Depression Screening Measures Research Articles

Improved Scoring of the Center for Epidemiologic Studies Depression Scale – Revised: An Item Response Theory Analysis

AbstractThe Center for Epidemiologic Studies Depression Scale – Revised (CESD-R) is a popular self-report screening measure for depression. A 20-item questionnaire with scores ranging from 0 to 4 for each item, the CESD-R can produce total scores ranging from 0 to 80. However, the typical scoring protocol for the CESD-R restricts the range of possible scores to between 0 and 60 to retain the same range and clinical cutoff scores as the original CES-D. Despite the widespread adoption of this scoring approach, the psychometric impact has never been systematically examined. In an undergraduate and community adult sample (n = 869), item response theory analyses indicated that scoring the CESD-R with all 5 response options (CESD-R5opt) provided nearly twice as much information about a person’s latent depression for individuals with high levels of depression than did scoring the CESD-R with 4 response options per item (CESD-R4opt). The CESD-R5opt retained the strong reliability and factor structure of the CESD-R4opt and was more sensitive to individual differences for participants at high levels of depression compared to the CESD-R4opt. Results provide preliminary evidence that researchers and clinicians should score the CESD-R using the full 0-to-80 scale and a clinical cutoff score of 29.

P-477 Associations between maternal early pregnancy depression and longitudinal fetal growth

Abstract Study question Does maternal depression during early pregnancy affect fetal growth? Summary answer Maternal depression during early pregnancy is associated with increased fetal biometrics, higher birth weight, and also an elevated risk of macrosomia. What is known already Prenatal depression, a prevalent psychological condition occurring during pregnancy, affects approximately 7% to 25% of pregnant women. According to the developmental origins of health and disease theory, intrauterine adverse exposure, such as malnutrition and prenatal depression, may exert long-term effects by altering placental function and epigenetic modification. Growing evidence from epidemiologic studies has shown that maternal depression during mid-to-late stages of pregnancy may be associated with reduced fetal growth. However, the effect of depression may vary depending on the timing of intrauterine exposure. For early pregnancy depression, there is a limited number of studies examining its association with fetal growth. Study design, size, duration Prospective evaluation of the associations of maternal depression during early pregnancy with fetal growth and neonatal outcomes in 23,465 mothers. The study was conducted at a hospital-based center in Shanghai, China. The mothers were enrolled between March 2019 to April 2022. Participants/materials, setting, methods The Patient Health Questionnaire (PHQ-9) was used to screen for prenatal depression before 14 weeks’ gestational weeks. Fetal ultrasound parameters, including abdominal circumference(AC), head circumference(HC), femur length(FL),and humerus length(HL), along with birth outcomes were obtained from medical records. Estimated fetal weight(EFW) was calculated using the Hadlock formula. Differences in fetal growth trajectory of different maternal depressive statuses during three periods (16-23, 24-31, and 32-41 gestational weeks) were compared using a multilevel model with fractional polynomials. Main results and the role of chance In this prospective cohort study, maternal depressive symptoms affected 20402(13%) pregnant women during early pregnancy. Overall, compared to women without depressive symptoms, those with depressive symptoms during early pregnancy had higher longitudinal fetal trajectories, with an estimated increase in EFW (β = 0.33; 95% CI, 0.06-0.61), AC (β = 0.16; 95% CI, 0.04-0.29), HL (β = 0.14; 95% CI, 0.05-0.23), FL (β = 0.14; 95% CI, 0.03-0.25) and HL(β = 0.16; 95% CI, 0.04-0.27). Stratified by different gestational periods, the increments in HC (β = 0.16; 95% CI, 0.06-0.26), HL (β = 0.24; 95% CI, 0.11-0.38) and EFW (β = 0.60; 95% CI, 025-0.96) of women with depressive symptoms commenced after 32 weeks of gestational age and FL started after 24 gestational weeks (β = 0.24; 95% CI, 0.06-0.42 [24-31 weeks] and β = 0.19; 95% CI, 0.07-0.31 [32-41 weeks]). Notably, increases in AC among women with depressive symptoms were observed during 16-23 gestational weeks (β = 0.21; 95% CI, 0.04-0.39). What’s more, offspring born to mothers with early pregnancy depression had a significantly higher birth weight of 14.13g (95% CI, 1.33-27.81 g) and an increased risk of macrosomia (odds ratio, 1.21; 95% CI, 1.02-1.43). Limitations, reasons for caution A self-reported scale was used to assess the mental status of pariticipants, potentially introducing measurement bias. What’s more, long-term effects of early pregnancy depression on offspring were not explored due to the limited duration of follow-up thus far. Wider implications of the findings It may be necessary to reconsider the timing of prenatal depression screening and implement preventive measures during early pregnancy to mitigate excessive fetal growth. Further studies are warranted to validate the findings and supplement more biological evidence. Trial registration number not applicable

