New-onset Depression Research Articles

Unlike other medical conditions, type 2 diabetes is a risk factor for new-onset major depression after COVID-19

ObjectiveIt is unclear whether pre-COVID medical conditions are risk factors for post-COVID major depressive episode (MDE). We aimed to determine which pre-COVID medical conditions are risk factors for post-COVID MDE after a hospitalization for COVID-19. MethodsWe conducted a nested retrospective case-cohort study within a cohort of 650 patients evaluated six months after hospitalization for COVID-19 at Bicêtre hospital, France. Nine medical conditions present before COVID-19 (High blood pressure, obesity, type 2 diabetes, cardiac, respiratory and renal disease, immune deficiency, neoplasia and liver disease) were extracted from medical records. MDE was assessed using the Structured Clinical Interview for DSM-5 Disorders-Clinician Version (SCID-5-CV). Bivariate and multivariable analyses were performed to determine which pre-COVID medical conditions are independent risk factors for post-COVID new-onset MDE. ResultsPatients mean age was 62.8 (15.8), 258 (39.7 %) were women; 301 (46.3 %) had high blood pressure, 205 (32.4 %) had obesity, and 186 (28.6 %) had type 2 diabetes. Thirty-six (5.5 %) patients were diagnosed with a new-onset MDE. In contrast to other medical conditions, type 2 diabetes was significantly associated with new-onset MDE (OR = 2.51 [1.19–5.29]). ConclusionUnlike other pre-COVID medical conditions, type 2 diabetes is a risk factor for post-COVID MDE. Patients with type 2 diabetes should be screened for MDE after a hospitalization for COVID-19.

Childhood Trauma, Perceived Social Support, and Post-Partum Depression among Newly Married Women after Miscarriage

The study examined childhood trauma, perceived social support, and postpartum depression in married women with first-time miscarriages. After reviewing the literature, these hypotheses were formed. 1).Childhood trauma, perceived social support, and postpartum depression are significantly associated with newly married women with first miscarriage. 2)Early trauma and support networks are two major contributors to the new-onset maternal depression in newly married women experiencing a first perinatal loss. 3). There are significant family system differences in early trauma, support networks, and new-onset maternal depression for newly married women experiencing a first perinatal loss. The research has surveyed 250 newly married females in the b/t age group of 18–35 years after their first loss event. The sample includes public and private hospitals in Lahore and Faisalabad. Calculations were done according to the psychological measures: 1)Childhood Trauma Questionnaire 2)Perceived Social Support, and 3) Edinburgh Postnatal Depression Scale. Data analysis was done through SPSS.

BMI trajectories from infancy to 18 years and mental health in emerging adulthood

BackgroundStudies exploring early life-course BMI trajectories and subsequent mental health outcomes are limited but may provide important insights for early intervention. We investigated associations between BMI trajectories from 0 to 18 years and mental health outcomes in emerging adulthood. MethodsData were obtained from 434 participants in the Melbourne Atopy Cohort Study (MACS). Anthropometric data were collected across 26 timepoints from infancy to age 25 and group-based trajectory modelling was used to develop BMI trajectories from 0.1 to 18 years. Moderate-to-severe psychological distress (MSPD) and likely depression were assessed at age 18 and 25 years. Associations between BMI trajectories and mental health at 25 years and change in mental health between 18 and 25 years were estimated using logistic regression. History of asthma, hay fever or eczema were independently examined as potential effect modifiers. ResultsFive BMI trajectories were identified from 1 month to 18 years. When compared to the stable average BMI trajectory, we found an increased risk of MSPD (OR = 2.97; 95%CI: 1.09,8.06) and likely depression (3.56; 1.39,9.12) at age 25 in the average increasing-to-high trajectory. This group also had a greater likelihood of new-onset depression (4.82; 1.54,15.0) from 18 to 25 years of age. LimitationsMACS participants are not representative of the general population and mental health data was not available before 18 years of age. ConclusionExcessive weight gain across the childhood transition was associated with poorer mental health in emerging adulthood, highlighting the importance of monitoring growth to allow for early identification and stratification of individuals at risk of poor mental health.

