Positive Depression Screen Research Articles

What Happened and Why: Responding to Racism, Discrimination, and Microaggressions in the Clinical Learning Environment

Within clinical learning environments, medical students are uniquely faced with power differentials that make acts of racism, discrimination, and microaggressions (RDM) challenging to address. Experiences of microaggressions and mistreatment are correlated with higher rates of positive depression screening and lower satisfaction with medical training. We developed a curriculum for medical students beginning clerkship rotations to promote the recognition of and response to RDM. Guided by generalized and targeted needs assessments, we created a case-based curriculum to practice communication responses to address RDM. The communication framework, a 6Ds approach, was developed through adaptation and expansion of established and previously learned communication upstander frameworks. Cases were collected through volunteer submission and revised to maintain anonymity. Faculty and senior medical students cofacilitated the small-group sessions. During the sessions, students reviewed the communication framework, explored their natural response strategies, and practiced all response strategies. Of 196 workshop participants, 152 (78%) completed the evaluation surveys. Pre- and postsession survey cohort comparison demonstrated a significant increase in students' awareness of instances of RDM (from 34% to 46%), knowledge of communication strategies to mitigate RDM (presession M = 3.4, postsession M = 4.6, p < .01), and confidence to address RDM (presession M = 3.0, postsession M = 4.4, p < .01). Students gained valuable communication skills from interactive sessions addressing RDM using empathy, reflection, and relatability. The workshop empowered students to feel prepared to enter professional teams and effectively mitigate harmful discourse.

Development of an Auxiliary Platform (Mentali) for the Primary Screening of Anxiety and Depression in Young Adults.

The current COVID-19 pandemic has completely changed people's daily routines. This has had a big impact on mental health. In Mexico, medical school authorities are interested in understanding the mental health status of the student population to be able to provide support to students who may need help from a mental health specialist. The aim of this study was to develop a platform comprised of a mobile and web application called Mentali, to be used as an auxiliary tool for the detection of conditions such as anxiety and depression, as well as variations in mood, by analysis of the results of validated inventories. Following the Scrum software development methodology, Python, Dart and PHP programming languages were used for development of the application. This platform was used prospectively with 155 first year students taking part in the human medicine program. After 22 weeks, Mentali enabled the identification of 40 users with positive primary screening for anxiety and/or depression (45% for anxiety, 32.5% for both anxiety and depression, and 22.5% for altered mood). These students were contacted and referred to a psychologist; however, only 26 (65%) accepted psychological support. For all of these students a mental health disorder was confirmed. The results support the use of Mentali for the primary screening of anxiety and depression in young adults, including medical students.

Mental health surveillance of German adults in the COVID-19 pandemic: trends in depressive symptoms

Abstract Background While literature on mental health in the COVID-19 pandemic has grown rapidly, studies reporting on developments beyond the first wave using continuous, population-based data are still scarce. We examined monthly estimates of depressive symptom levels in Germany’s adult population covering almost two years of the pandemic and the year prior. Methods We analyzed representative data from two population-based telephone surveys of German adults: “German Health Update (GEDA)” and “COVID-19 vaccination rate monitoring in Germany (COVIMO).” Core symptoms of depression measured using the Patient Health Questionnaire-2 (PHQ-2) were observed in approximately 1,000 randomly sampled participants monthly from April 2019 to December 2021. We estimated three-month moving means and proportions as well as smoothing curves to produce time series graphs. Statistical comparisons between specific time periods were used to verify results of visual inspection. Analyses were stratified by gender, age and level of education to assess potential time trend differences between subgroups. Results Both the mean population depressive symptom score and the proportion of the population with a positive PHQ-2 depression screen first decreased to below 2019 levels between the first wave and summer of the pandemic and then increased from autumn 2020, reaching levels significantly above 2019 in 2021 and remaining elevated. 2021 saw a 2.2% increase in positive screens compared to 2019. Women, the youngest and eldest adults, and those with a high level of education experienced a particular increase in depressive symptoms between 2019 and 2021. However, we found no corresponding changes in symptom level differences between population subgroups. Conclusions Our finding of elevated depressive symptoms among Germany’s adults following an increase in the second wave of the pandemic demonstrate the importance of continued surveillance to assess the further development of mental health in the ongoing crisis. Key messages • Monthly data from April 2019 to December 2021 suggests that depressive symptoms decreased at the start of the pandemic and then increased from autumn 2020, reaching levels above 2019 in 2021. • Continued mental health surveillance is needed to assess the further development of mental health indicators in the ongoing crisis and its aftermath.

