Higher PHQ-9 Scores Research Articles

Current Status and Influencing Factors of Eating Behavior in Residents at the Age of 18~60: A Cross-Sectional Study in China.

As eating behavior is important to health, this cross-sectional study was conducted to analyze the factors influencing the eating behavior related to overweight and obesity of Chinese residents aged 18~60 based on the Ecological Model of Health Behavior. The short-form of the Eating Behavior Scale (EBS-SF) was applied to evaluate eating behavior. The multivariable linear stepwise regression analysis was used to identify and analyze the influence factors, and the receiver operating characteristic curves analysis to validate the predictive capability of the EBS-SF score in differentiating overweight and obesity. A total of 8623 participants were enrolled. In the personal characteristics, male (β = −0.03), older [36–45 years (β = −0.06) or 46–60 years (β = −0.07)], higher scores of Agreeableness (β = −0.04), Conscientiousness (β = −0.14) or Openness (β = −0.03) contributed to healthy eating behavior. In the individual behaviors, those who smoked (β = 0.04), drank alcohol (β = 0.05), exercised frequently (β = 0.07), had higher PHQ-9 scores (β = 0.29) may have improper eating habits. As for the interpersonal networks, the residents who were married (β = −0.04) behaved well when eating, while those who had offspring or siblings tended to have unhealthy eating behavior. At the community level, living in Western China (β = −0.03), having a monthly household income of 6001–9000 yuan per capita (β = −0.04), having no debt (β = −0.02), being retired (β = −0.03), or having lower PSSS scores (β = −0.03) led to lower EBS-SF scores. And the EBS-SF score demonstrated a moderate-high accuracy in predicting overweight and obesity.

1075-P: Racial/Ethnic Differences in the Association between Frailty and Depression among Adults with Diabetes

Individuals with diabetes are at increased risk of developing depression. The prevalence of depression in non-Hispanic Blacks (NHB) with diabetes is about 25%, higher than the prevalence among non-Hispanic Whites (NHWs) . Frailty, a measure of biological age and one’s increased susceptibility to negative health outcomes and has been found to be associated with disability and dependency. The aim of this study was to examine the association between depression and frailty and to understand whether this association differs by race/ethnicity among adults with diabetes. Data on 3792 adults with diabetes from NHANES (2003-2005) were analyzed. Depression was assessed using scores from the 9-item Patient Health Questionnaire (PHQ-9) . Frailty index composed of 46 variables (comorbidities, disability, symptoms, labs, general health) was created ranging from 0 - 1 (frail>=0.21; not frail<0.21) . Unadjusted and adjusted linear regression models were used to assess the association between depression and frailty. Covariates included age, sex, education, income-to-poverty ratio, marry, insurance, employment, smoke, physical activity, and body mass index. All models were stratified by race/ethnicity. Unadjusted models showed an association depression and frailty across all racial/ethnic groups with those who were frail having significantly higher PHQ9 scores (NHW: b 2.63; 95%CI:1.36, 3.89; NHB: b 3.26; 95%CI:2.23, 4.23; Hispanic/Other (H/O) : b 1.33; 95%CI:0.52, 2.14) . The association remained significant across all groups in adjusted models (NHW: b 4.5; 95%CI:1.9, 7.1; NHB: b 6.3; 95%CI:4.2, 8.4; H/O: b 2.1; 95%CI:0.5, 3.7) .While depression was associated with frailty across all racial/ethnic groups, NHBs who were frail had the highest mean PHQ9 score. Additional research is needed to identify the key drivers of this relationship and potential targets for home-based lifestyle intervention to improve care provided to and outcomes for frail patients with diabetes. Disclosure L.E.Egede: None. A.Z.Dawson: None. J.A.Campbell: None. R.J.Walker: None. Funding American Diabetes Association (1-19-JDF-075) ; National Institute of Diabetes and Digestive and Kidney Diseases (grant K24DK093699, R01DK118038, R01DK120861, Principal Investigator (PI) : Leonard Egede, MD) National Institute on Minority Health and Health Disparities (R01MD013826, PI: Egede/Walker)

Determining Prevalence of Depression and Covariates of Depression in a Cohort of Multiple Sclerosis Patients.

