Screening Tool For Depression Research Articles

Recommendations For The Management Of Patients With Depression In General Clinical Practice

Depression is one of the biggest health problems. If patient has symptoms of depression, then the patient should be treated. Patients with depression have a four times higher risk of suicide than the general population, which worsens their physical health and overall quality of life. This is associated with an increased risk of coronary heart disease, stroke, pain, alcohol abuse, smoking and illicit drug use. This determines the urgency of the problem of depression at the stage of primary care. A good family-patient relationship is essential in the treatment of depressed patients. In the practice of a general practitioner the prevalence of depression is 5%. Each year, two patients are hospitalized for depression, and one patient commits suicide every other day. The formation of the patient's attitude to the disorder depends on the correct assessment by doctor. There is a need for a clear ability to use various depression screening tools be general practitioners. This article discusses some available recommendations for depression management for primary health care physicians.

Validity and item response theory properties of the Patient Health Questionnaire-9 for primary care depression screening in Mozambique (PHQ-9-MZ)

BackgroundDepression is one of the leading causes of disability in Mozambique; however, few patients with depression are identified in primary care. To our knowledge, there are no validated tools for depression screening in Mozambique. The aim of this study was to validate the Patient Health Questionnaire-9 (PHQ-9) for use in primary care settings in Mozambique.MethodsThe PHQ-9 was adapted using a structured multi-phase process led by a team of bilingual experts followed by a review by lay individuals and pilot-testing including cognitive interviews. The final Mozambican PHQ-9 (PHQ-9-MZ) was applied among 502 individuals randomly selected from antenatal, postpartum, and general outpatient consultations in three Ministry of Health primary healthcare clinics in Sofala Province, Mozambique. The PHQ-9-MZ was evaluated against the MINI 5.0-MZ as a gold standard diagnostic tool.ResultsThe majority of participants were female (74%), with a mean age of 28. Using the MINI 5.0-MZ, 43 (9%) of the sample tested positive for major depressive disorder. Items of the PHQ-9-MZ showed good discrimination and factor loadings. One latent factor of depression explained 54% of the variance in scores. Questions 3 (sleep) and 5 (appetite) had the lowest item discrimination and factor loadings. The PHQ-9-MZ showed good internal consistency, with a Cronbach’s alpha of 0.84, and an area under the receiver operating characteristic curve (AUROC) of 0.81 (95% CI: 0.73, 0.89). The PHQ-2-MZ had an AUROC of 0.78 (95% CI: 0.70, 0.85). Using a cut-point of ≥9, the PHQ-9-MZ had a sensitivity of 46.5% and a specificity of 93.5%. Using a cut-point of ≥2, the PHQ-2-MZ had a sensitivity of 74.4% and a specificity of 71.7%. Increasing the cut-point to ≥3, the PHQ-2-MZ has a sensitivity of 32.6% and a specificity of 94.6%.ConclusionsThe PHQ-9-MZ and PHQ-2-MZ emerge as two valid alternatives for screening for depression in primary health care settings in Mozambique. Depending on program needs and weighing the value of minimizing false positives and false negatives, the PHQ-9-MZ can be employed with cut-points ranging from ≥8 to ≥11, and the PHQ-2-MZ with cut-points ranging from ≥2 to ≥3.

Screening for depression in movement disorders clinic.

Depression is the most common, though often under-recognised, neuropsychiatric disturbance in movement disorders (MD). This study aimed to establish whether a briefer screening measure such as a visual analogue screening measure (Emotions Thermometer) or Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) could be a potentially suitable screening tool for depression in MD patients. Patients attending a regional MD outpatient clinic completed the Emotional Thermometer 7-item tool (ET7), the Hospital Anxiety and Depression Scale (HADS) and the Neurological Disorders Depression Inventory for Epilepsy (NDDIE). We used the Major Depression Inventory which provided the diagnosis of depression based on ICD-10 and DSM-IV as our diagnostic gold standard to compare the performance of ET7 and its individual sub-scales, its briefer version ET4, HADS, and NDDIE. Sensitivity, specificity, positive predictive value, negative predictive value and receiver operating characteristic curves were calculated to compare the performance of the screening tools. In total, 188 patients were included in the analysis. The most accurate tools as determined by Receiver Operating Characteristics curve were HADS-D for ICD-10 depressive episode and DepT for DSM-IV major depression. ET4 performed well as a 'rule-out' screening tool for both DSM-IV and ICD-10 depression. ET4 performance was comparable to HADS without the need for clinician scoring. The briefer ET4 performed almost as well as ET7. Emotions Thermometer and NDDI-E are quick and reliable screening tools for depression in the MD population and are comparable to HADS. We suggest routine use of visual analogue ET4 as it is briefer, requires less time to complete and does not require scoring from the clinicians. It has the potential to be widely implemented across busy neurology clinics to assist in depression screening.

