History Of Treatment For Depression Research Articles

Associations between psychosocial work environment factors and first-time and recurrent treatment for depression: a prospective cohort study of 24,226 employees.

Adverse factors in the psychosocial work environment are associated with the onset of depression among those without a personal history of depression. However, the evidence is sparse regarding whether adverse work factors can also play a role in depression recurrence. This study aimed to prospectively examine whether factors in the psychosocial work environment are associated with first-time and recurrent treatment for depression. The study included 24,226 participants from the Danish Well-being in Hospital Employees study. We measured ten individual psychosocial work factors and three theoretical constructs (effort-reward imbalance, job strain and workplace social capital). We ascertained treatment for depression through registrations of hospital contacts for depression (International Statistical Classification of Diseases and Related Health Problems version 10 [ICD-10]: F32 and F33) and redeemed prescriptions of antidepressant medication (Anatomical Therapeutic Chemical [ATC]: N06A) in Danish national registries. We estimated the associations between work factors and treatment for depression for up to 2 years after baseline among those without (first-time treatment) and with (recurrent treatment) a personal history of treatment for depression before baseline. We excluded participants registered with treatment within 6 months before baseline. In supplementary analyses, we extended this washout period to up to 2 years. We applied logistic regression analyses with adjustment for confounding. Among 21,156 (87%) participants without a history of treatment for depression, 350 (1.7%) had first-time treatment during follow-up. Among the 3070 (13%) participants with treatment history, 353 (11%) had recurrent treatment during follow-up. Those with a history of depression generally reported a more adverse work environment than those without such a history. Baseline exposure to bullying (odds ratio [OR] = 1.72, 95% confidence interval [95% CI]: 1.30-2.32), and to some extent also low influence on work schedule (OR = 1.27, 95% CI: 0.97-1.66) and job strain (OR = 1.24, 95% CI: 0.97-1.57), was associated with first-time treatment for depression during follow-up. Baseline exposure to bullying (OR = 1.40, 95% CI: 1.04-1.88), lack of collaboration (OR = 1.31, 95% CI: 1.03-1.67) and low job control (OR = 1.27, 95% CI: 1.00-1.62) were associated with recurrent treatment for depression during follow-up. However, most work factors were not associated with treatment for depression. Using a 2-year washout period resulted in similar or stronger associations. Depression constitutes a substantial morbidity burden in the working-age population. Specific adverse working conditions were associated with first-time and recurrent treatment for depression and improving these may contribute to reducing the onset and recurrence of depression.

Disparities in the use of mental health services of adolescents in Chile

To examine disparities in the use of mental health services (MHS) in adolescents according to sociodemographic factors. 2,022 adolescents aged 13-19 years in Santiago, Chile, participated in the study. Between April and May 2008, they answered a self-report survey that assessed lifetime (history of treatment for depression) and current (psychological or pharmacological treatment) use of MHS, sociodemographic variables, and psychopathology as symptoms of depression, symptoms of generalized anxiety disorder, and risk of problematic substance use. Data were analyzed using logistic regression. 16.5% of participants reported lifetime use of MHS due to depression, 9.7% were on current psychological treatment, and 2.7% were on current pharmacological treatment. Among those meeting criteria for a mental health problem, only 14.9% to 18.9% were currently on treatment. Males, younger participants, and those who had immigrants' parents reported lower lifetime use of MHS due to depression. Those with parents with 9 to 12 years of education and who had immigrants' parents reported lower current MHS use. Youth not living with both parents reported higher lifetime and current MHS use. We observe a high treatment gap in those with mental health needs as well as differences in MHS use based on socio-demographic variables. These results may be useful for planning interventions that favor access to and use of MHS, especially in the most disadvantaged groups of adolescents.

Maternal aggressive behavior in interactions with adolescent offspring: Proximal social-cognitive predictors in depressed and nondepressed mothers.

