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Obeid S, Hemade A, Malaeb D, Sakr F, Dabbous M, Xu J, Ying Y, Jiang C, Meng R, Fekih-Romdhane F, Hallit S. Psychometric properties of the ultra-brief self-report Patient Health Questionnaire-4 (PHQ-4) to assess anxiety and depression in Arabic-speaking adults. BMC Psychiatry 2024; 24:537. [PMID: 39080577 PMCID: PMC11290276 DOI: 10.1186/s12888-024-05978-8] [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: 04/01/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Anxiety and depression are psychiatric disorders that often coexist and share some features. Developing a simple and cost-effective tool to assess anxiety and depression in the Arabic-speaking population, predominantly residing in low- and middle-income nations where research can be arduous, would be immensely beneficial. The study aimed to translate the four-item composite Patient Health Questionnaire - 4 (PHQ-4) into Arabic and evaluate its psychometric properties, including internal reliability, sex invariance, composite reliability, and correlation with measures of psychological distress. METHODS 587 Arabic-speaking adults were recruited between February and March 2023. An anonymous self-administered Google Forms link was distributed via social media networks. We utilized the FACTOR software to explore the factor structure of the Arabic PHQ-4. RESULTS Confirmatory factor analysis (CFA) indicated that fit of the two-factor model of the PHQ-4 scores was modest (χ2/df = .13/1 = .13, RMSEA = .001, SRMR = .002, CFI = 1.005, TLI = 1.000). Internal reliability was excellent (McDonald's omega = .86; Cronbach's alpha = .86). Indices suggested that configural, metric, and scalar invariance were supported across sex. No significant difference was found between males and females in terms of the PHQ-4 total scores, PHQ-4 anxiety scores, and PHQ-4 depression scores. The total score of the PHQ-4 and its depression and anxiety scores were significantly and moderately-to-strongly associated with lower wellbeing and higher Depression Anxiety and Stress Scale (DASS) total and subscales scores. CONCLUSION The PHQ-4 proves to be a reliable, valid, and cost-effective tool for assessing symptoms related to depression and anxiety. To evaluate the practical effectiveness of the Arabic PHQ-4 and to further enhance the data on its construct validity, future studies should assess the measure in diverse contexts and among specific populations.
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Affiliation(s)
- Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon.
| | - Ali Hemade
- Faculty of Medicine, Lebanese University, Hadat, Lebanon
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Jiale Xu
- School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, 311121, China
| | - Yiwei Ying
- School of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, 311121, China
| | - Chen Jiang
- School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, 311121, China
| | - Runtang Meng
- School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, 311121, China
- Engineering Research Center of Mobile Health Management System, Ministry of Education, Hangzhou, Zhejiang, 311121, China
| | - Feten Fekih-Romdhane
- Department of Psychiatry "Ibn Omrane", The Tunisian Center of Early Intervention in Psychosis, Razi Hospital, Manouba, 2010, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Psychology Department, College of Humanities, Effat University, Jeddah, 21478, Saudi Arabia.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
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Meng R, Jiang C, Dzierzewski JM, Zhu Y, Wang M, Yang N, Liu X, Guo L, Ping Y, Zhou C, Xu J, Zou W, Wang X, Lu L, Ma H, Luo Y, Spruyt K. Longitudinal measurement invariance and psychometric properties of the Patient Health Questionnaire-Four in China. BMC Psychiatry 2024; 24:517. [PMID: 39039478 PMCID: PMC11265176 DOI: 10.1186/s12888-024-05873-2] [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: 11/15/2023] [Accepted: 05/28/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Depression and anxiety symptoms among medical students are often a concern. The Patient Health Questionnaire-Four (PHQ-4), an important tool for depression and anxiety screening, is commonly used and easy to administer. This study aimed to assess and update the longitudinal measurement invariance and psychometric properties of the simplified Chinese version. METHODS A three-wave longitudinal survey was conducted among healthcare students using the PHQ-4. Structural validity was based on one-factor, two-factor, and second-order factor models, construct validity was based on the Self-Rated Health Questionnaire (SRHQ), Sleep Quality Questionnaire (SQQ), and Rosenberg Self-Esteem Scale (RSES), and longitudinal measurement invariance (LMI), internal consistency, and test-retest reliability were based on structural consistency across three time points. RESULTS The results of the confirmatory factor analysis indicated that two-factor model was the best fit, and LMI was supported at three time points. Inter-factor, factor-total, and construct validity correlations of the PHQ-4 were acceptable. Additionally, Cronbach's alpha, McDonald's omega, and the intraclass correlation coefficient demonstrated acceptable/moderate to excellent reliability of the PHQ-4. CONCLUSIONS This study adds new longitudinal evidence that the Chinese version of the PHQ-4 has promising LMI and psychometric properties. Such data lends confidence to the routine and the expanded use of the PHQ-4 for routine screening of depression and anxiety in Chinese healthcare students.
