Higher PHQ-9 Scores Research Articles

Association between subclinical thyroid dysfunction and depressive symptoms in the Korean adult population: The 2014 Korea National Health and Nutrition Examination Survey.

BackgroundClinical hyper and hypothyroidism are associated with a risk for depression.ObjectivesThis study was performed to investigate the association between depressive symptoms and subclinical thyroid dysfunction.MethodsAmong the 7,550 subjects who participated in the 2014 Korea National Health and Nutrition Examination Survey, 1,763 participants without overt thyroid disease were included in this study. Serum thyroid stimulating hormone (TSH), serum free thyroxine (fT4), and depressive symptoms were analyzed based on the Patient Health Questionnaire (PHQ9).ResultsThe percentages of subjects with subclinical hypothyroidism and subclinical hyperthyroidism were 3.3% and 2.6%, respectively. The percentages of subjects with moderate (10–14 points), moderately severe (15–19 points), and severe (≥20 points) depression according to the distribution of PHQ-9 scores were 4.7%, 1.1%, and 0.3%, respectively. TSH, fT4, and the percentage of patients with subclinical hypothyroidism were not significantly associated with PHQ-9 score. However, the percentage of patients with subclinical hyperthyroidism increased significantly with PHQ9 score (P = 0.002). Subjects with subclinical hyperthyroidism had higher PHQ-9 scores than those with normal thyroid function (mean ± standard error [SE], 4.2 ± 0.5 vs. 2.7 ± 0.1 points, P = 0.010). More subjects with subclinical hyperthyroidism had a PHQ9 score ≥ 10 than did those with normal thyroid function (mean ± SE, 17.1 ± 3.5 vs. 5.8 ± 0.6%, P = 0.005). We performed logistic regression analyses for the presence of depressive symptoms, using age, sex, education, household income, alcohol drinking, smoking, diabetes, cerebrovascular disease history, subclinical hypothyroidism, and subclinical hyperthyroidism as variables. Subclinical hyperthyroidism was associated with the presence of clinically relevant depression (PHQ9 score ≥ 10), (odds ratio [OR], 4.04; 95% confidence interval [CI], 1.75–9.31; P = 0.001), and clinically significant depression (PHQ9 score ≥ 15), (OR, 7.05; 95% CI, 1.67–29.67; P = 0.008), respectively. However, subclinical hypothyroidism was not associated with the presence of clinically relevant depression (OR, 1.15; 95% CI, 0.39–3.38; P = 0.800), or clinically significant depression (OR, 3.35; 95% CI, 0.71–15.79; P = 0.127).ConclusionsWe demonstrated that subclinical hyperthyroidism was independently associated with depressive symptoms in the Korean general population using national cross-sectional data.

Alcohol use in a rural district in Uganda: findings from community-based and facility-based cross-sectional studies

BackgroundUganda has one of the highest per capita alcohol consumption rates in sub-Saharan Africa. However, the prevalence of alcohol use disorders (AUD) remains unknown in many areas, especially in rural districts. This study aimed to estimate the prevalence of alcohol consumption and of alcohol use disorder among men, and to describe the distribution of drinking intensity, among men in in Kamuli District, Uganda.MethodsMen attending primary care clinics in Kamuli District were consecutively interviewed in a facility-based cross-sectional study, and a separate group of men were interviewed in a population-based cross-sectional study. In both studies the men were administered a structured questionnaire, which included the alcohol use disorder identification test (AUDIT) to screen for AUD, as well as sections about demographic characteristics, depression screening, internalized stigma for alcohol problems and treatment-seeking.ResultsAmong the 351 men enrolled in the Community study, 21.8% consumed alcohol in the past 12 months, compared to 39.6% of 778 men in the Facility Survey. The proportion of men who screened positive for AUD was 4.1% in the community study and 5.8% in the facility study. AUDIT scores were higher among older men, men with paid/self-employment status and higher PHQ-9 score (P < 0.05). Nearly half (47.5%) of the men with AUDIT-positive scores reported that alcohol use problems had ruined their lives. A majority (55.0%) of men with AUDIT-positive scores did not seek treatment because they did not think AUD was a problem that could be treated.ConclusionsInternalized stigma beliefs among AUDIT-positive men impede treatment-seeking. As part of any efforts to increase detection and treatment services for alcohol use problems, routine screening and brief interventions for internalized stigma must be incorporated within the normal clinical routine of primary health care.

