Incidence Of Depressive Disorders Research Articles

Global, regional, and national time trends in incidence for depressive disorders, from 1990 to 2019: an age-period-cohort analysis for the GBD 2019

BackgroundEven with advances in primary health care, depressive disorders remain a major global public health problem. We conducted an in-depth analysis of global, regional and national trends in depressive disorders incidence over the past 30 years.MethodsData on the incidence of depressive disorders were obtained by sex (female, male, and both), location (204 countries), age (5–84 years), year (1990–2019) from the Global Burden of Disease Study (GBD) 2019. Further, age-period-cohort modeling was used to estimate the net drift, local drift, age, period and cohort effects between 1990 and 2019.ResultsIn 2019, although the incidence of depressive disorders has increased by 59.3% to 290 million (95% UI: 256, 328), the age-standardized incidence rate has decreased by 2.35% to 3588.25 per 100,000 people (3152.71, 4060.42) compared to 1990. There was an emerging transition of incidences from the young and middle-aged population to the old population. From 1990 to 2019, the net drift of incidence rate ranged from −0.54% (−0.61%, −0.47%) in low-middle Socio-demographic Index (SDI) regions to 0.52% (0.25%, 0.79%) in high SDI regions. Globally, the incidence rate of depressive disorders increases with age, period effects showing a decreasing risk and cohort effects beginning to decline after the 1960s.ConclusionsOur current findings reflect substantial health disparities and potential priority-setting of depressive disorders incidence in the three dimensions of age, period and cohort across SDI regions, countries. The scope of healthcare to improve the progression of depressive disorders events can be expanded to include males, females of all ages.

Incidence of mental health diagnoses during the COVID-19 pandemic: a multinational network study.

Population-wide restrictions during the COVID-19 pandemic may create barriers to mental health diagnosis. This study aims to examine changes in the number of incident cases and the incidence rates of mental health diagnoses during the COVID-19 pandemic. By using electronic health records from France, Germany, Italy, South Korea and the UK and claims data from the US, this study conducted interrupted time-series analyses to compare the monthly incident cases and the incidence of depressive disorders, anxiety disorders, alcohol misuse or dependence, substance misuse or dependence, bipolar disorders, personality disorders and psychoses diagnoses before (January 2017 to February 2020) and after (April 2020 to the latest available date of each database [up to November 2021]) the introduction of COVID-related restrictions. A total of 629,712,954 individuals were enrolled across nine databases. Following the introduction of restrictions, an immediate decline was observed in the number of incident cases of all mental health diagnoses in the US (rate ratios (RRs) ranged from 0.005 to 0.677) and in the incidence of all conditions in France, Germany, Italy and the US (RRs ranged from 0.002 to 0.422). In the UK, significant reductions were only observed in common mental illnesses. The number of incident cases and the incidence began to return to or exceed pre-pandemic levels in most countries from mid-2020 through 2021. Healthcare providers should be prepared to deliver service adaptations to mitigate burdens directly or indirectly caused by delays in the diagnosis and treatment of mental health conditions.

Association Between Retirement Age and Incidence of Depressive Disorders: A 19-Year Population-Based Study

To investigate the occurrence of depressive disorders spanning the transition to retirement, and explore the relationship between retirement age and depressive disorders. We utilized a national population-based health insurance database encompassing 2 million Taiwanese individuals from 2000 to 2019. The study focused on individuals aged 50 years and older who were employed at the baseline, and 84,224 individuals had records of retirement during the follow-up period. Depressive disorders were identified using codes from the International Classification of Diseases. To assess the trend in the incidence of depressive disorders 7-year period before and after retirement, an interrupted time series analysis was performed. Cox-proportional hazard models were employed to investigate the association between retirement age and the occurrence of depressive disorders following retirement. The incidence of depression peaks at the time of retirement and shows a significant decrease after retirement. Incidence of depressive disorders was 6.4 and 7.6 per 1000 person-years among individuals who retired between the ages of 60-64 and 65-69. Comparing the two groups, those who retired between 65 and 69 exhibits a higher risk of developing depressive disorders (hazard ratio=1.10, 95% confidence interval=1.02-1.18). This association is particularly pronounced among women and individuals residing in areas with low urbanization levels. Retirement marks a crucial life milestone accompanied by a peak in depressive disorders. It is important to address the higher risk of depression associated with late retirement among socially disadvantaged groups.

