Need For Treatment Of Depression Research Articles

(056) PSYCHOSOCIAL FACTORS IN NEUROPROLIFERATIVE VESTIBULODYNIA PATIENTS WHO UNDERWENT COMPLETE VESTIBULECTOMY

Abstract Introduction Neuroproliferative vestibulodynia (NPV) is characterized by severe allodynia and hyperalgesia during entry penetration. Multiple psychosocial factors may contribute to the experience of pain from NPV. Concerning psychologic factors, women afflicted with NPV report difficulty with mental health issues such as anxiety and depression, high rates of negative emotions, substantial difficulties with psychosocial adjustment, and experience suicidal ideation. Objective This study focuses on psychosocial factors identified in a cohort of patients diagnosed with NPV who underwent vestibulectomy. Methods This is a chart review of 65 patients, median age 26 years (IQR 23-31) clinically diagnosed and pathologically confirmed with NPV. They completed validated instruments administered including the Female Sexual Function Index (FSFI), Sexual Distress Scale-Revised (SDS-R), McGill Pain Questionnaire-Short Form (SF-MPQ), Perceived Stress Scale (PSS), and Patient Health Questionnaire-9 (PHQ-9). The sex therapy evaluation performed on initial patient intake assessed psychosocial issues including effect of symptoms on quality of life, self-image, past trauma, and past/current relationship(s). Patients identified as having significant psychosocial issues were advised to undergo pre-op and/or post-op therapy. Results Based on history, initial psychological assessment, and psychosocial experiences with vestibular pain, post-operative therapy was recommended to 94% of our study cohort to maximize post-operative outcome. Our study cohort exhibited high levels of anxiety (53.8%) and depression (50.8%). Sexual abuse, assault and/or incest had been experienced by 32.3%. Other psychological issues included eating disorder (10.8%), bipolar (6.2%) as well as suicidal ideation (4.6%). Problems revolving around personal relationships include panic attacks around sex/men (21.5%), not pursuing sexual relationships (9.2%), lack of attraction toward current partner (4.6%) or being attracted to unavailable people (3.1%). A total of 15.4% of this cohort had complaints of low desire and 9.2% had a history of drug or alcohol abuse. Median FSFI total score was 13/36 (<26), with distress (≥11) consistent with sexual dysfunction in 56 of 61 patients. Median FSFI pain domain was 0/6; median FSDS-R (n=61) was 35/52, indicative of significant distress; median PHQ-9 was 6.5/27 with 23 patients’ scores consistent with possible need for depression treatment based on clinical judgment and 14 patients with score consistent with warranting treatment for depression. Median PSS was 22/40 with the most common level of stress being moderate (n=54). SF-MPQ median results (n=63) were 15/33 for sensory, 3/12 for affective and 4/5 for present pain intensity. With 3-46 month follow-up, 86.3% of patients (44/51) reported improvement on the Patient Global Impression of Improvement with 72.5% (37/51) reporting significant improvement. Conclusions While NPV is a biologic diagnosis, psychological factors likely contribute to the development, continuation, and consequences of NPV. We believe that the significant mental health issues in this NPV patient population made recovery from vestibulectomy more protracted than typically experienced after surgery. Psychological therapy would be beneficial in this population and should be continued postoperatively, as needed, to address psychological concerns and enhance quality of life. Disclosure No.

Exploring the relationship between anxiety, depression and wellbeing in doctors: a national cross-sectional survey and interviews

