Screening for Depression using the PHQ-9 questionnaire: a study for Tunisian individuals consulting in the primary health care centers.

INTRODUCTION: Depression is considered a global public health problem especially in the developed countries, where depression is the leading cause of morbidity. OBJECTIVES: To determine the point prevalence and the severity of depression in primary health care, to define the profile of patients suffering from depression and consulting in primary health care. To identify risk factors for depression, in particular chronic co-morbid conditions. METHODS: Our study was a descriptive and analytical cross-sectional study of 1000 patients aged over 18 years consulting in ten primary care structures. It took place during a period of six successive days from 8 to 13 April 2012. Depression was assessed by the 9-item-Patient Health Questionnaire (PHQ-9). RESULTS: In our sample, the average age was 42,4 years ranging from 18 to 89 years. Females were predominant with 66,6 %. According to the PHQ-9, the prevalence of major depressive episode (MDE) was 12,1 %. It was higher among women (13,5%) compared with men (9,3%) with an odds ratio of 1,5. The highest prevalence of MDE (19%) was noted in the age group of 45-54 years. The most prevalent clinical signs found in our population were sleep disorders (29,7%) and suicidal ideation (28,4%). Among patients with MDE, only 10% were followed up for depression. Major depressive disorder was significantly associated with comorbid chronic diseases (p < 0,001), especially diabetes (p = 0,043, OR = 2,1), musculoskeletal diseases (p = 0,028, OR = 2,1) and pulmonary diseases (p = 0,001 , OR = 5,5). Having one comorbid chronic condition multiplied the risk of having a MDE by 2,2. This risk was 3,2 for two or more comorbid chronic conditions. CONCLUSION: Depression in primary care remains a largely underdiagnosed and undertreated condition. Patients with chronic disorders are particularly vulnerable.

Emergency surgery for Crohn's disease.

BACKGROUND: Surgery has played an essential role in the treatment of Crohn's disease. Emergency can reveal previously unknown complications whose treatment affects prognosis. PURPOSE OF STUDY: Indicate the incidence of indications in emergent surgery for Crohn's disease. Specify the types of procedures performed in these cases and assess the Results of emergency surgery for Crohn's disease postoperatively,  in short , medium and long term. METHODS: Retrospective analysis of collected data of 38 patients, who underwent surgical resection for Crohn's disease during a period of 19 years from 1992 to 2011 at the department of surgery in MONGI SLIM Hospital, and among them 17 patients underwent emergency surgery for Crohn's disease. In addition to socio-demographic characteristics and clinical presentations of our study population, we evaluated the indications, the type of intervention, duration of evolution preoperative and postoperative complications and overall prognosis of the disease. RESULTS: Of the 38 patients with Crohn's disease requiring surgical intervention, 17/38 patients underwent emergency surgery. Crohn's disease was inaugurated by the complications requiring emergency surgery in 11 patients. The mean duration of symptoms prior to surgery was 1.5 year. The most common indication for emergency surgery was acute intestinal obstruction (n=6) followed by perforation and peritonitis (n=5). A misdiagnosis of appendicitis was found in 4 patients and a complicated severe acute colitis for undiagnosed Crohn's disease was found in 2 cases. The open conventional surgery was performed for 15 patients. Ileocolic resection was the most used intervention. There was one perioperative mortality and 5 postoperative morbidities. The mean of postoperative hospital stay was 14 days (range 4-60 days). Six patients required a second operation during the follow-up period. CONCLUSION: The incidence of emergency surgery for Crohn's disease in our experience was high (17/38 patients), and is not as rare as the published estimates. Emergency surgical indication could be frequently the first presentation of Crohn's disease.  Acute intestinal obstruction and perforation-peritonitis were the most common indications for emergent surgery in Crohn's disease in our study.

Coping strategies, optimism, and resilience factors associated with mental health outcomes among medical residents exposed to coronavirus disease 2019 in Qatar.

OBJECTIVE: The aim of this study is to examine the association between coping strategies, resilience, optimism and different mental health outcomes like stress, anxiety, and depression among the medical residents' during the COVID-19 pandemic, with consideration of different factors like seniority, frontliner, gender, and coping style. METHODS: An electronic survey was sent to all medical residents in Qatar. Depression, anxiety, and stress were assessed by the DASS-21. Professional quality of life was measured by the ProQOL scale. The coping mechanisms were assessed with the Brief-COPE, and resilience was measured by the Brief Resilience Scale. RESULTS: The most commonly used coping strategies were acceptance, religion, and active coping. The avoidant coping style scores were higher among junior residents (p = .032) and non-COVID-19 frontliners (p = .039). Optimism LOT-R score was higher in senior than in junior residents (p < .001). Lower avoidant coping scores, higher optimism, and higher resilience were associated with lower stress, anxiety, and depressive symptoms. CONCLUSION: It seems that avoidant coping styles can exacerbate depressive, anxiety, and stress symptoms in medical residents amidst the COVID-19 pandemic. Strategies promoting optimism, resilience, and approach coping styles can decrease the mental health burden of the pandemic on medical residents.

Mental Health, resilience, and religiosity in the elderly under COVID-19 quarantine in Qatar.

INTRODUCTION: Corona Virus Disease 2019 (COVID-19) quarantine has been associated with depression, anxiety, and stress symptoms. We hypothesize these symptoms might even be more pronounced in the elderly, who may be particularly sensitive to social isolation. However, certain individuals might be more resilient than others due to their coping mechanisms, including religious coping. OBJECTIVES: We aimed to examine the levels of perceived stress, depressive, and anxiety symptoms in older adults under COVID-19 quarantine in Qatar; and to identify the sociodemographic, psychological, and clinical factors associated with mental health outcomes, with a focus on the role of resilience, and religiosity. METHODS: A cross-sectional study assessing depressive, anxiety, and stress symptoms as well as resilience, and religiosity through a phone survey in adults aged 60 years or more under COVID-19 quarantine in the State of Qatar, in comparison to age and gender-matched controls. RESULTS: The prevalence of depressive, anxiety, and stress symptoms in elderly subjects under COVID-19 quarantine in Qatar was not significantly different from the prevalence in gender and age-matched controls. In the quarantined group, higher depressive, anxiety, and stress scores were associated with the female gender and with lower resilience scores but were not linked to age, psychiatric history, medical history, duration of quarantine, or religiosity. CONCLUSION: The elderly population does not seem to develop significant COVID-19 quarantine-related psychological distress, possibly thanks to high resilience and effective coping strategies developed through the years.