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Articles 1 - 30 of 45
Full-Text Articles in Medicine and Health Sciences
Empowering Nurses To Recognize Post-Stroke Depression In The African American Community, Deidra Frisbie, Robin Simon
Empowering Nurses To Recognize Post-Stroke Depression In The African American Community, Deidra Frisbie, Robin Simon
Doctor of Nursing Practice Projects
African Americans (AA) have the highest prevalence of stroke and death compared to other racial groups in the United States. Post-stroke depression (PSD) affects approximately 1/3 of all stroke patients and is underdiagnosed in the African American community.
Aim: By using a mHealth mobile app and a Psychiatry provider list at discharge, PSD can be identified, and interventions initiated, thus decreasing the sequela of PSD in AA.
Methods: Nurses were provided education on PSD, expressions of depression in African-Americans, cultural humility, implicit bias, and the importance of the nurse's role in developing a therapeutic relationship.
Results: Quantitative analysis revealed the …
The Mediating Effect Of Caregiving Relationship Quality On The Association Between Caregiving Stressors And Mental Health Problems Among Older Spousal Caregivers, Fei Wang, Elliane Irani
The Mediating Effect Of Caregiving Relationship Quality On The Association Between Caregiving Stressors And Mental Health Problems Among Older Spousal Caregivers, Fei Wang, Elliane Irani
Faculty Scholarship
Providing care to a spouse can be especially challenging for older adults given their compounding stressors resulting from aging and caregiving. This cross-sectional study examines the relationships between caregiving stressors and caregiver mental health problems and the potential mediator (i.e., caregiving relationship quality) of these associations. A total of 431 Americans (≥65 years) were selected from the National Study of Caregiving. Path analysis shows that care assistance was positively associated with caregiver mental health problems, and this association was mediated by negative relationship quality (Indirect effect =.14, p =.016). Moreover, role overload was positively associated with caregiver mental health problems, …
Implementing The Depression Screening Tool Phq-9 In The Annual Wellness Exam Of Concierge Family Medicine, Eric Iglesias
Implementing The Depression Screening Tool Phq-9 In The Annual Wellness Exam Of Concierge Family Medicine, Eric Iglesias
Doctor of Nursing Practice
Abstract
Background: Depression has been one of the most common mental health disorders that our population fact but is underdiagnosed and undertreated. Primary care providers are often the first line of defense in detecting depression. Because of this, implementing a depression screening tool in a primary care setting will improve holistic management of care and improve quality of life.
Project Aim: The aim of this project was to increase the number of clients who are evaluated for depression by using the PHQ-9 screening tool during their annual wellness exam and initiate treatment according to the Veteran’s Affairs/Department of Defense Depression …
Retrospective Evaluation Of Depression Screening Process Among Older Adult Patients In Primary Care For Quality Improvement., Ashley Dru Larson
Retrospective Evaluation Of Depression Screening Process Among Older Adult Patients In Primary Care For Quality Improvement., Ashley Dru Larson
Doctor of Nursing Practice Papers
Background: Depression is not a normal process of aging; it is a diagnosable and treatable medical condition. The US Preventive Services Task Force (USPSTF) recommends that older adults be screened for depression annually.
Aim: The purpose of this evidence-based practice (EBP) project was to evaluate the depression screening process for older adults (age 65+) in a primary health care setting and provide recommendations to the primary health care clinic for improving it.
