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D'Hondt S, Gisle L, De Pauw R, Van Cauteren D, Demarest S, Drieskens S, Cornelissen L, De Ridder K, Charafeddine R, Smith P. Anxiety and depression in people with post-COVID condition: a Belgian population-based cohort study three months after SARS-CoV-2 infection. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02655-9. [PMID: 38819519 DOI: 10.1007/s00127-024-02655-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/07/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Since the onset of the COVID-19 pandemic, most research has focused on the management of the acute symptoms of the disease. Yet some people tend to experience symptoms beyond the acute phase, defined as Post-COVID-19 Condition (PCC). This study aims to assess the impact of COVID-19 and PCC on anxiety and depression. METHODS This is a prospective longitudinal cohort study among the Belgian adult population with recent SARS-CoV-2 infection for which contact tracing was initiated. A total of 3127 people were followed-up just after their infection and three months later (from April 2021 to January 2022). Anxiety and depression were assessed at the two stages using the GAD-7 (Generalized Anxiety Disorder) and the PHQ-9 (Patient Health Questionnaire). RESULTS Three months after infection, participants with PCC (50%) had an increased probability of having both anxiety and depressive symptoms (p < 0.001). The proportion with anxiety and depressive symptoms at three months were significantly higher in people with PCC (11% and 19%) compared to people without persistent COVID symptoms (3.8% and 4.2%) and to a matched sub-sample not infected with SARS-CoV-2 (6.5% and 4.3%). Having at least one acute COVID-19 symptom (p < 0.001), experiencing financial loss following the infection (p < 0.001), and different PCC symptoms were associated with anxiety and depressive symptoms worsening over time. CONCLUSIONS This study showed that three months after a SARS-CoV-2 infection, one in two people suffer from PCC with significant consequences for their mental health. Follow-up on mental health must therefore have an important place in people suffering from PCC.
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Affiliation(s)
- Stéphanie D'Hondt
- Faculty of Public Health, Université catholique de Louvain, Rue Juliette Wytsmanstraat 14, Brussels, 1050, Belgium
| | - Lydia Gisle
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Robby De Pauw
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | | | - Stefaan Demarest
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Sabine Drieskens
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Laura Cornelissen
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Karin De Ridder
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Rana Charafeddine
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Pierre Smith
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium.
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium.
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Holzer KJ, Bartosiak KA, Calfee RP, Hammill CW, Haroutounian S, Kozower BD, Cordner TA, Lenard EM, Freedland KE, Tellor Pennington BR, Wolfe RC, Miller JP, Politi MC, Zhang Y, Yingling MD, Baumann AA, Kannampallil T, Schweiger JA, McKinnon SL, Avidan MS, Lenze EJ, Abraham J. Perioperative mental health intervention for depression and anxiety symptoms in older adults study protocol: design and methods for three linked randomised controlled trials. BMJ Open 2024; 14:e082656. [PMID: 38569683 PMCID: PMC11146368 DOI: 10.1136/bmjopen-2023-082656] [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: 11/29/2023] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Preoperative anxiety and depression symptoms among older surgical patients are associated with poor postoperative outcomes, yet evidence-based interventions for anxiety and depression have not been applied within this setting. We present a protocol for randomised controlled trials (RCTs) in three surgical cohorts: cardiac, oncological and orthopaedic, investigating whether a perioperative mental health intervention, with psychological and pharmacological components, reduces perioperative symptoms of depression and anxiety in older surgical patients. METHODS AND ANALYSIS Adults ≥60 years undergoing cardiac, orthopaedic or oncological surgery will be enrolled in one of three-linked type 1 hybrid effectiveness/implementation RCTs that will be conducted in tandem with similar methods. In each trial, 100 participants will be randomised to a remotely delivered perioperative behavioural treatment incorporating principles of behavioural activation, compassion and care coordination, and medication optimisation, or enhanced usual care with mental health-related resources for this population. The primary outcome is change in depression and anxiety symptoms assessed with the Patient Health Questionnaire-Anxiety Depression Scale from baseline to 3 months post surgery. Other outcomes include quality of life, delirium, length of stay, falls, rehospitalisation, pain and implementation outcomes, including study and intervention reach, acceptability, feasibility and appropriateness, and patient experience with the intervention. ETHICS AND DISSEMINATION The trials have received ethics approval from the Washington University School of Medicine Institutional Review Board. Informed consent is required for participation in the trials. The results will be submitted for publication in peer-reviewed journals, presented at clinical research conferences and disseminated via the Center for Perioperative Mental Health website. TRIAL REGISTRATION NUMBERS NCT05575128, NCT05685511, NCT05697835, pre-results.
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Affiliation(s)
- Katherine J Holzer
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Kimberly A Bartosiak
- Department of Orthopaedics, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Ryan P Calfee
- Department of Orthopaedics, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Chet W Hammill
- Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Simon Haroutounian
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Benjamin D Kozower
- Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Theresa A Cordner
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Emily M Lenard
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Kenneth E Freedland
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Bethany R Tellor Pennington
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Rachel C Wolfe
- Department of Pharmacy, Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - J Philip Miller
- Institute for Informatics, Data Science and Biostatistics, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USA
| | - Mary C Politi
- Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Yi Zhang
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Michael D Yingling
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Ana A Baumann
- Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Thomas Kannampallil
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
- Institute for Informatics, Data Science and Biostatistics, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USA
| | - Julia A Schweiger
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Sherry L McKinnon
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Joanna Abraham
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
- Institute for Informatics, Data Science and Biostatistics, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USA
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Hufnagel HJ, Lahmann C, Agostini H, Lange C, Pauleikhoff LJB. Psychometric assessment of patients with central serous chorioretinopathy and correlation with disease stage and progression: a case control study. BMC Ophthalmol 2024; 24:92. [PMID: 38424605 PMCID: PMC10902987 DOI: 10.1186/s12886-024-03356-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/18/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Central serous chorioretinopathy (CSC) has frequently been associated with increased stress levels as well as an increased prevalence of other psychiatric conditions. This study used standardized psychometric scores to assess stress, depression and anxiety levels of CSC patients and compared them to controls without retinal disease ("healthy") and with branch retinal vein occlusion (BRVO). METHODS Monocentric, longitudinal case control study on consecutive CSC patients seen at a tertiary referral center. Controls without retinal disease were recruited from the oculoplastics clinic and those with BRVO from the medical retina clinic. Patients completed pseudonymized tests measuring stress levels (PHQ-stress), depression (PHQ-9) and anxiety (GAD-7) at baseline and at 3- and 6-months follow-up. Higher scores indicated higher trait levels. RESULTS 65 CSC patients, 19 healthy controls and 19 BRVO patients were included in this study. CSC patients showed significantly higher stress levels at baseline compared to controls (p = 0.009), but not compared to BRVO patients (p = 1.00). At 3- and 6-months follow-up, no significant difference between groups was observed anymore. Acute CSC patients showed higher scores than those with chronic CSC, which also subsided over time. Depression and anxiety scores did not differ between groups at any timepoint. CONCLUSIONS Patients with CSC do not show higher initial stress levels than patients with BRVO, while anxiety and depression levels did not differ from controls. Stress may thus rather represent a consequence of the onset of visual deterioration observed in CSC or other ocular diseases.
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Affiliation(s)
- Hinrich J Hufnagel
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hansjürgen Agostini
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Clemens Lange
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- St. Franziskus Eye Center, Münster, Germany.
| | - Laurenz J B Pauleikhoff
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Wei H, Wang Z, Wang Y, Ma J, Chen Y, Guo M, Li Y, Du Y, Hu F. Detection of depression marker ASS1 in urine by gold nanoparticles based dual epitope-peptides imprinted sensor. Anal Chim Acta 2023; 1273:341479. [PMID: 37423651 DOI: 10.1016/j.aca.2023.341479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/03/2023] [Accepted: 06/02/2023] [Indexed: 07/11/2023]
Abstract
Trace detection of argininosuccinate synthetase 1 (ASS1), a depression marker, in urine samples is difficult to achieve. In this work, a dual-epitope-peptides imprinted sensor for ASS1 detection in urine was constructed based on the high selectivity and sensitivity of the "epitope imprinting approach". First, two cysteine-modified epitope-peptides were immobilized onto gold nanoparticles (AuNPs) deposited on a flexible electrode (ITO-PET) by gold-sulfur bonds (Au-S), then a controlled electropolymerization of dopamine was carried out to imprint the epitope peptides. After removing epitope-peptides, the dual-epitope-peptides imprinted sensor (MIP/AuNPs/ITO-PET) which with multiple binding sites for ASS1 was obtained. Compared with single epitope-peptide, dual-epitope-peptides imprinted sensor had higher sensitivity, which presented a linear range from 0.15 to 6000 pg ml-1 with a low limit of detection (LOD = 0.106 pg mL-1, S/N = 3). It had good reproducibility (RSD = 1.74%), repeatability (RSD = 3.60%), stability (RSD = 2.98%), and good selectivity, and the sensor had good recovery (92.4%-99.0%) in urine samples. This is the first highly sensitive and selective electrochemical assay for the depression marker ASS1 in urine, which is expected to provide help for the non-invasive and objective diagnosis of depression.
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Affiliation(s)
- Hong Wei
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, China
| | - Zixia Wang
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, China; Codonopsis Radix Industrial Technology Engineering Research Center, Gansu Province, Lanzhou, Gansu, 730000, China
| | - Yanping Wang
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, China; State Key Laboratory of Applied Organic Chemistry, Lanzhou University, Lanzhou, 730000, China; Codonopsis Radix Industrial Technology Engineering Research Center, Gansu Province, Lanzhou, Gansu, 730000, China
| | - Jing Ma
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, China
| | - Yan Chen
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, China
| | - Min Guo
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, China; Codonopsis Radix Industrial Technology Engineering Research Center, Gansu Province, Lanzhou, Gansu, 730000, China
| | - Yuanyuan Li
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, China
| | - Yongling Du
- College of Chemistry and Chemical Engineering, Lanzhou University, Lanzhou, 730000, China
| | - Fangdi Hu
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, China; State Key Laboratory of Applied Organic Chemistry, Lanzhou University, Lanzhou, 730000, China; Codonopsis Radix Industrial Technology Engineering Research Center, Gansu Province, Lanzhou, Gansu, 730000, China.
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Crespo-Ramos G, Bebu I, Krause-Steinrauf H, Hoogendoorn CJ, Fang R, Ehrmann D, Presley C, Naik AD, Katona A, Walker EA, Cherrington A, Gonzalez JS. Emotional distress and cardiovascular disease risk among participants enrolled in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) study. Diabetes Res Clin Pract 2023; 203:110808. [PMID: 37394014 PMCID: PMC10592312 DOI: 10.1016/j.diabres.2023.110808] [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: 01/19/2023] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 07/04/2023]
Abstract
AIMS People with type 2 diabetes (T2DM) have an increased risk of cardiovascular disease (CVD). We examined depressive symptoms (DS) and diabetes distress (DD) in relation to the estimated 10-year risk of CVD in adults with T2DM enrolled in the GRADE Emotional Distress Substudy. METHODS Linear regression models examined the associations of baseline DS and DD with estimated 10-year risk of CVD using the Atherosclerotic Cardiovascular Disease (ASCVD) risk score, adjusting for age, sex, race/ethnicity, education, income, diabetes duration, diabetes-related complications, and HbA1c. RESULTS A total of 1,605 GRADE participants were included: 54% Non-Latino (NL) White, 18% Latino, 19% NL-Black, 66% male, mean age 57.5 (SD = 10.25) years, diabetes duration 4.2 (SD = 2.8) years, and HbA1c 7.5% (SD = 0.5%). After incorporating covariates, only DS, especially cognitive-affective symptoms, were associated with ASCVD risk (estimate = 0.15 [95% CI: 0.04, 0.025], p = 0.006). Higher DS remained significantly associated with higher ASCVD risk when adding DD to covariates (estimate = 0.19 [95% CI: 0.07, 0.30], p = 0.002). DD was not associated with ASCVD risk when accounting for covariates. CONCLUSIONS Depressive symptoms, particularly cognitive-affective symptoms, are associated with increased 10-year predicted ASCVD risk among adults with early T2DM. Diabetes distress is not significantly associated with the predicted ASCVD risk when accounting for covariates.
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Affiliation(s)
- Gladys Crespo-Ramos
- Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ionut Bebu
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD, USA
| | - Heidi Krause-Steinrauf
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD, USA
| | | | - Ran Fang
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Caroline Presley
- Department of Medicine (General Internal and Preventive Medicine) University of Alabama, Birmingham, Birmingham, AL, USA
| | - Aanand D Naik
- School of Public Health, University of Texas Health Science Center, Houston, TX, USA
| | | | - Elizabeth A Walker
- Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrea Cherrington
- Department of Medicine (General Internal and Preventive Medicine) University of Alabama, Birmingham, Birmingham, AL, USA
| | - Jeffrey S Gonzalez
- Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA; Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA; New York-Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY, USA.
