Eight-item Patient Health Questionnaire Research Articles

Prevalence and variability of current depressive disorder in 27 European countries: a population-based study

SummaryBackgroundWe aimed to estimate the prevalence of current depressive disorder in 27 European countries, and to explore differences in prevalence between European countries and by gender.MethodsIn this population-based study, we analysed data from respondents living in 27 European countries who were included in the second wave of the European Health Interview Survey, collected between 2013 and 2015. We assessed the prevalence of current depressive disorder using the eight-item Patient Health Questionnaire (PHQ-8), with depressive disorder defined as a PHQ-8 score of 10 or higher. Prevalence estimates and 95% CIs were calculated for all 27 countries overall and for each country individually. We assessed variation in prevalence (country vs the rest of Europe) using crude and adjusted prevalence ratios obtained from negative binomial regression models. We did all analyses for the total sample and stratified by gender.FindingsOur analysis sample comprised 258 888 individuals, of whom 117 310 (weighted proportion 47·8%) were men and 141 578 (52·2%) were women. The overall prevalence of current depressive disorder was 6·38% (95% CI 6·24–6·52) with important variation across countries, ranging from 2·58% (2·14–3·02) in the Czech Republic to 10·33% (9·33–11·32) in Iceland. Prevalence was higher in women (7·74% [7·53–7·95]) than in men (4·89% [4·71–5·08]), with clear gender differences for all countries except Finland and Croatia. Compared with the other European countries in our sample, those with the highest adjusted prevalence ratios were Germany (1·80 [1·71–1·89]) and Luxembourg (1·50 [1·35–1·66]), and those with the lowest adjusted prevalence ratios were Slovakia (0·28 [0·24–0·33]) and the Czech Republic (0·32 [0·27–0·38]).InterpretationDepressive disorders, although common across Europe, vary substantially in prevalence between countries. These results could be a baseline for monitoring the prevalence of current depressive disorder both at a country level in Europe and for planning health-care resources and services.FundingUK Medical Research Council and CIBER Epidemiology and Public Health (CIBERESP).

Causal effect of tooth loss on depression: evidence from a population-wide natural experiment in the USA.

Depression severely affects people's health and well-being. Oral diseases have been suggested to be associated with depression, but so far, there is no causal evidence. This study aimed to identify the causal effect of tooth loss on depression among US adults in a natural experiment study. Instrumental variable analysis was conducted using data from 169 061 respondents born in 1940-1978 who participated in the 2006, 2008 or 2010 waves of the Behavioral Risk Factor Surveillance System (BRFSS). Random variation in tooth loss due to differential childhood exposure to drinking water fluoride was exploited as an instrument. US adults who were exposed to drinking water fluoride in childhood had more remaining teeth, therefore providing a robust instrument (F = 73.4). For each additional tooth loss, depressive symptoms according to the eight-item Patient Health Questionnaire depression (PHQ-8) score increased by 0.146 (95% CI 0.008-0.284), and the probability of having clinical depression (PHQ ⩾10) increased by 0.81 percentage points (95% CI -0.12 to 1.73). Tooth loss causally increased depression among US adults. Losing ten or more teeth had an impact comparable to adults with major depressive disorder not receiving antidepressant drugs.

1716. Prospective Multicenter Observational Cohort Study to Assess the Burden of Herpes Zoster Disease in the Eye: Baseline Results of Initial Patients

