Is This Patient Clinically Depressed?

Williams, John W; Noël, Polly Hitchcock; Cordes, Jeffrey A.; Ramı́rez, Gilbert; Pignone, Michael

doi:10.1001/jama.287.9.1160

Cited by 274 publications

(214 citation statements)

References 77 publications

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“…These likelihood ratios are similar to those reported for other depression screening instruments. 24,27 The Maslach Burnout Inventory (MBI) is considered the reference standard for the assessment of burnout. 28 However, its length (22 items) limits its utility in large surveys addressing multiple content areas.…”

Section: Methodsmentioning

confidence: 99%

Burnout and Distress Among Internal Medicine Program Directors: Results of A National Survey

et al. 2013

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BACKGROUND: Physician burnout and distress has been described in national studies of practicing physicians, internal medicine (IM) residents, IM clerkship directors, and medical school deans. However, no comparable national data exist for IM residency program directors. OBJECTIVE: To assess burnout and distress among IM residency program directors, and to evaluate relationships of distress with personal and program characteristics and perceptions regarding implementation and consequences of Accreditation Council for Graduate Medical Education (ACGME) regulations. MAIN MEASURES:The 2010 APDIM Annual Survey included validated items on well-being and distress, including questions addressing quality of life, satisfaction with work-life balance, and burnout. Questions addressing personal and program characteristics and perceptions regarding implementation and consequences of ACGME regulations were also included. KEY RESULTS: Of 377 eligible program directors, 282 (74.8 %) completed surveys. Among respondents, 12.4 % and 28.8 % rated their quality of life and satisfaction with work-life balance negatively, respectively. Also, 27.0 % reported emotional exhaustion, 10.4 % reported depersonalization, and 28.7 % reported overall burnout. These rates were lower than those reported previously in national studies of medical students, IM residents, practicing physicians, IM clerkship directors, and medical school deans. Aspects of distress were more common among younger program directors, women, and those reporting greater weekly work hours. Work-home conflicts were common and associated with all domains of distress, especially if not resolved in a manner effectively balancing work and home responsibilities. Associations with program characteristics such as program size and American Board of Internal Medicine (ABIM) pass rates were not found apart from higher rates of depersonalization among directors of community-based programs (23.5 % vs. 8.6 %, p=0.01). We did not observe any consistent associations between distress and perceptions of implementation and consequences of program regulations. CONCLUSIONS: The well-being of IM program directors across domains, including quality of life, satisfaction with work-life balance, and burnout, appears generally superior to that of medical trainees, practicing physicians, and other medical educators nationally. Additionally, it is reassuring that program directors' perceptions of their ability to respond to current regulatory requirements are not adversely associated with distress. However, the increased distress levels among younger program directors, women, and those at community-based training programs reported in this study are important concerns worthy of further study.

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Section: Methodsmentioning

confidence: 99%

Burnout and Distress Among Internal Medicine Program Directors: Results of A National Survey

et al. 2013

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“…As discussed previously, 11 this screening approach performs favorably relative to other depression screening instruments. 33,34 Statistical Analyses Standard univariate statistics were used to describe the sample. The association of QOL, burnout, depression, and fatigue with subsequent self-reported BBF exposure and motor vehicle incidents was ana-RESIDENT FATIGUE, DISTRESS, AND PERSONAL SAFETY lyzed using generalized estimating equations, an extension of generalized linear models that allows for correlated repeated measurements within individuals.…”

Section: Study Measuresmentioning

confidence: 99%

Association of Resident Fatigue and Distress With Occupational Blood and Body Fluid Exposures and Motor Vehicle Incidents

