Differences In Severity Of Depression Research Articles

Intermittent theta burst stimulation in adolescents and young adults with depressive disorders: protocol of a randomized, sham-controlled study with a sequential Bayesian design for adaptive trials.

Intermittent theta burst stimulation (iTBS), a variant of repetitive transcranial magnetic stimulation (rTMS), is an established treatment for adults with major depressive disorder (MDD). Due to its favorable safety profile, iTBS is also a promising early intervention in the transition phase from adolescence to early adulthood, but thishas not been systematically investigated to date. Thus, the EARLY-BURST trial investigates the efficacy and safety of iTBS over the left dorsolateral prefrontal cortex (lDLPFC) in treatment-seeking young patients (age 16-26years) with depressive disorders (i.e. major depressive disorder, persistent depressive disorder, bipolar depression), allowing for relevant co-morbidities. Participants have not received antidepressant or antipsychotic medication during the last 12months except for short-term (< 2weeks) on-demand medication. The trial will employ a novel sequential Bayesian, randomized, double-blind, parallel-group, sham-controlled design. Up to 90 patients at two clinical sites (Munich, Augsburg) will be randomized 1:1 to the treatment groups, with sequential analyses starting after 26 patients in each group completed the treatment. The primary outcome will be the difference in depression severity at week 6 (post-treatment visit) between active iTBS and sham iTBS, assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS). The trial is planned to be expanded towards a three-arm leapfrog design, contingent on securing additional funding. Thus, in addition to potentially providing evidence of iTBS's efficacy in adolescents and young adults with depressive disorders, the EARLY-BURST trial aims at setting the stage for subsequent platform trials in this dynamic research field, where novel adaptive study designs are required to meet the need for rapidly testing promising new vs established rTMS protocols.Trial registration: DRKS00033313.

Exploring the use of immunomethylomics in the characterization of depressed patients: A proof-of-concept study

Alterations in DNA methylation and inflammation could represent valid biomarkers for the stratification of patients with major depressive disorder (MDD). This study explored the use of DNA-methylation based immunological cell-type profiles in the context of MDD and symptom severity over time.In 119 individuals with MDD, DNA-methylation was assessed on whole blood using the Illumina Infinium MethylationEPIC 850 k BeadChip. Quality control and data processing, as well as cell type estimation was conducted using the RnBeads package. The cell type composition was estimated using epigenome-wide DNA methylation signatures, applying the Houseman method, considering six cell types (neutrophils, natural killer cells (NK), B cells, CD4+ T cells, CD8+ T cells and monocytes). Two cytokines (IL-6 and IL-1β) and hsCRP were quantified in serum. We performed a hierarchical cluster analysis on the six estimated cell-types and tested the differences between these clusters in relation to the two cytokines and hsCRP, depression severity at baseline, and after 6 weeks of treatment (celecoxib/placebo + vortioxetine). We performed a second cluster analysis with cell-types and cytokines combined. ANCOVA was used to test for differences across clusters. We applied the Bonferroni correction.After quality control, we included 113 participants. Two clusters were identified, cluster 1 was high in CD4+ cells and NK, cluster 2 was high in CD8+ T-cells and B-cells, with similar fractions of neutrophils and monocytes. The clusters were not associated with either of the two cytokines and hsCRP, or depression severity at baseline, but cluster 1 showed higher depression severity after 6 weeks, corrected for baseline (p = 0.0060). The second cluster analysis found similar results: cluster 1 was low in CD8+ T-cells, B-cells, and IL-1β. Cluster 2 was low in CD4+ cells and natural killer cells. Neutrophils, monocytes, IL-6 and hsCRP were not different between the clusters. Participants in cluster 1 showed higher depression severity at baseline than cluster 2 (p = 0.034), but no difference in depression severity after 6 weeks.DNA-methylation based cell-type profiles may be valuable in the immunological characterization and stratification of patients with MDD. Future models should consider the inclusion of more cell-types and cytokines for better a prediction of treatment outcomes.

Omega-3 polyunsaturated fatty acids in the prevention of relapse in patients with stable bipolar disorder: A 6-month pilot randomized controlled trial

This study investigated the efficacy and safety of omega-3 polyunsaturated fatty acids (n-3 PUFAs) in relapse prevention of bipolar disorder (BD), addressing the shortcomings of current medications. Thirty-one stable BD patients were randomized to receive n-3 PUFAs or placebo for 6 months and intergroup differences in the incidence of the recurrence of bipolar depression were assessed. Differences in depression severity, manic symptoms, and routine biochemical parameters were also assessed. Interestingly, n-3 PUFAs demonstrated a favorable preventive effect on bipolar depression recurrence (p=0.005; Log-Rank) and reduced depression severity compared to placebo, and were well-tolerated, suggesting their potential as a safe prophylactic therapy for BD.

