Screening Tool For Depression Research Articles

Managing Depression at a Free Clinic: A Pilot Study Using a Provider Survey

Introduction Community-based free clinics face unique challenges in treating depression. This research letter presents initial findings from an exploratory, in-progress study aimed at understanding barriers to depression care at a free clinic in South Florida. Methods A survey was distributed to primary care providers at the clinic that assessed barriers to depression care and ways to mitigate them. Results Nine of twelve providers responded. Providers felt confident using screening tools for depression but did not feel as confident about screening workflows. Providers felt more comfortable managing patients’ existing antidepressants versus prescribing new antidepressants. The most significant barriers providers faced in managing depression were (1) Patients’ social determinants of health, (2) Lack of outside referral options, and (3) Lack of in-house mental health resources. They indicated the most helpful improvement the clinic could make for depression services would be having an in-house social worker/licensed clinical therapist. Discussion Initial findings show that providers at this free clinic are confident in their ability to screen and treat depression, but factors including unclear workflows, inconsistent patient follow-up, and lack of referral options make it challenging to manage depression in this setting. Conclusion Initial findings of this pilot study suggest that procedural and situational barriers, not provider knowledge or willingness, limit the treatment of depression in this free clinic. An ongoing second phase of this study is surveying clinic patients to understand patient-facing barriers to mental health care in this setting.

Whānau Āwhina Plunket nurses' views on the use of the PHQ-3 postnatal depression screening tool: a survey.

Introduction In New Zealand, nurses visiting families postnatally use the Patient Health Questionnaire-3 (PHQ-3) to screen and detect postnatal depression. Exploring nurses' perception of the tool when using it with women across cultures is central to ensuring the PHQ-3 tool supports equitable screening and detection of postnatal depression, yet little is known about nurses' confidence with, and use of, the tool with people of differing cultures. Aim The aim of this study was to understand nurses' confidence in using the PHQ-3 to screen for postnatal depression, particularly its use cross-culturally. Methods Quantitative online survey research was carried out in 2019. Fifty-two percent of eligible registered nurses participated (n = 187), completing Likert scale responses and open questions about the use of the screening tool with specific groups, and barriers and facilitators to screening. Results Ninety-five percent of participants were confident in their use of the PQH-3, 70% of nurses agreed the PHQ-3 supports the identification of postnatal depression, and most respondents (54.5%) disagreed that the PHQ-3 was a good screening tool cross-culturally. Discussion Nurses were confident in their use of the PHQ-3, and it was relatively highly regarded in its ability to detect postnatal depression. However, less confidence in its use across cultures implies the PHQ-3 does not translate to evidence-based, cross-cultural care. To serve culturally diverse populations, consultation is needed on both languages used and cultural practices so that tools are appropriate, otherwise they cannot be validated for use cross-culturally.

Comparing depression screening tools (CESD-10, EPDS, PHQ-9, and PHQ-2) for diagnostic performance and epidemiologic associations among postpartum Kenyan women: Implications for research and practice

BackgroundIdentifying optimal depression screening tools for use in maternal health clinics could improve maternal and infant health. We compared four tools for diagnostic performance and epidemiologic associations. MethodsThis study was nested in a cluster-randomized trial in Kenya. Women in 20 maternal health clinics were evaluated at 6 weeks postpartum with Center for Epidemiologic Studies Depression Scale (CESD-10), Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 and -2 (PHQ-9, PHQ-2) for moderate-to-severe depressive symptoms (MSD) [CESD-10 ≥ 10, EPDS≥13, PHQ-9 ≥ 10, or PHQ-2 ≥ 3]. We assessed area under the curve (AUC) per scale (CESD-10, EPDS) against probable major depressive disorder (MDD) using the PHQ-9 scoring algorithm. Associations between MSD and intimate partner violence (IPV) were compared between scales. ResultsAmong 3605 women, median age was 24 and 10 % experienced IPV. Prevalence of MSD symptoms varied by tool: 13 % CESD-10, 9 % EPDS, 5 % PHQ-2, 3 % PHQ-9. Compared to probable MDD, the CESD-10 (AUC:0.82) had higher AUC than the EPDS (AUC:0.75). IPV was associated with MSD using all scales: EPDS (RR:2.5, 95%CI:1.7–3.7), PHQ-2 (RR:2.3, 95%CI:1.6–3.4), CESD-10 (RR:1.9, 95%CI:1.2–2.9), PHQ-9 (RR:1.8, 95%CI:0.8–3.8). LimitationsOur study did not include clinical diagnosis of MDD by a specialized clinician, instead we used provisional diagnosis of probable MDD classified by the PHQ-9 algorithm as a reference standard in diagnostic performance evaluations. ConclusionDepression screening tools varied in detection of postpartum MSD. The PHQ-2 would prompt fewer referrals and showed strong epidemiologic association with a cofactor.

