Patient Health Questionnaire-9 Total Scores Research Articles

Optimizing smartphone psychotherapy for depressive symptoms in patients with cancer: Multiphase optimization strategy using a decentralized multicenter randomized clinical trial (J-SUPPORT 2001 Study).

Patients with cancer experience various forms of psychological distress, including depressive symptoms, which can impact quality of life, elevate morbidity risk, and increase medical costs. Psychotherapy and pharmacotherapy are effective for reducing depressive symptoms among patients with cancer, but most patients prefer psychotherapy. This study aimed to develop an efficient and effective smartphone psychotherapy component to address depressive symptom. This was a decentralized, parallel-group, multicenter, open, individually randomized, fully factorial trial. Patients aged ≥20 years with cancer were randomized by the presence/absence of three cognitive-behavioral therapy (CBT) skills (behavioral activation [BA], assertiveness training [AT], and problem-solving [PS]) on a smartphone app. All participants received psychoeducation (PE). The primary outcome was change in the patient health questionnaire-9 (PHQ-9) total score between baseline and week 8. Secondary outcomes included anxiety. In total, 359 participants were randomized. Primary outcome data at week 8 were obtained for 355 participants (99%). The week 8 PHQ-9 total score was significantly reduced from baseline for all participants by -1.41 points (95% confidence interval [CI] -1.89, -0.92), but between-group differences in change scores were not significant (BA: -0.04, 95% CI -0.75, 0.67; AT: -0.16, 95% CI -0.87, 0.55; PS: -0.19, 95% CI -0.90, 0.52). As the presence of any of the three intervention components did not contribute to a significant additive reduction of depressive symptoms, we cannot make evidence-based recommendations regarding the use of specific smartphone psychotherapy.

Vitamin B12 deficiency and neuropsychiatric symptoms in Lebanon: A cross-sectional study of vegans, vegetarians, and omnivores.

Vitamin B12 deficiency is responsible for a variety of complications, particularly neurological/neuropsychiatric complications, including depression, irritability, paresthesia and insomnia. Since vitamin B12 is found in animal-derived products, vegans/vegetarians are at a greater risk for developing vitamin B12 deficiency. This study aims to investigate the occurrence of vitamin B12 deficiency among a sample of adult Lebanese population, with a particular emphasis on assessing the severity of its neurological/neuropsychiatric signs and symptoms, especially among vegans/vegetarians. A cross-sectional study was conducted among a sample of 483 Lebanese adults. Data was collected through a standardized questionnaire that included socio-demographic characteristics, the Patient Health Questionnaire-9 (PHQ-9), Generalized anxiety disorders-7 (GAD-7), and the Insomnia Severity Index (ISI) scales. Among the participants, 11.4% were in the vegan/vegetarian group, and about 43.1% had vitamin B12 deficiency. After analyzing the PHQ-9, GAD-7 and ISI total scores, higher scores were reported in participants with vitamin B12 deficiency, compared to individuals with normal vitamin B12 serum levels (p < 0.001). Regarding the diet type, vegans/vegetarians were more susceptible to developing depression compared to omnivores (mean scores of 11.92 vs 8.02 on the PHQ-9 scale, respectively, with p < 0.001). Of the patients with vitamin B12 deficiency, 81.1% reported having paresthesia compared to 43.7% of individuals with no vitamin B12 deficiency (p < 0.001). Vitamin B12 deficiency in Lebanon is notably high and is linked to an increased risk of developing depression, generalized anxiety disorder, insomnia, and paresthesia. Vegans/vegetarians exhibit a higher susceptibility to developing depression compared to omnivores, whereas the risk of developing insomnia, generalized anxiety disorder and paresthesia was statistically insignificant when comparing vegans/vegetarians to omnivores.

FC44: Prevalence of mental health outcomes and the impact of sex and mood or cognitive comorbidity in older adults during the COVID-19 pandemic

