Factor analysis of the Beck Depression Inventory-II with patients with chronic fatigue syndrome

Network analysis of somatic symptoms in Chinese patients with depressive disorder

Introduction

Network theory conceptualizes somatic symptoms as a network of individual symptoms that are interconnected and influenced by each other. In this conceptualization, the network's central symptoms have the strongest effect on other symptoms. Clinical symptoms of patients with depressive disorders are largely determined by their sociocultural context. To our knowledge, no previous study has investigated the network structure of somatic symptoms among Chinese patients with depressive disorders. The aim of this study was to characterize the somatic symptoms network structure in patients with depressive disorders in Shanghai, China.

Method

A total of 177 participants were recruited between October 2018 and June 2019. The Chinese version of the Patient Health Questionnaire-15 was used to assess somatic symptoms. In order to quantify the somatic symptom network structure, indicators of “closeness,” “strength,” and “betweenness” were employed as identifiers for network-central symptoms.

Result

The symptoms of “feeling your heart pound or race,” “shortness of breath,” and “back pain” had the highest centrality values, indicating that these symptoms were central to the somatic symptom networks. Feeling tired or mentally ill had the strongest positive correlation with insomnia or other sleep problems (r = 0.419), followed by chest pain and breathlessness (r = 0.334), back pain, and limb or joint pain (r = 0.318).

Discussion

Psychological and neurobiological research that offers insights into somatic symptoms may focus on these central symptoms as targets for treatment and future research.

Factor Analysis of the Beck Depression Inventory-II and Long-Term Hematopoietic Stem Cell Transplantation Survival Using the Research Domain Criteria Framework

The presence of depressive symptoms prior to hematopoietic stem cell transplantation (HSCT) is a common experience, with long-term impacts on survival. Using the National Institute of Mental Health Research Domain Criteria (RDoC) framework, this study sought to characterize depressive symptoms in patients prior to HSCT through exploratory factor analysis and to determine whether depressive factors were significant predictors of long-term survival. Individuals were included in the study if they were preparing to undergo HSCT and endorsed depressive symptoms measured by the Beck Depression Inventory-II (BDI-II). Patients were scheduled to undergo transplantation between 2005 and 2010. Survival analyses were conducted in 2022 to assess long-term outcomes. The primary outcomes were exploring the factor structure of the BDI-II and conducing univariate and multivariate Cox regression analyses of depression symptoms and known demographic and disease characteristics that impact survival. Of the 695 participants included in the study, most were male, middle aged (mean age, 55.08 ± 11.75 years), white, and married. Exploratory factor analysis revealed a 4-factor structure consisting of "negative valence systems: internalizing" (eg, worthlessness, guilt), "arousal and threat" (eg, agitation, irritability), "arousal and regulatory systems" (eg, loss of energy, fatigue), and "negative valence systems: externalizing" (eg, loss of pleasure, loss of interest). Univariate survival analyses identified age, sex, disease type, acute graft-versus-host disease (GVHD), and negative valence systems: externalizing as significant predictors of survival. Transplant type, chronic GVHD, performance status, and the other 3 depression factor structures were not significant in univariate models. In the multivariate model, older age (hazard ratio [HR], 1.031; 95% confidence interval [CI], 1.021 to 1.041; P < .001) and presence of negative valence systems: externalizing symptoms (HR, 1.132; 95% CI, 1.030 to 1.244; P = .010) were significant predictors of shorter survival. Additionally, individuals diagnosed with acute leukemia were significantly more likely to have shorter survival compared to those with other disease types, including amyloidosis (HR, .362; 95% CI, .229 to .575; P < .001) and non-Hodgkin lymphoma (HR, .526; 95% CI, .349 to .793; P = .002). Exploratory factor analysis of depressive symptoms mapped well onto the RDoC constructs. Loss of pleasure and loss of interest, two key components of depression, were predictive of shorter survival. Exploration of key components of depression rather than the total depression score may provide important prognostic information for long-term survivorship and may help inform future and more individualized care.

The unique association of posttraumatic stress disorder with hypertension among veterans: A replication of Kibler et al. (2009) using Bayesian estimation and data from the United States-Veteran Microbiome Project

OBJECTIVE

Kibler et al. (2009) reported that hypertension was related to PTSD independent of depression. These two conditions have significant diagnostic overlap. The present study sought to conceptually replicate this work with a veteran sample, using Bayesian estimation to directly update past results, as well as examine symptom severity scores in relation to hypertension.

METHOD

This was a secondary analysis of data obtained from the United States-Veteran Microbiome Project. Lifetime diagnoses of PTSD and major depressive disorder (MDD) were obtained from a structured clinical interview and hypertension diagnoses were extracted from electronic medical records. PTSD and depressive symptom severity were obtained from self-report measures. Logistic regressions with Bayesian estimation were used to estimate the associations between hypertension and (a) psychiatric diagnostic history and (b) symptom severity scores.

RESULTS

Compared with veterans without lifetime diagnoses of either disorder, the PTSD-only group was estimated to have a 29% increase in hypertension risk, and the PTSD + MDD group was estimated to have a 66% increase in hypertension risk. Additionally, higher levels of PTSD symptom severity were associated with a higher risk of hypertension.

