Validity of the patient health questionnaires(phq-2 and phq-9)for screening depression among human immunodeficiency virus patients in Lahore,Pakistan

BACKGROUND Many human immunodeficiency virus(HIV)infected patients suffer from depression,but a little focus is given to detecting and treating depression in primary health care.Detection of depression can be improved by introducing short,reliable,and valid screening instruments.AIM To determine the psychometric properties of the patient health questionnaire-2(PHQ-2)and patient health questionnaire-9(PHQ-9)for depression screening and diagnosis,and the sensitivity and specificity of the PHQ-2 in HIV infected patients.METHODS A cross-sectional study was conducted on 158 HIV-infected patients aged 18 years and above in Lahore,Pakistan.PHQ-2 was implemented to screen depression.PHQ-9 was implemented to diagnose major depressive disorder as a reference standard.Reliability,Validity tests and receiver operating characteristic curve were computed.RESULTS The Cronbach's alpha of PHQ-2 and PHQ-9 were 0.732 and 0.759,respectively.The study results showed that the score of 2 on PHQ-2 indicates the highest Youden's index of 0.924,with both sensitivity and specificity of 0.96,and the area under the curve for PHQ-2 was 0.98(95%CI:0.953-0.998).CONCLUSION Good psychometric properties for the PHQ-2 and PHQ-9 indicated their significant potential as tools for depression screening and diagnosis in the HIV-infected population.

Generalized Anxiety and Major Depressive Symptoms of General Public in South Korea during the Early COVID-19 Pandemic

The extent of viral spread and strategies in dealing with the COVID-19 pandemic have been different in each country.There are overall increased mental health concerns in many countries but it is unclear what the general public individuals who do not have heighten vulnerability to stressors for existing mental diseases or significant physical illnesses were experiencing during the pandemic.We evaluated the stressors and mental health of general public in South Korea that has a relatively low confirmed cases and deaths.Responses on the on-line survey questions were used to assess the mental and physical symptoms in association with individuals’reported stressors.Individuals with the symptoms of the generalized anxiety disorder(GAD)were reported in 58.9%,and major depression(MD)in 23.2%,mostly in minimal to mild degrees,cut-off scores of 5 and 10,respectively by the validated screening tools,GAD-7 and PHQ-9.Both GAD and MD symptoms were in 21.5%of the respondents.The total number of stress had significant association with the scores of GAD-7,PHQ-9,physical symptoms,sleep difficulties and resilience(p<0.01).GAD scores were also associated with sleep difficulties(p<0.01)and raising young children(p<0.05).MD scores were associated with sleep difficulties,job-dissatisfaction,and educational level(p<0.05).The limitations of the study include small sample size,usage of smartphone or email,potential under-reporting by stigma in the socio-cultural context and evolving nature of pandemic.We conclude that keeping careful watch for mental symptoms,stressors,sleep difficulties and other physical symptoms are important even for the individuals without previous mental illnesses during the pandemic era.

Association of total bilirubin with depression risk in adults with diabetes:A cross-sectional study

BACKGROUND Individuals with diabetes mellitus are more likely to experience depression,although most patients remain undiagnosed.The relation between total bilirubin and depression has been increasingly discussed,but limited studies have examined the association of total bilirubin with depression risk in adults with diabetes,which warrants attention.AIM To investigate the association between total bilirubin levels and the risk of depression in adults with diabetes.METHODS The study included adults with diabetes from the National Health and Nutrition Examination Survey 2007-2018.Depression was determined using the Patient Health Questionnaire-9.Multivariable logistic regression,propensity scorematched analysis and restricted cubic spline models were utilized to investigate the association between total bilirubin levels and depression risk in adults with diabetes.RESULTS The study included 4758 adults with diabetes,of whom 602(12.7%)were diagnosed with depression.After adjusting for covariates,we found that diabetic adults with lower total bilirubin levels had a higher risk of depression(OR=1.230,95%CI:1.006-1.503,P=0.043).This association was further confirmed after propensity score matching(OR=1.303,95%CI:1.034-1.641,P=0.025).Subgroup analyses showed no significant dependence of age,body mass index,sex,race or hypertension on this association.Restricted cubic spline models displayed an inverted U-shaped association of total bilirubin levels with depression risk within the lower range of total bilirubin levels.The depression risk heightened with the increasing levels of total bilirubin,reaching the highest risk at 6.81μmol/L and decreasing thereafter.CONCLUSION In adults with diabetes,those with lower levels of total bilirubin were more likely to have depressive symptoms.Serum total bilirubin levels may be used as an additional indicator to assess depression risk in adults with diabetes.