Maternal depressive symptoms are associated with elevations in harsh parenting behavior, including criticism, negative affect, and hostile or coercive behavior, and these behaviors contribute to associations between maternal depressive symptomatology and child functioning. We used multilevel survival analysis to examine social-cognitive processes as proximal predictors of the onset and offset of maternal aggressive behavior during interactions with their adolescent children. Low-income women (N = 180) were selected for either: (a) elevated depressive symptoms and a history of treatment for depression (depressed group) or (b) not more than mild levels of current depressive symptomatology, no history of depression treatment, and no current mental health treatment (nondepressed group). These women and their adolescent children (ages 11-14, M = 12.93; 96 male sex, as assigned at birth) participated in a dyadic problem-solving interaction and mothers completed a video-mediated recall procedure, in which they watched a segment of the interaction, labeled their adolescents' affect, and made attributions for their behavior. Mothers in the depressed group were more likely to initiate aggressive behavior and, once initiated, were less likely to transition out of it. Mothers in both groups were less likely to transition out of aggressive behavior when they made negative attributions for their adolescents' behavior. Findings point to promising cognitive and behavioral targets for intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Depression and Anxiety of At-Risk Patients in Antepartum Units: A Pilot Observational Study

Background Perinatal depression is a common yet underdiagnosed and undertreated disorder that can occur in any trimester of pregnancy and can extend into the postpartum period. The aim of this study was to evaluate depression and anxiety in at-risk antepartum patients hospitalized due to pregnancy complications. Methods In this prospective observational study, we measured anxiety and depression using the Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) and other contributing factors. Statistical analysis was performed using IBM SPSS Version 25.0 with significance set at a p-value <0.05. Results and Discussion While 78% had no prior history of treatment for depression (p=0.018), about 33% had a history of depression. Anxiety and depression scores increased from a mean score of 2.8 on PHQ-9 and 3.5 on GAD-7 on admission to 5.0 and 6.8 during antepartum hospitalization, respectively. Conclusions This pilot study showed that antepartum admission of at-risk patients was trending toward increased risk of anxiety and depression over time.

Biological, Psychiatric, Psychosocial, and Cognitive Factors of Poststroke Depression

Depression is the most common psychiatric condition that occurs after cerebrovascular accident, especially within the first year after stroke. Poststroke depression (PSD) may occur due to environmental factors such as functional limitations in daily activities, lower quality of life, or biological factors such as damage to areas in the brain involved in emotion regulation. Although many factors are hypothesized to increase the risk of PSD, the relative contribution of these factors is not well understood. We evaluated which cross-sectional variables were associated with increased odds of PSD in our adult outpatient stroke neuropsychology clinic population. The sample included 325 patients (49.2% female; mean age of 59-years old) evaluated at an average of 8.1 months after an ischemic or hemorrhagic stroke. Variables included in logistic regression were stroke characteristics, demographics, psychosocial factors, comorbid medical problems, comorbid psychiatric conditions, and cognitive status. The Mini International Neuropsychiatric Inventory was used to determine DSM-defined PSD and anxiety disorders. A standard neuropsychological test battery was administered. PSD occurred in 30.8% of the sample. Logistic regression indicated that increased odds of PSD were associated with a comorbid anxiety disorder (5.9 times more likely to suffer from PSD, p < 0.001). Further, increased odds of PSD were associated with a history of depression treatment before stroke (3.0 times more likely to suffer from PSD), fatigue (2.8 times more likely), memory impairment (2.4 times more likely), and younger age at stroke (all p values < 0.006). Results suggest that PSD is likely multifactorial and extends the literature by demonstrating that a comorbid anxiety disorder correlated strongest with PSD. Poststroke screening and treatment plans should address not only depression but comorbid anxiety.

Multimodal Feature Selection for Detecting Mothers' Depression in Dyadic Interactions with their Adolescent Offspring.