First Responders During COVID-19: Career Calling, PTSD, and Work Self-Efficacy

Introduction: During the COVID-19 pandemic, first responders were identified as a high-risk group for developing symptoms of post-traumatic stress disorder (PTSD) and depression, which are commonly associated with negative thoughts about oneself. This may pose risk to perceptions of work self-efficacy, an integral component of employee well-being and occupational functioning. In line with the Job Demands-Resources Model (Demerouti et al., 2001), the present study examined whether the degree to which first responders’ perceived career calling (i.e., a “summons” to work) served as a protective factor in the relationship between PTSD symptoms associated with the COVID-19 pandemic and perceptions of self-efficacy in the workplace. MethodsParticipants were 138 first responders from local county police and fire departments who completed online screening measures for probable PTSD and depression, as well as self-reports of work self-efficacy and career calling, between May and June 2020. Statistical analysis occurred between 2020-2021. ResultsModeration analysis, controlling for depression and relevant covariates, revealed an interaction between PTSD symptoms and career calling, ΔR2 = .04, p = .017. At low levels of career calling, there was a significant and negative relationship between PTSD symptoms and work self-efficacy (b = ‒0.14, p = .023), but not among first responders with average or high calling (p’s > .58). Positive screening rates were 22% for probable PTSD and 19% for depression. ConclusionsPerceiving a career calling may help protect first responders during COVID-19 from the deleterious effects of PTSD symptomatology on work self-efficacy. Prevention efforts targeting first responders with low calling strength may be warranted.

Influence of psychological factors on the relationship between subjective and objective memory in adults with pharmacoresistant temporal lobe epilepsy

PurposeMany adults with temporal lobe epilepsy (TLE) report subjective cognitive impairment; however, prior studies have shown a discrepancy between these subjective complaints and objective cognitive deficits on neuropsychological measures. Mood disorders/symptoms are also common in TLE and have been linked to greater subjective cognitive difficulties. To further understand these relationships, this retrospective study sought to determine if symptoms of depression and anxiety moderate or mediate the relationship between subjective cognitive impairment and objective cognitive performance in adults with TLE. MethodParticipants were 345 adults (mean age = 40.7; 55 % female) with pharmacoresistant TLE who completed self-report screening measures of depression, anxiety, and subjective cognitive function along with objective memory measures as part of a pre-surgical clinical neuropsychological evaluation. A series of linear regression analyses was conducted to examine the potential moderating and mediating effects of mood on the relationship between subjective and objective memory function after adjusting for relevant covariates. ResultsConsistent with existing literature, self-reported depression and anxiety symptoms were significantly correlated with subjective memory difficulties across all scales (all p < .001). Subjective memory impairment was also significantly correlated with objective memory performance on neuropsychological measures, albeit with small effect sizes (estimate range 0.04-0.20). Contrary to our hypothesis, depression and anxiety did not moderate or mediate the relationship between subjective memory complaints and objective memory performance. ConclusionsWhile symptoms of depression and anxiety were associated with subjective memory ability in this cohort of adults with TLE, this study suggests that mood symptoms do not fully explain the relationship between subjective and objective memory function, likely reflecting the complex and multifactorial relationships among these variables. Nevertheless, our results highlight the importance of screening for depression and anxiety symptoms and assessing patients' subjective memory complaints as part of a neuropsychological evaluation as each of these factors tap into a different aspect of the patient functioning.

