Kate Johnson

MONTREAL — Hypertensive patients who have depression are less likely to stick to their therapy regimen than are those without, or in remission from, depression, according to a study of 161 patients.

“This suggests that any change in depressive symptomatology over time can affect medication adherence and may be clinically important,” Sara Gallagher said at the annual meeting of the Society of Behavioral Medicine.

Her study was embedded in a randomized, controlled trial that tested the effect of a motivational interviewing on medication adherence. It involved hypertensive African Americans (mean age 54; 87% women) who were followed in primary care practice.

Depressive symptomatology was assessed at baseline and at 6 and 12 months with the Center for Epidemiologic Studies-Depression Scale. Forty-four percent were classified as nondepressed, and 19% were considered depressed. Thirty-seven percent were classified as remittent, having progressed from depressed to nondepressed over the course of the study, said Ms. Gallagher of New York (N.Y.) University.

Medication adherence was assessed at baseline and at 12 months with the self-reported Morisky scale. At baseline, 64% reported nonadherence. This dropped to 48% by study's end.

A multivariate analysis showed that depressive symptoms were associated with medication nonadherence, Ms. Gallagher said. Among the depressed patients, 34% reported adherence at 12 months, compared with 66% in the nondepressed group and 47% in the remittent group.

The finding that a remittence of symptoms can result in improved adherence suggests a benefit to addressing patient depression in this context, Ms. Gallagher said.

MONTREAL — Hypertensive patients who have depression are less likely to stick to their therapy regimen than are those without, or in remission from, depression, according to a study of 161 patients.

“This suggests that any change in depressive symptomatology over time can affect medication adherence and may be clinically important,” Sara Gallagher said at the annual meeting of the Society of Behavioral Medicine.

Her study was embedded in a randomized, controlled trial that tested the effect of a motivational interviewing on medication adherence. It involved hypertensive African Americans (mean age 54; 87% women) who were followed in primary care practice.

Depressive symptomatology was assessed at baseline and at 6 and 12 months with the Center for Epidemiologic Studies-Depression Scale. Forty-four percent were classified as nondepressed, and 19% were considered depressed. Thirty-seven percent were classified as remittent, having progressed from depressed to nondepressed over the course of the study, said Ms. Gallagher of New York (N.Y.) University.

Medication adherence was assessed at baseline and at 12 months with the self-reported Morisky scale. At baseline, 64% reported nonadherence. This dropped to 48% by study's end.

A multivariate analysis showed that depressive symptoms were associated with medication nonadherence, Ms. Gallagher said. Among the depressed patients, 34% reported adherence at 12 months, compared with 66% in the nondepressed group and 47% in the remittent group.

The finding that a remittence of symptoms can result in improved adherence suggests a benefit to addressing patient depression in this context, Ms. Gallagher said.

MONTREAL — Hypertensive patients who have depression are less likely to stick to their therapy regimen than are those without, or in remission from, depression, according to a study of 161 patients.

“This suggests that any change in depressive symptomatology over time can affect medication adherence and may be clinically important,” Sara Gallagher said at the annual meeting of the Society of Behavioral Medicine.

Her study was embedded in a randomized, controlled trial that tested the effect of a motivational interviewing on medication adherence. It involved hypertensive African Americans (mean age 54; 87% women) who were followed in primary care practice.

Depressive symptomatology was assessed at baseline and at 6 and 12 months with the Center for Epidemiologic Studies-Depression Scale. Forty-four percent were classified as nondepressed, and 19% were considered depressed. Thirty-seven percent were classified as remittent, having progressed from depressed to nondepressed over the course of the study, said Ms. Gallagher of New York (N.Y.) University.

Medication adherence was assessed at baseline and at 12 months with the self-reported Morisky scale. At baseline, 64% reported nonadherence. This dropped to 48% by study's end.

A multivariate analysis showed that depressive symptoms were associated with medication nonadherence, Ms. Gallagher said. Among the depressed patients, 34% reported adherence at 12 months, compared with 66% in the nondepressed group and 47% in the remittent group.

The finding that a remittence of symptoms can result in improved adherence suggests a benefit to addressing patient depression in this context, Ms. Gallagher said.

MONTREAL — Actinic keratoses are dynamic lesions and their expression varies over time, based on an 11-month study of the natural course of the lesions in people with extensive actinic damage.

“At any one time, less than half of the lesions are evident clinically,” said Dr. Craig Elmets, who reported his findings on at the annual meeting of the Society for Investigative Dermatology.

The pattern of regression and recurrence of actinic keratoses (AK) has implications for the treatment of the lesions, said Dr. Elmets, professor and chair of the department of dermatology and director of the Skin Disease Research Center at the University of Alabama, Birmingham.

“If one is going to treat individual lesions, then they need to be treated aggressively because at any one time only a minority of the [visible] AK are present,” he said. “In patients with extensive actinic damage, peel treatment may be a very good approach to treating these lesions.”

Dr. Elmets did not disclose any conflictst in regard to this study, but he serves on the advisory boards of several pharmaceutical companies.

The study followed AK lesions for 11 months in 26 individuals with extensive actinic damage. At baseline, the subjects had 10-40 actinic lesions and at least one prior histological diagnosis of an AK or a nonmelanoma skin cancer.

The subjects' AKs were mapped at baseline and at 3, 6, 9, and 11 months. The lesions also were biopsied at baseline and the end of the study. “If a lesion that had been selected for biopsy was no longer present clinically, the site where it had been was still biopsied,” Dr. Elmets explained.

At baseline, there were a total of 610 AKs in the study group (mean 23.5 per individual). At the end of the study, this number was not significantly different despite the development of 973 new lesions over the 11-month period.

About 40% of the lesions present at baseline had regressed by month 11, and nearly 200 of the lesions that were present at baseline regressed and then recurred, he said. “A total of 51 of the lesions regressed twice.”

Using a histologic grading scheme that was based on a cervical dysplasia model, Dr. Elmets noted little progression in the severity of lesions in terms of proliferation, atypia, or both features.

AKs have been thought to be precursors to squamous cell carcinomas in some cases. The presence of AKs is strongly predictive of individuals who are at increased risk for basal cell and squamous cell carcinomas.

MONTREAL — Actinic keratoses are dynamic lesions and their expression varies over time, based on an 11-month study of the natural course of the lesions in people with extensive actinic damage.

“At any one time, less than half of the lesions are evident clinically,” said Dr. Craig Elmets, who reported his findings on at the annual meeting of the Society for Investigative Dermatology.

The pattern of regression and recurrence of actinic keratoses (AK) has implications for the treatment of the lesions, said Dr. Elmets, professor and chair of the department of dermatology and director of the Skin Disease Research Center at the University of Alabama, Birmingham.

“If one is going to treat individual lesions, then they need to be treated aggressively because at any one time only a minority of the [visible] AK are present,” he said. “In patients with extensive actinic damage, peel treatment may be a very good approach to treating these lesions.”

Dr. Elmets did not disclose any conflictst in regard to this study, but he serves on the advisory boards of several pharmaceutical companies.

The study followed AK lesions for 11 months in 26 individuals with extensive actinic damage. At baseline, the subjects had 10-40 actinic lesions and at least one prior histological diagnosis of an AK or a nonmelanoma skin cancer.

The subjects' AKs were mapped at baseline and at 3, 6, 9, and 11 months. The lesions also were biopsied at baseline and the end of the study. “If a lesion that had been selected for biopsy was no longer present clinically, the site where it had been was still biopsied,” Dr. Elmets explained.

At baseline, there were a total of 610 AKs in the study group (mean 23.5 per individual). At the end of the study, this number was not significantly different despite the development of 973 new lesions over the 11-month period.

About 40% of the lesions present at baseline had regressed by month 11, and nearly 200 of the lesions that were present at baseline regressed and then recurred, he said. “A total of 51 of the lesions regressed twice.”

