Disorders In Primary Care Settings Research Articles

Comorbidity of Depression and Diabetes: A Literature Review on Systemic Flaws in Healthcare and the Benefits of Collaborative Diagnosis and Treatment in Primary Care Settings.

The increasing specialization and dispersion of healthcare systems have led to a shortage of resources to address comorbidities. Patients with coexisting mental and physical conditions are disadvantaged, as medical providers often only focus on the patient's mental illness while neglecting their physical needs, resulting in poorer health outcomes. This study aimed to shed light on the systemic flaws in healthcare systems that contribute to suboptimal health outcomes in individuals with comorbid diseases, including depression and diabetes. This paper also discusses the clinical and economic benefits of collaborative methods for diagnosing and treating depressive disorders in primary care settings. A comprehensive literature review of the relationship between depression and diabetes was conducted. The outcomes of the literature review were carefully analyzed. Several databases were searched using keywords such as "diabetes," "depression," "comorbidity," "prevalence," "epidemiology," and "risk factors" using Google Scholar and PubMed as search engines. The review and research papers written between 1961 and 2023 were our main focus. This study revealed improved depressive symptoms and better blood sugar and blood pressure control. Additionally, individuals with comorbid depression and diabetes have higher direct and secondary medical costs. Antidepressants and psychological interventions are equally effective in treating depressive symptoms in patients with diabetes, although they have conflicting effects on glycemic control. For individuals with comorbid diabetes and depression, clear care pathways, including a multidisciplinary team, are essential for achieving the best medical and mental health outcomes. Coordinated healthcare solutions are necessary to reduce the burden of illness and improve therapeutic outcomes. Numerous pathophysiological mechanisms interact with one another and may support the comorbidities of T2DM, and depressive disorders could exacerbate the course of both diseases.

The effectiveness of transdiagnostic cognitive behavioural therapy for anxiety disorders: the role of and impact of comorbid depression

ABSTRACT Transdiagnostic Cognitive Behaviour Therapy (tCBT), an intervention designed to be applicable across multiple diagnoses, was introduced to improve limitations in traditional therapy such as cost and access to trained therapists. It has been established as an effective and efficacious treatment for anxiety disorders, though there has been little research focussed on the role of depression. The current study investigated the role of comorbid depression during tCBT for anxiety disorders in primary care settings as an outcome and a moderator of anxiety outcomes. Results of multi-level ANOVAs indicated no significant difference in anxiety outcomes regardless of whether there was a comorbid depression diagnosis in the tCBT condition, and that individuals with a comorbid depression diagnosis experienced significantly greater reduction in anxiety severity than those without. Depression symptom severity decreased to a significantly greater extent in the tCBT condition than in TAU when the outcome measure of Patient Health Questionnaire was utilised as the outcome measure, but this was not mirrored when the Clinician Severity Rating was utilised as the outcome measure. This study provides preliminary support for the effectiveness of Transdiagnostic Cognitive Behaviour therapy for those with both a principal anxiety disorder and comorbid depression in symptom reduction.

Eating disorders, primary care, and stigma: an analysis of research trends and patterns.

Eating disorders (EDs) are a growing concern affecting millions worldwide. Early detection and treatment are crucial, but stigma can prevent people from seeking help. Primary care providers can play a critical role in early detection by coordinating care with other professionals. Understanding the research landscape on EDs, primary care, and stigma is essential for identifying knowledge gaps to direct future research and improve management. In this study, we aimed to analyze the scientific trends and patterns in research about EDs, primary care, and stigma. A bibliometric analysis was conducted using the Web of Science database to collect articles published between May 1986 and May 2023. Bibliometric indicators were utilized to examine authorship, collaboration patterns, and influential papers. Topic analysis was performed to identify stigma-related terms within the dataset. A total of 541 research articles were analyzed, and it was found that the average number of publications per year has increased linearly from nearly zero in 1986 to 41 in 2022. One of the study's main findings is that despite this linear increase over the years, the subject of stigma did not take a prominent place in the literature. Only a few stigma concepts could be identified with the topic analysis. The authors in the field are also interested in; screening, neurotic symptoms, training, adolescent, obesity-related conditions, and family. One-third of all publications were from 15 journals. However, only two of them were primary healthcare journals. Leading authors' collaborations were another critical finding from the network analysis. This may help to expand primary care related EDs research to end the mental health stigma. This study provides insights into the research trends and patterns regarding eating disorders, primary care, and stigma. Our findings highlight the need to address primary care's impact and stigma on EDs. The identified research gaps can guide future studies to improve the prevention, diagnosis, and treatment of eating disorders in primary care settings.

