Patient Health Questionnaire Depression Research Articles

Patient reported outcomes, control of hypertension and dyslipidemia: results of two epidemiological studies in Romania, conducted during pandemia (Snapshot-1) and post-pandemic (Snapshot-2)

Abstract Background Coexistence of hypertension and dyslipidemia is commonly found in daily practice. Patient reported outcomes (PRO) are increasingly used to guide clinical decision-making, as well as public reporting of health system performance. Purpose To assess patient reported outcomes (PRO: socio-economic factors, depression level, and treatment adherence) and control of blood pressure (BP) and LDL-cholesterol (LDL-C) during pandemia and in the post-pandemic period. Methods Two real-world, cross-sectional, multicentre, observational studies, with a similar design, were conducted in Romania during pandemia, in June 2021 (SnapShot-1), and post-pandemic, in June 2022 (SnapShot-2). They included 5004 consecutive outpatients diagnosed with both hypertension and dyslipidemia, addressing cardiologists, diabetologists, and general practitioners: 2469 in SnapShot-1 and 2535 in SnapShot-2. Patients completed a three-part questionnaire including: (1) questions on socio-economic factors; (2) Patient Health Questionnaire (PHQ-9) (Depression scale); and (3) Hill-Bone Medication Adherence Scale (HBMAS) for hypertension and dyslipidemia. Results Characteristics of patients were similar between studies: 65.0±10.0 years and 40.9% men (SnapShot-1), 63.6±10.7 years and 43.3% men (SnapShot-2). Most of the patients declared themselves as "adherent" to the prescribed treatment: 91.8% (SnapShot-1) and 93.0% (SnapShot-2) adherent to antihypertensive treatment; 89.6% (SnapShot-1) and 90.9% (SnapShot-2) adherent to lipid lowering treatment. Socio-economic factors were similar between studies, except education, with higher education rates in SnapShot-2 (Table 1). Compared to SnapShot-1, depression scores evaluated by PHQ-9 scale were lower in SnapShot-2, conducted post-pandemic: 5.9±4.9 for SnapShot-1, suggesting a "mild" depression level, vs. 4.9±4.6 for SnapShot-2, which is below the "mild" depression threshold. Similarly, the adherence scores measured by HBMAS were lower in SnapShot-1 vs. SnapShot-2: 33.8±3.0 vs. 34.0±2.9 for antihypertensive medication, and 33.5±3.5 vs. 33.7±3.4 for lipid lowering treatment (Table 2). Conclusion Data collected from two large epidemiological studies in Romania showed an improvement of post-pandemic depression rates, as well as an improvement of adherence scores. Use of PRO assessment in routine clinical practice could support identification of patients on risk for uncontrolled BP or LDL-C, in need of more intense medical care.

The psychological impact of COVID-19 pandemic on Iraqi health workers.

To explore the psychological impact of coronavirus disease-2019 on frontline healthcare workers in Iraq. The cross-sectional study was conducted from November 2020 to September 2021 after approval from the ethics review committee of the College of Medicine, Mustansiriyah University, Baghdad, Iraq, and comprised doctors and nurses from 4 teaching hospitals and 8 primary healthcare centres in Baghdad. Psychological sequels, like anxiety, depression, fear and insomnia, were assessed along with exposure to coronavirus disease-2019. The study questionnaire was based on the Patient Health Questionnaire Anxiety and Depression Scale. Data was analysed using SPSS 26. Of the 400 participants, 288(72%) were doctors and 112(28%) were nurses. Overall, 215(53.7%) subjects had had a coronavirus disease-2019 infection, 192(48%) reported having anxiety, 148(37%) fear, 100(25%) depressive symptoms, and 51(12.8%) complained of insomnia. Doctors were more likely to have anxiety than nurses (p<0.05), but the difference in terms of depression was not significant (p>0.05). The mental health of the frontline healthcare workers was found to have been affected by the coronavirus disease-2019 pandemic, with anxiety and fear being the main symptoms.

Model of integrated mental health video consultations for people with depression or anxiety in primary care (PROVIDE-C): assessor masked, multicentre, randomised controlled trial

ObjectiveTo evaluate whether an integrated mental health video consultation approach (PROVIDE model) can improve symptoms compared with usual care in adults with depression and anxiety disorders attending primary care.DesignAssessor masked,...

