PHQ-4 Scores Research Articles

Effects of a mobile health intervention based on a multitheoretical model of health behavior change on anxiety and depression, fear of cancer progression, and quality of life in patients with differentiated thyroid cancer: A randomized controlled trial

BackgroundDespite the high cure rate of differentiated thyroid cancer (DTC), patients endure side effects from treatment and psychological distress, impacting their quality of life. The potential of mobile health (mHealth) interventions to address these issues remains unexplored. The purpose of this study is to develop an mHealth intervention based on the Multi-Theoretical Model of Health Behavior Change (MTM) and evaluate its impact on reducing anxiety, depression, fear of cancer progression, and enhancing quality of life in DTC patients.MethodsA single-blind, single-center, prospective, randomized controlled trial was conducted. One hundred and eleven consecutive DTC patients from Harbin Medical University’s Fourth Hospital were enrolled from March 2023 to March 2024. Participants were randomized into a control group and an intervention group that received a 3-month mHealth intervention based on MTM theory. Outcomes were assessed using web-based questionnaires at baseline and conclusion.ResultsOne hundred four patients with DTC completed the study, with 7 lost to follow-up (6.3%). The intervention group experienced a significant drop in PHQ-4 scores post-MTM-mHealth intervention (P < .026), with no change in the control group, demonstrating a significant difference. The intervention group also had significantly lower anxiety (P < .015) and depression (P < .032) scores compared to controls. All PHQ-4 scores improved in the intervention group except for “Little interest or pleasure in doing things.” Anxiety levels were significantly lower in the intervention group (P < .026) but remained unchanged in controls. The control group exhibited a significant increase in FCR-4 scores at follow-up, differing from the intervention group (P < 0.001). Quality of life scores did not differ at baseline but saw a significant improvement in the intervention group, while the control group experienced no significant change. The intervention group had higher VAS scores (P < .030) and greater health education satisfaction across all dimensions (P < .019).ConclusionsThe MTM-based mHealth intervention significantly benefits DTC patients by reducing anxiety, fear of cancer recurrence, and improving quality of life, though its effect on depression requires further investigation.Trial registrationChina Clinical Trial Registry ChiCTR2200064321.

Sleep problems mediate the association between outdoor nighttime light and symptoms of depression and anxiety: A cross-sectional, multi-city study in Bulgaria

BackgroundNighttime light is a growing anthropogenic health threat, particularly in urban areas. Limited evidence suggests that exposure to outdoor artificial light at night (ALAN) may be associated with people's mental health by disrupting sleep-wake cycles. AimsWe assessed 1) the association between ALAN exposure and adults’ symptoms of depression and anxiety, 2) whether the association was modified by sex, age, and income, and 3) the mediating role of sleep problems. MethodsWe obtained cross-sectional data from 4,068 adults from the five largest Bulgarian cities. Depression and anxiety symptoms were measured using the 4-item Patient Health Questionnaire (PHQ-4). Sleep problems were self-reported based on three items. Outdoor ALAN at residential addresses was assessed using annual radiance levels obtained from satellite imagery. Regression models were adjusted for person-level characteristics, green space, and nitrogen dioxide (NO2). We also assessed effect modification by sex, age, and income. Using mediation analyses, we tested sleep problems as a mediator of the ALAN-PHQ-4 association. ResultsGreater ALAN exposure in the fully adjusted model was marginally associated with higher PHQ-4 scores. We observed no effect modification. The mediator, sleep problems, was also positively associated with ALAN. The mediation of sleep problems was significantly positive. While the direct association was null, the total ALAN association was marginally and positively associated with PHQ-4 scores. ConclusionsOur findings suggest a positive association between outdoor nighttime light pollution and mental health. Poor sleep quality is a possible pathway relating ALAN exposure to mental health. Considering the increasing ubiquity and intensity of urban nighttime illumination, light pollution-reducing policies may provide significant health benefits for urban populations.

