Screening Instrument For Depression Research Articles

Validation of a screening instrument for postpartum depression in Southern Brazil

Objectives. The objectives of this investigation was to assess the prevalence of postpartum depression in a sample of 101 women and to validate a Portuguese version of the Postpartum Depression Screening Scale (PDSS) in Southern BrazilMethods. Research volunteers completed the PDSS and underwent an assessment based on the Structured Clinical Interview for DSM-IV disorders (SCID). Parameters under investigation included the demographic characteristics of the sample, internal structure, and discriminant validity.Results. All questions in the Portuguese version of the PDSS attained significant Cronbach's alpha of 0.62. The factorial analysis of the Portuguese version of PDSS identified one principal factor that contributed 38.8% of the variance. The best cut-off score for the Portuguese version of the PDSS was a score of 81, which accounted for a sensitivity of 89% and a specificity of 72% in this sample.Conclusions. The Portuguese version of the PDSS demonstrated sound psychometric properties. The results of the factorial analysis also demonstrated that the Portuguese version of the PDSS assesses postpartum depressive disorders in a coherent and integrated manner. The original English version of the PDSS was successfully adapted to Portuguese.

Validity of the Brazilian version of the Geriatric Depression Scale (GDS) among primary care patients

The aim of the present study was to determine the validity of the Brazilian version of the Geriatric Depression Scale (GDS) with 30 (GDS-30), 15 (GDS-15), 10 (GDS-10), 4 (GDS-4) and 1 (GDS-1) items and to calculate the optimum cutoff points for identifying depression among elderly primary care subjects. A cross-sectional study was carried out involving 220 elderly patients recruited from four primary care clinics in northeastern Brazil. The following measurements were obtained: sociodemographic variables, Katz scale of independence in activities of daily living, and the GDS with 30, 15, 10, 4 and 1 item(s). A psychiatrist blinded to the results of the GDS applied the mood module of the Structured Clinical Interview for the DSM-IV for the diagnosis of major depressive episodes as the "gold standard." The use of the cut-off point of 10/11 for the GDS-30 produced sensitivity and specificity rates of 92.0% (95% CI: 70-98) and 79% (95% CI: 73-85), respectively. The positive predictive value (PPV) and the negative predictive value (NPV) were 49% and 98%, respectively. The optimum cut-off point for the GDS-15 was 4/5, at which sensitivity was 87% (95% CI: 71-95) and specificity was 82% (95% CI: 76-91), PPV was 51% and NPV was 97%. At the cut-off point of 3/4 the sensitivity, specificity, PPV and NPV for the GDS-10 were 76% (95% CI: 60-89), 81% (95% CI: 75-87), 46% (95% CI: 33-59%), and 94% (95% CI 89-97%), respectively. The optimum cut-off point for the GDS-4 was 0/1, at which sensitivity was 84% (95% CI: 68-93%); specificity was 75% (95% CI; 68-91%); PPV was 41% and NPV was 96%. For the GDS-1, sensitivity was 47%, specificity was 96%; PPV was 69% and NPV was 90%. The GDS-30, GDS-15, GDS-10 and GDS-4 proved to be good screening instruments for depression in primary care clinics in Brazil, whereas the GDS-1 failed to perform adequately.