Emotion detection for supporting depression screening.

Depression is the most prevalent mental disorder in the world. One of the most adopted tools for depression screening is the Beck Depression Inventory-II (BDI-II) questionnaire. Patients may minimize or exaggerate their answers. Thus, to further examine the patient's mood while filling in the questionnaire, we propose a mobile application that captures the BDI-II patient's responses together with their images and speech. Deep learning techniques such as Convolutional Neural Networks analyze the patient's audio and image data. The application displays the correlation between the patient's emotional scores and DBI-II scores to the clinician at the end of the questionnaire, indicating the relationship between the patient's emotional state and the depression screening score. We conducted a preliminary evaluation involving clinicians and patients to assess (i) the acceptability of proposed application for use in clinics and (ii) the patient user experience. The participants were eight clinicians who tried the tool with 21 of their patients. The results seem to confirm the acceptability of the app in clinical practice.

'Optimal' cutoff selection in studies of depression screening tool accuracy using the PHQ-9, EPDS, or HADS-D: A meta-research study.

Optimal cutoff thresholds are selected to separate 'positive' from 'negative' screening results. We evaluated how depression screening tool studies select optimal cutoffs. We included studies from previously conducted meta-analyses of Patient Health Questionnaire-9, Edinburgh Postnatal Depression Scale, or Hospital Anxiety and Depression Scale-Depression accuracy. Outcomes included whether an optimal cutoff was selected, method used, recommendations made, and reporting guideline and protocol citation. Of 212 included studies, 172 (81%) attempted to identify an optimal cutoff, and 147 of these 172 (85%) reported one or more methods. Methods were heterogeneous with Youden's J (N=35, 23%) most common. Only 23 of 147 (16%) studies described a rationale for their method. Rationales focused on balancing sensitivity and specificity without describing why desirable. 131 of 172 studies (76%) identified an optimal cutoff other than the standard; most did not make use recommendations (N=56; 43%) or recommended using a non-standard cutoff (N=53; 40%). Only 4 studies cited a reporting guideline, and 4 described a protocol with optimal cutoff selection methods, but none used the protocol method in the published study. Research is needed to guide how selection of cutoffs for depression screening tools can be standardized and reflect clinical considerations.

Validity and Reliability of the Chinese Version of the Edinburgh Postnatal Depression Scale for Fathers of Newborns.

Studies often use the Edinburgh Postnatal Depression Scale (EPDS) or the Beck Depression Inventory-II (BDI-II) as a screening tool for depression in new mothers or fathers following the birth of an infant, but no studies have evaluated EPDS as a predictor of postnatal depression for new fathers in a Chinese population. This study aimed to test the validity and reliability of a Chinese version of the EPDS for fathers of newborns in Taiwan. The study included 368 parents with newborns ≤2 months of age and without any health problems. Construct and criterion-related validities were assessed and Cronbach's alpha was used for measuring internal consistency reliability. The receiver operating characteristic (ROC) curve analyzed the optimal cutoff score for the EPDS. Scores for the Chinese EPDS were significantly higher for fathers who were >34 years of age, employed in a professional occupation, and participated in feeding their infant (p < .05). Mean scores among the fathers for the EPDS and BDI-II were significantly correlated (r = .64, p < .001). The Cronbach's alpha was .83 for the EPDS; ROC curve analysis revealed the optimal cutoff of the EPDS was ≥8 points and the area under the ROC curve was 0.91. The EPDS had good validity and reliability and should therefore be considered suitable for the evaluation of postnatal depression in fathers of newborn infants in Taiwan.

