Correlates and Predictors of Chronicity among Adolescents Living in Puerto Rico With a History of Depressive Symptoms.

Chronic depression (CD) among Hispanic/Latina(o) youths has been understudied, although chronicity is the biggest risk factor for treatment-resistant depression. We examined CD correlates and predictors among 291 youths (aged 12-18 years) living in Puerto Rico with a history of depressive symptoms. They completed the Children's Depression Inventory (CDI), the Depressive Symptoms Spectrum Assessment Inventory (DSSAI), and the Brief Structured Diagnostic Measure for Depression. We explored CD correlates using Odds Ratios adjusted for CDI-Total scores. With multiple logistic regression, we identified optimal predictors of a history of chronic depressive symptoms (HCDS) or any chronic depressive disorder (HACDD). Living zone (rural), history of depressive disorder, household size (< 4), age of onset of symptoms (< 13 years), death/suicidal thoughts at the first episode, antidepressants use, and scores ≥ 84th percentile in the DSSAI-Anhedonia subscale, accounted for 37% of HCDS variance. The latter five variables and socioeconomic status (lower-middle/low) best distinguished HACDD and episodic disorders (R 2 = .331). Identifying factors that distinguish chronic and episodic depression among Hispanic/Latina(o) youths may help to improve their diagnosis, access to and quality of care, as well as treatment selection, tailoring, and outcomes.

La depresión crónica (DC) juvenil se ha estudiado poco entre hispanas(os)/latinas(os), aun siendo factor de riesgo principal para la resistencia al tratamiento. Examinamos los correlatos y predictores de DC entre 291 jóvenes (de12­18 años) residentes en Puerto Rico con historial de síntomas depresivos. Estas(os) completaron el Children's Depression Inventory (CDI), el Inventario de Evaluación del Espectro de la Sintomatología Depresiva (INEESD) y la Evaluación Diagnóstica Estructurada Breve para la Depresión. Exploramos los correlatos de DC utilizando Odds Ratios ajustados por el CDI-Total. Utilizando regresión logística múltiple, identificamos predictores óptimos del historial de síntomas depresivos crónicos (HSDC) o cualquier trastorno depresivo crónico (HCTDC). Variables como zona de vivienda (rural), historial de trastornos depresivos, tamaño del hogar (< 4), edad de inicio de síntomas (< 13 años), pensamientos suicidas/mórbidos en el primer episodio, usar antidepresivos y puntuaciones ≥ al percentil 84 del INEESD-Subescala de Anhedonia explicaron 37% de la varianza del HSDC. Las últimas cinco variables y el nivel socioeconómico (medio-bajo/bajo) distinguieron mejor entre HCTDC y trastornos episódicos (R 2 = .331). Identificar factores discriminadores de DC vs. episódica entre jóvenes hispanas(os)/latinas(os) puede ayudar a mejorar su diagnóstico, acceso y calidad de servicios, así como la selección, adaptación y rendimiento del tratamiento.

Radiation oncologists' attitudes and beliefs about intensity-modulated radiation therapy and stereotactic body radiation therapy for prostate cancer.

BACKGROUND: To better understand how radiation oncologists perceive intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) for prostate cancer and how these perceptions may influence treatment decisions. METHODS: We conducted semi-structured interviews of radiation oncologists between January-May, 2016. We used a purposeful sampling technique to select participants across a wide range of experience, regions, and practice types. Two trained qualitative researchers used an inductive, iterative approach to code transcripts and identify themes. We then used content analysis and thematic analysis of the coded transcripts to understand radiation oncologists' attitudes and beliefs about IMRT and SBRT. RESULTS: Thematic saturation was achieved after 20 interviews. Participants were affiliated with academic (n = 13; 65%), private (n = 5; 25%), and mixed (n = 2; 10%) practices and had a wide range of clinical experience (median 19 years; range 4-49 years). Analysis of interview transcripts revealed four general themes: 1) most radiation oncologists offered surgery, brachytherapy, IMRT, and active surveillance for low-risk patients; 2) there was no consensus on the comparative effectiveness of IMRT and SBRT; 3) key barriers to adopting SBRT included issues related to insurance, reimbursement, and practice inertia; and 4) despite these barriers, most participants envisioned SBRT use increasing over the next 5-10 years. CONCLUSIONS: In the absence of strong opinions about effectiveness, nonclinical factors influence the choice of radiation treatment. Despite a lack of consensus, most participants agreed SBRT may become a standard of care in the future.

Mindfulness for Chronic Low Back Pain: A Qualitative Analysis.

Objective: Mindfulness is a nonpharmacologic mind-body therapy that has been shown to be effective in older adults with chronic low back pain (cLBP). There are few first-person accounts in the literature that describe the older adult experience and perspective while learning mindfulness and meditation to treat pain. The objective of this study was to investigate dominant themes present in the experiences of older adults applying mindfulness and meditation to cope with cLBP. Design: Qualitative analysis of four focus groups. Subject: Twenty-five adults age 65 years or older who had completed an eight-week mindfulness program. Methods: The focus groups met for a comprehensive discussion session about their experience with mindfulness and meditation. The audio for each session was recorded, and the discussions were transcribed. Codebook development, qualitative coding, and thematic analysis were performed. The coders each coded all four transcripts, following which they met to adjudicate all coding differences until they were in complete agreement on coding. Results: Several key themes were brought up by older adults utilizing mindfulness as a means of coping with pain, which included overcoming fear of pain ("Before [learning mindfulness], I used to dread pain"), pain awareness ("You're focusing more on being aware than the pain; now that's what helps me"), and pain significance ("It becomes insignificant"). Conclusions: The themes identify several ways mindfulness impacts older adults with cLBP, including decreased negative emotions related to chronic pain such as fear of pain, a different perspective or change in awareness about pain, and reducing the significance of pain.