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Value added? A pragmatic analysis of the routine use of PHQ-9 and GAD-7 scales in primary care. Gen Hosp Psychiatry 2022; 79:15-18. [PMID: 36209615 DOI: 10.1016/j.genhosppsych.2022.09.005] [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] [Received: 07/21/2022] [Revised: 08/31/2022] [Accepted: 09/26/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression and anxiety are common and often co-occur. The PHQ-9 and GAD-7 scales are frequently used to measure symptoms and track treatment response in these conditions. These instruments show substantial correlation. This study investigates the similarity between concurrent pairs of PHQ-9 and GAD-7 when used to monitor treatment outcomes. METHODS Data originated from a clinical registry within a behavioral health collaborative care program for a large primary care network. A total of 31,974 pairs of PHQ-9 and GAD-7 scores, from 5402 patient care episodes, were analyzed for correlation coefficient, distribution of score differences, and overlap in symptom burden categories. A Number Needed to Identify was calculated to quantify the marginal effect of performing both scales. RESULTS The correlation coefficient (Spearman's rho) was 0.74. 78.4% of concurrent scores were within 4 points of each other, and 56.4% of score pairs fell into the same severity class. The Number Needed to Identify for PHQ-9 was 8 while the NNI for GAD-7 was 14.1. CONCLUSIONS Concurrent pairs of PHQ-9 and GAD-7 were strongly associated and often similar in severity. In terms of identifying clinically significant symptoms, the marginal effect of using both measures appears moderate.
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Dörttepe ZÜ, Duman ZÇ. Examination of Telemental Health Practices in Caregivers of Children and Adolescents with Mental Illnesses: A Systematic Review. Issues Ment Health Nurs 2022; 43:625-637. [PMID: 35021018 DOI: 10.1080/01612840.2021.2013366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In this systematic review, effects of telemental health (TMH) practices' on caregivers of children/adolescents with mental illnesses were investigated. The literature review included databases, and reference lists of published studies. All studies published until September 2021 were reviewed. Eleven studies were included. Several services were provided via TMH: education, cognitive behavioral therapy (CBT), parent training, caregiver behavior training, family CBT. The effectiveness of TMH interventions on caregivers varied from low to high. Most reproducible findings were on caregivers' satisfaction, stress, therapeutic alliance and caregiver burden. Studies had a low to high bias risk. Most studies had small samples. Results built on the small but growing literature support TMH interventions' promising role in caregivers of children with mental illness. Future studies should estimate outcomes with medium to low effect size. Other caregiver groups, rarely considered in previous studies, should be included. Bias risk should be minimized. Larger, more methodologically rigorous studies should be conducted.
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Affiliation(s)
- Zümra Ülker Dörttepe
- Medical Services and Techniques Department, Vocational School of Health Sciences, Uşak University, Uşak, Turkey
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Fried EI, Flake JK, Robinaugh DJ. Revisiting the theoretical and methodological foundations of depression measurement. NATURE REVIEWS PSYCHOLOGY 2022; 1:358-368. [PMID: 38107751 PMCID: PMC10723193 DOI: 10.1038/s44159-022-00050-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 12/19/2023]
Abstract
Depressive disorders are among the leading causes of global disease burden, but there has been limited progress in understanding the causes and treatments for these disorders. In this Perspective, we suggest that such progress crucially depends on our ability to measure depression. We review the many problems with depression measurement, including limited evidence of validity and reliability. These issues raise grave concerns about common uses of depression measures, such as diagnosis or tracking treatment progress. We argue that shortcomings arise because depression measurement rests on shaky methodological and theoretical foundations. Moving forward, we need to break with the field's tradition that has, for decades, divorced theories about depression from how we measure it. Instead, we suggest that epistemic iteration, an iterative exchange between theory and measurement, provides a crucial avenue for depression measurement to progress.
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Affiliation(s)
- Eiko I. Fried
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Jessica K. Flake
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Donald J. Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, US
- Department of Applied Psychology, Northeastern University, Boston, Massachusetts, US
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Surman TL, Abrahams JM, Kim J, Surman HE, Roberts-Thomson R, Montarello JM, Edwards J, Worthington M, Beltrame J. Quality of life and frailty outcomes following surgical and transcatheter aortic valve replacement. J Cardiothorac Surg 2022; 17:113. [PMID: 35545790 PMCID: PMC9092884 DOI: 10.1186/s13019-022-01876-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background Our objective was to report on the prospective outcomes in the areas of depression, quality of life, angina, and frailty in SAVR and TAVR patients with aortic stenosis undergoing aortic valve intervention. Methods We recruited 300 patients across 3 groups (TAVR, SAVR, and CABG) over 12 months. Depression, quality of life, frailty, and angina were assessed followed by propensity score matching. Results Using logistical regression when all patient factors considered for all patients who had SAVR and TAVR, the only preoperative factors that impacted on 1 year mortality was hypertension and STS score. Quality of life improvements within each group over 12 months was significant (p value = 0.0001). Depression at 12 months between groups (p value = 0.0395) and within each group was significant (p value = 0.0073 for SAVR and 0.0001 for TAVR). Angina was most frequent in TAVR at 12 months in the QL (p = 0.0001), PL (p = 0.0007), and improvement was significant in the QL (SAVR p = 0.0010, TAVR p = 0.0001) and PL (SAVR p = 0.0002), TAVR p = 0.0007) domains in both groups. Frailty at 12 months improved in both groups, but was greatest in TAVR (p value = 0.00126). Conclusions This 12 months follow up of cardiac surgical patients has revealed significant improvement in PROMs and frailty in all groups by 3 months postoperative regardless of surgical or transcatheter approach. Outcome measures of quality of life and frailty could be utilized as a measure of outcome more regularly in patients undergoing aortic valve surgery regardless of approach.
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Affiliation(s)
- Timothy Luke Surman
- D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, North terrace, Adelaide, SA, 5000, Australia.
| | - John Matthew Abrahams
- D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, North terrace, Adelaide, SA, 5000, Australia
| | - Jaewon Kim
- Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | | | | | | | - James Edwards
- D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, North terrace, Adelaide, SA, 5000, Australia
| | - Michael Worthington
- D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, North terrace, Adelaide, SA, 5000, Australia
| | - John Beltrame
- Cardiology, Queen Elizabeth Hospital, Adelaide, SA, Australia
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Tait J, Edmeade L, Delgadillo J. Are depressed patients' coping strategies associated with psychotherapy treatment outcomes? Psychol Psychother 2022; 95:98-112. [PMID: 34617396 DOI: 10.1111/papt.12368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 07/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In theory, depression is thought to be associated with deficits in adaptive and excesses in maladaptive coping strategies. This study aimed to investigate associations between coping strategies and depression treatment outcomes. METHOD Participants (N = 126) completed measures of adaptive and maladaptive coping strategies before and after accessing evidence-based psychotherapies for depression. The primary outcome was self-reported depression severity measured with the Patient Health Questionnaire (PHQ-9). Hierarchical regression was used to investigate associations between coping strategies and post-treatment depression symptoms, controlling for therapeutic alliance and relevant demographics. RESULTS Lower pre-treatment engagement coping and higher rumination predicted higher post-treatment depression, but both of these effects became non-significant after controlling for baseline depression severity. Similarly, correlations between change in rumination and change in depression were no longer significant after controlling for baseline severity. CONCLUSIONS Deficits in adaptive (engagement) and excesses in maladaptive (rumination) coping strategies may simply be proxy indicators (epiphenomena) of depression severity. PRACTITIONER POINTS Lower pre-treatment engagement coping predicted higher post-treatment depression Higher pre-treatment rumination predicted higher post-treatment depression Change in rumination during treatment correlated with change in depression symptoms However, none of the above associations remained statistically significant after controlling for baseline depression severity.
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Affiliation(s)
- James Tait
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, UK
| | | | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, UK
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Cherrier MM, Higano CS, Gray HJ. Cognitive skill training improves memory, function, and use of cognitive strategies in cancer survivors. Support Care Cancer 2022; 30:711-720. [PMID: 34368888 PMCID: PMC8639759 DOI: 10.1007/s00520-021-06453-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/19/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Cancer survivors commonly report symptoms of impaired cognition. This project examined effectiveness of a behavioral skills training intervention to improve cognition and reduce cognitive dysfunction symptoms in cancer survivors. METHODS Participants were randomly assigned to group-based workshops focused on learning new cognitive skills (skills treatment-TX) or an active control of education workshops (education control-EC) or a passive control of wait list (WL). Participants were evaluated pre- and post intervention with subjective mood and symptom questionnaires and objective neurocognitive tests. RESULTS One hundred twenty-eight participants (mean age 59 years), average 4.6 years (+ / - 5.5 years) post cancer treatment with various cancer types (breast, bladder, prostate, colon, uterine), were enrolled. Analysis of all participants who attended workshop(s) revealed improvement in the TX workshop completers on all objective cognitive measures (attention, concentration, declarative, and working memory) save one test of selective attention, and improvement on a single measure (verbal memory) and decline (selective attention) in the EC group. TX workshop completers also improved on all symptom and mood measures, in contrast to EC group which improved on a single subscale of a symptom measure, but increased on an anxiety measure. TX group alone improved on a quantified measure of each participants' unique, "top three," self-described cognitive symptoms. CONCLUSION Improvement from behavioral skills training was evident from objective cognitive tests, subjective symptom measures, and quantified, individual patient-specific symptoms. Behavioral skill training is an effective treatment for cognitive dysfunction in cancer survivors, and should be considered as a treatment option by health care providers.
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Affiliation(s)
- Monique M. Cherrier
- Department of Psychiatry and Behavioral Sciences, University of Washington, Box 356560, Seattle, WA 98195, USA,Fred Hutchinson Cancer Consortium, Seattle, WA 98195, USA,Corresponding author
| | - Celestia S. Higano
- Department of Medicine, Division of Oncology, University of Washington, Seattle, WA 98195, USA,Fred Hutchinson Cancer Research Center, Seattle, WA 98195, USA
| | - Heidi J. Gray
- Fred Hutchinson Cancer Consortium, Seattle, WA 98195, USA,Department of Medicine, Division of Oncology, University of Washington, Seattle, WA 98195, USA,Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, USA
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12
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Tambling RR, D’Aniello C, Russell BS. Mental Health Literacy: a Critical Target for Narrowing Racial Disparities in Behavioral Health. Int J Ment Health Addict 2021; 21:1-15. [PMID: 34785992 PMCID: PMC8582339 DOI: 10.1007/s11469-021-00694-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 01/04/2023] Open
Abstract
One of the most persistent and troubling health disparities is the underutilization of mental health services, particularly for depression and anxiety, commonly occurring behavioral health concerns. The gap between individuals who need mental health care and those who receive care is large, and identified barriers to treatment include poor mental health and insurance literacy, as well as stigmatizing attitudes toward mental health disorders. The present study presents the results of an inquiry into the mental health literacy, insurance literacy, internalized stigma, and mental health symptoms. Results suggest that mental health literacy is poor and associated with higher rates of depression, anxiety, stress, internalized stigma, and caregiver burden. Implications of poor mental health literacy, as well as demographic disparities in literacy, are discussed.
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Affiliation(s)
- R. R. Tambling
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Road, Unit 1058, Storrs, CT 06269-1058 USA
| | - C. D’Aniello
- Department of Community, Family, and Addiction Services, Texas Tech University, Lubbock, TX USA
| | - B. S. Russell
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Road, Unit 1058, Storrs, CT 06269-1058 USA
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13
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Patalay P, Fried EI. Editorial Perspective: Prescribing measures: unintended negative consequences of mandating standardized mental health measurement. J Child Psychol Psychiatry 2021; 62:1032-1036. [PMID: 32986859 DOI: 10.1111/jcpp.13333] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/14/2020] [Accepted: 08/21/2020] [Indexed: 01/10/2023]
Abstract
In July 2020, two of the largest funders of mental health research worldwide - the National Institute of Mental Health (NIMH) and the Wellcome Trust - announced plans to standardize mental health measurement. Specifically, obtaining funding for research related to depression and anxiety will be conditional on using four specific measures. While we agree that there are obvious benefits to standardizing mental health measurement, some of which are discussed in the announcement by NIMH and Wellcome, here we focus on potential unintended negative consequences of this initiative: Lacking transferability across settings: scales were developed for specific settings (e.g. community, clinic) and purposes (e.g. intervention studies), and their properties might not be easily transferable between settings. Narrowing the scope of inquiry: individuals experience mental health difficulties in wide-ranging ways, and the narrow scope of the proposed scales risks limiting important insights for research and treatments. Lowering the threshold for robust evidence: empirical findings limited to a specific imperfect measure are less robust than if such evidence is (re)produced across multiple scales. Creating a two-tiered mental health science: arbitrarily conferring gold standard status on some imperfect measures over others will create an artificial two-tiered system leading to an impoverishment of mental health research. Recommendations for mitigating these negative consequences include the following: mandating a wider set of measures that have been validated for specific populations and research purposes, funding research assessing the measurement properties of scales across settings and purposes, stressing the limitations of mandated measures to avoid en masse application and replacement of measures across studies and health systems and creating speed bumps to ensure that any widespread adoption of mandated measures does not result in impoverishment of mental health science.
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Affiliation(s)
- Praveetha Patalay
- Centre for Longitudinal Studies and MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Eiko I Fried
- Clinical Psychology Unit, Leiden University, Leiden, The Netherlands
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14
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Black S, Bowyer D, Graham P, Irvine Fitzpatrick L, Pate K, Woodrow A, Schwannauer M. Effectiveness of interpersonal psychotherapy for community living depressed women involved with the justice system. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2021; 31:183-197. [PMID: 33969558 DOI: 10.1002/cbm.2199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/24/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Despite the prevalence of depression among women in the justice system, and its potentially significant consequences, there is a dearth of studies investigating psychological treatments for depression in this context, especially outside prison. AIMS Our aim was to gather preliminary data on whether individual interpersonal psychotherapy (IPT) is an acceptable and effective treatment for depression in women at an early stage in the justice system. METHOD In this pilot study, IPT was offered to 24 depressed women following their first or second contact with the justice system. The women were assessed using a range of scales to quantify depression, anxiety, post-traumatic stress disorder (PTSD) and social support. Multilevel models were used to explore interactions between change in depression and other features given the multiplicity and complexity of problems. Details on engagement and attrition were also collected. RESULTS Therapy attrition was low, despite challenging life-circumstances and depression scores followed a linear trajectory with scores significantly decreasing over the time (β = -0.59, SE = 0.07, p < 0.001). Participants with more adverse life events, attachment related anxiety and lower social support had poorer outcomes. CONCLUSIONS AND IMPLICATIONS Results are encouraging. More than half of the hard-to-reach women who were eligible did engage, and retention rates suggest the therapy was acceptable to them. Depression scores improved, and potential factors affecting treatment outcome were identified. A randomised controlled trial is now warranted, ensuring adequate supplementary support for women with dependants living on their own and without employment.
