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Shulyaev K, Spielberg Y, Gur-Yaish N, Zisberg A. Family Support During Hospitalization Buffers Depressive Symptoms Among Independent Older Adults. Clin Gerontol 2024; 47:341-351. [PMID: 37493087 DOI: 10.1080/07317115.2023.2236097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
OBJECTIVES Hospitalization is a stressful event that may lead to deterioration in older adults' mental health. Drawing on the stress-buffering hypothesis, we examined whether family support during hospitalization would moderate the relations between level of independence and in-hospital depressive symptoms. METHOD This research was a secondary analysis of a cohort study conducted with a sample of 370 hospitalized older adults. Acutely ill older adults reported their level of independence at time of hospitalization and their level of depressive symptoms three days into the hospital stay. Family support was estimated by a daily report of hours family members stayed with the hospitalized older adult. RESULTS Independent older adults whose family members stayed longer hours in the hospital had fewer depressive symptoms than independent older adults with shorter family visits. Relations between depressive symptoms and family support were not apparent for dependent older adults, even though their family members stayed more hours. CONCLUSIONS This study partially supports the stress-buffering hypothesis, in that social support ameliorated depressive symptoms among hospitalized independent older adults. CLINICAL IMPLICATIONS Assessing depressive symptoms and functional ability and creating an environment conducive to family support for older adults may be beneficial to hospitalized older adults' mental health.
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Affiliation(s)
- Ksenya Shulyaev
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel
- The Minerva Centre on Intersectionality in Aging (MCIA), Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel
| | - Yochy Spielberg
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel
| | - Nurit Gur-Yaish
- The Faculty of Graduate Studies, Oranim Academic College of Education, Kiryat Tiv'on, Israel
| | - Anna Zisberg
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel
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2
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Walter HJ, Abright AR, Bukstein OG, Diamond J, Keable H, Ripperger-Suhler J, Rockhill C. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders. J Am Acad Child Adolesc Psychiatry 2023; 62:479-502. [PMID: 36273673 DOI: 10.1016/j.jaac.2022.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To enhance the quality of care and clinical outcomes for children and adolescents with major depressive disorder (MDD) and persistent depressive disorder (PDD). The aims are as follows: (1) to summarize empirically based guidance about the psychosocial and psychopharmacologic treatment of MDD and PDD in children and adolescents; and (2) to summarize expert-based guidance about the assessment of these disorders as an integral part of treatment, and the implementation of empirically based treatments for these disorders in clinical practice. METHOD Statements about the treatment of MDD and PDD are based upon empirical evidence derived from a critical systematic review of the scientific literature conducted by the Research Triangle Institute International-University of North Carolina at Chapel Hill (RTI-UNC) Evidence-based Practice Center under contract with the Agency for Healthcare Research and Quality (AHRQ). Evidence from meta-analyses published since the AHRQ/RTI-UNC review is also presented to support or refute the AHRQ findings. Guidance about the assessment and clinical implementation of treatments for MDD and PDD is informed by expert opinion and consensus as presented in previously published clinical practice guidelines, chapters in leading textbooks of child and adolescent psychiatry, the DSM-5-TR, and government-affiliated prescription drug information websites. RESULTS Psychotherapy (specifically, cognitive-behavioral and interpersonal therapies) and selective serotonin reuptake inhibitor (SSRI) medication have some rigorous (randomized controlled trials, meta-analyses) empirical support as treatment options. Because effective treatment outcomes are predicated in part upon accuracy of the diagnosis, depth of the clinical formulation, and breadth of the treatment plan, comprehensive, evidence-based assessment may enhance evidence-based treatment outcomes. CONCLUSION Disproportionate to the magnitude of the problem, there are significant limitations in the quality and quantity of rigorous empirical support for the etiology, assessment, and treatment of depression in children and adolescents. In the context of a protracted severe shortage of child and adolescent-trained behavioral health specialists, the demonstration of convenient, efficient, cost-effective, and user-friendly delivery mechanisms for safe and effective treatment of MDD and PDD is a key research need. Other research priorities include the sequencing and comparative effectiveness of depression treatments, delineation of treatment mediators and moderators, effective approaches to treatment nonresponders and disorder relapse/recurrence, long-term effects and degree of suicide risk with SSRI use, and the discovery of novel pharmacologic or interventional treatments.
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Fakhari A, Herizchi S, Sadeghi-Bazargani H, Amiri S, Noorazar SG, Mirzajanzade M, Barzegar H, Farahbakhsh M, Azizi H. Prevalence of psychiatric disorders in the aging population in the northeastern of Iran. MIDDLE EAST CURRENT PSYCHIATRY 2023. [DOI: 10.1186/s43045-023-00287-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Abstract
Background
The prevalence of psychiatric disorders by demographic characteristics in elderly people is poorly understood, at least in the northwest of Iran. We aimed to estimate the prevalence of various psychiatric disorders in the elderly population in East Azerbaijan Province, Tabriz. A total of 1000 aging people were randomly selected from the general population. Data were collected using valid structured instruments and face-to-face interviews by trained psychologists. The Structured Clinical Interview for DSM-IV-TR (SCID-IV) and Abbreviated Mental Test Questionnaire were used. Chi-square (χ2) test was used for categorized variables, and an independent T-test was carried out for quantitative variables.
Results
Overall, 38.5% of the elderly had at least one mental disorder (47.2% women, 27.3% men). The prevalence of major depressive disorder (MDD) and any anxiety disorders was 16.6% (22.4% female and 9.3% male) and 16.7% (23.1% female and 8.6% male), respectively. Likewise, the overall prevalence of any depressive symptoms, post-traumatic stress disorder (PTSD), general anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and panic disorders were 21.6%, 7%, 5.3%, and 5.9%, respectively. The prevalence of any mental disorder in the first, second, and third quartiles of the socio-economic level was 54.3%, 37%, and 17.8%, respectively. The prevalence of any mental disorders among the marginalized and the non-marginalized population is 55.3 and 31.5%, respectively.
Conclusions
We found 38.5% (47.2% women, 27.3% men) of the elderly people had any mental disorders, and 21.6% of them had any depressive disorders. The prevalence of mental disorders in elders was almost like adults and middle-aged people in this study. However, the prevalence of mental disorders was higher than in marginalized population and low socio-economic status.
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Nowicka-Sauer K, Jarmoszewicz K, Molisz A, Sobczak K, Sauer M, Topolski M. Applying Machine Learning to Construct a Model of Risk of Depression in Patients Following Cardiac Surgery with the Use of the SF-12 Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4876. [PMID: 36981783 PMCID: PMC10048966 DOI: 10.3390/ijerph20064876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Depression is a common problem in patients with cardiovascular diseases. Identifying a risk factor model of depression has been postulated. A model of the risk of depression would provide a better understanding of this disorder in this population. We sought to construct a model of the risk factors of depression in patients following cardiac surgery, with the use of machine learning. METHODS AND MEASURES Two hundred and seventeen patients (65.4% men; mean age 65.14 years) were asked to complete the short form health survey-12 (SF-12v.2), three months after hospital discharge. Those at risk of depression were identified based on the SF-12 mental component summary (MCS). Centroid class principal component analysis (CCPCA) and the classification and regression tree (CART) were used to design a model. RESULTS A risk of depression was identified in 29.03% of patients. The following variables explained 82.53% of the variance in depression risk: vitality, limitation of activities due to emotional problems (role-emotional, RE), New York Heart Association (NYHA) class, and heart failure. Additionally, CART revealed that decreased vitality increased the risk of depression to 45.44% and an RE score > 68.75 increased it to 63.11%. In the group with an RE score < 68.75, the NYHA class increased the risk to 41.85%, and heart failure further increased it to 44.75%. CONCLUSION Assessing fatigue and vitality can help health professionals with identifying patients at risk of depression. In addition, assessing functional status and dimensions of fatigue, as well as the impact of emotional state on daily functioning, can help determine effective intervention options.
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Affiliation(s)
- Katarzyna Nowicka-Sauer
- Department of Family Medicine, Faculty of Medicine, Medical University of Gdańsk, Dębinki 2 Str., 80-211 Gdańsk, Poland
- Department of Cardiac Surgery, Kashubian Centre for Cardiac and Vascular Diseases, Ceynowa Specialist Hospital, Jagalskiego 10 Str., 84-200 Wejherowo, Poland;
| | - Krzysztof Jarmoszewicz
- Department of Cardiac Surgery, Kashubian Centre for Cardiac and Vascular Diseases, Ceynowa Specialist Hospital, Jagalskiego 10 Str., 84-200 Wejherowo, Poland;
| | - Andrzej Molisz
- Department of Otolaryngology, University Clinical Centre, Medical University of Gdańsk, Smoluchowskiego 17 Str., 80-214 Gdansk, Poland;
| | - Krzysztof Sobczak
- Division of Medical Sociology and Social Pathology, Faculty of Health Sciences, Medical University of Gdańsk, Tuwima 15 Str., 80-210 Gdańsk, Poland;
| | - Marta Sauer
- Radiation Protection Office, University Clinical Centre, Medical University of Gdańsk, Smoluchowskiego 17 Str., 80-214 Gdańsk, Poland;
| | - Mariusz Topolski
- Department of Systems and Computer Networks, Faculty of Information and Communication Technology, Wroclaw University of Science and Technology, Janiszewskiego 11/17 Str., 50-372 Wroclaw, Poland;
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Devita M, De Salvo R, Ravelli A, De Rui M, Coin A, Sergi G, Mapelli D. Recognizing Depression in the Elderly: Practical Guidance and Challenges for Clinical Management. Neuropsychiatr Dis Treat 2022; 18:2867-2880. [PMID: 36514493 PMCID: PMC9741828 DOI: 10.2147/ndt.s347356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
Depression is one of the most common mood disorders in the late-life population and is associated with poor quality of life and increased morbidity, disability and mortality. Nevertheless, in older adults, it often remains undetected and untreated. This narrative review aims at giving an overview on the main definitions, clinical manifestations, risk and protective factors for depression in the elderly, and at discussing the main reasons for its under/misdiagnosis, such as cognitive decline and their overlapping symptomatology. A practical approach for the global and multidisciplinary care of the older adult with depression, derived from cross-checking evidence emerging from the literature with everyday clinical experience, is thus provided, as a short and flexible "pocket" guide to orient clinicians in recognizing, diagnosing and treating depression in the elderly.
