Article

Using the QIDS-SR16 to Identify Major Depressive Disorder in Primary Care Medical Patients

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Abstract

Major depressive disorder (MDD) is a serious and prevalent mental health issue. As the majority of MDD cases are identified and treated by one's primary care physician, it is imperative that care providers utilize accurate and efficient methods for diagnosing MDD in primary care settings. The present study is the first to investigate the accuracy of the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR(16)) as a screen for MDD. A heterogeneous sample of 155 primary care patients completed the QIDS-SR(16) prior to attending a primary care appointment. Participants were then assessed for psychopathology using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) by clinicians who were blind to QIDS-SR(16) scores. Scores on the QIDS-SR(16) were compared to clinician-assessed current and lifetime diagnoses derived from the SCID, which represented the gold-standard criterion measure. Receiver operator characteristic analysis was utilized to determine the optimal QIDS-SR(16) cut score to correctly classify participants based on their MDD status as assessed by the SCID. The test revealed a robust area under the curve (.82, p<0.00001) and suggested that a cut score of 13 or 14 provided the best balance of sensitivity (76.5%) and specificity (81.8%) in this primary care sample. Over 80% of participants were correctly classified. Separate analyses by race were conducted to address the possibility that different cut scores may be more accurate for African American and Caucasians. Findings from the present study provide support for the use of the QIDS-SR(16) as a screening measure for identifying primary care patients who will meet diagnostic criteria for MDD based on clinician assessment.

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... The nine-item Patient Health Questionnaire (PHQ-9; Spitzer et al., 1999;Kroenke et al., 2001;Gilbody et al., 2007;Arroll et al., 2010) and the 16-item Quick Inventory of Depressive Symptomatology -Self-Rated (QIDS-SR16; Rush et al., 2003;Bernstein et al., 2010;Lamoureux et al., 2010) were chosen for their brevity, ease of administration, good validity, reliability, wide usage, and close correspondence to DSM-IV criteria for major and minor depression. Both have shown adequate psychometric properties in primary care settings, and can be used to screen for depression and to monitor treatment. ...
... Translated versions have been validated in Chinese, Malay, Thai, and Turkish community samples (Corapcioglu and Ozer, 2004;Azah et al., 2005;Lotrakul et al., 2008;Yeung et al., 2008;Liu et al., 2011). The QIDS-SR16 has been validated in primary care and outpatient psychiatric settings in the US (Rush et al., 2003;Lamoureux et al., 2010). However, the screening properties of the PHQ-9 and QIDS-SR16 have yet to be directly compared in primary care patients, and neither instrument has been validated in a multiethnic Asian sample. ...
... Cronbach's α is 0.80, which indicates good internal consistency (Bernstein et al., 2010). The QIDS-SR16 has been validated in primary care (Lamoureux et al., 2010), and it is increasingly used as an outcome measure in randomized clinical trials. ...
Article
Depression is common, disabling, and the single most important factor leading to suicide, yet it is underdiagnosed in busy primary care settings. A key challenge facing primary care clinicians in Asia is the selection of instruments to facilitate depression screening. Although the nine-item Patient Health Questionnaire (PHQ-9) and 16-item Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR16 ) are used internationally, they have not been directly compared or widely validated in Asian primary care populations. This study aimed to validate the PHQ-9 and QIDS-SR16 against a structured interview diagnosis of Diagnostic and Statistical Manual, 4th Edition, depression based on the Mini-International Neuropsychiatric Interview in a multiethnic Asian sample. From April through August 2011, we enrolled 400 English-speaking Singaporean primary care patients. Participants completed a demographic data form, the PHQ-9, and the QIDS-SR16 . They were assessed independently for major and minor depression using the Mini-International Neuropsychiatric Interview. Sensitivity and specificity for diagnosing major depression were 91.7% and 72.2%, respectively, for the PHQ-9 (optimal cutoff score of 6), and 83.3% and 84.7%, respectively, for the QIDS-SR16 (optimal cutoff score of 9). The QIDS-SR16 also detected minor depression at an optimal cutoff score of 7, with a sensitivity of 94.4% and specificity of 77.9%. The PHQ-9 and QIDS-SR16 showed good internal consistency (Cronbach's α: 0.87 and 0.79, respectively) and good convergent validity (correlation coefficient: r = 0.73, P < 0.001). The overall prevalence of major and minor depressive disorders was 9%. The PHQ-9 and QIDS-SR16 appear to be valid and reliable for depression screening in Asian primary care settings.
... Additionally, QIDS-SR16 will be used to classify participants regarding presence of clinical depression at all measurement points (T0-T5). A comparison of QIDS-SR16 scores to current and lifetime diagnosis based on Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) as measure criterion showed that QIDS-SR16 is a reliable screening instrument for diagnosis of clinical depression [77]. Cut-off scores of 13 and 14 yielded best results for sensitivity (76.5%) and specificity (81.8%) leading to correct classification of over 80% of participants [77]. ...
... A comparison of QIDS-SR16 scores to current and lifetime diagnosis based on Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) as measure criterion showed that QIDS-SR16 is a reliable screening instrument for diagnosis of clinical depression [77]. Cut-off scores of 13 and 14 yielded best results for sensitivity (76.5%) and specificity (81.8%) leading to correct classification of over 80% of participants [77]. For this study, a score ≥ 13 is defined as cut-off to identify possible cases of clinical depression for all measurement points within the 36-month followup period. ...
... Third, presence of clinical depression will not be assessed with standardized diagnostic procedures at baseline or follow-up. Since QIDS-SR16 has been shown to have high predictive validity as a screening instrument for MDD [77], this instrument was applied to identify possible cases of MDD. ...
Article
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Background: People in green professions are exposed to a variety of risk factors, which could possibly enhance the development of depression. Amongst possible prevention approaches, internet- and mobile-based interventions (IMIs) have been shown to be effective and scalable. However, little is known about the effectiveness in green professions. The aim of the present study is to examine the (cost-)effectiveness of a tailored IMI program for reducing depressive symptoms and preventing the onset of clinical depression compared to enhanced treatment as usual (TAU+). Methods: A pragmatic randomized controlled trial (RCT) will be conducted to evaluate a tailored and therapeutically guided preventive IMI program in comparison to TAU+ with follow-ups at post-treatment (9 weeks), 6-, 12-, 24-, and 36-months. Entrepreneurs in green professions, collaborating spouses, family members and pensioners (N = 360) with sufficient insurance status and at least subthreshold depression (PHQ-9 ≥ 5) are eligible for inclusion. Primary outcome is depressive symptom severity (QIDS-SR16). Secondary outcomes include incidence of depression (QIDS-SR16), quality of life (AQoL-8D) and negative treatment effects (INEP). A health-economic evaluation will be conducted from a societal perspective. The IMI program is provided by psychologists of an external service company and consists of six guided IMIs (6-8 modules, duration: 6-8 weeks) targeting different symptoms (depressive mood, depressive mood with comorbid diabetes, perceived stress, insomnia, panic and agoraphobic symptoms or harmful alcohol use). Intervention choice depends on a screening of participants' symptoms and individual preferences. The intervention phase is followed by a 12-months consolidating phase with monthly contact to the e-coach. Discussion: This is the first pragmatic RCT investigating long-term effectiveness of a tailored guided IMI program for depression prevention in green professions. The present trial builds on a large-scale strategy for depression prevention in green professions. The intended implementation of the IMI program with a nationwide rollout has the potential to reduce overall depression burden and associated health care costs in case of given effectiveness. Trial registration: German Clinical Trial Registration: DRKS00014000 . Registered on 09 April 2018.
... Montgomery-Asberg Depression Rating Scale (MADRS) was used as the criterion standard [32]. On the other hand, Lamoureux et al. (2010), who conducted their study among primary care medical patients (N = 155) in an urban Midwestern US city, yielded higher cut-off scores of 13 and 14 points (SN = 76.5%, SP = 81.8%,) ...
... SP = 81.8%,) [41]. Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) was selected as criterion standard [41]. ...
... [41]. Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) was selected as criterion standard [41]. Study conducted by Sung et al. (2013) among Singapore primary care patients (N = 400) had identified 9 points as the optimal cut-off for MDD (SN = 83.3%, ...
Article
Full-text available
Depression is ranked as the second-leading cause for years lived with disability worldwide. Objective monitoring with a standardized scale for depressive symptoms can improve treatment outcomes. This study evaluates the construct and concurrent validity of the Malay Self-Report Quick Inventory of Depressive Symptomatology (QIDS-SR16) among Malaysian clinical and community samples. This cross-sectional study was based on 277 participants, i.e., patients with current major depressive episode (MDE), n = 104, and participants without current MDE, n = 173. Participants answered the Malay QIDS-SR16 and were administered the validated Malay Mini-International Neuropsychiatric Interview (MINI) for DSM-IV-TR. Factor analysis was used to determine construct validity, alpha statistic for internal consistency, and receiver operating characteristic (ROC) analysis for concurrent validity with MINI to determine the optimal threshold to identify MDE. Data analysis provided evidence for the unidimensionality of the Malay QIDS-SR16 with good internal consistency (Cronbach’s α = 0.88). Based on ROC analysis, the questionnaire demonstrated good validity with a robust area under the curve of 0.916 (p < 0.000, 95% CI 0.884–0.948). A cut-off score of nine provided the best balance between sensitivity (88.5%) and specificity (83.2%). The Malay QIDS-SR16 is a reliable and valid instrument for identifying MDE in unipolar or bipolar depression.
... The QIDS-SR 16 is a reliable and validated instrument used widely in longitudinal clinical trials (Cheng et al., 2018;Cunningham and Shapiro, 2018;Kalmbach et al., 2015;Landsness et al., 2011;Taylor et al., 2014). The QIDS-SR 16 assesses the severity of the nine diagnostic symptom criteria used in the Diagnostic and Statistical Manual of Mental Disorders, and shows strong consistency with a diagnosis of Major Depressive Disorder via a Structured Interview for the DSM (Lamoureux et al., 2010;Surís et al., 2016;Yeung et al., 2012). Scores range from none (0-5), mild (6-10), moderate (11-15), severe (16-20), and very severe (21-27) (Rush et al., 2006). ...
... Clinically significant depression was determined using these psychometrically derived severity categories, and was operationalized as a score of 11 or higher, corresponding to moderate severity or higher. A 'moderate' rather than a 'severe' threshold was selected to achieve better balance between sensitivity and specificity; the sensitivity and specificity for a threshold of ≥11 was 82.4% and 70.3% respectively, as opposed to 52.9% and 88.4% (severe or very severe) (Lamoureux et al., 2010). This threshold can also be considered clinically significant because it is consistent with clinical practices used to screen and triage patients for treatment or prevention. ...
... Though results from dCBT-I studies show promise, some limitations should be considered in continuing research. First, depression in this study was evaluated with a self-report instrument rather than clinical interviews, although validation of the QIDS-SR 16 against clinical diagnosis indicates good sensitivity and specificity at the cutoff selected (82.4% and 70.3%, respectively [Lamoureux et al., 2010]). Additionally, the use of brief validated self-report instruments is becoming more standard in clinical practice, both as a part of the evidence-based practice movement and as a response to increasing demands of higher productivity and efficiency of clinicians. ...
Article
Background There has been growing support for digital Cognitive Behavioral Therapy (dCBT-I) as a scalable intervention that both reduces insomnia and prevents depression. However, the mechanisms by which dCBT-I reduces and prevents depression is less clear. Methods This was a randomized controlled trial with two parallel arms: dCBT-I (N=358), or online sleep education as the control condition (N=300). Outcome variables were measured at pre-treatment, post-treatment, and one-year follow-up, and included the Insomnia Severity Index (ISI), the Quick Inventory of Depressive Symptomatology (QIDS-SR16), and the Perseverative Thinking Questionnaire (PTQ). The analyses tested change in PTQ scores as a mediator for post-treatment insomnia, post-treatment depression, and incident depression at one-year follow-up. Results Reductions in rumination (PTQ) were significantly larger in the dCBT-I condition compared to control. Results also showed that reductions in rumination significantly mediated the improvement in post-treatment insomnia severity (proportional effect = 11%) and post-treatment depression severity (proportional effect = 19%) associated with the dCBT-I condition. Finally, reductions in rumination also significantly mediated the prevention of clinically significant depression via dCBT-I (proportional effect = 42%). Limitations Depression was measured with a validated self-report instrument instead of clinical interviews. Durability of results beyond one-year follow-up should also be tested in future research. Conclusions Results provide evidence that rumination is an important mechanism in how dCBT-I reduces and prevents depression.
