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Vilar A, Sánchez-Martínez N, Blasco MJ, Álvarez-Salazar S, Batlle Vila S, G Forero C. Content agreement of depressive symptomatology in children and adolescents: a review of eighteen self-report questionnaires. Eur Child Adolesc Psychiatry 2024; 33:2019-2033. [PMID: 35962831 DOI: 10.1007/s00787-022-02056-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/25/2022] [Indexed: 11/03/2022]
Abstract
Identifying major depression in children and adolescents is more challenging than in adults. Questionnaires are often used for screening or guiding clinical assessment. Several instruments of different lengths are used as equivalent measures in diagnostic decisions. In this paper, we explore to what extent 18 commonly used depression scales for children and adolescents explore depression clinical symptoms as established by standard DSM-5 diagnosis criteria. We analyzed scale content adequacy by examining the overlap between scale contents and consensus clinical symptoms, the diagnostic time frame for active symptom assessment, and readability for the target age group. The 18 scales encompassed 52 distinct symptoms. These scales included just 50% of clinical symptoms required for diagnosis. The content overlap was low; on average, 29% of symptoms coincide across scales. Half of the scales did not use the standard period for active symptom appraisal, and some did not include a period for assessment. The reading levels on six scales were inappropriate for the scale's target population age group. The substantial heterogeneity in defining the depressive syndrome, the low overlap among scales, different periods of a positive diagnosis, and mismatch of reading competence for detecting may lead to heterogeneity in clinical diagnoses when using different scales. Improving the content of self-report in terms of homogeneity of diagnostic criteria would lead to better diagnostic decisions and patient management.
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Affiliation(s)
- Ana Vilar
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Institut de Neuropsiquiatria I Addiccions (INAD), Hospital de Dia Infanto Juvenil Litoral Mar, Parc de Salut Mar, Barcelona, Spain
| | - Néstor Sánchez-Martínez
- Department of Medicine, Universitat Internacional de Catalunya (UIC), C/Josep Trueta S/N (Hospital Universitari General de Catalunya, Sant Cugat del Vallès, 08195, Barcelona, Spain
| | - Maria Jesús Blasco
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
- Health Services Research Group, IMIM- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Samantha Álvarez-Salazar
- Department of Medicine, Universitat Internacional de Catalunya (UIC), C/Josep Trueta S/N (Hospital Universitari General de Catalunya, Sant Cugat del Vallès, 08195, Barcelona, Spain
| | - Santiago Batlle Vila
- Institut de Neuropsiquiatria I Addiccions (INAD), Direcció Procés Atenció Comunitària I Programes Especials. Parc de Salut Mar, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Carlos G Forero
- Department of Medicine, Universitat Internacional de Catalunya (UIC), C/Josep Trueta S/N (Hospital Universitari General de Catalunya, Sant Cugat del Vallès, 08195, Barcelona, Spain.
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Rodrigues M, Oprea A, Johnson K, Dufort A, Sanger N, Ghiassi P, Sanger S, Panesar B, D'Elia A, Parpia S, Samaan Z, Thabane L. Primary outcome reporting in clinical trials for older adults with depression. BJPsych Open 2024; 10:e60. [PMID: 38450491 PMCID: PMC10951853 DOI: 10.1192/bjo.2023.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/29/2023] [Accepted: 12/18/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Findings from randomised controlled trials (RCTs) are synthesised through meta-analyses, which inform evidence-based decision-making. When key details regarding trial outcomes are not fully reported, knowledge synthesis and uptake of findings into clinical practice are impeded. AIMS Our study assessed reporting of primary outcomes in RCTs for older adults with major depressive disorder (MDD). METHOD Trials published between 2011 and 2021, which assessed any intervention for adults aged ≥65 years with a MDD diagnosis, and that specified a single primary outcome were considered for inclusion in our study. Outcome reporting assessment was conducted independently and in duplicate with a 58-item checklist, used in developing the CONSORT-Outcomes statement, and information in each RCT was scored as 'fully reported', 'partially reported' or 'not reported', as applicable. RESULTS Thirty-one of 49 RCTs reported one primary outcome and were included in our study. Most trials (71%) did not fully report over half of the 58 checklist items. Items pertaining to outcome analyses and interpretation were fully reported by 65% or more of trials. Items reported less frequently included: outcome measurement instrument properties (varied from 3 to 30%) and justification of the criteria used to define clinically meaningful change (23%). CONCLUSIONS There is variability in how geriatric depression RCTs report primary outcomes, with omission of details regarding measurement, selection, justification and definition of clinically meaningful change. Outcome reporting deficiencies may hinder replicability and synthesis efforts that inform clinical guidelines and decision-making. The CONSORT-Outcomes guideline should be used when reporting geriatric depression RCTs.
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Affiliation(s)
- Myanca Rodrigues
- Health Research Methodology Graduate Program, Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada
| | - Anna Oprea
- Life Sciences Undergraduate Program, School of Interdisciplinary Science, McMaster University, Canada
| | - Keily Johnson
- Psychology, Neuroscience and Behaviour Undergraduate Program, Faculty of Science, McMaster University, Canada
| | - Alexander Dufort
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada
| | - Nitika Sanger
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada
| | - Pegah Ghiassi
- Delivery Management Office, Canadian Partnership Against Cancer, Toronto, Canada
| | | | - Balpreet Panesar
- Neuroscience Graduate Program, McMaster University, Canada; and Department of Psychiatry and Behavioural Neurosciences, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - Alessia D'Elia
- Neuroscience Graduate Program, McMaster University, Canada; and Department of Psychiatry and Behavioural Neurosciences, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - Sameer Parpia
- Department of Oncology, McMaster University, Canada; and Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada; and Mood Disorders Program, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada; Population Health Research Institute, Ontario, Canada; and Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare Hamilton, Ontario, Canada
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Leuchter MK, Citrenbaum C, Wilson AC, Tibbe TD, Jackson NJ, Krantz DE, Wilke SA, Corlier J, Strouse TB, Hoftman GD, Tadayonnejad R, Koek RJ, Slan AR, Ginder ND, Distler MG, Artin H, Lee JH, Adelekun AE, Leuchter AF. A comparison of self- and observer-rated scales for detecting clinical improvement during repetitive transcranial stimulation (rTMS) treatment of depression. Psychiatry Res 2023; 330:115608. [PMID: 37984281 DOI: 10.1016/j.psychres.2023.115608] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/06/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
Clinical outcomes of repetitive Transcranial Magnetic Stimulation (rTMS) for treatment of Major Depressive Disorder (MDD) vary widely, and no single mood rating scale is standard for assessing rTMS outcomes. This study of 708 subjects undergoing clinical rTMS compared the performance of four scales in measuring symptom change during rTMS treatment. Self-report and observer ratings were examined weekly with the Inventory of Depressive Symptomatology 30-item (IDS), Patient Health Questionnaire 9-item (PHQ), Profile of Mood States 30-item (POMS), and Hamilton Depression Rating Scale 17-item (HDRS). While all scales were correlated and detected significant improvement, the degree of improvement over time as well as response (33-50%) and remission (20-24%) rates varied significantly. Higher baseline severity was associated with lower likelihood of remission, and greater improvement by sessions 5 and 10 predicted response across all scales. Use of only a single scale to assess outcome conferred 14-36% risk of failing to detect response/remission indicated by another scale. The PHQ was most likely to indicate improvement and least likely to miss response or remission. These findings indicate that assessment of symptom burden during rTMS treatment may be most accurately assessed through use of multiple instruments.
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Affiliation(s)
- Michael K Leuchter
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA.
| | - Cole Citrenbaum
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | | | - Tristan D Tibbe
- Department of Psychology, University of California, Los Angeles, CA 90024, USA; Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA 90024, USA
| | - Nicholas J Jackson
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA 90024, USA
| | - David E Krantz
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Scott A Wilke
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Juliana Corlier
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Thomas B Strouse
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Gil D Hoftman
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Reza Tadayonnejad
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA; Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Ralph J Koek
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Aaron R Slan
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Nathaniel D Ginder
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Margaret G Distler
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Hewa Artin
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - John H Lee
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Adesewa E Adelekun
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Andrew F Leuchter
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
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Excessive-reassurance seeking and mental health: Interpersonal networks for emotion regulation. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-00955-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractIn the context of research on depression, previous studies have explained relationships between excessive-reassurance seeking and mental health from the perspective of interpersonal rejection by significant others. The present study examined the mechanisms underlying these relationships from the perspective of “emotionships”, which indicates the diversity of interpersonal networks for emotion regulation. We also examined how the most significant other’s interpersonal acceptance plays a role in processes that underlie the relationship between excessive-reassurance seeking and mental health as mediated through emotionships. 118 students completed three questionnaires. First, they completed measures of excessive-reassurance seeking, depression and well-being. Second, to assess emotionships, participants nominated individuals they seek in different emotion regulation scenarios. Third, participants selected the most significant other that they nominated previously and answered questions about this individual’s acceptance tendency. Moderated mediation analysis results indicated that in a case that the most significant other did not tend to accept others, those who engaged in excessive-reassurance seeking had fewer emotionships, and fewer emotionships predicted deterioration of well-being. In contrast, when the most significant other tended to accept others, these negative effects of ERS behavior on well-being via emotionships were not found. These findings suggest that maintaining interpersonal networks for emotion regulation and the most significant other’s interpersonal acceptance may be important for preventing deterioration of mental health among excessive-reassurance seekers.
