Toward a generalizable model of symptoms in major depressive disorder

BACKGROUND: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: The IDS provided more complete factors coverage than did the HDRS or BDI and thus may be more useful in research on symptom profiles.     

Cephalometric analysis of changes in occlusal relationship

This article assesses the reliability and validity of the Cocaine Selective Severity Assessment (CSSA), a measure of cocaine abstinence signs and symptoms. Interrater reliability and scale internal consistency were high. Initial CSSA scores were significantly higher in cocaine-dependent subjects than in alcohol-dependent subjects. Initial CSSA scores were highly correlated with recent cocaine use and with severity measures from the Addiction Severity Index (ASI) including the interviewer severity rating and composite score in the drug section. Among cocaine-dependent subjects, initial CSSA scores were higher for those who failed to achieve abstinence or who subsequently dropped out of treatment. Further, CSSA scores showed consistent and marked declines over time for subjects who continued in treatment and remained abstinent. The CSSA appears to be a reliable and valid measure of cocaine abstinence symptoms and a useful predictor of negative outcomes in cocaine dependence treatment.     

How ill is the patient at this time? Cues determining clinician's global judgments.

Studied the relationship between an unstructured global rating of severity of illness and structured ratings of individual symptoms (e.g., Brief Psychiatric Rating Scale) in 278 25-60 yr old depressed women. Correlational analyses revealed that patients rated as more severely ill were those showing psychomotor retardation, depressive delusions, agitation, guilt, initial insomnia, hopelessness, suicidal tendencies, verbal complaint of depressed feelings and observed appearance of depression, and less short-term reactivity of mood. Findings suggest that patients showing greater severity on the core symptoms of depression and more characteristics of psychotic or endogenous depression are perceived as more ill. A multiple regression equation derived from 30 symptoms accounted for 56% of variance in the global scale. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negative symptoms in stroke patients and length of hospital stay

The purpose of this study was to assess whether the presence and severity of psychiatric symptoms in stroke patients correlate with their length of stay (LOS) in a rehabilitation unit, with special emphasis on the role of negative symptoms (NS). Twenty-three stroke patients, consecutively recruited from the inpatient rehabilitation unit, were evaluated on admission with the Mini-Mental State Examination (MMSE), the Positive and Negative Symptom Scale (PANSS), the Hamilton Depression Rating Scale (HDRS), the Scale for Assessment of Negative Symptoms (SANS), and the Functional Independent Measure (FIM). NS scores significantly correlated with LOS, with SANS total score being the most informative, and the attentional impairment subscale the least. The group of patients with pronounced NS stayed in the hospital twice as long as patients with the score on the NS subscale of PANSS below 16. These two groups did not differ in their cognitive performance or in the positive symptom subscale of PANSS scores. Total FIM score on admission was lower and HDRS scores higher in patients with pronounced NS. However, these differences, unlike those of LOS, have not reached statistical significance. The presence and severity of NS in stroke patients are associated with a longer hospital stay. Identification and treatment of NS might lead to a faster discharge from rehabilitation unit.     

Psychometric properties of the Beck Depression Inventory for Youth in a sample of girls.

A new measure has been developed to assess depressive symptoms, the Beck Depression Inventory for Youth (BDI-Y; J. S. Beck, A. T. Beck, & J. B. Jolly, 2001). This research extends previous validation research of BDI-Y total scores by examining internal consistency and convergent and predictive validity within a school-based sample (n = 859) of girls 9-13 years old by age level and for selected races or ethnic groups. Scores had high internal consistency, and there was support for using the BDI-Y to assess depressive symptoms. Reliability was slightly lower for 9-year-olds, but reliability and validity estimates did not differ by race or ethnic group. Finally, confirmatory factor analysis results provide some support for unidimensionality of scores but also point toward possible refinements. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Evaluation of the Automatic Thoughts Questionnaire: Negative cognitive processes and depression among children.

