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Bouloukaki I, Christodoulakis A, Margetaki K, Aravantinou Karlatou A, Tsiligianni I. Exploring the Link between Social Support and Patient-Reported Outcomes in Chronic Obstructive Pulmonary Disease Patients: A Cross-Sectional Study in Primary Care. Healthcare (Basel) 2024; 12:544. [PMID: 38470655 PMCID: PMC10930953 DOI: 10.3390/healthcare12050544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
We aimed to explore the link between social support and various patient-reported outcome measures (PROMs) in primary care patients with COPD. This was a cross-sectional study with 168 patients with COPD from six primary care centers in Crete, Greece. We collected data on sociodemographic characteristics, medical history, disease-specific quality of life, the COPD Assessment Test (CAT), fatigue, the Fatigue Severity Scale (FSS), phycological parameters, Patient Health Questionnaire-9, General Anxiety Disorder-7, sleep complaints, the Pittsburg Sleep Quality Index, the Athens Insomnia scale (AIS), and the Epworth Sleepiness Scale. Social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS). Out of 168 patients with COPD, 114 (68.9%) exhibited low levels of social support. Low social support (MSPSS total ≤ 5) was positively associated with COPD symptoms (CAT score ≥ 10) (OR = 3.97, 95%CI:1.86-8.44; p < 0.01), fatigue (FSS ≥ 36) (OR = 2.74, 95%CI:1.31-5.74; p = 0.01), and insomnia symptoms (AIS ≥ 6) (OR = 5.17 95%CI:2.23-12.01; p < 0.01), while the association with depressive symptoms (PHQ-9 ≥ 10) was marginally significant (OR = 3.1, 95%CI:0.93-10.36; p = 0.07). Our results suggest that lower levels of social support are positively associated with PROMs in patients with COPD. Therefore, our findings show an additional way to improve the overall health of patients with COPD in primary care by putting social support at the epicenter of actions.
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Affiliation(s)
- Izolde Bouloukaki
- Department of Social Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (A.C.); (K.M.); (A.A.K.); (I.T.)
| | - Antonios Christodoulakis
- Department of Social Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (A.C.); (K.M.); (A.A.K.); (I.T.)
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71410 Heraklion, Greece
| | - Katerina Margetaki
- Department of Social Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (A.C.); (K.M.); (A.A.K.); (I.T.)
| | - Antonia Aravantinou Karlatou
- Department of Social Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (A.C.); (K.M.); (A.A.K.); (I.T.)
| | - Ioanna Tsiligianni
- Department of Social Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (A.C.); (K.M.); (A.A.K.); (I.T.)
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Basta M, Skourti E, Simos P, Soumaki E, Li Y, Gerostergios G, Samiotakis G, Dafermos V, Drakaki M, Papadakis N, Vgontzas AN. Associations between sleep complaints, suicidal ideation and depressive symptoms among adolescents and young adults in Greece. J Sleep Res 2023; 32:e13900. [PMID: 37039423 DOI: 10.1111/jsr.13900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 03/08/2023] [Accepted: 03/21/2023] [Indexed: 04/12/2023]
Abstract
Depression prevalence increases significantly during adolescence/early adulthood. Depression in youth may present suicidal ideation, while suicide represents the leading cause of death in this age group. Moreover, adolescents/young adults frequently report sleep complaints that may partially be due to depressive symptoms. Studies on the associations between depression, sleep complaints and suicidality in this age group are limited. We aimed to examine associations between depressive symptoms, sleep complaints and suicidal ideation in a large (n = 2771), representative sample of adolescents (age: 15-17 years, n = 512) and young adults (age: 18-24 years, n = 2259) from the general population in Greece. A telephone structured questionnaire was administered. Depressive symptoms were assessed using the modified Patient Health-7 questionnaire score, while presence of suicidal ideation and sleep complaints were assessed using the ninth and third question of Patient Health-9 questionnaire, respectively. Mediation logistic regression analysis revealed significant direct paths from depressive symptoms to sleep complaints (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.19-1.24; OR 1.21, 95% CI 1.18-1.24) and suicidal ideation (OR 1.18, 95% CI 1.14-1.22; OR 1.18, 95% CI 1.14-1.22), as well as sleep complaints and suicidal ideation (OR 1.82, 95% CI 1.32-2.50; OR 1.91, 95% CI 1.33-2.76) in the total group and in young adults, respectively, but not among adolescents. Moreover, we detected a significant indirect effect of depressive symptoms on suicidal ideation mediated by sleep complaints (18.8%) in young adults. These findings support the hypothesis that treatment of sleep disturbances among youth with depression may independently further reduce suicidal risk.
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Affiliation(s)
- M Basta
- Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
- Sleep Research and Treatment Center, Department of Psychiatry, Penn State University, Hershey, Pennsylvania, USA
- Department of Child and Adolescent Psychiatry, University Hospital of Heraklion, Crete, Greece
| | - E Skourti
- Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
| | - P Simos
- Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
- Computational Biomedicine Lab, Institute of Computer Science, Foundation for Research and Technology-Hellas, Heraklion, Greece
| | - E Soumaki
- Department of Child and Adolescent Psychiatry, University Hospital of Heraklion, Crete, Greece
| | - Y Li
- Department of Sleep Medicine, Mental Health Center of Shantou University, Shantou, Guangdong, China
| | - G Gerostergios
- Department of Child and Adolescent Psychiatry, University Hospital of Heraklion, Crete, Greece
| | - G Samiotakis
- Department of Child and Adolescent Psychiatry, University Hospital of Heraklion, Crete, Greece
| | - V Dafermos
- Department of Political Science, University of Crete, Rethymno, Greece
| | - M Drakaki
- Department of Political Science, University of Crete, Rethymno, Greece
| | - N Papadakis
- Department of Political Science, University of Crete, Rethymno, Greece
| | - A N Vgontzas
- Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
- Sleep Research and Treatment Center, Department of Psychiatry, Penn State University, Hershey, Pennsylvania, USA
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Papachristodoulou E, Kakoullis L, Christophi C, Psarelis S, Hajiroussos V, Parperis K. The relationship of neutrophil-to-lymphocyte ratio with health-related quality of life, depression, and disease activity in SLE: a cross-sectional study. Rheumatol Int 2023; 43:1841-1848. [PMID: 37405441 PMCID: PMC10435585 DOI: 10.1007/s00296-023-05381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/22/2023] [Indexed: 07/06/2023]
Abstract
The neutrophil-to-lymphocyte ratio (NLR) emerged as a potential biomarker in SLE, but its association with several outcomes remains unclear. We aimed to evaluate the relationship between NLR and SLE disease activity, damage, depression, and health-related quality of life. A cross-sectional study was conducted, including 134 patients with SLE who visited the Division of Rheumatology between November 2019 and June 2021. Demographics and clinical data including NLR, Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus disease activity index (SELENA-SLEDAI), Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), physician global assessment (PhGA), patient global assessment (PGA), patient health questionnaire (PHQ)-9, patient self-rated health, and lupus quality of life (LupusQoL) scores, were collected. Patients were stratified into two groups and compared using the NLR cut-off of 2.73, the 90th percentile value of healthy individuals. The analysis included t-test for continuous variables, χ2-test for categorical variables, and logistic regression adjusting for age, sex, BMI, and glucocorticoid use. Among the 134 SLE patients, 47 (35%) had an NLR ≥ 2.73. The NLR ≥ 2.73 group had significantly higher rates of severe depression (PHQ ≥ 15), poor/fair self-rated health, and the presence of damage (SDI ≥ 1). These patients also scored significantly lower in LupusQoL domains (physical health, planning, and body image), and higher in SELENA-SLEDAI, PhGA, and PGA. Logistic regression confirmed that high NLR is associated with severe depression (PHQ ≥ 15) (OR:7.23, 2.03-25.74), poor/fair self-rated health (OR:2.77,1.29-5.96), high SELENA-SLEDAI score(≥ 4) (OR:2.22,1.03-4.78), high PhGA (≥ 2) (OR:3.76, 1.56-9.05), and presence of damage (SDI ≥ 1) (OR:2.67, 1.11-6.43). High NLR in SLE may indicate depression, worse quality of life, active disease, and the presence of damage.
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Affiliation(s)
- Eleni Papachristodoulou
- Department of Medicine, University of Cyprus Medical School, Nicosia, Cyprus
- Department of Medicine, University of Patras School of Health Sciences, Patras, Greece
| | - Loukas Kakoullis
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Costas Christophi
- Department of Biostatistics and Epidemiology, Cyprus University of Technology, Limassol, Cyprus
| | - Savvas Psarelis
- Department of Rheumatology, Nicosia General Hospital, University of Cyprus Medical School, Nicosia, Cyprus
| | | | - Konstantinos Parperis
- Department of Internal Medicine, Division of Rheumatology, University of Cyprus Medical School, Palaios Dromos Lefkosias Lemesou No. 215/6, Aglantzia, 2029, Nicosia,, Cyprus.
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Aagaard A, Ravn SL, Andersen TE, Vaegter HB. Interpretation of the Patient Health Questionnaire 9 in High-Impact Chronic Pain: Do We Measure Depressive Symptoms the Way We Think? Clin J Pain 2023; 39:501-515. [PMID: 37440339 DOI: 10.1097/ajp.0000000000001142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/22/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES Depression is prevalent among patients with chronic pain and may impact pain management. An accurate assessment is, however, complicated by overlapping symptoms. This study investigated how patients with high-impact chronic pain interpreted and responded to the Patient Health Questionnaire 9 (PHQ-9) to identify problematic items and causes hereof. MATERIALS AND METHODS Cognitive interviews using the Three-Step Test-Interview procedure were conducted during the completion of the PHQ-9 in 33 patients with high-impact chronic pain referred to interdisciplinary treatment. Responses were analyzed using 4 coding categories: (1) "congruent" (response consistent with intention); (2) "incongruent" (response not consistent intention); (3) "ambiguous" (response both congruent and incongruent or insufficient to evaluate congruency); and (4) "confused" (response with confused or misunderstood statements). Next, the content of responses to problematic items was analyzed to identify causes for noncongruency, and encountered response difficulties were identified across all items. RESULTS Three items (items 2, 6, and 9) performed as intended (>97% congruent responses), while 7 items (items 1, 3, 4, 5, 7, 8, and 10) were identified as problematic (<50% congruent responses). Problematic items had 1 or more issues: Responses were based on (1) pain-related issues or (2) other (non-pain) factors unrelated to depression, or item structure caused response difficulties due to wordings, reversion, or having 2 questions in 1. DISCUSSION Problematic items limit the construct validity of the PHQ-9, leaving an increased risk of inflated depression scores in high-impact chronic pain. Identified problems should guide future revisions to enhance validity and screening accuracy for the benefit of both research and clinical practice.
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Affiliation(s)
| | - Sophie Lykkegaard Ravn
- Departments of Psychology
- Specialized Hospital for Polio and Accident Victims, Roedovre, Denmark
| | | | - Henrik Bjarke Vaegter
- Clinical Research, Faculty of Health Sciences, University of Southern Denmark
- Pain Research Group, Pain Center, University Hospital Odense
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Hennemann S, Killikelly C, Hyland P, Maercker A, Witthöft M. Somatic symptom distress and ICD-11 prolonged grief in a large intercultural sample. Eur J Psychotraumatol 2023; 14:2254584. [PMID: 37767693 PMCID: PMC10540649 DOI: 10.1080/20008066.2023.2254584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/12/2023] [Indexed: 09/29/2023] Open
Abstract
Background: Grief is a multi-faceted experience including emotional, social, and physical reactions. Research in ICD-11 prolonged grief disorder (PGD) in different cultural contexts has revealed different or potentially missing grief symptoms that may be relevant.Objective: This study thus aimed to explore the prevalence of somatic symptom distress and its associations with grief and negative affect in a culturally diverse sample of bereaved individuals with symptoms of PGD.Methods: Based on cross-sectional survey data from the Measurement and Assessment of Grief (MAGIC) project, this study included 1337 participants (mean age 23.79 yrs, 76.1% female) from three regions (USA: 62.3%, Turkey/Iran: 24.2%, Cyprus/Greece: 13.5%), who experienced a loss of a significant other. Associations between somatic symptom distress (Somatic Symptom Scale, SSS-8), symptoms of PGD (International Prolonged Grief Disorder Scale, IPGDS-33), anxiety (Generalized Anxiety Disorder Questionnaire, GAD-7), depression (Patient Health Questionnaire, PHQ-9) as well as demographic and loss related characteristics were investigated. Three hundred and thirteen participants (23.4%) scored above the proposed cut-off for clinically severe PGD.Results: 'High' or 'very high' levels of somatic symptom distress were more frequent in a possible PGD group (58.2%), than in a non-PGD group (22.4%), p < .001, as divided per cut-off in the IPGDS. In a multiple regression analysis, PGD symptoms were significantly but weakly associated with somatic symptom distress (β = 0.08, p < .001) beyond demographics, loss-related variables, and negative affect. Negative affect (anxiety and depression) mediated the relationship of PGD symptoms with somatic symptom distress and the indirect effect explained 58% of the variance.Conclusions: High levels of somatic symptom distress can be observed in a substantial proportion of bereaved across cultures. Our findings suggest that PGD is related to somatic symptom distress partly and indirectly through facets of negative affect.