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Depression, Is It Treatable in Adults Utilising Dietary Interventions? A Systematic Review of Randomised Controlled Trials. Nutrients 2022; 14:nu14071398. [PMID: 35406011 PMCID: PMC9003461 DOI: 10.3390/nu14071398] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 01/27/2023] Open
Abstract
This systematic literature review examined whole food or whole diet interventions to treat depression. The inclusion criteria encompassed adults, depression, a recognized depression scale and a whole food or diet intervention. APA PsychINFO, CINAHL, the Cochrance Central Register of Controlled Trails, MEDLINE and Scopus were searched for original research addressing diet as a treatment for depression in adult populations. The quality of the study was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. Seven studies; with 49,156 participants; met the eligibility criteria. All these studies found positive outcomes with depression levels decreasing after dietary intervention. The calculated effect size varied from small (Cohen’s d = 0.32) to very large (Cohen’s d = 1.82). The inconsistent nature of the studies limited the synthesis of the data. Recommendations are provided to enhance future study design and measurement outcomes. Overall, the findings show a positive result for diets that promote an increased intake of fresh produce, wholegrains, low-fat dairy and lean protein sources, while also decreasing the intake of processed and high-fat foods. No funding was provided for this review. The protocol for this review is registered with PROSPERO (CRD42020210426).
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Asghar J, Tabasam M, Althobaiti MM, Adnan Ashour A, Aleid MA, Ibrahim Khalaf O, Aldhyani THH. A Randomized Clinical Trial Comparing Two Treatment Strategies, Evaluating the Meaningfulness of HAM-D Rating Scale in Patients With Major Depressive Disorder. Front Psychiatry 2022; 13:873693. [PMID: 35722557 PMCID: PMC9197773 DOI: 10.3389/fpsyt.2022.873693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/02/2022] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Due to the complexity of symptoms in major depressive disorder (MDD), the majority of depression scales fall short of accurately assessing a patient's progress. When selecting the most appropriate antidepressant treatment in MDD, a multidimensional scale such as the Hamilton Depression Rating scale (HAM-D) may provide clinicians with more information especially when coupled with unidimensional analysis of some key factors such as depressed mood, altered sleep, psychic and somatic anxiety and suicidal ideation etc. METHODS HAM-D measurements were carried out in patients with MDD when treated with two different therapeutic interventions. The prespecified primary efficacy variables for the study were changes in score from baseline to the end of the 12 weeks on HAM-D scale (i.e., ≤ 8 or ≥50% response). The study involved three assessment points (baseline, 6 weeks and 12 weeks). RESULTS Evaluation of both the absolute HAM-D scores and four factors derived from the HAM-D (depressed mood, sleep, psychic and somatic anxiety and suicidal ideation) revealed that the latter showed a greater promise in gauging the anti-depressant responses. CONCLUSION The study confirms the assumption that while both drugs may improve several items on the HAM-D scale, the overall protocol may fall short of addressing the symptoms diversity in MDD and thus the analysis of factor (s) in question might be more relevant and meaningful.
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Affiliation(s)
- Junaid Asghar
- Faculty of Pharmacy, Gomal University, D. I. Khan, Pakistan
| | - Madiha Tabasam
- Faculty of Pharmacy, Gomal University, D. I. Khan, Pakistan
| | | | - Amal Adnan Ashour
- Department of Oral & Maxillofacial Surgery, Taif University, Taif, Saudi Arabia
| | - Mohammed A Aleid
- College of Education, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Osamah Ibrahim Khalaf
- Al-Nahrain Nanorenewable Energy Research Center, Al-Nahrain University, Baghdad, Iraq
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Rodrigues M, Sanger N, Dufort A, Sanger S, Panesar B, D'Elia A, Parpia S, Samaan Z, Thabane L. Outcomes reported in randomised controlled trials of major depressive disorder in older adults: protocol for a methodological review. BMJ Open 2021; 11:e054777. [PMID: 34725082 PMCID: PMC8562520 DOI: 10.1136/bmjopen-2021-054777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Major depressive disorder (MDD or depression) is prevalent among adults aged 65 years and older. The effectiveness and safety of interventions used to treat depression is often assessed through randomised controlled trials (RCTs). However, heterogeneity in the selection, measurement and reporting of outcomes in RCTs renders comparisons between trial results, interpretability and generalisability of findings challenging. There is presently no core outcome set (COS) for use in RCTs that assess interventions for older adults with MDD. We will conduct a methodological review of the literature for outcomes reported in trials for adults 65 years and older with depression to assess the heterogeneity of outcome measures. METHODS AND ANALYSIS RCTs evaluating pharmacotherapy, psychotherapy, or any other treatment intervention for older adults with MDD published in the last 10 years will be located using electronic database searches (MEDLINE, Embase, PsycINFO and the Cochrane Central Register of Controlled Trials). Reviewers will conduct title and abstract screening, full-text screening and data extraction of trials eligible for inclusion independently and in duplicate. Outcomes will be synthesised and mapped to core outcome-domain frameworks. We will summarise characteristics associated with trials and outcomes. ETHICS AND DISSEMINATION We hope that findings from our methodological review will reduce variability in outcome selection, measurement and reporting and facilitate the development of a COS for older adults with MDD. Our review will also inform evidence synthesis efforts in identifying the best treatment practices for this clinical population. Ethics approval is not required, as this study is a literature review. PROSPERO REGISTRATION NUMBER CRD42021244753.
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Affiliation(s)
- Myanca Rodrigues
- Health Research Methodology Graduate Program, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nitika Sanger
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Alexander Dufort
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Sanger
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - Balpreet Panesar
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Alessia D'Elia
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Sameer Parpia
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Mood Disorders Program, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
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Shen JF, Yin XB, Wang S, Jiang NZ, Sun HW, Wang Y, Wang YY. Association between depressive symptoms and suicidal risk: Based on self-reported and clinical-interview measurements from a network perspective. Psych J 2021; 11:171-178. [PMID: 33847075 DOI: 10.1002/pchj.445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/31/2020] [Accepted: 02/24/2021] [Indexed: 11/07/2022]
Abstract
Suicide is commonly found in patients with major depressive disorder (MDD), while the associations among depressive symptoms and their relationships with suicidal risk remain unclear. This study identified the symptoms associated with suicidal risk and the most central symptoms in the MDD networks based on both self-reported and clinical-interview scales. A total of 446 outpatients with MDD were recruited. The Mini International Neuropsychiatric Interview (MINI) was used to assess the suicidal risk. The 13-item Beck Depression Inventory (BDI-13) and 17-item Hamilton Depression Rating Scale (HAMD-17) were used to measure the depressive symptoms. Network analysis was used to estimate the network models. Ten symptoms in the BDI-13 network were related to suicidal risk, among which sadness had the strongest association. Among the six symptoms in the HAMD-17 network that were associated with suicidal risk, guilty feeling was the strongest. Sense of failure was the most central symptom in the BDI-13 network, while depressed mood had the highest centrality in the HAMD-17 network. The depressive symptoms related to suicide risk and the clinical features of MDD showed different characteristics based on different assessment types. Combining self-reported and clinician-rated assessments in future studies and clinical practice might lead to some new findings.
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Affiliation(s)
- Jian-Fei Shen
- School of Psychology, Weifang Medical University, Weifang, China
| | - Xun-Bao Yin
- School of Psychology, Weifang Medical University, Weifang, China
| | - Shuai Wang
- School of Psychology, Weifang Medical University, Weifang, China
| | - Neng-Zhi Jiang
- School of Psychology, Weifang Medical University, Weifang, China
| | - Hong-Wei Sun
- School of Psychology, Weifang Medical University, Weifang, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Yan-Yu Wang
- School of Psychology, Weifang Medical University, Weifang, China
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Noble A, Nevitt S, Holmes E, Ridsdale L, Morgan M, Tudur-Smith C, Hughes D, Goodacre S, Marson T, Snape D. Seizure first aid training for people with epilepsy attending emergency departments and their significant others: the SAFE intervention and feasibility RCT. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
No seizure first aid training intervention exists for people with epilepsy who regularly attend emergency departments and their significant others, despite such an intervention’s potential to reduce clinically unnecessary and costly visits.
Objectives
The objectives were to (1) develop Seizure first Aid training For Epilepsy (SAFE) by adapting a broader intervention and (2) determine the feasibility and optimal design of a definitive randomised controlled trial to test SAFE’s efficacy.
Design
The study involved (1) the development of an intervention informed by a co-design approach with qualitative feedback and (2) a pilot randomised controlled trial with follow-ups at 3, 6 and 12 months and assessments of treatment fidelity and the cost of SAFE’s delivery.
Setting
The setting was (1) third-sector patient support groups and professional health-care organisations and (2) three NHS emergency departments in England.
Participants
Participants were (1) people with epilepsy who had visited emergency departments in the prior 2 years, their significant others and emergency department, paramedic, general practice, commissioning, neurology and nursing representatives and (2) people with epilepsy aged ≥ 16 years who had been diagnosed for ≥ 1 year and who had made two or more emergency department visits in the prior 12 months, and one of their significant others. Emergency departments identified ostensibly eligible people with epilepsy from attendance records and patients confirmed their eligibility.
Interventions
Participants in the pilot randomised controlled trial were randomly allocated 1 : 1 to SAFE plus treatment as usual or to treatment as usual only.
Main outcome measures
Consent rate and availability of routine data on emergency department use at 12 months were the main outcome measures. Other measures of interest included eligibility rate, ease with which people with epilepsy could be identified and routine data secured, availability of self-reported emergency department data, self-reported emergency department data’s comparability with routine data, SAFE’s effect on emergency department use, and emergency department use in the treatment as usual arm, which could be used in sample size calculations.
