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ABSTRACT: Background: Parkinson's disease (PD) is frequently complicated by co-occurring psychiatric problems such as depression and anxiety that negatively affect the course and management of the illness. Yet, in most cases, these psychiatric comorbidities are neither recognized nor treated to remission. The primary purpose of this study was to identify and describe barriers to mental health care utilization for people with PD. Secondary objectives included the assessment of attitudes and preferences regarding the need for mental health services in the PD community and the acceptability of telehealth interventions as a method for improving access and quality of care. Methods: A total of 769 people with PD completed an anonymous cross-sectional questionnaire assessing barriers to mental health care utilization in this medical population. Respondents were drawn from a national sample.Results: Commonly endorsed barriers to mental health care utilization in PD reflect the patients' incomplete understanding of mental health problems, access issues, and illness-specific concerns, as well as the inadequate screening and detection of psychiatric complications by medical providers and the need for more effective treatments in this medical population. Several demographic, medical, and psychiatric variables also influenced the likelihood of accessing mental health care. Interest in telehealth approaches to mental health treatment was high and, in several instances, correlated with perceived barriers to mental health care utilization. Conclusions: People with PD may encounter a multitude of barriers that impede their pursuit of mental health care. Clinical implications are discussed and further research is needed to replicate and extend these findings.
Journal of Geriatric Psychiatry and Neurology 04/2013; · 3.07 Impact Factor
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ABSTRACT: BACKGROUND: Studies have consistently shown that Latinos with depression have lower adherence to antidepressant medication. Given that low adherence is associated with poorer response to treatment, this is a likely source of unequal care. The current study examined the efficacy of a motivational interviewing intervention for improving antidepressant adherence among Latinos with a depressive disorder. METHODS: Participants were 50 Latinos with a DSM-IV diagnosis of major depression or dysthymia who were receiving treatment at a community mental health center. Participants were recruited from July 2007 to December 2009 and were randomized to receive usual care (UC) or Motivational Enhancement Therapy for Antidepressants (META). META participants received three sessions of motivational interviewing as an enhancement to their usual care. Participants were assessed as baseline (time 1), 5 weeks (time 2), and 5 months (time 3). Antidepressant adherence was measured with the Medication Event Monitoring System (MEMS®) and changes in depression were measured with the Beck Depression Inventory-II (BDI-II). RESULTS: After adjusting for covariates, META participants showed significantly higher antidepressant adherence than UC participants at time 2 (72% versus 42%, respectively, p < .01) and time 3 (60% versus 34%, p < .01). The groups did not differ on mean BDI-II score across time. However, after adjusting for covariates, META participants were significantly more likely to show symptom remission on the BDI-II, compared to UC participants (OR = 7.0, p < .05). CONCLUSIONS: This initial trial of META demonstrated feasibility and promising effects for improving antidepressant adherence. Some effects on depression were also observed.
Depression and Anxiety 01/2013; · 4.18 Impact Factor
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ABSTRACT: The purpose of this study was to examine predictors of treatment response to cognitive-behavioral therapy (CBT) for depression in Parkinson's disease (PD).
The sample comprised 80 depressed (DSM-IV criteria) adults with PD (60% male) and their caregivers who participated in an National Institutes of Health-sponsored randomized-controlled trial of CBT vs. clinical monitoring from April 2007 until July 2010. Individually administered CBT was provided to people with PD for 10 weeks, modified to address the unique needs of the medical population, and supplemented with up to 4 separate caregiver educational sessions. Treatment response was defined a priori as a rating of depression much improved or very much improved on the Clinical Global Impression-Improvement Scale or ≥ 50% reduction in the baseline Hamilton Depression Rating Scale score. It was hypothesized (a priori) that caregiver participation in treatment, motor disability, psychiatric comorbidity, and executive functioning would be significant predictors of response to CBT at end-of-treatment (Week 10) and short-term follow-up (Week 14).
At Week 10, caregiver participation was the only significant predictor of treatment response in the CBT group. At Week 14, both caregiver participation and executive functioning predicted response to CBT. Treatment group, baseline depression severity, executive functioning, motor disability, psychiatric comorbidity, marital status, and caregiver burden were also related to change in depression scores, for all participants, in secondary and exploratory models.
Caregiver participation may enhance acute treatment response to psychosocial interventions for depression in PD. Further research is needed to extend and replicate these findings.