Identification of postpartum symptom informedness and preparedness typologies and their associations with psychological health: A latent class analysis

BackgroundBirthing parents, defined as postpartum women and people with various gender identities who give birth, commonly experience challenging postpartum symptoms. However, many report feeling uninformed and unprepared to navigate their postpartum health. ObjectiveTo identify typologies of postpartum symptom informedness and preparedness using latent class analysis (LCA) and to examine the associated patient and healthcare characteristics. MethodsWe used survey data from a large, multi-method, longitudinal research project Postnatal Safety Learning Lab. Participants were recruited using convenience sampling and enrolled between November 2020 and June 2021. LCA was used to identify subgroups of birthing parents with different symptom informedness and preparedness using 10 binary variables (N = 148). Bivariate analysis was conducted to examine the association between characteristics and each typology. FindingsThe 3-class models had better fit indices and interpretability for both informedness and preparedness typologies: High, High-moderate, and Moderate-low. The sample characteristics were different by typologies. In the modified discrimination in medical settings assessment, we found higher discrimination scores in the moderate-low informedness and preparedness typologies. The moderate-low preparedness typology had a higher percentage of birthing parents who did not have private insurance, underwent cesarean section, and planned for formula or mixed infant feeding. The median PHQ-4 scores at 4 weeks postpartum were lower among those in high informedness and preparedness typologies. ConclusionIn our sample, 18 to 21 % of birthing parents were in the moderate-low informedness or preparedness typologies. Future research and practice should consider providing tailored information and anticipatory guidance as a part of more equitable and supportive care.

Epidemiological features of depression and anxiety among homeless adults with healthcare access problems in London, UK: descriptive cross-sectional analysis.

In England in 2021, an estimated 274 000 people were homeless on a given night. It has long been recognised that physical and mental health of people who are homeless is poorer than for people who are housed. There are few peer-reviewed studies to inform health and social care for depression or anxiety among homeless adults in this setting. To measure the symptoms of depression and anxiety among adults who are homeless and who have difficulty accessing healthcare, and to describe distribution of symptoms across sociodemographic, social vulnerability and health-related characteristics. We completed structured questionnaires with 311 adults who were homeless and who had difficulty accessing healthcare in London, UK, between August and December 2021. We measured anxiety and depression symptoms using the 4-item Patient Health Questionnaire (PHQ-4) score. We compared median PHQ-4 scores across strata of the sociodemographic, social vulnerability and health-related characteristics, and tested for associations using the Kruskal-Wallis test. The median PHQ-4 score was 8 out of 12, and 40.2% had scores suggesting high clinical need. Although PHQ-4 scores were consistently high across a range of socioeconomic, social vulnerability and health-related characteristics, they were positively associated with: young age; food insecurity; recent and historic abuse; joint, bone or muscle problems; and frequency of marijuana use. The most common (60%) barrier to accessing healthcare related to transportation. Adults who are homeless and have difficulty accessing healthcare have high levels of depression and anxiety symptoms. Our findings support consideration of population-level, multisectoral intervention.

Predictors for Burnout Among Healthcare Workers in a Post -Covid Era

IntroductionWe aimed to study predictive factors for burnout (BO) among healthcare workers in a tertiary hospital in Singapore.ObjectivesWe hypothesized that burnout would be assoiciated with singles, females, and foreign born staff recently moved into this country, unaccompanied by family members.We further hypothesised that BO would be associated with those scoring less on resilience. Recognising that social support mitigated against stress and burnout, we hypothesized that those who perceived less support would be more prone to BO.MethodsThe study questionnaire was sent via corporate email to all staff with email access. We stressed that data would be fully anonymised. No financial rewards were given for participation which was carried out on a voluntary basis.The following instruments were used, viz. F-SozU K-6, a brief form of the perceived social support questionnaire; Connor Davidson Resilience Scale; Oldenburg Burnout Inventory; Patient Health Questionnaire-4 item; Demand Control Support Questionnaire and Leisure Time Satisfaction Scale. Ethics approval for the study was sought from the SingHealth Centralised Institutional Review Board, which granted exemption of participant consent.Analyses were performed using Stata version 17.0 (StataCorp. 2021), with statistical significance set as 2-sided 5% (p&lt;0.05). The reliability and internal consistency of the scales used were assessed using Cronbach Alphas and Confirmatory Factor Analysis (CFA).ResultsNeither males nor females were more at risk for BO. And contrary to what we hypothesised those who recently moved to this nation were not at greater risk for BO (p&gt;0.05). Multivariate analyses showed that younger workers displayed higher burnout scores (p &lt; 0.001).The psychological demand sub-score was positively associated with burnout [ 0.61 (95% CI 0.45 to 0.77), p &lt; 0.001)]. Conversely, decision latitude [-0.33 (95% CI -0.44 to -0.21), p &lt; 0.001)] and support [-0.47 (95% CI -0.60 to -0.35), p &lt; 0.001] were negatively associated with BO.Those who experienced anxiety or depressive symptoms were respectively more likely to experience burnout [0.30 (95% CI 0.02 to 0.58), p = 0.035 and 0.72 (95% CI 0.41 to 1.02), p &lt; 0.001], with a clear association between higher PHQ-4 scores and risk for burnout (r = 0.619).Moreover, satisfaction with utilisation of leisure time was inversely related to BO [-0.55 (95% CI -0.68 to –0.41; p &lt; 0.001)]. We could not find any association between number of years worked, profession, marital status and perceived social support and BO, on multivariate anbalysis (p&gt;0.05).ConclusionsStrress reduction interventions should be made available for all staff, especially addressing those at highest risk for burnout.Disclosure of InterestNone Declared