Association of Resident Fatigue and Distress With Perceived Medical Errors

Fatigue and distress have been separately shown to be associated with medical errors. The contribution of each factor when assessed simultaneously is unknown. To determine the association of fatigue and distress with self-perceived major medical errors among resident physicians using validated metrics. Prospective longitudinal cohort study of categorical and preliminary internal medicine residents at Mayo Clinic, Rochester, Minnesota. Data were provided by 380 of 430 eligible residents (88.3%). Participants began training from 2003 to 2008 and completed surveys quarterly through February 2009. Surveys included self-assessment of medical errors, linear analog self-assessment of overall quality of life (QOL) and fatigue, the Maslach Burnout Inventory, the PRIME-MD depression screening instrument, and the Epworth Sleepiness Scale. Frequency of self-perceived, self-defined major medical errors was recorded. Associations of fatigue, QOL, burnout, and symptoms of depression with a subsequently reported major medical error were determined using generalized estimating equations for repeated measures. The mean response rate to individual surveys was 67.5%. Of the 356 participants providing error data (93.7%), 139 (39%) reported making at least 1 major medical error during the study period. In univariate analyses, there was an association of subsequent self-reported error with the Epworth Sleepiness Scale score (odds ratio [OR], 1.10 per unit increase; 95% confidence interval [CI], 1.03-1.16; P = .002) and fatigue score (OR, 1.14 per unit increase; 95% CI, 1.08-1.21; P < .001). Subsequent error was also associated with burnout (ORs per 1-unit change: depersonalization OR, 1.09; 95% CI, 1.05-1.12; P < .001; emotional exhaustion OR, 1.06; 95% CI, 1.04-1.08; P < .001; lower personal accomplishment OR, 0.94; 95% CI, 0.92-0.97; P < .001), a positive depression screen (OR, 2.56; 95% CI, 1.76-3.72; P < .001), and overall QOL (OR, 0.84 per unit increase; 95% CI, 0.79-0.91; P < .001). Fatigue and distress variables remained statistically significant when modeled together with little change in the point estimates of effect. Sleepiness and distress, when modeled together, showed little change in point estimates of effect, but sleepiness no longer had a statistically significant association with errors when adjusted for burnout or depression. Among internal medicine residents, higher levels of fatigue and distress are independently associated with self-perceived medical errors.

Gender as a determinant of responses to a self-screening questionnaire on anxiety and depression by patients with coronary artery disease

Because patients with coronary artery disease (CAD) could benefit from interventions to decrease psychological distress, it is important to identify these individuals. Both salivary cortisol level and the Hospital Anxiety and Depression Scale (HADS) are recognized measures of stress/anxiety and depression. This study was designed to determine whether there is an association between anxiety and depression, as measured by the HADS, and salivary cortisol levels among patients with CAD, and whether this association is affected by gender. All adult residents of Alberta, Canada, undergoing their first cardiac catheterization for CAD (>or=50% occlusion of >or=2 coronary arteries) were eligible for participation in this study. A 14-question survey (the HADS) and 3 saliva-collection devices (a 1-day supply) were sent to the participants' home within 1 week of their initial cardiac catheterization. Participants were asked to take saliva samples for determination of cortisol levels on waking and at 30 and 60 minutes after waking, and then return the completed questionnaire and saliva samples using a prepaid express mailing envelope. Seventy-one adults (52 men and 19 women) participated in the study. Mean (SD) ages were 68.4 (4.6) years for men and 69.1 (4.4) years for women. Among the women, significant negative correlations were found between the HADS anxiety score and the wake-up and 30-minute cortisol levels (higher HADS scores were associated with lower cortisol levels) (all, P < 0.05). Also among women, negative correlations were found between the HADS depression score and the salivary cortisol values, but the differences were not statistically significant. Conversely, among the men, nonsignificant positive correlations were found between the HADS anxiety scores and the salivary cortisol levels (higher HADS scores were associated with higher cortisol levels), and statistically significant positive correlations were observed between the HADS depression scores and all 3 salivary cortisol values (all, P < 0.05). Our findings suggest that the HADS is an appropriate screening instrument for anxiety and depression in patients with CAD. In particular, the scale appears to be sensitive for measuring anxiety in women and depression in men. When the HADS is used clinically as a screening tool, it should be examined through a "gender-based lens.".

