Screening for Depression in the Medically Ill: The Suggested Utility of a Cognitive-Based Approach

Objective: There is a need for a valid measure of depression in the medically ill, and one that is independent of medical illness characteristics. As yet, there is no such widely accepted measure. We thus report on the early development of such a measure using cognitive constructs that define depressive mood state nuances. Method: We studied 67 patients with a significant medical illness, verbally administering a set of 81 provisional items. Sample members also alternatively completed one of two comparison measures: the Hospital Anxiety and Depression Scale (HADS) or the Beck Depression Inventory for Primary Care (BDI-PC). A psychiatrist interviewed a subset to determine severity of any depression and whether subjects met formalized caseness criteria for depression. The Composite International Diagnostic Interview (CIDI) was also administered during interviews to assess agreement with psychiatrist judgements about caseness. Results: A 16-item measure with high internal consistency was derived, with validation analyses suggesting it was distinctly superior to the HADS and somewhat superior to the BDI-PC measure. Conclusions: A cognitive-based approach (as used by both our measure and the BDI-PC) to screen for depression in medically ill groups appears to have distinct utility in identifying depressed patients, and in avoiding confounding influences of physical symptoms.

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Shades of Blue and Gray: A Comparison of the Center for Epidemiologic Studies Depression Scale and the Composite International Diagnostic Interview for Assessment of Depression Syndrome in Later Life

The Gerontologist ◽

10.1093/geront/gnz044 ◽

2019 ◽

Vol 60 (4) ◽

pp. e242-e253 ◽

Cited By ~ 2

Author(s):

Linh Dang ◽

Liming Dong ◽

Briana Mezuk

Keyword(s):

Short Form ◽

Depression Scale ◽

Composite International Diagnostic Interview ◽

Later Life ◽

Epidemiologic Studies ◽

Diagnostic Interview ◽

Psychiatric Research ◽

And Gender ◽

Ethnicity And Gender ◽

Design And Methods

Abstract Background and Objectives Psychiatric research lacks the equivalent of a thermometer, that is, a tool that accurately measures mental disorder regardless of context. Instead, the psychometric properties of scales that purport to assess psychopathology must be continuously evaluated. To that end, this study evaluated the diagnostic agreement between the eight-item Center for Epidemiologic Studies Depression Scale (CESD-8) and the Composite International Diagnostic Interview—short form (CIDI-SF) in the Health and Retirement Study (HRS). Research Design and Methods Data come from 17,613 respondents aged >50 from the 2014 wave of the HRS. Kappa coefficients were used to assess the agreement between the 2 instruments on depression classification across a range of thresholds for identifying case status, including variation across subgroups defined by age, race/ethnicity, and gender. Results The point prevalence of depression syndrome estimated by the CESD was higher than that estimated by the CIDI-SF (CESD: 9.9%–19.5% depending on the cutoff applied to the CESD vs CIDI-SF: 7.7%). Assuming CIDI-SF as the gold standard, the CESD yielded a sensitivity of 56.2%–70.2% and specificity of 84.7%–94.0% across the range of cutoffs. The agreement on depression classification was weak (κ = 0.32–0.44). Discussion and Implications Depression cases identified by the CESD have poor agreement with those identified by the CIDI-SF. Conceptually, psychological distress as measured by the CESD is not interchangeable with depression syndrome as measured by the CIDI-SF. Population estimates of depression among older adults based on the CESD should be interpreted with caution.

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The Visual Analogue Mood Scale: Can a Single-Item Scale Accurately Classify Depressive Mood State?

Psychological Reports ◽

10.2466/pr0.1999.85.3f.1238 ◽

1999 ◽

Vol 85 (3_suppl) ◽

pp. 1238-1243 ◽

Cited By ~ 32

Author(s):

William D. Scott Killgore

Keyword(s):

College Students ◽

Mood State ◽

Depression Scale ◽

Rate Sensitivity ◽

Depressive Mood ◽

Affective States ◽

Single Item ◽

Hit Rate ◽

Mood Scale ◽

Item Scale

Visual analogue mood scales provide extremely rapid, single-item assessment of affective states. This study examined discrimination on a single-item visual analogue depression scale between dysphoric or mildly depressed and nondepressed individuals in a sample of 284 college students. The visual analogue mood scale significantly discriminated subjects by mood category and achieved comparable hit rate, sensitivity, and specificity relative to other well validated mood scales.

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Erkennungsgüte dreier deutschsprachiger Screeninginstrumente für Depression bei hospitalisierten Patienten mit koronarer Herzerkrankung

Psychiatrische Praxis ◽

10.1055/s-0042-123434 ◽

2017 ◽

Vol 46 (01) ◽

pp. 41-48 ◽

Cited By ~ 1

Author(s):

Mira Tschorn ◽

Nina Rieckmann ◽

Volker Arolt ◽

Katja Beer ◽

Wilhelm Haverkamp ◽

...