Forced migration and psychological distress among migrants in transit through Mexico

Objective. To assess the presence of psychological distress among non-Mexican migrants in-transit through Mexico, and to evaluate the association of forced migration and psychological distress in this population. Materials and methods. Cross-sectional survey of a non-probability sample of non-Mexican migrants in six shelters in Mexico, November 2021 - May 2022. We assessed psychological distress with the PHQ-4, and defined forced migration as migration motivated by social or political conflict, violence or insecurity, natural disasters or sexual identity. We analyzed the association between forced migration and psychological distress, adjusting by other variables, by means of negative binomial regression. Results. Out of 2,355 participants, 52.2% were forced migrants, and 51% of all participants had PHQ-4 scores in the mild-severe range. Forced migration was associated with higher PHQ-4 scores (coefficient 0.11, p=.004), as were experiences of violence before the journey (coefficient 0.16, p&lt;.001) and violence during the journey (coefficient .09, p=.013). Conclusion. Our results confirm that persons who leave their countries of origin because of forced mobility experience more psychological distress than other types of migrants. It is important to address the mental health needs of this group of migrants in transit through Mexico.

Anxiety and Depression Symptoms After the Dobbs Abortion Decision

ImportanceIn 2022, the US Supreme Court abolished the federal right to abortion in the Dobbs v Jackson Women’s Health Organization decision. In 13 states, abortions were immediately banned via previously passed legislation, known as trigger laws.ObjectiveTo estimate changes in anxiety and depression symptoms following the Dobbs decision among people residing in states with trigger laws compared with those without them.Design, Setting, and ParticipantsUsing the nationally representative repeated cross-sectional Household Pulse Survey (December 2021-January 2023), difference-in-differences models were estimated to examine the change in symptoms of depression and anxiety after Dobbs (either the June 24, 2022, Dobbs decision, or its May 2, 2022, leaked draft benchmarked to the baseline period, prior to May 2, 2022) by comparing the 13 trigger states with the 37 nontrigger states. Models were estimated for the full population (N = 718 753), and separately for 153 108 females and 102 581 males aged 18 through 45 years.ExposureResiding in states with trigger laws following the Dobbs decision or its leaked draft.Main Outcomes and MeasuresAnxiety and depression symptoms were measured via the Patient Health Questionnaire-4 ([PHQ-4]; range, 0-12; scores of more than 5 indicate elevated depression or anxiety symptoms; minimal important difference unknown).ResultsThe survey response rate was 6.04% overall, and 87% of respondents completed the PHQ-4. The population-weighted mean age was 48 years (SD, 17 years), and 51% were female. In trigger states, the mean PHQ-4 scores in the baseline period and after the Dobbs decision were 3.51 (95% CI, 3.44 to 3.59) and 3.81 (95% CI, 3.75 to 3.87), respectively, and in nontrigger states were 3.31 (95% CI, 3.27 to 3.34) and 3.49 (95% CI, 3.45 to 3.53), respectively. There was a significantly greater increase in the mean PHQ-4 score by 0.11 (95% CI, 0.06 to 0.16; P < .001) in trigger states vs nontrigger states. From baseline to after the draft was leaked, the change in PHQ-4 was not significantly different for those in trigger states vs nontrigger states (difference-in-differences estimate, 0.09; 95% CI, −0.03 to 0.21; P = .15). From baseline to after the Dobbs opinion, there was a significantly greater increase in mean PHQ-4 scores for those in trigger states vs nontrigger states among females aged 18 through 45 years (difference-in-differences estimate, 0.23; 95% CI, 0.08 to 0.37; P = .002). Among males aged 18 through 45 years, the difference-in-differences estimate was not statistically significant (0.14; 95% CI, −0.08 to 0.36; P = .23). Differences in estimates for males and females aged 18 through 45 were statistically significant (P = .02).Conclusions and RelevanceIn this study of US survey data from December 2021 to January 2023, residence in states with abortion trigger laws compared with residence in states without such laws was associated with a small but significantly greater increase in anxiety and depression symptoms after the Dobbs decision.