Depression is the most common psychological disorder, a leading cause of disability world-wide, and a major contributor to inter-generational transmission of psychopathology within families. To contribute to our understanding of depression within families and to inform modality selection and feature reduction, it is critical to identify interpretable features in developmentally appropriate contexts. Mothers with and without depression were studied. Depression was defined as history of treatment for depression and elevations in current or recent symptoms. We explored two multimodal feature selection strategies in dyadic interaction tasks of mothers with their adolescent children for depression detection. Modalities included face and head dynamics, facial action units, speech-related behavior, and verbal features. The initial feature space was vast and inter-correlated (collinear). To reduce dimensionality and gain insight into the relative contribution of each modality and feature, we explored feature selection strategies using Variance Inflation Factor (VIF) and Shapley values. On an average collinearity correction through VIF resulted in about 4 times feature reduction across unimodal and multimodal features. Collinearity correction was also found to be an optimal intermediate step prior to Shapley analysis. Shapley feature selection following VIF yielded best performance. The top 15 features obtained through Shapley achieved 78% accuracy. The most informative features came from all four modalities sampled, which supports the importance of multimodal feature selection.

Language Use in Mother-Adolescent Dyadic Interaction: Preliminary Results.

This preliminary study applied a computer-assisted quantitative linguistic analysis to examine the effectiveness of language-based classification models to discriminate between mothers (n = 140) with and without history of treatment for depression (51% and 49%, respectively). Mothers were recorded during a problem-solving interaction with their adolescent child. Transcripts were manually annotated and analyzed using a dictionary-based, natural-language program approach (Linguistic Inquiry and Word Count). To assess the importance of linguistic features to correctly classify history of depression, we used Support Vector Machines (SVM) with interpretable features. Using linguistic features identified in the empirical literature, an initial SVM achieved nearly 63% accuracy. A second SVM using only the top 5 highest ranked SHAP features improved accuracy to 67.15%. The findings extend the existing literature base on understanding language behavior of depressed mood states, with a focus on the linguistic style of mothers with and without a history of treatment for depression and its potential impact on child development and trans-generational transmission of depression.

A-07 Initial Symptoms, Pre-Existing Emotional Factors, and Symptoms of Stress During Recovery from Concussion

Abstract Purpose: Investigate the association of initial symptoms, mechanism of concussion, and emotional state with symptoms of stress reported during recovery from concussion in high school students. Methods: Concussed High School students (n = 183) aged 13–18 were evaluated within 30 days of injury at a North Texas Concussion Registry (ConTex) clinic with 71% (n = 130) sport-related. Subjects completed a medical history, the Sport Concussion Assessment Tool-5 Symptom Evaluation (PCSS), General Anxiety Disorder (GAD-7), and Patient Health Questionnaire-8 (PHQ-8) at initial visit. At three-month follow-up subjects completed the PTSD Checklist for DSM-5 (PCL-5). A linear regression was conducted predicting total scores on the follow up PCL-5. Predictors included initial Total PCSS Symptom Score, GAD-7, PHQ-8, sex, mechanism of injury (sport vs non-sport) and history of treatment for anxiety/depression. Results: A multiple regression model predicting participant’s total PCL-5 score at three month follow-up (R2 = 0.40, p &amp;lt; 0.001) included PHQ-8 (β = 0.34, p &amp;lt; 0.001), GAD-7 (β = 0.20, p = 0.016), history of treatment for depression (β = 0.17, p = 0.015), severity of initial symptoms (β = 0.15, p = 0.045) and mechanism of injury (β = −0.14, p = 0.018). There was no significant difference in PCL-5 scores between sport vs non-sport injury groups. Conclusions: Pre-existing depression and higher levels of self-reported anxiety and/or depression at time of injury may be associated with increased symptoms of stress during concussion recovery. Severity of initial symptoms and mechanism of injury may also be related to feelings of stress during recovery. Further investigations should include baseline measure of stress prior to injury.

A National Retrospective Study of Antidepressants' Effects on Overdose and Self-Harm Among Adults Treated With Opioid Analgesics.