CONCLUSION

PTSD diagnosis and symptom severity are uniquely associated with hypertension, independent of MDD or depressive symptom severity. These results support previous findings that PTSD might be a modifiable risk factor for the prevention and treatment of hypertension. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Disentangling the "who" and "when" of parents' depressive symptoms: A daily diary study analysis

Parents' depressive symptoms vary across days, but factors predicting this fluctuation are not well understood. The present study utilized ecological momentary assessments to capture 1620 days of parents' lived experience in a diverse sample of 146 mothers and fathers from Appalachia who reported on daily fluctuation in family chaos, family financial hardship, and lack of social support, as well as depressive symptoms every day for 14 consecutive days. Data were analyzed using a multilevel modeling framework. Results reveal that on days when parents experience higher family chaos, higher family financial hardship, and lower social support than they typically do, they also experience greater depressive symptoms. Daily linkages between low social support and depressive symptoms were uniform across families. In contrast, daily linkages between depressive symptoms and family financial hardship and chaos were strongest among families who experienced chronic levels of adversity. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Development of a scale to assess obsessive-compulsive tendencies among Japanese university students

Obsessive-compulsive (OC) tendencies refer to obsessions and compulsions in a nonclinical group, which are risk factors for obsessive-compulsive disorder (OCD). OC tendencies and OC symptoms are mainly assessed using five factors: ordering, obsessions, cleaning, hoarding, and checking. However, since hoarding is now classified as an independent diagnosis in the DSM-V, this factor was not included and was instead replaced by indecisiveness. Furthermore, many established scales used for measuring OC tendencies were originally created for OCD patients; thus, they cannot adequately capture OC tendencies. Therefore, this study aimed to develop a scale to assess OC tendencies among Japanese university students with a revised five-factor structure: ordering, obsessions, cleaning, indecisiveness, and checking. We examined the factor structure, reliability, criterion-related validity, and convergent validity of the OC tendencies scale by administering two surveys. In Survey 1 (N = 216), an exploratory factor analysis (EFA) was conducted to examine the criterion-related and convergent validity and reliability of the OC tendencies scale. In Survey 2 (N = 202), a confirmatory factor analysis (CFA) was conducted. EFA and CFA utilized a five-factor structure comprising checking, ordering, indecisiveness, cleaning, and obsessions. Correlations with other scales indicated that the OC tendencies scale had efficient convergent validity, criterion-related validity, internal consistency, and test-retest reliability. This study validated the five-factor structure of OC tendency in Japanese university students. However, indecisiveness was also strongly correlated with trait-anxiety. As this scale is easy to administer among large groups, it has the potential to contribute to mental health support for university students by measuring OC tendencies experienced on a daily basis, which have not been adequately measured in the past.

Risks for Developing Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in College Students Following Infectious Mononucleosis: A Prospective Cohort Study

BACKGROUND

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) involves severe fatigue, unrefreshing sleep, and cognitive impairment, leading to functional difficulties; prior studies have not evaluated risk factors with behavioral and immune data collected before developing ME/CFS. Up to 5% of university students develop infectious mononucleosis (IM) annually, and 9-12% meet criteria for ME/CFS 6 months later. We sought to determine predictors of ME/CFS.

METHODS

We enrolled college students at the start of the school year (time 1), identified those who developed IM (time 2), and followed them for 6 months (time 3), identifying 3 groups: those who developed ME/CFS, severe ME/CFS (meeting >1 set of criteria), and who were asymptomatic. We conducted 8 behavioral and psychological surveys and analyzed cytokines at 3 time points.

RESULTS

238 of the 4501 students (5.3%) developed IM; 6 months later, 55 of the 238 (23%) met criteria for ME/CFS and 157 (66%) were asymptomatic. 67 of the 157 asymptomatic students served as controls. Students with severe ME/CFS were compared with students who were asymptomatic at 3 time points. The former group was not different from the latter group at time 1 (prior to developing IM) in stress, coping, anxiety, or depression but were different in several behavioral measures and had significantly lower levels of IL-6 and IL-13. At time 2 (when they developed IM), the 2 ME/CFS groups tended to have more autonomic complaints and behavioral symptoms while the severe-ME/CFS group had higher levels of IL-12 and lower levels of IL-13 than the recovered group.

CONCLUSIONS

At baseline, those who developed ME/CFS had more physical symptoms and immune irregularities, but not more psychological symptoms, than those who recovered.

A Multi-Center Disclusion Time Reduction (DTR) Randomized Controlled Occlusal Adjustment Study Using Occlusal Force and Timing Sensors Synchronized with Muscle Physiology Sensors

Objective—To perform a Randomized Controlled Trial (RCT) Disclusion Time Reduction (DTR) study at five Dental Colleges, using intraoral sensors and muscular electrodes. Methods and Materials—One hundred students were randomly assigned to a treatment group to receive the ICAGD coronoplasty, or a control group that received tooth polishing. All subjects answered symptom questionnaires: Beck Depression Inventory-II, Functional Restrictions, and Chronic Pain Symptom and Frequency. Subjects self-reported after ICAGD or placebo at 1 week, 1 month, 3 months, and 6 months. The Student’s t-Test analyzed the measured data. The Mann–Whitney U Test analyzed the subjective data (Alpha = 0.05). Results—The Disclusion Times, BDI-II scores, and Symptom Scales were similar between groups prior to treatment (p > 0.05). At 1 week, all three measures reduced in the treatment group, continuing to decline over 6 months (p < 0.05), but not for the controls (p > 0.05). Symptom Frequency, Functional Restrictions, and Pain Frequencies were higher in the treated group (p < 0.05), but declined after ICAGD compared to the control group (p < 0.05). Conclusions—ICAGD reduced Pain, Functional Restrictions, Symptom Frequency, and Emotional Depression within 1 week, which continued for 6 months. The tooth polishing did not initiate a placebo response.

