Burden Of Depressive Symptoms Research Articles

Collaborative Care for Injured Older Adults

Older adults with recent injuries can have impaired long-term biopsychosocial function and may benefit from interventions adapted to their needs. To determine if a collaborative care intervention, Trauma Medical Home (TMH), improved the biopsychosocial function of older patients in the year after injury. This was a single-blinded, randomized clinical trial conducted at 4 level I trauma centers in Indianapolis, Indiana, and Madison, Wisconsin. Between October 2017 and October 2021, patients aged 50 years and older with an Injury Severity Score (ISS) of 9 or greater and without traumatic brain or spinal cord injury were enrolled. Exclusions were significant brain injury or a spinal cord injury with a persistent neurologic deficit at the time of enrollment, extensive burns, pregnancy, incarceration, neurodegenerative disease, visual or auditory impairment that would preclude study participation, a life expectancy of less than 1 year, significant alcohol or drug use history, and acute stroke during admission. Of 10 276 patients screened, 430 were randomized and 299 completed 12-month follow-up. Data were analyzed from March to July 2023. Intervention patients received 6 months of TMH delivered by a nurse care coordinator guided by an interdisciplinary team (trauma surgeon, pulmonary critical care and geriatrician physicians, nurses, and psychologist) in partnership with primary care. The care coordinator used standard protocols to monitor and treat biopsychosocial symptoms. Primary outcomes were Medical Outcome Study Short Form-36 (SF-36) score and Short Physical Performance Battery (SPPB) score at 12 months. Secondary outcomes were Patient Health Questionnaire-9 (PHQ-9) score, the Generalized Anxiety Disorder scale-7 (GAD-7) score, and health care utilization. A total of 429 participants (228 [53.1%] female; mean [SD] age, 69.3 [10.8] years; mean [SD] ISS, 12.3 [4.6]) completed baseline assessments and were randomized. Follow-up was 76% (n = 324) at 6 months and 70% (n = 299) at 12 months. There were no differences between the TMH and usual care groups at 12 months in SF-36 Physical Component Summary score (mean [SD], 40.42 [12.82] vs 39.18 [12.43]), SF-36 Mental Component Summary score (mean [SD], 53.92 [10.02] vs 53.21 [10.82]), or SPPB score (mean [SD], 8.00 [3.60] vs 8.28 [3.88]). Secondary outcomes were also no different. Planned subgroup analysis revealed patients with baseline symptoms of anxiety or depression (high GAD-7 and PHQ-9 scores) experienced improvement in the Mental Component Summary score when randomized to the TMH intervention. The TMH intervention did not significantly influence quality of life, depressive and anxiety symptoms, or physical function of older adults with injury at 12 months. Subgroup analysis showed positive impact in patients with a high burden of anxiety and depression symptoms at enrollment. Collaborative care interventions may improve long-term outcomes of select patients, but further research is needed. ClinicalTrials.gov Identifier: NCT03108820.

Quality of Life and Depression Symptoms After Therapy De-Escalation in HPV+ Oropharyngeal Squamous Cell Carcinoma

Despite interest in therapy de-escalation for survivors of human papillomavirus-mediated oropharyngeal squamous cell carcinoma (HPV-positive OPSCC), the association of de-escalated therapy with patient-reported quality of life (QoL) outcomes and burden of depressive symptoms remains unclear. To identify associations between clinicopathologic and therapeutic variables with patient-reported QoL outcomes and depression symptom burden in patients with HPV-positive OPSCC, who were enrolled in a therapy de-escalation trial. In this nonrandomized controlled, open-label, curative-intent therapy de-escalation clinical trial in adults with stage I, II, and III HPV-positive OPSCC, patients were recruited from a high-volume head and neck oncology practice. The main outcomes of this study included quantitative, patient-reported QoL and depression symptoms per well-validated inventories. Patient-reported QoL was based on Functional Assessment of Cancer Therapy-Head & Neck (FACT-HN) scores (range, 0-148; lower score indicates inferior QoL). Patient-reported depression-related symptom burden was based on Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) scores (range, 0-27; a higher score indicates a higher burden of depression symptoms). Baseline clinicopathologic and treatment variables were paired with FACT-HN and QIDS-SR scores at baseline, 3, 6, 12, 24, and 36 months. Linear mixed-effect models with a random intercept were used for each participant and fixed effects for other measures. Regression coefficients are reported with 95% CIs. A total of 95 patients were followed up for a median (IQR) of 2.2 (1.6-3.2) years. Of these, 93 patients (98%) were male with a mean (SD) age of 60.5 (8.2) years. Overall, 54 participants (57%) had a history of current or former smoking, 47 (50%) underwent curative-intent surgery (with or without adjuvant therapy), and 48 (50%) underwent primary radiotherapy (with or without chemotherapy). The median (IQR) radiotherapy dose was 60 (60-70) Gy. Five deaths and 2 recurrence events were observed (mean [SD] recurrence interval, 1.4 [1.5] years). A higher radiotherapy dose was the only modifiable factor associated with inferior patient-reported QoL (lower FACT-HN) (coefficient, -0.66 [95% CI, -1.09 to -0.23]) and greater burden of depression-related symptoms (higher QIDS-SR) (coefficient, 0.11 [95% CI, 0.04-0.19]). With the 70-Gy dose as reference, improvements in FACT-HN and QIDS-SR scores were identified when patients received 51 to 60 Gy (coefficient, 12.75 [95% CI, 4.58-20.92] and -2.17 [-3.49 to -0.85], respectively) and 50 Gy or lower (coefficient, 15.03 [4.36-25.69] and -2.80 [-4.55 to -1.04]). In this nonrandomized controlled, open-label, curative-intent therapy de-escalation trial, a higher radiotherapy dose was associated with inferior patient-reported QoL and a greater burden of depression-related symptoms. This suggests opportunities for improved QoL outcomes and reduced depression symptom burden with a reduction in radiotherapy dose. ClinicalTrials.gov Identifier: NCT04638465.

