A Brief Depression Screening Tool for Perinatal Clinical Practice: The Performance of the PHQ-2 Compared with the PHQ-9

Introduction There is ongoing interest in using brief screening instruments to identify perinatal depression in clinical practice. One ultra-brief screening instrument for depression is the Patient Health Questionnaire-2 (PHQ-2), but thus far its accuracy in perinatal clinical practice has been barely researched. In the present study, we aimed to assess the screening accuracy of the PHQ-2 against the Patient Health Questionnaire-9 (PHQ-9) in a large sample of perinatal women. Method A total of 1155 consecutive women attending 11 health care centers throughout Italy completed the PHQ-9 (which includes the PHQ-2) during pregnancy (27-40 weeks) or postpartum (1-13 weeks). Sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio positive, likelihood ratio negative, and overall accuracy were calculated using cut points 3 or greater and 2 or greater. Results During pregnancy, PHQ-2 greater than or equal to 3 revealed low sensitivity (38.4%-44.7%) but high specificity (97.8%-99.3%). In postpartum, it revealed moderate sensitivity (56.9%-70.6%), high specificity (95.8%-99.8%), and fair overall accuracy in pregnancy (70%). The alternative threshold greater than or equal to 2 revealed very high sensitivity (pregnancy: 92.1%-95.2%; postpartum: 87.1%-95.2%), moderate specificity (pregnancy: 78.1%-83.2%; postpartum: 68.8%-81.1%) and good overall accuracy, both during pregnancy (87%) and postpartum (84%). Discussion The PHQ-2 provided acceptable accuracy for screening for depression compared with the PHQ-9. In perinatal screening practice, a threshold of 2 or greater should be preferred as this ensures high sensitivity, missing only approximately 6% to 8% of cases, and a false-positive rate (percentage of women classified as affected with depressive symptoms when they are not) of 19% to 25%

Poor social support is associated with preterm birth rather than maternal prenatal anxiety and depression: a retrospective case-control study

Maternal psychological adversities experienced during pregnancy appear to be associated with a trend towards suboptimal birth outcomes, including a shorter gestation period . Preterm birth (i.e. birth before 37 completed weeks of gestation) is the leading cause of neonatal morbidity and mortality, and is associated with adverse effects on mothers’ mental health as well as mother-child relationships . This indicates that preterm birth has a significant emotional impact on families, as well as economic implications for public-sector services. However, despite growing research on this topic, evidence of the specific effects of women’s prenatal mental health on birth outcomes remains unclear and conflicting at times. Therefore, we aimed to examine the impact of pregnant women’s psychosocial distress (specifically, anxiety, depressive symptoms, and level of perceived social support) on preterm birth. The sample for this retrospective case-control study included participants from a longitudinal investigation (2017–2018) of maternal perinatal mental health. Participant recruitment was carried out in perinatal health care centres, facilities associated with the Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Sciences, University of Brescia, Italy. This study was conducted in collaboration with the Italian National Institute of Health (Istituto Superiore di Sanità). The inclusion criteria were being pregnant or having a biological child aged ≤6 months, and being able to speak and read Italian. Exclusion criteria were being under 18 years of age, having current psychotic symptoms, or having issues with substance misuse. All participants provided written informed consent prior to entering the study. Before signing the consent form, a healthcare professional involved in the study provided each potential participant with detailed information about the study’s aims and methods, as well as the observational nature of the study. The participant information sheets and consent form made explicit the voluntary nature of their involvement and the right to wthdraw from the study at any time. Ethical approval for the study was obtained from the ethics committee of the Healthcare Centre of Bologna Hospital (Register Number: 0077805, June 27, 2017) The Psychosocial and Clinical Assessment (PCA) form was used to collect information about participants’ sociodemographic characteristics as well as obstetric, clinical, and treatment-related factors. An unstructured clinical interview was used to collect information on both past and current emotional and psychiatric conditions. Both, the PCA and the clinical interview, were administered in person by female clinical psychologists trained in perinatal mental health assessment. To compare categorical data, a X2 test or the exact Fisher’s test, whenever appropriate (n <5 in any cell), were used. All tests were two-tailed with statistical significance set at p = 0.05. All data were coded and analysed using the Statistical Package for the Social Sciences (SPSS, version 26 for Windows Chicago, Illinois 69606, USA). Two hundred and sixty-four Italian women (mean age: 34.2 years, SD: 4.8) were included in the analysis. The total sample comprised 43 mothers who had delivered preterm infants, born before 37 gestational weeks (i.e. cases), and 221 mothers who had had full-term deliveries (i.e. controls). The mean gestational age at delivery in the cases and controls was 34.4 ± 2.9 and 39.6 ± 1.1 weeks, respectively. The two groups did not differ in any sociodemographic characteristics (i.e. age, marital status, educational level, employment status, and socioeconomic status), excluding confounding for the main confounding variables, obstetric aspects (i.e. first pregnancy, history of abortions, and assisted reproductive technology), and mental health features (i.e. mild to severe anxiety or depressive symptoms during pregnancy and number of participants taking medication for anxiety or depression). Furthermore, the two groups did not differ in levels of perceived support from partners (it must be noted that more than 80% of full-term mothers and 90% of preterm mothers reported receiving enough or more than enough emotional as well as practical support from their partner). However, compared to the controls, the cases were significantly more likely to perceive less or no practical (X2 = 7.1, p = 0.029) and emotional (X2 = 6.2, p = 0.045) support from friends and relatives during pregnancy. This study contributed to the relatively scarce literature investigating the association between preterm birth and prenatal maternal mental health and social support characteristics. Our findings align with prior studies that indicated that poor social support enhanced expectant mothers’ stress levels [7], which is a significant predictive factor for preterm birth [8]. Furthermore, recent evidence suggests that support from friends attenuates pregnant women’s psychological stress across the transition to parenthood . Healthcare professionals engaged in providing care to pregnant women, such as medical general practitioners, gynaecologists, and mental health specialists need to assess the quantity and quality of future mothers’ social support (which is a factor that can affect stress levels in pregnant women), even if the pregnant woman does not have anxiety or depressive symptoms. This is necessary in order to help expectant mothers and to prevent possible adverse effects on the foetus and the neonate. In this sense, our findings can provide useful information to Italian health policy planners to consider developing cost-effective programs for the prevention of premature birth, focused on enhancing the levels of social support for pregnant women. In addition, this study may represent the first step to a more in-depth analysis investigating the perception of support from friends and relatives for mothers of preterm children. However, findings from the current study must be interpreted in light of three main limitations: i) a limited sample size, ii) lack of assessment of the level of prenatal psychological stress as a variable, and iii) lack of a structured diagnostic interview to diagnose anxiety and depressive symptoms according to DSM-5 criteria. However, it should be noted that the third limitation was attenuated by the fact that all participants were assessed by licensed clinical psychologists trained in perinatal mental health assessment. Poor social support appears to be a greater risk factor than maternal prenatal anxiety and depressive symptoms, for preterm birth. Thus, it is important for mental health specialists to consider the health and well-being of pregnant women and their future children beyond mental health symptomatology and diagnosis

