Mean Patient Health Questionnaire-9 Score Research Articles

Psychosocial Screening in an Outpatient Community Radiation Oncology Center

<h3>Purpose/Objective(s)</h3> Cancer patients frequently suffer from depression and psychosocial impairments due to their disease and treatment. Depression in cancer patients has been reported to decrease quality of life, increase morbidity, lengthen hospital stay, decrease motivation to obtain treatment, and reduce therapy adherence. Psychosocial services have been shown to help patients cope with treatment-related stress. However, there is currently very little data on the best way to identify patients who would benefit from these services. Resources are needed to screen for depressive symptoms among oncology outpatients. The aim of this study was to investigate the frequency of depression among radiation oncology patients and evaluate the use of the Patient Health Questionnaire-9 (PHQ-9) as a screening tool to identify patients that may benefit from a referral to psychosocial services. <h3>Materials/Methods</h3> The PHQ-9 was incorporated into routine clinical evaluation of outpatient radiation oncology patients. Patients with a diagnosis of any cancer completed the PHQ-9. Patients with a score of 5 to 9 were given educational material on available support services and re-screened at their next appointment. Patients with a score equal to or greater than 10 were referred for further evaluation for psychotherapy by a psychologist. <h3>Results</h3> From January to December 2021, a total of 2457 patients underwent PHQ-9 screening. 19.4% were screened during their initial consult, 78.6% were screened during a follow-up appointment, 1.6% were screened during a re-consult, and 0.2% were screened while they were on treatment. PHQ-9 scores ranged from 0 to 24. The majority of patients (97.8%) who underwent screening, scored less than 10 (n = 2404) and 1.8% of patients scored equal to or greater than 10 (n = 45). Data were missing on 8 patients. A total of 57 referrals were made. Of the referrals made, 59.6% refused referral (n = 34) and 40.3% accepted a referral (n = 23). 21% of the patients who accepted a referral had scored less than 10 on the PHQ-9 and self-referred themselves (n = 12). Of the patients who were referred or self-referred to Psychology, the mean PHQ-9 score was 10.5 (SD = 4.7). <h3>Conclusion</h3> Cancer necessitates an enhanced continuum of care. With the significant burden of depression among cancer patients, the integration of mental health services, particularly mental health screenings, and psychosocial consultation and referral, is critically needed and should be scaled up in cancer treatment facilities. Clinic-based interventions provided by healthcare providers are imperative to address cancer patient mental health needs. These findings provide a practical means to incorporate protocols for depression screening enhancing mental health access among cancer patients.

The correlation between OSA-related quality of life and two mental statuses in adolescent Chinese patients with cleft palate: A comprehensive study.

To analyze obstructive sleep apnea (OSA)-related quality of life (QoL), the statuses of depression and anxiety, and to reveal the correlation between OSA-related QoL and two mental statuses in Chinese adolescent patients with cleft palate (CP). The Obstructive Sleep Apnea Questionaire-18 (OSA-18), the Generalized Anxiety Disorder Scale (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9) were applied to assess OSA-related QoL and the statuses of anxiety and depression in Chinese adolescent patients with CP, respectively. Non-CP adolescents were also included in the control group. OSA-related QoL and the two mental statuses were compared between the study and control groups. The correlation between the OSA-related QoL and two mental statuses was estimated in Chinese adolescent patients with CP. A total of 8.7% patients showed a moderate or high impact of OSA on QoL, while all the adolescents from the control group showed little impact. The mean total OSA-18 score of the study group (36.261 ± 13.500) was significantly higher than the control (28.435 ± 8.934). The mean PHQ-9 scores of the study group and the control group were statistically different (3.957 vs. 2.113). The GAD-7 score in the study group was slightly higher than the control group (3.043 vs. 2.194), while the proportion of moderate-severe anxiety in the study group was relatively larger than that in the control group (6.5% vs. 1.6%). Moreover, there was a positive correlation between the OSA-related QoL and the statuses of anxiety and depression respectively, and the differences in GAD-7 and PHQ-9 scores between the moderate or high impact group and the little impact group were statistically significant. Chinese adolescents with CP reported a rate of moderate or high impact of OSA on QoL of 8.7%, which was significantly higher than adolescents without CP. The OSA-related QoL was worse and depression was severer in Chinese CP adolescents than in the control, while anxiety and depression in Chinese CP adolescents were associated with OSA-related QoL.

Vitamin D Alleviates Anxiety and Depression in Elderly People with Prediabetes: A Randomized Controlled Study.

