Moderate-severe Depression Research Articles

Psychological changes of 84 patients with common type of COVID-19 in Jingzhou, Hubei

Objective To investigate the psychological changes of 84 patients with common type of coronavirus disease 2019 (COVID-19) in Jingzhou City, Hubei, and we aim to guide their psychological rehabilitation training. Methods Using the general condition questionnaire, generalized anxiety scale and depression scale, 84 patients with common COVID-19 admitted to the Second People's Hospital of Jingzhou City in Hubei from January 28th to February 10th, 2020, were investigated by questionnaires at the time of admission, discharge, and on the 14th and 28th day after discharge. The disordered Logistic regression model was used for statistical analysis. Results The incidence of mild, moderate and severe anxiety was respectively 39.29%, 36.90% and 17.86%; The 28 days after discharge were 14.29%, 2.38% and 2.38%, respectively. The incidence rates of mild, moderate, moderate-severe and severe depression were 45.24%, 32.14%, 14.29% and 7.14%, respectively, at the time of diagnosis; and 19.05%, 4.76%, 1.19% and 1.19%, respectively, at the 28th day after discharge. The results of multi-factor analysis showed that the anxiety of different degrees was easy to appear in primary and secondary schools, migrant workers and their families, especially migrant workers. Female, age, family workers were prone to depression, persons with primary and secondary school education level and family workers were prone to mild and moderate-severe depression, especially we should pay attention to the people with university education level. Conclusion COVID-19 patients are with different degrees of anxiety and depression psychological problems, and the factors affecting different degrees of anxiety and depression are not the same, community workers and medical staff should strengthen the psychological rehabilitation treatment of patients after discharge, as soon as possible to make patients recover a healthy psychological state. 摘要：目的 探讨湖北荆州市84例普通型新型冠状病毒肺炎(简称新冠肺炎)患者的心理变化特征, 指导患者心理 康复训练。 方法 使用一般情况调査表、广泛性焦虑量表和抑郁量表, 对湖北荆州市第二人民医院2020年1月28日至 2020年2月10日收治的84名普通型新冠肺炎患者进行人院时、出院时、出院后第14天和第28天问卷调査。运用无序 多分类Logistic回归模型进行统计分析。 结果 84例新冠肺炎患者确诊时轻度、中度和重度焦虑发生率分别是 39.29%、36.90%、17.86%;出院后第28天分别为14.29%、2.38%、2.38%;确诊时抑郁症轻度、中度、中重度及重度发生率 分别是45.24%、32.14%、14.29%、7.14%, 出院后第28天分别为19.05%、4.76%、1.19%、1.19%。多因素分析结果显示:初 中及以下和进城打工者以及家庭工作者易出现不同程度的焦虑情绪, 尤其是进城打工者。女性、年龄、家庭工作者容 易出现抑郁症, 受初中及以下教育者和家庭工作者容易患轻度和中重度抑郁症, 尤其应重视受大学教育者。 结论 新 冠肺炎患者易出现不同程度的焦虑及抑郁心理问题, 且不同程度焦虑和抑郁情绪的影响因素不完全相同, 社区工作者 和医务人员应该加强患者出院后的心理康复治疗, 让患者尽早恢复健康的心理状态

Relationship between Depression Symptoms and Different Types of Measures of Obesity (BMI, SAD) in US Women.

Objective To estimate the relationship between obesity (defined by both BMI and SAD) and various levels of depressive symptoms in women in the United States. Methods This is a cross-sectional design. All data were collected from NHANES 2011-2012 and 2013-2014. The Patient Health Questionnaire (PHQ-9) was the primary variable used to index depressive symptoms. SAD was assessed using an abdominal caliper. We stratified participates into three groups according to SAD (trisection): T1: low (11.8-18.4 cm), T2: middle (18.5-22.8 cm), and T3: high (22.9-40.1 cm). Other data were collected following the NHANES protocols. We aimed to investigate the effects of obesity on the depression in the NHANES populations. Results A total of 4477 women were enrolled in the final study population. Participants with a high SAD had the highest risk of clinical depression symptoms (OR = 1.2, 95% CI: 1.1-1.4), which was, in particular, the case for moderate-severe depression (OR = 1.4, 95% CI: 1.1-1.7) and severe depression (OR = 1.4, 95% CI: 1.0-1.9). We also found a significant relationship between SAD and BMI (r = 0.836). We did, however, not find a significant relationship between BMI and severe depression. Conclusions SAD had a better correlation with clinical depression symptoms than BMI, especially regarding severe depression symptoms.

