Pre-existing Mental Health Diagnoses Research Articles

Longitudinal change in symptoms of depression, anxiety and post-traumatic stress disorder during the COVID-19 pandemic among Mexican college students.

Longitudinal studies suggest the psychological difficulties precipitated by the COVID-19 pandemic have gradually declined, but our understanding of the factors that predict change in mental health is limited. We evaluated the mental health of Mexican college students during the early stage of the pandemic and 4 months later, as well as predictors of change in students' mental health. Participants were 648 students (71% women, Mage = 21.46) from a private University in Northern Mexico who completed online surveys from May 2020 to September 2020. Students' self-reported levels of mental health symptoms (depression, anxiety and post-traumatic stress disorder) significantly decreased from May to September. Poor physical health, more COVID-related worry and higher initial levels of peer social support predicted less change in psychological symptoms. On the other hand, more hours of sleep per night and a pre-existing mental health diagnosis predicted steeper decreases in symptoms. Findings suggest reductions in mental health difficulties that are consistent with theoretical frameworks of resilience among Mexican college students. In addition, results underscore the interplay between physical, psychological and social functioning, and the need for continued monitoring of mental health and intervention efforts that address physical health, sleep and pandemic-related worry in University settings.

Dose-Response Effect of Mental Health Diagnoses on Concussion Recovery in Children and Adolescents.

Pre-existing mental health diagnoses may contribute to greater emotional symptom burden and prolonged recovery after concussion. Youth with pre-existing mental health diagnoses will have greater emotional symptom burden, greater risk for delayed return to exercise, and more prolonged recovery from concussion than those without those diagnoses. Prospective cohort. Level 3. A prospective registry of youth concussion was examined for differences in emotional symptom burden after injury to develop a predictive risk model for prolonged recovery. The impact of individual and total number of pre-existing mental health diagnoses (0, 1, 2, and 3+) was assessed, and multivariable logistic regression was performed to identify factors associated with prolonged recovery. Among a cohort of 3105 youth with concussion, those with a history of mental health diagnoses, in a dose-response fashion, had greater postinjury emotional symptom burden (7 emotional symptoms vs 4; P < 0.01), visio-vestibular dysfunction (65% abnormal vs 56% abnormal; P < 0.01), later return to symptom-limited exercise (23 vs 21 days; P < 0.01), and overall longer concussion recovery (38 days, interquartile range [IQR] 18, 80) versus 25 days (IQR 13, 54; P < 0.01). Boys with prolonged recovery after concussion had greater emotional symptom burden than girls (5 emotional symptoms vs 3; P < 0.01). Pre-existing mental health diagnoses are associated with greater postinjury emotional symptom burden and longer concussion recovery in a dose-response fashion. Visiovestibular deficits and delayed return to exercise are also associated with pre-existing mental health diagnoses and prolonged recovery. Boys with prolonged recovery from concussion experience greater emotional symptom burden than girls. Addressing pre-existing mental health diagnoses is essential to concussion management. Boys with prolonged recovery from concussion may particularly benefit from interventions to address their higher emotional symptom burden. Interventions, including a home visio-vestibular exercise program and symptom-limited exercise, may contribute to improving time to concussion recovery.

Impact of pre-existing mental health diagnoses on development of post-COVID and related symptoms: a claims data-based cohort study

This study aimed to examine the association of prior mental health diagnoses with the onset of Post-COVID-19 condition (PCC). We conducted a retrospective comparative cohort study and secondary analysis of routinely collected claims data from participants in statutory health insurance in Bavaria, Germany, from January 2015 to June 2022. Study participants were 619,560 patients with confirmed COVID-19, 42,969 with other respiratory tract infection (ORI), and 438,023 controls. Using diagnoses coded according to the German modification of the ICD-10, the associations between prior mental health diagnoses and a PCC diagnosis (primary outcome) or associated symptoms (secondary outcomes) were estimated using multiple Cox proportional hazards regression models. Mental disorders (hazard ratio [HR] 1.36, 95% confidence interval [CI] 1.30–1.42), anxiety (HR 1.14, 95% CI 1.07–1.20), depression (HR 1.25, 95% CI 1.19–1.30) and somatoform disorders (HR 1.30, 95% CI 1.24–1.36) were associated with higher risks for PCC. Mental disorders were associated with the same or even greater risk for a diagnosis of malaise and fatigue in the control cohort (HR 1.71, 95% CI 1.52–1.93) and ORI cohort (HR 1.43, 95% CI 1.20–1.72), than in the COVID-19 cohort (HR 1.43, 95% CI 1.35–1.51). In summary, prior mental comorbidity was associated with an increased risk of PCC and its associated symptoms in all cohorts, not specifically in COVID-19 patients.