Journal of Consulting and Clinical Psychology 03/2012; 80(4):694-9. · 4.85 Impact Factor
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Michael A Gara,
William A Vega,
Stephan Arndt,
Michael Escamilla,
David E Fleck,
William B Lawson,
Ira Lesser,
Harold W Neighbors,
Daniel R Wilson,
Lesley M Arnold,
Stephen M Stratowski
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ABSTRACT: Rates of clinical diagnoses of schizophrenia in African American individuals appear to be elevated compared with other ethnic groups in the United States, contradicting population rates derived from epidemiologic surveys.
To determine whether African American individuals would continue to exhibit significantly higher rates of clinical diagnoses of schizophrenia, even after controlling for age, sex, income, site, and education, as well as the presence or absence of serious affective disorder, as determined by experts blinded to race and ethnicity. A secondary objective was to determine if a similar pattern occurred in Latino subjects.
Ethnicity-blinded and -unblinded diagnostic assessments were obtained in 241 African American individuals (mean [SD] age, 34.3 [8.1] years; 57% women), 220 non-Latino white individuals (mean [SD] age, 32.7 [8.5] years; 53% women), and 149 Latino individuals (mean [SD] age, 33.5 [8.0] years; 58% women) at 6 US sites. Logistic regression models were used to determine whether elevated rates of schizophrenia in African American individuals would persist after controlling for various confounding variables including blinded expert consensus diagnoses of serious affective illness.
Six academic medical centers across the United States.
Six hundred ten psychiatric inpatients and outpatients.
Relative odds of unblinded clinical diagnoses of schizophrenia in African American compared with white individuals.
A significant ethnicity/race effect (χ(2)(2)=10.4, P=.01) was obtained when schizophrenia was narrowly defined, controlling for all other predictors. The odds ratio comparing African American with non-Latino white individuals was significant (odds ratio=2.7; 95% CI, 1.5-5.1). Similar differences between African American and white individuals occurred when schizophrenia was more broadly defined (odds ratio=2.5; 95% CI, 1.4-4.5). African American individuals did not differ significantly from white individuals in overall severity of manic and depressive symptoms but did evidence more severe psychosis.
African American individuals exhibited significantly higher rates of clinical diagnoses of schizophrenia than non-Latino white subjects, even after controlling for covariates such as serious affective disorder.
Archives of general psychiatry 02/2012; 69(6):593-600. · 12.26 Impact Factor
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ABSTRACT: Although face-to-face cognitive-behavioral therapy (CBT) was found to be beneficial for the treatment of depression in Parkinson disease (dPD) in a recent randomized-controlled trial, access to care was identified as a critical issue that needs to be addressed in order to improve the management of this nonmotor complication in PD. The purpose of this study was to examine the feasibility and effect of telephone-based CBT for dPD.
Twenty-one depressed people with PD participated in a National Institutes of Health-sponsored uncontrolled pilot trial of telephone-based CBT in an academic medical center from October 2009 to February 2011. The Hamilton Depression Rating Scale was the primary outcome. Treatment was provided to people with PD for 10 weeks, modified for delivery over the phone, and supplemented with 4 separate phone-based caregiver educational sessions. Assessments were completed at baseline and 5 (midpoint), 10 (end-of-treatment), and 14 weeks (follow-up) post-enrollment.
Twenty (95%) people with PD completed the study treatment. Phone-based CBT was associated with significant improvements in depression, anxiety, negative thoughts, and coping. Mean Hamilton Depression Rating Scale change from baseline to week 10 was 7.91 points (P < .001, Cohen d = 1.21).
Telephone-based CBT may be a feasible and helpful approach for treating dPD and warrants further exploration in randomized-controlled trials. Results were comparable to those observed in the few in-person cognitive-behavioral treatment studies for dPD conducted to date.
Journal of Geriatric Psychiatry and Neurology 12/2011; 24(4):206-14. · 3.07 Impact Factor
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ABSTRACT: Despite the negative effects of depression in Parkinson's disease, there is currently no evidence-based standard of care. The purpose of this study was to examine the efficacy of individually administered cognitive-behavioral therapy (CBT), relative to clinical monitoring (with no new treatment), for depression in this medical population.