The effectiveness of nurse practitioner care for patients with mental health conditions in primary care settings: A systematic review

BackgroundThe nurse practitioner (NP) workforce is key to meeting the demand for mental health services in primary care settings. PurposeThe purpose of this study is to synthesize the evidence focused on the effectiveness of NP care for patients with mental health conditions in primary care settings, particularly focused on primary care NPs and psychiatric mental health NPs and patients with anxiety, depression, and substance use disorders. MethodsStudies published since 2014 in the United States studying NP care of patients with anxiety, depression, or substance use disorders in primary care settings were included. FindingsSeventeen studies were included. Four high-quality studies showed that NP evidence-based care and prescribing were comparable to that of physicians. Seven low-quality studies suggest that NP-led collaborative care is associated with reduced symptoms. DiscussionMore high-quality evidence is needed to determine the effectiveness of NP care for patients with mental health conditions in primary care settings.

Depression and anxiety during and after episodes of COVID-19 in the community

Understanding the connection between physical and mental health with evidence-based research is important to inform and support targeted screening and early treatment. The objective of this study was to document the co-occurrence of physical and mental health conditions during and after the experience of symptomatic SARS-CoV-2 illness episodes. Drawing from a national symptoms' surveillance survey conducted in the UK in 2020, this study shows that individuals with symptomatic forms of SARS-CoV-2 (identified by anosmia with either fever, breathlessness or cough) presented significantly higher odds of experiencing moderate and severe anxiety (2.41, CI 2.01–2.90) and depression (3.64, CI 3.06–4.32). Respondents who recovered from physical SARS-CoV-2 symptoms also experienced higher odds of anxiety and depression in comparison to respondents who never experienced symptoms. The findings are robust to alternative estimation models that compare individuals with the same socioeconomic and demographic characteristics and who experienced the same local and contextual factors such as mobility and social restrictions. The findings have important implications for the screening and detection of mental health disorders in primary care settings. They also suggest the need to design and test interventions to address mental health during and after physical illness episodes.

Factors associated with Indonesian family physicians' knowledge of depression: A cross-sectional study.

Depression is a common mental disorder in primary care settings both globally and locally. Even with considerable impacts on patients' quality of life and public healthcare costs, most people with depression do not receive evidence-based treatment. Integrating mental healthcare services into primary care is essential to address the treatment gap for depression. As counsellors and care coordinators, family physicians have a vital role in providing primary mental healthcare services. This study aims to assess Indonesian family physicians' knowledge of depression and identify the associated factors. This cross-sectional observational study included a total of 83 family physicians from the Association of Indonesian Family Physicians. Data were collected using online questionnaires, including demographic and knowledge assessment instruments and the Care Coordinator Scale (CCS). Descriptive and multiple linear regression analyses were performed. The knowledge of depression, particularly in terms of prevention, diagnosis, pharmacological treatment, and post-referral treatment, was insufficient among the family physicians. The medication education (P=0.006) and follow-up care plan (P=0.04) domains of the CCS were associated with the family physicians' knowledge of the management of depression in the linear regression analysis (R2=0.077). Interventions to improve Indonesian family physicians' knowledge of depression, focusing on medication/pharmacological treatment and considering them as care coordinators, are essential.

Predictive potential of somatic symptoms for the identification of subthreshold depression and major depressive disorder in primary care settings.