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Affiliation(s)
- Severin Hennemann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Clare Killikelly
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
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Bhagavathula AS, Bentley BL, Woolf B, Dissanayaka TD, Rahmani J. Increased risk of stroke among patients with ankylosing spondylitis: A systematic review and meta-analysis. REUMATOLOGIA CLINICA 2023; 19:136-142. [PMID: 36906389 DOI: 10.1016/j.reumae.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/28/2022] [Indexed: 03/11/2023]
Abstract
BACKGROUND Ankylosing spondylitis is a chronic inflammatory disease that is associated with adverse cardiovascular events. This study aimed to determine the relationship between ankylosing spondylitis and the risk of stroke. METHODS A systematic literature search in PubMed/MEDLINE, Scopus, and Web of Science were conducted from inception to December 2021 to identify relevant articles investigating the risk of stroke in patients with ankylosing spondylitis. A random-effects model (DerSimonian and Laird) was used to estimate a pooled hazard ratio (HR) and 95% confidence intervals (CI). Meta-regression based on the length of follow-up and subgroup analysis based on the type of stroke, study location, and year of publication to investigate the source of heterogeneity. RESULTS A total of eleven studies comprising 1.7 million participants were included in this study. Pooled analysis showed a significantly increased stroke risk (56%) among patients with ankylosing spondylitis (HR: 1.56, 95% CI 1.33-1.79). Subgroup analysis revealed a higher risk of ischemic stroke among patients with ankylosing spondylitis (HR: 1.46, 95% CI: 1.23-1.68). However, meta-regression analysis showed no association between the duration of ankylosing spondylitis and stroke incidence (Coef=-0.0010, P=0.951). CONCLUSION This study reveals that ankylosing spondylitis was associated with an increased risk of suffering a stroke. Management of cerebrovascular risk factors and the control of systemic inflammation should be considered in patients with ankylosing spondylitis.
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Affiliation(s)
- Akshaya Srikanth Bhagavathula
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy at Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Barry L Bentley
- Cardiff School of Technologies, Cardiff Metropolitan University, Cardiff, UK; Collaboration for the Advancement of Sustainable Medical Innovation, University College London, London, UK
| | - Benjamin Woolf
- Department of Psychological Sciences, University of Bristol, Bristol BS8 1TH, UK
| | - Thusharika D Dissanayaka
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka; Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Jamal Rahmani
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Apostolara P, Adamakidou T, Mouta E, Vus V, Malliarou M, Mantzorou M, Papathanasiou IV. BURNOUT AND DEPRESSION OF GREEK HEALTHCARE PROFESSIONALS WORKING IN REFUGEES' RECEPTION CENTERS AND ACCOMMODATION PROGRAMS. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2023; 51:228-233. [PMID: 37589107 DOI: 10.36740/merkur202303107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
OBJECTIVE Aim: The investigation of health professionals' burnout and depression, working in refugees' reception centers and their possible intercorrelation. PATIENTS AND METHODS Materials and methods: A descriptive correlation study was carried out in health professionals, who worked in refugees' reception centers and accommodation programs throughout Greece. Data were collected using an anonymous questionnaire through online Google Forms. The questionnaire contained demographics, the Copenhagen Burnout Questionnaire (CBI-Gr) and the Patient Health Questionnaire (PHQ-9). The SPSS 22.00 was used for the statistical analysis and the significance level was set at 0.05. RESULTS Results: The sample consisted of 125 healthcare professionals working in refugees' reception centers and accommodation programs, the majority of tchem were women (62.4%), aged between 30-39 years (39.2%) nurses (24.8%) and with a master's degree (28%). A strong linear positive correlation was found between depression and burnout (r=0.542, p=0.000). A statistically significant correlation was also recorded between burnout and female gender (p=0.001), the age group of 30-39 (p=0.042) and nursing profession (p=0.003). CONCLUSION Conclusions: A strong linear relationship between burnout and depression was revealed, a finding indicating that it is imperative to implement interventions to strengthen the resilience of health professionals working in refugees' reception centers.
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Affiliation(s)
| | | | | | - Viktor Vus
- INSTITUTE FOR SOCIAL AND POLITICAL PSYCHOLOGY, KYIV, UKRAINE
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Asimakopoulou E, Paoullis P, Shegani A, Argyriadis A, Argyriadi A, Patelarou E, Patelarou A. Translation, Adaptation and Validation of the Pandemic Fatigue Scale (PFS) in the Greek Language. Healthcare (Basel) 2022; 10:healthcare10112118. [PMID: 36360459 PMCID: PMC9690820 DOI: 10.3390/healthcare10112118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/10/2022] [Accepted: 10/19/2022] [Indexed: 11/04/2022] Open
Abstract
The growing fatigue of citizens due to the COVID-19 pandemic has already been addressed and its results are visible and threatens citizen compliance. The aim of this study was to translate and validate the Pandemic Fatigue Scale (PFS) in the Greek language. A cross-sectional study was conducted between October 2021 to March 2022. The translation and cultural adaptation process was developed according to the research protocols among the university student population in Cyprus and tested the psychometric properties of PFS. Three hundred thirty-four subjects participated in the study through a web survey, which included general information and the study process. The internal consistency for the total PFS showed good reliability (six items, a = 0.88). A weak statistically significant positive correlation was found between the PFS and the Greek versions of Generalised Anxiety Disorder Assessment—GAD-7 (r = 0.1.96; p < 0.001) and the PFS and Patient Health Questionnaire—PHQ-9 (r = 0.173; p = 0.002) demonstrating good concurrent validity. Recovering from the pandemic, it is necessary to build systems to detect and respond to future healthcare crises. The results suggest that the psychometric properties of the Greek PFS are satisfactory. The measure of pandemic fatigue allows for identifying fatigue groups for targeted interventions and testing how pandemic fatigue might be reduced in such situations.
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Affiliation(s)
- Evanthia Asimakopoulou
- Department of Nursing, School of Health Sciences, Frederick University, Nicosia 1036, Cyprus
- Correspondence: ; Tel.: +357-22394394; Fax: +357-22438234
| | - Panagiotis Paoullis
- Department of Nursing, School of Health Sciences, Frederick University, Nicosia 1036, Cyprus
| | - Antonio Shegani
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, St Thomas’ Hospital, London SE1 7EH, UK
| | - Alexandros Argyriadis
- Department of Nursing, School of Health Sciences, Frederick University, Nicosia 1036, Cyprus
| | - Agathi Argyriadi
- Department of Psychology and Social Sciences, Frederick University, Nicosia 1036, Cyprus
| | - Evridiki Patelarou
- Department of Nursing, Faculty of Health Sciences, Hellenic Mediterranean University, 71410 Crete, Greece
| | - Athina Patelarou
- Department of Nursing, Faculty of Health Sciences, Hellenic Mediterranean University, 71410 Crete, Greece
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9
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Christodoulaki A, Baralou V, Konstantakopoulos G, Touloumi G. Validation of the Patient Health Questionnaire-4 (PHQ-4) to screen for depression and anxiety in the Greek general population. J Psychosom Res 2022; 160:110970. [PMID: 35728338 DOI: 10.1016/j.jpsychores.2022.110970] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The Patient Health Questionnaire-4 (PHQ-4) is an ultra-brief self-report screening scale for depression and anxiety with promising psychometric properties; however, its reliability and validity have not been investigated in Greece yet. The objective of the current study was to investigate the reliability and validity of the PHQ-4 and to establish a cut-off score to identify depression and anxiety in the Greek general population. METHODS The reliability of the PHQ-4 was assessed using a random sample of 204 students from Athens, Greece. The internal consistency (Cronbach's α) was evaluated whereas the test-retest reliability was measured over a one-week period with intra-class correlation (ICC). The scale's validity was assessed in a cross-sectional study of 591 adults living in Greece using confirmatory factor analysis (CFA). Cut-offs were determined using the Mini International Neuropsychiatric Interview (MINI) as the gold standard. RESULTS Cronbach's α of the PHQ-4 was 0.80 and the overall ICC 0.96. CFA yielded a two-factor model, structurally invariant by age and gender. A GAD-2 score of 2 was the optimal cut-off point to detect any anxiety disorder (sensitivity = 0.82, specificity = 0.75) and 3 to detect generalized anxiety disorder (sensitivity = 0.77, specificity = 0.82). As for PHQ-2, a score of 2 was the optimal cut-off point to detect any depressive disorder (sensitivity = 0.87, specificity = 0.85) and 3 to detect major depressive disorder (sensitivity = 0.77, specificity = 0.94). CONCLUSIONS The PHQ-4 is a reliable and valid screening scale for depression and anxiety in the Greek general population.
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Affiliation(s)
- Anna Christodoulaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Valia Baralou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - George Konstantakopoulos
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Greece; Research Department of Clinical, Education and Health Psychology, University College London, UK.
| | - Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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Michas G, Magriplis E, Micha R, Chourdakis M, Koutelidakis A, Dimitriadis G, Panagiotakos D, Zampelas A. Prevalence and factors associated with smoking in a nationally representative sample of Greek adults: The Hellenic National Nutrition and Health Survey (HNNHS). Hellenic J Cardiol 2022; 67:19-27. [PMID: 35605946 DOI: 10.1016/j.hjc.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 05/02/2022] [Accepted: 05/14/2022] [Indexed: 11/18/2022] Open
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.hjc.2022.05.005. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal
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Affiliation(s)
- George Michas
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece
| | - Emmanuella Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece
| | - Renata Micha
- Department of Food Science and Nutrition, School of Agricultural Sciences, University of Thessaly, 43 100, Karditsa, Greece
| | - Michail Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54 124 Thessaloniki, Greece
| | - Antonis Koutelidakis
- Department of Food Science and Nutrition, University of Aegean, Mytilini, Greece
| | - George Dimitriadis
- 2ndDepartment of Internal Medicine, Research Institute and Diabetes Center, National and Kapodistrian University of Athens, "Attikon" University Hospital, Haidari, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education Harokopio University, Athens, Eleftheriou Venizelou 70, 176 76 Athens, Greece
| | - Antonis Zampelas
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece.
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Self-stigma among clients of outpatient psychiatric clinics: A cross-sectional survey. PLoS One 2022; 17:e0269465. [PMID: 35776719 PMCID: PMC9249178 DOI: 10.1371/journal.pone.0269465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 05/22/2022] [Indexed: 11/21/2022] Open
Abstract
Self-stigma is common among people with mental disorders. A large body of research has examined associations between self-stigma and sociodemographic, clinical and psychosocial factors but the results are still conflicting. The aim of this study was to describe self-stigma among persons with affective and psychotic disorders and identify sociodemographic and clinical factors associated with experiences of self-stigma. A cross-sectional survey was performed with Finnish clients (N = 898) at 16 psychiatric clinics using self-reported questionnaires. The data were analyzed using descriptive statistics and with one-way and multi-way analysis of variance (ANOVA). The results showed that clients in community settings experience self-stigma (a total mean SSMIS-SF score of 74.8 [SD 22.3]). Having a diagnosis of an affective disorder, having a long history of mental disorder (>16 years) and the severity of depressive symptoms were the key factors associated with experiences of self-stigma. Clients living in community settings should be assessed regularly for depressive symptoms of mental disorders, and interventions should be conducted, especially at an early stage of the illness, to reduce self-stigma. Factors associated with self-stigma should be taken into account in the future development of interventions to reduce stigma.
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Michas G, Magriplis E, Micha R, Chourdakis M, Koutelidakis A, Dimitriadis G, Panagiotakos D, Zampelas A. WITHDRAWN: Prevalence and factors associated with smoking in a nationally representative sample of Greek adults: The Hellenic National Nutrition and Health Survey (HNNHS). Hellenic J Cardiol 2022:S1109-9666(22)00068-9. [PMID: 35605945 DOI: 10.1016/j.hjc.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 05/02/2022] [Accepted: 05/14/2022] [Indexed: 11/18/2022] Open
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.hjc.2022.05.005. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal
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Affiliation(s)
- George Michas
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece
| | - Emmanuella Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece
| | - Renata Micha
- Department of Food Science and Nutrition, School of Agricultural Sciences, University of Thessaly, 43 100, Karditsa, Greece
| | - Michail Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54 124 Thessaloniki, Greece
| | - Antonis Koutelidakis
- Department of Food Science and Nutrition, University of Aegean, Mytilini, Greece
| | - George Dimitriadis
- 2(nd) 1Department of Internal Medicine, Research Institute and Diabetes Center, National and Kapodistrian University of Athens, Attikon University Hospital, Haidari, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education Harokopio University, Athens, Eleftheriou Venizelou 70, 176 76 Athens, Greece
| | - Antonis Zampelas
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece.