Effects of a psychosocial intervention at one-year follow-up in a PREDIMED-plus sample with obesity and metabolic syndrome

This study examines if overweight/obesity are related to higher impulsivity, food addiction and depressive symptoms, and if these variables could be modified after 1 year of a multimodal intervention (diet, physical activity, psychosocial support). 342 adults (55-75 years) with overweight/obesity and metabolic syndrome (MetS) from the PREDIMED-Plus Cognition study were randomized to the intervention or to the control group (lifestyle recommendations). Cognitive and psychopathological assessments were performed at baseline and after 1-year follow-up. At baseline, higher impulsivity was linked to higher food addiction and depressive symptoms, but not to body mass index (BMI). Food addiction not only predicted higher BMI and depressive symptoms, but also achieved a mediational role between impulsivity and BMI/depressive symptoms. After 1 year, patients in both groups reported significant decreases in BMI, food addiction and impulsivity. BMI reduction and impulsivity improvements were higher in the intervention group. Higher BMI decrease was achieved in individuals with lower impulsivity. Higher scores in food addiction were also related to greater post-treatment impulsivity. To conclude, overweight/obesity are related to higher impulsivity, food addiction and depressive symptoms in mid/old age individuals with MetS. Our results also highlight the modifiable nature of the studied variables and the interest of promoting multimodal interventions within this population.

Perfectionism, depression and anxiety in chronic fatigue syndrome: A systematic review

OBJECTIVE

High levels of depression and anxiety are experienced alongside Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). Psychological causal and maintenance factors are not well-understood. Perfectionism is a multifactorial, transdiagnostic risk factor for various physical and mental health conditions. This systematic review assesses the association between perfectionism and depression and/or anxiety in people with CFS/ME.

METHOD

Systematic literature searches used a combination of terms for 'perfectionism', 'depression', 'anxiety' and 'CFS/ME'. Peer-reviewed English-language papers reporting quantitative data regarding the relationship between perfectionism and depression and/or anxiety in adults (aged 18-65 years) with a clinical diagnosis of CFS/ME were included. Screening, selection and assessment of risk of bias was completed independently by two authors. Bivariate and multivariate associations between perfectionism and anxiety and depression were extracted. Data were synthesised narratively.

RESULTS

Seven studies, reported in eight papers, were included. Seven examined the relationship between perfectionism and depression. Moderate-strong significant positive associations were found between depression and maladaptive perfectionism (r = 0.42 to .48, p < .01), and its component factors of concern over mistakes (r = 0.40 to .60, p < .01) and doubts about actions (r = 0.51 to .60, p < .01). Methodological limitations included sample size justification and selection, psychometric measures, and control of potential confounders.

CONCLUSION

Maladaptive perfectionism is consistently associated with depression in patients with CFS/ME. The relationship between perfectionism and anxiety is under-researched. Corroboration is required from longitudinal, cross-cultural studies. Clinical understanding may be increased through examining the interplay between maladaptive perfectionism, depression and anxiety and the physical and cognitive symptoms of CFS/ME.

Predicting Antidepressant Citalopram Treatment Response via Changes in Brain Functional Connectivity After Acute Intravenous Challenge

Introduction: The early and therapy-specific prediction of treatment success in major depressive disorder is of paramount importance due to high lifetime prevalence, and heterogeneity of response to standard medication and symptom expression. Hence, this study assessed the predictability of long-term antidepressant effects of escitalopram based on the short-term influence of citalopram on functional connectivity. Methods: Twenty nine subjects suffering from major depression were scanned twice with resting-state functional magnetic resonance imaging under the influence of intravenous citalopram and placebo in a randomized, double-blinded cross-over fashion. Symptom factors were identified for the Hamilton depression rating scale (HAM-D) and Beck's depression inventory (BDI) taken before and after a median of seven weeks of escitalopram therapy. Predictors were calculated from whole-brain functional connectivity, fed into robust regression models, and cross-validated. Results: Significant predictive power could be demonstrated for one HAM-D factor describing insomnia and the total score (r = 0.45-0.55). Remission and response could furthermore be predicted with an area under the receiver operating characteristic curve of 0.73 and 0.68, respectively. Functional regions with high influence on the predictor were located especially in the ventral attention, fronto-parietal, and default mode networks. Conclusion: It was shown that medication-specific antidepressant symptom improvements can be predicted using functional connectivity measured during acute pharmacological challenge as an easily assessable imaging marker. The regions with high influence have previously been related to major depression as well as the response to selective serotonin reuptake inhibitors, corroborating the advantages of the current approach of focusing on treatment-specific symptom improvements.

Factor structure and gender invariance of the Beck Depression Inventory - second edition (BDI-II) in a community-dwelling sample of adults

Objective: The main purpose of this study was to investigate the factor structure of the Beck Depression Inventory – Second Edition (BDI-II) in a sample of adults. Specifically, we evaluated the BDI-II based on confirmatory factor analysis of different measurement models, and compared the optimal factor structure of the BDI-II by gender using measurement invariance analysis.

Method: A cross-sectional survey with 717 community-dwelling adults was conducted. The Brazilian Portuguese version of the BDI-II was administered. Seven different models (one-, two-, three-factor models and their bifactor structures) were tested through CFA. CFA and multigroup analysis were executed with the software MPLUS (Weighted Least Squares Estimator – WLSMV).

Results: Four bifactor models reached acceptable fit indices. A bifactor model with two specific factors (Cognitive–Affective, and Somatic-Affective) provided the best fit to the data. The multigroup analysis of this model demonstrated invariance by gender.

Conclusions: Our findings support the use of the total BDI-II score to identify depressive symptoms, including gender comparisons. Since a bifactor structure fit the data better, the scores of the specific factors should not be used as the first choice, or at least should be used with caution. The analysis of the severity of depression, based on a total score, seems to be the most appropriate option.