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15
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Counterfactual thoughts and regret intensity as correlates of depressive symptoms among polytechnic students in Nigeria. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01756-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Petrelis M, Domeyer PR. Translation and validation of the Greek version of the Somatic Symptom Scale-8 (SSS-8) in patients with chronic low back pain. Disabil Rehabil 2021; 44:4467-4473. [PMID: 33725461 DOI: 10.1080/09638288.2021.1900415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE To translate and validate the Greek version of the Somatic Symptom Scale-8 (SSS-8) in patients with chronic low back pain (CLBP). MATERIALS AND METHODS The Greek SSS-8, created through forth and back translation and cultural adaption processes, was handed over to 145 patients recruited using simple random sampling. Test-retest, composite, and internal consistency reliability were assessed. Construct validity was examined by assessing correlations with Patient Health Questionnaire-15 (PHQ-15), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and EuroQoL 5-dimension 5-level (EQ-5D-5L) instruments. Structural validity was assessed using confirmatory factor analysis (CFA). Convergent, discriminant, and known group validity were also evaluated. RESULTS The response rate was 95.1% (138 subjects, mean age 43.2 ± 11.7) and the overall Cronbach's alpha was 0.831. Test-retest reliability assessment revealed excellent results (Pearson's r > 0.996; Lin's concordance coefficient > 0.995; intraclass correlation coefficient >0.995, all p < 0.001). Composite reliability scores for the pain, cardiopulmonary, and fatigue domains were 0.712, 0.787, and 0.567, respectively. The correlation analyses indicated good construct validity. CFA revealed excellent fit results and known group validity output indicated a linear increasing trend in the severity of somatic symptom disorders (SSDs), depression, and anxiety with higher PHQ-15, PHQ-9, and GAD-7 scores (Jonckheere-Terpstra test, p value < 0.001). CONCLUSIONS The Greek SSS-8 was shown to be a reliable and valid tool for measuring SSDs in patients with CLBP.Implications for RehabilitationAccording to the Global Burden of Diseases Study 2017, LBP was one of the leading causes of disability for both sexes combined since 1990.Strategies to identify SSDs in patients with LBP at an earlier stage are essential both for the provision of an optimal targeted treatment and for minimizing its direct and indirect economic burden.The Greek SSS-8 is a standardized and validated instrument, which its utilization will enhance the physical therapy assessment process in the Greek population.Not only is the SSS-8 an easy-to-use and highly accurate diagnostic tool for detecting SSDs, but also a short alternative to PHQ-15 in settings with limited assessment time.
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Affiliation(s)
- Matthaios Petrelis
- Department of Health Care Management, School of Social Sciences, Hellenic Open University, Patra, Greece.,TYPET Physiotherapy Department, Athens, Greece
| | - Philippe-Richard Domeyer
- Department of Health Care Management, School of Social Sciences, Hellenic Open University, Patra, Greece.,TYPET Physiotherapy Department, Athens, Greece
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17
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Pal R, Sachdeva N, Bhansali A, Sharma A, Walia R. Prevalence of Depression and Psychological Distress and Perturbations of Cortisol Dynamics in Attendants of Hospitalized Patients: An Observational Pilot Study. Cureus 2020; 12:e12067. [PMID: 33354484 PMCID: PMC7746007 DOI: 10.7759/cureus.12067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Attendants of in-hospital patients are prone to undue stress resulting in depression, anxiety, melancholy and psychological distress. Hitherto available studies cater to attendants of patients admitted in critical care units and none have ventured to look into their cortisol dynamics. Herein, we have evaluated the magnitude of psychological distress and depression amongst ostensibly healthy attendants of non-critically ill patients and correlated them with cortisol dynamics. Methods: Non-critically ill patients admitted to the general medicine ward were chosen by purposive sampling and one attendant was selected from each patient. Those with known risk factors, psychiatric illnesses, chronic drug intake, addictions, and overweight/obesity were excluded. Psychological distress and depression were assessed using the General Health Questionnaire 12-items (GHQ-12) and the Patient Health Questionnaire (PHQ-9), respectively. Morning plasma cortisol, late-night plasma cortisol (LNPC), late-night salivary cortisol (LNSC), urinary free cortisol (UFC), and plasma cortisol after overnight 1 mg dexamethasone administration were measured. Results: After exclusion, 39 participants were recruited (M:F=2.3:1.6). The mean age was 34.1±11.4 years. The mean duration of stay in hospital ambience prior to recruitment was 16.2±1.2 days. Based on the PHQ-9 score, 55% of the participants had depression. Psychological distress prevailed in 13% of participants as per the GHQ-12 score. The median LNPC/LNSC was higher in participants with depression compared to those with no depression, however, there was no statistically significant difference. There was no significant correlation between GHQ-12/PHQ-9 scores and cortisol dynamics. Conclusions: Although depression is prevalent in about half of the patient attendants, cortisol dynamics remain largely unaltered over a short period of two to three weeks.
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Affiliation(s)
- Rimesh Pal
- Endocrinology, Post Graduate Institute of Medical Education & Research, Chandigarh, IND
| | - Naresh Sachdeva
- Endocrinology, Post Graduate Institute of Medical Education & Research, Chandigarh, IND
| | - Anil Bhansali
- Endocrinology, Post Graduate Institute of Medical Education & Research, Chandigarh, IND
| | - Akhilesh Sharma
- Psychiatry, Post Graduate Institute of Medical Education & Research, Chandigarh, IND
| | - Rama Walia
- Endocrinology, Post Graduate Institute of Medical Education & Research, Chandigarh, IND
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18
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Almonte MT, Capellàn P, Yap TE, Cordeiro MF. Retinal correlates of psychiatric disorders. Ther Adv Chronic Dis 2020; 11:2040622320905215. [PMID: 32215197 PMCID: PMC7065291 DOI: 10.1177/2040622320905215] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/08/2020] [Indexed: 12/27/2022] Open
Abstract
Diagnosis and monitoring of psychiatric disorders rely heavily on subjective self-reports of clinical symptoms, which are complicated by the varying consistency of accounts reported by patients with an impaired mental state. Hence, more objective and quantifiable measures have been sought to provide clinicians with more robust methods to evaluate symptomology and track progression of disease in response to treatments. Owing to the shared origins of the retina and the brain, it has been suggested that changes in the retina may correlate with structural and functional changes in the brain. Vast improvements in retinal imaging, namely optical coherence tomography (OCT) and electrodiagnostic technology, have made it possible to investigate the eye at a microscopic level, allowing for the investigation of potential biomarkers in vivo. This review provides a summary of retinal biomarkers associated with schizophrenia, bipolar disorder and major depression, demonstrating how retinal biomarkers may be used to complement existing methods and provide structural markers of pathophysiological mechanisms that underpin brain dysfunction in psychiatric disorders.
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Affiliation(s)
- Melanie T. Almonte
- Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, UK
- Imperial College Ophthalmic Research Group (ICORG), Imperial College London, UK
| | | | - Timothy E. Yap
- Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, UK
- Imperial College Ophthalmic Research Group (ICORG), Imperial College London, UK
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19
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Levis B, Benedetti A, Ioannidis JPA, Sun Y, Negeri Z, He C, Wu Y, Krishnan A, Bhandari PM, Neupane D, Imran M, Rice DB, Riehm KE, Saadat N, Azar M, Boruff J, Cuijpers P, Gilbody S, Kloda LA, McMillan D, Patten SB, Shrier I, Ziegelstein RC, Alamri SH, Amtmann D, Ayalon L, Baradaran HR, Beraldi A, Bernstein CN, Bhana A, Bombardier CH, Carter G, Chagas MH, Chibanda D, Clover K, Conwell Y, Diez-Quevedo C, Fann JR, Fischer FH, Gholizadeh L, Gibson LJ, Green EP, Greeno CG, Hall BJ, Haroz EE, Ismail K, Jetté N, Khamseh ME, Kwan Y, Lara MA, Liu SI, Loureiro SR, Löwe B, Marrie RA, Marsh L, McGuire A, Muramatsu K, Navarrete L, Osório FL, Petersen I, Picardi A, Pugh SL, Quinn TJ, Rooney AG, Shinn EH, Sidebottom A, Spangenberg L, Tan PLL, Taylor-Rowan M, Turner A, van Weert HC, Vöhringer PA, Wagner LI, White J, Winkley K, Thombs BD. Patient Health Questionnaire-9 scores do not accurately estimate depression prevalence: individual participant data meta-analysis. J Clin Epidemiol 2020; 122:115-128.e1. [PMID: 32105798 DOI: 10.1016/j.jclinepi.2020.02.002] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/08/2020] [Accepted: 02/18/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Depression symptom questionnaires are not for diagnostic classification. Patient Health Questionnaire-9 (PHQ-9) scores ≥10 are nonetheless often used to estimate depression prevalence. We compared PHQ-9 ≥10 prevalence to Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) major depression prevalence and assessed whether an alternative PHQ-9 cutoff could more accurately estimate prevalence. STUDY DESIGN AND SETTING Individual participant data meta-analysis of datasets comparing PHQ-9 scores to SCID major depression status. RESULTS A total of 9,242 participants (1,389 SCID major depression cases) from 44 primary studies were included. Pooled PHQ-9 ≥10 prevalence was 24.6% (95% confidence interval [CI]: 20.8%, 28.9%); pooled SCID major depression prevalence was 12.1% (95% CI: 9.6%, 15.2%); and pooled difference was 11.9% (95% CI: 9.3%, 14.6%). The mean study-level PHQ-9 ≥10 to SCID-based prevalence ratio was 2.5 times. PHQ-9 ≥14 and the PHQ-9 diagnostic algorithm provided prevalence closest to SCID major depression prevalence, but study-level prevalence differed from SCID-based prevalence by an average absolute difference of 4.8% for PHQ-9 ≥14 (95% prediction interval: -13.6%, 14.5%) and 5.6% for the PHQ-9 diagnostic algorithm (95% prediction interval: -16.4%, 15.0%). CONCLUSION PHQ-9 ≥10 substantially overestimates depression prevalence. There is too much heterogeneity to correct statistically in individual studies.
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Affiliation(s)
- Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec, Canada; Department of Medicine, McGill University, Montréal, Québec, Canada
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA; Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA; Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA
| | - Ying Sun
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Zelalem Negeri
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Chen He
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Yin Wu
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Ankur Krishnan
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Parash Mani Bhandari
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Dipika Neupane
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Mahrukh Imran
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Psychology, McGill University, Montréal, Québec, Canada
| | - Kira E Riehm
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Nazanin Saadat
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Marleine Azar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Jill Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, Québec, Canada
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Simon Gilbody
- Hull York Medical School and the Department of Health Sciences, University of York, Heslington, NY, UK
| | - Lorie A Kloda
- Library, Concordia University, Montréal, Québec, Canada
| | - Dean McMillan
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Ian Shrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Roy C Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sultan H Alamri
- Faculty of Medicine, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Hamid R Baradaran
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran; Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
| | - Anna Beraldi
- Kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Klinik für Psychiatrie, Psychotherapie & Psychosomatik, Lehrkrankenhaus der Technischen Universität München, Munich, Germany
| | - Charles N Bernstein
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Arvin Bhana
- Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa; Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Gregory Carter
- Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia
| | - Marcos H Chagas
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Dixon Chibanda
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Kerrie Clover
- Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Crisanto Diez-Quevedo
- Servei de Psiquiatria, Hospital Germans Trias i Pujol, Badalona, Spain; Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Jesse R Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Felix H Fischer
- Department of Psychiatry, McGill University, Montréal, Québec, Canada; Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Leila Gholizadeh
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Lorna J Gibson
- Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Eric P Green
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Brian J Hall
- Department of Psychology, Faculty of Social Sciences, Global and Community Mental Health Research Group, University of Macau, Macau Special Administrative Region, China; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily E Haroz
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London Weston Education Centre, London, UK
| | - Nathalie Jetté
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mohammad E Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Yunxin Kwan
- Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore
| | - Maria Asunción Lara
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz. San Lorenzo Huipulco, Tlalpan, México D. F. Mexico
| | - Shen-Ing Liu
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Sonia R Loureiro
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ruth Ann Marrie
- Departments of Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura Marsh
- Baylor College of Medicine, Houston and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Anthony McGuire
- Department of Nursing, St. Joseph's College, Standish, ME, USA
| | - Kumiko Muramatsu
- Department of Clinical Psychology, Graduate School of Niigata Seiryo University, Niigata, Japan
| | - Laura Navarrete
- Department of Epidemiology and Psychosocial Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Flávia L Osório
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; National Institute of Science and Technology, Translational Medicine, Ribeirão Preto, Brazil
| | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Angelo Picardi
- Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA; American College of Radiology, Philadelphia, PA, USA
| | - Terence J Quinn
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Alasdair G Rooney
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburg, Edinburgh, Scotland, UK
| | - Eileen H Shinn
- Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | | | - Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | | | - Martin Taylor-Rowan
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, Scotland, UK
| | - Alyna Turner
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Henk C van Weert
- Department of General Practice, Amsterdam Institute for General Practice and Public Health, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Paul A Vöhringer
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago, Chile; Millennium Institute for Depression and Personality Research (MIDAP), Ministry of Economy, Macul, Santiago, Chile; Psychiatry Department, Tufts Medical Center, Tufts University, Boston, MA, USA
| | - Lynne I Wagner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Jennifer White
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Kirsty Winkley
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Department of Medicine, McGill University, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montréal, Québec, Canada; Department of Psychology, McGill University, Montréal, Québec, Canada; Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada; Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada.
