New-onset Depression Research Articles

The association between depression and length of stay in the intensive care unit.

Depression is common after patients are discharged from the intensive care unit (ICU) and has a negative impact on quality of life and mortality. There is inconsistent information about ICU admission and the risk of depression. The aim of our study was to investigate the association between the risk of depression and length of ICU stay.ICU survivors between 20 and 65 years old were enrolled in this study using data from Taiwan's nationwide population database. All study subjects were followed for a maximum of 1 year or until they were diagnosed with new-onset depression. The association between the length of ICU stay and the depression risk among ICU survivors was estimated using a Cox regression model. The screened diagnostic records of ICU survivors with depression were also investigated to find the potential disease effect of depression.Compared to patients with ICU stays between 8 and 14 days, the adjusted HR (95% confidence interval) for depression in patients with ICU stays between 1 to 3 days, 4 to 7 days, 15 to 21 days, and ≥22 days were 1.08 (1.03–1.13), 1.01 (0.96–1.05), 1.08 (1.01–1.14), and 1.12 (1.06–1.19), respectively. For patients with depression after discharge from the ICU, the most common primary diagnosis was intracerebral hemorrhage.There is a risk of depression after ICU discharge, and the incidence of depression may be higher among patients between 20 and 49 years old. The risk of depression was U-shaped, with higher risks associated with ICU stays of 1 to 3 days and more than 15 days.

New-onset depression among children, adolescents, and adults with hidradenitis suppurativa

Informationon the risk of depression among children, adolescents, and adults with hidradenitis suppurativa (HS) is limited. To compare the risk of new-onset depression in patients with HS with that of control individuals. Retrospective cohort analysis of 49,280 adult and 3042 pediatric patients with HS and matched control individuals identified by using electronic health record data. The primary outcome was incident depression. The crude incidence rate was 4.8 per 100 person-years in adult patients with HS compared to 3.0 per 100 person-years in control individuals. Among pediatric patients, the crude incidence rate was 4.2 per 100 person-years in patients with HS compared with 2.3 per 100 person-years in control individuals. In adjusted analysis, adults and pediatric patients with HS had a 10% (hazard ratio, 1.10; 95% confidence interval, 1.07-1.13; P<.001) and 26% (hazard ratio, 1.26; 95% confidence interval, 1.10-1.44; P<.001), respectively, increased risk of developing depression compared to control individuals. Among patients with HS, factors associated with depression included female sex, whiterace, smoking, and body mass index/obesity in adults and pediatric patients and substance abuse in adults only. Patients not seeking care in health systems within the database were not captured. Children, adolescents, and adults with HS are at an increased risk for developing depression, independent of other common risk factors for depression.

Rate of diagnostic conversion to bipolar disorder in adults with unipolar depression and psychopharmacological treatment in the republic of Korea: A nationwide register-based study

BackgroundPatients with bipolar disorder (BD) and depressive episodes are usually diagnosed with major depressive disorder (MDD). It is clinically important to estimate diagnostic conversion rate from MDD to BD and identify factors characterizing MDD patients at highest risk. We investigated conversion rate from depression to BD, stratified by age and sex, and associated psychopharmacological treatment patterns. MethodsData were extracted from the National Health Insurance to include 817,759 patients 18 years or older with new-onset antidepressant-treated depression between 2011 and 2015. We estimated rate of conversion from unipolar depression to BD stratified by age and sex during follow-up (357,343 person-years) and investigated the related medication patterns. ResultsDuring follow-up (median, 155 days; range, 2–1,442 days), 19,179 patients had diagnostic conversion to BD. Conversion rate was highest for patients aged 18–29 years; it gradually decreased with age until 60–69 years. Overall conversion rate to BD was 58.48 per 1,000 person-years for males and 50.97 per 1,000 person-years for females. For patients aged 18–39 years, the rate was higher for females. Patients with conversion to BD were prescribed more antidepressants. When the diagnosis changed to BD, 51% of patients were prescribed additional antipsychotics and/or mood stabilizers. LimitationsThe limited follow-up period may have underestimated conversion rate to BD. Data were restricted to participants with pharmaceutically treated depression. ConclusionsThe rate of diagnostic conversion from depression to BD differed by sex and age and was highest for females aged 18–29 years. Diagnostic conversion was accompanied by relevant prescription changes.