Depression and myocardial injury in ST-segment elevation myocardial infarction:A cardiac magnetic resonance imaging study

BACKGROUND Depression is common in patients with myocardial infarction and has been independently associated with adverse outcomes.However,the association between depression and myocardial injury on cardiac magnetic resonance(CMR)in patients with ST-segment elevation myocardial infarction(STEMI)has still not been assessed.AIM To assess the association between depression and myocardial injury on CMR in patients with STEMI.METHODS A total of 107 STEMI patients undergoing primary percutaneous coronary intervention(P-PCI)were analyzed in this prospectivecohort study.Each subject completed the Patient Health Questionnaire-9(PHQ-9)to assess the presence and severity of depressive symptoms.CMR was performed at a median of 3 d after PPCI for quantifying post-MI myocardial injury.Correlations between depression identified by the PHQ-9 and myocardial injury measured on CMR were assessed.RESULTS In this study,19 patients(17.8%)were diagnosed with major depression identified by the PHQ-9≥10.PHQ-9 was analyzed both as a continuous variable and dichotomous variable.After multivariable adjustment,the proportion of patients with large infarction size was significantly higher in the major depression group(PHQ-9≥10)(OR:4.840,95%CI:1.122–20.868,P=0.034).When the PHQ-9 was evaluated as a continuous variable,after multivariable adjustment,an increased PHQ-9 score was associated with an increased risk of large infarction size(OR:1.226,95%CI:1.073–1.401,P=0.003).CONCLUSION In patients with STEMI undergoing PCI,depression was independently associated with a large infarction size.

Relationship of depression and sleep quality,diseases and general characteristics

BACKGROUND Depression is the most common type of depressive disorder.The most common sleep disorder associated with depression is insomnia.Insomnia and depression are closely related.AIM To investigate the relationship of designed questionnaire items and depression,and analyze the related factors with depression.METHODS Questionnaire included Patient Health Questionnaire-9(PHQ-9)and Pittsburgh sleep quality index(PSQI),12 kinds of diseases,8 general characteristics,and 20 insomnia characteristics,totally 56 items were filled out by 411 patients enrolled.RESULTS All the 9 items of PHQ-9,6 components of PSQI(except sleep duration),education,living situation,exercise,years of insomnia,western medicine treatment,Chinese medicine treatment,psychotherapy,kinds of insomnia,treatment expected to treat insomnia,psychological counseling,habit of 1 h before bed,habit of lunch break,diagnosed depression,coronary heart disease,mental illness showed significant difference between without and with depression group.By univariate analysis and multivariate analysis.The odds ratio of education,exercise,kinds of insomnia,habit of 1 h before bed,diagnosed depression,coronary heart disease(P=0.01)showed significant difference.Their odds ratios were 0.71(0.55,0.93),2.09(1.32,3.31),0.76(0.63,0.91),0.89(0.81,0.98),0.32(0.17,0.60),0.43(0.23,0.79).CONCLUSION We demonstrated that education,exercise,kinds of insomnia,habit of 1 h before bed,diagnosed depression and coronary heart disease affect the depression.

Can the management of depression in type 2 diabetes be democratized?

