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Wang F, Jia L. BMI moderates the relationship between depression and chronic obstructive pulmonary disease: A cross‑sectional survey. Heart Lung 2024; 68:68-73. [PMID: 38936063 DOI: 10.1016/j.hrtlng.2024.06.013] [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: 04/11/2024] [Revised: 06/19/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Prior research has established a connection between depression and chronic obstructive pulmonary disease (COPD). However, the influence of age and BMI on this association remains unclear. OBJECTIVES We used the National Health and Nutrition Examination Survey (NHANES) database to explore the relationship between depression and COPD, and to investigate whether age and Body mass index (BMI) act as moderators in this relationship. METHODS We analyzed data from 10,940 participants in the NHANES database. Depression served as the independent variable. COPD status served as the outcome variable. We employed multivariable logistic regression to examine the relationship between depression and COPD. RESULTS Of the 10,940 respondents surveyed, about 3.9 % had COPD and 8.5 % had depression. The prevalence of depression in COPD patients was significantly greater than the prevalence of overall respondents (21.1 % VS.8.5 %). We found that the association between depression and COPD was mediated by BMI status. Controlling for other covariates, the association between depression and COPD increased significantly. For the underweight group, the impact of depression on the risk of COPD was lower compared to the normal BMI group. CONCLUSION This study confirms a significant association between depression and COPD, with BMI serving as a moderator. These findings enhance our understanding of the complex interplay between depression and COPD and underscore the importance of considering individual physical health characteristics in clinical assessments. The results have significant implications for clinical practice and public health policymaking.
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Affiliation(s)
- Feng Wang
- Xin'an International Hospital, Department of Respiratory and Critical Care Medicine, Jiaxing, Zhejiang 314000, PR China
| | - Liangliang Jia
- Xin'an International Hospital, Department of Respiratory and Critical Care Medicine, Jiaxing, Zhejiang 314000, PR China.
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Harry ML, Sanchez K, Ahmedani BK, Beck AL, Coleman KJ, Coley RY, Daida YG, Lynch FL, Rossom RC, Waring SC, Simon GE. Assessing the differential item functioning of PHQ-9 items for diverse racial and ethnic adults with mental health and/or substance use disorder diagnoses: A retrospective cohort study. J Affect Disord 2023; 338:402-413. [PMID: 37127116 PMCID: PMC10524453 DOI: 10.1016/j.jad.2023.04.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Improving health equity in depression care and suicide screening requires that measures like the Patient Health Questionnaire 9 (PHQ-9) function similarly for diverse racial and ethnic groups. We evaluated PHQ-9 differential item functioning (DIF) between racial/ethnic groups in a retrospective cohort study of secondary electronic health record (EHR) data from eight healthcare systems. METHODS The population (n = 755,156) included patients aged 18-64 with mental health and/or substance use disorder (SUD) diagnoses who had a PHQ-9 with no missing item data in the EHR for primary care or mental health visits between 1/1/2009-9/30/2017. We drew two random samples of 1000 from the following racial/ethnic groups originally recorded in EHRs (n = 14,000): Hispanic, and non-Hispanic White, Black, Asian, American Indian/Alaska Native, Native Hawaiian/Other Pacific Islander, multiracial. We assessed DIF using iterative hybrid ordinal logistic regression and item response theory with p < 0.01 and 1000 Monte Carlo simulations, where change in model R2 > 0.01 represented non-negligible (e.g., clinically meaningful) DIF. RESULTS All PHQ-9 items displayed statistically significant, but negligible (e.g., clinically unmeaningful) DIF between compared groups. The negligible DIF varied between random samples, although six items showed negligible DIF between the same comparison groups in both random samples. LIMITATIONS Our findings may not generalize to disaggregated racial/ethnic groups or persons without mental health and/or SUD diagnoses. CONCLUSIONS We found the PHQ-9 had clinically unmeaningful cross-cultural DIF for adult patients with mental health and/or SUD diagnoses. Future research could disaggregate race/ethnicity to discern if within-group identification impacts PHQ-9 DIF.
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Affiliation(s)
- Melissa L Harry
- Essentia Health, Essentia Institute of Rural Health, Duluth, MN, USA.
| | - Katherine Sanchez
- Baylor Scott and White, Center for Applied Health Research, Temple, TX, USA
| | - Brian K Ahmedani
- Henry Ford Health, Center for Health Policy & Health Services Research, Detroit, MI, USA
| | - Arne L Beck
- The Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, USA
| | - Karen J Coleman
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA
| | - R Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Yihe G Daida
- Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Frances L Lynch
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | - Stephen C Waring
- Essentia Health, Essentia Institute of Rural Health, Duluth, MN, USA
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Rene C, Faustin M, Bonhomme J, Deschamps MM, Jean-Gilles M, Rosenberg R, Ibrahim M, McNairy M, Pape JW, Devieux JG. An Adapted Self-screening Tool for Peripartum Cardiomyopathy in Haiti. Crit Pathw Cardiol 2023; 22:19-24. [PMID: 36812340 PMCID: PMC9976336 DOI: 10.1097/hpc.0000000000000312] [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] [Indexed: 02/24/2023]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) is considered rare in the United States; however, the literature notes that the disease has a higher prevalence in developing countries such as Haiti. Dr. James D. Fett, a US cardiologist, developed and validated a self-assessment measure for PPCM in the United States to aid women to easily differentiate the signs and symptoms of heart failure from those related to a normal pregnancy. Although this instrument was validated, it lacks the adaptation necessary to account for the language, culture, and education of the Haitian population. OBJECTIVE The aim of this study was to translate and culturally adapt the Fett PPCM self-assessment measure for use among a Haitian Creole speaking population. METHODS A preliminary Haitian Creole direct translation was developed from the original English Fett self-test. A total of four focus groups with medical professionals and 16 cognitive interviews with members of a community advisory board were conducted to refine the preliminary Haitian Creole translation and adaptation. RESULTS The adaptation focused on incorporating cues that would be tangible and connected to the reality of the Haitian population while maintaining the intended meaning of the original Fett measure. CONCLUSIONS The final adaptation provides an instrument suitable for administration by auxiliary health providers and community health workers to help patients distinguish symptoms of heart failure from symptoms related to normal pregnancy and further quantify the severity of signs and symptoms that might be indicative of heart failure.
