Depression Screening in a population-based study: Brazilian National Health Survey 2019 / Rastreamento de sintomas depressivos em um estudo de base populacional: Pesquisa Nacional de Saúde 2019

Abstract This study evaluated the prevalence of positive screening for depression in Brazil and its associated factors. We used data from National Health Survey 2019 (Pesquisa Nacional de Saúde - PNS), a population-based survey with 88,531 adults. The Patient Health Questionnaire (PHQ-9) was used with two scoring methods, the algorithm and the cutoff point≥10. The variables included sociodemographic characteristics. The prevalence ratios and 95% confidence intervals (95%CI) were estimated using Poisson regression. The positive screening for depression was 10.8% (95%CI: 10.4-11.0), at the cutoff point ≥10 and 5.7% (95%CI: 5.4-6.0) for algorithm. Significant differences were found in prevalence in some Brazilian states. Multivariable analyses showed that being female, black, under 70 years of age, having little education, being single, and living in an urban area were independently associated with a depressive symptoms. The highest association was found in the states of Sergipe, Goiás, Piauí, Espírito Santo, São Paulo, Alagoas and lowest in Pará, Mato Grosso and Maranhão. The prevalence of positive screening for depression in Brazil has increased in recent years. More investment in mental health resources is necessary and surveys such as the PNS should be continued.

Resumo Este estudo avaliou a prevalência de triagem positiva para depressão no Brasil e seus fatores associados. Utilizou-se dados da Pesquisa Nacional de Saúde 2019 (PNS), um inquérito de base populacional com 88.531 adultos. Para avaliar os sintomas depressivos utilizou-se o Patient Health Questionnaire (PHQ-9) com dois métodos de pontuação: o algoritmo e o ponto de corte ≥10. As variáveis incluíram características sociodemográficas. Utilizou-se a regressão de Poisson para obter razões de prevalência, com intervalo de confiança de 95% (IC95%). A triagem positiva para depressão foi de 10,8% (IC95%: 10,4-11,0), no ponto de corte ≥10 e 5,7% (IC95%: 5,4-6,0) para o algoritmo. Houve diferenças significativas na prevalência entre alguns estados brasileiros. Análises multivariadas mostraram que ser do sexo feminino, negro, ter menos de 70 anos, ter baixa escolaridade, ser solteiro e residir em área urbana estiveram independentemente associados a sintomas depressivos. A maior associação foi encontrada nos estados de Sergipe, Goiás, Piauí, Espírito Santo, São Paulo, Alagoas e a menor no Pará, Mato Grosso e Maranhão. A prevalência de triagem positiva para depressão no Brasil tem aumentado nos últimos anos. É necessário mais investimento em saúde mental e pesquisas como a PNS devem ser feitas continuamente.

Application analysis of the 9-item Patient Health Questionnaire in adolescents / 四川精神卫生

ObjectiveTo investigate the measurement invariance and the score distribution characters of the 9-item Patient Health Questionnaire （PHQ-9）， and to test its feasibility in comparing depression among adolescents of different sexes and ages. MethodsFrom September 2018 to May 2019， 12 241 adolescents aged 10 to 19 years old across 22 primary and secondary schools in Hangzhou were included based on cluster sampling method， and they were investigated by PHQ-9. The measurement invariance was tested by multi-group confirmatory factor analysis. Poisson regression analysis and Logistic regression analysis were adopted to explore the score distribution of PHQ-9 by sex and age. ResultsThe configural， metric， scalar and strict invariances （χ2=2 492.527， df=79， P<0.01， RMSEA=0.071， SRMR=0.031， CFI=0.942， TLI=0.947， ΔCFI=0.004， ΔTLI=0.002 compared with the scalar model） of PHQ-9 across sex were all acceptable， and the configural， metric and scalar invariances （χ2=3 311.991， df=414， P<0.01， RMSEA=0.076， SRMR=0.055， CFI=0.928， TLI=0.937， ΔCFI=0.010， ΔTLI=0.002 compared with the metric model） across age were acceptable. The detection rate of mild depressive symptoms in girls was higher than that in boys （52.99% vs. 46.65%， χ2=48.344， P<0.01）. The PHQ-9 total scores of girls aged 13 to 17 were higher than those of boys （D=0.092~0.144， P<0.01）. There was an interaction between sex and age （χ2=32.800， df=1， P<0.01， OR=0.895）. Except low self-evaluation and suicide or self-injury， the detection rate of assessed symptom on each item of girls was higher than that of boys （P<0.05）. ConclusionIt is discovered that PHQ-9 has measurement equivalence across sex and age in adolescents， and girls and older adolescents scored higher in PHQ-9.

A study on Depression using PHQ9 among Patients Attending Outpatient Department of a Tertiary Care Leprosy Hospital in the City of Kolkata, West Bengal

The consequences of leprosy are often disability and impairments. The physical health ramifications that are evident in the studies, as well as the stigma attached to the disease have implications for a person’s mental health. Depression, among other mental health issues, are frequent among persons with leprosy. This study aims to assess the burden of depression among patients suffering from the consequences of Leprosy (Disability) and its association with demographic and clinical factors. The study was conducted in the Premananda Memorial Leprosy Hospital in Kolkata, West Bengal. During the period of study, 99 consecutive patients aged 18 years and above attending the outpatient clinic were assessed for depression using Patient Health Questionnaire-9 (PHQ-9). The questionnaires were administered in the patient’s language, either in Bengali or Hindi.PHQ-9 is a validated tool to screen for depression that carries nine questions, each with a score of 3. The clinician had administered the questionnaire. Descriptive statistics were used to report the findings, and multivariate linear regression was applied to study the association between depression and other factors. The burden of depression among these 99 leprosy patients attending Tertiary Care Hospital as screened with the PHQ9 was about 53.5%. People with grade 1 and grade 2 disabilities had 2.6% and 5.6% more chances of developing signs of mental ill-health than those without any disability.The duration of disease and levels of disability wereobserved tohave a strong positive relation with depression among persons with leprosy. There is a need for effective counselling services at Tertiary care centres for reducing the psychosocial consequences.

