Does It Matter What Screener We Use? A Comparison of Ultra-brief PHQ-4 and E-mwTool-3 Screeners for Anxiety and Depression Among People With and Without HIV.

The burden of depression and anxiety disorders is high in sub-Saharan Africa, especially for people with HIV (PWH). The Patient Health Questionnaire-4 (PHQ-4) and Electronic Mental Wellness Tool-3 (E-mwTool-3) are ultra-brief screening tools for these disorders. We compared the performance of PHQ-4 and E-mwTool-3 for screening MINI-International Neuropsychiatric Interview diagnoses of depression and anxiety among a sample of individuals with and without HIV in two primary care clinics and one general hospital in Maputo City, Mozambique. Areas-under-the-curve (AUC) were calculated along with sensitivities and specificities at a range of cutoffs. For PWH, at a sum score cutoff of ≥ 1, sensitivities were strong: PHQ-4:Depression = 0.843; PHQ-4:Anxiety = 0.786; E-mwTool-3:Depression = 0.843; E-mwTool-3:Anxiety = 0.929. E-mwTool-3 performance was comparable to PHQ-4 among people with and without HIV.

Using the Patient Health Questionnaire-2 to improve depression screening in head and neck cancer patients.

PURPOSE: The purpose of this study is to examine the use of the Patient Health Questionnaire-2 (PHQ-2) to screen for depression in patients undergoing treatment for head and neck cancer and to evaluate potential patient-specific risk factors that may contribute to depression. MATERIALS AND METHODS: This is a retrospective study at a tertiary-level hospital of outpatient adult patients with head and neck cancer who completed the PHQ-2/9 from 2019 to 2020. Patients were given a PHQ-2 during a surveillance visit. A positive PHQ-2 screen (score ≥ 3) prompted further evaluation with a PHQ-9. Patients were stratified into either low risk (PHQ-2 score < 3) or high risk (PHQ-2 score ≥ 3) for depression. Univariate regression was performed on all variables, and a multivariate logistic regression was performed on statistically significant variables (P < 0.05). RESULTS: In total, 110 patients were included in this study. Fifteen (14 %) patients had a positive PHQ-2 screen with a score ≥ 3 and underwent evaluation with a PHQ-9. The median PHQ-9 score was 15 (6-26). The PHQ-2 ≥ 3 group were significantly younger (59 years vs. 67 years; P = 0.03) and had a greater number of patients with a psychiatric history (33 % vs. 8 %; P < 0.01). CONCLUSIONS: There is a strong association between a PHQ-2 score ≥ 3 and detection of depressive symptoms among patients with head and neck cancer. Younger age and pretreatment mental illness are significant risk factors for developing depression following treatment. Early screening and treatment should be considered for all patients to mitigate the burden of depression and suicide in this patient population. Further research is warranted to investigate utilization of the PHQ-2/9 to detect depression and barriers that exist for timely screening and interventions.

Validity and Performance of the Patient Health Questionnaire (PHQ-2) for Screening of Depression in a Rural Chilean Cohort.

Validity of PHQ-2 to screen for depression was assessed in an agricultural population in Chile. The sample included 4767 adults enrolled from 2014 to 2017 in a population-based cohort of chronic disease in Maule, Chile. Receiver operating characteristic (ROC) curve analysis was used to find the optimal PHQ-2 cut-off for depression, defined as the highest Youden index, using PHQ-9 as a reference standard. Sensitivity, specificity, and Youden J index were calculated for every cut-off point of PHQ-2. Prevalence of depression measured by PHQ-9 and PHQ-2 was 18% and 18.4%, respectively. Corresponding rates for women were 24.7% and 23.6%, and 8.3% and 10.9 for men. The optimal PHQ-2 cut-off score was 3, achieved with a sensitivity of 74.6%, specificity 93.9%, and Youden index of 0.68. The area under the curve for the ROC analysis ROC curve was 0.92 (95% CI 0.91-0.93). PHQ-2 has good performance for use as a test for depression screening in a rural population of Chile and can be easily applied in areas with low resources.

The reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) and PHQ-2 in patients with infertility.