The Cost of Poor Mental Health in Total Joint Arthroplasty

BackgroundThe purpose of this analysis was to evaluate (1) the impact of depression on resource utilization and financial outcomes in bundled total joint arthroplasty (TJA) and (2) whether similar effects are seen using baseline patient-reported outcome scores. MethodsAll elective bundled TJA cases from 2017 to 2018 at an academic system in the New York City area were included. We analyzed variables associated with cost differences seen between patients with and without depression, and between patients with low (<40th percentile) and high baseline (>60th percentile) Veterans RAND 12-Item Health Survey mental component scores (MCSs). We also analyzed whether depression or low MCS could predict worse financial outcomes. ResultsOur population included 825 patients, 418 with patient-reported outcome scores data. Depression was associated with higher rates of skilled nursing facility (SNF) discharge (42.7% vs 36.5%, P = .04), SNF payments ($16,200 vs $12,100, P = .0002), and average total episode costs ($31,000 vs $27,000, P = .04). Depression predicted bundle cost to be greater than target price (OR 1.82, 95% CI: 1.04-.16; P = .04) and SNF payment greater than 75th percentile (OR: 1.91; 95% CI: 1.00-3.65; P < .05). Similar effects were not seen using MCS. ConclusionThis is the first study to determine that depression predicts bundle cost greater than target price and SNF payment greater than 75th percentile. Our results emphasize the importance of accurate preoperative assessment of mental health in optimization of care, focusing on attenuating the increased SNF payments associated with depression. As similar effects were not seen using MCS, future studies should analyze the use of validated screening tools for depression, such as the PHQ-9, for more accurate assessments of patient mental health in TJA.

Anxiety and depression on the liver transplant waiting list: a case for psychological prehabilitation?

Introduction:Anxiety and depression in patients awaiting liver transplantation are associated with worse clinical outcomes. However, optimising patient mental health is not routinely addressed in pre-transplant care.Aims:To understand the prevalence of anxiety and depression in patients awaiting transplantation and their access to pharmacological and psychological therapies.Methods:Patients awaiting transplantation were offered screening for anxiety and depression using the Hospital Anxiety and Depression Screening (HADS) tool. Data pertaining to patient demographics and previous treatment for anxiety and depression were recorded and analysed.Findings:Over 50% of patients recorded abnormal scores for anxiety and depression. Of the 19 patients screened, 42% had received treatment for either disorder, and most found the intervention unhelpful due to lack of follow-up appointments and limited understanding of their underlying chronic liver disease. There was a significant association between female sex and screening positive for depression.Conclusion:Anxiety and depression are prevalent in patients awaiting liver transplantation. The integration of a psychologist into the transplantation multidisciplinary team may improve patient outcomes.

Cut-off points for Polish-language versions of depression screening tools among patients with Type 2 diabetes

AimsScreening tools can help improve the detection of depression in patients with diabetes, yet the psychometric properties of most translations of scales, which are originally published in English, have not been assessed. Thus we studied the screening performance of widely used depression measures. MethodWe applied the cut-off points of the English-language versions of the Beck Depression Inventory (BDI); Hospital Anxiety and Depression Scale (HADS); Depression in Diabetes Self-Rating Scale (DDS-RS); Brief Self-Rating Scale of Depression and Anxiety (BS-RSDA); and Problematic Areas in Diabetes Survey (PAID), all of which were used to assess diabetes-specific distress in a sample of 101 patients with Type 2 diabetes. The Mini International Neuropsychiatric Interview and the Hamilton Depression Rating Scale (HDRS) were used to diagnose depression. ResultsWhen the English cut-off points were used, the tools had varied values of both sensitivity and specificity. When the best cut-off points were used, all measures had either very good or good sensitivity. Taking into account their length, the HADS and the BS-RSDA seem to be the best among the screening tools. ConclusionsEffective initial diagnosis of depression in patients with diabetes during a routine medical visit requires the use of screening tools that have adequate cut-off points.The analyses presented in this article show that screening tools should be validated and the cut-off points that are used should be population-specific.