Diagnostic Accuracy of Spanish Language Depression-Screening Instruments

To make decisions about implementing systematic depression screening, primary care physicians who serve Spanish-speaking populations need to know whether Spanish language depression-screening instruments are accurate. We aimed to review systematically the evidence regarding diagnostic accuracy of depression-screening instruments in Spanish-speaking primary care populations. We searched PubMed, PsycINFO, CINAHL, EMBASE, and Cochrane Libraries from inception to May 28, 2008, for studies examining the diagnostic accuracy of Spanish language depression case-finding instrument(s) administered to primary-care outpatients. Two authors independently assessed studies for inclusion and quality. Twelve studies met inclusion criteria. In general primary care screening, the Spanish language version of the Center for Epidemiologic Studies-Depression scale (CES-D) had sensitivities ranging from 76% to 92% and specificities ranging from 70% to 74%. We found no US study reporting the accuracy of the Primary Care Evaluation of Mental Disorders (PRIME-MD-9) or the Patient Health Questionnaire (PHQ-9) depression module in Spanish-speakers. One fair-quality European study and 1 poor-quality study conducted in Honduras found the 9-item PRIME-MD had sensitivities ranging from 72% to 77% and specificities ranging from 86% to 100%. The 2-item PRIME-MD was 92% sensitive, but only 44% specific for depression in 1 US study. In geriatric outpatients, the 15-item Spanish language version of the Geriatric Depression Scale (GDS) had sensitivities ranging from 76% to 82%, and specificities ranging from 64% to 98%. In postpartum women, the Spanish language version of the Edinburgh Postnatal Depression Scale (EPDS) was 72% to 89% sensitive and 86% to 95% specific for major depression (2 non-US studies). The Spanish language version of the Postpartum Depression Screening Scale (PDSS) was 78% sensitive and 85% specific for combined major/minor depression (1 US study). For depression screening in Spanish-speaking outpatients, fair evidence supports the diagnostic accuracy of the CES-D and PRIME-MD-9 in general primary care, the GDS-15-Spanish for geriatric patients, and the Spanish language versions of the EPDS or PDSS for postpartum patients. The ultrashort 2-item version of PRIME-MD may lack specificity in US Spanish-speakers.

THIS ARTICLE HAS BEEN RETRACTED A psychometric evaluation of the Chinese version of the Hospital Anxiety and Depression Scale in patients with coronary heart disease

Aim. To evaluate further the psychometric properties of the Chinese version of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for anxiety and depression in Chinese patients with coronary heart disease in Xian, China.Background. There is considerable evidence that anxiety and depression are common in patients with coronary heart disease (CHD) and are associated with increased morbidity and mortality. A valid, reliable and sensitive screening tool that can be used readily on this group of patients would be useful for assessment, intervention and outcome evaluation.Design. A single group, cross‐sectional study.Method. Measurement performance was tested on 314 Chinese patients with coronary heart disease and repeated on 173 of them two weeks later.Results. The Chinese version of HADS (C‐HADS) had acceptable internal consistency and test‐retest reliability, with a Cronbach alpha of 0·85 and intraclass correlation coefficient of 0·90, respectively. There was acceptable concurrent validity with significant (p &lt; 0·05) correlations between the anxiety and depression subscales of the C‐HADS and CHD patients’ perceived health status as measured by the Chinese Mandarin version of the Short Form‐36 health survey (CM:SF‐36). Principal components analysis revealed a three‐factor solution accounting for 53% of the total variance. The three underlying sub‐scale dimensions are depression, psychic anxiety and psychomotor anxiety. The responsiveness of the C‐HADS was also satisfactory with significant correlation between the changes in the C‐HADS score and the changes in the Mental Health domain of the CM:SF‐36 (p &lt; 0·01). Finally, over one‐third of the patients demonstrated psychological distress.Conclusion. Empirical data support the C‐HADS as a reliable and valid screening instrument for the assessment of anxiety and depression in Chinese‐speaking patients with CHD. A tri‐dimensional scoring approach should be considered as potentially clinically useful for this group of patients.Relevance to clinical practice. The C‐HADS can guide and evaluate the delivery of psychological care for Chinese patients with CHD.

Implementation of a Depression Screening Instrument on Patients With Cardiac Events

Implementation of a Depression Screening Instrument on Patients With Cardiac Events

A psychometric evaluation of the Chinese version of the Hospital Anxiety and Depression Scale in patients with coronary heart disease

