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Depression: HELP
Articles by Hua Chen
Based on 16 articles published since 2008
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Between 2008 and 2019, Hua Chen wrote the following 16 articles about Depression.
 
+ Citations + Abstracts
1 Article Racial/ethnic differences in the treatment of adolescent major depressive disorders (MDD) across healthcare providers participating in the medicaid program. 2018

Yucel, Aylin / Essien, Ekere J / Sanyal, Swarnava / Mgbere, Osaro / Aparasu, Rajender R / Bhatara, Vinod S / Alonzo, Joy P / Chen, Hua. ·University of Houston College of Pharmacy, Houston, TX, USA. Electronic address: ayucel01@amgen.com. · University of Houston College of Pharmacy, Houston, TX, USA. Electronic address: EJEssien@uh.edu. · University of Houston College of Pharmacy, Houston, TX, USA. Electronic address: ssanyal@uh.edu. · Bureau of Epidemiology, Houston Health Department. Electronic address: Osaro.Mgbere@houstontx.gov. · University of Houston College of Pharmacy, Houston, TX, USA. Electronic address: rraparasu@uh.edu. · University of South Dakota, Sioux Falls, SD, USA. Electronic address: vsbhatara@gmail.com. · University of Houston College of Pharmacy, Houston, TX, USA. Electronic address: jalonzo@pharmacy.tamhsc.edu. · University of Houston College of Pharmacy, Houston, TX, USA. Electronic address: hchen20@uh.edu. ·J Affect Disord · Pubmed #29656260.

ABSTRACT: BACKGROUND: To examine whether racial/ethnic differences in receipt of MDD treatment could be explained by the specialty of provider diagnosing the adolescent. METHOD: Adolescents (10-20 years-old) with ≥2 MDD diagnoses were identified using 2005-2007 Medicaid data from Texas. Patients were categorized based on the types of provider who gave the initial MDD diagnosis (psychiatrist (PSY-I), social worker/psychologist (SWP-I), and primary care physician (PCP-I)). Within the sub-cohorts identified by each type of provider, patients were further divided by racial/ethnic groups. RESULTS: Of the 13,234-new pediatric MDD cases diagnosed, 61% were SWP-I, 33% PSY-I and 6% PCP-I. Results of the analysis using general linear multi-level model showed that being first diagnosed by a psychiatrist was associated with higher chance of receiving MDD related treatment (PCP-I vs. PSY-I (OR: 0.54, 95%CI: 0.4-0.7) and SWP-I vs. PSY-I (OR: 0.17, 95%CI: 0.1-0.2)). Specifically, regarding the receipt of pharmacotherapy, an interaction effect was detected between types of identifying providers and patients' race/ethnicity. The analysis stratified by race/ethnicity found Whites received comparable treatment regardless being PCP-Is or PSY-Is, while for Hispanics, being first identified by a PCP was associated with lower likelihood of receiving treatment as compared to being first identified by a psychiatrist. Further analysis stratified by provider types showed that a significant racial/ethnic variation in medication utilization was observed in PCP-Is, but not in PSY-Is. CONCLUSION: For adolescents with MDD, being first diagnosed by a psychiatrist was associated with higher treatment rate and reduced racial/ethnic variation in the utilization of pharmacotherapy.

2 Article Risk of Mortality Associated with Anticholinergic Use in Elderly Nursing Home Residents with Depression. 2017

Chatterjee, Satabdi / Bali, Vishal / Carnahan, Ryan M / Chen, Hua / Johnson, Michael L / Aparasu, Rajender R. ·Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, Texas Medical Center, University of Houston, 1441 Moursund Street, Houston, TX, 77030, USA. · Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA. · Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, Texas Medical Center, University of Houston, 1441 Moursund Street, Houston, TX, 77030, USA. rraparasu@uh.edu. ·Drugs Aging · Pubmed #28656508.

