Browsing by Subject "Depression"
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Item 4. Getting A Grip On My Depression: A Grounded Theory Explaining How Latina Adolescents Experience, Self-Manage, And Seek Treatment For Depressive Symptoms(Journal of Adolescent Health, 2019) McCord Stafford, Allison; Aalsma, Matthew C.; Bigatti, Silvia M.; Oruche, Ukamaka M.; Burke Draucker, ClaireLatina adolescents are more likely to experience depressive symptoms and less likely to receive mental health services than White peers. Although evidence-based treatments exist to treat adolescent depression, few treatments have been modified to meet the cultural needs of this population. In order to develop culturally sensitive strategies for preventing, identifying, and treating depressive symptoms in Latina adolescents, it is necessary to understand how they experience, self-manage, and seek treatment for their depressive symptoms over time from their own perspective. The purpose of this study was to develop a theoretical framework that explains how Latina adolescents experience, self-manage, and seek treatment for their depressive symptoms.Item (506) The complex relationship between pain intensity and physical functioning in fibromyalgia: the mediating role of depression(The Journal of Pain, 2016) Steiner, Jennifer L.; Bigatti, Silvia M.; Slaven, James E.; Ang, Dennis C.Fibromyalgia (FM) is typically associated with the experience of diffuse pain and physical impairment. Depression also commonly co-exists in patients with FM, and it has been correlated with pain intensity and physical functioning. Previous research suggests an association between pain intensity and physical functioning; however, the direct causal relationship between improvements in pain intensity and in functioning is not observed in many FM patients. This may suggest that another factor such as depression is mediating this relationship. The present work examined the possibility of a mediating role of depression in the relationship between pain intensity and functioning over the course of time. 216 patients with FM completed self-report measures of pain intensity, depression, and physical impairment as part of a larger longitudinal study which investigated interventions to increase physical activity among FM patients. Assessments were completed at baseline, 12 weeks, 24 weeks, and 36 weeks. Longitudinal mediational analyses indicated that depression is a statistically significant partial mediator of the relationship between pain intensity and self-reported physical functioning at all four assessment points. To the authors’ knowledge, this is the first study to explicitly examine this relationship in a sample of FM patients, as well as the first to do so using a longitudinal design; this may significantly add to our understanding of the complexities behind creating improvements in physical functioning in this population. Clinical implication for these findings include focusing on depression and psychological correlates of depression as first line therapeutic targets in improving physical functioning of patients with FM, and treating co-morbid depression in patients with fibromyalgia earlier in the course of treatment to prevent engagement in and the perpetuation of the cycle of disability. This work was a secondary data analysis from a study funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases.Item A cross-validation of the provisional diagnostic instrument (PDI-4)(Springer Nature, 2012-10-15) Faries, Douglas E.; Houston, John P.; Sulcs, Ellen M.; Swindle, Ralph W.; Psychiatry, School of MedicineBackground: The Provisional Diagnostic Instrument (PDI-4) is a brief, adult self-report instrument for 4 common psychiatric diagnoses in primary care patients: major depressive episode (MDE), generalized anxiety disorder (GAD), attention deficit hyperactivity disorder (ADHD), and bipolar I disorder based on past or present mania. Our objective was to assess validity of the PDI-4 in a population independent of the study population originally used to develop the scale. Methods: An online version of the 17-item PDI-4 was administered to 1,047 adults in the US; respondents also completed the PHQ-9, HADS-A, CAARS-S, and MDQ within the online survey. Respondents self-reported diagnosis by a healthcare professional with the terms depression (n=221), anxiety (n=218), attention deficit disorder (n=206), bipolar or manic depressive disorder (n=195), or none of these (n=207). Statistical analyses examined convergent and discriminant validity, and operating characteristics of the PDI-4 relative to the individual, validated, self-rated scales PHQ-9, HADS-A, CAARS-S, and MDQ, for each PDI-4 diagnosis. Results: Convergent validity of the PDI-4 was supported by strong correlations with the corresponding individual scales (range of 0.63 [PDI-4 and MDQ] to 0.87 [PDI-4 and PHQ-9]). Operating characteristics of the PDI-4 were similar to results in the previous site-based study. The scale exhibited moderate sensitivities (0.52 [mania] to 0.70 [ADHD]) and strong specificities (0.86 [mania] to 0.92 [GAD]) using the individual scales as the gold standards. ANOVAs demonstrated that PDI-4 discriminated between subsets of patients defined by pre-specified severity level cutoff scores of the individual scales. However, overlapping symptoms and co-morbidities made differentiation between mental diagnoses much weaker than differentiation from the control group with none of the diagnoses. Conclusions: The PDI-4 appears to be a suitable, brief, self-rated tool for provisional diagnoses of common mental disorders. However, the high level of symptom overlap between these diagnoses emphasizes that such brief scales are not a replacement for thorough diagnostic evaluation by trained medical providers.Item A Model of Community-Based Behavioral Intervention for Depression in Diabetes: Program ACTIVE(American Diabetes Association, 2010) de Groot, Mary; Kushnick, Michael; Doyle, Todd; Merrill, Jennifer; McGlynn, Mark; Shubrook, Jay; Schwartz, Frank; Medicine, School of MedicineDepression affects one in four people with diabetes and significantly affects diabetes health. Earlier studies of the treatment of depression have documented that cognitive behavioral therapy (CBT) and exercise have each been found to be effective in treating depression in people with and without diabetes in the context of medical settings. Individuals in rural areas lack regular access to medical centers and require treatment options that may be adapted for local communities. To date, no studies have combined CBT and exercise for people with diabetes. This article presents a translational behavioral depression intervention study designed for individuals with type 2 diabetes in a rural Appalachian region as a model of an interdisciplinary approach to the treatment of depression in diabetes.Item A Patient-Centered Nurse-Supported Primary care-based Collaborative Care Program to Treat Opioid Use Disorder and Depression: Design and Protocol for the MI-CARE Randomized Controlled Trial(Elsevier, 2023) DeBar, Lynn L.; Bushey, Michael A.; Kroenke, Kurt; Bobb, Jennifer F.; Schoenbaum, Michael; Thompson, Ella E.; Justice, Morgan; Zatzick, Douglas; Hamilton, Leah K.; McMullen, Carmit K.; Hallgren, Kevin A.; Benes, Lindsay L.; Forman, David P.; Caldeiro, Ryan M.; Brown, Ryan P.; Campbell, Noll L.; Anderson, Melissa L.; Son, Sungtaek; Haggstrom, David A.; Whiteside, Lauren; Schleyer, Titus K. L.; Bradley, Katharine A.; Psychiatry, School of MedicineBackground: Opioid use disorder (OUD) contributes to rising morbidity and mortality. Life-saving OUD treatments can be provided in primary care but most patients with OUD don't receive treatment. Comorbid depression and other conditions complicate OUD management, especially in primary care. The MI-CARE trial is a pragmatic randomized encouragement (Zelen) trial testing whether offering collaborative care (CC) to patients with OUD and clinically-significant depressive symptoms increases OUD medication treatment with buprenorphine and improves depression outcomes compared to usual care. Methods: Adult primary care patients with OUD and depressive symptoms (n ≥ 800) from two statewide health systems: Kaiser Permanente Washington and Indiana University Health are identified with computer algorithms from electronic Health record (EHR) data and automatically enrolled. A random sub-sample (50%) of eligible patients is offered the MI-CARE intervention: a 12-month nurse-driven CC intervention that includes motivational interviewing and behavioral activation. The remaining 50% of the study cohort comprise the usual care comparison group and is never contacted. The primary outcome is days of