Somatic Items Research Articles

The factor structure the PHQ-9 in Russian patients recovered from COVID-19

IntroductionThe nine-item Patient Health Questionnaire-9 (PHQ-9) is the first choice for screening for depression in primary care and other medical settings. The PHQ-9 has been shown to be a reliable and valid measure of depression symptoms, but there is disagreement among researchers about the factor structure of this questionnaire. Recent systematic reviews have found four different factor models of the PHQ-9, with one- and two-factor models being the most common. This discrepancy may be due to linguistic, cultural and clinical differences between the populations studied. The factor structure of the Russian version of the PHQ-9 during the COVID-19 pandemic has not been examined in any study to date.ObjectivesThe aim of our study was to determine the factorial structure and internal consistency of the Russian version of the PHQ-9 in COVID-19 survivors.MethodsFourteen thousand 725 (female - 11479 (78.0%), age - 18-79 years (M - 47.09, SD - 12.70) participants completed an online survey including the PHQ-9 and an ad hoc questionnaire focusing on sociodemographic and COVID-related characteristics. McDonald’s omega coefficient was estimated to determine the internal consistency of the questionnaire. Exploratory structural equation modelling (ESEM) with weighted least squares mean and variance adjusted estimator and geomin rotation was performed in Mplus 7.ResultsESEM provided evidence for a three-factor structure of the PHQ-9, representing affective (items 2, 6, 9), anergic (items 1, 3) and somatic (items 3, 5, 7, 8) dimensions of depression. These factors fit the data well (CFI - 0.998; TLI - 0.994; RMSEA (95% CI) - 0.028 (0.024 - 0.032)), better than a single factor (CFI - 0. 955; TLI - 0. 940; RMSEA (95% CI) - 0.089 (0.087 - 0.092)) and two-factor (CFI - 0.985; TLI - 0.971; RMSEA (95% CI) - 0.062 (0.059 - 0.065)). The McDonald’s omega was 0.82.ConclusionsOur study revealed a three-factor structure of the Russian version of the PHQ-9 in COVID-19 survivors. COVID-19. A high internal consistency of the Russian version of the instrument was confirmed.Disclosure of InterestNone Declared

Impact of depressive symptoms on medication adherence in older adults with chronic neurological diseases

BackgroundNonadherence to medication contributes substantially to worse health outcomes. Especially among older adults with chronic illness, multimorbidity leads to complex medication regimes and high nonadherence rates. In previous research, depressive symptomology has been identified as a major contributor to nonadherence, and some authors hypothesize a link via motivational deficits and low self-efficacy. However, the exact mechanisms linking depressive symptomology and nonadherence are not yet understood. This is in part because the often-employed sum scores cannot do justice to the complexity of depressive symptomology; instead, it is recommended to assess the influence of individual symptoms.MethodsFollowing this symptom-based approach, we performed correlation, network and regression analysis using depressive symptoms as depicted by the items of the revised Beck Depression Inventory II (BDI) to assess their influence with nonadherence in N = 731 older adults with chronic neurological diseases. Nonadherence was measured with the self-report Stendal Adherence to Medication Score (SAMS).ResultsEven when controlling for sociodemographic and health-related covariates, the BDI remained the most influential contributor to nonadherence. Across different methods, Loss of Interest and Difficulty with Concentration were identified as particularly influential for nonadherence, linking nonadherence with other affective or somatic BDI items, respectively. Additionally, Fatigue, Problems with Decision Making, Suicidal Thoughts, and Worthlessness contribute to nonadherence.ConclusionUsing a symptom-driven approach, we aimed to understand which depressive symptoms contribute to higher levels of nonadherence. Our results refine previous hypotheses about motivation and control beliefs by suggesting that it is not merely a lack of beliefs in the efficacy of medication that connects depressive symptoms and nonadherence, but rather an overall lack of interest in improving one’s health due to feelings of worthlessness and suicidal tendencies. This lack of interest is further substantiated by already sparse resources caused by changes in concentration and fatigue. In order to improve health outcomes and reduce nonadherence, these associations between depressive symptoms must be further understood and targeted in tailored interventions.