Nationwide trends in the prevalence and incidence of depressive disorders and their correlates among adults with disabilities in Korea from 2006 to 2017.

Evidence suggests that people with disabilities are more likely to suffer from depression. Previous studies have focused on depressive disorders in specific disability types or age groups using small-scale cross-sectional samples. We investigated longitudinal trends in the prevalence and incidence of depressive disorders according to disability types and severity levels in the entire Korean adult population. The age-standardised prevalence and incidence of depressive disorders were investigated using National Health Insurance claims data from 2006 to 2017. The odds of depressive disorders by type and severity were examined using logistic regression after adjusting for sociodemographic characteristics and comorbidities based on merged 2006 to 2017 data. Both the incidence and prevalence of depressive disorders were higher among the disabled than the non-disabled, with the prevalence gap being larger than the incidence gap. In regression analyses, adjusting for sociodemographic characteristics and comorbidities considerably reduced the odds ratios, particularly for incidence. The severity of disabilities was inversely associated with the incidence of depressive disorders. Brain injury and disabilities in major internal organs were associated with lower odds of developing depressive disorders than in non-disabled individuals. A significant proportion of depressive disorders in disabled individuals are caused by financial hardships or comorbidities rather than disabilities themselves. We must pay special attention to those who cannot access healthcare services due to severe disabilities and those whose depressive disorders are misdiagnosed as intellectual disabilities. More research is required to elucidate the causal mechanisms underlying depressive disorders in people with various types and severities of disabilities.

The association of FKBP5 polymorphisms with the severity of depressive disorder in patients with methamphetamine use disorders.

Co-occurring depressive disorder (DD) in patients of methamphetamine use disorder (MAUD) impacts the diagnosis, treatment, and prognosis of the disease. Although FKBP5 has been associated with a variety of psychiatric disorders, whether FKBP5 influences depression susceptibility in MAUD is unknown so far. Here, we sequenced six FKBP5 single-nucleotide polymorphism (SNP) sites (rs4713916, rs6926133, rs9470080, rs737054, rs4713902, and rs9470079) in 282 methamphetamine users. MAUD and DD were evaluated by clinical questionnaires. SPSS was used to analyze the relationship between FKBP5 SNPs and DD in individuals with MAUD. Of the 282 methamphetamine users, 161 individuals met the MAUD criteria, and among them, 50 patients (31.1%) had DD co-occurring. Importantly, the incidence of DD in individuals with MAUD was 3.314 times greater than that of the methamphetamine users who did not meet the MAUD criteria (p < 0.001). Although none of the six SNPs of FKBP5 were correlated with the co-occurrence of DD in the population with MAUD, two FKBP5 alleles (rs4713916A and rs6926133A) were substantially associated with the higher DD scores in patients with MAUD (p < 0.05). Moreover, those with the two risk alleles do not have much higher scores than those with a single risk allele, and the strong linkage disequilibrium of the two SNPs may be the underlying cause of this result. Despite having weak linkage disequilibrium with either rs4713916 or rs6926133, FKBP5 rs9470079 became risky when paired with either. The results of this study revealed that the FKBP5 risk alleles (rs4713916A and rs6926133A) were associated with a greater probability of severe DD in patients with MAUD. These findings here would help with the development of biological early warning markers and the creation of personalized treatment strategies for MAUD.

Association of Psychotic Experiences and Incident Depression in a Longitudinal Population-Based Community Survey.