... The QIDS can also be analysed categorically: A comparison of QIDS-SR16 scores with current and lifetime diagnosis based on Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) as a measure criterion showed that QIDS-SR16 is a reliable screening instrument for the diagnosis of MDD. 68 The cut-off scores of 13 and 14 yielded best results for sensitivity (76.5%) and specificity (81.8%), leading to correct classification T0, baseline; T1, 9 weeks after randomisation; T2, 6 months after randomisation; T3, 12 months after randomisation; T4, 24 months after randomisation; T5, 36 months after randomisation. *The primary outcome is the standardised mean difference between intervention and control group at T1. MPI will also be assessed at T0 and T2-T5 as secondary outcome. ...
... Open access of over 80% of the participants. 68 In this study, the cut-off score in QIDS-SR16 for clinical depression is set to 13 for all measurement points within the 36-month follow-up period. ...
... Within this study, categorical analyses are planned to determine the prevalence and incidence of MDD within the target population. For this purpose, cut-off scores for QIDS will be used to define MDD (eg, QIDS ≥13 indicates MDD 68 ). In-depth diagnostic procedures (eg, SCID interviews) could be more reliable to determine such estimates, but these are rather cost and time intensive. ...
Article
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Introduction: Chronic pain is highly prevalent, associated with substantial personal and economic burdens, and increased risk for mental disorders. Individuals in green professions (agriculturists, horticulturists, foresters) show increased prevalence of chronic pain and other risk factors for mental disorders. Available healthcare services in rural areas are limited. Acceptance towards face-to-face therapy is low. Internet and mobile-based interventions (IMIs) based on Acceptance and Commitment Therapy (ACT) might be a promising alternative for this population and may enable effective treatment of chronic pain. The present study aims to evaluate the clinical and cost-effectiveness of an ACT-based IMI for chronic pain in green professions in comparison with enhanced treatment as usual (TAU+). Methods and analysis: A two-armed pragmatic randomised controlled trial will be conducted. Two hundred eighty-six participants will be randomised and allocated to either an intervention or TAU+ group. Entrepreneurs in green professions, collaborating spouses, family members and pensioners with chronic pain are eligible for inclusion. The intervention group receives an internet-based intervention based on ACT (7 modules, over 7 weeks) guided by a trained e-coach to support adherence (eg, by positive reinforcement). Primary outcome is pain interference (Multidimensional Pain Interference scale; MPI) at 9 weeks post-randomisation. Secondary outcomes are depression severity (Quick Inventory Depressive Symptomology; QIDS-SR16), incidence of major depressive disorder, quality of life (Assessment of Quality of Life; AQoL-8D) and possible side effects associated with the treatment (Inventory for the Assessment of Negative Effects of Psychotherapy; INEP). Psychological flexibility (Chronic Pain Acceptance Questionnaire, Committed Action Questionnaire, Cognitive Fusion Questionnaire) will be evaluated as a potential mediator of the treatment effect. Furthermore, mediation, moderation and health-economic analyses from a societal perspective will be performed. Outcomes will be measured using online self-report questionnaires at baseline, 9-week, 6-month, 12-month, 24-month and 36-month follow-ups. Ethics and dissemination: This study was approved by the Ethics Committee of the University of Ulm, Germany (file no. 453/17-FSt/Sta; 22 February 2018). Results will be submitted for publication in peer-reviewed journals and presented at conferences. Trial registration number: German Clinical Trial Registration: DRKS00014619. Registered on 16 April 2018.
... The QIDS-SR 16 is a validated and reliable instrument that is used widely in longitudinal clinical trials, including those involving sleep that we and others have conducted [17,18,[37][38][39]. The QIDS-SR 16 assesses the severity of the nine diagnostic symptom criteria used in Diagnostic and Statistical Manual of Mental Disorders and shows strong consistency with a diagnosis of Major depressive disorder via a structured interview for the DSM [40][41][42]. Scores range from none (0-5), mild (6-10), moderate (11)(12)(13)(14)(15), severe (16)(17)(18)(19)(20), and very severe (21)(22)(23)(24)(25)(26)(27) [43]. Clinically significant depression was determined using these psychometrically derived severity categories and was operationalized as a score of 11 or higher, corresponding to moderate severity or higher. ...
... Clinically significant depression was determined using these psychometrically derived severity categories and was operationalized as a score of 11 or higher, corresponding to moderate severity or higher. A "moderate" rather than a "severe" threshold was selected to achieve better balance between sensitivity and specificity; the sensitivity and specificity for a threshold of at least 11 (moderate severity or higher) was 82.4% and 70.3%, respectively, as opposed to 52.9% and 88.4% (severe or very severe) [40]. This threshold can also be considered clinically significant because it is consistent with practices used in common depression screening programs that triage patients for treatment, such as the National Depression Screening Day. ...
... Results of this study should be interpreted in light of some limitations. First, cases of depression in this study did not use clinician-evaluated diagnosis, though validation of the QIDS-SR 16 against clinical diagnosis indicates adequate sensitivity and specificity at the cutoff selected (82.4% and 70.3%, respectively [40]). In addition, the use of a self-report instrument to screen for depression is generalizable to clinical practice and existing depression prevention programs (e.g. ...
Article
Study Objectives Insomnia is a common precursor to depression; yet, the potential for insomnia treatment to prevent depression has not been demonstrated. Cognitive behavioral therapy for insomnia (CBT-I) effectively reduces concurrent symptoms of insomnia and depression and can be delivered digitally (dCBT-I); however, it remains unclear whether treating insomnia leads to sustained reduction and prevention of depression. This randomized controlled trial examined the efficacy of dCBT-I in reducing and preventing depression over a 1-year follow-up period. Methods Patients with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) insomnia disorder were randomly assigned to receive dCBT-I or an attentional control. The follow-up sample included 358 patients in the dCBT-I condition and 300 patients in the online sleep education condition. The primary outcome measure was relative rate ratios for depression at 1-year follow-up. Insomnia responses to treatment were also tested as predictors of incident depression at the 1-year follow-up. Results At 1-year follow-up, depression severity continued to be significantly lower in the dCBT-I condition relative to control. In addition, the number of individuals who reported no depression at 1-year follow-up was 51% higher in the dCBT-I condition relative to control. In those with minimal to no depression at baseline, the incident rate of moderate-to-severe depression at 1-year follow-up was reduced by half in the dCBT-I condition relative to the control condition. Conclusion dCBT-I showed robust effects as an intervention that prevents depression. Future research should examine dose–response requirements and further characterize mechanisms of action of dCBT-I for depression prevention. Clinical Trial Sleep to Prevent Evolving Affective Disorders; NCT02988375.
... Scores between 0 and 5, 6 and 10, 11 and 15, 16 and 20, and >20, indicate normal health status, or mild, moderate, severe, or very severe depressive symptom severity, respectively (36). Compared to current and lifetime diagnosis based on Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID), the QIDS-SR16 proved to be a reliable screening instrument for a diagnosis of clinical depression (37) with good in (α = 0.86) (36). ...
... A total score of 13 and greater is defined as cut-off for possible cases of clinical depression for all time points (T0-T3). This value was selected as it yield best results for sensitivity (76.5%) and specificity (81.8%) and resulted in a correct classification of over 80% of participants (37). ...
Preprint
Background: Farmers show high levels of depressive symptoms and mental health problems in various studies. This study is part of a nationwide prevention project carried out by a German social insurance company for farmers, foresters and gardeners (SVLFG ) to implement internet- and tele-based services among others to improve mental health in this population. The aim of the present study is to evaluate the (cost-)effectiveness of personalized tele-based coaching for reducing depressive symptom severity and preventing the onset of clinical depression, compared to enhanced treatment as usual (TAU+ ).Methods: In a two-armed, pragmatic randomized controlled trial (N=312) with follow-ups at post-treatment (6 months), 12 months and 18 months, insured farmers, foresters and gardeners, collaborating family members and pensioners with elevated depressive symptoms (PHQ-9 ≥ 5) will be randomly allocated to personalized tele-based coaching or TAU+. The coaching is provided by psychologists and consists of up to 34 tele-based sessions for 25 to 50 minutes delivered over 6 months. Primary outcome is depressive symptom severity at post-treatment. Secondary outcomes include depression onset, anxiety, stress and quality of life. A health-economic evaluation will be conducted from a societal perspective. Discussion: This study is the first pragmatic randomized controlled trial evaluating the (cost-) effectiveness of a nationwide tele-based preventive service for farmers. If proven effective, the implementation of personalized tele-based coaching has the potential to reduce disease burden and health care costs both at an individual and societal level.
... Scores between 0 and 5, 6 and 10, 11 and 15, 16 and 20, and >20, indicate normal health status, or mild, moderate, severe, or very severe depressive symptom severity, respectively (36). Compared to current and lifetime diagnosis based on Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID), the QIDS-SR16 proved to be a reliable screening instrument for a diagnosis of clinical depression (37) with good in (α = 0.86) (36). ...
... A total score of 13 and greater is defined as cut-off for possible cases of clinical depression for all time points (T0-T3). This value was selected as it yield best results for sensitivity (76.5%) and specificity (81.8%) and resulted in a correct classification of over 80% of participants (37). ...
Article
Full-text available
Background: Farmers show high levels of depressive symptoms and mental health problems in various studies. This study is part of a nationwide prevention project carried out by a German social insurance company for farmers, foresters, and gardeners (SVLFG) to implement internet- and tele-based services among others to improve mental health in this population. The aim of the present study is to evaluate the (cost-)effectiveness of personalized tele-based coaching for reducing depressive symptom severity and preventing the onset of clinical depression, compared to enhanced treatment as usual. Methods: In a two-armed, pragmatic randomized controlled trial (N = 312) with follow-ups at post-treatment (6 months), 12 and 18 months, insured farmers, foresters, and gardeners, collaborating family members and pensioners with elevated depressive symptoms (PHQ-9 ≥ 5) will be randomly allocated to personalized tele-based coaching or enhanced treatment as usual. The coaching is provided by psychologists and consists of up to 34 tele-based sessions for 25–50 min delivered over 6 months. Primary outcome is depressive symptom severity at post-treatment. Secondary outcomes include depression onset, anxiety, stress, and quality of life. A health-economic evaluation will be conducted from a societal perspective. Discussion: This study is the first pragmatic randomized controlled trial evaluating the (cost-)effectiveness of a nationwide tele-based preventive service for farmers. If proven effective, the implementation of personalized tele-based coaching has the potential to reduce disease burden and health care costs both at an individual and societal level. Clinical Trial Registration: German Clinical Trial Registration: DRKS00015655.
... Scores between 0 and 5, 6 and 10, 11 and 15, 16 and 20, and >20, indicate normal health status, or mild, moderate, severe, or very severe depressive symptom severity, respectively (36). Compared to current and lifetime diagnosis based on Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID), the QIDS-SR16 proved to be a reliable screening instrument for a diagnosis of clinical depression (37) with good in (α = 0.86) (36). ...
... A total score of 13 and greater is defined as cut-off for possible cases of clinical depression for all time points (T0-T3). This value was selected as it yield best results for sensitivity (76.5%) and specificity (81.8%) and resulted in a correct classification of over 80% of participants (37). ...
... The psychometric properties of the QIDS-SR 16 have been assessed on a range of different samples: individuals with depressive disorder (Rush et al., 2003;Trivedi et al., 2004;Carmody et al., 2006;Rush et al., 2006aRush et al., , 2006b; bipolar disorder (Trivedi et al., 2004;Rush et al., 2006b); co-occurring asthma and depressive disorder (Brown et al., 2008); out-patients with chronic kidney disease (Hedayati et al., 2009); older adults (Doraiswamy et al., 2010); and US primary care consulters (Lamoureux et al., 2010). The majority of those studies have assessed the QIDS-SR 16 as a depression severity measure, though some have assessed the scale in terms of diagnostic accuracy (Hedayati et al., 2009;Lamoureux et al., 2010). ...
... The psychometric properties of the QIDS-SR 16 have been assessed on a range of different samples: individuals with depressive disorder (Rush et al., 2003;Trivedi et al., 2004;Carmody et al., 2006;Rush et al., 2006aRush et al., , 2006b; bipolar disorder (Trivedi et al., 2004;Rush et al., 2006b); co-occurring asthma and depressive disorder (Brown et al., 2008); out-patients with chronic kidney disease (Hedayati et al., 2009); older adults (Doraiswamy et al., 2010); and US primary care consulters (Lamoureux et al., 2010). The majority of those studies have assessed the QIDS-SR 16 as a depression severity measure, though some have assessed the scale in terms of diagnostic accuracy (Hedayati et al., 2009;Lamoureux et al., 2010). Some of the studies assessed the validity of the QIDS-SR 16 in relation to a clinician administered reference standard measure of depression severity (e.g. ...