Keyword(s):

Depression Scale ◽

Composite International Diagnostic Interview ◽

Diagnostic Interview ◽

Patient Health Questionnaire ◽

Anxiety And Depression ◽

Depressive Störungen ◽

Health Questionnaire ◽

Hospital Anxiety ◽

Patient Health

Zusammenfassung Ziel Vergleich der Erkennungsgüte von drei Depressions-Screeninginstrumenten bei Patienten mit koronarer Herzerkrankung (KHK). Methodik 1019 KHK-Patienten erhielten den Patient Health Questionnaire (PHQ-9 und PHQ-2) und die Hospital Anxiety and Depression Scale (HADS-D) sowie ein klinisches Interview (Composite International Diagnostic Interview) als Referenzstandard. Ergebnisse Bezüglich der Erkennungsgüte waren PHQ-9 und HADS-D dem PHQ-2 überlegen. Optimale Cut-off-Werte waren 7 (PHQ-9 und HADS-D) und 2 (PHQ-2). Schlussfolgerung PHQ-9 und HADS-D haben eine vergleichbare Diskriminationsfähigkeit für depressive Störungen bei KHK-Patienten.

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Does Functional Somatic Symptoms Measurement Differ Across Sex and Age? Differential Item Functioning in Somatic Symptoms Measured With the CIDI

Assessment ◽

10.1177/10731911211017228 ◽

2021 ◽

pp. 107319112110172

Author(s):

Angélica Acevedo-Mesa ◽

Rei Monden ◽

Sebastian Castro-Alvarez ◽

Judith G. M. Rosmalen ◽

Annelieke M. Roest ◽

...

Keyword(s):

Differential Item Functioning ◽

Clinical Care ◽

Somatic Symptoms ◽

Composite International Diagnostic Interview ◽

Physical Symptoms ◽

Diagnostic Interview ◽

Future Research ◽

Assessment Instruments ◽

Item Functioning ◽

Sum Scores

Functional Somatic Symptoms (FSS) are physical symptoms that cannot be attributed to underlying pathology. Their severity is often measured with sum scores on questionnaires; however, this may not adequately reflect FSS severity in subgroups of patients. We aimed to identify the items of the somatization section of the Composite International Diagnostic Interview that best discriminate FSS severity levels, and to assess their functioning in sex and age subgroups. We applied the two-parameter logistic model to 19 items in a population-representative cohort of 962 participants. Subsequently, we examined differential item functioning (DIF). “Localized (muscle) weakness” was the most discriminative item of FSS severity. “Abdominal pain” consistently showed DIF by sex, with males reporting it at higher FSS severity. There was no consistent DIF by age, however, “Joint pain” showed poor discrimination of FSS severity in older adults. These findings could be helpful for the development of better assessment instruments for FSS, which can improve both future research and clinical care.

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Depression in the medically ill

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867419888576 ◽

2019 ◽

Vol 54 (4) ◽

pp. 346-366 ◽

Cited By ~ 2

Author(s):

Joshua D Rosenblat ◽

Paul Kurdyak ◽

Fiammetta Cosci ◽

Michael Berk ◽

Michael Maes ◽

...

Keyword(s):

Systematic Review ◽

Depressive Disorders ◽

Medical Condition ◽

Physical Symptoms ◽

Stepped Care ◽

Effect Sizes ◽

Medical Illness ◽

Medically Ill ◽

Psychotherapeutic Interventions ◽

Moderate Effect

Background: Depressive disorders are significantly more common in the medically ill compared to the general population. Depression is associated with worsening of physical symptoms, greater healthcare utilization and poorer treatment adherence. The present paper provides a critical review on the assessment and management of depression in the medically ill. Methods: Relevant articles pertaining to depression in the medically ill were identified, reviewed and synthesized qualitatively. A systematic review was not performed due to the large breadth of this topic, making a meaningful summary of all published and unpublished studies not feasible. Notable studies were reviewed and synthesized by a diverse set of experts to provide a balanced summary. Results: Depression is frequently under-recognized in medical settings. Differential diagnoses include delirium, personality disorders and depressive disorders secondary to substances, medications or another medical condition. Depressive symptoms in the context of an adjustment disorder should be initially managed by supportive psychological approaches. Once a mild to moderate major depressive episode is identified, a stepped care approach should be implemented, starting with general psychoeducation, psychosocial interventions and ongoing monitoring. For moderate to severe symptoms, or mild symptoms that are not responding to low-intensity interventions, the use of antidepressants or higher intensity psychotherapeutic interventions should be considered. Psychotherapeutic interventions have demonstrated benefits with small to moderate effect sizes. Antidepressant medications have also demonstrated benefits with moderate effect sizes; however, special caution is needed in evaluating side effects, drug–drug interactions as well as dose adjustments due to impairment in hepatic metabolism and/or renal clearance. Novel interventions for the treatment of depression and other illness-related psychological symptoms (e.g. death anxiety, loss of dignity) are under investigation. Limitations: Non-systematic review of the literature. Conclusion: Replicated evidence has demonstrated a bidirectional interaction between depression and medical illness. Screening and stepped care using pharmacological and non-pharmacological interventions is merited.

