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Background: Patients with inflammatory bowel disease (IBD) are more susceptible to mental health problems than the general population; however, temporal trends in psychiatric diagnoses' incidence or prevalence in the United States are lacking. We sought to identify these trends among patients with IBD using national Veterans Heath Administration data., Methods: We ascertained the presence of anxiety, depression, or posttraumatic stress disorder among veterans with IBD (ulcerative colitis or Crohn's disease) during fiscal years 2000-2015. Patients with prior anxiety, depression, or posttraumatic stress disorder before their first Veterans Health Administration IBD encounter were excluded to form the study cohort. We calculated annual prevalence, incidence rates, and age standardized and stratified by gender using a direct standardization method., Results: We identified 60,086 IBD patients (93.9% male). The prevalence of anxiety, depression, and/or posttraumatic stress disorder increased from 10.8 per 100 with IBD in 2001 to 38 per 100 with IBD in 2015; 19,595 (32.6%) patients had a new anxiety, depression, and/or posttraumatic stress disorder diagnosis during the study period. The annual incidence rates of these mental health problems went from 6.1 per 100 with IBD in 2001 to 3.6 per 100 in 2015. This trend was largely driven by decline in depression., Conclusions: The prevalence of anxiety, depression, and posttraumatic stress disorder is high among US veterans with IBD and increasing, given the chronicity of IBD and psychological diagnoses. Incidence, particularly depression, appears to be declining. Confirmation and reasons for this encouraging trend are needed., (Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation 2019.)

In patients with migraine, depression is associated with poorer medical prognosis, decreased quality of life, and increased risk of suicidality and disability; yet, behavioral interventions have rarely been investigated. The current study compared the efficacy of two 1-day (5- to 6-h) interventions for co-occurring migraine and depression: (1) acceptance and commitment therapy plus migraine education (ACT-ED), and (2) support plus migraine education (S-ED). One hundred and thirty-six patients with comorbid depression and migraine were randomized to a treatment. One hundred and three (76%) completed the ACT-ED (N = 56) or S-ED (N = 47) workshop. Primary outcomes were depression diagnosis and symptoms. Secondary outcomes were anxiety symptoms, headache-related disability and general functioning, and quality of life. Assessments were completed at baseline and 3 and 6 months following the workshop. At the 6-month follow-up, on categorical outcomes, a significantly greater number of people in the ACT-ED condition no longer met criteria for a major depressive episode and exhibited a > 50% drop in symptoms on the Hamilton Rating Scale of Depression. Similarly, though, weaker results were found when examining depressive symptoms dimensionally. On secondary outcomes, people in the ACT-ED condition exhibited significantly greater improvements in anxiety, headache-related disability, and quality of social relationships, compared to S-ED, No differences between groups were observed in general functioning. A 1-day (5- to 6-h) ACT workshop can deliver substantial and lasting benefits to depressed migraineurs, over and above those provided by group support and education. This approach is an attractive alternative to weekly psychotherapy. Clinicaltrials.gov # NCT02108678.

Objective: To evaluate effects of an online, hour-long migraine education and management education program on health outcomes in people with migraine experiencing significant depressive symptoms., Methods: Eligible individuals in the community with comorbid migraine and depressive symptoms (n = 95) participated in the 12-week study. Participants completed self-report questionnaires examining general functioning, headache-specific disability, migraine frequency, pain, and depressive symptoms, before, and at 2, 6, and 12 weeks following the migraine education and management program. Primary analyses evaluated change over time in each outcome, using individual linear growth curve models., Results: After watching the migraine education and management video, there were significant effects of time (across all time points) for average pain level in the past 30 days (b = -0.20, p < .001), most intense pain level in the past 30 days (b = -0.33, p < .001) depression (Patient Health Questionnaire-8; b = -0.28, p = .002), and headache-specific disability (Headache Disability Inventory; b = -1.32, p < .001), such that each of these outcomes improved linearly over time., Conclusions: A brief, online educational video is practical and effective and can lead to enhanced migraine knowledge and self-management skills and lessen the burden of migraine and concurrent depressive symptoms., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Depression during pregnancy is highly prevalent and is associated with increased risk of a variety of negative psychological and medical outcomes in both mothers and offspring. Antenatal depression often co-occurs with significant anxiety, potentially exacerbating morbidities for women and their children. However, screening during the antenatal period is frequently limited to assessment of depression so that other significant comorbid disorders may be missed. Follow-up assessment by clinicians has similarly focused primarily on detection of depressive symptoms. Anxiety, obsessive compulsive disorder, and post-traumatic stress disorder, among others, often go undetected in perinatal care settings, even when depression is identified. Failing to recognize these comorbid diagnoses may lead to inadequate treatment or only partial alleviation of distress. Consequently, screening for and assessment of comorbid disorders is warranted. In this study, 382 pregnant women (M age = 25.8 [SD = 5.3] years, 85.0% Caucasian) receiving care at a university hospital clinic and Maternal Mental Health Care centers in eastern Iowa and who screened positive for depression on the Beck Depression Inventory completed the Structured Clinical Interview for DSM-IV to assess comorbid mental health symptoms and diagnoses. Overall, findings demonstrate high rates of anxiety disorders among women both with and without current major depression, although depressed women reported higher rates of generalized anxiety disorder and post-traumatic stress disorder. Notably, however, incidence-specific symptoms were comparable across groups. Routine screening of both anxiety and depression during pregnancy should be conducted.