Beck Depression Inventory-II: Self-report or interview-based administrations show different results in older persons

ABSTRACTBeck Depression Inventory-II (BDI-II) is one of the most-used rating scales. It was developed as a tool administered either as a self-rating or interview-based, observer-rating scale.

OBJECTIVE

The goal of this study is to compare BDI-II scores obtained with two standard methods of administration in community-based older persons.

METHODS

BDI-II was administered at first in the self-rated version to a sample of 60 mentally healthy older persons (age 60-87 years). Afterward, the interview-based administration was performed.

ANALYSES

We compared the scores with nonparametric tests - Spearman's correlation coefficient and Wilcoxon Signed Ranks test. We also computed internal consistency.

RESULTS

Self-rated BDI-II yielded significantly higher total score than interview (p &lt; 0.001, P = 88%). The correlation between total scores was moderate (rs = 0.46, p &lt; 0.001). Item analysis revealed a larger decrease (lower scores) in the somatic items in the interview-based version.

CONCLUSIONS

The two methods of administration result in different total score in healthy older persons. Therefore, interpretation of the scores should reflect the administration, which should be always specified in the studies.

Impaired Health-Related Quality of Life in Adolescent Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: The Impact of Core Symptoms

Objective: The objectives of this study were to compare the health-related quality of life (HRQOL) of a North American population of adolescents and young adults with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) to (1) healthy controls (HC), (2) adolescents with ME/CFS in other countries, and (3) other forms of pediatric chronic illness, and (4) to examine the influence of the core illness symptoms in the Institute of Medicine (IOM) case definition on impaired HRQOL. Study design: Cross-sectional study comparing individuals with ME/CFS referred to a tertiary care Chronic Fatigue clinic and HC. Eligible participants were age 10-30 years and met the Fukuda criteria for CFS. HC were eligible if they were age 10-30 years, with self-reported good, very good, or excellent general health. Pediatric HRQOL was measured using the PedsQL (Pediatric Quality of Life Inventory) and other validated instruments. Results: We enrolled 55 consecutive ME/CFS patients (46 F) aged 10-23 years. From a pool of 69 potential HC we selected 55 with similar age and gender distribution for comparison. The total and subscale scores on the PedsQL and on all other measures of HRQOL indicated significantly worse function among those with ME/CFS (all P < 0.001). The self-reported frequency of post-exertional malaise (PEM) was significantly associated with the severity of impaired HRQOL (P < 0.001). Cognitive impairment had a weaker association with the PedsQL score (P = 0.02). Orthostatic intolerance was present in 96% of the ME/CFS population. Of the 55 who satisfied the Fukuda criteria, 47 (85%) also satisfied the IOM criteria for the diagnosis. Those meeting the IOM criteria had worse PedsQL total scores than those meeting just the Fukuda criteria (P < 0.001). Conclusions: HRQOL was substantially lower in an ambulatory population of adolescents and young adults with ME/CFS than for healthy controls in North America, consistent with reports from other continents. HRQOL was also lower in ME/CFS than has been described in children with asthma, diabetes mellitus, epilepsy, eosinophilic gastroenteritis, and cystic fibrosis. The findings of this study lend further support to the inclusion of PEM, cognitive impairment, and orthostatic intolerance as core symptoms of pediatric ME/CFS.

Validity and reliability of the Beck Depression Inventory II (BDI-II) in family caregivers of children with chronic diseases

BACKGROUND

Information on the psychometric properties of the Beck Depression Inventory II (BDI-II) in family caregivers of children with chronic diseases is currently unavailable, indicating a significant gap in the literature. Therefore, we investigated 1) which of the five evaluated measurement models had the best fit, 2) the scale's reliability, and 3) the scale's convergent validity.

METHODS

In 2018, a cross-sectional ex post facto study with non-probability convenience sampling was conducted in 446 family caregivers of children with chronic diseases at the National Institute of Health in Mexico City; the family caregivers responded to the BDI-II and a battery of instruments measuring anxiety, caregiver burden, parental stress, well-being, and quality of life. A confirmatory factor analysis was conducted to determine the fit of the five models. Cronbach's alpha and composite reliability were calculated to assess the scale's reliability, and Spearman´s rank correlation was used to investigate the scale's convergent validity.

RESULTS

This study provided evidence that the two-factor somatic-affective and cognitive model had the best fit. The BDI-II demonstrated adequate reliability and evidence of convergent validity, as the BDI-II factors were positively correlated with anxiety, caregiver burden, and parental stress and negatively correlated with well-being and quality of life.

CONCLUSIONS

The findings reveal that the BDI-II is a valid, reliable, and culturally relevant instrument to measure depression in family caregivers of children with chronic diseases.

Effects of unsupportive social interactions, stigma, and symptoms on patients with myalgic encephalomyelitis and chronic fatigue syndrome

Prior research has found a heightened risk of suicide in patients with myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS). It is possible that a number of factors including stigma, unsupportive social interactions, and severe symptoms could lead to the development of depression, suicidal ideation, and heightened risk of suicide in this patient population. Prior studies have indicated that patients often report the legitimacy of their illness being questioned by family, friends, and even their physicians. This study aimed to determine whether stigma experienced, social support, symptomology, and functioning may be associated with depression and endorsement of suicidal ideation (SI) in patients with a self-reported diagnosis of ME or CFS. Findings indicated that participants that endorsed both SI and depression, in contrast to those that did not, experienced more frequent unsupportive social interactions in the form of blame for their illness, minimization of its severity, and social distancing from others. In addition, 7.1% of patients with ME and CFS endorsed SI but do not meet the criteria for clinical depression These findings highlight the importance of stigma and unsupportive social interactions as risk factors for suicidal thoughts or actions among patients with ME and CFS. Community psychologists have an important role to play in helping educate health care professionals and the public to these types of risk factors for patients marginalized by ME and CFS.