ABSTRACT: BACKGROUND: Few studies have evaluated the association between anticholinergic use and mortality in elderly nursing home residents. OBJECTIVE: The aim of this study was to examine the risk of mortality associated with anticholinergic use among elderly nursing home residents with depression. METHODS: The study employed a population-based nested case-control design using 2007-2010 Minimum Data Set (MDS)-linked Medicare data from all states. The base cohort included Medicare beneficiaries aged ≥65 years, diagnosed with depression as of 2007, and with any MDS assessment in 2007. Cases were identified as patients who died anytime between January 1, 2008 and December 31, 2010. For each case, four age- and sex-matched controls were selected using incidence density sampling. Anticholinergic exposure was defined using the Anticholinergic Drug Scale (ADS). Prescription of clinically significant anticholinergic medications (ADS level 2/3) 60 days preceding the event date formed the primary exposure. Conditional logistic regression model stratified on matched case-control sets was performed to assess mortality risk, after controlling for other risk factors. RESULTS: The study sample included 44,948 cases who died and 179,792 matched controls. After adjusting for other risk factors, clinically significant anticholinergic use was associated with significant risk of death (odds ratio [OR] 1.31; 95% CI 1.28-1.34) compared with non-use. Level-specific analysis indicated high mortality risk with only markedly anticholinergic (ADS level 3) medication use (OR 1.46; 95% CI 1.42-1.51). CONCLUSIONS: Use of clinically significant anticholinergic medications was associated with a 31% increase in risk of mortality among elderly nursing home residents with depression. With increasing safety concerns, there is a significant need to optimize anticholinergic use in the vulnerable population.

3 Article Risk of Mortality in Elderly Nursing Home Patients with Depression Using Paroxetine. 2017

Bali, Vishal / Chatterjee, Satabdi / Johnson, Michael L / Chen, Hua / Carnahan, Ryan M / Aparasu, Rajender R. ·Engage2Health, Health Advocate, Westlake Village, California. · Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas. · Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa. ·Pharmacotherapy · Pubmed #28079266.

ABSTRACT: OBJECTIVE: Among selective serotonin reuptake inhibitors (SSRIs), paroxetine is strongly anticholinergic and might lead to a higher risk of adverse outcomes such as mortality. This study examined the risk of mortality in depressed elderly nursing home patients using paroxetine and other SSRIs. METHODS: This study used 2007-2010 Minimum Data Set-linked Medicare data and a propensity score (PS)-matched retrospective cohort study design to achieve the study objective. New users of paroxetine and other SSRIs were followed until they reached the end of the follow-up period (1 year), switched to a different antidepressant class, used psychotherapy, or had a gap of more than 15 days in the use of index antidepressant class, whichever occurred earlier. A robust Cox proportional hazard (PH) model was used to evaluate the risk of mortality associated with the use of paroxetine and other SSRIs in depressed elderly nursing home residents. RESULTS: The PS matching yielded 4620 patients each in the two treatment groups. The unadjusted incidence of mortality was 269 (2.9%) for paroxetine and 288 (3.1%) for other SSRIs users in the matched cohort. The robust Cox PH model did not find any significant difference in the risk mortality between the two groups (hazard ratio 1.01; 95% confidence interval 0.86-1.19). CONCLUSIONS: This study did not find any significant difference in the risk of mortality between users of paroxetine and other SSRIs among elderly nursing home patients with depression. There is a need for further evaluation of other adverse effects of paroxetine due to its anticholinergic effects in the geriatric population.

4 Article Poor sleep quality and nightmares are associated with non-suicidal self-injury in adolescents. 2017

Liu, Xianchen / Chen, Hua / Bo, Qi-Gui / Fan, Fang / Jia, Cun-Xian. ·Department of Epidemiology, Shandong University School of Public Health and Shandong University Center for Suicide Prevention Research, Shandong University, No. 44, Wenhuaxi Rd, Lixia Dist, Jinan, 250012, China. xliu69@uthsc.edu. · The University of Tennessee Health Science Center, Memphis, TN, 38163, USA. xliu69@uthsc.edu. · Department of Epidemiology, Shandong University School of Public Health and Shandong University Center for Suicide Prevention Research, Shandong University, No. 44, Wenhuaxi Rd, Lixia Dist, Jinan, 250012, China. · Center for Disease Control and Prevention of Lijin County, Lijin, 257400, China. · School of Psychology, South China Normal University, Shipai, Guangzhou, 510631, China. · Department of Epidemiology, Shandong University School of Public Health and Shandong University Center for Suicide Prevention Research, Shandong University, No. 44, Wenhuaxi Rd, Lixia Dist, Jinan, 250012, China. jiacunxian@sdu.edu.cn. ·Eur Child Adolesc Psychiatry · Pubmed #27383464.

