Screening For Depression In Patients Research Articles

Screening for depression in patients with epilepsy: same questions but different meaning to different patients.

Patient-reported outcome measures (PROMs) such as the Neurological Disorders Depression Inventory in Epilepsy (NDDI-E), a 6-item epilepsy-specific PROM, is used to screen for major depressive disorder symptoms for patients with epilepsy (PWE). The validity and interpretation of PROMs can be affected by differential item functioning (DIF), which occurs when subgroups of patients with the same underlying health status respond to and interpret questions about their health status differently. This study aims to determine whether NDDI-E items exhibit DIF and to identify subgroups of PWE that exhibit DIF in NDDI-E items. Data were from the Calgary Comprehensive Epilepsy Program database, a clinical registry of adult PWE in Calgary, Canada. A tree-based partial credit model based on recursive partitioning (PCTree) was used to identify subgroups that exhibit DIF on NDDI-E items using patients' characteristics as covariates. Differences in the identified subgroups were characterized using multinomial logistic regression. Of the 1,576 patients in this cohort, 806 (51.1%) were female, and the median age was 38.0 years. PCTree identified four patient subgroups defined by employment status, age, and sex. Subgroup 1 were unemployed patients ≤ 26 years old, subgroup 2 were unemployed patients > 26 years, subgroup 3 were employed females, while subgroup 4 were employed male patients. The subgroups exhibited significant differences on education level, comorbidity index scores, marital status, type of epilepsy, and driving status. PWE differed in their interpretation and responses to questions about their depression symptoms, and these differences were a function of sociodemographic and clinical characteristics.

Rapid screening for depression in patients with heart failure

Introducción: Este estudio identificó síntomas depresivos en pacientes con insuficiencia cardíaca (IC), mediante la prueba rápida EPD.3PO. Método: Estudio observacional descriptivo, de corte transversal, no probabilístico. Un total de 100 pacientes mayores de 18 años, con IC clínicamente estables, sin diagnóstico previo o tratados por depresión que ingresaron a consulta externa en una Clínica de la ciudad de Florencia, Caquetá (Colombia) fueron reclutados para este estudio. Después de la firma voluntaria del consentimiento informado, los pacientes fueron entrevistados para colectar variables de tipo sociodemográfico y posteriormente se realizó la prueba rápida EPD.3PO. Resultados: Acorde con el resultado de la prueba rápida EPD.3PO, el 64?% de los pacientes contestó afirmativamente a la pregunta ¿si se ha sentido triste o desesperanzado? 38% de los encuestados respondieron positivamente a la pregunta ¿ha presentado pérdida de interés en realizar actividades diarias?, y el 17?% de los pacientes respondió positivamente a la tercera pregunta ¿ha pensado en dejar de vivir? Se considera positiva la prueba ante cualquier respuesta positiva. Conclusiones: Los pacientes con insuficiencia cardiaca presentan síntomas depresivos, detectados por prueba de Tamizaje rápido (EPD.3PO), la cual se puede considerar una prueba eficiente y de sensibilidad en esta población.

Screening for depression in patients with epilepsy: What are the benefits for physicians and patients in the real-life setting.

Screening for depression in people with epilepsy (PWE) is highly recommended in order to avoid underdiagnosis, misdiagnosis, or delayed diagnosis of this highly impacting comorbidity. Here we evaluated the impact of reporting and suggesting depression via the Beck Depression Inventory (BDI) on medical decision-making, and thereby the value of a depression screening for good medical practice. Of 445 BDI data sets, PWE with scores indicating moderate (BDI 19-29) to severe depressive disorder (BDI >29) were extracted and clinical reports were retrospectively reviewed regarding decisions on antidepressants, anti-seizure medications (ASMs), and non-pharmaceutical interventions. Sixty-four PWE (14%; 56% female; mean age 39.7 years) showed elevated BDI scores, with 40 (63%) categorized as moderate depression and 24 (37%) as severe depression. Thirty-nine percent of PWE already had a pre-existing diagnosis of depression and 53% left the clinic with the diagnosis of depression, half of them with antidepressants. High depression scores were associated with any intervention in 53%, interventions with potentially mood affecting ASM in 19%, treatment with antidepressants in 11%, and non-pharmaceutical interventions in 41%. Non-pharmaceutical interventions were related to BDI scores. Changes of potentially mood-affecting ASMs were more frequent in PWE with moderate scores, and introduction of antidepressants appeared as a trend related to higher depression scores. The finding of an only weak relation between high depression scores, diagnoses of depression, and treatment consequences questions the diagnosis and treatment pathway and the clinical value of the BDI screening in PWE. Prospective standard procedures need to be established for depression diagnosis and treatment including follow-up evaluations of the validity of the diagnosis and effectiveness of the decisions taken.

