Using the PHQ-9 and GAD-7 to screen for acute distress in transgender youth: findings from a pediatric endocrinology clinic

2019 ◽  
Vol 32 (1) ◽  
pp. 71-74 ◽  
Author(s):  
Danielle N. Moyer ◽  
Kara J. Connelly ◽  
Amy L. Holley
Keyword(s):  
Retrospective Chart Review ◽  
Medical Intervention ◽  
Screening Tools ◽  
Pediatric Endocrinology ◽  
Gender Nonconforming ◽  
Acute Distress ◽  
Patient Health ◽  
And Gender ◽  
Endocrinology Clinic

Abstract Background Transgender and gender nonconforming (TGNC) youth are at higher risk for anxiety and depression than their peers. The referral rate for those seeking specialty medical care has rapidly increased in recent years. This paper examines the use of brief screening tools with clear cutoffs to assist physicians in rapidly identifying TGNC youth in acute distress. Methods A retrospective chart review was conducted for patients aged 11–18 years being treated in a pediatric endocrinology clinic for gender dysphoria. Patient Health Questionnaires for depression (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) were collected for patients attending an initial consultation (n=79) or follow-up appointment (n=115). Results Screener data identified high rates of acute distress, including depression (47%), anxiety (61%), and suicidal ideation (30%). Distress was not associated with age or gender identity. More youth endorsed clinically significant anxiety at initial consultation appointments versus follow-up appointments. Conclusions The results support the use of the PHQ-9 and GAD-7 as brief, easy-to-use screening measures that can be administered by physicians to rapidly identify acute distress and inform treatment recommendations among TGNC youth seeking medical intervention.

Experiencing Misgendered Pronouns: A Classroom Activity to Encourage Empathy

2017 ◽  
Vol 45 (3) ◽  
pp. 269-278 ◽  
Author(s):  
Jessica MacNamara ◽  
Sarah Glann ◽  
Paul Durlak
Keyword(s):  
Research University ◽  
Discussion Board ◽  
Social Boundaries ◽  
Class Discussion ◽  
Transgender People ◽  
Gender Nonconforming ◽  
The Social ◽  
And Gender ◽  
Large Research

How can teachers help students understand the importance of gender pronouns for transgender and gender-nonconforming people? This article presents a gender pronoun reversal activity that simulates the experience of being verbally misgendered. Students followed up on the activity by posting reflections on an online class discussion board. The activity promoted empathy among cisgender students for transgender people and reflexivity regarding the social boundaries of gender identity. Empathy and reflexivity were common responses among students enrolled in Sociology of Diversity and Sociology of Gender at a large research university in the northeast. We present the activity, including preparation and follow-up along with an analysis of student responses.

Abstract P187: When A Global Crisis Closes Your Clinic: A Telemedicine Approach for Transient Ischemic Attack and Minor Stroke Care During the Covid-19 Pandemic

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Rachelle Dugue ◽  
Joshua Z Willey ◽  
Eliza C Miller ◽  
Ian M Kronish ◽  
Bernard P Chang
Keyword(s):  
New York ◽  
Secondary Prevention ◽  
Retrospective Chart Review ◽  
Stroke Care ◽  
Medical Intervention ◽  
Minor Stroke ◽  
Ischemic Attack ◽  
Peripheral Vertigo ◽  
Patient Infection