Article
It is widely believed that severity of depressive disorder should guide treatment selection and many guidelines emphasise this factor. The Quick Inventory of Depressive Symptomatology (QID-SR) is a self-complete measure of depression severity which includes all DSM-IV criterion symptoms for major depressive disorder. The object of this study was to assess the psychometric properties of the QIDS-SR in a primary care sample. Adult primary care patients completed the QIDS-SR and were assessed by a psychiatrist (blind to QIDS-SR) with the 17-item Hamilton Rating Scale for Depression (GRID-HAMD). Internal consistency, homogeneity and convergent and discriminant validity of the QIDS-SR were assessed. Severity cut-off scores for QIDS-SR were assessed for convergence with HRSD-17 cut-offs. Published methods for converting scores to HRSD-17 were also assessed. Two hundred and eighty-six patients participated: mean age = 49.5 (s.d. = 13.8), 68% female, mean HRSD-17 = 12.6 (s.d. = 7.6). The QIDS-SR exhibited acceptable internal consistency (Cronbach's alpha = 0.86), a robust factor structure indicating one underlying dimension and correlated highly with the HRSD-17 (r = 0.79) but differed significantly in how it categorised the severity of depression relative to the HRSD-17 (Wilcoxon Signed Rank Test p < 0.001). Using published methods to convert QIDS-SR scores to HRSD-17 scores did not result in alignment of severity categorisation. In conclusion, psychometric properties of the QIDS-SR were found to be strong in terms of internal consistency, factor structure and convergent and discriminant validity. Using conventional scoring and conversion methods the scale was found not to concur with the HRSD-17 in categorising the severity of depressive symptoms.
... Onset and remission of MDD was based on categorical analysis of QIDS-SR16. QIDS-SR16 ≥ 13 was defined as cut-off score for categorization as MDD case at baseline and 6-and 12-month FU (Lamoureux et al., 2010). Additionally, onset and remission of MDD and BPD were analyzed based on a self-report version of CIDI (Auerbach et al., 2018). ...
... Seventh, as a methodical limitation we did not apply standardized diagnostic interviews for MDD and BPD categorization, but categorized participants at baseline and FU measurement points according to a cut-off scores of QIDS-SR16 and additionally self-report versions of the CIDI. Screening scales cannot ensure perfect classification of MDD and BPD when compared with structured clinical interviews (Kessler et al., 2013b(Kessler et al., , 2013aLamoureux et al., 2010). Further, analyses for onset and remission of MDD or BPD are exploratory in nature and substantially underpowered as we were only able to analyze the corresponding reduced subsamples of participants fulfilling or not fulfilling cut-off scores. ...
Article
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Objective Evidence of long-term stability for positive mental health effects of internet-based interventions (IBIs) for depression prevention is still scarce. We evaluate long-term effectiveness of a depression prevention program in green professions (i.e. agriculture, horticulture, forestry). Methods This pragmatic RCT (n = 360) compares a tailored IBI program to enhanced treatment as usual (TAU+) in green professions with at least subthreshold depression (PHQ ≥ 5). Intervention group (IG) received one of six IBIs shown previously to efficaciously reduce depressive symptoms. We report 6- and 12-month follow-up measures for depression, mental health and intervention-related outcomes. Intention-to-treat and per-protocol regression analyses were conducted for each measurement point and complemented by latent growth modeling. Results After 6 months, depression severity (β = −0.30, 95%-CI: −0.52; −0.07), insomnia (β = −0.22, 95%-CI: −0.41; −0.02), pain-associated disability (β = −0.26, 95%-CI: −0.48; −0.04) and quality of life (β = 0.29, 95%-CI: 0.13; 0.45) in IG were superior to TAU+. Onset of possible depression was not reduced. After 12 months, no intervention effects were found. Longitudinal modeling confirmed group effects attenuating over 12 months for most outcomes. After 12 months, 55.56% of IG had completed at least 80% of their IBI. Conclusions Stability of intervention effects along with intervention adherence was restricted. Measures enhancing long-term effectiveness of IBIs for depression health promotion are indicated in green professions. Trial registration German Clinical Trial Registration: DRKS00014000. Registered: 09 April 2018.
... Minimum training is required for its administration and it is freely available for use (see www.ids-qids.org), so, it is both timeand resource-efficient (7). The measure consists of 16 items that assess the nine symptom domains used to diagnose a MDE in the Diagnostic and Statistical Manual of Mental Disorders (DSM): sleep disturbance (items 1-4), depressed (sad) mood (item 5), change in appetite or weight (items 6-9), concentration/decision making (item 10), self-view (item 11), suicidal ideation (item12), interest (item13), energy/fatigue (item14), and psychomotor agitation/retardation (items 15 and 16) (8). ...
... These item-scale correlation coefficients are significantly higher than ours used to compare the QIDS-SR 16 The internal consistencies of the QIDS obtained in studies from the United States were greater than our Cronbach's α coefficient, but there was no statistically significant difference between them (z=0.55, p>0.05) (5,7,16,18). ...
Article
Objective: To evaluate the validity and reliability of 16-item self-report version of the Quick Inventory of Depressive Symptomatology (QIDS-SR16) scale in comparison with BDI-II-Turkish (BDI-II-T) in a young sample of Turkish university students. Methods: A slightly modified version of the QIDS-SR16-Turkish (QIDS-SR16-T) available at www.ids-qids.org, along with the BDI-II-T, was administered to 628 young Turkish university students who attended the Family Health Center in Uludag University Campus between February and April 2010. Descriptive analyses, Student's t-test, receiver operating characteristic (ROC) analysis, and confirmatory factor analyses were used in the study. Results: The mean age of the participants was 21.1 +/- 2.16 (SD) years; 67.8% were female and 32.2% were male. Cronbach's a coefficient for internal consistency of the QIDS-SR16-T was found to be 0.769. The mean item-total correlation was 0.45, ranging from 0.29 to 0.71. The correlation between the BDI-II-T and QIDS-SR16-T was 0.72. ROC curve analysis suggested 9 as the optimal cut-off for a clinical depression level for the QIDS-SR16-T. Conclusion: We observed that the QIDS-SR16-T demonstrated good psychometric properties in a sample of young Turkish students and has convergent validity with the BDI-II-T, a widely used scale for depression. It is essential to diagnose reliably the major depressive disorder and to follow up the patients by valid screening instruments in primary care setting. The internal consistencies of the QIDS determined in studies from the United States were greater than our Cronbach's alpha coefficient, but there was no statistically significant difference between them (z=0.55, p>0.05). The QIDS-SR16-T can be reliably used in primary care settings. (Archives of Neuropsychiatry 2012;49: 1-5)
... This measure also showed strong internal reliability in this study (Cronbach's α = 0.81). The QIDS-SR 16 assesses the severity of the nine diagnostic symptom criteria used in the Diagnostic and Statistical Manual of Mental Disorders, and shows strong consistency with a diagnosis of major depressive disorder via a Structured Interview for the DSM (Lamoureux et al., 2010;Surís, Holder, Holliday, & Clem, 2016;Yeung et al., 2012). To examine changes in non-sleep symptoms of depression, analyses only utilized non-sleep items from the QIDS (items 1-4 were dropped) unless otherwise specified. ...
... Clinically significant depression was determined using a psychometrically derived threshold of 11 or higher (corresponding to moderate severity or higher). This cutoff has 82.4% sensitivity and 70.3% specificity with a SCID diagnosis of major depressive disorder (Lamoureux et al., 2010) and is consistent with clinical practices for screening and triaging patients for treatment or prevention. ...
Article
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Background While the negative consequences of insomnia are well-documented, a strengths-based understanding of how sleep can increase health promotion is still emerging and much-needed. Correlational evidence has connected sleep and insomnia to resilience; however, this relationship has not yet been experimentally tested. This study examined resilience as a mediator of treatment outcomes in a randomized clinical trial with insomnia patients. Methods Participants were randomized to either digital cognitive behavioral therapy for insomnia (dCBT-I; n = 358) or sleep education control ( n = 300), and assessed at pre-treatment, post-treatment, and 1-year follow-up. A structural equation modeling framework was utilized to test resilience as a mediator of insomnia and depression. Risk for insomnia and depression was also tested in the model, operationalized as a latent factor with sleep reactivity, stress, and rumination as indicators (aligned with the 3-P model). Sensitivity analyses tested the impact of change in resilience on the insomnia relapse and incident depression at 1-year follow-up. Results dCBT-I resulted in greater improvements in resilience compared to the sleep education control. Furthermore, improved resilience following dCBT-I lowered latent risk, which was further associated with reduced insomnia and depression at 1-year follow-up. Sensitivity analyses indicated that each point improvement in resilience following treatment reduced the odds of insomnia relapse and incident depression 1 year later by 76% and 65%, respectively. Conclusions Improved resilience is likely a contributing mechanism to treatment gains following insomnia therapy, which may then reduce longer-term risk for insomnia relapse and depression.
... The diagnostic of major depressive episode was based on (1) clinician diagnosis (as the decision to 'prescribe an antidepressant to treat a major depressive episode' was the inclusion criteria), (2) a specific assessment of the nine DSM-IV criteria for major depressive episode (and the fact that at least 5 of these criteria are present) and the (3) Self-Report Quick Inventory of Depressive Symptomatology (QIDS-SR). This 16-item brief rating of depressive symptoms was designed to assess severity, but has highly acceptable psychometric properties and usefulness (Rush et al., 2003) and good capacity to correctly classify depressed patients in primary care centres (Lamoureux et al., 2010). ...
Article
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The cumulative duration of depressive episodes, and their repetition, has a detrimental effect on depression recurrence rates and the chances of antidepressant response, and even increases the risk of dementia, raising the possibility that depressive episodes could be neurotoxic. Psychomotor retardation could constitute a marker of this negative burden of past depressive episodes, with conflicting findings according to the use of clinical versus cognitive assessments. We assessed the role of the Retardation Depressive Scale (filled in by the clinician) and the time required to perform the neurocognitive d2 attention test and the Trail Making Test (performed by patients) in a sample of 2048 depressed outpatients, before and after 6 to 8 weeks of treatment with agomelatine. From this sample, 1140 patients performed the TMT-A and –B, and 508 performed the d2 test, at baseline and after treatment. At baseline, we found that with more past depressive episodes patients had more severe clinical level of psychomotor retardation, and that they needed more time to perform both d2 and TMT. When the analyses were performed again after treatment, and especially when the analyses were restricted to patients with clinical remission, the cognitive tests were the only ones correlated with past depressive episodes. Psychomotor retardation tested at a cognitive level was therefore systematically revealing the burden of past depressive episodes, with an increased weight for patients with less remaining symptoms. If prospectively confirmed, interventions such as cognitive remediation therapy could benefit from a more specific focus on neurocognitive retardation.
... The following guidelines were put forth by Rush and colleagues (2003) for estimating the level of severity of MDD symptoms using the QIDS-SR16: none (0-5), mild (6-10), moderate (11-15), severe (16-20), and very severe (≥ 21). Further research has found cutoff scores ranging between 13 and 14 to be the most useful in terms of sensitivity and specificity in identifying individuals suffering from MDD (Lamoureux et al., 2010). Given that one item assessing for suicidal ideation was omitted during online screening, the current study used QIDS-SR16 scores of ≥ 12 as indicative of a relatively high level of MDD symptoms for screening individuals into the study. ...
Thesis
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Meta-cognitive reactions to emotions involve the manner in which individuals cognitively appraise and emotionally respond to the provocation of their feelings (e.g., viewing sadness as weakness, becoming embarrassed that one is sad). The manner in which an individual meta-cognitively responds to his or her emotions may be an important consideration in disorders characterized by emotional pathology, such as mood and anxiety disorders. Previous research has linked negative beliefs regarding emotions and discomfort with one’s feelings to anxiety and depressive pathology. The current study examined meta-cognitive reactions to sadness, anger, and anxiety, as assessed by self-report and structured interview, in relation to self-reported symptoms of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in college students. Study findings indicated that individuals with higher levels of symptoms of psychopathology (i.e., individuals in the MDD and GAD analogue groups) were less comfortable with their negative emotions, viewed their negative emotions as more problematic, were more fearful of the provocation of their negative emotions, and viewed themselves as less able to effectively cope with their negative emotions, as compared to relatively healthy individuals. Additionally, an exploratory analysis found a trend for individuals in the GAD analogue group to be more fearful of anxiety than individuals in the MDD analogue group. Finally, fear of negative emotions was found to moderate the relationship between worry and GAD symptoms, as well as the relationship between brooding and MDD symptoms, such that higher levels of fear of negative emotions strengthened these relationships. The manner in which individuals cognitively appraise and emotionally respond to their feelings is a relatively understudied area of research that has meaningful implications for the understanding and treatment of MDD and GAD. Further research is needed to elucidate distinctive emotional processes in MDD and GAD, including meta-cognitive reactions to emotions, in order to refine our understanding of the nature of these two disorders and inform cognitive-behavioral interventions that can specifically target important areas of emotional dysfunction and distress.
