Browsing by Subject "Depression"
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Item Open Access A Laboratory Investigation of Mindfulness and Reappraisal As Emotion Regulation Strategies(2013) Keng, ShianLingEffective emotion regulation plays an important role in psychological health. Two commonly-researched emotion regulation strategies are reappraisal, a cognitive change-based strategy, and mindfulness, an acceptance-based strategy. Although their potential in facilitating adaptive emotion regulation has been empirically demonstrated, little work has directly compared their cognitive and emotion regulatory effects, particularly in a symptomatic population. Using an analogue depressed sample, this study examined the relative effects of mindfulness and reappraisal in reducing sad mood and whether individual differences in trait mindfulness and habitual use of reappraisal moderated the effects. The study also compared the extent to which implementation of these strategies incurred cognitive resources and affected attitudes towards negative experiences. One hundred and twenty-nine participants were randomly assigned to receive training in mindfulness, reappraisal, or no training prior to undergoing an autobiographical sad mood induction. Following mood induction, participants rated their sadness on a visual analog scale before completing a Stroop test. Results showed that mindfulness and reappraisal were superior to no training, and equivalent in their effects in lowering sad moods. Compared to the mindfulness group, the reappraisal group reported significantly higher Stroop interference scores, reflecting greater depletion of cognitive resources. Higher trait mindfulness predicted greater reductions in sadness in the reappraisal group, but not in the mindfulness group. Habitual reappraisal did not moderate the effects of either mindfulness or reappraisal. Mindfulness, relative to reappraisal or no training, resulted in significant increases in acceptance of negative experiences and decreases in maladaptive beliefs about rumination. Overall, the study suggests that although mindfulness and reappraisal are equally effective in down-regulating sad mood, they incur different levels of cognitive costs and lead to differential changes in attitudes towards negative experiences.
Item Open Access A randomized clinical trial of a coping improvement group intervention for HIV-infected older adults.(J Behav Med, 2011-04) Heckman, Timothy G; Sikkema, Kathleen J; Hansen, Nathan; Kochman, Arlene; Heh, Victor; Neufeld, Sharon; AIDS and Aging Research GroupThis research tested if a 12-session coping improvement group intervention (n = 104) reduced depressive symptoms in HIV-infected older adults compared to an interpersonal support group intervention (n = 105) and an individual therapy upon request (ITUR) control condition (n = 86). Participants were 295 HIV-infected men and women 50-plus years of age living in New York City, Cincinnati, OH, and Columbus, OH. Using A-CASI assessment methodology, participants provided data on their depressive symptoms using the Geriatric Depression Screening Scale (GDS) at pre-intervention, post-intervention, and 4- and 8-month follow-up. Whether conducted with all participants (N = 295) or only a subset of participants diagnosed with mild, moderate, or severe depressive symptoms (N = 171), mixed models analyses of repeated measures found that both coping improvement and interpersonal support group intervention participants reported fewer depressive symptoms than ITUR controls at post-intervention, 4-month follow-up, and 8-month follow-up. The effect sizes of the differences between the two active interventions and the control group were greater when outcome analyses were limited to those participants with mild, moderate, or severe depressive symptoms. At no assessment period did coping improvement and interpersonal support group intervention participants differ in depressive symptoms.Item Unknown A Structured Approach to Detecting and Treating Depression in Primary Care: VitalSign6 Project.(Annals of family medicine, 2019-07) Jha, Manish K; Grannemann, Bruce D; Trombello, Joseph M; Clark, E Will; Eidelman, Sara Levinson; Lawson, Tiffany; Greer, Tracy L; Rush, A John; Trivedi, Madhukar HPurpose
This report describes outcomes of an ongoing quality-improvement project (VitalSign6) in a large US metropolitan area to improve recognition, treatment, and outcomes of depressed patients in 16 primary care clinics (6 charity clinics, 6 federally qualified health care centers, 2 private clinics serving low-income populations, and 2 private clinics serving patients with either Medicare or private insurance).Methods