Depression screening in patients with coronary heart disease : Anarrative review of the current evidence.

In view of the large and sometimes conflicting body of research, this narrative review summarizes the current evidence on depression screening in patients with coronary heart disease. Depression is arisk factor for development and progression of coronary heart disease. Consequently, many international cardiac guidelines recommend screening for depression in patients with coronary heart disease. However, the efficacy and implementation of these guidelines are debated due to the lack of empirical evidence supporting the benefits of routine depression screening. Studies conducted in cardiac routine care support this assumption: Patients with positive depression screens do not receive adequate follow-up care, which highlights gaps in the detection-to-treatment pathway. Barriers to effective screening and treatment include system-level factors, such as insufficient integration of mental health resources in cardiology, and patient-related factors like stigma and low acceptance of mental health treatment. Innovative interventions that address these barriers and involve patients as active partners in depression care should be developed through atheory-driven, transparent, multistage process involving key stakeholders such as patients, nurses, and cardiologists. Asound methodological evaluation of such multilevel interventions could answer the question of whether early detection of depression in patients with coronary heart disease would lead to health benefits.

Improved Screening for Depression in Patients Initiating Fertility Treatment

ObjectiveTo improve screening for depression in patients who are initiating fertility treatment at a reproductive endocrinology and infertility (REI) center by screening all patients at their initial visit using the Patient Health Questionnaire–9 (PHQ-9). DesignThis quality improvement project was conducted using a plan–do–study–act cycle implemented with a postintervention study design. Setting/Local ProblemA medium-size REI center in a mid-Atlantic U.S. metropolitan area where screening for mental health status in patients initiating fertility treatments was not occurring. ParticipantsPatients who were scheduled in person with REI providers for a new patient consult regarding fertility were declared eligible. Intervention/MeasurementsThe PHQ-9 was administered by providers at initial consults for patients seeking fertility treatments from October 2022 to February 2023. Three cycles of the plan–do–study–act model were used to execute change. For all patients who scored 5 to 9 (mild depression), conversations regarding counseling referrals occurred. For all patients who scored ≥10 (moderate to severe depression), a referral for counseling and medication management was generated. Data were analyzed via descriptive statistics. ResultsA total of 115 participants were included. A screening rate of 84.3% (n = 97) was achieved for patients initiating treatment. Of the 97 screened, 21 patients had a score of ≥5; 19 were given a referral for counseling. However, none of the patients attended a counseling session or started medication prescribed by their primary care provider during the 2-month follow-up period. Barriers identified included costs, personal preferences, and access to services. ConclusionThe PHQ-9 screening tool was implemented at an REI clinic to improve the frequency of mental health screenings and provide necessary referrals. However, additional follow-up is needed to ensure patients are receiving appropriate mental health care.

Pain and incident cognitive impairment in very old Mexican American adults.

Studies have investigated the association between pain and cognitive impairment among older adults, but the findings are mixed. We assessed the relationship of activity-limiting pain (pain interference) with incident cognitive impairment and the mediating effect of depressive symptoms among Mexican American adults aged ≥80. Data were taken from the Hispanic Established Population for the Epidemiological Study of the Elderly (2010-2016). Pain interference, or pain that limited daily activities in the last 12 months, was categorized into none, untreated pain interference, and treated pain interference. Cognitive impairment was defined as scoring <21 on the Mini-Mental State Examination and difficulty with at least one instrumental activity of daily living. We used general estimation equations to assess this relationship between pain and incident cognitive impairment over the 6-year period (n = 313). Participants reporting both untreated and treated pain interference had higher odds of incident cognitive impairment than those reporting no pain or pain interference (untreated adjusted odds ratio [aOR]: 2.18; 95% confidence interval [CI]: 1.09-4.36; treated aOR: 1.99; 95% CI: 1.15-3.44). Depressive symptoms explained 15.0% of the total effect of untreated pain and 25.3% of treated pain. Among very old Mexican American adults, both treated and untreated pain interference was associated with incident cognitive impairment. This association was partially mediated by depressive symptoms, underscoring a need for depression screening in patients with chronic pain. Future work is needed to examine mechanistic/causal pathways between pain and subsequent cognitive impairment and the role of pharmacological and non-pharmacological treatments in these pathways.