A Retrospective Chart Review Evaluating the Changes in Depressive Symptoms in Adult Patients With Attention-Deficit/Hyperactivity Disorder (ADHD) With the Treatment of the Underlying ADHD.

Adult attention-deficit/hyperactivity disorder (ADHD) represents a significant public health burden. ADHD is often comorbid with many other psychiatric disorders, with a high co-occurrence with depression. However, there is a paucity in our understanding of the potential impact of treating patients' ADHD on their depressive symptoms. The primary objective of this study was to assess the effect of treating adult ADHD on comorbid depressive symptoms without directly administering treatment for depression in an integrated behavioral health clinic in the primary care setting. We performed a retrospective chart review between April 2021 and May 2022 on adult patients treated in the Primary Care Adult Integrated Behavioral Health Clinic at an urban family medicine residency clinic. For patients with ADHD, we administered the Adult ADHD Self-Report Scale (ASRS-v1.1) to serve as a marker of ADHD symptom burden and the nine-item Patient Health Questionnaire(PHQ-9) to serve as a marker of depressive symptom burden. We administered the questionnaires prior to initiating ADHD treatment and again at the three-month follow-up visit. The ADHD treatment included pharmacotherapy and brief psychological interventions targeted at ADHD. We compared the ASRS scores and PHQ-9 scores at baseline and after three months to determine whether ADHD treatment had any impact on PHQ-9 scores. At baseline, the average ASRS score was 11.3 and the average PHQ-9 score was 8.25. Comparing scores after three months of intervention to the initial scores, our preliminary results demonstrated a trend of improvement in both ASRS and PHQ-9 scores. A total of 75% (n=24/32) of the patients had an improvement in ASRS scores, and 56.7% (n=17/30) of the patients had an improvement in PHQ-9 scores at three months. At three months, there was a decline in PHQ-9 scores with a decrease in ASRS scores following treatment. Our preliminary results suggest that integrated behavioral health treatment of ADHD using a combination of pharmacological and non-pharmacological interventions may play a role in improving comorbid depressive symptoms.

Global burden of depression or depressive symptoms in children and adolescents: A systematic review and meta-analysis

BackgroundDepression is the leading cause of health-related disability. A proportion of depression cases begin in childhood and increase dramatically during adolescence. This systematic review and meta-analysis aimed to estimate the global prevalence of depression or depressive symptoms in children and adolescents and explore the temporal and regional distribution of depression or depressive symptoms. MethodsThis systematic review and meta-analysis identified peer-reviewed literature published through April 8, 2023, using the MEDLINE, Embase and APA PsycINFO databases, supplemented by reverse reference searches. Observational studies published in English and based on validated instruments with prevalence data on depression or depressive symptoms in children and adolescents aged ≤18 years were eligible. Random-effects meta-analysis and meta-regression analysis were performed using R software. ResultsThis systematic review and meta-analysis included a total of 96 studies (29 countries, 528,293 participants) published between 1989 and 2022. The pooled prevalence of mild-to-severe, moderate-to-severe, and major depression were 21.3 % (95%CI, 16.7 %–26.7 %), 18.9 % (95%CI, 14.6 %–24.2 %), and 3.7 % (95%CI, 2.7 %–5.1 %) respectively. Meta-regression analysis showed that from 1989 to 2022, the prevalence of mild-to-severe and moderate-to-severe depression increased over time (P = 0.002, P = 0.034, respectively), but the prevalence of major depression did not change significantly (P = 0.636). LimitationsOnly English articles were included. There was significant heterogeneity across the included studies. The studies included were mostly based on self-report scales to assess depressive symptoms. ConclusionIn this systematic review, about one in five children and adolescents globally suffered from depression or had depressive symptoms, and this proportion was increasing over time.

Associations Between Depression Symptom Burden and Delirium Risk: A Prospective Cohort Study.

Delirium and depression are prevalent in aging. There is considerable clinical overlap, including shared symptoms and comorbid conditions, including Alzheimer's disease, functional decline, and mortality. Despite this, the long-term relationship between depression and delirium remains unclear. This study assessed the associations of depression symptom burden and its trajectory with delirium risk in a 12-year prospective study of older hospitalized individuals. A total of319141 UK Biobank participants between 2006 and 2010 (mean age 58 years [range 37-74, SD = 8], 54% women) reported frequency (0-3) of 4 depressive symptoms (mood, disinterest, tenseness, or lethargy) in the preceding 2 weeks prior to initial assessment visit and aggregated into a depressive symptom burden score (0-12). New-onset delirium was obtained from hospitalization records during 12 years of median follow-up. 40451 (mean age 57 ± 8; range 40-74 years) had repeat assessment on average 8 years after their first visit. Cox proportional hazard models examined whether depression symptom burden and trajectory predicted incident delirium. A total of5753 (15 per 1000) newly developed delirium during follow-up. Increased risk for delirium was seen for mild (aggregated scores 1-2, hazards ratio, HR = 1.16, [95% confidence interval (CI): 1.08-1.25], p < .001), modest (scores 3-5, 1.30 [CI: 1.19-1.43], p < .001), and severe (scores ≥ 5, 1.38 [CI: 1.24-1.55], p < .001) depressive symptoms, versus none in the fully adjusted model. These findings were independent of the number of hospitalizations and consistent across settings (eg, surgical, medical, or critical care) and specialty (eg, neuropsychiatric, cardiorespiratory, or other). Worsening depression symptoms (≥1 point increase), compared to no change/improved score, were associated with an additional 39% increased risk (1.39 [1.03-1.88], p = .03) independent of baseline depression burden. The association was strongest in those over 65 years at baseline (p for interaction <.001). Depression symptom burden and worsening trajectory predicted delirium risk during hospitalization. Increased awareness of subclinical depression symptoms may aid delirium prevention.

