ADVERSE CHILDHOOD EXPERIENCES IN PSYCHOACTIVE SUBSTANCE USE DISORDERS: A STRUCTURED LITERATURE REVIEW

Adverse childhood experiences include psychological, physical, and sexual forms of abuse, as well as dysfunction in the home, including substance abuse among family members, and mental health problems in the family. These experiences are among the most intense and frequent sources of stress that children can experience early in life, and they also increase their risk of various behavioural disorders and substance abuse. Aim: The study aimed to investigate the prevalence and potential impact of childhood adverse experiences in connection to alcohol and other psychoactive substance abuse and addiction. Methods: A structured literature review was conducted, and an electronic search of the PubMed database was performed. The review process initially identified 653 articles, of which 11 were included in the review. Results: Smokers and alcohol users are more likely to report an adverse childhood experience compared to people who do not report harmful habits. Parental divorce was one of the most common negative experiences that affected 17-59.5% of the respondents. The results of the Adverse Childhood Experiences Survey are a potentially significant predictor of risky behaviour

Latvian family physicians' experience and attitude in diagnosing and managing depression

Depression is among the most common mental disorders in primary care. Despite high prevalence rates it remains to be under-diagnosed in primary care settings over the world. This study was aimed to identify Latvian family physicians’ (FPs) experience and attitude in diagnosing and managing depression. It was carried out within the framework of the National Research Programme BIOMEDICINE 2014–2017. After educational seminars on diagnosing and managing depression, FPs were asked to complete a structured questionnaire. In total 216 respondents were recruited. Most of the doctors, or 72.2% (n = 156), agreed with the statement that patients with depression use primary care facilities more often than other patients. More than a half of physicians, or 66.3% (n = 143) quite often asked their patients about their psycho-emotional status and 65.7% (n = 142) of clinicians thought that they can successfully assess a patient’s psychoemotional status and possible mental disorders. The majority, or 91.6 % (n = 198), supposed that routine screening for depression is necessary in Latvia. Despite the fact that a significant number, or 62.6% (n = 135) of FPs thought that their practice was well suitable for the treatment of depressive patients, half of the respondents, or 50.9% (n = 110), assessed their ability to build a trustful contact and to motivate patients for treatment as moderate. Although FPs acknowledged the importance and necessity to treat depression, current knowledge and management approaches were far from optimal. This justifies the need to provide specific training programmes for FPs.Peer reviewe

The effect of different degrees of lockdown and self-identified gender on anxiety, depression and suicidality during the COVID-19 pandemic : Data from the international COMET-G study

Publisher Copyright: © 2022Introduction: During the COVID-19 pandemic various degrees of lockdown were applied by countries around the world. It is considered that such measures have an adverse effect on mental health but the relationship of measure intensity with the mental health effect has not been thoroughly studied. Here we report data from the larger COMET-G study pertaining to this question. Material and Methods: During the COVID-19 pandemic, data were gathered with an online questionnaire from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Anxiety was measured with the STAI, depression with the CES-D and suicidality with the RASS. Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively. Statistical Analysis: It included the calculation of Relative Risk (RR), Factorial ANOVA and Multiple backwards stepwise linear regression analysis Results: Approximately two-thirds were currently living under significant restrictions due to lockdown. For both males and females the risk to develop clinical depression correlated significantly with each and every level of increasing lockdown degree (RR 1.72 and 1.90 respectively). The combined lockdown and psychiatric history increased RR to 6.88 The overall relationship of lockdown with severity of depression, though significant was small. Conclusions: The current study is the first which reports an almost linear relationship between lockdown degree and effect in mental health.publishersversionPeer reviewe

Point prevalence and sex-specific associated factors of depression in Latvian general population