BackgroundHerpes Zoster Ophthalmicus (HZO) affects 10-20% of adults with herpes zoster; ≥ 50% of these cases manifest as serious ocular diseases. This 1-year prospective observational cohort study aims to determine patient-reported HZO symptoms as well as economic and quality of life burden among 300 HZO patients from 6 major US ophthalmology practices. Here, we report baseline data from 13 initial enrollees.MethodsInclusion criteria were: participants ≥ 18 years, diagnosis of clinically active HZO, English or Spanish speaking, be willing and able to respond to study assessments, not be enrolled in a concurrent interventional HZO trial. Information are collected via 1) a clinical assessment form completed by the practice (baseline) and 2) patient questionnaires (baseline, 3, 6, and 12 months) on symptoms, medications, healthcare use, vision function, depression, and work productivity impact. Baseline results are presented for patients recruited during the first 6 months of enrollment from the first 4 sites to go live: diagnoses, and patient-reported symptoms and outcomes (eight-item Patient Health Questionnaire [PHQ-8] for depressive symptoms, National Eye Institute 25-item Visual Function Questionnaire [NEI-VFQ-25] for vision-related quality of life, and Zoster Brief Pain Inventory [ZBPI] for pain).ResultsThe mean age of participants is 71 years; 11 are female and 9 are retired. Seven participants are college graduates or hold other degrees. All have health insurance coverage, with most (10) having primary insurance through Medicare. HZO diagnoses (Table 1) were: keratitis (4), iridocyclitis (4), conjunctivitis (1), other HZO diagnosis (3), other ocular diagnosis (6). Patient-reported symptoms (Table 2) were: pain above the eye, sensitivity to light, redness, feeling of sand/grit in the eye (9 each). The mean overall PHQ-8 and NEI-VFQ-25 scores were 5.9 (Standard Deviation [SD]:4.5) and 74.6 (SD:13.9), respectively; the mean ZBPI score for worst pain severity was 3.3 (SD:3.8) (Table 3).Table 1. HZO Diagnosis at Baseline based on Clinical Assessment Form (N=13) Table 2. Patient-reported Symptoms in the HZO-Affected Eye at Baseline (N=13) Table 3. Patient-reported Outcomes: Depressive Symptoms, Vision-Related Quality of Life, and Herpes Zoster Pain at Baseline (N=13) ConclusionThis study represents the first large scale effort to quantify HZO burden. Findings will inform development of a formal patient-reported symptom scale for use in research and clinical practice.FundingGlaxoSmithKline Biologicals SA (GSK study identifiers: 209235/HO-17-17967)DisclosuresLaura T. Pizzi, PharmD, MPH, ORCID: 0000-0002-7366-7661, GlaxoSmithKline (Research Grant or Support) Soham Shukla, PharmD, ORCID: 0000-0002-4139-0856, GSK (Employee)Rutgers University (Employee) Brandon J. Patterson, PharmD, PhD, GSK (Employee, Shareholder) Debora A. Rausch, MD, ORCID: 0000-0001-9759-2687, GSK (Employee) Philip O. Buck, PhD, MPH, ORCID: 0000-0002-3898-3669, GSK (Employee, Shareholder) Ann P. Murchison, MD, MPH, GSK (Grant/Research Support)

Vitamin D3 Found Ineffective at Preventing Depression

Back to table of contents Previous article Next article Clinical & ResearchFull AccessVitamin D3 Found Ineffective at Preventing DepressionNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:15 Sep 2020https://doi.org/10.1176/appi.pn.2020.9a25AbstractThe trial involved over 18,000 middle-aged and older adults from across the country who took a high dose of vitamin D supplements or placebo daily for over five years.iStock/Helin Loik-TomsonHigh-dose vitamin D3 supplements do not appear to be effective at preventing depression in older adults, according to a large, placebo-controlled study published August 4 in JAMA.Observational studies have suggested that people with lower blood levels of vitamin D are at higher risk of late-life depression, while other research has found that vitamin D deficiency may be involved in seasonal depressive disorder. But to date prospective studies of people taking vitamin D supplements have yielded little evidence that adding vitamin D protects against depression.It is possible that previous supplement studies examined vitamin D doses that were too low and/or the studies were too short in duration. This new study addressed previous shortcomings by evaluating over 18,000 older adults across the United States for over five years.The adults were participants in the Vitamin D and Omega-3 Trial (VITAL), a randomized study examining the effects of daily vitamin D3 and/or fish oil supplements on the prevention of cancer and cardiovascular disease. As an ancillary part of the study (VITAL-DEP), participants were also given the eight-item Patient Health Questionnaire (PHQ-8) during their periodic assessments to screen for depressive symptoms. Participants who were currently receiving treatment for depression or had another psychiatric or neurological condition were excluded from this ancillary analysis.The final sample included 9,181 adults who took 2,000 IU/d of vitamin D3 daily for an average of 5.3 years and 9,172 adults who took placebo for the same average time. By the end of the study, 609 adults taking vitamin D3 and 625 taking placebo received a diagnosis of depression or developed clinically relevant depressive symptoms (a PHQ-8 score of ≥10)—which the authors noted was not a significant difference between the groups.There was also no significant difference between the two groups in overall mood over time; average PHQ-8 scores rose by 0.20 points in the vitamin D3 group and 0.16 points in the placebo group.“By no means is this study a verdict on vitamin D as a supplement in general,” said study author Olivia Okereke, M.D., the director of geriatric psychiatry at Massachusetts General Hospital and an associate professor of psychiatry and epidemiology at Harvard Medical School. “This vitamin is important for bone health and immune health and potentially other conditions.”She continued, “The findings indicate that for an average adult, taking vitamin D3 supplements for the purpose of improving mood will provide no benefit.”Okereke and colleagues also looked at data on various subgroups in the study to see whether there might be a population that experienced a positive effect from vitamin D3. However, vitamin D3 did not appear to prevent depression in any of the tested subgroups, including grouping by sex, ethnicity, age group, and depression history.“Now, there was one interesting signal that showed adults with normal body weight [body mass index score of 25 or less] might be gaining some protection from depression,” Okereke noted. This signal mirrored some data seen in the main VITAL study, which was published last year in the New England Journal of Medicine. This study found that while vitamin D3 supplements did not prevent cancer or major cardiovascular events in the general population, the supplements did appear to reduce the risk of cancer in adults with low body mass index.Okereke cautioned that the findings on obesity are still preliminary, but if there was one variable worth pursuing with further research, that would be it.The VITAL-DEP researchers are reviewing data related to fish oil and depression and hope to release those findings soon.VITAL-DEP was supported by a grant from the National Institute of Mental Health. The main VITAL study was supported by grants from the National Cancer Institute; the National Heart, Lung, and Blood Institute; the National Institute of Neurological Disorders and Stroke; the National Center for Complementary and Integrative Health; and the Office of Dietary Supplements. Pharmavite LLC and Pronova BioPharma/ BASF donated the vitamin D3 and fish oil for the study, respectively. ■“Effect of Long-term Vitamin D3 Supplementation vs Placebo on Risk of Depression or Clinically Relevant Depressive Symptoms and on Change in Mood Scores: A Randomized Clinical Trial” is posted here.The parent VITAL study, “Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease” is posted here. ISSUES NewArchived