The relationship of climate change awareness and psychopathology in persons with pre-existing mental health diagnoses

IntroductionPersons with pre-existing mental health diagnoses are known to be more vulnerable to the consequences of climate change, such as extreme weather events and rising temperatures. However, it remains unclear if this holds true for adverse effects of climate change awareness, too.MethodsN = 89 patients of a psychosomatic outpatient clinic were assessed with well-established mental health questionnaires (PHQ-9 for depressive, GAD-7 for anxious, and PTSS-10 for post-traumatic symptoms) in their original form and in a modified version (PHQ-9-C, GAD-7-C, PTSS-10-C) specifically asking for patients’ symptom load regarding climate change awareness, and instruments evaluating personality factors (OPD-SF, SOC, RQ).Results21% of the sample reported at least mild symptoms of anxiety regarding climate change awareness, and 11% mild symptoms of depression due to climate change awareness. General anxiety (GAD-7) scores significantly predicted if people reported any psychological symptoms due to climate change awareness. In multiple regression analyses, higher scores of clinical symptoms of depression, anxiety or post-traumatic stress predicted higher scores of depressive, anxious or post-traumatic symptoms regarding climate change awareness, and higher scores of psychological symptoms regarding climate change awareness predicted each other. Younger participants reported significantly more traumatic symptoms regarding climate change awareness.DiscussionThe reported mental health impairments regarding climate change awareness in persons with pre-existing mental health diagnoses indicate an increased vulnerability. Hereby, depressive mental health burden seems to induce a predominantly depressive processing of climate change resulting in climate chance related depression. This holds also true for anxious and traumatic symptoms, and points toward biased attentional and memory processes and mood congruent processing.

COVID-19 Pandemic and the Incidence of Postpartum Depression: a Retrospective Cohort Study

Introduction: To estimate the association between COVID-19 and postpartum depression (PPD) in a retrospective cohort study. Material and methods: Pregnant women who delivered between September 2019-June 2021 at a Mouth Sinai Health System practice in New York City were identified. Baseline information about maternal health, pregnancy outcomes, and postpartum visits were obtained from electronic health records. Edinburgh Postnatal Depression Scores (EPDS) were used as a postpartum depressive symptom marker. Three analyses were performed to compare scores between: (1) women who delivered before and after COVID-19, (2) pregnant women who delivered after the pandemic who did and did not contract COVID-19, and 3) pregnant women eligible for the COVID-19 vaccine who were and were not vaccinated. Results: A total of 1.797 pregnant women were identified. Pregnant women during the pandemic had statistically significant higher rates of pre-existing mental health diagnoses and psychiatric medicine use compared to those who were pregnant before. No difference was observed in EPDS scores of pregnant women who delivered before vs. after the start of COVID-19 nor between COVID-vaccinated and unvaccinated pregnant women. Women who contracted COVID-19 in pregnancy had lower EPDS scores than women who did not. Results remain unchanged after controlling for baseline mental health diagnoses. Conclusions: In our cohort, EPDS scores were not associated with pregnancy during the pandemic, COVID infection while pregnant, or COVID vaccination during pregnancy. However, we did identify a higher incidence of baseline mental health diagnoses during the COVID pandemic, but that did not lead to a higher rate of positive screens for postpartum depression.

Characterizing long-COVID brain fog: a retrospective cohort study.