Minocycline in depression not responding to first-line therapy: A systematic review and meta-analysis.

Major depressive disorder is often resistant to first-line treatment, with around 30% failing to respond to traditional therapy. Treatment-resistant depression results in prolonged hospitalization and healthcare costs. Anti-inflammatory drugs have shown promising results in depression not responding to initial therapy. Minocycline has anti-inflammatory properties and crosses the blood-brain barrier. It has demonstrated varied results in several randomized controlled trials (RCTs). We assessed the efficacy of minocycline compared to placebo in depression not responding to one first-line antidepressant via a systematic review and meta-analysis. We performed a comprehensive literature search across PubMed, Cochrane, and Scopus for RCTs. We visualized the results using forest plots and drapery plots. We assessed and explored heterogeneity using I2, prediction interval, and meta-regression. Then, we rated the certainty of the evidence. Four RCTs revealed a non-significant difference in depression severity [-3.93; 95% CI: -16.14 to 8.28], rate of response [1.15; 0.33-4.01], and rate of remission [0.94; 0.44-2.01]. However, the reduction in depression severity is significant at a trend of P < .1. The high between-study heterogeneity (I2 = 78%) for depression severity could be answered by meta-regression (P = .02) for the duration of therapy. There is no significant difference with minocycline compared to placebo for depression not responding to first-line antidepressant therapy. However, the treatment response varies with treatment duration and patients' neuroinflammatory state. Thus, larger and longer RCTs, especially in diverse disease subgroups, are needed for further insight. This is needed to allow greater precision medicine in depression and avoid elevated healthcare expenditure associated with hit-and-trial regimens. CRD42023398476 (PROSPERO).

Association of interleukin-6 with suicidal ideation in veterans: a longitudinal perspective.

Studies showing associations between inflammation in suicide are typically cross-sectional. Present study investigated how cytokine levels track with suicidal ideation and severity longitudinally. Veterans with a diagnosis of major depressive disorder (MDD) with or without suicide attempt history (MDD/SA n = 38, MDD/NS n = 41) and non-psychiatric non-attempter controls (HC n = 33) were recruited, MDD/SA and HC groups were followed longitudinally at 3 months and 6 months. Blood plasma was collected and processed using Luminex Immunology Multiplex technology. Significant differences in depression severity (BDI) and suicidal ideation severity (SSI) were observed across all groups at study entry, wherein MDD/SA group had the highest scores followed by MDD/NS and HC, respectively. Cytokines IL-1β, IL-4, TNF-α, IFN-γ, and IL-6 were examined at study entry and longitudinally, with IL6 levels differing significantly across the groups (p = 0.0123) at study entry. Significant differences in changes in cytokine levels between depressed attempters and the control group were detected for IL-6 (interaction F1,91.77 = 5.58, p = 0.0203) and TNF-α (F1,101.73 = 4.69, p = 0.0327). However, only depressed attempters showed a significant change, in IL-6 and TNF-α levels, decreasing over time [IL-6: b = -0.04, 95% CI = (-0.08, -0.01), p = 0.0245 and TNF-α: b = -0.02, 95% CI = (-0.04, -0.01), p = 0.0196]. Although IL-6 levels were not predictive of suicidal ideation presence [OR = 1.34, 95% CI = (0.77, 2.33), p = 0.3067], IL-6 levels were significantly associated with suicidal ideation severity (b = 0.19, p = 0.0422). IL-6 was not associated with presence of suicidal ideation. IL-6 however, was associated with severity of ideation, suggesting that IL-6 may be useful in clinical practice, as an objective marker of heightened suicide risk.

A Standard Practice Protocol for Addressing Depression in a Hospice Setting.