Methods: This EBP project involved collecting retrospective data from August to October 2022, including aggregate data (demographics), from all older adults who were seen in …
The Overlooked Care Plan- Nursing Mindset Related To Self-Care: An Integrative Review, Marie Mulford
The Overlooked Care Plan- Nursing Mindset Related To Self-Care: An Integrative Review, Marie Mulford
Doctoral Dissertations and Projects
COVID-19 brought to light many things worldwide. One of the pressing issues was the increased rates of burnout, depression, and suicidal risk among nurses. This called for examining nurses’ work experiences and overall well-being during the Coronavirus pandemic. Furthermore, it was revealed that the nursing mindset regarding self-care was overlooked. This integrative review will inform stakeholders about the “overlooked care plan.” This review will be a call to action built on existing knowledge and facilitate policy for the nursing profession. Building upon nursing science, informative research, and facilitating policy initiatives, this review will serve as a call to action for …
Resilience And Prenatal Mental Health In Pakistan: A Qualitative Inquiry, Shireen Shehzad, David Arthur, An-Sofie Van Parys, Nicole Letourneau, Gail Wagnild, Shahirose Sadrudin Premji, Nargis Asad, Olivier Degomme
Resilience And Prenatal Mental Health In Pakistan: A Qualitative Inquiry, Shireen Shehzad, David Arthur, An-Sofie Van Parys, Nicole Letourneau, Gail Wagnild, Shahirose Sadrudin Premji, Nargis Asad, Olivier Degomme
School of Nursing & Midwifery
Background: Women in Pakistan suffer from a high rate of depression. The stress of low-income, illiteracy, exposure to violence and living in a patriarchal society are predisposing vulnerabilities for depression, particularly during and following pregnancy. The resilience of an individual plays a significant role in promoting prenatal mental health, but this has yet to be thoroughly researched. In this article, our objective is to identify the core characteristics of resilience among pregnant women, which will then help us in developing an intervention.
Methods: The exploratory-descriptive study was conducted over 6 months in five different antenatal hospitals in Sindh, Pakistan. A …
Improving Patient Outcomes In Substance Use Disorder Through Behavioral Therapy In Depression Development And Impacts Of Social Determinants Of Health During And After Substance Use Treatment, Jerry Ryan Armstrong, Chyanne Napp
Improving Patient Outcomes In Substance Use Disorder Through Behavioral Therapy In Depression Development And Impacts Of Social Determinants Of Health During And After Substance Use Treatment, Jerry Ryan Armstrong, Chyanne Napp
Doctoral Projects
Substance Use Disorder (SUD) is a growing problem in the United States (U.S.) and worldwide and relapse is a common occurrence among those facing SUD. Limited scholarly research has been published addressing evidence-based treatment improvement strategies. This study focused on improving SUD treatment through the incorporation of depression tracking from admission to and discharge from inpatient treatment, as well as the incorporation of social determinants of health education during treatment, with an evaluation of relapse rates 30-days after inpatient treatment discharge. Results indicated a significant improvement in depression scores from admission to discharge. Results also revealed improved knowledge regarding social …
Prevalence Of Health-Risk Behaviours Among Indigenous Australians With Diabetes: A Review, Sharon Atkinson-Briggs, Alicia Jenkins, Christopher Ryan, Laima Brazionis
Prevalence Of Health-Risk Behaviours Among Indigenous Australians With Diabetes: A Review, Sharon Atkinson-Briggs, Alicia Jenkins, Christopher Ryan, Laima Brazionis
Journal of the Australian Indigenous HealthInfoNet
Aboriginal and Torres Strait Islander Australians are at high risk of Type 2 diabetes and its complications. Optimal lifestyle choices can improve health outcomes. A thematic review of original research publications related to smoking, nutrition, alcohol intake, physical activity and emotional wellness in Aboriginal and Torres Strait Islander Australians with diabetes was performed. Overall, 7118 English-language publications were identified by search engines (PubMed, CINAHL, Scopus, Medline-Web of Science, and Google Scholar) with search terms Indigenous Australians OR Aboriginal and Torres Strait Islanders AND diabetes AND lifestyle OR smoking OR nutrition OR alcohol OR physical activity OR emotional wellbeing and their …
Association Between Suicidal Attempts In Connection To Discrimination Among Trans Genders, Asghar Ali, Saad Ahmed Khan, Shah Zeb, Zahir Munir, Tazeen Saeed Ali
Association Between Suicidal Attempts In Connection To Discrimination Among Trans Genders, Asghar Ali, Saad Ahmed Khan, Shah Zeb, Zahir Munir, Tazeen Saeed Ali
School of Nursing & Midwifery
Suicide has become a serious public health challenge across the world with around 800,000 people dying by suicide each year. Amongst these a majority of the people (79%) belongs to low and middle-income countries.
Objective:The study aimed to identify the association between suicidal attempts in connection to discrimination among transgender.
Methods: An analytical cross-sectional study was conducted. Data were collected from a registered NGO (Gender Interactive Alliance) from February to May, 2020, using a universal and purposive sampling technique.DatawasanalyzedonSPSS(version21.0).Meanandstandarddeviationwas calculated for frequency distribution, while Chi-square was used for categorical variables.