Funding Information: The data collection was financed by the European Social Fund and Ministry of Health of the Republic of Latvia in the frame of the “Study on the prevalence of mental disorders and suicidal behavior in the adult population of Latvia” within the project “Integrated measures for health promotion and disease prevention” (Nr.9.2.4.1/16/I/001). The analysis, interpretation of data, language editing procedures, writing of the manuscript, and publication were financed by the European Social Fund and Latvian state budget within the project no. 8.2.2.0/20/I/004 “Support for involving doctoral students in scientific research and studies” at Rīga Stradiņš University. Publisher Copyright: Copyright © 2023 Vinogradova, Kivite-Urtane, Vrublevska and Rancans.Background: This cross-sectional study aimed to determine the current prevalence of depression, and analyze sex-specific associated socio-demographic and health-related factors for depression in a representative sample of the general adult population of Latvia. Methods: Specially trained professional interviewers conducted computerassisted face-to-face interviews with a multistage stratified probability sample from the general Latvian adult population (n = 2,687). A 9-item Patient Health Questionnaire (PHQ) was used for assessment of depression. Respondents were interviewed using the specially developed questionnaire about sociodemographic factors as well as the alcohol use disorder module of the Mini International Neuropsychiatric Interview. Binary logistic regression was used to calculate the odds ratios (OR) for the univariate and multivariate logistic analyses. Results: The point prevalence of depression according to the PHQ-9 was 6.4% (95% CI 5.8–7.6). After adjustment for all independent variables analyzed, being divorced, widowed, or living separately increased the odds of depression [aOR 2.6 (95% CI, 1.2–5.8), p = 0.02] in males. For females, unfinished primary education [aOR 5.2 (95% CI 2.0–13.6), p = 0.001] and economically inactive status [aOR 2.0 (95% CI, 1.1–3.6), p = 0.03] were strongly associated with depression. Limitations: The cross-sectional design of the study did not allow us to draw conclusions about causality. Patients with bipolar, organic, and symptomatic depression states were not excluded. Conclusion: The prevalence of depression in the general adult population is 6.4%, with the most significant sex-specific factors associated with depression for males – being divorced, widowed, or living separately, and for females it was poor education and economic inactivity.publishersversionPeer reviewe

Beliefs in Conspiracy Theories and Mental Health in the Student Community of Latvia During the COVID-19 Outbreak

BACKGROUND: The objective of this study was to investigate self-reported changes in mental health and their association with various sociodemographic factors and beliefs in conspiracy theories among university and college students in Latvia during the second state of emergency caused by COVID-19. SUBJECTS AND METHODS: This cross-sectional study was conducted as part of an international research project, where university and college students were anonymously asked to complete an online self-report questionnaire. Changes in anxiety and depression were assessed using self-rated questions. Statistical analysis involved Pearson's chi-square test and univariate binary logistic regression.ression. RESULTS: The study comprised 1047 students, with 828 females (79.08% aged 21.71±0.09). Worsening in self-reported anxiety was more prevalent among females (69.3%, p<0.001), unemployed respondents (70.0%, p=0.003), individuals who were were not working during the lockdown (70.3%, p<0.001), those experiencing deterioration in general health condition (93.0%, p<0.001), and those belonging to or having knowledge of someone in a vulnerable group (69.5%, p=0.004). Worsening self-reported depression was more prevalent in respondents who did not work during the lockdown (63.9%, p=0.014) and those with deteriorating general health conditions (93.0%, p<0.001). Increased odds ratios (OR) for experiencing changes in anxiety and depression were associated with beliefs in the following conspiracy theories: 'Recommended measures are an attempt to restrict human rights' (OR=1.49, p=0.019 and OR=2.40, p<0.001, respectively). Furthermore, increased OR for experiencing changes in depression were associated with beliefs in the following conspiracy theories: 'The COVID-19 vaccine was ready before the virus spread' (OR=3.11, p=0.007), 'COVID-19 has a lower mortality rate" (OR=1.85, p<0.001)', 'Recommended measures are an attempt to restrict human rights' (OR=2.40, p<0.001), and 'The COVID-19 outbreak is the creation of world leaders' (OR=2.17, p=0.003). CONCLUSIONS: Self-reported changes in depression and anxiety were associated with certain beliefs in specific conspiracy theories.Peer reviewe