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Validity of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adult primary care users in Bucaramanga, Colombia. ACTA ACUST UNITED AC 2020; 50:11-21. [PMID: 33648690 DOI: 10.1016/j.rcp.2019.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/01/2019] [Accepted: 09/20/2019] [Indexed: 02/08/2023]
Abstract
The patient health questionnaire-9 (PHQ-9) is one of the most widely used self-report instruments in primary care. There is no criterion validity of the PHQ-9 in Colombia. The objective was to validate the PHQ-9 as a screening tool in primary care. A cross-sectional, scale criterion validity study was performed using as reference criterion the mini neuropsychiatric interview (MINI) in male and female adult users of primary care centres. We calculated the internal consistency and convergent and criterion validity of the PHQ-9 by analysing the receiver operating characteristics (ROC) and the area under the curve (AUC). We analysed 243 participants; 184 (75.7%) were female. The average age was 34.05 (median of 31 and SD = 12.47). Cronbach's α was 0.80 and McDonald's ω was 0.81. Spearman's Rho was 0.64 for HADS-D (P <0.010) and 0.70 for PHQ-2 (P <0.010). The AUC was 0.92 (95% CI 0.880-0.963). The optimal cut-off point of PHQ-9 was ≥7: sensitivity of 90.38 (95% CI: 81.41-99.36); specificity of 81.68 (95% CI: 75.93-87.42); PPV 57.32 (95% CI: 46.00-68.63); NPV 96.89 (95% CI: 93.90-99.88); Youden index 0.72 (95% CI: 0.62-0.82); LR+ 4.93 (95% CI: 3.61-6.74); LR- 0.12 (95% CI: 0.005-0.270). In sum, the Colombian version of PHQ-9 is a valid and reliable instrument for depression screening in primary care in Bucaramanga, with a cut-off point ≥7.
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Morillo Sarto H, Barcelo-Soler A, Herrera-Mercadal P, Pantilie B, Navarro-Gil M, Garcia-Campayo J, Montero-Marin J. Efficacy of a mindful-eating programme to reduce emotional eating in patients suffering from overweight or obesity in primary care settings: a cluster-randomised trial protocol. BMJ Open 2019; 9:e031327. [PMID: 31753880 PMCID: PMC6886952 DOI: 10.1136/bmjopen-2019-031327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/19/2019] [Accepted: 10/24/2019] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Little is known about the applicability of mindfulness-based interventions in Spanish adults with overweight/obesity. The objective of the present study protocol is to describe the methods that will be used in a cluster randomised trial (CRT) that aims to evaluate the effectiveness of a mindfulness eating (ME) programme to reduce emotional eating (EE) in adults with overweight/obesity in primary care (PC) settings. METHODS AND ANALYSIS A CRT will be conducted with approximately 76 adults with overweight/obesity from four PC health centres (clusters) in the city of Zaragoza, Spain. Health centres matched to the average per capita income of the assigned population will be randomly allocated into two groups: 'ME +treatment as usual (TAU)' and 'TAU alone'. The ME programme will be composed of seven sessions delivered by a clinical psychologist, and TAU will be offered by general practitioners. The primary outcome will be EE measured by the Dutch Eating Behaviour Questionnaire (DEBQ) at post test as primary endpoint. Other outcomes will be external and restrained eating (DEBQ), binge eating (Bulimic Investigatory Test Edinburgh), eating disorder (Eating Attitude Test), anxiety (General Anxiety Disorder-7), depression (Patient Health Questionnaire-9), mindful eating (Mindful Eating Scale), dispositional mindfulness (Five Facet Mindfulness Questionnaire) and self-compassion (Self-Compassion Scale). Anthropometric measures, vital signs and blood tests will be taken. A primary intention-to-treat analysis on EE will be conducted using linear mixed models. Supplementary analyses will include secondary outcomes and 1-year follow-up measures; adjusted models controlling for sex, weight status and levels of anxiety and depression; the complier average causal effect of treatment; and the clinical significance of improvements. ETHICS AND DISSEMINATION Positive results of this study may have a significant impact on one of the most important current health-related problems. Approval was obtained from the Ethics Committee of the Regional Authority. The results will be submitted to peer-reviewed journals, and reports will be sent to participants. TRIAL REGISTRATION NUMBER NCT03927534 (5/2019).
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Affiliation(s)
- Hector Morillo Sarto
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
- Basic Psychology Department, Faculty of Psychology, University of Zaragoza, Teruel, Spain
| | - Alberto Barcelo-Soler
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
- Institute of Health Research of Aragon (IIS), Zaragoza, Spain
| | - Paola Herrera-Mercadal
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
- Institute of Health Research of Aragon (IIS), Zaragoza, Spain
| | - Bianca Pantilie
- Oral and Maxillofacial Surgery Department, Miguel Servet University Hospital, Zaragoza, Aragón, Spain
| | - Mayte Navarro-Gil
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
- Institute of Health Research of Aragon (IIS), Zaragoza, Spain
| | - Javier Garcia-Campayo
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
- Institute of Health Research of Aragon (IIS), Zaragoza, Spain
| | - Jesus Montero-Marin
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
- Spanish Association of Mindfulness and Compassion, Zaragoza, Spain
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22
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Wiriyakijja P, Porter S, Fedele S, Hodgson T, McMillan R, Shephard M, Ni Riordain R. Validation of the HADS and PSS‐10 and psychological status in patients with oral lichen planus. Oral Dis 2019; 26:96-110. [DOI: 10.1111/odi.13220] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/16/2019] [Accepted: 10/22/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Paswach Wiriyakijja
- UCL Eastman Dental Institute London UK
- Department of Oral Medicine Faculty of Dentistry Chulalongkorn University Bangkok Thailand
| | | | - Stefano Fedele
- UCL Eastman Dental Institute London UK
- NIHR University College London Hospitals Biomedical Research Centre London UK
| | - Tim Hodgson
- Eastman Dental Hospital UCLH Foundation NHS Trust London London UK
| | - Roddy McMillan
- Eastman Dental Hospital UCLH Foundation NHS Trust London London UK
| | - Martina Shephard
- Eastman Dental Hospital UCLH Foundation NHS Trust London London UK
| | - Richeal Ni Riordain
- UCL Eastman Dental Institute London UK
- Department of Oral Medicine Cork University Dental School and Hospital Cork Ireland
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Karabatzakis M, Den Oudsten BL, Gosens T, De Vries J. Psychometric properties of the psychosocial screening instrument for physical trauma patients (PSIT). Health Qual Life Outcomes 2019; 17:172. [PMID: 31718663 PMCID: PMC6852899 DOI: 10.1186/s12955-019-1234-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 10/15/2019] [Indexed: 02/08/2023] Open
Abstract
Background Early detection of psychosocial problems post-injury may prevent them from becoming chronic. Currently, there is no psychosocial screening instrument that can be used in patients surviving a physical trauma or injury. Therefore, we recently developed a psychosocial screening instrument for adult physical trauma patients, the PSIT. The aim of this study was to finalize and psychometrically examine the PSIT. Methods All adult (≥ 18 years) trauma patients admitted to a Dutch level I trauma center from October 2016 through September 2017 without severe cognitive disorders (n = 1448) received the PSIT, Impact of Events Scale-Revised (IES-R), Patient Health Questionnaire-9 (PHQ-9), Rosenberg Self-Esteem Scale (RSES), State-Trait Anxiety Inventory-State (STAI-S), and the World Health Organization Quality of Life-Abbreviated version (WHOQOL-Bref). After 2 weeks, a subgroup of responding participants received the PSIT a second time. The internal structure (principal components analysis, PCA; and confirmatory factor analysis, CFA), internal consistency (Cronbach’s alpha, α), test-retest reliability (Intraclass Correlation Coefficient, ICC), construct validity (Spearman’s rho correlations), diagnostic accuracy (Area Under the Curve, AUC), and potential cut-off values (sensitivity and specificity) were examined. Results A total of 364 (25.1%) patients participated, of whom 128 completed the PSIT again after 19.5 ± 6.8 days. Test-retest reliability was good (ICC = 0.86). Based on PCA, five items were removed because of cross-loadings ≥ 0.3. Three subscales were identified: (1) Negative affect (7 items; α = 0.91; AUC = 0.92); (2) Anxiety and Post-Traumatic Stress Symptoms (4 items; α = 0.77; AUC = 0.88); and (3) Social and self-image (4 items; α = 0.79; AUC = 0.92). CFA supported this structure (comparative fit index = 0.96; root mean square error of approximation = 0.06; standardized rood mean square residual = 0.04). Four of the five a priori formulated hypotheses regarding construct validity were confirmed. The following cut-off values represent maximum sensitivity and specificity: 7 on subscale 1 (89.6% and 83.4%), 3 on subscale 2 (94.4% and 90.3%), and 4 on subscale 3 (85.7% and 90.7%). Conclusion The final PSIT has good psychometric properties in adult trauma patients.
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Affiliation(s)
- Maria Karabatzakis
- Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Brenda Leontine Den Oudsten
- Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Taco Gosens
- Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands.,Department of Orthopaedics and Traumatology, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Jolanda De Vries
- Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands. .,Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands. .,Department of Medical Psychology, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), P.O. Box 90151, 5000 LC, Tilburg, The Netherlands.
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24
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Kemmeren LL, van Schaik A, Smit JH, Ruwaard J, Rocha A, Henriques M, Ebert DD, Titzler I, Hazo JB, Dorsey M, Zukowska K, Riper H. Unraveling the Black Box: Exploring Usage Patterns of a Blended Treatment for Depression in a Multicenter Study. JMIR Ment Health 2019; 6:e12707. [PMID: 31344670 PMCID: PMC6686640 DOI: 10.2196/12707] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 05/23/2019] [Accepted: 06/10/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Blended treatments, combining digital components with face-to-face (FTF) therapy, are starting to find their way into mental health care. Knowledge on how blended treatments should be set up is, however, still limited. To further explore and optimize blended treatment protocols, it is important to obtain a full picture of what actually happens during treatments when applied in routine mental health care. OBJECTIVE The aims of this study were to gain insight into the usage of the different components of a blended cognitive behavioral therapy (bCBT) for depression and reflect on actual engagement as compared with intended application, compare bCBT usage between primary and specialized care, and explore different usage patterns. METHODS Data used were collected from participants of the European Comparative Effectiveness Research on Internet-Based Depression Treatment project, a European multisite randomized controlled trial comparing bCBT with regular care for depression. Patients were recruited in primary and specialized routine mental health care settings between February 2015 and December 2017. Analyses were performed on the group of participants allocated to the bCBT condition who made use of the Moodbuster platform and for whom data from all blended components were available (n=200). Included patients were from Germany, Poland, the Netherlands, and France; 64.5% (129/200) were female and the average age was 42 years (range 18-74 years). RESULTS Overall, there was a large variability in the usage of the blended treatment. A clear distinction between care settings was observed, with longer treatment duration and more FTF sessions in specialized care and a more active and intensive usage of the Web-based component by the patients in primary care. Of the patients who started the bCBT, 89.5% (179/200) also continued with this treatment format. Treatment preference, educational level, and the number of comorbid disorders were associated with bCBT engagement. CONCLUSIONS Blended treatments can be applied to a group of patients being treated for depression in routine mental health care. Rather than striving for an optimal blend, a more personalized blended care approach seems to be the most suitable. The next step is to gain more insight into the clinical and cost-effectiveness of blended treatments and to further facilitate uptake in routine mental health care.
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Affiliation(s)
- Lise L Kemmeren
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anneke van Schaik
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Johannes H Smit
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jeroen Ruwaard
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Artur Rocha
- Centre for Information Systems and Computer Graphics, Institute for Systems Engineering and Computers, Technology and Science, Porto, Portugal
| | - Mário Henriques
- Centre for Information Systems and Computer Graphics, Institute for Systems Engineering and Computers, Technology and Science, Porto, Portugal
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Jean-Baptiste Hazo
- Eceve, Unit 1123, Inserm, Université de Paris, Paris, France.,Unité de Recherche en Economie de la Santé, Assistance Publique, Hôpitaux de Paris, Paris, France.,World Health Organization Collaborating Centre for Research and Training in Mental Health, Lille, France
| | - Maya Dorsey
- Eceve, Unit 1123, Inserm, Université de Paris, Paris, France.,Unité de Recherche en Economie de la Santé, Assistance Publique, Hôpitaux de Paris, Paris, France.,World Health Organization Collaborating Centre for Research and Training in Mental Health, Lille, France
| | - Katarzyna Zukowska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Heleen Riper
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Institute of Telepsychiatry, University of Southern Denmark, Odense, Denmark
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Carmean M, Grigorian A, Stefan J, Godes N, Burton K, Joe VC. What Happens After a Positive Screen for Depression and Posttraumatic Stress Disorder in the Outpatient Burn Clinic? J Burn Care Res 2019; 40:590-594. [DOI: 10.1093/jbcr/irz051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 03/29/2019] [Indexed: 12/18/2022]
Abstract
Abstract
Multiple reports have demonstrated a wide prevalence of both depression and posttraumatic stress disorder (PTSD) within 1 year of burn injury. The purpose of this study is to determine outcomes of burn patients after a positive outpatient screen for depression or PTSD at an American Burn Association-verified burn center. All patients who screened positive were offered referral for psychologic and/or psychiatric counseling. Rescreening was performed with a goal of approximately 6 months. A total of 445 patients were enrolled with 91 (20.6%) screening positive for depression and 59 (13.4%) for PTSD. TBSA burned was associated with a positive screen for depression (P = .008) and PTSD (P = .012) while electrical injury was associated with a positive screen for depression (P = .029). Rescreening was done in 15.5% with 23% rescreening positive for depression and 15% for PTSD. The study validated the need for early screening and referral for psychologic and/or psychiatric counseling in this population.