... The symptom itself is rarely presented directly, because the patient is generally not aware that he/she is depressed. In the primary care setting, depression in fact rarely presents with the classic psychiatric symptoms of sadness or loss of interest (9). By far, the most likely complaints are those of a physical nature-fatigue, lack of interest, sleep disturbance, appetite disturbance, bowel disturbance, irritability, lack of sexual interest and performance or some other somatic complaint. ...
... The score range is 27 and is categorised 5 ways; Normal (0-5), Mild (6-10), Moderate (11-15), Severe (16-20), Very Severe (≥21). Criticisms of QIDS include the fact it was designed to measure depression severity in out-patients and therefore is not suitable for use in a primary care setting (Cameron et al., 2013;Lamoureux et al., 2010) and whilst it is has high reliability when differentiating depressed from non-depressed patients it tends to categorise patients as more severely depressed than other measures, resulting in unneeded treatment and medication (Cameron et al., 2013). ...
Thesis
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Clinical depression is a prominent cause of disability and burden worldwide. Despite this prevalence, the diagnosis of depression, due to its complex clinical characterisation, is a difficult and time consuming task. Currently, there is a real need for an automated and objective diagnostic aid for use in primary care settings and specialist clinics. Accordingly this thesis investigates the use of paralinguistic cues for automatically assessing a speaker’s level of depression. Investigations are undertaken to establish the effects of depression in spectral representations of speech and their subsequent acoustic models. A novel Probabilistic Acoustic Volume (PAV) method for robustly estimating Acoustic Volume is presented and a Monte Carlo approximation that enables the computation of this measure outlined. Results indicate that reductions in spectral variations can quantitatively characterise speech affected by depression. Within the acoustic models the following statistically significant findings are made across two key datasets: reductions in localised acoustic variance, a flattening of the acoustic trajectory and reductions in three different Acoustic Volume measures. Further results gained using an array of PAV points give strong statistical evidence that the spectral feature space also becomes more concentrated. Together these observations demonstrate there is a reduction in the local and global spread of phonetic events in acoustic space in speech affected by depression. A range of novel approaches for performing depression prediction are also investigated. A comprehensive series of acoustic supervector experiments demonstrate the suitability of the Kullback-Leibler divergence based representation to the task and highlight the difficulties of performing nuisance mitigation within this paradigm. A further series of tests opens up the possibilities for using Relevance Vector Machines when predicting depression using a brute-forced feature space. Of particular interest are tests performed using a novel 2-stage rank regression framework designed specifically for regression analysis using ordinal depression scores. Three unique implementations are shown to match or out-perform corresponding conventional regression systems. Further results presented highlight the benefits of using the framework; most notably that, in contrast to conventional regressor fusion, score level fusion of the two-stage systems consistently improves prediction performance.
... 24 We used the widely accepted QIDS score cut points of 11 or greater, the clinical threshold for moderately severe symptoms, 25 and 14 or greater, the threshold that optimally balances sensitivity and specificity for estimating MDE. 26 ...
Article
Importance Low-income and minority mothers experience a disproportionate incidence of depression and lack access to treatment services. Development of prevention strategies in accessible community-based venues is a potentially important public health strategy. Objective To determine the efficacy of a depression prevention strategy embedded in Head Start. Design, Setting, and Participants This randomized clinical trial was performed from February 15, 2011, through May 9, 2016, at 6 Head Start agencies serving families at or below the federal poverty level. Participants included mothers with depressed mood, anhedonia, or depression history but who were not in a current major depressive episode. Participants were followed up for 12 months with masked outcome assessments. Final follow-up was completed on May 9, 2016. Interventions Participants were randomized to a problem-solving education (PSE) intervention (n = 111) or usual Head Start services (n = 119). Main Outcomes and Measures Primary outcomes were problem-solving skills and depressive symptoms. To capture the chronicity and intensity of symptoms, the Quick Inventory of Depressive Symptoms was administered bimonthly, and rates of clinically significant symptom elevations were compared across groups. Secondarily, the presence of a major depressive episode was assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders. Results Among the 230 participants, 152 (66.1%) were Hispanic, with a mean (SD) age of 31.4 (7.3) years. An intention-to-treat analysis among 223 participants contributing follow-up data found no differences in problem-solving skills across groups. The mean (SD) number of depressive symptom elevations among the PSE participants was 0.84 (1.39) compared with 1.12 (1.47) among the usual service participants (adjusted incident rate ratio [aIRR], 0.60; 95% CI, 0.41-0.90). In analyses stratified according to baseline depressive symptoms, PSE exerted a preventive effect among those with lower-level baseline symptoms, with a mean (SD) of 0.39 (0.84) elevations among PSE participants compared with 0.88 (1.37) among usual service participants (aIRR, 0.39; 95% CI, 0.21-0.75). However, no difference was observed among those with higher-level baseline symptoms (mean [SD] elevations, 2.06 [1.92] for PSE and 2.00 [1.91] for usual service; aIRR, 1.10; 95% CI, 0.67-1.80). Analysis of symptom scores followed the same pattern, with an adjusted mean reduction of 1.33 (95% CI, 0.36-2.29) among participants with lower-level baseline symptoms. Conclusions and Relevance The PSE intervention is efficacious in preventing depressive symptom episodes and performs optimally among those with initial low-level symptoms. Additional effectiveness studies in Head Start are necessary to develop meaningful public health programs. Trial Registration clinicaltrials.gov Identifier: NCT01298804
... The specific translation of the QIDS-SR 16 -T used in this study is available from the first author. The QIDS-SR 16 requires minimal training to administer and is freely available for use (7). The 16 items span the nine core symptom domains as defined by the text revision of version IV of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (8). ...
Article
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Comparative validity and reliability study of the QIDS-SR16 in Turkish and American college student samples Objective: To evaluate the validity and reliability of the Quick Inventory of Depressive Symptomatology, self-reported version, in a Turkish student sample (QIDS-SR16-T) by comparing it to (a) the American version (QIDS-SR16-US) and (b) the Turkish version of the Beck Depression Inventory (BDI-II-T). Materials and Methods: Slightly modified versions of the QIDS-SR16-T, and the BDI-II-T were administered to 626 outpatients at the Uludag University campus-based family health center. The QIDS-SR16-US was administered to 584 respondents at an American university. SAS and MPlus were used to provide descriptive statistics, classical exploratory factor analysis, and item response theory analyses (in the form of a multiple group confirmatory factor analysis). Results: The internal consistency (Cronbach a) of the QIDS-SR16-T was 0.77. Both QIDS-SR16 versions were unidimensional, but the BDI-II-T was not. The mean QIDS-SR16-T and QIDS-SR16-US item-total correlations were similar. The correlation between the QIDS-SR16-T and BDI-II-T was 0.72 (.90 when disattenuated). Multiple-group confirmatory factor analysis suggested that the QIDS-SR16-T and QIDS-SR16-US had the same factor loadings but different intercepts. This reflects group differences in level of depression, perhaps because the Turkish respondents, unlike their US counterparts, were seen in a medical context where illness-related depression is more prevalent. Scores on the QIDS-SR16-T and the BDI-II-T were also equated. Discussion: The QIDS-SR16-T has good psychometric properties and convergent validity with the BDI-II-T. Its use is recommended when a self-reported instrument is appropriate.
... The adequacy of the psychometric properties of the QIDS-SR 16 has been demonstrated across multiple and diverse samples, primarily in the USA: outpatients with MDD (Carmody et al., 2006;Liu et al., 2013;Rush et al., 2003;Trivedi et al., 2004;Zimmerman et al., 2012) or bipolar disorder (Bernstein et al., 2010a;Trivedi et al., 2004); primary-care medical patients (Lamoureux et al., 2010); patients with chronic kidney disease (Hedayati et al., 2009) or with co-morbid asthma and MDD (Brown et al., 2008); adolescents (Bernstein et al., 2010b), young adults (González et al., 2013), and elderly individuals (Doraiswamy et al., 2010). ...
... In addition, both instruments are valid depression screening instruments for patients at different developmental stages, including the elderly (Doraiswamy et al., 2010) and adolescents . Lamoureux et al. (2010) reported that a cutoff score of 13 or 14 on the QIDS-SR 16 performs adequately as a depression screening instrument in primary care medical patients (sensitivity, 76.5%, and specificity, 81.8%). In a study of less educated, socially disadvantaged populations, Bernstein et al. (2007) compared the QIDS-SR 16 with the QIDS-C 16 and found that the QIDS-SR 16 is a satisfactory substitute for the more timeconsuming QIDS-C 16 . ...
Article
This study aimed to investigate the psychometric properties of the Chinese translations of the Quick Inventory of Depressive Symptomatology (QIDS(16)), including the Clinician-Rated (QIDS-C(16)), Self-report (QIDS-SR(16)), and Interactive Voice Response (QIDS-SR-IVR(16)) formats. Thirty depressed Chinese Americans were assessed with Chinese translations of the QIDS-SR(16), QIDS-SR-IVR(16), and QIDS-C(16). Cronbach alpha estimates of internal scale consistency on the QIDS-SR(16), QIDS-SR-IVR(16), and QIDS-C(16) were 0.70, 0.74, and 0.79, respectively. Intercorrelations among the measures were QIDS-SR(16) and QIDS-SR-IVR(16), r = 0.79; QIDS-SR(16) and QIDS-C(16), r = 0.61; and QIDS-SR-IVR(16) and QIDS-C(16), r = 0.69 (all p values < 0.01). The areas under the curve for the receiver operating characteristics of the QIDS-SR(16) and QIDS-SR-IVR(16) were 0.78 (95% confidence interval, 0.61-0.95) and 0.81 (95% confidence interval, 0.65-0.96), respectively. The respective screening sensitivities/specificities were 0.73/0.74 and 0.86/0.58. The Chinese translations of the QIDS(16) have adequate psychometric properties and may be useful tools for depression screening.
... Given the design and exploratory aims of the study, the results presented here are primarily descriptive. For the analyses, a QIDS score higher than 13 is considered to indicate severe depressive symptoms and a high probability of a diagnosis of major depressive disorder (45)(46)(47)(48). HIV viral load < 50 copies/mL were considered undetectable viral load (i.e., virally suppressed). ...
Article
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Using a mobile research facility, we enrolled 141 opioid users from a neighborhood of Philadelphia, an urban epicenter of the opioid epidemic. Nearly all (95.6%) met DSM-5 criteria for severe opioid use disorder. The prevalence of HIV infection (8.5%) was more than seven times that found in the general population of the city. Eight of the HIV-positive participants (67.0%) reported receiving antiretroviral treatment but almost all of them had unsuppressed virus (87.5%). The majority of participants (57.4%) reported symptoms consistent with major depressive disorder. Severe economic distress (60.3%) and homelessness were common (57%). Polysubstance use was nearly universal, 72.1% had experienced multiple overdoses and prior medication for opioid use disorder (MOUD) treatment episodes (79.9%), but few currently engaged in addiction care. The prevalence, multiplicity and severity of chronic health and socioeconomic problems highlight consequences of the current opioid epidemic and underscore the urgent need to develop integrated models of treatment.
... The RMRS has good overall reliability (α = 0.84) and demonstrated convergent validity with the Connor Davidson Resilience Scale-10 and criterion validity with the Maslach Burnout Inventory-Human Services Survey [23,24]. The survey also included the Generalized Anxiety Disorder Scale (GAD-7) [25], the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR16) [26,27], and the Perceived Stress Scale (PSS) [28]. Total scores were computed for PSS, GAD-7, and QIDS-SR16 and used as continuous variables for variance and correlation analyses. ...
Article
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Background: Global health crises, such as the COVID-19 pandemic, confront healthcare workers (HCW) with increased exposure to potentially morally distressing events. The pandemic has provided an opportunity to explore the links between moral distress, moral resilience, and emergence of mental health symptoms in HCWs. Methods: A total of 962 Canadian healthcare workers (88.4% female, 44.6 + 12.8 years old) completed an online survey during the first COVID-19 wave in Canada (between April 3rd and September 3rd, 2020). Respondents completed a series of validated scales assessing moral distress, perceived stress, anxiety, and depression symptoms, and moral resilience. Respondents were grouped based on exposure to patients who tested positive for COVID-19. In addition to descriptive statistics and analyses of covariance, multiple linear regression was used to evaluate if moral resilience moderates the association between exposure to morally distressing events and moral distress. Factors associated with moral resilience were also assessed. Findings: Respondents working with patients with COVID-19 showed significantly more severe moral distress, anxiety, and depression symptoms (F > 5.5, p < .020), and a higher proportion screened positive for mental disorders (Chi-squared > 9.1, p = .002), compared to healthcare workers who were not. Moral resilience moderated the relationship between exposure to potentially morally distressing events and moral distress (p < .001); compared to those with higher moral resilience, the subgroup with the lowest moral resilience had a steeper cross-sectional worsening in moral distress as the frequency of potentially morally distressing events increased. Moral resilience also correlated with lower stress, anxiety, and depression symptoms (r > .27, p < .001). Factors independently associated with stronger moral resilience included: being male, older age, no mental disorder diagnosis, sleeping more, and higher support from employers and colleagues (B [0.02, |-0.26|]. Interpretation: Elevated moral distress and mental health symptoms in healthcare workers facing a global crisis such as the COVID-19 pandemic call for the development of interventions promoting moral resilience as a protective measure against moral adversities.