The presence of heterogenous somatic symptoms frequently obscures the recognition of depression in primary care. We aimed to explore the association between somatic symptoms and subthreshold depression (SD) and Major Depressive Disorder (MDD), as well as to determine the predictive potential of somatic symptoms in identifying SD and MDD in primary care. Data were derived from the Depression Cohort in China study (ChiCTR registry number: 1900022145). The Patient Health Questionnaire-9 (PHQ-9) was used to assess SD by trained general practitioners (GPs), and the Mini International Neuropsychiatric Interview depression module was used to diagnose MDD by professional psychiatrists. Somatic symptoms were assessed using the 28-item Somatic Symptoms Inventory (SSI). In total of 4,139 participants aged 18-64 years recruited from 34 primary health care settings were included. The prevalence of all 28 somatic symptoms increased in a dose-dependent manner from non-depressed controls to SD, and to MDD (P for trend <0.001). Hierarchical clustering analysis grouped the 28 heterogeneous somatic symptoms into three clusters (Cluster 1: energy-related symptoms, Cluster 2: vegetative symptoms, and Cluster 3: muscle, joint, and central nervous symptoms). Following adjustment for potential confounders and the other two clusters of symptoms, per 1 increase of energy-related symptoms exhibited significant association with SD (OR = 1.24, 95% CI, 1.18-1.31) and MDD (OR = 1.50, 95% CI, 1.41-1.60) The predictive performance of energy-related symptoms in identifying individuals with SD (AUC = 0.715, 95% CI, 0.697-0.732) and MDD (AUC = 0.941, 95% CI, 0.926-0.963) was superior to the performance of total SSI and the other two clusters (P < 0.05). Somatic symptoms were associated with the presence of SD and MDD. In addition, somatic symptoms, notably those related to energy, showed good predictive potential in identifying SD and MDD in primary care. The clinical implication of the present study is that GPs should consider the closely related somatic symptoms for early recognition for depression in practice.

Barriers and facilitators to nurse practitioner buprenorphine prescribing for opioid use disorder in primary care settings.

Increasing access to opioid use disorder (OUD) treatment is critical to curbing the opioid epidemic, particularly for rural residents who experience numerous health and health care disparities, including higher overdose death rates and limited OUD treatment access compared with urban dwellers. Buprenorphine-naloxone is an evidence-based treatment for OUD that is well suited for rural areas. However, providers must have a specialized federal waiver to prescribe the medication. Despite the acceleration of the opioid epidemic in rural areas and the recent liberalization of federal buprenorphine-naloxone prescribing laws, few providers hold buprenorphine-naloxone prescribing waivers and even fewer prescribe the medication. This study explores barriers and facilitators to buprenorphine-naloxone prescribing among nurse practitioners (NPs) working in primary care settings in eastern North Carolina. Individual interviews were conducted with 13 NPs working in primary care settings in eastern North Carolina. Qualitative thematic analysis was used to identify perceived barriers and facilitators to buprenorphine-naloxone prescribing. Analysis found prescribing barriers related to OUD stigma, perceived knowledge, federal and state regulation, and prescribing resources and found facilitators related to adopting a person-centered approach, developing prescriber skills, and access to prescribing resources. The barriers and facilitators that NPs experience related to buprenorphine prescribing for OUD are similar to those faced by physicians, although the barriers arguably more profound. Future research should consider how to mitigate these prescribing barriers to facilitate NP buprenorphine prescribing for OUD. To our knowledge, this is the first qualitative study of NP buprenorphine-naloxone prescribing in rural areas. Given the prominence of OUD in rural regions and the key role NPs play in primary care provision, this study lays import groundwork for developing interventions to support buprenorphine-naloxone prescribing by NPs practicing in rural regions.

Prevalence and associated factors of common mental disorders in primary care settings in Sofala Province, Mozambique.

In Mozambique, the prevalence of common mental illness in primary care is not well established. This study aimed to assess the prevalence of, and associated factors for, common mental illness in patients accessing primary care services in three Ministry of Health clinics in Mozambique. Adult patients were recruited from the waiting rooms of prenatal, postpartum and general out-patient consultations. A mental health professional administered a diagnostic interview to examine prevalence of major depressive disorder (MDD), generalised anxiety disorder (GAD), post-traumatic stress disorder (PTSD) and any substance misuse or dependence. Generalised linear mixed models were used to examine the odds of each disorder and sociodemographic associations. Of 502 patients interviewed, 74.1% were female (n = 372) and the average age was 27.8 years (s.d. = 7.4). Of all participants, 23.9% (n = 120) met diagnostic criteria for at least one common mental disorder; 8.6% were positive for MDD (n = 43), 13.3% were positive for GAD (n = 67), 4.8% were positive for PTSD (n = 24) and 4.0% were positive for any substance misuse or dependence (n = 20). Patients attending prenatal or postpartum consultations had significantly lower odds of any common mental disorder than patients attending out-patient primary care. Age was negatively associated with MDD, but positively associated with substance misuse or dependence. Over 20% of patients attending primary care in Mozambique may have common mental disorders. A specific focus on patients attending general out-patient visits, young people for depression, and older people and men for substance misuse/dependence would provide a targeted response to high-risk demographics.

