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Shen Y, Yuan S, Liu J, Sun B, Chen Z, Zheng L, Chen L, Chen H, Feng H, He H. The reliability, validity and screening effect of the happiness index scale among inpatients in a general hospital. BMC Psychiatry 2022; 22:601. [PMID: 36085028 PMCID: PMC9463772 DOI: 10.1186/s12888-022-04219-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/24/2022] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND The Happiness Index Scale (HIS) is a newly developed scale by our group to screen for common psychological illnesses among general hospital inpatients. This study aimed to analyze the reliability, validity and screening effect of the HIS and to explore its clinical application. METHODS From April 1, 2021, to December 31, 2021, a total of 8405 continuous inpatients were enrolled from different departments of a large tertiary general hospital with 1385 inpatient beds in Guangzhou, Guangdong Province, China. Using a cross-sectional survey design, each participant was assessed with the Patient Health Questionnaire 9(PHQ-9), Generalized Anxiety Disorder 7 items(GAD-7), Athens Insomnia Scale (AIS), Columbia Suicide Severity Rating Scale (C-SSRS) and HIS within 24 h of admission. McDonald's ω coefficient, the Guttman split-half coefficient and the test-retest reliability coefficient were used to evaluate the reliability of the HIS and the construct validity and criterion validity of the validity tests. Scores on the PHQ-9, GAD-7, AIS, and C-SSRS were used as the gold standard tools to analyze the screening effect of the HIS. RESULTS The HIS exhibited very good reliability, with a McDonald's ω coefficient of 0.825, a Guttman split-half coefficient of 0.920 and a test-retest reliability coefficient of 0.745 (P < 0.05). Confirmatory factor analysis showed a satisfactory model fitting index with a χ2/df = 2.602, a root mean squared error of approximation (RMSEA) of 0.014, a standardized root mean square residual (SRMR) of 0.010, a comparative fit index (CFI) of 0.992, and a Tucker-Lewis index (TLI) of 0.983. The correlation coefficient between the total score of each dimension of the scale and the corresponding criterion was 0.854 ~ 0.949 (P < 0.001). The HIS showed a very good distinguishing effect. The average HIS score of inpatients who screened positive for psychological problems was significantly higher than that of inpatients who screened negative for psychological problems (t = 3790.619, P < 0.001). The effect size was very large (Cohens d = 2.695, 95% CI = 2.630 ~ 2.761). Approximately 90.2% of the positive and negative screening results of the HIS were matched with the gold standard tools, with a kappa value of 0.747 (P < 0.001). The screening effect test showed a sensitivity (true positive rate) of 92.9% and a specificity (true negative rate) of 89.5%. CONCLUSION The HIS exhibited satisfactory reliability and validity and a clinically meaningful screening effect with a much shorter version compared to the commonly used screening scales. Thus, it could potentially be useful as the first screening step to rule out psychological conditions for inpatients in general hospitals or to remind medical teams of further psychological concerns.
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Affiliation(s)
- Yizhong Shen
- grid.410737.60000 0000 8653 1072The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China ,The Third People’s Hospital of Zhuhai, Zhuhai, China
| | - Shuai Yuan
- grid.410737.60000 0000 8653 1072The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jingwen Liu
- grid.410737.60000 0000 8653 1072The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bin Sun
- grid.410737.60000 0000 8653 1072The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zilin Chen
- grid.410737.60000 0000 8653 1072The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lijiao Zheng
- The Third People’s Hospital of Zhuhai, Zhuhai, China
| | - Lihao Chen
- The Third People’s Hospital of Zhuhai, Zhuhai, China
| | - Hanwei Chen
- The Third People’s Hospital of Zhuhai, Zhuhai, China
| | - Huiqiang Feng
- grid.459864.20000 0004 6005 705XGuangzhou Panyu Central Hospital, Guangzhou, China
| | - Hongbo He
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
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2
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Ottenhoff JSE, Ring D, Molen ABMVD, Coert JH, Teunis T. Surgeons Attitude toward Psychosocial Aspects of Trapeziometacarpal Osteoarthritis. J Hand Microsurg 2022; 14:315-321. [DOI: 10.1055/s-0042-1748879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Background There is notable evidence that unhelpful thoughts (symptoms of anxiety and depression) increase symptom intensity among patients with trapeziometacarpal osteoarthritis (TMC OA). Surgeons may or may not be mindful of this line of evidence when interacting with patients. In a survey-based experiment, we randomized surgeons to be prompted about the psychosocial aspects of TMC OA. We aimed to measure the influence of mindfulness of mental health on treatment recommendations and willingness to discuss mental health interventions.
Methods We randomized 121 hand surgeons to read one of two paragraphs: (A) about biomedical treatment options for TMC OA, or (B) about the impact of mental and social aspects on TMC OA. Thereafter, surgeons were asked several questions about their opinions and treatment recommendations.
Results We found that prompting surgeons with information about the psychosocial aspects of TMC OA did not influence their attitudes or treatment recommendations. Most surgeons were willing to offer patients a workbook (92%) or psychologist referral (84%). Among the few surgeons declining to refer, their reasoning was “it would not be of any help” and “stigmatization.”
Conclusion The observation that a paragraph to encourage mindfulness about the psychosocial aspects of TMC OA, which had no influence on surgeon opinions, suggests that awareness may not be a major factor accounting the relatively limited implementation of this evidence in practice to date. Surgeons seem aware of the importance of psychological influence and barriers may include availability, stigma, and a sense of futility. This is a diagnostic study that reflects level of evidence III.
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Affiliation(s)
- Janna S. E. Ottenhoff
- Plastic, Reconstructive, and Hand Surgery Department, University Medical Center Utrecht, Utrecht, the Netherlands
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, United States
| | - Aebele B. Mink van der Molen
- Plastic, Reconstructive, and Hand Surgery Department, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J. Henk Coert
- Plastic, Reconstructive, and Hand Surgery Department, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Teun Teunis
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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3
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Zhang GQ, Canner JK, Prince EJ, Stem M, Taylor JP, Efron JE, Atallah C, Safar B. History of depression is associated with worsened postoperative outcomes following colectomy. Colorectal Dis 2021; 23:2559-2566. [PMID: 34166552 DOI: 10.1111/codi.15790] [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: 02/03/2021] [Revised: 04/21/2021] [Accepted: 06/10/2021] [Indexed: 02/08/2023]
Abstract
AIM Depression is a prevalent disorder that is associated with adverse health outcomes, but an understanding of its effect in colorectal surgery remains limited. The purpose of this study was to examine the impact of history of depression among patients undergoing colectomy. METHOD United States patients from Marketscan (2010-2017) who underwent colectomy were included and stratified by whether they had a history of depression within the past year, defined as (1) a diagnosis of depression during the index admission, (2) a diagnosis of depression during any inpatient or (3) outpatient admission within the year, and/or (4) a pharmacy claim for an antidepressant within the year. The primary outcomes were length of stay (LOS) and inpatient hospital charge. Secondary outcomes included in-hospital mortality and postoperative complications. Logistic, negative binomial, and quantile regressions were performed. RESULTS Among 88 981 patients, 21 878 (24.6%) had a history of depression. Compared to those without, patients with a history of depression had significantly longer LOS (IRR = 1.06, 95% CI [1.05, 1.07]), increased inpatient charge (β = 467, 95% CI [167, 767]), and increased odds of in-hospital mortality (OR = 1.37, 95% CI [1.08, 1.73]) after adjustment. History of depression was also independently associated with increased odds of respiratory complication, pneumonia, and delirium (all P < 0.05). CONCLUSION History of depression was prevalent among individuals undergoing colectomy, and associated with greater mortality and inpatient charge, longer LOS, and higher odds of postoperative complication. These findings highlight the impact of depression in colorectal surgery patients and suggest that proper identification and treatment may reduce postoperative morbidity.