... As indicated in Table 7.1, the norming, reliability, and validity of the QIDS-SR are excellent. Lamoureux et al. (2010) conducted ROC analysis in a sample of 125 primary care patients who completed the QIDS-SR and the SCID and concluded that a score of 11 on the QIDS-SR provided the best balance of sensitivity (Sn = .81) and specificity (Sp = .72) ...
Chapter
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This chapter focuses on the assessment of depression in adults. It focuses on major depressive disorder (MDD) because the empirical support for the tools and theories and therapies described in this chapter focuses most frequently on MDD. Many other disorders, as well as phenomena that are not disorders (e.g., grief), share features with MDD, and many of the assessment tools described in this chapter will be helpful in those cases as well. The chapter begins with an overview of the nature of the disorder, which is followed by reviews of assessment instruments designed for the purposes of (a) diagnosis, (b) case conceptualization and treatment planning, and (c) treatment monitoring and evaluation. We include recommendations for instruments that have the greatest scientific support and that assess depression in a clinically sensitive manner.
... Second, we did not assess formal diagnoses and thus cannot determine to what extent clinical diagnoses were represented in this sample, but a largely nonclinical representation in this sample could have led to restriction of range and reduced effects of interest. Regarding the severity of our sample, 13% of participants were at or above the QIDS clinical cutoff suggested for differentiating major depressive disorder (i.e., a score of 13 or greater; Lamoureux et al., 2010). Third, our sample also had a limited representation of age; further research is needed to assess how SERQ skills vary across the lifespan. ...
Article
Background In cognitive behavioral therapies, patients work to develop or strengthen various emotion regulation skills. Understanding the role of such skills in treatment and how focusing on different skills might be used to effectively personalize treatments requires a measure suited to these purposes. With this goal in mind, we developed the Styles of Emotion Regulation Questionnaire (SERQ) to capture individual differences in the broad range of emotion regulation skills taught in these therapies, suited for assessing skills among treatment naïve participants and those participating in treatment. Methods In this study, 512 participants completed the SERQ. We conducted separate factor analyses of items assessing frequency of skill use and the extent to which skills were impaired when upset. Results Analyses suggested four skill factors and one emotionally impaired coping factor. In 17 of 20 tests, SERQ scores were related to anxiety, depression, stress, and features of borderline personality disorder. Discussion Initial results suggest the potential of the SERQ as a measure of emotion regulation strategies taught in cognitive behavioral therapy. We encourage future research using the SERQ in clinical contexts.
... Onset and remission of potential MDD was evaluated based on categorical analyses of QIDS-SR16. A cut-off score ≥ 13 (Lamoureux et al., 2010) was defined as criterion for potential MDD. Onset and remission of potential MDD and bipolar disorder (BPD) was also calculated based on a CIDI self-report version (Auerbach et al., 2018). ...
Article
Background: Major Depressive Disorder (MDD) has a major impact on public health. Reduction of depression burden in general population is of greatest importance and might be achieved by implementation of depression prevention measures into routine care. We evaluate an online prevention measure as part of a national project aiming to reduce depression in the occupational group of green professions. Methods: This two-armed pragmatic RCT (n = 360) evaluates the effectiveness of a tailored internet-based intervention (IMI) program compared to enhanced treatment as usual. The IMI program entailed access to one of six guided IMIs each focusing on different symptom areas (depressive mood with optional comorbid diabetes, perceived stress, insomnia, panic and agoraphobia and harmful alcohol consumption). Eligible were entrepreneurs, spouses, family members and pensioners in green professions with adequate insurance status and at least subthreshold depression (PHQ≥5). Primary outcome was depressive symptom severity (QIDS-SR16) at 9-weeks post-treatment (T1). Various secondary outcomes were assessed at T1. Results: A small effect of depression reduction (d=-0.28, 95%-CI: -0.50 to -0.07) was found at T1 favouring the IMI program (β=-0.22, 95%-CI: -0.41 to -0.02, p=.033). Categorical analysis indicated a reduced risk of potential MDD with NNTB=28.11. Adherence to the IMI program at T1 was exceptionally low. Limitations: Results are limited to green professions and representativeness might be restricted by self-selection of participants. Conclusion: Depression burden in green professions can be reduced by this online prevention measure. Yet, short-term effectiveness is restricted by low adherence rates. Trial Registration German Clinical Trial Registration: DRKS00014000. Registered: 09 April 2018. Full text available: https://authors.elsevier.com/a/1c2o-bXYig%7EEw
... A possible instrument of choice is the Inventory of Depressive Symptomatology, Self-report (IDS-SR), which is different from other copies of questionnaire because it gives an equivalent weighting for each depressive symptom and is designed to include all the DSM-IV diagnostic criteria for MDD [17,18]. The IDS-SR has been shown to have a good diagnostic validity regarding MDD [19,20], and has been used in large international studies [21]. But IDS-SR has never been validated through the Internet. ...
Article
Objectives: Patients with social anxiety disorder (SAD) often have a fear of seeking professional help. In this study, we intended to validate the Taiwanese version of the Inventory of Depressive Symptomatology, Self-report (IDS-SR), and to investigate whether severity of depression and/or social anxiety is associated with professional help-seeking among Internet users with SAD. Methods: In the study part I, we recruited volunteers through the internet, assessed their social anxiety and depression, and examined the Taiwanese version of the IDS-SR. In study Part II, we again recruited volunteers from the Internet and outpatient clinic, and did the telephone or face-to-face interview to establish the validity of the IDS-SR. Finally, the results of both parts were integrated to analyze help-seeking behaviors. Results: We included 2,079 participants in study part I, which showed that the IDS-SR was reliable. In the Part II study, the IDS-SR was found to be valid from 104 participants. Among the study Part I participants who reached the threshold of SAD, a high prevalence (52.9%) of major depressive disorder was found. Multiple logistic regression analysis of scores of the participants who met the threshold of SAD (n = 1,483) revealed that the IDS-SR total score was significantly associated with professional help-seeking (p < 0.001), whereas the severity of social anxiety was not. Conclusion: The Taiwanese version of IDS-SR was valid and reliable. The severity of depression, rather than that of social anxiety, was associated with professional help-seeking behaviors among Internet users with SAD. Screening depression in people with SAD has the potential in identifying those who may seek professional help.
Article
Background: The Affective Symptoms Scale (ASRS) is a unique instrument designed to separately measure depressive and manic symptoms in mood disorders. We validated the ASRS against the Patient Health Questionnaire (PHQ-9) and the Quick Inventory of Depressive Symptomatology (QIDS-16). Methods: A retrospective study of 258 patients who completed the PHQ-9, QIDS-16 and ASRS as part of routine clinical care. To establish meaningful clinical thresholds for the depression subscale of the ASRS, it was equated with the QIDS and the PHQ-9. Results: The depression subscale of the ASRS had significant positive correlations with the QIDS-16 and the PHQ-9 (respectively, r = 0.8, t[253] = 19.8, p < 0.001, and r = 0.8, t[245] = 28.2, p < 0.001). The equipercentile equating method with the PHQ-9 indicated that the thresholds corresponded to ASRS depression subscale scores of 5.4, 10.6, 16.1, and 23. Equating with the QIDS indicated that thresholds corresponded to ASRS depression subscale scores of 5.1, 11, 18.4, and 27.5. Limitations: Limitations include a small sample size that did not allow more detailed statistical analysis, such as Item Response Theory. The population is a heterogenous population at a university outpatient setting. Conclusions: The ASRS depression subscale significantly correlated with the PHQ-9 and QIDS-16. Our proposed threshold scores for the ASRS are 5, 11, 16 and 23 to indicated mild, moderate, severe and very severe depression respectively.
Article
Objectives . To explore the association between return to work (RTW) and mental health outcomes in Black men in Philadelphia recovering from serious traumatic injuries. Methods . We analyzed data from 498 Black men aged ≥ 18 years living in Philadelphia who were admitted to a Level I trauma center for injury between January 2013 and June 2017. We used multivariable logistic regression to estimate the association between pre-injury occupation, RTW and depression or PTSD 3 months after hospitalization. Results . In adjusted analyses, men who had not RTW at follow-up had higher odds of poor mental health outcomes than men who had RTW (OR: 2.7, 95% CI: 1.8, 4.2). Additional significant factors included: younger age, lack of or public health insurance and higher lifetime experiences of racism. Conclusions . The mental health recovery trajectory of injured Black men living in Philadelphia is associated with RTW and other factors that can influence financial stability and economic resources. Policy implications . Programmatic strategies that seek to optimize recovery after injury in Black men should include consideration of key structural factors such as employment, financial stability, and the impact of racism-related exposures.
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Chronic leg ulcer may have an impact on patients' quality of life. This study aimed to identify the impact of leg ulcers on patient's quality of life using the Dermatology Life Quality Index and to define the main factors correlated with this perception. Cross-sectional, non-probabilistic sampling study. We included patients with chronic leg ulcers being treated for at least 3 months. A sociodemographic and clinical survey was conducted to assess the profile of the ulcers. We administered a screening for depressive symptoms and the Dermatology Life Quality Index. We performed a descriptive statistical analysis, chi-square test and Mann-Whitney test for categorical data, Pearson for numeric variables, and multiple regression for categorical data. Forty-one patients were assessed. Their mean age was 61.78 years. Venous ulcers (48.8%) were the most prevalent. Seventy-three percent of the sample perceived no impact/low impact on quality of life in the past week, and 26.8% perceived moderate/high impact. A multiple regression analysis identified the causes of lesion, pain related to the ulcers, time of onset, and severity of the depressive symptoms as the variables that had an influence on quality of life. The majority of the sample perceived low or no impact of the condition on the quality of the life. The variables etiology of the lesion (p<0.001), pain related to the ulcers (p=0.001), time of onset (p=0.006), and severity of the depressive symptoms (p<0.001) had an influence on the quality of life, suggesting the need for further studies with more robust designs to confirm the causal relationship between these characteristics and quality of life.
Article
Effective management of depression is predicated upon reliable assessment. The Quick Inventory of Depressive Symptomatology (QIDS) is a depression severity scale with both self-rated (QIDS-SR16) and clinician-rated (QIDS-C16) versions. Although widely used in research, the psychometric properties of the QIDS16 have not been systematically reviewed. We performed a systematic review of studies of the psychometric properties (factor structure, internal consistency, convergent validity, discriminant validity, test-retest reliability and responsiveness to change) of the QIDS-SR16 or QIDS-C16. Six databases were searched: MEDLINE, EMBASE, PsycINFO, CinAHL, Web of Science and the Cochrane Central Register of Controlled Trials. Findings were summarised, bias assessed and correlations with reference standards were pooled. 37 studies (17,118 participants) were included in the review. Both versions of the QIDS16 were unidimensional. Cronbach's alpha ranged from 0.69 to 0.89 for the QIDS-SR16 and 0.65 to 0.87 for the QIDS-C16. The QIDS-SR16 correlated moderately to highly with several depression severity scales. Seven studies were pooled where QIDS-SR16 was correlated with the HRSD-17 (r = 0.76, CI 0.69, 0.81) in patients diagnosed with depression. Four studies examined convergent validity with the QIDS-C16. Four studies examined discriminant validity, for the QIDS-SR16 alone. Eighteen studies had at least one author who was a co-author of the original QIDS16 study. Most studies were conducted in the USA (n = 26). The QIDS-SR16 and the QIDS-C16 are unidimensional rating scales with acceptable internal consistency. To justify the use of the QIDS16 scale in clinical practice, more research is needed on convergent and discriminant validity, and in populations outside the USA.
