Prior Diagnosis Of Depression Research Articles

Prevalence and Correlates of Attention Deficit Hyperactivity Disorder among College Students in Jeddah, Saudi Arabia.

Background:Childhood attention deficit hyperactivity disorder (ADHD) is commonly diagnosed in Saudi Arabia, but there is negligible evidence regarding adult ADHD in college students.Objective:To determine the prevalence and correlates of ADHD among undergraduates at King Abdulaziz University, Jeddah, Saudi Arabia.Methods:In this cross-sectional study, 2280 undergraduate students from 11 colleges at King Abdulaziz University, one of the largest university in Saudi Arabia, were approached in person with a questionnaire that elicited information regarding demographics, education, psychiatric history, health behaviors, and ADHD. A validated Arabic version of the Adult ADHD Self-Report Scale was used.Results:A total of 2059 students (90%) completed the questionnaire (mean age: 21.2 years). Almost one-tenth (11.9%) of the sample met the criteria for adult ADHD; only 6.5% had been diagnosed with ADHD in childhood and <1% (0.8%) had taken medication for the same. Multivariate analyses revealed that high family income, low grade in the last semester, parental divorce, diagnosis of childhood ADHD, prior diagnosis of depression, greater severity of current depression and anxiety, and cigarette smoking increased the likelihood of adult ADHD.Conclusion:A notable proportion of students in this study had suspected adult ADHD. Early evaluation of students with ADHD and identification of those at risk may potentially help in improving their academic performance and quality of life.

Factors Associated With Early and Late Post-stroke Fatigue in Patients With Mild Impairment. Results From the Stroke Cohort Study Augsburg.

BackgroundPost-stroke fatigue is a common symptom after stroke. However, studies on the factors associated with early and late fatigue are scarce. The objective of this study was to identify variables associated with early and late fatigue.MethodsIn the German Stroke Cohort Augsburg (SCHANA) study, participants were interviewed during their hospital stay and completed a postal questionnaire 3 and 12 months post-stroke. Fatigue was assessed using the Fatigue Assessement Scale (FAS). In addition, depression was measured by the Patient Health Questionnaire (PHQ-9), general health status by the EQ-5D visual analog scale, and physical activity by the International Physical Activity Questionnaire (IPAQ). Multivariable regression models were used to determine the associations between FAS scores at 3 and 12 months post-stroke and demographic, psychosocial and health-related covariables.ResultsAmong 505 participants, the frequency of fatigue was 31.1% 3 months and 29.1% 12 months post-stroke. Prior stroke (ß = 2.37, p = 0.0076), prior diagnosis of depression (ß = 5.04, p = 0.0001), higher NIHSS (ß = 0.25, p = 0.0360) and higher PHQ-9 scores (ß = 0.55, p < 0.0001) were significantly associated with higher fatigue levels 3 months post-stroke. Additionally, younger age (ß = −0.07, p = 0.0219), a worse rating of general health at baseline (ß = −0.04, p = 0.0287) and low pre-stroke physical activity (ß = −0.0004, p = 0.0089) were significantly associated with higher fatigue levels 12 months after stroke.ConclusionsFatigue is a common and persisting symptom even in patients with mild impairment. Prior depressive disorder and early depressive symptoms were the most relevant predictors of both early and late fatigue.

Depression, anxiety, and diabetes-related distress in type 2 diabetes in primary care in Greece: Different roles for glycemic control and self-care.

Objectives:The psychological distress of people living with diabetes is increased and associated with poorer glycemic outcomes and self-care. We aimed to examine the frequency of depression, anxiety, and diabetes-related distress (DRD) of individuals with type 2 diabetes (T2D) in primary care (PC) and their comparative associations with clinical, self-care, and socio-demographic characteristics, testing for possible different roles on glycemic control and self-care.Methods:This is a cross-sectional study of 182 adults with a T2D diagnosis of at least six months, recruited between August 2019-March 2020 and May-October 2020, from an urban PC unit. Participants were screened for symptoms of depression (Patient Health Questionnaire-9 (PHQ-9)), anxiety (Generalized Anxiety Disorder-7 (GAD-7)), and DRD (Diabetes Distress Scale (DDS)). Clinical, self-care, and socio-demographic parameters were recorded.Results:The frequency of clinically significant symptoms of depression was 16.6%, (PHQ-9 score ⩾10), anxiety 17.7% (GAD-7 score ⩾10), and DRD 22.6% (DDS score ⩾2). All PHQ-9, GAD-7, and DDS scores intercorrelated, and higher scores were found to be associated with female gender, lower income, and prior diagnosis of depression. Higher PHQ-9 and GAD-7 scores were found to be associated with lower education, more hypoglycemia episodes, more blood glucose self-tests and antidepressant or benzodiazepine use. The retired/housewives scored significantly lower in GAD-7 and DDS compared to the unemployed participants. Higher DDS scores were associated with higher glycated hemoglobin, higher fasting plasma glucose, and insulin use. It was also noted that higher PHQ-9 scores were associated with lower uric acid levels and were significantly higher in the sedentary lifestyle group.Conclusion:DRD was associated with poorer glycemic outcomes while depressive symptoms were associated with lower physical activity perhaps sharing different roles for glycemic control and self-care. The psychological burden of individuals with T2D may be considered in PC.