BackgroundDepression is one of the most common symptoms experienced by multiple sclerosis patients and may be secondary to the disease itself as well as other variables such as age, disease severity and side effects of treatment.ObjectiveTo determine if there is an association between disease modifying therapies and depression rates based on PHQ9 scores in multiple sclerosis.MethodsThis was a retrospective chart review. Patients followed at the University of Texas Southwestern Multiple Sclerosis and Neuroimmunology Clinic from 2017 to 2020 were included in this study. Patients’ most recent PHQ-9 scores were used. The following data was extracted from patient charts: disease modifying therapy, age, disease duration, gender, antidepressant use and ambulatory status.ResultsData from our study included 2611 individual PHQ-9 scores. The majority of our patients were female and the mean age across all treatment groups was 50.37 years old. The median disease duration across all treatment groups was 12.74 years. Most patients in this cohort required no ambulatory assistance. 43.86% of patients were on antidepressants and use was correlated with a higher PHQ9 score. The median PHQ 9 score across all treatment groups was 4 (Interquartile range = 7). Across treatment groups, patients on interferon therapy had the lowest PHQ 9 scores with a median of 2.ConclusionsOur study demonstrated that there were lower PHQ-9 scores among interferon treatment group as compared to other disease modifying therapies and non-treatment groups

Factors Associated With Early and Late Post-stroke Fatigue in Patients With Mild Impairment. Results From the Stroke Cohort Study Augsburg.

BackgroundPost-stroke fatigue is a common symptom after stroke. However, studies on the factors associated with early and late fatigue are scarce. The objective of this study was to identify variables associated with early and late fatigue.MethodsIn the German Stroke Cohort Augsburg (SCHANA) study, participants were interviewed during their hospital stay and completed a postal questionnaire 3 and 12 months post-stroke. Fatigue was assessed using the Fatigue Assessement Scale (FAS). In addition, depression was measured by the Patient Health Questionnaire (PHQ-9), general health status by the EQ-5D visual analog scale, and physical activity by the International Physical Activity Questionnaire (IPAQ). Multivariable regression models were used to determine the associations between FAS scores at 3 and 12 months post-stroke and demographic, psychosocial and health-related covariables.ResultsAmong 505 participants, the frequency of fatigue was 31.1% 3 months and 29.1% 12 months post-stroke. Prior stroke (ß = 2.37, p = 0.0076), prior diagnosis of depression (ß = 5.04, p = 0.0001), higher NIHSS (ß = 0.25, p = 0.0360) and higher PHQ-9 scores (ß = 0.55, p < 0.0001) were significantly associated with higher fatigue levels 3 months post-stroke. Additionally, younger age (ß = −0.07, p = 0.0219), a worse rating of general health at baseline (ß = −0.04, p = 0.0287) and low pre-stroke physical activity (ß = −0.0004, p = 0.0089) were significantly associated with higher fatigue levels 12 months after stroke.ConclusionsFatigue is a common and persisting symptom even in patients with mild impairment. Prior depressive disorder and early depressive symptoms were the most relevant predictors of both early and late fatigue.

Social Media Usage, Working Memory, and Depression: An Experimental Investigation among University Students.

Social media usage (SMU) and its relationship with working memory (WM) and academic performance remain unclear, and there is a lack of experimental evidence. We investigated whether WM mediates the association between SMU and academic performance, including the roles of depression, anxiety, and disordered social media use as possible contributors. A sample of 118 undergraduate students aged 19 to 28 from Saudi Arabia performed a WM test twice; for one assessment, participants were required to interact with social media before the test, and the other test was preceded by painting online. We also measured grade point average (GPA), habitual social media usage (SMU), depression (PHQ-9), anxiety (GAD-7), and disordered social media usage (SMDS). There was no significant difference between WM scores in the social media condition compared to the control condition, but when solely considering at least moderately depressed participants, social media use predicted significantly more errors in the social media condition compared to the control condition. Furthermore, higher SMDS scores were significantly predicted by higher PHQ-9 scores and more hours of habitual SMU. GPA scores were not predicted by WM performance or SMU. The present study is one of the first experimental attempts to compare the relationship between SMU and WM and highlights the priming effect of depression on the relationship between SMU and WM.

A comparison of the effects of sudden gains and depression spikes on short- and long-term depressive symptoms in a randomized controlled trial of behavioral activation and cognitive behavioural therapy.