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Affiliation(s)
- Cassandra Rene
- From the Robert Stempel College of Public Health & Social Work, Miami, FL
| | - Mikerlyne Faustin
- From the Robert Stempel College of Public Health & Social Work, Miami, FL
| | | | | | | | - Rhonda Rosenberg
- From the Robert Stempel College of Public Health & Social Work, Miami, FL
| | | | - Margaret McNairy
- Weill Cornell Medical Center, Center for Global Health & Division of Medicine, New York, NY
| | - Jean W Pape
- The GHESKIO Centers, Port-au-Prince, Haiti
- Weill Cornell Medical Center, Center for Global Health & Division of Medicine, New York, NY
| | - Jessy G Devieux
- From the Robert Stempel College of Public Health & Social Work, Miami, FL
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Sánchez-Millán HA, Alicea-Cruz A, Pedrogo CP. Measuring Psychological Flexibility: The Cultural Adaptation and Psychometric Properties of the AAQ for Substance Abuse among Spanish Speaking Population in Correctional and Community settings. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022; 23:31-37. [PMID: 35273902 PMCID: PMC8903168 DOI: 10.1016/j.jcbs.2021.11.002] [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: 01/03/2023]
Abstract
Evaluating psychological flexibility is key in determining the mechanism of action of an ACT intervention. This study aims to evaluate the psychometric properties of the Spanish version of the Acceptance and Action Questionnaire - Substance Abuse (AAQ-SA), a measure of psychological flexibility, among 402 adults with Substance Use Disorders (SUDs) in Puerto Rico recruited from either a prison population or community treatment settings. To evaluate the factor structure of the AAQ-SA, we conducted confirmatory factor analyses with the two-factor structure proposed by the original authors and the three-factor structure found in a Mexican sample. We found the two-factor structure to be a better fit of the data from our sample. After implementing modifications to the model, the two-factor structure demonstrated adequate model fit indices. To gather evidence of convergent validity, we evaluated correlations between scores of the AAQ-SA and those of depression, self-efficacy, and self-stigma measures. The current study suggests that the AAQ-SA is a promising measure of psychological flexibility for the present target populations. Further research is needed to examine the psychometric properties of scores of the AAQ-SA, including discriminant validity.
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Affiliation(s)
| | | | - Coralee Pérez Pedrogo
- Albizu University, San Juan, Puerto Rico P.O. BOX 9023711, 00902-3711,University of Puerto Rico Medical Sciences Campus Box 365067. San Juan, Puerto Rico 00936
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Hu S, Chen Y, Chen Y, Wang C. Depression and Anxiety Disorders in Patients With Inflammatory Bowel Disease. Front Psychiatry 2021; 12:714057. [PMID: 34690829 PMCID: PMC8531580 DOI: 10.3389/fpsyt.2021.714057] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/30/2021] [Indexed: 12/12/2022] Open
Abstract
Mental health is a significant yet overlooked aspect of inflammatory bowel disease (IBD) patient care, with challenges in determining optimal treatments and psychological health resources. The most common psychological conditions in patients with IBD are anxiety and depression. The increased prevalence of these mental disorders appeals to mental screening of each person diagnosed with IBD at initial consultation. There are simple and clinically viable methods available to screen for mental problems. Psychological methods may be as or even more significant as a therapeutic modality. Herein we discuss the three major areas of psychological co-morbidity in IBD: (1) the prevalence and risk factors associated with anxiety and depression disorders for patients with IBD; (2) diagnosis of psychological disorders for patients with IBD; (3) treatment with patients with IBD and mental disorders. The gastroenterologists are encouraged to screen and treat these patients with IBD and mental disorders, which may improve outcomes.
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Affiliation(s)
- Shurong Hu
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiping Chen
- Department of Psychiatry, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Chen
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Caihua Wang
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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6
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Moore A, van Loenhout JAF, de Almeida MM, Smith P, Guha-Sapir D. Measuring mental health burden in humanitarian settings: a critical review of assessment tools. Glob Health Action 2020; 13:1783957. [PMID: 32657249 PMCID: PMC7480646 DOI: 10.1080/16549716.2020.1783957] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/03/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The effects of disasters and conflicts are widespread and heavily studied. While attention to disasters' impacts on mental health is growing, mental health effects are not well understood due to inconsistencies in measurement. OBJECTIVE The purpose of this study is to review mental health assessment tools and their use in populations affected by disasters and conflicts. METHOD Tools that assess posttraumatic stress disorder, depression, substance use disorder, and general mental health were examined. This review began with a search for assessment tools in PubMed, PsycINFO, and Google Scholar. Next, validation studies for the tools were obtained through snowball sampling. A final search was conducted for scientific studies using the selected tools in humanitarian settings to collect the data for analysis. The benefits and limitations described for each tool were compiled into a complete table. RESULTS Twelve assessment tools were included, with 88 studies using them. The primary findings indicate that half of the studies used the Impact of Events Scale-Revised. The most common limitation discussed is that self-report tools inaccurately estimate the prevalence of mental health problems. This inaccuracy is further exacerbated by a lack of cultural appropriateness of the tools, as many are developed for Western contexts. CONCLUSION It is recommended that researchers and humanitarian workers reflect on the effectiveness of the mental health assessment tool they use to accurately represent the populations under study in emergency settings. In addition, mental health assessment should be coupled with action.