Psychometric Analysis and Factor Structure of the Spanish Version of the Eight-Item Patient Health Questionnaire in a General Sample of Puerto Rican Adults

Depressive disorders may cause significant impairment in social, occupational, and academic areas of functioning. This research aims to analyze the psychometric properties and factor structure of the Spanish version of the eight-item Patient Health Questionnaire (PHQ-8) in a sample of 494 Puerto Rican adults. We analyzed the Cronbach alpha internal consistency, construct validity, discriminant validity, and factor structure of the instrument. The findings of the study revealed that the PHQ-8 obtained an excellent internal consistency of .92. Pearson’s r correlation analysis showed a high and statistically significant association between PHQ-8 and the Generalized Anxiety Disorder (GAD-7) providing evidence of concurrent validity. We conducted confirmatory factor analyses to examine the factor structure of the PHQ-8. The two models (unidimensional and multidimensional) showed an adequate adjustment to the data, but the unidimensional model was recommended. The PHQ-8 is a plausible adaptation of the PHQ-9 that may be used in any study directed to explore depressive symptoms without considering suicidal thoughts.

Resilience: a nationwide study of medical educators.

This article was migrated. The article was marked as recommended. Background: Medical educators have the potential to play an important role in addressing resilience issues across the medical education continuum. Yet, limited research has explored this cohort, particularly in the UK context. This study aims to address this gap by exploring resilience and the factors that relate to resilience in UK medical educators. Methods: A cross-sectional online questionnaire was employed. It contained the validated Connor-Davidson Resilience Scale 25 (CD-RISC-25) and the eight-item Patient Health Questionnaire Depression Scale (PHQ-8), for determining medical educator resilience and depression levels respectively. Sociodemographic characteristics were also collected to identify potential factors associated with resilience. Finally, participants identified factors that facilitated or undermined their resilience through open-ended questions. Data were analysed using quantitative (e.g. multiple regression analysis), and qualitative (i.e. thematic framework analysis) approaches. Results: Among 244 UK participants, the mean CD-RISC-25 score was 72.9 and standard deviation 10.3. The PHQ-8 score was the only significant negative predictor identified (B = -1.22, p < 0.001). Other sociodemographic variables examined were not found to be predictors of CD-RISC-25 scores. Educators identified multidimensional factors influencing their resilience, but predominately viewed internal factors as being supportive, and external factors as undermining. Conclusions: Medical educators in this study had resilience levels that were comparable to other population samples. The study also highlights the importance of considering external factors, such as contextual and sociocultural influences, in addition to individual factors when addressing resilience.

