1
|
Adhibai R, Kosiyaporn H, Markchang K, Nasueb S, Waleewong O, Suphanchaimat R. Depressive symptom screening in elderly by passive sensing data of smartphones or smartwatches: A systematic review. PLoS One 2024; 19:e0304845. [PMID: 38935797 PMCID: PMC11210876 DOI: 10.1371/journal.pone.0304845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 05/21/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The elderly is commonly susceptible to depression, the symptoms for which may overlap with natural aging or other illnesses, and therefore miss being captured by routine screening questionnaires. Passive sensing data have been promoted as a tool for depressive symptoms detection though there is still limited evidence on its usage in the elderly. Therefore, this study aims to review current knowledge on the use of passive sensing data via smartphones and smartwatches in depressive symptom screening for the elderly. METHOD The search of literature was performed in PubMed, IEEE Xplore digital library, and PsycINFO. Literature investigating the use of passive sensing data to screen, monitor, and/or predict depressive symptoms in the elderly (aged 60 and above) via smartphones and/or wrist-worn wearables was included for initial screening. Studies in English from international journals published between January 2012 to September 2022 were included. The reviewed studies were further analyzed by a narrative analysis. RESULTS The majority of 21 included studies were conducted in Western countries with a few in Asia and Australia. Most studies adopted a cohort study design (n = 12), followed by cross-sectional design (n = 7) and a case-control design (n = 2). The most popular passive sensing data was related to sleep and physical activity using an actigraphy. Sleep characteristics, such as prolonged wakefulness after sleep onset, along with lower levels of physical activity, exhibited a significant association with depression. However, cohort studies expressed concerns regarding data quality stemming from incomplete follow-up and potential confounding effects. CONCLUSION Passive sensing data, such as sleep, and physical activity parameters should be promoted for depressive symptoms detection. However, the validity, reliability, feasibility, and privacy concerns still need further exploration.
Collapse
Affiliation(s)
- Rujira Adhibai
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Hathairat Kosiyaporn
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Kamolphat Markchang
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Sopit Nasueb
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Orratai Waleewong
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Rapeepong Suphanchaimat
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| |
Collapse
|
2
|
Federman AD, Becker J, Carnavali F, Rivera Mindt M, Cho D, Pandey G, Chan L, Curtis L, Wolf MS, Wisnivesky JP. Relationship Between Cognitive Impairment and Depression Among Middle Aged and Older Adults in Primary Care. Gerontol Geriatr Med 2024; 10:23337214231214217. [PMID: 38476882 PMCID: PMC10929046 DOI: 10.1177/23337214231214217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 03/14/2024] Open
Abstract
Objectives: To determine rates of previously undetected cognitive impairment among patients with depression in primary care. Methods: Patients ages 55 and older with no documented history of dementia or mild cognitive impairment were recruited from primary care practices in New York City, NY and Chicago, IL (n = 855). Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA) and depression with the Patient Health Questionnaire-8. Results: The mean age was 66.8 (8.0) years, 45.3% were male, 32.7% Black, and 29.2% Latinx. Cognitive impairment increased with severity of depression: 22.9% in persons with mild depression, 27.4% in moderate depression and 41.8% in severe depression (p = .0002). Severe depression was significantly associated with cognitive impairment in multivariable analysis (standardized β = -.11, SE = 0.33, p < .0001). Discussion: Depression was strongly associated with previously undetected cognitive impairment. Primary care clinicians should consider screening, or expand their screening, for both conditions.
Collapse
Affiliation(s)
| | | | | | - Monica Rivera Mindt
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Fordham University, New York, NY, USA
| | - Dayeon Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gaurav Pandey
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lili Chan
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | |
Collapse
|
3
|
Rodríguez-Fernández JM, Hoertel N, Saner H, Raji M. Acculturation and Disparities in Telemedicine Readiness: A National Study. Int J Aging Hum Dev 2023:914150231219259. [PMID: 38111265 DOI: 10.1177/00914150231219259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Telemedicine provided older adults the ability to safely seek care during the coronavirus disease (COVID-19) pandemic. This study aimed to evaluate the potential impact of acculturation factors in telemedicine uptake between ethnic groups. As part of the National Health and Aging Trends Study 2018 survey, 303 participants (≥65 years) were interviewed. We assessed the impact of acculturation on telemedicine readiness by race and ethnicity. Compared to the white non-Hispanic immigrant population, Hispanic and Asian/Pacific Islander (API) populations had significantly lower telemedicine readiness and uptake. Limited English proficiency or older age at the time of migration was associated with telemedicine unreadiness and uptake in the Hispanic and API populations. Our findings suggested that acculturation factors play a substantial role in telemedicine uptake among older adult immigrants in the United States. Therefore, acculturation factors should be considered when promoting and adopting telemedicine technologies in older adults.
Collapse
Affiliation(s)
| | - Nicolas Hoertel
- AP-HP, Centre-Université de Paris, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Issy-les-Moulineaux, France
- INSERM, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
- Faculté de Santé, UFR de Médecine, Université de Paris, Paris, France
| | - Hugo Saner
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | - Mukaila Raji
- Division of Geriatrics, Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| |
Collapse
|
4
|
Fusco A, Olowofela B, Dagra A, Hatem R, Pierre K, Siyanaki MRH, Lucke–Wold B. Management of Neuropsychiatric Symptoms for Chronic Traumatic Encephalopathy. MEDPRESS PSYCHIATRY AND BEHAVIORAL SCIENCES 2022; 1:202209003. [PMID: 36745148 PMCID: PMC9893853 DOI: 10.33582/mppbs.2022.202209003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repeated head injury. The common presenting neuropsychiatric manifestations and diagnostic strategies for early diagnosis and subsequent treatment will be reviewed. This article discusses methods for injury prevention, risk assessment, and methods for supportive symptom management including lifestyle modifications, physical, occupational, and neurorehabilitation, and pharmaceutical management. Lastly, we propose the use of assessment tools validated for other neurodegenerative disorders in CTE to establish a baseline, track outcomes, and measure improvement in this population.
