Assessing the Applicability of E-Therapies for Depression,Anxiety, and Other Mood Disorders Among Lesbians and Gay Men: Analysis of 24 Web- and Mobile Phone-Based Self-Help Interventions

Background

Lesbians and gay men have disproportionately high rates of depression and anxiety, and report lower satisfaction with treatments. In part, this may be because many health care options marginalize them by assuming heterosexuality, or misunderstand and fail to respond to the challenges specifically faced by these groups. E-therapies have particular potential to respond to the mental health needs of lesbians and gay men, but there is little research to determine whether they do so, or how they might be improved.

Objective

We sought to examine the applicability of existing mental health e-therapies for lesbians and gay men.

Methods

We reviewed 24 Web- and mobile phone-based e-therapies and assessed their performance in eight key areas, including the use of inclusive language and content and whether they addressed mental health stressors for lesbians and gay men, such as experiences of stigma related to their sexual orientation, coming out, and relationship issues that are specific to lesbians and gay men.

Results

We found that e-therapies seldom addressed these stressors. Furthermore, 58% (14/24) of therapies contained instances that assumed or suggested the user was heterosexual, with instances especially prevalent among better-evidenced programs.

Conclusions

Our findings, and a detailed review protocol presented in this article, may be used as guides for the future development of mental health e-therapies to better accommodate the needs of lesbians and gay men.     

The importance of parental support in the lives of gay, lesbian, and bisexual individuals

This article underscores the very important role that parental acceptance and support plays in furthering the psychological well-being of gay, lesbian, and bisexual individuals. Parents, Families, and Friends of Lesbians and Gays (PFLAG), an organization dedicated to this goal, has as its mission the support for family members, education of the public, and advocacy for equal rights for lesbians, gay men, and bisexuals. By "coming out" themselves, straight parents and relatives-including those in the mental health field-not only can extend the support they offer to their gay/lesbian/bisexual children and relatives but also play a significant role in reducing the stigma of being gay, lesbian, or bisexual and in mainstreaming gay, lesbian, and bisexual issues.     

Psychological sequelae of hate-crime victimization among lesbian, gay, and bisexual adults

Questionnaire data about criminal victimization experiences were collected from 2,259 Sacramento-area lesbians, gay men, and bisexuals (N = 1,170 women, 1,089 men). Approximately 1/5 of the women and 1/4 of the men had experienced victimization because of their adult sexual orientation. Hate crimes were less likely than nonbias crimes to have been reported to police. Compared with other recent crime victims, lesbian and gay hate-crime survivors manifested significantly more symptoms of depression, anger, anxiety, and posttraumatic stress. They also displayed significantly more crime-related fears and beliefs, lower sense of mastery, and more attributions of their personal setbacks to sexual prejudice than did nonbias crime victims and nonvictims. Comparable differences were not observed among bisexuals. The findings highlight the importance of recognizing hate-crime survivors' special needs in clinical settings and in public policy.     

Sexual-orientation-related differences in verbal fluency

This study examined the performance of 60 heterosexual men, 60 gay men, 60 heterosexual women, and 60 lesbians on 3 tests of verbal fluency known to show gender differences: letter, category, and synonym fluency. Gay men and lesbians showed opposite-sex shifts in their profile of scores. For letter fluency, gay men outperformed all other groups; lesbians showed the lowest scores. For category fluency, gay men and heterosexual women jointly outperformed lesbians and heterosexual men. Finally, gay men outperformed all other groups on synonym fluency, whereas lesbians and heterosexual men performed similarly. A difference between heterosexual men and women was demonstrated on category and synonym fluency only. The findings implicate within-sex differences in the functioning of the prefrontal and temporal cortices.     