Using a histologic grading scheme that was based on a cervical dysplasia model, Dr. Elmets noted little progression in the severity of lesions in terms of proliferation, atypia, or both features.

AKs have been thought to be precursors to squamous cell carcinomas in some cases. The presence of AKs is strongly predictive of individuals who are at increased risk for basal cell and squamous cell carcinomas.

MONTREAL — Actinic keratoses are dynamic lesions and their expression varies over time, based on an 11-month study of the natural course of the lesions in people with extensive actinic damage.

“At any one time, less than half of the lesions are evident clinically,” said Dr. Craig Elmets, who reported his findings on at the annual meeting of the Society for Investigative Dermatology.

The pattern of regression and recurrence of actinic keratoses (AK) has implications for the treatment of the lesions, said Dr. Elmets, professor and chair of the department of dermatology and director of the Skin Disease Research Center at the University of Alabama, Birmingham.

“If one is going to treat individual lesions, then they need to be treated aggressively because at any one time only a minority of the [visible] AK are present,” he said. “In patients with extensive actinic damage, peel treatment may be a very good approach to treating these lesions.”

Dr. Elmets did not disclose any conflictst in regard to this study, but he serves on the advisory boards of several pharmaceutical companies.

The study followed AK lesions for 11 months in 26 individuals with extensive actinic damage. At baseline, the subjects had 10-40 actinic lesions and at least one prior histological diagnosis of an AK or a nonmelanoma skin cancer.

The subjects' AKs were mapped at baseline and at 3, 6, 9, and 11 months. The lesions also were biopsied at baseline and the end of the study. “If a lesion that had been selected for biopsy was no longer present clinically, the site where it had been was still biopsied,” Dr. Elmets explained.

At baseline, there were a total of 610 AKs in the study group (mean 23.5 per individual). At the end of the study, this number was not significantly different despite the development of 973 new lesions over the 11-month period.

About 40% of the lesions present at baseline had regressed by month 11, and nearly 200 of the lesions that were present at baseline regressed and then recurred, he said. “A total of 51 of the lesions regressed twice.”

Using a histologic grading scheme that was based on a cervical dysplasia model, Dr. Elmets noted little progression in the severity of lesions in terms of proliferation, atypia, or both features.

AKs have been thought to be precursors to squamous cell carcinomas in some cases. The presence of AKs is strongly predictive of individuals who are at increased risk for basal cell and squamous cell carcinomas.

MONTREAL — Hypertensive patients who have depression are less likely to stick to their therapy regimen than are those who are not depressed or are in remission from depression, according to a study presented at the annual meeting of the Society of Behavioral Medicine.

Sara Gallagher of New York (N.Y.) University, studied 161 hypertensive African Americans who were followed in primary care practice. The patients had a mean age of 54 years, and 87% of them were women. Depressive symptomatology was assessed using the Center for Epidemiologic Studies-Depression (CES-D) scale.

A total of 44% of patients were classified as nondepressed, with a CES-D score of less than 16 at all time points, while 19% were considered depressed, with a score of 16 or above at all time points. A total of 37% of patients were classified as remittent, meaning that they progressed from depressed to nondepressed over the course of the study, said Ms. Gallagher.

Medication adherence was assessed at baseline and at 12 months using the self-reported Morisky scale. At baseline, 64% of the study population reported nonadherence to their medication, and this dropped to 48% at the end of the study.

A multivariate analysis revealed that depressive symptoms were tied to drug nonadherence, Ms. Gallagher reported. Among the depressed patients, only 34% reported adherence at 12 months, compared with 66% in the nondepressed group and 47% in the remittent group.

The finding that a remittence of depressive symptoms can result in improved adherence suggests a benefit to addressing patient depression, she said.

MONTREAL — Hypertensive patients who have depression are less likely to stick to their therapy regimen than are those who are not depressed or are in remission from depression, according to a study presented at the annual meeting of the Society of Behavioral Medicine.

Sara Gallagher of New York (N.Y.) University, studied 161 hypertensive African Americans who were followed in primary care practice. The patients had a mean age of 54 years, and 87% of them were women. Depressive symptomatology was assessed using the Center for Epidemiologic Studies-Depression (CES-D) scale.

A total of 44% of patients were classified as nondepressed, with a CES-D score of less than 16 at all time points, while 19% were considered depressed, with a score of 16 or above at all time points. A total of 37% of patients were classified as remittent, meaning that they progressed from depressed to nondepressed over the course of the study, said Ms. Gallagher.

Medication adherence was assessed at baseline and at 12 months using the self-reported Morisky scale. At baseline, 64% of the study population reported nonadherence to their medication, and this dropped to 48% at the end of the study.

A multivariate analysis revealed that depressive symptoms were tied to drug nonadherence, Ms. Gallagher reported. Among the depressed patients, only 34% reported adherence at 12 months, compared with 66% in the nondepressed group and 47% in the remittent group.

The finding that a remittence of depressive symptoms can result in improved adherence suggests a benefit to addressing patient depression, she said.

MONTREAL — Hypertensive patients who have depression are less likely to stick to their therapy regimen than are those who are not depressed or are in remission from depression, according to a study presented at the annual meeting of the Society of Behavioral Medicine.

Sara Gallagher of New York (N.Y.) University, studied 161 hypertensive African Americans who were followed in primary care practice. The patients had a mean age of 54 years, and 87% of them were women. Depressive symptomatology was assessed using the Center for Epidemiologic Studies-Depression (CES-D) scale.

A total of 44% of patients were classified as nondepressed, with a CES-D score of less than 16 at all time points, while 19% were considered depressed, with a score of 16 or above at all time points. A total of 37% of patients were classified as remittent, meaning that they progressed from depressed to nondepressed over the course of the study, said Ms. Gallagher.

Medication adherence was assessed at baseline and at 12 months using the self-reported Morisky scale. At baseline, 64% of the study population reported nonadherence to their medication, and this dropped to 48% at the end of the study.

A multivariate analysis revealed that depressive symptoms were tied to drug nonadherence, Ms. Gallagher reported. Among the depressed patients, only 34% reported adherence at 12 months, compared with 66% in the nondepressed group and 47% in the remittent group.

The finding that a remittence of depressive symptoms can result in improved adherence suggests a benefit to addressing patient depression, she said.

MONTREAL — Despite postmarketing concerns about the psychiatric side effects of varenicline for smoking cessation, the medication appears to be safe in patients who are depressed or at risk for depression, Jennifer B. McClure, Ph.D., reported at the annual meeting of the Society of Behavioral Medicine.

In a subanalysis of the Chronicle Offers Management to Patients With Advanced Signs and Symptoms of Heart Failure (COMPASS-HF) trial, 661 smokers with a baseline history of depression, or a risk of depression, were monitored for mood changes and compared with 516 nondepressed smokers during their 12-week course of varenicline (Chantix) combined with behavioral smoking-cessation counseling (J. Gen. Intern. Med. 2009;24:563-9).

“We think that physicians should continue to closely monitor patients who are using varenicline, particularly if they have a psychiatric history,” she said.

Although people with a history of depression were more likely than nondepressed people to report side effects with the medication, “we didn't find an overall difference in their qualitative symptom experience or treatment outcomes,” said Dr. McClure, who is affiliated with Group Health Center for Health Studies, Seattle.

The study, funded by the National Cancer Institute, was a collaborative effort between Group Health; Free & Clear Inc., Seattle; and SRI International, an independent, nonprofit, research and development organization in Menlo Park, Calif. Medication was provided by Pfizer Inc., manufacturer of varenicline.

Varenicline was approved by the Food and Drug Administration about 3 years ago. It works by blocking nicotinic receptors and thus the rewarding effects of nicotine, while stimulating some dopamine release in order to provide relief from craving and withdrawal, Dr. McClure said.

Shortly after its release to market, the FDA raised concerns that varenicline might be associated with increased neuropsychiatric symptoms, including depressed mood, agitation, suicidal ideation, and behavior—particularly in people with a psychiatric history, she said.

