Patient Health Questionaire-9 Research Articles

The relationship between stigma and quality of life in hospitalized middle-aged and elderly patients with chronic diseases: the mediating role of depression and the moderating role of psychological resilience

ObjectivePatients with chronic diseases may have some psychological problems due to their own or surrounding environmental factors, which can adversely affect the patient’s illness and life. Given that the number of chronically ill patients in China is currently increasing every year, more research is needed to determine the best ways to manage changes in psychological status and psychological stress responses in chronically ill patients. The researchers constructed a mediated moderation model to explore the impact of stigma on the quality of life of chronically ill patients, as well as the mediating role of depression and the moderating role of psychological resilience.MethodsA stratified sampling method was used to select 363 middle-aged and old-aged patients with chronic diseases aged 45 years and older from the Affiliated Hospital of Zhejiang University for the study. Data were collected from patients with chronic diseases such as cardiac, respiratory, renal, and other chronic diseases using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), the Stigma Scale for Patients with Chronic Diseases (SSCI), the Patient Health Questionaire-9 (PHQ-9), the Quality of Life Inventory (SF-12), and the Conner-Davidson Resilience Scale (CD-RISC) were collected from patients with cardiac, respiratory, renal, and other chronic diseases. A descriptive analysis was used to describe the sample. Linear regression was used to evaluate the relationship between the variables. Mediation and moderation analyses were used to explore the mediating role of depression and the moderating role of psychological resilience.ResultsThere was a moderate negative correlation between stigma and quality of life (r = -0.378, P < 0.01). There was a moderate negative correlation between depression and quality of life (r = -0.497, P < 0.01). There was a moderately positive correlation between psychological resilience and quality of life (r = 0.382, P < 0.01). There was a moderate negative correlation between psychological resilience and depression (r = -0.348, P < 0.01). There was a weak negative correlation between psychological resilience and stigma (r = -0.166, P < 0.01). There was a strong positive correlation between stigma and depression (r = 0.607, P < 0.01) The mediation study showed that stigma was a significant predictor of quality of life and that stigma and quality of life were mediated to some extent by depression, with the mediating effect accounting for 67.55% of the total effect. The direct path from stigma to depression is moderated by psychological resilience (β = -0.0018, P < 0.01).ConclusionsDepression mediates the relationship between stigma and quality of life, while psychological elasticity plays a moderating role between stigma and depression, and when the level of psychological elasticity increases, the more significant the role of stigma on depression. As a physiologically and psychologically vulnerable group, patients with chronic diseases’ overall quality of life and mental health should be taken more seriously, and clinical workers should pay timely attention to the psychological and mental conditions of patients with chronic diseases and provide timely and appropriate interventions and therapeutic measures. The relevant results of this study also provide a new perspective for clinical work on psychological intervention for patients with chronic diseases.

Using Unannounced Standardized Patients to Assess Clinician Telehealth and Communication Skills at an Urban Student Health Center

PurposeAs the COVID-19 pandemic forced most colleges and universities to go online, student health centers rapidly shifted to telehealth platforms without frameworks for virtual care provision. An urban student health center implemented a needs assessment involving unannounced standardized patients (USPs) to evaluate the integration of a new telehealth workflow and clinicians' virtual communication skills. MethodsFrom April to May 2021, USPs conducted two video visits with 12 primary care and four women's health clinicians (N = 16 clinicians; 32 visits). Cases included (1) a 21-year-old female presenting for birth control with a positive Patient Health Questionaire-9 and (2) a 21-year-old male, who vapes regularly, with questions regarding safe sex with men. Clinicians were evaluated using a checklist completed by the USP immediately following the visit and a systematic chart review of the electronic health record. ResultsUSP feedback indicates most clinicians received high ratings for general communication skills but may benefit from educational intervention in several key telemedicine skills. Clinicians struggled with using nonverbal signals to enrich communication (47% well done), acknowledging emotions (34% well done), and using video for information gathering (34% well done). Low rates of standard screenings (e.g., 63% administered the PHQ-2, <50% asked about alcohol use) suggested protocols for in-person care were not easily incorporated into telehealth practices, and clinicians may benefit from enhanced care team support. Performance reports were shared with clinicians and leadership postvisit. DiscussionResults suggest project design and implementation is scalable and feasible for use at other institutions, offering a structured methodology that can improve general student health care.

The longitudinal association of stressful life events with depression remission among SHARP trial participants with depression and hypertension or diabetes in Malawi.

