Patient Health Questionnaire Research Articles

Mapping of the network connection between sleep quality symptoms, depression, generalized anxiety, and burnout in the general population of Peru and El Salvador

BackgroundA meta-analysis of randomized controlled trials has suggested a bidirectional relationship between sleep problems and mental health issues. Despite these findings, there is limited conclusive evidence on the relationship between sleep quality, depression, anxiety, and burnout.ObjectiveThe current study aimed to evaluate the relationships between sleep quality symptoms, anxiety, depression, and burnout in samples of adult individuals from two Latin American countries, Peru and El Salvador, through network analysis and to identify key symptoms that reinforce the correlation and intensify the syndromes.MethodsA total of 1012 individuals from El Salvador and Peru participated, with an average age of 26.5 years (SD = 9.1). Symptom networks were constructed for both countries based on data from the Jenkins Sleep Scale, Patient Health Questionnaire-2, General Anxiety Disorder-2, and a single burnout item.ResultsThe results indicated that Depressed Mood, Difficulty Falling Asleep, and Nervousness were the most central symptoms in a network in the participating countries. The strongest conditional associations were found between symptoms belonging to the same construct, which were similar in both countries. Thus, there is a relationship between Nervousness and Uncontrollable Worry, Anhedonia and Depressed Mood, and Nighttime Awakenings and Difficulty in Staying Asleep. It was observed that burnout is a bridge symptom between both countries and presents stronger conditional associations with Tiredness on Awakening, Depressed Mood, and Uncontrollable Worry. Other bridge symptoms include a Depressed Mood and Nervousness. The network structure did not differ between the participants from Peru and El Salvador.ConclusionThe networks formed by sleep quality, anxiety, depression, and burnout symptoms play a prominent role in the comorbidity of mental health problems among the general populations of Peru and El Salvador. The symptom-based analytical approach highlights the different diagnostic weights of these symptoms. Treatments or interventions should focus on identifying central and bridge symptoms.

The Complex Relationship Between Pain, Mental Health, and Quality-of-Life in Patients With Cirrhosis Undergoing Liver Transplant Evaluation.

Patients with cirrhosis undergoing liver transplant evaluation have high rates of pain and mental health comorbidities; both may significantly impair health-related quality of life (HRQL). We investigated the association between pain, anxiety/depression, and HRQL in this population. In 62 patients with cirrhosis undergoing liver transplant evaluation, we performed 4 validated assessments to characterize: pain (Brief Pain Inventory-Short Form, BPI-SF), anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-8), and liver-specific HRQL (Chronic Liver Disease Questionnaire). The presence of pain was determined using the BPI-SF screening question. Linear regression was used to identify demographic or clinical factors predictive of pain severity (PS) and interference (PI) and to evaluate the association between pain, anxiety/depression, and HRQL. Seventy-one percent of patients reported pain, 26% had clinical depression, and 24% had moderate-severe anxiety. Neither liver disease severity, nor its complications were associated with pain (PS or PI), but anxiety and depression were predictors of pain on bivariate analysis. Only depression remained a significant predictor of PS (b=0.28, P<0.05) and PI (b=0.30, P<0.05) in multivariable models. HRQL was inversely associated with PS, PI, depression, and anxiety, but only anxiety (b=-0.14, P=0.003) remained associated with HRQL in the adjusted model. Pain is present in over 70% of patients with cirrhosis undergoing liver transplant evaluation. Anxiety and depression were highly correlated with pain and appeared to be key drivers in predicting poor HRQL. Evaluating and managing mental health comorbidities should be explored as a strategy to improve HRQL in patients with cirrhosis and pain.

