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Gunzler DD, Dolata J, Figueroa M, Kauffman K, Pencak J, Sajatovic M, Sehgal AR. Using latent variables to improve the management of depression among hemodialysis patients. Ren Fail 2024; 46:2350767. [PMID: 39091090 PMCID: PMC11299459 DOI: 10.1080/0886022x.2024.2350767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Screening for depression can be challenging among hemodialysis patients due to the overlap of depressive symptoms with dialysis or kidney disease related symptoms. The aim of this study was to understand these overlapping symptoms and develop a depression screening tool for better clinical assessment of depressive symptoms in dialysis patients. METHODS We surveyed 1,085 dialysis patients between March 1, 2018 and February 28, 2023 at 15 dialysis facilities in Northeast Ohio with the 9-item patient health questionnaire (PHQ-9) and kidney disease quality of life (KDQOL) instrument. To evaluate overlap across questionnaire items, we used structural equation modeling (SEM). We predicted and transformed factor scores to create a hemodialysis-adjusted PHQ-9 (hdPHQ-9). In exploratory analysis (N = 173), we evaluated the performance of the hdPHQ-9 relative to the PHQ-9 that also received a Mini-International Neuropsychiatric Interview. RESULTS Our study sample included a high percentage of Black patients (74.6%) and 157 (14.5%) survey participants screened positive for depression (PHQ-9 ≥ 10). The magnitude of overlap was small for (respectively, PHQ-9 item with KDQOLTM item) fatigue with washed out, guilt with burden on family, appetite with nausea and movement with lightheaded. The hdPHQ-9 showed reasonably high sensitivity (0.81 with 95% confidence interval [CI] 0.58, 0.95) and specificity (0.84 with 95% CI 0.77, 0.89); however, this was not a significant improvement from the PHQ-9. CONCLUSION There is little overlap between depressive symptoms and dialysis or kidney disease symptoms. The PHQ-9 was found to be an appropriate depression screening instrument for dialysis patients.
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Affiliation(s)
- Douglas D. Gunzler
- Center for Health Care Research and Policy, Population Health and Equity Research Institute, The MetroHealth System, Cleveland, OH, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Jacqueline Dolata
- Center for Health Care Research and Policy, Population Health and Equity Research Institute, The MetroHealth System, Cleveland, OH, USA
| | - Maria Figueroa
- Center for Health Equity, Engagement, Education and Research, Population Health and Equity Research Institute, The MetroHealth System, Cleveland, OH, USA
| | - Kelley Kauffman
- Center for Health Equity, Engagement, Education and Research, Population Health and Equity Research Institute, The MetroHealth System, Cleveland, OH, USA
| | - Julie Pencak
- Center for Health Equity, Engagement, Education and Research, Population Health and Equity Research Institute, The MetroHealth System, Cleveland, OH, USA
| | - Martha Sajatovic
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Ashwini R. Sehgal
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Center for Health Equity, Engagement, Education and Research, Population Health and Equity Research Institute, The MetroHealth System, Cleveland, OH, USA
- Institute for Health Opportunity, Partnership, and Empowerment, The MetroHealth System, Cleveland, OH, USA
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Scherder RJ, van Dorp M, Prins A, van Klaveren C, Cornelisz I, Killestein J, Weinstein HC. Rest-Activity Rhythm, Pain, and Motor Activity in Multiple Sclerosis. Int J MS Care 2023; 25:157-162. [PMID: 37469337 PMCID: PMC10353695 DOI: 10.7224/1537-2073.2021-030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND Although the relationships among physical disability, mood disorders, and pain are well described in multiple sclerosis (MS), little is known about whether those symptoms are associated with sleep disturbances. METHODS Forty-six patients with MS experiencing pain participated. Sleep was indirectly measured by assessing rest-activity rhythm via actigraphy: interdaily stability, intradaily variability, and relative amplitude. Pain was assessed using visual and verbal analog scales, mood by the Beck Depression Inventory and Symptom Checklist-90, and physical disability by the Expanded Disability Status Scale. RESULTS Incorporating mood, pain, and physical disability into 1 regression model resulted in a significant association with interdaily stability. CONCLUSIONS Compared with intradaily variability and relative amplitude, interdaily stability seems to be the most vulnerable actigraphy variable for mood disturbances, pain, and physical disabilities.
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Affiliation(s)
- Rogier J. Scherder
- From the Department of Clinical Neuropsychology, Free University, Amsterdam, the Netherlands (RJS, CvK, IC)
| | - M.J. van Dorp
- Tante Louise, Bergen op Zoom, the Netherlands (MJvD)
| | - A.J. Prins
- Atlant, Kuiltjesweg, Beekbergen, the Netherlands (AJP)
| | - C. van Klaveren
- From the Department of Clinical Neuropsychology, Free University, Amsterdam, the Netherlands (RJS, CvK, IC)
| | - I. Cornelisz
- From the Department of Clinical Neuropsychology, Free University, Amsterdam, the Netherlands (RJS, CvK, IC)
| | - J. Killestein
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, the Netherlands (JK)
| | - Henry C. Weinstein
- Department of Neurology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (HW)
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A short-term exercise program in patients with multiple sclerosis: is body mass index important? Int J Rehabil Res 2021; 44:138-143. [PMID: 33724971 DOI: 10.1097/mrr.0000000000000462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Obesity is a health problem that can exacerbate the symptoms of multiple sclerosis (MS). In the current study, we aimed to investigate the effectiveness of a short-term exercise program on fatigue, depression, anxiety, and walking performance in normal-weight and overweight patients with MS (PwMS). Sixty-two PwMS were divided into groups according to their BMI (BMI normal/BMI high). Also, they were all included in the exercise program. The participants took a moderate-intensity walking program 5 days a week for 4 weeks, including 30 min between 5 min of warm-up and 5 min of cooling periods. Also, patients underwent breathing, posture, flexibility, and stretching exercises for 4 weeks. Fatigue, depression, anxiety, 6-minute walking test (6MWT), and BMI were measured before and after the 4 weeks. After the exercise program, there were statistically significant improvements in fatigue, depression, anxiety, and the 6MWT. However, no relation could be detected between the examined variables and BMI. All patients participated effectively in the exercise program, regardless of BMI. The results obtained from this study support that a short-term exercise program is an effective therapeutic intervention, unrelated to BMI, in improving fatigue, depression, anxiety, and walking performance in PwMS.
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Rodgers S, Calabrese P, Ajdacic-Gross V, Steinemann N, Kaufmann M, Salmen A, Manjaly ZM, Kesselring J, Kamm CP, Kuhle J, Chan A, Gobbi C, Zecca C, Müller S, von Wyl V. Major depressive disorder subtypes and depression symptoms in multiple sclerosis: What is different compared to the general population? J Psychosom Res 2021; 144:110402. [PMID: 33631437 DOI: 10.1016/j.jpsychores.2021.110402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/04/2021] [Accepted: 02/13/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To compare and characterize major depressive disorder (MDD) subtypes (i.e., pure atypical, pure melancholic and mixed atypical-melancholic) and depression symptoms in persons with multiple sclerosis (PwMS) with persons without MS (Pw/oMS) fulfilling the DSM-5 criteria for a past 12-month MDD. METHODS MDD in PwMS (n = 92) from the Swiss Multiple Sclerosis Registry was compared with Pw/oMS (n = 277) from a Swiss community-based study. Epidemiological MDD diagnoses were based on the Mini-SPIKE (shortened form of the Structured Psychopathological Interview and Rating of the Social Consequences for Epidemiology). Logistic and multinomial regression analyses (adjusted for sex, age, civil status, depression and severity) were computed for comparisons and characterization. Latent class analysis (LCA) was conducted to empirically identify depression subtypes in PwMS. RESULTS PwMS had a higher risk for the mixed atypical-melancholic MDD subtype (OR = 2.22, 95% CI = 1.03-4.80) compared to Pw/oMS. MDD in PwMS was specifically characterized by a higher risk of the two somatic atypical depression symptoms 'weight gain' (OR = 6.91, 95% CI = 2.20-21.70) and 'leaden paralysis' (OR = 3.03, 95% CI = 1.35-6.82) and the symptom 'irritable/angry' (OR = 3.18, 95% CI = 1.08-9.39). CONCLUSIONS MDD in PwMS was characterized by a higher risk for specific somatic atypical depression symptoms and the mixed atypical-melancholic MDD subtype. The pure atypical MDD subtype, however, did not differentiate between PwMS and Pw/oMS. Given the high phenomenological overlap with MS symptoms, the mixed atypical-melancholic MDD subtype represents a particular diagnostic challenge.
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Affiliation(s)
- Stephanie Rodgers
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zurich, Switzerland.
| | - Pasquale Calabrese
- Division of Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Vladeta Ajdacic-Gross
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich (PUK), Zurich, Switzerland
| | - Nina Steinemann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zurich, Switzerland
| | - Marco Kaufmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zurich, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Zina-Mary Manjaly
- Department of Neurology, Schulthess Clinic, Zürich, Switzerland; Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Jürg Kesselring
- Department of Neurology and Neurorehabilitation, Rehabilitation Centre Kliniken Valens, Valens, Switzerland
| | - Christian P Kamm
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland; Neurocentre, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Claudio Gobbi
- Department of Neurology, Multiple Sclerosis Center (MSC), Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Chiara Zecca
- Department of Neurology, Multiple Sclerosis Center (MSC), Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Stefanie Müller
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zurich, Switzerland
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Hoffmeister J, Basso MR, Reynolds B, Whiteside D, Mulligan R, Arnett PA, Combs DR. Effects of diminished positive mood and depressed mood upon verbal learning and memory among people with multiple sclerosis. J Clin Exp Neuropsychol 2021; 43:117-128. [PMID: 33622171 DOI: 10.1080/13803395.2020.1853066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: Cognitive impairment affects as many as 65% of people with multiple sclerosis (PWMS), and memory impairment confers greater severity of disability and functional impairment. Depression is also common among PWMS, and lifetime prevalence rates are as high as 50%. Research has yet to clearly define the relationship between memory dysfunction and depression among PWMS, and may reflect incomplete assessment of depressive symptoms. The present study examined different aspects of depressive symptoms including anhedonia (i.e., diminished positive mood) and their relationships with verbal learning and memory among PWMS.Method: Participants were 48 healthy individuals and 96 PWMS. They were primarily Caucasian (90.3%) and female (75.0%). Participants completed the California Verbal Learning Test-2 (CVLT-2) to assess verbal learning and memory and the Chicago Multiscale Depression inventory to assess depressed mood (CMDI-Mood) and diminished positive mood (CMDI-DPM).Results: Linear regression revealed that the main effect of CMDI-DPM and the interaction of CMDI-DPM and CMDI-Mood significantly explained variance across learning, recall, and recognition CVLT-2 indices. Follow-up analyses indicated that CMDI-DPM was only significant in the absence of high CMDI-Mood scores. CMDI-Mood explained variance in only CVLT-2 Trial B.Conclusions: Depressed mood had little direct effect upon memory performance in PWMS. In the absence of severe depressed mood, higher levels of positive mood corresponded to better memory performance. However, the impact of diminished positive mood was rendered null among those endorsing high levels of depressed mood. These data may imply that anhedonia corresponds with poorer memory function among PWMS, and suggests that investigators and clinicians should assess multiple mood dimensions among PWMS.