Because individuals with a history of depression who are receiving opioids are at higher risk for adverse events, the authors examined whether antidepressant treatment reduces risk for overdose and self-harm among individuals with a history of depression who receive opioids. Commercial insurance claims of individuals with a history of depression receiving opioids from 2007 to 2017 were used to quantify the association between antidepressant fills and adverse events among individuals after initiation of opioid treatment; the authors accounted for selection into treatment and used discrete-time, proportional hazards survival models. Among 283,374 adults with a history of depression treatment, 8,203 experienced 47,486 adverse events from 2007 to 2017 in the 12 months after initiation of opioid treatment. Approximately half (N=144,052, 50.8%) filled an antidepressant prescription at least once in the 12 months after the opioid episode began. Individuals receiving antidepressants for at least 6 weeks had a reduced risk for any adverse event (adjusted odds ratio [AOR]=0.79, 95% confidence interval [CI]=0.65-0.97) as well as a reduced risk for opioid overdoses (AOR=0.78, 95% CI=0.64-0.96), overdoses from nonopioid controlled substances (AOR=0.76, 95% CI=0.62-0.94), overdoses from other substances (AOR=0.79, 95% CI=0.65-0.97), and other self-harm events (AOR=0.82, 95% CI=0.67-1.00). Individuals with a history of depression who received opioid analgesics had a significantly lower risk for overdose and self-harm after they had been taking antidepressants for at least 6 weeks. Universal screening for mood disorders among individuals receiving opioids, and promptly providing evidence-based depression treatment when appropriate, may reduce adverse events.

The Wicked Problem of Physician Well-Being.

The collective threat to physician well-being is a complex issue with no clear solution. Even before the coronavirus disease 2019 pandemic, physicians suffered from widespread burnout and moral injury, with negative consequences for patient care, physician health, and the health care system. Initial clinician well-being efforts leaned heavily on individual-focused interventions. However, workplace culture and environment are key factors that affect burnout, and therefore clinician well-being efforts require both individual-focused and systems-level interventions. A sustainable culture of support in medicine is necessary to foster physician well-being.

An evaluation of patient-reported outcomes in sickle cell disease within a conceptual model

PurposeTo examine the relations between patient-reported outcomes (PROs) within a conceptual model for adults with sickle cell disease (SCD) ages 18 – 45 years enrolled in the multi-site Sickle Cell Disease Implementation Consortium (SCDIC) registry. We hypothesized that patient and SCD-related factors, particularly pain, and barriers to care would independently contribute to functioning as measured using PRO domains.MethodsParticipants (N = 2054) completed a 48-item survey including socio-demographics and PRO measures, e.g., social functioning, pain impact, emotional distress, and cognitive functioning. Participants reported on lifetime SCD complications, pain episode frequency and severity, and barriers to healthcare.ResultsHigher pain frequency was associated with higher odds of worse outcomes in all PRO domains, controlling for age, gender and site (OR range 1.02–1.10, 95% CI range [1.004–1.12]). Reported history of treatment for depression was associated with 5 of 7 PRO measures (OR range 1.58–3.28 95% CI range [1.18–4.32]). Fewer individual barriers to care and fewer SCD complications were associated with better outcomes in the emotion domain (OR range 0.46–0.64, 95% CI range [0.34–0.86]).ConclusionsStudy results highlight the importance of the biopsychosocial model to enhance understanding of the needs of this complex population, and to design multi-dimensional approaches for providing more effective interventions to improve outcomes.

Late-onset depression: A risk factor for major neurocognitive disorder?