Exposure to COVID-19 during the First and the Second Wave of the Pandemic and Coronavirus-Related PTSD Risk among University Students from Six Countries-A Repeated Cross-Sectional Study.

This study aimed to reveal differences in exposure to coronavirus disease (COVID-19) during the first (W1) and the second (W2) waves of the pandemic in six countries among university students and to show the prevalence and associations between exposure to COVID-19 and coronavirus-related post-traumatic stress syndrome (PTSD) risk during W2. The repeated cross-sectional study was conducted among university students from Germany, Poland, Russia, Slovenia, Turkey, and Ukraine (W1: n = 1684; W2: n = 1741). Eight items measured exposure to COVID-19 (regarding COVID-19 symptoms, testing, hospitalizing quarantine, infected relatives, death of relatives, job loss, and worsening economic status due to the COVID-19 pandemic). Coronavirus-related PTSD risk was evaluated by PCL-S. The exposure to COVID-19 symptoms was higher during W2 than W1 among students from all countries, except Germany, where, in contrast, the increase in testing was the strongest. Students from Poland, Turkey, and the total sample were more frequently hospitalized for COVID-19 in W2. In these countries, and Ukraine, students were more often in quarantine. In all countries, participants were more exposed to infected friends/relatives and the loss of a family member due to COVID-19 in W2 than W1. The increase in job loss due to COVID-19 was only noted in Ukraine. Economic status during W2 only worsened in Poland and improved in Russia. This was due to the significant wave of restrictions in Russia and more stringent restrictions in Poland. The prevalence of coronavirus-related PTSD risk at three cutoff scores (25, 44, and 50) was 78.20%, 32.70%, and 23.10%, respectively. The prediction models for different severity of PTSD risk differed. Female gender, a prior diagnosis of depression, a loss of friends/relatives, job loss, and worsening economic status due to the COVID-19 were positively associated with high and very high coronavirus-related PTSD risk, while female gender, a prior PTSD diagnosis, experiencing COVID-19 symptoms, testing for COVID-19, having infected friends/relatives and worsening economic status were associated with moderate risk.

Association of neighborhood greenness with depressive symptoms in elderly women

BACKGROUND AND AIM: Epidemiological evidence of the beneficial association between greenness and depression in the elderly is still limited and results of studies are inconsistent. In this study, we aimed to investigate the association between neighbourhood greenness and depression in elderly women. METHODS: We enrolled 821 women (aged 66-80) from the German SALIA cohort for the 2007-2010 follow-up examination. Greenness was assessed for each participant using the Normalized Difference Vegetation Index (NDVI) (year 2009) for different circular buffers (100-m, 300-m, 500-m and 1000-m) around the residential address. We used two depression outcomes: self-reported doctor diagnosis of ever depression and the frequency of depressive symptoms by using the 20-items Center for Epidemiological Studies Depression Scale (CESD-R). Cross-sectional associations were assessed using adjusted logistic and linear regression models. RESULTS:In the adjusted models, a 0.1-point increase in NDVI within 300-m was associated with a decreased odds of prior diagnosis of depression (odds ratios (OR): 0.691, 95% confidence intervals (CI): 0.495, 0.965). Similarly, a 0.1-point increase in NDVI within 1000-m was associated with decreased depressive symptoms assessed with the CESD-R score (-12.5% difference in the mean; 95% CI: -21.2%, -3.7%). The results were not consistent across different buffers even though they were in the same direction. CONCLUSIONS:Urban greening might potentially decrease depression rates in elderly population. KEYWORDS: depression, depressive symptoms, elderly, greenspace, NDVI

Depression and HIV viral nonsuppression among people engaged in HIV care in an urban clinic, 2014-2019.