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Affiliation(s)
- George Q Zhang
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph K Canner
- Department of Surgery, Johns Hopkins Surgery Center for Outcomes Research, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Elizabeth J Prince
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Miloslawa Stem
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James P Taylor
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan E Efron
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chady Atallah
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bashar Safar
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Rogers JP, Watson CJ, Badenoch J, Cross B, Butler M, Song J, Hafeez D, Morrin H, Rengasamy ER, Thomas L, Ralovska S, Smakowski A, Sundaram RD, Hunt CK, Lim MF, Aniwattanapong D, Singh V, Hussain Z, Chakraborty S, Burchill E, Jansen K, Holling H, Walton D, Pollak TA, Ellul M, Koychev I, Solomon T, Michael BD, Nicholson TR, Rooney AG. Neurology and neuropsychiatry of COVID-19: a systematic review and meta-analysis of the early literature reveals frequent CNS manifestations and key emerging narratives. J Neurol Neurosurg Psychiatry 2021; 92:932-941. [PMID: 34083395 DOI: 10.1136/jnnp-2021-326405] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/12/2021] [Indexed: 12/18/2022]
Abstract
There is accumulating evidence of the neurological and neuropsychiatric features of infection with SARS-CoV-2. In this systematic review and meta-analysis, we aimed to describe the characteristics of the early literature and estimate point prevalences for neurological and neuropsychiatric manifestations.We searched MEDLINE, Embase, PsycINFO and CINAHL up to 18 July 2020 for randomised controlled trials, cohort studies, case-control studies, cross-sectional studies and case series. Studies reporting prevalences of neurological or neuropsychiatric symptoms were synthesised into meta-analyses to estimate pooled prevalence.13 292 records were screened by at least two authors to identify 215 included studies, of which there were 37 cohort studies, 15 case-control studies, 80 cross-sectional studies and 83 case series from 30 countries. 147 studies were included in the meta-analysis. The symptoms with the highest prevalence were anosmia (43.1% (95% CI 35.2% to 51.3%), n=15 975, 63 studies), weakness (40.0% (95% CI 27.9% to 53.5%), n=221, 3 studies), fatigue (37.8% (95% CI 31.6% to 44.4%), n=21 101, 67 studies), dysgeusia (37.2% (95% CI 29.8% to 45.3%), n=13 686, 52 studies), myalgia (25.1% (95% CI 19.8% to 31.3%), n=66 268, 76 studies), depression (23.0% (95% CI 11.8% to 40.2%), n=43 128, 10 studies), headache (20.7% (95% CI 16.1% to 26.1%), n=64 613, 84 studies), anxiety (15.9% (5.6% to 37.7%), n=42 566, 9 studies) and altered mental status (8.2% (95% CI 4.4% to 14.8%), n=49 326, 19 studies). Heterogeneity for most clinical manifestations was high.Neurological and neuropsychiatric symptoms of COVID-19 in the pandemic's early phase are varied and common. The neurological and psychiatric academic communities should develop systems to facilitate high-quality methodologies, including more rapid examination of the longitudinal course of neuropsychiatric complications of newly emerging diseases and their relationship to neuroimaging and inflammatory biomarkers.
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Affiliation(s)
- Jonathan P Rogers
- Division of Psychiatry, University College London, London, UK .,South London and Maudsley NHS Foundation Trust, London, UK
| | - Cameron J Watson
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - James Badenoch
- Medical School, University of Birmingham, Birmingham, UK
| | | | - Matthew Butler
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jia Song
- East London NHS Foundation Trust, London, UK
| | - Danish Hafeez
- School of Medical Sciences, The University of Manchester, Manchester, UK
| | | | | | - Lucretia Thomas
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Silviya Ralovska
- Department of Neurology, Psychiatry, Physiotherapy and Rehabilitation, Preventive Medicine, and Public Health, Sofia University St Kliment Ohridski, Sofia, Bulgaria
| | | | | | | | - Mao Fong Lim
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Daruj Aniwattanapong
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Zain Hussain
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Stuti Chakraborty
- Department of Physical Medicine and Rehabilitation, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Ella Burchill
- Faculty of Medicine and Life Sciences, King's College London, London, UK
| | - Katrin Jansen
- Department of Psychology, University of Münster, Münster, Germany
| | - Heinz Holling
- Department of Psychology, University of Münster, Münster, Germany
| | - Dean Walton
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Thomas A Pollak
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark Ellul
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK.,National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infection, University of Liverpool, Liverpool, UK.,Institute of Infection, Veterinary, and Zoological Science, University of Liverpool, Liverpool, UK
| | - Ivan Koychev
- Department of Psychiatry, University of Oxford, Oxford, UK.,Department of Psychological Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tom Solomon
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK.,National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infection, University of Liverpool, Liverpool, UK
| | - Benedict Daniel Michael
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK.,National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infection, University of Liverpool, Liverpool, UK.,Institute of Infection, Veterinary, and Zoological Science, University of Liverpool, Liverpool, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alasdair G Rooney
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
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5
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Kang Y, Wang H, Li X, Tao Y, Yang X, Deng W, Yu J, Zhou Q, Li T, Guo W. A brief web-based screening plus emotional-disorder health education was associated with improvement of mental health awareness and service-seeking attitudes among patients seeking nonpsychiatric clinical services in China. Depress Anxiety 2021; 38:571-587. [PMID: 33225571 DOI: 10.1002/da.23118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 10/02/2020] [Accepted: 11/01/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Low recognition and intervention rates of emotional disorders among nonpsychiatric clinical patients are primarily attributable to poor mental health awareness of patients and a paucity of mental health care resources. This study aims to investigate the association of a resource-saving brief web-based emotional-disorder self-screening plus a health self-education program (BWBED-SS + HSE) with improved mental health awareness and service-seeking attitudes among nonpsychiatric clinical patients. METHOD A sample of 2065 patients seeking health services in nonpsychiatric clinical settings underwent BWBED-SS + HSE using mobile terminals. Participants were defined as being at high risk of anxiety and/or depression according to the optimal cut-off point of ≥11 on the Huaxi emotional-distress index (HEI). RESULTS The rate of participants at high risk of anxiety and/or depression was 6.63%. Following participation in the BWBED-SS + HSE, after controlling for demographics, type of hospital, and test time, the rates of participants considering themselves as having an emotional disorder and willing to seek mental health services among those at high risk of anxiety and/or depression increased from 29.93% to 47.45% (adjusted odds ratio [aOR] = 2.28, p = .002) and from 11.68% to 29.93% (aOR = 3.65, p < .001), respectively. CONCLUSIONS The BWBED-SS + HSE were associated with improved mental health awareness and service-seeking attitudes among patients seeking nonpsychiatric clinical services in China.
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Affiliation(s)
- Yukun Kang
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Huiyao Wang
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Xiaojing Li
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Yujie Tao
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Xia Yang
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Wei Deng
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Jianying Yu
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Qian Zhou
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Tao Li
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Wanjun Guo
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
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6
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Beeler PE, Cheetham M, Held U, Battegay E. Depression is independently associated with increased length of stay and readmissions in multimorbid inpatients. Eur J Intern Med 2020; 73:59-66. [PMID: 31791574 DOI: 10.1016/j.ejim.2019.11.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Little is known about the impact of depression across a broad range of multimorbid patients hospitalized for reasons other than depression. The objective of the study was to investigate in a large sample of multimorbid inpatients whether ancillary depression is associated with increased length of stay (LOS) and readmissions, two important clinical outcomes with implications for healthcare utilization and costs. METHODS We retrospectively analyzed a cohort of 253,009 multimorbid inpatients aged ≥18 at an academic medical center, 8/2009-8/2017. PRIMARY OUTCOME LOS. SECONDARY OUTCOMES LOS related to different main diagnoses, readmissions within 1, 3, 6, 12, and 24-months after discharge. RESULTS Multivariable linear regression showed 24% longer LOS in patients with ancillary depression (1.24; 95% confidence interval [CI]: 1.22, 1.25). Females stayed 22% longer (1.22; 95% CI: 1.20, 1.25), males 24% (1.24; 95% CI: 1.22, 1.27). We identified 16 main diagnosis clusters in which ancillary depression was associated with significant LOS increases, with associations being strongest for "Failure and rejection of transplanted organs and tissues", "Other noninfective gastroenteritis and colitis", and "Other soft tissue disorders, not elsewhere classified". Multivariable logistic and Poisson regression showed independent associations of ancillary depression with increased readmission odds and frequencies at 1, 3, 6, 12, and 24 months. CONCLUSIONS Ancillary depression was independently associated with increased LOS and more readmissions across a broad range of multimorbid inpatients.
