Detecting depression in elderly medical inpatients.

Prevalence rates for depression indicate that elderly medical patients are a population at high risk. Studies of middle-aged adults show that detection of depression in medical patients by primary health care providers is poor and that screening instruments can improve detection, although little is known about geriatric patients. The present study used Research Diagnostic Criteria to assess the base rate of detection by nonpsychiatric physicians in a random sample of 150 elderly medical inpatients. In addition, the psychometric properties of three slightly different self-report screening instruments were evaluated. Results indicated that detection by house staff was extremely low (8.7%). All three instruments were much more sensitive, were equally specific, and yielded greater predictive power than the procedures used by hospital staff. All three instruments were especially sensitive to major depression. Of the scales, the Beck Depression Inventory (BDI), the BDI Psychological subscale, and the Geriatric Depression Scale had the best reliability and validity and were the most efficient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Replicating the chronic disease score (CDS) from automated pharmacy data

Michael Von Korff and colleagues at the Center for Health Studies, Group Health Cooperative (GHC) of Puget Sound created a measure of chronic disease status (CDS) using automated outpatient pharmacy data. They reported the measure appeared to provide a stable and valid measure of health status. The availability of such a measure could become a new tool for a variety of applications, including screening, resource allocation, and quality assurance. The measure was replicated for its reliability and construct and predictive validity in the KPNW membership using automated pharmacy data. Reliability and validity were tested using correlation and regression techniques. The CDS showed test-retest reliability over time. It showed construct validity with the RAND-36 instrument and the BSI-8 depression screener. It showed predictive validity with health care visits and hospitalizations. The results were similar to those at GHC. The findings indicated that the CDS can serve, with certain precautions, as a readily accessible low cost measure of health status.     

Comparing two measures of depression in spinal cord injury.

Compared 2 measures of depression, the Zung Self-Rating Depression Scale (SRDS) and the Brief Symptom Inventory (BSI), and discussed their use with (1) 162 spinal cord injury (SCI) outpatients and (2) 30 SCI inpatients. Sample 2 was used to study the predictor validity of the tests based on clinicians' ratings of Ss' depression status. Results indicate a fair degree of correlation between these tests. Fairly good test reliability was also found. The SRDS was more clearly delineated into distinct conceptual factors than the BSI. An analysis of predictive validities of the 2 tests using test scores and independent clinician ratings suggests that the BSI and the SRDS were the most useful predictors of depression among SCI Ss. However, the SRDS was superior for identifying SCI persons at risk of being depressed during or after rehabilitation hospitalization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects

BACKGROUND: Research on the dimensional structure and reliability of the Hospital Anxiety and Depression Scale (HADS) and its relationship with age is scarce. Moreover, its efficacy in determining the presence of depression in different patient groups has been questioned. METHODS: Psychometric properties of the HADS were assessed in six different groups of Dutch subjects (N = 6165): (1) a random sample of younger adults (age 18-65 years) (N = 199); (2) a random sample of elderly subjects of 57 to 65 years of age (N = 1901); (3) a random sample of elderly subjects of 66 years or older (N = 3293); (4) a sample of consecutive general practice patients (N = 112); (5) a sample of consecutive general medical out-patients with unexplained somatic symptoms (N = 169); and (6) a sample of consecutive psychiatric out-patients (N = 491). RESULTS: Evidence for a two-factor solution corresponding to the original two subscales of the HADS was found, although anxiety and depression subscales were strongly correlated. Homogeneity and test-retest reliability of the total scale and the subscales were good. The dimensional structure and reliability of the HADS was stable across medical settings and age groups. The correlations between HADS scores and age were small. The total HADS scale showed a better balance between sensitivity and positive predictive value (PPV) in identifying cases of psychiatric disorder as defined by the Present State Examination than the depression subscale in identifying cases of unipolar depression as defined by ICD-8. CONCLUSIONS: The moderate PPV suggests that the HADS is best used as a screening questionnaire and not as a 'case-identifier' for psychiatric disorder or depression.     

A French-Canadian scale for suicide ideation for use with adolescents.