Older people are prone to frailness, present poor adherence to pharmacotherapy, and often have adverse drug effects. Therefore, it is important to develop effective and safe interventions to mitigate the burden of anxiety and depression disorders in this population. The aim of this study was to investigate the effect of vitamin D supplementation on the anxiety and depression status of elderly people with prediabetes. Participants were randomly assigned a weekly dose of vitamin D3 of 25,000 IU (n = 45, mean age 73.10 ± 7.16 years) or nothing (n = 45, mean age 74.03 ± 7.64 years), in addition to suggested lifestyle measures. The State-Trait Anxiety Inventory subscales (STAI-T and STAI-S) and the Patient Health Questionnaire-9 (PHQ-9) were used to evaluate anxiety and depression levels, respectively, at baseline, 6, and 12 months. A total of 92.68% of the participants in the vitamin D group and 97.14% of the controls exhibited vitamin D deficiency (<20 ng/mL) at baseline. Mean STAI-T scores were lower in supplemented individuals than in the control group at 6 (38.02 ± 9.03 vs. 43.91 ± 7.18, p = 0.003) and 12 months (32.35 ± 7.77 vs. 44.97 ± 7.78, p < 0.001). The same pattern was evident for STAI-S scores at 6 (37.11 ± 7.88 vs. 43.20 ± 9.33, p = 0.003) and 12 months (32.59 ± 6.45 vs. 44.60 ± 9.53, p < 0.001). Supplemented participants demonstrated lower mean PHQ-9 scores compared to controls at 6 (15.69 ± 6.15 vs. 19.77 ± 8.96, p = 0.021) and 12 months (13.52 ± 5.01 vs. 20.20 ± 8.67, p < 0.001). Participants with deficiency and insufficiency at baseline experienced equal benefits of supplementation in terms of anxiety and depression scores. In conclusion, in a high-risk population, a weekly vitamin D supplementation scheme was effective in alleviating anxiety and depression symptoms. More studies are needed to elucidate the relevant mechanisms.

Covid-19 anksiyete sıklığında sosyal medya bağımlılığının rolü nedir? Kesitsel bir çalışma.

Amaç: Pandemi sürecinde gerek iletişim gerek bilgilenme amacı ile sosyal medya maruziyeti artmıştır. Bu çalışmanın amacı koronavirüs anksiyetesi ile sosyal medya bağımlılığı arasındaki ilişkiyi saptamaktır.&#x0D; Gereç ve Yöntem: Tek merkezli, kesitsel tipte olan araştırmaya Gaziosmanpaşa Eğitim ve Araştırma Hastanesi Aile Hekimliği Polikliniği’ne 15 Eylül 2020- 15 Ekim 2020 tarihleri arasında başvuran 297 hasta alındı. Katılımcılara Koronavirüs Anksiyete Ölçeği (KAÖ) kısa formu, Hasta Sağlık Anketi-9 (PHQ-9), Bergen Sosyal Medya Bağımlılığı Ölçeği (BSMBÖ) uygulandı. Elde edilen verilerin istatistiksel analizleri için IBM SPSS Statistics 22 (IBM SPSS, Türkiye) programı kullanıldı. Anlamlılık p≤0,05 düzeyinde değerlendirildi.&#x0D; Bulgular: Ortalama yaşı 37,30±13,86 yıl ve %66 ‘ı (n:196) kadın, %34’ü (n:101) erkek olan 297 hastanın %11,8’inde (n= 35) koronavirus anksiyetesi, %23,2’sinde (n= 69) olası depresyon ve %9,1’inde (n= 27) sosyal medya bağımlılığı izlenmiştir. KAÖ puanı ortalaması 3,06±3,71, PHQ-9 puanı ortalaması 5,13±5,87, BSMBÖ puanı ortalaması 11,15±4,99 saptanmıştır. PHQ-9 puanının sırasıyla KAÖ (p= 0,043; r= 0,118) ve BSMBÖ (p= 0,004; r= 0,166) puanı arttıkça arttığı gözlenmiştir. KAÖ ile BSMBÖ puanları arasında anlamlı bir ilişki gözlenmemiştir (p= 0,525; r= -0,037). Düşük eğitim düzeyinin (ilkokul / ortaokul) KAÖ puanı üzerine 2,7 kat risk arttırıcı (OR= 2,691; C.I.= 1,300-5,571; p= 0,008) etkisi olduğu bulunmuştur.&#x0D; Sonuç: Koronavirus anksiyetesi görülenlerle görülmeyenlerin sosyal medya bağımlılık sıklığının benzer olması, medya kaynaklı artan bilgi maruziyetinde korkulduğu gibi koronavirus anksiyetesinin artmayabileceğini, eğitim düzeyinin asıl risk faktörü olduğunu göstermiştir.

A Comparative Analysis of Depressive Symptoms Following Sports-Related Concussion in Youth Athletes Versus Their Age-Matched Non-concussed Counterparts.