Psychometric testing of the indonesian version of beck depression inventory-ii among Indonesian floods survivors

Introduction: Indonesia is a multi-linguistic country using the official language of Bahasa Indonesia. It is important to use formal language to collect research data without misinterpretation of study outcome and intervention effect with high accuracy. Therefore, this study aimed to analyze whether the Beck Depression Inventory-II (BDI-II) instrument translated into the Indonesian version was reliable and valid for measuring depression in floods-affected communities. Methods: The forward-backward translation was used to translate the BDI-II from English to Indonesian version. We tested the reliability and validity including content and construct validity through exploratory factor analysis (EFA) with varimax rotation and confirmatory factor analysis (CFA). We recruited 107 annual flood survivors in West Java, Indonesia as participants to test the psychometric testing. Results: The structures shown by the EFA are two factors, with Factor 1 representing negative cognitive-attitude domains and somatic symptom items consisting of Factor 2. The CFA concludes that the general factor model best fits the data on the basis Goodness-of-Fit Index (GFI)= 0.8; Root Mean Square Error of Approximation (RMSEA)= 0.09; Standard Root-Mean-Square Residual (SRMSR)); Comparative Fit Index (CFI)= 0.81; Tucker–Lewis Index (TLI)= 0.79; and p-value χ2 = < 0.01, χ2/df: 1.82). Conclusions: The results showed that the BDI-II Indonesian version has good reliability and validity and can be used to measure depression status among people who suffer floods in community setting. Future studies need to be validated within multiple socio-cultural groups.

A Comparison of Depressive Symptom Presentation in Adolescent Type 1 Diabetes and Pediatric Primary Care Samples

Background. Depression is a common comorbidity in adolescents with type 1 diabetes (T1D). It is unclear if patterns of responses from questionnaires used to screen for depressive symptoms are influenced by the burden of living with T1D and/or the consequences of hyperglycemia. Based on this gap in the adolescent research, we sought to identify potential differences in depression screening response patterns between adolescents with and without T1D and relate response patterns with glycemic outcomes. Methods. Using a retrospective case–control design, we analyzed electronic health records for age, sex, and race-matched adolescents 13–18 years of age from a pediatric diabetes clinic (n = 477) and a pediatric primary care clinic (n = 477) in the United States. Adolescents in both settings were screened for depressive symptoms during the same time period using the Patient Health Questionnaire-9 (PHQ-9). Results. Participant demographics for matched characteristics were: 53.5% male, 71.7% White, median age 13.0 (interquartile range = 13.0, 14.0). After controlling for type of insurance, adolescents with T1D were more likely to have higher total PHQ-9 scores (odds ratio (OR) = 1.51, 95% CI = 1.17, 1.98, p = 0.002 ) and higher somatic subscores (OR = 1.57, 95% CI = 1.20, 2.05, p = 0.001 ) compared to the primary care sample. The pattern of item endorsement greater than “not at all” indicated that adolescents with T1D were more likely to have higher values for somatic items such as “trouble falling asleep” and “feeling tired” than those in the primary care sample. Item-total correlations and Cronbach’s α indicated that all items were contributing to the overall score in the same manner in each group. Conclusions. Symptom endorsement for sleep and fatigue were higher for adolescents with T1D and without T1D. Study results support the need for further examination of the origins of somatic symptoms in T1D and for an additional examination of the specificity of depression screening instruments used in routine pediatric diabetes care.

Investigating the Measurement Invariance of the Caregiver-Teacher Report Form (C-TRF) Factors in a Norwegian Early Childhood Education and Care Context

The Caregiver-Teacher Report Form (C-TRF) is an instrument frequently used by researchers and clinicians to assess psychopathology in preschool children based on information from early childhood education and care professionals. However, the measurement invariance of this instrument has not been investigated. Thus, the aim of the current study was to investigate the measurement invariance of the C-TRF for (1) girls vs. boys, and (2) for children below the age of three years old vs. three years or older, as measurement invariance is a prerequisite for a meaningful comparison of latent means between groups. Based on reports of 2904 children from 353 early childhood education and care professionals, our results showed full scalar invariance for an adapted C-TRF model, which supports the applicability of the instrument. However, awareness of the factor Somatic complaints and items with out-of-range parameters is warranted.