Preoperative Depression Screening in Patients with Distal Radius Fractures: An Evaluation of Its Modifiability on Outcomes for Patients with Depressive Disorder

Abstract Background It is unclear whether nonpharmacologic intervention for depressive disorder (DD) in the preoperative period can prevent postoperative complications in hand surgery patients. Questions/Purpose The aims were to evaluate whether psychotherapy visits/depression screenings within 90 days of open reduction and internal fixation (ORIF) for distal radius fractures (DRFs) were associated with lower rates of (1) medical complications and (2) health care utilization (emergency department [ED] visits and readmissions). Methods A retrospective analysis of an administrative claims database from 2010 to 2021 was performed. DD patients who underwent ORIF for DRF were 1:5 propensity score matched by comorbidities, including those who did (n = 8,993) and did not (n = 44,503) attend a psychotherapy visit/depression screening 90 days before surgery. Multivariate logistic regression models were constructed to compare the odds ratio (OR) of medical complications, ED visits, and readmissions within 90 days. The p-values less than 0.001 were significant. Results DD patients who did not attend a preoperative psychotherapy visit/depression screening experienced fivefold higher odds of total medical complications (25.66 vs. 5.27%; OR: 5.25, p &lt; 0.0001), including surgical site infections (1.23 vs. 0.14%; OR: 8.71, p &lt; 0.0001), deep wound infections (0.98 vs. 0.17%; OR: 6.00, p &lt; 0.0001), and transfusions (1.64 vs. 0.22%; OR: 7.61, p &lt; 0.0001). Those who did not attend a psychotherapy visit/depression screening experienced higher odds of ED utilizations (9.71 vs. 2.71%; OR: 3.87, p &lt; 0.0001), however, no difference in readmissions (3.40 vs. 3.54%; OR: 0.96, p = 0.569). Conclusion Depression screening may be a helpful preoperative intervention to optimize patients with DD undergoing hand surgery to minimize postoperative complications and health care utilization. Level of Evidence Level III.

Preoperative Depression Screening in Primary Lumbar Fusion: An Evaluation of Its Modifiability on Outcomes in Patients with Diagnosed Depressive Disorder

Studies have reported the detrimental effects of depression following spine surgery; however, none have evaluated whether preoperative depression screening in patients with a history of depression is protective from adverse outcomes and lowers health care costs. We studied whether depression screenings/psychotherapy visits within 3 months before 1- to 2-level lumbar fusion were associated with lower medical complications, emergency department utilization, readmissions, and health care costs. The PearlDiver database from 2010 to 2020 was queried for depressive disorder (DD) patients undergoing primary 1- to 2-level lumbar fusion. Two cohorts were 1:5 ratio matched and included DD patients with (n= 2,622) and DD patients without (n= 13,058) a preoperative depression screen/psychotherapy visit within 3 months of lumbar fusion. A 90-day surveillance period was used to compare outcomes. Logistic regression models computed odds ratio (OR) of complications and readmissions. P value < 0.003 was significant. DD patients without depression screening had significantly greater incidence and odds of experiencing medical complications (40.57% vs. 16.00%; OR 2.71, P < 0.0001). Rates of emergency department utilization were increased in patients without screening versus screening (15.78% vs. 4.23%; OR 4.25, P < 0.0001), despite no difference in readmissions (9.31% vs. 9.53%; OR 0.97, P= 0.721). Finally, 90-day reimbursements ($51,160 vs. $54,731) were significantly lower in the screened cohort (all P < 0.0001). Patients who underwent a preoperative depression screening within 3 months of lumbar fusion had decreased medical complications, emergency department utilization, and health care costs. Spine surgeons may use these data to counsel their patients with depression before surgical intervention.

