Primary Care Evaluation Research Articles

Anxiety, depression, and suicidal ideations among patients with dermatological problems

BACKGROUND: High comorbidity is seen in psychiatric illness and dermatological problems ranging between 21% and 43%, which could be due to cosmetic impact/body image perception/disfigurement due to disease per se; majority of the cases go undetected due to overshadowing of mental illness by physical ailment, stigma, or improper assessment. The present research attempted to evaluate the comorbidity of anxiety, depression, and suicidal ideations among dermatological conditions METHODS: A population-based cross-sectional study with consecutive sampling was conducted in the outpatient department of a dermatology clinic. The Primary Care Evaluation of Mental Disorders (Patient Health Questionnaire-9 and Generalized Anxiety Disorder- 7) was used to assess the presence of psychiatric symptoms in these patients. RESULTS: A total of 1076 patients were included in the study, with age ranging between 10 and 82 years. Females had significantly more depression, anxiety, and suicidal ideation among individuals suffering from dermatitis. Males had significantly more anxiety among individuals suffering from lichen simplex chronicus. Females had significantly more depression and suicidal ideation among individuals suffering from hair disorders. Overall, 22% of individuals had suicidal ideation, of which 4.2% had active suicidal ideations. CONCLUSION: Significant active suicidal ideations were observed among individual dermatological conditions. Female reported having more depressive symptoms with no gender difference in anxiety disorder.

Depression, Socioeconomic Factors, and Ethnicity as Predictors of Cardiorespiratory Fitness Before and After Cardiac Rehabilitation.

To determine whether cardiac patients with psychosocial or socioeconomic problems have lower peak oxygen uptake ((Equation is included in full-text article.)O2peak) and whether these factors modify the effect of cardiac rehabilitation (CR). A retrospective cohort study of patients with ischemic heart disease, valvular heart disease, or heart failure referred for CR. (Equation is included in full-text article.)O2peak was assessed by a maximal cardiopulmonary exercise test. Pre-existing depression was defined by use of antidepressants and new-onset depression by a modified Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire at CR intake. Socioeconomic status was defined by educational attainment and working status; ethnicity as Western European or non-Western European. Full data from baseline assessment were available on 1217 patients and follow-up on 861 patients. Mean ± SD (Equation is included in full-text article.)O2peak before CR was 21.8 ± 6.8 mL/kg/min. After multivariable adjustment, lower (Equation is included in full-text article.)O2peak was associated with lower educational attainment, not working, and non-Western ethnicity but not with depression. Mean improvement of (Equation is included in full-text article.)O2peak following CR was 2.4 ± 4.3 mL/kg/min. After multivariable adjustment educational attainment, employment status and ethnicity were significant predictors of improvement of (Equation is included in full-text article.)O2peak while depression was not. Education, attachment to the workforce, and ethnicity were all associated with lower (Equation is included in full-text article.)O2peak before CR, and the disparity was increased following CR. Having pre-existing depression and new-onset depression did not influence (Equation is included in full-text article.)O2peak either before or after CR. These results point to important subgroups in need of specially-tailored rehabilitation programs.

Using Item Response Theory to evaluate the psychometric characteristics of questions in a Brazilian programme and the performance of dental teams in primary care.

ObjectivesFirst, to assess the psychometric properties of key questions included in a public sector evaluation of primary dental care in Brazil; and second, to evaluate the performance of dental teams in relation to these items.MethodsSecondary analysis of a national primary care dataset monitoring quality and access to dental care. Data were collected through face-to-face interviews with representatives of dental teams participating in the ‘National Programme for Improving Access and Quality of Primary Care’. Twenty-three mandatory questions about the dentists’ reported delivery of dental procedures were included in the analysis. Item Response Theory (IRT) modelling was applied to measure the psychometric properties of the instrument—level of difficulty and discrimination parameter of each item—and then to estimate dental team performance scores based on these parameters. Based on IRT, possible scores ranged from -4 to +4.ResultsThree of the 23 mandatory items were removed due to poor internal consistency, resulting in a scale of 20 items for assessing dental team performance. The results showed variation in procedures delivered by the dental teams; whilst more than a half of the procedures were executed by at least 80% of the dental teams, those relating to dentures (partial/total) and frenectomy (lingual/labial) were performed by less than 30%. Amongst the 20 items included in the model, those related to partial/total dentures and oral cancer follow-up presented higher levels of difficulty and were less frequently provided. The items relating to the treatment of deciduous teeth and access to the dental pulp of permanent teeth had the highest discrimination parameters and, consequently, greater weight in the performance’s score estimation; therefore, dental teams that did not perform these items had the lowest performance scores. In the present study, dental team performance scores ranged from -3.66 to +1.87 with a mean/median of -0.06/+0.01.ConclusionThe findings suggest that whilst the items within the instrument demonstrated some potential to discriminate between poor and very poor teams, they were ineffective in discriminating between poor and good teams. Whilst Brazilian dental teams perform many mandatory procedures, variation in the nature of their delivery of care requires further investigation to enhance service provision to the population.