The aim of this study was to describe the risk of viral nonsuppression across the depression care cascade. A clinical cohort study. We used depressive symptoms (PHQ-8 ≥ 10) self-reported on computer-assisted surveys, clinical diagnoses of depression in the medical record in the prior year and pharmacologic (any prescription for an antidepressant) and psychologic treatments for depression (attendance at at least two mental health visits in the prior year) to classify patients into groups: no history of depression; prior depression diagnosis; current indication for depression treatment (symptoms or clinical diagnosis); and treated depression (stratified by presence of persistent symptoms). We associated position in the depression care cascade with viral nonsuppression (>200 copies/ml) 7 days before to 6 months after the index self-report of depressive symptoms. History of depression [adjusted risk difference (aRD) relative to no history = 5.9%, 95% confidence interval (95% CI): 1.5-10.3] and current depression (symptoms or diagnosis) in the absence of treatment (aRD relative to no current depression or depression treatment = 4.8%, 95% CI: 1.8-7.8) were associated with a higher risk of viral nonsuppression than no history of depression. Depression treatment mitigated this association (aRD = -0.4%, 95% CI: -2.5 to 1.7). The relationship between depression care cascade and viral suppression is complex. Untreated depression and clinically unrecognized depressive symptoms were both related to viral nonsuppression. Treated depression was not associated with viral nonsuppression; however, a high proportion of treated patients still had depressive symptoms. Depression treatment should be titrated if patients' symptoms are not responsive and patients with a history of depression should be monitored for ART adherence.

1024-P: Association, Prevalence, and Occurrence of Depression and Anxiety in Indian T2DM Patients

Background: Depression is found to be common among patients with diabetes and it is associated with poor outcomes in disease control. Mani objective of the study was to study the prevalence and occurrence of depression and anxiety in patients of type 2 diabetes mellitus (T2DM). Materials:115 adults with T2DM without prior diagnosis of depression and 115 matched controls were evaluated. Sociodemographic and relevant clinical variables were collected. They were evaluated for depression and anxiety using Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale respectively. Results: Significantly larger proportion of diabetic patients had depression [32 (27.8%) vs. 11 (9.57%), P = 0.005), anxiety (38 (33%) vs. 16 (13.9%, P = 0.005) and comorbid depression and anxiety (28 (24.3%) vs. 10 (8.7%), P = 0.005) as compared to healthy controls. The prevalence rate of depression was higher in age between 41 and 60 years (18.8% vs. 7.6%, respectively) in diabetic and healthy control group. Diabetic women had higher depression (21.2% vs. 8.7%) and anxiety (18.8% vs. 9.7%) than men. Depression was found significantly associated with retinopathy 28.6% (p=0.005), nephropathy 16.3% (p=0.005) and ischemic heart disease (IHD) 17.2% (p=0.005) in the present study. Comorbid depression and anxiety was significantly associated with age (40-60 years), obesity (BMI ≥ 25 kg/m2), poor glycemic control (≥7.5%), insulin therapy, nephropathy, neuropathy, and IHD but no significant association was found with education level. Conclusion: This study found a high proportion of depression and anxiety among patients with T2DM. Public health measures are required to create more awareness for managing depression in diabetes. Disclosure N. Kumar: None. A. K. Chandra: None. S. Ahsan: None. A. Kumar: None.

Disease trajectories and mortality among individuals diagnosed with depression: a community-based cohort study in UK Biobank.

Patients with depression are at increased risk for a range of comorbid diseases, with, however, unclear explanations. In this large community-based cohort study of the UK Biobank, 24,130 patients diagnosed with depression were compared to 120,366 matched individuals without such a diagnosis. Follow-up was conducted from 6 months after the index date until death or the end of 2019, for the occurrence of 470 medical conditions and 16 specific causes of death. The median age at the time of the depression diagnosis was 62.0 years, and most of the patients were female (63.63%). During a median follow-up of 4.94 years, 129 medical conditions were found to be significantly associated with a prior diagnosis of depression, based on adjusted Cox regression models. Using disease trajectory network analysis to visualize the magnitude of disease–disease associations and the temporal order of the associated medical conditions, we identified three main affected disease clusters after depression (i.e., cardiometabolic diseases, chronic inflammatory diseases, and diseases related to tobacco abuse), which were further linked to a wider range of other conditions. In addition, we also identified three depression-mortality trajectories leading to death due to cardiovascular disease, respiratory system disease and malignant neoplasm. In conclusion, an inpatient diagnosis of depression in later life is associated with three distinct network-based clusters of medical conditions, indicating alterations in the cardiometabolic system, chronic status of inflammation, and tobacco abuse as key pathways to a wide range of other conditions downstream. If replicated, these pathways may constitute promising targets for the health promotion among depression patients.