Eighty depressed (based on DSM-IV criteria) patients with Parkinson's disease participated in a randomized, controlled trial of CBT relative to clinical monitoring (1:1 ratio) in an academic medical center from April 2007 to July 2010. All patients continued to maintain stable medication regimens under the care of their personal physicians. The 17-item Hamilton Depression Rating Scale (HAM-D) total score was the primary outcome. CBT was modified to meet the unique needs of the Parkinson's disease population and provided for 10 weeks. Assessments were completed by blind raters at baseline and 5 (midpoint), 10 (end of treatment), and 14 weeks (follow-up evaluation) postrandomization.
The CBT group reported greater reductions in depression (change in HAM-D score) than the clinical monitoring group. At week 10, the mean HAM-D score change was 7.35 for CBT relative to 0.05 for clinical monitoring. CBT was also superior to clinical monitoring on several secondary outcomes (i.e., Beck Depression Inventory scores, anxiety, quality of life, coping, Parkinson's disease symptom ratings). There were more treatment responders in the CBT group than the clinical monitoring group (56% versus 8%, respectively).
CBT may be a viable approach for the treatment of depression in Parkinson's disease. Further research is needed to replicate and extend these findings.
American Journal of Psychiatry 06/2011; 168(10):1066-74. · 12.54 Impact Factor
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ABSTRACT: A group of children, aged 8 to 13 years, presenting to their pediatricians with multiple medically unexplained physical symptoms (MUPS) were compared with a control group of children from the identical age range who were, according to their pediatricians, free of unexplained physical symptoms. The groups were compared on both self-reported and parented-rated scales assessing physical symptoms and psychosocial functioning. The multiple MUPS group, relative to controls, exhibited significantly higher levels of parent-reported emotional/behavioral symptoms and a trend toward higher patient-reported anxiety than controls. Parents' and child's reports of symptomatology were modestly correlated. Symptom patterns characteristic of pediatric somatization differed as a function of whether child or parent reports were analyzed. Methodological issues in research on pediatric somatization were addressed and some directions for future research emerged.
Clinical Pediatrics 05/2011; 50(10):904-9. · 1.15 Impact Factor
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ABSTRACT: In the case of large-scale epidemiological studies, there is evidence of substantial disagreement when lay diagnoses of schizophrenia based on structured interviews are compared with expert diagnoses of the same patients. Reasons for this level of disagreement are investigated in the current study, which made use of advances in text-mining techniques and associated structural representations of language expressions. Specifically, the current study examined whether content analyses of transcribed diagnostic interviews obtained from 150 persons with serious psychiatric disorders yielded any discernable patterns that correlated with diagnostic inconsistencies of schizophrenia. In summary, it was found that the patterning or structure of spontaneous self-reports of emotion states in the diagnostic interview was associated with diagnostic inconsistencies of schizophrenia, irrespective of confounders; i.e., age of patient, gender, or ethnicity. In particular, complex emotion patterns were associated with greater disagreement between experts and trained lay interviewers than were simpler patterns.
The Journal of nervous and mental disease 09/2010; 198(9):609-13. · 1.77 Impact Factor
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ABSTRACT: To examine the frequency of somatic symptoms in a community population of various ethnic backgrounds and to identify correlates of these symptoms such as psychopathology, use of services, and personal distress.
Using a 14-symptom inventory with interviewer probes for somatic symptoms, we determined the presence of general physical symptoms (GPS) in a sample of 4864 white, Latino, and Asian US community respondents. Medically "edited" verbatim interview responses were used to decide whether or not physical symptoms would qualify as medically unexplained physical symptoms (MUPS). We then assessed the association between GPS and MUPS and psychiatric disorders, psychological distress, and use of services, in both unadjusted and multivariate regression analyses.
One-third (33.6%) of the respondents reported at least one GPS and 11.1% reported at least one MUPS within the last year. 10.7% of respondents had three or more GPS and 1.5% had three or more MUPS. Three or more GPS and MUPS were positively associated with depressive, anxiety, and substance use disorders; service use; and psychological distress in unadjusted comparisons. In multivariate regressions, GPS persisted as a significant predictor, but there was no significant independent effect of MUPS, after controlling for GPS and other covariates.
Regardless of the presence or absence of medical explanations, physical symptoms are an important component of common mental disorders such as depression and anxiety and predict service use in community populations. These results suggest that three or more current GPS can be used to designate a "case" and that detailed probes and procedures aimed at determining whether or not physical symptoms are medically unexplained may not be necessary for classification purposes.