Trajectories and correlates of poor mental health in India over the course of the COVID-19 pandemic: a nationwide survey

IntroductionThe COVID-19 pandemic had large impacts on mental health; however, most existing evidence is focused on the initial lockdown period and high-income contexts. By assessing trajectories of mental health symptoms...

The Ultrashort Mental Health Screening Tool Is a Valid and Reliable Measure With Added Value to Support Decision-making.

Mental health influences symptoms, outcomes, and decision-making in musculoskeletal healthcare. Implementing measures of mental health in clinical practice can be challenging. An ultrashort screening tool for mental health with a low burden is currently unavailable but could be used as a conversation starter, expectation management tool, or decision support tool. (1) Which items of the Pain Catastrophizing Scale (PCS), Patient Health Questionnaire (PHQ-4), and Brief Illness Perception Questionnaire (B-IPQ) are the most discriminative and yield a high correlation with the total scores of these questionnaires? (2) What is the construct validity and added clinical value (explained variance for pain and hand function) of an ultrashort four-item mental health screening tool? (3) What is the test-retest reliability of the screening tool? (4) What is the response time for the ultrashort screening tool? This was a prospective cohort study. Data collection was part of usual care at Xpert Clinics, the Netherlands, but prospective measurements were added to this study. Between September 2017 and January 2022, we included 19,156 patients with hand and wrist conditions. We subdivided these into four samples: a test set to select the screener items (n = 18,034), a validation set to determine whether the selected items were solid (n = 1017), a sample to determine the added clinical value (explained variance for pain and hand function, n = 13,061), and a sample to assess the test-retest reliability (n = 105). Patients were eligible for either sample if they completed all relevant measurements of interest for that particular sample. To create an ultrashort screening tool that is valid, reliable, and has added value, we began by picking the most discriminatory items (that is, the items that were most influential for determining the total score) from the PCS, PHQ-4, and B-IPQ using chi-square automated interaction detection (a machine-learning algorithm). To assess construct validity (how well our screening tool assesses the constructs of interest), we correlated these items with the associated sum score of the full questionnaire in the test and validation sets. We compared the explained variance of linear models for pain and function using the screening tool items or the original sum scores of the PCS, PHQ-4, and B-IPQ to further assess the screening tool's construct validity and added value. We evaluated test-retest reliability by calculating weighted kappas, ICCs, and the standard error of measurement. We identified four items and used these in the screening tool. The screening tool items were highly correlated with the PCS (Pearson coefficient = 0.82; p < 0.001), PHQ-4 (0.87; p < 0.001), and B-IPQ (0.85; p < 0.001) sum scores, indicating high construct validity. The full questionnaires explained only slightly more variance in pain and function (10% to 22%) than the screening tool did (9% to 17%), again indicating high construct validity and much added clinical value of the screening tool. Test-retest reliability was high for the PCS (ICC 0.75, weighted kappa 0.75) and B-IPQ (ICC 0.70 to 0.75, standard error of measurement 1.3 to 1.4) items and moderate for the PHQ-4 item (ICC 0.54, weighted kappa 0.54). The median response time was 43 seconds, against more than 4 minutes for the full questionnaires. Our ultrashort, valid, and reliable screening tool for pain catastrophizing, psychologic distress, and illness perception can be used before clinician consultation and may serve as a conversation starter, an expectation management tool, or a decision support tool. The clinical utility of the screening tool is that it can indicate that further testing is warranted, guide a clinician when considering a consultation with a mental health specialist, or support a clinician in choosing between more invasive and less invasive treatments. Future studies could investigate how the tool can be used optimally and whether using the screening tool affects daily clinic decisions. Level II, diagnostic study.