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Affiliation(s)
- Maria Devita
- Department of General Psychology (DPG), University of Padua, Padua, Italy.,Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Rossella De Salvo
- Department of General Psychology (DPG), University of Padua, Padua, Italy
| | - Adele Ravelli
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Marina De Rui
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Alessandra Coin
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Giuseppe Sergi
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Daniela Mapelli
- Department of General Psychology (DPG), University of Padua, Padua, Italy
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6
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Borges MK, Aprahamian I, Romanini CV, Oliveira FM, Mingardi SVB, Lima NA, Cecato JF, Petrella M, Oude Voshaar RC. Depression as a determinant of frailty in late life. Aging Ment Health 2021; 25:2279-2285. [PMID: 33307781 DOI: 10.1080/13607863.2020.1857689] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Accumulating evidence shows depression as a risk factor for frailty, but studies are mainly population-based and widely differ in their assessment of either depression or frailty. We investigated the association between depression and frailty among geriatric outpatients using different assessment instruments for both conditions. METHOD Among 315 geriatric outpatients (mean age 72.1 years, 68.3% female sex) participating the MiMiCS-FRAIL cohort study, major and subthreshold depression were measured with psychiatric diagnostic interview according to DSM-5 criteria (SCID-5) as well as with instruments to screen and measure severity of depressive symptoms (GDS-15 and PHQ-9). Frailty was assessed according to a screening instrument (FRAIL-BR) and a multidimensional Frailty Index (FI-36 items). Multiple logistic and linear regression were performed to assess the association between depression (independent variable) and frailty (dependent variable) adjusted for confounders. RESULTS Frailty prevalence in patients with no, subthreshold or major depressive disorder increases from either 14.5%, 46.5% to 65.1% when using the FRAIL-BR questionnaire, and from 10.2%, 20.9%, to 30.2% when using the FI-36 index. These association remain nearly the same when adjusted for covariates. Both the FRAIL-BR and the FI-36 were strongly associated with major depressive disorder, subthreshold depression, and depressive symptoms by PHQ-9 and GDS-15. CONCLUSION Late life depression and frailty are associated in a dose-dependent manner, irrespective of the used definitions. Nonetheless, to avoid residual confounding, future research on underlying biological mechanisms should preferably be based on formal psychiatric diagnoses and objectively assessment frailty status.
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Affiliation(s)
- Marcus K Borges
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ivan Aprahamian
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil.,Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carla V Romanini
- Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Fabiana M Oliveira
- Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Silvana V B Mingardi
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Natália A Lima
- Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Juliana F Cecato
- Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Marina Petrella
- Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Richard C Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Tan MM, Su TT, Ting RSK, Allotey P, Reidpath D. Religion and mental health among older adults: ethnic differences in Malaysia. Aging Ment Health 2021; 25:2116-2123. [PMID: 32741203 DOI: 10.1080/13607863.2020.1799939] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Religion and spirituality gain importance as a person ages. Research has shown that religion has a salutary effect on mental health, and it is associated with health differently across ethnic groups. The current study examined ethnic differences in the association between religion and mental health among older adults in a predominantly Muslim population and multicultural setting. METHODS Data of 7068 participants (4418 Malays, 2080 Chinese and 570 Indians) aged ≥55 years that were collected as part of the community health survey conducted in 2013 in the South East Asia Community Observatory (SEACO) were analyzed using bivariate and multiple regressions. Analyses were stratified by ethnicity. RESULTS The importance of having an enriched religious/spiritual life was associated with higher scores of depression, anxiety and stress among Chinese and higher score of depression among Malays, while belief in a higher power was associated with better mental health among Malays, Chinese and Indians. CONCLUSION The current study showed that there were ethnic variations in the associations between religion and mental health, and the associations depended on the religious variable included in the analysis. The findings of this study showed that religion could be another potential channel to improve mental health among older adults by accommodating and understanding their religious beliefs.
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Affiliation(s)
- Min Min Tan
- South East Asia Community Observatory (SEACO), Monash University, Selangor, Malaysia.,Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Selangor, Malaysia
| | - Tin Tin Su
- South East Asia Community Observatory (SEACO), Monash University, Selangor, Malaysia.,Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Selangor, Malaysia
| | - Rachel Sing-Kiat Ting
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Selangor, Malaysia
| | - Pascale Allotey
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Selangor, Malaysia.,International Institute for Global Health, United Nations University, Cheras, Malaysia
| | - Daniel Reidpath
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Selangor, Malaysia.,International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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8
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Wang L, Kroenke K, Stump TE, Monahan PO. Screening for perinatal depression with the Patient Health Questionnaire depression scale (PHQ-9): A systematic review and meta-analysis. Gen Hosp Psychiatry 2021; 68:74-82. [PMID: 33360526 PMCID: PMC9112666 DOI: 10.1016/j.genhosppsych.2020.12.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/13/2020] [Accepted: 12/13/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Perinatal depression (PND) is a prevalent and disabling problem both during pregnancy and the postpartum period. The legacy screening measure has been the Edinburgh Postnatal Depression Scale (EPDS). This systematic review examines the validity of the PHQ-9 as a screener for PND. METHODS The following databases were searched from January 2001 (when the PHQ-9 was first published) through June 2020: MEDLINE, Embase, and PsychInfo. Studies that compared the PHQ-9 to a criterion standard psychiatric interview were used to determine the operating characteristics of sensitivity, specificity and area under the curve (AUC). Studies comparing the PHQ-9 to the EPDS and other depression scales evaluated convergent validity. RESULTS A total of 35 articles were eligible for criterion (n = 10) or convergent (n = 25) validity. Meta-analysis of the 7 criterion validity studies using the standard PHQ-9 cut point ≥10 showed a pooled sensitivity, specificity and AUC of 0.84, 0.81 and 0.89, respectively. Operating characteristics of the PHQ-9 and EPDS were nearly identical in head-to-head comparison studies. The median correlation between the PHQ-9 and EPDS was 0.59, and categorical agreement was moderate. CONCLUSIONS The PHQ-9 appears to be a viable option for perinatal depression screening with operating characteristics similar to the legacy EPDS.
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Affiliation(s)
- Larry Wang
- Indiana University, School of Medicine, Indianapolis, IN, United States.
| | - Kurt Kroenke
- Indiana University, School of Medicine, Indianapolis, IN, United States; Regenstrief Institute Inc, Indianapolis, IN, United States.
| | - Timothy E. Stump
- Department of Biostatistics, Indiana University Fairbanks School of Public Health and School of Medicine, Indianapolis, IN, USA
| | - Patrick O. Monahan
- Department of Biostatistics, Indiana University Fairbanks School of Public Health and School of Medicine, Indianapolis, IN, USA
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9
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Laures-Gore JS, Dotson VM, Belagaje S. Depression in Poststroke Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1798-1810. [PMID: 33181048 DOI: 10.1044/2020_ajslp-20-00040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The aim of this tutorial is to provide speech-language pathologists with foundational knowledge of poststroke depression comorbidly occurring with aphasia. Given the negative effect of depression on functional outcomes and mortality, it is crucial that speech-language pathologists possess this knowledge in order to better advocate for and treat their patients. Method and Results Three areas of complementary expertise (speech-language pathology, psychology, and neurology) collaborated on this tutorial to address the following areas: (a) provide terminology associated with depression and related mood disorders, (b) describe the potential underlying pathophysiology of depression in the general population, (c) provide an overview of our existing understanding of comorbid poststroke depression and aphasia, and (d) summarize current assessment methods and interventions for poststroke depression in adults with aphasia. Conclusion Given the compounding impact aphasia and depression have on rehabilitation outcomes, it is imperative that speech-language pathologists understand terminology, assessment, and treatment practices for depression.
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Affiliation(s)
| | - Vonetta M Dotson
- Department of Psychology, Georgia State University, Atlanta
- Gerontology Institute, Georgia State University, Atlanta
| | - Samir Belagaje
- Departments of Neurology and Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia
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10
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Tully PJ, Higgins R. Depression Screening, Assessment, and Treatment for Patients with Coronary Heart Disease: A Review for Psychologists. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12075] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Phillip J Tully
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide,
- Department of Medicine, Flinders Medical Centre and Flinders University of South Australia,
| | - Rosemary Higgins
- Heart Research Centre,
- Department of Physiotherapy, The University of Melbourne,
- Cabrini Health,
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11
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Reichardt LA, Nederveen FE, van Seben R, Aarden JJ, van der Schaaf M, Engelbert RHH, van der Esch M, Twisk JWR, Bosch JA, Buurman BM. The longitudinal association between depressive symptoms and functional abilities in older patients. J Psychosom Res 2020; 137:110195. [PMID: 32731046 DOI: 10.1016/j.jpsychores.2020.110195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/18/2020] [Accepted: 07/19/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To investigate the course of depressive symptoms, and basic and instrumental activities of daily living (collectively described as, (I)ADL functioning) from acute admission until one year post-discharge, the longitudinal association between depressive symptoms and (I)ADL functioning, and to disaggregate between- and within-person effects to examine whether changes in depressive symptoms are associated with changes in (I)ADL functioning. METHODS Prospective multicenter cohort of acutely hospitalized patients aged ≥70. Data gathered over a one-year period were assessed using validated measures of depressive symptoms (GDS-15) and physical functioning (Katz-ADL index). A Poisson mixed model analysis was used to examine the association between the courses and a hybrid model was used to disentangle between- and within-subject effects. RESULTS The analytic sample included 398 patients (mean age = 79.6 years, SD = 6.6). Results showed an improvement in depressive symptoms and physical functions over time, whereby changes in depressive symptoms were significantly associated with the course of ADL function (rate ratio (RR) = 0.91, p < .001) and IADL function (RR = 0.94, p < .001), even after adjustment for confounding variables. Finally, both between- and within-person effects of depressive symptoms were significantly associated with the course of ADL function (between-person: RR = 0.85, p < .001; within-person: RR = 0.94, p < .001) and IADL function (between-person: RR = 0.87, p < .001; within-person: RR = 0.97, p < .001). CONCLUSION The course of depressive symptoms and physical functions improved over time, whereby changes in depressive symptoms were significantly associated with changes in physical functions, both at group and individual level. These changes in (I)ADL functioning lie mostly above the estimated minimally important change for both scales, implying clinically relevant changes.
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Affiliation(s)
- Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Floor E Nederveen
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Jesse J Aarden
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Raoul H H Engelbert
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
| | - Martin van der Esch
- ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, the Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychology, Section of Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands..
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
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12
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Brown A, Peres L, Brown T, Haines T, Stolwyk R. A prospective investigation of factors associated with depressive symptoms in older adults' post-hospitalisation. Int J Geriatr Psychiatry 2020; 35:671-682. [PMID: 32100323 DOI: 10.1002/gps.5285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/08/2020] [Accepted: 02/13/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The transition from hospital to home is a period where older adults are at risk of experiencing depressive symptoms. The present study applied the Social Antecedent Model of Psychopathology (SAMP) to identify factors present at hospital discharge associated with depressive symptoms at discharge and future symptoms at 3- and 6-month post-discharge home. METHOD 286 older adults aged over 65 (M = 78.38, SD = 7.68, 57% female) reported on a range of variables that were mapped to the SAMP at hospital discharge, 3- and 6-month post-discharge. RESULTS At baseline assessment, male gender, increased anxiety symptoms, low social support and low perceived coping ability were associated with concurrent baseline depressive symptoms. Depressive symptoms at baseline were strongly associated with future depressive symptoms at 3- and 6-month post-discharge. Low household physical activity was also associated with depressive symptoms at 3 months and elevated baseline anxiety symptoms and low social support were associated with depressive symptoms at 6-month post-discharge. CONCLUSION Pre-discharge screening of depressive and anxiety symptoms, social support, household physical activity and coping ability may assist in identifying elderly patients at risk of developing depressive symptoms during the hospital-to-home transition. These factors may also serve as potential targets for preventative interventions post-discharge for older adults.