Primary Care Physician Recognition and Documentation of Depressive Symptoms Among Chinese and Latinx Patients During Routine Visits: A Cross-Sectional Study

Purpose: Asian and Latinx individuals have a high burden of untreated depression. Under-recognition of depressive symptoms may contribute to existing disparities in depression treatment. The objective of this cross-sectional study was to determine whether physicians recognize and treat depressive symptoms for Chinese and Latinx patients during routine primary care visits.Methods: We analyzed data from 1171 Chinese and Latinx patients who were interviewed within 1 week after a primary care visit in a large academic practice, which had not yet implemented universal depression screening. We included participants with depressive symptoms (defined as a Patient Health Questionaire-2 score ≥3) and no prior history of depression (N=118). We investigated whether patients perceived having a mental health need in the prior year and conducted chart reviews to assess provider recognition of depressive symptoms, defined as documentation of symptoms, antidepressant initiation, or mental health referral within 30 days of the visit. We further examined differences by race/ethnicity and language preference.Results: Among the 118 patients with depressive symptoms and no prior depression diagnosis (mean age 68), 71 (61%) reported a mental health need in the prior 12 months; however, providers recognized depressive symptoms in only 8/118 patients (7%). The number of patients with recognized symptoms was small across race/ethnicity and language preference groups and we found no significant differences.Conclusion: Physicians recognized and documented depressive symptoms for 1 in 10 Chinese and Latinx patients during routine primary care visits. Targeted efforts are needed to address under-recognition of symptoms and improve depression care for these populations.

Evidence of Resilience in Kidney Donors: A New York Statewide Cohort Analysis

IntroductionDonor nephrectomy (DN) is a procedure performed to provide recipients with a kidney to treat end-stage renal disease. The following analysis evaluated depression diagnosis in DN patients compared to controls. MethodsDN patients and matched controls were identified between 2000 and 2009 from the Statewide Planning and Research Cooperative System database. Cohorts were tracked for depression incidence. Multivariable logistic regression was used to determine independent predictors of a postoperative depression diagnosis. ResultsThe total study cohort included 2108 DN cases and 2108 controls. In both donors and controls, the baseline rate of depression was 0.95% (n = 20). The 5-year incidence of depression diagnosis after exposure increased in both cohorts (donors: 2.5%, n = 53; controls: 7.2%, n = 152; P < .001). The 5-year relative risk for developing depression was 2.65 (CI 1.59-4.42, P = .0002) in donors and 7.60 (CI 4.79-12.07, P < .001) in controls. On multivariable regression, being a donor was associated with reduced risk of developing postoperative depression (OR = 0.322, CI 0.233-0.445, P < .001), and the greatest risk factor for postoperative depression was a prior depressive diagnosis (OR = 7.811, CI 3.814-15.997, P < .001). ConclusionOur analysis shows that the strongest risk factor for depression was a prior diagnosis of depression. However, willingness to undergo donor nephrectomy is associated with less subsequent depression than the control population, suggesting that kidney donors may be a more resilient cohort.

Treatment-resistant depression and risk of all-cause mortality and suicidality in Danish patients with major depression

ObjectiveTreatment-resistant depression (TRD) has been associated with higher mortality and risk of suicide, but this has mainly been showed in few studies which did not include self-harm. The aim was to investigate the association of TRD with all-cause mortality, suicide and self-harm in a nationwide cohort of patients with major depression and explore any differences in relation to patient characteristics. MethodsFirst-time hospital contacts for major depression between January 1, 1996 and December 31, 2014 were identified in Danish patient registers (ICD-10: F32 and F33). TRD was defined as two shifts in antidepressant treatment, assessed from one year prior depression diagnosis until one year after. Information on mortality, suicide and self-harm was obtained from Danish registers and associations between TRD and the three prognostic outcomes were analyzed using Cox Proportional Hazard Regression. ResultsTRD was not associated with all-cause mortality the first year of follow-up (adjusted HR (aHR) 1.04, 95% confidence interval (CI) [0.98–1.11]), and the HR for mortality was lower the following 1–5 years. However, TRD was associated with higher rates of suicide (0–1 year: aHR 2.20, 95% CI [1.77–2.74]; 1–5 years: aHR 1.70, 95% CI [1.42–2.03]) and self-harming behavior (0–1 year: aHR 1.51, 95% CI [1.36–1.66]; 1–5 years: aHR 1.59, 95% CI [1.48–1.70]). The above risk estimates varied only slightly across sociodemographic and clinical patient characteristics. ConclusionsPatients with TRD have higher rates of suicide and self-harm compared with non-TRD patients, whereas there seems to be no increase overall in all-cause mortality – in fact, there was a lower rate at follow-up after 1 year. We found only a few differences in HRs for mortality or suicidality across patient characteristics.