Inclusion in this retrospective analysis was restricted to the first 25,000 patients (aged ≥12 years) screened with the 2-item Patient Health Questionnaire (PHQ-2) in the aforementioned quality-improvement project. Further evaluations with self-reports and clinician assessments were recorded for those with positive screen (PHQ-2 >2). Data collected from August 2014 though November 2016 were available at 3 levels: (1) initial PHQ-2 (n = 25,000), (2) positive screen (n = 4,325), and (3) clinician-diagnosed depressive disorder with 18 or more weeks of enrollment (n = 2,160).Results
Overall, 17.3% (4,325/25,000) of patients screened positive for depression. Of positive screens, 56.1% (2,426/4,325) had clinician-diagnosed depressive disorder. Of those enrolled for 18 or more weeks, 64.8% were started on measurement-based pharmacotherapy and 8.9% referred externally. Of the 1,400 patients started on pharmacotherapy, 45.5%, 30.2%, 12.6%, and 11.6% had 0, 1, 2, and 3 or more follow-up visits, respectively. Remission rates were 20.3% (86/423), 31.6% (56/177), and 41.7% (68/163) for those with 1, 2, and 3 or more follow-up visits, respectively. Baseline characteristics associated with higher attrition were: non-white, positive drug-abuse screen, lower depression/anxiety symptom severity, and younger age.Conclusion
Although remission rates are high in those with 3 or more follow-up visits after routine screening and treatment of depression, attrition from care is a significant issue adversely affecting outcomes.Item Unknown Acute Adverse Events After Spinal Cord Injury and Their Relationship to Long-term Neurologic and Functional Outcomes: Analysis From the North American Clinical Trials Network for Spinal Cord Injury.(Critical care medicine, 2019-11) Jiang, Fan; Jaja, Blessing NR; Kurpad, Shekar N; Badhiwala, Jetan H; Aarabi, Bizhan; Grossman, Robert G; Harrop, James S; Guest, Jim D; Schär, Ralph T; Shaffrey, Chris I; Boakye, Max; Toups, Elizabeth G; Wilson, Jefferson R; Fehlings, Michael G; North American Clinical Trials Network CollaboratorsObjectives
There are few contemporary, prospective multicenter series on the spectrum of acute adverse events and their relationship to long-term outcomes after traumatic spinal cord injury. The goal of this study is to assess the prevalence of adverse events after traumatic spinal cord injury and to evaluate the effects on long-term clinical outcome.Design
Multicenter prospective registry.Setting
Consortium of 11 university-affiliated medical centers in the North American Clinical Trials Network.Patients
Eight-hundred one spinal cord injury patients enrolled by participating centers.Interventions
Appropriate spinal cord injury treatment at individual centers.Measurements and main results
A total of 2,303 adverse events were recorded for 502 patients (63%). Penalized maximum logistic regression models were fitted to estimate the likelihood of neurologic recovery (ASIA Impairment Scale improvement ≥ 1 grade point) and functional outcomes in subjects who developed adverse events at 6 months postinjury. After accounting for potential confounders, the group that developed adverse events showed less neurologic recovery (odds ratio, 0.55; 95% CI, 0.32-0.96) and was more likely to require assisted breathing (odds ratio, 6.55; 95% CI, 1.17-36.67); dependent ambulation (odds ratio, 7.38; 95% CI, 4.35-13.06) and have impaired bladder (odds ratio, 9.63; 95% CI, 5.19-17.87) or bowel function (odds ratio, 7.86; 95% CI, 4.31-14.32) measured using the Spinal Cord Independence Measure subscores.Conclusions
Results from this contemporary series demonstrate that acute adverse events are common and are associated with worsened long-term outcomes after traumatic spinal cord injury.Item Unknown Alterations in acylcarnitines, amines, and lipids inform about the mechanism of action of citalopram/escitalopram in major depression.