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Major depressive disorder is associated with pro-inflammatory markers, such as cytokines TNF-alpha, IL-6, IL-1ß, and C-reactive protein. Galectin-3 is a novel emerging biomarker with pro-inflammatory properties. It is a saccharide binding protein distributed throughout many tissues with varying functions and is a predictor of poor outcomes in patients with heart failure and stroke. However, its role as a predictor in depressive symptom severity remains undefined. Data from the community-based Dallas Heart Study (n = 2554) were examined using a multiple linear regression analysis to evaluate the relationship between galectin-3 and depressive symptom severity as assessed with Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) scores. Additional covariates included age, sex, race/ethnicity, body mass index (BMI), years of education, serum creatinine, history of diabetes, and smoking history. Galectin-3 levels statistically significantly predicted QIDS-SR depressive symptom severity (β = 0.055, p = .015). Female sex, smoking status, and BMI were found to be statistically significant positive predictors of depression severity, while age, years of education, non-Hispanic White race, and Hispanic ethnicity were negative predictors of depressive symptom severity. In this large sample, higher galectin-3 levels were associated with higher levels of depressive symptoms. The findings suggest that galectin-3 may be a new and useful inflammatory biomarker associated with depression.
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A common setting where depression is identified and treated is in primary care, where there is a need for low‐intensity and cost‐effective interventions to be used as part of a stepped‐care model. The current study involved a pilot, parallel‐group, randomized controlled trial of a video self‐help intervention for primary care patients based on Acceptance and Commitment Therapy (ACT). The intervention, called LifeStories, consisted of storytelling vignettes of patients describing their use of ACT‐consistent coping skills for depression. Primary care patients were recruited to determine feasibility, acceptability, and potential clinical effects of the intervention. A total of 21 participants were assigned to use LifeStories over a period of 4 weeks, and 19 participants were assigned to an attention‐matched comparison group. Qualitative feedback indicated that participants using LifeStories found the intervention to be engaging and useful in transmitting key ACT principles. Furthermore, those receiving LifeStories rated their level of “transportation” or immersion in the videos higher than the control group. Both conditions showed large improvements in levels of depression at a 12‐week follow‐up. There were no significant differences in symptom outcomes between groups; however, because this was a pilot study, it was not powered to detect differences between interventions. Both conditions additionally showed smaller effect size changes in psychological flexibility, a key ACT mechanism. The results suggest LifeStories to be a feasible and acceptable psychological intervention that may improve depression, and further research is warranted to determine its effectiveness as part of a stepped‐care approach to treating depression in primary care.
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The CES-D-10, QIDS-SR, and DASS-21-DEP are brief self-report instruments for depression that have demonstrated strong psychometric properties in clinical and community samples. However, it is unclear whether any of the three instruments is superior for assessing depression and treatment response in an acute, diagnostically heterogeneous, treatment-seeking psychiatric population. The present study examined the relative psychometric properties of these instruments in order to inform selection of an optimal depression measure in 377 patients enrolled in a psychiatric partial hospital program. Results indicated that the three measures demonstrated good to excellent internal consistency and strong convergent validity. They also demonstrated fair to good diagnostic utility, although diagnostic cut-off scores were generally higher than in previous samples. The three measures also evidenced high sensitivity to change in depressive symptoms over treatment, with the QIDS-SR showing the strongest effect. The results of this study indicate that any of the three depression measures may satisfactorily assess depressive symptoms in an acute psychiatric population. Thus, selection of a specific assessment tool should be guided by the identified purpose of the assessment. In a partial hospital setting, the QIDS-SR may confer some advantages, such as correspondence with DSM criteria, greater sensitivity to change, and assessment of suicidality.
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Galectin-3 (Gal3) is expressed by microglia and performs functions including adhesion; activation of macrophages and fibroblasts, and mediates inflammatory responses in the hippocampus. The present study examined whether serum Gal3 levels predict hippocampal volume in a multi-ethnic, community-based sample. Results of a multiple linear regression (controlling for depression, serum creatinine level, age, BMI, total brain volume, MoCA score, sex, ethnicity, smoking status, history of diabetes) showed that Gal3 levels significantly predicted left (p = .027) but not right hippocampal volume. The relationship was stronger in men than women. Findings suggest this novel inflammatory biomarker is associated with human hippocampal volume.
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We sought to assess potential mechanisms of action of a patient navigation intervention in Head Start, designed to help depressed mothers engage with mental health care. We employed mixed methods, linking qualitative interviews (n = 21) to a randomized intervention pilot (n = 47). Early in follow-up, navigated mothers had lower mean depressive symptom scores than non-navigated mothers (9.61 vs. 12.95, p = 0.03). These differences attenuated but preceded a greater likelihood of engaging with care among navigated mothers. Navigated mothers reported greater self-esteem (score 21.45 vs. 18.60, p = 0.05) and greater confidence in their ability to self-manage depression (7.65 vs. 5.67, p = 0.01). In qualitative interviews, navigated mothers linked decreased symptom burden to feeling activated; they communicated optimism toward the future and a willingness to work toward symptom improvement by trying something new. Early symptom relief, behavioral activation, self-esteem, self-management, and optimism represent plausible navigation mechanisms of action. These constructs require formal testing.
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Objectives: Psychological distress is common in survivors of traumatic injury, yet across United States’ trauma systems, it is rare that standard injury care integrates psychological evaluation and professional mental healthcare. The purpose of this study was to explore help-seeking for psychological symptoms in injured Black men living in Philadelphia. Design: A subset of a cohort of 551 injured Black men admitted to a Trauma Center in Philadelphia participated in qualitative interviews that explored their perceptions of psychological symptoms after injury and the factors that guided their decision to seek professional mental health help. Data from 32 participants were analyzed for narrative and thematic content. Results: Three overarching themes emerged: (1) facilitators of help-seeking, (2) barriers to help-seeking, and (3) factors underlying the decision not to consider professional help. Five participants felt that their injury-related psychological distress was severe enough to merit professional help despite any perceived barriers. Seventeen participants identified systemic and interpersonal obstacles to professional help that prevented them from seeking this kind of care. These included: financial constraints, limited access to mental healthcare services, and fear of the judgments of mental healthcare professionals. Ten participants would not consider professional help; these men perceived a lack of need and sufficiency in their existing social support networks. Conclusions: Research is needed to inform or identify interventions that diminish the impact of barriers to care, and identify from whom, where, and how professional mental health help might be more effectively offered to injured Black men in recovery environments like Philadelphia.
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Introduction Farmers have a high risk for depression (MDD). Preventive measures targeting this often remotely living population might reduce depression burden. The study aimed to evaluate the effectiveness of personalized telephone coaching in reducing depressive symptom severity and preventing MDD in farmers compared to enhanced treatment as usual (TAU + ). Methods In a two-armed, pragmatic randomized controlled trial ( N = 314) with post-treatment at 6 months, farming entrepreneurs, collaborating family members and pensioners with elevated depressive symptoms (PHQ-9 ≥ 5) were randomized to personalized telephone coaching or TAU + . The coaching was provided by psychologists and consists on average of 13 (±7) sessions a 48 min (±15) over 6 months. The primary outcome was depressive symptom severity (QIDS-SR16). Results Coaching participants showed a significantly greater reduction in depressive symptom severity compared to TAU + ( d = 0.39). Whereas reliable symptom deterioration was significantly lower in the intervention group compared to TAU + , no significant group differences were found for reliable improvement and in depression onset. Further significant effects in favor of the intervention group were found for stress ( d = 0.34), anxiety ( d = 0.30), somatic symptoms ( d = 0.39), burnout risk ( d = 0.24–0.40) and quality of life ( d = 0.28). Discussion Limiting, we did not apply an upper cutoff score for depressive symptom severity or controlled for previous MDD episodes, leaving open whether the coaching was recurrence/relapse prevention or early treatment. Nevertheless, personalized telephone coaching can effectively improve mental health in farmers. It could play an important role in intervening at an early stage of mental health problems and reducing disease burden related to MDD. Trial registration number and trial register German Clinical Trial Registration: DRKS00015655
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After initial interviews with 20,291 adults in the National Institute of Mental Health Epidemiologic Catchment Area Program, we estimated prospective 1-year prevalence and service use rates of mental and addictive disorders in the US population. An annual prevalence rate of 28.1% was found for these disorders, composed of a 1-month point prevalence of 15.7% (at wave 1) and a 1-year incidence of new or recurrent disorders identified in 12.3% of the population at wave 2. During the 1-year follow-up period, 6.6% of the total sample developed one or more new disorders after being assessed as having no previous lifetime diagnosis at wave 1. An additional 5.7% of the population, with a history of some previous disorder at wave 1, had an acute relapse or suffered from a new disorder in 1 year. Irrespective of diagnosis, 14.7% of the US population in 1 year reported use of services in one or more component sectors of the de facto US mental and addictive service system. With some overlap between sectors, specialists in mental and addictive disorders provided treatment to 5.9% of the US population, 6.4% sought such services from general medical physicians, 3.0% sought these services from other human service professionals, and 4.1% turned to the voluntary support sector for such care. Of those persons with any disorder, only 28.5% (8.0 per 100 population) sought mental health/addictive services. Persons with specific disorders varied in the proportion who used services, from a high of more than 60% for somatization, schizophrenia, and bipolar disorders to a low of less than 25% for addictive disorders and severe cognitive impairment. Applications of these descriptive data to US health care system reform options are considered in the context of other variables that will determine national health policy.
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Little is known about the general population prevalence or severity of DSM-IV mental disorders. To estimate 12-month prevalence, severity, and comorbidity of DSM-IV anxiety, mood, impulse control, and substance disorders in the recently completed US National Comorbidity Survey Replication. Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using a fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. Nine thousand two hundred eighty-two English-speaking respondents 18 years and older. Twelve-month DSM-IV disorders. Twelve-month prevalence estimates were anxiety, 18.1%; mood, 9.5%; impulse control, 8.9%; substance, 3.8%; and any disorder, 26.2%. Of 12-month cases, 22.3% were classified as serious; 37.3%, moderate; and 40.4%, mild. Fifty-five percent carried only a single diagnosis; 22%, 2 diagnoses; and 23%, 3 or more diagnoses. Latent class analysis detected 7 multivariate disorder classes, including 3 highly comorbid classes representing 7% of the population. Although mental disorders are widespread, serious cases are concentrated among a relatively small proportion of cases with high comorbidity.
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The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study evaluated feasible treatment strategies to improve clinical outcomes for real-world patients with treatment-resistant depression. Although the study found no clear-cut "winner", it does provide guidance on how to start therapy and how to proceed if initial treatment fails.
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Errors in Byline, Author Affiliations, and Acknowledgment. In the Original Article titled “Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication,” published in the June issue of the ARCHIVES (2005;62:617-627), an author’s name was inadvertently omitted from the byline on page 617. The byline should have appeared as follows: “Ronald C. Kessler, PhD; Wai Tat Chiu, AM; Olga Demler, MA, MS; Kathleen R. Merikangas, PhD; Ellen E. Walters, MS.” Also on that page, the affiliations paragraph should have appeared as follows: Department of Health Care Policy, Harvard Medical School, Boston, Mass (Drs Kessler, Chiu, Demler, and Walters); Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, Md (Dr Merikangas). On page 626, the acknowledgment paragraph should have appeared as follows: We thank Jerry Garcia, BA, Sara Belopavlovich, BA, Eric Bourke, BA, and Todd Strauss, MAT, for assistance with manuscript preparation and the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on the data analysis. We appreciate the helpful comments of William Eaton, PhD, Michael Von Korff, ScD, and Hans-Ulrich Wittchen, PhD, on earlier manuscripts. Online versions of this article on the Archives of General Psychiatry Web site were corrected on June 10, 2005.
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The Sequential Treatment Alternatives to Relieve Depression (STAR*D) trial confirmed that many patients with major depressive disorder have a chronic or recurrent course of depression, and nearly half report anxious features. Patients vary widely in their acceptance of specific treatments and strategies.
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The effectiveness of the Beck Anxiety (BAI-PC) and Depression (BDI-PC) Inventories for Primary Care for discriminating 56 primary care patients (20–77 yrs old) with and without Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) diagnosed anxiety and mood disorders was studied. The Anxiety and Mood modules from the Primary Care Evaluation of Mental Disorders were used to establish diagnoses. The coefficient alphas for the BAI-PC and BDI-PC were, respectively, .90 and .88. A BAI-PC cutoff score of 5 and above yielded the highest clinical efficiency (82%) with 85% sensitivity and 81% specificity for identifying patients with and without panic, generalized anxiety, or both disorders, whereas a BDI-PC cutoff score of 6 and above afforded the highest clinical efficiency (92%) with 83% sensitivity and 95% specificity for detecting patients with and without major depressive disorders. The use of these instruments to screen primary care patients before conducting extensive diagnostic evaluations with them was discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Background. Studies that examined community samples have reported several risk factors for the development of depressive episodes. The few studies that have been performed on primary care samples were mostly cross-sectional. Most samples had originated from highly developed industrial countries. This is the first study that prospectively investigates the risk factors of depressive episodes in an international primary care sample. Methods. A stratified primary care sample of initially non-depressed subjects ( N = 2445) from 15 centres from all over the world was examined for the presence or absence of a depressive episode (ICD-10) at the 12 month follow-up assessment. The initial measures addressed sociodemographic variables, psychological/psychiatric problems and social disability. Logistic regression analysis was carried out to determine their relationship with the development of new depressive episodes. Results. At the 12-month follow-up, 4·4% of primary care patients met ICD-10 criteria for a depressive episode. Logistic regression analysis revealed that the recognition by the general practitioner as a psychiatric case, repeated suicidal thoughts, previous depressive episodes, the number of chronic organic diseases, poor general health, and a full or subthreshold ICD-10 disorder were related to the development of new depressive episodes. Conclusions. Psychological/psychiatric problems were found to play the most important role in the prediction of depressive episodes while sociodemographic variables were of lower importance. Differences compared with other studies might be due to our prospective design and possibly also to our culturally different sample. Applied stratification procedures, which resulted in a sample at high risk of developing depression, might be a limitation of our study.