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Affiliation(s)
- Aimee Brown
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences,, Monash University, Clayton, Victoria, Australia
| | - Lisa Peres
- RMIT University, Melbourne, Victoria, Australia
| | - Ted Brown
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Melbourne, Victoria, Australia
| | - Terence Haines
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Melbourne, Victoria, Australia
| | - Rene Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences,, Monash University, Clayton, Victoria, Australia
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13
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Velloza J, Njoroge J, Ngure K, Thuo N, Kiptinness C, Momanyi R, Ayub S, Gakuo S, Mugo N, Simoni J, Heffron R. Cognitive testing of the PHQ-9 for depression screening among pregnant and postpartum women in Kenya. BMC Psychiatry 2020; 20:31. [PMID: 31996166 PMCID: PMC6990517 DOI: 10.1186/s12888-020-2435-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 01/08/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND African women face high rates of depression, particularly during pregnancy or postpartum or after a recent HIV diagnosis. The Patient Health Questionnaire-9 (PHQ-9) depression screening tool has been quantitatively validated and extensively used to identify depression and link individuals to care. However, qualitative work is necessary to identify important opportunities to improve PHQ-9 question comprehension and performance among Kenyan women. METHODS We administered the Kiswahili or English PHQ-9 (based on preference) to 29 pregnant and postpartum women in Thika, Kenya. Following administration, we conducted cognitive interviews with a purposive sample of 20 women. We used analytic memos and data matrices to identify themes around scale acceptability, comprehension, and decision and response processes. RESULTS Most participants preferred to answer the PHQ-9 in Kiswahili (N = 15; 52%). Among the 20 interview participants, 12 (60%) had scores ≥5, indicating depressive symptoms. Overall, participants found the scale acceptable as an interviewer-administered tool. Participants reported few problems related to comprehension but had difficulty answering items not relevant to their lives (e.g., "watching television") and double-barreled items (e.g., "poor appetite or overeating"). They were hesitant to endorse items related to "duties as a wife and mother" and suicidal ideation. Most participants had difficulty distinguishing between response options of "several days" and "more than half the days". CONCLUSIONS We detected several problems related to PHQ-9 comprehension, decision processes, and response processes. We provide recommended changes to instructions and item wording to improve PHQ-9 validity among Kenyan women.
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Affiliation(s)
- Jennifer Velloza
- Department of Global Health, University of Washington, Seattle, USA. .,Department of Epidemiology, University of Washington, Seattle, USA. .,International Clinical Research Center, University of Washington, Box 359927, 325 Ninth Avenue, Seattle, WA, 98104, USA.
| | - John Njoroge
- Partners in Health and Research Development, Nairobi, Kenya
| | - Kenneth Ngure
- 0000 0000 9146 7108grid.411943.aDepartment of Community Health Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Nicholas Thuo
- Partners in Health and Research Development, Nairobi, Kenya
| | | | | | - Snaidah Ayub
- Partners in Health and Research Development, Nairobi, Kenya
| | - Stephen Gakuo
- Partners in Health and Research Development, Nairobi, Kenya
| | - Nelly Mugo
- 0000000122986657grid.34477.33Department of Global Health, University of Washington, Seattle, USA ,Partners in Health and Research Development, Nairobi, Kenya ,0000 0001 0155 5938grid.33058.3dCenter for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Jane Simoni
- 0000000122986657grid.34477.33Department of Global Health, University of Washington, Seattle, USA ,0000000122986657grid.34477.33Department of Psychology, University of Washington, Seattle, USA
| | - Renee Heffron
- 0000000122986657grid.34477.33Department of Global Health, University of Washington, Seattle, USA ,0000000122986657grid.34477.33Department of Epidemiology, University of Washington, Seattle, USA
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Thom R, Silbersweig DA, Boland RJ. Major Depressive Disorder in Medical Illness: A Review of Assessment, Prevalence, and Treatment Options. Psychosom Med 2019; 81:246-255. [PMID: 30720699 DOI: 10.1097/psy.0000000000000678] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Major depression, as well as other depressive disorders, is commonly comorbid with other medical illnesses, particularly chronic and systemic medical illnesses. The co-occurrence of the disorders is so common that it challenges our notions of the meaning of comorbidity and our desire to neatly separate psychiatric and medical illnesses. The overlap between symptoms of physical illness and the neurovegetative symptoms of major depression and the initial normative emotional response to physical illness add to the challenge of accurate diagnosis and timely treatment of depression in the medically ill. We review the literature on the comorbidity of depression and the various medical illnesses, including diagnostic and treatment approaches. The differential diagnosis for major depression among medically ill patients should include delirium and medication-induced symptoms. We suggest that major depression itself may be best conceptualized as a systemic illness whose pathophysiology overlaps with other systemic medical illnesses. The initial treatment strategies for major depression in medical illness are like those for the general population; however, the comorbid medical illnesses may interfere with remission. To illustrate these points, we describe a patient with clinical characteristics covered in this review who experienced major depression as well as several chronic illnesses, including hypersensitivity pneumonitis, multiple sclerosis, chronic pain due to degenerative joint disease, and diabetes mellitus.
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Affiliation(s)
- Robyn Thom
- From the Department of Psychiatry (Thom, Silbersweig, Boland), Brigham and Women's Hospital; and Harvard Medical School (Thom, Silbersweig, Boland), Boston, Massachusetts
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15
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Biella MM, Borges MK, Strauss J, Mauer S, Martinelli JE, Aprahamian I. Subthreshold Depression Needs A Prime Time In Old Age Psychiatry? A Narrative Review Of Current Evidence. Neuropsychiatr Dis Treat 2019; 15:2763-2772. [PMID: 31576131 PMCID: PMC6765057 DOI: 10.2147/ndt.s223640] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/06/2019] [Indexed: 11/23/2022] Open
Abstract
This study aims to carry out a narrative review, aiming to update the literature on subsyndromic depression (SD), which is the most prevalent depressive disorder in older adults, and no formal guidelines or consensus are dedicated to this topic. We carried out an electronic search for articles on SD. Relevant articles were retrieved from Pubmed, EMBASE and Web of Science using the search terms "subthreshold depression," "prevalence," "treatment" and "older adults" in several combinations. Original articles in English were included from inception to 1st March 2019. No clear consensus exists in the literature on its nosologic classification, diagnostic tools, causes, course, outcomes or management. SD diagnosis should base in depressive symptoms scales and DSM criteria. Treatment relies mainly on collaborative care and psychotherapy. SD is relevant in clinical practice and research in geriatric psychiatry. Given the negative outcomes and potential benefits of treatment, we recommend brief psychotherapy as first-line treatment and use of psychotropic agents in cases with greater severity and/or functional impairment in association with psychotherapy. SD can precede major depressive disorder, but it also may consist of a primary depressive disorder in older adults. Furthermore, adequate treatment of SD can prevent or reduce negative outcomes associated with depressive symptoms such as worsening of clinical comorbidities, loss of functionality, increased demand for health services, and increased mortality.
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Affiliation(s)
- Marina Maria Biella
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marcus Kiiti Borges
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jason Strauss
- Geriatric Psychiatry, Cambridge Health Alliance, Harvard Medical School, Boston, MA, USA
| | - Sivan Mauer
- Department of Psychiatry, Tufts Medical Center, Tufts University Scholl of Medicine, Boston, MA, USA
| | - José Eduardo Martinelli
- Geriatrics & Psychiatry Division, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
| | - Ivan Aprahamian
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Geriatrics & Psychiatry Division, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
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16
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East African HIV care: depression and HIV outcomes. Glob Ment Health (Camb) 2019; 6:e9. [PMID: 31258923 PMCID: PMC6582461 DOI: 10.1017/gmh.2019.6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 04/05/2019] [Accepted: 04/22/2019] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Depression is a common co-morbidity for people living with HIV (PLWH) and is associated with elevated plasma HIV RNA levels. While depression correlates with deficits in antiretroviral (ARV) adherence, little data exist to inform the relationship between depression and HIV vial load more broadly. OBJECTIVE To examine the relationship between depression and viral load in the African Cohort Study (AFRICOS) independently of ARV adherence. DESIGN PLWH in Kenya, Uganda and Tanzania underwent screening for depression using the Center for Epidemiologic Studies Depression Scale (CESD) upon enrollment at AFRICOS HIV care sites. SETTING AFRICOS is an ongoing prospective longitudinal cohort study enrolling HIV-infected adults at HIV care centers including sites in Kenya, Tanzania and Uganda. These sites are administered by President's Emergency Plan For AIDS Relief programs. PARTICIPANTS HIV+ individuals were eligible if they were at least 18 years old, receiving HIV care at the enrolling clinic and consented to data and specimen collection. MAIN OUTCOME MEASURE CESD. RESULTS Among 2307 participants, 18-25% met the CESD threshold for depression. Depression was associated with decreased ARV adherence (OR 0.59, p = 0.01). Higher scores on three CESD items were significantly associated with 209-282% higher viral load, independently of ARV adherence among participants on ARVs ⩾6 months. CONCLUSIONS PLWH had high prevalence of depression on the CESD. Diverse depression symptoms were independently associated with increases in viral load, underscoring the need for comprehensive treatment of depression.
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17
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Buscariollo DL, Cronin AM, Borstelmann NA, Punglia RS. Impact of pre-diagnosis depressive symptoms and health-related quality of life on treatment choice for ductal carcinoma in situ and stage I breast cancer in older women. Breast Cancer Res Treat 2018; 173:709-717. [PMID: 30406869 DOI: 10.1007/s10549-018-5006-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/09/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To examine whether pre-diagnosis patient-reported health-related quality of life (HRQOL) and depressive symptoms are associated with local treatment for older women with ductal carcinoma in situ (DCIS) and stage I breast cancer (BC). METHODS Using the SEER-MHOS dataset, we identified women ≥ 65 years old with DCIS or stage I BC diagnosed 1998-2011 who completed surveys ≤ 24 months before diagnosis. Depressive symptoms were measured by major depressive disorder (MDD) risk and HRQOL was measured by Physical and Mental Component Summary scores (PCS and MCS, respectively) of the SF-36/VR-12. Associations with treatment choice (breast-conserving surgery [BCS] and radiation therapy [RT], BCS alone, mastectomy) were assessed with multivariable multinomial logistic regression, controlling for patient characteristics. RESULTS We identified 425 women with DCIS and 982 with stage I BC. Overall, 20.4% endorsed depressive symptoms placing them at risk for MDD pre-diagnosis; mean MCS and PCS scores were 52.3 (SD = 10.1) and 40.5 (SD = 11.5), respectively. Among women with DCIS, those at risk for MDD were more likely to receive BCS (adjusted odds ratio [AOR] 2.04, 95% CI 1.04-4.00, p = 0.04) or mastectomy (AOR 1.88, 95% CI 0.91-3.86, p = 0.09) compared to BCS + RT. For DCIS, MCS score was not associated with treatment; higher PCS score was associated with decreased likelihood of receiving mastectomy versus BCS + RT (AOR 0.71 per 10-point increase, 95% CI 0.54-0.95, p = 0.02). For BC, none of the measures were significantly associated with treatment. CONCLUSION Older women at risk for MDD before DCIS diagnosis were less likely to receive RT after BCS, compared to BCS alone or mastectomy.