Depressive disorders are leading contributors to morbidity in low- and middle-income countries and are particularly prevalent among people with non-communicable diseases (NCD). Stressful life events (SLEs) are risk factors for, and can help identify those at risk of, severe depressive illness requiring more aggressive treatment. Yet, research on the impact of SLEs on the trajectory of depressive symptoms among NCD patients indicated for depression treatment is lacking, especially in low resource settings. This study aims to estimate the longitudinal association of SLEs at baseline with depression remission achievement at three, six, and 12 months among adults with either hypertension or diabetes and comorbid depression identified as being eligible for depression treatment. Participants were recruited from 10 NCD clinics in Malawi from May 2019-December 2021. SLEs were measured by the Life Events Survey and depression remission was defined as achieving a Patient Health Questionaire-9 (PHQ-9) score <5 at follow-up. The study population (n = 737) consisted predominately of females aged 50 or higher with primary education and current employment. At baseline, participants reported a mean of 3.5 SLEs in the prior three months with 90% reporting ≥1 SLE. After adjustment, each additional SLE was associated with a lower probability of achieving depression remission at three months (cumulative incidence ratio (CIR) 0.94; 95% confidence interval: 0.90, 0.98, p = 0.002), six months (0.95; 0.92, 0.98, p = 0.002) and 12 months (0.96; 0.94, 0.99, p = 0.011). Re-expressed per 3-unit change, the probability of achieving depression remission at three, six, and 12 months was 0.82, 0.86, and 0.89 times lower per 3 SLEs (the median number of SLEs). Among NCD patients identified as eligible for depression treatment, recent SLEs at baseline were associated with lower probability of achieving depression remission at three, six, and 12 months. Findings suggest that interventions addressing SLEs during integrated NCD and depression care interventions (e.g., teaching and practicing SLE coping strategies) may improve success of depression treatment among adult patient populations in low-resource settings and may help identify those at risk of severe and treatment resistant depression.

Ketamine for depressive symptoms: A retrospective chart review of a private ketamine clinic.

There is currently no published evidence demonstrating the effectiveness and safety of subanaesthetic doses of ketamine, when administered intravenously as an adjunct treatment for depressive symptoms, in a real world setting in South Africa. This retrospective chart review reports the clinical response (change in Patient Health Questionnaire - 7 score) to an initial infusion series of ketamine added to usual treatment, and the pattern of its subsequent maintenance use, for depressive symptoms. A private ketamine clinic in Hilton, KwaZulu-Natal. The medical records of all patients who attended a private ketamine clinic between August 2019 and 31 May 2021 were retrospectively analysed. Depression symptoms were evaluated using the Patient Health Questionaire-9 (PHQ-9) administered immediately before and 24 h after each treatment. Response was defined as a score decrease of more than 50%. Among the 154 patients who received ketamine infusions for depression, 67 completed a six infusion initial series, with a response rate of 60.6% and remission rate of 32.4%. Of the 154, 50% no longer experienced any suicidal ideation after treatment and adverse events were uncommon, with 6.2% of infusions requiring intervention for adverse events, mostly nausea. In addition, 48.5% of those who completed the initial series continued to receive maintenance infusions, with no evidence of escalating use or abuse. Incorporating intravenous ketamine into the existing treatment regimens at a private clinic was associated with reduced acuteness of depression severity and suicidal ideation. This approach appeared safe and tolerable, showing no signs of abuse or dependence. This is the first known naturalistic study reporting on ketamine use for depressive symptoms in South Africa.

Effect of computerized cognitive training on mood, cognition, and serum brain-derived neurotrophic factor level in late-life depression - a pilot randomized controlled trial.

The aim of this pilot randomized controlled trial was to test the feasibility of a computerized cognitive training targeting executive dysfunction in late-life depression and to investigate its impact on mood, cognition, and brain-derived neurotrophic factor (BDNF) levels. A total of 28 community-living Chinese individuals aged 55-75 with moderate-to-severe depression and cognitive symptoms (but without mild cognitive impairment or dementia) were recruited from a community centre in Hong Kong. Participants were randomly allocated to either the experimental (receiving computerized cognitive training) or the control group (receiving computer-based health education). Both programs lasted for one hour and were conducted twice a week for 6 weeks at the community centre. We assessed mood using the Hamilton Rating Scale for Depression (HAM-D) and Patient Health Questionaire-9 (PHQ-9), cognition using the Montreal Cognitive Assessment (MoCA), and serum BDNF levels at baseline and follow-up. We performed repeated measures analysis of variance to compare the differences in outcome changes between groups and correlation analysis to test if changes in mood and cognition correlated with changes in BDNF level. Our sample had a mean age of 66.8 (SD = 5.3) years, a mean HAM-D score of 19.4 (SD = 7.5), and a mean PHQ-9 score of 18.0 (SD = 6.3). No adverse effects were reported. Significant differences were observed between the experimental and control groups in changes in HAM-D (-8.4 vs. -2.9; group difference = -5.5; p = 0.01), PHQ-9 (-6.6 vs. -0.6; -6.0; p < 0.001), MoCA (1.4 vs. -1.3; 2.7; p = 0.001), and serum BDNF levels (in pg/ml; 2088.3 vs. -3277.4; 5365.6; p = 0.02). Additionally, changes in HAM-D, PHQ-9, and MoCA scores correlated significantly with changes in BDNF level. With computerized cognitive training improving mood and cognition and increasing serum BDNF levels in 6 weeks, it may serve as a safe and effective evidence-based alternative or adjuvant treatment for late-life depression. https://www.chictr.org.cn/indexEN.html, identifier ChiCTR1900027029.