Collapse
Affiliation(s)
- Anna Fusco
- University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Abeer Dagra
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Rami Hatem
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Kevin Pierre
- University of Florida Department of Radiology, Gainesville, FL, USA
| | | | | |
Collapse
|
5
|
Detecting depression in persons living with mild cognitive impairment: a systematic review. Int Psychogeriatr 2022; 34:453-465. [PMID: 35357300 DOI: 10.1017/s1041610222000175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Depression is common in persons experiencing mild cognitive impairment (MCI), with 32% (95% Cl 27, 37) overall experiencing depression. Persons with MCI who have depression have more cognitive changes compared to those without depression. To understand how we can detect depressive symptoms in persons with MCI, we undertook a systematic review to identify tools that were validated compared with a reference standard. DESIGN We searched MEDLINE, EMBASE, PsycINFO, and Cochrane from inception to April 25, 2021, and conducted a gray literature search. Title/abstract and full-text screening were completed in duplicate. Demographic information, reference standards, prevalence, and diagnostic accuracy measures were then extracted from included articles (PROSPERO CRD: CRD42016052120). RESULTS Across databases, 8,748 abstracts were generated after removing duplicates. Six hundred and sixty-five records underwent full-text screening, with six articles included for data extraction. Nine tools were identified compared to a reference standard, with multiple demonstrating a sensitivity of 100% (Brief Assessment Schedule Depression Cards, Beck Depression Inventory-II, Cornell Scale for Depression in Dementia, Zung Self-Rated Depression Scale, and the Neuropsychiatric Inventory). The second highest sensitivity reported was 89% (Patient Health Questionnaire-9). Too few studies were available for a meta-analysis. CONCLUSIONS Multiple depression detection tools have been examined amongst MCI outpatients, with several showing high sensitivity. However, this evidence is only present in single studies, with little demonstration of how differing MCI types affect accuracy. More research is needed to confirm the accuracy of these tools amongst persons with MCI. At this time, several tools could be suitable for use in cognitive clinics.
Collapse
|
6
|
Rodríguez-Fernández JM, Danies E, Hoertel N, Galanter W, Saner H, Franco OH. Telemedicine Readiness Across Medical Conditions in a US National Representative Sample of Older Adults. J Appl Gerontol 2021; 41:982-992. [PMID: 34855553 DOI: 10.1177/07334648211056231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Telemedicine has provided older adults the ability to seek care remotely during the coronavirus disease (COVID-19) pandemic. However, it is unclear how diverse medical conditions play a role in telemedicine uptake. A total of 3379 participants (≥65 years) were interviewed in 2018 as part of the National Health and Aging Trends Study. We assessed telemedicine readiness across multiple medical conditions. Most chronic medical conditions and mood symptoms were significantly associated with telemedicine unreadiness, for physical or technical reasons or both, while cancer, hypertension, and arthritis were significantly associated with telemedicine readiness. Our findings suggest that multiple medical conditions play a substantial role in telemedicine uptake among older adults in the US. Therefore, comorbidities should be taken into consideration when promoting and adopting telemedicine technologies among older adults.
Collapse
Affiliation(s)
| | | | - Nicolas Hoertel
- 26930AP-HP. Centre-Université de Paris, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Issy-les-Moulineaux, France.,INSERM, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, Paris, France.,Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France
| | | | - Hugo Saner
- Institute of Social and Preventive Medicine (ISPM), 30317University of Bern, Bern, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), 30317University of Bern, Bern, Switzerland
| |
Collapse
|
7
|
Hugunin J, Yuan Y, Rothschild AJ, Lapane KL, Ulbricht CM. Risk factors associated with suicidal ideation in newly admitted working-age nursing home residents. J Affect Disord 2021; 295:243-249. [PMID: 34482055 PMCID: PMC8551025 DOI: 10.1016/j.jad.2021.08.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Suicide is a leading cause of mortality in the United States and recent initiatives have sought to increase monitoring of suicide risk within healthcare systems. Working-age adults (22-64 years) admitted to nursing homes may be at risk for suicidal ideation, yet little is known about this population. METHODS The national nursing home database, Minimum Dataset 3.0, was used to identify 323,436 working-age adults newly admitted to a nursing home in 2015. This cross-sectional study sought to describe sociodemographic and clinical characteristics, examine behavioral health treatment received, and determine resident characteristics associated with suicidal ideation at nursing home admission using logistic regression and reports adjusted odds ratios (aOR). RESULTS Suicidal ideation was present among 1.27% of newly admitted working-age residents. Almost 25% of those with suicidal ideation had no psychiatric diagnosis. Factors associated with increased odds of suicidal ideation included younger age (aOR 1.90), admission from the community (aOR 1.92) or a psychiatric hospital (aOR 2.38), cognitive impairments (aOR 1.46), pain (aOR 1.40), rejection of care (aOR 1.91), and psychiatric comorbidity (aOR depression: 1.91, anxiety disorder: 1.11, bipolar disorder: 1.62, schizophrenia: 1.32, post-traumatic stress disorder: 1.17). LIMITATIONS Due to the cross-sectional nature of this study, no causal inferences about suicidal ideation and the explored covariates can be made. The Minimum Dataset 3.0 has only one measure of suicidal ideation the Patient Health Questionnaire. CONCLUSION Factors other than psychiatric diagnosis may be important in identifying newly admitted working-age nursing home residents who require on-going suicide screening and specialized psychiatric care.
Collapse
Affiliation(s)
- Julie Hugunin
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, United States.