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13
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Kintzoglanakis K, Gkousiou A, Vonta P, Sagmatopoulos A, Copanitsanou P. Depression, anxiety, and diabetes-related distress in type 2 diabetes in primary care in Greece: Different roles for glycemic control and self-care. SAGE Open Med 2022; 10:20503121221096605. [PMID: 35600704 PMCID: PMC9118887 DOI: 10.1177/20503121221096605] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/05/2022] [Indexed: 12/28/2022] Open
Abstract
Objectives: The psychological distress of people living with diabetes is increased and associated with poorer glycemic outcomes and self-care. We aimed to examine the frequency of depression, anxiety, and diabetes-related distress (DRD) of individuals with type 2 diabetes (T2D) in primary care (PC) and their comparative associations with clinical, self-care, and socio-demographic characteristics, testing for possible different roles on glycemic control and self-care. Methods: This is a cross-sectional study of 182 adults with a T2D diagnosis of at least six months, recruited between August 2019-March 2020 and May-October 2020, from an urban PC unit. Participants were screened for symptoms of depression (Patient Health Questionnaire-9 (PHQ-9)), anxiety (Generalized Anxiety Disorder-7 (GAD-7)), and DRD (Diabetes Distress Scale (DDS)). Clinical, self-care, and socio-demographic parameters were recorded. Results: The frequency of clinically significant symptoms of depression was 16.6%, (PHQ-9 score ⩾10), anxiety 17.7% (GAD-7 score ⩾10), and DRD 22.6% (DDS score ⩾2). All PHQ-9, GAD-7, and DDS scores intercorrelated, and higher scores were found to be associated with female gender, lower income, and prior diagnosis of depression. Higher PHQ-9 and GAD-7 scores were found to be associated with lower education, more hypoglycemia episodes, more blood glucose self-tests and antidepressant or benzodiazepine use. The retired/housewives scored significantly lower in GAD-7 and DDS compared to the unemployed participants. Higher DDS scores were associated with higher glycated hemoglobin, higher fasting plasma glucose, and insulin use. It was also noted that higher PHQ-9 scores were associated with lower uric acid levels and were significantly higher in the sedentary lifestyle group. Conclusion: DRD was associated with poorer glycemic outcomes while depressive symptoms were associated with lower physical activity perhaps sharing different roles for glycemic control and self-care. The psychological burden of individuals with T2D may be considered in PC.
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Affiliation(s)
| | | | | | | | - Panagiota Copanitsanou
- General Hospital of Piraeus “Tzaneio,” Piraeus, Greece
- Department of Nursing Science, National and Kapodistrian University of Athens, Athens, Greece
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14
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Depression and Anxiety Symptoms in Adolescents and Young Adults in Greece: prevalence and associated factors. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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15
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Alexopoulos P, Roukas D, Efkarpidis A, Konstantopoulou G, Soldatos R, Karaivazoglou K, Kontogianni E, Assimakopoulos K, Iliou T, Εconomou P, Gourzis P, Politis A. Hospital workforce mental reaction to the pandemic in a low COVID-19 burden setting: a cross-sectional clinical study. Eur Arch Psychiatry Clin Neurosci 2022; 272:95-105. [PMID: 33904979 PMCID: PMC8078092 DOI: 10.1007/s00406-021-01262-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/20/2021] [Indexed: 11/26/2022]
Abstract
Τhe COVID-19 pandemic has mental health implications for both healthcare workforces and general population, particularly in regions heavily hit by the crisis. Τhe study aimed (i) to investigate anxiety- and depression severity differences between staff of a COVID-19 treatment unit (N = 84) and a hospital without such a unit (N = 55) in comparison to participants of a convenience general population online survey (N = 240) and (ii) to explore relations between such symptoms and hospital staff reaction to COVID-19 in a low COVID-19 burden setting. Anxiety was studied with the Generalized Anxiety Disorder 7-Item in hospital workforces and with the Hospital Anxiety Depression Scale (HADS) in online survey participants. Depression symptoms were assessed with the Patient Health Questionnaire-9 in hospital employees and the HADS in the online survey sample. Symptoms were classified as absent/minimal, borderline abnormal or indicating clinical caseness. Staff reaction to COVID-19 was tapped with a 9-item-questionnaire and the 22-item Impact of Event Scale-revised (IES-R). Proper tests for differences and stepwise ordered logistic regression models were employed. Anxiety- and depression severity was higher in hospital workforces than in online survey participants (P < 0.05). Anxiety was more severe in frontline- compared to backstage employees (P < 0.001) was inversely correlated with age (P = 0.011) and positively with avoidance (P = 0.028). Both anxiety and depression symptoms related to intrusion symptoms (P < 0.001). Regarding the relatively long data collection period, an inverse association between crisis duration and depression symptoms was detected (P = 0.025). These observations point to the urgent need for distress-mitigating interventions for hospital workforces even in low COVID-19 burden settings.
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Affiliation(s)
- Panagiotis Alexopoulos
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Patras University General Hospital, University of Patras, Patras, Greece.
- Department of Psychiatry and Psychotherapy, Klinikum Rechts Der Isar, Faculty of Medicine, Technische Universität München, Munich, Germany.
| | - Dimitrios Roukas
- Department of Psychiatry, 417 Army Equity Fund Hospital (NIMTS) Hospital, Athens, Greece
| | - Apostolos Efkarpidis
- Nursing Services Department, General Hospital of Syros "Vardakeio and Proio", Ermoupolis, Greece
| | - Georgia Konstantopoulou
- Special Office for Health Consulting Services and Faculty of Education and Social Work, School of Humanities and Social Sciences, University of Patras, Patras, Greece
| | - Rigas Soldatos
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Karaivazoglou
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Patras University General Hospital, University of Patras, Patras, Greece
| | - Evagellia Kontogianni
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Assimakopoulos
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Patras University General Hospital, University of Patras, Patras, Greece
| | - Theodoros Iliou
- Medical Informatics Laboratory, Faculty of Medicine, School of Health Sciences, Democritus University of Thrace, Alexandroupolis, Greece
| | - Polychronis Εconomou
- Department of Civil Engineering (Statistics), University of Patras, Patras, Greece
| | - Philippos Gourzis
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Patras University General Hospital, University of Patras, Patras, Greece
| | - Antonios Politis
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry, Johns Hopkins Medical School, Baltimore, MD, USA
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16
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Janela D, Costa F, Molinos M, Moulder RG, Lains J, Francisco GE, Bento V, Cohen SP, Correia FD. Asynchronous and Tailored Digital Rehabilitation of Chronic Shoulder Pain: A Prospective Longitudinal Cohort Study. J Pain Res 2022; 15:53-66. [PMID: 35035234 PMCID: PMC8755939 DOI: 10.2147/jpr.s343308] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/22/2021] [Indexed: 12/21/2022] Open
Abstract
Background Chronic shoulder pain (SP) is responsible for significant morbidity, decreased quality of life and impaired work ability, resulting in high socioeconomic burden. Successful SP management is dependent on adherence and compliance with effective evidence-based interventions. Digital solutions may improve accessibility to such treatments, increasing convenience, while reducing healthcare-related costs. Purpose Present the results of a fully remote digital care program (DCP) for chronic SP. Patients and Methods Interventional, single-arm, cohort study of individuals with chronic SP applying for a digital care program. Primary outcome was the mean change between baseline and 12 weeks on the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Secondary outcomes were change in pain (NPRS), analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI) and engagement. Results From 296 patients at program start, 234 (79.1%) completed the intervention. Changes in QuickDASH between baseline and end-of-program were both statistically (p < 0.001) and clinically significant, with a mean reduction of 51.6% (mean −13.45 points, 95% CI: 11.99; 14.92). Marked reductions were also observed in all secondary outcomes: 54.8% in NPRS, 44.1% ceased analgesics consumption, 55.5% in surgery intent, 37.7% in FABQ-PA, 50.3% in anxiety, 63.6% in depression and 66.5% in WPAI overall. Higher engagement was associated with higher improvements in disability. Mean patient satisfaction score was 8.7/10.0 (SD 1.6). Conclusion This is the first real-world cohort study reporting the results of a multimodal remote digital approach for chronic SP rehabilitation. High completion and engagement rates were observed, which were associated with clinically significant improvement in all health-related outcomes, as well as marked productivity recovery. These promising results support the potential of digital modalities to address the global burden of chronic musculoskeletal pain.
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Affiliation(s)
- Dora Janela
- SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA
| | - Fabíola Costa
- SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA
| | - Maria Molinos
- SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA
| | - Robert G Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center McGovern Medical School, and TIRR Memorial Hermann, Houston, TX, USA
| | - Virgílio Bento
- SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA
| | - Steven P Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Fernando Dias Correia
- SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA.,Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Khaled SM, Amro I, Bader L, Woodruff P, Alabdulla MA, Bellaj T, Marzouk Y, Hasan Y, Al-Kaabi IM, Haddad PM. Factors associated with depression and anxiety in the adult population of Qatar after the first COVID-19 wave: a cross-sectional study. DISCOVER PSYCHOLOGY 2021. [PMCID: PMC8686347 DOI: 10.1007/s44202-021-00009-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is limited data from Arabic-speaking countries on risk factors for depression and anxiety during the COVID-19 pandemic. Country-specific data is necessary given differences in culture, demographics, and COVID-19 infection and mortality rates. The main purpose of the study is to identify the factors associated with symptoms of depression-anxiety in the adult population of Qatar during the first year of the COVID-19 pandemic. We conducted a cross-sectional online survey in Qatar between July and December 2020 after Qatar’s first COVID-19 wave and before the beginning of the second wave. Depression-anxiety was defined as a cut-off of 20 or higher on the Patient Health Questionnaire-Anxiety Depression Scale (PHQ-ADS). Of 1138 participants, 71.0% were female, 69.0% Arabs, 70.0% Non-Qataris, and 77.0% were < 40 years (the median age in Qatar is 32 years). In a fully-adjusted model, six variables were significantly associated with moderate-to-severe levels of depression or anxiety on the PHQ-ADS; Arab ethnicity (OR = 1.67, p = 0.026), never married versus married (OR = 1.69, p = 0.015), prior history of psychiatric disorder versus no history (OR = 1.80, p = 0.009), increased worries due to social media use for COVID-related news/updates (OR = 1.72, p = 0.003), a history of COVID-19 (OR = 1.76, p = 0.039), loneliness (OR = 1.91, p < 0.001), and lower levels of religiosity (OR = 0.96, p = 0.039). These associations also pertained in the reduced model, with the exception of religiosity which was only marginally statistically significant (OR = 0.97, p = 0.055). The potential risk factors identified may assist with anxiety and depression prevention in future COVID-19 waves, and similar national events, and assist with early intervention to treat sufferers.
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Affiliation(s)
- Salma Mawfek Khaled
- Social and Economic Survey Research Institute –SESRI, Qatar University, P.O. Box: 2713, Doha, Qatar
- Department of Public Health, College of Health Sciences, Qatar University, P.O. Box 2713, Doha, Qatar
- Department of Population Medicine, College of Medicine, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Iman Amro
- Social and Economic Survey Research Institute –SESRI, Qatar University, P.O. Box: 2713, Doha, Qatar
| | - Lina Bader
- Social and Economic Survey Research Institute –SESRI, Qatar University, P.O. Box: 2713, Doha, Qatar
| | - Peter Woodruff
- University of Sheffield, Western Bank, Sheffield, S10 2TN UK
| | - Majid A. Alabdulla
- Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
- Clinical Science Department, College of Medicine, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Tarek Bellaj
- College of Art and Sciences, Qatar University, P.O. Box: 2713, Doha, Qatar
| | - Yousri Marzouk
- College of Art and Sciences, Qatar University, P.O. Box: 2713, Doha, Qatar
| | - Youssef Hasan
- College of Art and Sciences, Qatar University, P.O. Box: 2713, Doha, Qatar
| | | | - Peter M. Haddad
- Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
- Clinical Science Department, College of Medicine, Qatar University, P.O. Box 2713, Doha, Qatar
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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Eleftheriou A, Rokou A, Arvaniti A, Nena E, Steiropoulos P. Sleep Quality and Mental Health of Medical Students in Greece During the COVID-19 Pandemic. Front Public Health 2021; 9:775374. [PMID: 34869189 PMCID: PMC8639533 DOI: 10.3389/fpubh.2021.775374] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/27/2021] [Indexed: 01/09/2023] Open
Abstract
Background-Aim: Medical students have been greatly affected by the COVID-19 pandemic due to their educational program, which comprises theoretical knowledge and also clinical duties, making them vulnerable to viral exposures and possibly affecting their everyday life. The aim of this study was to explore changes in sleep and mental health parameters among medical students in Greece during the second year of the pandemic. Methods: This cross-sectional study comprised students of all medical schools in Greece (n = 7), using an anonymous online survey. Participants completed the following questionnaires: Pittsburgh Sleep Quality Index (PSQI), Athens Insomnia Scale (AIS), Fatigue Severity Scale (FSS), General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9). Statistical analysis was conducted with the use of SPSS v.26 (IBM SPSS, Armonk NY, USA). Results: Out of the 562 received responses, 559 met the inclusion criteria. The largest proportion of the respondents came from 4th-year (27.8%) and the majority of the sample were females (69.8%). Only 5.9% of the participants reported having been infected by SARS-COV-2. Most of the respondents experienced insomnia (65.9%, mean AIS score: 7.59 ± 4.24), poor sleep quality (52.4%, mean PSQI score: 6.6 ± 3.25) and increased fatigue (48.5%, mean 35.82 ± 11.74). Moderate to severe symptoms of anxiety (mean 9.04 ± 5.66) and depression (mean 9.36 ± 6.15) were noted. Suicidal ideation was found in 16.7% of the sample, while use of sleeping pills in the previous month was reported by 8.8% (n = 47). Further analysis revealed independent associations between sleep and mental health parameters. Higher AIS score was associated with greater FSS score; higher PSQI scores with higher GAD-7 and PHQ-9 scores. Additionally, female students were found to be significantly more affected than males by the COVID-19 pandemic, displaying higher levels of insomnia, sleep disturbances, anxiety and depression. In addition, those with a history of COVID-19 infection or in close proximity with a positive case reported significantly more significant post-traumatic symptoms in IES-COVID-19 questionnaire. Conclusions: In the aftermath of the COVID-19 pandemic, prevalence of sleep and mental health disorders among Greek medical students is significant, highlighting the need for better surveillance of students' wellbeing and subsequent counseling, with special focus on female students and other affected groups.