Anesthesia for cesarean delivery and subsequent depression: A nationwide retrospective cohort study

BackgroundPostpartum depression is a major psychiatric disorder associated with maternal suicide and child developmental disturbances. In this study, we aimed to investigate whether general anesthesia for cesarean delivery is associated with a higher rate of new-onset depression after delivery than neuraxial anesthesia. MethodsThis is a nationwide retrospective cohort study using data retrieved from the National Health Insurance Research Database between 2014 and 2018. Women who had cesarean delivery under general or neuraxial anesthesia were enrolled. After 1:4 propensity score matching, there were 4544 and 18,176 women under the general and neuraxial anesthesia groups, respectively. The primary outcome was new-onset depression diagnosed after delivery in a time-to-event analysis setting. ResultsAfter propensity-score matching, the rate of new-onset depression diagnosed within 1 year was 1.10 % (50/4488) and 0.86 % (157/18176) after cesarean delivery under general and neuraxial anesthesia, respectively. For depression diagnosed within 90 days of delivery, significant difference between the two groups was noted (0.51 % vs. 0.30 %, P = 0.031). In the time-to-event analysis with Cox regression model, women who delivered under general anesthesia were associated with significantly higher risk of postpartum depression within 90 days (Hazard ratio [HR], 1.71; 95 % CI, 1.05–2.79) compared with those under neuraxial anesthesia. LimitationsThe observational design only allows asserting association, rather than establishing causality between exposure and outcomes. ConclusionsWomen who underwent cesarean delivery under general anesthesia had a higher risk of subsequent depression within 90 days than those under neuraxial anesthesia. Early screening for depressive disorders might facilitate timely management.

Natural History and Outcomes of Individuals With Functional Bowel Disorder: A 9-year Population-Based Longitudinal Study.

Long-term studies characterizing the natural history of functional bowel disorder (FBD) from community-based settings and exploring association with psychological factors are sparse. We aimed to evaluate the evolution of symptoms, health outcomes, and association of FBD with psychological disorders in Chinese population. Individuals identified from random sampling of residents of Hangzhou, China, participated in a baseline survey in January 2010. Follow-up phone survey was conducted in December 2018. FBD was diagnosed based on Rome III criteria. Among 452 individuals (mean age 44.6 ± 15.3 years, 174 [38%] male) who completed the study, the prevalence of FBD was 36.3% (95% confidence interval [CI] 32.6-40.0%) at enrollment and 36.1% (95% CI 32.3-39.8%) at follow-up survey ( P = 0.94). However, 214 individuals (47%) had interval change in diagnosis. Although no difference in incidence of organic disease or death was observed, a higher proportion of patients with FBD (16/164, 9.8% vs 9/288, 3.1%; P = 0.003) compared with those without FBD received non-cancer-related abdominal and/or pelvic surgery during follow-up. FBD was associated with anxiety and/or depression at initial (adjusted odds ratio [AOR] = 1.7, 95% CI 1.7-2.7, P = 0.02) and follow-up (AOR = 8.0, 95% CI 3.2-20.0, P < 0.001) surveys. Diagnosis of FBD at baseline was associated with new-onset anxiety and/or depression at follow-up (AOR = 3.2, 95% CI 1.2-8.3, P = 0.01). Although the prevalence of FBD remained stable, transformation of symptoms was common over time. Patients with FBD may have increased risk of receiving non-cancer-related abdominal and/or pelvic surgery. FBD symptoms at baseline increased the risk of new-onset anxiety and/or depression by 3.2-fold over the next 9 years.

The role of prepulse inhibition in predicting new-onset postpartum depression

Predictive measures for postpartum depression (PPD), which affects around 12% of childbearing women, would enable early, targeted support. Here we explore prepulse inhibition (PPI), a measure of sensorimotor processing, as a biological tool for prediction of women at risk for PPD. Using data from the longitudinal BASIC study in Uppsala, Sweden, we used PPI measures from late pregnancy and reports on depressive symptoms assessed 6 weeks postpartum with the Edinburgh Postnatal Depression Scale to determine the association between pregnancy PPI and PPD. Lower PPI was associated with PPD onset in women who were not depressed during pregnancy. Further studies are encouraged to validate these promising results suggesting PPI as a predictive marker of new-onset PPD.

Depression in the Perinatal Period: Course and Outcome of Depression in the Period from the Last Trimester of Pregnancy to One Year after Delivery in Primiparous Mothers.

