History Of Mental Health Diagnosis Research Articles

The Interplay of Sleep Quality, Mental Health, and Sociodemographic and Clinical Factors among Italian College Freshmen.

Background/Objectives: Sleep and mental health are closely linked, with sleep deprivation increasing the risk of mental health problems in college students. This study aimed to analyze the role of sleep in the mental health status of a sample of Italian freshmen, considering various mental health outcomes and potential interactions between sleep and other relevant factors, such as sociodemographic characteristics, academic experiences, and mental health history. Methods: All freshmen from a medium-sized Italian university were invited to participate in a multidimensional online survey (n = 3756). Sleep quality was assessed through questions on average hours of sleep per night and on satisfaction of perceived sleep quality. Mental health outcomes included psychophysical well-being, psychological distress, substance use, and problematic internet use. Statistical analysis involved multivariate analysis of variance, followed by pairwise comparisons. Results: The sample (n = 721) exhibited low levels of well-being and a high prevalence of psychological distress (52.1%). Approximately one-third of students (n = 258) were dissatisfied with their sleep quality, and one-fourth (n = 186) reported inadequate sleep (less than 7 h per night). More specifically, 24.4% of students slept on average six hours per night, and 1.4% slept five hours or less. Satisfaction with perceived sleep quality significantly influenced well-being, psychological distress, and cannabis use (ηp2 = 0.02). Interaction effects were observed between satisfaction with sleep quality and drop-out intentions (ηp2 = 0.01), as well as between satisfaction with sleep quality and history of mental health diagnosis (ηp2 = 0.02), both of which were significant for psychological distress and cannabis use. Conclusions: This study highlights the influence of perceived sleep quality on academic distress among college freshmen, particularly those with higher intentions of leaving university and with a history of mental health diagnosis.

Racism-related stress and mental health among black women living in Los Angeles County, California: A comparison of postpartum mood and anxiety disorder screening scales.

To assess Black women's exposure to and appraisal of racism-related stress during the postpartum period and to distinguish its impact on three indicators of postpartum mood and anxiety disorders (PMADs) symptoms. Data from the Black Mothers' Mental Wellness Study (N = 231) and linear regression models estimated the associations between racism-related stress and the PMAD indicators: 3-item Edinburgh Postnatal Depression Scale (EPDS-3), 8-item Patient Health Questionnaire (PHQ-8), and PHQ-15. The majority of participants (80.5%, N = 186) experienced racism a few times a year or more, of which 37.1% (N = 69) were bothered somewhat and 19.3% (N = 36) a lot. Racism-related stress, income, level of education, and history of mental health diagnosis explained greater variance in PMAD symptoms as measured by the PHQ-8 score (R2 = 0.58, p = < 0.001) compared to the EPDS-3 (R2 = 0.46, p = < 0.001) or the PHQ-15 (R2 = 0.14, p = 0.035). Racism is a stressor for Black women living in Los Angeles County, California. Racism-related stress and emotional expression of PMAD symptoms were salient to the postpartum mental health of the Black women in this study. Findings from this study suggest that the PHQ-8 should be used to assess how racism impacts Black women's postpartum mental health.

Exploring the prevalence and predictors of low resilience and likely PTSD in residents of two provinces in Canada during the 2023 wildfires.

The recent wildfires in Canada serve as a stark example of the substantial and enduring harm they cause to the health of individuals and communities. Assessing the prevalence and correlates of Post-traumatic stress disorder (PTSD) and low resilience is valuable for policymakers in public health. The study aimed to assess the prevalence and predictors of low resilience and likely PTSD among subscribers of Text4Hope, an e-mental health program that delivered daily supportive messages to residents of Nova Scotia (NS) and Alberta(AB) during the recent wildfires. Data collection was through a self-administered online survey completed by residents of the affected regions of NS and AB from May 14 to June 23, 2023. Data were analyzed using Statistical Package for the Social Sciences. Out of 298 respondents, the prevalence of low resilience and likely PTSD in our sample were 52.0 and 39.3%, respectively. Unemployed respondents were about 3 times more likely to experience both low resilience and PTSD symptoms compared to those employed. Respondents with a history of mental health diagnosis were about 4 times more likely to experience likely PTSD compared to those with no history of mental health diagnosis. This study established that unemployment and a history of mental health diagnosis predicted likely PTSD, while unemployment was associated with low resilience during the wildfire. These findings offer insights for clinical interventions and the creation of psychosocial support programs for vulnerable populations.

Dose-Response Effect of Mental Health Diagnoses on Concussion Recovery in Children and Adolescents.

