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Fukase R, Murakami M, Ikeda T. Leaflet information by the local government on mental health during the coronavirus disease 2019 pandemic: a cross-sectional study in a rural area in Japan. Fam Pract 2023:7174234. [PMID: 37208306 DOI: 10.1093/fampra/cmad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic and associated infodemic increased depression and anxiety. Proper information can help combat the infodemic and promotes mental health; however, rural residents have more difficulties in getting correct information than urban residents. OBJECTIVE To examine whether the information on COVID-19 provided by the local government maintained the mental health of rural residents in Japan. METHODS A self-administered questionnaire survey of Okura Village (northern district of Japan) residents aged ≥16 years was conducted in October 2021. The main outcomes, depressive symptoms, psychological distress, and anxiety were measured using the Center for Epidemiologic Studies Depression Scale, Kessler Psychological Distress Scale, and Generalized Anxiety Disorder scale 7-item. Exposure was defined as whether the resident read the leaflet on COVID-19 distributed by the local government. The targeted maximum likelihood estimation was used to analyse the effect of leaflet reading on the main outcomes. RESULTS A total of 974 respondents were analysed. Reading the leaflet was significantly lower risk for depressive symptoms relative risk (95% confidence interval): 0.64 (0.43-0.95). Meanwhile, no clear effects of leaflet reading were observed on mental distress and anxiety. CONCLUSIONS In rural areas with local governments, analogue information may be effective to prevent depression.
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Affiliation(s)
- Ryu Fukase
- Department of Internal Medicine (General Medicine), Yamagata Prefectural Kahoku Hospital, Yamagata, Japan
- Department of Health Policy Science, Graduate School of Medical Science, Yamagata University, Yamagata, Japan
| | - Masayasu Murakami
- Department of Health Policy Science, Graduate School of Medical Science, Yamagata University, Yamagata, Japan
| | - Takaaki Ikeda
- Department of Health Policy Science, Graduate School of Medical Science, Yamagata University, Yamagata, Japan
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Bandurska E. The Voice of Patients Really Matters: Using Patient-Reported Outcomes and Experiences Measures to Assess Effectiveness of Home-Based Integrated Care-A Scoping Review of Practice. Healthcare (Basel) 2022; 11:healthcare11010098. [PMID: 36611558 PMCID: PMC9819009 DOI: 10.3390/healthcare11010098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022] Open
Abstract
Background: The aim of the study is to analyze the prevalence of using patients’ reported outcomes measures and experiences (PROMs and PREMs) in relation to integrated care (IC). Material and methods: To select eligible studies (<10 years, full-text), PubMed was used. The general subject of the articles referring to the type of disease was indicated on the basis of a review of all full-text publications discussing the effectiveness of IC (N = 6518). The final search included MeSH headings related to outcomes measures and IC. Full-text screening resulted in including 73 articles (23 on COPD, 40 on diabetes/obesity and 10 on depression) with 93.391 participants. Results: Analysis indicated that authors used multiple outcome measures, with 54.8% of studies including at least one patient reported. PROMs were more often used than PREMs. Specific (disease or condition/dimension) outcome measures were reported more often than general, especially those dedicated to self-assessment of health in COPD and depression. PROMs and PREMs were most commonly used in studies from the USA and Netherlands. Conclusion: Using PROMS/PREMS is becoming more popular, although it is varied, both due to the place of research and type of disease.
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Affiliation(s)
- Ewa Bandurska
- Center for Competence Development, Integrated Care and e-Health, Medical University of Gdańsk, Debowa 30, 80-208 Gdansk, Poland
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3
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Brygger Venø L, Jarbøl DE, Ertmann RK, Søndergaard J, Pedersen LB. Barriers to assessing vulnerability in pregnant women. A cross-sectional survey in Danish general practice. Fam Pract 2022:cmac134. [PMID: 36420813 DOI: 10.1093/fampra/cmac134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Undetected vulnerability in pregnancy contributes to inequality in maternal and perinatal health and is associated with negative birth outcomes and adverse child outcomes. Nationwide reports indicate important barriers to assessing vulnerability among Danish general practitioners. OBJECTIVE To explore general practitioners perceived barriers to vulnerability assessment in pregnant women and whether the barriers are associated with practice organization of antenatal care, general practitioner, and practice characteristics. METHODS The questionnaire was sent to all Danish general practitioners (N = 3,465). Descriptive statistics described the barriers to assessing vulnerability in pregnant women. Analytical statistics with ordered logistic regression models were used to describe the association between selected barriers to vulnerability assessment and antenatal care organization, and general practitioner and practice characteristics. RESULTS 760 general practitioners (22%) answered. Barriers to vulnerability assessment were related to lacking routines for addressing vulnerability, lacking attention to and record-keeping on vulnerability indicators, an insufficient overview of vulnerable pregnant women, and perceived insufficient remuneration for antenatal care consultations. Not prioritizing extra time when caring for vulnerable pregnant women was associated with experiencing more barriers. Always prioritizing continuity of care was associated with experiencing fewer barriers. General practitioners of either young age, male gender, or who did not prioritize extra time to care for vulnerable pregnant women experienced more barriers. CONCLUSION Barriers to vulnerability assessment among pregnant women do exist in general practice and are associated with organizational characteristics such as lacking prioritization of extra time and continuity in antenatal care consultations. Also, general practitioner characteristics like male gender and relatively young age are associated with barriers to vulnerability assessment.
