Objective: To investigate whether depression symptom severity is associated with poor long-term glycemic control among individuals with mental illness and co-morbid type 2 diabetes mellitus (T2DM). Methods: 2842 psychiatry outpatients (PCARES Registry, 2015-2020) were included. T2DM diagnosis and all available glucose labs were extracted from electronic health records. Scores on the 9-item patient health questionnaire (PHQ-9) provided baseline depression severity: 0-9 (none-mild), 10-27 (moderate-to-severe). With baseline lab within (f) 90 days of the baseline PHQ-9 date, all follow-up labs had to be <= 365 days of the preceding lab, and not exceed one-year after the second follow-up lab date. 1255 individuals met the timeline criteria for glucose. Linear mixed-effects models provided coefficients for the association between depression symptom severity and long-term glucose levels, after adjusting for socio-demographics, BMI, anti-psychotic medications, and follow-up time. Results: Among 1255 patients with a mean f SD age (45.9 f 16.8 years), PHQ-9 score (11.9 f 7.1), and glucose (111.7 f 45.1 mg/dl), 65% identified as females, 85% as non-Hispanic white, 60% had moderate-to-severe depression symptoms (N = 753) and 31% (N = 390) had T2DM. Individuals with moderate-to-severe depression symptoms (N = 245) showed a significant long-term increase in glucose levels at 6.7 (2.7) mg/dl over follow-up, indicating poor glycemic control (P = 0.01), whereas those with none-to-mild depression symptoms (N = 145) showed no significant long-term changes in glucose levels (P = 0.40); (P depression symptom severity X follow-up time = 0.03) Conclusions: Our findings support the need for improved diabetes care for patients with mental illness and T2DM and regular depression screening among individuals with T2DM.

Objective: Patients with psychotic disorders have higher rates of medical comorbidities and premature mortality compared to the general population but have been shown to access primary care at low rates. Young adults are at risk of disengaging from primary care services during the transition to adulthood. This descriptive qualitative research study sought to explore barriers and facilitators to engaging with primary care among young adults with first-episode psychosis (FEP). Methods: Ten patients aged 18-30 years receiving care in a coordinated specialty care clinic for FEP were recruited from October 2021 to December 2022. Participants were interviewed using a semistructured interview guide. Interviews were recorded and transcribed. A codebook was created inductively using data from the transcripts, and themes were generated from group consensus. Results: Two themes relating to access to primary care were identified: (1) barriers, which included scheduling conflicts and missed appointments, active mental illness symptoms, and difficulties in rapport with the primary care physician (PCP) and (2) facilitators, which included proximity to home, absence of financial barriers, availability of urgent appointments, and caring, nonjudgmental attitudes of the PCP. Conclusion: Improving engagement in primary care is critical for young adults with FEP to establish beneficial patterns of health care use and timely access to preventative care. This study identifies factors that may help facilitate care with PCPs, which could increase timely utilization of medical care and reduce premature mortality within this vulnerable population. Prim Care Companion CNS Disord 2025;27(5):25m03974. Author affiliations are listed at the end of this article.