Observations on the efficacy of edaravone dexborneol in preventing post-stroke depression and its inflammatory mechanism: a prospective, randomized, control trial.

This study aimed to observe the effect of edaravone dexborneol (EDB) on the incidence of early post-stroke depression (PSD) and explore its inflammatory mechanisms. A prospective, randomized controlled study was conducted from January 2022 to June 2023, involving patients with acute ischemic stroke (AIS) at the Neurology Department of the Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine. The control group received routine treatment, while the experimental group received routine combined EDB treatment. The main outcome measures included PSD incidence, Patient Health Questionnaire (PHQ-9) and Hamilton Depression Scale (HAMD) scores on days 14 and 30, and inflammatory factor levels on day 14. A total of 93 patients were included in the study, 51 in the experimental group and 42 in the control group. On day 14, the PSD incidence was 13.7% in the experimental group, lower than 31.0% in the control group (95%CI 0.127-0.996; p = 0.044). Compared to the control group, the experimental group showed significantly lower concentrations of pro-inflammatory cytokines IL-1β (95%CI 3.353-5.184), IL-6 (95%CI 2.694-3.426), TNF-α (95%CI 4.985-12.196), IFN-γ (95%CI 0.163-0.451), MCP-1 (95%CI 0.335-0.787), IL-17A (95%CI 0.543-1.024), and IL-23p19 (95%CI 1.677-1.959) (all p < 0.001), and higher levels of anti-inflammatory cytokines IL-4 (95%CI -1.087 to -0.941), IL-10 (95%CI -6.125 to -1.662), and IL-13 (95%CI -6.078 to -2.953) (all p ≤ 0.001). On day 30, the PSD incidence in the experimental group was 15.7%, lower than 40.5% in the control group (95%CI 0.103-0.725; p = 0.007). Compared with the control group, the experimental group had lower PHQ-9 scores on day 14 (95%CI 0.034-1.577; p = 0.041) and day 30 (95%CI 0.018-1.573; p = 0.045), and also had lower HAMD scores on day 14 (95% CI 0.281-2.856; p = 0.018) and day 30 (95% CI 0.647-3.482; p = 0.005). EDB could reduce the incidence of early PSD, reduce pro-inflammatory cytokine levels, and elevate anti-inflammatory cytokine levels, which was possibly related to the anti-inflammatory mechanism of EDB. http://www.chictr.org.cn/, identifier [ChiCTR2300067750].

Influence of parental attitudes and coping styles on mental health during online teaching in the COVID-19 pandemic

During the COVID-19 pandemic, the online delivery model became the primary mode of education. With multiple pressures on society and families, mental health issues for parents have become particularly pronounced. Most of the current research has focused on the psychological state of education practitioners and children, with little attention to parents’ mental health issues. Therefore, this study explored the attitudes and coping styles of parents who experienced the process of their children being taught online over a long period and the factors influencing their mental health. This cross-sectional study was conducted between November 2021 and January 2022, using an anonymous online questionnaire to survey 1500 parents with children aged 6–13 years. The Chinese versions of the Patient Health Questionnaire Depression Scale (PHQ-9), the Parenting Stress Scale (PSS), the General Mental Health Questionnaire (GHQ-12), and the Brief Coping Style Scale (SCSQ), and a related factors questionnaire were used to survey the subjects. The normal distribution of the data was examined using the Shapiro–Wilk method. A multivariate regression analysis was conducted to identify factors significantly associated with parental mental health during the COVID-19 pandemic. Only 30.24% of parents agreed with online classes during the pandemic, and 52.28% used positive coping methods during stressful situations. Multivariate regression models identified significant factors associated with parental mental health: parent’s gender, child’s grade level, perceived stress about online classes, whether the child has ADHD, positive or negative coping styles, and subjective attitudes of support for online classes or not. The results of the study suggest that as online classes become more socially acceptable, it is necessary to be concerned about the risk of mental illness for parents and develop policies and interventions, especially for parents who adopt negative coping styles and endorse online classes. The focus should be on the stress of online classes on parents, improving the acceptance of online classes and psychological well-being, regulating the way parents deal with their children, and targeting subgroups of children with ADHD symptoms during the COVID-19 pandemic.