The effects of adverse childhood experiences on pregnancy-related anxiety and acceptance of motherhood role

BackgroundAdverse childhood experiences are a factor that may cause physical illness and deterioration of lifelong well-being in addition to many mental and psychiatric problems in the future. It is important to question and treat them.ObjectiveThis study examined the effects of adverse childhood experiences on pregnancy-related anxiety and acceptance of motherhood role.MethodsThis cross-sectional study was conducted on 536 pregnant women. The data were collected using the “Personal Information Form”, the “Adverse Childhood Experience Questionnaire (ACEQ)”, the “Acceptance of Motherhood Role (AoMR)” subscale of the “Prenatal Self Evaluation Questionnaire (PSEQ)” and the “Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQ-R2)”.ResultsIt was found that those with high levels of negative childhood experience had higher levels of anxiety in pregnancy and lower acceptance of maternal role than the other groups (p<0.05). Additionally, a one-unit change in the AoMR score led to a 0.23-unit decrease in the ACEQ score, whereas a one-unit change in the PRAQ-R2 score led to a 0.57-unit increase in the ACEQ score (p<0.001).ConclusionAdverse childhood events increase pregnancy-related anxiety and negatively affect acceptance of motherhood role.     

The impact of a depression awareness campaign on mental health literacy and mental morbidity among gay men

Background

High prevalences of depression and suicidality have been found among gay men. This paper assesses the possible impact of Blues-out, a depression awareness campaign based on the European Alliance Against Depression targeting the gay/lesbian community in Geneva, Switzerland.

Methods

In 2007 and 2011, pre- and post-intervention surveys were conducted among two distinct samples of gay men in Geneva, recruited by probability-based time–space sampling. Effect sizes and net percent changes are reported for mental health literacy and mental health outcomes in 2007 and 2011 as well as among men aware and unaware of Blues-out in 2011.

Results

43% of the respondents correctly recognized depression in 2011 with no change vis-à-vis 2007. Despite small effect sizes, significant net decreases (from −18% to −28%) were seen in lifetime suicide plans, 12-month suicidal ideation, lifetime depression, and 4-week psychological distress between 2007 and 2011. These decreases were not accompanied by changes in any of the numerous items on attitudes/knowledge, found only when comparing men aware and unaware of Blues-out in 2011. More men aware of Blues-out found specialists and psychological therapies helpful than their counterparts and correctly identified depression and gay men's greater risk for depression.

Limitations

Community-level assessment with no control.

Conclusions

Although improvement in depression recognition and decrease in suicide attempts could not be replicated unequivocally in this adapted intervention among gay men, there are indications that this evidence-based depression awareness campaign may have lessened suicidality and mental morbidity and improved mental health literacy and help-seeking.     

Persistent Symptoms After Acute COVID-19 Infection in Omicron Era

BackgroundWe aim to compare the clinical characteristics and subjectively reported symptoms of the acute coronavirus disease (COVID) phase and those of the post-acute COVID phase to examine varying factors that affect the number of persistent symptoms and their categories.MethodsWe categorized 1,122 patients who visited the post coronavirus disease 2019 (COVID-19) clinic into two groups: “acute group” (< 4 weeks following diagnosis of COVID-19) and “post-acute group” (> 4 weeks following diagnosis of COVID-19). We statistically compared clinical characteristics between the two groups and determined which factors are associated with the number of persistent symptoms and their categories.ResultsThe persistent symptoms of post COVID-19 conditions were classified into three categories as follows: Category A (the prevalence of symptoms is higher in the acute-visit group than in the post-acute-visit group), Category B (the prevalence of symptoms is not different between the two groups) and Category C (the prevalence of symptoms is higher in the post-acute-visit group than in the acute-visit group). Category A mainly included respiratory symptoms. Category B had generalized weakness, weight loss, cardiologic symptoms, hypogeusia, hyposmia, anxiety, and various gastrointestinal symptoms. Category C included fatigue, decreased attention, depression, blurred vision, hair loss, and sexual dysfunction. Anxiety, depression, fatigue and age were also associated with the number of symptoms and their categories, and anxiety is the most correlated factor (P < 0.001) among them.ConclusionThe persistent symptoms of post COVID-19 condition involve multi-organ and continue for four weeks or greater. Therefore, long-term observation and multidisciplinary interventions are essential for patients with post COVID-19 conditions.     