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Affiliation(s)
- Runtang Meng
- School of Public Health, Hangzhou Normal University, Hangzhou, 311121, Zhejiang, China.
- Engineering Research Center of Mobile Health Management System, Ministry of Education, Hangzhou, Zhejiang, China.
| | - Chen Jiang
- School of Public Health, Hangzhou Normal University, Hangzhou, 311121, Zhejiang, China
| | | | - Yihong Zhu
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Meng Wang
- Ophthalmology Center, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang, China
| | - Nongnong Yang
- School of Public Health, Hangzhou Normal University, Hangzhou, 311121, Zhejiang, China
| | - Xiaoxue Liu
- Global Health Research Division, Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Lina Guo
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yufan Ping
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Caojie Zhou
- School of Public Health, Hangzhou Normal University, Hangzhou, 311121, Zhejiang, China
| | - Jiale Xu
- School of Public Health, Hangzhou Normal University, Hangzhou, 311121, Zhejiang, China
| | - Wenjing Zou
- School of Public Health, Hangzhou Normal University, Hangzhou, 311121, Zhejiang, China
| | - Xiaowen Wang
- School of Public Health, Hangzhou Normal University, Hangzhou, 311121, Zhejiang, China
| | - Liping Lu
- School of Public Health, Hangzhou Normal University, Hangzhou, 311121, Zhejiang, China
| | - Haiyan Ma
- School of Public Health, Hangzhou Normal University, Hangzhou, 311121, Zhejiang, China
- Engineering Research Center of Mobile Health Management System, Ministry of Education, Hangzhou, Zhejiang, China
| | - Yi Luo
- School of Nursing, Ningbo College of Health Sciences, Ningbo, Zhejiang, China
| | - Karen Spruyt
- Université Paris Cité, NeuroDiderot, INSERM, Paris, France
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Moreno X, Moreno F. Factor structure and measurement invariance of the Patient Health Questionnaire-4 among the Chilean population. PLoS One 2024; 19:e0304623. [PMID: 38820399 PMCID: PMC11142508 DOI: 10.1371/journal.pone.0304623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/14/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND The PHQ-4 is an ultrabrief screening test for depression and anxiety symptoms. The psychometric properties of this test among the population in Chile are unknown. This study was aimed to determine the factor structure of the PHQ-4 in the adult population in Chile, and to assess its measurement invariance across different groups. METHODS The study considered a nationally representative sample of 10921 people aged 18 and above, in Chile in 2021. Exploratory and confirmatory factor analysis were conducted, and configural, metric, scalar, and strict measurement invariance were assessed. RESULTS The two-factor structure of the PHQ-4 supported the two underlying constructs of depression and anxiety. This model explained 67% of the variance and had excellent fit (CFI: 0.9999; TLI: 0.9994; RMSEA: 0.0107; SRMR: 0.0022). Strict measurement invariance held across gender, age, area of residence, household income quintile, immigrant or host population, and indigenous or non-indigenous population (ΔCFI<0.01). CONCLUSION The PHQ-4 can be used to assess depressive and anxiety symptoms in population studies, and as a screening test for depression and anxiety in public mental health programs in Chile.