Continued high prevalence of HIV, HBV and HCV among injecting and noninjecting drug users in Italy

We estimated the prevalence of HIV, HBV and HCV infections among injecting and non-injecting drug users treated within public drug-treatment centres in Italy to determine the correlates of infection. In the sample of 1330 drug users, the prevalence of HIV was 14.4% among drug injectors and 1.6% among non-injectors; the prevalence of HBV was 70.4% among injecting drug users and 22.8% among non-injectors and of HCV was 83.2% among injecting drug users and 22.0% among non-injectors. Old age, unemployment, and intravenous drug use were significantly correlated with each of the infections, as well as a longer history of injecting drug use. The results indicate that these infections continue to circulate among drug users, highlighting the need for monitoring of this group in Italy

Incidence of Newly HIV Diagnosed Cases among Foreign Migrants in Italy: 2006-2013

Objective: In Europe, during the last years the proportion of foreign migrants among AIDS and HIV cases is growing. In Italy, the number of new cases of HIV represented by foreign migrants has progressively increased, but the new HIV diagnoses incidence among foreign migrants has decreased, because of the increase in the total number of foreign migrants in recent years. Nevertheless, the new HIV diagnoses incidence among foreign migrants is still high if compared to that among Italians. The aim of the study was to analyze the characteristics of foreign migrants with a new HIV diagnosis and the new HIV diagnoses incidence among foreign migrants diagnosed in Italy between 2006 and 2013. Methods: The new diagnoses incidence was calculated as the ratio between the number of new HIV diagnoses among foreign migrants and the number of foreign migrants residing in Italy. The new HIV diagnoses incidence was compared with that among Italians using the standardized incidence ratio (SIR) adjusted by age and gender. Results: During the study period (2006-2013), of the 25,545 new diagnoses reported by the HIV surveillance system, 28.8% were among foreign migrants. The incidence of new HIV diagnoses among foreign migrants for the entire study period was 26.7 cases per 100,000 foreign migrant residents, compared to 5.1 per 100,000 among Italians. The incidence of new HIV diagnoses decreased over time for foreign migrants: from 42.5 per 100,000foreign migrant residents in 2006 to 20.0 per 100,000 foreign migrant residents in 2013, whereas for Italians it remained stable. The SIR confirmed the marked difference between the two populations: specifically the overall incidence of new diagnoses was more than four times higher among foreign migrants, compared to Italians.Conclusion: The results stress the need to reinforce the efforts aimed at reducing the circulation of HIV in this population

