Distributional patterns of item responses and total scores on the PHQ-9 in the general population: data from the National Health and Nutrition Examination Survey

Mental health attitudes, norms, beliefs, and experiences with care among young Black men: A theory of planned behavior assessment

OBJECTIVE

Young Black/African American men (YBM) are at greater risk for trauma and related mental health concerns compared to young non-Hispanic White men but are less likely to receive mental health care when needed. The current study used a Theory of Planned Behavior (TPB)-guided framework to qualitatively explore beliefs, norms, and intentions related to seeking mental health screening and linkage to care (LTC) among YBM exposed to trauma.

METHOD

Participants (N = 55, Mage = 23 years) were YBM aged 18-30 recruited from urban community settings in Kansas City, MO, between October 2018 and April 2019 for participation in focus groups.

RESULTS

Participants discussed lived experiences with trauma and mental health care, plus salient behavioral beliefs-both positive and negative. Key normative referents were significant others and family members, and participants endorsed greater motivation to seek care with their support. Control beliefs ranged from individual and interpersonal facilitators and barriers to more systemic factors (e.g., availability of providers, cost, lack of access, disparities in incarceration).

CONCLUSIONS

Tailored interventions are needed to promote engagement in mental health services among YBM, with strategies that recognize cultural contexts and ongoing needs for general well-being. Recommendations for providers and systems are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Mental health issues and psychological risk factors among Paraguayan healthcare workers during the COVID-19 pandemic

BACKGROUND

There is an increasing concern regarding the mental health of healthcare workers during the COVID-19 pandemic.

AIMS

This study aimed to assess the psychological impact of the COVID-19 exposure among Paraguayan healthcare workers.

METHODS

A cross-sectional descriptive study has been carried out in five hospitals of Paraguay. Demographic and occupational exposure to COVID-19 were collected through a short questionnaire. Mental health status was assessed with the GAD-7, the PHQ-9, and the PCL-C. Logistic regression was used to determine psychological risk factors.

RESULTS

432 participants were surveyed. 218 (50.46%) were physicians. The prevalence of symptoms of anxiety, depression and PTSD was 48.15, 41.90, and 5.79%, respectively. There were no significant differences in anxiety (128 [29.63%] vs. 80 [18.52%]; p = 0.3303), depression (102 [23.61%] vs. 79 [18.29%]; p = 0.6703), or PTSD (14 [3.24%] vs. 11 [2.55%]; p = 0.8074) between frontline versus second-line workers. Main risk factors associated with psychological distress included work experience <5 years for depression and a COVID-19 positive diagnosis or having family/friends with a COVID-19 positive diagnosis for PTSD.

CONCLUSIONS

Paraguayan healthcare workers reported high prevalence of anxiety, depression, and a low prevalence of PTSD. A positive diagnosis of COVID-19 and work experience <5 years are important psychological risk factors.

Family function, anxiety and depression in adults with disabilities: a network analysis

Background

The prevalence of family dysfunction, anxiety and depression is high in people with disabilities due to long-term activity constraints and social difficulties. Recently, although studies have attempted to provide guidance for family therapy by focusing on the relationship between family function and negative emotions, the specific effects of improved family function during family therapy on alleviation of anxiety and depressive symptoms have been obscured. Thus, this study attempted to elucidate the impact of specific family functioning on specific symptoms of anxiety and depression through network analysis.

Methods

Family APGAR Index Questionnaire (APGAR), Generalized Anxiety Scale (GAD-7), and Patient Health Questionnaire Depression Scale (PHQ-9) were used to survey 897 adults with disabilities in Sichuan Province. Meanwhile, network analysis for studying the relationship between anxiety, depression and family functioning among the disabled via R software.

Results

The network analysis showed that (1) Nodes PHQ4 ("Energy"), APGAR3 ("Growth"), GAD1 ("Nervousness") and GAD4 ("Relaxing Trouble") were central nodes in the network model; (2) Bridge nodes linking family function, anxiety and depressive symptoms in the sample were PHQ9 ("Suicide ideation"), PHQ6 ("Worthlessness"), GAD1 ("Nervousness") and GAD5 ("Restlessness"); (3) The node APGAR5 ("Resolve") directly connects the bridge symptoms PHQ9 ("Suicide ideation") and PHQ8 ("Motor").

Conclusion

This study suggests that therapists could target the resolve of family members during family therapy to reduce suicidal ideation and enhance the level of activity of people with disabilities, thereby improving the network of anxiety and depression symptoms and alleviating negative emotions of people with disabilities.

Inattentive responding can induce spurious associations between task behaviour and symptom measures

Although online samples have many advantages for psychiatric research, some potential pitfalls of this approach are not widely understood. Here we detail circumstances in which spurious correlations may arise between task behaviour and symptom scores. The problem arises because many psychiatric symptom surveys have asymmetric score distributions in the general population, meaning that careless responders on these surveys will show apparently elevated symptom levels. If these participants are similarly careless in their task performance, this may result in a spurious association between symptom scores and task behaviour. We demonstrate this pattern of results in two samples of participants recruited online (total N = 779) who performed one of two common cognitive tasks. False-positive rates for these spurious correlations increase with sample size, contrary to common assumptions. Excluding participants flagged for careless responding on surveys abolished the spurious correlations, but exclusion based on task performance alone was less effective.