Results
(1) Nine health-care professionals and 23 service users provided feedback that generated an intervention considered to be NHS feasible and well positioned to achieve its purpose. (2) The consent rate was 12.5%, with 53 people with epilepsy and 38 significant others recruited. The eligibility rate was 10.6%. Identifying people with epilepsy from attendance records was resource intensive for emergency department staff. Those recruited felt more stigmatised because of epilepsy than the wider epilepsy population. Routine data on emergency department use at 12 months were secured for 94.1% of people with epilepsy, but the application process took 8.5 months. Self-reported emergency department data were available for 66.7% of people with epilepsy, and people with epilepsy self-reported more emergency department visits than were captured in routine data. Most participants (76.9%) randomised to SAFE received the intervention. The intervention was delivered with high fidelity. No related serious adverse events occurred. Emergency department use at 12 months was lower in the SAFE plus treatment as usual arm than in the treatment as usual only arm, but not significantly so. Calculations indicated that a definitive trial would need ≈ 674 people with epilepsy and ≈ 39 emergency department sites.
Limitations
Contrary to patient statements on recruitment, routine data secured at the pilot trial’s end indicated that ≈ 40% may not have satisfied the inclusion criterion of two or more emergency department visits.
Conclusions
An intervention was successfully developed, a pilot randomised controlled trial conducted and outcome data secured for most participants. The consent rate did not satisfy a predetermined ‘stop/go’ level of ≥ 20%. The time that emergency department staff needed to identify eligible people with epilepsy is unlikely to be replicable. A definitive trial is currently not feasible.
Future work
Research to more easily identify and recruit people from the target population is required.
Trial registration
Current Controlled Trials ISRCTN13871327.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 39. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Adam Noble
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Sarah Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Emily Holmes
- Centre for Health Economics and Medicine Evaluation, Bangor University, Bangor, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, King’s College London, London, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King’s College London, London, UK
| | | | - Dyfrig Hughes
- Centre for Health Economics and Medicine Evaluation, Bangor University, Bangor, UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Tony Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Darlene Snape
- Department of Health Services Research, University of Liverpool, Liverpool, UK
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Caci H, Baylé FJ, Dossios C, Robert P, Boyer P. The Spielberger trait anxiety inventory measures more than anxiety. Eur Psychiatry 2020; 18:394-400. [PMID: 14680715 DOI: 10.1016/j.eurpsy.2003.05.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
AbstractObjectiveResearchers tried to explain the overlap between anxiety and depression by suggesting that some items of self-administered questionnaires were badly selected and that both constructs should rather be considered as multidimensional. Thus, we hypothesise that the Spielberger trait anxiety inventory (TAI) includes items related to depression.MethodA non-clinical sample of 193 subjects filled out the TAI and the Hospitalised Anxiety–Depression Scale. Factors were postulated on the basis of item content and submitted to confirmatory factor analysis (CFA).ResultsWe found five factors: a 10-item anxiety factor containing three factors, a four-item unsuccessfulness factor correlated with the HADS anhedonia factor, and a six-item happiness factor.ConclusionThe TAI scale encompasses measures of anxiety, depression and well-being. Consequently, the overlap with other measures of depression may result from item selection. This work awaits replication in independent normal and pathological samples.
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Affiliation(s)
- Hervé Caci
- Service de Pédiatrie, CHU de Nice, Hôpital Archet 2, 151, route de Saint-Antoine de Ginestière, BP 3079, 06202 Nice 3, France.
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van Eeden WA, van Hemert AM, Carlier IVE, Penninx BW, Giltay EJ. Severity, course trajectory, and within-person variability of individual symptoms in patients with major depressive disorder. Acta Psychiatr Scand 2019; 139:194-205. [PMID: 30447008 PMCID: PMC6587785 DOI: 10.1111/acps.12987] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Depression shows a large heterogeneity of symptoms between and within persons over time. However, most outcome studies have assessed depression as a single underlying latent construct, using the sum score on psychometric scales as an indicator for severity. This study assesses longitudinal symptom-specific trajectories and within-person variability of major depressive disorder over a 9-year period. METHODS Data were derived from the Netherlands Study of Depression and Anxiety (NESDA). This study included 783 participants with a current major depressive disorder at baseline. The Inventory Depressive Symptomatology-Self-Report (IDS-SR) was used to analyze 28 depressive symptoms at up to six time points during the 9-year follow-up. RESULTS The highest baseline severity scores were found for the items regarding energy and mood states. The core symptoms depressed mood and anhedonia had the most favorable course, whereas sleeping problems and (psycho-)somatic symptoms were more persistent over 9-year follow-up. Within-person variability was highest for symptoms related to energy and lowest for suicidal ideation. CONCLUSIONS The severity, course, and within-person variability differed markedly between depressive symptoms. Our findings strengthen the idea that employing a symptom-focused approach in both clinical care and research is of value.
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Affiliation(s)
- W. A. van Eeden
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
| | - A. M. van Hemert
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
| | - I. V. E. Carlier
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
| | - B. W. Penninx
- Department of PsychiatryAmsterdam Public Health Research Institute and Amsterdam NeuroscienceVU University Medical CenterGGZ inGeestAmsterdamThe Netherlands
| | - E. J. Giltay
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
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Prevalence and Risk Factors for Antenatal Depression in Ethiopia: Systematic Review. DEPRESSION RESEARCH AND TREATMENT 2018; 2018:3649269. [PMID: 30112199 PMCID: PMC6077581 DOI: 10.1155/2018/3649269] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 05/06/2018] [Accepted: 05/21/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Antenatal depression is a syndrome, in which women experience depressed mood, excessive anxiety, insomnia, and change in weight during the period of pregnancy. Maternal depression negatively influences child outcomes and maternal health. Antenatal depression was measured by different rating scales, namely, BDI, EPDS, and PHQ. The objective of this systematic review was to synthesize logical evidence about the prevalence and potential risk factors of antenatal depression in Ethiopia. METHODS Our team explored multiple databases including PSYCHINFO, MEDLINE, Embase, Google Scholar, and Google Search to detect studies published with data on the prevalence of antenatal depression. We found 246 research papers on antenatal depression, of which 210 did not correspond to the title and 27 were duplicates. Subsequently, nine articles were used for synthesis prevalence, of which four studies were selected in the analysis of the effect of unplanned pregnancy on antenatal depression. Figures were extracted from published reports and grey literature, and any lost information was requested from investigators. Estimates were pooled using random-effects meta-analyses. RESULTS The pooled prevalence of antenatal depression for five studies selected, which had used BDI, was 25.33 (20.74, 29.92). The other four studies that had included other screening tools (3 EPDS and 1 PHQ) had the prevalence decreased to 23.56 (19.04, 28.07), and the pooled effect of unplanned pregnancy on antenatal depression was 1.93 (1.81, 2.06). Factors such as age, marital status, income, occupation, history of the previous mental disorder, antenatal follow-up, unplanned pregnancy, complication during to pregnancy, age of mother during pregnancy, conflict, and social support were associated with antenatal depression. CONCLUSIONS Antenatal depression is a common maternal problem; further attention should be given to the effect of unplanned pregnancy, social support, pregnancy-related complications, family conflicts, and violence on pregnant women. All these are possible risk factors for antenatal depression.
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Hofmann SG, Curtiss J, McNally RJ. A Complex Network Perspective on Clinical Science. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2017; 11:597-605. [PMID: 27694457 DOI: 10.1177/1745691616639283] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Contemporary classification systems for mental disorders assume that abnormal behaviors are expressions of latent disease entities. An alternative to the latent disease model is the complex network approach. Instead of assuming that symptoms arise from an underlying disease entity, the complex network approach holds that disorders exist as systems of interrelated elements of a network. This approach also provides a framework for the understanding of therapeutic change. Depending on the structure of the network, change can occur abruptly once the network reaches a critical threshold (the tipping point). Homogeneous and highly connected networks often recover more slowly from local perturbations when the network approaches the tipping point, potentially making it possible to predict treatment change, relapse, and recovery. In this article, we discuss the complex network approach as an alternative to the latent disease model and its implications for classification, therapy, relapse, and recovery.
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Affiliation(s)
- Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University
| | - Joshua Curtiss
- Department of Psychological and Brain Sciences, Boston University
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Fried EI, Cramer AOJ. Moving Forward: Challenges and Directions for Psychopathological Network Theory and Methodology. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2017; 12:999-1020. [DOI: 10.1177/1745691617705892] [Citation(s) in RCA: 346] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since the introduction of mental disorders as networks of causally interacting symptoms, this novel framework has received considerable attention. The past years have resulted in over 40 scientific publications and numerous conference symposia and workshops. Now is an excellent moment to take stock of the network approach: What are its most fundamental challenges, and what are potential ways forward in addressing them? After a brief conceptual introduction, we first discuss challenges to network theory: (1) What is the validity of the network approach beyond some commonly investigated disorders such as major depression? (2) How do we best define psychopathological networks and their constituent elements? And (3) how can we gain a better understanding of the causal nature and real-life underpinnings of associations among symptoms? Next, after a short technical introduction to network modeling, we discuss challenges to network methodology: (4) heterogeneity of samples studied with network analytic models, and (5) a lurking replicability crisis in this strongly data-driven and exploratory field. Addressing these challenges may propel the network approach from its adolescence into adulthood and promises advances in understanding psychopathology both at the nomothetic and idiographic level.