Depression in young adults is associated with increased carotid atherosclerotic burden: insights from the Corinthia study

Abstract Introduction Depression appears to have a detrimental effect not only on mental health but also in the progression of various diseases. Purpose The examination of a potential association between depression and atherosclerosis progression in a rural population. Methods In the context of the cross-sectional Corinthia study, volunteers fulfilled a questionnaire concerning emotional health. The Geriatric Depression Scale was used for individuals aged 60 or more while the Zung self-rating depression score was preferred in younger adults. Carotid ultrasonography examination was performed to evaluate the mean carotid intima-media thickness (cIMT). Thickness of cIMT>1.5 mm or protrusion >50% compared to adjacent segments was considered as atherosclerotic plaque. Results Young adults with significant depression were usually female and did not differ significantly on other risk factors of atherosclerosis compared to those with mild or no depressive disorder. Importantly, those with moderate-severe depression appeared to have increased mean cIMT (Mild-No depression: 0.85±0.30mm, Moderate-severe depression: 0.91±0.42mm, p=0.04) and a higher carotid plaque burden (Mild-No depression: 12.8%, Moderate-severe depression: 20.3%, p=0.04). With regards to the elderly, those with moderate-severe depression were usually smokers (Mild-No depression: 13.9%, Moderate-severe depression: 24.2%, p=0.01). However, mean cIMT (Mild-No depression: 1.11±0.47mm, Moderate-severe depression: 1.09±0.39mm, p=0.69) and carotid plaques (Mild-No depression: 31.1%, Moderate-severe depression: 36.1%, p=0.36) did not differ according to depression status in this subgroup. Conclusion Significant depressive disorder is associated with accelerated carotid atherosclerosis in young individuals. Funding Acknowledgement Type of funding source: None

A Survey of Psychological Responses During the Coronavirus Disease 2019 (COVID-19) Epidemic among Chinese Police Officers in Wuhu.

BackgroundThe outbreak of coronavirus disease 2019 (COVID-19) has presented serious threats to people’s health and lives. Police officers are bravely fighting on the front lines of the epidemic. The main purpose of this study was to assess the prevalence and severity of psychological responses among police officers during the COVID-19 pandemic and find influencing factors in depression and anxiety.MethodsA cross-sectional online questionnaire was administered to police officers in Wuhu through WeChat, and data were collected between March 10 and 26, 2020. A total of 3,561 questionnaires were received, of which 3,517 were considered valid. The questionnaires included demographic information and a psychological survey. The depression scale of the Patient Health QuestionnaireQ9) and Generalized Anxiety Disorder scale were utilized to assess depression and anxiety, respectively.ResultsThe mean depression score of participants was 4.10±4.87 (0–27), and 12.17%had moderate–severe depression. The mean anxiety score of participants was 3.59±4.228 (0–21), and 8.79% had moderate–severe anxiety. Older and married police officers were at higher risk of anxiety. Those with a bachelor’s degree or above, living near the city center, and taking sleeping pills were at greater risk of depression and anxiety. Auxiliary police had lower depression and anxiety scores. Depression scores were strongly correlated withanxiety scores (r=0.863, p<0.001).ConclusionOur findings identify factors associated with higher levels of depression and anxiety that can be utilized to develop psychological interventions to improve the mental health of vulnerable populations during the COVID-19 pandemic.

Psychological Impairment and Coping Strategies During the COVID-19 Pandemic Among Students in Pakistan: A Cross-Sectional Analysis.