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Affiliation(s)
- Daniela L Buscariollo
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Angel M Cronin
- Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Nancy A Borstelmann
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rinaa S Punglia
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.
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18
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Walker J, Burke K, Wanat M, Fisher R, Fielding J, Mulick A, Puntis S, Sharpe J, Esposti MD, Harriss E, Frost C, Sharpe M. The prevalence of depression in general hospital inpatients: a systematic review and meta-analysis of interview-based studies. Psychol Med 2018; 48:2285-2298. [PMID: 29576041 DOI: 10.1017/s0033291718000624] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Comorbid depression in the medically ill is clinically important. Admission to a general hospital offers an opportunity to identify and initiate treatment for depression. However, we first need to know how common depression is in general hospital inpatients. We aimed to address this question by systematically reviewing the relevant literature. METHODS We reviewed published prevalence studies in any language which had used diagnostic interviews of general hospital inpatients and met basic methodological quality criteria. We focussed on interview-based studies in order to estimate the proportion of patients with a diagnosis of depressive illness. RESULTS Of 158 relevant articles, 65 (41%) describing 60 separate studies met our inclusion criteria. The 31 studies that focussed on general medical and surgical inpatients reported prevalence estimates ranging from 5% to 34%. There was substantial, highly statistically significant, heterogeneity between studies which was not materially explained by the covariates we were able to consider. The average of the reported prevalences was 12% (95% CI 10-15), with a 95% prediction interval of 4-32%. The remaining 29 studies, of a variety of specific clinical populations, are described. CONCLUSIONS The available evidence suggests a likely prevalence high enough to make it worthwhile screening hospital inpatients for depression and initiating treatment where appropriate. Further, higher quality, research is needed to clarify the prevalence of depression in specific settings and to further explore the reasons for the observed heterogeneity in estimates.
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Affiliation(s)
- Jane Walker
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Katy Burke
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Marta Wanat
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Rebecca Fisher
- Department of Primary Care Health Sciences,University of Oxford, Oxford, UK
| | - Josephine Fielding
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Amy Mulick
- Department of Medical Statistics,London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen Puntis
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Joseph Sharpe
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Michelle Degli Esposti
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford,Oxford,UK
| | - Chris Frost
- Department of Medical Statistics,London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Sharpe
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
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19
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Senanayake S, Gunawardena N, Palihawadana P, Suraweera C, Karunarathna R, Kumara P. Depression and psychological distress in patients with chronic renal failure: Prevalence and associated factors in a rural district in Sri Lanka. J Psychosom Res 2018; 112:25-31. [PMID: 30097132 DOI: 10.1016/j.jpsychores.2018.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Chronic Kidney Disease (CKD) is known to adversely affect mental health. The study was aimed at estimating the prevalence of depression and psychological distress and the associated factors among CKD patients living in Anuradhapura, a rural district in Sri Lanka. METHOD A community-based, cross-sectional study included a representative sample of 1174 CKD patients, drawn proportionately from all registered patients in all 19 Medical Officer of Health areas in the district of Anuradhapura. Trained paramedical staff visited the households and administered the locally validated Centre for Epidemiologic Studies Depression Scale and General Health Questionnaire-12 to screen for depression and psychological distress. Information related to associated factors was obtained through an interviewer-administered questionnaire. RESULTS A total of 1118 CKD patients participated, with a response rate of 95.2%. The mean age was 58.3 (SD 10.8) years. 62.7% of participants were males. The majority of participants was in CKD stage 4 (58.3%). The screening revealed that 75.0% (95% CI 72.5-77.5) of participants were psychologically distressed while 65.2% (95%CI 62.4-68.0) were found to be depressed. Multiple logistic regression analysis revealed advanced age, unemployment and poor health related quality of life contributed significantly to both depression and psychological distress. CONCLUSION Depression and psychological distress were significant in this community. Policymakers should consider the likely high prevalence of psychological distress and depression among CKD patients as well as the need for specific mental health services to confirm diagnosis and initiate effective management. Identified associated factors should be used to identify targeted preventative interventions.
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Affiliation(s)
| | | | | | | | - R Karunarathna
- North Central Provincial Directors Office, Anuradhapura, Sri Lanka
| | - Priyantha Kumara
- North Central Provincial Directors Office, Anuradhapura, Sri Lanka
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20
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Saracino RM, Cham H, Rosenfeld B, J Nelson C. Latent Profile Analyses of Depressive Symptoms in Younger and Older Oncology Patients. Assessment 2018; 27:1383-1398. [PMID: 29947548 DOI: 10.1177/1073191118784653] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The aging of America will include a significant increase in the number of older patients with cancer, many of whom will experience significant depressive symptoms. Although geriatric depression is a well-studied construct, its symptom presentation in the context of cancer is less clear. Latent profile analysis was conducted on depressive symptoms in younger (40-64 years) and older (≥65 years) patients with cancer (N = 636). The sample was clinically heterogeneous (i.e., included all stages, dominated by advanced stage disease). Participants completed questionnaires including the Center for Epidemiological Studies Depression Scale, which was used for the latent profile analysis. A four-class pattern was supported for each age group. However, the four-class pattern was significantly different between the younger and older groups in terms of the item means within each corresponding latent class; differences were primarily driven by severity such that across classes, older adults endorsed milder symptoms. An unexpected measurement issue was uncovered regarding reverse-coded items, suggesting that they may generate unreliable scores on the Center for Epidemiological Studies Depression Scale for a significant subset of patients. The results indicate that cancer clinicians can expect to see depressive symptoms along a continuum of severity for patients of any age, with less severe symptoms among older patients.
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Affiliation(s)
- Rebecca M Saracino
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Fordham University, Bronx, NY, USA
| | | | - Barry Rosenfeld
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Fordham University, Bronx, NY, USA
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21
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Saracino RM, Rosenfeld B, Nelson CJ. Performance of four diagnostic approaches to depression in adults with cancer. Gen Hosp Psychiatry 2018; 51:90-95. [PMID: 29427869 PMCID: PMC5869111 DOI: 10.1016/j.genhosppsych.2018.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The potentially confounding influence of somatic symptoms in identifying depression in medically ill patients has long been of concern, resulting in several proposed alternative diagnostic approaches. These approaches have been compared in the cancer setting, but the strengths and weaknesses of the alternative approaches have rarely been examined. The purpose of the current study was to examine the performance of four approaches to depression assessment among ambulatory cancer patients. METHOD Outpatients were recruited from a large cancer center (N = 611). Participants had to be 40 years or older, English-speaking, and have a cancer diagnosis. All participants completed a sociodemographic questionnaire and a modified Patient Health Questionnaire-9 with additional items targeting the Endicott and Cavanaugh substitutive criteria. RESULTS Depression prevalence varied significantly by diagnostic approach, with the inclusive approach identifying the largest proportion as depressed (9.3%, n = 57), followed by the Endicott-substitutive (6.2%, n = 38), exclusive (4.6%, n = 28), and Cavanaugh-substitutive approach (1.8%, n = 11). Somatic items were significantly elevated across all four approaches. CONCLUSIONS The inclusive approach that retains use of somatic symptoms is appropriate when screening cancer patients for depression. The fact that somatic symptoms were more prevalent across approaches suggests that they may not inflate the prevalence of depression as much as some have feared. Rather, somatic items may explain variance in depressive symptoms beyond that explained by the presence of cancer and its treatment. Additionally, the Endicott items appeared useful for capturing depressive symptoms that are not included in the existing DSM criteria, and may have a place in clinical and research settings.
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Affiliation(s)
- Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, NY, New York 10022, United States; Psychology Department, Fordham University, Dealy Hall 226, 441 East Fordham Road, Bronx, NY 10458, United States.
| | - Barry Rosenfeld
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, NY, New York 10022, United States; Psychology Department, Fordham University, Dealy Hall 226, 441 East Fordham Road, Bronx, NY 10458, United States
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, NY, New York 10022, United States
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22
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Ghaemmohamadi MS, Behzadifar M, Ghashghaee A, Mousavinejad N, Ebadi F, Saeedi Shahri SS, Seyedin H, Behzadifar M, Bragazzi NL. Prevalence of depression in cardiovascular patients in Iran: A systematic review and meta-analysis from 2000 to 2017. J Affect Disord 2018; 227:149-155. [PMID: 29073577 DOI: 10.1016/j.jad.2017.10.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/01/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND In both developed and developing countries, cardiovascular disease is on the rise, representing nowadays one of the main challenges for the health systems worldwide. This increase generates relevant costs. The aim of this study was to conduct a systematic and meta-analytical review of the prevalence of depression in cardiovascular patients in Iran. METHODS Articles written in English and Persian were searched from January 2000 to July 2017 in different scholarly databases. RESULTS 12 studies were retained and included in the current meta-analysis. Selected studies were published between 2008 and 2016. The number of patients participating in these studies was 9292. Based on the random-effects model, the prevalence of depression in cardiovascular patients in Iran was 47% [95% confidence interval or CI 38-56], I2=98.2% with P = 0.000. The relative risk (RR) of depression in cardiovascular patients yielded a value of 1.30 [95%CI 1.05-1.62] with P < 0.001. Women are more at risk for depression than men. CONCLUSION The current meta-analysis estimated the prevalence of depression among cardiovascular patients in Iran. The prevalence found computed by the present study is higher than the figures found in developed countries. Depression with cardiovascular disease causes many problems for these patients, and early diagnosis and treatment significantly helps in improving quality of life, as well as saving costs and resources.
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Affiliation(s)
- Mozhgan Sadat Ghaemmohamadi
- Student Research Committee, Faculty of Health Management and Information Sciences Branch, Iran University of Medical Sciences, Tehran, Iran
| | - Meysam Behzadifar
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Ghashghaee
- Student Research Committee, Faculty of Health Management and Information Sciences Branch, Iran University of Medical Sciences, Tehran, Iran
| | - Nasrin Mousavinejad
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Faezeh Ebadi
- Student Research Committee, Faculty of Health Management and Information Sciences Branch, Iran University of Medical Sciences, Tehran, Iran
| | - Sahar Sadat Saeedi Shahri
- Student Research Committee, Faculty of Health Management and Information Sciences Branch, Iran University of Medical Sciences, Tehran, Iran
| | - Hesam Seyedin
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Nicola Luigi Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Abstract
Both antidepressants and psychological treatments are effective in the management of late-life depression. Nevertheless, there remains a considerable challenge to improve the prognosis for depression in older people. Endlessly increasing the range of antidepressants does not seem to be the answer, so attention is turning to new combinations of treatments and new ways of delivering care and improving treatment uptake. Collaboration between specialist and primary care, case management and multifaceted interventions are currently the most exciting prospects. There is good evidence for the role of both medication and psychological treatment in keeping the patient well after recovery.
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Spijker EE, Jones K, Duijff JW, Smith A, Christey GR. Psychiatric comorbidities in adult survivors of major trauma: findings from the Midland Trauma Registry. J Prim Health Care 2018; 10:292-302. [DOI: 10.1071/hc17091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTION
Information for primary care providers about the outcomes of adult survivors of major medical trauma in the first year of recovery is not widely available. In particular, risks of impairment across multiple domains of functioning are poorly understood.
