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ABSTRACT: The aim of this paper is to report on patient satisfaction with the Black Dog Institute Depression Clinic, a tertiary referral service providing assessment and treatment advice to patients with mood disorders.
Patients who attended the Depression Clinic over the period 2006-2007 received questionnaires in the mail assessing satisfaction with the services received. Of the 321 patients attending, 114 (35%) replied. Results from 110 patients were subsequently analysed.
Overall, patients were very satisfied with the services received. However, a number of priority areas were identified including provision of information about diagnosis, causal factors and treatment options; managing patient expectations about services offered; the need for improvement of communication between patient and psychiatrist; and the need for adequate de-briefing for those who receive an unexpected or differing diagnosis.
Patient satisfaction is a central component in shaping clinical service development to ensure delivery of effective health care. Findings from this study have implications for the improved delivery of psychiatric services.
Australasian Psychiatry 03/2008; 16(1):27-32. · 0.86 Impact Factor
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ABSTRACT: Antenatal anxiety has received increased attention with regards to both its impact on infant outcomes and as a risk factor for postnatal depression. The measurement of anxiety in the perinatal setting, however, has proven to be challenging. The aims of the present study are to: determine whether antenatal anxiety as measured by the Brief Measure of Worry Severity (BMWS) is a significant predictor of postnatal depression (PND); examine the psychometric properties of a new measure of anxiety - the BMWS - in an antenatal sample; and examine the comparative capacity of the BMWS to the Speilberger State Trait Anxiety Inventory (STAI) in predicting PND.
A sample of 748 women completed the BMWS and STAI during the third trimester of pregnancy and returned the Edinburgh Postnatal Depression Scale (EPDS) at 8 weeks postpartum.
Women with high antenatal anxiety on the BMWS were 2.6 times more likely to have probable PND than those with low scores, even after controlling for confounding factors, including level of antenatal depression on the EPDS. In contrast, the STAI was no longer a significant predictor of PND after controlling for these variables. The BMWS has good construct validity, with scores on this scale correlating strongly with scores on other measures of anxiety, depression and perinatal risk.
When compared to those who participated in the follow-up at 8 weeks postnatally, those who did not participate appeared to be at greater risk of developing PND, raising the possibility of attrition bias within this sample.
The findings from this study suggest that the BMWS has utility in measuring antenatal anxiety in both clinical and research settings and that antenatal anxiety is an important precursor of PND.
Journal of Affective Disorders 09/2007; 101(1-3):169-74. · 3.52 Impact Factor
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ABSTRACT: Depression measurement tools in cross-cultural research require careful design and thorough validation to ensure that cognitive concepts in one culture can be appropriately translated and applied to a differing culture. The aim of this study was to validate the Chinese version of a screening measure of state depression, the 10-item Depression in Medically Ill (DMI-10), and we report three interdependent studies. An initial bilingual test-retest study identified four (of the 10) items as having poor cross-cultural validity. A second study involved focus groups participants exploring the meaning of translated items with Chinese speakers. The third study repeated the bilingual test-retest analyses on the modified DMI-10 form and demonstrated improved correlation coefficients on all items and an excellent overall correlation (r=0.87) between the Chinese and English versions. The Chinese DMI-10 should prove useful as a tool in cross-cultural research to understand the Chinese experience of depression. The findings of this study have methodological implications for cross-cultural research on depression.
Journal of Nervous & Mental Disease 02/2007; 195(1):20-5. · 1.68 Impact Factor
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ABSTRACT: Objective: There has been considerable debate about the diagnostic rules for bipolar II disorder, particularly the 4-day duration criteria for hypomanic episodes. This study examined whether highs lasting minutes or hours differed from longer highs in terms of clinical features and symptom severity. It also examined whether duration of highs predicted bipolar disorder being diagnosed.Method: A total of 518 subjects with significant episodes of depression and ‘highs’ completed a web-based self-report questionnaire. Those who reported their longest highs lasting minutes or hours were compared with those who reported longer durations of highs on a range of clinical variables and measures of symptom severity.Results: Subjects whose highs lasted minutes or hours reported clinical features and severity of symptoms similar to those whose highs lasted 3–7 days. However, the odds of being diagnosed with bipolar disorder for those with highs lasting 3–7 days were almost three times higher than for those whose highs lasted minutes or hours.Conclusion: The 4-day DSM-IV minimum-duration criteria for hypomania may lead to failure to diagnose subjects with brief highs who have true bipolar disorder and thus should be reconsidered.