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Assessing Depression in Cardiac Patients: What Measures Should Be Considered?

Depression Research and Treatment ◽

10.1155/2014/148256 ◽

2014 ◽

Vol 2014 ◽

pp. 1-17 ◽

Cited By ~ 8

Author(s):

M. Ceccarini ◽

G. M. Manzoni ◽

G. Castelnuovo

Keyword(s):

Rating Scale ◽

Depressive Symptomatology ◽

Depression Scale ◽

Composite International Diagnostic Interview ◽

Diagnostic Interview ◽

Cardiac Patients ◽

Cardiac Events ◽

Premature Deaths ◽

Cardiac Symptoms ◽

Hospitalised Patients

It is highly recommended to promptly assess depression in heart disease patients as it represents a crucial risk factor which may result in premature deaths following acute cardiac events and a more severe psychopathology, even in cases of subsequent nonfatal cardiac events. Patients and professionals often underestimate or misjudge depressive symptomatology as cardiac symptoms; hence, quick, reliable, and early mood changes assessments are warranted. Failing to detect depressive signals may have detrimental effects on these patients’ wellbeing and full recovery. Choosing gold-standard depression investigations in cardiac patients that fit a hospitalised cardiac setting well is fundamental. This paper will examine eight well established tools following Italian and international guidelines on mood disorders diagnosis in cardiac patients: the Hospital Anxiety and Depression Scale (HADS), the Cognitive Behavioural Assessment Hospital Form (CBA-H), the Beck Depression Inventory (BDI), the two and nine-item Patient Health Questionnaire (PHQ-2, PHQ-9), the Depression Interview and Structured Hamilton (DISH), the Hamilton Rating Scale for Depression (HAM-D/HRSD), and the Composite International Diagnostic Interview (CIDI). Though their strengths and weaknesses may appear to be homogeneous, the BDI-II and the PHQ are more efficient towards an early depression assessment within cardiac hospitalised patients.

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A Brief Depression Scale for Use in the Medically Ill

The International Journal of Psychiatry in Medicine ◽

10.2190/m1f5-f40p-c4kd-ypa3 ◽

1992 ◽

Vol 22 (2) ◽

pp. 183-195 ◽

Cited By ~ 68

Author(s):

HArold G. Koenig ◽

Harvey J. Cohen ◽

Dan G. Blazer ◽

Keith G. Meador ◽

Ron Westlund

Keyword(s):

Geriatric Depression Scale ◽

Depression Scale ◽

Medical Illness ◽

Psychiatric Interview ◽

Medically Ill ◽

Medical Inpatients ◽

Practical Tool ◽

Zung Depression Scale ◽

Depression Scales ◽

Item Scale

Objective: Using items from two existing depression scales, we have sought to develop a brief self-rated instrument for detecting major depressive disorder (M.D.D.) in medically ill, hospitalized patients. Method: Forty-two items from the Geriatric Depression Scale (G.D.S.) and Carroll Depression Scale were administered to 559 men under age 40 or over age 70 consecutively admitted to the hospital. Eighty-two M.D.D.'s were diagnosed in this group by structured psychiatric interview. After eliminating 12 items confounded by medical illness, 11 items were selected using regression analysis, correlation with the total score, and factor analysis. The 11-item scale includes an assessment of the five DSM-III-R criteria for M.D.D. which are least confounded by medical illness (mood, suicidal intent, guilt or worthlessness, concentration, and psychomotor agitation). The scale was then tested in 78 medical inpatients who were later assessed for M.D.D. using a structured psychiatric interview. Results: Ten out of twelve M.D.D.'s were identified (83% sensitivity) and depression excluded in 51 of 66 non-depressed subjects (77% specificity) (compared with 82% sensitivity and 76% specificity for the 30-item G.D.S.). Scores on the 11-item scale were also correlated with the G.D.S. (.92), the Zung Depression Scale (.58), and the C.E.S.-D (.67). Conclusion: The 11-item scale is a practical tool for clinicians who screen patients for depression and for investigators who need a brief measure of depression in studies involving medical inpatients.