Prevalence of Depression in the General Population of Latvia and Primary Care Sample in Riga and Riga District. Summary of the Doctoral Thesis

Promocijas darbs izstrādāts Rīgas Stradiņa universitātē. Aizstāvēšana: 2018. gada 10. septembrī plkst. 15.00 Rīgas Stradiņa universitātes Medicīnas promocijas padomes atklātā sēdē Rīgā, Dzirciema ielā 16, Hipokrāta auditorijā.Ievads. Depresija ir viena no visbiežākajām psihiskajām saslimšanām Eiropas populācijā. PVO prognozē, ka 2020. gadā tā būs otrā biežākā slimība invaliditātē pavadīto gadu dēļ visā pasaulē. Neskatoties uz plašo depresijas izplatības pētījumu klāstu dažādās Eiropas valstīs, Latvijā nav datu par depresijas izplatību vispārējā populācijā, ar to saistītiem faktoriem, kā arī primārās aprūpes līmenī nav ieviesti validēti depresijas skrīninginstrumenti, kas ģimenes ārstiem atvieglotu depresijas diagnosticēšanu. Promocijas darbs veikts ar mērķi noskaidrot depresijas izplatību Latvijas vispārējā populācijā, ar to saistītos sociāli demogrāfiskos fun ar veselību saistītos faktorus, kā arī noteikt depresijas izplatību pacientu kopā primārajā aprūpē Rīgā un Rīgas rajonā un validēt depresijas skrīninga instrumentu. Materiāls un metodes. Pētījums veikts trīs secīgos posmos. Pirmajā pētījuma posmā tika noskaidrota depresijas izplatība pēdējo divu nedēļu laikā un ar to saistītie faktori tika noteikti Latvijas iedzīvotāju aptaujā par atkarību izraisošo vielu lietošanu 2011. gadā ar izlases apjomu 4493 iedzīvotāji. Sociāldemogrāfiskie dati, veselības stāvokļa pašvērtējums, depresija un alkohola lietošana tika noskaidrota strukturētas intervijas veidā. Depresija tika noteikta, izmantojot PHQ-9 skalu. Tika pielietots Hī kvadrāta tests un loģistiskās regresijas metode. Faktoru samērošana tika atspoguļota divos modeļos: Modelī 1 faktori tika samēroti pēc dzimuma un vecuma, Modelī 2 tika veikta vienlaicīgi visu faktoru samērošana. Otrajā pētījuma posmā tika noskaidrota depresijas un “mazās depresijas” pēdējo 12 mēnešu izplatība un saistība ar veselības aprūpes dienestu apmeklēšanas biežumu, somatiskām saslimšanām, kavētām darba dienām veselības dēļ, kā arī veselības pašvērtējumu un smēķēšanas statusu. Pētījums veikts Latvijas iedzīvotāju veselību ietekmējošo paradumu pētījuma, 2012 ietvaros. Kopējais izlases apjoms bija 3003 iedzīvotāji. Depresija un “mazā depresija” tika noteikta, izmantojot Īsas Internacionālas Neiropsihiatriskas Intervijas (Mini International Neuropsychiatric Interview jeb M.I.N.I.) depresijas moduli. Ar veselību saistītie faktori tika noskaidroti strukturētas intervijas veidā. Veselību ietekmējošo faktoru