Addressing inequities in headache care by embedding services in a community health center in Boston, MA.

There is a critical need to diagnose and treat headache disorders in primary care settings. This is especially true for those who face systemic barriers to healthcare access due to racism or poverty. In order to target those at higher risk of disability associated with neurologic disease in our healthcare system, we embedded a specialized headache and neurology clinic within the Brigham and Women's Hospital Southern Jamaica Plain Community Health Center in Boston, MA. The goal was to create a sustainable, integrated clinic consistent with the CHC's racial justice mission, with an emphasis on equitable care, awareness of structural barriers to care, improved communication with primary care and inclusion of trainees as important members of a healthcare team. In its' first year, the clinic had over 400 patient visits, with a near-perfect rate of completion of consults. In addition to improved access to tertiary care headache services, successes have included improving continuity of care, cultivating a model of shared care with primary care practitioners and stimulating interest in headache medicine among staff and trainees. Challenges have included the use of staff time to complete prior authorizations, and the need to find or develop Spanish-language and culturally appropriate patient educational resources. By providing care within the patient's medical home, the headache specialist gains a deeper appreciation of a patient's social determinants of health and can readily access resources to navigate barriers. The personal and professional fulfillment that headache specialists may experience while doing this important work could help protect against burnout. Sustainability depends on ensuring equitable provider reimbursement; departmental and institutional support is essential. We believe this clinic can serve as a model for specialists throughout the United States who wish to improve the delivery of care to patient populations who face access barriers.

Screening for Autism Spectrum Disorders in Underserved Populations: Global Versus Specific Surveillance Instruments

Objective: The identification of developmental delays during well-child visits is insufficient with clinical judgment alone (30-50%). Method: We analyzed the usefulness of clustering communication and social-personal areas from neurodevelopmental screening ASQ-3 and Denver II PRUNAPE questionnaires, compared with M-CHAT and ADOS as the initial screening for detection of Autism Spectrum Disorders (ASD) at well-child controls at primary-care settings in lowand middle-income countries (LMIC). Results: One hundred children at the Department of Pediatrics from 12 to 66 months (average: 35 months), were assessed by a developmental pediatrician, trained and supervised by ECHO-model. The assessment was completed with a full assessment for autism with a child neurologist, and a child-juvenile psychiatrist. Thirty-one of 100 children arrived at autism spectrum disorder diagnostic criteria. Conclusion: Failure at ASQ-3 communication plus social-personal clusters was in good agreement with M-CHAT to predict risk criteria for autism compared with a full assessment protocol. Clustering Communication and Personal-Social developmental skills from global screeners were sufficient at the pediatric visits, let differential diagnoses with global developmental delay, and communication developmental disorders. These scales covered a wide range of ages for early identification of children with an autism spectrum disorder in primary care settings within an on-site or online format

Effectiveness of the internet-based Unified Protocol transdiagnostic intervention for the treatment of depression, anxiety and related disorders in a primary care setting: a randomized controlled trial