Pre-existing mental health diagnoses may contribute to greater emotional symptom burden and prolonged recovery after concussion. Youth with pre-existing mental health diagnoses will have greater emotional symptom burden, greater risk for delayed return to exercise, and more prolonged recovery from concussion than those without those diagnoses. Prospective cohort. Level 3. A prospective registry of youth concussion was examined for differences in emotional symptom burden after injury to develop a predictive risk model for prolonged recovery. The impact of individual and total number of pre-existing mental health diagnoses (0, 1, 2, and 3+) was assessed, and multivariable logistic regression was performed to identify factors associated with prolonged recovery. Among a cohort of 3105 youth with concussion, those with a history of mental health diagnoses, in a dose-response fashion, had greater postinjury emotional symptom burden (7 emotional symptoms vs 4; P < 0.01), visio-vestibular dysfunction (65% abnormal vs 56% abnormal; P < 0.01), later return to symptom-limited exercise (23 vs 21 days; P < 0.01), and overall longer concussion recovery (38 days, interquartile range [IQR] 18, 80) versus 25 days (IQR 13, 54; P < 0.01). Boys with prolonged recovery after concussion had greater emotional symptom burden than girls (5 emotional symptoms vs 3; P < 0.01). Pre-existing mental health diagnoses are associated with greater postinjury emotional symptom burden and longer concussion recovery in a dose-response fashion. Visiovestibular deficits and delayed return to exercise are also associated with pre-existing mental health diagnoses and prolonged recovery. Boys with prolonged recovery from concussion experience greater emotional symptom burden than girls. Addressing pre-existing mental health diagnoses is essential to concussion management. Boys with prolonged recovery from concussion may particularly benefit from interventions to address their higher emotional symptom burden. Interventions, including a home visio-vestibular exercise program and symptom-limited exercise, may contribute to improving time to concussion recovery.

Prevalence of poor body image and its correlation with self-esteem and depression in middle-aged women

Objective This study aimed to determine the prevalence and predictors of poor body image and its influence on low self-esteem and depression in middle-aged women. Methods The study was a cross-sectional survey of 372 women using a predesigned online questionnaire. Main outcome measures were mean scores on the nine-point body image scale (BIS) and prevalence of poor body image (BIS ≥ 10). Significant sociodemographic, physical and mental health predictors of BIS ≥ 10 were established using logistic regression analysis. Correlation of body image with self-esteem, assessed by Rosenberg’s self-esteem scale, and depression, assessed by Beck’s Depression Inventory, was established using Pearson’s correlation coefficient and the odds ratios were determined using logistic regression analysis. Results The mean scores obtained for body image were 5.52 (standard deviation 4.82) and the prevalence of BIS ≥ 10 was 17.4%. Significant predictors of poor body image were education status (0.59, 95% confidence interval [CI] = 0.39–0.89), body mass index (2.26, 95% CI = 1.12–4.55), social support structure (0.35, 95% CI = 0.16–0.79), diagnosis of mental illness (3.74, 95% CI = 1.31–10.66) and perception of menopause (positive vs. negative: 0.20, 95% CI = 0.07–0.55). Body image scores correlated with self-esteem (r = −0.46; 95% CI = −0.54 to −0.38) and depression (r = 0.59; 95% CI = 0.52–0.65). BIS ≥ 10 significantly increased the odds of low self-esteem (5.71; 95% CI = 2.66–12.26) and depression (11.25; 95% CI = 4.9–27.7). Conclusions The prevalence of poor body image in middle-aged women was 17.4%. This strongly correlated with low self-esteem and depression. A lower education status, higher body mass index, a negative perception of menopause, poor social support structure and a history of mental health diagnosis increased the odds of poor body image prevalence in middle-aged women.

Anxiety trajectories from pregnancy to one-year postpartum and their contributors during the COVID-19 pandemic

ABSTRACT Background Anxiety in the peripartum period (pregnancy through one-year postpartum) has negative impacts on mothers and infants. During the COVID-19 pandemic, high rates of anxiety were reported worldwide, but trajectories for how these symptoms change longitudinally in the peripartum period remain unknown. Methods A total of 1,411 women who were pregnant during the second U.S. COVID-19 surge completed four study questionnaires between December 2020 and March 2022, including assessments of anxiety symptoms (GAD-7) and individual and community-level contributors. Latent Class Growth Mixture Models (LCGMM) were used to identify anxiety trajectories, and multinomial logistic regression was used to identify contributors to class membership. Results Three classes of anxiety symptom trajectories were identified. Class 1 (n = 956, 67.8%) experienced minimal/mild anxiety throughout the peripartum period. Class 2 (n = 362, 25.7%) experienced initial moderate anxiety that remained stable. Class 3 (n = 93, 6.6%) experienced initial moderate anxiety that increased to severe in the postpartum period. Stress and history of mental health diagnosis contributed to higher initial levels of anxiety and ongoing social support contributed to lower levels of anxiety. In addition, financial insecurity increased the risk of belonging to Class 3. Conclusions Screening for anxiety symptoms and psychosocial vulnerabilities in the peripartum period is vital, as is early intervention. This is especially the case among women with limited financial and social resources who may experience chronic or worsening anxiety as they transition to parenthood.