AIM
To determine the extent to which adults’ experience impaired health-related quality of life (QoL), symptoms of post-traumatic stress disorder, depression, chronic pain and harmful alcohol use during the year following major trauma, and to identify factors associated with outcomes.
METHODS
Adults (aged ≥16 years) admitted to Waikato Hospital following major trauma sustained in Waikato District between 1 June 2010 and 1 July 2011 were sent a questionnaire in their first year of recovery. They were asked about their QoL, mental health, experiences of pain, post-traumatic stress disorder symptoms and use of alcohol.
RESULTS
Sixty-five questionnaires were completed (40% response rate). In the year following major trauma, trauma survivors met criteria for post-traumatic stress disorder (45%), harmful alcohol use (26%), moderate to severe chronic pain (23%) and depression (18%). Reports of poor health-related QoL were common, ranging from self-care difficulties (31%) to pain and discomfort (72%). Younger age, previous psychiatric illness, substance use, intensive care unit admission and length of hospitalisation were associated with symptoms. Thirty-seven adults (57%) reported symptoms in at least two domains.
DISCUSSION
A significant proportion of adults experience adverse psychosocial outcomes in the first year following major trauma. Screening and management of potentially comorbid psychosocial needs could improve care and outcomes for survivors.
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Thompson LMA, Bobonis Babilonia M. Distinguishing Depressive Symptoms From Similar Cancer-Related Somatic Symptoms: Implications for Assessment and Management of Major Depression after Breast Cancer. South Med J 2017; 110:667-672. [PMID: 28973709 DOI: 10.14423/smj.0000000000000705] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Prevalence rates of major depressive disorder (MDD) following breast cancer diagnosis are estimated to be ~5% to >20%, and these rates range from slightly below to somewhat above the expected prevalence rate for MDD in the general population of women in the United States. Women with a history of MDD are at increased risk for recurrence of MDD after breast cancer and need to be monitored closely. To properly diagnose and treat MDD, healthcare providers must be able to recognize depressive symptoms and distinguish them from similar somatic symptoms that are associated with breast cancer and breast cancer treatment. The National Comprehensive Cancer Network and the American Society of Clinical Oncology have published guidelines for the screening, assessment, and care of adult cancer patients with depressive symptoms. Use of a standardized and validated screening measure may help healthcare providers identify patients in need of further assessment or treatment. Evidence-based nonpharmacological interventions such as cognitive behavioral therapy and antidepressant medications are recommended treatment options.
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Affiliation(s)
- Lora M A Thompson
- From the Supportive Care Medicine Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Margarita Bobonis Babilonia
- From the Supportive Care Medicine Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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Zisberg A. Anxiety and depression in older patients: the role of culture and acculturation. Int J Equity Health 2017; 16:177. [PMID: 28978328 PMCID: PMC5628440 DOI: 10.1186/s12939-017-0666-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/15/2017] [Indexed: 11/12/2022] Open
Abstract
Background Anxiety and depression are major health concerns in general among older adults and especially during hospitalization, as they lead to numerous negative outcomes. There is currently no sufficient body of research examining the role of cultural background in patients’ experience of these conditions. Better identifying patients at risk may help reduce inequity and provide patient-centered, culturally sensitive care. The current study explores the roles of culture and acculturation in anxiety and depression levels in recent and veteran Russian immigrants compared with native Israelis and veteran immigrants from Middle Eastern countries. Methods Secondary analysis of a prospective cohort study of cognitively intact older adults (70+) hospitalized for acute conditions in internal medical units in two hospitals in Israel during 2009–11. Depression and anxiety were assessed within 48 h of admission through personal interview using the Tucker Depression Rating and the Short Anxiety Screening Tests. Demographic and health data were collected from electronic health records. Immigration status was defined by country and emigration year. Study hypotheses were tested employing analyses of covariance, modeling anxiety and depression symptoms separately, controlling for potential confounders. Results Significant differences between study groups were observed in fully adjusted models for anxiety symptoms (F[3, 515] = 5.24, p < .01) when both veteran (21 ± 5.83) and recent (20.2 ± 5.23) Russian immigrants expressed higher anxiety levels than native Israelis (18.35 ± 5.23) and veteran immigrants (18 ± 5.03) (from p = .05 to p < 0.01). No significant differences were found in anxiety symptoms between recent and veteran Russian immigrants. Both depression and anxiety symptoms showed an interaction effect of study immigration groups by sex: while no differences were observed among native Israelis, significantly higher depression and anxiety were observed among women than men in the other groups. Conclusions Culture of origin may play a central role in determining expression of anxiety symptoms and perhaps modify acculturation. During hospitalization, special attention should be given to the level of anxiety among not only recent but also veteran immigrants. Further research may explore whether elevated anxiety is a result of stress due to hospitalization or a stable trait.
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Affiliation(s)
- Anna Zisberg
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Studies, University of Haifa, Mount Carmel, 31905, Haifa, Israel.
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Scott JE, Mathias JL, Kneebone AC. Depression and anxiety after total joint replacement among older adults: a meta-analysis. Aging Ment Health 2016; 20:1243-1254. [PMID: 26252414 DOI: 10.1080/13607863.2015.1072801] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Patients usually experience good physical recovery after total joint replacement (TJR); however, it is unclear whether mood also improves. The current meta-analysis examined changes in depression and anxiety following TJR in older (≥50 years) patients in order to address this gap in the literature. METHODS Data from 26 studies (4045 TJR, 55 controls) that assessed depression and/or anxiety pre- and post-surgery in TJR patients, with or without a control group, were analyzed. Prevalence rates and Cohen's d effect sizes were used to evaluate changes in the prevalence and severity of depression/anxiety, respectively. RESULTS Approximately 23% of TJR patients had clinically significant levels of depression prior to surgery, which decreased to 13% one year later. The prevalence of anxiety could not be evaluated due to the limited available data. TJR patients did not show any clinically meaningful reductions in symptoms of depression or anxiety, following surgery. Compared to controls, there was no difference in symptom progression over time; although only one study examined this. CONCLUSIONS TJR patients appear to have higher rates of clinically significant symptoms of depression before and after surgery, compared to the general population, however more research with adequate control groups is needed to confirm this. Only a modest improvement in the severity of depression and anxiety symptoms was noted post-surgery. However, existing research is limited; preventing definite conclusions regarding the impact of TJR on mood.
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Affiliation(s)
- J E Scott
- a School of Psychology , University of Adelaide , Adelaide , Australia
| | - J L Mathias
- a School of Psychology , University of Adelaide , Adelaide , Australia
| | - A C Kneebone
- a School of Psychology , University of Adelaide , Adelaide , Australia.,b Department of Clinical Psychology , Flinders Medical Centre , Bedford Park , Australia
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Saracino RM, Rosenfeld B, Nelson CJ. Towards a new conceptualization of depression in older adult cancer patients: a review of the literature. Aging Ment Health 2016; 20:1230-1242. [PMID: 26312455 PMCID: PMC4925309 DOI: 10.1080/13607863.2015.1078278] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Identifying depression in older adults with cancer presents a set of unique challenges, as it combines the confounding influences of cancer and its treatment with the developmental changes associated with aging. This paper reviews the phenomenology of depression in older adults, and individuals diagnosed with cancer. METHOD PsychInfo, PubMed, Web of Science, and Google Scholar databases were searched for English-language studies addressing the phenomenology, symptoms, or assessment of depression in older adults and those with cancer. RESULTS The Diagnostic and Statistical Manual for Mental Disorders (DSM) criteria that appear to be relevant to both older adults and cancer patients are anhedonia, concentration difficulties, sleep disturbances, psychomotor retardation/agitation, and loss of energy. Possible alternative criteria that may be important considerations included constructs such as loss of purpose, loneliness, and irritability in older adults. Among cancer patients, tearfulness, social withdrawal, and not participating in treatment despite ability to do so were identified as potentially important symptoms. CONCLUSIONS Current DSM criteria may not adequately assess depression in older cancer patients and alternative criteria may be important to inform the understanding and identification of depression in this population. Enhancing diagnostic accuracy of depression is important as both the over-diagnosis and under-diagnosis is accompanied with significant costs. Thus, continued research exploring the phenomenology and identifying effective indicators of depression in older cancer patients is needed.
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Affiliation(s)
- Rebecca M. Saracino
- Department of Psychology, Fordham University, Bronx, NY 10458, USA,Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA,Corresponding author.
| | - Barry Rosenfeld
- Department of Psychology, Fordham University, Bronx, NY 10458, USA,Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
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LaMantia MA, Perkins AJ, Gao S, Austrom MG, Alder CA, French DD, Litzelman DK, Cottingham AH, Boustani MA. Response to depression treatment in the Aging Brain Care Medical Home model. Clin Interv Aging 2016; 11:1551-1558. [PMID: 27826188 PMCID: PMC5096774 DOI: 10.2147/cia.s109114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the effect of the Aging Brain Care (ABC) Medical Home program’s depression module on patients’ depression severity measurement over time. Design Retrospective chart review. Setting Public hospital system. Participants Patients enrolled in the ABC Medical Home program between October 1, 2012 and March 31, 2014. Methods The response of 773 enrolled patients who had multiple patient health questionnaire-9 (PHQ-9) scores recorded in the ABC Medical Home program’s depression care protocol was evaluated. Repeatedly measured PHQ-9 change scores were the dependent variables in the mixed effects models, and demographic and comorbid medical conditions were tested as potential independent variables while including random effects for time and intercept. Results Among those patients with baseline PHQ-9 scores >10, there was a significant decrease in PHQ-9 scores over time (P<0.001); however, the effect differed by gender (P=0.015). On average, women’s scores (4.5 point drop at 1 month) improved faster than men’s scores (1 point drop at 1 month). Moreover, both men and women had a predicted drop of 7 points (>50% decline from baseline) on the PHQ-9 at 6 months. Conclusion These analyses demonstrate evidence for the sustained effectiveness of the ABC Medical Home program at inducing depression remission outcomes while employing clinical staff who required less formal training than earlier clinical trials.