Pubic hair removal methods and associated factors on female sexuality in Fayoum Governorate, Egypt

Background Pubic hair removal (PHR) is a popular practice among women. They remove pubic hair by different methods, usually for visual, esthetic, or psycho-sexual aspects, as being more attractive and feminine to affect their sexual life. Objectives To assess the impact of different methods of PHR on sexual function among sexually active females in Fayoum Governorate, Egypt. And to understand factors affecting the choice of methods used in this grooming practice. Patients and methods This cross-sectional study included 500 sexually active women who completed the study structured questionnaire, which included demographics, reproductive and medical history data, assessment of sexual function in the past 4 weeks using Female Sexual Function Index (FSFI), PHR items, and the Patient Health Questionnaire depression scale-9 in the last 2 weeks. Results Almost all the participants (99.2%) preferred to remove pubic hair, and the most frequently mentioned method is shaving and creams (43.8%). The prevalence of female sexual dysfunction was 50.5% of our participants. There was a significant difference in the mean FSFI scores between different methods of PHR; with laser, users, had higher FSFI scores of arousal, lubrication, and satisfaction domains (P&lt;0.05). Wax or sweet users and laser users were more satisfied with their body image than shaving users. Conclusions Female sexual dysfunction is a widespread problem; it may result in depression and may be affected by the type of method used for PHR. Laser users had better sexual functions than users of other methods.

Subjective and objective sleep quality assessment in adolescent patients with inflammatory bowel disease

ObjectivesThere is a link between inflammatory bowel disease (IBD) and poor sleep quality that is presumed to be multifactorial. The purpose of this study was to identify factors that impact sleep quality in this group including clinical disease activity, depression, anxiety, quality of life, and disordered social media use through questionnaires. MethodsThis prospective study analyzed sleep quality in adolescent patients ages 13 to 18 with a diagnosis of IBD using objective data from wrist actigraphy and subjective report from the Pittsburgh Sleep Quality Index (PSQI). Additional screeners including the Short Pediatric Crohn's Disease Activity Index or Pediatric Ulcerative Colitis Activity Index, Pediatric Quality of Life Inventory Gastrointestinal Symptoms Module, Generalized Anxiety Disorder 7-item screener, Patient Health Questionnaire depression screener, and Social Media Disorder scale were also collected. ResultsTwenty-three subjects enrolled and 16 completed questionnaires. 62.5 % of participants were in clinical remission and the remaining 37.5 % had mild to severe clinical IBD activity. Poor subjective sleep quality was associated with a shorter duration of sleep time and an increased clinical disease activity score. Patients in clinical remission slept for a longer duration than those with mild IBD activity. ConclusionsThis study did not identify a significant relationship between sleep quality and psychosocial factors in the adolescent population with IBD, though their influence cannot be discounted. There was a connection between the presence of disease activity and shorter sleep duration. Similarly, PSQI scores correlated with sleep time but not sleep quality.

Association of Limited Health Literacy With Clinical and Patient-Reported Outcomes in Individuals With Systemic Lupus Erythematosus.

Health literacy is an important social determinant of health, with limited health literacy associated with worse health outcomes. This study examined the associations between limited health literacy with patient-reported outcomes and disease activity/damage among 267 Black women with active systemic lupus erythematosus (SLE) enrolled in the Peer Approaches to Lupus Self-Management (PALS) program. The three-item Chew Health Literacy Screening was used to dichotomize those reporting in the "limited" range on any item with outcomes compared via generalized linear models. Baseline surveys and assessments obtained at study entry as part of the PALS study were used. Primary outcomes included disease activity and lupus damage; other secondary outcomes included patient activation, self-efficacy, physician/patient communication, and quality of life. The study included 267 Black women with SLE. In covariate-adjusted analyses, participants with limited health literacy (88 [33%]) were more likely to have lower patient activation (Patient Activation Measure P < 0.0001), lower self-efficacy (Lupus Self-Efficacy P < 0.0001), higher lupus damage (self-administered Brief Index of Lupus Damage P=.016), higher disease activity (Systemic Lupus Activity Questionnaire symptom severity P=0.006), and worse physician/patient communication (patient-centered care P < 0.0001) compared to those with adequate health literacy. Those with limited health literacy also reported worse lupus quality of life (P=0.0004) and greater levels of stress (Perceived Stress Scale-4 P < 0.0001) and were 2.4 times more likely to have probable major depression (Patient Health Questionnaire Depression Scale-8 of ≥10 P=0.004) and probable anxiety disorder (General Anxiety Disorder-7 of ≥10 P=0.007) compared to those with adequate health literacy. Black women with SLE and limited health literacy have worse clinical outcomes and represent a particularly vulnerable population with significantly disparate health outcomes. These findings suggest health literacy and complexities of managing SLE may impair clinical care in multiple domains, ultimately contributing to higher disease activity and death/damage, and are important to address in clinical care and future interventions in patients with SLE.