Improved outcomes for depressed elder abuse victims with video-delivered psychotherapy during COVID-19

Objective: There is a lack of evidence-based scalable therapies for elder abuse victims, with no current remotely delivered tailored psychotherapy. The purpose of this manuscript is to (a) examine the effectiveness of a brief therapy for depression for elder abuse victims, and (b) to compare remote intervention delivery via phone or video to the traditional in-person delivery. Method: PROTECT, Providing Options to Elderly Clients Together, is a brief therapy developed in collaboration with partners at the Department for the Aging (DFTA) of New York City. During the COVID-19 outbreak, PROTECT delivery shifted from in-person to phone or video delivery. Depression severity was tracked using the Patient Health Questionaire-9 (PHQ-9). Reduction in depression severity was evaluated using a linear mixed effects model with non-inferiority test to compare the effectiveness of video vs in-person delivery of PROTECT. Results: PROTECT reduced depression (average 5.15 PHQ-9 points). Video and phone delivery were non-inferior to in-person delivery. The video group completed therapy more quickly than the in-person group and had a more rapid improvement in depression symptoms. Conclusions: PROTECT therapy delivered remotely reduces depression among diverse elder abuse victims. Video delivery of PROTECT could increase reach and scalability to serve more vulnerable older depressed victims.

P163: Closing the gap: Funded psychology in residential aged care in Australia.

Objective:Historically, older adults in residential aged care facilities (RACF) in Australia had no access to government funded psychology services despite high rates of anxiety and depression. Change Futures is a registered charity that provides funded psychology to more than 220 RACFs in south-east Queensland and northern New South Wales, Australia, and since 2015 has been providing free psychology services to older adults living in aged care, using a predominately provisional psychologist workforce. This presentation will discuss the model of service that is provided, and the findings of a recent outcomes report.Method:Data was collected via clinician entered eHealth records in the 2021/2022 financial year from 01/07/2021 to 30/06/2022. Outcome measures were analysed using six repeated measure t-tests to compare clinical change from first and last assessments.Results:A total of 2865 residents were seen in 17,754 individual sessions and 298 group sessions. Staff education was provided in 94 sessions with 838 participants, who worked in RACFs. The most common presenting issue was difficulties with adjustment (70%), comorbid anxiety and depression (28%), depression (27%), loneliness (18%), and anxiety (17%). Outcomes of the psychology program showed statistically significant improvements on all measures, including the Kessler 5 psychological distress scale, Geriatric anxiety scale, Patient health Questionaire-9, De Jong Gierveld Loneliness Scale, and Brief Adjustment Scale.Conclusion:The described service model resulted in significant improvements to the psychological wellbeing of older adults, and represents an effective and sustainable training approach for provisional psychologists.

Cognitive Performance and Diabetic Retinopathy: What Your Eyes Can Reveal About Your Brain.

Diabetic retinopathy (DR) is a chronic diabetes complication. People with Type 2 Diabetes Mellitus (T2DM) have two times the risk for dementia, suggesting it is a new chronic diabetes complication. Evaluate the association of DR with cognitive performance in a T2DM population. Cross-sectional study with 400 T2DM adults from whom socio-demographic, clinical, laboratory data were collected, and screening test for depression symptoms (Patient Health Questionaire- 9 (PHQ-9)), Mini-Mental State Examination (MMSE), Semantic Verbal Fluency Test, Trail Making Test A and B, Word Memory test were performed. All cognitive test scores were converted into Global Cognition z-Score (GCS(z)). The association between GCS(z) < 0 with DR was performed using a multivariate binary logistic regression model adjusted for age ≥ 65 years, school years ≤ 6 years, DM duration ≥ 10 years, depression symptoms score > 9 at PHQ-9, arterial hypertension, physical activity, diabetic retinopathy, macular edema, and cardiovascular disease. After exclusions, the 251 eligible patients were 56.6% female, with a mean age of 61.1 (±9.8) years, DM duration of 12.6 (±8.9) years, and 7.6 (±4.2) years of school education. DR prevalence was 46.5%. Multivariate Logistic Regression Model showed an association between DR and GCS(z) < 0, with odds ratio (CI95%) of 2.50 (1.18-5.34), adjusted for age, low education level, arterial hypertension and depression symptoms (OD and CI95% respectively: 5.46(2.42-12.34); 12.19 (5.62-26.46); 2.55 (0.88-7.39); 3.53 (1.55-8.07)). In this T2DM population, having DR increased the chance for worse cognitive performance even when adjusted for age, low education level, presence of arterial hypertension, and depression symptoms.