Validation and Comparison of Three Short Depression Screening Tools Among Chinese Community-Dwelling Older Adults.

The current study validated and compared three short Geriatric Depression Scales (GDS), including the GDS-5, D'Ath GDS-4, and van Marwijk GDS-4, among 917 Chinese community-dwelling older adults. The GDS-5, D'Ath GDS-4, and van Marwijk GDS-4 presented satisfactory accuracy against the GDS-15 (area under the curve [AUC] = 0.872 to 0.952), and the GDS-5 and D'Ath GDS-4 had better accuracy than the van Marwijk GDS-4. Satisfactory accuracy (AUC = 0.842 to 0.979) for the three scales was also observed across subgroups by age, sex, education, cognitive function, and multimorbidity. The GDS-5 but not D'Ath GDS-4 and van Marwijk GDS-4 retained a 2-point optimal cutoff for depressive symptoms across subgroups. The GDS-5 (average inter-item correlation coefficient [AIIC] = 0.233) and the D'Ath GDS-4 (AIIC = 0.171) but not van Marwijk GDS-4 (AIIC = 0.128) had acceptable internal consistency. Three scales had stable test-retest reliability within a 1- to 2-week interval (intraclass correlation coefficient = 0.670 to 0.885). The GDS-5 is an accurate and reliable depression screening tool with an invariable optimal cutoff among Chinese community-dwelling older adults. The variable optimal cutoffs for the D'Ath GDS-4 and van Marwijk GDS-4 across subgroups may limit their applicability in this population. [Research in Gerontological Nursing, 15(6), 283-291.].

Final validation of the mental health screening tool for depressive disorders: A brief online and offline screening tool for major depressive disorder.

Early screening for depressive disorders is crucial given that major depressive disorder (MDD) is one of the main reasons of global burden of disease, and depression is the underlying cause for 60% of suicides. The need for an accurate screening for depression with high diagnostic sensitivity and specificity in a brief and culturally adapted manner has emerged. This study reports the final stage of a 3-year research project for the development of depression screening tool. The developed Mental Health Screening Tool for Depressive Disorders (MHS:D) was designed to be administered in both online and offline environments with a high level of sensitivity and specificity in screening for major depressive disorder. A total of 527 individuals completed two versions (online/offline) of the MHS:D and existing depression scales, including the BDI-II, CES-D, and PHQ-9. The Mini International Neuropsychiatric Interview (MINI) for diagnostic sensitivity/specificity was also administered to all participants. Internal consistency, convergent validity, factor analysis, item response theory analysis, and receiver operating characteristics curve (ROC) analysis were performed. The MHS:D showed an excellent level of internal consistency and convergent validity as well as a one-factor model with a reasonable level of model fit. The MHS:D could screen for major depressive disorder accurately (0.911 sensitivity and 0.878 specificity for both online and paper-pencil versions). Item response theory analysis suggested that items from the MHS:D could provide significantly more information than other existing depression scales. These statistical analyses indicated that the MHS:D is a valid and reliable scale for screening Korean patients with MDD with high diagnostic sensitivity and specificity. Moreover, given that the MHS:D is a considerably brief scale that can be administered in either online or paper-pencil versions, it can be used effectively in various contexts, particularly during the pandemic.

Research Unwrapped 2. The Impact Of Covid-19 On Perinatal Mental Health - Part 2

The COVID-19 pandemic is associated with significant increase in the prevalence of anxiety and to a lesser extent depression. Screening tools for depression and anxiety may underestimate the impact of the pandemic on perinatal mental health. There is a need to incorporate more sensitive measures into the screening process for mental illness in the perinatal period.

Building a SW program in a private hem/onc practice: Using the PHQ-9 as a starting point.

