Development of a Depression Screening Protocol for At Risk Patients Based on the Adverse Childhood Experience Questionnaire

Background: Adverse childhood experiences (ACEs) are associated with increased risk for adult depression. Utilization of the Patient Health Questionnaire Nine (PHQ-9), in combination with Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSMV) criteria, aids in the diagnosis of comorbid depression and assessment of severity. Objectives: To standardize the process of screening new adult patients at a specialty care clinic for ACEs. Then, implement a depression screening protocol based on ACE criteria to identify adult patients with comorbid depression. Methods: Demographic, ACE score, PHQ-9 score, and protocol implementation data collected and analyzed by the Doctor of Nursing Practice (DNP) student during initial new patient visit, as well as subsequent visits (if applicable). Results: Of the 105 patients, 104 (99%) were appropriately screened for ACEs, and if applicable depression via the PHQ-9. Following protocol implementation, 15 patients were identified and diagnosed with comorbid depression with appropriate follow-up completed in 93%. Conclusions: Depression screening in at risk patients demonstrating significant childhood trauma leads to an increase in diagnosis comorbid depression. Implications: Depression screening in adults, following assessment of childhood trauma via the ACE questionnaire, aids in the identification of patients with comorbid depression

Gray matter volume correlates of Comorbid Depression in Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) involves diverse neurodevelopmental syndromes with significant deficits in communication, motor behaviours, emotional and social comprehension. Often, individuals with ASD exhibit comorbid conditions, one of the most prevalent being depression characterized by a persistent change in mood and diminished interest in previously enjoyable activities. Due to communicative challenges and lack of appropriate assessments in individuals with ASD, comorbid depression can often go undiagnosed during routine clinical examinations, which may aggravate their problems. The current literature on comorbid depression in adults with ASD is limited. Therefore, understanding the neural basis of the comorbid psychopathology of depression in ASD is crucial for identifying objective brain-based markers for its timely and effective management. Towards this end, using structural MRI and phenotypic data from the Autism Brain Imaging Data Exchange II (ABIDE II) repository, we specifically examined the pattern of relationship regional grey matter volume (rGMV) has with comorbid depression and autism severity within regions of a priori interest in adults with ASD (n = 44). The severity of comorbid depression correlated negatively with the rGMV of the right thalamus. Additionally, a significant interaction was evident between the severity of comorbid depression and core ASD symptoms towards explaining the rGMV in the left cerebellum crus II. The whole-brain regional rGMV differences between ASD and typically developed (TD, n = 39) adults remained inconclusive. The results further the understanding of the neurobiological underpinnings of comorbid depression in adults with ASD and are relevant in exploring structural neuroimaging-based biomarkers in the same cohort.Comment: 33 pages, 3 figures, 3 tables, journal submissio

Prev Chronic Dis

IntroductionObesity and depression are among the leading causes of disease worldwide. Their bidirectional relationship often results in comorbid depression and obesity, which further increases the risk of adverse health outcomes. Further evidence is needed on the correlates and synergistic association with other noncommunicable diseases. The objective of our study was to examine the correlates and synergistic association of comorbid depression and obesity with other noncommunicable diseases in a large sample of Australian men.MethodsOur cross-sectional study used data on 13,763 men aged 18 to 55 from the first wave (2013\u20132014) of the Australian Ten to Men study. Body mass index was calculated from self-reported weight and height. The Patient Health Questionnaire-9 was used to assess depression. We calculated the weighted prevalence of depression, obesity, and comorbid depression and obesity and examined correlates of comorbid depression and obesity by using logistic regression. We used the synergy index to measure the synergistic association of depression and obesity with other noncommunicable diseases.ResultsThe weighted prevalence of depression, obesity, and comorbid depression and obesity among Australian men were 12.5%, 22.2%, and 3.7%, respectively. Age, marital status, area-level socioeconomic index, educational attainment, household income, employment status, and physical activity were significantly associated with comorbid depression and obesity. Men with comorbid depression and obesity, compared with men without comorbid depression and obesity, had 7.6 times the risk of diabetes and 6.7 times the risk of hypertension.ConclusionCo-occurrence of depression and obesity among Australian men is associated with a set of individual- and area-level correlates and a higher risk of noncommunicable diseases. The correlates identified in our study are useful in planning interventions and screening in primary care settings.32614771PMC7367080806

Comorbid depression and risk of cardiac events and cardiac mortality in people with diabetes: A systematic review and meta-analysis