The relationship between depression based on patient health questionaire-9 and cardiovascular mortality in patients with hypertension

BackgroundDepression and hypertension are increasingly prevalent in the U.S., with evidence suggesting significant comorbidity. Despite this, the specific relationship within the U.S. hypertensive population is underexplored. Our study investigates this link using data from the 2007–2014 NHANES database and mortality data from the National Death Index. MethodsA total of 8677 participants were included in this cohort study. Depression diagnosis was made based on the Patient Health Questionnaire-9. Hypertension was defined either through a self-reported previous diagnosis, current antihypertensive medication use, or blood pressure exceeding standard thresholds. Cardiovascular disease mortality was determined by mortality recorded with National Death Index on December 31, 2019. The cox proportional hazards regression method was applied to analyze the association of depression with cardiovascular mortality in hypertension. ResultsDuring an average follow-up of 8.2 years, 599 deaths were confirmed from cardiovascular disease. The association of depression with cardiovascular mortality in hypertension was significantly positive (HR, 1.0263(95%CI = 1.0033, 1.0498), p = 0.0247). In addition, the risk of cardiovascular mortality increased gradually with the severity of depressive symptoms (p for trend =0.0259). This positive relationship was basically stable in different subgroup analyses and sensitivity analyses. LimitationsThe observational design of our study hinders establishment of a causal relationship. Potential bias due to subjective reporting and the absence of depression treatment data represent limitations, although their impact on the conclusions is deemed minimal. ConclusionsDepression is associated with cardiovascular mortality risk in patients with hypertension. The worsening depressive symptoms, the higher risk of cardiovascular mortality.

The impact of psychological resilience on chronic patients’ depression during the dynamic Zero-COVID policy: the mediating role of stigma and the moderating role of sleep quality

ObjectiveChronic patients are experiencing depression caused by themselves or the surrounding environment, how to cope with the change of mentality and adjust the psychological stress response, especially under the background of the current dynamic Zero-COVID policy in China, is a problem worth further discussion. The researchers constructed a mediating regulation model to test the influence of psychological resilience on depression of chronic patients during dynamic Zero-COVID, as well as the mediating role of stigma and the moderating role of sleep.MethodFrom October 2021 to February 2022, this study used a multi-stage sampling method and random number table method to collect data in the Shang Cheng District of Hangzhou City, Zhejiang Province. Firstly, the Second Affiliated Hospital of the Zhejiang University School of Medicine, a third-class hospital was randomly selected from the Shang Cheng District. Secondly, three departments were strategically selected from this hospital: endocrinology, dermatology, and traditional Chinese medicine. Thirdly, survey points were set up in each department, and chronic patients were strategically selected for questionnaire surveys. Finally, a face-to-face survey was conducted on 398 chronic patients who met the criteria for inclusion. In addition, chronic medical illness burden was assessed using the Cumulative Illness Rating Scale-Geriatrics (CIRS-G), psychological resilience was measured by the Conner-Davidson Resilience Scale (CD-RISC), stigma was measured by the Stigma Scale for Chronic Illness (SSCI), sleep was measured by the Pittsburgh Sleep Quality Index(PSQI) and depression was estimated by the Patient Health Questionaire-9(PHQ-9). SPSS (version 25.0) and PROCESS (version 4.0) were used for correlation analysis, mediation analysis, and mediated moderation analysis.ResultsPsychological resilience was negatively correlated with depression, stigma, and sleep. Depression was positively correlated with stigma and sleep. Stigma and sleep were positively correlated; Stigma played a mediating role in the relationship between psychological resilience and depression; Sleep moderated the first half of the pathway “psychological resilience to stigma to depression”.ConclusionPsychological resilience affected depression directly and indirectly through stigma. At the same time, sleep played a moderating role between psychological resilience and depression. The correlation between psychological resilience and stigma was stronger when levels of sleep levels were higher.