Validity, reliability and cut-offs of the Patient Health Questionnaire-9 as a screening tool for depression among patients living with epilepsy in Rwanda.

BackgroundPatients with epilepsy (PwE) have an increased risk of active and lifetime depression. Two in 10 patients experience depression. Lack of trained psychiatric staff in low- and middle-income countries (LMIC) creates a need for screening tools that enable detection of depression in PwE. We describe the translation, validity and reliability assessment of the Patient Health Questionnaire-9 (PHQ-9) as a screening tool for depression among PwE in Rwanda.MethodPHQ-9 was translated to Kinyarwanda using translation-back translation and validated by a discussion group. For validation, PwE of ≥15 years of age were administered the PHQ-9 and Hamilton Depression Rating Scale (HDRS) by trained psychiatry staff at Visit 1. A random sample of 20% repeated PHQ-9 and HDRS after 14 days to assess temporal stability and intra-rater reliability. Internal structure, reliability and external validity were assessed using confirmatory factor analysis, reliability coefficients and HDRS-correlation, respectively. Maximal Youden’s index was considered for cut-offs.ResultsFour hundred and thirty-four PwE, mean age 30.5 years (SD ±13.3), were included of whom 33.6%, 37.9%, 13.4%, and 15.1% had no, mild, moderate and severe depression, respectively. PHQ-9 performed well on a one-factor model (unidimensional model), with factor loadings of 0.63–0.86. Reliability coefficients above 0.80 indicated strong internal consistency. Good temporal stability was observed (0.79 [95% CI: 0.68–0.87]). A strong correlation (R = 0.66, p = 0.01) between PHQ-9 and HDRS summed scores demonstrated robust external validity. The optimal cut-off for the PHQ-9 was similar (≥5) for mild and moderate depression and ≥7 for severe depression.ConclusionPHQ-9 validation in Kinyarwanda creates the capacity to screen PwE in Rwanda at scores of ≥5 for mild or moderate and ≥7 for severe depression. The availability of validated tools for screening and diagnosis for depression is a forward step for holistic care in a resource-limited environment.

Why validation is not enough: Setting the scene for the implementation of the Kimberley Mum's Mood Scale.

BackgroundThe two part Kimberley Mum’s Mood Scale (KMMS) has been developed and validated as a culturally appropriate perinatal depression and anxiety screening tool for Aboriginal women living in the sparsely populated Kimberley region of North West Australia. As part of implementation aspects of user acceptability were explored to improve clinical utilisation of the KMMS.MethodsEighteen health professionals involved in perinatal care participated in an online survey or a qualitative semi-structured interview. Ten Aboriginal women (who held administrative, professional or executive roles) were subsequently interviewed in depth to further explore aspects of KMMS user acceptability.ResultsMany of the health professionals were not using the second part of the KMMS (the psychosocial discussion tool). Time constraints and a perception that the KMMS is only appropriate for women with literacy issues were identified by health professionals as significant barriers to KMMS uptake. In contrast the Aboriginal women interviewed considered the KMMS to be important for literate Aboriginal women and placed high value on having the time and space to ‘yarn’ with health professionals about issues that are important to them.ConclusionImplementing the KMMS across the Kimberley region requires health professionals to be trained. It also requires strategic engagement with health services to ensure health professionals and mangers understand the rationale and significance of the KMMS and are engaged in its successful implementation.

The validity and reliability of the PHQ-9 in screening for post-stroke depression

BackgroundDepression affects about 30% of stroke survivors within 5 years. Timely diagnosis and management of post-stroke depression facilitate motor recovery and improve independence. The original version of the Patient Health Questionnaire-9 (PHQ-9) is recognized as a good screening tool for post-stroke depression. However, no validation studies have been undertaken for the use of the Thai PHQ-9 in screening for depression among Thai stroke patients.MethodsThe objectives were to determine the criterion validity and reliability of the Thai PHQ-9 in screening for post-stroke depression by comparing its results with those of a psychiatric interview as the gold standard. First-ever stroke patients aged ≥45 years with a stroke duration 2 weeks–2 years were administered the Thai PHQ-9. The gold standard was a psychiatric interview leading to a DSM-5 diagnosis of depressive disorder and adjustment disorder with a depressed mood. The summed-scored-based diagnosis of depression with the PHQ-9 was obtained. Validity and reliability analyses, and a receiver operating characteristic curve analysis, were performed.ResultsIn all, 115 stroke patients with a mean age of 64 years (SD: 10 years) were enrolled. The mean PHQ-9 score was 5.2 (SD: 4.8). Using the DSM-5 criteria, 11 patients (9.6%) were diagnosed with depressive disorder, 12 patients (10.5%) were diagnosed with adjustment disorder with a depressed mood. Both disorders were combined as a group of post-stroke depression. The Thai PHQ-9 had satisfactory internal consistency (Cronbach’s alpha: 0.78). The algorithm-based diagnosis of the Thai PHQ-9 had low sensitivity (0.52) but very high specificity (0.94) and positive likelihood ratio (9.6). Used as a summed-scored-based diagnosis, an optimal cut-off score of six revealed a sensitivity of 0.87, specificity of 0.75, positive predictive value of 0.46, negative predictive value of 0.95, and positive likelihood ratio of 3.5. The area under the curve was 0.87 (95% CI: 0.78–0.96).ConclusionsThe Thai PHQ-9 has acceptable psychometric properties for detecting a mixture of major depression and adjustment disorder in post-stroke patients, with a recommended cut-off score of ≥6 for a Thai population.