Background. Cardiovascular disease (CVD) and depression are the leading causes of disability in the U.S. Using electronic health record data, we describe the CVD burden among persons with mental illness enrolled in the Penn State Psychiatry Clinical Assessment and Rating Evaluation System (PCARES) Registry between 2015 and 2020. Methods. CVD burden assessment included prevalence of CVD conditions (any major CVD or individual CVD risk factors), indicated medication prescriptions for CVD risk factors, and mean levels of body mass index (BMI, kg/m2), glycosylated hemoglobin (HbA1C, %), glucose (mg/dl), and lipids (mg/dl). We compared the CVD burden between the PCARES sample to a representative sample of adults from the U.S. general population (NHANES 2013-2016) using one-sample chi-square/t-tests for proportions/means. The CVD burden in NHANES participants was adjusted to PCARES age, race, and sex statistics. Results. The PCARES sample (N=3556) had a mean (SE) age of 42.4 (0.3) years and comprised 63.0% women, 85.0% non-Hispanic Caucasians, and 41.0% with major depressive disorder. CVD burden was higher in the PCARES sample compared to NHANES participants for any major CVD (8.6% vs. 4.6%), diabetes (18.4% vs. 10.4%), BMI (30.3 vs. 28.3), HbA1C (6.1 vs. 5.6), cholesterol (185.6 vs. 181.7), triglycerides (153.3 vs. 136.1), and indicated antihypertensive (94.3% vs. 76.9%) and cholesterol-lowering (49.5% vs. 36.7%) medications (Bonferroni-corrected p=0.03 for each outcome). The CVD burden was lower in the PCARES sample compared to NHANES participants for hypertension (45.9% vs. 50.4%), dyslipidemia (43.2% vs. 61.9%), HDL-C (48.4 vs. 41.4), and LDL-C (107.9 vs. 112.0) (Bonferroni-corrected p=0.03 for each outcome). Glucose levels (110.9 vs. 111.9) and indicated antidiabetic medications (87.4% vs. 86.6%) were similar in the two samples (p>0.05). Conclusions. The CVD burden was higher in persons with mental illness compared to the U.S. general population. Integrated mental and physical healthcare services could reduce long-term disability among persons with mental illness.

Background: We examined the relationship between baseline cardiovascular (CV) disease/risk factors and longitudinally-collected scores on the patient health questionnaire (PHQ-9) depression scale using an outpatient sample of individuals with mental illness (PCARES Registry, 2015-2020). Methods: Individuals with >= 2 repeated PHQ-9 assessments over one-year from the baseline PHQ-9 measurement (N = 2110) were included for trajectory modeling, with five depression symptom severity trajectory groups determined a priori (lowest, lower, middle, higher, and highest). Proportional odds models provided the association between baseline CV disease/risk factors and the odds of belonging to the more severe depression symptom trajectory group. In a sub-sample (baseline PHQ-9 score >=10), linear-mixed effects models provided the association between baseline CV disease/risk factors and longitudinal PHQ-9 scores (N = 1118). Results: 2110 individuals included 65% females, 87% non-Hispanic white, 50% in lower and middle severity groups, with mean +/- SD age: 43.0 +/- 16.8 years and PHQ-9 score: 10.8 +/- 7.0. Adjusting for socio-demographics and BMI [OR (95% CI)]: individuals with baseline hypertension [1.4 (1.2-1.7)], diabetes [1.3 (1.0-1.6)], dyslipidemia [1.2 (1.0-1.4)], tobacco use [2.0 (1.6-2.6)], and higher number of CV disease/risk factors (P-trend<0.0001) had significantly higher odds of more severe depression symptom trajectories; longitudinal PHQ-9 scores significantly decreased during 1-year follow-up, and the decrease was relatively lesser in individuals with hypertension or >=1 CV disease/risk factors than those without these conditions. Limitations: Clinic-based patient sample limits generalizability of findings. Conclusions: Presence/absence of baseline CV risk factors significantly influenced longitudinal depression symptom severity among psychiatry outpatients, demonstrating the need for depression screening and surveillance among individuals with CV risk factors.