Introduction: Recent work has demonstrated the safety and feasibility of rapid outpatient evaluation for presentations of TIA and non-disabling stroke. Our outpatient TIA and stroke clinic, Rapid Access Vascular Evaluation-Neurology (RAVEN) clinic, instituted in 2016, encountered unprecedented challenges in operations during the COVID-19 surge in New York City, leading to the creation of a telemedicine approach to minimize patient and staff exposure risk. To date, few virtual TIA/stroke clinics have reported on safety and feasibility outcomes. Hypothesis: We hypothesized that rapid follow-up of patients with suspected TIA and minor stroke via telemedicine would be feasible and safe during the pandemic. Methods/Results: We performed a retrospective chart review of patients with TIA and minor stroke who were referred to the virtual clinic from the emergency department (ED) between March and June 2020 (the local peak of the COVID-19 pandemic) when RAVEN in-person visits were suspended. A total of 24 patients were discharged early from the ED and referred for RAVEN evaluation with 20 patients evaluated as scheduled; 4 were lost to RAVEN follow-up. Ultimately, 60% of these patients were diagnosed with TIA or minor stroke after completing their remote evaluation; the rest were diagnosed as stroke mimics (seizure, migraine with aura, neuropathy, peripheral vertigo, stroke recrudescence). The median NIHSS calculated at initial ED evaluation was 1 with a maximum NIHSS of 5. A new medical intervention for secondary prevention was prescribed for 70% of patients prior to ED discharge. Amongst patients contacted by phone 3-5 months post-RAVEN evaluation, 4 of 15 had an increased modified Rankin score. Of the 24 patients referred for RAVEN evaluation, 7 returned to the ED within 90 days, with 3 patients citing neurologic complaints. On follow-up via phone conducted 2-5 months after RAVEN evaluation, 3 of 17 patients self-reported either a positive COVID-19 test or suspected COVID-19 diagnosis over the study period. Conclusion: A telemedicine-based approach to evaluate TIA and stroke in the RAVEN model helped limit patient infection risk, optimize resource allocation, establish accurate, timely diagnoses, and effectively implement secondary prevention strategies.

scholarly journals Six-Month Outcomes for Collaborative Care Management of Depression Among Smoking and Nonsmoking Patients

2017 ◽  
Vol 4 ◽  
pp. 233339281772164 ◽  
Author(s):  
Daniel R. Witt ◽  
Gregory M. Garrison ◽  
Cesar A. Gonzalez ◽  
Terrence J. Witt ◽  
Kurt B. Angstman
Keyword(s):  
Tobacco Use ◽  
Collaborative Care ◽  
Care Management ◽  
Patient Adherence ◽  
Retrospective Chart Review ◽  
Demographic Variables ◽  
Depression Treatment ◽  
Intention To Treat ◽  
Patient Health

Background: Collaborative care management (CCM) is an evidence-based model that contributes to better outcomes for depression treatment in the primary care setting. Tobacco use increases overall economic costs, morbidity, and mortality and has been shown to impact behavioral health outcomes. Our study aims to observe clinical outcomes for depression treatment for patients with comorbid tobacco use and depression within the CCM model. Methods: A retrospective chart review study of 2826 adult patients with depression enrolled in CCM was performed to determine the association between regular tobacco use and depression outcomes. Baseline intake data consisting of clinical and demographic variables along with 6-month follow-up of Patient Health Questionnaire-9 (PHQ-9) scores for smokers (n = 727, 25.7%) and nonsmokers (n = 2099, 74.3%) were obtained. Depression remission was defined as a PHQ-9 score <5 and persistent depressive symptoms (PDS) as a PHQ-9 score ≥10 at 6 months. Results: Using an intention-to-treat analysis, the multivariate modeling demonstrated that smokers, at 6 months, had an increased adjusted odds ratio (AOR) for PDS: 1.624 (95% CI: 1.353-1.949). Furthermore, smokers had a lower AOR of depression remission: 0.603 (95% CI: 0.492-0.739). Patient adherence to treatment was also lower in smokers with an AOR of 0.666 (95% CI: 0.553-0.802). Conclusions: Smokers enrolled in CCM were associated with reduced treatment adherence and worse outcomes for depression treatment at 6 months compared to nonsmokers, even when baseline clinical and demographic variables were controlled. Thus, new tailored practices may be warranted within the CCM model to treat comorbid depression and tobacco use disorders.

Sex Reclassification for Trans and Gender Nonconforming People: From the Medicalized Body to the Privatized Self

2019 ◽  
Author(s):  
Ido Katri
Keyword(s):  
21St Century ◽  
Legal Status ◽  
Medical Intervention ◽  
The Body ◽  
Third Party ◽  
Gender Nonconforming ◽  
Ex Post ◽  
Identification Documents ◽  
And Gender ◽  
Laws And Policies