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Affiliation(s)
- Louise Brygger Venø
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ruth Kirk Ertmann
- Research Unit of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Line Bjørnskov Pedersen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- DaCHE, Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Treharne GJ, Carroll R, Tan KKH, Veale JF. Supportive interactions with primary care doctors are associated with better mental health among transgender people: results of a nationwide survey in Aotearoa/New Zealand. Fam Pract 2022; 39:834-842. [PMID: 35259758 PMCID: PMC9508874 DOI: 10.1093/fampra/cmac005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Past research has established that transgender people experience significant disparities in mental health outcomes and healthcare dissatisfaction compared with cisgender people, but more research is needed on how supportive healthcare interactions relate to the mental health of transgender people. OBJECTIVES The 2 main aims of our analyses were: (i) to establish the most common negative experiences in healthcare and the most common supportive experiences specifically with primary care doctors for transgender people; and (ii) to examine the association of supportive experiences with mental health variables after controlling for demographic factors. METHODS Data from the 2018 Counting Ourselves nationwide survey of transgender people were analysed using regression modelling. The 948 participants with a primary care doctor or general practitioner were included in analyses. Participants were aged 14-83 years old (mean 30.20). RESULTS The most common supportive experiences involved primary care doctors treating transgender people equitably, with competence, and with respect. Participants with more negative healthcare experiences had higher psychological distress as well as higher likelihood of reporting nonsuicidal self-injury and suicidality. Conversely, participants with more experiences of supportive primary care doctors had lower psychological distress and were less likely to have attempted suicide in the past 12 months. CONCLUSION When transgender people receive supportive care from their primary care providers they experience better mental health, despite ongoing negative healthcare experiences. Future research is needed to confirm ways of supporting positive trajectories of mental health for transgender people but these findings demonstrate the importance of positive aspects of care.
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Affiliation(s)
- Gareth J Treharne
- Department of Psychology, University of Otago, Dunedin, Aotearoa, New Zealand
| | - Rona Carroll
- Department of Primary Health Care and General Practice, University of Otago, Wellington, Aotearoa, New Zealand
| | - Kyle K H Tan
- Trans Health Research Lab, School of Psychology, University of Waikato, Hamilton, Aotearoa, New Zealand
| | - Jaimie F Veale
- Trans Health Research Lab, School of Psychology, University of Waikato, Hamilton, Aotearoa, New Zealand
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Miroševič Š, Klemenc-Ketiš Z, Selič P. The 14-item Resilience scale as a potential screening tool for depression/anxiety and quality of life assessment: a systematic review of current research. Fam Pract 2019; 36:262-268. [PMID: 30165643 DOI: 10.1093/fampra/cmy081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Due to the expensive and time-consuming diagnostics, most general physicians do not use a standardized psychodiagnostic tool to detect depression and anxiety and often rely on their own judgment. This often leads to inaccuracy of identification of patients with mental disorders. OBJECTIVE To systematically review the literature of the 14-item resilience scale (RS-14) and offer directions for future studies. METHODS Fourteen studies that included a translated/validated RS-14 regardless of the sample were included through Medline and CINAHL databases and the following questions were addressed: (i) What are the factor structure, internal consistency and repeatability of the RS-14? (ii) Is RS-14 concordant with other scales for measuring resilience, and what is the concurrent validity of this instrument? (iii) What are the critiques, conclusions and limitations of previous studies? RESULTS Most factor analyses demonstrated a one-factor solution and confirmed 14-item scale. Cronbach's α for was high (M = 0.88); the test-retest reliability was satisfactory in three (0.70 < r > 0.83) out of four studies (r = 0.49). Results of concurrent validity showed positive correlation with some variables, including quality of life and a negative correlation with depression and anxiety. Among other limitations, the biggest drawback was a non-representative sample. CONCLUSIONS RS-14 was found to perform well in clinical and non-clinical sample. Due to its wide use of population, time efficiency and good results on concurrent validity, we suggest future studies to examine whether RS-14 has a potential to serve as a first distress and quality of life screening tool in the family medicine practices.
