OBJECTIVE: To use an individual participant data meta-analysis to evaluate the accuracy of two PHQ-9 diagnostic algorithms for detecting major depression and compare accuracy between the algorithms and the standard PHQ-9 cutoff score of ≥10.
METHODS: Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, Web of Science (January 1, 2000, to February 7, 2015). Eligible studies that classified current major depression status using a validated diagnostic interview.
RESULTS: Data were included for 54 of 72 identified eligible studies (n participants = 16,688, n cases = 2,091). Among studies that used a semi-structured interview, pooled sensitivity and specificity (95% confidence interval) were 0.57 (0.49, 0.64) and 0.95 (0.94, 0.97) for the original algorithm and 0.61 (0.54, 0.68) and 0.95 (0.93, 0.96) for a modified algorithm. Algorithm sensitivity was 0.22-0.24 lower compared to fully structured interviews and 0.06-0.07 lower compared to the Mini International Neuropsychiatric Interview. Specificity was similar across reference standards. For PHQ-9 cutoff of ≥10 compared to semi-structured interviews, sensitivity and specificity (95% confidence interval) were 0.88 (0.82-0.92) and 0.86 (0.82-0.88).
CONCLUSIONS: The cutoff score approach appears to be a better option than a PHQ-9 algorithm for detecting major depression.
PATIENTS AND METHODS: The study included 123 patients (mean age 64.6 years, SD 7. 95) with LUTS who were treated medically (with alpha-blockers, i.e. terazosin, prazosin, doxazosin and alfuzosin), and 52 patients (mean age 69.6 years, SD 7.94) with LUTS and confirmed to have benign prostatic hyperplasia (BPH) who underwent transurethral resection of the prostate (TURP). Both groups were assessed at baseline and 3 months after treatment using standardized questionnaires (the Beck Depression Inventory, the State-Trait Anxiety Inventory and the General Health Questionnaire-12).
RESULTS: Patients before TURP were significantly more depressed, worried and psychiatrically morbid than were those before medical treatment. Three months after medical and surgical treatment, there was significantly less depression, anxiety and psychiatric morbidity in the TURP than in the medication group.
CONCLUSIONS: TURP is a better treatment than medication for minimising anxiety, depression and psychiatric morbidity after treatment in patients with LUTS, but causes greater psychological stress before treatment.
METHOD: The study included 2322 nationally representative community-dwelling elderly in Malaysia, randomly selected through a multi-stage proportional cluster random sampling from Peninsular Malaysia. The elderly were surveyed on socio-demographic information, cognitive function, depression and intrinsic religiosity. A four-step moderated hierarchical regression analysis was employed to test the moderating effect. Statistical analyses were performed using SPSS (version 15.0).
RESULTS: Bivariate analyses showed that both depression and intrinsic religiosity had significant relationships with cognitive function. In addition, four-step moderated hierarchical regression analysis revealed that the intrinsic religiosity moderated the association between depression and cognitive function, after controlling for selected socio-demographic characteristics.
CONCLUSION: Intrinsic religiosity might reduce the negative effect of depression on cognitive function. Professionals who are working with depressed older adults should seek ways to improve their intrinsic religiosity as one of the strategies to prevent cognitive impairment.
METHODS: In this cross-sectional study, 101 TBI patients were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders to assess the rates of depressive and anxiety disorders after TBI. The association of socio-demographic and clinical factors with depressive and anxiety disorders were determined using Pearson's Chi-Square test.
RESULTS: A total of 25% of TBI patients (n = 25/101) were diagnosed with depressive disorders, of which 15% had major depressive disorder (n = 15/101) and 10% had minor depression (n = 10/101). Fourteen percent of TBI patients had anxiety disorders (n = 14/101), of which post-traumatic stress disorder (PTSD) was the commonest anxiety disorder (9%, n = 9/101). Seven percent of TBI patients (n = 7/101) had comorbid depressive and anxiety disorders. The only factor associated with depressive disorder was the duration of TBI (≥ 1 year) while the only factor associated with anxiety disorder was the mechanism of trauma (assault).