ABSTRACT: Non-suicidal self-injury (NSSI) is prevalent and is associated with increased risk of suicidal behavior in adolescents. This study examined which sleep variables are associated with NSSI, independently from demographics and mental health problems in Chinese adolescents. Participants consisted of 2090 students sampled from three high schools in Shandong, China and had a mean age of 15.49 years. Participants completed a sleep and health questionnaire to report their demographic and family information, sleep duration and sleep problems, impulsiveness, hopelessness, internalizing and externalizing problems, and NSSI. A series of regression analyses were conducted to examine the associations between sleep variables and NSSI. Of the sample, 12.6 % reported having ever engaged in NSSI and 8.8 % engaged during the last year. Univariate logistic analyses demonstrated that multiple sleep variables including short sleep duration, insomnia symptoms, poor sleep quality, sleep insufficiency, unrefreshed sleep, sleep dissatisfaction, daytime sleepiness, fatigue, snoring, and nightmares were associated with increased risk of NSSI. After adjusting for demographic and mental health variables, NSSI was significantly associated with sleeping <6 h per night, poor sleep quality, sleep dissatisfaction, daytime sleepiness, and frequent nightmares. Stepwise logistic regression model demonstrated that poor sleep quality (OR = 2.18, 95 % CI = 1.37-3.47) and frequent nightmares (OR = 2.88, 95 % CI = 1.45-5.70) were significantly independently associated with NSSI. In conclusion, while multiple sleep variables are associated with NSSI, poor sleep quality and frequent nightmares are independent risk factors of NSSI. These findings may have important implications for further research of sleep self-harm mechanisms and early detection and prevention of NSSI in adolescents.

5 Article Risk of Cognitive Decline Associated With Paroxetine Use in Elderly Nursing Home Patients With Depression. 2016

Bali, Vishal / Chatterjee, Satabdi / Johnson, Michael L / Chen, Hua / Carnahan, Ryan M / Aparasu, Rajender R. ·Department of Pharmaceutical Health Outcomes and Policy, Texas Medical Center, College of Pharmacy, University of Houston, Houston, TX, USA. · Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA. · Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA rraparasu@uh.edu. ·Am J Alzheimers Dis Other Demen · Pubmed #27765867.

ABSTRACT: OBJECTIVE: This study evaluated the risk of cognitive decline associated with paroxetine use in elderly nursing home patients with depression. METHODS: A retrospective cohort study was conducted using the 2007 to 2010 Medicare Part D claims and minimum data set (MDS) data involving new users of paroxetine and other selective serotonin reuptake inhibitors (SSRIs). The primary outcome was MDS Cognition Scale. The repeated-measures mixed model was used to examine the effect of paroxetine on cognition after controlling for other factors. RESULTS: The baseline MDS Cognition Scale measures for paroxetine (n = 63) and other SSRI users (n =1018) were 2.02 (±1.85) and 2.50 (±2.39), respectively. The repeated-measures mixed model did not find statistically significant difference in cognition with the use of paroxetine (β = 0.02, 95% CI: -0.16 to 0.21]) when compared to other SSRIs. CONCLUSIONS: There was no differential effect of paroxetine on cognition when compared to other SSRIs.

6 Article Comparative risk of hip fractures in elderly nursing home patients with depression using paroxetine and other selective serotonin reuptake inhibitors. 2016

Bali, Vishal / Chatterjee, Satabdi / Johnson, Michael L / Chen, Hua / Carnahan, Ryan M / Aparasu, Rajender R. ·Senior Health Outcomes Researcher, Health Advocate, Westlake Village, CA, USA. · Department of Pharmaceutical Health Outcomes & Policy, College of Pharmacy, University of Houston, Texas Medical Center, 1441 Moursund Street, Houston, TX 77030-3407, USA. · Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA. ·J Comp Eff Res · Pubmed #27426927.

ABSTRACT: AIM: To evaluate comparative safety of paroxetine and other selective serotonin reuptake inhibitors (SSRIs) for the risk of hip fractures. PATIENTS & METHODS: A propensity score-matched retrospective cohort study was conducted using 2007-2010 Minimum Data Set linked Medicare data. Robust Cox proportional hazards model was used to evaluate the risk of hip fractures in depressed elderly nursing home residents. RESULTS: Cox analysis did not find any significant difference in the risk of hip fractures for the paroxetine users (hazard ratio: 1.09; 95% CI: 0.91-1.32) when compared with other SSRIs. Results from the sensitivity analysis supported the main findings. CONCLUSION: There was no differential risk of hip fractures between paroxetine and other SSRIs. Future studies are needed to evaluate other anticholinergic effects of paroxetine.