Inflammatory and mental health sequelae of COVID-19

The COVID-19 pandemic has caused significant negative consequences to mental health. Increased inflammatory factors and neuropsychiatric symptoms, such as cognitive impairment (“brain fog”), depression, and anxiety are associated with long COVID [post-acute sequelae of SARS-CoV-2 infection (PASC), termed neuro-PASC]. The present study sought to examine the role of inflammatory factors as predictors of neuropsychiatric symptom severity in the context of COVID-19. Adults (n = 52) who tested negative or positive for COVID-19 were asked to complete self-report questionnaires and to provide blood samples for multiplex immunoassays. Participants who tested negative for COVID-19 were assessed at baseline and at a follow-up study visit (∼4 weeks later). Individuals without COVID-19 reported significantly lower PHQ-4 scores at the follow-up visit, as compared to baseline (p = 0.03; 95% CI-1.67 to −0.084). Individuals who tested positive for COVID-19 and experienced neuro-PASC had PHQ-4 scores in the moderate range. The majority of people with neuro-PASC reported experiencing brain fog (70% vs. 30%). Those with more severe COVID-19 had significantly higher PHQ-4 scores, as compared to those with mild disease (p = 0.008; 95% CI 1.32 to 7.97). Changes in neuropsychiatric symptom severity were accompanied by alterations in immune factors, particularly monokine induced by gamma interferon (IFN-γ) (MIG, a. k.a. CXCL9). These findings add to the growing evidence supporting the usefulness of circulating MIG levels as a biomarker reflecting IFN-γ production, which is important because individuals with neuro-PASC have elevated IFN-γ responses to internal SARS-CoV-2 proteins.

Surrogates' experience during the COVID-19 pandemic: mental health, social support, and relationship with intended parents.

To examine surrogates' mental health, social support, and relationship with intended parents (IPs) during the COVID-19 pandemic from March 2020 to February 2022. Data were collected between April 29, 2022 and July 31, 2022, at an academic IVF center in Canada using an 85-item online anonymous cross-sectional survey that included three standardized scales measuring mental health (PHQ-4), loneliness, and social support. Eligible surrogates actively involved in surrogacy during the study period received email invitations. The response rate was 50.3% (338/672); 320 submitted surveys were analyzed. Two-thirds (65%) of respondents experienced mental health concerns during the pandemic and were significantly less comfortable about seeking mental health support than those without concerns. Nonetheless, 64% were highly satisfied with their surrogacy experience; 80% received a high level of support from their IPs, and 90% reported a good relationship with them. The final hierarchical regression model identified five significant predictors, explaining 39.4% of the variance in PHQ-4 scores: a prior mental health history, COVID-19 impact on personal life, surrogacy satisfaction, loneliness, and social support. COVID-19 created an unprecedented challenge to surrogacy care, increasing surrogates' risk of experiencing mental health symptoms. Our data show that IP support and the surrogate-IP relationship were fundamentals to surrogacy satisfaction. The findings are relevant to fertility and mental health practitioners in identifying surrogates who are more susceptible to mental health challenges. Fertility clinics should ensure adequate psychological screening of surrogate candidates and proactively offer mental health support services.

LONELINESS AND PSYCHOLOGICAL DISTRESS AMONG AFRICAN AMERICAN ASSISTED LIVING RESIDENTS APPROACHING END OF LIFE

Abstract Social isolation and loneliness are common at end of life and important contributors to psychological distress, particularly among older adults. Despite evidence that isolation and loneliness are generally prevalent in assisted living (AL), little research has examined these states within the context of end of life (EOL). This study uses secondary data from an EOL study in assisted living to qualitatively characterize the experience of isolation and loneliness in African American AL residents with varying levels of psychological distress. We performed a thematic analysis using ethnographic and interview data collected from 25 residents (64% female) in a large (90+ bed) all-African American AL community in metropolitan Atlanta. We assessed psychological distress using the PHQ-4 and used this measure in qualitative analysis to explore varying patterns of social isolation and loneliness across residents. Findings showed high variability in psychological distress based on PHQ-4 scores (range 0–12, mean = 3.5, SD = 3.75). Across themes of social isolation and loneliness, we compared experiences of residents with low and high psychological distress. The maintenance of agency in the face of isolation and loneliness was the predominant pattern among the low-distress group, while passive withdrawal was consistently identified among the high-distress group. We classified these themes in terms of individual interpersonal relationships characterized by self-isolation and negotiation of family connections, as well as AL community-level relationships characterized by the liminality of the lived AL experience. Results have important implications for multilevel interventions designed to reduce social isolation, loneliness, and psychological distress among this population.