Proposal for a methodology to estimate the potential coverage of primary care teamsPropuesta de una metodología para estimar el área de cobertura potencial de los equipos de atención primaria

RESUMOObjetivo.Apresentar metodologia para avaliação empírica da atenção primária à saúde (APS) por meio da construção de representações digitais das áreas de cobertura potencial das equipes da APS.Métodos.Estudo de natureza metodológica. As áreas potenciais foram construídas por análise combinatória entre setores censitários e localização das unidades básicas de saúde (UBS) que apresentavam equipes de APS no Brasil. Foram utilizadas seis regras para parametrizar o algoritmo de construção das áreas potenciais. Assim, foram estipuladas seis restrições que viabilizaram o modelo utilizado: seleção de setores censitários próximos à UBS; setores contíguos; setores mutuamente excludentes; setores localizados no mesmo município da UBS; somatório de 4 500 usuários por equipe de saúde em cada UBS; e volume de população adscrita proporcional ao número de equipes de APS alocadas na UBS. A partir de 316 574 setores censitários e 39 758 UBS, foi desenvolvida uma matriz de vizinhança sobre a qual iterou um algoritmo de grafo que testava combinações de setores que atendessem simultaneamente as regras estipuladas.Resultados.Foram definidos 1 901 114 arcos ligando 30 351 setores censitários, permitindo a construção de 26 907 áreas potenciais. A partir desse resultado é possível fazer análises inframunicipais no que tange ao monitoramento de indicadores da APS. Os parâmetros customizáveis do algoritmo podem ser ajustados para contemplar diferentes conjuntos de regras e adaptados para diferentes países.Conclusões.O uso de abordagens amparadas em geoprocessamento pode criar condições para avaliação do impacto da APS, levando-se em conta bases de dados secundárias e com nível de análise inframunicipal, de UBS e até mesmo de equipes.

Prenatal evaluation in primary care in Northeast Brazil: factors associated with its adequacy.

ABSTRACTOBJECTIVE To characterize prenatal care and verify possible factors associated with its adequacy.METHODS This is a cross-sectional study based on interviews with health care professionals and consultations on official documents of women attending prenatal of the primary health care in the city of João Pessoa, capital of Paraíba, in the Northeast region of Brazil. Prenatal care was evaluated by an index with criteria referring to aspects of structure, process and outcome, denominated IPR/Prenatal. The multivariate logistic regression method revealed that demographic, socioeconomic, reproductive and maternal morbidity variables were possible determinants for prenatal adequacy.RESULTS The survey involved 130 services and 1,625 primary health care patients. Prenatal care was adequate in approximately 23% of the cases. Low prevalence of referral to maternity, educational strategies and examinations were observed. The analysis showed that non-adolescent women (OR = 1,390), with a longer period of schooling (OR = 1.750), higher per capita income (OR = 1,870) and primiparous women (OR = 1,230) were more likely to have an adequate prenatal.CONCLUSIONS Prenatal care, when evaluated by broader criteria, showed a low percentage of adequacy. Strategies should be developed to ensure the referral to the maternity where the birth will take place and health education activities and examinations to provide adequate prenatal care in the municipality under study. In addition, factors associated with adequacy must be considered by managers and health professionals.

Personality and widowhood increase the risk for incident depression in the two years following the first acute coronary syndrome