To evaluate further the psychometric properties of the Chinese version of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for anxiety and depression in Chinese patients with coronary heart disease (CHD) in Xian, China. There is considerable evidence that anxiety and depression are common in patients with CHD and are associated with increased morbidity and mortality. A valid, reliable and sensitive screening tool that can be used readily on this group of patients would be useful for assessment, intervention and outcome evaluation. A single group, cross-sectional study. Measurement performance was tested on 314 Chinese patients with CHD and repeated on 173 of them two weeks later. The Chinese version of HADS (C-HADS) had acceptable internal consistency and test-retest reliability, with a Cronbach's alpha of 0.85 and intraclass correlation coefficient of 0.90, respectively. There was acceptable concurrent validity with significant (p < 0.05) correlations between the anxiety and depression subscales of the C-HADS and CHD patients' perceived health status as measured by the Chinese-Mandarin version of the Short Form-36 health survey (CM:SF-36). Principal components analysis revealed a three-factor solution accounting for 53% of the total variance. The three underlying sub-scale dimensions are depression, psychic anxiety and psychomotor anxiety. The responsiveness of the C-HADS was also satisfactory with significant correlation between the changes in the C-HADS score and the changes in the mental health domain of the CM:SF-36 (p < 0.01). Finally, over one-third of the patients demonstrated psychological distress. Empirical data support the C-HADS as a reliable and valid screening instrument for the assessment of anxiety and depression in Chinese-speaking patients with CHD. A tri-dimensional scoring approach should be considered as potentially clinically useful for this group of patients. The C-HADS can guide and evaluate the delivery of psychological care for Chinese patients with CHD.

Screening Depression Among Institutionalized Older Chinese Men by Minimum Data Set

To compare the effectiveness of the Minimum Data Set-based Depression Rating Scale (MDS-DRS) and Geriatric Depression Scale (GDS) in screening depression among older institutionalized Chinese men living in Taiwan. MDS Nursing Home 2.1 Chinese version, Mini-Mental State Examination (MMSE), and short form Geriatric Depression Scale (GDS-15) were used among elderly residents in Banciao Veterans Home. Screening results of MDS-DRS and GDS-15, and relationship between 16 MDS Mood and Anxiety symptoms and depression were evaluated. The prevalence of depression defined by MDS-DRS and GDS were 0.2% and 8.7%, respectively. Multiple logistic regression disclosed that E1a (OR: 12.9, 95% CI: 2.8-58.8, p = 0.001), E1k (OR: 15.6, 95% CI: 5.6-43.5, p < 0.001), and E1l (OR: 22.2, 95% CI: 6.1-83.3, p < 0.001) were all independent associative factors for GDS-defined depression but only explained 51.9% of all depressive subjects. The effectiveness of MDS-DRS is limited, and a new MDS-based depression screening instrument is needed.

The Diagnostic Accuracy of Brief Screening Questions for Psychosocial Risk Factors of Poor Outcome From an Episode of Pain

To determine the diagnostic accuracy of brief screening questions for psychosocial risk factors predictive of poor outcome from an episode of pain. Six electronic databases were searched, content experts contacted, and reference and citation tracking performed. Studies were included that examined the diagnostic accuracy of 1-item screening or 2-item screening questions for depression, anxiety, fear-avoidance beliefs, social isolation, catastrophization, or somatization and were published in English. Studies were assessed for quality, and data extracted describing study characteristics and the diagnostic accuracy of brief screening questions. Four cross-sectional studies met the inclusion criteria and all met 4 or more of our 6 method quality criteria. These studies examined the diagnostic accuracy of brief screening tools for depression (sensitivity = 50.5% to 82.1%, specificity = 71.0% to 90.6%, and overall accuracy = 74.6% to 80.6%) and anxiety (sensitivity 63.0% to 94.0%, specificity = 53.0% to 71.2%, and overall accuracy = 60.0% to 68.1%). No studies were identified that examined the diagnostic accuracy of brief screening questions for fear-avoidance beliefs, social isolation, catastrophization, and somatization. Data were only available on the accuracy of brief screening instruments for depression and anxiety, and there was variability in the results. Head-to-head studies are required to determine if this variability reflects differential question accuracy or population characteristics, and studies that determine the diagnostic accuracy of brief screening questions for other common psychosocial risk factors would be useful.