“Unfortunately, due to the nature of the reports to the FDA, we are not able to determine if varenicline itself was the cause of the symptoms reported—it's possible they were due to nicotine withdrawal, substance use, the psychiatric conditions themselves, or some other factors. Unfortunately, subjects with a psychiatric history were excluded from the original efficacy trials.”

Research shows that between one- and two-thirds of smokers have a history of depression, and that smokers with a history of depression report more symptoms of nicotine withdrawal, have more negative affect after they quit, and have higher relapse rates, compared with nondepressed smokers, she added.

“But because varenicline does stimulate some release of dopamine, it's possible that it might ameliorate some of this negative effect and other side effects, and so prevent relapse.”

At baseline, the subjects in the study were screened briefly for symptoms of depression. “We didn't do an in-depth clinical interview. We just looked for the hallmark symptoms by asking: 'Have you ever, for a 2-week period or more, felt down, depressed, or hopeless, or had little interest or pleasure in doing things?'” she said.

Depressed and nondepressed subjects had similar nonsmoking rates at 21 days (49% vs. 47%, respectively) and 3 months (45% vs. 43%, respectively). However, depressed patients were more likely to report depression, anxiety, tension, agitation, difficulty concentrating and sleeping, and confusion. Depressed patients also were more likely to report other known side effects of the medication. However, despite this, negative affect actually declined in both groups, Dr. McClure said. One case of suicidal ideation was reported in a subject with undisclosed, untreated bipolar disorder.

Additional research is necessary in order to more fully tease out the safety and effectiveness of varenicline among psychologically vulnerable populations, she concluded.

Dr. McClure said she had no conflicts to disclose in connection with this study.

MONTREAL — Despite postmarketing concerns about the psychiatric side effects of varenicline for smoking cessation, the medication appears to be safe in patients who are depressed or at risk for depression, Jennifer B. McClure, Ph.D., reported at the annual meeting of the Society of Behavioral Medicine.

In a subanalysis of the Chronicle Offers Management to Patients With Advanced Signs and Symptoms of Heart Failure (COMPASS-HF) trial, 661 smokers with a baseline history of depression, or a risk of depression, were monitored for mood changes and compared with 516 nondepressed smokers during their 12-week course of varenicline (Chantix) combined with behavioral smoking-cessation counseling (J. Gen. Intern. Med. 2009;24:563-9).

“We think that physicians should continue to closely monitor patients who are using varenicline, particularly if they have a psychiatric history,” she said.

Although people with a history of depression were more likely than nondepressed people to report side effects with the medication, “we didn't find an overall difference in their qualitative symptom experience or treatment outcomes,” said Dr. McClure, who is affiliated with Group Health Center for Health Studies, Seattle.

The study, funded by the National Cancer Institute, was a collaborative effort between Group Health; Free & Clear Inc., Seattle; and SRI International, an independent, nonprofit, research and development organization in Menlo Park, Calif. Medication was provided by Pfizer Inc., manufacturer of varenicline.

Varenicline was approved by the Food and Drug Administration about 3 years ago. It works by blocking nicotinic receptors and thus the rewarding effects of nicotine, while stimulating some dopamine release in order to provide relief from craving and withdrawal, Dr. McClure said.

Shortly after its release to market, the FDA raised concerns that varenicline might be associated with increased neuropsychiatric symptoms, including depressed mood, agitation, suicidal ideation, and behavior—particularly in people with a psychiatric history, she said.

“Unfortunately, due to the nature of the reports to the FDA, we are not able to determine if varenicline itself was the cause of the symptoms reported—it's possible they were due to nicotine withdrawal, substance use, the psychiatric conditions themselves, or some other factors. Unfortunately, subjects with a psychiatric history were excluded from the original efficacy trials.”

Research shows that between one- and two-thirds of smokers have a history of depression, and that smokers with a history of depression report more symptoms of nicotine withdrawal, have more negative affect after they quit, and have higher relapse rates, compared with nondepressed smokers, she added.

“But because varenicline does stimulate some release of dopamine, it's possible that it might ameliorate some of this negative effect and other side effects, and so prevent relapse.”

At baseline, the subjects in the study were screened briefly for symptoms of depression. “We didn't do an in-depth clinical interview. We just looked for the hallmark symptoms by asking: 'Have you ever, for a 2-week period or more, felt down, depressed, or hopeless, or had little interest or pleasure in doing things?'” she said.

Depressed and nondepressed subjects had similar nonsmoking rates at 21 days (49% vs. 47%, respectively) and 3 months (45% vs. 43%, respectively). However, depressed patients were more likely to report depression, anxiety, tension, agitation, difficulty concentrating and sleeping, and confusion. Depressed patients also were more likely to report other known side effects of the medication. However, despite this, negative affect actually declined in both groups, Dr. McClure said. One case of suicidal ideation was reported in a subject with undisclosed, untreated bipolar disorder.

Additional research is necessary in order to more fully tease out the safety and effectiveness of varenicline among psychologically vulnerable populations, she concluded.

Dr. McClure said she had no conflicts to disclose in connection with this study.

MONTREAL — Despite postmarketing concerns about the psychiatric side effects of varenicline for smoking cessation, the medication appears to be safe in patients who are depressed or at risk for depression, Jennifer B. McClure, Ph.D., reported at the annual meeting of the Society of Behavioral Medicine.

In a subanalysis of the Chronicle Offers Management to Patients With Advanced Signs and Symptoms of Heart Failure (COMPASS-HF) trial, 661 smokers with a baseline history of depression, or a risk of depression, were monitored for mood changes and compared with 516 nondepressed smokers during their 12-week course of varenicline (Chantix) combined with behavioral smoking-cessation counseling (J. Gen. Intern. Med. 2009;24:563-9).

“We think that physicians should continue to closely monitor patients who are using varenicline, particularly if they have a psychiatric history,” she said.

Although people with a history of depression were more likely than nondepressed people to report side effects with the medication, “we didn't find an overall difference in their qualitative symptom experience or treatment outcomes,” said Dr. McClure, who is affiliated with Group Health Center for Health Studies, Seattle.

The study, funded by the National Cancer Institute, was a collaborative effort between Group Health; Free & Clear Inc., Seattle; and SRI International, an independent, nonprofit, research and development organization in Menlo Park, Calif. Medication was provided by Pfizer Inc., manufacturer of varenicline.

Varenicline was approved by the Food and Drug Administration about 3 years ago. It works by blocking nicotinic receptors and thus the rewarding effects of nicotine, while stimulating some dopamine release in order to provide relief from craving and withdrawal, Dr. McClure said.

Shortly after its release to market, the FDA raised concerns that varenicline might be associated with increased neuropsychiatric symptoms, including depressed mood, agitation, suicidal ideation, and behavior—particularly in people with a psychiatric history, she said.

“Unfortunately, due to the nature of the reports to the FDA, we are not able to determine if varenicline itself was the cause of the symptoms reported—it's possible they were due to nicotine withdrawal, substance use, the psychiatric conditions themselves, or some other factors. Unfortunately, subjects with a psychiatric history were excluded from the original efficacy trials.”

Research shows that between one- and two-thirds of smokers have a history of depression, and that smokers with a history of depression report more symptoms of nicotine withdrawal, have more negative affect after they quit, and have higher relapse rates, compared with nondepressed smokers, she added.

“But because varenicline does stimulate some release of dopamine, it's possible that it might ameliorate some of this negative effect and other side effects, and so prevent relapse.”

At baseline, the subjects in the study were screened briefly for symptoms of depression. “We didn't do an in-depth clinical interview. We just looked for the hallmark symptoms by asking: 'Have you ever, for a 2-week period or more, felt down, depressed, or hopeless, or had little interest or pleasure in doing things?'” she said.