Burden of postpartum depression in sub-Saharan Africa: An updated systematic review

Postpartum depression (PPD) is a significant public health concern in resource-constrained sub-Saharan Africa (SSA). Efforts to combat this burden are hampered by the region’s wide variation in reported prevalence. This review aimed to systematically synthesize up-to-date data on PPD in SSA. The review was structured per the Preferred Reporting Item for Systematic Reviews and Meta-analyses. Included in the review were studies that reported the prevalence of PPD in SSA. A search was undertaken of PubMed, Medline, CINAHL, Academic Search Complete, and PsycINFO. A random-effect model was fitted to estimate the pooled burden of postpartum depressive symptoms in SSA. We conducted subgroup analyses to estimate the distribution of postpartum depressive symptoms based on important study characteristics: sample size, the timing of diagnosis, design, study setting/region, instrument, and income/ economy. The prevalence of postpartum depressive symptoms ranged from 3.8% to 69.9%, with a pooled estimate of 22.1% (CI 18.5–26.2; I2 = 98.2; Tau = 0.848; p&lt;0.001). There was a significant variation in postpartum depressive symptoms with sample size (p&lt;0.001). The highest prevalence (25.6% CI 21.5–30.1) was obtained within 12 weeks postpartum. The prevalence estimate was highest (23.3%; CI 20.1–26.8) with the Edinburgh Postnatal Depression Scale (EPDS). South Africa (30.6%; CI 23.6–38.7) and Zimbabwe (29.3%; CI 22.2–37.5) reported the highest prevalence rates, while Tanzania (13.5%; CI 10.1–17.9) reported the lowest prevalence estimates. Upper-middle SSA countries presented the highest prevalence rates (30.6%; CI 23.6–38.7). The prevalence was highest within the period 2010–2015. PPD constitutes a significant health burden in SSA and is fast becoming an epidemic in southern Africa. Significance: Given that PPD is a recurring mental health challenge among women in sub-Saharan Africa, there is an urgent need for strategic policy provisions to ameliorate its burden. An increase in prevalence of PPD from 2005–2010 to 2015–2021 is indicative of the need for national governments to intensify efforts targeted at achieving the UN Sustainable Development Goals 3 and 5 in the region. In SSA, the prevalence of PPD is highest (approximately 30%) in Southern Africa, precisely South Africa and Zimbabwe, where it is fast becoming an epidemic; hence strategies are needed to curtail its growing trend. There is a need to characterise and stratify the risk factors of PPD in sub-Saharan to guide policy development of predictive algorithms and implementation strategies.

Prevalence of depressive symptoms and correlates among individuals who self-reported SARS-CoV-2 infection after optimizing the COVID-19 response in China.

The burden of depression symptoms has increased among individuals infected with SARS-CoV-2 during COVID-19 pandemic. However, the prevalence and associated factors of depressive symptoms among individuals infected with SARS-CoV-2 remain uncertain after optimizing the COVID-19 response in China. An online cross-sectional survey was conducted among the public from January 6 to 30, 2023, using a convenience sampling method. Sociodemographic and COVID-19 pandemic-related factors were collected. The depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Logistic regression analysis was performed to explore the associated factors with depressive symptoms. A total of 2,726 participants completed the survey. The prevalence of depression symptoms was 35.3%. About 58% of the participants reported experiencing insufficient drug supply. More than 40% of participants reported that they had missed healthcare appointments or delayed treatment. One-third of participants responded experiencing a shortage of healthcare staff and a long waiting time during medical treatment. Logistic regression analysis revealed several factors that were associated with depression symptoms, including sleep difficulties (OR, 2.84; 95% CI, 2.34-3.44), chronic diseases (OR, 2.15; 95% CI, 1.64-2.82), inpatient treatment for COVID-19 (OR, 3.24; 95% CI, 2.19-4.77), with COVID-19 symptoms more than 13 days (OR, 1.30, 95% CI 1.04-1.63), re-infection with SARS-CoV-2 (OR, 1.52; 95% CI, 1.07-2.15), and the increased in demand for healthcare services (OR, 1.32; 95% CI, 1.08-1.61). This study reveals a moderate prevalence of depression symptoms among individuals infected with SARS-CoV-2. The findings underscore the importance of continued focus on depressive symptoms among vulnerable individuals, including those with sleeping difficulties, chronic diseases, and inpatient treatment for COVID-19. It is necessary to provide mental health services and psychological interventions for these vulnerable groups during the COVID-19 epidemic.

Early Effects of the COVID-19 Pandemic on Patients in a Virtual Multicenter Spontaneous Coronary Artery Dissection (SCAD) Registry

BackgroundThe COVID-19 pandemic effects among patients with a history of spontaneous coronary artery dissection (SCAD), a cause of acute coronary syndrome associated with emotional and physical stress, are unknown. MethodsFor this cross-sectional cohort study, participants of the Mayo Clinic “Virtual” Multicenter SCAD Registry were surveyed about the COVID-19 pandemic. ResultsAmong 1352 participants, 727 (53.8%) completed surveys between June 2, 2021 and September 29, 2021. The majority of respondents (96.7%) were female, with a mean age of 54.9 ± 9.4 years. At the time of completing the survey, which was early in the pandemic, 91 respondents (12.6%) reported having prior COVID-19 symptoms, with < 1% experiencing hospitalization (n = 4) or cardiac complications (n = 6). A total of 14% had ≥ moderate anxiety symptoms, per the General Anxiety Disorder-7 item survey, and 11.8% had ≥ moderate depressive symptoms, per the Patient Health Questionnaire-9 item. Higher stress scores on the Likert scale were correlated with pandemic-related reduction in work hours and/or pay and/or unemployment (P = 0.013), remote work and/or change of job (P < 0.001), and loss of insurance and/or medical coverage (P = 0.025). A higher anxiety level, as measured on the Likert scale, was correlated with pandemic-related remote work and/or change of job (P = 0.007) and loss of insurance and/or medical coverage (P = 0.008). Since the start of the pandemic, 54% of respondents reported having at least monthly chest pain. Chest pain and COVID symptoms were each associated with higher scores on the General Anxiety Disorder-7 item survey and the Patient Health Questionnaire-9 item. ConclusionsEarly in the pandemic, COVID-19 symptoms, hospitalization, and cardiac complications were uncommon among SCAD patients. The burden of anxiety and depressive symptoms was minimal to mild, similar to that in prior reports. Likert-scale measures of stress and anxiety were higher among persons with work and/or pay reduction and/or unemployment, remote work and/or change of job, and loss of insurance and/or medical coverage. Over half of respondents reported experiencing chest pain, which was correlated with depressive and anxiety symptoms, highlighting an overarching clinical need.

