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Clinical studies regarding satisfaction and occlusal forces with the complete denture in relation to the menopause are sparse.The purpose of this clinical study was to compare satisfaction levels and occlusal force with complete dentures in premenopausal and postmenopausal Indian women.Twenty premenopausal (group pre-MP) and 20 postmenopausal (group post-MP) completely edentulous participants were selected based on inclusion and exclusion criteria, and estradiol levels were measured. Complete dentures were delivered to all participants following standard fabrication and insertion protocols. Three months after denture insertion, when participants were free of postinsertion complaints, satisfaction level (by using a valid and reliable questionnaire), depression level by using the Patient Health Questionnaire, (PHQ-9) and occlusal force (with a gnathodynamometer) were measured. The obtained data of all parameters were tabulated and compared by using a statistical software program (α=.05).For questions pertaining to the overall satisfaction of maxillary and mandibular dentures, the 2 study groups encountered a significant difference with the premenopausal group showing significantly higher satisfaction levels (P.001). Depression scores in the postmenopausal women group were significantly higher than those of the premenopausal women group (P.001). A negative correlation was found between the overall satisfaction with complete dentures and depression levels in the participants indicating decreased overall satisfaction with increasing depression levels in participants (rho=-0.698). The premenopausal group recorded significantly higher estradiol levels than the postmenopausal group (P.001). Mean occlusal force with complete dentures in the premenopausal women group was significantly higher than that of the postmenopausal women group (P.001). A positive correlation was found between the estradiol levels and occlusal forces in the participants indicating that with decreasing estradiol levels, the occlusal forces decrease in the participants (r=0.740).Satisfaction levels and occlusal force with complete dentures were significantly higher in premenopausal women group than in the postmenopausal group.

Background COVID-19 is a global pandemic that has raised worldwide public health concerns. The wide spread of the virus has led to unprecedented disturbance to regular life for people around the globe and impacted their mental health. Aims The aims of the current study were to investigate the prevalence of psychiatric symptoms related to insomnia, depression, and anxiety, and identify risk factors contributing to psychological stress in Lebanese young population during COVID-19 pandemic. Method A cross-sectional study was done on the Lebanese young population. Participants were 4397 males and females aged 18 to 35 years who filled a self-administered online questionnaire. Three validated scales were used to measure the mental health status of the participants during the COVID-19 pandemic: 7-item Insomnia Severity Index for insomnia, the Patient Health Questionnaire 9-item depression module for depression, and the 7-item Generalized Anxiety Disorder scale for anxiety. Results The median interquartile range scores for anxiety, insomnia, and depression, were 8 (4–13), 10 (5–14), and 9 (5–12) respectively. Higher anxiety scores were reported with female gender (P

Purpose Literature is scarce regarding cancer care utilization during the massive outbreak of coronavirus disease 2019 (COVID-19) in the Republic of Korea. We investigated functional impairments in mental health and their relationships with depression, anxiety regarding the viral epidemic, and disruptions in healthcare service utilization among cancer patients in the COVID-19 pandemic era.Materials and Methods We used an online survey with questions related to the disturbances faced by patients with cancer in utilizing healthcare services in the pandemic era. Current mental health status was assessed using the Work and Social Adjustment Scale (WSAS), Stress and Anxiety to Viral Epidemics-6 (SAVE-6) scale, Patient Health Questionnaire-9 (PHQ-9), Insomnia Severity Index (ISI), Brief Resilience Scale (BRS), Cancer-Related Dysfunctional Beliefs about Sleep Scale (C-DBS), and Fear of COVID-19 over Cancer (FCC).Results Among the 221 responders, 95 (43.0%) reported disruptions in healthcare service utilization during the COVID-19 pandemic. Logistic regression analysis revealed that functional impairment in the mental health of these patients was expected due to disruptions in healthcare service utilization, high levels of depression, anxiety regarding the viral epidemic, fear of COVID over cancer, and low resilience. Mediation analysis showed that patient resilience and cancer-related dysfunctional beliefs about sleep partially mediated the effects of viral anxiety on functional impairment.Conclusion In this pandemic era, patients with cancer experience depression, anxiety regarding the viral epidemic, and disruptions in healthcare service utilization, which may influence their functional impairments in mental health.

espanolIntroduccion: La pandemia por COVID-19 puede tener consecuencias psicosociales importantes en la poblacion. Objetivo: Determinar los niveles de sintomas de ansiedad, depresion y conductas de autocuidado durante la pandemia de COVID-19 en poblacion general. Metodo: Encuesta en linea distribuida durante tres semanas mediante muestreo no probabilistico. Se empleo el Cuestionario sobre la Salud del Paciente PHQ-9, la Escala del Trastorno de Ansiedad Generalizada GAD-7 y la Escala analoga visual de conductas de autocuidado. Se realizaron analisis descriptivos y de comparacion entre los grupos con ansiedad y depresion. Resultados: Se incluyeron 1508 participantes, 20.8 % presento sintomas de ansiedad grave y 27.5 %, sintomas de depresion grave. Ser mujer, soltero(a) no tener hijos, presentar comorbilidad medica y antecedentes de atencion a la salud mental estuvieron relacionados con la presencia de mayores niveles de sintomas de ansiedad y depresion; 66 a 80 % de la poblacion cumplia con las recomendaciones de autocuidado. Se identifico la necesidad de recibir atencion de salud mental. Conclusion: Se observo mayor numero de individuos con sintomas de ansiedad y depresion moderadas a graves que en otras pandemias. Los efectos psicologicos de la pandemia de COVID-19 se consideran un problema de salud mental publica emergente, por lo que se recomienda la implementacion de programas para su atencion. EnglishIntroduction: The COVID-19 pandemic can have important psychosocial consequences in the population. Objective: To determine the levels of anxiety, depression and self-care symptoms during the COVID-19 pandemic in the general population. Method: Online survey distributed over three weeks using a non-probability sampling. The PHQ-9 Patient Health Questionnaire, the GAD-7 Generalized Anxiety Disorder Scale and Visual analog scale for self-care behaviors were used. Between-group (anxiety and depression) descriptive and comparison analyses were carried out. Results: Out of 1508 included participants, 20.8% had symptoms of severe anxiety, while 27.5% showed symptoms of severe depression. Being a woman, being single, having no children, having medical comorbidities and a history of mental health care were risk factors for developing symptoms of anxiety and depression; 66 to 80 % of the population complied with self-care recommendations. A need for receiving mental health care was identified in our study population. Conclusion: A larger number of individuals with moderate to severe anxiety and depression symptoms were observed than in other pandemics. COVID-19 pandemic psychological effects are considered an emerging public health problem, and implementation of programs for their care is therefore recommended.

Background The microbiome's role in the etiology of depression has been a topic of many recent investigations. Findings suggest that dysbiosis, which describes a general disturbance in the gut microbiome, underlies negative gastrointestinal symptoms and is implicated in depression. We studied associations between gastrointestinal symptoms and depressive symptoms at a population level using cross-sectional data from the National Health and Nutrition Examination Survey (2005–2016, n = 36,287). We hypothesized that the odds of depressive symptoms would be significantly higher in those showing signs of gastrointestinal distress. Methods We analyzed 31,191 adults participating in the National Health and Nutrition Examination Survey from 2005–2016. Outcomes included presence of mucus or liquid in bowel leakage and stomach illness in the past month, diarrhea in the past year, and number of weekly bowel movements. The survey (and thus, our analyses) does not include microbiome samples, only self-reported gastrointestinal symptoms. Depressive symptoms were measured using the Patient Health Questionnaire. Moderate, moderately severe, and severe scores were coded as a positive outcome. Results Compared to those without depressive symptoms, those with moderate-to-severe depressive symptoms had elevated odds of bowel mucus (odds ratio = 2.78; 95% confidence interval = 1.82–4.24), bowel liquid (odds ratio = 2.16; 95% confidence interval = 1.63–2.86), stomach illness (odds ratio = 1.82; 95% confidence interval = 1.31–2.53), diarrhea (sometimes vs. never odds ratio = 1.72; 95% confidence interval = 1.30–2.29), and constipation (sometimes vs. never odds ratio = 2.76; 95% confidence interval = 2.11–3.62). Overall, those with gastrointestinal symptoms were significantly more likely to have depressive symptoms. Conclusions While the intricacies of the brain-gut axis are being investigated at the molecular level, these population data provide further evidence for the association between depressive symptoms and signs of dysbiosis, which may inform health care providers' patient interactions.

Study Design: Retrospective cohort.Purpose: This study aimed to assess the relationship between preoperative narcotic consumption and patient-reported outcomes (PRO) in patients undergoing minimally invasive (MIS) lumbar decompression (LD).Overview of Literature: Previous studies report negative effects of narcotic consumption on perioperative outcomes and recovery; however, its impact on quality of life and surgical outcomes is not fully understood.Methods: A surgical database was retrospectively reviewed for patients undergoing primary, single-level MIS LD from 2013 to 2020. Patients lacking preoperative narcotic consumption data were excluded. Demographics, spinal pathologies, and operative characteristics were collected. Patients were grouped based on preoperative narcotic consumption. Patient Health Questionnaire-9 (PHQ-9), Visual Analog Scale (VAS) for back and leg, Oswestry Disability Index (ODI), 12-item Short Form Physical Component Summary, and Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF) were collected preoperatively and postoperatively. Preestablished values were used to calculate achievement of minimum clinically important difference (MCID). Differences in mean PROs and MCID achievement between groups were evaluated.Results: The cohort was 453 patients; 184 used preoperative narcotics and 269 did not. Significant differences were found in American Society of Anesthesiologists classification, ethnicity, insurance type, and estimated blood loss between groups. Significant differences were also found in preoperative PHQ-9, VAS leg, ODI, and PROMIS-PF between groups (all pp>0.05). A higher rate of MCID achievement was associated with the narcotic group for PHQ-9 and PROMIS-PF at 6 weeks (both p≤0.050), VAS leg at 1 year (p=0.009), and overall for ODI and PHQ-9 (both p≤0.050).Conclusions: Preoperative narcotic consumption was associated with worse preoperative depression, leg pain, disability, and physical function. In patients consuming preoperative narcotics, a higher proportion achieved an overall MCID for disability and depressive symptoms. Patients taking preoperative narcotic medications may report significantly worse preoperative PROs but demonstrate greater improvements in postoperative disability and mental health.

