Screening Instrument For Depression Research Articles

The Center for Epidemiologic Studies Depression Scale is an adequate screening instrument for depression and anxiety disorder in adults with congential heart disease

BackgroundThe Center for Epidemiological Studies Depression Scale (CES-D) is an instrument that is commonly used to screen for depression in patients with chronic disease, but the characteristics of the CES-D in adults with congenital heart disease (CHD) have not yet been studied. The aim of this study was to investigate the criterion validities and the predictive powers of the CES-D for depression and anxiety disorders in adults with CHD.MethodsTwo hundred patients were screened with the CES-D and secondarily interviewed with a diagnostic instrument, i.e., the Mini International Neuropsychiatric Instrument. The sensitivity and specificity values of the CES-D were calculated by cross-tabulation at different cutoff scores. Receiver operating characteristic (ROC) curves were used to assess the optimal cutoff point for each disorder and to assess the predictive power of the instrument.ResultsThe CES-D exhibited satisfactory criterion validities for depression and for all combinations of depression and/or anxiety. With a desired sensitivity of at least 80%, the optimal cutoff scores were 18. The predictive power of the CES-D in the patients was best for major depression and dysthymia (area under the ROC curve: 0.92) followed by the score for any combination of depression and/or anxiety (0.88).ConclusionThe use of CES-D to simultaneously screen for both depression and anxiety disorders may be useful in adults with CHD. Trial registration: CESDEP 212. Registered 2 March 2014 (retrospectively registered).

Hair cortisol as a biological marker for burnout symptomatology

Burnout is a syndrome with negative impact on cognitive performance and mood as a consequence of long-term stress at work. It is further associated with increased risk for mental and physical diseases. One potential pathway to mediate chronic work-stress and adverse health conditions in burnout is through alterations in long-term glucocorticoid secretion. Here, we present cross-sectional data on hair cortisol/cortisone (hairF/hairE) concentrations and burnout from a population-based sample of the Dresden Burnout Study (DBS; N=314 hair samples). Burnout symptoms (emotional exhaustion, cynical attitudes toward work, and reduced efficacy) were assessed with the Maslach Burnout Inventory-General Survey (MBI-GS). To control for potential confounds, depressivity was as well assessed using the Patient Health Questionnaire (PHQ-9) screening instrument for major depression. The present findings indicate specific hypercortisolism in participants who suffer from burnout. No significant associations were found between depressivity and hairF/hairE.

Validation of the WHO-5 as a first-step screening instrument for depression in adults with diabetes: Results from Diabetes MILES - Australia.

Screening for depression is recommended internationally. The World Health Organization's 5-item Well-being Index (WHO-5) is used clinically to screen for depression but its empirical suitability for this purpose is not well documented. We investigated the psychometric properties of the WHO-5 and its suitability for identifying likely depression in Australian adults with diabetes. The Diabetes MILES - Australia study dataset provided a sample of N=3249 who completed the WHO-5 (positively-worded 5-item measure of emotional well-being) and the PHQ-9 (9-item measure of depressive symptoms). Analyses were conducted for the full sample, and separately by diabetes type and treatment (type 1, non-insulin-treated type 2, and insulin-treated type 2 diabetes). Construct (convergent and factorial) validity and reliability of the WHO-5 were examined. ROC analyses were used to examine the sensitivity and specificity of the WHO-5 as a depression screening instrument, comparing two commonly used WHO-5 cut-off values (≤7 and <13) with the PHQ-9. For the whole sample, the WHO-5 demonstrated satisfactory internal consistency reliability (α=0.90) and convergent validity with the PHQ-9 (r=-0.73, p<0.001). Confirmatory factor analysis partially supported factorial validity: Χ2(5)=834.94, p<0.001; RMSEA=0.23, 90% CI 0.21-0.24; CFI=0.98, TLI=0.96; factor loadings=0.78-0.92. The AUC was 0.87 (95% CI: 0.86-0.89, p<0.001). The sensitivity/specificity of the WHO-5 for detecting likely depression was 0.44/0.96 for the ≤7 cut-off, and 0.79/0.79 for the <13 cut-off, with similar findings by diabetes type and treatment. These findings support use of a WHO-5 cut-point of <13 to identify likely depression in Australian adults with diabetes, regardless of type/treatment.

