Higher Patient Health Questionnaire-9 Scores Research Articles

The Prevalence of Pretransplant Frailty and Mental Distress in Hematopoietic Cell Transplantation and Association with Clinical Outcomes

Frailty is a phenotype of decreased physiologic reserve associated with increased risk of toxicities and nonrelapse mortality (NRM) in hematopoietic cell transplant (HCT) recipients. The incidence, predictors, and adverse effects of pre-HCT frailty are not well known. We evaluated the association of pre-HCT frailty, defined using Fried's criteria, with age and baseline characteristics in patients ≥18 years undergoing autologous (auto) or allogeneic (allo) HCT for hematological malignancies. Assessments were performed as part of routine pre-HCT evaluations and then retrospectively analyzed. We additionally investigated the association of mental health distress indicators with frailty and the association between frailty and transplant outcomes including NRM and overall survival (OS) plus healthcare utilization. Patients undergoing HCT for hematological malignancies were analyzed (total n = 300; 162 auto, 138 allo). The overall prevalence of frailty was 18%, 21.7% among alloHCT, and 14.8% among autoHCT recipients, with similar distributions of frailty domains. Logistic regression analysis of the overall cohort revealed that older age was associated with an increased risk of frailty (odds ratio [OR] 1.37, 95% confidence interval [CI] [1.02-1.82]; P = 0.04). AlloHCT (OR 2.03, CI [1.07-3.84]; P = .03), and patient health questionnaire-9 (PHQ-9) (health depression) score ≥10 (OR 6.28, CI 1.93-20.43; P < .01) were each independently associated with pre-HCT frailty. In alloHCT patients, older age (OR 1.44, CI [1.00-2.06]; P = .05) was the only significant risk factor for pre-HCT frailty, while for autoHCT patients, only a higher PHQ-9 score was associated with frailty (OR 6.43, CI [1.34-30.82]; P = .02). For the whole cohort OS at 1 year was lower in frail recipients at 83% (95% CI, 70-91%) versus 92% (95% CI, 88-95%) in nonfrail (P = .04); with multivariate analysis showing higher risk of death in the frail group (hazard ratio [HR] 2.31, CI 0.97-5.46; P = .06). In the alloHCT cohort, multivariate analysis showed greater 1-year mortality in frail recipients (HR 2.55, CI [0.99-6.56]; P = .053). In the alloHCT recipients, we observed a 1-year NRM of 20% in frail patients versus 9% in nonfrail, and multivariate analysis showed a marginally higher risk of NRM in the frail group (HR 2.70, CI 0.90-8.10; P = .08). Frailty was not associated with higher risk of relapse in alloHCT or autoHCT recipients. Frail alloHCT patients experienced a longer initial hospital stay following HCT compared to nonfrail recipients (P < .01). We observed a high prevalence of pre-HCT frailty across all age groups, and identify older age is a risk factor for frailty, particularly in alloHCT recipients. Frailty is associated with a greater risk of NRM and lower survival which needs investigation in a larger cohort. Frailty associates with greater HCT complexity suggesting a need for early assessments and targeted interventions for this vulnerable population. Our findings suggest the utility of frailty and mental distress screening along with multidisciplinary interventions in pre-HCT to limit the morbidity of HCT.

The relationship between gambling behaviour and gambling-related harm: A data fusion approach using open banking data.

UK-based gambling policymakers have proposed affordability checks starting at monthly losses of £125. The present study combines open banking data with self-reports of the Problem Gambling Severity Index (PGSI) and other relevant information to explore the harm profiles of people who gamble at different levels of electronic gambling behaviour. This was a data fusion study in which participants consented to share their bank data via an open banking application programming interface (API) and who also completed relevant self-report items. Hierarchical hurdle models were used to predict being an at-risk gambler (PGSI > 0) and being a 'higher-risk' gambler (higher PGSI scores among those with non-zero scores) using four specifications of electronic gambling behaviour (net-spend, outgoing expenditure, incoming withdrawals, interaction model combining expenditure and withdrawals), and by adding self-reported data across two additional steps. The study took place in the United Kingdom. Participants were past-year people who gamble (n = 424), recruited via Prolific. Self-report measures were used of gambling-related harm (PGSI), depression [Patient Health Questionnaire 9 (PHQ-9)], age and gender; bank-recorded measures of income and electronic gambling behaviour. Unharmed gamblers had an average monthly gambling net-spend of £16.41, compared with £208.91 among highest-risk gamblers (PGSI ≥ 5). Being an at-risk gambler (PGSI > 0) was predicted significantly by all four types of gambling behaviour throughout all three steps [1.08 ≤ odds ratios (ORs) ≤ 2.92; Ps < 0.001), with only outgoing expenditure being significant in the interaction model (2.26 ≤ ORs ≤ 2.81; Ps < 0.001). Higher PHQ-9 scores also predicted at-risk gambling in steps 2-3 (1.09 ≤ ORs ≤ 1.10; Ps < 0.001), as did lower age (0.95 ≤ ORs ≤ 0.96; Ps < 0.001) and male gender identity in step 3 (2.51 ≤ ORs ≤ 2.95; Ps < 0.001). Being a higher-risk gambler was predicted significantly by gambling behaviour only in the expenditure-only (1.16 ≤ ORs ≤ 1.17; Ps ≤ 0.048) and withdrawal-only (1.08 ≤ ORs ≤ 1.09; Ps ≤ 0.004) models, and was not predicted by income (0.98 ≤ ORs ≤ 1.14; Ps ≥ 0.601), age (0.98 ≤ ORs ≤ 0.99; Ps ≥ 0.143) or male gender identity (1.07 ≤ ORs ≤ 1.15; Ps ≥ 0.472). The UK government's proposed affordability checks for gamblers should rarely affect people who are not experiencing gambling-related harm. At-risk gambling is predicted well by different types of gambling behaviour. Novel insights about gambling can be generated by fusing self-reported and objective data.