| | - Yiyang Yuan
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Anthony J Rothschild
- Department of Psychiatry, University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA, United States
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Christine M Ulbricht
- National Institute of Mental Health, National Institutes of Health, the Department of Health and Human Services, Bethesda, MD, United States (formerly: Departments of Population and Quantitative Health Sciences & Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States)
| |
Collapse
|
8
|
Yuan Y, Lapane KL, Rothschild AJ, Ulbricht CM. Changes in depressive symptoms and cognitive impairment in older long-stay nursing home residents in the USA: a latent transition analysis. Aging Ment Health 2021; 25:1903-1912. [PMID: 33222506 PMCID: PMC8141058 DOI: 10.1080/13607863.2020.1849021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To longitudinally examine the latent statuses of depressive symptoms and their association with cognitive impairment in older U.S. nursing home (NH) residents. METHOD Using Minimum Data Set 3.0, newly-admitted, long-stay, older NH residents with depression in 2014 were identified (n = 88,532). Depressive symptoms (Patient Health Questionnaire-9) and cognitive impairment (Brief Interview of Mental Status) were measured at admission and 90 days. Latent transition analysis was used to examine the prevalence of and the transition between latent statuses of depressive symptoms from admission to 90 days, and the association of cognitive impairment with the statuses at admission. RESULTS Four latent statuses of depressive symptoms were identified: 'Multiple Symptoms' (prevalence at admission: 17.3%; 90 days: 13.6%), 'Depressed mood' (20.0%; 19.5%), 'Fatigue' (27.4%; 25.7%), and 'Minimal Symptoms' (35.3%; 41.2%). Most residents remained in the same status from admission to 90 days. Compared to residents who were cognitively intact, those with moderate impairment were more likely to be in 'Multiple Symptoms' and 'Fatigue' statuses; those with severe impairment had lower odds of belonging to 'Multiple Symptoms', 'Depressed Mood', and 'Fatigue' statuses. CONCLUSION By addressing the longitudinal changes in the heterogeneous depressive symptoms and the role of cognitive impairment, findings have implications for depression management in older NH residents.
Collapse
Affiliation(s)
- Yiyang Yuan
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L. Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Anthony J. Rothschild
- Department of Psychiatry, University of Massachusetts Medical School and UMass Memorial Healthcare, Worcester, MA, USA
| | - Christine M. Ulbricht
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
9
|
Niculescu I, Arora T, Iaboni A. Screening for depression in older adults with cognitive impairment in the homecare setting: a systematic review. Aging Ment Health 2021; 25:1585-1594. [PMID: 32677506 DOI: 10.1080/13607863.2020.1793899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Previous systematic reviews have examined depression screening in older adults with cognitive impairment (CI) in outpatient and inpatient clinics, nursing homes, and residential care. Despite an increasing number of older adults with CI receiving care in their homes, less is known about best depression screening practices in homecare. The objective of this review is to identify evidence-based practices for depression screening for individuals with CI receiving homecare by assessing tool performance and establishing the current evidence for screening practices in this setting. METHODS This review is registered under PROSPERO (ID: CRD42018110243). A systematic search was conducted using MEDLINE, EMBASE, Health and Psychosocial Abstracts, PsycINFO and CINAHL. The following criteria were used: assessment of depression at home in older adults (>55 years) with CI, where performance outcomes of the depression screening tool were reported. RESULTS Of 5,453 studies, only three met eligibility criteria. These studies evaluated the Patient Health Questionnaire (n = 236), the Geriatric Depression Scale (n = 79) and the Mental Health Index (n = 1,444) in older adults at home with and without CI. Psychometric evaluation demonstrated moderate performance in the subsamples of people with CI. CONCLUSION At present, there is insufficient evidence to support best practices in screening for depression in people with CI in homecare.
Collapse
Affiliation(s)
- Iulia Niculescu
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Rehabilitation Sciences, University of Toronto, Toronto, Canada
| | - Twinkle Arora
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Andrea Iaboni
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Rehabilitation Sciences, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| |
Collapse
|
10
|
Mate K, Fulmer T, Pelton L, Berman A, Bonner A, Huang W, Zhang J. Evidence for the 4Ms: Interactions and Outcomes across the Care Continuum. J Aging Health 2021; 33:469-481. [PMID: 33555233 PMCID: PMC8236661 DOI: 10.1177/0898264321991658] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: An expert panel reviewed and summarized the literature related to the evidence for the 4Ms-what matters, medication, mentation, and mobility-in supporting care for older adults. Methods: In 2017, geriatric experts and health system executives collaborated with the Institute for Healthcare Improvement (IHI) to develop the 4Ms framework. Through a strategic search of the IHI database and recent literature, evidence was compiled in support of the framework's positive clinical outcomes. Results: Asking what matters from the outset of care planning improved both psychological and physiological health statuses. Using screening protocols such as the Beers' criteria inhibited overprescribing. Mentation strategies aided in prevention and treatment. Fall risk and physical function assessment with early goals and safe environments allowed for safe mobility. Discussion: Through a framework that reduces cognitive load of providers and improves the reliability of evidence-based care for older adults, all clinicians and healthcare workers can engage in age-friendly care.
Collapse
Affiliation(s)
- Kedar Mate
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - Terry Fulmer
- The John A. Hartford Foundation, New York, NY, USA
| | - Leslie Pelton
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - Amy Berman
- The John A. Hartford Foundation, New York, NY, USA
| | - Alice Bonner
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - Wendy Huang
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Jinghan Zhang
- Columbia University Mailman School of Public Health, New York, NY, USA
| |
Collapse
|
11
|
Nicastri C, Hensley J, Lane S. Managing the Forgetful Patient: Best Practice for Cognitive Impairment. Med Clin North Am 2021; 105:75-91. [PMID: 33246524 DOI: 10.1016/j.mcna.2020.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The primary care physician is well positioned to identify and treat patients with cognitive impairment (CI). Simple, validated tools can screen for CI in the office. Identifying the type of dementia and stage of the disease helps to guide care. A thorough history, medication review, physical examination, laboratory workup, and imaging studies can help identify specific causes contributing to memory loss. A patient-centered, multidisciplinary team approach includes nonpharmacological and pharmacologic treatments. Patient safety and preservation of functional status should be at the forefront of caring for the forgetful patient.