Long COVID or post-COVID condition (PCC) is a common complication following acute COVID-19 infection. PCC is a multi-systems disease with neurocognitive impairment frequently reported regardless of age. Little is known about the risk factors, associated biomarkers and clinical trajectory of patients with this symptom. To determine differences in clinical risk factors, associated biochemical markers and longitudinal clinical trajectories between patients with PCC with subjective neurocognitive symptoms (NC+) or without (NC-). A retrospective longitudinal cohort study was performed using a well-characterized provincial database of patients with clinically confirmed PCC separated into NC+ and NC- cohorts. Demographical, clinical and biochemical differences at initial consultation between the two patient cohorts were analyzed in cross-section. Multivariate regression analyses were conducted to identify independent risk factors for neurocognitive impairment. Determination of the recovery trajectory was performed using serial assessments of the patient-reported health-related quality of life (HR-QoL) metric Eq-5D-5L-vas score. Women, milder acute infection and pre-existing mental health diagnoses were independently associated with subjective neurocognitive impairment at 8months post-infection. NC + patients demonstrated lower levels of IgG, IgG1 and IgG3 compared to NC- patients. The NC + cohort had poorer HR-QoL at initial consultation 8months post-infection with gradual improvement over 20months post-infection. Neurocognitive impairment represents a severe phenotype of PCC, associated with unique risk factors, aberrancy in immune response and a delayed recovery trajectory. Those with risk factors for neurocognitive impairment can be identified early in the disease trajectory for more intense medical follow-up.

1798-PUB: Clinical Factors Associated with Positive Depression Screen in Youth with Type 1 Diabetes Before and During the COVID 19 Pandemic

We have previously shown that 1 out of 5 adolescents with type 1 diabetes (T1D) scored positive for depression with no differences between 2019 (pre pandemic) vs 2020 (pandemic). We aimed to identify clinical factors associated with a positive screen and if these differ pre (2019) and during (2020) the pandemic in a large academic children’s hospital. We included 239 adolescents with T1D who completed a PHQ-9 screen in both years (52% female, 97 % non-Hispanic white, mean (SD) age 15.1 ± 1.7 years, T1D duration 7.0 ± 4.0 years, 54% and 63% were on insulin pumps, 68% and 62% were on continuous glucose monitors in 2019 and 2020 respectively. In 2019 12%, 4% and 3% had mild (PHQ-9 score 5-9), moderate (score 10-14), and severe (score &amp;gt;15) depression respectively with similar rates in 2020 at 9%, 3% and 3%. In univariable logistic regression, elevated HbA1c (OR 1.59, p&amp;lt;0.001) and prior mental health history (OR 15.5, p&amp;lt;0.001) increased the odds of a positive screen in 2019, but not age (p=0.94), diabetes duration (p=0.64) or pump/CGM use (p=0.33/p=0.16). Similar findings were seen in 2020. Proportion of adolescents with a positive 2019 screen who were not in counseling (n=6, 14%) doubled in 2020 (n=10, 29%), possibly reflecting inadequate access to services during the pandemic, albeit small numbers. There was no association between a positive depression screen and screening for comorbidities (thyroid, celiac disease, and dyslipidemia) or complications (nephropathy and retinopathy) in 2019 or 2020. Though the prevalence of depression did not change during the pandemic, the most vulnerable groups were those with pre-existing mental health diagnoses and uncontrolled diabetes. This highlights the need for continued mental health therapy services in this group. Screening for comorbidities or complications was not associated with a positive depression screen which is reassuring and may relate to these screens being done in clinic, including screening for retinopathy. Disclosure S.Sriram: None. C.March: None. L.M.Leikam: None. J.Schreiber: None. R.Muzumdar: None. I.Libman: Advisory Panel; Novo Nordisk.

Mental health care utilization among men with castration-resistant prostate cancer receiving abiraterone or enzalutamide.

Abiraterone and enzalutamide are castration-resistant prostate cancer (CRPC) therapies with potentially distinct associations with mental health symptoms given their differing antiandrogen targets. We used national Veterans Health Administration data to identify patients with CRPC who received first-line abiraterone or enzalutamide from 2010 to 2017. Using Poisson regression, we compared outpatient mental health encounters per 100 patient-months on drug between the abiraterone and enzalutamide cohorts adjusting for patient factors (e.g., age). We compared mental health encounters in the year before versus after starting therapy using the McNemar test. We identified 2902 CRPC patients who received abiraterone (n = 1992) or enzalutamide (n = 910). We found no difference in outpatient mental health encounters between the two groups (adjusted incident rate ratio [aIRR] 1.04, 95% confidence interval [CI] 0.95-1.15). However, men with preexisting mental health diagnoses received 81.3% of the outpatient mental health encounters and had higher rates of these encounters with enzalutamide (aIRR 1.21, 95% CI 1.09-1.34). Among patients with ≥1 year of enrollment before and after starting abiraterone (n = 1139) or enzalutamide (n = 446), there was no difference in mental health care utilization before versus after starting treatment (17.0% of patients vs. 17.6%, p = 0.60, abiraterone; 16.4% vs. 18.4%, p = 0.26, enzalutamide). We found no overall differences in mental health care utilization between CRPC patients who received first-line abiraterone versus enzalutamide. However, men with preexisting mental health diagnoses received the majority of mental health care and had more mental health visits with enzalutamide.