7 Article Anticholinergic Medication Use and Risk of Fracture in Elderly Adults with Depression. 2016

Chatterjee, Satabdi / Bali, Vishal / Carnahan, Ryan M / Chen, Hua / Johnson, Michael L / Aparasu, Rajender R. ·Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Texas. · Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa. ·J Am Geriatr Soc · Pubmed #27294403.

ABSTRACT: Limited research exists regarding the effect of anticholinergics on falls and fractures in elderly nursing home residents in the United States. This study examined the risk of fractures associated with anticholinergic medication use in elderly nursing home residents with depression. A nested case-control design involving a cohort of elderly adults with depression from the 2007 to 2010 Minimum Data Set (MDS)-linked Medicare data was used to evaluate the risk of fractures. The study sample included Medicare beneficiaries aged 65 and older diagnosed with depression having at least one nursing home stay during 2007 to 2010 and no history of falls or fractures in 2007 (base period). Cases were individuals with incident fractures after the baseline period. For each case, four age- and sex-matched controls were selected using incidence density sampling. Anticholinergic exposure was defined using the Anticholinergic Drug Scale (ADS). Prescription of Level 2 or 3 anticholinergic medications within 30 days before the event date was the primary exposure. The primary outcome was an inpatient or outpatient claim for a fracture between January 1, 2008, and December 31, 2010. A conditional logistic regression model stratified on matched case-control sets was used to evaluate association between anticholinergic use and fractures, controlling for other risk factors of the outcome. The study sample consisted of 40,452 individuals with fractures and 161,808 matched controls. After adjusting for other risk factors, high-level anticholinergic use was associated with 14% greater fracture risk than nonuse (odds ratio (OR) = 1.14, 95% confidence interval (CI) = 1.11-1.17). The high risk of fractures remained consistent across levels of anticholinergic potency (Level 2, OR = 1.15, 95% CI = 1.11-1.19; Level 3, OR = 1.10, 95% CI = 1.07-1.15). The study findings remained consistent in multiple sensitivity analyses. Overall, use of high-level anticholinergic medications was associated with greater risk of fracture than no use in elderly adults with depression. Given safety concerns, there is a need to optimize anticholinergic use in elderly adults.

8 Article Anticholinergic Medication Use and Risk of Dementia Among Elderly Nursing Home Residents with Depression. 2016

Chatterjee, Satabdi / Bali, Vishal / Carnahan, Ryan M / Johnson, Michael L / Chen, Hua / Aparasu, Rajender R. ·Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA. · Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA. · Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA. Electronic address: rraparasu@uh.edu. ·Am J Geriatr Psychiatry · Pubmed #26976294.

ABSTRACT: OBJECTIVE: To examine the risk of dementia with anticholinergic use among elderly nursing home residents with depression. DESIGN: Population-based nested case-control study. SETTING: Population-based study involving 2007-2010 Minimum Data Set-linked Medicare data from all 50 states. PARTICIPANTS: Medicare beneficiaries aged 65 years and older, diagnosed with depression, and no history of dementia as of 2007 (baseline period). Cases were identified as patients with incident dementia following the baseline period. For each case, four age- and sex-matched control subjects were selected using incidence density sampling. MEASUREMENTS: Anticholinergic exposure was defined using Anticholinergic Drug Scale. Prescription of clinically significant anticholinergic medications (levels 2 and 3) 30 days preceding the event date formed the primary exposure. The primary outcome was dementia diagnosis, between January 1, 2008, and December 31, 2010. A conditional logistic regression model stratified on matched case-control sets was performed to assess dementia risk, after controlling for other risk factors. RESULTS: The study sample included 28,388 cases diagnosed with dementia and 113,352 matched control subjects. After adjusting for other risk factors, clinically significant anticholinergic use was associated with significant risk of dementia (OR: 1.26; 95% CI: 1.22-1.29) compared with non-use. The findings remained consistent across levels of anticholinergic potency (level 2, OR: 1.37, 95% CI: 1.31-1.44; level 3, OR: 1.15, 95% CI: 1.10-1.19). CONCLUSION: Use of clinically significant anticholinergic medications was associated with a 26% increase in risk of dementia among elderly nursing home residents with depression. With increasing safety concerns, there is a significant need to optimize anticholinergic use, especially for those who are at risk for dementia.

