Depression screening in patients with vascular disease.

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

Scoliosis severity does not impact the risk of scoliosis in family members.

Does scoliosis severity increase scoliosis risk or severity in relatives? In a cohort of 1257 severe idiopathic scoliosis patients, the percentage with at least one affected relative was compared across the categories of patient sex, major curve severity (Cobb angle), and treatment method. In total, 138 (11%) of 1257 patients had at least one affected first-degree relative and 59 (5%) had at least one affected second-degree relative. As expected, males were more likely to have affected first-degree relatives than females (18 vs. 10% with a risk difference of -0.0864) [95% confidence interval (CI): -0.14 to -0.03; P=0.0002]. However, the major curve severity of the patient (<25°, 25°-49°, and ≥50°) did not impact the prevalence of having at least one affected relative (P=0.69). Surgically treated patients had no greater risk than nonsurgically treated patients of having either an affected relative or a surgically treated relative [11 vs. 11% (odds ratio: 0.912; 95% CI: 0.640-1.299, P=0.61), 6 vs. 5% (OR: 0.788; 95% CI: 0.485-1.280, P=0.34), respectively]. Therefore, our data suggest that scoliosis severity does not independently influence the risk of either scoliosis or its severity in family members.