PHQ-9 Overestimates Depression Prevalence

Back to table of contents Previous article Next article Clinical & ResearchFull AccessPHQ-9 Overestimates Depression PrevalenceTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:4 Jun 2020https://doi.org/10.1176/appi.pn.2020.5b6AbstractFor accurate estimates, use data amassed through diagnostic methods rather than through the Patient Health Questionnaire-9.The Patient Health Questionnaire-9 (PHQ-9) is often used in research to estimate the prevalence of depression in a population. However, a meta-analysis in the Journal of Clinical Epidemiology suggests that using this common screening tool this way can lead to substantial overestimates when compared with diagnostic methods such as the Structured Clinical Interview (SCID) for the Diagnostic and Statistical Manual of Mental Disorders.The PHQ-9 is good for tracking depressive symptoms but is not designed to capture the prevalence of depression.—Brooke Levis, Ph.D.“Disease prevalence estimates have important implications for interpreting medical research, understanding disease burden, and making decisions about health care resource utilization,” wrote Brooke Levis, Ph.D., who conducted the research during her doctoral training at McGill University in Montreal, and colleagues. “Administering diagnostic interviews in large enough samples to estimate prevalence, however, is resource intensive. Thus, researchers sometimes use self-report depression symptom questionnaires or screening tools instead and label the percentage of participants scoring above a screening cutoff as depression prevalence.”The researchers analyzed data from 44 studies that included a total of 9,242 participants. They estimated the percentage of participants who scored at least 10 on the PHQ-9, the percentage of participants who were classified as having major depression based on the SCID, and the differences between the two estimates. The researchers found the prevalence of depression using the PHQ-9 to be 24.6%, compared with 12.1% using the SCID. This means that using PHQ-9 data more than doubles the estimate of depression compared with using SCID data.“We weren’t surprised [by the results] because theoretically, one would expect this. Screening tools are supposed to cast a wide net to find lots of people to examine, not to estimate disorder prevalence,” Levis told Psychiatric News. In other words, the true prevalence may be different from what PHQ-9 estimates suggest because many people who report depressive symptoms on the PHQ-9 do not meet the diagnostic criteria for deression when they are further evaluated with tools such as the SCID.“The message is simple: Researchers who want to estimate depression prevalence should use appropriate methods, not the PHQ-9,” Levis said. “It’s good for other things, such as monitoring depression symptom levels, but not for this.”“Although the finding is not surprising, given that the PHQ is a screening tool, it is good to see this quantified,” said APA Director of Research and Deputy Medical Director Nitin Gogtay, M.D. “Screening tools are to be taken as [such] and not to bypass a thorough clinical interview and the use of semi-structured interviews, which tend to be more thorough.”Some policymakers may interpret the results to mean that fewer people have depression than previously thought and attempt to allocate fewer resources to mental health care. That would be a mistake, said study co-author Brett Thombs, Ph.D., a professor in the Department of Psychiatry at McGill University. “Anybody who cares about mental health knows that many people with mental health conditions [already] can’t access the kind of care they need, when they need it, and the amount they need,” Thombs said. “We don’t need to exaggerate estimates of prevalence to make that clear.”In their conclusion, the researchers noted that although they looked at data from one only depression screening tool, the PHQ-9, they “expect that other [screening] tools would similarly exaggerate depression prevalence.” ■This study was funded by the Canadian Institutes of Health Research. “Patient Health Questionnaire-9 Scores Do Not Accurately Estimate Depression Prevalence: Individual Participant Data Meta-Analysis” is posted here. ISSUES NewArchived

