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Alias A, Bertrand L, Bisson-Gervais V, Henry M. Suicide in obstructive lung, cardiovascular and oncological disease. Prev Med 2021; 152:106543. [PMID: 34538370 DOI: 10.1016/j.ypmed.2021.106543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 01/04/2023]
Abstract
Healthcare institutions face increasing demands stemming from the burden of noncommunicable diseases. The personal, social, financial and societal impact of these diseases are well-documented. However, the mental health concerns and trajectories of patients afflicted by chronic medical diseases have been under-recognized and are under-resourced. Despite that chronic diseases are associated with substantially increased risk of suicide, the medical world has largely failed to properly address suicide in the medically ill. Considering their high prevalence and mortality rate, this review article will highlight the mental health burden and suicide risk in obstructive lung, cardiovascular (including stroke) and oncological disease, in light of relevant data and conceptual models of suicide. Finally, general evidence-based suicide intervention strategies and potential selective adaptation of these strategies to the chronic medically ill patient populations and medical settings will be reviewed.
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Affiliation(s)
- Ali Alias
- Faculty of Medicine and Health Sciences, McGill University, 3605 de la Montagne, Montreal, QC H3G 2M1, Canada
| | - Lia Bertrand
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, St Joseph's Healthcare Hamilton, West 5(th) Campus, 100 West 5(th) Street, Hamilton, ON L8N 3K7, Canada.
| | - Vanessa Bisson-Gervais
- Faculty of Medicine and Health Sciences, McGill University, 3605 de la Montagne, Montreal, QC H3G 2M1, Canada
| | - Melissa Henry
- Gerald Bronfman Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, 5100 de Maisonneuve Blvd. West, Suite 720, Montreal, QC H4A 3T2, Canada; Segal Cancer Centre, Jewish General Hospital, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, QC H3T 1E2, Canada; Lady-Davis Institute for Medical Research, Jewish General Hospital, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, QC H3T 1E2, Canada
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Korpinen L, Pääkkönen R. Self-reported depression and anxiety symptoms and usage of computers and mobile phones among working-age Finns. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2015; 21:221-8. [PMID: 26323782 DOI: 10.1080/10803548.2015.1029292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of the work is to study self-reported depression and anxiety symptoms among working-age Finns using logistical regression models. The study was carried out as a cross-sectional study by posting a questionnaire to 15,000 working-age persons. The responses (6121) revealed that 101 (1.7%) Finnish working-age persons suffered depression very often and 77 (1.3%) suffered anxiety very often during the last 12 months. Symptoms uncovered in the comparative analysis of respondents who had quite often or more often depression to respondents who had less depression showed differentiation. The same result was obtained in the analysis of self-reported anxiety symptoms. With the logistical regression models (from depression and anxiety), we found associations between physical symptoms (in shoulder) and depression and between different mental symptoms and anxiety or depression. In the future, it is important to take into accout that persons with physical symptoms can also have mental symptoms (depression or anxiety).
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A Cross-Sectional Study of the Psychological Needs of Adults Living with Cystic Fibrosis. PLoS One 2015; 10:e0127944. [PMID: 26102351 PMCID: PMC4478009 DOI: 10.1371/journal.pone.0127944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Depression and anxiety are prevalent in people with cystic fibrosis (CF), yet psychological services are rarely accessible in CF clinics. This cross-sectional single center study reports on a psychological needs assessment of people with CF. METHODS We asked adults attending a CF clinic, without integrated psychological services, to complete a psychological needs assessment survey that included items on: a) past access to psychological services (via a CF referral service), b) concerns relevant to discuss with a psychologist, and c) their likelihood of accessing psychological services if available at the CF clinic, and standardized measures of depression (CES-D) and anxiety (GAD-7). RESULTS We enrolled 49 participants and 45 (91.8%) completed the survey. Forty percent reported elevated symptoms of depression and 13% had elevated anxiety. A majority of individuals (72.2% and 83.3%, respectively) indicated they would be likely to use psychological services, if available at the clinic. Concerns considered most relevant to discuss with a psychologist were: 1) worries (51.1%), 2) mood (44.4%), 3) life stress (46.6%), 4) adjustment to CF (42.2%), 5) life transitions (42.2%) and 6) quality of life (42.2%). CONCLUSIONS This study highlights the rationale for screening adults with CF for depression and anxiety, and to facilitate provision of psychological services and preventative mental health interventions as an integral component of multi-disciplinary CF care.