High levels of stress are expected when crises affect people's lives. Therefore, this Web-based, cross-sectional study was conducted among university students from Pakistan to investigate the psychological impairment and coping strategies during the coronavirus disease 2019 (COVID-19) pandemic. Google Forms were used to disseminate the online questionnaire to assess anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9), and coping strategies (Brief-COPE). A total of 1134 responses (age, 21.7 ± 3.5 y) were included. The frequency of students having moderate-severe anxiety and depression (score ≥ 10) were ≈ 34% and 45%, respectively. The respondents' aged ≥ 31 y had significantly lower depression score than those ≤ 20 y (P = 0.047). Males had significantly less anxiety (6.62 ± 5.70 vs 7.84 ± 5.60; P = 0.001) and depression (8.73 ± 6.84 vs 9.71 ± 7.06; P = 0.031) scores. Those having family members, friends, or acquaintances infected with disease had significantly higher anxiety scores (8.89 ± 5.74 vs 7.09 ± 5.56; P < 0.001). Regarding coping strategies, the majority of respondents were found to have adopted religious/spiritual coping (6.45 ± 1.68) followed by acceptance (5.58 ± 1.65), self-distraction (4.97 ± 1.61), and active coping (4.81 ± 1.57). In conclusion, COVID-19 caused significant impairment on mental health of the students. The most frequent coping strategies adopted by students were religious/spiritual and acceptance coping. During epidemics, mental health of students should not be neglected.

Burnout and psychological distress amongst Australian healthcare workers during the COVID-19 pandemic.

Objective:To examine psychological distress in healthcare workers (HCWs) during the COVID-19 pandemic in April–May 2020.Methods:A cross-sectional survey examining demographic, employment and mental health characteristics of HCWs in a large metropolitan hospital in Australia.Results:HCWs showed significant symptoms of moderate-severe level depression (21%), anxiety (20%) and posttraumatic stress disorder (PTSD; 29%), associated with burnout, prior psychiatric history, profession and resilience.Conclusion:Despite low levels of COVID contact, moderate to high levels of psychological distress were reported. Continued monitoring and support for HCWs’ mental well-being is warranted as the COVID-19 pandemic develops.

Terapia cognitivo-conductual grupal sobre la sintomatología depresiva-ansiosa y temperatura nasal en mujeres con cáncer de mama: Estudio piloto

Objetivo. Evaluar el efecto de una intervención cognitivo-conductual grupal sobre la sintomatología ansiosa-depresiva y el funcionamiento autonómico afectivo en mujeres con cáncer de mama. Método. Estudio pre-experimental con una muestra de 17 mujeres mexicanas con un nivel de depresión de moderada-severa y diagnóstico de cáncer de mama. Los instrumentos de evaluación fueron el Inventario de Depresión de Beck y la Escala de ansiedad de Hamilton; además de una evaluación del funcionamiento autonómico mediante el registro intra-sesión de la temperatura periférica nasal. Resultados. Se observó una reducción de los síntomas de depresión (Z=-3.182, p=0.001), ansiedad (Z=-2.697, p=0.007) y un incremento de la temperatura al finalizar el tratamiento (Z=-2.669, p=008) que se mantuvo por seis meses (Z=-3.266, p=0.001). Conclusión. La terapia cognitivo conductual grupal fue eficaz para la reducción de la sintomatología ansiosa-depresiva y la regulación autonómica en el grupo de mujeres con cáncer de mama.

Schools health promotion among adolescents in Northern Nigeria

Abstract Background Jigawa and Kano States, Northern Nigeria have some of the worst human development outcomes globally for adolescents across a wide range of health indicators. Our aim was to understand health awareness, beliefs, and behaviours of adolescents in school in Jigawa and Kano States, to inform prioritization and development of health promotion interventions in the region. Methods We carried out a cross-sectional survey followed by focus group discussions (FGDs) with adolescents aged 15 to 20 years from four schools in Jigawa and Kano States (July-August 2019). Adolescents (274 per school) were randomly selected stratified by class-year (SS1 and SS2); 64 participated in FGDs (8 groups of 8). Trained researchers administered a questionnaire face-to-face via smart phones. Topics included: mental health; tobacco use; substance misuse; violence and unintentional injury; physical and dietary behaviours; and hygiene. FGDs investigated topics in greater depth. Here we report prevalence and predictors of mental health calculated from survey responses, and thematic analysis of interview findings. Results One thousand and seventy-nine students completed the survey (98%);∼50% girls. Preliminary analysis showed prevalence of moderate-severe anxiety was higher in girls than boys (6.8% girls, 0.8% boys, p &amp;lt; 0.001); and moderate-severe depression (10.3% girls, 0.5% boys, p &amp;lt; 0.001). Up to 50% boys and girls experienced violence or abuse in school, and 16% used a prescription drug without a prescription in past 30 days. Multivariable logistic regression showed female gender (aOR =4.0, 95% CI; 2.7,6.0); 30-day off-prescription drug use - aOR=2.3 (1.5,3.8); and being hit or slapped by a teacher - aOR=1.7, (1.1, 2.6) were predictors of moderate to severe anxiety. Results were similar for moderate to severe depression. Qualitative findings supported and contextualized these results. Conclusions Results will inform school-based interventions to improve health of adolescents in the region. Key messages Administering a health questionnaire to gather health information of adolescents in school in Kano and Jigawa states, Nigeria was feasible. Health questionnaire and focus group data will be shared with school and community leaders to shape school-based interventions to improve health outcomes amongst adolescents.