Introduction:Older adults are at greater risk for developing severe illness from SARS-COV2 infection and may be more vulnerable to negative mental health outcomes as a result of public health guidelines that increase social isolation. We assessed mental health outcomes in older adults with normal cognition (NC), past history of major depressive disorder (i.e., remitted; rMDD), or mild cognitive impairment (MCI) to determine the prevalence of depression, anxiety, general stress, and post-traumatic stress during the COVID-19 pandemic and the impact of diagnosis and sex.Methods:The sample included 108 older adults (37 males, mean age=72.1 years): 71 older adults with normal cognition (NC) based on normal neuropsychological test performance and no psychiatric history, 21 rMDD participants based on DSM5 criteria, and 16 MCI participants based on NIA-AA criteria. Participants completed self-report measures of depression [Patient Health Questionnaire-9 (PHQ-9)], anxiety [Patient-Reported Outcomes Measurement Information System (PROMIS)], general stress [Perceived Stress Scale (PSS)] and post-traumatic stress [Impact of Events Scale Revised (IES-R)] through video- or teleconferencing. Prevalence rates of clinically significant psychiatric symptoms were expressed as the percentage of participants with total scores that exceed the normal cut-offs. Separate MANOVAs were used to examine the effects of diagnosis and sex. Non-normally distributed data (PHQ-9 and PROMIS total scores) were rank-transformed.Results:Approximately 1/3rd of participants endorsed clinically significant symptoms based on scores exceeding the cut-off for normal: 33.7% on PHQ-9, 31.3% on PROMIS-Anxiety, 35.5% on PSS, 38.3% on IES-R. rMDD participants scored higher on all measures compared to NC participants (p’s &lt; .005) while MCI participants scored higher on the PSS compared to NC (p=.035). Women scored higher on all measures compared to men.Conclusions:These rates of approximately 1/3rd reporting clinically significant symptoms of depression, anxiety, general stress, and post-traumatic stress are higher than those described in population surveys of older adults but are comparable to prevalence rates of psychiatric symptoms in the general adult population. The effects of diagnosis and sex indicate that older adults with previous depression or current MCI, as well as women overall, are particularly vulnerable to developing clinically significant psychiatric

The association between insulin resistance and depressive symptoms – A national representative cross-sectional study

ObjectiveIncreasing evidence suggests a positive association between insulin resistance (IR) and depression. However, whether sex-or body mass index–specific differences exist remains controversial, and only few studies have analyzed specific symptom domains. Thus, the present study aimed to analyze the association between IR and depressive symptom domains and to clarify the effects of sex and body mass index. MethodsThe study sample comprised 4007 participants, aged 19–79, from the Korea National Health and Nutrition Examination Study 2020. Participants completed health interviews and examinations, providing data on circulating insulin and glucose levels, the Patient Health Questionnaire-9 (PHQ-9), and related covariates. IR was calculated using the homeostasis model assessment of insulin resistance. Associations between IR and PHQ-9 were analyzed using negative binomial regression with adjustments for the complex survey design. ResultsThe association between log-transformed IR and PHQ-9 total scores was statistically significant (incidence rate ratio [IRR] = 1.17, 95% confidence interval [CI] = 1.07–1.29, p = 0.001). Only body mass index specific differences were statistically significant, as the association was only significant in those without obesity (IRR = 1.21, 95% CI = 1.06–1.38, p = 0.005). IR was associated with cognitive/affective (IRR = 1.23, 95% CI = 1.08–1.41, p = 0.002) and somatic (IRR = 1.14, 95% CI = 1.04–1.25, p = 0.005) depressive symptom domains. Sensitivity analyses revealed similar results. ConclusionsIR was positively associated with cognitive/affective and somatic depressive symptoms in non-obese individuals.

Youth screening depression: Validation of the Patient Health Questionnaire-9 (PHQ-9) in a representative sample of adolescents

BackgroundDepression symptoms and mood disorders constitute one of the major public health challenges among youths. Thus, early prevention and intervention for depression should be a priority. The main goal of the present study was to validate the Patient Health Questionnaire-9 (PHQ-9) scores in a school-based sample of non-clinical adolescents. MethodStratified random sampling was conducted. Participants were 2235 students (M = 14.49, SD =1.76, range= 12–18 years), 52.9 % were female, from 34 secondary schools in Spain. Several previously validated self-reported questionnaires of mental health and psychopathology were administrated. ResultsThe unidimensional factorial model of the PHQ-9 items showed adequate goodness of fit indices. Strong measurement invariance across gender was found. Omega for the PHQ-9 total score was 0.87. The PHQ-9 total score was positively associated with anxiety symptoms and emotional and behavioral problems, and negatively associated with prosocial behavior and quality of life. ConclusionsThe PHQ-9 is a brief, easy, and reliable tool for assessing self-reported depressive symptoms in both clinical and school settings. PHQ-9 may be used as a screening tool for universal early detection and monitorization of depression symptoms during adolescence.

