Using computerised adaptive tests to screen for perinatal depression in underserved women of colour

2021 ◽  
pp. ebmental-2021-300262
Author(s):  
Elizabeth Wenzel ◽  
Beatriz Penalver Bernabe ◽  
Shannon Dowty ◽  
Unnathi Nagelli ◽  
Lacey Pezley ◽  
...  
Keyword(s):  
Low Income ◽  
Perinatal Depression ◽  
Concordance Correlation ◽  
Adaptive Tests ◽  
Clinical Notes ◽  
Underserved Women ◽  
Pregnancy And Postpartum ◽  
Patient Health ◽  
Severity Of Depression ◽  
Perinatal Women

BackgroundCompared with traditional screening questionnaires, computerised adaptive tests for severity of depression (CAT-DI) and computerised adaptive diagnostic modules for depression (CAD-MDD) show improved precision in screening for major depressive disorder. CAT measures have been tailored to perinatal women but have not been studied in low-income women of colour despite high rates of perinatal depression (PND).ObjectiveThis study aimed to examine the concordance between CAT and traditional measures of depression in a sample of primarily low-income black and Latina women.MethodsIn total, 373 women (49% black; 29% Latina) completed the Patient Health Questionnaire-9 (PHQ-9), CAD-MDD and CAT-DI at 845 visits across pregnancy and postpartum. We examined the concordance between continuous CAT-DI and PHQ-9 scores and between binary measures of PND diagnosis on CAD-MDD and the PHQ-9 (cut-off score >10). We examined cases with a positive PND diagnosis on the CAD-MDD but not on the PHQ-9 (‘missed’ cases) to determine whether clinic notes were consistent with CAD-MDD results.FindingsCAT-DI and PHQ-9 scores were significantly associated (concordance correlation coefficient=0.67; 95% CI 0.58 to 0.74). CAD-MDD detected 5% more case of PND compared with PHQ-9 (p<0.001). The average per-visit rate of PND was 14.4% (14.5% in blacks, 14.9% in Latinas) on the CAD-MDD, and 9.5% (9.8% in blacks, 8.8% in Latinas) on the PHQ-9. Clinical notes were available on 60% of ‘missed’ cases and validated CAD-MDD PND diagnosis in 89% of cases.ConclusionsCAD-MDD detected 5% more cases of PND in women of colour compared with traditional tests, and the majority of these cases were verified by clinician notes.Clinical implicationsUse of CAT in routine clinic care may address health disparities in PND screening.

scholarly journals Validation and calibration of the patient health questionnaire (PHQ-9) in Argentina

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
María Urtasun ◽  
Federico Manuel Daray ◽  
Germán Leandro Teti ◽  
Fernando Coppolillo ◽  
Gabriela Herlax ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Convergent Validity ◽  
Patient Health Questionnaire ◽  
Receiver Operating Curve ◽  
Local Version ◽  
Health Questionnaire ◽  
Good Ability ◽  
Patient Health ◽  
Severity Of Depression ◽  
Degrees Of Severity

Abstract Background The Patient Health Questionnaire-9 (PHQ-9) is a brief tool to assess the presence and severity of depressive symptoms. This study aimed to validate and calibrate the PHQ-9 to determine appropriate cut-off points for different degrees of severity of depression in Argentina. Methods We conducted a cross-sectional study on an intentional sample of adult ambulatory care patients with different degrees of severity of depression. All patients who completed the PHQ-9 were further interviewed by a trained clinician with the Mini International Neuropsychiatric Interview (MINI) and the Beck Depression Inventory-II (BDI-II). Reliability and validity tests, including receiver operating curve analysis, were performed. Results One hundred sixty-nine patients were recruited with a mean age of 47.4 years (SD = 14.8), of whom 102 were females (60.4%). The local PHQ-9 had high internal consistency (Cronbach’s alpha = 0.87) and satisfactory convergent validity with the BDI-II scale [Pearson’s correlation = 0.88 (p < 0.01)]. For the diagnosis of Major Depressive Episode (MDE) according to the MINI, a PHQ-9 ≥ 8 was the optimal cut-off point found (sensitivity 88.2%, specificity 86.6%, PPV 90.91%). The local version of PHQ-9 showed good ability to discriminate among depression severity categories according to the BDI-II scale. The best cut off points were 6–8 for mild cases, 9–14 for moderate and 15 or more for severe depressive symptoms respectively. Conclusions The Argentine version of the PHQ-9 questionnaire has shown acceptable validity and reliability for both screening and severity assessment of depressive symptoms.

scholarly journals Feasibility of Utilizing Social Media to Promote HPV Self-Collected Sampling among Medically Underserved Women in a Rural Southern City in the United States (U.S.)

