Background Despite its popularity, little is known about the measurement invariance of the Patient Health Questionnaire‐9 (PHQ‐9) across U.S. sociodemographic groups. Use of a screener shown not to possess measurement invariance could result in under/over‐detection of depression, potentially exacerbating sociodemographic disparities in depression. Therefore, we assessed the factor structure and measurement invariance of the PHQ‐9 across major U.S. sociodemographic groups. Methods U.S. population representative data came from the 2005–2016 National Health and Nutrition Examination Survey (NHANES) cohorts. We conducted a measurement invariance analysis of 31,366 respondents across sociodemographic factors of sex, race/ethnicity, and education level. Results Considering results of single‐group confirmatory factor analyses (CFAs), depression theory, and research utility, we justify a two‐factor structure for the PHQ‐9 consisting of a cognitive/affective factor and a somatic factor (RMSEA = 0.034, TLI = 0.985, CFI = 0.989). On the basis of multiple‐group CFAs testing configural, scalar, and strict factorial invariance, we determined that invariance held for sex, race/ethnicity, and education level groups, as all models demonstrated close model fit (RMSEA = 0.025–0.025, TLI = 0.985–0.992, CFI = 0.986–0.991). Finally, for all steps ΔCFI was <−0.004, and ΔRMSEA was <0.01. Conclusions We demonstrate that the PHQ‐9 is acceptable to use in major U.S. sociodemographic groups and allows for meaningful comparisons in total, cognitive/affective, and somatic depressive symptoms across these groups, extending its use to the community. This knowledge is timely as medicine moves towards alternative payment models emphasizing high‐quality and cost‐efficient care, which will likely incentivize behavioral and population health efforts. We also provide a consistent, evidence‐based approach for calculating PHQ‐9 subscale scores.

Key Points Question Is self-referred brief admission more effective than treatment as usual in reducing the use of inpatient services for individuals who self-harm and are at risk of suicide? Findings In this randomized clinical trial of 125 adults in Sweden, the brief admission group did not show reduced inpatient service use compared with the control group. Both groups showed significant decreases in days admitted to the hospital and in emergency department visits, but only the brief admission group showed a significant decrease in duration of compulsory admission. Meaning Brief admission does not seem to be more effective than treatment as usual in reducing the use of inpatient services.

SummaryObjectiveThe increase in technology and online social networks (OSNs) may present healthcare providers with an innovative modality for delivering weight management programmes that could have an impact on health care at the population level. The objective of this study was to evaluate the feasibility and efficacy of using an OSN to deliver a weight loss programme to inform future, large‐scale trials.MethodsSeventy individuals (age = 47 ± 12.4, minority = 24.3%) with obesity (BMI = 36.2 ± 4.0) completed a 6‐month weight loss intervention and were randomized to either a conference call or OSN delivery group. Weight loss was achieved by reducing energy intake by 500–700 kcal·d−1 below estimated total daily energy expenditure and progressing physical activity to 300 min/week. Behavioural weight loss strategies were delivered weekly throughout the intervention.ResultsConference call and OSN groups produced clinically meaningful weight loss of ≥5% from baseline to 6 months (phone = −6.3 ± 6.4%, OSN = −5.8 ± 6.7%). There was no significant difference in weight change between groups (p = 0.765).ConclusionThe phone and OSN groups met the American Heart Association/American College of Cardiology/The Obesity Society's Guidelines by reducing baseline weight by 5–10% within 6 months. OSNs appear to be a viable delivery platform for weight loss interventions; however, larger scale adequately powered trials are needed.

Patient falls during unassisted ambulation may be reduced through appropriate examination of these five physical elements/attributes.

The purpose of this conceptual replication study was to investigate the efficacy of an early literacy intervention when it was implemented by special educators in general education classrooms with students in the class participating in the lessons. The study was conducted in 16 schools in three states. Eighty students with severe disabilities participated in the study. Students in the intervention group received Early Literacy Skills Builder (ELSB) instruction, and students in the “business-as-usual” control group received literacy instruction planned by special education teachers to address the students’ individualized education program literacy goals. Literacy assessments were conducted in five waves scheduled across the school year. Results showed that students receiving ELSB instruction made greater gains in assessed literacy skills than students in the control group. These findings provide evidence that students with severe disabilities can benefit from comprehensive emergent literacy instruction when it is implemented in general education settings.