Collapse
Affiliation(s)
- Catherine Nicastri
- Department of Medicine, Renaissance School of Medicine at SUNY Stony Brook, Stony Brook University Hospital, HSC-T-16-020, 101 Nicolls Road, Stony Brook, NY 11794, USA
| | - Jennifer Hensley
- Department of Medicine, Renaissance School of Medicine at SUNY Stony Brook, Stony Brook University Hospital, HSC-T-16-020, 101 Nicolls Road, Stony Brook, NY 11794, USA
| | - Susan Lane
- Department of Medicine, Renaissance School of Medicine at SUNY Stony Brook, Stony Brook University Hospital, HSC-T-16-020, 101 Nicolls Road, Stony Brook, NY 11794, USA.
| |
Collapse
|
12
|
Jiraniramai S, Wongpakaran T, Angkurawaranon C, Jiraporncharoen W, Wongpakaran N. Construct Validity and Differential Item Functioning of the PHQ-9 Among Health Care Workers: Rasch Analysis Approach. Neuropsychiatr Dis Treat 2021; 17:1035-1045. [PMID: 33854319 PMCID: PMC8041649 DOI: 10.2147/ndt.s271987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/22/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The Patient Health Questionnaire (PHQ-9) is a widely used self-report questionnaire to screen depression. Its psychometric property has been tested in many populations including health care workers. We used Rasch measurement theory to examine the psychometric properties of PHQ-9 regarding item difficulty, item fit and the differences between subgroups of respondents classified by sex, age, education and alcohol user status, based on the same overall location of participants. PATIENTS AND METHODS In total, 3204 health care workers of Maharaj Nakorn Chiang Mai Hospital participated and were administered the PHQ-9. Rating scale Rasch measurement modeling was used to examine the psychometric properties of the PHQ-9. RESULTS The data fitted well to the Rasch model and no violations of the assumption of unidimensionality were observed. All 9 items could form a unidimensional construct of overall depressive severity. Suicidal ideation was the least endorsed while sleep problem was the most. No disordered category and threshold of the rating response were observed. No locally dependent items were observed. No items were found to show differential item functioning across age, sex, education and alcohol consumption. The item-person Wright map showed that the PHQ-9 did not target well with the sample, and a wide gap suggesting few or no items exist to differentiate participants at a certain ability level among the PHQ-9 items. CONCLUSION The PHQ-9 can be used as a screening questionnaire for major depressive disorder as its psychometric property was verified based on Rasch measurement model. The findings are generally consistent with related studies in other populations. However, the PHQ-9 may be unsuitable for assessing depressive symptoms among health care workers who have low levels of depression.
Collapse
Affiliation(s)
- Surin Jiraniramai
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Kingdom of Thailand
| | - Tinakon Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Kingdom of Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Kingdom of Thailand
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Kingdom of Thailand
| | - Nahathai Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Kingdom of Thailand
| |
Collapse
|
13
|
Yuan Y, Min HS, Lapane KL, Rothschild AJ, Ulbricht CM. Depression symptoms and cognitive impairment in older nursing home residents in the USA: A latent class analysis. Int J Geriatr Psychiatry 2020; 35:769-778. [PMID: 32250496 PMCID: PMC7552436 DOI: 10.1002/gps.5301] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/12/2020] [Accepted: 03/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To identify subgroups of nursing home (NH) residents in the USA experiencing homogenous depression symptoms and evaluate if subgroups vary by cognitive impairment. METHODS We identified 104 465 newly admitted, long-stay residents with depression diagnosis at NH admission in 2014 using the Minimum Data Set 3.0. The Patient Health Questionnaire-9 was used to measure depression symptoms and the Brief Interview of Mental Status for cognitive impairment (intact; moderately impaired; severely impaired). Latent class analysis (LCA) with logistic regression was used to: (a) construct the depression subgroups and (b) estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of the associations between the subgroups and cognitive impairment level, adjusting for demographic and clinical characteristics. RESULTS The best-fitted LCA model suggested four subgroups of depression: minimal symptoms (latent class prevalence: 42.4%), fatigue (32.0%), depressed mood (14.5%), and multiple symptoms (11.2%). Odds of subgroup membership varied by cognitive impairment. Compared to residents with intact cognition, those with moderate or severe cognitive impairment were less likely to belong to the fatigue subgroup [aOR(95% CI): moderate: 0.75 (0.71-0.80); severe: 0.26 (0.23-0.29)] and more likely to belong to the depressed mood subgroup [aOR (95% CI): moderate: 4.54 (3.55-5.81); severe: 6.41 (4.86-8.44)]. Residents with moderate cognitive impairment had increased odds [aOR (95% CI): 1.19 (1.12-1.27)] while those with severe impairment had reduced odds of being in the multiple symptoms subgroup [aOR (95% CI): 0.63 (0.58-0.68)]. CONCLUSIONS Findings provide a basis for improving depression management with consideration of both subgroups of depression symptoms and levels of cognitive function.
Collapse
Affiliation(s)
- Yiyang Yuan
- Clinical and Population Health Research PhD Program,
Graduate School of Biomedical Sciences, University of Massachusetts Medical School,
Worcester, MA, USA,Department of Population and Quantitative Health Sciences,
University of Massachusetts Medical School, Worcester, MA, USA
| | - Hye Sung Min
- Department of Population and Quantitative Health Sciences,
University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L. Lapane
- Department of Population and Quantitative Health Sciences,
University of Massachusetts Medical School, Worcester, MA, USA
| | - Anthony J. Rothschild
- Department of Psychiatry, University of Massachusetts
Medical School and UMass Memorial Healthcare, Worcester, MA, USA
| | - Christine M. Ulbricht
- Department of Population and Quantitative Health Sciences,
University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
14
|
Capogna E, Manca R, De Marco M, Hall A, Soininen H, Venneri A. Understanding the effect of cognitive/brain reserve and depression on regional atrophy in early Alzheimer's disease. Postgrad Med 2019; 131:533-538. [PMID: 31478419 DOI: 10.1080/00325481.2019.1663127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Introduction: Depression in patients with mild cognitive impairment (MCI) and dementia of the Alzheimer's type (AD) is associated with worse prognosis. Indeed, depressed MCI patients have worse cognitive performance and greater loss of gray-matter volume in several brain areas. To date, knowledge of the factors that can mitigate this detrimental effect is still limited. The aim of the present study was to understand in what way cognitive reserve/brain reserve and depression interact and are linked to regional atrophy in early stage AD. Methods: Depression was evaluated with the Patient Health Questionnaire-9 in 90 patients with early AD, and a cutoff of ≥ 5 was used to separate depressed (n = 44) from non-depressed (n = 46) patients. Each group was further stratified into high/low cognitive reserve/brain reserve. Cognitive reserve was calculated using years of education as proxy, while normalized parenchymal volumes were used to estimate brain reserve. Voxel-based morphometry was carried out to extract and analyze gray-matter maps. 2 × 2 ANCOVAs were run to test the effect of the reserve-by-depression interaction on gray matter. Age and hippocampal ratio were used as covariates. Composite indices of major cognitive domains were also analyzed with comparable models. Results: No reserve-by-depression interaction was found in the analytical models of gray matter. Depression was associated with less gray matter volume in the cerebellum and parahippocampal gyrus. The brain reserve-by-depression interaction was a significant predictor of executive functioning. Among those with high brain reserve, depressed patients had poorer executive skills. No significant results were found in association with cognitive reserve. Conclusion: These findings suggest that brain reserve may modulate the association between neurodegeneration and depression in patients with MCI and dementia of the AD type, influencing in particular executive functioning.