0408 Insomnia, hypersomnia, and depression in buprenorphine treated opioid use disorder subjects

Abstract Introduction Sleep disturbances and depression are highly prevalent in Opioid use disorder subjects treated with buprenorphine. However, the association between sleep disturbances such as insomnia/hypersomnia and depression in the above patient population is not known. The aim of the study is to examine the association between sleep disturbances including insomnia and hypersomnia with depressive disorders in buprenorphine treated opioid use disorder (OUDB) subjects. Methods We studied 92 OUDB (38±11.2y, 49% female, 9% minority) at the Recovery, Advocacy, Empowerment and Service program (RASE) and Internal Medicine clinics of Wellspan (York, PA). Subjects completed the Patient Health Questionaire-9 (PHQ-9), Insomnia Severity Index (ISI), Epworth sleepiness scale (ESS), and opioid craving scale (OCS). Depression was defined as a PHQ 9 score ≥ 10, insomnia with an ISI score of &amp;gt;15 and excessive daytime sleepiness (EDS) with an ESS score of &amp;gt;10. Binary logistic regression analysis evaluated the likelihood of OUDB subjects having depression in relation to insomnia, excessive daytime sleepiness (EDS), opioid craving, duration of opioid use, duration since last use of any illegal substance, number of rehabilitation treatments and buprenorphine dosage. Results No differences between in OUDB subjects with (n=47) and without (n=34) depression were observed in age, duration of opioid dependence, duration of buprenorphine treatment, number of rehabilitation treatments or time since last use of any illegal substance. Subjects with depression had significantly higher ISI (18.2±4.2 verus11.8±6.6, p&amp;lt; 0.01), ESS (11.2±4.7 versus 8.2±4.1, p&amp;lt; 0.01 ) scores and a trend towards higher OCS score (3.2±4.1 verus1.9±2.2, p=0.056) as compared to those without depression. The odds of depression associated with Insomnia and EDS were 8.5 (95%CI=2.3-31.2) and 4.4 (95%CI=1.1-17) times respectively in this patient population. Conclusion Insomnia and hypersomnia are highly associated with depression in buprenorphine treated OUDBs patients. Insomnia and hypersomnia needs to be evaluated early and receive targeted treatment during early abstinence in order to prevent relapse in this patient population. Support (if any) This project is supported by the Junior Faculty Development Program, Penn State College of Medicine

The association between adverse childhood experiences and perinatal depression symptom trajectories

Having a history of adverse childhood experiences is associated with an increased risk for treatment-resistant depression in the general population. Whether this relationship is true in the perinatal context is unknown. This study aimed to examine the association between adverse childhood experiences and the trajectories of antenatal and postpartum depression among people enrolled in a perinatal collaborative care program for mental healthcare. This retrospective cohort study included all pregnant and postpartum people who were referred to and enrolled in a perinatal collaborative care program for mental healthcare and who delivered at a single, quaternary care institution between March 2016 and March 2021. Individuals referred to the collaborative care program were linked with a care manager and had access to evidence-based mental health treatment such as a psychiatric consult, pharmacotherapy, and psychotherapy. All individuals enrolled in the collaborative care program underwent adverse childhood experience screens at intake. A score of >3 on the validated Adverse Childhood Experiences Questionnaire was defined as a high adverse childhood experience score. Depression symptom monitoring occurred via electronic Patient Health Questionaire-9 screening every 2 to 4 weeks, and escalation of care was recommended for those without evidence of improvement. Antenatal depression trajectories were determined by comparing the earliest available prenatal Patient Health Questionaire-9 score closest to the time of referral to collaborative care with the latest Patient Health Questionaire-9 score before delivery. Postpartum trajectories were determined by comparing the earliest postpartum Patient Health Questionaire-9 score after delivery with the latest score before 12 weeks' postpartum. Depression trajectories were categorized as improved, stable, or worsened based on whether the Patient Health Questionaire-9 scores changed by at least 2 standard deviations (ie, 5 points on the Patient Health Questionaire-9 scale). Bivariable and multivariable analyses were performed. Of the 1270 people who met the inclusion criteria, 294 (23.1%) reported a high adverse childhood experience score. Those with a high adverse childhood experience score were more likely to experience a worsened antenatal depression trajectory than those with a low adverse childhood experience score (10.3% vs 4.3%; P=.008). This association persisted after adjusting for potential confounders (adjusted odds ratio, 2.39; 95% confidence interval, 1.05-5.46). There was no significant difference in the postpartum depression trajectories between those with a high and those with a low adverse childhood experience score. Having a high adverse childhood experience score is associated with a worsened antenatal depression trajectory for those enrolled in a collaborative care program. Given its high prevalence, future research should evaluate effective modalities of perinatal depression prevention and treatment specific for pregnant people with a history of adverse childhood experiences.

Predictors and incidence of depression and anxiety in women undergoing infertility treatment: A cross-sectional study.