BackgroundResearch has shown that internet-based cognitive behavioural therapy (iCBT) can be a very promising solution to increase access to and the dissemination of evidence-based treatments to all of the population in need. However, iCBT is still underutilized in clinical contexts, such as primary care. In order to achieve the effective implementation of these protocols, more studies in ecological settings are needed. The Unified Protocol (UP) is a transdiagnostic CBT protocol for the treatment of emotional disorders, which includes depression, anxiety and related disorders, that has shown its efficacy across different contexts and populations. An internet-based UP (iUP) programme has recently been developed as an emerging internet-based treatment for emotional disorders. However, the internet-delivered version of the UP (iUP) has not yet been examined empirically. The current project seeks to analyse the effectiveness of the iUP as a treatment for depression, anxiety and related emotional disorders in a primary care public health setting.MethodsThe current study will employ a parallel-group, randomized controlled trial design. Participants will be randomly assigned to (a) the internet-based Unified Protocol (iUP), or (b) enhanced waiting list control (eWLC). Randomization will follow a 2:1 allocation ratio, with sample size calculations suggesting a required sample of 120 (iUP=80; eWLC=40). The Mini-International Neuropsychiatric Interview (M.I.N.I.) will be used for assessing potential participants. The Overall Anxiety Severity and Impairment Scale (OASIS) and the Overall Depression Severity and Impairment Scale (ODSIS) as well as other standardized questionnaires will be used for assessments at baseline, 4 weeks, 8 weeks and 12 weeks from baseline and for the iUP condition during the follow-up.DiscussionCombining the advantages of a transdiagnostic treatment with an online delivery format may have the potential to significantly lower the burden of emotional disorders in public health primary care setting. Anxiety and depression, often comorbid, are the most prevalent psychological disorders in primary care. Because the iUP allows for the treatment of different disorders and comorbidity, this treatment could represent an adequate choice for patients that demand mental health care in a primary care setting.Trial registrationISRCTN18056450 https://doi.org/10.1186/ISRCTN18056450.

Developing a Predictive Model for Depressive Disorders Using Stacking Ensemble and Naive Bayesian Nomogram: Using Samples Representing South Korea.

This study provided baseline data for preventing depression in female older adults living alone by understanding the degree of their depressive disorders and factors affecting these depressive disorders by analyzing epidemiological survey data representing South Koreans. To achieve the study objective, this study explored the main risk factors of depressive disorders using the stacking ensemble machine technique. Moreover, this study developed a nomogram that could help primary physicians easily interpret high-risk groups of depressive disorders in primary care settings based on the major predictors derived from machine learning. This study analyzed 582 female older adults (≥60 years old) living alone. The depressive disorder, a target variable, was measured using the Korean version of Patient Health Questionnaire-9. This study developed five single predictive models (GBM, Random Forest, Adaboost, SVM, XGBoost) and six stacking ensemble models (GBM + Bayesian regression, RandomForest + Bayesian regression, Adaboost + Bayesian regression, SVM + Bayesian regression, XGBoost + Bayesian regression, GBM + RandomForest + Adaboost + SVM + XGBoost + Bayesian regression) to predict depressive disorders. The naive Bayesian nomogram confirmed that stress perception, subjective health, n-6 fatty acid, n-3 fatty acid, mean hours of sitting per day, and mean daily sleep hours were six major variables related to the depressive disorders of female older adults living alone. Based on the results of this study, it is required to evaluate the multiple risk factors for depression including various measurable factors such as social support.

Management of Opioid Use Disorder in Primary Care Settings With a Focus on Long-Acting Medication Formulations.

Management of Opioid Use Disorder in Primary Care Settings With a Focus on Long-Acting Medication Formulations.

6.2 Evaluation of an Artificial Intelligence–Based Medical Device Designed to Aid in the Diagnosis of Autism Spectrum Disorder in the Primary Care Setting

The lack of diagnostic tools for autism spectrum disorder (ASD) in primary care settings and long waiting lists for specialist assessment contribute to an average delay of 3 years between first parental concern and diagnosis. This study examined the performance of an artificial intelligence–based device intended to aid primary care practitioners (PCPs) in the diagnosis of ASD. This was a prospective multisite pivotal study conducted in 6 states using a double-blind active comparator design with 425 completed subjects (36% female) ages 18 to 72 months with concern for developmental delay. Previous research developed, tuned, and tested a device that uses a gradient-boosted decision-tree machine learning algorithm that analyzes 64 behavioral features from 3 distinct inputs: 1) caregiver questionnaire; 2) 2 to 4 minutes of home videos analyzed by trained video analysts; and 3) PCP questionnaire. Device results were compared to diagnosis by independent agreement of specialist clinicians based on clinical assessment, including a modified Child Autism Rating Scale (CARS-2) and DSM-5 criteria. Specialists were child and adolescent psychiatrists, child psychologists, pediatric neurologists, and developmental behavioral pediatricians experienced in diagnosing ASD. Comparison of device results to specialist diagnosis found the following for subjects with determinate device results: positive predictive value (PPV) = 80.8% (95% CI, 70.3-88.8); negative predictive value (NPV) = 98.3% (90.6-100); sensitivity = 98.4% (91.6-100); and specificity = 78.9% (67.6-87.7). There was no evidence that device performance significantly varied when the PCP used the device remotely compared to in-person. Using this device, PCPs could efficiently, accurately, and equitably diagnose a subset of children aged 18 to 72 months old, thereby streamlining specialist referrals and facilitating earlier ASD diagnosis and interventions. The results further provide preliminary evidence that PCP evaluation of the child can be done via telemedicine or in-person with no degradation in device performance.