Extended the Scale for Suicide Ideation (SSI) and evaluated whether the adaptation of the SSI by A. F. De Man et al (see record 1987-30114-001) that had been validated for use with adults could also be used with adolescents. 110 French-Canadian adolescents (aged 11–18 yrs) participated in an analysis of the reliability and validity of a French version of the SSI. Item analysis and coefficient alpha results suggested good reliability. Correlations with selected personality variables were obtained. Associations were found between suicide ideation and measures of self-esteem, multi-dimensional locus of control, life stress, depression, anomie, and age. (French abstract) (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Screening for dementia with the memory impairment screen

OBJECTIVES: To validate a sensitive and specific screening test for AD and other dementias, assess its reliability and discriminative validity, and present normative data for its use in various applied settings. BACKGROUND: To improve discrimination in screening for AD and dementia, we developed the Memory Impairment Screen (MIS), a 4-minute, four-item, delayed free- and cued-recall test of memory impairment. The MIS uses controlled learning to ensure attention, induce specific semantic processing, and optimize encoding specificity to improve detection of dementia. METHODS: Equivalent forms of the MIS were given at the beginning and end of the testing session to assess alternate forms reliability. Discriminative validity was assessed in a criterion sample of 483 aged individuals, 50 of whom had dementia according to Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised) criteria. RESULTS: The MIS had good alternate forms reliability, high construct validity for memory impairment, and good discriminative validity in terms of sensitivity, specificity, and positive predictive value. We present normative data for use in settings with different base rates (prevalences) of AD and dementia. CONCLUSION: The MIS provides efficient, reliable, and valid screening for AD and other dementias.     

Patient-caregiver functional unit scale: a new scale to assess the patient-caregiver dyad

BACKGROUND AND OBJECTIVES: This study evaluated the reliability and validity of the Patient-Caregiver Functional Unit Scale (PCFUS), a new instrument to assess the stability or endurance of patient-caregiver dyads. METHODS: Patient-caregiver dyads were recruited from a nursing home (NH) (n = 38), a comprehensive geriatric assessment program (CGA) (n = 20), and an ambulatory medical clinic (controls) (n = 85). Caregivers were eligible if they assisted, or were available to assist, the patient with personal and instrumental activities of daily living, without pay. Data were collected by interviewer-administered questionnaires. Inter-rater and test-retest reliability were evaluated among the CGA sample. Validity was assessed by comparing PCFUS scores among the NH, CGA, and control groups and by correlation of PCFUS scores with other standardized caregiver burden measures. RESULTS: The PCFUS had excellent inter-rater and test-retest reliability. Mean PCFUS scores were significantly lower (ie, less stable patient-caregiver dyad) in NH than CGA and control caregivers. PCFUS scores were significantly associated with Burden Interview, Perceived Stress Scale, and Geriatric Depression Scale scores and risk factors for caregiver stress (eg, patient's cognitive impairment, disruptive behaviors). CONCLUSIONS: The PCFUS is a short, easily administered measure with good reliability and validity and is applicable to clinical and research settings.     

Eating Disorder Diagnostic Scale: Additional Evidence of Reliability and Validity.

The authors conducted 4 studies investigating the reliability and validity of the Eating Disorder Diagnostic Scale (HDDS; E. Stice, C. F. Telch, & S. L. Rizvi, 2000), a brief self-report measure for diagnosing anorexia nervosa, bulimia nervosa, and binge eating disorder. Study 1 found that the HDDS showed criterion validity with interview-based diagnoses, convergent validity with risk factors for eating pathology, and internal consistency. Studies 2 and 3 found that the EDDS was sufficiently sensitive to detect the effects of eating disorder prevention programs. Regarding predictive validity, Studies 3 and 4 found that the EDDS predicted response to a prevention program and future onset of eating pathology and depression. Results provide additional evidence of the reliability and validity of this scale and suggest it may be useful in clinical and research applications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prion protein immunohistochemical staining in the brains of monkeys with transmissible spongiform encephalopathy

BACKGROUND: Spirituality is receiving greater attention in the medical literature, especially in the family practice journals. A widely applicable instrument to assess spirituality has been lacking, however, and this has hampered research on the relationship between spirituality and health in the clinical setting. METHODS: A new instrument, called the Spiritual Involvement and Beliefs Scale, was designed to be widely applicable across religious traditions, to assess actions as well as beliefs to address key components not assessed in other available measures, and to be easily administered and scored. The instrument is a questionnaire containing 26 items in a modified Likert-type format. Following careful pretesting, the instrument was administered to 50 family practice patients and 33 family practice educators. The validity and reliability of the instrument were then evaluated. RESULTS: By several measures, instrument reliability and validity are very good, with high internal consistency (Cronbach's alpha = .92); strong test-retest reliability (r = .92); a clear four-factor structure; and a high correlation (r = .80) with another established measure of spirituality, the Spiritual Well-Being Scale. CONCLUSIONS: The Spiritual Involvement and Beliefs Scale (SIBS) appears to have good reliability and validity. Compared with other instruments that assess spirituality, the SIBS has several theoretical advantages, including broader scope, use of terms that avoid cultural-religious bias, and assessment of both beliefs and actions. More testing is underway to further assess its usefulness.     