Evidence for underuse and overuse of antidepressants in older adults: Results of a large population‐based study

Depression is common among elderly people. However, diagnosis and adequate treatment is frequently difficult. Research on underuse and overuse of antidepressants in elderly persons is scarce. This study investigates the utilization and appropriateness of pharmacological and psychological depression treatment in a large cohort of community-dwelling adults. A subsample of 3117 participants (aged 55-85y) of the third follow-up (2008-2010) of the large population-based German ESTHER study was included. Depression was assessed using the eight-item Patient Health Questionnaire (PHQ-8). In the course of a home visit, study doctors collected complete information on medication. Logistic regression analyses were conducted to determine the relationship of depression with both underuse and overuse of antidepressants. The analyses were then adjusted for socioeconomic variables, psychosomatic comorbidities, and motivation to seek help. One hundred sixty-three participants (5.2%; 95% confidence interval [CI], 4.5-6.1) fulfilled the criteria for major depression. Underuse of antidepressants was present in 126 depressed participants (77.3%; 70.1-83.5). Persons who were motivated to seek help, who had an established depression diagnosis, or who were taking more than five different medications had lower odds of underuse. Anxiety was associated with higher odds for underuse. Overuse of antidepressants (prescription without clinical indication) was found in 96 cases (41.7%; 35.3-48.4) of all antidepressant prescriptions. Depression treatment in older adults is frequently insufficient; it appears to depend on diagnosis as well as the patients' motivation to seek help. Education regarding the diagnosis of depression in the elderly as well as guidelines for appropriate treatment is needed.

Evaluating the eight-item Patient Health Questionnaire's psychometric properties with Mexican and Central American descent university students.

Depression can be a serious aliment influencing the lives of millions of persons. Person's health conditions worsen and daily functioning declines in the presence of depression. However, little attention has been given to how depression is accurately assessed in diverse populations from other countries residing in the United States. Thus, this study examined the factor structure, factorial invariance, concurrent validity, and convergent validity of the widely used 8-item Patient Health Questionnaire (PHQ-8) among emerging adults of Mexican and Central American (e.g., Salvadorians, Guatemalans) men and women residing in the United States. Undergraduate student participants (n = 2,782) completed an online or paper-and-pencil version of the assessment. Support was found for two-factor and one-factor solutions; however, the unidimensional structure was recommended due to the very high correlation between the two factors (r ≥ .87). The unidimensional scale was invariant between (a) Mexican and Central American descent and (b) men and women. Depressive symptoms (as measured in the PHQ-8) were significantly correlated with another valid and reliable measured of depression, and scores on the PHQ-8 were significantly correlated with theoretically related variables (i.e., quality of life, parental support, and perceived stress). (PsycINFO Database Record

Associations of Smoking, Physical Inactivity, Heavy Drinking, and Obesity with Quality-Adjusted Life Expectancy among US Adults with Depression

ObjectivesTo examine associations between four health behaviors (smoking, physical inactivity, heavy alcohol drinking, and obesity) and three health indices (health-related quality of life, life expectancy, and quality-adjusted life expectancy (QALE)) among US adults with depression. MethodsData were obtained from the 2006, 2008, and 2010 Behavioral Risk Factor Surveillance System data. The EuroQol five-dimensional questionnaire (EQ-5D) health preference scores were estimated on the basis of extrapolations from the Centers for Disease Control and Prevention’s healthy days measures. Depression scores were estimated using the eight-item Patient Health Questionnaire. Life expectancy estimates were obtained from US life tables, and QALE was estimated from a weighted combination of the EQ-5D scores and the life expectancy estimates. Outcomes were summarized by depression status for the four health behaviors (smoking, physical inactivity, heavy alcohol drinking, and obesity). ResultsFor depressed adults, current smokers and the physically inactive had significantly lower EQ-5D scores (0.040 and 0.171, respectively), shorter life expectancy (12.9 and 10.8 years, respectively), and substantially less QALE (8.6 and 10.9 years, respectively). For nondepressed adults, estimated effects were similar but smaller. Heavy alcohol drinking among depressed adults, paradoxically, was associated with higher EQ-5D scores but shorter life expectancy. Obesity was strongly associated with lower EQ-5D scores but only weakly associated with shorter life expectancy. ConclusionsAmong depressed adults, physical inactivity and smoking were strongly associated with lower EQ-5D scores, life expectancy, and QALE, whereas obesity and heavy drinking were only weakly associated with these indices. These results suggest that reducing physical inactivity and smoking would improve health more among depressed adults.