2021 ◽  
Vol 18 (20) ◽  
pp. 10820
Author(s):  
Matthew Asare ◽  
Beth A. Lanning ◽  
Sher Isada ◽  
Tiffany Rose ◽  
Hadii M. Mamudu
Keyword(s):  
Social Support ◽  
Social Media ◽  
Low Income ◽  
Pap Smear ◽  
Multinomial Logistic Regression ◽  
The United States ◽  
Medically Underserved ◽  
Willingness To Participate ◽  
Underserved Women ◽  
Support Cost

Background: Social media (Facebook, WhatsApp, Instagram, Twitter) as communication channels have great potential to deliver Human papillomavirus self-test (HPVST) intervention to medically underserved women (MUW) such as women of low income. However, little is known about MUW’s willingness to participate in HPVST intervention delivered through social media. We evaluated factors that contribute to MUW’s intention to participate in the social media-related intervention for HPVST. Methods: A 21-item survey was administered among women receiving food from a local food pantry in a U.S. southern state. Independent variables were social media usage facilitators (including confidentiality, social support, cost, and convenience), and barriers (including misinformation, time-consuming, inefficient, and privacy concerns). Dependent variables included the likelihood of participating in social-driven intervention for HPVST. Both variables were measured on a 5-point scale. We used multinomial logistic regression to analyze the data. Results: A total of 254 women (mean age 48.9 ± 10.7 years) comprising Whites (40%), Hispanics (29%), Blacks (27%), and Other (4%) participated in the study. We found that over 44% of the women were overdue for their pap smears for the past three years, 12% had never had a pap smear, and 34% were not sure if they had had a pap smear. Over 82% reported frequent social media (e.g., Facebook) usage, and 52% reported willingness to participate in social media-driven intervention for HPVST. Women who reported that social media provide privacy (Adjusted Odds Ratio (AOR) = 6.23, 95% CI: 3.56, 10.92), provide social support (AOR = 7.18, 95% CI: 4.03, 12.80), are less costly (AOR = 6.71, 95% CI: 3.80, 11.85), and are convenient (AOR = 6.17, 95% CI: 3.49, 10.92) had significantly increased odds of participating in social media intervention for HPVST. Conclusions: The findings underscore that the majority of the MUW are overdue for cervical cancer screening, regularly use social media, and are willing to participate in social media-driven intervention. Social media could be used to promote HPV self-testing among MUW.

Physical exercise programme during pregnancy decreases perinatal depression risk: a randomised controlled trial

2018 ◽  
Vol 53 (6) ◽  
pp. 348-353 ◽  
Author(s):  
Marina Vargas-Terrones ◽  
Ruben Barakat ◽  
Belen Santacruz ◽  
Irene Fernandez-Buhigas ◽  
Michelle F Mottola
Keyword(s):  
Perinatal Depression ◽  
Controlled Trial ◽  
Intervention Group ◽  
Depression Scale ◽  
Late Pregnancy ◽  
Perinatal Period ◽  
Exercise Programme ◽  
Epidemiological Studies ◽  
Intention To Treat ◽  
Pregnancy And Postpartum

IntroductionThe incidence of depression is high during the perinatal period. This mood disorder can have a significant impact on the mother, the child and the family.ObjectiveTo examine the effect of an exercise programme during pregnancy on the risk of perinatal depression.MethodsHealthy women who were <16 weeks pregnant were randomly assigned to two different groups. Women in the intervention group participated in a 60 min exercise programme throughout pregnancy, 3 days per week, which was conducted from October 2014 to December 2016. The Center for Epidemiological Studies-Depression Scale was used to measure the risk of depression at the beginning of the study (12–16 weeks), at gestational week 38 and at 6 weeks postpartum.ResultsOne hundred and twenty-four pregnant women were allocated to either the intervention (IG=70) or the control (CG=54) group. No differences were found in the percentage of depressed women at baseline (20% vs 18.5%) (χ2=0.043; p=0.836). A smaller percentage of depressed women were identified in the IG compared with the CG at 38 gestational weeks (18.6% vs 35.6%) (χ2=4.190; p=0.041) and at 6 weeks postpartum (14.5% vs 29.8%) (χ2=3.985; p=0.046) using the per-protocol analysis. No significant differences were found using the intention-to-treat analyses, except in the multiple imputation analysis at week 38 (18.6% vs 34.4%) (χ2=4.085; p=0.049).ConclusionAn exercise programme performed during pregnancy may reduce the prevalence of depression in late pregnancy and postpartum.Trial registration numberNCT02420288; Results.

Sharing clinical notes, and placebo and nocebo effects: Can documentation affect patient health?

2020 ◽  
pp. 135910532094858 ◽  
Author(s):  
Charlotte R Blease ◽  
Tom Delbanco ◽  
John Torous ◽  
Moa Ponten ◽  
Catherine M DesRoches ◽  
...  
Keyword(s):  
Health Effects ◽  
Health Records ◽  
Clinical Notes ◽  
Adverse Health Effects ◽  
Randomized Controlled ◽  
Patient Health ◽  
Clinician Experiences ◽  
Nocebo Effects ◽  
Trigger Mechanisms ◽  
Preliminary Support

This paper connects findings from the field of placebo studies with research into patients’ interactions with their clinician’s visit notes, housed in their electronic health records. We propose specific hypotheses about how features of clinicians’ written notes might trigger mechanisms of placebo and nocebo effects to elicit positive or adverse health effects among patients. Bridging placebo studies with (a) survey data assaying patient and clinician experiences with portals and (b) randomized controlled trials provides preliminary support for our hypotheses. We conclude with actionable proposals for testing our understanding of the health effects of access to visit notes.

scholarly journals Social Support—A Protective Factor for Depressed Perinatal Women?