Abdominal volume index: a predictive measure in relationship between depression/anxiety and obesity

BackgroundObesity is a risk factor for mood disorder (such as depression and anxiety). We aimed to assess application of A Body Shape Index (ABSI) and abdominal volume index (AVI), as new indices of obesity to evaluate the relationship between obesity and depression/anxiety.MethodsThis cross sectional study was conducted on 307 overweight and obese women (249 females, 58 males) 20–60 years in Iran in 2017–2018. The anthropometric measures including weight, waist circumference, hip circumference, body fat and derived values of body mass index, waist-hip ratio, AVI and ABSI were evaluated. HADS questionnaire for depression and anxiety completed.ResultsPrevalence of depression was 36.1% in women; men 24.1%; overweight 28.1%; obese 36.5 % and central obesity 33.7%. Anxiety was apparent in 27.1% of overweight 30.3 % obese and 29.6% central obesity. People with depression and anxiety had higher WC, BF and AVI. ABSI had no significant correlation with depression/anxiety. The odds of depression (1.06; 95% CI, 1.02–1.12) and anxiety (1.06; 95% CI, 1.01–1.11) were elevated with increase AVI.ConclusionOur results suggested that AVI as an indirect measure of abdominal obesity along with WC and BF could be useful in predicting the relationship between obesity and depression/anxiety.     

The effect of anxiety and depression scores of couples who underwent assisted reproductive techniques on the pregnancy outcomes

ObjectiveThe aim of this study was to determine the effect of anxiety and depression scores of couples who underwent Assisted Reproductive Techniques (ART) on pregnancy outcomes.MethodThis study was conducted as a prospective and comparative study with 217 couples. The study data was collected by using a semi-structured questionnaire and the Turkish version of the State-Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI). The questionnaire, STAI and BDI were applied to couples who initiated ART treatment. Couples'' state anxiety scores were re-evaluated after embryo transfer (ET).ResultsA significant relationship was found between the depression score of women and pregnancy outcome (p < 0.05). It was determined that anxiety scores for both men and women were higher before the ART procedure, but their anxiety scores decreased after ET (p < 0.05). Spouses of women with a negative pregnancy outcome had higher trait and state anxiety mean scores (p > 0.05) and lower depression scores (p <0.05) than spouses of women with a positive pregnancy outcome.ConclusionStudy results indicated that the anxiety and depression scores of couples who had achieved a positive pregnancy result were lower than for couples with a negative result. The results of this study will contribute to the health professionals especially to the nurses who spend the most time with couples in providing consulting services and supporting psychological status of couples during ART process in Turkey.     

Anxiety and depression levels of healthcare workers during Covid-19 pandemic

BackgroundCoronavirus disease 2019 (covid-19), which causes a pandemic in the world, has started to appear in turkey since march 2020. Healthcare workers are at the top of the groups most at risk for covid-19 infection, which can have a negative impact on psychological state.ObjectivesIt was aimed to evaluate anxiety and depression levels among healthcare workers.Methodsthis cross-sectional study performed via an online survey in april 2020. Participants answered questions about sociodemographic features, personal views and experiences about covid-19 and the hospital anxiety and depression scale (hads).ResultsA total of 300 healthcare workers,193 men and 107 women, participated in the survey. According to hads, 44.6% of participants scored above anxiety and 68.2% scored above depression cut-off points. Being younger than 50 and taking care of covid-19 patients in hospitals were independently associated with anxiety risk. Female gender, young age (less than 50) and having comorbidity were independent risk factors for depression.ConclusionHealthcare workers were at high risk of anxiety and depression during covid-19 outbreak. For this reason, psychological support should be given, especially to the group with high risk.     

Effects of the COVID-19 pandemic on psychology and disease activity in patients with ankylosing spondylitis and rheumatoid arthritis