Abstract P121: Racial and Ethnic Differences in Ideal Cardiovascular Health and Perception About Weight Among Females With High Education, Income, and Bmi in the US, 2011-2012

Introduction: Higher education and income can modify behavioral risk factors for lifetime cardiovascular disease (CVD) risk. The aim of this study was to observe ethnic differences in the CV health, as measured by inadequate cardiovascular health index (CVHI) category, among a cohort of females with high family income, education, and BMI. We also examined differences in perception about self-reported weight and attitudes toward weight loss and exercise. Methods: Adult non-pregnant females aged 20 years or older from the 2011-2012 NHANES were included in the study. Participants were at least college educated, had a poverty to income ratio of 350% or above, and BMI (≥ 30). Weighted regression was adjusted for demographics, PHQ-9 score, perception about weight, if participant tried to lose weight last year, and history of CVD, angina, or heart attack. Results: The sample represented 2,990,456 eligible females in the US. About 13.2% Hispanic perceived their weight to be about right as compared to 10% Black, and 3.3% White. About 89% Hispanics tried to lose weight in past year compared to 71% White and Black. Weighted regression showed that Hispanic (β: -2.47, 95% CI: -4.44, -0.50) and Black (β: -0.74, 95% CI: -1.93, 0.45) had low CVHI score as compared to White. Higher PHQ9 score (β: -0.12, p &gt; 0.05) and those who did not try to lose weight (β: -1.55, p &lt; 0.01) were associated with lower, and those with positive attitude towards their weight were associated with higher CVHI score (β: 0.38, p &gt; 0.05). Our study suggests huge variations in these characteristics by country of birth and citizenship with corroborated ambiguity in definitions. Conclusion: Previous research is inconclusive about existence of Hispanic paradox in cardiovascular health domain. Our study suggests that Hispanic ethnicity was a significant predictor of negative CVHI, when socioeconomic status (SES) was high among all obese females. There was higher prevalence of history of weight management and low CVHI score among Hispanic females; Hispanic females belonging to higher SES may be at a higher risk for CVD related adverse events. In our study, effect of education and income diminished and SES was not associated with participant’s willingness to lose weight despite being obese. Health disparities expressed as differences in CVHI exist despite high education and family income.

Associations between Depressive Symptomatology and Neurocognitive Impairment in HIV/AIDS.

Mood disorders and neurocognitive impairments are debilitating conditions among patients with HIV/AIDS. How these comorbidities interact and their relationships to systemic factors remain uncertain. Herein, we investigated factors contributing to depressive symptomatology (DS) in a prospective cohort of patients with HIV/AIDS in active care that included neuropsychological assessment. Among patients with HIV/AIDS receiving combination antiretroviral therapy (cART) and ongoing clinical assessments including measures of sleep, health-related quality of life (HQoL), neuropsychological testing, and mood evaluation (Patient Health Questionnaire-9 [PHQ-9]) were performed. Univariate and multivariate analyses were applied to the data. In 265 persons, 3 categories of DS were established: minimal (PHQ-9: 0-4; n = 146), mild (PHQ-9: 5-9; n = 62), and moderate to severe (PHQ-9: 10+; n = 57). Low education, unemployment, diabetes, reduced adherence to treatment, HIV-associated neurocognitive disorders (HAND), low health-related quality of life (HQoL), reduced sleep times, and domestic violence were associated with higher PHQ-9 scores. Motor impairment was also associated with more severe DS. In a multinomial logistic regression model, only poor HQoL and shorter sleep duration were predictive of moderate to severe depression. In this multivariate model, the diagnosis of HAND and neuropsychological performance (NPz) were not predictive of DS. Symptoms of depression are common (45%) in patients with HIV/AIDS and represent a substantial comorbidity associated with multiple risk factors. Our results suggest that past or present immunosuppression and HAND are not linked to DS. In contrast, sleep quality and HQoL are important variables to consider in screening for mood disturbances among patients with HIV/AIDS and distinguishing them from neurocognitive impairments.