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Affiliation(s)
- Anna Eleftheriou
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Aikaterini Rokou
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Aikaterini Arvaniti
- Department of Psychiatry, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evangelia Nena
- Laboratory of Social Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Paschalis Steiropoulos
- Department of Pulmonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece,*Correspondence: Paschalis Steiropoulos
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Parperis K, Psarelis S, Chatzittofis A, Michaelides M, Nikiforou D, Antoniade E, Bhattarai B. Association of clinical characteristics, disease activity and health-related quality of life in SLE patients with major depressive disorder. Rheumatology (Oxford) 2021; 60:5369-5378. [PMID: 33547787 DOI: 10.1093/rheumatology/keab123] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine the contributing factors associated with major depressive disorder (MDD) in SLE patients and examine the association between disease-specific health-related quality of life [lupus quality of life (LupusQoL)] domains and MDD. METHODS Depression was assessed by the patient health questionnaire (PHQ)-9, and scores ≥10 indicate MDD. Demographic data, LupusQoL domains, clinical and other features of the SLE patients were described and compared between MDD (PHQ-9 ≥10) and non-MDD (PHQ-9 <10) groups using χ2 tests for categorical variables and Wilcoxon rank sum tests for non-normal continuous variables. The risk of MDD was evaluated for the patient and physician-reported features individually using log-binomial models to estimate relative risks and 95% confidence limits. RESULTS Eighty-eight patients with SLE met eligibility criteria, with a mean (range) age of 48.6 (19-80), mostly female (80%) and with a mean disease duration of 13.2 years. Compared with the non-MDD group, patients with MDD (n = 32, 36%) were more likely to have the following SLE manifestations: mucocutaneous, vascular, ocular, pulmonary and musculoskeletal involvement. Self-rated health described as poor/fair was markedly associated with MDD (P < 0.001, relative risk = 0.48). Based on relative risks, higher pain visual analogue score, and patient and physician global assessment scores were also linked to MDD. The LupusQoL domain scores were notably lower in the MDD patients, with a statistically significant reduction in all LupusQoL domains. CONCLUSION Predictors of MDD in SLE patients include higher scores in pain and global assessment, poor or fair self-reported health, and specific organ involvement. These findings may help clinicians to recognize and manage MDD promptly.
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Affiliation(s)
- Konstantinos Parperis
- Department of Medicine, Division of Rheumatology, University of Cyprus Medical School, Nicosia, Cyprus and University of Arizona College of Medicine, Phoenix, AZ, USA
| | | | | | | | | | - Elpida Antoniade
- Department of Medicine, University of Cyprus Medical School, Nicosia, Cyprus
| | - Bikash Bhattarai
- Department of Biostatistics, Valleywise Health and University of Arizona College of Medicine, Phoenix, Arizona, USA
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20
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Voitsidis P, Nikopoulou VA, Holeva V, Parlapani E, Sereslis K, Tsipropoulou V, Karamouzi P, Giazkoulidou A, Tsopaneli N, Diakogiannis I. The mediating role of fear of COVID-19 in the relationship between intolerance of uncertainty and depression. Psychol Psychother 2021; 94:884-893. [PMID: 33216444 PMCID: PMC7753422 DOI: 10.1111/papt.12315] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/04/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Living during the COVID-19 pandemic is characterized by the emergence of great uncertainty surrounding multiple aspects of daily life. This study explored the relationship between intolerance of uncertainty (IU) and depression, as well as the potential mediation effect of COVID-19-related fear. DESIGN AND METHODS A cross-sectional study was conducted through an online survey from 10 April until 13 April 2020, three weeks after a national lockdown had been imposed in Greece. The convenience sample used in this study consisted of 2,827 adults. Participants voluntarily provided sociodemographic data and completed the following scales: the Intolerance of Uncertainty Scale (IUS-12), the Fear of COVID-19 Scale (FCV-19S), and the Brief Patient Health Questionnaire (PHQ-9) Depression Scale. RESULTS Participants appeared to be moderately depressed [M = 14.75, SD = 4.52]. There was a significant indirect effect of IU to depressive symptoms ((.058), CI (0.051-0.066)). FCV-19S was tested as a mediator in the relationship between IUS-12 (independent variable) and PHQ-9 (dependent variable). Partial mediation of fear of COVID-19 was supported ((.54) (.41) = 13, CI (0.051-0.066), Sobel z-value = 14.93). CONCLUSIONS Depressive symptomatology affected study participants at a moderate level. IU was shown to be a significant predictor of depressive symptomatology with higher levels of IU being associated with more severe depressive symptoms. Fear of COVID-19 partially mediated this association. The mediation effect may be explained by the uncertainty around COVID-19-related health issues, which are reflected in the FCV-19S and cause worry and/or anxiety. Uncertainty related with other factors, such as the impact on the economy and education, not assessed by the FCV-19S, may explain part of the relationship between IU and depressive symptoms that is not mediated by FCV-19S. PRACTITIONER POINTS Intolerance of uncertainty is related to depressive symptomatology, and fear of COVID-19 explains part of the relation. Fear of COVID-19 indicates worry and anxiety related to health issues. Psychotherapeutic interventions enhancing individuals' capacity to endure uncertainty could be beneficial. Provision of simple and clear information by the authorities should be a priority issue.
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Affiliation(s)
- Panteleimon Voitsidis
- 1st Department of PsychiatrySchool of MedicineAristotle University of ThessalonikiThessalonikiGreece
| | - Vasiliki Aliki Nikopoulou
- 1st Department of PsychiatrySchool of MedicineAristotle University of ThessalonikiThessalonikiGreece
| | - Vasiliki Holeva
- 1st Department of PsychiatrySchool of MedicineAristotle University of ThessalonikiThessalonikiGreece
| | - Eleni Parlapani
- 1st Department of PsychiatrySchool of MedicineAristotle University of ThessalonikiThessalonikiGreece
| | - Konstantinos Sereslis
- 1st Department of PsychiatrySchool of MedicineAristotle University of ThessalonikiThessalonikiGreece
| | - Virginia Tsipropoulou
- 1st Department of PsychiatrySchool of MedicineAristotle University of ThessalonikiThessalonikiGreece
| | - Panayiota Karamouzi
- 1st Department of PsychiatrySchool of MedicineAristotle University of ThessalonikiThessalonikiGreece
| | - Aikaterini Giazkoulidou
- 1st Department of PsychiatrySchool of MedicineAristotle University of ThessalonikiThessalonikiGreece
| | - Nektaria Tsopaneli
- 1st Department of PsychiatrySchool of MedicineAristotle University of ThessalonikiThessalonikiGreece
| | - Ioannis Diakogiannis
- 1st Department of PsychiatrySchool of MedicineAristotle University of ThessalonikiThessalonikiGreece
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Neupane D, Levis B, Bhandari PM, Thombs BD, Benedetti A. Selective cutoff reporting in studies of the accuracy of the Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale: Comparison of results based on published cutoffs versus all cutoffs using individual participant data meta-analysis. Int J Methods Psychiatr Res 2021; 30:e1873. [PMID: 33978306 PMCID: PMC8412225 DOI: 10.1002/mpr.1873] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/16/2021] [Accepted: 04/01/2021] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Selectively reported results from only well-performing cutoffs in diagnostic accuracy studies may bias estimates in meta-analyses. We investigated cutoff reporting patterns for the Patient Health Questionnaire-9 (PHQ-9; standard cutoff 10) and Edinburgh Postnatal Depression Scale (EPDS; no standard cutoff, commonly used 10-13) and compared accuracy estimates based on published cutoffs versus all cutoffs. METHODS We conducted bivariate random effects meta-analyses using individual participant data to compare accuracy from published versus all cutoffs. RESULTS For the PHQ-9 (30 studies, N = 11,773), published results underestimated sensitivity for cutoffs below 10 (median difference: -0.06) and overestimated for cutoffs above 10 (median difference: 0.07). EPDS (19 studies, N = 3637) sensitivity estimates from published results were similar for cutoffs below 10 (median difference: 0.00) but higher for cutoffs above 13 (median difference: 0.14). Specificity estimates from published and all cutoffs were similar for both tools. The mean cutoff of all reported cutoffs in PHQ-9 studies with optimal cutoff below 10 was 8.8 compared to 11.8 for those with optimal cutoffs above 10. Mean for EPDS studies with optimal cutoffs below 10 was 9.9 compared to 11.8 for those with optimal cutoffs greater than 10. CONCLUSION Selective cutoff reporting was more pronounced for the PHQ-9 than EPDS.
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Affiliation(s)
- Dipika Neupane
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, UK
| | - Parash M Bhandari
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada.,Department of Medicine, McGill University, Montréal, Québec, Canada.,Department of Psychology, McGill University, Montréal, Québec, Canada.,Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada.,Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Department of Medicine, McGill University, Montréal, Québec, Canada.,Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec, Canada
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22
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Petrelis M, Domeyer PR. Translation and validation of the Greek version of the Somatic Symptom Scale-8 (SSS-8) in patients with chronic low back pain. Disabil Rehabil 2021; 44:4467-4473. [PMID: 33725461 DOI: 10.1080/09638288.2021.1900415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE To translate and validate the Greek version of the Somatic Symptom Scale-8 (SSS-8) in patients with chronic low back pain (CLBP). MATERIALS AND METHODS The Greek SSS-8, created through forth and back translation and cultural adaption processes, was handed over to 145 patients recruited using simple random sampling. Test-retest, composite, and internal consistency reliability were assessed. Construct validity was examined by assessing correlations with Patient Health Questionnaire-15 (PHQ-15), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and EuroQoL 5-dimension 5-level (EQ-5D-5L) instruments. Structural validity was assessed using confirmatory factor analysis (CFA). Convergent, discriminant, and known group validity were also evaluated. RESULTS The response rate was 95.1% (138 subjects, mean age 43.2 ± 11.7) and the overall Cronbach's alpha was 0.831. Test-retest reliability assessment revealed excellent results (Pearson's r > 0.996; Lin's concordance coefficient > 0.995; intraclass correlation coefficient >0.995, all p < 0.001). Composite reliability scores for the pain, cardiopulmonary, and fatigue domains were 0.712, 0.787, and 0.567, respectively. The correlation analyses indicated good construct validity. CFA revealed excellent fit results and known group validity output indicated a linear increasing trend in the severity of somatic symptom disorders (SSDs), depression, and anxiety with higher PHQ-15, PHQ-9, and GAD-7 scores (Jonckheere-Terpstra test, p value < 0.001). CONCLUSIONS The Greek SSS-8 was shown to be a reliable and valid tool for measuring SSDs in patients with CLBP.Implications for RehabilitationAccording to the Global Burden of Diseases Study 2017, LBP was one of the leading causes of disability for both sexes combined since 1990.Strategies to identify SSDs in patients with LBP at an earlier stage are essential both for the provision of an optimal targeted treatment and for minimizing its direct and indirect economic burden.The Greek SSS-8 is a standardized and validated instrument, which its utilization will enhance the physical therapy assessment process in the Greek population.Not only is the SSS-8 an easy-to-use and highly accurate diagnostic tool for detecting SSDs, but also a short alternative to PHQ-15 in settings with limited assessment time.
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Affiliation(s)
- Matthaios Petrelis
- Department of Health Care Management, School of Social Sciences, Hellenic Open University, Patra, Greece.,TYPET Physiotherapy Department, Athens, Greece
| | - Philippe-Richard Domeyer
- Department of Health Care Management, School of Social Sciences, Hellenic Open University, Patra, Greece.,TYPET Physiotherapy Department, Athens, Greece
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23
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Michas G, Magriplis E, Micha R, Chourdakis M, Chrousos GP, Roma E, Dimitriadis G, Panagiotakos D, Zampelas A. Sociodemographic and lifestyle determinants of depressive symptoms in a nationally representative sample of Greek adults: The Hellenic National Nutrition and Health Survey (HNNHS). J Affect Disord 2021; 281:192-198. [PMID: 33326892 DOI: 10.1016/j.jad.2020.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/08/2020] [Accepted: 12/05/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The aim of this study was to assess depressive symptomatology prevalence among Greek adults amidst the financial crisis and to explore the association between depressive symptoms and sociodemographic and lifestyle factors. METHODS The Hellenic National Nutrition and Health Survey including a nationally representative adult sample (3,675 adults; 48.7% males) was used. Trained personnel gathered information on sociodemographic and anthropometric characteristics and lifestyle status. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and clinically relevant depressive symptomatology was defined as PHQ-9 score≥10, or on anti-depressant medication. Associations between depressive symptoms and the assessed factors were estimated using stratified multivariable logistic regression. RESULTS The prevalence of clinically relevant depression was 9.4%. In the regression, female sex, marital status (widowed vs. married), financial difficulties (yes vs. no), professional status (employed vs. unemployed), body mass index status (overweight/obese vs. normal weight), and smoking status (current and ex-smokers vs. never smokers) were significant, with an increased likelihood for depressive symptomatology in all variables, other than employment. LIMITATIONS The cross-sectional nature of the study does not allow detection of changes over time. Furthermore, it does not allow determining the presence of a temporal relationship between depression and the sociodemographic and lifestyle variables that we tested. CONCLUSION This study estimates a high prevalence of depressive symptoms among adults during the Greek financial crisis and points out important associations of depressive symptoms with different sociodemographic determinants and lifestyle factors, and provides policy health makers valuable information in their efforts to deal with this epidemic.