Depression can worsen physical suffering and psychiatric distresses in individuals with life-limiting illnesses and is associated with increased rates of pain, fatigue, dyspnea, and worse survival outcomes. Evidence supports protocol development to address depression in the hospice setting using validated screening tools and a process for referral and treatment. After protocol development and integration of validated screening tools into the electronic medical record, newly admitted patients meeting inclusion criteria were screened during the social workers' initial psychosocial assessment. Patients were referred for pharmacological and nonpharmacological treatment strategies based on the severity of depression detailed in the protocol. Of all patients who met inclusion criteria, 100% were screened using the Patient Health Questionnaire-2 with 52% being identified as having some severity of depression, 26% being appropriately referred for treatment, and 50% receiving a pharmacological strategy, whereas 26% received nonpharmacological strategies. There was a statistically significant difference in severity of depression found between those identified as having a depressed mood preintervention and those with some severity of depression using a validated screening tool postintervention. Implementing a standardized practice protocol to address depression in a hospice setting allowed for consistent evaluation through the use of validated screening tool(s) and increased recognition of those with symptoms of depression.

Long-term outcomes of once weekly v. twice weekly sessions of cognitive behavioral therapy and interpersonal psychotherapy for depression.

Twice weekly sessions of cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for major depressive disorder (MDD) lead to less drop-out and quicker and better response compared to once weekly sessions at posttreatment, but it is unclear whether these effects hold over the long run. Compare the effects of twice weekly v. weekly sessions of CBT and IPT for depression up to 24 months since the start of treatment. Using a 2 × 2 factorial design, this multicentre study randomized 200 adults with MDD to once or twice weekly sessions of CBT or IPT over 16-24 weeks, up to a maximum of 20 sessions. Main outcome measures were depression severity, measured with the Beck Depression Inventory-II and the Longitudinal Interval Follow-up Evaluation. Intention-to-treat analyses were conducted. Compared with patients who received once weekly sessions, patients who received twice weekly sessions showed a significant decrease in depressive symptoms up through month 9, but this effect was no longer apparent at month 24. Patients who received CBT showed a significantly larger decrease in depressive symptoms up to month 24 compared to patients who received IPT, but the between-group effect size at month 24 was small. No differential effects between session frequencies or treatment modalities were found in response or relapse rates. Although a higher session frequency leads to better outcomes in the acute phase of treatment, the difference in depression severity dissipated over time and there was no significant difference in relapse.

Mental wellbeing of frontline health workers post-pandemic: lessons learned and a way forward.

To assess the state of mental wellbeing among medical and dental frontline health workers as the COVID-19 pandemic transitions to an endemic phase and to determine what employer-provided intervention strategies these workers perceive as effective and desirable to improve their mental wellbeing. An anonymous online survey distributed to frontline health workers in a hospitalist program of a tertiary care medical center and a university dental school in Minnesota in September 2022. The survey contained validated tools to measure depression severity, levels of perceived stress, and mental health status as well as questions to determine effective strategies to improve emotional wellbeing among these health workers. Data was evaluated on an aggregate level as well as stratified by level (e.g., physician, staff) and field (e.g., medicine, dentistry). On average, all groups of health workers suffered from moderate to moderately severe depression, had a much higher perceived stress level than average, and had a fair mental health status. There were no significant differences in depression severity, stress level, or mental health status among physicians, dentists, medical staff, and dental staff. The majority of the respondents perceived adjusted work hours, rewards and incentives, and teamwork as the most effective and desirable strategies to improve their mental wellbeing. The current mental wellbeing of frontline health workers is poor. Many are dissatisfied with healthcare and consider leaving the industry. To improve their employees' mental wellbeing, healthcare employers might want to consider adjusted work hours, rewards, and teamwork as these intervention strategies are perceived as most effective and desirable by the intended recipients.

Electroconvulsive therapy vs Esketamine among patients with Major Depressive Episode