The aim of this study was to examine the effects of sudden gains and depression spikes in a randomized controlled trial of cognitive behavioral therapy (CBT) and behavioral activation (BA) for depression (COBRA trial). This is a secondary analysis of 300 adults with major depressive disorder (MDD) who received CBT (n = 156) or BA (n = 144) (Richards et al., 2016). The Patient Health Questionnaire (PHQ-9) and Structured Clinical Interview Schedule (SCID) were used to measure depression symptoms at 6-, 12-, and 18-month follow-up. One-hundred and ten (37%) individuals experienced sudden gains, and 77 (26%) experienced depression spikes. There were no differences in rates of gains or spikes between treatments. Individuals with sudden gains had lower PHQ-9 scores across follow-up and were less likely to meet SCID criteria than those without a sudden gain. Generalized estimating equation (GEE) models demonstrated that individuals who had a sudden gain and were in CBT had lower PHQ-9 scores at 6 and 18 months than those in BA. Conversely, individuals who had a depression spike and were in CBT had higher PHQ-9 scores across follow-up compared to those without a depression spike and also a greater chance of meeting SCID criteria for MDD at 18 months than those who received BA. The short- and long-term impact of discontinuous change varied by type of treatment package. Identifying strategies within treatment packages and client processes that are associated with gains and spikes may help to inform treatment planning and clinical decision-making. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Comparison of self-esteem and depression among fertile and infertile women in a low resource setting

This study aimed to explore the effect of infertility on self-esteem and depression, and to identify the sociodemographic and infertility characteristics associated with self-esteem and depression among infertile women in Ekiti State, Nigeria. Self-esteem and depression were assessed in 100 infertile women and 100 women seeking family planning (controls) using the Rosenberg Self-Esteem Scale (RSES) and Patient Health Questionnaire (PHQ-9), respectively. Infertile women had significantly lower RSES score (19.4 ± 4.5 vs. 20.7 ± 4.4, p=.038) and higher PHQ-9 score (5.1 ± 4.1 vs. 3.8 ± 3.5, p=.023) compared to controls. Among infertile women, marital status, being remarried, duration of infertility, and RSES score were associated with PHQ-9 score on simple linear regression. On multiple linear regression analysis, the RSES score had a negative association with the PHQ-9 score (β= −0.32, p<.001). In conclusion, infertile women have lower self-esteem and higher depression scores. Mental health screening and management should be an integral part of care administered to infertile women. Impact Statement What is already known on this subject? Infertility is a global health problem with negative effects on the mental health and quality of life of couples, especially women. What the results of this study add? Infertile women have lower self-esteem and higher depression scores. The prevalence of major depressive disorder (MDD) is higher among infertile women. Longer duration of infertility, older age, ≤6 years of formal education, and low self-esteem are significant associations of MDD among infertile women. What the implications are of these findings for clinical practice and/or further research? Mental health screening and management should be included in the care given to women undergoing evaluation and treatment for infertility. Larger community-based studies evaluating other aspects of mental health among infertile couples are encouraged.

The relationship between mental health/physical activity and pain/dysfunction in working-age patients with knee osteoarthritis being considered for total knee arthroplasty: a retrospective study

BackgroundIncreasing total knee arthroplasty (TKA) surgeries are being performed on working-age patients with prominent manifestations of pain and dysfunction. But few studies have explored the risk factors for pain and dysfunction in working-age patients with knee osteoarthritis (KOA) being considered for TKA. Therefore, this study sought to explore the relationship between mental health/physical activity and pain/dysfunction in working-age patients with KOA being considered for TKA.MethodsThis study was a secondary analysis of data derived from a public database, the Work participation In Patients with Osteoarthritis cohort study, which included 152 working-age patients (65 men and 87 women) with KOA planning for TKA. We analyzed preoperative data comprising age, educational level, body mass index (BMI), mental factors (Patient Health Questionnaire-9 [PHQ-9] and the 36-Item Short Form Survey Instrument [SF-36 mental health]), physical activity level, and clinical outcomes (the Western Ontario and McMaster Universities Osteoarthritis Index and SF-36 sub-item score). Multivariate regression analysis was performed to determine risk factors for pain and dysfunction in working-age patients with KOA being considered for TKA.ResultsWomen had lower pain, worse function, and higher PHQ-9 scores than men (p < 0.001). The depression scores were significantly linearly related to pain and function scores in women after adjusting for age, BMI, educational level, and physical activity (P < 0.05), whereas this relation was not observed in men. After adjusting for age, BMI, educational level, and mental factors, exercise time was found to be positively correlated with pain scores in women (P < 0.05).ConclusionsDepression scores and exercise time were significantly correlated with pain and dysfunction in working-age women with KOA being considered for TKA.