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Jauregui A, Ponte J, Salgueiro M, Unanue S, Donaire C, Gómez MC, Burgos-Alonso N, Grandes G. Efficacy of a cognitive and behavioural psychotherapy applied by primary care psychologists in patients with mixed anxiety-depressive disorder: a research protocol. BMC FAMILY PRACTICE 2015; 16:39. [PMID: 25879932 PMCID: PMC4373067 DOI: 10.1186/s12875-015-0248-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 02/23/2015] [Indexed: 11/16/2022]
Abstract
Background In contrast with the recommendations of clinical practice guidelines, the most common treatment for anxiety and depressive disorders in primary care is pharmacological. The aim of this study is to assess the efficacy of a cognitive-behavioural psychological intervention, delivered by primary care psychologists in patients with mixed anxiety-depressive disorder compared to usual care. Methods/Design This is an open-label, multicentre, randomized, and controlled study with two parallel groups. A random sample of 246 patients will be recruited with mild-to-moderate mixed anxiety-depressive disorder, from the target population on the lists of 41 primary care doctors. Patients will be randomly assigned to the intervention group, who will receive standardised cognitive-behavioural therapy delivered by psychologists together with usual care, or to a control group, who will receive usual care alone. The cognitive-behavioural therapy intervention is composed of eight individual 60-minute face-to face sessions conducted in eight consecutive weeks. A follow-up session will be conducted over the telephone, for reinforcement or referral as appropriate, 6 months after the intervention, as required. The primary outcome variable will be the change in scores on the Short Form-36 General Health Survey. We will also measure the change in the frequency and intensity of anxiety symptoms (State-Trait Anxiety Inventory) and depression (Beck Depression Inventory) at baseline, and 3, 6 and 12 months later. Additionally, we will collect information on the use of drugs and health care services. Discussion The aim of this study is to assess the efficacy of a primary care-based cognitive-behavioural psychological intervention in patients with mixed anxiety-depressive disorder. The international scientific evidence has demonstrated the need for psychologists in primary care. However, given the differences between health policies and health services, it is important to test the effect of these psychological interventions in our geographical setting. Trial registration NCT01907035 (July 22, 2013).
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Affiliation(s)
- Amale Jauregui
- Sopela Health Centre, Basque Health Service (Osakidetza), Sopela, Spain.
| | | | - Monika Salgueiro
- Primary Care Research Unit of Bizkaia (UIAPB)- Osakidetza, Luis Power 18, 4ª planta, E-48014, Bilbao, Spain. .,Basic Psychological Processes and Development Department, Faculty of Psychology, University of the Basque Country (UPV/EHU), Donostia-San Sebastian, Spain.
| | - Saloa Unanue
- Sopela Health Centre, Basque Health Service (Osakidetza), Sopela, Spain. .,School of Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain.
| | | | | | - Natalia Burgos-Alonso
- Primary Care Research Unit of Bizkaia (UIAPB)- Osakidetza, Luis Power 18, 4ª planta, E-48014, Bilbao, Spain. .,Department of Preventive Medicine and Public Health, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Leioa, Spain.
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia (UIAPB)- Osakidetza, Luis Power 18, 4ª planta, E-48014, Bilbao, Spain.