Multidimensionality within the Edinburgh postnatal depression scale: application issues of specific structure

ABSTRACT Objective and background The 10-item Edinburgh Postnatal Depression Scale (EPDS) is a widely-used screening measure for postnatal depression. Factor analysis studies have suggested an embedded sub-scale could be used for screening for anxiety disorders. The current investigation sought to replicate and extend a recent study supporting this assertion. Methods A cross-sectional design. EPDS data were collected at up to two years postpartum. Confirmatory factor analysis, correlational and distributional characteristics of the measure were examined. Participants were a large sample (N = 985) of postpartum women in the Czech Republic. Results Factor structure findings substantially replicated the models evaluated by Della Vedova et al. (2022). Bifactor models, however, offered a better fit to data. A general factor of depression explained most of the variance in data in most models compared to embedded sub-scales across models. Conclusion The model proposed by Della Vedova et al. (2022) offered an excellent fit to data. However, the findings from the bifactor modelling suggest the dominance of a general factor of depression which indicates the potential application of an embedded anxiety sub-scale for screening may be overstated.

52 Internalizing Psychopathology is Highly Related to Subjective Cognitive Impairment and the Discrepancy Between Objective and Subjective Cognitive Impairment: A Preliminary Cross-Sectional Study.

Objective:Eliciting perceived cognitive complaints is a routine part of a clinical neuropsychological evaluation, presumably because complaints are informative of underlying pathology. However, there is no strong empirical support that subjective cognitive impairment (SCI) is actually related to objective cognitive impairment as measured by neurocognitive tests. Instead, internalizing psychopathology is thought to predominately influence the endorsement of SCI. Specifically, individuals with greater symptoms of depression and anxiety, when accounting for comorbidities, have a higher disposition to overestimate their degree of cognitive impairment as compared to objective testing. Yet, there are few existing studies that have determined which factors influence both SCI and the discrepancy between subjective and objective cognitive impairment in general outpatient populations. The current study examined the relationship between subjective and objective cognitive impairment in a clinically diverse sample of outpatients. We additionally explored the associations between SCI and relevant intrapersonal factors including internalizing psychopathology, number of medical comorbidities, and demographics. Finally, we quantified the degree of discrepancy between subjective and objective impairment and examined this discrepancy in relation to the intrapersonal factors.Participants and Methods:The sample comprised 142 adult women and men (age range 18–79 years) seen in an outpatient neuropsychology clinic for a diverse range of referral questions. Scores on the cognition portion of the WHO Disability Assessment Schedule (WHODAS 2.0) were used to index SCI. A composite score from 14 measures across various domains of cognitive functioning served as an objective measure of cognitive functioning. Internalizing psychopathology was measured via a standardized composite of scores from screening measures of anxiety and depression. Medical comorbidities were indexed by the number of different ICD diagnostic categories documented in patients' medical records. Demographics included age, sex, race, and years of formal education. Objective-subjective discrepancy scores were computed by saving standardized residuals from a linear regression of neurocognitive test performance on the WHODAS 2.0 scores.Results:A hierarchical linear regression revealed that objective cognitive impairment was not significantly related to SCI (p &gt; .05), explaining less than 2% of the variance in SCI ratings. Likewise, participants' demographics (age, sex, education, race) and number of comorbidities were not significantly related to their SCI ratings, explaining about 6% of the variance. However, participants' level of internalizing psychopathology was significantly associated with SCI (F[10, 131] = 4.99, p &lt; .001), and explained approximately 20% of the variance in SCI ratings. Similarly, the degree of discrepancy between subjective and objective cognitive impairment was primarily influenced by internalizing psychopathology (F[9, 132] = 5.20, p &lt; .001, R2 = 21%) and largely unrelated to demographics and number of comorbidities, which explained about 6% of the variance.Conclusions:These findings are consistent with prior research suggesting that SCI may be more indicative of the extent of internalizing psychopathology rather than actual cognitive impairment. Taken together, these results illuminate potential treatment and diagnostic implications associated with assessing perceived cognitive complaints during a neuropsychological evaluation.

The relationship between mood and anxiety and cognitive phenotypes in adults with pharmacoresistant temporal lobe epilepsy.