The global incidence of infertility is increasing year by year, and the association between infertility and mental illness has been widely concerned. The aim of this study was to investigate the incidence of anxiety and depression in infertile women in China and explore the risk factors which might lead to anxiety and depression. From January 2020 to December 2020, female infertile patients who received assisted reproduction technology (ART) treatment at West China Second Hospital were recruited and a total of 1712 eligible female patients were finally enrolled in this study. Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionaire-9 (PHQ-9) were used to evaluate the patients' psychological status. The reliability of all scales was evaluated by Cronbach's α and Spearman-Brown half coefficient, and Kaiser-Meyer-Olkin (KMO) value was calculated by factor analysis to evaluate validity. Univariate and multivariate logistic regression analysis were applied for assessing independent risk factors of anxiety and depression, respectively. The incidence of anxiety and depression in infertile women were 25.2% and 31.3%, respectively. Cronbach's α coefficients and Spearman-Brown half-fold coefficients of GAD-7 and PHQ-9 were 0.870, 0.825, 0.852 and 0.793, respectively. Univariate and multivariate logistic regression analysis showed that education level (junior college degree or above, OR:1. 6, 95% CI: 1.2-2.1, P = 0.003), somatic symptoms (severe somatic symptoms, OR:15.2, 95%CI: 5.6-41.3, P<0.001), sleep quality (poor sleep quality, OR:9.3, 95% CI:4.7-18.4, P<0.001) were independent risk factors for anxiety. And age>35 years old, moderate and severe somatic symptoms and poor sleep quality were independent risk factors for depression. Somatic symptoms and poor sleep quality are both the risk factors of anxiety and depression symptoms of infertile woman. And high educated (junior college degree or above) patients are more likely to be complicated with anxiety symptoms, while elderly patients (age>35) are prone to be complicated with depression symptoms.

Loneliness and depressive symptoms among men who have sex with men in China: A cross-sectional study.

While psychosocial problems and their related factors in men who have sex with men (MSM) have been well documented in developed countries, there are still not many studies addressing this issue in China and the results are inconsistent. This study aimed to assess the prevalence of loneliness and depressive symptoms among MSM, examine their associated factors, and investigate potential factors moderating the link between depressive symptoms and loneliness. A cross-sectional study was conducted in Taizhou of Zhejiang Province in China between April and November 2021. Loneliness was assessed using the 3-item UCLA Loneliness Scale (UCLA-3), and depressive symptoms were measured using the Patient Health Questionaire-9 (PHQ-9). Data from 655 MSM were eligible for analysis. Logistic regression models were used to examine the associations between independent variables and the outcomes of loneliness and depression. The interaction terms were added in the models to assess the moderating effects. Of the MSM sample, 13.28 and 7.48% perceived loneliness and reported moderate-to-severe depressive symptoms, respectively. We found that participants who experienced loneliness were more likely to have younger age (OR 0.44, 95% CI 0.21, 0.93, 15-32 years as reference group), low social support (OR 3.60, 95% CI 2.14, 6.04), low self-esteem (OR 3.03, 95% CI 1.45, 6.32) and moderate-to-severe depressive symptoms (OR 5.45, 95% CI 2.66, 11.15). The participants with moderate-to-severe depressive symptoms were more likely to have low self-esteem (OR 6.78, 95% CI 3.08, 14.95) and feelings of loneliness (OR 5.51, 95% CI 2.66, 11.40). Stratified analyzes showed that the magnitude of the associations between depressive symptoms and loneliness varied in MSM with different age, marital status, and self-esteem. Our study suggests that we need to pay attention to feelings of loneliness and depressive symptoms and their closely associated factors such as social support and self-esteem among MSM in China. The MSM who were young, not married, and had low self-esteem were especially vulnerable to the impact of depressive symptoms on loneliness.

Impact of long working hours on depressive symptoms among COVID-19 frontline medical staff: The mediation of job burnout and the moderation of family and organizational support.

During the COVID-19 pandemic, the frontline medical staff faced more workload and heavier physical and mental stress, which increased their job burnout and negative emotions. However, little is known about the potential factors mediating and moderating these relations. This study investigates the association between long working hours and depressive symptoms among frontline medical staff in China, and explores the potential mediating effect of job burnout, and moderating effect of family and organizational support on these associations. Data of 992 frontline medical staff who participated in the prevention and control of COVID-19 was obtained from the online survey conducted in November to December 2021 in China. Depressive symptoms were evaluated using the Patient Health Questionaire-9 (PHQ-9). Moderated mediating model was employed to understand the relationship between long working hours (X), depressive symptoms (Y) mediated through job burnout (M), moderated by family support (W1) and organizational support (W2), while controlling all possible covariates. 56.96% of participants worked more than 8 h per day. 49.8% of them had depressive symptoms (PHQ-9 ≥ 5) and 65.8% experienced job-related burnout. Long working hours was positively associated with depressive symptoms score (β = 0.26, 95% CI:0.13 ~ 0.40). Mediation analyses revealed that job burnout significantly mediated this relationship (indirect effect = 0.17, 95% CI: 0.08 ~ 0.26). Moderated mediation further indicated that both two interactions of social support (family support W1, organizational support W2) and job burnout were negatively related to depressive symptoms among frontline medical staff, indicating that higher social support being less job burnout with lower depressive symptoms. Longer working hours and higher job burnout may contribute to worse mental health among frontline medical staff. Social support could buffer the detrimental effects by reducing their job burnout. The main contribution of this study was to estimate the negative effect of long working hours on depressive symptoms among frontline medical staff and explore the potential mediating role of job burnout and moderating role of social support on these associations.

