Primary Care Sample Research Articles

Examining Changes in Behavioral, Emotional, and Tic Symptoms in a Pediatric Sample in the First Year of the Pandemic.

Previous studies have documented worsening behavioral and emotional symptoms in children during the COVID-19 pandemic, although much focus has been on internalizing conditions with relatively short follow-up time. We examined a range of symptoms before and during the pandemic through mid-2021 in a primary care sample. Children 4-17 (n = 181) who completed emotional and behavioral assessments prior to the pandemic and then completed a follow-up assessment during the pandemic were included in our analyses. We examined changes in broad-based and clinical scales, including the Behavior Assessment System for Children and the Diagnostic and Statistical Manual of Mental Disorders, across the total sample and among subgroups using paired t-tests. Subgroups included sex, race, and ethnicity, and baseline internalizing, externalizing, and adaptive scores. Children without clinically significant elevations in internalizing, externalizing, and adaptive scores at baseline experienced worsening of symptoms in a greater number of areas than children with clinically significant elevations at baseline. Females and Black children tended to experience greater worsening of symptoms than males and White children, respectively. Our findings suggest worsening symptoms in children persisting one year into the pandemic, particularly for those without clinically significant symptoms at baseline.

Associations among sleep quality, cognitive processing therapy, and posttraumatic stress disorder symptoms in a primary care setting.

Evidence describing the association between sleep quality and trauma-focused therapy is mixed. This secondary analysis of a primary care sample examined whether (a) baseline sleep quality moderated posttraumatic stress disorder (PTSD) symptom severity over time across groups receiving different doses of cognitive processing therapy (CPT) and (b) sleep quality improved over time with CPT. Participants were 227 adults who screened positive for PTSD and were participating in a clinical trial comparing two models of PTSD treatment delivery in primary care. The Pittsburgh Sleep Quality Index (PSQI) and PTSD Checklist for DSM-5 (PCL-5) were used to assess sleep disturbance and PTSD symptom severity, respectively. Multiple linear regression was used to assess whether baseline PSQI scores moderated 12-month PCL-5 scores across CPT dosage groups (0 sessions: 51.1%, 1-7 sessions: 31.7%; ≥ 8 sessions [adequate dose]: 17.2%) and whether PSQI scores differed by group at 12-month follow-up. Post hoc analyses examined changes in PCL-5 sleep disturbance items. Baseline sleep disturbance did not moderate the effect of CPT on PTSD severity among participants with an adequate CPT dose, p>.112.Sleep quality improved with adequate dose, B = -2.63, SE = 0.75,p<.001. Differences in change scores across groups for PCL-5 Item 2,F(2, 435) = 11.34,and Item 20,H(2) = 32.04, indicated that participants with an adequate CPT dose had greater reductions in trauma-related sleep symptoms than those who received 0-7 sessions, ps <.001. Residual post-CPT sleep impairment despite adequate PTSD improvement warrants further interventions.

Dimensionality, Sensitivity and Specificity of Different Versions of the Shirom-Melamed Burnout Questionnaire/Measure in Clinical and Non-Clinical Populations.

The Shirom-Melamed Burnout Questionnaire/Measure (SMBQ/SMBM) is a self-report instrument frequently used for assessing degree of burnout and screening for stress-related exhaustion disorder. The aim of the present study was three-fold. First, to examine reliability and construct validity of different versions of SMBM with 6-22 items in a clinical context. Second, to examine the criterion validity by assessing sensitivity and specificity and determining clinical cut-offs for these versions of the SMBM, and third to examine the prevalence of burnout in a general population and primary care sample using the proposed cut-offs. Two Swedish samples were used for the first two purposes: a clinical sample of patients diagnosed with exhaustion disorder (n=149), and a matched sample of healthy controls (n=60). For the third purpose a sample from the general population (n=3406), and a primary care clinical sample (n=326) was used. The modified versions of the SMBM showed good internal consistency, construct validity, dimensionality and model fit on the clinical exhaustion disorder sample, as well as configural measurement invariance across clinical and non-clinical samples. The sensitivity (94.6%-95.3%) and specificity (93.3%-95.0%) in identifying cases with exhaustion disorder based on the cut-off of 4.0 for the 19-, 16- and 11-items versions, and on the cut-off of 3.75 for the 6-item version was high. The prevalence of burnout was 81.2% in the primary care sample and 16.6% in the general population sample. The findings indicate that the SMBM is a useful instrument for screening for exhaustion disorder and burnout.