Perinatal Mental Health Problems –What Midwives and Nurses can do?

Maternal mental health is largely neglected in low and middle income countries. There is no routine screeningor treatment of maternal mental disorders in primary care settings in most parts of our country. Womenof every culture, age, income level and race can develop perinatal mood or anxiety disorder. Symptomscan appear any time during pregnancy and the first 12 months after childbirth. According to the WorldHealth Organization, worldwide about 10% of pregnant women and 13% of women who have given birthexperience a mental disorder, primarily depression.Risk factors involved in causing maternal mental health issues include previous history or family historyof mental health problems, poverty, extreme stress, childhood abuse and neglect, violence, interpersonalconflict, inadequate support from family, alcohol or drug abuse, and unplanned or unwanted pregnancy,natural disasters, and negative experiences from previous pregnancies. With severe depression, the mothersfail to adequately eat, sleep, bathe or adequately care for herself or the baby. The risk of suicide or harmingthe baby is also possible. Prolonged or severe mental illness affects family life, hampers mother infantbonding, breastfeeding and infant care.Specialized midwives can be effectively involved in promoting healthy pregnancies, in primary andsecondary prevention, early identification, and timely provision of quality specialist care to the affectedwomen. However, identification and management of mental disorders by non- specialized health providersis strongly recommended by the World Health Organization.

PILOT STUDY - A STUDY IN SELECTED HOSPITALS TO ASSESS THE EFFECTIVENESS OF TRILOGY IN REDUCING ANXIETY AND WORRIES IN DEPRESSED PATIENTS

ABSTRACT India is the most depressed country in the world, according to the world health organisation. Depression is one of the most commonly diagnosed mental disorders in primary care settings. The NMHS provides information on prevalence, disability, treatment gap and socioeconomic impact associated with depressive disorders among adults in India. The crude prevalence rate of mood disorder was estimated to vary from as low as 0.5 to as high as 78 per 1000 population. One in six people aged 10-19 years is suffering from depression. Globally, depression is one of the leading causes of mental illness, suicide and disability among adolescents. Outcomes: - The overall comparison in experimental group among tests regarding level of anxiety that paired sample ‘t’ test was calculated to significant difference in within group to test scores of level of anxiety in experimental group revealed that there was a highly statistically significant difference found in the level of anxiety in outcome scores between pre and post-1 test in experimental. The overall mean difference between pre test (29.3±5.77) and post test -1 (20.13±3.74) group with mean difference was 9.2. The obtained ‘t’ value was 10.94 with p&lt;0.001 which was statistically highly significant difference between pre test and post test -1. The overall mean difference between pre test (29.3±5.77) and post test -2 (18.9±6.95) groups with mean difference was 10.4. The obtained ‘t’ value was 10.56 with p&lt;0.001 which was statistically highly significant difference between pre and post-2. The overall mean difference between pre test (29.3±5.77) and post test -3 (14.6±7.95) groups with mean difference was 14.73. The obtained ‘t’ value was 12.41 with p&lt;0.001 which was statistically highly significant difference between pre test and post test -3. Conclusion:-Hence, Comparison of overall interpretation regarding level of anxiety in experimental group depicts that, there was significant difference found between t

Risk factors for severity of depression in participants with chronic medical conditions in rural primary health care settings in India.