Ketamine treatment for depression: qualitative study exploring patient views.

Ketamine is a new and promising treatment for depression but comes with challenges to implement because of its potential for abuse. We sought the views of patients to inform policy and practical decisions about the clinical use of ketamine before large-scale roll-out is considered. This qualitative study used three focus groups and three validation sessions from 14 patients with prior diagnoses of depression but no experience of ketamine treatment. Focus groups explored their views about clinical use of ketamine and the best way for ketamine to be administered and monitored. The qualitative data were analysed by three service-user researchers using thematic analysis. Five themes were generated: changing public perceptions, risks, monitoring, privacy and data protection, and practical aspects. Participants were conscious of the stigma attached to ketamine as a street drug and wanted better public education, and evidence on the safety of ketamine after long-term use. They felt that monitoring was required to provide evidence for ketamine's safe use and administration, but there were concerns about the misuse of this information. Practical aspects included discussions about treatment duration, administration and accessibility (for example who would receive it, under what criteria and how). Patients are enthusiastic about ketamine treatment but need more information before national roll-out. The wider societal impact of ketamine treatment also needs to be considered and patients need to be part of any future roll-out to ensure its success.

Evaluating a Standardized Transition of Care Process for Pediatric Inflammatory Bowel Disease Patients.

To reduce lapses in care for pediatric inflammatory bowel disease (IBD) patients approaching adulthood, a health maintenance transition visit (HMV) was developed to supplement standard medical care (SMV). Our aim was to assess the effect of the HMV on transition readiness. A retrospective chart review was conducted at a single center with demographics and clinical data from HMV and SMV visits. Effectiveness of the HMV was assessed by the patient health questionanaire-9 (PHQ-9) and transition readiness assessment questionnaire (TRAQ) scores. A total of 140 patients, 80% Caucasian and 59% male completed an HMV. The mean age was 18 ± 2 years old, and 93% of patients reported inactive or mild disease. Patients who completed at least 1 prior HMV scored significantly higher on the TRAQ when transferring to adult care compared to patients transferred at their first HMV visit (92 vs. 83, p < 0.05). Of patients with no prior depression diagnosis, 36% had a positive screen for depression. A significant relationship was identified between disease status and PHQ-9 (p < 0.05). This study demonstrated a structured HMV increased transition readiness and quantified the significant under-diagnosis of depression in this population, emphasizing the importance of screening. These results indicate depression may affect patients’ transition preparedness.

Antepartum Edinburgh Depression Score: Implications for Postpartum Care [04E

INTRODUCTION: Depression is a common complication that impacts perinatal outcomes. There is a paucity of literature investigating associations between an elevated Edinburgh Depression Score (EDS) 10 or greater and treatment (pharmacologic and behavioral) on postpartum visit adherence and contraception. METHODS: A retrospective cohort study of women with a singleton liveborn delivery who were screened antenatally using the EDS between 2010 and 2016 was performed. Primary outcomes were postpartum visit attendance within 12 weeks and contraception use. Secondary outcomes included contraceptive choice and effect of treatment on outcomes. Institutional Review Board approval was obtained for this study. RESULTS: 1,730 patients underwent antenatal EDS screening, and 619 (36%) had an elevated EDS. Women with an elevated EDS were more likely to be black, have higher parity, have a history of depression, or a history of drug or tobacco use. After controlling for potential confounders, women with an elevated EDS had decreased postpartum visit attendance (adjusted OR (aOR) 0.75, 95% CI 0.57–0.98, P=.03) and increased contraception use (aOR 1.37, 95% CI 1.01–1.86, P=.04), specifically with higher sterilization rates (aOR 2.13, 95% CI 1.38–3.27, P=.001). The magnitude of both postpartum visit nonattendance and sterilization rates increased with increasing EDS. Psychotherapy, but not antidepressant use, was associated with improved postpartum visit attendance, especially among those without prior diagnosis of depression (71.5% vs 92.9%, P=.03). CONCLUSION: Antenatal depressive symptomatology is associated with postpartum visit nonattendance and higher sterilization rates, with effect sizes modulated by symptom severity. Treatment with psychotherapy may improve postpartum visit attendance among women with depressive symptoms.