Effects of the COVID-19 pandemic on senior dental students in Korea: Examining stress, burnout, and depression

Background/purposeThe COVID-19 pandemic has had a profound and enduring impact on various aspects of society, including medical education and the training of dental students. The field of dentistry, given its nature, is particularly susceptible to the challenges posed by a pandemic. Prolonged exposure to the pandemic is believed to have increased stress and burnout among medical and dental students. This study aimed to investigate and analyze the relationship between COVID-19 and stress, burnout, and depression in Korean dental students. Materials and methodsA cross-sectional survey was conducted among 162 third and fourth-grade students from the School of Dentistry at Seoul National University. The survey comprised four main sections: general information, the Maslach Burnout Inventory (MBI), the Patient Health Questionnaire-9 (PHQ-9), and the Impact of Event Scale-Revised (IES-R). ResultsThe results indicated significant differences in age, study time, career satisfaction, and counseling needs between third and fourth-grade students. The fourth-grade students exhibited higher scores in the IES-R survey, PHQ-9 total score, emotional exhaustion, and depersonalization subscale items of the MBI. Furthermore, the group with abnormal responses to COVID-19 demonstrated lower levels of career satisfaction. ConclusionFourth-grade dental students experienced higher levels of depression, vulnerability to the effects of COVID-19, and burnout. These findings highlight the need for addressing the mental health challenges faced by dental students during the COVID-19 pandemic.

The differences of event-related potential components in patients with comorbid depression and anxiety, depression, or anxiety alone

BackgroundThere was a high comorbidity rate of major depressive disorder (MDD) and generalized anxiety disorder (GAD), showing a poor prognosis and significant detrimental impact on functioning. The study aimed to find whether patients with comorbid GAD and MDD had some differences in cognitive functions from patients with MDD or GAD alone. Methods360 adult patients were enrolled from inpatient department of psychiatry from 2020 to 2022. They were divided into three groups with 120 patients for each group: MDD, GAD, and MDD + GAD. All the patients completed psychological evaluation scales including patient health questionnaire-9 (PHQ-9) and 7-item generalized anxiety disorder (GAD-7). All the patients underwent examinations of auditory brainstem response and event-related potentials (ERPs). ResultsIn MDD + GAD group, P3b latency was significantly longer than patients with MDD alone, and P300 reaction time was positively correlated with total score of GAD-7 and PHQ-9, and PHQ-9 total score was also significantly positively correlated with P2-P3b amplitude (all p < 0.05). In addition, MDD patients had significantly longer P300 reaction time and lower P2-P3b amplitude than the GAD group (p < 0.05). LimitationsIt was a single-center and cross-sectional study, and we used self-report scales as assessment tools. ConclusionsPatients with MDD and GAD comorbidity might have a worse cognitive function than MDD patients, and the severity of cognitive impairments was positively correlated with the severity of anxiety and depression symptoms.

0356 Is There an Association Between Insomnia and Temperament in Adults?

Abstract Introduction Insomnia is an increasingly prevalent health concern influenced by environmental, biological, and dispositional factors. Adult temperament is the collection of fundamental characteristics that some have hypothesized may predispose individuals to insomnia. Despite this, there is little research on the relationship between insomnia and specific temperament factors in adults. A few investigations have shown negative affect as the most consistent association with poor sleep. This study investigated relationships between insomnia and adult temperament and tested whether the association between negative affect and insomnia is better explained by depression. Methods Participants were 66 adults, (Mdn = 23, 18-49 years old), 50% female, 86% white, ranging from good (no insomnia) to poor sleepers (mild to moderate insomnia). Data were pooled from two protocols designed to investigate associations between sleep and transdiagnostic features of mental illness. As part of a broader array of questionnaires and assessments, participants completed the insomnia severity index (ISI), adult temperament questionnaire (ATQ), and the patient health questionnaire-9 (PHQ-9). The ATQ subscales were calculated according to previously identified factors: negative affect, effortful control, orienting sensitivity, and extraversion/surgency. Spearman’s coefficient was used to explore associations between each temperament factor and insomnia severity. Multiple regression was used to determine whether the associations between insomnia severity and negative affect remained when adjusting for PHQ-9 total score, not including the sleep items. Results Insomnia severity was significantly correlated with negative affect (ρ = 0.345, p = .005), but no other temperament factors (p&amp;gt; .05, for all). Regression analysis of all four ATQ factors and the PHQ-9 in predicting ISI outcomes resulted in an R2 of .45, PHQ-9 being the only significant regressor (p&amp;lt; .05). Conclusion We failed to find support for the hypothesis that individual differences in temperament confer risk for insomnia. Although insomnia was associated with negative affect in bivariate correlation analysis, this association may be better explained by their shared association with depression. We recommend investigating how temperament interacts with various psychological conditions such as depression and anxiety to better understand the individual differences that may impact risks for developing insomnia. Support (if any) n/a

Sleep Quality in An Acute Inpatient Rehabilitation Setting: The Importance of Prior Sleep Disorders