Background/aim The COVID-19 outbreak is known to increase stress levels of most patients with chronic diseases. Patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA) are highly susceptible to environmental stress. In the current study, we aimed to determine how the COVID-19 pandemic psychologically affected patients with chronic progressive diseases such as AS and RA and the effects of these psychological factors on disease activity. Materials and methods Age and sex-matched patients with AS (n = 80), RA (n = 80), and healthy controls (n = 80) were included in the study. All participants were evaluated with the “Perceived COVID-19 Threat Form (PCTF)”, “Suicide-Ideation Scale (SIS)”, “Hospital Anxiety and Depression Scale (HADS)”, “The Ability to Cope with Trauma (PACT)”, and “Psychological General Well-Being Index (PGWB)” scales. BASDAI was used in patients with AS, and DAS28 was used in patients with RA to assess disease severity.Results Compared to healthy individuals, patients with RA and AS had lower PGWB scores and higher HADS depression and anxiety subscale scores. Almost all psychometric assessment test scores were worse in AS patients with high-disease activity compared to those in low-disease activity. PACT scores were higher in patients with moderate RA compared to patients with mild RA (p = 0.006). While a positive correlation was identified between BASDAI and most of the psychometric assessment test scores (r = 0 .36 for PCTF, r = 0.53 for depressive scores, r = 0.54 for anxiety scores, r = 0.57 for suicidal ideation), DAS28 scores were found to be associated only with PACT total and PACT perceived forward-focused subscale scores (r = –.26 and r = .33, respectively). Conclusion Psychologically, AS and RA patients were found to be worse off compared to healthy controls. The perceived COVID threat and psychological status were associated with disease activity in AS, but not RA patients. Patients with chronic illnesses may be more vulnerable to the psychological effects of the pandemic, which can worsen disease activity.     

Binge eating as a determinant of emotional state in overweight and obese males with cardiovascular disease

ObjectivesThe present study investigates the association between depression, anxiety and binge eating at baseline with weight-change after an approximately 1-year period in a clinical sample of obese adult males with cardiovascular disease.MethodsAt the time of the first measurement, the sample consisted of 69 overweight and obese men (age range between 36 and 74); 34 patients attended a follow-up measurement 6–17 months after the first measurement, and completed selected psychological instruments.ResultsAfter the follow-up period, only 28.7% patients’ lost weight, 29.9% patients’ had the same weight, and finally 41.4% patients’ gained weight. When comparing the first and the second assessments, the level of anxiety and depression is relatively stable. Men, who, at the time of the second assessment, gained weight, and were binge eating at baseline, were more depressed and anxious in comparison with the other two groups of patients.ConclusionsIt is necessary to focus primarily on binge eating symptoms as a part of weight reduction treatment as well as to treat anxiety and depression in CVD patients. Binge eating is an eating disorder per se, and therefore it is important to treat it before the person starts weight reduction procedures as part of the risk prevention treatment for CVD patients.     

Twitter Social Media is an Effective Tool for Breast Cancer Patient Education and Support: Patient-Reported Outcomes by Survey

BackgroundDespite reported benefits, many women do not attend breast cancer support groups. Abundant online resources for support exist, but information regarding the effectiveness of participation is lacking. We report the results of a Twitter breast cancer support community participant survey.ObjectiveThe aim was to determine the effectiveness of social media as a tool for breast cancer patient education and decreasing anxiety.MethodsThe Breast Cancer Social Media Twitter support community (#BCSM) began in July 2011. Institutional review board approval with a waiver of informed consent was obtained for a deidentified survey that was posted for 2 weeks on Twitter and on the #BCSM blog and Facebook page.ResultsThere were 206 respondents to the survey. In all, 92.7% (191/206) were female. Respondents reported increased knowledge about breast cancer in the following domains: overall knowledge (80.9%, 153/189), survivorship (85.7%, 162/189), metastatic breast cancer (79.4%, 150/189), cancer types and biology (70.9%, 134/189), clinical trials and research (66.1%, 125/189), treatment options (55.6%, 105/189), breast imaging (56.6%, 107/189), genetic testing and risk assessment (53.9%, 102/189), and radiotherapy (43.4%, 82/189). Participation led 31.2% (59/189) to seek a second opinion or bring additional information to the attention of their treatment team and 71.9% (136/189) reported plans to increase their outreach and advocacy efforts as a result of participation. Levels of reported anxiety before and after participation were analyzed: 29 of 43 (67%) patients who initially reported “high or extreme” anxiety reported “low or no” anxiety after participation (P<.001). Also, no patients initially reporting low or no anxiety before participation reported an increase to high or extreme anxiety after participation.ConclusionsThis study demonstrates that breast cancer patients’ perceived knowledge increases and their anxiety decreases by participation in a Twitter social media support group.     

