Geoffrey Schrader

Preoperative depression and mortality in coronary artery bypass surgery: Preliminary findings

Background: There is convincing evidence to suggest that depression significantly increases the risk of mortality following myocardial infarction. There are few data concerning depression as a risk factor for mortality following cardiac surgery. The aim of the present observational study was to determine if preoperative depressive symptoms resulted in an increased risk of late mortality following cardiac surgery.

Identification, course, and treatment of depression after admission for a cardiac condition: rationale and patient characteristics for the identifying depression as a comorbid condition (IDACC) project

BACKGROUND Given the prevalence of cardiovascular disease and the high rates of depression among cardiac patients, there is a need to develop practical ways to identify this population and provide pragmatic general-practitioner-based interventions for managing depression as a comorbid condition. METHOD The Identifying Depression As a Comorbid Condition (IDACC) study employed a hybrid design, incorporating a randomized controlled trial nested within a prospective cohort study. IDACC screened for depression in patients hospitalized in South Australia for a range of cardiac conditions, with outcome measures monitored for 12 months after discharge. The subgroup identified as depressed was entered into the nested IDACC trial, which tests the hypothesis that identifying depression and offering an evidence-based intervention to general practitioners, incorporating multidisciplinary telephone case conferencing, will reduce levels of depression, improve quality of life, and reduce associated economic costs. RESULTS At baseline, 46.3% of 1455 participants screened were classified as depression cases on the basis of their score on the Center for Epidemiological Studies Depression Scale (> or =16) or the Hospital Anxiety and Depression Scale (> or =8). Elevated scores were associated with being younger, female, divorced or separated, not employed, living alone, having a lower level of education, and having poorer health and quality of life. Nearly one fifth (19.4%) of participants had Center for Epidemiological Studies Depression Scale scores >27, which is indicative of major depression. CONCLUSIONS This project confirms, in an Australian setting, the high prevalence of depressive symptoms among hospitalized cardiac patients. Follow-up over 12 months will enhance understanding of the natural history of depression in cardiac patients, while the nested trial will inform on effectiveness of an intervention involving tailored advice and support to general practitioners.

Predictors of depression three months after cardiac hospitalization.

Objective: Depression occurs comorbidly in patients hospitalized for a range of cardiac conditions and procedures. This study examines the fluctuations in depressive symptomatology from index hospitalization to 3 months after hospitalization and determines predictors of depression 3 months after hospital admission for a cardiac condition or procedure. Methods: Baseline clinical and demographic variables collected from a prospective study of the natural history of depression in 833 hospitalized cardiac patients were entered into a multinomial regression analysis. Results: Similar proportions of participants were found to have no, mild, or moderate to severe depression at baseline and at 3 months, although 35.8% of participants had moved from one depression level to another during that period. Baseline characteristics predicting depression at 3 months after hospitalization were: a mild or moderate to severe level of depressive symptoms at hospitalization; younger age; smoking; self-reported previous diagnosis of a cardiac condition; and self-reported history of depression, anxiety, or stress. Conclusions: The five clinically accessible variables identified as predictors in this study may assist physicians in identification of cardiac patients who are at risk of persistent depression and who may require active intervention. Given that depression in cardiac patients is related to increased mortality and morbidity and that it is currently poorly diagnosed, these findings may have implications for preventing adverse outcomes.

Do psychosocial factors predict weight loss following gastric surgery for obesity

This study was undertaken to determine whether psychosocial factors determined during a pre-operative semi-structured psychiatric interview were associated either with the amount of weight loss following obesity surgery or with dropping out from follow-up after surgery. Multiple regression and discriminant function analysis of weight loss at six, twelve, twenty four and thirty six months showed no correlation between psychosocial variables and the amount of weight lost or with dropping out from follow-up. It is concluded that the type of psychiatric interview performed in this study does not yield information which reliably predicts weight loss after surgery for obesity.

The recollection of affect.

A group of psychiatric in-patients significantly over-estimated the intensity of their depression when asked to recollect how depressed they had been one week earlier. The initial level of depression affected the accuracy of recall. Unexpectedly, patients who were more depressed initially had more accurate recall, particularly for biological and symptomatically negative items of the Zung Self-Rating Depression Scale.

Predictors of Depression 12 Months after Cardiac Hospitalization: The Identifying Depression as a Comorbid Condition Study

Objective: To determine characteristics which predict depression at 12 months after cardiac hospitalization, and track the natural history of depression. Method: Depressive symptoms were monitored at baseline, 3 and 12 months in a cohort of 785 patients, using the self-report Center for Epidemiological Studies Depression Scale. Multinomial regression analyses of baseline clinical and demographic variables identified characteristics associated with depression at 12 months. Results: Three baseline variables predicted moderate to severe depression at 12 months: depression during index admission, past history of emotional health problems and current smoking. For those who were depressed during cardiac hospitalization, 51% remained depressed at both 3 and 12 months. Persistence was more evident in patients who had moderate to severe depressive symptoms when hospitalized. Mild depression was as likely to persist as to remit. Conclusions: Three clinically accessible characteristics at the time of cardiac hospitalization can assist in predicting depression at 12 months and may aid treatment decisions. Depressive symptoms persist in a substantial proportion of cardiac patients up to 12 months after hospitalization.