The Automatic Thoughts Questionnaire (ATQ [S. D. Hollon and P. C. Kendall; see PA, Vol 66:180]) assesses negative thoughts that are associated with depression among adults. In this study, the scale was extended to children. Internal consistency and validity of the ATQ were evaluated with 250 child psychiatric inpatient children (ages 6 to 13). Validity was evaluated by examining whether depressed and nondepressed children differed on the scale, whether performance was related to other measures of cognitive attributional processes, and whether the measure was more closely related to depression and cognitive processes than to other constructs predicted to be less central to negative thoughts. The ATQ showed high internal consistency and yielded moderate to high item–total score correlations. Convergent validity was supported by the finding that the ATQ correlated positively with severity of depression, hopelessness, and external locus of control and negatively with self-esteem. Discriminant validity was suggested, but not strongly supported, by higher correlations between ATQ and measures of depression and other cognitive processes than between the ATQ and severity of impairment, prosocial behavior, and positive affective experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Longitudinal Analysis of the Course of Depressive Symptomatology in Geriatric Patients With Cancer of the Breast, Colon, Lung, or Prostate.

This study mapped the trajectory of depression and its components (depressive mood, somatic expression of depression, and lack of positive affect) for 1 year after an initial cancer diagnosis, revealing the complex nature of the psychological response to the cancer experience. The analysis was based on 4 waves of panel data from 860 older patients with incident breast, colon, lung, or prostate cancer. Predictors of depressive symptoms included cancer site; stage; comorbidities; sociodemographic characteristics; and indicators of physical functioning, symptom severity, and treatment. Patients' overall depressive symptoms declined, especially depressive mood and somatic indicators. By contrast, the sense of well-being did not recover; in fact, it would have deteriorated without improvements in physical functioning and physical symptoms. The present findings show the importance of psychological assessments and symptom management during cancer treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of depression in adolescents using the Center for Epidemiologic Studies Depression Scale.

Operating characteristics of the Center for Epidemiologic Studies Depression Scale (CES-D) were examined by using data from 4 samples of students in Grades 9–12. The CES-D was found to have good internal consistency and test–retest reliability. Dimensionality was comparable to that found for adults. Structure varied little by order of assessment (Trial 1 of Trial 2), age, or gender. Salience of items, in terms of rank order of mean item scores, was remarkably similar to that reported for college and general adult samples. With the standard cutoff score of 16 or more, half of the high school students were classified as depressed. There was a pronounced gender effect, with proportionately more women reporting depressive symptoms across the 4 samples. Although it appears that the CES-D scale may be appropriate for use with adolescents, the issues of stability of scores over time, appropriate cutoff scores, and usefulness in detecting cases of clinical depression remain unresolved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression in independently living elderly, a study with the Zung-12

The psychometric properties of the Zung-12, a short rating scale for the measurement of depression, were studied in a random sample (N = 79) taken from an elderly population living in their own homes in a medium sized town. Both internal and test-retest reliability of the Zung-12 are satisfactory. According to factor analyses the rating scale has a unidimensional structure. High correlations with the Befindlichkeitsskala and the SSWO support the convergent validity. No relation is found between depression score and age, amount of help received and household composition. Women and subjects with lower education appeared to have higher depression scores than respectively men and subjects with higher education. Administration of the Zung-12 in the morning produces higher depression scores than in the afternoon. 10% of the subjects score above the cutting point on one of the occasions, 4% on both occasions. Reliable change scores were calculated to indicate the statistical significance of differences between two administrations.     

Construction and validation of a specific quality of life instrument for adolescents with spine deformities