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Affiliation(s)
- Melissa Carmean
- UC Irvine Health Rehabilitation Services, Orange, California
| | | | | | | | | | - Victor C Joe
- UC Irvine Department of Surgery, Orange, California
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26
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Shin C, Lee SH, Han KM, Yoon HK, Han C. Comparison of the Usefulness of the PHQ-8 and PHQ-9 for Screening for Major Depressive Disorder: Analysis of Psychiatric Outpatient Data. Psychiatry Investig 2019; 16:300-305. [PMID: 31042692 PMCID: PMC6504773 DOI: 10.30773/pi.2019.02.01] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/01/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to demonstrate that the Patient Health Questionnaire (PHQ)-8 is not less useful than the PHQ-9 as a screening test for major depressive disorder (MDD). METHODS We performed a retrospective analysis of 567 patients in psychiatric outpatient units. The Mini International Neuropsychiatric Interview was used to diagnose MDD. We derived the validity and reliability of the PHQ-8 and PHQ-9. To evaluate the ability of the PHQ-8 and PHQ-9 to discriminate MDD, we drew receiver operating characteristic (ROC) curves and compared the areas under the curves (AUCs). RESULTS Of the 567 participants, 207 (36.5%) were diagnosed with MDD. Cronbach's αs for the PHQ-8 and PHQ-9 were 0.892 and 0.876, respectively. Similar to the PHQ-9, the PHQ-8 was also associated with scores on the Hamilton Depression Rating Scale in a correlation analysis. When we drew ROC curves for the PHQ-8 and PHQ-9, there was no statistically significant difference in the AUCs. With a cutoff score of 10, the PHQ-8 showed a sensitivity of 58.3%, specificity of 83.1%, positive predictive value of 53.4%, and negative predictive value of 85.7%. CONCLUSION In a psychiatric outpatient sample, the PHQ-8 was as useful as the PHQ-9 for MDD screening.
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Affiliation(s)
- Cheolmin Shin
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung-Hoon Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyu-Man Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ho-Kyoung Yoon
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
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Validation of a brief mental health screening tool for common mental disorders in primary healthcare. S Afr Med J 2019; 109:278-283. [PMID: 31084695 DOI: 10.7196/samj.2019.v109i4.13664] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Integrating care for common mental disorders (CMDs) such as depression, anxiety and alcohol abuse into primary healthcare (PHC) should assist in reducing South Africa (SA)'s quadruple burden of disease. CMDs compromise treatment adherence, health behaviour change and self-management of illnesses. Appropriate identification of mental disorders in primary care can be facilitated by brief, easy-to-administer screening that promotes high specificity. OBJECTIVES To establish the criterion-based validity of a seven-item Brief Mental Health (BMH) screening tool for assessing positive symptoms of CMDs in primary care patients. METHODS A total of 1 214 participants were recruited from all patients aged ≥18 years visiting 10 clinics as part of routine care in the Newcastle subdistrict of Amajuba District in KwaZulu-Natal Province, SA, over a period of 2 weeks. Consenting patients provided basic biographical information prior to screening with the BMH tool. PHC nurses remained blind to this assessment. PHC nurse-initiated assessment using the Adult Primary Care (APC) guidelines was the gold standard against which the performance of the BMH tool was compared. A specificity standard of 80% was used to establish cut-points. Specificity was favoured over sensitivity to ensure that those who did not have CMD symptoms were excluded, as well as to reduce over-referrals. RESULTS Of the participants, 72% were female. The AUD-C (alcohol abuse) performed well (area under the curve (AUC) 0.91 (95% confidence interval (CI) 0.88 - 0.95), cut-point ≥4, Cronbach alpha 0.87); PHQ-2 (depression) performed reasonably well (AUC 0.72 (95% CI 0.65 - 0.78), cut-point ≥3, alpha 0.71); and GAD-2 (anxiety) performance was acceptable (AUC 0.69 (95% CI 0.58 - 0.80), cut-point ≥3, alpha 0.62). Using the higher cut-off scores, patients who truly did not have CMD symptoms had negative predictive values (NPVs) of >90%. Overall, 26% of patients had CMD positive symptoms relative to 8% using the APC guidelines. CONCLUSIONS Using a higher specificity index, the positive predictive value and NPV show that at higher cut-point values the BMH not only helps identify individuals with alcohol misuse, depression and anxiety symptoms but also identifies a majority of those who do not have symptoms (true negatives), thus not overburdening nurses with false positives needing assessment. Research is needed to assess whether use of such a short and valid screening tool is generalisable to other clinic contexts as well as how mental health screening should best be introduced into routine clinic functioning and practice.
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Yamabe K, Liebert R, Flores N, Pashos CL. Health-related quality of life outcomes, economic burden, and associated costs among diagnosed and undiagnosed depression patients in Japan. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:233-243. [PMID: 30881068 PMCID: PMC6419602 DOI: 10.2147/ceor.s179901] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Depression is associated with substantial health and economic burden. This study examined the impact of diagnosed and undiagnosed depression on health-related outcomes and costs among Japanese adults. Methods A retrospective, observational study was conducted using 2012-2014 Japan National Health and Wellness Survey (N=83,504) data. Differences between respondents diagnosed with depression (n=2,843) and undiagnosed with depression (weighted n=2,717) and controls without depression (weighted n=2,801) in health-related quality of life, impairment to work productivity and daily activities (Work Productivity and Activity Impairment Questionnaire), health care resource utilization, and annual costs were evaluated. Propensity score weighting and weighted generalized linear models were used to compare groups on the outcome variables, after adjusting for covariates. Results Overall, respondents with undiagnosed depression had significantly better outcomes than those diagnosed with depression, but significantly worse outcomes than controls (for all, P<0.001). The mean Mental Component Summary scores were lower in the diagnosed group when compared with undiagnosed respondents and controls (33.2 vs 34.5 vs 48.6). Similar findings were obtained for mean Physical Component Summary (49.2 vs 49.5 vs 52.8) and health state utility scores (0.61 vs 0.62 vs 0.76). Additionally, the diagnosed group reported greater absenteeism (13.1 vs 6.6 vs 2.5%), presenteeism (41.4 vs 38.1 vs 18.8%), overall work productivity impairment (47.2 vs 41.1 vs 20.2%), and activity impairment (48.4 vs 43.3 vs 21.1%) than the undiagnosed and control groups, respectively. Consistently, patients with diagnosed depression had higher annual per patient direct (1.6-fold) and indirect costs (1.1-fold) than those in the undiagnosed depression group. Conclusion Diagnosed depression was associated with lower health-related quality of life and greater impairment in work productivity and daily activities, higher health care resource utilization, and higher costs, compared with undiagnosed respondents and controls. These study findings suggest a need for greater awareness of depression symptoms among Japanese adults, which is needed to facilitate proper diagnosis and treatment.
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Affiliation(s)
- Kaoru Yamabe
- Healthcare Policy and Access, Takeda Pharmaceutical Company Limited, Nihonbashi, Chuouku, Tokyo 103-8668, Japan,
| | - Ryan Liebert
- Health Outcomes Research, Kantar Health, New York, NY 10010, USA
| | - Natalia Flores
- Health Outcomes Research, Kantar Health, New York, NY 10010, USA
| | - Chris L Pashos
- Global Outcomes & Epidemiology Research, Data Sciences Institute, Takeda Pharmaceuticals International, Inc., Cambridge, MA 02139, USA
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Feasibility and impact of a guided symptom exposure augmented cognitive behavior therapy protocol to prevent symptoms of pharmacologically induced depression: A pilot study. COGNITIVE THERAPY AND RESEARCH 2019; 43:679-692. [PMID: 31777409 DOI: 10.1007/s10608-018-09990-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Depression is the leading cause of disability and a major cause of morbidity worldwide, with societal costs now upwards of 1 trillion dollars across the globe. Hence, extending current efforts to augment prevention outcomes is consistent with global public health interests. Although many prevention programs have been developed and have demonstrated efficacy, studies have yet to demonstrate that CBT is effective in preventing symptoms in populations at risk for developing depression induced by pharmacological substances. Using a randomized, controlled design, this pilot study reports on the feasibility and preliminary effects of a novel, guided symptom exposure augmented cognitive behavioral prevention intervention (GSE-CBT) in a sample diagnosed with Hepatitis C at risk for developing medication induced depression. Results demonstrated that the guided symptom exposure augmented CBT (GSE-CBT) was feasible in this population and was delivered with high integrity. Although not statistically different, we observed a pattern of lower depression levels in the GSE-CBT group versus those in the control group throughout. This pilot study demonstrates that a psychosocial prevention intervention is feasible for use in patients at risk for developing pharmacologically induced depression and that a guided symptom exposure augmented CBT protocol has the potential to prevent symptoms of depression that develop as a side effect to taking these medications. Results are preliminary and future studies should use larger samples and test the intervention in other populations.
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Screening for depression: Review of the Patient Health Questionnaire-9 for nurse practitioners. J Am Assoc Nurse Pract 2019; 30:406-411. [PMID: 29905589 DOI: 10.1097/jxx.0000000000000052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Depression is a major health concern encountered by nurse practitioners working in an array of health care settings. Many current guidelines and articles on this topic recommend using the Patient Health Questionnaire-9 (PHQ-9) as a screening tool. Nurse practitioners should have a sophisticated knowledge of this tool. METHODS Review of the criteria for diagnosing depression as well as depression screening tools. Database search of EMBASE, CINAHL, and MEDLINE for articles about the PHQ-9. Discussion of how the instrument is used in the clinical setting. CONCLUSIONS The PHQ-9 is a free tool that nurse practitioners can use to screen patients in the primary care environment. Screening will detect more instances of depression, which is often missed in this population of patients. IMPLICATIONS FOR PRACTICE Nurse practitioners can and should use the PHQ-9 when screening for depression. However, they should do so with full knowledge and awareness of its strengths and limitations.
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Lahey R, Ewald B, Vail M, Golden R. Identifying and managing depression through collaborative care: expanding social work's impact. SOCIAL WORK IN HEALTH CARE 2019; 58:93-107. [PMID: 30590995 DOI: 10.1080/00981389.2018.1556977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
While behavioral health symptoms commonly present in primary care, most primary care providers lack the time, resources, and expertise to identify and treat them on their own. To address this need, many quality improvement efforts are underway to expand teams and integrate behavioral health assessments and interventions into primary care. Due to their expertise in behavioral health, community supports, and behavioral activation, social workers are natural leaders in integrating care. This paper describes one urban academic medical center's efforts to ensure adolescent and adult patients with depressive symptoms are connected to adequate care and support. A case study is included to demonstrate the Collaborative Care Team model as described, including details regarding the role social workers play. Key quality improvement and policy considerations for scaling up and sustaining collaborative initiative are included.
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Affiliation(s)
- Rebecca Lahey
- a Social work and Community Health , Rush University Medical Center , Chicago , Illinois , USA
| | - Bonnie Ewald
- a Social work and Community Health , Rush University Medical Center , Chicago , Illinois , USA
| | - Matthew Vail
- a Social work and Community Health , Rush University Medical Center , Chicago , Illinois , USA
| | - Robyn Golden
- a Social work and Community Health , Rush University Medical Center , Chicago , Illinois , USA
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Norton J, Oude Engberink A, Gandubert C, Macgregor A, David M, Mann A, Ritchie K, Ancelin ML, Capdevielle D. Frequent attendance and the concordance between PHQ screening and GP assessment in the detection of common mental disorders. J Psychosom Res 2018; 110:1-10. [PMID: 29764597 DOI: 10.1016/j.jpsychores.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Frequent Attenders (FAs) have high rates of both common mental disorders (CMD) and physical disorders, partly justifying this service use behaviour. This study examines both case and non-case concordance between CMDs as estimated by a self-report screening questionnaire and as rated by the general practitioner (GP), in FAs compared to Other Attenders (OAs). METHODS 2275 patients of an overlapping sample of 55 GPs from 2 surveys performed 10 years apart, completed in the waiting room the Patient Health Questionnaire (PHQ) and Client Service Receipt Inventory on 6-month service use. For each patient, the GP rated mental health on a 0-4 scale, with a clear indication that scores of 2 and above referred to caseness. PHQ-CMDs included major and other depressive, anxiety, panic, and somatoform disorders, identified using the original PHQ DSM-IV criteria-based algorithms. FA was defined as the top 10% of attenders in age, sex and survey-year stratified subgroups. RESULTS FAs had higher rates of PHQ-CMDs (42% versus 23% for OAs, p < .0001). They reported more personal and social problems, disability and had higher GP-rated physical illness. Survey-day antidepressant/anxiolytic medication prescription was higher for FAs (p < .0001), with (p = .02) but also without a CMD (p < .0001). Both GP/PHQ case and non-case concordance differed between FAs and OAs, with a non-case concordance odds ratio of 0.5 (95% CI: 0.3-0.7, p = .001) for FAs compared to OAs. CONCLUSION Despite a greater likelihood of GPs detecting CMDs in FAs, our findings suggest a potential risk of 'over-detection' of patients not reaching CMD threshold criteria among FAs.