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.

Evidence of new-onset depression among persons with migraine after discontinuing antidepressants

Antidepressants have been hypothesized to cause tardive dysphoria—the delayed development of negative emotional symptoms. We assessed the risk of tardive dysphoria in a cohort of persons with migraine taking anti-migraine antidepressants with no known diagnosis of any mood or anxiety disorder. We included all outpatient encounters in a university hospital system for migraine from January 2008 through October 2018, excluding subjects with prior psychiatric diagnoses. Kaplan–Meier survival curves and multivariable Cox proportional hazards analyses were conducted. 13,048 subjects were included; 1191 took an antidepressant; 402 discontinued an antidepressant. In multivariable analyses examining the first year after exposure, antidepressant use was not significantly associated with risk of a depression, any mood disorder (including depression, mania, and other mood disorders), or anxiety. Antidepressant discontinuation was significantly associated with increased risk of depression, but not any mood disorder or anxiety. Among persons with migraine with no known psychiatric diagnosis, antidepressants did not appear to be associated with indicators of tardive dysphoria. Antidepressant discontinuation, however, was associated with increased risk of a depression diagnosis.

New antidepressant utilization pre- and post-bereavement: a population-based study of partners and adult children.

Bereavement is associated with increased morbidity and mortality, but few studies have examined the specific timing of depression onset. This study examines the risk of developing new-onset depression in adult children and partners by month, 1year before and after death. Using population-based registers in Denmark, we assembled a cohort of 236,000 individuals who died a natural death (2010-2016). Partners and adult children of the deceased were identified and demographic and prescription data were collected. GEE logistic regression was used to model whether the bereaved received a new antidepressant prescription around the death of their loved one across 24 time intervals (12months before and after death). Male and female partners had an increase in receipt of new antidepressant prescriptions in the 11months after the death of their partner, with a peak increase 2 or 3months after death. Partners also increased new antidepressant prescription use 2months before death. Characteristics of the decedents including cause of death were not associated with new antidepressant prescription in the surviving partner. Adult children did not have increased odds of being prescribed new antidepressants at any time. Both male and female partners have increase in new antidepressant utilization before and after the death of their partner. Our work points to the importance of supporting partners not only after the death of their partner, but also in the period before death when families may be actively engaged in caregiving for the seriously ill.

Prevalence and new onset of depression and anxiety among participants with AMD in a European cohort

To investigate the prevalence and new onset of depression and anxiety among subjects with age-related macular degeneration (AMD) and its association with AMD in a large European cohort with relatively good visual acuity. 11,834 participants enrolled in the German population-based Gutenberg Health Study were studied. AMD was diagnosed by grading of fundus photographs. Depression and anxiety were assessed with the Patient Health Questionnaire and the Generalized Anxiety Disorder-2 Scale, respectively. Logistic regression analyses were performed and adjusted for several parameters. 1,089 (9.2%) participants were diagnosed having AMD. Prevalence of depression in AMD and non-AMD participants was 7.2% and 8.0%, respectively and prevalence of anxiety was 4.2% and 7.0%, respectively. New onset of depression and anxiety at 5-year follow-up in AMD subjects was 2.6% and 3.6%, respectively. AMD was not associated with depression (OR 0.93; CI 95% 0.70–1.20; p = 0.62). AMD was associated with less anxiety (OR 0.67; CI 95% 0.47–0.93; p = 0.02). This is the first study analyzing both prevalence and new onset of depression and anxiety in AMD subjects. AMD- and non-AMD participants had a similar prevalence and new onset of depression in our population-based sample. Participants without AMD had a higher prevalence of anxiety. AMD was not associated with depression.

New Onset Depression and Anxiety After Spinal Fusion Surgery: Incidence and Risk Factors.