Incidence of Depression and First-Line Antidepressant Therapy in People with Obesity and Depression in Primary Care.

The aim of this study was to describe theage- and gender-specific incidence of depression, the dose-response relationship between BMI and risk of depression (Cox proportional hazards), and antidepressant drug prescribing in adults with overweight or obesity. A retrospective electronic health record study using the Clinical Practice Research Datalink was conducted to identify adults with overweight and obesity (≥ 18 years) with incident depression (no prior depression diagnosis in their records), followed up from 2000 to 2019. Among 519,513 adults, incidence of depression was 9.2 per 1,000 person-years and was higher in women and in 40- to 59-year-old men who had severe obesity. Compared with having overweight, the hazard of depression increased with each BMI category as follows: 1.13 (30-34 kg/m2 ; 95% CI: 1.10-1.16), 1.34 (35-39 kg/m2 ; 1.29-1.40), 1.51 (40-44 kg/m2 ; 1.41-1.61), and 1.67 (45-49 kg/m2 ; 1.48-1.87), attenuating at BMI 50+ kg/m2 (1.54; 2.91-1.84). Antidepressants were prescribed as first-line therapy in two-thirds (66.3%) of cases. Prescriptions for fluoxetine reduced over time (20.4% [2000]; 8.8% [2018]), and prescriptions for sertraline increased (4.3% [2000]; 38.9% [2018]). We recommend guidance on antidepressant drug prescribing and specific services for people with obesity and depression that address both symptoms and behaviors.

P008 EVALUTING THE EFFECTIVENESS OF TRANSITION OF CARE FOR PEDIATRIC INFLAMMATORY BOWEL DISEASE PATIENTS USING A STANDARDIZED TRANSITION PROCESS

Abstract Significance The incidence of inflammatory bowel disease (IBD) is rising around the globe. As pediatric IBD patients approach adulthood, they are in jeopardy of a lapse in care. We developed a standardized a health maintenance transition visit (HMV) to supplement standard medical care visits (SMV) to prepare patients for transition. Our aim was to assess the effectiveness of the structured HMV using the Transition Readiness Assessment Questionnaire (TRAQ) to predict readiness at time of transfer to an adult gastroenterologist. Methods A retrospective chart review was conducted including demographics and clinical data from HMV visits and pediatric or adult SMV visits. Clinical variables included scheduling, providers, TRAQs, Patient Health Questionnaire-9 (PHQ9), health maintenance goals, and disease status. The effectiveness of the HMV was accessed by attendance, PHQ9 screening, adherence to health recommendations, and TRAQ scores. Results 140 patients completed at least one HMV. The patient cohort was 80% white and 59% male. Mean age was 18 ± 2 years old at the time of their first HMV. The majority of patients had a primary IBD diagnosis of Crohn’s disease (75%), followed by ulcerative colitis (21%), and unclassified IBD (4%). Most patients had inactive disease (68%) around the time of the first HMV, while a minority had mild (20%) or moderate (12%) disease activity based on PGA. The average TRAQ score at the first HMV visit was 66 ± 17. Patients who completed at least 1 prior HMV (n=8) scored significantly higher on the TRAQ when transferring to the adult care compared to patients (n=29) who were transferred at their first HMV visit (92 vs 83, p&amp;lt;0.05). Of the 56 patients who completed the PHQ9 depression screen, 22 had a positive screen. Of the patients with no prior diagnosis of depression, 36% had a positive screen with the severity of depression ranging from mild to severe. Across all visits, 45 patients were transferred into adult care following a HMV. Conclusions This study demonstrated that a structured HMV prior to transfer may increase transition readiness as assessed by the TRAQ. In addition, new diagnosis of depression was made in a significant portion of patients screened, emphasizing the importance of regular screening for psychological issues. Future studies are needed to validate these findings and potentially move towards a standard template for transition readiness in pediatric IBD patients.