Fibromigraine: A cohort study retrospective

ObjectivesTo diagnose fibromyalgia in patients with migraine and assess the quality of life of these patients. Patients and MethodsA prospective, cross-sectional study was carried out, comparing groups, in a non-randomized sample, consisting of patients diagnosed with migraine. The sample was evaluated using the Widespread Pain Index (WPI) and Symptom Severity Scale (SSS) questionnaires to diagnose fibromyalgia. Quality of life and level of depression were assessed, respectively, using the Headache Impact Test-6 (HIT-6) and Patient Health Questionnaire-9 (PHQ-9). ResultsWe interviewed 100 patients (5 men and 95 women) diagnosed with migraine, with a mean age of 37.1±11.0 years, ranging from 19 to 64 years. Thirty-four patients (34%) had migraine and fibromyalgia concomitantly. Migraine predominated in females, both in the presence and absence of fibromyalgia. In both groups, there was no difference in headache characteristics. In the group with fibromyalgia, there was a predominance of allodynia and a higher PHQ-9 score (p&lt;0.001). ConclusionsPatients with migraine are more predisposed to depression when there is an association with fibromyalgia.

The association between postpartum depressive symptoms and contraception

BackgroundPostpartum depression affects 10-20% of birthing people and is associated with changes in healthcare utilization. Little is known about the association between postpartum depressive symptoms and choice to use contraception, however both un- or under-treated depression and short interpregnancy intervals pose significant perinatal health risks. ObjectiveTo evaluate whether postpartum depressive symptoms are associated with changes in decisions to use any method of contraception. Study DesignThis retrospective cohort study included birthing people who delivered between 2017-2022 and were referred to a collaborative care program for mental health care. Through this program, birthing people with mental health conditions have access to specialized perinatal mental health care and prospective symptoms monitoring via a patient registry. Postpartum depressive symptoms are assessed via the Patient Health Questionnaire-9 (PHQ-9) and scores were stratified by severity according to clinical cutoffs. Contraceptive method choice was determined by documentation in the electronic health record and dichotomized as “none” if the participant declined all forms of contraception both at delivery and at the postpartum visit. Bivariable and multivariable analyses were performed. ResultsOf the 1871 participants that met inclusion criteria, 160 (8.5%) had postpartum PHQ-9 scores > 14, representing moderately severe or worse depressive symptoms and 43 (2.3%) had severe (PHQ-9 > 19) depressive symptoms. Compared to birthing people with PHQ-9 ≤ 14, those with higher PHQ-9 scores were more likely to have medical comorbidities, have a higher body mass index, to self-identify as Black, Native Hawaiian or Pacific Islander, or Hispanic/Latina, have a preterm delivery, and less likely to be married or nulliparous. There were no differences in any other sociodemographic or clinical characteristics. The choice to use any contraceptive method decreased with increasing depressive symptoms in bivariable and multivariable analyses, reaching statistical significance in birthing people with severe depressive symptoms (aOR 2.92, 95% CI 1.46-5.84). ConclusionSevere perinatal depressive symptoms are associated with a declination of any form of postpartum contraception. This finding becomes increasingly relevant as abortion access continues to be threatened across the US, compounding the potential impact of opting not to use contraception.

Severity and Factors Associated with Depressive Symptoms Among Type 2 Diabetic Patients in Vietnam.