saistība ar depresiju un “mazo depresiju” tika noteikta, izmantojot multinomiālo loģistisko regresiju un izteikta izredžu attiecībās (OR). Trešajā posmā Valsts pētījumu programmas BIOMEDICINE (2014–2017) ietvaros 6 ģimenes ārstu praksēs Rīgā un Rīgas rajonā tika veikts pilotpētījums, kurā tika veikta depresijas skrīnginstrumenta Patient Health Questionnaire-9 (PHQ-9) validācija ar kopējo izlases apjomu 272 pacienti, kā arī noskaidrota depresijas punkta prevalence un izplatība dzīves laikā. Validācijas standarts bija diagnostiskā intervija M.I.N.I. Tika noteikta PHQ-9 skalas jutība, specifiskums, iekšējā ticamība. Rezultāti. Depresijas pēdējo 2 nedēļu izplatība kopumā bija 6,7%. Tā bija biežāk sastopama sievietēm nekā vīriešiem, respektīvi, 7,8% (95%TI 6,5–9,2) un 5,6% (95%TI 4,4–6,8). Lielākas izredzes depresijai pēdējās 2 nedēļās bija sievietēm, pilsētās (taču ne galvaspilsētā) dzīvojošiem cilvēkiem, kam ir viduvējs vai slikts veselības pašvērtējums, veselības pasliktināšanās pēdējo 12 mēnešu laikā, alkohola atkarība. Depresijas izplatība pēdējos 12 mēnešos bija 7,9%, bet “mazās depresijas” izplatība – 7,7%. Pašu ziņotās somatsikās slimības bija biežāk sastopamas cilvēkiem ar depresiju un arī ar “mazo depresiju” nekā tiem, kam depresija netika noteikta. Veselības aprūpes dienestu apmeklējumi 6 vai vairāk reizes pēdējo 12 mēnešu laikā, trīs vai vairāku somatisko slimību esamība, viduvējs vai zemāk kā viduvējs veselības pašvērtējums un smēķēšana bija saistīti ir augstākām izredzēm depresijai. Trīs vai vairāk esošas somatisko slimības, invaliditātes pensijas saņemšana un slikts veselības pašvērtējums bija asociēts ar augstākām izredzēm “mazai depresijai”. Depresijas punkta prevalence ģimenes ārstu prakšu pacientu kopā bija 13,6%, savukārt ar depresiju jebkad ir saskārušies 22,4% pacientu. PHQ-9 skalas kopējā punktu summa ≥ 10 uzrādīja jutību 0,86 un specifiskumu 0,89. Skalas iekšējā ticamība bija 0,83. Secinājumi. Pētījuma ietvaros ir noskaidroti ar depresiju saistītie sociāldemogrāfiskie un ar veselību saistītie faktori. Tie var būt izmantojami depresijas skrīninga mērķpopulācijas definēšanai. PHQ-9 validācijas pētījums atklāja, ka šī skala ir izmantojama ģimenes ārstu ikdienas darbā, kas varētu uzlabot depresijas skrīningu un diagnostiku. PHQ-9 kopējā punktu summa ≥10 ir saistāma ar depresiju.Promocijas darbs veikts ar Valsts pētījumu programmas “Biomedicīna sabiedrības veselībai (BIOMEDICINE)” projekta “Nozīmīgāko psihisko slimību un kognitīvās disfunkcijas radīto veselības problēmu izpēte un sloga mazināšana” apakšprojekta Nr. 5.8.1. daļēju finansiālu atbalstu