Objective: To investigate whether the severity of depression symptoms is associated with poor long-term control of plasma glucose levels in individuals with type 2 diabetes. Methods: Electronic health record [EHR] data of 2842 individuals with mental illness enrolled in the Penn State Clinical Assessment and Rating Evaluation System [PCARES] registry were used. Demographics, body mass index [BMI], baseline type 2 diabetes mellitus [T2DM] status and all available glucose labs were extracted from the EHR. The nine-item patient health questionnaire [PHQ-9] was used to determine baseline depression symptoms. PHQ-9 scores greater than/equal to 10 indicated moderate-to-severe depression symptoms, whereas scores less than 10 indicated none-to-mild depression symptoms. While the baseline glucose measurement had to be within ± 90 days of the baseline PHQ-9 date, longitudinal glucose measurements had to be on or after this date and within one year of the second follow-up glucose lab test date. Each glucose lab test had to be within one year of the preceding lab test. There were 917 individuals that met the criteria for baseline and follow-up glucose measurements and contributed to the effective study sample. Linear mixed-effects models were used to assess the association between baseline depression and changes in glucose levels, with a focus on persons with baseline diabetes. Results are reported as beta-coefficients (standard errors [SE]) and P -values. Results: The study sample included 917 individuals, with 65% females (596 of 917) and 85% (780 of 917) Non-Hispanic Caucasians. The mean (SD) age, PHQ-9 score, BMI, and glucose were 47.7 (16.9) years, 12.0 (7.1), 31.6 (8.6) Kg/m 2, and 115.9 (48.8) mg/dl, respectively. At baseline, 62.0% had moderate-to-severe depression (569 of 917), and 37.1% of persons had T2DM (341 of 917). Among individuals without T2DM, there was no association between the severity of depression symptoms and follow-up glucose levels with a beta (SE) of 1.1 (1.1) and P =0.32. Among persons with T2DM (N=341), there was an average increase in glucose levels by 2.8 (2.1) mg/dl, P =0.17, per year of follow-up. When stratified by the severity of depression symptoms, individuals with moderate-to-severe depression symptoms had a significant increase in glucose levels at 6.2 (2.7) mg/dl, P =0.02, per year of follow-up, indicative of poor control of blood glucose levels. Whereas, among persons with none-to-mild depression symptoms, blood glucose levels showed a non-significant decline at 2.6 (3.4) mg/dl, P =0.45, per year of follow-up. Conclusions: In this clinic-based sample of persons with mental illness, moderate-to-severe depression symptoms were associated with significantly increasing blood glucose levels among persons with co-morbid T2DM. Our findings underscore integrated physical and mental healthcare services and routine depression screening among persons with diabetes.

Joint hypermobility in Ehlers‐Danlos Syndromes (EDS) predisposes persons with EDS to frequent subluxations and dislocations, chronic arthralgia, and soft‐tissue rheumatism. Epidemiologic trends of rheumatologic conditions among persons with EDS are lacking. Prescription claims databases can reflect underlying disease burdens by using medication claims as disease proxies. We examined the prevalence of prescription claims for commonly prescribed immunomodulator and antiinflammatory (IMD) drugs among persons with EDS compared with their matched control person, and hypothesized peripubertal increases among female persons with EDS.

Sub-optimal diet and physical activity (PA) levels have been associated with increased risk of cardiovascular disease (CVD) mortality. The relationship between pre-cancer diagnosis diet quality and PA level on CVD mortality risk in cancer survivors is unclear. We examined the association between pre-cancer diagnosis diet quality and leisure-time PA and their interaction on CVD mortality in cancer survivors. Diet quality was characterized by the Alternative Mediterranean Diet Index (aMED). Leisure-time PA was converted to a metabolic equivalent of task hours per week (MET-h/wk). During a median of 6.3 years of follow-up of 18,533 female cancer survivors, we identified 915 CVD deaths. aMED score was not associated with CVD mortality. PA level was inversely associated with CVD mortality (HRQ1-Q4 = 0.74; 95% CI: 0.61–0.88; Ptrend = 0.0014). Compared to cancer survivors with the lowest pre-diagnosis aMED score and PA level, cancer survivors with higher aMED scores and higher MET-hrs/wk were at a 33% lower risk of CVD mortality (HR = 0.67; 95% CI: 0.52–0.87). Overall, this study shows PA to be a strong predictor of CVD mortality in female cancer survivors. Our observations support the importance of PA throughout the lifecycle in lowering CVD mortality risk.