<h3>Research Objectives</h3> To assess whether demographic and clinical factors might impact sleep quality during inpatient stay in a rehabilitation setting. <h3>Design</h3> In this prospective study, patients were assessed for their sleep quality at admission and discharge. <h3>Setting</h3> Patients admitted in the acute inpatient rehabilitation unit of Casa Colina Hospital and Centers for Healthcare (Pomona, California) were included in the study. <h3>Participants</h3> Thirty five patients participated to this study (age=61±16 years old; BMI=30±7kg/m2; 18 females, 18 Caucasians). <h3>Interventions</h3> None. <h3>Main Outcome Measures</h3> The Pittsburg Sleep Quality Index (PSQI) was administered as primary outcome. Demographic and clinical data were collected as covariates (i.e., age, BMI, gender, race, cause of hospitalization, pre-hospital setting and prior diagnosis of sleep disorders). The level of anxiety and depression were also assessed using Beck Anxiety Inventory (BAI) and Patient Health Questionnaire-9 (PHQ-9). <h3>Results</h3> The average length of hospitalization was 18±8 days. Cause of hospitalization included stroke (20%), spinal cord injury (28%), orthopedic (28%) and other diagnosis (23%). In this sample, 22% had a sleep disorder diagnosis (mostly sleep apnea) and 60% came from an acute care unit. ANOVAs with repeated measures were performed on the outcome measure (PSQI) controlling for BMI and age. Among the demographic and clinical variables considered, the presence of sleep disorders had an effect on changes in PSQI total scores. The PSQI decreased significantly in patients with prior diagnosis of sleep disorders. The pre-hospital setting trended toward statistical significance only for the group without sleep disorders. The initial level of anxiety or depression did not have an effect on the PSQI scores. However, changes in BAI and PHQ-9 total scores were related to changes in PSQI. Finally, our dataset did not reveal an effect of race or gender. <h3>Conclusions</h3> Prior sleep disorders diagnoses factors has an impact on sleep quality during hospitalization. These results identify high-risk patient characteristics that impact sleep hygiene which will be taken into consideration in developing an intervention for improving inpatient sleep hygiene. <h3>Author(s) Disclosures</h3> The authors have nothing to declare.

Depression, Anxiety, and Insomnia Among Older COVID-19 Survivors: A Cross-Sectional Study

Objective: The psychological morbidities following coronavirus disease (COVID-19) infection among survivors have been identified as a significant public health challenge since the beginning of the COVID-19 pandemic. Emerging evidence indicates higher prevalence of psychological consequences among elderly COVID-19 survivors. The aim of this study was to explore the psychological morbidities among elderly COVID-19 survivors and associated socio-demographic and clinical factors.Methods: A cross-sectional study among older COVID-19 survivors (age &gt;50 years) was conducted in a tertiary care hospital from October 2021 to December 2021. Patients attending medical outpatient department were screened for laboratory-confirmed COVID-19 infection in the past and they were recruited for the study after obtaining written informed consent. The study used a semi-structured proforma and rating scales such as Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and The Insomnia Severity Index (ISI) for depression, anxiety, and insomnia, respectively.Results: The study results indicate that the prevalence of depression, anxiety, and insomnia among 99 older COVID-19 survivors is 35.4%, 31.3%, and 21.2%, respectively. There was statistically significant higher mean of ISI total score (p=0.012) among females. There was statistically significant higher mean PHQ-9 total score among widowed/seperated/divorced group when compared to married group (p=0.006). There was statistically significant higher mean ISI total score (p=0.011) among patients who received oxygen therapy while admitted for COVID-19. There was significantly higher rate of depression among females (p=0.047), widowed/seperated/divorced group (p=0.001), and patients who received oxygen therapy (p=0.004).Conclusion: This study findings implicates that elderly COVID-19 survivors are at significantly higher risk for post-COVID-19 psychological morbidities and should be screened regularly during follow-ups for timely and effective management.

Central Symptoms of Insomnia in Relation to Depression and COVID-19 Anxiety in General Population: A Network Analysis.

Background: Insomnia is prevalent among the general population, and studies have shown an increase in insomnia symptoms during the novel coronavirus (COVID-19) pandemic. Despite numerous studies of insomnia, few studies have investigated insomnia symptoms in detail. In this study, we used network analysis to investigate interactions between insomnia symptoms in the general population. Furthermore, given the effect of COVID-19 on mental health, we also investigated how anxiety response to COVID-19 and depression related to insomnia symptoms. Methods: Data from 785 non-infected participants were used. The Insomnia Severity Index (ISI), Stress and Anxiety to Viral Epidemics—6 Scale (SAVE-6), and Patient Health Questionnaire—9 (PHQ-9) were used to measure insomnia symptoms, anxiety response to COVID-19, and depression, respectively. Network analysis was performed using R Studio. Centrality indices and edge weights were obtained, and each index was evaluated using bootstrapping methods. Results: The network revealed ISI7 (worry about current sleep pattern) to be the most central insomnia symptom. ISI7 was strongly connected to SAVE-6 total score, and ISI2 (difficulty staying asleep) was strongly connected to PHQ-9 total score. Conclusion: High centrality of ISI7 supports the role of dysfunctional cognitions in etiological models of insomnia and thus the cognitive behavioral therapy for insomnia. The relationship between ISI7 and SAVE-6 is explained by transposition of worry and fear of contracting COVID-19 to worry about sleep patterns. The link between ISI2 and PHQ-9 necessitate further investigations of whether specific symptoms of insomnia are more associated with depression.