Background and objectiveAthletics is the leading cause of pediatric concussion, and depression is a major comorbidity associated with concussion in the pediatric population. Prior studies have described the risk of depression after concussion in high school-, collegiate-, and elite-level athletes, but there is scarce data on younger athletes. Interpretation of existing research on the association of depression with concussions in youth athletes is complicated by diverse study designs, varying measures of depression, differing timelines for symptom development, and a lack of control groups. Furthermore, limited research exists on sex-related differences in the development of depressive symptoms following sports-related concussions (SRC) in younger athletes. This study used the Seattle Pediatric Concussion Research Collaborative (SPCRC) Data Repository to compare depressive symptoms between youth athletes at one month post-SRC and non-concussed age-matched controls by using a standardized measure of depressive symptoms: the Patient Health Questionnaire-9 (PHQ-9). The secondary goal was to compare PHQ-9 scores between males and females for both concussed and non-concussed groups.MethodsThis study entailed a secondary analysis of data collected as part of the SPCRC Data Repository. We conducted a retrospective subgroup analysis of PHQ-9 scores at one month post-concussion for concussed youth athletes. We compared the PHQ9 scores of concussed youth athletes with PHQ-9 scores collected at the time of enrollment for non-concussed youth athletes.ResultsAfter random age-matching, a cohort of 266 patients (133 in the concussed group and 133 in the non-concussed control group) was included in the final analysis. The mean age was 13.8 years (range: 5-18 years). For the concussed group, a history of SRC was associated with a higher mean total PHQ-9 score at one month post-concussion compared with the control group at the time of enrollment (6.14 ±5.46 versus 1.53 ±1.81, respectively, p<0.0001). All nine subdomains of the PHQ-9 showed significantly higher scores in the concussion group compared with the control group (p<0.0001). Significantly higher scores were observed when comparing mean total PHQ-9 scores for male athletes in the concussion group with male athletes in the control group (7.03 ±5.72 versus 1.59 ±1.66, p<0.0001) and for female athletes in the concussion group compared with female controls (5.28 ±5.10 versus 1.49 ±1.92, p<0.0001). No significant differences were observed between sexes for total PHQ-9 scores or PHQ-9 subscores.ConclusionAt one month post concussion, youth with SRC demonstrated higher levels of depressive symptoms as measured by PHQ-9 compared with age-matched typically developing controls. No significant differences were identified in total PHQ-9 scores and subscores between male and female participants for either the concussion or control group. This study suggests that clinicians need to be vigilant and monitor for symptoms of depression in young athletes for at least one month post-concussion.

Clinical significance of osmophobia and its effect on quality of life in people with migraine.

In this study, we aimed to evaluate the clinical significance of osmophobia and its effect on quality of life in people with migraine. A total of 145 people with migraine were included in this cross-sectional study. Patients were evaluated with the migraine data form, the Migraine 24-Hour Quality of Life Questionnaire (24-HrMQoLQ), the Migraine Disability Assessment Scale (MIDAS), the Patient Health Questionnaire-9 (PHQ-9), the Insomnia Severity Index (ISI), the Generalized Anxiety Disorder-7 (GAD-7), the Allodynia Symptom Checklist (ASC), and the Fatigue Severity Scale (FSS). To evaluate the presence of osmophobia retrospectively, a semi-structured interview was conducted with the patients by the neurologist. The mean 24-Hr-MQoLQ of patients with osmophobia was significantly lower than those without osmophobia. The decrease in the 24-Hr-MQoLQ was statistically significant in the areas of feeling and concerns and social functionality. The mean of the MIDAS scale was higher significantly in patients with osmophobia than those without osmophobia. In addition, the mean ISI, PHQ-9, FSS and ASC scores of patients with osmophobia were statistically significantly higher than those without osmophobia. Both 24-h and 3-month quality of life of people with migraine with osmophobia were more affected than those without osmophobia. At the same manner, insomnia, depression, fatigue and allodynia were observed at higher rates in people with migraine with osmophobia than in migraine without osmophobia. Osmophobia, which is one of the specific symptoms that distinguishes migraine from other headache disorders, deserves further and multifaceted investigation.

Trends of Prevalence Estimates and Risk Factors of Depressive Symptoms among Healthcare Workers Over one Year of the COVID-19 Pandemic.

COVID-19 pandemic has an overwhelming psychologic burden on healthcare workers (HCWs). This study aims to investigate the changes in the prevalence, estimates, severity, and risk factors of depressive symptoms among HCWs within the first year of the COVID-19 pandemic. An observational e-survey collected data on HCWs' socio-demographic characteristics, occupational situation, and depressive symptoms as measured by Patient Health Questionnaire-9 (PHQ-9). The e-survey was distributed one month after the onset of the COVID-19 pandemic (onset group) and again after one year (one-year group). A total of 422 HCWs were included (Mean (SD) age, 35.3 (9.9) years; 71.3% males), with 211 (50%) participants in each group. In the total cohort, the mean PHQ-9 score was 8.5, and 36.7% reported clinically significant levels of depressive symptoms with a PHQ-9 score of ≥10. Compared to the onset group, the one-year group reported a higher risk of major depressive disorder (41.7% vs. 31.8%; OR 1.538; 95%CI 1.032-2.291; p=0.034), a higher mean PHQ-9 score (9.5 (6.8) vs. 7.4 (5.3), p<0.001), and more severe depressive symptoms (p<0.005). Participants who were younger, unmarried, underwent testing for COVID-19, reported lower monthly income, did not receive special COVID-19 education, or had lower satisfaction with institutional preparedness had significantly higher depression scores and symptoms in both onset and one-year groups (p<0.05 for each category). Female gender and direct contact with COVID-19 patients or samples were significant risk factors within the onset group. Occupation as a physician, history of COVID-19 testing or infection, and perception of significant changes in work schedule or intensity were significantly associated with higher depression scores and symptoms among the one-year group. This study sheds light on an unspoken but significant rise in prevalence estimates and severity of depressive symptoms among HCWs over a year of the COVID-19 pandemic and shows the vulnerable subgroups for whom a psychological intervention might be warranted.