Depressed and nondepressed subjects had similar nonsmoking rates at 21 days (49% vs. 47%, respectively) and 3 months (45% vs. 43%, respectively). However, depressed patients were more likely to report depression, anxiety, tension, agitation, difficulty concentrating and sleeping, and confusion. Depressed patients also were more likely to report other known side effects of the medication. However, despite this, negative affect actually declined in both groups, Dr. McClure said. One case of suicidal ideation was reported in a subject with undisclosed, untreated bipolar disorder.

Additional research is necessary in order to more fully tease out the safety and effectiveness of varenicline among psychologically vulnerable populations, she concluded.

Dr. McClure said she had no conflicts to disclose in connection with this study.

MONTREAL — A twice-daily dose of celecoxib given over a period of 9 months was associated with a 60% reduction in the incidence of nonmelanoma skin cancer, according to the results of a new study.

“Inhibition of COX-2 is an effective means of limiting the development of cutaneous squamous and basal cell carcinomas in humans,” said Dr. Craig Elmets at the annual meeting of the Society for Investigative Dermatology.

The findings suggest that pharmaceutical agents such as celecoxib may offer greater protection against skin cancer than do sunscreens, which are only “modestly effective,” said Dr. Elmets, professor and chair of the department of dermatology and director of the Skin Disease Research Center at the University of Alabama, Birmingham. “There's only about a 35% reduction in squamous cell carcinomas when sunscreens are used on a regular basis over a 5-year period of time, and there's no reduction in basal cell carcinomas.”

The multicenter, randomized, placebo-controlled study was funded by the National Cancer Institute and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, with additional funding from Pfizer through a contractual agreement with the National Institutes of Health, he said. Dr. Elmets did not disclose any personal conflicts of interest.

The study enrolled 238 patients with nonmelanoma skin cancers from eight U.S. centers. The mean age of the patients was 65 years, most were male, and virtually all were white.

“The study was terminated somewhat early because of concerns of cardiovascular effects due to another COX-2 inhibitor,” he noted.

Subjects in the study had Fitzpatrick skin types I-III, extensive actinic damage with 10-40 actinic keratoses (AKs), and a prior histologic diagnosis of either AK or nonmelanoma skin cancer. Subjects were excluded if they required treatment with NSAIDs, although cardioprotective doses of aspirin were allowed.

At entry, patients had a mean number of 22 AKs, and between 2.1 and 2.5 nonmelanoma skin cancers, he said.

Patients were randomized to either placebo or celecoxib 200 mg twice daily, which is the approved dosage for arthritis, Dr. Elmets said. “We were concerned about cardiovascular abnormalities and GI abnormalities, and if anything there was a bias towards patients in the celecoxib group having a prior history of that.”

A comparison of the number of AKs at baseline and completion showed a lack of effect of celecoxib, compared with placebo, he noted. However, the development of new cutaneous basal and squamous cell carcinomas was much reduced. “We were delighted to find that celecoxib was quite effective, with a 58% reduction compared to placebo-treated controls,” he said.

If the two types of lesions are considered separately, celecoxib treatment led to a 58% reduction in squamous cell carcinoma (SCC), and a 62% reduction in basal cell carcinoma (BCC).

“The difference between the [placebo and treated] groups started to become apparent quite rapidly, at 3 months, and persisted throughout the study. We were concerned that there might be one or two outliers that were skewing the results, so rather than looking at the total number of skin cancers, we also looked at the number of individuals who developed BCC or SCC or both. Again we found that patients with celecoxib had fewer BCCs and SCCs than the placebo group.”

There were no differences in adverse events including cardiovascular adverse events between the two groups, Dr. Elmets reported. During the question period, he acknowledged that there were higher blood pressures reported in the treatment group.

The data are “very compelling,” commented Dr. Maryam Asgari of Kaiser Permanente in Oakland, Calif., in an interview. But she suggested perhaps the study was too short to have such dramatic conclusions. “I know that typically for most cancers you would need a study to last 2-5 years before you would expect to measure an effect,” she said. Similarly, adverse events from COX-2 inhibitors would likely need longer to develop.

Dr. Asgari said her research in the same field has produced the opposite results. Her study found no protective effect for all NSAIDs—both selective and nonselective COX inhibitors—on the incidence of squamous cell carcinoma. A previous paper published by her group also found no protective effect of these drugs on melanomas (J. Natl. Cancer Inst. 2008;100:967-71).

Celecoxib's lack of effect on AKs is a puzzling result, she added. “You would think that if COX-2 inhibitors are working to prevent new cancers from arising that they would also have a pretty dramatic effect on actinic keratoses because they both share the same pathway.”

Finally, patients in the COX-2 study were allowed to take cardioprotective doses of aspirin—an important factor that the analysis did not adjust for, she pointed out. “Even low-dose aspirin inhibits COX, and it could just be that the people in the treatment arm were much more likely to be on aspirin as well.”

MONTREAL — A twice-daily dose of celecoxib given over a period of 9 months was associated with a 60% reduction in the incidence of nonmelanoma skin cancer, according to the results of a new study.

“Inhibition of COX-2 is an effective means of limiting the development of cutaneous squamous and basal cell carcinomas in humans,” said Dr. Craig Elmets at the annual meeting of the Society for Investigative Dermatology.

The findings suggest that pharmaceutical agents such as celecoxib may offer greater protection against skin cancer than do sunscreens, which are only “modestly effective,” said Dr. Elmets, professor and chair of the department of dermatology and director of the Skin Disease Research Center at the University of Alabama, Birmingham. “There's only about a 35% reduction in squamous cell carcinomas when sunscreens are used on a regular basis over a 5-year period of time, and there's no reduction in basal cell carcinomas.”

The multicenter, randomized, placebo-controlled study was funded by the National Cancer Institute and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, with additional funding from Pfizer through a contractual agreement with the National Institutes of Health, he said. Dr. Elmets did not disclose any personal conflicts of interest.

The study enrolled 238 patients with nonmelanoma skin cancers from eight U.S. centers. The mean age of the patients was 65 years, most were male, and virtually all were white.

“The study was terminated somewhat early because of concerns of cardiovascular effects due to another COX-2 inhibitor,” he noted.

Subjects in the study had Fitzpatrick skin types I-III, extensive actinic damage with 10-40 actinic keratoses (AKs), and a prior histologic diagnosis of either AK or nonmelanoma skin cancer. Subjects were excluded if they required treatment with NSAIDs, although cardioprotective doses of aspirin were allowed.

At entry, patients had a mean number of 22 AKs, and between 2.1 and 2.5 nonmelanoma skin cancers, he said.

Patients were randomized to either placebo or celecoxib 200 mg twice daily, which is the approved dosage for arthritis, Dr. Elmets said. “We were concerned about cardiovascular abnormalities and GI abnormalities, and if anything there was a bias towards patients in the celecoxib group having a prior history of that.”

A comparison of the number of AKs at baseline and completion showed a lack of effect of celecoxib, compared with placebo, he noted. However, the development of new cutaneous basal and squamous cell carcinomas was much reduced. “We were delighted to find that celecoxib was quite effective, with a 58% reduction compared to placebo-treated controls,” he said.

If the two types of lesions are considered separately, celecoxib treatment led to a 58% reduction in squamous cell carcinoma (SCC), and a 62% reduction in basal cell carcinoma (BCC).

“The difference between the [placebo and treated] groups started to become apparent quite rapidly, at 3 months, and persisted throughout the study. We were concerned that there might be one or two outliers that were skewing the results, so rather than looking at the total number of skin cancers, we also looked at the number of individuals who developed BCC or SCC or both. Again we found that patients with celecoxib had fewer BCCs and SCCs than the placebo group.”

There were no differences in adverse events including cardiovascular adverse events between the two groups, Dr. Elmets reported. During the question period, he acknowledged that there were higher blood pressures reported in the treatment group.

The data are “very compelling,” commented Dr. Maryam Asgari of Kaiser Permanente in Oakland, Calif., in an interview. But she suggested perhaps the study was too short to have such dramatic conclusions. “I know that typically for most cancers you would need a study to last 2-5 years before you would expect to measure an effect,” she said. Similarly, adverse events from COX-2 inhibitors would likely need longer to develop.