2019 ◽  
Vol 16 (8) ◽  
pp. 1426 ◽  
Author(s):  
Jeannette Milgrom ◽  
Yafit Hirshler ◽  
John Reece ◽  
Charlene Holt ◽  
Alan W. Gemmill
Keyword(s):  
Social Support ◽  
Child Development ◽  
Protective Factor ◽  
Perinatal Depression ◽  
Psychological Treatment ◽  
Controlled Trial ◽  
Late Pregnancy ◽  
Antenatal Depression ◽  
Depression And Anxiety ◽  
Perinatal Women

Social support before and after childbirth is a possible protective factor for perinatal depression. Currently, there is a lack of longitudinal studies beyond the first year postpartum exploring the relationship of social support with depression and anxiety. Social support is also a possible protective factor for adverse child development, which is a known consequence of perinatal depression. The present study followed up a cohort of depressed women (n = 54) from a randomised controlled trial of psychological treatment for antenatal depression. We examined the trajectory of the relationships between perceived social support (Social Provisions Scale), depression (Beck Depression Inventory), and anxiety (Beck Anxiety Inventory) twice in pregnancy and twice postpartum up to two years. The influence of social support on child development and parenting-related stress was also explored. Two aspects of social support, Reassurance of Worth and Reliable Alliance, were strongly related to perinatal depression and anxiety, particularly when predicting symptoms in late pregnancy. However, the effect of postnatal depression on child development at 9 and 24 months post-birth was not mediated by social support. These results suggest the importance of adjusting current interventions for depressed perinatal women to focus on social support in late pregnancy and the first six months postpartum.

scholarly journals The Impact of the Revised WIC Food Package on Maternal Nutrition During Pregnancy and Postpartum

2019 ◽  
Vol 188 (8) ◽  
pp. 1493-1502 ◽  
Author(s):  
Rita Hamad ◽  
Akansha Batra ◽  
Deborah Karasek ◽  
Kaja Z LeWinn ◽  
Nicole R Bush ◽  
...  
Keyword(s):  
Low Income ◽  
Maternal Nutrition ◽  
Temporal Trends ◽  
Dietary Quality ◽  
Sensitivity Analyses ◽  
Control Group ◽  
Food Package ◽  
Pregnancy And Postpartum ◽  
Before And After ◽  
The Impact

Abstract The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritional support for pregnant and postpartum women and young children. The typical food package provided to recipient families was revised in October 2009 to include more whole grains, fruits, vegetables, and low-fat milk. Little is known about whether these revisions improved nutrition among women during this critical period of the life course. We conducted a quasiexperimental difference-in-differences analysis, comparing WIC recipients (“treatment” group) before and after the WIC policy change, while accounting for temporal trends among nonrecipients (“control” group). We examined nutritional outcomes among a cohort of 1,454 women recruited during pregnancy in 2006–2011 in Memphis and surrounding Shelby County, Tennessee. We found improvements in several measures of dietary quality and nutrient intake during pregnancy, although these did not persist into the postpartum period. Results were robust to numerous sensitivity analyses. At a time when federal WIC funding is threatened, this study provides some of the first evidence of the benefits of recent WIC revisions among low-income women.

Trajectory of mental health among low-income smokers across pregnancy and postpartum

2017 ◽  
Vol 171 ◽  
pp. e43
Author(s):  
Victoria H. Coleman-Cowger ◽  
Bartosz Koszowski ◽  
Mishka Terplan
Keyword(s):  
Mental Health ◽  
Low Income ◽  
Pregnancy And Postpartum

Prevalence of depression in Tunisian general population

2017 ◽  
Vol 41 (S1) ◽  
pp. S523-S523
Author(s):  
H. Belhadj ◽  
R. Jomli
Keyword(s):  
General Population ◽  
World Health ◽  
Cross Sectional ◽  
Gender Education ◽  
Prevalence Of Depression ◽  
Patient Health ◽  
Severity Of Depression ◽  
Competing Interest ◽  
Health Organization ◽  
Detection Of Depression

IntroductionDepression is a major burden for the health-care system worldwide.ObjectiveTo identify prevalence and severity of depression in Tunisian general population and define socoiodemographic characteristics of screened positive to depression participants.MethodWe undertook a cross-sectional and descriptive study. A total of 134 participants, representative of the Tunisian general population, were enrolled. Age, gender, and educational level were the major criteria for representativeness. Depression was assessed with the Patient Health Questionnaire (PHQ-9).ResultsThe cut-off score was 10. The prevalence of depression was 13.4%. There were no statistical difference in gender, education and age for the prevalence of depression.ConclusionThe World Health Organization ranks depression as the fourth leading cause of disability worldwide. Thus, the detection of depression and the dissemination of treatment in the general population are very important to reduce the burden of the disease.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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