Affective disorders: A question of continuing treatment during pregnancy (Review).

Fetal development, especially in the first trimester, has proven to be heavily influenced by external factors, such as chemical intake of medication. Chronic psychiatric treatment might interfere with the anatomical and physiological wellbeing of the fetus, because psychotropic medication proceeds past the placenta, into the amniotic fluid, and can enter breast milk. Hence some of the medications prescribed for mood disorders should be reconsidered during pregnancy, without sub-optimally treating when it is needed. A literature review is presented which systematically collects modern data and synthesizes previous interdisciplinary research findings on the safety of psychiatric treatment for affective disorders during pregnancy (term-based) and lactation. Antidepressants and mood stabilizers, fundamental strategies in treating affective disorders, have been classified by the FDA as C respectively D drugs pertaining to their risk, with some exception. Most guidelines recommend pharmacologically treating moderate-severe depression, preferably with SSRIs. Evidence advocates that drugs should be used during pregnancy only if clearly needed and the benefit outweighs the risk to the fetus. However, guidelines the American College of Obstetricians and Gynecologists state that antidepressants are a preferred first course of treatment and does not take into account the severity of the depression. Among mood-stabilizers, lithium is considered to be the safest option for pregnant women. Anticonvulsants have a higher risk of teratogenicity compared with lithium, with lamotrigine being the safest one. All mood stabilizers should be recommended in the lowest effective doses. There is controversy regarding the safety of second-generation antipsychotics during pregnancy and further research is required. Several case reports and meta-reviews have been published in order to emphasize the safety of electroconvulsive therapy (ECT) during pregnancy, but practitioners still stigmatize this procedure. Evaluating the overall risk-benefit ratio should be assessed by the medical care provider, taking into consideration current findings.

Prevalence and Predictors of Anxiety and Depression Symptoms during the COVID-19 Pandemic and Compliance with Precautionary Measures: Age and Sex Matter.

Effective management of the global pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (also known as COVID-19), resulted in the implementation of severe restrictions in movement and enforcement of social distancing measures. This study aimed to understand and characterize the psychosocial effects of the COVID-19 pandemic in the general population and to identify risks and protective factors that predict changes in mental health status. In addition, the study investigated compliance with precautionary measures (PM) to halt the spread of the virus. The online anonymous survey collected information on sociodemographic data, compliance with PM, quality of life (QOL), and mental health via the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). A total of 1642 adult participants (71.6% women, 28.4% men) completed the survey in the European island country, Cyprus. A large percentage (48%) reported significant financial concerns and 66.7% significant changes in their QOL. About 41% reported symptoms associated with mild anxiety; 23.1% reported moderate-severe anxiety symptoms. Concerning depression, 48% reported mild and 9.2% moderate-severe depression symptoms. Women, younger age (18–29), student status, unemployment status, prior psychiatric history, and those reporting greater negative impact on their QOL, were at higher risk for increased anxiety and depression symptoms (p < 0.05). The youngest age group and males also reported lower levels of compliance with PM. Higher compliance with PM predicted lower depression scores (p < 0.001) but higher anxiety for measures related to personal hygiene. The results of this study provide important data on the effects of the COVID-19 outbreak on mental health and QOL and identify a variety of personal and social determinants that serve as risks and protective factors. Furthermore, it has implications for policy makers demonstrating the need for effective mental health programs and guidance for the implementation of PM as a public health strategy.