Prevalence of Anxiety and Depression in the Iranian General Population during the COVID-19 Pandemic: A Web-Based Cross-Sectional Study.

Objective: This study aimed to determine prevalence of anxiety and depression and associated factors in the general population of Iran during the COVID-19 pandemic. Method : We conducted this web-based cross-sectional study on 5328 individuals in Iran between 17th and 29th of April 2020. Data were collected using the convenience sampling method through an anonymous online questionnaire via social media like WhatsApp and Telegram. The online survey collected data on demographic variables, COVID-19-related variables, and symptoms of anxiety and depression. Anxiety and depression were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), respectively. Simple and multiple logistic regression analyses were performed to determine independent predictors of anxiety and depression. Results: The mean GAD-7 and PHQ-9 total scores were 7.17 (SD = 5.42) and 7.80 (SD = 6.68), respectively. Prevalence of anxiety, depression, and comorbid anxiety-depression were 30.1%, 33.4%, and 22.1%, respectively. According to the adjusted analysis, anxiety was significantly associated with female gender, being young and middle-aged, being unemployed or a housewife, having chronic diseases, spending considerable time thinking about COVID-19, having family members, friends, and/or relatives infected with COVID-19, and death of family members, relatives or friends due to COVID-19. Same results were also found for depression. Furthermore, depression was associated with being single, being resident in urban area, and having high risk individual in family. Conclusion: Prevalence of anxiety and depression were considerably higher in the general population of Iran during the COVID-19 pandemic. In addition, the findings suggest that more attention needs to be paid to vulnerable groups such as women, young/middle-aged adults, the unemployed, and people with chronic disease.

Prevalence and Factors Associated With PTSD-Like Symptoms Linked to the COVID-19 Pandemic Among Patients With Major Depressive Disorders Seeking Emergency Care.

The aim of this study was to evaluate the psychological impact and coping strategies experienced by depressed inpatients during the second wave of the COVID-19 pandemic in Italy. We recruited 75 depressed inpatients. Logistic regression was used to determine predictors of PTSD-like symptoms measured with Impact of Event Scale–Revised. Predicting variables were age, sex, the Coping Orientation to Problems Experienced subscales scores, the Anxiety Status Inventory total score, and the Patient Health Questionnaire-9 total score. The prevalence of PTSD-like stress symptoms was 41.33%. Age, social and avoidance coping strategies, and anxiety levels were significant predictors of PTSD-like symptoms. Our findings suggest that the COVID-19 pandemic in depressed inpatients is associated with PTSD-like stress symptoms, anxiety, and maladaptive coping.

Kardiyovasküler Hastalığa Sahip Bireylerde Koronavirüs Fobisi ve Depresyonun Değerlendirilmesi

Objective: Although there are numerous studies examining the psychological effects of COVID-19 pandemic on the general population, the number of studies on individuals with cardiovascular disease is limited. This study aimed to determine coronavirus phobia and depressive symptoms and their possible associated factors in cardiovascular disease patients during the current pandemic period. Material and methods: In this cross-sectional study, patients applied to the cardiology outpatient clinic due to a cardiovascular disease between November-December, 2020, and individuals without any cardiovascular diseases were included. Participants answered a questionnaire consisting of sociodemographic variables, Patient Health Questionnaire-9 (PHQ-9) and COVID-19 Phobia Scale (CP19-S). Results: In total, 372 people participated. The CPS-19 and PHQ-9 total scores of the patient group were higher than the control group. Patients reported that they most afraid of someone in the family might infected with the coronavirus. PHQ-9 total scores of females, CP19-S and PHQ-9 total scores of those with a history of psychiatric illness were high. Psychological, somatic, social subscale scores, CP19-S and PHQ-9 total scores of married patients were lower than singles. High leveled-education increased CP19-S total, psychological and social sub-scores. While the psychological and somatic subscale scores of the smokers were high, their PHQ-9 total scores were low. Those admitted to intensive care due to COVID-19 reflected low economic subscale and CP19-S total scores. Correlation analysis detected a correlation between the CP19-S subscale, total scores and PHQ-9 total scores. Conclusion: The COVID-19 pandemic has psychologically affected cardiovascular patients. Evaluation of this effect may guide the taking of measures that will contribute to the prognosis and mortality of patients with cardiovascular disease.