Effect of smartphone addiction on mental health and sleep quality among undergraduate pharmacy students in a Nigerian public university

Purpose The purpose of this study was to explore the relationship between smartphone addiction, mental health and sleep quality among undergraduate pharmacy students in a Nigerian public university. Design/methodology/approach A cross-sectional study was conducted among undergraduate pharmacy students in a Nigerian university. Data was collected using self-administered questionnaires, including Smartphone Addiction Scale-Short version, Patient Health Questionnaire, Generalized Anxiety Disorder Scale and Pittsburgh Sleep Quality Index. The data obtained were analyzed using descriptive statistics, the chi-square test and the Pearson correlation. Probability values less than 0.05 were considered statistically significant. Findings A total of 410 undergraduate pharmacy students participated in the study, giving a response rate of 95.57%. The prevalence of smartphone addiction, depression and anxiety symptoms were 40.24%, 28.30% and 23.66%, respectively. Most students had poor sleep quality (96.10%). The prevalence of smartphone addiction had a moderate positive correlation with the severity of depression (r = 0.363, p &lt; 0.01) and anxiety (r = 0.261, p &lt; 0.01) symptoms. Nevertheless, smartphone addiction showed no connection with sleep quality (r = 0.022, p = 0.663). Research limitations/implications The study was conducted in a single public university in Nigeria, hence this might limit its generalizability. The provision of mental health support within universities could help address the high prevalence of smartphone addiction, mental health issues and poor sleep quality. Originality/value To the best of the authors’ knowledge, this was the first study to examine smartphone addiction among pharmacy students in a resource-limited setting with multicultural and multiethnic groups.

Enhancing psychological well-being in college students: the mediating role of perceived social support and resilience in coping styles

BackgroundThe prevalence of depression among college students is higher than that of the general population. Although a growing body of research suggests that depression in college students and their potential risk factors, few studies have focused on the correlation between depression and risk factors. This study aims to explore the mediating role of perceived social support and resilience in the relationship between trait coping styles and depression among college students.MethodsA total of 1262 college students completed questionnaires including the Trait Coping Styles Questionnaire (TCSQ), the Patient Health Questionnaire-9 (PHQ-9), the Perceived Social Support Scale (PSSS), and the Resilience Scale-14 (RS-14). Common method bias tests and spearman were conducted, then regressions and bootstrap tests were used to examine the mediating effects.ResultsIn college students, there was a negative correlation between perceived control PC and depression, with a significant direct predictive effect on depression (β = -0.067, P < 0.01); in contrast, negative control NC showed the opposite relationship (β = 0.057, P < 0.01). PC significantly positively predicted perceived social support (β = 0.575, P < 0.01) and psychological resilience (β = 1.363, P < 0.01); conversely, NC exerted a significant negative impact. Perceived social support could positively predict psychological resilience (β = 0.303, P < 0.01), and both factors had a significant negative predictive effect on depression. Additionally, Perceived social support and resilience played a significant mediating role in the relationship between trait coping styles and depression among college students, with three mediating paths: PC/NC → perceived social support → depression among college students (-0.049/0.033), PC/NC→ resilience → depression among college students (-0.122/-0.021), and PC/NC → perceived social support → resilience → depression among college students (-0.016/0.026).ConclusionThe results indicate that trait coping styles among college students not only directly predict lower depression but also indirectly influence them through perceived social support and resilience. This suggests that guiding students to confront and solve problems can alleviate their depression.

Detecting depression severity using weighted random forest and oxidative stress biomarkers

This study employs machine learning to detect the severity of major depressive disorder (MDD) through binary and multiclass classifications. We compared models that used only biomarkers of oxidative stress with those that incorporate sociodemographic and health-related factors. Data collected from 830 participants, based on the Patient Health Questionnaire (PHQ-9) score, inform our analysis. In binary classification, the Random Forest (RF) classifier achieved the highest Area Under the Curve (AUC) of 0.84 when all features were included. In multiclass classification, the AUC improved from 0.84 with only oxidative stress biomarkers to 0.88 when all characteristics were included. To address data imbalance, weighted classifiers, and Synthetic Minority Over-sampling Technique (SMOTE) approaches were applied. Weighted random forest (WRF) improved multiclass classification, achieving an AUC of 0.91. Statistical tests, including the Friedman test and the Conover post-hoc test, confirmed significant differences between model performances, with WRF using all features outperforming others. Feature importance analysis shows that oxidative stress biomarkers, particularly GSH, are top ranked among all features. Clinicians can leverage the results of this study to improve their decision-making processes by incorporating oxidative stress biomarkers in addition to the standard criteria for depression diagnosis.