Both type 2 diabetes and depression are common and are projected to increase.There is increasing evidence for a bidirectional relationship between the two.Diabetes is a risk factor for depression;contrariwise,individuals with depression are at greater risk of developing diabetes.They are a burden for both the individual and the society.Co-existent depression worsens diabetic control because of obesity,insulin resistance and the adverse metabolic effects of anti-diabetes medicines.In addition,compliance to lifestyle measures required for diabetes is also compromised such as following a specific diet,taking proper medications on time,getting metabolic parameters assessed and maintaining a sleep cycle.Depression occurs in many grades;mild depression is more common in diabetes than frank or full-blown depression leading to suicide.Unfortunately,there are not enough trained and accessible mental health professionals such as psychologists or psychiatrists to deal with the increasing burden of depression in diabetes.Therefore,alternate models for management of mild to moderate depression are required.There is evidence that a team-approach by employing health care assistants can lower the risk of cardiac risk factors.INtegrating DEPrEssioN and Diabetes treatmENT study was carried out to determine whether the team-approach using non-health care professionals could be effective in managing mild to moderate depression and to study its effects on metabolic parameters among subjects with type 2 diabetes mellitus.The international study,carried out in four independent centers in India assessed the impact of a trained but not qualified non-psychiatrist in coordinating and forming a fulcrum between the patient,the family and the consultant endocrinologist/diabetologist.The interventions were fine-tuned to be culturally appropriate by qualitative interviews before they began.It was shown that the outcomes of both depression and diabetes could be improved by the employment of a clinical care coordinator.It is possible to scale up the studies to wider geographical areas and health-care organizations.

Evaluation of Depression and Quality of Life in Patients With Psoriasis

Objective:To measure the prevalence of depression in patients with psoriasis and to evaluate the relationship between the severity of psoriasis and depression and its effect on patients’quality of life.Methods:A total of 154 patients with a confirmed diagnosis of psoriasis were assessed to determine the severity of psoriasis based on the psoriasis area and severity index score,presence,and severity of depression using the patient health questionnaire 9,and quality of life using the dermatology life quality index 10.Pearson correlation coefficient was used to demonstrate the relationship between continuous variables with 95%confidence intervals(CIs);P<0.00001 was taken to indicate statistical significance.Results:The severity of psoriasis was mild in 36.36%of patients,moderate in 25.97%,severe in 32.47%,and very severe in 5.20%.Of the 154 patients,139(90.3%)had depression;the severity of depression was mild in most affected patients(46.7%)and severe in 2.6%of patients.Psoriasis had a moderate effect on the quality of life in 37.01%of patients and a very large effect in 33.77%of patients.The severity of psoriasis was positively correlated with depression(Pearson correlation coefficient,r=0.42,P<0.00001,95%CI:0.28–0.54)and quality of life(r=0.43,P<0.00001,95%CI:0.29–0.55).Conclusion:Depression is a common comorbidity in patients with psoriasis.The severity of psoriasis is positively correlated with the severity of depression and is associated with poor quality of life.

柴胡加龙骨牡蛎汤加味治疗轻中度原发性高血压合并抑郁肝阳上亢证的临床观察

目的:探讨柴胡加龙骨牡蛎汤加味对轻中度原发性高血压合并抑郁肝阳上亢证的临床有效性与安全性,并评估其对血管内皮功能的影响。方法:选择2016年2月至2018年5月在天津市泰达医院门诊患者,现代医学符合轻中度原发性高血压合并抑郁诊断标准,中医诊断符合肝阳上亢证的患者共121例,随机分为治疗组(60例)和对照组(61例)。两组患者均给予基础西药降压治疗,治疗组在基础西药方案的基础上,服用中药柴胡加龙骨牡蛎汤加味方,每天1剂,2次/d。疗程为4周。观察治疗前后治疗组和对照组两组患者的血压、患者健康问卷抑郁自评量表(PHQ-9)评分,中医证候积分,C反应蛋白,内皮依赖性血管舒张功能及不良反应。结果:与本组治疗前比较,两组患者治疗后血压均能降低(P<0.05),组间比较,治疗后治疗组血压较对照组下降(P<0.05)。治疗后治疗组PHQ-9评分,肝阳上亢证积分,C反应蛋白水平均较对照组降低(P<0.05)。与对照组治疗后比较,治疗组细胞依赖性舒张功能(FMD)和内皮细胞非依赖性舒张功能(GTN)水平升高(P<0.05)。两组患者均未见显著不良反应。结论:柴胡加龙骨牡蛎汤加味在治疗轻中度原发性高血压合并抑郁患者具有一定临床疗效,能在降压的同时,还能改善抑郁、改善中医证候、减轻炎性反应,改善内皮依赖性血管舒张功能,且具有较好的安全性,体现了中医药治疗高血压的多靶点、多成分、整体综合调节优势。