The Impact of the COVID-19 Pandemic on Self-Reported Outcomes in Patients With Adrenal Insufficiency.

CONTEXT: The COVID-19 pandemic has impacted healthcare environment. OBJECTIVE: To determine the impact of the pandemic on self-reported outcomes in patients with adrenal insufficiency (AI). DESIGN AND SETTING: Prospective longitudinal survey study at 2 tertiary centers. PARTICIPANTS: Patients with AI. INTERVENTION: Patient-centered questionnaire. MAIN OUTCOME MEASURES: Depression Anxiety Stress Scales-21, Short Form-36, and AI self-management. RESULTS: Of 342 patients, 157 (46%) had primary AI, 109 (32%) had secondary AI, and 76 (22%) had glucocorticoid-induced AI. When compared to prepandemic, daily glucocorticoid dose and number of adrenal crises did not change. However, patients reported a higher financial impact from AI (34% vs 23%, P = 0.006) and difficulty accessing medical care (31% vs 7%, P < 0.0001) during the pandemic. A third of patients reported difficulty managing AI during the pandemic. After adjusting for duration and subtypes of AI, younger patients [odds ratio (OR) 2.3, CI 95% 1.3-4.1], women (OR 3.7, CI 95% 1.9-7.1), poor healthcare access(OR 4.2, CI 95% 2.3-7.7), lack of good insurance support (OR 2.8, CI 95% 1.3-5.9), and those with a higher financial impact (OR 2.3, CI 95% 1.3-4.3) reported greater difficulties managing AI. Patients were more likely to report a higher anxiety score (≥8) if they found managing AI challenging during the pandemic (OR 3.0, CI 95% 1.3-6.9), and had lower Physical Component Summary (OR 4.9, CI 95% 2.2-11.0) and Mental Component Summary (OR 4.1, CI 95% 1.8-9.5) scores prior to the pandemic. CONCLUSIONS: A third of patients with AI reported difficulties with management of AI during the pandemic, particularly in younger patients, women, and those with poor healthcare access.

The Impact of Poor Nutrient Intakes and Food Insecurity on the Psychological Distress among Community-Dwelling Middle-Aged and Older Adults during the COVID-19 Pandemic.

This study aimed to investigate the impact of food insecurity and poor nutrient intake on the psychological health of middle-aged and older adults during the COVID-19 pandemic. A sub-sample of 535 individuals aged 52 years and above, from the earlier cohort and interventional studies (n = 4) from four selected states in Peninsular Malaysia, were recruited during the COVID-19 outbreak (April to June 2020). Telephone interviews were conducted by trained interviewers with a health sciences background to obtain participants' information on health status, physical activity, food security, and psychological health (General Health Questionnaire-12; normal and psychological distress). Univariate analyses were performed for each variable, followed by a logistic regression analysis using SPSS Statistics version 25.0. Results revealed food insecurity (OR = 17.06, 95% CI: 8.24-35.32, p < 0.001), low protein (OR = 0.981, 95% CI: 0.965-0.998, p < 0.05), and fiber intakes (OR = 0.822, 95% CI: 0.695-0.972, p < 0.05) were found to be significant factors associated with the psychological distress group after adjusting for confounding factors. The findings suggested that food insecurity and insufficiencies of protein and fiber intakes heightened the psychological distress during the COVID-19 pandemic. Optimal nutrition is vital to ensure the physical and psychological health of the older population, specifically during the current pandemic.

Itch and Mental Health in Dermatological Patients across Europe: A Cross-Sectional Study in 13 Countries.

Itch is a highly prevalent and multidimensional symptom. We aimed to analyze the association between itch and mental health in dermatological patients. This multicenter study is observational and cross-sectional and was conducted in dermatological clinics across 13 European countries. A total of 3,530 patients and 1,094 healthy controls were included. Patients were examined clinically. Outcome measures were itch (presence, chronicity, and intensity), the Hospital Anxiety and Depression Scale, EQ-5D visual analogue scale, sociodemographics, suicidal ideation, and stress (negative life events and economic difficulties). Ethical approval was obtained. Results showed significant association between the presence of itch in patients and clinical depression (odds ratio, 1.53; 95% confidence interval, 1.15-2.02), suicidal ideation (odds ratio, 1.27; 95% confidence interval, 1.01-1.60), and economic difficulties (odds ratio, 1.24; 95% confidence interval, 1.10-1.50). The mean score of reported generic health status assessed by the EQ-5D visual analogue scale was 65.9 (standard deviation = 20.1) in patients with itch, compared with 74.7 (standard deviation = 18.0) in patients without itch (P < 0.001) and 74.9 (standard deviation = 15.7) in controls with itch compared with 82.9 (standard deviation = 15.6) in controls without itch (P < 0.001). Itch contributes substantially to the psychological disease burden in dermatological patients, and the management of patients should include access to multidisciplinary care.