Prevalence of Depression in the General Population of Latvia and Primary Care Sample in Riga and Riga District. Doctoral Thesis

Promocijas darbs izstrādāts Rīgas Stradiņa universitātē. Aizstāvēšana: 2018. gada 10. septembrī plkst. 15.00 Rīgas Stradiņa universitātes Medicīnas promocijas padomes atklātā sēdē Rīgā, Dzirciema ielā 16, Hipokrāta auditorijā.Ievads. Depresija ir viena no visbiežākajām psihiskajām saslimšanām Eiropas populācijā. PVO prognozē, ka 2020. gadā tā būs otrā biežākā slimība invaliditātē pavadīto gadu dēļ visā pasaulē. Neskatoties uz plašo depresijas izplatības pētījumu klāstu dažādās Eiropas valstīs, Latvijā nav datu par depresijas izplatību vispārējā populācijā, ar to saistītiem faktoriem, kā arī primārās aprūpes līmenī nav ieviesti validēti depresijas skrīninginstrumenti, kas ģimenes ārstiem atvieglotu depresijas diagnosticēšanu. Promocijas darbs veikts ar mērķi noskaidrot depresijas izplatību Latvijas vispārējā populācijā, ar to saistītos sociāli demogrāfiskos fun ar veselību saistītos faktorus, kā arī noteikt depresijas izplatību pacientu kopā primārajā aprūpē Rīgā un Rīgas rajonā un validēt depresijas skrīninga instrumentu. Materiāls un metodes. Pētījums veikts trīs secīgos posmos. Pirmajā pētījuma posmā tika noskaidrota depresijas izplatība pēdējo divu nedēļu laikā un ar to saistītie faktori tika noteikti Latvijas iedzīvotāju aptaujā par atkarību izraisošo vielu lietošanu 2011. gadā ar izlases apjomu 4493 iedzīvotāji. Sociāldemogrāfiskie dati, veselības stāvokļa pašvērtējums, depresija un alkohola lietošana tika noskaidrota strukturētas intervijas veidā. Depresija tika noteikta, izmantojot PHQ-9 skalu. Tika pielietots Hī kvadrāta tests un loģistiskās regresijas metode. Faktoru samērošana tika atspoguļota divos modeļos: Modelī 1 faktori tika samēroti pēc dzimuma un vecuma, Modelī 2 tika veikta vienlaicīgi visu faktoru samērošana. Otrajā pētījuma posmā tika noskaidrota depresijas un “mazās depresijas” pēdējo 12 mēnešu izplatība un saistība ar veselības aprūpes dienestu apmeklēšanas biežumu, somatiskām saslimšanām, kavētām darba dienām veselības dēļ, kā arī veselības pašvērtējumu un smēķēšanas statusu. Pētījums veikts Latvijas iedzīvotāju veselību ietekmējošo paradumu pētījuma, 2012 ietvaros. Kopējais izlases apjoms bija 3003 iedzīvotāji. Depresija un “mazā depresija” tika noteikta, izmantojot Īsas Internacionālas Neiropsihiatriskas Intervijas (Mini International Neuropsychiatric Interview jeb M.I.N.I.) depresijas moduli. Ar veselību saistītie faktori tika noskaidroti strukturētas intervijas veidā. Veselību ietekmējošo faktoru saistība