Characterization of HIV-Associated Neurocognitive Impairment in Middle-Aged and Older Persons With HIV in Lima, Peru.

Background: With widespread use of antiretroviral medications, people living with HIV (PWH) are living longer worldwide, increasing their risk of developing neurocognitive impairment (NCI). The proportion of Peruvians over age 60 is expected to increase to 25% of the population by 2050, including PWH. Therefore, the problem of aging and NCI, especially in the setting of HIV infection, is uniquely pressing. We sought to study the rates of and risk factors associated with NCI among middle-aged and older PWH in Lima, Peru.Materials and Methods: Sociodemographic, medical (infectious and non-infectious), and psychiatric comorbidity and laboratory data were collected. We administered a brief neuropsychological battery evaluating seven cognitive domains affected in HIV-associated NCI and a depression screening. Cognitive test raw scores were converted to T-scores that were demographically adjusted. Descriptive statistics were performed together with regression (unadjusted and adjusted) analyses to determine potential risk factors for NCI among PWH.Results: This was a cross-sectional study in which 144 PWH aged ≥40 years attending a large HIV clinic in Lima, Peru, were recruited from September 2019 to March 2020. Mean age was 51.6 ± 7.7 years, and mean years of education were 14.0 ± 3.1 with 15% females. Median [interquartile range (IQR)] current CD4 and nadir CD4 were 554 (371, 723) and 179 (83, 291), respectively, and 10% currently had AIDS. The prevalence of NCI was 28.5%, and many demonstrated difficulty with attention and working memory (70%). One-quarter of PWH had mild depression or worse on Patient Health Questionnaire 9 (PHQ-9 ≥ 5). In bivariate analyses, neither a depression history nor a higher PHQ-9 score correlated with NCI. No other non-communicable medical or psychiatric comorbidity nor HIV characteristic was predictive of NCI. Having a positive lifetime history of hepatitis B infection, pulmonary tuberculosis, or syphilis increased risk of NCI (PR 1.72; 95% CI 1.04–2.86) in unadjusted analyses, but not in adjusted analyses.Conclusions: NCI among older Peruvians with HIV was found to be highly prevalent with levels consistent with prior reports of HIV-associated NCI worldwide. Common latent HIV-associated co-infections, including latent syphilis, hepatitis B infection, or pulmonary tuberculosis, may increase the risk of NCI among middle-aged and older PWH in Peru.

Comparison of self-esteem and depression among fertile and infertile women

AimsThis study aimed to explore the effect of infertility on self–esteem and depression, and to identify the sociodemographic and infertility characteristics associated with self-esteem and depression among infertile women in Ekiti State, Nigeria.MethodSelf-esteem and depression were assessed in 100 infertile women and 100 women seeking family planning (controls) using the Rosenberg Self-Esteem Scale (RSES) and Patient Health Questionnaire (PHQ-9), respectively. PHQ-9 score ≥10 was defined as major depressive disorder (MDD). Continuous variables were presented as mean ± standard deviation and categorical variables as frequency (percentage). Cases and controls were compared using Student's t test. χ2 or Fisher's exact (when cell size &lt;5) tests were performed to compare proportions. Simple and multiple linear regression analyses were used to examine the association between the sociodemographic, infertility characteristics and RSES or PHQ-9 scores among infertile womenResultInfertile women had significantly lower RSES score (19.4 ± 4.5 vs. 20.7 ± 4.4, p = 0.038) and higher PHQ-9 score (5.1 ± 4.1 vs 3.8 ± 3.5, p = 0.023) compared to controls. Seventeen infertile women (17%) and 8 women in the control group (8%) had MDD (PHQ-9 score ≥10) and were referred for further evaluation. Among infertile women, marital status, being remarried, duration of infertility, and RSES score were associated with PHQ-9 score on simple linear regression. Similar association was not seen in the controls. On multiple linear regression analysis, RSES score had a negative association with PHQ-9 score (β = -0.32, p &lt; 0.001) among infertile women. Older age [OR (95% CI):1.13 (1.01–1.25); p = 0.030], ≤6 years formal education [OR (95% CI): 4.76 (1.13–20.00); p = 0.033], being remarried [OR (95% CI): 10.87 (1.86–63.64); p = 0.008], longer duration of infertility [OR (95% CI): 1.11 (1.01–1.22); p = 0.040] and RSES score [OR (95% CI): 0.79 (0.67–0.92); p = 0.003] were significantly associated with MDD. On multiple logistic regression analysis, only the association between RSES score and MDD remained statistically significant (p = 0.004)ConclusionInfertile women have lower self-esteem and higher depression scores in comparison to women seeking family planning. Mental health screening and management should be an integral part of care administered to infertile women