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Affiliation(s)
- P E Beeler
- Department of Internal Medicine, University Hospital Zurich & University of Zurich, Zurich, Switzerland; University Research Priority Program "Dynamics of Healthy Aging", University Zurich, Zurich, Switzerland; Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland.
| | - M Cheetham
- Department of Internal Medicine, University Hospital Zurich & University of Zurich, Zurich, Switzerland; University Research Priority Program "Dynamics of Healthy Aging", University Zurich, Zurich, Switzerland.
| | - U Held
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland.
| | - E Battegay
- Department of Internal Medicine, University Hospital Zurich & University of Zurich, Zurich, Switzerland; University Research Priority Program "Dynamics of Healthy Aging", University Zurich, Zurich, Switzerland; Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland.
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7
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Walker J, Burke K, Wanat M, Fisher R, Fielding J, Mulick A, Puntis S, Sharpe J, Esposti MD, Harriss E, Frost C, Sharpe M. The prevalence of depression in general hospital inpatients: a systematic review and meta-analysis of interview-based studies. Psychol Med 2018; 48:2285-2298. [PMID: 29576041 DOI: 10.1017/s0033291718000624] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Comorbid depression in the medically ill is clinically important. Admission to a general hospital offers an opportunity to identify and initiate treatment for depression. However, we first need to know how common depression is in general hospital inpatients. We aimed to address this question by systematically reviewing the relevant literature. METHODS We reviewed published prevalence studies in any language which had used diagnostic interviews of general hospital inpatients and met basic methodological quality criteria. We focussed on interview-based studies in order to estimate the proportion of patients with a diagnosis of depressive illness. RESULTS Of 158 relevant articles, 65 (41%) describing 60 separate studies met our inclusion criteria. The 31 studies that focussed on general medical and surgical inpatients reported prevalence estimates ranging from 5% to 34%. There was substantial, highly statistically significant, heterogeneity between studies which was not materially explained by the covariates we were able to consider. The average of the reported prevalences was 12% (95% CI 10-15), with a 95% prediction interval of 4-32%. The remaining 29 studies, of a variety of specific clinical populations, are described. CONCLUSIONS The available evidence suggests a likely prevalence high enough to make it worthwhile screening hospital inpatients for depression and initiating treatment where appropriate. Further, higher quality, research is needed to clarify the prevalence of depression in specific settings and to further explore the reasons for the observed heterogeneity in estimates.
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Affiliation(s)
- Jane Walker
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Katy Burke
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Marta Wanat
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Rebecca Fisher
- Department of Primary Care Health Sciences,University of Oxford, Oxford, UK
| | - Josephine Fielding
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Amy Mulick
- Department of Medical Statistics,London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen Puntis
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Joseph Sharpe
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Michelle Degli Esposti
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford,Oxford,UK
| | - Chris Frost
- Department of Medical Statistics,London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Sharpe
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
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8
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Zhou Q, Li N. The impact of major physical diseases and its outcomes on depressive symptoms among Chinese population. J Ment Health 2017; 28:148-152. [PMID: 29256317 DOI: 10.1080/09638237.2017.1417561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Depression was common among people with physical diseases. Evidence was lacked on the impact of outcomes of physical diseases on mental health. AIM Using a national representative data of the China Health and Retirement Longitudinal Study, we aimed to explore the impact of major physical diseases and its outcomes on mental health among Chinese population. METHODS Using a multi-stage cluster sampling design, the CHARLS survey collected information of 19 549 subjects in the 2013/2014 follow-up survey. Depressive symptoms were measured by the 10-item version of the Center for Epidemiological Studies Depression (CES-D). RESULTS The prevalence rate of depressive symptoms in the study population was 21.2%. Major physical diseases were significantly associated with depressive symptoms. Compared to people who did not experience major physical diseases, participants who fully recovered after hospitalization were at similar level of developing depressive symptoms (OR = 1.16), participants who experienced major physical diseases but were not admitted to hospitals were more likely to develop depressive symptoms (OR = 2.14), and those who discharged from hospitals without recovery were also more likely to have depressive symptoms (OR = 2.24). CONCLUSIONS Screening for depression among hospitalized population and training among general practitioners were necessary. During hospitalization, collaborative care for both physical and mental health could be beneficial.
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Affiliation(s)
- Qin Zhou
- a School of Public Administration , University of International Business and Economics , Beijing , China and
| | - Ning Li
- b Institute of Population Research, Peking University , Beijing , China
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9
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Wang J, Guo WJ, Zhang L, Deng W, Wang HY, Yu JY, Luo SX, Huang MJ, Dong ZQ, Li DJ, Song JP, Jiang Y, Cheng NS, Liu XH, Li T. The development and validation of Huaxi emotional-distress index (HEI): A Chinese questionnaire for screening depression and anxiety in non-psychiatric clinical settings. Compr Psychiatry 2017; 76:87-97. [PMID: 28445837 DOI: 10.1016/j.comppsych.2017.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 03/16/2017] [Accepted: 04/03/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Depression and anxiety among general hospital patients are common and under-recognized in China. This study aimed toward developing a short questionnaire for screening depression and anxiety in non-psychiatric clinical settings, and to test its reliability and validity. METHODS The item pool which included 35 questions about emotional distress was drafted through a comprehensive literature review. An expert panel review and the first clinical test with 288 general hospital patients were conducted for the primary item selection. The second clinical test was performed to select the final item in 637 non-psychiatric patients. The reliability and validity of the final questionnaire were tested in 763 non-psychiatric patients, in which 211 subjects were interviewed by psychiatrists using Mini International Neuropsychiatric Interview (MINI). Multiple data analysis methods including principal components analysis (PCA), item response theory (IRT), and receiver operating characteristic (ROC) curve were used to select items and validate the final questionnaire. RESULTS The series selection of items resulted in a 9-item questionnaire, namely Huaxi Emotional-distress Index (HEI). The Cronbach's α coefficient of HEI was 0.90. The PCA results showed a unidimensional construct. The area under the ROC curve (AUC) was 0.88 when compared with MINI interview. Using the optimal cut-off score of HEI (≥11), the sensitivity and specificity were 0.880 and 0.766, respectively. CONCLUSIONS The HEI is considered as a reliable and valid instrument for screening depression and anxiety, which may have substantial clinical value to detect patients' emotional disturbances especially in the busy non-psychiatric clinical settings in China.
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Affiliation(s)
- Jian Wang
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China; Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China; Shenzhen Key Laboratory for Psychological Healthcare, Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Wan-Jun Guo
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China; Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China.
| | - Lan Zhang
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China; Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Wei Deng
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China; Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Hui-Yao Wang
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Jian-Ying Yu
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Shan-Xia Luo
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Ming-Jin Huang
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China; Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Zai-Quan Dong
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Da-Jiang Li
- Department of Medical Administration, West China Hospital of Sichuan University, Chengdu, China
| | - Jin-Ping Song
- Nursing Department, West China Hospital of Sichuan University, Chengdu, China
| | - Yu Jiang
- Department of Medical Oncology, Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Nan-Sheng Cheng
- Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Xie-He Liu
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Tao Li
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China; Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China.
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Singh I, Fernando P, Griffin J, Edwards C, Williamson K, Chance P. Clinical outcome and predictors of adverse events of an enhanced older adult psychiatric liaison service: Rapid Assessment Interface and Discharge (Newport). Clin Interv Aging 2016; 12:29-36. [PMID: 28053514 PMCID: PMC5192058 DOI: 10.2147/cia.s104278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Hospitals are currently admitting an increasing number of older people, and more than one-third could have an underlying mental health problem. The existing Older Adult Mental Health (OAMH) liaison service was increasingly unable to meet the escalating needs of older and frail patients. Therefore, the service was modernized and enhanced on an “invest-to-save” principle to provide a prompt holistic assessment for older adults with mental health problems. The objective of this study was a service evaluation to appraise clinical outcome, minimize the length of stay, and measure the predictors of adverse outcomes to streamline this enhanced service. Materials and methods Patient demographics, social care needs, comorbidity burden (Charlson comorbidity index, CCI), and functional status (Barthel index, BI) were recorded from November 2014 to February 2015. Frailty status (frailty index, FI) was measured by an index (Rockwood index) of accumulated deficits. The outcomes were compared with the previous OAMH liaison service data over the same period a year earlier. Results The new Rapid Assessment Interface and Discharge service assessed 339 patients compared to 179 by the previous liaison team over the 4-month period. Mean age was 82.18±8.04 years, with 60% women; preadmission BI was 14.96±4.35, and admission BI was 11.38±5.73 (P<0.001, paired t-test); mean CCI was 1.66±1.53, and mean FI was 0.34±0.99, and 80% were on polypharmacy. The direct discharges from front door were increased by 7%. The mean hospital stay reduced from 35 to 20 days in acute site and from 108 to 47 days in long-stay wards. The cost benefits were based on the mean reduction in hospital stay (41.8 days) and admission reduction (2.2 days), leading to a total annualized bed savings of 44 days. FI was the most highly significant factor between patient groups with a good and poor outcome (P=0.00003, independent groups t-test, t=−4.38, df 98). Conclusion Prompt mental health assessments for acutely unwell frail older people are not only cost effective but also improve clinical outcomes.