Screening for anxiety and depression after stroke: Comparison of the Hospital Anxiety and Depression Scale and the Montgomery and Åsberg Depression Rating Scale

Objective Anxiety and depression after stroke are frequent, but are often overlooked and not assessed. The aims of the study were to (1) assess the prevalence of anxiety and depression and (2) compare the performance of the Hospital Anxiety and Depression Scale (HADS) and Montgomery and Åsberg Depression Rating Scale (MADRS) as screening instruments for anxiety and depression disorders 4 months after stroke. Methods Stroke patients, consecutively admitted to a stroke unit, were assessed with HADS and MADRS 4 months after stroke ( n=104). Depression and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV (SCID). Measures were compared in terms of correlations, sensitivity, specificity, positive and negative predictive value, overall agreement, kappa, and ROC curves, using DSM-IV diagnoses of “at least one current significant anxiety disorder” (Anxiety) and “any current depression” (Depression), as the clinical criteria. Results Anxiety occurred in 23% of patients and Depression in 19% (13% major depression, 3% minor depression, 4% dysthymia). For Anxiety, the optimal screening cut-off was 4 for HADS-A and 6 for HADS-total; for Depression, optimal cut-offs were 4 for HADS-D, 11 for HADS-total, and 8 for MADRS. At cut-offs commonly used in clinical practice for depression screening (HADS-D: 8, MADRS: 12), the MADRS performed marginally better than the HADS. Conclusion Anxiety is as prevalent as depression 4 months after stroke. MADRS and HADS-D perform acceptably as screening instruments for depression, and HADS-A for anxiety after stroke. However, lower HADS cut-offs than recommended for the general population should be considered for stroke patients.

The Psychosocial Screen for Cancer (PSSCAN): Further validation and normative data

BackgroundWe have previously reported on the development of a cancer-specific screening instrument for anxiety and depression (PSSCAN). No information on cut-off scores or their meaning for diagnosis was available when PSSCAN was first described. Needed were additional analyses to recommend empirically justified cut-off scores as well as data norms for healthy adult samples so as to lend meaning to the recommended cut-off scores.MethodsWe computed sensitivity/specificity indices based on a sample of 101 cancer patients who had provided PSSCAN data on anxiety and depression and who had completed another standardized instrument with strong psychometrics. Next, we compared mean scores for four samples with known differences in health status, a healthy community sample (n = 561), a sample of patients with a representative mix of cancer subtypes (n = 570), a more severely ill sample of in-patients with cancer (n = 78), and a community sample with a chronic illness other than cancer (n = 85).ResultsSensitivity/specificity analyses revealed that an excellent balance of sensitivity/specificity was achievable with 92%/98% respectively for clinical anxiety and 100% and 86% respectively for clinical depression. Newly diagnosed patients with cancer were no more anxious than healthy community controls but showed elevations in depression scores. Both, patients with chronic illness other than cancer and those with longer-standing cancer diagnoses revealed greater levels of distress than newly diagnosed cancer patients or healthy adult controls.ConclusionThese additional data on criterion validity and community versus patient norms for PSSCAN serve to enhance its utility for clinical practice.

Clinical and Psychometric Validation of the Geriatric Depression Scale (GDS) for Portuguese Elders

The main purpose of this study is the adaptation and psychometric validation of the Geriatric Depression Scale (GDS) for the Portuguese population. The analyses of temporal (α (27 items) = .995) and internal (.91) consistencies, inter-rater reliability (Kappa = .87), and concurrent (.83) and factorial (3 factor) validities demonstrate that GDS is highly reliable as a screening instrument for geriatric depression. This conclusion was further validated by both discriminant function analysis and diagnostic value testing, which showed a sensitivity of 100%, a specificity of 83%, a positive predictive value of 93%, and a negative predictive value of 100%. The study has also evaluated GDS applicability to clinical assessment and therapeutic intervention with elders suffering from moderate feelings of loneliness linked to recurring suicidal ideation.