9 Article Comparative Effectiveness of Second-Generation Antidepressants in Reducing the Risk of Dementia in Elderly Nursing Home Residents with Depression. 2016

Bali, Vishal / Holmes, Holly M / Johnson, Michael L / Chen, Hua / Fleming, Marc L / Aparasu, Rajender R. ·Health Advocate, Westlake Village, California. · Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas. · Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, Texas Medical Center, University of Houston, Houston, Texas. ·Pharmacotherapy · Pubmed #26748455.

ABSTRACT: STUDY OBJECTIVE: Second-generation antidepressants have been shown to improve cognition and depression symptomatology, which are the major risk factors for dementia; however, little is known about the comparative effectiveness of antidepressants in reducing the risk of dementia. Thus, the objective of this study was to evaluate the long-term comparative effectiveness of different antidepressant classes in reducing the risk of dementia in elderly nursing home residents with depression. DESIGN: Propensity score-adjusted retrospective cohort study. DATA SOURCE: Multistate Minimum Data Set-linked Medicare Parts A, B, and D data files. PATIENTS: A total of 25,108 nursing home residents (65 years and older) with a diagnosis of depression and without a dementia diagnosis who were Medicare beneficiaries and new users of selective serotonin reuptake inhibitors (SSRIs; 19,952 [79.5%]), serotonin-norepinephrine reuptake inhibitors (SNRIs; 2381 [9.5%]), or tetracyclic antidepressants (2775 [11.1%]) between 2007 and 2010. MEASUREMENTS AND MAIN RESULTS: New users of SSRIs, SNRIs, and tetracyclics were followed over a 2-year period for the occurrence of dementia. A Cox proportional hazards regression model was used to evaluate the comparative effectiveness of SNRIs and tetracyclics in reducing the risk of dementia, with the SSRI class used as the reference category after controlling for propensity scores and their interactions terms. The unadjusted incidence of dementia was 8.2% for SSRI users, 6.0% for SNRI users, and 7.2% for tetracyclic users. The propensity score-adjusted Cox model did not find any significant difference in the risk of dementia in elderly nursing home residents who used SNRIs (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.84-1.19) or tetracyclics (HR 1.01, 95% CI 0.87-1.17) compared with the SSRI users. CONCLUSION: This study did not find any significant differences in reducing the risk of dementia among the new users of second-generation antidepressant classes. Further studies are needed to evaluate the profiles of second-generation antidepressants on cognition in this vulnerable population.

10 Article Comparative Cognitive Profile of Second-Generation Antidepressants in Elderly Nursing Home Residents With Depression. 2016

Bali, Vishal / Johnson, Michael L / Chen, Hua / Fleming, Marc L / Holmes, Holly M / Aparasu, Rajender R. ·Health Advocate, Westlake Village, CA, USA. · University of Houston, Houston, TX, USA. · University of Texas MD Anderson Cancer Center, Houston, TX, USA. · University of Houston, Houston, TX, USA rraparasu@uh.edu. ·Ann Pharmacother · Pubmed #26610873.

ABSTRACT: BACKGROUND: Past literature suggests that the use of second-generation antidepressants improves cognition in depressed elderly patients. OBJECTIVE: This study assessed the comparative cognitive profile of commonly used second-generation antidepressant classes in elderly residents with depression. METHODS: A multiple propensity score adjusted retrospective cohort study was conducted using 2007-2010 Medicare Part D claims and Minimum Data Set (MDS). Elderly nursing home residents (65 years or older) with depression using a new prescription of selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tetracyclics constituted the study cohort. The outcome of interest was cognition, measured using the MDS Cognition Scale. Cognition was measured at each quarterly assessment after antidepressant initiation for a maximum of 1 year. The propensity score-adjusted repeated-measures mixed model was used to evaluate the comparative profile of SSRIs, SNRIs, and tetracyclics with respect to cognition. RESULTS: The study cohort comprised 1518 elderly nursing home residents. Of these, 1081 received SSRIs (71.21%), 320 received tetracyclics (21.08%), and 117 received SNRIs (7.71%). The propensity score-adjusted repeated-measures mixed model did not show any statistically significant difference in cognition with the use of SSRIs (β = -0.14; 95% CI = -0.53, 0.25) or tetracyclics (β = -0.36; 95% CI = -0.80, 0.08) when compared with SNRIs, after controlling for other factors. CONCLUSIONS: The cognitive effect of SSRIs, SNRIs, and tetracyclics was similar in elderly nursing home residents with depression. Further studies are needed to evaluate the long-term cognitive effects of second-generation antidepressants in this vulnerable population.