A Depressive Symptom Scale for the California Psychological Inventory: Construct Validation of the CPI-D.

To facilitate life span research on depressive symptomatology, a depressive symptom scale for the California Psychological Inventory (CPI) is needed. The authors constructed such a scale (the CPI-D) and compared its psychometric properties with 2 widely used self-report depression scales: the Beck Depression Inventory and the Center for Epidemiological Studies Depression Scale. Construct validity of the CPI-D was examined in 3 studies. Study 1 established content validity, classifying CPI-D items into Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition depressive symptoms. Study 2 used 3 large samples to gather evidence for reliability and validity: Correlational analyses demonstrated alpha reliability and convergent and discriminant validity; factor analysis provided evidence for discriminant validity with anxiety; and regression analyses demonstrated comparative validity with existing standard PI scales. Study 3 used clinician ratings of depression and anxiety as criteria for external validity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subdural hygromas after bone marrow transplantation: results of a prospective study

Postnatal depression occurs in 10-15% of women. The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-report scale designed specifically as a screening instrument for the postnatal period. It was initially validated for use in the UK, but has subsequently been validated for other communities. It has not been validated for an African community. OBJECTIVE: To determine whether the EPDS is a valid screening scale for depression in a Johannesburg community cohort. PARTICIPANTS AND SETTING: 103 women attending the postnatal clinic at Coronation Hospital, Johannesburg, South Africa. METHOD: The EPDS was validated against the Diagnostic and Statistical Manual (DSM-IV) criteria for depression. It was administered verbally to participants and translated into one of six South African languages where necessary. RESULTS: A threshold of 11/12 on the EPDS identified 100% of women with major depression and 70.6% of women with minor depression. For major and minor depression combined, sensitivity was 80%, specificity 76.6%, positive predictive value 52.6% and negative predictive value 92.2%. CONCLUSION: The EPDS, administered verbally, is a valid screening instrument in this urban South African community.     

Assessment of depressive affect in clinical practice.

Describes a new short-form measure of nonpsychotic depression (the Generalized Contentment Scale) designed for use in clinical settings to evaluate the course of therapy with single clients. It has a high reliability and also has good face, discriminant, and construct validity. The scale was developed specially for use in repeated administrations with the same client. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cross-situational consistency in causal attributions: Does attributional style exist?

Two studies evaluated the concept of an attributional style, as operationalized by the Attributional Style Questionnaire (ASQ). Study 1, with 1,333 undergraduates, examined the reliability and validity of the ASQ and analyzed the factor structure of the measure. Only weak evidence of a cross-situationally consistent attributional style was found. An attempt to identify Ss who tended to be very consistent in their causal attributions on the ASQ similarly did not provide strong support for the attibutional style concept. In Study 2, the relation between scores on the ASQ and causal attributions for actual negative events, as assessed by the Social Readjustment Rating Scale, were examined among 85 pregnant women. Attributional Style scores were poor predictors of actual causal attributions, and selecting highly consistent Ss did not improve the ASQ's predictive validity. Implications for the attributional style concept and an attributional analysis of depression are discussed. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subtlety of the MMPI—2 Depression Scale: A subject laid to rest?

This study was designed to examine the relative validity of the Wiener-Harmon Depression-Obvious (D-O) and Depression-Subtle (D-S) subscales of the Minnesota Multiphasic Personality Inventory—2. With samples of psychiatric outpatients classified as depressed (n?=?31) and nondepressed (n?=?44) on the basis of extensive diagnostic interviews, criterion validity was supported for overall Scale 2 scores, as well as those based on the D-O subscale. Concurrent validity was upheld when Scale 2 and the D-O subscale were compared with a standard criterion indicator of depression. Results failed to support the validity of the D-S subscale as a measure of depression in psychiatric outpatients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of MMPI--2 measures of psychopathic deviance in a forensic setting.