Collapse
Affiliation(s)
- Elettra Capogna
- Department of Neuroscience, University of Sheffield , Sheffield , UK
| | - Riccardo Manca
- Department of Neuroscience, University of Sheffield , Sheffield , UK
| | - Matteo De Marco
- Department of Neuroscience, University of Sheffield , Sheffield , UK
| | - Anette Hall
- Institute of Clinical Medicine, Neurology, University of Eastern Finland , Kuopio , Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland , Kuopio , Finland
| | - Annalena Venneri
- Department of Neuroscience, University of Sheffield , Sheffield , UK
| |
Collapse
|
15
|
Poritz JMP, Mignogna J, Christie AJ, Holmes SA, Ames H. The Patient Health Questionnaire depression screener in spinal cord injury. J Spinal Cord Med 2018; 41:238-244. [PMID: 28355958 PMCID: PMC5901461 DOI: 10.1080/10790268.2017.1294301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CONTEXT Although depression is not inevitable following spinal cord injury/dysfunction (SCI/D), it can have a negative impact on rehabilitation. Evidence-based assessment of depression utilizing self-report instruments, such as the Patient Health Questionnaire-9 (PHQ-9), is considered good clinical practice. Although the PHQ-9 has been studied in individuals with SCI/D, little is known about the clinical utility of the Patient Health Questionnaire-2 (PHQ-2). Traditional cutoff scores for the PHQ-2 were examined to explore their operating characteristics as related to PHQ-9 results. METHODS Archival data were collected for 116 Veterans with SCI/D who completed the PHQ-2 and PHQ-9 as one component of their routine, comprehensive SCI annual evaluation at a Veterans Affairs Medical Center. Logistic regressions were performed to determine the impact of different cutoff scores for the PHQ-2 on the likelihood that participants would endorse clinically significant levels of depressive symptoms on the PHQ-9 (≥10). RESULTS Using a cutoff score of 3 or greater correctly classified 94.8% of the cases, outperforming the other cutoff scores. A cutoff score of 3 or greater had a sensitivity of 83.3% and specificity of 97.8%, and yielded a positive predictive value of 90.9% and a negative predictive value of 95.7%. CONCLUSION The PHQ-2 shows promise as a clinically useful screener in the community-residing SCI/D population. Findings regarding the presence of suicidal ideation emphasize the importance of routine screening for depressive symptomatology in the SCI/D population. Future research should investigate the role of the PHQ-2 in clinical decision-making and treatment monitoring.
Collapse
Affiliation(s)
| | - Joseph Mignogna
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA,Central Texas Veterans Health Care System, Temple, Texas, USA,Texas A&M College of Medicine, Temple, Texas, USA
| | - Aimee J. Christie
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA,Baylor College of Medicine, Houston, Texas, USA
| | - Sally A. Holmes
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA,Baylor College of Medicine, Houston, Texas, USA
| | - Herb Ames
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA,Baylor College of Medicine, Houston, Texas, USA,Correspondence to: Herb Ames, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, Texas 77030 USA.
| |
Collapse
|
16
|
Hunt LJ, Lee SJ, Harrison KL, Smith AK. Secondary Analysis of Existing Datasets for Dementia and Palliative Care Research: High-Value Applications and Key Considerations. J Palliat Med 2017; 21:130-142. [PMID: 29265949 DOI: 10.1089/jpm.2017.0309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To provide a guide to researchers selecting a dataset pertinent to the study of palliative care for people with dementia and to aid readers who seek to critically evaluate a secondary analysis study in this domain. BACKGROUND The impact of dementia at end-of-life is large and growing. Secondary dataset analysis can play a critical role in advancing research on palliative care for people with dementia. METHODS We conducted a broad search of a variety of resources to: 1. identity datasets that include information germane to dementia and palliative care research; 2. review relevant applications of secondary dataset analysis in the published literature; and 3. explore potential validity and reliability concerns. RESULTS We synthesize findings regarding: 1. Methodological approaches for determining the presence of dementia; 2. Inclusion and measurement of key palliative care items as they relate to people with dementia; and 3. Sampling and study design issues, including the role and implications of proxy-respondents. We describe and compare a selection of high-value existing datasets relevant to palliative care and dementia research. DISCUSSION While secondary analysis of existing datasets requires consideration of key limitations, it can be a powerful tool for efficiently enhancing knowledge of palliative care needs among people with dementia.
Collapse
Affiliation(s)
- Lauren J Hunt
- 1 Department of Physiological Nursing, University of California , San Francisco, San Francisco, California.,2 San Francisco Veterans Affairs Medical Center , San Francisco, California
| | - See J Lee
- 2 San Francisco Veterans Affairs Medical Center , San Francisco, California.,3 Division of Geriatrics, Department of Medicine, University of California , San Francisco, San Francisco, California
| | - Krista L Harrison
- 2 San Francisco Veterans Affairs Medical Center , San Francisco, California.,3 Division of Geriatrics, Department of Medicine, University of California , San Francisco, San Francisco, California
| | - Alexander K Smith
- 2 San Francisco Veterans Affairs Medical Center , San Francisco, California.,3 Division of Geriatrics, Department of Medicine, University of California , San Francisco, San Francisco, California
| |
Collapse
|
17
|
Donders J, Darland K. Psychometric properties and correlates of the PHQ-2 and PHQ-9 after traumatic brain injury. Brain Inj 2017; 31:1871-1875. [PMID: 28686062 DOI: 10.1080/02699052.2017.1334962] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PRIMARY OBJECTIVE To determine the predictive accuracy of the Patient Health Questionnaire (PHQ)-2 in predicting PHQ-9 findings and to examine demographic, historical, and injury correlates of PHQ-9 ratings. RESEARCH DESIGN Retrospective analysis of data collected as part of routine clinical outpatient care over a period of 30 months on 168 persons with mild to severe traumatic brain injury, who were referred for neuropsychological evaluation within 1-12 months after injury. MAIN OUTCOMES AND RESULTS PHQ-2 scores ≥2 had a sensitivity of 0.90 in predicting PHQ-9 scores ≥10, and a sensitivity of 0.95 in predicting endorsement of any passive or active suicidal thoughts on the PHQ-9. Premorbid history of having experienced personal abuse was the strongest predictor of post-injury PHQ-9 ratings. CONCLUSIONS The PHQ-2 has adequate sensitivity in predicting PHQ-9 findings and can be used as a screener in clinical practice in persons with traumatic brain injury, as long as formal psychometric assessment is supplemented with a comprehensive review of premorbid history.