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Høifødt RS, Lillevoll KR, Griffiths KM, Wilsgaard T, Eisemann M, Waterloo K, Kolstrup N. The clinical effectiveness of web-based cognitive behavioral therapy with face-to-face therapist support for depressed primary care patients: randomized controlled trial. J Med Internet Res 2013; 15:e153. [PMID: 23916965 PMCID: PMC3742404 DOI: 10.2196/jmir.2714] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 07/03/2013] [Accepted: 07/12/2013] [Indexed: 11/13/2022] Open
Abstract
Background Most patients with mild to moderate depression receive treatment in primary care, but despite guideline recommendations, structured psychological interventions are infrequently delivered. Research supports the effectiveness of Internet-based treatment for depression; however, few trials have studied the effect of the MoodGYM program plus therapist support. The use of such interventions could improve the delivery of treatment in primary care. Objective To evaluate the effectiveness and acceptability of a guided Web-based intervention for mild to moderate depression, which could be suitable for implementation in general practice. Methods Participants (N=106) aged between 18 and 65 years were recruited from primary care and randomly allocated to a treatment condition comprising 6 weeks of therapist-assisted Web-based cognitive behavioral therapy (CBT), or to a 6-week delayed treatment condition. The intervention included the Norwegian version of the MoodGYM program, brief face-to-face support from a psychologist, and reminder emails. The primary outcome measure, depression symptoms, was measured by the Beck Depression Inventory-II (BDI-II). Secondary outcome measures included the Beck Anxiety Inventory (BAI), the Hospital Anxiety and Depression Scale (HADS), the Satisfaction with Life Scale (SWLS), and the EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D). All outcomes were based on self-report and were assessed at baseline, postintervention, and at 6-month follow-up. Results Postintervention measures were completed by 37 (71%) and 47 (87%) of the 52 participants in the intervention and 54 participants in the delayed treatment group, respectively. Linear mixed-models analyses revealed a significant difference in time trends between the groups for the BDI-II, (P=.002), for HADS depression and anxiety subscales (P<.001 and P=.001, respectively), and for the SWLS (P<.001). No differential group effects were found for the BAI and the EQ-5D. In comparison to the control group, significantly more participants in the intervention group experienced recovery from depression as measured by the BDI-II. Of the 52 participants in the treatment program, 31 (60%) adhered to the program, and overall treatment satisfaction was high. The reduction of depression and anxiety symptoms was largely maintained at 6-month follow-up, and positive gains in life satisfaction were partly maintained. Conclusions The intervention combining MoodGYM and brief therapist support can be an effective treatment of depression in a sample of primary care patients. The intervention alleviates depressive symptoms and has a significant positive effect on anxiety symptoms and satisfaction with life. Moderate rates of nonadherence and predominately positive evaluations of the treatment also indicate the acceptability of the intervention. The intervention could potentially be used in a stepped-care approach, but remains to be tested in regular primary health care. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12610000257066; http://apps.who.int/trialsearch/trial.aspx?trialid=ACTRN12610000257066 (Archived by WebCite at http://www.webcitation.org/6Ie3YhIZa).
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Dumesnil H, Cortaredona S, Verdoux H, Sebbah R, Paraponaris A, Verger P. General practitioners' choices and their determinants when starting treatment for major depression: a cross sectional, randomized case-vignette survey. PLoS One 2012; 7:e52429. [PMID: 23272243 PMCID: PMC3525552 DOI: 10.1371/journal.pone.0052429] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 11/13/2012] [Indexed: 11/18/2022] Open
Abstract
Background In developed countries, primary care physicians manage most patients with depression. Relatively few studies allow a comprehensive assessment of the decisions these doctors make in these cases and the factors associated with these decisions. We studied how general practitioners (GPs) manage the acute phase of a new episode of non-comorbid major depression (MD) and the factors associated with their decisions. Methodology/Principal Findings In this cross-sectional telephone survey, professional investigators interviewed an existing panel of randomly selected GPs (1249/1431, response rate: 87.3%). We used case-vignettes about new MD episodes in 8 versions differing by patient gender and socioeconomic status (blue/white collar) and disease intensity (mild/severe). GPs were randomized to receive one of these 8 versions. Overall, 82.6% chose pharmacotherapy; among them GPs chose either an antidepressant (79.8%) or an anxiolytic/hypnotic alone (18.5%). They rarely recommended referral for psychotherapy alone, regardless of severity, but 38.2% chose it in combination with pharmacotherapy. Antidepressant prescription was associated with severity of depression (OR = 1.74; 95%CI = 1.33–2.27), patient gender (female, OR = 0.75; 95%CI = 0.58–0.98), GP personal characteristics (e.g. history of antidepressant treatment: OR = 2.31; 95%CI = 1.41–3.81) and GP belief that antidepressants are overprescribed in France (OR = 0.63; 95%CI = 0.48–0.82). The combination of antidepressants and psychotherapy was associated with severity of depression (OR = 1.82; 95%CI = 1.31–2.52), patient's white-collar status (OR = 1.58; 95%CI = 1.14–2.18), and GPs' dissatisfaction with cooperation with mental health specialists (OR = 0.63; 95%CI = 0.45–0.89). These choices were not associated with either GPs' professional characteristics or psychiatrist density in the GP's practice areas. Conclusions/Significance GPs' choices for treating severe MD complied with clinical guidelines better than those for mild MD; GPs rarely recommended psychotherapy alone but rather as a complement to pharmacotherapy. Their decisions were mainly influenced by personal life experience and attitudes regarding treatment more than by professional characteristics. These results call into question the methods and content of continuing medical education in France about MD management.