Internalized homophobia and internalizing mental health problems: A meta-analytic review

Research on internalized homophobia (IH) has linked it to both mental and physical health outcomes. Extant research indicates that IH and mental health are related in a variety of different subgroups of lesbian, gay and bisexual (LGB) persons. However, much of this research has suffered from methodological issues. Studies have frequently substituted distress-related constructs (e.g., self-esteem and general well-being) for measures of internalizing mental health problems. Furthermore, many studies have misapplied measures of IH designed for gay men with lesbian samples. The current study used Hierarchical Linear Modeling to perform meta-analysis. Effect sizes were combined across multiple studies that used dimensional measures of internalizing mental health problems (i.e., depression and anxiety). The use of multilevel modeling techniques allowed for the evaluation of moderating effects on these relationships, including those of gender, year of data collection, mean age of the sample, publication type, and type of symptomatology measured. Thirty-one studies were meta-analyzed for the relationship between IH and mental health (N = 5831), revealing a small to moderate overall effect size for the relationship between the two variables. Higher levels of IH were associated with higher scores on dimensional measures of internalizing mental health problems. Significant moderating effects were also found for mean age of the sample and the type of symptomatology measured in each study. The relationship between IH and internalizing mental health problems was stronger in studies with a higher mean age. The relationship between IH and depressive symptomatology was stronger than the relationship between IH and symptoms of anxiety. Limitations and future research directions are discussed as well as implications for clinical practice.     

Risk Factors of Unplanned Readmission after Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis

PurposeWith an increasing number of anterior cervical discectomy and fusion (ACDF) being conducted for degenerative cervical disc disease, there is a rising interest in the related quality of management and healthcare costs. Unplanned readmission after ACDF affects both the quality of management and medical expenses. This meta-analysis was performed to evaluate the risk factors of unplanned readmission after ACDF to improve the quality of management and prevent increase in healthcare costs.Materials and MethodsWe searched the databases of PubMed, EMBASE, Web of Science, and Cochrane Library to identify eligible studies using the searching terms, “readmission” and “ACDF.” A total of 10 studies were included.ResultsAmong the demographic risk factors, older age [weighted mean difference (WMD), 3.93; 95% confidence interval (CI), 2.30–5.56; p<0.001], male [odds ratio (OR), 1.23; 95% CI, 1.10–1.36; p<0.001], and private insurance (OR, 0.34; 95% CI, 0.17–0.69; p<0.001) were significantly associated with unplanned readmission. Among patient characteristics, hypertension (HTN) (OR, 2.14; 95% CI, 1.41–3.25; p<0.001), diabetes mellitus (DM) (OR, 1.59; 95% CI, 1.20–2.11; p=0.001), coronary artery disease (CAD) (OR, 2.87; 95% CI, 2.13–3.86; p<0.001), American Society of Anesthesiologists (ASA) physical status grade >2 (OR, 2.13; 95% CI, 1.68–2.72; p<0.001), and anxiety and depression (OR, 1.39; 95% CI, 1.29–1.51; p<0.001) were significantly associated with unplanned readmission. Among the perioperative factors, pulmonary complications (OR, 22.52; 95% CI, 7.21–70.41; p<0.001) was significantly associated with unplanned readmission.ConclusionMale, older age, HTN, DM, CAD, ASA grade >2, anxiety and depression, pulmonary complications were significantly associated with an increased occurrence of unplanned readmission after ACDF.     

Global prevalence of depression and anxiety in patients with hepatocellular carcinoma: Systematic review and meta-analysis