Childhood experiences, personality, and polyunsaturated essential fatty acid (PUFA) composition have all been shown to affect the likelihood of depressive symptoms. Few studies have addressed relationships between these factors in their influence on the occurrence or course of depressive symptoms. The following analysis was designed to do so. Subjects, 15-20 years old, had either begun antidepressant treatment within the preceding month (n = 88), or had never taken psychiatric medications (n = 92). Baseline assessments included a structured diagnostic interview, the self-completed Multiphasic Personality Questionnaire, and a determination of plasma PUFA phospholipid composition. Depressive symptom levels were assessed at baseline and again at 4, 8 and 12 months. Omega-3 composition and general childhood trauma scores were unrelated to each other but both correlated, in predicted directions, with negative emotionality. Low omega-3 composition and history of childhood trauma were associated with persistence of depressive symptoms during follow-up, largely through their effects on negative emotionality. Negative emotionality appears to comprise a final common pathway to depressive disorder through which the diverse risk factors of childhood adversity and low omega-3 composition are expressed., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Migraine is a complex neurological disorder that substantially impairs a person's functioning and is often comorbid with depression. Currently, little is known about psychological coping strategies that may underlie disability and depression in patients with migraine., Purpose: This study examines concurrent relations between depression and disability on the one hand and pain acceptance and values-based action on the other hand in patients with migraine., Method: Ninety-three patients with migraine and depressive symptoms-being evaluated for a larger project examining the impact of a behavioral intervention on depression in patients with migraine-completed measures of depression, disability, pain acceptance, and values-based action. Using multiple regression analyses, the contributions of pain acceptance and values-based action to depression and disability were assessed., Results: Low pain acceptance was strongly associated with depression and disability (r s(2) = .15-.37) in these patients. Low pain acceptance also explained unique variance in disability, beyond that of depression. Values-based action related modestly to depression and disability (r s(2) = .02-.07)., Conclusion: Pain acceptance can contribute to our understanding of psychological health and functioning. An important next step would be to examine whether targeting acceptance in treatment of patients with migraine would lead to improvements in their mental health and functioning.

Objective: To determine whether a 1-day behavioral intervention, aimed at enhancing psychological flexibility, improves headache outcomes of migraine patients with comorbid depression., Background: Migraine is often comorbid with depression, with each disorder increasing the risk for onset and exacerbation of the other. Managing psychological triggers, such as stress and depression, may result in greater success of headache management., Method: Sixty patients with comorbid migraine and depression were assigned to a 1-day Acceptance and Commitment Training plus Migraine Education workshop (ACT-ED; N = 38) or to treatment as usual (TAU; N = 22). Patients completed a daily headache diary prior to, and for 3 months following, the intervention. Clinical variables examined included headache frequency/severity, medication use, disability, and visit to a health care professional. Comparisons were made between baseline findings and findings at the 3-month follow up., Results: Participants assigned to the ACT-ED condition exhibited significant improvements in headache frequency, headache severity, medication use, and headache-related disability. In contrast, the TAU group did not exhibit improvements. The difference in headache outcomes between ACT-ED and TAU was not statistically significant over time (ie, the treatment by time interaction was nonsignificant). These results complement those of a previous report showing effects of ACT-ED vs TAU on depression and disability., Conclusion: A 1-day ACT-ED workshop targeting psychological flexibility may convey benefit for patients with comorbid migraine and depression.These pilot study findings merit further investigation using a more rigorously designed large-scale trial.