Social Inequalities and Depressive Symptoms in Adults: The Role of Objective and Subjective Socioeconomic Status.

BackgroundThere is substantial evidence that lower objective socioeconomic status (SES)—as measured by education, occupation, and income—is associated with a higher risk of depression. Less is known, however, about associations between perceptions of social status and the prevalence of depression. This study investigated associations of both objective SES and subjective social status (SSS) with depressive symptoms among adults in Germany.MethodsData were obtained from the 2013 special wave of the German Health Update study, a national health survey of the adult population in Germany. Objective SES was determined using a composite index based on education, occupation, and income. The three single dimensions of the index were also used individually. SSS was measured using the MacArthur Scale, which asks respondents to place themselves on a 10-rung ‘social ladder’. Regression models were employed to examine associations of objective SES and SSS with current depressive symptoms, as assessed with the eight-item Patient Health Questionnaire depression scale (PHQ-8 sum score ≥10).ResultsAfter mutual adjustment, lower objective SES and lower SSS were independently associated with current depressive symptoms. The associations were found in both sexes and persisted after further adjustment for sociodemographic factors, long-term chronic conditions, and functional limitations. Mediation analyses revealed a significant indirect relationship between objective SES and depressive symptoms through SSS. When the three individual dimensions of objective SES were mutually adjusted, occupation and income were independently associated with depressive symptoms. After additional adjustment for SSS, these associations attenuated but remained significant.ConclusionsThe findings suggest that perceptions of low social status in adults may be involved in the pathogenesis of depression and play a mediating role in the relationship between objective SES and depressive symptoms. Prospective studies are needed to establish the direction of effects and to address questions of causality.

Social and emotional support as a protective factor against current depression among individuals with adverse childhood experiences.

Depression is one of the most prevalent mental health disorders among adults with adverse childhood experiences (ACE). Several studies have well documented the protective role of social support against depression in other populations. However, the impact of perceived social and emotional support (PSES) on current depression in a large community sample of adults with ACE has not been studied yet. This study tests the hypothesis that PSES is a protective factor against current depression among adults with ACE.Data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) involving adults with at least one ACE were used for the purpose of this study (n = 12.487). PSES had three categories: Always, Usually/Sometimes, and Rarely/Never. Current depression, defined based on the responses to the eight-item Patient Health Questionnaire (PHQ-8) depression scale, was treated as a binary outcome of interest: Present or absent. Logistic regression models were used for the analysis adjusting for all potential confounders.When compared to individuals who reported that they rarely/never received social and emotional support, individuals who reported that they always received were 87% less likely to report current depression (AOR: 0.13 [95% CI: 0.08–0.21]); and those who reported that they usually/sometimes received social and emotional support were 69% less likely to report current depression (AOR: 0.31 [95% CI: 0.20–0.46]).The results of this study highlight the importance of social and emotional support as a protective factor against depression in individuals with ACE. Health care providers should routinely screen for ACE to be able to facilitate the necessary social and emotional support.

Associations of self-reported and objectively measured sleep disturbances with depression among primary caregivers of children with disabilities.

ObjectiveThe objective of this study was to determine the association between sleep and depression using both self-reported (subjective) and actigraphic (objective) sleep traits.MethodsA cross-sectional study was conducted among 175 female primary caregivers of children with disabilities receiving care at a rehabilitation center in Punta Arenas, Chile. The eight-item Patient Health Questionnaire was used to ascertain participants’ depression status. The Pittsburgh Sleep Quality Index was used to define subjective, or perceived, sleep quality. Wrist-worn actigraph monitors, worn for seven consecutive nights, were used to characterize objective sleep quality and disturbances. Interviewer-administered questionnaires were used to collect information on sociodemographic and lifestyle factors. Linear regression models were fit using continuous sleep parameters as the dependent variables and depression status as the independent variable. Multivariable models were adjusted for body mass index, marital status, smoking status, education level, and children’s disabilities.ResultsUsing an eight-item Patient Health Questionnaire score ≥10, 26.3% of participants presented with depression. Depressed women were more likely to self-report overall poorer (subjective) sleep compared to non-depressed women; however, differences in sleep were not consistently noted using actigraphic (objective) sleep traits. Among the depressed, both sleep duration and total time in bed were significantly underestimated. In multivariable models, depression was negatively associated with sleep duration using both subjective (β=−0.71, standard error [SE] =0.25; P=0.006) and objective sleep (β=−0.42, SE =0.19; P=0.026).ConclusionThe association between sleep and depression differed comparing subjective and objective methods of assessment. Research strategies allowing for the integration of both perceived and objective measures of sleep traits are encouraged.

