Motivation and Use of Telehealth Among People with Depression in the United States.

INTRODUCTION: The global mental health crisis, compounded by the challenges of the COVID-19 pandemic, underscores the urgent need for accessible mental health care solutions. Telehealth services have emerged as a promising technology to address barriers to access mental health services. However, population-based studies examining telehealth utilization among individuals with depression are limited. METHODS: Using data from the National Cancer Institute's Health Information National Trends Survey (HINTS) of 2022 (n = 4502), we investigated telehealth utilization among individuals diagnosed with depression in the United States. We employed multivariable logistic regression analysis to assess the association, adjusting for demographics, health behaviors, health status, trust in the medical system, and access to transportation. We also studied the factors that motivated the use of telehealth among individuals diagnosed with depression. RESULTS: In the multivariable adjusted logistic regression models, individuals diagnosed with depression (AOR 2.59, 95% CI 1.96-3.42) were significantly more likely to use telehealth services relative to individuals with no depression diagnosis. Other factors associated with increased telehealth use included women (AOR 1.36, 95% CI 1.07-1.72), Hispanic ethnicity (AOR 1.78, 95% CI 1.28-2.48), being married or living with a partner (AOR 1.30, 95% CI 1.05-1.62), frequent healthcare visits (AOR 2.31, 95% CI 1.71-3.11), health insurance coverage (AOR 1.86, 95% CI 1.04-3.34), confidence in self-care (AOR 1.38, 95% CI 1.07-1.78), and lack of reliable transportation (AOR 1.57, 95% CI 1.01-2.42). Major motivation factors that influenced telehealth use among individuals with depression primarily included convenience, such as reduced travel times, as well as clinicians' recommendations. CONCLUSION: Telehealth is a promising option for accessing mental health care, particularly for those with depression. Further research is needed to understand how well telehealth works and how it can be combined with traditional care, ensuring fair costs and keeping information safe.

Palliative Care Interventions Effects on Psychological Distress: A Systematic Review & Meta-Analysis.

BACKGROUND: Managing psychological distress is an objective of palliative care. No meta-analysis has evaluated whether palliative care reduces psychological distress. OBJECTIVES: Examine the effects of palliative care on depression, anxiety, and general psychological distress for adults with life-limiting illnesses and their caregivers. DESIGN: We searched PubMed, PsycInfo, Embase, and CINAHL for randomized clinical trials (RCTs) of palliative care interventions. RCTs were included if they enrolled adults with life-limiting illnesses or their caregivers, reported data on psychological distress at 3 months after study intake, and if authors had described the intervention as "palliative care." RESULTS: We identified 38 RCTs meeting our inclusion criteria. Many (14/38) included studies excluded participants with common mental health conditions. There were no statistically significant improvements in patient or caregiver anxiety (patient SMD: -0.008, P = 0.96; caregiver SMD: -0.21, P = 0.79), depression (patient SMD: -0.13, P = 0.25; caregiver SMD -0.27, P = 0.08), or psychological distress (patient SMD: 0.26, P = 0.59; caregiver SMD: 0.04, P = 0.78). CONCLUSIONS: Psychological distress is not likely to be reduced in the context of a typical palliative care intervention. The systemic exclusion of patients with common mental health conditions in more than 1/3 of the studies raises ethical questions about the goals of palliative care RCTS and could perpetuate inequalities.

Validation of the Sour Seven Questionnaire for screening delirium in hospitalized seniors by informal caregivers and untrained nurses.

BACKGROUND: Delirium is a common condition in hospitalized seniors that nonetheless often goes undetected by nurses or is delayed in being detected which negatively impacts quality of care and outcomes. We sought to develop a new screening tool for delirium, The Sour Seven Questionnaire, a 7-item questionnaire suitable to be completed from informal or untrained caregiver observation. The study aimed to develop the scoring criteria for a positive delirium screen and assess concurrent validity of the questionnaire against a geriatric psychiatrist's assessment. METHODS: A pilot study of 80 hospitalized seniors over age 65 recruited from three units (2 medical, 1 orthopedic). Participants were assessed using the Confusion Assessment Method (CAM) with a brief cognitive screen and the Sour Seven Questionnaire posed to the appointed informal caregiver (family member) or untrained nurse for up-to 7 days. Subjects testing positive on the CAM and a random sample of negatively CAM screened subjects were assessed by the geriatric psychiatrist. RESULTS: From 80 participants, 21 screened positive for delirium on the CAM. 18 of the 21 CAM positive screens were diagnosed to have delirium by the geriatric psychiatrist, and 17 of the 18 randomly assigned negative CAM screens were confirmed as not having delirium. From the questionnaires on these 39 participants, weighted scoring for each of the 7 questions of the Sour Seven Questionnaire was developed based on their relative risks for correctly predicting delirium when compared to the geriatric psychiatrist's clinical assessment. Total scoring of the questionnaire resulted in the following positive predictive values for delirium: 89% with a total score of 4 (sensitivity 89.5%, specificity 90%), and 100% with a total score of 9 (sensitivity 63.2%, specificity 100%). Comparison between scoring on questionnaires posed to informal caregivers versus untrained nurses showed no differences. CONCLUSION: A weighted score of 4 in the Sour Seven Questionnaire has concurrent validity as a screening tool for delirium and a score of 9 is diagnostic for delirium. The Sour Seven Questionnaire is the first screening tool for delirium shown to be suitable for use by informal caregivers and untrained nurses in hospitalized seniors.