Prevalence of mental health outcomes and effects of sex and mood or cognitive comorbidity in older adults during the COVID-19 pandemic

IntroductionOlder adults are at greater risk for developing severe illness from SARS-COV2 infection and may be more vulnerable to negative mental health outcomes as a result of public health guidelines that increase social isolation. In the current study, we assessed mental health outcomes in a cohort of older adults with normal cognition (NC), past history of major depressive disorder (i.e., remitted; rMDD), or mild cognitive impairment (MCI) to determine the prevalence of clinically significant symptoms of depression, anxiety, general stress, and post-traumatic stress. Additionally, we assessed the effects of mood or cognitive diagnosis and sex on symptom severity. Based on the pre-pandemic literature, we predicted that the presence of rMDD or MCI diagnosis would be associated with increased severity of psychiatric symptoms during the COVID-19 pandemic. We also predicted that women would experience greater severity of psychiatric symptoms compared to men.MethodsThe study included 108 older adults (37 males, mean age=72.1 years) who were participating in existing longitudinal studies. The sample included 71 older adults with normal cognition (NC) based on normal neuropsychological test performance and who were free of lifetime history of psychiatric illness, 21 rMDD participants based on DSM5 criteria, and 16 MCI participants based on the presence of memory concerns, impaired performance on neuropsychological assessments, and intact functional independence. Participants completed self-report measures of depression, anxiety, and stress through video- or teleconferencing with a research assistant. Measures included the Patient Health Questionnaire-9 (PHQ-9) to assess depression, the Patient-Reported Outcomes Measurement Information System (PROMIS) to measure anxiety, the Perceived Stress Scale (PSS) to measure stress, and the Impact of Events Scale-Revised (IES-R) to assess post-traumatic stress symptoms. Prevalence rates of clinically significant psychiatric symptoms were expressed as the percentage of participants with total scores that exceed the normal cut-offs for each respective measure. Separate MANOVAs were used to examine the effects of diagnosis and sex. Non-normally distributed data (PHQ-9 and PROMIS total scores) were rank-transformed and entered into MANOVA.ResultsWithin the sample of 108 participants, 33.7% exceeded the normal cut-off on the PHQ-9, 31.3% had clinically significant anxiety symptoms on the PROMIS-Anxiety, 35.5% had clinically significant stress scores on the PSS, and 38.3% had clinically significant post-traumatic stress scores on the IES-R. MANOVA showed statistically significant effects of diagnosis on all measures: PHQ-9 [F(2,90)=5.380, p=.006], PROMIS-Anxiety [F(2,90)=11.687, p<.001], PSS [F(2,90)=8.480, p<.001], and IES-R [F(2,90)=5.027, p=.009]. MDD participants scored higher on all measures compared to NC participants: PHQ-9 (p=.005), PROMIS-Anxiety (p<.001), PSS (p<.001), and IES-R (p=.004). In addition, MCI participants scored higher on the PSS compared to NC participants (p=.035). MANOVA showed significant effects of sex on all measures: PHQ-9 [F(1,91)=7.046, p=.009], PROMIS-Anxiety [F(1,91)=8.623, p=.004], PSS [F(1,91)=12.553, p<.001], and IES-R [F(1,91)=10.529, p=.002] such that women scored higher on all measures compared to men.ConclusionsOverall, over one-third of study participants reported clinically significant symptoms of depression, anxiety, general stress, and post-traumatic stress during the COVID-19 pandemic. These rates are higher than those described in population studies of older adults based on anonymous online surveys, which are reported to be 24.9% for depression, 19.4% for anxiety, 10.3% for stress, and 28.3% for post-traumatic stress; but are comparable to the prevalence rates of psychiatric symptoms in the general adult population. As predicted, presence of rMDD increased the severity of all psychiatric symptoms. However, MCI was also associated with increased stress compared to those with normal cognition, despite absence of current or past psychiatric illness. These findings suggest that older adults with previous depression or current MCI, as well as women overall, are particularly vulnerable to developing clinically significant psychiatric symptomatology during the COVID-19 pandemic. Limitations of the current study are the inclusion of participants in existing studies, as opposed to sampling from the general population and the relatively small sample size. Nevertheless, the current findings suggest that some clinical populations, including those with rMDD and MCI, as well as women overall, may benefit from receiving interventions for mental health during the current and future pandemics.This research was funded byThis study was funded by the Ontario Ministry of Health and Long-Term Care Alternative Funding Plan. The funders had no role in the design of the study, analysis, or preparation of the manuscript.

