• The Association Between Factors Related to Vitamin D and Depression in Future Pharmacists

      Campbell, Ashley; Slack, Marion; Isemede, Tosan; Frent, Adina; Zehri, Sumaiyya; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: To determine whether there is a relationship between factors related to vitamin D and depression in pharmacy students. Methods: A questionnaire was administered to subjects that included questions regarding history of vitamin D levels, diet, supplementation, sun exposure, the Patient Health Questionnaire-9 (PHQ-9), and demographic information. Students were classified as adequate or inadequate in vitamin D. Based on PHQ-9 scores, subjects were placed into different severity categories of depression. Chi-square test was performed to determine whether inadequate vitamin D levels were associated with depression. Main Results: The questionnaire was completed by 218 subjects; 96 males and 122 females (71.6% were ≤26 years old). Approximately 74% of subjects failed to meet the RDA recommendation of 600 units of vitamin D per day through diet and/or supplementation. The average amount of vitamin D consumed from diet alone by all subjects was 1125 ± 1644.15 units/week. There was a significant difference in the amount of vitamin D obtained from diet between the first-year students compared to the second-year students (p= 0.008). Although there was not a significant difference in depression (any severity) between those who had inadequate versus adequate vitamin D consumption (p= 0.56), 4 (6.6%) of first-year students were categorized as having severe depression whereas none of the second and third-year students fell into this category. Conclusions: Although results from this study did not demonstrate a relationship between inadequate vitamin D consumption and depressive symptoms, almost 30 students were classified as at least moderately-depressed, suggesting the possible need for further interventions.
    • Impact of Depression on Health-Related Quality of Life Among Older Adults with Myocardial Infarction in the United States

      Bhattacharjee, Sandipan; Vadiei, Nina; Howard, Brooke; Lundgren, Terra; Morse, Shawn; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: We assessed the effect of depression on health-related quality of life (HRQoL) among myocardial infarction (MI) survivors in the United States (US). Methods: Using the 2015 Behavioral Risk Factor Surveillance System (BRFSS) data, our study sample consisted of survey participants who were MI survivors aged 50 years and older who also reported having depression post-MI. Our dependent variable (HRQoL) comprised of number of days physical and mental health was poor during the past 30 days; activity limitations; received recommended sleep; how often emotional support received; life satisfaction and perceived general health. We conducted multivariable binomial and multinomial logistic regression analyses examining the association of presence/absence of depression on HRQoL after adjusting for demographic, socioeconomic and other health variables (a-priori α=0.05). Main Results: Our study sample consisted of 20,483 adults with MI; 5,343 (26.19%) reported having depression. Survivors with depression were more likely to report fair/poor general health, limitations in activity, dissatisfaction with life, and a greater number of poor mental and physical health days compared to those without depression. For example: MI survivors with depression reported 2.7 times more (Adjusted Odds Ratio: 2.65: 95% Confidence Interval 2.06-3.45; p<0.0001) fair/poor perceived general health than MI survivors without depression. There was no difference in level of emotional support or sleep quality. Conclusions: In this nationally representative sample of adults in the US, MI survivors with depression had poorer HRQoL compared to MI survivors without depression. These findings underline the need for developing appropriate supportive care for MI survivors with depression.
    • Meta-Analysis: Pharmacological Treatment of Depression in Advanced Cancer

      Regan, John; Stewart, Matthew; Regan, John; College of Pharmacy, The University of Arizona (The University of Arizona., 2013)
      Specific Aims: To evaluate efficacy of the current pharmacological treatment of depression in the adult advanced and terminal cancer patient population. Methods: Trials assessing a pharmacological treatment for depression in cancer patients were found using MEDLINE and PSYCINFO databases. Comprehensive Meta-Analysis software was used to generate a random effects model forest plot, a funnel plot, classical fail-safe N, I2, and Kendall’s tau. Main Results: Ten studies, with an aggregate population was 1,167 patients, were used in this meta-analysis to generate a random effects variance model. The effect size was 0.42 +/- 0.09 (p < 0.01). I2 for aggregate data was 66.16 (p < 0.01). Kendall’s tau with continuity correction was 0.272 (P-value [2-tailed] = .244). The classic fail-safe N was 151 (p < 0.1). Three studies reported a significant increase in adverse effects between treatment and comparison group. Conclusion: Antidepressants were shown to have a moderate effect size when treating depression in advanced and terminal cancer patients. These medications were well tolerated. Antidepressant medications are beneficial as part of a comprehensive treatment plan for cancer patients diagnosed with depression.
    • Patterns and Predictors of Depression Treatment among Older Adults with Dementia and Depression in Ambulatory Care Settings in the United States

      Bhattacharjee, Sandipan; Sun, Chongwoo; Gobin, Philippe; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: Dementia, or neurocognitive disorder (NCD), is the deterioration of performance in mental function, and is a disease state only expected to become more prevalent in the coming decades. Depression is twice as likely to develop in this population and is also shown to increase the rate of decline in those with NCD. This study was designed to determine patterns and predictors of depression treatment in elderly dementia patients in the ambulatory care setting in the United States using the Anderson Behavioral Model (ABM) Methods: We conducted retrospective cross-sectional study design by using multiple years (2005–2015) of data from the National Ambulatory Medical Care Survey (NAMCS), an ongoing yearly survey administered by the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC). The NAMCS uses a multistage probability design to obtain systematic random weekly samples of patients from physicians across the nation using a Patient Record Form capable of recording up to three diagnoses codes and eight prescription medications for each visit. A weighted frequency for national prevalence values was generated from our data analysis. A multivariate regression analysis was completed to determine which predisposing, enabling, and need factors were significant determinants to the nature of antidepressant treatment. Main Results: A total of 655 (un-weighted) ambulatory visits by older adults with dementia and depression were recorded by National Ambulatory Medical Care Survey, or a national estimate of 14.46 million elderly patients visits with both NCD and depression. Predisposing factors such as race, age, sex, geographic region, and metro/non-metro; enabling factors such as insurance and physician specialty; and need factors such as new prescription drug, new patient, or reason for visit, or chronic disease states, were recorded. Multivariate analysis revealed gender, physician specialty, metro/non-metro, geographical region, and number of medications were significant determinants in how an elder NCD patient in the ambulatory setting receives treatment for depression. Conclusions: 62.89% of patients were treated for depression, with 61.45% of all patients receiving an antidepressant and 4.94% of patients receiving psychotherapy. Psychotherapy was utilized infrequently in this population, and SSRIs were the most common form of pharmacotherapy. This suggests this patient population is vulnerable to untreated depression and reveals a need for long-term studies investigating health outcomes in these patients.