ar depresiju un “mazo depresiju” tika noteikta, izmantojot multinomiālo loģistisko regresiju un izteikta izredžu attiecībās (OR). Trešajā posmā Valsts pētījumu programmas BIOMEDICINE (2014–2017) ietvaros 6 ģimenes ārstu praksēs Rīgā un Rīgas rajonā tika veikts pilotpētījums, kurā tika veikta depresijas skrīnginstrumenta Patient Health Questionnaire-9 (PHQ-9) validācija ar kopējo izlases apjomu 272 pacienti, kā arī noskaidrota depresijas punkta prevalence un izplatība dzīves laikā. Validācijas standarts bija diagnostiskā intervija M.I.N.I. Tika noteikta PHQ-9 skalas jutība, specifiskums, iekšējā ticamība. Rezultāti. Depresijas pēdējo 2 nedēļu izplatība kopumā bija 6,7%. Tā bija biežāk sastopama sievietēm nekā vīriešiem, respektīvi, 7,8% (95%TI 6,5–9,2) un 5,6% (95%TI 4,4–6,8). Lielākas izredzes depresijai pēdējās 2 nedēļās bija sievietēm, pilsētās (taču ne galvaspilsētā) dzīvojošiem cilvēkiem, kam ir viduvējs vai slikts veselības pašvērtējums, veselības pasliktināšanās pēdējo 12 mēnešu laikā, alkohola atkarība. Depresijas izplatība pēdējos 12 mēnešos bija 7,9%, bet “mazās depresijas” izplatība – 7,7%. Pašu ziņotās somatsikās slimības bija biežāk sastopamas cilvēkiem ar depresiju un arī ar “mazo depresiju” nekā tiem, kam depresija netika noteikta. Veselības aprūpes dienestu apmeklējumi 6 vai vairāk reizes pēdējo 12 mēnešu laikā, trīs vai vairāku somatisko slimību esamība, viduvējs vai zemāk kā viduvējs veselības pašvērtējums un smēķēšana bija saistīti ir augstākām izredzēm depresijai. Trīs vai vairāk esošas somatisko slimības, invaliditātes pensijas saņemšana un slikts veselības pašvērtējums bija asociēts ar augstākām izredzēm “mazai depresijai”. Depresijas punkta prevalence ģimenes ārstu prakšu pacientu kopā bija 13,6%, savukārt ar depresiju jebkad ir saskārušies 22,4% pacientu. PHQ-9 skalas kopējā punktu summa ≥ 10 uzrādīja jutību 0,86 un specifiskumu 0,89. Skalas iekšējā ticamība bija 0,83. Secinājumi. Pētījuma ietvaros ir noskaidroti ar depresiju saistītie sociāldemogrāfiskie un ar veselību saistītie faktori. Tie var būt izmantojami depresijas skrīninga mērķpopulācijas definēšanai. PHQ-9 validācijas pētījums atklāja, ka šī skala ir izmantojama ģimenes ārstu ikdienas darbā, kas varētu uzlabot depresijas skrīningu un diagnostiku. PHQ-9 kopējā punktu summa ≥10 ir saistāma ar depresiju.Promocijas darbs veikts ar Valsts pētījumu programmas “Biomedicīna sabiedrības veselībai (BIOMEDICINE)” projekta “Nozīmīgāko psihisko slimību un kognitīvās disfunkcijas radīto veselības problēmu izpēte un sloga mazināšana” apakšprojekta Nr. 5.8.1. daļēju finansiālu atbalstu