Dr. Asgari said her research in the same field has produced the opposite results. Her study found no protective effect for all NSAIDs—both selective and nonselective COX inhibitors—on the incidence of squamous cell carcinoma. A previous paper published by her group also found no protective effect of these drugs on melanomas (J. Natl. Cancer Inst. 2008;100:967-71).

Celecoxib's lack of effect on AKs is a puzzling result, she added. “You would think that if COX-2 inhibitors are working to prevent new cancers from arising that they would also have a pretty dramatic effect on actinic keratoses because they both share the same pathway.”

Finally, patients in the COX-2 study were allowed to take cardioprotective doses of aspirin—an important factor that the analysis did not adjust for, she pointed out. “Even low-dose aspirin inhibits COX, and it could just be that the people in the treatment arm were much more likely to be on aspirin as well.”

MONTREAL — A twice-daily dose of celecoxib given over a period of 9 months was associated with a 60% reduction in the incidence of nonmelanoma skin cancer, according to the results of a new study.

“Inhibition of COX-2 is an effective means of limiting the development of cutaneous squamous and basal cell carcinomas in humans,” said Dr. Craig Elmets at the annual meeting of the Society for Investigative Dermatology.

The findings suggest that pharmaceutical agents such as celecoxib may offer greater protection against skin cancer than do sunscreens, which are only “modestly effective,” said Dr. Elmets, professor and chair of the department of dermatology and director of the Skin Disease Research Center at the University of Alabama, Birmingham. “There's only about a 35% reduction in squamous cell carcinomas when sunscreens are used on a regular basis over a 5-year period of time, and there's no reduction in basal cell carcinomas.”

The multicenter, randomized, placebo-controlled study was funded by the National Cancer Institute and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, with additional funding from Pfizer through a contractual agreement with the National Institutes of Health, he said. Dr. Elmets did not disclose any personal conflicts of interest.

The study enrolled 238 patients with nonmelanoma skin cancers from eight U.S. centers. The mean age of the patients was 65 years, most were male, and virtually all were white.

“The study was terminated somewhat early because of concerns of cardiovascular effects due to another COX-2 inhibitor,” he noted.

Subjects in the study had Fitzpatrick skin types I-III, extensive actinic damage with 10-40 actinic keratoses (AKs), and a prior histologic diagnosis of either AK or nonmelanoma skin cancer. Subjects were excluded if they required treatment with NSAIDs, although cardioprotective doses of aspirin were allowed.

At entry, patients had a mean number of 22 AKs, and between 2.1 and 2.5 nonmelanoma skin cancers, he said.

Patients were randomized to either placebo or celecoxib 200 mg twice daily, which is the approved dosage for arthritis, Dr. Elmets said. “We were concerned about cardiovascular abnormalities and GI abnormalities, and if anything there was a bias towards patients in the celecoxib group having a prior history of that.”

A comparison of the number of AKs at baseline and completion showed a lack of effect of celecoxib, compared with placebo, he noted. However, the development of new cutaneous basal and squamous cell carcinomas was much reduced. “We were delighted to find that celecoxib was quite effective, with a 58% reduction compared to placebo-treated controls,” he said.

If the two types of lesions are considered separately, celecoxib treatment led to a 58% reduction in squamous cell carcinoma (SCC), and a 62% reduction in basal cell carcinoma (BCC).

“The difference between the [placebo and treated] groups started to become apparent quite rapidly, at 3 months, and persisted throughout the study. We were concerned that there might be one or two outliers that were skewing the results, so rather than looking at the total number of skin cancers, we also looked at the number of individuals who developed BCC or SCC or both. Again we found that patients with celecoxib had fewer BCCs and SCCs than the placebo group.”

There were no differences in adverse events including cardiovascular adverse events between the two groups, Dr. Elmets reported. During the question period, he acknowledged that there were higher blood pressures reported in the treatment group.

The data are “very compelling,” commented Dr. Maryam Asgari of Kaiser Permanente in Oakland, Calif., in an interview. But she suggested perhaps the study was too short to have such dramatic conclusions. “I know that typically for most cancers you would need a study to last 2-5 years before you would expect to measure an effect,” she said. Similarly, adverse events from COX-2 inhibitors would likely need longer to develop.

Dr. Asgari said her research in the same field has produced the opposite results. Her study found no protective effect for all NSAIDs—both selective and nonselective COX inhibitors—on the incidence of squamous cell carcinoma. A previous paper published by her group also found no protective effect of these drugs on melanomas (J. Natl. Cancer Inst. 2008;100:967-71).

Celecoxib's lack of effect on AKs is a puzzling result, she added. “You would think that if COX-2 inhibitors are working to prevent new cancers from arising that they would also have a pretty dramatic effect on actinic keratoses because they both share the same pathway.”

Finally, patients in the COX-2 study were allowed to take cardioprotective doses of aspirin—an important factor that the analysis did not adjust for, she pointed out. “Even low-dose aspirin inhibits COX, and it could just be that the people in the treatment arm were much more likely to be on aspirin as well.”

MONTREAL — Although the prevalence of human papillomavirus is similar among females and males, physicians will need to be careful about promoting a vaccine that specifically targets men, according to a survey of male college students.

Efficacy trials suggest that the Gardasil HPV vaccine, which is currently approved for females only, is efficacious in males, and it could be approved for this population as early as the fall, said Mary Gerend, Ph.D., of Florida State University, Tallahassee.

However, her study of 221 young males suggests that their attitudes about the acceptability of the vaccine are only slightly positive, and depend partly on what it is called. On a scale of 1 (unlikely) to 6 (very likely) they indicated a 3.6 level of interest in receiving the vaccine, she reported.

"Marketing it as 'the cervical cancer' vaccine may not be the most effective strategy for this group," she said at the annual meeting of the Society of Behavioral Medicine.

The men in her group were aged 18–26 years, and 96% of them were heterosexual. Although only 47% had a current partner, 81% indicated that they had had sexual intercourse. The group reported a mean of 4.8 lifetime partners (range 0–34).

"Younger men were more interested, as were gay and bisexual men," Dr. Gerend said, adding that other predictors of interest were having already had sex, having a current partner, and ever being tested for a sexually transmitted infection.

Regarding a potential name for the vaccine, most of the group (76%) said they preferred "Gardasil" or "the HPV vaccine."

In a separate study of 356 heterosexual male college students, Dr. Gerend found that emphasizing the benefits of vaccination for a man's partner versus the personal benefits did not boost interest in vaccination (Sex. Transm. Dis. 2009;36:58-62).

Dr. Gerend did not disclose any conflicts of interest.

MONTREAL — Although the prevalence of human papillomavirus is similar among females and males, physicians will need to be careful about promoting a vaccine that specifically targets men, according to a survey of male college students.

Efficacy trials suggest that the Gardasil HPV vaccine, which is currently approved for females only, is efficacious in males, and it could be approved for this population as early as the fall, said Mary Gerend, Ph.D., of Florida State University, Tallahassee.

However, her study of 221 young males suggests that their attitudes about the acceptability of the vaccine are only slightly positive, and depend partly on what it is called. On a scale of 1 (unlikely) to 6 (very likely) they indicated a 3.6 level of interest in receiving the vaccine, she reported.

"Marketing it as 'the cervical cancer' vaccine may not be the most effective strategy for this group," she said at the annual meeting of the Society of Behavioral Medicine.

The men in her group were aged 18–26 years, and 96% of them were heterosexual. Although only 47% had a current partner, 81% indicated that they had had sexual intercourse. The group reported a mean of 4.8 lifetime partners (range 0–34).

"Younger men were more interested, as were gay and bisexual men," Dr. Gerend said, adding that other predictors of interest were having already had sex, having a current partner, and ever being tested for a sexually transmitted infection.

Regarding a potential name for the vaccine, most of the group (76%) said they preferred "Gardasil" or "the HPV vaccine."