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Affiliation(s)
| | | | - Bradley Reynolds
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | | | - Ryan Mulligan
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Peter A Arnett
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - Dennis R Combs
- Department of Psychology, University of Texas at Tyler, Tyler, TX, USA
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Scherder R, Kant N, Wolf E, Pijnenburg ACM, Scherder E. Pain and Cognition in Multiple Sclerosis. PAIN MEDICINE 2018; 18:1987-1998. [PMID: 28340237 DOI: 10.1093/pm/pnw290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective The goal of the present study was to examine the relationship between pain and cognition in patients with multiple sclerosis. Design Cross-sectional. Setting Nursing home and personal environment of the investigators. Subjects Two groups of participants were included: 91 patients with multiple sclerosis and 80 matched control participants. Methods The level of pain was measured by the following pain scales: Number of Words Chosen-Affective, Colored Analogue Scale for pain intensity and suffering from pain, and the Faces Pain Scale. Mood was tested by administering the Beck Depression Inventory and the Symptom Check List-90 anxiety and depression subscale. Global cognitive functioning was assessed by the Mini Mental State Examination. Memory and executive functions were assessed by several neuropsychological tests. Results Multiple sclerosis (MS) patients scored significantly lower than control participants on the majority of the neuropsychological tests. The MS patients experienced more pain compared with control participants, despite the fact that they were taking significantly more pain medication. No significant correlation was observed between cognition and pain in MS patients. Verbal working memory explained 10% of pain intensity (trend). Mood appeared to be a significant predictor of pain in patients with multiple sclerosis. Conclusion The lack of a relationship between cognition and pain might be explained by the fact that, compared with control participants, patients with multiple sclerosis activate other non-pain-related areas to perform executive functions and memory tasks.
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Affiliation(s)
- R Scherder
- Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands
| | - N Kant
- Nieuw Unicum, Zandvoort, The Netherlands
| | - E Wolf
- Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands
| | - A C M Pijnenburg
- Department of Orthopaedics, Amstelland Hospital, Amstelveen, The Netherlands
| | - E Scherder
- Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands
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7
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Sensory Function and Chronic Pain in Multiple Sclerosis. Pain Res Manag 2018; 2018:1924174. [PMID: 29849839 PMCID: PMC5937424 DOI: 10.1155/2018/1924174] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/06/2018] [Accepted: 03/22/2018] [Indexed: 12/19/2022]
Abstract
Objective To examine whether hypoesthesia and chronic pain are related in patients with MS. Methods Sixty-seven MS patients with pain and 80 persons without MS were included. Sensory functioning was tested by bedside neurological examination. Touch, joint position (dorsal column-medial lemniscus pathway), temperature sense, and pain (spinothalamic tract) were tested. Pain intensity was measured by the Colored Analogue Scale (CAS Intensity) and the Faces Pain Scale (FPS); pain affect was also measured by CAS Affect and Number of Words Chosen-Affective (NWC-A). Mood was assessed with the SCL-90 anxiety and depression subscales and the Beck Depression Inventory (BDI). Results A significant negative relationship was found between pain intensity and the function of the dorsal column-medial lemniscal pathway, but not with the spinothalamic tract. Conclusion In addition to the already known relation between hyperesthesia and pain, hypoesthesia for touch and joint position also seems to be related to chronic pain in MS patients.
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Scherder R, Kant N, Wolf ET, Pijnenburg B, Scherder EJ. Psychiatric and physical comorbidities and pain in patients with multiple sclerosis. J Pain Res 2018; 11:325-334. [PMID: 29491716 PMCID: PMC5815482 DOI: 10.2147/jpr.s146717] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background It has been observed that patients with multiple sclerosis (MS), who have psychiatric and physical comorbidities such as depression and COPD, have an increased risk of experiencing more pain. In this study, we have distinguished between pain intensity and pain affect, as the latter, particularly, requires treatment. Furthermore, while pain and comorbidities have been assessed using questionnaires, this is possibly a less reliable method for those who are cognitively vulnerable. Objective The aim of this study was to determine whether psychiatric and physical comorbidities can predict pain intensity and pain affect in MS patients, susceptible to cognitive impairment. Methods Ninety-four patients with MS and 80 control participants participated in this cross-sectional study. Besides depression and anxiety, 47 additional comorbidities were extracted from patients’ medical records. Depression and anxiety were assessed using the Beck Depression Inventory and the Symptom Check List-90. Pain was assessed using the Number of Words Chosen Affective, Coloured Analog Scale, and the Faces Pain Scale. Cognitive functions, for example, memory and executive functions, were assessed using several neuropsychological tests. Results The main findings indicate that psychiatric comorbidities (depression and anxiety) predict both pain intensity and pain affect and that total physical comorbidity predicts only pain affect in MS patients, susceptible to cognitive impairment. Conclusion Both psychiatric and physical comorbidities predict pain affect. All three clinical outcomes enhance MS patients’ suffering.
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Affiliation(s)
| | | | - Evelien T Wolf
- Department of Clinical Neuropsychology, Vrije Universiteit, Amsterdam
| | - Bas Pijnenburg
- Acibadem International Medical Center, Amsterdam, the Netherlands
| | - Erik Ja Scherder
- Department of Clinical Neuropsychology, Vrije Universiteit, Amsterdam
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Brown RF, Thorsteinsson EB, Smithson M, Birmingham CL, Aljarallah H, Nolan C. Can body temperature dysregulation explain the co-occurrence between overweight/obesity, sleep impairment, late-night eating, and a sedentary lifestyle? Eat Weight Disord 2017; 22:599-608. [PMID: 28929462 DOI: 10.1007/s40519-017-0439-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 09/04/2017] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Overweight/obesity, sleep disturbance, night eating, and a sedentary lifestyle are common co-occurring problems. There is a tendency for them to co-occur together more often than they occur alone. In some cases, there is clarity as to the time course and evolution of the phenomena. However, specific mechanism(s) that are proposed to explain a single co-occurrence cannot fully explain the more generalized tendency to develop concurrent symptoms and/or disorders after developing one of the phenomena. Nor is there a clinical theory with any utility in explaining the development of co-occurring symptoms, disorders and behaviour and the mechanism(s) by which they occur. Thus, we propose a specific mechanism-dysregulation of core body temperature (CBT) that interferes with sleep onset-to explain the development of the concurrences. METHODS A detailed review of the literature related to CBT and the phenomena that can alter CBT or are altered by CBT is provided. RESULTS Overweight/obesity, sleep disturbance and certain behaviour (e.g. late-night eating, sedentarism) were linked to elevated CBT, especially an elevated nocturnal CBT. A number of existing therapies including drugs (e.g. antidepressants), behavioural therapies (e.g. sleep restriction therapy) and bright light therapy can also reduce CBT. CONCLUSIONS An elevation in nocturnal CBT that interferes with sleep onset can parsimoniously explain the development and perpetuation of common co-occurring symptoms, disorders and behaviour including overweight/obesity, sleep disturbance, late-night eating, and sedentarism. Nonetheless, a significant correlation between CBT and the above symptoms, disorders and behaviour does not necessarily imply causation. Thus, statistical and methodological issues of relevance to this enquiry are discussed including the likely presence of autocorrelation. LEVEL OF EVIDENCE Level V, narrative review.
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Affiliation(s)
| | - Einar B Thorsteinsson
- School of Behavioural, Cognitive and Social Sciences Psychology, University of New England, Armidale, NSW, 2351, Australia.
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10
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Kim S, Zemon V, Rath JF, Picone M, Gromisch ES, Glubo H, Smith-Wexler L, Foley FW. Screening Instruments for the Early Detection of Cognitive Impairment in Patients with Multiple Sclerosis. Int J MS Care 2017; 19:1-10. [PMID: 28243180 DOI: 10.7224/1537-2073.2015-001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cognitive impairments are common in individuals with MS and adversely affect functioning. Early detection of cognitive impairment, therefore, would enable earlier, and possibly more effective, treatment. We sought to compare self-reports with a short neuropsychological test as possible screening tools for cognitive impairment. METHODS One hundred patients with MS were tested with the Minimal Assessment of Cognitive Function in Multiple Sclerosis; z scores were used to derive the Cognitive Index (CI). Receiver operator characteristic curve analyses were performed, with criteria for impairment set at -1.5 and -2.0 SD below the mean. Scores from two self-reports (the Multiple Sclerosis Neuropsychological Screening Questionnaire-Patient Version and the Behavior Rating Inventory of Executive Function-Adult Version [BRIEF-A]) and a neuropsychological test (the Symbol Digit Modalities Test [SDMT]) were entered as test variables. Exploratory regression analyses were conducted with 1) CI and self-reports and 2) CI and the Problem-Solving Inventory (PSI). RESULTS Classification accuracy was high or moderately high for SDMT when the criterion was -2.0 or -1.5 SD, respectively, but low for the self-reports. Hierarchical linear regression showed that the SDMT alone was the best predictor of cognitive impairment; adding the self-reports did not improve the model. Exploratory analyses indicated that certain self-reports (BRIEF-A, PSI) provided some explanatory power in separate models. CONCLUSIONS The SDMT is a more accurate screening tool for cognitive impairment; however, self-reports provide additional information and may complement objective testing. Results suggest that screening for cognitive impairment may require a multidimensional approach.