BACKGROUND: Depression in patients with infertility often goes undiagnosed and untreated. The Patient Health Questionnaire-9 (PHQ-9) and its ultra-brief version (i.e. PHQ-2) are widely used measures of depressive symptoms. These scales have not been validated in patients with infertility. The aim of the present study was to examine the reliability and validity of the PHQ-9 and PHQ-2 in patients with infertility. METHODS: In this cross-sectional study, a total of 539 patients with infertility from a referral infertility clinic in Tehran, Iran completed the PHQ-9, along with other relevant scales: the WHO-five Well-being Index (WHO-5), the Hospital Anxiety and Depression Scale (HADS), and the Generalized Anxiety Disorder-7 (GAD-7). Factor structure and internal consistency of PHQ-9 were examined via confirmatory factor analysis (CFA) and Cronbach's alpha, respectively. Convergent validity was evaluated by relationship with WHO-5, HADS and GAD-7. RESULTS: The mean total PHQ-9 and PHQ-2 scores were 8.47 ± 6.17 and 2.42 ± 1.86, respectively, and using a cut-off value of 10 (for PHQ-9) and 3 (for PHQ-2), the prevalence of depressive symptoms was 38.6 and 43.6%, respectively. The Cronbach's alphas for PHQ-9 and PHQ-2 were, respectively, 0.851 and 0.767, indicating good internal consistency. The CFA results confirmed the one-factor model of the PHQ-9 (χ2/df = 4.29; CFI = 0.98; RMSEA = 0.078 and SRMR = 0.044). Both PHQ-9 and PHQ-2 showed moderate to strong correlation with the measures of WHO-5, HADS-depression, HADS-anxiety, and the GAD-7, confirming convergent validity. In univariate analysis, female sex, long infertility duration, and unsuccessful treatment were significantly associated with depression symptoms. CONCLUSION: Both PHQ-9 and PHQ-2 are brief and easy to use measures of depressive symptoms with good psychometric properties that appear suitable for routine use in patients with infertility.

Anxiety, depression, and regret of donation in living kidney donors.

BACKGROUND: Previous studies have reported a wide range of prevalence of post-donation anxiety, depression, and regret in living kidney donors (LKDs). It is also unclear what risk factors are associated with these outcomes. METHODS: We screened 825 LKDs for anxiety and depression using 2-item GAD-2 and PHQ-2 scales and asked about regret. RESULTS: Overall, 5.5% screened positive for anxiety, 4.2% for depression, and 2.1% reported regretting their donation. While there was moderate correlation between positive anxiety and depression screens (r = 0.52), there was no correlation between regret and positive screens (r < 0.1 for both). A positive anxiety screen was more likely in LKDs with a positive depression screen (adjusted relative risk [aRR] 13.72, 95% confidence interval [CI] 6.78-27.74, p < 0.001). Similarly, a positive depression screen was more likely in LKDs with a positive anxiety screen (aRR 19.50, 95% CI 6.94-54.81, p < 0.001), as well as in those whose recipients experienced graft loss (aRR 5.38, 95% CI 1.29-22.32, p = 0.02). Regret was more likely in LKDs with a positive anxiety screen (aRR 5.68, 95% CI 1.20-26.90, p = 0.03). This was a single center cross-sectional study which may limit generalizability and examination of causal effects. Also, due to the low prevalence of adverse psychosocial outcomes, we may lack power to detect some associations between donor characteristics and anxiety, depression, or regret. CONCLUSIONS: Although there is a low prevalence of anxiety, depression, and regret of donation among LKDs, these are interrelated conditions and a positive screen for one condition should prompt evaluation for other conditions.

Psychological Attributes of Ultramarathoners.

