2
|
Wolfe F, Schmukler J, Jamal S, Castrejon I, Gibson KA, Srinivasan S, Häuser W, Pincus T. Diagnosis of Fibromyalgia: Disagreement Between Fibromyalgia Criteria and Clinician-Based Fibromyalgia Diagnosis in a University Clinic. Arthritis Care Res (Hoboken) 2019; 71:343-351. [PMID: 30724039 DOI: 10.1002/acr.23731] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 08/14/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Recent studies have suggested that fibromyalgia is inaccurately diagnosed in the community, and that ~75% of persons reporting a physician diagnosis of fibromyalgia would not satisfy published criteria. To investigate possible diagnostic misclassification, we compared expert physician diagnosis with published criteria. METHODS In a university rheumatology clinic, 497 patients completed the Multidimensional Health Assessment Questionnaire (MD-HAQ) and the 2010 American College of Rheumatology preliminary diagnostic criteria modified for self-administration during their ordinary medical visits. Patients were evaluated and diagnosed by university rheumatology staff. RESULTS Of the 497 patients, 121 (24.3%) satisfied the fibromyalgia criteria, while 104 (20.9%) received a clinician International Classification of Diseases (ICD) diagnosis of fibromyalgia. The agreement between clinicians and criteria was 79.2%. However, agreement beyond chance was only fair (κ = 0.41). Physicians failed to identify 60 criteria-positive patients (49.6%) and incorrectly identified 43 criteria-negative patients (11.4%). In a subset of 88 patients with rheumatoid arthritis (RA), the kappa value was 0.32, indicating slight to fair agreement. Universally, higher polysymptomatic distress scores and criteria-based diagnosis were associated with more abnormal MD-HAQ clinical scores. Women and patients with more symptoms but fewer pain areas were more likely to receive a clinician's diagnosis than to satisfy fibromyalgia criteria. CONCLUSION There is considerable disagreement between ICD clinical diagnosis and criteria-based diagnosis of fibromyalgia, calling into question ICD-based studies. Fibromyalgia criteria were easy to use, but problems regarding clinician bias, meaning of a fibromyalgia diagnosis, and the validity of physician diagnosis were substantial.
Collapse
Affiliation(s)
- Frederick Wolfe
- Arthritis Diseases Center, National Data Bank for Rheumatic Diseases, and University of Wichita School of Medicine, Wichita, Kansas
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Evans K, Spiby H, Morrell CJ. A psychometric systematic review of self-report instruments to identify anxiety in pregnancy. J Adv Nurs 2015; 71:1986-2001. [PMID: 25818179 DOI: 10.1111/jan.12649] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2015] [Indexed: 11/28/2022]
Abstract
AIMS To report a systematic review of the psychometric properties of self-report instruments to identify the symptoms of anxiety in pregnancy to help clinicians and researchers select the most suitable instrument. BACKGROUND Excessive anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy, the optimal methods to identify anxiety in pregnancy have not been confirmed. DESIGN Psychometric systematic review. DATA SOURCES A systematic literature search of the multiple databases (1990-September 2014). REVIEW METHODS Identification of self-report instruments to measure anxiety in pregnancy using COSMIN guidelines to assess studies reporting a psychometric evaluation of validity and reliability. RESULTS Thirty-two studies were included. Studies took place in the UK, Australia, Belgium, Canada, Germany, Italy, Scandinavia, Spain and the Netherlands. Seventeen different instruments were identified. Measures of validity were reported in 19 papers and reliability in 16. The overall quality of the papers was rated as fair to excellent using the COSMIN checklist. Only one paper scored excellent in more than one category. CONCLUSION Many instruments have been adapted for use in different populations to those for which they were designed. The State Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale and the Hospital Anxiety and Depression Scale have been tested more frequently than other instruments, yet require further assessment to confirm their value for use in pregnancy.
