BACKGROUND
Depression, anxiety and somatization are the most common mental disorders in primary care as well as medical specialty populations; each is present in at least 5-10% of patients and frequently comorbid with one another. An efficient means for measuring and monitoring all three conditions would be desirable.


METHODS
Evidence regarding the psychometric and pragmatic characteristics of the Patient Health Questionnaire (PHQ)-9 depression, generalized anxiety disorder (GAD)-7 anxiety and PHQ-15 somatic symptom scales are synthesized from two sources: (1) four multisite cross-sectional studies (three conducted in primary care and one in obstetric-gynecology practices) comprising 9740 patients, and (2) key studies from the literature that have studied these scales.


RESULTS
The PHQ-9 and its abbreviated eight-item (PHQ-8) and two-item (PHQ-2) versions have good sensitivity and specificity for detecting depressive disorders. Likewise, the GAD-7 and its abbreviated two-item (GAD-2) version have good operating characteristics for detecting generalized anxiety, panic, social anxiety and post-traumatic stress disorder. The optimal cutpoint is > or = 10 on the parent scales (PHQ-9 and GAD-7) and > or = 3 on the ultra-brief versions (PHQ-2 and GAD-2). The PHQ-15 is equal or superior to other brief measures for assessing somatic symptoms and screening for somatoform disorders. Cutpoints of 5, 10 and 15 represent mild, moderate and severe symptom levels on all three scales. Sensitivity to change is well-established for the PHQ-9 and emerging albeit not yet definitive for the GAD-7 and PHQ-15.


CONCLUSIONS
The PHQ-9, GAD-7 and PHQ-15 are brief well-validated measures for detecting and monitoring depression, anxiety and somatization.

Iconography : The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review

Sexual Dysfunction: A Guide for Assessment and Treatment

This article explores how Canadian youth who participate in Gay-Straight Alliances (GSA) and teachers who advise them perceive and/or experience bi/pansexuality. Participants’ perspectives on, definitions of, and alignment with bi/pansexuality are examined as they unpack mis/understandings associated with nonmonosexual identities. For GSA members, bisexual and pansexual identity labels were not interchangeable terms; bisexuality was associated with the fe/male binary and pansexuality served as a personal contestation to this dichotomy. Despite these distinctions, both nonmonosexualities were marked by invisibility, mis/understandings, and prejudice in school. Findings emphasize how students’ knowledge of sexual diversity and fluidity was more nuanced than their GSA advisors due to personal online research. GSA participation enabled bi/pansexual knowledge exchange among students and teachers, and promoted overall understandings of bi/pansexualities. Although GSA involvement facilitated opportunitie...

“It's not Pans, It's People”: Student and Teacher Perspectives on Bisexuality and Pansexuality

This empirical research explores the conditions, challenges, and lived experiences of how four diverse Canadian educators transcended heteronormative and gender-normative educational environments to become activist-educators for lesbian, gay, bisexual, transgender, and queer inclusion in their K–12 schools and communities. The co-creation of queer ethnographic counter narratives reveal the impetus and conditions that drove these teachers to become activist-educators in their K–12 schools, their motivations for coming out in heteronormative and gender-normative educational environments, the ensuing backlash they experienced during their efforts at promoting educational and cultural change, their individual processes in becoming critical change agents, and the educational strategies and tactics they developed from years of activist work within their schools.

Sexual minority teachers as activist-educators for social justice

Background Sexual dysfunctions (SD) in schizophrenia are frequent with strong impact on adherence and quality of life. Current recommendations stipulate to switch to prolactin-sparing antipsychotic in case of SD. Objectives To synthetize in a systematic review data on the SD prevalence and the associated risk factors in schizophrenia (SZ). Methods Medline, Google Scholar, PsychInfo, and Cochrane were explored, without any year or language restriction. Results Overall, 89 studies and 25,490 participants were included in the present review. SZ subjects aged 18–70 reported high SD frequency [30%–82%] (men [33%- 85%]; women [25%- 85%]). For SZ men erectile dysfunction [31%–95%] was the most frequent SD vs. loss of libido for women [31%–100%]. The following risk factors were associated with increased SD: 1. Illness severity (including psychotic symptomatology, early age at SZ onset, negative symptomatology, and continuous illness course), 2. Depressive symptomatology 3. Antipsychotics (especially first generation antipsychotics, risperidone and antipsychotic polytherapy). Switching to prolactin-sparing antipsychotics has shown effectiveness in some studies (especially aripiprazole). Antidepressants were not found to be associated with SD in SZ subjects. Conclusion The prevalence of SD is high in SZ subjects. In addition to the current guidelines, the present review suggests that treating depressive symptoms may be a major intervention to improve SD in SZ subjects. Sociodemographic variables, physical illnesses, metabolic syndrome and peripheral inflammation have been poorly or never explored and should be included in future studies.

Sexual dysfunctions in schizophrenia: Beyond antipsychotics. A systematic review.