Depression Among Immigrant Nigerians in Canada.

Immigrant status, especially a few years post arrival, is a major risk factor for depression in populations that have been adequately studied. While information on depression among Asian migrants, including those from India, China and Philippines, in Canada have been reported in previous studies, there is inadequate information about depression among Nigerian immigrants who make up the largest percentage of African migrants and black population residing in Canada. A cross-sectional study was conducted among 187 Nigerian immigrants in Canada. Participants completed the Patient Health Questionnaire (PHQ-9). Descriptive and multivariate logistic regression analyses were carried out using IBM SPPS. About half (51.7%, n = 91) of the participants screened positive to the PHQ-9. Being female, unmarried, not being at all satisfied with the decision to migrate, and having stayed for more than 10 years in Canada significantly increased the risk of screening positive to depression. More than half of the participants screened positive for depression, suggesting an important mental health concern and the potential need for intervention. This population differed from other immigrant populations from previous studies because the absence of social support, satisfaction with employment status, and perceived discrimination did not significantly predict a positive screen for depression in this study.

Cross-Sectional Analysis of Mental Health among University Students: Do Sex and Academic Level Matter?

University students’ mental health and well-being is a growing public health concern. There is a lack of studies assessing a broad range of mental health domains by sex and academic level of study. This cross-sectional online survey of BSc, MSc, and PhD students (n = 3353, 67% female) enrolled at one university in Germany assessed a wide scope of mental health domains, covering positive (i.e., self-rated health, self-esteem, student engagement) and negative aspects (i.e., perceived stress, irritation, and screening positive for depression, anxiety, comorbidity, and psychological distress). We evaluated differences in mental health by sex and academic level. Overall, although self-rated health did not differ by sex and academic level, females and lower academic level were associated with less favorable mental health. Males reported higher prevalence of high self-esteem, and higher engagement (all p ≤ 0.04). Conversely, mean perceived stress and cognitive/emotional irritation were higher among females, as were rates for positive screenings for anxiety, anxiety and depression comorbidity, and psychological distress (p < 0.001 for all). Likewise, lower academic level (BSc) was associated with lower rates of high self-esteem (p ≤ 0.001), increased perceived stress (p < 0.001), and higher prevalence of positive screening for depression, anxiety, comorbidity, and psychological distress (p ≤ 0.002 for all), while higher academic level (PhD) was linked to increased student engagement (p < 0.001 for all). Although the effect sizes of sex and academic level on student mental health were modest, these findings support a need for action to establish and expand early detection and prevention programs, on-campus advisory services, and peer counseling that focus on the sex-specific and academic-study-level-specific factors, as well as mental health and career development resources for students. Academics and policy makers need to consider multipronged intervention strategies to boost confidence of students and their academic career.

1.31 Effects of the COVID-19 Pandemic on Depressive Symptoms in Adolescents

The primary aim is to investigate the psychological impact on adolescents over different periods during the pandemic by focusing on the prevalence of depression. A secondary aim analyzes if specific risk factors make adolescents more vulnerable to a positive depression screening.

The Associations of Breastfeeding and Postnatal Experiences With Postpartum Depression Among Mothers of Hospitalized Infants in Tertiary Hospitals.