Collapse
Affiliation(s)
- Kerry Evans
- Nottingham University Hospitals NHS Trust, UK
| | - Helen Spiby
- School of Health Sciences, University of Nottingham, UK.,School of Nursing and Midwifery, University of Queensland, Brisbane, Australia
| | | |
Collapse
|
6
|
Ryan J, Rapley M, Dziurawiec S. The Meaning of Coping for Psychiatric Patients. QUALITATIVE HEALTH RESEARCH 2014; 24:1068-1079. [PMID: 25013205 DOI: 10.1177/1049732314541011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Contemporary psychiatric theory holds that a precipitant of major mental illness is the inability of some vulnerable individuals to cope with the difficulties of everyday life. Such mentally ill people are characterized as having deficient, dysfunctional, or absent coping skills. Recently, researchers have exerted considerable effort to distinguish between productive and nonproductive coping. In this article, we argue that not only are such conceptualizations reliant on reductive, circular logic, but they also miss the essentially rational, local, and individual nature of coping in psychiatric patients' lives. We used semistructured interviews and thematic analyses of psychiatric patients' descriptions of their coping. Patients reported that professional intervention reduced their ability to cope, that they distrusted the mental health system and its professionals, that coping mechanisms were misinterpreted, that situational crises modulated coping, and that sometimes coping was just "not coping." We argue for a more respectful, nuanced understanding of coping among mental health professionals.
Collapse
Affiliation(s)
| | - Mark Rapley
- University of East London, London, United Kingdom
| | | |
Collapse
|
7
|
Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, Silove D. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980-2013. Int J Epidemiol 2014; 43:476-93. [PMID: 24648481 PMCID: PMC3997379 DOI: 10.1093/ije/dyu038] [Citation(s) in RCA: 1520] [Impact Index Per Article: 152.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Since the introduction of specified diagnostic criteria for mental disorders in the 1970s, there has been a rapid expansion in the number of large-scale mental health surveys providing population estimates of the combined prevalence of common mental disorders (most commonly involving mood, anxiety and substance use disorders). In this study we undertake a systematic review and meta-analysis of this literature. METHODS We applied an optimized search strategy across the Medline, PsycINFO, EMBASE and PubMed databases, supplemented by hand searching to identify relevant surveys. We identified 174 surveys across 63 countries providing period prevalence estimates (155 surveys) and lifetime prevalence estimates (85 surveys). Random effects meta-analysis was undertaken on logit-transformed prevalence rates to calculate pooled prevalence estimates, stratified according to methodological and substantive groupings. RESULTS Pooling across all studies, approximately 1 in 5 respondents (17.6%, 95% confidence interval:16.3-18.9%) were identified as meeting criteria for a common mental disorder during the 12-months preceding assessment; 29.2% (25.9-32.6%) of respondents were identified as having experienced a common mental disorder at some time during their lifetimes. A consistent gender effect in the prevalence of common mental disorder was evident; women having higher rates of mood (7.3%:4.0%) and anxiety (8.7%:4.3%) disorders during the previous 12 months and men having higher rates of substance use disorders (2.0%:7.5%), with a similar pattern for lifetime prevalence. There was also evidence of consistent regional variation in the prevalence of common mental disorder. Countries within North and South East Asia in particular displayed consistently lower one-year and lifetime prevalence estimates than other regions. One-year prevalence rates were also low among Sub-Saharan-Africa, whereas English speaking counties returned the highest lifetime prevalence estimates. CONCLUSIONS Despite a substantial degree of inter-survey heterogeneity in the meta-analysis, the findings confirm that common mental disorders are highly prevalent globally, affecting people across all regions of the world. This research provides an important resource for modelling population needs based on global regional estimates of mental disorder. The reasons for regional variation in mental disorder require further investigation.
Collapse
Affiliation(s)
- Zachary Steel
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, NSW, Australia, Centre for Population Mental Health Research, South West Sydney Local District Network, Sydney, NSW, Australia, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK, Centre for Mental Health, Public Health Foundation of India and Sangath, Goa, India
| | - Claire Marnane
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, NSW, Australia, Centre for Population Mental Health Research, South West Sydney Local District Network, Sydney, NSW, Australia, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK, Centre for Mental Health, Public Health Foundation of India and Sangath, Goa, India
| | - Changiz Iranpour
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, NSW, Australia, Centre for Population Mental Health Research, South West Sydney Local District Network, Sydney, NSW, Australia, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK, Centre for Mental Health, Public Health Foundation of India and Sangath, Goa, India
| | - Tien Chey
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, NSW, Australia, Centre for Population Mental Health Research, South West Sydney Local District Network, Sydney, NSW, Australia, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK, Centre for Mental Health, Public Health Foundation of India and Sangath, Goa, India
| | - John W Jackson
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, NSW, Australia, Centre for Population Mental Health Research, South West Sydney Local District Network, Sydney, NSW, Australia, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK, Centre for Mental Health, Public Health Foundation of India and Sangath, Goa, India
| | - Vikram Patel
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, NSW, Australia, Centre for Population Mental Health Research, South West Sydney Local District Network, Sydney, NSW, Australia, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK, Centre for Mental Health, Public Health Foundation of India and Sangath, Goa, India
| | - Derrick Silove
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, NSW, Australia, Centre for Population Mental Health Research, South West Sydney Local District Network, Sydney, NSW, Australia, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK, Centre for Mental Health, Public Health Foundation of India and Sangath, Goa, India
| |
Collapse
|
10
|
Matthey S, Ross-Hamid C. The validity of DSM symptoms for depression and anxiety disorders during pregnancy. J Affect Disord 2011; 133:546-52. [PMID: 21641046 DOI: 10.1016/j.jad.2011.05.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 05/06/2011] [Accepted: 05/06/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND The applicability of the symptom criteria for diagnostic mood and anxiety disorders has in recent times been questioned for women in the perinatal period, due to the overlap of diagnostic symptoms with normal symptoms due to the physical changes of pregnancy or postpartum, (e.g., sleep difficulties). METHOD 118 women in their second or early third trimester of pregnancy participated in a telephone interview that included the depression and anxiety modules of the MINI diagnostic interview, and an attributional probe question asking the woman whether endorsement of a symptom was due to the physical changes of her pregnancy or due to her mood or worries. RESULTS 66% of pregnant women who met criteria for major depression reported that a sufficient number of their symptoms were due to the normal physical changes of their pregnancy, such that they would no longer meet criteria for a diagnosis of major depression. Attributional probing resulted in the rate of major depression falling from 6.8% to 1.7%. The impact on anxiety disorders appears to be less. LIMITATIONS An important issue is whether women's attributional perceptions are valid, though the face validity of some of their responses means that credence should be given to the findings. In addition, it would be useful from a validity perspective to undertake the same attributional probing with other populations where symptom presence is most likely due to mood, such as unemployed or recently separated adults without physical complaints. CONCLUSION Rates of depressive disorders in pregnancy, using DSM symptom criteria, are significantly over-estimated due to the natural occurrence of many of the symptoms as a result of the pregnancy. Rates of anxiety disorders are also inflated, but to a lesser degree. This means that the validation of self-report mood measures, typically done against DSM diagnoses, is likely to have produced erroneous findings (e.g., optimum cut-off scores). It is probable that a similar finding would be obtained for the postpartum period. Thus future use of DSM symptom criteria for depression and anxiety in perinatal mental health work should use some form of attributional probing question to more accurately understand the applicability of symptoms to a diagnosis in this population.
Collapse
Affiliation(s)
- Stephen Matthey
- South Western Sydney Local Health Network, Infant, Child & Adolescent Mental Health Service-Research Unit, Liverpool Hospital, Mental Health Centre, Liverpool BC, NSW, Australia.
| | | |
Collapse
|