Retrospective database study. We sought to investigate trends and risk factors for new-onset anxiety and/or depression within 6 months after elective spine surgery. Surgery represents a stressful experience associated with a number of physiological and psychological consequences. A subset of patients develop clinically significant symptoms of new-onset anxiety or depression. However, the incidence of and risk factors for these adverse outcomes after spine surgery remain ill-defined. We performed a retrospective analysis including anterior cervical discectomy and fusion and posterior lumbar fusion cases from 2012 to 2015, utilizing the Truven MarketScan database. Primary outcomes were new-onset depression, new-onset anxiety, and new-onset depression and/or anxiety after surgery. Potential risk factors included patient demographics, comorbidities, hospital and procedural characteristics as well as perioperative opioid regimens. Multivariable logistic regression models measured associations between risk factors and outcomes. Odds ratios (OR) were reported and results with P < 0.0167 were considered statistically significant. Among 39,495 unique patients, overall incidence of new-onset depression and anxiety was 6% and 11.2%, respectively. In adjusted analyses, significant risk factors across all three outcomes included chronic opioid use (ORs ranging from 1.31 to 2.93; P < 0.01), female sex (ORs ranging from 1.25 to 1.67; P < 0.01), longer length of stay (ORs ranging from 1.05 to 1.08; P < 0.01), and readmission within 6 months of surgery (OR ranging from 1.31 to 1.68; P < 0.01). We identified several risk factors contributing to increased odds of new-onset depression and/or anxiety after spine fusion surgery. These data may aid the implementation of preventative measures among identified high-risk patients. 3.

Gamification in Late-Life Depression: A Serious Game for a Serious Problem

In the older population, one of the serious health concerns associated with negative outcomes such as comorbidity, loss of physical autonomy, excessive use of health care resources, and increased mortality is the onset of mood disorder [1]. Late-life depression (LLD) is an umbrella term to define depressed mood in people older than 65 years. It can have a variety of presentations: as recurrent disease stemming from earlier life (early onset depression [EOD]); as new-onset depression (late-onset depression [LOD]); as a mood disorder secondary to a general medical condition; or as mood symptoms secondary to substance or medication use [2]. Mistakenly, LLD is believed as a normal part of aging. For older people, depression could be the epiphenomenon of underlying biological processes (vascular changes, metabolic disturbances and neurodegenerative diseases); conversely, it could be the leading cause of cognitive impairment [3].

Aspects of diastolic dysfunction in patients with new and recurrent depression.

ObjectiveThe main objective of this study was to evidence the potential impact of the intensity, duration and recurrence of depression on the development of arterial stiffness (AS) leading to left ventricular hypertrophy (LVH) and diastolic dysfunction (DD) in patients with new onset depression (NOD) and recurrent depression (RD) in comparison to 33 control subjects without depression. Another aim was to identify potential predictive factors regarding the occurrence of diastolic dysfunction (DD).MethodsOur study group included 58 patients diagnosed with NOD and 128 diagnosed with RD, without any previously diagnosed significant heart diseases. The intensity of depression was evaluated by means of the Montgomery-Asberg Depression Rating Scale (MADRS). Assessment of pulse wave velocity (PWV), left ventricular mass index (LVMI) and echocardiographic parameters characterizing DD were performed for each patient.ResultsThe cardiology evaluations suggested an increased prevalence of AS in all patients, of significantly higher rate than in controls (p<0.001), which was statistically correlated with the severity and duration of depression. Another significant finding was an increased prevalence of DD (29.31% and 63.28%, respectively; p<0.001) correlated with the MADRS score, total duration and number of recurrences/relapses. The multivariate logistic regression analysis identified PWV, the intensity and duration of depression as significant predictive factors for the occurrence of DD.ConclusionsIn our study, diastolic dysfunction was a common finding among patients with RD, but it was also noted, to a lesser extent, in those suffering with NOD. DD was associated with altered AS, and strongly correlated with the intensity and the duration of depressive symptoms. The two latter factors, together with an increased PWV, were strong predictors for the occurrence of DD.