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Affiliation(s)
- Špela Miroševič
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip, Ljubljana, Slovenia
| | - Zalika Klemenc-Ketiš
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip, Ljubljana, Slovenia.,Department of Family Medicine, Faculty of Medicine, University of Maribor, Taborska, Maribor, Slovenia.,Community Health Centre Ljubljana, Metelkova, Ljubljana, Slovenia
| | - Polona Selič
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip, Ljubljana, Slovenia
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Iglesias-González M, Aznar-Lou I, Gil-Girbau M, Moreno-Peral P, Peñarrubia-María MT, Rubio-Valera M, Serrano-Blanco A. Comparing watchful waiting with antidepressants for the management of subclinical depression symptoms to mild-moderate depression in primary care: a systematic review. Fam Pract 2017; 34:639-648. [PMID: 28985309 DOI: 10.1093/fampra/cmx054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background The benefits of watchful waiting (WW) over antidepressants (ADs) for the treatment of depression in primary care (PC) are unclear. Objective We aimed to systematically review the evidence supporting either WW or ADs for the treatment of subclinical depressive symptoms and mild-moderate depression in a PC setting. Methods This systematic review was registered at PROSPERO (42016036345). Four electronic sources (EMBASE, PubMed, PsycINFO, Web of Knowledge) were systematically searched from inception to November 2016 for controlled trials comparing WW and ADs in PC following established guidelines. The studies had to include adult population with new symptoms of subclinical depression or mild-moderate depression. Patients in the intervention group should receive a WW approach, while patients in the control group underwent treatment with ADs. The abstraction form included information on the setting, characteristics of the study population, total sample size, size of the control and intervention groups and date of the study. Outcome measures and variability were extracted. Results The scarcity of studies and the considerable clinical and methodological heterogeneity discouraged us from performing a meta-analysis. Three articles were included and qualitatively synthesized. There was no evidence for the superiority of one treatment option over the other, although two of the studies suggested small differences in favour of ADs when less conservative analyses were conducted (per protocol analysis and analysis not adjusted for missingness predictors). Conclusions Superiority was not demonstrated by either treatment option. More robust evidence is needed to inform recommendations for the management of depressive symptoms in PC.
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Affiliation(s)
- Maria Iglesias-González
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
| | - Ignacio Aznar-Lou
- Institut de Recerca Sant Joan de Déu, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Madrid, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - Montse Gil-Girbau
- Institut de Recerca Sant Joan de Déu, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Madrid, Spain
- School of Pharmacy, University of Barcelona, Barcelona, Spain
- Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain
| | - Patricia Moreno-Peral
- Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain
- Unidad de Investigación del Distrito Sanitario de Atención Primaria Málaga-Guadalhorce, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - M Teresa Peñarrubia-María
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
- Idiap Jordi Gol i Gurina, Institut Català de la Salut (ICS), Catalonia, Spain
| | - Maria Rubio-Valera
- Institut de Recerca Sant Joan de Déu, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Madrid, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
- School of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Antoni Serrano-Blanco
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
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Borsje P, Hems MAP, Lucassen PLBJ, Bor H, Koopmans RTCM, Pot AM. Psychological distress in informal caregivers of patients with dementia in primary care: course and determinants. Fam Pract 2016; 33:374-81. [PMID: 26969508 DOI: 10.1093/fampra/cmw009] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The course of psychological distress in informal caregivers of patients with dementia has been investigated in longitudinal studies with conflicting outcomes. OBJECTIVES We investigated the course and determinants of psychological distress in informal caregivers of patients with dementia in primary care. METHODS In this prospective observational cohort study, data were collected at baseline, after 9 and 18 months. We assessed cognition and neuropsychiatric symptoms (NPS) of the patient (Mini-Mental State Examination and Neuropsychiatric Inventory) and psychological distress (Sense of Competence Questionnaire, Center for Epidemiological Studies Depression scale and General Health Questionnaire 12-tem version) of the informal caregivers. Determinants for the course of psychological distress were caregivers' age, gender and relationship with the patient, patients' cognition and NPS, participation in a care program and admission to long-term care facilities (LTCF). With linear mixed models, the course over time for psychological distress and its determinants were explored. RESULTS We included 117 informal caregivers, of whom 23.1% had a high risk for depression and 41.0% were identified to be likely to have mental problems at baseline. We found a stable pattern of psychological distress over time. Higher frequency of NPS, informal caregivers' age between 50 and 70 years and being female or spouse were associated with higher psychological distress. For patients who were admitted to a LTCF during the study psychological distress of the informal caregivers improved. CONCLUSIONS GPs should focus on NPS in patients with dementia and on caregivers' psychological distress and be aware of their risk for depression and mental problems, specifically to those who are spouse, female or between 50 and 70 years of age.