P778 Longitudinal trajectory of fatigue in inflammatory bowel disease patients: a prospective study

Abstract Background Fatigue is a commonly reported and sometimes disabling symptom in patients with inflammatory bowel disease (IBD). Its prevalence, mechanism, and impact remain poorly understood. Using a large cohort of patients with IBD, we aimed to prospectively determine the trajectory of fatigue and to identify determinants and impact of incident and prevalent fatigue on patients with IBD. Methods This prospective study was nested within the IBD partners cohort, a validated internet-based cohort of patients with IBD. Participants were invited to prospectively complete questionnaires assessing fatigue status at baseline and subsequently after 6 and 12 months. Fatigue was assessed using the validated Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) score. A FACIT-F score of &amp;lt; 43 was defined as significant fatigue. We examined the trajectory and predictors of different courses of fatigue including incident fatigue (not fatigued as baseline but fatigued at 6 months) and resolved fatigue (fatigue at baseline but resolved on follow-up). Results A total of 2429 patients (1605 CD, 824 UC) completed baseline assessment among whom 1057 completed a second assessment at 6 months. First, we identified three distinct patterns of fatigue. Episodic fatigue defined as fatigue at any one (but not both) time point was the most common, affecting 1182 patients (57.0%). Persistent fatigue (at both baseline and follow-up) affected 33.5% (n = 695) while only 196 patients (9.5%) reported no fatigue at any time point (n = 196) (Figure). Patients that reported persistent or intermittent fatigue were more likely to have active disease (p &amp;lt; 0.001), be younger, (p &amp;lt; 0.001), report anaemia (p = 0.002) and low vitamin B12 levels (p &amp;lt; 0.001) and to have a prior diagnosis of depression, anxiety or sleep disorder (p &amp;lt; 0.001). Among patients who were not fatigued at baseline, 26% developed new fatigue at 6 months defined as incident fatigue). The strongest predictor of this being presence of sleep disturbance at baseline (OR 2.45, 95% CI 0.24–1.55) (Table). In contrast, only 12.3% of those with fatigue at baseline had symptom resolution by month 6. Resolution of fatigue was more common in those with UC (p = 0.03), quiescent disease at baseline (p = 0.006), not receiving biologic therapy at baseline (p = 0.016) and no sleep disturbance (p &amp;lt; 0.001), anxiety (p = 0.002) and depressive (p = 0.005) symptoms at baseline. Conclusion Our findings indicate three distinct trajectories of fatigue in patients with IBD with their distinct predictors. Importantly, 26% of patients developed new onset fatigue at 6 months demonstrating the substantial impact of this on patients with IBD.

Air pollution is associated with depressive symptoms in elderly women with cognitive impairment

BackgroundStudies on air pollution and depression in the elderly are limited and the results are heterogeneous. ObjectivesWe examined the association of ambient air pollution exposure and diagnosis and symptoms of depression in the elderly; and whether any associations were confounded or modified by cognitive decline. MethodsWe enrolled 821 elderly women from the German SALIA cohort (follow-up examination, 2007–2010). Self-reported depressive symptoms and level of cognition were evaluated using the CESD-R Scale and the CERAD-Plus test, respectively. We used two depression endpoints for analyses: self-reported doctor diagnosis of depression and frequency of depressive symptoms (CESD-R score). Long-term concentrations of particulate matter (PM) size fractions and nitrogen oxides (NOx) modeled by land-use regression were assigned to home addresses. Cross-sectional associations were assessed using adjusted logistic and linear regression models. ResultsConcentrations of coarse particles (PMcoarse), fine particles (PM2.5 and PM2.5 abs) and NO2 were significantly associated with diagnosis of depression (e.g. for PM2.5 OR = 1.62, 95%CI: 1.06, 2.46 and for NO2 OR = 1.54, 95% CI: 1.08, 2.19). Similarly, an increase of one interquartile range in PM10, PM2.5, NO2 and NOx was associated with depressive symptoms assessed with the CESD-R score (e.g. for PM2.5 16.2% difference in the mean; 95% CI: 5.8%, 26.5% and for NO2 14.5%; 95% CI: 4.8%, 24.2%). These associations were stronger in women with cognitive decline (e.g. Pint for PM2.5:0.022 and NO2:0.017) compared to women with normal cognition. In addition, living less than 100 m distance to major roads was significantly associated with diagnosis (OR = 1.99, 95% CI: 1.14, 3.47) and symptoms (19.7%; 95% CI: 4.3%, 35.1%) of depression. We did not observe any interaction effect of cognition on prior diagnosis of depression. ConclusionsExposure to air pollution was associated with diagnosis of depression and depressive symptoms in elderly women. Women with impaired cognition may be at greater risk of depressive symptoms when exposed to air pollution.