Exercise May Offset Genetic Risk for Depression

Back to table of contents Previous article Next article Clinical & ResearchFull AccessExercise May Offset Genetic Risk for DepressionTerri D’ArrigoTerri D’ArrigoSearch for more papers by this authorPublished Online:3 Jan 2020https://doi.org/10.1176/appi.pn.2020.1a27AbstractBoth high-intensity and low-intensity physical activity may offer protection from depressive episodes.Regular exercise may help prevent depression in people who have a higher genetic risk for the disorder, according to a study posted November 5, 2019, in Depression & Anxiety. Moreover, patients do not have to run marathons to derive any benefit: Gentler forms of exercise such as walking and yoga also appear to offer some protection.Some patients may find exercise daunting, so psychiatrists should explain that it is OK to start slowly, says Jordan W. Smoller, M.D., Sc.D.Massachusetts General HospitalAlthough prior research has suggested that physical activity has positive effects on depression, this study answers two key questions in a more concrete way, said researcher Jordan W. Smoller, M.D. Sc.D., a professor of psychiatry at Harvard Medical School and a professor of epidemiology at Harvard T.H. Chan School of Public Health.“Can we see a preventive effect of physical activity on new-onset depression in a real-world health care setting? And if so, do we see that effect even in people who may be genetically predisposed to develop depression?” asked Smoller, who is also the director of the Psychiatric and Neurodevelopmental Genetics Unit at Massachusetts General Hospital. “The answer to both questions is yes.”To arrive at their conclusions, Smoller and colleagues analyzed data from 7,968 adults in the Partners Biobank, an ongoing study of patients in the Partners HealthCare hospital system in Massachusetts. The database contains patients’ electronic health records, genomic data, and data from lifestyle surveys to help researchers understand how genes, lifestyle, and environment affect health. Overall, roughly 8% of patients in the study were diagnosed with depression within two years of completing a baseline lifestyle survey that asked how much physical activity they engaged in each week.First, the researchers divided the patients according to their polygenic risk score for depression.“The polygenic risk score is a sum of the many small effects of genetic variations that may contribute to a trait, in this case, depression,” Smoller explained. The more variations people have, the greater their risk. Indeed, those with higher polygenic risk scores were significantly more likely to develop a new episode of depression over the two years.Next, the researchers looked at the effect of physical activity. They found that the more physical activity patients reported, the less likely they were to develop depression. This effect was seen even in those with the highest polygenic risk for depression. For example, 12.7% of those in the high genetic risk group who exercised less than an hour a week developed depression, compared with 8.1% of those in the same group who exercised at least 3.2 hours a week, or an average of about 45 minutes a day. Both low-intensity exercise such as yoga and stretching and high-intensity exercise such as dancing, aerobics, and using exercise machines were associated with a lower risk of having a depressive episode, even after the researchers accounted for the patients’ polygenic risk score.Combined with prior research to date, this study demonstrates that “there is now pretty compelling evidence that physical activity of many different kinds may reduce the risk of new-onset depression and symptoms of depression,” Smoller said.He said he includes a discussion of exercise and physical activity in his visits with his patients and encourages other psychiatrists to do the same.“[Psychiatrists] should be trained and educated to support physical activity as part of what we do in counseling our patients,” he said. Yet he acknowledged that the prospect of exercising may seem daunting to patients, so it is important to stress that they can start slowly.This study was funded by the National Genome Research Institute and the National Institute of Mental Health. ■“Physical Activity Offsets Genetic Risk for Incident Depression Assessed Via Electronic Health Records in a Biobank Cohort Study” is posted here. ISSUES NewArchived

Does Coronary Microvascular Spasm Exist? Objective Evidence from Intracoronary Doppler Flow Measurements During Acetylcholine Testing

A 43-year-old woman with recurrent atypical angina underwent invasive coronary angiography including intracoronary Doppler blood flow assessment and coronary spasm provocation testing. While obstructive epicardial disease could be ruled-out angiographically, the patient experienced reproduction of her angina symptoms after intracoronary administration of acetylcholine (100 µg) during spasm provocation testing. Simultaneously, the ECG showed new-onset ST-segment depression in the absence of epicardial spasm. In addition, coronary flow velocity was significantly reduced after acetylcholine compared to the baseline condition. Following intracoronary administration of nitroglycerine (200 µg), the patient’s symptoms as well as the ECG changes and coronary flow reduction were reversed. Considering the ongoing challenges in appropriate evaluation of the pathophysiological mechanisms of coronary microvascular dysfunction, simultaneous intracoronary Doppler flow measurement during spasm testing – as shown in this case – may provide objective evidence for microvascular spasm in addition to the standardized diagnostic criteria, especially if they are ambiguous.