Prevalence of depression in Type 1 diabetes and the problem of over-diagnosis.

To determine the prevalence of depression and diabetes distress in adults with Type 1 diabetes and the rate of false-positives when compared with rates of major depressive disorder. The sample consisted of 368 individuals with Type 1 diabetes, aged > 19 years. Individuals completed: the eight-item Patient Health Questionnaire depression scale (PHQ8), which was coded using four scoring criteria (scores > 10, >12 and >15, and Diagnostic and Statistical Manual of Mental Disorders 5 (DSM) algorithm scores); the Type 1 Diabetes Distress Scale; and the Structured Clinical Interview for DSM Disorders (SCID) to assess major depressive disorder. The prevalence rates of depression according to the eight-item Patient Health Questionnaire were: score >10, 11.4%; score >12, 7.1%; score >15, 3.8%; and positive algorithm result, 4.6%. The prevalence of major depressive disorder was 3.5%; and the prevalence of at least moderate diabetes distress was 42.1%. Depending on the criterion used, the false-positive rate when using the Patient Health Questionnaire compared with the results when using the SCID varied from 52 to 71%. Of those classified as depressed on the PHQ-8 or Structured Clinical Interview for DSM Disorders, between 92.3 and 96.2% also reported elevated diabetes distress. No significant association was found between any group classed as having depression according to the PHQ8 or the SCID and HbA1c concentration. Depression was significantly associated with more other life stress, more complications and a lower level of education. We found an unexpectedly low rate of current depression and major depressive disorder in this diverse sample of adults with Type 1 diabetes, and a very high rate of false-positive results using the Patient Health Questionnaire. Considering the high prevalence of diabetes distress, much of what has been considered depression in adults with Type 1 diabetes may be attributed to the emotional distress associated with managing a demanding chronic disease and other life stressors and not necessarily to underlying psychopathology.

Impact of depression on quality-adjusted life expectancy (QALE) directly as well as indirectly through suicide.

To estimate quality-adjusted life expectancy (QALE) loss among US adults due to depression and QALE losses associated with the increased risk of suicide attributable to depression. We ascertained depressive symptoms using the eight-item Patient Health Questionnaire (PHQ-8) on the 2006, 2008, and 2010 Behavioral Risk Factor Surveillance System (BRFSS) surveys. We estimated health-related quality of life (HRQOL) scores from BRFSS data (n = 276,442) and constructed life tables from US Compressed Mortality Files to calculate QALE by depression status. QALE loss due to depression is the difference in QALE between depressed and non-depressed adults. QALE loss associated with suicide deaths is the difference between QALE from only those deaths that did not have suicide recorded on the death certificate and QALE from all deaths including those with a suicide recorded on the death certificate. At age 18, QALE was 28.0 more years for depressed adults and 56.8 more years for non-depressed adults, a 28.9-year QALE loss due to depression. For depressed adults, only 0.41 years of QALE loss resulted from deaths by suicide, and only 0.26 years of this loss could be attributed to depression. Depression symptoms lead to a significant burden of disease from both mortality and morbidity as assessed by QALE loss. The 28.9-year QALE loss at age 18 associated with depression markedly exceeds estimates reported elsewhere for stroke (12.4-year loss), heart disease (10.3-year loss), diabetes mellitus (11.1-year loss), hypertension (6.3-year loss), asthma (7.0-year loss), smoking (11.0-year loss), and physical inactivity (8.0-year loss).

Comorbid depression and substance abuse among safety-net clients in Los Angeles: a community participatory study.