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Affiliation(s)
- Ashley Moore
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Joris Adriaan Frank van Loenhout
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Maria Moitinho de Almeida
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Pierre Smith
- Institute of Health and Society IRSS, Université Catholique de Louvain, Brussels, Belgium
| | - Debarati Guha-Sapir
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
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Glynn TR, Mendez NA, Jones DL, Dale SK, Carrico AW, Feaster DJ, Rodriguez AE, Safren SA. Trauma exposure, PTSD, and suboptimal HIV medication adherence among marginalized individuals connected to public HIV care in Miami. J Behav Med 2020; 44:147-158. [PMID: 33098541 DOI: 10.1007/s10865-020-00191-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/08/2020] [Indexed: 11/25/2022]
Abstract
Individuals living with HIV report disproportionately high levels of trauma exposure and PTSD symptoms, both which have been associated with suboptimal ART adherence. Often conflated, the question arises as to which construct is driving subsequent HIV self-care behavior. Given the HIV disparities among Black and Hispanic/Latinx individuals, and that Miami is a geographic region with a high racial/ethnic minority make up and a unique socioeconomic environment, it is important to explore factors related to HIV outcomes in Miami to mitigate its uncontrolled epidemic. This study aimed to examine the association of trauma exposure, PTSD symptoms, and relevant additional key factors with adherence to ART among a sample of majority Black and Hispanic/Latinx individuals who are economically marginalized receiving public HIV care in Miami, FL (N = 1237) via a cross-sectional survey. Sequential linear regression was used to examine the study aim in four blocks: (1) trauma, (2) PTSD symptoms, and key covariates of ART adherence including (3) depression and substance use (potential psychological covariates), and (4) indicators of socioeconomic status (potential structural covariates). In the first block, trauma exposure was associated with worse adherence. However, in the second block, the association with trauma dropped and PTSD was significantly associated with worse adherence. Of note, for those experiencing high levels of trauma exposure, adherence was negatively impacted regardless of PTSD. When other key factors associated with adherence were entered in the third and fourth blocks, neither trauma exposure nor PTSD were uniquely significant. In this final model, depression, substance use, and unstable housing were uniquely associated with worse adherence. Trauma-informed models of HIV care that holistically address co-occurring factors are warranted to cater to communities with HIV health disparities and keep them from falling off the HIV care continuum.
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Affiliation(s)
- Tiffany R Glynn
- Department of Psychology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA
| | - Noelle A Mendez
- Department of Psychology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Allan E Rodriguez
- Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA.
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Duthely LM, Sanchez-Covarrubias AP, Mohamed AB, Potter JE. A Multilingual, Culturally Competent Mobile Health Intervention to Improve Treatment Adherence Among Women Living With HIV: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e17656. [PMID: 32438338 PMCID: PMC7334759 DOI: 10.2196/17656] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/17/2020] [Accepted: 03/20/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Adherence to HIV care is complex, as barriers to care are multidimensional, particularly for ethnic minority women. Mobile health (mHealth) solutions are supportive in improving HIV health care outcomes. In the United States, however, mHealth interventions are not widely implemented in public HIV clinics and have not been customized for women. There is an unmet need for culturally and linguistically appropriate mHealth interventions that address the health care needs of minority women living with HIV. OBJECTIVE This study aims to describe a protocol investigating the feasibility of an mHealth intervention for treatment adherence among women living with HIV. This is a two-phase, mixed methods, pilot randomized controlled trial that begins with qualitative patient interviews to inform the system design. Participants will be block randomized by language (English, Spanish, and Haitian Creole) to 1 of 2 study arms. METHODS Women (age ≥18 years) who were followed up at the women's HIV clinic of an academic medical center, with a recent history of nonadherence to HIV care (missed appointments, unsuppressed viral load, or not taking medications as prescribed), will be enrolled. The experimental arm will receive the intervention, which includes health reminders and psychoeducational messaging, plus clinical standard of care reminders. The psychoeducational messaging will target patient-level barriers of HIV stigma and medical mistrust and resilience as a patient-level strength. The control arm will receive standard of care reminders only (ie, mailed appointments and automated telephone calls). All aspects of the study and intervention will be offered in the participants' preferred language. The primary outcome is the feasibility and acceptability of the study. The secondary outcomes are changes in self-reported medication adherence, depression symptoms, HIV stigma, medical mistrust, resilience, and clinic attendance and viral suppression extracted from the participants' medical records. Data will be assessed at baseline (T0) and 2 subsequent clinic visits-approximately 3 to 4 months from the baseline (time 1; T1) and 6 to 9 months from the baseline (time 2; T2). Qualitative data will be transcribed and analyzed iteratively. Bivariate analyses will compare data by the study group (chi-square, odds ratios, and t tests). Exploratory analyses will be conducted for each outcome variable-T1 and T2 values will be compared with values at T0 by the study group. RESULTS As of March 2020, baseline quantitative data were collected on 54 participants (28 English speakers, 14 Spanish speakers, and 12 Haitian Creole speakers). The first 3 focus groups (1 in each of the 3 languages) were completed, with a total of 20 participants. The findings are currently being integrated into the beta version of the mHealth texting system. CONCLUSIONS The findings of this novel HIV adherence intervention may shed light on the barriers and facilitators of HIV health care and the mechanisms of an mHealth intervention that is customized for ethnic minority women living with HIV. TRIAL REGISTRATION ClinicalTrials.gov NCT03738410; https://clinicaltrials.gov/ct2/show/NCT03738410. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/17656.