INTRODUCTION: As the popularity of ultramarathon participation increases, there still exists a lack of understanding of the unique psychological characteristics of ultramarathon runners. The current study sought to investigate some of the psychological and behavioral factors that are involved in ultramarathon running. METHODS: We obtained information from participants of the Bear Chase Trail Race via an online survey. This race is a single-day, multidistance race consisting of a 10 k, half marathon, 50 k, 50 mi, and 100 k run in Lakewood, Colorado, at a base altitude of 1680 m with total altitude in climbs ranging from 663 to 2591 m. We correlated information from the Exercise Addiction Inventory and the Patient Health Questionnaire-2 and demographic information with race finish times. RESULTS: Out of 200 runners who started the race, 98 (48%) completed the survey. Over half of the runners were men (61.2%), and the average age was 39.0 years (SD±8.9; range 21-64 years). A number of respondents (20%) screened positive for exercise addiction concerns. Approximately 20% of our sample screened positive for depressive symptoms (Patient Health Questionnaire-2 score >3). The majority of participants reported receiving strong social support from current partners with regard to their ultramarathon running training time and goals. CONCLUSIONS: Although only a screening, the number of positive screens on the Exercise Addiction Inventory suggests use of screening measures with an ultramarathon running population. Athletes with positive screening tests should be fully evaluated for depression and exercise addiction because this would enable appropriate athlete support and treatment referral.

Burnout in Graduate Medical Education: Uncovering Resident Burnout Profiles Using Cluster Analysis.

Background: Burnout is common among residents and negatively impacts patient care and professional development. Residents vary in terms of their experience of burnout. Our objective was to employ cluster analysis, a statistical method of separating participants into discrete groups based on response patterns, to uncover resident burnout profiles using the exhaustion and engagement sub-scales of the Oldenburg Burnout Inventory (OLBI) in a cross-sectional, multispecialty survey of United States medical residents. Methods: The 2017 ACGME resident survey provided residents with an optional, anonymous addendum containing 3 engagement and 3 exhaustion items from the OBLI, a 2-item depression screen (PHQ-2), general queries about health and satisfaction, and whether respondents would still choose medicine as a career. Gaussian finite mixture models were fit to exhaustion and disengagement scores, with the resultant clusters compared across PHQ-2 depression screen results. Other variables were used to demonstrate evidence for the validity and utility of this approach. Results: From 14 088 responses, 4 clusters were identified as statistically and theoretically distinct: Highly Engaged (25.8% of respondents), Engaged (55.2%), Disengaged (9.4%), and Highly Exhausted (9.5%). Only 2% of Highly Engaged respondents screened positive for depression, compared with 8% of Engaged respondents, 29% of Disengaged respondents, and 53% of Highly Exhausted respondents. Similar patterns emerged for the general query about health, satisfaction, and whether respondents would choose medicine as a career again. Conclusion: Clustering based on exhaustion and disengagement scores differentiated residents into 4 meaningful groups. Interventions that mitigate resident burnout should account for differences among clusters.

Validation of the Patient Health Questionnaire-9 and Patient Health Questionnaire-2 in the General Korean Population.

OBJECTIVE: The Patient Health Questionnaire-9 (PHQ-9) and PHQ-2 have not been validated in the general Korean population. This study aimed to validate and identify the optimal cutoff scores of the PHQ-9 and PHQ-2 in screening for major depression in the general Korean population. METHODS: We used data from 6,022 participants of the Korean Epidemiological Catchment Area Study for Psychiatric Disorders in 2011. Major depression was diagnosed according to the Korean Composite International Diagnostic Interview. Validity, reliability, and receiver operating characteristic curve analyses were performed using the results of the PHQ-9 and Euro Quality of life-5 dimension (EQ-5d). RESULTS: Of the 6,022 participants, 150 were diagnosed with major depression (2.5%). Both PHQ-9 and PHQ-2 demonstrated relatively high reliability and their scores were highly correlated with the "anxiety/depression" score of the EQ-5d. The optimal cutoff score of the PHQ-9 was 5, with a sensitivity of 89.9%, specificity of 84.1%, positive predictive value (PPV) of 12.6%, negative predictive value (NPV) of 99.7%, positive likelihood ratio (LR+) of 5.6, and negative likelihood ratio (LR-) of 0.12. The optimal cutoff score of the PHQ-2 was 2, with a sensitivity of 85.3%, specificity of 83.2%, PPV of 11.6%, NPV of 99.5%, LR+ of 5.1, and LR- of 0.18. CONCLUSION: The PHQ-9 and PHQ-2 are valid tools for screening major depression in the general Korean population, with suggested cutoff values of 5 and 2 points, respectively.