11 Article Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors. 2015

Bali, Vishal / Chatterjee, Satabdi / Carnahan, Ryan M / Chen, Hua / Johnson, Michael L / Aparasu, Rajender R. ·Dr. Bali, Dr. Chatterjee, Dr. Chen, Dr. Johnson, and Dr. Aparasu are with the Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston. Dr. Carnahan is with the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City. Send correspondence to Dr. Aparasu (e-mail: rraparasu@uh.edu ). ·Psychiatr Serv · Pubmed #26234334.

ABSTRACT: OBJECTIVE: Selective serotonin reuptake inhibitors (SSRIs) are the first line of treatment for depression. Among the SSRIs, paroxetine has strong anticholinergic properties and may lead to increased risk of adverse cognitive outcomes among elderly patients. This study evaluated the comparative risk of dementia associated with use of paroxetine and other SSRIs among elderly nursing home patients. METHODS: A retrospective cohort study using propensity score matching was conducted with 2007-2010 Minimum Data Set-linked Medicare data. The study population included elderly nursing home patients with depression who were new users of SSRIs. Patients were followed for a maximum of two years after index SSRI use. The risk of dementia was modeled by using a robust Cox proportional hazards model to account for clustering within matched users of paroxetine and other SSRIs. RESULTS: The unmatched cohort included 19,952 new users of SSRIs; 1,898 used paroxetine, and 18,054 used other SSRIs. In the propensity-matched cohort of 3,796 patients, the unadjusted incidence of dementia was 7.5% for users of paroxetine and 8.6% for users of other SSRIs. There was no difference in the risk of dementia for users of paroxetine or other SSRIs. These study findings remained robust in multiple sensitivity analyses involving various measures of dementia. CONCLUSIONS: Compared with use of other SSRIs, use of paroxetine was not associated with higher risk of dementia among elderly nursing home patients with depression. Future studies are needed to evaluate the impact of paroxetine on other cognition measures.

12 Article Descriptive analysis of the cost-effectiveness of depressed patients undergoing total knee arthroplasty: an economic decision analysis. 2014

Gong, Long / Chen, Hua. ·Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China, Gonglong301@163.com. ·J Orthop Sci · Pubmed #24996623.

ABSTRACT: BACKGROUND: Recent rising concern about the cost-effectiveness ratio of total knee arthroplasty (TKA) led us to evaluate this successful procedure from the economic perspective, thereby helping policy-makers to conduct medical resource allocation more effectively and efficiently. However, up to now no study has investigated the influence of patients' psychological factors on their evaluation of TKA's cost-effectiveness. Therefore, we decided to determine whether and how depression, which is a common negative psychological factor in the population undergoing TKA, affects their economic evaluation of the procedure. METHODS: A total of 312 patients who had undergone TKA were graded into three groups based on the level of depression measured by the Center for Epidemiological Studies Depression Scale (CES-D) scores. Clinical effectiveness information was obtained using the WOMAC questionnaire; total costs related to TKA were acquired through interviews with patients and review of their medical records in the computing system. RESULTS: Patients with high-level depression (3491.9$/QALYS; 95% CI, 3471.1-3491.9$/QALYS) had greater cost-effectiveness compared tothose with low-level (2447.1$/QALYS; 95% CI, 2427.9-2466.3$/QALYS) and middle-level (3027.2$/QALYS; 95% CI, 3011.0-3043.4$/QALYS) depression. We concluded there was a significant positive correlation between cost-effectiveness and the level of depression after TKA (r = 0.703, P = 0.014). Significant differences in the costs of hospital stay, medical treatment, rehabilitation, and outpatient care were detected among the three groups. CONCLUSIONS: Our study might help policy-makers and clinicians identify which types of patients benefit most from TKA and then advise high-risk patients (high-level depression status in this study) about how to recovery better with limited resource allocation. Preoperative evaluation of patients' psychological state may decrease unnecessary economic burdens and suffering during the recovery period.

13 Article Relationship of depression, stress and endothelial function in stable angina patients. 2013

Chen, Hua / Zhang, Lijie / Zhang, Min / Song, Xiantao / Zhang, Hua / Liu, Yue / Lv, Shuzheng. ·Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, PR China. ·Physiol Behav · Pubmed #23688945.