Toward Game-Based Digital Mental Health Interventions: Player Habits and Preferences.

BackgroundDesigners of digital interventions for mental health often leverage interactions from games because the intrinsic motivation that results from game-based interventions may increase participation and translate into improved treatment efficacy. However, there are outstanding questions about the suitability (eg, are desktop or mobile interventions more appropriate?) and intervention potential (eg, do people with depression activate enough to play?) of games for mental health.ObjectiveIn this paper, we aimed to describe the presently unknown relationship between gaming activity and indicators of well-being so that designers make informed choices when designing game-based interventions for mental health.MethodsWe gathered validated scales of well-being (Beck’s Depression Inventory [BDI-II], Patient Health Questionnaire [PHQ-9], trait anxiety [TA], and basic psychological needs satisfaction [BPNS]), play importance (control over game behavior: control; gamer identity: identity), and play behavior (play frequency, platform preferences, and genre preferences) in a Web-based survey (N=491).ResultsThe majority of our participants played games a few times a week (45.3%, 222/490) or daily (34.3%, 168/490). In terms of depression, play frequency was associated with PHQ-9 (P=.003); PHQ-9 scores were higher for those who played daily than for those who played a few times a week or less. Similarly, for BDI-II (P=.01), scores were higher for those who played daily than for those who played once a week or less. Genre preferences were not associated with PHQ-9 (P=.32) or BDI-II (P=.68); however, platform preference (ie, mobile, desktop, or console) was associated with PHQ-9 (P=.04); desktop-only players had higher PHQ-9 scores than those who used all platforms. Platform preference was not associated with BDI-II (P=.18). In terms of anxiety, TA was not associated with frequency (P=.23), platform preference (P=.07), or genre preference (P=.99). In terms of needs satisfaction, BPNS was not associated with frequency (P=.25) or genre preference (P=.53), but it was associated with platform preference (P=.01); desktop-only players had lower needs satisfaction than those who used all platforms. As expected, play frequency was associated with identity (P<.001) and control (P<.001); those who played more had identified more as a gamer and had less control over their gameplay. Genre preference was associated with identity (P<.001) and control (P<.001); those who played most common genres had higher control over their play and identified most as gamers. Platform preference was not associated with control (P=.80), but was with identity (P=.001); those who played on all devices identified more as a gamer than those who played on mobiles or consoles only.ConclusionsOur results suggest that games are a suitable approach for mental health interventions as they are played broadly by people across a range of indicators of mental health. We further unpack the platform preferences and genre preferences of players with varying levels of well-being.

Negative effects of diabetes-related distress on health-related quality of life: an evaluation among the adult patients with type 2 diabetes mellitus in three primary healthcare clinics in Malaysia.