The present study aims to determine if psychotic experiences in a general population sample are a risk factor for depressive disorders at a 15-year follow-up visit. A longitudinal population cohort of adults over age 18 from East Baltimore were followed from 1981 to 1996 with 1409 participants included in analyses. Delusions and hallucinations and depressive disorders were assessed using DSM-III criteria. Odds ratios were obtained using logistic regression with psychotic experiences modeled both dichotomously and as count variables as predictors of major and minor depressive disorders at wave three. Age, race, and sex were included as covariates in the model. Both delusions and hallucinations were associated with an increased odds of incident depressive disorders. Delusions, but not hallucinations, were associated with increased odds of major depressive disorder (adjusted odds ratio, 3.04 [95% CI=1.29-7.13]) and both delusions and hallucinations were associated with increased odds of minor depressive disorder (adjusted odds ratios, 4.6 [95% CI=2.11-10.04] and 3.93 [95% CI=2.11-7.32]). There was a dose-response relationship in number of psychotic experiences reported and odds of depressive disorders. Lifetime psychotic experiences, particularly delusions, in the absence of mental disorders, are associated with later depressive disorders. Results persist in a dose-response manner. Future research should determine whether transitory versus persistent psychotic experiences have a differential effect on later depression.

Long-term incidence of depression in rectal cancer patients with or without stoma: a population-based cohort study.

Significant improvements have been made in the surgical treatment of rectal cancer with a higher sphincter-saving rate without compromising oncologic results. There have been studies about the quality of life of rectal cancer patients after surgery. However, no study has reported the long-term annual incidence of depression after rectal cancer surgery according to stoma status. The objective of this study was to determine the annual incidence of depression after rectal cancer surgery and the factors affecting it, especially the prevalence of depression according to the presence or duration of a stoma. Using the Korea National Health Insurance Service database, patients who underwent radical surgery for rectal cancer from 2002 to 2019 were searched. We analyzed the incidence and risk factors of depression in patients who underwent radical surgery for rectal cancer according to stoma status. Annual incidence of depression in rectal cancer patients was decreasing annually for 15 years after surgery. There was no statistically significant difference in the incidence of depression according to the stoma status. However, the diagnosis of depression within 1 year after surgery was statistically significantly increased in the permanent stoma group. There was no difference in the overall incidence of depressive disorders among patients with rectal cancer based on their stoma status. However, a permanent stoma seems to increase the incidence in the first year after surgery. Education and intensive assessments of depressive disorders in patients with permanent stoma within 1 year after surgery are needed, particularly for female patients who are under 50 years old.

Preventing the onset of depressive disorders in low-and middle-income countries: An overview.

Depressive disorders constitute an important and costly public health problem and worldwide most of the disease burden is suffered in low-and middle-income countries (LMICs). Treatments only have limited possibilities to reduce the disease burden of depressive disorders. Prevention may be one of the alternative ways to further reduce the disease burden of depressive disorders. In this paper, the results of a subgroup analysis of a previous meta-analysis on the effect of preventive interventions on the incidence of depressive disorders was undertaken. Only 6% of all trials examining the possibility to prevent the onset of major depression have been conducted in LMICs, and these studies find significantly smaller effects than those in high-income settings. It is too early, therefore, to consider implementing and disseminating preventive interventions in LMICS. However, in optimal conditions and assuming that evidence-based preventive interventions will be developed, investments should be made into treatment, universal, selective and indicated prevention, as well as in social institutions focusing on larger risk factors for mental health problems.

Understanding the basis of major depressive disorder in oncological patients: Biological links, clinical management, challenges, and lifestyle medicine.

In recent years, the incidence of different types of cancer and patient survival have been rising, as well as their prevalence. The increase in survival in recent years exposes the patients to a set of stressful factors such as more rigorous follow-up and more aggressive therapeutic regimens that, added to the diagnosis of the disease itself, cause an increase in the incidence of depressive disorders. These alterations have important consequences for the patients, reducing their average survival and quality of life, and for these reasons, special emphasis has been placed on developing numerous screening tests and early recognition of depressive symptoms. Despite that cancer and major depressive disorder are complex and heterogeneous entities, they also share many critical pathophysiological mechanisms, aiding to explain this complex relationship from a biological perspective. Moreover, a growing body of evidence is supporting the relevant role of lifestyle habits in the prevention and management of both depression and cancer. Therefore, the present study aims to perform a thorough review of the intricate relationship between depression and cancer, with a special focus on its biological links, clinical management, challenges, and the central role of lifestyle medicine as adjunctive and preventive approaches to improve the quality of life of these patients.