Psychometric assessment of the Edinburgh Postnatal Depression Scale in an obstetric population

The prevalence and negative effects of perinatal depression are well known. The Edinburgh Postnatal Depression Scale (EPDS) is a common screening tool for perinatal depression and it is recommended for use by several professional organizations. The current study tested competing EPDS factor structures and assessed EPDS change from intake to 6-week follow-up, and identified demographic correlates in an outpatient obstetric sample. Using a retrospective observational study design, medical records were coded for demographic, mental health, and EPDS patient data (n = 524). Confirmatory factor analysis, t-tests, and ANOVA were utilized. Findings included: (1) a 3-factor model (i.e. anxiety, depression, anhedonia) of the EPDS displayed the best fit to the current data; (2) small declines in all 3 subscales of the EPDS from intake to 6-week follow-up appointments and; (3) demographic correlates of EPDS subscales included history of depression, history of anxiety, race, and pregnancy status (i.e. first child or not). The 3-factor structure can be used in clinical practice to assess perinatal depression in a nuanced fashion. Given that history of depression and anxiety are risk factors for perinatal depression, a thorough assessment of these items in clinical practice is needed.

Identification and Management of Perinatal Depression: Differences between Healthcare Providers

Objective: Pilot data was collected to examine providers’ beliefs, knowledge, self-efficacy, barriers, and practices related to perinatal depression and how they may differ across provider types. Background: High prevalence and detrimental impact of depression during pregnancy and the first year postpartum (i.e. perinatal period) on maternal and child health outcomes highlights the need for improving diagnosis and treatment during this critical period. Healthcare providers play a significant role in helping to identify and manage perinatal depression. Methods: Ninety-nine providers (e.g. physicians, nurses, mental health workers, public health practitioners) who provide care to pregnant women in Colorado completed a 64-item online survey. Results: Although 94% of providers reported it was their responsibility to recognize perinatal depression, variations across specialties with regards to responsibility to treat were found. Most providers (91%) reported use of a screening tool for depression, 60% of providers provide counseling on perinatal depression, and 80% of providers refer patients for treatment of perinatal depression on at least a monthly basis. Significant differences in knowledge, self-efficacy, current practices, and perceived patient barriers were found across provider specialties. Conclusion: These findings highlight the need for expansion of online training programs to increase awareness of mental health resources in the community, improve confidence related to diagnosis and treatment of perinatal mood disorders, and to enhance communication between mental health specialists and healthcare providers in order to effectively identify and manage maternal depression.

Correlation between patient health questionnaire-2 and postoperative pain in laparoscopic cholecystectomy.

BackgroundPostoperative pain is affected by preoperative depression. If the risk of postoperative pain associated with depression can be predicted preoperatively, anesthesiologists and/or surgeons can better manage it with personalized care. The objective of this study was to determine the efficacy of Patient Health Questionnaire-2 (PHQ-2) depression screening tool as a predictor of postoperative pain.MethodsA total of 50 patients scheduled for elective laparoscopic cholecystectomy with an American Society of Anesthesiologists physical status 1 or 2 were enrolled. They answered the PHQ-2, which consists of two questions, under the supervision of a researcher on the day before the surgery. The numerical rating scale (NRS) scores were assessed at post-anesthesia care unit (PACU), at 24, and 48 postoperative hours, and the amount of intravenous patient-controlled analgesia (IV-PCA) administered was documented at 24, 48, and 72 postoperative hours. At 72 h, the IV-PCA device was removed and the final dosage was recorded.ResultsThe NRS score in PACU was not significantly associated with the PHQ-2 score (correlation coefficients: 0.13 [P = 0.367]). However, the use of analgesics after surgery was higher in patients with PHQ-2 score of 3 or more (correlation coefficients: 0.33 [P = 0.018]).ConclusionsWe observed a correlation between the PHQ-2 score and postoperative pain. Therefore, PHQ-2 could be useful as a screening test for preoperative depression. Particularly, when 3 points were used as the cut-off score, the PHQ-2 score was associated with the dosage of analgesics, and the analgesic demand could be expected to be high with higher PHQ-2 scores.