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.

Association between neutrophil to high-density lipoprotein cholesterol ratio (NHR) and depression symptoms among the United States adults: a cross-sectional study

BackgroundDepression acts as a noteworthy worldwide public health challenge. Identifying accessible biomarkers is crucial for early diagnosis and intervention. The relationship between depression in adult Americans and the neutrophil to high-density lipoprotein cholesterol ratio (NHR) was investigated in this research.MethodsThe relationship between NHR and depressive symptoms was analyzed utilizing National Health and Nutrition Examination Survey data from 2005 to 2018 and the Patient Health Questionnaire-9. The study included 33,871 participants with complete NHR and depression data. Adjusted multivariable logistic regression models were used to account for possible confounders, and subgroup analyses were conducted to investigate effect changes.ResultsElevated NHR levels were positively correlated with a heightened risk of depression (OR = 1.03, 95% CI: 1.01–1.05, P < 0.0005). After the NHR was divided into tertiles, those in the top tertile had an 18% higher chance of developing depression than those in the bottom tertile (OR = 1.18; 95% CI: 1.05–1.32; P for trend = 0.0041). Subgroup analyses revealed variations in this association based on race and marital status. Additionally, the relationship between NHR and depression demonstrated a U-shaped pattern, with a significant breakpoint identified at an NHR of 6.97.ConclusionThese results imply that the NHR may be a potential biomarker for depression risk, with implications for early detection and personalized treatment. Further research is needed to elucidate the mechanisms underlying the NHR-depression link and establish causality.

Effects of aerobic and resistance exercises on psychological and cognitive functions in patients with post-stroke migraine

ABSTRACT Objective To investigate the impact of a combination of aerobic and resistance exercises on the psychological and cognitive functions of post-stroke migraine patients. Methods This study recruited 100 patients suffering from post-stroke migraine pain who were admitted to the hospital, categorizing them into a control group (n = 50) and an intervention group (n = 50). The control group received conventional drug treatment, while the intervention group received the exercise-based intervention that combined aerobic exercise with resistance exercise. Results Before treatment, both groups displayed similar Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Mini-mental State Examination (MMSE) and MoCA scores. However, after the intervention, the intervention group exhibited lower scores on these measures compared to the control group (all p < 0.05). Additionally, there were no discernible disparity in Migraine Disability Assessment (MIDAS) and Headache Impact Test (HIT-6) scores between the two cohorts of patients before treatment (p > 0.05), whereas the intervention group demonstrated significantly lower MIDAS and HIT-6 scores following the intervention (p < 0.05). Although there were no discernible distinctions in National Institute of Health stroke scale (NIHSS) and Stroke Specialized Quality of Life Scale (SS-QOL) measurements between the two patient groups before treatment (p > 0.05), the intervention group exhibited a significant decrease in NIHSS scores and a notable increase in SS-QOL scores after the intervention (p > 0.05). Moreover, the satisfaction rate and overall satisfaction rate were significantly higher in the intervention group (p < 0.05). Conclusion The combination of aerobic and resistance exercises demonstrated positive effects on the psychological well-being and overall quality of life for post-stroke migraine patients.

School modality, race and ethnicity, and mental health of U.S. adolescents during the COVID-19 pandemic