Objective: To examine the association of comorbid occurrence of diabetes and depression with risk of cardiovascular endpoints including cardiovascular mortality, coronary heart disease and stroke. Research Design and Methods: A systematic review and metaanalysis. We searched PUBMED/MEDLINE, Medscape, Cochrane Library, CINAHL, EMBASE and Scopus databases assessing cardiac events and mortality associated with depression in diabetes up until 1 December 2018. Pooled hazard ratios were calculated using random- effects models. Results: Nine studies met the inclusion criteria. The combined pooled hazard ratios showed a significant association of cardiac events in people with depression and type 2 diabetes, compared to those with type 2 diabetes alone. For cardiovascular mortality the pooled hazard ratio was 1.48 (95% CI: 1.185, 1.845), p=0.001, for coronary heart disease 1.37 (1.165, 1.605), p?0.001 and for stroke 1.33 (1.291, 1.369), p?0.001. Heterogeneity was high in the meta-analysis for stroke events (I-squared = 84.7%) but was lower for coronary heart disease and cardiovascular mortality (15% and 43.4% respectively). Meta-regression analyses showed that depression was not significantly associated with the study level covariates mean age, duration of diabetes, length of follow-up, BMI, sex and ethnicity (p?0.05 for all models). Only three studies were found that examined the association of depression in type 1 diabetes, there was a high degree of heterogeneity and data synthesis was not conducted for these studies. Conclusions: We have demonstrated a 47.9% increase in cardiovascular mortality, 36.8% increase in coronary heart disease and 32.9% increase in stroke in people with diabetes and comorbid depression. The presence of depression in a person with diabetes should trigger the consideration of evidence-based therapies for cardiovascular disease prevention irrespective of the baseline risk of cardiovascular disease or duration of diabetes

Cognitive behavior therapy in panic disorder and comorbid major depression - A naturalistic study

Background: There is a lack of evidence about the effectiveness of cognitive behavior therapies (CBT) in settings of routine clinical care as well as in the treatment of panic and comorbid disorders. Methods: We investigated a group-oriented CBT approach for 80 patients with panic disorder including 35 patients with current comorbid major depression. Assessments took place 6 months before treatment, at the beginning and end of treatment, and 1 year later. Structured interviews and multiple clinical self-rating scales were used. Results: Panic patients with comorbid major depression showed higher anxiety-specific and nonspecific pathology. The most striking benefits were in reducing avoidance behavior, while improvements concerning catastrophic beliefs were smaller, but still significant. For most self-rating scale results, patients with and without comorbid depression improved to a comparable degree. However, the end-state functioning of patients with panic disorder and current comorbid depression at admission is significantly lower than for patients with panic disorder alone, Conclusions: The results point to the necessity to develop and improve treatment approaches for patients with comorbidity of panic disorder and current major depression. Copyright (C) 2000 S.Karger AG, Basel

Sociodemographic predictors of depression among survivors of armed conflict with posttraumatic stress disorder in Dogonahawa, north central Nigeria

Background: Survivors of mass violence are at high risk of developing a wide range of psychological disorders. Nevertheless, little is known about the impact of trauma in post conflict low-income countries where armed conflict abounds.Objective: This study was carried out to assess the prevalence of comorbid  depression among victims of armed- conflict in Dogonahawa, north-central Nigeria who developed posttraumatic stress disorder (PTSD) and those who did not. It also assessed the socio-demographic predictors for comorbid depression among those who developed PTSD.Method: A cross-sectional study that employed a multi stage sampling technique to select eligible subjects in Dogonahawa, north-central Nigeria. The PTSD module of Mini International Neuropsychiatric Interview (MINI) was used to assess for current symptoms of PTSD, while the Beck Depression Inventory-II (BDI-II) was used to assess for depression.Results: The results showed that 55.5% and 44.7% of the respondents had PTSD and PTSD with comorbid depression respectively. The difference in prevalence was statistically significant with adults diagnosed with PTSD in this community being significantly more likely to experience comorbid depression than those without PTSD (p< 0.001). Being a female gender and being the head of household were found to be the predictors for comorbid depression among respondents with PTSD.Conclusions: Mental health consequences of conflict continued to endure four years after the armed conflict. In the light of the above, mental health emergency  interventions after exposure to traumatic event need to be developed to enhance healing and recovery.KeyWords: PTSD, co-morbid depression, sociodemographic predictors, depression, Armed, Conflict, Dogonahaw

The global distribution of comorbid depression and anxiety in people with diabetes mellitus: risk-adjusted estimates

Background: Previous reports suffer from the problem that they simply pooled data using aggregate means or standard meta-analytic method. The aim of the current study was to re-estimate the point prevalence of comorbid depression and anxiety in people with diabetes. Methods: The estimates were calculated using recently introduced directly standardized effect estimate method, which gives corrected risk-adjusted estimates for the population of interests. Reported are global and regional burden of prevalence, presented as risk-adjusted prevalence estimates with 95% confidence intervals. Results: Globally, the burden of comorbid depression was higher than the burden of anxiety (23.36% vs. 17.58%) symptoms and/or disorder in people with diabetes. There was a higher burden of comorbid depression in people living in developing regions (26.32%), in women (15.41%), and when assessed by self-report scales (SRS) (22.66%). The burden of anxiety was higher in developed regions in people with Type 2 diabetes mellitus (20.15%) and when assessed by SRS (20.75%). No statistically significant differences were observed due to gross heterogeneity across countries. Conclusions: There are wide-ranging differences in studies in developed and developing regions, regarding the burden of comorbid depression and of anxiety among people with diabetes and both conditions affect approximately a fifth of the diabetic population