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Affiliation(s)
- Ximena Moreno
- Facultad de Psicología y Humanidades, Universidad San Sebastián, Santiago, Chile
| | - Francisco Moreno
- Department of Mathematics and Computer Science, University of Santiago, Santiago, Chile
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Apputhurai P, Palsson OS, Bangdiwala SI, Sperber AD, Mikocka-Walus A, Knowles SR. Confirmatory validation of the patient health questionnaire - 4 (PHQ-4) for gastrointestinal disorders: A large-scale cross-sectional survey. J Psychosom Res 2024; 180:111654. [PMID: 38569449 DOI: 10.1016/j.jpsychores.2024.111654] [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: 02/11/2024] [Revised: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE Using the large Rome Foundation Global Epidemiology Survey dataset, the aim of this study was to evaluate the construct and convergent validity and internal consistency of the PHQ-4 across both gastrointestinal and non-gastrointestinal condition cohorts. Another aim was to provide descriptive information about the PHQ-4 including means, confidence intervals and percentage of caseness using a large representative sample. METHODS A cross-sectional survey was conducted in 26 countries. Confirmatory factor and internal consistency analyses were conducted across subsamples of patients with gastrointestinal conditions (i.e., disorders of gut-brain interaction [DGBI; any DGBI, individual DGBI, and DGBI region], gastroesophageal reflux disease (GERD), coeliac disease, diverticulitis, inflammatory bowel disease (IBD), cancer anywhere in the gastrointestinal tract, peptic ulcer) and those without a gastrointestinal condition. Convergent validity was also assessed via a series of Pearson's correlation coefficients with PROMIS (physical and mental quality of life), and PHQ-12 (somatisation). RESULTS Based on 54,127 participants (50.9% male; mean age 44.34 years) confirmatory factor analysis indicated acceptable to excellent model fits for the PHQ-4 across all subsamples and individual DGBI and DGBI region (Comparative Fit Index >0.950, Tucker-Lewis Index >0.950, Root Mean Squared Error of Approximation <0.05, and Standardised Root Mean Square Residual <0.05). The PHQ-4 was found to demonstrate convergent validity (Pearson's correlation coefficients >±0.4), and good internal consistency (Cronbach's α > 0.75). CONCLUSIONS This study provides evidence that the PHQ-4 is a valid and reliable tool for assessing mental health symptomology in both gastrointestinal and non-gastrointestinal cohorts.
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Affiliation(s)
- Pragalathan Apputhurai
- Department of Health Sciences and Biostatistics, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Olafur S Palsson
- Center for Functional GI & Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shrikant I Bangdiwala
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Ami D Sperber
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Simon R Knowles
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia.
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Adzrago D, Walker TJ, Williams F. Reliability and validity of the Patient Health Questionnaire-4 scale and its subscales of depression and anxiety among US adults based on nativity. BMC Psychiatry 2024; 24:213. [PMID: 38500115 PMCID: PMC10949792 DOI: 10.1186/s12888-024-05665-8] [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: 07/10/2023] [Accepted: 03/06/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The burdens of anxiety and depression symptoms have significantly increased in the general US population, especially during this COVID-19 epidemiological crisis. The first step in an effective treatment for anxiety and depression disorders is screening. The Patient Health Questionnaire-4 (PHQ-4, a 4-item measure of anxiety/depression) and its subscales (PHQ-2 [a 2-item measure of depression] and Generalized Anxiety Disorder [GAD-2, a 2-item measure of anxiety]) are brief but effective mass screening instruments for anxiety and depression symptoms in general populations. However, little to no study examined the psychometric properties (i.e., reliability and validity) of the PHQ-4 and its subscales (PHQ-2 and GAD-2) in the general US adult population or based on US nativity (i.e., foreign-born vs. the US-born). We evaluated the psychometric properties of the PHQ-4 and its subscales in US adults, as well as the psychometric equivalence of the PHQ-4 scale based on nativity. METHODS We conducted a cross-sectional survey of 5,140 adults aged ≥ 18 years. We examined the factorial validity and dimensionality of the PHQ-4 with confirmatory factor analysis (CFA). A multiple-group confirmatory factor analysis (MCFA) was used to evaluate the comparability of the PHQ-4 across nativity groups. Reliability indices were assessed. Also, the scales' construct validities were assessed by examining the associations of both the PHQ-4 and its subscales' scores with the sociodemographic characteristics and the 3-item UCLA Loneliness scale. RESULTS The internal consistencies were high for the PHQ-4 scale (α = 0.92) and its subscales of PHQ-2 (α = 0.86) and GAD-2 (α = 0.90). The CFA fit indices showed evidence for the two-factor structure of the PHQ-4. The two factors (i.e., anxiety and depression) were significantly correlated (r = 0.92). The MCFA demonstrated measurement invariance of the PHQ-4 across the nativity groups, but the model fits the data better in the foreign-born group. There were significant associations of the PHQ-4 scale and its subscales' scores with the sociodemographic characteristics and the UCLA Loneliness scale (all p < 0.001). CONCLUSIONS The PHQ-4 and its subscales are reliable and valid measures to screen anxiety and depression symptoms in the general US adult population, especially in foreign-born individuals during the COVID-19 pandemic.