The Impact of COVID-19 on Hyperhidrosis Patients in the Mental Health and Quality of Life: A Web-Based Surveillance Study

Background: We aimed to investigate the impact of the COVID-19 pandemic on the degree of depression among hyperhidrosis patients and their quality of life. Methods: 222 patients were contacted through an online questionnaire. Patients reported quality of life (QoL), including treatment and changes in symptoms during the pandemic, and also responded to the Patient Health Questionnaire-9 (PHQ-9) to evaluate the severity of depression. Those were compared with the result from the general population. Spearman correlation and multiple linear regression were performed to identify the factors related to the PHQ-9 score. Results: Half of the patients were female. The mean PHQ-9 score (5.25) of hyperhidrosis patients was higher than the general population, and female patients displayed significantly higher PHQ-9 scores than males (p = 0.002). QoL was impaired more in females. About 10% of patients experienced worsening symptoms, and 30% had difficulties getting appropriate management. Significant negative correlations were found between the PHQ-9 and age or disease duration. Predictive factors for the PHQ-9 were female (p = 0.006) and facial hyperhidrosis (p = 0.024). Conclusions: The level of depression among hyperhidrosis patients was higher than the general population during the COVID-19 pandemic; female and facial hyperhidrosis patients need much more psychiatric attention. Though hyperhidrosis is classified as benign and often neglected by clinicians, we need to give more awareness to the mental burden imposed by the COVID-19 pandemic.

High Depressive Symptoms, Low Family Functioning, and Low Self-Efficacy in Mothers of Children With Autism Spectrum Disorder Compared to Two Control Groups.

Parents of children with autism spectrum disorder (ASD) face unique challenges in raising their children, and they are at higher risk for depression compared to parents of children with typical development (TD) and other disabilities. (1) To compare prevalence of depressive symptoms among mothers of children with ASD (n = 101), Down syndrome (DS, n = 101), and TD (n = 43) and (2) to describe the relationships among depression, self-efficacy, and family functioning, and describe the mediating role of maternal child care self-efficacy between depressive symptoms and child behavior. In this cross-sectional study, mothers completed the Social Communication Questionnaire, Aberrant Behavior Checklist, Patient Health Questionnaire-9 (PHQ-9), Family Assessment Device General Functioning Scale, and Maternal Self-Efficacy Scale. Mothers of children with ASD had significantly higher mean PHQ-9 scores (p < .001), higher proportion of positive depression screening (p < .001), and lower family functioning (p < .001). Better family functioning is associated with less depression, better self-efficacy, and less severe ASD symptoms and behaviors. Self-efficacy mediated the relationship between depression and child ASD symptoms, and problematic behavior. The rates of reported history of depression and low family functioning in mothers of children with ASD are twice the rate in mothers of children with DS and TD. Maternal child care self-efficacy is protective against maternal depression, even in the presence of severe child problematic behaviors and ASD symptoms. Interventions that increase child care self-efficacy and family functioning may be helpful in addressing depression in mothers of children with ASD.

565-P: Vitamin D Supplementation Improves Anxiety and Depression Status in Elderly People with Prediabetes: An Open-Label 12-Month Randomized Controlled Study

Background: The combination of prediabetes and depressive or anxiety symptoms is known to increase the risk of progression to diabetes. We aimed to assess the effects of vitamin D supplementation on anxiety and depression status among elderly people with prediabetes. Methods: Participants were randomly assigned to a weekly dose of vitamin D3 of 25,000 IU (n=45) or nothing (n = 45) , in addition to lifestyle measures. The State Trait Anxiety Inventory and the Patient Health Questionnaire-9 (PHQ-9) tools were used to evaluate anxiety and depression levels, respectively, at baseline, 6 and 12 months. Results: Participants in the intervention and control group presented comparable baseline characteristics in terms of age (73.± 7.16 vs. 74.03 ± 7.64 years, respectively) , fasting glucose (103.4 ± 12.vs. 102.29 ± 12.82 mg/dl, respectively) and HbA1c values (5.87 ± 0.21 vs. 5.87 ± 0.22 %, respectively) . In the supplemented group, 25-hydroxyvitamin D concentrations increased significantly at 6 (26.56 ± 8.64 ng/ml) and 12 months (28.71 ± 9.03 ng/ml) compared to baseline (19.98 ± 6.73 ng/ml, p&amp;lt;0.0 for both comparisons) . The mean trait anxiety scores were lower in supplemented individuals than the control group at 6 (38.02 ± 9.03 vs. 43.91 ± 7.18, respectively, p=0.003) and 12 months (32.35 ± 7.77 vs. 44.97 ± 7.78, respectively, p&amp;lt;0.001) . The same pattern was evident for state anxiety scores at 6 (37.± 7.88 vs. 43.20 ± 9.33, p=0.003) and 12 months (32.59 ± 6.45 vs. 44.60 ± 9.53, p&amp;lt;0.001) . Supplemented participants demonstrated lower mean PHQ-9 scores compared with controls at 6 (15.69 ± 6.15 vs. 19.77 ± 8.96, respectively, p=0.021) and 12 months (13.52 ± 5.vs. 20.20 ± 8.67, respectively, p&amp;lt;0.001) . Conclusion: In a high-risk population, a weekly vitamin D supplementation scheme was effective in reducing anxiety and depression levels. Further studies are needed to elucidate the relevant mechanisms. Disclosure E.Zaromytidou: None. M.Grammatiki: Research Support; Lilly. E.Manthou: None. I.S.Psarrakou: None. I.Iakovou: None. A.Gotzamani: None. K.Kotsa: Advisory Panel; Abbott, Novo Nordisk, Research Support; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Speaker's Bureau; AstraZeneca, Merck Sharp &amp; Dohme Corp., Novartis AG, Sanofi. T.Koufakis: Advisory Panel; Novo Nordisk, Speaker's Bureau; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly, Novo Nordisk. G.Dimakopoulos: None. D.Drivakou: None. G.Meristoudis: None. S.Konstantinidou: None. G.Karaliolios: None. E.Melidou: None. P.Rakitzi: None.