Informing Use of the Patient Health Questionnaire-2 to Detect Moderate or Greater Depression Symptoms in Adolescents and Young Adults in Outpatient Primary Care.

OBJECTIVE: We compared the Patient Health Questionnaire (PHQ)-2 to the PHQ-9 and examined the implications of using various cutoff scores on the PHQ-2 to detect moderate or greater depressive symptoms on the PHQ-9. We hypothesized that a cutoff score of ≥2 would be optimal for detecting scores of ≥10 on the PHQ-9. METHODS: Demographic and depression screening data from 3,256 routine preventive visits for patients aged 12-25 years at the adolescent and young adult clinic at Children's Hospital Colorado between March 2017 and July 2019 were collected retrospectively. Patients completed routine depression screening at 2,183 visits which were included for analysis. PHQ-2 scores and PHQ-9 scores were calculated for each included patient visit. Associations between different PHQ-2 cutoff scores and moderate or greater depressive symptoms on the PHQ-9 (≥10) were evaluated. RESULTS: A PHQ-2 score ≥2 had a sensitivity of 89% and specificity of 83% for detecting patients with moderate or greater depressive symptoms on the PHQ-9. On a receiver operating characteristic curve, a PHQ-2 cutoff of ≥2 optimized sensitivity and specificity. Analysis of gender and ethnic/racial subgroups demonstrated the same optimal cutoff score for each group studied. For patients aged 21 years and older a PHQ-2 cutoff of ≥3 was most accurate. DISCUSSION: Lowering the positive PHQ-2 cutoff to ≥2 has several clinical advantages, including increased detection of moderate or greater depressive symptoms and depressive disorders. Providers may increase identification of depression by making this change particularly if they follow a positive PHQ-2 with a full PHQ-9.

A new PHQ-2 for Chinese adolescents: identifying core items of the PHQ-9 by network analysis.

BACKGROUND: The importance of preventing and treating adolescent depression has been gradually recognized in Chinese society, especially in the context of the COVID-19 pandemic. Early screening is the first step. The Patient Health Questionnaire-9 (PHQ-9) is a leading scale in the field of depression screening. To improve screening efficiency in large-scale screening, an even shorten scale is desirable. The PHQ-2, which only included two items measuring anhedonia and depressed mood, is an ultra-form of the PHQ-9. However, emerging evidence suggests that there may be a better short form for the PHQ-9, especially for adolescents. Therefore, using two large samples of Chinese adolescents, this study aimed to identify the core items of the PHQ-9 and examine the short form consisting of core items. METHODS: Surveys were conducted among primary and middle school students in two Chinese cities with different economic levels during the COVID-19 pandemic. Two gender-balanced samples aged 10 to 17 (nSample 1 = 67281, nSample 2 = 16726) were collected. Network analysis was used to identify the core items of the PHQ-9, which were extracted to combine a short version. Reliability, concurrent validity, and the receiver operating characteristic curve (ROC) of the short form were examined. Analyses were gender-stratified. RESULTS: Network analysis identified fatigue and depressed mood as core items in the PHQ-9 among Chinese adolescents. Items measuring Fatigue and Mood were combined to be a new PHQ-2 (PHQ-2 N). The PHQ-2 N displayed satisfactory internal consistency and current validity. Taking the PHQ-9 as a reference, the PHQ-2 N showed higher ROC areas and better sensitivity and specificity than the PHQ-2. The optimal cutoff score for the PHQ-2 N was 2 or 3. CONCLUSIONS: Fatigue and depressed mood are the central symptoms of the depressive symptom network. The PHQ-2 N has satisfactory psychometric properties and can be used in rapid depression screening among Chinese adolescents.

Impact of COVID-19 on the mental health of adolescents and youth in Nairobi, Kenya.