Patients with temporal lobe epilepsy (TLE) are often at a high risk for cognitive and psychiatric comorbidities. Several cognitive phenotypes have been identified in TLE, but it is unclear how phenotypes relate to psychiatric comorbidities, such as anxiety and depression. This observational study investigated the relationship between cognitive phenotypes and psychiatric symptomatology in TLE. A total of 826 adults (age = 40.3, 55% female) with pharmacoresistant TLE completed a neuropsychological evaluation that included at least two measures from five cognitive domains to derive International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) cognitive phenotypes (i.e., intact, single-domain impairment, bi-domain impairment, generalized impairment). Participants also completed screening measures for depression and anxiety. Psychiatric history and medication data were extracted from electronic health records. Multivariable proportional odds logistic regression models examined the relationship between IC-CoDE phenotypes and psychiatric variables after controlling for relevant covariates. Patients with elevated depressive symptoms had a greater odds of demonstrating increasingly worse cognitive phenotypes than patients without significant depressive symptomatology (odds ratio [OR] = 1.123-1.993, all corrected p's < .05). Number of psychotropic (OR = 1.584, p < .05) and anti-seizure medications (OR = 1.507, p < .001), use of anti-seizure medications with mood-worsening effects (OR = 1.748, p = .005), and history of a psychiatric diagnosis (OR = 1.928, p < .05) also increased the odds of a more severe cognitive phenotype, while anxiety symptoms were unrelated. This study demonstrates that psychiatric factors are not only associated with function in specific cognitive domains but also with the pattern and extent of deficits across cognitive domains. Results suggest that depressive symptoms and medications are strongly related to cognitive phenotype in adults with TLE and support the inclusion of these factors as diagnostic modifiers for cognitive phenotypes in future work. Longitudinal studies that incorporate neuroimaging findings are warranted to further our understanding of the complex relationships between cognition, mood, and seizures and to determine whether non-pharmacologic treatment of mood symptoms alters cognitive phenotype.

A - 163 Investigating the Relationship between the Brief Resilience Scale (BRS) and Screening Measures of Anxiety, Depression, and Emotional Symptoms in Adolescents with Concussion.

Resilience has been found to be a factor in concussion recovery, and the Brief Resilience Scale (BRS) has been validated as a measure of resilience in adults. Investigation of the BRS in adolescents with concussion and its relationship with current measures of anxiety, depression, and emotional symptoms may prove beneficial in further understanding emotional response to concussions in adolescents. Participants aged 12-17 who sustained a concussion (n = 1168) were evaluated within 30days of injury at a North Texas Concussion Registry (ConTex) clinic. Participants completed the Brief Resilience Scale (BRS), the General Anxiety Disorder 7 scale (GAD-7), the Patient Health Questionnaire depression scale (PHQ-8), and the emotional cluster (feeling irritable, sad, nervous, and more emotional) of the Sport Concussion Assessment Tool 5th Edition Symptom Evaluation (SCAT5) at initial visit. Pearson's correlation coefficient (r) was used to determine the relationship between scores on these four measures. Pearson correlations between BRS scores and scores from the other measures were modest but statistically significant: GAD-7 (r = -0.392, p < 0.001), PHQ-8 (r = -0.321, p < 0.001), and the emotional cluster of the SCAT5 (r = -0.301, p < 0.001). Comparison of BRS score with GAD-7, PHQ-8, and the emotional cluster of the SCAT5 indicates that resilience may exhibit a modest inverse correlation with screening measures of anxiety, depression, and emotional symptoms, and thus a discrete factor for use in evaluating initial emotional response to concussion in adolescents.

Single-item depression screening with the Neurobehavioral Symptom Inventory (NSI): Do scores assist clinicians with predicting need for mental health interventions?

The purpose of this study was to examine the relationship between a single item for depression from the Neurobehavioral Symptom Inventory (NSI) and a common depression screening measure to predict need for further mental health consultation for veterans with traumatic brain injury (TBI). Three hundred eighty veterans referred to a Veterans Affairs Health Care System TBI clinic for evaluation were administered the NSI and a common depression screening measure (Beck Depression Inventory-Second Edition; BDI-II). Receiver Operating Characteristic (ROC) curve analyses were conducted to determine best cutoff scores on the BDI-II corresponding with a single item of the NSI item pertaining to depression (i.e., "depressed or sad"). Using multiclass ROC curve analyses, results suggested that a minimum score of 3 (severe) on the specific NSI item indicated need for further mental health referral without warranting additional screening for depression. Analyses further demonstrated that removal of invalid NSI protocols did not significantly change ROC curve findings. Therefore, the NSI item for depression can still be used for making clinical decisions despite the protocol being considered otherwise invalid. Implications for treatment and recommendations for screening are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychometric properties of the Patient Health Questionnaire-4 (PHQ-4) in 9230 adults across seven European countries: Findings from the ESTSS ADJUST study