An Observational Study on Depressive Illness in Hemodialysis Recipients: A Review on its Association and Prognostication

Major Depressive Disorder (MDD) is one of the most common psychiatric illnesses. The effect of depression on one’s physical health is well-known, which can include anything from weight gain or loss to chronic illnesses such as heart disease, kidney or gastrointestinal problems. Provided the increasing prevalence of patients suffering from End Stage Renal Disease (ESRD) and receiving hemodialysis treatment, it is important to investigate how MDD affects the outcome of their treatment. The incidence of depression in dialysis patients ranges from 10% to 66% in various studies, with prevalence reaching as high as 100%. The purpose of this article is to find the prevalence and severity of major depressive disorder in dialysis patients as well as to describe the possible pathways MDD worsens the dialysis outcome. Our study population consisted of 51 End Stage Renal Disease (ESRD) patients sampled from the Department of Nephrology at BIRDEM General Hospital. Neurocognitive, physical symptoms, the severity of MDD and presence of comorbid conditions including diabetics and hypertension, were measured in our study. The ESRD patient sample consisted 47.7% moderately depressed patients, 34% severely depressed, 11.4% mild and 6.8% with minimal MDD patients. Analogous to Hypertension and Diabetic patients with depression, the number of Chronic Kidney Disease (CKD) patients with mostly moderate severe depression increased with the duration of the disease. The article explains a myriad of biologic, behavioral, genetic and social factors underlying the association of depression and adverse medical outcomes in patients with CKD and ESRD. Moreover, neuroimaging data is required for further discussion on relationship between Depression and CKD. The implication of this study is to emphasize the importance of dialysis patients’ overall health and to serve as a pretext for further research into depression in dialysis patients.&#x0D; Bangladesh Crit Care J March 2020; 8(1): 41-47

Natural history and visual outcome of nonarteritic anterior ischemic optic neuropathy in Southern Taiwan: a pilot study.

To investigate the natural course, visual outcome, and risk factors for visual loss after nonarteritic anterior ischemic optic neuropathy (NAION) attack in Chinese patients from a tertiary medical center in Southern Taiwan. This is a longitudinal observational study that included sixty NAION patients, who were seen in our neuro-ophthalmology clinic from 2007 to 2016. Records of their ophthalmic history, medical history, best-corrected visual acuity (BCVA), visual field (VF) testing, and optical coherence tomography (OCT) were obtained for analysis. When the first visit was within two weeks after NAION onset, 62% of patients had BCVA of less than 0.1 (logMAR BCVA ≥ 1) and 38% had at least moderate-severe depression (VF grade ≥ 3) on VF on the initial visit. VA stabilized at three months after onset and was predictive of VA at 12months. Diabetes mellitus was a risk factor associated with VA worsening. Sixty-one percent of patients had BCVA of less than 0.1 at 12months after onset. VF remained relatively unchanged during the disease, with 41% eyes having VF grade ≥ 3 at 12months after onset. On OCT, all quadrants of retinal nerve fiber layer thickened initially, returned to the level of the fellow eye at one month, and continued thinning up to 12months slowly. In Southern Taiwan, a higher proportion of Chinese patients (over half) presented with severe visual loss during the first two weeks of NAION attack and at 12months after the onset of NAION as compared to the findings previously reported in Caucasians. Understanding the natural course of NAION in Chinese patients may provide insights toward a possible therapeutic window for NAION treatments in this group of patients.

Depression and HIV risk behaviors among adolescent girls and young women seeking family planning services in Western Kenya.

We assessed prevalence of human immunodeficiency virus (HIV) risk behaviors and depressive symptoms among adolescent girls and young women (AGYW) aged 15-24 years attending four public family planning clinics in Western Kenya from January to June 2019. Moderate-to-severe depression (MSD) was defined as a Center for Epidemiologic Studies Depression Scale (CESD-10) score ≥10. Among 487 AGYW, the median age was 22 years (interquartile range 20-23), and 59 (12%) AGYW reported MSD. MSD was more prevalent among AGYW without a current partner (p = 0.001) and associated with HIV risk factors including partner ≥10 years older, recent transactional sex, forced sex, intimate partner violence, and alcohol use (each p ≤ 0.005). Thirty-four percent of AGYW with MSD had a high HIV risk score corresponding to 5 to 15 incident HIV cases per 100 person-years. Overlapping high prevalence of depression and HIV risk among AGYW underscores the need for integrated mental health and HIV services in family planning clinics.

