The long-term mental health outcome of adolescent with depression and alcohol abuse comorbidity

Background Alcohol abuse often co-occurs with adolescent depression and about 1-2% suffer from the dual diagnosis in adolescence. This group is often undertreated or receive inadequate treatment for either of the conditions. Both conditions affect the developing brain and poor long-term outcome might be a potential risk. Yet, long-term follow-up studies are scarce. The aim of this study was to analyse if adolescent depression and alcohol abuse predict poorer mental health in adulthood compared to individuals without either or both conditions. Methods A community-based sample of individuals with adolescent depression in 1991-93 and matched non-depressed peers were followed up using a structured diagnostic interview after 15 years. The participation rate was 65% (depressed n = 227; non-depressed controls n = 155). Information on alcohol abuse in adolescence was collected at baseline with a structured interview. The outcome was mental disorders between the ages 19-31 years; information on depression and alcohol abuse was collected at the follow-up with a structured diagnostic interview. The statistical method used was binary logistic regression. Results Adolescents with depression and alcohol abuse had an excess risk of recurrence of depression (OR 2.12, p < 0.05) and alcohol abuse (OR 6.72, p < 0.01) in adulthood, compared with adolescents with depression only, even when adjusted for confounders. Adolescents with alcohol abuse only had not significantly worse long-term outcome compared with their healthy peers. Conclusions The co-occurrence of depression and alcohol abuse in adolescence is associated with long-lasting health consequences compared to either condition alone. This finding indicates that there is a need to prioritize this group of patients that is at risk of suboptimal treatment, and to further develop effective treatment adjusted to the co-occurring condition. Key messages The co-occurrence of adolescent depression and alcohol abuse has long lasting mental health consequences compared to either condition alone. Improved treatment methods are important for this group of adolescents.

Does Assessment Method Matter in Detecting Mental Health Distress among Ashkenazi and Mizrahi Israeli Women with Breast Cancer?

Authors examined differences in assessment method (structured diagnostic interview versus self-report questionnaire) between ethnic groups in the prevalence of mood and anxiety disorders among women with breast cancer. A convenience sample of 88 Mizrahi (Jews of Middle Eastern/North African descent, n = 42) and Ashkenazi (Jews of European/American descent, n = 46) women with breast cancer from oncology units in three health centers across Israel participated in the study. Participants were within eight months of diagnosis. Participants completed the Hospital Anxiety and Depression Scale (HADS) and a structured diagnostic interview, the Mini-International Neuropsychiatric Interview (MINI). Approximately one-third (31.8 percent, n = 28) of participants were diagnosed with at least one mood or anxiety disorder based on the MINI. Significantly more Mizrahi participants (42.9 percent) were diagnosed with at least one mood or anxiety disorder, compared with their Ashkenazi counterparts (21.7 percent). Mean score on HADS was below the optimal cutoff score (≥13) among all participants, with no significant difference in mean score for emotional distress based on HADS between the two ethnic groups. The findings highlight the role of measurement variance in assessing mental health distress among women with breast cancer in general and among ethnic and racial minorities in particular.

Psychiatric Disorders and Future Violent Arrests: A Prospective Study Among Detained Girls

This study scrutinizes if detained girls with psychiatric disorders were at risk for future violent arrests during adolescence. A structured diagnostic interview was performed to determine the presence of various psychiatric disorders in 313 detained girls. Official juvenile arrest records were collected. With three exceptions that are in need of replication, psychiatric disorders (e.g., post-traumatic stress disorder, subtypes of conduct disorder), psychiatric disorder categories (e.g., anxiety disorders), and psychiatric comorbidity patterns were not prospectively related to future violent arrests. Our findings suggest that detained girls with psychiatric disorders should not be considered more dangerous than their counterparts without disorders, at least not during adolescence.

Development of a claims-based algorithm to identify potentially undiagnosed chronic migraine patients

Objective To develop a claims-based algorithm to identify undiagnosed chronic migraine among patients enrolled in a healthcare system. Methods An observational study using claims and patient survey data was conducted in a large medical group. Eligible patients had an International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) migraine diagnosis, without a chronic migraine diagnosis, in the 12 months before screening and did not have a migraine-related onabotulinumtoxinA claim in the 12 months before enrollment. Trained clinicians administered a semi-structured diagnostic interview, which served as the gold standard to diagnose chronic migraine, to enrolled patients. Potential claims-based predictors of chronic migraine that differentiated semi-structured diagnostic interview-positive (chronic migraine) and semi-structured diagnostic interview-negative (non-chronic migraine) patients were identified in bivariate analyses for inclusion in a logistic regression model. Results The final sample included 108 patients (chronic migraine = 64; non-chronic migraine = 44). Four significant predictors for chronic migraine were identified using claims in the 12 months before enrollment: ≥15 versus <15 claims for acute treatment of migraine, including opioids (odds ratio = 5.87 [95% confidence interval: 1.34–25.63]); ≥24 versus <24 healthcare visits (odds ratio = 2.80 [confidence interval: 1.08–7.25]); female versus male sex (odds ratio = 9.17 [confidence interval: 1.26–66.50); claims for ≥2 versus 0 unique migraine preventive classes (odds ratio = 4.39 [confidence interval: 1.19–16.22]). Model sensitivity was 78.1%; specificity was 72.7%. Conclusions The claims-based algorithm identified undiagnosed chronic migraine with sufficient sensitivity and specificity to have potential utility as a chronic migraine case-finding tool using health claims data. Research to further validate the algorithm is recommended.

Sensitivity and specificity of the Akena Visual Depression Inventory (AViDI-18) in Kampala (Uganda) and Cape Town (South Africa)

BackgroundVisual scales may be particularly useful in screening for depression in patients with low literacy. However, few have been validated and none are in common use.AimModification and validation of a visual scale to screen for depression in low literacy settings.MethodWe assessed the validity, reliability and factor loading of a 28-item visual depression inventory using pictorial items depicting depression signs and symptoms. We validated a revised scale comprised of 18 items known as the Akena Visual Depression Inventory (AViDI-18) against a structured diagnostic interview (Mini-International Neuropsychiatric Inventory) in 343 patients in Kampala (Uganda) and Cape Town (South Africa).ResultsThe 18 pictorial items had acceptable validity and reliability. The area under the curve (AUC) score of the AViDI-18 was 0.9. AUC scores were not significantly associated with sociodemographic variables.ConclusionThe AViDI-18 is a valid screen for depression in patients with low literacy.Declaration of interestNone.