Emotional Support, Depressive Symptoms, and Age-Related Alterations in Male Body Composition: Cross-Sectional Findings from the Men's Health 40+ Study.

More depressive symptoms and low emotional support have been related to worse body composition. Body composition significantly deteriorates in aging men. Therefore, we aimed to examine whether high emotional support and low depressive symptoms are associated with better body composition and a decelerated age-related deterioration of body composition in aging men. A cross-sectional analysis including 269 self-reporting healthy men aged between 40 and 75 years living in the German-speaking part of Switzerland was conducted. Participants completed questionnaires on emotional support and depressive symptoms. The depression screening instrument was used to form a group with low (N = 225) and moderate (N = 44) depressive symptoms. Body mass index (BMI) and waist-to-hip ratio (WHR) were measured, and cell proportion (CP), fat mass (FM), and water balance (WB) were obtained using bioelectrical impedance analysis. Age-related associations emerged for WHR, CP, FM, and WB, but not for BMI. Emotional support was negatively associated with BMI, WHR, and WB, and only trend-wise with CP and FM. Group comparisons revealed that more depressive symptoms were associated with lower levels of CP and higher levels of WB. Both emotional support and depressive symptoms were significant moderators of the association between age and specific measures of body composition such as CP, FM, and WB. However, after correction for multiple testing for moderation analyses only the moderation effects of depressive symptoms on the association between age and WB and CP remained significant. Low depressive symptoms were associated with a better body composition as well as a decelerated decline in body composition and the role of emotional support acting as a buffer against age-related deterioration of body composition merits further investigation.

Clinical Utility of the Patient Health Questionnaire-9 in the Assessment of Major Depression After Broad-Spectrum Traumatic Brain Injury

ObjectiveTo determine the predictive validity of the Patient Health Questionnaire-9 (PHQ-9) when screening for symptoms of depression after traumatic brain injury. DesignRetrospective analysis of data collected as part of routine clinical outpatient care over a period of 30 months. SettingRegional rehabilitation facility. ParticipantsPersons (N=137) with mild to severe traumatic brain injury who were referred for neuropsychological evaluation within 1 to 12 months. InterventionsNot applicable. Main Outcome MeasuresPHQ-9 and Minnesota Multiphasic Personality Inventory-2-Restructured Form. ResultsPHQ-9 scores ≥10 had a sensitivity of 91.7 and a specificity of 60.2 for predicting a diagnosis of major depression. Correlations between scores of PHQ-9 and Minnesota Multiphasic Personality Inventory-2-Restructured Form Demoralization (.64) and Low Positive Emotions (.48) scales ranged from large to medium. Premorbid outpatient psychiatric treatment was the most consistent predictor of PHQ-9 elevations as well as final diagnoses of major depression. ConclusionsThe PHQ-9 has adequate clinical utility as a screening instrument for depression in outpatients with traumatic brain injury. Elevations on this instrument cannot, however, be automatically attributed to neuropathology, especially not in the context of premorbid psychiatric dysfunction. Clinicians should conduct more thorough follow-up assessment in those with highly elevated PHQ-9 scores.

