Factors associated with anxiety and depression in rheumatoid arthritis patients: a cross-sectional study

BACKGROUND: The management of anxiety and depression symptoms in rheumatoid arthritis (RA) patients is vital. Previous study findings on this topic are conflicting, and the topic remains to be thoroughly investigated. This study aimed to clarify the association of RA disease activity with anxiety and depression symptoms after controlling for physical disability, pain, and medication. METHODS: We conducted a cross-sectional study of RA patients from the XXX Rheumatoid Arthritis Management Alliance cohort. We assessed patients using the Disease Activity Score (DAS28), Health Assessment Questionnaire Disability Index (HAQ-DI), and Hospital Anxiety and Depression Scale (HADS). Anxiety and depression symptoms were defined by a HADS score ≥ 8. We analyzed the data using multivariable logistic regression analyses. RESULTS: Of 517 participants, 17.6% had anxiety symptoms and 27.7% had depression symptoms. The multivariable logistic regression analysis demonstrated that DAS28 was not independently associated with anxiety symptoms (odds ratio [OR] [95% confidence interval; CI] 0.93 [0.48-1.78]; p = 0.82) and depression symptoms (OR [95% CI] 1.45 [0.81-2.61]; p = 0.22). However, DAS28 patient global assessment (PtGA) severity was associated with anxiety symptoms (OR [95% CI] 1.15 [1.02-1.29]; p = 0.03) and depression symptoms (OR [95% CI] 1.21 [1.09-1.35]; p < 0.01). Additionally, HAQ-DI scores ≤ 0.5 were associated with anxiety symptoms (OR [95% CI] 3.51 [1.85-6.64]; p < 0.01) and depression symptoms (OR [95% CI] 2.65 [1.56-4.50]; p < 0.01). Patients using steroids were more likely to have depression than those not using steroids (OR [95% CI] 1.66 [1.03-2.67]; p = 0.04). CONCLUSIONS: No association was found between RA disease activity and anxiety and depression symptoms in the multivariable logistic regression analysis. Patients with high PtGA scores or HAQ-DI scores ≤ 0.5 were more likely to experience anxiety and depression symptoms, irrespective of disease activity remission status. Rather than focusing solely on controlling disease activity, treatment should focus on improving or preserving physical function and the patient's overall sense of well-being

Approaches to suicide prevention: Ideas and models presented by Japanese and international early career psychiatrists

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146308/1/pcn12737.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146308/2/pcn12737_am.pd

Prognostic factors and effect modifiers for personalisation of internet-based cognitive behavioural therapy among university students with subthreshold depression: A secondary analysis of a factorial trial

BACKGROUND: Internet-cognitive behavioural therapy (iCBT) for depression can include multiple components. This study explored depressive symptom improvement prognostic factors (PFs) and effect modifiers (EMs) for five common iCBT components including behavioural activation, cognitive restructuring, problem solving, self-monitoring, and assertion training. METHODS: We used data from a factorial trial of iCBT for subthreshold depression among Japanese university students (N = 1093). The primary outcome was the change in PHQ-9 scores at 8 weeks from baseline. Interactions between each component and various baseline characteristics were estimated using a mixed-effects model for repeated measures. We calculated multiplicity-adjusted p-values at 5 % false discovery rate using the Benjamini-Hochberg procedure. RESULTS: After multiplicity adjustment, the baseline PHQ-9 total score emerged as a PF and exercise habits as an EM for self-monitoring (adjusted p-values <0.05). The higher the PHQ-9 total score at baseline (range: 5-14), the greater the decrease after 8 weeks. For each 5-point increase at baseline, the change from baseline to 8 weeks was bigger by 2.8 points. The more frequent the exercise habits (range: 0-2 points), the less effective the self-monitoring component. The difference in PHQ-9 change scores between presence or absence of self-monitoring was smaller by 0.94 points when the participant exercised one level more frequently. Additionally, the study suggested seven out of 36 PFs and 14 out of 160 EMs examined were candidates for future research. LIMITATIONS: Generalizability is limited to university students with subthreshold depression. CONCLUSIONS: These results provide some helpful information for the future development of individualized iCBT algorithms for depression