Validity of evaluation scales for post-stroke depression: a systematic review and meta-analysis

BackgroundPost-stroke depression (PSD) is closely associated with poor stroke prognosis. However, there are some challenges in identifying and assessing PSD. This study aimed to identify scales for PSD diagnosis, assessment, and follow-up that are straightforward, accurate, efficient, and reproducible.MethodsA systematic literature search was conducted in 7 electronic databases from January 1985 to December 2023.ResultsThirty-two studies were included, the Patient Health Questionnaire-9 (PHQ-9) and Hamilton Depression Scale (HDRS) had higher diagnostic accuracy for PSD. The sensitivity, specificity, and diagnostic odds ratio of PHQ-9 or diagnosing any depression were 0.82, 0.87, and 29 respectively. And for HDRS, used for diagnosing major depression, the scores were 0.92, 0.89, and 94. Furthermore, these two scales also had higher diagnostic accuracy in assessing depressive symptoms during both the acute and chronic phases of stroke. In patients with post-stroke aphasia and cognitive impairment, highly diagnostic scales have not been identified for assessing depressive symptoms yet.ConclusionsThe PHQ-9 and HDRS scales are recommended to assess PSD. HDRS, which demonstrates high diagnostic performance, can replace structured interviews based on diagnostic criteria.

Investigation of screening questions to identify insomnia in cancer patients

The high prevalence of insomnia in cancer patients leads to a significant reduction in the quality of life of those affected. A detailed record of symptoms therefore plays an essential role for further course of treatment. Which screening instruments enable identification of cancer patients with insomnia is the subject of this single-arm nonrandomized study. During the data collection period, cancer patients meeting the following criteria: self-reported tiredness and/or trouble falling or staying asleep or sleeping too much in an electronic patient-reported outcome measurement were enrolled. For further analysis, focus was placed on the Patient Health Questionnaire Depression Scale (PHQ-8), the Minimal Documentation System (MIDOS2) and the Insomnia Severity Index (ISI). Frequency, correlation, and variance analyses were conducted to identify likely predictors of insomnia. Our findings indicate a closer correlation between the screening question pertaining to sleep disorders and the ISI, compared to the question on tiredness and the ISI. The initial recording of sleep-related parameters plays an essential role for cancer patients in order to identify and treat modifiable factors as promptly as possible. For an initial assessment, we recommend asking about trouble falling or staying asleep or sleeping too much.

Longitudinal invariance of the Patient Health Questionnaire-9 among patients receiving pharmacotherapy for major depressive disorder: A secondary analysis of clinical trial data.