Prevalence of depression in female patients with hypertension attending outdoor clinic in a Secondary care centre in Northern India

Background: Hypertension is one of the most serious medical conditions affecting a huge population worldwide. Similarly, depression is also one of the major conditions affecting people nowadays especially women who are housewives. There is a direct correlation associated between Hypertension and Depression, where each can worsen the others prognosis. Aims and Objective: Prevalence of depression in female patients with hypertension attending outdoor clinic in a Secondary care centre in Northern India. Materials and Methods: In our study we included 270 patients. Consent was taken and a semi structured proforma was used for collection of socio demographic details. HAM-D scale was used to assess Depression in the patients. Statistical analysis was done of the data that was collected. Results: 68.9% of the sample population had depression, with majority of them having mild symptoms. Moreover, there was statistically significant positive correlation between the duration of hypertension and mean HAM-D score. Conclusions: There is a requirement for proper screening of depression in patients especially females with hypertension so that they can be treated properly and at the earliest.

S921 Improving Depression Screening in Patients with IBD – A Quality Improvement Initiative

S921 Improving Depression Screening in Patients with IBD – A Quality Improvement Initiative

Wellness for the Wounded: Mental Health Care in the Diabetic Limb Salvage Team.

Managing patients with diabetic foot ulcers mandates coordinated input from multiple disciplines. Our practice has published previously on the value of a multidisciplinary team, incorporating skills from plastic surgery, vascular surgery, podiatry, rheumatology, and hyperbaric oxygen therapy in a single location.1 A relatively underdiscussed and poorly recognized component of the multidisciplinary team is mental health care through psychiatrists and psychosocial support. The effects of acute and chronic wound formation on a patient’s quality of life are well documented. Much of the literature comes from studies on trauma and burn survivors. In these fields, preexisting mental health conditions have been linked to higher rates of reoperation, longer hospital stays, and longer times to return to preinjury activity.2 More recently, validated surveys that assess emotional quality of life, such as the 36-Item Short-Form Health Survey, have been applied to the chronic wound populations.3 Patients with chronic leg ulcers have the highest rates of depression among patients with skin diseases and consistently report lower quality of life, worse physical functioning, and higher levels of pain.4 However, few studies comment on the critical role of psychiatrists, psychologists, and social support in the chronic wound population. In the chronic wound population, the interplay of mental health and wound-related outcomes is critical. Chronic diseases, such as diabetes, require lifelong maintenance therapy and diligent monitoring for acute emergencies. Patients who have difficulty adapting to their intensive medically necessary care face higher disease burden and are at risk for experiencing the extremes of disease progression, such as limb loss. Research shows that patients with high mental illness burden often have difficulty adhering to medication schedules. Patients who are prescribed psychiatric medication take, on average, 58 to 65 percent of all prescribed medications.5 Patients with chronic wounds and diabetic foot ulcers are seen bimonthly to weekly by a team of specialized wound care physicians who are not trained to recognize or manage psychiatric disease. Adding psychiatry or behavioral psychology to the wound team provides critical services that allow for prompt identification of disease. Incorporating providers who are equipped to manage physical and mental aspects of care is essential to improve health outcomes and reduce health care costs. To accomplish this goal, all centers that provide care for patients with diabetic wounds can (1) incorporate a dedicated expert in mental health on their team, (2) consistently refer all diabetic wound patients who are exhibiting signs of mental health distress to a behavioral health specialist, (3) educate existing staff members on the role of mental health in wound healing, and (4) screen patients for depression and anxiety during all stages of care. There is abundant need for research into the relationship between successful chronic wound management and mental health support. More longitudinal analyses of the development of new or progression of preexisting psychiatric conditions as a consequence of chronic wound formation will help guide treatment of coexisting conditions. Quality trials also need to assess which behavioral or pharmacologic treatments yield the greatest benefit to wound healing and functional outcomes. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Depression Among Patients With Type 2 Diabetes Mellitus at King Abdulaziz University Hospital (KAUH): A Cross-Sectional Study.