Role of psychosocial status in predicting health-related quality of life at 1-year follow-up among newly diagnosed people living with HIV.

BackgroundPsychosocial problems are common among people living with HIV (PLWH) and have been cross-sectionally associated with health-related quality of life (HRQoL). We evaluated the longitudinal relationship between psychosocial status and HRQoL among PLWH during the first year after diagnosis.MethodA consecutive sample of newly diagnosed PLWH was recruited from Changsha Center for Disease Control and Prevention in Hunan Province, China. Assessments were conducted at baseline and 1 year later. The measures used in this study included the Medical Outcomes Study HIV Survey (MOS-HIV), the 9-item Patient Health Questionnaire (PHQ-9), the HIV/AIDS Stress Scale (SS-HIV) and the Social Support Rating Scale (SSRS). The trajectories of depression from baseline to 1-year follow-up were categorized into four groups: never (PHQ-9 < 10 at two time points), new-onset (PHQ-9 < 10 at baseline & PHQ-9 ≥ 10 at follow-up), recovered (PHQ-9 ≥ 10 at baseline & PHQ-9 < 10 at follow-up) and persistent depression (PHQ-9 ≥ 10 at two time points). In addition, the trajectories of stress and social support were classified by calculating the proportions of participants whose stress and social support scores changed between baseline and 1-year follow-up by more than 0.5 effect size in either direction. Generalized linear models were used to examine the potential role of baseline and changes in psychosocial status in predicting the HRQoL at 1 year, after adjusting for socio-demographic and clinical characteristics.ResultsA total of 410 participants completed both the baseline and 1-year follow-up surveys. Higher stress levels at baseline predicted a lower HRQoL at 1 year, while baseline depression status and social support did not predict 1-year HRQoL scores. Compared to those who were never depressed at both baseline and follow-up, participants who experienced new-onset or persistent depression had lower HRQoL at 1 year. Additionally, the 1-year HRQoL score of participants who recovered from depression by follow-up was comparable to that of participants who were never depressed. Moreover, participants who experienced increases in stress levels by follow-up had lower HRQoL scores at 1 year than those with decreases in stress levels. Changes in social support did not predict 1-year HRQoL scores in this study.ConclusionsAssessing psychosocial status regularly and implementing effective interventions targeted at psychosocial problems may be particularly important for PLWH to improve their HRQoL. Among PLWH, special attention should be given to those with new-onset or persistent depression and those with high stress levels at the time of diagnosis and increased stress levels 1 year after the new HIV diagnosis.

Risk factors for new-onset depression or anxiety following total joint arthroplasty: the role of chronic opioid use

BackgroundSeveral studies have evaluated the impact of preoperative depression on outcomes following total joint arthroplasty (TJA), however few have studied new-onset depression or anxiety after TJA. We aimed to identify...

Risk of Dementia and Depression in Young and Middle-aged Men Presenting with Nonmetastatic Prostate Cancer Treated with Androgen Deprivation Therapy