Background and Objectives: One of the most significant psychiatric problems in women is depression related to the perinatal period. Our study aims to determine the frequency and course of depressive symptomatology in the perinatal period with particular reference to objective rate and outcome of postpartum depression. Materials and Methods: One hundred and eighty-eight pregnant/postnatal women were included in a prospective, longitudinal, observational study during which the depressive symptomatology was estimated at the third trimester of pregnancy, and the first, sixth, and twelfth month' postpartum. All participants completed a semi-structured sociodemographic questionnaire constructed for research purposes, the Edinburgh Postnatal Depression Scale, Toronto Alexithymia Scale, Beck Anxiety Inventory, and The Mood Disorder Questionnaire at each time point. Postpartum depression diagnosis was confirmed by a trained and certified psychiatrist with long-standing experience. For a better understanding of the trajectory of depressive symptomatology and genuine postpartum depression, we classified depression into those with new-onset and those left over from the previous observation period. Results: In general, 48.9% of participants in the study were depressed at some point during the investigation. A total of 10.6% of women were depressed in the third trimester. The highest percentage of new-onset depression (25%) was in the first month after giving birth and was maintained for up to six months, after which the appearance was sporadic. Most of the postpartum depression resolved in the period from the first month to the sixth month after childbirth (20.7%). The episodes mainly had characteristics of unipolar depression. Conclusions: Our results imply that a new onset of depression is most intensive during the first six months, and after that, it is sporadic. Further studies are needed to explore whether all depressive symptomatology in the postnatal period is the same, or perhaps postpartum depression, classified in this way, has specific characteristics, etiology, and consequently different treatment and preventive options.

Understanding the relationship between palliative care consultation and mental health services in patients with pancreatic cancer: A US cross-sectional analysis.

e13729 Background: Anxiety and depression can worsen symptom burden, quality of life, and end-of-life care for pancreatic cancer patients. Palliative care consultation has been used in other areas to improve holistic care and has been successful. This study aims to investigate the effects palliative care consultation on mental health (MH) service utilization, including pharmacotherapy, among pancreatic cancer patients. Methods: The sample consisted of pancreatic cancer patients within Optum’s de-Identified Integrated Claims-Clinical dataset diagnosed with new-onset anxiety or depression. Palliative care consultation (PC) within 12 months of cancer diagnosis was the exposure variable, while utilization of MH services or pharmacotherapy after depression or anxiety was diagnosed were the outcomes of interest. Covariates included patient demographics and the Charlson Comorbidity Index (CCI). The association of MH services and pharmacotherapy with PC were quantified using multiple logistic regression. Results: Within the database, 4029 patients were identified as having newly diagnosed pancreatic cancer. Of these 4029 patients, only 1022 patients received a palliative care consultation (25.36%). Of the patients that received PC, there was a higher percentage of African Americans, patients received a higher score on the CCI, and there was a higher prevalence of anxiety and depression, compared to those without PC. Notably, patients that were diagnosed with only anxiety or only depression were less likely to document treatment of each modality compared to patients diagnosed with both anxiety and depression (aOR - 0.551 for anxiety; aOR - 0.376 for depression). The specific mental health diagnosis was not the only variable that influenced mental health treatment, age, region of care, and CCI all had significant effects. Regarding palliative care, no statistically significant difference was observed between the documentation of mental health treatment between patients that received palliative care and those that did not. Conclusions: Palliative care remains underutilized among pancreatic cancer patients. This study identifies variables that influence the mental health treatment provided for patients with pancreatic cancer, and even identifies specific cohorts that are more vulnerable based on age and region of care. The findings of this study highlight information that providers can use while making clinical decisions and provide a foundation for further research determining the effects of palliative on mental health for patients with advanced, complex diseases.