Predictors of Seeking Mental Health Treatment in Black Men: Therapy Fears and Expectations About Counseling

The current study examined predictors of mental health treatment among Black men while incarcerated. Participants were 76 individuals who identified as Black Americans and were recruited from a correctional setting. Using secondary data analysis (Shaw, L. B., & Morgan, R. D. (2011). Inmate attitudes toward treatment: Mental health service utilization and treatment effects. Law and Human Behavior, 35(4), 249–261. https://doi.org/10.1007/s10979-010-9233-5.), results indicated that Black men with a mental health diagnosis were more likely than those without a diagnosis to report receiving mental health treatment while incarcerated. Additionally, linear regression analyses indicated that only expectations about treatment (i.e., personal commitment; not therapy fears or history of mental health diagnosis) significantly predicted the current use of mental health treatment. Implications for research and practice are discussed.

The Effect of Preoperative Diagnosis of Depression and/or Anxiety on Patient-Reported Outcomes Following Chest Wall Masculinization Surgery.

Individuals with gender dysphoria have disproportionately high rates of depression and anxiety compared to the cis-gender population. While the benefits of gender affirmation surgery have been well documented, it is unclear whether depression and anxiety affect postoperative patient-reported outcomes (PRO). The authors evaluated the impact of preoperative anxiety or depression on clinical and PRO in patients undergoing chest masculinization surgery. Patients who underwent chest masculinization surgery within a 5-year period were reviewed. Demographics and clinical variables were abstracted from medical records. PRO of chest, nipple and scar satisfaction were obtained postoperatively using the BODY-Q. Groups were stratified by preoperative anxiety, preoperative depression, both or no history of mental health diagnosis. Univariate and multivariate analysis were performed. Of 135 patients with complete survey responses, 10.4% had anxiety, 11.9% depression, 20.7% both diagnoses, and 57.0% no diagnosis. Clinical data and outcomes were similar. Patients with preoperative depression correlated with lower satisfaction scores for scar appearance (p=0.006) and were significantly more likely to report feelings of depression postoperatively (p=0.04). There were no differences in chest or nipple satisfaction among groups. While anxiety and depression are prevalent in gender minorities, we found no association with postoperative clinical outcomes. Patients with preoperative depression were more likely to report lower satisfaction with scar appearance and feelings of depression postoperatively. However, there were no differences in chest or nipple satisfaction. These results highlight the importance of perioperative mental health counseling but also suggest that patients can be satisfied with their results despite a coexisting mental health diagnosis.

Social work in alcohol and other drug service navigation: supporting social complexity in dual diagnosis

PurposeMany people with dual diagnosis present with social complexity that impedes service access. The role of social work support in such service navigation is poorly understood. This study aims to characterise client presentations to an Australian telephone-based social work alcohol and other drug (AOD) service navigation and linkage program, with consideration of presentation complexity compared between those clients who present with or without self-reported mental health (MH) concerns and a history of MH diagnoses, to identify differences in baseline characteristics, and linkage outcomes.Design/methodology/approachA retrospective audit was conducted of routinely collected clinical information from a six-month period, selected to capture the social and health challenges experienced during the mid-pandemic period (mid-2021) in Victoria, Australia, during which a number of lockdowns resulted in a reliance on telephone-based services. The audit focused on client and presentation characteristics, and compared clients with and without a history of co-occurring MH and AOD concerns.FindingsIt was found that three in four people accessing an Australian telephone-based AOD service navigation and linkage program presented with dual diagnosis. Individuals with dual diagnosis required more support from the service compared to those without a co-occurring MH disorder; but overall, were just as likely to achieve a successful linkage to services, when offered holistic, long-term social work support.Originality/valueThis study focused on the role of social workers in this service navigation program in supporting individuals with complexity. It also highlights the challenges in operationalising social complexity factors alongside clinical MH and AOD diagnoses, and points to the need for further research to guide future service development for this vulnerable client group.