Association of Screen Time with Depression or Anxiety in Adolescence: In Pakistan

Depression is a serious medical illness and impacted on everything that a person feels or perceive which causes persistent feeling of sadness, loneliness, anger, anxiety and depressive disorders. There is a close association exist between depression and over screening of smartphones, computer screens or various electric appliances thus increasing the risk of depressive disorders or negatively impacted psychological well-being. The incidence of depressive disorder was seen more frequently in females than in males due to increased screening time or social networking. This study aims to determine the link of screen time and depression or anxiety in the general population. To find out the association that whether increased screening time is associated with depressive symptoms in general population or not. Cross sectional study design was selected for study and 50 individuals was selected. Convenience sampling technique was used to collect samples. Their demographic information, screen time, anxiety and depression were assessed through pre-planned questionnaire. Data wasrecorded and analyzed through SPSS version 23. The results shown that the 70.37% female suffered from depression due to increased screen time and 29.63% male suffered. Increased monitoring time leads to an increased risk of depression and anxiety, though causality cannot be determined.

Impact of the COVID-19 pandemic on diagnoses of common mental health disorders in adults in Catalonia, Spain: a population-based cohort study

ObjectiveTo investigate how trends in incidence of anxiety and depressive disorders have been affected by the COVID-19 pandemic.DesignPopulation-based cohort study.SettingRetrospective cohort study from 2018 to 2021 using the Information System...

Ten-year trends in depression care in Taiwan

The number of psychiatrists working in community clinics in Taiwan has increased dramatically in the recent decade. This study aimed to investigate the trend of prevalence and incidence of depressive disorders and assess the quality of depression care between 2007 and 2016 in Taiwan. We used the claims database derived from Taiwan's National Health Insurance (NHI) program, in which approximately 23.0 million individuals were enrolled, translating to a coverage rate of 99%. Patients with depressive disorders were identified based on International Classification of Diseases codes. The process indicators of depression care quality included visit, duration, and dose adequacy. The outcome indicators included the rate of psychiatric hospitalisation, emergency visit, self-harm hospitalisation, and suicide. The prevalence of treated depressive disorders increased from 1.61% in 2007 to 1.92% in 2016, i.e., a 25% increase, whereas the incidence of first-ever or recurrent depressive disorder did not change significantly. The number of patients treated by psychiatrists and in community clinics also increased. The quality of depression care improved, the proportion of patients receiving minimum psychiatric clinic follow-up and adequate medication increased, and the rate of emergency visits, psychiatric hospitalisation, and self-harm hospitalisation declined. The community-based psychiatric services increased and the quality indicators of depression care in Taiwan improved during 2007-2016. The causality warrants further investigations.

Analysis of the epidemiological state of mental disorders and pharmaceutical provision of patients with medicines by the government of Ukraine.