Screening of depression and anxiety in adolescents with cystic fibrosis and caregivers in Turkey by PHQ-9 and GAD-7 questionnaires.

Depression and anxiety symptoms in patients with cystic fibrosis (CF) and their caregivers are 2-3 times higher than in the normal population. This study aims to evaluate the frequency and severity of depression and anxiety symptoms and to determine possible risk factors in CF patients and their mother and/or fathers at Marmara University CF center. The study included 132 CF patients who were followed up at our CF center. Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Questionnaire (GAD-7) were used to screen depression and anxiety. The questionnaires were completed by 50 CF patients (aged 12-17 years) and 132 parents of patients (aged 0-17 years). While moderate to severe depressive symptoms were seen in 26% of patients, 33.7% of mothers and 14.6% of fathers; moderate to severe anxiety were present in 18%, 21.8% and 8.5%, respectively. None of the demographic characteristics was identified as a predictor of depression or anxiety. GAD-7 scores have shown a higher prevalence of anxiety in mothers of patients with chronic methicillin-resistant Staphylococcus aureus (p = .034). Additionally, hospitalization in the last 12 months was significantly correlated with higher PHQ-9 scores in fathers (p = .043). Analysis of patients' adherence to medical treatment and airway clearance showed higher depression and anxiety in mothers of the nonadherent group (p = .002). Depression and anxiety were common in CF patients and their parents. These results illustrate the importance of depression/anxiety screening and psychosocial support for the CF patient and their parents.

English

The purpose of this study was to document potential effect of depression on academic outcomes. We collected a cross sectional data from 710 pre-engineering university students in northwestern part of Ethiopia using cluster sampling. Depressive symptoms were assessed using a locally validated version of Patient Health Questionnaire (PHQ-9) at a cut off 5-9 and 10 or more indicating mild and major depressive symptoms, respectively. The types of substances that students experienced in the last three months were assessed. Multivariable linear regression was carried out to examine whether depressive symptoms predicted academic outcomes (cumulative GPA and perceived difficulties in learning process). Higher PHQ-9 scores were reported by 71.4% (30% mild and 41.4% major levels): of the students. Increment in depression (β=0.296, 95% CI: 0.223, 0.370), anxiety score (β=0.119, 95% CI: 0.011, 0.227), substance use (β=0.169, 95% CI: 0.045, 0.293) and stressful life events (β=0.306, 95% CI: 0.080, 0.532) scores were positively correlated with perceived difficulties in learning. Each increment in self-efficacy score (β=0.006, 95% CI: 0.001, 0.012) was positively associated with semester GPA. However, PHQ-9 score did not independently associate with semester GPA (β = -0.001, 95% CI: -0.007, 0.00). Depressive symptoms were associated with perceived difficulties in learning. Future follow-up studies and intervention strategies are needed to demonstrate causality. Key words: Depression, academic outcomes, substance use, universities students.