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Affiliation(s)
- Inderpal Singh
- Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board
| | - Priya Fernando
- Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board
| | - Jane Griffin
- Royal Gwent Hospital, Aneurin Bevan University Board
| | - Chris Edwards
- Royal Gwent Hospital, Aneurin Bevan University Board
| | - Kathryn Williamson
- Department of Old Age Psychiatry, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Wales, UK
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Chen KY, Evans R, Larkins S. Why are hospital doctors not referring to Consultation-Liaison Psychiatry? - a systemic review. BMC Psychiatry 2016; 16:390. [PMID: 27829386 PMCID: PMC5103418 DOI: 10.1186/s12888-016-1100-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/28/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Consultation-Liaison Psychiatry (CLP) is a subspecialty of psychiatry that provides care to inpatients under non-psychiatric care. Despite evidence of benefits of CLP for inpatients with psychiatric comorbidities, referral rates from hospital doctors remain low. This review aims to understand barriers to CLP inpatient referral as described in the literature. METHODS We searched on Medline, PsychINFO, CINAHL and SCOPUS, using MESH and the following keywords: 1) Consultation-Liaison Psychiatry, Consultation Liaison Psychiatry, Consultation Psychiatry, Liaison Psychiatry, Hospital Psychiatry, Psychosomatic Medicine, the 2) Referral, Consultation, Consultancy and 3) Inpatient, Hospitalized patient, Hospitalized patient. We considered papers published between 1 Jan 1965 and 30 Sep 2015 and all articles written in English that contribute to understanding of barriers to CLP referral were included. RESULTS Thirty-five eligible articles were found and they were grouped thematically into three categories: (1) Systemic factors; (2) Referrer factors; (3) Patient factors. Systemic factors that improves referrals include a dedicated CLP service, active CLP consultant and collaborative screening of patients. Referrer factors that increases referrals include doctors of internal medicine specialty and comfortable with CLP. Patients more likely to be referred tend to be young, has psychiatric history, live in an urban setting or has functional psychosis. CONCLUSION This is the first systematic review that examines factors that influence CLP inpatient referrals. Although there is research in this area, it is of limited quality. Education could be provided to hospital doctors to better recognise mental illness. Collaborative screening of vulnerable groups could prevent inpatients from missing out on psychiatric care. CLP clinicians should use the knowledge gained in this review to provide quality engagement with referrers.
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Affiliation(s)
- Kai Yang Chen
- James Cook University, 1 James Cook Drive, Townsville, QLD 4811, Australia. .,Townsville Hospital and Health Service, 100 Angus Smith Drive, Townsville, QLD 4814, Australia.
| | - Rebecca Evans
- James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
| | - Sarah Larkins
- James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
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Topitz A, Benda N, Saumer G, Friedrich F, König D, Soulier N, Freidl M. [Prevalence and recognition of depression among inpatients of non-psychiatric hospital departments]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2015; 29:63-70. [PMID: 25868683 DOI: 10.1007/s40211-015-0145-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 03/17/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE The purpose of this study is to compare the prevalence of depression among different types of hospital departments. Furthermore, it compares different methods for assessment of its recognition by non-psychiatric physicians. METHODS 993 inpatients of internal, surgical, gynecological and physical rehabilitation wards of community hospitals were interviewed by research psychiatrists using the Clinical Interview Schedule. Ward physicians were asked to fill in a short questionnaire in order to assess whether they could correctly identify patients with mental illnesses. In addition, routine discharge diagnoses were assessed. RESULTS Of the total sample, 13.3 % suffered from depression. Depression was most frequent on physical rehabilitation units (24.2 %), followed by surgical (9.8 %) and internal (9.5 %) wards. On gynecological wards, prevalence of depression was lowest (8.7 %). Of those suffering from depression, 45.7 % were identified as mentally ill by non-psychiatric ward physicians when using questionnaire data. Only 21.0 % of the depressed received a psychiatric discharge diagnosis, which equals less than half of those identified by questionnaire. RESULTS Of the total sample, 13.3 % of patients suffered from depression. Depression was most frequent in physical rehabilitation units (24.2 %), followed by surgical (9.8 %) and internal (9.5 %) wards. In gynecological wards, the prevalence of depression was the lowest (8.7 %). Of those suffering from depression, 45.7 % were identified as mentally ill by non-psychiatric ward physicians when using questionnaire data. Only 21.0 % of the depressed received a psychiatric discharge diagnosis, less than half of those identified by the questionnaire. CONCLUSIONS Depression is very common among inpatients of physical hospital departments. Unfortunately, depression is frequently overlooked in everyday clinical work. Routine discharge diagnoses give only very limited information about how often ward physicians recognize mental disorders. Furthermore, hospital discharge diagnoses should not be used for planning mental health services.
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Affiliation(s)
- Andrea Topitz
- Klinische Abteilung für Sozialpsychiatrie, Univ.-Klinik für Psychiatrie und Psychotherapie Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich,
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13
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Watrowski R, Rohde A. Validation of the Polish version of the Hospital Anxiety and Depression Scale in three populations of gynecologic patients. Arch Med Sci 2014; 10:517-24. [PMID: 25097583 PMCID: PMC4107242 DOI: 10.5114/aoms.2013.36520] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/23/2013] [Accepted: 04/19/2013] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION We analyzed the psychometric properties of the Polish version of the Hospital Anxiety and Depression Scale (HADS) in gynecologic patients. MATERIAL AND METHODS A total of 252 patients, consisting of three subgroups - endocrinologic gynecology (n = 67), high-risk pregnancy (n = 124), and outpatient gynecologic clinic (n = 61) - responded to the HADS, the 12-item Well-being Questionnaire (W-BQ12), the Spielberger State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory-II (BDI-II), and the Hamilton Depression Scale (HAMD). Socio-demographic data were obtained by self-report and interviews. RESULTS The HADS presented good internal consistency with Cronbach's α at 0.84 and 0.78 for depression and anxiety subscales, respectively, and 0.88 for the whole questionnaire. The principal component analysis with Eigenvalues > 1 revealed a three-factor structure. Factors 1 ("depression"), and 2 ("anxiety"), as well as the separate Factor 3, explained 23.48%, 21.42%, and 12.07% of the variance, respectively. The items with shared loadings were A1, A3, and A6. The HADS scores correlated strongly with other depression and well-being scales, but not with STAI-X1/X2. CONCLUSIONS The Polish HADS revealed a three-factor structure, and 3/7 HADS-A items showed ambiguous factor loadings. All other psychometric properties were satisfactory. The HADS seems to be suitable for use in gynecologic patients, preferentially as an indicator for global psychological distress.