AimsTo examine the relationship between depression, anxiety and wellbeing in doctors.BackgroundThe relationship between doctor wellbeing and mental health diagnoses is not well evidenced in the literature. There is a lack of comparable measurement of wellbeing in doctors within the National Health Service, meaning the effectiveness of wellbeing interventions is unknown.MethodA cross-sectional survey containing the PHQ9, GAD7 and WEMWBS questionnaires to measure depression, anxiety and wellbeing respectively, was advertised online nationally. The relationships between the total scores were explored using Spearman's rho correlation coefficients and Chi square tests. Thematic analysis of semi-structured interviews offered further insights.ResultSixty-seven doctors returned completed questionnaires. 29.9% had PHQ9 scores >5 and 41.8% had GAD7 scores >5. Therefore, over a quarter of the participants had a score that would suggest a management plan was needed for depression, and a third for anxiety. Moderate negative correlation between the total WEMWBS scores and the total PHQ , rs= –0.775, p = 0.00, N = 67 and GAD7 scores rs= –0.724, , p = 0.00, N = 67 was seen. Statistically significant differences between those with low wellbeing scores (WEMWBS < 40) and normal wellbeing scores (WEMWBS ≥ 40) in relation to the need for a management plan for depression (PHQ9 > 10) X2 (1, N = 67) = 12.395, p = 0.00 and anxiety (GAD7>10) X2 (1, N = 67) = 5.611, p = 0.018 were seen. The main themes identified from the interviews (n = 10) were the importance of social support outside of work, cynicism about an NHS plan check-in and a tendancy to neglect wellbeing until it has dipped.ConclusionThere is a moderate negative correlation between anxiety, depression and wellbeing, but they are not opposites and separate measures for wellbeing should be used. It is clinically useful to note that only those with a WEMWBS score of <45 had a PHQ9 score suggesting the need for treatment of depression.

Depression as a Mediator or Moderator Between Preparatory Grief and Sense of Dignity in Patients With Advanced Cancer.

The objectives of the study were to evaluate the relationship between depression, preparatory grief, and loss of dignity in patients with advanced cancer and whether depression has a mediator and/or a mediator role between preparatory grief and dignity. The participants were 120 patients with advanced cancer who completed the Greek version of the Patient Dignity Inventory, the Greek Hospital Anxiety and Depression Scale, and the Preparatory Grief in Advanced Cancer Patients questionnaire. Depression was highly correlated with preparatory grief and loss of dignity. Additionally, strong relationship was found between preparatory grief and loss of dignity. Mediation analyses revealed that preparatory grief influenced loss of dignity as well as indirectly by its effect on depression. However, there was not any affect of depression as moderator. The effect of depression on preparatory grief in patients with advanced cancer and dignity emphasizing the need for further research to confirm the current relationship as well as the need for treatment of depression.

School-Based Curriculum to Improve Depression Literacy Among US Secondary School Students: A Randomized Effectiveness Trial.

To determine the effectiveness of a universal school-based depression education program. In 2012-2015, we matched 6679 students from 66 secondary schools into pairs by state (Maryland, Delaware, Pennsylvania, Michigan, and Oklahoma) and randomized to the Adolescent Depression Awareness Program (ADAP; n = 3681) or to a waitlist control condition (n = 2998). Trained teachers delivered ADAP as part of the health education curriculum to students aged 14 to 15 years. The primary outcome was depression literacy. Secondary outcomes included mental health stigma and, in a subset of the sample, the receipt of mental health services. Follow-up was at 4 months. ADAP resulted in significantly higher levels of depression literacy among participating students than did waitlist controls, after adjusting for pretest assessment depression literacy (P < .001). Overall, ADAP did not significantly affect stigma (P = .1). After ADAP, students approached 46% of teachers with concerns about themselves or others. Of students who reported the need for depression treatment, 44% received treatment within 4 months of ADAP implementation. ADAP is an effective public health intervention for improving depression literacy among students. Clinicaltrials.gov NCT02099305.

Perceived need for depression treatment among persons entering inpatient opioid detoxification.