BackgroundThe four-item Patient Health Questionnaire-4 (PHQ-4) is a widely used screening measure for depression and anxiety. ObjectivesThis study aimed to test factor structure and measurement invariance in an adult sample of the general population across seven European countries. MethodA total sample of 9230 adults, 71.3 % female, Mage = 44.35 (SD = 14.11) from seven countries (Austria, Croatia, Georgia, Germany, Lithuania, Portugal, and Sweden) participated in the study. We applied confirmatory factor analysis (CFA) to examine the factor structure and measurement invariance testing to evaluate measurement equivalence across countries, gender, and age groups. ResultsThe CFA yielded that a two-factor PHQ-4 model with separate depression and anxiety factors had the best fit. Partial scalar measurement invariance was established across different groups based on gender, age, and country. ConclusionsThe PHQ-4 is a valid and reliable measure that can be applied to screen for depression and anxiety in the general population. LimitationsThe limitation of the study includes the sampling, which resulted in the sample structure with the majority of females, predominantly of high education and from urban communities.

Prenatal Sleep Linked to Postpartum Mental Health Outcomes [ID: 1375042

INTRODUCTION: Sleep disturbances commonly occur in pregnancy; and the postpartum state confers elevated risk for mental health disorders. In nonpregnant populations, sleep problems have been linked to mental health problems. The scant research on the association between prenatal sleep disturbances and postpartum mental health has produced mixed results. The goal of this project was to evaluate the association between prenatal sleep and postpartum mental health. METHODS: This IRB-approved prospective cohort study included 336 individuals receiving prenatal care at a single institution between August 2020 and April 2021. Participants completed a baseline questionnaire upon recruitment, in the first or early second trimester, and a follow-up questionnaire at 4–8 weeks postpartum. Individuals completed surveys for sleep (Pittsburgh Sleep Quality Index [PSQI]), depression (Patient Health Questionnaire depression scale [PHQ-8]), and anxiety (General Anxiety Disorder scale [GAD-7]). RESULTS: After adjusting for baseline depression and potential confounders, prenatal global sleep quality (PSQI, &gt;5) was associated with development of postpartum depression (PHQ-8, ≥10) (relative risk [RR] 1.12: 95% CI 1.01–1.25). Specifically, sleep quality (RR 2.18: 95% CI 1.22–3.91) and sleep latency (RR 1.52: 95% CI 1.06–2.17) were associated with postpartum depression. Prenatal sleep problems were associated with higher postpartum anxiety scores (RR 1.09: 95% CI 0.99–1.20), but findings did not reach statistical significance. CONCLUSION: Prenatal sleep problems are associated with the development of postpartum depression. Research suggests that treating prenatal insomnia may prevent postpartum depression. Screening for sleep disorders in pregnancy could potentially be used to target screening and prevention measures for postpartum depression.

An Alcohol Symptom Checklist identifies high rates of alcohol use disorder in primary care patients who screen positive for depression and high-risk drinking

BackgroundAlthough alcohol use disorder can complicate depression management, there is no standard process for assessing AUD symptoms (i.e., AUD diagnostic criteria) in primary care for patients who screen positive for depression. This study characterizes the association between depressive symptoms and high-risk drinking reported by primary care patients on screening measures in routine care. Then, using data from a novel clinical program, this study characterizes the association between depressive symptoms and AUD symptoms reported by primary care patients with high-risk drinking via an Alcohol Symptom Checklist.MethodsIn this cross-sectional study, electronic health record data were obtained from patients who visited 33 Kaiser Permanente Washington primary care clinics between 03/2018 and 02/2020 and completed depression (PHQ-2) and alcohol consumption (AUDIT-C) screening measures as part of routine care (N = 369,943). Patients who reported high-risk drinking (AUDIT-C scores 7–12) also completed an Alcohol Symptom Checklist where they reported the presence or absence of 11 AUD criteria as defined by the DSM-5 (N = 8,184). Generalized linear models estimated and compared the prevalence of high-risk drinking (AUDIT-C scores 7–12) and probable AUD (2–11 AUD symptoms on Alcohol Symptom Checklists) for patients with and without positive depression screens.ResultsPatients who screened positive for depression had a 131% higher prevalence of high-risk drinking than those who screened negative (5.2% vs. 2.2%; p < 0.001). Among patients with high-risk drinking, positive depression screens were associated with a significantly higher prevalence of probable AUD (69.8% vs. 48.0%; p < 0.001), with large differences in the prevalence of probable AUD observed with increasing PHQ-2 scores (e.g., probable AUD prevalence of 37.6%, 55.3% and 65.2%, for PHQ-2 scores of 0, 1, and 2, respectively). Although the overall prevalence of high-risk drinking was higher for male patients, similar patterns of association between depression screens, high-risk drinking, and AUD symptoms were observed for male and female patients.ConclusionsPatients with positive depression screens are more likely to have high-risk drinking. Large percentages of patients with positive depression screens and high-risk drinking report symptoms consistent with AUD to healthcare providers when given the opportunity to do so using an Alcohol Symptom Checklist.