Worsening Mental Health in Adolescent Heart Failure and Transplant Patients During the COVID-19 Pandemic

PurposeCenter for Disease Control data shows a significant increase in percentage of adults with symptoms of anxiety or depressive disorder during the COVID-19 pandemic. Adolescent heart failure (HF) and heart transplant (HT) recipients report higher prevalence of mood symptoms compared to general adolescent population. The effects of the COVID-19 pandemic on mental health outcomes in Adolescent HF and HT recipients remains unknown.MethodsElectronic Mental Health Screens, Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), were administered at quarterly intervals to patients aged 11 years and older presenting for ambulatory HF and HT care at our center. Screening results from August 2020- February 2021 (COVID Screen) were compared to results from August 2019- March 2020 (Pre-COVID Screen). When multiple Pre-COVID screens were available, the one closest to pandemic start date (April 2020) was used and in case of multiple COVID screens, the one completed during the peak of COVID wave (November-January 2021) was used.ResultsDemographic data for 37 patients with paired screens is summarized in Table 1. There was a significant increase in mean GAD-7 score, 2.51 (±2.98) Pre-COVID to 3.76 (±4.99) during COVID (p=0.04) and no significant change in mean PHQ-9 score, 2.73 (±3.71) Pre-COVID to 4.05 (±4.83) during COVID (p=0.06). Although there was no significant difference in Pre-COVID screen scores by age or race, the COVID Screen scores were significantly higher for younger adolescents and Black patients for both PHQ-9 and GAD-7 (Table 1). Nine patients (24.3%) were receiving treatment for mood disorders pre-COVID and 11 (29.7%) during COVID (p=0.50).ConclusionAdolescents with HF and HT reported worsening anxiety symptoms during COVID similar to the worsening mental health trends for young adults noted nationwide. Younger and Black adolescents with HF or HT reported worse anxiety and depression symptoms during the pandemic compared to other demographics.

Attenuated brain derived neurotrophic factor and depression in type 2 diabetes mellitus patients: A case-control study

Problem consideredType 2 diabetes mellitus (T2DM) and depression are two of the most prevalent chronic and devastating diseases. Brain derived neurotrophic factor (BDNF) is postulated to modulate the secretion and actions of insulin. Furthermore, a strong association has been demonstrated between BDNF and depression. Although depression is a common neuropsychiatric comorbidity of T2DM, the association of BDNF levels with depression in T2DM remains unclear. Thus, the purpose of the present study was to assess the serum BDNF levels in healthy controls and T2DM patients and explore the association of serum BDNF levels with depression in T2DM patients. MethodsIn this study depression was assessed using Patient Health Questionnaire-9 (PHQ-9) and serum BDNF levels were estimated by ELISA technology. Resultsand conclusions: A total of 88 subjects were included in the study. The mean PHQ-9 score for T2DM patients (3.91 ± 5.88) was higher than in healthy subjects (1.02 ± 3.02), p = 0.031. Subsequently, the prevalence of depression was higher in T2DM patients 16 (36.36%) as compared to healthy subjects 5 (11.36%), p < 0.001. The serum level of BDNF was lower in T2DM patients (15.17 ± 2.81 ng/ml) than in healthy subjects (24.65 ± 13.81 ng/ml) than, p < 0.0001. Additionally, serum BDNF levels were lower in T2DM patients with depression (13.87 ± 2.62 ng/ml) than in those without depression (15.92 ± 2.77 ng/ml), p = 0.02. An inverse association was found between BDNF levels and PHQ-9 scores (r2 = 0.2003, p = 0.002). The results suggest that BDNF might influence the presence of depression in T2DM patients. However, further studies are warranted to elucidate the mechanism by which BDNF may influences depression in T2DM patients.

Prevalence of depression and anxiety among patients with breast cancer: a cross-sectional study

Background: Breast cancer patients have a significant rate of depression, according to prior studies. During some phases of patient management, particularly early after surgery, these patients are at risk for depression. Objectives: to assess the prevalence of depression and anxiety among patients with breast cancer and risk factors associated with it. Methods: This cross-sectional study enrolled 74 patients diagnosed with breast cancer in the general surgery clinic at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. Two questionnaires were used, Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7), filled in by patients who attended the clinic or electronically by sending the questionnaires to the patients. Significant depression was defined as PHQ-9 score 10 and significant anxiety was defined as GAD-7 score 10. Sociodemographic and medical data were also collected. This research was approved by the unit of biomedical ethics at King Abdulaziz University Faculty of Medicine. Results: From the 74 patients with breast cancer, 36% of the women were found to have depression and 24% were found to have anxiety and the prevalence of having both depression and anxiety was 23.0%. Mean PHQ-9 score was (8.9, SD: 5.8). The mean GAD-7 score was (6.7, SD: 5.2). Significant depression and significant anxiety were found to be more in Saudi nationals, those who did not go for surgical therapy, patients with metastatic disease at the time of filling in the questionnaire and married women. These results were not statistically significant. Conclusion: This study showed that the prevalence of depression and anxiety was similar to previously conducted studies; it also showed no associations between the risk factors studied and anxiety or depression in patients with breast cancer. Keywords: Breast Cancer, depression, anxiety, Saudi Arabia, PHQ-9, GAD-7

The Impact of Telephone-Based Cognitive Behavioral Therapy on Mental Health Distress and Disordered Eating Among Bariatric Surgery Patients During COVID-19: Preliminary Results from a Multisite Randomized Controlled Trial.