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Affiliation(s)
- George Michas
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece
| | - Emmanuella Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece
| | - Renata Micha
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece
| | - Michael Chourdakis
- Department of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54 124 Thessaloniki, Greece
| | - George P Chrousos
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 115 27 Athens, Greece
| | - Eleftheria Roma
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 115 27 Athens, Greece
| | - George Dimitriadis
- 2nd Department of Internal Medicine, Research Institute and Diabetes Center, National and Kapodistrian University of Athens, "Attikon" University Hospital, Haidari, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education Harokopio University, Athens, Eleftheriou Venizelou 70, 176 76 Athens, Greece
| | - Antonis Zampelas
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece.
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24
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Chatzittofis A, Karanikola M, Michailidou K, Constantinidou A. Impact of the COVID-19 Pandemic on the Mental Health of Healthcare Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041435. [PMID: 33546513 PMCID: PMC7913751 DOI: 10.3390/ijerph18041435] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 12/16/2022]
Abstract
The coronavirus disease 2019 (COVID-19) has a great impact on healthcare workers (HCWs) that includes negative mental health outcomes, such as post-traumatic stress, anxiety and depressive symptoms. In this cross-sectional study, we report on mental health outcomes among HCWs in Cyprus. Data were collected between 3 May and 27 May 2020, with the use of an online questionnaire that included demographics (sex, age, occupation, education, work sector, years of work experience), the 9-item Patient Health Questionnaire (PHQ-9) which assesses depressive symptoms, the Impact of Events Scale Revised (IES-R), which measures post-traumatic stress disorder (PTSD) symptoms, and the-10 item Perceived Stress Scale (PSS-10) which quantifies stress responses. Participants (42% physicians, 24% nurses, 18% physiotherapists, 16% classified as “other”) were 58% of female gender and aged 21–76. A total of 79 (18.6%) and 62 HCWs (14.6%) reported clinically significant depressive (PHQ-9 ≥ 10) and post-traumatic stress (IES-R > 33) symptoms respectively. Nurses were more likely than physicians to suffer from depression (adjusted prevalence ratio 1.7 (1.06–2.73); p = 0.035) and PTSD (adjusted prevalence ratio 2.51 (1.49–4.23); p = 0.001). Even in a country with a rather low spread of the COVID-19, such as Cyprus, HCWs reported a substantial mental health burden, with nurses reporting increased depressive and PTSD symptoms compared to other HCWs.
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Affiliation(s)
- Andreas Chatzittofis
- Medical School, University of Cyprus, Nicosia 1678, Cyprus;
- Department of Clinical Sciences/Psychiatry, Umeå University, 90187 Umeå, Sweden
- Correspondence:
| | - Maria Karanikola
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol 3041, Cyprus;
| | - Kyriaki Michailidou
- Biostatistics Unit, The Cyprus Institute of Neurology and Genetics and Cyprus School of Molecular Medicine, Nicosia 1683, Cyprus;
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25
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Chatzittofis A, Constantinidou A, Artemiadis A, Michailidou K, Karanikola MNK. The Role of Perceived Organizational Support in Mental Health of Healthcare Workers During the COVID-19 Pandemic: A Cross-Sectional Study. Front Psychiatry 2021; 12:707293. [PMID: 34790134 PMCID: PMC8591071 DOI: 10.3389/fpsyt.2021.707293] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Data support the link between the coronavirus disease 2019 (COVID-19) pandemic and mental distress in healthcare workers (HCWs). Although previous studies have documented the association between organizational policies and employees' psychological and mental status, there is still scant evidence regarding the effect of perceived organizational support (POS) on mental distress in HCWs during the pandemic. Aims: The present study aimed to assess the association between POS and mental distress in HCWs during the COVID-19 pandemic. The role of POS in stress, depressive and trauma symptoms in HCWs was investigated. Methods: This was an online cross-sectional study in 424 HCWs. Data were collected during the first wave of the pandemic, and included demographics, a 7-item questionnaire assessing POS, the "Patient Health Questionnaire" assessing depressive symptoms, the "Impact of Events Scale Revised," measuring post-traumatic stress disorder (PTSD) symptoms and the "Perceived Stress Scale" assessing perceived stress. Results: The mean POS score was 3.33 [standard deviation:1.85; range 0-7]. Younger (p < 0.001), less experienced (p < 0.001), female (p = 0.002), and non-physician HCWs (p = 0.031) were more likely to report lower self-perceived organizational support than older, male, more experienced physicians. Self-perceived organizational support was significantly and negatively associated with and self-assessed intensity of stress, depressive and traumatic symptoms, after adjusting for putative confounders (p < 0.001). Discussion: Self-perceived organizational support was significantly associated with HCWs' self-assessed mental status during the pandemic. Organizational support and mental distress should be addressed simultaneously in HCWs during the COVID-19 pandemic to increase resilience among them.
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Affiliation(s)
- Andreas Chatzittofis
- Medical School, University of Cyprus, Nicosia, Cyprus.,Department of Clinical Sciences and Psychiatry, Umeå University, Umeå, Sweden
| | | | | | - Kyriaki Michailidou
- Biostatistics Unit, Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Maria N K Karanikola
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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26
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Smarr KL, Keefer AL. Measures of Depression and Depressive Symptoms. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:608-629. [PMID: 33091258 DOI: 10.1002/acr.24191] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/17/2020] [Indexed: 01/27/2023]
Affiliation(s)
- Karen L Smarr
- Harry S. Truman Memorial Veterans' Hospital and University of Missouri School of Medicine, Columbia
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27
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Siarava E, Hyphantis T, Pelidou SH, Kyritsis AP, Markoula S. Factors related to the adverse events of antiepileptic drugs. Epilepsy Behav 2020; 111:107199. [PMID: 32534420 DOI: 10.1016/j.yebeh.2020.107199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the present study was to explore the factors related to the severity of the adverse effects of antiepileptic drugs (AEDs), experienced by patients with epilepsy. MATERIALS AND METHODS A case study was conducted in adult patients with epilepsy and followed up at the Epilepsy Outpatients of the University Hospital of Ioannina in Northwest Greece. The Adverse Event Profile (AEP) questionnaire for AEDs adverse effects assessment, the Defense style questionnaire (DSQ-88) and the Patient Health Questionnaire (PHQ-9) for depression' severity evaluation were used to estimate the severity of adverse effects, the defense style, and the depressive symptoms, respectively. RESULTS Sixty-three patients with epilepsy (M/F:28/35), with a mean age of 37.6 ± 13.41, were recruited in the study. The univariate analysis showed that both the Maladaptive style of defense and the PHQ-9 score were significantly associated with the AEP score. After multivariate regression analysis female gender, the load of AEDs, the PHQ-9 score, and the Adaptive defense style remained significant coefficients. CONCLUSION There are also nonpharmacological factors that may contribute to the severity of the adverse effects of AEDs, experienced by the patients with epilepsy.
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Affiliation(s)
- Eleftheria Siarava
- Department of Neurology, University of Ioannina, Ioannina 45110, Greece.
| | - Thomas Hyphantis
- Department of Psychiatry, University of Ioannina, Ioannina 45110, Greece
| | | | | | - Sofia Markoula
- Department of Neurology, University of Ioannina, Ioannina 45110, Greece
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28
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Parlapani E, Holeva V, Nikopoulou VA, Sereslis K, Athanasiadou M, Godosidis A, Stephanou T, Diakogiannis I. Intolerance of Uncertainty and Loneliness in Older Adults During the COVID-19 Pandemic. Front Psychiatry 2020; 11:842. [PMID: 32973584 PMCID: PMC7468454 DOI: 10.3389/fpsyt.2020.00842] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/03/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic imposed a psychological burden on people worldwide, including fear and anxiety. Older adults are considered more vulnerable during public health emergency crises. Therefore, the aim of the present study was to investigate the psychological response of older adults during the acute phase of the pandemic in Greece. METHOD This cross-sectional study was part of a larger three-day online survey. A total of 103 participants over the age of 60 fulfilled inclusion criteria. The survey included sociodemographic questions and six psychometric scales: the Fear of COVID-19 Scale (FCV-19S), the Brief Patient Health Questionnaire (PHQ-9) depression scale, the Generalized Anxiety Disorder scale (GAD-7), the Athens Insomnia Scale (AIS), the Intolerance of Uncertainty Scale (IUS-12), and the De Jong Gierveld Loneliness Scale (JGLS). RESULTS A significant proportion of the participants reported moderate to severe depressive symptoms (81.6%), moderate to severe anxiety symptoms (84.5%), as well as disrupted sleep (37.9%). Women reported significantly higher levels of COVID-19-related fear, more severe depressive symptoms and sleep disturbances, as well as higher levels of intolerance of uncertainty. Participants living alone showed higher levels of loneliness. Intolerance of uncertainty was shown to modulate levels of loneliness. CONCLUSIONS During the quarantine, attention was promptly drawn upon the risks related with older people's loneliness. Studies identifying factors that may contribute to loneliness during a public health emergency facilitate the implementation of supportive interventions. Preparedness to address and manage older people's loneliness may limit this deleterious emotional response during the pandemic, as well as at the post-COVID-19 phase.
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Affiliation(s)
- Eleni Parlapani
- 1st Department of Psychiatry, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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29
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Rapti E, Damigos D, Apostolara P, Roka V, Tzavara C, Lionis C. Patients with chronic pain: evaluating depression and their quality of life in a single center study in Greece. BMC Psychol 2019; 7:86. [PMID: 31864407 PMCID: PMC6925892 DOI: 10.1186/s40359-019-0366-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/12/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Chronic pain constitutes one of the most common reasons for seeking health care services and may even lead to disability. Chronic pain has been associated with depression and deterioration of the quality of life. The aim of our study is to outline the burden of chronic pain in the context of a primary health care (PHC) setting in Greece and to investigate its association with depression and quality of life. METHODS A cross-sectional study was conducted from September 2016 to November 2016. The subjects of the study comprised 200 individuals who visited the regional medical center of Ag. Theodoroi, Greece. The collected data were from a representative sample of 200 adults and included demographic data, social and medical history, presence and characteristics of chronic pain and questions from three questionnaires for the assessment of pain (BPI- short form), the investigation of depression (PHQ-9) and the evaluation of the quality of life (EuroQ-5D) validated in Greek language. Multiple regression analysis was used in order to find associated factors with quality of life, depression and chronic pain. RESULTS A percentage of 56.8% of the participants, the majority of whom (62%) were women, reported chronic pain. Among individuals with pain, lower back area was the most common location. Based on the given questionnaire, depression was detected in 22. 5% of the participants who claimed chronic pain. Regression analyses revealed that women and respondents with chronic mental disorders like depression and anxiety had significantly higher scores on the pain scale and suffered pain which had a greater impact on their daily activities. According to regression analysis decreased quality of life was expressed by women, as well as participants with a chronic mental disorder. A significant reverse correlation emerged between the quality of life, depression and pain scales. CONCLUSION Chronic pain, as it has been studied within this PHC setting, is a common health care problem. Individuals who had experienced chronic pain and depression had a lower health-related quality of life.