Comparing self-reported symptom scores across time requires longitudinal measurement invariance (LMI), a psychometric property that means the measure is functioning identically across all time points. Despite its prominence as a measure of depression symptom severity in both research and health care, LMI has yet to be firmly established for the Patient Health Questionnaire-9 depression module (PHQ-9), particularly over the course of antidepressant pharmacotherapy. Accordingly, the objective of this study was to assess for LMI of the PHQ-9 during pharmacotherapy for major depressive disorder. This was a secondary analysis of data collected during a randomized controlled trial. A total of 1,944 veterans began antidepressant monotherapy and completed the PHQ-9 six times over 24 weeks of treatment. LMI was assessed using a series of four confirmatory factor analysis models that included all six time points, with estimated parameters increasingly constrained across models to test for different aspects of invariance. Root-mean-square error of approximation of the chi-square difference test values below 0.06 indicated the presence of LMI. Exploratory LMI analyses were also performed for separate sex, age, and race subgroups. Root-mean-square error of approximation of the chi-square difference test showed minimal change in model fits during invariance testing (≤ 0.06 for all steps), supporting full LMI for the PHQ-9. LMI was also supported for all tested veteran subgroups. As such, PHQ-9 sum scores can be compared across extended pharmacotherapy treatment durations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Clinical and cost-effectiveness of remote-delivered, online lifestyle therapy versus psychotherapy for reducing depression: results from the CALM non-inferiority, randomised trial

We conducted the first non-inferiority, randomised controlled trial to determine whether lifestyle therapy is non-inferior to psychotherapy with respect to mental health outcomes and costs when delivered via online videoconferencing. An individually randomised, group treatment design with computer-generated block randomisation was used. Between May 2021-April 2022, 182 adults with a Distress Questionnaire-5 score=≥8 (indicative depression) were recruited from a tertiary mental health service in regional Victoria, Australia and surrounds. Participants were assigned to six 90-min sessions over 8-weeks using group-based, online videoconferencing comprising: (1) lifestyle therapy (targeting nutrition, physical activity) with a dietitian and exercise physiologist (n=91) or (2) psychotherapy (Cognitive Behavioural Therapy) with psychologists (n=91). The primary outcome was Patient Health Questionnaire-9 (PHQ-9) depression at 8-weeks (non-inferiority margin ≤2) using Generalised Estimating Equations (GEE). Cost-minimisation analysis estimated the mean difference in total costs from health sector and societal perspectives. Outcomes were assessed by blinded research assistants using Computer Assisted Telephone Interviews. Results are presented per-protocol (PP) and Intention to Treat (ITT) using beta coefficients with 95% Confidence Intervals (CIs). The sample was 80% women (mean: 45-years [SD:13.4], mean PHQ-9:10.5 [SD:5.7]. An average 4.2 of 6 sessions were completed, with complete data for n=132. Over 8-weeks, depression reduced in both arms (PP: Lifestyle (n=70) mean difference:-3.97, 95% CIs:-5.10,-2.84; and Psychotherapy (n=62): mean difference:-3.74, 95% CIs:-5.12,-2.37; ITT: Lifestyle (n=91) mean difference:-4.42, 95% CIs:-4.59,-4.25; Psychotherapy (n=91) mean difference:-3.82, 95% CIs:-4.05,-3.69) with evidence of non-inferiority (PP GEE β:-0.59; 95% CIs:-1.87, 0.70, n=132; ITT GEE β:-0.49, 95% CIs:-1.73, 0.75, n=182). Three serious adverse events were recorded. While lifestyle therapy was delivered at lower cost, there were no differences in total costs (health sector adjusted mean difference: PP AUD$156 [95% CIs-$182, $611, ITT AUD$190 [95% CIs-$155, $651] ]; societal adjusted mean difference: PP AUD$350 [95% CIs:-$222, $1152] ITT AUD$ 408 [95% CIs-$139, $1157]. Remote-delivered lifestyle therapy was non-inferior to psychotherapy with respect to clinical and cost outcomes. If replicated in a fully powered RCT, this approach could increase access to allied health professionals who, with adequate training and guidelines, can deliver mental healthcare at comparable cost to psychologists. This trial was funded by the Australian Medical Research Future Fund (GA133346) under its Covid-19 Mental Health Research Grant Scheme.

Residential natural hazard risk and mental health effects.