Results: Overall, 250 transgender were approached through a registered …
Hospital Nursing Factors Associated With Decreased Odds Of Mortality In Older Adult Medicare Surgical Patients With Depression, Aparna Kumar, Douglas Sloane, Linda Aiken, Matthew Mchugh
Hospital Nursing Factors Associated With Decreased Odds Of Mortality In Older Adult Medicare Surgical Patients With Depression, Aparna Kumar, Douglas Sloane, Linda Aiken, Matthew Mchugh
College of Nursing Faculty Papers & Presentations
Background: Depression is common, costly, and has deleterious effects in older adult surgical patients. Little research exists examining older adult surgical patient outcomes and depression and the potential for nursing factors to affect these outcomes. The purpose of this study was to determine the relationship between hospital nursing resources, 30-day mortality; and the impact of depression on this relationship.
Methods: This was a retrospective cohort study employing a national nurse survey, hospital data, and Medicare claims data from 2006-2007. The sample included: 296,561 older adult patients, aged 65-90, who had general, orthopedic, or vascular surgery in acute care general hospitals …
Adolescents With Depression Capstone Benchmark Project, Myeshia Salter
Adolescents With Depression Capstone Benchmark Project, Myeshia Salter
MSN Capstone Projects
This change project promotes the inclusion of adolescent involvement within the informed consenting process for recommended treatment plans for symptoms of depression. This project proposal will include the adolescent throughout the development of the treatment plan to promote compliance. The incorporation of this plan will encourage autonomy in the adolescent and aid with developing a plan that the adolescent agrees with. The current process does not include the adolescents' desires or opinions, which results in poor efficacy of the treatment plan, thus exacerbating the symptoms of depression.
Depression, Gerardo Serrano
Depression, Gerardo Serrano
Nursing Student Class Projects (Formerly MSN)
Depression is a common illness worldwide, with an estimated 3.8% of he population affected, including 5.0% among adults and 5.7% among adults older than 60 years (Schomerus et at., 019). Approximately 280 million people in the world have depression (Schomerus et at., 2019). Depression is different from usual mood fluctuations nd short-lived emotional responses to challenges in everyday life. Especially hen recurrent and with moderate or severe intensity, depression may become serious health condition. It can cause he affected person to suffer greatly and unction poorly at work, at school and in he family. At its worst, depression can lead …
An Evaluation Of Mindstrong™ Implementation With Graduate Nursing Students, Angela B. Sabblut
An Evaluation Of Mindstrong™ Implementation With Graduate Nursing Students, Angela B. Sabblut
Dissertations
Problem: Nursing graduate students are at increased risk of greater stress, anxiety, and depression (Hoying, 2020; Melnyk et al., 2020). Cognitive Behavioral Therapy is the gold standard in the treatment of anxiety and depression (Hoying et al., 2020; Melnyk et al., 2015; Melnyk et al., 2020). MINDSTRONG™, a CBT-based training program, has been proven in many studies to be effective in helping individuals prevent or cope with these issues (The Ohio State University College of Nursing, 2020).
Methods: This Quality Improvement (QI) project was a descriptive-observational, pre-post design. Sample and setting were nursing graduate students from a Midwestern, middle-sized urban, …
Improving Recognition And Treatment Of Depression Among Women Using Phq-9 During Office Visits, Victoria Nwokocha, Heather Owens, Chris Webb
Improving Recognition And Treatment Of Depression Among Women Using Phq-9 During Office Visits, Victoria Nwokocha, Heather Owens, Chris Webb
Graduate Theses, Dissertations, and Capstones
Depression can affect productivity and earnings among women, slow down the pace of active participation in social and family life, and increase health costs as well as distract attention from optimal health targets. Depression is the highest source of disability in NYC, with billions of dollars annually in related productivity losses. Although healthcare spending on depression affected patients is largely on hospital admissions, an estimated 40% of affected persons in New York do not get the adequate attention and care needed, with women most often affected by depression. This is an indication that the bedrock of preventive medicine for mental …
Evaluating Patient Health Questionnaire-9 (Phq-9) Use In Burn Survivors, Chelsey Friend
Evaluating Patient Health Questionnaire-9 (Phq-9) Use In Burn Survivors, Chelsey Friend
Dissertations
Problem: A burn injury affects both psychological and physical health, resulting in a greater than 50% major depressive disorder morbidity. The purpose of this quality improvement (QI) project is to evaluate the use of the Patient Health Questionnaire-9 (PHQ-9) in adult burn survivors, with an aim to increase the use of the screening tool.