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Affiliation(s)
- Rafał Watrowski
- Department of Gynecology and Obstetrics, St. Josefskrankenhaus, Freiburg, Germany
| | - Anke Rohde
- Department of Gynecologic Psychosomatics, Women’s University Hospital Bonn, Germany
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Moayedoddin B, Rubovszky G, Mammana L, Jeannot E, Sartori M, Garin N, Andreoli A, Canuto A, Perrier A. Prevalence and clinical characteristics of the DSM IV major depression among general internal medicine patients. Eur J Intern Med 2013; 24:763-6. [PMID: 23816277 DOI: 10.1016/j.ejim.2013.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 05/26/2013] [Accepted: 05/27/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence and clinical characteristics of the DSM IV major depressive disorder (MDD) among patients admitted to the General Internal Medicine Service of the Geneva University Hospital. METHOD 557 patients admitted to the IM of the Geneva University Hospital aged 18 to 70 were investigated. Each subject was assessed by a clinical psychologist using the SCID (Structured Clinical Interview Depression for DSM-IV) questionnaire. RESULTS 69 patients (12.4%) met diagnostic criteria for MDD (men: 8.8%, women: 16.9%, p=.004). Among subjects with major depression, depressed mood (97%), fatigue (91%), and diminished interest and pleasure (81%) were the most prevalent symptoms. Recurrent thoughts of death were present in 48% of depressed patients. CONCLUSIONS This study raises further evidence that an elevated proportion of patients admitted to an acute care general internal medicine facility meet DSM IV criteria for MDD with nearly half of depressed patients suffering from recurrent thoughts of death. It emphasizes the necessity of a targeted, continuous, and active support given by the psychiatry liaison service in the internal medicine setting.
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Affiliation(s)
- Babak Moayedoddin
- Liaison Psychiatry and Crisis Intervention Service, Department of Psychiatry, University Hospitals of Geneva (HUG), Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Switzerland.
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Su JA, Tsai CS, Hung TH, Chou SY. Change in accuracy of recognizing psychiatric disorders by non-psychiatric physicians: five-year data from a psychiatric consultation-liaison service. Psychiatry Clin Neurosci 2011; 65:618-23. [PMID: 22176280 DOI: 10.1111/j.1440-1819.2011.02272.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIM Psychiatric disorders are easily underestimated and under-recognized by physicians. The aim of the present study was to investigate the change in accuracy of recognizing psychiatric symptoms. METHODS Consecutive 5-year consultation-liaison data were collected and patients with one of the five common psychiatric diagnoses, including depressive disorders, substance use disorders, delirium, anxiety disorders and psychotic disorders, were chosen for analysis. The primary care physician's initial impression of a psychiatric diagnosis was recorded based on their reason for referral on the referral sheets. Accurate recognition was defined as matching of the physician's initial impression with the psychiatrist's final diagnosis. Mentioning the core symptoms of psychiatric diagnostic criteria or common synonyms would be considered as correct recognition. RESULTS The overall accuracy of recognition was 41.5% and there was no significant change during this 5-year period. Substance use disorders were the one diagnosis with the highest agreement, followed by delirium, depressive disorders, anxiety disorders, and psychotic disorders. As for the factors associated with accurate recognition, male patients or those with multiple physical illnesses were more likely to have their psychiatric symptoms recognized correctly. CONCLUSIONS Without comprehensive postgraduate psychiatric education, the accuracy of recognizing psychiatric symptoms does not improve year by year. Education should focus on common psychiatric problems among medical inpatients, especially those easily misdiagnosed, such as depression and delirium.
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Affiliation(s)
- Jian-An Su
- Department of Psychiatry, Chang Gung Memorial Hospital at Chiayi, Taiwan
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Abstract
This study aimed to describe the demographic and clinical characteristics of consecutive referrals to a liaison psychiatry outpatient clinic, based within a National Health Service (NHS) general hospital. All outpatient referrals to the service between January 2005 and January 2008 were subjected to retrospective completion of a proforma for post hoc data collection. Data relating to characteristics of the referral, patients, diagnosis, and nature and extent of contact were extracted for scrutiny. The majority (60.2%) of referrals to the service came from physicians based within the general hospital. Where conveyed, depression (26.7%) was the most commonly cited reason for referral. Diagnoses of both mood (affective) disorders (32.9%) and neurotic, stress-related and somatoform disorders (54.7%) were common. Cognitive behaviour therapy (56.1%) was the most commonly used intervention followed by pharmacological therapy (25.4%). In conclusion, the study provides a description of the nature of the work encountered in a liaison psychiatry setting and demonstrates the extent of services provided for medical specialties within the general hospital.
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Affiliation(s)
- J Sharp
- Glasgow Liaison Psychiatry Service, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, UK.
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Wang T, Chen YL, Lu YR. A survey of depression patients with physical symptoms as the first symptom attending gastroenterology outpatient clinic of a general hospital: an analysis of 5 754 cases. Shijie Huaren Xiaohua Zazhi 2010; 18:851-853. [DOI: 10.11569/wcjd.v18.i8.851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To make a survey of depression patients with physical symptoms as the first symptoms attending gastroenterology outpatient clinic of a general hospital and to analyze the reasons for misdiagnosis of the disease.
METHODS: A total of 5 754 depression patients with somatic symptoms as the first symptom were surveyed with a self-rating mental health scale (SCL-90) and Chinese Classification and Diagnostic Criteria for Mental Disorders, 3rd edition (CCMD-3).
RESULTS: Only a small part of the patients (5.3%) visited psychological department, while most of the patients visited other clinical departments, of which only a small number of patients (7.2%) were identified by non-psychological physicians.
CONCLUSION: Only very few depression patients with physical symptoms as the first symptom can be identified and given appropriate treatment in gastroenterology outpatient clinics of general hospitals.
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Rettew DC, Lynch AD, Achenbach TM, Dumenci L, Ivanova MY. Meta-analyses of agreement between diagnoses made from clinical evaluations and standardized diagnostic interviews. Int J Methods Psychiatr Res 2009; 18:169-84. [PMID: 19701924 PMCID: PMC6878243 DOI: 10.1002/mpr.289] [Citation(s) in RCA: 167] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 06/13/2008] [Accepted: 12/15/2008] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED Standardized diagnostic interviews (SDIs) have become de facto gold standards for clinical research. However, because clinical practitioners seldom use SDIs, it is essential to determine how well SDIs agree with clinical diagnoses. In meta-analyses of 38 articles published from 1995 to 2006 (N = 15,967 probands), mean kappas (z-transformed) between diagnoses from clinical evaluations versus SDIs were 0.27 for a broad category of all disorders, 0.29 for externalizing disorders, and 0.28 for internalizing disorders. Kappas for specific disorders ranged from 0.19 for generalized anxiety disorder to 0.86 for anorexia nervosa (median = 0.48). For diagnostic clusters (e.g. psychotic disorders), kappas ranged from 0.14 for affective disorders (including bipolar) to 0.70 for eating disorders (median = 0.43). Kappas were significantly higher for outpatients than inpatients and for children than adults. However, these effects were not significant in meta-regressions. CONCLUSIONS Diagnostic agreement between SDIs and clinical evaluations varied widely by disorder and was low to moderate for most disorders. Thus, findings from SDIs may not fully apply to diagnoses based on clinical evaluations of the sort used in the published studies. Rather than implying that SDIs or clinical evaluations are inferior, characteristics of both may limit agreement and generalizability from SDI findings to clinical practice.
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Affiliation(s)
- David C Rettew
- Department of Psychiatry, University of Vermont College of Medicine, Burlington, VT 05401, USA.
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Su JA, Chang CJ, Chou SY. What is the "mask" of depressed inpatients from the viewpoint of surgeons and internal medicine physicians? Int J Psychiatry Clin Pract 2009; 13:223-8. [PMID: 24916824 DOI: 10.1080/13651500902815228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective. Depressed inpatients are easily misrecognized by general hospital physicians. Therefore, our study aimed to examine the following issues: (1) how primary care doctors recognize depressed inpatients; (2) if there are any differences between internal medicine physicians and surgeons with regard to this recognition; (3) the factors associated with the accurate recognition of depression. Methods. Four hundred and twenty-five consecutive patients from internal medical or surgical wards who had been diagnosed with depression were enrolled in this study. The reasons for referral were recorded from the referral sheet. Accurate recognition of depression was defined as depressive disorder or depressed core symptoms, which were the reasons for referral. Results. The rate of correct recognition of depression was the same for both physicians and surgeons. Depressed inpatients from the internal medicine wards were referred more commonly for suicide problems and unexplained physical symptoms, while a greater number of depressed patients from the surgical wards were referred for insomnia, agitation/irritability, cognitive impairment, and past psychiatric history. Multiple physical comorbidities, depression treatment history, and depression of a higher severity were independent factors associated with accurate recognition. Conclusions. Postgraduate education is still needed with regarded to understanding depression. The educational content should be specific to the different specialties and the patient characteristics in different wards.
