Gender differences in the endorsement of symptoms for depression and anxiety: are gender-biased items responsible?

Conversational assessment using artificial intelligence is as clinically useful as depression scales and preferred by users

BACKGROUND

Depression is prevalent, chronic, and burdensome. Due to limited screening access, depression often remains undiagnosed. Artificial intelligence (AI) models based on spoken responses to interview questions may offer an effective, efficient alternative to other screening methods.

OBJECTIVE

The primary aim was to use a demographically diverse sample to validate an AI model, previously trained on human-administered interviews, on novel bot-administered interviews, and to check for algorithmic biases related to age, sex, race, and ethnicity.

METHODS

Using the Aiberry app, adults recruited via social media (N = 393) completed a brief bot-administered interview and a depression self-report form. An AI model was used to predict form scores based on interview responses alone. For all meaningful discrepancies between model inference and form score, clinicians performed a masked review to determine which one they preferred.

RESULTS

There was strong concurrent validity between the model predictions and raw self-report scores (r = 0.73, MAE = 3.3). 90 % of AI predictions either agreed with self-report or with clinical expert opinion when AI contradicted self-report. There was no differential model performance across age, sex, race, or ethnicity.

LIMITATIONS

Limitations include access restrictions (English-speaking ability and access to smartphone or computer with broadband internet) and potential self-selection of participants more favorably predisposed toward AI technology.

CONCLUSION

The Aiberry model made accurate predictions of depression severity based on remotely collected spoken responses to a bot-administered interview. This study shows promising results for the use of AI as a mental health screening tool on par with self-report measures.

The Mediating Role of Depression and of State Anxiety οn the Relationship between Trait Anxiety and Fatigue in Nurses during the Pandemic Crisis

The coronavirus pandemic (COVID-19) is a global health crisis with a particular emotional and physical impact on health professionals, especially nurses. The aim of this study was to investigate the prevalence of anxiety, depression and fatigue and their possible relationships among nurses during the pandemic. The study population consisted of nurses from five tertiary-level public hospitals in Athens who completed the Fatigue Assessment Scale (FAS), Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) questionnaires. Gender, age and years of work experience were recorded. The study was conducted from mid-November to mid-December 2021. The sample included 404 nurses (69 males and 335 females) with a mean age of 42.88 years (SD = 10.90) and 17.96 (SD = 12.00) years of work experience. Symptoms of fatigue were noted in 60.4% of participants, while 39.7% had symptoms of depression, 60.1% had abnormal scores on state anxiety and 46.8% on trait anxiety, with females showing higher scores on all scales (p < 0.05). High positive correlations (p < 0.01) were found between the FAS, BDI, State Anxiety and Trait Anxiety scales. Regression analysis showed that 51.7% of the variance in FAS scores can be explained by trait anxiety, an additional 6.2% by the BDI and 1.2% by state anxiety. Mediation analysis showed that state anxiety and BDI mediate the relationship between trait anxiety and FAS. Finally, BDI was found to exert a moderating role in the relationship between trait anxiety and fatigue. In conclusion, our study showed that nurses continue to experience high rates of anxiety, depression and fatigue. The variation in fatigue appears to be significantly dependent on trait anxiety. Depressive symptomatology and state anxiety exert a parallel positive mediation on the relationship between trait anxiety and fatigue, with depression exhibiting a moderating role in this relationship.

Depressive and anxiety symptoms in early childhood education teachers: Relations to professional well-being and absenteeism

This study investigated how early childhood education teachers' (N = 444) depressive and anxiety symptoms predicted their professional well-being outcomes and absenteeism over the course of one school year in Ghana. Higher anxiety and depressive symptoms predicted lower job motivation and job satisfaction and higher levels of emotional exhaustion at the end of the school year. Increased depressive symptoms were further associated with more days absent over the course of the school year. Findings point to the importance of considering teachers' mental health for early educational quality. Implications for policy and practice are discussed.