(Translational psychiatry, 2021-03-02) MahmoudianDehkordi, Siamak; Ahmed, Ahmed T; Bhattacharyya, Sudeepa; Han, Xianlin; Baillie, Rebecca A; Arnold, Matthias; Skime, Michelle K; John-Williams, Lisa St; Moseley, M Arthur; Thompson, J Will; Louie, Gregory; Riva-Posse, Patricio; Craighead, W Edward; McDonald, William; Krishnan, Ranga; Rush, A John; Frye, Mark A; Dunlop, Boadie W; Weinshilboum, Richard M; Kaddurah-Daouk, Rima; Mood Disorders Precision Medicine Consortium (MDPMC)Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for major depressive disorder (MDD), yet their mechanisms of action are not fully understood and their therapeutic benefit varies among individuals. We used a targeted metabolomics approach utilizing a panel of 180 metabolites to gain insights into mechanisms of action and response to citalopram/escitalopram. Plasma samples from 136 participants with MDD enrolled into the Mayo Pharmacogenomics Research Network Antidepressant Medication Pharmacogenomic Study (PGRN-AMPS) were profiled at baseline and after 8 weeks of treatment. After treatment, we saw increased levels of short-chain acylcarnitines and decreased levels of medium-chain and long-chain acylcarnitines, suggesting an SSRI effect on β-oxidation and mitochondrial function. Amines-including arginine, proline, and methionine sulfoxide-were upregulated while serotonin and sarcosine were downregulated, suggesting an SSRI effect on urea cycle, one-carbon metabolism, and serotonin uptake. Eighteen lipids within the phosphatidylcholine (PC aa and ae) classes were upregulated. Changes in several lipid and amine levels correlated with changes in 17-item Hamilton Rating Scale for Depression scores (HRSD17). Differences in metabolic profiles at baseline and post-treatment were noted between participants who remitted (HRSD17 ≤ 7) and those who gained no meaningful benefits (<30% reduction in HRSD17). Remitters exhibited (a) higher baseline levels of C3, C5, alpha-aminoadipic acid, sarcosine, and serotonin; and (b) higher week-8 levels of PC aa C34:1, PC aa C34:2, PC aa C36:2, and PC aa C36:4. These findings suggest that mitochondrial energetics-including acylcarnitine metabolism, transport, and its link to β-oxidation-and lipid membrane remodeling may play roles in SSRI treatment response.Item Unknown An experience-sampling study of depressive symptoms and their social context.(J Nerv Ment Dis, 2011-06) Brown, Leslie H; Strauman, Timothy; Barrantes-Vidal, Neus; Silvia, Paul J; Kwapil, Thomas RBoth clinical and subclinical depression are associated with social impairment; however, few studies have examined the impact of social contact in the daily lives of people with depressive symptoms. The current study used the experience-sampling methodology to examine associations between depressive symptoms, social contact, and daily life impairment in 197 young adults. Depressive symptoms were associated with increased isolation, negative affect, anhedonia, and physical symptoms, decreased positive affect, and social and cognitive impairment in daily life. For people with more depressive symptoms, being with social partners who were perceived as close was associated with greater decreases in negative affect, as well as increases in positive affect. Ironically, participants with depressive symptoms reported spending less time with people whom they perceived as close, minimizing the protective effects of socializing. These results suggest that people experiencing depressive symptoms may be especially sensitive to the nature of social interactions.Item Unknown Assessment of the psychometric properties of an English version of the cancer dyspnea scale in people with advanced lung cancer.(Journal of pain and symptom management, 2012-11) Uronis, Hope E; Shelby, Rebecca A; Currow, David C; Ahmedzai, Sam H; Bosworth, Hayden B; Coan, April; Abernethy, Amy PContext
Dyspnea is a poorly understood subjective sensation. Existing dyspnea measures fail to adequately address its multidimensionality. A Japanese group developed and validated the Cancer Dyspnea Scale (CDS) for assessing dyspnea in patients with advanced lung cancer.Objectives
We evaluated the validity and reliability of the English version of the CDS (CDS-E) that has 12 items and takes, on average, 140 seconds for individuals to complete.Methods
Eligible patients had advanced lung cancer, consented, and were fluent in English. Participants completed a 100 mm visual analogue scale (VAS), the modified Borg scale, the CDS-E, the Hospital Anxiety and Depression Scale, and the Functional Assessment of Cancer Therapy--Lung quality-of-life scale. Demographic, radiographic, and treatment information were obtained from patients' medical records.Results