Anxiety and depression in patients wearing prosthetic eyes

PurposeTo investigate anxiety and depression levels in prosthetic eye–wearing patients using standardized psychometric instruments, to define factors associated with these psychological diseases, and to identify a potential healthcare gap.MethodsA total of 295 prosthetic eye wearers were screened using the 7-item generalized anxiety disorder scale (GAD-7) and the 9-item patient health questionnaire (PHQ-9). Scores of GAD-7 and PHQ-9 were correlated with scores of general physical and mental health functioning, vision-related quality of life, appearance-related distress, appearance-related social function, and further biosocial factors.ResultsFive patients (2%) had a pre-diagnosed anxiety disorder, and 20 patients (7%) had a pre-diagnosed depression. However, our screening revealed 26 patients (9%) with anxiety symptoms, 31 patients (11%) with depression symptoms, and 40 patients (14%) suffering from both anxiety and depression symptoms. This underdiagnosing for both anxiety and depression disorders was significant (p < 0.001, respectively). Higher GAD-7 scores were significantly associated with higher PHQ-9 scores, lower appearance-related social function, lower mental health functioning, and female gender (p ≤ 0.021, respectively). Higher PHQ-9 scores were significantly associated with lower physical and mental health functioning, higher educational degree, and non-traumatic eye loss (p ≤ 0.038, respectively).ConclusionsAnxiety and depression disorders seem to be underdiagnosed in prosthetic eye wearers and to have higher incidence compared with the general population. Therefore, a psychometric screening should be routinely implemented in the clinical care. For a successful long-term rehabilitation, integrated care by a multidisciplinary team including ophthalmic plastic surgeons, ophthalmologists, ocularists, general practitioners, and psychologists is essential.

Factors related to mental health of inpatients with COVID-19 in Wuhan, China

ObjectiveTo evaluate the mental health status of hospitalized patients with coronavirus disease 2019 (COVID-19) and to explore the related factors. MethodThis was a cross-sectional survey among COVID-19 inpatients in two isolation wards of a designated hospital in Wuhan, China, from March 7, 2020, to March 24, 2020. Participants’ demographic data, clinical data and levels of circulating inflammatory markers were collated. Mental health symptoms were evaluated with questionnaires, which included the Insomnia Severity Index (ISI) scale, the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder (GAD-7) scale, and questions about patients’ self-perceived illness severity. Multivariate linear regression analysis was performed to explore factors that associated with mental symptoms, and a structural equation model (SEM) was used to assess the possible relationships between those factors and the patients’ mental health. ResultsAmong the 85 participants, 45.9% had symptoms of depression (PHQ-9 ≥ 5), 38.8% had anxiety (GAD-7 ≥ 5), and 54.1% had insomnia (ISI ≥ 8). According to multivariate regression analysis, female sex, a higher level of interleukin (IL)-1β and greater self-perceived illness severity were all significantly associated with a higher PHQ-9 score, higher GAD-7 score and higher ISI score. In addition, the disease duration and the neutrophil to lymphocyte ratio (NLR) were positively related to patients’ self-perceived illness severity. The results of the SEM analyses suggested that sex (β = 0.313, P < 0.001), self-perceived illness severity (β = 0.411, P < 0.001) and levels of inflammatory markers (β = 0.358, P = 0.002) had direct effects on patients’ mental health. The disease duration (β = 0.163, P = 0.003) and levels of inflammatory markers (β = 0.101, P = 0.016) also indirectly affected patients’ mental health, with self-perceived illness severity acting as a mediator. ConclusionA majority of COVID-19 infected inpatients reported experiencing mental health disturbances. Female sex, disease duration, levels of inflammatory markers and self-perceived illness severity are factors that could be used to predict the severity of patients’ mental symptoms.

COVID-19 Impact Among Spine Surgeons in Latin America.

Study Design:Cross-sectional study.Objective:The aim of this study was to evaluate the impact of the COVID-19 outbreak in spine surgeons in Latin America.Methods:A questionnaire was sent to Latin American spine surgeons from April 4 to 6, 2020. Surgeon characteristics were recorded. The impact of COVID-19 on economic well-being, work, and mental health were also determined. All variables were compared and analyzed.Results:Two hundred four surgeons answered the complete survey; most of them were male (96.6%), the average age was 47.7 years; 58.8% (n = 120) were orthopedic surgeons and 41.2% (n = 84) were neurosurgeons. The majority of the respondents were from Argentina (59.8%, n = 122), followed by Brazil (17.2%, n = 35), Chile (6.4%, n = 13), and Mexico (5.9%, n = 12). Most of the surgeons reported performing emergency procedures only during the pandemic (76.5%, n = 156). Half used telemedicine or online consultation modalities (54.4%, n = 111). The average concern about the financial situation due to the pandemic was 7.53 in a scale of 1 to 10 (10 being the worst scenario). Twenty-two percent (n = 45) of the surgeons had a score over 10 in the Patient Health Questionnaire (PHQ-9; scores higher than 10 needs referral to confirm depression diagnosis). Young age and neurosurgery as a specialty were associated with higher PHQ-9 scores.Conclusions:COVID-19 has an impact in the daily working practice and financial situation of spine surgeons in Latin America. The long-term psychological impact should be taken into consideration to avoid a heavier burden for health care providers.