Depression and substance abuse are common among low-income adults from racial-ethnic minority groups who receive services in safety-net settings, although little is known about how clients differ by service setting. This study examined characteristics and service use among depressed, low-income persons from minority groups in underresourced communities who did and did not have a substance abuse history. The study used cross-sectional baseline client data (N=957) from Community Partners in Care, an initiative to improve depression services in Los Angeles County. Clients with probable depression (eight-item Patient Health Questionnaire) from substance abuse programs were compared with depressed clients with and without a history of substance abuse from primary care, mental health, and social and community programs. Sociodemographic, health status, and services utilization variables were examined. Of the 957 depressed clients, 217 (23%) were from substance abuse programs; 269 (28%) clients from other sectors had a substance abuse history, and 471 (49%) did not. Most clients from substance abuse programs or with a substance abuse history were unemployed and impoverished, lacked health insurance, and had high rates of arrests and homelessness. They were also more likely than clients without a substance abuse history to have depression or anxiety disorders, psychosis, and mania and to use emergency rooms. Clients with depression and a substance abuse history had significant psychosocial stressors and high rates of service use, which suggests that communitywide approaches may be needed to address both depression and substance abuse in this safety-net population.

Excess Burden of Depression among HIV-Infected Persons Receiving Medical Care in the United States: Data from the Medical Monitoring Project and the Behavioral Risk Factor Surveillance System

BackgroundWith increased life expectancy for HIV-infected persons, there is concern regarding comorbid depression because of its common occurrence and association with behaviors that may facilitate HIV transmission. Our objectives were to estimate the prevalence of current depression among HIV-infected persons receiving care and assess the burden of major depression, relative to that in the general population.Methods and FindingsWe used data from the Medical Monitoring Project (MMP) and the Behavioral Risk Factors Surveillance System (BRFSS). The eight-item Patient Health Questionnaire was used to identify depression. To assess the burden of major depression among HIV-infected persons receiving care, we compared the prevalence of current major depression between the MMP and BRFSS populations using stratified analyses that simultaneously controlled for gender and, in turn, each of the potentially confounding demographic factors of age, race/ethnicity, education, and income. Each unadjusted comparison was summarized as a prevalence ratio (PR), and each of the adjusted comparisons was summarized as a standardized prevalence ratio (SPR). Among HIV-infected persons receiving care, the prevalence of a current episode of major depression and other depression, respectively, was 12.4% (95% CI: 11.2, 13.7) and 13.2% (95% CI: 12.0%, 14.4%). Overall, the PR comparing the prevalence of current major depression between HIV-infected persons receiving care and the general population was 3.1. When controlling for gender and each of the factors age, race/ethnicity, and education, the SPR (3.3, 3.0, and 2.9, respectively) was similar to the PR. However, when controlling for gender and annual household income, the SPR decreased to 1.5.ConclusionsDepression remains a common comorbidity among HIV-infected persons. The overall excess burden among HIV-infected persons receiving care is about three-times that among the general population and is associated with differences in annual household income between the two populations. Relevant efforts are needed to reduce this burden.

Community-partnered evaluation of depression services for clients of community-based agencies in under-resourced communities in Los Angeles.

As medical homes are developing under health reform, little is known regarding depression services need and use by diverse safety-net populations in under-resourced communities. For chronic conditions like depression, primary care services may face new opportunities to partner with diverse community service providers, such as those in social service and substance abuse centers, to support a collaborative care model of treating depression. To understand the distribution of need and current burden of services for depression in under-resourced, diverse communities in Los Angeles. Baseline phase of a participatory trial to improve depression services with data from client screening and follow-up surveys. Of 4,440 clients screened from 93 programs (primary care, mental health, substance abuse, homeless, social and other community services) in 50 agencies, 1,322 were depressed according to an eight-item Patient Health Questionnaire (PHQ-8) and gave contact information; 1,246 enrolled and 981 completed surveys. Ninety-three programs, including 17 primary care/public health, 18 mental health, 20 substance abuse, ten homeless services, and 28 social/other community services, participated. Comparisons by setting in 6-month retrospective recall of depression services use. Depression prevalence ranged from 51.9 % in mental health to 17.2 % in social-community programs. Depressed clients used two settings on average to receive depression services; 82 % used any setting. More clients preferred counseling over medication for depression treatment. Need for depression care was high, and a broad range of agencies provide depression care. Although most participants had contact with primary care, most depression services occurred outside of primary care settings, emphasizing the need to coordinate and support the quality of community-based services across diverse community settings.