Diabetes and psychiatric disorders often co-occur. The prevalence of depression in a person with diabetes is two times higher than that of the general population. During the last decade, the prevalence of diabetes in Vietnam has nearly doubled. However, there is little data regarding depressive symptoms among people with diabetes. Therefore, this study aims to explore the level of depressive symptoms and its associated factors among patients with type 2 diabetes mellitus in Hanoi, Vietnam. A cross-sectional study was conducted among 519 patients diagnosed with type 2 diabetes at the Agricultural General Hospital, one of the largest primary care hospitals for diabetes in Hanoi, Vietnam. Patient Health Questionnaire-9 (PHQ-9) was used to assess the severity of depressive symptoms. Multivariate Tobit and logistic regression models were applied to examine factors associated with the severity of depressive symptoms and medication adherence. Approximately 45.2% of participants were identified as having depressive symptoms at different levels. The proportion of patients with mild, moderate, moderately severe, and severe depressive symptoms is 36.0%, 7.6%, 1.4%, and 0.2% respectively. Regarding the treatment process, patients being treated for their diabetes for a longer time were more likely to have depressive symptoms. Depression was positively linked to currently drinking alcohol (Coef = 1.04; 95% CI = 0.30-1.78), having comorbidities (Coef = 1.08; 95% CI = 0.15; 2.01) and having irregular physical activities (Coef = -1.28; 95% CI = -2.18; -0.38). Patients with severe depressive symptoms (higher PHQ-9 score) were more likely to be non-adherent to their medications in the last month (AOR = 1.30; 95% CI = 1.17; 1.46). Our study shows that a high percentage of patients with diabetes have depressive symptoms. There is a strong association between having depressive symptoms and non-adherence to medications in the last month. To reduce the risk of developing depressive symptoms, depression should be screened at the initial treatment process and patients should be advised to avoid alcohol and to engage in physical activities regularly.

Demoralization in cancer survivors: an updated systematic review and meta-analysis for quantitative studies.

Demoralization can cause impairments across all life aspects of cancer patients. Cancer patients are also vulnerable during their survivorship. The purpose of this review is to examine the risk of demoralization and associated risk factors among cancer survivors who have completed their primary anti-cancer treatment or time since diagnosis ≥5 years without recurrence. We searched databases of PubMed, Cochrane, Embase, PsycINFO and ClinicalTrial.gov to identify eligible studies which reported the demoralization level among cancer survivors. A random-effect meta-analysis model was used for calculating mean demoralization level. Heterogeneity was evaluated by I2 statistics. Funnel plots and Egger's regression tests were performed for checking publication bias. We used one-study-removed method for sensitivity analysis. Subgroup analysis was also done to examine the difference of demoralization level between cancer types. Meta-regression was performed to reveal risk factors of demoralization. A meta-analysis of 12 articles involving 2902 cancer survivors was conducted. The mean demoralization score among cancer survivors was 25.98 (95% CI: 23.53-28.43). Higher demoralization level was seen in participants with older age, higher female ratio, higher married/living together status ratio and higher patient health questionnaire-9 score. The literature review revealed correlations between demoralization and suicide risk, anxiety and quality of life. No consistent correlation between demoralization and post-traumatic stress symptoms could be seen. High demoralization level is noticed among cancer survivors. Risks for females, elder patients or breast cancer survivors are identified. More longitudinal or interventional studies for cancer survivors' demoralization are expected in the future.

Combined influence of nutritional and inflammatory status and depressive symptoms on mortality among US cancer survivors: Findings from the NHANES

BackgroundInflammation and nutrition and depression are interrelated, and both are related to changes in mortality rates. We investigated the association of nutritional and inflammation index or depressive symptoms with the risk of all-cause mortality or cause-specific mortality among cancer survivors. MethodsA prospective cohort of a nationally representative sample of cancer survivors, aged 40 years or older (n = 2331; weighted population, 15 248 255; 67.6 ± 11.0 years; 50.6 % males), were recruited from the US National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. Advanced lung cancer inflammation index (ALI) reflected inflammation and nutritional status and Patient Health Questionnaire 9 (PHQ-9) demonstrated depressive symptoms. The independent and joint associations of ALI and PHQ-9 score with mortality outcomes were examined among cancer survivors and Cox regression analysis based on weights was used to calculate the relative risk. ResultsWe identified 605 all-cause deaths (cancer, 204; non-cancer, 401) over a median of 6.2 years of follow-up (15,385 person-years; interquartile range, 3.3–9.8 years). High ALI was observed to be consistently associated with lower risks of all-cause (hazard ratio [HR], 0.516; 95 % CI, 0.400–0.667) and non-cancer (HR, 0.414; 95 % CI, 0.291–0.588) mortality compared with low ALI in a series of adjusted models. Meanwhile, lower PHQ-9 score (0–4) was associated with lower risks of all-cause (HR, 0.686; 95 % CI, 0.521–0.903) and non-cancer (HR, 0.686; 95 % CI, 0.474–0.992) mortality compared with higher PHQ-9 score (≥10). Furthermore, joint analyses showed that high ALI was associated with a decreased risk of death among cancer survivors who were not depressive. Specifically, survivors with high ALI but not depressive symptoms had the lowest overall (HR, 0.404; 95 % CI, 0.228–0.715) risks. ConclusionIn this cohort study, we observed impact of nutritional and inflammatory status and depressive symptoms on mortality among cancer survivors, with the lowest risks of death from both all causes and non-cancer being noted among the combination of high level ALI with no depression.