Depression is common among persons with opioid use disorder. We examined the perceived need for depression treatment (PNDT) among opioid-dependent patients and the relationship of PNDT to depression screening result. Between May and December 2015, we surveyed consecutive persons (n = 440) seeking inpatient opioid detoxification. We used the Patient Health Questionnaire-2 (PHQ-2) to screen for depression. To assess perceived need for depression services, participants were asked, "Do you believe you should be treated for depression?" Response options were recorded into four categories: "Not Depressed (ND)," "Perceive Need for Depression Treatment (PNDT)," "Depressed/Don't Want Treatment," and "Currently Treated." Participants' mean age was 32.3 (±8.7) years; 70.7% were male. Nearly two out of three persons screened positive for depression yet only 8.2% were being treated for depression prior to admission. Screening positive for depression was associated with a 2.95 (95%CI 1.82-4.81, p < .005) fold increase in the expected odds of PNDT. But nearly half of those depressed (48%) did not perceive the need for treatment. Approximately 40% of the participants (n = 177) perceived that they were not depressed; of these persons, 52% screened positive for depression. Detoxification program staff should screen patients for depression, and if a clinical diagnosis is confirmed, discuss treatment options, exploring the level of interest in mental health treatment for depression. Screening for and addressing depression, including patients' interest in treatment, should be central to post-detoxification aftercare planning. (Am J Addict 2017;26:395-399).

Depression in the older adult: What should be considered?

Introduction:The updated American Geriatrics Society (AGS) 2015 Beers Criteria include the following antidepressant classes as potentially inappropriate medications to be used with caution in older adults: selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, and mirtazapine.Methods:A search of the medical literature using PubMed and references included in the AGS 2015 Beers Criteria.Results:The treatment of depression in the older adult can additionally be complicated by comorbid conditions, as 80% of older adults have at least 1 comorbid condition and 50% have at least 2. These considerations limit the pharmacologic treatment options for depression in older adults. However, the treatment of major depression should not be overlooked, as it is quite common, with estimates of up to 5% of older adults in the community and up to 13.5% in older adults who receive home health care.Discussion:This article reviews treatment considerations of depression in the older adult, including both available screening tools and a discussion balancing the need for treatment of depression in this population with the concerns addressed in the 2015 Beers Criteria.

Unmet need for treatment of depression among immigrants from the former USSR in the US: A primary care study

The stress of immigration can increase risk for major depressive disorder (MDD), while cultural factors can contribute to difficulty in diagnosis and treatment of MDD among immigrant populations. Consequently, immigrants are less likely to have their treatment needs met. Our goal was to assess the unmet need for the diagnosis and treatment of depression among immigrants from the former USSR-a large immigrant group in the US-as well as demographic characteristics and immigration history associated with depression. We conducted a survey in an urban primary care clinic using measures of MDD symptoms (Patient Health Questionnaire-9), functioning, and treatment history among 102 Russian-speaking immigrants. Current moderate-to-severe symptoms of MDD were reported by 26.5% of participants with 33.3% of the symptomatic patients reporting suicidal ideation. Among participants with probable MDD, 63.0% reported not receiving mental health treatment and 59.3% never being diagnosed with MDD. The rates of untreated depression did not vary by gender nor did they diminish with prolonged stay in the US. Results suggest that undiagnosed and untreated depression is highly prevalent in this immigrant group.

Internet treatment addressing either insomnia or depression, for patients with both diagnoses: a randomized trial.

To compare treatment effects when patients with insomnia and depression receive treatment for either insomnia or depression. A 9-w randomized controlled trial with 6- and 12-mo follow-up. Internet Psychiatry Clinic, Stockholm, Sweden. Forty-three adults in whom comorbid insomnia and depression were diagnosed, recruited via media and assessed by psychiatrists. Guided Internet-delivered cognitive behavior therapy (ICBT) for either insomnia or depression. Primary outcome measures were symptom self-rating scales (Insomnia Severity Index [ISI] and the Montgomery Åsberg Depression Rating Scale [MADRS-S]), assessed before and after treatment with follow-up after 6 and 12 mo. The participants' use of sleep medication and need for further treatment after completion of ICBT was also investigated. The insomnia treatment was more effective than the depression treatment in reducing insomnia severity during treatment (P = 0.05), and equally effective in reducing depression severity. Group differences in insomnia severity were maintained during the 12-mo follow-up period. Post treatment, participants receiving treatment for insomnia had significantly less self-rated need for further insomnia treatment (P < 0.001) and used less sleep medication (P < 0.05) than participants receiving treatment for depression. The need for depression treatment was similar in both groups. In this study, Internet-delivered treatment with cognitive behavior therapy (ICBT) for insomnia was more effective than ICBT for depression for patients with both diagnoses. This indicates, in line with previous research, that insomnia when comorbid with depression is not merely a symptom of depression, but needs specific treatment. The trial was registered at Clinicaltrials.gov, registration ID: NCT01256099.