BackgroundPatients with type 2 diabetes mellitus (T2D) often experienced change in life, altered self-esteem and increased feelings of uncertainty about the future that challenge their present existence and their perception of quality of life (QoL). There was a dearth of data on the association between diabetes-related distress (DRD) and health-related quality of life (HRQoL). This study examined the determinants of HRQoL, in particular the association between DRD and HRQoL by taking into account the socio-demographic-clinical variables, including depressive symptoms (DS) in adult patients with T2D.MethodsThis cross-sectional study was conducted in 2012–2013 in three public health clinics in Malaysia. The World Health Organization Quality of Life-Brief (WHOQOL-BREF), 17-items Diabetes Distress Scale (DDS-17), and 9-items Patient Health Questionnaire (PHQ-9) were used to measure HRQoL, DRD and DS, respectively. The aim of this research was to examine the association between the socio-demographic-clinical variables and HRQoL as well as each of the WHOQOL-BREF domain score using multivariable regression analyses.ResultsThe response rate was 93.1 % (700/752). The mean (SD) for age was 56.9 (10.18). The majority of the patients were female (52.8 %), Malay (53.1 %) and married (79.1 %). About 60 % of the patients had good overall HRQoL. The mean (SD) for Overall QoL, Physical QoL, Psychological QoL, Social Relationship QoL and Environmental QoL were 61.7 (9.86), 56.7 (10.64), 57.9 (11.73), 66.8 (15.01) and 65.3 (13.02), respectively. The mean (SD) for the total DDS-17 score was 37.1 (15.98), with 19.6 % (136/694) had moderate distress. DDS-17 had a negative association with HRQoL but religiosity had a positive influence on HRQoL (B ranged between 3.07 and 4.76). Women, especially younger Malays, who had diabetes for a shorter period of time experienced better HRQoL. However, patients who were not married, had dyslipidaemia, higher levels of total cholesterol and higher PHQ-9 scores had lower HRQoL. Macrovascular complications showed the largest negative effect on the overall HRQoL (adjusted B = −4.98, 95 % CI −8.56 to −1.40).ConclusionThe majority of primary care adult with T2D had good overall HRQoL. Furthermore, the independent determinants for HRQoL had also concurred with many past studies. In addition, the researchers found that DRD had negative effects on HRQoL, but religiosity had positive influence on HRQoL. Appropriate support such as primary care is needed for adult patients with T2D to improve their life and their HRQoL.Trial registrationNMRR-12-1167-14158

The relationship between depressive symptoms, diabetes symptoms, and self-management among an urban, low-income Latino population

ObjectiveTo investigate the prevalence of depression symptoms among Latinos with diabetes following transition from hospital to home and the relationship of depressive symptoms to diabetes symptom severity and self-management activities. Methods203 Latino patients with diagnosed diabetes completed a survey assessing depressive symptoms (PHQ-9), diabetes symptom severity, and diabetes self-management activities (SDSCA). Characteristics and diabetes outcomes between patients with and without probable major depression were compared. Associations between PHQ-9 scores and diabetes outcomes were assessed. Multivariate regression models evaluated the relationship between depressive symptoms and diabetes outcomes and exercise after controlling for patient characteristics. Results31.5% of participants indicated probable major depression (PHQ-9≥10). More severe diabetes symptoms and less reported exercise were associated with higher PHQ-9 scores. Regression models showed no relationship between self-management and depression. More severe diabetes symptoms were significantly associated with being female, married, and having probable major depression. Odds of exercising were reduced by 6% for every one-unit increase in PHQ-9 score. ConclusionsThe prevalence of probable depressive symptoms is high in this population. Having depressive symptoms is an indicator of poorer diabetes symptoms. Screening for depressive symptoms may help identify individuals who need additional support with diabetes symptom and self-management.

Abstract 308: Predictors of Depression Recognition and Site Variability in Depression Recognition in Young AMI Survivors

Background: Depression among acute myocardial infarction (AMI) survivors is common and associated with adverse outcomes in the year following their AMI. In young women and men, about 1 in 3 patients suffer from depressive symptoms following their AMI. Early depression recognition is important to ensure timely treatment, and potentially improve outcomes. It is unknown, however, how well providers recognized potential depression in young AMI patients, what patient factors are associated with recognition, and how much variation there is across centers. Methods: VIRGO is a multi-center, international, prospective observational study that enrolled 3,350 AMI patients aged 18-55 years (67.1% women) between 2008-2012. During the index hospitalization for AMI, the Patient Health Questionnaire [PHQ-9] was administered to collect depressive symptoms experienced over the past 2 weeks (cut-off score ≥10 indicated potential depression). Demographic, socio-economic, cardiovascular risk, AMI-severity, and depression treatment data were collected through patient interviews and chart abstraction. Depression recognition was defined as having PHQ-9 scores ≥10 and receiving depression treatment (anti-depressants and/or counseling referral) at discharge and/or at 1-month follow-up. Results: During AMI admission, 1,057 (32%) patients had PHQ-9 scores ≥10. Overall, 41% were recognized by their providers. Independent predictors of having patients’ depressive symptoms recognized were: having health insurance (OR=1.46, CI95% 1.03-2.06), history of lung disease (OR=2.02, CI95% 1.36-2.99), and a higher PHQ-9 score (OR=1.06, CI95% 1.03-1.10). African Americans (OR=0.34, CI95% 0.21-0.54), males (OR=0.52, CI95% 0.37-0.74) and married patients (OR=0.72, CI95% 0.54-0.95) were less likely to be recognized. Recognition rates by AMI treating facility (Figure) ranged from 15 to 60%, with a median OR of 1.25 (CI = 1.00, 1.61). Conclusion: Depression recognition rates are poor in young AMI patients with substantial variation observed across AMI treating facilities. Males, African Americans, and uninsured patients are less often recognized and may continue to be at risk of poor AMI outcomes.