Validation of the neuroconnective endophenotype questionnaire (NEQ): a new clinical tool for medicine and psychiatry resulting from the contribution of Ehlers-Danlos syndrome.

The link between anxiety disorders and joint hypermobility syndrome (now under hypermobility spectrum disorders, which include hypermobile Ehlers-Danlos syndrome) has been widely replicated over the past 30 years and has grown beyond the initial nosological limits. To integrate clinical and research progress in this field, a new neuroconnective endophenotype (NE) and its corresponding instrument, the Neuroconnective Endophenotype Questionnaire (NEQ), have been developed. This new clinical construct, created with the active participation of patients, includes both somatic and psychological dimensions and symptoms and resilience items. The NE includes five dimensions: (1) sensorial sensitivity, (2) body signs and symptoms, (3) somatic conditions, (4) polar behavioral strategies, and (5) psychological and psychopathological dimensions. The NEQ information is collected through four self-administered questionnaires (sensorial sensitivity, body signs and symptoms, polar behavioral strategies, and psychological characteristics) and a structured diagnostic part that should be completed by a trained observer. This hetero-administered part incorporates (a) psychiatric diagnoses (using structured criteria, e.g., MINI), (b) somatic disorders diagnosis, using structured criteria, and (c) assessment of joint hypermobility criteria. In a sample of 36 anxiety cases with 36 matched controls, the NEQ obtained high scores for test-retest, inter-rater reliability, and internal consistency. As for predictive validity, cases and controls significantly differed in all five dimensions and hypermobility measurements. We can conclude that the NEQ has achieved acceptable reliability and validity values and, therefore, is ready to be used and tested in different samples. This original and consistent construct including somatic and mental items may improve clinical specificity, the search for more comprehensive therapies, and their genetic and neuroimaging bases.

The comparison of plasma zonulin levels between symptom exacerbation and treatment response periods in schizophrenia: a case-control study with follow-up

IntroductionPlasma zonulin is acknowledged to be a biomarker for intestinal permeability. Previous studies have demonstrated significant relationships regarding potential effects of zonulin in several major psychiatric conditions including attention deficit and hyperactivity disorder, autism spectrum disorder and depression, however its role in schizophrenia still remains unclear.ObjectivesWe aimed to identify the alterations of plasma zonulin levels between the different periods of the illness and we strive to reveal the associations between plasma zonulin levels and symptoms in patients with chronic schizophrenia.Methods30 patients with schizophrenia and 29 healthy controls participated in the study. Sociodemographic data form and Positive and Negative Syndrome Scale (PANSS) were administered. Blood sampling was performed for patients who are in exacerbation and following treatment response periods along with the healthy controls. ELISA method was utilized to measure plasma zonulin levels.ResultsThe groups did not differ in plasma zonulin level comparisons. Plasma zonulin did not fluctuate between the symptom exacerbation and treatment response periods of the patients. Besides, plasma zonulin level was found to be associated with passive/apathetic social withdrawal, active social avoidance, and somatic concern items of the PANSS in a negative direction.ConclusionsThis is the first follow-up study in the literature that assesses plasma zonulin in patients with schizophrenia. The measurement of plasma zonulin may not be a convenient parameter in distinguishing symptom exacerbation and treatment response periods in chronic schizophrenia, nevertheless it may have implications on reduced social interaction and somatic symptoms. Our study can provide better insight for future studies to be more cautious while interpreting the associations of plasma zonulin levels with psychiatric disorders.Disclosure of InterestNone Declared

Adolescent idiopathic scoliosis patients treated with bracing, surgery, or observation showed no difference in behavioral and emotional function over a 2-year period.

