BackgroundThe Center for Epidemiologic Studies Depression Scale (CES-D) is a commonly used instrument to measure depressive symptomatology. Despite this, the evidence for its psychometric properties remains poorly established in Chinese populations. The aim of this study was to validate the use of the CES-D in Chinese primary care patients by examining factor structure, construct validity, reliability, sensitivity and responsiveness.Methods and ResultsThe psychometric properties were assessed amongst a sample of 3686 Chinese adult primary care patients in Hong Kong. Three competing factor structure models were examined using confirmatory factor analysis. The original CES-D four-structure model had adequate fit, however the data was better fit into a bi-factor model. For the internal construct validity, corrected item-total correlations were 0.4 for most items. The convergent validity was assessed by examining the correlations between the CES-D, the Patient Health Questionnaire 9 (PHQ-9) and the Short Form-12 Health Survey (version 2) Mental Component Summary (SF-12 v2 MCS). The CES-D had a strong correlation with the PHQ-9 (coefficient: 0.78) and SF-12 v2 MCS (coefficient: -0.75). Internal consistency was assessed by McDonald’s omega hierarchical (ωH). The ωH value for the general depression factor was 0.855. The ωH values for “somatic”, “depressed affect”, “positive affect” and “interpersonal problems” were 0.434, 0.038, 0.738 and 0.730, respectively. For the two-week test-retest reliability, the intraclass correlation coefficient was 0.91. The CES-D was sensitive in detecting differences between known groups, with the AUC >0.7. Internal responsiveness of the CES-D to detect positive and negative changes was satisfactory (with p value <0.01 and all effect size statistics >0.2). The CES-D was externally responsive, with the AUC>0.7.ConclusionsThe CES-D appears to be a valid, reliable, sensitive and responsive instrument for screening and monitoring depressive symptoms in adult Chinese primary care patients. In its original four-factor and bi-factor structure, the CES-D is supported for cross-cultural comparisons of depression in multi-center studies.
ObjectiveTo identify the factors associated with 12-month mental health service use in primary care patients with depressive symptoms.DesignCross-sectional followed by 12-month cohort study.Setting and participants10 179 adult patients were recruited from the waiting rooms of 59 primary care clinics across Hong Kong to complete a questionnaire which screened for depression. 518 screened-positive participants formed the cohort and were telephoned at 3, 6 and 12 months to monitor mental health service use.Primary and secondary outcomes▸ Help-seeking preferences;▸ Intention to seek help from a healthcare professional;▸ 12-month mental health service use.ResultsAt baseline, when asked who they would seek help from if they thought they were depressed, respondents preferred using friends and family (46.5%) over a psychiatrist (24.9%), psychologist (22.8%) or general practitioner (GP; 19.9%). The presence of depressive symptoms was associated with a lower intention to seek help from family and friends but had no effect on intention to seek help from a healthcare professional. Over 12 months, 24.3% of the screened-positive cohort reported receiving services from a mental health professional. Factors associated with service use included identification of depression by the GP at baseline, having a past history of depression or other mental illness, and being a public sector patient. Having a positive intention to seek professional help or more severe depressive symptoms at baseline was not associated with a greater likelihood of receiving treatment.ConclusionsMental health service use appears to be very low in this setting with only one in four primary care patients with depressive symptoms receiving treatment from a psychiatrist, GP or psychologist over a year. To help reduce the burden of illness, better detection of depressive disorders is needed especially for patients who may be undertreated such as those with no prior diagnosis of depression and those with more severe symptoms.
An approximate continuum theory for interaction between dislocation and inhomogeneity of any shape and properties J. Appl. Phys. 109, 113529 (2011) Direct comparison of boron, phosphorus, and aluminum gettering of iron in crystalline silicon J. Appl. Phys. 109, 073521 (2011) Impact of type of crystal defects in multicrystalline Si on electrical properties and interaction with impurities J. Appl. Phys. 109, 033504 (2011) Low-temperature acoustic properties of nanostructured zirconium obtained by intensive plastic deformation Low Temp.The isochronal and isothermal annealing characteristics of acceptor-doped GaAs:Be grown at low substrate temperatures (300 "C) by molecular-beam epitaxy (LTMBE) have been studied. The Be was introduced in a range of concentrations from lOi to 1019 cm -3. Electrical measurements of as-grown material up to the highest Be concentration of lOI cm -3 show that no free holes are contributed to the valence band even though Raman spectroscopy of the Be local vibrational mode indicates that the majority of the Be impurities occupy substitutional sites. It is proposed that Be acceptors are rendered inactive by the high concentration of Aso,-related native donor defects present in LTMBE material. The concentration of Aso,-related defects in the neutral charge state was estimated from infrared absorption measurements to be as high as 3 X 1019 cm -3. A distinct annealing stage at 5OO.Y!, similar to that found in irradiation-damaged and plastically deformed GaAs, marks a rapid decrease in the concentration of As o,-related defects. A second annealing stage near 800 "C corresponds to the activation of Be acceptors. The presence of gallium vacancies V,, was investigated by slow positron annihilation. Results indicate an excess concentration of Voa in LTMBE layers over bulk-grown crystals. Analysis of isothermal annealing kinetics for the removal of Aso=-related defects gives an activation energy of 1.7 kO.3 eV. The defect removal mechanism is modeled with VG,-assisted diffusion of AsGa to As precipitates.
BackgroundThis study aimed to examine the prevalence, risk factors, detection rates and management of primary care depression in Hong Kong.MethodsA cross-sectional survey containing the PHQ-9 instrument was conducted on waiting room patients of 59 primary care doctors. Doctors blinded to the PHQ-9 scores reported whether they thought their patients had depression and their management.Results10,179 patients completed the survey (response rate 81%). The prevalence of PHQ-9 positive screening was 10.7% (95% CI: 9.7%-11.7%). Using multivariate analysis, risk factors for being PHQ-9 positive included: being female; aged ≤34 years; being unmarried; unemployed, a student or a homemaker; having a monthly household income < HKD$30,000 (USD$3,800); being a current smoker; having no regular exercise; consulted a doctor or Chinese medical practitioner within the last month; having ≥ two co-morbidities; having a family history of mental illness; and having a past history of depression or other mental illness. Overall, 23.1% of patients who screened PHQ-9 positive received a diagnosis of depression by the doctor. Predictors for receiving a diagnosis of depression included: having higher PHQ-9 scores; a past history of depression or other mental health problem; being female; aged ≥35 years; being retired or a homemaker; being non-Chinese; having no regular exercise; consulted a doctor within the last month; having a family history of mental health problems; and consulted a doctor in private practice.In patients diagnosed with depression, 43% were prescribed antidepressants, 11% were prescribed benzodiazepines, 42% were provided with counseling and 9% were referred, most commonly to a counselor.ConclusionAbout one in ten primary care patients screen positive for depression, of which doctors diagnose depression in approximately one in four. At greatest risk for depression are patients with a past history of depression, who are unemployed, or who have multiple illnesses. Patients most likely to receive a diagnosis of depression by a doctor are those with a past history of depression or who have severe symptoms of depression. Chinese patients are half as likely to be diagnosed with depression as non-Chinese patients. Over half of all patients diagnosed with depression are treated with medications.
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