Literature Collection

BACKGROUND: Depression is the second most common chronic condition affecting women of reproductive age; 23.4% of women enter pregnancy with depression and use of selective serotonin reuptake inhibitors (SSRIs) in pregnancy is often necessary for maternal wellbeing. However, SSRI use during pregnancy can cause congenital malformations, postpartum haemorrhage (PPH), and persistent pulmonary hypertension of the newborn (PPHN). In UK primary care, prescribing formularies are one medium by which prescribers are provided with local medicines advice. AIM: To review all local prescribing formularies with respect to prescribing SSRIs in women of reproductive age, during pregnancy, and during breastfeeding. DESIGN & SETTING: A systematic review of prescribing formularies in England and Wales. METHOD: A systematic keyword search of all clinical commissioning group and Integrated Care Board websites in England and Local Health Board websites in Wales was undertaken between December 2021-22 to identify prescribing formularies. Data were extracted on prescribing guidance for SSRIs. RESULTS: Seventy-four prescribing formularies were reviewed. Of these, 14.9% (n = 11/74) provided links to the Medicines and Healthcare products Regulatory Agency guidance on congenital abnormalities associated with SSRIs, 28.4% (n = 21/74) provided links to guidance on PPH risk, and 1.4% (n = 1/74) provided links to guidance on PPHN. Specific local guidance was given on SSRI prescribing for women of reproductive age, during pregnancy, and during breastfeeding in 12.2% (n = 9/74), 23.0% (n = 17/74), and 21.6% (n = 16/74) of formularies, respectively. CONCLUSION: Our results suggest that prescribers may be poorly informed by local formularies about the risks of SSRI use around pregnancy. This could place babies at increased risk of unintentional SSRI exposure.

OBJECTIVE: The growing population of older adults with serious mental illness (SMI) faces significant unmet needs as they age. Despite the increasing prevalence of SMI among older adults, limited research has focused on their specific needs, particularly within racially and ethnically diverse populations. This study examines the self-reported needs of 746 adults aged 50 years and older using data collected between 2018 and 2022 from the Bridge, a supportive housing agency in New York. METHODS: Need was operationalized as reported difficulties older adults encounter with various functional domains, including activities of daily living, instrumental activities of daily living, and mobility tasks. Data were analyzed using the team-based and patient-centered Rapid and Rigorous Qualitative Data Analysis method. Identified themes were categorized according to the social determinants of health framework. RESULTS: The most frequently reported subcategories of needs included housing (17.4%), access to care (10.7%), and social support systems (7.9%). Many participants emphasized the need for stable, accessible housing. Difficulties in accessing healthcare included challenges in obtaining mental health services, medications, and specialized care such as dental and vision services. Difficulties in social support systems involved a need for stronger family connections, companionship, and community involvement. Additionally, maintaining independence (6.6%) and holistic well-being (6.1%) emerged as key concerns, with participants emphasizing the importance of self-sufficiency and overall mental and physical well-being. CONCLUSION: The findings of this study underscore the gap between existing supportive services and the multidimensional needs of racially and ethnically diverse older adults with SMI. Addressing these challenges requires integrated healthcare models, housing stability initiatives, and expanded social support programs to improve quality of life and long-term outcomes for this vulnerable population.

BACKGROUND: To investigate the impact of patient selection in different health sectors on sensitivities and specificities of psychosomatic questionnaires and clinical signs and symptoms (CSS) for predicting daily life impairment (DLI) in individuals after SARS-CoV-2 infection. METHODS: Secondary data analysis of three independent cross-sectional surveys in general population (n = 2828), fourteen primary care practices (n = 204), and rehabilitation hospital (n = 161). DLI and symptoms were captured using questionnaires. PHQ-15 (Patient Health Questionnaire-15) and SSD-12 (Somatic Symptom Disorder-12), PHQ-2 (Patient Health Questionnaire-2), GAD-2 (Generalized Anxiety Disorder-2), and FAS (Fatigue Assessment Scale) were used to assess somatic symptom disorder (SSD), depression, anxiety and fatigue. Diagnostic indices were calculated to predict DLI. RESULTS: The sensitivities of questionnaires and CSS increased, and specificities decreased from general population to practices and hospital. SSD-12 had a higher diagnostic odds ratio (dOR; 95 % confidence interval) (17.4; 12.6-24.0) in population than in practices (8.4; 3.6-19.7) or hospital (8.1; 1.7-31.7). FAS > 22 had higher dOR (15.0; 11.8-19.1) in population than in practices (5.3; 2.8-9.8) or hospital (4.8; 1.4-16.3). The pattern (population / practice / hospital) was similar in depression (9.2; 7.0-12.0 / 8.0; 3.6-18.1 / 12.2; 1.5-96.2) and anxiety (8.0; 6.0-10.8 / 2.4; 1.0-5.6 / 3.0; 0.6-14.1). Areas under the curves of questionnaires were highest in population, followed by hospital, and consistently lower for practices. CONCLUSION: There is a large variation in sensitivities and specificities to predict DLI. The extent to which SSD or psychosomatic comorbidity contributes to DLI varied across the health sectors in which patients are diagnosed and treated.