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Corvol A, Dreier A, Prudhomm J, Thyrian JR, Hoffmann W, Somme D. Consequences of clinical case management for caregivers: a systematic review. Int J Geriatr Psychiatry 2017; 32:473-483. [PMID: 28181696 DOI: 10.1002/gps.4679] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/11/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Informal caregivers are deeply involved in the case management process. However, little is known about the consequences of such programs for informal caregivers. This systematic literature review, reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, addressed the consequences of clinical case management programs, whether positive or negative, for caregivers of frail older persons or persons with dementia. METHODS We systematically identified and analyzed published randomized trials and quasi-experimental studies comparing case management programs to usual care, which discussed outcomes concerning caregivers. RESULTS Sixteen studies were identified, and 12 were included after quality assessment. Seven identified at least one positive result for caregivers, and no negative effect of case management has been found. Characteristics associated with positive results for caregivers were a high intensity of case management and programs specifically addressed to dementia patients. CONCLUSIONS Despite the numerous methodological challenges in the assessment of such complex social interventions, our results show that case management programs can be beneficial for caregivers of dementia patients and that positive results for patients are achieved without increasing caregivers' burden. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Aline Corvol
- Service de gériatrie, CHU Rennes, Rennes, France.,Centre de Recherche sur l'Action Politique en Europe UMR, Rennes, France
| | - Adina Dreier
- German Center for Neurodegenerative Diseases (DZNE), Rostock/ Greifswald, Greifswald, Germany.,Institute for Community Medicine, Dep. Epidemiology of Health and Community Health, University Medicine, Greifswald, Germany
| | | | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Rostock/ Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/ Greifswald, Greifswald, Germany.,Institute for Community Medicine, Dep. Epidemiology of Health and Community Health, University Medicine, Greifswald, Germany
| | - Dominique Somme
- Service de gériatrie, CHU Rennes, Rennes, France.,Faculté de médecine, Université de Rennes 1, Rennes, France.,Centre de Recherche sur l'Action Politique en Europe UMR, Rennes, France
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Wu PC, Huang TW. Person Heterogeneity of the BDI-II-C and Its Effects on Dimensionality and Construct Validity: Using Mixture Item Response Models. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2017. [DOI: 10.1177/0748175610384808] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Pei-Chen Wu
- National PingTung University of Education, PingTung, Taiwan ROC,
| | - Tsai-Wei Huang
- National Chiayi University in Taiwan, Chiayi City, Taiwan, ROC
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The 52 symptoms of major depression: Lack of content overlap among seven common depression scales. J Affect Disord 2017; 208:191-197. [PMID: 27792962 DOI: 10.1016/j.jad.2016.10.019] [Citation(s) in RCA: 292] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/03/2016] [Accepted: 10/21/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Depression severity is assessed in numerous research disciplines, ranging from the social sciences to genetics, and used as a dependent variable, predictor, covariate, or to enroll participants. The routine practice is to assess depression severity with one particular depression scale, and draw conclusions about depression in general, relying on the assumption that scales are interchangeable measures of depression. The present paper investigates to which degree 7 common depression scales differ in their item content and generalizability. METHODS A content analysis is carried out to determine symptom overlap among the 7 scales via the Jaccard index (0=no overlap, 1=full overlap). Per scale, rates of idiosyncratic symptoms, and rates of specific vs. compound symptoms, are computed. RESULTS The 7 instruments encompass 52 disparate symptoms. Mean overlap among all scales is low (0.36), mean overlap of each scale with all others ranges from 0.27 to 0.40, overlap among individual scales from 0.26 to 0.61. Symptoms feature across a mean of 3 scales, 40% of the symptoms appear in only a single scale, 12% across all instruments. Scales differ regarding their rates of idiosyncratic symptoms (0-33%) and compound symptoms (22-90%). LIMITATIONS Future studies analyzing more and different scales will be required to obtain a better estimate of the number of depression symptoms; the present content analysis was carried out conservatively and likely underestimates heterogeneity across the 7 scales. CONCLUSION The substantial heterogeneity of the depressive syndrome and low overlap among scales may lead to research results idiosyncratic to particular scales used, posing a threat to the replicability and generalizability of depression research. Implications and future research opportunities are discussed.
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Mossie TB, Sibhatu AK, Dargie A, Ayele AD. Prevalence of Antenatal Depressive Symptoms and Associated Factors among Pregnant Women in Maichew, North Ethiopia: An Institution Based Study. Ethiop J Health Sci 2017; 27:59-66. [PMID: 28458491 PMCID: PMC5390229 DOI: 10.4314/ejhs.v27i1.8] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/14/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Antenatal depression is one of the common problems during pregnancy with a magnitude of 20% to 30% globally. It can negatively endanger women's and off springs lives. As there are scarce reports on this area in Northern Ethiopia, it is important to carry out different studies that explore the magnitude of the problem and related factors in rural areas. The aim of this study is thus to assess the magnitude of antenatal depressive symptoms and associated factors among women at Maichew Town, North Ethiopia. METHODS A facility based cross sectional study was conducted among 196 pregnant women from April to June 2015. Pregnant women who had antenatal care follow-ups at the public health facilities were included in the study. Through proportional allocation to each facility, systematic random sampling technique was used to select the study participants. We used the local language version of Beck Depression Inventory to assess depressive symptoms with a cutoff point of 14 or more. Data was collected by trained Psychiatric Nurses; data entry and analysis were processed by SPSS window 20. The level of significance was determined using odds ratio and 95% confidence interval. RESULTS About 16.3% of the participants had never given birth before, and 46.4% and 42.3% were in the third and second trimesters of pregnancy respectively. Unwanted pregnancy was reported by 25.5% of the participants. Among those with previous pregnancy, 7.1% had previous obstetric complication. The magnitude of depression was 31.1%. Pregnant women with low level of income (AOR=3.66 (95%CI; 1.12, 11.96)), unmarried (AOR=4.07 (95% CI; 1.18, 14.04)) and house wives (AOR= 4.24 (1.38, 13.03)) were risk groups for depression. CONCLUSION Antenatal depression is a common problem; thus screening activities of depression in antenatal care services should be emphasized with more concern to unmarried women, those with low level of income and house wives.
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Affiliation(s)
- Tilahun Belete Mossie
- Psychiatry Unit, School of Nursing, College of Health Sciences, Mekelle University, Ethiopia
| | - Adam Kiros Sibhatu
- Psychiatry Unit, School of Nursing, College of Health Sciences, Mekelle University, Ethiopia
| | - Abate Dargie
- College of Health Sciences, Debre Birhan University, Debre Birhan, Ethiopia
| | - Ashenafi Damte Ayele
- Psychiatry Unit, School of Nursing, College of Health Sciences, Mekelle University, Ethiopia
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Shin J, Park EC, Lee SG, Choi Y, Kim JH, Kim TH. The cross-interaction between global and age-comparative self-rated health on depressive symptoms-considering both the individual and combined effects. BMC Psychiatry 2016; 16:433. [PMID: 27919247 PMCID: PMC5139095 DOI: 10.1186/s12888-016-1098-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 10/30/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Numerous studies suggesting the relation between self-rated health (SRH) and depression have been reported using different measures. Therefore, we attempted to determine the difference in a depressive scale based on the different ways of measuring health between global SRH (SRH-global) and age-comparative SRH (SRH-age). Then, the combined effect of SRH-global and SRH-age on depressive symptoms was further investigated. METHODS Data from the Korean Longitudinal Study of Ageing (KLoSA) from 2008 to 2012 were analyzed. We divided the SRH-global and SRH-age into three levels-high, middle, and low-and combined each into nine new categories (SRH-combi). The Center for Epidemiologic Studies Depression Scale-10 Korean edition was used as the dependent variable. RESULTS A total of 8621 participant were enrolled at baseline. Individuals with lower SRHs-age compared to SRH-global tended to be more vulnerable to depressive symptoms. Low SRH-global with low (b = 0.654, p < 0.001) and middle SRH-age (b = 0.210, p = 0.003) showed association with higher CESD scores. Participants with high SRH-global × low SRH-age also had higher scores (b = 0.536, p < 0.001) compared to the "middle SRH-global × middle SRH-age" reference group. In contrast, among the middle (b = -0.696, p < 0.001) and high SRH-global (b = -0.545, p < 0.001) groups, participants with superior SRH-age had statistically lower CESD scores than the reference group. CONCLUSIONS Although a sole general SRH has historically been widely used, it has been suggested that use of both general and age-comparative SRH would be more powerful and easy when we consider analyzing depression in old age.
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Affiliation(s)
- Jaeyong Shin
- Department of Preventive Medicine, Yonsei University, College of Medicine, Seoul, South Korea ,Institute of Health Services Research, Yonsei University, College of Medicine, Seoul, South Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University, College of Medicine, Seoul, South Korea ,Institute of Health Services Research, Yonsei University, College of Medicine, Seoul, South Korea
| | - Sang Gyu Lee
- Department of Hospital Administration, Graduate School of Public Health, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 210-752 South Korea
| | - Young Choi
- Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea
| | - Jae-Hyun Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea ,Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, South Korea ,Institute on Aging, Ajou University Medical Center, Suwon, South Korea
| | - Tae Hyun Kim
- Department of Hospital Administration, Graduate School of Public Health, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 210-752, South Korea.