Secure Messaging Intervention in Patients Starting New Antidepressant to Promote Adherence: Pilot Randomized Controlled Trial.

There are a range of effective pharmacological and behavioral treatments for depression. However, approximately one-third of patients discontinue antidepressants within the first month of treatment and 44% discontinue them by the third month of treatment. The major reasons reported for discontinuation were side effect burden, patients experiencing that the medications were not working, and patients wanting to resolve their depression without using medication. This study tested the acceptability, feasibility, and preliminary effectiveness of an SMS messaging intervention designed to improve antidepressant adherence and depression outcomes in veterans. The intervention specifically targeted the key reasons for antidepressant discontinuation. For example, the secure message included reminders that it can take up to 6 weeks for an antidepressant to work, or prompts to call their provider should the side effect burden become significant. This pilot was a 3-armed randomized controlled trial of 53 veterans undergoing depression treatment at the Iowa City Veterans Affairs Health Care System. Veterans starting a new antidepressant were randomized to secure messaging only (SM-Only), secure messaging with coaching (SM+Coach), or attention control (AC) groups. The intervention lasted 12 weeks with follow-up assessments of key outcomes at 6 and 12-weeks. This included a measure of antidepressant adherence, depressive symptom severity, and side effect burden. The 2 active interventions (SM-Only and SM+Coach) demonstrated small to moderate effect sizes (ESs) in improving antidepressant adherence and reducing side effect burden. They did not appear to reduce the depressive symptom burden any more than in the AC arm. Veteran participants in the SM arms demonstrated improved medication adherence from baseline to 12 weeks on the Medication Adherence Rating Scale compared with those in the AC arm, who had a decline in adherence (SM-Only: ES=0.09; P=.19; SM+Coach: ES=0.85; P=.002). Depression scores on the 9-Item Patient Health Questionnaire decreased for all 3 treatment arms, although the decline was slightly larger for the SM-Only (ES=0.32) and the SM+Coach (ES=0.24) arms when compared with the AC arm. The 2 intervention arms indicated a decrease in side effects on the Frequency, Intensity, and Burden of Side Effects Ratings, whereas the side effect burden for the AC arm increased. These differences indicated moderate ES (SM-Only vs AC: ES=0.40; P=.07; SM+Coach: ES=0.54; P=.07). A secure messaging program targeting specific reasons for antidepressant discontinuation had small-to-moderate ES in improving medication adherence. Consistent with prior research, the intervention that included brief synchronic meetings with a coach appeared to have a greater benefit than the SMS-alone intervention. Veterans consistently engaged with the SMS messaging in both treatment arms throughout the study period. They additionally provided feedback on which texts were most helpful, tending to prefer messages providing overall encouragement rather than specific wellness recommendations. ClinicalTrials.gov NCT03930849; https://clinicaltrials.gov/study/NCT03930849.

P175: Cohort differences in depressive burden in old age: role of psychosocial, behavioral, and functional factors

Objective:Rapid societal changes occurred during the course of the 20th century. Previous literature has found an increase in depression over time for younger and middle- aged populations. Among older adults, the prevalence of major depression has been found to be stable over time, while for the milder forms, the findings are limited by the largely non-representative nature of analyzed samples. Given the dramatic secular changes in several factors linked to old-age depression, a careful examination of depressive symptom burden and prevalence of depression in representative cohorts of similarly-aged older adults separated in time is required.Methods:We will analyze data on 2,041 older adults from the Swedish National Study on Aging and Care in Kungsholmen. Separate individuals, aged 60 and 81 years were assessed with a Comprehensive Psychopathological Rating Scale (CPRS) during detailed clinical examinations, separated in time by 15 years (2001 vs. 2016). Information on 21 depressive symptoms, is subsequently combined into diagnoses of major depression (presence of at least one core symptom [low mood and/or loss of interest], and at least five out of the nine symptoms); minor depression (presence of at least one core symptom, and two to four symptoms in total), and subsyndromal depression (presence of at least two symptoms in the absence of any other depression diagnoses). Psychosocial (loneliness, bereavement), behavioral (alcohol consumption, smoking), and functional factors (impairments in activities of daily living) are used as potential explanatory factors for any observed cohort differences in symptom burden or prevalence of depression.Results:For the 60-year old age-group, comparison of symptom burden and diagnostic status will be done across 739 participants assessed in 2001 and 677 people assessed in 2013. For the 81-year old age- group, comparisons will involve 236 people assessed in 2001, 194 people assessed in 2010, and 195 people assessed in 2016.Conclusion:Preliminary results are expected by March, once data entry and cleaning are completed. We hypothesize that the burden of depressive symptoms and the prevalence of depression will be lower in later born cohorts and that explanatory factors may account for some of the cohort effect.