Major depressive disorder

Major depressive disorder (MDD) is characterized by persistent depressed mood, loss of interest or pleasure in previously enjoyable activities, recurrent thoughts of death, and physical and cognitive symptoms. People with MDD can have reduced quality of life owing to the disorder itself as well as related medical comorbidities, social factors, and impaired functional outcomes. MDD is a complex disorder that cannot be fully explained by any one single established biological or environmental pathway. Instead, MDD seems to be caused by a combination of genetic, environmental, psychological and biological factors. Treatment for MDD commonly involves pharmacological therapy with antidepressant medications, psychotherapy or a combination of both. In people with severe and/or treatment-resistant MDD, other biological therapies, such as electroconvulsive therapy, may also be offered.

Regular Exercise Is Associated With Low Fatigue Levels and Good Functional Outcomes After COVID-19: A Prospective Observational Study

OBJECTIVE

The aim of the study is to identify the impact of postacute SARS-CoV-2 infection on patient outcomes.

DESIGN

This is a prospective, repeated measure, observational study of consented adults with positive SARS-CoV-2 quantitative polymerase chain reaction or antigen test more than 28 days after infection. Only data from the initial study visit are reported, including disease history, symptoms checklist, patient questionnaires, cognitive tests, social/medical histories, vitals, grip strength, and 2-min walk distance.

RESULTS

Two hundred eighteen patients were studied: 100 hospitalized (57.3 ± 15.4 yrs, 62% male, body mass index: 31.3 ± 8.0) and 118 nonhospitalized (46.2 ± 14.6 yrs, 31% male, body mass index: 29.7 ± 7.5). Post-COVID patients reported mean 1.76 symptoms; ≥15% reported fatigue, memory loss, and shortness of breath. Grip strength was 14% lower than norms ( P < 0.0001). Fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue), mood (Patient Health Questionnaire), and well-being (EuroQol 5 Dimension 5 Level) scores were lower than the population norms ( P < 0.05). Hospitalized versus nonhospitalized post-COVID patients performed worse on cognitive assessments (processing speed test-Wechsler Adult Intelligence Scale-Fourth Edition Symbol Search) and reported less regular exercise (≥30 mins ≥3× per week; P < 0.05). In addition, 30% had severe fatigue (by the Functional Assessment of Chronic Illness Therapy-Fatigue); those patients reported less exercise ( P < 0.05). In multivariate models, lack of exercise was independently associated with multiple post-COVID-19 impairments.

CONCLUSIONS

Low levels of exercise are an independent risk factor for post-COVID sequelae. Patients who report less exercise have low grip strength, higher levels of fatigue, memory loss, shortness of breath, depression, and poorer quality of life.

Depression and anxiety among multiethnic middle school students: Age, gender, and sociocultural environment

BACKGROUND

Depression and anxiety-related disorders are common among adolescents. Research attention to early adolescence and low-income ethnically diverse populations is limited.

AIM

To conduct screening for depression and anxiety at an early age with attention to gender and socioenvironmental context within a low-income setting.

METHOD

Mixed methods included the PHQ-9A and GAD-10 screening instruments and ethnographic interviews.

RESULTS

75 ethnically diverse middle school students were included. Mean years age was 11.2 (0.74). Females had higher PHQ-9A sum scores than males (p = .002, Mann-Whitney test) and higher GAD-10 sum scores than males (p = .016, Mann-Whitney test). After controlling for multiple comparisons, girls had higher mean responses on three PHQ-9A items (p < .006, two-sided t-test) and only one GAD-10 item (p < .005, two-sided t-test). Ethnographic interviews revealed contexts associated with girls' experiences of depression and anxiety, including gender-based violence in both school and home environments. Salient for girls and boys alike were worries about consequences of COVID-19 for family with respect to illness, death, job loss, economic hardship. Fears over student perceptions of intensified discrimination and racism in school and community were prominent. These problems were experienced by students as barriers to educational engagement.

CONCLUSION

Specific attention to early adolescence is needed to identify emergence of subsyndromal conditions which may benefit from therapeutic attention to reduce symptom severity, identify sociocultural, structural, and gender-specific stressors, and to enhance educational engagement.

The moderating role of sexual minority status in the associations of the experience and tolerance of shame-related emotions to suicide risk

OBJECTIVE

This study examined the associations of the experience and tolerance of shame-related emotions to suicide risk, as well as the moderating role of sexual minority status.

METHODS

Community adults (N = 360) were recruited via MTurk and completed self-report questionnaires. Hierarchical regression analyses examined the main and interactive associations of sexual minority status and shame-related variables to suicide risk.

RESULTS

Results revealed significant positive associations between self-disgust and suicide risk for sexual minority and heterosexual participants, although the magnitude was greater for sexual minority participants. Additionally, tolerance of shame was significantly negatively related to suicide risk only among sexual minority participants. Finally, exploratory analyses examining the three-way interaction of self-disgust, shame tolerance, and sexual minority status revealed a significant negative association between shame tolerance and suicide risk only among sexual minority participants with high levels of self-disgust.

CONCLUSION

Results highlight the relevance of shame-related experiences to suicide risk among sexual minorities.

Racial and Ethnic Disparities: Essential Workers, Mental Health, and the Coronavirus Pandemic

Evidence is emerging of the pandemic disproportionately impacting communities of color. This study investigates mental health distress among essential workers during the coronavirus pandemic across race and ethnicity. We evaluate individual responses to the patient health questionnaire and general anxiety disorder questionnaire using a unique, nationally representative data set. Our findings suggest that essential healthcare workers reported the highest rates of mental health distress at the beginning of the coronavirus pandemic. However, when evaluated across race and ethnicity, we find that Black essential healthcare workers disproportionately report symptoms of anxiety; while, Hispanic essential healthcare workers disproportionately report symptoms of depression. Additionally, we find that being a Black or Hispanic essential nonhealthcare worker is associated with higher levels of distress related to anxiety and depression. These findings highlight the additional dimensions to which Black and Hispanic Americans may be disproportionately affected by the coronavirus pandemic. Furthermore, it calls into question how the essential worker classification, compounded by US unemployment policies, is potentially amplifying the mental health distress experienced by workers.