BackgroundWhile minoritized ethnoracial groups were most likely to be in online learning during the COVID-19 pandemic, the impact of these ethnoracial disparities on adolescent mental health is unclear. Since past studies do not directly examine whether the association between school modality and self-reported mental health outcomes varied by race and ethnicity among U.S. adolescents during the COVID-19 pandemic, this study addresses the gap.MethodsAdolescents aged 13 to 17 years old (n = 510) were surveyed for self-reports of anxiety and depression symptoms using the 4-item Patient Health Questionnaire during Spring 2021. Seemingly unrelated regressions were used to estimate the differential association between school modality and mental health by respondents’ race and ethnicity.ResultsEstimates without interaction between school modality and race and ethnicity suggested that Latino respondents reported a significantly higher frequency of depressive symptoms than their White counterparts (b = 0.459; p < 0.05). Similarly, the estimates without the interaction suggested respondents reporting hybrid learning had a higher frequency of depressive symptoms than in-person learning (b = 0.504; p < 0.05). Estimates with interaction between school modality and race and ethnicity suggested fully online learning was associated with poorer mental health only among White respondents and better mental health among Black respondents. Among adolescents attending school fully online, Black adolescents reported fewer mental health symptoms than their White counterparts (anxiety, b =– 1.364; p < 0.05, and depression, b =– 1.647; p < 0.05).ConclusionsFully online learning may have benefitted the mental health of Black adolescents during the COVID-19 pandemic, perhaps because it buffered racial discrimination and social anxiety in schools. Additional interventions should be explored to promote in-person school environments that better support the mental health of Black adolescents. Moreover, prioritizing equitable access to broadband internet will provide better access to online learning and ensure positive mental health, particularly for adolescents from minoritized ethnoracial groups during instances of future pandemics. Future research should continue to consider the race and ethnicity of adolescents to promote mental well-being in schools across learning modalities.

Effects of Shugan Tiaoshen intradermal needling intervention on attentional networks in subthreshold depression: a randomized controlled trial

To analyze the effects of Shugan Tiaoshen (regulating liver and harmonizing spirit) intradermal needling protocol on the attentional networks of patients with subthreshold depression using the attention network test (ANT). Eighty patients with subthreshold depression were randomly divided into an intradermal needling group (40 cases) and a sham needling group (40 cases, 2 cases dropped out), with an additional 43 healthy subjects as a normal group. The intradermal needling group received intradermal needling treatment, while the sham needling group received sham intradermal needling, with the needle tip not penetrating the skin. The bilateral Xinshu (BL 15), Ganshu (BL 18), Shentang (BL 44) as well as auricular points Xin (CO15) and Gan (CO12) were selected alternately. Treatments were administered twice a week for a total of 6 weeks in the two groups. The patient health questionnaire-9 (PHQ-9) and generalized anxiety disorder (GAD-7) scores were observed before treatment, after 3 weeks of treatment, after treatment, and at 1 month after the end of treatment (follow-up), and the ANT of the two groups of patients with subthreshold depression before and after treatment as well as the normal group of healthy subjects was compared. The PHQ-9 and GAD-7 scores of the patients with subthreshold depression were decreased after 3 weeks of treatment, after treatment, and in follow-up in the two groups (P<0.05), the differences in PHQ-9 and GAD-7 scores before and after treatment were greater in the intradermal needling group than those in the sham needling group (P<0.01). Before treatment, the executive control network reaction time of the subthreshold depression group (the intradermal needling group and the sham needling group) was higher than that of the normal group (P<0.05). Compared before treatment, the executive control network reaction time of the patients in the intradermal needling group and the sham needling group was decreased after treatment (P<0.05), and the alerting network reaction time of the intradermal needling group was increased after treatment (P<0.05); the difference in alerting network reaction time before and after treatment was greater in the intradermal needling group than that of the sham needling group (P<0.01). Regulating liver and harmonizing spirit intradermal needling protocol could effectively improve depressive and anxious symptoms in patients with subthreshold depression, and enhance the efficiency of the alerting network.