Characterizing Life Stress and Psychological Distress During Acute SCI: A Mixed Methods Analysis of Tele-CBT Notes

<h3>Research Objectives</h3> To characterize domains of life stressors encountered by individuals with acute spinal cord injury (SCI) and change in psychological distress in the context of tele-cognitive behavioral therapy (tele-CBT). <h3>Design</h3> A within-arm (tele-CBT) mixed methods analysis in an ongoing randomized controlled trial to assess the efficacy of CBT telepsychology intervention on depressive symptomology, secondary symptoms (anxiety), and quality of life (QoL). <h3>Setting</h3> Community setting. <h3>Participants</h3> Fifteen individuals (Demographics: mean injury age=47.93years [SD=20.17], 53.3% male, 26.7% White; Injury Characteristics: time since injury mean=67.97days [SD=53.36], 66.7% traumatic etiology, 46.7% tetraplegia, 33.3% complete SCI) with acute SCI. <h3>Interventions</h3> The intervention group received 10 tele-CBT sessions over 12 weeks via Apple's FaceTime application with a licensed psychologist specializing in treating individuals with SCI. Session adhered to the basic structure outlined in Wenzel et al. (2011)1 and the study psychologist used individualized behavioral and/or cognitive strategies. <h3>Main Outcome Measures</h3> Domains of life stressors qualitatively coded from CBT therapy notes. Patient Health Questionnaire-9 (PHQ-9)2 and Generalized Anxiety Disorder-7 (GAD-7)3 measured each session. <h3>Results</h3> Findings are preliminary as the study is ongoing. Participants attended an average of 9.8 CBT sessions. Thirty life stressors typically associated with psychological distress were identified from participants' CBT notes. The most frequently concerns were pain (73.3%), relationship issues (66.7%), sleep problems (60.0%), other non-SCI medical concerns (46.7%), COVID-19 (46.7%), UTIs (40.0%), perceived burden (26.7%), fatigue (26.7%), and returning to work (26.7%). At the first CBT session, the average PHQ-9 and GAD-7 total scores were 7.00 (SD= 3.72) and 5.80 (SD= 4.42). Over the course of therapy, symptoms of depression and anxiety decreased (PHQ-9:B=-0.346, SE=0.051, p<.001; GAD-7:B=-0.232, SE=0.109, p<.05). <h3>Conclusions</h3> Individuals with acute SCI experience a diverse range of challenges that may impact mood.4–6 Although the majority of concerns and life stressors endorsed were medical, a substantial number were related to relationships, perceived burden, and resumption of functional roles.5 Tele-CBT provided by an SCI specialist may be an effective intervention to support adjustment and bolster against life stressors after acute SCI. <h3>Author(s) Disclosures</h3> The authors have no disclosures to report.

Screening for Psychological Distress in Vietnamese Cancer Patients: An Evaluation of the Distress Thermometer.

BackgroundPsychological distress is prevalent in patients with cancer, negatively affecting their treatment and quality of life. Clinical guidelines recommended screening all cancer patients routinely for psychological problems using simple measures such as the Distress Thermometer (DT) and Problem List (PL). This study is the first research in Vietnam to identify the optimal DT cutoff point to screen distress and the relationship with PL items among cancer patients.Methods300 cancer patients were recruited from 10 departments at Vietnam National Cancer Hospital (K hospital) and completed the DT and PL. Participants also completed the Patient Health Questionnaire‐9 (PHQ‐9) and the Generalized Anxiety Disorder‐7 (GAD‐7) with standard cutoff scores for identifying significant depression and anxiety.ResultsReceiver operating characteristic (ROC) curve analyses showed that a DT cutoff score of 4 had an area under the ROC curve of 0.81 and 0.82 using the PHQ‐9 and GAD‐7 cutoff scores of 10 as the criterion, respectively. This indicated good overall accuracy. This cutoff also showed a sensitivity of 0.87 and 0.92 for PHQ‐9 and GAD‐7 total score defined cases, respectively. Both specificity values were 0.58. In terms of the PL, 164 distressed patients (54.7%) reported significantly more emotional problems, family issues, and practical and physical problem, implying various causes contribute to psychological distress among cancer patients.ConclusionsThe study showed that the DT with a cutoff of 4 accompanied with PL is a simple and effective instrument compared to previous, longer measures commonly used to detect psychosocial distress in Vietnamese cancer patients. This cutoff point also identified patients with problems contributing towards distress.