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Hind D, Kaklamanou D, Beever D, Webster R, Lee E, Barkham M, Cooper C. The assessment of depression in people with multiple sclerosis: a systematic review of psychometric validation studies. BMC Psychiatry 2016; 16:278. [PMID: 27491674 PMCID: PMC4973535 DOI: 10.1186/s12888-016-0931-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 06/15/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The prevalence of depression in people with multiple sclerosis (PwMS) is high; however, symptoms common to both conditions makes measurement difficult. There is no high quality overview of validation studies to guide the choice of depression inventory for this population. METHODS A systematic review of studies validating the use of generic depression inventories in people with MS was conducted using MEDLINE and PsycINFO. Studies validating the use of depression inventories in PwMS and published in English were included; validation studies of tests for cognitive function and general mental health were excluded. Eligible studies were then quality assessed using the COSMIN checklist and findings synthesised narratively by instrument and validity domain. RESULTS Twenty-one studies (N = 5,991 PwMS) evaluating 12 instruments were included in the review. Risk of bias varied greatly between instrument and validity domain. CONCLUSIONS The review of validation studies was constrained by poor quality reporting and outcome reporting bias. Well-conducted evaluations of some instruments are unavailable for some validity domains. This systematic review provides an evidence base for trade-offs in the selection of an instrument for assessing self-reported symptoms of depression in research or clinical practice involving people with MS. We make detailed and specific recommendations for where further research is needed. TRIAL REGISTRATION PROSPERO CRD42014010597.
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Affiliation(s)
- Daniel Hind
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Daphne Kaklamanou
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, Heart of the Campus, 42 Collegiate Crescent, Sheffield, S10 2BQ, UK.
| | - Dan Beever
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Ellen Lee
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Michael Barkham
- Centre for Psychological Services Research, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Cindy Cooper
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
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Hasselmann H, Bellmann-Strobl J, Ricken R, Oberwahrenbrock T, Rose M, Otte C, Adli M, Paul F, Brandt AU, Finke C, Gold SM. Characterizing the phenotype of multiple sclerosis–associated depression in comparison with idiopathic major depression. Mult Scler 2016; 22:1476-1484. [DOI: 10.1177/1352458515622826] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/26/2015] [Indexed: 11/17/2022]
Abstract
Background: Depression is a common co-morbidity in patients with multiple sclerosis (MS). While somatic symptoms of MS correlate with depression levels, it is unclear whether the clinical presentation of MS-associated depression differs from patients with “idiopathic” major depressive disorder (MDD). Objective: To compare the clinical phenotype of depression among MS and idiopathic MDD patients. Methods: Mean relative contribution of individual Beck Depression Inventory-II (BDI-II) items was evaluated among n = 139 patients with relapsing-remitting MS and n = 85 MDD patients without somatic illness. Next, comparisons were repeated in n = 38 MS with clinically relevant depressive symptoms (BDI-II > 19) and n = 38 MDD patients matched for sex, age, and depression severity. Finally, the underlying construct of depression was compared across groups using confirmatory factor analysis (CFA). Results: Comparisons on a whole-group level produced the expected differences along somatic/non-somatic symptoms. However, when appropriately controlling for depression severity, age, and sex, only four items contributed differentially to BDI-II total scores in MS versus MDD. CFA suggested that the underlying depression construct is essentially identical in both groups. Conclusion: The clinical phenotype of “idiopathic” MDD and MS-associated depression appears similar when adequately examined. The relevance of these findings for psychotherapeutic approaches for MS-associated depression should be explored in future studies.
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Affiliation(s)
- Helge Hasselmann
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany/NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Berlin, Germany/Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Roland Ricken
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Timm Oberwahrenbrock
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Rose
- Division of Psychosomatic Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Otte
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany/Fliedner Klinik Berlin, Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Berlin, Germany/Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany/Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander U Brandt
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Finke
- Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany/Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stefan M Gold
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany/Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hintsa T, Elovainio M, Jokela M, Ahola K, Virtanen M, Pirkola S. Is there an independent association between burnout and increased allostatic load? Testing the contribution of psychological distress and depression. J Health Psychol 2016; 21:1576-86. [DOI: 10.1177/1359105314559619] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Burnout has been suggested to be related to depression. We examined the relationship between burnout and allostatic load, and whether this association is independent of psychological distress and depression. We measured burnout psychological distress, depression, and allostatic load in 3283 participants. Higher burnout ( β = 0.06, p =0.003) and cynicism ( β = 0.03, p = 0.031) and decreased professional efficacy ( β = 0.03, p = 0.007) were related to higher allostatic load independent of age, sex, education, occupation and psychological distress. Depression, however, explained 60 percent of the association. Burnout is related to higher allostatic load, and this association partly overlaps with co-occurring depression.
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Affiliation(s)
| | | | | | - Kirsi Ahola
- Finnish Institute of Occupational Health, Finland
| | | | - Sami Pirkola
- National Institute for Health and Welfare, Finland
- Lapland Hospital District, Finland
- University of Oulu, Finland
- Helsinki University Central Hospital, Finland
- University of Tampere, Finland
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Abstract
Objective: To assess the validity and reliability of mood measures for use with people with multiple sclerosis (MS). Design: Four mood measures designed for use with people with communication and cognitive problems were completed; two were completed with the patient at interview and two by hospital staff or carers of the patients. This procedure was repeated two weeks later to assess test–retest reliability. Subjects: People with MS at a rehabilitation unit ( n = 22) and living in the community ( n = 27). Main outcome measures: The Stroke Aphasic Depression Questionnaire (SADQ) and Signs of Depression Scale (SODS) were completed by rehabilitation unit staff or by carers of the patients. An assistant psychologist completed the Visual Analogue Self-Esteem Scale (VASES) and the Visual Analogue Mood Scales (VAMS) with each patient. The Guy's Neurological Disability Scale (GNDS) was administered to assess physical disability. Nonprofessional carers were asked to complete the General Health Questionnaire 12 (GHQ-12) about themselves. Results: In both samples there were significant correlations between scores on the two self-report measures (VASES and VAMS) ( rs = 0.51–0.79) and between scores on the two observational measures (SADQ and SODS) ( rs = 0.62–0.81) but not between the observational and self-report measures. There was a significant correlation between the SODS and the carer GHQ ( rs = 0.68, p < 0.01), indicating that carer mood infuenced reporting of patients' mood. There was no significant infuenced of profession on the observational measures, indicating good inter-rater reliability. Test–retest reliability was high for patients in the community but not for patients in hospital. Conclusions: In both the inpatient and community samples, the self-report and observational mood measures appeared to be measuring different aspects of patients' mood. Further investigation is needed to determine which of these is providing the most accurate information.
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Affiliation(s)
- Madeleine J Groom
- Clinical Psychology Services, Nottinghamshire Healthcare NHS Trust and School of Psychology, University of Nottingham, Nottingham, UK
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15
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Knaster P, Estlander AM, Karlsson H, Kaprio J, Kalso E. Diagnosing Depression in Chronic Pain Patients: DSM-IV Major Depressive Disorder vs. Beck Depression Inventory (BDI). PLoS One 2016; 11:e0151982. [PMID: 27008161 PMCID: PMC4805196 DOI: 10.1371/journal.pone.0151982] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 03/06/2016] [Indexed: 11/30/2022] Open
Abstract
Background Diagnosing depression in chronic pain is challenging due to overlapping somatic symptoms. In questionnaires, such as the Beck Depression Inventory (BDI), responses may be influenced more by pain than by the severity of depression. In addition, previous studies have suggested that symptoms of negative self-image, a key element in depression, are uncommon in chronic pain-related depression. The object of this study is to assess the relationship of the somatic and cognitive-emotional items of BDI with the diagnosis of depression, pain intensity, and disability. Methods One hundred consecutive chronic pain patients completed the Structured Clinical Interview for DSM Disorders (SCID) for the diagnosis of major depressive disorder (MDD) according to DSM-IV. Two subscales of BDI (negative view of self and somatic-physical function) were created according to the factor model presented by Morley. Results In the regression analysis, the somatic-physical function factor associated with MDD, while the negative view of self factor did not. Patients with MDD had higher scores in several of the BDI items when analysed separately. Insomnia and weight loss were not dependent on the depression diagnosis. Limitations The relatively small sample size and the selected patient sample limit the generalisability of the results. Conclusions Somatic symptoms of depression are also common in chronic pain and should not be excluded when diagnosing depression in pain patients. Regardless of the assessment method, diagnosing depression in chronic pain remains a challenge and requires careful interpretation of symptoms.
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Affiliation(s)
- Peter Knaster
- Pain Clinic, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- * E-mail:
| | - Ann-Mari Estlander
- Pain Clinic, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hasse Karlsson
- Department of Clinical Science, University of Turku, Turku, Finland
| | - Jaakko Kaprio
- Faculty of Medicine and Institute for Molecular Medicine, University of Helsinki, Helsinki, Finland
| | - Eija Kalso
- Pain Clinic, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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16
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Strober LB, Arnett PA. Depression in multiple sclerosis: The utility of common self-report instruments and development of a disease-specific measure. J Clin Exp Neuropsychol 2015. [PMID: 26223270 DOI: 10.1080/13803395.2015.1063591] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The ultimate objective of the present investigation was to improve the detection of depression in multiple sclerosis (MS) by comparing common self-report depression measures to a new, modified measure, which takes into account the contribution that symptoms of MS may have on individuals' reports. There has been a longstanding concern regarding the accurate assessment of depression in MS, particularly with regard to the overlap of MS symptomatology and neurovegetative depression symptoms on self-report questionnaires, which may lead to an overdiagnosis of depression in MS. To address these difficulties, we previously proposed a "trunk and branch" of depression in MS. This model allows for the delineation of what symptoms are most reflective of depression in MS. By identifying these symptoms, it was possible to develop a modified Beck Depression Inventory (BDI) in which only the items found to be most related to depression in MS are included in the new measure, the MS Specific BDI (MS-BDI). We compared this measure to common self-report instruments (Beck Depression Inventory-Second Edition, BDI-II; Beck Depression Inventory-Fast Screen, BDI-FS; Chicago Multiscale Depression Inventory, CMDI). Results suggest that cutoffs of 4 on the BDI-FS and 23 on the CMDI Mood subscale are most useful when screening for depression in MS, with a sensitivity for both of 100%, while a cutoff of 19 on the BDI-II, a cutoff of 22 on the CMDI Evaluative scale, and a cutoff of 8 on the MS-BDI had high specificities, suggesting they can be used as to assist in diagnosing depression in MS.