Impacto de la presencia de depresión y ansiedad en pacientes con artritis psoriásica / Impact of depression and anxiety in patients with psoriatic arthritis

Introducción: un tercio de los pacientes con artritis psoriásica (APs) sufre ansiedad y/o depresión, lo que podría impactar negativamente en la actividad de la enfermedad. Los objetivos de este estudio fueron: evaluar la prevalencia de depresión y ansiedad en pacientes con APs, estudiar su asociación con diferentes factores sociodemográficos y clínicos, y determinar el efecto sobre los diferentes componentes de los índices compuestos de la actividad de la APs. Materiales y métodos: se incluyeron pacientes con APs que cumplían criterios de la Classification criteria of psoriatic arthritis (CASPAR). La depresión se definió según el Patient Health Questionnaire-9 (PHQ-9) y la ansiedad según el cuestionario General Anxiety Disorder-7 (GAD-7). Se realizó regresión logística múltiple para identificar variables asociadas a ansiedad y depresión. Resultados: se incluyeron 100 pacientes con APs, de los cuales el 26% y el 59% presentaron depresión mayor y ansiedad respectivamente. Los pacientes con depresión mayor tuvieron mayor actividad de la enfermedad, dolor, fatiga, ansiedad, y menor educación formal y peor calidad de vida. Aquellos con ansiedad manifestaron mayor actividad de la enfermedad, dolor y fatiga, y peor calidad de vida y capacidad funcional. La alta actividad de la enfermedad y la menor educación formal se asociaron independientemente con depresión mayor. Conclusiones: la presencia de depresión mayor y ansiedad se asoció con mayor actividad de la enfermedad en pacientes con APs.

Introduction: nearly one-third of psoriatic arthritis (PsA) patients suffer from anxiety and/or depression. The objectives of this study were to estimate the prevalence of depression and anxiety in patients with PsA, establish the relationship with different socio-demographic and clinical factors, and determine the effect of depression and anxiety on various components of disease activity scores. Materials and methods: patients with PsA who met the Classification criteria of psoriatic arthritis (CASPAR) criteria were included. Depression was defined according to the Patient Health Questionnaire-9 (PHQ-9) and anxiety according to the General Anxiety Disorder-7 (GAD-7) questionnaire. Multiple logistic regression was performed to identify variables associated with anxiety and depression. Results: 100 patients were included. The prevalence of major depression and anxiety was 26% and 59%, respectively. Patients with major depression had higher disease activity, pain, fatigue and anxiety, less formal education and worse quality of life. In comparison those patients with anxiety showed higher disease activity, pain and fatigue and worse quality of life and functional capacity. High disease activity and low formal education were independently associated with the existence of major depression. Conclusions: patients with PsA who suffer from major depression and anxiety show higher disease activity levels.

Psychometric properties of the Spanish version of the Patient Health Questionnaire-9 in users of the Ecuadorian public health care system

Introduction: Depression is one of the most prevalent public health problems worldwide and remains an underdiagnosed disease, especially in developing countries. The availability of instruments that permit detecting this problem is essential for reducing the burden of this disorder. The aim of this study was to examine the psychometric properties (factor structure, sex invariance, internal consistency, and convergent and divergent validity) of the Spanish version of the PHQ-9 (Patient Health Questionnaire-9). Method: A sample of 366 public hospital users in Ecuador was recruited and accordingly completed a survey that included sociodemographic data, the PHQ-9, and other standards of measurement such as the Beck Depression Inventory-II (BDI-II), the Generalised Anxiety Disorder Scale (GAD-7), the Positive and Negative Affect Scale (PANAS), and the Quality-of-Life Index (QLI). Results: The unidimensional factor model of the PHQ-9 provided the best fit for the data. The PHQ-9 assesses depressive symptoms equivalently in both sexes, and presents high internal consistency, as well as good convergent and divergent validity with the other constructs. Conclusion: The application of the PHQ-9 could aid in the screening of patients with depressive symptomatology in the Ecuadorian public health system (EPHS).

Introducción: La depresión es uno de los problemas de salud pública más prevalentes a nivel mundial, y suele ser subdiagnosticada especialmente en países en vías de desarrollo. Contar con instrumentos que permitan realizar un cribado de este problema es fundamental para reducir el costo de este trastorno. El objetivo de este artículo fue examinar las propiedades psicométricas (estructura factorial, invarianza en función del sexo, consistencia interna, validez convergente y divergente) de la versión española del PHQ-9 (Patient Health Questionnaire-9). Método: Se reclutó una muestra de 366 usuarios de un hospital público en Ecuador, los cuales respondieron una encuesta que incluía datos sociodemográficos, el PHQ-9, el inventario de depresión de Beck-II (BDI-II), la Escala de Trastorno de Ansiedad Generalizada-7 (GAD-7), la Escala de Afecto Positivo y Negativo (PANAS), y el índice de calidad de vida (QLI). Resultados: El modelo unidimensional del PHQ-9 proporcionó mejor ajuste de los datos. El PHQ-9 evalúa síntomas depresivos de forma equivalente en ambos sexos y presenta una elevada consistencia interna, así como una buena validez convergente y divergente con el resto de los constructos. Conclusión: La administración del PHQ-9 podría apoyar el cribado de pacientes con sintomatología depresiva en el sistema público de salud ecuatoriano (SSPE).