In a separate study of 356 heterosexual male college students, Dr. Gerend found that emphasizing the benefits of vaccination for a man's partner versus the personal benefits did not boost interest in vaccination (Sex. Transm. Dis. 2009;36:58-62).

Dr. Gerend did not disclose any conflicts of interest.

MONTREAL — Although the prevalence of human papillomavirus is similar among females and males, physicians will need to be careful about promoting a vaccine that specifically targets men, according to a survey of male college students.

Efficacy trials suggest that the Gardasil HPV vaccine, which is currently approved for females only, is efficacious in males, and it could be approved for this population as early as the fall, said Mary Gerend, Ph.D., of Florida State University, Tallahassee.

However, her study of 221 young males suggests that their attitudes about the acceptability of the vaccine are only slightly positive, and depend partly on what it is called. On a scale of 1 (unlikely) to 6 (very likely) they indicated a 3.6 level of interest in receiving the vaccine, she reported.

"Marketing it as 'the cervical cancer' vaccine may not be the most effective strategy for this group," she said at the annual meeting of the Society of Behavioral Medicine.

The men in her group were aged 18–26 years, and 96% of them were heterosexual. Although only 47% had a current partner, 81% indicated that they had had sexual intercourse. The group reported a mean of 4.8 lifetime partners (range 0–34).

"Younger men were more interested, as were gay and bisexual men," Dr. Gerend said, adding that other predictors of interest were having already had sex, having a current partner, and ever being tested for a sexually transmitted infection.

Regarding a potential name for the vaccine, most of the group (76%) said they preferred "Gardasil" or "the HPV vaccine."

In a separate study of 356 heterosexual male college students, Dr. Gerend found that emphasizing the benefits of vaccination for a man's partner versus the personal benefits did not boost interest in vaccination (Sex. Transm. Dis. 2009;36:58-62).

Dr. Gerend did not disclose any conflicts of interest.

A new report from the National Survey on Drug Use and Health provides data on the prevalence of past-year depression among veterans aged 21–39.

An estimated 25%-30% of veterans of the wars in Iraq and Afghanistan have reported symptoms of a mental disorder or cognitive condition. The report is at www.oas.samhsa.gov/2k8/veteransDepressed/veteransDepressed.htm

A new report from the National Survey on Drug Use and Health provides data on the prevalence of past-year depression among veterans aged 21–39.

An estimated 25%-30% of veterans of the wars in Iraq and Afghanistan have reported symptoms of a mental disorder or cognitive condition. The report is at www.oas.samhsa.gov/2k8/veteransDepressed/veteransDepressed.htm

A new report from the National Survey on Drug Use and Health provides data on the prevalence of past-year depression among veterans aged 21–39.

An estimated 25%-30% of veterans of the wars in Iraq and Afghanistan have reported symptoms of a mental disorder or cognitive condition. The report is at www.oas.samhsa.gov/2k8/veteransDepressed/veteransDepressed.htm

MONTREAL — Suicide screening can be done quickly and easily for veterans attending routine primary care visits, according to Hani Shabana, Ph.D., of the Veterans Affairs Medical Center in Salem, Va.

“Primary care is a largely untapped resource” for suicide prevention in this population, he said, noting evidence that many suicides are completed within days of a primary care visit.

“Many veterans are prone to things like chronic pain, posttraumatic stress syndrome, and depression, and there is a push within Veterans Affairs to get mental health providers integrated into the primary care setting,” he said at the annual meeting of the Society of Behavioral Medicine.

Evidence from the Centers for Disease Control and Prevention suggests that up to 20% of all suicides are completed by veterans, a group that is highly trained with guns and that has access to other lethal weapons, he said.

A review of 40 published studies confirms that contact with a primary care provider is much more common than contact with mental health services prior to completed suicide. About 45% of people in the study had visited a primary care provider within 1 month of their suicide; 20% had seen a mental health specialist. Older individuals had higher rates of contact with a primary care provider, compared with younger people (Am. J. Psychiatry 2002;159:909–16).

An increase in suicide rates among veterans prompted Dr. Shabana's hospital to establish a primary care screening program that captures every veteran at the institution who has not been seen by primary care within the previous 2 weeks.

At intake, nursing staff ask one simple question: “In the past 2 weeks, have you had urges to harm yourself or others?” A positive answer triggers a thorough assessment with either a primary care or mental health provider at the hospital. “We assess risk factors, social/demographic factors, current life stressors, and protective factors to come up with an overall assessment of whether they are at low, moderate, or high risk for suicide,” he said.

Among a group of veterans who screened positive for the initial intake question, 177 were being seen by a mental health provider, 62 had received mental health treatment previously, and 159 had never been treated.

Data on these veterans showed that 110 were prescribed mental health treatment, 118 were referred to specialty treatment for things such as substance abuse or posttraumatic stress syndrome, 29 were followed by a primary care physician, 31 were followed by a mental health expert, 43 declined help, and 7 were hospitalized. Among the 118 referred for specialty treatment, 63% had never been offered help before, Dr. Shabana said.

“We are pretty excited about this last group because we are always looking for people who are floating around the system who need help but haven't been getting it,” he said. The beauty of the screening model is that it is simple and effective, he explained.

There are reduced barriers to access because of the simple handoff from the intake nurse to a primary care or mental health provider, and there is no obligation to see a mental health expert.

“Some veterans get squeamish about mental health and so for them to have a relationship with their primary care provider is easier, and sometimes helps ease them over to [receiving care from] a mental health expert.

MONTREAL — Suicide screening can be done quickly and easily for veterans attending routine primary care visits, according to Hani Shabana, Ph.D., of the Veterans Affairs Medical Center in Salem, Va.

“Primary care is a largely untapped resource” for suicide prevention in this population, he said, noting evidence that many suicides are completed within days of a primary care visit.

“Many veterans are prone to things like chronic pain, posttraumatic stress syndrome, and depression, and there is a push within Veterans Affairs to get mental health providers integrated into the primary care setting,” he said at the annual meeting of the Society of Behavioral Medicine.

Evidence from the Centers for Disease Control and Prevention suggests that up to 20% of all suicides are completed by veterans, a group that is highly trained with guns and that has access to other lethal weapons, he said.

A review of 40 published studies confirms that contact with a primary care provider is much more common than contact with mental health services prior to completed suicide. About 45% of people in the study had visited a primary care provider within 1 month of their suicide; 20% had seen a mental health specialist. Older individuals had higher rates of contact with a primary care provider, compared with younger people (Am. J. Psychiatry 2002;159:909–16).

An increase in suicide rates among veterans prompted Dr. Shabana's hospital to establish a primary care screening program that captures every veteran at the institution who has not been seen by primary care within the previous 2 weeks.

At intake, nursing staff ask one simple question: “In the past 2 weeks, have you had urges to harm yourself or others?” A positive answer triggers a thorough assessment with either a primary care or mental health provider at the hospital. “We assess risk factors, social/demographic factors, current life stressors, and protective factors to come up with an overall assessment of whether they are at low, moderate, or high risk for suicide,” he said.

Among a group of veterans who screened positive for the initial intake question, 177 were being seen by a mental health provider, 62 had received mental health treatment previously, and 159 had never been treated.

Data on these veterans showed that 110 were prescribed mental health treatment, 118 were referred to specialty treatment for things such as substance abuse or posttraumatic stress syndrome, 29 were followed by a primary care physician, 31 were followed by a mental health expert, 43 declined help, and 7 were hospitalized. Among the 118 referred for specialty treatment, 63% had never been offered help before, Dr. Shabana said.

“We are pretty excited about this last group because we are always looking for people who are floating around the system who need help but haven't been getting it,” he said. The beauty of the screening model is that it is simple and effective, he explained.

There are reduced barriers to access because of the simple handoff from the intake nurse to a primary care or mental health provider, and there is no obligation to see a mental health expert.