The number of patients with mental disorders is growing every year, which has a significant impact on the increase in cases of disability and loss of one of the five years of healthy life. In Ukraine, the incidence of depressive disorders and disorders caused by alcohol consumption exceeds that of Eastern Europe. The COVID-2019 global pandemic has affected the rapid spread of new cases of depressive disorders (53.2 million or 27.6%) and anxiety disorders (76.2 million or 25.6%) in 2020. These trends in Ukraine and the world have led to changes in the formation and implementation of the National Mental Health Policy, as most disorders are successfully treated with access to medicine and availability of medicines for patients.&#x0D; The aim of the work was to assess the current state of morbidity and prevalence of mental disorders in Ukraine and the world, as well as to analyse the access of medicines for patients according to current government programs.&#x0D; The objectі of the study were the data of the Center for Mental Health and Monitoring of Drugs and Alcohol of the Ministry of Health of Ukraine, regulations documents, analytical reports, international websites. The study used methods of analysis, systematization, generalization, analytical and graphical.&#x0D; The study found an annual increase in outpatient mental health care and a sharp decline in inpatient and day care. Depressive disorders show a growth trend of 6.25% in Ukraine for the period 2018–2020, for comparison – only in 2020 in the world such growth was 27.6%. Analysis of medical practice shows that most mental disorders are not diagnosed as special cases, and are treated as concomitant diseases, which significantly affects the incidence and prevalence and as a consequence of the formation of government programs to provide patients with vital medicines in outpatient treatment.&#x0D; The provision of drugs to patients on an outpatient basis today occurs according to the list of diseases defined by the Resolution of the Cabinet of Ministers of Ukraine No. 1303. Since October 1, the program of reimbursement of medicine for 9 INN has been expanded, which allowed patients with mental disorders to receive medicines free of charge or with a surcharge, without reference to their location.&#x0D; The study revealed negative trends in the incidence and prevalence of mental disorders in Ukraine as a whole and in regions compared to similar indicators in the world, as well as identify key issues affecting the formation of government programs to provide patients with basic medicines.

The contribution of type 2 diabetes mellitus to hypothalamic inflammation and depressive disorders in young patients with obesity.

BackgroundTo explore the contribution of type 2 diabetes mellitus (T2DM) to hypothalamic inflammation and depressive disorders in young patients with obesity.MethodsAccording to the diagnostic criteria for T2DM, all of patients with obesity were divided into the diabetic and the non-diabetic groups. The severity of depressive disorders was assessed by self-rating depression scale (SDS). The signal intensity (SI) ratio of the T2-weighted phase of the superior hypothalamus/amygdala (H/A) was measured using a quantitative magnetic resonance imaging (MRI) technique to evaluate hypothalamic inflammation. Univariate and multivariate logistic regression analysis was used to find the influencing factors of depressive disorder. The prediction equation’s sensitivity and specificity for the depressive disorder were calculated based on the receiver operating characteristic (ROC) curve.ResultsIn young patients with obesity and diabetes, the incidence of depression is 79.49%, which was much higher than that in patients without diabetes (P<0.001). The SI of the left H/A in young patients with obesity and diabetes is significantly higher than that in non-diabetic patients (P<0.001). The relative risks of depression are fasting blood glucose (FBG) (OR 1.60; CI: 1.26–2.05), HbA1c (OR 1.94; CI: 1.40–2.68) and triglycerides (OR 1.40; CI: 1.03–1.90). Only FBG enters the predictive equation for depressive disorder, with a 52.8% sensitivity and 84.5% specificity.ConclusionsIn young diabetic patients with obesity, the incidence of depressive disorder is high, a mechanism possibly related to the left hypothalamus inflammation. Elevated FBG can be an independent predictor of depressive disorder in young patients with obesity.

Validation of Machine Learning-Based Individualized Treatment for Depressive Disorder Using Target Trial Emulation

This study aims to develop and validate the use of machine learning-based prediction models to select individualized pharmacological treatment for patients with depressive disorder. This study used data from Taiwan’s National Health Insurance Research Database. Patients with incident depressive disorders were included in this study. The study outcome was treatment failure, which was defined as psychiatric hospitalization, self-harm hospitalization, emergency visits, or treatment change. Prediction models based on the Super Learner ensemble were trained separately for the initial and the next-step treatments if the previous treatments failed. An individualized treatment strategy was developed for selecting the drug with the lowest probability of treatment failure for each patient as the model-selected regimen. We emulated clinical trials to estimate the effectiveness of individualized treatments. The area under the curve of the prediction model using Super Learner was 0.627 and 0.751 for the initial treatment and the next-step treatment, respectively. Model-selected regimens were associated with reduced treatment failure rates, with a 0.84-fold (95% confidence interval (CI) 0.82–0.86) decrease for the initial treatment and a 0.82-fold (95% CI 0.80–0.83) decrease for the next-step. In emulation of clinical trials, the model-selected regimen was associated with a reduced treatment failure rate.