Forced migrant women’s Mental Health in the perinatal period in Germany- A mixed-method study

Abstract Background After forced migration, pregnant women and new mothers face specific challenges in the host country. Little research focuses on the impact these challenges have on forced migrant (FM) women’s mental health (MH). The study’s aim shed light on FM women’s mental wellbeing in the perinatal period. Methods For this mixed-method study 15 individual problem-centered interviews were carried out in Arabic with FM mothers living in Germany within the postnatal period to one year postpartum. The transcripts were analysed using the Framework Analysis. In addition, structured quantitative interviews with 3070 new mothers were conducted on 3 obstetric wards in Berlin over a period of 23 months using an adapted version of the MFMCQ and the PHQ4. FM women (n = 187) were compared with immigrant (n = 1192) and non-immigrant women (n = 1673). A Kruskal-Wallis-Test was performed to compare the three groups. Results In the qualitative interviews mothers stated having depression and varied emotions (e.g. unavoidable sadness, relief). Most FM mothers indicated contextual factors (e.g. bad housing conditions) and structural barriers in perinatal healthcare as negatively impacting their MH. The preliminary quantitative analysis of the interviews conducted in birth clinics directly after birth showed no significant differences in the mean scores of the PHQ-4 within the compared groups (mFMW= 2.83; mimmi=2.61; mnonimmi= 2.5; p=.72). Conclusions While the quantitative study part indicates that PHQ-4 scores are independent of FM experience, the qualitative part shows that FM new mothers face particular burdens in their living conditions that make them vulnerable to MH issues. Inconsistent results could be attributed to the different timing in which the structured questionnaires and qualitative interviews were conducted. Key messages • To promote Mental health of new mothers, we advocate for a diversity oriented, responsive healthcare system. • Effective approaches must be provided to include FM mothers in existing Early Childhood Intervention programs.

Impact of occupational SARS-CoV-2 risk on the mental distress of non-healthcare employees in Germany

Abstract Background The SARS-CoV-2 pandemic posed major challenges to employees and companies. Differences between industries and professions in occupational SARS-CoV-2 infection risk (OSIR) became apparent early on. This study examines the mental distress in terms of depression and anxiety symptoms of non-healthcare workers during the first and second Corona waves in Germany. Methods We conducted an online survey from December 2020 to June 2021 among employees from industrial enterprises, local public transport, the public and the financial sector. High and potential OSIR was defined based on job information. Depression and anxiety symptoms were rated with the 4-item Patient Health Questionnaire (PHQ-4). Categorized PHQ-4 scores were modeled with ordinal random-intercept logistic multinomial regression models and presented with odds ratios (OR) and 95% confidence intervals (95% CI). Results Overall, 516 of 1,545 participants (33.4%) were determined to be at increased OSIR. Anxiety and depression symptoms worsened during the pandemic in all OSIR groups. Risks for more severe depressive and anxiety symptoms were higher among employees with high (OR 2.35; 95% CI 1.33-4.16) and potential OSIR (OR 1.70; 95% CI 1.19-2.43) compared to employees without OSIR. Severity of mental distress differed also by the extent of perceived job protection, interactions with colleagues, work-privacy conflicts, and overcommitment. Conclusions OSIR had a negative impact on employee’s depressive symptoms and anxiety. Reducing SARS-CoV-2 exposure through workplace protective measures, strengthening interactions among colleagues, and supporting employees with work-privacy conflicts could help better protect employees’ mental health. Key messages • The risk for more severe depressive and anxiety symptoms increases with higher occupational SARS-CoV-2 infection risk. • Improvements in SARS-CoV-2 exposure at work, colleague interactions, and work-privacy conflicts could help better protect mental health.