BackgroundPostpartum depression has been linked to undesirable outcomes for mother-infant dyads, interfering with childcare and breastfeeding practices. This study aimed to determine the prevalence of depressive symptoms among mothers during the postpartum period and its association with breastfeeding and postpartum experiences.MethodologyThis cross-sectional study involved mothers of hospitalized infants (n = 219) at two tertiary hospitals in Klang Valley, Malaysia. Mothers were screened for postpartum depression using the Edinburgh Postnatal Depression Scale with a cut-off of ≥12 for positive screening for depression. Mothers were asked to complete questionnaires on breastfeeding experience, which included breastfeeding self-efficacy and challenges. The questionnaires also collected information on postnatal experiences, including birth outcomes, anxiety and stress levels, and social support. Multiple linear regression was used to ascertain the association of postpartum depression levels with breastfeeding and postnatal experiences.ResultsOverall, 30% of mothers in this study screened positive for depression. Based on multiple linear regression, a higher score of postpartum depression was significantly associated with unpleasant breastfeeding and postnatal experiences reflected by increased scores of anxiety and stress, lower infant birth weight, increased breastfeeding problems, and lower level of social support (p < 0.005).ConclusionsMaternal emotions, birth outcomes, breastfeeding issues, and social support were associated with postpartum depression. Efforts should be made to increase maternal support, and screening for maternal depression during infant hospital stays should be encouraged.

Positive influences of the COVID-19 pandemic on community dwelling adults in Trinidad and Tobago: a cross sectional study

Background Since the onset of the coronavirus (COVID-19) pandemic its negative effects have been highlighted globally. There is little literature that examines the positive impact on daily living. Aims To examine the positive influences of government-imposed COVID-19 public health restrictions on adults throughout Trinidad and Tobago (TT) and their associated factors. Method A cross-sectional study, using an adapted pretested online survey instrument, was conducted amongst non-institutionalised, community-dwelling adults using convenience sampling. Results Of 1287 completed and weighted responses, the mean age (S.D.) was 39.2 (14.6) years, 49% were males, and 61% completed secondary level education. The top 5 positive experiences were more time spent with family (80%), more down-time (78%), learning new skills (68%), more time for hobbies (66%), self-care (57%), more time spent with friends (55%) and eating healthier (50%). The importance of religion, working from home, and an increase in marijuana use emerged as positive correlates for certain positive experiences, while participants with chronic illness, and a positive anxiety or depression screen, were negatively associated with most positive experiences. Conclusions Despite the negative consequences of the COVID19 pandemic, several positives were highlighted in this study. These findings have implications for social policies toward building resilience within the community.

An Alcohol Symptom Checklist identifies high rates of alcohol use disorder in primary care patients who screen positive for depression and high-risk drinking

BackgroundAlthough alcohol use disorder can complicate depression management, there is no standard process for assessing AUD symptoms (i.e., AUD diagnostic criteria) in primary care for patients who screen positive for depression. This study characterizes the association between depressive symptoms and high-risk drinking reported by primary care patients on screening measures in routine care. Then, using data from a novel clinical program, this study characterizes the association between depressive symptoms and AUD symptoms reported by primary care patients with high-risk drinking via an Alcohol Symptom Checklist.MethodsIn this cross-sectional study, electronic health record data were obtained from patients who visited 33 Kaiser Permanente Washington primary care clinics between 03/2018 and 02/2020 and completed depression (PHQ-2) and alcohol consumption (AUDIT-C) screening measures as part of routine care (N = 369,943). Patients who reported high-risk drinking (AUDIT-C scores 7–12) also completed an Alcohol Symptom Checklist where they reported the presence or absence of 11 AUD criteria as defined by the DSM-5 (N = 8,184). Generalized linear models estimated and compared the prevalence of high-risk drinking (AUDIT-C scores 7–12) and probable AUD (2–11 AUD symptoms on Alcohol Symptom Checklists) for patients with and without positive depression screens.ResultsPatients who screened positive for depression had a 131% higher prevalence of high-risk drinking than those who screened negative (5.2% vs. 2.2%; p < 0.001). Among patients with high-risk drinking, positive depression screens were associated with a significantly higher prevalence of probable AUD (69.8% vs. 48.0%; p < 0.001), with large differences in the prevalence of probable AUD observed with increasing PHQ-2 scores (e.g., probable AUD prevalence of 37.6%, 55.3% and 65.2%, for PHQ-2 scores of 0, 1, and 2, respectively). Although the overall prevalence of high-risk drinking was higher for male patients, similar patterns of association between depression screens, high-risk drinking, and AUD symptoms were observed for male and female patients.ConclusionsPatients with positive depression screens are more likely to have high-risk drinking. Large percentages of patients with positive depression screens and high-risk drinking report symptoms consistent with AUD to healthcare providers when given the opportunity to do so using an Alcohol Symptom Checklist.