Suicidal ideation in non-depressed individuals: The effects of a chronic, misunderstood illness

Chronic illness is a risk factor for suicide but is often explained with depression. Research has shown an increased suicide rate in patients with myalgic encephalomyelitis and chronic fatigue syndrome, but specific risk factors have been unexplored. We qualitatively analyzed responses from 29 patients who endorsed suicidal ideation but did not meet depression criteria. Two themes were developed: (1) feeling trapped and (2) loss of self, loss of others, stigma and conflict. Myalgic encephalomyelitis and chronic fatigue syndrome caused patients severe disability, restructured their lives, and inflicted serious pain. Participants emphasized that they were not depressed, but felt trapped by the lack of treatments available.

Validity and reliability of the Beck Depression Inventory (BDI-II) in general and hospital population of Dominican Republic

The Beck Depression Inventory-II (BDI-II) is currently one of the most widely used measures in both research and clinical practice for assessing depression. Although the psychometric properties of the scale have been well established through many studies worldwide, so far there is no study examining the validity and reliability of BDI-II in Republic Dominican. The purpose of the present study was twofold: (a) to examine the latent structure of BDI-II by testing several competing models proposed in the literature; and (b) to provide evidence of validity and reliability of the BDI-II in Republic Dominican. Confirmatory factor analysis indicated that a bifactor model with a general depression factor and three specific factors consisting of cognitive, affective and somatic showed the best fit to the data. Internal reliability was moderate to high for all subscales and for the total scale. Scores on BDI-II discriminated between clinical and general population, supporting for external validity. Practical implications are discussed and suggestions for further research are also made.

Postdialysis recovery time is extended in patients with greater self-reported depression screening questionnaire scores

INTRODUCTION

Most patients take time to recover after a hemodialysis (HD) session. It has been suggested that recovery time is associated with intradialytic hypotension and rapid solute clearances. Other studies have reported a linkage to depression. We investigated the association between recovery time and intradialytic hypotension and depression.

METHODS

In five UK HD units, we screened for depressive symptoms using the Beck depression inventory-II, Patient Health Questionnaire, and recorded sessional blood pressures and Kt/Vurea.

FINDINGS

Seven hundred and one HD patients were studied; 63.6% male, mean age 64.1 ± 16.6 years, 33.5% diabetic. About 24.1% recovered in <1 hour, 27% 1-4 hours, 15.4% 4-8 hours, 10.7% 8-12 hours, and 22.8% after 12 hours. Systolic blood pressure fell by ≥20 mmHg in 30.9% postdialysis, and to <100 mmHg in 7.6%. In multivariate analysis, patients with recovery times >1 hour were more likely to be female, have high self-reported Beck depression inventory-II scores, a past medical history of depression, and be living without a partner. Longer recovery times were also associated with very low postdialysis systolic blood pressures (<100 mmHg), and higher body weight. However, the model predicted only 18% of the variation in recovery times. We found no association between recovery times and short-term mortality risk.

DISCUSSION

Prolonged postdialysis recovery times are associated with higher self-reported depression scores, and very low postdialysis blood pressure. Future studies investigating changes in dialysis practice and recovery times will need to target strategies to prevent intradialytic hypotension and adjust for patient psychological status.

Multidimensionality of the Langner Symptom Survey and Replication of a Cutoff Score in Emerging Adults

This study investigated the dimensionality of the Langner Symptom Survey and replicated a recent finding regarding a clinically validated cutoff score in emerging adults. Nine hundred thirteen (631 females and 282 males) students at a private university in the Midwestern United States participated online as part of a larger study and completed the Langner Symptom Survey and a demographic questionnaire. Results from exploratory principal components and confirmatory factor analyses provided support for both a six- and three-factor model of the Langner Symptom Survey, with the three-factor model offering marginally better confirmatory fit indices and greater parsimony of interpretation. A cutoff score of 5 denoting clinically significant psychological distress and need for treatment was supported through analysis of receiver-operating characteristic, sensitivity, specificity, and total classification accuracy based on psychological service utilization, and this result successfully replicated a recently published finding. The Langner Symptom Survey may function as a multidimensional measure of psychological distress and need for treatment in emerging adults that may need a lexical update.

Cross-Cultural Validation of the Korean Version of the Chalder Fatigue Scale

PURPOSE

University students are vulnerable to fatigue. If not adequately dealt with, fatigue might develop into various health problems and negatively affect quality of life (QOL). The present study examined psychometric properties of the Korean version of the Chalder Fatigue Scale (K-CFQ) in university students.

METHOD

Data were obtained from two samples of undergraduate students in Korea. The first dataset (N = 557) was collected in a cross-sectional survey in 2015 and the second dataset (N = 338) from a longitudinal survey with three time points over a semester period in 2016. Participants completed measures of fatigue, QOL, depression, anxiety, and sleep quality.

RESULTS

Three-factor model (physical fatigue, low energy, and mental fatigue) rather than the original two-factor model (physical and mental fatigue) provided a better goodness of fit indices to the data. Internal consistency of the K-CFQ was satisfactory, with Cronbach's α value of 0.88 for the total scale and those of subscales ranging from 0.73 to 0.87. Its convergent validity was supported by its significant association with anxiety, depression, sleep quality, and QOL. Significant association between T1 K-CFQ with physical QOL at T2 and T3 supported its predictive validity. Its known-group validity was proven with higher K-CFQ scores observed in the participants with depression and those with poor sleep quality.