Journal of psychosomatic research 07/2010; 69(1):1-8. · 2.91 Impact Factor
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ABSTRACT: Stigma associated with mental illness is an important yet understudied issue among Latinos. This study examined the psychometric properties of four stigma measures with a sample of Spanish-speaking Latino primary care patients. The study evaluated the scale for Perceived Discrimination Devaluation (PDD), the Stigma Concerns About Mental Health Care (SCMHC) scale, the Latino Scale for Antidepressant Stigma (LSAS), and the Social Distance (SD) scale.
Participants (N=200) were low-income Latinos who were screened for depression with the Patient Health Questionnaire (PHQ-2) and asked about their depression treatment history, and they completed the four stigma measures at two time points (25 and 30 months from baseline). The four stigma measures were examined for internal consistency, convergent validity, construct validity, and criterion-related validity.
The factor-analytic results generally provided support for the construct validity of the measures. The four stigma measures also demonstrated internal consistency between two time points. Patients who reported greater social distance from individuals with depression were more likely to have been receiving treatment for emotional care in the past three months (odds ratio [OR]=.70, p<.05). Also, Latinos who scored high on the SCMHC (OR=.64, p<.05) and LSAS (OR=.77, p<.05) were less likely to have been taking antidepressant medications.
The SCMHC, LSAS, and SD scales received support for their reliability and construct validity. Results also showed some support for their criterion-related validity. A more mixed picture emerged for the PDD. Stigma ratings were associated with depression treatment utilization. Stigma ratings changed over time and were associated with treatment experiences.
Psychiatric services (Washington, D.C.) 04/2010; 61(4):373-9. · 2.81 Impact Factor
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ABSTRACT: Sleep disturbances have been reported to be one of the most troubling manifestations of menopause. While hormone replacement therapy (HRT) has historically been considered a first-line treatment for menopausal insomnia, many women are now seeking alternative treatments due to concerns about the risks and side-effects of HRT. The goal of this study was to evaluate the effect of ramelteon, a selective melatonin receptor agonist, for the treatment of menopausal insomnia.
A total of 20 healthy peri- and postmenopausal women with insomnia participated in this six-week, prospective, open-label trial of ramelteon (8 mg) at an academic medical centre. Participants completed sleep-wake diaries on a daily basis for six weeks. Self-report measures of sleep impairment, daytime functioning, quality of life and mood were also completed on a bi-weekly basis.
Significant improvements in latency to sleep onset, total sleep time and sleep efficiency were observed in diary data while gains in sleep quality, sleep impairment, daytime functioning, quality of life and mood were found in self-report measures. There was no evidence of tolerance or rebound over the course of the trial.
Overall, results suggest that ramelteon is an effective non-hormonal approach for the treatment of insomnia in menopause. Randomized-controlled trials are needed to further evaluate the efficacy of this intervention.
Menopause International 04/2009; 15(1):13-8.
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ABSTRACT: Patients diagnosed as having somatization disorder (SD) who present with a lifetime history of multiple, medically unexplained physical symptoms represent a significant challenge to health care providers. To date, no psychotherapeutic or pharmacologic intervention has been found to produce clinically meaningful improvement in symptoms or functioning of patients with SD. We examined the efficacy of cognitive-behavioral therapy (CBT) for SD.
Eighty-four participants meeting criteria for SD were randomly assigned to 1 of 2 conditions: (1) standard medical care augmented by a psychiatric consultation intervention or (2) a 10-session, manualized, individually administered CBT regimen added to the psychiatric consultation intervention. Assessments were conducted at baseline and 3, 9, and 15 months after baseline. The primary outcome measure was the severity scale of the Clinical Global Impression Scale for Somatization Disorder (CGI-SD). Secondary outcome measures were responder status as determined by clinical ratings, self-reported measures of physical functioning and somatic symptoms, and health care utilization assessed via medical records.
Fifteen months after baseline, somatization symptoms were significantly less severe in the group treated with CBT (0.84 points on the CGI-SD 7-point scale) (P<.001). Patients treated with CBT also were significantly more likely to be rated as either very much improved or much improved than patients treated with only augmented standard medical care (40% [n = 17] vs 5% [n = 2]). Cognitive-behavioral therapy was associated with greater improvements in self-reported functioning and somatic symptoms and a greater decrease in health care costs.