Associations between depression, stress, and e-cigarette use among OEF/OIF veterans

ABSTRACT The COVID-19 pandemic has had profound mental and behavioral health implications for the general U.S. population. However, little is known regarding outcomes for U.S. veterans, who represent a population with high rates of depression, stress, and e-cigarette use. One month prior to the pandemic-related closures (February 2020), 1230 OEF/OIF veterans (ages 18–40) completed an online baseline survey. Six months later, participants completed a follow-up survey (83% retention rate). Hierarchical negative binomial regressions were used to examine the relationship between baseline depression and past 30-day e-cigarette use at follow-up and whether baseline stress moderated this relationship. Veterans who screened positive for depression or who endorsed higher stress levels reported greater e-cigarette use at follow-up. Stress also moderated the relationship between depression and e-cigarette use, such that regardless of stress levels, a positive depression screen was associated with greater rates of later e-cigarette use. However, for those with a negative depression screen, higher stress levels were associated with greater e-cigarette use relative to lower stress levels. Veterans with pre-pandemic depression and stress may be at highest risk for e-cigarette use. Ongoing assessment and treatment for depression and promoting stress management skills for veterans in e-cigarette use prevention and intervention programs may be valuable.

Influence of Subclinical Anxiety and Depression on Quality of Life and Perception of Facial Paralysis.

Introduction: Patients with facial paralysis have increased psychosocial distress, which affects overall quality of life (QOL). Objective: To evaluate the relationship between QOL and paralysis severity among patients with subclinical anxiety and/or depression. Methods: Patients with facial paralysis were screened for anxiety and depression using the Generalized Anxiety Disorder-2 and Patient Health Questionnaire-2 surveys. QOL scores (Facial Clinimetric Evaluation) and paralysis severity scores (House-Brackmann [HB] and Sunnybrook [SB]) were collected. Patients with a mental health diagnosis or treatment were excluded. Univariate and multivariate analyses and Pearson's correlations were performed after stratifying by anxiety and/or depression screenings. Results: Positive anxiety and depression screening rates were 25.78% and 22.66%, respectively. Patients screening positive had significantly worse QOL scores despite no difference in paralysis severity. QOL scores did not correlate with SB scores among patients who screened positive for depression. Conclusion: Patients screening positive for anxiety and/or depression demonstrated worse QOL, which did not correlate with paralysis severity suggesting that health care professionals should remain alert to mental health symptoms when QOL impairment is out of proportion with the severity of paralysis.

The mental health burden of racial and ethnic minorities during the COVID-19 pandemic.