The CES-D as a Measure of Psychological Distress Among International Students: Measurement and Structural Invariance Across Gender

Detecting psychological distress among international students can be challenging given diverse languages, cultural backgrounds, and lack of refined measurement properties of measures tailored to international students. Despite the challenges, ensuring that a psychological distress measure works effectively has considerable potential value for assessment purposes. The current study evaluates the measurement properties of a short 10-item version of Radloff's Center for Epidemiologic Studies Depression Scale (CES-D). Grounded in long-standing evidence on gender differences in depressive symptoms, specific attention was given to examining measurement invariance of the CES-D Short-form across women and men. Based on a large, two-cohort sample of international students ( N = 468), and through multiple analyses evaluating factor structure and measurement invariance, we derived an even briefer, seven-item single-factor form of the CES-D (CES-D Short-form International) that can be used with international students.

The Association between Psychological Distress and Self-Reported Sleep Duration in a Population-Based Sample of Women and Men

Mental health and sleep are intricately linked. This study characterized associations of psychological distress with short (≤6 hours) and long (≥9 hours) sleep duration among adults aged ≥18 years. 2013 Behavioral Risk Factor Surveillance System data (n = 36,859) from Colorado, Minnesota, Nevada, Tennessee, and Washington included the Kessler 6 (K6) scale, which has been psychometrically validated for measuring severe psychological distress (SPD); three specifications were evaluated. Overall, 4.0% of adults reported SPD, 33.9% reported short sleep, and 7.8% reported long sleep. After adjustment, adults with SPD had 1.58 (95% CI: 1.45, 1.72) and 1.39 (95% CI: 1.08, 1.79) times higher probability of reporting short and long sleep duration, respectively. Using an ordinal measure showed a dose-response association with prevalence ratios of 1.00, 1.16, 1.38, 1.67, and 2.11 for short sleep duration. Each additional point added to the K6 scale was associated with 1.08 (95% CI: 1.07, 1.10) and 1.02 (95% CI: 1.00, 1.03) times higher probability of reporting short and long sleep duration, respectively. Some results were statistically different by gender. Any psychological distress, not only SPD, was associated with a higher probability of short sleep duration but not long sleep duration. These findings highlight the need for interventions.

Gender differences in depressive symptom profiles and patterns of psychotropic drug usage in Asian patients with depression: Findings from the Research on Asian Psychotropic Prescription Patterns for Antidepressants study

OBJECTIVES

The purpose of this study was to investigate whether there were gender-specific depressive symptom profiles or gender-specific patterns of psychotropic agent usage in Asian patients with depression.

METHOD

Clinical data from the Research on Asian Psychotropic Prescription Patterns for Antidepressant study (1171 depressed patients) were used to determine gender differences by analysis of covariates for continuous variables and by logistic regression analysis for discrete variables. In addition, a binary logistic regression model was fitted to identify independent clinical correlates of the gender-specific pattern on psychotropic drug usage.

RESULTS

Men were more likely than women to have loss of interest (adjusted odds ratio = 1.379, p = 0.009), fatigue (adjusted odds ratio = 1.298, p = 0.033) and concurrent substance abuse (adjusted odds ratio = 3.793, p = 0.008), but gender differences in other symptom profiles and clinical features were not significant. Men were also more likely than women to be prescribed adjunctive therapy with a second-generation antipsychotic (adjusted odds ratio = 1.320, p = 0.044). However, men were less likely than women to have suicidal thoughts/acts (adjusted odds ratio = 0.724, p = 0.028). Binary logistic regression models revealed that lower age (odds ratio = 0.986, p = 0.027) and current hospitalization (odds ratio = 3.348, p < 0.0001) were independent clinical correlates of use of second-generation antipsychotics as adjunctive therapy for treating depressed Asian men.

CONCLUSION

Unique gender-specific symptom profiles and gender-specific patterns of psychotropic drug usage can be identified in Asian patients with depression. Hence, ethnic and cultural influences on the gender preponderance of depression should be considered in the clinical psychiatry of Asian patients.

Geriatric Anxiety Scale: item response theory analysis, differential item functioning, and creation of a ten-item short form (GAS-10)

BACKGROUND

The Geriatric Anxiety Scale (GAS; Segal et al. (Segal, D. L., June, A., Payne, M., Coolidge, F. L. and Yochim, B. (2010). Journal of Anxiety Disorders, 24, 709-714. doi:10.1016/j.janxdis.2010.05.002) is a self-report measure of anxiety that was designed to address unique issues associated with anxiety assessment in older adults. This study is the first to use item response theory (IRT) to examine the psychometric properties of a measure of anxiety in older adults.