Investigation of temporomandibular disorders in patients with fibromyalgia syndrome: A case-control study

IntroductionThe aim of this study is to compare the frequency of temporomandibular disorders and to examine the temporomandibular pain and functionality levels between healthy female participants and female patients diagnosed with fibromyalgia. Materials and methodsOur study included 300 participants. Patients were evaluated according to the Diagnostic Criteria for Temporomandibular Disorders: Assessment Instruments (DC/TMD). While evaluating the patients using DC/TMD, TMD Pain Screener and Symptom questionnaire were used within the scope of Axis I, and Graded Chronic Pain Scale, Jaw Functional Limitation Scale-8 (JFLS-8), Patient Health Questionnaire (PHQ-4) and Oral Behaviors Checklist were applied. ResultsBruxism, tooth grinding and masseter hypertrophy were found to be significantly higher in fibromyalgia patients compared to healthy volunteers (p<0.001). The pain screener, JFLS-8, PHQ-4 and OBC scores and GCPS levels were found to be increased in the fibromyalgia group compared to healthy individuals (p<0.001). Considering the post-examination diagnoses of the participants, the diagnoses of myalgia (p=0.022) and disc displacement with reduction (p<0.001) were significantly higher than healthy individuals. ConclusionsFibromyalgia is a common pathology, therefore, TMD symptoms, which are more difficult to diagnose and often missed, should be questioned in fibromyalgia patients and should be kept in mind in the management of fibromyalgia patients.

Fear of Deportation and Associations with Mental Health Among Michigan Residents of Middle Eastern & North African Descent.

Anti-immigrant rhetoric and immigration policy enforcement in the United States over the last 2 decades has increased attention to fear of deportation as a determinant of poor health. We describe its association with mental health outcomes among Middle East and North African (MENA) residents of Michigan. Using a convenience sample of MENA residents in Michigan (n = 397), we conducted bivariate and multiple variable regression to describe the prevalence of deportation worry and examine the relationship between deportation worry and depressive symptoms (PHQ-4 scores). We found that 33% of our sample worried a loved one will be deported. Deportation worry was associated with worse mental health (p < 0.01). Immigration policies are health policies and deportation worry impacts mental and behavioral health.

Green exercise, mental health symptoms, and state lockdown policies: A longitudinal study

Lockdown policies aimed at decreasing the transmission of COVID-19 showed unintended mental health consequences; however, natural settings may offer a respite for individuals suffering from depression or anxiety symptoms. Previous cross-sectional literature reports protective effects of outdoor exposure on mental health during the COVID-19 pandemic. We longitudinally assess whether green exercise corresponded with a decline in adverse mental health symptoms, controlling for state lockdown policies. We also examine whether the relation differed by state lockdown status. As our exposure variable, we specificized participation in an outdoor walk, jog, or hike (green exercise). We used, as the outcome variable, the 4-item Patient Health Questionnaire (PHQ-4) to measure anxiety and depression symptoms. We utilized the Understanding America Study (UAS), a nationally representative sample of 8253 adults across 50 states in the US, surveyed biweekly between March 10, 2020–May 26, 2021. Linear fixed effect analyses controlled for time-invariant individual factors, as well as employment status, and household income. Regression results indicate a modest decline in PHQ-4 scores of approximately 0.10 (less mental health symptoms) as a function of green exercise, controlling for state lockdown status. We also find a slightly greater protective effect of green exercise on mental health symptoms during state lockdown policies. Additionally, we find that green exercise, as opposed to indoor exercise, corresponds with a decrease in PHQ-4 scores during lockdown. Contact with nature may improve mood and decrease mental health symptoms, especially during stress-inducing periods such as the COVID-19 pandemic. Green exercise as a recommended behavioral intervention may hold relevance for greater public health.

Psychological Resilience, Coping, and Distress in Admitted Patients With COVID-19 Infection.

Objective: To assess psychological resilience, coping, and related psychological distress in admitted COVID-19 patients. Predictors of subsequent development of posttraumatic stress symptoms (PTSS) and disability were also studied.Methods: Stable inpatients with COVID-19 (aged > 18 years with mild symptoms) admitted to a tertiary care hospital from April 2020 to December 2020 were recruited for the study. During admission, the patients were assessed for resilience, coping, and psychological distress using the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), Brief COPE (Coping Orientation to Problems Experienced), and 4-item Patient Health Questionnaire (PHQ-4). Similarly, they were assessed at 4 weeks after discharge using the PTSD Checklist for DSM-5 and World Health Organization Disability Assessment Schedule.Results: A total of 176 patients were recruited for the study and assessed during their admission, and 102 were reassessed during follow-up. Of the patients, 17.6% during admission and 58.8% at follow-up had significant psychological distress (PHQ-4 score > 2). The mean ± SD CD-RISC-10 score was 27.94 ± 5.82. The most used coping strategies were emotional support, religion, and acceptance. Increased resilience was associated with better education (rs[100] = 0.265, P = .007), less psychological distress (r[100] = -0.596, P = .001), and healthy coping strategies. PHQ-4, PCL-5, and disability scores at follow-up were positively correlated (Pearson correlation). The multiple regression model statistically significantly predicted PTSS (F7, 94 = 2.660, P < .015, adjusted R2 = 0.103).Conclusions: COVID-19 patients with better resilience are associated with reduced psychological distress. Better resilient traits and reduced psychological distress may prevent ensuing PTSS and disability.