Sex reclassification is a core issue of gender nonconforming legal engagements. Access to proper identification documents for trans and nonbinary people relates to lower levels of exposure to anti-trans violence, discrimination, and suicidality. In the first decades of the 21st century, the majority of global jurisdictions have seen some kind of reform with respect to sex reclassification. Nonbinary classifications, such as the X marker, are also becoming available for those who wish not to be classified as either M or F. Across the globe, five major policy streams can be found: total ban on reclassification, that is, having no law or policy in place that allows for reclassification; reproduction-related prerequisite, that is, requiring applicants to undergo sterilization or genital-related surgery; other medical intervention-based schemes, that is, requiring applicants to provide proof that they have modified their body using some kind of gender-related medical technology; corroboration requirements, that is, requiring that a third party, usually a medical professional, corroborates the identity of the applicant; and the emerging “gold standard,” gender self-determination, that is, laws and policies requiring only an expression of a desire or need to be reclassified. These streams of policy provide varying levels of access to proper identification documents and place different burdens on applicants, some requiring bodily modifications while others rely on autonomous will. Yet all these policies still demand an alignment between the internal truth of the body and external facts, resonating with the logic of birth assignment of sex itself—that is, the idea that the allocation of differentiated legal status of M or F reflects an immutable truth about legal subjects. Current laws and policies fail to address harms caused to gender nonconforming people by state mechanisms themselves. They only provide remedies ex post facto. In the early 21st century, all countries assign a differentiated legal status of either M or F at birth based solely, in almost all cases, on external genitals of newborns. This differentiated legal status is recorded on the birth certificate and becomes a part of one’s legal identity for life. This allocation of status reflects the idea that external genitals of newborns are proof of their owners’ future roles as men or women, that is, an idea that there is a pre-legal alignment between certain bodily configurations, social role, and gender performance. This mundane administrative mechanism not only justifies different treatment for men and women but also marks trans and nonbinary people as others. In order to better address the harm caused by systems of gendered distribution of resources and opportunities, there is a need to go beyond sex reclassification to question birth assignment itself.

scholarly journals Time to Reach Glycemic Goal on an Outpatient Academic Endocrinology Clinic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A479-A480
Author(s):  
Leopoldo M Cobos Salinas ◽  
Fernando Reyes San Martin ◽  
Merri Pendergrass ◽  
Dinkar Rupakula
Keyword(s):  
Chart Review ◽  
Insurance Coverage ◽  
Retrospective Chart Review ◽  
Initial Visit ◽  
Acute Hyperglycemia ◽  
The Us ◽  
New Diagnosis ◽  
Lost To Follow Up ◽  
Endocrinology Clinic

Abstract Background: The achievement of the A1C goals in the US did not improve in 2017 compared to 2014. Guidelines for which patients with T2DM to refer to an endocrinologist are not well defined. Furthermore, there is no consensus about how long patients should be followed by an endocrinologist. Experts have recommended referral to an endocrinologist for new diagnosis, acute hyperglycemia, A1C &gt; 7.0, &gt; 8.0 for 6 months, or A1C 1.4 times the upper limit of normal. However, with the current number of board-certified endocrinologists in the US, it would be impossible for patients with those criteria to be seen even once. To determine which patients should be followed by an endocrinologist, it would help to know which patients are most likely to achieve ongoing benefit. To focus on patients that have a higher chance of improvement, it is important to know the average time it would take to reach an individualized A1C goal and focus on patients more likely to improve. Objective: We performed this quality improvement assessment to 1) determine the percentage of patients with T2DM who achieved their individualized A1C goals (Age 18–55: 7.0% +/- .5%, 55–75: 7.5% +/- .5%, &gt;75: 9.0% +/- .5%) at 12 months after their initial endocrinologist visit and 2) compare characteristics of patients who achieved A1C goals by 12 months versus those who did not achieve goals. Material and Methods: We performed a retrospective chart review of patients with T2DM who had an initial visit at an academic endocrinology clinic between 10/1/2017 and 05/31/2018 (N= 48, 52% female, baseline 9.6%, 48% male, baseline [BL] HbA1c 9.9%). Data for 12 months following the initial visit were collected. Results: Following their initial visit, 21/48 (44%, BL A1c 10.3%) were lost to follow-up. Of those with at least one additional visit, 12/27 (44%, BL A1c 11.3%, P&lt;0.05) achieved A1C goal by the 12-month period. Of those, 6/12 (50%, BL A1c 10.3%), 1/12 (8%, BL A1c 9.9%), 4/12 (25%, BL A1c 9.0%), 1/12 (8%, BL A1c 8.8%) achieved goals by 3, 6, 9, and 12 months respectively. Those who did achieve their goals were slightly older (52 +/- 25yrs) than those who did not (50 +/- 12yrs), p&lt; 0.05. No significant differences between those who were lost to follow-up, achieved goals, or who did not achieve goals with respect to gender, insurance coverage, or regimen. However, those who did continued care had a worse A1c of 11.3%. Conclusion: Of patients with T2DM and uncontrolled hyperglycemia presenting to an academic endocrine clinic, nearly half are lost to follow-up after the initial visit. Future efforts should be made to better understand and potentially improve this. Of additional concern, only about half of patients with at least one additional visit achieved their A1C goal after 12 months, and 91% of those achieved their goals by 9 months. Further study will be needed to determine whether patients who are uncontrolled after 9–12 months will have any further benefit from endocrine follow-up.