A New BOS: Burnout Syndrome in Lung Transplant Physicians

Burnout is common in all types of physicians, but little is known about burnout in lung transplant physicians. The purpose of this study was to explore burnout and its relationship to job factors and depression in lung transplant physicians. We conducted a cross-sectional study in September 2019 of lung transplant pulmonologists and surgeons worldwide. The survey included demographic and job characteristics, the Maslach Burnout Inventory (MBI), and the Patient Health Questionnaire-2 (PHQ-2), a screening tool for depression. The MBI included assessment of emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Ninety lung transplantation pulmonologists and surgeons completed the survey. Physicians completing the survey were predominantly male (80%), pulmonologists (84.4%), and from the United States (73.3%). High emotional exhaustion is present in 42.2% of physicians, while high depersonalization was present in 15.6% and low personal accomplishment in 21.1%. Depression was present in 15.6% of responders. There was significant association between emotional exhaustion score and total score on the PHQ-2 (ρ=0.72, p<0.001). Gender, transplant volume, type of job, age, and call hours were not associated with differences in burnout. There was significantly greater emotional exhaustion in physicians with more years of experience (p=0.013). Greater time spent in the clinical care of lung transplantation patients was associated with a higher EE score (ρ=0.28, p=0.008), while greater time spent in teaching/education was associated with a lower EE score (ρ=-0.32, p=0.006). Those responders with high emotional exhaustion were more likely to find their job had a negative impact on their lives (p<0.001). Emotional exhaustion is common in lung transplant physicians and is associated with depression and a negative impact on life. More experienced transplant physicians have higher emotional exhaustion than less experienced physicians. More information is needed to determine if certain characteristics such as resilience allow retention in the field of lung transplantation despite high burnout levels.

Text Messaging as a Screening Tool for Depression and Related Conditions in Underserved, Predominantly Minority Safety Net Primary Care Patients: Validity Study.

BackgroundSMS text messaging is an inexpensive, private, and scalable technology-mediated assessment mode that can alleviate many barriers faced by the safety net population to receive depression screening. Some existing studies suggest that technology-mediated assessment encourages self-disclosure of sensitive health information such as depressive symptoms while other studies show the opposite effect.ObjectiveThis study aimed to evaluate the validity of using SMS text messaging to screen depression and related conditions, including anxiety and functional disability, in a low-income, culturally diverse safety net primary care population.MethodsThis study used a randomized design with 4 study groups that permuted the order of SMS text messaging and the gold standard interview (INTW) assessment. The participants for this study were recruited from the participants of the prior Diabetes-Depression Care-management Adoption Trial (DCAT). Depression was screened by using the 2-item and 8-item Patient Health Questionnaire (PHQ-2 and PHQ-8, respectively). Anxiety was screened by using the 2-item Generalized Anxiety Disorder scale (GAD-2), and functional disability was assessed by using the Sheehan Disability Scale (SDS). Participants chose to take up the assessment in English or Spanish. Internal consistency and test-retest reliability were evaluated by using Cronbach alpha and intraclass correlation coefficient (ICC), respectively. Concordance was evaluated by using an ICC, a kappa statistic, an area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity. A regression analysis was conducted to examine the association between the participant characteristics and the differences in the scores between the SMS text messaging and INTW assessment modes.ResultsOverall, 206 participants (average age 57.1 [SD 9.18] years; females: 119/206, 57.8%) were enrolled. All measurements except the SMS text messaging–assessed PHQ-2 showed Cronbach alpha values ≥.70, indicating acceptable to good internal consistency. All measurements except the INTW-assessed SDS had ICC values ≥0.75, indicating good to excellent test-retest reliability. For concordance, the PHQ-8 had an ICC of 0.73 and AUROC of 0.93, indicating good concordance. The kappa statistic, sensitivity, and specificity for major depression (PHQ-8 ≥8) were 0.43, 0.60, and 0.86, respectively. The concordance of the shorter PHQ-2, GAD-2, and SDS scales was poor to fair. The regression analysis revealed that a higher level of personal depression stigma was associated with reporting higher SMS text messaging–assessed PHQ-8 and GAD-2 scores than the INTW-assessed scores. The analysis also determined that the differences in the scores were associated with marital status and personality traits.ConclusionsDepression screening conducted using the longer PHQ-8 scale via SMS text messaging demonstrated good internal consistency, test-retest reliability, and concordance with the gold standard INTW assessment mode. However, care must be taken when deploying shorter scales via SMS text messaging. Further regression analysis supported that a technology-mediated assessment, such as SMS text messaging, may create a private space with less pressure from the personal depression stigma and therefore encourage self-disclosure of depressive symptoms.Trial RegistrationClinicalTrials.gov NCT01781013; https://clinicaltrials.gov/ct2/show/NCT01781013International Registered Report Identifier (IRRID)RR2-10.2196/12392