OBJECTIVE. Physical activity is known to improve depressive symptoms. The present study was undertaken to examine physical inactivity as a predictor of incident depression in systemic lupus erythematosus (SLE). METHODS. Data derive from the California Lupus Epidemiology Study (CLUES), a longitudinal cohort with confirmed SLE diagnoses. Physical inactivity was assessed from a single item, “I rarely or never do any physical activities,” and depressive symptoms by the 8-item Patient Health Questionnaire (PHQ-8). Analysis included those not depressed at baseline (PHQ-8 score 3-fold increased risk of incident depression among the sedentary group (HR 3.88 [95% Cl 1.67–9.03]). CONCLUSION. In this diverse SLE cohort, a simple question about physical inactivity was highly predictive of incident depression over the subsequent 2 years. Results suggest an urgent need for approaches to reduce sedentary behavior in this high-risk population.

Duloxetine is a treatment approved by the US Food and Drug Administration for both osteoarthritis (OA) pain and depression, though uptake of duloxetine in knee OA management varies. We examined the cost-effectiveness of adding duloxetine to knee OA care in the absence or presence of depression screening.We used the Osteoarthritis Policy Model, a validated computer microsimulation of knee OA, to examine the value of duloxetine for patients with knee OA who have moderate pain by comparing 3 strategies: 1) usual care, 2) usual care plus duloxetine for patients who screen positive for depression on the Patient Health Questionnaire 9 (PHQ-9), and 3) usual care plus universal duloxetine. Outcome measures included quality-adjusted life years (QALYs), lifetime direct medical costs, and incremental cost-effectiveness ratios (ICERs), discounted at 3% annually. Model inputs, drawn from the published literature and national databases, included annual cost of duloxetine ($721-937); average pain reduction for duloxetine (17.5 points on the Western Ontario and McMaster Universities Osteoarthritis Index pain scale [0-100]), and likelihood of depression remission with duloxetine (27.4%). We considered 2 willingness-to-pay (WTP) thresholds of $50,000/QALY and $100,000/QALY. We varied parameters related to the PHQ-9 and the cost of duloxetine, efficacy, and toxicities to address uncertainty in model inputs.The screening strategy led to an additional 17 QALYs per 1,000 subjects and increased costs by $289/subject (ICER = $17,000/QALY). Universal duloxetine led to an additional 31 QALYs per 1,000 subjects and $1,205 per subject (ICER = $39,300/QALY). Under the majority of sensitivity analyses, universal duloxetine was cost-effective at the $100,000/QALY threshold.The addition of duloxetine to usual care for knee OA patients with moderate pain, regardless of depressive symptoms, is cost-effective at frequently used WTP thresholds.

Background Italy was one of the first countries to be heavily hit by the spread of the new Coronavirus. Longitudinal studies are needed to investigate the real effect of COVID-19 on adult mental health. The Italian Twin Registry carried out a study to investigate, over time, the course of depressive symptoms in the general population. Methods The study relies on data collected just before the beginning (February 2020) and the end (June 2020) of the first lockdown. Symptoms of depression were assessed using the Patient Health Questionnaire, and total scores or categorized depression scores were considered in the analyzes. Results A total of 1690 adult twins were recruited. The study showed a mean depression score of 1.11 immediately before lockdown and 1.20 immediately after, with an overall prevalence of depressive symptoms increasing from 33.6 to 38.9%. Depressive symptoms immediately after the restriction period were associated with Covid-19 symptoms affecting households, financial problems due to the pandemic and poor social support. Independently of the baseline risk of depressive symptoms, we observed an increased risk among younger and less educated people. Compared to the pre-lockdown period, women and middle-aged people also were found to be at greater risk of developing depressive symptoms. Limitations Possible participation bias and residual selection bias. Conclusions The study shows that the COVID-19 pandemic was associated with an increased depressive symptomatology and that, in such health emergency times, the most vulnerable persons are young adults, women, and those living in a socially, culturally, or economically disadvantaged environment.

Objectives To elucidate the association between cardio-metabolic risk factors and depressive symptoms among US adults. Methods Data on 9,477 adults ≥ age 18 from the US National Health and Nutrition Examination Survey (NHANES) 2013-2018 were used. Number of cardio-metabolic risk (CMR) factors, from 0-5, was based on BMI, blood pressure, fasting blood glucose, and lipid levels. Depressive symptoms by Patient Health Questionnaire (PHQ-9) scores were categorized “no to mild symptoms” (0-9) and “clinically-significant depressive (CSD) symptoms” (10-27). Logistic regression analysis tested associations between CMR factors and CSD symptoms, adjusted for age, gender, education, income, race/ethnicity and smoking status. Results CSD symptoms were significantly associated with low HDL, abdominal obesity, and high triglycerides. Increased numbers of CMR factors were associated with increased odds of CSD symptoms, from 1.45 times for 1 CMR to 2.55 times for 5 CMRs. The cross-sectional nature of the present study has resulted in some limitations like the inability to determine the direction and causality of the effects between depression and CMR. The study data was subject to response bias and recall errors as the participants self-reported the use of medications. Conclusions In US adults, cardio-metabolic risk factors were associated with clinically-significant depressive symptoms. Public health and clinical programs should include screening for both health issues, intervention for modifiable risk factors, and support for social determinants of health.

Background The prevalence of depression amongst adolescents with type 1 diabetes is estimated to be 2-3 times higher than in the general population. In adults with type 1 diabetes and depression short-term outcomes are worse compared to individuals just diagnosed with type 1 diabetes. This study aims to determine if depressive symptom endorsement is associated with glycemic outcomes and short-term complications in adolescents with type 1 diabetes. Methods Analysis was conducted using electronic medical records from the T1D Exchange Quality Improvement Collaborative. Adolescents with type 1 diabetes, aged 12-18, receiving treatment in a diabetes clinic who had been screened for depression with the PHQ-9 between 2016-2018 were eligible for inclusion. Individuals must have also had HbA1c data available from the day of depression screening and from 10-24 weeks after screening; the final sample size was 1,714. Results Almost 30% of adolescents endorsed mild or greater (PHQ-9 ≥ 5) depressive symptoms. Endorsement of mild or greater depressive symptoms was associated with an 18% increased risk of an HbA1c ≥7.5% and a 42% increased risk of an HbA1c ≥9.0% on the day of screener administration. Depressive symptom endorsement was also associated with an 82% increased risk for DKA. Conclusions This study suggests that depression symptoms are associated with an increased risk for elevated HbA1c and short-term complications. With the rising incidence of type 1 diabetes in youth, routine screening, and appropriate management of depression is needed. This article is protected by copyright. All rights reserved.

Background There is a paucity of data on depression, anxiety and post-traumatic stress disorder after left ventricular assist device (LVAD) implantation. We designed an observational study to integrate these with functional capacity and health-related quality of life (HR-QOL) in surviving LVAD patients. Methods and Results Consenting patients between 1 month and 9 years after LVAD implantation (n = 121) were screened for functional capacity (World Health Organization Disability Assessment Schedule 2.0 [WHODAS 2.0)]); HR-QOL (European Quality of Life [EQ-5D] and Visual Assessment Scales [EQ-VAS]), depression (Patient Health Questionnaire [PHQ-9], anxiety (Generalized Anxiety Disorder Scale [GAD-7]) and post-traumatic stress disorder (Impact of Event Scale Revised [IES-R]). Of the 94% of patients who consented, 34.7% reported impaired functional capacity (WHODAS 2.0 score of ≥25%), 23.1%–34.7% HR-QOL problems (domain EQ-5D of ≥3), 10.7% “poor health” (EQ-VAS of ≤40), 14.9% depression (PHQ-9 of >14), 11.7% suicidal ideation and 17.5% anxiety (GAD-7 of >10). Among these patients, 23.5% had a positive screen for post-traumatic stress disorder (IES-R of ≥24). An EQ-VAS of 80 or greater predicted good functional capacity (P Conclusions One-third of discharged LVAD patients reported impaired function, HR-QOL, and psychological issues. A standardized evaluation before and after LVAD implantation could facilitate psychologic prehabilitation, inform decision-making, and identify indications for mental health intervention.

Purpose This report from VitalSign6 project describes treatment selection, follow-up rates and remission outcomes by initial depression severity using the PCP-FIRST model. Methods This retrospective analysis included 32,106 patients aged ≥12 years screened with the Patient Health Questionnaire 2-item (PHQ-2) from November 2016 to July 2019 across 37 primary care clinics. PHQ-2 positive-screen patients (PHQ-2 ≥ 3) received 9-item PHQ (PHQ-9) and 7-item Generalized Anxiety Disorder scales, clinician assessments, and evaluation for pharmacotherapy management with measurement-based care (MBC). Results Of PHQ-2 screened patients, 18.7% (5994/32,106) were positive and received a PHQ-9. Of 5994 patients with PHQ-9, 2571 received a clinical diagnosis of depression of whom, 333 had none-mild depression (PHQ-9 Conclusions Despite this being a real-world, usual care sample, remission outcomes exceed real world remission rate expectations of 6% in primary care.