Acta Neuropsychiatrica 01/2007; 19(1):38 - 44. · 0.58 Impact Factor
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ABSTRACT: As division between unipolar and bipolar disorders can be problematic, we sought to develop a self-report questionnaire of mood 'highs' that would both distinguish true Bipolar Disorder from any elevated mood states in unipolar depression and sharpen the distinction between Bipolar I and II conditions.
A 46-item questionnaire was developed and completed by 157 out-patients presenting with a major depressive episode, and clinically diagnosed as having either Bipolar I (BP-I), Bipolar II (BP-II) or Unipolar (UP) depression, although DSM-IV duration criteria for BP-I and BP-II were not imposed.
Factor analyses identified four key constructs to mood 'highs', while additional analyses refined the questionnaire to 27 items. The refined measure was highly accurate in distinguishing composite Bipolar (BP-I and BP-II) from UP subjects (AUC = 0.93, sensitivity = 81%; specificity = 98%, positive predictive value = 0.95). Questionnaire scores were similar for BP-I and BP-II subjects, raising the possibility that the core mood state differs little in severity across the two expressions, and that their distinction allows an alternative model that weights the presence or absence of psychotic features.
Our study advances understanding of boundary distinctions between bipolar and unipolar mood disorders, and between BP-I and BP-II conditions, and allows consideration of a model distinguishing BP-I from BP-II by the presence of psychotic features only. The described model is the mirror image of a hierarchical structural model for conceptualizing psychotic and melancholic depression, allowing an 'isomer model' for linking the mood swing states.
Journal of Affective Disorders 12/2006; 96(1-2):67-73. · 3.52 Impact Factor
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ABSTRACT: It is commonly reported that "the Chinese" have low rates of depression, partially reflecting a greater tendency to somatize and to be less likely to seek help.
To examine the impact of acculturation on depression reporting and help-seeking patterns.
We compared 50 highly acculturated Chinese with age and gender-matched non-Chinese control subjects in a western region on measures of state and lifetime depression, attributional interpretation of somatic cues and help-seeking.
The highly acculturated Chinese did not differ in state depression rates or tendency to 'somatize'. There were trends for the Chinese to be less likely to view any depressive episode as a 'disorder' and to seek help for a psychological problem.
Differences held to exist in the Chinese in acknowledging, reporting and seeking help for depression appear strongly culturally determined.
Journal of Affective Disorders 09/2006; 94(1-3):239-42. · 3.52 Impact Factor
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ABSTRACT: We sought to develop a refined measure of eight personality traits or constructs observed in those who develop depression. We report the psychometric properties of the derived Temperament and Personality (T and P) questionnaire, as well as a pilot study examining its capacity to differentiate over-represented personality traits in those with depression.
The factor structure of the T&P measure was examined in a general practice sample of 529 subjects. We imposed a range of factorial solutions to determine how higher-order molar constructs arborized to eight lower-order constructs. Scale scores generated at each derived tier were contrasted for 52 out-patients with major depression and control subjects from the general practice sample to pursue over-represented personality constructs, and to clarify if an optimal number of constructs could be identified.
In the factor analysis, some 90% of the items loaded on their a priori construct. The questionnaire showed high internal consistency, test-retest reliability and minimal sensitivity to mood state effects. Analyses rejected the hypothesis that risk to depression might be generally affected by individuals merely scoring high on all 'normal' personality styles, whether higher-order or lower-order traits.