One hundred twelve participants were enrolled at three sites in the U.S., Australia, and the U.K. Mean age was 64.5 years (SD 11.5); 90% were Caucasian, 68% had Eastern Cooperative Oncology Group performance status 0-1, and 50% had non-small cell carcinoma. All completed the CDS-E independently, without difficulty. The CDS-E had reasonable internal consistency overall (Cronbach's α = 0.71) and for each of the three factors (effort, anxiety, discomfort Cronbach's α = 0.80-0.84). CDS-E scores were significantly correlated with the 100mm VAS (r = 0.82; P < 0.001) and the modified Borg (r = 0.87; P < 0.001). After factor analysis, the CDS-E was revised by removing three items (r-CDS-E).Conclusion
The CDS-E and r-CDS-E are reliable and valid measures of the sensation and the psychological components of dyspnea, with the shorter version having similar psychometric properties.Item Unknown Association between depression and hypertension using classic and revised blood pressure thresholds.(Family practice, 2020-10) DeMoss, Dustin S; Teigen, Kari J; Claassen, Cynthia A; Fisk, Mandy J; Blair, Somer E; Bakre, Sulaimon A; Hurd, Cheryl L; Rush, Augustus JBackground
In a primary care population, the relationship between treatment of depression and hypertension (HTN) under the recently revised American College of Cardiology and American Heart Association HTN thresholds for diagnosing HTN is unknown.Objective
To compare the association between changes in severity of co-occurring depression and HTN over time using the newly revised versus previous HTN guidelines.Methods
In this retrospective cohort study, outpatients ≥18 years (n = 3018) with clinically significant depressive symptoms and elevated blood pressure at baseline were divided into a 'revised' guideline group (baseline blood pressure ≥130/80 mmHg), a 'classic' guideline group (≥140/90 mmHg) and a 'revised-minus-classic' group (≥130/80 and <140/90 mmHg). Depressive symptom change was assessed using the Patient Health Questionnaire-9 (PHQ-9). Correlations between changes in PHQ-9 scores and HTN levels by group over a 6- to 18-month observation period were assessed using robust regression analysis.Results
There were demographic and clinical differences between groups. A total of 41% of study subjects (1252/3018) had a visit during the follow-up period where additional PHQ-9 and HTN results were available. Depressive symptom change was unrelated to change in blood pressure in the revised and revised-minus-classic groups. The classic HTN group demonstrated a clinically insignificant change in systolic blood pressure for each unit change in PHQ-9 score (β = 0.23, P-value =0.02).Conclusions
Although a statistically significant association between reduced HTN levels and improvement in depressive symptoms was demonstrated under classic HTN guidelines, there was no clinically meaningful association between treatment of depression and improved HTN levels under either guideline.Item Unknown Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease.(J Am Heart Assoc, 2013-03-19) Watkins, Lana L; Koch, Gary G; Sherwood, Andrew; Blumenthal, James A; Davidson, Jonathan RT; O'Connor, Christopher; Sketch, Michael HBACKGROUND: Depression has been related to mortality in coronary heart disease (CHD) patients, but few studies have evaluated the role of anxiety or the role of the co-occurrence of depression and anxiety. We examined whether anxiety is associated with increased risk of mortality after accounting for depression in individuals with established CHD. METHODS AND RESULTS: The cohort was composed of 934 men and women with confirmed CHD (mean age, 62±11 years) who completed the Hospital Anxiety and Depression scale (HADS) during hospitalization for coronary angiography. Over the 3-year follow-up period, there were 133 deaths. Elevated scores on the HADS anxiety subscale (HADS-A≥8) were associated with increased risk of mortality after accounting for established risk factors including age, congestive heart failure, left ventricular ejection fraction, 3-vessel disease, and renal disease (hazard ratio [HR], 2.27; 95% CI, 1.55 to 3.33; P<0.001). Elevated scores on the HADS depression subscale (HADS-D≥8) were also associated with increased risk of mortality (HR, 2.18; 95% CI, 1.47 to 3.22; P<0.001). When both psychosocial factors were included in the model, each maintained an association with mortality (anxiety, HR, 1.83; 95% CI, 1.18 to 2.83; P=0.006; depression, HR, 1.66; 95% CI, 1.06 to 2.58; P=0.025). Estimation of the HR for patients with both anxiety and depression versus those with neither revealed a larger HR than for patients with either factor alone (HR, 3.10; 95% CI, 1.95 to 4.94; P<0.001). CONCLUSIONS: Anxiety is associated with increased risk of mortality in CHD patients, particularly when comorbid with depression. Future studies should focus on the co-occurrence of these psychosocial factors as markers of increased mortality risk.Item Open Access Association of maternal depression and hypothyroidism with infant gastroschisis: a population-based cohort study in Canada.