Depression Onset After a Spouse’s Cardiovascular Event

Although cardiovascular disease (CVD) is a known risk factor for depression, evidence is lacking regarding whether and to what extent a spouse's CVD is associated with the subsequent mental health of individuals. To examine the association between CVD onset in spouses and subsequent depression. This cohort study examined 277 142 matched married couples enrolled in the Japan Health Insurance Association health insurance program between April 2015 and March 2022, covering approximately 40% of the working-age population in Japan. Index individuals (primary insured) whose spouses (dependent) experienced incident CVD between April 2016 and March 2022 were 1:1 matched to controls whose spouses did not experience CVD. Matching was based on age, sex, income, or the onset date of the spouses' CVD. Data analysis was conducted from April 2016 to March 2022. Spousal onset of CVD between fiscal years 2016 and 2021. The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes were used to identify the composite CVD outcomes (stroke, heart failure, and myocardial infarction). Multivariate Cox proportional hazards models were used to investigate the association between spouses' new-onset CVD and individuals' depression, adjusting for sociodemographic characteristics and comorbidities of index individuals (diabetes, hypertension, and CVD) and spouses (diabetes, hypertension, and depression). Subgroup analyses were conducted according to sex, age, income levels, and history of CVD. Among 277 142 matched pairs of married couples, 263 610 (95.1%) had a male index individual; the mean (SD) age of index individuals was 58.2 (10.2) years. A new onset of depression was observed in 4876 individuals (1.8%). In multivariable Cox models, there was an association between the spouse's CVD and the individuals' depression (hazard ratio, 1.13 [95% CI, 1.07-1.20]). The subgroup analysis found no evidence of heterogeneity in sex, age, income level, or CVD history. The results were consistent when additionally adjusted for health behaviors (smoking, alcohol consumption, physical activity, and use of antihypertensive drugs) and objectively measured physical health conditions (body mass index, blood pressure, cholesterol levels, glucose levels, and estimated glomerular filtration rate) (hazard ratio, 1.16 [95% CI, 1.06-1.28]). In this nationwide cohort study of matched couples, a spouse's onset of CVD was associated with an increased risk of an individual's depression. These findings highlight the importance of preventive care for mental health disorders in individuals whose spouses experience incident CVD.

Efficacy and safety of esketamine for perioperative depression in patients undergoing elective surgery: A meta-analysis of randomized controlled trials

BackgroundDepression is a prevalent mood disorder during the perioperative period, with both preoperative concurrent depression and new-onset postoperative depression impacting postoperative recovery. Recent studies have indicated that the dissociative anesthetic esketamine may alleviate perioperative depressive symptoms. ObjectiveThis meta-analysis aimed to assess the efficacy and safety of esketamine in treating perioperative depression. MethodsWe selected randomized controlled trials comparing esketamine to placebo in terms of postoperative depressive symptoms. The primary outcome was postoperative depression scores, with secondary outcomes including the prevalence of postoperative depression, pain scores using the Visual Analogue Scale or Numeric Rating Scale, and incidences of adverse reactions such as nausea/vomiting, dizziness, dreams/nightmares, hallucinations. ResultsWe enrolled a total of 17 studies involving 2462 patients. The esketamine group demonstrated a significant reduction in postoperative depression scores within one week after surgery (SMD −0.47, 95% CI (−0.66, −0.27), P < 0.001) and over the long term (SMD −0.44, 95% CI (−0.79, −0.09), P = 0.01). Furthermore, esketamine significantly decreased the prevalence of postoperative depression both within one week (RR 0.46, 95% CI (0.33, 0.63), P < 0.001) and over the long term (RR 0.50, 95% CI (0.36, 0.70), P < 0.001). Additionally, esketamine effectively relieved pain on the first postoperative day compared to control. However, it also increased the risks of dizziness and hallucinations for a short time. ConclusionThis meta-analysis suggests that the intraoperative or postoperative application of esketamine could be a potentially effective treatment for perioperative depression, although the increased risk of adverse reactions should be considered.

Socioeconomic status and incident depressive symptoms among older adults: A 3-year longitudinal study from the Japan Gerontological Evaluation Study.