Findings suggest that, while identified constructs linked well with the widely accepted theoretical model of personality (the Five Factor Model) at one tier, such a fixed model may be too inflexible. We therefore detail potential advantages to using a multi-tiered model of personality traits in application studies.
Psychological Medicine 09/2006; 36(8):1131-9. · 6.16 Impact Factor
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ABSTRACT: We have previously found that the level of acculturation in Chinese subjects influences reporting of depression. It is not clear to what extent such differences in reporting are a consequence of differences in the recognition of depressive symptoms. This study examined the influence of acculturation and personal depressive experience on recognition of depressive symptoms in a sample of Chinese subjects and controls in a western region.
A 35-item Depressive Symptom Questionnaire was given to 385 Chinese subjects, grouped according to their language preference, and 143 non-Chinese Controls all recruited from general practices. Subjects rated recognition of symptoms on a 3-point scale according to the likelihood of someone who had depression experiencing each of the 35 symptoms. Three symptom dimensions were extracted using factor analysis: core, cognitive and somatic symptoms. The influence of acculturation and previous experience of depression on these symptom dimensions was examined.
The level of acculturation in the Chinese influenced the recognition of 'somatic' and 'cognitive' symptoms, but the Chinese groups did not differ from Controls in recognition of 'core' symptoms. Previous experience of depression led to greater recognition of all three dimensions of symptoms, regardless of level of acculturation.
Westernized Chinese, despite varying levels of acculturation, appeared capable of recognizing depressive symptoms as well as Control subjects. This suggests that the influence of acculturation on reporting on depressive symptoms may be due to factors other than the recognition of depression. This study has implications for the early detection of depression among the Chinese in differing geographical regions.
Journal of Affective Disorders 08/2006; 93(1-3):141-7. · 3.52 Impact Factor
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ABSTRACT: We have previously observed that prescription of some antidepressant class drugs (particularly the SSRIs) is associated with attenuation of the number, duration and severity of both high and low mood states in those with Bipolar II Disorder. We examined whether SSRIs are a mood stabilizer for Bipolar II Disorder.
We report a randomized, double-blind, placebo-controlled cross-over study lasting 9 months in a sample of 10 patients who had not had previous treatment with any antidepressant, antipsychotic or mood stabilizer drug.
Treatment with the SSRI led to a significant reduction in depression severity, percentage of days depressed or high, and percentage of days impaired, when compared with placebo. There was no indication that the SSRI led to a worsening of illness course.
Given the small sample size and a weighting to those with a rapid cycling condition, replication with a larger and more heterogeneous sample of those with Bipolar Disorder is required.
This proof of concept study finds preliminary support for the potential utility of SSRIs in managing Bipolar II Disorder, with clear improvements in depression and impairment and some suggested benefit for hypomania.
Journal of Affective Disorders 07/2006; 92(2-3):205-14. · 3.52 Impact Factor
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ABSTRACT: Studies of depression in the Chinese have long identified low rates and a greater likelihood of somatization, findings which could reflect cultural influences or real differences. We report a study from a western region examining the impact of acculturation on depression to clarify the role of cultural factors.
In a Sydney-based study, Chinese subjects (n = 385) and a matched control group of 143 non-Chinese subjects completed either a Chinese or English questionnaire assessing state and lifetime depression, attributional style, depression recognition and help-seeking. The impact of acculturation was examined by several strategies.
Any tendency by the Chinese to somatize depression appeared to be attenuated by acculturation. State depression levels countered the view that Chinese necessarily deny depression. Lifetime depression rate differences were also attenuated by acculturation, with Chinese subjects being less likely than controls to judge episodes as a distinct disorder and to seek professional help.
Results suggest that Australian Chinese do not differ intrinsically in recognizing and ascribing depressive symptoms, and that the greater the degree of acculturation, the greater the tendency for reporting persistent and impairing depressive episodes.
Psychological Medicine 11/2005; 35(10):1475-83. · 6.16 Impact Factor
