New PHQ-9 Assessment for Depression

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Now, more than ever, mental health forms a major component of my work in nutrition. The COVID-19 pandemic has led to an unprecedented increase in stress among communities and individuals, worsening or triggering mental health conditions such as depression.

I now offer a free online PHQ-9 assessment.  The PHQ-9 is a simple, 9-question instrument for screening, diagnosing, monitoring and measuring the severity of depression.

PHQ-9 is one of the most used depression screens among Primary Care workers, clinicians and researchers. The assessment is endorsed by a number of leading health organizations, including the National Institute for Health and Care Excellence (NICE). The assessment takes 3 minutes to complete.

The PHQ-9 evaluation, together with the Cambridge Brain Sciences (CBS) Health Assessment, gives you a far deeper insight of what is going on with both your cognitive and mental health.   These scientifically-validated assessments help further inform your personal nutrition and care programme, providing quantifiable evidence.  

How do we evaluate the PHQ-9 Assessment?

We evaluate your PHQ-9 alongside other clinical considerations including the findings from your initial in-depth nutrition consultation. For instance, were your current symptoms triggered by psychosocial stressor(s)? What is the duration of the present episode and are you receiving any other treatment or support?  To what degree are your symptoms impairing your usual work and activities?  Is there a history of similar episodes? Is there a family history?   

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How does depression relate to digestive health and nutrition?

There is mounting evidence that the good bacteria in the gut (our microbiota) influence our brain and our mood. And indeed, it is the food that we eat that determines the types of bacteria that inhabit our gut.   Some bacteria are beneficial but others are not and may contribute to inflammation in the body. This is where a targeted and individualised holistic nutrition programme may be beneficial: to help rebalance and strengthen your gut microbiome and help reduce inflammation.

Our gut bacteria produce hundreds of neurochemicals that the brain uses to regulate basic physiological processes as well as mental processes such as learning, memory and mood.. Our gut bacteria manufacture about 95 percent of our serotonin, which influences our mood and sleep patterns.

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People with chronic inflammatory diseases such as diabetes, cardiovascular disease and autoimmune disorders are at greater risk of developing depression. Depression can also be one of the symptoms of many inflammatory neurological conditions, such as multiple sclerosis and Parkinson’s disease. Depression may even be a risk in developing Alzheimer’s disease later in life.

How does inflammation contribute to depression?

Studies support that the brains of patients with depression have higher levels of inflammation. Their microglia – the brain’s immune system cells – are also more active. This increased activity could end up being detrimental, leading to changes in how the brains cells function and communicate.

Another study found that people with depression had more neutrophils, lymphocytes, and monocytes and inflammatory proteins in their blood compared to those without depression. This is another indicator of inflammation in the body in general.

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Additional benefits of a Cognitive Health and PHQ-9 Assessment

Research shows that even if your focus is not mental health, a quick measure of depression can be beneficial. Depression and cognition are associated with a wide variety of mental and physical illnesses. A study published in JAMA Psychiatry (Sullivan et al., 2013) found that depression was associated with accelerated cognitive decline among type 2 diabetes patients. The greatest decline occurred in patients with a PHQ-9 score of 10 or more at baseline and 20 months later. The researchers propose that depression may be causing or worsening the risk of dementia.

Another study (Hawkins et al., 2016) involved patients with heart failure, who have high rates of depression and cognitive impairment. The researchers found that certain PHQ-9 scores predicted performance in multiple cognitive domains. They suggest treatments known to affect depression and cognition, including CBT and physical exercise, may be most impactful on this population.

Would you benefit from a tailored nutrition programme? Contact Charlotte Fraser at enquiries@naturopathic-nutrition.com to organise an online PHQ-9 and CBS Health Assessment.

Grammatical Reasoning is Affected by Mental Health … and Being Underwater

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In the Cambridge Brain Sciences Health Assessment I send clients, there’s a Grammatical Reasoning task. You need to work out the meaning of verbal statements, and then determine if they are true or not. The score provides a scientific measure of how well you combine verbal abilities with reasoning skills to solve problems.  Some people find the task simple, but for others, the task can be quite challenging.  Changes to nutrition, sleep, fitness and stress can improve your score however.

The Grammatical Reasoning task was first developed to measure the mental capabilities of divers.  Divers often show signs akin to drunkenness after swimming to extreme depths. In fact, you can observe impairments in Grammatical Reasoning from depths of around 30 metres.  In an interesting twist, it would appear that it isn’t only depth or compressed air responsible for impairment, but the stress of being at sea as well. Click here to watch Adrian Owen, chief scientific officer – Cambridge Brain Sciences, explain the science behind Grammatical Reasoning.

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Ocean Brain Coral

Why Test Grammatical Reasoning?

Verbal reasoning is associated with mental health factors, like stress, and extends to anxiety and depression. Recently, Goodall et al. (2018) found that depressed youth consistently scored lower in verbal reasoning tasks. The conclusion: “the findings support the need to consider neurocognitive functioning when treating youth with depression.”  Poorer attention, verbal memory, visual memory and verbal reasoning skills are also identified in youth with depression.   

We all have a subjective idea of how our brains are doing. For instance, what’s your definition of ‘fine’ compared to mine? Some days you might experience “brain fog” but, on other days, feel like you can conquer the world. Just how much better are we on those good days? Can health and lifestyle changes making a difference? That’s where the CBS Health Assessment is really useful, it helps quantify those subjective feelings. It enables us to determine what is supporting us on the good days so that we can have more of them.

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Where does this fit with Nutrition?

We don’t pay much attention to our brain but our cognitive health affects all areas of life. Every second of every day. When our brain is performing, every activity in our daily life is just easier. Such as remembering where you put your mobile phone or planning the layout of your new room. What’s more, the brain and bowel (‘The Second Brain’) are in constant dialogue, they are intrinsically linked. For me, the CBS Health Assessment is a useful indicator also of your underlying gut health.

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Scientifically-validated, the measures help me assess, monitor, and manage core areas of cognition to tailor every nutrition programme. What’s more, you get a fuller appreciation of how changes in nutrition, exercise, movement, sleep, social engagement can improve your overall health.

Would you benefit from an in-depth nutrition consultation? Contact Charlotte Fraser Naturopathic Nutrition at enquiries@naturopathic-nutrition.com for a free basic (4 task) online CBS Health Assessment.