High prevalence rates of both Vitamin B12 insufficiency and depressive symptoms exist in pregnant women. Although the association between depressive symptoms and certain nutrient deficiencies like iron, folate, or Vitamin B12 has been established, the specific relationship between low‐normal serum Vitamin B12 levels and depressive symptoms in pregnant women in the United States has not been studied closely. Using 2005–2006 National Health and Nutrition Examination Survey data, a secondary analysis was conducted to examine the association between low‐normal serum Vitamin B12 level and depression, as measured by a score of 10 or higher on the Patient Health Questionnaire‐9, in pregnant women (N = 174). In bivariate regression models, Vitamin B12 level, experiencing poverty, and pre‐pregnancy body mass index (BMI) were significant predictors of depression. In multivariate logistic regression models, pregnant women with low‐normal serum Vitamin B12 levels (OR = 3.82, 95% CI [1.10–13.31], p < 0.04) were 3.82 times more likely to experience depression, controlling for sociodemographic characteristics, pre‐pregnancy BMI, and the biomarkers hemoglobin and folate. Identifying and treating pregnant women with low‐normal Vitamin B12 levels may enhance prenatal depression management.
Identity disturbance can be defined as interference with one’s sense of self. It is a criterion for several diagnoses outlined in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision), and patients who have suffered childhood trauma or neglect are at risk of experiencing an identity disturbance in conjunction with mood, anxiety, psychotic, or substance use disorders. Limited guidance exists in the form of guidelines or clinical evidence on the specific management of identity disturbance. This article uses a clinical exemplar to highlight the features of one subject’s identity disturbance. The author discusses evidence and guidelines supporting various treatment strategies and applies them during the subject’s clinical course, concluding with the author’s clinical recommendations.
Providing psychiatric services in the primary care setting is challenging. The multidisciplinary, coordinated approach of collaborative care models (CCMs) addresses these challenges. The purpose of the current article is to discuss the implementation of a CCM at a free medical clinic (FMC) where volunteer staff provide the majority of services. Essential components of CCMs include (a) comprehensive screening and assessment, (b) shared development and communication of care plans among providers and the patient, and (c) care coordination and management. Challenges to implementing and sustaining a CCM at a FMC in Virginia attempting to meet the medical and psychiatric needs of the underserved are addressed. Although the CCM produced favorable outcomes, sustaining the model long-term presented many challenges. Strategies for addressing these challenges are discussed.
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