Background The role of vitamin D in depression has been gaining increased research interest. However, little is known about the independent associations of serum 25-hydroxyvitamin D3 (25(OH)D3) and D2 (25(OH)D2) with depressive symptoms. The goal of this study was to examine the metabolites of vitamin D and their associations with depression. Methods This study was conducted in US females using data from the National Health and Nutrition Examination Survey 2011–2014. Depressive symptoms were assessed using a nine-item Patient Health Questionnaire, and serum 25(OH)D3 and 25(OH)D2 levels were measured using liquid chromatography-tandem mass spectrometry. Linear regression and generalized additive models were applied to evaluate the associations between 25(OH)D3, 25(OH)D2 and depression. Results A negative association between serum 25(OH)D3 and depressive symptoms was observed in the fully adjusted model. This association was also found among widowed, divorced, separated, and never-married individuals. The association between 25(OH)D2 and depressive symptoms was not statistically significant, but the dose-response analysis revealed an inverted U-shaped relationship between them with an inflection point at 56.2 nmol/L. To the left of the inflection point, we detected a positive association between 25(OH)D2 and depressive symptoms, whereas a negative association was observed to the right of the inflection point. Limitations The study used a cross-sectional approach, so causation cannot be determined. Conclusions Our study shows an inverse linear association between serum 25(OH)D3 and depressive symptoms in US females. The association between 25(OH)D2 and depression follows an inverted U-shaped curve with the inflection point at 56.2 nmol/L.

BACKGROUND: Repetitive transcranial magnetic stimulation (TMS) is an evidence-based treatment for pharmacoresistant major depressive disorder (MDD), however, the evidence in veterans has been mixed. To this end, VA implemented a nationwide TMS program that included evaluating clinical outcomes within a naturalistic design. TMS was hypothesized to be safe and provide clinically meaningful reductions in MDD and posttraumatic stress disorder (PTSD) symptoms. METHODS: Inclusion criteria were MDD diagnosis and standard clinical TMS eligibility. Of the 770 patients enrolled between October 2017 and March 2020, 68.4% (n=521) met threshold-level PTSD symptom criteria. Treatments generally used standard parameters (e.g., left dorsolateral prefrontal cortex, 120% motor threshold, 10Hz, 3000 pulses/treatment). Adequate dose was operationally defined as 30 sessions. MDD and PTSD symptoms were measured using the 9-item patient health questionnaire (PHQ-9) and PTSD checklist for DSM-5 (PCL-5), respectively. RESULTS: Of the 770 who received at least one session, TMS was associated with clinically meaningful (Cohen’s d>1.0) and statistically significant (all p

Background Since the declaration of the novel Corona Virus Disease (COVID-19) as a global pandemic by the World Health Organization, frontline healthcare workers (HCWs) and staff in the Emergency Departments (ED) started experiencing feelings of anxiety and fear from the projected exponential spread and the potential burden on the healthcare system and infrastructure. In Lebanon, major local factors contributing to this fear were the rapid escalation of COVID-19 cases across the country, the lack of preparedness, and the shortage of personal protective equipment, in addition to the evolving economic crisis and financial restrictions. This study aims to investigate the immediate psychological impact of the COVID-19 outbreak on ED staff working in a hospital environment in relation to their household income. Methods Self-reported cross-sectional survey was delivered to the frontline staff working at the Department of Emergency Medicine of AUBMC in Beirut, Lebanon. General demographic characteristics, scores of Generalized Anxiety Disorder 7 (GAD-7), scores of Patient Health Questionnaire 9 (PHQ-9), and scores of Burnout Measure-Short (BMS) version were collected. Results 74 HCWs (49.6%) participated in the study. The mean age for participants was (31.78 ± 9.49). More than half of the participants were nurses and more than 70% reported a monthly salary of less than 2000 USD. The household income was negatively associated with the participant's scores on the GAD-7 and PHQ-9, but not the BMS. Previous mental health diagnosis was positively associated with the PHQ-9 and BMS scores, while seeking mental health care was negatively associated with the PHQ-9 and BMS scores. Conclusion At our tertiary care center in a low-income, low resource country amidst the COVID-19 pandemic, the HCWs reported marked psychological disturbances on different scales. In particular, the financial burden was associated with increased anxiety and clinical depression, but was not associated with burnout.

Objectives Interventions to prevent postpartum common mental disorders (PCMD) among unselected populations of women have had limited success. The aim was to determine whether What Were We Thinking (WWWT) a gender-informed, psychoeducational programme for couples and babies can prevent PCMD among primiparous women 6 months postpartum. Design Cluster-randomised controlled trial. Setting 48 Maternal and Child Health Centres (MCHCs) from 6 Local Government Areas in Melbourne, Australia were allocated randomly to usual care (24) or usual care plus WWWT (24). Participants English-speaking primiparous women receiving primary care at trial MCHCs were recruited to the intervention (204) and control (196) conditions. Of these, 187 (91.7%) and 177 (90.3%) provided complete data. Intervention WWWT is a manualised programme comprising primary care from a trained nurse, print materials and a face-to-face seminar. Main outcome measures Data sources were standardised and study-specific measures collected in blinded computer-assisted telephone interviews at 6 and 26 weeks postpartum. The primary outcome was PCMD assessed by Composite International Diagnostic Interviews and Patient Health Questionnaire (PHQ) Depression and Generalised Anxiety Disorder modules. Results In intention-to-treat analyses the adjusted OR (AOR) of PCMD in the intervention compared to the usual care group was 0.78 (95% CI 0.38 to 1.63, ns), but mild to moderate anxiety symptoms (AOR 0.58, 95% CI 0.35 to 0.97) and poor self-rated health (AOR 0.46, 95% CI 0.22 to 0.97) were significantly lower. In a per protocol analysis, comparing the full (three component) intervention and usual care groups, the AOR of PCMD was 0.36, (95% CI 0.14 to 0.95). The WWWT seminar was appraised as salient, comprehensible and useful by >85% participants. No harms were detected. Conclusions WWWT is readily integrated into primary care, enables inclusion of fathers and addresses modifiable risks for PCMD directly. The full intervention appears a promising programme for preventing PCMD, optimising family functioning, and as the first component of a stepped approach to mental healthcare. Trial registration number ACTRN12613000506796; Results.

Background We investigated the evolving prevalence of mood and anxiety symptoms among healthcare workers from May, 2020 to January, 2021; risk factors for adverse outcomes; and characteristic modes of affective responses to pandemic-related stressors. Methods 2,307 healthcare workers (78.9% female, modal age 25-34) participated in an online survey assessing depression (Patient Health Questionnaire [PHQ-9]) and anxiety symptoms (Generalized Anxiety Disorder scale [GAD-7]), demographic variables, and self-reported impact of pandemic-related stressors. 334 subjects were reassessed ∼6 months later. Results The prevalence of clinically significant depression and anxiety was 45.3% and 43.3%, respectively, and a majority (59.9%–62.9%) of those individuals had persistent significant symptoms at 6-month follow-up. Younger age, female gender, and specific occupations (support staff > nurses > physicians) were associated with increased depressive and anxiety symptoms. The most important risk factors were social isolation and fear of contracting COVID-19. The prevalence of clinically significant mood and anxiety symptoms increased by 39.8% from May, 2020 to January, 2021. PHQ-9 and GAD-7 scores were highly correlated and associated with nearly identical risk factors, suggesting that they are not capturing independent constructs in this sample. Principal components analysis identified seven orthogonal symptom domains with unique risk factors. Conclusions Clinically significant mood and anxiety symptoms are highly prevalent and persistent among healthcare workers, and are associated with numerous risk factors, the strongest of which are related to pandemic stressors and potentially modifiable. Interventions aimed at reducing social isolation and mitigating the impact of fear of infection warrant further study.

Family functioning is a modifiable factor associated with major depressive disorder (MDD) and complicated grief (CG) among the bereaved families of patients with advanced cancer; however, the evidence regarding this association is limited.We aimed to explore the association of family functioning with possible MDD and CG among the bereaved families of patients with advanced cancer who died in palliative care units.This study is a part of the J-HOPE4 study, a nationwide cross-sectional multi-purpose questionnaire survey conducted in 2018. We recruited potential participants from 164 inpatient palliative care units in Japan and assessed family functioning with the Family Relations Index (FRI). Family functioning was classified into three categories (Well-functioning: FRI ≥ 10, Intermediate: FRI = 8〜9, Dysfunctioning ≤ 7). The Patient Health Questionnaire 9 (PHQ-9) and the Brief Grief Questionnaire (BGQ) were used to assess depression (PHQ-9 score ≥ 10) and complicated grief (BGQ score ≥ 8), respectively. Multinomial logistic regression analysis was performed with possible MDD and CG and factors the family functioning.A total of 615 questionnaires were returned, of which 54.0 % (n = 510) age of questionnaires could be used. Although family functioning was associated with possible MDD (21.1% in Dysfunctional; 9.3% in Well-functional, P = 0.016), it was not associated with possible CG (14.8% in Dysfunctional; 9.9% in Well-functional, P = 0.929). Possible MDD and CG were significantly associated with deteriorated family relationships (OR:8.29; P = 0.004 and OR:34.00; P0.001, respectively), and consulting with health care providers about their concerns (OR:0.23; P = 0.003 and OR:0.23; P = 0.003, respectively).Family function was affected by post-bereavement possible MDD and not by CG. Our findings suggest that health care providers can identify risk factors for MDD among bereaved, dysfunctional family members.