Associations between pro- and anti-inflammatory cytokines and depressive symptoms in patients with diabetes – potential differences by diabetes type and depression screening instruments

Associations between pro- and anti-inflammatory cytokines and depressive symptoms in patients with diabetes – potential differences by diabetes type and depression screening instruments

Psychosocial Factors and 30-Day Hospital Readmission among Individuals Receiving Maintenance Dialysis: A Prospective Study

Background: Thirty-day hospital readmissions are common among maintenance dialysis patients. Prior studies have evaluated easily measurable readmission risk factors such as comorbid conditions, laboratory results, and hospital discharge day. We undertook this prospective study to investigate the associations between hospital-assessed depression, health literacy, social support, and self-rated health (separately) and 30-day hospital readmission among dialysis patients. Methods: Participants were recruited from the University of North Carolina Hospitals, 2014-2016. Validated depression, health literacy, social support, and self-rated health screening instruments were administered during index hospitalizations. Multivariable logistic regression models with 30-day readmission as the dependent outcome were used to examine readmission risk factors. Results: Of the 154 participants, 58 (37.7%) had a 30-day hospital readmission. In unadjusted analyses, individuals with positive screening for depression, lower health literacy, and poorer social support were more likely to have a 30-day readmission (vs. negative screening). Positive depression screening and poorer social support remained significantly associated with 30-day readmission in models adjusted for race, heart failure, admitting service, weekend discharge day, and serum albumin: adjusted OR (95% CI) 2.33 (1.02-5.15) for positive depressive symptoms and 2.57 (1.10-5.91) for poorer social support. The area under the receiver operating characteristic curve (AUC) of the multivariable model adjusted for social support status was significantly greater than the AUC of the multivariable model without social support status (test for equality; p value = 0.04). Conclusion: Poor social support and depressive symptoms identified during hospitalizations may represent targetable readmission risk factors among dialysis patients. Our findings suggest that hospital-based assessments of select psychosocial factors may improve readmission risk prediction.

Comparison of four brief depression screening instruments in ovarian cancer patients: Diagnostic accuracy using traditional versus alternative cutpoints

ObjectivesWe compared the diagnostic accuracy of 4 depression screening scales, using traditional and alternative scoring methods, to the gold standard Structured Clinical Interview-DSM IV major depressive episode (MDE) in ovarian cancer patients on active treatment. MethodsAt the beginning of a new chemotherapy regimen, ovarian cancer patients completed the following surveys on the same day: the Center for Epidemiological Studies Depression Scale (CES-D), the Beck Depression Inventory Fast-Screen for Primary Care (BDI-FastScreen), the Patient Health Questionnaire-9 (PHQ-9), and a 1-item screener (“Are you depressed?”). Each instrument's sensitivity, specificity, positive predictive value (PPV) and negative predictive value were calculated with respect to major depression. To control for antidepressant use, the analyses were re-run for a subsample of patients who were not on antidepressants. ResultsOne hundred fifty-three ovarian cancer patients were enrolled into the study. Only fourteen participants met SCID criteria for current MDE (9%). When evaluating all patients regardless of whether they were already being treated with antidepressants, the two-phase scoring approach with an alternate cutpoint of 6 on the PHQ-9 had the best positive predictive value (PPV=32%). Using a traditional cutpoint of 16 on the CES-D resulted in the lowest PPV (5%); using a more stringent cutpoint of 22 resulted in a slightly improved but still poor PPV, 7%. ConclusionsScreening with a two-phase PHQ-9 proved best overall, and its accuracy was improved when used with patients who were not already being treated with antidepressants.

Diagnostic Accuracy of German Depression Screenings in Patients with Coronary Heart Disease

To compare the diagnostic accuracy of German depression screening instruments in patients with coronary heart disease (CHD). 1019 CHD patients completed the Patient Health Questionnaire (PHQ-9 and PHQ-2) and the Hospital Anxiety and Depression Scale (HADS-D). The Composite International Diagnostic Interview served as reference standard for "any depressive disorder" and "major depression". The accuracy of the PHQ-9 and the HADS-D was comparable according to the area under the curve, and both were superior to the PHQ-2. The optimal cut-off according to the Youden index (maximum sum of sensitivity and specificity) was 7 for both instruments. At this optimal cut-off, the PHQ-9 had a higher sensitivity compared to the HADS-D, but a lower specificity (below 68). Results remained similar when patients who reported that they currently underwent treatment for depression were excluded. The PHQ-9 and the HADS-D have comparable overall diagnostic accuracy in CHD patients. In line with previous screening studies with CHD patients, the optimal cut-offs were below the cut-offs that are recommended in the literature.