STUDY DESIGN: The development and construction of a specific instrument for measuring quality of life in adolescents with spine deformities was investigated. OBJECTIVES: To assess the validity and reliability of the Quality of Life Profile for Spine Deformities. SUMMARY OF BACKGROUND DATA: An 88-item questionnaire was self-administered to 174 patients ranging in age from 10 to 20 years with spine deformities. Items were rated on a five-point Likert scale. Higher scores means high level of impairment in quality of life. Age, gender, menarche or voice change, salient symptoms in the medical record, ordinary parameters on physical examination, and measurements on standard anteroposterior and lateral radiographs were recorded. The retest was done 10 days after the initial administration in a subsample of 35 patients. METHODS: The test-retest reliability was analyzed calculating the intraclass correlation coefficient. Internal consistency was measured with the Cronbach's alpha method. Factor analysis was used to obtain a reduced number of variables. Construct validity was assessed using the principal components model of factor analysis based on the correlation matrix and using the varimax computer algorithm for orthogonal rotation. Discriminant validity was assessed using the Kruskal-Wallis test. RESULTS: The Quality of Life Profile for Spine Deformities contained 21 items and five factors in conceptual terms labeled psychosocial functioning, sleep disturbances, back pain, body image, and back flexibility. The overall questionnaire score showed an internal consistency of 0.88 and a test-retest correlation of 0.91. Patients with structural curves showed significantly higher scores in all dimensions of the Quality of Life Profile for Spine Deformities except for the subscale of body image than patients with postural curves. When patients were grouped according to the symptom of back pain, those with backache had a significantly higher quality of life overalls score and scores in the dimensions of sleep disturbances and pain. Brace-treated patients showed statistically significant differences in the quality of life overall score and scores in the dimensions of psychosocial functioning and back flexibility. CONCLUSIONS: The instrument developed for measuring quality of life in patients with spine deformities during the period of bone growth has validity, internal consistency, and high test-retest reliability. The conceptualization of quality of life of the Quality of Life Profile for Spine Deformity includes psychosocial dimensions and pain and function.     

Functional characterization of a novel type of 1 alpha,25-dihydroxyvitamin D3 response element identified in the mouse c-fos promoter

The measurement characteristics of two asthma symptom diary scales developed for use as health outcome measures in clinical trials of asthma therapy were investigated. A daytime diary scale was designed to capture the frequency and inconvenience of daytime asthma symptoms and their effects on activities, and a nocturnal asthma symptom diary scale was designed to capture awakenings with asthma symptoms. The internal consistency, reliability, validity and responsiveness of both asthma diary scales were assessed in 346 adult asthma patients in two placebo-controlled clinical trials of an investigational asthma therapy, a leukotriene biosynthesis inhibitor. The daytime symptom scale showed sufficient internal consistency (0.90-0.92), and the daytime and nocturnal symptom scales showed sufficient test retest reliability (0.69-0.87). Construct validity was demonstrated by generally moderate-to-strong correlations for changes in the diary scales with changes in other measures of asthma status, such as forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), and puffs of beta-agonist inhaler. Both scales demonstrated significant responsiveness to change in asthma due to therapy in one of the clinical trials. Based on these results, the daytime and nocturnal asthma symptom diary scales show measurement characteristics appropriate for use as asthma outcome measures in clinical trials of asthma therapy.     

Identifying patients with depression in the primary care setting: a more efficient method

OBJECTIVE: To determine if there is a core subset of depressive symptoms that could be used to efficiently diagnose depression after administering the 2-item PRIME-MD a screening questionnaire for depression. METHODS: One thousand patients selected randomly and by convenience from 4 primary care clinics were assessed by PRIME-MD and completed a questionnaire measuring the following validation variables: functional status and well-being, disability days, somatic symptoms, depression severity, suicidal thoughts, health care utilization, and the physician-patient relationship. RESULTS: Four symptoms (sleep disturbance, anhedonia, low self-esteem, and decreased appetite) accounted for virtually all the depression symptom-related variance in functional status and well-being, with 8.3% of patients having 2 of these symptoms and 8.2% having 3 or 4 of these symptoms. There was excellent agreement between diagnosis based on core symptoms and major depression (K= 0.77; overall accuracy rate, 94%). There were significant differences (P<.001) among patients with negative depression screen, 0 to 1, 2, and 3 to 4 core symptoms with scores on each of the validation variables getting progressively worse in these 4 groups. A cutoff point of 2 core symptoms identified all but 3 patients with major depression and an additional 5% of the entire sample without major depression who were significantly (P<.05) worse than patients without depression on each of the validation variables. CONCLUSION: A strategy that includes the use of a 2-item depression screener followed by the evaluation of 4 core depressive symptoms is an efficient and effective way of identifying and classifying primary care patients with depression in need of clinical attention.     