The Prevalence and Correlative Factors of Depression Among Chinese Teachers During the COVID-19 Outbreak

Background: Epidemiological data on outbreak-associated depression of Chinese teachers are not available. This study aimed to investigate the prevalence and correlates of depression among teachers during the coronavirus disease 2019 (COVID-19) outbreak in mainland China.Methods: A large cross-sectional online survey was conducted during the COVID-19 outbreak. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). The Connor-Davidson Resilience Scale 25 (CD-RISC 25) and Perceived Stress Scale-10 (PSS-10) were used to measure the mental resilience and stress of participants. The correlative factors of depression were analyzed.Results: In this study, 1,096 teachers were analyzed with a median (range) age of 41 (20–65) years. Of them, 624 (56.9%) suffered from depression (PHQ-9 total score of >4). The multivariate analyses showed that participants with aged ≥41 years (OR = 0.752, 95% CI:0.578–0.979, p = 0.034), participating in epidemic prevention and control (OR = 1.413, 95% CI:1.070–1.867, p = 0.015), thinking prolonged school closure have bad effect (OR = 1.385, 95% CI:1.017–1.885, p = 0.038), sleep duration/day of <6 h (OR = 1.814, 95% CI:1.240–2.655, p < 0.001), physical exercise duration/day of <30 min (OR = 1.619, 95% CI:1.247–2.103, p < 0.001), spending less time with family (OR = 1.729, 95% CI: 1.063–2.655, p = 0.002), being concerned about COVID-19 (OR = 0.609, 95% CI:0.434–0.856, p = 0.004), having poor mental resilience (OR = 6.570, 95% CI:3.533–12.22, p < 0.001) and higher PSS-10 scores (OR = 9.058, 95% CI:3.817–21.50, p < 0.001) were independently associated with depression.Conclusion: During the COVID-19 outbreak, depression was common among teachers. Age, participating in epidemic prevention and control, opinions toward distant teaching and prolonged school closure, sleep duration/day, physical exercise duration, spending time with family, attitude toward COVID-19, mental resilience and stress represented the independent factors for suffering from depression.

Psychometric Properties of a Chatbot Version of the PHQ-9 With Adults and Older Adults.

Background: The Patient Health Questionnaire-9 (PHQ-9) is a brief depression measure that has been validated. A chatbot version of the PHQ-9 would allow the assessment of depressive symptoms remotely, at a large scale and low cost.Objective: The current study aims to: Assess the feasibility of administering the PHQ-9 in a sample of adults and older adults via chatbot, report the psychometric properties of and identify the relationship between demographic variables and PHQ-9 total scores.Methods: A sample of 3,902 adults and older adults in the US and Canada were recruited through Facebook from August 2019 to February 2020 to complete the PHQ-9 using a chatbot.Results: A total of 3,895 (99.82%) completed the PHQ-9 successfully. The internal consistency of the PHQ-9 was 0.896 (p < 0.05). A one factor structure was found to have good model fit [X2 (27, N = 1,948) = 365.396, p < 0.001; RMSEA = 0.080 (90% CI: 0.073, 0.088); CFI and TLI were 0.925 and 0.900, respectively, and SRMR was 0.039]. All of the demographic characteristics in this study were found to significantly predict PHQ-9 total score, however; their effect was negligible to weak.Conclusions: There was a large sample of adults and older adults were open to completing assessments via chatbot including those over 75. The psychometric properties of the chatbot version of the PHQ-9 provide initial support to the utilization of this assessment method.

The magnitude of depression in heart failure patients and its association with NYHA class

IntroductionDepression is commonly present among HF patients and is associated with adverse clinical outcomes. However, research regarding its association with New York Heart Association (NYHA) class is still scarce.ObjectivesTo evaluate the presence of depression symptoms in HF outpatients and analyze its association with NYHA class.MethodsThis study is part of a larger research project (Deus Ex-Machina/NORTE-01-0145-FEDER-00026). HF patients were recruited from an outpatient clinic at a University Hospital. Exclusion criteria were: unable to communicate, severe visual acuity deficit or NYHA class IV. Sociodemographic data and NYHA class were registered. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression, with a score ≥10 indicating clinically relevant depression.ResultsA sample of 136 HF patients was included, with a median age of 59 (range: 24-81) years old, where 66% were men. Almost half of the patients (49%) were in NYHA class II, followed by class I (36%) and class III (15%). The median score of PHQ-9 was 4(range:0-18), with 26% showing clinically relevant depression. PHQ-9 total score was associated with NYHA class (p=0.001), with higher median scores in worse NYHA classes [class I: 3 (IQR: 5.5), class II: 4 (IQR: 8) and class III: 8.5 (IQR:9.3)].ConclusionsIn this study, depression was present in 26% of HF outpatients and was associated with more severe HF symptoms. Consequently, preventing, monitoring, and treating depression in the management of these patients is recommended. Further research is needed for a deeper analysis of this association.