Pregnant and Nonpregnant Women in Cape Town, South Africa: Drug Use, Sexual Behavior, and the Need for Comprehensive Services

The multiple risks associated with methamphetamine use are of serious concern for women. These risks and consequences are magnified during pregnancy. This secondary analysis of a parent study compared 26 pregnant to 356 nonpregnant women in Cape Town, South Africa, on selected demographic, psychosocial, and HIV-risk domains to identify their treatment service needs. Proportionally, more pregnant than nonpregnant women are using methamphetamine, P = .01, although a very high rate of women used methamphetamine. Women reported similar monthly rates of sexual intercourse, but pregnant women were significantly less likely to report condom use, P < .0001, maintaining their risky behavior. Both groups reported elevated Center for Epidemiological Studies Depression Scale CES-D means, suggesting a need for depression treatment. Results demonstrate a pervasive need for women's comprehensive treatment, regardless of pregnancy status. Moreover, findings support the urgent need for women-focused and pregnancy-specific treatment services for methamphetamine use. Finally, a job-skills training/employment component focus is suggested.

Seasonal severity of depressive symptoms as a predictor of health service use in a community-based sample

Objective To determine whether severity of seasonal depressive symptoms is an independent predictor of depression-specific health service use. Methods Cross-sectional telephone survey evaluating mood-related symptom changes across seasons using a structured interview based on the World Mental Health Composite International Diagnostic Interview, in a community sample representative of the province of Ontario, Canada ( N = 1605). This study focuses on the 625 individuals (out of a total of 1605 interviewed) who screened positive for lifetime depressive symptoms. Severity of seasonal symptoms of depression (or “seasonality”) was measured using the Seasonal Depression Severity (SDS) score (range 0–36). The primary outcome was lifetime depression-specific use of health services from a physician (family physician or psychiatrist). Lifetime psychotropic medication use, use of health services from a non-physician therapist, and psychiatric hospitalization were secondary outcomes. Other important variables that are known to predict depression-specific health service use were considered in multivariable analysis. Results In our sample of individuals with depressive symptoms, those who had used physician health services had higher SDS scores than non-users (11.5 (SD 7.2) vs. 9.7 (SD 6.4), t(616) = 3.182, P = 0.001). In multivariable analysis, SDS score was independently associated with depression-specific health service use by a physician (OR = 1.04, 95% CI 1.01–1.07, p = 0.004). The relationship between seasonality and use of psychotropic medication use was similar (OR = 1.04, 95% CI 1.01–1.07, p = 0.007). Conclusions Seasonality was independently associated with depression-specific health service use for individuals with depressive symptoms. The results imply that greater seasonality may independently reflect increased severity and need for treatment of depression.

Unmet Need for Treatment of Major Depression in the United States

This study examined the extent and correlates of perceived unmet need for treatment among individuals with depression in the U.S. general population. Analyses were based on a representative sample of 6,510 adult participants in the 2005 and 2006 National Surveys on Drug Use and Health who reported a major depressive episode in the past 12 months. A total of 3,568 (62.4%) participants had sought mental health treatment in the past 12 months, and 2,942 (37.6%) had not; 34.9% and 26.8% of these groups, respectively, reported unmet need for treatment. In both groups, older age was associated with a lower likelihood of reporting unmet need for treatment, whereas greater distress and impairment and higher education were associated with a greater likelihood of reporting unmet need. Among treatment seekers, treatment from general medical providers was associated with greater likelihood of unmet need, and more outpatient visits and insurance coverage for the full year were associated with a lower likelihood of unmet need. The most common reason for not seeking needed treatment was a concern about costs (cited as a reason by 46.0% of the total sample). Even though rates of treatment seeking have increased, many persons with major depression continue to experience unmet need for treatment, which in this study was mainly attributable to concerns about treatment costs.

