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1.
Curr Opin Psychiatry ; 34(4): 434-443, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1637741

ABSTRACT

PURPOSE OF REVIEW: To reduce the spread of infection from the coronavirus disease 2019 (COVID-19), mental healthcare facilities were forced to make the rapid transition from face-to-face services to virtual care. This systematic review aims to synthesize the extant literature reporting on barriers of telemental health (TMH) during the COVID-19 pandemic and how facilities have worked to overcome these barriers, to inform best practices for TMH delivery. RECENT FINDINGS: Most recent findings came from case studies from mental health professionals which reported on barriers related to institutional, provider and patient factors, and how these barriers were overcome. Common barriers identified in the literature include: technological difficulties; issues regarding safety, privacy and confidentiality; therapeutic delivery and the patient-provider relationship; and a loss of sense of community. Studies also reported on the benefits to TMH interventions/tools, as well as suggestions for improvements in the delivery of TMH services. SUMMARY: As the COVID-19 pandemic evolves, mental healthcare providers continue to find creative and feasible solutions to overcome barriers to the delivery of TMH. Dissemination of these solutions is imperative to ensure the best quality of mental healthcare for patients across the globe.


Subject(s)
COVID-19/prevention & control , Health Services Accessibility/statistics & numerical data , Mental Disorders/therapy , Mental Health Services , Quality Improvement , Telemedicine/methods , COVID-19/psychology , Humans , Mental Disorders/psychology , Pandemics , SARS-CoV-2
2.
S Afr Med J ; 111(2): 13204, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1636958
3.
Curr Opin Psychiatry ; 34(4): 351-356, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1635161

ABSTRACT

PURPOSE OF REVIEW: The COVID-19 pandemic and associated restrictions have uniquely and disproportionately affected vulnerable populations. This review summarizes recent evidence on the relationship between psychiatric disorders, substance use disorders and COVID-19, highlighting acute and long-term risks, pharmacotherapy interactions and implications regarding appropriate and timely evidence-based treatment. RECENT FINDINGS: Evidence points to a complex relationship between psychiatric and substance use disorders and COVID-19. A range of risk factors associated with psychiatric and substance use disorders increases the risk of exposure to, and complications arising from, the COVID-19 virus. COVID-19 infection has been indicated as having acute and potential long-term impacts on both psychiatric and substance use disorders. Social disruption associated with restrictions imposed to curb transmission has also been identified as a risk factor for new onset of disorders and recurrence and exacerbation of existing conditions. SUMMARY: Early recognition and intervention are key to preventing chronic disability associated with psychiatric disorders, substance use disorders, and their co-occurrence. It is critical that those most in need of services do not fall through the cracks of our healthcare systems. The pandemic has fast tracked the opportunity for widespread implementation of digital health interventions but ensuring these are accessible and available to all, including our most vulnerable, will be a critical task for our future health and social ecosystems.


Subject(s)
COVID-19/complications , COVID-19/psychology , Mental Disorders/complications , Mental Disorders/psychology , Substance-Related Disorders/complications , Substance-Related Disorders/psychology , Drug Interactions , Humans , Mental Disorders/drug therapy , Pandemics , Risk Factors , SARS-CoV-2 , Vulnerable Populations/psychology
5.
PLoS One ; 17(1): e0262363, 2022.
Article in English | MEDLINE | ID: covidwho-1622363