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Affiliation(s)
- Lunthita M Duthely
- Obstetrics, Gynecology and Reproductive Services, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Alex P Sanchez-Covarrubias
- Miami Clinical and Translational Sciences Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Adhar B Mohamed
- Obstetrics, Gynecology and Reproductive Services, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - JoNell E Potter
- Obstetrics, Gynecology and Reproductive Services, Miller School of Medicine, University of Miami, Miami, FL, United States
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Sebera F, Vissoci JRN, Umwiringirwa J, Teuwen DE, Boon PE, Dedeken P. Validity, reliability and cut-offs of the Patient Health Questionnaire-9 as a screening tool for depression among patients living with epilepsy in Rwanda. PLoS One 2020; 15:e0234095. [PMID: 32530968 PMCID: PMC7292570 DOI: 10.1371/journal.pone.0234095] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/18/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with epilepsy (PwE) have an increased risk of active and lifetime depression. Two in 10 patients experience depression. Lack of trained psychiatric staff in low- and middle-income countries (LMIC) creates a need for screening tools that enable detection of depression in PwE. We describe the translation, validity and reliability assessment of the Patient Health Questionnaire-9 (PHQ-9) as a screening tool for depression among PwE in Rwanda. METHOD PHQ-9 was translated to Kinyarwanda using translation-back translation and validated by a discussion group. For validation, PwE of ≥15 years of age were administered the PHQ-9 and Hamilton Depression Rating Scale (HDRS) by trained psychiatry staff at Visit 1. A random sample of 20% repeated PHQ-9 and HDRS after 14 days to assess temporal stability and intra-rater reliability. Internal structure, reliability and external validity were assessed using confirmatory factor analysis, reliability coefficients and HDRS-correlation, respectively. Maximal Youden's index was considered for cut-offs. RESULTS Four hundred and thirty-four PwE, mean age 30.5 years (SD ±13.3), were included of whom 33.6%, 37.9%, 13.4%, and 15.1% had no, mild, moderate and severe depression, respectively. PHQ-9 performed well on a one-factor model (unidimensional model), with factor loadings of 0.63-0.86. Reliability coefficients above 0.80 indicated strong internal consistency. Good temporal stability was observed (0.79 [95% CI: 0.68-0.87]). A strong correlation (R = 0.66, p = 0.01) between PHQ-9 and HDRS summed scores demonstrated robust external validity. The optimal cut-off for the PHQ-9 was similar (≥5) for mild and moderate depression and ≥7 for severe depression. CONCLUSION PHQ-9 validation in Kinyarwanda creates the capacity to screen PwE in Rwanda at scores of ≥5 for mild or moderate and ≥7 for severe depression. The availability of validated tools for screening and diagnosis for depression is a forward step for holistic care in a resource-limited environment.
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Affiliation(s)
- Fidèle Sebera
- CARAES Neuropsychiatric Hospital, Ndera, Kigali, Rwanda
- Centre Hospitalier Universitaire Kigali (CHUK), Kigali, Rwanda
| | - Joao Ricardo Nickenig Vissoci
- Department of Surgery, Duke University Medical School, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | | | | | | | - Peter Dedeken
- UCB Pharma, Brussels, Belgium
- Ghent University Hospital, Ghent, Belgium
- Heilig Hart Hospitaal, Lier, Belgium
- * E-mail:
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Rahill GJ, Joshi M, Galea J, Ollis J. Experiences of sexual and gender minorities in an urban enclave of Haiti: despised, beaten, stoned, stabbed, shot and raped. CULTURE, HEALTH & SEXUALITY 2020; 22:690-704. [PMID: 31318325 DOI: 10.1080/13691058.2019.1628305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 06/03/2019] [Indexed: 06/10/2023]
Abstract
Studies of sexual and gender minorities in Haiti and globally typically involve HIV research and programming with men who have sex with men. We conducted focus groups with individuals in Haiti's Cité Soleil slum whose assigned gender at birth matched neither their gender identity nor contextual heteronormative constructions of gender roles, i.e. transwomen and transmen. The Yogyakarta Principles provided the study framework. Focus group participants offered emic perspectives on overall well-being, identities, biopsychosocial strengths and HIV-protective and risk factors. We found that gender expression that conflicts with contextual norms evoked recurring, humiliating and intentionally injurious sexual assaults against participants, heightening their HIV risk; participants endured beatings, shootings, stabbings, stonings and socio-political violence. Lack of confidentiality and stigma hinder participants' access to scarce HIV resources. Indistinct boundaries between sexuality, gender identity and gender expression merged with traditional gender-based roles to perpetuate sexual violence towards transwomen by cisgender heterosexual men and by transmen towards cisgender heterosexual women. Despite resignation to omnipresent violence, participants showed resilience regarding gender identity. Needed are integrated socio-behavioural and health programmes to challenge existing gender inequities while providing training on human rights and HIV risk reduction for Haitian sexual and gender minorities.
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Affiliation(s)
- Guitele J Rahill
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Manisha Joshi
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Jerome Galea
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Jenifer Ollis
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
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Fan X, She R, Liu C, Zhong H, Lau JTF, Hao C, Li J, Hao Y, Li L, Gu J. Evaluation of smartphone APP-based case-management services among antiretroviral treatment-naïve HIV-positive men who have sex with men: a randomized controlled trial protocol. BMC Public Health 2020; 20:85. [PMID: 31959139 PMCID: PMC6971898 DOI: 10.1186/s12889-020-8171-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 01/07/2020] [Indexed: 01/06/2023] Open
Abstract
Background Men who have sex with men (MSM) are disproportionally affected by HIV in China. ‘Treatment as Prevention’ is a promising strategy for HIV prevention but requires adequate adherence. Mobile health (mHealth) may be an acceptable and feasible approach for service delivery, but there is little evidence supporting mHealth intervention for improving antiretroviral treatment adherence among HIV-infected MSM in low- and middle-income countries, including China. This study will aim to develop a smartphone application-based case-management service and compare its efficacy to standard care with regards to adherence, CD4, HIV viral load and psychosocial outcomes among MSM patients in Guangzhou, China. Methods A non-blinded 1:1 parallel-group randomised controlled trial will be conducted in Guangzhou Eighth People’s Hospital, with 300 MSM enrolled in each arm. Eligible MSM who are newly initiating ART will be randomly assigned to an intervention group (standard-of-care case management plus mHealth intervention) or a control group (standard-of-care case management). The development of the mHealth intervention will be based on the information–motivation–behavioural skills theory of ART adherence, and comprise four components: educational articles, one-to-one online communication with case managers, support-service information and hospital-visit reminders. Outcome measures will be collected at baseline and at months 1, 3, 6, and 12. The primary outcomes will be ART adherence and CD4 count at month 6. Secondary outcomes include HIV RNA, sexual behaviours, mental health status, illness perceptions, and quality of life. χ2 test and t-test will be used for between-group comparisons. Intervention effects will be evaluated using General estimating equation performed by SAS 9.0, on the principle of intention-to-treat. Structural equation modelling will be used to test potential mechanisms of intervention effect. Discussion This study is the first to explore the efficacy of mHealth intervention in the case management services targeted at HIV-infected MSM in low-and middle-income countries. Once proven effective, the innovative mHealth service could be integrated into the routine case management of PLWH. as well as be tailored to the patient management service for other chronic conditions. Trial registration ClinicalTrial.gov: NCT03860116; Registered on 1 March 2019.