IntroductionMajor depressive disorder is one of the most common and disabling mental disorders. More than 30% of individuals do not achieve remission after several trials of antidepressants and treatment-resistant depression (TRD) is associated with premature mortality. Electroconvulsive therapy (ECT) is considered the gold-standard for TRD treatment,unfortunately it´s underused due to health care barriers and association with adverse cognitive impairment. So, scientists have sought to identify alternative treatments that approach ECT-equivalent efficacy. Trials with Ketamine and more recently with its S-enantiomer (Esketamine) has been made, revealing a rapid and robust antidepressant effect, emerging as an option for TRD treatment.ObjectivesWe we aim to conduct a qualitative review, comparing clinical efficacy, tolerability and acceptability between the use of Esketamine and ECT as a TRD treatment.MethodsWe conduct a non-systematic review of recent evidence between the use of Esketamine and ECT as a TRD treatment, using PubMed/Medline database.ResultsTo compare clinical efficacy, tolerability and acceptability between the use of Esketamine and ECT as a TRD treatment we analyzed outcomes of interest. First,ECT was superior to Esketamine improving depressive symptoms. Comparing suicidal ideation and suicide attempts, most results were not statistically different. About cognition impairment, Esketamine performed better than ECT, particularizing attention, verbal memory, and executive functions; no differences were found for immediate memory or visual memory.About adverse effects Esketamine has less risk of headache and muscle pain, but higher reports of transient, dissociative or depersonalization symptoms, blurred vision, diplopia and nystagmus. An important consideration for clinicians is the comparative tolerability and safety of Esketamine vs ECT; as ECT involves a full dose of anesthesia,it is expected that Esketamine would be better tolerated and safer than ECT. But no study assessed the relative tolerability or acceptability of these different adverse effect profiles.The best strategy for relapse prevention appears to be continuing ECT, continuing pharmacotherapy, or using some combination of both; but Esketamine continuing treatment is effective too.ConclusionsECT may be superior to Esketamine for improving depression severity in the acute phase, but long-term outcomes of these treatments are important to be considered. There are just two studies with long-term follow-up after the trial completed:one found no difference in depression severity during the 3-month follow-up, and the other reported that the remission rates were not different between groups by the 12-month follow-up period.Therefore,future research is needed to further optimize long-term treatment outcomes for both Esketamine and ECT to prevent relapse. Until then,treatment options should be individualized and patient-centered.Disclosure of InterestNone Declared

Predicting Depression Severity from Spontaneous Speech as Prompted by a Virtual Agent

IntroductionOne of the major challenges in clinical psychiatry remains the absence of well established objective measures of symptoms’ severity. Clinical insights are mainly provided through keen behavioral observation and subjective questionnaires and scales.ObjectivesThe aim of this paper is to predict depression severity through speech using the features extracted from the speech as provided by participants during a semi-structured dialogue with a virtual avatar.MethodsWe use data from a subset of the DAICWOZ dataset consisting in 142 dialogues between participants and a virtual avatar during which the avatar uses several prompts to maintain a conversation with the participant. The avatar uses prompts involving the topics of travel, dream jobs, and memorable experiences. From the speech generated from the dialogue, we extract participant utterances separated by prompt and extract features from the three sets of transcripts. We extract content features from the transcript and acoustic features from the excerpt corresponding to the speech from the participant for the prompt in question.We perform regression experiments on the PHQ8 items using the features extracted from each set of transcripts. Furthermore, we combine the features extracted from each set of transcripts and compute partial spearman correlations between them and the PHQ8 items using gender as a covariate.ResultsWith our best regression model we obtain an R2 of 0.1, explaining 10% of the variance in the PHQ total score. Additionally, we obtain a mean absolute error of 1.25, suggesting that the regressor can detect with more or less precision clinically meaningful differences in depression severity between participants. Partial correlations between the total score and the features show significant correlations between features dependent on the amount of speech generated by each participant, along with the complexity of syntactic structures used.ConclusionsAutomatic analysis of spontaneous speech could help with the detection and monitoring of signs of depression. By combining the use of this technology with timely intervention strategies for instance provided by a virtual agent it could contribute to timely prevention.Disclosure of InterestA. König: None Declared, M. Mina Employee of: ki:elements GmbH, S. Schäfer Employee of: ki:elements GmbH, N. Linz Shareolder of: ki:elements GmbH, Employee of: ki:elements GmbH, J. Tröger Shareolder of: ki:elements GmbH, Employee of: ki:elements GmbH

Worse off by waiting for treatment? The impact of waiting time on clinical course and treatment outcome for depression in routine care

BackgroundLong-term untreated major depressive disorder (MDD) is associated with a less favorable clinical course. Waiting time, defined as the interval between diagnostic workup and treatment initiation, may be clinically relevant given the prolongation of the pre-existing duration of untreated MDD. However, it is currently unknown whether and to what extent waiting time affects treatment course in routine outpatient care. MethodsRetrospectively extracted data from 715 outpatients with MDD who received naturalistic outpatient MDD treatment were examined. Treatment outcome was defined as the difference in depression severity at the start of treatment and six months thereafter. Clinical course during waiting time was defined by the difference in severity at diagnostic workup and at treatment initiation. We analyzed the association between waiting time and treatment outcome and between waiting time and clinical course during this waiting time using multivariable regression analyses. We adjusted for severity and suicidality as potential confounders. ResultsAn increased duration of the waiting time was associated with a less favorable treatment outcome (B = 0.049, SE = 0.019, p = 0.01). This association persisted after adjustment for potential confounders (B = 0.053, SE = 0.02, p = 0.01). No association was found between length of waiting time and clinical course during waiting time. LimitationsStrict definitions resulted in smaller sample sizes for the final analyses. The uncontrolled design may be questionable to definitively establish the impact of waiting time on treatment outcome. ConclusionsA prolonged waiting time is significantly associated with less favorable treatment outcome. Reduction of waiting time deserves priority in depression treatment planning to improve clinical outcomes.