Validez del Cuestionario de salud del paciente-9 (PHQ-9) para cribado de depresión en adultos usuarios de Atención Primaria en Bucaramanga, Colombia / Validity of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adult primary care users in Bucaramanga, Colombia

RESUMEN El Cuestionario de salud del paciente-9 (PHQ-9) es uno de los instrumentos de autoinforme más utilizado en Atención Primaria (AP). No existe validez de criterio del PHQ-9 en Colombia. El objetivo fue realizar la validez de criterio del PHQ-9 como instrumento de cribado en AP. Se realizó un estudio trasversal de validez de criterio de una escala usando como criterio de referencia la minientrevista neuropsiquiátrica (MINI) en usuarios adultos de centros de AP de ambos sexos. Se calcularon la consistencia interna y la validez convergente y de criterio del PHQ-9 mediante el análisis de las características operativas del receptor (COR) y el área bajo la curva (ABC). Participaron 243 pacientes, 184 (75,7%) fueron de sexo femenino. El promedio de edad fue 34,05 (mediana 31 y DE = 12,47). El α de Cronbach fue 0,80 y ω de McDonald, 0,81. La rho de Spearman fue 0,64 para HADS-D (p < 0,010) y 0,70 para PHQ-2 (p < 0,010). El ABC fue 0,92 (IC del 95%, 0,880-0,963). El punto de corte óptimo del PHQ-9 fue ≥ 7: sensibilidad de 90,38 (IC del 95%: 81,41-99,36); especificidad de 81,68 (IC del 95%: 75,93-87,42); el VPP 57,32 (IC del 95%: 46,00-68,63); el VPN 96,89 (IC del 95%: 93,90-99,88); índice de Youden 0,72 (IC del 95%: 0,62-0,82; LR+ 4,93 (IC del 95%: 3,61-6,74); LR- 0,12 (IC del 95%: 0,005-0,270). En conclusión, la versión colombiana del PHQ-9 es un instrumento válido y confiable para el cribado de depresión en AP de Bucaramanga, con un punto de corte ≥ 7.

ABSTRACT The patient health questionnaire-9 (PHQ-9) is one of the most widely used self-report instruments in primary care. There is no criterion validity of the PHQ-9 in Colombia. The objective was to validate the PHQ-9 as a screening tool in primary care. A cross-sectional, scale criterion validity study was performed using as reference criterion the mini neuropsychiatric interview (MINI) in male and female adult users of primary care centres. We calculated the internal consistency and convergent and criterion validity of the PHQ-9 by analysing the receiver operating characteristics (ROC) and the area under the curve (AUC). We analysed 243 participants; 184 (75.7%) were female. The average age was 34.05 (median of 31 and SD = 12.47). Cronbach's α was 0.80 and McDonald's ω was 0.81. Spearman's Rho was 0.64 for HADS-D (P <0.010) and 0.70 for PHQ-2 (P <0.010). The AUC was 0.92 (95% CI 0.880-0.963). The optimal cut-off point of PHQ-9 was ≥7: sensitivity of 90.38 (95% CI: 81.41-99.36); specificity of 81.68 (95% CI: 75.93-87.42); PPV 57.32 (95% CI: 46.00-68.63); NPV 96.89 (95% CI: 93.90-99.88); Youden index 0.72 (95% CI: 0.62-0.82); LR+ 4.93 (95% CI: 3.61-6.74); LR- 0.12 (95% CI: 0.005-0.270). In sum, the Colombian version of PHQ-9 is a valid and reliable instrument for depression screening in primary care in Bucaramanga, with a cut-off point ≥ 7.

Efecto de la pandemia por COVID-19 en la salud mental de los otorrinolaringólogos en Hispanoamérica / COVID-19 pandemic effects on otolaryngologist's mental health in Hispanoamerica

Introducción: la pandemia puede generar compromiso en la salud mental y los otorrinolaringólogos son los especialistas con mayor riesgo de exposición y contagio por SARS-CoV-2. Materiales y métodos: estudio de corte transversal en otorrinolaringólogos de Hispanoamérica, donde se evaluaron variables socioeconómico/demográficas y su asociación con las escalas PHQ-9 y GAD-7. Resultados: se estudiaron 256 otorrinolaringólogos de dieciséis países de Hispanoamérica. La escala PHQ-9 presentó una media de 5,45 (DE 4,22). La escala GAD-7 presentó una media de 4,55 (DE 3,457). La prevalencia de depresión mayor y ansiedad fue del 14,8 % y 7 %, respectivamente. En el análisis multivariado, los otorrinolaringólogos a los que se les ha realizado prueba con hisopado nasofaríngeo tienen una predicción significativa para presentar una puntuación alta en la escala PHQ-9 (coeficiente ß = 2,350; p=0.027). En la puntuación de la escala GAD-7, los individuos con mayor edad tienen una predicción significativa de menor puntuación en la escala (coeficiente ß = -0,144; p=0,002). Los otorrinolaringólogos con más años de experiencia (coeficiente ß = 0,909; p=0,037) y aquellos a los que les han realizado prueba de RT-PCR con hisopado nasofaríngeo para SARS-CoV-2 tienen una predicción significativa para presentar una puntuación alta en la escala GAD-7 (coeficiente ß = 2,370; p=0,027). Conclusión: en el transcurso de la pandemia, los otorrinolaringólogos de Hispanoamérica han presentado cambios drásticos de sus condiciones sociales y económicas y experimentado sus potenciales efectos en la salud mental. La exposición a al hisopado nasofaríngeo para el diagnóstico de COVID-19 fue la única variable independiente que se asoció con aumento de las puntuaciones en las escalas GAD-7 y PHQ-9.