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Affiliation(s)
- Xiaoyan Fan
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Rui She
- Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Cong Liu
- Infectious Disease Centre, Guangzhou Eighth People's Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Haidan Zhong
- Infectious Disease Centre, Guangzhou Eighth People's Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Joseph T F Lau
- Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.,Centre for Medical Anthropology and Behavioural Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Chun Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, People's Republic of China.,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jinghua Li
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, People's Republic of China.,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Yuantao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, People's Republic of China.,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Linghua Li
- Infectious Disease Centre, Guangzhou Eighth People's Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, People's Republic of China. .,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.
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12
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de Silva PS, O’Toole A, Marc LG, Ulysse CA, Testa MA, Julsgaard M, Ngyuen D, Ananthakrishnan A, Laursen T, Højgaard A, Christensen LA, Korzenik J, Friedman S. Development of a Sexual Dysfunction Scale for Women With Inflammatory Bowel Disease. Inflamm Bowel Dis 2018; 24:2350-2359. [PMID: 30165525 PMCID: PMC6185125 DOI: 10.1093/ibd/izy202] [Citation(s) in RCA: 21] [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: 01/19/2018] [Indexed: 12/11/2022]
Abstract
Background Women with inflammatory bowel disease (IBD) may have decreased sexual function. To understand how common this condition is in our female patients, we developed a new IBD-specific Female Sexual Dysfunction Scale (the IBD-FSDS). Methods We performed a prospective cross-sectional study of 454 female IBD patients ≥18 years of age attending 1 of 3 IBD clinics in the United States or Denmark. We gathered information on sexual function via a de novo 23-item scale. General sexual functioning was measured with the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale-Revised (FSDS-R). Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9). Medical history and sociodemographic data were collected via chart review. Exploratory factor analyses (EFAs) of the English language version of IBD-FSDS assessed unidimensionality, factor structure, reliability, criterion validity, and construct validity. Results EFAs suggested retaining 15-items creating a unidimensional scale with strong internal consistency reliability (α = 0.93). Validity of the English language IBD-FSDS was measured using Spearman's coefficient, demonstrating significant criterion validity with the FSDS-R (P < 0.05) and the FSFI (P < 0.05) and significant construct validity with the composite for cases of active IBD (P < 0.05) and PHQ-9 (P < 0.05). Sexual dysfunction in women with IBD was significantly associated with depression (P = 0.042), active IBD (P = 0.002), and no history of surgery (P = 0.044). Conclusions We have developed and validated an IBD-specific scale to assess the psychosexual impact of IBD in women. This novel screening questionnaire may help health care providers recognize factors contributing to impaired sexual function in their female patients.
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Affiliation(s)
| | | | - Linda G Marc
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Christine A Ulysse
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Marcia A Testa
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Mette Julsgaard
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Deanna Ngyuen
- Massachusetts General Hospital, Boston, Massachusetts
| | | | - Tine Laursen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Astrid Højgaard
- Sexological Centre, Aalborg University Hospital, Aalborg, Denmark
| | - Lisbet A Christensen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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13
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Psychiatric comorbidities in patients with inflammatory bowel disease. Indian J Gastroenterol 2018; 37:307-312. [PMID: 30196516 DOI: 10.1007/s12664-018-0870-9] [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] [Received: 02/11/2018] [Accepted: 07/22/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Psychiatric comorbidities are associated with inflammatory bowel disease (IBD). We conducted an observational study to evaluate the prevalence of depression and anxiety in patients with IBD. METHODS Seventy consecutive consenting patients with IBD (62 ulcerative colitis [UC], 8 Crohn's disease [CD]; 40 males, mean age [SD] 36.2 [11.3] years) and 100 healthy volunteers (44 males, age 31.22 [SD] [10.5] years) as controls were enrolled. All participants were directed to take self-assessment tests, Patient Health Questionnaire -9 (PHQ-9) and Symptom Checklist Anxiety Scale (SCL-A20). Participants having a score ≥ 10 on PHQ-9, or ≥ 29 on SCL-A20 were administered the Hamilton Depression Rating Scale (HAM-D) or Hamilton Anxiety (HAM-A) scales, respectively. The severity of depression and anxiety was graded with HAM-D and HAM-A scales, respectively. The protocol was approved by the Institutional Ethics Committee. RESULTS The prevalence of depression (34.3% vs. 5%, p < 0.0001, OR 9.7) and anxiety (18.6% vs. 2%, p = 0.0002, OR 11.17) was higher in patients with IBD as compared to controls. The severity of depression was higher in patients compared to controls (mean rank 17 vs. 7, p = 0.04). The prevalence of depression was not different between UC and CD; all IBD patients with anxiety had UC. The mean duration of disease and history of corticosteroid treatment or surgery for IBD were not associated with the presence of depression or anxiety. Patients with severe CD (Crohn's disease activity index, CDAI > 450) had more severe depression. The severity of UC did not correlate with severity of anxiety or depression in UC. CONCLUSIONS Anxiety and depression are more prevalent in IBD patients as compared to healthy individuals.