We examined the convergent and discriminant validity of the Minnesota Multiphasic Personality Inventory--2 (MMPI--2) measures of psychopathy, including the Clinical Scale 4, Restructured Clinical Scale 4 (RC4), Content Scale Antisocial Practices (ASP), and Personality Psychopathology Five Scale Disconstraint (DISC). Comparisons of the empirical correlates of these scales were conducted with 2 samples of participants evaluated at a criminal court clinic. The 2 samples included 59 men and 19 women and 913 men and 327 women, respectively. Two types of criteria (clinician ratings and archival record review) were utilized in the analyses. Relative to Clinical Scale 4, RC4 had significantly greater convergent validity in predicting psychopathy as measured by the Psychopathy Checklist--Screening Version (S. D. Hart, D. N. Cox, & R. D. Hare, 1995) and behavioral criteria associated with this construct. RC4 also showed substantially improved discriminant validity when compared with its Clinical Scale counterpart. Among all the MMPI-2 scales studied, RC4 was the best measure of the social deviance traits of psychopathy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening instruments for depression and anxiety following stroke: experience in the Perth community stroke study

Evaluation of the relative efficacy of three screening instruments for depression and anxiety in a group of stroke patients was undertaken as part of the Perth community stroke study. Data are presented on the sensitivity and specificity of the Hospital Anxiety and Depression Scale (HAPS), the Geriatric Depression Scale and the General Health Questionnaire (GHQ) (28-item version) in screening patients 4 months after stroke for depressive and anxiety disorders diagnosed according to DSM-III criteria. The GHQ-28 and GDS but not the HADS depression, were shown to be satisfactory screening instruments for depression, with the GHQ-28 having an overall superiority. The performance of all 3 scales for screening post-stroke anxiety disorders was less satisfactory. The HADS anxiety had the best level of sensitivity, but the specificity and positive predictive values were low and the misclassification rate high.     

Identifying chronic affective disorders in outpatients: Validation of the General Behavior Inventory.

The validity of the General Behavior Inventory (GBI) in screening outpatients for chronic unipolar and bipolar affective conditions was evaluated. The GBI was administered to 492 consecutive patients at a university clinic and a community mental health center. Using a stratified random sampling plan, 167 patients were selected and administered blind structured diagnostic interviews. In addition, unipolar depressives were followed up 6 months after the initial evaluation. Overall, the GBI exhibited fair-to-good positive predictive power and good-to-excellent negative predictive power. In addition, GBI scores in the case range were consistently associated with poor outcome at the 6-month follow-up. These findings suggest that the GBI may provide an economical means of screening for chronic unipolar and bipolar affective conditions in outpatient settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychometric properties of the Geriatric Depression Scale among the institutionalized aged.

Validity and reliability of the Geriatric Depression Scale (GDS) were examined among 806 nursing home and congregate apartment residents (mean age 84 years). The scale was highly internally consistent and, although a clean factor structure emerged, basically unidimensional. Test-retest reliability at 1 mo was good, but correlations with staff-rated depression were only moderate. GDS-based classifications of respondents as suffering possible major, minor, or no depression were fairly consistent with those based on a symptom checklist and with clinical diagnoses. However, both the GDS and the checklist yielded high false negative rates vis à vis clinically diagnosed minor depression. There were no differences in reliability or validity for cognitively impaired and intact groups. GDS responses did not vary with age or length of institutionalization, but there was a positive correlation with functional disability and ill health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating depressed primary care patients improves their physical, mental, and social functioning

BACKGROUND: This study describes the functioning of primary care patients with major depressive disorder, the relationship of medical comorbidity to functional status, and the effects of depression-specific treatment on functional status after 8 months. METHODS: Patients were randomized to a protocol intervention (nortriptyline hydrochloride or interpersonal psychotherapy) or to usual care with the patient's physician in a clinical trial of primary care treatments of depression. Their functional status was evaluated using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Global Assessment Scale. Medical comorbidity was assessed with the Duke Severity of Illness Checklist. The Hamilton Rating Scale for Depression and Beck Depression Inventory were used to measure depressive severity. Assessments were conducted at baseline and at 1, 2, 4, and 8 months after randomization. RESULTS: At baseline, patients reported substantial impairments in the functional domains as assessed by the SF-36 and Global Assessment Scale. Severity of general medical illness and depression were not correlated. Greater medical comorbidity was associated with diminished physical, but not psychological, functioning. Mean scores on SF-36 scales and the Global Assessment Scale improved significantly during the 8 months of follow-up. Patients assigned to protocol treatments showed greater improvement, compared with those assigned to usual care, on the SF-36 mental summary scale and most individual scales but not on the SF-36 physical summary scale. However, patients who completed protocol treatment also experienced significant improvement on the physical summary scale. Medical comorbidity was only a weak predictor of outcome. CONCLUSIONS: Primary care patients with major depressive disorder report substantial impairments in physical, psychological, and social functioning on initial assessment. Severity of baseline medical comorbidity did not correlate with severity of depression and only weakly correlated with functional status at 8 months. Functional impairments improve with time, but standardized depression-specific treatment is associated with greater improvement in more domains of functioning than is a physician's usual care.