For patients diagnosed as having SD, CBT may produce clinical benefits beyond those that result from the current state-of-the-art treatment.
Archives of Internal Medicine 08/2006; 166(14):1512-8. · 11.46 Impact Factor
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ABSTRACT: Although not all abused children grow up to be abusive parents, it is well known that people who were severely mistreated by their parents as compared to those who were not are at higher risk for mistreating their children. It has also been shown that abusive parents often have unrealistic expectations for their children—expectations based on distorted perceptions of their children's needs, feelings, and abilities. In this paper, we examine the utility of new methods developed in social psychology to study: (1) the impact of abuse on the structure and content of interpersonal and self-perception and (2) the interrelationships among an abused mother's social and self-perception, the quality of her interactions with her child, and the child's development. Case studies will be presented to illustrate how these new methods reflect risk for abuse as predicted independently by clinicians treating the cases.
Infant Mental Health Journal 02/2006; 13(1):83 - 98. · 0.61 Impact Factor
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ABSTRACT: Within somatization, unexplained neurological symptoms (UNSs) have been shown to mark a distinct subgroup with greater clinical severity. However, some UNSs resemble ataque de nervios somatic symptoms. This raises questions about cultural factors related to Hispanics with somatization characterized by UNSs. To examine cultural factors, preliminary analyses examined the relationship between Hispanic ethnicity, UNSs, and ataque de nervios. Data were obtained from 127 primary care patients (95 Hispanic, 32 European American) with somatization. The Composite International Diagnostic Interview provided somatization data, whereas the Primary Care Evaluation of Mental Disorders was used for data on Axis I disorders. Ataque de nervios was assessed via a proxy measure. Within each ethnic group, cross-tabs examined the relationship between ataque de nervios and multiple UNSs, and ataque de nervios and selected Axis I disorders. Only among Hispanics, a significant overlap was found between ataque de nervios and having four or more UNSs (p < .001), and ataque de nervios and a diagnosis of panic disorder (p = .05). Although equal percentages of European Americans and Hispanics experience multiple UNSs, these results show that the presentation of UNSs among some Hispanics may be qualitatively different, because it may involve features related to ataque de nervios. A diagnosis of panic disorder also appears to interact with cultural factors.
Journal of Nervous & Mental Disease 02/2005; 193(1):32-9. · 1.68 Impact Factor
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ABSTRACT: The authors studied the psychometric characteristics of a standardized data-collection method for assessing the complexity of an individual's cognitions about self and other people (social cognitive complexity). A total of 437 college undergraduates were assessed using this method and concurrently assessed for depression, self-deception, impression management, self-esteem, and positive/negative affectivity. It was found that a measure of overall social cognitive complexity was internally consistent and demonstrated concurrent and discriminant validity. In particular, a composite measure of the complexity of both positive and negative cognitions of self and other was associated with greater self-reported depression, after controlling for the other variables studied (, impression management). It was also found that social cognitive complexity moderated the degree of global self-evaluation in self-reported depression, such that global self-evaluation accounted for a considerably higher amount of the variance of depression in low-complex individuals than it did in high-complex individuals.