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Affiliation(s)
- Jian-An Su
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
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Rifel J, Švab I, Šter MP, Pavlič DR, King M, Nazareth I. Impact of demographic factors on recognition of persons with depression and anxiety in primary care in Slovenia. BMC Psychiatry 2008; 8:96. [PMID: 19108731 PMCID: PMC2639378 DOI: 10.1186/1471-244x-8-96] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 12/24/2008] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Research has repeatedly shown that family physicians fail to diagnose up to 70% of patients with common mental disorders. Objective of the study is to investigate associations between persons' gender, age and educational level and detection of depression and anxiety by their family physicians. METHODS We compared the results of two independent observational studies that were performed at the same time on a representative sample of family medicine practice attendees in Slovenia. 10710 patients participated in Slovenian Cross-sectional survey and 1118 patients participated in a first round of a cohort study (PREDICT-D study). Logistic regression was used to examine the effects of age, gender and educational level on detection of depression and anxiety. RESULTS The prevalence of major depression and Other Anxiety Syndrome (OAS) amongst family practice attendees was low. The prevalence of Panic Syndrome (PS) was comparable to rates reported in the literature. A statistical model with merged data from both studies showed that it was over 15 times more likely for patients with ICD-10 criteria depression to be detected in PREDICT-D study as in SCS survey. In PREDICT-D study it was more likely for people with higher education to be diagnosed with ICD-10 criteria depression than in SCS survey. CONCLUSION People with higher levels of education should probably be interviewed in a more standardized way to be recognised as having depression by Slovenian family physicians. This finding requires further validation.
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Affiliation(s)
- Janez Rifel
- Department of family medicine, Medical faculty, University in Ljubljana, Slovenia.
| | - Igor Švab
- Department of family medicine, Medical faculty, University in Ljubljana, Slovenia
| | - Marija Petek Šter
- Department of family medicine, Medical faculty, University in Ljubljana, Slovenia
| | - Danica Rotar Pavlič
- Department of family medicine, Medical faculty, University in Ljubljana, Slovenia
| | - Michael King
- Department of Mental Health Sciences, Royal Free and University College Medical School, University College London, Hampstead Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Irwin Nazareth
- General Practice Research Framework, University College London, Rowland Hill Street, London NW3 2PF, UK
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Cepoiu M, McCusker J, Cole MG, Sewitch M, Belzile E, Ciampi A. Recognition of depression by non-psychiatric physicians--a systematic literature review and meta-analysis. J Gen Intern Med 2008; 23:25-36. [PMID: 17968628 PMCID: PMC2173927 DOI: 10.1007/s11606-007-0428-5] [Citation(s) in RCA: 256] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 09/29/2007] [Accepted: 10/04/2007] [Indexed: 01/04/2023]
Abstract
BACKGROUND Depression, with up to 11.9% prevalence in the general population, is a common disorder strongly associated with increased morbidity. The accuracy of non-psychiatric physicians in recognizing depression may influence the outcome of the illness, as unrecognized patients are not offered treatment for depression. OBJECTIVES To describe and quantitatively summarize the existing data on recognition of depression by non-psychiatric physicians. METHODS We searched the following databases: MEDLINE (1966-2005), Psych INFO (1967-2005) and CINAHL (1982-2005). To summarize data presented in the papers reviewed, we calculated the Summary receiver operating characteristic (ROC) and the summary sensitivity, specificity and odds ratios (ORs) of recognition, and their 95% confidence intervals using the random effects model. MEASUREMENTS AND MAIN RESULTS The summary sensitivity, specificity, and OR of recognition using the random effects model were: 36.4% (95% CI: 27.9-44.8), 83.7% (95% CI: 77.5-90.0), and 4.0 (95% CI: 3.2-4.9), respectively. We also calculated the Summary ROC. We performed a metaregression analysis, which showed that the method of documentation of recognition, the age of the sample, and the date of study publication have significant effect on the summary sensitivity and the odds of recognition, in the univariate model. Only the method of documentation had a significant effect on summary sensitivity, when the age of the sample and the date of publication were added to the model. CONCLUSION The accuracy of depression recognition by non-psychiatrist physicians is low. Further research should focus on developing standardized methods of documenting non-psychiatric physicians' recognition of depression.
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Affiliation(s)
- Monica Cepoiu
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, Montreal, QC, Canada.
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McCusker J, Cole M, Ciampi A, Latimer E, Windholz S, Belzile E. Major depression in older medical inpatients predicts poor physical and mental health status over 12 months. Gen Hosp Psychiatry 2007; 29:340-8. [PMID: 17591511 DOI: 10.1016/j.genhosppsych.2007.03.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Revised: 03/21/2007] [Accepted: 03/22/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the 12-month effects upon physical and mental health status of a diagnosis of major or minor depression among older medical inpatients. METHODS Patients 65 years and older, admitted to the medical wards of two university-affiliated hospitals, with at most mild cognitive impairment, were screened for major and minor depression (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria). All depressed patients and a random sample of nondepressed patients were invited to participate. The physical functioning and mental health subscales of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were measured at baseline and at 3, 6 and 12 months. RESULTS Two hundred ten patients completed the SF-36 at baseline and at one or more follow-ups. In multiple linear regression analysis for longitudinal data, adjusting for baseline level of the SF-36 subscale outcome, severity of physical illness, premorbid disability, age, sex and other covariates, patients with major depression at baseline had lower SF-36 scores at follow-up, in comparison to patients with no depression [physical health, 9.22 (95% CI -15.52 to -2.93); mental health, 6.28 (95% CI -11.76 to -0.79)]. CONCLUSION A diagnosis of major depression in cognitively intact older medical inpatients is associated with sustained poor physical and mental health status over the following 12 months.
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Affiliation(s)
- Jane McCusker
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, Montreal (Quebec), Canada H3T 1M5.
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McCusker J, Cole M, Ciampi A, Latimer E, Windholz S, Elie M, Belzile E. Twelve-month course of depressive symptoms in older medical inpatients. Int J Geriatr Psychiatry 2007; 22:411-7. [PMID: 17096457 DOI: 10.1002/gps.1689] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The study aimed: (1) to describe the 12-month course of depressive symptoms among medical inpatients aged 65+, and (2) to investigate predictors of a more severe course that could be identified easily by non-psychiatric staff. METHODS Patients were recruited at two Montreal hospitals. Inclusion criteria were: aged 65+, admitted to medical service, at most mild cognitive impairment. Patients were screened for major and minor depression (DSM-IV criteria). All depressed patients and a random sample of non-depressed patients were invited to participate in the prospective study. The Hamilton Depression Scale (HAMD) was administered at admission, 3, 6, and 12 months. Individual patient trajectories of depressive symptoms over time were grouped using hierarchical clustering into three patient groups with a minimal, mild, and moderate/severe course of symptoms, respectively. The baseline predictors of a more severe clinical course were identified using ordinal logistic regression. RESULTS Two hundred and thirty-two patients completed baseline and one or more follow-up interviews. Baseline patient characteristics that independently predicted a more severe symptom course included higher initial HAMD score, depressive core symptoms lasting 6 months or more, and female sex. CONCLUSION The 12-month course of depression symptoms in this medically ill older sample was generally stable. Patients who will experience a more severe course can be identified by non-psychiatric staff at admission to hospital.
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Affiliation(s)
- Jane McCusker
- Department of Clinical Epidemiology and Community Studies, St Mary's Hospital, and Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
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Abstract
BACKGROUND Studies of recognition of depression in older (aged 65 or more) medical inpatients show low rates of recognition of depression by attending physicians. However, few studies have compared different measures of recognition of depression. OBJECTIVES (1) To compare the validity of four indicators of recognition of depression and a global measure of recognition against a diagnosis of depression and (2) to explore the effect of patient characteristics on recognition of depression. METHODS In a cohort of 264 medical inpatients 65 years and older (115 with major or minor depression, 78 with no depression), sensitivities, specificities, and diagnostic odds ratios (DOR) of 4 indicators of recognition (symptoms, diagnosis, treatment, and referral) and a global measure of recognition (any of the 4 indicators) were calculated. The associations between patient characteristics (age, sex, history of depression, antidepressant use before admission, severity of depression, comorbidity, duration of hospitalization, disability, and hospital of admission) and recognition were explored using multiple logistic regression. RESULTS Less than half of the depressed patients were recognized. The indicator with the highest sensitivity was treatment (27.8%, 95% confidence interval [CI] 20.0-37.0), whereas the indicator with the best specificity was diagnosis (96.6%, 95% CI 91.9-98.7). The unadjusted DOR of global recognition was 2.6 (95% CI 1.5, 4.4). Less comorbidity, more severe depression symptoms, a history of depression, longer hospital stay, and antidepressant use before admission were significantly associated with better global recognition. CONCLUSION Recognition of depression in elderly medical inpatients depends upon the indicator of recognition used.