CONCLUSIONS

Current results suggest that K-CFQ is a valid and reliable measure of fatigue, and a better model fit of the three-factor structure of the K-CFQ implies potential cross-cultural differences in the dimensionality of fatigue.

Approaching recovery from myalgic encephalomyelitis and chronic fatigue syndrome: Challenges to consider in research and practice

There are unique methodological challenges to studying and assessing recovery in myalgic encephalomyelitis and chronic fatigue syndrome. This study explored these challenges through interviewing 13 physicians who treat myalgic encephalomyelitis and chronic fatigue syndrome. Our deductive thematic analysis produced four themes to consider when approaching recovery: lifespan differences in the illness experience; the heterogeneity of myalgic encephalomyelitis and chronic fatigue syndrome-case definitions, etiological stance, and misdiagnosis; patient follow-up and selection bias; and assessment logistics. We discuss how researchers and clinicians can use these considerations when working with patients, drafting recovery criteria, and interpreting treatment outcomes.

Excessive daytime sleepiness and fatigue may indicate accelerated brain aging in cognitively normal late middle-aged and older adults

Excessive daytime sleepiness (EDS) and fatigue increases with age. The aim of this study was to investigate the association between EDS and fatigue with cortical thickness and hippocampal volume in cognitively normal, late middle-aged and older adults. We performed a cross-sectional observational study of 1374 cognitively-normal subjects aged 50 years and older who had a structural MRI. Regional cortical thickness and hippocampal volume were measured. Multiple linear regression models were fit to explore associations between EDS and fatigue and structural MRI measures in different brain regions, adjusting for multiple covariates. EDS was defined as Epworth Sleepiness Scale ≥10. Fatigue severity was assessed with the Beck Depression Inventory-2. 208 participants had EDS, 27 had significant fatigue, and 11 had both. Participants with EDS or fatigue had significantly lower cognitive scores, more disturbed sleep, and medical comorbidities. The presence of EDS was associated with both global and regional atrophy, whereas fatigue was more associated with frontal and temporal changes. Cortical thinning predicted by EDS and fatigue was maximal in the temporal region with average reduction of 34.2 μm (95% CI, -54.1, -14.3; P = 0.001) and 90.2 μm (95% CI, -142.1, -38.2; P = 0.001), respectively. Fatigue was also associated with hippocampal volume reduction of -374.2 mm³ (95% CI, -670.8, -77.7; P = 0.013). Temporal cortical thinning predicted by presence of EDS and fatigue was equivalent to more than 3.5 and 9 additional years of aging, respectively. EDS and fatigue were associated with cortical thickness reduction primarily in regions with increased age-susceptibility, which may indicate accelerated brain aging.

Chronic fatigue syndrome (CFS) symptom-based phenotypes in two clinical cohorts of adult patients in the UK and The Netherlands

OBJECTIVE

Studies have provided evidence of heterogeneity within chronic fatigue syndrome (CFS), but few have used data from large cohorts of CFS patients or replication samples.

METHODS

29 UK secondary-care CFS services recorded the presence/absence of 12 CFS-related symptoms; 8 of these symptoms were recorded by a Dutch tertiary service. Latent Class Analysis (LCA) was used to assign symptom profiles (phenotypes). Regression models were fitted with phenotype as outcome (in relation to age, sex, BMI, duration of illness) and exposure (in relation to comorbidities and patient-reported measures).

RESULTS

Data were available for 7041 UK and 1392 Dutch patients. Almost all patients in both cohorts presented with post-exertional malaise, cognitive dysfunction and disturbed/unrefreshing sleep, and these 3 symptoms were excluded from LCA. In UK patients, six phenotypes emerged: 'full' polysymptomatic (median 8, IQR 7-9 symptoms) 32.8%; 'pain-only' (muscle/joint) 20.3%; 'sore throat/painful lymph node' 4.5%; and 'oligosymptomatic' (median 1, IQR 0-2 symptoms) 4.7%. Two 'partial' polysymptomatic phenotypes were similar to the 'full' phenotype, bar absence of dizziness/nausea/palpitations (21.4%) or sore throat/painful lymph nodes (16.3%). Women and patients with longer duration of illness were more likely to be polysymptomatic. Polysymptomatic patients had more severe illness and more comorbidities. LCA restricted to 5 symptoms recorded in both cohorts indicated 3 classes (polysymptomatic, oligosymptomatic, pain-only), which were replicated in Dutch data.

CONCLUSIONS

Adults with CFS may have one of 6 symptom-based phenotypes associated with sex, duration and severity of illness, and comorbidity. Future research needs to determine whether phenotypes predict treatment outcomes, and require different treatments.

Factor Analysis of the DePaul Symptom Questionnaire: Identifying Core Domains

The present study attempted to identify critical symptom domains of individuals with Myalgic Encephalomyelitis (ME) and chronic fatigue syndrome (CFS). Using patient and control samples collected in the United States, Great Britain, and Norway, exploratory factor analysis (EFA) was used to establish the underlying factor structure of ME and CFS symptoms. The EFA suggested a four-factor solution: post-exertional malaise, cognitive dysfunction, sleep difficulties, and a combined factor consisting of neuroendocrine, autonomic, and immune dysfunction symptoms. The use of empirical methods could help better understand the fundamental symptom domains of this illness.

Depression in Rheumatoid Arthritis and its relation to disease activity

Objectives:

To determine the level of depression in Rheumatoid Arthritis and its relationship with severity of Rheumatoid Arthritis.

Methods:

This cross sectional analytical study was conducted from March 2014 to May 2014.