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Affiliation(s)
- Petra Borsje
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health and Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands, Thebe, Region South-East, Goirle, The Netherlands,
| | - Marleen A P Hems
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health and
| | - Peter L B J Lucassen
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health and
| | - Hans Bor
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health and
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health and Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands, Joachim end Anna, Centre for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Anne Margriet Pot
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands and School of Psychology, The University of Queensland, St Lucia, Australia
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Carey M, Yoong SL, Grady A, Bryant J, Jayakody A, Sanson-Fisher R, Inder KJ. Unassisted detection of depression by GPs: who is most likely to be misclassified? Fam Pract 2015; 32:282-7. [PMID: 25722482 DOI: 10.1093/fampra/cmu087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Meta-analyses indicate 50% of cases of depression are not detected by GPs. It is important to examine patient and GP characteristics associated with misclassification so that systems can be improved to increase accurate detection and optimal management for groups at risk of depression. OBJECTIVE To examine patient and GP characteristics associated with GP misclassification of depression for patients classified by the Patient Health Questionnaire-9 as depressed. METHODS A cross-sectional study within general practices in two states of Australia. GPs completed a one-page paper and pencil survey indicating whether they thought each patient was clinically depressed. Patients completed a computer tablet survey while waiting for their appointment to provide demographic information and indicate depression status. Chi-square analyses were used to determine whether patient and GP characteristics were associated with a false-negative and false-positive result. The probability of misclassification was modelled using Generalized Estimating Equations to account for clustering of patients. RESULTS Fifty GPs from 12 practices participated. GPs completed surveys for 1880 patients. Younger patients aged 25-44, and those with a health care card were less likely to have a false-negative assessment. Patients with 0-3 GP visits in the past 12 months, and those with private health insurance were less likely to have a false-positive assessment. GPs who worked five sessions or fewer per week were more likely to make false-positive assessments.
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Affiliation(s)
- Mariko Carey
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, Hunter Medical Research Institute, New Lambton Heights,
| | | | - Alice Grady
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, Hunter Medical Research Institute, New Lambton Heights
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, Hunter Medical Research Institute, New Lambton Heights
| | - Amanda Jayakody
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, Hunter Medical Research Institute, New Lambton Heights
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, Hunter Medical Research Institute, New Lambton Heights
| | - Kerry J Inder
- Hunter Medical Research Institute, New Lambton Heights, NHMRC Centre for Research Excellence in Mental Health and Substance Use, Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, Australia
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9
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Carey M, Jones KA, Yoong SL, D'Este C, Boyes AW, Paul C, Inder KJ, Sanson-Fisher R. Comparison of a single self-assessment item with the PHQ-9 for detecting depression in general practice. Fam Pract 2014; 31:483-489. [PMID: 24839267 DOI: 10.1093/fampra/cmu018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Several factors need to be considered when selecting a screening tool for depression including accuracy, level of burden for patients and for staff to administer and follow-up. OBJECTIVE This study aimed to explore the utility of a single self-assessment item in identifying possible cases of depression in primary care by examining sensitivity and specificity with the nine-item Patient Health Questionnaire (PHQ-9) at different thresholds. DESIGN Cross-sectional survey presented on a touchscreen computer. PARTICIPANTS Adult patients attending 12 urban general practices in Australia completed a health status questionnaire (n = 1004). MAIN MEASURES Depression was assessed by the PHQ-9 and a single self-assessment item. Sensitivity, specificity, and positive and negative predictive values were calculated for the single item using a PHQ-9 score of 10 or more as the criterion value. KEY RESULTS A total of 1004 participants (61% female, 48% aged 55 years or older) completed both the PHQ-9 and a single self-assessment item. When using a threshold of mild depression or greater, the single item had adequate specificity (76%, 95% CI: 71-80%), with 76 out of every 100 people defined as non-depressed by the PHQ-9 also identified as not depressed by the single item. Sensitivity was high (91%, 95% CI: 84-95%), with the single item identifying 91 out of every 100 true cases (as defined by the PHQ-9). CONCLUSIONS The single self-assessment item has high sensitivity and moderate specificity to identify possible cases of depression when used at a threshold of mild depression or greater.