Collapse
Affiliation(s)
- Jacobus Donders
- a Psychology Service , Mary Free Bed Rehabilitation Hospital , Grand Rapids , MI , USA
| | | |
Collapse
|
18
|
Swartz RH, Cayley ML, Lanctôt KL, Murray BJ, Cohen A, Thorpe KE, Sicard MN, Lien K, Sahlas DJ, Herrmann N. The "DOC" screen: Feasible and valid screening for depression, Obstructive Sleep Apnea (OSA) and cognitive impairment in stroke prevention clinics. PLoS One 2017; 12:e0174451. [PMID: 28376127 PMCID: PMC5380324 DOI: 10.1371/journal.pone.0174451] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/09/2017] [Indexed: 01/20/2023] Open
Abstract
Background Post-stroke Depression, Obstructive sleep apnea (OSA) and Cognitive impairment (“DOC”) are associated with greater mortality, worse recovery and poorer quality of life. Best practice recommendations endorse routine screening for each condition; yet, all are under-assessed, diagnosed and treated. We seek to determine the feasibility and validity of an integrated tool (“DOC” screen) to identify stroke clinic patients at high-risk of depression, OSA, and cognitive impairment. Methods All consecutive new referrals to a regional Stroke Prevention Clinic who were English-speaking and non-aphasic were eligible to be screened. Time for screen completion was logged. DOC screen results were compared to the neuropsychological battery and polysomnogram assessments using a modified receiver operator characteristic and area under the curve analysis. Data is reported to conform to STARD guidelines. Findings 1503 people were screened over 2 years. 89% of eligible patients completed the screen in 5 minutes or less (mean 4.2 minutes), less than half the time it takes to complete the Montreal Cognitive Assessment (MoCA). 437 people consented to detailed testing. Of those, 421 completed the Structured Clinical Interview for Depression within 3 months of screening, 387 completed detailed neuropsychological testing within 3 months, and 88 had overnight polysomnograms. Screening scores combined with demographic variables (age, sex, education, body mass index), had excellent validity compared to gold standard diagnoses: DOC-Mood AUC 0.90; DOC-Apnea AUC 0.80; DOC-Cog AUC 0.81. DOC screen scores can reliably categorize patients in to low-, intermediate- or high-risk groups for further action and can do so with comparable accuracy to more time-consuming screens. Conclusions Systematic screening of depression, obstructive sleep apnea, and cognitive impairment in 5 minutes or less is feasible and valid in a high volume stroke clinic using the DOC screen. The DOC screen may facilitate improved identification and treatment of these comorbidities to improve function in patients after stroke and in those with other neurological diseases that share these comorbid conditions (e.g. Alzheimer’s disease/mild cognitive impairment, Parkinson’s disease, Traumatic Brain Injury, multiple sclerosis).
Collapse
Affiliation(s)
- Richard H. Swartz
- University of Toronto, Toronto, Ontario, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Toronto, Ontario, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, Ontario, Canada
- University of Toronto Stroke Program, Toronto, Ontario, Canada
- * E-mail:
| | - Megan L. Cayley
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Krista L. Lanctôt
- University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Brian J. Murray
- University of Toronto, Toronto, Ontario, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Toronto, Ontario, Canada
| | - Ashley Cohen
- St. Michael’s Hospital, Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Kevin E. Thorpe
- University of Toronto, Toronto, Ontario, Canada
- St. Michael’s Hospital, Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Michelle N. Sicard
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Karen Lien
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Demetrios J. Sahlas
- McMaster University, Hamilton, Ontario, Canada
- Department of Medicine (Neurology), Hamilton Health Sciences, Hamilton, Ontario, Canada
- Hamilton General Hospital, Toronto, Ontario, Canada
| | - Nathan Herrmann
- University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
19
|
Rodríguez-Fernández JM, Danies E, Martínez-Ortega J, Chen WC. Cognitive Decline, Body Mass Index, and Waist Circumference in Community-Dwelling Elderly Participants. J Geriatr Psychiatry Neurol 2017; 30:67-76. [PMID: 28077009 DOI: 10.1177/0891988716686832] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to explore the association of body mass index (BMI), waist circumference (WC), and BMI and WC changes over time with cognitive decline in a nationally representative sample. METHODS A total of 5239 participants (≥65 years) were followed for 3 years as part of the National Health and Aging Trends Study. Cox proportional hazard regression was applied to model the risk of cognitive decline. RESULTS BMI, after adjusting for WC and main confounders, was associated with reduced risk of cognitive decline (hazard ratio [HR] 0.97 for each unit BMI increase, 0.95-0.99). After stratifying by gender and age, this effect remained significant among females and young elders ≤80 years. A BMI decrease and WC increase >10% over the study period were associated with increased risk of cognitive decline (HR 1.98, 1.16-3.38; HR 1.30, 1.04-1.62, respectively). CONCLUSION In the elderly individuals, lean mass, as measured by BMI adjusted for WC, was associated with reduced risk of cognitive decline. Loss of lean mass and gain of fat mass, as measured by WC adjusted for BMI, were associated with elevated risk of cognitive decline.