Medication profile and polypharmacy in adults with pediatric-onset spinal cord injury.

Cross-sectional survey. To describe the medications taken by individuals who had sustained a spinal cord injury (SCI) in childhood or adolescence (age <19 years) and to report the prevalence of polypharmacy and its association with demographic, injury-related and psychosocial factors. Community. Structured interviews of adults with pediatric-onset SCI. Routine medications and secondary health conditions (SHCs) experienced were recorded. Polypharmacy was defined as the concomitant use of five or more different types of medications. Bivariate analyses and multiple regression models were conducted to determine associations between polypharmacy and demographic factors, injury-related factors, number of SHCs and psychosocial outcomes (FIM, SF-12v2 Health Survey, CHART, PHQ-9). A total of 159 participants (male, 63%; tetraplegia, 59%) with mean age 35.0±6.2 years (range, 26.7-50.9 years) were included. Most common routine medications were muscle relaxants (50.3%), bladder medications (48.5%), bowel agents (41.5%), analgesics (26.4%) and antidepressants (16.9%). Polypharmacy was present in 30.8% (n, 49) and was more prevalent in those with tetraplegia (40.2% vs 17.9%; P=0.003). Participants with polypharmacy were older, had lower FIM, CHART and SF-12v2 scores, and higher PHQ-9 scores. Regression models indicate the total number of SHCs, time since injury and tetraplegia to be significant positive predictors of polypharmacy. Duration of SCI and SHCs are risk factors for polypharmacy in this population of adults with SCI. Measures should be taken to prevent the occurrence of SHCs throughout adulthood so as to prevent the potentially adverse physiological effects and psychosocial outcomes associated with polypharmacy.

153 AMPK Activation Positively Regulates Fatty Acid-Stimulated Neurotensin Secretion

Background Our aim was to assess the prevalence of sexual dysfunction in our male patients with IBD and to identify associated factors that may be preventable, reversible and treatable. Methods As there is no available sexual function questionnaire specific to IBD, we performed a literature search of existing generic questionnaires to identify relevant domains of sexual function. We then added questions specific to IBD such as the effects of IBD symptoms, medications and surgery on sexual function for a total of 43 questions. In addition, our new IBD Sexual Dysfunction Scale (IBDSDS) contains validated erectile function (International Index of Erectile Function; IIEF) and depression screening tools (Patient Health Questionnaire 9; PHQ-9). Male patients older than 18 attending IBD clinics at the Brigham and Women's Hospital and Beth Israel Deaconess Medical Center were invited to complete the survey. Results 156 patients completed the IBDSDS (CD 57.7%, UC 42.3%). The mean age was 42 (range 20-84). 87% of respondents were in a relationship that could involve sexual activity. 2% had not been sexually active in the last year; 70% were married or longterm partnered. 20% of patients reported that IBD caused hesitancy in starting a new relationship and 7.8% attributed IBD to the breakup of an existing relationship. 38% reported that IBD had a negative impact on their desire for sexual activity, 26% that IBD prevented them from having sex, 18% that IBD caused problems during sex, and 20% that IBD made them feel guilty about sex. Patients with moderate/severe depression (PHQ-9 >10) had lower sexual satisfaction scores (p 5 had significantly lower satisfaction with sex life scores (p=0.0152), more difficulty getting an erection (p=0.0245) and poorer quality of erection (p=0.0049). UC patients with a SCCAI score > 4 had higher PHQ-9 scores (p=0.0025) but no difference in sexual function scores. Patients > 50 years had lower sexual satisfaction scores (p= 0.0214), more difficulty getting erections (p= 0.0042), keeping erections (p= 0.0007) and poorer quality of erections (p 50, active Crohn's, the presence of an ileostomy and comorbid depression contribute to impaired sexual function in male IBD patients as measured by the IBDSDS. We should strive for disease remission and screen for underlying depression in our patients.