Sexual dysfunction (SD) is pervasive and underreported, and its effects on quality of life are underestimated. Due in part to its bidirectional relationship with depression, SD can be difficult to diagnose; it is also a common side effect of many antidepressants, leading to treatment noncompliance. While physicians often count on patients to spontaneously report SD, treatment is optimized when the clinician instead performs a thorough assessment of sexual functioning before and during drug therapy using a standardized questionnaire such as the Arizona Sexual Experiences Scale (ASEX). Separating the effects of the disorder from those of medications is challenging; we present a concise, evidence-based schematic to assist physicians in minimizing treatment-emergent sexual dysfunction (TESD) while treating depression. Vascular, hormonal, neurogenic, and pharmacological factors should be considered when a patient presents with SD. We also recommend that physicians obtain patient information about baseline and historical sexual functioning before prescribing a drug that may lead to SD and follow up accordingly. When the goal is to treat depression while attenuating the risk of sexual symptoms, physicians may wish to consider agomelatine, bupropion, desvenlafaxine, moclobemide, trazodone, vilazodone, and vortioxetine.

https://journals.sagepub.com/doi/pdf/10.1177/2045125317720642

Assessment and management of sexual dysfunction in the context of depression

Background Screening for major depressive disorder (MDD) in tertiary care settings can be challenging, as patients often present with complex symptom profiles and false positives are common. We used machine learning (ML) to test our composite screening application—EarlyDetect (ED), which includes extant validated scales as well as a selection of life history factors—for predictive accuracy, with the central aim of improving specificity in tertiary settings. Methods This was a retrospective, naturalistic study at a tertiary mental health centre in western Canada. Participants (n = 955; 56.4% female; mean age 35.4; 34.6% MDD) completed ED and underwent a clinical interview with a blinded psychiatrist for diagnostic accuracy. ML was used to make more confident predictions at an individual level. Results Using composite scoring, the balanced accuracy of our tool was 72.0%, with a sensitivity of 74.2% and a specificity of 69.8%, with an AUC of 0.781. Compared with the MDD symptoms-only model, the fully composite ED model improved balanced accuracy by 5.6%, specificity by 13%, and AUC by 0.072. Limitations Patients were assessed using clinical psychiatric evaluations, which are subjective. There is also the potential for self-reporting bias, particularly with depressed patients. Finally, the cross-sectional design of this study rules out conclusions of causality. Conclusions Our results show improved MDD. detection accuracy using composite measures and highlight key predictive factors that contribute to the accurate diagnosis of MDD, including disability, family history of mental illness, and stressful events. These factors may need to be included in regular screening assessments.

Screening for major depressive disorder in a tertiary mental health centre using EarlyDetect: A machine learning-based pilot study

Growing into Resilience: Sexual and Gender Minority Youth in Canada is designed with the primary purpose of assisting caring professionals serving in diverse environments—including homes, schools, ...

Growing into resilience: sexual and gender minority youth in Canada

Users’ experiences in mental health assessment are multifaceted, including their emotional experiences. Yet, studies of mobile apps for psychiatric assessment have centered on diagnostic accuracy a...

Usability and Emotions of Mental Health Assessment Tools: Comparing Mobile App and Paper-and-Pencil Modalities

ABSTRACT This study investigated how COVID-19 has affected the wellness of a group of Inuit youth leaders in Nunavut in the context of their involvement with an ongoing mental health research initiative, the Making I-SPARX Fly in Nunavut [I-SPARX] project. The study had three goals: (1) to understand how the pandemic has affected I-SPARX leaders’ perceived involvement in the I-SPARX Project; (2) to build knowledge around how the pandemic has impacted the daily life and wellbeing of youth in Nunavummiut communities; and (3) to acquire a culturally specific understanding of their coping mechanisms and resilience strategies through the lens of Inuit Qaujimajatuqangit (IQ). Nine Inuit youth were interviewed virtually about their participation in I-SPARX, their life during the pandemic, and their coping strategies. Their comments were analysed using inductive thematic analysis. Pandemic challenges, the utility of I-SPARX teachings and participation, and culturally and community-embedded pathways to resilience were discussed. The implications of COVID-19 on Inuit youth in remote communities are not fully understood. The current study illuminates their experiences of the pandemic to inform future research on ways in which Inuit youth might be supported in situations, such as a global pandemic, that restrict their traditional resilience-enhancing activities and create social isolation.

https://www.tandfonline.com/doi/pdf/10.1080/22423982.2022.2043577?needAccess=true

How did Nunavummiut youth cope during the COVID-19 pandemic? A qualitative exploration of the resilience of Inuit youth leaders involved in the I-SPARX project

Jeffrey Hankey

Papers

Assessment and management of sexual dysfunction in the context of depression

Screening for major depressive disorder in a tertiary mental health centre using EarlyDetect: A machine learning-based pilot study

Growing into resilience: sexual and gender minority youth in Canada

Usability and Emotions of Mental Health Assessment Tools: Comparing Mobile App and Paper-and-Pencil Modalities

How did Nunavummiut youth cope during the COVID-19 pandemic? A qualitative exploration of the resilience of Inuit youth leaders involved in the I-SPARX project