Introduction: The COVID-19 pandemic could affect the mental health, especially to the health workforce directly exposed to the virus. ENT surgeons have one of the highest risks of exposure and infection by SARS-CoV-2. Methods: Cross-sectional study in otolaryngologists from Hispanoamerica. Socioeconomic and demographic variables were evaluated with the PHQ-9 and GAD-7 score. Results: 256 ENT surgeons from sixteen Hispanoamerican countries were studied. The PHQ-9 scale presented an average of 5.45 (SD 4.22). The GAD-7 score presented an average of 4.55 (SD 3.457). The prevalence of major depression and generalized anxiety disorders were 14.8 % and 7 %, respectively. In the multivariate analysis, the otolaryngologists who have been tested by nasopharyngeal swab have a significant prediction to present a higher score on the PHQ-9 score (coefficient ß = 2.350, p=0.027), while on the GAD-7 score, older individuals have a significant prediction of lower score (coefficient ß = -0.144, p=0.002). Otolaryngologists with more years of experience (coefficient ß = 0.909, p=0.037) and those who have undergone RT-PCR testing with nasopharyngeal swab have a significant prediction to present a higher GAD-7 (coefficient ß = 2.370, p = 0.027). Conclusion: During the pandemic, otolaryngologists in Hispanoamerica have presented drastic changes in their social and economic conditions, and their potential effects on mental health. Exposure to the nasopharyngeal swab test for the diagnosis of COVID-19 was the only independent variable that was associated with higher scores on GAD-7 and PHQ-9.

Relação entre diabetes e sintomas depressivos / Relationship between diabetes and depressive symptoms

O diabete é das doenças crônicas mais recorrentes a nível mundial, e está relacionada com diversas comorbidades, dentre elas a depressão. Este estudo teve por objetivo correlacionar essa doença com transtornos depressivos. Foi realizado estudo transversal e prospectivo com 100 pacientes selecionados. A coleta de dados foi feita por aplicação de 3 questionários: um sobre o perfil socioeconômico do entrevistado; outro, sobre o tempo, tipo do diabete, tratamento e complicações; e um terceiro com 9 perguntas que avaliaram a presença de sintomas para episódio de depressão maior. Em conclusão, mostrou-se que 48% dos pacientes não apresentaram sintomas depressivos; 21% sintomas leves; 12% moderados; 9% moderadamente severo e 10% graves. Assim, foi possível verificar importante associação entre sintomas depressivos e portadores de diabete.

Diabetes is one of the most recurrent chronic diseases worldwide, and is related to several comorbidities, including depression. This study aimed to correlate this disease with depressive disorders. A cross-sectional and prospective study was carried out with 100 selected patients. Data collection was carried out by applying 3 questionnaires: one about the interviewee's socioeconomic profile; another, about time, type of diabetes, treatment and complications; and a third with 9 questions that assessed the presence of symptoms for a major depressive episode. In conclusion, it was shown that 48% of the patients did not present depressive symptoms; 21% mild symptoms; 12% moderate; 9% moderately severe and 10% severe. Thus, it was possible to verify an important association between depressive symptoms and patients with diabetes.

Sintomas depressivos e fatores associados em puérperas de um hospital-escola em Cuiabá/MT / Depressive symptoms and associated factors in postpartum women at a teaching hospital in Cuiabá/MT

A Depressão Pós-Parto (DPP) é um problema de saúde pública mundial. Os fatores de risco para seu desenvolvimento podem variar considerando-se aspectos psicossociais. Este estudo objetivou identificar sintomas depressivos e fatores associados em puérperas no Hospital Universitário Júlio Muller (HUJM), na cidade de Cuiabá - MT. Participaram 30 puérperas, entre 18 anos e 39 anos (M= 26,96 anos). Como instrumentos foram utilizados entrevista semiestruturada e questionário PHQ-9. Os dados foram analisados por meio de estatística descritiva e do modelo de regressão linear simples (Teste F), que correlacionou dados da entrevista e escores do PHQ-9. Como resultados, constatou-se que a maioria eram multíparas, com baixa escolaridade e em relacionamento estável. Apresentaram sinais de risco para o desenvolvimento da DPP metade das participantes, sendo o estresse gestacional o principal fator associado. Os resultados evidenciam a importância da identificação precoce dos sintomas depressivos e ressaltam a importância da avaliação psicológica para tal identificação na área da saúde.

Postpartum depression (PPD) is a worldwide public health problem. The risk factors for its development can vary considering psychosocial aspects. This study aimed to identify depressive symptoms and associated factors in puerperal women at the Júlio Muller University Hospital (HUJM), in the city of Cuiabá - MT. 30 puerperal women participated, between 18 years and 39 years (M = 26.96 years). As instruments, semi-structured interviews and a PHQ-9 questionnaire were used. The data were analyzed using descriptive statistics and the simple linear regression model (Test F), which correlated interview data and PHQ-9 scores. As a result, it was found that the majority were multiparous, with low education and in a stable relationship. Half of the participants showed signs of risk for the development of PPD, with gestational stress being the main associated factor. The results show the importance of early identification of depressive symptoms and emphasize the importance of psychological assessment for such identification in the health area.