Efavirenz Is Not Associated with an Increased Risk of Depressive Disorders in Patients Living with HIV: An 11-Year Population-Based Study in Taiwan.

(1) Background: This study aimed to determine the association between the use of efavirenz and depressive disorders among human immunodeficiency virus (HIV)-infected patients. (2) Methods: A retrospective cohort study was conducted using Taiwan’s National Health Insurance Database. We identified patients receiving anti-retroviral therapy (ART) between 2000 and 2009; these patients were followed until 2010 for diagnoses of depressive disorders using the Cox proportional hazard model to estimate hazard ratios. (3) Results: After up to 11 years of follow-up, the incidence of depressive disorders for the efavirenz-treated group was estimated at 12.2/1000 person-years (PYs), and the control group was at 12.5/1000 PY (p = 0.822). The independent risk factors for depressive disorders included an insurance premium of less than NTD 17,820 (New Taiwan Dollars—NTD) (adjusted hazard ratio (aHR) 2.59, 95% confidence interval (CI), 1.79–3.76, p < 0.001), and between NTD 17,821 and NTD 26,400 (aHR 1.55, 95% CI, 1.04–2.31, p = 0.030), living in Southern Taiwan (aHR 1.49, 95% CI, 1.21–1.84, p = 0.002), and with a psychiatric history (excluding depressive disorders) (aHR 4.59, 95% CI, 3.51–6.01, p = 0.030). (4) Conclusions: This study concluded that ART-treated patients with a past history of psychiatric disorders, lower insurance premium, and living in Southern Taiwan have an increased risk of depressive disorders, which are not associated with the use of efavirenz.

The incidence of depressive disorders in patients with schizophrenia

Summary. Introduction. Historically, depressive disorders have been described in various forms of schizophrenia by Kraepelin (1923) or as a reaction to illness by Bleuler (1922). One of the alternative points of view that has been considered in recent years is that depressive disorders are a comorbid condition of schizophrenia or one of the manifestations of schizophrenia. However, to date, depression, as a symptom, is not included in the diagnostic criteria of the ICD-10. Methodological approaches to diagnosing depressive disorders in patients with schizophrenia differ in different countries and research groups. This influences the prevalence rates of depressive disorders in schizophrenic patients. Purpose. The study and systematization of studies of the incidence of depressive disorders in patients with schizophrenia.Methods. Russian-language and foreign literature was analyzed with a search depth of 10 years (2010–2020) in the following databases: PubMed, Springer, Wiley Online Library, Taylor &amp; Francis Online, US National Library of Medicine National Institutes of Health, Science Direct and eLIBRARY .RU.Results. A total of 51 studies of depressive disorders in children and adults with schizophrenia were found.Conclusion. The frequency of occurrence of depressive disorders in patients with schizophrenia varies from 9.1 and to 100%, the average frequency is 41.6%. Their frequency is variable and depends on the region of residence and ethnicity. It is noted that depressive disorders in patients with schizophrenia are more often recorded among residents of the Middle East (72.7%), Russia (61.8%) and Europe (39.6%), less often among residents of Southeast Asia (32%) and the Pacific region ( 37.3%). The countries with the highest incidence of depressive disorders in schizophrenia include: USA, Germany, China; and to the countries with the lowest frequency — Denmark, Israel, South Africa. Also, I would like to note that the largest number of studies conducted was in Europe (16 studies with 36 928 patients with schizophrenia), the USA (6 studies with 2314 patients) and the Russian Federation (6 studies with 582 patients). In general, in the world, according to 51 studies analyzed, the incidence of depressive disorders in schizophrenia in men is higher than in women, although gender differences did not reach statistical significance in all regions of the world.