Measuring Social Toxicity in Acute Myeloid Leukemia

Background: AML is an aggressive and costly cancer to treat, which often results in lower quality of life, including worse and more frequent depression and anxiety, physical strains, and financial toxicity. AML can also have a considerable impact on social well-being, including personal and work domains. While individual social impacts of cancer are often considered, we propose that social toxicity is a unique construct-much like financial toxicity-that should be measured as such. This study aims to (1) determine the feasibility of creating a composite measure of social toxicity and (2) examine the prevalence of social toxicity in AML patients and survivors and its relationship to other patient reported outcomes. Methods: 109 AML patients and survivors enrolled in the Cancer Support Community's online survey, the Cancer Experience Registry, between Jan-Mar 2023 and completed at least 50% of items pertinent to social toxicity. First, six indices were coded (1=Yes; 0=No) based on negative social impact: PROMIS Social Function T-score (1=&amp;lt;40); three items from CancerSupportSource including changes to work, school, or home life, problems in your relationship with your spouse/partner, and feeling lonely or isolated (1=moderately to very seriously concerned); employment (1=unemployed due to disability/other), and medication interfering with daily life (1=agree or strongly agree). Then, a social toxicity composite score was calculated by summing the number of indicators present (possible range = 0-6; higher scores = more social toxicity). Lastly, we investigated the relationship between social toxicity and patient reported outcomes, including anxiety and depression (PROMIS-29 4-item T-scores) and financial toxicity (11-item FACIT-COST). Results: Among the sample, 63(58%) were women and 91(84%) were Non-Hispanic White, with a mean(SD) age of 63.6(13.3) years (range: 29-86). Median time since diagnosis was 2 years; 57(52%) participants reported that they were currently receiving treatment. The most frequently endorsed indicator of social toxicity was changes in work, school, or home life (46%), followed by PROMIS social function (28%), employment status (27%), feeling lonely or isolated (23%), relationship problems with spouse/partner (17%), and medication interference (6%). Individual indices moderately correlated with financial toxicity, anxiety, and depression (average rs=-.36, .39, and .45, respectively). The largest percentage of the sample (39%) had a social toxicity composite score of 0 (M=1.5; SD=1.5), with the remaining score distribution as follows:1(18%), 2(17%), 3(13%), 4(10%), 5(2%), 6(&amp;lt;1%). PROMIS anxiety (M=54.2; SD=10.8) and depression (M=50.8; SD=9.6) significantly correlated (p&amp;lt;.001) with social toxicity (r=.62 and .71, respectively), such that great social toxicity was related to greater anxiety and depression symptom burden. Social toxicity was also correlated with FACIT-COST (M=21.6; SD=13.0; r=-.60), such that greater social toxicity was related to worse financial well-being. Between groups analysis reveals more social toxicity among those aged 18-64 (n=46; M=1.8; SD=1.7) vs. those aged 65+ (n=63; M=1.2; SD=1.4; t=1.975, p&amp;lt;.05) as well as those who are currently receiving treatment (n=57; M=1.6; SD=1.4) vs. not (n=48; M=1.2; SD=1.7; t=1.311, p&amp;lt;.10). Conclusions: The current findings suggest that social toxicity-negative social impact due to cancer diagnosis or treatment-can be assessed using a composite score of indices that reflect individuals' social activity and well-being across multiple life domains. While 39% of the sample reported no social toxicity, 69% had at least one of the selected indices, with the most frequent being changes in work, school, or home life. Social toxicity was significantly related to other patient reported outcomes with a larger magnitude correlation than that observed for individual indices, including anxiety, depression, and financial toxicity, thus indicating its potential importance in the larger cancer landscape, especially for those younger than 65 and those currently receiving treatment. Social toxicity is particularly important to investigate for patients dealing with aggressive and costly cancers, such as AML, and methods of measurement for assessing social toxicity should continue to be explored in additional clinical populations to better align individuals with tailored support resources.

Depression and heart failure - the incidence of depressive symptoms assessed by the PHQ9 and their association with HF outcomes

Abstract Background Depression is a prevalent, debilitating, and potentially modifiable comorbidity that affects heart failure (HF) patients and is associated with increased mortality and morbidity. Current HF guidelines recommend addressing depression using questionnaires, including the Patient Health Questionnaire-9 (PHQ-9), which is a 9-item questionnaire that can be self-administered in less than 3 minutes. Objectives To evaluate the performance of PHQ-9 in a Portuguese cohort of HF patients and present a practical approach for the screening and management of depression in patients with HF. Methods We conducted a prospective study enrolling consecutive patients observed in the HF clinic from June 2022 to August 2022. Patients answered the PHQ-9 before the beginning of the appointment, during which the physician evaluated the results and managed them according to the suggested protocol. – figure 1. We then evaluated the severity of depression by PHQ-9 at baseline and its association with the levels of serum NT-proBNP, the severity of HF symptoms, and the incidence of a composite of all-cause mortality and HF exacerbation at 90-days follow-up. Results A total of 124 patients were observed in the HF consultation and answered PHQ-9: mean age of 74±12,1years, 68% (n=84) male, 82% (n=102) with NYHA I-II, 48% (n=60) with preserved ejection fraction, 23% (n=29) with a previous diagnosis of depression and on antidepressant therapy. After the evaluation of PHQ-9, 52% (n=65), 27% (n=33), 10% (n=12), 8% (n=10) and 3% (n=4) had minimal, mild, moderate, moderately severe, and severe depression symptoms, respectively. In the no previous depression diagnosis group, 49% (n=46) had at least mild depressive symptoms. The presence of depressive symptoms was associated with higher levels of serum NT-proBNP (r=0.31; p&amp;lt;0.001) and worse HF symptoms assessed by the NYHA classification (p&amp;lt;0,001). Patients who met the composite outcomes (death or HF exacerbation) during follow-up had a significantly higher PHQ-9 score (10±7 vs. 5±5; p&amp;lt;0,001). Conclusions This study confirmed the high prevalence of depressive symptoms in this real-world cohort of HF patients and demonstrated that screening for depressive symptoms can be efficiently integrated in the HF consultation. A higher burden of depressive symptoms was associated with higher serum NT-proBNP, more severe symptoms and higher incidence of death or HF admissions.