ABSTRACT

AIM/GOAL/PURPOSE: Population surveys underrepresent people with severe mental ill health. This paper aims to use multiple regression analyses to explore perceived social support, loneliness and factor associations from self-report survey data collected during the Covid-19 pandemic in a sample of individuals with severe mental ill health. DESIGN/METHODOLOGY/APPROACH: We sampled an already existing cohort of people with severe mental ill health. Researchers contacted participants by phone or by post to invite them to take part in a survey about how the pandemic restrictions had impacted health, Covid-19 experiences, perceived social support, employment and loneliness. Loneliness was measured by the three item UCLA loneliness scale. FINDINGS: In the pandemic sub-cohort, 367 adults with a severe mental ill health diagnosis completed a remote survey. 29-34% of participants reported being lonely. Loneliness was associated with being younger in age (adjusted OR = -.98, p = .02), living alone (adjusted OR = 2.04, p = .01), high levels of social and economic deprivation (adjusted OR = 2.49, p = .04), and lower perceived social support (B = -5.86, p < .001). Living alone was associated with lower perceived social support. Being lonely was associated with a self-reported deterioration in mental health during the pandemic (adjusted OR = 3.46, 95%CI 2.03-5.91). PRACTICAL IMPLICATIONS: Intervention strategies to tackle loneliness in the severe mental ill health population are needed. Further research is needed to follow-up the severe mental ill health population after pandemic restrictions are lifted to understand perceived social support and loneliness trends. ORIGINALITY: Loneliness was a substantial problem for the severe mental ill health population before the Covid-19 pandemic but there is limited evidence to understand perceived social support and loneliness trends during the pandemic.


Subject(s)
COVID-19/psychology , Loneliness/psychology , Mental Disorders/psychology , Adult , Aged , Aged, 80 and over , Cohort Studies , Depression/psychology , Depression/virology , Female , Humans , Male , Mental Disorders/virology , Mental Health , Middle Aged , Pandemics/statistics & numerical data , SARS-CoV-2/pathogenicity , Social Isolation/psychology , Surveys and Questionnaires , United Kingdom , Young Adult
6.
PLoS One ; 17(1): e0262136, 2022.
Article in English | MEDLINE | ID: covidwho-1622352

ABSTRACT

BACKGROUND: As the emergency department (ED) has evolved into the de-facto site of care for a variety of substance use disorder (SUD) presentations, trends in ED utilization are an essential public health surveillance tool. Changes in ED visit patterns during the COVID-19 pandemic may reflect changes in access to outpatient treatment, changes in SUD incidence, or the unintended effects of public policy to mitigate COVID-19. We use a national emergency medicine registry to describe and characterize trends in ED visitation for SUDs since 2019. METHODS: We included all ED visits identified in a national emergency medicine clinical quality registry, which included 174 sites across 33 states with data from January 2019 through June 2021. We defined SUD using ED visit diagnosis codes including: opioid overdose and opioid use disorder (OUD), alcohol use disorders (AUD), and other SUD. To characterize changes in ED utilization, we plotted the 3-week moving average ratio of visit counts in 2020 and 2021 as compared to visit counts in 2019. FINDINGS: While overall ED visits declined in the early pandemic period and had not returned to 2019 baseline by June 2021, ED visit counts for SUD demonstrated smaller declines in March and April of 2020, so that the proportion of overall ED visits that were for SUD increased. Furthermore, in the second half of 2020, ED visits for SUD returned to baseline, and increased above baseline for OUD ever since May 2020. CONCLUSIONS: We observe distinct patterns in ED visitation for SUDs over the course of the COVID-19 pandemic, particularly for OUD for which ED visitation barely declined and now exceeds previous baselines. These trends likely demonstrate the essential role of hospital-based EDs in providing 24/7/365 care for people with SUDs and mental health conditions. Allocation of resources must be directed towards the ED as a de-facto safety net for populations in crisis.