The purpose of this study was to assess if behavior and emotional function, as measured by the Pearson Behavioral Assessment Survey for Children, Second Edition (BASC-2) in patients and parents, changes with differing treatment protocols in patients with adolescent idiopathic scoliosis (AIS). One previous study showed abnormal BASC-2 scores in a substantial number of patients diagnosed with AIS; however, no study has assessed how these scores change over the course of treatment. AIS patients aged 12 to 21 years completed the BASC-2. The 176-item questionnaire was administered to subjects at enrollment, assessing behavioral and emotional problems across 16 subscales of 5 domains: school problems, internalizing problems, inattention/hyperactivity, emotional symptoms index, and personal adjustment. Parents were given an equivalent assessment survey. Surveys were administered again after 2 years. Subject treatment groups (bracing, surgery, and observation) were established at enrollment. Patients were excluded if they did not complete the BASC-2 at both time points. Forty-six patients met the inclusion criteria, with 13 patients in the surgical, 20 in the bracing, and 13 in the observation treatment groups. At enrollment, 26% (12/46) of subjects with AIS had a clinically significant score in 1 or more subscales, and after 2 years 24% (11/46) of subjects reported a clinically significant score in at least 1 subscale (P = .8). There were no significant differences in scores between enrollment and follow-up in any treatment group. Similar to what was reported in a previous study, only 36% (4/11) of patients had clinically significant scores reported by both patient and parent, conversely 64% (7/11) of parents were unaware of their child's clinically significant behavioral and emotional problems. Common patient-reported subscales for clinically significant and at-risk scores at enrollment included anxiety (24%; 11/46), hyperactivity (24%; 11/46), attention problems (17%; 8/46), and self-esteem (17%; 8/46). At 2-year follow-up, the most commonly reported subscales were anxiety (28%; 13/46), somatization (20%; 9/46), and self-esteem (30%; 14/46). Patients with AIS, whether observed, braced or treated surgically, showed no significant change in behavior and emotional distress over the course of their treatment, or compared with each other at 2-year follow-up.

Mood symptoms in cervical dystonia: Relationship with motor symptoms and quality of life

BackgroundCervical dystonia (CD) has a high prevalence of anxiety and depression. The relationship between motor severity, mood symptoms and QoL is unclear and how to adequately assess these is also unknown. Instruments like the BAI, BDI and HADS are often used but items within these relating to somatic symptoms might influence the results. MethodsPatients with idiopathic cervical dystonia (CD) were included. The BAI, BDI, HADS, CIDP58 and TWSTRS2- severity score were used for assessment of motor, mood and QoL symptoms. Pearson’s correlations between motor and non-motor symptom scores were assessed. The psychometric properties of the psychiatric tools were measured and principal component analysis performed after identifying items that could correspond to somatic symptoms. Results201 participants were included. 42% of participants had either significant depression or anxiety symptoms or both when measured by BAI and BDI and 51% of patients met criteria on HADS. HADS-A and HADS-D, BAI and BDI were poorly correlated with TWSTRS2-S. The HADS-A and HADS-D both showed strong correlation with the sleep subdomain of CDIP58. Psychometric and principal component analysis on 149/201 participants did not reveal factor loadings consistent with the a priori somatic groupings. However mean scores were higher for somatic items. ConclusionA good score on the CDIP58, a commonly used tool, does not indicate mild disease severity or minimal mood symptoms. Minimal motor symptoms, similarly, also does not imply a positive QoL. Clinicians should be mindful on ideal methods for performing a holistic assessment of CD patients. This likely warrants a combination of motor, QoL and mood assessment tools.