Abstract 16922: One-Year Latent Health Status Trajectories in Patients With Symptomatic Peripheral Artery Disease

Background: Symptomatic peripheral artery disease (PAD) can dramatically impact health status. We aimed to characterize typical health status trajectories following initiation of PAD specialty care and to identify demographic, medical, and psychosocial predictors of suboptimal recovery. Methods: Adults with new or worsening PAD (Rutherford 1-3) presenting to vascular clinics in the US, Australia, and Netherlands 2011-2015 in the PORTRAIT study were included. Demographics, comorbidities, and psychosocial measures including the EQ-5D (generic health status), PHQ-8 (depression), GAD-2 (anxiety), PSS (stress), ESSI (social support) were obtained upon initial evaluation. Peripheral Artery Questionnaires (PAQ; 0-100, higher = better PAD-specific health status) were administered at 0, 3, 6, and 12 months. Latent trajectory modeling was used to identify typical PAQ score trajectories by Bayesian information criterion. Predictors of favorable vs. poor recovery trajectory (&lt;10-point PAQ increase at 1 year) were assessed by logistic regression. Missingness was handled by multiple imputation. Results: The final cohort included 1,204 patients, had a mean age of 67.5 (±9.4) years, was 62.5% male, and 82.1% white. A 5-group model best fit the data (Figure). At 1 year, the High (n=401), Intermediate (n=400), and Sustained Response (n=98) groups demonstrated “favorable” mean PAQ changes of +16.8 , +24.0, and +59.4 points, respectively. The Low (n=150) and Transient Response (n=155) groups demonstrated “poor” recovery of +8.6 and +7.6 points, respectively. Significant predictors of poor recovery included age, nonwhite race, worse EQ-5D, and worse PHQ-8 (all p&lt;0.05). Conclusion: Patients with symptomatic PAD follow predictable health status trajectories after initiating care. Poor recovery trajectory is predicted by age, nonwhite race, worse generic health status, and depressive symptom burden. Further emphasis should be placed on these factors during treatment.

Female sex and burden of depressive symptoms predict insufficient response to telemedical treatment in adult attention-deficit/hyperactivity disorder: results from a naturalistic patient cohort during the COVID-19 pandemic.

Attention-deficit/hyperactivity disorder (ADHD) is a chronic neuropsychiatric disorder, that typically manifests itself during childhood and persists in a majority of the affected individuals into adulthood, negatively affecting physical and mental health. Previous studies have shown detrimental effects of the COVID-19 pandemic on mental health in individuals with ADHD. Thus, telemedicine could be a useful tool for optimizing treatment-outcomes in adult ADHD by improving treatment adherence and persistence. However, data on telemedical treatment outcomes in adult patients with ADHD is scarce. We report here the sub-cohort analysis of a naturalistic cohort of adult patients (N = 254) recruited between April 2020-April 2021, comparing the effects of telemedical treatment on participants either clinically diagnosed with depression (N = 54) or ADHD (N = 67). Participants were asked to fill out the WHO-5 repetitively during >12 weeks of telemedical treatment. Furthermore scores of WHO-5, SCL-90R and BDI-II, psychopathology, psychosocial functioning, sociodemographic data, medical records and a feedback survey were analyzed for both groups and compared. Participants with ADHD were further stratified according to the development of well-being during the study period in order to identify factors associated with a satisfactory treatment outcome. Participants with depression reported a significant improvement of well-being during the course of the study, while no such effect could be seen in participants with ADHD on a group level. Despite the good outcome, participants with depression were more severely affected at baseline, with significantly worse psychopathology and a more precarious labor and financial situation. A detailed analysis of ADHD participants without clinical improvement revealed significantly higher BDI-II scores than for ADHD participants with a satisfactory outcome (p = 0.03, Mann-Whitney-U-Test), suggesting successful treatment was hampered by the combination of ADHD and depressive symptoms. Furthermore, female sex among ADHD patients was correlated with an unfavorable treatment outcome during the course of the study (p = 0.001, Spearman correlation) as well as living with children (p = 0.02, Spearman correlation). Besides screening for depressive symptoms before telemedical treatment, future research should address the specific needs of female ADHD patients as these patients may be at a particularly high risk of being overburdened with family work.

The importance of screening for functional neurological disorders in patients with persistent post-concussion symptoms.

Functional neurological disorder (FND) may commonly co-occur with persistent symptoms following a psychological trauma or physical injury such as concussion. To explore the occurrence of FND in a population with persistent post-concussion symptoms (PPCS) and the associations between FND and depression as well as anxiety in participants with PPCS. Sixty-three individuals with PPCS presenting to a specialized brain injury clinic completed the following questionnaires: screening for somatoform disorder conversion disorder subscale (SOM-CD), Rivermead post-concussion symptom questionnaire (RPQ), patient health questionnaire-9 (PHQ-9), and generalized anxiety disorder questionnaire- 7 (GAD-7). Both multiple linear regression and logistic regression were conducted to evaluate the relationship between questionnaires and adjust for covariates. We found that total RPQ score (βˆ= 0.27; 95% CI = [0.16, 0.38]), GAD-7 score (βˆ= 0.71; 95% CI = [0.50, 0.92]) and PHQ-9 score (βˆ= 0.54; 95% CI = [0.32, 0.76]) were positively associated with SOM-CD score individually, after consideration of other covariates. Participants meeting the criteria for severe FND symptoms were 4.87 times more likely to have high PPCS symptom burden (95% CI = [1.57, 22.84]), 8.95 times more likely to have severe anxiety (95% CI = [3.31, 35.03]) and 4.11 times more likely to have severe depression symptom burden (95% CI = [1.77, 11.53]). The findings of this study indicate an association between FND and post-concussion symptoms as well as an association between FND and symptoms of depression and anxiety in patients with PPCS. Patients with PPCS should be screened for FND to provide a more targeted treatment approach that includes somatic-focused interventions.

