The Utility of the Ces-D as a Depression Screening Measure among Low-Income Women Attending Primary Care Clinics

2001 ◽  
Vol 31 (1) ◽  
pp. 25-40 ◽  
Author(s):  
Janet L. Thomas ◽  
Glenn N. Jones ◽  
Isabel C. Scarinci ◽  
Daniel J. Mehan ◽  
Phillip J. Brantley
Keyword(s):  
Primary Care ◽  
Positive Predictive Value ◽  
Low Income ◽  
Predictive Value ◽  
Depression Screening ◽  
Care Practice ◽  
Primary Care Clinics ◽  
Medical Disorders ◽  
Cut Score ◽  
Low Income Women

Objective: Depressive disorders are among the most common medical disorders seen in primary care practice. The Center for Epidemiologic Studies-Depression (CES-D) scale is one of the measures commonly suggested for detecting depression in these clinics. However, to our knowledge, there have been no previous studies examining the validity of the CES-D among low-income women attending primary care clinics. Method: Low-income women attending public primary care clinics ( n = 179, ages 20–77) completed the CES-D and the Diagnostic Interview Schedule for the DSM-IV (DIS-IV). Results: The results supported the validity of the CES-D. The standard cut-score of 16 and above yielded a sensitivity of .95 and specificity of .70 in predicting Major Depressive Disorder (MDD). However, over two-thirds of those who screened positive did not meet criteria for MDD (positive predictive value = .28). The standard cut-score appears valid, but inefficient for depression screening in this population. An elevated cut-score of 34 yielded a higher specificity (.95) and over 50 percent of the patients who screened positive had a MDD (positive predictive value = .53), but at great cost to sensitivity (.45). Conclusion: Results indicated that the CES-D appears to be as valid for low-income, minority women as for any other demographic group examined in the literature. Despite similar validity, the CES-D appears to be inadequate for routine screening in this population. The positive predictive value remains very low no matter which cut-scores are used. The costs of the false positive rates could be prohibitive, especially in similar public primary care settings.

Factor Structure of the Center for Epidemiologic Studies Depression Scale in Low- Income Women Attending Primary Care Clinics

2004 ◽  
Vol 20 (2) ◽  
pp. 106-115 ◽  
Author(s):  
Janet L. Thomas ◽  
Phillip J. Brantley
Keyword(s):  
Primary Care ◽  
Factor Structure ◽  
Low Income ◽  
Factor Model ◽  
Population Sample ◽  
Depression Scale ◽  
Epidemiologic Studies ◽  
Primary Care Clinics ◽  
Primary Care Settings ◽  
Low Income Women

Given the high rates of major depressive disorder in primary care settings, routine use of screening measures to assist in identifying depressed individuals is warranted. The Center for Epidemiologic Studies Depression Scale (CES-D) ( Radloff, 1977 ) is a self-rated measure of distress commonly used to screen for depression in primary care settings. The present study was undertaken to confirm the original four-factor model in a sample of low-income women attending primary care clinics (N = 179). Although the original four-factor structure has been replicated in a variety of population groups, internal validity of the measure has not been previously examined in this population sample. A series of confirmatory factor analytic procedures failed to replicate the original four-factor structure or a second-order model. An exploratory analysis, using principal components and a VARIMAX rotation yielded three factors: Depressed Affect/Somatic Symptoms, Positive Affect, and Interpersonal Difficulties. Results of this study add support to previous research documenting an increased somatic presentation of depression in low-income samples. Implications for the use of the CES-D as a screening tool to identify depression in similar primary care samples are discussed.

Examination of the Temporal Relationship between Smoking and Major Depressive Disorder among Low-Income Women in Public Primary Care Clinics

2002 ◽  
Vol 16 (6) ◽  
pp. 323-330 ◽  
Author(s):  
Isabel C. Scarinci ◽  
Janet Thomas ◽  
Phillip J. Brantley ◽  
Glenn N. Jones
Keyword(s):  
Primary Care ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Low Income ◽  
Temporal Relationship ◽  
Smoking Initiation ◽  
First Episode ◽  
Major Depressive ◽  
Primary Care Clinics ◽  
Low Income Women