Total 102 cases of Rheumatoid Arthritis (RA) diagnosed as per ACR (American College of Rheumatology) 1987 criteria were enrolled from Rheumatology Department, Fatima Memorial Hospital. Severity of Rheumatoid Arthritis was assessed by Health Assessment Questionnaire (HAQ) and disease activity score (DAS - 28) while severity of depression was measured by Beck Depression Inventory (BDI) scale II questionnaire. The relationship between depression and disease activity (severity) of Rheumatoid Arthritis was assessed by calculating correlation coefficient between depression, disease activity score (DAS 28) of Rheumatoid Arthritis and health assessment questionnaire (HAQ).

Results:

Out of 102 patients, 77(75.5%) were females and 25(24.5%) males. The mean age of patients was 43.5± 11.9 years and the mean duration of disease was 7.8 ± 5.5 years.71.5% of Rheumatoid Arthritis patients were found to have some degree of depression and this was directly related to the severity of disease. Moderate and severe depression were present in 23 (22.5%) and 19(18.6%) patients respectively.

Conclusion:

In this study, almost three-fourths of Rheumatoid Arthritis patients were found to have depression. There was a strong association between Rheumatoid Arthritis disease activity and the level of depression. So it is imperative for clinicians treating Rheumatoid Arthritis patients to screen them for co morbid depression and manage it accordingly.

Diagnostic Methods for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop

BACKGROUND

The diagnosis of myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) is based on clinical criteria, yet there has been no consensus regarding which set of criteria best identifies patients with the condition. The Institute of Medicine has recently proposed a new case definition and diagnostic algorithm.

PURPOSE

To review methods to diagnose ME/CFS in adults and identify research gaps and needs for future research.

DATA SOURCES

MEDLINE, PsycINFO, and Cochrane databases (January 1988 to September 2014); clinical trial registries; and reference lists.

STUDY SELECTION

English-language studies describing methods of diagnosis of ME/CFS and their accuracy.

DATA EXTRACTION

Data on participants, study design, analysis, follow-up, and results were extracted and confirmed. Study quality was dual-rated by using prespecified criteria, and discrepancies were resolved through consensus.

DATA SYNTHESIS

Forty-four studies met inclusion criteria. Eight case definitions have been used to define ME/CFS; a ninth, recently proposed by the Institute of Medicine, includes principal elements of previous definitions. Patients meeting criteria for ME represent a more symptomatic subset of the broader ME/CFS population. Scales rating self-reported symptoms differentiate patients with ME/CFS from healthy controls under study conditions but have not been evaluated in clinically undiagnosed patients to determine validity and generalizability.

LIMITATIONS

Studies were heterogeneous and were limited by size, number, applicability, and methodological quality. Most methods were tested in highly selected patient populations.

CONCLUSION

Nine sets of clinical criteria are available to define ME/CFS, yet none of the current diagnostic methods have been adequately tested to identify patients with ME/CFS when diagnostic uncertainty exists. More definitive studies in broader populations are needed to address these research gaps.

Self-loathing aspects of depression reduce postoperative opioid cessation rate

OBJECTIVE

We previously reported that increased preoperative Beck Depression Inventory II (BDI-II) scores were associated with a 47% (95% CI 24%-64%) reduction in the rate of opioid cessation following surgery. We aimed to identify the underlying factors of the BDI-II (affective/cognitive vs somatic) associated with a decreased rate of opioid cessation after surgery.

METHODS

We conducted a secondary analysis of the data from a previously reported prospective, longitudinal, observational study of opioid use after five distinct surgical procedures (total hip replacement, total knee replacement, thoracotomy, mastectomy, and lumpectomy) in 107 patients. The primary endpoint was time to opioid cessation. After exploratory factor analysis of the BDI-II, mean summary scores were calculated for each identified factor. These scores were evaluated as predictors of time to opioid cessation using Cox proportional hazards regression.

RESULTS

The exploratory factor analysis produced three factors (self-loathing symptoms, motivational symptoms, emotional symptoms). All three factors were significant predictors in univariate analysis. Of the three identified factors of the BDI-II, only preoperative self-loathing symptoms (past failure, guilty feelings, self-dislike, self-criticalness, suicidal thoughts, worthlessness) independently predicted a significant decrease in opioid cessation rate after surgery in the multivariate analysis (HR 0.86, 95% CI 0.75-0.99, P value 0.037).

CONCLUSIONS

Our results identify a set of negative cognitions predicting prolonged time to postoperative opioid cessation. Somatic symptoms captured by the BDI-II were not primarily responsible for the association between preoperative BDI-II scores and postoperative prolonged opioid use.

An investigation of the factor structure of the beck depression inventory-II in anorexia nervosa

Symptoms of depression frequently co-occur with eating disorders and have been associated with negative outcomes. Self-report measures such as the Beck Depression Inventory-II (BDI-II) are commonly used to assess for the presence of depressive symptoms in eating disorders, but the instrument's factor structure in this population has not been examined. The purposes of this study were to explore the factor structure of the BDI-II in a sample of individuals (N = 437) with anorexia nervosa undergoing inpatient treatment and to examine changes in depressive symptoms on each of the identified factors following a course of treatment for anorexia nervosa in order to provide evidence supporting the construct validity of the measure. Exploratory factor analysis revealed that a three-factor model reflected the best fit for the data. Confirmatory factor analysis was used to validate this model against competing models and the three-factor model exhibited strong model fit characteristics. BDI-II scores were significantly reduced on all three factors following inpatient treatment, which supported the construct validity of the scale. The BDI-II appears to be reliable in this population, and the factor structure identified through this analysis may offer predictive utility for identifying individuals who may have more difficulty achieving weight restoration in the context of inpatient treatment. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.