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Schuler M, Strohmayer M, Mühlig S, Schwaighofer B, Wittmann M, Faller H, Schultz K. Assessment of depression before and after inpatient rehabilitation in COPD patients: Psychometric properties of the German version of the Patient Health Questionnaire (PHQ-9/PHQ-2). J Affect Disord 2018; 232:268-275. [PMID: 29499510 DOI: 10.1016/j.jad.2018.02.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/05/2018] [Accepted: 02/16/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Depression is a frequent comorbidity of COPD and leads to worse clinical COPD-outcomes. PHQ-9 and PHQ-2 are two widely used brief instruments to assess depression. However, psychometric properties in COPD patients are unknown. This study examines factorial validity, measurement invariance and composite reliability (CR) of PHQ-9/PHQ-2, respectively, and concordance between both tools. METHODS This is a secondary analysis of N = 561 COPD patients who filled out the PHQ-9 at the begin (T0), the end (T1) and 3/6/9/12 (T2/T3/T4/T5) months after pulmonary inpatient rehabilitation. Structural equation modeling was used to examine factorial validity and measurement invariance between gender, GOLD disease severity groups and over time. Concordance was assessed using Cohen's Kappa, Yules Y, positive and negative agreement. RESULTS A one-factor model (with one freed residual covariance) showed best model fit. At least partial scalar invariance could be established. Concordance between both instruments was substantial. 31.7% (26.2%) COPD patients showed clinically relevant depression according to PHQ-9 (PHQ-2) at T0. At T0-T2, PHQ-9 classified more patients as depressed than did PHQ-2. According to both measures, depression rates declined after rehabilitation. Reliability was high for both PHQ-9 (CR = 0.94) and PHQ-2 (CR = 0.89). LIMITATIONS No gold-standard (clinical interview) to assess depression was used. Therefore, diagnostic accuracy for PHQ-9/PHQ-2 remains unclear. CONCLUSIONS PHQ-9 and PHQ-2 fulfill important psychometric criteria (factorial validity, invariance, reliability) for measuring depression in COPD. The results support their use in clinical practice to assess severity of depression. Diagnostic accuracy to identify major/minor depression of both instruments should be examined in future studies.
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Affiliation(s)
- Michael Schuler
- University of Würzburg, Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, Würzburg, Germany.
| | - Miriam Strohmayer
- University of Würzburg, Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, Würzburg, Germany
| | - Stephan Mühlig
- Chemnitz University of Technology, Clinical Psychology and Psychotherapy, Chemnitz, Germany
| | - Birgit Schwaighofer
- Bad Reichenhall Clinic, Centre for Rehabilitation, Pneumology and Orthopedics, Bad Reichenhall, Germany
| | - Michael Wittmann
- Bad Reichenhall Clinic, Centre for Rehabilitation, Pneumology and Orthopedics, Bad Reichenhall, Germany
| | - Hermann Faller
- University of Würzburg, Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, Würzburg, Germany
| | - Konrad Schultz
- Bad Reichenhall Clinic, Centre for Rehabilitation, Pneumology and Orthopedics, Bad Reichenhall, Germany
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15
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Terloyeva D, Nugmanova Z, Akhmetova G, Akanov A, Patel N, Lazariu V, Norelli L, McNutt LA. Untreated depression among persons living with human immunodeficiency virus in Kazakhstan: A cross-sectional study. PLoS One 2018; 13:e0193976. [PMID: 29590151 PMCID: PMC5873996 DOI: 10.1371/journal.pone.0193976] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/22/2018] [Indexed: 12/17/2022] Open
Abstract
Background In Kazakhstan, scarce official prevalence data exists for mood disorders. This study investigates the occurrence of depressive symptoms among people living with HIV/AIDS (PLWHA), and the relationship between depressive symptoms, HIV treatment initiation and antiretroviral treatment (ART) adherence. Methods A cross-sectional study was conducted among patients seen at the Almaty AIDS Center between April and December 2013. Two data sources were used: 1) self-administered survey that included the Patient Health Questionnaire (PHQ-9) to capture depression symptoms and 2) medical record review. Two primary outcomes were evaluated with log-binomial models and Fisher’s exact test: the relationship between depression symptoms and 1) HIV treatment group, and 2) HIV adherence. Results Of the 564 participants, 9.9% reported symptoms consistent with a depressive disorder. None had received treatment for depression. Among those not on ART, a relationship between depressive symptoms and low CD4 counts (≤ 350 cells/mm3) was evident (7.1% for CD4 ≤ 350 cells/mm3 vs. 0.9% for CD4 > 350 cells/mm3, p = 0.029). In multivariable analysis, a higher prevalence of depressive symptoms was statistically associated with ART treatment, positive hepatitis C virus (HCV) status, and being unmarried. For those taking ART, treatment adherence was not statistically associated with a lower prevalence of depressive symptoms (12.5% vs 20.0%, p = 0.176); limited power may have impacted statistical significance. Conclusions Untreated depression was found among PLWHA suggesting the need to evaluate access to psychiatric treatment. A collaborative strategy may be helpful to optimize HIV treatment outcomes.
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Affiliation(s)
- Dina Terloyeva
- Department of HIV infection and Infection Control, Asfendiyarov Kazakh National Medical University (KNMU), Almaty, Kazakhstan
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Zhamilya Nugmanova
- Department of HIV infection and Infection Control, Asfendiyarov Kazakh National Medical University (KNMU), Almaty, Kazakhstan
| | | | - Aikan Akanov
- Department of Public Health, Asfendiyarov Kazakh National Medical University (KNMU), Almaty, Kazakhstan
| | - Nimish Patel
- Albany College of Pharmacy & Health Sciences, Albany, New York, United States of America
| | - Victoria Lazariu
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, United States of America
| | - Lisa Norelli
- Department of Psychiatry, Albany Medical College, Albany, New York, United States of America
| | - Louise-Anne McNutt
- Institute for Health and the Environment, University at Albany, State University of New York, Rensselaer, New York, United States of America
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16
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O’Toole A, de Silva PS, Marc LG, Ulysse CA, Testa MA, Ting A, Moss A, Korzenik J, Friedman S. Sexual Dysfunction in Men With Inflammatory Bowel Disease: A New IBD-Specific Scale. Inflamm Bowel Dis 2018; 24:310-316. [PMID: 29361102 PMCID: PMC6014620 DOI: 10.1093/ibd/izx053] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Men with inflammatory bowel disease (IBD) may have increased sexual dysfunction. To measure the prevalence of sexual dysfunction in our male patients, we aimed to develop a new IBD-specific Male Sexual Dysfunction Scale (the IBD-MSDS). METHODS We used a cross-sectional survey and enrolled male patients (N = 175) ≥18 years old who attended IBD clinics at 2 Boston hospitals. We collected information on sexual functioning via a 15-item scale. General male sexual functioning was measured using the International Index of Erectile Dysfunction (IIEF); the Patient Health Questionnaire (PHQ-9) measured depressive symptoms. Medical history and sociodemographic information were extracted from medical record review. Exploratory factor analyses (EFA) assessed unidimensionality, factor structure, reliability, and criterion and construct validity of the 15-item scale. We used regression models to identify clinical factors associated with sexual dysfunction. RESULTS EFA suggested retaining 10-items generating a unidimensional scale with strong internal consistency reliability, α = 0.90. Criterion validity assessed using Spearman's coefficient showing that the IBD-MSDS was significantly correlated with all the subscales of the IIEF. The IBD-MSDS was significantly correlated (construct validity) with the PHQ-9 (P < 0.001) and the composite score for active IBD cases (P < 0.05). Male sexual dysfunction in IBD was significantly associated with the presence of an ileoanal pouch anastomosis (P = 0.047), depression (P < 0.001), and increased disease activity (P = 0.021). CONCLUSIONS We have developed and validated an IBD-specific scale to assess the psychosexual impact of IBD. This new survey tool may help physicians screen for and identify factors contributing to impaired sexual functioning in their male patients.