Background We evaluated the risk factors for pain catastrophizing, kinesiophobia, and elevated depressive symptoms among patients undergoing high-grade cartilage defect surgery. We hypothesized that cartilage patients would demonstrate high scores on pain catastrophizing, kinesiophobia, and depression testing prior to surgery. Methods Two hundred and ten patients undergoing surgery for high-grade cartilage defects (56% chondroplasty, 36% microfracture, 22% autologous chondrocyte implantation) completed a preoperative survey before undergoing surgery. Outcome scores assessed were: International Knee Documentation Committee-Symptom (IKDC-S) score, Tegner activity score, Pain catastrophizing scale (PCS), Tampa scale for kinesiophobia (TSK-11), and Patient Health Questionnaire depression scale (PHQ-9). Multivariate logistic regression was used to determine what pre-operative factors predicted pain catastrophizing, kinesiophobia, and elevated depressive symptoms. Results The mean pre-operative Tegner score was 5.8 (SD 2.4) and IKDC-S score was 44.7 (SD 11.1). Prior to surgery, 19% had abnormal pain catastrophizing (PCS ≥ 20 points), 14.4% had moderate-severe depression (PHQ ≥ 10), and 49.0% had high kinesiophobia (TSK-11 ≥ 25). Lower pre-operative Tegner scores predicted moderate-severe depressive symptoms (per point decrease, OR 1.36, 95% CI 1.06, 1.76; p = 0.008). Predictors of elevated pain catastrophizing were lower pre-operative IKDC-S scores (per 5-point decrease, OR 1.28, 95% CI 1.08, 1.51; p = 0.002) and symptom duration >6 months (OR 2.20 CI 1.14, 4.32; p = 0.02). A lower pre-operative IKDC-S score (per 5-point decrease, OR 1.17, CI 1.03, 1.33; p = 0.02) predicted elevated kinesiophobia. Conclusion Low self-reported function, low activity level and symptom duration greater than six months are associated with poor preoperative psychological status.

Background There is a lack of data concerning impact of COVID-19 among older adults (OA) living at long-term care (LTC) centers. This study investigated how COVID-19 has affected this population. The prevalence of and risk factors for post-traumatic stress, depression, and anxiety were investigated. Methods A semi-structured interview to determine the effect of COVID-19 was conducted to 200 OA at two government LTC centers. The 17-item Post-traumatic Stress Disorder Checklist, the 9-item Patient Health Questionnaire, and the 7-item Generalized Anxiety Disorder Scale were used to evaluate post-traumatic stress, depression, and anxiety, respectively. Results Most OA reported moderate or severe impact of COVID-19. The most impacted area was financial due to decreased support from outside the center. Seventy percent of OA reported no or mild psychological stress from COVID-19; however, 5.5% had post-traumatic stress, 7.0% had depression, and 12.0% had anxiety. Higher psychological stress from COVID-19 and having respiratory tract infection symptoms were independently associated with post-traumatic stress, depression, and anxiety. Receiving COVID-19 news via social media was independently associated with post-traumatic stress and depression. Having psychiatric comorbidity was independently associated with depression. Conclusions OA living in LTC centers reported moderate or severe impact from COVID-19, especially financial, but relatively low psychological stress. Psychological stress from COVID-19, having respiratory tract infection symptoms, and receiving COVID-19 news via social media were risk factors for psychological disorders. Limitations The data reflected the post-outbreak period. There is limitation in the generalizability of the results for other countries with different health care systems.

Background Depression is the leading cause of disease burden among women worldwide. However, an understanding of symptom profiles among women at risk of mood disorders is limited. We determined distinct profiles of affective symptoms among high risk women, along with their distinguishing characteristics. Methods Women were recruited from 17 clinical sites affiliated with the National Network of Depression Centers. They completed measures of depression (Patient Health Questionnaire – 9) and anxiety (Generalized Anxiety Disorder – 7) as well as questions regarding demographics, reproductive status, behavioral/mental health history, and life stress/adversity. Latent class analysis and multinomial logistic regression were used to identify and characterize symptom profiles. Results 5792 women participated, ages 18 to 90 (M = 38). Three latent classes were identified: generally asymptomatic (48%), elevated symptoms of comorbid anxiety and depression (16%), and somatic symptoms (36%). Financial security and greater social support were protective factors that distinguished asymptomatic women. The profile of the class with elevated anxiety/depressive symptoms constituted a complex mix of adverse social determinants and potentially heritable clinical features, including a diagnosis of Bipolar Disorder. Women in the 3rd latent class were characterized by menstrual irregularity and a stronger expression of neurovegetative symptoms, especially sleep disturbance and fatigue. Limitations Limitations included less than optimal racial diversity of our sample and reliance on self-report. Conclusions Different symptom profiles may reflect distinct subtypes of women at risk of mood disorders. Understanding the etiology and mechanisms underlying clinical and psychosocial features of these profiles can inform more precisely targeted interventions to address women's diverse needs.

Leisure time physical activity (LTPA) is beneficial for late-life depression (LLD). The main purpose of this study was to estimate the associations between LTPA parameters (intensity, duration, frequency) and LLD.Through the 2018 Women Health Needs Survey, data on 1,892 women aged 55-70 in Hunan, China, were studied. Depression was measured by the 9-item Patient Health Questionnaire (PHQ-9). Self-reported LTPA parameters were collected. Binary logistic regression models were used to compute odds ratios (OR) for LTPA for predicting depression. Sensitivity analyses were conducted to examine the effect of missing values.Moderate LTPA volume (OR = 0.582, p = 0.027, 95% CI [0.360-0.941] for 150-299 min/week and OR = 0.392, p = 0.002, 95% CI [0.215-0.714] for ≥300 min/week) was associated with reduced depression, while vigorous LTPA could increase the risk (OR = 2.414, p = 0.029, 95% CI [1.095-5.325] for75 min/week and OR = 3.824, p = 0.007, 95% CI [1.439-10.158] for ≥75 min/week). Frequent (6-7 days/week), moderate LTPA had a lower risk (OR = 0.570, p = 0.021, 95% CI [0.353-0.918]), while frequent (≥3 days/week), vigorous LTPA increased the risk (OR = 5.103, p = 0.001, 95% CI [1.977-13.172]). The adjusted relationship between the duration and depression was not observed. The results were supported by the sensitivity analysis based on missing value replacement.In this cross-sectional study, LTPA data were self-reported and no data on light LTPA were collected.Moderate LTPA, associated with mental health benefits, should be recommended for older women instead of vigorous LTPA.

Introduction Suicide is a leading cause of mortality in the United States and recent initiatives have sought to increase monitoring of suicide risk within healthcare systems. Working-age adults (22–64 years) admitted to nursing homes may be at risk for suicidal ideation, yet little is known about this population. Methods The national nursing home database, Minimum Dataset 3.0, was used to identify 323,436 working-age adults newly admitted to a nursing home in 2015. This cross-sectional study sought to describe sociodemographic and clinical characteristics, examine behavioral health treatment received, and determine resident characteristics associated with suicidal ideation at nursing home admission using logistic regression and reports adjusted odds ratios (aOR). Results Suicidal ideation was present among 1.27% of newly admitted working-age residents. Almost 25% of those with suicidal ideation had no psychiatric diagnosis. Factors associated with increased odds of suicidal ideation included younger age (aOR 1.90), admission from the community (aOR 1.92) or a psychiatric hospital (aOR 2.38), cognitive impairments (aOR 1.46), pain (aOR 1.40), rejection of care (aOR 1.91), and psychiatric comorbidity (aOR depression: 1.91, anxiety disorder: 1.11, bipolar disorder: 1.62, schizophrenia: 1.32, post-traumatic stress disorder: 1.17). Limitations Due to the cross-sectional nature of this study, no causal inferences about suicidal ideation and the explored covariates can be made. The Minimum Dataset 3.0 has only one measure of suicidal ideation the Patient Health Questionnaire. Conclusion Factors other than psychiatric diagnosis may be important in identifying newly admitted working-age nursing home residents who require on-going suicide screening and specialized psychiatric care.

Background Most children now survive cardiac surgery, and the focus of quality improvement initiatives has shifted toward more complex outcome measures. The aim of this investigation was to study the impact of early postoperative morbidities on parent-reported patient quality of life and parental anxiety or depression over 6 months. Methods This prospective case-matched cohort study was conducted in 5 UK children’s cardiac centers. Measures of impact for patient categories of “single morbidity,” “multiple morbidities,” and “extracorporeal life support (ECLS)” were compared with “no morbidity.” The measures used were the Pediatric Quality of Life Inventory (PedsQL) and the 4-item Patient Health Questionnaire (PHQ-4) at 6 weeks and 6 months postoperatively. The study modeled the outcomes using mixed effects regression, adjusting for case mix and clustering within centers. Results The study included 666 patients who underwent operation at a median age of 81 days (interquartile range, 10 to 325 days). At 6-week follow-up, significant adjusted differences to the reference group with no morbidity were found for total PedsQL scores, which were lower in patients with ECLS (P = .01), multiple morbidities (P < .001), and a single morbidity (P = .04), as well as the proportion of parents with anxiety and depression, which were higher in the group with multiple morbidities (P = .04 and P = .01, respectively). At 6 months, measures had improved in all morbidity groups. The only significant adjusted difference in the reference group was for physical PedsQL scores in ECLS (P = .04) and multiple morbidities (P < .01). Conclusions Patient and parent well-being are strongly influenced by postoperative morbidities early after surgery, with improvement by 6 months. Family psychological support and holistic rehabilitation are vital for children who experience postoperative morbidities.