Mental health effects are frequently reported following natural disasters. However, little is known about effects of living in a hazard-prone region on mental health. We analyzed data from 9,312 Gulf Long-term Follow-up Study participants who completed standardized mental health questionnaires including the Patient Health Questionnaire-9 (depression=score≥10), Generalized Anxiety Disorder Questionnaire-7 (anxiety=score≥10), and Primary Care PTSD Screen (PTSD=score≥3). Geocoded residential addresses were linked to census-tract level natural hazard risk scores estimated using the National Risk Index (NRI). We considered an overall risk score representing 18 natural hazards, and individual scores for hurricanes, heatwaves, coastal flooding and riverine flooding. Log binomial regression estimated prevalence ratios (PR) and 95% confidence intervals (CI) for associations between risk scores (quartiles) and mental health outcomes. Increasing hurricane and coastal flooding scores were associated with all mental health outcomes in a suggestive exposure-response manner. Associations were strongest for PTSD, with PRs for the highest vs. lowest quartile of hurricane and coastal flooding risks of 2.29(1.74-3.01) and 1.59(1.23-2.05), respectively. High heatwave risk was associated with anxiety (PR=1.25(1.12-1.38)) and depression (PR=1.19(1.04-1.36)) and suggestively with PTSD (PR=1.20(0.94-1.52)). Results suggest that living in areas prone to natural disasters is one factor associated with poor mental health status.

Association of both depressive symptoms scores and specific depressive symptoms with all-cause and cardiovascular disease mortality

BackgroundThe presence of depression related to an increased risk of all-cause and cardiovascular disease (CVD) mortality has been reported. However, studies conducted on certain specific depressive symptoms are scarce. Our purpose was to assess the effect of both depressive symptoms scores and certain specific depressive symptoms on all-cause and CVD mortality.MethodsIn the present cohort study, all participants, aged 18 years or older, were enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2014. Depressive symptoms score was assessed using the validated 9-item Patient Health Questionnaire Depression Scale (PHQ-9), which ranges from 0 to 27, with a PHQ-9 score ≥ 10 diagnosed as depression. The outcome events were all-cause and CVD mortality, which were followed up from 2005 to 2014. The associations of both depressive symptoms score and certain specific depressive symptoms with all-cause and CVD mortality were examined by weighted multivariable proportional hazards models.ResultsA total of 26,028 participants aged ≥ 18 years were included in the statistical analysis, including 12,813 (49.2%) males and 13,215 (50.8%) females, with a mean (SD) age of 47.34 (18.86) years. During the 9.32 (3.20) years of mean (SD) follow-up, 3261 deaths were recorded, of which 826 were cardiovascular deaths. All-cause mortality was 16.87/1000 person-years in subjects with depression. In terms of CVD mortality, these figures were 4.53/1000 person-years. In the full model (model 3), elevated depressive symptoms scores were independently associated with an increased risk of all-cause mortality (Highest depression symptom score group: adjusted hazard ratio, 1.63; 95% CI 1.44–1.85) and CVD mortality (Highest depression symptom score group: adjusted hazard ratio, 1.73; 95% CI 1.34–2.24). All 9 specific depressive symptoms that make up the PHQ-9 were related to an increased risk of all-cause mortality. However, only 3 symptoms, including trouble sleeping or sleeping too much, poor appetite or overeating, and suicidal ideation, were no significantly associated with an increased risk of CVD mortality.ConclusionsThe elevated depressive symptoms scores were strongly associated with an increased risk of all-cause and CVD mortality in US adults. Furthermore, all 9 specific depressive symptoms were associated with high all-cause mortality. However, trouble sleeping or sleeping too much, poor appetite or overeating, and suicidal ideation might not increase the risk of CVD mortality.

Comparison of the Psychological Impact of COVID-19 on Healthcare Workers between 2022 and 2023 in a Romanian COVID-19 Hub Hospital

We assessed depression, anxiety, and stress in healthcare workers (HCWs) in 2023 and the evolution of depression in 2023 compared with 2022. In September–November 2023, 181 HCWs from the Infectious Diseases Hospital, Cluj-Napoca, Romania, completed the Depression, Anxiety, and Stress 21 Scale (DASS-21 R), the Patient Health Questionnaire 9 (PHQ-9), and the Hamilton Anxiety Rating Scale (HAM-A). The prevalence of moderate-to-severe levels was 13.8% for DASS-Depression, 18.8% for DASS-Anxiety, 16.1% for DASS-Stress, 19.9% for PHQ-9, and 18.2% for HAM-A. Moderate-to-severe PHQ-9 depression was significantly lower in the 2023 study group (19.9%, N = 181) compared with 2022 (30.6%, N = 114) (p = 0.04), also within the 2022–2023 follow-up participants (N = 88) (p = 0.03). We did not find significant statistical differences between those infected vs. non-infected, vaccinated vs. non-vaccinated, or working with vs. not working with SARS-CoV-2 infected patients. Males were significantly more stressed (p = 0.02) and anxious (p = 0.03), and physicians in training had the highest prevalence of moderate-to-severe depression (31.6%), followed by physicians (25.6%). In 2023, depression, anxiety, and stress symptoms decreased but remained within a concerning range. By addressing these psychological issues, we may reduce the possibility of medical errors and prevent professional crises in the healthcare system.