P–504 A randomised controlled trial comparing expectant management or intrauterine-insemination in couples with unexplained subfertility and a poor prognosis for natural conception: the impact on health-related-quality-of-life

Abstract Study question Is health-related quality of life (HRQoL) in women with unexplained subfertility and a poor prognosis influenced by expectant management or intrauterine insemination with ovarian stimulation? Summary answer HRQoL did not differ, except for the relational domain which was lower after expectant management. Anxiety and depression disorders occurred frequently in both groups. What is known already In couples with unexplained subfertility and a poor prognosis, IUI with ovarian stimulation (IUI-OS) is a first line treatment. Not much is known about quality of live or depression and anxiety in these couples. The Fertility Quality of Life (FertiQoL) is reliable for assessment within relational and social domains, the Hospital Anxiety and Depression Scale (HADS) is a reliable tool to detect anxiety and depression disorders. Study design, size, duration We performed a multicentre RCT in couples with unexplained subfertility with a poor prognosis of conceiving naturally within one year. Women were allocated 1:1 to six months expectant management or to six months IUI-OS. HRQoL was assessed with standard self-administered psychometric measures with established reliability and validity: FertiQol and HADS. We intended to include 1091 couples but after almost 4 years, the study had to stop due to slow inclusion and therefore lack of funding. Participants/materials, setting, methods Between June 2017 and September 2020, we recruited 178 women of wich 92 were assigned expectant management and 86 IUI-OS. All women who participated and could read Dutch were eligible for the HRQoL measurements because HRQoL questionnaires in foreign languages were not yet available online. Women completed the questionnaires before randomisation, 3 and 6 months after randomisation. We used mixed model analyses to assess differences between treatment groups and the effect of time. Main results and the role of chance One hundred sixty-two women could read Dutch and were invited (162/178 (91%)). Analyzable data of the FertiQol questionnaire were available for 80% (130/162). Compared to women allocated to IUI-OS, women allocated to expectant management had a lower FertiQol score in the relational domain (mean difference –4.3 (95% CI –7.3 to –1.3) but not in the social domain (mean diff van –0.8 (95% CI –4.5 to 2.9). Data of the HADS questionnaire were available of 156 women (96% (156/162)). Both groups had comparable scores in the Anxiety (mean difference –0.20; 95% CI 0.63; –0.99 to 0.6) and Depressions score (mean difference 0.002; 95% CI –0.67 to 0.67) at all three moments. At baseline, the incidence of an anxiety disorder (definition score 8 or higher) was 19% (30/156) and increased to 30% and 29% at 3 months and 6 months respectively. The incidence of a depression disorder (definition score 8 or higher) was 5% (7/156) and increased to 16% and 18% at 3 months and 6 months respectively. The incidences of anxiety or depression disorders did not differ significantly between expectant management and IUI. Limitations, reasons for caution Our randomized controlled trial did not reach the planned sample size. The results are only applicable to women with unexplained subfertility and a poor prognosis and not to all women with unexplained subfertility. Wider implications of the findings: Although often assumed, IUI-OS does not improve HRQoL compared to expectant management in all domains. IUI might prevent loss of quality of the relationship, but the impact seems small. Future studies should look into the high incidence of anxiety and depression disorders in these women and how to support them. Trial registration number Trial register NL5455 (NTR5599)

MO215DEPRESSIVE DISORDER IN LUPIC PATIENTS WITH LUPUS NEPHRITIS: DATA FROM A POPULATION OF 67 PATIENTS WITH BIOPSY PROVEN LUPUS NEPHRITIS