Association between depression severity, mental health recovery and dropout from behavioral health care treatment

BackgroundUnderstanding the relationship between depression severity, patient recovery, and treatment continuity may help optimize the delivery of behavioral health services. MethodsUsing Cox proportional hazards regression, this study measures the association between treatment dropout and baseline depression severity, as measured by the Patient Health Questionnaire (PHQ-9), and the association between treatment dropout and baseline recovery, as measured by the Recovery Assessment Scale (RAS). The study also explores heterogeneity by service line (general mental health, substance use disorder, and eating disorder), residential versus intermediate level of care setting, age groups (adolescent and adult), and dropout factors. The data include 14,689 patients treated at a multi-state behavioral health care provider, discharged between 2021 and 2022. Premature dropout from behavioral health care treatment for any cause, patient factors and administrative factors were used as separate outcomes. FindingsA unit increase in baseline PHQ-9 was associated with a 1.2% reduced treatment dropout risk (hazard ratio (HR): 0.988; 95% confidence interval [0.983–0.992]). A unit increase in baseline RAS score was associated with 0.5% increased dropout likelihood (HR: 1.005; 95% CI [1.004, 1.007]). Subgroup analyses show associations are driven by general mental health, adolescent, and intermediate level of care subgroups. Patients with higher baseline suicidality and lower willigness to ask for helphad a reduced risk of dropout. InterpretationPatients with greater depression severity and lower recovery scores at admission were more likely to stay in behavioral health treatment, especially among adolescents, patients with general mental health issues, and outpatients.

Associations between parental bonding and health-related quality of life in a clinical sample of youths aged 14-35 years in Singapore.

Individuals with psychiatric disorders tend to report having poorer bonds with their parents during their early years. These individuals often experience lower quality of life as well. This study investigated the associations between aspects of parental bonding and health-related quality of life (HRQOL) in a clinical sample of youths. It was hypothesised that high parental care and low parental overprotectiveness would be associated with higher levels of HRQOL. Data were obtained from a larger cross-sectional study. The sample consisted of 400 psychiatric outpatients: 191 patients aged 14-21 (mean ± standard deviation 18.1 ± 2.22) years and 209 patients aged 22-35 (28.0 ± 4.33) years. The Parental Bonding Instrument was used to measure parental care and overprotectiveness. Short Form-12 measured physical health (physical component summary [PCS]) and mental health (mental component summary [MCS]) components of HRQOL, and the 8-item Patient Health Questionnaire assessed depressive symptoms. These scales and a sociodemographic form were self-administered. Multivariable linear regression was used for analysis. About half of the sample reported affectionless control for mothers (46.6%) and fathers (45.9%). After controlling for sociodemographic variables, no significant relationship was found between aspects of parental bonding and PCS scores. Maternal care was associated with MCS scores (β = 0.32, P < 0.01) and PHQ-8 scores (β = -0.12, P < 0.05). Our results suggest that youths who experienced quality care from their mothers exhibit better mental health functioning despite their clinical diagnoses, which suggests that early maternal care exerts an overall long-term protective effect. Early parental education that promotes positive parenting practices could improve the overall HRQOL of individuals in adulthood despite their clinical diagnoses.

Understanding the Relationship Between User Game Preferences and Depressive Symptoms: A Pilot Study.

Objective: Following the initial measures taken to manage the repercussions of the COVID-19 pandemic, mental health conditions have become a critical concern. Mental health has become a foremost priority not only for health care providers but also for many other organizations, such as educational institutions, companies, and government agencies. A significant proportion of the Australian population having experienced mental disorders highlights the need for effective interventions. Those with pre-existing mental health issues experienced particularly pronounced effects. Among these challenges, advancements in technology offer new possibilities for mental health support. Videogames have shown effectiveness in mitigating symptoms of depression. Previous research has shown that game interface preferences correlate with players' emotional responses. This study aims to use MoodJumper, a game we designed, developed, and evaluated to examine the choice of game preferences in individuals with depressive symptoms. Materials and Methods: A pilot study was carried out after obtaining the Human Ethics committee's approval (n = 20). The participants were asked to fill out a Patient Health Questionnaire-9 (PHQ-9) questionnaire. They then played with the MoodJumper game for 20-30 minutes. Upon completing the game session, they were asked to fill out a questionnaire regarding their experience. Results: The results indicate a nonsignificant correlation between music preference, the direction of movement, and depressive symptoms meaning no significant relationship was found between depressive symptoms and chosen settings. However, a significant negative correlation was found between decision-making ability regarding game preferences and Patient Health Questionnaire-9 scores showing the difficulty of choosing preferred settings when having depressive symptoms. Conclusion: This contribution paves the way for designing and evaluating more impactful game experiences for individuals with mental health challenges.

