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      Depression and Anxiety During the COVID‐19 Pandemic in an Urban, Low‐Income Public University Sample

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          Abstract

          Mental health disparities in the aftermath of national disasters and the protective role of socioeconomic status are both well documented. We assessed the prevalence of depression and anxiety symptoms among underresourced public university students during the COVID‐19 pandemic in New York City. Between April 8, 2020, and May 2, 2020, adult students ( N = 1,821) across the CUNY system completed an online survey examining COVID‐19–related stressors and mental health and sociodemographic factors. Using multivariable logistical regression to assess the association between COVID‐19–related stressors and depression and anxiety symptoms, we found a high prevalence and severity of depression and anxiety symptoms. We also observed that more exposure to COVID‐19–related stressors was associated with increased depressive (27.0%, 41.4%, and 63.1% for low‐, medium‐, and high‐level stressors, respectively) and anxiety symptoms (19.3%, 34.6%, 52.2%). In addition, the degree of exposure to COVID‐19–related stressors served as an important predictor of depression and anxiety symptoms. Compared to high levels of stressors, the odds of depression were 0.2, 95% CI [0.2, 0.3] for low‐ and 0.4, 95% CI [0.3, 0.5] for medium‐level stressors; for anxiety, the odds were 0.2, 95% CI [0.2, 0.3] for low and 0.05, 95% CI [0.4, 0.6] for medium stressors. Finally, household savings of less than $5,000 increased the risk of anxiety but not depression symptoms, OR = 1.3, 95% CI [1.0,1.6]. Together, these findings tell a devastating story of psychological distress among students from lower socioeconomic groups living in the COVID‐19 epicenter of the U.S. pandemic.

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          A brief measure for assessing generalized anxiety disorder: the GAD-7.

          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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            The PHQ-9: validity of a brief depression severity measure.

            While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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              The PHQ-9

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                Author and article information

                Contributors
                mrudenstine@ccny.cuny.edu
                Journal
                J Trauma Stress
                J Trauma Stress
                10.1002/(ISSN)1573-6598
                JTS
                Journal of Traumatic Stress
                John Wiley and Sons Inc. (Hoboken )
                0894-9867
                1573-6598
                12 October 2020
                : 10.1002/jts.22600
                Affiliations
                [ 1 ] Department of Psychology City College of New York New York New York USA
                [ 2 ] School of Public Health Boston University Boston Massachusetts USA
                Author notes
                [*] [* ]Correspondence concerning this article should be addressed to Sasha Rudenstine, Department of Psychology, City College of New York, 160 Convent Avenue NAC 8/122B, New York, NY 10031. E‐mail: mrudenstine@ 123456ccny.cuny.edu

                Author information
                https://orcid.org/0000-0002-7659-0874
                Article
                JTS22600
                10.1002/jts.22600
                7675401
                33045107
                e84e490a-53c2-4c75-bc45-4aba94ffbb14
                © 2020 International Society for Traumatic Stress Studies

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 08 June 2020
                : 17 September 2020
                : 18 September 2020
                Page count
                Figures: 1, Tables: 3, Pages: 11, Words: 8112
                Categories
                Research Article
                Research Articles
                Custom metadata
                2.0
                corrected-proof
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.4 mode:remove_FC converted:19.11.2020

                Emergency medicine & Trauma
                Emergency medicine & Trauma

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