Background: Depression in medically ill patients occurs at twice the rate found in the general population. Though pharmacologic and psychotherapeutic interventions for depression are effective, response to treatment and access to care are barriers for this population. A multidimensional telehealth intervention was designed to focus on these barriers by delivering a phone based intervention that addressed managing one's illness and coping emotionally., Methods: Veterans with diabetes, hypertension, or chronic pain and depressive symptoms were randomized to one of three conditions: Usual Care (n=23), Illness Management Only (n=31), or Combined Psychotherapy and Illness Management (n=29). Those randomized to the Combined or Illness Management Only intervention group received 10 phone visits. Veterans in the Combined group received all aspects of the illness management program plus a manualized depression intervention. Subjects completed assessments at baseline, week 5, and 10 to test the main hypothesis that veterans in the Combined condition would have a greater decline in depressive symptoms., Results: The Combined intervention yielded a significant decline in depressive symptoms when compared with Usual Care. However, the there was no significant difference between the Combined and Illness Management Only groups., Limitations: This is a pilot study with a small sample size relative to a standard randomized controlled trial in psychotherapy., Conclusions: This telephone-based intervention succeeded in reducing depressive symptoms in veterans with chronic illness. It adds to the building evidence base for providing phone-delivered mental health services., (© 2013 Elsevier B.V. All rights reserved.)

The patient-reported outcomes measurement information system (PROMIS) offers standardized assessment measures of clinically relevant patient-reported outcomes. This study evaluated the reliability and validity of select PROMIS measures with U.S. military veterans following orthopedic surgery. Data for the current study were collected as part of a pilot randomized control trial assessing the efficacy of a 1-day Acceptance and Commitment Therapy workshop on persistent postsurgical pain in at-risk veterans undergoing orthopedic surgery. Sixty-seven participants completed surveys 3 months after surgery. Participants completed the following PROMIS instruments: PROMIS Anxiety Short Form 8a, PROMIS Depression Short Form 8b, and PROMIS Pain Interference Short Form 8a. PROMIS measures were compared to the Generalized Anxiety Disorder 7-Item Scale, the Patient Health Questionnaire 9-Item Scale, and the Brief Pain Inventory Pain Interference subscale, respectively. All three PROMIS measures demonstrated excellent internal consistency (Cronbach's αs ranged from .93 to .96) and each loaded onto a single factor. The PROMIS measures were moderately correlated with their respective comparison measures (r = .69 to .76). The PROMIS anxiety and PROMIS depression measures were highly correlated to one another (r = .91). Findings highlight the potential utility of these PROMIS measures in veterans following orthopedic surgery and the overlap between the PROMIS depression and anxiety measures in this sample. [ABSTRACT FROM AUTHOR]

Psychological inflexibility is a multifaceted construct reflecting a rigid dominance of psychological reactions over chosen values and contingencies in guiding action. Psychological inflexibility has been related to depressive and anxiety symptoms and has been studied as a target of treatment for different forms of psychopathology. This construct, however, remains understudied among some at-risk groups. To close this gap in knowledge, the current study examined cross-sectional relations between psychological inflexibility and (1) symptoms of depression among adults with migraines (n = 2936) and (2) symptoms of anxiety and depression among adults at-risk for cardiovascular disease (n = 921). Results indicate that psychological inflexibility significantly related to depressive and anxiety symptoms among these populations. Results are discussed in terms of treatment implications for such persons. • Nearly half of the US population has a chronic medical condition. • Depression and anxiety are common among patients with chronic medical conditions. • Psychological inflexibility is significantly related to depressive symptoms in migraineurs. • Psychological inflexibility is significantly related to distress in patients with cardiovascular disease risk. [ABSTRACT FROM AUTHOR]