Exploring perinatal depression symptom clusters as predictors of childbearing outcomes

IntroductionPerinatal depression is related to poorer outcomes for women and their children. Measurement indices that categorize perinatal depression as present or absent are commonly used in clinical practice and research efforts. Categorization minimizes the health effects of potentially different symptom clusters and may confound understanding of health outcomes.ObjectivesThe objective of this investigation is to explore the symptom clusters resulting from administering two commonly used depression screening instruments during pregnancy and postpartum.Aims(1) Identify the depressive symptom clusters for perinatal depression; (2) Test whether symptom clusters predict maternal and newborn outcomes, and if so, whether these differ from categorization analytics.MethodsA secondary analysis was conducted on data from a longitudinal study of 139 women. They participated from their 3rd trimester of pregnancy through 8 months after birth and completed surveys at five times using the center for epidemiologic studies Depressed Mood Scale (CES-D) and the Edinburgh Postnatal Depression Survey (EPDS). Analysis procedures included cluster analysis and hierarchical regression.ResultsIndividual symptoms were reported by 2.9–31.7% of the sample. Separate clusters (CES-D = 4; EPDS = 2) were identified and, of these, two clusters were primary predictors of maternal and newborn outcomes. Results differed from that obtained with cut-score analytics.ConclusionsExamination of depression symptom clusters as related to health outcomes during childbearing has significance for clinical practice and research, particularly for women who would not score as depressed on established screening instruments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Depression in the elderly with chronic medical illness

BackgroundThere is a bi-directional relationship between depression and chronic medical disorders.AimsThe objectives of our study were to measure the prevalence of depression in the elderly with chronic medical illness in primary care and to determine the socio-demographic and clinical factors related to depression.MethodsWe conducted a descriptive and analytical cross-sectional study of patients aged over 65, followed at the outpatient chronic diseases in Oudhref's district hospital (south of Tunisia) during the month of September 2014. We used two instruments: the activity of daily living (ADL) to determine the degree of autonomy and the geriatric depression scale (GDS) validated in Tunisia.ResultsAt the end of our investigation, 100 chronic disease patients met inclusion criteria. The average age of our population was 75 years. Prevalence of depression was 48%. The most frequent chronic pathology was hypertension (79%), followed by diabetes (70%). In analytical study, we noted no correlation between depression and socio-demographic variables such as age, sex and marital status. Regarding clinical variables, depression was significantly more frequent in patients with sensory impairments (82% vs 18%, P = 0.017), dependent (80% vs 20%, P = 0.002). Regarding chronic disease, depression was significantly more frequent in patients with respiratory disease (80% vs 20%, P = 0.033), a higher number of comorbidities (P = 0.005), who were hospitalised at least once (P = 0.015).ConclusionDepression is common in elderly with a chronic disease. Using screening instruments for major depression by primary care clinicians will help to detect depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Depression in epilepsy

To review some aspects of the relationship between epilepsy and depression that have recently received increasing attention and may become major research topics in the near future. Epidemiological studies show that depression and suicide are, in some cases, premorbid symptoms preceding the onset of the epilepsy. Suicide is also three times more frequent in epilepsy than in the general population. Reliable screening instruments for depression and suicidality in patients with epilepsy are now available but data from real life clinical settings are needed to develop shared clinical pathways between neurology and psychiatry. Data in children with epilepsy are still limited although it is well known that, outside epilepsy, almost 50% of adult patients with mood and anxiety disorders have a previous history during childhood. Despite increasing attention to the problem, the additional stigma associated with mental health problems still represents one of the major barriers to prompt diagnosis and treatment. New studies will focus on the development of shared clinical pathways between neurology and psychiatry for mood disorders and suicide prevention. New global campaigns on the double stigma will support this process in areas where psychiatric comorbidities are still underdiagnosed and undertreated.