Association Between Periviable Delivery and New Onset of or Exacerbation of Existing Mental Health Disorders.

To evaluate whether there is an association between periviable delivery and new onset of or exacerbation of existing mental health disorders within 12 months postpartum. We conducted a retrospective cohort study of individuals with liveborn singleton neonates delivered at 22 or more weeks of gestation from 2008 to 2017 in the MarketScan Commercial Research Database. The exposure was periviable delivery , defined as delivery from 22 0/7 through 25 6/7 weeks of gestation. The primary outcome was a mental health morbidity composite of one or more of the following: emergency department encounter associated with depression, anxiety, psychosis, posttraumatic stress disorder, adjustment disorder, self-harm, or suicide; new psychotropic medication prescription; new behavioral therapy visit; and inpatient psychiatry admission in the 12 months postdelivery. Secondary outcomes included components of the primary composite. Those with and without periviable delivery were compared using multivariable logistic regression adjusted for clinically relevant covariates, with results reported as adjusted incident rate ratios (aIRRs). Effect modification by history of mental health diagnoses was assessed. Incidence of the primary outcome by 90-day intervals postdelivery was assessed. Of 2,300,244 included deliveries, 16,275 (0.7%) were periviable. Individuals with periviable delivery were more likely to have a chronic health condition, to have undergone cesarean delivery, and to have experienced severe maternal morbidity. Periviable delivery was associated with a modestly increased risk of the primary composite outcome, occurring in 13.8% of individuals with periviable delivery and 11.0% of individuals without periviable delivery (aIRR 1.18, 95% CI 1.12-1.24). The highest-risk period for the composite primary outcome was the first 90 days in those with periviable delivery compared with those without periviable delivery (51.6% vs 42.4%; incident rate ratio 1.56, 95% CI 1.47-1.66). Periviable delivery was associated with a modestly increased risk of mental health morbidity in the 12 months postpartum.

Risk factors for developmental vulnerability: Insight from population-level surveillance using the Early Development Instrument

Objectives Population-level studies may elucidate the most promising intervention targets to prevent negative outcomes of developmental vulnerability in children. This study aims to bridge the current literature gap on identifying population-level developmental vulnerability risk factors using combined social and biological/health information. Methods This study assessed developmental vulnerability among kindergarten children using the 2016 Early Development Instrument (EDI) and identified risk factors of developmental vulnerability using EDI data cross-linked to a population-wide administrative health dataset. A total number of 23,494 children aged 5–6 were included (48% female). Prenatal, neonatal, and early childhood risk factors for developmental vulnerability were investigated, highlighting the most important ones contributing to early development. Results The main risk factors for developmental vulnerability were children with a history of mental health diagnosis (risk ratio = 1.46), biological sex–male (risk ratio = 1.51), and poor socioeconomic status (risk ratio = 1.58). Conclusion Our study encompasses both social and health information in a populational-level representative sample of Alberta, Canada. The results confirm evidence established in other geographic regions and jurisdictions and demonstrate the association between perinatal risk factors and developmental vulnerability. Based on these results, we argue that the health system should adopt a multilevel prevention and intervention strategy, targeting individual, family, and community together.

Evaluation of the gap in delivery of opioid agonist therapy among individuals with opioid-related health problems: a population-based retrospective cohort study.