Criterion and construct validity of the Beck Depression Inventory (BDI-II) to measure depression in patients with cancer: The contribution of somatic items

Background/ObjectiveScreening for depression in patients with cancer can be difficult due to overlap between symptoms of depression and cancer. We assessed validity of the Beck Depression Inventory (BDI-II) in this population. MethodData was obtained in an outpatient neuropsychiatry unit treating patients with and without cancer. Psychometric properties of the BDI-II Portuguese version were assessed separately in 202 patients with cancer, and 376 outpatients with mental health complaints but without cancer. ResultsConfirmatory factor analysis suggested a three-factor structure model (cognitive, affective and somatic) provided best fit to data in both samples. Criterion validity was good for detecting depression in oncological patients, with an area under the ROC curve (AUC) of 0.85 (95% confidence interval [CI], 0.76–0.91). A cut-off score of 14 had sensitivity of 87% and specificity of 73%. Excluding somatic items did not significantly change the ROC curve for BDI-II (difference AUCs = 0.002, p=0.9). A good criterion validity for BDI-II was also obtained in the non-oncological population (AUC = 0.87; 95% CI 0.81–0.91), with a cut-off of 18 (sensitivity=84%; specificity=73%). ConclusionsThe BDI-II demonstrated good psychometric properties in patients with cancer, comparable to a population without cancer. Exclusion of somatic items did not affect screening accuracy.

Identifying the Subtypes of Major Depressive Disorder Based on Somatic Symptoms: A Longitudinal Study Using Latent Profile Analysis.

BackgroundTwo-thirds of major depressive disorder (MDD) patients initially present with somatic symptoms, yet no study has used approaches based on somatic symptoms to subtype MDD. This study aimed to classify MDD via somatic symptoms and tracked the prognosis of each subtype.MethodsData were obtained from the study of Algorithm Guided Treatment Strategies for Major Depressive Disorder (AGTs-MDD). We recruited 395 subjects who received monotherapy of mirtazapine or escitalopram and conducted 2-, 4-, 6-, 8-, and 12-week follow-up assessments (n = 311, 278, 251, 199, and 178, respectively). Latent profile analysis (LPA) was performed on somatic symptom items of the depression and somatic symptoms scale (DSSS). Generalized linear mixed models (GLMM) were used to study the longitudinal prognosis of the subtypes classed by LPA. Primary outcome measures were the Hamilton Depression Rating Scale (HAMD), HAMD score reduction rate, as well as somatic and depressive items of DSSS.ResultsThree subtypes of MDD were found, namely, depression with mild somatic symptoms (68.9%), depression with moderate somatic symptoms (19.2%), and depression with severe somatic symptoms (11.9%). Scores of HAMD (F = 3.175, p = 0.001), somatic (F = 23.594, p < 0.001), and depressive (F = 4.163, p < 0.001) DSSS items throughout the 12-week follow-up showed statistical difference among the three subtypes. The moderate group displayed a higher HAMD-17 score and a lower reduction rate at the 6th week, and more severe depressive symptoms both at the 4th and 6th weeks.ConclusionThe results indicate that somatic symptoms should be emphasized in patients with MDD, and more attention is needed for those with moderate somatic symptoms, which may be relevant to a worse prognosis.

Symptom dimensions of anxiety and depression in patients receiving peritoneal dialysis compared to haemodialysis

Differences in symptom burden, treatment satisfaction and autonomy between patients receiving peritoneal dialysis and haemodialysis could be reflected by a difference in symptom dimensions of anxiety and depression. The aim of this study is to assess differences in prevalence and symptom dimensions of anxiety and depression between patients receiving peritoneal dialysis and haemodialysis. Baseline data from the Depression Related Factors and Outcomes in Dialysis Patients With Various Ethnicities and Races Study were used. Symptoms of anxiety and depression were measured with the Beck Anxiety Inventory and Beck Depression Inventory- second edition. Linear and logistic regression models were used to compare anxiety and depression total scores and somatic and subjective/cognitive symptom dimension scores between patients receiving peritoneal dialysis and haemodialysis, adjusted for potential confounders. In total, 84 patients receiving peritoneal dialysis and 601 patients receiving haemodialysis were included. Clinically significant symptoms of anxiety and depression were present in respectively 22% and 43% of the patients, with no differences between dialysis modality. Both modalities scored high on the somatic symptom dimensions and on individual somatic items. Almost all patients reported symptoms related to loss of energy and sleep. No differences in symptom dimensions of anxiety and depression were found between patients receiving peritoneal dialysis and haemodialysis. The high prevalence of somatic symptom dimensions in both groups underscores the possible interaction between somatic and psychiatric symptoms in dialysis patients and the need for early recognition and treatment of symptoms of anxiety and depression regardless of treatment modalities.