A systematic review of screening instruments for depression for use in antenatal services in low resource settings

BackgroundIn low resource settings, short, valid and reliable instruments with good high sensitivity and specificity are essential for the screening of depression in antenatal care. A review of published evidence on screening instruments for depression for use in antenatal services in low resource settings was conducted. The aim of this review was to appraise the best available evidence on screening instruments suitable for detecting depression in antenatal care in low resource settings.MethodsSearching, selection, quality assessment, and data abstraction was done by two reviewers. ScienceDirect, CINAHL, MEDLINE, PubMed, SABINET and PsychARTICLES databases were searched using relevant search terms. Retrieved studies were evaluated for relevancy (whether psychometric data were reported) and quality. Data were synthesised and sensitivity and specificity of instruments were pooled using forest plots.ResultsEleven articles were included in the review. The methodological quality ranged from adequate to excellent. The review found 7 tools with varying levels of accuracy, sensitivity and specificity, including the Edinburgh Postnatal Depression Scale, Beck Depression Index, Centre for Epidemiologic Studies Depression Scale 20, Hamilton Rating Scale for Depression, Hopkins Symptoms Checklist-25, Kessler Psychological Distress Scale and Self-Reporting Questionnaire. The Edinburgh Postnatal Depression Scale was most common and had the highest level of accuracy (AUC = .965) and sensitivity.ConclusionThis review suggests that the Edinburgh Postnatal Depression Scale can be a suitable instrument of preference for screening antenatal depression in low resource settings because of the reported level of accuracy, sensitivity and specificity.Prospero registrationCRD42015020316.

Predictors and Barriers to Mental Health Treatment Utilization Among Older Veterans Living With HIV.

To identify key mood, social, and functional correlates of current participation in mental health treatment and barriers to participation in mental health treatment among older HIV infected (HIV+) veterans. HIV+ veterans (N = 150) aged ≥ 50 years receiving HIV-related medical care at the VA San Diego Healthcare System, San Diego, California, anonymously completed a survey assessing current self-reported mood, social support, daily functioning problems, mental health service utilization, and barriers to participating in mental health services. Veterans also completed the 2-item Patient Health Questionnaire (PHQ-2), a validated depression screening instrument frequently used in primary care settings. Data were collected from February 2014 to May 2014. Overall, 44% of participants screened positive for depressive symptomatology on the PHQ-2; 55% of those who screened positive were participating in mental health treatment. Of the 45% of veterans who screened positive on the PHQ-2 and were not in treatment, two-thirds (66%) stated they had been offered services; however, they were not engaging in or accepting the services. Regardless of PHQ-2 status, current self-reported depressive symptoms emerged as an independent, significant positive predictor of participation in mental health treatment (odds ratio = 5.98; 95% CI, 1.16-30.72; P = .03), whereas anxiety, HIV-related stigma, sufficiency of social support, and daily functioning problems were not associated with mental health treatment utilization. Primary reported barriers to mental health treatment included scheduling/availability, travel time and transportation, and discomfort with group settings. Results of this study suggest there may be a need to better engage older HIV+ veterans in depression-related treatment. The use of telehealth technology, such as teletherapy, electronic devices, and cell phone-based programs, may be beneficial in helping older HIV+ veterans overcome many barriers that restrict their participation in mental health treatment.

Mental health policies in South-East Asia and the public health role of screening instruments for depression.