Article
This paper describes the rationale and methods entailed in developing the Inventory of Depressive Symptomatology (IDS) in both clinician-rated (IDS-C) and self-reported (IDS-SR) formats. Psychometric features of the both the IDS-C and IDS-SR are presented. These scales are compared to the Hamilton Rating Scale for Depression (HRS-D) in the detection of symptom change in patients with major depressive (n = 184) or bipolar disorder (n = 141). The face validity and established psychometric features of the IDS-C and IDS-SR indicate that either may be useful in detecting symptom change, as well as in detecting residual symptoms in depressed patients. Further efforts to shorten each measure are indicated. Copyright © 2000 Whurr Publishers Ltd.
Article
OBJECTIVE: To determine patient and provider characteristics associated with increased risk of nondetection of mental health problems by primary care physicians. DESIGN: Cross-sectional patient and physician surveys conducted as part of the Medical Outcomes Study. PARTICIPANTS: We studied 19,309 patients and 349 internists and family physicians. MEASUREMENTS AND MAIN RESULTS: We counted “detection” of a mental health problem whenever physicians reported, in a postvisit survey, that they thought the patient had a mental health problem or that they had counseled or referred the patient for mental health. Key independent variables included patient self-reported demographic characteristics, health-related quality of life (HRQOL), depression diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders, and physician demographics and proclivity to provide counseling for depression. Logistic regression analysis, adjusted for HRQOL, revealed physicians were less likely to detect mental health problems in African Americans (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.46 to 0.86), men (OR, 0.64; 95% CI, 0.54 to 0.75), and patients younger than 35 years (OR, 0.61; 95% CI, 0.44 to 0.84), and more likely to detect them in patients with diabetes (OR, 1.4; 95% CI, 1.0 to 1.8) or hypertension (OR, 1.3; 95% CI, 1.1 to 1.6). In a model that included DSM-III diagnoses, odds of detection remained reduced for African Americans as well as for Hispanics (OR, 0.29; 95% CI, 0.11 to 0.71), and patients with more-severe DSM-III diagnoses were more likely to be detected. Physician proclivity toward providing counseling for depression influenced the likelihood of detection. CONCLUSIONS: Patients’ race, gender, and coexisting medical conditions affected physician awareness of mental health problems. Strategies to improve detection of mental health problems among African Americans, Hispanics, and men should be explored and evaluated.
Article
Background: The aim of this study was to identify internationally relevant risk factors for the persistence of depression in primary care. None of the previous studies examining primary care patients could examine an equivalently large international sample. The findings from the WHO Collaborative Study on ‘Psychological Problems in General Health Care’ might be generalised to different cultural environments. Methods: A primary care sample of depressed subjects (ICD-10) (n=725) from 15 centres from all over the world was reinvestigated for the presence of depression after 12 months. Logistic regression analysis was used to determine the relationship of sociodemographic variables, characteristics of mental illness, and social disability with depression at follow-up. Results: 33.5% of the subjects met ICD-10 criteria for a current depressive episode at the 12-month follow-up. Logistic regression analysis revealed that years of formal education, unemployment, depression severity, antidepressant use, abdominal pain as the main reason for consulting the general practitioner, and ‘Repeated suicidal thoughts’ were related to depression after 1 year. Limitations: We have only poor information about details of the actual course of patients between the two assessments. Conclusions: Our findings of significant variables are generally comparable to results of previously conducted studies. Sociodemographic and disease-specific variables play an important role in the prediction of depression at the 12-month follow-up. General practitioners must be careful in the consideration of these variables but also of individual patient characteristics.
Article
Major depressive disorder has been recently found to be associated with high medical utilization and more functional impairment than most chronic medical illnesses. Major depression is a common illness among persons in the community, in ambulatory medical clinics, and in inpatient medical care. Studies have estimated that major depression occurs in 2%-4% of persons in the community, in 5%-10% of primary care patients, and 10%-14% of medical inpatients. In each setting there are two to three times as many persons with depressive symptoms that fall short of major depression criteria. Recent studies have found that in one-third to one-half of patients with major depression, the symptoms persist over a 6-month to one-year period. The majority of longitudinal studies have determined that severity of initial depressive symptoms and the presence of a comorbid medical illness were predictors of persistence of depression.
Article
The Inventory for Depressive Symptomatology (IDS) is a new measure of depressive signs and symptoms. Both self-report and clinician-rated versions are under development. The IDS-SR (self-report) was completed by 289 patients, 285 of whom were outpatients. Unipolar major depression (n = 174), bipolar disorder (n = 44), euthymic (S/P unipolar or bipolar) depression (n = 33), and other psychiatric disorders (n = 38) were included. The IDS-SR had good internal reliability (coefficient alpha = 0.85), and significantly correlated with both the Hamilton Rating Scale for Depression (HRSD) (r = 0.67) and the Beck Depression Inventory (BDI) (r = 0.78). The clinician-rated IDS (IDS-C) was administered to 82 outpatients (75 with unipolar or bipolar disorder, 5 with other psychiatric disorders, and 2 euthymic (S/P unipolar) depressions). Coefficient alpha (0.88) suggested strong internal consistency. The IDS-C correlated highly with both the HRSD (r = 0.92) and the BDI (r = 0.61). Discriminant and factor analyses provided evidence for construct validity for both the IDS-C and IDS-SR. Both scales significantly differentiated endogenous from nonendogenous depression defined by Research Diagnostic Criteria (RDC). Factor structures for the IDS-SR revealed four factors: mood/cognition, anxiety, selected endogenous symptoms, and hyperphagia-hypersomnia. The IDS appears applicable to both inpatients and outpatients with endogenous, atypical, and nonendogenous major depression, and may have utility with dysthymics.
Article
A method is presented for evaluating the amount of information a medical test provides about individual patients. Emphasis is placed on the role of a test in the evaluation of patients with a chronic disease. In this context, the yield of a test is best interpreted by analyzing the prognostic information it furnishes. Information from the history, physical examination, and routine procedures should be used in assessing the yield of a new test. As an example, the method is applied to the use of the treadmill exercise test in evaluating the prognosis of patients with suspected coronary artery disease. The treadmill test is shown to provide surprisingly little prognostic information beyond that obtained from basic clinical measurements.
Article
To evaluate the usefulness of case-finding instruments for identifying patients with major depression in primary care settings. A MEDLINE search of the English-language medical literature; bibliographies of selected papers; and experts. Studies that were done in primary care settings with unselected patients and that compared case-finding instruments with accepted diagnostic criterion standards for major depression were selected. 9 case-finding instruments were assessed in 18 studies. More than 15,000 patients received screening with a case-finding instrument; approximately 5300 of these received criterion standard assessment. Case-finding instruments ranged in length from 2 to 28 questions. Average administration times ranged from less than 2 minutes to 6 minutes. Sensitivities and specificities for detecting major depression ranged from 67% to 99% and from 40% to 95%, respectively. No significant differences between instruments were found. Overall sensitivity was 84% (95% CI, 79% to 89%); overall specificity was 72% (CI, 67% to 77%). If a case-finding instrument were administered to 100 primary care patients with a 5% prevalence of major depression, the clinician could expect that 31 patients would screen positive, that 4 of the 31 would have major depression, and that 1 patient with major depression would not be identified. Several instruments with reasonable operating characteristics are available to help primary care clinicians identify patients with major depression. Because the operating characteristics of these instruments are similar, selection of a particular instrument should depend on issues such as feasibility, administration and scoring times, and the instruments' ability to serve additional purposes, such as monitoring severity or response to therapy.
Article
Synopsis The psychometric properties of the 28- and 30-item versions of the Inventory of Depressive Symptomatology, Clinician-Rated (IDS-C) and Self-Report (IDS-SR) are reported in a total of 434 (28-item) and 337 (30-item) adult out-patients with current major depressive disorder and 118 adult euthymic subjects (15 remitted depressed and 103 normal controls). Cronbach's α ranged from 0·92 to 0·94 for the total sample and from 0·76 to 0·82 for those with current depression. Item total correlations, as well as several tests of concurrent and discriminant validity are reported. Factor analysis revealed three dimensions (cognitive/mood, anxiety/arousal and vegetative) for each scale. Analysis of sensitivity to change in symptom severity in an open-label trial of fluoxetine ( N = 58) showed that the IDS-C and IDS-SR were highly related to the 17-item Hamilton Rating Scale for Depression. Given the more complete item coverage, satisfactory psychometric properties, and high correlations with the above standard ratings, the 30-item IDS-C and IDS-SR can be used to evaluate depressive symptom severity. The availability of similar item content for clinician-rated and self-reported versions allows more direct evaluations of these two perspectives.
Article
This study has two goals: 1) to establish a generalizable model of the symptoms observed in outpatients with major depressive disorder (MDD); and 2) to compare symptom coverage of the Inventory of Depressive Symptomatology, Clinician-Rated (IDS-C) and Self-Report (IDS-SR) to that of the Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory (BDI). A factor analysis of IDS-C, IDS-SR, HDRS, and BDI items was carried out on 324 adult outpatients with MDD. Patients with coexisting Axis I or III illness or those taking psychotropic medication were excluded. Ten primary factors were identified, six of which were substantially intercorrelated, defining a second-order factor of general depression severity. Schmid-Leiman orthogonalization identified the symptoms most associated with general severity. The IDS provided more complete factors coverage than did the HDRS or BDI and thus may be more useful in research on symptom profiles.
Article
The SCID was administered twice, once by telephone and once in person (1 week later) to 41 college age men. For major depression (lifetime k =.64, current k =.66), results indicated good agreement. The lifetime occurrence estimate based on the telephone SCID diagnosis was lower than the in-person SCID estimate. Kappas for specific diagnoses were calculable for simple phobia (lifetime k =. 47, current k = .03) and social phobia (lifetime k =.29). Base rates were less than 10% for all individual diagnoses except lifetime major depression; therefore, the kappas may be unstable. For all diagnoses where there were any positive cases, percentages of negative agreement and specificity were high, whereas percentages of positive agreement and sensitivity were lower. Overall agreement was fair for specific lifetime diagnoses but poor for current diagnoses. These results suggest caution in assuming comparability of in-person and telephone SCID diagnoses. Circumstances under which a telephone SCID may be useful and ways to improve reliability are discussed.
Article
In order to assess differences between self-assessment and clinician's assessment of depression, 64 depressed in-patients were assessed for depressive symptomatology at admission (D0), 10 days (D10) and 28 days (D28) after the beginning of antidepressant treatment, using the Inventory for Depressive Symptomatology Clinician Rated (IDS-C) and the Inventory for Depressive Symptomatology Self-Rated (IDS-SR). Associated symptoms (SCL-90R) were assessed at D0 and personality dimensions (TCI) at D28. Although agreement was high between IDS-C and IDS-SR total scores, D0, D0-D10 and D0-D28 total scores were significantly different between IDS-C and IDS-SR, showing a higher sensitivity to change for IDS-C as compared to IDS-SR. Differences between IDS-C and IDS-SR were due mostly to mood items and not to somatic items. Discrepancies between self-assessment and clinician's assessment of depressive symptomatology were linked neither to age, sex, familial status, single/recurrent and length of episode, nor to depression severity, but to associated symptoms and, to a lesser extent, personality dimensions: patients over-estimating their depressive symptomatology change relative to the psychiatrist tended to score high on phobic anxiety, Cooperativeness (especially Social Acceptance) and Self-Transcendence (especially Self-forgetfulness) and vice-versa.