Objective: To report on the mental health status of adolescents and youth in relation to the COVID-19 pandemic in Nairobi County, Kenya. Methodology: This was a mixed-methods study with cross-sectional quantitative and qualitative components conducted in Nairobi County, Kenya from August to September 2020. The quantitative survey involved phone interviews of n = 1,217 adolescents and youth. Qualitative components included virtual focus group discussions (FGDs) with adolescents and youth (n = 64 unmarried youths aged 16-25 years, across 8 FGDs) and youth-serving stakeholders (n = 34, across 4 FGDs), key informant interviews (n = 12 higher-level stakeholders from Ministries of Health, Gender, and Education), and in-depth interviews with youth (n = 20) so as to examine the COVID-19 impact on mental health. Results: Among the participants, 26.6% of young men and 30.0% of young women reported probable depressive symptoms, of whom 37.7% of young men and 38.9% of young women reported little interest or pleasure in doing various activities. Hopelessness and feeling down nearly every day was additionally reported by 10.7% of young women and 6.3% of young men. Further, about 8.8% of young men and 7.6% of young women reported they could not get the emotional help and support they may need from people in their life. Multivariable regression results showed an association between depressive symptoms and reduced working hours due to COVID-19 and increased intimate partner violence. Additionally, the results show that respondents with higher emotional help and support were less likely to report depressive symptoms. Qualitative results confirm the quantitative findings and exemplify the negative behavior arising from the impact of adherence to COVID-19 prevention measures. Conclusion: Mental health issues were common among adolescents and youth and may have been augmented by isolation and economic hardships brought about by COVID-19 restrictions. There is a need for concerted efforts to support adolescents and young people to meet their mental health needs, while considering the unique variations by gender. There is need to urgently strengthen the mental health system in Kenya, including via integrating psychosocial support services in communities, schools, and healthcare services, to ensure adolescents and young persons are not left behind.

Comparing depression screening tools (CESD-10, EPDS, PHQ-9, and PHQ-2) for diagnostic performance and epidemiologic associations among postpartum Kenyan women: Implications for research and practice.

BACKGROUND: Identifying optimal depression screening tools for use in maternal health clinics could improve maternal and infant health. We compared four tools for diagnostic performance and epidemiologic associations. METHODS: This study was nested in a cluster-randomized trial in Kenya. Women in 20 maternal health clinics were evaluated at 6 weeks postpartum with Center for Epidemiologic Studies Depression Scale (CESD-10), Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 and -2 (PHQ-9, PHQ-2) for moderate-to-severe depressive symptoms (MSD) [CESD-10 ≥ 10, EPDS≥13, PHQ-9 ≥ 10, or PHQ-2 ≥ 3]. We assessed area under the curve (AUC) per scale (CESD-10, EPDS) against probable major depressive disorder (MDD) using the PHQ-9 scoring algorithm. Associations between MSD and intimate partner violence (IPV) were compared between scales. RESULTS: Among 3605 women, median age was 24 and 10 % experienced IPV. Prevalence of MSD symptoms varied by tool: 13 % CESD-10, 9 % EPDS, 5 % PHQ-2, 3 % PHQ-9. Compared to probable MDD, the CESD-10 (AUC:0.82) had higher AUC than the EPDS (AUC:0.75). IPV was associated with MSD using all scales: EPDS (RR:2.5, 95%CI:1.7-3.7), PHQ-2 (RR:2.3, 95%CI:1.6-3.4), CESD-10 (RR:1.9, 95%CI:1.2-2.9), PHQ-9 (RR:1.8, 95%CI:0.8-3.8). LIMITATIONS: Our study did not include clinical diagnosis of MDD by a specialized clinician, instead we used provisional diagnosis of probable MDD classified by the PHQ-9 algorithm as a reference standard in diagnostic performance evaluations. CONCLUSION: Depression screening tools varied in detection of postpartum MSD. The PHQ-2 would prompt fewer referrals and showed strong epidemiologic association with a cofactor.

Evaluating the Modified Patient Health Questionnaire-2 and Insomnia Severity Index-2 for Daily Digital Screening of Depression and Insomnia: Validation Study.