The association between socioeconomic status (SES) and the onset of depressive symptoms has attracted considerable attention. However, few studies have simultaneously examined the association of multiple SES indicators, including "assets," with the onset of depressive symptoms. Therefore, this study examined the association of four SES indicators in old age ('years of education' 'equivalent income,' 'equivalent assets,' and 'the longest-held job') with new-onset depressive symptoms in a large Japanese dataset. This longitudinal study used panel data of cognitively and physically independent older adults from the Japan Gerontological Evaluation Study (JAGES) conducted in 2013 and 2016. Multivariate logistic regression analysis was conducted to examine the association of each SES indicator with new-onset depressive symptoms, and odds ratios and 95% confidence intervals (CIs) were calculated. We analyzed the data of 40,257 older adults, with a mean age (± standard deviation) of 72.9 (±5.5) years. In the follow-up survey, 4292 older adults had new-onset depression symptoms (10.7%). 39.3% had 10-12years of education. 36.9% had an equivalent income of up to JPY 1.99 million. 24.4% had equivalent assets of JPY 4-17.99 million. Most had a clerical job for the long time. Furthermore, fewer years of education (males: OR=1.42, 95% CI=1.22-1.64, p-value <0.001/females: 1.26, [1.09-1.47], p=0.002), lower income (males: 1.64, [1.34-2.01], p<0.001/females: 1.82, [1.49-2.22], p<0.001), and fewer assets (males: 1.40, [1.16-1.68], p<0.001/females: 1.21, [1.02-1.42], p=0.025) resulted in higher odds of having new-onset depressive symptoms, even when other SES indicators were entered simultaneously. All four SES indicators have an independent association with the development of new-onset depressive symptoms among older adults, reflecting different aspects of SES. The association between the "longest-held job" and new-onset depressive symptoms can be largely explained by other SES indicators. A multifaceted and lifetime approach is required to prevent the onset of depressive symptoms in old age.

Depression risk in chronic tonsillitis patients underwent tonsillectomy: a global federated health network analysis.

Background: Tonsillectomy is a common surgery in the US, with possible postoperative complications. While small studies indicate postoperative depressive symptoms may occur, large-scale evidence is lacking on the tonsillectomy-depression link. Methods: We conducted a retrospective cohort study using the TriNetX US collaborative network, offering de-identified electronic health data from 59 collaborative healthcare organizations (HCOs) in the United States. In this study, people being diagnosed of chronic tonsillitis between January 2005 and December 2017 were enrolled. Patients deceased, with previous record of cancers or psychiatric events before index date were excluded. 14,874 chronic tonsillitis patients undergoing tonsillectomy were propensity score matched 1:1 to controls for age, sex, and race. New-onset depression risks were evaluated over 5 years post-tonsillectomy and stratified by age and sex. Confounders were adjusted for including demographics, medications, comorbidities and socioeconomic statuses. Results: After matching, the difference of key baseline characteristics including age, sex, comedications status and obesity status was insignificant between tonsillectomy and non-tonsillectomy groups. Tonsillectomy had a 1.29 times higher 5-year depression risk versus matched controls (95% CI, 1.19-1.40), with elevated risks seen at 1 year (HR=1.51; 95% CI, 1.28-1.79) and 3 years (HR=1.30; 95% CI, 1.18-1.43). By stratifications, risks were increased for both males (HR=1.30; 95% CI, 1.08-1.57) and females (HR=1.30; 95% CI, 1.18-1.42), and significantly higher in ages 18-64 years (HR=1.37; 1.26-1.49), but no significance observed for those 65 years and older. After performing sensitivity analyses and applying washout periods of 6, 12, and 36 months, the outcome remained consistent with unadjusted results. Conclusion: This real-world analysis found tonsillectomy was associated with a 30% higher 5-year depression risk versus matched non-tonsillectomy patients with chronic tonsillitis. Further mechanistic research is needed to clarify the pathophysiologic association between depression and tonsillectomy. Depression is not commonly mentioned in the current post-tonsillectomy care realm; however, the outcome of our study emphasized the possibility of these suffering condition after operation. Attention to psychological impacts following tonsillectomy is warranted to support patient well-being, leading to better management of post-tonsillectomy individuals.

Maternal outcomes of a cohort of pregnancies affected by non-immune hydrops fetalis.