West

Tan

Shanafelt

2012

Mayo Clinic Proceedings

135

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Objective: To evaluate the effect of resident physicians' distress on their personal safety. Participants and Methods: We conducted a prospective, longitudinal cohort study of internal medicine residents at Mayo Clinic in Rochester, Minnesota. Participants completed surveys quarterly from July 1, 2007, through July 31, 2011, during their training period. Frequency of self-reported blood and body fluid (BBF) exposures and motor vehicle incidents was recorded. Associations of validated measures of quality of life, burnout, symptoms of depression, fatigue, and sleepiness with a subsequently reported BBF exposure or motor vehicle incident were determined using generalized estimating equations for repeated measures. Results: Data were provided by 340 of 384 eligible residents (88.5%). Of the 301 participants providing BBF exposure data, 23 (7.6%) reported having at least 1 BBF exposure during the study period. Motor vehicle incidents were reported by 168 of 300 respondents (56.0%), including 34 (11.3%) reporting a motor vehicle crash and 130 (43.3%) reporting a near-miss motor vehicle crash. Other than the low personal accomplishment domain of burnout, distress and fatigue at one time point exhibited no statistically significant associations with BBF exposure in the subsequent 3 months. However, diminished quality of life, burnout, positive screening for depression, fatigue, and sleepiness were each associated with statistically significantly increased odds of reporting a motor vehicle incident in the subsequent 3 months. Conclusion: Exposures to BBF are relatively uncommon among internal medicine residents in current training environments. Motor vehicle incidents, however, remain common. Our results confirm the importance of fatigue and sleepiness to resident safety concerns. In addition, higher levels of distress may be contributory factors to motor vehicle crashes and other related incidents. Interventions designed to address both fatigue and distress may be needed to optimally promote patient and resident safety.

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“…Its validity and reliability as a diagnostic measure as well as its utility in assessing depression severity and monitoring treatment response are well-established. [5][6][7][8][9][10][11][12] No studies, however, have yet examined the factor structure and differential functioning of the PHQ-9 in different racial/ethnic minority groups. In fact, relatively few studies have systematically investigated racial/ethnic differences in the function of other depression screening instruments.…”

mentioning

confidence: 99%

Using the patient health questionnaire-9 to measure depression among racially and ethnically diverse primary care patients

Huang¹,

et al. 2006

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OBJECTIVE:The Patient Health Questionnaire depression scale (PHQ-9) is a well-validated, Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) criterion-based measure for diagnosing depression, assessing severity and monitoring treatment response. The performance of most depression scales including the PHQ-9, however, has not been rigorously evaluated in different racial/ethnic populations. Therefore, we compared the factor structure of the PHQ-9 between different racial/ethnic groups as well as the rates of endorsement and differential item functioning (DIF) of the 9 items of the PHQ-9. The presence of DIF would indicate that responses to an individual item differ significantly between groups, controlling for the level of depression. MEASUREMENTS:A combined dataset from 2 separate studies of 5,053 primary care patients including non-Hispanic white (n =2,520), African American (n =598), Chinese American (n =941), and Latino (n =974) patients was used for our analysis. Exploratory principal components factor analysis was used to derive the factor structure of the PHQ-9 in each of the 4 racial/ethnic groups. A generalized MantelHaenszel statistic was used to test for DIF. RESULTS:One main factor that included all PHQ-9 items was found in each racial/ethnic group with a coefficients ranging from 0.79 to 0.89. Although endorsement rates of individual items were generally similar among the 4 groups, evidence of DIF was found for some items. CONCLUSIONS:Our analyses indicate that in African American, Chinese American, Latino, and non-Hispanic white patient groups the PHQ-9 measures a common concept of depression and can be effective for the detection and monitoring of depression in these diverse populations.

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Is This Patient Clinically Depressed?

Cited by 274 publications

References 77 publications

Burnout and Distress Among Internal Medicine Program Directors: Results of A National Survey

Burnout and Distress Among Internal Medicine Program Directors: Results of A National Survey

Association of Resident Fatigue and Distress With Occupational Blood and Body Fluid Exposures and Motor Vehicle Incidents

Using the patient health questionnaire-9 to measure depression among racially and ethnically diverse primary care patients

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