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Affiliation(s)
- Mariko Carey
- Priority Research Centre for Health Behaviour (PRCHB), University of Newcastle, Callaghan, New South Wales, Australia, Hunter Medical Research Institute, New Lambton, New South Wales, Australia,
| | - Kimberley A Jones
- Priority Research Centre for Health Behaviour (PRCHB), University of Newcastle, Callaghan, New South Wales, Australia, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Sze Lin Yoong
- Priority Research Centre for Health Behaviour (PRCHB), University of Newcastle, Callaghan, New South Wales, Australia, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia and
| | - Allison W Boyes
- Priority Research Centre for Health Behaviour (PRCHB), University of Newcastle, Callaghan, New South Wales, Australia, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Christine Paul
- Priority Research Centre for Health Behaviour (PRCHB), University of Newcastle, Callaghan, New South Wales, Australia, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Kerry J Inder
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia, NHMRC Centre for Research Excellence in Mental Health and Substance Use, Centre for Translational Neuroscience and Mental Health, University of Newcastle, New South Wales, Australia
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour (PRCHB), University of Newcastle, Callaghan, New South Wales, Australia, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
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Jenkinson CE, Winder RE, Sugg HVR, Roberts MJ, Ridgway N, Kuyken W, Wiles N, Kessler D, Campbell J. Why do GPs exclude patients from participating in research? An exploration of adherence to and divergence from trial criteria. Fam Pract 2014; 31:364-70. [PMID: 24621557 DOI: 10.1093/fampra/cmu005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The role of GPs in recruiting or excluding participants critically underpins the feasibility, external validity and generalizability of primary care research. A better understanding of this role is needed. AIM To investigate why GPs excluded potentially eligible participants from a large scale randomized controlled trial (RCT), to determine the proportion of patients excluded on account of trial eligibility compared with other reasons, and to explore the impact of such exclusions on the management and generalizability of RCTs. DESIGN AND SETTING Secondary analysis of data from the CoBalT study, a multi-centre general-practice-based RCT investigating cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression. METHOD GPs were asked to screen patient lists generated from computerized record searches for trial eligibility and to provide narrative reasons for excluding patients. These reasons were coded independently by two researchers, with a third researcher resolving discrepancies. RESULTS Thirty-one percent (4750/15,379) of patients were excluded at the GP screening stage, including 663 on patient lists that remained unscreened. Of the 4087 actively excluded patients, 67% were excluded on account of trial exclusion criteria, 20% for other criteria (half of which were comorbid conditions) and 13% without reason. CONCLUSION Clear, comprehensive criteria, particularly with regards to comorbidities, are required for GPs to confidently screen patients for potential participation in research. Future studies should promote inclusivity and encourage GPs to adopt a liberal approach when screening patient lists. This would enhance the validity and generalizability of primary care research and encourage greater patient autonomy.
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Affiliation(s)
- Caroline E Jenkinson
- Primary Care Research Group, University of Exeter Medical School, Smeall Building, St Luke's Campus, Exeter, EX1 2LU,
| | - Rachel E Winder
- Primary Care Research Group, University of Exeter Medical School, Smeall Building, St Luke's Campus, Exeter, EX1 2LU
| | - Holly V R Sugg
- Mood Disorders Centre, Washington Singer Laboratories, University of Exeter, Exeter, EX4 4QG
| | - Martin J Roberts
- Collaboration for the Advancement of Medical Education Research, Assessment, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, PL4 8AA
| | - Nicola Ridgway
- Academic Unit of Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, G12 0XH, UK, TEKS, Les Toits Blancs, 23 Rue du Praya, 05100 Montgenevre, France and
| | - Willem Kuyken
- Mood Disorders Centre, Washington Singer Laboratories, University of Exeter, Exeter, EX4 4QG
| | - Nicola Wiles
- School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 2BN, UK
| | - David Kessler
- School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 2BN, UK
| | - John Campbell
- Primary Care Research Group, University of Exeter Medical School, Smeall Building, St Luke's Campus, Exeter, EX1 2LU
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