To describe the maternal outcomes of a prospective cohort of non-immune hydrops fetalis (NIHF) pregnancies with negative standard-of-care evaluations. This study was a secondary analysis of a prospective cohort study of NIHF pregnancies with negative work-ups (infection, alloimmune anemia, fetomaternal hemorrhage, and chromosomal disorders). Outcomes were obstetric complications, including pre-eclampsia, mirror syndrome, preterm birth, polyhydramnios, postpartum hemorrhage, and maternal mental health. Forty pregnancies were included. Four patients developed pre-eclampsia (4/40, 10.0%); three occurred postpartum. None was diagnosed with mirror syndrome. Of the 31 continued pregnancies, 16 (51.6%) resulted in early fetal death or stillbirth and 15 (48.4%) resulted in live births. Of the 15 live births, 8 (53.3%) were delivered by primary cesarean delivery; 5 (62.5%) were for hydrops fetalis. Eleven live births (73.3%) were delivered preterm; 9 (81.8%) were indicated, most commonly for fetal indications (7/9, 77.8%). Polyhydramnios occurred in 14/40 (35.0%) cases. Where EBL was recorded (n=37), there were 5(13.5%) cases of postpartum hemorrhage and an additional 3(8.1%) had uterine atony without hemorrhage. Eighteen patients (18/40, 45.0%) had new-onset or exacerbated depression or anxiety symptoms. Our study identified several important adverse outcomes of pregnancies complicated by NIHF with negative standard-of-care evaluations, including a high rate of postpartum pre-eclampsia and worsened mental health. We identified a higher rate of cesarean delivery and preterm birth, both primarily for fetal indications. We also observed the known relationship between polyhydramnios, hemorrhage, and atony, but noted that this risk included pregnancies concluding in dilation and evacuation. Counseling after a diagnosis of NIHF should include these adverse outcomes.

Association between physical activity and depressive symptoms in adolescents: A prospective cohort study

It remains uncertain whether a protective association between physical activity and depression exists among adolescents and what the optimal level of physical activity might be. This study aimed to estimate the associations of physical activity levels with depressive symptoms and new-onset depression, while identifying potential modifying factors influencing the relationships. In this cohort study, we initially enrolled 1957 participants at baseline and followed up with 1738 of them after two years. Our analysis focused on data from 1482 students who provided complete information on both physical activity and depressive symptoms. Generalized linear regression and restricted cubic spline regression models were performed. Our adjusted models revealed that engaging in 4–7 h/week of moderate-to-vigorous physical activity (MVPA) at baseline was negatively associated with subsequent depressive symptoms and new-onset depression compared to the non-MVPA group. However, exceeding 7 h/week of MVPA did not provide substantial benefits. Furthermore, drinking and screen time potentially modified the relationship between MVPA and new-onset depression. Our findings suggest that 4–7 h of MVPA per week may be an appropriate level to reduce depressive symptoms in adolescents. Moreover, individual behaviors (e.g., drinking and screen time) warrant heightened attention in interventions targeting the reduction of depression in this population.

Worse prognosis in females with new onset of depression after oral cancer diagnosis: a retrospective case-control study.

Sex-related discrepancies in the prognosis of oral cancer patients have not been clarified. This study aimed to assess survival outcomes and potential prognostic factors in female and male patients with oral cancer. A retrospective search of the TriNetX network (TriNetX, Cambridge, Massachusetts, USA) was conducted to identify patients diagnosed with oral cancer (International Classification of Diseases (ICD)-10 codes C02-C06), within the past 20 years from the access date April 21, 2023. Patients were categorized according to sex (female vs. male). Following matching for age and risk factors such as nicotine dependence and alcohol abuse, Kaplan-Meier analysis was performed and risk, odds, and hazard ratios were calculated. Outcome variables were five-year disease-free survival (DFS) and overall survival (OS). Additionally, the female and male patient cohort were compared with regard to the novel diagnosis of depression (depressive episode, major depressive disorder, dysthymic disorder) after the tumor diagnosis. A total of 77,348 patients were assessed. After propensity score matching, 26,578 male and 26,578 female patients were included in each group (mean age 63 years). DFS (71.92% in females vs. 68.29% in males; hazard ratio (HR) 0.870; p < 0.001) and OS (77.08% in females vs. 71.74% in males; HR 0.793; p < 0.001) were significantly higher in the female cohort. However, in patients diagnosed with depression after the initial cancer diagnosis (N = 4,824), survival was worse in female patients compared to male patients (82.48% in females vs. 86.10% in males; HR 1.341; p < 0.001). This retrospective case-control study showed that females with oral cancer had a better DFS and OS than males. However, survival in females with a newly diagnosed depression after the oral cancer diagnosis was worse compared to those of male oral cancer patients. Depression may be a relevant prognostic factor that contributes to sex disparities in oral cancer patients.