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Affiliation(s)
- Aoibhlinn O’Toole
- Center for Crohn’s and Colitis, Brigham and Women’s Hospital, Boston, Massachusetts, USA,Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Punyanganie S de Silva
- Center for Crohn’s and Colitis, Brigham and Women’s Hospital, Boston, Massachusetts, USA,Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Linda G Marc
- Harvard School of Public Health, Department of Biostatistics, Boston, Massachusetts, USA
| | - Christine A Ulysse
- Harvard School of Public Health, Department of Biostatistics, Boston, Massachusetts, USA
| | - Marcia A Testa
- Harvard School of Public Health, Department of Biostatistics, Boston, Massachusetts, USA
| | - Amanda Ting
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA,Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Alan Moss
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA,Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Josh Korzenik
- Center for Crohn’s and Colitis, Brigham and Women’s Hospital, Boston, Massachusetts, USA,Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Sonia Friedman
- Center for Crohn’s and Colitis, Brigham and Women’s Hospital, Boston, Massachusetts, USA,Harvard Medical School, Harvard University, Boston, Massachusetts, USA,Address correspondence to: Sonia Friedman, MD, Center for Crohn’s and Colitis, Brigham and Women’s Hospital, Boston, Massachusetts, USA; Harvard Medical School, Harvard University, Boston, Massachusetts, USA. E-mail:
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17
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Haroz EE, Bass J, Lee C, Oo SS, Lin K, Kohrt B, Michalopolous L, Nguyen AJ, Bolton P. Development and cross-cultural testing of the International Depression Symptom Scale (IDSS): a measurement instrument designed to represent global presentations of depression. Glob Ment Health (Camb) 2017; 4:e17. [PMID: 29230313 PMCID: PMC5719484 DOI: 10.1017/gmh.2017.16] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/21/2017] [Accepted: 06/29/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Self-report measurement instruments are commonly used to screen for mental health disorders in Low and Middle-Income Countries (LMIC). The Western origins of most depression instruments may constitute a bias when used globally. Western measures based on the DSM, do not fully capture the expression of depression globally. We developed a self-report scale design to address this limitation, the International Depression Symptom Scale-General version (IDSS-G), based on empirical evidence of the signs and symptoms of depression reported across cultures. This paper describes the rationale and process of its development and the results of an initial test among a non-Western population. METHODS We evaluated internal consistency reliability, test-retest reliability and inter-rater reliability of the IDSS-G in a sample N = 147 male and female attendees of primary health clinics in Yangon, Myanmar. For criterion validity, IDSS-G scores were compared with diagnosis by local psychiatrists using the Structured Clinical Interview for DSM (SCID). Construct validity was evaluated by investigating associations between the IDSS-G and the Patient Health Questionnaire (PHQ), impaired function, and suicidal ideation. RESULTS The IDSS-G showed high internal consistency reliability (α = 0.92), test-retest reliability (r = 0.87), and inter-rater reliability (ICC = 0.90). Strong correlations between the IDSS-G and PHQ-9, functioning, and suicidal ideation supported construct validity. Criterion validity was supported for use of the IDSS-G to identify people with a SCID diagnosed depressive disorder (major depression/dysthymia). The IDSS-G also demonstrated incremental validity by predicting functional impairment beyond that predicted by the PHQ-9. Results suggest that the IDSS-G accurately assesses depression in this population. Future testing in other populations will follow.
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Affiliation(s)
- E. E. Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, USA
| | - J. Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, USA
| | - C. Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, USA
| | | | - K. Lin
- Thu Kha Nwe Specialist Clinic, Yangon, Myanmar
| | - B. Kohrt
- Duke University, Duke Global Health Institute & Department of Psychiatry and Behavioral Sciences, Durham, NC, USA
| | - L. Michalopolous
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY, USA
| | - A. J. Nguyen
- University of Virginia Curry School of Education, Charlottesville, VA, USA
| | - P. Bolton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, USA
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18
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Nallusamy V, Afgarshe M, Shlosser H. Reliability and validity of Somali version of the PHQ-9 in primary care practice. Int J Psychiatry Med 2016. [PMID: 28629295 DOI: 10.1177/0091217417696732] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Depression is one of the common mental health problems noticed in immigrants because of the experiences related to their resettlement which is the case for Somali population. Depression increases mortality, morbidity, disability, and costs of health care which can be controlled by screening depression in the primary care setting using a culturally and linguistically congruent screening tool. The aim of the current study is to translate the English PHQ-9 into Somali language using evidence-based translational methodology and establish psychometric properties of the Somali PHQ-9. Methods The initial validation of the Somali PHQ-9 was studied by comparing the original and back translation versions using the comparability and interpretability tool in a sample of 56 monolingual health care professionals. The reliability and validity of the Somali version were established by psychometric analysis in a sample of 47 bilingual health-care workers. Results Cronbach's alpha was 0.79 for the Somali version with the inter-item correlation mean of 0.33 and item-to-total correlation mean in the range of 0.40-0.80 ( p < 0.01). Pearson correlation for the item-to-item correlation between English and Somali version was between 0.70 and 0.93 ( p < 0.01) with the paired t-test showing no significant difference between the item means. Conclusions The Somali PHQ-9 showed a good reliability, homogeneity, and internal consistency. The construct validity for the Somali PHQ-9 was also established showing that the Somali PHQ-9 has similar reliability and validity like the other translated versions of PHQ-9.