Association between work-related physical activity and depressive symptoms in Korean workers: data from the Korea national health and nutrition examination survey 2014, 2016, 2018, and 2020

BackgroundThe workplace experiences of employees can impact their mental health. Depressive symptoms, which are experienced by workers, are a mental health issue that deserves attention. Several studies have evaluated physical activity to prevent possible depression in workers in a work environment, however, research on physical activity and depression symptoms directly related to work is still insufficient. Therefore, we aimed to identify the relationship between work-related physical activity and depression among South Korean workers.MethodsWe used data from the Korean National Health and Nutrition Examination Survey conducted in 2014, 2016, 2018, and 2020, which included 31,051 participants. We excluded, participants aged < 15 years (n = 4,663), unemployed and economically inactive persons (n = 9,793), those who did not engage in work-related physical activities (n = 1,513) and leisure physical activities (n = 1,558), or those with missing data (n = 450). Therefore, the study included 13,074 participants. Work-related activity was measured by self-reporting, while depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). Multiple logistic regression analysis was performed to investigate the association between work-related physical symptoms and depressive symptoms among workers.ResultsIndividuals who engaged in work-related physical activity had higher PHQ-9 scores than those who did not (male: odds ratio [OR]: 1.71, 95% confidence interval [CI]: 1.16–2.52; female: OR: 2.33, 95% CI: 1.66–3.29). High-intensity work-related physical activity significantly increased depressive symptoms (male: OR: 2.15, 95% CI: 1.04–4.43; female: OR: 2.90, 95% CI: 1.46–5.96). When classified according to the severity of depressive symptom, the OR of depressive symptoms of workers engaged in both leisure and work-related physical activities tended to be lower than that of those engaged only in work-related physical activities.ConclusionKorean workers who engaged in work-related physical activities exhibited more depressive symptoms. Therefore, our findings suggest that balancing work-related and leisure physical activities can help Korean workers prevent development of depressive symptoms.

Health-related quality of life in Hong Kong physicians up to 20 years post-graduation: A cross-sectional survey.

Problems with health-related quality of life can affect physicians' ability to work effectively. This study compared the health-related quality of life of Hong Kong physicians to the general population and explored the factors associated with mental and physical health-related quality of life. This cross-sectional study was conducted from January to April 2016. Medical graduates from the University of Hong Kong participated in a survey containing the Short Form-12 Item Health survey version 2, Patient Health Questionnaire-9, Copenhagen Burnout Inventory, and items on lifestyle behaviors, career satisfaction, and socio-demographics. 496 responses were received. The mean physical component summary score was 53.2 (SD = 7.6), similar to the general population. The mean mental component summary score was 43.6 (SD = 11.8), significantly worse than the general population (P<0.01). Compared to the general population, all Short-Form 12 Health Survey version 2 domains were worse in doctors, aside from bodily pain and general health. Regular exercise was positively associated with physical component summary scores (Coeff 2.024; P = 0.047); but having children and higher personal burnout scores were negatively associated with it (Coeff -1.890; P = 0.036; and Coeff -0.045; P = 0.027, respectively). Poorer mental component summary scores correlated with worse personal (Coeff -0.284; P< 0.001), work-related (Coeff -0.135; P = 0.040), and patient-related burnout (Coeff -0.060; P = 0.041), and higher Patient Health Questionnaire-9 scores (Coeff -9.170; P<0.001). There were significant differences in mental health (P = 0.042) and mental component summary scores (P = 0.012) across age groups, but not with gender. Hong Kong physicians are less impacted by physical health than mental health. Compared to the general population, doctors' mental health has a more significant impact on their lives. Interventions aimed to improve burnout and depression rates in physicians may improve physicians' mental health-related quality of life.

The Psychological Impacts of COVID-19 Pandemics on Pregnant Women in Hong Kong—Results of a Web-Based Cross-Sectional Survey