SAT397 A Low Dose Cyproterone Acetate In Feminizing Hormone Treatment

Abstract Disclosure: S. Korpaisarn: None. J. Arunakul: None. K. Chaisuksombat: None. T. Rattananukrom: None. Background: A feminizing hormone therapy (FHT) for transgender women (TW) who have not undergone gonadectomy consists of estrogens and antiandrogens. Cyproterone acetate (CPA) is the most common antiandrogen used in Thailand. A standard dose of CPA is 25-50 mg/day. Recent data showed that a low-dose CPA might be effective in testosterone suppression. However, the result was limited due to the small number of subjects. Our recent survey showed that CPA 12.5 mg/day was commonly used among Thai TW. This study aimed to evaluate the effectiveness of CPA 12.5 mg/day in testosterone suppression. Methods: The retrospective cohort chart review was done on all TW receiving FHT in a transgender clinic at Ramathibodi Hospital between January 2014-July 2022. Among the TW who initiated FHT during the study period, the effectiveness and safety of CPA 12.5 mg/day were compared with the standard dose of CPA. Only TW with information at 3-month follow-up were analyzed for a median time of achieving the T level at the goal (&amp;lt;50 ng/dL) using a Cox regression analysis and a proportion of TW achieving T level at goal at 3 months using risk ratio regression model. All TW who initiated CPA were analyzed for changes in laboratory measurements using a generalized estimating equation (GEE). Results: A total of 89 transwomen were initially reviewed. Forty-one TW initiated CPA, and 37 TW had information at the 3-month follow-up visit. Among the latter, 22 TW (59.5%) started with CPA 12.5 mg. The median age of FHT initiation were 19 years (IQR 15-23) in CPA 12.5 mg group and 20 years (IQR 17-27) in the standard CPA dose group (p-value=0.504). Median follow-up time was 7.5 months (IQR 3-12) and 9 months (IQR 6-12), respectively (p-value=0.402). Baseline T levels were not different, with the median level at 518 ng/dL (IQR 173-787) in CPA 12.5 mg and 752 ng/dL (IQR 56-957) in control (p-value =0.653). In terms of effectiveness, the median time when T levels were suppressed at goal (&amp;lt;50 ng/dL) was 3 months in both groups. The proportion of TW who achieved targeted testosterone level within 3 months was 72.7% in CPA 12.5 mg and 86.7% in control with the risk ratio (RR) of 0.84 (95%CI 0.60-1.17, p-value= 0.295) for univariable analysis. The multivariable analysis showed an adjusted RR of 0.85 (95% CI 0.46-1.57, p-value=0.606). The multivariable GEE showed no difference between testosterone level changes. Only the LDL levels was significantly lower in the CPA 12.5 mg dose group with the difference of -13.72 mg/dL (95%CI (-25.86) – (-1.58), p-value=0.027). Other laboratories were not different among the 2 groups. There was no report of cardiovascular disease or new-onset depression in both groups.Conclusion: A CPA of 12.5 mg/day is effective in testosterone suppression as the standard dose of CPA in a FHT for TW with a comparable safety profile. This low-dose CPA regimen could be used as a FHT since it has a 50% cost reduction with equivalent effectiveness. Presentation: Saturday, June 17, 2023

Association Between Post-COVID Pulmonary Dysfunction and New-Onset Anxiety and Depression and the Impact of Incentive Spirometer-Based Exercises.

Association Between Post-COVID Pulmonary Dysfunction and New-Onset Anxiety and Depression and the Impact of Incentive Spirometer-Based Exercises.

Randomized pilot trial of the "Mom Power" trauma- and attachment-informed multi-family group intervention in treating and preventing postpartum symptoms of depression among a health disparity sample.