METHOD

A large sample of older adults (n = 581; mean age = 72.32 years, SD = 7.64 years, range = 60 to 96 years; 64% women; 88% European American) completed the GAS. IRT properties were examined. The presence of differential item functioning (DIF) or measurement bias by age and sex was assessed, and a ten-item short form of the GAS (called the GAS-10) was created.

RESULTS

All GAS items had discrimination parameters of 1.07 or greater. Items from the somatic subscale tended to have lower discrimination parameters than items on the cognitive or affective subscales. Two items were flagged for DIF, but the impact of the DIF was negligible. Women scored significantly higher than men on the GAS and its subscales. Participants in the young-old group (60 to 79 years old) scored significantly higher on the cognitive subscale than participants in the old-old group (80 years old and older).

CONCLUSIONS

Results from the IRT analyses indicated that the GAS and GAS-10 have strong psychometric properties among older adults. We conclude by discussing implications and future research directions.

Are male and female responses to social phobia diagnostic criteria comparable?

Females typically report higher social phobia levels than males in community samples, and this may be due to sex bias in assessment measures. This study aims to establish whether patterns of responding to social phobia diagnostic criteria in the Composite International Diagnostic Interview (CIDI) are comparable across males and females. A subsample of participants in the Australian National Survey of Mental Health and Wellbeing (1997) reporting at least one social fear were selected (n = 1755). Analyses were conducted using a series of multi-group confirmatory factor analyses for categorical data, with unique steps to model invariance of residual variances. Partial, but not full, invariance was established, as males and females differed in their responses to items assessing physical anxiety symptoms at low levels of social fear. Whilst these differences were statistically significant, they are likely not to affect clinical practice or rates of social phobia diagnosis. This supports differences on this measure being interpreted as genuine, and strengthens findings females are more vulnerable to social phobia than males.

Prevalence of anxiety and depression among chronic bronchitis patients and the associated factors

BACKGROUND AND OBJECTIVE

Patients with COPD, including those with chronic bronchitis (CB), have a high risk of suffering from psychiatric disorders. Although depression has always received greater attention in these patients, most of the published studies have been of poor methodological quality. Anxiety has received less attention than depression among COPD patients. The aim of this study was to assess the prevalence of anxiety and depression among patients with CB and to identify associated factors.

METHODS

This was a descriptive, epidemiological population-based study. The study was based on individual data obtained from the 2006 Spanish National Health Survey. Subjects aged 40years and over were selected for the study. Individuals with CB were identified using a specific questionnaire. Sociodemographic characteristics and health-related variables were analysed.

RESULTS

Of the 20,060 subjects selected, 1320 were categorized as having CB (6.5%). The prevalence of anxiety was 15.6% among subjects with CB and 9.4% among those without the disease (P<0.01). Variables that were independently and significantly associated with anxiety among CB patients were female gender, increased age and concomitant comorbidities. The prevalence of depression was 15.9% among subjects with CB and 7.6% among those without the disease (P<0.05). Variables associated with depression among CB patients were female gender, middle age, poorer self-perception of health status, concomitant comorbidities, abstemiousness and the need for emergency room attendance in the previous year.

CONCLUSIONS

Anxiety or depression is around twice as frequent among CB patients as it is among those without CB. Variables associated with anxiety or depression among CB patients included female gender and concomitant comorbidities.

Psychometric properties of the Center for Epidemiologic Studies Depression Scale (CES-D) in French clinical and nonclinical adults

BACKGROUND

Previous research on the Center for Epidemiologic Studies Depression Scale (CES-D) has five main limitations. First, no study provided evidence of the factorial equivalence of this instrument across samples of depressive and community participants. Second, only one study included systematic tests of measurement invariance based on confirmatory factor analyses (CFA), and this study did not consider the higher-order factor structure of depression, although it is the CES-D global scale score that is most often used in the context of epidemiological studies. Third, few studies investigated the screening properties of the CES-D in non-English-language samples and their results were inconsistent. Fourth, although the French version of the CES-D has been used in several previous studies, it has never been systematically validated among community and/or depressed adults. Finally, very few studies have taken into account the ordered-categorical nature of the CES-D answer scale. The purpose of the study reported herein was therefore to examine the construct validity (i.e., factorial, reliability, measurement invariance, latent mean invariance, convergence, and screening properties) of the CES-D in a French sample of depressed patients and community adults.