Background: We sought to assess the anxiety and depression scores of pregnant women in Hong Kong during the COVID-19 pandemic and to evaluate the impact of demographic, economic and social factors on these scores. Methods: This was part of an ongoing worldwide cross-sectional study conducted from 22 May 2020 to 28 February 2021. Data were collected through an anonymous web-based survey. The severity of depression and anxiety was assessed using the Patient Health Questionnaire-9 (PHQ-9) score and the General Anxiety Disorder-7 (GAD-7) score, respectively. Results: A total of 361 participants completed both the GAD-7 and PHQ-9 questionnaires. Participants with psychiatric illness reported a significant higher median GAD-7 score (6.00, interquartile range [IQR] 3.00–7.75 vs. 2.00, IQR 0.00–6.00, p = 0.001), while the median PHQ-9 score was also higher but was not statistically significant (6.50, IQR 3.00–11.00 vs. 5.00, IQR 3.00–8.00, p = 0.066). A higher proportion of participants with psychiatric illness reported moderate-severe depression and anxiety (35.7% vs. 16.5%, p = 0.002, 17.8% vs. 3.6%, p &lt; 0.001 respectively). Multivariate regression analysis demonstrated that financial difficulty, in education and pregnancy by in-vitro fertilization were associated with a higher PHQ-9 score in pregnant women during the COVID-19 pandemic, while underlying psychiatric illness was associated with a higher GAD-7 score. Support from a partner was demonstrated to be associated with a reduced level of depression and anxiety in pregnancy. Conclusions: Pregnant women with underlying psychiatric illness were more vulnerable during the COVID-19 pandemics than the non-psychiatric counterparts. Partner support is important for alleviating depression and anxiety in pregnancy during the COVID-19 pandemic. Clinical Trial Registration: The study was registered at http://www.clinicaltrials.gov, registration number NCT04377412.

Psychological impact of the COVID-19 pandemic on waitlisted pre-bariatric surgery patients in Saudi Arabia: A cross-sectional study.

BackgroundDuring the COVID-19 pandemic, the number of bariatric surgeries was decreased to ensure patient safety. This study aimed to evaluate the effect of such delays on the psychological status and weight management behaviors of waitlisted pre-bariatric surgery patients in Jeddah, Saudi Arabia.Materials and methodsA web-based cross-sectional survey was conducted. Results were then evaluated with simple descriptive statistics and inferential analyses through the Chi-square test, one-way ANOVA, and the general linear regression model.ResultsOf 437 patients, 208 successfully completed the survey. Approximately half of the participants reported weight change (46.6%, n = 97), while other weight management behaviors remained unchanged. The mean Patient Health Questionnaire-9 (PHQ-9) total score of the respondents was 8.29 ± 6.3, indicating mild depression. Higher PHQ-9 scores were associated with being a student, unhealthy dietary habits, physical inactivity, worsened psychological status, and weight gain. Among these factors, being a student was the strongest predictor of the total PHQ-9 score.ConclusionThe COVID-19 pandemic significantly affected the psychological status of patients with obesity on the bariatric surgery waitlist. Since delays in bariatric surgeries could worsen patients’ psychological status, as substantiated in this study, the provision of virtual care through telemedicine and the development of policies for reintroducing bariatric surgeries for future lockdowns are highly recommended.

Investigation of non-motor symptoms in patients with amyotrophic lateral sclerosis

[Objective] Few studies have comprehensively investigated the non-motor symptoms of amyotrophic lateral sclerosis (ALS). We aimed to investigate this aspect of ALS. [Methods] We held a nationwide webinar, titled “ALS Café,” and distributed self-report questionnaires to ALS patients. In addition to the frequency of non-motor symptoms such as fatigue, pain, sleep disorders, defecation disorders, sialorrhea, and sexual problems, we evaluated the quality of life (QoL), ALS Functional Rating Scale-Revised (ALSFRS-R), and Patient Health Questionnaire-9 (PHQ-9). [Results] The average age of the 33 respondents (19 male, 14 female) was 60.8 ± 11.2; 96.7% of respondents had some non-motor symptoms. The median ALSFRS-R was 32.0, and seven (21.2%) of the respondents had a PHQ-9 score of 10 or higher. Fatigue was the most common non-motor symptom (81.8%), followed by pain (60.6%), defecation disorders (57.6%), sleep disorders (48.5%), sialorrhea (48.5%), and sexual problems (24.2%). Fatigue was more frequent in females (P = 0.03). Among the non-motor symptoms, pain was the most common factor affecting QoL, followed by fatigue. More than 90% of ALS patients answered that they had never consulted a physician/counselor about sexual problems. Patients with pain had higher PHQ-9 scores than those without (P = 0.01). There was no correlation between the ALSFRS-R score and QoL and PHQ-9. [Conclusions] Most patients with amyotrophic lateral sclerosis had non-motor symptoms, and fatigue and pain were the most common. We showed that many non-motor symptoms affected QoL without correlating with ALSFRS-R score. Attention should be paid to those even if the motor symptoms of ALS are mild.