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Khachadourian V, Armenian H, Demirchyan A, Melkonian A, Hovanesian A. A post-earthquake psychopathological investigation in Armenia: methodology, summary of findings, and follow-up. DISASTERS 2016; 40:518-533. [PMID: 26578424 DOI: 10.1111/disa.12166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The post-earthquake psychopathological investigation (PEPSI) was designed to probe the short-and long-term effects of the earthquake in northern Armenia on 7 December 1988 on survivors' mental and physical health. Four phases of this study have been conducted to date, and, overall, more than 80 per cent of a sub-sample of 1,773 drawn from an initial cohort of 32,743 was successfully followed during 2012. This paper describes the methodology employed in the evaluation, summarises previous findings, details the current objectives, and examines the general characteristics of the sample based on the most recent follow-up phase outcomes. Despite a significant decrease in psychopathology rates between 1990 and 2012, prevalence rates of post-traumatic stress disorder and depression among study participants in 2012 were greater than 15 and 26 per cent, respectively. The paper also notes the strengths and limitations of the study vis-à-vis future research and highlights the importance and potential practical implications of similar assessments and their outcomes.
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Affiliation(s)
- Vahe Khachadourian
- Research Associate at the College of Health Sciences, American University of Armenia, Armenia
| | - Haroutune Armenian
- Professor at the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, United States
| | - Anahit Demirchyan
- Senior Research Specialist at the College of Health Sciences, American University of Armenia, Armenia
| | | | - Ashot Hovanesian
- Chief Executive Officer at Synergy International Systems, United States
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21
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Fried EI. Are more responsive depression scales really superior depression scales? J Clin Epidemiol 2016; 77:4-6. [PMID: 27247271 DOI: 10.1016/j.jclinepi.2016.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 05/23/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Eiko I Fried
- Faculty of Psychology and Educational Sciences, University of Leuven, Tiensestraat 102, Leuven 3000, Belgium.
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Fried EI, Epskamp S, Nesse RM, Tuerlinckx F, Borsboom D. What are 'good' depression symptoms? Comparing the centrality of DSM and non-DSM symptoms of depression in a network analysis. J Affect Disord 2016; 189:314-20. [PMID: 26458184 DOI: 10.1016/j.jad.2015.09.005] [Citation(s) in RCA: 387] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/20/2015] [Accepted: 09/05/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND The symptoms for Major Depression (MD) defined in the DSM-5 differ markedly from symptoms assessed in common rating scales, and the empirical question about core depression symptoms is unresolved. Here we conceptualize depression as a complex dynamic system of interacting symptoms to examine what symptoms are most central to driving depressive processes. METHODS We constructed a network of 28 depression symptoms assessed via the Inventory of Depressive Symptomatology (IDS-30) in 3,463 depressed outpatients from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. We estimated the centrality of all IDS-30 symptoms, and compared the centrality of DSM and non-DSM symptoms; centrality reflects the connectedness of each symptom with all other symptoms. RESULTS A network with 28 intertwined symptoms emerged, and symptoms differed substantially in their centrality values. Both DSM symptoms (e.g., sad mood) and non-DSM symptoms (e.g., anxiety) were among the most central symptoms, and DSM criteria were not more central than non-DSM symptoms. LIMITATIONS Many subjects enrolled in STAR*D reported comorbid medical and psychiatric conditions which may have affected symptom presentation. CONCLUSION The network perspective neither supports the standard psychometric notion that depression symptoms are equivalent indicators of MD, nor the common assumption that DSM symptoms of depression are of higher clinical relevance than non-DSM depression symptoms. The findings suggest the value of research focusing on especially central symptoms to increase the accuracy of predicting outcomes such as the course of illness, probability of relapse, and treatment response.
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Affiliation(s)
- Eiko I Fried
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.
| | - Sacha Epskamp
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Francis Tuerlinckx
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Denny Borsboom
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
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Fried EI, Nesse RM. Depression sum-scores don't add up: why analyzing specific depression symptoms is essential. BMC Med 2015; 13:72. [PMID: 25879936 PMCID: PMC4386095 DOI: 10.1186/s12916-015-0325-4] [Citation(s) in RCA: 495] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/13/2015] [Indexed: 02/06/2023] Open
Abstract
Most measures of depression severity are based on the number of reported symptoms, and threshold scores are often used to classify individuals as healthy or depressed. This method--and research results based on it--are valid if depression is a single condition, and all symptoms are equally good severity indicators. Here, we review a host of studies documenting that specific depressive symptoms like sad mood, insomnia, concentration problems, and suicidal ideation are distinct phenomena that differ from each other in important dimensions such as underlying biology, impact on impairment, and risk factors. Furthermore, specific life events predict increases in particular depression symptoms, and there is evidence for direct causal links among symptoms. We suggest that the pervasive use of sum-scores to estimate depression severity has obfuscated crucial insights and contributed to the lack of progress in key research areas such as identifying biomarkers and more efficacious antidepressants. The analysis of individual symptoms and their causal associations offers a way forward. We offer specific suggestions with practical implications for future research.
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Affiliation(s)
- Eiko I Fried
- University of Leuven, Faculty of Psychology and Educational Sciences, Research Group of Quantitative Psychology and Individual Differences, Tiensestraat 102, 3000, Leuven, Belgium.
| | - Randolph M Nesse
- School of Life Sciences, Arizona State University, Room 351 Life Sciences Building A, Tempe, AZ, 85287-450, USA.
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Dingley C, Roux G. The role of inner strength in quality of life and self-management in women survivors of cancer. Res Nurs Health 2013; 37:32-41. [PMID: 24357538 DOI: 10.1002/nur.21579] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2013] [Indexed: 11/06/2022]
Abstract
The role of inner strength in quality of life (QOL) and self-management, primary variables in the Theory of Inner Strength, were examined with demographic and clinical characteristics in 107 women with cancer. The strongest predictors of QOL were depressive symptoms, inner strength, and time since diagnosis, respectively, accounting for 82% of the variance in QOL. When depressive symptoms were excluded due to multicollinearity, 64% of variance in QOL was explained by inner strength, time since diagnosis, and comorbidities, with inner strength the strongest predictor. The strongest predictors of self-management were depressive symptoms and inner strength, accounting for 17% of the variance. Results contribute to theory development and suggest the value of supporting inner strength to enhance QOL in cancer survivors.
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Hawley CJ, Gale TM, Smith PSJ, Jain S, Farag A, Kondan R, Avent C, Graham J. Equations for converting scores between depression scales (MÅDRS, SRS, PHQ-9 and BDI-II): good statistical, but weak idiographic, validity. Hum Psychopharmacol 2013; 28:544-51. [PMID: 24519690 DOI: 10.1002/hup.2341] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 04/25/2013] [Accepted: 06/17/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND A variety of depression rating scales are currently used in clinical and research practice. As these scales are generally thought to correlate well, there may be some benefit in deriving equations to translate the score on one scale to that on another. METHOD Using pairwise ratings, we compared the Montgomery-Åsberg Depression Rating Scale (MÅDRS), Beck Depression Inventory II (BDI-II), Patient Health Questionnaire (PHQ-9) and Zung Self Rated Scale (SRS). The primary comparisons of interest were as follows: PHQ-9 and MÅDRS, PHQ-9 and BDI-II, SRS and MÅDRS, and SRS and PHQ-9. One hundred and fifty pairs of ratings were collected for each of these four comparisons, and these were used in a regression analysis to generate a predictive equation between scale pairs. The predictive equations were then tested for accuracy by using novel data. RESULTS There was a reasonably strong correlation between scales. Simple regression equations describe the relationships between certain permutations of the BDI-II, PHQ-9, SRS and MÅDRS well enough to allow the score on one scale to be estimated from the score on another. On average, the equations work well. However, when used to predict individual cases, they often fail. CONCLUSION It does appear that conversion equations for depression scores are precise enough to be of use when applied to averages; these might aid comparison of data across different studies, meta-analysis or instrument selection for clinical trials. But regarding scale translation at the idiographic level, the variability we have observed is so great that severe doubt is cast on the validity of such an approach.
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Affiliation(s)
- Chris J Hawley
- Hertfordshire Partnership University Foundation NHS Trust, QEII Hospital, Mental Health Unit, Welwyn Garden City, Hertfordshire
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Cameron IM, Crawford JR, Cardy AH, du Toit SW, Lawton K, Hay S, Mitchell K, Sharma S, Shivaprasad S, Winning S, Reid IC. Psychometric properties of the Quick Inventory of Depressive Symptomatology (QIDS-SR) in UK primary care. J Psychiatr Res 2013; 47:592-8. [PMID: 23419617 DOI: 10.1016/j.jpsychires.2013.01.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 11/30/2012] [Accepted: 01/21/2013] [Indexed: 11/29/2022]
Abstract
It is widely believed that severity of depressive disorder should guide treatment selection and many guidelines emphasise this factor. The Quick Inventory of Depressive Symptomatology (QID-SR16) is a self-complete measure of depression severity which includes all DSM-IV criterion symptoms for major depressive disorder. The object of this study was to assess the psychometric properties of the QIDS-SR16 in a primary care sample. Adult primary care patients completed the QIDS-SR16 and were assessed by a psychiatrist (blind to QIDS-SR16) with the 17-item Hamilton Rating Scale for Depression (GRID-HAMD). Internal consistency, homogeneity and convergent and discriminant validity of the QIDS-SR16 were assessed. Severity cut-off scores for QIDS-SR16 were assessed for convergence with HRSD-17 cut-offs. Published methods for converting scores to HRSD-17 were also assessed. Two hundred and eighty-six patients participated: mean age = 49.5 (s.d. = 13.8), 68% female, mean HRSD-17 = 12.6 (s.d. = 7.6). The QIDS-SR16 exhibited acceptable internal consistency (Cronbach's alpha = 0.86), a robust factor structure indicating one underlying dimension and correlated highly with the HRSD-17 (r = 0.79) but differed significantly in how it categorised the severity of depression relative to the HRSD-17 (Wilcoxon Signed Rank Test p < 0.001). Using published methods to convert QIDS-SR16 scores to HRSD-17 scores did not result in alignment of severity categorisation. In conclusion, psychometric properties of the QIDS-SR16 were found to be strong in terms of internal consistency, factor structure and convergent and discriminant validity. Using conventional scoring and conversion methods the scale was found not to concur with the HRSD-17 in categorising the severity of depressive symptoms.