METHODS

A total sample of 469 participants, comprising 163 clinically depressed patients and 306 community adults, was involved in this study. The factorial validity, and the measurement and latent mean invariance of the CES-D across gender and clinical status, were verified through CFAs based on ordered-categorical items. Correlation and receiver operator characteristic curves were also used to test the convergent validity and screening properties of the CES-D.

RESULTS

The present results: (i) provided support for the factor validity and reliability of a second-order measurement model of depression based on responses to the CES-D items; (ii) revealed the full measurement invariance of the first- and second-order measurement models across gender; (iii) showed the partial strict measurement invariance (four uniquenesses had to be freely estimated, but the factor variance-covariance matrix also proved fully invariant) of the first-order factor model and the complete measurement invariance of the second-order model across patients and community adults; (iv) revealed a lack of latent mean invariance across gender and across clinical and community subsamples (with women and patients reporting higher scores on all subscales and on the full scale); (v) confirmed the convergent validity of the CES-D with measures of depression, self-esteem, anxiety, and hopelessness; and (vi) demonstrated the efficacy of the screening properties of this instrument among clinical and nonclinical adults.

CONCLUSION

This instrument may be useful for assessing depressive symptoms or for the screening of depressive disorders in the context of epidemiological studies targeting French patients and community men and women with a background similar to those from the present study.

A very short visual analog form of the Center for Epidemiologic Studies Depression Scale (CES-D) for the idiographic measurement of depression

BACKGROUND

The experience sampling method, also referred to as ecological momentary assessment (ESM-EMA) has recently gained popularity in the study of depression. However, no psychometrically sound multidimensional depression questionnaires specifically designed for the ESM-EMA context are currently available.

AIMS

The main objective of the present study was to develop and validate a very short visual analog scale of the Center for Epidemiologic Studies Depression Scales (CES-D-VAS-VS) specifically designed for the ESM-EMA context. To this end, the full French version of the CES-D was adapted for the ESM-EMA context. From this full-length adapted version a very short version was then extracted from this longer instrument and validated.

STUDY DESIGN

A sample comprising 163 patients with a major depressive episode (MDE) and 306 participants without mental disorders was involved in this study.

RESULTS

The obtained results provided support for the factor validity, strong measurement invariance (invariance of the loadings and intercepts of the measurement model) across sex and clinical status groups, reliability and convergent validity of the CES-D-VAS-VS. This instrument comprises 4 items measuring positive affect, depressive affect, somatic complaints and disturbed interpersonal relationships.

CONCLUSION

The present results provide preliminary evidence regarding the construct validity of the CES-D-VAS-VS among patients and community adults sample but also underline the need to rely on latent variables methods in the use of this instrument to account for the differential levels of measurement errors (uniquenessess) that were observed across groups.

A life-course and time perspective on the construct validity of psychological distress in women and men. Measurement invariance of the K6 across gender

Background

Psychological distress is a widespread indicator of mental health and mental illness in research and clinical settings. A recurrent finding from epidemiological studies and population surveys is that women report a higher mean level and a higher prevalence of psychological distress than men. These differences may reflect, to some extent, cultural norms associated with the expression of distress in women and men. Assuming that these norms differ across age groups and that they evolve over time, one would expect gender differences in psychological distress to vary over the life-course and over time. The objective of this study was to investigate the construct validity of a psychological distress scale, the K6, across gender in different age groups and over a twelve-year period.

Methods

This study is based on data from the Canadian National Population Health Survey (C-NPHS). Psychological distress was assessed with the K6, a scale developed by Kessler and his colleagues. Data were examined through multi-group confirmatory factor analyses. Increasing levels of measurement and structural invariance across gender were assessed cross-sectionally with data from cycle 1 (n = 13019) of the C-NPHS and longitudinally with cycles 1 (1994-1995), 4 (2000-2001) and 7 (2006-2007).