Associations between neighborhood socioeconomic deprivation and severity of depression: Data from the National Health and Nutrition Examination Survey, 2011–2014

Neighborhood socioeconomic disadvantage may contribute to depression. This study examined associations between neighborhood socioeconomic disadvantage, measured as deprivation, and depression severity within a broadly representative sample of the U.S. adult population. The sample (n = 6308 U.S. adults) was from the 2011–2014 National Health and Nutrition Examination Survey. Neighborhood deprivation was calculated using the 2010 U.S. Census and shown in tertile form. Depression severity was calculated from responses to the Patient Health Questionnaire-9 (PHQ-9) as a continuous depression severity score and binary Clinically Relevant Depression (CRD). Multilevel modeling estimated the relationship between deprivation and depression (reference = low deprivation). Models were additionally stratified by gender and race/ethnicity. U.S. adults living in high deprivation neighborhoods were more likely to have a higher PHQ-9 score (p < 0.0001). In unadjusted models, living in high deprivation neighborhoods associated with higher PHQ-9 (β = 0.89, SE = 0.15, p < 0.0001) and higher odds of CRD (OR = 1.35, 95% CI = 1.20–1.51). Living in medium deprivation neighborhoods associated with higher PHQ-9 (β = 0.49, SE = 0.16, p = 0.0019). Associations between deprivation and depression severity lost significance after adjusting for individual-level SES. The results suggest that, for U.S. adults, the relationship between neighborhood-level disadvantage and depression may be attenuated by individual-level SES.

Depressive Symptoms and Coping Strategies in Community-Dwelling Older People Amidst the COVID-19 Pandemic: A Mixed-Method Study

ABSTRACT This study aimed to examine depressive symptoms of community-dwelling older people amidst COVID-19 and explore how naturally occurring coping strategies were associated with depression. A mixed-method cross-sectional telephone survey was conducted with 375 older people aged 60 years and above between March and May 2020 in Hong Kong. Trained social workers interviewed participants and assessed depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9). Attribute coding and thematic analysis were adopted for qualitative data analyses. Generalized linear models (GLM) were used to examine the effects of demographics, self-reported risk factors and coping strategies on PHQ-9 scores. Participants’ average PHQ-9 score was 1.9 (SD = 2.9), suggesting a low risk for depression in general. Over half of the participants reported adaptive coping strategies, including learning new things, staying physically, mentally, and socially active, and having a positive mind-set. GLM results indicated that living with family members (other than spouse) and/or others, maladaptive coping, and self-reported risk factors were significantly associated with higher PHQ-9 scores, while adaptive coping was significantly associated with lower PHQ-9 scores. Our study contributed to the growing literature on older people’s resilience and adaptive coping during the pandemic, and the results may have implications for mental health promotion and community care.

Aggression is more strongly associated with suicidality, independent of depression, than emotional instability and impulsivity in people with epilepsy

PurposeWe evaluated the relative contributions of emotional instability, impulsivity, and aggression to the presence of suicide risk in people with epilepsy after adjusting for depressive symptoms. MethodsThis was a cross-sectional study that used the short form of the Affective Lability Scale (ALS-18), the Barratt Impulsiveness Scale Version 11 (BIS-11), the Brief Aggression Questionnaire (BAQ), and the Patient Health Questionnaire-9 (PHQ-9). Suicidality was assessed using the Mini International Neuropsychiatric Interview (MINI), and the presence of suicide risk was defined as a MINI suicidality score ≥1. Stepwise logistic regression and mediation analyses using a two-stage regression method were performed. ResultsOf the 171 subjects (63.2% men) included, suicide risk was present in 38 subjects (22.2%). The stepwise logistic regression analysis identified four variables that were independently associated with suicide risk: higher PHQ-9 score, higher BAQ score, longer duration of epilepsy, and unemployment. The univariate analysis showed that ALS-18 and BIS-11 scores were significantly associated with suicide risk; however, they were backward eliminated from the logistic model according to the criterion of p > 0.1. The mediating effects of ALS-18 and BIS-11 scores on suicide risk via PHQ-9 scores (but not BAQ scores) were significant, with the proportion mediated 61.5% and 54.0% of the total effect, respectively. ConclusionsAlongside depressive symptoms, aggression may be a more useful concept than emotional instability and impulsivity for identifying suicidal risk in people with epilepsy.

Epidemiological Relevance of Elevated Preoperative Patient Health Questionnaire-9 Scores on Clinical Improvement Following Lumbar Decompression.