Methods: A mixed-methods pre/post-survey design with an educational component was utilized to assess nurse knowledge, confidence, willingness, and barriers to completion of the PHQ-9. Aggregate data were collected to determine PHQ-9 completion rates for patients admitted to and discharged from the unit during the two months …
Improved Monitoring Of Depression And Suicidal Ideation In Low-Income Adolescents Through Evidenced Based Provider Education, Sunday Adeyeye
Improved Monitoring Of Depression And Suicidal Ideation In Low-Income Adolescents Through Evidenced Based Provider Education, Sunday Adeyeye
Doctor of Nursing Practice Final Manuscripts
Background: Adolescents from low-income status experience more prevalent thoughts of suicide than their financially secure peers. Nearly 15% considered taking their own life. Suicidal ideation among adolescents in California ranges from 4% to 67%. Depression and suicidal thoughts are underdiagnosed among adolescents, with higher disparities among minority and lower socioeconomic backgrounds.
Purpose: This project involved consistent screening of high-risk adolescents for potential depression and suicidal ideation using a patient health questionnaire recommended by the U.S. Preventive Services Task Force screening.
Process: This project involved adolescents 12–18 years old who had visited a federally qualified healthcare center in San Bernardino, California. …
Implementing Universal Depression Screening In A College Health Clinic, Marilyn J. Grabau
Implementing Universal Depression Screening In A College Health Clinic, Marilyn J. Grabau
Doctor of Nursing Practice Scholarly Projects
BACKGROUND: College students are at high risk for depression, and this carries a considerable burden. The American College Health Association supports depression screening on college campuses recognizing that early identification leads to better outcomes.
LOCAL PROBLEM: The project site is a public university located in New England. The college campus health center incorporates medical and counseling services. From August 2019 to December of 2019, 67% of students seen in the counseling center described depressed mood as the presenting concern. Currently there is no routine depression screening in place.
METHODS: This QI project implemented universal depression screening at the student health …
Improving Compliance With Treatments For End-Stage Renal Disease Patients On Hemodialysis, Susan Blakeney
Improving Compliance With Treatments For End-Stage Renal Disease Patients On Hemodialysis, Susan Blakeney
Doctoral Projects
According to Blumrosen et al. (2020), the dialysis population cost expenditure is greater than “seven percent of the Medicare budget at nearly $40 billion a year” even though this population is “less than one percent of the Medicare population” (p. 1436). Additionally, the renal disease population is growing in the United States and internationally which contributes to rising healthcare costs around the globe (Levin, 2018).
The purpose of this Doctor of Nursing Practice (DNP) project was to identify the factors or reasons hemodialysis patients miss treatments or only stay for partial treatment. Hemodialysis patients are required to have treatments three …
Implementation Of Phq-2 Screening Tool In A Telemedicine Based Setting, Joanna Luong
Implementation Of Phq-2 Screening Tool In A Telemedicine Based Setting, Joanna Luong
Doctor of Nursing Practice Projects
Background Major depression is one of the most common mental health disorders in the United States, affecting nearly 17.3 million of the population. As cases continue to rise throughout the ongoing pandemic of COVID-19, telemedicine has become a popular modality for accessibility to mental health care. Adequate screening, availability of resources and services, prompt treatment, and simple follow ups can contribute to treatment success rates and higher positive outcomes.
Theoretical Framework
The expanded collaborative chronic care model theoretical framework translates to this project in that it approaches management of patients with a team approach for those who screen positive for …
Implementation Of Routine Screening With Patient Health Questionnaire 9 (Phq-9) Of Adults With Crohn’S Disease, Jo A. Muller-Krause
Implementation Of Routine Screening With Patient Health Questionnaire 9 (Phq-9) Of Adults With Crohn’S Disease, Jo A. Muller-Krause
Doctor of Nursing Practice Projects
Introduction: Mild levels of depression have been measured with screening tools at rates of 15-24% in adults with Crohn’s disease (CD). The spectrum of the impact of depressive symptoms is measurable and documented for those with CD. Patient perspectives support the integration of psychological care, and the Patient Health Questionnaire 9 (PHQ-9) is a well validated tool for the measurement of depressive symptoms.