Depressive Symptom Trajectories Associated With Standard and Accelerated rTMS

Abstract Background To determine if an accelerated rTMS protocol results in distinct depressive symptom response trajectories, compared to a standard rTMS protocol. We also sought to validate previous analyses that identified distinct depressive symptom response trajectories with rTMS treatment using an external dataset. Method Data from two recent clinical trials comparing accelerated rTMS protocol delivered to the left dorsolateral prefrontal cortex (DLPFC) with standard once-daily rTMS protocol were used to identify depressive symptom response trajectories. The accelerated protocol in Trial 1 was conventional 10-Hz rTMS, while Trial 2 employed intermittent theta burst stimulation (iTBS). Participants were adult outpatients (18–70 years old) with bipolar or unipolar depression and moderate-severe depression (Montgomery Asberg Depression Rating Scale score >19) who had failed to respond to adequate courses of two different antidepressants. We used group-based trajectory modeling to identify MADRS response trajectories, and regression techniques adjusting for baseline depressive symptom severity to determine the association between treatment protocol and depressive symptom response trajectory. Results Treatment outcomes of 189 participants were analysed. We identified four distinct response trajectories: “nonresponse” (N = 59; 30.7%), “minimal response” (N = 65; 34.1%), “higher symptoms, response” (N = 26; 14.6%), “lower symptoms, response” (N = 39; 20.6%). We failed to find an association between rTMS protocol (accelerated vs standard) with depressive symptom response trajectory even after adjusting for baseline depressive symptom severity. Conclusion The accelerated rTMS protocol in this study did not impact depressive symptom response trajectories. This work provides further confirmatory evidence that there are distinct depressive symptom response trajectories with rTMS delivered to the left DLPFC. Australian new zealand clinical trials registry ACTRN12616000443493 and ACTRN12613000044729.

Prevalence and determinants of perinatal depression among labour migrant and refugee women on the Thai-Myanmar border: a cohort study

BackgroundPerinatal depression is a significant contributor to maternal morbidity and mortality globally. Migrant women, particularly those living in low- and middle-income settings, represent a particularly vulnerable group due to stressors experienced before, during and after migration. The vast majority of global migration flows occurring within and between low- and middle-income regions, yet existing evidence focuses predominantly on migrants in high-income destinations. This study aimed to redress this significant gap in the evidence by determining the prevalence and determinants of perinatal depression among migrant women on the Thai-Myanmar border.MethodsA cohort of labour migrant and refugee women was followed-up from the first trimester of pregnancy to one month post-partum. Depression status was assessed in the first, second and third trimesters of pregnancy and at one month post-partum using the Structured Clinical Interview for the Diagnosis of DSM-IV Disorders. Women diagnosed with depression had immediate access to care. Data on potential demographic, social and clinical associated factors was collected using a questionnaire. Prevalence and incidence of any depressive disorder and moderate-severe depressive disorder was calculated. Univariable and multivariable logistic regression using complete case analysis was used to estimate odds ratios (OR) of association between exposure variables and depression status.ResultsFive hundred sixty-eight women participated. Period prevalence (from first trimester of pregnancy to one month post-partum) of moderate-severe perinatal depression was 18.5% (95% CI 15.4–21.9%). Overall, 15.4% (95% CI 11.8–19.6%) of women developed new-onset moderate-severe depression during the study period. Forty-two participants received treatment for depression. Risk factors were interpersonal violence (OR 4.5; 95% CI 1.9–11.1); history of trauma (OR 2.4; 95% CI 1.4–4.3); self-reported history of depression (OR 2.3; 95% CI 1.2–4.2); labour migrant status (OR 2.1; 95% CI 1.1–4.0); low social support (OR 2.1; 95% CI 1.1–3.7); and maternal age (OR 1.1 per year; 95% CI 1.0–1.1). Limitations of the study include that culturally specific manifestations of depression may have been missed.ConclusionsPerinatal depression represents a significant burden among migrant women on the Thai-Myanmar border. Programmes to address the determinants along with early case identification and effective treatment and referral systems are key to addressing perinatal depression in this low-resource setting.