Limited research exists regarding the influence of preoperative depression on postoperative mental health, physical function, and pain in lumbar decompression (LD) patients. This study aims to evaluate the association of depressive symptoms as measured by the Patient Health Questionnaire-9 (PHQ-9) with other mental health and physical function clinical outcomes among patients undergoing LD. A prospectively maintained surgical registry was reviewed for primary LD from March 2016 to May 2019. Patients were stratified into 3 preoperative PHQ-9 score subgroups. Higher PHQ-9 scores indicated greater depressive symptoms. We assessed demographic and perioperative characteristics among subgroups with appropriate statistical testing. We also evaluated outcome instruments and postoperative improvement for the following outcomes: PHQ-9, Short Form 12 (SF-12), Veterans RAND 12-Item (VR-12), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), visual analog scale (VAS) leg, and VAS back. The 351-subject cohort was 70.4% men with an average age of 47 years; 186 subjects had minimal preoperative depressive symptoms (PHQ-9 <5), 94 had moderate (5≤ PHQ-9 ≤10), and 71 had severe (PHQ-9 >10). Subgroups with more severe symptoms of depression had worse mental health outcome scores (PHQ-9, 12-Mental Health Composite Score [12-MCS], and VR-12-MCS) and a positive linear association with greater pre- to postoperative mental health improvements at all timepoints. Subgroups with more severe symptoms of depression had worse PROMIS-PF scores at all timepoints, though VAS pain scores had no depression symptom association by 1 year. Patients with more severe preoperative depressive symptoms, as evaluated by PHQ-9, have a greater improvement in PHQ-9, SF-12, and VR-12 scores, but more severe PHQ-9 scores are associated with worse overall physical function scores. This study demonstrates the relevance of preoperative depressive symptoms and their necessity in future risk factor models. Severity of preoperative PHQ-9 acts as a significant risk factor to postoperative pain and mental and physical health improvement.

Depression, anxiety, and diabetes-related distress in type 2 diabetes in primary care in Greece: Different roles for glycemic control and self-care.

Objectives:The psychological distress of people living with diabetes is increased and associated with poorer glycemic outcomes and self-care. We aimed to examine the frequency of depression, anxiety, and diabetes-related distress (DRD) of individuals with type 2 diabetes (T2D) in primary care (PC) and their comparative associations with clinical, self-care, and socio-demographic characteristics, testing for possible different roles on glycemic control and self-care.Methods:This is a cross-sectional study of 182 adults with a T2D diagnosis of at least six months, recruited between August 2019-March 2020 and May-October 2020, from an urban PC unit. Participants were screened for symptoms of depression (Patient Health Questionnaire-9 (PHQ-9)), anxiety (Generalized Anxiety Disorder-7 (GAD-7)), and DRD (Diabetes Distress Scale (DDS)). Clinical, self-care, and socio-demographic parameters were recorded.Results:The frequency of clinically significant symptoms of depression was 16.6%, (PHQ-9 score ⩾10), anxiety 17.7% (GAD-7 score ⩾10), and DRD 22.6% (DDS score ⩾2). All PHQ-9, GAD-7, and DDS scores intercorrelated, and higher scores were found to be associated with female gender, lower income, and prior diagnosis of depression. Higher PHQ-9 and GAD-7 scores were found to be associated with lower education, more hypoglycemia episodes, more blood glucose self-tests and antidepressant or benzodiazepine use. The retired/housewives scored significantly lower in GAD-7 and DDS compared to the unemployed participants. Higher DDS scores were associated with higher glycated hemoglobin, higher fasting plasma glucose, and insulin use. It was also noted that higher PHQ-9 scores were associated with lower uric acid levels and were significantly higher in the sedentary lifestyle group.Conclusion:DRD was associated with poorer glycemic outcomes while depressive symptoms were associated with lower physical activity perhaps sharing different roles for glycemic control and self-care. The psychological burden of individuals with T2D may be considered in PC.

Sex Differences in Behavioral Symptoms and the Levels of Circulating GFAP, Tau, and NfL in Patients With Traumatic Brain Injury.

Traumatic brain injury (TBI) affects millions of Americans each year and has been shown to disproportionately impact those subject to greater disparities in health. Female sex is one factor that has been associated with disparities in health outcomes, including in TBI, but sex differences in biomarker levels and behavioral outcomes after TBI are underexplored. This study included participants with both blunt and blast TBI with majority rating their TBI as mild. Time since injury was 5.4 (2.0, 15.5) years for females and 6.8 (2.4, 11.3) years for males. The aim of this cross sectional study is to investigate the relationship between postconcussive, depression, and post-traumatic stress disorder (PTSD) symptoms, as well as health related quality of life (HRQOL), and the levels of glial fibrillary acidic protein (GFAP), total tau (t-tau), neurofilament light chain (NfL), and ubiquitin C-terminal hydrolase-L1 (UCH-L1). Behavioral outcomes were evaluated with the Neurobehavioral Symptom Inventory (NSI), Patient Health Questionnaire-9 (PHQ-9), PTSD Checklist- Civilian Version (PCL-C), short form (SF)-36, and plasma levels of total tau, GFAP, NfL, and UCHL-1 measured with the Simoa-HDX. We observed that females had significantly higher levels of GFAP and tau (ps < 0.05), and higher PHQ-9 scores, NSI total scores, NSI- vestibular, NSI-somatosensory, NSI-affective sub-scale scores (ps < 0.05)), than males. In addition, females had lower scores in HRQOL outcomes of role limitations due to emotional problems, vitality, emotional well-being, social functioning, and pain compared to males (ps < 0.05). Correlation analysis showed positive associations between levels of tau and the NSI-total and NSI-cognitive sub-scale scores (ps < 0.05) in females. No significant associations were found for NfL or GFAP with NSI scores. For female participants, negative correlations were observed between tau and NfL concentrations and the SF-36 physical function subscale (ps < 0.05), as well as tau and the social function subscale (p < 0.001), while GFAP levels positively correlated with role limitations due to emotional problems (p = 0.004). No significant associations were observed in males. Our findings suggest that sex differences exist in TBI-related behavioral outcomes, as well as levels of biomarkers associated with brain injury, and that the relationship between biomarker levels and behavioral outcomes is more evident in females than males. Future studies are warranted to corroborate these results, and to determine the implications for prognosis and treatment. The identification of candidate TBI biomarkers may lead to development of individualized treatment guidelines.