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Affiliation(s)
- Ekaterini Rapti
- Medical Center of Ag. Theodoroi-Loutrakiou, Dimitriou Stamou 8 St, Ag. Theodoroi, Corinthia, Greece
| | - Dimitrios Damigos
- Medical Psychology, Laboratory, Medical Psychology, University of Ioannina, Medical School, University of Ioannina, Ioannina, Greece
| | - Paraskevi Apostolara
- Nursing Department, University of West Attica, Scientific Partner of Faculty of NursingNational and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Roka
- Hellenic Navy, Navy Hospital of Athens, Scientific Partner of Faculty of Nursing, Adjunct Academic Staff, MSc Health Care Management, National and Kapodistrian University of Athens, Hellenic Open University, Athens, Greece
| | - Chara Tzavara
- Biostatistician, Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
| | - Christos Lionis
- General Practice and Primary Health Care, Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Greece
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30
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Basta M, Karakonstantis S, Koutra K, Dafermos V, Papargiris A, Drakaki M, Tzagkarakis S, Vgontzas A, Simos P, Papadakis N. NEET status among young Greeks: Association with mental health and substance use. J Affect Disord 2019; 253:210-217. [PMID: 31054446 DOI: 10.1016/j.jad.2019.04.095] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/27/2019] [Accepted: 04/21/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Prior studies have shown that young people "not in education, employment or training" ("NEET") are at higher risk for psychopathology and substance abuse. Similar studies are lacking in Southern European populations. We aimed to examine the associations of anxiety and depressive symptoms, and substance use with NEET status in a large, randomized population-based sample in Greece. METHODS A telephone structured questionnaire was conducted in a representative sample of 2771 young Greeks aged 15-24 years. Anxiety and depressive symptoms were assessed with GAD-7 and PHQ-9 scales, respectively. Substances use and several sociodemographic parameters were also examined. RESULTS In our sample 16.4% were NEETs. In multivariate analyses, NEETs compared to non-NEETs were older, with lower family income, without insurance and more likely to be married and smoke. Furthermore, NEET status was associated with a higher GAD-7 score among older NEETs and long-term NEETs (NEETs unemployed for more than a year). Moreover, being NEET among older participants was associated with severe symptoms of anxiety and moderate/severe symptoms of depression. LIMITATIONS This was a telephone survey and a clinical evaluation of the patients was not performed. Furthermore, the structured interview was not designed to detect the level of substance use or the reasons for being NEET. CONCLUSIONS NEET status is frequent among young Greeks. Older, and long-term NEETs appear to be at higher risk for presenting anxiety/depression symptoms. Whether NEET status is associated with adverse outcomes later in life requires longitudinal studies.
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Affiliation(s)
- Maria Basta
- Department of Psychiatry, University Hospital of Heraklion, Voutes, Heraklion, Crete Zip Code 71110, Greece..
| | - Stamatis Karakonstantis
- Department of Psychiatry, University Hospital of Heraklion, Voutes, Heraklion, Crete Zip Code 71110, Greece
| | - Katerina Koutra
- Department of Psychology, University of Crete, Rethymno, Greece
| | - Vassilis Dafermos
- Department of Political Science, University of Crete, Rethymno, Greece
| | | | - Maria Drakaki
- Department of Political Science, University of Crete, Rethymno, Greece
| | | | - Alexandros Vgontzas
- Department of Psychiatry, University Hospital of Heraklion, Voutes, Heraklion, Crete Zip Code 71110, Greece
| | - Panagiotis Simos
- Department of Psychiatry, University Hospital of Heraklion, Voutes, Heraklion, Crete Zip Code 71110, Greece
| | - Nikos Papadakis
- Department of Political Science, University of Crete, Rethymno, Greece
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31
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Khaled SM. Prevalence and potential determinants of subthreshold and major depression in the general population of Qatar. J Affect Disord 2019; 252:382-393. [PMID: 31003107 DOI: 10.1016/j.jad.2019.04.056] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/28/2019] [Accepted: 04/08/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is a paucity of epidemiological studies of depression in war-free Arab countries. This study estimated the prevalence and potential determinants of Subthreshold (SUBDE) and Major Depressive Episode (MDE) in migrants and non-migrants typical of Qatar and neighboring Gulf countries. METHODS A telephone survey of a probability-based sample of 2,424 participants was conducted in February 2017. The sample was divided based on nationality and income: Low-Income Migrants (LIMs), High Income Migrants (HIMs), and non-migrants or Qatari Nationals (QNs). Participants completed the nine-item Physician Health Questionnaire (PHQ-9). Ethnicity, sociodemographics, health- and work-related information was collected. Bivariate and multinomial logistic regression analyses were used. RESULTS Overall prevalence of any depression ranged between 4.2% (95% CI: 3.3-5.3) and 6.6% (95% CI: 5.4-7.9) for a cut-off of 12 and 10, respectively. The diagnostic algorithm for SUBDE and MDE resulted in estimates of 5.5% (95% CI: 4.4-6.8) and 3.6% (95% CI: 2.8-4.5), respectively. SUBDE, but not MDE rates, were significantly increased in LIMs (OR=2.96, p = 0.004) and HIMs (OR = 2.00, p = 0.014) compared with non-migrants. Arab ethnicity was significantly associated with SUBDE: relative to South Asians (OR = 3.77, p < 0.001) and other ethnicities (OR = 3.61, p = 0.029). Arab ethnicity was significantly associated with MDE: relative to South Asians (OR = 10.42, p < 0.001) and South East Asians (OR = 3.54, p = 0.007). LIMITATIONS Clinical diagnostic interviews for depression were not included. CONCLUSION Using the PHQ-9, depression prevalence in Qatar was comparable to general population estimates from Western countries. Migrant status and ethnicity were associated with SUBDE and MDE with implications for early screening and community intervention.
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Affiliation(s)
- Salma M Khaled
- Social and Economic Survey Research Institute, Qatar University, Doha, Qatar.
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Karageorgou D, Magriplis E, Mitsopoulou A, Dimakopoulos I, Bakogianni I, Micha R, Michas G, Chourdakis M, Ntouroupi T, Tsaniklidou S, Argyri K, Panagiotakos D, Zampelas A, Fappa E, Theodoraki EM, Trichia E, Sialvera TE, Varytimiadi A, Spyreli E, Koutelidakis A, Karlis G, Zacharia S, Papageorgiou A, Chrousos G, Dedoussis G, Dimitriadis G, Manios I, Roma E. Dietary patterns and lifestyle characteristics in adults: results from the Hellenic National Nutrition and Health Survey (HNNHS). Public Health 2019; 171:76-88. [DOI: 10.1016/j.puhe.2019.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/26/2019] [Accepted: 03/21/2019] [Indexed: 10/26/2022]
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Patrick S, Connick P. Psychometric properties of the PHQ-9 depression scale in people with multiple sclerosis: A systematic review. PLoS One 2019; 14:e0197943. [PMID: 30779803 PMCID: PMC6380554 DOI: 10.1371/journal.pone.0197943] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 01/28/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Depression affects approximately 25% of people with MS (pwMS) at any given time. It is however under recognised in clinical practice, in part due to a lack of uptake for brief assessment tools and uncertainty about their psychometric properties. The 9-item Patient Health Questionnaire (PHQ-9) is an attractive candidate for this role. OBJECTIVE To synthesise published findings on the psychometric properties of the 9-item Patient Health Questionnaire (PHQ-9) when applied to people with multiple sclerosis (pwMS). DATA SOURCES PubMed, Medline and ISI Web of Science databases, supplemented by hand-searching of references from all eligible sources. STUDY ELIGIBILITY CRITERIA Primary literature written in English and published following peer-review with a primary aim to evaluate the performance of the PHQ-9 in pwMS. OUTCOME MEASURES Psychometric performance with respect to appropriateness, reliability, validity, responsiveness, precision, interpretability, acceptability, and feasibility. RESULTS Seven relevant studies were identified, these were of high quality and included 5080 participants from all MS disease-course groups. Strong evidence was found supporting the validity of the PHQ-9 as a unidimensional measure of depression. Used as a screening tool for major depressive disorder (MDD) with a cut-point of 11, sensitivity was 95% sensitivity and specificity 88.3% (PPV 51.4%, NPV 48.6%). Alternative scoring systems that may address the issue of overlap between somatic features of depression and features of MS per se are being developed, although their utility remains unclear. However data on reliability was limited, and no specific evidence was available on test-retest reliability, responsiveness, acceptability, or feasibility. CONCLUSIONS The PHQ-9 represents a suitable tool to screen for MDD in pwMS. However use as a diagnostic tool cannot currently be recommended, and the potential value for monitoring depressive symptoms cannot be established without further evidence on test-retest reliability, responsiveness, acceptability, and feasibility. REGISTRATION PROSPERO register ID: CRD42017067814.
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Affiliation(s)
- Sarah Patrick
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Connick
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Drenkard C, Bao G, Lewis TT, Pobiner B, Priest J, Lim SS. Physician-patient interactions in African American patients with systemic lupus erythematosus: Demographic characteristics and relationship with disease activity and depression. Semin Arthritis Rheum 2019; 48:669-677. [PMID: 30075991 PMCID: PMC6509352 DOI: 10.1016/j.semarthrit.2018.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/18/2018] [Accepted: 05/29/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE African American patients with systemic lupus erythematosus (SLE) are at high risk for poor outcomes. Both patient characteristics and the severity of the disease may influence physician-patient interactions, which in turn can impact disease outcomes. We aimed to examine whether patient perceptions of interpersonal processes of care (i.e. physician-patient interactions) varied by demographic characteristics, disease activity, and/or depression in African American patients with SLE. METHODS The Georgians Organized Against Lupus (GOAL) is a cohort drawn from a population-based registry of people with SLE. We conducted a cross-sectional analysis of patient-reported data collected in 2016-17 among 698 African American participants (out of 863 GOAL participants). We assessed physician-patient interactions (communication, patient-centered decision making, and physician interpersonal style) through the Interpersonal Processes of Care survey (IPC-29), disease activity through the Systemic Lupus Activity Questionnaire, and depression through the Patient Health Questionnaire-9. Mean scores of the IPC-29 scales were compared by gender, age and educational attainment with Wilcoxon rank-sum 2-sample test or Kruskal Wallis test. We conducted linear trend test to examine demographic-adjusted scores of IPC across severity of disease activity and depression, and multivariate logistic regression analyses to examine the association of disease activity and depression with suboptimal IPC scores. RESULTS Overall, the lowest mean scores were observed for the patient-centered decision making domain, and specifically about how often doctors assessed patients' problems to follow recommendations and treatment among females compared with males (mean scores 3.13 ± 1.42 and 3.64 ± 1.38, respectively; p = 0.015). Mean scores for the assumed socioeconomic level subdomain (how often doctors make assumptions about a patient's socioeconomic level) were worse in individuals aged 18-34 (mean score 1.59 ± 0.94), compared to those aged 35-55 (mean score 1.47 ± 0.94; p = 0.033). Patients with some college or higher educational attainment reported poorer mean scores for most communication and interpersonal style scales than those who reported high-school or less. We found significant linear trends of poorer scores for all communication scales across more severe disease activity and depression symptoms, and poorer scores for all interpersonal style scales across more severe disease activity. Multivariate models revealed that while depression was associated with suboptimal quality of both communication (OR 1.20; 95% CI 1.04-1.39) and interpersonal style (OR 1.12; 95% CI 1.01-1.25), disease activity only increased the odds of suboptimal interpersonal style (OR 1.13; 95% CI 1.03-1.25). CONCLUSION In the African American population with SLE, suboptimal interactions with providers may be explained in part by the mental and physical symptoms of the patient, regardless of age, gender and education. In addition to standard of care treatment, SLE patients with more severe disease activity and depression might need provider-based interventions focused on communication and interpersonal style.
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Affiliation(s)
- Cristina Drenkard
- Emory University, Department of Medicine, Division of Rheumatology, 49 Jesse Hill Jr. Dr. SE, Atlanta, GA 30303, USA.
| | - Gaobin Bao
- Emory University, Department of Medicine, Division of Rheumatology, 49 Jesse Hill Jr. Dr. SE, Atlanta, GA 30303, USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Julie Priest
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | - S Sam Lim
- Emory University, Department of Medicine, Division of Rheumatology, 49 Jesse Hill Jr. Dr. SE, Atlanta, GA 30303, USA
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Wang X, Dai L, Yin M, Deng Y. The factor structure, reliability and validity of the Chinese version of the Van Dream Anxiety Scale. Neuropsychiatr Dis Treat 2019; 15:57-67. [PMID: 30613147 PMCID: PMC6306070 DOI: 10.2147/ndt.s192891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/PURPOSE Dream emotions and contents are associated with psychological well-being. Dream disturbances, such as frequent nightmares and dream anxiety, are associated with a variety of psychopathological conditions. Therefore, it is important to consider nightmares and the resulting dream anxiety. To address this issue, the Van Dream Anxiety Scale (VDAS) was designed especially for measuring nightmare frequency and dream anxiety caused by frightening dreams. As a Chinese version of VDAS may be helpful in promoting study of nightmare and dream anxiety among Chinese population, in the current study, we sought to develop a Chinese version of the VDAS (CVDAS). METHODS We translated the VDAS into Chinese. To evaluate its validity and reliability, a sample of 1,081 Chinese college students from two universities answered the CVDAS, GAD-7, PHQ-9 and EPQ-R-N. Ninety of them answered the CVDAS twice. We also conducted exploratory factor analysis (EFA) to explore the structure of CVDAS. RESULTS Excellent internal consistency (Cronbach's alpha coefficient was 0.926), split-half reliability (equal-length Spearman-Brown coefficient was 0.938) and good test-retest reliability (the intraclass correlation coefficient was 0.942 and t=-1.478, P=0.143) of the CVDAS was presented. Exploratory factor analyses indicated a two-factor structure: sleep-related disturbances caused by nightmares and dysfunction caused by nightmares. Convergent and divergent validities were acceptable. CONCLUSION The CVDAS shows promise for the measurement of nightmare frequency and specific dream anxiety in Chinese population. Future study should confirm the reliability and validity in the clinical population and further improve this scale.