Although opioid-related harms have reached new heights across North America, the size of the gap in opioid agonist therapy (OAT) delivery for opioid-related health problems is unknown in most jurisdictions. This study sought to characterize the gap in OAT treatment using a cascade of care framework, and determine factors associated with engagement and retention in treatment. A population-based retrospective cohort study. Ontario, Canada. Individuals who sought medical care for opioid-related health problems or died from an opioid-related cause between 2005 and 2019. Monthly treatment status for buprenorphine/naloxone or methadone OAT between 2013 and 2019 (i.e. 'off OAT', 'retained on OAT < 6 months', 'retained on OAT ≥ 6 months'). Of 122 811 individuals in the cohort, 97 516 (79.4%) received OAT at least once during the study period. There was decreasing 6-month treatment retention over time. Model results indicated that males had higher odds of being on OAT each month [odds ratio (OR) = 1.26, 95% confidence interval (CI) = 1.23-1.28] but lower odds of OAT retention (OR = 0.90, 95% CI = 0.88-0.92), while the reverse was observed for older individuals (monthly: OR = 0.76 per 10-year increase, 95% CI = 0.76-0.77; retention: OR = 1.36 per 10-year increase, 95% CI = 1.34-1.38) and individuals with higher neighbourhood income (e.g. highest income quintile, monthly: OR = 0.79, 95% CI = 0.77-0.82; highest income quintile, retention: OR = 1.15, 95% CI = 1.11-1.20). Individuals residing in rural areas and with a history of mental health diagnoses had poorer outcomes overall, including lower odds of being on OAT each month (rural: OR = 0.75, 95% CI = 0.73-0.78; mental health: OR = 0.89, 95% CI = 0.87-0.92) and OAT retention (rural: OR = 0.79, 95% CI = 0.77-0.82; mental health: OR = 0.81, 95% CI = 0.78-0.83), as well as higher risk of starting/stopping OAT [rural, starting OAT: hazard ratio (HR) = 1.07, 95% CI = 1.05-1.10; mental health, starting OAT: HR = 1.20, 95% CI: 1.18-1.23; rural, stopping OAT: HR = 1.24, 95% CI: = 1.22-1.26; mental health, stopping OAT: HR = 1.11, 95% CI = 1.09-1.13]. Individuals with a history of mental health diagnoses also had a higher risk of death, regardless of OAT status (off OAT death: HR = 1.49, 95% CI = 1.33-1.66; on OAT death: HR = 1.20, 95% CI = 1.09-1.31). Factors influencing engagement and declining retention in treatment with opioid agonist therapy in Ontario's health system include age, sex and neighbourhood income, as well as mental health diagnoses or residing in rural regions.

Cognitive and psychological improvements following CogSMART in veterans with mental health diagnoses

Introduction The present study examined the efficacy of a CogSMART-based program in improving cognitive and emotional functioning in a clinic-based sample of Veterans presenting with cognitive concerns and history of mental health diagnoses. Method Forty Veterans (Mage = 61.2 years, 85% male) completed a weekly CogSMART-based group program as well as a battery of neuropsychological and psychological measures at both pre- and post-group evaluations. Participants met DSM-5 criteria for at least one mental health diagnosis. Results Significant improvements on global cognition as well as measures of learning/memory and attention were observed from pre- to post-group (p < .05, cohen’s d range = .48–1.01). As many as 33.3% of participants showed significant improvement, depending on the cognitive domain. Significant overall improvements were observed in depression symptoms and life satisfaction (p < .01, cohen’s d = .67 and .59, respectively). Over one-third of the sample demonstrated a reliable improvement in depressive symptoms, 25% in anxiety symptoms, and 18% in life satisfaction. Conclusions Among individuals with mental health diagnosis but without major neurocognitive disorders, CogSMART-based interventions may be an effective treatment for improving aspects of cognition, depression, and life satisfaction.

Tobacco Treatment Outcomes for Hospital Patients With and Without Mental Health Diagnoses.

BackgroundThe prevalence of mental health conditions is higher in cigarette smokers than nonsmokers. However, those with diagnosed mental health disorders are understudied within general inpatient hospital settings. This study seeks to evaluate how having a mental health diagnosis influences response to a brief opt-out inpatient tobacco treatment intervention.MethodsData included 4,153 admitted patients who completed a tobacco treatment visit. Post-discharge self-reported abstinence was obtained via response to an automated call 1-month after discharge. Mental health co-morbidities were assessed by reviewing electronic medical records. Logistic regression was used to assess associations between having a mental health diagnosis and patients' smoking history, interest in quitting smoking, and post-discharge abstinence.ResultsOverall 34.1% of patients were diagnosed with mental health disorders, most commonly depression or substance use disorders. Patients with a diagnosed mental health disorder were more likely to report a history of long-term heavy smoking and were less likely to express an interesting in remaining abstinent from smoking after hospitalization. An intent-to-treat analysis using logistic regression analysis found lower rates of self-reported smoking abstinence in those with a mental health disorder compared to those without (9 vs. 13.2%, p < 0.001).ConclusionsPatients with a history of mental health diagnoses, such as depression or substance use disorders, was associated with lower rates of smoking abstinence in patients after hospitalization. Hospital based opt-out smoking cessation programs have shown to be generally effective and efficient. However, certain subpopulations may require tailored intervention in order to improve treatment outcomes. Future research is needed to develop brief, effective tobacco treatment for hospital patients with comorbid mental health diagnoses.