Components of smartphone cognitive-behavioural therapy for subthreshold depression among 1093 university students: a factorial trial

BACKGROUND: Internet-based cognitive-behavioural therapy (iCBT) is effective for subthreshold depression. However, which skills provided in iCBT packages are more effective than others is unclear. Such knowledge can inform construction of more effective and efficient iCBT programmes. OBJECTIVE: To examine the efficacy of five components of iCBT for subthreshold depression. METHODS: We conducted an factorial trial using a smartphone app, randomly allocating presence or absence of five iCBT skills including self-monitoring, behavioural activation (BA), cognitive restructuring (CR), assertiveness training (AT) and problem-solving. Participants were university students with subthreshold depression. The primary outcome was the change on the Patient Health Questionnaire-9 (PHQ-9) from baseline to week 8. Secondary outcomes included changes in CBT skills. FINDINGS: We randomised a total of 1093 participants. In all groups, participants had a significant PHQ-9 reduction from baseline to week 8. Depression reduction was not significantly different between presence or absence of any component, with corresponding standardised mean differences (negative values indicate specific efficacy in favour of the component) ranging between -0.04 (95% CI -0.16 to 0.08) for BA and 0.06 (95% CI -0.06 to 0.18) for AT. Specific CBT skill improvements were noted for CR and AT but not for the others. CONCLUSIONS: There was significant reduction in depression for all participants regardless of the presence and absence of the examined iCBT components. CLINICAL IMPLICATION: We cannot yet make evidence-based recommendations for specific iCBT components. We suggest that future iCBT optimisation research should scrutinise the amount and structure of components to examine. TRIAL REGISTRATION NUMBER: UMINCTR-000031307

A Call for a Rational Polypharmacy Policy: International Insights From Psychiatrists

OBJECTIVE: Recently, rational polypharmacy approaches have been proposed, regardless of the lower risk and cost of monotherapy. Considering monotherapy as first-line treatment and polypharmacy as rational treatment, a balanced attitude toward polypharmacy is recommended. However, the high prevalence of polypharmacy led the Japanese government to establish a polypharmacy reduction policy. Based on this, the association between the policy and psychiatrists' attitude toward polypharmacy has been under debate. METHODS: We developed an original questionnaire about Psychiatrists' attitudes toward polypharmacy (PAP). We compared the PAP scores with the treatment decision-making in clinical case vignettes. Multiple regression analyses were performed to quantify associations of explanatory variables including policy factors and PAP scores. The anonymous questionnaires were administered to psychiatrists worldwide. RESULTS: The study included 347 psychiatrists from 34 countries. Decision-making toward polypharmacy was associated with high PAP scores. Multiple regression analysis revealed that low PAP scores were associated with the policy factor (β=-0.20, p=0.004). The culture in Korea was associated with high PAP scores (β=0.34, p<0.001), whereas the culture in India and Nepal were associated with low scores (β=-0.15, p=0.01, and β=-0.17, p=0.006, respectively). CONCLUSION: Policy on polypharmacy may influence psychiatrists' decision-making. Thus, policies considering rational polypharmacy should be established

関節リウマチ患者の身体的状態が精神的健康を媒介し疼痛へ与える影響

京都大学0048新制・課程博士博士(医学)甲第21630号医博第4436号新制||医||1033(附属図書館)京都大学大学院医学研究科医学専攻(主査)教授 古川 壽亮, 教授 髙橋 良輔, 教授 妻木 範行学位規則第4条第1項該当Doctor of Medical ScienceKyoto UniversityDFA