European Portuguese Version of the Game Addiction Scale-7: Factor Structure and Psychometric Properties

Introduction: Game addiction (GA) can be described as a compulsive and excessive usage of computers or video games that causes emotional and or social problems. The current study tested the factor structure and psychometric properties of the European Portuguese Game Addiction Scale (GAS-7-PT) short version. Methods: The sample encompassed 375 participants, 233 women (62.1%) and 142 men (37.9%), with a mean age of 21.71 (standard deviation = 5.82) years old. Participants completed a set of self-report measures online: the GAS-7-PT, the Scale of Involvement in Video Games and the Patient Health Questionnaire-4. Results: Confirmatory factor analyses confirmed a biological sex invariant single-factor structure with a very good fit to the data. The GAS-7-PT showed good reliability and test-retest reliability. Correlations with related and unrelated measures suggested convergent validity, and partial correlation results pointed to incremental validity. Men showed significantly higher scores than women. Conclusion: The GAS-7-PT is a self-report instrument with suitable psychometric properties for clinical and research contexts. The availability of a European Portuguese version confirms the GAS-7 robust consistency and allows further cross-cultural clinical research.

Effectiveness of personalized rehabilitation in adults suffering from persistent concussion symptoms as compared to usual care: a randomized control trial protocol

BackgroundSymptoms reported by patients who sustain a concussion are non-specific. As such, clinicians are better able to manage patients when a standardized clinical exam is performed to sub-type the driver(s) of symptoms. Aerobic exercise and multimodal rehabilitation have consistently shown to be a possibly effective means to manage this population; however, the optimal training prescription is unclear. Thus, there is a need to further examine the effectiveness of personalized rehabilitative treatments. Our primary aim is to evaluate the response to personalized therapy on recovery, as measured by The Rivermead Post-concussion Symptoms Questionnaire (RPQ) when compared to an active control.MethodsWe will conduct a multi-center 12-week case-crossover randomized controlled trial. 50 participants will be recruited from out-patient University Health Network clinics and community-based clinical practices around the greater Toronto area. Participants will be randomized at baseline to Group A: a personalized care program followed by an active control or Group B: an active control followed by a personalized care program. Participants will be included should they be 21 years of age and older and have symptoms that have persisted beyond 4 weeks but less than 1 year. Participants will undergo 6-weeks of care in their respective streams. After 6-weeks, participants will undergo a re-examination. They will then crossover and undertake the alternative treatment for 6 weeks. At the end of 12 weeks, participants will undertake the endpoint examinations. The primary outcome will be the Rivermead Postconcussion Questionnaire (RPQ). The secondary outcomes will be changes in standardized clinical examination, Neck Disability Index (NDI), Patient Health Questionnaire (PHQ-9) and an electroencephalography (EEG) via NeuroCatch™. The statistical analysis to be performed is composed of an adjusted model using an analysis of variance, specifically using an unpaired t-test to test for associations between variables and outcomes.DiscussionGiven the recommendations from reviews on the topic of rehabilitation for adults with persistent concussion symptoms, we are undertaking a controlled trial. The documented high costs for patients seeking care for persistent symptoms necessitate the need to evaluate the effectiveness of a personalized rehabilitative program compared to the current standard of care.Trial registrationClinicalTrials.gov ID: NCT06069700.