buprenorphine treatment provided during the intervention period. The powered secondary outcome is change in Patient Health Questionnaire (PHQ)-9 depression scores. Both outcomes are obtained from secondary electronic healthcare sources and compared in "intent-to-treat" analyses. Conclusion: MI-CARE addresses the need for rigorous encouragement trials to evaluate benefits of offering CC to generalizable samples of patients with OUD and mental health conditions identified from EHRs, as they would be in practice, and comparing outcomes to usual primary care. We describe the design and implementation of the trial, currently underway.Item Accuracy of Alternative PHQ-9 Scoring Algorithms to Screen for Depression in People Living With HIV in Sub-Saharan Africa(Wolters Kluwer, 2025) Bernard, Charlotte; Font, Hélène; Zotova, Natalia; Wools-Kaloustian, Kara; Goodrich, Suzanne; Kamaru Kwobah, Edith; Rogers Awoh, Ajeh; Nko'o Mbongo'o, Guy Calvin; Nsonde, Dominique Mahambu; Gandou, Paul; Minga, Albert; Tine, Judicaël Malick; Ndiaye, Ibrahima; Dabis, François; Seydi, Moussa; de Rekeneire, Nathalie; Yotebieng, Marcel; Jaquet, Antoine; IeDEA Cohort Collaboration; Medicine, School of MedicineBackground: Screening for depression remains a priority for people living with HIV (PLWH) accessing care. The 9-item Patient Health Questionnaire (PHQ-9) is a widely used depression screening tool, but has limited accuracy when applied across various cultural contexts. We aimed to evaluate the performance of alternative PHQ-9 scoring algorithms in sub-Saharan African PLWH. Setting: Five HIV programs in Cameroon, Côte d'Ivoire, Kenya, Senegal, and the Republic of Congo. Methods: Adult PLWH were screened for depression during the 2018-2022 period. Diagnosis confirmation was done by psychiatrist blinded clinical evaluation (gold standard). Diagnostic performances, including sensitivity and area under the curve (AUC) of the traditional PHQ-9 scoring (positive screening - score ≥ 10), were compared to alternative scoring algorithms including (1) the presence of ≥1 mood symptom (PHQ-9 items 1 and 2) combined with ≥2 other symptoms listed in the PHQ-9, and (2) a simplified recoding of each 4-response item into 2 categories (absence/presence). Results: A total of 735 participants were included [54% women, median age 42 years (interquartile range 34-50)]. Depression was diagnosed by a psychiatrist in 95 (13%) participants. Alternative scoring sensitivities (0.59-0.74) were higher than that of the traditional score's (0.39). Compared to traditional scoring, AUC was significantly higher for PHQ-9 alternative scoring. Across settings, alternative scoring algorithms increased sensitivity and reduced variability. Conclusions: As a primary screening test, new scoring algorithms seemed to improve the PHQ-9 sensitivity in identifying depression and reducing heterogeneity across settings. This alternative might be considered to identify PLWH in need of referral for further diagnostic evaluations.Item Accuracy of nine-item Patient Health Questionnaire against psychiatric diagnosis for depression among people with HIV(Wolters Kluwer, 2024) Yotebieng, Marcel; Zotova, Natalia; Bernard, Charlotte; Goodrich, Suzanne; Rogers Awoh, Ajeh; Watnick, Dana; Nsonde, Dominique Mahambu; Tchiengang Moungang, Elodie Flore; Nguemo Noumedem, Julie Laure; Nko'o Mbongo'o, Guy Calvin; Minga, Albert; Seydi, Moussa; Gandou, Paul; Kwobah, Edith Kamaru; Atwoli, Lukoye; Jaquet, Antoine; Wools-Kaloustian, Kara; Anastos, Kathryn; IeDEA Consortium; Medicine, School of MedicineObjective: The aim of this study was to assess the performance of the nine-item Patient Health Questionnaire (PHQ-9) against psychiatrist diagnosis in people with HIV (PWH). Design: Cross-sectional analysis of data collected between January 2018 and July 2022 across five sites in Cameroon, Cote d'Ivoire, Kenya, Senegal, and the Republic of Congo. Participants were ≥18 years and receiving HIV care at the participating site. PHQ-9 was administered by study staff followed by a psychiatrist's evaluation within 3 days. Results: Overall, 778 participants with complete data were included: 297 (38.2%) in Cameroon, 132 (17.0%) in Congo, 148 (19.0%) in Cote d'Ivoire, 98 (12.6%) in Kenya, and 103 (13.2%) in Senegal. The area under the curve for PHQ-9 score was generally high ranging from 0.935 [95% confidence interval (CI): 0.893, 0.977] in Cote d'Ivoire to 0.768 (95% CI: 0.589, 0.947) in Congo. However, for the common cut-off score ≥10, sensitivity was low: 50% or lower in Cameroon, Congo and Senegal, 66.7% in Kenya and 70.6% in Cote d'Ivoire. But negative predictive values (NPV) were high: 98.9% (95% CI: 96.9%, 99.8%) in Cameroon, 96.1 (95% CI: 91.1, 98.7) in Cote d'Ivoire, 96.3% (95% CI: 89.7%, 99.2%) in Kenya, 95.7% (95% CI: 90.2%, 98.6%) in Congo, and 89.0% (95% CI: 81.2%, 94.4%) in Senegal. Interpretation: Across all countries, PHQ-9 score ≥10 performed very poorly (low sensitivity) as a tool to identify psychiatrist diagnosed depression. However, the observed high NPV suggests it can be used to rule out depression.Item Accuracy of PHQ-9 Against Psychiatric Diagnosis for Depression Among People Living with HIV: A Mixed-Method Study in Cameroon, Kenya, and the Republic of Congo(Elsevier, 2022-05-13) Yotebieng, Marcel; Zotova, Natalia; Watnick, Dana; Goodrich, Suzanne; Rogers Awoh, Ajeh; Mahambu Nsonde, Dominique; Tchiengang Moungang, Elodie Flore; Nguemo Noumedem, Julie Laure; Mbongo'o Nko'o, Guy Calvin; Gandou, Paul; Kamaru Kwobah, Edith; Atwoli, Lukoye; Wools-Kaloustian, Kara; Anastos, Kathryn; Medicine, School of MedicineBackground: Depression is highly prevalent among people living with HIV (PLWH) and is known to negatively impact HIV care and HIV clinical outcomes. Integration of depression management into HIV care is challenging because of the difficulties identifying depression. The aim of this study was to assess the performance of the 9-item Patient Health questionnaire (PHQ-9) as a diagnostic instrument against psychiatrist diagnosis in PLWH. Methods: Data were collected between January 2018 and June 2021 across three sites in Cameroon, Kenya, and the Republic of Congo. Participants were ≥18 years, diagnosed with HIV between 3-24 months prior to enrollment. PHQ-9 was administered by study staff followed by a psychiatrist’s evaluation within 3 days. In Cameroon, in-depth qualitative and cognitive interviews were conducted with a sub-sample of participants. Results: Overall, 530 participants with complete data were included: 300 (56.6%) in Cameroon, 132 (24·9%) in Congo, and 98 (18·5%) in Kenya. PHQ-9 was highly accurate in excluding current depression, with areas under the curve for the continuous PHQ-9 score from 0·888 (95% CI: 0·784, 0·992) in Cameroon, 0·802 (95% CI: 0·603, 1·00) in Kenya, to 0·768 (95% CI: 0·589, 0·947) in Congo and negative predictive values (NPV) of 98·9% (95% CI: 96·9%, 99·8%) in Cameroon, 95·7% (95% CI: 90·2%, 98·6%) in Congo, and 96·3% (95% CI: 89·7%, 99·2%) in Kenya for a score >9. However, its sensitivity and positive predictive value (PPV) were generally low, ranging respectively, from 50·0% (95% CI: 11·8%, 88·2%) and 17·7% (3·8%, 43·3%) in Cameroon, 50·0% (95% CI: 18·7%, 81·3%) and 29·4% (95% CI: 10·3%, 56·0%) in Congo, to 66·7% (95% CI: 29·9%, 92·5%) and 37·5% (95% CI: 15·2%, 64·6%) in Kenya for scores >9. Cognitive interviews identified challenges in understanding some questions as well as processing response categories. Interpretation: PHQ-9 performed very poorly (low sensitivity and PPV) as a tool to identify psychiatrist diagnosed depression and caution must be exercised before using it as the only guide to initiating PLWH on pharmacological treatment. However, the observed high NPV suggests it can be used to rule out depression or to identify those to be referred for further evaluation.Item Additive Impact of Cardiometabolic Multimorbidity and Depression on Cognitive Decline: Findings from Multi‐Regional Cohorts and Generalization from Community to Clinic(Wiley, 2025-01-09) Zhao, Xuhao; Yan, Yifan; Lipnicki, Darren M.; Pang, Ting; Chen, Christopher; Wong, Tien Yin; Cheng, Ching Yu; Venketasubramanian, Narayanaswamy; Chong, Eddie; Costa, Erico; Lipton, Richard B.; Katz, Mindy J.; Ritchie, Karen; Carriere, Isabelle; Scarmeas, Nikolaos; Gureje, Oye; Hendrie, Hugh C.; Gao, Sujuan; Guerra, Ricardo Oliveira; Rolandi, Elena; Riedel-Heller, Steffi G.; Ganguli, Mary; Aiello, Allison E.; Ho, Roger Chun-Man; Sanchez-Juan, Pascual; Lobo, Antonio; Sachdev, Perminder S.; Xu, Xiaolin; Xu, Xin; Psychiatry, School of MedicineBackground: To estimate the additive associations of cardiometabolic multimorbidity (CMM) and depression on long‐term cognitive trajectory in multi‐regional cohorts