scholarly journals A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children

2020 ◽  
pp. 98-110
Author(s):  
Julia Temple Newhook ◽  
Jake Pyne ◽  
Kelley Winters ◽  
Stephen Feder ◽  
Cindy Holmes ◽  
...  
Keyword(s):  
Gender Nonconforming ◽  
Critical Commentary ◽  
Follow Up Studies ◽  
And Gender

Identifying depressive symptoms among diabetes type and the impact on hemoglobin A1c

2018 ◽  
Vol 31 (1) ◽  
pp. 39-44 ◽  
Author(s):  
Bethany A. Glick ◽  
K. Ming Chan Hong ◽  
Kathryn Obrynba ◽  
Manmohan K. Kamboj ◽  
Robert P. Hoffman
Keyword(s):  
Depressive Symptoms ◽  
Glycemic Control ◽  
Retrospective Chart Review ◽  
Risk Groups ◽  
Diabetes Type ◽  
Counseling Intervention ◽  
Depression Risk ◽  
Patient Health ◽  
And Gender ◽  
The Impact

AbstractBackground:This study was designed to determine the effects of diabetes type and gender on depression risk determined by a highly sensitive screening questionnaire in adolescents. Glycemic control and counseling affect were also studied.Methods:A retrospective chart review of patients seen between 2013 and 2015 was performed. Five hundred and thirty adolescents with type 1 (T1DM) or 2 (T2DM) diabetes mellitus completed the Patient Health Questionnaire-9 (PHQ-9) to identify depressive symptoms. Hemoglobin A1c(HbA1c) was measured when the PHQ-9 was given, and at 1 year. Patients with increased depression risk were referred for counseling and comparisons were made between those who did and did not attend.Results:Females with T2DM, but not males, had increased depression compared to T1DM. Females had increased depression compared to males in T1DM (p = 0.046) and a near significant increase in T2DM (p = 0.069). In T1DM, but not T2DM, HbA1clevels were increased in high and moderate, compared to low, risk depression risk groups (p = 0.007). Follow-up HbA1cwas unchanged 1 year later and there were no differences between those involved in counseling and those who refused to attend. Sex and type of diabetes had no effect on response to counseling.Conclusions:These results demonstrate increased depression in adolescents with T2DM compared to T1DM and in females compared to controls. Glycemic control did not change in adolescents who reported moderate to severe symptoms of depression and received counseling intervention compared to adolescents who declined counseling.

Abstract TP151: Box Checking for Comprehensive Stroke Care Metrics of Depression Screening: Does It Actually Equate to Better Treatment

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Parneet Grewal ◽  
Ray Mirembo ◽  
William Mathias ◽  
Jessica D Lee
Keyword(s):  
Depressive Symptoms ◽  
Parietal Lobe ◽  
Antidepressant Treatment ◽  
Retrospective Chart Review ◽  
Screening Tools ◽  
Appointment Adherence ◽  
Post Stroke ◽  
Common Location ◽  
Post Stroke Depression