Development and psychometric evaluation of the Yale–Brown Obsessive-Compulsive Scale—Second Edition.

The Yale–Brown Obsessive-Compulsive Scale (Y-BOCS; Goodman, Price, Rasmussen, Mazure, Delgado, et al., 1989) is acknowledged as the gold standard measure of obsessive-compulsive disorder (OCD) symptom severity. A number of areas where the Y-BOCS may benefit from revision have emerged in past psychometric studies of the Severity Scale and Symptom Checklist. Therefore, we created the Yale–Brown Obsessive-Compulsive Scale—Second Edition (Y-BOCS–II) by revising the Severity Scale item content and scoring framework, integrating avoidance into the scoring of Severity Scale items, and modifying the Symptom Checklist content and format. One hundred thirty treatment-seeking adults with OCD completed a battery of measures assessing OCD symptom severity and typology and depressive and anxious symptomology. Interrater and test–retest reliability were assessed on a subsample of participants. The Y-BOCS–II showed strong internal consistency for the Symptom Checklist (Kuder–Richardson-20 = .91) and Severity Scale (α = .89). Test–retest and interrater reliabilities were both high (intraclass correlations > .85). Confirmatory factor analyses did not show adequate fit with previous models of the Y-BOCS. Exploratory factor analysis revealed a two-factor solution generally consistent with the Obsession and Compulsion Severity subscales. Construct validity was supported by strong correlations with clinician-rated measures of OCD symptom severity and moderate correlations with measures of worry and depressive symptoms. Taken together, the Y-BOCS–II has excellent psychometric properties in assessing the presence and severity of obsessive-compulsive symptoms. Although the Y-BOCS remains a reliable and valid measure, the Y-BOCS–II may provide an alternative method of assessing symptom presence and severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expression of a neutral horseradish peroxidase in Escherichia coli

Many measures of depression severity appear confounded by including depressive sub-typing features. We report the design of a brief (11 item) self-report scale of depression severity (the AUSSI), assessing both mood state and social impairment domains, and designed to be independent of sub-typing features. Mood severity and functional impairment scores demonstrated some independence in a sample of 360 patients. Patients with a 'melancholic' depressive type (categorised by four differing systems) differed from residual 'non-melancholic' depressed patients by having higher impairment scores, but the assigned groups did not differ, in the main, by mood severity scores. Advantages of the measure are summarised.     

Reliability and validity of the Hamilton Depression Inventory: A paper-and-pencil version of the Hamilton Depression Rating Scale Clinical Interview.

A self-report, paper-and-pencil version of the Hamilton Depression Rating Scale (HDRS; M. Hamilton, 1960) was developed. This measure, the Hamilton Depression Inventory (HDI; W. M. Reynolds & K. A. Kobak, 1995) consists of a 23-item full form, a 17-item form, and a 9-item short form. The 17-item HDI form corresponds in content and scoring to the standard 17-item HDRS. With a sample of psychiatric outpatients with major depression (n?=?140 ), anxiety disorders (n?=?99), and nonreferred community adults (n?=?118), the HDI forms demonstrated high levels of reliability (rα?=?.91 to .94, rtt?=?.95 to .96). Extensive validity evidence was presented, including content, criterion related, construct, and clinical efficacy of the HDI cutoff score. Overall, the data support the reliability and validity of the HDI as a self-report measure of severity of depression. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Disability in geriatric depression

OBJECTIVE: The authors' purpose was to identify the relationship of disability to clinical measures that are part of a comprehensive psychiatric examination of depressed elderly patients. METHOD: The disability of 75 elderly inpatients and outpatients with major depression whose cognitive function ranged from normality to mild dementia was assessed with the Philadelphia Multilevel Assessment Instrument. Age at onset of depression, chronicity of depression, severity of depression, cognitive impairment, medical burden, social support and living environment were assessed with standardized instruments. RESULTS: Impairment in instrumental activities of daily living was significantly associated with advanced age, severity of depression, and medical burden. The relationship of depressive symptoms to impairment in instrumental activities of daily living was not influenced by age or medical burden. Anxiety and depressive ideation as well as retardation and weight loss were significantly associated with impairment in instrumental activities of daily living. Interviewer-rated global disability was associated with advanced age at onset of depression, medical burden, and overall cognitive impairment. Specifically, a disturbance in initiation and perseveration was significantly related to global disability. CONCLUSIONS: Impairment in instrumental activities of daily living appears to be a relatively independent dimension of health status that is related to depressive symptoms, particularly anxiety and depressive ideation as well as retardation and weight loss. Global disability may be associated with impairment in initiation and perseveration and with late onset of depression. These findings provide a basis for studies investigating whether psychotherapy aimed at depressive ideation and rehabilitation efforts focused on instrumental activities of daily living can improve the outcome of geriatric depression.     