Patient ethnicity and perceptions of families and friends regarding depression treatment

Objective. Black Americans are less likely than white Americans to seek professional treatment for depression. Whether treatment recommendations are sought and implemented by patients will be influenced by the role families and friends play in diagnostic acceptance and treatment decisions. We investigated the association of ethnicity with the perceived need for treatment of depression by family and friends of older primary care patients. Design. Cross-sectional survey of 355 older adults with and without significant depressive symptoms was conducted. At the baseline visit, family and friends’ ratings of apathy and need for depression treatment were obtained on 314 of the 355 patients (88% response rate) and examined according to ethnicity. Participants were interviewed using standardized measures of chronic medical conditions, functional status, and psychological status. Results. Older black patients compared to older white patients were less likely to be rated as needing depression treatment by their family and friends (odds ratio (OR)=0.34; 95% confidence interval (CI)=[0.18, 0.64]) adjusting for depressive symptoms, cognition, functional status, and other potentially influential characteristics. Conclusions. Our study suggests that patient ethnicity may play a role in a family member's or friend's perceived need for depression treatment of older adults who present in the primary care setting. Further study of attitudes, expectations, and values of patients and family members or friends in primary care settings may help elucidate the interplay of physician, patient, and family member or friend.

Beliefs About Depression and Depression Treatment Among Depressed Veterans

Because of the misunderstanding and stigmatization of mental health disorders and treatment, health beliefs may be important in treatment seeking for depression. It is important to understand patients' beliefs about mental health disorders and mental health treatment to improve systems of care. We studied beliefs about depression and depression treatment among patients in a randomized trial of a chronic care intervention to improve depression treatment in the Veterans Administration healthcare system (n = 395). The Depression Beliefs Inventory was used to assess beliefs regarding: (1) perceived need for depression treatment, (2) the efficacy of depression treatment, and (3) treatment barriers, including stigma, at baseline and 6 months. We calculated descriptive statistics on patients' baseline beliefs, and used multiple regression to investigate the extent to which beliefs changed in intervention and treatment as usual patients between baseline and 6-month assessments. We used logistic regression to investigate the relationship between beliefs and antidepressant initiation, adherence and clinical response. At baseline, 73% of our sample believed that they had depression, and 66% believed that taking antidepressants would be helpful for their depression. However, the depression intervention had few effects on beliefs, and individual beliefs were generally not associated with taking medication or clinical response. However, a summary measure of beliefs was found to have predictive validity with respect to initiating and adhering to antidepressant treatment. Our results highlight the potential difficulty in modifying individuals' attitudes regarding depression and depression treatment in chronic care models for depression interventions.

The structure and prevalence of mental disorders in patients of mental health and diagnostic centers in Armenia

Background and aims:In western countries, the majority of depressed patients are treated in primary care, and in developing countries, the majority of such population is not revealed. The main objective of this study was to find out the structure and prevalence of mental disorders at the mental health and multidisciplinary diagnostic Centers.Methods:We work out appropriate documents to collect the clinical and epidemiological data. The mental disorders diagnosed according to ICD-10. There were investigated 148 patients at the Center “Stress” and 122–Center “Diagnostica”. The first group we conditionally named “psychiatric”, and the second one “diagnostic”. Baseline data on diagnosis, symptomatology and other independent variables was collected.Results:Of the 148 “psychiatric” patients the highest was the number of patients with depressive disorders (F 32, 33, 34) – 45 (27.6%), then the mental disorders due to brain damage, dysfunction and physical disease (F06,07) – 15.6%, and dissociative (conversion) disorders (F44) – 14.7%. Among 122 “diagnostic” patient the most frequent diagnosis was Neurasthenia (F48.0) – 24.6%, then depression (F32,33,34) – 24.5%, and mental disorders due to brain damage, dysfunction and physical disease” (F06,07) – 19.7%. So the rate of depressive disturbances was high in both groups. It was common for depressed people to present with somatic rather than psychological complaints.Conclusions:Of people with a need for depression treatment, great majority reject it. Results of this study will contribute to a better understanding of depressive disorders in primary health care settings in Armenia.