Depressive Symptoms in Adults with Autosomal Dominant Polycystic Kidney Disease.

Background: Individuals with autosomal dominant polycystic kidney disease (ADPKD) face mental health challenges linked to disease progression and its heritable nature. Prior studies reported mixed associations between depressive symptoms and ADPKD severity and progression. Here, we assessed depressive symptoms and disease severity over three years in ADPKD patients without end-stage kidney disease. Methods: 283 adults with ADPKD were enrolled from April 2013 to June 2023 in a single-center prospective observational study. ADPKD severity was assessed with estimated GFR and htTKV. Depressive symptoms were assessed with the Beck Depression Inventory-II (BDI-II). Depressive symptom burden was compared to previously reported cohorts of patients with other chronic, progressive diseases. The relationship of ADPKD severity and ADPKD-related pain with depressive symptoms was estimated using multiple linear regression, adjusting for potential confounders. Results: Among 283 adult ADPKD patients(mean age 45; 81% White; 61% female), 15.5% reported moderate depressive symptoms (BDI-II ≥ 11). Depressive symptom prevalence (all ages) was lower than in primary care samples. For the older individuals in our cohort, depressive symptom prevalence was similar to those in healthy older adults. ADPKD severity [eGFR: 73±33 ml/min/1.73m2, htTKV: 1104±80 cc/meter] was unrelated to depressive symptoms, although frequent pain (abdominal, back, and/or flank pain experienced at least daily) strongly associated with higher depressive symptom levels. Baseline depressive symptoms did not predict kidney function (eGFR, htTKV) at 36 months, adjusting for baseline measures and confounders. Conclusions: Our results reveal a relatively low prevalence of clinically significant depressive symptoms in a large sample of adult patients with ADPKD who were not undergoing renal replacement therapy. However, frequent pain was associated with a greater degree of depressive symptoms, underscoring the importance of adequate pain control. While these findings highlight the resilience of patients with ADPKD, routine mental health screening is recommended, and validated pain assessment tools may provide useful resources to quantify and manage pain in ADPKD.

Performance of the Amsterdam IADL scale in Assessing Functional Decline among Older People in Primary Health Care

AbstractBackgroundThe Amsterdam Instrumental ADL Questionnaire (A‐IADL‐Q) has shown promising performance in detecting subtle impairment in IADL independency. Importantly, it has not been validated in older people in a primary care setting, i.e., where the initial work‐up and triaging of cognitive impairment occurs. The main aim was to examine the accuracy of the A‐IADL‐Q for estimating the cognitive stage in a primary care sample, both in the whole population and within the Alzheimer’s disease (AD) continuum. Secondary aims were to examine associations with the clinical dementia rating (CDR) scale and global cognition (MMSE), including the effects of non‐cognitive co‐morbidities and medications.MethodThis cross‐sectional study includes informants of 362 participants from the BioFINDER‐Primary care study. They completed the A‐IADL‐Q (higher scores = “better”) either on an iPad or at home on a computer. Cognitive stage was assessed by a dementia expert (blinded to A‐IADL‐Q scores). Amyloid status was determined using FDA‐approved CSF or PET measures. The main outcome was cognitive stage according to the NIA‐AA scale. Secondary outcomes were CDR‐sum of the boxes (CDR‐SOB) and MMSE. Receiver Operating Curves (ROC) analyses were used to calculate the area under the curves (AUCs).ResultThe mean age of participants (44.9% female) was 76.1 (SD 7.2) years. Out of which, 83 (23%) had subjective cognitive decline (SCD), 169 (47%) mild cognitive impairment (MCI), and 110 (30%) dementia. The AUC (95% CI) for differentiating between SCD versus MCI/dementia was 0.89 (0.85‐0.92), and it was 0.89 (0.85‐0.93) for SCD/MCI versus dementia. In amyloid positive participants (n = 303), AUCs were similar. Better A‐IADL‐Q scores were associated with worse results on CDR‐SOB (r = ‐0.73, p&lt;0.001) and better global cognition (MMSE, r = 0.361, p&lt;0.001). The effects of different co‐morbidities on the A‐IADL score, adjusted for cognitive stage, will be presented at AAIC.ConclusionOur findings suggest that the A‐IADL‐Q accurately estimates the cognitive stage among cognitively impaired older people (with high prevalence of comorbidities) in a primary care setting. This can aid primary care physicians in the diagnosis of cognitive impairment, clinical management/support, and as part of the work‐up for identifying eligible participants for anti‐amyloid treatment.