Abstract 11723: Depression and Obesity Are Associated with Chest Pain in Patients with Non-Obstructive Coronary Artery Disease

Introduction: Chest pain in patients with non-obstructive coronary artery disease (NO-CAD) is a major clinical problem impacting the quality of life and can present a therapeutic challenge for providers. The objective of this study was to identify clinical factors associated with chest pain frequency in NO-CAD patients. Mainly, we investigated the hypothesis that increased body mass index (BMI) and depression are associated with increased chest pain frequency in NO-CAD patients. Methods: We identified a sample of 439 patients with NO-CAD (mean age 55.3 years, 50% women, 72% white) in the Emory Cardiovascular Biobank, a database of patients who underwent coronary angiography for suspected myocardial ischemia. Sociodemographic variables, clinical risk factors like BMI, and Patient Health Questionnaire 9 (PHQ9) results - a depression screening tool - were collected. We measured chest pain frequency through a questionnaire that asked patients how many times they had chest pain, chest tightness, or angina over the preceding four weeks. Within the sample, 180 patients (41%) reported no chest pain, chest tightness, or angina, and 259 patients (69%) reported one or more instances of chest pain, chest tightness, or angina in the preceding four weeks. We compared these two groups using t-test, Mann-Whitney U test, and multivariate logistic regression analyses. Results: The sample mean BMI was 30.6 ± 6.6 kg/m 2 . The median PHQ9 score was 3.0, with scores ranging from 0 to 27 and 34% having minimal to major depressive symptoms. Compared to those with no chest pain, patients with chest pain had higher BMI (31.5 ± 7.1 vs 29.4 ± 5.6 kg/m 2 , p=0.001) and higher PHQ9 scores (median [interquartile range]: 4 [1,8] vs 1 [0,3], p&lt;0.001). Furthermore, higher BMI and PHQ9 scores were associated with higher odds of chest pain (odds ratio [95% confidence interval]: 1.041 [1.004-1.079] and 1.104 [1.044-1.168], respectively). Conclusions: In patients with NO-CAD, higher BMI and PHQ9 scores were associated with higher chest pain frequency. Thus, weight and depression optimization could reduce symptoms and improve quality of life in NO-CAD patients; however, this needs further study.

Functional Disability After Ischemic Stroke: A Community-Based Cross-Sectional Study in Shanghai, China.

Objective: This study aimed to understand the demographics, functional disabilities, cognitive impairment, and depressive mood among stroke patients and to explore the correlation between functional disability and the other health conditions so as to provide some data for community rehabilitation among stroke patients.Methods: A cross-sectional study was conducted to investigate the functional status of ischemic stroke patients with stroke history between 1 month and 2 years by applying the modified Rankin Scale (mRS). Data were collected during October 2016 and January 2017 from 11 communities in two districts of Shanghai, China. We used face-to-face questionnaire interviews to collect information on sociodemographics, vascular risks associated with stroke, cognitive function [Mini-Mental State Examination (MMSE)], and depression [Patient Health Questionnaire-9 (PHQ-9)]; and we applied SPSS 24.0 for data analysis.Results: In this study, 305 patients with ischemic stroke were finally recruited, including 189 (61.97%) men, with an average age of 67 years. According to the mRS score, ischemic stroke patients were divided into patients without symptoms (controls, mRS = 0), patients without obvious disability (mRS = 1), and patients with mild to severe disability (mRS = 2–5). Ischemic stroke patients with different mRS levels demonstrated significant differences in age, tobacco smoke exposure, previous stroke history, cognitive function, and depression status. Compared with patients without symptoms (mRS = 0), patients with mRS = 1 had a lower MMSE score [odds ratio (OR): 0.48, 95% confidence interval (CI): 0.26–0.90]; and patients with mRS = 2–5 had a lower MMSE score [OR = 0.16, 95% CI: 0.08–0.33], had a higher PHQ-9 score [OR = 5.36, 95% CI: 2.19–13.11], and were more likely to have previous stroke history [OR = 2.18, 95% CI: 1.01–4.79].Conclusion: Lower degrees of functional independence are related to cognitive impairment, as well as the previous stroke history and depression status.