BackgroundPatients undergoing bariatric surgery have high rates of psychiatric comorbidity, which may increase their vulnerability to COVID-19-related mental health distress. Exacerbation of mental health distress and disordered eating could have significant negative effects on long-term weight management and quality of life for these patients if untreated.ObjectiveTo determine the efficacy of a telephone-based cognitive behavioral therapy (Tele-CBT) intervention in improving depressive, anxiety, and disordered eating symptoms during COVID-19.MethodsParticipants were recruited as part of a larger randomized controlled trial study (clinicaltrials.gov ID: NCT03315247) between March 2020 and March 2021 and randomized 1:1 to receive Tele-CBT or standard bariatric care. Outcomes of Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Emotional Eating Scale (EES), and Binge Eating Scale (BES) were measured at baseline, immediately post-intervention, and 3 months post-intervention. Linear mixed models were used to test the effect of intervention group, time, and group-by-time interaction for each outcome.ResultsEighty-one patients were included in the intention-to-treat analysis. Mean (SD) age of participants was 47.68 (9.36) years and 80.2% were female. There were significant group-by-time interactions for all outcomes and significant differences between groups across time. There were significant decreases in mean GAD-7 (p = 0.001), PHQ-9 (p < 0.001), EES-Total (p = 0.001), EES-Anger (p = 0.003), EES-Anxiety (p < 0.001), EES-Depression (p < 0.001), and BES (p = 0.002) scores for the Tele-CBT group at post-intervention and follow-up when compared to baseline and the control group.ConclusionTele-CBT is a feasible and effective treatment for improving psychological distress and disordered eating among post-operative bariatric surgery patients during the COVID-19 pandemic.Graphical abstract

Quality of life outcomes in two phase 3 trials of setmelanotide in patients with obesity due to LEPR or POMC deficiency

IntroductionIndividuals with proopiomelanocortin (POMC) or leptin receptor (LEPR) deficiency are young and experience severe obesity, hyperphagia, and comorbidities, which can impair quality of life (QOL).MethodsTwo pivotal Phase 3 trials explored the effect of setmelanotide on body weight and hunger in individuals with obesity due to POMC (NCT02896192) or LEPR (NCT03287960) deficiency. QOL and depression were investigated in parallel using the disease-specific, age-appropriate Impact of Weight on Quality of Life-Lite (IWQOL-Lite), Pediatric Quality of Life Inventory (PedsQL), and Patient Health Questionnaire-9 (PHQ-9).ResultsIn total, the POMC and LEPR trials enrolled 21 patients. Adults (≥ 18 years old; n = 7) had moderate-to-severe impairment in QOL at baseline, with mean (standard deviation [SD]) IWQOL-Lite total score 60.3 (13.2; maximum IWQOL-Lite total score = 100). The effect of setmelanotide on IWQOL-Lite total score was observed as soon as Week 5. Among those with scores at Week 52, 5 of 6 adults experienced a clinically meaningful improvement, with mean (SD) total scores increased from baseline by 24.2 (12.1) points. Children (6–12 years old; n = 2) and adolescents (13–17 years old; n = 4) had impaired QOL at baseline, with mean (SD) self-reported PedsQL total scores 53.3 (6.2) and 63.3 (29.1), respectively (maximum PedsQL total score = 100). Three of 5 patients experienced clinically meaningful improvement in PedsQL, with 2 children whose PedsQL total score increased by 28.3 and 3.3 points and 3 adolescents whose mean (SD) total score increased from baseline by 5.8 (18.3) points. Baseline mean (SD) PHQ-9 score (in those ≥ 12 years old) was 5.3 (3.8) and was generally maintained through Week 52.ConclusionsPatients with POMC or LEPR deficiency had impaired, and in some cases severely impaired, QOL before setmelanotide treatment. Setmelanotide improved QOL in patients as early as Week 5, with some patients no longer experiencing impaired QOL at Week 52. Improvements in QOL may be related to a reduction in hunger and body weight associated with setmelanotide. Because of the highly complex psychological consequences of rare genetic diseases of obesity, some patients may require a long period of treatment to improve QOL and benefit from interdisciplinary care.

From Office-Based Treatment to Telehealth: Comparing Clinical Outcomes and Patient Participation in a Psychiatric Intensive Outpatient Program with a Large Transdiagnostic Sample.