Autonomic Dysregulation And Low Heart Rate Variability In Spinal Cord Injury (SCI): A Marker For Depression

Background: Spinal cord injury (SCI) results in physical, autonomic, and psychological consequences. Depression is among one the most common psychological effects of SCI, with an incidence of 22%. Depression is associated with reduced heart rate variability (HRV), but it remains unclear if autonomic dysregulation possesses depression risk in SCI. Thus, this study aims to explore the association between HRV and depression in SCI. Methodology: Ninety-one spinal cord injured patients (eighty-eight males and three female) representing three levels of severity of injury (cervical, high thoracic, and low thoracic) were recruited. Basal/resting HRV was assessed using 1000Hz Polar Heart rate monitor RS800 CX and Kubios HRV software. PHQ-9 assessed the depression; a cut of 10 was used to divide the sample into patients with probable Major Depressive Disorder (MDD) and non-MDD. Results: Non-parametric tests for between-group comparisons showed a significant difference in HRV variables (p<0.05) between the probable MDD and non-MDD SCI. Significant differences in HRV were observed between the low and high thoracic (p<0.05) and low thoracic and cervical group (p<0.05), suggesting that the functioning of the autonomic nervous system might differ with level of SCI. Conclusion: Depression in SCI has been associated with injury-related factors; we use the neurovisceral theory to explain the role of the autonomic nervous system in depression in SCI.

Prevalence and risk factors for depression among antenatal women during third trimester of pregnancy in a tertiary care centre

Background: With the rising incidence of Maternal deaths due to suicide as evident from reports of Kerala state confidential review of maternal deaths, there is a felt need for screening for depression in study antenatal population. Though there have been various screening tools used, a simplified tool validated in study population was not used in study antenatal women till now. The objective of this study was to estimate the prevalence of depression among antenatal women admitted in the department of obstetrics and gynecology, Government Medical College, Thrissur and also to study the risk factors associated with depression in the study population.Methods: A questionnaire based cross sectional observational study was conducted among 100 antenatal women in their third trimester. PHQ-9 questionnaire was used to screen for depression and the information regarding risk factors was collected from the patient, her caregivers and from clinical records. Data analysis was done using EPI-INFO/SPSS software.Results: Prevalence of depression among hospitalized mothers: 53%. Most cases (70%) had: mild depression (PHQ Score: 5-9). Only very few (2%) of them had severe depression (PHQ score: more than 20). 9% had: moderately severe depression (PHQ score: 15-19). 19% had: moderate depression (PHQ score: 10-14). Statistically significant risk factors identified in this study were fetal gender preference, anxiety about labour process, anxiety about labour pain, anxiety about making the baby a part of their life and anxiety about baby’s health.Conclusions: The prevalence of depression among hospitalized mothers using PHQ-9 scale is high (53%). Screening for depression was found to be feasible and can be made a part of routine antenatal care so that appropriate interventions can be provided to improve maternal mental health and thereby prevent the maternal mortality occurring due to suicides.

Incidence of depression in patients with hepatitis C treated with direct-acting antivirals

Objective: Depression has been associated with hepatitis C, as well as with its treatment with proinflammatory cytokines (i.e., interferon). The new direct-acting antiviral agents (DAAs) have minimal adverse effects and high potency, with a direct inhibitory effect on non-structural viral proteins. We studied the incidence and associated factors of depression in a real-life prospective cohort of chronic hepatitis C patients treated with the new DAAs. Methods: The sample was recruited from a cohort of 91 patients with hepatitis C, of both sexes, with advanced level of fibrosis and no HIV coinfection, consecutively enrolled during a 6-month period for DAA treatment; those euthymic at baseline (n=54) were selected. All were evaluated through the depression module of the Patient Health Questionnaire (PHQ-9-DSM-IV), at three time points: baseline, 4 weeks, and end-of-treatment. Results: The cumulative incidence (95%CI) of major depression and any depressive disorder during DAA treatment was 13% (6.4-24.4) and 46.3% (33.7-59.4), respectively. No differences were observed between those patients with and without cirrhosis or ribavirin treatment (p > 0.05). Risk factors for incident major depression during DAA treatment included family depression (relative risk 9.1 [1.62-51.1]), substance use disorder (11.0 [1.7-73.5]), and baseline PHQ-9 score (2.1 [1.1-3.1]). Conclusions: The findings of this study highlight the importance of screening for new depression among patients receiving new DAAs, and identify potential associated risk factors.

Efficacy and Safety of Modified Chaihu Jia Longgu Muli Tang in Treating Mild to Moderate Essential Hypertension Complicated with Depression and Liver-Yang Hyperactivity Syndrome / 中国实验方剂学杂志