BackgroundDepression and dementia/major neurocognitive disorder (MNCD) are the most common psychiatric morbidities in elderly people. ObjectivesTo assess whether late-onset depression (LOD)—defined as onset of first major depressive episode occurring at or above 50 years—and other socio-demographic and clinical variables are risk factors for MNCD in those aged 60 years or above. MethodsA hospital-based, case-control study was undertaken, with 170 cases of MNCD and 172 controls without MNCD (as assessed using Malayalam adaptation of Addenbrooke's Cognitive Examination). Participants were evaluated for LOD using Structured Clinical Interview for Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition-Text Revision- Research Version. ResultsLOD had a crude OR of 1.22 (95% CI = 0.75–2.00). On univariate analysis, age group ≥80 years, family history of MNCD, hypertension, hyperlipidaemia, movement disorder, normal pressure hydrocephalus and history of treatment for depression were found to be significant risk factors and low income a significant protective factor. After adjusting for socio-demographic and clinical variables using multiple logistic regression, LOD was not found to be a significant risk factor for MNCD (adjusted OR = 0.62, 95% CI = 0.32–1.20). Age ≥80 years, female sex, history of treatment for depression, family history of MNCD, hyperlipidaemia and movement disorders were significant risk factors for MNCD, in the model. ConclusionsLOD does not increase the risk of MNCD significantly in elderly population. Increasing age, female sex, a positive family history of MNCD and medical comorbidities like hyperlipidaemia and movement disorders were significant risk factors along with a history of treatment for depression.

Affective and Autonomic Reactivity During Parent-Child Interactions in Depressed and Non-Depressed Mothers and Their Adolescent Offspring.

Depression presents risks that are profound and intergenerational, yet research on the association of depression with the physiological processes that might be associated with impaired mental and physical health has only recently been contextualized within the family environment. Participants in this multi-method case-control study were 180 mother-adolescent dyads (50% mothers with a history of depression treatment and current depressive symptoms). In order to examine the association between maternal depression and affective and autonomic reactivity amongst these mothers and their adolescent offspring we collected self-reported measures of positive and negative affect, as well as measures of cardiovascular and electrodermal autonomic activity, during mother-adolescent interaction tasks. Findings indicated that depressed mothers and their adolescent offspring exhibited greater self-reported negative affect reactivity during a problem-solving interaction and blunted (i.e., low) sympathetic activity as measured via skin conductance level across both interaction tasks. These effects remained significant after controlling for a range of potential covariates, including medication use, sex, age, adolescents own mental health symptoms, and behavior of the other interactant, along with correcting for multiple comparisons. Findings indicate that depressed mothers and their adolescent offspring both exhibit patterns of affect and physiology during interactions that are different from those of non-depressed mothers and their offspring, including increased negative affect reactivity during negative interactions and blunted sympathetic activity across both positive and negative interactions. These findings have potential implications for understanding the role of family processes in the intergenerational transmission of risk for depressive disorders.

Physical health impairment, disability and suicidal intent among self-harm survivors in South India

Background: Suicide is major public health concern in India. There are limited data examining the relationship between health impairment, disability and severity of suicidal intent. The aim of the study was to examine the associations of health impairment and disability with severity of suicidal intent among survivors following an act of self-harm.Methods: A pilot exploratory study of 453 self-harm survivors from a specialist hospital in South India. Socio-demographics, physical health impairment, disability (WHO Disability Schedule-II), suicidal intent, (Pierce suicide intent scale) and mental disorders were studied.Results: Arthritis was the most common physical impairment among self-harm survivors followed by gastrointestinal, sensory impairment and difficulty with mobilization. Nearly 10% of participants had some degree of functional impairment, with 38% experiencing severe physical pain in the week prior to self-harm. Past history of depression treatment, age, education and occupation influenced positively PSIS scores. There were significant associations between suicidal intent and disability.Conclusions: Indian self-harm survivors indicated complex relationships between physical health, disability and suicidal intent. Understanding these associations may help to develop suicide prevention strategies. Our findings suggest a need for integrating a comprehensive of physical health assessment in self harm survivors.