Depresijas izplatība Latvijas vispārējā populācijā un primārā aprūpē Rīgā un Rīgas rajonā. Promocijas darba kopsavilkums

The doctoral thesis was carried out in Rīga Stradiņš University, Latvia. Defence: at the public session of the Doctoral Council of Medicine on 10 September 2018 at 15.00 in Hippocrates Lecture Theatre, Rīga Stradiņš University, 16 Dzirciema Street, Riga.Background. Depression is one among the most common mental disorders in European general population. The WHO prognoses that by 2020 depression will be a second leading disorder in terms of disability adjusted life years. Despite rich data on depression prevalence rates in European countries, no population-based studies of the prevalence of depression and associated factors have been conducted in Latvia. The aim of the doctoral thesis was to determine the prevalence of depression, associated sociodemographic and health-related factors, as well as to determine the prevalence of depression of the primary care patients in Riga and Riga district and to validate a depression screening tool in primary care sample. Material and methods. The study was conducted in three consecutive sections. First, the point prevalence of depression and associated sociodemographic correlates in the general population was estimated in a cross-sectional general population survey on substance use in Latvia in 2011 with a total sample of 4493 Latvian inhabitants. Sociodemographic, self-rated health status, alcohol use measures, and data about depression were evaluated from the structured face-to-face interviews. To assess depression, participants were interviewed using the Patient Health Questionnaire-9 (PHQ-9) with a cut-off score of ≥ 10. Logistic regression models were applied to the data. Model 1 was adjusted only by gender and age, Model 2 was adjusted by all simultaneous factors. Second, the 12-month prevalence of depression, “minor depression” and associated health related factors was determined in the study that was a part of the Health Behaviour among the Latvian Adult Population survey in 2012 with a total population of 3003. Data was collected by face-to-face interviews. In order to measure depression and minor depression, the participants were interviewed using the depressive episode module of the Mini International Neuropsychiatric Interview (M.I.N.I.). Multinomial logistic regression was used because the dependent variable (depression status) had more than two categories. Third, in 2014, a pilot study was conducted within the framework of the Latvian National Research Programme BIOMEDICINE (2014–2017) to assess the prevalence of depression in primary care sample at 6 primary care settings and to estimate the PHQ-9 cutoff score with the best sensitivity, specificity, Criterion validity was assessed against the M.I.N.I. The criterion validity of the PHQ-9 was analyzed in terms of sensitivity, specificity, and positive and negative predictive values for different cutoff scores. Results. The point prevalence of depression in the general population was 6.7%. Depression was more common in females (7.8%, 95%CI6.2%–9.5%) than males (5.6%, 95%CI4.2%–6.9%). The odds of having depression were higher in females, in urban dwellers (though not in the capital city, Riga), in persons with alcohol dependence, with poor subjective health status and having a dissatisfaction with life. The 12-month prevalence of major depression was 7.9%, while for minor depression it was 7.7%. The prevalence of self-reported somatic illnesses was higher among people with depression and minor depression than in people with no depression. The odds of having 12-month depression were higher for those who had used healthcare services six or more times, those who had three or more somatic disorders during the past 12 months, those who perceived their health status as being below average, and those who were regular and occasional smokers. The odds of having minor depression was increased for those who had at least three somatic disorders, those who received disability pension, and those who perceived their health status to be below average. In primary care setting 22.4% of patients had experienced a lifetime depression episode, and 13.6% of patients had current depression. A cutoff score of 10 was established for the PHQ-9 (sensitivity 0.86, specificity 0.89%), correctly classifying 86.4% of patients with current depression. The reliability analysis showed that the items of the PHQ-9 were highly consistent (Cronbach’s alpha 0.83). Conclusions. Certain socio-demographic and health-related factors associated with depression and minor depression have been identified. The findings outline certain individuals who might be at a higher risk of having depression. The factors associated with major or minor depression could be used as indicators for health providers to initiate screening for depression. The optimal cut-off score of the PHQ-9 that had the best psychometric characteristics for diagnosing depression was ≥10. The study demonstrates that the PHQ-9 is a reliable and effective instrument to evaluate depression among patients visiting their general practitioner in Latvia.The Doctoral Thesis has been partially supported by the National Research Programme BIOMEDICINE 2014–2017 (No. 5.8.1)

Latvian family physicians’ experience diagnosing depression in somatically presenting depression patients: A qualitative study

Background: Depression continues to be under-diagnosed in primary care settings. One factor that influences physicians’ likelihood of diagnosing depression is patients’ presentation style. Patients who initially present with somatic symptoms are diagnosed at a lower rate and with greater delay than patients who present with psychosocial complaints. Objectives: To identify the barriers preventing depression diagnosis in somatically presenting patients in an Eastern European primary care setting. Methods: Thematic analysis of semi-structured interviews with 16 family physicians (FPs) in Latvia. FPs were sampled using a maximum variation strategy, varying on patient load, urban/rural setting, FP gender, presence/absence of on-site mental health specialists, and FP years of practice. Results: FPs observed that a large subgroup of depression patients presented with solely somatic complaints. FPs often did not recognize depression in somatically presenting patients until several consultations had passed without resolution of the somatic complaint. When FPs had psychosocial information about the somatically presenting patient, they recognized depression more quickly. Use of depression screening questionnaires was rare. Barriers to diagnosis continued beyond recognition. Faced with equivocal symptoms that undermined clinical certainty, FPs postponed investigating their clinical suspicion that the patient had depression and pursued physical examinations that delayed depression diagnosis. FPs also used negative physical examination results to convince reluctant patients of a depression diagnosis. Conclusion: Delayed recognition, the need to rule out physical illness, and the use of negative physical examination results to discuss depression with patients all slowed the path to depression diagnosis for somatically presenting patients in Latvian primary care