Probabilistic Dynamics of Wind Excitation on Glass Facade

In recent years there are many buildings the facades of which are filled with glass material. As this tendency continues, new types of glass material, support system and structure have been developed. On the other hand, wind is one of the main loads on the glass facades and it is a dynamic load. However, dynamic character of these new facades are not known and glass is known to have low damping. The danger of vibrations on glass facades caused by wind is pointed out. The first aim of this study is to estimate the dynamic character of the glass facade and to obtain the dynamic wind load on a glass facade. First, the characters of natural dynamic wind were studied and velocity pressure of natural wind was numerically produced. Vibration of the glass facades under fluctuating natural wind were simulated in time series. The simulation has been carried out on glass facades with ESG (Einscheiben-Sicherheits-Glas; Single Panel Safety Glass), with areas of 2.5-6.0m2. The glass plates are along the edges linearly supported or at the points by the fittings. The results of the time series simulations were transformed into spectra by FFT(Fast Fourier Transform). In the spectrum of the deformation of the large surface area and point-support glass, the resonance effect are recognized around the first natural frequency of the facades. By using results of the time series calculation of motion of the facade, the motion-induced wind load is calculated backwards. The sum of the fluctuating natural wind load and the motion-induced wind load is the total wind load which acts on the facade element. The problem of fatigue for the glass material is pointed out and a fatigue analysis is needed. For the fatigue analysis of glass, the S-N curve (Wöhler curve) and loading-cycle are necessary. The second aim of this thesis is to estimate the loading-cycle of wind during the lifetime of the facade. There are a few counting methods of the loading-cycle from a time series random force. But in this study a new method to make a loading-cycle model from a spectrum of the load is suggested. By using the spectrum, frequency information is well reflected in the loading-cycle model. First, the loading-cycle of 10 minutes under each wind condition was calculated by using this new method. Then the loading cycle model which is equivalent to the entire lifetime of the structure is probabilistically derived. Appearance ratio of the 10 minute mean wind velocity is known to fit the Weibull distribution. Considering a loading-cycle of each 10-minute wind and the appearance ratio of these wind conditions, the loading cycle model of 50 years can be calculated. By using this method, loading-cycles on glass facades built at heights of 20 m and 50 m for buildings that are located in Frankfurt and Hamburg were calculated

Providing Brief Personalized Therapies for Insomnia Among Workers Using a Sleep Prompt App: Randomized Controlled Trial

スマートフォンアプリによる睡眠改善の効果を実証 --ショート・メッセージによる行動変容技術の有効性--. 京都大学プレスリリース. 2022-07-26.[Background:] Insomnia is the most common sleep disorder and the foremost health concern among workers. We developed a new sleep prompt app (SPA) for smartphones to positively alter the users' consciousness and behavior by sending timely short messages for mild sleep problems at an early stage. [Objective:] The aim of this study is to investigate the effectiveness of the SPA in providing brief personalized therapy for insomnia among workers. [Methods:] We conducted a 2-arm parallel randomized controlled trial. The intervention group used the SPA, and the control group received no intervention. Participants were recruited between November 2020 and January 2021. The researcher sent emails for recruitment to more than 3000 workers of 2 companies and 1 university in Japan. The SPA provided personalized prompt messages, sleep diaries, sleep hygiene education, stimulus control therapy, and sleep restriction therapy. The prompt messages were sent automatically to the participants to encourage them to improve their sleep habits and sleep status and were optimized to the individual's daily rhythm. The intervention program duration was 4 weeks. The primary outcome was a change in the Insomnia Severity Index (ISI) for the study period. The ISI was obtained weekly using a web questionnaire. [Results:] A total of 116 Japanese workers (intervention group n=60, control group n=56) with sleep disorders were recruited. Two participants in the intervention group were excluded from the analyses because of challenges in installing the SPA. The mean ISI scores at baseline were 9.2 for both groups; however, after 4 weeks, the mean ISI scores declined to 6.8 and 8.0 for the intervention and control groups, respectively. Primary analysis using a linear mixed model showed a significant improvement in the temporal trends of the ISI in the SPA group and in the total population (P=.03). Subgroup analyses of ISI-8-insomniacs revealed a significant improvement in the temporal trends of ISI in the SPA group (P=.01), and the CFS score for physical condition significantly improved following the intervention (P=.02). [Conclusions:] This study demonstrates the effectiveness of the SPA in providing brief personalized therapy for insomnia among Japanese workers with mild insomnia. The physical fatigue score significantly improved in ISI-8-insomniacs. Thus, SPA could play an important role in reducing the adverse effects of sleep disorders in workers. To promote the wide use of the SPA in the future, further studies are required to examine its effectiveness in other age groups and individuals with health problems. [Trial Registration:] University Medical Information Network Clinical Trials Registry (UMIN-CTR) UMIN000042263; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R00004629