Changes in UK parental mental health symptoms over 10months of the COVID-19 pandemic.

The threats to health, associated restrictions and economic consequences of the COVID-19 pandemic have been linked to increases in mental health difficulties for many. Parents, in particular, have experienced many challenges such as having to combine work with home-schooling their children and other caring responsibilities. Yet, it remains unclear how parental mental health has changed throughout the pandemic or what factors may have mitigated or compounded the impact of the pandemic on parents' mental health. We examined monthly survey data from two linked UK-based longitudinal studies: COVID-19: Supporting Parents, Adolescents and Children during Epidemics' (Co-SPACE) and COVID-19: Supporting Parents and Young Children during Epidemics' (Co-SPYCE). Data from 5576 parents/carers of 2-17-year-old children collected between April 2020 and January 2021 was analysed using mixed-effect modelling and latent class growth (mixture) modelling. Parental stress and depression, but not anxiety, were higher during the periods of restrictions. This pattern was most pronounced for parents with primary-school-aged children, those that worked at home or had other adults in the household. Being younger, reporting secondary or below education, working out of home, having secondary-school-aged children or children with special education needs (SEN)/neurodevelopmental disorders (ND) further moderated whether, how and when parental mental health symptoms changed. Although around three quarters of parents reported consistently low mental health symptoms, a substantial minority reported consistently high or increasing symptoms of anxiety, stress and depression. The latter were more likely to be parents who were younger than average, were a single adult in the household, had a pre-existing mental health diagnosis or had a child with special educational needs or a ND. These findings emphasise how different personal circumstances and pre-existing inequalities shaped how parents were affected by this unprecedented global pandemic and highlight the need for support and consideration to meet the needs of families in the future.

Clinical covariates of self-harm and suicidality in a community sample of Irish Travellers

IntroductionIrish Travellers are an indigenous minority group in Ireland. Health inequalities have been widely reported within the Traveller community, with a shorter life expectancy of 11 years less than the general population. Travellers also have higher mortality rates of 3.5 times higher than the general population in Ireland. Suicide is a serious problem in the Traveller community with a suicide rate of 11% among Travellers: 6 times higher in women and 7 times higher in men compared with their counterparts in the general population.ObjectivesThere is a paucity of research into the clinical characteristics of self-harm and suicidality among Irish Travellers despite the elevated suicide rates in this community. This study aims to bridge the knowledge gap in the mental health of Irish Travellers, focusing on the clinical factors associated with self-harm and suicidality in a community sample of Irish Travellers.MethodsThis is a cross-sectional study. Study participants completed self-report and interview-based validated questionnaires that screen for anxiety (General Anxiety Disorder assessment: GAD-7), depression (Patient Health Questionnaire: PHQ-9), and suicidality (Suicide Behaviours Questionnaire-Revised: SBQ-R and Adult Suicidal Ideation Questionnaire: ASIQ). Ethical approval was granted through the Clinical Research Ethics Committee, University College Dublin.ResultsDespite an active recruitment campaign, participation rate from Irish Travellers in this study was low, with only five participants completing this study. Three were male. The mean age of the study participants was 39±14.7 years. All had pre-existing mental health diagnoses, most commonly anxiety disorder. All had at least one previous episode of self-harm and 80% had a positive family history of self-harming behaviour. No participants reported a history of alcohol or substance misuse. Over half of the participants reported severe anxiety and depressive symptoms with median GAD-7 score of 19 and PHQ-9 score of 21 respectively. All participants demonstrated significant risk of suicidal behaviour based on their SBQ-R and ASIQ scores.ConclusionsDespite elevated rates of suicidality and mental illness in this ethnic minority group, Irish Travellers demonstrated lower participation in mental health research, including this study. These recruitment challenges suggest that factors such as stigma, shame and lack of trust may be contributory. These factors may also act as barriers to them accessing mental healthcare when they develop mental health symptoms such as anxiety and depression, associated with increased risk of self-harm and suicidal behaviours. There is a need for better engagement strategies with Travellers to promote awareness into their needs and reduce mental health problems in this population.Disclosure of InterestNone Declared