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Affiliation(s)
- David Adzrago
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 11545 Rockville Pike, 20852, Rockville, MD, USA.
| | - Timothy J Walker
- Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 11545 Rockville Pike, 20852, Rockville, MD, USA.
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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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Havnen A, Lydersen S, Mandahl A, Lara-Cabrera ML. Factor structure of the patient health questionnaire-4 in adults with attention-deficit/hyperactivity disorder. Front Psychiatry 2023; 14:1176298. [PMID: 37520219 PMCID: PMC10375022 DOI: 10.3389/fpsyt.2023.1176298] [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: 02/28/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Background Persons with attention-deficit/hyperactivity disorder (ADHD) frequently experience symptoms of anxiety and depression. In this population, there is a need for validated brief self-report screening questionnaires to assess the severity of comorbid mental health problems. The Patient Health Questionnaire 4 (PHQ-4) is a self-report questionnaire that may contribute to this purpose as it can screen for both disorders efficiently. However, this will be the first study examining the factor structure of the PHQ-4 in samples of adults with ADHD, and also evaluating the validity of the Norwegian version of the PHQ-4. Objectives The aim of the current cross-sectional study was to examine the factor structure and validity of the Norwegian version of the PHQ-4 in a sample of adults who reported having been diagnosed with ADHD. Methods Of 496 invited, a total of 326 participants (66%) completed the PHQ-4, The World Health Organization Five Well-Being Index, the Oslo Social Support Scale and the 4-item Perceived Stress Scale electronically in a web-portal between the 9th and 30th of June 2020. Results Confirmatory factor analysis of the PHQ-4 supported a two-factor structure [RMSEA = 0.038 (90% CI 0.000-0.159), CFI = 1.00, TLI = 0.999, SRMR = 0.004], consisting of a depression factor and an anxiety factor. Standardized factor loadings were 0.79 to 0.97. The PHQ-4 was negatively correlated with well-being and social support and positively correlated with perceived level of stress. Conclusion This study indicates promising psychometric properties of the PHQ-4 as a measure of anxiety and depressive symptoms in adults with self-reported ADHD who are fluent in Norwegian. The questionnaire's brevity makes it a valuable resource in research and clinical settings. However, more studies are needed to test the instrument in a clinical sample.
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Affiliation(s)
- Audun Havnen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Nidaros Division of Psychiatry, Community Mental Health Centre, St. Olav’s University Hospital, Trondheim, Norway
| | - Stian Lydersen
- Faculty of Medicine and Health Sciences, Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arthur Mandahl
- Vårres Regional User-Led Center Central-Norway, Trondheim, Norway
| | - Mariela Loreto Lara-Cabrera
- Faculty of Medicine and Health Sciences, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Nidelv Division of Psychiatry, Community Mental Health Centre, St. Olav’s University Hospital, Trondheim, Norway
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Regalado D, Connolly ME, Krutsch K, Stark A, Kendall-Tackett K, Garner CD. Psychiatric medication use among pregnant and breastfeeding mothers who used cannabis for mental health concerns: A cross-sectional survey study. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231199391. [PMID: 37746858 PMCID: PMC10521288 DOI: 10.1177/17455057231199391] [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: 12/13/2022] [Revised: 08/12/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Use of cannabis during pregnancy and breastfeeding is increasing. Mental health concerns are reported as common reasons for maternal cannabis use, but little is known about the use of psychiatric medications in this population. OBJECTIVES This study aimed to describe psychiatric medication use among pregnant and breastfeeding mothers who used cannabis for mental health concerns. DESIGN Anonymous, online cross-sectional survey. METHODS Data were collected from May 2018 to August 2019 among pregnant and breastfeeding mothers who used cannabis. This study included mothers who reported cannabis use for mental health concerns (n = 1363). The survey assessed the timing of cannabis use (during pregnancy and/or lactation); use of cannabis to address depression, posttraumatic stress disorder, or anxiety; use of psychiatric medications; psychiatric distress (Patient Health Questionnaire-4); and demographic information. Differences between groups were examined using t-test and chi-square test in SPSS. RESULTS The mean age was 29.7 years; most were married (62%); 74% were White non-Hispanic, 9% Hispanic, and 17% Black, Indigenous or other People of Color. Mental health symptoms prompting cannabis use included anxiety (96%), depression (75%), and posttraumatic stress disorder (36%). Only 24% of respondents (n = 322) reported concomitant use of psychiatric medications, primarily selective serotonin reuptake inhibitors (72%, n = 232) and benzodiazepines (21%, n = 68). The composite Patient Health Questionnaire-4 showed most respondents had no (61%) or mild (27%) psychological distress; 14% screened positive for depression; and 17% screened positive for anxiety. Respondents who used psychiatric medications more often screened positive mental health concerns. CONCLUSION Most mothers who used cannabis for mental health concerns were not taking psychiatric medications. This may be due to a mismatch between perceived mental health and screening results, un- or under-treated mental illness, or preference for cannabis over psychiatric medications. Improved management of perinatal mental health and effective patient education about risks of cannabis versus medication use are needed.