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Affiliation(s)
- Michael A LaMantia
- Indiana University Center for Aging Research; Regenstrief Institute, Inc.; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; Department of Medicine, University of Vermont College of Medicine, Burlington, VT
| | - Anthony J Perkins
- Indiana University Center for Health Innovation and Implementation Science; Indiana Clinical and Translational Sciences Institute
| | - Sujuan Gao
- Regenstrief Institute, Inc.; Department of Biostatistics, Indiana University School of Medicine
| | - Mary G Austrom
- Department of Psychiatry, Indiana University School of Medicine; Indiana University Alzheimer's Disease Center
| | | | - Dustin D French
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University; Veterans Affairs Health Services Research and Development Service, Chicago, IL
| | - Debra K Litzelman
- Regenstrief Institute, Inc.; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; Indiana University Center for Health Services and Outcomes Research, Indianapolis, IN, USA
| | - Ann H Cottingham
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Malaz A Boustani
- Indiana University Center for Aging Research; Regenstrief Institute, Inc.; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; Indiana University Center for Health Innovation and Implementation Science
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Benraad CEM, Kamerman-Celie F, van Munster BC, Oude Voshaar RC, Spijker J, Olde Rikkert MGM. Geriatric characteristics in randomised controlled trials on antidepressant drugs for older adults: a systematic review. Int J Geriatr Psychiatry 2016; 31:990-1003. [PMID: 26924120 DOI: 10.1002/gps.4443] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 01/10/2016] [Accepted: 01/20/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Meta-analyses of antidepressant drug treatment trials have found that increasing age is associated with a less favourable outcome. Because the prevalence of geriatric characteristics, like disability, medical co-morbidity, malnutrition, cognitive (dys)function and frailty increase with age and are associated with depression, these characteristics are likely to modify the treatment outcome of antidepressant drugs in late-life depression. This review examines how these five characteristics are taken into account in randomised controlled trials (RCTs) with antidepressant drugs for major depressive disorder in patients aged 60 years or above. DESIGN A systematic search in PubMED, PsychInfo and EMBASE, from the year 2000 onwards, yielded 27 RCTs, with a total of 6356 subjects with a median age of 71 years. Two reviewers independently assessed whether each characteristic was considered as inclusion or exclusion criterion, descriptive variable, stratification variable, co-variable, outcome measure, or in adverse effect monitoring. RESULTS Malnutrition and frailty were not taken into account in any study. Disability was used as an outcome measure in five studies. Two studies explicitly included a population with possibly serious medical co-morbidity. Cognitive status was the only condition taken into account as co-variable (n = 3) or stratifying variable (n = 1) and was used as outcome measure in seven studies. CONCLUSIONS We conclude that geriatric characteristics are rarely taken into account in RCTs on antidepressant drugs in late-life depression, and studies including the oldest adults are underrepresented. This warrants recruitment of the oldest adults and adjustment of treatment strategies in future studies. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Carolien E M Benraad
- Department of Geriatrics/Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Old Age Psychiatry and Geriatrics, Pro Persona Mental Health Care, Nijmegen, The Netherlands
| | - Floor Kamerman-Celie
- Department of Old Age Psychiatry and Geriatrics, Pro Persona Mental Health Care, Nijmegen, The Netherlands
| | - Barbara C van Munster
- Department of Old Age Psychiatry and Geriatrics, Pro Persona Mental Health Care, Nijmegen, The Netherlands.,Department of Internal Medicine, Section of Geriatrics, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Jan Spijker
- Program for Mood Disorders, Pro Persona Mental Health Care, Nijmegen, The Netherlands.,Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- Department of Geriatrics/Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
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Cook KF, Kallen MA, Bombardier C, Bamer AM, Choi SW, Kim J, Salem R, Amtmann D. Do measures of depressive symptoms function differently in people with spinal cord injury versus primary care patients: the CES-D, PHQ-9, and PROMIS ®-D. Qual Life Res 2016; 26:139-148. [PMID: 27416833 DOI: 10.1007/s11136-016-1363-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate whether items of three measures of depressive symptoms function differently in persons with spinal cord injury (SCI) than in persons from a primary care sample. METHODS This study was a retrospective analysis of responses to the Patient Health Questionnaire depression scale, the Center for Epidemiological Studies Depression scale, and the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS®) version 1.0 eight-item depression short form 8b (PROMIS-D). The presence of differential item function (DIF) was evaluated using ordinal logistic regression. RESULTS No items of any of the three target measures were flagged for DIF based on standard criteria. In a follow-up sensitivity analyses, the criterion was changed to make the analysis more sensitive to potential DIF. Scores were corrected for DIF flagged under this criterion. Minimal differences were found between the original scores and those corrected for DIF under the sensitivity criterion. CONCLUSIONS The three depression screening measures evaluated in this study did not perform differently in samples of individuals with SCI compared to general and community samples. Transdiagnostic symptoms did not appear to spuriously inflate depression severity estimates when administered to people with SCI.
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Affiliation(s)
- Karon F Cook
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Michael A Kallen
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Charles Bombardier
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Alyssa M Bamer
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Seung W Choi
- Data Recognition Corporation
- CTB, Monterey, CA, USA
| | - Jiseon Kim
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Rana Salem
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA, USA
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Entry into Residential Care After Discharge from Hospital. AGEING INTERNATIONAL 2016. [DOI: 10.1007/s12126-015-9236-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Saracino RM, Weinberger MI, Roth AJ, Hurria A, Nelson CJ. Assessing depression in a geriatric cancer population. Psychooncology 2016; 26:1484-1490. [PMID: 27195436 DOI: 10.1002/pon.4160] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/26/2016] [Accepted: 04/17/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine the ability of three popular self-report measures of depression to assess depression in a geriatric cancer setting. METHOD Cancer patients 70 years or older and on active treatment completed the Geriatric Depression Scale-Short Form, the Hospital Anxiety and Depression Scale, and the Center for Epidemiological Studies Depression Scale-Revised, and were interviewed using the depression module of the Structured Clinical Interview for DSM disorders (SCID) as the 'gold standard.' Analyses included calculating internal consistency, ROC curves, and the sensitivity and specificity to detect major depression (MDD) or minor depression (i.e. subthreshold depression). RESULTS In a sample of 201 cancer patients (85% White; 64% completed college degree or higher), all three of the self-report measures produced adequate internal consistency and predicted depression greater than chance. However, the published cutoff scores for detecting MDD produced inadequate sensitivity, suggesting these scores will miss as many as 33%-83% of geriatric cancer patients who are depressed. Revised cutoff scores were lower than published cutoff scores. CONCLUSION Although these measures produced good internal consistency and were better than chance at predicting depression in a geriatric cancer sample, the published cutoff scores for these measures did not perform well in predicting MDD nor minor depression. Of the three measures, the CES-D appeared to have the most utility. This data suggests that these popular screening measures may be inadequate for reliably identifying depression in a geriatric cancer population. Researchers and clinicians, therefore, should use caution when selecting depression measures for geriatric cancer patients and consider using the lower cut-off scores presented here.
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Affiliation(s)
- Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark I Weinberger
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Roth
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Arti Hurria
- Cancer and Aging Research Program, City of Hope Comprehensive Cancer Center, USA
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Howe CQ, Robinson JP, Sullivan MD. Psychiatric and psychological perspectives on chronic pain. Phys Med Rehabil Clin N Am 2016; 26:283-300. [PMID: 25952065 DOI: 10.1016/j.pmr.2014.12.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Chronic pain patients often have psychiatric disorders that negatively influence their responses to treatment. Also, many of them have dysfunctional beliefs and coping strategies, even if they do not meet DSM-5 criteria for a psychiatric disorder. Physiatrists should have a low threshold for referring both groups of patients for mental health services. This article describes psychiatric disorders that are highly prevalent among pain patients and also describes psychological processes that contribute to poor coping by the patients. Finally, it discusses factors that a physiatrist should consider in deciding whether to refer patients to psychiatrists versus psychologists.
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Affiliation(s)
- Catherine Q Howe
- Physical Medicine & Rehabilitation, University of Washington, Seattle, WA, USA
| | - James P Robinson
- Physical Medicine & Rehabilitation, University of Washington, Seattle, WA, USA.
| | - Mark D Sullivan
- Physical Medicine & Rehabilitation, University of Washington, Seattle, WA, USA
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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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de Man-van Ginkel JM, Hafsteinsdóttir TB, Lindeman E, Geerlings MI, Grobbee DE, Schuurmans MJ. Clinical Manifestation of Depression after Stroke: Is It Different from Depression in Other Patient Populations? PLoS One 2015; 10:e0144450. [PMID: 26637178 PMCID: PMC4670173 DOI: 10.1371/journal.pone.0144450] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 11/18/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Despite ample research on depression after stroke, the debate continues regarding whether symptoms such as sleep disturbances, loss of energy, changes in appetite and diminished concentration should be considered to be consequences of stroke or general symptoms of depression. By comparing symptoms in depressed and non-depressed stroke patients with patients in general practice and patients with symptomatic atherosclerotic diseases, we aim to further clarify similarities and distinctions of depression after stroke and depression in other patient populations. Based on this, it is possible to determine if somatic symptoms should be evaluated in stroke patients in diagnosing depression after stroke. METHODS An observational multicenter study is conducted in three hospitals and seven general practices including 382 stroke patients admitted to hospital with a clinical diagnosis of intracerebral hemorrhage or ischemic infarction, 1160 patients in general practice (PREDICT-NL), and 530 patients with symptomatic atherosclerotic diseases (SMART-Medea). RESULTS The prevalence of major depressive disorder according to DSM-IV criteria was 14.1% (95% CI 11.0%-18.0%) in the stroke cohort, 5.4% (95% CI 3.8%-7.9%) in the symptomatic atherosclerotic diseases cohort and 12.9% (95% CI 11.1%-15.0%) in the general practice cohorts. Comparing depressed patients of the three cohorts demonstrated broadly similar symptom profiles, as well as comparable levels of individual symptom prevalence. However, the stroke patients suffered more severely from these symptoms than patients in the other populations. CONCLUSIONS The findings suggest that depression after stroke is not a different type of depression. This finding indicates that all depressive symptoms should be evaluated in stroke patients, including somatic symptoms.
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Affiliation(s)
- Janneke M. de Man-van Ginkel
- Department of Rehabilitation, Nursing Science and Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Nursing Science, program in Clinical Health Sciences University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Thóra B. Hafsteinsdóttir
- Department of Rehabilitation, Nursing Science and Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Nursing Science, program in Clinical Health Sciences University Medical Center Utrecht, Utrecht, The Netherlands
- University of Professional Education Utrecht, Department of Healthcare, Utrecht, The Netherlands
- Faculty of Nursing, University of Iceland, Reykjavik, Iceland
| | - Eline Lindeman
- Department of Rehabilitation, Nursing Science and Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Centre of Excellence for Rehabilitation Medicine, Rehabilitation Center ‘De Hoogstraat’, The Netherlands
| | - Mirjam I. Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Diederick E. Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke J. Schuurmans
- Department of Rehabilitation, Nursing Science and Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Nursing Science, program in Clinical Health Sciences University Medical Center Utrecht, Utrecht, The Netherlands
- University of Professional Education Utrecht, Department of Healthcare, Utrecht, The Netherlands
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Simon GE, Rossom RC, Beck A, Waitzfelder BE, Coleman KJ, Stewart C, Operskalski B, Penfold RB, Shortreed SM. Antidepressants are not overprescribed for mild depression. J Clin Psychiatry 2015; 76:1627-32. [PMID: 26580702 PMCID: PMC4866597 DOI: 10.4088/jcp.14m09162] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 09/25/2014] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate overprescribing of antidepressant medication for minimal or mild depression. METHOD Electronic records data from 4 large health care systems identified outpatients aged 18 years or older starting a new episode of antidepressant treatment in 2011 with an ICD-9 diagnosis of depressive disorder (296.2, 296.3, 311, or 300.4). Patient Health Questionnaire-9 (PHQ-9) depression severity scores at time of treatment initiation were used to examine the distribution of baseline severity and the association between baseline severity and patients' demographic and clinical characteristics. RESULTS Of 19,751 adults beginning treatment in 2011, baseline PHQ-9 scores were available for 7,051. In those with a baseline score, 85% reported moderate or severe symptoms (PHQ-9 score of 10 or more), 12% reported mild symptoms (PHQ-9 score of 5 to 9), and 3% reported minimal symptoms (PHQ-9 score of less than 5). The proportion reporting minimal or mild symptoms when starting treatment increased with age, ranging from 11% in those under age 65 years to 26% in those aged 65 and older. The proportion with minimal or mild symptoms was also moderately higher among patients living in wealthier neighborhoods and those treated by psychiatrists. Nevertheless, across all subgroups defined by sex, race/ethnicity, prescriber specialty, and treatment history, the proportions with minimal or mild symptoms did not exceed 18%. Secondary analyses, including weighting and subgroup analyses, found no evidence that estimates of baseline severity were biased by missing PHQ-9 scores. CONCLUSIONS In these health systems, prescribing of antidepressant medication for minimal or mild depression is much less common than suggested by previous reports. Given that this practice may sometimes be clinically appropriate, our findings indicate that overprescribing of antidepressants for mild depression is not a significant public health concern.