Mode of delivery and postpartum depression: the role of patient preferences

The purpose of this study was to explore the relationship between strength of preference for vaginal delivery, delivery mode undergone, and postpartum depression. We conducted a secondary analysis of data from a longitudinal study of delivery-mode preferences. During an interview between 24-36 weeks of gestation, participants were asked whether they preferred vaginal or cesarean delivery; the strength of this preference was measured by the standard gamble metric. Depression was assessed antepartum and at 8-10 weeks and 6-8 months after delivery by using the Patient Health Questionnaire (PHQ-9). The primary outcome was PHQ-9 score at 8-10 weeks after delivery. We used multivariable regression analysis to assess the effect of strength of preference for vaginal delivery and delivery mode undergone on postpartum depression. Of 160 participants, 33.1% were nulliparous, and 30.6% had a previous cesarean delivery. Most of the participants (92.4%) preferred vaginal delivery, but the strength of preference varied substantially. The mean strength-of-preference score (0-1 scale; higher scores denote stronger vaginal delivery preference) was 0.658 (SD, ±0.352). A significant interaction emerged between the effects of delivery mode and vaginal delivery preference score on postpartum PHQ-9 score (P = .047). Specifically, a stronger preference for vaginal delivery was associated with higher PHQ-9 scores among women who underwent cesarean delivery (P = .027) but not among women who underwent vaginal delivery (P = .761). The interaction between delivery mode and vaginal delivery preference score was no longer significant at 6-8 months after delivery. Women who have a strong antepartum preference for vaginal delivery and deliver by cesarean may be at increased risk for depression in the early postpartum period.

Mental Health and Suicidal Behavior Among Graduate Students

The objective of this paper is to describe the mental health and service utilization of graduate students at a large southeastern university and identify psychological factors associated with their student suicidal behavior. E-mail invitations to complete the Interactive Screening Program, an online anonymous mental health questionnaire, were sent to graduate students. The questionnaire included the Patient Health Questionnaire (PHQ-9) as well as items assessing suicide behavior, anxiety, negative emotion, substance use, eating behavior, and service utilization. A total of 301 graduate students responded to the questionnaires between 14 July 2010 and 24 January 2012. With regards to suicide, 7.3 % of the sample reported thoughts of suicide, 2.3 % reported having plans for suicide, and 1.7 % had hurt themselves in the past 2 weeks; while 9.9 % had ever made a suicide attempt in their lifetime. Graduate students had PHQ-9 scores indicating mild depression, and more than half endorsed feeling nervous, irritable, stressed, anxious, lonely, or having fights/arguments. In terms of service utilization, 22.2 % of the sample was currently taking some type of medication, and 18.5 % currently in counseling/therapy are females and those with higher PHQ-9 scores more likely to be using services. Those endorsing suicidal behavior in the past 2 weeks had significantly higher depression scores than those without such behavior and were characterized by more anxiety, negative emotions (such as loneliness, anger, hopelessness, desperation, and being out of control), substance use, and eating problems. Graduate students experience significant amounts of stress and anxiety, and their suicidal behavior is strongly characterized by depression, hopelessness, desperation, lack of control, and eating problems. Future work with this population should focus on the development and evaluation of mental health and wellness interventions and on ways to promote help-seeking, especially among male students.

