Psychometric analysis of the Patient Health Questionnaire in Danish patients with an implantable cardioverter defibrillator (The DEFIB-WOMEN study)

Pedersen, Susanne S.; Mathiasen, Kim; Makransky, Guido

doi:10.1016/j.jpsychores.2016.09.010

Cited by 17 publications

(17 citation statements)

References 54 publications

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“…All items are scored on a 0- to 3-point scale with a total score of 0-27, and higher scores indicated more severe depression. One study of the Danish version confirmed unidimensionality and reliability but suggests collapsing the two middle response categories [38]. However, the scale used in the Internetpsykiatrien clinic followed the original structure of the questionnaire.…”

Section: Methodsmentioning

confidence: 99%

Guided Internet-Based Cognitive Behavioral Therapy for Adult Depression and Anxiety in Routine Secondary Care: Observational Study

Mathiasen¹,

Riper²,

Andersen³

et al. 2018

J Med Internet Res

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BackgroundInternet-based cognitive behavioral therapy (iCBT) is a promising new treatment method for depression and anxiety. However, it is important to determine whether its results can be replicated in routine care before its implementation on a large scale. Although many studies have demonstrated the efficacy of iCBT under controlled conditions, only a few studies have investigated its effectiveness in routine care. Furthermore, several effects of iCBT such as treatment effects in routine care are unclear.ObjectiveThis study aimed to evaluate the clinical effectiveness of iCBT for depression and anxiety in routine secondary care.Methodsn a retrospective cohort study, we analysed patients treated for depression or anxiety in a dedicated iCBT clinic in secondary care in Denmark. Patients were examined before treatment and weekly thereafter by using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 scales for the diagnoses of depression and anxiety, respectively. Primary analyses were conducted using a linear mixed-effects model with random slope and intercept. Secondary analyses were conducted using baseline characteristics as predictors (gender, age, highest level of education, occupational status, marital status, psychotropic medication use, consumption of alcohol, and leisure drugs). Additionally, logistic regression analyses were used to predict noncompletion of treatment.ResultsA total of 203 (depression, N=60; anxiety, N=143) patients were included. Participants were mainly female (78.3% with depression and 65.7% with anxiety), with a mean age of 36.03 (SD 10.97) years (range, 19-67 years) for patients with depression and 36.80 (SD 13.55) years (range, 19-69 years) for patients with anxiety. The completion rates were 62% (37) and 40% (57) for depression and anxiety treatments, respectively. The primary analyses revealed large and significant reductions in the symptom levels of depression (beta=-6.27, SE 0.83, P<.001, d=1.0) and anxiety (beta=-3.78, SE 0.43, P<.001, d=1.1). High baseline severity of the primary disorder was associated with high treatment gains (r=-0.31 for depression; r=-0.41 for anxiety). In patients with anxiety, high baseline severity also predicted a high risk of noncompletion (odds ratio=1.08, CI=1.01-1.16, P=.03). An increase in the baseline severity of the comorbid disorder slightly increased the risk of noncompletion for both disorders (depression: odds ratio=1.03, CI=1.01-1.06, P=.02; anxiety: odds ratio=1.08, CI=1.01-1.16, P=.03).ConclusionsiCBT can be clinically effective in routine care. Since depression and anxiety are costly and debilitating disorders that are vastly undertreated, this finding is important. Additionally, iCBT may help bridge the gap between the need for treatment and its provision. Our results are comparable to the within-group results of efficacy and effectiveness studies. Our noncompletion rates are similar to those observed in psychotherapy but are higher than those reported in similar clinics. Multiple factors predicted outcome and n...

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Section: Methodsmentioning

confidence: 99%

Guided Internet-Based Cognitive Behavioral Therapy for Adult Depression and Anxiety in Routine Secondary Care: Observational Study

Mathiasen¹,

Riper²,

Andersen³

et al. 2018

J Med Internet Res

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“…In order to advance the field and enhance the quality of care for patients with CVD we need to: Implement screening of patients in clinical practice in order to identify the subset of patients at risk. We have core questions available for the physicians to include in their interview 36 and full, standardised and validated questionnaires 37–41 to make a more extended assessment that has been shown to predict patient and clinical outcomes. Start incorporating psychosocial factors into CVD risk prediction models at an equal level to standard risk factors, such as age and smoking, as psychosocial factors are not only risk modifiers but also independent risk factors for poor patient and clinical outcomes. 36 Design effective interventions that target psychosocial risk factors and that use a more precision medicine approach rather than a ‘one-size-fits-all’ approach.…”