BACKGROUND: The Patient Health Questionnaire-2 (PHQ-2) and Insomnia Severity Index-2 (ISI-2) are screening assessments that reflect the past 2-week experience of depression and insomnia, respectively. Retrospective assessment has been associated with reduced accuracy owing to recall bias. OBJECTIVE: This study aimed to increase the reliability of responses by validating the use of the PHQ-2 and ISI-2 for daily screening. METHODS: A total of 167 outpatients from the psychiatric department at the Yongin Severance Hospital participated in this study, of which 63 (37.7%) were male and 104 (62.3%) were female with a mean age of 35.1 (SD 12.1) years. Participants used a mobile app ("Mental Protector") for 4 weeks and rated their depressive and insomnia symptoms daily on the modified PHQ-2 and ISI-2 scales. The validation assessments were conducted in 2 blocks, each with a fortnight response from the participants. The modified version of the PHQ-2 was evaluated against the conventional scales of the Patient Health Questionnaire-9 and the Korean version of the Center for Epidemiologic Studies Depression Scale-Revised. RESULTS: According to the sensitivity and specificity analyses, an average score of 3.29 on the modified PHQ-2 was considered valid for screening for depressive symptoms. Similarly, the ISI-2 was evaluated against the conventional scale, Insomnia Severity Index, and a mean score of 3.50 was determined to be a valid threshold for insomnia symptoms when rated daily. CONCLUSIONS: This study is one of the first to propose a daily digital screening measure for depression and insomnia delivered through a mobile app. The modified PHQ-2 and ISI-2 were strong candidates for daily screening of depression and insomnia, respectively.

Patient Health Questionnaire-9 Item Pairing Predictiveness for Prescreening Depressive Symptomatology: Machine Learning Analysis.

BACKGROUND: Anhedonia and depressed mood are considered the cardinal symptoms of major depressive disorder. These are the first 2 items of the Patient Health Questionnaire (PHQ)-9 and comprise the ultrabrief PHQ-2 used for prescreening depressive symptomatology. The prescreening performance of alternative PHQ-9 item pairings is rarely compared with that of the PHQ-2. OBJECTIVE: This study aims to use machine learning (ML) with the PHQ-9 items to identify and validate the most predictive 2-item depressive symptomatology ultrabrief questionnaire and to test the generalizability of the best pairings found on the primary data set, with 6 external data sets from different populations to validate their use as prescreening instruments. METHODS: All 36 possible PHQ-9 item pairings (each yielding scores of 0-6) were investigated using ML-based methods with logistic regression models. Their performances were evaluated based on the classification of depressive symptomatology, defined as PHQ-9 scores ≥10. This gave each pairing an equal opportunity and avoided any bias in item pairing selection. RESULTS: The ML-based PHQ-9 items 2 and 4 (phq2&4), the depressed mood and low-energy item pairing, and PHQ-9 items 2 and 8 (phq2&8), the depressed mood and psychomotor retardation or agitation item pairing, were found to be the best on the primary data set training split. They generalized well on the primary data set test split with area under the curves (AUCs) of 0.954 and 0.946, respectively, compared with an AUC of 0.942 for the PHQ-2. The phq2&4 had a higher AUC than the PHQ-2 on all 6 external data sets, and the phq2&8 had a higher AUC than the PHQ-2 on 3 data sets. The phq2&4 had the highest Youden index (an unweighted average of sensitivity and specificity) on 2 external data sets, and the phq2&8 had the highest Youden index on another 2. The PHQ-2≥2 cutoff also had the highest Youden index on 2 external data sets, joint highest with the phq2&4 on 1, but its performance fluctuated the most. The PHQ-2≥3 cutoff had the highest Youden index on 1 external data set. The sensitivity and specificity achieved by the phq2&4 and phq2&8 were more evenly balanced than the PHQ-2≥2 and ≥3 cutoffs. CONCLUSIONS: The PHQ-2 did not prove to be a more effective prescreening instrument when compared with other PHQ-9 item pairings. Evaluating all item pairings showed that, compared with alternative partner items, the anhedonia item underperformed alongside the depressed mood item. This suggests that the inclusion of anhedonia as a core symptom of depression and its presence in ultrabrief questionnaires may be incompatible with the empirical evidence. The use of the PHQ-2 to prescreen for depressive symptomatology could result in a greater number of misclassifications than alternative item pairings.

Probable depression and its correlates among undergraduate students in Johannesburg, South Africa.