Nutrient deficiency profiles and depression: A latent class analysis study of American population

BackgroundResearch into the effects of nutrition on depression is often performed by examining the effects of singular nutrients and dietary styles (e.g.: vegan, Mediterranean). The present study is the first one to establish the effects of patterns of nutritional deficiency within the American population and examines their effects on depression. MethodsData was drawn from National Health and Nutrition Examination Survey (NHANES). Latent class analysis was performed to identify homogeneous groups of nutrient deficiency. A 3-step analysis was performed to establish class-dependant differences in depression severity. BCH analysis revealed unique predictors of depression dependant on most probable class. ResultsAnalysis revealed 4 classes of nutrient deficiency. Magnesium and dietary fibre were the least endorsed. ‘Nutrient deprived’ individuals showed the highest depression severity (Mean = 4.137, SD = 0.337). Profiles were predicted by different socioeconomic and anthropogenic predictors with meeting minimum calories showing the strongest odds of not being nutrient deprived (OR between 5.44 and 11.11). Overall, age (β = −0.115, p ≤ 0.01) and income (β = −0.147, p ≤ 0.01) were the strongest protecting factors while being female (β = 0.128, p ≤ 0.01) and arthritis (β = 0.130, p ≤ 0.01) were the strongest risk factors. LimitationsThe study involved binary variables based on minimum daily intakes and did not account for positive effects of exceeding minimum recommended doses. ConclusionsThe study supports the notion of a negative relationship between good nutrition and depression. Finding unique risk factors for depression symptoms supports the utility of nutrient deficiency profiling.

Changes in the TMS-evoked potential N100 in the dorsolateral prefrontal cortex as a function of depression severity in adolescents

Studies using transcranial magnetic stimulation with simultaneous electroencephalography (TMS-EEG) revealed an imbalance between cortical excitation and inhibition (E/I) in the dorsolateral prefrontal cortex (DLPFC) in depression. As adolescence is a developmental period with an increase in depression prevalence and profound neural changes, it is crucial to study the relationship between depression and cortical excitability in adolescence. We aimed to investigate the cortical excitability of the DLPFC in adolescents with depression and a dependency of the TMS-evoked potential N100 on the depression severity. 36 clinical patients (12–18 years of age; 21 females) with a major depressive episode were assessed twice in a longitudinal design: shortly after admission (T0) and after six weeks of intervention (T1). GABA-B-mediated cortical inhibition in the left and right DLPFC, as assessed by the N100, was recorded with EEG. Significantly higher depression scores were reported at T0 compared to T1 (p < 0.001). N100 amplitudes were significantly increased (i.e., more negative) at T0 compared to T1 (p = 0.03). No significant hemispheric difference was found in the N100 component. The correlation between the difference in depression severity and the difference in N100 amplitudes (T0–T1) obtained during stimulation of the left DLPFC did not remain significant after correction for testing in both hemispheres. Higher N100 amplitudes during a state of greater depression severity are suggestive of an E/I imbalance in the DLPFC in adolescents with an acute depressive episode. The N100 reduction potentially reflects a normalization of DLPFC over inhibition in association with decreased depressive symptomatology, indicating severity dependency.

Behavioral and psychological factors in individuals with migraine without psychiatric comorbidities