Objective:To observe the clinical efficacy and safety of modified Chaihu Jia Longgu Muli Tang in treating mild to moderate essential hypertension complicated with depression and liver-Yang hyperactivity syndrome.Method:Totally 121 mild to moderate hypertensive patients complicated with depression in line with the inclusive criteria were randomized into treatment group and control group. All of the enrolled patients in treatment group and control group were treated with conventional therapy. In treatment group, patients were given modified Chaihu Jia Longgu Muli Tang, one dose per day. The treatment course lasted for 4 weeks. Blood pressure, patient health questionnaire-9 (PHQ-9) score, score of traditional Chinese medicine syndrome, C-reactive protein (CRP), endothelial-dependent vasodilation, and adverse effect were observed in this study.Result:Both systolic blood pressure and diastolic blood pressure were significantly lowered when compared to control group (P<0.05). PHQ-9 score was significantly improved in treatment group (P<0.05). The score of traditional Chinese medicine syndrome was significantly improved in treatment group compared to control group (P<0.05). CRP was significantly improved in treatment group compared with control group (P<0.05). Endothelial-dependent vasodilation was significantly improved in treatment group compared with control group (P<0.05). No severe adverse effect was observed in this research.Conclusion:Chaihu Jia Longgu Muli Tang has a creation clinical efficacy in the treatment of mild to moderate essential hypertension with depression. In addition to the effect in reducing both systolic and diastolic blood pressure, modified Chaihu Jia Longgu Muli Tang was also effective in improving depression, traditional Chinese medicine syndrome and endothelial-dependent vasodilation, and reducing the level of CRP with little adverse effect.

Depresión del adulto mayor peruano y variables sociodemográficas asociadas: análisis de endes 2017 / Depression of the peruvian elderly adult and associated sociodemographical variables, analysis of endes 2017

Objetivo: Determinar las variables sociodemográficas asociadas a la depresión en el adulto mayor peruano a partir de la información obtenida mediante la Encuesta Demográfica y de Salud Familiar (ENDES) del año 2017 realizada por el Instituto Nacional de Estadística e Informática (INEI). Métodos: Estudio observacional, correlacional y de corte transversal que usó una muestra probabilística de 4917 adultos mayores (60 años a más). Para la determinación de depresión en la población se usó como instrumento el Patient Health Questionnaire (PHQ) de 9 preguntas, incluido en el cuestionario de salud en la sección de salud mental del ENDES 2017. Resultados: La prevalencia de depresión en el adulto mayor peruano en el año 2017 fue de 14,2%. Como variables sociodemográficas asociadas a la depresión fueron el sexo femenino [ORaj 1,995 (1,684 -2,364)]; carecer de instrucción [ORaj 2,524 (2,126 - 2,996)]; la edad mayor de 75 años [ORaj 1,763 (1,494 - 2,080)]; vivir en una zona rural [ORaj 1,410 (1,198 -1,659)]; y ser pobre [ORaj 1,456 (1,229 - 1,724)]. No hubo asociación entre depresión y discapacidad (p=0,704). [ORaj 1,103 (0,663 - 1,835)]. Conclusión: La prevalencia de depresión en el adulto mayor peruano es alta. Las variables sociodemográficas que estuvieron asociadas como factores de riesgo para el desarrollo de depresión en el adulto mayor fueron de sexo femenino, el carecer de instrucción, edad mayor de 75 años, vivir en zona rural y ser pobre.

Objective: To determine the sociodemographic variables associated with depression in the elderly of Peru based on the information obtained through the Demographic and Family Health Survey (ENDES) of the year 2017 carried out by the National Institute of Statistics and Informatics (INEI). Methods: An observational, correlational and cross-sectional study that used a probabilistic sample of 4917 older adults (60 years and over). For the determination of depression in the population, the Patient Health Questionnaire (PHQ) of 9 questions included in the health questionnaire in the mental health section of ENDES 2017 was used as an instrument. Results: The prevalence of depression in the Peruvian elderly in 2017 was 14.2%. As sociodemographic variables associated with depression were the female sex [OR 1.995 (1.684 -2.364)]; lack instruction [ORaj 2.524 (2.126-2996)]; the age over 75 years [ORaj 1.763 (1.494 2.080)]; live in a rural area [ORaj 1.410 (1.198 -1.659)]; and be poor [ORaj 1.456 (1.229 - 1.724)]. It was not associated with disability (p = 0.704). [ORaj 1.103 (0.663-1835)]. Conclusion: It was concluded that the prevalence of depression in the Peruvian adult is high. Among the sociodemographic variables that were identified as risk factors for presenting depression were female sex, lacking education, age over 75, living in rural areas and being poor.

Depression and its predictors among people living with HIV/AIDS on antiretroviral therapy

Background: HIV infection is one of the raising public health problems. HIV diagnosis is usually associated with stigma and often results in mental illness among the people infected. Depression is the most common mental illness in HIV patients as found by various studies. Hence the present study aimed to determine the proportion of depression and its socio-demographic and clinical predictors among people living with HIV/AIDS (PLHA).Methods: A hospital based cross sectional study was done among 322 PLHA on Antiretroviral therapy attending ART centre at GIMS Teaching Hospital, Gadag. After taking written informed consent from the patients, a predesigned proforma which included socio-demographic variables, clinical details, and CD-4 count, along with patient health questionnaire (PHQ) 9 was administered to assess depression in PLHA.Results: Out of the 322 people living with HIV/AIDS, 108 (33.5%) had depressed. According to PHQ 9 questionnaire, 19.9% had mild depression, 10.6% moderate depression and 3.1% had moderate severe depression. It was noted that 40.3% of females had depression compared to 24.8% of males. PHLA who were on ART for less than one year had higher proportion of depression (61.1%) compared to those with 5 years duration of ART (28.6%) and it was statistically significant.Conclusions: In the study 33.5% of PHLA had depression. Socio-economic status, gender, duration of ART had significant association with depression whereas age, education, place of residence, CD4 count were not associated with depression. Depression screening among PHLA can be done at regular follows ups at ART centres.