“Some veterans get squeamish about mental health and so for them to have a relationship with their primary care provider is easier, and sometimes helps ease them over to [receiving care from] a mental health expert.

MONTREAL — Suicide screening can be done quickly and easily for veterans attending routine primary care visits, according to Hani Shabana, Ph.D., of the Veterans Affairs Medical Center in Salem, Va.

“Primary care is a largely untapped resource” for suicide prevention in this population, he said, noting evidence that many suicides are completed within days of a primary care visit.

“Many veterans are prone to things like chronic pain, posttraumatic stress syndrome, and depression, and there is a push within Veterans Affairs to get mental health providers integrated into the primary care setting,” he said at the annual meeting of the Society of Behavioral Medicine.

Evidence from the Centers for Disease Control and Prevention suggests that up to 20% of all suicides are completed by veterans, a group that is highly trained with guns and that has access to other lethal weapons, he said.

A review of 40 published studies confirms that contact with a primary care provider is much more common than contact with mental health services prior to completed suicide. About 45% of people in the study had visited a primary care provider within 1 month of their suicide; 20% had seen a mental health specialist. Older individuals had higher rates of contact with a primary care provider, compared with younger people (Am. J. Psychiatry 2002;159:909–16).

An increase in suicide rates among veterans prompted Dr. Shabana's hospital to establish a primary care screening program that captures every veteran at the institution who has not been seen by primary care within the previous 2 weeks.

At intake, nursing staff ask one simple question: “In the past 2 weeks, have you had urges to harm yourself or others?” A positive answer triggers a thorough assessment with either a primary care or mental health provider at the hospital. “We assess risk factors, social/demographic factors, current life stressors, and protective factors to come up with an overall assessment of whether they are at low, moderate, or high risk for suicide,” he said.

Among a group of veterans who screened positive for the initial intake question, 177 were being seen by a mental health provider, 62 had received mental health treatment previously, and 159 had never been treated.

Data on these veterans showed that 110 were prescribed mental health treatment, 118 were referred to specialty treatment for things such as substance abuse or posttraumatic stress syndrome, 29 were followed by a primary care physician, 31 were followed by a mental health expert, 43 declined help, and 7 were hospitalized. Among the 118 referred for specialty treatment, 63% had never been offered help before, Dr. Shabana said.

“We are pretty excited about this last group because we are always looking for people who are floating around the system who need help but haven't been getting it,” he said. The beauty of the screening model is that it is simple and effective, he explained.

There are reduced barriers to access because of the simple handoff from the intake nurse to a primary care or mental health provider, and there is no obligation to see a mental health expert.

“Some veterans get squeamish about mental health and so for them to have a relationship with their primary care provider is easier, and sometimes helps ease them over to [receiving care from] a mental health expert.

MONTREAL — Major depression is associated with a twofold increase in the risk of incident diabetic foot ulcers, according to the results of a large, prospective, population-based cohort study.

The findings suggest strong benefits in screening for and treating depression to prevent this complication, said Dr. Lisa Williams, of the department of dermatology at the University of Washington, Seattle.

“Depression is twice as common in patients with diabetes,” she said at the annual meeting of the Society for Investigative Dermatology. “At any one time, 11%-12% of patients with diabetes have major depression, and 31% have significant depressive symptoms.”

Until now, it has not been known whether depression increases the incidence of diabetic foot ulcers. However, it is known that “depression is associated with more severe and larger diabetic foot ulcers, and poor healing and recurrence. Depression is also associated with a threefold increase in mortality rate among patients with their first foot ulcer,” she said.

Her study, funded by the National Institute of Mental Health, included 3,474 patients from the Pathways Epidemiologic Study, a prospective cohort of primary care diabetes patients from nine clinics in western Washington State.

Major and minor depression were assessed using the Patient Health Questionnaire (PHQ-9), and there was a mean follow-up of about 4 years. New-onset foot ulcers were assessed during the course of the study, using ICD-9 codes.

There were 401 diagnoses of major and 290 diagnoses of minor depression in the cohort, and 121 incident foot ulcers, said Dr. Williams, who reported no conflicts of interest.

Compared with patients with no depression, Dr. Williams and her coinvestigators found a significant increase in the risk of foot ulcers in patients with major, but not minor, depression (hazard ratios, 2.0 and 1.3, respectively).

There was no difference between depressed and nondepressed patients in foot self-care. However, previous research has shown that depression in patients with diabetes is associated with poor self-care, as well as hyperglycemia, smoking, and obesity, she said. “In our study, we found that compared with nondepressed patients, depressed patients were older, unmarried, had [a higher BMI], were more likely to smoke, and had more diabetes complications.

MONTREAL — Major depression is associated with a twofold increase in the risk of incident diabetic foot ulcers, according to the results of a large, prospective, population-based cohort study.

The findings suggest strong benefits in screening for and treating depression to prevent this complication, said Dr. Lisa Williams, of the department of dermatology at the University of Washington, Seattle.

“Depression is twice as common in patients with diabetes,” she said at the annual meeting of the Society for Investigative Dermatology. “At any one time, 11%-12% of patients with diabetes have major depression, and 31% have significant depressive symptoms.”

Until now, it has not been known whether depression increases the incidence of diabetic foot ulcers. However, it is known that “depression is associated with more severe and larger diabetic foot ulcers, and poor healing and recurrence. Depression is also associated with a threefold increase in mortality rate among patients with their first foot ulcer,” she said.

Her study, funded by the National Institute of Mental Health, included 3,474 patients from the Pathways Epidemiologic Study, a prospective cohort of primary care diabetes patients from nine clinics in western Washington State.

Major and minor depression were assessed using the Patient Health Questionnaire (PHQ-9), and there was a mean follow-up of about 4 years. New-onset foot ulcers were assessed during the course of the study, using ICD-9 codes.

There were 401 diagnoses of major and 290 diagnoses of minor depression in the cohort, and 121 incident foot ulcers, said Dr. Williams, who reported no conflicts of interest.

Compared with patients with no depression, Dr. Williams and her coinvestigators found a significant increase in the risk of foot ulcers in patients with major, but not minor, depression (hazard ratios, 2.0 and 1.3, respectively).

There was no difference between depressed and nondepressed patients in foot self-care. However, previous research has shown that depression in patients with diabetes is associated with poor self-care, as well as hyperglycemia, smoking, and obesity, she said. “In our study, we found that compared with nondepressed patients, depressed patients were older, unmarried, had [a higher BMI], were more likely to smoke, and had more diabetes complications.

MONTREAL — Major depression is associated with a twofold increase in the risk of incident diabetic foot ulcers, according to the results of a large, prospective, population-based cohort study.

The findings suggest strong benefits in screening for and treating depression to prevent this complication, said Dr. Lisa Williams, of the department of dermatology at the University of Washington, Seattle.

“Depression is twice as common in patients with diabetes,” she said at the annual meeting of the Society for Investigative Dermatology. “At any one time, 11%-12% of patients with diabetes have major depression, and 31% have significant depressive symptoms.”

Until now, it has not been known whether depression increases the incidence of diabetic foot ulcers. However, it is known that “depression is associated with more severe and larger diabetic foot ulcers, and poor healing and recurrence. Depression is also associated with a threefold increase in mortality rate among patients with their first foot ulcer,” she said.

Her study, funded by the National Institute of Mental Health, included 3,474 patients from the Pathways Epidemiologic Study, a prospective cohort of primary care diabetes patients from nine clinics in western Washington State.

Major and minor depression were assessed using the Patient Health Questionnaire (PHQ-9), and there was a mean follow-up of about 4 years. New-onset foot ulcers were assessed during the course of the study, using ICD-9 codes.

There were 401 diagnoses of major and 290 diagnoses of minor depression in the cohort, and 121 incident foot ulcers, said Dr. Williams, who reported no conflicts of interest.

Compared with patients with no depression, Dr. Williams and her coinvestigators found a significant increase in the risk of foot ulcers in patients with major, but not minor, depression (hazard ratios, 2.0 and 1.3, respectively).