BACKGROUND:Cardiovascular disease (CVD) and depression are the leading causes of disability in the U.S. Using five cycles (2009-2018) of the U.S. National Health and Nutrition Examination Survey, we examined the cross-sectional association between CVD risk factor burden and depression severity in nonpregnant adults with no history of CVD events. METHODS:With at least 3000 participants per cycle, the overall N was 18,175. CVD risk factors were ascertained through self-report, lab tests, or medications. The sum of hypertension, diabetes, dyslipidemia, and current smoking represented a CVD risk score variable (range: 0-4). Depression severity was assessed using scores on the 9-item patient health questionnaire: 0-9 (none-mild) and 10-27 (moderate-to-severe). Logistic regression models were performed to investigate the association between CVD risk score categories and moderate-to-severe depression. Cycle-specific odds ratios (OR) were meta-analyzed to obtain a pooled OR (95 % CI) (Q-statistic p > 0.05). RESULTS:Compared to participants with no CVD risk factors, participants with risk scores of 1, 2, 3, and 4, had 1.28 (0.92-1.77), 2.18 (1.62-2.94), 2.53 (1.86-3.49), 2.97 (1.67-5.31) times higher odds of moderate-to-severe depression, respectively, after adjusting for socio-demographics and antidepressant use (linear trend p < 0.0001). This relationship persisted after additionally adjusting for lifestyle variables. LIMITATIONS:NHANES data is cross-sectional and self-reported, thus preventing causal assessments and leading to potential recall bias. CONCLUSIONS:Among U.S. adults, CVD risk factor burden was associated with worsened depression symptoms. Integrated mental and physical healthcare services could improve risk stratification among persons with CVD and depression, possibly reducing long-term disability and healthcare costs.

Drugs used for the treatment of hyperlipidaemias, to reduce platelet aggregation and to achieve thrombolysis are discussed. Their major mechanisms of action, key pharmacokinetic principles essential for their safe use, and important adverse effects are explained. Each class of drug is also given context for effective clinical use.

We previously reported increased pain and gastrointestinal (GI) medication prescription claims among persons with Ehlers-Danlos syndromes (EDS) and peripubertal increase in opioid and anti-emetic claims among women with EDS. Herein, we hypothesized a higher proportion of respiratory and co-occurring respiratory and GI medication prescription claims among persons with EDS compared to their matched controls with increases among peripubertal women with EDS. We compared the proportions of respiratory and co-occurring respiratory and GI medication prescription claims among persons with EDS (aged 5-62) against their age-, sex-, state of residence-, and earliest claim date-matched controls using 10 years of private prescription claims data. Prescription claims among persons with EDS versus matched controls were increased for eight medication classes (p < .0001): intranasal/inhaled corticosteroids (ICS) (30.8% vs. 19.0%), oral steroids (30.0% vs. 16.5%), H1-antihistamines (26.2% vs. 12.2%), short-acting beta agonists (22.7% vs. 11.6%), decongestants (21.6% vs. 15.9%), leukotriene modifiers (8.9% vs. 3.6%), ICS/long-acting beta agonists (5.7% vs. 2.9%), muscarinic antagonists (2.5% vs. 0.9%), and co-occurring prescriptions (29% vs. 10%). Our results suggest a critical time window for peripubertal intervention and research and a need to focus on the pathogenesis and clinical evaluation of EDS-specific respiratory and aerodigestive disorders.

