scholarly journals Effects of Pre-Transplant Depression and Anxiety Symptoms on Morbidity and Mortality Post-Heart Transplant: A Retrospective Cohort Study

2016 ◽  
Vol 35 (4) ◽  
pp. S146
Author(s):  
F.R. Epstein ◽  
A. Lucero
2021 ◽  
Author(s):  
Margaret T Anton ◽  
Heidi Mochari-Greenberger ◽  
Evie Andreopoulos ◽  
Reena L Pande

BACKGROUND Digital solutions, such as web-based and mobile interventions, have the potential to streamline pathways to mental health services and improve access to mental health care. Although there are a growing number of randomized trials establishing the efficacy of digital interventions for common mental health problems, less is known about the real world impact of these tools. AbleTo Digital+, a commercially available mental health application for depression and anxiety, offers a unique opportunity to understand the clinical impact of such tools delivered in real world contexts. OBJECTIVE The primary objective of this study was to examine the magnitude of change in depression and anxiety symptoms among individuals who used AbleTo Digital+ programs, as well as to evaluate Digital+ module completion and use of 1:1 coaching. METHODS In this retrospective cohort study, we analyzed previously collected and permanently de-identified data from a consecutive cohort of 1,896 adults who initiated use in one of the three Digital+ eight-module programs (Depression, Generalized Anxiety, or Social Anxiety) between January 1 and June 30, 2020. Depression, generalized anxiety, and social anxiety symptoms were assessed within each program using the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), and the Social Phobia Inventory (SPIN) respectively. Linear mixed effects models were built to assess the association between module completion and symptom change among users who completed at least four modules and had at least mild baseline symptom elevations, controlling for age, gender, and baseline symptom severity. Digital+ use, including module completion, 1:1 coaching calls, and in-app coach messaging were also evaluated. RESULTS Large effects were observed among Depression (d=1.5), Generalized Anxiety (d=1.2), and Social Anxiety (d=1.0) program participants who completed at least four modules and had mild baseline elevations (n=470). Associations between module completion and change in depression (????=-1.2; P<.001), generalized anxiety (????=-1.1; P<.001), and social anxiety (????=-2.4; P<.0001) symptom scores retained significance with covariate adjustment. Participants completed an average of 2.6 (SD=2.7) modules. The average total length of app use was 7.5 weeks (SD=11.9). Approximately two-thirds of users engaged in 1:1 coaching calls (66.8%) or in-app text messaging (66.10%). Participants who completed at least four modules participated in significantly more coaching calls per module (M=1.1; SD=0.7)than users who completed fewer than four modules (M=1.0; SD=1.2; t=-2.1, P=.03). CONCLUSIONS This study demonstrated that AbleTo Digital+ users experienced significant reductions in depression, generalized anxiety, and social anxiety symptoms over the course of the program.


2021 ◽  
Vol 28 ◽  
pp. 50-55
Author(s):  
Chonlada Krutsri ◽  
Pongsasit Singhatas ◽  
Preeda Sumpritpradit ◽  
Tharin Thampongsa ◽  
Samart Phuwapraisirisan ◽  
...  

2020 ◽  
Author(s):  
Akin Osibogun ◽  
Akin Abayomi ◽  
Oluchi Kanma-Okafor ◽  
Jide Idris ◽  
Abimbola Bowale ◽  
...  

Abstract Background: The current pandemic of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown epidemiological and clinical characteristics that appear worsened in hypertensive patients. The morbidity and mortality of the disease among hypertensive patients in Africa have yet to be well described.Methods: In this retrospective cohort study all confirmed COVID-19 adult patients (≥18 years of age) in Lagos between February 27 to July 6 2020 were included. Demographic, clinical and outcome data were extracted from electronic medical records of patients admitted at the COVID-19 isolation centers in Lagos. Outcomes included dying, being discharged after recovery or being evacuated/transferred. Descriptive statistics considered proportions, means and medians. The Chi-square and Fisher’s exact tests were used in determining associations between variables. Kaplan–Meier survival analysis and Cox regression were performed to quantify the risk of worse outcomes among hypertensives with COVID-19 and adjust for confounders. P-value ≤0.05 was considered statistically significant.Results: A total of 2075 adults with COVID-19 were included in this study. The prevalence of hypertension, the most common comorbidity, was 17.8% followed by diabetes (7.2%) and asthma (2.0%). Overall mortality was 4.2% while mortality among the hypertensives was 13.7%. Severe symptoms and mortality were significantly higher among the hypertensives and survival rates were significantly lowered by the presence of an additional comorbidity to 50% from 91% for those with hypertension alone and from 98% for all other patients (P<0.001). After adjustment for confounders (age and sex), severe COVID-19and death were higher for hypertensives {severe/critical illness: HR=2.41, P=0.001, 95%CI=1.4–4.0, death: HR=2.30, P=0.001, 95%CI=1.2–4.6, for those with hypertension only} {severe/critical illness: HR=3.76, P=0.001, 95%CI=2.1–6.4, death: crude HR=6.63, P=0.001, 95%CI=3.4–1.6, for those with additional comorbidities}. Hypertension posed an increased risk of severe morbidity (approx. 4-fold) and death (approx. 7-fold) from COVID-19 in the presence of multiple comorbidities. Conclusion: The potential morbidity and mortality risks of hypertension especially with other comorbidities in COVID-19 could help direct efforts towards prevention and prognostication. This provides the rationale for improving preventive caution for people with hypertension and other comorbidities and prioritizing them for future antiviral interventions.


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