Factors influencing delay in cancer diagnosis: a qualitative study in Chile, Colombia and Ecuador

Abstract Background Although the greatest delays in cancer diagnosis in Latin America occur in the provider interval, little is known about related factors. This study, part of EquityCancer-LA, aims to analyse the factors influencing access to cancer diagnosis from key stakeholders’ perspective in healthcare networks of Chile, Colombia, and Ecuador. Methods A qualitative, descriptive-interpretative study was conducted in two networks per country in 2023, using semi-structured individual interviews (n = 114) with a criterion sample of primary care (PC) (n = 40) and secondary/tertiary hospitals (n = 44) health/administrative professionals, managers, and policy makers (n = 30). Thematic analysis was performed, segmented by country. Results The analysis revealed interacting factors that cause cumulative delays, with differences between countries. In all, participants identified networks structural characteristics (deficits in diagnostic resources; geographical accessibility), organizational factors (long waiting times, especially after referral), and limited knowledge of PC doctors, which all lead to delayed referral. In Chile and Colombia, barriers related to care rationing/prioritization policies hampered access to tests, and in Chile, increased delays for non-prioritized conditions. Barriers related to the health system organization also emerged: in Chile, problems related to private services subcontracting and the voucher system for using them; in Colombia, the management of care by insurers (authorizations; fragmented and short-term contracting of providers); and in Ecuador, health system underfunding. The barriers mostly affected the elderly, those with low socioeconomic status, limited social support networks, and rural areas residents. Conclusions The results reveal significant barriers in access to timely cancer diagnosis, which can and should be addressed with specific cancer diagnosis policies and general measures that strengthen public healthcare systems and networks. Key messages • Key health system factors influencing provider delays in cancer diagnosis are identified. • Evidence is provided for the design of policies to improve timely cancer diagnosis in studied countries.

Exploring Associations of Somatic Symptom Disorder with Personality Dysfunction and Specific Maladaptive Traits

Introduction: According to ICD-11, personality disorders (PDs) are defined by the severity of self and interpersonal dysfunction in terms of personality functioning (PF) and an optional assessment of specific maladaptive personality trait expressions. Also, somatoform disorders are replaced by somatic symptom disorder (SSD). This study examines associations using the novel diagnostic criteria of SSD in an unselected primary care sample, PF, and maladaptive traits in patients with and without SSD. Methods: An anonymized cross-sectional study was conducted. A questionnaire including SSD-12 (Somatic Symptom Disorder B Criteria Scale-12) and PHQ-15 (Patient Health Questionnaire-15), LPFS-BF 2.0 (Level of Personality Functioning Scale – Brief Form) and PID-5BF+M (Modified Personality Inventory for DSM-5 – Brief Form Plus) was used. A bifactor (S-1) model was calculated with PF (reference for general factor) and personality traits (specific factors) to estimate associations between PF, specific maladaptive personality traits, and SSD. Differences in personality scales between SSD and non-SSD patients were calculated with the Mann-Whitney U test. Results: A total of 624 patients in six general practices participated (mean age 47 years; 60.4% female). SSD-12 and PHQ-15, respectively, showed significant associations with PF (γ = 0.51; γ = 0.48; p < 0.001), negative affectivity (γ = 0.50; γ = 0.38, p < 0.001) and psychoticism (γ = 0.29; γ = 0.28; p < 0.010). Besides, SSD-12 was significantly associated with disinhibition (γ = −0.38; p < 0.010) and anankastia (γ = −0.16; p < 0.010). Patients with SSD showed significantly impaired PF and maladaptive traits in all scales (p < 0.001). Conclusion: Impaired PF explains moderate to large amounts of the SSD symptoms and maladaptive personality traits negative affectivity, psychoticism, disinhibition, and anankastia show specific associations beyond PF. An in-depth understanding of these relations might be helpful to improve doctor-patient communication and treatment in SSD.