Youth depression and inflammation: Cross-sectional network analyses of C-Reactive protein, interleukin-6 and symptoms in a population-based sample

BackgroundInflammation-related proteins constitute a promising avenue in studying biological correlates of major depressive disorder (MDD). However, MDD is a heterogeneous condition – a crucial aspect to be considered in association studies. We examined whether inflammatory proteins are associated with categorical diagnosis, a dimensional total sum-score, and specific depressive symptoms among youths. MethodsWe analyzed data from the 1993 Pelotas Birth Cohort, a population-based study in Brazil that followed individuals up to age 22 years. Categorical psychiatric diagnoses were derived using adapted modules of the Mini International Neuropsychiatric Interview (MINI). Dimensional symptomatology was assessed using the Brazilian Portuguese version of the Center for Epidemiological Studies–Depression Scale–Revised (CESD-R). We estimated network structures that included individual depressive symptoms as measured by CESD-R items, peripheral inflammatory markers (C-Reactive Protein [CRP] and Interleukin-6 [IL-6]), as well as relevant covariates. ResultsWe evaluated 2586 participants (mean age = 22.5[SD = 0.33]) There were no associations between concentrations of inflammatory proteins and categorical diagnosis of MDD or with CESD-R total sum-scores. In symptom-specific analysis, CRP and IL-6 were positively connected to somatic and cognitive items. DiscussionWe found cross-sectional connections of two commonly studied inflammatory proteins and specific depressive symptoms. Conducting symptom-specific analyses in relation to biological markers might advance our understanding of the heterogeneity of MDD.

Listening to the Shenzhen Primary Healthcare Context to Adapt the mhGAP-IG.v2 for the Assessment of Depression: Qualitative Workshops with Primary Healthcare Leaders

In Shenzhen, despite recent primary and mental healthcare reform, Primary healthcare doctors (PHC) have limited access to diagnostic tools and a significant mental health treatment gap presides. The World Health Organization’s (WHO) mental health gap intervention guide (mhGAP-IG.v2) offers a non-specialist and evidence-based guide for the assessment of depression however requires adaptation to the context of use. Bilingual (Mandarin and English) qualitative research was undertaken with 30 PHC leaders from Shenzhen to compare their assessment approach for depression against the mhGAP-IG.v2 in order to identify context-specific modifications for a local guide. Local assessment differentiators included: a need for culturally sensitive translation of depression symptoms; a preference for a broad, non-hierarchical symptom presentation (including somatic, behavioural and anxiety items); national prioritisation of suicide patients; the integration of family into the cycle of care; limited primary care awareness of a depressive episode in Bipolar Disorder; and China’s specialist-led diagnostic approach. Contextual modification of mhGAP-IG.v2 is recommended to take account of China’s unique cultural and primary health system response to depression. Ongoing mental health training is required to develop professional confidence in the recognition of mental disorders.

Psychometric properties of the Center for Epidemiologic Studies Depression (CES-D) scale in stroke survivors