266 Background: Hematology/oncology patients historically have high need for social work support. Community practices lack the structure and financial support of hospital practices, often hindering the growth of social work programs. PHQ-9 is a 9-question multipurpose tool for depression screening, diagnosing, monitoring and intervening. This project assessed using the PHQ-9 as a central focus to build a SW program: staff education, EHR automaticity improvement, and enhancement of patient navigation to improve PHQ-9 compliance and patient interventions. Methods: In a multi-office Hem/Onc practice, patients complete the PHQ-9 self-assessment tool, data is entered by MAs, and MD completes an action item according to score. Interventions, which began 1/1/22, included having patients complete the PHQ-9 via a PRO application before visit, interfacing of PRO application with EHR (MA adds score to treatment plan), educating MAs importance of mental health monitoring in health care setting, generating new workflow for MA to send EHR message to SW and notify MD if high score obtained, rapid cycle review of data with MDs, and building out of SW department to accept referrals. Our primary endpoint was % of PHQ-9s completed of those scheduled (every six months). Secondary endpoint was total number of patients internally referred for SW services since 4/1/22 (when psychotherapy services became available). Results: From 7/1/21-12/31/21 (before implementation), of 22,492 visits, 72% had a PHQ-9 reported (with no ongoing monitoring or intervention). From 1/1/22-5/31/22, 88% of 18,655 visits had a PHQ-9 reported. 1,114 patients had a score of 10 or greater on the PHQ-9 between 1/1/22-5/31/22, and of those patients, 100% were assessed for social work intervention. 724 patients were offered referral for mental health services externally; 390 patients have been recommended for internal SW referral (72 have registered for psychotherapy to begin 7/1/22). Conclusions: Our results illustrate the ability to achieve engagement of a SW program in a private practice setting over a limited time by using the PHQ-9 as a primary focus. Education of all staff involved in the process is paramount and will be emphasized when rolling out future components of the SW program: support groups, educational lecture series, and other concrete services.

Depression screening scores for teens with T1D need adjusting

Observing that some depression screening tools can miss cases of depression in teens with diabetes, authors of a new study suggest that adjusted cutoff scores could help better detect depressive disorders in adolescents with Type 1 diabetes.

Diagnosis and Treatment of Depression in Patients with Epilepsy

Depression has not been highlighted in the field of epilepsy research and treatment despite its harmful effects on patients’ daily living. Depression in patients with epilepsy is still underrecognized and undertreated by neurologists due to a lack of training about the psychiatric aspects of neurological disorders, lack of knowledge about the management of depression and the use of antidepressants, lack of time in the outpatient setting, misconceptions about seizure risk with psychotropic medications, and lack of communication with psychiatrists. Therefore, it is critical to acknowledge depression in patients with epilepsy through education and the application of screening tools and establish evidence-based medicine for its treatment. The Neurological Disorders Depression Inventory for Epilepsy is the most efficient and practical screening tool for depression and is also effective to detect suicidality in patients with epilepsy. The International League Against Epilepsy recently provided practical recommendations for the treatment of depression in patients with epilepsy. For mild depression, psychotherapy is the first-line treatment, and where medication is used, selective serotonin reuptake inhibitors (SSRIs) are first-choice medications. For moderate to severe depression, SSRIs remain the first-choice medications and psychotherapy can be combined with antidepressants. Antidepressant treatment should be maintained for at least 6 months following remission from a first depressive episode but it should be prolonged to 9 months in patients with a history of previous episodes and should continue even longer in cases of residual symptomatology until such symptoms have subsided and in those with severe depression. Key words: Epilepsy; Depression; Diagnosis; Antidepressive agents; Psychotherapy.

Validity of the patient health questionnaires (phq-2 and phq-9) for screening depression among human immunodeficiency virus patients in Lahore, Pakistan.

BACKGROUNDMany human immunodeficiency virus (HIV) infected patients suffer from depr-ession, but a little focus is given to detecting and treating depression in primary health care. Detection of depression can be improved by introducing short, reliable, and valid screening instruments.AIMTo determine the psychometric properties of the patient health questionnaire-2 (PHQ-2) and patient health questionnaire-9 (PHQ-9) for depression screening and diagnosis, and the sensitivity and specificity of the PHQ-2 in HIV infected patients.METHODSA cross-sectional study was conducted on 158 HIV-infected patients aged 18 years and above in Lahore, Pakistan. PHQ-2 was implemented to screen depression. PHQ-9 was implemented to diagnose major depressive disorder as a reference standard. Reliability, Validity tests and receiver operating characteristic curve were computed. RESULTSThe Cronbach's alpha of PHQ-2 and PHQ-9 were 0.732 and 0.759, respectively. The study results showed that the score of 2 on PHQ-2 indicates the highest Youden's index of 0.924, with both sensitivity and specificity of 0.96, and the area under the curve for PHQ-2 was 0.98 (95%CI: 0.953-0.998).CONCLUSIONGood psychometric properties for the PHQ-2 and PHQ-9 indicated their significant potential as tools for depression screening and diagnosis in the HIV-infected population.