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Affiliation(s)
- J Norton
- Inserm, U1061, Montpellier, France; University of Montpellier, U1061, Montpellier, France.
| | - A Oude Engberink
- Department of General Practice, Faculty of Medicine, University of Montpellier, France
| | - C Gandubert
- Inserm, U1061, Montpellier, France; University of Montpellier, U1061, Montpellier, France
| | - A Macgregor
- University Department of Adult Psychiatry, Montpellier University Hospital, Montpellier, France
| | - M David
- Department of General Practice, Faculty of Medicine, University of Montpellier, France
| | - A Mann
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - K Ritchie
- Inserm, U1061, Montpellier, France; University of Montpellier, U1061, Montpellier, France; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - M L Ancelin
- Inserm, U1061, Montpellier, France; University of Montpellier, U1061, Montpellier, France
| | - D Capdevielle
- Inserm, U1061, Montpellier, France; University of Montpellier, U1061, Montpellier, France; University Department of Adult Psychiatry, Montpellier University Hospital, Montpellier, France
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González-Blanch C, Medrano LA, Muñoz-Navarro R, Ruíz-Rodríguez P, Moriana JA, Limonero JT, Schmitz F, Cano-Vindel A. Factor structure and measurement invariance across various demographic groups and over time for the PHQ-9 in primary care patients in Spain. PLoS One 2018; 13:e0193356. [PMID: 29474410 PMCID: PMC5825085 DOI: 10.1371/journal.pone.0193356] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 02/02/2018] [Indexed: 11/18/2022] Open
Abstract
The Patient Health Questionnaire (PHQ-9) is a widely-used screening tool for depression in primary care settings. The purpose of the present study is to identify the factor structure of the PHQ-9 and to examine the measurement invariance of this instrument across different sociodemographic groups and over time in a sample of primary care patients in Spain. Data came from 836 primary care patients enrolled in a randomized controlled trial (PsicAP study) and a subsample of 218 patients who participated in a follow-up assessment at 3 months. Confirmatory factor analysis (CFA) was used to test one- and two-factor structures identified in previous studies. Analyses of multiple-group invariance were conducted to determine the extent to which the factor structure is comparable across various demographic groups (i.e., gender, age, marital status, level of education, and employment situation) and over time. Both one-factor and two-factor re-specified models met all the pre-established fit criteria. However, because the factors identified in the two-factor model were highly correlated (r = .86), the one-factor model was preferred for its parsimony. Multi-group CFA indicated measurement invariance across different demographic groups and across time. The present findings suggest that physicians in Spain can use the PHQ-9 to obtain a global score for depression severity in different demographic groups and to reliably monitor changes over time in the primary care setting.
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Affiliation(s)
- César González-Blanch
- Mental Health Centre, University Hospital “Marqués de Valdecilla”- IDIVAL, Santander, Spain
| | | | - Roger Muñoz-Navarro
- Department of Basic Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain
| | | | - Juan Antonio Moriana
- Department of Psychology, University of Córdoba/ Maimónides Institute for Research in Biomedicine of Cordoba-IMIBIC/Reina Sofía University Hospital, Córdoba, Spain
| | - Joaquín T. Limonero
- Department of Basic Psychology, Autonomous University of Barcelona, Bellaterra, Barcelona, Spain
| | | | - Antonio Cano-Vindel
- Department of Basic Psychology, University Complutense of Madrid, Madrid, Spain
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Bevilacqua LA, Dulak D, Schofield E, Starr TD, Nelson CJ, Roth AJ, Holland JC, Alici Y. Prevalence and predictors of depression, pain, and fatigue in older- versus younger-adult cancer survivors. Psychooncology 2018; 27:900-907. [PMID: 29239060 DOI: 10.1002/pon.4605] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND As the number of older adults in the United States continues to grow, there will be increasing demands on health care providers to address the needs of this population. Cancer is of particular importance, with over half of all cancer survivors older than 65 years. In addition, depression, pain, and fatigue are concerns for older adults with cancer and have been linked to poorer physical outcomes. METHODS For this retrospective chart review, 1012 eligible participants were identified via a query of the Electronic Medical Record for all patients referred to 1 of 4 Survivorship Clinics at Memorial Sloan Kettering Cancer Center. All patients were between the ages of 30 to 55 (younger adults) and >65 (older adults). Depression was measured using the Patient Health Questionnaire-9 (PHQ-9). RESULTS The overall rate of depression in this sample of adult cancer survivors was 9.3%. There were no differences in the rates of clinically significant depression (defined as PHQ-9 score ≥10) between younger and older adult cohorts. However, there was a small trend toward higher mean PHQ-9 scores in the younger adult cohort (3.42 vs 2.95; t = 1.763, P = .10). Women reported greater rates of depression and higher pain and fatigue scores. Hispanic/Latino patients also reported significantly greater rates of depression. CONCLUSION There were no observed differences in depression between older and younger adult cancer survivors. Gender and ethnic discrepancies in depression were observed. Future research should focus on understanding the nature of these differences and targeting interventions for the groups most vulnerable to depression after cancer treatment.
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Affiliation(s)
- Lisa A Bevilacqua
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Deirdre Dulak
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tatiana D Starr
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Roth
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jimmie C Holland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yesne Alici
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Manea L, Boehnke JR, Gilbody S, Moriarty AS, McMillan D. Are there researcher allegiance effects in diagnostic validation studies of the PHQ-9? A systematic review and meta-analysis. BMJ Open 2017; 7:e015247. [PMID: 28965089 PMCID: PMC5640143 DOI: 10.1136/bmjopen-2016-015247] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To investigate whether an authorship effect is found that leads to better performance in studies conducted by the original developers of the Patient Health Questionnaire (PHQ-9) (allegiant studies). DESIGN Systematic review with random effects bivariate diagnostic meta-analysis. Search strategies included electronic databases, examination of reference lists and forward citation searches. INCLUSION CRITERIA Included studies provided sufficient data to calculate the diagnostic accuracy of the PHQ-9 against a gold standard diagnosis of major depression using the algorithm or the summed item scoring method at cut-off point 10. DATA EXTRACTION Descriptive information, methodological quality criteria and 2×2 contingency tables. RESULTS Seven allegiant and 20 independent studies reported the diagnostic performance of the PHQ-9 using the algorithm scoring method. Pooled diagnostic OR (DOR) for the allegiant group was 64.40, and 15.05 for non-allegiant studies group. The allegiance status was a significant predictor of DOR variation (p<0.0001).Five allegiant studies and 26 non-allegiant studies reported the performance of the PHQ-9 at recommended cut-off point of 10. Pooled DOR for the allegiant group was 49.31, and 24.96 for the non-allegiant studies. The allegiance status was a significant predictor of DOR variation (p=0.015).Some potential alternative explanations for the observed authorship effect including differences in study characteristics and quality were found, although it is not clear how some of them account for the observed differences. CONCLUSIONS Allegiant studies reported better performance of the PHQ-9. Allegiance status was predictive of variation in the DOR. Based on the observed differences between independent and non-independent studies, we were unable to conclude or exclude that allegiance effects are present in studies examining the diagnostic performance of the PHQ-9. This study highlights the need for future meta-analyses of diagnostic validation studies of psychological measures to evaluate the impact of researcher allegiance in the primary studies.
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Affiliation(s)
- Laura Manea
- Deparment of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, United Kingdom
| | - Jan Rasmus Boehnke
- Dundee Centre for Health And Related Research, University of Dundee, Dundee, United Kingdom
| | - Simon Gilbody
- Deparment of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, United Kingdom
| | | | - Dean McMillan
- Deparment of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, United Kingdom
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Muñoz-Navarro R, Cano-Vindel A, Medrano LA, Schmitz F, Ruiz-Rodríguez P, Abellán-Maeso C, Font-Payeras MA, Hermosilla-Pasamar AM. Utility of the PHQ-9 to identify major depressive disorder in adult patients in Spanish primary care centres. BMC Psychiatry 2017; 17:291. [PMID: 28793892 PMCID: PMC5550940 DOI: 10.1186/s12888-017-1450-8] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/28/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The prevalence of major depressive disorder (MDD) in Spanish primary care (PC) centres is high. However, MDD is frequently underdiagnosed and consequently only some patients receive the appropriate treatment. The present study aims to determine the utility of the Patient Health Questionnaire-9 (PHQ-9) to identify MDD in a subset of PC patients participating in the large PsicAP study. METHODS A total of 178 patients completed the full PHQ test, including the depression module (PHQ-9). Also, a Spanish version of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was implemented by clinical psychologists that were blinded to the PHQ-9 results. We evaluated the psychometric properties of the PHQ-9 as a screening tool as compared to the SCID-I as a reference standard. RESULTS The psychometric properties of the PHQ-9 for a cut-off value of 10 points were as follows: sensitivity, 0.95; specificity, 0.67. Using a cut-off of 12 points, the values were: sensitivity, 0.84; specificity, 0.78. Finally, using the diagnostic algorithm for depression (DSM-IV criteria), the sensitivity was 0.88 and the specificity 0.80. CONCLUSIONS As a screening instrument, the PHQ-9 performed better with a cut-off value of 12 versus the standard cut-off of 10. However, the best psychometric properties were obtained with the DSM-IV diagnostic algorithm for depression. These findings indicate that the PHQ-9 is a highly satisfactory tool that can be used for screening MDD in the PC setting. TRIAL REGISTRATION Current Controlled Trials ISRCTN58437086 . Registered 20 May 2013.
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Affiliation(s)
- Roger Muñoz-Navarro
- Department of Basic Psychology, Faculty of Psychology, University of Valencia, Av. Blasco Ibáñez, 21, 46010, Valencia, Spain.
| | - Antonio Cano-Vindel
- 0000 0001 2157 7667grid.4795.fDepartment of Basic Psychology, University Complutense of Madrid, Madrid, Spain
| | | | - Florian Schmitz
- 0000 0004 1936 9748grid.6582.9Department of Psychology, Ulm University, Ulm, Germany
| | | | - Carmen Abellán-Maeso
- Hospital Ntra. Sra. Perpetuo Socorro, Mental Health Service of Albacete, Albacete, Spain
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Pols AD, van Dijk SE, Bosmans JE, Hoekstra T, van Marwijk HWJ, van Tulder MW, Adriaanse MC. Effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: A pragmatic cluster randomized controlled trial. PLoS One 2017; 12:e0181023. [PMID: 28763451 PMCID: PMC5538642 DOI: 10.1371/journal.pone.0181023] [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: 12/07/2016] [Accepted: 06/20/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose Given the public health significance of poorly treatable co-morbid major depressive disorders (MDD) among patients with type 2 diabetes mellitus (DM2) and coronary heart disease (CHD), we need to investigate whether strategies to prevent the development of major depression could reduce its burden of disease. We therefore evaluated the effectiveness of a stepped-care program for subthreshold depression in comparison with usual care in patients with DM2 and/or CHD. Methods A cluster randomized controlled trial, with 27 primary care centers serving as clusters. A total of 236 DM2 and/or CHD patients with subthreshold depression (nine item Patient Health Questionnaire (PHQ-9) score ≥ 6, no current MDD according to DSM-IV criteria) were allocated to the intervention group (N = 96) or usual care group (n = 140). The stepped-care program was delivered by trained practice nurses during one year and consisted of four sequential treatment steps: watchful waiting, guided self-help, problem solving treatment and referral to the general practitioner. The primary outcome was the 12-month cumulative incidence of MDD as measured with the Mini International Neuropsychiatric Interview (MINI). Secondary outcomes included severity of depression (measured by PHQ-9) at 3, 6, 9 and 12 months. Results Of 236 patients (mean age, 67,5 (SD 10) years; 54.7% men), 210 (89%) completed the MINI at 12 months. The cumulative incidence of MDD was 9 of 89 (10.1%) participants in the intervention group and 12 of 121 (9.9%) participants in the usual care group. We found no statistically significant overall effect of the intervention (OR = 1.21; 95% confidence interval (0.12 to 12.41)) and there were no statistically significant differences in the course or severity of depressive symptoms between the two groups. Conclusions This study suggest that Step-Dep was not more effective in preventing MDD than usual care in a primary care population with DM2 and/or CHD and subthreshold depression.