SAT-457 The Association Between Thyroid Stimulating Hormone and Severe Depression: A Historical Cohort Study

Introduction: Hypothyroidism is implicated in the pathophysiology and clinical course of mood disorders. This study aimed to investigate the association between TSH and severe depression.Methods: The historical cohort included all consecutive adult patients (≥ 18 years) who had a TSH and PHQ-9 questionnaire data within 6 months of index visit, between October 2016 and July 2019, at the University of Utah Health. Data on demographics, hypothyroidism, TSH, PHQ-9, thyroid hormone replacement (THR), and antidepressant medications were extracted electronically. T-test and chi-square were used to compare continuous and categorical variables respectively. Logistic regression and one-way ANOVA were used to evaluate the association between TSH and depression severity. A sub-group analysis was performed among mood disorder patients without a diagnosis of overt hypothyroidism, comparing euthyroid patients (TSH 0.3-4) and patients with sub-clinical hypothyroidism based on TSH 4-10.Results: The cohort included 26,722 patients, mean age 46.3 years, 79.5% Caucasian, 68% females, and mean BMI 30. Mean PHQ-9 score was 8.2, 10% patients had severe depression (PHQ-9 ≥20), and 51% were on antidepressants and 26% on mood stabilizers. Mean TSH was 2.85, 19% patients had a diagnosis of hypothyroidism, and 20% patients were on THR. Patients with severe depression were more likely to have a higher mean TSH (p=0.06), be on antidepressants (p= <0.0001), and have a higher BMI (p=0.0003). There was a positive correlation between TSH and PHQ-9 score (p= 0.04). TSH was associated with severe depression, odds ratio 1.006 (1.003-1.009), after adjusting for potential co-variates. Hypothyroid patients who were on THR had a lower mean PHQ-9 score (p= <0.0001) as compared to hypothyroid patients not on THR. Patients with TSH from 7-10 had a higher PHQ-9 score as compared to those who had a TSH from 4-7 (p= <0.003).Conclusion: Severe depression was associated with higher TSH. Subclinical hypothyroidism with TSH above 50th percentile was associated with higher PHQ-9 scores. Future RCTs should evaluate the effect of THR in (a) patients with severe depression and (b) patients with mood disorders who have subclinical hypothyroidism.

What\u2019sPrEP?: peer navigator acceptability among minority MSM in Washington

BackgroundPeer navigation is a promising strategy to link at-risk minority men who have sex with men (MSM) to HIV prevention services including pre-exposure prophylaxis (PrEP).MethodsThirty-two Black and 63 Latinx HIV-negative MSM living in western Washington completed a survey examining attitudes towards peer navigation and PrEP. Factor analysis derived a score for peer navigator acceptability, and linear regression identified associations with this outcome.ResultsForty-eight percent were interested in peer navigation. Being insured, higher sexual stigma, and higher PHQ-9 score were associated with higher acceptability, while higher income and having a regular medical provider were associated with lower acceptability. In multivariable analysis, higher sexual stigma predicted higher acceptability, while higher income predicted lower acceptability. Men preferred that peers be matched on sexual orientation, race, age and culture.ConclusionPeer navigation interventions to reach minority men should address stigma, focus on lower-income men, and try to match peers to clients to the extent possible.