Researching the researchers: psychological distress and psychosocial stressors according to career stage in mental health researchers

BackgroundAlthough there are many benefits associated with working in academia, this career path often involves structural and organisational stressors that can be detrimental to wellbeing and increase susceptibility to psychological distress and mental ill health. This exploratory study examines experiences of work-related psychosocial stressors, psychological distress, and mental health diagnoses among mental health researchers.MethodsThis international cross-sectional study involved 207 mental health researchers who were post-graduate students or employed in research institutes or university settings. Work-related psychosocial stressors were measured by the Copenhagen Psychosocial Questionnaire III (COPSOQ III). Psychological distress was assessed using the Depression-Anxiety-Stress Scale-21 (DASS-21). Thoughts of suicide was assessed using an adaptation of the Patient Health Questionnaire-9 (PHQ-9). History of mental health diagnoses was assessed through a custom questionnaire. Pearson’s chi-square test of independence was used to compare mental health diagnoses and suicidal ideation across career stages. The association between work-related psychosocial stressors and psychological distress was conducted using multivariate linear regression controlling for key demographic, employment-related and mental health factors.ResultsDifferences in ‘demands at work’ and the ‘work-life balance’ domain were lowest among support staff (p = 0.01). Overall, 13.4% of respondents met the threshold for severe psychological distress, which was significantly higher in students compared to participants from other career stages (p = 0.01). Among the subgroup of participants who responded to the question on mental health diagnoses and suicidal ideation (n = 152), 54% reported a life-time mental health diagnosis and 23.7% reported suicidal ideation since their academic career commencement. After controlling for key covariates, the association between the ‘interpersonal relations and leadership’ domain and psychological distress was attenuated by the mental health covariates included in model 3 (β = −0.23, p = 0.07). The association between the remaining work-related psychosocial stressors and psychological distress remained significant.ConclusionsDespite working in the same environment, research support staff report experiencing significantly less psychosocial stressors compared to postgraduate students, early-middle career researchers and senior researchers. Future research that targets key modifiable stressors associated with psychological distress including work organization and job content, and work-life balance could improve the overall mental health and wellbeing of mental health researchers.

Perceptions of Help-Seeking Barriers Among College Students With Mental Health Disabilities

Colleges and universities are seeing increasing numbers of students seeking mental health services, including both students who have a history of mental health conditions and those seeking support for the first time. The academic consequences for students with mental health conditions are significant, including poor class attendance, lower grade-point average, and course failure. Individuals struggling academically are less likely to persist and graduate with a degree. Understanding student experiences, including their satisfaction with mental health services, is critical to providing effective resources. Perceptions of stigma, campus climate, and satisfaction with services are among the most prevalent barriers to help-seeking, presenting significant challenges to efforts to support student mental health. This study used data from the Healthy Minds questionnaire to examine differences in perceptions of help-seeking barriers based on students’ history of mental health diagnoses and indicators of self-harm. Results indicated students with histories of mental health and/or risk of self-harm have fewer positive perceptions of stigma, campus climate, and satisfaction with services on campus. Suggestions for professionals providing supports to college students with mental health disabilities are provided.

Abstract PS9-29: Factors influencing fatigue in breast cancer patients undergoing breast irradiation

Abstract Background: Fatigue is one of the most common acute complications of radiation therapy (RT). It can have a serious impact on a patient’s quality of life and ability to engage in treatment, and has been associated with lower recurrence-free and overall survival in patients with breast cancer. The pathogenesis of radiation-induced fatigue remains elusive, and factors implicated include biological (low hemoglobin and elevated pro-inflammatory cytokines and chemokines) and psychological (pain, depression and anxiety). Although it is a common clinical issue, optimal treatment strategies are lacking, and a better understanding of the mechanisms involved is needed to devise effective interventions. The purpose of this exploratory, non-randomized, prospective study was to examine a number of possible biological and psychological factors influencing fatigue in patients undergoing breast irradiation for early stage breast cancer. Methods: All subjects were assessed at five time points: immediately before RT, mid-point of RT, end of RT, and 6 months and 1 year after completion of RT. Clinical evaluation of skin toxicity and cosmetic outcome and laboratory measures evaluating anemia and hepatic toxicity were performed. Laboratory markers of systemic inflammatory/stress response included salivary cortisol, CRP and cytokines. Caspase-1 and caspase-3, novel markers of apoptosis, were also collected. Fatigue, distress, depression, anxiety, sleep, energy level and pain were assessed at each time point using validated measures. A two-sample student t-test or a non-parametric Wilcoxon rank sum test was used to identify significant associations between fatigued and non-fatigued subjects at each time point. Results: Fifty-three subjects completed the study. Subjects were predominantly white and non-Hispanic, middle to upper-middle class, with a mean age of 59. Fatigued subjects were more likely than non-fatigued subjects to have a history of anxiety and/or depression. Across all subjects, fatigue increased during treatment and returned to or near baseline by 6 months after treatment. Fatigue was significantly associated with overall distress, energy level, and some measures of physical and functional well-being during treatment; these associations were not present at baseline and resolved by 6 months. Fatigued subjects were more likely to have increases in depression scores by the end of treatment, although mean depression scores did not reach clinical significance. Fatigue was significantly associated with breast-specific pain by the end of treatment, and this resolved by 6 months. Fatigue was significantly associated with some measures of sleep at baseline, and this persisted during treatment and resolved by 6 months to 1 year. Fatigue was not associated with measures of skin toxicity and cosmetic outcome and laboratory measures of anemia, hepatic toxicity, salivary cortisol, caspase-1, caspase-3, and IL-10; most other cytokines were undetectable. Conclusions: This was a comprehensive, longitudinal study evaluating the association of biological and psychological factors with the development of fatigue in patients undergoing breast irradiation. As expected, in patients experiencing heightened fatigue during breast irradiation, fatigue was greatest at the end of treatment and returned to or near baseline by 6 months after treatment. Important associations with the development of fatigue included physical and functional parameters, and of particular significance were patients with a prior history of mental health diagnoses. In contrast to previous studies, we did not find an increase in pro-inflammatory or in novel biomarkers including caspase-1 and caspase-3. Identification of and interventions directed at those patients at risk could impact positively on the experience associated with fatigue and radiation. Citation Format: Edward Perry, Sudhanshu Mulay, Jayesh Kamath, Robert Dowsett, Rong Wu, Xiaoyan Wang, Matthew Greenwood, Jacob Neuwirth, James Grady, Bruce Liang, Susan Tannenbaum. Factors influencing fatigue in breast cancer patients undergoing breast irradiation [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-29.