BackgroundIt is well known that the course of migraine is influenced by comorbidities and that individual psychological characteristics may impact on the disease. Proper identification of psychological factors that are relevant to migraine is important to improve non-pharmacological management. This study aimed at investigating the relationship between psychological factors and migraine in subjects free of psychiatric comorbidities.MethodsA sample of women with episodic (EM) and chronic migraine (CM) without history of psychiatric comorbidities were included in this cross-sectional study. The study also included female healthy controls (HC) without migraine or other primary headaches. We evaluated sleep, anxiety, depression, intolerance of uncertainty, decision making style and tendence to pain catastrophizing by validated self-report questionnaires or scales. Comparisons among groups were performed using ANOVA and Bonferroni post-hoc tests. Statistical significance was set at p < 0.05.ResultsA total of 65 women with EM (mean age ± SD, 43.9 ± 7.2), 65 women with CM (47.7 ± 8.5), and 65 HC (43.5 ± 9.0) were evaluated. In sleep domains, CM patients reported poorer overall sleep quality, more severe sleep disturbances, greater sleep medication use, higher daytime dysfunction, and more severe insomnia symptoms than HC. EM group showed better sleep quality, lower sleep disturbances and sleep medication use than CM. On the other hand, the analysis highlighted more severe daytime dysfunction and insomnia symptoms in EM patients compared to HC. In anxiety and mood domains, CM showed greater trait anxiety and a higher level of general anxiety sensitivity than HC. Specifically, CM participants were more afraid of somatic and cognitive anxiety symptoms than HC. No difference in depression severity emerged. Finally, CM reported a higher pain catastrophizing tendency, more severe feeling of helplessness, and more substantial ruminative thinking than EM and HC, whilst EM participants reported higher scores in the three above-mentioned dimensions than HC. The three groups showed similar decision-making styles, intolerance of uncertainty, and strategies for coping with uncertainty.ConclusionsEven in individuals without psychiatric comorbidities, specific behavioral and psychological factors are associated with migraine, especially in its chronic form. Proper identification of those factors is important to improve management of migraine through non-pharmacological strategies.

Predictors of engagement with remote sensing technologies for symptom measurement in Major Depressive Disorder

BackgroundRemote sensing for the measurement and management of long-term conditions such as Major Depressive Disorder (MDD) is becoming more prevalent. User-engagement is essential to yield any benefits. We tested three hypotheses examining associations between clinical characteristics, perceptions of remote sensing, and objective user engagement metrics. MethodsThe Remote Assessment of Disease and Relapse – Major Depressive Disorder (RADAR-MDD) study is a multicentre longitudinal observational cohort study in people with recurrent MDD. Participants wore a FitBit and completed app-based assessments every two weeks for a median of 18 months. Multivariable random effects regression models pooling data across timepoints were used to examine associations between variables. ResultsA total of 547 participants (87.8% of the total sample) were included in the current analysis. Higher levels of anxiety were associated with lower levels of perceived technology ease of use; increased functional disability was associated with small differences in perceptions of technology usefulness and usability. Participants who reported higher system ease of use, usefulness, and acceptability subsequently completed more app-based questionnaires and tended to wear their FitBit activity tracker for longer. All effect sizes were small and unlikely to be of practical significance. LimitationsSymptoms of depression, anxiety, functional disability, and perceptions of system usability are measured at the same time. These therefore represent cross-sectional associations rather than predictions of future perceptions. ConclusionsThese findings suggest that perceived usability and actual use of remote measurement technologies in people with MDD are robust across differences in severity of depression, anxiety, and functional impairment.

Effectiveness of a Guided Internet- and Mobile-Based Intervention for Patients with Chronic Back Pain and Depression (WARD-BP): A Multicenter, Pragmatic Randomized Controlled Trial

Introduction: There is neither strong evidence on effective treatments for patients with chronic back pain (CBP) and depressive disorder nor sufficiently available mental health care offers. Objective: The aim is to assess the effectiveness of internet- and mobile-based interventions (IMI) as a scalable approach for treating depression in a routine care setting. Methods: This is an observer-masked, multicenter, pragmatic randomized controlled trial with a randomization ratio of 1:1.Patients with CBP and diagnosed depressive disorder (mild to moderate severity) were recruited from 82 orthopedic rehabilitation clinics across Germany. The intervention group (IG) received a guided depression IMI tailored to CBP next to treatment-as-usual (TAU; including medication), while the control group (CG) received TAU. The primary outcome was observer-masked clinician-rated Hamilton depression severity (9-week follow-up). The secondary outcomes were: further depression outcomes, pain-related outcomes, health-related quality of life, and work capacity. Biostatistician blinded analyses using regression models were conducted by intention-to-treat and per protocol analysis. Results: Between October 2015 and July 2017, we randomly assigned 210 participants (IG, n = 105; CG, n = 105), mostly with only a mild pain intensity but substantial pain disability. No statistically significant difference in depression severity between IG and CG was observed at the 9-week follow-up (β = –0.19, 95% CI –0.43 to 0.05). Explorative secondary depression (4/9) and pain-related (4/6) outcomes were in part significant (p < 0.05). Health-related quality of life was significantly higher in the IG. No differences were found in work capacity. Conclusion: The results indicate that an IMI for patients with CBP and depression in a routine care setting has limited impact on depression. Benefits in pain and health-related outcomes suggest that an IMI might still be a useful measure to improve routine care.

