PURPOSE Although screening for unipolar depression is controversial, it is potentially an effi cient way to fi nd undetected cases and improve diagnostic acumen. Using a reference standard, we aimed to validate the 2-and 9-question Patient Health Questionnaires (PHQ-2 and PHQ-9) in primary care settings. The PHQ-2 comprises the fi rst 2 questions of the PHQ-9. METHODSConsecutive adult patients attending Auckland family practices completed the PHQ-9, after which they completed the Composite International Diagnostic Interview (CIDI) depression reference standard. Sensitivities and specifi cities for PHQ-2 and PHQ-9 were analyzed. RESULTS There were 2,642 patients who completed both the PHQ-9 and the CIDI. Sensitivity and specifi city of the PHQ-2 for diagnosing major depression were 86% and 78%, respectively, with a score of 2 or higher and 61% and 92% with a score 3 or higher; for the PHQ-9, they were 74% and 91%, respectively, with a score of 10 or higher. For the PHQ-2 a score of 2 or higher detected more cases of depression than a score of 3 or higher. For the PHQ-9 a score of 10 or higher detected more cases of major depression than the PHQ determination of major depression originally described by Spitzer et al in 1999.CONCLUSIONS We report the largest validation study of the PHQ-2 and PHQ-9, compared with a reference standard interview, undertaken in an exclusively primary care population. The PHQ-2 score or 2 or higher had good sensitivity but poor specifi city in detecting major depression. Using a PHQ-2 threshold score of 2 or higher rather than 3 or higher resulted in more depressed patients being correctly identifi ed. A PHQ-9 score of 10 or higher appears to detect more depressed patients than the originally described PHQ-9 scoring for major depression.

Background:Canadian public safety personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police officers) are exposed to potentially traumatic events as a function of their work. Such exposures contribute to the risk of developing clinically significant symptoms related to mental disorders. The current study was designed to provide estimates of mental disorder symptom frequencies and severities for Canadian PSP.Methods:An online survey was made available in English or French from September 2016 to January 2017. The survey assessed current symptoms, and participation was solicited from national PSP agencies and advocacy groups. Estimates were derived using well-validated screening measures.Results:There were 5813 participants (32.5% women) who were grouped into 6 categories (i.e., call center operators/dispatchers, correctional workers, firefighters, municipal/provincial police, paramedics, Royal Canadian Mounted Police). Substantial proportions of participants reported current symptoms consistent with 1 (i.e., 15.1%) or more (i.e., 26.7%) mental disorders based on the screening measures. There were significant differences across PSP categories with respect to proportions screening positive based on each measure.Interpretation:The estimated proportion of PSP reporting current symptom clusters consistent with 1 or more mental disorders appears higher than previously published estimates for the general population; however, direct comparisons are impossible because of methodological differences. The available data suggest that Canadian PSP experience substantial and heterogeneous difficulties with mental health and underscore the need for a rigorous epidemiologic study and category-specific solutions.

Highlights: Psychotherapies for sexual minority youth should be sensitive to their unique needs. Computerised CBT was acceptable and feasible to deliver to this population. Preliminary data on the effectiveness of Rainbow SPARX were promising (d=1.01). Rainbow SPARX can be used as an adjunct to face-to-face therapy. Our objectives for the open pilot trial were: 1) to ascertain the acceptability of Rainbow SPARX (using the results of a post-intervention satisfaction questionnaire and by establishing completion rates); 2) to assess feasibility (based on recruitment and uptake rates); and, 3) to collect preliminary data on the program"s effectiveness. *Highlights (for review) Method ParticipantsParticipants were sexual minority youth (i.e. young people attracted to the same sex, both sexes, or not sure of their sexual attractions) aged 13 to 19 years old with depressive symptoms (i.e. Child Depression Rating Scale -Revised raw score ≥30) at baseline, living in Auckland (a city and region with over 1.5 million people), New Zealand. Sexual minority youth with severe depressive symptoms, at risk of suicide or self-harm could be included, provided they reported Potential participants who were not receiving the necessary face-to-face support preintervention were not excluded from the study, but were referred for support by the researcher (ML). Those receiving antidepressant medication or other relevant therapies (e.g. CBT or interpersonal therapy) were able to take part; these additional treatments were documented at the pre-intervention assessment. Participants were excluded if they were adolescents exclusively sexually attracted to the opposite sex (i.e. they responded that they were attracted to the opposite sex in the sexual attraction question).The mean age of the open trial participants (n=21) was 16.5 years (range 13-19 years, SD=1.6) and 11 participants (52.4%) identified as male. In terms of ethnicity, 15 (71.4%) were New Zealand European, 2 (9.5%) were Māori, 1 (4.8%) was of a Pacific ethnicity and 3 (14.3%)were Asian. Seven of the 21 participants were receiving professional help for mental health issues at baseline, with one of these participants receiving two forms of assistance: four participants were engaged in weekly (or more frequent) counseling at a high school or a tertiarylevel educational institution, and they had all been attending sessions for more than three months; two participants were taking antidepressants and both had been prescribed these for more than three months; and, two of the participants were current clients of a state-funded outpatient child and adolescent mental health service. ProceduresA youth-led organization for sexual minority youth promoted the study and four high schools supportive of this initiative also encouraged participation. The study was advertised and endorsed by the sexual minority media. Written parental and participant informed consent was CCBT FOR DEPRESSION IN SEXUAL MINORITY YOUTH 8 obtained from those under 16 and young people were able to provide written ...