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Affiliation(s)
- Monica Cepoiu
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, Montreal, QC, Canada.
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Carballeira Y, Dumont P, Borgacci S, Rentsch D, de Tonnac N, Archinard M, Andreoli A. Criterion validity of the French version of Patient Health Questionnaire (PHQ) in a hospital department of internal medicine. Psychol Psychother 2007; 80:69-77. [PMID: 17346381 DOI: 10.1348/147608306x103641] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Depressive disorders are overrepresented among the patients admitted to non-psychiatric units in general hospitals. However, the majority of depressed patients fail to be identified within this care setting. Since a self-administered questionnaire (Patient Health Questionnaire, PHQ-9) has given encouraging results in English and Spanish, new research should test its criterion validity in a French-speaking environment. DESIGN The study included 292 patients admitted to the internal medicine units of the University Hospitals of Geneva. Each patient filled the PHQ-9; 212 patients also underwent a blinded DSM-IV diagnostic assessment by a psychiatrist. METHODS In order to assess the validity of PHQ-9 against the gold standard of the psychiatrist's DSM-IV diagnosis, we calculated overall accuracy, sensitivity, specificity, positive predictive value and Cohen kappa coefficients. We also studied the relationship between the PHQ-9 diagnostic and the severity of depression. Finally, analysis focused on the presence of a diagnosis of depression. RESULTS Within the framework of the study, PHQ-9 showed an acceptable level of specificity. However, its sensitivity in detecting major depression was low (about 50% of false-negative results). As regards the overall presence of depressive disorders, this instrument performed hardly any better (35% of false negatives). Other characteristics of the population under investigation may have affected the data. CONCLUSIONS The French version of PHQ-9 demonstrated low sensitivity as compared with psychiatrist-established diagnosis of DSM-IV A criterion and major depressive episode.
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Rentsch D, Dumont P, Borgacci S, Carballeira Y, deTonnac N, Archinard M, Andreoli A. Prevalence and treatment of depression in a hospital department of internal medicine. Gen Hosp Psychiatry 2007; 29:25-31. [PMID: 17189741 DOI: 10.1016/j.genhosppsych.2006.08.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 08/25/2006] [Accepted: 08/25/2006] [Indexed: 12/11/2022]
Abstract
BACKGROUND Depressive disorders are overrepresented among patients admitted to nonpsychiatric units of general hospitals, but the majority of depressed patients are not identified in this setting. Effective and well-tolerated treatments and reliable diagnostic criteria, together with new assessment tools (self-administered or not), have been developed with encouraging results. Nevertheless, few studies have utilized standardized instruments and extensive clinical interviews by well-trained psychiatrists to assess depression. New research should test these tools in a French-speaking environment. METHODS The investigation covered 292 patients aged 18-65 who were admitted over a period of 6 months to the internal medicine units of Geneva University Hospitals. Each patient filled in a self-administered questionnaire for depression [Patient Health Questionnaire (PHQ-9)]; 212 patients were also evaluated by a psychiatrist using DSM-IV diagnostic assessment and the Hamilton Depression Rating Scale during the first week of their hospital stay; both assessments were single-blinded. RESULTS Psychiatric clinical interviews identified a high proportion (26.9%) of depressive disorders (37% among women) for all diagnoses; 11.3% (17.3% among women) of the patients met the DSM-IV criteria for major depression. The PHQ-9 identified depressive disorders among 34.9% of patients (42% among women) and identified a major depressive syndrome among 18.4% of patients (29.6% among women). Physicians in the internal medicine unit identified only about half the depressive patients; at the time of psychiatric examination, fewer than one in four patients was receiving antidepressant therapy. CONCLUSIONS Our findings confirm the results of previous investigations, which showed that the failure to detect and treat depression is a major health problem among patients admitted to nonpsychiatric units of a general hospital.
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Affiliation(s)
- Denis Rentsch
- Service d'accueil, d'urgences et de liaison psychiatriques, Unité de psychiatrie de liaison, University Hospitals of Geneva, 1211 Geneva, Switzerland.
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Weinert C, Meller W. Epidemiology of depression and antidepressant therapy after acute respiratory failure. PSYCHOSOMATICS 2006; 47:399-407. [PMID: 16959928 DOI: 10.1176/appi.psy.47.5.399] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors enrolled 277 subjects with acute respiratory failure to describe the epidemiology of depressive disorders and antidepressant use during and after intensive care. By SCID criteria, the prevalence of major depressive episode at 2 months was 16%, and 16% had depressive disorder not otherwise specified. Mood disorder incidence was 25% or 28%, depending on methodology. Pre-ICU physical functioning and depression were associated with 2- and 6-month depression severity. At 2 months, the prevalence of antidepressant medication use was 49%, and the incidence was 28%. Depression and antidepressant pharmacotherapy are frequent during recovery from acute respiratory failure.
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Affiliation(s)
- Craig Weinert
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
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Michaud L, Voellinger R, Burnand B, Stiefel F. Major depressive disorders in the general hospital: how to implement guidelines. J Psychosom Res 2006; 60:455-9. [PMID: 16650585 DOI: 10.1016/j.jpsychores.2005.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2005] [Revised: 09/08/2005] [Accepted: 10/05/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVE An implementation study that evaluated the impact of previously adopted guidelines on the clinical practice of medical residents was conducted to improve the recognition and treatment of major depressive disorders (MDDs) in hospitalized patients with somatic diseases. METHODS Guidelines were implemented in two wards (ENT and oncology) using intranet diffusion, interactive sessions with medical residents, and support material. Discharge letters of 337 and 325 patients, before and after the intervention, respectively, were checked for statement of diagnosis or treatment of MDDs and, in a post hoc analysis, for any mention about psychiatric management. RESULTS No difference was found in the number of diagnosed or treated MDDs before and after the intervention. However, significantly more statements about psychological status (29/309 vs. 13/327) and its management (36/309 vs. 19/327) were observed after the intervention (P<.01). CONCLUSION The intervention was not successful in improving the management of MDDs. However, a possible effect on general psychological aspects of medical diseases was observed.
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Affiliation(s)
- Laurent Michaud
- Clinical Epidemiology Center, Institute of Social and Preventive Medicine, University Hospital, Lausanne, Switzerland
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Gerson S, Mistry R, Bastani R, Blow F, Gould R, Llorente M, Maxwell A, Moye J, Olsen E, Rohrbaugh R, Rosansky J, Van Stone W, Jarvik L. Symptoms of depression and anxiety (MHI) following acute medical/surgical hospitalization and post-discharge psychiatric diagnoses (DSM) in 839 geriatric US veterans. Int J Geriatr Psychiatry 2004; 19:1155-67. [PMID: 15526306 DOI: 10.1002/gps.1217] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE We addressed the relatively unexplored use of screening scores measuring symptoms of depression and/or anxiety to aid in identifying patients at increased risk for post-discharge DSM-IV Axis I diagnoses. We were unable to find such studies in the literature. METHOD Elderly veterans without recent psychiatric diagnoses were screened for depression and anxiety symptoms upon admission to acute medical/surgical units using the Mental Health Inventory (MHI). Following discharge, those who had exceeded cut-off scores and had been randomized to UPBEAT Care (Unified Psychogeriatric Biopsychosocial Evaluation and Treatment, a clinical demonstration project) were evaluated for DSM diagnoses. We report on 839 patients, mostly male (96.3%; mean age 69.6 +/- 6.7 years), comparing three groups, i.e. those meeting screening criteria for symptoms of (i) depression only; (ii) anxiety only; and (iii) both depression and anxiety. RESULTS Despite absence of recent psychiatric history, 58.6% of the 839 patients received a DSM diagnosis post-discharge (21.8% adjustment; 15.4% anxiety; 7.5% mood; and 14.0% other disorders). Patients meeting screening criteria for both depression and anxiety symptoms received a DSM diagnosis more frequently than those meeting criteria for anxiety symptoms only (61.9% vs 49.0%, p = 0.017), but did not differ significantly from those meeting criteria for depressive symptoms only (61.9% vs 56.8%, p = 0.174). Although exceeding the MHI screening cut-off scores for depression, anxiety, or both helped to identify patients with a post-discharge DSM diagnosis, the actual MHI screening scores failed to do so. CONCLUSION Screening hospitalized medical/surgical patients for symptoms of depression, anxiety, and particularly for the combination thereof, may help identify those with increased risk of subsequent DSM diagnoses, including adjustment disorder.