Aims Early engagement in advance care planning (ACP) is recommended in heart failure (HF) management. We investigated the preferences of patients with HF regarding ACP and end‐of‐life (EOL) care, including their desired timing of ACP initiation. Methods and results Data were collected using a 92‐item questionnaire survey, which was directly distributed to hospitalized patients by dedicated physicians and nurses in a university hospital setting. One‐hundred eighty‐seven patients agreed to participate (response rate: 92.6%), and 171 completed the survey [valid response rate: 84.7%; men: 67.3%; median age: 73.0 (63.0–81.0) years]. Logistic regression analyses were conducted to identify the predictors of positive attitudes towards ACP. Most recognized ACP as important for their care (n = 127, 74.3%), 48.1% stated that ACP should be initiated after repeated HF hospitalizations in the past year, and 29.0% preferred ACP to begin during the first or second HF hospitalization. Only 21.7% of patients had previously engaged in ACP conversations during HF management. Positive attitudes towards ACP were associated with lower depressive symptoms [two‐item Patient Health Questionnaire; odds ratio (OR): 0.75, 95% confidence interval (CI): 0.61–0.92, P‐value: 0.006], marriage (OR: 2.53, 95% CI: 1.25–5.12, P‐value: 0.010), and a high educational level (OR: 2.66, 95% CI: 1.28–5.56, P‐value: 0.009), but not with severity of HF (represented by Seattle Heart Failure Model risk score). Regarding EOL care, while ‘Saying what one wants to tell loved ones’ (83.4%), ‘Dying a natural death’ (81.8%), and ‘Being able to stay at one's favorite place’ (75.6%) were the three most important factors for patients, preferences for ‘Receiving sufficient treatment’ (56.5%) and ‘Knowing what to expect about future condition’ (50.3%) were divergent. Conclusions Despite patients' preferences for ACP conversations, there was a discrepancy between preference and engagement in ACP among patients hospitalized for HF. Patients' preferences regarding EOL care may differ; physicians need to consider the appropriate ACP approach to align with patients' care goals.

Maternal postpartum smoking is associated with several negative outcomes for mother and child. The relationship between bonding impairment (BI) and maternal postpartum smoking is less known. The aim of the present study was to assess the relationship between BI and maternal postpartum smoking at 6 to 8 months after childbirth in a primary care sample of low-income mothers who had depression during the previous pregnancy. We performed a cross-sectional, secondary analysis from a community trial with 356 postpartum women from public primary care clinics in Sao Paulo, Brazil. The main outcome measure was maternal postpartum smoking. The main exposure variable was BI assessed with the Postpartum Bonding Questionnaire. A socio-demographic questionnaire evaluated maternal and obstetric characteristics. Postpartum depression was assessed with the Patient Health Questionnaire. Crude and adjusted prevalence ratios (PR) of the association between BI and maternal postpartum smoking, with 95% confidence intervals (CI), were calculated using Poisson regression. Multivariate analysis was performed using three models (Model 1 adjusted for randomization during pregnancy, Model 2 adjusted for Model 1 plus mother’s socioeconomic and obstetric characteristics, and Model 3 adjusted for Model 2 plus postpartum depression). Maternal postpartum smoking occurred in 16.7% of our sample. In the multivariable analysis, BI was associated with maternal postpartum smoking (PR:2.04; CI 95% 1.08:3.84). Women presenting bonding problems are at higher risk of smoking after childbirth. Intervention to enhance mother–child bonding may have the potential to decrease maternal postpartum smoking.

Purpose: Depression is a major mental disorder and has drastic effects on people suffering from other terminal illnesses like cancer. Many patients struggling with chronic or fatal illnesses rely on spirituality to cope. Spirituality in Indian culture has always been a vital component in indigenous health systems.Objective: To determine the relationship between spirituality and depression among patients with cancer visiting a tertiary care institute of Uttarakhand State in northern India. Design: A descriptive cross-sectional survey.Sample: A total of 103 cancer patients visiting inpatient and outpatient departments of a selected tertiary care institute of Uttarakhand state of northern India. Methods: Participants were administered the socio-demographic proforma, Patient Health Questionnaire (PHQ-9) (Kroenke, Spitzer, and Williams, 2001), System of Belief Inventory (SBI-15R). Findings: The mean score of depression among cancer patients was 9.12±6.537 (CI, 7.84-10.39). Patients with high spirituality have minimal or no depression. We found a statistically significant negative correlation between depression and spirituality (r=-0.209, p=0.05).Conclusions: Health care professionals can incorporate spirituality in caring for cancer patients to develop a positive outlook on living despite the illness. Implications for Psychosocial Providers Or Policy: Establishing a spiritual support program as an integral part of a multidisciplinary approach can better cancer treatment in the Indian setting.

Purpose The study aims to investigate long-term psychological distress and its risk factors in the burn survivors. Design A longitudinal study with follow-up interviews was conducted from November 2015-June 2018. A post-burn baseline interview was conducted 6 months after the event, followed by annual surveys for three years. Methods The burn survivors received structured assessment through telephone in the four-wave interviews, including the five-item Brief Symptom Rating Scale (BSRS-5); two-item Patient Health Questionnaire (PHQ-2); four-item Startle, Physiological Arousal, Anger, and Numbness Scale (SPAN-4); and six-item Impact of Event Scale (IES-6) alongside demographic data and other health-related assessment. Findings A total of 180 respondents with the mean age of 23 years old completed the four waves of interview. Using the BSRS-5 as the outcome, each variable had different input in psychological distress during the follow-up years. The main finding was that the SPAN-4 score could predict more than 62% of psychological distress between 6 months and 3 years after the disaster. The generalized estimating equation demonstrated that SPAN-4, IES-6, family functioning impairment, hypnotics use, adaptation to the event, and PHQ-2 could predict psychological distress. However, the variable of follow-up year did not exemplify significant estimation in the model. Conclusions The results indicated that different factors had various influences on psychological distress across the four follow-up stages. PTSD-like symptoms, depression, and anxiety were the most common psychological problems experienced by the young burn cohort in the longitudinal post-traumatic period. Clinical relevance Healthcare providers should be aware of psychological consequences of traumatic events within up to a 3-year post-burn period, particularly post-traumatic stress, depression, and anxiety symptoms.

Background and objectives Significant psychological morbidity exists in patients with active pemphigus. Pemphigus being a chronic disease, psychological morbidity may exist in pemphigus patients in remission as well. The objectives of the study were to assess the psychological morbidity in pemphigus patients in clinical remission and to correlate it with clinico-demographic parameters. Patients and methods Pemphigus patients in clinical remission were consecutively included and were asked to respond to the Hindi/English version of Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7) and panic disorder module of PHQ. Results Of 107 patients recruited, 41 (38.3 %, 95 % CI: 29.1-48.2 %) patients were found to have either depression (33 [30.8 %, 95 % CI: 22.2-40.5 %]) or anxiety (38 [35.5 %, 95 % CI: 26.5-45.4 %] syndrome based on cut-offs of PHQ-9 score and GAD-7 score, respectively. Number of patients with mild, moderate and moderately severe/severe depression syndrome were 26 (24.3 %, 95 % CI: 17.2-33.2 %), 7 (6.5 %, 95 % CI: 0.3-12.9 %) and 0 respectively and patients with mild, moderate, severe anxiety syndrome were 29 (27.1 %, 95 % CI: 19.6-36.2 %), 9 (8.4 %, 95 % CI: 4.5-15.2 %) and 0 respectively. Patients with anxiety or depression syndrome had significantly higher clinical disease activity in the past, number of days spent in dermatology inpatient and significantly shorter clinical remission at the time of assessment as compared to those without these symptoms. Conclusions Significant burden of mild/moderate depression or anxiety syndrome associated with past severity of disease and shorter duration of clinical remission was found.

Context Comprehensive sports medicine care goes beyond the treatment of injuries resulting from athletic activities. Ultimately, it is a competence that includes knowledge in physical therapy, training, nutrition, coaching, motivation, competition, mentoring, psychology, and spirituality that allows the physician and patient to collaborate on promoting the patient’s health goals. The current literature demonstrates a lack of knowledge in the Osteopathic Primary Care Sports Medicine Model’s effectiveness in performance. Objectives To determine whether a comprehensive osteopathic primary care sports medicine approach can improve performance and health outcomes in collegiate athletes. Methods A randomized controlled trial commenced just prior to the start of the lacrosse season and concluded at the end of the season. All the New York Institute of Technology (NYIT) collegiate lacrosse players were educated first in a 1-day seminar of the core competencies, and all participants had access to ask questions on their own volition. Then they were randomized into two groups, either the experimental group receiving the direct osteopathic primary care sports medicine intervention (n=18) or the control group not having active intervention (n=19). Also, the overall team winning percentage for that season was computed and compared to that for the previous years and the following year. Participants were assessed before and after the intervention with the Patient Health Questionnaire (PHQ-9), the 36-Item Short Form Survey (SF-36), custom Osteopathic Primary Care Sports Medicine questionnaire, and body fat composition, and their changes were compared between the experimental group and the control group. Collected data were analyzed using the repeated-measures analysis of variance. Results Thirty-seven participants were enrolled in the study. After 14 participants were excluded due to being lost to follow-up, 23 athlete records were analyzed. The winning percentage of the team was highest during the year of the study period time than in the 3 previous years and the following year. The test group did not have any statistically significant change in the PHQ-9, SF-36, custom Osteopathic Primary Care Sports Medicine questionnaire, as well as in body fat composition. Conclusions When used during a collegiate lacrosse season, this Osteopathic Primary Care Sports Medicine intervention did not significantly improve health outcomes. This preliminary study, despite its limitations in compliance and study population size, did demonstrate improvement in overall team performance when comparing the intervention sport season to other seasons but was not statistically significantly. Therefore, further studies are warranted to improve the understanding in this approach to athlete health outcomes and performance.