(Scientific reports, 2023-05) Liu, Shiliang; Claude, Hughes; Yong, Shin Jie; Chen, DunjinGastroschisis has increased globally over recent decades, and this increase has not been explained by identified risk factors. We conducted a population-based study of infants born in Canada, 2004-2020. We used "winter" months (i.e., September through June) and northern areas of residence as indicators of less sunlight/less active lifestyle, while "summer" (i.e., July and August) and southern areas were considered as reference. Rate of gastroschisis for infants conceived in winter (3.4 per 10,000) was higher than for infants conceived in summer (2.2 per 10,000; p < 0.001). Exposure to winter, and northern area, hypothyroidism, substance or tobacco uses and depressive disorder were initially identified as risk factors for gastroschisis. There was a significant interaction between women < 24 years of age and 2-month conception intervals (rate ratio (RR): 1.42 (95% confidence interval [CI] 1.19-1.70). The association of maternal depression (mean ratio 2.19, 95% CI 0.87-3.50, p = 0.001) with infant gastroschisis was mediated by hypothyroidism (mean ratio 1.04, 95% CI 1.01-1.07, p < 0.001), whereas substance use, hypothyroidism, tobacco smoking and gestational diabetes showed 5.5-, 3.1-, 2.7-, and 1.2-fold associations, respectively, with maternal depression. In contrast to the summer conception interval of low gastroschisis risk, an elevated risk of gastroschisis spans the other ten months in association with higher levels of stress adaptation, thermoregulation and metabolism, reproduction, and growth effector hormones. Our findings suggest that periconception depression with mediation by hypothyroidism, may play a causal role in offspring gastroschisis.Item Open Access Associations Between a New Disruptive Behaviors Scale and Teamwork, Patient Safety, Work-Life Balance, Burnout, and Depression.(Joint Commission journal on quality and patient safety, 2020-01) Rehder, Kyle J; Adair, Kathryn C; Hadley, Allison; McKittrick, Katie; Frankel, Allan; Leonard, Michael; Frankel, Terri Christensen; Sexton, J BryanBackground
Disruptive and unprofessional behaviors occur frequently in health care and adversely affect patient care and health care worker job satisfaction. These behaviors have rarely been evaluated at a work setting level, nor do we fully understand how disruptive behaviors (DBs) are associated with important metrics such as teamwork and safety climate, work-life balance, burnout, and depression.Objectives
Using a cross-sectional survey of all health care workers in a large US health system, this study aimed to introduce a brief scale for evaluating DBs at a work setting level, evaluate the scale's psychometric properties and provide benchmarking prevalence data from the health care system, and investigate associations between DBs and other validated measures of safety culture and well-being.Results
One or more of six DBs were reported by 97.8% of work settings. DBs were reported in similar frequencies by men and women, and by most health care worker roles. The six-item disruptive behavior scale demonstrated an internal consistency of α = 0.867. DB climate was significantly correlated with poorer teamwork climate, safety climate, job satisfaction, and perceptions of management; lower work-life balance; increased emotional exhaustion (burnout); and increased depression (p < 0.001 for each). A 10-unit increase in DB climate was associated with a 3.89- and 3.83-point decrease in teamwork and safety climate, respectively, and a 3.16- and 2.42-point increase in burnout and depression, respectively.Conclusion