The prospective relation between borderline personality disorder symptoms and suicide risk: The mediating roles of emotion regulation difficulties and perceived burdensomeness

BACKGROUND

Despite the strong link between borderline personality disorder (BPD) symptoms and suicide risk, little is known about the mechanisms underlying this association. Theory-driven research clarifying the pathways through which BPD symptoms increase suicide risk over time is needed and may highlight relevant treatment targets for decreasing suicide risk among individuals with heightened BPD symptoms. This study examined the prospective relations among BPD symptoms, emotion regulation (ER) difficulties, perceived burdensomeness, thwarted belongingness, and suicide risk across five assessments over a 7-month period. Consistent with the interpersonal theory of suicide, we hypothesized that greater BPD symptoms would predict greater suicide risk over time via greater ER difficulties and, subsequently, greater perceived burdensomeness.

METHODS

A U.S. nationwide sample of 500 adults (47 % women; mean age = 40.0 ± 11.64) completed a prospective online study, including an initial assessment and four follow-up assessments over the next seven months.

RESULTS

Results revealed a significant indirect relation between BPD symptoms and greater suicide risk over time through greater ER difficulties and later perceived burdensomeness. Results also provided evidence for transactional relations between BPD symptoms and ER difficulties and suicide risk over time.

LIMITATIONS

All constructs were assessed via self-report questionnaire data. Our measure of suicide risk focuses on only suicidal ideation, plans, and impulses, and not suicide attempts or preparatory behaviors.

CONCLUSIONS

Results highlight both ER- and interpersonal-related factors as key mechanisms underlying suicide risk among community adults with BPD symptoms.

Psychosocial Outcomes of Individuals Attending a Suicide Bereavement Peer Support Group: A Follow-Up Study

Individuals bereaved by suicide represent an important group in terms of postvention. While peer support groups are often accessed by those bereaved, few studies have examined their impact in terms of physical and mental health wellbeing. The aim of this study was to examine psychosocial outcomes of individuals attending suicide bereavement peer support groups in Ireland. Between August 2020 and June 2021, all members were invited to complete a survey, with new members also surveyed at three- and six-month follow-up, to examine changes in wellbeing, depressive symptoms and grief reactions. Results were analyzed using descriptive statistics and mixed linear regression models. The 75 participants were mostly female, with lower levels of overall wellbeing and a higher prevalence of depressive symptoms and suicidal ideation than the general population. Participants also reported high levels of social adjustment difficulties and grief reactions, which were more pronounced for those more recently bereaved. At follow-up (n = 28), a significant improvement in wellbeing and a reduction in grief reactions were found, adjusting for time since bereavement. Participants identified the groups as creating a safe space and providing a sense of belonging and hope. Notwithstanding the small number of participants at follow-up, these findings underline the enduring mental health challenges for those bereaved by suicide and provide further evidence for the role of peer support in postvention.

Validation of the patient health questionnaire-9 and the generalized anxiety disorder-7 in Lithuanian student sample

BACKGROUND

The Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder Questionnaire- 7 (GAD-7) are short screening instruments used for detection of depression and anxiety symptoms in various settings, including general and mental health care as well as the general population. The aim of this study is to evaluate psychometric properties and factorial structure of the PHQ-9 and the GAD-7 in a sample of Lithuanian university students.

METHODS

1368 students (mean age 22.5±4.8) completed the PHQ-9 and the GAD-7 questionnaires online; after the completion of the survey, students were asked to provide phone contact for an additional interview. Eligible students were approached later by trained interviewers and completed The Clinical Interview Schedule-Revised for assessment of depressive and anxiety disorders.

RESULTS

Results showed that the PHQ-9 and the GAD-7 are reliable screening tools for depression and anxiety (Cronbach alpha 0.86 and 0.91, respectively). The one-factor structure of the PHQ-9 and the GAD-7 was confirmed by the Confirmatory Factor Analysis. A cut-off of ≥10 for the PHQ-9 resulted in 71% sensitivity and 66% specificity recognizing students with increased risk for mood or anxiety disorder. For the GAD-7, a cut-off ≥9 resulted in 73% sensitivity and 70% specificity recognizing students at risk. The PHQ-9 was sensitive but not specific in recognizing students with depressive disorders. The sensitivity and specificity of the GAD-7 in differentiating students with generalized anxiety disorders were low.

CONCLUSIONS

The PHQ-9 and the GAD-7 have sufficient formal psychometric properties, but their clinical utility as diagnostic tools for recognition of depressive and anxiety disorders in students is limited. Due to low specificity and high false positive rates, both scales are recommended only as an initial screening tool for recognition of subjects with increased risk of mental disorders, however positive cases should be later assessed using more comprehensive instruments.

Prevalence and variability of current depressive disorder in 27 European countries: a population-based study

BACKGROUND

We aimed to estimate the prevalence of current depressive disorder in 27 European countries, and to explore differences in prevalence between European countries and by gender.

METHODS

In this population-based study, we analysed data from respondents living in 27 European countries who were included in the second wave of the European Health Interview Survey, collected between 2013 and 2015. We assessed the prevalence of current depressive disorder using the eight-item Patient Health Questionnaire (PHQ-8), with depressive disorder defined as a PHQ-8 score of 10 or higher. Prevalence estimates and 95% CIs were calculated for all 27 countries overall and for each country individually. We assessed variation in prevalence (country vs the rest of Europe) using crude and adjusted prevalence ratios obtained from negative binomial regression models. We did all analyses for the total sample and stratified by gender.