Article
Both the interrater and test-retest-retest reliability of axis I and axis II disorders were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). Fair-good median interrater kappa (.40-.75) were found for all axis II disorders diagnosed five times or more, except antisocial personality disorder (1.0). All of the test-retest kappa for axis II disorders, except for narcissistic personality disorder (1.0) and paranoid personality disorder (.39), were also found to be fair-good. Interrater and test-retest dimensional reliability figures for axis II were generally higher than those for their categorical counterparts; most were in the excellent range (> .75). In terms of axis I, excellent median interrater kappa were found for six of the 10 disorders diagnosed five times or more, whereas fair-good median interrater kappa were found for the other four axis I disorders. In general, test-retest reliability figures for axis I disorders were somewhat lower than the interrater reliability figures. Three test-retest kappa were in the excellent range, six were in the fair-good range, and one (for dysthymia) was in the poor range (.35). Taken together, the results of this study suggest that both axis I and axis II disorders can be diagnosed reliably when using appropriate semistructured interviews. They also suggest that the reliability of axis II disorders is roughly equivalent to that reliability found for most axis I disorders.
Article
The clinician-administered version of the Liebowitz Social Anxiety Scale (LSAS-CA) is a commonly used assessment device for the evaluation of social anxiety disorder and has been shown to have strong psychometric characteristics. Because of its apparently straightforward rating format and potential savings in time and effort, interest in the use of the LSAS as a self-report (LSAS-SR) measure has increased, and the LSAS-SR has been used in a number of studies. However, the psychometric properties of the LSAS-SR have not been well established. This study examined the psychometric properties of the LSAS-SR in comparison to the LSAS-CA in a sample of 99 individuals with a primary diagnosis of social anxiety disorder and 53 individuals with no current psychiatric disorder. There was little difference between the two versions of the LSAS on any scale or subscale score. Both forms were internally consistent and the subscale intercorrelations for the two forms were essentially identical. Correlations of each LSAS-SR index with its LSAS-CA counterpart were all highly significant. Finally, the convergent and discriminant validity of the two forms of the LSAS was shown to be strong. Results of this study suggest that the self-report version of the LSAS compares well to the clinician-administered version and may be validly employed in the assessment of social anxiety disorder.
Article
To clarify whether screening adults for depression in primary care settings improves recognition, treatment, and clinical outcomes. The MEDLINE database was searched from 1994 through August 2001. Other relevant articles were located through other systematic reviews; focused searches of MEDLINE from 1966 to 1994; the Cochrane depression, anxiety, and neurosis database; hand searches of bibliographies; and extensive peer review. The researchers reviewed randomized trials conducted in primary care settings that examined the effect of screening for depression on identification, treatment, or health outcomes, including trials that tested integrated, systematic support for treatment after identification of depression. A single reviewer abstracted the relevant data from the included articles. A second reviewer checked the accuracy of the tables against the original articles. Compared with usual care, feedback of depression screening results to providers generally increased recognition of depressive illness in adults. Studies examining the effect of screening and feedback on treatment rates and clinical outcomes had mixed results. Many trials lacked power to detect clinically important differences in outcomes. Meta-analysis suggests that overall, screening and feedback reduced the risk for persistent depression (summary relative risk, 0.87 [95% CI, 0.79 to 0.95]). Programs that integrated interventions aimed at improving recognition and treatment of patients with depression and that incorporated quality improvements in clinic systems had stronger effects than programs of feedback alone. Compared with usual care, screening for depression can improve outcomes, particularly when screening is coupled with system changes that help ensure adequate treatment and follow-up.
Article
Studies that examined community samples have reported several risk factors for the development of depressive episodes. The few studies that have been performed on primary care samples were mostly cross-sectional. Most samples had originated from highly developed industrial countries. This is the first study that prospectively investigates the risk factors of depressive episodes in an international primary care sample. A stratified primary care sample of initially non-depressed subjects (N = 2,445) from 15 centres from all over the world was examined for the presence or absence of a depressive episode (ICD-10) at the 12 month follow-up assessment. The initial measures addressed sociodemographic variables, psychological/psychiatric problems and social disability. Logistic regression analysis was carried out to determine their relationship with the development of new depressive episodes. At the 12-month follow-up, 44% of primary care patients met ICD-10 criteria for a depressive episode. Logistic regression analysis revealed that the recognition by the general practitioner as a psychiatric case, repeated suicidal thoughts, previous depressive episodes, the number of chronic organic diseases, poor general health, and a full or subthreshold ICD-10 disorder were related to the development of new depressive episodes. Psychological/psychiatric problems were found to play the most important role in the prediction of depressive episodes while sociodemographic variables were of lower importance. Differences compared with other studies might be due to our prospective design and possibly also to our culturally different sample. Applied stratification procedures, which resulted in a sample at high risk of developing depression, might be a limitation of our study.
Article
The aim of this study was to identify internationally relevant risk factors for the persistence of depression in primary care. None of the previous studies examining primary care patients could examine an equivalently large international sample. The findings from the WHO Collaborative Study on 'Psychological Problems in General Health Care' might be generalised to different cultural environments. A primary care sample of depressed subjects (ICD-10) (n=725) from 15 centres from all over the world was reinvestigated for the presence of depression after 12 months. Logistic regression analysis was used to determine the relationship of sociodemographic variables, characteristics of mental illness, and social disability with depression at follow-up. 33.5% of the subjects met ICD-10 criteria for a current depressive episode at the 12-month follow-up. Logistic regression analysis revealed that years of formal education, unemployment, depression severity, antidepressant use, abdominal pain as the main reason for consulting the general practitioner, and 'Repeated suicidal thoughts' were related to depression after 1 year. We have only poor information about details of the actual course of patients between the two assessments. Our findings of significant variables are generally comparable to results of previously conducted studies. Sociodemographic and disease-specific variables play an important role in the prediction of depression at the 12-month follow-up. General practitioners must be careful in the consideration of these variables but also of individual patient characteristics.
Article
The 16-item Quick Inventory of Depressive Symptomatology (QIDS), a new measure of depressive symptom severity derived from the 30-item Inventory of Depressive Symptomatology (IDS), is available in both self-report (QIDS-SR(16)) and clinician-rated (QIDS-C(16)) formats. This report evaluates and compares the psychometric properties of the QIDS-SR(16) in relation to the IDS-SR(30) and the 24-item Hamilton Rating Scale for Depression (HAM-D(24)) in 596 adult outpatients treated for chronic nonpsychotic, major depressive disorder. Internal consistency was high for the QIDS-SR(16) (Cronbach's alpha =.86), the IDS-SR(30) (Cronbach's alpha =.92), and the HAM-D(24) (Cronbach's alpha =.88). QIDS-SR(16) total scores were highly correlated with IDS-SR(30) (.96) and HAM-D(24) (.86) total scores. Item-total correlations revealed that several similar items were highly correlated with both QIDS-SR(16) and IDS-SR(30) total scores. Roughly 1.3 times the QIDS-SR(16) total score is predictive of the HAM-D(17) (17-item version of the HAM-D) total score. The QIDS-SR(16) was as sensitive to symptom change as the IDS-SR(30) and HAM-D(24), indicating high concurrent validity for all three scales. The QIDS-SR(16) has highly acceptable psychometric properties, which supports the usefulness of this brief rating of depressive symptom severity in both clinical and research settings.
Article
Little is known about lifetime prevalence or age of onset of DSM-IV disorders. To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
Article
There is an increasing interest in trying to identify patients with chronic physical illness who would benefit from interventions to decrease psychological distress. The Hospital Anxiety and Depression Scale (HADS) is one measure that can be effectively used to identify patients struggling with anxiety and/or depression in addition to comorbid medical illness such as cardiac disease. The aim of this study is to determine if the HADS correctly identified patients with depression according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [determined using the Primary Care Evaluation of Mental Disorders (PRIME-MD), a gold-standard diagnostic tool], as depressed and to determine which items on the HADS most strongly predicted the PRIME-MD major depression diagnosis among cardiac patients. Patient data were obtained from a randomized controlled trial of treatment for psychological distress in patients surviving recent myocardial infarction or life-threatening ischemic heart disease. The HADS was used to evaluate depression and/or anxiety among patients hospitalized for heart disease, and the PRIME-MD was used to diagnose major depressive disorder (MDD) in these patients. We used receiver-operating characteristic (ROC) curves and logistic regression to analyze patient responses to both of these measures. Among the 79 study patients, the area under the ROC curve (AUC) for the HADS depression subscale was 0.81 with an S.E. of 0.05, and the AUC was 0.70 for the HADS anxiety subscale with an S.E. of 0.06. Using a cutoff of 7 on each HADS subscale to determine PRIME-MD diagnosis of MDD, the sensitivity and specificity were 81% and 54%, respectively, for the depression subscale and 81% and 40%, respectively, for the anxiety subscale. In addition, a few individual HADS items predicted PRIME-MD diagnosis of MDD, namely, concentration and positive anticipation (depression items) and relaxed and worry (anxiety items), each of which were strongly correlated with PRIME-MD diagnosis of MDD. Finally, items positive anticipation and relaxed provided reasonable approximations to the results found from the HADS depression subscale measure, which performed better than the HADS anxiety subscale in predicting PRIME-MD diagnosis of depression. Using the HADS to detect mental disorders in primary care populations can save valuable physician time, and perhaps ensure that patients are treated for their mental distress as well as medical disease.
Article
Nine DSM-IV-TR criterion symptom domains are evaluated to diagnose major depressive disorder (MDD). The Quick Inventory of Depressive Symptomatology (QIDS) provides an efficient assessment of these domains and is available as a clinician rating (QIDS-C16), a self-report (QIDS-SR16), and in an automated, interactive voice response (IVR) (QIDS-IVR16) telephone system. This report compares the performance of these three versions of the QIDS and the 17-item Hamilton Rating Scale for Depression (HRSD17). Data were acquired at baseline and exit from the first treatment step (citalopram) in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. Outpatients with nonpsychotic MDD who completed all four ratings within +/-2 days were identified from the first 1500 STAR*D subjects. Both item response theory and classical test theory analyses were conducted. The three methods for obtaining QIDS data produced consistent findings regarding relationships between the nine symptom domains and overall depression, demonstrating interchangeability among the three methods. The HRSD17, while generally satisfactory, rarely utilized the full range of item scores, and evidence suggested multidimensional measurement properties. In nonpsychotic MDD outpatients without overt cognitive impairment, clinician assessment of depression severity using either the QIDS-C16 or HRSD17 may be successfully replaced by either the self-report or IVR version of the QIDS.
Article
The present study provides additional data on the psychometric properties of the 30-item Inventory of Depressive Symptomatology (IDS) and of the recently developed Quick Inventory of Depressive Symptomatology (QIDS), a brief 16-item symptom severity rating scale that was derived from the longer form. Both the IDS and QIDS are available in matched clinician-rated (IDS-C30; QIDS-C16) and self-report (IDS-SR30; QIDS-SR16) formats. The patient samples included 544 out-patients with major depressive disorder (MDD) and 402 out-patients with bipolar disorder (BD) drawn from 19 regionally and ethnicically diverse clinics as part of the Texas Medication Algorithm Project (TMAP). Psychometric analyses including sensitivity to change with treatment were conducted. Internal consistencies (Cronbach's alpha) ranged from 0.81 to 0.94 for all four scales (QIDS-C16, QIDS-SR16, IDS-C30 and IDS-SR30) in both MDD and BD patients. Sad mood, involvement, energy, concentration and self-outlook had the highest item-total correlations among patients with MDD and BD across all four scales. QIDS-SR16 and IDS-SR30 total scores were highly correlated among patients with MDD at exit (c = 0.83). QIDS-C16 and IDS-C30 total scores were also highly correlated among patients with MDD (c = 0.82) and patients with BD (c = 0.81). The IDS-SR30, IDS-C30, QIDS-SR16, and QIDS-C16 were equivalently sensitive to symptom change, indicating high concurrent validity for all four scales. High concurrent validity was also documented based on the SF-12 Mental Health Summary score for the population divided in quintiles based on their IDS or QIDS score. The QIDS-SR16 and QIDS-C16, as well as the longer 30-item versions, have highly acceptable psychometric properties and are treatment sensitive measures of symptom severity in depression.
Article
The nine-item mood module of the Patient Health Questionnaire (PHQ-9) was developed to screen and to diagnose patients in primary care with depressive disorders. We systematically reviewed the psychometric literature on the PHQ-9 and performed a meta-analysis to ascertain its summary sensitivity and specificity. EMBASE, PubMed and PsycINFO were used to search literature up to July 2006. Studies were included if (1) they investigated the diagnostic accuracy of the PHQ-9 and (2) the PHQ-9 had been compared with a reference test. The quality of the studies was appraised using the Quality Assessment of Diagnostic Accuracy Studies. We calculated sensitivity, specificity and confidence intervals for each included study. We used the random effects model to calculate the summary sensitivity and specificity. We found a sensitivity of 0.77 (0.71-0.84) and a specificity of 0.94 (0.90-0.97) for the PHQ-9. The positive predictive value in an unselected primary care population was 59%, which increased to 85-90% when the prior probability increased to 30-40%. In primary care, the PHQ-9 is a valid diagnostic tool if used in selected subgroups of patients with a high prevalence of depressive disorder.
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