Depressive and/or anxiety scoring instruments used as screening tools for predicting postoperative delirium after cardiac surgery: A pilot study

BackgroundDepression is common in patients with cardiac disease. Depression is a risk factor for developing postoperative delirium, a common and serious complication to cardiac surgery. ObjectivesThe aim was to evaluate if screening tools for depression can be used to predict postoperative delirium after cardiac surgery. MethodsThis was a prospective population-based pilot study including 26 patients between 23 and 80 years of age undergoing cardiac surgery in Sweden during 2018. The day before surgery the participants filled out the depression screening instruments Hospital Anxiety and Depression Scale and Patient Health Questionnaire. After discharge the patient charts were examined for documentation of symptoms of delirium. ResultsFive (20%) patients screened positive regarding depression using the Hospital Anxiety and Depression Scale and 7 patients (27%) screened positive using The Patient Health Questionnaire. Four (22%) patients showed symptoms of postoperative delirium, none of them screened positive for depression prior to surgery. ConclusionWe found no difference between the questionnaires PHQ-9 and HADS regarding identifying depressive symptoms. Moreover, we found that post-operative delirium, to a certain extent, can be detected by reading the patient́s charts postoperatively. However, this pilot study showed that screening tools for delirium need to be better implemented.

Healthcare utilization and out-of-pocket expenditures associated with depression in adults: a cross-sectional analysis in Nepal

BackgroundDespite attempts to improve universal health coverage (UHC) in low income countries like Nepal, most healthcare utilization is still financed by out-of-pocket (OOP) payments, with detrimental effects on the poorest and most in need. Evidence from high income countries shows that depression is associated with increased healthcare utilization, which may lead to increased OOP expenditures, placing greater stress on families. To inform policies for integrating mental healthcare into UHC in LMIC, we must understand healthcare utilization and OOP expenditure patterns in people with depression. We examined associations between symptoms of depression and frequency and type of healthcare utilization and OOP expenditure among adults in Chitwan District, Nepal.MethodsWe analysed data from a population-based survey of 2040 adults in 2013, who completed the PHQ-9 screening tool for depression and answered questions about healthcare utilization. We examined associations between increasing PHQ-9 score and healthcare utilization frequency and OOP expenditure using negative binomial regression. We also compared utilization of specific outpatient service providers and their related costs among adults with and without probable depression, determined by a PHQ-9 score of 10 or more.ResultsWe classified 80 (3.6%) participants with probable depression, 70.9% of whom used some form of healthcare in the past year compared to 43.9% of people without probable depression. Mean annual OOP healthcare expenditures were $118 USD in people with probable depression, compared to $110 USD in people without. With each unit increase in PHQ-9 score, there was a 14% increase in total healthcare visits (95% CI 7–22%, p < 0.0001) and $9 USD increase in OOP expenditures (95% CI $2–$17; p < 0.0001). People with depression sought most healthcare from pharmacists (30.1%) but reported the greatest expenditure on specialist doctors ($36 USD).ConclusionsIn this population-based sample from Central Nepal, we identified dose-dependent increases in healthcare utilization and OOP expenditure with increasing PHQ-9 scores. Future studies should evaluate whether provision of mental health services as an integrated component of UHC can improve overall health and reduce healthcare utilisation and expenditure, thereby alleviating financial pressures on families.

Comparison of the performance of two depression rating scales in patients with epilepsy in southern China

ObjectiveThe aim of this study was to evaluate and compare the performance of the Chinese version of the Neurological Disorder Depression Inventory for Epilepsy (CNDDI-E) with that of the depression subscale of the Hospital Anxiety and Depression Scale (C-HADS-D) as screening tools for depression in the same patients with epilepsy (PWE). MethodsA total of 213 consecutive PWE were evaluated. Receiver operating characteristic (ROC) analysis was performed using the C-NDDI-E and C-HADS-D as predictors and the Chinese version of the Mini International Neuropsychiatric Interview (C-MINI) as the gold standard. ResultsThe area under the curve (AUC) for the C-NDDI-E was 0.870, and the optimal cutoff score was >11 (sensitivity 85.71%, specificity 79.78%); for the C-HADS-D, the AUC was 0.804, and the optimal cutoff score was >5 (sensitivity 85.71%, specificity 62.36%). The AUC for the C-NDDI-E was larger than the AUC for the C-HADS-D, but the comparison of the AUCs revealed no significant differences (P = 0.1444). ConclusionOur findings indicate that the C-NDDI-E and C-HADS-D have high validity and support the use of these screening tools for depression in PWE. Moreover, the C-NDDI-E is a better screening scale for diagnosing depression than the C-HADS-D according to the results of this study.

