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Many individuals seeking mental health services for depression often suffer from a comorbid medical condition. The goal of the present study was to assess the presence of medical comorbidity in a community mental health center setting that primarily serves a Medicare and Medicaid population, characterize the types of comorbid medical conditions experienced in this setting, and explore the association between medical conditions on the alliance, attrition from services, and outcome. Medical diagnoses were collected from patient charts and structured clinical interviews from 353 participants who had a baseline assessment as part of a comparative effectiveness study of cognitive and dynamic therapies for major depressive disorder. We calculated the Charlson Comorbidity Index and the number of total medical diagnoses for each patient. Results from this study revealed that a high percentage of patients in this setting experienced a comorbid medical condition. No significant associations were found between the number of medical conditions or the Charlson Comorbidity Index and the alliance. No significant relationship was found between the number of medical conditions or the Charlson Comorbidity Index and early attrition from treatment or treatment outcome. However, exploratory analyses found that presence of a nervous system disorder was associated with relatively poorer treatment outcomes after initial engagement. Implications of these findings are discussed. Treatments for major depressive disorder may benefit from addressing the impact of medical disorders on physical functioning.

Introduction Evidence suggests that individuals with generalized anxiety disorder exhibit decreases in slow-wave sleep (SWS). Because SWS has been shown to be modifiable, it is imperative to better understand the relationship between symptoms of anxiety and amount of SWS to inform treatment development. This study aimed to explore the relationship between anxiety and SWS, and to investigate the impact of slow-wave sleep disruption on state anxiety. Methods Twenty-seven participants’ (mean age 30.9) were recruited as part of an ongoing study examining the relationship between SWS and depression. Participants spent two nights in the laboratory: baseline (BL) and slow-wave disruption (SWD), where SWS was disrupted using auditory stimulation. Anxiety was measured using the State-Trait Anxiety Inventory (STAI). Both trait and state anxiety (BL, SWD) measures were collected. Repeated measures ANOVA was used to determine the impact of SWD on state anxiety. Results Participants’ trait anxiety scores were significantly correlated with percent N3, such that greater anxiety was associated with less N3 (r = -0.43; p<0.05). Individuals were then categorized as either high-anxiety (HA) or low-anxiety (LA) by median split (M=46.5). Results of the repeated measures showed a significant main effect of group (F=43.963; p<0.001), with HA individuals showing greater state anxiety than LA individuals. A significant interaction of group*condition was also found (F(1,24)=4.703; p=0.40). LA participants showed a significant increase in state anxiety following SWD (t=-2.539; p=0.028), while HA participants showed no change. Conclusion The current findings replicate previous research showing that anxious individuals have a reduced amount of SWS and demonstrate that decreases in SWS may exacerbate anxiety in individuals with low anxiety. Further, this work suggests that individuals with high anxiety may be more resilient to changes in anxiety state than individuals with low anxiety when SWS is reduced. Support (If Any) Goldschmied: K23MH118580 (NIMH)

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Objective Previous research has documented associations between trauma and interpersonal problems. We examined the impact of trauma on interpersonal problems among depressed patients seeking treatment in a community mental health setting. Methods A total of 453 patients seeking treatment and screened for a comparative effectiveness study of therapies for depression were included. We conducted analyses relating the 32‐item inventory of interpersonal problems (IIP‐32) to trauma measures. Results 99.1% of the sample experienced a traumatic event. There were significant associations between the total number of traumas, the number of sexually and physically assaultive traumas, and both gender and race. The number of sexually assaultive traumas was significantly related to the IIP‐32 “too caring” subscale (simple r = 0.167, p < 0.001). Controlling for demographics and other IIP‐32 subscales, the total number of traumas remained significantly related to the IIP‐32 “too caring” domain (partial r = 0.163, p < 0.001). Conclusions Traumatic events are prevalent among community populations and these experiences are associated with certain interpersonal problems. Trauma and interpersonal problems are key issues for the treatment of patients in the community mental health setting.