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Affiliation(s)
- Alide D. Pols
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
- Department of General Practice & Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Susan E. van Dijk
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
| | - Judith E. Bosmans
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
| | - Trynke Hoekstra
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics, VU University Amsterdam, Amsterdam, the Netherlands
| | - Harm W. J. van Marwijk
- Department of General Practice & Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
- CLAHRC Greater Manchester and NIHR School for Primary Care Research, the University of Manchester, Manchester, United Kingdom
| | - Maurits W. van Tulder
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
| | - Marcel C. Adriaanse
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
- * E-mail:
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Simoneau G, Levis B, Cuijpers P, Ioannidis JPA, Patten SB, Shrier I, Bombardier CH, de Lima Osório F, Fann JR, Gjerdingen D, Lamers F, Lotrakul M, Löwe B, Shaaban J, Stafford L, van Weert HCPM, Whooley MA, Wittkampf KA, Yeung AS, Thombs BD, Benedetti A. A comparison of bivariate, multivariate random-effects, and Poisson correlated gamma-frailty models to meta-analyze individual patient data of ordinal scale diagnostic tests. Biom J 2017; 59:1317-1338. [PMID: 28692782 DOI: 10.1002/bimj.201600184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 05/08/2017] [Accepted: 05/16/2017] [Indexed: 12/16/2022]
Abstract
Individual patient data (IPD) meta-analyses are increasingly common in the literature. In the context of estimating the diagnostic accuracy of ordinal or semi-continuous scale tests, sensitivity and specificity are often reported for a given threshold or a small set of thresholds, and a meta-analysis is conducted via a bivariate approach to account for their correlation. When IPD are available, sensitivity and specificity can be pooled for every possible threshold. Our objective was to compare the bivariate approach, which can be applied separately at every threshold, to two multivariate methods: the ordinal multivariate random-effects model and the Poisson correlated gamma-frailty model. Our comparison was empirical, using IPD from 13 studies that evaluated the diagnostic accuracy of the 9-item Patient Health Questionnaire depression screening tool, and included simulations. The empirical comparison showed that the implementation of the two multivariate methods is more laborious in terms of computational time and sensitivity to user-supplied values compared to the bivariate approach. Simulations showed that ignoring the within-study correlation of sensitivity and specificity across thresholds did not worsen inferences with the bivariate approach compared to the Poisson model. The ordinal approach was not suitable for simulations because the model was highly sensitive to user-supplied starting values. We tentatively recommend the bivariate approach rather than more complex multivariate methods for IPD diagnostic accuracy meta-analyses of ordinal scale tests, although the limited type of diagnostic data considered in the simulation study restricts the generalization of our findings.
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Affiliation(s)
- Gabrielle Simoneau
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec H3A 1A2, Canada
| | - Brooke Levis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec H3A 1A2, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec H3T 1E2, Canada
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam 1018 HV, The Netherlands
| | - John P A Ioannidis
- Department of Medicine, Department of Health Research and Policy, Department of Statistics, Stanford University, Stanford, CA 94305, USA
| | - Scott B Patten
- Departments of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Ian Shrier
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec H3A 1A2, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec H3T 1E2, Canada
| | - Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Flavia de Lima Osório
- Department of Neuroscience and Behavior, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão, Preto 14049, Brazil
| | - Jesse R Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA
| | - Dwenda Gjerdingen
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Femke Lamers
- Department of Psychiatry, EMGO Institute, VU University Medical Center, Amsterdam 1081 HL, The Netherlands
| | - Manote Lotrakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg 20246, Germany
| | - Juwita Shaaban
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan 16150, Malaysia
| | - Lesley Stafford
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Henk C P M van Weert
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam 1081 HV, The Netherlands
| | - Mary A Whooley
- Department of Veterans Affairs Medical Center, San Francisco, CA 94121, USA
| | - Karin A Wittkampf
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam 1081 HV, The Netherlands
| | - Albert S Yeung
- Depression Clinical and Research Program, Massachussets General Hospital, Boston, MA 02114, USA
| | - Brett D Thombs
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec H3A 1A2, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec H3T 1E2, Canada.,Departments of Psychiatry, Educational and Counselling Psychology, and Psychology, McGill University, Montréal, Québec H3A 1Y2, Canada.,Department of Medicine, McGill University, Montréal, Québec H4A 3J1, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec H3A 1A2, Canada.,Department of Medicine, Department of Health Research and Policy, Department of Statistics, Stanford University, Stanford, CA 94305, USA.,Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec H4A 3J1, Canada
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Alson AR, Robinson DM, Ivanova D, Azer J, Moreno M, Turk ML, Nitturkar A, Blackman KS. Depression in primary care: Strategies for a psychiatry-scarce environment. Int J Psychiatry Med 2017; 51:182-200. [PMID: 27079777 DOI: 10.1177/0091217416636580] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
More than an algorithm to guide primary care providers through treatment options, integrated care, also called collaborative care, is a validated, systematic, multidisciplinary approach to depression treatment in primary care. Historically, integrated care emerged in response to a mismatch between a growing demand for mental health treatment and scarce mental healthcare resources. Working together, psychiatrists and primary care providers have demonstrated that the principles and tools of chronic disease management improve depression outcomes in primary care. Currently, most antidepressants are prescribed by primary care providers, but with disappointing rates of full, sustained remission. Primary care patients may derive the greatest benefit from existing depression treatment guidelines when they are melded with an approach informed by integrated care principles. This paper will present established guidelines for pharmacologic management of depression as part of a broader framework for depression treatment in the primary care office.
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Affiliation(s)
- Amy R Alson
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | | | - John Azer
- University of Virginia Health System, VA, USA
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Levis B, Benedetti A, Levis AW, Ioannidis JPA, Shrier I, Cuijpers P, Gilbody S, Kloda LA, McMillan D, Patten SB, Steele RJ, Ziegelstein RC, Bombardier CH, de Lima Osório F, Fann JR, Gjerdingen D, Lamers F, Lotrakul M, Loureiro SR, Löwe B, Shaaban J, Stafford L, van Weert HCPM, Whooley MA, Williams LS, Wittkampf KA, Yeung AS, Thombs BD. Selective Cutoff Reporting in Studies of Diagnostic Test Accuracy: A Comparison of Conventional and Individual-Patient-Data Meta-Analyses of the Patient Health Questionnaire-9 Depression Screening Tool. Am J Epidemiol 2017; 185:954-964. [PMID: 28419203 DOI: 10.1093/aje/kww191] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/14/2016] [Indexed: 12/16/2022] Open
Abstract
In studies of diagnostic test accuracy, authors sometimes report results only for a range of cutoff points around data-driven "optimal" cutoffs. We assessed selective cutoff reporting in studies of the diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) depression screening tool. We compared conventional meta-analysis of published results only with individual-patient-data meta-analysis of results derived from all cutoff points, using data from 13 of 16 studies published during 2004-2009 that were included in a published conventional meta-analysis. For the "standard" PHQ-9 cutoff of 10, accuracy results had been published by 11 of the studies. For all other relevant cutoffs, 3-6 studies published accuracy results. For all cutoffs examined, specificity estimates in conventional and individual-patient-data meta-analyses were within 1% of each other. Sensitivity estimates were similar for the cutoff of 10 but differed by 5%-15% for other cutoffs. In samples where the PHQ-9 was poorly sensitive at the standard cutoff, authors tended to report results for lower cutoffs that yielded optimal results. When the PHQ-9 was highly sensitive, authors more often reported results for higher cutoffs. Consequently, in the conventional meta-analysis, sensitivity increased as cutoff severity increased across part of the cutoff range-an impossibility if all data are analyzed. In sum, selective reporting by primary study authors of only results from cutoffs that perform well in their study can bias accuracy estimates in meta-analyses of published results.
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Buchheit T, Van de Ven T, Hsia HLJ, McDuffie M, MacLeod DB, White W, Chamessian A, Keefe FJ, Buckenmaier CT, Shaw AD. Pain Phenotypes and Associated Clinical Risk Factors Following Traumatic Amputation: Results from Veterans Integrated Pain Evaluation Research (VIPER). PAIN MEDICINE 2016; 17:149-61. [PMID: 26177330 DOI: 10.1111/pme.12848] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To define clinical phenotypes of postamputation pain and identify markers of risk for the development of chronic pain. DESIGN Cross-sectional study of military service members enrolled 3-18 months after traumatic amputation injury. SETTING Military Medical Center. SUBJECTS 124 recent active duty military service members. METHODS Study subjects completed multiple pain and psychometric questionnaires to assess the qualities of phantom and residual limb pain. Medical records were reviewed to determine the presence/absence of a regional catheter near the time of injury. Subtypes of residual limb pain (somatic, neuroma, and complex regional pain syndrome) were additionally analyzed and associated with clinical risk factors. RESULTS A majority of enrolled patients (64.5%) reported clinically significant pain (pain score ≥ 3 averaged over previous week). 61% experienced residual limb pain and 58% experienced phantom pain. When analysis of pain subtypes was performed in those with residual limb pain, we found evidence of a sensitized neuroma in 48.7%, somatic pain in 40.8%, and complex regional pain syndrome in 19.7% of individuals. The presence of clinically significant neuropathic residual limb pain was associated with symptoms of PTSD and depression. Neuropathic pain of any severity was associated with symptoms of all four assessed clinical risk factors: depression, PTSD, catastrophizing, and the absence of regional analgesia catheter. CONCLUSIONS Most military service members in this cohort suffered both phantom and residual limb pain following amputation. Neuroma was a common cause of neuropathic pain in this group. Associated risk factors for significant neuropathic pain included PTSD and depression. PTSD, depression, catastrophizing, and the absence of a regional analgesia catheter were associated with neuropathic pain of any severity.
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Campbell DG, Bonner LM, Bolkan CR, Lanto AB, Zivin K, Waltz TJ, Klap R, Rubenstein LV, Chaney EF. Stigma Predicts Treatment Preferences and Care Engagement Among Veterans Affairs Primary Care Patients with Depression. Ann Behav Med 2016; 50:533-44. [PMID: 26935310 PMCID: PMC4935614 DOI: 10.1007/s12160-016-9780-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Whereas stigma regarding mental health concerns exists, the evidence for stigma as a depression treatment barrier among patients in Veterans Affairs (VA) primary care (PC) is mixed. PURPOSE This study tests whether stigma, defined as depression label avoidance, predicted patients' preferences for depression treatment providers, patients' prospective engagement in depression care, and care quality. METHODS We conducted cross-sectional and prospective analyses of existing data from 761 VA PC patients with probable major depression. RESULTS Relative to low-stigma patients, those with high stigma were less likely to prefer treatment from mental health specialists. In prospective controlled analyses, high stigma predicted lower likelihood of the following: taking medications for mood, treatment by mental health specialists, treatment for emotional concerns in PC, and appropriate depression care. CONCLUSIONS High stigma is associated with lower preferences for care from mental health specialists and confers risk for minimal depression treatment engagement.
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Affiliation(s)
| | - Laura M Bonner
- Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
- Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Cory R Bolkan
- Department of Human Development, Washington State University Vancouver, Vancouver, WA, USA
| | - Andrew B Lanto
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Kara Zivin
- Center for Clinical Management Research, Health Services Research and Development Service, VA Ann Arbor Health Care System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Thomas J Waltz
- Center for Clinical Management Research, Health Services Research and Development Service, VA Ann Arbor Health Care System, Ann Arbor, MI, USA
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
| | - Ruth Klap
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Lisa V Rubenstein
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- UCLA School of Medicine, Los Angeles, CA, USA
- RAND Health Program, Santa Monica, CA, USA
| | - Edmund F Chaney
- Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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Kroenke K, Wu J, Yu Z, Bair MJ, Kean J, Stump T, Monahan PO. Patient Health Questionnaire Anxiety and Depression Scale: Initial Validation in Three Clinical Trials. Psychosom Med 2016; 78:716-27. [PMID: 27187854 PMCID: PMC4927366 DOI: 10.1097/psy.0000000000000322] [Citation(s) in RCA: 246] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We examine the reliability and validity of the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS)-which combines the nine-item Patient Health Questionnaire depression scale and seven-item Generalized Anxiety Disorder scale-as a composite measure of depression and anxiety. METHODS Baseline data from 896 patients enrolled in two primary-care based trials of chronic pain and one oncology-practice-based trial of depression and pain were analyzed. The internal reliability, standard error of measurement, and convergent, construct, and factor structure validity, as well as sensitivity to change of the PHQ-ADS were examined. RESULTS The PHQ-ADS demonstrated high internal reliability (Cronbach α values of .8 to .9) in all three trials. PHQ-ADS scores can range from 0 to 48 (with higher scores indicating more severe depression/anxiety), and the estimated standard error of measurement was approximately 3 to 4 points. The PHQ-ADS showed strong convergent (most correlations, 0.7-0.8 range) and construct (most correlations, 0.4-0.6 range) validity when examining its association with other mental health, quality of life, and disability measures. PHQ-ADS cutpoints of 10, 20, and 30 indicated mild, moderate, and severe levels of depression/anxiety, respectively. Bifactor analysis showed sufficient unidimensionality of the PHQ-ADS score. PHQ-ADS change scores at 3 months differentiated (p < .0001) between individuals classified as worse, stable, or improved by a reference measure, providing preliminary evidence for sensitivity to change. CONCLUSIONS The PHQ-ADS may be a reliable and valid composite measure of depression and anxiety which, if validated in other populations, could be useful as a single measure for jointly assessing two of the most common psychological conditions in clinical practice and research. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT00926588 (SCOPE); NCT00386243 (ESCAPE); NCT00313573 (INCPAD).