The Impact of Prior Mental Health Diagnosis on Emergency Room Visits and Mortality Following a Cancer Diagnosis

Cancer patients are at increased risk of mental and emotional distress. Patients with prior mental health diagnoses may be particularly vulnerable following a cancer diagnosis. The aim of this study was to investigate the impact of prior mental health diagnosis on emergency visits and mortality following a cancer diagnosis. An institutional de-identified electronic health data warehouse was used to identify patients with and without a prior history of mental health diagnosis (MHD, ICD10 codes F00-F99, excluding tobacco codes F17.2XX) who subsequently received a new diagnosis of cancer (ICD10 codes C00-97). Demographics, including age, sex, race, marital and smoking status, time to emergency room (ER) visit and mortality from date of cancer diagnosis, ICD cancer group, and comorbidities were extracted; Charlson score excluding cancer was calculated. Propensity score matching was used to identify a matched cohort of patients without prior history of MHD with similar demographics, Charlson score, cancer group, length of follow up, and year of diagnosis, and uni- and multi-variate Cox regression (MVA) was applied with time to ER visit and mortality as endpoints. A total of 34,475 patients with 175,784 person-years of follow up and complete data were identified who received a new cancer diagnosis between January 1981 and July 2019, of whom 7,689 (22.3%) had a prior MHD. Mood disorder (50%, ICD10 F30-39), anxiety-related disorders (28%, ICD10 F40-48), and non-tobacco substance use disorders (8%, ICD-10 F10-19) were most common. Patients with a prior MHD were more likely to be female (54% vs 47%, P<2ê-16, Logistic regression), African American (7% vs 4%, P = 0.007), to be a current or former smoker (45% vs 36%, P<2ê-16), to have a higher Charlson score (mean 1.5 vs 0.83, P<2.2ê-16), and less likely to be married (47% vs 60%, P<2ê-16). On MVA, prior MHD was associated with a higher rate of ER visit following a cancer diagnosis (Hazard ratio [HR] 1.28, 95% CI 1.22-1.35, P<2ê-16), but not mortality (P = 0.33). 1.2% of first ER visits among patients with prior MHD were for suicidal ideation, compared to 0.15% among patients without prior MHD (Odds ratio 8.4, 95% CI 3.7-19.2, P<0.0001, Fisher’s exact test). Propensity matching identified a cohort of patients without prior MHD (N = 7,689) with similar demographics, cancer type, a more similar Charlson score (1.7 vs 1.6), and follow up (5.9 vs 5.7 years). In comparison to this matched cohort, patients with a prior MHD still had a significantly higher rate of ER visit following a cancer diagnosis (HR 1.28, 95% CI 1.20-1.36, P<5.6ê-16), but not mortality (P = 0.34). In this retrospective cohort, presence of a mental health diagnosis prior to cancer diagnosis was associated with a higher rate of emergency room visits, but not mortality, after accounting for demographic and clinical covariates. Patients with risk factors reported here may benefit from focused mental health and supportive care following a cancer diagnosis.