As the lives of people living with HIV (PLWH) become increasingly normalized, more focus is being given to the associated comorbidities of HIV, including those related to mental health such as depression. This study aims to evaluate the correlation between depressive symptoms and HIV outcomes in Vietnam through the measurement of CD4 cell count. A mixed design was utilized, in which both a longitudinal assessment of CD4 cell counts and a cross-sectional survey of depressive symptoms were conducted on 481 patients in the Bach Mai and Ha Dong HIV clinics (Hanoi, Vietnam). CD4 cell count data was extracted from the medical records of participants, and depressive symptoms were screened using the Patient Health Questionnaire (PHQ-9). The results illustrate that the presence of moderately severe to severe depressive symptoms is associated with lower CD4 cell counts, indicating poorer HIV outcomes resulting from comorbid depression. This correlation was especially noticeable in the PHQ-9 items for psychomotor agitation/retardation (p < 0.05) and suicidal ideation (p < 0.05). Future policy and treatment options for HIV in Vietnam should consider the presence of comorbid mental health conditions in order to provide more suitable and effective treatment in the goal of providing a higher quality of life for PLWH.

Patients with cirrhosis have high prevalence of erectile dysfunction (ED). The aim of this study was to study the efficacy and safety of tadalafil for ED in patients with cirrhosis.140 cirrhotic males with ED were randomized into tadalafil 10 mg daily (n = 70) or placebo (n = 70) for 12 weeks. ED was diagnosed if erectile function (EF) domain score was 25 in International Index of Erectile Function (IIEF) questionnaire. The erectile function domain consists of six questions concerning erection frequency, erection firmness, frequency of partner penetration, frequency of maintaining erection after penetration, ability to maintain erection to completion of intercourse and confidence in achieving and maintaining erection. Primary outcome was proportion of patients having an increase in 5 points in EF domain of the IIEF. Generalized Anxiety Disorder 7 (GAD-7) questionnaire was used for screening and severity measuring of GAD. The presence of depression was screened using the Patient Health Questionnaire (PHQ-9) and the assessment of health related quality of life was done using the Short Form (36) Health Survey.At the end of 12 weeks, more patients in tadalafil group achieved 5 points increase in the EF domain of the IIEF when compared with the placebo group [44(62.9%) vs. 21(30%), p 0.001]. At the end of 12 weeks, patients receiving tadalafil had significantly more change in scores on the erectile function domain, orgasmic function domain, intercourse satisfaction domain, overall satisfaction domain, erection vaginal penetration rates and successful intercourse; significantly more decline in the GAD-7 and PHQ-9 scores; significantly more improvement in scores of five of the eight domains of SF-36 (general health perception, vitality score, social functioning, role emotional and mental health) and the mental component summary rates when compared with placebo. The development of side effects and the changes in HVPG were not significantly different between the two groups.Tadalafil therapy may enhance erectile function, improve anxiety, depression and quality of life; and is well tolerated by men with cirrhosis (CTP score 10) and ED. However, further larger and long-term studies are needed to confirm these results and look for rarer side effects of using tadalafil in patients with cirrhosis.ClinicalTrials.gov identifier number NCT03566914; first posted date: June 25, 2018.

Background The real-world course of health-related quality of life (HRQoL) in atopic dermatitis (AD) is not well established. Aim To examine predictors, longitudinal course and phenotypes of HRQoL in adult patients with AD. Methods This was a prospective dermatology-practice based study of 955 patients with AD (age 18-97 years). Patients were assessed at baseline and approximately 6, 12, 18 and 24 months. HRQoL was assessed using the 10-item short-form Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health (PGH). AD severity and impact was assessed by patient-reported global AD severity, Patient-Oriented Eczema Measure (POEM), Eczema Area and Severity Index (EASI), Objective SCORing Atopic Dermatitis (O-SCORAD), Investigator's Global Assessment (IGA), Numerical Rating Scale (NRS) average and worst itch, PROMIS sleep-related impairment (SRI), and nine-item Patient Health Questionnaire (PHQ)-9. Repeated-measures regression models were constructed to examine itch over time. Results In multivariable linear regression models controlling for age, race/ethnicity, history of asthma, hay fever and food allergy, baseline PGH-physical (PGH-P4) T scores were inversely associated with patient-reported global AD severity, POEM, EASI, objective SCORAD, IGA, NRS average and worst itch, PROMIS SRI and PHQ-9, with stepwise decreases of physical health with worsening severity. PGH-mental health (PGH-M4) T scores were associated with all aforementioned severity measures aside from POEM. In multivariable repeated measures linear regression models, decreased PGH-P4 and PGH-M4 T scores and mapped five-dimension EuroQoL over time were associated with self-reported global AD severity, NRS worst and mean itch, POEM, PROMIS sleep disturbance and SRI, EASI, objective SCORAD, IGA and PHQ-9. Latent class analysis identified six classes of HRQoL, which were associated with measures of AD severity, nonwhite race, Hispanic ethnicity and having only public health insurance, but not age or sex. Conclusion Patients with AD have a heterogeneous longitudinal course and distinct patterns of HRQoL. Many patients had fluctuating HRQoL over time. Most patients with moderate to severe disease at baseline had persistent HRQoL impairment over time.

Acrylamide (AA) is widely present in heat-processed carbohydrate-rich food, cigarette smoke, and the environment. Prolonged exposure to AA may cause central nervous system damage. However, few epidemiologic studies assessed the association between hemoglobin adduct levels of AA or its metabolite glycidamide (GA) and depressive symptoms. We included 3595 US adults (≥18 years) from the National Health and Nutrition Examination Survey (NHANES) 2013-2016. Data for hemoglobin adduct levels from AA and GA (HbAA and HbGA) were used as a measure of internal dose. Depressive symptom data were from mental health questionnaires and measured by nine-item Patient Health Questionnaire (PHQ-9) scores. Results of logistic regression models showed a positive association between HbAA in quartile 4 and depressive symptoms with ORs and 95% CI of 2.47 (1.29, 4.77) [ORcontinuous HbAA and 95% CI: 1.006 (1.000, 1.013)], but an inverse association was detected in quartiles 2 and 3 of HbGA/HbAA [0.62 (0.38, 0.99) and 0.54 (0.32, 0.92), respectively]. Especially, an association between HbAA and depressive symptoms was strengthened in smokers, in age 18-39 and 40-59 years and BMI 25-30 kg/m2 groups. Further explorations are needed to study the found associations between HbAA, HbGA, and depressive symptoms.

To evaluate the role of sexual behavior stigma as a determinant of depressive symptoms among men who have sex with men (MSM) and transgender women (TGW) in Kigali, Rwanda. MSM/TGW aged ≥ 18 years were recruited using respondent-driven sampling (RDS) between March–August, 2018. Mental health was assessed using the Patient Health Questionnaire (PHQ-9). Sexual behavior stigma from friends and family, healthcare workers, and community members was assessed using a validated instrument. Multinomial logistic regression models were used to determine the association between sexual behavior stigma and depressive symptoms and depression. Secondary analyses further compared depression and depressive symptoms among MSM and TGW. Among the 736 participants included, 14% (106/736) identified as TGW. Depression 8.9% (RDS-adjusted, 7.6%; 95% CI, 4.6–10.6) and mild/moderate symptoms of depression 26.4% (RDS-adjusted, 24.1%; 95% CI, 19.4–28.7) were common and higher among TGW compared to MSM (p

OBJECTIVE To compare the mental health experiences associated with coronavirus disease 2019 (COVID-19) in adults with and without diabetes. RESEARCH DESIGN AND METHODS Between 29 May 2020 and 30 June 2020, 2,176 U.S. adults completed an online survey including demographics, COVID-19 experiences, depression (eight-item Patient Health Questionnaire) and anxiety (seven-item Generalized Anxiety Disorder) symptoms, perceived stress (10-item Perceived Stress Scale), resilience (Brief Resilience Scale), and diabetes-related distress (in participants with diabetes) (17-item Diabetes Distress Scale). RESULTS Mean age was 49.6 years (SD 16.9); participants were primarily women (80.0%) and White (88.3%), with an annual household income of ≥$60,000 (57.6%). One hundred reported a diagnosis of type 1 diabetes (4.6%), 304 type 2 diabetes (13.9%), and 145 prediabetes (6.6%). Nearly one-third (29.7%) indicated decreases in income attributable to the pandemic. Participants with type 1 diabetes had higher levels of diabetes distress than participants with type 2 diabetes (P < 0.05), with moderate severity in both groups. Participants with type 2 diabetes had significantly more comorbidities and COVID-19 risk factors than all other groups (all P < 0.01). After controlling for covariates, participants with type 2 diabetes reported significantly more depressive symptoms than those without diabetes (P < 0.05) and lower levels of resilience (P < 0.05). Subgroup analyses by sex and age indicated that women and younger adults, particularly those age 18–34 years, reported significantly more depression and anxiety symptoms, stress, and diabetes-related distress and lower levels of resilience than men and adults age ≥51 years. CONCLUSIONS In this naturalistic observational study, participants with type 2 diabetes reported more depression, lower resilience, and significantly more COVID-19 risk factors and medical comorbidities than participants without diabetes. Overall, our participants demonstrated worse depression and anxiety symptoms during compared with before the pandemic.

Background The items of the Patient Health Questionnaire-9 (PHQ-9) represent the criterion symptoms for DSM-IV major depression. This study evaluated the extent to which the PHQ-9 functions as a patient-reported outcome measure (PROM) specific to patients with major depressive disorder. Method Data were from the Veterans Outcome Assessment survey for 8848 patients beginning treatment in VA general mental health clinics, including 5754, re-surveyed after 3 months. The PHQ-9’s performance as a PROM was evaluated by comparing rank order correlations between both initial scores and improvements over 3 months between the PHQ-9 and several transdiagnostic PROMs across a range of diagnoses and comorbidities. Performance of PHQ-9-related patient-reported outcome-based performance measures (PROM-PM) were evaluated by comparing rates of response and remission across patient groups. Results Correlations between the PHQ-9 and transdiagnostic measures were significant and comparable in magnitude across a range of diagnoses and for cases with depression with or without comorbidities. Rates of response and remission were comparable across most patient groups. Limitations Limitations include use of clinical diagnoses as recorded in health records, and the relatively short time between assessments. Conclusions In these settings, the PHQ-9 functions more as a general measure of symptoms or distress than as a disease-specific scale. This supports its use as a PROM for patients beyond those with major depression, including those with related diagnoses and those with comorbidities, and use of related PROM-PMs in clinical settings where diagnoses may not be precise and comorbidities may be common.