Depression Severity and Depression Stigma Among Students: A Survey of Universities in Five Countries.

In the university setting, mental disorders have come under greater scrutiny and more attention has been given toward addressing the social stigmas associated with mental illness in an effort to promote mental well-being and improve mental health care delivery on-campus. Depression has been previously linked to a reduction in quality of life, suicidal ideation, and poor academic performance. However, few studies have directly compared the burden of depression or stigmatized views between multiple universities. As a result, this cross-sectional study of university students from five countries was performed to determine the burden of depressive disorders, the stigmatizations of beliefs related to depression, and international variation. A questionnaire consisting of a sociodemographic survey, Patient Health Questionnaire-9 (PHQ-9), and Depression Stigma Scale (DSS) was distributed via multiple routes to undergraduate and graduate students at institutions in the United States, Taiwan, United Arab Emirates, Egypt, and Czech Republic. The point prevalence of depression was determined by using the algorithm scoring method of the PHQ-9. Depression severity was determined according to the summed-item scoring method of the PHQ-9. The degree of stigmatization of beliefs was determined by continuous scores on the DSS subscales for personal and perceived stigma. Differences in depression severity, personal stigma, and perceived stigma were determined according to analysis of variance and further studied using post hoc Tukey's tests. Responses were collected from students in the United States (n = 593), United Arab Emirates (n = 134), Taiwan (n = 217), Egypt (n = 105), and Czech Republic (n = 238). Of 1287 responses, 30.7% (n = 396) screened positive for a depressive disorder: 18.0% (n = 232) for major depressive disorder and 12.7% (n = 164) for another depressive disorder. Depression severity differed internationally (p < 0.001). Emirati students significantly exhibited most depression followed by Czech, American, and Taiwanese students (all ps < 0.001). There was also a difference between students of different countries in terms of personal stigma (p < 0.001), with Emirati students holding more stigmatized personal views than Czech, American, Egyptian, and Taiwanese students (all ps < 0.001). Students similarly demonstrated differences in terms of personal stigma (p < 0.001). Egyptian students exhibited the most perceived stigma followed by Emirati, Taiwanese, American, and Czech students (all ps < 0.001). These findings suggest a high point prevalence of depression among university students and differences in the severity of depression, which has implications for the delivery of mental health care in this population. There were significant differences in terms of personal and perceived stigma between university students, indicating resource allocation for university-based campaigns to reduce depression stigma may need to be tailored to the population. After implementation of stigma reduction programs, future follow-up surveys can be done to compare degrees of stigma before and after the intervention.

COVID-19 Pandemic: Looking After the Mental Health of Our Healthcare Workers.

COVID-19 Pandemic: Looking After the Mental Health of Our Healthcare Workers.

Association of Race and Ethnicity With Late-Life Depression Severity, Symptom Burden, and Care