773 Insurance Coverage Does Not Increase Risk of Depression and Anxiety in Burn Patients

IntroductionA burn injury can have long-term mental and physical effects on individual patients. When burn injuries occur at work, there is an additional unfamiliar stress of income loss and dependence on a third-party payer. Patients with claims through the Bureau of Worker’s Compensation (BWC) report frustration and overall dissatisfaction in working with the BWC to achieve claim coverage. Of workers who are off of work more than 5 days due to a work-related injury, 10% are diagnosed with depression in the 12 months following the injury (Carnide, 2016).In our clinic, screening for depression and anxiety is done through the Patient Health Questionnaire (PHQ-4), a valid four-item assessment tool that utilizes a Likert style measurement to assess symptoms of depression and anxiety (Kroenke et al., 2009). This is a health questionnaire that determines a patient’s risk for depression and anxiety as mild, moderate, or severe.ObjectiveTo determine if there is a correlation between insurance type and PHQ-4 scores in burn patients. We hypothesized that risk of depression and anxiety could differ based on payer, which can affect a patient’s access to care, referral approval, and financial burden of treatment. Additional focus was placed on BWC patients due to their reported frustrations and dissatisfaction in working with BWC and the established correlation between depression and missed work.MethodsA quality improvement project was initiated based on increased rates of referrals for psychological evaluation and treatment in BWC patients. A retrospective review was conducted of outpatient burn clinic visits where a PHQ-4 questionnaire was completed in the past 3 fiscal years: 7/1/2019-6/30/2021.ResultsTotal of 1932 visits with PHQ-4 collection were reviewed within the above specified time frame. The rates of moderate and high-risk scores for anxiety and depression were highest with BWC and Medicaid patients. Patients with private insurance showed a lower risk of moderate and severe depression. However, there was no significant difference when comparing BWC verses all other insurance. Table 1ConclusionsOverall there was no significant difference in risk of anxiety and depression with BWC versus other insurance coverage based on PHQ-4 scores. Limitations of the study include no distinction of extent of burn injury/burn depth, burn care/treatments, length of hospital stay if any; no distinction was made amongst BWC patients and their length of time off of work. A portion of the timeframe reviewed was during the COVID-19 pandemic.

Coping with COVID: risk and resilience factors for mental health in a German representative panel study.

The coronavirus disease 2019 (COVID-19) pandemic might affect mental health. Data from population-representative panel surveys with multiple waves including pre-COVID data investigating risk and protective factors are still rare. In a stratified random sample of the German household population (n = 6684), we conducted survey-weighted multiple linear regressions to determine the association of various psychological risk and protective factors assessed between 2015 and 2020 with changes in psychological distress [(PD; measured via Patient Health Questionnaire for Depression and Anxiety (PHQ-4)] from pre-pandemic (average of 2016 and 2019) to peri-pandemic (both 2020 and 2021) time points. Control analyses on PD change between two pre-pandemic time points (2016 and 2019) were conducted. Regularized regressions were computed to inform on which factors were statistically most influential in the multicollinear setting. PHQ-4 scores in 2020 (M = 2.45) and 2021 (M = 2.21) were elevated compared to 2019 (M = 1.79). Several risk factors (catastrophizing, neuroticism, and asking for instrumental support) and protective factors (perceived stress recovery, positive reappraisal, and optimism) were identified for the peri-pandemic outcomes. Control analyses revealed that in pre-pandemic times, neuroticism and optimism were predominantly related to PD changes. Regularized regression mostly confirmed the results and highlighted perceived stress recovery as most consistent influential protective factor across peri-pandemic outcomes. We identified several psychological risk and protective factors related to PD outcomes during the COVID-19 pandemic. A comparison of pre-pandemic data stresses the relevance of longitudinal assessments to potentially reconcile contradictory findings. Implications and suggestions for targeted prevention and intervention programs during highly stressful times such as pandemics are discussed.