Development and psychometric evaluation of a questionnaire for the assessment of depression in primary care: a cross-sectional study

ObjectivesTo develop a new questionnaire for the diagnostic assessment of depression adapted to the primary care setting by combining psychiatric criteria and heuristics of general practitioners (GPs). Psychometric evaluation of...

Self-reported pain severity and use of cannabis and opioids in persons with HIV in an urban primary care setting in Northern California: A cross-sectional study.

Persons with HIV (PWH) experience high levels of pain. We examined the relationship of pain severity with use of cannabis and prescription opioids among PWH. This cross-sectional study evaluated associations between self-reported pain (moderate/severe vs mild/none) and cannabis and prescription opioid use in a primary care sample of PWH enrolled in an alcohol use treatment study at Kaiser Permanente, San Francisco. Prevalence ratios (PR) for moderate/severe pain associated with cannabis, opioid use, or both in the prior 30 days were obtained from Poisson regression models. Adjusted models included race/ethnicity, education, employment, HIV ribonucleic acid levels, depression, and anxiety. Overall, 614 PWH completed baseline questionnaires from May 2013 to May 2015, among whom 182/614 (29.6%) reported moderate/severe pain. The prevalence of moderate/severe pain varied by substances: 19.1% moderate/severe pain among study participants who reported neither cannabis or opioids, 30.2% for cannabis alone, 41.2% for opioids alone, and 60.9% for those reporting both substances. In adjusted models, compared with PWH who reported neither substance (reference), prevalence of moderate/severe pain was higher for those using cannabis alone (PR 1.54; 95% CI 1.13-2.09), opioids alone (PR 1.96; 95% CI 1.31-2.94), and those reporting both (PR 2.66; 95% CI 1.91-3.70). PWH who reported opioid and/or cannabis use were more likely to report moderate/severe pain compared with PWH who did not report use of these substances. To improve patient care, it is vital to assess patients' approaches to pain management including substance use and target appropriate interventions to reduce pain in PWH.

National survey conducted among Italian pediatricians examining the therapeutic management of croup

National survey conducted among Italian pediatricians examining the therapeutic management of croup

ICD-11 post-traumatic stress disorder and complex post-traumatic stress disorder in mental health support-seeking former-serving Australian defence force veterans.