174 Older Emergency Department Patients Who Screen Positive for Depression are Less Likely to Receive Referrals for Treatment and Counseling

Establishment of “senior” (geriatric) emergency departments (SEDs) is becoming more frequent across the US, and many of these centers screen for for various key comorbidities associated with the elderly. However, the selection of which items to include in screening has not been validated. Treatment of depression is known to be efficacious and can significantly enhance quality of life, even in the elderly. It is critical to determine whether those who screen positive for depression are receiving appropriate treatment, and that referrals are made to appropriately intervene for these individuals. This study evaluated these parameters in a senior cohort as a function of ED patient age. This was a nested prospective study in the senior ED of a community hospital with an annual volume of approximately 52,000. The study included screening, interview and chart review of SED patients > 65 years of age. All consenting patients were screened for depression using the Yesavage 5-point depression scale (GDS). Patients were excluded if not considered competent by mini-Cog testing (unless they had an authorized representative) or if they were prisoners. Patients with a GDS of > 2 were considered “at-risk” and assessed for prior diagnosis of depression and whether they are currently under treatment. Demographic features and insurance status were recorded, as was the presence or absence of current treatment and whether follow-up referral was provided by the ED. Groups were divided into the “younger old” ages 65-74, and “older old,” ages >75 for analysis. Chi square/Fisher’s exact analysis was conducted for the two age cohorts, using GraphPad Prism 6.0.1 (GraphPad Software Inc., San Diego, California, USA). A total of 6,312 patients were screened, with 93 screening positive for depression. Sixty-two patients were either not being treated for depression (65.6% female) or had not been previously diagnosed. Among those not currently receiving treatment, the older group was much less likely to receive treatment ( 65-75 age group 57.9%, >75 age group 19.4 %, Fisher’s exact, two tailed, p=0.0018). In the ED, referrals were less likely to be made for the older group than the younger group (see diagram). In a cohort of geriatric ED patients screening positive for depression, older seniors >75 were much less like to be receiving prior treatment or to receive referrals than those aged < 75. Whether this is due to “apathy towards seniors” in the health system or other causes, an opportunity exists to improve provision of referral for psychiatric care for senior ED users screening positive for depression.Tabled 1Treatment of depression stratified by ageTreatmentY/NAges 65-75Age > 75TotalYes11718No83644Total194362% Treated57.919.4 Open table in a new tab

The Correlation Between Dry Eyes, Anxiety and Depression: The Sicca, Anxiety and Depression Study.

To determine whether improvement in the severity of dry eye disease (DED) symptoms correlates with improvement in anxiety and depression. This prospective interventional case series recruited 45 adults with evidence of DED. Patients were administered the University of North Carolina Dry Eye Management Scale (DEMS), Generalized Anxiety Disorder 7-item scale (GAD-7), and Personal Health Questionnaire Depression Scale (PHQ-8) to evaluate the severity of DED symptoms, anxiety, and depression, respectively. Standard of care treatment was provided for patients for 3 to 6 months, followed by re-administration of the DEMS, GAD-7, and PHQ-9 surveys. Statistical analysis was performed to assess the relationships between changes in survey scores. Participants had a mean age of 65.5 (SD, 13.3) years, and 37 (84.6%) were women. Seven patients were lost to follow-up. DEMS and GAD-7 significantly improved from 5.8 ± 1.8 to 4.6 ± 0.2.2 (P = 0.01) and from 5.6 ± 5.5 to 3.3 ± 4.6 (P = 0.05), respectively. Changes in DEMS correlated with changes in PHQ-8 (ρ = 0.3 P = 0.05), but not with changes in GAD-7 (ρ = 0.2 P = 0.3). Changes in DEMS correlated with changes in both PHQ-8 and GAD-7 in the subgroup of patients without prior depression or anxiety diagnosis (ρ = 0.6, P = 0.002; ρ = 0.4, P = 0.02). A multivariate analysis showed that the relationship between DEMS, PHQ-8, and GAD-7 was independent of a prior diagnosis of depression or anxiety and of the presence of comorbidities. There is a significant correlation between the severity of DED and symptoms of depression and anxiety. Effective DED treatment could have a positive impact on the symptoms of depression and anxiety.