The trajectory of mental health problems for UK emerging adults during COVID-19

Initial COVID-19 restrictions were associated with declining mental health, particularly in UK emerging adults. Prior research has yet to examine changes in mental health in this demographic over the entire course of the three UK national lockdowns. Drawing upon the Understanding Society COVID-19 Survey, this study examined the trajectory of mental health problems for emerging adults (18-29-year-olds) from April 2020–September 2021. Mental health problems were assessed at nine time-points using the General Health Questionnaire. The analytic sample included 1018 participants (304 males, 714 females). Growth curve modelling was used to examine the trajectory of mental health problems and the associated sociodemographic and health covariates. Females and those with fewer household members, lower income, no private garden, and pre-existing mental or physical health diagnoses reported more mental health problems. Gender differences were evident in the rate of change. Females' mental health problems declined from the first lockdown until just after the relaxation of initial restrictive measures (September 2020), increased until April 2021 (constituting lockdowns two and three), and then slightly decreased until September 2021 during the phased exit from restrictions. Males’ mental health problems followed a similar trajectory, with a greater rate of increase in mental health problems from July 2020–April 2021, and a greater rate of decline from April–September 2021. Females reported more mental health problems throughout the three national lockdowns than males. These findings can inform public health policies targeted toward young adult populations and highlight sub-populations at greater risk of worsening mental health.

COVID-19-related health worries and generalized anxiety symptoms: Higher risks in perinatal women without a pre-existing generalized anxiety diagnosis

The perinatal period has been well-established as a time of vulnerability to anxiety, as has the COVID-19 pandemic. Perinatal women with a prior diagnosis of Generalized Anxiety Disorder (GAD) may be anticipated to be at particular risk for elevated symptom burden when facing the overlay of these stressors. This study examined whether pre-existing anxiety exacerbates COVID-19-related health worries on anxiety symptom severity among a sample of women who entered perinatal status during the COVID-19 pandemic. We assessed COVID-19-related health worries, past diagnosis of GAD, and current generalized anxiety symptoms cross-sectionally in 1,587 perinatal U.S. women during the COVID-19 pandemic (May 21, 2020 to June 24, 2021). Among perinatal women who reported high levels of COVID-19-related health worries, those with a pre-existing GAD diagnosis were 3.56 times more likely to score at clinically significant levels of generalized anxiety, while those without a pre-existing GAD diagnosis were 6.51 times more likely. COVID-19-related health worries posed a larger risk for elevated anxiety symptoms among those without a pre-existing diagnosis of GAD. Greater access to treatment and psychoeducation for such individuals may be warranted for individuals without a pre-existing mental health diagnosis.

Mental health in the injured athlete–why the spikes protocol matters

Athletes are a unique subset of patients that pose unique challenges to the treating physician. The mental health of injured athletes is becoming increasingly recognized as a vital part of adequate care of these patients. Numerous studies link poor mental health function and pre-existing mental health diagnoses to poor outcomes including delayed return to play, inability to return to play, risk of re-injury, and exacerbation of underlying mental health problems. Because this is a topic not often studied by team physicians and this manuscript aims to provide a practical tool to help these physicians communicate with injured athletes. The SPIKES protocol is an effective way to acknowledge and adequately communicate with this unique patient population.