Different Depression Treatment Recommendations and Adherence for Spanish- and English-Speaking Patients.

INTRODUCTION: National guidelines recommend primary care providers (PCPs) screen patients for depression with a standardized tool and address positive screenings. However, depression prevalence is lower in Latinos (8% to 15%, with Spanish speakers at 8%) than non-Latino whites (22%). As a result of these prevalence differences, PCPs may use ethnicity and language of the patient to determine depression screening behaviors. This study examined standard of care (SoC) depression treatment recommendations by ethnicity and language for patients who screened positive for major depression during a medical visit. METHODS: 275 patients scored ≥10 on the Patient Health Questionnaire-9 screening; a chart review assessed treatment referrals, followed by semistructured interviews with 18 patients and 7 PCPs regarding depression treatment behaviors. RESULTS: 138 patients (50%) received SoC treatment recommendations. After controlling for age, gender, and race, a binary logistic regression was performed to determine language and ethnicity effects on SoC depression treatment recommendations (psychotherapy/pharmacotherapy vs other). Spanish-speaking Latinos were 72% less likely to receive SoC recommendations than English speakers (odds ratio [OR] = 0.39). Interviews with Spanish-speaking patients confirmed that negative perceptions about medications, patient noncompliance, and a shortage of bilingual behavioral health providers within the clinic impacted SoC recommendations and uptake. CONCLUSIONS: Spanish-speaking Latinos did not receive or follow through with SoC recommendations as often as English speakers regardless of ethnicity. Future studies should explore reasons why language is a barrier to SoC recommendations for Latinos and explore culturally and linguistically sensitive methods to effectively treat Spanish speakers for depression during a medical visit.

Assessing the effect of patient to provider language discordance on depression screening utilizing the Patient Health Questionnaire: an epidemiology study.

Background: As depression screening becomes a standard in primary care, the question remains of how effective and equitable screening can be implemented to avoid cultural and language-related disparities. Methods: In this retrospective cohort study, rates of depression screening were compared for 3626 adult patients at a family medicine residency-based health centre in Pennsylvania, USA. The PHQ-2/PHQ-9 modality was verbally administered by nursing staff at the time of patient intake as part of a universal screening initiative. Chi-square analysis was used to determine the univariate associations of performed depression screening with variables of language, ethnicity, gender and number of office visits. A binary logistic regression was then performed to measure whether univariate associations remain significant after correction for other variables. Results: Chi-square analysis revealed significant differences in screening based on univariate associations of language, gender and number of office visits. No significant difference was found for age or ethnicity. Binary logistic regression revealed the following odds ratio of being screened for depression for each variable: Spanish language (OR = 0.694, CI = 0.559 to 0.862), female gender (OR = 1.155, CI = 1.005 to 1.328) and office visit frequency of three or more office visits per year (OR = 2.103, CI = 1.835 to 2.410). Conclusions: Spanish-speaking adults were significantly less likely to be screened for depression than their English-speaking counterparts. Women were more likely to be screened than men, and the odds of screening increased with more frequent exposure to the office. Future studies should be directed at validating these findings in multiple clinical settings.

Is assessment of depression equivalent for migrants of different cultural backgrounds? Results from the German population-based Gutenberg Health Study (GHS).

BACKGROUND: Bearing in mind the multicultural background of a national population, little is known about the measurement invariance across different cultures or ethnicities of frequently used screeners for depression. For this reason, the main objective of the current study is to assess the measurement invariance of the Patient Health Questionnaire (PHQ-9) across groups with different migration backgrounds. METHODS: We provided psychometric analyses (descriptive statistics at item and scale level, reliability analysis, exploratory [EFA] and confirmatory factor analyses [CFA]) comparing a native population with first- and second-generation migrants of the German population-based Gutenberg Health Study with N = 13,973 participants completing the PHQ-9. Furthermore, we conducted measurement invariance analyses among different groups of first-generation migrants. RESULTS: Comparing the native population with first- and second-generation migrants, a higher prevalence for mental distress was found for first generation. Although mean score patterns were similar for all groups, analyses of item loadings among first-generation migrants yielded some variance in patterns pointing out that certain items have a distinct impact on depression for specific groups. With regard to the factorial validity for all groups, EFA and CFA provided evidence for the proposed one latent factor structure of the PHQ-9. Depression assessed by the PHQ-9 turned out to be equivalent from a psychometric perspective across different groups stratified by their migration background. CONCLUSIONS: Overall, results of thorough scale and item analyses, especially multigroup confirmatory analyses, provided support that depression, assessed by the PHQ-9, can be considered as psychometrically equivalent across all analyzed groups.