Evidence-based practice in Chile

What treatment outcomes matter in adolescent depression? A Q-study of priority profiles among mental health practitioners in the UK and Chile

Evidence-based and person-centred care requires the measurement of treatment outcomes that matter to youth and mental health practitioners. Priorities, however, may vary not just between but also within stakeholder groups. This study used Q-methodology to explore differences in outcome priorities among mental health practitioners from two countries in relation to youth depression. Practitioners from the United Kingdom (UK) (n = 27) and Chile (n = 15) sorted 35 outcome descriptions by importance and completed brief semi-structured interviews about their sorting rationale. By-person principal component analysis (PCA) served to identify distinct priority profiles within each country sample; second-order PCA examined whether these profiles could be further reduced into cross-cultural "super profiles". We identified three UK outcome priority profiles (Reduced symptoms and enhanced well-being; improved individual coping and self-management; improved family coping and support), and two Chilean profiles (Strengthened identity and enhanced insight; symptom reduction and self-management). These could be further reduced into two cross-cultural super profiles: one prioritized outcomes related to reduced depressive symptoms and enhanced well-being; the other prioritized outcomes related to improved resilience resources within youth and families. A practitioner focus on symptom reduction aligns with a long-standing focus on symptomatic change in youth depression treatment studies, and with recent measurement recommendations. Less data and guidance are available to those practitioners who prioritize resilience outcomes. To raise the chances that such practitioners will engage in evidence-based practice and measurement-based care, measurement guidance for a broader set of outcomes may be needed.

Validity and Performance of the Patient Health Questionnaire (PHQ-2) for Screening of Depression in a Rural Chilean Cohort

Validity of PHQ-2 to screen for depression was assessed in an agricultural population in Chile. The sample included 4767 adults enrolled from 2014 to 2017 in a population-based cohort of chronic disease in Maule, Chile. Receiver operating characteristic (ROC) curve analysis was used to find the optimal PHQ-2 cut-off for depression, defined as the highest Youden index, using PHQ-9 as a reference standard. Sensitivity, specificity, and Youden J index were calculated for every cut-off point of PHQ-2. Prevalence of depression measured by PHQ-9 and PHQ-2 was 18% and 18.4%, respectively. Corresponding rates for women were 24.7% and 23.6%, and 8.3% and 10.9 for men. The optimal PHQ-2 cut-off score was 3, achieved with a sensitivity of 74.6%, specificity 93.9%, and Youden index of 0.68. The area under the curve for the ROC analysis ROC curve was 0.92 (95% CI 0.91-0.93). PHQ-2 has good performance for use as a test for depression screening in a rural population of Chile and can be easily applied in areas with low resources.