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Affiliation(s)
- Hélène Dumesnil
- UMR912, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Institut National de la Santé et de la Recherche Médicale (INSERM), Marseille, France
- UMR-S912, Aix Marseille Université, Institut Recherche et Développement (IRD), Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur (ORS Paca), Marseille, France
| | - Sébastien Cortaredona
- UMR912, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Institut National de la Santé et de la Recherche Médicale (INSERM), Marseille, France
- UMR-S912, Aix Marseille Université, Institut Recherche et Développement (IRD), Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur (ORS Paca), Marseille, France
| | - Hélène Verdoux
- U657, Université Bordeaux, Bordeaux, France
- U657, INSERM, Bordeaux, France
| | - Rémy Sebbah
- Union régionale des professionnels de santé - Médecins libéraux - Provence-Alpes-Côte d'Azur, Marseille, France
| | - Alain Paraponaris
- UMR912, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Institut National de la Santé et de la Recherche Médicale (INSERM), Marseille, France
- UMR-S912, Aix Marseille Université, Institut Recherche et Développement (IRD), Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur (ORS Paca), Marseille, France
| | - Pierre Verger
- UMR912, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Institut National de la Santé et de la Recherche Médicale (INSERM), Marseille, France
- UMR-S912, Aix Marseille Université, Institut Recherche et Développement (IRD), Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur (ORS Paca), Marseille, France
- * E-mail:
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Orive M, Quintana JM, Vrotsou K, Las Hayas C, Bilbao A, Barrio I, Matellanes B, Padierna JA. Applying a coping with stress questionnaire for cancer patients to patients with non-cancer chronic illnesses. J Health Psychol 2012; 18:737-49. [PMID: 23221615 DOI: 10.1177/1359105312464673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
One of the few instruments to evaluate coping skills among patients with chronic illnesses is the Cuestionario de Afrontamiento al Estrés para Pacientes Oncológicos (CAEPO), created initially for cancer patients. We evaluate how well CAEPO applies to patients with non-cancer chronic illnesses. A total of 344 patients (115 with chronic hepatitis C, 120 with inflammatory bowel disease and 109 with recurrent vertigo) completed the CAEPO. Exploratory factor analysis and Cronbach's alpha provide only partial support for the seven factors suggested by the original CAEPO. A streamlined version with fewer dimensions and items may be a better solution for identifying coping strategies among these patients.
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Affiliation(s)
- Miren Orive
- Health Services Research on Chronic Patients Network (REDISSEC), Hospital Galdakao-Usansolo, Spain.
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Alaghehbandan R, MacDonald D, Barrett B, Collins K, Chen Y. Using Administrative Databases in the Surveillance of Depressive Disorders—Case Definitions. Popul Health Manag 2012; 15:372-80. [DOI: 10.1089/pop.2011.0084] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Reza Alaghehbandan
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Don MacDonald
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
- Research and Evaluation Department, Newfoundland and Labrador Centre for Health Information, St. John's, Newfoundland, Canada
| | - Brendan Barrett
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Kayla Collins
- Research and Evaluation Department, Newfoundland and Labrador Centre for Health Information, St. John's, Newfoundland, Canada
| | - Yue Chen
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Høifødt RS, Strøm C, Kolstrup N, Eisemann M, Waterloo K. Effectiveness of cognitive behavioural therapy in primary health care: a review. Fam Pract 2011; 28:489-504. [PMID: 21555339 DOI: 10.1093/fampra/cmr017] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Depression and anxiety are highly prevalent disorders causing substantial impairment in daily life. Cognitive behavioural therapy (CBT) delivered face-to-face or as self-help has shown to be an effective treatment for these disorders. Such treatments may be suitable for delivery in primary health care. AIM The aim of the article was to review research on the effectiveness of CBT for depression and anxiety disorders delivered in primary care by primary care therapists. METHODS A literature search of quantitative studies of the effectiveness of CBT delivered in primary care was conducted on multiple electronic databases. A total of 17 studies were included in the review. RESULTS Eight studies of supported Internet- or computer-based CBT, six of which were randomized controlled trials (RCTs), indicate that this treatment is effective for mild to moderate depression and anxiety. Five studies suggest that this treatment may be more effective than usual care for mild to moderate but not for more severe symptoms. Results of four RCTs of brief therapies using written self-help material suggest that while such interventions are effective, no particular approach outperformed any other, including usual care. Five RCTs of CBT delivered face-to-face show that this treatment can be effective when delivered by therapists highly educated in the mental health field. However, many primary care therapists may find such interventions too time consuming. CONCLUSIONS CBT delivered in primary care, especially including computer- or Internet-based self-help programs, is potentially more effective than usual care and could be delivered effectively by primary care therapists.