There was no difference between depressed and nondepressed patients in foot self-care. However, previous research has shown that depression in patients with diabetes is associated with poor self-care, as well as hyperglycemia, smoking, and obesity, she said. “In our study, we found that compared with nondepressed patients, depressed patients were older, unmarried, had [a higher BMI], were more likely to smoke, and had more diabetes complications.

MONTREAL — Suicide screening can be done quickly and easily for veterans attending routine primary care visits, according to Hani Shabana, Ph.D., from the Veterans Affairs Medical Center, Salem, Va.

“Primary care is a largely untapped resource” for suicide prevention in this population, he said, noting evidence that many suicides are completed within days of a primary care visit.

“Many veterans are prone to things like chronic pain, post-traumatic stress syndrome, and depression, and there is a push within Veterans Affairs to get mental health providers integrated into the primary care setting,” he said at the annual meeting of the Society of Behavioral Medicine.

Evidence from the Centers for Disease Control and Prevention suggest that up to 20% of all suicides are completed by veterans, a group that is highly trained with guns and that has access to other lethal weapons, he said.

A review of 40 published studies confirms that contact with a primary care provider is much more common than contact with mental health services prior to completed suicide. About 45% of people in the study had visited a primary care provider within one month of their suicide; 20% had seen a mental health specialist.

Older individuals had higher rates of contact with a primary care provider than younger people (Am. J Psychiatry 2002;159:909–16).

An increase in suicide rates among veterans prompted Dr. Shabana's hospital to establish a primary care screening program that captures every veteran at the institution who has not been seen by primary care within the previous two weeks.

At intake, nursing staff ask one simple question: “In the past two weeks have you had urges to harm yourself or others?” A positive answer triggers a thorough assessment with either a primary care or mental health provider at the hospital.

“We assess risk factors, social/demographic factors, current life stressors and protective factors to come up with an overall assessment of whether they are at low, moderate, or high risk for suicide,” he said.

Among a group of veterans who screened positive for the initial intake question, 177 were currently already being seen by a mental health provider, 62 had received mental health treatment previously, and 159 had never been treated.

Data on these veterans showed that 110 were prescribed mental health treatment, 118 were referred to specialty treatment for things such as substance abuse or post-traumatic stress syndrome, 29 were followed by a primary care physician, 31 were followed by a mental health expert, 43 declined help, and 7 were hospitalized.

Among the 118 referred for specialty treatment, 63% had never been offered help before, said Dr. Shabana.

“We are pretty excited about this last group because we are always looking for people who are floating around the system who need help but haven't been getting it.”

The beauty of the screening model is that it is simple and effective, he explained.

There are reduced barriers to access because of the simple hand-off from the intake nurse to a primary care or mental health provider, and there is no obligation to see a mental health expert.

“Some veterans get squeamish about mental health and so for them to have a relationship with their primary care provider is easier, and sometimes helps ease them over to a mental health expert.”

MONTREAL — Suicide screening can be done quickly and easily for veterans attending routine primary care visits, according to Hani Shabana, Ph.D., from the Veterans Affairs Medical Center, Salem, Va.

“Primary care is a largely untapped resource” for suicide prevention in this population, he said, noting evidence that many suicides are completed within days of a primary care visit.

“Many veterans are prone to things like chronic pain, post-traumatic stress syndrome, and depression, and there is a push within Veterans Affairs to get mental health providers integrated into the primary care setting,” he said at the annual meeting of the Society of Behavioral Medicine.

Evidence from the Centers for Disease Control and Prevention suggest that up to 20% of all suicides are completed by veterans, a group that is highly trained with guns and that has access to other lethal weapons, he said.

A review of 40 published studies confirms that contact with a primary care provider is much more common than contact with mental health services prior to completed suicide. About 45% of people in the study had visited a primary care provider within one month of their suicide; 20% had seen a mental health specialist.

Older individuals had higher rates of contact with a primary care provider than younger people (Am. J Psychiatry 2002;159:909–16).

An increase in suicide rates among veterans prompted Dr. Shabana's hospital to establish a primary care screening program that captures every veteran at the institution who has not been seen by primary care within the previous two weeks.

At intake, nursing staff ask one simple question: “In the past two weeks have you had urges to harm yourself or others?” A positive answer triggers a thorough assessment with either a primary care or mental health provider at the hospital.

“We assess risk factors, social/demographic factors, current life stressors and protective factors to come up with an overall assessment of whether they are at low, moderate, or high risk for suicide,” he said.

Among a group of veterans who screened positive for the initial intake question, 177 were currently already being seen by a mental health provider, 62 had received mental health treatment previously, and 159 had never been treated.

Data on these veterans showed that 110 were prescribed mental health treatment, 118 were referred to specialty treatment for things such as substance abuse or post-traumatic stress syndrome, 29 were followed by a primary care physician, 31 were followed by a mental health expert, 43 declined help, and 7 were hospitalized.

Among the 118 referred for specialty treatment, 63% had never been offered help before, said Dr. Shabana.

“We are pretty excited about this last group because we are always looking for people who are floating around the system who need help but haven't been getting it.”

The beauty of the screening model is that it is simple and effective, he explained.

There are reduced barriers to access because of the simple hand-off from the intake nurse to a primary care or mental health provider, and there is no obligation to see a mental health expert.

“Some veterans get squeamish about mental health and so for them to have a relationship with their primary care provider is easier, and sometimes helps ease them over to a mental health expert.”

MONTREAL — Suicide screening can be done quickly and easily for veterans attending routine primary care visits, according to Hani Shabana, Ph.D., from the Veterans Affairs Medical Center, Salem, Va.

“Primary care is a largely untapped resource” for suicide prevention in this population, he said, noting evidence that many suicides are completed within days of a primary care visit.

“Many veterans are prone to things like chronic pain, post-traumatic stress syndrome, and depression, and there is a push within Veterans Affairs to get mental health providers integrated into the primary care setting,” he said at the annual meeting of the Society of Behavioral Medicine.

Evidence from the Centers for Disease Control and Prevention suggest that up to 20% of all suicides are completed by veterans, a group that is highly trained with guns and that has access to other lethal weapons, he said.

A review of 40 published studies confirms that contact with a primary care provider is much more common than contact with mental health services prior to completed suicide. About 45% of people in the study had visited a primary care provider within one month of their suicide; 20% had seen a mental health specialist.

Older individuals had higher rates of contact with a primary care provider than younger people (Am. J Psychiatry 2002;159:909–16).

An increase in suicide rates among veterans prompted Dr. Shabana's hospital to establish a primary care screening program that captures every veteran at the institution who has not been seen by primary care within the previous two weeks.

At intake, nursing staff ask one simple question: “In the past two weeks have you had urges to harm yourself or others?” A positive answer triggers a thorough assessment with either a primary care or mental health provider at the hospital.

“We assess risk factors, social/demographic factors, current life stressors and protective factors to come up with an overall assessment of whether they are at low, moderate, or high risk for suicide,” he said.

Among a group of veterans who screened positive for the initial intake question, 177 were currently already being seen by a mental health provider, 62 had received mental health treatment previously, and 159 had never been treated.

Data on these veterans showed that 110 were prescribed mental health treatment, 118 were referred to specialty treatment for things such as substance abuse or post-traumatic stress syndrome, 29 were followed by a primary care physician, 31 were followed by a mental health expert, 43 declined help, and 7 were hospitalized.

Among the 118 referred for specialty treatment, 63% had never been offered help before, said Dr. Shabana.

“We are pretty excited about this last group because we are always looking for people who are floating around the system who need help but haven't been getting it.”

The beauty of the screening model is that it is simple and effective, he explained.

There are reduced barriers to access because of the simple hand-off from the intake nurse to a primary care or mental health provider, and there is no obligation to see a mental health expert.

“Some veterans get squeamish about mental health and so for them to have a relationship with their primary care provider is easier, and sometimes helps ease them over to a mental health expert.”