Ethics for Clinicians and Surgeons: Speaking the Truth

JBR is a rural worker, he is 68 years old, and six months ago he started to have difficulties urinating during this period he lost 15 kilos (almost 33 pounds) and started to feel bone pain. About a week ago he suffered a fall and had to be hospitalized. At the hospital, they diagnosed a fracture of the femur and, after a more detailed investigation, it was detected that JBR had prostate cancer with bone metastases. His family did not want the diagnosis to be revealed to him, due to a history of treatment for depression, 3 years ago, after the death of his wife. However, the patient asked to be told the result of the biopsy performed during hospitalization. In this situation, how should the doctor proceed?

Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: the e-coachER RCT.

There is modest evidence that exercise referral schemes increase physical activity in inactive individuals with chronic health conditions. There is a need to identify additional ways to improve the effects of exercise referral schemes on long-term physical activity. To determine if adding the e-coachER intervention to exercise referral schemes is more clinically effective and cost-effective in increasing physical activity after 1 year than usual exercise referral schemes. A pragmatic, multicentre, two-arm randomised controlled trial, with a mixed-methods process evaluation and health economic analysis. Participants were allocated in a 1 : 1 ratio to either exercise referral schemes plus e-coachER (intervention) or exercise referral schemes alone (control). Patients were referred to exercise referral schemes in Plymouth, Birmingham and Glasgow. There were 450 participants aged 16-74 years, with a body mass index of 30-40 kg/m2, with hypertension, prediabetes, type 2 diabetes, lower limb osteoarthritis or a current/recent history of treatment for depression, who were also inactive, contactable via e-mail and internet users. e-coachER was designed to augment exercise referral schemes. Participants received a pedometer and fridge magnet with physical activity recording sheets, and a user guide to access the web-based support in the form of seven 'steps to health'. e-coachER aimed to build the use of behavioural skills (e.g. self-monitoring) while strengthening favourable beliefs in the importance of physical activity, competence, autonomy in physical activity choices and relatedness. All participants were referred to a standard exercise referral scheme. Minutes of moderate and vigorous physical activity in ≥ 10-minute bouts measured by an accelerometer over 1 week at 12 months, worn ≥ 16 hours per day for ≥ 4 days including ≥ 1 weekend day. Other accelerometer-derived physical activity measures, self-reported physical activity, exercise referral scheme attendance and EuroQol-5 Dimensions, five-level version, and Hospital Anxiety and Depression Scale scores were collected at 4 and 12 months post randomisation. Participants had a mean body mass index of 32.6 (standard deviation) 4.4 kg/m2, were referred primarily for weight loss and were mostly confident self-rated information technology users. Primary outcome analysis involving those with usable data showed a weak indicative effect in favour of the intervention group (n = 108) compared with the control group (n = 124); 11.8 weekly minutes of moderate and vigorous physical activity (95% confidence interval -2.1 to 26.0 minutes; p = 0.10). Sixty-four per cent of intervention participants logged on at least once; they gave generally positive feedback on the web-based support. The intervention had no effect on other physical activity outcomes, exercise referral scheme attendance (78% in the control group vs. 75% in the intervention group) or EuroQol-5 Dimensions, five-level version, or Hospital Anxiety and Depression Scale scores, but did enhance a number of process outcomes (i.e. confidence, importance and competence) compared with the control group at 4 months, but not at 12 months. At 12 months, the intervention group incurred an additional mean cost of £439 (95% confidence interval -£182 to £1060) compared with the control group, but generated more quality-adjusted life-years (mean 0.026, 95% confidence interval 0.013 to 0.040), with an incremental cost-effectiveness ratio of an additional £16,885 per quality-adjusted life-year. A significant proportion (46%) of participants were not included in the primary analysis because of study withdrawal and insufficient device wear-time, so the results must be interpreted with caution. The regression model fit for the primary outcome was poor because of the considerable proportion of participants [142/243 (58%)] who recorded no instances of ≥ 10-minute bouts of moderate and vigorous physical activity at 12 months post randomisation. The design and rigorous evaluation of cost-effective and scalable ways to increase exercise referral scheme uptake and maintenance of moderate and vigorous physical activity are needed among patients with chronic conditions. Adding e-coachER to usual exercise referral schemes had only a weak indicative effect on long-term rigorously defined, objectively assessed moderate and vigorous physical activity. The provision of the e-coachER support package led to an additional cost and has a 63% probability of being cost-effective based on the UK threshold of £30,000 per quality-adjusted life-year. The intervention did improve some process outcomes as specified in our logic model. Current Controlled Trials ISRCTN15644451. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 63. See the NIHR Journals Library website for further project information.