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Affiliation(s)
- Lauren B Strober
- a Neuropsychology and Neuroscience Laboratory , Kessler Foundation , West Orange , NJ , USA
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17
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Gunzler DD, Morris N. A tutorial on structural equation modeling for analysis of overlapping symptoms in co-occurring conditions using MPlus. Stat Med 2015; 34:3246-80. [PMID: 26045102 DOI: 10.1002/sim.6541] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 04/29/2015] [Accepted: 05/08/2015] [Indexed: 01/02/2023]
Abstract
Structural equation modeling (SEM) is a very general approach to analyzing data in the presence of measurement error and complex causal relationships. In this tutorial, we describe SEM, with special attention to exploratory factor analysis, confirmatory factor analysis, and multiple indicator multiple cause modeling. The tutorial is motivated by a problem of symptom overlap routinely faced by clinicians and researchers, in which symptoms or test results are common to two or more co-occurring conditions. As a result of such overlap, diagnoses, treatment decisions, and inferences about the effectiveness of treatments for these conditions can be biased. This problem is further complicated by increasing reliance on patient-reported outcomes, which introduces systematic error based on an individual's interpretation of a test questionnaire. SEM provides flexibility in handling this type of differential item functioning and disentangling the overlap. Scales and scoring approaches can be revised to be free of this overlap, leading to better care. This tutorial uses an example of depression screening in multiple sclerosis patients in which depressive symptoms overlap with other symptoms, such as fatigue, cognitive impairment, and functional impairment. Details of how MPlus (Muthén & Muthén, Los Angeles, CA, USA) software can be used to address the symptom overlap problem, including data requirements, code and output are described in this tutorial.
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Affiliation(s)
- Douglas D Gunzler
- Center for Health Care Research and Policy, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, U.S.A
| | - Nathan Morris
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, U.S.A
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18
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Grech LB, Kiropoulos LA, Kirby KM, Butler E, Paine M, Hester R. The effect of executive function on stress, depression, anxiety, and quality of life in multiple sclerosis. J Clin Exp Neuropsychol 2015; 37:549-62. [DOI: 10.1080/13803395.2015.1037723] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fuss S, Trottier K, Carter J. An investigation of the factor structure of the beck depression inventory-II in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2014; 23:43-50. [PMID: 25504530 DOI: 10.1002/erv.2338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/24/2014] [Accepted: 11/18/2014] [Indexed: 11/09/2022]
Abstract
Symptoms of depression frequently co-occur with eating disorders and have been associated with negative outcomes. Self-report measures such as the Beck Depression Inventory-II (BDI-II) are commonly used to assess for the presence of depressive symptoms in eating disorders, but the instrument's factor structure in this population has not been examined. The purposes of this study were to explore the factor structure of the BDI-II in a sample of individuals (N = 437) with anorexia nervosa undergoing inpatient treatment and to examine changes in depressive symptoms on each of the identified factors following a course of treatment for anorexia nervosa in order to provide evidence supporting the construct validity of the measure. Exploratory factor analysis revealed that a three-factor model reflected the best fit for the data. Confirmatory factor analysis was used to validate this model against competing models and the three-factor model exhibited strong model fit characteristics. BDI-II scores were significantly reduced on all three factors following inpatient treatment, which supported the construct validity of the scale. The BDI-II appears to be reliable in this population, and the factor structure identified through this analysis may offer predictive utility for identifying individuals who may have more difficulty achieving weight restoration in the context of inpatient treatment. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Samantha Fuss
- Eating Disorder Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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20
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Gunzler DD, Perzynski A, Morris N, Bermel R, Lewis S, Miller D. Disentangling Multiple Sclerosis and depression: an adjusted depression screening score for patient-centered care. J Behav Med 2014; 38:237-50. [PMID: 24880636 DOI: 10.1007/s10865-014-9574-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 05/17/2014] [Indexed: 01/30/2023]
Abstract
Screening for depression can be challenging in Multiple Sclerosis (MS) patients due to the overlap of depressive symptoms with other symptoms, such as fatigue, cognitive impairment and functional impairment, for MS patients. The aim of this study was to understand these overlapping symptoms and subsequently develop an adjusted depression screening tool for better clinical assessment of depressive symptoms in MS patients. We evaluated 3,507 MS patients with a self-reported depression screening (PHQ-9) score using a multiple indicator multiple cause modeling approach. Our models showed significant differential item functioning effects denoting significant overlap of depressive symptoms with all MS symptoms under study and good model fit. The magnitude of the overlap was especially large for fatigue. Adjusted depression screening scales were formed based on factor scores and loadings that will allow clinicians to understand the depressive symptoms separate from other symptoms for MS patients for improved patient care.
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Affiliation(s)
- Douglas D Gunzler
- Center for Health Care Research and Policy, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109-1998, USA,
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21
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Amtmann D, Kim J, Chung H, Bamer AM, Askew RL, Wu S, Cook KF, Johnson KL. Comparing CESD-10, PHQ-9, and PROMIS depression instruments in individuals with multiple sclerosis. Rehabil Psychol 2014; 59:220-229. [PMID: 24661030 DOI: 10.1037/a0035919] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE This study evaluated psychometric properties of the Patient Health Questionnaire-9 (PHQ-9), the Center for Epidemiological Studies Depression Scale-10 (CESD-10), and the 8-item PROMIS Depression Short Form (PROMIS-D-8; 8b short form) in a sample of individuals living with multiple sclerosis (MS). RESEARCH METHOD Data were collected by a self-reported mailed survey of a community sample of people living with MS (n = 455). Factor structure, interitem reliability, convergent/discriminant validity and assignment to categories of depression severity were examined. RESULTS A 1-factor, confirmatory factor analytic model had adequate fit for all instruments. Scores on the depression scales were more highly correlated with one another than with scores on measures of pain, sleep disturbance, and fatigue. The CESD-10 categorized about 37% of participants as having significant depressive symptoms. At least moderate depression was indicated for 24% of participants by PHQ-9. PROMIS-D-8 identified 19% of participants as having at least moderate depressive symptoms and about 7% having at least moderately severe depression. None of the examined scales had ceiling effects, but the PROMIS-D-8 had a floor effect. CONCLUSIONS Overall, scores on all 3 scales demonstrated essential unidimensionality and had acceptable interitem reliability and convergent/discriminant validity. Researchers and clinicians can choose any of these scales to measure depressive symptoms in individuals living with MS. The PHQ-9 offers validated cutoff scores for diagnosing clinical depression. The PROMIS-D-8 measure minimizes the impact of somatic features on the assessment of depression and allows for flexible administration, including Computerize Adaptive Testing (CAT). The CESD-10 measures 2 aspects of depression, depressed mood and lack of positive affect, while still providing an interpretable total score.
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Affiliation(s)
| | | | - Hyewon Chung
- Department of Education, Chungnam National University
| | | | | | - Salene Wu
- Department of Rehabilitation Medicine
| | - Karon F Cook
- Department of Medical Social Sciences, Northwestern University
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Osborne LA, Gareth Noble J, Maramba IDC, Jones KH, Middleton RM, Lyons RA, Ford DV, Reed P. Outcome measures for multiple sclerosis. PHYSICAL THERAPY REVIEWS 2014. [DOI: 10.1179/1743288x13y.0000000094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kim S, Foley FW, Picone MA, Halper J, Zemon V. Depression levels and interferon treatment in people with multiple sclerosis. Int J MS Care 2014; 14:10-6. [PMID: 24453727 DOI: 10.7224/1537-2073-14.1.10] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Multiple sclerosis (MS) is the most common cause of neurologic disease in young and middle-aged adults, and 75% of patients are female. Nearly one in two patients with MS will experience clinically significant depression-approximately three times the prevalence rate in the general population. This study used a cross-sectional approach to examine the link between depression levels and use of interferon medications among individuals with MS. Data were collected from 694 patients of the Multiple Sclerosis Comprehensive Care Center at Holy Name Medical Center in Teaneck, New Jersey. Analysis of variance was used to compare depression scores between patients taking and not taking interferons. Regression analyses with depression scores as the dependent variable were also conducted. The Beck Depression Inventory (BDI) was reduced to a set of dimensions by principal components analysis. Two components were identified, reflecting somatic and cognitive symptoms. The results showed no significant relationship between depression levels and interferon treatment. Significant associations were observed between depression and both age and disability status, with younger, more disabled patients tending to be more depressed.