Effectiveness of personalized rehabilitation in adults suffering from persistent concussion symptoms as compared to usual care: a randomized control trial protocol

BackgroundSymptoms reported by patients who sustain a concussion are non-specific. As such, clinicians are better able to manage patients when a standardized clinical exam is performed to sub-type the driver(s) of symptoms. Aerobic exercise and multimodal rehabilitation have consistently shown to be a possibly effective means to manage this population; however, the optimal training prescription is unclear. Thus, there is a need to further examine the effectiveness of personalized rehabilitative treatments. Our primary aim is to evaluate the response to personalized therapy on recovery, as measured by The Rivermead Post-concussion Symptoms Questionnaire (RPQ) when compared to an active control.MethodsWe will conduct a multi-center 12-week case-crossover randomized controlled trial. 50 participants will be recruited from out-patient University Health Network clinics and community-based clinical practices around the greater Toronto area. Participants will be randomized at baseline to Group A: a personalized care program followed by an active control or Group B: an active control followed by a personalized care program. Participants will be included should they be 21 years of age and older and have symptoms that have persisted beyond 4 weeks but less than 1 year. Participants will undergo 6-weeks of care in their respective streams. After 6-weeks, participants will undergo a re-examination. They will then crossover and undertake the alternative treatment for 6 weeks. At the end of 12 weeks, participants will undertake the endpoint examinations. The primary outcome will be the Rivermead Postconcussion Questionnaire (RPQ). The secondary outcomes will be changes in standardized clinical examination, Neck Disability Index (NDI), Patient Health Questionnaire (PHQ-9) and an electroencephalography (EEG) via NeuroCatch™. The statistical analysis to be performed is composed of an adjusted model using an analysis of variance, specifically using an unpaired t-test to test for associations between variables and outcomes.DiscussionGiven the recommendations from reviews on the topic of rehabilitation for adults with persistent concussion symptoms, we are undertaking a controlled trial. The documented high costs for patients seeking care for persistent symptoms necessitate the need to evaluate the effectiveness of a personalized rehabilitative program compared to the current standard of care.Trial registrationClinicalTrials.gov ID: NCT06069700.

Association between masticatory function and depression in older adults: Results from NHANES 2009 to 2018.

Depression is prevalent among older adults. Although the number of missing teeth is considered to be associated with depression, the relationship between masticatory function, which is usually indicated by functional tooth units (FTUs), and depression in older adults remains unclear. This study used data from the National Health and Nutrition Examination Survey (NHANES) 2009-2018. The number of FTUs was defined as pairs of opposing natural and artificial teeth. Depression was accessed using the Patient Health Questionnaire (PHQ-9), and participants who scored ≥10 on PHQ-9 were diagnosed with depression. Logistic regression analyses, propensity score matching (PSM) analyses and subgroup analyses were conducted to assess the association between FTU and depression. The analysis included 5764 individuals over 60 years. An association between FTU and the risk of depression among older adults was detected (odds ratio [OR] = 0.951, 95% confidence interval [CI] 0.915-0.989), suggesting protective roles of more FTUs. Significant increase in the risk of depression in 0 ≤ FTUs ≤ 3 was observed compared with 10 ≤ FTUs ≤ 12 (OR = 1.819, 95% CI 1.157-2.858). However, no significant increase in the risk of depression in 4 ≤ FTUs ≤ 9 was found. After PSM, significant increase in the risk of depression in 0 ≤ FTUs ≤ 3 was still detected compared with 4 ≤ FTUs ≤ 12 (OR = 1.484, 95% CI 1.030-2.136). Subgroup analyses demonstrated consistent results in all subgroups, except for individuals aged 76-80 and drinking regularly. The findings suggested the association between impaired masticatory function and the risk of depression among older adults. Longitudinal studies are needed to elucidate the role of masticatory function impairment in the development of depression further.

Depression and Implantable Cardioverter-Defibrillator Implantation in Black Patients at Risk for Sudden Cardiac Death.