The World Health Organization (WHO) South-East Asia Region, which contributes one quarter of the world's population, has a significant burden due to mental illnesses. Mental health has been a low priority in most countries of the region. Although most of these countries have national mental health policies, implementation at ground level remains a huge challenge. Many countries in the region lack mental health legislation that can safeguard the rights of people with mental illnesses, and governments have allocated low budgets for mental health services. It is imperative that concerned authorities work towards scaling up both financial and human resources for effective delivery of mental health services. Policymakers should facilitate training in the field of mental health and aim towards integrating mental health services with primary health care, to reduce the treatment gap. Steps should also be taken to develop a robust mental health information system that can provide baseline information and insight about existing mental health services and help in prioritization of the mental health needs of the individual countries. Although evidence-based management protocols such as the WHO Mental Health Gap Action Programme (mhGAP) guidelines facilitate training and scaling up of care in resource-limited countries, the identification of mental disorders like depression in such settings remains a challenge. Development and validation of brief psychiatric screening instruments should be prioritized to support such models of care. This paper illustrates an approach towards the development of a new culturally adapted instrument to identify depression that has scope for wider use in the WHO South-East Asia Region.

Development of a potential screening measure for adolescent depression.

Few adolescent-specific depression screening instruments have been developed in recent years using multi-method approaches (qualitative and quantitative), and some of those available have limitations with an adolescent audience. We describe the development of a potential measure - the Taouk Scale for Adolescent Depression. Draft items were informed by findings from focus groups and reviews by adolescents and healthcare professionals, resulting in a provisional 97-item scale. This was administered to a nation-wide sample of 3087 secondary students. Exploratory factor analysis was used in a development subset to examine dimensionality of items and reduce their number, with the final item set evaluated in a validation subset. Four reliable factors - negative outlook, emotional distress, behavioural changes and cognitive and somatic disturbances - were obtained from the exploratory factor analysis, resulting in a 28-item instrument, which was corroborated by confirmatory factor analysis. The final scale includes a number of novel items not included in current measures, i.e., whether respondents wear more black clothing than usual, deliberately damage property, take more risks, 'space out' at school and are engaged in substance abuse and/or increased sexual activity. The Taouk Scale for Adolescent Depression demonstrated sound psychometric properties and may have utility for future screening and future epidemiological purposes. It appears to be a valid and reliable screening instrument for adolescent depression that includes a number of novel items. Further research is necessary to confirm its criterion validity in clinically depressed samples.

Accuracy of Depression Screening Tools to Detect Major Depression in Children and Adolescents: A Systematic Review.

Depression screening among children and adolescents is controversial, and no clinical trials have evaluated benefits and harms of screening programs. A requirement for effective screening is a screening tool with demonstrated high accuracy. The objective of this systematic review was to evaluate the accuracy of depression screening instruments to detect major depressive disorder (MDD) in children and adolescents. Data sources included the MEDLINE, MEDLINE In-Process, EMBASE, PsycINFO, HaPI, and LILACS databases from 2006 to September 30, 2015. Eligible studies compared a depression screening tool to a validated diagnostic interview for MDD and reported accuracy data for children and adolescents aged 6 to 18 years. Risk of bias was assessed with QUADAS-2. We identified 17 studies with data on 20 depression screening tools. Few studies examined the accuracy of the same screening tools. Cut-off scores identified as optimal were inconsistent across studies. Width of 95% confidence intervals (CIs) for sensitivity ranged from 9% to 55% (median 32%), and only 1 study had a lower bound 95% CI ≥80%. For specificity, 95% CI width ranged from 2% to 27% (median 9%), and 3 studies had a lower bound ≥90%. Methodological limitations included small sample sizes, exploratory data analyses to identify optimal cut-offs, and the failure to exclude children and adolescents already diagnosed or treated for depression. There is insufficient evidence that any depression screening tool and cut-off accurately screens for MDD in children and adolescents. Screening could lead to overdiagnosis and the consumption of scarce health care resources.