Abstract Background and Aims Systemic lupus erythematosus is a multi-organ, multi-systemic autoimmune disease with significant burden on generally young patients. Renal involvement is relatively frequent, recent studies cite a prevalence of 15-60% of patients, and 25% develop end-stage renal disease after 10 years of disease onset. We studied the incidence of depressive disorders in a population of 67 patients with biopsy proven lupus nephritis. Data about depression in patients with renal involvement of lupus is still scarce. We identified variables associated with the development of depressive disorders in lupus patients. Method We concluded a single center transversal study to assess the incidence of depressive disorder in patients with biopsy proven lupus nephritis. We used the self-report Beck Depression/ Anxiety Inventory (BDI/ BAI), 1961/ 1990, translated in Romanian and validated in the Romanian population to diagnose depression. We also wanted to identify risk factors associated with depression in such patients. We used EpiInfo for the statistical analysis and data was extracted from medical records. Results We included in the study patients diagnosed with systemic lupus erythematosus, and had renal biopsy between January 2008 – December 2018. Patients were followe-up until May 2020. Beck Depression/Anxiety Inventory was administered a single time during the follow-up visit between (March 2019 – May 2020). In our study group, 58 patients were female (86.5%). Median age at diagnosis of lupus disease was 29 years (min 10 years, max 62 years). Median duration of the disease until the self-assessment inventory was 10 years (min 1.5 years, max 30 years). Median duration of corticosteroid treatment was 10.1 years (min 1.58 years, max 29). 1 patient had class I, 2 had class II, 12 had class III, 32 had class IV, 12 had class V, 1 had class VI, 1 had classes III+V, 1 had classes IV+V of lupus nephritis (ISN classification of lupus nephritis). 13 patients had normal scores of the Beck Inventory (0-9 points), 7 had mild depression (10 - 15 points), 37 had moderate depression (16- 23 points), 10 had severe depression (24-63 points). We identified female gender (p=0.009), duration of corticosteroid therapy (p=0.036), duration of the lupic disease (p=0.036) to be independently associated with depression development. Other variables, such as creatinine levels at the moment of the assessment, duration of maintenance therapy with mycofenolate mofetil or azathioprine, proteinuria, inflammatory markers were not associated significantly with depression. Conclusion We identified clinical variables associated with depression development in patients with lupus nephritis. The study brings data useful for the clinician, helping doctors focus on the variables that predict depression in lupus patients and making screening for depressive disorders more focused on the patients with risk factors.

Epidemiology and costs of depressive disorder in Spain: the EPICO study

Depressive Disorders are the most common psychiatric diagnoses in the general population. To estimate the frequency, costs associated with Depressive Disorders in usual clinical practice, and in the whole Spanish population, a longitudinal, retrospective, observational study was carried out using data from the BIG-PAC database®. Study population: all patients aged ≥ 18 years with a diagnosis of a Depressive Disorder in 2015–2017. Prevalence was computed as the proportion of Depressive Disorder cases in the adult general population, and the incidence rate, as the number of new Depressive Disorder cases diagnosed per 1,000 person-years in the population using health services, during 2015–2017. We collected demographic variables, comorbidity, direct health costs, and indirect costs (temporary and permanent disability). Health costs related to Depressive Disorders were estimated according to the annual resource use rate (resource/patient/year). Indirect costs were calculated according to the human capital method. Using the study data and information from the Spanish National Institute of Statistics, we estimated the cost of Depressive Disorders corresponding to the Spanish adult population, including premature mortality. 69,217 Depressive Disorder patients aged ≥ 18 years who met the inclusion/exclusion criteria were studied (mean age: 56.8 years; female: 71.4%). Prevalence of Depressive Disorders in the general population was 4.73% (95% CI: 4.70–4.76%). Annual incidence rates (2015–2017) were 7.12, 7.35 and 8.02 per 1,000 person-years, respectively. Total costs observed in our Depressive Disorder patients were € 223.9 million (corresponding to a mean of € 3,235.3; mean/patient/year), of which, 18.4% were direct health care costs and 81.6%, non-health indirect costs (18% temporary occupational disability, 63.6% permanent disability). Considering also the cost of premature death, the mean cost per patient/year was € 3,402 and the estimated societal costs of Depressive Disorders in Spain were € 6,145 million. The prevalence and incidence of Depressive Disorders are consistent with other series reviewed. Resource use and total costs (especially non-health costs) were high.