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Abstract. Background: Infectious disease-related public health emergencies (epidemics) may increase suicide risk, and high-quality evidence is needed to guide an international response. Aims: We investigated the potential impacts of epidemics on suicide-related outcomes. Method: We searched MEDLINE, EMBASE, PsycInfo, CINAHL, Scopus, Web of Science, PsyArXiv, medRxiv, and bioRxiv from inception to May 13–16, 2020. Inclusion criteria: primary studies, reviews, and meta-analyses; reporting the impact of epidemics; with a primary outcome of suicide, suicidal behavior, suicidal ideation, and/or self-harm. Exclusion criteria: not concerned with suicide-related outcomes; not suitable for data extraction. PROSPERO registration: #CRD42020187013. Results: Eight primary papers were included, examining the effects of five epidemics on suicide-related outcomes. There was evidence of increased suicide rates among older adults during SARS and in the year following the epidemic (possibly motivated by social disconnectedness, fears of virus infection, and concern about burdening others) and associations between SARS/Ebola exposure and increased suicide attempts. A preprint study reported associations between COVID-19 distress and past-month suicidal ideation. Limitations: Few studies have investigated the topic; these are of relatively low methodological quality. Conclusion: Findings support an association between previous epidemics and increased risk of suicide-related outcomes. Research is needed to investigate the impact of COVID-19 on suicide outcomes.

The evidence on the relative efficacy of selective serotonin reuptake inhibitors and tricyclic antidepressants in primary care is sparse and of variable quality. The study setting is likely to be an important factor in assessing the efficacy and tolerability of treatment with antidepressant drugs.

It is feasible, acceptable and efficacious to deliver computerized CBT to depressed adolescents in a school setting. Generalizability is limited by the size of the study.

PURPOSE We wanted to assess the effectiveness of a home-based physical activity program, the Depression in Late Life Intervention Trial of Exercise (DeLLITE), in improving function, quality of life, and mood in older people with depressive symptoms. METHODSWe undertook a randomized controlled trial involving 193 people aged 75 years and older with depressive symptoms at enrollment who were recruited from primary health care practices in Auckland, New Zealand. Participants received either an individualized physical activity program or social visits to control for the contact time of the activity intervention delivered over 6 months. Primary outcome measures were function, a short physical performance battery comprising balance and mobility, and the Nottingham Extended Activities of Daily Living scale. Secondary outcome measures were quality of life, the Medical Outcomes Study 36-item short form, mood, Geriatric Depression Scale (GDS-15), physical activity, Auckland Heart Study Physical Activity Questionnaire, and self-report of falls. Repeated measures analyses tested the differential impact on outcomes over 12 months' follow-up. RESULTSThe mean age of the participants was 81 years, and 59% were women. All participants scored in the at-risk category on the depression screen, 53% had a Diagnostic and Statistical Manual of Mental Disorders or International Classifi cation of Diseases, Tenth Revision diagnosis of major depression or scored more than 4 on the GDS-15 at baseline, indicating moderate or severe depression. Almost all participants, 187 (97%), completed the trial. Overall there were no differences in the impact of the 2 interventions on outcomes. Mood and mental health related quality of life improved for both groups. CONCLUSIONThe DeLLITE activity program improved mood and quality of life for older people with depressive symptoms as much as the effect of social visits. Future social and activity interventions should be tested against a true usual care control. 2010;8:214-223. doi:10.1370/afm.1093. Ann Fam Med INTRODUCTIONL ow mood in community-dwelling older people is common and is associated with poor physical function.1 Poor physical function predicts development of depression, 2 disability, health service use, and institutionalization, 3 and disability in turn predicts development of depression.2 Physical activity has the potential to interrupt the development of disability from both depression 4 and poor physical function. 5Even small gains in physical performance and mood may result in signifi cant benefi ts in functional status (ability to perform activities of daily living) and quality of life. 6 Physical activity programs improve physical performance, 7 and there are several established ways of promoting physical activity to older people, such as physician advice with community folNgaire Kerse, PhD, MBChB Karen J. Hayman, RN 215 AC T IV I T Y PRO GR A M A ND DEPR ES SED EL DER LYlow-up, 8 supervised group activity programs, and wider community level intervention. 7,9 The most frail may...