Background: Depression can increase the risk of diabetes-related complications, healthcare expenditures, and morbidity in patients with type 2 diabetes mellitus (T2DM). There have been increasing cases of diabetes in Saudi Arabia; however, research correlating depression with diabetes is lacking. The aim of this study was to find out how common depression is among T2DM patients at King Abdulaziz University Hospital (KAUH), Jeddah, and assess any additional risk factors for depression in these patients.Methodology: A cross-sectional study using computer-assisted telephone interviews was conducted among patients with T2DM from June to August 2021. A total of 215 participants completed the survey. Symptoms and signs of depression were assessed using the Patient Health Questionnaire (PHQ-9). Univariate, bivariate, and multivariate statistical analyses were used to determine the prevalence and risk factors associated with depression.Results: Depression was shown to be prevalent in 54% of type 2 diabetes patients, with the most common associated risk factors being not exercising (p=0.00) and having at least one diabetes-related complication (p=0.001). There was no evidence of a significant relationship between depression and gender or age, although females were, in general, more depressed than males.Conclusion: Diabetic patients have a significantly high prevalence of depression; therefore, it is vital to conduct regular screening for depression in patients diagnosed with T2DM.

Assess and address: Screening and management of depression in patients with chronic heart failure.

About one in three patients with heart failure (HF) have depression. Comorbid HF and depression are associated with poor outcomes and increased health care burden. Clinical guidelines recommend routine depression screening in patients with HF. Depression screening was not being systematically implemented in an outpatient cardiology clinic. To create a sustainable process for a cardiology clinic to screen adults with chronic HF for depression, identify patients who have an elevated depression screening score and initiate an evidence-based treatment algorithm for patients with depressive symptoms. A nurse practitioner (NP)-led process improvement project administered the Patient Health Questionnaire (PHQ-9) tool to patients with HF. The score was reviewed by the NP and, if elevated, addressed with assessment and plan. Compliance was measured by the percentage of patients screened. Clinical impact was measured by percentage of patients with an elevated score with a documented treatment plan. Postimplementation results for four Plan-Do-Study-Act cycles were 38%, 68%, 72%, and 66%, respectively, with a total 63% of patients screened during the entire project. Twenty unique patients (13.2%) had elevated PHQ-9 scores; all had a documented treatment plan. We demonstrated how a screening protocol and an accompanying treatment algorithm can be successfully implemented in an outpatient cardiology clinic. Elements of success included a standardized screening protocol, a clinical support algorithm for treatment/referral, an optimized electronic medical record, and a follow-up system for patients with significant depressive symptoms. Stakeholder engagement throughout the project informed iterative changes and provided direction for sustainability.

Diagnostic accuracy of scales for depression screening in patients with heart failure: systematic review and meta-analysis

Introduction: despite the existence of recommendations for the screening depressive symptoms in patients with cardiovascular disease and heart failure (HF), there are no comparative data regarding the performance of psychometric scales used in patients with HF. This study compares the psychometric performance of screening scales used for depressive symptoms in such patients. Methods: PRISMA declaration recommendations were used for the systematic review. MEDLINE, EMBASE, Psychology and Behavioral Sciences Collection, SCOPUS, Lilacs, Australasian Medical Index and the African Index from January 2000 to February 2016 were used for the search. The eligible articles were published in any language and they assessed the psychometric properties of screening scales for depressive symptoms in patients with HF. QUADAS-2 criteria was used for quality assessment, and a meta-analysis developed through a hierarchical model obtained the cluster estimations for sensitivity, specificity, likelihood ratio, predictive values, and diagnostic odds ratio (DOR) with 95% confidence intervals. Results: the initial search identified 1238 citations; only three gathered the inclusion criteria for quantitative assessment. The combined sensitivity and specificity was 56% (95% IC: 45-67%; T2=0.05) and 98% (95% IC: 96-99%; T2=0.01) respectively. The area under the curve was 0.92 (95% IC: 0.90-0.94). The variables related with the index test, reference test, Global QUDAS-2 score, and language predicted heterogeneity. Limitations: significant heterogeneity, small number of studies, selective cutoff report, and the lack of a cost-effectiveness analysis. Conclusions: The GDS-15, HADS-D, PHQ-9, CAT-D and PROMIS scales performed similarly with high specificity values.

Depression screening in patients with vascular disease.