Introduction: Patient participation and clinical outcomes of a precoronavirus disease 2019 (COVID-19) office-based transdiagnostic psychiatric intensive outpatient program (IOP) were compared with those of telehealth IOP during COVID-19. Materials and Methods: Weeks of enrollment, Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) assessments, and sociodemographic and clinical factors (including group track and diagnosis) were collected during pre-COVID-19 (n = 191) and during COVID-19 (n = 200). Continuous and categorical measures of GAD-7 and PHQ-9 were analyzed; potential sociodemographic and clinical covariates to scores were also explored. Results: There were no statistically significant differences in participation between time periods. Associations were observed between PHQ-9/GAD-7 score improvement and number of assessments. Significant score reductions occurred in both periods, and differences in change scores were not significant. Sociodemographic and clinical factors were not significantly different between time periods. Patients with commercial insurance had significantly higher improvement in both mean and categorical PHQ-9 scores (t = 2.77, p = 0.006; χ2 = 10.47, df = 1, p = 0.001) and GAD-7 scores (t = 2.29, p = 0.023; χ2 = 8.58, df = 1, p = 0.003) than those with public insurance. Patients with anxiety disorders had significantly greater improvements (F = 4.49, p = 0.004; χ2 = 9.15, df = 3, p = 0.027) in GAD-7 during COVID-19. Discussion: Significant improvements in PHQ-9/GAD-7 scores and measures of participation were not significantly different between telehealth and office-based IOP, nor were they greatly influenced by clinical or sociodemographic factors. Further study is needed of possible care disparities for publicly insured patients. Conclusion: Despite some limitations, telehealth IOP appears to be a clinically appropriate option for a diverse sociodemographic and diagnostically heterogeneous psychiatric population.

Association of Inventory to Measure and Assess imaGe Disturbance - Head and Neck Scores With Clinically Meaningful Body Image-Related Distress Among Head and Neck Cancer Survivors.

Objective: The Inventory to Measure and Assess imaGe disturbance – Head and Neck (IMAGE-HN) is a validated patient-reported outcome measure of head and neck cancer-related body image-related distress (BID). However, the IMAGE-HN score corresponding to clinically relevant BID is unknown. The study objective is to determine the IMAGE-HN cutoff score that identifies head and neck cancer patients with clinically relevant BID.Methods: We conducted a cross-sectional study at six academic medical centers. Individuals ≥18 years old with a history of head and neck cancer treated with definitive intent were included. The primary outcome measure was the IMAGE-HN. A Receiver Operating Characteristic curve analysis was performed to identify the IMAGE-HN score that maximized sensitivity and specificity relative to a Body Image Scale score of ≥10 (which indicates clinically relevant BID in a general oncology population). To confirm the validity of the IMAGE-HN cutoff score, we compared the severity of depressive [Patient Health Questionnaire-9 (PHQ-9)] and anxiety symptoms [Generalized Anxiety Disorder-7 (GAD-7)], and quality of life [University of Washington-QOL (UW-QOL)] in patients with IMAGE-HN scores above and below the cutoff.Results: Of the 250 patients, 70.4% were male and the mean age was 62.3 years. An IMAGE-HN score of ≥22 was the optimal cutoff score relative to a Body Image Scale score of ≥10 and represents a clinically relevant level of head and neck cancer-related BID. Relative to those with an IMAGE-HN score of <22, patients with IMAGE-HN scores of ≥22 had a clinically meaningful increase in symptoms of depression (mean PHQ-9 score difference = 5.8) and anxiety (mean GAD-7 score difference = 4.1) as well as worse physical (mean UW-QOL score difference = 18.9) and social-emotional QOL (mean UW-QOL score difference = 21.5). Using an IMAGE-HN cutoff score ≥22, 28% of patients had clinically relevant BID.Conclusion: An IMAGE-HN score of ≥22 identifies patients with clinically relevant head and neck cancer-related BID. This score may be used to detect patients who could benefit from strategies to manage their distress, select patients for studies evaluating interventions to manage head and neck cancer-related BID, and improve our understanding of the underlying epidemiology of the disorder.

The impact of socioeconomic status on mental health and health-seeking behavior across race and ethnicity in a large multiple sclerosis cohort

BackgroundPsychiatric symptoms are common in multiple sclerosis (MS) and may contribute to worse MS outcomes. Previous studies suggest the burden of symptoms may vary by race, ethnicity and socioeconomic status (SES). Our objective was to expand upon this previous work and explore the associations between SES, race, and ethnicity, as predictors of psychiatric symptoms, mental health attitudes, and health-seeking behavior in patients with MS. MethodsPersons with MS answered a national web-based survey including demographic characteristics (including race, ethnicity and measures of SES), mental health attitudes, the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Modified Fatigue Impact Scale 5-item version (MFIS-5), and the Alcohol Use Disorders Identification Test (AUDIT). The survey also queried mental health availability and perceptions of care. We measured neighborhood-level SES (nSES) of each participant using the Agency for Healthcare Research and Quality (AHRQ) index that was calculated from 5-digit postal codes. Other indicators of participant-level SES included education level and self-reported household income. We assessed the association between race, ethnicity, and neighborhood/participant-level SES indicators and affective symptom burden using generalized linear models that were adjusted for age, sex, and MS characteristics. Results2095 participants answered the survey (mean AHRQ index 54.6 ± 5.4, age 51.3 ± 12.2 years, 7% Black/African American, 5.4% Hispanic/Latino, and 81.8% female). Those in the lowest quartile of nSES (most disadvantaged) were more likely to be either Black/African American or Hispanic/Latino as compared to those in highest quartile (least disadvantaged). Those in the lowest quartile of nSES had higher mean MFIS-5 (1.02 points; 95% CI: 0.39, 1.43), PHQ-9 (1.24 points; 95% CI: 0.49, 1.98), and GAD-7 (0.69 points; 95% CI: -0.01, 1.38) scores relative to those in the highest quartile. Of those who consumed alcohol (n = 1489), participants in the lowest AHRQ quartile had lower mean AUDIT scores (-0.73 points; 95% CI: -1.18, -0.29) as compared to those in higher quartiles. Race and ethnicity were not associated with self-reported psychiatric symptom burden in this cohort. SES was also associated with self-reported improvement of symptoms after receiving mental health care. A higher proportion of Black/African American (44.1% vs 30.2%, p = 0.003) and Hispanic/Latino (49.1% vs 30.6%, p<0.001) participants were more likely to report they would “definitely go” receive mental health care if services were co-located with their MS care as compared to white and Non-Hispanic/Latino participants, respectively. ConclusionHigher SES was associated with a lower burden of psychiatric symptoms and with a higher likelihood of self-reported symptom recovery after receiving mental health treatment. Attitudes regarding mental health care delivery in MS varied according to racial and ethnic background. Future longitudinal studies in more diverse populations should assess whether co-location of mental health services with MS care helps to reduce the gap between access and need of mental health care in MS.