ICD-11 complex post-traumatic stress disorder is a more severe condition than post-traumatic stress disorder, and recent studies indicate it is more prevalent among military samples. In this study, we tested the psychometric properties of the International Trauma Questionnaire, assessed the relative prevalence rates of post-traumatic stress disorder and complex post-traumatic stress disorder in the sample population and explored relationships between complex post-traumatic stress disorder and post-traumatic stress disorder and a range of risk factors. Survey participants (N = 189) were mental health support-seeking former-serving veterans of the Australian Defence Force (ADF) recruited from primary care. Confirmatory factor analysis was used to test the factorial validity of the International Trauma Questionnaire. The latent structure of the International Trauma Questionnaire was best represented by a two-factor second-order model consistent with the ICD-11 model of complex post-traumatic stress disorder. The International Trauma Questionnaire scale scores demonstrated excellent internal reliability. Overall, 9.1% (95% confidence interval = [4.8%, 13.5%]) met diagnostic requirements for post-traumatic stress disorder and an additional 51.4% (95% confidence interval = [44.0%, 58.9%]) met requirements for complex post-traumatic stress disorder. Those meeting diagnostic requirements for complex post-traumatic stress disorder were more likely to have served in the military for 15 years or longer, had a history of more traumatic life events and had the highest levels of depression, anxiety and stress symptoms. The International Trauma Questionnaire can effectively distinguish between post-traumatic stress disorder and complex post-traumatic stress disorder within primary care samples of Australian Defence Force veterans. A significantly greater proportion of Australian Defence Force veterans met criteria for complex post-traumatic stress disorder than post-traumatic stress disorder. Australian military mental health services should adopt the International Trauma Questionnaire to routinely screen for complex post-traumatic stress disorder and develop complex post-traumatic stress disorder specific interventions to promote recovery in Australian Defence Force veterans with complex post-traumatic stress disorder.

Evolution of Depressive Symptoms Among Depression Subtypes of Clinical and Functional Variables in Primary Care in Chile.

To compare the evolution of depressive symptoms among depressive subtypes based on clinical and functional variables in a sample of primary care in Chile. A longitudinal study was conducted in the Maule Region of Chile, focusing on 8 primary care from February 2014 to September 2015. Clinical and functional variables, including Mini International Neuro-psychiatric Interview, Outcome Questionnaire interpersonal and social sub-scales, were applied in a latent class analysis. This analysis categorized 210 patients into 3 subtypes: complex depression (N = 100), recurrent depression (n = 96), and unique depression (n = 14). Complex depression, exhibited a higher probability of suicide attempts, interpersonal and social dysfunction, and association with adverse childhood experiences according the Brief Physical and Sexual Abuse Questionnaire. Patients were monitored over 1 year with the Hamilton scale. The Kruskal-Wallis, non-parametric test, followed by paired Mann-Whitney test evaluated difference in the severity of depressive symptoms between the groups. Additionally, data on mental health interventions were collected. Out of the 210 patients, 89% were women, with a median age of 50 (range 37-58), and 40.1% with only primary education. Sociodemographic characteristics not differ between groups. Significant differences in depressive symptom severity between the groups were found (X2 90.06, P < .001, Kruskal-Wallis test, η2 = 0.084). Post hoc analyses indicated higher depressive symptoms in complex depression compared to recurrent (Z = -9.501, P < .001) and unique (Z = -2.877, P = .004) depression, with no significant difference between recurrent and unique depression (Z = -1.58, P = .113). There were no differences in the number of medical and psychological controls between the groups. The patients with complex depression required greater modifications in the pharmacological prescriptions than those belonging to the other groups. These results provide additional evidence of a complex depression subtype in primary care in Chile associated with adverse childhood experiences, that had worse resolution of depressive symptoms. Contrary to expectations, patients belonging to this group did not receive further medical and psychological interventions, probably due to a lack of specific clinical recommendations.

Fever management in children and insights into fever of unknown origin: a survey among Italian pediatricians.