Stressful experiences impact clinical symptoms in people with endometriosis

Endometriosis is a chronic condition that affects ~10% of women globally. Its symptoms include chronic pelvic pain, heavy periods and tiredness/fatigue, which have been associated with poorer quality of life and mental health. We aim to explore the impact of the COVID-19 pandemic on pain and fatigue symptoms and their interactions with the impact on mental health in people with endometriosis. This global cross-sectional online survey study collected data from 4717 adults with self-reported surgical/radiological diagnosis of endometriosis between May and June 2020. The survey included questions on the current status and changes of endometriosis symptoms (pelvic pain, tiredness/fatigue, and bleeding patterns), mental health, pain catastrophising, and the impact of the COVID-19 pandemic on the respondents’ lives. Compared to 6 months earlier, Respondents reported a marked worsening of their endometriosis symptoms (endometriosis-associated pain (39.3%; 95% CI: 37.7, 40.5), tiredness/fatigue (49.9%; 95% CI: 48.4, 51.2) and bleeding patterns (39.6%; 95% CI: 38.2, 41)) and mental health (38.6%; 95% CI: 37.2, 39.9). Those with a pre-existing mental health diagnosis (38.8%) were more likely to report their symptoms worsening. Worsening of pain and tiredness/fatigue was significantly correlated with worsening of mental health (P &lt; 0.001). The relationship between changes in mental health and (a) change in pain and (b) change in fatigue was found to be weakly mediated by pain catastrophising scores (pain: B = 0.071, lower limit of confidence interval (LLCI) = 0.060, upper limit of confidence interval (ULCI) = 0.082, tiredness/fatigue: B = 0.050, LLCI = 0.040, ULCI = 0.060). This study demonstrates that stressful experiences impact the physical and mental health of people with endometriosis. The findings highlight the need to consider psychological approaches in the holistic management of people with endometriosis. Lay summary Endometriosis is a chronic condition in which tissue similar to that of the lining of the womb grows outside it. It affects around 10% of women globally, and the symptoms often include persistent pelvic pain, heavy periods and tiredness/fatigue. These symptoms are associated with impaired mental health and life quality. This study used an online questionnaire to assess the experiences of people with endometriosis during the first months of the pandemic. Results from 4717 adults revealed that pelvic pain, tiredness/fatigue and bleeding worsened in more than 39% of the participants. Poor mental health was also exacerbated and associated with worsening in tiredness/fatigue. Further analysis revealed that this relationship could be partially explained by ‘pain catastrophising’, which measures how participants think about their pain. Our results suggest that stressful experiences like the pandemic negatively impact the already burdened mental health of people with endometriosis, who could benefit from psychological interventions.

Screening for inattention, hyperactivity and impulsivity in children with haemophilia: A quality improvement intervention.

Children with haemophilia have been reported with increased rates of inattention (IN) and hyperactivity/impulsivity (HI) and, therefore, are particularly vulnerable to poor social and academic outcomes. To examine the benefit of utilizing a formal screening process for IN/HI in children with haemophilia during comprehensive clinic visits using a quality improvement approach. At a single haemophilia treatment centre, screening for psychosocial issues was expanded and formalised to include (1) the Conners 3rd Edition (Conners3) screening tool for IN/HI symptoms administered during the standard psychosocial assessment (SPA) by the social worker and school advocacy coordinator, (2) formal pathways to diagnosis and intervention as indicated including psychology consultation, psychological testing, or referral to community-based mental health professionals, and in-person advocacy assistance in the patient's community school. Forty-four patients, age 9.9±4.8 years (range 3-16) were targeted. The initial screening approach was modified to improve the communication with caretakers during assessments and streamline diagnostic pathways if no, moderate or significant behavioural concerns were identified. Eleven patients had pre-existing mental health diagnoses. Thirteen of the remaining 33 patients (39.4%) received a new mental health diagnosis, ADHD in 8/33 (24.2%). Of the total cohort, 54.5% were found to have a mental health diagnosis. The rate of ADHD (29.5%) was significantly higher than reported in the general population. The described process, developed through a QI approach, allowed formal and objective screening for IN/HI, streamlined a pathway to diagnosis and intervention, and identified undiagnosed disabilities in children with haemophilia improving their access to services.

Pre-existing Mental Health Diagnoses Are Associated With Higher Rates of Postoperative Complications, Readmissions, and Reoperations Following Arthroscopic Rotator Cuff Repair