Major depression is associated with increased morbidity and mortality in vascular surgery patients. The US Preventive Services Task Force and American Heart Association recommend routine depression screening for adults, especially those with cardiovascular disease. Since routine depression screening has not been implemented in most vascular surgery clinics across the nation, we sought to determine the feasibility of depression screening and understand the prevalence and predictors of depression in patients presenting to a single institution's vascular surgery clinic over a 4month period. From June to September 2020, vascular surgery clinic patients were administered a 26-item survey that included validated scales for depression (PHQ-9), pain, frailty, alcohol dependence, and nicotine dependence. Although not validated, the Rosenberg Self-Esteem Scale was also administered. Patient charts were reviewed for demographic information and medical history. 9-digit patient zip codes were used to determine Area Deprivation Index, a measure of socioeconomic status. Univariate and multivariate analyses were performed to understand the factors associated with increased depression prevalence in the study population. A total of 140 (36.4%) of 385 patients met study inclusion criteria. 35.7% of them screened positive for mild to severe depression (PHQ-9 scores ≥5). On univariate analysis, major depression was significantly associated with lower socioeconomic status (p = 0.007), higher frailty (p < 0.001), lower self-esteem (p < 0.001), higher daily pain (p < 0.001), health problems that interfere with social activities (p < 0.001), fatigue (p < 0.001), unmarried status (p = 0.031), and lack of primary care provider (p = 0.048). Multivariate analyses significantly predicted higher frailty (B= 0.487, p = 0.007) and lower self-esteem (B= -0.413, p < 0.001) in patients with depression. Depression was not associated with gender, age, employment status, smoking status, alcohol use, or type of vascular disease. More than one-third of vascular surgery clinic patients have comorbid depression. Higher frailty and lower self-esteem are significant risk factors for depression. Prevention and early identification of frailty may improve outcomes. Depression screening in vascular surgery clinics is feasible and could be useful in determining which patients may benefit from more frequent follow-up and monitoring for associated comorbidities. Vascular surgeons may play an important role in screening for depression and referring patients for psychotherapy and/or pharmacotherapy.

The interrelationship of chronic cough and depression: a prospective population-based study.

BackgroundChronic cough is a debilitating medical condition that is often complicated by psychomorbidities such as depressive symptoms. Nevertheless, little is known about the impact of chronic cough on the risk of developing depression. Therefore, we investigated the association between chronic cough and prevalent, incident and recurrent depression in a population-based sample of middle-aged and older persons.MethodsWithin the Rotterdam Study, a population-based cohort, we defined chronic cough as reporting daily coughing for ⩾3 months. Depression was assessed using the Center for Epidemiologic Studies Depression scale, clinical interviews and medical records. Associations between chronic cough and depression were determined with linear, logistic and Cox regression analyses.ResultsThe study included 5877 participants (mean±sd age 72±8 years, 59% female) who contributed 37 287 person-years of follow-up. At baseline, participants with chronic cough reported more depressive symptoms (adjusted standardised mean difference 0.15, 95% CI 0.07–0.22) compared to those without chronic cough. Over time, chronic cough was associated with an increased risk of depression in participants with a history of depression (hazard ratio (HR) 1.45, 95% CI 1.13–1.84), but not in those without a history of depression (HR 0.91, 95% CI 0.68–1.22).ConclusionsAdults with chronic cough have a disproportionate burden of depressive symptoms and an increased risk of recurrent depression. This highlights the importance of screening for depression in patients with chronic cough.

Screening for depression in patients in treatment for alcohol use disorder using the Beck Depression Inventory-II and the Hopkins Symptom Checklist-10

Alcohol use disorder (AUD) and major depressive disorder (MDD) are prevalent disorders that often co-occur. The aim of the study was to investigate how the Beck Depression Inventory (BDI-II) and Hopkins Symptom Checklist (HSCL-10) perform as screening instruments for MDD in AUD patients in treatment. The study included 127 mainly AUD inpatients currently in treatment at rehabilitation clinics in Norway. Demographic and clinical variables were examined using questionnaires and clinical interviews. The factor structures of the BDI-II and HCSL-10 were examined, as well as internal consistency and receiver operating characteristic (ROC) curve analyses. The Mini International Neuropsychiatric Interview (M.I.N.I.) was used as standard for diagnosing MDD. In total, 14% of the participants were diagnosed with MDD. BDI-II factor analysis retrieved three factors; cognition, somatic complaints and affect, and factor analysis for the HSCL-10 retrieved two factors; depression and anxiety. The optimal cut-off for the BDI-II was 24.5 with sensitivity of 80% and specificity of 78%. For HSCL-10 the optimal cut-off was 2.35, giving sensitivity of 80% and specificity of 69%. Both the BDI-II and HSCL-10 may be clinically useful screening instruments for MDD in AUD patients. There was a tendency that the affect factor of the BDI-II and the depression factor of the HSCL-10 were slightly more suitable for identifying MDD than the other factors. Optimal cut-offs for both the BDI-II and the HSCL-10 in this patient group were higher than cut-offs commonly used in the general population.