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Affiliation(s)
- Isobel M Cameron
- Applied Medical Sciences (Psychiatry), University of Aberdeen, Clinical Research Centre, Royal Cornhill Hospital, Aberdeen, UK.
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The State-Trait Anxiety Inventory: Shadows and Lights on its Construct Validity. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2013. [DOI: 10.1007/s10862-013-9354-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lako IM, Bruggeman R, Knegtering H, Wiersma D, Schoevers RA, Slooff CJ, Taxis K. A systematic review of instruments to measure depressive symptoms in patients with schizophrenia. J Affect Disord 2012; 140:38-47. [PMID: 22099566 DOI: 10.1016/j.jad.2011.10.014] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 10/11/2011] [Accepted: 10/11/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Depressive symptoms require accurate recognition and monitoring in clinical practice of patients with schizophrenia. Depression instruments developed for use in depressed patients may not discriminate depressive symptoms from negative psychotic symptoms. OBJECTIVE We reviewed depression instruments on their reliability and validity in patients with schizophrenia. METHODOLOGY A systematic literature search was carried out in three electronic databases. Psychometric properties were extracted for those instruments of which reliability, divergent, concurrent and predictive validity were reported in one or more publications. RESULTS Forty-eight publications described the reliability and validity of six depression instruments in patients with schizophrenia. The only self-report was the Beck Depression Inventory (BDI). The Brief Psychiatric Rating Scale-Depression subscale (BPRS-D), Positive and Negative Syndrome Scale-Depression subscale (PANSS-D), Hamilton Rating Scale for Depression (HAMD), Montgomery Asberg Depression Rating Scale (MADRS) and Calgary Depression Scale for Schizophrenia (CDSS) were clinician rated. All instruments were reliable for the measurement of depressive symptoms in patients with schizophrenia. The CDSS most accurately differentiated depressive symptoms from other symptoms of schizophrenia (divergent validity), correlated well with other depression instruments (concurrent validity), and was least likely to miss cases of depression or misdiagnose depression (predictive validity). CONCLUSIONS We would recommend to use the CDSS for the measurement of depressive symptoms in research and in daily clinical practice of patients with schizophrenia. A valid self-report instrument is to be developed for the use in clinical practice.
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Affiliation(s)
- Irene M Lako
- Rob Giel Research Center (RGOc), Department of Psychiatry (UCP), University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
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Cheung HN, Power MJ. The development of a new multidimensional depression assessment scale: preliminary results. Clin Psychol Psychother 2012; 19:170-8. [PMID: 22336997 DOI: 10.1002/cpp.1782] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Depression is a major problem for mental health. Empirical studies and clinical observations have shown that the symptoms of depression occur across four main domains-emotional, cognitive, somatic and interpersonal. However, commonly used depression assessment scales fail to address the evaluation of interpersonal symptoms, as summarized in this paper. Therefore, a new depression assessment scale, which aimed to evaluate all four domains of depressive symptomatology, was developed. In an initial analysis, a pilot 85-item questionnaire containing possible depressive symptoms was distributed for evaluation to experts from different mental health professions, from which 52 items were subsequently selected for the new multidimensional depression assessment scale. One hundred community participants completed the questionnaire along with the Beck Depression Inventory-II. The results indicated that the new depression scale had good psychometric properties. It was found to be reliable and valid for the assessment of depression severity and symptomatology, though it is emphasized that these data are only preliminary and based on a relatively healthy sample.
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Affiliation(s)
- Ho Nam Cheung
- Clinical Psychology, University of Edinburgh, Medical School, Teviot Place, Edinburgh, UK
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McAllister M, Wood AM, Dunn G, Shiloh S, Todd C. The perceived personal control (PPC) questionnaire: Reliability and validity in a sample from the United Kingdom. Am J Med Genet A 2011; 158A:367-72. [DOI: 10.1002/ajmg.a.34374] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 10/17/2011] [Indexed: 11/07/2022]
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McClintock SM, Haley C, Bernstein IH. Psychometric considerations of depression symptom rating scales. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/npy.11.59] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Levinger I, Selig S, Goodman C, Jerums G, Stewart A, Hare DL. Resistance Training Improves Depressive Symptoms in Individuals at High Risk for Type 2 Diabetes. J Strength Cond Res 2011; 25:2328-33. [DOI: 10.1519/jsc.0b013e3181f8fd4a] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Berard RMF, Boermeester F, Hartman N, Rust AL. The use of depression rating scales in an adolescent psychiatric population: sex and age differences. Int J Adolesc Med Health 2011; 9:313-320. [PMID: 22912246 DOI: 10.1515/ijamh.1997.9.4.313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Skoogh J, Ylitalo N, Larsson Omeróv P, Hauksdóttir A, Nyberg U, Wilderäng U, Johansson B, Gatz M, Steineck G. ‘A no means no’—measuring depression using a single-item question versus Hospital Anxiety and Depression Scale (HADS-D). Ann Oncol 2010; 21:1905-1909. [DOI: 10.1093/annonc/mdq058] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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The structure of the Hospital Anxiety and Depression Scale in four cohorts of community-based, healthy older people: the HALCyon program. Int Psychogeriatr 2010; 22:559-71. [PMID: 20214846 DOI: 10.1017/s1041610210000256] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The Hospital Anxiety and Depression Scale (HADS) is widely used but evaluation of its psychometric properties has produced equivocal results. Little is known about its structure in non-clinical samples of older people. METHODS We used data from four cohorts in the HALCyon collaborative research program into healthy aging: the Caerphilly Prospective Study, the Hertfordshire Ageing Study, the Hertfordshire Cohort Study, and the Lothian Birth Cohort 1921. We used exploratory factor analysis and confirmatory factor analysis with multi-group comparisons to establish the structure of the HADS and test for factorial invariance between samples. RESULTS Exploratory factor analysis showed a bi-dimensional structure (anxiety and depression) of the scale in men and women in each cohort. We tested a hypothesized three-factor model but high correlations between two of the factors made a two-factor model more psychologically plausible. Multi-group confirmatory factor analysis revealed that the sizes of the respective item loadings on the two factors were effectively identical in men and women from the same cohort. There was more variation between cohorts, particularly those from different parts of the U.K. and in whom the HADS was administered differently. Differences in social-class distribution accounted for part of this variation. CONCLUSIONS Scoring the HADS as two subscales of anxiety and depression is appropriate in non-clinical populations of older men and women. However, there were differences between cohorts in the way that individual items were linked with the constructs of anxiety and depression, perhaps due to differences in sociocultural factors and/or in the administration of the scale.
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De Souza J, Jones LA, Rickards H. Validation of self-report depression rating scales in Huntington's disease. Mov Disord 2010; 25:91-6. [PMID: 19908314 DOI: 10.1002/mds.22837] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The aim of this study was to assess the criterion validity of three self-report measures of depression in a sample of patients with Huntington's disease (HD). Fifty patients with HD completed the Beck Depression Inventory-II (BDI-II), the Hospital Anxiety and Depression Scale (HADS), and the Depression Intensity Scale Circles (DISCs). Current psychiatric status was assessed using the schedules for clinical assessment in neuropsychiatry (SCAN), and ICD-10 diagnosis was used as the gold standard. Receiver operating characteristics (ROC) curves were obtained and the sensitivity, specificity, positive, and negative predictive values were calculated for different cut-off scores on each rating scale. Twelve patients (24%) met ICD-10 criteria for depressive disorder. The depression sub-scale of the HADS (HADS-D) at an optimal cut-off of 6/7 was found to discriminate maximally between depressed and nondepressed patients in this population. The DISCs at a cut-off of 1/2 also performed well at detecting possible "cases" of depression, whereas the BDI-II performed the least satisfactorily of all scales. The HADS-D and DISCs are good screening measures for depression in the HD population and the DISCs may be particularly useful in those patients with more severe communicative and cognitive deficits.
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Affiliation(s)
- Jennifer De Souza
- Birmingham and Solihull Mental Health Foundation Trust, Neuropsychiatry Service, Birmingham B15 2FG, United Kingdom.
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Vera-Villarroel P, Buela-Casal G, Zych I, Córdova-Rubio N, Celis-Atenas K, Zepeda L, Spielberger CD. Chilean Experimental Version of the State-Trait Depression Questionnaire (ST–DEP): State Subscale (S–DEP). Psychol Rep 2010; 106:65-77. [DOI: 10.2466/pr0.106.1.65-77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Depression is the most prevalent mental disorder and one of the most important health problems in Chile. The current study shows data for validity and reliability of the State subscale (S–DEP) of the Chilean experimental version of the State-Trait Depression Questionnaire (ST–DEP). The procedure conducted with the original version of the questionnaire was replicated on a sample of 300 university students. The utilized measures were the State Depression Questionnaire, Beck Depression Inventory, the State-Trait Anxiety Inventory, and neutral depressive, mild depressive, and moderate depressive vignettes. Results indicated that the factor structure was replicable, the internal consistency was good, and the situations were ranked as expected. The scale distinguishes intensities of depression. Clinicians and researchers in Chile are provided with a new measure for state depression.
