Association between acute critical life events and the speed of onset of depressive episodes in male and female depressed patients.

BACKGROUND: A series of studies indicate that a fast onset of a depressive episode (within 7 days) is a clinical variable useful for indicating bipolarity even when no manic episode has occurred to date. The role of acute critical life events as an external trigger for a fast onset of the depression is unclear so far. Therefore, aim of this investigation was to analyse the effects of acute critical life events on the speed of onset of depressive episodes. METHODS: Speed of onset of depression was assessed using the patient interview "Onset of Depression Inventory". Acute critical life events occurring within the last 6 months before the onset of first depressive symptoms were assessed using the Munich Interview for the Assessment of Life Events and Conditions. RESULTS: 96 of 100 (96.0%) patients had at least one acute critical life event within six months prior to first symptoms of a depressive episode. 22 patients (22.0%) had a fast onset of depression (≤ 7 days). Faster onset of the current depressive episode was significantly associated with a higher number of acute minor life events (ß = - 0.23; p = 0.02), but overall fast onset of a depressive episode was not significantly associated with more acute critical life events in the six months before the onset of the depression. The association between the number of acute critical life events in the half-year period preceding the onset of unipolar depressive disorders and speed of onset for the current depressive episode was neither dependent from gender nor the presence of prior depressive episodes. CONCLUSIONS: Speed of onset of depression is not strongly influenced by external trigger e.g. acute critical life events.

Feasibility of telerehabilitation to address the orientation and mobility needs of individuals with visual impairment: perspectives of current guide dog users.

OBJECTIVE: To assess guide dog users' perspectives on the feasibility of telerehabilitation for their O&M needs. METHOD: An online survey gathered insights from 56 guide dog (GD) users (Mean age = 59, Mean GD used = 4, Mean duration of use = 22 years). Thirteen GD users further participated in interviews or focus groups to explore survey responses. Data were analyzed using content analysis. FINDINGS: Most (40) were blind, and 16 had low vision, with intermediate (25) and advanced (25) communication technology proficiency. Most GD users (46) underwent residential training, and 10 received one-on-one visits. Qualitative analysis revealed acceptance of telerehabilitation services, citing accessibility as an advantage. However, GD users expressed concerns about safety, potential loss of behavioral observation, and social contact loss. Success depended on the type of technology, service type, and personal attributes. CONCLUSION: While feasible, telerehabilitation services may not be universally suitable for all training stages. Flexibility and applicability in service design are necessary to accommodate individual preferences and experience levels.

Telerehabilitation of Orientation & Mobility (O&M) services for individuals that are blind or have low vision potentially offers a hybrid service delivery mode, reducing wait time and travel costs.A remote O&M service offer could allow rehabilitation professionals to provide services across borders, to rural and remote regions, and reach a broader client base.Rehabilitation professionals should collaborate with technology companies to improve remote rehabilitation service delivery and address clients' concerns.Rehabilitation professionals should ensure that their approach to utilizing this telerehabilitation services is flexible and patient-centered, accommodating the client's need for in-person services.