Racial/ethnic minorities have been disproportionately impacted by COVID-19. The effects of COVID-19 on the long-term mental health of minorities remains unclear. To evaluate differences in odds of screening positive for depression and anxiety among various racial and ethnic groups during the latter phase of the COVID-19 pandemic, we performed a cross-sectional analysis of 691,473 participants nested within the prospective smartphone-based COVID Symptom Study in the United States (U.S.) and United Kingdom (U.K). from February 23, 2021 to June 9, 2021. In the U.S. (n=57,187), compared to White participants, the multivariable odds ratios (ORs) for screening positive for depression were 1·16 (95% CI: 1·02 to 1·31) for Black, 1·23 (1·11 to 1·36) for Hispanic, and 1·15 (1·02 to 1·30) for Asian participants, and 1·34 (1·13 to 1·59) for participants reporting more than one race/other even after accounting for personal factors such as prior history of a mental health disorder, COVID-19 infection status, and surrounding lockdown stringency. Rates of screening positive for anxiety were comparable. In the U.K. (n=643,286), racial/ethnic minorities had similarly elevated rates of positive screening for depression and anxiety. These disparities were not fully explained by changes in leisure time activities. Racial/ethnic minorities bore a disproportionate mental health burden during the COVID-19 pandemic. These differences will need to be considered as health care systems transition from prioritizing infection control to mitigating long-term consequences.

Correlates of patient-reported cognitive performance with regard to disability

The patient-reported form of the Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) assesses perceived problems attributable to cognitive and neuropsychiatric symptoms. It is inconsistently related to objective cognitive performance in multiple sclerosis (MS), while strongly correlated with depression. We assessed whether the relationship between subjective and objective cognitive screening tools is moderated by disability. Furthermore, we investigated the MSNQ as a screening tool for both cognitive impairment and depression. 275 MS patients completed the patient-reported MSNQ, two‐question screening tool for depression and Symbol Digit Modalities Test (SDMT) and were divided into Expanded Disability Status Scale (EDSS) subgroups: Low 0.0–3.0, Medium 3.5–6.0, High 6.5–9.0. MSNQ scores correlated significantly with depression but not SDMT in all subgroups. After correcting for age, sex, education, EDSS and depression, MSNQ significantly predicted SDMT in the total group, but not the subgroups. MSNQ significantly predicted a positive depression and/or cognitive impairment screen in the total group and all subgroups. The relationship between subjective and objective cognitive screening tools is not influenced by physical disability. MSNQ scores are substantially influenced by depression, and reflect cognitive function to some degree. Patient-reported cognitive measures can be useful to identify patients requiring further (neuro)psychological assessment.

We Can’t Just Wait This Out: Burnout and Fulfillment among SGO Members over the First Two Waves of the COVID-19 Pandemic (051)