Latent Classes of Cognitive Functioning Among Depressed Older Adults Without Dementia.

Use latent class analysis (LCA) to identify patterns of cognitive functioning in a sample of older adults with clinical depression and without dementia and assess demographic, psychiatric, and neurobiological predictors of class membership. Neuropsychological assessment data from 121 participants in the Alzheimer's Disease Neuroimaging Initiative-Depression project (ADNI-D) were analyzed, including measures of executive functioning, verbal and visual memory, visuospatial and language functioning, and processing speed. These data were analyzed using LCA, with predictors of class membership such as depression severity, depression and treatment history, amyloid burden, and APOE e4 allele also assessed. A two-class model of cognitive functioning best fit the data, with the Lower Cognitive Class (46.1% of the sample) performing approximately one standard deviation below the Higher Cognitive Class (53.9%) on most tests. When predictors of class membership were assessed, carrying an APOE e4 allele was significantly associated with membership in the Lower Cognitive Class. Demographic characteristics, age of depression onset, depression severity, history of psychopharmacological treatment for depression, and amyloid positivity did not predict class membership. LCA allows for identification of subgroups of cognitive functioning in a mostly cognitively intact late life depression (LLD) population. One subgroup, the Lower Cognitive Class, more likely to carry an APOE e4 allele, may be at a greater risk for subsequent cognitive decline, even though current performance on neuropsychological testing is within normal limits. These findings have implications for early identification of those at greatest risk, risk factors, and avenues for preventive intervention.

Mothers’ Mental Health Care Use After Screening for Postpartum Depression at Well-Child Visits

ObjectiveThe American Academy of Pediatrics recommends postpartum depression (PPD) screening. It is unknown whether pediatricians are effective in linking mothers to mental health services. The objectives of the current study are to determine 1) mental health care use among women with Medicaid insurance after a positive PPD screen and 2) maternal and infant factors that predict the likelihood of mental health care use. MethodsRetrospective cohort design of mothers attending their infants’ 2-month well child visit at 1 of 5 urban primary care practices between 2011 and 2014. A linked dataset of the child's electronic health records, maternal Medicaid claims, and birth certificates was used. The primary outcome was mental health care use within 6 months of a positive PPD screen. Multivariate logistic regression was used to estimate maternal and infant clinical and sociodemographic factors that predict service use. ResultsIn total, 3052 mothers met study criteria, 1986 (65.1%) completed the PPD screen, and 263 (13.2%) screened positive for PPD, of whom 195 (74.1%%) were referred for services. Twenty-three women (11.8%) had at least 1 Medicaid claim for depression within 6 months of screening. In multivariate modeling, mothers with a history of depression in the previous year (odds ratio = 3.80, 1.20–12.11) were more likely to receive mental health services after a positive screen. ConclusionsFew mothers who screened positive for PPD received mental health services. Mothers without a recent history of depression treatment may be especially at risk for inadequate care. Additional mechanisms to improve access to mental health services after PPD screening are needed.