FINDINGS

Our analysis sample comprised 258 888 individuals, of whom 117 310 (weighted proportion 47·8%) were men and 141 578 (52·2%) were women. The overall prevalence of current depressive disorder was 6·38% (95% CI 6·24-6·52) with important variation across countries, ranging from 2·58% (2·14-3·02) in the Czech Republic to 10·33% (9·33-11·32) in Iceland. Prevalence was higher in women (7·74% [7·53-7·95]) than in men (4·89% [4·71-5·08]), with clear gender differences for all countries except Finland and Croatia. Compared with the other European countries in our sample, those with the highest adjusted prevalence ratios were Germany (1·80 [1·71-1·89]) and Luxembourg (1·50 [1·35-1·66]), and those with the lowest adjusted prevalence ratios were Slovakia (0·28 [0·24-0·33]) and the Czech Republic (0·32 [0·27-0·38]).

INTERPRETATION

Depressive disorders, although common across Europe, vary substantially in prevalence between countries. These results could be a baseline for monitoring the prevalence of current depressive disorder both at a country level in Europe and for planning health-care resources and services.

FUNDING

UK Medical Research Council and CIBER Epidemiology and Public Health (CIBERESP).

The GAD-7 and the PHQ-8 exhibit the same mathematical pattern of item responses in the general population: analysis of data from the National Health Interview Survey

Background

Recent studies have shown that, among the general population, responses to depression-rating scales follow a common mathematical pattern. However, the mathematical pattern among responses to the items of the Generalized Anxiety Disorder-7 (GAD-7) is currently unknown. The present study investigated whether item responses to the GAD-7, when administered to the general population, follow the same mathematical distribution as those of depression-rating scales.

Methods

We used data from the 2019 National Health Interview Survey (31,997 individuals), which is a nationwide survey of adults conducted annually in the United States. The patterns of item responses to the GAD-7 and the Patient Health Questionnaire-8 (PHQ-8), respectively, were analyzed inductively.

Results

For all GAD-7 items, the frequency distribution for each response option (“not at all,” “several days,” “more than half the days,” and “nearly every day,” respectively) was positively skewed. Line charts representing the responses to each GAD-7 item all crossed at a single point between “not at all” and “several days” and, on a logarithmic scale, showed a parallel pattern from “several days” to “nearly every day.” This mathematical pattern among the item responses was identical to that of the PHQ-8. This characteristic pattern of the item responses developed because the values for the “more than half the days” to “several days” ratio were similar across all items, as were the values for the “nearly every day” to “more than half the days” ratio.

Conclusions

Our results suggest that the symptom criteria of generalized anxiety disorder and major depression have a common distribution pattern in the general population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00657-9.

Depression and Suicidal Ideation in a Sample of Malaysian Healthcare Workers: A Preliminary Study During the COVID-19 Pandemic

Objective: The burden of suicidal behavior is anticipated to increase as a sequela of the COVID-19 pandemic. However, there is limited evidence on suicidal behavior among healthcare workers, an at-risk population. Our study aimed to investigate suicidal ideation in terms of the rate and associated factors in a sample of Malaysian healthcare workers during the early-phase of the COVID-19 pandemic. Methods: A subpopulation analysis (N = 171) was conducted within a larger, nation-wide cross-sectional study of Malaysian healthcare worker psychological distress from March 18-21, 2020. Current suicidal ideation was measured with item 9 of the Patient Health Questionnaire-9 (PHQ-9). The following independent variables were assessed: socio-demographic profile, occupation and service-related factors, health-anxiety (Health Anxiety Inventory, HAI), lifetime anxiety disorder and severity of depression (PHQ-9). Results: The proportion of healthcare workers with current suicidal ideation (19/171) and clinical depression (17/171) were 11.1 and 9.9%, respectively. Multivariable analysis showed that clinical depression was the most significant factor associated with current suicidal ideation (p < 0.001, OR = 55.983, 95% CI = 9.015-347.671) followed by mild (subthreshold) depression (p = 0.001, OR = 115.984, 95% CI = 2.977-85.804). Service duration of more than 10 years was associated with significantly less suicidal ideation (p = 0.049, OR = 0.072, 95% CI = 0.005-0.993). Conclusions: Depression (subthreshold and especially within the clinical range) and early-career status (<10 years in service) may be target areas of early intervention for reduction of suicidal ideation amongst healthcare workers who have served during the COVID-19 pandemic. Further research is warranted to elucidate specific occupational stressors related to COVID-19 work conditions to tailor appropriate suicide preventive strategies in this population.

Mathematical pattern of Kessler psychological distress distribution in the general population of the U.S. and Japan

BACKGROUND

Although the 6-item Kessler psychological scale (K6) is a useful depression screening scale in clinical settings and epidemiological surveys, little is known about the distribution model of the K6 score in the general population. Using four major national survey datasets from the United States and Japan, we explored the mathematical pattern of the K6 distributions in the general population.

METHODS

We analyzed four datasets from the National Health Interview Survey, the National Survey on Drug Use and Health, and the Behavioral Risk Factor Surveillance System in the United States, and the Comprehensive Survey of Living Conditions in Japan. We compared the goodness of fit between three models: exponential, power law, and quadratic function models. Graphical and regression analyses were employed to investigate the mathematical patterns of the K6 distributions.

RESULTS

The exponential function had the best fit among the three models. The K6 distributions exhibited an exponential pattern, except for the lower end of the distribution across the four surveys. The rate parameter of the K6 distributions was similar across all surveys.

CONCLUSIONS

Our results suggest that, regardless of different sample populations and methodologies, the K6 scores exhibit a common mathematical distribution in the general population. Our findings will contribute to the development of the distribution model for such a depression screening scale.

