undergoing lumbar spine surgery (n = 122) completed EMAs quantifying depressive symptoms up to 5 times daily for 3 weeks preoperatively. Correlations (rank-biserial or Spearman) among EMA means, a chart-based depression history, and 1-time preoperative depression surveys (PHQ-9 and Psychache Scale) were analyzed. Confirmatory factor analysis was used to categorize PHQ-9 questions as somatic or non-somatic; subscores were compared with a propensity score-matched general population cohort. The associations of each screening modality with 6-month surgical outcomes (pain, disability, physical function, pain interference) were analyzed with multivariable regression. The association between EMA Depression scores and a depression history was weak (rrb = 0.34 [95% confidence interval (CI), 0.14 to 0.52]). Moderate correlations with EMA-measured depression symptoms were observed for the PHQ-9 (rs = 0.51 [95% CI, 0.37 to 0.63]) and the Psychache Scale (rs = 0.68 [95% CI, 0.57 to 0.76]). Compared with the matched general population cohort, spine surgery candidates endorsed similar non-somatic symptoms but significantly greater somatic symptoms on the PHQ-9. EMA Depression scores had a stronger association with 6-month surgical outcomes than the other depression screening modalities did. A history of depression in the medical record is not a reliable indication of preoperative depression symptom severity. Cross-sectional depression assessments such as PHQ-9 have stronger associations with daily depression symptoms but may conflate somatic depression symptoms with spine-related disability. As an alternative to these methods, mobile health technology and EMAs provide an opportunity to collect real-time, longitudinal data on depression symptom severity, potentially improving prognostic accuracy. Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Differences at Index Surgery in Operative Complexity and Residual Disease for Earlier and Later Repeat Lumbar Surgery.

Retrospective review, single-institution cohort studies. To compare patients with earlier (i.e. <1.5y) and later (i.e. >1.5y) repeat lumbar surgery to patients with no repeat surgery according to clinical characteristics at index surgery. Grouping patients as earlier or later repeat surgery may reveal different associations when compared to patients with no repeat surgery. Patients undergoing index surgery for diverse conditions reported preoperative demographic/clinical variables, including comorbidity and depressive symptoms. Extent (i.e. complexity) of surgery was assigned based on a valid index that included decompression, fusion and instrumentation. Co-existing disease at non-operated levels was ascertained from imaging reports. Postoperative records of all medical visits up to the time of this study (12y) were reviewed for repeat surgery. Patients were grouped as earlier (<1.5y) or later surgery (≥1.5y) and compared to patients with no repeat surgery in separate multivariable analyses. Among 1,334 patients (51% men, mean age 59), 82% did not have repeat surgery, 7% had earlier and 11% had later repeat surgery. Compared to no surgery, earlier surgery was associated with more comorbidity (OR 1.7, CI 1.1-2.6, P=0.02), positive depression screen (OR 1.9, CI 1.2-2.9, P=0.006), opioid use (OR 1.8, CI 1.2-2.8, P=0.008), and greater extent of index surgery (OR 1.1, CI 1.0-1.1, P=0.0009). Compared to no surgery, later surgery was associated with pre-index lumbar surgery (OR 1.9, CI 1.3-2.8, P=0.0005) and disease at non-operated levels at index surgery (OR 1.6, CI 1.0-2.4, P=0.05). Earlier surgeries were more likely to involve only the same vertebra as index surgery (51% vs. 16%) and later surgeries were more likely to involve only other levels (5% vs. 36%, P=0.01). Earlier and later repeat lumbar surgeries differed in complexity and residual disease compared to no repeat surgery. These findings have implications for patient counseling regarding short and long-term postoperative spine health.

Screening for depression in chronic haemodialysis patients as a part of care in dialysis setting: a cross-sectional study.

Depressive disorder is common among haemodialysis patients. The purpose of this study was to explore approaches to diagnosing depression in the context of a real-life setting, with the view of creating practical recommendations. It also aimed to evaluate the prevalence of depression and dementia. We conducted a cross-sectional study in two Dialysis Centres in Poland. Cognitive functions were evaluated using Mini-Mental State Examination (MMSE). The screening for depressive symptoms was assessed using Beck Depression Inventory II (BDI-II). The diagnosis of major depressive disorder was confirmed by a psychiatrist using Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). Sociodemographic and clinical data were also collected. Initially, 136 patients agreed to participate in the study. Dementia was found in 13% of the study group. Sixty-two patients did not agree to perform all the proposed tests and were not included in the analysis, which eventually consisted of 70 patients. According to BDI-II, depressive symptoms were present in 35.7% of patients, while the diagnosis of major depressive disorder (MDD) was confirmed by the psychiatrist in 25.7%. According to the ROC analysis the optimal cut-off score for diagnosing MDD using BDI-II was ≥13 points. This study suggests that the regular screening for depressive symptoms, followed by a psychiatric consultation in selected patients, might improve diagnosing depression with the goal of achieving a higher quality of life and a lower mortality rate. It may also be a cost-effective model for the management of depression among the haemodialysis population.

Malnutrition suppresses improvements in depression symptoms in older adult patients with stroke undergoing convalescent rehabilitation

Background & AimsDepression symptoms are both prevalent and associated with poor prognosis in patients with convalescent stroke. Therefore, the improvement of depression symptoms is important for patients with convalescent stroke. This study aimed to examine whether malnutrition diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria and its components are associated with improvements in depression symptoms in patients with stroke undergoing rehabilitation. MethodsThis was a retrospective cohort study of older adult patients with convalescent stroke. Inclusion criteria comprised patients aged ≥65 years experiencing their first occurrence of stroke and admitted for rehabilitation therapy. Patients were classified into either the malnutrition or normal nutrition groups based on the diagnosis of malnutrition using the GLIM criteria. The Geriatric Depression Screening Scale (GDS)-15 was used to evaluate depression symptoms. The primary outcome of the study was the change in depression symptoms, indicating a change in GDS score from admission to discharge. The association between malnutrition diagnosed using the GLIM criteria and change in depression symptoms was assessed using multiple regression analysis. Additionally, associations with the constructs of the GLIM criteria were investigated. ResultsThe malnutrition group comprised 64 (45%) patients, with a mean age of 78.2 years; 77 (54%) and 66 (46%) were males and females, respectively. Multiple regression analysis showed that malnutrition, diagnosed using the GLIM criteria (β: −0.306, p < 0.001), was independently associated with changes in depression symptoms. Moreover, the GLIM criterion component of reduced muscle mass (β: −0.235, p < 0.001) demonstrated a negative association with a change in depression symptoms. ConclusionMalnutrition and reduced muscle mass, diagnosed using the GLIM criteria in patients with stroke undergoing convalescent rehabilitation, were found to suppress the improvement of depression symptoms.