Collapse
Affiliation(s)
| | - Emily Danies
- 1 Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - José Martínez-Ortega
- 1 Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - William C Chen
- 2 Department of Neurosurgery, University of California, San Francisco, CA, USA
| |
Collapse
|
20
|
Diagnostik und multimodale Therapie der Altersdepression. Z Gerontol Geriatr 2017; 50:99-105. [DOI: 10.1007/s00391-016-1174-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
|
21
|
Manea L, Gilbody S, Hewitt C, North A, Plummer F, Richardson R, Thombs BD, Williams B, McMillan D. Identifying depression with the PHQ-2: A diagnostic meta-analysis. J Affect Disord 2016; 203:382-395. [PMID: 27371907 DOI: 10.1016/j.jad.2016.06.003] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/28/2016] [Accepted: 06/03/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is interest in the use of very brief instruments to identify depression because of the advantages they offer in busy clinical settings. The PHQ-2, consisting of two questions relating to core symptoms of depression (low mood and loss of interest or pleasure), is one such instrument. METHOD A systematic review was conducted to identify studies that had assessed the diagnostic performance of the PHQ-2 to detect major depression. Embase, MEDLINE, PsychINFO and grey literature databases were searched. Reference lists of included studies and previous relevant reviews were also examined. Studies were included that used the standard scoring system of the PHQ-2, assessed its performance against a gold-standard diagnostic interview and reported data on its performance at the recommended (≥3) or an alternative cut-off point (≥2). After assessing heterogeneity, where appropriate, data from studies were combined using bivariate diagnostic meta-analysis to derive sensitivity, specificity, likelihood ratios and diagnostic odds ratios. RESULTS 21 studies met inclusion criteria totalling N=11,175 people out of which 1529 had major depressive disorder according to a gold standard. 19 of the 21 included studies reported data for a cut-off point of ≥3. Pooled sensitivity was 0.76 (95% CI =0.68-0.82), pooled specificity was 0.87 (95% CI =0.82-0.90). However there was substantial heterogeneity at this cut-off (I(2)=81.8%). 17 studies reported data on the performance of the measure at cut-off point ≥2. Heterogeneity was I(2)=43.2% pooled sensitivity at this cut-off point was 0.91 (95% CI =0.85-0.94), and pooled specificity was 0.70 (95% CI =0.64-0.76). CONCLUSION The generally lower sensitivity of the PHQ-2 at cut-off ≥3 than the original validation study (0.83) suggests that ≥2 may be preferable if clinicians want to ensure that few cases of depression are missed. However, in situations in which the prevalence of depression is low, this may result in an unacceptably high false-positive rate because of the associated modest specificity. These results, however, need to be interpreted with caution given the possibility of selectively reported cut-offs.
Collapse
Affiliation(s)
- Laura Manea
- Hull York Medical School and Department of Health Sciences, University of York, United Kingdom
| | - Simon Gilbody
- Hull York Medical School and Department of Health Sciences, University of York, United Kingdom
| | - Catherine Hewitt
- Department of Health Sciences, University of York, United Kingdom
| | - Alice North
- Department of Health Sciences, University of York, United Kingdom
| | - Faye Plummer
- Department of Health Sciences, University of York, United Kingdom
| | | | - Brett D Thombs
- Hull York Medical School and Department of Health Sciences, University of York, United Kingdom; Department of Health Sciences, University of York, United Kingdom
| | - Bethany Williams
- Department of Health Sciences, University of York, United Kingdom
| | - Dean McMillan
- Hull York Medical School and Department of Health Sciences, University of York, United Kingdom.
| |
Collapse
|
22
|
|
23
|
Smith M, Haedtke C, Shibley D. Evidence-Based Practice Guideline: Late-Life Depression Detection. J Gerontol Nurs 2015; 41:18-25. [DOI: 10.3928/00989134-20150115-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
24
|
Petersen JJ, Paulitsch MA, Hartig J, Mergenthal K, Gerlach FM, Gensichen J. Factor structure and measurement invariance of the Patient Health Questionnaire-9 for female and male primary care patients with major depression in Germany. J Affect Disord 2015; 170:138-42. [PMID: 25240840 DOI: 10.1016/j.jad.2014.08.053] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 08/28/2014] [Accepted: 08/29/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression is characterized by gender-specific distinctions, with women being affected more often than men. The Patient Health Questionnaire-9 (PHQ-9) is frequently used to assess depression in primary healthcare. Previous research has yielded heterogeneous findings on the factor structure, and little is known of its measurement invariance across gender. The aim of this study was 1) to evaluate the fit of four previously hypothesized models of PHQ-9 factor structure in patients with major depression in German family practices, and 2) to test the measurement invariance of the best-fitting model across gender. METHODS We used the baseline data from a cluster-randomized controlled trial. The diagnosis of major depression was based on the PHQ-9 and confirmed by the family physician. We calculated Confirmatory Factor Analyses (CFA) to assess which of the previously hypothesized factor structures (a one- and three different two-factor solutions) would best fit our data. We also calculated Complex Survey Analyses (CSA) and Multi Sample Analyses (MSA). RESULTS We included 626 participants (75.4% women and 24.6% men). A two-factor model with five 'somatic' labeled items and four 'non-somatic' labeled items presented the best fit indices. The model measurement was invariant across gender. LIMITATIONS The inclusion criteria used in the main trial mean the study sample was not representative of all patients with major depression in German family practices. CONCLUSIONS The measurement invariance across gender revealed by this study is a precondition for the use of the PHQ-9 without gender-specific adaptation in patients with major depression in German family practices.