BackgroundPrevious studies have found an association between androgen deprivation therapy (ADT) and an increased risk of dementia and depression in elderly men. This association remains controversial, and little is known about the effects of ADT in younger men. ObjectiveTo examine the association between the receipt of ADT and these outcomes in young men aged 40–64 yr presenting with nonmetastatic prostate cancer (PCa). Design, setting, and participantsFor this observational study, we identified 9117 men aged 40–64 yr diagnosed with localized PCa between 2007 and 2014, without a pre-existing neurocognitive diagnosis, using the TRICARE military database. Outcome measurements and statistical analysisKaplan-Meier curves were fitted to compare ADT versus no ADT. We also performed a subgroup analysis in patients undergoing ADT for ≥12 mo. The association between ADT and new-onset dementia or depression was evaluated using inverse-probability-of treatment-weight–adjusted Cox proportional hazards regression analysis. Results and limitationsPatients receiving ADT had a significantly higher incidence of depression (30.2 vs 15.8 per 1000 person years) and dementia (17.9 vs 7.5 per 1000 person years). The risk of developing either outcome was higher in the ADT cohort (depression: hazard ratio [HR] 2.07, p < 0.001; dementia: HR 1.70, p = 0.052). Additionally, there was a dose-response relationship between the duration of ADT and either outcome. ConclusionsIn our cohort of young men with PCa, the receipt of ADT was associated with an increased risk of developing dementia and depression. Long-term use of ADT was associated with the highest risk of neurocognitive outcomes. Patient summaryIn this study, we looked at the risk of dementia and depression in patients <65 yr of age undergoing androgen deprivation therapy (ADT) for prostate cancer. We found that these patients had a higher risk of dementia and depression than those who did not undergo ADT.

A comparative study of depressive symptoms and survival in patients with lung cancer

Objective To explore the changes of depression in patients with lung cancer and their impacts on the survival period, so to provide evidence for psychological treatment of patients with lung cancer. Methods 339 lung cancer patients diagnosed and treated in our hospital and other hospital from 2010 to 2013 were included. The depression status of patients was diagnosed by the Depression Scale of Epidemiological Research Center and followed up every year. To observe the changes of depressive symptoms during the survival period, and to evaluate the impact of depressive symptoms on the survival rate of patients. Results Among 339 participants, 133 (39%) had depression symptoms at baseline and an additional 71 (21%) developed new-onset depression symptoms during treatment. At baseline, depression symptoms were associated with increased mortality (hazard ratio [HR], 1.19, 95% CI: 1.04-1.34). Participants were classified into the following four groups based on longitudinal changes in depression symptoms from baseline to follow-up: never depression symptoms (n=135), new-onset depression symptoms (n=71), depression symptom remission (n=46), and persistent depression symptoms (n=87). HRs were as follows: new-onset depression symptoms, 1.36 (95% CI: 1.12-1.61), depression symptom remission, 1.11 (95% CI: 0.97-1.25), and persistent depression symptoms, 1.33 (95% CI: 1.09-1.57). Conclusions Among patients with lung cancer, longitudinal changes in depression symptoms are associated with differences in mortality. Symptom remission is associated with a similar mortality rate as never having had depression, which is lower than that in persistent and new-onset depression symptoms. Key words: Lung neoplasms; Depression; Survival rate

Depression and Suicide After Bariatric Surgery.

Individuals with morbid obesity benefit from bariatric surgery with respect to weight loss and decreases in obesity-related somatic disorders. This paper focuses on psychosocial outcomes and provides a narrative review of recent meta-analyses and controlled studies concerning postoperative depression and suicide. Considerable evidence shows short- and medium-term improvement in depressive symptoms after surgery. However, a subgroup of patients exhibits erosion of these improvements or new onset of depression in the long run. Some studies have found an increased risk for suicide among postoperative patients. Prospective longitudinal examinations of factors contributing to the increased risk for postoperative depression and suicide and the interaction between these factors are warranted. The inclusion of mental health professionals in bariatric teams would help to monitor patients for negative psychosocial outcomes and to identify those patients who are vulnerable to depression, suicide, and any other forms of deliberated self-harm following surgery.

Nursing Home Star Ratings and New Onset of Depression in Long-Stay Nursing Home Residents