Analysis of factors influencing the trajectory of fatigue in maintenance haemodialysis patients: a longitudinal study.

To explore the potential categories and influencing factors of fatigue trajectory in maintenance haemodialysis patients. Between June 2023 and December 2023, a convenience sample of 306 maintenance haemodialysis patients in a tertiary hospital haemodialysis centre in Zhenjiang City was selected as the study population, and patient information was collected monthly after the baseline survey using the General Information Questionnaire, Pittsburgh Sleep Quality Scale, Piper Fatigue Revision Scale, Collaborative Social Support Scale, Patient Health Questionnaire Depression Scale, Comprehensive Economic Toxicity Rating Scale, and Fear of Disease Progression Simplified Scale, for a total of six follow-up visits. In addition, the potential category growth model was used to identify the developmental trajectory of fatigue, and univariate analysis and binary logistic regression were used to analyse its determinants. The 6month fatigue trajectory of maintenance haemodialysis patients could be divided into two categories: persistent low-fatigue group (59.8%) and fluctuating high-fatigue group (40.2%). Age, surgical history, level of social support, sleep, economic toxicity, and changes in ultrafiltration volume during dialysis were the influencing factors for repeated fatigue in maintenance haemodialysis patients (p < 0.05). The fatigue trajectory of maintenance haemodialysis patients is heterogeneous, suggesting that clinical workers should focus on the haemodialysis patients with repeated fatigue and make targeted interventions to improve their fatigue status and reduce the occurrence of adverse events in patients.

Relationship between Patient Health Questionnaire (PHQ-9) and Montgomery-Asberg Depression Rating Scale (MADRS) total scores in older adults with major depressive disorder: An analysis of the OPTIMUM clinical trial

BackgroundThe Patient Health Questionnaire (PHQ-9) and Montgomery-Asberg Depression Rating Scale (MADRS) are commonly used scales to measure depression severity in older adults. MethodsWe utilized data from the Optimizing Outcomes of Treatment-Resistant Depression in Older Adults (OPTIMUM) clinical trial to produce conversion tables relating PHQ-9 and MADRS total scores. We split the sample into training (N = 555) and validation samples (N = 187). Equipercentile linking was performed on the training sample to produce conversion tables for PHQ-9 and MADRS. We compared the original and estimated scores in the validation sample with Bland-Altman analysis. We compared the depression severity level using the original and estimated scores with Chi-square tests. ResultsThe Bland-Altman analysis confirmed that differences between the original and estimated scores for at least 95 % of the sample fit within 1.96 standard deviations of the mean difference. Chi-square tests showed a significant difference in the proportion of participants at each depression severity category determined using the original and estimated scores. LimitationsThe conversion tables should be used with caution when comparing depression severity at the individual level. ConclusionsOur conversion tables relating PHQ-9 and MADRS scores can be used to compare treatment outcomes using aggregate data in studies that only used one of these scales.

Sex Differences in the Association of Depression Symptoms and Cardiovascular Disease in Adults in the United States.