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Affiliation(s)
- Diego Regalado
- School of Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Meghan E. Connolly
- School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Kaytlin Krutsch
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Amarillo, TX, USA
- InfantRisk Center, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Amy Stark
- Department of Psychiatry, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | | | - Christine D. Garner
- InfantRisk Center, Texas Tech University Health Sciences Center, Amarillo, TX, USA
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, TX, USA
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Hsu CY, Chen CL, Tsai LY, Tsai JM. Pregnancy-Related Stress Among Pregnant Women Receiving Tocolytic and Non-Tocolytic Treatments Where Both Used Complementary Medicine. Front Pharmacol 2022; 13:870659. [PMID: 35721134 PMCID: PMC9201384 DOI: 10.3389/fphar.2022.870659] [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: 02/07/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: This study aimed to compare the pregnancy stress among pregnant women in receiving tocolytic and non-tocolytic treatments where both used complementary medicine. Methods: A cross-sectional survey was conducted among 35 pregnant women receiving tocolytic treatment and 35 receiving non-tocolytic treatment, where both used complementary medicine in a medical center in central Taiwan. A basic information questionnaire that contained demographic variables and types of complementary medicine used and the Pregnancy Stress Rating Scale were used for the analysis. Results: The types of complementary medicines were surveyed using the multiple-choice questionnaire. Natural products (77.5%) were most commonly used by pregnant women receiving tocolytic treatment, followed by alternative medicine (13.75%), manipulative and body-based practices (5%), and mind and body medicine (3.75%). In pregnant women who were receiving non-tocolytic treatment, natural products (59.1%) were most commonly used, followed by manipulative and body-based practices (16.4%), alternative medicine (15.4%), mind and body medicine (7.3%), and energy therapy (1.8%). According to the analysis of covariance test results, while both used complementary medicine in groups, pregnant women receiving tocolytic treatment were less stressed than those who were receiving non-tocolytic treatment (Pregnancy Stress Rating Scale score, p = 0.038), especially in dimension 2 (stress caused by infant care and changes in family relationships) (p = 0.015) and dimension 5 (stress caused by changes in physical appearance and function) (p = 0.008), which showed statistically significant differences (p < 0.05). Linear regression analysis results showed that the gestational age significantly associated with pregnancy stress (Pregnancy Stress Rating Scale score, p = 0.029; dimension 2, p = 0.016; and dimension 5, p = 0.001). Conclusion: Among both who used complementary medicine, pregnancy stress was significantly lower in pregnant women who were receiving tocolytic treatment than in those who were receiving non-tocolytic treatment. This finding can be used as a reference for future pregnant women’s health studies.