Physicians’ Awareness of Depression Among Their Patients in Saudi Arabia

BackgroundDepression is a global public health burden, and although it is multifactorial, its development is highly associated with chronic diseases. Thus, physicians’ knowledge and attitude toward depression are vital for the recognition and treatment of depression among patients with chronic illnesses. This study aims to examine physicians’ knowledge and attitude toward depression in Saudi Arabia and to determine factors that significantly influence them.MethodologyAn online survey using a 12-item questionnaire was completed by 50 physicians between January and June 2020. Knowledge (K) and attitude (A) scores were calculated and compared nonparametrically based on scores by gender and years of experience.ResultsParticipants’ years of clinical experience was found to significantly influence the participants’ K scores, with those with fewer than one year of experience having the highest K scores of all participants (p < 0.05). Years of experience had a similar influence on the A scores. Furthermore, gender was an influencing factor as male participants had higher A scores than female participants. Years of experience and gender influenced the A scores independently. Male physicians more commonly referred patients to a mental health specialist than female physicians, and had significantly higher A scores and more years of experience. There was a direct correlation between the K and A score, indicating that participants’ knowledge of depression positively influenced their attitude toward depression.ConclusionsIn this study, participants’ gender and years of experience have been identified to have a significant impact on their knowledge and attitude toward comorbid depression when treating patients with chronic illnesses. This identifies an important gap and offers preliminary insight into the readiness and practice of holistic care for patients, particularly for those treated by physicians of differing gender and experience levels. Findings further demonstrate that it is most beneficial to patients with chronic illnesses that physicians utilize a holistic approach and consider depression when developing their treatment plans. This would involve being able to detect and manage depression among their patients properly, as well as referring patients to mental health specialists when needed. Clinical guidelines should be updated to emphasize the use of depression screening tools for patients with chronic diseases.

Depression prediction using machine learning: a review

Predicting depression can mitigate tragedies. Numerous works have been proposed so far using machine learning algorithms. This paper reviews publications from online electronic databases from 2016 to 2020 that use machine learning techniques to predict depression. The aim of this study is to identify important variables used in depression prediction, recent depression screening tools adopted, and the latest machine learning algorithms used. This understanding provides researchers with the fundamental components essential to predict depression. Fifteen articles were found relevant. We based our review on the systematic mapping study (SMS) method. Three research questions were answered through this review. We discovered that sixteen variables were deemed important by the literature. Not all of the reviewed literature utilizes depression screening tools in the prediction process. Nevertheless, from the five screening tools discovered, the most frequently used were hospital anxiety and depression scale (HADS) and hamilton depression rating scale (HDRS) for general population, while for literature targeting older population geriatric depression scale (GDS) was often employed. A total of twenty-two machine learning algorithms were identified employed to predict depression and random forest was found to be the most reliable algorithm across the publications.

Men's Depression, Externalizing, and DSM-5-TR: Primary Signs and Symptoms or Co-occurring Symptoms?

Men's Depression, Externalizing, and DSM-5-TR: Primary Signs and Symptoms or Co-occurring Symptoms?

Transparency and completeness of reporting of depression screening tool accuracy studies: A meta-research review of adherence to the Standards for Reporting of Diagnostic Accuracy Studies statement.