Journal of Nervous & Mental Disease 11/2002; 190(10):670-6. · 1.68 Impact Factor
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ABSTRACT: Conducted an empirically based study in which the judgments of experts were used to identify the theoretical/methodological structure of the field of personality and social psychology, as well as the core "interest communities" extant in these disciplines. The similarities of figures prominent in the history of the field were judged by 16 of the American Psychological Association's Division 8 (Society of Personality and Social Psychology) Fellows. Multidimensional scaling of these similarity judgments revealed 3 general dimensions along which the figures varied: synthetic vs analytic, internal vs external determinants of behavior, and prominence. An alternate view of the field was provided by a taxonomic scheme in which the figures were grouped along major ideological, substantive, and methodological lines. The following 5 contemporary interest communities were identified from the self-characterizations of the Fellows: (a) psychoanalysis and psychiatry, (b) modern personality theory, (c) measurement and individual differences, (d) sociology, and (e) social psychology. Statements of implications for future directions in the field were also obtained from Ss. (38 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Journal of Personality and Social Psychology 06/1983; 45(1):57-73. · 5.08 Impact Factor
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ABSTRACT: A number of studies have shown that co-occurrences among trait adjectives in memory-based personality descriptions are highly predictable from ratings of the adjectives in terms of their similarity in meaning. The purpose of the present study (300 undergraduates) was to provide an empirical answer to the question of whether similarity-in-meaning judgments reflect only linguistic factors (i.e., shared semantic features) or also contain beliefs about trait co-occurrences. In the former, the use of co-occurrences among trait adjectives to study implicit personality theory would be highly questionable. An empirically based measure of linguistic similarity based on shared linguistic features among trait adjectives was proposed and used for the 1st time. Also obtained were actual personality descriptions and meaning-similarity judgments using the same adjectives. The pattern of correlations among these independent data bases indicates that meaning-similarity judgments contained 2 components: shared features and perceived co-occurrence. Personality descriptions contained shared features to a lesser extent. The study thus supports the use of trait descriptions to study implicit personality theory but leaves unresolved the question of whether such descriptions are accurate reflections of reality. (31 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Journal of Personality and Social Psychology 08/1981; 41(3):450-457. · 5.08 Impact Factor
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ABSTRACT: Using a free-response format, 14 undergraduates each described 36 target persons (TPs). A set-theoretical model was proposed for representing the perceived similarities and differences among persons described. Four types of TPs were identified: supersets (SUPs), subsets (SUBs), disliked contrasts (DCs), and miscellaneous (Ms). SUPs are TPs whose perceived characteristics subsume those of many of the other persons described. SUBs are TPs described with only a limited portion of the characteristics attributed to the SUPs. DCs are those disliked TPs who were described with a set of terms almost completely different from those used to describe the other TPs. Ms are TPs who could not be identified as SUPs, SUBs, or DCs. As predicted, SUPs were persons who were perceived as least significant; SUBs and Ms could not be distinguished from one another. It is suggested that SUPs provide the perceptual categories for the construing of persons, and the correspondence of this idea with other extant psychological ideas (e.g., transference) is discussed. (25 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Journal of Personality and Social Psychology 11/1979; 37(12):2161-2170. · 5.08 Impact Factor
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ABSTRACT: Adaptive inferential feedback (AIF) partner training is a cognitive technique that teaches the friends and family members of depressed patients to respond to the patients’ dysfunctional thoughts in a targeted manner. These dysfunctional attributions, which AIF addresses, are a common residual feature of depression amongst remitted patients, and are associated with poor long-term consequences. Thus, an AIF partner training intervention, as a supplement to individual cognitive-behavioral therapy (CBT), may help to improve clinical outcomes through the continuing reinforcement of the cognitive restructuring that takes place in the context of the patient’s individual treatment. This 10-patient pilot study examines the feasibility and outcome of the augmentation of standard CBT with 4 sessions of AIF partner training. The patients’ depression, anxiety, negative inferences, and perception of social support, and their partners’ knowledge and provision of AIF significantly improved over the course of the study, with gains maintained at 2-month follow-up. Further research is needed to investigate any incremental value of this intervention beyond standard CBT. A detailed case example, illustrating the application of AIF partner training techniques, is included.
Cognitive and Behavioral Practice 14(4):350-363. · 1.33 Impact Factor
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ABSTRACT: The authors examined the reliability and validity of the PHQ-15, a measure of current somatic complaints. An index of medically unexplained symptoms was used as a key criterion. Data were utilized from medical outpatients enrolled in a treatment study for moderate-to-severe somatization (N=172). Approximately 68% of the sample was Hispanic. Results showed that the PHQ-15 was moderately related to a history of medically unexplained symptoms among non-Hispanic participants. Results indicated ethnic differences on the validity profile of the PHQ-15 showing that the criterion variables were less predictive of the PHQ-15 among Hispanics than among non-Hispanics. Also, among the Hispanic group, the PHQ-15 was less related to medically unexplained symptoms and more to psychiatric distress. General support was provided for using the PHQ-15 with clinical samples composed of non-Hispanics. Also, the PHQ-15 appears to measure medically unexplained symptoms, psychiatric distress, and physical functioning. Further study is recommended to better evaluate ethnic variations and other types of validity for the PHQ-15.
Psychosomatics 47(5):392-8. · 2.12 Impact Factor