Multiple imputation validation study: addressing unmeasured survey data in a longitudinal design

Background

Questionnaires used in longitudinal studies may have questions added or removed over time for numerous reasons. Data missing completely at a follow-up survey is a unique issue for longitudinal studies. While such excluded questions lack information at one follow-up survey, they are collected at other follow-up surveys, and covariances observed at other follow-up surveys may allow for the recovery of the missing data. This study utilized data from a large longitudinal cohort study to assess the efficiency and feasibility of using multiple imputation (MI) to recover this type of information.

Methods

Millennium Cohort Study participants completed the 9-item Patient Health Questionnaire (PHQ) depression module at 2 time points (2004, 2007). The suicidal ideation item in the module was set to missing for the 2007 assessment. Several single-level MI models using different sets of predictors and forms of suicidal ideation were used to compare self-reported values and imputed values for this item in 2007. Additionally, associations with sleep duration and smoking status, which are related constructs, were compared between self-reported and imputed values of suicidal ideation.

Results

Among 63,028 participants eligible for imputation analysis, 4.05% reported suicidal ideation on the 2007 survey. The imputation models successfully identified suicidal ideation, with a sensitivity ranging between 34 and 66% and a positive predictive value between 36 and 42%. Specificity remained above 96% and negative predictive value above 97% for all imputed models. Similar associations were found for all imputation models on related constructs, though the dichotomous suicidal ideation imputed from the model using only PHQ depression items yielded estimates that were closest with the self-reported associations for all adjusted analyses.

Conclusions

Although sensitivity and positive predictive value were relatively low, applying MI techniques allowed for inclusion of an otherwise missing variable. Additionally, correlations with related constructs were estimated near self-reported values. Therefore, the other 8 depression items can be used to estimate suicidal ideation that was completely missing from a survey using MI. However, these imputed values should not be used to estimate population prevalence.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-020-01158-w.

Patterns of item score and total score distributions on depression rating scales in the general population: evidence and mechanisms

Recent research has demonstrated that item scores and total scores on depression rating scales exhibit common distribution shapes in a general population. Specifically, responses to depressive symptom items show a proportional relationship between response options, except for the lower end option, whereas total scores exhibit an exponential distribution, except for the lower end of the distribution. The common mathematical distributions of item scores and total scores may help explain the scoring mechanism of a depression rating scale. This paper, therefore, discusses how the distribution shapes are generated. Two conditions are assumed: (1) each individual's latent degree of depression forms an exponential distribution in a general population, and (2) the threshold of each depressive symptom forms a normal distribution. A simulation study applying the two assumptions revealed that simulated total scores follow an exponential distribution through a strong linear relationship between an individual's latent trait of depression and simulated total scores. Furthermore, the strong linear relationship between total scores and the individual's latent trait of depression supports the prevailing view that total scores on a Likert type scale tend toward interval data. Regarding item scores, an analysis of boundary curves, which divide the distribution of total scores by each item score, revealed that the lower end option and the next option distances have a trade-off relationship, and the remaining option distances have a proportional relationship across all items. In conclusion, the assumption that a latent trait of depression follows an exponential distribution helps explain the mathematical pattern of item response and total score distribution. Furthermore, the item score and total score distribution shapes on depression rating scales may serve as evidence of the level of measurement.

Accuracy of Self-Reported Items for the Screening of Depression in the General Population

INTRODUCTION

Though self-reported items (SRD, self-reported depression) are commonly used in health surveys and cohort studies, their metric properties as a depression indicator remain unclear. The aims were to evaluate the measurement properties of SRD using the Patient Health Questionnaire-8 (PHQ-8) as reference and to identify factors related to the agreement between both indicators.

METHODS

Data from the European Health Interview Survey in Spain in 2014/2015 (n = 22,065) were analyzed. Two indicators of depression were considered: SRD based on two items yes/no (positive: both yes), and the PHQ-8 (positive ≥ 10). Socioeconomic factors and use of health services were considered as independent variables. The prevalence of depression, sensitivity, specificity, global agreement, and positive and negative predictive values (PPV and NPV) of SRDs were evaluated using the PHQ-8 as a reference. Logistic regression models were fitted to determine factors associated with the agreement between indicators.

RESULTS

The prevalence of depression was lower when assessed with PHQ-8 (5.9%) than with SRD (7.7%). SRD sensitivity and PPV were moderate-low (52.9% and 40.4%, respectively) whereas global agreement, specificity, and NPV were high (92.7%, 95.1%, and 97.0%, respectively). Positive agreement was associated with marital status, country of birth, employment status, and social class. Negative agreement was related to all independent variables except country of birth.

CONCLUSIONS

SRD items tend to overestimate the current prevalence of depression. While its use in health surveys and cohorts may be appropriate as a quick assessment of possible depression, due to their low sensitivity, its use in clinical contexts is questionable.