We explored the prevalence of insomnia, confirm the associated psychological factors and current coping strategies among undergraduate medical during their clinical years. This cross-sectional, quantitative, descriptive study was conducted at the department of medical education, college of medicine, King Saud University (KSU), Riyadh, Saudi Arabia. The participants (n = 463) were the 3rd to 5th year, and intern medical clinical students. We collected responses about sleep, using the Insomnia Severity Index (ISI). We also used Kessler-10 (K10), Psychological Distress and the Patient Health Questionnaire (PHQ-9). Items related to Coping strategies were also used from our previously published study and COVID-19 issues were explored using a self-developed questionnaire. According to the ISI ranking, 162 (34.9 %) of the participants had insomnia, among them 57.4% of females and 42.6% were males. Age groups between 22 and 25 have more sleeping disorder (43.2%) as compared to other age groups. 3rd-year students have more insomnia 36.41% as compared to other years. Individuals with insomnia symptoms were more likely (1.67 times higher) to be female students (OR = 1.67; P = 0.005) as compared to male students. A significantly high prevalence (3.37 times high) of insomnia was noted for those students or interns who have attended their clinical training irregularly as compare to regularly attending participants (OR = 2.32; P = 0.12) during COVID-19. Transition time i.e. year 3 of medical program was more stressful for the students and female students perceived stress and insomnia more than their male counterparts. It is important to address identified disorder early in order to reduce psychological morbidity and its harmful implications for medical students and young physicians.

ObjectiveSocial inhibition may promote symptoms of depression and anxiety in adults from an outpatient hospital population. The current work builds on a previously corroborated construct of social inhibition and examines the psychometric properties of this assessment tool and its predictive validity in the adult outpatient hospital population. MethodsA total of 350 adult outpatients receiving treatment at the department of Medical Psychology or Psychiatry completed measures of social inhibition and symptoms of anxiety (7-item Generalized Anxiety Disorder scale) and depression (9-item Patient Health Questionnaire). Factor analyses, reliability estimates, and regression analyses were used to replicate the robustness of the model of social inhibition, and the 15-item Social Inhibition Questionnaire (SIQ15). ResultsIn the current sample (N =350; Mage =45 years; 67.4% women), factor analyses confirmed the previously suggested three-factor model of social inhibition as measured by the SIQ15. The subscales of behavioral inhibition, interpersonal sensitivity and social withdrawal proved to be internally consistent (Cronbach's α be-tween 0.87/0.95) and stable over time (test-retest reliability between r =0.76/0.83). At baseline, interpersonal sensitivity and social withdrawal were associated with anxiety and depressive symptoms. At three months follow-up, only interpersonal sensitivity was related to depressive symptoms. ConclusionsSocial inhibition is associated with anxiety and depression at baseline and can be reliably assessed with the SIQ15 in an outpatient hospital population. The association of interpersonal sensitivity with depressive symptoms at three-month follow-up suggests an important aim for future research on the development of preventive methods for affective symptoms in socially inhibited outpatients.

Background and objective: The Coronavirus Anxiety Scale (CAS) is an instrument that measures the severity of anxiety due to COVID-19 or coronaphobia. In the context of the COVID-19 pandemic, older adults are the most vulnerable age group; therefore, the aim of the study was to evaluate the psychometric properties of the CAS in this group. Materials and method: 274 Peruvian older adults participated (Mage = 67.86; SD = 6.34, 64.6% women). In addition to the CAS, the 2-item Patient Health Questionnaire (PHQ-2), and 2-item Generalized Anxiety Disorder Scale (GAD-2) were applied. Confirmatory Factor Analysis (CFA) was used to assess the factor structure of the CAS and Item Response Theory was used to analyze item characteristics. A sequence of hierarchical variance models was used to evaluate the measurement invariance of the CAS according to age. To assess reliability, Cronbach's alpha coefficient (α) and the omega coefficient (ω) were used. The correlations between the CAS score and the scores of the PHQ-2 and GAD-2 scales were calculated with Pearson's correlation coefficient (r). Results: The results of the CFA indicated that the unidimensional model of the CAS fitted the data adequately and showed very good reliability (α and ω ≥ .83). Likewise, all items provided high information and adequate discrimination, which allowed for better detection of average and high levels of coronaphobia in the older adult population. However, the CAS did not show evidence of being strictly invariant between older adults aged 60–65 years and 66–86 years. The CAS showed significant correlations with anxiety (r = .72; [95%CI: .66, .87] p < .01) and depression (r = .53; [95%CI: .43, .76] p < .01). Conclusion: The CAS in Spanish shows evidence of validity based on internal structure, convergent and divergent validity, as well as an adequate reliability estimate to assess coronaphobia in older adults. The CAS can be used to detect average and high levels of coronaphobia in the older adult population.

SUMMARY OBJECTIVE: Psychological effects of the coronavirus disease 2019 (COVID-19) pandemic on pregnant women with diabetes and hypertension are not yet studied. Besides the pregnancy, these women have additional risk factors for severe acute respiratory syndrome due to COVID-19 and are considered a particularly vulnerable, unique population. We aimed to assess their mental health during this pandemic. METHODS: This is a cross-sectional study carried out at a Brazilian tertiary hospital. Women with pregnancies complicated by hypertension and/or diabetes were evaluated. The primary outcome was anxiety, and depressive symptoms evaluated with the State-Trait Anxiety Inventory and Patient Health Questionnaire. Perception of changing habits during quarantine was evaluated as a secondary outcome. RESULTS: Seventy-nine patients were included. The prevalence of State-Trait Anxiety Inventory ≥40 was 79.7% and that of Patient Health Questionnaire ≥10 was 59.2%. Lower social support was correlated with higher scores on both scales. Time spent with electronic devices was perceived as greater by 62% of the women. CONCLUSIONS: Pregnant women with diabetes and hypertension presented high levels of anxiety and depressive symptoms during the COVID-19 pandemic. Considering that these symptoms can affect both the mother's and offspring's health, it is necessary to implement tools to improve their mental health.

Objective Physical activity (PA) can improve symptoms of both depression and heart failure (HF), but objective activity data among recently hospitalized HF patients with co-morbid depression is lacking. We examined PA and the relationship between daily step counts and mood, health-related quality of life (HRQoL), and heart health among patients enrolled in a clinical trial treating HF and co-morbid depression. Methods We screened hospitalized patients with systolic HF (left ventricular ejection fraction [LVEF] ≤45%) and New York Heart Association (NYHA) class II-IV symptoms for depression using the 2-item Patient Health Questionnaire (PHQ-2) and telephoned screen-positive patients to administer the PHQ-9 two-weeks post-discharge. If the patient scored PHQ-9 ≥ 10 and agreed to continue in our study, we administered our baseline assessment and mailed them an armband accelerometer. We instructed patients to wear the armbands for 7 days before returning them and classified their data as "usable" if they wore it ≥10 hours per day on ≥4 separate days. Results We mailed accelerometers to 531 depressed HF patients and 222 (42%) returned them with usable data. Their median age was 64 years, 54% were women, 23% were non-White, and they walked a median of 1,170 steps daily. Higher median daily step counts were associated with lower NYHA class and better physical- and heart failure-specific HRQoL, but not mood symptoms, mental HRQoL, or LVEF. Conclusions Patients with HF and co-morbid depression are generally sedentary following hospital discharge. While mood symptoms and LVEF were unrelated to objective physical activity, patients with higher step counts self-reported better HRQoL.Trial registrationClinicalTrials.gov identifier NCT02044211.

Background: Type 2 diabetes mellitus (T2DM) is linked to a significant rate of depression and cognitive impairment, according to previous studies. However, limited research has been done on the effects of diabetes treatment on depression, cognitive function, or overall quality of life (QoL). This planned study investigated into depression, cognitive function, and quality of life in T2DM patients, as well as its relationship to treatment received. To study the association of insulin therapy with depression, cognition and quality of life in T2DM patients. Methods: This was a crosssectional study that included 300 participants, comprising of 150 T2DM patients and 150 healthy individuals. The Patient health questionnaire and the Mini-mental state examination were used to measure depression and cognitive function, respectively. QoL was assessed using the Short-Form 36 (SF-36) questionnaire. Based on the type of treatment, all of the patients were divided into two subgroups: oral hypoglycemic medications (OHAs) and insulin. Results: The study included 300 participants, including T2DM patients (n=150) and healthy controls (n=150). In individuals with T2DM, the chances of mild (aOR 2.21, 95 % Ci 1.16-4.20; p=0.016) and severe (aOR 4.32, 95 % Ci 1.27-14.67; p=0.019) depression was higher. T2DM patients were also more likely to have cognitive impairment (aOR 2.86, 95 % Ci 1.16-6.99; p=0.021). Patients taking insulin had a substantially increased risk of depression (OR 2.127, 95 % Ci 1.070-4.228, p=0.036). Insulin-treated patients exhibited considerably poorer QoL ratings. Conclusion: The research illustrates that insulin therapy has a negative impact on depression and QoL in T2DM patients. As a result, it is recommended that insulin-treated T2DM patients require psychological assistance. In such cases, it is advised that measures to enhance QoL be implemented.