Mental disorders, suicidal ideation, plans and attempts among Canadian police.

BackgroundRecent investigations have demonstrated a significant prevalence of mental health disorders, including post-traumatic stress disorder (PTSD), and suicidal ideation, plans and attempts among Canadian public safety personnel, including police officers. What remains unknown is the relationship between mental disorders and suicide among sworn police officers, and the prevalence of both among civilian police workers.AimsTo examine the relationship between suicidal ideation, plans and attempts and positive mental health screens for depression, anxiety, panic disorder, alcohol abuse and PTSD among Canadian sworn and civilian police employees.MethodsParticipants completed an online survey that included self-report screening tools for depression, anxiety, panic disorder, alcohol abuse and PTSD. Respondents were also asked if they ever contemplated, planned or attempted suicide. Between-group (Royal Canadian Mounted Police [RCMP], provincial/municipal police and civilians) differences on mental health screening tools were calculated using Kruskal–Wallis analyses. The relationship between mental disorders and suicidal ideation, plans and attempts was evaluated with a series of logistic regressions.ResultsThere were 4236 civilian and sworn officer participants in the study. RCMP officers reported more suicidal ideation than other police and scored highest on measures of PTSD, depression, anxiety, stress and panic disorder, which were significantly associated with suicidal ideation and plans but not attempts. Relative to provincial and municipal police, civilians reported more suicide attempts and scored higher on measures of anxiety.ConclusionsThe results identify a strong relationship between mental health disorders and increased risk for suicidal ideation, plans and attempts among sworn and civilian Canadian police employees.

777 Use of the PHQ-2 as a Depression Screening Tool

Abstract Introduction In 2015, the Burn Quality Improvement Program (BQUIP) guidelines recommended systematic screening of Major Depressive Disorder at all verified burn centers. Our level one trauma center rolled out a program to screen all patients entering the burn service starting in June 2018. This project evaluates the program after the first year of implementation. Methods All patients over age 12 admitted to the burn service were screened by bedside nurses using the 2-item Patient Health Questionnaire (PHQ-2). Exclusion for screening included those who were intubated and sedated and/or not alert or oriented. A reminder for the PHQ-2 screener automatically popped up in the nursing task list in the electronic medical record until it was given or patient was coded as not appropriate for screening. Results A total of 509 patients were admitted to the Burn Service between June 2018 and May 2019. Of those, 40 were identified as not being appropriate for screening due to prolonged mental impairment (e.g. not able to regain consciousness), and 116 (24%) were not screened for unknown reasons. The remaining patients (n=353, 77%) were screened with the PHQ-2 and 94% of these patients were screened on the same day of admit. Of the patients screened, 28 (8%) scored above the clinical cut-off for probable depression (PHQ-2 ³ 3) and 265 (75.1%) did not endorse any symptoms on the PHQ-2 (PHQ-2 = 0). Of the 28 that screened positive on the PHQ-2, 16 (57.1%) received psychological services. Of those that did not receive psychology services, the majority were admitted for less than 3 days (n=10, 76.9%). Conclusions In the first year of the program the vast majority of eligible patients were able to be screened by nursing staff with a 2-item measure within one day of admit to the burn service. This success is likely due to the automation of the task in the electronic medical record, the ease of use of the PHQ-2 and the dedication of the nursing staff. The 8% rate of a positive screen is higher than the general population. Given that most patients were screened within 24 hours of admission, we are capturing depressive symptoms that predate the injury. We know that depression can impair burn recovery (e.g. affect participation in therapy, impede wound healing) and lead to poorer long term outcomes. Systematic screening of depressive symptoms upon admission will allow us to intervene earlier and potentially reduce barriers to optimal recovery. Despite high screening rates, about 40% of patients did not receive psychological intervention. We will be discussing utilization of resources for providing inpatient services to patients with a positive screen. Applicability of Research to Practice The PHQ-2 is an effective screening tool for depressive symptoms for patients on an inpatient burn unit. These findings are important for hospital systems looking to screen for and treat the mental health needs of burn patients. Depression screening will be required for BQUIP starting in 2020.