Objectives: To assess the impact of COVID-19 on the mental health of SGO members during the first wave (W1) and second wave (W2) of the pandemic.Methods: During W1 and W2 of the COVID-19 pandemic (June 15 to July 1, 2020 and January 15 to 31, 2021), SGO members received an anonymous survey consisting of validated measures to assess for professional fulfillment and burnout (PFI), generalized anxiety (GAD-2), depression (PHQ-2), PTSD (IES-6), and novel questions regarding COVID-19 stressors. Univariate and multivariable analyses were utilized to determine associations between W1 and W2.Results: A total of 478 responses were recorded (23.3% response rate). Ninety-nine W2 responders who took both W1 and W2 surveys were excluded, leaving 379 total responses (W1: 254, W2: 125). The majority of responders were female (68.3%), aged ≤45 (55.7%), and non-Hispanic White ethnicity (69.9%). Overall, 16.1% and 14.0% reported a history of anxiety and depression, respectively. Personal COVID infections and institutional COVID burden were higher in W2 (p=0.01, p=<.0001), with 7.1% versus 15.2% infections and 31.1% versus 11.2% reporting low burden compared to 23.2% versus 42.4% reporting high burden. Positive screening for anxiety, depression, and PTSD was reported in 25%, 17%, and 61% of responders in W1, compared to 19.7%, 5%, and 31.4% in W2, respectively. In both W1 and W2, after adjusting for demographic covariates, low professional fulfillment was associated with anxiety (p-values <0.01), while burnout remained associated with anxiety, depression, and PTSD (p-values <0.04). No difference in overall burnout or professional fulfillment was found on a multivariable analysis comparing W1 and W2. With respect to low professional fulfillment, history of anxiety was found to be an independent modifier between W1 and W2 (p=0.03), as those with no preexisting anxiety (n=318) were 1.72 times more likely to have lower fulfillment in W1 versus W2 (95% CI: 1.02-2.92). Similarly, age was an identified modifier related to burnout between W1 and W2 (p=0.04), where those aged ≥ 56 years were 2.7 times more likely to endorse burnout in W1 versus W2 (95% CI: 0.84-8.63). Multivariable analysis of novel COVID-19 stressors (Table 1) demonstrated significantly higher levels of reported stress in W1 versus W2 due to change in work quality/deployment, current/potential PPE shortage, and significantly lower levels of stress regarding finances.Conclusions: Among 379 SGO members surveyed during W1 and W2 of the pandemic, burnout and low professional fulfillment remained prevalent in over 40% of members. Proportionately higher numbers of respondents endorsed low professional fulfillment, anxiety, depression, and PTSD in W1 versus W2, while the rate of burnout remained unchanged between the waves. Although no overall association was found between burnout and fulfillment in W1 and W2 on primary analysis, results of this study found that as the pandemic progressed into W2, older respondents (≥56) and those without a history of anxiety were more likely to have less burnout and higher professional fulfillment, raising important questions regarding potential determinants of resilience among healthcare workers. The trend towards improvement of professional fulfillment levels and stability in burnout levels between W1 and W2 may also provide important insight on SGO member wellness and its temporal associations in response to external stressors, while also highlighting the associations of burnout with pan positive screening for anxiety, depression, and PTSD, further adding to the ongoing need to address these mental health issues for our healthcare providers.

Cyberbullying Among Adolescents with Chronic Illnesses in Thailand: Prevalence and Relationship with Health-Risk Behaviors.

The use of social media may enhance the quality of life in adolescents living with chronic illnesses but may increase the risk of cyberbullying. The aim of this study was to estimate the prevalence of cyberbullying among adolescents with chronic illnesses and relationship with health-risk behaviors. This is an online survey of randomly recruited adolescents aged 11 to 18 years with chronic illness managed at Siriraj Hospital, Thailand, during 2019 to 2020. Participants were asked to respond anonymously to validated online questionnaires to evaluate health-risk behaviors, experience with cyberbullying, and depression-screening questions. Three hundred forty-one participants with a mean age of 15.02 ± 2.17 years (interquartile range 12.8, 17.2) responded. Reported risk behaviors included sexual activity in 42 participants (12.3%) with almost half (47.6%) having practiced unsafe sex. Alcohol drinking and polysubstance use were also found in 8.5% and 1.2%, respectively. 38 (11.1%) felt depressed within the previous 2-week period. 56 (16.4%) had been a cyberbully victim. Among the victims, 25 (44.6%) were also cyberbullies themselves. Chronically ill adolescents were more likely to be a victim of cyberbullying if they knew someone who had also been a victim (adjusted odds ratio [aOR] 5.25 [95% confidence interval [CI] = 1.80-15.29], p < 0.001) or had a positive depression screening (aOR 6.182 [95% CI = 2.41-15.85], p < 0.001). Underlying diseases, age, sex, risky behaviors, and time spent online were not associated with being cyberbullied. Thai adolescents with chronic illness were similar to their healthy peers regarding health-risk behaviors and the likelihood of being a victim of cyberbullying. Screening for risky behaviors, evidence of depression, and online activity during routine medical visits was an opportunity to prevent cyberbullying.