Long-Term Psychiatric Symptoms in Autoimmune Encephalitis Remission

Objective To identify the prevalence of self-reported symptoms of depression and anxiety among patients in remission from autoimmune encephalitis (AE). Background Although prior studies have found a high prevalence of residual cognitive deficits among patients in remission from AE, there is a paucity of data on long-term psychiatric outcomes for this patient population. In normal populations, median Patient Health Questionaire-9 (PHQ9) and General Anxiety Disorder-7 (GAD7) scores were reported to be, respectively, around 3 and 2, with prevalence of depressive and anxiety symptoms on these questionnaires reported as around 24% and 23%. Design/Methods Retrospective cross-sectional cohort study at a tertiary center AE clinic between 2012-01-01 and 2021-12-31. Patients were contacted via phone or regular follow-up and completed the PHQ9 and GAD7. Results Forty-one patients were contacted; 29 responded (71%) and were included. Seventeen (59%) were female. Median age was 32.5 years (range 5-77). Autoantibody results were N-methyl-D-aspartate receptor (n = 14, 48%), negative (n = 7, 24%), leucine-rich glioma-inactivated 1 (n = 6, 21%), and contactin-associated protein-like 2 (n = 1, 3%). Median time from disease onset to questionnaire collection was 6.3 years (range 1.5-23.0). Ten patients (37%) were experiencing symptoms of depression as measured by the PHQ9, with six (60%) reporting moderate-to-severe symptoms. Median PHQ9 score was 3 (range 0-18). Six patients (22%) were experiencing symptoms of anxiety on the GAD7, with one (17%) reporting moderate-to-severe symptoms. Median GAD7 score was 2 (range 0-10). Eight patients (28%) reported a psychiatric history prior to the onset of AE, which was associated with increased PHQ9 scores (p = 0.04, Wilcoxon rank sum test). Conclusions The prevalence of self-reported depressive and anxious symptoms in this cohort in remission from AE was similar to general populations. Patients with a psychiatric history that preceded onset of AE had higher PHQ9 scores. These results may be affected by censoring bias and lower sensitivity of self-reported diagnostic tools.

Depression and anxiety symptoms among Arab/Middle Eastern American college students: Modifying roles of religiosity and discrimination.

We examine mental health outcomes in a national sample of Arab/Middle Eastern college students using the Healthy Minds Study (HMS) from 2015-2018 and assess the modifying roles of religion and discrimination. HMS is an annual web-based survey administered to random samples of undergraduate and graduate students at participating colleges and universities. A total of 2,494 Arab/Middle Eastern and 84,423 white students were included in our sample. Our primary outcomes of depression and anxiety symptoms were assessed using the Patient Health Questionaire-9 (PHQ-9) and the Generalized Anxiety Disorder 7-item (GAD-7) scale, respectively. Survey-weighted logistic regression models were fit for each outcome using an Arab ethnicity indicator. Effect modification by religiosity and discrimination was examined by adding an interaction term to the model. Odds of depression (adjusted odds ratio, AOR: 1.40, 95% CI: 1.24, 1.57) and anxiety (AOR: 1.41, 95% CI: 1.25, 1.60) were higher for Arab/Middle Eastern students than for white students. For Arab/Middle Eastern students, religiosity was a protective factor for both depression (AOR: 0.84, 95% CI: 0.79, 0.90) and anxiety (AOR: 0.91, 95% CI: 0.85, 0.97). Arab/Middle Eastern students who experienced discrimination had higher odds of depression (AOR: 1.41, 95% CI: 1.28, 1.56) and anxiety (AOR: 1.49, 95% CI: 1.36, 1.65) than those who had not. Arab/Middle Eastern American college students are a vulnerable subgroup on college campuses experiencing a high burden of depression and anxiety symptoms which are dampened by religiosity and amplified by discrimination.

Building Emotional Awareness and Mental Health (BEAM): A Pilot Randomized Controlled Trial of an App-Based Program for Mothers of Toddlers.