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Affiliation(s)
- Chen-Yuan Hsu
- College of Nursing and Health Sciences, Dayeh University, Dacun, Taiwan
| | - Ching-Li Chen
- College of Nursing and Health Sciences, Dayeh University, Dacun, Taiwan.,Taichung Veterans General Hospital, Taichung, Taiwan
| | - Li-Yun Tsai
- College of Nursing and Health Sciences, Dayeh University, Dacun, Taiwan
| | - Jung-Mei Tsai
- College of Nursing and Health Sciences, Dayeh University, Dacun, Taiwan.,Mackay Memorial Hospital, Taipei, Taiwan.,Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.,Department of Nursing, Mackay Medical College, New Taipei, Taiwan
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Declercq E, Feinberg E, Belanoff C. Racial inequities in the course of treating perinatal mental health challenges: Results from listening to mothers in California. Birth 2022; 49:132-140. [PMID: 34459012 PMCID: PMC9292331 DOI: 10.1111/birt.12584] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Concern with depression during the perinatal period has resulted in multiple states enacting legislation to require universal screening of mothers for postpartum depression. Despite this concern, rates of women receiving mental health counseling during pregnancy and postpartum remain low. This study examines factors, especially inequities in race/ethnicity, associated with receiving perinatal mental health counseling. METHODS This study draws on data from the Listening to Mothers in California survey of 2539 women, based on a representative sample of birth certificate files of women who gave birth in 2016. The survey included a series of mental health questions, based on the 4-item Patient Health Questionnaire (PHQ-4), and questions on the receipt of counseling, whether a practitioner asked respondents about their mental health, and whether the respondent was taking medications for anxiety or depression. RESULTS We found non-Latina Black women to experience both higher rates of prenatal depressive symptoms and significantly lower use of postpartum counseling services and medications than non-Latina White women. Among women with depressive symptoms, those asked by a practitioner about their mental health status reported a 46% rate of counseling compared with 20% who were not asked, and in a multivariable analysis, those asked were almost six times more likely (aOR 5.96; 95% CI 1.6-21.7) to report counseling. DISCUSSION These findings lend evidence to those advocating for state laws requiring universal screening for depressive symptoms to reduce inequities and help address the underuse of counseling services among all women with depressive symptoms, particularly women of color.
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Affiliation(s)
| | - Emily Feinberg
- Division of General PediatricsBoston University School of MedicineBostonMAUSA
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11
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The Effect of Physical Activity on Body Constitution and Psychological Health in Older Adults: Evidence From an Analysis of a Biobank Research Database. J Aging Phys Act 2022; 31:465-473. [DOI: 10.1123/japa.2022-0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/09/2022] [Accepted: 09/02/2022] [Indexed: 11/22/2022]
Abstract
This study aims to describe the relationship between physical activity, suboptimal health status based on traditional Chinese medicine, and psychological health in older people in Taiwan. A total of 4,497 older individuals were selected from the Taiwan Biobank Research Database. Suboptimal health status was assessed using a body constitution questionnaire to measure yang deficiency, yin deficiency, and stasis. The results showed that older adults involved in physical activity had a lower likelihood of yang/yin deficiency and stasis constitutions than physically inactive people. Participants with yang deficiency or stasis constitutions had a higher likelihood of poor psychological health, whereas those with yin deficiency had a greater likelihood of depression. People involved in physical activity had a lower likelihood of depression than physically inactive people. Compared with male older adults, females had a lower percentage of physical activity habits, poorer body constitutions, and poorer psychological health.
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12
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Kim S, Hernández-Díaz S, Zhu Y, Wyszynski D, Huybrechts KF. Association between SARS-CoV-2 infection during pregnancy and postpartum depressive and anxiety symptoms: finding from the International Registry of Coronavirus Exposure in Pregnancy (IRCEP) study. Arch Womens Ment Health 2022; 25:1105-1118. [PMID: 36301380 PMCID: PMC9610338 DOI: 10.1007/s00737-022-01274-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/19/2022] [Indexed: 12/25/2022]
Abstract
While there has been concern over the perinatal mental health implications of the COVID-19 outbreak, evidence on the risk of postpartum depression and anxiety following SARS-CoV-2 infection is limited. We studied this question using the International Registry of Coronavirus Exposure in Pregnancy, which included both a prospective and retrospective cohort. Study participants were required to have been tested for SARS-CoV-2 between the date of last menstrual period and delivery. The exposure of interest was SARS-CoV-2 infection during pregnancy, as well as COVID-19 severity (severe, moderate, mild, and asymptomatic). The outcome was postpartum depression and anxiety symptoms, assessed by the 4-item Patient Health Questionnaire. The final analytic cohort consisted of 3819 participants (COVID-19 positive: 771; COVID-19 negative: 3048). After adjusting for confounding by socio-demographics, prior obstetric and maternal health comorbidities, mothers with severe COVID-19 had an increased risk of depressive (aRR: 1.72; 95%CI: 1.18-2.52) and anxiety (aRR: 1.40; 0.98-2.00) symptoms. The strength of the association was attenuated for women with moderate COVID-19 (aRR = 1.12; 0.86-1.44 for depressive symptoms; aRR = 1.18; 0.96-1.44 for anxiety symptoms). No increased risk was observed for mild or asymptomatic illness. The findings can inform targeted interventions to minimize the risk of adverse COVID-19-related mental health outcomes for pregnant women.