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Affiliation(s)
- Sonya Kim
- Ferkauf School of Psychology, Yeshiva University, Bronx, NY, USA (SK, FWF, VZ); Multiple Sclerosis Comprehensive Care Center, Holy Name Medical Center, Teaneck, NJ, USA (SK, FWF, MAP); and Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (JH)
| | - Frederick W Foley
- Ferkauf School of Psychology, Yeshiva University, Bronx, NY, USA (SK, FWF, VZ); Multiple Sclerosis Comprehensive Care Center, Holy Name Medical Center, Teaneck, NJ, USA (SK, FWF, MAP); and Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (JH)
| | - Mary Ann Picone
- Ferkauf School of Psychology, Yeshiva University, Bronx, NY, USA (SK, FWF, VZ); Multiple Sclerosis Comprehensive Care Center, Holy Name Medical Center, Teaneck, NJ, USA (SK, FWF, MAP); and Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (JH)
| | - June Halper
- Ferkauf School of Psychology, Yeshiva University, Bronx, NY, USA (SK, FWF, VZ); Multiple Sclerosis Comprehensive Care Center, Holy Name Medical Center, Teaneck, NJ, USA (SK, FWF, MAP); and Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (JH)
| | - Vance Zemon
- Ferkauf School of Psychology, Yeshiva University, Bronx, NY, USA (SK, FWF, VZ); Multiple Sclerosis Comprehensive Care Center, Holy Name Medical Center, Teaneck, NJ, USA (SK, FWF, MAP); and Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (JH)
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Palfai T, Cheng D, Coleman S, Bridden C, Krupitsky E, Samet J. The influence of depressive symptoms on alcohol use among HIV-infected Russian drinkers. Drug Alcohol Depend 2014; 134:85-91. [PMID: 24120857 PMCID: PMC4524808 DOI: 10.1016/j.drugalcdep.2013.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 09/12/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Depressive symptoms have been linked to HIV progression through a number of biobehavioral mechanisms including increased alcohol use. Although research supports an association between alcohol use and depressive symptoms among HIV patients, there have been few studies that have examined whether depressive symptoms predict subsequent drinking, especially among heavy drinking HIV-infected patients. METHOD Heavy drinking Russian HIV-infected patients (n=700) were recruited from addiction and HIV care settings for a randomized controlled trial of a risk reduction intervention [HERMITAGE]. GEE overdispersed Poisson regression analyses were conducted to assess the association between depressive symptoms and alcohol consumption 6-months later. RESULTS In adjusted analyses, depressive symptom severity was significantly associated with drinks per day (global p=.02). Compared to the non-depressed category, mild depressive symptoms were significantly associated with more drinks per day [IRR=1.55, (95% CI: 1.14, 2.09)], while moderate [IRR=1.14, (95% CI: 0.83, 1.56)] and severe [IRR=1.48, (95% CI: 0.93, 2.34)] depressive symptoms were not. Associations between depressive symptom severity and heavy drinking days were not statistically significant (global p=.19). Secondary analyses using the BDI-II screening threshold (BDI-II>14) and the BDI-II cognitive subscale suggested an association between depressive symptoms and drinks per day over time but not heavy episodic drinking. CONCLUSIONS Among heavy drinking HIV-infected patients, elevated depressive symptoms were associated with greater subsequent alcohol use. These findings suggest that depressive symptoms may be important to address in efforts to reduce alcohol-related risks among HIV-infected populations.
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Affiliation(s)
- T.P. Palfai
- Department of Psychology, Boston University, 648 Beacon Street, Boston, MA 02021, USA,Corresponding author. Tel.: +1 617 353 9345; fax: +1 617 353 9609. (T.P. Palfai)
| | - D.M. Cheng
- Department of Biostatistics, School of Public Health, Boston University, Crosstown Center, 801 Massachusetts Avenue, Boston, MA 02218, USA
| | - S.M. Coleman
- Department of Biostatistics, School of Public Health, Boston University, Crosstown Center, 801 Massachusetts Avenue, Boston, MA 02218, USA
| | - C. Bridden
- Department of Medicine, Boston University School of Medicine, Crosstown Center, 801 Massachusetts Avenue, Boston, MA 02218, USA
| | - E. Krupitsky
- St. Petersburg Bekhterev Research Psychoneurological Institute, 3 Bekhterev Street, St. Petersburg 192019, Russia
| | - J.H. Samet
- Department of Medicine, Boston University School of Medicine, Crosstown Center, 801 Massachusetts Avenue, Boston, MA 02218, USA
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Zeleke BM, Ayele TA, Woldetsadik MA, Bisetegn TA, Adane AA. Depression among women with obstetric fistula, and pelvic organ prolapse in northwest Ethiopia. BMC Psychiatry 2013; 13:236. [PMID: 24070342 PMCID: PMC3849390 DOI: 10.1186/1471-244x-13-236] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 09/24/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The prevalence of depression is not well studied among women with pelvic floor disorders. Hence, this study aimed to determine the prevalence of depression and its associated factors among women with pelvic floor disorders. METHODS A cross-sectional study was conducted among 306 women with one or more of the advanced pelvic floor disorders who attended at the gynaecologic outpatient clinic of Gondar university referral hospital in the six months data collection period. Women who complained of urinary or faecal incontinence or protruding mass per vagina were assessed and staged accordingly. Eligible women i.e. those with advanced pelvic organ prolapse or obstetric fistula were included consecutively. A structured questionnaire was used to obtain socio-demographic data and medical histories for all consenting women. Interviews were done by a female midwife nurse. Depression measures were obtained using the Beck's Depression Inventory (BDI) tool administered by the midwife nurse after intensive training. Data were entered into a computer using Epi Info version 3. 5.3, and then exported to SPSS version 20 for analysis. Multiple logistic regressions were fitted and Odds ratios with 95% confidence intervals were calculated to identify associated factors. RESULTS Of the 306 women interviewed, 269 had advanced pelvic organ prolapse (stages 3 and 4), 37 had obstetric fistula. All four women (100%) with both faecal and urinary incontinence, 97.0% those with urinary incontinence due to obstetric fistula and 67.7% of those with advanced pelvic organ prolapse (stages 3 and 4) had symptoms of depression. Depression was significantly associated with age 50 years or older (P < 0.01), marital status (P < 0.05), history of divorce (p < 0.01), self perception of severe problem (P < 0.05), and having stage 3 pelvic organ prolapse (P < 0.01). CONCLUSION Women with advanced pelvic organ prolapse, and obstetric fistula had high prevalence of depressive symptoms. A holistic management approach, including mental health care is recommended for women having such severe forms of pelvic floor disorders.
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Affiliation(s)
- Berihun Megabiaw Zeleke
- Epidemiology and Biostatistics department, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Tadesse Awoke Ayele
- Epidemiology and Biostatistics department, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulatu Adefris Woldetsadik
- Department of Gynaecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Telake Azale Bisetegn
- Department of Reproductive Health and Health Education, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Akilew Awoke Adane
- Epidemiology and Biostatistics department, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Ó Donnchadha S, Burke T, Bramham J, O'Brien MC, Whelan R, Reilly R, Kiiski H, Lonergan R, Kinsella K, Kelly S, McGuigan C, Hutchinson M, Tubridy N. Symptom overlap in anxiety and multiple sclerosis. Mult Scler 2013; 19:1349-54. [PMID: 23413298 DOI: 10.1177/1352458513476742] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The validity of self-rated anxiety inventories in people with multiple sclerosis (pwMS) is unclear. However, the appropriateness of self-reported depression scales has been widely examined. Given somatic symptom overlap between depression and MS, research emphasises caution when using such scales. OBJECTIVE This study evaluates symptom overlap between anxiety and MS in a group of 33 individuals with MS, using the Beck Anxiety Inventory (BAI). METHODS Participants underwent a neurological examination and completed the BAI. RESULTS A novel procedure using hierarchical cluster analysis revealed three distinct symptom clusters. Cluster one ('wobbliness' and 'unsteady') grouped separately from all other BAI items. These symptoms are well-recognised MS-related symptoms and we question whether their endorsement in pwMS can be considered to reflect anxiety. A modified 19-item BAI (mBAI) was created which excludes cluster one items. This removal reduced the number of MS participants considered 'anxious' by 21.21% (low threshold) and altered the level of anxiety severity for a further 27.27%. CONCLUSION Based on these data, it is suggested that, as with depression measures, researchers and clinicians should exercise caution when using brief screening measures for anxiety in pwMS.
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Sundgren M, Maurex L, Wahlin Å, Piehl F, Brismar T. Cognitive impairment has a strong relation to nonsomatic symptoms of depression in relapsing-remitting multiple sclerosis. Arch Clin Neuropsychol 2013; 28:144-55. [PMID: 23291310 DOI: 10.1093/arclin/acs113] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
It is unclear how cognitive impairment in multiple sclerosis (MS) is influenced by physical disability, fatigue, and depression. Our aim was to identify the strongest clinical predictors for cognitive impairment in relapsing-remitting MS (RRMS) patients. The clinical risk factors included in the analysis were physical disability (EDSS), fatigue (FSS), the somatic and nonsomatic components of depression (BDI), disease progression rate [Multiple Sclerosis Severity Score (MSSS)], and psychotropic medication. Cognitive impairment had a prevalence of 30.5% in patients affecting preferentially attention, executive functions, processing speed and visual perception/organization. MSSS was not associated with cognitive impairment, depression, or fatigue. In regression models, cognitive performance was best predicted by the nonsomatic symptoms of depression alone or in combination with physical disability. Exclusion of patients with any psychotropic medication did not influence the results. Our results underscore the importance of evaluating depressive symptoms when suspecting cognitive impairment in patients with RRMS.
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Affiliation(s)
- Mathias Sundgren
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Boeschoten RE, Dekker J, Uitdehaag BMJ, Polman CH, Collette EH, Cuijpers P, Beekman ATF, van Oppen P. Internet-based self-help treatment for depression in multiple sclerosis: study protocol of a randomized controlled trial. BMC Psychiatry 2012; 12:137. [PMID: 22967202 PMCID: PMC3493307 DOI: 10.1186/1471-244x-12-137] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 08/31/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Depression in MS patients is frequent but often not treated adequately. An important underlying factor may be physical limitations that preclude face-to-face contact. Internet-based treatment showed to be effective for depressive symptoms in general and could thus be a promising tool for treatment in MS. METHODS/DESIGN Here, we present a study protocol to investigate the effectiveness of a 5 week Internet-based self-help problem solving treatment (PST) for depressive symptoms in MS patients in a randomized controlled trial. We aim to include 166 MS patients with moderate to severe depressive symptoms who will be randomly assigned to an Internet-based intervention (with or without supportive text-messages) or waiting list control group. The primary outcome is the change in depressive symptoms defined by a change in the sum score on the Beck Depression Inventory (BDI-II). Secondary outcomes will include measures of anxiety, fatigue, cognitive functioning, physical and psychological impact of MS, quality of life, problem solving skills, social support, mastery, satisfaction and compliance rate. Assessments will take place at baseline (T0), within a week after the intervention (T1), at four months (T2) and at ten months follow-up (T3: only the intervention group). The control group will be measured at the same moments in time. Analysis will be based on the intention-to-treat principle. DISCUSSION If shown to be effective, Internet-based PST will offer new possibilities to reach and treat MS patients with depressive symptoms and to improve the quality of care. TRIAL REGISTRATION The Dutch Cochrane Center, NTR2772.