Objectives: Incident depression, occurring after an acute coronary syndrome (ACS) in never depressed patients, exerts a negative effect on the cardiac prognosis. Nonetheless only a few studies have evaluated the risk factor for incident depression and, particularly, no study have investigated the role of personality disorders. Therefore, the aim of this study is to verify if personality disorders represent a risk for incident depression in patients at their first ACS.Method: The study sample was selected among never depressed patients who were consecutively admitted to the Coronary Intensive Care Unit, from January 2009 to March 2012, for the first ACS. The study sample included 262 patients. The presence of depressive disorder was assessed with the Primary Care Evaluation of Mental Disorders (DSM-IV criteria), whereas its severity was evaluated with the Hospital Anxiety and Depression Scale. Evaluations were collected at baseline and at 1, 2, 4, 6, 9, 12 and 24 months of follow-up. Moreover, at baseline personality disorders were investigated with the Structured Clinical Interview for DSM-IV Axis II disorders.Results: Out of 262 subjects, a depressive disorder was diagnosed in 56 patients (21%). At baseline risk factors for incident depression were being widowed, having a distress reaction and narcissistic personality traits.Conclusion: Clinicians should keep in mind these characteristics when facing patients at their first ACS, given the detrimental effect of depression on cardiac prognosis. A psychological support should prevent the onset of incident depression in these patients.

Notes from young physician candidates on the primary health care system

In this paper, we aim to share our experiences and observations made during the obligatory primary care internship at a Family Health Center and a Community Health Center. We noted our experiences in a systematic manner using the key characteristics of good primary care provision defined in World Health Organization Primary Care Evaluation Tool (access to the services, comprehensiveness, continuity and coordination of care). We also pointed out the importance of a medical education curriculum for Primary Health Care (PHC) focusing on the potential struggles of the new graduates. Eventually, we realized that PHC is an underestimated topic within medical education and stronger PHC in Turkey would greatly benefit the patients and the system. Demographic features of the district in which we have worked had both its unique advantages and disadvantages. We observed that most of the problems encountered during the provision of PHC in these centers were due to flawed coordination among primary and other level providers, suboptimal work environment and conditions including high number of patients per primary care physician, underestimation of certain preventive services such as family planning and a need for better health information systems. We believe that undergraduate training at PHC level should be emphasized and undertaken through an effective partnership between stakeholders.

General medical services by non-medical health professionals: a systematic quantitative review of economic evaluations in primary care.

Previous systematic reviews have found that nurses and pharmacists can provide equivalent, or higher, quality of care for some tasks performed by GPs in primary care. There is a lack of economic evidence for this substitution. To explore the costs and outcomes of role substitution between GPs and nurses, pharmacists, and allied health professionals in primary care. A systematic review of economic evaluations exploring role substitution of allied health professionals in primary care was conducted. Role substitution was defined as 'the substitution of work that was previously completed by a GP in the past and is now completed by a nurse or allied health professional'. The following databases were searched: Ovid MEDLINE, CINAHL, Cochrane Library, National Institute for Health and Care Excellence (NICE), and the Centre for Reviews and Dissemination. The review followed guidance from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Six economic evaluations were identified. There was some limited evidence that nurse-led care for common minor health problems was cost-effective compared with GP care, and that nurse-led interventions for chronic fatigue syndrome and pharmacy-led services for the medicines management of coronary heart disease and chronic pain were not. In South Korea, community health practitioners delivered primary care services for half the cost of physicians. The review did not identify studies for other allied health professionals such as physiotherapists and occupational therapists. There is limited economic evidence for role substitution in primary care; more economic evaluations are needed.

Temperament and Depression After a First Acute Coronary Syndrome.

Few studies assess the role of personality styles in predicting the onset of depression among cardiac patients. This study evaluates whether temperament and character can represent a risk factor for the development of incident first-ever depressive episodes in patients at their first acute coronary syndrome (ACS). Two hundred sixty-seven (72.1%) subjects (male) completed the Temperament and Character Inventory (TCI) a few days after the cardiac event. At baseline and after 1, 2, 4, 6, 9, 12, and 24 months of follow-up, the participants completed the Primary Care Evaluation of Mental Disorder (PRIME-MD) and the Hospital Anxiety and Depression Scale to establish the presence of a depressive episode and its severity. During the follow-up, 61 (22.8%) participants developed a depressive episode. Temperamental risk factors for incident depression were scored high on novelty seeking and harm avoidance at the TCI. Given the detrimental effect of depression on cardiac prognosis, clinicians should take temperament variables into account when determining the treatment plans of their patients with ACS.

General practitioners' satisfaction after a geriatric assessment into primary care: data from FAP study

This is anobservationaldescriptive study performed in Occitanie region. 26 GPs have involved in this project. The gathering of information was performed through an online survey. GPs estimated that most of the patients benefiting from a primary care geriatric evaluation would have declined hospital evaluation. 92% of thesurveyed GPsgave a strongly positive or positive opinion regarding the detection of previously unidentified health issues andthe improvementof patient care following this evaluation. 42% of the GPs found that the personalized plan of cares is difficult or very difficult to do. 73% of the GPs considered that they have a better knowledge of frailty syndrome and cognitive impairment after the evaluation. GPsfeedback was very positive and promising for the future. It could be interesting to develop this geriatric evaluation in primary care into new regions.