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Affiliation(s)
- Xiang Wang
- Department of Clinical Psychology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China,
| | - Lisha Dai
- Department of Clinical Psychology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China,
| | - Meng Yin
- Department of Clinical Psychology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China,
| | - Yunlong Deng
- Department of Clinical Psychology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China, .,Psychosomatic Health Institute, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China,
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Rancans E, Trapencieris M, Ivanovs R, Vrublevska J. Validity of the PHQ-9 and PHQ-2 to screen for depression in nationwide primary care population in Latvia. Ann Gen Psychiatry 2018; 17:33. [PMID: 30083220 PMCID: PMC6071402 DOI: 10.1186/s12991-018-0203-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 07/27/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Depression is highly underdiagnosed in primary care settings in Latvia. Screening for depression in primary care is potentially an efficient way to find undetected case s and improve diagnostics. We aimed to validate both a nine-item and two-item Patient Health Questionnaire (PHQ-9 and PHQ-2) in the Latvian and Russian languages in primary care settings using a representative sample in Latvia. MATERIALS AND METHODS The study was carried out within the framework of the National Research Program BIOMEDICINE to assess the prevalence of mental disorders at 24 primary care facilities. During a 1-week period, all consecutive adult patients were invited to complete the PHQ-9 and PHQ-2. Criterion validity was assessed against the Mini International Neuropsychiatric Interview (MINI). RESULTS There were 1467 patients who completed the PHQ-9 and the MINI. Overall, the PHQ-9 items showed good internal reliability (Cronbach's alpha 0.81 for Latvian version and 0.79 for Russian version of the PHQ-9). A cut-off score of 8 or greater was established for the PHQ-9 (sensitivity 0.75 and 0.79, specificity 0.84 and 0.80 for Latvian and Russian languages, respectively). For the PHQ-2, a score of 2 or higher (sensitivity 0.79 and 0.79, specificity 0.65 and 0.67 for Latvian and Russian languages) detected more cases of depression than a score of 3 or higher. CONCLUSIONS We suggest GPs ask patients to respond to the first 2 questions of the PHQ-9. If their score is positive, the patients should then complete the PHQ-9.
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Affiliation(s)
- Elmars Rancans
- Department of Psychiatry and Narcology, Riga Stradins University, Tvaika Street 2, Riga, 1005 Latvia
| | - Marcis Trapencieris
- Institute of Philosophy and Sociology, University of Latvia, Kalpaka bulv. 4, Riga, Latvia
| | - Rolands Ivanovs
- Department of Psychiatry and Narcology, Riga Stradins University, Tvaika Street 2, Riga, 1005 Latvia
| | - Jelena Vrublevska
- Department of Psychiatry and Narcology, Riga Stradins University, Tvaika Street 2, Riga, 1005 Latvia
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Delis F, Carvalho AF, Poulia N, Bozidis P, Paika V, Ntountoulaki E, Papaioannou D, Guthrie E, Antoniou K, Hyphantis TN. Resilience Mediates the Influence of a Polymorphism in the Serotonin Transporter Gene on the Relationship between the Burden of Chronic Illness and Depression. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 86:305-307. [PMID: 28903099 DOI: 10.1159/000478020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/30/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Foteini Delis
- Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Dadfar M, Kalibatseva Z, Lester D. Reliability and validity of the Farsi version of the Patient Health Questionnaire-9 (PHQ-9) with Iranian psychiatric outpatients. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2018; 40:144-151. [DOI: 10.1590/2237-6089-2017-0116] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/23/2017] [Indexed: 12/27/2022]
Abstract
Abstract Introduction: The Patient Health Questionnaire-9 (PHQ-9) is a brief screening and diagnostic tool for depression. It has been used in research and clinical practice in primary care and other clinical and non-clinical settings. The PHQ-9 has not had its validity examined in psychiatric and psychological settings in Iran. Methods: A cross-sectional study was conducted to investigate the validation of the Farsi version of the PHQ-9. A convenience sample of 130 Iranian volunteer psychiatric outpatients was selected from psychiatric and psychological clinics. They completed the PHQ-9, the Patient Health Questionnaire-15 (PHQ-15), the World Health Organization-five Well-Being Index (WHO-5), and the short form of the Beck Depression Inventory-13 (BDI-13). Data were analyzed by descriptive statistics, Cronbach's α, Pearson correlation coefficient, principal component analysis, exploratory factor analysis, and confirmatory factor analysis. Results: Mean score of the PHQ-9 was 12.83 (standard deviation = 6.25), indicating moderately severe depression in the sample. Cronbach's α coefficient for PHQ-9 was 0.88, and one-week test-retest reliability 0.79. The PHQ-9 correlated 0.64 with PHQ-15, −0.35 with WHO-5, and 0.70 with BDI-13, indicating good construct and criterion-related validity. The results of the factor analysis of PHQ-9 items identified and confirmatory factor analysis confirmed a single factor labeled general depression. Conclusions: The PHQ-9 appears to have a unidimensional structure, adequate validity and reliability, and can be useful in epidemiological/research settings. Based on previous literature and on the present findings, the PHQ-9 may have applicability to other contexts in the studied population, but this needs to be confirmed by other studies.
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Vrublevska J, Trapencieris M, Rancans E. Adaptation and validation of the Patient Health Questionnaire-9 to evaluate major depression in a primary care sample in Latvia. Nord J Psychiatry 2018; 72:112-118. [PMID: 29105551 DOI: 10.1080/08039488.2017.1397191] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Depression is one of the most common mental disorders in primary care settings and is often underdiagnosed and undertreated by general practitioners (GPs). To date, no depression screening instruments have been validated for use in primary care settings in Latvia. The aim of this study was to establish the validity and cutoff score of the Patient Health Questionnaire-9 (PHQ-9) among primary care patients in Latvia. MATERIALS AND METHODS During a one-week period, all consecutive patients aged 18 years or older visiting their GP of health concerns at 6 primary care settings were invited to complete the PHQ-9 questionnaire in their native language (Latvian or Russian). Criterion validity was assessed against the Mini International Neuropsychiatric Interview (M.I.N.I.), which was conducted over the telephone by a psychiatrist less than 2 weeks after a primary care physician visit. RESULTS In total, 324 patients were evaluated using the PHQ-9, 272 of whom agreed to be interviewed with the M.I.N.I. Overall, the PHQ-9 items showed good internal (Cronbach's alpha 0.84) reliability. A cutoff score of 10 was established for the PHQ-9 (sensitivity 86.49%, specificity 89.36%), correctly classifying 86.4% of patients with current depression. CONCLUSIONS The PHQ-9 appears to be a reliable and valid instrument that can be used to diagnose major depression among Latvian and Russian speaking adults at the primary care level.
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Affiliation(s)
- Jelena Vrublevska
- a Department of Psychiatry and Narcology , Riga Stradins University , Riga , Latvia
| | - Marcis Trapencieris
- b Institute of Philosophy and Sociology , University of Latvia , Riga , Latvia
| | - Elmars Rancans
- a Department of Psychiatry and Narcology , Riga Stradins University , Riga , Latvia
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Lu W, Bian Q, Wang W, Wu X, Wang Z, Zhao M. Chinese version of the Perceived Stress Scale-10: A psychometric study in Chinese university students. PLoS One 2017; 12:e0189543. [PMID: 29252989 PMCID: PMC5734731 DOI: 10.1371/journal.pone.0189543] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/27/2017] [Indexed: 11/18/2022] Open
Abstract
Chinese university students often suffer from acute stress, which can affect their mental health. We measured and evaluated perceived stress in this population using the Simplified Chinese version of the 10-item Perceived Stress Scale (SCPSS-10). The SCPSS-10, Patient Health Questionnaire (PHQ), and Generalized Anxiety Disorder 7-item scale (GAD-7) were conducted in 1096 university students. Two weeks later, 129 participants were re-tested using the SCPSS-10. Exploratory factor analysis yielded two factors with Eigen values of 4.76 and 1.48, accounting for 62.41% of the variance. Confirmatory factor analysis demonstrated good fit of this two-factor model. The internal consistency reliability, as measured by Cronbach's α, was 0.85. The test-retest reliability coefficient was 0.7. The SCPSS-10 exhibited high correlation with the PHQ-9 and GAD-7, indicating an acceptable concurrent validity. The SCPSS-10 exhibited satisfactory psychometric properties in Chinese university students.
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Affiliation(s)
- Wei Lu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Qian Bian
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Wenzheng Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Xiaoling Wu
- Academic Affairs Office, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
- * E-mail: (MZ); (ZW)
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
- * E-mail: (MZ); (ZW)
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Manea L, Boehnke JR, Gilbody S, Moriarty AS, McMillan D. Are there researcher allegiance effects in diagnostic validation studies of the PHQ-9? A systematic review and meta-analysis. BMJ Open 2017; 7:e015247. [PMID: 28965089 PMCID: PMC5640143 DOI: 10.1136/bmjopen-2016-015247] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To investigate whether an authorship effect is found that leads to better performance in studies conducted by the original developers of the Patient Health Questionnaire (PHQ-9) (allegiant studies). DESIGN Systematic review with random effects bivariate diagnostic meta-analysis. Search strategies included electronic databases, examination of reference lists and forward citation searches. INCLUSION CRITERIA Included studies provided sufficient data to calculate the diagnostic accuracy of the PHQ-9 against a gold standard diagnosis of major depression using the algorithm or the summed item scoring method at cut-off point 10. DATA EXTRACTION Descriptive information, methodological quality criteria and 2×2 contingency tables. RESULTS Seven allegiant and 20 independent studies reported the diagnostic performance of the PHQ-9 using the algorithm scoring method. Pooled diagnostic OR (DOR) for the allegiant group was 64.40, and 15.05 for non-allegiant studies group. The allegiance status was a significant predictor of DOR variation (p<0.0001).Five allegiant studies and 26 non-allegiant studies reported the performance of the PHQ-9 at recommended cut-off point of 10. Pooled DOR for the allegiant group was 49.31, and 24.96 for the non-allegiant studies. The allegiance status was a significant predictor of DOR variation (p=0.015).Some potential alternative explanations for the observed authorship effect including differences in study characteristics and quality were found, although it is not clear how some of them account for the observed differences. CONCLUSIONS Allegiant studies reported better performance of the PHQ-9. Allegiance status was predictive of variation in the DOR. Based on the observed differences between independent and non-independent studies, we were unable to conclude or exclude that allegiance effects are present in studies examining the diagnostic performance of the PHQ-9. This study highlights the need for future meta-analyses of diagnostic validation studies of psychological measures to evaluate the impact of researcher allegiance in the primary studies.
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Affiliation(s)
- Laura Manea
- Deparment of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, United Kingdom
| | - Jan Rasmus Boehnke
- Dundee Centre for Health And Related Research, University of Dundee, Dundee, United Kingdom
| | - Simon Gilbody
- Deparment of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, United Kingdom
| | | | - Dean McMillan
- Deparment of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, United Kingdom
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How common is depression in patients with polymyalgia rheumatica? Clin Rheumatol 2017; 37:1633-1638. [DOI: 10.1007/s10067-017-3691-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/25/2017] [Accepted: 05/18/2017] [Indexed: 11/26/2022]
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The relationship of the perceived impact of the current Greek recession with increased suicide risk is moderated by mental illness in patients with long-term conditions. J Psychosom Res 2017; 96:98-105. [PMID: 28545799 DOI: 10.1016/j.jpsychores.2017.03.008] [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: 11/20/2016] [Revised: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Adverse life events may contribute to the emergence of suicidality. We aimed to test the relationship between the impact of the Greek recession and suicidal risk in people with long-term conditions (LTCs) and to determine whether this relationship is moderated by the presence of a mental disorder. METHODS Suicidal risk (RASS) and crisis parameters were assessed in a cross-sectional survey including 376 patients with LTCs (type-II diabetes mellitus, rheumatological disorders and chronic obstructive pulmonary disease) attending the Emergency Department or specialty clinics. A diagnosis of mental disorder was confirmed by the Mini International Neuropsychiatric Interview (MINI) interview. Hierarchical regression models were used to quantify moderator effects. RESULTS Suicidal risk was significantly associated with the perceived impact of the recession (p=0.028). However, moderation analysis showed that this relationship was significant only in those diagnosed with either major depressive disorder or generalized anxiety disorder. CONCLUSIONS These findings suggest that the perceived impact of the current Greek recession is not correlated with suicidal risk per se, but the recession may act as precipitator in combination with other risk factors, such as the presence of a mental illness, thus supporting the importance of early diagnosis and treatment of mental disorders in vulnerable groups.