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Affiliation(s)
- Vasumathi Nallusamy
- 1 Frontier Nursing University, Hyden, KY, USA.,2 Gargar Clinic & Urgent Care, Minneapolis, MN, USA
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19
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Sawaya H, Atoui M, Hamadeh A, Zeinoun P, Nahas Z. Adaptation and initial validation of the Patient Health Questionnaire - 9 (PHQ-9) and the Generalized Anxiety Disorder - 7 Questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample. Psychiatry Res 2016; 239:245-52. [PMID: 27031595 DOI: 10.1016/j.psychres.2016.03.030] [Citation(s) in RCA: 205] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 03/10/2016] [Accepted: 03/16/2016] [Indexed: 10/22/2022]
Abstract
The Patient Health Questionnaire - 9 (PHQ-9) and Generalized Anxiety Disorder - 7 (GAD-7) are short screening measures used in medical and community settings to assess depression and anxiety severity. The aim of this study is to translate the screening tools into Arabic and evaluate their psychometric properties in an Arabic-speaking Lebanese psychiatric outpatient sample. The patients completed the questionnaires, among others, prior to being evaluated by a clinical psychiatrist or psychologist. The scales' internal consistency and factor structure were measured and convergent and discriminant validity were established by comparing the scores with clinical diagnoses and the Psychiatric Diagnostic Screening Questionnaire - MDD subset (PDSQ - MDD). Results showed that the PHQ-9 and GAD-7 are reliable screening tools for depression and anxiety and their factor structures replicated those reported in the literature. Sensitivity and specificity analyses showed that the PHQ-9 is sensitive but not specific at capturing depressive symptoms when compared to clinician diagnoses whereas the GAD-7 was neither sensitive nor specific at capturing anxiety symptoms. The implications of these findings are discussed in reference to the scales themselves and the cultural specificity of the Lebanese population.
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Affiliation(s)
- Helen Sawaya
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mia Atoui
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aya Hamadeh
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Pia Zeinoun
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ziad Nahas
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon.
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20
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Abstract
Objectives Mental health conditions can erode quality of life and interfere with health-related behaviours such as medication adherence. We aimed to determine the prevalence and correlates of depression and other psychosocial factors among self-identified men who have sex with men (MSM) in coastal Kenya. Design A cross-sectional survey. Methods Psychosocial and mental health characteristics were assessed in an audio computer-assisted self-interview (ACASI) survey among 112 MSM participating in two ongoing HIV-positive and HIV-negative cohorts in Mtwapa, Kenya. Results One-third of participants met criteria for major depressive disorder [16.1%, 95% confidence interval (95% CI) 9.8–24.2] or other depressive disorder (15.2%, 95% CI 9.1–23.2). Alcohol abuse was reported by 45% of respondents (95% CI 35.2–54.3) and other substance abuse by 59.8% (95% CI 50.1–69.0). Sexual and HIV stigma were moderate, with median scores of 11 [interquartile range (IQR) 6–17, potential range 0–33] and 25 (IQR 23–29, potential range 11–44), respectively. There were significant bivariate correlations between alcohol abuse, other substance abuse, sexual stigma and childhood and recent abuse. In a multivariable linear regression model, sexual stigma (beta = 0.17, 95% CI 0.03–0.32) and marriage to a woman (beta = −2.41 95% CI −4.74 to −0.09) were each associated with depression score. Conclusion We found moderate to high levels of depression and substance abuse, and moderate levels of sexual stigma. These variables were highly inter-correlated and associated with an experience of trauma or abuse. Comprehensive mental health services are needed in this population to address these issues.
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Crabtree-Ramírez B, Vega YNC, Shepherd BE, Turner M, Carriquiry G, Fink V, Luz PM, Cortes CP, Rouzier V, Padgett D, Jayathilake K, McGowan CC, Person AK. Temporal Trends in Age at HIV Diagnosis in Cohorts in the United States, the Caribbean, and Central and South America. AIDS Behav 2015; 19:1599-608. [PMID: 25613592 DOI: 10.1007/s10461-014-0974-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the United States (USA), the age of those newly diagnosed with HIV is changing, particularly among men who have sex with men (MSM). A retrospective analysis included HIV-infected adults from seven sites in the Caribbean, Central and South America network (CCASAnet) and the Vanderbilt Comprehensive Care Clinic (VCCC-Nashville, Tennessee, USA). We estimated the proportion of patients <25 years at HIV diagnosis by calendar year among the general population and MSM. 19,466 (CCASAnet) and 3,746 (VCCC) patients were included. The proportion <25 years at diagnosis in VCCC increased over time for both the general population and MSM (p < 0.001). Only in the Chilean site for the general population and the Brazilian site for MSM were similar trends seen. Subjects <25 years of age at diagnosis were less likely to be immunocompromised at enrollment at both the VCCC and CCASAnet. Recent trends in the USA of greater numbers of newly diagnosed young patients were not consistently observed in Latin America and the Caribbean. Prevention efforts tailored to young adults should be increased.
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Kroenke K. Capsule commentary on Marc et al., Reliability and validity of the Haitian Creole PHQ-9. J Gen Intern Med 2014; 29:1691. [PMID: 25127729 PMCID: PMC4242890 DOI: 10.1007/s11606-014-2998-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kurt Kroenke
- VA HSR&D Center for Health Information and Communication; Regenstrief Institute, Inc, Indianapolis, IN, USA,
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