Socioeconomic status and well-being during COVID-19: A resource-based examination

The authors assess levels and within-person changes in psychological well-being (i.e., depressive symptoms and life satisfaction) from before to during the COVID-19 pandemic for individuals in the United States, in general and by socioeconomic status (SES). The data is from 2 surveys of 1,143 adults from RAND Corporation's nationally representative American Life Panel, the first administered between April-June, 2019 and the second during the initial peak of the pandemic in the United States in April, 2020. Depressive symptoms during the pandemic were higher than population norms before the pandemic. Depressive symptoms increased from before to during COVID-19 and life satisfaction decreased. Individuals with higher education experienced a greater increase in depressive symptoms and a greater decrease in life satisfaction from before to during COVID-19 in comparison to those with lower education. Supplemental analysis illustrates that income had a curvilinear relationship with changes in well-being, such that individuals at the highest levels of income experienced a greater decrease in life satisfaction from before to during COVID-19 than individuals with lower levels of income. We draw on conservation of resources theory and the theory of fundamental social causes to examine four key mechanisms (perceived financial resources, perceived control, interpersonal resources, and COVID-19-related knowledge/news consumption) underlying the relationship between SES and well-being during COVID-19. These resources explained changes in well-being for the sample as a whole but did not provide insight into why individuals of higher education experienced a greater decline in well-being from before to during COVID-19. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Depression and anxiety in patients with heart disease and/or cancer based on the National Health Interview Survey

Depression and anxiety in patients with heart disease and/or cancer have been shown to affect quality of life, adherence with medical management, and prognosis. We investigated the association of the diagnoses of cancer, heart disease, or both with self-reported symptoms consistent with serious mental illness (SMI). We used the K6 score to identify self-reported symptoms consistent with SMI from patients' responses to the 2017 National Health Interview Survey. Our final cohort included 24,777 individual surveys. Of those respondents, 1509 reported cancer, 2639 reported heart disease, and 534 reported both. About 96% of patients reported a K6 score <13, and 4% reported a K6 score ≥13, which is suggestive of SMI. Logistic regression identified significant associations between SMI and an inability to afford mental care/counseling, an inability to afford prescribed medications, and unemployed status, with odds ratios of 6.97, 2.94, and 3.49, respectively. Having both heart disease and cancer was independently associated with SMI (odds ratio = 2.57; 95% confidence interval, 1.53-4.31; P < 0.001). In conclusion, in a nationally representative self-reported questionnaire, patients with a combined diagnosis of cancer and heart disease were significantly more likely to report SMI than those with either diagnosis alone.

Association between Depression and Renal Hyperfiltration in a General Chinese Population

BACKGROUND

Depression is prevalent in patients with all stages of CKD and is associated with adverse outcome. Abnormally elevated GFR, or hyperfiltration, may play a crucial role in the initiation and progression of CKD. However, the association between depression and hyperfiltration is not known. The aim of this study is to investigate the relationship between depression and hyperfiltration.

METHODS

This was an observational cross-sectional study. A total of 3,716 volunteers (1,303 males and 2,413 females) aged 40-75 years without CKD from a community in China were included for the study. Depressive symptoms and the presence of a minor or major depressive episode were assessed with the 9-item Patient Health Questionnaire (PHQ-9) and Diagnostic and Statistical Manual of Mental Disorders (4th edition)-based structured interview, respectively.

RESULTS

The mean age of the participants in the present study was 53.8 ± 9.0 years. 115 participants had clinically relevant depression, and 122 participants had a minor or major depressive episode. In a multivariable logistic regression analysis adjusted for potential confounders, the association between clinically relevant depression and renal hyperfiltration remained significant in men but not in women. As compared with men without depression (PHQ <5) or depressive episodes, those with clinically relevant depression (PHQ ≥10) had a significantly higher risk of renal hyperfiltration. The fully adjusted OR (95% CI) was 4.81 (1.62-14.30, p = 0.005), those with a major depressive episode had a higher risk of renal hyperfiltration (OR 7.45; 95% CI 2.04-27.21, p = 0.002).

CONCLUSION

Depressive symptoms and major depressive episodes are associated with renal hyperfiltration in middle-aged and elderly Chinese men without CKD. Future studies are needed to verify and clarify the role of depression in the development of abnormally high eGFR and CKD.

Sedentary behaviour is associated with depression symptoms: Compositional data analysis from a representative sample of 3233 US adults and older adults assessed with accelerometers

BACKGROUND

Evidence supporting the individual associations of sedentary behaviours with depression symptoms commonly ignores the inherent co-dependency between physical activity, sedentary behaviours and sleep in a given 24-hour period. Data analysis based on compositional methods effectively deals with this issue.

AIM

To investigate the association between sedentary behaviour and depression symptoms synergistically using compositional analysis methods.

METHODS

Participants were a representative sample of 3233 US adults and older adults from the 2005-2006 cycle of the NHANES with valid 24-hour lifestyle behaviours data (i.e., accelerometer-derived physical activity and sedentary behaviour and self-reported sleep) and available self-reported depression symptoms (PHQ-9). The association between sedentary behaviour and depression symptoms scoring was investigated using a compositional zero-inflated Poisson regression analysis. Subsequently, the model estimates were used to evaluate the effects on depression symptoms of replacing time spent in sitting activities with physical activity of different intensities and sleep.

LIMITATIONS

The current study is limited by its cross-sectional design. Also, sleep time was self-reported, which could bias our estimations.

RESULTS

Increased sedentary behaviour relative to other behaviours was statistically significantly associated with increased depression symptoms (p < 0.001). Reallocating 60 min time from sedentary behaviours to moderate-to-vigorous physical activity (MVPA) and sleep was associated with small reductions in depression symptoms.

CONCLUSIONS

A synergistic compositional analysis of accelerometer data uncovered a detrimental association between sedentary behaviour and depression symptoms. These results add to evidence from previous studies. The observed association seems to be principally driven by corresponding reductions in MVPA and sleep duration.

Depression and Suicidal Ideation Among Patients With Cancer in the United States: A Population-Based Study

PURPOSE

To evaluate the association between cancer diagnosis and depression and suicidal ideation in a population-based cohort in the United States.