Accurate and complete study reporting allows evidence users to critically appraise studies, evaluate possible bias, and assess generalizability and applicability. We evaluated the extent to which recent studies on depression screening accuracy were reported consistent with Standards for Reporting of Diagnostic Accuracy Studies (STARD) statement requirements. MEDLINE was searched from January 1, 2018 through May 21, 2021 for depression screening accuracy studies. 106 studies were included. Of 34 STARD items or sub-items, the number of adequately reported items per study ranged from 7 to 18 (mean=11.5, standard deviation [SD]=2.5; median=11.5), and the number inadequately reported ranged from 3 to 17 (mean=10.1, SD=2.5; median=10.0). There were eight items adequately reported, seven partially reported, 11 inadequately reported, and four not applicable in ≥50% of studies; the remaining four items had mixed reporting. Items inadequately reported in ≥70% of studies related to the rationale for index test cut-offs examined, missing data management, analyses of variability in accuracy results, sample size determination, participant flow, study registration, and study protocol. Recently published depression screening accuracy studies are not optimally reported. Journals should endorse and implement STARD adherence.

Applying machine learning methods to psychosocial screening data to improve identification of prenatal depression: Implications for clinical practice and research.

We utilized machine learning (ML) methods on data from the PROMOTE, a novel psychosocial screening tool, to quantify risk for prenatal depression for individual patients and identify contributing factors that impart greater risk for depression. Random forest algorithms were used to predict likelihood for being at high risk for prenatal depression (Edinburgh Postnatal Depression Scale; EPDS ≥ 13 and/or positive self-injury item) using data from 1715 patients who completed the PROMOTE. Performance matrices were calculated to assess the ability of the PROMOTE to accurately classify patients. Probability for depression was calculated for individual patients. Finally, recursive feature elimination was used to evaluate the importance of each PROMOTE item in the classification of depression risk. PROMOTE data were successfully used to predict depression with acceptable performance matrices (accuracy = 0.80; sensitivity = 0.75; specificity = 0.81; positive predictive value = 0.79; negative predictive value = 0.97). Perceived stress, emotional problems, family support, age, major life events, partner support, unplanned pregnancy, current employment, lifetime abuse, and financial state were the most important PROMOTE items in the classification of depression risk. Results affirm the value of the PROMOTE as a psychosocial screening tool for prenatal depression and the benefit of using it in conjunction with ML methods. Using such methods can help detect underreported outcomes and identify what in patients' lives makes them more vulnerable, thus paving the way for effective individually tailored precision medicine.

Diagnostic Evaluation of Depression Screening Tools in Asian New Zealanders.

This study aimed to compare the Kessler Psychological Distress Scale (K10) and Short-Form 12-Item Health Survey Mental Component Score (SF-12 MCS) for the effectiveness as screening tools for depression in Asian New Zealanders. A national, representative New Zealand Health Survey (NZHS) data set was used. In total, 1,277 participants were included in the analyses. The sensitivity and specificity values, as well as the areas under the receiver operating characteristics curves (AUROC), for the K10 and the SF-12 MCS scores were examined. The AUROCs for K10 and SF-12 MCS were 0.787 (95% CI [0.736, 0.837]) and 0.725 (95% CI [0.656, 0.793]), respectively. A less than optimal sensitivity and positive predictive value of K10 support the need to reexamine the optimal cut-off point according to the results of the Youden index. Strengthening the K10 predictive accuracy will increase the practical application among Asian populations.

Correlates of patient-reported cognitive performance with regard to disability

The patient-reported form of the Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) assesses perceived problems attributable to cognitive and neuropsychiatric symptoms. It is inconsistently related to objective cognitive performance in multiple sclerosis (MS), while strongly correlated with depression. We assessed whether the relationship between subjective and objective cognitive screening tools is moderated by disability. Furthermore, we investigated the MSNQ as a screening tool for both cognitive impairment and depression. 275 MS patients completed the patient-reported MSNQ, two‐question screening tool for depression and Symbol Digit Modalities Test (SDMT) and were divided into Expanded Disability Status Scale (EDSS) subgroups: Low 0.0–3.0, Medium 3.5–6.0, High 6.5–9.0. MSNQ scores correlated significantly with depression but not SDMT in all subgroups. After correcting for age, sex, education, EDSS and depression, MSNQ significantly predicted SDMT in the total group, but not the subgroups. MSNQ significantly predicted a positive depression and/or cognitive impairment screen in the total group and all subgroups. The relationship between subjective and objective cognitive screening tools is not influenced by physical disability. MSNQ scores are substantially influenced by depression, and reflect cognitive function to some degree. Patient-reported cognitive measures can be useful to identify patients requiring further (neuro)psychological assessment.