Assessment of depression and its correlates among college students in Rishikesh Uttarakhand

Background: Depression is a major contributor to the overall global burden of disease and is the leading cause of disability worldwide. Objective: To assess the levels of depression and its correlate among college students in Rishikesh, Uttarakhand. Methodology: Community based cross sectional study was conducted from February 2018 to April 2018 among 126 students of a Government PG College Rishikesh belonging to age 18 -26 years. A pre-validated semi- structured pretested Physical Health Questionnaire (PHQ-9) was applied for this purpose. Results: Mean age of the participants was 22.84±1.5 years. Overall prevalence of depression among study population was 74.60% among them 4% were severely depressed. 58% of females and 40% males had suicidal ideations. Majority of participants were stressed with the undue peer pressure followed by career pressure. Physical activity for atleast 30 minutes a day for 5 days in a week was found to be significantly (p<0.02, odds ratio 0.20 (0.06-0.7 at 95%CI) beneficial for depression. Conclusion: Depression is prevalent among college going population. Peer pressure, academic stress, career pressure, financial stress in home, undue parental expectations on students are associated with depression among college going students.

La depresión es un determinante mayor de la capacidad funcional en pacientes con artritis reumatoidea, independientemente de la actividad de la enfermedad / Depression is a major driver of functional capacity in patients with rheumatoid arthritis regardless of disease activity

La depresión es una de las comorbilidades más frecuentemente reportadas en pacientes con Artritis Reumatoidea (AR). Su presencia se asocia a mayores costos de salud, mayor mortalidad y reduce las probabilidades de alcanzar una buena respuesta al tratamiento. Objetivo: Evaluar la prevalencia de depresión en pacientes argentinos con AR y establecer su relación con diferentes factores sociodemográficos y clínicos. Material y métodos: Se incluyeron pacientes ≥18 años de edad, con diagnóstico de AR según criterios ACR-EULAR 2010. Se consignaron datos sociodemográficos, comorbilidades, características clínicas, actividad de la enfermedad y tratamiento actual. Se administraron los cuestionarios EQ-5D-3L, QOL-RA, HAQ-A y PHQ-9. Los valores de PHQ-9 de 5-9, 10-14, 15-19 y ≥20 determinan la presencia de depresión leve, moderada, moderada/severa y severa, respectivamente y un valor de corte ≥10, depresión mayor. Análisis estadístico: Test T de Student, ANOVA y Chi². Regresión lineal múltiple. Resultados: Se incluyeron 258 pacientes, con un tiempo mediano (m) de evolución de la enfermedad de 9 años (RIC 3,6-16,7). La m de depresión valorada por PHQ-9 de 6 (RIC 2-12,5). La prevalencia de depresión mayor fue de 33,8%. Sesenta y seis (25,6%), 42 (16,3%), 27 (10,5%) y 18 (7%) pacientes presentaron depresión leve, moderada, moderada/severa y severa, respectivamente. Los pacientes con depresión mayor mostraron menor capacidad funcional (HAQ-A X1,6±0,8 vs X0,7±0,7, p <0,0001), peor calidad de vida (QOL-RA X5,4±1,8 vs X7,3±1,6, p <0,0001), más dolor (EVN X56,2±27,5 mm vs X33,4±25,7 mm, p <0,0001), mayor actividad de la enfermedad (DAS28-ERS X4,3±1,4 vs X3,3±1,3, p <0,0001), mayor frecuencia de desempleo (71% vs 29%, p=0,015 ) y de comorbilidades (67% vs 33%, p=0,017) y menor frecuencia de actividad física (22% vs 35%, p=0,032). En el análisis multivariado, peor capacidad funcional (OR: 2,1, IC 95%: 1,6-4,3, p <0,0001) y calidad de vida (OR: 0,7, IC 95%: 0,5-0,8, p <0,0001) se asociaron independientemente a la presencia de depresión mayor. Conclusiones: La prevalencia de depresión mayor medida por PHQ-9 en esta cohorte argentina de pacientes con AR fue de 33,8%. La presencia de depresión tiene un impacto negativo sobre la capacidad funcional y la calidad de vida de estos pacientes, independientemente de la actividad de la enfermedad.

Depression is one of the most frequent comorbidity in patients with Rheumatoid Arthritis (RA). It's presence is associated with higher healthcare costs, mortality rate and reduced odds of achieving a good treatment response. Objective: To determine the prevalence of depression in Argentinean patients with RA and to establish its relationship with different sociodemographic and clinical factors. Material and methods: Consecutive patients ≥18 years old, with a diagnosis of RA according to ACR-EULAR 2010 criteria were included. Sociodemographic data, comorbidities, RA characteristics, disease activity and current treatment were registered. Questionnaires were administered: EQ-5D-3L, QOL-RA, HAQ-A and PHQ-9. PHQ-9 scores of 5-9, 10-14, 15-19, ≥20 represent mild, moderate, moderate/severe and severe depression, respectively and a cut-off value ≥10, major depression. Statistical analysis: Student's T, ANOVA and Chi² tests. Multiple logistic regression. Results: 258 patients were included, with a median (m) disease duration of 9 years (IQR 3.6-16.7). The m PHQ-9 score was 6 (IQR 2-12.3). The prevalence of major depression was 33.8%. 66 (25.6%), 42 (16.3%), 27 (10.5%) and 18 (7%) patients presented mild, moderate, moderate/severe and severe depression, respectively. Patients with mayor depression had worse functional capacity (HAQ-A X 1.6±0.8 vs X 0.7±0.7, p <0.0001), poorer quality of life (QOL-RA X 5.4±1.8 vs X 7.3±1.6, p <0.0001), greater pain (NVS X 56.2±27.5 mm vs X 33.4±25.7 mm, p <0.0001), higher disease activity (DAS28-ESR X 4.3±1.4 vs X 3.3±1.3, p <0.0001), higher frequency of unemployment (71% vs 29%, p=0.015 ) and comorbidities (67% vs 33%, p=0.017) and lower frequency of physical activity (22% vs 35%, p=0.032). In the multivariate analysis, patients with moderate and severe depression had worse functional capacity (OR: 2.1, 95% CI: 1.6-4.3, p <0.0001) and quality of life (OR: 0.7, 95% CI: 0.5-0.8, p <0.0001), independently of disease activity. Conclusion: The prevalence of mayor depression in this Argentinean cohort of patients with RA was 33.8%. The presence of depression had a negative impact on functional capacity and quality of life regardless of disease activity.