Adding perinatal anxiety screening to depression screening: is it worth it?

Screening for peripartum depression is widely recommended and should now be the standard of care. However, little research exists on peripartum anxiety screening. The purpose of this study was to assess whether adding perinatal anxiety screening would increase the identification of women who would benefit from mental health support. The existing practice at our clinic was depression screening via the Patient Health Questionnaire-2 at all prenatal visits; screenings were prospectively tracked for 3 months in women presenting for visit at 24-28 weeks gestation (Patient Health Questionnaire-2-only group). We then added Generalized Anxiety Disorder 2-item validated anxiety scale assessment to prenatal visits at 24-28 weeks gestation (Patient Health Questionnaire-2+Generalized Anxiety Disorder 2-item group). Our primary study outcome was the rate of positive depression and anxiety screens during pregnancy; secondary outcomes included referral rates to mental health services and obstetric and medical outcomes. A total of 100 women with visits at 24-28 weeks gestation were eligible to be screened during the Patient Health Questionnaire-2-only period; 125 women were eligible for screening during the Patient Health Questionnaire-2+Generalized Anxiety Disorder 2-item period. In the Patient Health Questionnaire-2-only group, 51 women were screened, with 2 positive depression screens. In the Patient Health Questionnaire-2+Generalized Anxiety Disorder 2-item group, 40 women were screened, with 5 positive screens for depression and 4 for anxiety. Three women who were anxiety-positive had been negative via depression screening. Mental health referral was not different between the 2 groups (odds ratio, 1.75; 95% confidence interval, 0.76-4.97), but a significant increase in referral was noted for Patient Health Questionnaire-2+Generalized Anxiety Disorder 2-item subgroups with a history of mental health diagnosis (odds ratio, 14.9; 95% confidence interval, 5.6-39.7) or substance abuse (odds ratio, 26.7; 95% confidence interval, 4.6-155.0). Screening for perinatal anxiety may increase referral rates to mental health professionals who can then diagnose and treat women who experience mood and anxiety disorders. Anxiety screening may be particularly useful in populations with a history of mental health diagnoses or substance abuse. Further research is necessary to understand how perinatal anxiety screening should be best implemented.

271 Higher Charlson-Deyo Score May Result in Delay to Colonoscopy in Veterans Subsequently Diagnosed With Colorectal Cancer

INTRODUCTION: Colorectal cancer (CRC) is the second most common cause of cancer deaths in the United States and expected to cause 51,020 deaths in 2019. Early detection with yearly fecal occult blood test (FOBT) has been proven to decrease CRC mortality. A 30-day delay from positive FOBT to colonoscopy has been shown to be associated with increased risk of CRC. 1 Currently, the Veterans Affairs Health System (VAHS) treats approximately 11% of CRCs in the United States. The compounding effects of an aging population, physician shortage, and increased military personnel entering the VAHS can increase demands on VAHS resources. The primary aim of this study was to determine risk factors that caused delay to colonoscopy. METHODS: We retrospectively reviewed records of 600 patients referred for colonoscopy between January 1999 and January 2009 and were subsequently diagnosed with CRC. Patients were excluded if a prior CRC diagnosis had been established. The final study cohort consisted of 530 patients. Using Chi square and Fisher's testing, we examined the relationship between 10 variables and delay in time from initial consultation to colonoscopy. Variables consisted of age, sex, race, ethnicity, CRC location, marital status, history of mental health diagnosis, tobacco use, substance abuse, Charlson/Deyo (C/D) score and season of referral for colonoscopy. A delay in time was defined as 30 days or greater. Further logistic regression analysis adjusted for age, race, CRC location and C/D score. RESULTS: A total of 87.17% of patients experienced a delay in time from initial consultation to colonoscopy. When analyzed with a predictive variable of delay to colonoscopy, C/D score of ≥2 versus 0, was associated with higher odds of delay in time to colonoscopy (OR = 2.18, P = 0.02). African American race and Hispanic ethnicity was associated with a higher odds of delay in time to colonoscopy, but was not statistically significant (OR = 1.47, P = 0.47, OR = 1.37, P = 0.48). CONCLUSION: Patients with a C/D score ≥2 were 218% more likely to have delay in time from initial consult to colonoscopy, resulting in a delayed CRC diagnosis. C/D score may be used to determine which patients should have more frequent reminders to schedule their colonoscopy to prevent delays in care. Randomized and prospective studies will need to be performed.