Disruptive behaviors are common, measurable, and associated with safety culture and health care worker well-being. This concise DB scale affords researchers a new, valid, and actionable tool to assess DBs.Item Open Access Challenges in the diagnosis and treatment of depression in autism spectrum disorders across the lifespan.(Dialogues Clin Neurosci, 2015-06) Chandrasekhar, Tara; Sikich, LinmarieDiagnosis and treatment of comorbid neuropsychiatric illness is often a secondary focus of treatment in individuals with autism spectrum disorder (ASD), given that substantial impairment may be caused by core symptoms of ASD itself. However, psychiatric comorbidities, including depressive disorders, are common and frequently result in additional functional impairment, treatment costs, and burden on caregivers. Clinicians may struggle to appropriately diagnose depression in ASD due to communication deficits, atypical presentation of depression in ASD, and lack of standardized diagnostic tools. Specific risk and resilience factors for depression in ASD across the lifespan, including level of functioning, age, family history, and coping style, have been suggested, but require further study. Treatment with medications or psychotherapy may be beneficial, though more research is required to establish guidelines for management of symptoms. This review will describe typical presentations of depression in individuals with ASD, review current information on the prevalence, assessment, and treatment of comorbid depression in individuals with ASD, and identify important research gaps.Item Open Access Clinical research challenges posed by difficult-to-treat depression.(Psychological medicine, 2022-02) Rush, A John; Sackeim, Harold A; Conway, Charles R; Bunker, Mark T; Hollon, Steven D; Demyttenaere, Koen; Young, Allan H; Aaronson, Scott T; Dibué, Maxine; Thase, Michael E; McAllister-Williams, R HamishApproximately one-third of individuals in a major depressive episode will not achieve sustained remission despite multiple, well-delivered treatments. These patients experience prolonged suffering and disproportionately utilize mental and general health care resources. The recently proposed clinical heuristic of 'difficult-to-treat depression' (DTD) aims to broaden our understanding and focus attention on the identification, clinical management, treatment selection, and outcomes of such individuals. Clinical trial methodologies developed to detect short-term therapeutic effects in treatment-responsive populations may not be appropriate in DTD. This report reviews three essential challenges for clinical intervention research in DTD: (1) how to define and subtype this heterogeneous group of patients; (2) how, when, and by what methods to select, acquire, compile, and interpret clinically meaningful outcome metrics; and (3) how to choose among alternative clinical trial design options to promote causal inference and generalizability. The boundaries of DTD are uncertain, and an evidence-based taxonomy and reliable assessment tools are preconditions for clinical research and subtyping. Traditional outcome metrics in treatment-responsive depression may not apply to DTD, as they largely reflect the only short-term symptomatic change and do not incorporate durability of benefit, side effect burden, or sustained impact on quality of life or daily function. The trial methodology will also require modification as trials will likely be of longer duration to examine the sustained impact, raising complex issues regarding control group selection, blinding and its integrity, and concomitant treatments.Item Open Access Cognitive Processes in Response to Goal Failure: A Study of Ruminative Thought and its Affective Consequences.(J Soc Clin Psychol, 2013-05-01) Jones, NP; Papadakis, AA; Orr, CA; Strauman, TJFailure to make progress toward personal goals can lead to negative affective states, such as depression and anxiety. Past research suggests that rumination in response to goal failure may prolong and intensify those acute emotional responses, but that process remains unclear. We examined ruminative thought processes following experimentally manipulated exposure to past failures to attain advancement (promotion) goals and safety (prevention) goals. We predicted that priming of past promotion and prevention goal failures would lead individuals to think repetitively about these failures and that negative affect would be evoked by their recognition of their failures. Further, we predicted that when people experience a sufficient magnitude of negative affect, ruminative thought would intensify and prolong the negative affect associated with that type of goal failure. Results yielded strong support for our predictions regarding promotion goal failure and modest support for those regarding prevention goal failure.Item Open Access Datapoints: Use of medications and counseling for depression by Asian and multiple-race adolescents aged 12-17 years.(Psychiatric services (Washington, D.C.), 2012-09) Wu, Li-Tzy; Blazer, Dan GItem Open Access Depression in pregnancy, infant birth weight and DNA methylation of imprint regulatory elements.