Depression in myasthenia gravis: a heterogeneous and intriguing entity.

Depressive symptoms in myasthenia gravis (MG) are common, may mimic other disease features, and contribute to misdiagnosis and diagnostic delay. Nevertheless, the clinical determinants of depressive symptoms in MG remain poorly studied, in particular their overlap with fatigue. Moreover, studies in MG have rarely looked at distinct depression phenotypes. In 68 consecutive MG patients, we ascertained cognitive-affective and somatic depression with the Beck Depression Inventory (BDI), and also assessed age at disease onset, education, marital state, work ability, sleepiness, fatigue, and treatment modalities. Disease severity was graded according to the Myasthenia Gravis Foundation of America (MGFA) classification. The prevalence of moderate-severe depression was 20.5%. While depression and fatigue showed large overlap (n = 37, 54.4%), only fatigue increased with disease severity, while BDI scores did not. Thymectomy was independently associated with lower BDI scores, but had no impact on fatigue. Total BDI scores were similar in patients with predominantly cognitive-affective and with predominantly somatic depression. However, ESS correlated only with cognitive-affective BDI, and younger age was independently associated with cognitive-affective BDI. Conversely, female sex and thymectomy were independently associated with somatic BDI. Depression and fatigue are highly prevalent and largely overlapping comorbidities in MG, but only fatigue increased with disease severity, and only depression was milder in thymectomized patients. Comparative use of BDI subscales in MG reveals distinct depression phenotypes with distinct correlations to other disease features.

Outcomes of Depression Screening for Adolescents Accessing Pediatric Primary Care-Based Services

PurposeAssess outcomes of depression screening among adolescents accessing pediatric primary care-based services. These findings will contribute to development of clinical protocols for depression screening and intervention in primary care settings. Design and methodsRetrospective chart review conducted via electronic medical records at a pediatric primary care-based clinic to extract PHQ-9 data for adolescents screened from 1/17/2018 to 4/18/2018. De-identified data included age, gender, ethnicity, provider, PHQ-9, and referral/follow-up/medication status. ResultsData included 1213 adolescents of whom N = 600 were depressed without additional comorbidities; 96 adolescents had PHQ-9 scores >5. Descriptive analyses by age, gender, ethnicity, referral type, follow-up, and provider services identified targeted primary care-based interventions for depression and referral. Depression screening occurred primarily at well child visits. 82.5% of those with PHQ-9 scores >5 were not currently receiving treatment. Overall, referrals by physicians (45.8%) and nurse practitioners (42.9%) were equivalent with more referrals for adolescents with moderate-severe depression. Nurse practitioners provided more counseling than physicians among adolescents with mild to moderate depression. ConclusionsAdolescent mental health necessitates an enhanced continuum of care. Primary care-based interventions provided by pediatric nurse practitioners are imperative to address adolescent mental health needs. Findings provide practical means to incorporate protocols for depression enhancing primary care-based mental health access. Practice implicationsNeed for incorporation of practical modalities for depression assessment and follow up as recommended by American Academy of Pediatrics. Future study for comparison of methods (phone/text reminder, follow up appointment, online resource reminder, telehealth), indicated to enhance follow-up care for adolescents experiencing depression.

Implementing an mhGAP-based training and supervision package to improve healthcare workers\u2019 competencies and access to mental health care in Malawi

BackgroundIt is now well established that the integration of mental health care into primary care is one of the most effective ways of reducing the substantial treatment gap for mental disorders which exists in most low- and middle-income countries. This study set out to determine whether a Mental Health Gap Action Programme (mhGAP) training and supervision package could be contextualised and implemented within the existing health care system in five districts in Southern Malawi. In addition, the study assessed the feasibility of holding community awareness events and establishing peer support groups in each district to further improve the access of the population to evidence-based mental health care.MethodsA lead training team of experienced Malawian mental health professionals was appointed and mhGAP training materials were contextualised for use in Malawi. The lead team delivered a 4-day training package to district mental health teams in five districts covering three core conditions: psychosis, moderate-severe depression, and alcohol and substance use disorders. District mental health teams then delivered a 2-day training package and provided monthly supervision for 3 months to 500 non-specialist healthcare workers. Paired sample t-tests were used to compare knowledge, confidence and attitude scores before and immediately after training, and after 6 months in two districts. Case detection rates measured pre- and post-training in the pilot district were compared using Wilcoxon Rank Sum Test. Community awareness events were held and peer support groups were established in each of the five districts. The acceptability of the package was assessed through focus group discussions involving specialist and non-specialist healthcare workers, users and carers.ResultsNon-specialist healthcare workers’ knowledge and confidence scores significantly increased immediately after training in comparison to pre-training. These scores were maintained at 6 months. However, no statistically significant change in attitude scores was detected. Case detection rates increased immediately after the training in comparison to pre-training. Responses from focus group discussion participants illustrated the programme’s acceptability.ConclusionsThis study demonstrated that, with minimal additional funding and working within existing structures, an mhGAP based training at primary and secondary health care levels is feasible in Southern Malawi.