Purpose: Increase depression screening of adult CD patients in the outpatient gastroenterology clinic and evaluate the provider perspectives regarding PHQ-9, depression, and CD.
Conceptual Framework: The Johns Hopkins Nursing Evidence Based Practice (JHNEBP) Model was selected as …
Implementation Of Depression Screening In A Nursing Home, Titilayo Raji
Implementation Of Depression Screening In A Nursing Home, Titilayo Raji
Doctor of Nursing Practice Projects
Abstract
Background/Introduction
Unidentified and untreated depression among nursing home residents leads to poor quality-of-life and substantial healthcare dollars are utilized for care management. Use of validated instruments and routine screening provides opportunity for early detection and treatment.
Purpose
The purpose of this project was to educate employees of a nursing home on the use of the Geriatric Depression Screening (GDS) tool, implement it on two units of the nursing home, and evaluate the feasibility and acceptability of this quality improvement project.
Method
An educational presentation was delivered to introduce the implementation plan, GDS screening tool, and protocol for data collection. …
Improving Depression Surveillance At The We Care Clinic, Kaitlin Springer, Emma Hanney
Improving Depression Surveillance At The We Care Clinic, Kaitlin Springer, Emma Hanney
Doctor of Nursing Practice Projects
Depression is one of the most underdiagnosed and untreated disorders affecting more than 16 million people in the United States each year (Henry et al., 2020). Unmanaged depression can lead to emotional suffering, decreased productivity, reduced income, impaired relationships, and an increased risk for comorbidities (Sinisalchi et al., 2020). It can affect anyone, however, individuals who are non-white, female, undereducated, disabled, pregnant or postpartum, have low socioeconomic status, or lack social support are at an increased risk (United States Preventative Services Task Force, 2019). The Southern Illinois University Edwardsville We Care Clinic provides primary care to minority patient populations who …
The Implementation Of A Mental Health Screening Protocol In An Occupational Health Setting, Chandra A. Pierson-Rye
The Implementation Of A Mental Health Screening Protocol In An Occupational Health Setting, Chandra A. Pierson-Rye
Doctor of Nursing Practice Projects
Background
Occupational injuries are disturbingly common and can occur regardless of employment industry, given that virtually every job in every industry has some degree of risk. Literature suggests that once an injury has occurred, psychosocial factors such as depression can play a pivotal role in the progression of pain, determine whether a subsequent disability develops, and the length of time an employee is off work.
Theoretical Framework
Both pain and depression are hypothesized to follow the same descending pathway in the CNS and have the same biochemical basis, serotonin and norepinephrine. The Biophysical Model of Pain can be used to …
The Effects Of The Transition From Pre-Nursing To Nursing On Mental Health, Andrew J. Davis, Paige R. Mullins, Kimberly A. Sell
The Effects Of The Transition From Pre-Nursing To Nursing On Mental Health, Andrew J. Davis, Paige R. Mullins, Kimberly A. Sell
Undergraduate Honors Theses
Mental health is an ever-growing crisis among adolescents and young adults, with suicide as second leading cause of death and the number of those negatively affected continually on the rise. Transitions are one of the major stressors prevalent among these age groups, placing individuals at risk for mental health deficits. This quantitative voluntary response comparative study assesses the transitional mental health of pre-nursing students and students in the nursing program at East Tennessee State University. Emailed to all with a declared major of pre-nursing or nursing, this study measured mental health using evidenced based assessment tools. The PHQ-9 for depression …
Nutrition On The Prevention And Treatment Of Depression, Gracie Polen
Nutrition On The Prevention And Treatment Of Depression, Gracie Polen
Nursing | Senior Theses
Today, the general population consumes a diet high in sugars, saturated fats, incomplete protein sources, and the tendency to exceed the bodies caloric requirements. The trend of obesity due to poor dietary habits is alarming. Mental illness has increasingly risen over the past decade. Specifically, the incidence of depression has reached a startling rate. The relationship between poor dietary intake and depression have grown together and it is imperative that methods are introduced to aid in resolving this issue. The prevention and treatment of depression needs to be explored through alternative methods. Healthier dietary choices have been shown to have …