Background:Depression and chronic medical disorders are strongly linked. There are limited studies addressing the correlates of the severity of depression in patients with co-morbid disorders in primary care settings. This study aimed to identify the socio-demographic and disease-specific risk factors associated with the severity of depression at baseline among patients participating in a randomized controlled trial (HOPE study).Methods:Participants were part of a randomized controlled trial in 49 primary care health centers in rural India. We included adults (≥ 30 years) with at least mild Depression or Anxiety Disorder and at least one Cardiovascular disorder or Type 2 Diabetes mellitus. They were assessed for the severity of depression using the PHQ-9, severity of anxiety, social support, number of co-morbid chronic medical illnesses, anthropometric measurements, HbA1c, and lipid profile.Results:Proportionately there were more women in the moderate category of depression than men. Ordinal logistic regression showed co-morbid anxiety and a lower level of education significantly increased the odds of more severe depression, while more social support was significantly negatively associated with depression severity in women. In men, anxiety was positively associated with greater depression severity; while reporting more social support was negatively associated with depression.Limitations:This is a cross-sectional study and thus, no causal conclusions are possibleConclusions:Anxiety and poor social support in both genders and lower educational levels in women were associated with increased severity of depression. Early identification of risk factors and appropriate treatment at a primary care setting may help in reducing the morbidity and mortality associated with depression.

Identifying and Making Recommendations for Pediatric Anxiety Disorders in Primary Care Settings: A Video-Based Training.

IntroductionPediatric anxiety disorders have high rates of prevalence and confer risk for later disorders if they go undetected. In primary care, they are underdiagnosed, partly because pediatricians often lack relevant training. We developed a brief, video-based training program for pediatric residents aimed at improving early identification of anxiety disorders in primary care.MethodsVideo content was consistent with the American Academy of Pediatrics Behavioral Health Competencies, as applied to the evaluation of anxiety disorders and guidance for discussing treatment options. This training can be delivered in two formats: videos (43 minutes) can be shown in a live, group-based format, or accessed via an online, asynchronous training. We tested this training program using both formats and developed surveys to evaluate knowledge about child anxiety, perceived evaluation skills, and satisfaction with the training. We also developed a video-based vignette to measure sensitivity to detecting disorders (how much the condition is interfering, diagnostic severity, and referral urgency).ResultsPediatric residents from two residency programs completed the training and pre- and posttraining assessments to evaluate program efficacy. Residents’ knowledge and perceived evaluation skills increased posttraining, with large effect sizes. Residents also demonstrated increased sensitivity to detecting anxiety disorders on the vignette-based assessment and reported high levels of satisfaction.DiscussionOur results suggested that residents participating in this training improved their evaluation skills and that residents found the training beneficial. Video-based trainings can significantly supplement existing education. This cost-effective and minimally burdensome training program can be used to enhance resident education in a much-needed area.

Depression, Anxiety, and Stress among Rural South Indian Women-Prevalence and Correlates: A Community-Based Study.

Background The burden of common mental disorders (CMDs) which includes depression, anxiety, and stress-related disorders are on the rise in India. Women in rural areas form one of the high-risk groups with respect to CMDs due to their compromised status of living. Objective The aim of the study was to estimate the prevalence of depression, anxiety, and stress, and the predictors to depression among women in rural Puducherry. Methods A community-based, cross-sectional study was performed in 2016, among women aged 18 to 59 years, residing in the rural area of Puducherry. Prevalence of CMDs was determined using the Depression Anxiety Stress Scale (DASS)-21. Using a systematic random sampling method, women were interviewed in their houses. The socio-demographic characteristics along with risk factors for depression were captured using a semi-structured proforma. A multivariable logistic regression model was used to determine the predictors of depression. Results A total of 301 women were surveyed and their mean age (SD) was 34.9 (10.2) years. The prevalence of depression, anxiety, and stress was found to be 15% (95% CI: 11.3–19.3), 10.6% (95% CI: 7.5–14.5), and 5% (95% CI: 3–8), respectively. Multivariable analysis identified that lesser education and living separately/divorced to be significant predictors for depression in these women. Conclusion About one in six adult women living in a rural area was found to be depressed, which is considerably high. This emphasizes the need for screening among women for common mental disorders in primary care settings, especially in rural areas so that early diagnoses happen and thus reduce the impact due to mental disability.