P006 AFTER-HOURS PATIENT PHONE CALLS TO GI FELLOWS WITHIN AN IBD MEDICAL HOME

Abstract Objective The Inflammatory Bowel Disease (IBD) Medical Home is a care delivery model that provides a comprehensive, patient-centered, coordinated care environment, previously shown to lead to an approximate 50% reduction in unplanned care. However, the frequency and nature of IBD medical home patient phone calls to gastroenterology (GI) fellows after-hours, and the contribution to unplanned care from these encounters, is unknown. Methods We included all patients that were seen in the IBD medical home between 7/1/2015 to 6/30/2016 (n = 293) and examined all phone call activity in the subsequent year: 7/1/2016 to 6/30/2017. After-hours phone calls were defined as documented calls that were routed to on-call GI fellows when the clinic is closed. The details of each after-hours encounter were reviewed, and were categorized by the reason for call, training year of the GI fellow, advice given to patient, and unplanned care outcomes. For comparison, we also tracked frequency of patient calls for symptoms during clinic hours. Demographic information, disease type, disease activity index, quality of life (QoL), and depression/anxiety scores documented most recently to the start of the observation period were included in the analysis. Comparisons were made using Chi-square, T-tests and non-parametric median tests. Results 259 of 293 patients (86.7%) had any documented phone interaction. Only 36 patients (12.3%) placed a total of 63 after-hours phone calls to GI fellows, with calls for symptoms representing the majority (71.4%). Among calls for symptoms (n = 45), patients were advised by GI fellows to present to the emergency department (ED) 44.4% of the time. There was no significant difference in ED recommendations by fellow training level (p = 0.17). Of the 20 ED encounters advised by fellows, 9 (45%) did not result in admission; and 2 patients had new cross-sectional imaging. Of the 11 admissions, 10 also had new cross-sectional imaging, with generation of 10 inpatient IBD consults, as well as 1 surgery for seton placement. After-hours callers were more likely to have Crohn’s disease and higher GAD-7 scores, with trends towards lower SIBDQ scores and higher PHQ-9 scores, but similar disease activity index scores, number of clinic visits, and demographics, compared to patients who called with symptoms during clinic hours (Table 1). Conclusions Among patients established within an IBD medical home model, a small population of patients called after hours resulting in frequent recommendation to present to the ED from GI fellows, however it is unknown if these encounters meaningfully changed their IBD care. Higher psychosocial complexity may influence this care behavior. Further studies of triage processes and educational initiatives aimed at GI fellows may help minimize unplanned ED and inpatient care in this patient population.

Relative importance of perceived physical and social neighborhood characteristics for depression: a machine learning approach

PurposeThe physical and social neighborhood environments are increasingly recognized as determinants for depression. There is little evidence on combined effects of multiple neighborhood characteristics and their importance. Our aim was (1) to examine associations between depression severity and multiple perceived neighborhood environments; and (2) to assess their relative importance.MethodsCross-sectional data were drawn from a population-representative sample (N = 9435) from the Netherlands. Depression severity was screened with the Patient Health Questionnaire (PHQ-9) and neighborhood perceptions were surveyed. Supervised machine learning models were employed to assess depression severity-perceived neighborhood environment associations.ResultsWe found indications that neighborhood social cohesion, pleasantness, and safety inversely correlate with PHQ-9 scores, while increasing perceived distance to green space and traffic were correlated positively. Perceived distance to blue space and urbanicity seemed uncorrelated. Young adults, low-income earners, low-educated, unemployed, and divorced persons were more likely to have higher PHQ-9 scores. Neighborhood characteristics appeared to be less important than personal attributes (e.g., age, marital and employment status). Results were robust across different ML models.ConclusionsThis study suggested that the perceived social environment plays, independent of socio-demographics, a role in depression severity. Contrasted with person-level and social neighborhood characteristics, the prominence of the physical neighborhood environment should not be overstated.

Depressive Symptoms among Industrial Workers in Vietnam and Correlated Factors: A Multi-Site Survey.

Depressive disorders have been found to be a significant health issue among industrial workers, resulting from work-related factors and causing serious burdens for the workers as well as their employers. Literature on mental health problems of Vietnamese industrial workers has been limited, despite the rapid foreign investment-fueled industrialization process of the country. This study aimed to fill the gap in literature by examining the prevalence of depressive disorders and their potential associated factors among a cohort of Vietnamese industrial workers. A cross-sectional study was conducted in 3 industrial areas in Hanoi and Bac Ninh. A total of 289 workers agreed to participate in the study. Generalized linear mixed models were applied to identify associated factors with depression status of respondents. 38.6% of participants reported suffering depression. Factors found to be positively associated with the possibility of having depression and higher PHQ9 score were long working hours, suffering more health problems, and health hazards exposure at work. Meanwhile, being females, having more children, living with parents, engaging in smoking, and being local workers were found to correlate with lower likelihood of being depressed. The findings suggested the importance of regular health screening, work safety assurance, and social support outside of workplace on the mental health of the workers.