OS08.7.A DEPRESSIVE SYMPTOMS IN ASSOCIATION WITH TUMOR LOCATIONS AT DIAGNOSIS IN PATIENTS WITH DIFFUSE GLIOMA

Abstract BACKROUND Depressive symptoms are common in glioma patients and occur more frequent than in patients with other cancer types. The presence of tumors in specific brain regions that potentially disturb brain functions could contribute to this difference. These lesions may cause an inadequate emotional response to an incurable and lethal disease with consequences for patient counseling and neurosurgical strategies. In this study, we examine the association between brain tumor location and depressive symptoms at presentation in patients with diffuse glioma using several methods for lesion symptom mapping. MATERIAL AND METHODS The retrospective cohort consisted of patients with diffuse glioma who had a preoperative MR-scan and completed the Center for Epidemiologic Studies Depression scale (CES-D) before treatment. We classified patients based on unexpectedly low ( ≤6), intermediate (7-20) and unexpectedly high (&amp;gt;20) CES-D scores. Tumors were segmented in 3D and corresponding white matter disconnectomes were derived from normative tractography. We first correlated tumor and disconnectome with CES-D using sparse canonical correlation analysis to identify clusters of associated brain voxels. Next, we assessed the association between tumor locations and CES-D category using Bayesian multivariable categorical regression analysis of patient and tumor characteristics, including the overlap of tumors and disconnectomes with specific brain atlas structures, the probability of disconnection of white matter tracts, and functional network changes in local efficiency and eigenvector centrality. RESULTS We included 201 patients with a median age of 45 years (range 18-81), consisting of 62% males and 29% grade 4 gliomas. CES-D was completed a median of three weeks before surgery, was unexpectedly low in 29% and unexpectedly high in 15% of patients. Tumors located in the left (L) pallidum and right (R) thalamus were related to unexpectedly low CES-D, whereas tumors in the L hippocampus, L nucleus accumbens and R putamen were related to unexpectedly high CES-D. Disconnection of the R temporal subsection of the cingulum bundle, L optic radiation, L superior longitudinal fasciculus I and L uncinate fasciculus (UF) were related to unexpectedly low CES-D, whereas disconnection of the R corticospinal tract, R fornix, and L UF were related to unexpectedly high CES-D. Neither voxel clusters nor network measures were associated with CES-D. CONCLUSION Both unexpectedly low and unexpectedly high depressive symptom burden is common in patients with diffuse glioma at presentation. These dysfunctional emotional responses may be associated with the location of the tumor. Awareness of this phenomenon may be important in patient counseling and neurosurgical strategies. * these authors contributed equally

Milieu-specific differences in symptom severity and treatment outcome in psychosomatic rehabilitation in Germany.

Previous studies that focused on socioeconomic differences did not comprehensively explain existing inequalities in psychosomatic rehabilitation in Germany. We applied a social milieu approach, which additionally includes sociocultural factors such as lifestyles, attitudes and values, to investigate differences among patients in symptom severity, psychosocial impairment and improvement over the course of the intervention. As a model for social milieus, the empirical Sinus milieus were used. 2,000 patients of two psychosomatic rehabilitation clinics in Germany were included and their milieu was assessed with the Sinus milieu indicator for Germany 10/2018 questionnaire. BDI-II (N = 1,832) and HEALTH-49 (N = 1,829) questionnaires were used to measure depressiveness and psychosocial impairment at admission (T0) and discharge after 5 weeks of treatment (T1). Milieu differences in severity and improvement were analyzed by mixed-model ANOVAs. Milieu distribution was not representative of the overall population of Germany. We found significant differences between patients from different milieus in both BDI-II and HEALTH-49 (p < 0.001). Patients from the Precarious Milieu had the highest burden of depressive symptoms in BDI-II and the highest impairment on all HEALTH-49 scales at T0 and T1. Over the course of rehabilitation, patients from all milieus improved significantly in all domains (p < 0.001). Significant interaction effects showed milieu-dependent differences in improvement for depressiveness on the BDI-II [F(9, 1822) = 2.50, p = 0.008] and for three HEALTH-49 scales, namely Psychological well-being [F(9, 1819) = 3.30, padj = 0.005], Interactional difficulties [F(9, 1819) = 2.74, padj = 0.036] and Activity and Participation [F(9, 1819) = 4.94, padj < 0.001], while post-hoc tests only revealed two significant group differences for the last scale. In all domains, patients from the Precarious Milieu retained higher symptoms and impairment at T1 than patients from better-off milieus had at T0. Social milieu was associated with symptom severity, treatment access and outcome of psychosomatic rehabilitation patients. Milieu-specific sociocultural habits, psychosocial needs and therapeutic demands may help describe differences and should be considered in therapy planning and implementation, to improve equal access, quality and effectiveness of rehabilitation. Therefore, further research on milieu-specific differences and needs is necessary.

Correlates of Rates and Treatment Readiness for Depressive Symptoms, Pain, and Fatigue in Hemodialysis Patients: Results from the TĀCcare Study.