ABSTRACT Purpose This study aimed to evaluate the psychometric properties of the Center for Epidemiologic Studies Depression (CES-D) scale in adults with stroke. Methods A secondary analysis of the Stroke Recovery in Underserved Populations Cohort Study. The CES-D was administrated to 828 stroke patients at discharge from inpatient rehabilitation facilities and at 3- and 12-month follow-ups. Data were analyzed using classical test theory (CTT) and Rasch measurement model. Results Confirmatory factor analyses of the CES-D items showed excellent fit of a four-factor model (CFI = 0.98; TLI = 0.98; RMSEA = 0.05). CTT analyses revealed satisfactory reliability and validity. Rasch analyses also supported the unidimensionality of each factor (subscale). Wright maps indicated a floor effect and item gaps. A few items displayed differential item functioning: 3 items (1 depressed affect and 2 somatic symptoms) across gender, 1 item (depressed affect) across time of assessment and all # somatic symptom items across time of assessment. Conclusion The four-factor structure of the CES-D was confirmed and its psychometric properties were validated, supporting the use of four subscales to characterize depressive symptomatology in adults with stroke. Supplementary assessments are needed for evaluating and comparing somatic symptoms over time. A refinement of the CES-D was recommended to better differentiate stroke survivors with subtle depressive symptoms.

Psychometric Properties of the PHQ-9, HADS, and CES-D Questionnaires and the Prevalence of Depression in Patients with Cancer Receiving Radiotherapy

Objective: The primary aim was to compare the psychometric properties among the Patient Health Questionnaire (PHQ-9) (both including and excluding somatic symptom items), the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D), and the Center for Epidemiologic Studies Depression Scale (CES-D) in detecting depression in cancer patients receiving radiotherapy. The secondary aim was to investigate the prevalence of depression in this group of patients.Materials and Methods: Overall, 198 participants with cancer diagnosis from a radiology clinic took part in the study. They completed PHQ-9, HADS-D, and CES-D questionnaires and were interviewed in line with the Mini-International Neuropsychiatric Interview (M.I.N.I.) to confirm the diagnosis. The PHQ-9 was analyzed for three scoring methods: sum-score, inclusive (including all items), and exclusive (excluding 4 somatic symptom items) methods. The psychometric properties of each questionnaire were analyzed. The prevalence of depression measured by the M.I.N.I. was evaluated.Results: The sum-score method of the PHQ-9 had an equal sensitivity (100%) to the HADS-D and CES-D, and had a slightly higher specificity (91.1%) than the HADS-D (87.4%) and CES-D (90.6%). When compared results within the PHQ-9, the sum-score method had greater sensitivity than the inclusive (71.4%) and exclusive (42.9%) methods, and had a slightly lower specificity than the inclusive (96.9%) and exclusive (97.4%) methods. The prevalence of depression assessed by the M.I.N.I was 3.5%.Conclusion: The sum-score method of the PHQ-9 seemed to be the best tool to use for depression screening in cancer patients receiving radiotherapy due to its excellent sensitivity and specificity.

Irritable Bowel Syndrome in Dialysis Patients and Symptom Check List Revised (SCL 90-R) Screening.

Irritable bowel syndrome (IBS) is a frequently seen functional bowel disease. Although not lifethreatening, it impairs quality of life and leads to economic losses. IBS symptoms are widespread in dialysis patients. Psychopathological disorders are known to increase in both IBS and dialysis patients. The purpose of this study was to investigate the prevalence of IBS, IBS-related factors, and psychopathological disorders in patients. One hundred fifty patients followed-up in hemodialysis (HD) or peritoneal dialysis (PD) programs were included in this prospective study. Patients were divided into groups with and without diagnoses of IBS based on the Rome-III diagnostic criteria. The Symptom Check List Revised (SCL90-R) test was then applied to the patients. Patients with and without IBS were compared according to the scores obtained from the questionnaire. IBS was determined in 59 (39.3%) of the dialysis patients. The prevalence of IBS was significantly higher in women (P = .030). The presence of coronary artery disease (CAD) and use of erythropoietin (EPO) were significantly higher in patients with IBS (P = .029, P = .031). Somatization, obsessive-compulsive disorder, interpersonal sensitivity, depression, anxiety, phobic anxiety, psychoticism, and additional items were also higher in patients with IBS. Subscale scores for somatization, depression, and additional parameters in dialysis patients with IBS were above the threshold values for screening. IBS is common in dialysis patients. The presence of CAD or use of EPO were frequently observed in dialysis patients with IBS, and psychopathologies in depression, somatization, and additional subparameters were also higher in these patients.