99: The difference in burnout between millennials and non-millennials among gynecologic surgeons

Burnout is a psychological syndrome that develops secondary to prolonged job-related stressors and is especially common in the medical field. Our study aims to determine the burnout rate among Minimally Invasive Gynecologic Surgeons (MIGS) as well as the personal and professional factors associated with this condition. We conducted a cross-sectional study via an anonymous electronic survey among active members of the American Association of Gynecologic Laparoscopists (AAGL). Burnout related survey analysis of a sample of 216 active 2017 AAGL members. We compared Maslach Burnout Inventory-Human Services Survey (MBI) survey, validated Medical Outcomes Study Short Form- 12 questions (SF-12) questionnaire, CAGE questionnaire, and Primary Care Evaluation of Mental Disorders Patient Health Questionnaire-2 (PRIME-MD PHQ-2) between participants. Among responders, 111 participants (51%) did not have burnout, and 105 (49%) participants did have burnout. Risk factors included female gender (p=0.001), work in the private setting (p=0.024), practice general OB/GYN (P=0.004), and have an incentive-based productivity salary (p=0.048). Physicians affected by burnout had higher emotional burnout total scores (p<0.001), depersonalization total scores (p<0.001), and smaller personal accomplishment scores (p<0.001). They had a significant increase in depression screening on the PRIME-MD PHQ-2 (p=0.032) and also had a lower mental component summary score on SF-12 scores (p=0.034). When comparing millennials to non-millennials we found no difference in burnout scores (p=0.989). On regression analysis comparing millennials to non-millennials, we saw a significant difference in SF-12 scores (P<0.001). Insufficient amount of literature describes burnout within the field of obstetrics and gynecology, and even fewer studies investigate this issue within OBGYN subspecialties. In this work, we uncover risk factors pertinent to the AAGL community and the effect of burnout on AAGL providers.

An Opportunity for Quality: The Need for Better Evaluation of Family Health Teams in Ontario.

In the past decade, primary care has undergone significant changes toward system improvement, which has improved patient outcomes and reduced costs. Family health teams (FHTs) were introduced in Ontario as part of primary care renewal. FHTs address a lack of capacity and integration among providers and service inaccessibility experienced by the population. We explore, the potential for positive impact of FHTs and the lack of built-in evaluation strategies to assess performance. We provide four suggestions to better support rigorous evaluation of FHTs. This commentary considers Ontario's efforts to improve capacity, quality and evaluation in primary care through FHTs.

Does primary-care use of the HURT questionnaire aid the reduction of headache burden? Lessons for study design from an evaluation in primary care of the Arabic version

Does primary-care use of the HURT questionnaire aid the reduction of headache burden? Lessons for study design from an evaluation in primary care of the Arabic version

Development and validation of the Vietnamese Primary Care Assessment Tool - provider version.

To adapt the provider version of the Primary Care Assessment Tool (PCAT) for Vietnam and determine its internal consistency and validity. There is a growing need to measure and explore the impact of various characteristics of health care systems on the quality of primary care. It would provide the best evidence for policy makers if these evaluations come from both the demand and supply sides of the health care sector. Comparatively more researchers have studied primary care quality from the consumer perspective than from the provider's perspective. This study aims at the latter. Our study translated and adapted the PCAT provider version (PCAT PE) into a Vietnamese version, after which a cross-sectional survey was conducted to examine the feasibility, internal consistency and validity of the Vietnamese PCAT provider version (VN PCAT PE). All general doctors working at 152 commune health centres in Thua Thien Hue province had been selected to participate in the survey. The VN PCAT PE is an instrument for evaluation of primary care in Vietnam with 116 items comprising six scales representing four core primary care domains, and three additional scales representing three derivative domains. From the translation and cultural adaptation stage, two items were combined, two items were removed and one item was added. Six other items were excluded due to problems in item-total correlations. All items have a low non-response or 'don't know/don't remember' response rate, and there were no floor or ceiling effects. All scales had a Cronbach's alpha above 0.80, except for the Coordination scale, which still was above the minimum level of 0.70. The VN PCAT PE demonstrates adequate internal consistency and validity to be used as an effective tool for measuring the quality of primary care in Vietnam from the provider perspective.

Frequency of psychiatric disorders in nonemergent admissions to emergency department.