Black patients meeting indications for implantable cardioverter-defibrillators (ICDs) have lower rates of implantation compared with White patients. There is little understanding of how mental health impacts the decision-making process among Black patients considering ICDs. Our objective was to assess the association between depressive symptoms and ICD implantation among Black patients with heart failure. This is a secondary analysis of the VIVID (Videos to Address Racial Disparities in ICD Therapy via Innovative Designs) randomized trial, which enrolled self-identified Black individuals with chronic systolic heart failure. Depressive symptoms were assessed by the Patient Health Questionnaire-2 and the Mental Component Summary of the 12-Item Short-Form Health Survey. Decisional conflict was measured by an adapted Decisional Conflict Scale (DCS). ANCOVA was used to assess differences in Decisional Conflict Scale scores. Multivariable logistic regression was used to examine the association between depressive symptoms and ICD implantation. Among 306 participants, 60 (19.6%) reported depressed mood, and 142 (46.4%) reported anhedonia. Participants with the lowest Mental Component Summary of the 12-Item Short-Form Health Survey scores (poorer mental health and higher likelihood of depression) had greater decisional conflict regarding ICD implantation compared with those with the highest Mental Component Summary of the 12-Item Short-Form Health Survey scores (adjusted mean difference in Decisional Conflict Scale score, 3.2 [95% CI, 0.5-5.9]). By 90-day follow-up, 202 (66.0%) participants underwent ICD implantation. There was no association between either the Patient Health Questionnaire-2 score or the Mental Component Summary of the 12-Item Short-Form Health Survey score and ICD implantation. Depressed mood and anhedonia were prevalent among ambulatory Black patients with chronic systolic heart failure considering ICD implantation. The presence of depressive symptoms did not impact the likelihood of ICD implantation in this population.

The association between self-rated health, number of family members, and cognitive function in community-dwelling older adults: Mediating role of depression.

With the increasing number of older adults, research on cognitive function has expanded. However, studies examining the mediating effect of depression on the association between complex factors and cognitive function in older adults are still insufficient. Additionally, there is a lack of studies that have investigated these relationships by integrating multiple factors related to the cognitive function of older adults. Therefore, our study investigated the association between the number of family members, self-rated health, depression, and cognitive function in community-dwelling older adults and highlighted the mediating role of depression in these relationships. We used data from 218 older adults aged over 65 collected in a previous study. The independent variables were the number of family members and self-rated health, and the dependent variable was cognitive function measured by the cognitive impairment screening test (CIST). The mediation variable was depression measured by the Patient Health Questionnaire-9 (PHQ-9). Structural equation modeling was used to examine the association between the independent, dependent, and mediation variable. The mean ages of the participants were 81.71 (standard deviation [SD] = 6.00) years, with 198 females (90.83%) and 20 males (9.17%). The structural equation model demonstrated a good model fit (chi-square value = 33.375; degrees of freedom = 24; p-value = 0.0964; RMSEA = 0.042; CFI = 0.970; TLI = 0.956; SRMR = 0.042). Self-rated health and the number of family members were not directly associated with cognitive function; however, depression had significant indirect effects (self-rated health to cognitive function: coefficient = -0.023, p-value = 0.017; number of family members and cognitive function: coefficient = 0.012, p-value = 0.030). Our findings indicated that depression plays a crucial mediating role between self-rated health, number of family members, and cognitive function. The results highlight the need for comprehensive strategies for mental health care to support cognitive health in older adults.

Who Am I? Self-concept in Adults with Cystic Fibrosis: Association with Anxiety and Depression.

Cystic Fibrosis (CF) is a progressive condition resulting in reduced lung function and strongly associated with elevated anxiety and depression symptoms. Self-concept refers to an individual's overarching sense of identity, a positive level of which is widely associated with reduced anxiety and depression. There is a significant lack of self-concept research within CF. This study explores the association between self-concept and anxiety and depression in adults with CF. 64 adults living with CF in Western Australia completed validated online questionnaires (Generalised Anxiety Disorder-7, Patient Health Questionnaire-9, Tennessee Self-Concept Questionnaire 2: Short-Form) and consented to the collection of medical data. Descriptive, t-test, correlation and multiple regression analysis were undertaken. Higher levels of self-concept were associated with lower levels of anxiety and depression symptoms. Lower self-concept levels were a significant predictor of increased anxiety and depression symptoms after accounting for physical health status. Mean self-concept scores for those who required mental health intervention were significantly lower compared to those that did not. This study identifies a significant relationship between self-concept and anxiety and depression in adults with CF. Further research is required to establish causation and test the feasibility of self-concept interventions in reducing anxiety and depression symptoms.