A Validity and Reliability Study of the Japanese Version of the Geriatric Depression Scale 15 (GDS-15-J)

ABSTRACTObjective: The 15-item Geriatric Depression Scale (GDS-15) is one of the most widely used screening instruments for depression among the elderly. The aim of this study was to examine the validity and reliability of the Japanese version of the GDS-15 (GDS-15-J) in comparison with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for depression.Methods: The study participants were 128 elderly outpatients (age range, 55 to 92 years) categorized into two groups (76 non-depressive patients, 52 depressive patients) based on the DSM-IV-TR criteria for depression.Results: Logistic regression analysis showed that regardless of age and sex, the GDS-15-J score could be used to screen patients for depression (p < .001). The validity of the GDS-15-J for depression assessed against DSM-IV-TR criteria was excellent based on receiver operating characteristic analysis (optimal cutoff point: 6/7; sensitivity: .98; specificity: .86). The recommended optimal cutoff score when screening for depression is 6/7. To evaluate the constructive validity of the GDS-15-J, factor analysis was performed. Three factors were extracted. Cronbach’s alpha reliability coefficient was .83 to the GDS-15-J scale, which indicated a high degree of internal consistency.Conclusion: The GDS-15-J is a clinically applicable screening instrument for depression.Clinical Implications: In this study this version of the GDS-15-J displayed excellent psychometric properties using a 6/7 cut off. Analyses suggest some items that might be removed in future studies of an abbreviated scale.

Mental disorders in adults with congenital heart disease: Unmet needs and impact on quality of life

ObjectiveIn adult congenital heart disease (ACHD), mental health status and quality of life become important issues due to improved life expectancy. Current literature provides conflicting data regarding mental health status in ACHD. Furthermore, none of the studies so far compared prevalence rates with a matched control group. MethodsThe prevalence of mental disorders was assessed in 150 ACHD using a structured interview, and compared to 12-months estimates of the general German population. Quality of life (QoL) was measured with World Health Organization Quality of Life instrument. Furthermore, we related the diagnostic results of widely used screening instruments for depression (Beck Depression Inventory-2; BDI-2; Hospital Anxiety and Depression Scale; HADS) with clinical diagnoses, to receive optimal sensitivity and specificity values. ResultsThe prevalence of psychiatric disorders was significantly higher in ACHD than in the general population (48.0%; CI: 44.7–60.0 vs. 35.7%; CI: 33.5–37.9). Mood (30.7%; CI: 24.0–38.0 vs. 10.7%;CI:9.4–12.0) and anxiety disorders (28.0%; CI:22.0–36.7 vs. 16.8%; CI: 15.0–18.6) were the leading causes of psychiatric illness. Sixteen of 150 ACHD patients (10.7%) received specific treatment for psychiatric disorders before entering the study. Overall quality of life was independently and negatively associated with a diagnosis of major depression (p<0.001), alcohol dependency (p=0.004), nicotine dependency (p=0.036), and NYHA class (p=0.007). Accuracy of the HADS-D and BDI-2 as screening instruments was moderate (AUC 0.60–0.81), depending on the cut-off score used. ConclusionsPsychiatric disorders, particularly mood and anxiety disorders are significantly more frequent in ACHD compared to the general population. However, these disorders are rarely diagnosed resulting in under treatment and loss of quality of life. Quality of life is independently associated with the existence of mood, anxiety and substance use disorders. When self-rating instruments (BDI-2, HADS) are used as screening instruments in ACHD care, lower cut-off values are recommended.

Screening for Depression in Adults

Description Update of the 2009 US Preventive Services Task Force (USPSTF) recommendation on screening for depression in adults. Methods The USPSTF reviewed the evidence on the benefits and harms of screening for depression in adult populations, including older adults and pregnant and postpartum women; the accuracy of depression screening instruments; and the benefits and harms of depression treatment in these populations. Population This recommendation applies to adults 18 years and older. Recommendation The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. (B recommendation)