Detection and management of depression in adult primary care patients in Hong Kong: a cross-sectional survey conducted by a primary care practice-based research network

BackgroundThis study aimed to examine the prevalence, risk factors, detection rates and management of primary care depression in Hong Kong.MethodsA cross-sectional survey containing the PHQ-9 instrument was conducted on waiting room patients of 59 primary care doctors. Doctors blinded to the PHQ-9 scores reported whether they thought their patients had depression and their management.Results10,179 patients completed the survey (response rate 81%). The prevalence of PHQ-9 positive screening was 10.7% (95% CI: 9.7%-11.7%). Using multivariate analysis, risk factors for being PHQ-9 positive included: being female; aged ≤34 years; being unmarried; unemployed, a student or a homemaker; having a monthly household income < HKD$30,000 (USD$3,800); being a current smoker; having no regular exercise; consulted a doctor or Chinese medical practitioner within the last month; having ≥ two co-morbidities; having a family history of mental illness; and having a past history of depression or other mental illness. Overall, 23.1% of patients who screened PHQ-9 positive received a diagnosis of depression by the doctor. Predictors for receiving a diagnosis of depression included: having higher PHQ-9 scores; a past history of depression or other mental health problem; being female; aged ≥35 years; being retired or a homemaker; being non-Chinese; having no regular exercise; consulted a doctor within the last month; having a family history of mental health problems; and consulted a doctor in private practice.In patients diagnosed with depression, 43% were prescribed antidepressants, 11% were prescribed benzodiazepines, 42% were provided with counseling and 9% were referred, most commonly to a counselor.ConclusionAbout one in ten primary care patients screen positive for depression, of which doctors diagnose depression in approximately one in four. At greatest risk for depression are patients with a past history of depression, who are unemployed, or who have multiple illnesses. Patients most likely to receive a diagnosis of depression by a doctor are those with a past history of depression or who have severe symptoms of depression. Chinese patients are half as likely to be diagnosed with depression as non-Chinese patients. Over half of all patients diagnosed with depression are treated with medications.

Patient Health Questionnaire for School-Based Depression Screening Among Chinese Adolescents

The aim of this study was to determine the reliability and validity of a Chinese version of the Patient Health Questionnaire-9 item (PHQ-9) and its 2 subscales (1 item and 2 items) for the screening of major depressive disorder (MDD) among adolescents in Taiwan. A total of 2257 adolescents were recruited from high schools in Taipei. The participants completed assessments including demographic information, the Chinese version of the PHQ-9, and the Rosenberg Self-Esteem Scale, and data on the number of physical illnesses and mental health service utilizations were recorded. Among them, 430 were retested using the PHQ-9 within 2 weeks. Child psychiatrists interviewed a subsample of the adolescents (n = 165) using the Kiddie-Schedule for Affective Disorder and Schizophrenia Epidemiological Version as the criterion standard. The PHQ-9 had good internal consistency (α = 0.84) and acceptable test-retest reliability (0.80). The participants with higher PHQ-9 scores were more likely to have MDD. Principal component factor analysis of the PHQ-9 yielded a 1-factor structure, which accounted for 45.3% of the variance. A PHQ-9 score ≥15 had a sensitivity of 0.72 and a specificity of 0.95 for recognizing MDD. The area under the receiver operating characteristic curve was 0.90. The screening accuracy of the 2 subscales was also satisfactory, with a Patient Health Questionnaire-2 item cutoff of ≥3 being 94.4% sensitive and 82.5% specific and a Patient Health Questionnaire-1 item cutoff of ≥2 being 61.1% sensitive and 87.7% specific. The PHQ-9 and its 2 subscales appear to be reliable and valid for detecting MDD among ethnic Chinese adolescents in Taiwan.

Depression is correlated with the psychological and physical aspects of sexual dysfunction in men