ABSTRACT: Endothelial dysfunction has been considered as one of potential mechanisms by which depression and stress might contribute to the development of coronary artery disease (CAD). Recent studies suggest that circulating endothelial progenitor cells (EPCs) and brachial artery flow-mediated dilation (FMD) are related to endothelial function and progression of CAD. We investigated the relationships between the level of circulating CD34/KDR(+) EPCs and CD133/KDR(+) EPCs, brachial FMD, and scores of depression and stress measured with the Depression Anxiety Stress Scales in 288 stable angina patients without major psychiatric disorders. As defined by the ≥75th percentile, 100 (35%) subjects had high depression score (≥8), and 84 (29%) subjects had high stress score (≥10). Subjects with high depression or stress score had significantly lower FMD (1.86±0.14 vs. 3.63±0.17%, p<0.001; 2.05±0.18 vs. 3.48±0.17%, p<0.001) and percentage of circulating CD34/KDR(+) EPCs (0.97±0.11 vs. 1.94±0.17%, p<0.001; 1.09±0.13 vs. 1.68±0.16%, p=0.005), but not CD133/KDR(+) EPCs (0.52±0.04 vs. 0.66±0.06%, p=0.057; 0.61±0.05 vs. 0.59±0.05%, p=0.833), as compared with subjects with normal depression or stress score. Multivariate regression analysis indicated that high depression score (OR 1.09, 95% CI: 1.04-1.15, p<0.001), but not stress score or percentage of circulating EPCs, independently predicted impaired brachial FMD. In conclusions, our results demonstrated that in stable angina patients without major psychiatric disorders, a high depression or stress score was related to attenuated brachial FMD and depletion of circulating EPCs. However, only the depression score, but not the stress score or the level of EPCs, was an independent predictor for decreased brachial FMD.

14 Article Relationships between vascular dysfunction, circulating endothelial progenitor cells, and psychological status in healthy subjects. 2011

Chen, Hua / Yiu, Kai-Hang / Tse, Hung-Fat. ·Cardiology Division, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong. ·Depress Anxiety · Pubmed #21681866.

ABSTRACT: BACKGROUND: Although the mechanisms remain unclear, depression and mental stress are associated with endothelial dysfunction and increases risk of cardiovascular disease (CVD). Recent studies suggest that circulating endothelial progenitor cells (EPC) play an important role in endothelial repair and correlate with endothelial function. METHODS: We studied the relationship between the level of circulating CD34/KDR(+) EPCs and CD133/KDR(+) EPCs, brachial artery flow-mediated dilation (FMD), Depression Anxiety Stress Scales in 129 normal individuals (54 ± 10 years, 54 men) without prior CVD or diabetes. RESULTS: Their median depression score (DS) and stress score (SS) was 4 (range 0-34) and 6 (range 0-32), respectively. As defined by the ≥75th percentile, 41 subjects (32%) had high DS (≥8) and 31 (24%) had high SS (≥14). Subjects with high DS had significantly lower FMD (5.4 ± 2.7 versus 8.0 ± 4.0%, P<0.001) and percentage of CD34/KDR(+) EPC (1.2 ± 1.3 versus 2.0 ± 2.4%, P = 0.037), but not CD133/KDR(+) EPC (0.56 ± 0.42 versus 0.68 ± 0.76%, P = 0.44), than those with normal DS. In contrast, there were no significant difference in FMD (6.8 ± 3.5 versus 7.3 ± 3.9%, P = 0.46), percentages of circulating CD34/KDR(+) EPC (1.20 ± 1.28 versus 1.95 ± 2.34%, P = 0.052) and CD133/KDR(+) EPC (0.55 ± 0.41 versus 0.67 ± 0.73%, P = 0.52) between subjects with high and normal SS. Multivariate regression analysis revealed that high DS (OR 1.08, 95% CI: 1.02-1.15, P = 0.010) and old age (OR 1.05, 95% CI: 1.01-1.10, P = 0.019), but not SS or percentage of circulating EPC, were independent predictors for decreased FMD. CONCLUSIONS: Our results demonstrated that, in subjects without significant CVD, a high DS was associated with impaired brachial FMD and depletion of circulating EPC. However, only DS, but not SS or EPC count, was an independent predictor for impaired brachial FMD.

15 Article Extent of functional impairment in children and adolescents with depression. 2010

Nagar, Saurabh / Sherer, Jeffrey T / Chen, Hua / Aparasu, Rajender R. ·University of Houston, Texas Medical Center, Houston, TX 77030-3407, USA. ·Curr Med Res Opin · Pubmed #20629599.