Elevated alanine aminotransferase independently predicts new onset of depression in employees undergoing health screening examinations

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of elevated alanine aminotransferase (ALT). NAFLD is associated with insulin resistance and hepatic inflammation. Similarly, patients with depression exhibit insulin resistance and increased inflammatory markers. However, no study has shown a clear association between elevated ALT and the development of depression. The aim of the study was to test whether elevated ALT, a surrogate marker for NAFLD, predicts the development of depression. The present prospective cohort study investigated 12 180 employed adults referred for health examinations that included fasting blood tests and anthropometric measurements between 2003 and 2010. Exclusion criteria were: baseline minor/major depression, excessive alcohol consumption and other causes for ALT elevation. Depression was evaluated by the eight-item Patient Health Questionnaire (PHQ-8) score. The final cohort included 5984 subjects [69.4% men, aged 45.0 (s.d. = 10.24) years]. The incidence rate of minor and major depression was 3.8% and 1.4%, respectively. Elevated ALT was a significant independent predictor for the occurrence of minor [odds ratio (OR) 2.02, 95% confidence interval (CI) 1.40-2.92] and major (OR 3.132, 95% CI 1.81-5.40) depression after adjusting for age, gender, body mass index, education level, serum levels of lipids, glucose, smoking and physical activity. Adding subjective health and affective state parameters (sleep disturbances, self-rated health, anxiety and burnout) as potential mediators only slightly ameliorated the association. Persistently elevated ALT was associated with the greatest risk for minor or major depression as compared with elevation only at baseline or follow-up (p for trend < 0.001). Elevated ALT was associated with developing depressive symptoms, thus suggesting that NAFLD may represent an independent modifiable risk factor for depression.

Current depression among women in California according to residence in the California-Mexico border region

To estimate the prevalence of current depression; examine the relationship between current depression and immigration, health status, health care access, and health behaviors; and assess differences by California-Mexico border region (Imperial and San Diego Counties) among women in California. Using a cross-sectional, representative sample of adult women from the California Women's Health Survey (n = 13 454), a statewide telephone survey, prevalence of current depression and predictors of depression were examined in California and according to border region residence. Depression was assessed with the eight-item Patient Health Questionnaire. The prevalence of current depression for women in California was 12.0%. It was similar in the border (13.0%) and the nonborder (11.9%) regions. Odds of current depression in women were lower among recent immigrants (< 5 years or 5 to < 10 years in the United States) than in women born in the United States and in immigrants who had been living in the United States for 10 to < 15 years or longer (P < 0.05). Odds ratios for current depression and health status, health care access, and binge drinking were larger in the border region than outside the border region. Similar prevalences of current depression were observed among those who live in the border region of California and in those who do not, but the relationship between depression and health status, health care access, and binge drinking varied by border region residence. Ideally, future surveillance of depression and its predictors along the Mexico-California border will be conducted binationally to inform interventions and tracking such as the Healthy Border Program's objectives.

Intimate Partner Violence and Depression in a Population-Based Sample of Women: Can Social Support Help?

Data from the 2006 Behavioral Risk Factor Surveillance System in Nevada was analyzed to determine whether social support is independently associated with depression in a population-based sample of women with a history of intimate partner violence (IPV). More than a quarter (27%) of the women who were randomly chosen to participate in the survey reported lifetime IPV (n = 472). Twenty-four percent of abused women were categorized as currently depressed according to the eight-item Patient Health Questionnaire (PHQ). Abused women who reported low social support, adjusted odds ratio (AOR) = 4.95, 95% CI (1.69-14.49), or moderate social support, AOR = 2.71, 95% CI (1.00-7.33), were more likely to be depressed than women who reported high levels of social support. Other independent risk factors for depression included younger age, AOR = 5.36, 95% CI (1.36-25.39); low education (less than high school), AOR = 12.55, 95% CI (2.78-56.72); fair or poor perceived health status, AOR = 3.72, 95% CI (1.39-9.87); being overweight or obese, AOR = 3.21, 95% CI (1.26-8.19); having experienced sexual IPV, AOR = 4.95, 95% CI (1.08-22.74); and having experienced both physical and sexual IPV, AOR = 4.54, 95% CI (2.07-9.99). There is an urgent need for routine screening for IPV and depression in clinic and community settings. Interventions that target younger women who experience IPV and aim to decrease depression in this vulnerable population are likely to be most effective if they promote social support, increase education opportunities, and support healthy weight loss behaviors.