Results

Higher levels of measurement and structural invariance across gender were reached only after the constraint of equivalence was relaxed for various parameters of a few items of the K6. Some items had a different pattern of gender non invariance across age groups and over the course of the study. Gender differences in the expression of psychological distress may vary over the lifespan and over a 12-year period without markedly affecting the construct validity of the K6.

Conclusions

This study confirms the cross-gender construct validity of psychological distress as assessed with the K6 despite differences in the expression of some symptoms in women and in men over the life-course and over time. Findings suggest that the higher mean level of psychological distress observed in women reflects a true difference in distress and is unlikely to be gender-biased. Gender differences in psychological distress are an important public health and clinical issue and further researches are needed to decipher the factors underlying these differences.

Predictors of mental health, subjective burden, and rewards in family caregivers of patients with chronic liver disease

Patients with chronic liver disease (CLD) often experience severe symptoms that cause functional impairment and necessitate assistance from a family caregiver. Few studies investigate family caregivers of patients with CLD. This descriptive correlation study described demographic characteristics, depressive and anxiety symptom levels, and prevalence of hazardous drinking, rewards, and subjective burden and explicated predictors of subjective burden and mental health status for a convenience sample of 73 family caregivers of persons with CLD. Interventions are needed to offset decreased income reported by caregivers and to treat depressive symptoms; clinically significant levels were present, and clinical referrals were warranted in this study sample.

Cardiovascular risk factors and life events as antecedents of depressive symptoms in middle and early-old age: PATH Through Life Study

OBJECTIVE

To evaluate cardiovascular risk factors (CVRF) and life events (LE) as predictors of depressive symptoms in a mid-life and an early late-life cohort to determine whether they had independent or interacting effects, and whether there were age differences in the effects.

METHODS

Cohorts aged 40 to 44 years (n = 2530) and 60 to 64 years (n = 2551) at baseline (Wave 1) were followed up after 4 years (Wave 2) as part of the PATH Through Life Study based in Canberra and Queanbeyan, Australia. Cross-sectional analyses evaluated rates of CVRF and LE in depressed compared with nondepressed participants. Hierarchical generalized linear models were used to evaluate demographic variables, CVRF (diabetes, smoking, alcohol, body mass index, cholesterol medication, hypertension), LE, and Wave 1 depressive symptoms as predictors of depressive symptoms at Wave 2.

RESULTS

At baseline, those with high levels of depressive symptoms were more likely to report smoking, using cholesterol-lowering medications, hypertension, diabetes, past stroke, and higher body mass index. Predictors of depressive symptoms at Wave 2 in the cohort of 40- to 44-year-old persons included Wave 1 depressive symptoms, diabetes, and LE at Wave 2. In the cohort of 60- to 64-year-old individuals, Wave 1 depression, stroke, smoking, low education, and Wave 2 LE predicted depressive symptoms. There was no evidence of interactions between CVRF and LE.

CONCLUSIONS

LE and CVRF are independent sets of risk factors for depressive symptoms with different effects in the 40- to 44-year-old and 60- to 64-year-old cohorts. These findings have implications for preventative strategies for depression.

Gender differences in depression and anxiety across the adult lifespan: the role of psychosocial mediators

BACKGROUND

There is robust epidemiological and clinical evidence that a greater number of women than men experience depression and anxiety. This study investigated a number of socio-demographic, health and lifestyle, psychological and social factors as possible mediators for the gender difference in depression and anxiety in three cohorts (20-24, 40-44, 60-64).

METHODS

Responses were from a representative, community based survey (n = 7,485) conducted in Canberra and Queanbeyan (NSW), in Australia. Depression and anxiety were measured using the self-report Goldberg Anxiety and Depression Scales. The analyses initially identified gender differences in the potential mediators, followed by univariate and multivariate mediation models.

RESULTS

The results indicated several shared mediators for depression and anxiety across the three age groups including: childhood adversity, mastery, behavioural inhibition, ruminative style, neuroticism, physical health, physical activity, and perceived interpersonal and employment problems. There was a decrease in the number of social mediators as age increased. The multivariate models accounted for gender differences in both conditions for all age groups, except for anxiety in the 20-24 years old. This suggests further important unmeasured mediators for this age group.

CONCLUSIONS

These findings add to the literature surrounding gender differences in depression and anxiety, and provide a basis for future research exploring variation in these gender disparities over the adult lifespan.