ABSTRACT: OBJECTIVE: Pediatric depression is often associated with clinically significant distress or impairment in school, home and social activities. However, very little is known about the extent of functional impairment in children with depression based on national level data. This study examined the extent of functional impairment in children and adolescents aged 5 to 17 years with depression based on 2005-2006 Medical Expenditure Panel Survey (MEPS) data. RESEARCH DESIGN AND METHODS: This study involved retrospective cross-sectional analysis of 2005-2006 MEPS data. Functional impairment in children was assessed using the parent-reported Columbia Impairment Scale (CIS). The CIS is a 13 item, lay-interviewer-administered global impairment scale. The analysis focused on children with depression. Functional impairment was ascertained using the mean summated scores of the CIS after conducting psychometric analysis. The Wilson and Cleary model was used to examine the factors associated with functional impairment in children and adolescents. RESULTS: Analysis of the CIS revealed that Cronbach's alpha of the parent-reported CIS was 0.90 with item-to-total correlations ranging from 0.51 to 0.77. The mean summated CIS score in children and adolescents with depression (CIS, 19.88) was higher (p < 0.05) than those without depression (CIS, 6.09). Multivariate linear regression revealed the interaction between age and depression was significant (p < 0.05) and therefore stratified regression analysis was performed by age. In both age groups, the diagnosis of depression was strongly associated (p < 0.01) with functional impairment (+7 units in 5-11 years, +11 units in 12-17 years). The presence of developmental, respiratory tract, attention deficit, and anxiety disorders also increased functional impairment in children and adolescents (p < 0.05). Family factors such as parents' psychiatric illness, their education and their living arrangement significantly contributed (p < 0.05) to impairment in children and adolescents. CONCLUSIONS: Functional impairment is significant in pediatric depression and understanding of personal and family factors can play an important role in the assessment, management and treatment of depression. The limitations of the study include cross-sectional study design and reliance on parent-reported data on medical condition and impairment.

16 Article Antipsychotic drug use among elderly nursing home residents in the United States. 2008

Kamble, Pravin / Chen, Hua / Sherer, Jeff / Aparasu, Rajender R. ·Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, Houston, Texas 77030, USA. ·Am J Geriatr Pharmacother · Pubmed #19028374.

ABSTRACT: BACKGROUND: Antipsychotic utilization in elderly nursing home residents has increased substantially in recent years, primarily due to the use of atypical antipsychotic agents. However, few studies have examined antipsychotic utilization patterns in nursing home residents in the United States since the introduction of atypical agents in the 1990s. OBJECTIVE: The goal of this study was to examine the prevalence of and the factors associated with antipsychotic drug use among elderly nursing home residents in the United States. METHODS: This study involved a cross-sectional analysis of prescription and resident data files from the 2004 National Nursing Home Survey (NNNHS). The analysis focused on the use of 11 typical and 6 atypical antipsychotic agents among a nationally representative sample of elderly patients (aged > or =65 years). Descriptive weighted analysis was performed to examine antipsychotic prevalence patterns. Multiple logistic regression analysis within the conceptual framework of the Andersen behavioral model was used to examine the factors associated with antipsychotic drug use among the elderly nursing home residents. RESULTS: According to the 2004 NNHS, 0.32 million elderly nursing home residents received antipsychotic medications, for an overall prevalence of 24.82%. Most received atypical agents (23.45%), while 1.90% received typical agents. Frequently reported diagnoses among the elderly using an antipsychotic agent were dementia (70%), depression (41%), and anxiety (18%). Among the predisposing characteristics, female gender and age (> or =85 years) were negatively associated with antipsychotic drug use. Need factors such as increasing dependence in decision-making ability regarding tasks of daily life, depressed mood indicators, behavioral symptoms, history of falls, and bowel incontinence were positively associated with antipsychotic drug use. In addition to the use of antipsychotic agents in schizophrenia and bipolar mania, this study found high use in conditions such as dementia, anxiety, depression, and parkinsonism in the elderly. CONCLUSIONS: Nearly 1 in 4 elderly nursing home residents in the United States received antipsychotic agents. Predisposing and need factors played a vital role in determining the use of antipsychotic agents in these elderly patients. Overall, the study findings suggest that there is a need to monitor antipsychotic drug use by elderly patients in US nursing homes in light of recent efficacy and safety data on atypical agents.