BackgroundFamilies have faced unprecedented challenges during the COVID-19 pandemic, leading to increased maternal mental health problems and barriers to accessing care. Innovative programs are needed to support both maternal mental health and parenting, and to buffer the long-term impacts of stress on young children. Using a patient-oriented approach, our research team aimed to co-develop and pilot test an App-based psychoeducation and social-connection platform: Building Emotional Awareness and Mental Health (BEAM).MethodsThe co-development process involved a parent advisory board from conceptualization and design, through to direct participation in the program delivery. The BEAM program includes weekly videos and activities based on Unified Protocol therapy modules and emotion-focused parenting strategies, a weekly telehealth group review session, and access to a private online forum for support from other mothers and clinical coaches. A parallel randomized control trial was conducted across two provinces in Canada. Mothers of preschool children (aged 18–36 months old), with moderate-to-severe depression (Patient Health Questionaire-9 ≥ 10), were recruited online and randomized to either the 10-week BEAM intervention or treatment as usual (TAU) control group. Online surveys (ensuring researcher blinding) included questions about feasibility and acceptability of the program and pre/post self-report measures of mental health, parenting, positive coping and child behavior outcomes. The primary outcome measures were symptoms of depression and parenting stress. Data were analyzed using mixed models and an intention-to-treat approach.Results65 participants were randomized, by an online allocation tool, to the BEAM (n = 33) and TAU (n = 32) groups. Engagement was relatively high at the beginning of the program, with 78.8% starting the BEAM App and 70.6% attending ≥1 telehealth session. Most respondents felt socially supported, satisfied with the App, and found it easy to use. Pre-post results indicated interaction effects with greater reductions in overall mental health problems, and specifically anxiety and sleep symptoms, among BEAM vs. control participants. There were also time effects with reductions in depression symptoms across both groups. No significant treatment effects emerged for the other mental health symptoms, parenting problems, positive coping, or child behavior outcomes. Descriptive data are included to highlight possible areas of promise for future large efficacy trials. Technological difficulties and other challenges that may have led to attrition and impacted outcomes are discussed. There were no adverse events related to study participation.ConclusionsThe BEAM program has promise as a novel, feasible and acceptable intervention for improving mental health among mothers of young children.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [NCT04772677].

Psychometric properties of the emotional processing scale in individuals with psychiatric symptoms and the development of a brief 15-item version

The 25-item Emotional Processing Scale (EPS) can be used with clinical populations, but there is little research on its psychometric properties (factor structure, test–retest reliability, and validity) in individuals with psychiatric symptoms. We administered the EPS-25 to a large sample of people (N = 512) with elevated psychiatric symptoms. We used confirmatory factor analysis to evaluate three a priori models from previous research and then evaluated discriminant and convergent validity against measures of alexithymia (Toronto Alexithymia Scale-20), depressive symptoms (Patient Health Questionaire-9), and anxiety symptoms (Generalized Anxiety Disorder-7). None of the a priori models achieved acceptable fit, and subsequent exploratory factor analysis did not yield a clear factor solution for the 25 items. A 5-factor model did, however, achieve acceptable fit when we retained only 15 items, and this solution was replicated in a validation sample. Convergent and discriminant validity for this revised version, the EPS-15, was r = − 0.19 to 0.46 vs. TAS-20, r = 0.07− 0.25 vs. PHQ-9, and r = 0.29− 0.57 vs. GAD-7. Test–retest reliability was acceptable (ICC = 0.73). This study strengthens the case for the reliability and validity of the 5-factor structure of the EPS but suggest that only 15 items should be retained. Future studies should further examine the reliability and validity of the EPS-15.

173-LB: Cognitive Performance and Diabetic Retinopathy

Background: Diabetic retinopathy (DR) is a chronic diabetes complication. People with type 2 diabetes mellitus (T2DM) have two times the risk for dementia, suggesting it is a new chronic diabetes complication. Objective: Evaluate the association of DR with cognitive performance in a T2DM population. Methods: Cross-sectional study with 400 T2DM adults from whom socio-demographic, clinical, laboratory data, screening test for depression symptoms [Patient Health Questionaire-9 (PHQ-9) ], Mini Mental State Examination (MMSE) , Semantic Verbal Fluency test, Trail Making test A and B, Word Memory test were collected and performed. All cognitive test scores were converted into Global Cognition z-Score [GCS (z) ]. The association between GCS (z) &amp;lt; 0 with DR was performed using backward multivariate binary logistic regression model adjusted forage ≥ 65 years, school years ≤ 6 years, DM duration ≥ 10 years, depression symptoms score &amp;gt; 9 at PHQ-9, arterial hypertension, physical activity, diabetic retinopathy, macular edema and cardiovascular disease. Results: After exclusions, the 251 eligible patients were 56.6% female, mean age 61.1 (±9.8) years, DM duration of 12.6 (±8.9) years and 7.6 (±4.2) years of school education. DR prevalence was 46.5%. Multivariate Binaric Logistic Regression Model showed an association between DR and GCS (z) &amp;lt; 0, with odds ratio (CI95%) of 2.50 (1.18-5.34) , adjusted for age, low education level, arterial hypertension and depression symptoms [OD and CI95%respectively: 5.46 (2.42-12.34) ; 12.19 (5.62-26.46) ; 2.55 (0.88-7.39) ; 3.53 (1.55-8.07) ]. Conclusion: In this T2DMpopulation, having DR increased the chance for worse cognitive performance even when adjusted for age, low education level, presence of arterial hypertension, and depression symptoms. Disclosure A. R. A. Faria: None.