Background/AimsDepression and anxiety are associated with poorer outcomes in patients with hepatocellular carcinoma (HCC). However, the prevalence of depression and anxiety in HCC are unclear. We aimed to establish the prevalence of depression and anxiety in patients with HCC.MethodsMEDLINE and Embase were searched and original articles reporting prevalence of anxiety or depression in patients with HCC were included. A generalized linear mixed model with Clopper-Pearson intervals was used to obtain the pooled prevalence of depression and anxiety in patients with HCC. Risk factors were analyzed via a fractional-logistic regression model.ResultsSeventeen articles involving 64,247 patients with HCC were included. The pooled prevalence of depression and anxiety in patients with HCC was 24.04% (95% confidence interval [CI], 13.99–38.11%) and 22.20% (95% CI, 10.07–42.09%) respectively. Subgroup analysis determined that the prevalence of depression was lowest in studies where depression was diagnosed via clinician-administered scales (16.07%;95% CI, 4.42–44.20%) and highest in self-reported scales (30.03%; 95% CI, 17.19–47.01%). Depression in patients with HCC was lowest in the Americas (16.44%; 95% CI, 6.37–36.27%) and highest in South-East Asia (66.67%; 95% CI, 56.68–75.35%). Alcohol consumption, cirrhosis, and college education significantly increased risk of depression in patients with HCC.ConclusionsOne in four patients with HCC have depression, while one in five have anxiety. Further studies are required to validate these findings, as seen from the wide CIs in certain subgroup analyses. Screening strategies for depression and anxiety should also be developed for patients with HCC.     

Prevalence of mental disorders,psychological distress,and mental health services use among lesbian,gay, and bisexual adults in the United States

Recent estimates of mental health morbidity among adults reporting same-gender sexual partners suggest that lesbians, gay men, and bisexual individuals may experience excess risk for some mental disorders as compared with heterosexual individuals. However, sexual orientation has not been measured directly. Using data from a nationally representative survey of 2,917 midlife adults, the authors examined possible sexual orientation-related differences in morbidity, distress, and mental health services use. Results indicate that gay-bisexual men evidenced higher prevalence of depression, panic attacks, and psychological distress than heterosexual men. Lesbian-bisexual women showed greater prevalence of generalized anxiety disorder than heterosexual women. Services use was more frequent among those of minority sexual orientation. Findings support the existence of sexual orientation differences in patterns of morbidity and treatment use.     

Quality of life,anxiety and depressive disorders in patients with extrasystolic arrhythmia

IntroductionThe aim of this study was to perform a comparative and economic analysis of the degree of development of anxiety-depressive disorder in patients with different types of extrasystolic arrhythmia using different assessment scales.Material and methodsThe study was conducted in 2018–2019 at the premises of clinic No. 4, involving 450 patients (Moscow, Russia). Patients were divided into three groups: with coronary heart disease (CHD) (147 patients), with myocardiodystrophy (MCD) (113) and with cardiopsychoneurosis (CPN) (190). Everyone underwent round-the-clock electrocardiography (ECG) and echocardiography. If symptoms of depressive disorder are detected in a timely manner, the risk of adverse cardiovascular diseases may be reduced.ResultsDepression and anxiety indicators on all three scales differed significantly (p ≤ 0.05) in patients with supraventricular extrasystole (more than 40 points on the Zung scale, 14 points on the Montgomery-Asberg depression scale, more than 38 points on Zung and 3 points on Covi anxiety scales). For patients with ventricular extrasystole, a significant difference was established between groups 1 and 2 only in terms of the level of depression on the Zung scale. Factors of psychogenic origin determine the development of cardiac rhythm disturbances.ConclusionsThe study showed that for supraventricular extrasystoles, these factors determine the overall health of the patient. The differences between the three groups are significant on all scales of depression and anxiety (p ≤ 0.05). The most susceptible to depression and anxiety are patients with extrasystolic arrhythmias diagnosed with CHD, as well as MCD.     

How the topic of homosexuality is taught at U.S. medical schools.

In 1991 the authors surveyed all U.S. medical schools to assess both the number of curriculum hours devoted to the topic of homosexuality and the instructional strategies employed in its academic treatment; responses were sought from faculty with responsibility for teaching the topic (mostly directors of medical student education in psychiatry). Of the 126 schools, 82 (65%) responded. The mean number of hours reported was 3 hours and 26 minutes, with significant differences based on geographic region. The most frequently cited strategy was lectures in human sexuality, followed distantly by panel presentations and meetings with gay men or lesbians (both health care providers and others). To enhance sensitivity and comfort with gay and lesbian issues and to counter stereotypic responses, the authors propose that the topic of homosexuality be wholly integrated throughout the curriculum.