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Orive M, Padierna JA, Las Hayas C, Vrotsou K, Quintana JM. Use of the long and short forms of the depression in the medically ill questionnaire in a Spanish population. Assessment 2011; 20:511-20. [PMID: 21245050 DOI: 10.1177/1073191110397273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study sought to translate, using a back-translation procedure, and evaluate the psychometric characteristics of Depression in the Medically Ill questionnaire (DMI-18) and its short version (DMI-10) in a Spanish population. Patients with somatic disorders (N = 366) completed the translated DMI-18 and another depression questionnaire. Among these, 167 were also assessed by a mental health professional (gold standard) to test criterion validity. Furthermore, coefficient alpha for both the versions were high (>.90), and convergent validity assessed against the Beck Depression Inventory for Primary Care, the Hospital Anxiety and Depression Scale, and the Patient Health Questionnaire-9 was satisfactory (r > .74). Confirmatory factor analysis results supported the one-factor model. When compared with the gold standard, sensitivity and specificity were 93% and 73% for DMI-18 and 87% and 74% for DMI-10, respectively. Thus, both the versions are acceptable measures that can be used by nonpsychiatric professionals to detect affective comorbidities in their patients.
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Affiliation(s)
- Miren Orive
- Hospital Galdakao-Usansolo, Galdakao-Bizkaia, Spain.
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Orive M, Padierna JA, Quintana JM, Las-Hayas C, Vrotsou K, Aguirre U. Detecting depression in medically ill patients: Comparative accuracy of four screening questionnaires and physicians' diagnoses in Spanish population. J Psychosom Res 2010; 69:399-406. [PMID: 20846541 DOI: 10.1016/j.jpsychores.2010.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 04/18/2010] [Accepted: 04/19/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this study is to compare the diagnostic accuracy of four depression screening tools commonly used in patients with medical disorders, relative to a reference diagnostic standard-a structured psychiatric interview. METHODS The Depression in the Medically Ill-18 (DMI-18) questionnaire was administered to 167 patients with medical disorders; of those, 53 completed the Beck Depression Inventory for Primary Care (BDI-PC), 67 the Hospital Anxiety and Depression Scale (HADS), and 46 the Patient Health Questionnaire-9 (PHQ-9). The entire sample was also interviewed with a structured psychiatric interview conducted by a mental health professional. Sensitivity, specificity, likelihood ratios (LRs), and area under the curve (AUC) were calculated and compared for the different measures. RESULTS At their respective recommended cutoff points, sensitivities [95% confidence interval (CI)] were 86% (70-95), 82% (63-94), 93% (86-97), and 68% (47-85) for the HADS-D, BDI-PC, DMI-18, and PHQ-9, respectively, while specificities ranged from 72% (47-90) for BDI-PC to 89% (72-98) for PHQ-9. The sensitivities of DMI-18 were significantly higher compared to those of HADS-D (P=.045) and PHQ-9 (P=.01). The PHQ-9 questionnaire obtained the most favorable positive LR (6.35; 95% CI, 2.48-18.36). In contrast, the DMI-18 showed the best negative LR (0.09; 95% CI, 0.04-0.18). Areas under the curves (95% CI) ranged from 0.92 (0.83-1.02) to 0.84 (0.74-0.94). Statistically significant differences were found between the AUCs of the DMI-10 and the BDI-PC. CONCLUSION Our results suggest that all evaluated scales have acceptable abilities and can be used as screening instruments for depression in patients with medical disorders. The DMI stands out for its sensitivity.
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Affiliation(s)
- Miren Orive
- Research Unit-CIBER Epidemiología y Salud Pública (CIBERESP), Hospital Galdakao-Usansolo, Bizkaia, Spain.