(Epigenetics : official journal of the DNA Methylation Society, 2012-07) Liu, Y; Murphy, SK; Murtha, AP; Fuemmeler, BF; Schildkraut, J; Huang, Z; Overcash, F; Kurtzberg, J; Jirtle, R; Iversen, ES; Forman, MR; Hoyo, CDepressed mood in pregnancy has been linked to low birth weight (LBW, 4,500 g) infants had 5.9% higher methylation at the PLAGL1 DMR compared with normal birth weight infants. Our findings confirm that severe maternal depressed mood in pregnancy is associated with LBW, and that MEG3 and IGF2 plasticity may play important roles.Item Open Access Depression Symptoms Are Associated with Poor Functional Status Among Operative Spinal Deformity Patients.(Spine, 2021-04) Lafage, Renaud; Ang, Bryan; Schwab, Frank; Kim, Han Jo; Smith, Justin S; Shaffrey, Christopher; Burton, Douglas; Ames, Christopher; Mundis, Gregory; Hostin, Richard; Bess, Shay; Klineberg, Eric; Passias, Peter; Lafage, Virginie; on behalf of the International Spine Study Group (ISSG)Study design
Retrospective review of prospective multicenter database.Objective
The aim of this study was to investigate how preoperative mental status affects preoperative and postoperative disability and health scores in adult spinal deformity (ASD) patients.Summary of background data
The relationship between health-related quality of life (HRQOL) and depression has previously been documented. However, the influence of depression on clinical outcomes among ASD patients is not well understood.Methods
ASD patients with minimum 2-year follow-up were stratified based on preoperative mental health measured by Short Form 36 (SF-36) mental component score (MCS). Patients with MCS in the 25th and 75th percentile of the cohort were designated as having low and high MCS, respectively. After matching by preoperative demographics and deformity, pre- and post-HRQOL were compared between the two groups. Further analysis was performed to identify individualized questions on the SF-36 that could potentially screen for patients with low MCS.Results
Five hundred thirteen patients were assessed (58.4 years' old, 79% women, mean MCS 45.5). Thresholds for low and high MCS cohorts were 35.0 and 57.3, respectively. After matching by preoperative alignment, low MCS patients had worse Oswestry Disability Index (ODI) (52.3 ± 17.0 vs. 35.7 ± 14.6, P < 0.001) and Scoliosis Research Society-22R scores for all domains (all P < 0.001) compared to high MCS patients. Similar results were maintained at 2-year postop, with low MCS patients having a worse ODI (35.2 ± 20.2 vs. 19.7 ± 18.6, P < 0.001) and MCS (42.4 ± 13.5 vs. 58.6 ± 7.1, P < 0.001). Despite similar preoperative Physical Component Score (PCS), low MCS patients were less likely to reach MCID for PCS (46.1% vs. 70.6%, P < 0.01) and had a lower satisfaction at 2-year follow-up (3.88 ± 1.07 vs. 4.39 ± 0.94, P < 0.001). Questions 5a, 9d, and 9f on the SF-36 were found to be independent predictors of low MCS.Conclusion
ASD patients with low MCS are more likely to experience functional limitations before and after surgery and are less likely to be satisfied postoperatively, even when similar clinical goals are achieved. Incorporating psychological factors may assist in decision making.Level of Evidence: 3.Item Open Access Depression, Functional Dependence, Quality of Life and Return to Work Among Hospitalized Burn Patients in Wuhan, China(2019) Silva-Nash, Jennifer RebeccaBurn injuries are devastating in both the acute and chronic phases. Survivors face life-lasting effects from such injuries, often decreasing general health, quality of life and employment status. With increased survival rates post-burn injury, increased research is needed to evaluate the recovery status of patients post discharge, and to identify residual patient needs.
This study measured depression, functional dependence in activities of daily living, quality of life (QoL) and return to work (RTW) 3- and 6-months, and identified factors associated with poor outcomes. Inpatients at Wuhan Third Hospital were asked to join the study as they were being discharged. 280 participants completed the baseline survey, where depression severity and functional dependence were measured using Patient Health Questionnaire-9 and the Barthel Index, respectively. QoL was measured using the Burn Specific Health Survey Brief (BSHS-B) 3- and 6-month, and RTW was collected at the same time-points. Factors associated with each outcome were identified through hypothesis tests and logistic regression models.