Collapse
Affiliation(s)
- Juliana J Petersen
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany.
| | - Michael A Paulitsch
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Johannes Hartig
- Department of Educational Quality and Evaluation, German Institute for International Educational Research, Frankfurt am Main, Germany
| | - Karola Mergenthal
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Jochen Gensichen
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany; Institute of General Practice, Friedrich Schiller University Hospital Jena, Jena, Germany
| |
Collapse
|
25
|
Davydow DS, Zivin K, Langa KM. Hospitalization, depression and dementia in community-dwelling older Americans: findings from the national health and aging trends study. Gen Hosp Psychiatry 2014; 36:135-41. [PMID: 24388630 PMCID: PMC3951607 DOI: 10.1016/j.genhosppsych.2013.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 11/25/2013] [Accepted: 11/26/2013] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The objective was to estimate the prevalence of both dementia and depression among community-dwelling older Americans and to determine if hospitalization is independently associated with dementia or depression in this population. METHOD This cross-sectional study utilized data from a nationally representative, population-based sample of 7197 community-dwelling adults ≥ 65 years old interviewed in 2011 as part of the National Health and Aging Trends Study. Information on hospitalizations was obtained from self- or proxy-report. Possible and probable dementia was assessed according to a validated algorithm. Depressive symptoms were assessed with the Patient Health Questionnaire-2. RESULTS An estimated 3.1 million community-dwelling older Americans may have dementia, and approximately 5.3 million may have substantial depressive symptoms. After adjusting for demographic and social characteristics, medical diagnoses, smoking history, serious falls and pain symptoms, being hospitalized in the previous year was independently associated with greater odds of probable dementia (odds ratio [OR]: 1.42, 95% confidence interval [95% CI]: 1.16-1.73) and substantial depressive symptoms (OR: 1.60, 95% CI: 1.29-1.99). CONCLUSIONS Dementia and depression are common in community-dwelling older Americans, and hospitalization is associated with these conditions. Additional research increasing understanding of the bidirectional relationship between hospitalizations, dementia and depression, along with targeted interventions to reduce hospitalizations, is needed.
Collapse
Affiliation(s)
- Dimitry S Davydow
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
| | - Kara Zivin
- Ann Arbor Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Psychiatry and Behavioral Sciences University of Michigan, Ann Arbor, MI, USA; Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth M Langa
- Ann Arbor Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA; Institute for Social Research, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
26
|
Mansbach WE, MacDougall EE, Clark KM, Mace RA. Preliminary investigation of the Kitchen Picture Test (KPT): A new screening test of practical judgment for older adults. AGING NEUROPSYCHOLOGY AND COGNITION 2013; 21:674-92. [DOI: 10.1080/13825585.2013.865698] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
27
|
Davis K, Pearlstein T, Stuart S, O'Hara M, Zlotnick C. Analysis of brief screening tools for the detection of postpartum depression: comparisons of the PRAMS 6-item instrument, PHQ-9, and structured interviews. Arch Womens Ment Health 2013; 16:271-7. [PMID: 23579244 PMCID: PMC3722286 DOI: 10.1007/s00737-013-0345-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 03/22/2013] [Indexed: 11/27/2022]
Abstract
Postpartum depression (PPD) is an important mental health issue affecting approximately 10 % of women. Self-report screening measures represent utility for detecting PPD in both clinical and research settings. The current study sought to inspect the accuracy of two screening measures compared to clinical interviews. As part of an ongoing clinical trial, 1,392 women between the ages of 18 and 45 were screened for PPD using the Patient Health Questionnaire-9 (PHQ-9) and a six-item scale developed from CDC Pregnancy Risk Assessment questions (PRAMS-6). Three item subscales of the PRAMS-6 were also inspected-three depression (PRAMS-3D) and three anxiety items (PRAMS-3A). Receiver operating characteristics compared the diagnostic accuracy of the PHQ-9, PRAMS-6, PRAMS-3D, and PRAMS-3A to both the Structured Clinical Interview for the DSM-IV (SCID) and the Hamilton Rating Scale for Depression. The PHQ-9, PRAMS-6, and PRAMS-3D all showed moderate accuracy at diagnosing PPD. Diagnostic cut points are provided. The PRAMS-6 instrument is a brief and effective screening tool for PPD. The time frame of symptom assessment may account for some variability in accuracy between the PHQ-9 and PRAMS screening instruments.
Collapse
|
28
|
Choi NG, Sirey JA, Bruce ML. Depression in Homebound Older Adults: Recent Advances in Screening and Psychosocial Interventions. CURRENT TRANSLATIONAL GERIATRICS AND EXPERIMENTAL GERONTOLOGY REPORTS 2013; 2:16-23. [PMID: 23459163 PMCID: PMC3582679 DOI: 10.1007/s13670-012-0032-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Homebound older adults are more likely than their ambulatory peers to suffer from depression. Unfortunately, the effectiveness of antidepressant medications alone in such cases is limited. Greater benefits might be realized if patients received both pharmacotherapy and psychotherapy to enhance their skills to cope with their multiple chronic medical conditions, isolation, and mobility impairment; however, referrals to specialty mental health services seldom succeed due to inaccessibility, shortage of geriatric mental health providers, and cost. Since a large proportion of homebound older adults receive case management and other services from aging services network agencies, the integration of mental health services into these agencies is likely to be cost-efficient and effective. This review summarizes recent advances in home-based assessment and psychosocial treatment of depression in homebound recipients of aging services.
Collapse
Affiliation(s)
- Namkee G. Choi
- The University of Texas at Austin School of Social Work, 1925 San Jacinto Blvd, Austin, TX 78712; ; 512-232-9590; 512-471-9600 (fax)
| | - Jo Anne Sirey
- Department of Psychiatry, Westchester Division, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605; ; 914-997-4333; 914-682-6979 (fax)
| | - Martha L. Bruce
- Department of Psychiatry, Westchester Division, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605; ; 914-997-5977
| |
Collapse
|
29
|
[Identifying depression in the general population - a comparison of PHQ-9, PHQ-8 and PHQ-2]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2012; 58:3-10. [PMID: 22427121 DOI: 10.13109/zptm.2012.58.1.3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the comparability of depression as defined by PHQ-9, PHQ-8 and PHQ-2 in the German general population. METHODS The PHQ-9 was assessed in a representative sample (N = 2524). Depression diagnosis and depression severity as measured either by PHQ-9, PHQ-8 or PHQ-2 were compared. RESULTS PHQ-8 and PHQ-9 performed comparably in identifying depressive persons, though there are slight differences in rating depression severity. In comparison, the PHQ-2 showed the best performance in the detection of any depressive disorder. CONCLUSIONS The PHQ-9 should be used in clinical settings, whereas in research and when persons are being approached via telephone/mail/internet the PHQ-8 is preferable. The PHQ-2 is recommended as a very economic and brief screener for depressive disorders.
Collapse
|