Family-Centered Psychosocial Care For Pediatric Oncology Patients, Jessica W. Casey
Family-Centered Psychosocial Care For Pediatric Oncology Patients, Jessica W. Casey
UNLV Theses, Dissertations, Professional Papers, and Capstones
Psychosocial conditions are prevalent in pediatric oncology patients (Kahalley et al., 2013). Family and social support are essential aspects of a patient's health care outcomes (Merck & McElfresh, 2019). Anxiety and depression are common in pediatric oncology patients due to trauma during treatment (Pao & Kazak, 2015). These patients also can have preexisting developmental or behavioral conditions before starting treatment. Treatment side effects can also cause cognitive and behavioral changes (Nixon, 2014b). Nurses should be knowledgeable and confident in their ability to care for patients' psychosocial health and development. The purpose of this Doctor of Nursing Practice (DNP) project is …
Dnp Final Report: Seal The Deal In Dementia Care, Christian D. Garrett
Dnp Final Report: Seal The Deal In Dementia Care, Christian D. Garrett
DNP Final Reports
Background: Individuals with dementia are often burdened with behavioral problems, which augment health care costs and burden of disease. Treatment of behavioral symptoms with pet therapy is acknowledged to be emotionally beneficial. Robotic pets have demonstrated similar promising effects without the undesirable outcomes of traditional pet therapy. Robotic pet therapy offers an effective replacement to traditional pet therapy.
Objective: The DNP scholarly project rigorously appraises the effectiveness of the SAR, PARO, an FDA approved biofeedback device, for non-pharmacological treatment of dementia-related symptoms.
Methods: An experimental design with repeated measures guided the study. Pre- and post- measures included reliable, valid tools …
Light Acupuncture And Five-Element Music Therapy For Nurses' Mental Health And Well-Being During And Post-Covid-19: Protocol For A Randomised Cross-Over Feasibility Study, Carol Chunfeng Wang, Johnny Lo, Rosemary Saunders, Esther Adama, Caroline Bulsara, Christopher Etherton-Beer, Angela Wei Hong Yang
Light Acupuncture And Five-Element Music Therapy For Nurses' Mental Health And Well-Being During And Post-Covid-19: Protocol For A Randomised Cross-Over Feasibility Study, Carol Chunfeng Wang, Johnny Lo, Rosemary Saunders, Esther Adama, Caroline Bulsara, Christopher Etherton-Beer, Angela Wei Hong Yang
Research outputs 2022 to 2026
INTRODUCTION: Australian nurses have experienced higher levels of anxiety during the COVID-19 pandemic compared with the prepandemic. This may have affected their long-term mental health and intention to stay in the profession resulting in a workforce shortage, which further impacts the health of the public. Management is urgently required to improve nurses' well-being. However, there is limited evidence available. The proposed clinical trial aims to evaluate the feasibility and therapeutic effects of using a combination of light acupuncture and five-element music therapy to improve nurses' mental health and well-being during and post-COVID-19. METHODS AND ANALYSIS: This randomised, single blinding, two-arm …
Dnp Final Report: Psychosocial Screening For Oncology Patients, Robyn V. Beard
Dnp Final Report: Psychosocial Screening For Oncology Patients, Robyn V. Beard
DNP Final Reports
Background: Patients with cancer often face severe distress related to fear of death, body disfigurement, financial stress, and lack of support system. This distress may lead to physical and emotional symptoms that bring patients to seek care at emergency departments, delay care or make poor health choices, and increase utilization of prescription drugs. With the already over burdened healthcare system, addressing these psychosocial needs is vital to improving patients outcomes as well as improving healthcare expenditure. Purpose: The purpose of this evidence based practice project was to improve perceived quality of life for oncology patients through detailed screening and behavioural …
The Effects Of Covid-19 On Well-Being Of Healthcare Workers, Hannah Meissner
The Effects Of Covid-19 On Well-Being Of Healthcare Workers, Hannah Meissner
Honors Theses
The development of the new coronavirus disease, COVID-19, led to the spread of turmoil across the United States and further around the globe. With the virus creating uncertainty among the population, the evidence began to demonstrate that individuals could have devastating health effects, including death. Healthcare workers are among those who were on the frontlines in order to care for the infected, ultimately increasing their own chances of acquiring the virus and putting their health at risk. These workers have experienced a direct impact due to this exposure in the form of isolation, anxiety, depression, suicide, and sleep disturbances. With …