Subject(s)
Ambulatory Care/statistics & numerical data , COVID-19/psychology , Emergency Service, Hospital/statistics & numerical data , Mental Disorders/psychology , Mental Health/statistics & numerical data , Substance-Related Disorders/psychology , Humans , Pandemics/statistics & numerical data
7.
BMC Psychiatry ; 22(1): 2, 2022 01 04.
Article in English | MEDLINE | ID: covidwho-1606619

ABSTRACT

BACKGROUND: There is an increasing trend of door locking practices in acute psychiatric care. The aim of the present study was to illuminate the symbolic dimensions of doors in Greek mental health nurses' experiences of open and locked working spaces. RESULTS: A sequential mixed-method designexplored the experiences of nurses working in both open and locked psychiatric acute care units. Participants experiences revealed four types of doors related to the quality of recovery-oriented care: (a) the open door, (b) the invisible door, (c) the restraining door, and (d) the revolving door. Open doors and permeable spacesgenerated trust and facilitated the diffusion of tension and the necessary perception of feeling safe in order to be involved in therapeutic engagement. When the locked unit was experienced as a caring environment, the locked doors appeared to be "invisible". The restraining doors symbolized loss of control, social distance and stigma echoing the consequences of restrictingpeople's crucial control over spaceduring the COVID-19 pandemicin relation toviolence within families, groups and communities. The revolving door (service users' abscondence/re-admission) symbolised the rejection of the offered therapeutic environment and was a source of indignation and compassion fatigue in both open and locked spaces attributed to internal structural acute care characteristics (limited staffing levels, support, resources and activities for service users) as well as 'locked doors' in the community (limited or no care continuity and stigma). CONCLUSIONS: The impact of COVID-19 restrictions on people's crucial control of space provides an impetus for erecting barriers masked by the veil of habit and reconsidering the impact of the simple act of leaving the door open/locked to allow both psychiatric acute care unit staff and service users to reach their potential.


Subject(s)
COVID-19 , Mental Disorders , Greece , Humans , Mental Disorders/therapy , Psychotherapy , SARS-CoV-2
8.
Curr Opin Psychiatry ; 34(3): 277-286, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1599453

ABSTRACT

PURPOSE OF REVIEW: Direct face-to-face interview between a psychiatrist and a patient is crucial in psychiatric evaluation, however, such traditional interviews are becoming difficult to conduct because of the infection risk in the COVID-19 era. As telepsychiatry, video interviews using internet are suggested to be useful to evaluate and assist individuals with mental disorders. However, some patients especially with social phobia, depression, and autism spectrum disorder (ASD) hesitate to use even such face-to-face-like tools. Communication robots have been proposed as future assistant tools for such patients. Herein, we summarize recent advancements in robot psychiatry, and propose the benefits of communication robots in psychiatric evaluation. RECENT FINDINGS: Recent studies have suggested that communication robots are effective in assisting people with ASD. As a pilot trial, we herein conducted semi-structured interviews to evaluate depression and hikikomori, a form of pathological social withdrawal, using a communication robot and a psychiatrist, respectively. There was almost identical evaluation between the two. Interestingly, a person with hikikomori answered that the robot was easier to disclose. SUMMARY: Robots can reduce the burden of human resources and the infection risk in the COVID-19 era. Robot interview is expected to be implemented for future evaluation system in psychiatry.


Subject(s)
COVID-19 , Communication , Mental Disorders/diagnosis , Psychiatry , Robotics , Humans , Psychiatry/trends , Robotics/trends
9.
Lancet ; 398(10303): 920-930, 2021 09 04.
Article in English | MEDLINE | ID: covidwho-1593950

ABSTRACT

The COVID-19 pandemic has heightened interest in how physician mental health can be protected and optimised, but uncertainty and misinformation remain about some key issues. In this Review, we discuss the current literature, which shows that despite what might be inferred during training, physicians are not immune to mental illness, with between a quarter and a third reporting increased symptoms of mental ill health. Physicians, particularly female physicians, are at an increased risk of suicide. An emerging consensus exists that some aspects of physician training, working conditions, and organisational support are unacceptable. Changes in medical training and health systems, and the additional strain of working through a pandemic, might have amplified these problems. A new evidence-informed framework for how individual and organisational interventions can be used in an integrated manner in medical schools, in health-care settings, and by professional colleagues is proposed. New initiatives are required at each of these levels, with an urgent need for organisational-level interventions, to better protect the mental health and wellbeing of physicians.