Twelve-month prevalence, correlates, and treatment preference of adults with DSM-IV major depressive episode in Hong Kong

Background The most recent large-scale community mental health survey of depression among adults in Hong Kong was conducted over two decades ago. The lifetime prevalence rates of DSM-III major depressive disorder (females 2.44% and males 1.29%) in that study do not tally with several indices of worsened social health and clinical prevalence studies of depression in contemporary Hong Kong. Methods Each of 5004 adults randomly drawn from the general population completed a telephone interview that generated the DSM-IV-based diagnosis of major depressive episode (MDE), sociodemography, help-seeking, and other epidemiological data. Results Twelve-month prevalence of MDE was 8.4%. The female-to-male ratio was low but typical of surveys in Chinese communities. Female sex and unemployment were associated with increased risk. 32.5% of respondents with MDE reported frequent thoughts of suicide. Recognition of the need for treatment of depression was high but actual treatment rate and preference for mental health specialists were low. Limitations Response rate was low though cooperation rate was moderately high. Detailed demography, comorbidity, and clinical reappraisal interviews were not covered. Conclusions Resolving issues of stigma and mode of symptom elicitation may lead to more valid prevalence estimates of depression among Chinese people. Although longitudinal studies are needed to confirm a genuine increase in prevalence, depression is likely to be more common in Hong Kong than previously suggested. High recognition of the need for treatment but low rate of actual treatment calls for policy and programs that improve access to treatment.

Attitudes and illness factors associated with low perceived need for depression treatment among young adults

We do not yet fully understand how low perceived need for treatment leads many young adults to not seek care for their depression. A cross-sectional study of 10,962 depressed young adults (ages 16-29) who visited a depression screening/education Internet website. Based on the Theory of Reasoned Action, we developed a multivariate model to determine the effects of beliefs and attitudes, social norms, past treatment behavior, and symptom severity on low perceived depression treatment need (i.e., not agreeing that one needs depression treatment). Negative beliefs and attitudes, social norms, and past treatment behavior predicted low perceived depression treatment need and explained more than half the model variance. Even after adjusting for depression severity and symptoms of other mental disorders, lacking confidence in either a biological or counseling based explanation or treatment approach for depression predicted low perceived depression treatment need. Lack of helpful treatment experiences and/or confidence in either of the currently practiced depression treatment models may prevent many young adults from seeking depression treatment.

Stigma Beliefs of Asian Americans with Depression in an Internet Sample

To study the beliefs of Asian Americans with depression about stigma associated with depression treatment among friends, employers, and family. Participants completed the Center for Epidemiologic Studies-Depression Scale (CES-D) anonymously on the Internet. In this cross-sectional design, those who screened positive for depression were asked questions regarding stigma (n = 68 656). We used analysis of variance (ANOVA) and analysis of covariance (ANCOVA) to compare Asian Americans with whites and also to make comparisons by age and sex. Further, we stratified for Asian Americans and used ANOVA and ANCOVA to compare age and sex. We used linear regression to assess how stigma beliefs were associated with self-reported need for depression treatment. Asian Americans overall had greater stigma beliefs than did whites for all 3 stigma outcomes (P < 0.001), especially those related to family. Although this same pattern existed for subjects aged between 16 and 29 years and between 30 and 45 years (P < 0.001), among those aged under 16 years, this existed for family stigma (P < 0.001) but not for friends or employer stigma. In our stratified analyses among Asian Americans, male participants had greater stigma beliefs than did female participants for friends (P < 0.001) and employer (P < 0.05) but not for family. The pattern of Asian Americans having greater stigma levels than whites may be changing among younger Asian Americans because of acculturation. Also, among Asian Americans, unlike previous research showing no sex differences for stigma, we show that male participants had greater stigma levels than did female participants. Future directions should include measuring stigma after culture-specific interventions.