Validation of the Edinburgh Postnatal Depression Scale and prevalence of postnatal depression at two months postpartum in a sample of Greek mothers

The EPDS has been validated as a screening instrument for postnatal depression in numerous communities over the last 20 years. Absence of a validation study for the Greek population has limited significantly its use in Greece. A community sample of 109 women was recruited on the second day postpartum in the two largest maternity hospitals in Athens. Ninety‐five women consented to participate and to complete the EPDS, the Beck Depression Inventory (BDI), the 28‐item General Health Questionnaire (GHQ), and the 26‐item WHO‐Quality of Life (WHO‐QOL). Of them, 81 consented to be reassessed 2 months later. At that time, in addition to the baseline questionnaires, the Structured Clinical Interview for DSM‐III‐R (SCID), non‐patient version, was conducted in order to establish psychiatric diagnosis of major and minor depression. The clinical diagnosis was used to test the criterion validity of the EPDS, and the GHQ, BDI and WHO‐QOL scores were used to assess the concurrent validity of the EPDS. Cronbach's alpha coefficient was used to measure the internal consistency of the scales. A cut‐off point of 11/12 on the EPDS showed optimum Receiver Operating Characteristics. The SCID showed that 12.4% of the subjects met criteria for depression at two months postpartum.

The role of lateralization in the functional outcome of patients after middle cerebral artery stroke

Event Abstract Back to Event The role of lateralization in the functional outcome of patients after middle cerebral artery stroke Sanja Draca1*, Aleksandra Stefanovic1, Aleksandra Dragin1, Biljana Ljesevic1 and Dalibor Paspalj1 1 Clinic "Dr M.Zotovic", Russia Objective: To test the influence of lateralization (right vs. left hemisphere lesion) to the motor and behavioral sequels in patients after middle cerebral artery (MCA) territory infarct. Materials and methods: This study included a total of 31 patients with chronic stroke (1 year post stroke) of MCA origin, aged 54-78 years. The study included the patients with right MCA infarction (14 patients), or left MCA infarction (17 patients). All patients were treated with conventional physical and occupational therapy during 2 months following stroke. Measures: Upper extremity (UE) spasticity was assessed by the Modified Ascworth Scale (MAS), UE motor functions by the Fugl-Meyer Motor Impairment Scale (FMA)-upper extremity portion, and the performance of the paretic arm in the of activities of daily living by the Chedoke Arm and Hand Activity Inventory (CAHAI). The Beck Depression Inventory (BDI)-II was used as a screening instrument for depression. Results: No significant difference was found for MAS score (2, 3 vs. 2, 1), FM score (20, 9 vs. 27, 8), as well as the CAHAI score (43, 3 vs. 49, 6) between patients with right vs. left MCA infarction. Nevertheless, the patients with left hemisphere lesion had a significantly increased BDI-II scores compared to patients with right hemisphere lesion (8, 7 vs. 16, 2, p < 0, 05). Conclusion: These results indicate that UE motor recovery did not differ between patients with right or left MAC infarction. However, an increased rate of PSD in patients with left hemisphere lesion (both cortical and subcortical) compared to patients with right hemisphere lesion, indicates a need for depressive symptoms screening in stroke patients. Conference: 41st European Brain and Behaviour Society Meeting, Rhodes Island, Greece, 13 Sep - 18 Sep, 2009. Presentation Type: Poster Presentation Topic: Poster presentations Citation: Draca S, Stefanovic A, Dragin A, Ljesevic B and Paspalj D (2009). The role of lateralization in the functional outcome of patients after middle cerebral artery stroke. Conference Abstract: 41st European Brain and Behaviour Society Meeting. doi: 10.3389/conf.neuro.08.2009.09.137 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 09 Jun 2009; Published Online: 09 Jun 2009. * Correspondence: Sanja Draca, Clinic "Dr M.Zotovic", Belgrade, Russia, odracha@EUnet.rs Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Sanja Draca Aleksandra Stefanovic Aleksandra Dragin Biljana Ljesevic Dalibor Paspalj Google Sanja Draca Aleksandra Stefanovic Aleksandra Dragin Biljana Ljesevic Dalibor Paspalj Google Scholar Sanja Draca Aleksandra Stefanovic Aleksandra Dragin Biljana Ljesevic Dalibor Paspalj PubMed Sanja Draca Aleksandra Stefanovic Aleksandra Dragin Biljana Ljesevic Dalibor Paspalj Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Validation of a screening instrument for postpartum depression in Southern Brazil

Validation of a screening instrument for postpartum depression in Southern Brazil

Cognition in type 2 diabetes: Association with vascular risk factors, complications of diabetes and depression.