Subject(s)
Mental Disorders/epidemiology , Physicians/psychology , Suicide/statistics & numerical data , Burnout, Professional , COVID-19/epidemiology , Female , Humans , Male , Mental Disorders/prevention & control , Pandemics , Physicians, Women/psychology , Risk Factors , SARS-CoV-2 , Substance-Related Disorders/epidemiology , Suicide/prevention & control , Work Schedule Tolerance
10.
Int J Environ Res Public Health ; 18(24)2021 12 09.
Article in English | MEDLINE | ID: covidwho-1598579

ABSTRACT

Common mental health disorders (CMDs) represent a major public health concern and are particularly prevalent in people experiencing disadvantage or marginalisation. Primary care is the first point of contact for people with CMDs. Pharmaceutical interventions, such as antidepressants, are commonly used in the treatment of CMDs; however, there is concern that these treatments are over-prescribed and ineffective for treating mental distress related to social conditions. Non-pharmaceutical primary care interventions, such as psychological therapies and "social prescribing", provide alternatives for CMDs. Little is known, however, about which such interventions reduce social inequalities in CMD-related outcomes, and which may, unintentionally, increase them. The aim of this protocol (PROSPERO registration number CRD42021281166) is to describe how we will undertake a systematic review to assess the effects of non-pharmaceutical primary care interventions on CMD-related outcomes and social inequalities. A systematic review of quantitative, qualitative and mixed-methods primary studies will be undertaken and reported according to the PRISMA-Equity guidance. The following databases will be searched: Assia, CINAHL, Embase, Medline, PsycInfo and Scopus. Retrieved records will be screened according to pre-defined eligibility criteria and synthesised using a narrative approach, with meta-analysis if feasible. The findings of this review will guide efforts to commission more equitable mental health services.


Subject(s)
Mental Disorders , Mental Health , Humans , Mental Disorders/epidemiology , Mental Disorders/therapy , Meta-Analysis as Topic , Primary Health Care , Qualitative Research , Socioeconomic Factors , Systematic Reviews as Topic
11.
Adv Exp Med Biol ; 1337: 99-106, 2021.
Article in English | MEDLINE | ID: covidwho-1596046

ABSTRACT

Social distancing and the recent lockdown due to COVID-19 have increased the feeling of disconnection, isolation, and suffering in vulnerable individuals and have brought forward questions regarding locked acute care psychiatric units that cannot be answered by the literature. In Greece, there is no available research on how locked ward environments are perceived and experienced by mental health professionals. The aim of the present study is to illuminate nursing care providers' perceptions of psychiatric care in units with locked doors. Fifteen nursing care providers were interviewed and inductive content analysis was employed to explore their experiences of working in locked psychiatric acute care units. Negative and positive feelings about door locking did not appear to match the specific system of practice. Some participants described how locked doors influenced their professional role by placing emphasis on control rather than care while others regarded locked doors as a symbolic way of therapeutic boundary setting. Participants had positive experiences when they perceived their working environment as caring. The therapeutic benefits of locked doors were prominent when locked doors were perceived as "invisible."


Subject(s)
COVID-19 , Mental Disorders , Communicable Disease Control , Humans , Mental Disorders/therapy , SARS-CoV-2 , Security Measures
12.
PLoS One ; 16(3): e0248009, 2021.
Article in English | MEDLINE | ID: covidwho-1575841