Background: Depression is associated with high rates of morbidity and mortality. Globally, depression is higher among university students than the general population-making it a significant public health problem. Despite this, there is limited data on the prevalence in university students in the Gauteng province, South Africa. This study determined the prevalence of screening positive for probable depression and its correlates among undergraduate students at the university of the Witwatersrand, Johannesburg, South Africa. Methods: A cross-sectional study, using an online survey was conducted among undergraduate students at the University of the Witwatersrand in 2021. Patient Health Questionnaire (PHQ-2) was used to assess the prevalence of probable depression. Descriptive statistics was computed and conducted bivariate and multivariable logistic regression to identify factors associated with probable depression. Age, marital status, substance use (alcohol use, cannabis use, tobacco use, and other substance use) were included in the multivariable model apriori determined confounders and other factors were only added if they had a p-value <0.20 in the bivariate analysis. A p-value of 0.05 was considered statistically significant. Results: The response rate was 8.4% (1046/12404). The prevalence of screening positive for probable depression was 48% (439/910). Race, substance use, and socio-economic status were associated with odds of screening positive for probable depression. Specifically reporting white race (adjusted OR (aOR) = 0.64, 95% CI: 0.42, 0.96), no cannabis use (aOR = 0.71, 95% CI: 0.44-0.99), higher spending power in the form of having the most important things but few luxury goods (aOR = 0.50, 95% CI: 0.31, 0.80) and having enough money for luxury goods and extra things (aOR = 0.44, 95% CI: 0.26-0.76) were associated with lower odds of screening positive for probable depression. Discussion: In this study, screening positive for probable depression was common among undergraduate students at the University of the Witwatersrand, Johannesburg, South Africa and associated with sociodemographic and selected behavioral factors. These findings call for strengthening the awareness and use of counselling services among undergraduate students.

The COVID-19 pandemic in Italy: Depressive symptoms immediately before and after the first lockdown.

BACKGROUND: Italy was one of the first countries to be heavily hit by the spread of the new Coronavirus. Longitudinal studies are needed to investigate the real effect of COVID-19 on adult mental health. The Italian Twin Registry carried out a study to investigate, over time, the course of depressive symptoms in the general population. METHODS: The study relies on data collected just before the beginning (February 2020) and the end (June 2020) of the first lockdown. Symptoms of depression were assessed using the Patient Health Questionnaire, and total scores or categorized depression scores were considered in the analyzes. RESULTS: A total of 1690 adult twins were recruited. The study showed a mean depression score of 1.11 immediately before lockdown and 1.20 immediately after, with an overall prevalence of depressive symptoms increasing from 33.6 to 38.9%. Depressive symptoms immediately after the restriction period were associated with Covid-19 symptoms affecting households, financial problems due to the pandemic and poor social support. Independently of the baseline risk of depressive symptoms, we observed an increased risk among younger and less educated people. Compared to the pre-lockdown period, women and middle-aged people also were found to be at greater risk of developing depressive symptoms. LIMITATIONS: Possible participation bias and residual selection bias. CONCLUSIONS: The study shows that the COVID-19 pandemic was associated with an increased depressive symptomatology and that, in such health emergency times, the most vulnerable persons are young adults, women, and those living in a socially, culturally, or economically disadvantaged environment.

The Interaction between Exercise and Marital Status on Depression: A Cross-Sectional Study of the Taiwan Biobank.

Few studies evaluating the relationship between depression and exercise consider peoples' socio-demographic characteristics. This cross-sectional study investigated the interaction between exercise and marital status and depression in Taiwanese adults. Data from the 2-item Patient Health Questionnaire (PHQ-2) was recruited from the Taiwan Biobank. Participants indicated their exercise status, showing 5015 no-exercise cases and 3407 exercise cases. Marital status, including unmarried, divorced or separated, and widowed, were all significant, especially among the no-exercise group. The relationship between exercise/no exercise and marital status was examined; no exercise and unmarried, divorced or separated, and widowed, as well as exercise and married were significant to PHQ-2. Gender was significant in both the married and unmarried groups. The association between exercise, marital status, gender, and education on PHQ-2 score was also significant. Married people, especially men, had lower depression scores. Additionally, exercise had a protective effect against depression for unmarried people, especially women.

Validity, Reliability, and Optimal Cut-off Scores of the WHO-5, PHQ-9, and PHQ-2 to Screen Depression Among University Students in Iran.