Repeated admissions of patients with undiagnosed psychiatric problems in emergency departments (ED) is a major contributor to patient unsatisfaction and overcrowding in EDs. We evaluated the presence of psychiatric disorders in non-emergent admissions in the ED of a tertiary care hospital. This cross-sectional study was carried out in Eskisehir Osmangazi University Hospital between December 2015 and March 2016. The study group consists of 4320 non-emergent patients (31% of all admissions to non-emergent ED). Psychiatric assessments of patients were done using the Primary Care Evaluation of Mental Disorders (PRIME-MD) scale prior to their discharge from the ED. The Mann-Whitney U, Kruskal-Wallis and Chi-square tests, as well as multivariate logistic regression, were performed for statistical analysis. The mean age was 30 ± 11.7 years years ranging from 18 to 78 years. Among non-emergent cases, 44% had at least one psychiatric disorder. The most frequent psychiatric disorder was mood disorder (major and minor depression). Females with a comorbid disease and lower education level had increased risk for mood disorders, anxiety disorders, and somatoform disorders. Single males with a comorbid disease had increased risk for alcohol dependence. Undiagnosed patients with psychiatric disorders appear to be frequent users of medical emergency department services. These results might be helpful in developing more effective strategies to serve the mental health needs of the undiagnosed. People's awareness of psychiatric disorders should be increased.

Primary Care Research Priorities in Low-and Middle-Income Countries

To identify and prioritize the needs for new research evidence for primary health care (PHC) in low-and middle-income countries (LMICs) about organization, models of care, and financing of PHC. Three-round expert panel consultation of LMIC PHC practitioners and academics sampled from global networks, via web-based surveys. Iterative literature review conducted in parallel. Round 1 (pre-Delphi survey) elicited possible research questions to address knowledge gaps about organization and models of care and about financing. Round 2 invited panelists to rate the importance of each question, and in round 3 panelists provided priority ranking. One hundred forty-one practitioners and academics from 50 LMICs from all global regions participated and identified 744 knowledge gaps critical to improving PHC organization and 479 for financing. Four priority areas emerged: effective transition of primary and secondary services, horizontal integration within a multidisciplinary team and intersectoral referral, integration of private and public sectors, and ways to support successfully functioning PHC professionals. Financial evidence priorities were mechanisms to drive investment into PHC, redress inequities, increase service quality, and determine the minimum necessary budget for good PHC. This novel approach toward PHC needs in LMICs, informed by local academics and professionals, created an expansive and prioritized list of critical knowledge gaps in PHC organization and financing. It resulted in research questions, offering valuable guidance to global supporters of primary care evaluation and implementation. Its source and context specificity, informed by LMIC practitioners and academics, should increase the likelihood of local relevance and eventual success in implementing research findings.

Process evaluation of a National Primary Eye Care Programme in Rwanda

BackgroundVisual impairment is a global public health problem, with an estimated 285 million affected globally, of which 43% are due to refractive error. A lack of specialist eye care in low and middle-income countries indicates a new model of care would support a task-shifting model and address this urgent need. We describe the features and results of the process evaluation of a national primary eye care (PEC) programme in Rwanda.MethodsWe used the Medical Research Council process evaluation framework to examine the implementation of the PEC programme, and to determine enablers and challenges to implementation. The process evaluation uses a mixed methods approach, drawing on results from several sources including a survey of 574 attendees at 50 PEC clinics, structured clinical observations of 30 PEC nurses, in-depth interviews with 19 key stakeholders, documentary review and a participatory process evaluation workshop with key stakeholders to review collated evidence and contextualize the results.ResultsStructured clinical assessment indicated that the PEC provided is consistent with the PEC curriculum, with over 90% of the clinical examination processes conducted correctly. In 4 years, programme monitoring data showed that nearly a million PEC eye examinations had been conducted in every health centre in Rwanda, with 2707 nurses trained. The development of the eye health system was an important enabler in the implementation of PEC, where political support allowed key developments such as inclusion of eye-drops on the essential medicines list, the inclusion of PEC on insurance benefits, the integration of PEC indicators on the health management information systems and integration of the PEC curriculum into the general nursing school curriculum. Challenges included high turnover of primary care nurses, lack of clarity and communication on the future funding of the programme, competing priorities for the health sector and sustained supervision to assure quality of care.ConclusionsA model of a national primary eye care programme is presented, with service delivery to all areas in Rwanda. Key learning from this evaluation is the importance of strengthening the eye health care system, together with a strong focus on training primary care nurses using a PEC curriculum.