A cross sectional study of depression during pregnancy and its risk factors among pregnant women attending a tertiary care hospital in Puducherry, India

Background: Depression during pregnancy is a recognized global health issue which can lead to wide range of maternal and neonatal complications to extremes like maternal suicide to infanticide. This study was done to estimate the magnitude of depression during pregnancy and its risk factors among pregnant women attending a tertiary care hospital in Puducherry.Methods: A descriptive cross sectional study was done among 220 pregnant women attending routine antenatal checkup in outpatient department of a tertiary care hospital in Puducherry, using a systematic random sampling technique. A semi structured questionnaire using Patient Health Questionnaire-9 was used to screen the mothers for antenatal depression.Results: 220 pregnant women were evaluated for antenatal depression. Mean age of the study participants was 25.02±3.13 years. Using PHQ-9 authors found that 19.5% pregnant women were having risk for antenatal depression, of which the mild, moderate and moderately severe levels of depression were 16.4%, 1.4% and 1.8% respectively. The risk of antenatal depression was statistically significant among the women age more than 30 years, husband’s educational status as higher secondary and below, residence in rural area, multigravida, having a male child, strained relationship, no support during pregnancy and pressure for a male child. Logistic regression analysis revealed age ≥30 years (aOR 3.03, 95% CI 1.04-8.82), and no support during pregnancy (aOR 3.30, 95% CI 1.10-9.90) were the significant factors.Conclusions: Since the risk for antepartum depression is huge in this region, there is a need for screening for antepartum depression as a routine antenatal checkup in the out patient department. Reinforcing the importance of appropriate for conception and support for the mother during pregnancy plays a vital role in reducing the magnitude of this depression.

Prevalence of Depression and its Associated Factors among Jordanian Diabetic Foot Patients

Background: Diabetes mellitus is widespread metabolic disorders with long-term complications, which include significant psychosocial dysfunctions such as depression and physiological dysfunctions such as diabetic foot (DF). Related to diabetic studies in general, the prevalence of depression is high and causes deterioration in health related outcomes and quality of life, whereas the studies about depression and diabetic foot in specific are meager and insufficient. Purposes: The purposes of this study were to assess the prevalence of depression, to identify factors associated with depression, and to identify the rate of unscreened depression among diabetic foot patients. Methods: The design of this study is cross-sectional. A convenience sampling of 216 diabetic foot patients was recruited from diabetic clinics of government hospitals in Jordan during the period from January 2016 to March 2016. Data was collected using a structured self-report questionnaire which consisted of 2 sections including socio-demographic questions with one self-reported question, and Patient Health Questionnaire-9 (PHQ-9) scale to assess depression. Results: The current study showed that 179 diabetic foot patients (82.9%) had depression according to PHQ-9 scale with different levels of depression, namely, mild, moderate, moderately severe, and severe that consist 25%, 25.5%, 18.5%, and 13.9% of the total sample respectively. Multiple linear regression showed that the availability of social support by the family and being a nurse as main healthcare provider were associated with low depression scores among DF patients, also high glycated hemoglobin was associated with high depression scores (F=8.923, p=0.001). Conclusion: Prevalence of depression among Jordanian diabetic foot patients and the rate of unscreened depression were high, which indicates an urgent need for thorough assessment of depression level that may help in early detection, treatment, and prevention of depression among diabetic foot patients. Several factors viewed to be associated with depression level that should take into consideration in the diabetic foot care plans.

Prevalence and implications of depression in type-2 diabetes mellitus: a follow up study

Background: There are not many longitudinal or prospective studies to determine the association between Diabetes Mellitus (DM) and depression in Indian scenario. Present study was mainly intended to find out the prevalence of depression in diabetic individuals and its impact on diabetes. The aim of the present endeavour was to study the prevalence of depression in diabetic patients, its impact on the clinical course of diabetes and to study the association between clinical courses of depression and diabetes.Methods: It is a prospective analytical study done in MGMCRI. All diabetic patients, aged 30years and above were taken up. Those who screened positive for depression were further assessed using PHQ9 questionnaire and were subjected to antidepression management. From the total number of diabetic patients screened, the prevalence of depression was calculated. Equal number of T2DM patients who screened negative for psychiatric disorders were taken as control. PHQ-9, FBS, PPBS, HbA1c were measured at baseline and repeated at 3rd month of follow-up.Results: In our study the prevalence of depression among diabetic individuals was found to be 15%. The difference in improvement of HbA1c from baseline to follow up was statistically significant when compared between groups having mild, moderate and severe depression, with maximum fall of HbA1c in the group with severe depression. This implies the positive effect of treating depression on glycemic control.Conclusions: This study shows that when diabetes and depression were addressed together it has a positive effect on the glycemic control and the depressive symptoms emphasizing the need for a collaborative management and need for screening diabetes patients for depression for a better care.