To investigate the association between preoperative mental health disorders and postoperative complications, readmissions, and ipsilateral revision procedures among patients undergoing arthroscopic rotator cuff repair (RCR). A retrospective cohort study from 2010 to 2020 was performed using the PearlDiver database. Current Procedural Terminology and International Classification of Diseases codes were used to compare patients with and without mental health disorders who underwent arthroscopic RCR. Mental health disorders evaluated in this study include depressive disorder, major depressive disorder, major depressive affective disorder, bipolar disorder, dysthymic disorder, adjustment disorder, separation anxiety disorder, and posttraumatic stress disorder. Patients were matched at a 1:1 ratio based on age, sex, Charlson Comorbidity Index, body mass index, and tobacco use. Rates of complications and subsequent surgeries were compared between patients with and without a preoperative diagnosis of a mental health disorder. The 1-year preoperative prevalence of a mental health disorder from 2010 to 2020 was 14.6%. After 1:1 matching, patients with a mental health disorder who underwent arthroscopic RCR were nearly twice as likely to undergo a revision procedure (odds ratio 1.94, 95% confidence interval 1.76-2.14, P < .001) and more than twice as likely to experience conversion to shoulder arthroplasty (odds ratio 2.29, 95% confidence interval 1.88-2.80, P < .001) within 2 years of initial arthroscopy when compared with patients without a mental disorder. Patients with a mental disorder also experienced increased risk for 90-day readmission (1.9% vs 0%, P < .001) as well as multiple postoperative medical complications. Patients with pre-existing mental health diagnoses experience increased rates of 90-day postoperative complications and readmissions following arthroscopic RCR. In addition, patients with mental health diagnoses are more likely to undergo revision repair and conversion to shoulder arthroplasty within 2 years of the index procedure. Level III.

Effect of Gender-affirming Facial Feminization Surgery on Psychosocial Outcomes.

This study investigates the effect of gender-affirming facial feminization surgery (FFS) on psychosocial outcomes in patients with gender dysphoria. Comprehensive analyses of psychosocial outcomes after gender-affirming FFS are absent in the literature resulting in a paucity of information on the impact of FFS on quality of life as well as ramifications in health insurance coverage of FFS. Scores from 11 validated, quantitative instruments from the Patient-Reported Outcomes Measurement Information System (PROMIS) assessing anxiety, anger, depression, global mental health, global physical health, satisfaction with sex life, positive affect, emotional support, social isolation, companionship, and meaning and purpose. Patients within the preoperative group (pre-FFS) were evaluated >30 days before surgery and patients within the postoperative group (post-FFS) were evaluated ≥10 weeks after surgery. A total of 169 patients [mean (SD) age, 33.5 (10.8) years] were included. Compared with the pre-FFS group (n=107), the post-FFS group (n=62) reported improved scores anxiety (56.8±8.8 vs 60.1±7.9, P =0.01), anger (47.4±7.6 vs 51.2±9.6, P =0.01), depression (52.2±9.2 vs 57.0±8.9, P =0.001), positive affect (46.6±8.9 vs 42.9±8.7, P =0.01), meaning and purpose (49.9±10.7 vs 46.2±10.5, P =0.03), global mental health (46.7±7.6 vs 43.1±9.2, P =0.01), and social isolation (52.2±7.5 vs 55.4±7.4, P =0.01). Multivariable analysis to account for the effects of other gender-affirming surgeries, hormone therapy duration, preexisting mental health diagnoses, socioeconomic disparities, and patient-reported quality of social relationships on psychosocial functioning demonstrated that completion of FFS was independently predictive of improved scores. Gender-affirming FFS improves the quality of life by multiple psychosocial domains in transfeminine patients.