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Psychiatric disorders in relation to medical illness among patients of a general medical out-patient clinic

Psychological Medicine ◽

10.1017/s0033291700038952 ◽

1993 ◽

Vol 23 (1) ◽

pp. 167-173 ◽

Cited By ~ 92

Author(s):

Albert M. Van Hemert ◽

Michiel W. Hengeveld ◽

Jan H. Bolk ◽

Harry G. M. Rooijmans ◽

Jan P. Vandenbroucke

Keyword(s):

Psychiatric Disorders ◽

Clinical Care ◽

Physical Symptoms ◽

Somatization Disorder ◽

Medical Illness ◽

Psychiatric Interview ◽

Medically Ill ◽

General Internal ◽

Medical Diagnostic ◽

Unexplained Symptoms

SynopsisIn many patients clinical care in general medical settings is complicated by the presence of psychiatric disorders in addition to the presenting physical symptoms. In the present study the prevalence and type of psychiatric disorders was assessed in relation to the medical diagnostic findings in a general internal medicine out-patient clinic. The Present State Examination, a standardized psychiatric interview, was used to detect psychiatric disorders in 191 newly referred patients. Psychiatric disorders were found to be particularly prevalent among patients with medically ill-explained or unexplained symptoms. The prevalence of psychiatric disorders was 15% for patients with a medical explanation for their presenting symptom, 45% for patients with ill-explained and 38% for those with unexplained symptoms. Approximately 40% of the patients with psychiatric disorders met DSM-III-R criteria for somatization disorder or hypochondriasis, suggesting that these disorders contributed in particular to general medical out-patient referrals.

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The Depression Scale as a screening instrument for a subsequent depressive episode in primary healthcare patients

The British Journal of Psychiatry ◽

10.1192/bjp.bp.106.024752 ◽

2007 ◽

Vol 191 (1) ◽

pp. 50-54 ◽

Cited By ~ 14

Author(s):

Outi Poutanen ◽

Anna-Maija Koivisto ◽

Matti Joukamaa ◽

Aino Mattila ◽

Raimo K. R. Salokangas

Keyword(s):

Primary Care ◽

Primary Healthcare ◽

Depressive Episode ◽

Short Form ◽

Depression Scale ◽

Composite International Diagnostic Interview ◽

Screening Instrument ◽

Diagnostic Interview ◽

Scale Scores

BackgroundThere are numerous instruments for screening for depression. A feasible screen is good at both recognising and predicting depression.AimsTo study the ability of the Depression Scale and its items to recognise and predict a depressive episode.MethodA sample of patients attending primary care was examined in 1991–1992 and again 7 years later. The accuracy of the Depression Scale at baseline and at follow-up was tested against the Short Form of the Composite International Diagnostic Interview (CIDI-SF) diagnosis of depression at follow-up. The sensitivity and specificity of the Depression Scale and its items were assessed.ResultsBoth baseline and follow-up Depression Scale scores were consistent with the CIDI–SF diagnoses. It was possible to find single items efficient at both recognising and predicting depression.ConclusionsThe Depression Scale is a useful screening instrument for depression, with both diagnostic and predictive validity.

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Does Functional Somatic Symptoms measurement differ across Sex and Age? Differential Item Functioning in Somatic Symptoms measured with the CIDI

10.31234/osf.io/ks7fu ◽

2021 ◽

Author(s):

Angélica Acevedo-Mesa ◽

Rei Monden ◽

Sebastian Castro-Alvarez ◽

Judith Rosmalen ◽

Annelieke Roest ◽

...

Keyword(s):

Differential Item Functioning ◽

Somatic Symptoms ◽

Composite International Diagnostic Interview ◽

Physical Symptoms ◽

Diagnostic Interview ◽

Item Functioning ◽

Stage Disease ◽

Sum Scores ◽

Disease Study ◽

End Stage

Functional Somatic Symptoms (FSS) are physical symptoms that cannot be attributed to underlying pathology. Their severity is often measured with sum-scores on questionnaires; however, this may not adequately reflect FSS severity in subgroups of patients. We aimed to identify the items of the somatization section of the Composite International Diagnostic Interview that best discriminate FSS severity levels, and to assess their functioning in sex and age subgroups. We applied the Two Parameter Logistic Model to 19 items in a sample of 962 participants from the Prevention of Renal and Vascular End Stage Disease study. Subsequently, we examined Differential Item Functioning (DIF). “Localized (muscle) weakness” was the most discriminative item of FSS severity. “Abdominal pain” consistently showed DIF by sex, with males reporting it at higher FSS severity. There was no consistent DIF by age, however, “joint pain” showed poor discrimination of FSS severity in older adults. Clinicians and researchers could give differential attention to these symptoms when assessing FSS.

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