Predictors of reported alcohol intake during the first and second waves of the COVID-19 pandemic in Canada among middle-aged and older adults: results from the Canadian Longitudinal Study on Aging (CLSA)

ObjectiveTo examine proportions and predictors of change in alcohol intake and binge drinking during the first 2 waves of the COVID-19 pandemic among middle-aged and older participants in the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Questionnaire Study.MethodsA total of 28,559 (67.2% of the potential sample) CLSA participants consented to the study with 24,114 completing the exit survey (fall 2020). Descriptive statistics and logistic regressions to examine predictors of change (increase or decrease) in alcohol intake and binge drinking were performed.ResultsAmong alcohol users, 26.3% reported a change in alcohol consumption during the first 10 months of the pandemic. Similar percentages increased (13.0%) or decreased (13.3%) consumption. In our mutually adjusted logistic regression model, odds of change in alcohol intake were greater for younger age, higher income, current cannabis smoker, positive screen for depression, anxiety, and loneliness. The magnitude of all associations for decreased intake was less than that of increased intake, and the directions were opposite for male sex and age. Predictors of current binge drinking (27.9% of alcohol users) included male sex, younger age, higher education and income, cannabis use, depression, and anxiety.ConclusionFactors predictive of potentially worrisome alcohol use (i.e. increased intake, binge drinking) included younger age, sex, greater education and income, living alone, cannabis use, and worse mental health. Some of these factors were also associated with decreased intake, but the magnitudes of associations were smaller. This information may help direct screening efforts and interventions towards individuals at risk for problematic alcohol intake during the pandemic.

Residual sleepiness in veterans with post-traumatic stress disorder and obstructive sleep apnea.

The causes of residual excessive sleepiness (RES) in patients withpost-traumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) are multifactorial and modulated by comorbid conditions. The aim of the present study was to elucidate clinical and polysomnographic determinants of RES in continuous positive airway pressure (CPAP)-adherent OSA veterans with PTSD. The study protocol consisted of a retrospective analysis of consecutive cases of patients withPTSD who presented to the Veterans Affairs sleep clinics with adequately treated OSA between June 1, 2017 and October 15, 2021. Based on the Epworth Sleepiness Scale (ESS), patients were categorized into RES (ESS ≥ 11) and no RES (ESS < 11) groups. Demographic and PSG data were subjected to univariate and multivariate analyses to ascertain predictive factors of RES. Out of 171 veterans withPTSD who were adherent to CPAP, 59 (35%) continued to experience RES. The RES group had a decrease in mean ESS score of 1.2 ± 4.5 after CPAP treatment compared with 4.6 ± 4.9 for the no RES group (< 0.001). A dose-response was observed between CPAP use and RES (p = 0.003). Multivariate regression analysis identified higher baseline ESS (OR 1.30; 95% CI 1.16-1.44), greater percentage of time spent in REM sleep (OR 0.91; 95% CI 0.85-0.96), CPAP use less than 6h (OR 2.82; 95% CI 1.13-7.01), and a positive screen for depression (OR 1.69; 95% CI 1.03-4.72) as independent predictors of RES in patients withPTSD and OSA. RES is highly prevalent in patients withPTSD and OSA despite adherence to CPAP and is independently associated with percentage time spent in REM, duration of CPAP utilization, and symptoms of depression.

Clinically assessed and perceived unmet mental health needs, health care use and barriers to care for mental health problems in a Belgian general population sample