This study aimed to investigate the validity, reliability, and optimal cut-off points for the Patient Health Questionnaire-2 (PHQ-2), Patient Health Questionnaire-9 (PHQ-9), and Well-being Index (WHO-5) to screen mild depression among 400 Iranian students who completed these tools and Beck Depression Inventory (BDI-13). Further, a psychiatrist diagnosed the depression by using the "Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders." The validity and internal consistency of tools assessed and the accuracy were computed using the receiver operating characteristic (ROC) and area under the curve (AUC). The internal consistency values of PHQ-2, PHQ-9, and WHO-5 were .73, .88, and .94, respectively. The PHQ-2 (.53), PHQ-9 (.60), and WHO-5 (.54) were significantly associated with the BDI. The PHQ-2, PHQ-9, and WHO-5 had optimal cut-off points of 2, 5, and 9 with an AUC of .809, .851, and .823, respectively. Based on these findings, it is recommended to use the PHQ-9 for mild depression screening among medical university students in Iran because of its high sensitivity and specificity.

Association of mental health outcomes and lower patient satisfaction among adults with alopecia: A cross-sectional population-based study.

Background: Previous studies have found the increasing use of patient satisfaction scores by patients and insurance payers. Less is known about how patient mental health affects health care satisfaction. Objective: To examine the association between baseline mental health and health care satisfaction among adults with alopecia. Methods: We examined 543 adults with alopecia in the 2004-2016 Medical Expenditure Panel Survey. Mental health burden was assessed by the 6-item Kessler Psychological Distress Scale (K6) and 2-item Patient Health Questionnaire (PHQ2). Patient satisfaction was determined using the Consumer Assessment of Healthcare Providers and Systems survey. Results: Adults with versus without alopecia had higher rates of positive PHQ2 (adjusted odds ratio [95% CI], 1.37 [1.05-1.78]); positive K6 (1.57 [1.02-2.41]), and comorbid anxiety (1.85 [1.30-2.63]) and depression (1.68 [1.19-2.39]). Positive PHQ2 (2.15 [1.13, 4.11]) and positive K6 (6.04 [2.60, 14.05]) were associated with low patient satisfaction. Whereas, there were no differences in the rates of low patient satisfaction associated with comorbid anxiety (0.74 [0.33-1.67]) and depression (1.42 [0.72-2.78]). Limitations: Data are unavailable on alopecia areata phenotypes and treatment. Conclusions: Adults with alopecia and greater mental health symptoms report lower patient satisfaction. Clinicians may wish to adapt their communication style to support these patients and improve overall health care satisfaction.

Validity of the patient health questionnaire-2 (PHQ-2) for the detection of depression in primary care in Colombia.

BACKGROUND: The PHQ-2 is a screening test for major depressive disorder (MDD) derived from PHQ-9, which has shown to be useful in the detection of cases of clinical significance in previous studies. The psychometric properties of PHQ-2 in the Colombian population are unknown. METHODS: PHQ-2 were assessed in 243 patients in general medical consultations using the Mini-International Neuropsychiatric Interview (MINI) as the gold standard. Internal consistency, convergent validity and criterion validity were calculated by analyzing the Receptor Operating Characteristics (ROC) and the area under the curve (AUC). RESULTS: Cronbach's alpha and McDonald's omega coefficients were 0.71. Spearman's rho coefficients for correlations with PHQ-9 and HADS-D scores were 0.63 and 0.59 (p<0.01). AUC was 0.89. The optimal cut point was ≥2 with the following indicators: sensitivity 0.87 specificity 0.74; Youden index 0.60; PPV 0.47; NPV 0.95; (LR+) 3.24; (LR-) 0.18 (95% CI 0.09-0.37). Kappa coefficient between PHQ-2 and MINI for depression was .458 and 0.46 for HADS-D. LIMITATIONS: Since this study was done with people attending hospital, which could has implications for the prevalence of depression, affecting the validity indicators of the instrument. CONCLUSIONS: PHQ-2 show an acceptable test performance in the context of the study. However, the test could yield a considerable amount of false positives that would require specialized evaluation to establish a reliable diagnosis.