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Affiliation(s)
- Gregory E Simon
- Group Health Research Institute, 1730 Minor Ave, Seattle, WA 98101
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Wardenaar KJ, Wanders RBK, Roest AM, Meijer RR, De Jonge P. What does the beck depression inventory measure in myocardial infarction patients? a psychometric approach using item response theory and person-fit. Int J Methods Psychiatr Res 2015; 24:130-42. [PMID: 25994207 PMCID: PMC6878327 DOI: 10.1002/mpr.1467] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/04/2015] [Accepted: 03/17/2015] [Indexed: 11/05/2022] Open
Abstract
Observed associations between depression following myocardial infarction (MI) and adverse cardiac outcomes could be overestimated due to patients' tendency to over report somatic depressive symptoms. This study was aimed to investigate this issue with modern psychometrics, using item response theory (IRT) and person-fit statistics to investigate if the Beck Depression Inventory (BDI) measures depression or something else among MI-patients. An IRT-model was fit to BDI-data of 1135 MI patients. Patients' adherence to this IRT-model was investigated with person-fit statistics. Subgroups of "atypical" (low person-fit) and "prototypical" (high person-fit) responders were identified and compared in terms of item-response patterns, psychiatric diagnoses, socio-demographics and somatic factors. In the IRT model, somatic items had lower thresholds compared to depressive mood/cognition items. Empirically identified "atypical" responders (n = 113) had more depressive mood/cognitions, scored lower on somatic items and more often had a Comprehensive International Diagnostic Interview (CIDI) depressive diagnosis than "prototypical" responders (n = 147). Additionally, "atypical" responders were younger and more likely to smoke. In conclusion, the BDI measures somatic symptoms in most MI patients, but measures depression in a subgroup of patients with atypical response patterns. The presented approach to account for interpersonal differences in item responding could help improve the validity of depression assessments in somatic patients.
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Affiliation(s)
- Klaas J Wardenaar
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
| | - Rob B K Wanders
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
| | - Annelieke M Roest
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
| | - Rob R Meijer
- Department of Psychometrics and Statistics, University of Groningen, Groningen, The Netherlands
| | - Peter De Jonge
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
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Prospective study of depression among dialysis patients in Saudi Arabia. Int Urol Nephrol 2015; 47:1001-10. [DOI: 10.1007/s11255-015-0977-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 04/06/2015] [Indexed: 11/26/2022]
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Religious vs. conventional cognitive behavioral therapy for major depression in persons with chronic medical illness: a pilot randomized trial. J Nerv Ment Dis 2015; 203:243-51. [PMID: 25816046 DOI: 10.1097/nmd.0000000000000273] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We examine the efficacy of conventional cognitive behavioral therapy (CCBT) versus religiously integrated CBT (RCBT) in persons with major depression and chronic medical illness. Participants were randomized to either CCBT (n = 67) or RCBT (n = 65). The intervention in both groups consisted of ten 50-minute sessions delivered remotely during 12 weeks (94% by telephone). Adherence to treatment was similar, except in more religious participants in whom adherence to RCBT was slightly greater (85.7% vs. 65.9%, p = 0.10). The intention-to-treat analysis at 12 weeks indicated no significant difference in outcome between the two groups (B = 0.33; SE, 1.80; p = 0.86). Response rates and remission rates were also similar. Overall religiosity interacted with treatment group (B = -0.10; SE, 0.05; p = 0.048), suggesting that RCBT was slightly more efficacious in the more religious participants. These preliminary findings suggest that CCBT and RCBT are equivalent treatments of major depression in persons with chronic medical illness. Efficacy, as well as adherence, may be affected by client religiosity.
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Hu A, Xue Z, Mwansisya TE, Zhou A, Pu W, Chen X, Sun M, Wang P, Fan H, Wang Z, Ouyang X, Liu Z, Rosenheck R. Major depressive disorder in hemodialysis patients in China. Asia Pac Psychiatry 2015; 7:78-84. [PMID: 24259452 DOI: 10.1111/appy.12110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 09/29/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Major depressive disorder (MDD) has been regarded as the most common psychiatric disorder among hemodialysis (HD) patients. However, few studies have investigated MDD in HD patients in Mainland China. This study sought to investigate the prevalence and treatment of MDD, as well as the sociodemographic and clinical characteristics in this population. METHODS Two hundred sixty HD patients were screened with the nine-item Patient Health Questionnaire, and the formal diagnosis of MDD was further assessed using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Severity of depressive symptoms was assessed with Hamilton Rating Scale for Depression. Finally, patients meeting diagnostic criteria were compared with those who did not on demographic and clinical characteristics. RESULTS Among the 260 subjects, 26.2% screened positively and 10% were confirmed to have a diagnosis of MDD. Among HD patients with MDD, 69.2% had severe or very severe depressive symptoms. There was no evidence of a clinical diagnosis or of treatment for MDD in any of the patients' medical records. Those with shorter duration of HD, lower monthly income, and lower levels of blood urea nitrogen were significantly more likely to have a diagnosis of MDD. DISCUSSION MDD is frequent in HD patients. Regular screening and professional diagnosis should be undertaken to increase the detection and treatment of MDD in HD patients. The effectiveness of interventions for MDD in HD patients deserves further research.
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Affiliation(s)
- Aimin Hu
- Institute of Mental Health, The Second Xiangya Hospital of Central South University, Changsha, China; Department of Medicine, Jishou University, Jishou, China
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Abstract
Cancer patients commonly experience depression and fatigue before, during, and after treatment. Symptoms can be debilitating, and the risks associated with unrecognized or inadequately treated depression are substantial. Inflammation may be important in the genesis of depression and fatigue in cancer patients; potential neurobiological mechanisms of inflammation-related behavioral symptoms are reviewed. Randomized studies of pharmacologic treatments for depression in cancer populations are limited, but available data are generally encouraging. Studies of pharmacologic treatments for cancer-related fatigue have been more numerous but with mixed results. A practical approach to pharmacologic treatment of depression and fatigue in cancer patients involves weighing the potential risks and benefits of specific agents, including potential for adverse or advantageous side effects. Progress in understanding the neurobiological mechanisms underlying inflammation-related behavioral symptoms will provide opportunities for the development of novel and targeted treatments.
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Abstract
OBJECTIVE Mortality on medical intensive care units (ICU) is approximately 25%. It is associated with age, severity of illness, and comorbidities. Preexisting depression is a risk factor for worse outcome in many diseases. The impact of depression on outcome of ICU patients has not been investigated. We assessed a possible association between mortality and preexisting depressive mood at the time of ICU admission. The primary end point was 28-day mortality. METHODS This single-center cohort study was conducted in a tertiary medical ICU. Two hundred patients were evaluated for preexisting depressive mood at ICU admission, determined by Hospital Anxiety and Depression Scale (HADS) score ≥8 in the depression dimension in patients with appropriate cognitive function. Patients with insufficient cognitive function were assessed using observer rating by next of kin by Hammond scale (cutoff ≥4) and/or a modified version of the Hospital Anxiety and Depression Scale for observer rating (cutoff ≥10). RESULTS In total, 66 (33%) of 200 patients were classified with preexisting depressive mood. Forty-nine (24.5%) of 200 patients had died by day 28. Of these, 23 (47%) had preexisting depressive mood as compared with 43 of 151 (29%) 28-day survivors (p = .017). Multiple logistic regression analysis revealed that preexisting depressive mood at the time of ICU admission is an independent risk factor for 28-day (odds ratio = 2.2, 95% confidence interval = 1.08-4.5, p = .030) and in-hospital mortality (median time till death = 20.5 [2-186] days, odds ratio = 2.58, 95% confidence interval = 1.31-5.1, p = .006). CONCLUSION Preexisting depressive mood might be an independent risk factor for 28-day mortality in medical ICU patients. This could have diagnostic and therapeutic implications for critically ill patients.
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Hegeman JM, de Waal MWM, Comijs HC, Kok RM, van der Mast RC. Depression in later life: a more somatic presentation? J Affect Disord 2015; 170:196-202. [PMID: 25254617 DOI: 10.1016/j.jad.2014.08.032] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Depression later in life may have a more somatic presentation compared with depression earlier in life due to chronic somatic disease and increasing age. This study examines the influence of the presence of chronic somatic diseases and increasing age on symptom dimensions of late-life depression. METHODS Baseline data of 429 depressed and non-depressed older persons (aged 60-93 years) in the Netherlands Study of Depression in Old Age were used, including symptom dimension scores as assessed with the mood, somatic and motivation subscales of the Inventory of Depressive Symptomatology-Self Report (IDS-SR). Linear regression was performed to investigate the effect of chronic somatic diseases and age on the IDS-SR subscale scores. RESULTS In depressed older persons a higher somatic disease burden was associated with higher scores on the mood subscale (B = 2.02, p = 0.001), whereas higher age was associated with lower scores on the mood (B = -2.30, p < 0.001) and motivation (B = -1.01, p = 0.006) subscales. In depressed compared with non-depressed persons, a higher somatic disease burden showed no different association with higher scores on the somatic subscale (F(1,12) = 9.2; p = 0.003; partial η(2)=0.022). LIMITATIONS Because the IDS-SR subscales are specific for old age, it was not feasible to include persons aged < 60 years to investigate differences between earlier and later life. CONCLUSIONS It seems that neither higher somatic disease burden nor higher age contributes to more severe somatic symptoms in late-life depression. In older old persons aged ≥ 70 years, late-life depression may not be adequately recognized because they may show less mood and motivational symptoms compared with younger old persons.