Testing for Differences in the Reporting of Somatic Symptoms of Depression in Racial/Ethnic Minorities.

We tested if Latinx and Black individuals are more likely to somaticize depression compared with their White counterparts. We analyzed 14,745 depression ratings from 4,101 people living with HIV from 2007 to 2014. We calculated the percentage of each depression score accounted for by somatic symptom items (e.g., feeling tired). We analyzed depression scores using generalized estimation equations, which accounts for repeated measures within each person. Somatic symptoms accounted for 70% of depression scores for White patients, 66% for Latinx patients, and 68% for Black patients. Across the 14,745 assessments, adjusting for age and sex, and within-person correlation, the percentage of the depression scores made up of somatic items was lower for Latinx (b = -.03, p < .0001) and Black patients (b = -.02, p < .001), compared with White patients. The idea that Latinx and Black individuals are likely to somaticize depression may lead to underdiagnoses and perpetuate stereotypes and inequities that are not supported by empirical data.

Measurement invariance testing of the patient health questionnaire-9 (PHQ-9) across people with and without diabetes mellitus from the NHANES, EMHS and UK Biobank datasets

BackgroundThe prevalence of depression is higher among those with diabetes than in the general population. The Patient Health Questionnaire (PHQ-9) is commonly used to assess depression in people with diabetes, but measurement invariance of the PHQ-9 across groups of people with and without diabetes has not yet been investigated. MethodsData from three independent cohorts from the USA (n=1,886 with diabetes, n=4,153 without diabetes), Quebec, Canada (n= 800 with diabetes, n= 2,411 without diabetes), and the UK (n=4,981 with diabetes, n=145,570 without diabetes), were used to examine measurement invariance between adults with and without diabetes. A series of multiple group confirmatory factor analyses were performed, with increasingly stringent model constraints applied to assess configural, equal thresholds, and equal thresholds and loadings invariance, respectively. One-factor and two-factor (somatic and cognitive-affective items) models were examined. ResultsResults demonstrated that the most stringent models, testing equal loadings and thresholds, had satisfactory model fit in the three cohorts for one-factor models (RMSEA = .063 or below and CFI = .978 or above) and two-factor models (RMSEA = .042 or below and CFI = .989 or above). LimitationsData were from Western countries only and we could not distinguish between type of diabetes. ConclusionsResults provide support for measurement invariance between groups of people with and without diabetes, using either a one-factor or a two-factor model. While the two-factor solution has a slightly better fit, the one-factor solution is more parsimonious. Depending on research or clinical needs, both factor structures can be used.

A rasch-based validity study of the HSCL-25

The Hopkins Symptom Checklist-25 (HSCL-25) is a commonly used questionnaire to assess anxiety and depression in trauma-affected refugees. Despite numerous studies evaluating criterion validity and reliability, few studies have assessed the construct validity of the scale. In the current study, a Rasch analysis was carried out based on responses from 635 Arabic and Persian speaking refugees. Results supported the use of an eight- or nine-item anxiety subscale score. The anxiety subscale fit the Rasch model with limited modifications, including the exclusion of purely somatic items. Results for the depression subscale revealed a range of issues. While a shortened scale which accounted for gender differences allowed for a fit with the Persian speaking sample, no fit could be obtained for the Arabic speaking sample. We discuss whether more flexible psychometric models may be necessary to derive valid estimates of depression in some cultures. Both constructs studied, anxiety and depression, were comorbid to PTSD in the included sample. Most respondents were chronically affected and often troubled by extensive post-settlement stress. Results may not generalize to other populations, e.g. non-refugees or more recently arrived refugees. Purely somatic items have no clear place in the HSCL-25 anxiety subscale, while the anxiety items show good potential to fit a Rasch model. The HSCL-25 depression subscale may not be suitable for summating a single total score, reflecting the need for either a simpler scale or a more complex approach to assessing responses.