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Affiliation(s)
- Rosa E Boeschoten
- Department of Psychiatry, VU University Medical Center Academic Anxiety Outpatient Clinic and GGZinGeest, A. J. Ernststraat 1187, Amsterdam, HL 1081, The Netherlands.
| | - Joost Dekker
- Department of Psychiatry, VU University Medical Center Academic Anxiety Outpatient Clinic and GGZinGeest, A. J. Ernststraat 1187, Amsterdam, HL, 1081, The Netherlands,EMGO Institute for Mental Health and Care Research, VU University, Amsterdam, The Netherlands
| | - Bernard MJ Uitdehaag
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Chris H Polman
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Emma H Collette
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Pim Cuijpers
- EMGO Institute for Mental Health and Care Research, VU University, Amsterdam, The Netherlands,Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Aartjan TF Beekman
- Department of Psychiatry, VU University Medical Center Academic Anxiety Outpatient Clinic and GGZinGeest, A. J. Ernststraat 1187, Amsterdam, HL, 1081, The Netherlands,EMGO Institute for Mental Health and Care Research, VU University, Amsterdam, The Netherlands
| | - Patricia van Oppen
- Department of Psychiatry, VU University Medical Center Academic Anxiety Outpatient Clinic and GGZinGeest, A. J. Ernststraat 1187, Amsterdam, HL, 1081, The Netherlands,EMGO Institute for Mental Health and Care Research, VU University, Amsterdam, The Netherlands
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Aalto AM, Elovainio M, Kivimäki M, Uutela A, Pirkola S. The Beck Depression Inventory and General Health Questionnaire as measures of depression in the general population: a validation study using the Composite International Diagnostic Interview as the gold standard. Psychiatry Res 2012; 197:163-71. [PMID: 22365275 DOI: 10.1016/j.psychres.2011.09.008] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 09/08/2011] [Accepted: 09/15/2011] [Indexed: 10/28/2022]
Abstract
The Beck Depression Inventory (BDI) and the General Health Questionnaire (GHQ) are commonly used in population studies as measures of depression. We examined in a population sample the validity of four scales for depressive symptoms, the GHQ-12, the 21- and 13-item versions of the BDI, and a new 6-item version of the BDI developed for this study. A total of 5561 participants in the "Health 2000" survey (30-79 years) completed the four scales and were assessed with the Composite International Diagnostic Interview (CIDI), which was used as the validation criterion. We selected items for the BDI-6 through an exploratory factor analysis for the BDI-21. The accuracy of the scales, including the BDI-6, was satisfactory (c-statistics 0.88-0.92 for depression within the past 2 weeks and 0.80-0.83 within the past 12 months) and slightly better for men (0.92-0.96 and 0.85-0.87) than for women (0.86-0.88 and 0.78-0.79). Higher scores in all the scales were associated with more severe depression and more recent depressive episodes. This study suggests that various versions of the BDI and the GHQ-12 are useful in detecting depressive disorders in the general population. Even the 6-item version of the BDI showed acceptable criterion validity, although replication in an independent dataset is needed to confirm its validity.
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Affiliation(s)
- Anna-Mari Aalto
- National Institute for Health and Welfare, Helsinki, Finland.
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Quaranta D, Marra C, Zinno M, Patanella AK, Messina MJ, Piccininni C, Batocchi AP, Gainotti G. Presentation and Validation of the Multiple Sclerosis Depression Rating Scale: A Test Specifically Devised to Investigate Affective Disorders in Multiple Sclerosis Patients. Clin Neuropsychol 2012; 26:571-87. [DOI: 10.1080/13854046.2012.668220] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Salgado PCB, Nogueira MH, Yasuda CL, Cendes F. Screening symptoms of depression and suicidal ideation in people with epilepsy using the Beck depression inventory. ACTA ACUST UNITED AC 2012. [DOI: 10.1590/s1676-26492012000300004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: To measure the severity of symptoms of depression and suicidal ideation in people with epilepsy (PWE) before and after epilepsy surgery using the Beck Depression Inventory (BDI). We aimed to determine the factors associated to depression in PWE. METHODS: PWE, regardless of epilepsy type, seizure type, duration or frequency of seizures, and AEDs were investigated. The sample (n=468) was divided into two groups: pre-operatory (n=346) and pos-operatory (n=122). RESULTS: Before epilepsy surgery female gender, unemployment and high seizure frequency were associated factors for the occurrence of symptoms of depression. After epilepsy surgery, the only factor associated to high level of depression symptoms was the lack of seizure remission. Suicidal ideation was associated to seizure frequency before and after epilepsy surgery. CONCLUSION: Our results confirm the generally held view that depression is common in PWE and provide further insight to the association of depression with certain socio-demographic and seizure-related factors before and after epilepsy surgery.
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Cooper CL, Hind D, Parry GD, Isaac CL, Dimairo M, O'Cathain A, Rose A, Freeman JV, Martin L, Kaltenthaler EC, Thake A, Sharrack B. Computerised cognitive behavioural therapy for the treatment of depression in people with multiple sclerosis: external pilot trial. Trials 2011; 12:259. [PMID: 22168507 PMCID: PMC3272061 DOI: 10.1186/1745-6215-12-259] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 12/14/2011] [Indexed: 11/10/2022] Open
Abstract
Background People with multiple sclerosis (MS) are at high risk of depression. We undertook a pilot trial of computerised cognitive behavioural therapy (CCBT) for the treatment of depression in people with MS to test the feasibility of undertaking a full trial. Methods Participants with a diagnosis of MS and clinical levels of depression were recruited through out-patient clinics and postal screening questionnaires at two UK centres and randomised to CCBT or usual care. Clinical outcomes included the Beck Depression Inventory (BDI-II) and Multiple Sclerosis Impact Scale (MSIS-29) at baseline, 8 and 21 weeks. Feasibility outcomes included: recruitment rate; reasons for refusal, withdrawal and dropout; feasibility and acceptability of the proposed outcome measures; sample size estimation and variation in and preferences for service delivery. Results Twenty-four participants were recruited. The recruitment rate, calculated as the proportion of those invited to fill in a screening questionnaire who were consented into the trial, was 4.1%. Recruitment through out-patient clinics was somewhat slower than through screening questionnaire mail-out but the overall recruitment yield was similar. Of the 12 patients in the CCBT arm, 9 (75%) completed at least four, and 6 completed all 8 CCBT sessions. For completers, the median time (IQR) to complete all eight CCBT sessions was 15 (13 to 20) weeks. Participants expressed concern about the face validity of the Beck Depression Inventory II for the measurement of self-reported depression in people with MS. The MSIS-29 was the patient-reported outcome measure which participants felt best reflected their concerns. The estimated sample size for a full trial is between 180 and 390 participants. NHS partners were not delivering CCBT in community facilities and participants preferred to access CCBT at home, with no one expressing a preference for use of CCBT in an alternative location. Conclusions A definitive trial, with a recruitment window of one year, would require the participation of around 13 MS centres. This number of centres could be reduced by expanding the eligibility criteria to include either other neurological conditions or people with more severe depression. The MSIS-29 should be used as a patient-important outcome measurement. Trial registration ISRCTN: ISRCTN81846800
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Affiliation(s)
- Cindy L Cooper
- Clinical Trials Research Unit, ScHARR, University of Sheffield, Regent Court, Sheffield, UK.
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Abstract
Multiple sclerosis is associated with high rates of depression. The extent to which this is related to living with chronic illness or part of the disease process remains unclear. This question was investigated by comparing rates of depression in MS with those in rheumatoid arthritis, which involves similar physical and psychosocial stressors but without central nervous system involvement. The study involved an on-line survey, which included measures of depression not confounded by somatic symptoms, medication use, self-reported physical functioning, pain, and other demographic variables. Results indicated that disease group (multiple sclerosis, rheumatoid arthritis) independently predicted depression above and beyond demographic and disease-related variables. Results support the hypothesis that depression in MS is partly determined by direct neurological consequences of the condition.
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Affiliation(s)
- Kathryn Holden
- Department of Psychology, University of Sheffield, Sheffield, UK.
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Abstract
Elucidating the relationship between fatigue and depression in multiple sclerosis (MS) patients is complicated by ambiguity regarding how these two constructs should be delineated. Neurovegetative symptoms of depression may reflect depression in MS patients, as they do in non-neurological populations; instead these items may measure disease-related fatigue; or disease-related fatigue and depression may reflect the same syndrome in MS patients. The present study sought to evaluate these possibilities by characterizing the underlying factor structure of self-report items designed to measure fatigue and depression symptoms. Questionnaires designed to measure fatigue and depression were administered to 174 MS patients and 84 healthy controls, and these items were subject to factor analysis. Results suggest that neurovegetative symptoms are poor indicators of depression in MS patients. Neurovegetative depression items were removed from the final model due to poor psychometric properties, or they loaded on Fatigue or Sleep Disturbance factors. The correlation between latent factors Depression and Fatigue was large (.47), but does not indicate that these phenomena are manifestations of the same construct. Hence, the results of this study support the notion that vegetative symptoms of depression do not reflect depression in MS patients, but instead measure symptoms of fatigue and sleep disturbance.