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Affiliation(s)
- J M Hegeman
- Department of Psychiatry, St. Antoniusziekenhuis, Utrecht, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
| | - M W M de Waal
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - H C Comijs
- Department of Psychiatry, EMGO Institute of Health and Care Research, VU Medical Centre, Amsterdam, The Netherlands
| | - R M Kok
- Department of Old Age Psychiatry, Parnassia, Den Haag, The Netherlands
| | - R C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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Lin C, Yen TH, Juang YY, Lin JL, Lee SH. Psychiatric comorbidity and its impact on mortality in patients who attempted suicide by paraquat poisoning during 2000-2010. PLoS One 2014; 9:e112160. [PMID: 25386676 PMCID: PMC4227688 DOI: 10.1371/journal.pone.0112160] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 10/13/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Paraquat poisoning is a lethal method of suicide used around the world. Although restricting its accessibility had been widely discussed, the underlying psychopathological mechanism of paraquat self-poisoning and its association with mortality have not yet been explicitly evaluated. METHODS We included all patients admitted to a tertiary general hospital in Taiwan between 2000 and 2010 following a suicide attempt by paraquat self-administration. Diagnoses were made upon psychiatric consultation based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The risk of mortality was calculated by logistic regression with various psychiatric or medical covariates. RESULTS The consultation-liaison psychiatry team assessed 157 patients who attempted suicide by paraquat poisoning. Mood disorders (54.0%), including dysthymic (26.7%) and major depressive disorders (24.7%), were the most common psychiatric diagnoses among the self-poisoning patients. Among those who attempted suicide, 87 patients (58.0%) died and dysthymic disorder (OR = 5.58, 95% CI: 1.13-27.69; p < 0.05) significantly increased the mortality risk after adjustment for relevant medical variables, including age, gender, severity index of paraquat poisoning (SIPP), and risk for respiratory failure. CONCLUSIONS Awareness of comorbid psychiatric illnesses, especially dysthymic disorder, is vital in the prevention and treatment of suicide by paraquat poisoning.
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Affiliation(s)
- Chemin Lin
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung branch, Keelung, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yeong-Yuh Juang
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ja-Liang Lin
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shwu-Hua Lee
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Palliative care as a primary therapeutic approach in advanced dementia: a narrative review. Clin Ther 2014; 36:1512-7. [PMID: 25457122 DOI: 10.1016/j.clinthera.2014.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/07/2014] [Accepted: 10/07/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE The goal of this narrative review was to identify and summarize the ways in which palliative care could benefit patients who have advanced dementia. METHODS This case-based discussion article examines current literature on palliative care for dementia. FINDINGS Dementia is an incurable, progressive disease that affects millions of subjects. The prevalence has grown in the last decade and is projected to continue on this trajectory. In the later stages of dementia, subjects require increasing levels of care due to severe cognitive and functional impairment. Although the field of palliative medicine focuses on improving the quality of life of patients with life-limiting illnesses, many patients with advanced dementia do not receive palliative care services. IMPLICATIONS Palliative care has been shown to improve patient and caregiver satisfaction, quality of life, and symptom burden at the end of life. Patients with advanced dementia would benefit from increased access to palliative care.
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Depression in patients with chronic kidney disease on dialysis in Saudi Arabia. Int Urol Nephrol 2014; 46:2393-402. [PMID: 25164589 DOI: 10.1007/s11255-014-0802-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/24/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Patients with chronic kidney disease on hemodialysis experience considerable psychological stress due to physical and social changes brought on by illness, increasing the risk of depressive disorder (DD). We examined the prevalence of DD and depressive symptoms, identified treatments for depression, and determined baseline demographic, social/behavioral, physical, and psychological correlates. METHODS A convenience sample of 310 dialysis patients in Jeddah, Saudi Arabia, was screened for DD using the Structured Clinical Interview for Depression and for depressive symptoms using the Hamilton Depression Rating Scale (HDRS). Established measures of psychosocial and physical health characteristics were administered, along with questions about current and past treatments. Bivariate and multivariate analyses identified independent correlates of DD and symptoms. RESULTS The prevalence of DD was 6.8 % (major depression 3.2 %, minor depression 3.6 %), and significant depressive symptoms were present in 24.2 % (HDRS 8 or higher). No patients with DD were being treated with antidepressant medication, whereas 28.6 % (6 of 21) were receiving counseling. Being a Saudi national, married, in counseling, or having a history of antidepressant were associated with DD in bivariate analyses. Correlates of depressive symptoms HDRS in multivariate analyses were Saudi nationality, marital status, stressful life events, poor physical functioning, cognitive impairment, overall severity of medical illness, and history of family psychiatric problems. CONCLUSIONS The prevalence of DD and depressive symptoms is lower in Saudi dialysis patients than in the rest of the world, largely untreated, and is associated with a distinct set of demographic, psychosocial, and physical health characteristics.
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Kroenke K, Yu Z, Wu J, Kean J, Monahan PO. Operating characteristics of PROMIS four-item depression and anxiety scales in primary care patients with chronic pain. PAIN MEDICINE 2014; 15:1892-901. [PMID: 25138978 DOI: 10.1111/pme.12537] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Depression and anxiety are prevalent in patients with chronic pain and adversely affect pain, quality of life, and treatment response. The purpose of this psychometric study was to determine the reliability and validity of the four-item Patient Reported Outcomes Measurement Information System (PROMIS) depression and anxiety scales in patients with chronic pain. DESIGN Secondary analysis of data from the Stepped Care to Optimize Pain care Effectiveness study, a randomized clinical trial of optimized analgesic therapy. SETTING Five primary care clinics at the Roudebush VA Medical Center (RVAMC) in Indianapolis, Indiana. SUBJECTS Two hundred forty-four primary care patients with chronic musculoskeletal pain. METHODS All patients completed the four-item depression and anxiety scales from the PROMIS 29-item profile, as well as several other validated psychological measures. The minimally important difference (MID) using the standard error of measurement (SEM) was calculated for each scale, and convergent validity was assessed by interscale correlations at baseline and 3 months. Operating characteristics of the PROMIS measures for detecting patients who had probable major depression or were anxiety-disorder screen-positive were calculated. RESULTS The PROMIS scales had good internal reliability, and the MID (as represented by two SEMs) was 2 points for the depression scale and 2.5 points for the anxiety scale. Convergent validity was supported by strong interscale correlations. The optimal screening cutpoint on the 4- to 20-point PROMIS scales appeared to be 8 for both the depression and anxiety scales. CONCLUSIONS The PROMIS four-item depression and anxiety scales are reasonable options as ultra-brief measures for screening in patients with chronic pain.
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Affiliation(s)
- Kurt Kroenke
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; Regenstrief Institute, Inc., Indianapolis, Indiana, USA
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Rathore JS, Jehi LE, Fan Y, Patel SI, Foldvary-Schaefer N, Ramirez MJ, Busch RM, Obuchowski NA, Tesar GE. Validation of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adults with epilepsy. Epilepsy Behav 2014; 37:215-20. [PMID: 25064739 PMCID: PMC4427235 DOI: 10.1016/j.yebeh.2014.06.030] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to assess the accuracy and operating characteristics of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adults with epilepsy. METHODS Tertiary epilepsy center patients served as the study population, with 237 agreeing to structured interview using the Mini-International Neuropsychiatric Interview (MINI), a "gold standard" instrument developed for rapid diagnosis of neuropsychiatric disorders, including major depressive disorder (MDD); 172 also completed the PHQ-9, and 127 completed both the PHQ-9 and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) within two days of the MINI. Sensitivity, specificity, positive and negative predictive values, and areas under the ROC curves for each instrument were determined. Cut-points of 10 for the PHQ-9 and 15 for the NDDI-E were used, and ratings at or above the cut-points were considered screen-positive. The PHQ-9 was divided into cognitive/affective (PHQ-9/CA) and somatic (PHQ-9/S) subscales to determine comparative depression screening accuracy. RESULTS The calculated areas under the ROC curves for the PHQ-9 (n=172) and the PHQ-9/CA and PHQ-9/S subscales were 0.914, 0.924, and 0.846, respectively, with the PHQ-9 more accurate than the PHQ-9/S (p=0.002) but not different from the PHQ-9/CA (p=0.378). At cut-points of 10 and 15, respectively, the PHQ-9 had higher sensitivity (0.92 vs 0.87) but lower specificity (0.74 vs 0.89) compared with the NDDI-E. The areas under the ROC curves of the PHQ-9 and the NDDI-E showed similar accuracy (n=127; 0.930 vs 0.934; p=0.864). SIGNIFICANCE The PHQ-9 is an efficient and nonproprietary depression screening instrument with excellent accuracy validated for use in adult patients with epilepsy as well as multiple other medical populations.
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Affiliation(s)
- Jaivir S. Rathore
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Department of Neurology and Rehabilitation, Neuropsychiatric Institute, University of Illinois Medical Center at Chicago (UIC), Illinois, U.S.A,Corresponding Author: Jaivir S. Rathore, M.D. 912 S. Wood St. 855N (M/C 769) UIC Chicago, IL 60612, U.S.A, Phone: +1-216-925-2499,
| | - Lara E. Jehi
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Youran Fan
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Sima I. Patel
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,MINCEP Epilepsy Care, University of Minnesota Medical Center, Minneapolis, Minnesota, U.S.A
| | - Nancy Foldvary-Schaefer
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Maya J. Ramirez
- Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Psychology Services, Tampa General Hospital, Tampa, Florida, U.S.A
| | - Robyn M. Busch
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Nancy A. Obuchowski
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - George E. Tesar
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
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Koenig HG, Berk LS, Daher NS, Pearce MJ, Bellinger DL, Robins CJ, Nelson B, Shaw SF, Cohen HJ, King MB. Religious involvement is associated with greater purpose, optimism, generosity and gratitude in persons with major depression and chronic medical illness. J Psychosom Res 2014; 77:135-43. [PMID: 25077855 DOI: 10.1016/j.jpsychores.2014.05.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/06/2014] [Accepted: 05/08/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Religious involvement may help individuals with chronic medical illness cope better with physical disability and other life changes. We examine the relationships between religiosity, depressive symptoms, and positive emotions in persons with major depression and chronic illness. METHODS 129 persons who were at least somewhat religious/spiritual were recruited into a clinical trial to evaluate the effectiveness of religious vs. secular cognitive behavioral therapy. Reported here are the relationships at baseline between religious involvement and depressive symptoms, purpose in life, optimism, generosity, and gratefulness using standard measures. RESULTS Although religiosity was unrelated to depressive symptoms (F=0.96, p=0.43) and did not buffer the disability-depression relationship (B=-1.56, SE 2.90, p=0.59), strong relationships were found between religious indicators and greater purpose, optimism, generosity, and gratefulness (F=7.08, p<0.0001). CONCLUSIONS Although unrelated to depressive symptoms in the setting of major depression and chronic medical illness, higher religious involvement is associated with positive emotions, a finding which may influence the course of depression over time.
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Affiliation(s)
- Harold G Koenig
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States; Department of Medicine, King Abdulaziz University (KAU), Jeddah, Saudi Arabia.
| | - Lee S Berk
- School of Allied Health Professions, Department of Pathology and Human Anatomy, School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Noha S Daher
- Epidemiology, Biostatistics, and Population Medicine, School of Public Health, Loma Linda University, Loma Linda, CA, United States
| | - Michelle J Pearce
- Center for Integrative Medicine, School of Medicine, University of Maryland, Baltimore, United States
| | - Denise L Bellinger
- Department of Pathology and Human Anatomy, School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Clive J Robins
- Department of Psychology and Neuroscience, Duke University Medical Center, Durham, NC, United States
| | - Bruce Nelson
- Department of Research, Glendale Adventist Medical Center, Glendale, CA, United States
| | - Sally F Shaw
- Department of Research, Glendale Adventist Medical Center, Glendale, CA, United States
| | - Harvey Jay Cohen
- Department of Medicine, Center for Aging and Human Development, Duke University Medical Center, Durham, NC, United States
| | - Michael B King
- Division of Psychiatry, Faculty of Brain Sciences, University College, London, United Kingdom
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