Screening for Depression in Patients with Chronic Wounds.

Screening for Depression in Patients with Chronic Wounds.

Comparison of different evaluation systems for assessing disease severity and treatment efficacy in patients with chronic obstructive pulmonary disease

To compare the practicability and clinical value of different evaluation systems for assessing disease severity and treatment efficacy in patients with chronic obstructive pulmonary disease (COPD). We retrospectively analyzed the clinical data of 28 patients with acute exacerbation of COPD admitted to our hospital between November, 2020 and January, 2021. All the patients were assessed with percentage of predicted forced expiratory volume in 1 second (FEV1% pred), COPD assessment test (CAT), modified British Medical Research Council (mMRC), baseline dyspnea index (BDI), clinical COPD questionnaire (CCQ), St. George's respiratory questionnaire (SGRQ), BODE index, Hamilton Depression Rating Scale (HDRS) at admission and with CAT, mMRC, transition dyspnea index (TDI), CCQ, SGRQ, and HDRS at 1 month after discharge. The correlations among FEV1% pred, CAT, mMRC, BDI, CCQ, SGRQ, BODE and HDRS at admission were analyzed. We also compared the TDI and scores of CAT, mMRC, CCQ, SGRQ, and HDRS at 1 month after discharge among the patients using single (n=8), dual (n=10) or triple inhaled medications (n=10) after discharge. Among these patients, FEV1% pred was moderately correlated with SGRQ and BDI (r=-0.66, r=0.61; P < 0.01), and CCQ activity score was closely correlated with mMRC, SGRQ activity score and BDI (r=0.82, r=0.92, r=-0.89; P < 0.01). SGRQ activity score was closely correlated with mMRC and BDI (r=0.84, r=-0.91; P < 0.01), and SGRQ symptom score was closely correlated with BODE (r=0.80, P < 0.01). SGRQ impact score was moderately correlated with HDRS (r=0.57, P < 0.01). In all the 28 patients, all the evaluation scores except for CCQ mental score and HDRS improved significantly after treatment (P < 0.05). At 1 month after discharge, CCQ total score decreased significantly in single therapy group (P < 0.05); CAT, mMRC, CCQ and SGRQ improved obviously in dual therapy group (P < 0.05); CCQ and SGRQ scores decreased significantly in triple therapy group (P < 0.05); the TDI did not differ significantly among the 3 groups (P>0.05). For patients with COPD, BDI and TDI are recommended over mMRC for assessing dyspnea. CAT, CCQ and SGRQ allow sensitive assessment of the treatment efficacy to serve as routine evaluation tests, and among them SGRQ is the most comprehensive and is thus recommended when sufficient time is allowed. BODE is relatively complex but highly valuable for predicting the patients'survival outcomes. HDRS is recommended for routine screening of depression in patients with COPD.

Economic outcomes of depression screening after acute coronary syndromes: The CODIACS-QoL randomized clinical trial

ObjectiveTo evaluate the cost-effectiveness of screening for depression in patients with acute coronary syndrome (ACS) and no history of depression. MethodsCost-effectiveness analysis of a randomized trial enrolling 1500 patients with ACS between 2013 and 2017. Patients were randomized to no screening, screening and notifying the primary care provider (PCP), and screening, notifying the PCP, and providing enhanced depression treatment. Outcomes measured were Healthcare utilization, costs, and incremental cost-effectiveness ratios. Results7.1% of patients screened positive for depressive symptoms. There was no significant difference in usage of mental health services, cardiovascular tests and procedures, and medications. Mean total costs in No Screen group ($7440), in Screen, Notify, and Treat group ($6745), and in Screen and Notify group ($6204). The difference was only significant in the Screen and Notify group versus the No Screen group (−$1236, 95% confidence interval -$2388 to -$96). Because mean QALYs were higher (+0.003 QALY in Screen and Notify; +0.004 QALYs in Screen, Notify, and Treat) and mean total costs were lower in both intervention groups, these interventions were cost-effective. There was substantial uncertainty because confidence intervals around cost differences were wide and QALY effects were small. ConclusionDepression screening strategies for patients with ACS may be modestly cost-effective.