and validate the generalizability of the findings in varying clinical settings. Method: Data harmonization was performed across 14 longitudinal cohort studies within the Cohort Studies of Memory in an International Consortium (COSMIC) group, spanning North America, South America, Europe, Africa, Asia, and Australia. Three external validation studies with distinct settings were employed to assess generalizability. Cross‐sectional and longitudinal analyses were conducted. CMM was defined as: 1) CMM5: ≥ 2 among hypertension, hyperlipidemia, diabetes mellitus, stroke, and heart disease and 2) CMM3 (aligned with previous studies): ≥ 2 among diabetes mellitus, stroke, and heart disease. Depression was identified using the Geriatric Depression Scale, Center for Epidemiological Studies‐Depression scale, or medical history. A one‐step individual participant data meta‐analysis was utilized to investigate associations between the co‐occurrence of CMM and depression and cognitive outcomes in the COSMIC studies. Stratified analyses were conducted based on baseline dementia status, demographics, and APOE genotype. Repeated analyses were performed in external validation studies for generalization. Result: Of the 32,450 older adults in the 14 COSMIC cohorts, we included 31,243 participants with complete data on CMM, depression, and cognitive assessment for cross‐sectional analyses. Among them, 23,242 who had at least 1 follow‐up cognitive assessment were included in the longitudinal analyses. From the three external studies we included 1964 participants, representing 3 multi‐ethnic Asian elderly cohorts (community cohort, memory clinic cohort, and stroke cohort). In the COSMIC studies analysis, the co‐occurrence of CMM and depression was associated with both cross‐sectional cognitive performance (β = ‐0.20, 95%CI = (‐0.25,‐0.16) for CMM5 and depression, β = ‐0.17, (95%CI = ‐0.044,‐0.031) for CMM3 and depression), and rate of cognitive decline (β = ‐0.038, 95%CI = (‐0.25,‐0.16) for CMM5 and depression, β = ‐0.023, (95%CI = ‐0.036, ‐0.009) for CMM3 and depression). This combined effect remained consistent across different subgroups particularly among participants without dementia. These findings were reproduced in the three external validation studies. Conclusion: Our study demonstrated an additive effect between CMM and depression on cognitive decline. Targeting both cardiometabolic and psychological conditions could lead to greater effectiveness in delaying or preventing cognitive decline.Item Adherence to escitalopram treatment in depression: a study of electronically compiled dosing histories in the ‘Depression: the search for phenotypes’ study(Wolters Kluwer, 2012) Wessels, Alette M.; Jin, Yuyan; Pollock, Bruce G.; Frank, Ellen; Lange, Anne-Catherine; Vrijens, Bernard; Fagiolini, Andrea; Kupfer, David J.; Rucci, Paola; Kepple, Gail; Anderton, Joel; Buttenfield, Joan; Bies, Robert R.; Medicine, School of MedicinePoor adherence to depression treatment is common. Understanding determinants of poor adherence to therapy is crucial to ensure optimal clinical outcomes. The aim of this study was to describe characteristics of dosing history in participants with depression receiving once daily escitalopram. Participants were randomly assigned to interpersonal psychotherapy (IPT) or pharmacotherapy. Participants assigned to IPT who did not evidence a response or remission had escitalopram added to their treatment. Adherence to pharmacotherapy was assessed using an electronically monitored pill cap (MEMS). Fifty-four participants on escitalopram alone and 32 on escitalopram+IPT were monitored. After 200 days, 71.7% of the participants in the escitalopram group and 54.8% of those in the escitalopram+IPT group were still engaged with the dosing regimen. Of those engaged in the dosing regimen, 17.9% (average over 210 days) of the participants did not take their medication (nonexecution). In 69% of the days participants took the correct dosage required. On average, participants had three drug holidays and the mean length of a holiday was 7 days per patient. No difference in adherence patterns was observed between patients receiving escitalopram alone vs. IPT+escitalopram. Early discontinuation of treatment and suboptimal daily execution of the prescribed regimen are the most common facets of poor adherence in this study population.