Examining scale discriminability in the BDI and CES-D as a function of depressive severity.

Scale discriminability is the ability of a measure to discriminate among individuals ordered along some continuum, such as depressive severity. We used a nonparametric item-response model to examine scale discriminability in the Beck Depression Inventory (BDI) and Center for Epidemiologic Studies Depression Scale (CES-D) in both college and depressed outpatient samples. In the college sample, the CES-D was more discriminating than the BDI, but a standard CES-D cutoff score of 16 overestimated the likely prevalence of depression (45%). The CES-D may be more effective than the BDI in detecting differences in depressive severity in college students but may be less specific. In the depressed outpatient sample, the CES-D was again more discriminating than the BDI. The superior scale discriminability of the CES-D offers one explanation for its poorer specificity in college samples. Endorsing many items that discriminate at low levels of depressive severity can result in scores that exceed a cutoff criterion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Memory complaint and memory performance in the depressed elderly.

Compared depressed and nondepressed elderly Ss recruited in the context of a large epidemiological study of health on measures of self-reported memory disturbance and an objective index of memory performance (free recall). Three groups were studied: (a) 26 Ss (mean age 71.56 yrs) meeting Research Diagnostic Criteria (RDC) for major depression, (b) 25 Ss (mean age 72.16 yrs) with high levels of self-reported depressive symptoms who did not meet RDC for major depression, and (c) 26 Ss (mean age 71.81 yrs) with low levels of self-reported depressive symptoms. Ss with high depression symptom levels reported significantly higher levels of memory complaint than did Ss with low symptom levels, but there were no differences in self-reported memory disturbance as a function of depression diagnosis. There were no significant differences between groups on the free-recall measure, either as a function of symptom level or diagnosis. It is argued that symptom severity rather than diagnosis of depression is important in determining impairment in depressed elderly people. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exercise of young thoroughbred horses increases impact strength of the third metacarpal bone

OBJECTIVE: The aim of this study was to assess the frequency and severity of depressive symptoms, to determine the rate of depressive disorder, to explore possible reasons for the development of depressive symptoms and to examine the effects of depression in a group of human immunodeficiency virus (HIV)-positive patients. METHOD: HIV-positive patients attending an outpatient treatment facility were assessed by the research psychologist and completed a number of questionnaires: the Beck Depression Inventory (BDI); the Life Event Inventory (LEI); the Core Bereavement Item (CBI-17) questionnaire; and the Psychosocial Adjustment to illness Scale (PAIS). Patients scoring > or = 14 on the BDI were seen by the psychiatrist for further assessment, and where appropriate, diagnoses were made according to DSM-III-R criteria. RESULTS: One hundred and ninety-two patients participated in the study; 95 scored > or = 14 on the BDI and one-third of these were found to have a depressive disorder. Factors significantly predictive of a BDI score > or = 14 were: an LEI score > 77; a diagnosis of acquired immunodeficiency syndrome (AIDS); being on sickness benefits or a pension; no current relationship; and a past history of depression. Few differences were demonstrated between those with a depressive disorder and those with a BDI score > or = 14 but no diagnosis of depressive disorder. Both groups had high mean PAIS scores indicating significant illness effects in multiple areas of function. CONCLUSIONS: Depressive symptoms are common among patients with HIV infection. Few factors differentiate between patients with a depressive disorder and those whose depressive symptoms do not meet diagnostic criteria. Substantial disability is present in both groups.