This study explores the relationship between depression and cardiovascular disease (CVD) in the US adult population, focusing on sex differences. Cross-sectional study. National Health and Nutrition Examination Survey data (2013-2018). A total of 14699 community-dwelling adults (≥20years). The Patient Health Questionnaire (PHQ-9) depression screening tool assessed depressive symptoms. CVD events included heart failure, coronary heart disease, angina, heart attack, or stroke. Adjusted prevalence ratios were estimated using a Poisson regression model. The study finds a positive association between CVD incidents and both mild to moderate depressive symptoms (aPR:1.42, P = .002) and moderately severe to severe depression (aPR:1.72, P = .024). Overall, females exhibit a 47% lower likelihood of CVD incidents compared to males. However, in a subgroup analysis, increased depressive symptoms correlate with higher CVD incidents in females (aPRs range: 2.09 to 3.43, P < .001) compared to males (aPRs range: 1.45 to 1.77, P < .001). Depression is associated with increased cardiovascular disease (CVD) risk. Females generally have a lower CVD risk than males, but more severe depressive symptoms elevate CVD risk in females. These findings emphasize the significance of considering sex differences. Further research is needed to understand the underlying mechanisms.

Attachment Style Modifies the Effect of Spousal Support on Postpartum Depression in Women.

This study aims to examine the impact of spousal support on postpartum depression in women with different attachment styles and assessing if attachment style influences this effect. From March to May 2022, 96 couples with late-stage pregnant women were randomly selected from tertiary maternity hospitals in Shandong and Guangdong provinces for a prepartum survey. Psychological assessments were conducted using the Adult Attachment Scale, Dyadic Coping Inventory, and the Patient Health Questionnaire-9 (PHQ-9) Depression Scale. To examine the relationship between each variable and postpartum depression, univariate and multiple logistic regression analyses were employed. Additionally, interaction analysis was used to analyze the interplay between different attachment styles and how spousal support influences women's postpartum depression. The findings revealed that even after accounting for confounding variables, prepartum spousal support was an independent predictor of postpartum depression (adjusted odds ratio (OR) = 0.82, 95% CI: 0.69-0.96, P = .015). Women with a secure attachment style showed a significantly lower incidence of postpartum depression compared to those with insecure attachment styles (24.2% vs. 46%, P = .037). In the secure attachment group, spousal support had a protective effect against postpartum depression (adjusted OR = 0.57, 95% CI: 0.36-0.91, P = .018), and attachment style emerged as a potential interactive factor influencing the impact of spousal support on postpartum depression (P for interaction = .029). The provision of spousal support, especially to individuals with secure attachment styles, plays a preventive role in postpartum depression. This underscores the importance of considering attachment styles in interventions targeting postpartum depression prevention.

Hypovitaminosis D is A Biological Vulnerability for Depressive Symptoms in Major Depression at the Era of the Coronavirus Disease Outbreak

Abstract Background: Major depressive disorder (MDD) is a prevalent mental health condition causing substantial global issues. Emerging evidence indicates that depression rates have risen during the coronavirus disease (COVID-19) pandemic. Insufficient vitamin D levels have been linked to increased psychological problems and heightened responses to stress. Objectives: This study aims to investigate the connection between serum vitamin D levels and depressive symptoms in individuals with MDD compared to healthy controls during the COVID-19 pandemic. Materials and Methods: This cross-sectional study included 90 MDD patients diagnosed according to Diagnostic and Statistical Manual of Mental Illnesses (DSM)-5 criteria version 7.0.2, assessed using the Mini International Neuropsychiatric Interview. During COVID-19 lockdown measures, participants completed the Patient Health Questionnaire depression module (PHQ-9) to assess depressive severity. Blood samples were collected for vitamin D assays. Statistical analyses were conducted using Statistical Package for the Social Sciences (SPSS), including receiver operating characteristic (ROC) curve analysis to predict depressive symptom severity. Results: Patient and control groups had similar mean age and body mass index (BMI), with most participants classified as obese (BMI &gt; 30 kg/m2). Female patients were predominant in the study. MDD patients exhibited significantly lower mean serum vitamin D levels compared to controls (10.3 ± 6.2 vs. 18.1 ± 9.6 ng/mL). Female patients had higher vitamin D levels than males. Correlations among serum vitamin D levels, BMI, MDD duration, and age were insignificant. ROC curve analysis indicated that lower vitamin D levels moderately predict MDD presence (area under curve [AUC] = 0.750) and, to a lesser extent, severe MDD (AUC = 0.739). Conclusion: The study suggests an inverse association between serum vitamin D levels and clinical depression during the COVID-19 era. However, the evidence is not entirely conclusive, prompting the need for further randomized trials to determine whether this relationship is causal.