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Strober LB, Arnett PA. Assessment Of Depression In Multiple Sclerosis: Development Of A “Trunk And Branch” Model. Clin Neuropsychol 2010; 24:1146-66. [DOI: 10.1080/13854046.2010.514863] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Beckner V, Howard I, Vella L, Mohr DC. Telephone-administered psychotherapy for depression in MS patients: moderating role of social support. J Behav Med 2009; 33:47-59. [PMID: 19941048 PMCID: PMC2813530 DOI: 10.1007/s10865-009-9235-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 11/01/2009] [Indexed: 11/11/2022]
Abstract
Depression is common in individuals with multiple sclerosis (MS). While psychotherapy is an effective treatment for depression, not all individuals benefit. We examined whether baseline social support might differentially affect treatment outcome in 127 participants with MS and depression randomized to either Telephone-administered Cognitive-Behavioral Therapy (T-CBT) or Telephone-administered Emotion-Focused Therapy (T-EFT). We predicted that those with low social support would improve more in T-EFT, since this approach emphasizes the therapeutic relationship, while participants with strong social networks and presumably more emotional resources might fare better in the more structured and demanding T-CBT. We found that both level of received support and satisfaction with that support at baseline did moderate treatment outcome. Individuals with high social support showed a greater reduction in depressive symptoms in the T-CBT as predicted, but participants with low social support showed a similar reduction in both treatments. This suggests that for participants with high social support, CBT may be a more beneficial treatment for depression compared with EFT.
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Affiliation(s)
- Victoria Beckner
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
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Nosek MA, Hughes RB, Robinson-Whelen S. The complex array of antecedents of depression in women with physical disabilities: Implications for clinicians. Disabil Rehabil 2009; 30:174-83. [PMID: 17852240 DOI: 10.1080/09638280701532219] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This article discusses the complex interrelation of elements of the physical, psychological, social, and environmental life context of women with physical disabilities and the association of these elements with significant disparities in rates of depression and access to mental health care for this population. METHODS Literature and concept review. RESULTS High rates of depression in women with physical disabilities are well documented in the literature. Many elements that are disproportionately common in the lives of women with physical disabilities, including socio-economic disadvantage, functional limitations, pain and other chronic health conditions, poor diet, physical inactivity, smoking, violence, low self-esteem, sexuality problems, chronic stress, environmental barriers, and barriers to health care, have also been linked with higher rates of depression and depressive symptomatology. Depression self-management interventions tailored for women with disabilities have been developed and proven effective. CONCLUSIONS Many women who must deal with the stresses surrounding an array of health problems may experience symptoms of depression without necessarily meeting the criteria for clinical depression. Psychologists, counselors, primary care physicians, specialists, and other medical and rehabilitation professionals are challenged to recognize the symptoms of depression in women with physical disabilities and assist them in obtaining appropriate psychological and pharmacological interventions.
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Affiliation(s)
- Margaret A Nosek
- Center for Research on Women with Disabilities, Baylor College of Medicine, PO Box 890286, Houston, Texas 77289, USA.
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Szigethy E, Craig AE, Iobst EA, Grand RJ, Keljo D, DeMaso D, Noll R. Profile of depression in adolescents with inflammatory bowel disease: implications for treatment. Inflamm Bowel Dis 2009; 15:69-74. [PMID: 18831071 PMCID: PMC2638168 DOI: 10.1002/ibd.20693] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND The purpose was to determine the utility of including neurovegetative symptoms in assessments of depression in youth with inflammatory bowel disease (IBD). METHODS Forty-one youth with IBD and concurrent depressive symptomatology were enrolled in an intervention trial and received either 9 modules of cognitive-behavioral therapy (PASCET-PI) or treatment as usual (TAU). Youth and their primary caregivers completed the Children's Depression Inventory (CDI) at pre- (T1) and posttreatment (T2). Disease severity measures and current steroid dosage were obtained at each timepoint. Change in the individual items of the CDI was compared across groups and examined in association with change in physical illness course. RESULTS Paired sample t-tests revealed significant changes in CDI item scores from T1 to T2 for a majority of the depressive symptoms assessed in the PASCET-PI group, but not for the TAU group. These changes did not appear to be linked to changes in disease severity and/or steroid dosage across these same timepoints. CONCLUSIONS The inclusion of somatic items in the assessment of depression in physically ill youth is important, as these symptoms seem to respond to psychotherapeutic intervention. The present results would suggest that improvements in depressive symptomatology are not solely related to improvements in the course of IBD and that these items do reflect an important part of the profile of depressive symptoms in youth with IBD. Future research is warranted to replicate present findings and explore the generalizability of these results to other pediatric illness populations.
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Affiliation(s)
- Eva Szigethy
- Children's Hospital of Pittsburgh/University of Pittsburgh Medical Center, Departments of Psychiatry and Gastroenterology, Pittsburgh, Pennsylvania
| | - Anna E. Craig
- Children's Hospital of Pittsburgh/University of Pittsburgh Medical Center, Departments of Psychiatry and Gastroenterology, Pittsburgh, Pennsylvania
| | - Emily A. Iobst
- Children's Hospital of Pittsburgh/University of Pittsburgh Medical Center, Departments of Psychiatry and Gastroenterology, Pittsburgh, Pennsylvania
| | - Richard J. Grand
- Children's Hospital of Boston, Center for Inflammatory Bowel Disease, Division of Gastroenterology and Nutrition, Boston, Massachusetts
| | - David Keljo
- Children's Hospital of Pittsburgh/University of Pittsburgh Medical Center, Departments of Psychiatry and Gastroenterology, Pittsburgh, Pennsylvania
| | - David DeMaso
- Children's Hospital of Boston, Department of Psychiatry, Boston, Massachusetts
| | - Robert Noll
- Children's Hospital of Pittsburgh/University of Pittsburgh Medical Center, Departments of Psychiatry and Gastroenterology, Pittsburgh, Pennsylvania
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Endorsement of self-report neurovegetative items of depression is associated with multiple sclerosis disease symptoms. J Int Neuropsychol Soc 2008; 14:1057-62. [PMID: 18954485 DOI: 10.1017/s1355617708081265] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Some researchers have suggested that general self-report depression scales may be inadequate for assessing depression among individuals with Multiple Sclerosis (MS), because many of such items represent MS disease symptoms. However, research has been mixed on this issue: whereas some studies provide support for symptom overlap, others have found opposing evidence. We investigated this issue in two different MS samples with three different strategies. We (1) examined reliable change in depression symptom categories at two time points over three years, (2) assessed the relationship between variables associated with depression and different depression symptom subscales, and (3) assessed the relationship between symptom subscales and physical disability. In each instance we found significant evidence that items meant to assess vegetative symptoms of depression may be influenced by presence of MS disease symptoms or were not associated with other core elements or central correlates of depression.
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Sexual Functioning and Mood Among Long-Term Survivors of Clear-Cell Adenocarcinoma of the Vagina or Cervix. J Psychosoc Oncol 2008. [DOI: 10.1300/j077v17n03_02] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Patten SB, Newman S, Becker M, Riddell C, Metz L. Disease management for depression in an MS clinic. Int J Psychiatry Med 2008; 37:459-73. [PMID: 18441632 DOI: 10.2190/pm.37.4.h] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Evidence-based treatments for depression in multiple sclerosis (MS) are available, but their implementation can be challenging. We explored the feasibility and effectiveness of implementing a disease management program for depression in an MS clinic. METHODS A non-randomized "before-after" design was used. The University of Calgary MS Clinic performs routine screening for depression using the Center for Epidemiologic Studies Depression Rating Scale (CES-D). During a six month baseline period, the screen results were not systematically acted upon. During a subsequent nine-month study period, a case manager was routinely notified of positive screens. These patients were offered disease management. Major depression was assessed six months later with a blind administration of the Mini Neuropsychiatric Interview (MINI). Quality of life (EQ-5D) and functional status (WHO DAS II) were also measured. RESULTS Eighty-three patients were enrolled in the study; 54 were in the disease management group and 29 received treatment as usual. There was a lower frequency of major depression in the intervention group six months post-screening. No differences in quality of life or functional status were seen. CONCLUSIONS Disease management approaches for depression were developed in primary care environments and have been adapted for geriatric and diabetic populations. These strategies may require modification for application in MS clinics. While an intervention for depression was effective in those who received it, its impact on the targeted clinical population was reduced by lower than expected rates of participation and higher than expected rates of treatment at baseline.
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Affiliation(s)
- Scott B Patten
- Department of Community Health Sciences, University of Calgary, AB, Canada.
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Wyrick S, Parker D, Grabowski D, Feuling HM, Ng AV. Relationships Among Walking Aids, Physical Activity, Depression, Fatigue, and Perceived Health in Assisted-Living Residents. J Appl Gerontol 2008. [DOI: 10.1177/0733464808315288] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study assesses whether physical activity, depression, fatigue, or perceived health are affected by use of a walking aid in residents of an assisted-living facility. From an assisted-living facility, 21 participants who were independent ambulators ( n = 8) or who used a cane or walker ( n = 13) participated. Physical activity was measured with accelerometers, and depression, fatigue, and perceived heath status were assessed with questionnaires. There were no differences in physical activity, depression, fatigue, or perceived health status between those using and those not using assistive devices. However, 15% of the participants reported moderate to severe depression, and 40% of participants reported at least mild depression. Depression was strongly correlated to fatigue. Thus, physical activity, depression, fatigue, and perceived health are not associated with walker or cane use in assisted-living facilities. Nevertheless, among all, mild depression is prevalent and strongly correlated to fatigue.
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Affiliation(s)
| | | | | | - Heidi M. Feuling
- Hales Corners Care Center, Wisconsin Marquette University,
Milwaukee, Wisconsin
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Brown RF, Tennant CC, Sharrock M, Hodgkinson S, Dunn SM, Pollard JD. Relationship between stress and relapse in multiple sclerosis: Part II. Direct and indirect relationships. Mult Scler 2006; 12:465-75. [PMID: 16900760 DOI: 10.1191/1352458506ms1296oa] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of this two-year prospective study was to determine which factors were: (i) directly related and/or (ii) indirectly related to multiple sclerosis (MS) relapse. These factors included life-event stressors, disease, demographic, psychosocial and lifestyle factors. BACKGROUND Relatively little attention has been paid to the role of non-clinical relapse predictors (other than stressful life-events) in MS, or factors that indirectly impact on the stress-relapse relationship. METHODS A total of 101 consecutive participants with MS were recruited from two MS clinics in Sydney, Australia. Stressful life-events, depression, anxiety and fatigue were assessed at study-entry and at three-monthly intervals for two years. Disease, demographic, psychosocial and lifestyle factors were assessed at baseline. Patient-reported relapses were recorded and corroborated by neurologists or evaluated against accepted relapse criteria. RESULTS MS relapse was predicted by acute stressor frequency counts, coping responses that utilized social support, and being born in Australia, but not by chronic stressors, disease, demographic, psychosocial or lifestyle factors. No factors were found to indirectly impact on the stress relapse relationship. CONCLUSIONS The number rather than severity of stressors was most important in relation to MS relapse risk, along with coping responses that utilized social support, suggesting that MS patients should avoid situations that are likely to generate multiple stressors or which provide few avenues for social support.