ABSTRACT

INTRODUCTION: Since the start of the pandemic, millions of people have been infected, with thousands of deaths. Many foci worldwide have been identified in retirement nursing homes, with a high number of deaths. Our study aims were to evaluate the spread of SARS-CoV-2 in the retirement nursing homes, the predictors to develop symptoms, and death. METHODS AND FINDINGS: We conducted a retrospective study enrolling all people living in retirement nursing homes (PLRNH), where at least one SARS-CoV-2 infected person was present. Medical and clinical data were collected. Variables were compared with Student's t-test or Pearson chi-square test as appropriate. Uni- and multivariate analyses were conducted to evaluate variables' influence on infection and symptoms development. Cox proportional-hazards model was used to evaluate 30 days mortality predictors, considering death as the dependent variable. We enrolled 382 subjects. The mean age was 81.15±10.97 years, and males were 140(36.7%). At the multivariate analysis, mental disorders, malignancies, and angiotensin II receptor blockers were predictors of SARS-CoV-2 infection while having a neurological syndrome was associated with a lower risk. Only half of the people with SARS-CoV-2 infection developed symptoms. Chronic obstructive pulmonary disease and neurological syndrome were correlated with an increased risk of developing SARS-CoV-2 related symptoms. Fifty-six (21.2%) people with SARS-CoV-2 infection died; of these, 53 died in the first 30 days after the swab's positivity. Significant factors associated with 30-days mortality were male gender, hypokinetic disease, and the presence of fever and dyspnea. Patients' autonomy and early heparin treatment were related to lower mortality risk. CONCLUSIONS: We evidenced factors associated with infection's risk and death in a setting with high mortality such as retirement nursing homes, that should be carefully considered in the management of PLRNH.


Subject(s)
COVID-19/pathology , Aged , Aged, 80 and over , Angiotensin Receptor Antagonists/administration & dosage , COVID-19/complications , COVID-19/mortality , COVID-19/virology , Dyspnea/etiology , Female , Fever/etiology , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Male , Mental Disorders/complications , Mental Disorders/pathology , Neoplasms/complications , Neoplasms/pathology , Nursing Homes , Proportional Hazards Models , Retrospective Studies , Risk Factors , SARS-CoV-2/isolation & purification , Sex Factors , Survival Rate
13.
Psychiatry Res ; 307: 114334, 2022 01.
Article in English | MEDLINE | ID: covidwho-1562021

ABSTRACT

SARS-CoV-2 infection causes a pulmonary disease (COVID-19) which spread worldwide generating fear, anxiety, depression in the general population as well as among subjects affected by mental disorders. Little is known about which different psychopathological changes the pandemic caused among individuals affected by different psychiatric disorders, which represents the aim of the present study. Specific psychometric scales were administered at three time points: T0 as outbreak of pandemic, T1 as lockdown period, T2 as reopening. Descriptive analyses and linear regression models were performed. A total of 166 outpatients were included. Overall, psychometric scores showed a significant worsening at T1 with a mild improvement at T2. Only psychopathology in schizophrenia (SKZ) patients and obsessive-compulsive (OC) symptoms did not significantly improve at T2. Subjects affected by personality disorders (PDs) resulted to be more compromised in terms of general psychopathology than depressed and anxiety/OC ones, and showed more severe anxiety symptoms than SKZ patients. In conclusion, subjects affected by PDs require specific clinical attention during COVID-19 pandemic. Moreover, the worsening of SKZ and OC symptoms should be strictly monitored by clinicians, as these aspects did not improve with the end of lockdown measures. Further studies on larger samples are needed to confirm our results. ClinicalTrials.gov Identifier: NCT04694482.


Subject(s)
COVID-19 , Mental Disorders , Anxiety/epidemiology , Communicable Disease Control , Humans , Mental Disorders/epidemiology , Pandemics , Retrospective Studies , SARS-CoV-2
14.
Eur J Psychotraumatol ; 12(1): 2001192, 2021.
Article in English | MEDLINE | ID: covidwho-1559108

ABSTRACT

This systematic review aims to summarize the prevalence of anxiety, depression, and insomnia in the general adult population and healthcare workers (HCWs) in several key regions worldwide during the first year of the COVID pandemic. Several literature databases were systemically searched for meta-analyses published by 22 September 2021 on the prevalence rates of mental health symptoms worldwide. The prevalence rates of mental health symptoms were summarized based on 388 empirical studies with a total of 1,067,021 participants from six regions and four countries. Comparatively, Africa and South Asia had the worse overall mental health symptoms, followed by Latin America. The research effort on mental health during COVID-19 has been highly skewed in terms of the scope of countries and mental health outcomes. The mental health symptoms are highly prevalent yet differ across regions, and such evidence helps to enable prioritization of mental health assistance efforts to allocate attention and resources based on the regional differences in mental health.