Objective: To examine the association between prevalent cardiovascular diseases (CVDs) and CVD risk factors and depression symptoms in a US general population sample. Methods: US adults in the 2013-14 and 2015-16 National Health and Nutrition Examination Survey were included. CVDs (coronary heart disease [CHD], congestive heart failure [CHF], stroke) and CVD risk factors: current smoking; hypertension [HTN]; diabetes mellitus [DM]; and dyslipidemia; systolic BP (SBP), HbA1C, fasting plasma glucose (FPG), serum cholesterol (C), triglycerides (TG), HDL-C, and LDL-C were based on patient-report or lab tests, or medication prescriptions. The sum of HTN, DM, dyslipidemia, and current smoking represented a CVD risk score variable (range: 0-4). Depression symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9): 0-9 (none-mild); 10-27 (moderate-to-severe). Logistic regression models were used to assess the association between CVDs and moderate-to-severe depression. Results: A total of 12,105 participants (52% females, 64% Caucasians) of mean (SE) age of 46.8 (0.3) years and BMI of 29.2 (0.1) kg/m 2 were included. Moderate-to-severe depression was prevalent among 8.1% of participants. The proportions (%) of CVD risk score categories of 0-4 were: 20.5; 31.4; 32.1; 14.6; 1.5. After adjusting for age, race, sex, BMI, marital and educational status, participants with risk scores of 1; 2; 3; and 4 had 1.3 (95% CI: 0.8-2.1); 2.4 (1.5-3.7); 5.0 (3.2-7.8); and 5.5 (2.9-10.4) times higher odds of having moderate-to-severe depression, compared to those without CVD risk. One percent higher HbA1C and a five mg/dl decrease in HDL-C were associated with 1.1 (95% CI: 1.1-1.2) and 1.0 (95% CI: 1.0-1.1) times higher odds of having moderate-to-severe depression, respectively. Self-reported CHD; stroke; CHF; and any CVD were associated with 3.5 (1.8-6.7); 1.7 (0.7-3.9); 2.1 (1.3-3.4); and 2.1 (1.2-3.6) times higher odds of having moderate-to-severe depression, after additional adjustment for current smoking, LDL-C, SBP, and FPG. Conclusions: Prevalent CVDs and CVD risk factors are significantly associated with depression symptoms in the US general population, underscoring the need to integrate mental and physical healthcare services.

BACKGROUND:The Ehlers-Danlos syndromes (EDSs) are a group of heritable disorders of connective tissue associated with an increased prevalence of both structural and functional GI conditions.METHODS:We used 10 years (2005-2014) of administrative claims data comprised of 4294 people with clinician-diagnosed EDS, aged 5-62 years, and compared their frequency of GI drug prescription claims to their age-, sex-, state of residence-, and earliest claim date-matched controls. We categorized the GI medications into the following groups: acid suppressants, anti-emetics, irritable bowel syndrome drugs, and visceral hypersensitivity (VHS) medications.KEY RESULTS:Compared to controls, a significantly higher proportion of persons with EDS had prescription claims for at least one GI drug group, as well as for drugs in each of the four GI drug groups included in our study. By age-group, 25.7% children and 45.1% adults with EDS had prescription claims for at least one GI drug group compared with only 7.4% and 21.0% of controls, respectively (p < 0.0001). By gender, 44.0% of women and 25.3% of men with EDS had prescription claims for at least one class of GI drugs compared with 19.2% and 9.6% of controls, respectively (p < 0.0001).CONCLUSIONS AND KEY INFERENCES:Predominant medication burden occurs among women with EDS, beginning peri-pubertally for anti-emetics and VHS drugs. High GI medication burden underscores previous evidence that GI dysmotility is common among persons with EDS.

Persons with the Ehlers-Danlos syndromes (EDS) report a wide range of respiratory symptoms, most commonly shortness of breath, exercise limitation, and cough. Also reported are noisy breathing attributed to asthma, difficulty with deep inhalation, and inspiratory thoracic pain. The literature consists of case reports and small cross-sectional and cohort studies. One case-control study estimated twofold to threefold greater respiratory disease burden among persons with EDS as compared to controls. The differential diagnosis for symptoms is broad. Structural alterations include pectus deformities, scoliosis, recurrent rib subluxations, and tracheobronchomalacia, associated with varying degrees of physiologic impairment. Those with vascular EDS have an increased risk of pneumothorax, intrapulmonary bleeding, cysts, and nonmalignant fibrous nodules. Functional aerodigestive manifestations such as inducible laryngeal obstruction may be misdiagnosed as asthma, with gastro-esophageal dysmotility and reflux as common contributing factors. Inflammatory manifestations include costochondritis, bronchiectasis, and localized respiratory allergic and nonallergic mast cell activation. Cranio-cervical instability can dysregulate respiratory control pathways. There is a need for careful phenotyping using standardized clinical tools and patient-reported outcomes and continuing collaboration with aerodigestive specialists including otolaryngologists and gastroenterologists. Also needed is further evaluation of respiratory symptoms in persons with hypermobility spectrum disorders. Personalized monitoring strategies are invaluable for interpretation and long-term management of respiratory symptoms.