Adjusted Cutoff Scores Increase Sensitivity of Depression Screening Measures in Adolescents With Type 1 Diabetes.

To measure the acceptability and diagnostic accuracy of commonly used depression screening measures to determine ideal cutoff scores that sensitively identify depressive disorders in adolescents with type 1 diabetes (T1D). One hundred adolescents (12-17 years old) completed a reference standard, semistructured diagnostic interview and both long and short versions of five commonly used depression screening measures in the United States. To assess feasibility and acceptability, we used screener completion time and participant ratings, respectively. We used descriptive statistics, area under the receiver operating characteristic (ROC) curve analyses, and paired-sample area differences under the ROC curve to assess each measure's diagnostic validity against our reference standard and to determine ideal cutoff scores for this sample. Adolescents had a mean age of 15.0 ± 1.7 years, time since T1D diagnosis of 6.0 ± 4.1 years, and glycated hemoglobin (HbA1c) of 8.9 ± 1.8%. Sixty percent of adolescents were male, 15% endorsed a current depressive disorder, and 15% endorsed lifetime suicidality. Measures demonstrated low sensitivity (0.33-0.67) to detect current depressive disorders using preexisting cutoff scores. However, adjusted cutoff scores increased sensitivity and reduced false negatives. All depression screening measures demonstrated "good" to "excellent" predictive validity, and the Children's Depression Inventory-2 Short version demonstrated significantly greater diagnostic accuracy than the Patient Health Questionnare-2 item version for adolescents. Clinics should consider using screening measures with the greatest diagnostic accuracy as identified in this study and adjusting measure cutoff scores to increase sensitivity and reduce false negatives.

Assessment of Patient-Reported Outcome Measures for Maternal Postpartum Depression Using the Consensus-Based Standards for the Selection of Health Measurement Instruments Guideline

Maternal depression is frequently reported in the postpartum period, with an estimated prevalence of approximately 15% during the first postpartum year. Despite the high prevalence of postpartum depression, there is no consensus regarding which patient-reported outcome measure (PROM) should be used to screen for this complex, multidimensional construct. To evaluate psychometric measurement properties of existing PROMs of maternal postpartum depression using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guideline and identify the best available patient-reported screening measure. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. PubMed, CINAHL, Embase, and Web of Science were searched on July 1, 2019, for validated PROMs of postpartum depression, and an additional search including a hand search of references from eligible studies was conducted in June 2021. Included studies evaluated 1 or more psychometric measurement properties of the identified PROMs. A risk-of-bias assessment was performed to evaluate methods of each included study. Psychometric measurement properties of each PROM were rated according to COSMIN criteria. A modified Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the level of evidence supporting each rating, and a recommendation class (A, recommended for use; B, further research required; or C, not recommended) was given based on the overall quality of each included PROM. Among 10 264 postpartum recovery studies, 27 PROMs were identified. Ten PROMs (37.0%) met the inclusion criteria and were used in 43 studies (0.4%) involving 22 095 postpartum women. At least 1 psychometric measurement property was assessed for each of the 10 validated PROMs identified. Content validity was sufficient in all PROMs. The Edinburgh Postnatal Depression Scale (EPDS) demonstrated adequate content validity and a moderate level of evidence for sufficient internal consistency (with sufficient structural validity), resulting in a recommendation of class A. The other 9 PROMs evaluated received a recommendation of class B. The findings of this systematic review suggest that the EPDS is the best available patient-reported screening measure of maternal postpartum depression. Future studies should focus on evaluating the cross-cultural validity, reliability, and measurement error of the EPDS to improve understanding of its psychometric properties and utility.

After Childbirth: Better Data Can Help Align Postpartum Needs with a New Standard of Care.

After Childbirth: Better Data Can Help Align Postpartum Needs with a New Standard of Care.