Prevalence and risk factors for anxiety and depression among school going adolescent of Rajkot, Gujarat, India

Background: Adolescence is a period of turmoil, leading to several mental health challenges including anxiety and/or depression. Anxiety and depressive disorders affects 10-15% of adolescents. Anxiety and depression are associated with substantial negative effects on adolescent’s social, emotional and academic success. This leads to poor social and coping skills, low self-esteem, perceptions of social rejection, and difficulty forming friendships. This study was carried out with an objective to study prevalence and risk factors for anxiety and depression among adolescents.Methods: A cross sectional study conducted from April 2014 to December 2015 among 1026 school going adolescents from 4 schools of Rajkot, Gujarat, India. Anxiety and depression were measured using Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) respectively. Chi-square test was applied as test of significance.Results: Majority of the students (58.1%) was belonged to early adolescent age group. Two third were males. Maximum adolescents (42.5%) were coming from class III. Prevalence of moderate-severe anxiety and depression was 9.9% and 18.5%. Anxiety was not significantly associated with age, gender and socio economic class. Prevalence of depression was significantly higher in boys (20.5%) as compared to girls (14.5%, p=0.02). Moderate to severe depression was gradually increased with increasing in age. Adolescent from upper socio economic class (I, II, III- 19.1%) were severely depressed than adolescent from lower socio economic class (IV, V- 4.1%).Conclusions: Anxiety and depression was significantly present in adolescent age group. Depression was commonly observed in boys and gradually increased with increasing in age. There is need of strengthening school health services with screening and cost effective interventions to minimize the risk of drug abuse, suicide and violence.

Depressive symptom trajectories associated with standard and accelerated rTMS

BackgroundTo determine if an accelerated rTMS protocol results in distinct depressive symptom response trajectories, compared to a standard rTMS protocol. We also sought to validate previous analyses that identified distinct depressive symptom response trajectories with rTMS treatment using an external dataset. MethodData from two recent clinical trials comparing accelerated rTMS protocol delivered to the left dorsolateral prefrontal cortex (DLPFC) with standard once-daily rTMS protocol were used to identify depressive symptom response trajectories. The accelerated protocol in Trial 1 was conventional 10-Hz rTMS, while Trial 2 employed intermittent theta burst stimulation (iTBS). Participants were adult outpatients (18–70 years old) with bipolar or unipolar depression and moderate-severe depression (Montgomery Asberg Depression Rating Scale score >19) who had failed to respond to adequate courses of two different antidepressants. We used group-based trajectory modeling to identify MADRS response trajectories, and regression techniques adjusting for baseline depressive symptom severity to determine the association between treatment protocol and depressive symptom response trajectory. ResultsTreatment outcomes of 189 participants were analysed. We identified four distinct response trajectories: “nonresponse” (N = 59; 30.7%), “minimal response” (N = 65; 34.1%), “higher symptoms, response” (N = 26; 14.6%), “lower symptoms, response” (N = 39; 20.6%). We failed to find an association between rTMS protocol (accelerated vs standard) with depressive symptom response trajectory even after adjusting for baseline depressive symptom severity. ConclusionThe accelerated rTMS protocol in this study did not impact depressive symptom response trajectories. This work provides further confirmatory evidence that there are distinct depressive symptom response trajectories with rTMS delivered to the left DLPFC. Australian new zealand clinical trials registryACTRN12616000443493 and ACTRN12613000044729.