Maternal and newborn health profile in a first nations community in Canada.

OBJECTIVES: We sought to characterize maternal health profiles and birth outcomes among First Nations people living in Southern Ontario. METHODS: We performed a retrospective chart review of all 453 women from the Six Nations Reserve, Ontario, who were pregnant between 2005 and 2010. Maternal health behaviours, past medical history, physical measurements, birth outcomes, and newborn characteristics were abstracted. Key maternal and newborn characteristics were compared with those of a cohort of non-First Nations women recruited from nearby Hamilton, Ontario. RESULTS: The average age of women in the study cohort was 25.1 ± 6.2 (mean ± SD) years, and 75.8% were multiparous. The mean pre-pregnancy BMI was 28.3 ± 6.6 kg/m(2), and the average weight gain in pregnancy was 14.9 ± 8.3 kg. Mean weight gain during pregnancy was inversely associated with pre-pregnancy BMI, and 57.1% of women gained more than the recommended weight. The prevalence of type 2 diabetes or gestational diabetes was 4.7%, hypertension was present before or during pregnancy in 5.6%, and 35% used tobacco during pregnancy. The mean gestational age at delivery was 39.5 ± 1.7 weeks and the mean crude birth weight was 3619 ± 557 g. The main determinants of newborn weight included sex of the newborn, pre-pregnancy BMI, and weight gain during pregnancy. Compared with a contemporary cohort of 622 non-First Nations mothers and newborns, First Nations mothers were, on average, younger (25.1 vs. 32.1 years; P < 0.001), had a higher mean pre-pregnancy BMI (28.3 vs. 26.8 kg/m(2); P < 0.001), and were more likely to use tobacco during pregnancy (35.0% vs. 14.4%; P < 0.001). First Nations newborns had significantly higher mean birth weight (+176 grams) and length (+2.3 cm) than non-First Nations newborns. CONCLUSION: First Nations mothers from the Six Nations Reserve tended to have a high pre-pregnancy BMI, tended to gain more than the recommended weight during pregnancy, and commonly used tobacco during pregnancy. Programs to prevent overweight/obesity and excess weight gain during pregnancy and to minimize smoking are required among women of child-bearing age in this community.

Objectifs : Nous avons cherché à caractériser les profils de santé maternelle et les issues de l'accouchement chez les peuples des Premières Nations vivant dans le sud de l'Ontario. Méthodes : Nous avons mené une analyse rétrospective des dossiers des 453 femmes de la Six Nations Reserve, en Ontario, qui étaient enceintes entre 2005 et 2010. Les comportements de santé maternelle, les antécédents médicaux, les mesures physiques, les issues de l'accouchement et les caractéristiques néonatales ont fait l'objet d'un résumé. Les caractéristiques maternelles et néonatales clés ont été comparées à celles d'une cohorte de femmes n'étant pas issues des Premières Nations qui ont été recrutées tout près, à Hamilton, en Ontario. Résultats : L'âge moyen des femmes de la cohorte d'étude était de 25,1 ± 6,2 ans (moyenne ± σ) et 75,8 % d'entre elles étaient multipares. L'IMC prégrossesse moyen était 28,3 ± 6,6 kg/m2 et le gain pondéral moyen pendant la grossesse était de 14,9 ± 8,3 kg. Le gain pondéral moyen pendant la grossesse était inversement proportionnel à l'IMC prégrossesse et 57,1 % des femmes ont dépassé le gain pondéral recommandé. La prévalence du diabète de type 2 ou du diabète gestationnel était de 4,7 %, une hypertension était présente avant ou pendant la grossesse chez 5,6 % des participantes et 35 % d'entre elles ont consommé du tabac pendant la grossesse. L'âge gestationnel moyen au moment de l'accouchement était de 39,5 ± 1,7 semaines et le poids de naissance brut moyen était de 3 619 ± 557 g. Parmi les principaux déterminants du poids néonatal, on trouvait le sexe du nouveau-né, l'IMC prégrossesse et le gain pondéral pendant la grossesse. Par comparaison avec une cohorte contemporaine de 622 mères et nouveau-nés n'étant pas issus des Premières Nations, les mères issues de ces dernières étaient, en moyenne, plus jeunes (25,1 vs 32,1 ans; P < 0,001), présentaient un IMC prégrossesse moyen plus élevé (28,3 vs 26,8 kg/m2; P < 0,001) et étaient plus susceptibles de consommer du tabac pendant la grossesse (35,0 % vs 14,4 %; P < 0,001). Les nouveau-nés issus des Premières Nations présentaient une longueur (+2,3 cm) et un poids de naissance (+176 grammes) moyens considérablement plus élevés, par comparaison avec les nouveau-nés n'étant pas issus des Premières Nations. Conclusion : Les mères issues des Premières Nations de la Six Nations Reserve ont eu tendance à présenter un IMC prégrossesse élevé et à dépasser le gain pondéral recommandé pendant la grossesse, en plus de consommer couramment du tabac pendant cette période. Des programmes qui visent la prévention de la surcharge pondérale / de l'obésité et du gain pondéral excédentaire pendant la grossesse, et qui visent à minimiser le tabagisme s'avèrent requis pour les femmes en âge de procréer de cette communauté.