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Addressing stigma of depression in Latino primary care patients. Gen Hosp Psychiatry 2010; 32:182-91. [PMID: 20302993 DOI: 10.1016/j.genhosppsych.2009.10.008] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 10/30/2009] [Accepted: 10/30/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To develop a validated stigma checklist to assist physicians in addressing depression in Latino patients. METHOD Two hundred low-income, Spanish-speaking, Latino patients in primary care clinics were screened for depression using Patient Health Questionnaires (PHQ-2 and PHQ-9), and medical records were reviewed. With the use of a wide pool of stigma items, empirical methods were used to develop a stigma checklist from this primary care sample and patient information was used to demonstrate construct validity. RESULTS Patients reporting higher levels of perceived stigma using the stigma checklist were less likely to disclose their depression diagnosis to their family and friends (P<.05) and also less likely to be taking depression medication (OR=.78; 95% CI, .62-.99). Patients with stigma were less likely to be able to manage their depression (OR=.79; 95% CI, .65-.96) and more likely to have missed scheduled appointment visits (OR=1.44; 95% CI, 1.03-2.02). CONCLUSION Given the strong relationship between stigma and care of depression, primary care clinicians should be aware of and address stigma among their depressed Latino patients. The stigma checklist presented for treating Spanish-speaking Latino patients in primary care may be used to assess depressed patients for stigma to help inform clinical management of patients.
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Harrison DL, Miller MJ, Schmitt MR, Touchet BK. Variations in the probability of depression screening at community-based physician practice visits. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2010; 12:PCC.09m00911. [PMID: 21274358 PMCID: PMC3025997 DOI: 10.4088/pcc.09m00911blu] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 01/04/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite depression screening being a US Preventive Services Task Force-recommended practice in primary care, little is known about the degree to which it is performed and the factors associated with its conduct. METHOD Using a nationally representative sample (National Ambulatory Medical Care Survey) of adult, community-based physician practice visits during the survey years 2005 to 2007 (total = 55,143; representing approximately 1.7 billion visits nationally), we estimated the probability of depression screening and variation by visit characteristics. RESULTS Depression screening occurred at 2.29% of adult, community-based physician practice visits. Visits with primary care physicians were more likely to include depression screening (AOR = 2.19; 95% CI, 1.31-3.65), as were visits for preventive (AOR = 4.09; 95% CI, 2.55-6.57) and chronic care (AOR = 2.00; 95% CI, 1.44-2.80) compared to visits for acute care. Compared to the Northeast, visits in the West were less likely to include depression screening (AOR = 0.27; 95% CI, 0.13-0.57), as were visits for patients having ≥ 6 visits within the past 12 months (AOR = 0.65; 95% CI, 0.42-1.00) when compared to visits for new patients. Depression screening was more common at visits for patients with ICD-9-diagnosed depression (AOR = 7.51; 95% CI, 5.38-10.50) and for females (AOR = 1.26; 95% CI, 1.00-1.57). Bivariate analyses revealed that depression screening was more common at visits for patients with hyperlipidemia (3.21% vs 2.09%, P = .0086), obesity (4.59% vs 2.08%, P < .0001), and osteoporosis (4.46% vs 2.21%, P = .0002) and less common at visits for patients with diabetes (1.58% vs 2.39%, P = .0102). CONCLUSIONS Depression screening at community-based physician practice visits in the United States appears to be low (2.29%) and may reflect an undefined optimal screening interval or strategy in published guidelines, lack of reimbursement incentives, or incomplete documentation in the medical record. Opportunities exist to improve depression screening in males, patients with chronic disease (especially diabetes), and the western region of the United States.
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Affiliation(s)
- Donald L Harrison
- Department of Pharmacy, Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma, Oklahoma City, OK, USA.
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Detweiler-Bedell JB, Friedman MA, Leventhal H, Miller IW, Leventhal EA. Integrating co-morbid depression and chronic physical disease management: identifying and resolving failures in self-regulation. Clin Psychol Rev 2008; 28:1426-46. [PMID: 18848740 PMCID: PMC2669084 DOI: 10.1016/j.cpr.2008.09.002] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 08/15/2008] [Accepted: 09/02/2008] [Indexed: 11/22/2022]
Abstract
Research suggests that treatments for depression among individuals with chronic physical disease do not improve disease outcomes significantly, and chronic disease management programs do not necessarily improve mood. For individuals experiencing co-morbid depression and chronic physical disease, demands on the self-regulation system are compounded, leading to a rapid depletion of self-regulatory resources. Because disease and depression management are not integrated, patients lack the understanding needed to prioritize self-regulatory goals in a way that makes disease and depression management synergistic. A framework in which the management of co-morbidity is considered alongside the management of either condition alone offers benefits to researchers and practitioners and may help improve clinical outcomes.
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