Childhood-onset versus adolescent-onset anxiety and depression: Epidemiological and neurodevelopmental aspects

Anxiety and depression are common in youth and are frequently accompanied by attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). However, it is unclear how common ADHD, ASD, and other neurodevelopmental disorders (NDDs, i.e., ADHD, ASD, developmental coordination disorder, learning disorder, and tic disorders) are in children versus adolescents with anxiety and depression. We aimed to delineate whether different anxiety/depression age-of-onset groups show distinguishable NDD patterns. The study was based on 4492 twins born in Sweden between 1998 and 2003 from the nation-wide population-based Child and Adolescent Twin Study in Sweden. Prevalence and odds ratios were calculated using screening measures of anxiety and depression at ages 9 and 15, and NDDs at age 9. Individuals with childhood-onset anxiety/depression had a substantially higher NDD prevalence compared to individuals with adolescent-onset anxiety/depression. Highest prevalence was found for individuals with anxiety/depression both in childhood and adolescence. In this group, individuals also had substantially higher odds of having at least one NDD (14.7, 95% CI 6.3 – 34.0) compared to individuals without anxiety/depression. This emphasizes the need to further investigate the etiology of childhood and adolescent anxiety/depression, as they most likely represent different constructs depending on age-of-onset, lending support for possibly different treatment approaches.

Potential Feasibility of an Online Hypnosis Intervention for Women with Persistent Pelvic Pain

ABSTRACT This study aimed to examine the potential feasibility of an online hypnotic intervention for women with persistent pelvic pain. The secondary aim was to explore the effect of the hypnosis intervention on anxiety, depression, pain severity, coping, pain catastrophizing, and pain disability in comparison to a no-intervention control. Twenty women with persistent pelvic pain completed assessment questionnaires and were recruited from a variety of social media sites related to persistent pelvic pain and randomized to either control or hypnotic intervention groups. The intervention group completed a 7-week online hypnotic intervention. Results found a 30% dropout rate and modest compliance (90%-40%) with practice of audio recordings. Comments from the 7 participants who completed the hypnosis intervention indicated it was acceptable. Significant reductions in screening measures of anxiety and depression were found; however, there were no significant effects shown for pain severity, avoidant coping, pain catastrophizing, or pain disability. The intervention is potentially feasible, but further refinement and optimization is needed to increase retention, compliance, and potential effects.

Examining the psychometric properties of brief screening measures of depression and anxiety in chronic pain: The Patient Health Questionnaire 2-item and Generalized Anxiety Disorder 2-item.

ObjectiveIndividuals with chronic pain experience anxiety and depressive symptoms at rates higher than the general population. The Patient Health Questionnaire 2‐item (PHQ‐2) and Generalized Anxiety Disorder 2‐item (GAD‐2) are brief screening measures of depression and anxiety, respectively. These brief scales are well‐suited for use in routine care due to their brevity and ease of administration, yet their psychometric properties have not been established in heterogeneous chronic pain samples when administered over the Internet.Materials and MethodsUsing existing data from randomized controlled trials of an established Internet‐delivered pain management program (n = 1333), we assessed the reliability, validity, diagnostic accuracy, and responsiveness to treatment change in the PHQ‐2 and GAD‐2, as well as the long‐form counterparts. Exploratory analyses were conducted to obtain cutoff scores using those participants with diagnostic data (n = 62).ResultsThe PHQ‐2 and GAD‐2 demonstrated appropriate reliability (eg, Cronbach's α = 0.79–0.84), validity (eg, higher scores in individuals with a diagnosis; p < 0.001), and responsiveness to treatment change (eg, pre‐ to post‐treatment scores, p < 0.001). The psychometric properties of the short forms compared well with the longer forms. Cutoff scores on the short forms were consistent with general population samples, while cutoff scores on the long forms were higher than previously observed using general population samples. All four scales favored specificity over sensitivity.ConclusionsThe PHQ‐2 and GAD‐2 demonstrated acceptable psychometric properties in the current sample, as did the long forms. Based on our findings, the PHQ‐2 and GAD‐2 can be used as screening tools with chronic pain samples when administered over the Internet.