The continued ageing of people with AIDS in Italy: recent trend from the national AIDS Registry

Introduction. In industrialized countries, the availability of highly active antiretroviral  therapy (HAART) caused a slow but substantial ageing of the AIDS epidemic mainly  due to the longer survival of persons with HIV/AIDS which has turned HIV into a manageable, chronic disease. The number of older people with AIDS is growing in many  European countries.We described the impact of AIDS among persons aged 50 years or more in Italy and  compared the characteristics of these cases with those of persons diagnosed with AIDS  at an age younger than 50. Methods. The source of data was the Italian AIDS Registry, from 1982 to 2011. We  defined “older” persons those aged 50 years or more, and younger individuals those aged  less  than  50  years.  We  built  two  multivariate  logistic  regression  models:  the  first  one  to identify factors associated with being older, and the second one to identify AIDS-defining diseases correlated with being older. Variables with a P value of < 0.05 were  entered in the model.Results. Of the total AIDS cases, 10.5% were among persons older than 49 years. This  proportion progressively increased from 0.0% in 1983 to 26.4% in 2011. Among older  cases, the incidence of AIDS was 2.0 per 100 000 residents in 1996, then decreased  to 1.4 per 100 000 in 2000 and levelled off around 1 per 100 000 residents until 2011.  Compared to younger cases, older cases were more frequently males, Italians, diagnosed  with AIDS in recent years, residing in Northern or Central Italy, non-injecting drug users, and late testers. Discussion. These findings stress the need for physicians to consider carefully the possibility of HIV infection among older individuals not to miss the opportunity to deliver  prevention messages, offer HIV testing, and make an early diagnosis.  

Elevated risks of death for diabetes mellitus and cardiovascular diseases in Italian AIDS cases

After the introduction of highly active antiretroviral therapies (HAART), an increased incidence of insulin resistance, diabetes mellitus (DM), and cardiovascular diseases has been described. The impact of such conditions on mortality in the post-HAART era has been also assessed in various modes in the literature. In this paper, we report on the death risks for DM, myocardial infarction, and chronic ischemic heart diseases that were investigated among 9662 Italian AIDS cases diagnosed between 1999 and 2005. Death certificates reporting DM, myocardial infarction, and chronic ischemic heart diseases were reviewed to identify the underlying cause of death, and to compare the observed numbers of deaths with the expected ones from the sex- and age-matched, general population of Italy. Person-years at risk of death were computed from date of AIDS diagnosis up to date of death or to December 31, 2006. Standardized mortality ratios (SMR) and their 95% confidence intervals (CI) were computed. DM and cardiovascular diseases were the cause of death for 43 out of 3101 deceased AIDS cases (i.e., 1.4% of all deaths). In comparison with the general population, the risks of death were 6.4-fold higher for DM (95% CI:3.5-10.8), 2.3-fold higher for myocardial infarction (95% CI:1.4-3.7) and 3.0 for chronic ischemic heart diseases (95% CI: 1.5-5.2)

The Impact of the COVID-19 Pandemic on Women's Perinatal Mental Health: Preliminary Data on the Risk of Perinatal Depression/Anxiety from a National Survey in Italy

Increasing evidence suggests that during the COVID-19 pandemic, anxiety and depression during the perinatal period increased. The aim of the study is to estimate the prevalence of risk for both maternal depression and anxiety among women attending 18 healthcare centres in Italy during the SARS-COV-2 pandemic and to investigate the psychosocial risks and protective factors associated. It was divided into a retrospective phase (2019, 2020, and the first nine months of 2021) and a prospective phase (which began in November 2021 and it is still ongoing), which screened 12,479 and 2349 women, respectively, for a total of 14,828 women in the perinatal period. To evaluate the risk of anxiety and depression, the General Anxiety Disorder-7 (GAD-7), the Edinburgh Postnatal Depression Scale (EPDS), and an ad hoc form were used to collect sociodemographic variables. In the prospective study, the average age of the women is 31 (range 18-52) years. Results showed that the percentage of women who had EPDS score ≥9 increased from 11.6% in 2019 to 25.5% in the period ranging from November 2021 to April 2022. In logistic regression models, the variables associated with the risk of depression at a level ≤0.01 include having economic problems (OR 2.16) and not being able to rely on support from relatives or friends (OR 2.36). Having the professional status of the housewife is a lower risk (OR 0.52). Those associated with the risk of anxiety include being Italian (OR 2.97), having an education below secondary school level (OR 0.47), having some or many economic problems (OR 2.87), being unable to rely on support from relatives or friends (OR 2.48), and not having attended an antenatal course (OR 1.41). The data from this survey could be useful to determine the impact of the SARS-COV-2 pandemic on women and to establish a screening program with common and uniformly applied criteria which are consistent with national and international women's mental health programs

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection