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Levi-Belz Y, Blank C, Groweiss Y, Neria Y. The impact of potentially morally injurious experience of betrayal on PTSD and depression following the October 7th terror attack. Sci Rep 2024; 14:18021. [PMID: 39098963 PMCID: PMC11298528 DOI: 10.1038/s41598-024-69035-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 07/31/2024] [Indexed: 08/06/2024] Open
Abstract
With about 1200 individuals murdered, the massacre of October 7th was one of the deadliest terrorist attacks in modern history. The mental health consequences of terrorist attacks have been documented. However, little is known of the impact of the potentially morally injurious experience (PMIE) of betrayal--in which individuals feel betrayed by leaders they once trusted--on levels of psychological burden in the aftermath of such an attack. In this national prospective cohort study, we examined to what extent the PMIE of betrayal exacerbates the risk for posttraumatic stress disorder (PTSD) and depression in the wake of the October 7th terrorist attack. A representative sample of 710 Israeli adults (362 female, 51.1%), Jews (557, 79.9%) and Arabs (153, 20.1%), aged 18-85 (M = 41.01, SD = 13.72) completed validated self-report questionnaires assessing PTSD, depression, and PMIE-betrayal at two timepoints: T1, in August 2023 (6-7 weeks before the attack) and T2, in November 2023 (5-6 weeks after the attack). In two hierarchical logistic regressions, we found that experience of PMIE-betrayal predicted diagnoses of both PTSD (OR 1.92, 95% CI 1.26-2.92) and depression (OR 2.03, 95% CI 1.37-3.01) at T2, beyond probable PTSD/depression at T1 and demographic and trauma-related variables. Moreover, in two repeated-measure analyses predicting PTSD/depression symptoms, we found significant interactions between PTSD/depression trajectories and PMIE-betrayal, meaning that the increase of PTSD/depression symptoms was significantly higher among participants experiencing betrayal in the context of the attack. Our study highlights the impact of PMIE of betrayal on the dramatic increase in psychopathology following the October 7th terror attack on Israel's population. Clinicians treating individuals coping with PTSD and depression should attend to their patients' possible exposure to betrayal following the attack. Moreover, national leaders and policymakers should take significant steps to repair the public's betrayal experience.
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Affiliation(s)
- Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, 40250, Emek Hefer, Israel.
- Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel.
| | - Carmel Blank
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, 40250, Emek Hefer, Israel
- Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | - Yoav Groweiss
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, 40250, Emek Hefer, Israel
| | - Yuval Neria
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, USA
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Teusen C, Bühner M, Hapfelmeier A, von Schrottenberg V, Linde K, Gensichen J, Schneider A. Development and psychometric evaluation of a questionnaire for the assessment of depression in primary care: a cross-sectional study. BMJ Open 2024; 14:e084102. [PMID: 39013641 PMCID: PMC11253771 DOI: 10.1136/bmjopen-2024-084102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/27/2024] [Indexed: 07/18/2024] Open
Abstract
OBJECTIVES To develop a new questionnaire for the diagnostic assessment of depression adapted to the primary care setting by combining psychiatric criteria and heuristics of general practitioners (GPs). Psychometric evaluation of the new questionnaire and first validity evidence. DESIGN The questionnaire was developed using cognitive interviews with think-aloud technique. Factorial validity was then examined in a cross-sectional study. SETTING Primary care. Five general practices in Bavaria, Germany. PARTICIPANTS 15 GPs, 4 psychiatrists/psychotherapists and 13 patients participated in cognitive expert interviews. A primary care sample of N=277 consecutive patients participated in the cross-sectional study. METHODS After consultation with experts and literature research, the questionnaire contained a self-rating part for patients and an external part for GPs. Items were then iteratively optimised using cognitive interviews. Factorial validity was examined. To estimate internal consistency, Cronbach's α was calculated. Validity was assessed by correlating the new questionnaire and the Patient Health Questionnaire-9 (PHQ-9). RESULTS The preliminary version of the two-part 'Questionnaire for the assessment of DEpression SYmptoms in Primary Care' (DESY-PC) comprised 52 items for patients (DESY-PAT-1: questions about patient's environment; DESY-PAT-2: questions about depression-specific symptoms) and 21 items for GPs (DESY-GP). The analysis of the DESY-PAT-1 revealed a one-factor solution ('environmental factors') with Cronbach's α of 0.55. The items of the DESY-PAT-2 were assigned to three factors, 'depressive cognitions', 'suicidality' and 'symptoms of fatigue', with Cronbach's α of 0.86, 0.79 and 0.85, respectively. Factorial analysis revealed two factors for the DESY-GP: 'depression symptoms' and 'medical history/external factors'. Cronbach's α was 0.90 and 0.59, respectively. After factorial analysis, the DESY-PAT was reduced to 28 items, and the DESY-GP was reduced to 15 items. Correlations of the DESY-PC with the PHQ-9 were high and significant, indicating convergent validity. CONCLUSIONS The new questionnaire represents an innovative extension of depression questionnaires and could be particularly suitable for general practices.
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Affiliation(s)
- Clara Teusen
- Institute of General Practice and Health Services Research, Department of Clinical Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | | | - Alexander Hapfelmeier
- Institute of General Practice and Health Services Research, Department of Clinical Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Institute of AI and Informatics in Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Victoria von Schrottenberg
- Institute of General Practice and Health Services Research, Department of Clinical Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Klaus Linde
- Institute of General Practice and Health Services Research, Department of Clinical Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital of the LMU Munich, Munich, Germany
- DFG-Graduiertenkolleg POKAL (DFG-GrK 2621/POKAL-Kolleg), Munich, Germany
| | - Antonius Schneider
- Institute of General Practice and Health Services Research, Department of Clinical Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
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Levi-Belz Y, Shoval-Zuckerman Y, Blank C, Groweiss Y, Neria Y. The moderating role of belongingness in the contribution of depression to suicide ideation following the October 7, 2023, terrorist attack in Israel: A nationwide prospective study. J Affect Disord 2024; 356:292-299. [PMID: 38615841 DOI: 10.1016/j.jad.2024.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION With >1300 civilians murdered, the terrorist attack of October 7 is one of the deadliest terrorist attacks in modern history. Previous research documented a sharp increase in depression in the aftermath of the attacks and the military conflict that followed. In this national prospective cohort study, we examined to what extent perceived belongingness (PB) moderates the association between depression and suicide ideation (SI) in the wake of the October 7th terrorist attack. METHODS A representative sample of 710 Israeli adults (of them, 362 females, 51.1 %), Jews (557, 79.9 %), and Arabs (153, 20.1 %), aged 18-85 (M = 41.01, SD = 13.72) completed questionnaires assessing depression, current SI, and perceived belongingness at two timepoints: T1 (in August 2023) and T2 (in November 2023). RESULTS Perceived belongingness at T1 predicted SI at T2 beyond demographic and trauma-related characteristics. Importantly, we found a significant interaction in which a PB at T1 moderated the link between depression and current SI at T2. Specifically, the level of depression at T2 contributed to current SI-T2 more strongly for individuals with low PB levels than for individuals with high PB levels. DISCUSSION Our study highlights the impact of PB on SI following the October 7th terrorist attack. Clinicians treating individuals coping with depression should attend to their patients' sense of belongingness, as low PB comprises a significant risk factor for current SI. Moreover, community and national initiatives that could increase levels of PB among the citizens may help to diminish suicide risk in the aftermath of the attack.
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Affiliation(s)
- Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel; Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel.
| | | | - Carmel Blank
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel; Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | - Yoav Groweiss
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Yuval Neria
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University Irving Medical Center, NY, USA
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DuBois D, Sundell J, Thomsen MR, Brown CC. Impact of the 2022 Infant Formula Shortage on Self-Reported Rates of Anxiety and Depression: Evidence from the Household Pulse Survey. J Perinat Neonatal Nurs 2024; 38:326-333. [PMID: 39074328 PMCID: PMC11296491 DOI: 10.1097/jpn.0000000000000839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
PURPOSE To evaluate the impact of the 2022 infant formula shortage on self-reported anxiety and depression. BACKGROUND The US national infant formula shortage of 2022 originated from supply chain disruptions triggered by the COVID-19 pandemic, and the shortage was further compounded by a recall of tainted formula products. METHODS We used survey-weighted data from the Household Pulse Survey (HPS) to measure self-reported anxiety and depression among individuals with formula-fed infants less than 1 year of age. We evaluated the association between 2 formula disruption variables (being impacted by the infant formula shortage or having difficulty obtaining formula in the last 7 days) with 2 mental health outcomes (anxiety and depression) using multivariable logistic regressions. RESULTS We found increased odds of self-reported anxiety (aOR: 3.13; P < .001) and depression (aOR: 3.05; P = .005) for respondents affected by the infant formula shortage. There were no adjusted associations between having difficulty obtaining formula in the last 7 days and anxiety and depression. CONCLUSIONS Individuals affected by the infant formula shortage had increased odds of both anxiety and depression. Continued efforts to improve food security for low-income infants is critical for ensuring equitable nutritional and health outcomes across infant populations. IMPLICATIONS FOR PRACTICE AND RESEARCH Continued efforts to reduce food insecurity for low-income infants are critically needed, as infant nutrition impacts caregiver mental health and infant health. Efforts to improve lactation support and breastfeeding initiation are needed in addition to improvements in access to formula.
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Affiliation(s)
- Dominique DuBois
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Joe Sundell
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Michael R. Thomsen
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Clare C. Brown
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Thielecke J, Buntrock C, Titzler I, Braun L, Freund J, Berking M, Baumeister H, Ebert DD. Telephone coaching for the prevention of depression in farmers: Results from a pragmatic randomized controlled trial. J Telemed Telecare 2024; 30:918-930. [PMID: 35695234 DOI: 10.1177/1357633x221106027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Farmers have a high risk for depression (MDD). Preventive measures targeting this often remotely living population might reduce depression burden. The study aimed to evaluate the effectiveness of personalized telephone coaching in reducing depressive symptom severity and preventing MDD in farmers compared to enhanced treatment as usual (TAU + ). METHODS In a two-armed, pragmatic randomized controlled trial (N = 314) with post-treatment at 6 months, farming entrepreneurs, collaborating family members and pensioners with elevated depressive symptoms (PHQ-9 ≥ 5) were randomized to personalized telephone coaching or TAU + . The coaching was provided by psychologists and consists on average of 13 (±7) sessions a 48 min (±15) over 6 months. The primary outcome was depressive symptom severity (QIDS-SR16). RESULTS Coaching participants showed a significantly greater reduction in depressive symptom severity compared to TAU + (d = 0.39). Whereas reliable symptom deterioration was significantly lower in the intervention group compared to TAU + , no significant group differences were found for reliable improvement and in depression onset. Further significant effects in favor of the intervention group were found for stress (d = 0.34), anxiety (d = 0.30), somatic symptoms (d = 0.39), burnout risk (d = 0.24-0.40) and quality of life (d = 0.28). DISCUSSION Limiting, we did not apply an upper cutoff score for depressive symptom severity or controlled for previous MDD episodes, leaving open whether the coaching was recurrence/relapse prevention or early treatment. Nevertheless, personalized telephone coaching can effectively improve mental health in farmers. It could play an important role in intervening at an early stage of mental health problems and reducing disease burden related to MDD. TRIAL REGISTRATION NUMBER AND TRIAL REGISTER German Clinical Trial Registration: DRKS00015655.
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Affiliation(s)
- Janika Thielecke
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Professorship of Psychology and Digital Mental Health Care, Technical University of Munich, Munich, Germany
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Lina Braun
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Johanna Freund
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Professorship of Psychology and Digital Mental Health Care, Technical University of Munich, Munich, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - David D Ebert
- Professorship of Psychology and Digital Mental Health Care, Technical University of Munich, Munich, Germany
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Alinaitwe R, Elyanu PJ, Kanywa JB, Akena D. Use of computer-assisted self-interview in detection of and referral for depression among adolescents living with HIV at an urban HIV treatment clinic in Uganda: a quasi-experimental study. BMJ Paediatr Open 2024; 8:e002383. [PMID: 38886110 PMCID: PMC11184185 DOI: 10.1136/bmjpo-2023-002383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/22/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Depression is common among adolescents living with HIV (ALHIV) and impacts their quality of life. However, it is not routinely detected and treated due to a lack of screening tools, coupled with large numbers of clients in the HIV clinics and limited staff. Enabling adolescents to do a self-assessment for depression on a tablet computer could possibly improve the detection of depression in this population. We set out to assess the detection and referral of depression among ALHIV in care in Uganda. METHODS This was a quasi-experimental study design with a historical control at Baylor College of Medicine of Children's Foundation. We conducted a retrospective chart review of 425 adolescents covering a 3-month period and documented the proportion screened for depression and referred to the clinic counsellors. From July to September 2022, eligible adolescents aged 10-19 years who had assented and consented self-assessed for depression using a Patient Health Questionnaire-Adolescent on a tablet computer-assisted self-interview (CASI). Adolescents who screened positive had a prompt on the tablet computers referring them to the counsellor for mental healthcare. We compared the proportions of participants screened for depression and referred to counsellors from clinic chart review and on the CASI using paired t-tests. RESULTS Out of 425 medical records reviewed, 54% (231/425) were females and the median age was 15 years. Of the participants who self-assessed on the CASI, 52% (222/425) were males and the median age of all participants was 16 years. Self-assessment on the CASI increased the rate of detection of depression from 0% to 23.3%. Of those referred on the CASI, 15% accessed care at the referral point. CONCLUSION The use of CASI improves the rate of detection of depression among ALHIV; however, there is a need to address the barriers to effective referral for mental health services.
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Affiliation(s)
| | | | | | - Dickens Akena
- Makerere University College of Health Sciences, Kampala, Uganda
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Bisby MA, Correa AB, Trujillo R, Dudeney J, Dear BF. Sudden gains in depression and anxiety during an online pain management programme for chronic pain. Eur J Pain 2024. [PMID: 38736167 DOI: 10.1002/ejp.2280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/09/2024] [Accepted: 04/26/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Chronic pain is associated with depression and anxiety symptoms. Pain management programms, delivered face-to-face or via the internet, can effectively help adults manage the impacts of chronic pain. Sudden gains are defined as substantial, rapid, and lasting symptom reductions that occur between consecutive treatment sessions and have been associated with better treatment outcomes in non-pain samples. This study examined whether adults with chronic pain report sudden gains in depression or anxiety symptoms during an 8-week online pain management programme, and whether sudden gains were associated with better treatment outcomes for depression or anxiety. Dominant theories of sudden gains argue that therapists are required for sudden gains to be maintained and improve treatment outcomes. METHODS Using data from a published randomized controlled trial (n = 338), sudden gains and treatment outcomes were compared across three levels of therapist guidance provided alongside the programme: weekly, optional, and self-guided. RESULTS Similar rates of sudden gains were observed in depression (22%) and anxiety (24%) across the treatment period, and most sudden gains occurred between Weeks 1 and 2 of treatment. Therapist guidance was not associated with sudden gains; higher baseline symptom severity emerged as the only consistent predictor of sudden gain status. No significant differences in treatment outcomes for depression or anxiety symptoms between sudden gainers and non-gainers were observed across therapist guidance conditions. CONCLUSIONS These results do not support an association between sudden gains in depression or anxiety symptoms and better post-treatment outcomes, at least for adults with chronic pain. SIGNIFICANCE STATEMENT Sudden gains in depression and anxiety symptoms were not associated with improved treatment outcomes for adults with chronic pain who participated in an online pain management programme, regardless of the level of therapist guidance provided. These findings suggest possible differences in symptom change in chronic pain samples compared to general population samples.
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Affiliation(s)
- Madelyne A Bisby
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Ashleigh B Correa
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Rachel Trujillo
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Joanne Dudeney
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Blake F Dear
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
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Riedl D, Kampling H, Nolte T, Kirchhoff C, Kruse J, Sachser C, Fegert JM, Gündel H, Brähler E, Grote V, Fischer MJ, Lampe A. Utilization of Mental Health Provision, Epistemic Stance and Comorbid Psychopathology of Individuals with Complex Post-Traumatic Stress Disorders (CPTSD)-Results from a Representative German Observational Study. J Clin Med 2024; 13:2735. [PMID: 38792277 PMCID: PMC11121826 DOI: 10.3390/jcm13102735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/02/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Complex post-traumatic stress disorder (CPTSD) is a severely debilitating recently added symptom cluster in the International Classification of Diseases (ICD-11). So far, only limited information on mental health treatment-uptake and -satisfaction of individuals with CPTSD is available. The aim of this study is to investigate these aspects in a representative sample of the German general population. Methods: Participants completed the International Trauma Questionnaire (ITQ) to identify participants with CPTSD, as well as questionnaires on mental health treatment uptake and satisfaction, adverse childhood experiences, anxiety, depression, working ability, personality functioning, and epistemic trust. Results: Of the included n = 1918 participants, n = 29 (1.5%) fulfilled the criteria for CPTSD. Participants with CPTSD had received mental health treatment significantly more often than participants with PTSD or depression (65.5% vs. 58.8% vs. 31.6%; p = 0.031) but reported significantly less symptom improvement (52.9% vs. 78.0% vs. 80.0%; p = 0.008). Lower levels of epistemic trust were associated with higher CPTSD symptoms (p < 0.001). Conclusions: Our study shows that while the vast majority of individuals with CPTSD had received mental health treatment, subjective symptom improvement rates are not satisfactory. CPTSD was associated with a broad number of comorbidities and impairments in functioning. Lower levels of epistemic trust may partially explain worse treatment outcomes.
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Affiliation(s)
- David Riedl
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria; (V.G.); (M.J.F.)
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, 35392 Giessen, Germany
| | - Tobias Nolte
- Anna Freud National Centre for Children and Families, London N1 9JH, UK
- Research Department for Clinical, Educational and Heath Psychology University College London, London WC1E 6BT, UK
| | - Christina Kirchhoff
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, 35392 Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, 35037 Marburg, Germany
| | - Cedric Sachser
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, 89075 Ulm, Germany
- German Center for Mental Health (DZPG), Partner Site Ulm, 89075 Ulm, Germany
| | - Jörg M. Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, 89075 Ulm, Germany
- German Center for Mental Health (DZPG), Partner Site Ulm, 89075 Ulm, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, University Ulm Medical Center, 89081 Ulm, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, 55131 Mainz, Germany
- Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria; (V.G.); (M.J.F.)
| | - Michael J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria; (V.G.); (M.J.F.)
- VAMED Rehabilitation Center Kitzbuehel, 6370 Kitzbuehel, Austria
| | - Astrid Lampe
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria; (V.G.); (M.J.F.)
- VAMED Rehabilitation Montafon, 6780 Schruns, Austria
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Gonçalves Pacheco JP, Kieling C, Manfro PH, Menezes AMB, Gonçalves H, Oliveira IO, Wehrmeister FC, Rohde LA, Hoffmann MS. How much or how often? Examining the screening properties of the DSM cross-cutting symptom measure in a youth population-based sample. Psychol Med 2024:1-12. [PMID: 38639338 DOI: 10.1017/s0033291724000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
BACKGROUND The DSM Level 1 Cross-Cutting Symptom Measure (DSM-XC) allows for assessing multiple psychopathological domains. However, its capability to screen for mental disorders in a population-based sample and the impact of adverbial framings (intensity and frequency) on its performance are unknown. METHODS The study was based on cross-sectional data from the 1993 Pelotas birth cohort in Brazil. Participants with completed DSM-XC and structured diagnostic interviews (n = 3578, aged 22, 53.6% females) were included. Sensitivity, specificity, positive (LR+), and negative (LR-) likelihood ratios for each of the 13 DSM-XC domains were estimated for detecting five internalizing disorders (bipolar, generalized anxiety, major depressive, post-traumatic stress, and social anxiety disorders) and three externalizing disorders (antisocial personality, attention-deficit/hyperactivity, and alcohol use disorders). Sensitivities and specificities >0.75, LR+ > 2 and LR- < 0.5 were considered meaningful. Values were calculated for the DSM-XC's original scoring and for adverbial framings. RESULTS Several DSM-XC domains demonstrated meaningful screening properties. The anxiety domain exhibited acceptable sensitivity and LR- values for all internalizing disorders. The suicidal ideation, psychosis, memory, repetitive thoughts and behaviors, and dissociation domains displayed acceptable specificity for all disorders. Domains also yielded small but meaningful LR+ values for internalizing disorders. However, LR+ and LR- values were not generally meaningful for externalizing disorders. Frequency-framed questions improved screening properties. CONCLUSIONS The DSM-XC domains showed transdiagnostic screening properties, providing small but meaningful changes in the likelihood of internalizing disorders in the community, which can be improved by asking frequency of symptoms compared to intensity. The DSM-XC is currently lacking meaningful domains for externalizing disorders.
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Affiliation(s)
- João Pedro Gonçalves Pacheco
- Department of Neuropsychiatry, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Mental Health Epidemiology Group, Santa Maria, Rio Grande do Sul, Brazil
| | - Christian Kieling
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Psychiatry and Legal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro H Manfro
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ana M B Menezes
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Helen Gonçalves
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Isabel O Oliveira
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Fernando C Wehrmeister
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, RS, Brazil
- Rady Faculty of Health Sciences, Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Luis Augusto Rohde
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
- UniEduK, Indaiatuba, São Paulo, Brazil
| | - Maurício Scopel Hoffmann
- Department of Neuropsychiatry, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Mental Health Epidemiology Group, Santa Maria, Rio Grande do Sul, Brazil
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
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Dong X, Li Y, Wang X, Duan Y, Liu M, Wang S, He X, Yang P, Wang Y, Xie J, Cheng ASK. Bidirectional associations between dietary diversity and depressive symptoms in Chinese adult women: A retrospective cohort study. J Affect Disord 2024; 351:683-693. [PMID: 38316259 DOI: 10.1016/j.jad.2024.01.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE This study aimed to examine the bidirectional associations between dietary diversity and clinical depressive symptoms in adult women, and influencing factors of clinical depressive symptoms. METHODS This longitudinal study included a total of 22,385 participants, each of whom underwent at least two data collections. We used convenience sampling to recruit women from a health management center of a general hospital in southern China from April 2015 to December 2021. They completed an online self-reported health questionnaire, which included demographic characteristics, lifestyle information, the Dietary Diversity Scale (DDS), and the Patient Health Questionnaire-9. RESULTS New-onset depressive symptoms and low dietary diversity were observed in this study among 1285 and 3223 participants, respectively. Negative associations were observed between baseline low dietary diversity and new-onset depressive symptoms (P < 0.05) and between baseline depressive symptoms and low dietary diversity (P < 0.001). Cross-lagged panel analysis indicated that dietary diversity negatively and prospectively predicted depressive symptoms, but vice versa (P < 0.05). Strong evidence of a nonlinear association between DDS scores and incident depressive symptoms was found (P nonlinear < 0.05) regardless of whether the variables were adjusted. Besides, age, menarche age, physical activity, sleep duration, longer sedentary behavior and other lifestyle factors were influencing factors of depressive symptoms (P < 0.05). CONCLUSIONS The present study identified bidirectional associations between dietary diversity and depressive symptoms, and the associations were found to have a non-linear pattern. Adherence to dietary diversity and a healthy lifestyle could be effective non-pharmacological preventive measures to reduce the incidence of depressive symptoms.
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Affiliation(s)
- Xiaoqian Dong
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha 410000, China; Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Ying Li
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha 410000, China.
| | - Xingxing Wang
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Yinglong Duan
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Min Liu
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Sha Wang
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xue He
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha 410000, China
| | - Pingting Yang
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha 410000, China
| | - Yaqin Wang
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha 410000, China.
| | - Jianfei Xie
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Andy S K Cheng
- The Hong Kong Polytechnic University, Department of Rehabilitation Sciences, Hong Kong, China.
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Dong X, Wang Y, Kang Y, Zhou X, Li J, Cao H, Li Y, Li Y, Yang P, Duan Y, Xie J. Protein-enriched and anti-inflammatory dietary patterns, healthy lifestyle index and depressive symptoms: A cross-sectional study of 287,945 adults in China. J Affect Disord 2024; 351:863-869. [PMID: 38342321 DOI: 10.1016/j.jad.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 01/18/2024] [Accepted: 02/08/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVES Depressive symptoms have a considerable negative impact on mental health. This study aimed to understand the relationship between the protein-enriched and anti-inflammatory dietary index scores, modified healthy lifestyle index scores (Modified HLIS), and depressive symptoms. METHODS This study used convenience sampling to conduct a single-center cross-sectional survey. From January 1, 2015 to December 31, 2020, a total of 287,945 Chinese adults from a health management center of a general hospital completed an online self-reported health questionnaire, which included demographic characteristics, the Dietary Diversity Scale, the Modified Healthy Lifestyle Index Scores and the Patient Health Questionnaire-9. RESULTS The higher anti-inflammatory dietary index scores (POR = 0.87; 95 % CI: 0.86-0.87; p < 0.001), moderate modified healthy lifestyle index scores (POR = 0.76; 95 % CI: 0.75-0.78; p < 0.001) and sufficient modified healthy lifestyle index scores (POR = 0.53; 95 % CI: 0.52-0.54; p < 0.001) were negatively associated with depressive symptoms, while the higher protein-enriched dietary index scores (POR = 1.01; 95 % CI: 1.01-1.02; p < 0.001) was positively correlated with depressive symptoms. CONCLUSIONS This study demonstrated that protein-enriched and anti-inflammatory dietary index scores, and multiple healthy lifestyles are associated depressive symptoms in adults.
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Affiliation(s)
- Xiaoqian Dong
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha 410000, China; Xiangya Nursing School, Central South University, Changsha 410000, China.
| | - Yaqin Wang
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha 410000, China.
| | - Yue Kang
- Xiangya Nursing School, Central South University, Changsha 410000, China.
| | - Xing Zhou
- Xiangya Nursing School, Central South University, Changsha 410000, China
| | - Jing Li
- Xiangya Nursing School, Central South University, Changsha 410000, China
| | - Huan Cao
- Xiangya Nursing School, Central South University, Changsha 410000, China
| | - Yuxuan Li
- Xiangya Nursing School, Central South University, Changsha 410000, China.
| | - Ying Li
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha 410000, China.
| | - Pingting Yang
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha 410000, China
| | - Yinglong Duan
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha 410000, China.
| | - Jianfei Xie
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha 410000, China.
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Caro-Fuentes S, Sanabria-Mazo JP. A Systematic Review of the Psychometric Properties of the Patient Health Questionnaire-4 in Clinical and Nonclinical Populations. J Acad Consult Liaison Psychiatry 2024; 65:178-194. [PMID: 38012988 DOI: 10.1016/j.jaclp.2023.11.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The Patient Health Questionnaire-4 (PHQ-4) is an ultra-brief instrument that measures depressive and anxiety symptoms. Although it has been frequently used in the last 15 years, no research has systematically reviewed its psychometric properties. OBJECTIVE This systematic review summarized, for the first time, the available published evidence on the psychometric properties of the PHQ-4. METHODS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and was registered in the Prospective Register of Systematic Reviews, under the identification code CRD42022381809. The search strategy was applied in Medline, PsycINFO, Web of Science, and SCOPUS from 2009 (year of publication) to 2023 (present). Two independent reviewers performed screening, data extraction, and methodological quality assessment of the studies. The data was reported through a narrative synthesis. RESULTS In total, 26 studies involving 93,466 participants from 19 countries, with clinical and nonclinical samples, were included. The two-factor structure was the most frequent, being invariant according to gender, age, geographic location, income, educational level, and language. The internal consistency was adequate for distress (α from 0.72 to 0.88), as well as for depression (α from 0.65 to 0.81) and anxiety (α from 0.74 to 0.84). The temporal stability of the instrument was verified through test-retest reliability, reporting an acceptable connection between both measures. Correlations with related measures were significant and in the expected direction. CONCLUSIONS The PHQ-4 is a reliable and valid instrument for screening depressive and anxiety symptoms, both for the clinical and nonclinical populations. Due to the brevity of its administration, the PHQ-4 could be a clinical tool that contributes to optimizing health resources.
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Affiliation(s)
- Sheila Caro-Fuentes
- Faculty of Health Sciences, Department of Psychology, Universidad Europea de Valencia, Valencia, Spain
| | - Juan P Sanabria-Mazo
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Basic, Developmental, and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain.
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Tugnawat D, Singh A, Anand A, Bondre A, Chandke D, Dhurve P, Joshi U, Khan A, Muke S, Negi B, Nikhare K, Rathore D, Ramaswamy R, Haney JR, Sen Y, Sharma K, Shrivastava R, Verma N, Vishwakarma R, Vishwakarma D, Vorapanya V, Patel V, Bhan A, Naslund JA. ESSENCE: An Implementation Research Program to Scale Up Depression Care in Rural Communities. Psychiatr Serv 2024; 75:167-177. [PMID: 37904491 DOI: 10.1176/appi.ps.202100223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
BACKGROUND Task sharing may involve training nonspecialist health workers (NSHWs) to deliver brief mental health interventions. This approach is promising for reducing the global mental health treatment gap. However, capacity is limited for training large cadres of frontline workers in low- and middle-income countries, hindering uptake of these interventions at scale. METHODS The ESSENCE (enabling translation of science to service to enhance depression care) project in Madhya Pradesh, India, aims to address these challenges through two sequential randomized controlled trials. First, a training trial will evaluate the effectiveness and cost-effectiveness of digital training, compared with conventional face-to-face training, in achieving clinical competency of NSHWs in delivering an intervention for depression. This initial trial will be followed by an implementation trial aimed at evaluating the effectiveness of a remote enhanced implementation support, compared with routine implementation support, in addressing barriers to delivery of depression care in primary care facilities. RESULTS This project involved developing and pilot testing a scalable smartphone-based program for training NSHWs to deliver a brief psychological intervention for depression screening. This initial research guided a randomized trial of a digital training approach with NSHWs to evaluate the effectiveness of this approach. This trial will be followed by a cluster-randomized trial to evaluate the effectiveness of remote implementation support in ensuring efficient delivery of depression care in primary care facilities. NEXT STEPS Findings from these trials may inform sustainable training and implementation support models to integrate depression care into primary care for scale-up in resource-constrained settings.
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Affiliation(s)
- Deepak Tugnawat
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Abhishek Singh
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Aditya Anand
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Ameya Bondre
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Dinesh Chandke
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Pooja Dhurve
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Udita Joshi
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Azaz Khan
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Shital Muke
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Babita Negi
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Kalyani Nikhare
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Dharmendra Rathore
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Rohit Ramaswamy
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Juliana Restivo Haney
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Yogendra Sen
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Kamlesh Sharma
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Ritu Shrivastava
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Narendra Verma
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Ram Vishwakarma
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Deepali Vishwakarma
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Vorapat Vorapanya
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Vikram Patel
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Anant Bhan
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - John A Naslund
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
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Ashton Rennison VL, Chovaz CJ, Zirul S. Cognition and psychological well-being in adults with post COVID-19 condition and analyses of symptom sequelae. Clin Neuropsychol 2024; 38:326-353. [PMID: 37350239 DOI: 10.1080/13854046.2023.2227407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/14/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE As the coronavirus disease 2019 (COVID-19) pandemic moves into its fourth year, gaining a better clinical understanding of individuals with post COVID-19 condition is paramount. The current study examined the neurocognitive and psychological status of adults with post COVID-19 condition, as well as explored the impact of high psychological burden on objective neurocognitive functioning and the relationship between subjective cognitive concerns and objective neurocognitive findings. METHOD Valid neuropsychological assessments were completed with 51 symptomatic adults who were 297.55 days, on average, following a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Participants completed brief self-report depression, anxiety, and PTSD questionnaires, a questionnaire with subjective ratings of cognitive abilities, and standardized neurocognitive tests that examined performance validity, attention, processing speed, verbal learning and memory, naming, visual construction, and executive functioning. RESULTS The participants were mostly Caucasian (80.39%), middle-aged (average 47.37 years), women (82.35%), who were never hospitalized (86.27%). Despite all individuals reporting cognitive problems in daily life, mean performances on objective testing did not reveal any neurocognitive deficits (at or below the 8th percentile) at a group level. Approximately half (49.02%) of the participants reported co-occurring mental health symptoms that were considered clinically elevated based on questionnaire results. High psychological symptom burden was associated with greater subjective cognitive difficulties but did not result in neurocognitive dysfunction on objective testing. CONCLUSIONS This study contributes to the literature regarding post COVID-19 condition in adults including the relationship between the cognitive and psychological symptoms. Results are summarized in key clinical learning points.
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Affiliation(s)
- V Lynn Ashton Rennison
- Psychology Department, London Health Sciences Centre, London, ON, Canada
- Schulich School of Medicine & Dentistry Department of Psychiatry, Western University, London, ON, Canada
| | - Cathy J Chovaz
- Psychology Department, King's University College at Western University, London, ON, Canada
| | - Sandra Zirul
- Psychology Department, London Health Sciences Centre, London, ON, Canada
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15
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Cosci F, Christensen KS, Ceccatelli S, Patierno C, Carrozzino D. Patient Health Questionnaire-9: A clinimetric analysis. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2024; 46:e20233449. [PMID: 38281157 PMCID: PMC11302993 DOI: 10.47626/1516-4446-2023-3449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/09/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE The Patient Health Questionnaire-9 (PHQ-9) is a widely used self-report measure of depression whose psychometric properties were found to be merely acceptable. Insufficient attention has been devoted to its clinimetric validity, while its clinical utility is still debated, particularly for assessing depression severity. This is the first study to test the PHQ-9 construct validity and clinical utility based on clinimetric principles. METHODS An online survey of 3,398 participants was conducted. Item response theory models (Rasch and Mokken analyses) were used to assess the PHQ-9 validity and determine its clinical utility. RESULTS Fit to the Rasch model was achieved after adjusting the sample size. Items 2, 4, 6, and 9 over-discriminated, while items 1, 5, and 7 under-discriminated. Local dependency between items 2 and 6 was indicated. The PHQ-9 was not unidimensional. A Loevinger's coefficient of 0.49 was found, indicating an acceptable level of scalability. CONCLUSION The PHQ-9 is an instrument with potential clinical utility as an overall index of depression, mainly for screening purposes. Substantial revision, particularly in the wording of over- and under-discriminating items, is needed.
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Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy
- International Lab of Clinical Measurements, University of Florence, Florence, Italy
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Kaj Sparle Christensen
- Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Sara Ceccatelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Chiara Patierno
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Danilo Carrozzino
- Department of Psychology Renzo Canestrari, University of Bologna, Bologna, Italy
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16
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Li L, Yang P, Duan Y, Xie J, Liu M, Zhou Y, Luo X, Zhang C, Li Y, Wang J, Chen Z, Zhang X, Cheng ASK. Association between dietary diversity, sedentary time outside of work and depressive symptoms among knowledge workers: a multi-center cross-sectional study. BMC Public Health 2024; 24:53. [PMID: 38166945 PMCID: PMC10762993 DOI: 10.1186/s12889-023-17567-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Low-diversity diets and sedentary status are risk factors for depressive symptoms, while knowledge workers were ignored before. The purpose of this current study was to examine the relationship between dietary diversity, sedentary time spent outside of work, and depressive symptoms among knowledge workers. STUDY DESIGN AND METHODS This was a multicenter and cross-sectional design that included 118,723 knowledge workers. Participants self-reported online between January 2018 and December 2020. Demographic information, the Dietary Diversity Scale, the Patient Health Questionnaire-9, dietary habits (which included eating three meals on time, midnight snacking, overeating, social engagement, coffee consumption, sugary drink consumption, smoking and alcohol use), sedentary time spent outside of work and physical activity were investigated. RESULTS The relationships between demographic information, dietary habits and dietary diversity, and depressive symptoms were estimated. Compared with the first and second levels of dietary diversity, the third level of dietary diversity (OR: 0.91; 95% CI: 0.84-0.98) reduced the risk of depressive symptoms. Knowledge workers with different degrees of sedentary status (2-4 h (OR: 1.11; 95% CI: 1.07-1.14), 4-6 h (OR: 1.21; 95% CI: 1.17-1.26), and > 6 h (OR: 1.49; 95% CI: 1.43-1.56), presented a progressively higher risk of depressive symptoms. CONCLUSION High amounts of sedentary time spent after work and low levels of dietary diversity are risk factors for depressive symptoms. In addition, an irregular diet and overeating are also major risk factors for knowledge workers.
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Affiliation(s)
- Lijun Li
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
- Nursing Department, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Pingting Yang
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Yinglong Duan
- Nursing Department, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jianfei Xie
- Nursing Department, The Third Xiangya Hospital of Central South University, Changsha, China.
| | - Min Liu
- Nursing Department, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Yi Zhou
- Xiangya Nursing School of Central South University, Changsha, China
| | - Xiaofei Luo
- Xiangya Nursing School of Central South University, Changsha, China
| | - Chun Zhang
- Xiangya Nursing School of Central South University, Changsha, China
| | - Ying Li
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jiangang Wang
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Zhiheng Chen
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiaohong Zhang
- Nursing Department, The Third Xiangya Hospital of Central South University, Changsha, China.
| | - Andy S K Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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17
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Hanmer J, Ray KN, Schweiberger K, Berkowitz SA, Palakshappa D. Accuracy of a Single Financial Security Question to Screen for Social Needs. Pediatrics 2024; 153:e2023062555. [PMID: 38037433 DOI: 10.1542/peds.2023-062555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVES Screening for social needs is recommended during clinical encounters but multi-item questionnaires can be burdensome. We evaluate if a single question about financial stress can be used to prescreen for food insecurity, housing instability, or transportation needs. METHODS We use retrospective medical record data from children (<11 years) seen at 45 primary pediatric care offices in 2022. Social needs screening was automated at well child visits and could be completed by the parent/guardian via the patient portal, tablet in the waiting room, or verbally with staff. We report the area under the receiver operating curve for the 5 response options of the financial stress question as well as sensitivity and specificity of the financial stress question ("not hard at all" vs any other response) to detect other reported social needs. RESULTS Of 137 261 eligible children, 130 414 (95.0%) had social needs data collected. Seventeen percent of respondents reported a housing, food, or transportation need. The sensitivity of the financial stress question was 0.788 for any one or more of the 3 other needs, 0.763 for food insecurity, 0.743 for housing instability, and 0.712 for transportation needs. Using the financial stress question as the first-step of a screening process would miss 9.7% of the families who reported food insecurity, 22.6% who reported housing instability, and 33.0% who reported transportation needs. CONCLUSIONS A single question screener about financial stress does not function well as a prescreen because of low sensitivity to reports of food insecurity, housing instability, and transportation needs.
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Affiliation(s)
- Janel Hanmer
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kristin N Ray
- Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kelsey Schweiberger
- Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Seth A Berkowitz
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Deepak Palakshappa
- Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina
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18
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Davis CH, Donahue ML, Gaudiano BA, Uebelacker LA, Twohig MP, Levin ME. Adding online storytelling-based acceptance and commitment therapy to antidepressant treatment for primary care patients: a randomized clinical trial. Cogn Behav Ther 2024; 53:48-69. [PMID: 37855277 PMCID: PMC10841889 DOI: 10.1080/16506073.2023.2265560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023]
Abstract
Depression is most often treated in primary care, where the prevailing treatment is antidepressant medication. Primary care patients with depression are less likely to be exposed to psychosocial interventions, despite evidence suggesting many of these treatments are effective. An example is acceptance and commitment therapy (ACT), a behavioral treatment for depression with a growing evidence base. A self-guided ACT intervention with a peer narrative (i.e. storytelling) format was developed with the intention of creating a treatment option for primary care patients that was more accessible than traditional psychotherapy. Titled LifeStories, the online program features videos of real individuals sharing coping skills for depression based on lived experiences and key ACT principles. A total of 93 primary care patients taking antidepressants were randomized to either continued antidepressant treatment alone or antidepressant treatment plus LifeStories for 4 weeks. There were no differences over time on depression severity and psychological inflexibility. However, LifeStories led to greater improvements in quality of life and increased patients' interest in additional treatment compared to antidepressant medication alone.Clinical trial pre-registration: ClinicalTrials.gov (NCT04757961).
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Affiliation(s)
| | | | - Brandon A. Gaudiano
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
- Butler Hospital, Providence, RI
| | - Lisa A. Uebelacker
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
- Butler Hospital, Providence, RI
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19
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Wang X, Wang H, Yu Q, Fu S, Yang Z, Ye Q, Lin F, Cai G. "High dietary live microbe intake is correlated with reduced risk of depressive symptoms: A cross-sectional study of NHANES 2007-2016". J Affect Disord 2024; 344:198-206. [PMID: 37827261 DOI: 10.1016/j.jad.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/31/2023] [Accepted: 10/08/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Recent research indicated that levels of dietary live microorganisms were inconsistently associated with the prevalence of depressive symptoms. This study aimed to investigate the correlation between consumption of live microorganisms and symptoms of depression. METHODS Data on 21,653 study participants were obtained from the National Health and Nutrition Examination Survey (NHANES). Dietary information was assessed using a self-report questionnaire. Depressive status was assessed using the Patient Health Questionnaire (PHQ-9). Generalized linear model, restricted cubic spline (RCS), and subgroup analyses were performed in this study. RESULTS After full adjustment for confounders, participants in the moderate-dietary microbe intake group had a lower prevalence of depressive symptoms than those in the lowest intake group [odds ratio (OR): 0.813, 95 % confidence interval (CI): 0.678-0.974, P = 0.026, and pseudo R2 = 0.12]. Participants in the highest-dietary microbe intake group had a lower prevalence of depressive symptoms than those in the lowest intake group (OR: 0.714, 95 % CI: 0.586-0.870, P = 0.001, and pseudo R2 = 0.12). An L-shaped dose-response relationship was observed in the RCS (the P value for nonlinear relationship = 0.007). In subgroup analyses, participants with male identity, normal weight, and high physical activity (PA) level showed a substantial correlation between dietary live microbe consumption and depressive symptoms (all P values for interaction <0.050). LIMITATIONS This study was limited by its cross-sectional study design, and self-reported dietary live microbe consumption and depressive symptoms. CONCLUSIONS A high dietary live microbe intake was nonlinearly correlated with a lower prevalence of depressive symptoms.
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Affiliation(s)
- Xuefei Wang
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 35001, China; Fujian Medical University, Fuzhou 35001, China
| | | | - Qianwen Yu
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 35001, China
| | - Shibo Fu
- Fujian Medical University, Fuzhou 35001, China
| | | | - Qinyong Ye
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 35001, China.
| | - Fabin Lin
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou 35001, China.
| | - Guoen Cai
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 35001, China.
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20
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Glavin D, Grua EM, Nakamura CA, Scazufca M, Ribeiro Dos Santos E, Wong GHY, Hollingworth W, Peters TJ, Araya R, Van de Ven P. Patient Health Questionnaire-9 Item Pairing Predictiveness for Prescreening Depressive Symptomatology: Machine Learning Analysis. JMIR Ment Health 2023; 10:e48444. [PMID: 37856186 PMCID: PMC10623235 DOI: 10.2196/48444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/13/2023] [Accepted: 08/10/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Anhedonia and depressed mood are considered the cardinal symptoms of major depressive disorder. These are the first 2 items of the Patient Health Questionnaire (PHQ)-9 and comprise the ultrabrief PHQ-2 used for prescreening depressive symptomatology. The prescreening performance of alternative PHQ-9 item pairings is rarely compared with that of the PHQ-2. OBJECTIVE This study aims to use machine learning (ML) with the PHQ-9 items to identify and validate the most predictive 2-item depressive symptomatology ultrabrief questionnaire and to test the generalizability of the best pairings found on the primary data set, with 6 external data sets from different populations to validate their use as prescreening instruments. METHODS All 36 possible PHQ-9 item pairings (each yielding scores of 0-6) were investigated using ML-based methods with logistic regression models. Their performances were evaluated based on the classification of depressive symptomatology, defined as PHQ-9 scores ≥10. This gave each pairing an equal opportunity and avoided any bias in item pairing selection. RESULTS The ML-based PHQ-9 items 2 and 4 (phq2&4), the depressed mood and low-energy item pairing, and PHQ-9 items 2 and 8 (phq2&8), the depressed mood and psychomotor retardation or agitation item pairing, were found to be the best on the primary data set training split. They generalized well on the primary data set test split with area under the curves (AUCs) of 0.954 and 0.946, respectively, compared with an AUC of 0.942 for the PHQ-2. The phq2&4 had a higher AUC than the PHQ-2 on all 6 external data sets, and the phq2&8 had a higher AUC than the PHQ-2 on 3 data sets. The phq2&4 had the highest Youden index (an unweighted average of sensitivity and specificity) on 2 external data sets, and the phq2&8 had the highest Youden index on another 2. The PHQ-2≥2 cutoff also had the highest Youden index on 2 external data sets, joint highest with the phq2&4 on 1, but its performance fluctuated the most. The PHQ-2≥3 cutoff had the highest Youden index on 1 external data set. The sensitivity and specificity achieved by the phq2&4 and phq2&8 were more evenly balanced than the PHQ-2≥2 and ≥3 cutoffs. CONCLUSIONS The PHQ-2 did not prove to be a more effective prescreening instrument when compared with other PHQ-9 item pairings. Evaluating all item pairings showed that, compared with alternative partner items, the anhedonia item underperformed alongside the depressed mood item. This suggests that the inclusion of anhedonia as a core symptom of depression and its presence in ultrabrief questionnaires may be incompatible with the empirical evidence. The use of the PHQ-2 to prescreen for depressive symptomatology could result in a greater number of misclassifications than alternative item pairings.
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Affiliation(s)
- Darragh Glavin
- Department of Electronic and Computer Engineering, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Eoin Martino Grua
- Department of Electronic and Computer Engineering, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Carina Akemi Nakamura
- Departamento de Psiquiatria, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcia Scazufca
- Departamento de Psiquiatria, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Gloria H Y Wong
- Department of Social Work and Social Administration, University of Hong Kong, Pok Fu Lam, China (Hong Kong)
- Sau Po Centre on Ageing, University of Hong Kong, Pok Fu Lam, China (Hong Kong)
| | | | - Tim J Peters
- Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Ricardo Araya
- Centre for Global Mental Health, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Pepijn Van de Ven
- Department of Electronic and Computer Engineering, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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21
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Harry ML, Sanchez K, Ahmedani BK, Beck AL, Coleman KJ, Coley RY, Daida YG, Lynch FL, Rossom RC, Waring SC, Simon GE. Assessing the differential item functioning of PHQ-9 items for diverse racial and ethnic adults with mental health and/or substance use disorder diagnoses: A retrospective cohort study. J Affect Disord 2023; 338:402-413. [PMID: 37127116 PMCID: PMC10524453 DOI: 10.1016/j.jad.2023.04.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Improving health equity in depression care and suicide screening requires that measures like the Patient Health Questionnaire 9 (PHQ-9) function similarly for diverse racial and ethnic groups. We evaluated PHQ-9 differential item functioning (DIF) between racial/ethnic groups in a retrospective cohort study of secondary electronic health record (EHR) data from eight healthcare systems. METHODS The population (n = 755,156) included patients aged 18-64 with mental health and/or substance use disorder (SUD) diagnoses who had a PHQ-9 with no missing item data in the EHR for primary care or mental health visits between 1/1/2009-9/30/2017. We drew two random samples of 1000 from the following racial/ethnic groups originally recorded in EHRs (n = 14,000): Hispanic, and non-Hispanic White, Black, Asian, American Indian/Alaska Native, Native Hawaiian/Other Pacific Islander, multiracial. We assessed DIF using iterative hybrid ordinal logistic regression and item response theory with p < 0.01 and 1000 Monte Carlo simulations, where change in model R2 > 0.01 represented non-negligible (e.g., clinically meaningful) DIF. RESULTS All PHQ-9 items displayed statistically significant, but negligible (e.g., clinically unmeaningful) DIF between compared groups. The negligible DIF varied between random samples, although six items showed negligible DIF between the same comparison groups in both random samples. LIMITATIONS Our findings may not generalize to disaggregated racial/ethnic groups or persons without mental health and/or SUD diagnoses. CONCLUSIONS We found the PHQ-9 had clinically unmeaningful cross-cultural DIF for adult patients with mental health and/or SUD diagnoses. Future research could disaggregate race/ethnicity to discern if within-group identification impacts PHQ-9 DIF.
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Affiliation(s)
- Melissa L Harry
- Essentia Health, Essentia Institute of Rural Health, Duluth, MN, USA.
| | - Katherine Sanchez
- Baylor Scott and White, Center for Applied Health Research, Temple, TX, USA
| | - Brian K Ahmedani
- Henry Ford Health, Center for Health Policy & Health Services Research, Detroit, MI, USA
| | - Arne L Beck
- The Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, USA
| | - Karen J Coleman
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA
| | - R Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Yihe G Daida
- Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Frances L Lynch
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | - Stephen C Waring
- Essentia Health, Essentia Institute of Rural Health, Duluth, MN, USA
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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22
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Villarreal-Zegarra D, Barrera-Begazo J, Otazú-Alfaro S, Mayo-Puchoc N, Bazo-Alvarez JC, Huarcaya-Victoria J. Sensitivity and specificity of the Patient Health Questionnaire (PHQ-9, PHQ-8, PHQ-2) and General Anxiety Disorder scale (GAD-7, GAD-2) for depression and anxiety diagnosis: a cross-sectional study in a Peruvian hospital population. BMJ Open 2023; 13:e076193. [PMID: 37714674 PMCID: PMC10510859 DOI: 10.1136/bmjopen-2023-076193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/21/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVES The Patient Health Questionnaire (PHQ) and Generalised Anxiety Disorder Scale (GAD) are widely used screening tools, but their sensitivity and specificity in low-income and middle-income countries are lower than in high-income countries. We conducted a study to determine the sensitivity and specificity of different versions of these scales in a Peruvian hospital population. DESIGN Our study has a cross-sectional design. SETTING Our participants are hospitalised patients in a Peruvian hospital. The gold standard was a clinical psychiatric interview following ICD-10 criteria for depression (F32.0, F32.1, F32.2 and F32.3) and anxiety (F41.0 and F41.1). PARTICIPANTS The sample included 1347 participants. A total of 334 participants (24.8%) were diagnosed with depression, and 28 participants (2.1%) were diagnosed with anxiety. RESULTS The PHQ-9's≥7 cut-off point showed the highest simultaneous sensitivity and specificity when contrasted against a psychiatric diagnosis of depression. For a similar contrast against the gold standard, the other optimal cut-off points were: ≥7 for the PHQ-8 and ≥2 for the PHQ-2. In particular, the cut-off point ≥8 had good performance for GAD-7 with sensitivity and specificity, and cut-off point ≥10 had lower levels of sensitivity, but higher levels of specificity, compared with the cut-off point of ≥8. Also, we present the sensitivity and specificity values of each cut-off point in PHQ-9, PHQ-8, PHQ-2, GAD-7 and GAD-2. We confirmed the adequacy of a one-dimensional model for the PHQ-9, PHQ-8 and GAD-7, while all PHQ and GAD scales showed good reliability. CONCLUSIONS The PHQ and GAD have adequate measurement properties in their different versions. We present specific cut-offs for each version.
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Affiliation(s)
- David Villarreal-Zegarra
- Escuela de Medicina, Universidad César Vallejo, Trujillo, Peru
- Instituto Peruano de Orientación Psicológica, Lima, Peru
| | | | | | | | - Juan Carlos Bazo-Alvarez
- Research Department of Primary Care and Population Health, University College London (UCL), London, UK
| | - Jeff Huarcaya-Victoria
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Ica, Peru
- Unidad de Psiquiatría de Enlace, Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
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23
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Yates M, Bechman K, Adas MA, Wright H, Russell M, Nagra D, Clarke B, Ledingham J, Norton S, Galloway J. Online Patient-Reported Outcome Measure Engagement Is Dependent on Demographics and Locality: Findings From an Observational Cohort. J Rheumatol 2023; 50:1178-1184. [PMID: 37188382 DOI: 10.3899/jrheum.2021-1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Online patient-reported outcome measures (PROMs) enable remote collection of perceptions of health status, function, and well-being. We aimed to explore patterns of PROM completion in patients with early inflammatory arthritis (EIA) recruited to the National Early Inflammatory Arthritis Audit (NEIAA). METHODS NEIAA is an observational cohort study design; we included adults from this cohort with a new diagnosis of EIA from May 2018 to March 2020. The primary outcome was PROM completion at baseline, 3 months, and 12 months. Mixed effects logistic regression and spatial regression models were used to identify associations between demographics (age, gender, ethnicity, deprivation, smoking, and comorbidity), clinical commissioning groups, and PROM completion. RESULTS Eleven thousand nine hundred eighty-six patients with EIA were included, of whom 5331 (44.5%) completed at least 1 PROM. Patients from ethnic minority backgrounds were less likely to return a PROM (adjusted odds ratio [aOR] 0.57, 95% CI 0.48-0.66). Greater deprivation (aOR 0.73, 95% CI 0.64-0.83), male gender (aOR 0.86, 95% CI 0.78-0.94), higher comorbidity burden (aOR 0.95, 95% CI 0.91-0.99), and current smoker status (aOR 0.73, 95% CI 0.64-0.82) also reduced odds of PROM completion. Spatial analysis identified 2 regions with high (North of England) and low (Southeast of England) PROM completion. CONCLUSION We define key patient characteristics (including ethnicity) that influence PROM engagement using a national clinical audit. We observed an association between locality and PROM completion, with varying response rates across regions of England. Completion rates could benefit from targeted education for these groups.
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Affiliation(s)
- Mark Yates
- M. Yates, PhD, K. Bechman, PhD, M. Russell, MB BChir, D. Nagra, MBBS, B. Clarke, MBBS, S. Norton, PhD, J. Galloway, PhD, Centre for Rheumatic Diseases, King's College London, London, UK
| | - Katie Bechman
- M. Yates, PhD, K. Bechman, PhD, M. Russell, MB BChir, D. Nagra, MBBS, B. Clarke, MBBS, S. Norton, PhD, J. Galloway, PhD, Centre for Rheumatic Diseases, King's College London, London, UK
| | - Maryam A Adas
- M.A. Adas, MSc, Centre for Rheumatic Disease, King's College London, London, UK, and Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Hannah Wright
- H. Wright, MSc, Healthcare Quality Improvement Partnership, London, UK
| | - Mark Russell
- M. Yates, PhD, K. Bechman, PhD, M. Russell, MB BChir, D. Nagra, MBBS, B. Clarke, MBBS, S. Norton, PhD, J. Galloway, PhD, Centre for Rheumatic Diseases, King's College London, London, UK
| | - Deepak Nagra
- M. Yates, PhD, K. Bechman, PhD, M. Russell, MB BChir, D. Nagra, MBBS, B. Clarke, MBBS, S. Norton, PhD, J. Galloway, PhD, Centre for Rheumatic Diseases, King's College London, London, UK
| | - Ben Clarke
- M. Yates, PhD, K. Bechman, PhD, M. Russell, MB BChir, D. Nagra, MBBS, B. Clarke, MBBS, S. Norton, PhD, J. Galloway, PhD, Centre for Rheumatic Diseases, King's College London, London, UK
| | - Joanna Ledingham
- J. Ledingham, PhD, Portsmouth Hospitals University NHS Trust - Rheumatology Portsmouth, Portsmouth, UK
| | - Sam Norton
- M. Yates, PhD, K. Bechman, PhD, M. Russell, MB BChir, D. Nagra, MBBS, B. Clarke, MBBS, S. Norton, PhD, J. Galloway, PhD, Centre for Rheumatic Diseases, King's College London, London, UK
| | - James Galloway
- M. Yates, PhD, K. Bechman, PhD, M. Russell, MB BChir, D. Nagra, MBBS, B. Clarke, MBBS, S. Norton, PhD, J. Galloway, PhD, Centre for Rheumatic Diseases, King's College London, London, UK;
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Ho EY, Karliner LS, Leung G, Harb R, Aguayo Ramirez G, Garcia ME. "How's your mood": Recorded physician mental health conversations with Chinese and Latino patients in routine primary care visits. PATIENT EDUCATION AND COUNSELING 2023; 114:107850. [PMID: 37364381 PMCID: PMC10528172 DOI: 10.1016/j.pec.2023.107850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/24/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Patient-physician communication patterns may influence discussions around depressive symptoms and contribute to engagement in depression care among racial/ethnic minority adults. We examined patient-physician communication about depressive symptoms during routine primary care visits with Chinese and Latino patients with and without language barriers. METHODS We examined 17 audio-recorded conversations between primary care physicians and Chinese (N = 7) and Latino (N = 10) patients who discussed mental health during their visit and reported depressive symptoms on a post-visit survey. Conversations (in English, Cantonese, Mandarin, Hoisan-wa, Spanish) were transcribed and translated by bilingual/bicultural research assistants and analyzed using inductive and deductive thematic and discourse analysis. RESULTS Patients initiated mental health discussion in eleven visits. Physicians demonstrated care in word choice and sometimes avoided openly mentioning depression; this could contribute to miscommunication around symptoms and treatment goals. Interpreters had difficulty finding single words to convey terms used by either patients or physicians. CONCLUSION Patients and doctors appeared willing to discuss mental health; however, variability in terminology presented challenges in mental health discussions in this culturally and linguistically diverse sample. PRACTICE IMPLICATIONS Further understanding patient preferred terminology about mental health symptoms and interpreter training in these terms could improve patient-physician communication about depressive symptoms and treatment preferences.
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Affiliation(s)
- Evelyn Y Ho
- Department of Communication Studies, University of San Francisco, San Francisco, CA, USA; Asian American Research Center on Health, University of California, San Francisco, San Francisco, CA, USA.
| | - Leah S Karliner
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Genevieve Leung
- Department of Rhetoric and Language, University of San Francisco, San Francisco, CA, USA
| | - Raneem Harb
- Department of Communication Studies, University of San Francisco, San Francisco, CA, USA
| | - Giselle Aguayo Ramirez
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Maria E Garcia
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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González-Sánchez A, Ortega-Moreno R, Villegas-Barahona G, Carazo-Vargas E, Arias-LeClaire H, Vicente-Galindo P. New cut-off points of PHQ-9 and its variants, in Costa Rica: a nationwide observational study. Sci Rep 2023; 13:14295. [PMID: 37652965 PMCID: PMC10471633 DOI: 10.1038/s41598-023-41560-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023] Open
Abstract
The PHQ-9 questionnaire is a screening test worldwide used to measure depression. But it cannot be used in Costa Rica, due to the fact that it has not previously been validated for its population. The present study aims to show the validation of the PHQ-9 questionnaire and its variants (PHQ-2, PHQ-4, PHQ-8) in a population sample of adults residing in Costa Rica. A sample was collected (n = 1162) using a self-administered questionnaire. Confirmatory Factor Analysis (CFA), Receiver Operating Characteristic (ROC) curve, and Multiple Group Confirmatory Factor Analysis (MGCFA) were tested. One factor was found that explained 73.33% of the variance with excellent internal consistency (α = 0.928). Goodness-of-fit measures were adequate (RMSEA = 0.107; CFI = 0.948), as was diagnostic power at a cut-off of 10 (78.60 for Sensitivity and 27.95 for 1-Specificity). External validation indices were good (r = 0.843 with GAD-7, r = - 0.647 with RS14, and r = 0.301 with FCV19S), and the model showed invariance by sex (∆χ2 = 27.90; df = 27; p < 0.001). Additionally, new cut-off points were proposed for PHQ-9 and its variants for Costa Rican male, female, and general populations. The PHQ-9 and its variants (PHQ-2, 4, and 8) are valid tools for detecting depression (and anxiety for PHQ-4) in Costa Rican population. In addition, new cut-off points differentiated by sex are proposed.
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Affiliation(s)
- Armando González-Sánchez
- Department of Statistics and Operative Research, University of Salamanca, Campus Miguel de Unamuno. C/ Alfonso X El Sabio, S/N, 37007, Salamanca, Spain.
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Virgen de la Vega, 10ª Planta, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain.
| | - Raúl Ortega-Moreno
- Psychology School, National University, Costa Rica (UNA), Heredia, Costa Rica
| | | | | | | | - Purificación Vicente-Galindo
- Department of Statistics and Operative Research, University of Salamanca, Campus Miguel de Unamuno. C/ Alfonso X El Sabio, S/N, 37007, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Virgen de la Vega, 10ª Planta, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
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Karimi K, Yaghoobi A, Güngör S, Karimi A, Sohrabi S. Measuring Dysfunctional Grief due to a COVID-19 Loss: A Kurdish Validation Study of the Pandemic Grief Scale. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231193183. [PMID: 37499262 PMCID: PMC10375224 DOI: 10.1177/00302228231193183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Millions of people are grieving the loss of someone who died of COVID-19. The current study aims to validate a Kurdish version of the Pandemic Grief Scale which is a brief English-language mental health screener to identify cases of dysfunctional grief associated with a COVID-19 death. We recruited 501 participants. Participants completed the PGS, WSAS, PHQ-9, and Optimism scales. The factor structure, reliability, and validity of the PGS were analyzed. Using exploratory factor analysis (N1 = 300), we derived an one-factor structure. In confirmatory factor analysis (N2 = 201), the one-factor model showed good to excellent fitness. The PGS was positively correlated with PHQ-4, and WSAS and negatively correlated with optimism. The scale was internally consistent with a Cronbach's alpha of .79. These results support that the Kurdish version of the PGS is a valid and reliable assessment to assess the severity of dysfunctional grief associated with a COVID-19 death.
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Affiliation(s)
- Kambiz Karimi
- Department of Psychology, Faculty of Economics and Social Sciences, Bu-Ali Sina University, Hamedan, Iran
| | - Abolghasem Yaghoobi
- Department of Psychology, Faculty of Economics and Social Sciences, Bu-Ali Sina University, Hamedan, Iran
| | - Sunay Güngör
- Department of Psychology, Faculty of Literature, Gümüşhane üniversitesi, Gümüşhane, Turkey
| | - Afagh Karimi
- Department of Philosophy, Faculty of Literature and Humanities, Kharazmi University, Tehran, Iran
| | - Saeed Sohrabi
- Computer Department, Technical and Vocational University, Kermanshah, Iran
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Lee MS, Lee H. The risk of obstructive sleep apnea is highly correlated with depressive symptoms among the Korean adults population: results from the 2020 Korea National Health and Nutrition Examination Survey. BMC Psychiatry 2023; 23:467. [PMID: 37370095 DOI: 10.1186/s12888-023-04983-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/22/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES We aimed to examine the association between Obstructive Sleep Apnea (OSA) risk, health behaviors, and depressive symptoms in a representative Korean sample. METHODS Cross-sectional data from the 2020 Korea National Health and Nutrition Examination Survey (KNHANES) were analyzed. The sample included 4,352 adults aged 40 years and older. Multiple linear regression analysis was performed to examine the association between OSA risk, health behaviors, and depressive symptoms. RESULTS In total, 23.1% of the participants reported a high risk of OSA. Of the respondents, 39.8%, 19.0%, 27.2%, and 8.7% reported hypertension, snoring, tiredness, and observed apnea, respectively. The prevalence of moderate-severe depressive symptoms among adults with high-risk OSA was 7.5%. The significant associations between OSA risk and sex with PHQ-9 were shown in univariate linear regression. In the multiple linear regression analysis, the association between high risk of OSA and PHQ-9 showed in total (B = 1.58; P < 0.001), male (B = 1.21; P < 0.001), and female (B = 1.93; P < 0.001). CONCLUSIONS A high risk of OSA was associated with an increased prevalence of depressive symptoms. Monitoring the risk factors of depressive symptoms, including OSA, or unhealthy behaviors may decrease the mental health issues of middle-aged and older adults.
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Affiliation(s)
- Mi-Sun Lee
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea
| | - Hooyeon Lee
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea.
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Dashputre A, Agho KE, Piya MK, Glenister K, Bourke L, Hannah S, Bhat R, Osuagwu UL, Simmons D. Prevalence and factors associated with mental health problems of psychological distress and depression among rural Victorians - analysis of cross-sectional data (Crossroads II). BMC Psychiatry 2023; 23:450. [PMID: 37340331 DOI: 10.1186/s12888-023-04931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 06/06/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Research suggests that rates of mental illness are similar in rural and urban Australia, although there are significant workforce shortages in rural regions along with higher rates of chronic disease and obesity and lower levels of socioeconomic status. However, there are variations across rural Australia and limited local data on mental health prevalence, risk, service use and protective factors. This study describes the prevalence of self-reported mental health problems of psychological distress and depression, in a rural region in Australia and aims to identify the factors associated with these problems. METHODS The Crossroads II study was a large-scale cross-sectional study undertaken in the Goulburn Valley region of Victoria, Australia in 2016-18. Data were collected from randomly selected households across four rural and regional towns and then screening clinics from individuals from these households. The main outcome measures were self-reported mental health problems of psychological distress assessed by the Kessler 10 and depression assessed by Patient Health Questionnaire-9. Unadjusted odd ratios and 95% confidence intervals of factors associated with the two mental health problems were calculated using simple logistic regression with multiple logistic regression using hierarchical modelling to adjust for the potential confounders. RESULTS Of the 741 adult participants (55.6% females), 67.4% were aged ≥ 55 years. Based on the questionnaires, 16.2% and 13.6% had threshold-level psychological distress and depression, respectively. Of those with threshold-level K-10 scores, 19.0% and 10.5% had seen a psychologist or a psychiatrist respectively while 24.2% and 9.5% of those experiencing depression had seen a psychologist or a psychiatrist, respectively in the past year. Factors such as being unmarried, current smoker, obesity, were significantly associated with a higher prevalence of mental health problems whereas physical activity, and community participation reduced the risk of mental health problems. Compared to rural towns, the regional town had higher risk of depression which was non-significant after adjusting for community participation and health conditions. CONCLUSIONS The high prevalence of psychological distress and depression in this rural population was consistent with other rural studies. Personal and lifestyle factors were more relevant to mental health problems than degree of rurality in Victoria. Targeted lifestyle interventions could assist in reducing mental illness risk and preventing further distress.
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Affiliation(s)
- Anushka Dashputre
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Kingsley E Agho
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Milan K Piya
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Macarthur Diabetes Endocrinology Metabolism Services, Camden and Campbelltown Hospitals, Campbelltown, NSW, 2560, Australia
| | - Kristen Glenister
- Department of Rural Health, University of Melbourne, Wangaratta, VIC, Australia
| | - Lisa Bourke
- Department of Rural Health, University of Melbourne, Shepparton, VIC, Australia
| | - Stephanie Hannah
- School of Science, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Ravi Bhat
- Department of Rural Health, University of Melbourne, Shepparton, VIC, Australia
| | - Uchechukwu L Osuagwu
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Bathurst Rural Clinical School (BRCS), School of Medicine, Western Sydney University, Bathurst, NSW, 2795, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
- Macarthur Diabetes Endocrinology Metabolism Services, Camden and Campbelltown Hospitals, Campbelltown, NSW, 2560, Australia.
- Department of Rural Health, University of Melbourne, Shepparton, VIC, Australia.
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Inkster B, Kadaba M, Subramanian V. Understanding the impact of an AI-enabled conversational agent mobile app on users' mental health and wellbeing with a self-reported maternal event: a mixed method real-world data mHealth study. Front Glob Womens Health 2023; 4:1084302. [PMID: 37332481 PMCID: PMC10272556 DOI: 10.3389/fgwh.2023.1084302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 05/12/2023] [Indexed: 06/20/2023] Open
Abstract
Background Maternal mental health care is variable and with limited accessibility. Artificial intelligence (AI) conversational agents (CAs) could potentially play an important role in supporting maternal mental health and wellbeing. Our study examined data from real-world users who self-reported a maternal event while engaging with a digital mental health and wellbeing AI-enabled CA app (Wysa) for emotional support. The study evaluated app effectiveness by comparing changes in self-reported depressive symptoms between a higher engaged group of users and a lower engaged group of users and derived qualitative insights into the behaviors exhibited among higher engaged maternal event users based on their conversations with the AI CA. Methods Real-world anonymised data from users who reported going through a maternal event during their conversation with the app was analyzed. For the first objective, users who completed two PHQ-9 self-reported assessments (n = 51) were grouped as either higher engaged users (n = 28) or lower engaged users (n = 23) based on their number of active session-days with the CA between two screenings. A non-parametric Mann-Whitney test (M-W) and non-parametric Common Language effect size was used to evaluate group differences in self-reported depressive symptoms. For the second objective, a Braun and Clarke thematic analysis was used to identify engagement behavior with the CA for the top quartile of higher engaged users (n = 10 of 51). Feedback on the app and demographic information was also explored. Results Results revealed a significant reduction in self-reported depressive symptoms among the higher engaged user group compared to lower engaged user group (M-W p = .004) with a high effect size (CL = 0.736). Furthermore, the top themes that emerged from the qualitative analysis revealed users expressed concerns, hopes, need for support, reframing their thoughts and expressing their victories and gratitude. Conclusion These findings provide preliminary evidence of the effectiveness and engagement and comfort of using this AI-based emotionally intelligent mobile app to support mental health and wellbeing across a range of maternal events and experiences.
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Affiliation(s)
- Becky Inkster
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Wysa Inc., Boston, MA, United States
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Pytell JD, Li X, Thompson C, Lesko CR, McCaul ME, Hutton H, Batey DS, Cachay E, Mayer KH, Napravnik S, Christopoulos K, Yang C, Crane HM, Chander G, Lau B. The temporal relationship of alcohol use and subsequent self-reported health status among people with HIV. AMERICAN JOURNAL OF MEDICINE OPEN 2023; 9:100020. [PMID: 37476695 PMCID: PMC10357948 DOI: 10.1016/j.ajmo.2022.100020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 06/14/2022] [Accepted: 06/24/2022] [Indexed: 07/22/2023]
Abstract
Background Alcohol use among people with HIV is associated with worse HIV treatment outcomes. Its impact on self-reported health status is unclear. Setting Longitudinal cohort of people with HIV engaged in care across 7 clinics participating in the Centers for AIDS Research Network of Integrated Care Systems between January 2011 and June 2014. Methods A total of 5046 participants were studied. A quantile regression model estimated the association of alcohol use levels with subsequent self-reported health status score, accounting for multiple covariates including depressive symptoms. Women, men who have sex with women, and men who have sex with men were analyzed separately. Results Prevalence of heavy alcohol use was 21%, 31%, and 37% among women, men who have sex with women, and men who have sex with men, respectively. Women with heavy alcohol use had a subsequently decreased median self-reported health status score compared to women with no or moderate alcohol use (odds ratio [OR]: 0.76; 95% confidence interval [CI]: 0.58-0.99); this association was not explained by the presence of depressive symptoms. There was no observed association of alcohol use level on subsequent self-reported health status among men who have sex with women. Men who have sex with men reporting no alcohol use had a subsequently decreased median self-reported health status compared to moderate alcohol use (OR: 0.88; 95% CI: 0.80-0.97). Conclusion Heavy alcohol use is associated with worsened self-reported health status at subsequent visits among women with HIV and not men with HIV.
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Affiliation(s)
- Jarratt D. Pytell
- Department of Medicine, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224, USA
| | - Ximin Li
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carol Thompson
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine R. Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary E. McCaul
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, MD, USA
| | - Heidi Hutton
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, MD, USA
| | - D. Scott Batey
- Department of Social Work, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward Cachay
- Department of Medicine, University of California, San Diego, CA, USA
| | - Kenneth H. Mayer
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katerina Christopoulos
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Cui Yang
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heidi M. Crane
- Department of Medicine, UW School of Medicine, University of Washington, Seattle, WA, USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bryan Lau
- Department of Medicine, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Łakuta P. Brief self-affirmation intervention for adults with psoriasis for reducing anxiety and depression and boosting well-being: Evidence from a randomized controlled trial. Psychol Med 2023; 53:2574-2584. [PMID: 34736546 PMCID: PMC10123834 DOI: 10.1017/s0033291721004499] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/05/2021] [Accepted: 10/15/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND There are relatively few studies to address mental health implications of self-affirming, especially across groups experiencing a chronic health condition. In this study, short- and longer-term effects of a brief self-affirmation intervention framed in terms of implementation intentions (if-then plans with self-affirming cognitions; S-AII) were evaluated against an active control group (non-affirming implementation intentions; N-AII), matched to the target condition, and mere goal intention condition (a non-active control) in adults with psoriasis. The three pre-registered primary outcomes captured depression, anxiety, and well-being. METHODS Adults with psoriasis (N = 175; Mage = 36.53, s.d. = 11.52) were randomized into S-AII, N-AII, or control. Participants' mental health outcomes were assessed prior to randomization (at baseline), at week 2 (post-intervention), and at a 1-month follow-up. RESULTS Linear mixed models were used and results were reported on the intention-to-treat principle. Analyses revealed that S-AII exerted significantly more improvement in the course of well-being (ds > 0.25), depressive symptoms (ds > -0.40), and anxiety (ds > -0.45) than the N-AII and control group at 2-week post-intervention. Though the differences between groups faded at 1-month follow-up, the within-group changes over time for S-AII in all mental health outcomes remained significant. CONCLUSIONS Brief and low-intensity S-AII intervention exerted in the short-term a considerable impact on mental health outcomes. The S-AII shows promising results as a relevant public mental health strategy for enhancing well-being and reducing psychological distress. Future studies could consider whether these effects can be further enhanced with booster interventions.
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Affiliation(s)
- Patryk Łakuta
- Institute of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland and Institute of Psychology, Cardinal Stefan Wyszyński University, Warsaw, Poland
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Rubinstein TB, Dionizovik-Dimanovski M, Davis AM, Smith C, Faust L, Rutstein B, Mitchell M, Jones JT, Harris JG, Rodriguez M, Tesher M, Onel K, Gabbay V, Stein REK, von Scheven E, Knight AM. Multicenter Study of Utility and Acceptability of Depression and Anxiety Screening in Adolescents and Young Adults With Childhood-Onset Systemic Lupus. Arthritis Care Res (Hoboken) 2023; 75:724-733. [PMID: 34806329 PMCID: PMC10544846 DOI: 10.1002/acr.24825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/28/2021] [Accepted: 11/18/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the utility and acceptability for depression and anxiety screening of adolescents and young adults (AYA) with childhood-onset systemic lupus erythematosus (cSLE) in the pediatric rheumatology setting. METHODS AYA with cSLE, ages 12-21 years, from 8 collaborating sites, were consecutively screened for depression and anxiety with the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-item scale (GAD-7). Demographic and disease characteristics were collected, as well as patient-reported outcome measures using the Patient Reported Outcomes Measurement Information System (PROMIS) pediatric profile-25. Acceptability of screening was assessed with postscreening surveys completed by AYA and parents. Chi-square and Wilcoxon rank sum tests examined the relationship between patient characteristics and history of previous screening. Spearman correlations examined relationships between screening scores, PROMIS domains, and other disease factors. RESULTS Among 106 AYA screened, 64 (60%) had been previously screened, 25 (24%) by general pediatricians. Thirty-two (30%) AYA screened positive, including 24% for depression, 17% for anxiety, and 14% for suicidal ideation. Depression and anxiety symptom severity were highly correlated with increased PROMIS domain scores for fatigue and pain interference and moderately correlated with increased pain severity, decreased mobility, and decreased peer relationships. Eighty-six percent of AYA and 95% of parents expressed comfort with screening in the pediatric rheumatology setting. CONCLUSION Depression, anxiety, and suicidal ideation are common among AYA with cSLE, and symptoms are correlated with important patient-reported outcomes. Mental health screening in the pediatric rheumatology setting was highly acceptable among AYA with cSLE and their parents.
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Affiliation(s)
- Tamar B Rubinstein
- Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, New York
| | | | - Alaina M Davis
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | | | - Lauren Faust
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Beth Rutstein
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Manda Mitchell
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | | | | | | | | | - Karen Onel
- Hospital for Special Surgery, New York, New York
| | - Vilma Gabbay
- Albert Einstein College of Medicine, Bronx, New York, and Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Ruth E K Stein
- Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, New York
| | | | - Andrea M Knight
- SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and Center for Pediatric Clinical Effectiveness & PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Bever MM, Maks CM. Developing and Implementing a Depression Screening and Referral Protocol Among College Students. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2023.104558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Damiano RF, Hoffmann MS, Gosmann NP, Pan PM, Miguel EC, Salum GA. Translating measurement into practice: Brazilian norms for the Patient Health Questionnaire (PHQ-9) for assessing depressive symptoms. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2023; 45. [PMID: 36934346 PMCID: PMC10668311 DOI: 10.47626/1516-4446-2022-2945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/22/2023] [Indexed: 03/20/2023]
Abstract
OBJECTIVE To provide practical norms for measuring depressive symptoms using the Patient Health Questionnaire 9 (PHQ-9) in Brazil using a state-of-art psychometrics analysis. METHODS We used a large and representative Brazilian dataset from the 'Pesquisa Nacional de Saúde - 2019'(PNS-2019), which includes 90,846 Brazilian citizens. First, to assess the scale structure, we assessed the unidimensional model using Confirmatory Factor Analysis (CFA). Second, we used Item Response Theory (IRT) to characterize depressive symptoms´ distribution. Then, we linked summed- and meanbased PHQ-9 scores with the IRT-based score by using generalized additive models. Finally, we generated percentiles, T scores, and a newly developed score, called D scores (decimal scores), to describe the PHQ-9 norms for Brazilian population. RESULTS CFA revealed a good fit to the unidimensional model, showing to be invariant to age and sex. IRT captured item-level information of the latent trait (reliable from 1 to 3 standard deviations above the mean). Brazilian norms were presented using summed-, T-scores, and D-scores. CONCLUSIONS This is the first study to define Brazilian´s norms for the PHQ-9 among a large representative sample, using robust psychometric tools. More precise PHQ-9 scores are now available and may be widely used in primary and specialized clinical care settings.
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Affiliation(s)
- Rodolfo Furlan Damiano
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Maurício Scopel Hoffmann
- Departamento de Neuropsiquiatria, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Natan Pereira Gosmann
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Seção de Afeto Negativo e Processos Sociais, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil
- Programa Ambulatorial de Transtornos de Ansiedade, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil
| | - Pedro Mario Pan
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Eurípedes Constantino Miguel
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Giovanni Abrahão Salum
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Seção de Afeto Negativo e Processos Sociais, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil
- Departamento de Psiquiatria e Medicina Legal, UFRGS, Porto Alegre, RS, Brazil
- Child Mind Institute, New York, NY, USA
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Witten E, Ryynanen J, Wisdom S, Tipp C, Chan SWY. Effects of soothing images and soothing sounds on mood and well-being. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:158-179. [PMID: 36342851 DOI: 10.1111/bjc.12400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Mental health problems are increasing at an alarming rate, calling for the need for more cost-effective and easily accessible interventions. Visual images and sounds depicting nature have been found to have positive effects on individuals' mood and well-being; however, the combined effects of images and sounds have been scarcely investigated. This study therefore aimed to compare the mood effects of viewing nature-related soothing images versus listening to soothing sounds versus a combination of both. METHODS In this study, 149 participants aged 18-83 years old (M = 35.88, SD = 15.63; 72.5% female, male 26.8%, .7% transgender) were randomised into three intervention conditions: images only, sounds only or combined (images and sounds). Baseline depressive and anxiety symptoms were indexed, and four outcome variables (positive affect, negative affect, serenity affect and depressive mood states) were measured pre- and post-intervention. RESULTS Findings showed that all participants, regardless of group, reported a decrease in negative affect, positive affect and depressive mood as well as an increase in serenity affect (including feelings of soothe). However, there were no group differences. Exploratory analyses found that individuals with higher levels of depressive and anxiety symptoms at baseline experienced greater reduction in negative affect and depressive mood state, as well as a larger increase in serenity affect. CONCLUSIONS These findings therefore provide preliminary evidence that, upon further research and development, images and sounds depicting nature can potentially be developed for use as an effective tool to improve mood and well-being.
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de Mélo Silva Júnior ML, Sapia AV, Cavalcanti Neto JM, Barbosa NMG, Neiva VBC, Sauaia Filho EN. The first wave of COVID-19 and mental distress of physician residents in Brazil: a comparison between two cohorts. HUMAN RESOURCES FOR HEALTH 2023; 21:10. [PMID: 36788532 PMCID: PMC9926430 DOI: 10.1186/s12960-022-00790-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/21/2022] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The reorganization of healthcare systems to face the COVID-19 pandemic has led to concerns regarding psychological distress of healthcare workers, and training requirements of physician residents. OBJECTIVE To assess the influence of COVID-19 pandemic on depression, anxiety, burnout and training schedules of residents. METHODS Two independent cross-sectional studies (the first in November 2019 [control], the second in June 2020, during the first wave of COVID-19 pandemic) enrolling physician residents from Brazil, using online surveys. In each of them, we collected demographic and training program data, and assessed depression, anxiety and burnout through PHQ-2, GAD-2 and MBI (2-item version) scales, respectively. We controlled confounding variables with logistic regression analysis. RESULTS The COVID-19 cohort (n = 524) presented a briefer workload and had at least 1 day off per week more frequently, in relation to the control cohort (n = 1 419). The majority of residents (464/524, 89.5%) had a reduction in their duty hours, and believed they would need an extra training period after the end of the pandemic (399/524, 76.2%). The frequency of depression increased (46.0% vs. 58.8%, aOR = 1.64, 95% CI = 1.32-2.05), anxiety did not change (56.5% vs. 56.5%, aOR = 1.24, 95% CI = 0.99-1.55) and burnout decreased (37.0% vs. 26.1%, aOR = 0.77, 95% CI = 0.60-0.99). Sensitivity analysis did not change these results. CONCLUSION Mental distress is frequent among residents and associated with both training program and social environments. The consequences of the COVID-19 pandemic on training requirements should be specifically addressed by supervisors and policymakers, in a case-by-case basis. Psychological support must be provided to healthcare workers.
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Affiliation(s)
- Mário Luciano de Mélo Silva Júnior
- Division of Neuropsychiatry, Medical Science Center, Universidade Federal de Pernambuco, 1235 Moraes Rego Av, Cidade Universitária, Recife, 50670-901 Brazil
- Medical School, Uninassau, Recife, Brazil
- Neurology Unit, Hospital da Restauração, Recife, Brazil
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Liang K, Chen S, Zhao Y, Ren Y, Ren Z, Chi X. A new PHQ-2 for Chinese adolescents: identifying core items of the PHQ-9 by network analysis. Child Adolesc Psychiatry Ment Health 2023; 17:11. [PMID: 36681826 PMCID: PMC9862239 DOI: 10.1186/s13034-023-00559-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The importance of preventing and treating adolescent depression has been gradually recognized in Chinese society, especially in the context of the COVID-19 pandemic. Early screening is the first step. The Patient Health Questionnaire-9 (PHQ-9) is a leading scale in the field of depression screening. To improve screening efficiency in large-scale screening, an even shorten scale is desirable. The PHQ-2, which only included two items measuring anhedonia and depressed mood, is an ultra-form of the PHQ-9. However, emerging evidence suggests that there may be a better short form for the PHQ-9, especially for adolescents. Therefore, using two large samples of Chinese adolescents, this study aimed to identify the core items of the PHQ-9 and examine the short form consisting of core items. METHODS Surveys were conducted among primary and middle school students in two Chinese cities with different economic levels during the COVID-19 pandemic. Two gender-balanced samples aged 10 to 17 (nSample 1 = 67281, nSample 2 = 16726) were collected. Network analysis was used to identify the core items of the PHQ-9, which were extracted to combine a short version. Reliability, concurrent validity, and the receiver operating characteristic curve (ROC) of the short form were examined. Analyses were gender-stratified. RESULTS Network analysis identified fatigue and depressed mood as core items in the PHQ-9 among Chinese adolescents. Items measuring Fatigue and Mood were combined to be a new PHQ-2 (PHQ-2 N). The PHQ-2 N displayed satisfactory internal consistency and current validity. Taking the PHQ-9 as a reference, the PHQ-2 N showed higher ROC areas and better sensitivity and specificity than the PHQ-2. The optimal cutoff score for the PHQ-2 N was 2 or 3. CONCLUSIONS Fatigue and depressed mood are the central symptoms of the depressive symptom network. The PHQ-2 N has satisfactory psychometric properties and can be used in rapid depression screening among Chinese adolescents.
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Affiliation(s)
- Kaixin Liang
- grid.263488.30000 0001 0472 9649School of Psychology, Shenzhen University, Shenzhen, 518061 China ,grid.263488.30000 0001 0472 9649The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health, Shenzhen University, Shenzhen, 518061 China
| | - Sitong Chen
- grid.263488.30000 0001 0472 9649School of Physical Education and Sport, Shenzhen University, Shenzhen, 518061 China
| | - Yue Zhao
- grid.263488.30000 0001 0472 9649School of Psychology, Shenzhen University, Shenzhen, 518061 China ,grid.263488.30000 0001 0472 9649The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health, Shenzhen University, Shenzhen, 518061 China
| | - Yizhen Ren
- grid.20513.350000 0004 1789 9964Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, 100875 China
| | - Zhanbing Ren
- grid.263488.30000 0001 0472 9649School of Physical Education and Sport, Shenzhen University, Shenzhen, 518061 China
| | - Xinli Chi
- School of Psychology, Shenzhen University, Shenzhen, 518061, China. .,The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health, Shenzhen University, Shenzhen, 518061, China.
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Burkauskas J, Slabadiene M, Podlipskyte A, Steibliene V. Factors associated with worsened clinical symptoms of psoriasis and disease-related quality of life during the COVID-19 lockdown: A cross-sectional study. Front Med (Lausanne) 2023; 9:1027853. [PMID: 36703886 PMCID: PMC9871456 DOI: 10.3389/fmed.2022.1027853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Objective In this cross-sectional study, we aimed to evaluate the factors associated with psoriasis symptom worsening and impaired quality of life (QoL) in individuals with psoriasis during the COVID-19 pandemic lockdown. Methods During the second COVID-19 national lockdown (January-April 2021) in Lithuania, individuals diagnosed with psoriasis were invited to fill in an anonymous online survey including sociodemographic and life-style factors, psoriasis-related clinical symptoms, the Dermatology Life Quality Index (DLQI) and the Patients' Health Questionnaire (PHQ). Results A total of 297 respondents completed the survey. The majority of them (52.5%) reported worsened clinical symptoms of psoriasis during the COVID-19 lockdown period. In total, 43.1% of responders reported significant depressive symptoms (PHQ-9 ≥ 10) and 23.6% reported impaired disease-related QoL (DLQI > 10). The strongest predictor of psoriasis symptoms worsening was the need for changes in psoriasis treatment, with an odds ratio (OR) of 2.73 (95% CI 1.37-5.44, p = 0.004) and decreased income (OR = 2.33, 95% CI 1.30-4.17, p = 0.004). The strongest predictor of impaired QoL was male sex (OR = 3.35, 95% CI 1.70-6.59, p < 0.001). Contribution of specific depressive symptoms was evident for both models. Conclusion Worsening of psoriasis symptoms during the COVID-19 lockdown was associated with decreased income, psoriasis treatment changes and depression symptoms. Impaired QoL was associated with male sex, symptom worsening and depression. Specific depression symptoms may have contributed to more symptom worsening and impaired QoL than the depressive symptomatology as a whole.
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Affiliation(s)
- Julius Burkauskas
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | | | - Aurelija Podlipskyte
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania,*Correspondence: Aurelija Podlipskyte ✉
| | - Vesta Steibliene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania,Psychiatry Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Connors JN, Kroenke K, Monahan P, Chernyak Y, Pettit K, Hayden J, Montgomery C, Brenner G, Millard M, Holmes E, Musey P. Comparing the effectiveness of existing anxiety treatment options among patients evaluated for chest pain and anxiety in the emergency department setting: Study protocol for the PACER pragmatic randomized comparative effectiveness trial. Contemp Clin Trials 2023; 124:107020. [PMID: 36423863 DOI: 10.1016/j.cct.2022.107020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/03/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Anxiety disorders are a common underlying cause of symptoms among low-risk chest pain patients evaluated in the emergency department setting. However, anxiety is often undiagnosed and undertreated in any setting, and causes considerable functional impairment to work, family, and social life. OBJECTIVES The Patient-Centered Treatment of Anxiety after Low-Risk Chest Pain in the Emergency Room (PACER) study is a pragmatic randomized trial to test the comparative effectiveness of existing anxiety treatments of graduated intensities and determine what options work best for patient subgroups based on anxiety severity and other comorbidities. METHODS The PACER trial will enroll 375 emergency department patients with low-risk chest pain and anxiety (GAD-7 score ≥ 8) and randomize them to either: 1) referral to primary care with enhanced care coordination, 2) online self-administered cognitive behavioral therapy with guided peer support, or 3) therapist-administered cognitive behavior therapy. Outcomes include anxiety symptoms (primary) as well as physical symptom burden, depression symptoms, functional impairment, ED recidivism, and occurrence of major adverse cardiac events. Statistical analyses will be conducted primarily using linear mixed models to perform a repeated measures analysis of patient-reported outcomes, assessed at 3, 6, 9, and 12-month follow-ups. DISCUSSION PACER is an innovative and pragmatic clinical trial that will compare the effectiveness of several evidence-based telecare-delivered treatments for anxiety. Results have the potential to inform clinical guidelines for evaluation and management of low-risk chest pain patients and promote adoption of findings in ED departments across the country.
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Affiliation(s)
- Jill Nault Connors
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Kurt Kroenke
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States; Regenstrief Institute, Inc., Indianapolis, IN, United States
| | - Patrick Monahan
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Yelena Chernyak
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Kate Pettit
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Julie Hayden
- National Alliance on Mental Illness (NAMI) of Greater Indianapolis, Inc., Indianapolis, IN, United States
| | - Chet Montgomery
- Patient Advisory Committee, Community Member, Indianapolis, IN, United States
| | - George Brenner
- Continuing the Care, LLC, Indianapolis, IN, United States
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, Australia
| | - Emily Holmes
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Paul Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States.
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Andersen BL, Myers J, Blevins T, Park KR, Smith RM, Reisinger S, Carbone DP, Presley CJ, Shields PG, Carson WE. Depression in association with neutrophil-to-lymphocyte, platelet-to-lymphocyte, and advanced lung cancer inflammation index biomarkers predicting lung cancer survival. PLoS One 2023; 18:e0282206. [PMID: 36827396 PMCID: PMC9956881 DOI: 10.1371/journal.pone.0282206] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/07/2023] [Indexed: 02/26/2023] Open
Abstract
Lung cancer is a product of inflammation and a dysfunctional immune system, and depression has similar dysregulation. Depression disproportionately affects lung cancer patients, having the highest rates of all cancers. Systemic inflammation and depression are both predictive of non-small cell lung cancer (NSCLC) survival, but the existence and extent of any co-occurrence is unknown. Studied is the association between systemic inflammation ratio (SIR) biomarker levels and patients' depressive symptoms, with the hypothesis that depression severity would be significantly associated with prognostically poor inflammation. Newly diagnosed stage-IV non-small cell lung cancer (NSCLC; N = 186) patients were enrolled (ClinicalTrials.gov Identifier: NCT03199651) and blood draws and depression self-reports (Patient Health Questionnaire-9) were obtained. For SIRs, cell counts of neutrophils (N), lymphocytes (L), and platelets (P) were abstracted for ratio (R) calculations for NLR, PLR, and the Advanced Lung cancer Inflammation Index (ALI). Patients were followed and biomarkers were tested as predictors of 2-year overall survival (OS) to confirm their relevance. Next, multivariate linear regressions tested associations of depression with NLR, PLR, and ALI. Overall 2-year mortality was 61% (113/186). Cox model analyses confirmed higher NLR [hazard ratio (HR) = 1.91; p = 0.001] and PLR (HR = 2.08; p<0.001), along with lower ALI (HR = 0.53; p = 0.005), to be predictive of worse OS. Adjusting for covariates, depression was reliably associated with biomarker levels (p ≤ 0.02). Patients with moderate/severe depressive symptoms were 2 to 3 times more likely to have prognostically poor biomarker levels. Novel data show patients' depressive symptoms were reliably associated with lung-relevant systemic inflammation biomarkers, all assessed at diagnosis/pretreatment. The same SIRs were found prognostic for patients' 2-year OS. Intensive study of depression, combined with measures of cell biology and inflammation is needed to extend these findings to discover mechanisms of depression toxicity for NSCLC patients' treatment responses and survival.
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Affiliation(s)
- Barbara L. Andersen
- Department of Psychology, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States of America
| | - John Myers
- Department of Biomedical Informatics and Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Tessa Blevins
- Department of Psychology, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States of America
| | - Kylie R. Park
- Department of Psychology, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States of America
| | - Rachel M. Smith
- Department of Biomedical Informatics and Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Sarah Reisinger
- Department of Internal Medicine, Division of Medical Oncology, College of Medicine, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States of America
| | - David P. Carbone
- Department of Internal Medicine, Division of Medical Oncology, College of Medicine, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States of America
| | - Carolyn J. Presley
- Department of Internal Medicine, Division of Medical Oncology, College of Medicine, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States of America
| | - Peter G. Shields
- Department of Internal Medicine, Division of Medical Oncology, College of Medicine, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States of America
| | - William E. Carson
- Department of Surgery, Division of Surgical Oncology, College of Medicine, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States of America
- * E-mail:
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Patra S, Patro BK, Padhy S, Mantri J. Relationship of Mindfulness with Depression, Self-Management, and Quality of Life in Type 2 Diabetes Mellitus: mindfulness is a Predictor of Quality of Life. INDIAN JOURNAL OF SOCIAL PSYCHIATRY 2023; 39:70-76. [PMID: 37396825 PMCID: PMC10310295 DOI: 10.4103/ijsp.ijsp_436_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Context Mindfulness interventions have shown promising results in both psychological and clinical outcomes of type 2 diabetes mellitus. Depression, self-management, and quality of life (QOL) have shown improvement with mindfulness interventions; however, little is known about dispositional mindfulness and its relationship with depression, self-management, and QOL in type 2 diabetes mellitus. Aims The aim of this study is to assess the relationship of dispositional mindfulness with depression, self-management, and QOL in patients of type 2 diabetes. Settings and Design Noncommunicable disease outpatient department of a tertiary care medical center of East India. Cross-sectional study. Subjects and Methods Ninety-nine patients with type 2 diabetes completed the Five Facets Mindfulness Questionnaire, Diabetes Self-Management Questionnaire, and World Health Organization QOL BREF questionnaire and Hamilton Rating Scale for depression. Statistical Analysis Used Pearson's correlation and hierarchical regression analysis using the SPSS software version 20.0. Results Describing, acting with awareness, and nonjudging facets of mindfulness showed a negative correlation with depression (P < 0.05). Acting with awareness and nonreactivity to inner experience were positively correlated with the physical activity domains of self-management (P < 0.05). All facets of mindfulness showed a positive correlation with four domains of QOL. In hierarchical regression analysis, after controlling for sociodemographic and clinical variables, mindfulness predicted the psychological domain of QOL, explaining 31% of the variance (P ≤ 0.001). However, mindfulness did not predict depression or self-management. Conclusions Dispositional mindfulness is a strong predictor of QOL in type 2 diabetes mellitus and hence can be targeted with interventions to improve psychological outcomes.
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Affiliation(s)
- Suravi Patra
- Department of Psychiatry, AIIMS, Bhubaneswar, Odisha, India
| | - Binod Kumar Patro
- Departments of Psychiatry and Community Medicine and Family Medicine, AIIMS, Bhubaneswar, Odisha, India
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Abstract
Importance Anxiety disorders have a lifetime prevalence of approximately 34% in the US, are often chronic, and significantly impair quality of life and functioning. Observations Anxiety disorders are characterized by symptoms that include worry, social and performance fears, unexpected and/or triggered panic attacks, anticipatory anxiety, and avoidance behaviors. Generalized anxiety disorder (6.2% lifetime prevalence), social anxiety disorder (13% lifetime prevalence), and panic disorder (5.2% lifetime prevalence) with or without agoraphobia are common anxiety disorders seen in primary care. Anxiety disorders are associated with physical symptoms, such as palpitations, shortness of breath, and dizziness. Brief screening measures applied in primary care, such as the Generalized Anxiety Disorder-7, can aid in diagnosis of anxiety disorders (sensitivity, 57.6% to 93.9%; specificity, 61% to 97%). Providing information about symptoms, diagnosis, and evidence-based treatments is a first step in helping patients with anxiety. First-line treatments include pharmacotherapy and psychotherapy. Selective serotonin reuptake inhibitors (SSRIs, eg, sertraline) and serotonin-norepinephrine reuptake inhibitors (SNRIs, eg, venlafaxine extended release) remain first-line pharmacotherapy for generalized anxiety disorder, social anxiety disorder, and panic disorder. Meta-analyses suggest that SSRIs and SNRIs are associated with small to medium effect sizes compared with placebo (eg, generalized anxiety disorder: standardized mean difference [SMD], -0.55 [95% CI, -0.64 to -0.46]; social anxiety disorder: SMD, -0.67 [95% CI, -0.76 to -0.58]; panic disorder: SMD, -0.30 [95% CI, -0.37 to -0.23]). Cognitive behavioral therapy is the psychotherapy with the most evidence of efficacy for anxiety disorders compared with psychological or pill placebo (eg, generalized anxiety disorder: Hedges g = 1.01 [large effect size] [95% CI, 0.44 to 1.57]; social anxiety disorder: Hedges g = 0.41 [small to medium effect] [95% CI, 0.25 to 0.57]; panic disorder: Hedges g = 0.39 [small to medium effect[ [95% CI, 0.12 to 0.65]), including in primary care. When selecting treatment, clinicians should consider patient preference, current and prior treatments, medical and psychiatric comorbid illnesses, age, sex, and reproductive planning, as well as cost and access to care. Conclusions and Relevance Anxiety disorders affect approximately 34% of adults during their lifetime in the US and are associated with significant distress and impairment. First-line treatments for anxiety disorders include cognitive behavioral therapy, SSRIs such as sertraline, and SNRIs such as venlafaxine extended release.
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Affiliation(s)
- Kristin L Szuhany
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Naomi M Simon
- Department of Psychiatry, New York University Grossman School of Medicine, New York
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Tomlinson M, Rotheram-Borus MJ. When less is more: The way forward for mental health interventions during the perinatal period. PLoS Med 2022; 19:e1004138. [PMID: 36512608 PMCID: PMC9747018 DOI: 10.1371/journal.pmed.1004138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, United Kingdom
| | - Mary Jane Rotheram-Borus
- Semel Institute Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California, United States of America
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Bruney TL, Zhang X. Improving perinatal depression screening and management: results from a federally qualified health center. J Public Health (Oxf) 2022; 44:910-917. [PMID: 34379113 DOI: 10.1093/pubmed/fdab317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/03/2021] [Accepted: 07/23/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Perinatal depression affects 8.5-20% of women. In a systematic review 22% of women with a positive depression screen use mental health services. The objective of this study was to examine the effectiveness of on-site management in the perinatal setting and barriers to care. METHODS This is a retrospective chart review of 1042 women who received perinatal care between 1 January to 31 December 2019. Primary outcome was percentage of patients who were assessed after a positive depression screen. The secondary outcome was to determine factors affecting patients' receptiveness to assessment/treatment. RESULTS 9.52% of women screened positive. Sixty-two (63.9%) met with an on-site social worker for assessment, 6 (6.2%) misunderstood the screening questions, and 33 (34.0%) met criteria for depression. Of those, 9 (27.3%) attended at least one follow-up, 8 (24.2%) were referred to or already in care, 7 (21.2%) no-showed, and 9 (27.3%) declined further care. English speaking patients were more likely to meet with a social worker for diagnostic assessment (69.9% versus 45.8%, P = 0.033). CONCLUSION On-site management of a positive depression screen yielded a follow-up rate of 64% versus 49% in other studies. Non-English language may be a barrier to accessing mental health car.
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Affiliation(s)
- Talitha L Bruney
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Xueting Zhang
- Albert Einstein College of Medicine, Bronx, NY, 10461, USA
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Teusen C, Hapfelmeier A, von Schrottenberg V, Gökce F, Pitschel-Walz G, Henningsen P, Gensichen J, Schneider A. Combining the GP's assessment and the PHQ-9 questionnaire leads to more reliable and clinically relevant diagnoses in primary care. PLoS One 2022; 17:e0276534. [PMID: 36269712 PMCID: PMC9586376 DOI: 10.1371/journal.pone.0276534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 10/08/2022] [Indexed: 11/07/2022] Open
Abstract
Background Screening questionnaires are not sufficient to improve diagnostic quality of depression in primary care. The additional consideration of the general practitioner’s (GP’s) assessment could improve the accuracy of depression diagnosis. The aim of this study was to examine whether the GP rating supports a reliable depression diagnosis indicated by the PHQ-9 over a period of three months. Methods We performed a secondary data analysis from a previous study. PHQ-9 scores of primary care patients were collected at the time of recruitment (t1) and during a follow-up 3 months later (t2). At t1 GPs independently made a subjective assessment whether they considered the patient depressive (yes/no). Two corresponding groups with concordant and discordant PHQ-9 and GP ratings at t1 were defined. Reliability of the PHQ-9 results at t1 and t2 was assessed within these groups and within the entire sample by Cohen’s Kappa, Pearson’s correlation coefficient and Bland-Altman plots. Results 364 consecutive patients from 12 practices in the region of Upper Bavaria/Germany participated in this longitudinal study. 279 patients (76.6%) sent back the questionnaire at t2. Concordance of GP rating and PHQ-9 at t1 led to higher replicability of PHQ-9 results between t1 and t2. The reliability of PHQ-9 was higher in the concordant subgroup (κ = 0.507) compared to the discordant subgroup (κ = 0.211) (p = 0.064). The Bland-Altman Plot showed that the deviation of PHQ-9 scores at t1 and t2 decreased by about 15% in the concordant subgroup. Pearson’s correlation coefficient between PHQ-9 scores at t1 and t2 increased significantly if the GP rating was concordant with the PHQ-9 at t1 (r = 0.671) compared to the discordant subgroup (r = 0.462) (p = 0.044). Conclusions The combination of PHQ-9 and GP rating might improve diagnostic decision making regarding depression in general practices. PHQ-9 positive results might be more reliable and accurate, when a concordant GP rating is considered.
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Affiliation(s)
- Clara Teusen
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University of Munich, Munich, Bavaria, Germany
- * E-mail:
| | - Alexander Hapfelmeier
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University of Munich, Munich, Bavaria, Germany
- Institute for AI and Informatics in Medicine, TUM School of Medicine, Technical University of Munich, Munich, Bavaria, Germany
| | - Victoria von Schrottenberg
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University of Munich, Munich, Bavaria, Germany
| | - Feyza Gökce
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University of Munich, Munich, Bavaria, Germany
| | - Gabriele Pitschel-Walz
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University of Munich, Munich, Bavaria, Germany
| | - Peter Henningsen
- Dept. of Psychosomatic Medicine and Psychotherapy, University Hospital TU Munich, Munich, Bavaria, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University of Munich, Munich, Bavaria, Germany
| | - Antonius Schneider
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University of Munich, Munich, Bavaria, Germany
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Ng CH, Xiao J, Chew NWS, Chin YH, Chan KE, Quek J, Lim WH, Tan DJH, Loke RWK, Tan C, Tang ASP, Goh XL, Nah B, Syn N, Young DY, Tamaki N, Huang DQ, Siddiqui MS, Noureddin M, Sanyal A, Muthiah M. Depression in non-alcoholic fatty liver disease is associated with an increased risk of complications and mortality. Front Med (Lausanne) 2022; 9:985803. [PMID: 36275825 PMCID: PMC9582593 DOI: 10.3389/fmed.2022.985803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background and aims The global prevalence of non-alcoholic fatty liver disease (NAFLD) is expected to rise continuously. Furthermore, emerging evidence has also shown the potential for concomitant depression in NAFLD. This study aims to examine the prevalence, risk factors, and adverse events of depression in NAFLD and evaluate whether treated depression can reverse the increased risks of adverse outcomes. Materials and methods This study analyses the 2000–2018 cycles of NHANES that examined liver steatosis with fatty liver index (FLI). The relationship between NAFLD and depression was assessed with a generalized linear mix model and a sensitivity analysis was conducted in the no depression, treated depression, and untreated depression groups. Survival analysis was conducted with cox regression and fine gray sub-distribution model. Results A total of 21,414 patients were included and 6,726 were diagnosed with NAFLD. The risk of depression in NAFLD was 12% higher compared to non-NAFLD individuals (RR: 1.12, CI: 1.00–1.26, p = 0.04). NAFLD individuals with depression were more likely to be older, females, Hispanics or Caucasians, diabetic, and have higher BMI. Individuals with depression have high risk for cardiovascular diseases (CVD) (RR: 1.40, CI: 1.25–1.58, p < 0.01), stroke (RR: 1.71, CI: 1.27–2.23, p < 0.01), all-cause mortality (HR: 1.50, CI: 1.25–1.81, p < 0.01), and cancer-related mortality (SHR: 1.43, CI: 1.14–1.80, p = 0.002) compared to NAFLD individuals without depression. The risk of CVD, stroke, all-cause mortality, and cancer-related mortality in NAFLD individuals with treated depression and depression with untreated treatment was higher compared to individuals without depression. Conclusion This study shows that concomitant depression in NAFLD patients can increase the risk of adverse outcomes. Early screening of depression in high-risk individuals should be encouraged to improve the wellbeing of NAFLD patients.
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Affiliation(s)
- Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,*Correspondence: Cheng Han Ng, ; orcid.org/0000-0002-8297-1569
| | - Jieling Xiao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas W. S. Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Department of Cardiology, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jingxuan Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ryan Wai Keong Loke
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Caitlyn Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ansel Shao Pin Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xin Lei Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Benjamin Nah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dan Yock Young
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Nobuharu Tamaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Daniel Q. Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Mohammad Shadab Siddiqui
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | | | - Arun Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore,Mark Muthiah, ; orcid.org/0000-0002-9724-4743
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Lewis CC, Marti CN, Scott K, Walker MR, Boyd M, Puspitasari A, Mendel P, Kroenke K. Standardized Versus Tailored Implementation of Measurement-Based Care for Depression in Community Mental Health Clinics. Psychiatr Serv 2022; 73:1094-1101. [PMID: 35538748 PMCID: PMC9529853 DOI: 10.1176/appi.ps.202100284] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective Measurement-based care (MBC) is an evidence-based practice that is rarely integrated into psychotherapy. The authors sought to determine whether tailored MBC implementation can improve clinician fidelity and depression outcomes compared with standardized implementation. Methods This cluster-randomized trial enrolled 12 community behavioral health clinics to receive 5 months of implementation support. Clinics randomized to the standardized implementation received electronic health record data captured with the nine-item Patient Health Questionnaire (PHQ-9), a needs assessment, clinical training, guidelines, and group consultation in MBC fidelity. Tailored implementation support included these strategies, but the training content was tailored to clinics’ barriers to MBC, and group consultation centered on overcoming these barriers. Clinicians (N=83, tailored; N=71, standardized) delivering individual psychotherapy to 4,025 adults participated. Adult patients (N=87, tailored; N=141, standardized) contributed data for depression outcome analyses. Results The odds of PHQ-9 completion were lower in the tailored group at baseline (odds ratio [OR]=0.28, 95% CI=0.08–0.96) but greater at 5 months (OR=3.39, 95% CI=1.00–11.48). The two implementation groups did not differ in full MBC fidelity. PHQ-9 scores decreased significantly from baseline (mean±SD=17.6±4.4) to 12 weeks (mean=12.6±5.9) (p<0.001), but neither implementation group nor MBC fidelity significantly predicted PHQ-9 scores at week 12. Conclusions Tailored MBC implementation outperformed standardized implementation with respect to PHQ-9 completion, but discussion of PHQ-9 scores in clinician-patient sessions remained suboptimal. MBC fidelity did not predict week-12 depression severity. MBC can critically inform collaborative adjustments to session or treatment plans, but more strategic system-level implementation support or longer implementation periods may be needed.
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Affiliation(s)
- Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle (Lewis); Abacist Analytics, Austin, Texas (Marti); Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island (Scott); School of Public Health, University of North Carolina, Chapel Hill (Walker); Department of Psychology, University of California, Los Angeles, Los Angeles (Boyd); Mayo Clinic, Rochester, Minnesota (Puspitasari); RAND Corporation, Santa Monica, California (Mendel); Department of Medicine, Indiana University, Bloomington (Kroenke)
| | - C Nathan Marti
- Kaiser Permanente Washington Health Research Institute, Seattle (Lewis); Abacist Analytics, Austin, Texas (Marti); Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island (Scott); School of Public Health, University of North Carolina, Chapel Hill (Walker); Department of Psychology, University of California, Los Angeles, Los Angeles (Boyd); Mayo Clinic, Rochester, Minnesota (Puspitasari); RAND Corporation, Santa Monica, California (Mendel); Department of Medicine, Indiana University, Bloomington (Kroenke)
| | - Kelli Scott
- Kaiser Permanente Washington Health Research Institute, Seattle (Lewis); Abacist Analytics, Austin, Texas (Marti); Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island (Scott); School of Public Health, University of North Carolina, Chapel Hill (Walker); Department of Psychology, University of California, Los Angeles, Los Angeles (Boyd); Mayo Clinic, Rochester, Minnesota (Puspitasari); RAND Corporation, Santa Monica, California (Mendel); Department of Medicine, Indiana University, Bloomington (Kroenke)
| | - Madison R Walker
- Kaiser Permanente Washington Health Research Institute, Seattle (Lewis); Abacist Analytics, Austin, Texas (Marti); Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island (Scott); School of Public Health, University of North Carolina, Chapel Hill (Walker); Department of Psychology, University of California, Los Angeles, Los Angeles (Boyd); Mayo Clinic, Rochester, Minnesota (Puspitasari); RAND Corporation, Santa Monica, California (Mendel); Department of Medicine, Indiana University, Bloomington (Kroenke)
| | - Meredith Boyd
- Kaiser Permanente Washington Health Research Institute, Seattle (Lewis); Abacist Analytics, Austin, Texas (Marti); Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island (Scott); School of Public Health, University of North Carolina, Chapel Hill (Walker); Department of Psychology, University of California, Los Angeles, Los Angeles (Boyd); Mayo Clinic, Rochester, Minnesota (Puspitasari); RAND Corporation, Santa Monica, California (Mendel); Department of Medicine, Indiana University, Bloomington (Kroenke)
| | - Ajeng Puspitasari
- Kaiser Permanente Washington Health Research Institute, Seattle (Lewis); Abacist Analytics, Austin, Texas (Marti); Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island (Scott); School of Public Health, University of North Carolina, Chapel Hill (Walker); Department of Psychology, University of California, Los Angeles, Los Angeles (Boyd); Mayo Clinic, Rochester, Minnesota (Puspitasari); RAND Corporation, Santa Monica, California (Mendel); Department of Medicine, Indiana University, Bloomington (Kroenke)
| | - Peter Mendel
- Kaiser Permanente Washington Health Research Institute, Seattle (Lewis); Abacist Analytics, Austin, Texas (Marti); Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island (Scott); School of Public Health, University of North Carolina, Chapel Hill (Walker); Department of Psychology, University of California, Los Angeles, Los Angeles (Boyd); Mayo Clinic, Rochester, Minnesota (Puspitasari); RAND Corporation, Santa Monica, California (Mendel); Department of Medicine, Indiana University, Bloomington (Kroenke)
| | - Kurt Kroenke
- Kaiser Permanente Washington Health Research Institute, Seattle (Lewis); Abacist Analytics, Austin, Texas (Marti); Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island (Scott); School of Public Health, University of North Carolina, Chapel Hill (Walker); Department of Psychology, University of California, Los Angeles, Los Angeles (Boyd); Mayo Clinic, Rochester, Minnesota (Puspitasari); RAND Corporation, Santa Monica, California (Mendel); Department of Medicine, Indiana University, Bloomington (Kroenke)
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Kim JW. Different roles of social participation in socioeconomic disparities in depressive symptoms of Koreans across age groups. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-021-01556-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Robles R, Ascencio L, Díaz D, Ruiz S, Gálvez L, Sánchez M, Espinoza F, Hernández-Posadas A, Fresán A, Vega H, Morales-Chainé S. Implementation Science of Telepsychotherapy for Anxiety, Depression, and Somatization in Health Care Workers Dealing with COVID-19. Telemed J E Health 2022; 29:751-760. [PMID: 36126309 DOI: 10.1089/tmj.2022.0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Cognitive behavioral therapy (CBT) has proven to be effective in treating affective and somatic symptoms, which are among the leading mental health problems of health care workers (HCWs) dealing with COVID-19 (HCW-COVID-19). However, efforts to develop and evaluate the strategies required to promote its implementation in clinical practice are still scarce, particularly in low- and middle-income countries. Objective: To describe and evaluate the implementation process and clinical impact of a brief, remote, manualized CBT-based intervention for moderate anxiety, depressive, and somatic symptoms among Mexican HCW-COVID-19 ≥18 years old. Methods: The implementation process comprises community engagement, intervention systematization and education, leadership engagement, and team-based coaching as main strategies. A total of 26 participants completed self-report measures of symptoms before and after treatment, and a subsample of 21 answered a final questionnaire on the acceptability of the intervention. Therapists registered the techniques used in each case, regardless of whether they were part of the intervention manual. Results: The number of sessions was 4.6 (2.43). The most frequently employed techniques were those included in the intervention manual, especially identifying and modifying maladaptive thoughts, used to treat 70% of HCW-COVID-19. Supplementary techniques were implemented to enhance treatment or meet HCW-COVID-19s special needs (such as workplace issues, insomnia, COVID-19 status, and bereavement). The intervention had a significant effect (delta Cohen's coefficients ≥1), and the majority of HCW-COVID-19 were "totally satisfied" with its contents and considered it "not complex" (95.2% and 76.1%, respectively). Conclusions: Telepsychotherapy for anxiety, depression, and somatization in HCW coping with health emergencies in middle-income countries is a feasible, clinically valuable, and acceptable form of treatment.
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Affiliation(s)
- Rebeca Robles
- Global Mental Health Research Center, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Leticia Ascencio
- Palliative Care Unit, National Cancer Institute, Mexico City, Mexico
| | - Dulce Díaz
- Global Mental Health Research Center, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Susan Ruiz
- Globality Studies Seminar, Medicine Faculty, National Autonomous University of Mexico, Mexico City, Mexico
| | - Lizette Gálvez
- Palliative Care Unit, National Cancer Institute, Mexico City, Mexico
| | - Magaly Sánchez
- Psycho-Onclology and Palliative Care Unit, Morelos Children's Hospital, Mexico City, Mexico
| | - Fátima Espinoza
- Coordination of Training Centers and Psychological Services, Psychology Faculty, National Autonomous University of Mexico, Mexico City, Mexico
| | - Alejandro Hernández-Posadas
- Coordination of Training Centers and Psychological Services, Psychology Faculty, National Autonomous University of Mexico, Mexico City, Mexico
| | - Ana Fresán
- Subdirectorate of Clinical Research, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Hamid Vega
- Global Mental Health Research Center, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Silvia Morales-Chainé
- Coordination of Training Centers and Psychological Services, Psychology Faculty, National Autonomous University of Mexico, Mexico City, Mexico
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Cüce İ, Altun Y. Validity and reliability characteristics of the Silhouettes Fatigue Scale in measuring multiple sclerosis-related fatigue in Turkish-speaking adults. Acta Neurol Scand 2022; 146:671-679. [PMID: 36121165 DOI: 10.1111/ane.13708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/11/2022] [Accepted: 09/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of this study is to investigate the reliability and validity as well as the clinical utility of the Silhouettes Fatigue Scale (SFS), a single-item visual scale to assess fatigue, in adult patients with multiple sclerosis (MS). METHODS The study included 61 MS patients and 73 matched healthy controls. Demographic data and disease-related variables of all participants were recorded. Then, the SFS, Visual Analogue Scale (VAS)-fatigue, Fatigue Impact Scale (FIS), Fatigue Severity Scale (FSS), and Beck Depression Inventory (BDI) were applied. SFS, VAS-fatigue, and FSS were repeated after one week. Reliability was evaluated with the intra-class correlation coefficient (ICC) and Bland-Altman analysis. Validity was tested by comparison of healthy controls and patients with MS and correlations with other scales. Accuracy and clinical utility were also evaluated. RESULTS SFS scores were 4.49 ± 3.11 (mean ± SD) in MS patients and 1.40 ± 1.44 in healthy controls (p < .001). The ICC for SFS was 0.946. The mean difference between test-retest measurements of SFS was -0.04651 (-95% CI, -0.4815-0.38848), and there was no systemic bias. SFS scores were not correlated with the expanded disability status scale, whereas they were poorly correlated with BDI. Correlations ranging from poor to good were calculated between the SFS and other fatigue-related scales. The optimum cut-off score of the SFS scale was four, with a sensitivity of 0.72 and a specificity of 0.84. CONCLUSION This study demonstrated that the SFS is a reliable, responsive, and valid scale with acceptable sensitivity and specificity to assess and quantify clinically significant fatigue in MS patients. These findings as well as the brief and understandable nature of the SFS were encouraging that this scale has good clinical utility.
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Affiliation(s)
- İsa Cüce
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Yaşar Altun
- Department of Neurology, Faculty of Medicine, Adıyaman University, Adıyaman, Turkey
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