Knowledge gaps persist regarding racial and ethnic variation in late-life depression, including differences in specific depressive symptoms and disparities in care. To examine racial/ethnic differences in depression severity, symptom burden, and care. This cross-sectional study included 25 503 of 25 871 community-dwelling older adults who participated in the Vitamin D and Omega-3 Trial (VITAL), a randomized trial of cancer and cardiovascular disease prevention conducted from November 2011 to December 2017. Data analysis was conducted from June to September 2018. Racial/ethnic group (ie, non-Hispanic white; black; Hispanic; Asian; and other, multiple, or unspecified race). Depressive symptoms, assessed using the Patient Health Questionnaire-8 (PHQ-8); participant-reported diagnosis, medication, and/or counseling for depression. Differences across racial/ethnic groups were evaluated using multivariable zero-inflated negative binomial regression to compare PHQ-8 scores and multivariable logistic regression to estimate odds of item-level symptom burden and odds of depression treatment among those with diagnosed depression. There were 25 503 VITAL participants with adequate depression data (mean [SD] age, 67.1 [7.1] years) including 12 888 [50.5%] women, 17 828 [69.9%] non-Hispanic white participants, 5004 [19.6%] black participants, 1001 [3.9%] Hispanic participants, 377 [1.5%] Asian participants, and 1293 participants [5.1%] who were categorized in the other, multiple, or unspecified race group. After adjustment for sociodemographic, lifestyle, and health confounders, black participants had a 10% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (rate ratio [RR], 1.10; 95% CI, 1.04-1.17; P < .001); Hispanic participants had a 23% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (RR, 1.23; 95% CI, 1.10-1.38; P < .001); and participants in the other, multiple, or unspecified group had a 14% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (RR, 1.14; 95% CI, 1.04-1.25; P = .007). Compared with non-Hispanic white participants, participants belonging to minority groups had 1.5-fold to 2-fold significantly higher fully adjusted odds of anhedonia (among black participants: odds ratio [OR], 1.76; 95% CI, 1.47-2.11; among Hispanic participants: OR, 1.96; 95% CI, 1.43-2.69), sadness (among black participants: OR, 1.31; 95% CI, 1.07-1.60; among Hispanic participants: OR, 2.09; 95% CI, 1.51-2.88), and psychomotor symptoms (among black participants: OR, 1.77; 95% CI, 1.31-2.39; among Hispanic participants: OR, 2.12; 95% CI, 1.28-3.50); multivariable-adjusted odds of sleep problems and guilt appeared higher among Hispanic vs non-Hispanic white participants (sleep: OR, 1.24; 95% CI, 1.01-1.52; guilt: 1.84; 95% CI, 1.31-2.59). Among those with clinically significant depressive symptoms (ie, PHQ-8 score ≥10) and/or those with diagnosed depression, black participants were 61% less likely to report any treatment (ie, medications and/or counseling) than non-Hispanic white participants after adjusting for confounders (adjusted OR, 0.39; 95% CI, 0.27-0.56). In this cross-sectional study, significant racial and ethnic differences in late-life depression severity, item-level symptom burden, and depression care were observed after adjustment for numerous confounders. These findings suggest a need for further examination of novel patient-level and clinician-level factors underlying these associations.

RACIAL AND ETHNIC DISPARITIES IN DEPRESSION SEVERITY, SYMPTOM BURDEN AND CARE AMONG OLDER ADULTS

Introduction IMPORTANCE: Knowledge gaps persist regarding racial and ethnic variation in late-life depression (LLD), including differences in specific depressive symptoms and disparities in care. Identifying disparities in symptom presentation and treatment of LLD is important, as doing so may guide approaches to reduce morbidity and mortality from LLD. Thus, we aimed to evaluate racial/ethnic differences in depression severity, item-level depressive symptom burden, and depression care. Methods DESIGN, SETTING, PARTICIPANTS: In this community based large cross-sectional study, we included 25,503 participants (mean age=67.1 years) in the late-life depression prevention ancillary study (VITAL-DEP) to the VITamin D and OmegA-3 TriaL, a randomized trial of cancer and cardiovascular disease prevention among 25,871 adults. EXPOSURE: Racial and ethnic group (Non-Hispanic White, Black, Hispanic, Asian and Others/unspecified). MAIN OUTCOMES AND MEASURES: Depressive symptoms were assessed using the Patient Health Questionnaire-8 (PHQ-8); participants reported diagnosis and medication and/or counseling for depression. Differences across racial/ethnic groups were evaluated using: multivariable zero-inflated negative binomial regression to compare PHQ-8 scores; multivariable logistic regression to estimate odds of item-level symptom burden and odds of depression treatment among those with diagnosed depression. Results There were 25,503 participants with adequate depression data (mean [standard deviation] age=67.1 [7.1] years), including: 12888 [50.5%] female, 17828 [69.9%] non-Hispanic White, 5004 [19.6%] Black, 1001 [3.9%] Hispanic, 377 [1.5%] Asian and 1293 [5.1%] Other-reporting/race-unspecified participants. After adjustment for sociodemographic, lifestyle and health confounders, compared to non-Hispanic Whites: Black participants had a 8% higher severity level of PHQ-8 scores (IRR (incidence rate ratio)=1.08, 95% CI: 1.02-1.15; p=0.01); Hispanic participants had 26% higher severity of PHQ-8 (IRR=1.26, 95% CI: 1.12-1.42; p Conclusions In this large cross-sectional study, we observed significant racial and ethnic differences in late-life depression severity, item-level symptom burden, and depression care, after adjustment for numerous confounders. Findings suggest a need for further examination of novel patient- and provider-level factors underlying these associations. This research was funded by: VITAL-DEP is supported by R01 MH091448 from NIMH.