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Affiliation(s)
- Sonia Kim
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Sonia Hernández-Díaz
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Yanmin Zhu
- Division of Pharmacoepidemiology & Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | | | - Krista F. Huybrechts
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA ,Division of Pharmacoepidemiology & Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
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Cervera-Torres S, Ruiz-Fernández S, Godbersen H, Massó L, Martínez-Rubio D, Pintado-Cucarella S, Baños RM. Influence of Resilience and Optimism on Distress and Intention to Self-Isolate: Contrasting Lower and Higher COVID-19 Illness Risk Samples From an Extended Health Belief Model. Front Psychol 2021; 12:662395. [PMID: 34108919 PMCID: PMC8180876 DOI: 10.3389/fpsyg.2021.662395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022] Open
Abstract
The study investigated the influence of resilience and dispositional optimism on, first, emotional distress and, second, the intention to self-isolate, experienced by people with a lower and higher illness risk, during the lockdown imposed in Spain during the first COVID-19 wave. These effects were investigated against the background of the Health Belief Model (HBM). A convenience sample of N = 325 participants completed an online survey including an ad-hoc questionnaire measuring the HBM core factors: Perceived health threat (susceptibility and severity of getting infected), and perceived quarantine benefits and costs. Self-efficacy and perceived social pressure were also measured. Based on reviews regarding pandemic outbreaks, quarantine benefits were conceptualized as the perceived effectiveness and solidary contribution of self-isolating in line with the quarantine protocols. Quarantine “psychosocial” costs were conceptualized as a composite of perceived boredom, loneliness, and economic concerns. Findings revealed an asymmetrical pattern of results so that (i) people at higher risk were more distressed by the perceived severity of getting infected whereas people at lower risk were more distressed by the psychosocial costs. Moreover, (ii) resilience and optimism were more “protective” against distress within the lower and higher risk groups, respectively. In addition, (iii) quarantine benefits and self-efficacy promoted the intention to self-isolate within both groups. However, (iv) optimism hindered such intention. This finding is discussed in the light of links between dispositional optimism and optimistic bias; the underestimation of experiencing negative events, which can relax the perceived health risk. Based on these findings, communication campaigns should prioritize information about the effectiveness of the implemented preventive behaviors rather than the costs of not implementing them, and be cautionary in encouraging excessive optimism.
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Affiliation(s)
- Sergio Cervera-Torres
- Department Multimodal Interaction Lab, Leibniz-Institut für Wissensmedien (IWM), Tübingen, Germany.,Department of Psychology, Valencian International University (VIU), Valencia, Spain.,LEAD Research Network, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Susana Ruiz-Fernández
- Department Multimodal Interaction Lab, Leibniz-Institut für Wissensmedien (IWM), Tübingen, Germany.,LEAD Research Network, Eberhard Karls University of Tübingen, Tübingen, Germany.,FOM Hochschule für Oekonomie and Management, Essen, Germany
| | | | - Lena Massó
- Department of Psychology, Valencian International University (VIU), Valencia, Spain
| | - David Martínez-Rubio
- Psicoforma, Psychology Center, Valencia, Spain.,Department of Psychology, Faculty of Health Sciences, Universidad Europea de Valencia, Valencia, Spain
| | - Sheila Pintado-Cucarella
- Department of Psychology, Valencian International University (VIU), Valencia, Spain.,Department of Psychology, Universidad de las Américas, Puebla, Mexico
| | - Rosa M Baños
- Department of Personality, Evaluation and Psychological Treatment, Universidad de Valencia, Valencia, Spain.,Centro de Investigación Biomédica en Red of Physiopathology of Obesity and Nutrition, Madrid, Spain
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