CONCLUSION: Major depressive disorder, minor depression and PTSD are common psychiatric complications of TBI. Clinicians should screen for depressive and anxiety disorders in TBI patients, particularly those with ≥1 year of injury and had sustained TBI from assault.
METHODS AND FINDINGS: We conducted a single-blind RCT (October 2017 -May 2019) with Chin (39.3%), Kachin (15.7%), and Rohingya (45%) refugees living in Kuala Lumpur, Malaysia. The trial included 170 participants receiving six 45-minute weekly sessions of IAT (97.6% retention, 4 lost to follow-up) and 161 receiving a multicomponent CBT also involving six 45-minute weekly sessions (96.8% retention, 5 lost to follow-up). Participants (mean age: 30.8 years, SD = 9.6) had experienced and/or witnessed an average 10.1 types (SD = 5.9, range = 1-27) of traumatic events. We applied a single-blind design in which independent assessors of pre- and posttreatment indices were masked in relation to participants' treatment allocation status. Primary outcomes were symptom scores of Post Traumatic Stress Disorder (PTSD), Complex PTSD (CPTSD), Major Depressive Disorder (MDD), the 5 scales of the Adaptive Stress Index (ASI), and a measure of resilience (the Connor-Davidson Resilience Scale [CDRS]). Compared to CBT, an intention-to-treat analysis (n = 331) at 6-week posttreatment follow-up demonstrated greater reductions in the IAT arm for all common mental disorder (CMD) symptoms and ASI domains except for ASI-3 (injustice), as well as increases in the resilience scores. Adjusted average treatment effects assessing the differences in posttreatment scores between IAT and CBT (with baseline scores as covariates) were -0.08 (95% CI: -0.14 to -0.02, p = 0.012) for PTSD, -0.07 (95% CI: -0.14 to -0.01) for CPTSD, -0.07 for MDD (95% CI: -0.13 to -0.01, p = 0.025), 0.16 for CDRS (95% CI: 0.06-0.026, p ≤ 0.001), -0.12 (95% CI: -0.20 to -0.03, p ≤ 0.001) for ASI-1 (safety/security), -0.10 for ASI-2 (traumatic losses; 95% CI: -0.18 to -0.02, p = 0.02), -0.03 for ASI-3 (injustice; (95% CI: -0.11 to 0.06, p = 0.513), -0.12 for ASI-4 (role/identity disruptions; 95% CI: -0.21 to -0.04, p ≤ 0.001), and -0.18 for ASI-5 (existential meaning; 95% CI: -0.19 to -0.05, p ≤ 0.001). Compared to CBT, the IAT group had larger effect sizes for all indices (except for resilience) including PTSD (IAT, d = 0.93 versus CBT, d = 0.87), CPTSD (d = 1.27 versus d = 1.02), MDD (d = 1.4 versus d = 1.11), ASI-1 (d = 1.1 versus d = 0.85), ASI-2 (d = 0.81 versus d = 0.66), ASI-3 (d = 0.49 versus d = 0.42), ASI-4 (d = 0.86 versus d = 0.67), and ASI-5 (d = 0.72 versus d = 0.53). No adverse events were recorded for either therapy. Limitations include a possible allegiance effect (the authors inadvertently conveying disproportionate enthusiasm for IAT in training and supervision), cross-over effects (counsellors applying elements of one therapy in delivering the other), and the brief period of follow-up.
CONCLUSIONS: Compared to CBT, IAT showed superiority in improving mental health symptoms and adaptative stress from baseline to 6-week posttreatment. The differences in scores between IAT and CBT were modest and future studies conducted by independent research teams need to confirm the findings.
TRIAL REGISTRATION: The study is registered under Australian New Zealand Clinical Trials Registry (ANZCTR) (http://www.anzctr.org.au/). The trial registration number is: ACTRN12617001452381.