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Dinh TQ, Yamada AM, Yee BWK. A culturally relevant conceptualization of depression: an empirical examination of the factorial structure of the Vietnamese Depression Scale. Int J Soc Psychiatry 2009; 55:496-505. [PMID: 19592442 DOI: 10.1177/0020764008091675] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite the high risk of depression among Vietnamese refugees, there has been insufficient attention to the psychometric properties of the most utilized scale, the Vietnamese Depression Scale (VDS: Kinzie et al., 1982). AIM The primary aim of the study is to empirically derive the factorial structure of the VDS to support its use as a culturally responsive depression screening tool in community samples of Vietnamese adults. METHOD The factorial structure, reliability, and associations of the VDS factors with recognized socio-demographic correlates were examined using data collected from interviews with a non-probability community sample of 180 Vietnamese refugee adults in the Houston area. RESULTS The empirically derived factorial structure of the VDS approximated the theorized conceptualization of depression introduced by the scale's originators. Three factors (depressed affect, somatic symptoms, and cultural-specific symptoms) accounted for 65% of the variance. As hypothesized, the VDS factors correlated with age and acculturation variables. CONCLUSION Overall results suggest that the conceptualization of depression among this sample of Vietnamese refugees has both universal and culturally specific features. Implications for providing culturally responsive mental health services are offered.
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Affiliation(s)
- Tam Q Dinh
- School of Social Work, University of Southern California, Los Angeles, CA, USA.
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Dagnan D, Jahoda A, McDowell K, Masson J, Banks P, Hare D. The psychometric properties of the Hospital Anxiety and Depressions Scale adapted for use with people with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2008; 52:942-949. [PMID: 18393957 DOI: 10.1111/j.1365-2788.2008.01053.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND There is increasing recognition of depression in people with intellectual disabilities (ID). There is a need to develop well-standardised self-report measures for both clinical and research purposes. This paper presents some psychometric properties of the Hospital Anxiety and Depression Scale (HADS) adapted for use with people with ID. The anhedonic emphasis in the depression scale of the HADS may be particularly useful for people with ID who present with high rates of physical co-morbidity. METHOD A total of 197 people with ID completed an adapted HADS; 32 participants also completed the Zung Depression Scale and 42 also completed the Glasgow Depression Scale. RESULTS The obtained factor structure is similar to the original form of the scale used with people without ID. However, the underlying question wording of the HADS, where most depression items are phrased positively and most anxiety items are phrased negatively, makes clear interpretation of the factor structure difficult. The HADS has an adequate internal reliability and correlates well with other self-report measures of depression. CONCLUSIONS The HADS may need further adaptation; however, the measurement of anhedonia is a useful addition to the self-report measures of depression available for people with ID.
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Affiliation(s)
- D Dagnan
- Cumbria Partnership NHS Foundation Trust, Community Learning Disabilities Service, The Old School, Main Street, Distington, Workington, Cumbria CA 14 5UJ, UK.
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Arana-Lechuga Y, Nuñez-Ortiz R, Terán-Pérez G, Castillo-Montoya C, Jiménez-Anguiano A, Gonzalez-Robles RO, Castro-Roman R, Velázquez-Moctezuma J. Sleep-EEG patterns of school children suffering from symptoms of depression compared to healthy controls. World J Biol Psychiatry 2008; 9:115-20. [PMID: 17853292 DOI: 10.1080/15622970701216665] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Depression in children is often an elusive disorder and its diagnostic tools are a matter of controversy. Several scales have been developed in an attempt to specifically detect some of the major aspects of depression, i.e. anhedonia, sadness, hopelessness. On the other hand, in adults depression frequently induces changes in sleep patterns, particularly a shortening in REM sleep latency. The alteration of sleep patterns in depressed children has been a matter of controversy. It is possible that a diagnostic deficiency might be the source of the contradictory reports. In the present study, The Child Depression Inventory, a rating scale specifically developed for child depression was applied to 396 school children (8-12 years of age). Nearly 15% of the children (N = 45) obtained scores higher than the established limit in this test for normal healthy subjects. A sample of children found within the highest (N = 25) and within the lowest (N = 25) scores in the scale were selected. After a clinical evaluation, only those who meet the inclusion criteria (N = 21 for depressed and N = 7 for healthy controls) were electroencephalographically recorded. Children with depressive symptoms showed a significant shortening in REM sleep latency (mean = 108 min) when compared to non-depressed (mean = 150 min). In addition, significant increases were observed in sleep latency, REM sleep duration and the number of awakenings. Furthermore, results showed an unexpected high frequency of EEG abnormalities in children with depressive symptoms (75%) characterized by sharp waves and polyspikes in the frontal region. The present results support the notion that depression, in children, is accompanied by changes in sleep patterns, mainly concerning REM sleep.
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Affiliation(s)
- Yoaly Arana-Lechuga
- Sleep Disorders Clinic, Universidad Autonoma Metropolitana, Iztapalapa, Mexico City
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RRS-4: short version of the Retardation Rating Scale to screen for depression in elderly inpatients. Am J Geriatr Psychiatry 2008; 16:331-5. [PMID: 18378558 DOI: 10.1097/jgp.0b013e318165dbe0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To develop a short version of the Retardation Rating Scale (RRS), an observer scale recently validated in geriatric inpatients. METHODS A neuropsychologist used a structured interview to assess 165 geriatric medical inpatients with the observer-rated Hamilton Depression Rating Scale, Montgomery and Asberg Rating Scale and RRS, and completed the 30-item Geriatric Depression Scale; 107 met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition clinical criteria for depression according to a gerontopsychiatrist's independent evaluation. A statistical model was applied to ascertain the most relevant RRS items; the psychometric properties of the four retained (RRS-4) were compared with standard scales. RESULTS RRS-4 psychometric properties were good: internal consistency (Cronbach alpha-coefficient = 0.81), positive concurrent validity with each of the standard depression scales (Spearman's r = 0.68-0.82) and the total RRS score (Pearson's r = 0.93). Considering clinical evaluation the "gold standard" for depression, a threshold of three yielded: 88% positive-predictive value, 68% negative-predictive value, with 88% accuracy for predicting depression exceeding the standard observer depression scales by 23%. CONCLUSION RRS-4 is a brief and easy-to-use observer scale that improves depression identification in elderly medical inpatients.
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Bonin-Guillaume S, Sautel L, Demattei C, Jouve E, Blin O. Validation of the Retardation Rating Scale for detecting depression in geriatric inpatients. Int J Geriatr Psychiatry 2007; 22:68-76. [PMID: 16988949 DOI: 10.1002/gps.1657] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Validation in the elderly of the Retardation Rating Scale (RRS), which includes items related to motor and mental retardation but not vegetative items, and may be particularly well-suited for the diagnosis of depression in the elderly. METHODS One hundred and sixty-five geriatric inpatients (105 depressed), aged 65 and over, without dementia, neuroleptic medication and increased risk of slowed mobility, were assessed with the RRS and three validated 'gold-standard' scales for geriatric depression (Hamilton Depression Rating Scale, Montgomery and Asberg Depression Rating Scale, Geriatric Depression Scale). Factor analysis used varimax rotation, Cronbach's, Spearman's and Ferguson's coefficients and the Mann-Whitney U-test to evaluate construct and internal consistency. Convergent validity and Receiver Operating Characteristics curves were also analyzed. RESULTS Factor analysis retained three interpretable domains: (1) motor items (45% of the variance); (2) mental items and (3) the cognitive items. Internal consistency was high (alpha = 0.91). Each item was strongly correlated with the total RRS score and associated with depression. The RRS showed good convergent validity and its total score increased with depression severity. A cut-off score of 10 yielded 79% sensitivity and 80% specificity, with 80% of the patients properly classified, that is 15% more than standard observer scales. CONCLUSION RRS is a valid screening tool for depression and improves recognition of depression in geriatric inpatients.
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Affiliation(s)
- Sylvie Bonin-Guillaume
- Service de Médecine Interne et Gériatrie, Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, 13915 Marseille Cedex 20, France
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Abstract
Research investigating the psychological distress of palliative care patients has contributed to our understanding of the needs and experiences of individuals approaching death. This paper aims to provide a brief review of such measurement of psychological distress in palliative care, focusing on established psychiatric and psychological research tools, and quantitative research methods. This includes clinical screening and diagnostic assessment instruments used to identify key distress-related symptoms and the presence of common clinical syndromes, such as depression, anxiety, delirium, as well as the broader psychological dimensions of suffering, such as existential concerns, spirituality, hope and demoralisation. There are important considerations in undertaking psychological research in palliative care, such as maintaining a balance between the methods and measurements that will address key research questions, and sensitivity to the range of physical and emotional demands facing individuals at the point of receiving palliative care. The clinical application of psychological and psychiatric research tools and methods can aid the detection of psychological distress, aid the thorough assessment of the psychological dimension of the patients' illness and care, aid the identification of individuals who would benefit from specific psychotherapeutic or pharmacologic interventions, and the evaluation of response to treatments.
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Affiliation(s)
- Brian Kelly
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW, Australia.