Few studies have objectively examined the relationship between depression and various stages of sexual function. Here we associate depression and sexual function using validated questionnaires. A retrospective review of 186 men was performed; demographics and serum hormone levels were obtained. Responses to questionnaires evaluating depressive symptoms (Patient Health Questionnaire (PHQ-9)), sexual function (International Index of Erectile Function (IIEF)) and hypogonadal symptoms (quantitative Androgen Decline in the Aging Male (qADAM)) completed by each patient were correlated using Spearman's rank correlation. Mean±s.d. subject age: 52.6±12.7 years; mean serum hormone levels: TT 429.8±239.2 ng dl(-1), free testosterone 9.72±7.5 pg ml(-1) and estradiol 34.4±22.8 pg ml(-1). Negative correlations were observed between total PHQ-9 score and the sexual desire (ρ=-0.210, P=0.006), intercourse satisfaction (ρ=-0.293, P<0.0001) and overall satisfaction (ρ=-0.413, P<0.0001) domains of the IIEF and individual IIEF questions pertaining to erectile function. Men with a PHQ-9 score 10 (mild depression or worse), had lower sexual desire and sex life satisfaction. A negative correlation between PHQ-9 score and qADAM score (ρ=-0.634, P<0.0001) was observed and men with higher PHQ-9 score had lower qADAM scores. Depressive symptoms in men correlate with both psychological as well as physical aspects of sexual function.

Problematic Internet use and associated risks in a college sample

ObjectiveThe Internet is commonly used among young adults; however, Internet use may become a problematic behavior. Past research has examined Internet behavior in young adults and its relationship to other behaviors and health issues, yet further research is needed to gain a more comprehensive understanding of this relationship. MethodA sample (n=2108) of college students (56.9% female) was examined using a self-report Internet survey concerning demographic characteristics, Internet use, health behaviors, psychosocial functioning, and psychiatric comorbidities. The IAT was used to determine levels of problematic Internet use (limited use (none or almost no use), mild use (typical user), moderate use (occasional problems) and severe use (frequent, serious problems)) and the MINI for testing for psychiatric problems. ResultsWe found that 237 students (12.9%) met criteria for limited Internet use, 1502 (81.8%) for mild Internet use and 98 (5.3%) for moderate to severe Internet use. Variables significantly associated with greater frequency of Internet use included lower Grade Point Average (p=.006), less frequent exercise (p=.018), higher PHQ-9 scores (p<.0001) (indicative of greater depression symptoms) and higher Perceived Stress Scores (p<.0001). ConclusionsThese data indicate that moderate to severe Internet use is associated with a range of psychosocial problems in young adults. More research is needed to better understand the relationship between Internet use and physical and mental health, as well as academic variables.

Association of screening for psychosocial distress in patients with newly diagnosed stage IV NSCLC and survival.

9030 Background: While screening for psychosocial distress has become an ASCO QOPI indicator of quality cancer care, data has yet to show an association with improved cancer outcomes. We examined the relationship between adherence to the QOPI measure for assessment of emotional well-being and survival in a sample of patients with newly diagnosed stage IV NSCLC. Methods: From 8/07 to 9/10, we recruited consecutive new patients in a multidisciplinary thoracic oncology clinic to participate in a research database for which patients completed self-report instruments for depression (PHQ-9) and anxiety (GAD-7) at their first oncology visit. We then performed a QOPI chart audit for patients with stage IV NSCLC who received care at our institution. To adhere to the QOPI measure, oncologists were required to document their own assessment of patient emotional well-being (without access to patient self-report data) within one month of the first office visit. Survival was calculated from first oncology visit to death. Cox proportional hazards models were used to test associations with survival. Results: 243 patients completed baseline assessments and had follow up. Emotional well-being was assessed in 90 (37%). Median survival of those with an emotional assessment was 12 months vs. 10 months for those without (p=.03). Yet, emotional assessment was associated with younger age (p=.01) and higher depression (p=.05) and anxiety scores (p=.03). Controlling for age, sex, performance status, smoking, primary oncology provider, PHQ-9, and GAD-7, having an assessment of emotional well-being was associated with improved survival (HR .68, 95% CI .49-.93, p=.02). Although higher PHQ-9 scores were independently associated with worse survival (HR 1.05, 95% CI 1.02-1.08, p=.004), neither depression nor anxiety moderated the relationship between clinician screening and survival. Conclusions: In this large prospective study of patients with newly diagnosed stage IV NSCLC, adherence to the QOPI measure for assessment of emotional well-being was associated with a survival benefit. This benefit appears to extend to all patients, not just those with depression and anxiety. Randomized trials are needed to confirm these findings.