METHODS

This was a cross-sectional study based on the National Health and Nutrition Examination Survey (NHANES) conducted for the years 2005 to 2016. Depression was assessed using a validated tool (Patient Health Questionnaire-9, and suicidal ideation was assessed by item number 9 of this tool. Propensity score matching was conducted to match survey respondents with cancer versus those without cancer. Multivariable logistic regression analysis was then conducted to evaluate factors associated with higher probability of depression and suicide among the whole postpropensity cohort.

RESULTS

A total of 32,178 survey respondents were eligible and included in the study. These included 3,043 respondents with cancer and 29,675 respondents without cancer. Within the postpropensity cohort, a cancer diagnosis was not associated with a higher probability of depressive disorders (odds ratio, 0.937; 95% CI, 0.819 to 1.073), whereas it was associated with a higher probability of suicidal ideation (for respondents without cancer v those with cancer: odds ratio, 0.695; 95% CI, 0.517 to 0.935).

CONCLUSION

Cancer diagnosis is associated with a higher probability of suicidal ideation. Screening for suicidal ideation should be part of the assessment of patients with cancer.

Age-Related Changes in Item Responses to the Patient Health Questionnaire-9: Evidence From the National Health and Nutrition Examination Survey

BACKGROUND

Epidemiological studies have shown that total scores in depression screening scales change with age, but the mechanism underlying these age-related changes remains unclear. Previous research has indicated that item responses in depression screening scales exhibit characteristic distributions in the general population. We analyzed Patient Health Questionnaire-9 (PHQ-9) data from a representative survey conducted in the USA, to determine how the response pattern for each item changed with age and whether the pattern of responses contributed to age-related changes in total scores.

METHODS

We analyzed PHQ-9 data for 17,274 participants in the 2011-2016 National Health and Nutrition Examination Survey. The PHQ-9 allows respondents to self-rate the frequency of depressive symptoms using a four-point scale ranging from "not at all" to "nearly every day".

RESULTS

The lines for all nine item responses followed the same characteristic pattern across all age groups, which was marked by intersection at a single point between "not at all" and "several days" and parallel patterns between "several days" and "nearly every day" on a logarithmic scale. The probability of "nearly every day" showed a reverse U-shaped pattern, in that it was low from 12-29 years, increased during 30-50 years, and then decreased at ≥60 years. The age-related change in the probability of a response of "nearly every day" coincided with the trajectory of the PHQ-9 total scores.

CONCLUSIONS

This study demonstrated that item responses for the PHQ-9 followed a similar mathematical pattern across the adult lifespan. Moreover, our findings suggested that the probability of a response of "nearly every day" played an important role in age-related changes in PHQ-9 total scores across adulthood.

Predicting recurrence of depression using lifelog data: an explanatory feasibility study with a panel VAR approach

BACKGROUND

Although depression has a high rate of recurrence, no prior studies have established a method that could identify the warning signs of its recurrence.

METHODS

We collected digital data consisting of individual activity records such as location or mobility information (lifelog data) from 89 patients who were on maintenance therapy for depression for a year, using a smartphone application and a wearable device. We assessed depression and its recurrence using both the Kessler Psychological Distress Scale (K6) and the Patient Health Questionnaire-9.

RESULTS

A panel vector autoregressive analysis indicated that long sleep time was a important risk factor for the recurrence of depression. Long sleep predicted the recurrence of depression after 3 weeks.

CONCLUSIONS

The panel vector autoregressive approach can identify the warning signs of depression recurrence; however, the convenient sampling of the present cohort may limit the scope towards drawing a generalised conclusion.

Efficacy of a mindful-eating programme to reduce emotional eating in patients suffering from overweight or obesity in primary care settings: a cluster-randomised trial protocol

INTRODUCTION

Little is known about the applicability of mindfulness-based interventions in Spanish adults with overweight/obesity. The objective of the present study protocol is to describe the methods that will be used in a cluster randomised trial (CRT) that aims to evaluate the effectiveness of a mindfulness eating (ME) programme to reduce emotional eating (EE) in adults with overweight/obesity in primary care (PC) settings.

METHODS AND ANALYSIS

A CRT will be conducted with approximately 76 adults with overweight/obesity from four PC health centres (clusters) in the city of Zaragoza, Spain. Health centres matched to the average per capita income of the assigned population will be randomly allocated into two groups: 'ME +treatment as usual (TAU)' and 'TAU alone'. The ME programme will be composed of seven sessions delivered by a clinical psychologist, and TAU will be offered by general practitioners. The primary outcome will be EE measured by the Dutch Eating Behaviour Questionnaire (DEBQ) at post test as primary endpoint. Other outcomes will be external and restrained eating (DEBQ), binge eating (Bulimic Investigatory Test Edinburgh), eating disorder (Eating Attitude Test), anxiety (General Anxiety Disorder-7), depression (Patient Health Questionnaire-9), mindful eating (Mindful Eating Scale), dispositional mindfulness (Five Facet Mindfulness Questionnaire) and self-compassion (Self-Compassion Scale). Anthropometric measures, vital signs and blood tests will be taken. A primary intention-to-treat analysis on EE will be conducted using linear mixed models. Supplementary analyses will include secondary outcomes and 1-year follow-up measures; adjusted models controlling for sex, weight status and levels of anxiety and depression; the complier average causal effect of treatment; and the clinical significance of improvements.

ETHICS AND DISSEMINATION

Positive results of this study may have a significant impact on one of the most important current health-related problems. Approval was obtained from the Ethics Committee of the Regional Authority. The results will be submitted to peer-reviewed journals, and reports will be sent to participants.

TRIAL REGISTRATION NUMBER

NCT03927534 (5/2019).