Background Osteoarthritis-related insomnia is the most common form of comorbid insomnia among older Americans. A randomized clinical trial found that six sessions of telephone-delivered cognitive behavioral therapy for insomnia (CBT-I) improved sleep outcomes in this population. Using these data, we evaluated the incremental cost-effectiveness of CBT-I from a healthcare sector perspective. Methods The study was based on 325 community-dwelling older adults with insomnia and osteoarthritis pain enrolled with Kaiser Permanente of Washington State. We measured quality-adjusted life years (QALYs) using the EuroQol 5-dimension scale. Arthritis-specific quality of life was measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Insomnia-specific quality of life was measured using the Insomnia Severity Index (ISI) and nights without clinical insomnia (i.e., "insomnia-free nights"). Total healthcare costs included intervention and healthcare utilization costs. Results Over the 12 months after randomization, CBT-I improved ISI and WOMAC by -2.6 points (95% CI: -2.9 to -2.4) and -2.6 points (95% CI: -3.4 to -1.8), respectively. The ISI improvement translated into 89 additional insomnia-free nights (95% CI: 79 to 98) over the 12 months. CBT-I did not significantly reduce total healthcare costs (-$1072 [95% CI: -$1968 to $92]). Improvements in condition-specific measures were not reflected in QALYs gained (-0.01 [95% CI: -0.01 to 0.01]); at a willingness-to-pay of $150,000 per QALY, CBT-I resulted in a positive net monetary benefit of $369 with substantial uncertainty (95% CI: -$1737 to $2270). Conclusion CBT-I improved sleep and arthritis function without increasing costs. These findings support the consideration of telephone CBT-I for treating insomnia among older adults with comorbid OA. Our findings also suggest potential limitations of the general quality of life measures in assessing interventions designed to improve sleep and arthritis outcomes.

The Patient-Focused Drug Development initiative of the U.S. Food and Drug Administration (FDA) aims to ensure that the patient experience of disease and treatment is an integral component of the drug development process. The 21st Century Cures Act and Prescription Drug User Fee Act (PDUFA) VI require the FDA to publicly report the type of patient-experience data reviewed in a new drug application (NDA) to inform regulatory decision-making. This report describes a recent approach adopted at Janssen of integrating patient-experience data into the NDA for esketamine (SPRAVATO®) nasal spray with a newly initiated oral antidepressant (esketamine + AD) for treatment-resistant depression. During the development of esketamine + AD, patient-experience data were collected using several patient-reported outcomes, including the Sheehan Disability Scale and 9-item Patient Health Questionnaire (PHQ-9). Additionally, a patient-preference study assessed the relative importance of benefits and harms that patients allocated to different attributes of treatment. Preferences were collected from patients enrolled in phase 3 esketamine trials and from an online panel of primarily ketamine-naive patients. Patient-experience data were integrated into the esketamine NDA, the FDA advisory committee meeting briefing document, and the Sponsor’s presentation. The FDA acknowledged reviewing the patient-experience data and determined that they supported esketamine + AD for treatment-resistant depression. This report highlights the importance of integrating patient-experience methods early in drug development, their impact on assessing patient-relevant benefits and risks, and how they can help improve clinical program design.

Over a span of 1 year, with millions infected, COVID-19 has spread to every part of the world and now poses a health threat to each and every one of us. The outbreak has consequently resulted in multiple health problems such as stress, anxiety, depressive symptoms, insomnia, panic, and denial globally. Several factors have contributed to this rising number of psychiatric consults all over the world. The primary objective of this study was to investigate the impact of COVID-19 pandemic on the mental health of Pakistani population during the second wave of the pandemic in this region. We conducted an online web-based cross-sectional survey comprising 500 participants. The questionnaire assessed the demographic information, attitude, and knowledge concerning COVID-19 outbreak in addition to generalized anxiety disorder (GAD) utilizing the GAD-7 scale and depressive symptoms using the Center for Epidemiology Scale for Depression (CES-D) scale. The response rate of the study was 90.9%. The results of the survey indicated a prevalence of 25.4% of GAD, and 18.8% of depressive symptoms. Furthermore, nearly 34.8% of participants feared contracting COVID-19, 62.8% obtained constant critical updates regarding COVID-19, while 17.6% did not understand the knowledge regarding COVID-19. In the multivariate regression models, GAD was significantly associated with gender, age, and checking constantly of critical updates regarding COVID-19. Similarly, participants under 30 years had a higher risk of developing depressive symptoms than those above (> 30 years). Lastly, participants with no formal education were also found to be more prone to developing depression. We identified a potential threat to mental health during the pandemic.

The severe acute respiratory syndrome coronavirus (SARS‐Cov‐2) resulting in the coronavirus disease 2019 (COVID‐19) is documented to have a negative psychosocial impact on patients. Home dialysis patients may be at risk of additional isolating factors affecting their mental health. The aim of this study is to describe levels of anxiety and quality of life during the COVID‐19 pandemic among home dialysis patients. This is a single‐centre survey of home dialysis patients in Toronto, Ontario. Surveys were sent to 98 home haemodialysis and 43 peritoneal dialysis patients. Validated instruments (Haemodialysis and Peritoneal Dialysis Treatment Satisfaction Questionnaire, Generalized Anxiety Disorder 7 Item [GAD7] Scale, Patient Health Questionnaire [PHQ‐9], Illness Intrusiveness Ratings Scale, Family APGAR Questionnaire and The Self Perceived Burden Scale) assessing well‐being were used. Forty of the 141 patients surveyed, participated in September 2020. The mean age was 53.1 ± 12.1 years, with 60% male, and 85% home haemodialysis, 80% of patients rated their satisfaction with dialysis at 8/10 or greater, 82% of respondents reported either “not at all” or “for several days” indicating frequency of anxiety and depressive symptoms, 79% said their illness minimally or moderately impacted their life, 76% of respondents were almost always satisfied with interactions with family members, 91% were never or sometimes worried about caregiver burden. Among our respondents, there was no indication of a negative psychosocial impact from the pandemic, despite the increased social isolation. Our data further supports the use of home dialysis as the optimal form of dialysis., SUMMARY AT A GLANCE This survey of home haemodialysis or peritoneal dialysis patients found no indication of a negative psychosocial impact from the COVID‐19 pandemic, despite the increased social isolation. Thus, patients who are able to practise dialysis at home and hence minimize infectious contacts do not experience high levels of psychosocial distress, adding to the paradigm of home dialysis as the optimal form of dialysis.

Aims and objectives We aimed to identify postpartum depression (PPD) trajectories and examine relevant predictors amongst smoking women. Background PPD can adversely affect families. Predictors of PPD trajectories amongst smoking women are understudied. Design Longitudinal cohort study. Methods A cohort of 49 U.S. women (current or ex-smoking) completed the Edinburgh Postnatal Depression Scale from birth to 24 months postpartum. Latent class growth modelling was used to identify PPD trajectories. Predictors of PPD trajectories were identified, adjusting for confounders. Effect modification by prenatal Patient Health Questionnaire (PHQ) depression score was also assessed. STROBE guidelines were followed in reporting results. Results Three PPD trajectories were identified: non-PPD, transient PPD and chronic PPD. In multinomial logistic regression, social support was associated with lower odds of membership in the chronic PPD trajectory compared to non-PPD trajectory: being married or having a partner sharing resources (odds ratio OR = .14 [.02, .85], p-value = .03), greater partner support (OR = .87 [.77, .98], p-value = .02) and greater family/friends support (OR = .53 [.34, .82], p-value = .004). Transient PPD showed no differences with non-PPD on any predictors. In ordinal logistic regression models, social support was associated with lower odds of membership in a more severe PPD depression trajectory when prenatal PHQ depression score was in the low range (being married or having a partner sharing resources: p for effect modification = .06; partner support: p for effect modification = .05; and family/friends support: p for effect modification = .005). Relevance to clinical practice Compared to the general population, chronic PPD trajectories were more common amongst smoking women. Social support was an important predictor of more severe PPD trajectories, especially when prenatal depression is low. Conclusion Our findings indicated that social support might decrease likelihood of severe PPD trajectories, especially when prenatal depression was low. Relevant predictors of transient PPD remained elusive.

Background Common mental health disorders (CMDs), including depression, anxiety and post-traumatic stress disorder (PTSD) may worsen both HIV and drug use outcomes, yet feasible tools to accurately identify CMDs have received limited study in this population. We aimed to validate the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder screen (GAD-7) and Primary Care PTSD screen for DSM-5 (PC-PTSD-5) in a methadone maintenance therapy (MMT) patient population in Hanoi, Vietnam. Methods We conducted a cross-sectional survey. The PHQ-9, GAD-7, and PC-PTSD-5 were administered to MMT patients. A blinded interviewer administered the Mini-International Neuropsychiatric Interview (MINI) as the reference gold standard. Total scores of each tool were compared with the MINI diagnoses using a receiver operating characteristic curves, and we identified the optimal respective cut-off scores using the Youden’s Index. Results We enrolled 400 MMT patients. Approximately 99.3% were male (n = 397) and 21.8% (n = 87) were HIV positive. The prevalence of major depressive disorder, generalized anxiety disorder and PTSD, respectively, was 10.5, 4 and 2%. Optimal cut-off scores for the PHQ-9, GAD-7 and PC-PTSD were ≥ 5, ≥3, and ≥ 4 with a sensitivity/specificity of 95.2%/91.9, 93.8%/87.5, and 62.5%/95.2%. Conclusions The prevalence of CMDs in the MMT population was lower than expected. A lower cut-off score may be considered when screening for CMDs in this population. Further research should investigate the validity of somatic symptom-based screening tools among other drug-using or MMT populations.