Section: Recommendations and Future Perspectivesmentioning

confidence: 99%

“…Implement screening of patients in clinical practice in order to identify the subset of patients at risk. We have core questions available for the physicians to include in their interview 36 and full, standardised and validated questionnaires [37][38][39][40][41] to make a more extended assessment that has been shown to predict patient and clinical outcomes. .…”

Section: Recommendations and Future Perspectivesmentioning

confidence: 99%

Psychosocial perspectives in cardiovascular disease

Pedersen

Känel

Tully

et al. 2017

Eur J Prev Cardiolog

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183

145

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Adaptation to living with cardiovascular disease may differ from patient to patient and is influenced not only by disease severity and limitations incurred by the disease but also by socioeconomic factors (e.g. health literacy), the patients' psychological make-up and susceptibility to distress. Co-morbid depression and/or anxiety is prevalent in 20% of patients with cardiovascular disease, which may be either transient or chronic. Distress, such as depression, reduces adherence, serves as a barrier to behaviour change and the adoption of a healthy lifestyle, and increases the risk that patients drop out of cardiac rehabilitation, impacting on patients' quality of life, risk of hospitalisation and mortality. Hence it is paramount to identify this subset of high-risk patients in clinical practice. This review provides a general overview of the prevalence of selected psychosocial risk factors, their impact on patient-reported and clinical outcomes, and biological and behavioural mechanisms that may explain the association between psychosocial factors and health outcomes. The review also provides recommendations on which self-report screening measures to use to identify patients at high risk due to their psychosocial profile, and the effectiveness of available trials that target these risk factors. Despite challenges and barriers associated with screening of patients combined with appropriate treatment, it is paramount that we treat not only the heart but also the mind in order to improve the quality of care and patient and clinical outcomes.

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“…Because of the ceiling effect, a patient with MDD seen in primary care who continues to work would score similarly to a depressed patient who is hospitalized because of difficulties with self‐care. While there are several studies of the PHQ‐9 using an item response theory approach, these have been of heterogeneous non‐depressed psychiatric, medical or community samples. We are unaware of any studies evaluating the performance of the PHQ‐9 items in a sample of depressed patients presenting for treatment.…”

Section: Severity Of Depressionmentioning

confidence: 99%

The severity of psychiatric disorders

2018

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The issue of the severity of psychiatric disorders has great clinical importance. For example, severity influences decisions about level of care, and affects decisions to seek government assistance due to psychiatric disability. Controversy exists as to the efficacy of antidepressants across the spectrum of depression severity, and whether patients with severe depression should be preferentially treated with medication rather than psychotherapy. Measures of severity are used to evaluate outcome in treatment studies and may be used as meaningful endpoints in clinical practice. But, what does it mean to say that someone has a severe illness? Does severity refer to the number of symptoms a patient is experiencing? To the intensity of the symptoms? To symptom frequency or persistence? To the impact of symptoms on functioning or on quality of life? To the likelihood of the illness resulting in permanent disability or death? Putting aside the issue of how severity should be operationalized, another consideration is whether severity should be conceptualized similarly for all illnesses or be disorder specific. In this paper, we examine how severity is characterized in research and contemporary psychiatric diagnostic systems, with a special focus on depression and personality disorders. Our review shows that the DSM-5 has defined the severity of various disorders in different ways, and that researchers have adopted a myriad of ways of defining severity for both depression and personality disorders, although the severity of the former was predominantly defined according to scores on symptom rating scales, whereas the severity of the latter was often linked with impairments in functioning. Because the functional impact of symptom-defined disorders depends on factors extrinsic to those disorders, such as self-efficacy, resilience, coping ability, social support, cultural and social expectations, as well as the responsibilities related to one's primary role function and the availability of others to assume those responsibilities, we argue that the severity of such disorders should be defined independently from functional impairment.

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Psychometric analysis of the Patient Health Questionnaire in Danish patients with an implantable cardioverter defibrillator (The DEFIB-WOMEN study)

Abstract: The unidimensionality and reliability of the Danish version of the PHQ-9 were confirmed. However, the associated consequences of the number of response options (3-point versus 4-point Likert scale) need to be further examined for the PHQ-9 both as a screening tool and outcome measure.

Cited by 17 publications

References 54 publications

Guided Internet-Based Cognitive Behavioral Therapy for Adult Depression and Anxiety in Routine Secondary Care: Observational Study

Guided Internet-Based Cognitive Behavioral Therapy for Adult Depression and Anxiety in Routine Secondary Care: Observational Study

Psychosocial perspectives in cardiovascular disease

The severity of psychiatric disorders

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