Patients on hemodialysis (HD) often experience clinically significant levels of pain, fatigue, and depressive symptoms. We explored potential sociodemographic differences in symptom burden, current treatment, and readiness to seek treatment for these symptoms in patients screened for the TĀCcare trial. In-center HD patients from Pennsylvania and New Mexico were screened for fatigue (≥5 on 0 to10-point Likert scale), pain (Likert scale ≥4), depressive symptoms (≥10 Patient Health Questionnaire-9) and readiness to seek treatment (5-item Stages of Behavior Change questionnaire). Symptom burden and treatment status by sociodemographic factors were evaluated using chi-square, Fisher's exact tests, and logistic regression models. From March 2018-Dec 2021, 506 of 896 (57%) patients screened met eligibility criteria and completed the symptom screening (mean age 60±13.9 years, 44% females, 17% Black, 25% American Indian, 25% Hispanics). Of these, 77% screened positive for ≥1 symptom and 35% of those were receiving treatment for ≥1 of these symptoms. Pain, fatigue, and depressive symptom rates were 52%, 64%, and 24%, respectively. Age <65 was associated with a higher burden of depressive symptoms, pain, and reporting ≥1 symptom (p<0.05). The percentage of patients ready to seek treatment increased with symptom burden. More males reported readiness to seek treatment (85% vs. 68% of females, p<0.001). Among those with symptoms and treatment readiness, income was inversely associated with pain (>$60k/yr: OR=0.16, CI=0.03-0.76), and living in less walkable neighborhoods with more depressive symptoms (OR= 5.34, CI=1.19-24.05) and fatigue (OR= 5.29, CI=1.38-20.33). Pain, fatigue, and depressive symptoms often occurred together, and younger age, less neighborhood walkability, and lower income were associated with a higher burden of symptoms in HD patients. Male patients were less likely to be receiving treatment for symptoms. These findings could inform priority HD patient symptom identification and treatment targets.

Consensus Paper: Cerebellum and Ageing.

Given the key roles of the cerebellum in motor, cognitive, and affective operations and given the decline of brain functions with aging, cerebellar circuitry is attracting the attention of the scientific community. The cerebellum plays a key role in timing aspects of both motor and cognitive operations, including for complex tasks such as spatial navigation. Anatomically, the cerebellum is connected with the basal ganglia via disynaptic loops, and it receives inputs from nearly every region in the cerebral cortex. The current leading hypothesis is that the cerebellum builds internal models and facilitates automatic behaviors through multiple interactions with the cerebral cortex, basal ganglia and spinal cord. The cerebellum undergoes structural and functional changes with aging, being involved in mobility frailty and related cognitive impairment as observed in the physio-cognitive decline syndrome (PCDS) affecting older, functionally-preserved adults who show slowness and/or weakness. Reductions in cerebellar volume accompany aging and are at least correlated with cognitive decline. There is a strongly negative correlation between cerebellar volume and age in cross-sectional studies, often mirrored by a reduced performance in motor tasks. Still, predictive motor timing scores remain stable over various age groups despite marked cerebellar atrophy. The cerebello-frontal network could play a significant role in processing speed and impaired cerebellar function due to aging might be compensated by increasing frontal activity to optimize processing speed in the elderly. For cognitive operations, decreased functional connectivity of the default mode network (DMN) is correlated with lower performances. Neuroimaging studies highlight that the cerebellum might be involved in the cognitive decline occurring in Alzheimer's disease (AD), independently of contributions of the cerebral cortex. Grey matter volume loss in AD is distinct from that seen in normal aging, occurring initially in cerebellar posterior lobe regions, and is associated with neuronal, synaptic and beta-amyloid neuropathology. Regarding depression, structural imaging studies have identified a relationship between depressive symptoms and cerebellar gray matter volume. In particular, major depressive disorder (MDD) and higher depressive symptom burden are associated with smaller gray matter volumes in the total cerebellum as well as the posterior cerebellum, vermis, and posterior Crus I. From the genetic/epigenetic standpoint, prominent DNA methylation changes in the cerebellum with aging are both in the form of hypo- and hyper-methylation, and the presumably increased/decreased expression of certain genes might impact on motor coordination. Training influences motor skills and lifelong practice might contribute to structural maintenance of the cerebellum in old age, reducing loss of grey matter volume and therefore contributing to the maintenance of cerebellar reserve. Non-invasive cerebellar stimulation techniques are increasingly being applied to enhance cerebellar functions related to motor, cognitive, and affective operations. They might enhance cerebellar reserve in the elderly. In conclusion, macroscopic and microscopic changes occur in the cerebellum during the lifespan, with changes in structural and functional connectivity with both the cerebral cortex and basal ganglia. With the aging of the population and the impact of aging on quality of life, the panel of experts considers that there is a huge need to clarify how the effects of aging on the cerebellar circuitry modify specific motor, cognitive, and affective operations both in normal subjects and in brain disorders such as AD or MDD, with the goal of preventing symptoms or improving the motor, cognitive, and affective symptoms.

Depression, physical activity, and incident cardiovascular disease among American Indians: The strong heart family study.

Little is known about the relationship of depression with incident cardiovascular disease (CVD) among American Indians (AIs), a population with a high burden of depressive symptoms and CVD. In this study, we examined the association of depressive symptoms with CVD risk among AIs and assessed whether an objective marker of ambulatory activity influenced the relationship. The study comprised participants from the Strong Heart Family Study, a longitudinal study of CVD risk among AIs free of CVD at baseline (2001-2003) and who participated in a follow-up examination (n = 2209). The Center for Epidemiologic Studies of Depression Scale (CES-D) was used to assess depressive symptoms and depressive affect. Ambulatory activity was measured using Accusplit AE120 pedometers. Incident CVD was defined as new myocardial infarction, coronary heart disease, or stroke (through 2017). Generalized estimating equations were used to examine the association of depressive symptoms with incident CVD. 27.5% of participants reported moderate or severe depressive symptoms at baseline and 262 participants developed CVD during follow-up. Compared to participants who reported no depressive symptoms, the odds ratios for developing CVD among those who reported mild, moderate, or severe symptoms were: 1.19 (95% CI: 0.76, 1.85), 1.61 (95% CI: 1.09, 2.37), and 1.71 (95% CI: 1.01, 2.91), respectively. Adjustment for activity did not alter findings. CES-D is a tool used to identify individuals with depressive symptoms and not a measure of clinical depression. Higher levels of reported depressive symptoms were positively associated with CVD risk in a large cohort of AIs.