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Affiliation(s)
- Sylvia Gerson
- UCLA Department of Psychiatry and Biobehavioral Sciences and Neuropsychiatric Institute and Hospital, Los Angeles, California, USA
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Doerfler LA, Paraskos JA. Anxiety, Posttraumatic Stress Disorder, and Depression in Patients With Coronary Heart Disease. ACTA ACUST UNITED AC 2004; 24:414-21. [PMID: 15632777 DOI: 10.1097/00008483-200411000-00009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Leonard A Doerfler
- University of Massachusetts Medical School, Worcester, Massachusetts, USA.
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Baumert J, Simon H, Gündel H, Schmitt C, Ladwig KH. The Impact of Event Scale--Revised: evaluation of the subscales and correlations to psychophysiological startle response patterns in survivors of a life-threatening cardiac event: an analysis of 129 patients with an implanted cardioverter defibrillator. J Affect Disord 2004; 82:29-41. [PMID: 15465574 DOI: 10.1016/j.jad.2003.09.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2003] [Revised: 09/17/2003] [Accepted: 09/22/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND The aim of the present study was to examine the reliability and validity of the Impact of Event Scale-Revised (IES-R) with special emphasis on the evaluation of the hyperarousal subscale against a standardized psychophysiological measurement. METHODS A total of 129 survivors of a life-threatening cardiac event underwent a psychodiagnostic evaluation and a psychophysiological acoustic startle reflex (ASR) paradigm. The ASR assessed the magnitude and habituation of electromyogram (EMG) and skin conductance responses (SCR) in response to the delivery of 15 acoustic startle trials. Pearson correlation and factor analysis was used to measure reliability and construct validity. The hyperarousal subscale was validated against the ASR in terms of sensitivity and specificity mainly using receiver operating characteristic (ROC) curve analysis. RESULTS A high reliability was found for the intrusion and avoidance subscale (alpha>0.8); however, the hyperarousal subscale showed a weaker reliability (alpha=0.66). No avoidance item, one intrusion item but four hyperarousal items revealed higher correlations to another than its assigned subscale. The hyperarousal subscale was not able to discriminate sufficiently between patients with and without exaggerated startle reactions as indicated by ROC curves running near the diagonal line. LIMITATIONS The scores in all three subscales are lower compared to subjects traumatized by non-cardiac events. CONCLUSIONS Reliability and construct validity for the intrusion and avoidance subscale proved to be high but was only sufficient for the hyperarousal subscale. Moreover, the criterion validity of the hyperarousal subscale regarding psychophysiological measurements is arguable and indicates further investigations in this area.
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Affiliation(s)
- Jens Baumert
- Institut und Poliklinik für Psychosomatische Medizin, Psychotherapie und Med. Psychologie Universitätsklinikum rechts der Isar der Technischen Universität München, Munich, Germany
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Oslin DW, Thompson R, Kallan MJ, TenHave T, Blow FC, Bastani R, Gould RL, Maxwell AE, Rosansky J, Van Stone W, Jarvik L. Treatment effects from UPBEAT: a randomized trial of care management for behavioral health problems in hospitalized elderly patients. J Geriatr Psychiatry Neurol 2004; 17:99-106. [PMID: 15157351 DOI: 10.1177/0891988703262539] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to examine the impact of the Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT) Program, an interdisciplinary mental health care management program, on the behavioral health symptoms of elderly veterans. Participants, 60 years and older, included 2637 veterans recruited from medical/surgical units who screened positively for significant depressive or anxiety symptoms and/or at-risk alcohol drinking. Participants were randomized to UPBEAT or to usual care. Primary outcomes were measured at baseline and at 6, 12, and 24 months. Participant nonadherence to the protocol was common and is a major limitation. There were no differences between UPBEAT and usual care patients on symptom or functional outcomes at any follow-up point. Exploratory analyses suggested that among participants with more physical health problems, there were greater improvements in depressive symptoms in those assigned to UPBEAT care. Despite a theoretical and practically sound intervention, participation was low and treatment outcomes, while generally good, appeared unaffected by the addition of the program.
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Affiliation(s)
- David W Oslin
- Section of Geriatric Psychiatry, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Room 3002, Philadelphia, PA 19104, USA.
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Holmes J, Bentley K, Cameron I. A UK survey of psychiatric services for older people in general hospitals. Int J Geriatr Psychiatry 2003; 18:716-21. [PMID: 12891640 DOI: 10.1002/gps.911] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psychiatric illness is common in older people in general hospitals, but little is known of the service models operating in the UK, or of the views of old age psychiatrists regarding service provision in this area. We set out to determine the range of UK old age psychiatry service models for older people in general hospital wards, and the opinions of clinicians on future service priorities and development. METHOD A postal questionnaire survey of old age psychiatrists providing psychiatric services to older people in general hospital wards. RESULTS 73% of services were provided through a generic, sector-based, consultation psychiatry model. The remaining 27% employed a range of general hospital-based liaison psychiatry services for older people, involved in proactively seeking referrals and educating general hospital staff. Those providing a generic sector-based model were significantly slower at responding to referrals. 89% of respondents were unhappy with their service to older people in general hospital wards, with only 11% preferring the generic sector-based model. Organisational barriers to change identified included the management of mental health care and physical care by different organisations. Training, both of psychiatric staff in this specialist area, and of general hospital staff in the detection and basic management of common psychiatric conditions in the general hospital setting, was felt to be necessary. CONCLUSIONS The management of co-morbid psychiatric and physical illness in older people is an important issue for health services. Old age psychiatrists are unhappy with the prevalent, reactive, consultation-based model, preferring a range of liaison psychiatry models based in the general hospital. The most important barriers to service development in this area were the separate managerial arrangements for psychiatric and physical care services, and a lack of evidence for effective old age psychiatry services in this setting.
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Affiliation(s)
- John Holmes
- University of Leeds School of Medicine, Academic Unit of Psychiatry and Behavioural Sciences, Leeds, UK.
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Voellinger R, Berney A, Baumann P, Annoni JM, Bryois C, Buclin T, Büla C, Camus V, Christin L, Cornuz J, de Goumoëns P, Lamy O, Strnad J, Burnand B, Stiefel F. Major depressive disorder in the general hospital: adaptation of clinical practice guidelines. Gen Hosp Psychiatry 2003; 25:185-93. [PMID: 12748031 DOI: 10.1016/s0163-8343(03)00009-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Major Depressive Disorder is particularly frequent among physically ill inpatients. Despite the considerable human burden and financial costs, Major Depressive Disorder remains under-detected and under-treated. To improve this situation, clinical practice guidelines for the management of Major Depressive Disorder were developed for patients in the general hospital. They were adapted from existing good quality guidelines. A literature search has been conducted to identify guidelines and systematic reviews about the management of Major Depressive Disorder. The quality of the existing guidelines was evaluated by means of the AGREE instrument (Appraisal of Guidelines for Research and Evaluation). Complementary literature searches were necessary to answer questions such as "depression and physical illness" or "antidepressants and somatic medication". The guidelines were discussed by a multidisciplinary internal panel. The final version was reviewed by an external panel. This paper presents the development process and a summary of these guidelines for the management of Major Depressive Disorder. The adaptation of good quality guidelines to local needs requires much time, effort and skills. Easier ways for the adaptation and use of high quality guidelines at the local level may result from better coordination, organization and updating of guidelines at a national or supranational level.
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Affiliation(s)
- Rachel Voellinger
- Clinical Epidemiology Center (CepiC), University Hospital, Lausanne, Switzerland
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