BackgroundMental health problems often remain undetected and untreated. Prior research suggests that this is mainly due to a lack of need-perception and attitudinal barriers. The aim of this study is to examine unmet mental health needs using both a clinically assessed and a self-perceived approach in a Belgian province.MethodsA cross-sectional survey study with a weighted representative sample of 1208 individuals aged 15 – 80 years old was carried out in 2021 in the province of Antwerp (Belgium). Mental health needs were defined as a positive symptom screening for depression (PHQ-9), anxiety (GAD-7) or alcohol abuse (AUDIT-C and CAGE), combined with experiencing significant dysfunction in daily life. Also 12-month health care use for mental health problems, self-perceived unmet mental health needs and reasons for not seeking (extra) help were assessed. Logistic regression analyses were used to explore the predictors of mental health problems, health care use, and objective and subjective unmet mental health needs.ResultsOne in five participants had a positive screening on one of the scales, of whom half experienced dysfunction, leading to a prevalence of 10.4% mental health needs. Among those, only half used health care for their mental health, resulting in a population prevalence of 5.5% clinically assessed unmet mental health needs. Fourteen percent of the total sample perceived an unmet mental health need. However, more women and younger people perceived unmet needs, while clinically assessed unmet needs were higher among men and older people. One in six of the total sample used health care for their mental health, most of whom did not have a clinically assessed mental health need. Motivational reasons were most often endorsed for not seeking any help, while a financial barrier was the most important reason for not seeking extra help.ConclusionsThe prevalence of unmet mental health needs is high. Assessed and perceived (unmet) mental health needs are both relevant and complementary, but are predicted by different factors. More research is needed on this discrepancy.

Associations Between Implementation of the Collaborative Care Model and Disparities in Perinatal Depression Care.

To evaluate whether perinatal collaborative care model implementation was associated with a reduction in racial disparities in depression care. This retrospective cohort study included pregnant and postpartum people who self-identified as either Black or White, and received prenatal care at academic faculty offices affiliated with an urban quaternary medical center. Individuals were divided into two cohorts to reflect the epochs of implementation. The primary outcome was the frequency of depression screening. The secondary outcome was the frequency of provision of a treatment recommendation for those with a positive depression screen. Antenatal and postpartum care were analyzed separately. A propensity score was used in multivariable models to control for confounders chosen a priori across implementation epoch. Interaction terms were created between race and implementation epoch to identify whether effect modification was present. Subgroup analyses were performed for outcomes with significant race-by-epoch interaction terms. Of the 4,710 individuals included in these analyses, 4,135 (87.8%) self-identified as White and 575 (12.2%) self-identified as Black. Before implementation, Black individuals were more likely to receive screening (adjusted odds ratio [aOR] 2.44) but less likely to have a treatment recommended when a positive screen was identified (aOR 0.05). In multivariable models, race-by-epoch interaction terms were significant for both antenatal screening (P<.001) and antenatal treatment recommendation (P=.045), demonstrating that implementation of the perinatal collaborative care model was associated with reductions in extant racial disparities. After implementation, there were no significant differences by race (referent=White) in screening for antenatal depression (aOR 1.22, 95% CI 0.89-1.68) or treatment recommendations for those who screened positive (aOR 0.64, 95% CI 0.27-1.53). Race-by-epoch interaction terms were not significant in multivariable models for either postpartum screening or treatment recommendation. Implementation of the perinatal collaborative care model is associated with a mitigation of racial disparities in antenatal depression care and may be an equity-promoting intervention for maternal health.

Subjective Assessments of Quality of Life Are Independently Associated with Depressive Symptoms among Older Adults Enrolled in Primary Care in Chile.

In Chile, depressive symptoms are highly prevalent among Chilean older adults, and research that examines the factors associated with them is scarce. This study aimed to determine if subjective assessments of quality of life are associated with positive screen for depressive symptoms among older adults enrolled in primary care in Chile. The participants of the study were people aged 70 years or more enrolled in primary care centers in three Chilean cities. The 15-item Geriatric Depression Scale was used to determine depressive symptoms. Multivariate logistic models were used to determine the associations. Overall, 17.28% men, and 26.47% women (p = 0.003) screened positive for depression. Subjective assessments of quality of life, including self-perceived health, memory, quality of life, and pain, were associated with a positive screen for depression. Only 17.65% of men and 43.55% of women who screened positive for depressive symptoms reported a diagnosis of depression. Assessments of quality of life in health checks of older adults in primary care could contribute to narrow the diagnosis and treatment gap by improving the ability to identify those who are more likely to experience depressive symptoms.