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Affiliation(s)
- R F Brown
- Department of Psychology, University of New England, Armidale, NSW, Australia.
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Abstract
The treatment of multiple sclerosis has been revolutionized during the past 10 years by the introduction of disease-modifying therapies. However, day-to-day management of the symptoms and complications of this condition will, for the foreseeable future, continue to be important management concerns. Among the most problematic and troublesome manifestations of multiple sclerosis are its neuropsychiatric manifestations. Most prominent among these are depression, pathologic laughing and crying, fatigue, cognitive problems, sleep disorders and disorders of sexual function. There have been relatively few randomized controlled trials of pharmacologic treatments for these conditions. Available treatments for the management of fatigue and cognitive deficits remain inadequate and patients must often accommodate these symptoms in their lifestyle.
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Affiliation(s)
- Scott B Patten
- University of Calgary, Department of Community Health Sciences, Alberta, Canada.
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Patterson K, Young C, Woods SP, Vigil O, Grant I, Atkinson JH. Screening for major depression in persons with HIV infection: the concurrent predictive validity of the Profile of Mood States Depression-Dejection Scale. Int J Methods Psychiatr Res 2006; 15:75-82. [PMID: 19722288 PMCID: PMC6878440 DOI: 10.1002/mpr.184] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Major Depressive Disorder (MDD) is among the most prevalent but underdiagnosed psychiatric disorders in persons with HIV infection. Given the known adverse impact of comorbid MDD on HIV disease progression and health-related quality of life, it is important both for research and for efficient, effective clinical care, to validate existing screening measures that may discriminate between MDD and the somatic symptoms of HIV (such as fatigue). In the current study, we evaluated the concurrent predictive validity of the Profile of Mood States (POMS) Depression-Dejection scale in detecting current MDD in 310 persons with HIV infection. The Structured Clinical Interview for DSM-IV (SCID) diagnosis of MDD and the Cognitive-Affective scale from the Beck Depression Inventory (BDI-CA) served as comparative diagnostic and severity measures of depression, respectively. Results demonstrated that the POMS Depression-Dejection scale accurately classified persons with and without MDD SCID diagnoses, with an overall hit rate of 80%, sensitivity of 55%, specificity of 84%, and negative predictive power of 91% using a recommended cutpoint of 1.5 standard deviations above the normative mean. Moreover, the POMS performed comparably to the BDI-CA in classifying MDD. Findings support the predictive validity of the POMS Depression-Dejection scale as a screening instrument for MDD in persons with HIV disease.
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Affiliation(s)
- Katherine Patterson
- Department of Psychiatry, University of California-San Diego, 150 West Washington Street, San Diego, CA 92103, USA
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Abstract
BACKGROUND Despite the high lifetime prevalence of depression in multiple sclerosis (MS), its longitudinal course is poorly understood. OBJECTIVE To examine the longitudinal course of and reliable change in different depression symptom clusters in MS, and the longitudinal association of interferon beta treatment and coping with depression symptoms. METHODS 53 MS patients were examined at two time points three years apart on the Beck Depression Inventory (BDI) and the Chicago Multiscale Depression Inventory (CMDI). RESULTS Correlations from time 1 to time 2 for BDI, CMDI-total, CMDI-evaluative scale, and CMDI-vegetative scale were all highly significant, and reliable change indices reflected little change over time. In contrast, the correlation over time for the CMDI-mood scale was significantly lower (p<0.05) than the CMDI-evaluative and CMDI-vegetative scale correlations, and over 40% of patients showed reliable change. Patients who improved in their mood showed increased use of active coping, while patients who worsened showed decreased active coping strategies; the latter were also significantly more likely to have been taking interferon beta drugs at both time points than patients who did not change in their mood functioning. CONCLUSIONS Mood symptoms of depression are significantly more variable over time than neurovegetative or negative evaluative symptoms in MS patients. Decreased use of active coping strategies may put patients at risk of increased depressed mood, whereas increased use of active coping may result in decreased depressed mood longitudinally. Interferon beta use may put patients at risk of increases in depressed mood.
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Affiliation(s)
- P A Arnett
- Penn State University, Psychology Department, 522 Bruce V Moore Bldg, University Park, PA 16802-3105, USA.
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Nocentini U, Pasqualetti P, Bonavita S, Buccafusca M, De Caro MF, Farina D, Girlanda P, Le Pira F, Lugaresi A, Quattrone A, Reggio A, Salemi G, Savettieri G, Tedeschi G, Trojano M, Valentino P, Caltagirone C. Cognitive dysfunction in patients with relapsing-remitting multiple sclerosis. Mult Scler 2006; 12:77-87. [PMID: 16459723 DOI: 10.1191/135248506ms1227oa] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cognitive dysfunction is considered one of the clinical markers of multiple sclerosis (MS). However, in the literature there are inconsistent reports on the prevalence of cognitive dysfunction, and separate data for the relapsing-remitting (RR) type of the disease are not always presented. In this study, we submitted 461 RRMS patients to a battery of neuropsychological tests to investigate their impairment in various cognitive domains. As a consequence of the exclusion criteria, the sample is not fully representative of the entire population of RRMS patients. In this selected sample, when only the eight scores of a core battery (Mental Deterioration Battery) were considered (with respective cutoffs), it emerged that 31% of the patients were affected by some degree of cognitive deficit. In particular, 15% had mild, 11.2% moderate and 4.8% had severe impairment. Information processing speed was the most frequently impaired area, followed by memory. When two other tests (SDMT and MCST) were added and cognitive domains were considered, it emerged that 39.3% of the patients were impaired in two or more domains. When four subgroups were obtained by means of cluster analysis and then compared, it emerged that information processing speed and memory deficits differentiated the still cognitively unimpaired from the mildly impaired MS patients. Significant associations were found between cognitive and clinical characteristics. However, due to the large sample size, clinically irrelevant relationships may also have emerged. Even with the limitations imposed by the sample selection and the possible underestimation of the prevalence and severity of cognitive dysfunction, these results seem to provide further evidence that information processing speed deficit may be an early and important marker of cognitive impairment in MS patients.
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Affiliation(s)
- U Nocentini
- Department of Neurology, University of Rome 'Tor Vergata' and IRCCS 'S. Lucia' Foundation, Rome, 00179 Italy.
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Patten SB, Lavorato DH, Metz LM. Clinical correlates of CES-D depressive symptom ratings in an MS population. Gen Hosp Psychiatry 2005; 27:439-45. [PMID: 16271659 DOI: 10.1016/j.genhosppsych.2005.06.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2005] [Revised: 06/28/2005] [Accepted: 06/30/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE In multiple sclerosis (MS), depression rating scales may be used as case-finding instruments for depressive disorders, but depressive symptom ratings may have clinical implications beyond their case-finding role. The objective of this analysis was to explore this possibility by carrying out descriptive analyses of symptom ratings obtained using the Center for Epidemiological Studies Depression Rating Scale (CES-D) in an MS clinic population. METHOD The analysis used cross-sectional baseline data collected from 589 subjects enrolled in a prospective cohort study. Data collection included demographic and clinical information including Extended Disability Status Scale ratings, a 54-item MS Quality of Life Scale and the Fatigue Impact Scale. RESULTS Across a spectrum of CES-D scores, correlations with other health indicators were observed. Depressive symptoms were higher in more disabled subjects. CES-D scores were correlated with the emotional well-being dimension of quality of life and with a social fatigue impact dimension. Alternative scoring of the CES-D had a negligible impact on the pattern of correlation. CONCLUSIONS CES-D ratings appear to be interpretable beyond the traditional yes/no categorization used in case finding. CES-D ratings are predictive of other clinical parameters in domains relevant to mental health.
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Affiliation(s)
- Scott B Patten
- Department of Community Health Sciences, University of Calgary, AB, Canada.
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McGuigan C, Hutchinson M. Unrecognised symptoms of depression in a community-based population with multiple sclerosis. J Neurol 2005; 253:219-23. [PMID: 16177840 DOI: 10.1007/s00415-005-0963-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Revised: 04/19/2005] [Accepted: 04/22/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS The association between multiple sclerosis (MS) and depression has been well established but prevalence estimates have varied widely. The aims of this study were to assess the point prevalence of previously unrecognised symptoms of depression in a community-based population with MS and examine their relationship to other disease characteristics. PATIENTS AND METHODS Three hundred and seventy six patients with clinically definite or probable MS (Poser criteria) were ascertained during the course of an epidemiological study on two counties in Ireland. Of these 211 agreed to participate in the study. Subjects were examined and a Kurtzke Expanded Disability Status Scale Score and Multiple Sclerosis Functional Composite score rated. Participants also completed a Beck's Depression Inventory-II and a Multiple Sclerosis Impact Scale. RESULTS In total 60 (28%) patients had moderate or severe symptoms of depression. Only thirty-five of the 211 patients had a history of depression as defined by a medical diagnosis of depression or prescription of an anti-depressant medication at any time prior to enrollment in the present study, of the remaining 176 patients, 41 (23.3%) had moderate or severe symptoms of depression as assessed by Beck's Depression Inventory-II. The only significant clinical difference between the 41 patients with pronounced depressive symptoms and the 135 less affected was shorter disease duration in the former. CONCLUSIONS In this study one in four patients with MS had unrecognised and therefore untreated symptoms of depression. Disability alone is not a good indicator of the likelihood of coexistent depressive symptoms.
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Affiliation(s)
- C McGuigan
- Dept. of Neurology, St. Mary's Hospital, London, UK.
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