Meta-Analysis of the Factor Structures of the Beck Depression Inventory-II

Two meta-analyses examined the factor structure of the Beck Depression Inventory-II (BDI-II). Study 1, which meta-analyzed 51 studies comprising 62 samples (N = 20,475) providing pattern matrices, determined that the two-factor solution comprising Cognitive and Somatic-Affective factors was supported for the full sample. The two-factor solution was also supported for subgroups of studies. As the factor structure varied somewhat between subgroups of studies, the strength of relationships between scale items and their underlying depressive symptoms varied. Hence, comparisons of mean BDI-II scores across subgroups can be misleading. Study 2 meta-analyzed 13 studies consisting of 16 samples (N = 5,128) providing covariance matrices among the 21 BDI-II items. The two-factor solution was again supported in Study 2. Nevertheless, the existence of a general depression factor was supported by the good fit of the one-factor model.

Point-prevalence of depression and associated risk factors

The study aimed to assess levels of depressive symptoms and associated risk factors in a sample of students in Bogotá, Colombia. A convenient sample (N = 254) of students at the University Antonio Nariño, Bogotá was invited to complete an online survey that contained questions associated with common risk factors for depression and the Beck Depression Inventory (BDI-II). Chi-square was used to analyze comparisons between demographic and risk factors and severity of depression, and comparisons between those depressed and not depressed. Odds Ratios and their 95% confidence interval (95% CI) were computed through logistic regression model developed for each independent variable. The point-prevalence of current depressive symptoms was 36.2%; women 47.3% and men 21.3%. Risk factors associated with depression included being a woman, having a previous diagnosis, suicidal ideation and (or) intent, sleep problems, a recent loss, and a history of family depression and alcoholism. The study confirms the high incidence of depression and associated risk factors in students. The results demonstrate a need for prevention measures, early detection and early intervention.

Understanding the Outcomes Measures used in Huntington Disease Pharmacological Trials: A Systematic Review

BACKGROUND

The identification of the gene mutation causing Huntington disease has raised hopes for new treatments to ease symptoms and slow functional decline. As such, there has been a push towards designing efficient pharmacological trials (i.e., drug trials), especially with regard to selecting outcomes measures that are both brief and sensitive to changes across the course of the disease, from subtle prodromal changes, to more severe end-stage changes.

OBJECTIVES

Recently, to aid in efficient development of new HD research studies, the National Institute of Neurological Disorders and Stroke (NINDS) published recommendations for measurement selection in HD. While these recommendations are helpful, many of the recommended measures have little published data in HD. As such, we conducted a systematic review of the literature to identify the most common outcomes measures used in HD clinical trials.

METHODS

Major medical databases, including PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials, were used to identify peer-reviewed journal articles in English from 2001 through April 2013; 151 pharmacological trials were identified.

RESULTS

The majority of HD clinical trials employed clinician-reported outcomes measures (93%); patient reported outcome measures (11%) and observer reported outcome measures (3%) were used with much less frequency.

CONCLUSIONS

We provide a review of the most commonly used measures across these trials, compare these measures to the clinical recommendations made by the NINDS working groups, and provide recommendations for selecting measures for future clinical trials that meet the Food and Drug Administration standards.

Assessment of depression in medical patients: a systematic review of the utility of the Beck Depression Inventory-II

To perform a systematic review of the utility of the Beck Depression Inventory for detecting depression in medical settings, this article focuses on the revised version of the scale (Beck Depression Inventory-II), which was reformulated according to the DSM-IV criteria for major depression. We examined relevant investigations with the Beck Depression Inventory-II for measuring depression in medical settings to provide guidelines for practicing clinicians. Considering the inclusion and exclusion criteria seventy articles were retained. Validation studies of the Beck Depression Inventory-II, in both primary care and hospital settings, were found for clinics of cardiology, neurology, obstetrics, brain injury, nephrology, chronic pain, chronic fatigue, oncology, and infectious disease. The Beck Depression Inventory-II showed high reliability and good correlation with measures of depression and anxiety. Its threshold for detecting depression varied according to the type of patients, suggesting the need for adjusted cut-off points. The somatic and cognitive-affective dimension described the latent structure of the instrument. The Beck Depression Inventory-II can be easily adapted in most clinical conditions for detecting major depression and recommending an appropriate intervention. Although this scale represents a sound path for detecting depression in patients with medical conditions, the clinician should seek evidence for how to interpret the score before using the Beck Depression Inventory-II to make clinical decisions.

Gender differences in perception of quality of life in adults with and without chronic health conditions: the role of depressive symptoms

Previous studies have shown that chronic conditions have a negative impact on quality of life. Furthermore, this impact appears to be different in males and females, but it is not yet clear what factors may mediate this relationship. Females with chronic health conditions had poorer quality of life in the physical and psychological domains as compared to males with chronic health conditions. The difference between male and female patients in the psychological domain disappeared when the analysis was adjusted for confounding factors such as age, presence of a chronic health condition, socioeconomic status, and depressive symptoms.

Attributions, distress and behavioural responses in the significant others of people with chronic fatigue syndrome

To test an attribution–emotion model of reactions to chronic fatigue syndrome/myalgic encephalomyelitis, 30 significant others of 30 adult patients with chronic fatigue syndrome/myalgic encephalomyelitis were administered a semi-structured interview about their beliefs regarding the patient’s illness and completed questionnaire measures of distress and behavioural responses to the patient. Spontaneous causal explanations (attributions) for illness events, symptom exacerbation and negative patient mood were extracted and coded. Significant others’ distress and negative behavioural responses towards the chronic fatigue syndrome/myalgic encephalomyelitis patient were associated with attributing illness events to causes personal and internal to the patient. Our findings may inform the future family-based interventions for chronic fatigue syndrome/myalgic encephalomyelitis.