High levels of pain, significant anxiety, or depressive symptoms before surgery put patients at elevated risk for chronic pain and prolonged opioid use following surgery. The purpose of this preliminary study was to assess the efficacy of a 1-day Acceptance and Commitment Therapy (ACT) workshop in "at-risk" veterans for the prevention of chronic pain and opioid use following orthopedic surgery. In a randomized controlled trial, 88 at-risk veterans undergoing orthopedic surgery were assigned to treatment as usual (TAU; n = 44) or TAU plus a 1-day ACT workshop (n = 44). Pain levels and opioid use were assessed up to 3 months following surgery. Pain acceptance and values-based behavior were assessed at baseline and 3-month follow-up. Participants who completed the ACT workshop reached pain and opioid cessation sooner than those in TAU. Postoperative complications exhibited a moderating effect on these outcomes, such that the effects of ACT were greater in patients without complications. Increases in pain acceptance and values-based behavior, processes targeted in ACT, were related to better outcomes. These promising results merit further investigation in a larger clinical trial. Providing an intervention before surgery for at-risk veterans has the potential to change clinical practice from a focus on management of postoperative pain to prevention of chronic pain in at-risk individuals.Perspective: This pilot study compared the effects of a 1-day preventive behavioral intervention (ACT) to TAU in at-risk veterans undergoing orthopedic surgery. Three months following the intervention, veterans receiving ACT exhibited quicker cessation of pain and opioid use. Focusing on preoperative pain management may help prevent chronic postsurgical pain. [ABSTRACT FROM AUTHOR]

Abstract: Background: Migraine is a common and disabling disorder that is highly comorbid with depression. The comorbidity of depression and migraine is a major health concern as it results in poorer prognosis and quality of life. Yet, effective treatments have rarely been investigated. Method: 45 patients with comorbid migraine and depression were assigned to a 1-day Acceptance and Commitment Training plus Migraine Education workshop (ACT-ED; N = 31) or to Wait List/Treatment as Usual (WL/TAU; N = 14). Assessment of depressive symptoms, general functioning, and migraine related disability were completed at baseline and 2-, 6-, and 12 weeks after the workshop. Results: At the 3-month follow up, participants in the ACT-ED condition exhibited significantly greater improvements in depressive symptoms, general functioning, and migraine-related disability than patients in the WL/TAU group. Conclusion: A 1-day ACT-ED workshop is a promising approach to the treatment for depression and disability in migraineurs that merits further investigation. [Copyright &y& Elsevier]

Background: Panic disorder (PD) and major depression frequently coexist but the nature of the relationship is controversial. Our aim was to determine if the risk for depression in a proband is influenced by the temporal sequence of comorbid PD and major depression in an affected family member. Methods: Of participants in a larger study of individuals who had a family, but no personal history of PD, 31 had a first-degree relative with comorbid PD and major depressive disorder (MDD). In 16, the onset of MDD preceded PD (HR-MDPD), and in 15, PD was established before the first depressive episode (HR-PDMD). Thirty-seven low-risk controls (LRC) described no first-degree relatives with psychiatric illness. Participants were assessed using the SADS-LA and provided family history data on first-degree relatives. Results: High-risk subjects whose first-degree relative had temporally primary depression had a 50% chance of having had a major depressive episode. Those with a first-degree relative with primary panic and secondary depression were at no greater risk of having had a depression than were normal controls (6.7% and 5.4%, respectively). Limitations: The use of the family history method has the intrinsic weakness of relying solely on proband knowledge. Conclusion: The temporal relationship between comorbid panic and depression may play an important role in determining the familial risk for depression in family members. [Copyright &y& Elsevier]

Background: The effectiveness of technology-assisted interventions designed to ameliorate depressive symptoms and improve antidepressant medication adherence is hampered by diminished usage over time and poor integration with clinical care.Objective: This manuscript presents patient perspectives on a texting and secure messaging intervention designed to engage providers and patients during a targeted transition period when patients were initiating a new antidepressant medication.Patient Involvement: Development of the intervention was guided by feedback from a presentation and discussion with an engagement panel of local stakeholders, including patients, who meet quarterly with research investigators.Methods: Semi-structured, qualitative, telephone interviews were conducted with 21 participants. Interviews were designed to identify the themes of self-determination and planned behavior in using the text messaging intervention. Qualitative analysis of participants' experiences used inductive and deductive coding, as well as pile sorting.Results: The intervention prompted participants to reflect about how they manage their mood, engage in behaviors guided by their values, and commit to making positive changes in how they acted in real-time. Elements of the intervention facilitated participant conversations with trusted friends and family over time about what had influenced their actions and feelings.Discussion: The texting intervention appeared to help participants live a life consistent with their values. However, we were unable to recruit mental health providers to participate.Practical Value: Technology to promote self-reflection and an "observing self" may work best when done in dialogue with important others, including mental health providers. Future directions of this research should find ways to understand provider buy-in, or lack thereof, in e-health interventions. [ABSTRACT FROM AUTHOR]