ObjectivesTo examine the association between nursing home (NH) quality and new onset of depression and severity of depressive symptoms in a national cohort of long-stay NH residents in the United States. DesignCohort study. Setting and participants129,837 long-stay residents without indicators of depression admitted to 13,921 NHs. MethodsNH quality was measured by Nursing Home Compare star ratings (overall, health inspection, staffing, quality measures) closest to admission. Study outcomes at 90 days from the Minimum Data Set 3.0 included depression diagnosis and severity of depressive symptoms (minimal; mild; moderate; moderately severe/severe). Symptoms were measured by resident self-report Patient Health Questionnaire (PHQ-9) or a staff-report observational version (PHQ-9-OV). Logistic and multinomial logistic models with generalized estimating equations were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). ResultsAt 90 days postadmission, 14.1% of residents had a new diagnosis of depression, and odds did not differ across star ratings. Nearly 90% of these residents had minimal depressive symptoms, with only 8.5% reporting mild symptoms and 2.6% with moderate to severe symptoms. Using minimal depressive symptoms as the reference, residents in NHs with 5-star overall ratings were 12% less likely than those in 3-star NHs to experience mild (95% CI: 0.81-0.96) and 31% less likely to experience moderate symptoms (95% CI: 0.58-0.82). In NHs with 1-star staffing compared to 3-star, residents had 37% higher odds of moderate symptoms (95% CI: 1.14-1.64) and 57% higher odds of moderately severe to severe depressive symptoms (95% CI: 1.17-2.12). The odds of any above-minimal depressive symptoms decreased as quality measure ratings increased. Conclusions/ImplicationsLower NH quality ratings were associated with more severe depressive symptoms. Further investigation is warranted to identify potential mechanisms for a targeted intervention to improve quality and provide more equitable care.

Depression, Socioeconomic Factors, and Ethnicity as Predictors of Cardiorespiratory Fitness Before and After Cardiac Rehabilitation.

To determine whether cardiac patients with psychosocial or socioeconomic problems have lower peak oxygen uptake ((Equation is included in full-text article.)O2peak) and whether these factors modify the effect of cardiac rehabilitation (CR). A retrospective cohort study of patients with ischemic heart disease, valvular heart disease, or heart failure referred for CR. (Equation is included in full-text article.)O2peak was assessed by a maximal cardiopulmonary exercise test. Pre-existing depression was defined by use of antidepressants and new-onset depression by a modified Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire at CR intake. Socioeconomic status was defined by educational attainment and working status; ethnicity as Western European or non-Western European. Full data from baseline assessment were available on 1217 patients and follow-up on 861 patients. Mean ± SD (Equation is included in full-text article.)O2peak before CR was 21.8 ± 6.8 mL/kg/min. After multivariable adjustment, lower (Equation is included in full-text article.)O2peak was associated with lower educational attainment, not working, and non-Western ethnicity but not with depression. Mean improvement of (Equation is included in full-text article.)O2peak following CR was 2.4 ± 4.3 mL/kg/min. After multivariable adjustment educational attainment, employment status and ethnicity were significant predictors of improvement of (Equation is included in full-text article.)O2peak while depression was not. Education, attachment to the workforce, and ethnicity were all associated with lower (Equation is included in full-text article.)O2peak before CR, and the disparity was increased following CR. Having pre-existing depression and new-onset depression did not influence (Equation is included in full-text article.)O2peak either before or after CR. These results point to important subgroups in need of specially-tailored rehabilitation programs.

Factors affecting recovery during the first 6months after hip fracture, using the decision tree model.

Hip fractures are one of the most common orthopedic problems that can reduce the quality of life in the elderly. Considering that, we aimed to provide a comprehensive assessment of the factors affecting recovery during the first 6months after hip fracture. All patients with hip fracture admitted to any of the orthopedic hospitals during July 10, 2011 to July 9, 2012 in Shiraz, Iran were included in this prospective cohort study. Patients' demographic data and also information regarding their performance and mobility after hip fracture was collected in two interviews at intervals of 6months. All analyses were done in R software and mostly by party packages and PCAmixdata package. Tree and forest models of conditional inference were used to evaluate the factors affecting the recovery after hip fracture. Two hundred sixty-six out of 514 patients (51.75%) with hip fracture recovered completely after a 6-month follow-up period. Osteoporosis, new-onset depression after hip fracture, and socioeconomic status (SES) were the most important predictors of patients' mobility status 6months after hip fracture. In identifying predictor variables, the conditional inference forest method provided a more appropriate fit for the data than the conditional inference tree. Awareness of the factors that affect patients' recovery can be helpful in improving the patients' health, as well as improving care services, thereby increasing the success of treatment. Osteoporosis, new-onset depression after hip fracture, and SES were the most important factors associated with patients' recovery. Therefore, focusing on these variables is essential.