BackgroundThe role of variables like duration of diabetes, diabetic control and microvascular complications in the causation of cognitive decline in patients with type 2 diabetes is not well studied. The contribution of hypertension to the cognitive decline in nondemented diabetic patients is unclear.Aims:We wanted to see if cognition in patients with type 2 diabetes is associated with the duration of diabetes, control of diabetes, complications of diabetes, vascular risk factors, or depression. We also looked at association of noncompliance with cognition, and depression.Settings and Design:We recruited ambulant patients with type 2 diabetes who are 55 years or more in age from the weekly diabetic clinic. We excluded patients with past history of stroke.Methods and Material:We selected the time taken for the Trial A test, delayed recall on ten-word list from Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Rowland Universal Dementia Assessment Scale (RUDAS) and Centre for Epidemiologic Studies Depression scale (CES-D) screening instrument to assess these patients.Statistical Analysis Used:We utilized mean, standard deviation, Chi-square test and Pearson's correlation for statistical analysis. We considered P < 0.05 to be significant.Results:RUDAS scores inversely correlated (r = −0.360) with CES-D scores (P = 0.002). Scores of the screening instrument for depression, the CES-D was associated with the duration of diabetes mellitus (P = 0.018), fasting blood glucose (P = 0.029) as well as with 2-hour post prandial blood glucose (P = 0.017).Conclusions:There is correlation between depression and global cognitive score. Depression seems to be associated with duration of diabetes and control of diabetes.

Diagnostic Accuracy of Spanish Language Depression-Screening Instruments

Diagnostic Accuracy of Spanish Language Depression-Screening Instruments

Depression Screening and Patient Outcomes in Cardiovascular Care

Several practice guidelines recommend that depression be evaluated and treated in patients with cardiovascular disease, but the potential benefits of this are unclear. To evaluate the potential benefits of depression screening in patients with cardiovascular disease by assessing (1) the accuracy of depression screening instruments; (2) the effect of depression treatment on depression and cardiac outcomes; and (3) the effect of screening on depression and cardiac outcomes in patients in cardiovascular care settings. MEDLINE, PsycINFO, CINAHL, EMBASE, ISI, SCOPUS, and Cochrane databases from inception to May 1, 2008; manual journal searches; reference list reviews; and citation tracking of included articles. We included articles in any language about patients in cardiovascular care settings that (1) compared a screening instrument to a valid major depressive disorder criterion standard; (2) compared depression treatment with placebo or usual care in a randomized controlled trial; or (3) assessed the effect of screening on depression identification and treatment rates, depression, or cardiac outcomes. Methodological characteristics and outcomes were extracted by 2 investigators. We identified 11 studies about screening accuracy, 6 depression treatment trials, but no studies that evaluated the effects of screening on depression or cardiovascular outcomes. In studies that tested depression screening instruments using a priori-defined cutoff scores, sensitivity ranged from 39% to 100% (median, 84%) and specificity ranged from 58% to 94% (median, 79%). Depression treatment with medication or cognitive behavioral therapy resulted in modest reductions in depressive symptoms (effect size, 0.20-0.38; r(2), 1%-4%). There was no evidence that depression treatment improved cardiac outcomes. Among patients with depression and history of myocardial infarction in the ENRICHD trial, there was no difference in event-free survival between participants treated with cognitive behavioral therapy supplemented by an antidepressant vs usual care (75.5% vs 74.7%, respectively). Depression treatment with medication or cognitive behavioral therapy in patients with cardiovascular disease is associated with modest improvement in depressive symptoms but no improvement in cardiac outcomes. No clinical trials have assessed whether screening for depression improves depressive symptoms or cardiac outcomes in patients with cardiovascular disease.

Review: screening or case-finding questionnaires used alone are not effective for management of depression

S Gilbody Dr S Gilbody, University of York, Leeds, UK; sg519@york.ac.uk What is the effectiveness of screening or case-finding questionnaires used alone for detection and management of depression? Studies selected...