Anxiety, depression, and cardiac outcomes after a first diagnosis of acute coronary syndrome.

Depression is an established risk factor for acute coronary syndrome (ACS), with an impact on cardiac prognosis; nonetheless, the literature disagrees on the role played by anxiety. No study has evaluated this relationship in a cardiac population with no history of depression and after their first diagnosis of ACS. The aim of this study is to explore these associations without the confounding role of long-lasting heart disease or psychiatric illnesses. Two hundred sixty-six patients with no history of depression completed the Hospital Anxiety and Depression Scale and the Primary Care Evaluation of Mental Disorder at baseline and at 1, 2, 4, 6, 9, 12, and 24 months follow-up after their first diagnosis of ACS. During the follow-up period, we collected information regarding the major adverse cardiac events. Developing a first-ever depressive episode, in a proportional hazard model, was associated with almost 3 times the risk of a recurrent cardiac event (odds ratio = 2.590, 95% confidence interval [CI] [1.321, 5.078], p = .006). Furthermore, a moderation analysis revealed that increasing levels of baseline anxiety had opposing effects on cardiac outcomes, being protective only in those who did not develop incident depression (B = -0.0824, 95% CI [-0.164, -0.005], p = .048). No dose-response effect between depressive or anxious symptoms and cardiac outcomes emerged. Our results confirm the detrimental effect of depression on cardiac prognosis in a selected population and suggest that anxiety after the first diagnosis of ACS might have different roles depending on the illness' course. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Trend and Implication of Primary Care Evaluation in U.S.

Trend and Implication of Primary Care Evaluation in U.S.

Prediction of depression and anxiety via patient-assessed tremor severity, not physician-reported motor symptom severity, in patients with Parkinson's disease or essential tremor who have undergone deep brain stimulation.

OBJECTIVEDeep brain stimulation (DBS) is an effective therapy for movement disorders such as idiopathic Parkinson's disease (PD) and essential tremor (ET). However, some patients who demonstrate benefit on objective motor function tests do not experience postoperative improvement in depression or anxiety, 2 important components of quality of life (QOL). Thus, to examine other possible explanations for the lack of a post-DBS correlation between improved objective motor function and decreased depression or anxiety, the authors investigated whether patient perceptions of motor symptom severity might contribute to disease-associated depression and anxiety.METHODSThe authors performed a retrospective chart review of PD and ET patients who had undergone DBS at the Cleveland Clinic in the period from 2009 to 2013. Patient demographics, diagnosis (PD, ET), motor symptom severity, and QOL measures (Primary Care Evaluation of Mental Disorders 9-item Patient Health Questionnaire [PHQ-9] for depression, Generalized Anxiety Disorder 7-item Scale [GAD-7], and patient-assessed tremor scores) were collected at 4 time points: preoperatively, postoperatively, 1-year follow-up, and 2-year follow-up. Multivariable prediction models with solutions for fixed effects were constructed to assess the correlation of predictor variables with PHQ-9 and GAD-7 scores. Predictor variables included age, sex, visit time, diagnosis (PD vs ET), patient-assessed tremor, physician-reported tremor, Unified Parkinson's Disease Rating Scale part III (UPDRS-III) score, and patient-assessed tremor over time.RESULTSSeventy PD patients and 17 ET patients were included in this analysis. Mean postoperative and 1-year follow-up UPDRS-III and physician-reported tremor scores were significantly decreased compared with preoperative scores (p < 0.0001). Two-year follow-up physician-reported tremor was also significantly decreased from preoperative scores (p < 0.0001). Only a diagnosis of PD (p = 0.0047) and the patient-assessed tremor rating (p < 0.0001) were significantly predictive of depression. A greater time since surgery, in general, significantly decreased anxiety scores (p < 0.0001) except when a worsening of patient-assessed tremor was reported over the same time period (p < 0.0013).CONCLUSIONSPatient-assessed tremor severity alone was predictive of depression in PD and ET following DBS. This finding suggests that a patient's perception of illness plays a greater role in depression than objective physical disability regardless of the time since surgical intervention. In addition, while anxiety may be attenuated by DBS, patient-assessed return of tremor over time can increase anxiety, highlighting the importance of long-term follow-up for behavioral health features in chronic neurological disorders. Together, these data suggest that the patient experience of motor symptoms plays a role in depression and anxiety-a finding that warrants consideration when evaluating, treating, and following movement disorder patients who are candidates for DBS.