Participatory Research as One Piece of the Puzzle: A Systematic Review of Consumer Involvement in Design of Technology-Based Youth Mental Health and Well-Being Interventions

Background Despite the potential of technology-based mental health interventions for young people, limited uptake and/or adherence is a significant challenge. It is thought that involving young people in the development and delivery of services designed for them leads to better engagement. Further research is required to understand the role of participatory approaches in design of technology-based mental health and well-being interventions for youth. Objective To investigate consumer involvement processes and associated outcomes from studies using participatory methods in development of technology-based mental health and well-being interventions for youth. Methods Fifteen electronic databases, using both resource-specific subject headings and text words, were searched describing 2 broad concepts-participatory research and mental health/illness. Grey literature was accessed via Google Advanced search, and relevant conference Web sites and reference lists were also searched. A first screening of titles/abstracts eliminated irrelevant citations and documents. The remaining citations were screened by a second reviewer. Full text articles were double screened. All projects employing participatory research processes in development and/or design of (ICT/digital) technology-based youth mental health and well-being interventions were included. No date restrictions were applied; English language only. Data on consumer involvement, research and design process, and outcomes were extracted via framework analysis. Results A total of 6210 studies were reviewed, 38 full articles retrieved, and 17 included in this study. It was found that consumer participation was predominantly consultative and consumerist in nature and involved design specification and intervention development, and usability/pilot testing. Sustainable participation was difficult to achieve. Projects reported clear dichotomies around designer/researcher and consumer assumptions of effective and acceptable interventions. It was not possible to determine the impact of participatory research on intervention effectiveness due to lack of outcome data. Planning for or having pre-existing implementation sites assisted implementation. The review also revealed a lack of theory-based design and process evaluation. Conclusions Consumer consultations helped shape intervention design. However, with little evidence of outcomes and a lack of implementation following piloting, the value of participatory research remains unclear.

Frequent attenders with mental disorders at a general hospital emergency department.

Objectives:  To define the clinical and demographic characteristics of frequent attenders with mental disorders at a general hospital ED; to determine whether those persons had additional attendances at other ED in the same city; and to assess the documented care of those frequent attenders.

An eHealth Intervention for Patients in Rural Areas: Preliminary Findings From a Pilot Feasibility Study

Background eHealth facilitation of chronic disease management has potential to increase engagement and effectiveness and extend access to care in rural areas. Objective The objective of this study was to demonstrate the feasibility and acceptability of an eHealth system for the management of chronic conditions in a rural setting. Methods We developed an online management program which incorporated content from the Flinders Chronic Condition Management Program (Flinders Program) and used an existing software platform (goACT), which is accessible by patients and health care workers using either Web-enabled mobile phone or Internet, enabling communication between patients and clinicians. We analyzed the impact of this eHealth system using qualitative and simple quantitative methods. Results The eHealth system was piloted with 8 recently hospitalized patients from rural areas, average age 63 (SD 9) years, each with an average of 5 chronic conditions and high level of psychological distress with an average K10 score of 32.20 (SD 5.81). Study participants interacted with the eHealth system. The average number of logins to the eHealth system by the study participants was 26.4 (SD 23.5) over 29 weeks. The login activity was higher early in the week. Conclusions The pilot demonstrated the feasibility of implementing and delivering a chronic disease management program using a Web-based patient-clinician application. A qualitative analysis revealed burden of illness and low levels of information technology literacy as barriers to patient engagement.

Depression and 5-year mortality in patients with acute myocardial infarction: Analysis of the IDACC database

Objective: Symptoms of depression are highly prevalent and persistent following myocardial infarction (MI). Whether depression is a risk factor for long-term mortality following MI remains controversial. The present study aimed to determine whether depression during hospitalisation for acute MI (AMI) predicted 5-year all-cause or cardiac mortality. Method: This study utilised the Identifying Depression as a Comorbid Condition (IDACC) database of 337 hospitalised patients with AMI. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale (CES-D). Data were linked to a government administrative death registry to determine 5-year mortality. Survival data were analysed using Cox’s proportional hazards model. Results: The mean age during AMI hospitalisation was 59 years ± 12, 74% of patients were men and depression (CES-D ≥ 16) was present in 132 patients (39.3%). The 5-year all-cause mortality rate was 10.4% (35 deaths) and the cardiac mortality rate was 6.5% (22 deaths). When depression was defined as a dichotomous variable, moderate to severe depression (defined by CES-D ≥ 27) at the time of AMI was associated with all-cause mortality (hazard ratio 2.54, 95% confidence interval 1.03 to 6.28; p = 0.04) but not cardiac mortality. However, when depression was defined by three categories (no depression CES-D < 16, mild depression CES-D 16–26, moderate to severe depression CES-D ≥ 27), it was not found to predict mortality. In addition, perceived social support was a predictor of all-cause and cardiac mortality in AMI patients. Conclusions: Our results indicate that the relationship between mortality and depression severity is not linear and that the association only becomes evident when the severity reaches a threshold level of CES-D ≥ 27, consistent with major depression. Low power may have influenced the finding of a lack of association between depression and cardiac mortality.