El objetivo de esa revisión sistemática es el de resumir la prevalencia de la ansiedad, la depresión y el insomnio, tanto en la población general adulta como en los trabajadores de salud de diferentes regiones clave alrededor del mundo durante el primer año de la pandemia por la COVID-19. Se revisaron de manera sistemática diversas bases de datos científicas buscando metaanálisis sobre la prevalencia de síntomas en salud mental alrededor del mundo, publicados hasta el 22 de setiembre del 2021. Se resumió la prevalencia de los síntomas de salud mental sobre la base de 388 estudios empíricos, comprendiendo a 1.067.021 participantes de cuatro países y de seis regiones. África y Asia meridional tuvieron, de manera general, los peores síntomas de salud mental, seguidas por Latinoamérica. El esfuerzo por realizar investigación en salud mental durante la pandemia por la COVID-19 ha estado altamente sesgado en torno a la envergadura de los países y de las medidas de resultado empleadas en salud mental. Los síntomas de salud mental son altamente prevalentes; no obstante, difieren a lo largo de diferentes regiones. Esta evidencia ayuda a permitir la priorización de los esfuerzos de atención en salud mental asignando la atención y recursos basados sobre las diferencias regionales en salud mental.


Subject(s)
COVID-19/psychology , Global Health/statistics & numerical data , Mental Disorders/epidemiology , Pandemics , Adult , Africa/epidemiology , Asia/epidemiology , Asia, Southeastern/epidemiology , COVID-19/epidemiology , China/epidemiology , Europe, Eastern/epidemiology , Health Personnel/psychology , Humans , Latin America/epidemiology , Prevalence , Spain/epidemiology
15.
Neurol Neuroimmunol Neuroinflamm ; 9(1)2022 01.
Article in English | MEDLINE | ID: covidwho-1546818

ABSTRACT

BACKGROUND AND OBJECTIVES: To understand the course of recovery from coronavirus disease 2019 (COVID-19) among patients with multiple sclerosis (MS) and to determine its predictors, including patients' pre-COVID-19 physical and mental health status. METHODS: This prospective and longitudinal cohort study recruited patients with MS who reported COVID-19 from March 17, 2020, to March 19, 2021, as part of the United Kingdom MS Register (UKMSR) COVID-19 study. Participants used online questionnaires to regularly update their COVID-19 symptoms, recovery status, and duration of symptoms for those who fully recovered. Questionnaires were date stamped for estimation of COVID-19 symptom duration for those who had not recovered at their last follow-up. The UKMSR holds demographic and up-to-date clinical data on participants as well as their web-based Expanded Disability Status Scale (web-EDSS) and Hospital Anxiety and Depression Scale (HADS) scores. The association between these factors and recovery from COVID-19 was assessed using multivariable Cox regression analysis. RESULTS: Of the 7,977 patients with MS who participated in the UKMSR COVID-19 study, 599 reported COVID-19 and prospectively updated their recovery status. Twenty-eight hospitalized participants were excluded. At least 165 participants (29.7%) had long-standing COVID-19 symptoms for ≥4 weeks and 69 (12.4%) for ≥12 weeks. Participants with pre-COVID-19 web-EDSS scores ≥7, participants with probable anxiety and/or depression (HADS scores ≥11) before COVID-19 onset, and women were less likely to report recovery from COVID-19. DISCUSSION: Patients with MS are affected by postacute sequelae of COVID-19. Preexisting severe neurologic impairment or mental health problems appear to increase this risk. These findings can have implications in tailoring their post-COVID-19 rehabilitation.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , Multiple Sclerosis/epidemiology , Registries , Adult , COVID-19/therapy , Comorbidity , Female , Humans , Longitudinal Studies , Male , Mental Disorders/epidemiology , Middle Aged , Outcome Assessment, Health Care , Risk , Time Factors , United Kingdom/epidemiology
17.
18.
Lancet Psychiatry ; 8(5): 444-450, 2021 05.
Article in English | MEDLINE | ID: covidwho-1537216