Perinatal depression, a common complication related to childbearing, impacts mothers, children, and families. Efficacious interventions reduce perinatal depression symptoms; effort is needed to prevent the onset of perinatal depression. To determine feasibility and preliminary efficacy in reducing perinatal depression, we conducted a community-based, randomized parallel open pilot trial of Mom Power, a group-based intervention to improve mental health and parenting in mothers with young children. Mom Power consists of 10 group sessions, focused on parenting, child development and self-care and three individual sessions, to build rapport and provide personalized referrals. Control group participants received psychoeducational mailings. Computer-based urn randomization assigned mothers with experiences of interpersonal violence, depression, or other traumatic experiences to Mom Power (68) or control (54). At 3-months post-treatment, the 31 retained women assigned to Mom Power were half as likely to meet criteria for probable depression (26%) as the 22 women retained in the control group (55%), with treatment predicting lower incidence of probable depression (OR = 0.13, p = 0.015). Moreover, among the 23 women who did not meet criteria for depression diagnosis at baseline, no women in the treatment group developed depression (n = 0, 0%) compared to control group women (n = 3, 30%). Logistic regression controlling for selective attrition confirmed the treatment effect on preventing new onset of depression (OR = 0.029, p = 0.012). These findings support the use of Mom Power for both treatment and prevention of perinatal depression. https://classic.clinicaltrials.gov/ct2/show/NCT01554215, NCT01554215.

A randomized controlled trial of a brief internet intervention to prevent anxiety and depression among college students

Brief, scalable, and transdiagnostic prevention efforts are needed to prevent depression and anxiety among college students. Growth mindset interventions are brief, often web-based interventions to prevent or reduce depression symptom severity that have not yet been evaluated within a college student population. In this study, college students (n = 371) were randomized to either a web-based growth mindset intervention or a psychoeducation control. We examined acceptability and usability ratings as well as the impact of the intervention on new-onset depression and anxiety and symptom trajectories as assessed by the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) over a six-month period. Results indicated that participants found the intervention to be acceptable and usable. Assessing the potential of the intervention as a universal prevention approach among participants below clinical cutoffs at baseline (GAD-7 or PHQ-9 <10, N = 239 and N=229, respectively), the intervention was not associated with a reduction in new-onset depression or anxiety, nor a reduction in depression symptom trajectories compared with the control group. Control group participants experienced a greater increase in anxiety symptoms severity than participants receiving the intervention (d = 0.24). Among individuals above clinical cutoffs at baseline (GAD-7 ≥ 10; N=132, or PHQ-9 ≥ 10; N=142), the intervention reduced symptom severity to the extent that it changed beliefs about emotions. While the intervention was acceptable among college students and demonstrated promising effects on anxiety symptom severity and changes in beliefs about emotions, more work is needed to strengthen this approach to prevent new-onset depression and anxiety.Trial registration: ClinicalTrials.gov Identifier: NCT03707522

Evaluating the Association of Montelukast Use on Neuropsychiatry-Related Healthcare Utilization and Depression in COVID-19-Hospitalized Veterans: A Nationwide VA Observational Cohort Study.

Montelukast's new boxed warning for neuropsychiatric events questions its use in the setting of coronavirus disease 2019 (COVID-19) due to increased risk for new-onset psychiatric diagnoses. We aim to evaluate the impact of using montelukast in patients hospitalized with COVID-19 on neuropsychiatry-related healthcare utilization and depression. This retrospective nationwide observational cohort study using the Veterans Health Administration database included patients from January 1, 2020, through July 1, 2021. The treatment cohorts consisted of patients with and without montelukast use prior to COVID-19 hospitalization and matched using propensity score (PS) to two control cohorts: patients with COVID-19-related hospitalization without prior montelukast use and patients with prior montelukast use who were hospitalized for reasons other than COVID-19. The primary outcome of psychiatric hospitalizations at 90days and 180days and mental health visits at 180 days were compared using Poisson or negative binomial regression. Secondary outcomes of new-onset depression and new use of antidepressants were analyzed using multivariable logistic regression. After PS matching, a total of 415 patients were included in COVID-19 with and without montelukast matched cohort and 409 patients in montelukast with and without COVID-19-related hospitalization matched cohorts. For the primary outcomes, inpatient psychiatric hospitalization at 90days [incidence rate ratio (IRR) 95% CI 1.79 (1.36-2.36)] and 180 days [IRR 95% CI 1.79 (1.32-2.25)] and mental health visits at 180 days [IRR 95% CI 1.72 (1.45-2.03)] were significantly higher in the montelukast with COVID-19 hospitalization group compared with those hospitalized without COVID-19. No difference in primary outcomes were noted in patients hospitalized with COVID-19 with and without use of montelukast. No significant difference was found in the secondary outcomes between either comparator group. Patients with prior montelukast use who were hospitalized with COVID-19 appeared to have increased rate of neuropsychiatry-related healthcare utilization.