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Affiliation(s)
- Kurt Kroenke
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
- Regenstrief Institute, Inc., Indianapolis, IN
| | - Jingwei Wu
- Department of Biostatistics, Indiana University, Indianapolis, IN
| | - Zhangsheng Yu
- Department of Biostatistics, Indiana University, Indianapolis, IN
| | - Matthew J. Bair
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
- Regenstrief Institute, Inc., Indianapolis, IN
| | - Jacob Kean
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN
- Regenstrief Institute, Inc., Indianapolis, IN
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN
| | - Timothy Stump
- Department of Biostatistics, Indiana University, Indianapolis, IN
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Krieke LVD, Jeronimus BF, Blaauw FJ, Wanders RB, Emerencia AC, Schenk HM, Vos SD, Snippe E, Wichers M, Wigman JT, Bos EH, Wardenaar KJ, Jonge PD. HowNutsAreTheDutch (HoeGekIsNL): A crowdsourcing study of mental symptoms and strengths. Int J Methods Psychiatr Res 2016; 25:123-44. [PMID: 26395198 PMCID: PMC6877205 DOI: 10.1002/mpr.1495] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/10/2015] [Accepted: 08/17/2015] [Indexed: 12/28/2022] Open
Abstract
HowNutsAreTheDutch (Dutch: HoeGekIsNL) is a national crowdsourcing study designed to investigate multiple continuous mental health dimensions in a sample from the general population (n = 12,503). Its main objective is to create an empirically based representation of mental strengths and vulnerabilities, accounting for (i) dimensionality and heterogeneity, (ii) interactivity between symptoms and strengths, and (iii) intra-individual variability. To do so, HowNutsAreTheDutch (HND) makes use of an internet platform that allows participants to (a) compare themselves to other participants via cross-sectional questionnaires and (b) to monitor themselves three times a day for 30 days with an intensive longitudinal diary study via their smartphone. These data enable for personalized feedback to participants, a study of profiles of mental strengths and weaknesses, and zooming into the fine-grained level of dynamic relationships between variables over time. Measuring both psychiatric symptomatology and mental strengths and resources enables for an investigation of their interactions, which may underlie the wide variety of observed mental states in the population. The present paper describes the applied methods and technology, and presents the sample characteristics. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lian Van Der Krieke
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Bertus F. Jeronimus
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Frank J. Blaauw
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
- University of GroningenJohann Bernoulli Institute for Mathematics and Computer Science, Distributed Systems GroupGroningenThe Netherlands
| | - Rob B.K. Wanders
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Ando C. Emerencia
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Hendrika M. Schenk
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Stijn De Vos
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Evelien Snippe
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Marieke Wichers
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Johanna T.W. Wigman
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Elisabeth H. Bos
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Klaas J. Wardenaar
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
| | - Peter De Jonge
- University of Groningen, University Medical Center GroningenDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE)GroningenThe Netherlands
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Reilly-Harrington NA, Shelton RC, Kamali M, Rabideau DJ, Shesler LW, Trivedi MH, McElroy SL, Sylvia LG, Bowden CL, Ketter TA, Calabrese JR, Thase ME, Bobo WV, Deckersbach T, Tohen M, McInnis MG, Kocsis JH, Gold AK, Singh V, Finkelstein DM, Kinrys G, Nierenberg AA. A tool to predict suicidal ideation and behavior in bipolar disorder: The Concise Health Risk Tracking Self-Report. J Affect Disord 2016; 192:212-8. [PMID: 26748736 PMCID: PMC9900871 DOI: 10.1016/j.jad.2015.12.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/11/2015] [Accepted: 12/27/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Few brief, self-report measures exist that can reliably predict adverse suicidality outcomes in patients with BD. This study utilized the Concise Health Risk Tracking Self-Report (CHRT) to assess suicidality in patients with BD and examined its psychometric performance, clinical correlates, and prospective value in predicting adverse events related to suicidality. METHODS The CHRT was administered at baseline and follow-up to 482 adult patients in Bipolar CHOICE, a 6-month randomized comparative effectiveness trial. The Columbia Suicide Severity Rating Scale (CSSRS) was used at baseline to assess lifetime history of suicide attempts and related behaviors. Clinician-rated measures of mood (Bipolar Inventory of Symptoms Scale) and bipolar symptoms (Clinical Global Impressions-Bipolar Version) were conducted at baseline and follow-up. RESULTS The CHRT showed excellent internal consistency and construct validity and was highly correlated with clinician ratings of depression, anxiety, and overall functioning at baseline and throughout the study. Baseline CHRT scores significantly predicted risk of subsequent suicidality-related Serious Adverse Events (sSAEs), after controlling for mood and comorbidity. Specifically, the hazard of a sSAE increased by 76% for every 10-point increase in baseline CHRT score. Past history of suicide attempts and related behaviors, as assessed by the CSSRS, did not predict subsequent sSAEs. LIMITATIONS The CSSRS was used to assess static risk factors in terms of past suicidal behaviors and may have been a more powerful predictor over longer-term follow-up. CONCLUSIONS The CHRT offers a quick and robust self-report tool for assessing suicidal risk and has important implications for future research and clinical practice.
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Affiliation(s)
- Noreen A. Reilly-Harrington
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Correspondence to: Massachusetts General Hospital, Department of Psychiatry, Bipolar Clinic & Research Program, 50 Staniford Street, Suite 580, Boston, MA 02114, USA. (N.A. Reilly-Harrington)
| | - Richard C. Shelton
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Masoud Kamali
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | - Leah W. Shesler
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Madhukar H. Trivedi
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Susan L. McElroy
- Lindner Center of HOPE, Mason, OH, USA,Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Louisa G. Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Charles L. Bowden
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
| | - Terence A. Ketter
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Joseph R. Calabrese
- Bipolar Disorders Research Center, University Hospital’s Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Michael E. Thase
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - William V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Mauricio Tohen
- Department of Psychiatry, University of New Mexico, Health Sciences Center, Albuquerque, NM, USA
| | - Melvin G. McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - James H. Kocsis
- Department of Psychiatry, Weill Cornell Medical College of Cornell University, New York, NY, USA Article history:
| | - Alexandra K. Gold
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Vivek Singh
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
| | | | - Gustavo Kinrys
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Andrew A. Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
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Mitchell AJ, Yadegarfar M, Gill J, Stubbs B. Case finding and screening clinical utility of the Patient Health Questionnaire (PHQ-9 and PHQ-2) for depression in primary care: a diagnostic meta-analysis of 40 studies. BJPsych Open 2016; 2:127-138. [PMID: 27703765 PMCID: PMC4995584 DOI: 10.1192/bjpo.bp.115.001685] [Citation(s) in RCA: 190] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 12/17/2015] [Accepted: 12/21/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The Patient Health Questionnaire (PHQ) is the most commonly used measure to screen for depression in primary care but there is still lack of clarity about its accuracy and optimal scoring method. AIMS To determine via meta-analysis the diagnostic accuracy of the PHQ-9-linear, PHQ-9-algorithm and PHQ-2 questions to detect major depressive disorder (MDD) among adults. METHOD We systematically searched major electronic databases from inception until June 2015. Articles were included that reported the accuracy of PHQ-9 or PHQ-2 questions for diagnosing MDD in primary care defined according to standard classification systems. We carried out a meta-analysis, meta-regression, moderator and sensitivity analysis. RESULTS Overall, 26 publications reporting on 40 individual studies were included representing 26 902 people (median 502, s.d.=693.7) including 14 760 unique adults of whom 14.3% had MDD. The methodological quality of the included articles was acceptable. The meta-analytic area under the receiver operating characteristic curve of the PHQ-9-linear and the PHQ-2 was significantly higher than the PHQ-9-algorithm, a difference that was maintained in head-to-head meta-analysis of studies. Our best estimates of sensitivity and specificity were 81.3% (95% CI 71.6-89.3) and 85.3% (95% CI 81.0-89.1), 56.8% (95% CI 41.2-71.8) and 93.3% (95% CI 87.5-97.3) and 89.3% (95% CI 81.5-95.1) and 75.9% (95% CI 70.1-81.3) for the PHQ-9-linear, PHQ-9-algorithm and PHQ-2 respectively. For case finding (ruling in a diagnosis), none of the methods were suitable but for screening (ruling out non-cases), all methods were encouraging with good clinical utility, although the cut-off threshold must be carefully chosen. CONCLUSIONS The PHQ can be used as an initial first step assessment in primary care and the PHQ-2 is adequate for this purpose with good acceptability. However, neither the PHQ-2 nor the PHQ-9 can be used to confirm a clinical diagnosis (case finding). DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
- Alex J Mitchell
- , MD, Department of Cancer Studies, University of Leicester, and Department of Psycho-Oncology, Leicestershire Partnership NHS Trust, Leicester, UK
| | | | - John Gill
- , MBChB, Medical School, University of Leicester, Leicester, UK
| | - Brendon Stubbs
- , PhD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Physiotherapy Department, South London and Maudsley NHS Foundation Trust, UK
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Diagnostic accuracy of the Patient Health Questionnaire-9 for assessment of depression in type II diabetes mellitus and/or coronary heart disease in primary care. J Affect Disord 2016; 190:68-74. [PMID: 26480213 DOI: 10.1016/j.jad.2015.09.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/20/2015] [Accepted: 09/25/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Depression is common among type 2 diabetes mellitus (DM2)/coronary heart disease (CHD) patients and is associated with adverse health effects. A promising strategy to reduce burden of disease is to identify patients at risk for depression in order to offer indicated prevention. This study aims to assess the diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) to be used as a tool to identify high risk patients. METHODS In this cross-sectional study, 586 consecutive DM2/CHD patients aged >18 were recruited through 23 general practices. PHQ-9 outcomes were compared to the Mini International Neuropsychiatric Interview (MINI), which was considered the reference standard. Diagnostic accuracy was evaluated for minor and major depression, comparing both sum- and algorithm based PHQ-9 scores. RESULTS For minor depression, the optimal cut-off score was 8 (sensitivity 71%, specificity 71% and an AUC of 0.74). For major depression, the optimal cut-off score was 10 resulting in a sensitivity of 84%, a specificity of 82%, and an AUC of 0.88. The positive predictive value of the PHQ-9 algorithm for diagnosing minor and major depression was 25% and 33%, respectively. LIMITATIONS Two main limitations apply. MINI Interviewers were not blinded for PHQ-9 scores and less than 10% of all invited patients could be included in the analyses. This could have resulted in biased outcomes. CONCLUSIONS The PHQ-9 sum score performs well in identifying patients at high risk of minor and major depression. However, the PHQ-9 showed suboptimal results for diagnostic purposes. Therefore, it is recommended to combine the use of the PHQ-9 with further diagnostics to identify depression.
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Moriarty AS, Gilbody S, McMillan D, Manea L. Screening and case finding for major depressive disorder using the Patient Health Questionnaire (PHQ-9): a meta-analysis. Gen Hosp Psychiatry 2015. [PMID: 26195347 DOI: 10.1016/j.genhosppsych.2015.06.012] [Citation(s) in RCA: 196] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The Patient Health Questionnaire (PHQ-9) is a widely used screening tool for major depressive disorder (MDD), although there is debate surrounding its diagnostic properties. For the PHQ-9, we aimed to: 1. Establish the diagnostic performance at the standard cutoff point (10). 2. Compare the diagnostic performance at the standard cutoff point in different clinical settings. 3. Assess whether there is selective reporting of cutoff points other than 10. METHODS We searched three databases - Embase, MEDLINE and PSYCHInfo - and performed a reverse citation search in Web of Science. We selected for inclusion studies of any design that assessed the PHQ-9 in adult populations against recognized gold-standard instruments for the diagnosis of either Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases criteria for major depression. Included studies had to report sufficient information to calculate 2*2 contingency tables. Data extraction and synthesis were performed independently by two researchers. For the included studies, we calculated pooled sensitivity, pooled specificity, positive likelihood, negative likelihood ratio and diagnostic odds ratio for cutoff points 7 to 15. RESULTS Thirty-six studies (21,292 patients) met inclusion criteria. Pooled sensitivity for cutoff point 10 was 0.78 [95% confidence interval (CI), 0.70-0.84], and pooled specificity was 0.87 (95% CI, 0.84-0.90). At this cutoff, the PHQ-9 is a better screener in primary care than secondary care settings. No conclusions could be drawn at cutoff points other than 10 due to selective reporting of data. CONCLUSIONS For MDD, the PHQ-9 has acceptable diagnostic properties at cutoff point 10 in different settings. We recommend that future studies report the full range of cutoff points to allow exploration of optimal cutoff points in different settings.
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Affiliation(s)
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, U.K. YO10 5DD
| | - Dean McMillan
- Department of Health Sciences, University of York, York, U.K. YO10 5DD
| | - Laura Manea
- Department of Health Sciences, University of York, York, U.K. YO10 5DD.
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van der Krieke L, Emerencia AC, Bos EH, Rosmalen JG, Riese H, Aiello M, Sytema S, de Jonge P. Ecological Momentary Assessments and Automated Time Series Analysis to Promote Tailored Health Care: A Proof-of-Principle Study. JMIR Res Protoc 2015; 4:e100. [PMID: 26254160 PMCID: PMC4705023 DOI: 10.2196/resprot.4000] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 06/16/2015] [Accepted: 06/24/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Health promotion can be tailored by combining ecological momentary assessments (EMA) with time series analysis. This combined method allows for studying the temporal order of dynamic relationships among variables, which may provide concrete indications for intervention. However, application of this method in health care practice is hampered because analyses are conducted manually and advanced statistical expertise is required. OBJECTIVE This study aims to show how this limitation can be overcome by introducing automated vector autoregressive modeling (VAR) of EMA data and to evaluate its feasibility through comparisons with results of previously published manual analyses. METHODS We developed a Web-based open source application, called AutoVAR, which automates time series analyses of EMA data and provides output that is intended to be interpretable by nonexperts. The statistical technique we used was VAR. AutoVAR tests and evaluates all possible VAR models within a given combinatorial search space and summarizes their results, thereby replacing the researcher's tasks of conducting the analysis, making an informed selection of models, and choosing the best model. We compared the output of AutoVAR to the output of a previously published manual analysis (n=4). RESULTS An illustrative example consisting of 4 analyses was provided. Compared to the manual output, the AutoVAR output presents similar model characteristics and statistical results in terms of the Akaike information criterion, the Bayesian information criterion, and the test statistic of the Granger causality test. CONCLUSIONS Results suggest that automated analysis and interpretation of times series is feasible. Compared to a manual procedure, the automated procedure is more robust and can save days of time. These findings may pave the way for using time series analysis for health promotion on a larger scale. AutoVAR was evaluated using the results of a previously conducted manual analysis. Analysis of additional datasets is needed in order to validate and refine the application for general use.
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Affiliation(s)
- Lian van der Krieke
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, Netherlands.
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