Fever is a common symptom in children, but despite existing guidelines, pediatricians may not fully apply recommendations. Fever of Unknown Origin (FUO) is generally referred to as an unexplained prolonged fever. However, a standardized FUO definition and management is missing. To collect updated data on the approach to fever and FUO among Italian pediatricians. A cross-sectional anonymous survey was conducted among a large sample of primary care and hospital pediatricians. The panel group formulated and proposed a practical FUO definition, using a modified Delphi approach. A 75% consensus was required to reach an agreement. Among 620 respondents, paracetamol was the first-choice antipyretic for 97.7% of participants, followed by ibuprofen; 38.4% prescribed antipyretics based on a specific body temperature rather than on child's discomfort, while physical methods were almost completely abandoned. Alternate treatment was recommended by 19.8% (123/620) of participants, 16.9% (105/620) would prescribe antipyretics to prevent adverse events following immunization. Regarding FUO diagnosis, 58.3% (362/620) considered as cut-off a body temperature above 38°C; the duration required was one week according to 36.45% (226/620) of participants, two weeks according to 35.32% (219/620). The FUO definition proposed by the expert panel reached 81% of consent. Large agreement was observed on first-level laboratory and instrumental investigations in the diagnostic evaluation of FUO, whereas more discrepancies arose on second and third-level investigations. Compared to what participants reported for the treatment of non-prolonged fever, a significant decrease in the prescription of paracetamol as first-choice drug in children with FUO was observed (80.5%; P < 0.0001). Interestingly, 39% of participants would empirically recommend antibiotics, 13.7% steroids, and 4.5% Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) for persistent FUO. Non-recommended behaviors in fever management persist among pediatricians, including alternating use of paracetamol and ibuprofen, and their prophylactic use for vaccinations. Our data confirm the variability in the definition, work-up, and management of FUO. We observed that in children with FUO paracetamol was significantly less commonly preferred than in non-prolonged fever, which is not supported by evidence. Our findings combined with evidence from existing literature underlined the need for future consensus documents.

Investigating the PHQ-9 With Mokken Scale Analysis and Cognitive Interviews.

Scores on the Patient Health Questionnaire-9 (PHQ-9) are frequently used to assess depression both in research and in clinical practice. The aim was to examine the validity of the PHQ-9 sum score by using Mokken scale analysis (Study I) and cognitive interviews (Study II) on the Icelandic version of PHQ-9. A primary care sample of 618 individuals was used in Study I. The results indicate that the PHQ-9 items are not close enough to perfectly unidimensional for their sum score to accurately order people on the depression severity dimension. In Study II, the sample consisted of 53 individuals, with 28 having a history of depression and 25 not. The findings reveal a number of issues concerning respondents' use of the PHQ-9. No systematic differences were found in the results of the two groups. The PHQ-9 sum score should thus be interpreted and used with great care. We provide scale revision recommendations to improve the quality of PHQ-9.

High test-retest reliability of the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire completed by primary care patients in routine care.

The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is a three-item screening measure of unhealthy alcohol use that is widely used in healthcare settings. Evidence shows high test-retest reliability of the AUDIT-C in research samples, but most studies had limited external validity and used small samples that could not be used to evaluate reliability across demographic subgroups and/or screening modalities. This study evaluates the test-retest reliability of the AUDIT-C completed in routine care in a large primary care sample, including across demographic subgroups defined by age, sex, race, ethnicity, and screening modality (i.e., completed in-clinic or online). We used electronic health record (EHR) data from Kaiser Permanente Washington. The sample included 18,491 adult primary care patients who completed two AUDIT-C screens 1-21 days apart as part of routine care in 2021. Test-retest reliability was evaluated for AUDIT-C total scores (0-12) and for a binary measure indicating unhealthy alcohol use (scores ≥3 women, ≥4 men). Using previously established cutoffs, we interpreted reliability coefficients >0.75 as indicating "excellent" reliability. AUDIT-C screens completed in routine care and documented in EHRs had excellent test-retest reliability for total scores (ICC = 0.87, 95% CI: 0.87-0.87) and the binary indicator of unhealthy alcohol use (κ = 0.79, 95% CI: 0.78-0.80). Reliability coefficients were good to excellent across all demographic groups and for in-clinic and online modalities. Higher reliability was seen when both screens were completed through online patient portals (ICC = 0.93, 95% CI: 0.93-0.93) versus in-clinic (ICC = 0.81, 95% CI: 0.79-0.82) or when one screen was completed using each modality (ICC = 0.83, 95% CI: 0.82-0.83). Lower reliability was seen in American Indian/Alaska Native (ICC = 0.82, 95% CI: 0.75-0.87) and multiracial individuals (ICC = 0.82, 95% 0.80-0.84). In real-world routine care conditions, AUDIT-C screens have excellent test-retest reliability across demographic subgroups and modalities (online and in-clinic). Future research should examine why reliability varies slightly across modalities and demographic subgroups.