Abstract P222: The Psychological Predictors Of Recovery After Acute Cardiac Events Study: Rationale And Design

Objective: To estimate the prospective association of cardiac anxiety at cardiac arrest (CA) discharge with subsequent risk for cardiovascular disease (CVD)/mortality after adjusting for general psychological distress and test its independent association with health-related quality of life (HRQoL). Our second objective is to test whether cardiac anxiety after CA is associated with low physical activity (PA) and/or short sleep shortly after discharge. Our third objective will test if low PA and/or short sleep mediate the association between cardiac anxiety and 12-month CVD/mortality post-discharge for CA. Further, the study will test the associations of general psychological distress with cardiac vagal control assessed by activity-adjusted heart rate variability. Background: Survivorship after CA is on the rise. However, survivors remain at markedly elevated risk for CVD, and many report poor HRQoL in the year after CA. Cardiac anxiety (i.e., cardiac specific-fear, avoidance behavior, and excessive cardiac symptom monitoring) has been shown in non-CA CVD patients to be associated with higher rates of psychological distress, avoidance of PA and poor sleep, patient-reported disability, and poor perceived health. Further, despite the association of low PA and poor sleep in CVD risk, no study has assessed those health behaviors in CA survivors. Design/Methods: This observational cohort study (anticipated n = 246) will evaluate CVD prognosis, HRQoL in the first year of survivorship of neurologically intact CA survivors admitted to New York Presbyterian Hospital between May 2021 and April 2026. At hospital discharge, 1, 6, and 12 months, study participants will be assessed for cardiac anxiety, and general psychological distress (screening measures for depression, posttraumatic stress, generalized anxiety symptoms), positive psychological factors (optimism, positive affect, purpose in life), functional (modified Rankin Scale) and telephone-based cognitive assessments. For 1-week post-discharge, and 1 week at 6-months post-discharge we will assess the level of PA and sleep duration using wrist-worn actigraphy, daily psychological factors using mobile ecological momentary assessment, and heart rate/heart rate variability using chest-worn patches. Results: Of the 21 patients enrolled to date (mean age 57 years, 10 women). The presentation will describe patterns of physical activity, sleep, both negative and positive psychological factors at 1-month post-discharge relative to discharge status. Conclusions: This is the first major prospective cohort study of CA survivorship, and the first to objectively assess health behaviors. By identifying malleable intervention targets for improving both CVD/mortality risk and post-CA HRQoL, this study could ignite the development of the first generation of CA survivorship interventions.

Construct validity and internal consistency of the Patient Health Questionnaire-9 (PHQ-9) depression screening measure translated into two Ugandan languages.

In Uganda, depression is a major public health issue because of its direct disease burden and as a risk factor and co-morbidity for other pervasive health issues. Psychometric assessment of translated depression measures is critical to public health planning to ensure proper screening, surveillance, and treatment of depression and related outcomes. We examined aspects of the validity and reliability of the Patient Health Questionnaire-9 (PHQ-9) translated into Luganda and Runyoro in a large population-based cohort of Ugandan adolescents and adults. Data from the ongoing open cohort AMBSO Population Health Surveillance study were analyzed from the Wakiso and Hoima districts in Uganda. Descriptive statistics were calculated for the overall sample and stratified by translated language. Construct validity was assessed for each translated scale using confirmatory factor analysis for ordinal data. The internal consistency of each translated scale was assessed using Cronbach's alpha, McDonald's omega total and omega hierarchical. Compared to the Runyoro-speaking subsample from Hoima (n=2297), participants in the Luganda-speaking subsample from Wakiso (n=672) were older (27 vs 21 years, p < 0.01) and a greater proportion were female (62% vs. 55%, p < 0.01). The Luganda-translated PHQ-9 had a sample mean of 3.46 (SD=3.26), supported a single-factor structure (RMSEA=0.05, CFI=0.96, TLI=0.94), and demonstrated satisfactory internal consistency (Cronbach's alpha=0.73, McDonald's omega total=0.76, McDonald's omega hierarchical=0.53). The Runyoro-translated PHQ-9 had a comparable sample mean of 3.58 (SD=3.00), also supported a one-factor structure (RMSEA=0.08, CFI=0.92, TLI=0.90), and demonstrated satisfactory internal consistency (Cronbach's alpha=0.72, McDonald's omega total=0.76, McDonald's omega hierarchical=0.57). Our preliminary findings indicate that the Luganda and Runyoro translations of the PHQ-9 had satisfactory construct validity and internal consistency in our sample of Ugandan adolescents and adults. Future studies should expand on this promising work by assessing additional psychometric characteristics of these translated measures in other communities in Uganda.