Optimal metrics for identifying long term patterns of depression in older HIV-infected and HIV-uninfected men who have sex with men

ABSTRACTObjectives: Center of Epidemiologic Studies–Depression Scale (CES-D) provides a snapshot of symptom severity at a single point in time. However, the best way of using CES-D to classify long-term depression is unclear.Method: To identify long-term depression among HIV-infected and HIV–uninfected 50+ year-old men who have sex with men (MSM) with at least 5 years of follow-up, we compared sensitivities and specificities of CES-D–based metrics (baseline CES-D; four consecutive CES-Ds; group-based trajectory models) thresholded at 16 and 20 to a clinician's evaluation of depression phenotype based on all available data including CES-D history, depression treatment history, drug use history, HIV disease factors, and demographic characteristics.Results: A positive depressive phenotype prevalence was common among HIV-infected (prevalence = 33.1%) and HIV-uninfected MSM (prevalence = 23.2%). Compared to the depressive phenotype, trajectory models of CES-D≥20 provided highest specificities among HIV-infected (specificity = 99.9%, 95% Confidence Interval [CI]:99.4%–100.0%) and HIV-uninfected MSM (specificity = 99.0%, 95% CI:97.4%–99.7%). Highest sensitivities resulted from classifying baseline CES-D ≥ 16 among HIV-infected MSM (sensitivity = 75.0%, 95% CI:67.3%–81.7%) and four consecutive CES-Ds ≥ 16 among HIV-uninfected MSM (sensitivity = 81.0%, 95% CI:73.7%–87.0%).Conclusion: Choice of method should vary, depending on importance of false positive or negative rate for long-term depression in HIV-infected and HIV-uninfected MSM.

The development and validation of the AMPREDICT model for predicting mobility outcome after dysvascular lower extremity amputation

ObjectiveThe objective of this study was the development of AMPREDICT-Mobility, a tool to predict the probability of independence in either basic or advanced (iBASIC or iADVANCED) mobility 1 year after dysvascular major lower extremity amputation. MethodsTwo prospective cohort studies during consecutive 4-year periods (2005-2009 and 2010-2014) were conducted at seven medical centers. Multiple demographic and biopsychosocial predictors were collected in the periamputation period among individuals undergoing their first major amputation because of complications of peripheral arterial disease or diabetes. The primary outcomes were iBASIC and iADVANCED mobility, as measured by the Locomotor Capabilities Index. Combined data from both studies were used for model development and internal validation. Backwards stepwise logistic regression was used to develop the final prediction models. The discrimination and calibration of each model were assessed. Internal validity of each model was assessed with bootstrap sampling. ResultsTwelve-month follow-up was reached by 157 of 200 (79%) participants. Among these, 54 (34%) did not achieve iBASIC mobility, 103 (66%) achieved at least iBASIC mobility, and 51 (32%) also achieved iADVANCED mobility. Predictive factors associated with reduced odds of achieving iBASIC mobility were increasing age, chronic obstructive pulmonary disease, dialysis, diabetes, prior history of treatment for depression or anxiety, and very poor to fair self-rated health. Those who were white, were married, and had at least a high-school degree had a higher probability of achieving iBASIC mobility. The odds of achieving iBASIC mobility increased with increasing body mass index up to 30 kg/m2 and decreased with increasing body mass index thereafter. The prediction model of iADVANCED mobility included the same predictors with the exception of diabetes, chronic obstructive pulmonary disease, and education level. Both models showed strong discrimination with C statistics of 0.85 and 0.82, respectively. The mean difference in predicted probabilities for those who did and did not achieve iBASIC and iADVANCED mobility was 33% and 29%, respectively. Tests for calibration and observed vs predicted plots suggested good fit for both models; however, the precision of the estimates of the predicted probabilities was modest. Internal validation through bootstrapping demonstrated some overoptimism of the original model development, with the optimism-adjusted C statistic for iBASIC and iADVANCED mobility being 0.74 and 0.71, respectively, and the discrimination slope 19% and 16%, respectively. ConclusionsAMPREDICT-Mobility is a user-friendly prediction tool that can inform the patient undergoing a dysvascular amputation and the patient's provider about the probability of independence in either basic or advanced mobility at each major lower extremity amputation level.