Deep Learning–Enabled Assessment of Left Heart Structure and Function Predicts Cardiovascular Outcomes

Deep Learning–Enabled Assessment of Left Heart Structure and Function Predicts Cardiovascular Outcomes

Minimal important difference metrics and test-retest reliability of the PTSD Checklist for DSM-5 with a primary care sample.

The PTSD Checklist for DSM-5 (PCL-5) is a measure of posttraumatic stress disorder (PTSD) symptom severity that is widely used for clinical and research purposes. Although previous work has examined metrics of minimal important difference (MID) of the PCL-5 in veteran samples, no work has identified PCL-5 MID metrics among adults in primary care in the United States. In this secondary analysis, data were evaluated from primary care patients (N = 971) who screened positive for PTSD and participated in a large clinical trial in federally qualified health centers in three U.S. states. Participants primarily self-identified as women (70.2%) and White (70.3%). We calculated test-retest reliability using clinic registry data and multiple distribution- and anchor-based metrics of MID using baseline and follow-up survey data. Test-retest reliability (Pearson's r, Spearman's ρ, intraclass correlation coefficient) ranged from adequate to excellent (.79-.94), with the shortest time lag demonstrating the highest reliability estimate. The MID for the PCL-5 was estimated using multiple approaches. Distribution-based approaches indicated an MID range of 8.5-12.5, and anchor-based approaches indicated an MID range of 9.8-11.7. Taken together, the MID metrics indicate that PCL-5 change scores of 9-12 likely reflect real change in PTSD symptoms and indicate at least an MID for patients, whereas PCL-5 change scores of 5 or less likely are not reliable. These findings can help inform clinicians using the PCL-5 in similar populations to track patient responses to treatment and help researchers interpret PCL-5 score changes in clinical trials.

Race, economic status, and disparities in the receipt of benzodiazepine prescriptions in a large primary care sample

Race, economic status, and disparities in the receipt of benzodiazepine prescriptions in a large primary care sample

A Comparison of Depressive Symptom Presentation in Adolescent Type 1 Diabetes and Pediatric Primary Care Samples.

Depression is a common comorbidity in adolescents with type 1 diabetes (T1D). It is unclear if patterns of responses from questionnaires used to screen for depressive symptoms are influenced by the burden of living with T1D and/or the consequences of hyperglycemia. Based on this gap in the adolescent research, we sought to identify potential differences in depression screening response patterns between adolescents with and without T1D and relate response patterns with glycemic outcomes. Using a retrospective case-control design, we analyzed electronic health records for age, sex, and race-matched adolescents 13-18 years of age from a pediatric diabetes clinic (n = 477) and a pediatric primary care clinic (n = 477) in the United States. Adolescents in both settings were screened for depressive symptoms during the same time period using the Patient Health Questionnaire-9 (PHQ-9). Participant demographics for matched characteristics were: 53.5% male, 71.7% White, median age 13.0 (interquartile range = 13.0, 14.0). After controlling for type of insurance, adolescents with T1D were more likely to have higher total PHQ-9 scores (odds ratio (OR) = 1.51, 95% CI = 1.17, 1.98, p = 0.002) and higher somatic subscores (OR = 1.57, 95% CI = 1.20, 2.05, p = 0.001) compared to the primary care sample. The pattern of item endorsement greater than "not at all" indicated that adolescents with T1D were more likely to have higher values for somatic items such as "trouble falling asleep" and "feeling tired" than those in the primary care sample. Item-total correlations and Cronbach's α indicated that all items were contributing to the overall score in the same manner in each group. Symptom endorsement for sleep and fatigue were higher for adolescents with T1D and without T1D. Study results support the need for further examination of the origins of somatic symptoms in T1D and for an additional examination of the specificity of depression screening instruments used in routine pediatric diabetes care.

Association between cannabis use disorder symptom severity and probability of clinically-documented diagnosis and treatment in a primary care sample

Association between cannabis use disorder symptom severity and probability of clinically-documented diagnosis and treatment in a primary care sample