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Williamson D, Brown E, Perlis RH, Ahl J, Baker RW, Tohen M. Clinical relevance of depressive symptom improvement in bipolar I depressed patients. J Affect Disord 2006; 92:261-6. [PMID: 16563521 DOI: 10.1016/j.jad.2006.02.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Revised: 02/03/2006] [Accepted: 02/08/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Gaps remain between rating scale changes obtained in a clinical trial and what those results mean in clinical practice. OBJECTIVE To better understand the relevance of results from a clinical trial we examined the relationship between rating scale measures and the clinicians' assessment of illness severity. METHODS Data from a randomized double-blind 8-week study of bipolar I depression were examined post hoc in patients who received placebo (PLA, n = 355), olanzapine (n = 351) (OLZ, 5 to 20 mg/d), or olanzapine-fluoxetine combination (n = 82) (OFC, 6 and 25, 6 and 50, or 12 and 50 mg/d). Principal components analysis identified related symptoms (factors) from Montgomery-Asberg Depression Rating Scale (MADRS) item scores. Regression analysis examined baseline to endpoint changes in factor scores and Clinical Global Impression (CGI) scores. Mixed-effects model repeated measures analysis assessed differences between treatment groups. RESULTS MADRS factors identified were: sadness, negative thoughts, detachment, and neurovegetative symptoms. Factor and CGI scores were significantly reduced from baseline to endpoint (LOCF) in the combination therapy group as compared with placebo (p < .01). Changes in factor scores were highly correlated (p < .001) with changes in the CGI. Over 80% of this treatment effect was attributable to indirect effects of improvements in the MADRS factors, the remaining difference could not be explained even when changes in the YMRS and HAMA scores were included in the analytical model. CONCLUSIONS The changes in MADRS factors were closely aligned with the clinician's assessment of overall depression severity, which may suggest a high degree of clinical relevance for differences observed between treatments.
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Affiliation(s)
- Doug Williamson
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN 46221, USA.
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Vadaparampil ST, Ropka M, Stefanek ME. Measurement of psychological factors associated with genetic testing for hereditary breast, ovarian and colon cancers. Fam Cancer 2005; 4:195-206. [PMID: 15951974 DOI: 10.1007/s10689-004-1446-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Accepted: 07/12/2004] [Indexed: 10/25/2022]
Abstract
Despite numerous individual studies of psychological factors (depression, anxiety, distress) related to genetic testing for inherited cancer syndromes (CGT), there has been no systematic review of the psychological factors are measured among individuals at increased risk for hereditary breast, ovarian, or colon cancer. Our review provides an analysis of psychological factors in studies of CGT and discusses the instruments most commonly used to measure them. We performed a literature search using three major OVID databases from 1993 to January 2003. In the 19 studies that met our inclusion criteria, the most commonly assessed psychological factors were distress, anxiety, and depression. These factors were most often measured by the impact of event scale (IES), the state-trait anxiety inventory (STAI), and the Centers for Epidemiologic Studies and Depression scale (CES-D), respectively. Our results show deficits in the existing body of literature on psychological factors associated with CGT including limited documentation of psychometrics and variability in instrumentation.
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Affiliation(s)
- Susan T Vadaparampil
- H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive LCS-FOW, Tampa, FL 33612, USA.
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Rush AJ, Trivedi MH, Carmody TJ, Ibrahim HM, Markowitz JC, Keitner GI, Kornstein SG, Arnow B, Klein DN, Manber R, Dunner DL, Gelenberg AJ, Kocsis JH, Nemeroff CB, Fawcett J, Thase ME, Russell JM, Jody DN, Borian FE, Keller MB. Self-reported depressive symptom measures: sensitivity to detecting change in a randomized, controlled trial of chronically depressed, nonpsychotic outpatients. Neuropsychopharmacology 2005; 30:405-16. [PMID: 15578008 DOI: 10.1038/sj.npp.1300614] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study evaluated and compared the performance of three self-report measures: (1) 30-item Inventory of Depressive Symptomatology-Self-Report (IDS-SR30); (2) 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16); and (3) Patient Global Impression-Improvement (PGI-I) in assessing clinical outcomes in depressed patients during a 12-week, acute phase, randomized, controlled trial comparing nefazodone, cognitive-behavioral analysis system of psychotherapy (CBASP), and the combination in the treatment of chronic depression. The IDS-SR30, QIDS-SR16, PGI-I, and the 24-item Hamilton Depression Rating Scale (HDRS24) ratings were collected at baseline and at weeks 1-4, 6, 8, 10, and 12. Response was defined a priori as a > or =50% reduction in baseline total score for the IDS-SR30 or for the QIDS-SR16 or as a PGI-I score of 1 or 2 at exit. Overall response rates (LOCF) to nefazodone were 41% (IDS-SR30), 45% (QIDS-SR16), 53% (PCI-I), and 47% (HDRS17). For CBASP, response rates were 41% (IDS-SR30), 45% (QIDS-SR16), 48% (PGI-I), and 46% (HDRS17). For the combination, response rates were 68% (IDS-SR30 and QIDS-SR16), 73% (PGI-I), and 76% (HDRS17). Similarly, remission rates were comparable for nefazodone (IDS-SR30=32%, QIDS-SR16=28%, PGI-I=22%, HDRS17=30%), for CBASP (IDS-SR30=32%, QIDS-SR16=30%, PGI-I=21%, HDRS17=32%), and for the combination (IDS-SR30=52%, QIDS-SR16=50%, PGI-I=25%, HDRS17=49%). Both the IDS-SR30 and QIDS-SR16 closely mirrored and confirmed findings based on the HDRS24. These findings raise the possibility that these two self-reports could provide cost- and time-efficient substitutes for clinician ratings in treatment trials of outpatients with nonpsychotic MDD without cognitive impairment. Global patient ratings such as the PGI-I, as opposed to specific item-based ratings, provide less valid findings.
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Affiliation(s)
- A John Rush
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390-9086, USA.
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Mystakidou K, Tsilika E, Parpa E, Katsouda E, Galanos A, Vlahos L. The Hospital Anxiety and Depression Scale in Greek cancer patients: psychometric analyses and applicability. Support Care Cancer 2004; 12:821-5. [PMID: 15480813 DOI: 10.1007/s00520-004-0698-y] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2004] [Accepted: 08/23/2004] [Indexed: 10/26/2022]
Abstract
GOALS OF WORK The aim of the present study was to validate the Greek version of the Hospital Anxiety and Depression Scale (HAD) in a palliative care unit. PATIENTS AND METHODS The scale was translated with the "forward-backward" procedure to Greek. It was administered twice, with a 1-week interval, to 120 patients with advanced cancer. Together with the HAD scale, the patients also completed the Spielberger State-Anxiety Scale (STAI-S). MAIN RESULTS Factor analyses identified a two-factor solution corresponding to the original two subscales of the HAD, which were found to be correlated. The Greek version of the HAD had Cronbach's alphas for the anxiety and depression scales of 0.887 and 0.703, respectively. Validity as performed using known-group analysis showed good results. Both anxiety and depression subscales discriminated well between subgroups of patients differing in disease severity as defined by ECOG performance status. Correlations between the HAD scale and the STAI-S was 0.681 for the anxiety subscale and 0.485 for the depression subscale. CONCLUSIONS These psychometric properties of the Greek version of the HAD scale confirm it as a valid and reliable measure when administered to patients with advanced cancer.
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Affiliation(s)
- Kyriaki Mystakidou
- Palliative Care Unit, Department of Radiology, University Areteion Hospital School of Medicine, 27 Korinthias Str., 115 26, Athens, Greece.
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Kontaxakis V, Havaki-Kontaxaki B, Margariti M, Stamouli S, Kollias C, Christodoulou G. Suicidal ideation in inpatients with acute schizophrenia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2004; 49:476-9. [PMID: 15362252 DOI: 10.1177/070674370404900709] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Schizophrenia has been associated with a high rate of suicide. This study investigates the prevalence of suicidal ideation in a population of inpatients with acute schizophrenia, together with the clinical parameters associated with suicidal thoughts. METHOD We assessed 93 schizophrenia patients. We matched subjects for age and sex and compared subjects with and without suicidal thoughts. We performed stepwise multiple regression analysis to assess the association between specific clinical symptoms and suicidal ideation. RESULTS Of the patients, 20.4% reported suicidal thoughts during the last 15 days. Severity of depressive symptoms, motor retardation, guilt feelings, pathological guilt, and self-depreciation predicted the patients' suicidal ideation. CONCLUSIONS Suicidal thoughts are frequent among inpatients with acute schizophrenia. Prevention of suicidal behaviour should include helping patients improve their self-esteem and reducing depression and guilt feelings.
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Abstract
There is a need to assess the contribution of mood disorder, especially anxiety and depression, in order to understand the experience of suffering in the setting of medical practice. Most physicians are aware of this aspect of the illness of their patients but many feel incompetent to provide the patient with reliable information. The Hospital Anxiety And Depression Scale, or HADS, was designed to provide a simple yet reliable tool for use in medical practice. The term 'hospital' in its title suggests that it is only valid in such a setting but many studies conducted throughout the world have confirmed that it is valid when used in community settings and primary care medical practice. It should be emphasised that self-assessment scales are only valid for screening purposes; definitive diagnosis must rest on the process of clinical examination.
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Affiliation(s)
- R Philip Snaith
- Senior Lecturer In Psychiatry, University of Leeds, 21 Gledhow Wood Road, Leeds LS8 4BW, UK.
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50
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Abstract
There is a need to assess the contribution of mood disorder, especially anxiety and depression, in order to understand the experience of suffering in the setting of medical practice. Most physicians are aware of this aspect of the illness of their patients but many feel incompetent to provide the patient with reliable information. The Hospital Anxiety And Depression Scale, or HADS, was designed to provide a simple yet reliable tool for use in medical practice. The term 'hospital' in its title suggests that it is only valid in such a setting but many studies conducted throughout the world have confirmed that it is valid when used in community settings and primary care medical practice. It should be emphasised that self-assessment scales are only valid for screening purposes; definitive diagnosis must rest on the process of clinical examination.
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Affiliation(s)
- R Philip Snaith
- Senior Lecturer In Psychiatry, University of Leeds, 21 Gledhow Wood Road, Leeds LS8 4BW, UK.
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