Nearly 15% of participants met the depression cut-off score, but over 70% required at least some assistance in daily living according to the BI results. Longer length of stay (LOS) resulted in greater odds of having a depressive PHQ-9 score. LOS, along with older age, female gender and full-thickness burns was significantly associated with functional dependence. 64.7% and 70.3% of participants reported a good QoL at 3- and 6- month follow-ups, respectively. Larger total body surface affected by burn and longer
LOS greatly decreases participant odds of having a good QoL at both time points. Three iv
months after hospital discharge, 66.4% of participants returned to work, and increased to 67.2% 6 months after discharge. Significant differences in RTW rate existed by age, education level, burn depth, LOS and BI score. Participants with LOS longer than two weeks had nearly 7 times lower odds of returning to work than those with stays one week or shorter, even after adjusting for burn depth and size.
There does not appear to be a large residual need for mental health services for burn injury patients at Wuhan Third Hospital, and high percentage of participants with favorable high QoL is reassuring that current burn care largely addresses patient needs. The percentage of patients reporting need for assistance in daily activities and lack of RTW demand the most attention in future rehabilitation interventions. The study reveals that participants with LOS longer than two weeks have much higher odds of having poor outcomes compared to patients with shorter stays. Further research should be carried out to establish the direction of the relationship between LOS and recovery outcomes to form plans to mitigate modifiable determinants. This would affect multiple adverse burn injury outcomes.
Item Open Access Depressive Symptoms and Incident Heart Failure in the Jackson Heart Study: Differential Risk Among Black Men and Women.(Journal of the American Heart Association, 2022-03) Gaffey, Allison E; Cavanagh, Casey E; Rosman, Lindsey; Wang, Kaicheng; Deng, Yanhong; Sims, Mario; O'Brien, Emily C; Chamberlain, Alanna M; Mentz, Robert J; Glover, LáShauntá M; Glover, LáShauntá M; Burg, Matthew MBackground Associations between depression, incident heart failure (HF), and mortality are well documented in predominately White samples. Yet, there are sparse data from racial minorities, including those who are women, and depression is underrecognized and undertreated in the Black population. Thus, we examined associations between baseline depressive symptoms, incident HF, and all-cause mortality across 10 years. Methods and Results We included Jackson Heart Study (JHS) participants with no history of HF at baseline (n=2651; 63.9% women; median age, 53 years). Cox proportional hazards models tested if the risk of incident HF or mortality differed by clinically significant depressive symptoms at baseline (Center for Epidemiological Studies-Depression scores ≥16 versus <16). Models were conducted in the full sample and by sex, with hierarchical adjustment for demographics, HF risk factors, and lifestyle factors. Overall, 538 adults (20.3%) reported high depressive symptoms (71.0% were women), and there were 181 cases of HF (cumulative incidence, 0.06%). In the unadjusted model, individuals with high depressive symptoms had a 43% greater risk of HF (P=0.035). The association remained with demographic and HF risk factors but was attenuated by lifestyle factors. All-cause mortality was similar regardless of depressive symptoms. By sex, the unadjusted association between depressive symptoms and HF remained for women only (P=0.039). The fully adjusted model showed a 53% greater risk of HF for women with high depressive symptoms (P=0.043). Conclusions Among Black adults, there were sex-specific associations between depressive symptoms and incident HF, with greater risk among women. Sex-specific management of depression may be needed to improve cardiovascular outcomes.Item Open Access Depressive symptoms, substance use, and HIV-related high-risk behaviors among opioid-dependent individuals: results from the Clinical Trials Network.(Substance use & misuse, 2011-01) Pilowsky, Daniel J; Wu, Li-Tzy; Burchett, Bruce; Blazer, Dan G; Ling, WalterThe sample included 343 opioid-dependent adults enrolled in two national multisite studies of the National Drug Abuse Treatment Clinical Trials Network (CTN001-002). Opioid-dependent individuals were recruited from 12 sites across the United States from January 2001 to July 2002. We examined associations between depressive symptoms, co-occurring substance use (i.e., the use of substances other than opioids), and HIV-related sexual and injection risk behaviors. Data were collected using the Addiction Severity Index and the HIV Risk Behavior Scale, and analyzed using linear regression. Depressive symptoms were associated with an increased level of injection risk behaviors but were not associated with risky sexual behaviors. The co-occurring use of amphetamines also increased the likelihood of risky sexual behaviors. The study limitations and clinical implications are noted. The study was funded by the U.S. National Institute on Drug Abuse.