Burden Of Depression Among Individuals With Irritable Bowel Syndrome(IBS) In The Medicaid Population

Objective: to determine the period prevalence of IBS and comorbid depression among individuals with Irritable Bowel Syndrome (IBS) in multi-state Medicaid population, and to assess the impact of comorbid depression on healthcare utilization and costs among individuals with IBS enrolled in fee-for-service Medicaid program. Methods: a retrospective cohort study was conducted using 2006-2008 Medicaid analytic extract files for 39 states. Beneficiaries with IBS were identified based on any medical claims for the disease. Beneficiaries with one or more medical claims for depression during the study period were considered to have had comorbid depression. For each beneficiary, the first claim for IBS in 2007 was considered as the index date. 12-month post index date all-cause and IBS-related healthcare utilization and costs were computed for each of the four medical service components “inpatient, outpatient, emergency room, and prescription drug. Generalized linear models were used to assess the impact of comorbid depression on healthcare utilization and costs. Results: the period prevalence of IBS in the population was 4.4 per 1,000 Medicaid beneficiaries. The period prevalence of comorbid depression among beneficiaries with IBS was 26.88%. Beneficiaries with IBS and depression had significantly greater all-cause and IBS-related inpatient, IBS-related outpatient, all-cause emergency room, all-cause and IBS-related prescription drug utilization, and IBS-related outpatient, all-cause and IBS-related emergency room, and all-cause and IBS-related prescription drug costs as compared to those without depression. Conclusion: given the impact on healthcare use and costs, there is a need for better screening and management of depression in this population

Early in-session predictors of response to trauma-focused cognitive therapy

Volume 1 of this thesis examines the predictors of response to trauma-focused treatment for posttraumatic stress disorder (PTSD). It is presented in three parts. Part 1 is a literature review of research evaluating the impact of trauma-focused therapy for PTSD on comorbid symptoms of depression. The Downs and Black (1998) checklist was used to assess study quality. Results indicated that both trauma-focused CBT and EMDR treatments were effective in reducing comorbid depression symptoms. However, as interventions varied widely and some studies were affected by significant methodological problems, the generalisability of these results may be limited, and thus areas for further research are also suggested. Part 2 is an empirical study exploring early in-session client and therapist factors that predict later response to treatment. Audio and video recordings of the first or second therapy session of 54 known treatment responders or non-responders were blind-rated for client perseverative thinking, therapist adherence and therapeutic alliance. Results revealed that more perseverative thinking was observed for non-responders than responders to treatment. No group differences were found in regards to therapist adherence or therapeutic alliance. Exploratory analyses revealed that across the sample as a whole, perseverative thinking was associated with reduced therapist adherence to the treatment manual and poorer therapeutic alliance. As this study is one of the first of its kind in this area, recommendations were made for future research opportunities to explore these findings further. Part 3 is a critical appraisal of the empirical study. This elaborates on the main findings of this project and discusses the methodological challenges involved in undertaking this type of research, particularly developing and applying a novel coding frame

Impact of depression on self-efficacy, illness perceptions and self-management among people with type 2 diabetes:A systematic review of longitudinal studies

BACKGROUND: Treating comorbid depression does not always improve outcomes for people with type 2 diabetes. Evidence is lacking on potential psychological and behavioural intermediaries of the impact of depression on diabetes outcomes.OBJECTIVE: To synthesise evidence on the impact of comorbid depression on self-efficacy, illness perceptions, and self-management in people with type 2 diabetes.DATA SOURCES: We searched PubMed, Embase, PsycINFO, and Global Health databases from inception up to 29th March 2023.STUDY ELIGIBILITY CRITERIA: Only prospective studies (cohort or intervention studies) were included, with no restrictions on language. The outcomes were self-efficacy, illness perceptions, and self-management.PARTICIPANTS: People with type 2 diabetes in community or health settings.EXPOSURE: Comorbid depression or depressive symptoms in people with type 2 diabetes.SYNTHESIS OF RESULTS: A narrative review of heterogeneous studies.RISK OF BIAS: The risk of bias was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies.RESULTS: Twenty-five studies were included, all from high-income countries. Depression was associated with lower self-efficacy (2 studies), poor illness perception (1 study), and poor self-management practices (17 studies) in people with type 2 diabetes. In 6/7 studies, depressive symptoms predicted less adherence to dietary recommendations, 8/10 studies found depressive symptoms were associated with poor medication adherence, 1/3 study found that depressive symptoms were associated with poor weight control, 3/4 with less physical exercise, and 2/3 with general self-care practices.LIMITATIONS: There were no studies from low- and middle-income countries and non-Western settings, and we cannot assume the mechanisms linking comorbid depression with diabetes outcomes are similar.CONCLUSIONS: Comorbid depression was associated with lower self-efficacy, poorer self-management, and less adaptive illness perceptions among people with diabetes.</p