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Paika V, Andreoulakis E, Ntountoulaki E, Papaioannou D, Kotsis K, Siafaka V, Fountoulakis KN, Pargament KI, Carvalho AF, Hyphantis T. The Greek-Orthodox version of the Brief Religious Coping (B-RCOPE) instrument: psychometric properties in three samples and associations with mental disorders, suicidality, illness perceptions, and quality of life. Ann Gen Psychiatry 2017; 16:13. [PMID: 28239407 PMCID: PMC5314716 DOI: 10.1186/s12991-017-0136-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/11/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The B-RCOPE is a brief measure assessing religious coping. We aimed to assess the psychometric properties of its Greek version in people with and without long-term conditions (LTCs). Associations between religious coping and mental illness, suicidality, illness perceptions, and quality of life were also investigated. METHODS The B-RCOPE was administered to 351 patients with diabetes, chronic pulmonary obstructive disease (COPD), and rheumatic diseases attending either the emergency department (N = 74) or specialty clinics (N = 302) and 127 people without LTCs. Diagnosis of mental disorders was established by the MINI. Associations with depressive symptom severity (PHQ-9), suicidal risk (RASS), illness perceptions (B-IPQ), and health-related quality of life (WHOQOL-BREF) were also investigated. RESULTS The Greek version of B-RCOPE showed a coherent two-dimensional factor structure with remarkable stability across the three samples corresponding to the positive (PRC) and negative (NRC) religious coping dimensions. Cronbach's alphas were 0.91-0.96 and 0.77-0.92 for the PRC and NRC dimensions, respectively. Furthermore, NRC was associated with poorer mental health, greater depressive symptom severity and suicidality, and impaired HRQoL. In patients with LTCs, PRC correlated with lower perceived illness timeline, while NRC was associated with greater perceived illness consequences, lower perceived treatment control, greater illness concern, and lower illness comprehensibility. CONCLUSIONS These findings indicate that the Greek-Orthodox B-RCOPE version may reliably assess religious coping. In addition, negative religious coping (i.e., religious struggle) is associated with adverse illness perceptions, and thus may detrimentally impact adaptation to medical illness. These findings deserve replication in prospective studies.
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Affiliation(s)
- Vassiliki Paika
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Elias Andreoulakis
- Third Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elisavet Ntountoulaki
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Dimitra Papaioannou
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Konstantinos Kotsis
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Vassiliki Siafaka
- Department of Speech and Language Therapy, Technological Educational Institute of Epirus, Ioannina, Greece
| | - Konstantinos N Fountoulakis
- Third Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kenneth I Pargament
- Department of Psychology, Bowling Green State University, Bowling Green, OH USA
| | - Andre F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE Brazil
| | - Thomas Hyphantis
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
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Diagnostic validity of the Patient Health Questionnaire-2 (PHQ-2) among Ethiopian adults. Compr Psychiatry 2016; 70:216-21. [PMID: 27567282 PMCID: PMC5108453 DOI: 10.1016/j.comppsych.2016.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/10/2016] [Accepted: 07/26/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The Patient Health Questionnaire-2 (PHQ-2) is an ultra-brief questionnaire widely used by researchers and clinicians to detect major depressive disorder (MDD). Despite its individual and societal impact, MDD is often undetected and untreated particularly among sub-Saharan Africans. We conducted this study to evaluate the reliability and validity of using the PHQ-2 as a screen for MDD among Ethiopian adults. METHODS A total of 926 adults attending outpatient departments in a major referral hospital in Addis Ababa, Ethiopia participated in this study. Construct validity was assessed by examining associations of PHQ-2 scores with World Health Organization Quality of Life (WHO-QOL) domains. We assessed criterion validity and performance characteristics against an independent, blinded, and psychiatrist administered semi-structured Schedules for Clinical Assessment in Neuropsychiatry (SCAN) interview using measures of sensitivity, specificity and receiver operating characteristics (ROC) curves. RESULTS The PHQ-2 items showed good reliability (intraclass correlation coefficient=0.92). Quality of life, as reflected by subscale scores for four WHO-QOL domains, was significantly lower among patients with increasing PHQ-2 scores demonstrating good construct validity. ROC analysis and Youden Index showed that a PHQ-2 threshold score of 3 offered optimal discriminatory power with respect to the diagnosis of MDD via the clinical interview (sensitivity=74% and specificity=60%). CONCLUSION The Amharic language version of the PHQ-2 had good sensitivity and fair specificity for detecting MDD compared against a psychiatrist administered SCAN diagnosis. This study provides evidence for the PHQ-2 as a reliable and valid ultra-brief screening tool for initial identification of MDD.
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Feng Y, Huang W, Tian TF, Wang G, Hu C, Chiu HFK, Ungvari GS, Kilbourne AM, Xiang YT. The psychometric properties of the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) and the Patient Health Questionnaire-9 (PHQ-9) in depressed inpatients in China. Psychiatry Res 2016; 243:92-6. [PMID: 27376668 DOI: 10.1016/j.psychres.2016.06.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 06/05/2016] [Accepted: 06/15/2016] [Indexed: 12/30/2022]
Abstract
This study examined the psychometric properties of the 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) and Patient Health Questionnaire-9 (PHQ-9). The study sample comprised 297 depressed inpatients. The severity of depressive symptoms was assessed with the Hamilton Rating Scale for Depression, the QIDS-SR and the PHQ-9 in all subjects at baseline and a random sample of 50 subjects two weeks later. The internal consistency, convergent validity, factor structure and sensitivity to change of these scales were assessed. Internal consistency (Cronbach's alpha) of the PHQ-9 and QIDS-SR were 0.88 and 0.83, respectively at baseline and 0.91 and 0.87, respectively at exit. Item to total score correlations were higher for the PHQ-9 than those for the QIDS-SR at baseline and exit. Three domains at baseline and two at study exit of the QIDS-SR had a correlation less than 0.65; while only two items at baseline and no item at exit were less than 0.65 for the PHQ-9. Both the PHQ-9 and the QIDS-SR showed uni-dimensional measurement properties at baseline; the two instruments were less sensitive than the HAMD to detect changes of depressive symptoms suggesting low convergent validity. The QIDS-SR and the PHQ-9 have similar and acceptable psychometric properties in most domains as tested in depressed inpatients.
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Affiliation(s)
- Yuan Feng
- Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China; China Clinical Research Center for Mental Disorders, China; Center of Depression, Beijing Institute for Brain Disorders, China
| | - Wei Huang
- Department of Psychiatry, Harbin First Specialist Hospital, Heilongjiang province, China
| | - Teng-Fei Tian
- Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China; China Clinical Research Center for Mental Disorders, China; Center of Depression, Beijing Institute for Brain Disorders, China
| | - Gang Wang
- Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China; China Clinical Research Center for Mental Disorders, China; Center of Depression, Beijing Institute for Brain Disorders, China.
| | - Chen Hu
- Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Gabor S Ungvari
- The University of Notre Dame Australia/Marian Centre, Perth, Australia; School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Amy M Kilbourne
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; Veterans Administration Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China.
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Ntountoulaki E, Guthrie E, Kotsis K, Paika V, Tatsioni A, Tomenson B, Fountoulakis KN, Carvalho AF, Hyphantis T. Double RASS cutpoint accurately diagnosed suicidal risk in females with long-term conditions attending the emergency department compared to their male counterparts. Compr Psychiatry 2016; 69:193-201. [PMID: 27423361 DOI: 10.1016/j.comppsych.2016.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 05/29/2016] [Accepted: 06/11/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Suicidal risk is often unrecognized in emergency department (ED). We aimed to assess its prevalence in patients with long-term conditions (LTCs) attending an ED and to test whether gender differences influence suicidal risk assessment, using the diagnostic accuracy properties of the Risk Assessment Suicidality Scale (RASS). METHODS The RASS was administered to 349 patients with diabetes, COPD and rheumatic diseases visiting an ED. The MINI interview was used as the criterion standard. ROC curve analysis was performed to determine the optimal RASS cutpoint for suicidal risk separately for males and females. Somatic (PHQ-15) and depressive (PHQ-9) symptoms were also assessed and factors associated with suicidal risk across gender were determined in hierarchical regression models. RESULTS The prevalence of suicidal risk according to the MINI was 22.9%; 16.6% of patients were at low, 5.1% at moderate, and 0.9% at high risk. At an optimal cutpoint of 270, RASS had 81.3% sensitivity and 81.8% specificity. The optimal RASS cutpoint for females (340) was double the cutpoint for males (175). Somatic symptom burden was associated with suicidal risk in both sexes but it became non-significant after depressive symptoms were taken into account; suicidal risk was also associated with history of depression in females and lower income in males. CONCLUSION There is a high prevalence of suicidal risk in patients with LTCs attending the ED. As the optimal RASS cutpoint for females was double the cutpoint for males, clinicians should bear in mind gender differences when assessing for suicidal risk in the ED.
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Affiliation(s)
- Elisavet Ntountoulaki
- Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Elspeth Guthrie
- Psychiatry Research Group, Medical School, University of Manchester, Manchester, UK
| | - Konstantinos Kotsis
- Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Vassiliki Paika
- Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Athina Tatsioni
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Barbara Tomenson
- Psychiatry Research Group, Medical School, University of Manchester, Manchester, UK
| | - Konstantinos N Fountoulakis
- Third Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andre F Carvalho
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Thomas Hyphantis
- Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
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Yioti G, Stefaniotou M, Ziavrou I, Kotsis K, Hyphantis T. Illness Perceptions, Psychiatric Manifestations, and Quality of Life in Patients with Inherited Retinal Dystrophies. Semin Ophthalmol 2016; 32:428-437. [DOI: 10.3109/08820538.2015.1118136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Georgia Yioti
- University Eye Clinic, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Maria Stefaniotou
- Department of Ophthalmology, University of Ioannina, Ioannina, Greece
| | - Ioulia Ziavrou
- Department of Psychiatry, University of Ioannina, Ioannina, Greece
| | | | - Thomas Hyphantis
- Department of Psychiatry, University of Ioannina, Ioannina, Greece
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Illness perceptions of people with long-term conditions are associated with frequent use of the emergency department independent of mental illness and somatic symptom burden. J Psychosom Res 2016; 81:38-45. [PMID: 26800637 DOI: 10.1016/j.jpsychores.2016.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 12/15/2015] [Accepted: 01/04/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether illness perceptions of patients with long-term conditions (LTCs) are associated with urgent healthcare use and whether this association is independent from mental illness and somatic symptom burden. METHODS Illness perceptions (B-IPQ) and somatic symptom severity (PHQ-15) were assessed in 304 patients with diabetes, rheumatological disorders and COPD attending an Accident and Emergency Department (AED) in Greece over a one year period. The presence of mental illness was determined by the Mini International Neuropsychiatric Interview. A Generalized Linear Model (Negative Binomial) regression was used to determine the associations of illness perceptions with AED use after adjusting for mental illness, somatic symptom severity, disease parameters and demographics. RESULTS Eighty-six patients (28.3%) reported at least one visit to the AED during the previous year and 75 (24.7%) twice or more. 124 patients (40.8%) had some form of mental disorder with 85 (28.0%) meeting criteria for major depressive disorder. The degree to which the patients had an understanding of their illness (illness comprehensibility) (p<0.01) along with younger age (p<0.05), additional comorbidities (p<0.05) and greater somatic symptom burden (p<0.001) was strongly associated with AED use; AED visits were expected to be reduced by 9.1% for each unit increase in illness comprehensibility. CONCLUSIONS The way people perceive their illness influences urgent healthcare seeking behavior independent of somatic symptom burden. This finding indicates that information provision may prove effective in reducing urgent healthcare use and encourage the design of psycho-educational interventions targeting disease-related cognitions in an attempt to prevent unnecessary healthcare utilization.
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Moriarty AS, Gilbody S, McMillan D, Manea L. Screening and case finding for major depressive disorder using the Patient Health Questionnaire (PHQ-9): a meta-analysis. Gen Hosp Psychiatry 2015. [PMID: 26195347 DOI: 10.1016/j.genhosppsych.2015.06.012] [Citation(s) in RCA: 196] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The Patient Health Questionnaire (PHQ-9) is a widely used screening tool for major depressive disorder (MDD), although there is debate surrounding its diagnostic properties. For the PHQ-9, we aimed to: 1. Establish the diagnostic performance at the standard cutoff point (10). 2. Compare the diagnostic performance at the standard cutoff point in different clinical settings. 3. Assess whether there is selective reporting of cutoff points other than 10. METHODS We searched three databases - Embase, MEDLINE and PSYCHInfo - and performed a reverse citation search in Web of Science. We selected for inclusion studies of any design that assessed the PHQ-9 in adult populations against recognized gold-standard instruments for the diagnosis of either Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases criteria for major depression. Included studies had to report sufficient information to calculate 2*2 contingency tables. Data extraction and synthesis were performed independently by two researchers. For the included studies, we calculated pooled sensitivity, pooled specificity, positive likelihood, negative likelihood ratio and diagnostic odds ratio for cutoff points 7 to 15. RESULTS Thirty-six studies (21,292 patients) met inclusion criteria. Pooled sensitivity for cutoff point 10 was 0.78 [95% confidence interval (CI), 0.70-0.84], and pooled specificity was 0.87 (95% CI, 0.84-0.90). At this cutoff, the PHQ-9 is a better screener in primary care than secondary care settings. No conclusions could be drawn at cutoff points other than 10 due to selective reporting of data. CONCLUSIONS For MDD, the PHQ-9 has acceptable diagnostic properties at cutoff point 10 in different settings. We recommend that future studies report the full range of cutoff points to allow exploration of optimal cutoff points in different settings.
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Affiliation(s)
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, U.K. YO10 5DD
| | - Dean McMillan
- Department of Health Sciences, University of York, York, U.K. YO10 5DD
| | - Laura Manea
- Department of Health Sciences, University of York, York, U.K. YO10 5DD.
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