ABSTRACT

Psychiatric disorders, and especially severe mental illness, are associated with an increased risk of severe acute respiratory syndrome coronavirus 2 infection and COVID-19-related morbidity and mortality. People with severe mental illness should therefore be prioritised in vaccine allocation strategies. Here, we discuss the risk for worse COVID-19 outcomes in this vulnerable group, the effect of severe mental illness and psychotropic medications on vaccination response, the attitudes of people with severe mental illness towards vaccination, and, the potential barriers to, and possible solutions for, an efficient vaccination programme in this population.


Subject(s)
COVID-19 , Immunization Programs , Mental Disorders/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Immunization Programs/ethics , Immunization Programs/methods , Immunization Programs/organization & administration , Mental Disorders/psychology , Risk Assessment , SARS-CoV-2 , Vaccination Coverage , Vulnerable Populations/psychology
20.
Pediatrics ; 148(1)2021 07.
Article in English | MEDLINE | ID: covidwho-1533449

ABSTRACT

BACKGROUND AND OBJECTIVES: Depression is common, and suicide rates are increasing. Adolescent depression screening might miss those with unidentified suicide risk. Our primary objective in this study was to compare the magnitude of positive screen results across different approaches. METHODS: From June 2019 to October 2020, 803 mostly Medicaid-enrolled adolescents aged ≥12 years with no recent history of depression or self-harm were screened with the Patient Health Questionnaire-9 Modified for Adolescents (PHQ-9A) and the Ask Suicide-Screening Questions (ASQ) across 12 primary care practices. Two PHQ-9A screening strategies were evaluated: screening for any type of depression or other mental illness (positive on any item) or screening for major depressive disorder (MDD) (total score ≥10). RESULTS: Overall, 56.4% of patients screened positive for any type of depression, 24.7% screened positive for MDD, and 21.1% screened positive for suicide risk. Regardless of PHQ-9A screening strategy, the ASQ identified additional subjects (eg, 2.2% additional cases compared with screening for any type of depression or other mental illness and 8.3% additional cases compared with screening positive for MDD). Of those with ≥6 month follow-up, 22.9% screened positive for any type of depression (n = 205), 35.6% screened positive for MDD (n = 90), and 42.7% with a positive ASQ result (n = 75) had a depression or self-harm diagnosis or an antidepressant prescription. CONCLUSIONS: Suicide risk screening identifies cases not identified by depression screening. In this study, we underscore opportunities and challenges in primary care related to the high prevalence of depression and suicide risk. Research is needed regarding optimal screening strategies and to help clinicians manage the expected number of screening-identified adolescents.


Subject(s)
Depression/epidemiology , Mass Screening/methods , Primary Health Care/methods , Suicide/statistics & numerical data , Adolescent , Antidepressive Agents/therapeutic use , COVID-19/epidemiology , COVID-19/psychology , Child , Depression/diagnosis , Depression/drug therapy , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/drug therapy , Depressive Disorder, Major/epidemiology , Female , Humans , Loneliness , Male , Mental Disorders/diagnosis , Mental Disorders/epidemiology , Pandemics , Risk Factors , SARS-CoV-2 , Social Isolation , Suicide/prevention & control , Young Adult
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