82. Gender-Affirming Facial Feminization Surgery Improves Patient-Reported Psychosocial Outcomes

Purpose: Comprehensive, prospective analyses of psychosocial outcomes after gender-affirming facial feminization surgery (FFS) are absent in the literature resulting in a knowledge gap on the effects of FFS on quality of life as well as ramifications in access to care for patients through health insurance coverage. The aim of this work is to determine the effect of gender-affirming FFS on psychosocial outcomes in patients with gender dysphoria by administering 11 validated, quantitative patient-reported outcomes measures. Methods: A prospective cohort study of patients evaluated for de novo gender-affirming FFS (2019-2021) at the University of California Los Angeles was conducted. Patients were prospectively administered 11 psychosocial assessments from the Patient-Reported Outcomes Measurement Information System before (>21 days preoperatively) and after (>90 days postoperatively) FFS. Patients who presented for revision FFS were excluded. Comparison of preoperative and postoperative groups were performed using Chi square analyses, independent t tests, and Mann Whitney U tests. Multivariable linear regression analyses were conducted for each of the psychosocial outcomes scores to assess the effects of the following independent variables: completion of FFS, completion of other gender-affirming surgeries, duration of hormone therapy for medical transition, presence of pre-existing mental health diagnoses, and socioeconomic disparities as defined by type of health insurance (private versus public). Selection of the independent variables for inclusion in the regression model was based on the known effects of each variable on psychosocial functioning in transgender patients. Results: 190 patients (mean age 33.1±10.6 years) were included. Compared with the preoperative FFS group (n=136), patients who completed FFS (n=54) reported improved scores in 6 of the 11 measures including anxiety (56.8±8.4 vs. 60.0±8.2, p=0.02), depression (52.2±8.7 vs. 56.7±8.9, p=0.002), positive affect (46.7±8.6 vs. 42.8±8.8, p=0.007), meaning and purpose (50.4±11.2 vs. 46.0±10.6, p=0.02), global mental health (46.4±7.1 vs. 43.3±9.0, p=0.02), and social isolation (51.8±7.5 vs. 55.2±7.9, p=0.02). Multivariable analysis to account for the effects of other gender-affirming surgeries, hormone therapy duration, pre-existing mental health diagnoses, and socioeconomic disparities on psychosocial functioning demonstrated that completion of FFS was independently predictive of improved psychosocial outcomes scores in the 6 measures. Conclusions: Gender-affirming facial feminization surgery improves anxiety, depression, positive affect, meaning and purpose, global mental health, and social isolation in patients with gender dysphoria.

Suicide Among Women and the Role of Women's Health Care Providers.

Suicide is a leading cause of death in the United States, with increasing rates among women. Women are more likely to experience suicidal ideation and engage in suicide behavior than men, and risk is elevated at key points where they may engage in care with a women's health care provider. This review describes the prevalence of and risk factors for suicide among women and highlights the role of obstetrician-gynecologists in suicide prevention. A PubMed, MEDLINE, and PsycINFO search was completed for English-language publications about suicide among women, including subtopics (eg, perinatal suicide, suicide during perimenopause). There are overlapping risk factors that contribute to suicide among women, including intimate partner violence and substance use. Specific groups of women may present with unique risk factors, such as women veterans, women in rural areas, and women with preexisting mental health diagnoses, particularly serious mental illnesses. Some women at risk for suicide are not seen in clinical settings, and thus community interventions may be beneficial. There are roles for obstetrician-gynecologists within and outside of the clinic to prevent suicide. Obstetrician-gynecologists can save lives by being aware of the prevalence of suicide ideation and behavior among women, understanding risk factors for suicide over the lifespan, regularly screening for these factors, asking directly about suicide ideation and intent, and being aware of clinical and community resources. Outside of the clinic, they can advocate for increased health care access and community-based interventions. These efforts can contribute to the reduction of preventable death and maternal mortality.

Mental health symptoms in children and adolescents during COVID-19 in Australia.

COVID-19 has led to disruptions to the lives of Australian families through social distancing, school closures, a temporary move to home-based online learning, and effective lockdown. Understanding the effects on child and adolescent mental health is important to inform policies to support communities as they continue to face the pandemic and future crises. This paper sought to report on mental health symptoms in Australian children and adolescents during the initial stages of the pandemic (May to November 2020) and to examine their association with child/family characteristics and exposure to the broad COVID-19 environment. An online baseline survey was completed by 1327 parents and carers of Australian children aged 4 to 17 years. Parents/carers reported on their child's mental health using five measures, including emotional symptoms, conduct problems, hyperactivity/inattention, anxiety symptoms and depressive symptoms. Child/family characteristics and COVID-related variables were measured. Overall, 30.5%, 26.3% and 9.5% of our sample scored in the high to very high range for emotional symptoms, conduct problems and hyperactivity/inattention, respectively. Similarly, 20.2% and 20.4% of our sample scored in the clinical range for anxiety symptoms and depressive symptoms, respectively. A child's pre-existing mental health diagnosis, neurodevelopmental condition and chronic illness significantly predicted parent-reported child and adolescent mental health symptoms. Parental mental health symptoms, having a close contact with COVID-19 and applying for government financial assistance during COVID-19, were significantly associated with child and adolescent mental health symptoms. Our findings show that Australian children and adolescents experienced considerable levels of mental health symptoms during the initial phase of COVID-19. This highlights the need for targeted and effective support for affected youth, particularly for those with pre-existing vulnerabilities.