Responses to depressive symptom items exhibit a common mathematical pattern across the European populations

The theoretical distribution of responses to depressive symptom items in a general population remains unknown. Recent studies have shown that responses to depressive symptom items follow the same pattern in the US and Japanese populations, but the degree to which these findings can be generalized to other countries is unknown. The purpose of this study was to conduct a pattern analysis on the EU population’s responses to depressive symptom items using data from the Eurobarometer. The Eurobarometer questionnaires include six depressive symptom items from the 12-item General Health Questionnaire. The pattern analysis revealed that, across the entire EU population, the ratios between “score = 2” and “score = 1” and between “score = 3” to “score = 2” were similar among the six items and resulted in a common pattern. This common pattern was characterized by an intersection at a single point between “score = 0” and “score = 1” and a parallel pattern between “score = 1” and “score = 3” on a logarithmic scale. Country-by-country analyses revealed that the item responses followed a common characteristic pattern across all 15 countries. Our results suggest that responses to depressive symptom items in a general population follow the same characteristic pattern regardless of the specific country.

Distribution of psychological distress is stable in recent decades and follows an exponential pattern in the US population

The prevalence of psychological distress is fairly stable in industrialised countries in recent decades, but the reasons for this stability remain unknown. To investigate the mechanisms underlying stability of psychological distress in the general population of the United States, we analysed the mathematical patterns of the distribution of psychological distress in recent decades. The present study utilised the Kessler psychological distress scale (K6) data from the 1997‒2017 United States National Health Interview Survey. We used overlap coefficients and graphical analysis to investigate the stability and mathematical patterns of the K6 distribution. Overlap coefficients and graphical analysis demonstrated that the distribution of K6 total scores was stable in the United States over the past two decades. Furthermore, the distributions of K6 total scores exhibited an exponential pattern, with the exception of the lower end of the distribution. These findings suggest that the lack of change in the prevalence of psychological distress over several decades is due to the stability of psychological distress distribution itself. Furthermore, the stability of the distribution of psychological distress over time may be linked to the exponential pattern of psychological distress distribution.

Further evidence that item responses on the Kessler Psychological Distress Scale exhibit the characteristic pattern in the general population

Background

Previous studies suggested that item responses on the 6-item Kessler Psychological Distress Scale (K6) exhibit characteristic distributions among the general population. To confirm the reproducibility of these findings, we conducted a pattern analysis of the K6 item responses using large-scale data from a US representative survey.

Methods

Data were drawn from the 2016, and 2017 National Health Interview Survey in the United States (33,028, and 26,742 individuals, respectively). We analyzed the patterns of item responses for the six items using normal and logarithmic scales and proposed a model of item responses.

Results

The lines for item responses showed the same pattern among the six items, characterized by crossing at a single point between "none" and "a little," and parallel patterns from "a little" to "all of the time" on a logarithmic scale. The ratio of "some" to "a little," "most" to "some," and "most" to "all of the time" were similar across the six items. The model of item responses, which was based on the findings that the decreasing ratios of "some" to "a little," "most" to "some," and "all of the time" to "most" were similar across the six items, explained the characteristic patterns of item responses.

Conclusion

These results provide further evidence that item responses on the K6 follow a particular distribution pattern among the general population.

Distribution of item responses and total item scores for the Center for Epidemiologic Studies Depression Scale (CES-D): Data from the Irish Longitudinal Study on Ageing (TILDA)

BACKGROUND

Previous studies have shown that item responses and total scores on depression screening scales follow characteristic distribution patterns in the United States and Japanese general populations. However, the degree to which these findings, especially in terms of item responses, can be generalized to a European population is unknown. Thus, we analyzed the item responses and total score distribution for the Center for Epidemiologic Studies Depression Scale (CES-D) in a representative Irish cohort from a large, recent study-the Irish Longitudinal Study on Ageing (TILDA).

METHODS

We used CES-D data from the 2009-2011 TILDA (8504 individuals). Responses for the 16 depressive symptoms included "rarely," "some of the time," "occasionally," and "all of the time." Item response patterns and total score distribution across these 16 depressive symptom items were examined using graphical analyses and exponential regression modeling.

RESULTS

Lines for item responses followed the same pattern across the 16 items. These lines were characterized by intersections in the vicinity of a single point between "rarely" and "some of the time" and parallel patterns from "some of the time" to "all of the time" on a log-normal scale. Total scores for the 16 items exhibited an exponential pattern, except for at the lower end of the distribution.

CONCLUSIONS

The present findings suggest that item responses and total scores on depression screening scales among the general population follow the same characteristic patterns across populations from multiple nations.

Stability of the Distribution of Patient Health Questionnaire-9 Scores Against Age in the General Population: Data From the National Health and Nutrition Examination Survey

Background: Epidemiological studies using the nine-item Patient Health Questionnaire (PHQ-9) have reported inconsistencies regarding the relationship between age and total scores. To determine whether this discrepancy is due to the stability of the distribution of PHQ-9 total scores against age, we investigated whether the total score distribution remains stable during adulthood, and also investigated the mathematical patterns of the total score distribution. Methods: The present study utilized data from 15,847 participants of the 2009-2014 United States National Health and Nutrition Examination Survey, all of whom responded to all PHQ-9 items. The stability of the total score distribution among different age groups was examined using overlap coefficients and graphical analysis. Results: High overlap coefficients were observed between all age groups for the distributions of PHQ-9 total scores, suggesting that the distribution of PHQ-9 total scores remains stable against age. Graphical analysis demonstrated that distributions of PHQ-9 total scores were similar across age groups. In addition, distributions of PHQ-9 total scores exhibited an exponential pattern, except at the lower end of the distribution. Conclusions: Our findings indicate that the stability of the distribution of PHQ-9 total scores throughout adulthood may underlie inconsistencies in the evidence regarding age-related changes in total depression scores.