Use of a Mobile Health (mHealth) Platform for Remote Assessment of Suicidal Ideation, Depression, and Anxiety: A Longitudinal Retrospective Study

ABSTRACT Introduction There is growing support for the use of integrated measurement-based care to capture symptom data in real time so treatment providers can make informed decisions about intervention strategies for mental health problems, such as depression and anxiety, both of which are known to increase suicide. We examined the potential scalability and effectiveness of a mobile health (mHealth) application with integrated behavioral health functions to capture remote patient-reported measurement of suicidal ideation and overall symptoms of depression and anxiety. Methods This study was an observational retrospective review of deidentified patient data, including symptoms of suicidal ideation, depression, and anxiety as measured by the Patient Health Questionnaire-9 (PHQ-9) or Generalized Anxiety Disorder 7 (GAD-7) scale, which were administered to and completed by patients on a smartphone or desktop application. After controlling for age, sex, and the presence of moderate versus severe symptoms at baseline, mean scores were analyzed with the Student's t-test. Results Of patients who took the PHQ-9 assessment at baseline and 8 weeks later (n = 764), the proportion who endorsed suicidal thinking decreased from 25% to 14.66% (p &amp;lt; 0.001) over 8 weeks. The mean PHQ-9 score was reduced from 14.69 (standard error [SE], 4.09) to 10.50 (SE, 5.94; p &amp;lt; 0.001), and a subset of individuals who continued use and took the PHQ-9 again at 24 weeks (n = 185) had a further decrease to 9.03 (SE, 7.09, p &amp;lt; 0.01). Although 21.62% of this subset still had suicidal thinking, the frequency of suicidal thoughts decreased. Of patients who took the GAD-7 at baseline and 8 weeks (n = 797) the mean score decreased from 14.20 (SE, 3.31) to 10.08 (SE, 5.55; p &amp;lt; 0.001) at 8 weeks and to 7.48 (SE, 6.54; p &amp;lt; 0.001) for a subset (n = 278) who continued use and took a GAD-7 at 24 weeks (n = 278). The sum of subgroup samples is larger than the whole because of instances of comorbid depression and anxiety. Conclusion Remote assessments within technology-supported integrated behavioral health care were feasible at scale. Change in symptoms could be observed at the individual and group level in real time, which may allow clinical teams to adjust treatments and improve outcomes. Prospective controlled studies are needed to determine what factors contribute to reductions in symptom severity.

Changes in PHQ-9 depression scores in acute stroke patients shortly after returning home.

Post-stroke depression is a disabling condition that occurs in approximately one-third of stroke survivors. There is limited information on changes in depressive symptoms shortly after stroke survivors return home. To identify factors associated with changes in post-stroke depressive symptoms during the early recovery period, we conducted a secondary analysis of patients enrolled in a clinical trial conducted during the transition period shortly after patients returned home (MISTT). The Michigan Stroke Transitions Trial (MISTT) tested the efficacy of social worker case management and access to online information to improve patient-reported outcomes following an acute stroke. Patient Health Questionnaire-9 (PHQ-9) scores were collected via telephone interviews conducted at 7 and 90 days post-discharge; higher scores indicate more depressive symptoms. Generalized estimating equations were used to identify independent predictors of baseline PHQ-9 score at 7 days and of changes over time to 90 days. Of 265 patients, 193 and 185 completed the PHQ-9 survey at 7 and 90 days, respectively. The mean PHQ-9 score was 5.9 at 7 days and 5.1 at 90 days. Older age, being unmarried, and having moderate stroke severity (versus mild) were significantly associated with lower 7-day PHQ-9 scores (indicating fewer depressive symptoms). However, at 90 days, both unmarried patients and those with moderate or high stroke severity had significant increases in depressive symptoms over time. In stroke patients who recently returned home, both marital status and stroke severity were associated with depressive symptom scores; however, the relationships were complex. Being unmarried and having higher stroke severity was associated with fewer depressive symptoms at baseline, but both factors were associated with worsening depressive symptoms over time. Identifying risk factors for changes in depressive symptoms may help guide effective management strategies during the early recovery period.