Factorial structure of the Spanish center for epidemiologic studies depression scales in HIV patients

Clinical utility of depression measures and symptoms: Implications for suicide risk assessment in high risk, resource limited youth populations

OBJECTIVE

Suicide risk for youth in resource- limited settings has been largely underrepresented in the literature and requires targeted examination of practical ways to address this growing public health concern. The present study focuses on the clinical utility of depression risk assessment tools addressing how and for whom suicide prevention intervention is most beneficial within a low-middle-income-country, high suicide risk youth sample.

METHODS

Youth who reported a previous suicide attempt versus those who did not were criterion to test the validity of depression and hopelessness symptom assessment tools. We used item analyses to identify depressive symptom endorsements that most informed youth suicide risk, which will better equip rural practitioners for targeted intervention and monitoring of youth with an already high risk for suicide.

RESULTS

Findings demonstrated that practitioners may target symptoms of social anhedonia, depressed mood, concentration disturbance, feelings of worthlessness, sleep disturbance, and fatigue for suicide prevention-intervention efforts among high-risk youth.

CONCLUSIONS

Study implications are for clinicians' use of the BDI-II and CES-D for depression symptom identification and suicide risk monitoring in settings with limited mental health infrastructure.

Neuropsychological changes in efavirenz switch regimens

BACKGROUND

Efavirenz is associated with side effects involving the central nervous system. However, it remains largely unknown whether switching off EFV improves neuropsychological performance.

METHODS

We utilized data from the Multicenter AIDS Cohort Study (MACS). Participants were categorized by their use of EFV: never on EFV (No EFV), continuously on EFV (No Switch-OFF) and on EFV and then switched off (Switch-OFF). Baseline time points were defined as visits when first neuropsychological data were available. In Analysis 1, we compared neuropsychological and Center for Epidemiological Studies-Depression Scale (CES-D) scores before and after EFV switch in Switch-OFF group, aligning participants at the time of switch. Analysis 2 evaluated trajectory of neuropsychological/CES-D score among the three groups.

RESULTS

This analysis included 1989 HIV-seropositive participants with neuropsychological data (1675 in No EFV, 44 in No Switch-OFF, and 270 in Switch-OFF group). At baseline, participants had a median age of 37 years, median CD4 cell count 442 cells/μl, and 22.9% viral suppression rate. In Analysis 1, neuropsychological and CES-D scores did not show clinically significant changes over 2 years prior to and 4 years after switch in Switch-OFF group. In Analysis 2, trends in neuropsychological and CES-D scores in the three different groups did not show significant differences during a median of 3.2 years of follow-up.

CONCLUSION

Discontinuation of EFV is not associated with changes in neuropsychological performance or severity of depression in men. Furthermore, we did not observe differences among participants who were never on EFV, continuously on EFV, and on EFV and then switched off.

Assessing the dimensionality of the CES-D using multi-dimensional multi-level Rasch models

Objectives

The CES-D is a widely used depression screening instrument. While numerous studies have analysed its psychometric properties using exploratory and various kinds of confirmatory factor analyses, only few studies used Rasch models and none a multidimensional one.

Methods

The present study applies a multidimensional Rasch model using a sample of 518 respondents representative for the Austrian general population aged 18 to 65. A one-dimensional model, a four-dimensional model reflecting the subscale structure suggested by [1], and a four-dimensional model with the background variables gender and age were applied.

Results

While the one-dimensional model showed relatively good fit, the four-dimensional model fitted much better. EAP reliability indices were generally satisfying and the latent correlations varied between 0.31 and 0.88. In the analysis involving background variables, we found a limited effect of the participants’ gender. DIF effects were found unveiling some peculiarities. The two-items subscale Interpersonal Difficulties showed severe weaknesses and the Positive Affect subscale with the reversed item wordings also showed unexpected results.

Conclusions

While a one-dimensional over-all score might still contain helpful information, the differentiation according to the latent dimension is strongly preferable. Altogether, the CES-D can be recommended as a screening instrument, however, some modifications seem indicated.

Screening value of the Center for epidemiologic studies - depression scale among people living with HIV/AIDS in Ho Chi Minh City, Vietnam: a validation study

BACKGROUND

Depression is believed to be under-diagnosed and under-treated in people living with HIV/AIDS (PLHIV). Early screening and referral to mental health services for treatment has been shown to enhance HIV patients' health during the course of HIV treatment. A lack of psychiatric specialist services for PLHIV at outpatient clinics (OPC) in Vietnam leads to insufficient identification of depression. However, alternative approaches are available such as the use of screening scales. This study investigated the psychometric properties of the Center for Epidemiologic Studies - Depression scale (CES-D) in Vietnamese HIV positive outpatients.

METHODS

A cross-sectional survey of 400 HIV positive outpatients was conducted in Ho Chi Minh City, Vietnam. Participants completed a self-reported questionnaire that included the CES-D. Participants were also interviewed independently by a psychiatrist who assessed for symptoms of major depressive disorder. CES-D reliability was measured by Cronbach's alpha. Criterion validity was evaluated by ROC analysis, Kappa index and the percentage of agreement between the CES-D and psychiatrists' interview. Construct validity was investigated by confirmatory factor analysis.

RESULTS

The reliability for the whole scale was good (Cronbach α = 0.81). The four sub-scales of the CES-D had lower levels of internal consistency with Cronbach alpha of 0.71, 0.73, 0.71 and 0.58 for somatic complaints, depressive affect, positive affect and interpersonal problems respectively. CES-D has adequate construct validity with CFI = 0.926, IFI = 0.927, GFI = 0.930 and RMSEA = 0.045 (90% CI = 0.037-0.053) in the final four-factor model. Area under curve was 0.88 indicating good criterion validity. At the cutoff of 16, the sensitivity and specificity were 79.8% and 83.0% respectively while the percentage of agreement between the CES-D and psychiatrists' interview was 82.0% with Kappa index at 0.60.

CONCLUSIONS

The CES-D was shown to be acceptable, reliable and valid for screening symptoms of depression in Vietnamese HIV outpatient clinic settings where mental health specialists are not always available. Routine use of the CES-D at HIV outpatient clinics, in combination with the availability of free-for-all national mental health services, is likely to be beneficial in improving the lives of PLHIV in Vietnam who have depression.