Objective: One in three stroke patients develop depression following the event. The exact cause of post stroke depression has been debated but may be due to brain injury resulting from stroke and psychological factors. We aimed to 1) Discover frequency of patients suffering from depressive symptoms post-stroke 2) Ascertain whether occurrence of post-stroke depression plays a role in adherence to follow up appointment 3) Determine the frequency of antidepressant treatment post-stroke and 4) Identify location of stroke most commonly associated with depression. Methods: We conducted a single institution, retrospective chart review of patients ≥18 years, discharged with ischemic stroke from October2017 - March2018. Variables such as age, sex, location of stroke, discharge PHQ9 score, depression treatment and follow up appointment adherence were determined. Results: In our cohort of 200 patients (48.5% M, 51.5% F), 28 (14.0%) had pre-existing diagnosis of depression. The mean PHQ9 on discharge was 5.32±5.16 (n=145, deficits too severe to obtain PHQ9 in 55 subjects), with 66 (45.5%) of patients having PHQ9 ≥5 at discharge, indicating at least mild depressive symptoms. While there was no difference in discharge NIHSS or modified Rankin scores, females were twice as likely to experience at least mild depressive symptoms post-stroke as compared to males (66.7% vs 33.3%, p=0.002). Only 19 patients with PHQ9≥5 at discharge were started or continued on antidepressants. On subgroup analysis of patients with PHQ9 ≥5 (n=66), the three most common locations of stroke, in descending order were right parietal (20, 30.3%), left subcortical (14, 21.2%) and right frontal (13, 19.6%). No association was found between discharge PHQ9 score and follow up appointment adherence. Conclusion: Discharge PHQ9 scores irrespective of treatment do not play a predictive role in follow up appointment adherence. Females were more likely than males to experience post stroke depression; and while depressive symptoms are common, patients were unlikely to be prescribed antidepressant therapy. The most common location of stroke associated with depression was right parietal lobe. Such patients should be assessed closely for symptoms of depression with standardized screening tools.

scholarly journals Gender incongruence and gender dysphoria in childhood and adolescence—current insights in diagnostics, management, and follow-up

2020 ◽  
Author(s):  
Hedi Claahsen - van der Grinten ◽  
Chris Verhaak ◽  
Thomas Steensma ◽  
Tim Middelberg ◽  
Joep Roeffen ◽  
...  
Keyword(s):  
Mental Health Professionals ◽  
Gender Dysphoria ◽  
Medical Intervention ◽  
Sex Characteristics ◽  
Childhood And Adolescence ◽  
Early Medical Intervention ◽  
Gnrh Analogues ◽  
Transgender Persons ◽  
And Gender

AbstractGender incongruence (GI) is defined as a condition in which the gender identity of a person does not align with the gender assigned at birth. Awareness and more social acceptance have paved the way for early medical intervention about two decades ago and are now part of good clinical practice although much robust data is lacking. Medical and mental treatment in adolescents with GI is complex and is recommended to take place within a team of mental health professionals, psychiatrists, endocrinologists, and other healthcare providers. The somatic treatment generally consists of the use of GnRH analogues to prevent the progression of biological puberty and subsequently gender-affirming hormonal treatment to develop sex characteristics of the self-identified gender and surgical procedures. However to optimize treatment regimens, long-term follow-up and additional studies are still needed. What is known• The prevalence of gender dysphoria increased significantly in the past years and can lead to significant complaints and burdens especially during puberty.• Pubertal suppression and gender-affirmed treatment can be effectively used in adolescence with gender dysphoria.What is new• Transgender mental and medical healthcare is a long-lasting process during which not only the child/adolescent with GI but also their parents/family have to be counseled in making choices about their social, medical, and legal transitions.• There are an increasing number of transgender persons defining as nonbinary. Therefore, an individualized approach by an experienced team is necessary.

scholarly journals Changes in Anxiety and Depression from Intake to First Follow-Up Among Transgender Youth in a Pediatric Endocrinology Clinic

2020 ◽  
Vol 5 (3) ◽  
pp. 196-200
Author(s):  
Annette L. Cantu ◽  
Danielle N. Moyer ◽  
Kara J. Connelly ◽  
Amy L. Holley
Keyword(s):  
Anxiety And Depression ◽  
Pediatric Endocrinology ◽  
Transgender Youth ◽  
Endocrinology Clinic
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