Purpose. To determine the prevalence of major depressive disorder (MDD) by smoking status, and the temporal relationship between smoking and MDD, and explore other smoking-related variables that may be associated with MDD. Design. Cross-sectional study. Setting. Public primary care clinics. Subjects. Researchers studied 338 women (76% African-Americans) who were randomly selected while attending appointments in two public primary care clinics. Measures. Data pertaining to smoking-related variables and MDD diagnosis were obtained using the Diagnostic Interview Schedule for the Diagnostic Statistical Manual of Mental Disorders IV (DSM-IV). Results. The prevalence of a lifetime history of MDD was significantly higher for current smokers (56.6%) than among former smokers (37.5%) or never-smokers (30.3%; p < .001). Most ever-smokers (81.3%) began smoking and were nicotine-dependent (63.6%) prior to their first episode of MDD. Using logistic regression, after controlling for demographic and smoking-related variables, age of smoking onset was the strongest variable associated with MDD among ever-smokers. Specifically, the odds of having an MDD decreased by 8.2% for each year delay in smoking initiation. Conclusion. These results suggest that smoking initiation precedes MDD and that smoking is associated with a high prevalence of MDD among low-income women attending primary care clinics. Further, the younger women start smoking the more likely they are to have MDD.

scholarly journals EVALUATING THE PREDICTIVE VALIDITY OF THE NIPISSING DISTRICT DEVELOPMENTAL SCREEN IN PRIMARY CARE SETTINGS AT THE 18-MONTH HEALTH SUPERVISION VISIT

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e37-e37
Author(s):  
Vinusha Gunaseelan ◽  
Patricia Parkin ◽  
Imaan Bayoumi ◽  
Patricia Jiang ◽  
Alexandra Medline ◽  
...  
Keyword(s):  
Primary Care ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Developmental Delay ◽  
Predictive Validity ◽  
Predictive Value ◽  
Screening Tools ◽  
Developmental Screening ◽  
Research Personnel ◽  
Health Supervision

Abstract BACKGROUND The Canadian Paediatric Society (CPS) recommends that every Canadian physician caring for young children provide an enhanced 18-month well-baby visit including the use of a developmental screening tool, such as the Nipissing District Developmental Screen (NDDS). The Province of Ontario implemented an enhanced 18-month well-baby visit specifically emphasizing the NDDS, which is now widely used in Ontario primary care. However, the diagnostic accuracy of the NDDS in identifying early developmental delays in real-world clinical settings is unknown. OBJECTIVES To assess the predictive validity of the NDDS in primary care for identifying developmental delay and prompting a specialist referral at the 18-month health supervision visit. DESIGN/METHODS This was a prospective longitudinal cohort study enrolling healthy children from primary care practices. Parents completed the 18-month NDDS during their child’s scheduled health supervision visit between January 2012 and February 2015. Using a standardized data collection form, research personnel abstracted data from the child’s health records regarding the child’s developmental outcomes following the 18-month assessment. Data collected included confirmed diagnoses of a development delay, specialist referrals, family history, and interventions. Research personnel were blind to the results of the NDDS. We assessed the diagnostic test properties of the NDDS with a confirmed diagnosis of developmental delay as the criterion measure. The specificity, sensitivity, positive predictive value, and negative predictive value were calculated, with 95% confidence intervals. RESULTS We included 255 children with a mean age of 18.5 months (range, 17.5–20.6) and 139 (55%) were male. 102 (40%) screened positive (1+ flag result on their NDDS). A total of 48 (19%) children were referred, and 23 (9%) had a confirmed diagnosis of a developmental delay (speech and language: 14; gross motor: 4; autism spectrum disorder: 3; global developmental delay: 1; developmental delay: 1). The sensitivity was 74% (95% CI: 52–90%), specificity was 63% (95% CI: 57–70%), positive predictive value was 17% (95% CI:10–25%), and the negative predictive value was 96% (95% CI: 92–99%). CONCLUSION For developmental screening tools, sensitivity between 70%-80% and specificity of 80% have been suggested. The NDDS has moderate sensitivity and specificity in identifying developmental delay at the 18-month health supervision visit. The 1+NDDS flag cut-point may lead to overdiagnosis with more children with typical development being referred, leading to longer wait times for specialist referrals among children in need. Future work includes investigating the diagnostic accuracy of combining the NDDS with other screening tools.

scholarly journals The Utility of the King-Devick Test in Evaluating Professional Ice Hockey Players with Suspected Concussion

2019 ◽  
Vol 34 (5) ◽  
pp. 781-781
Author(s):  
R J Echemendia ◽  
J M Bruce ◽  
J Thelen ◽  
P Comper ◽  
M Hutchison ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Rugby Union ◽  
Ice Hockey ◽  
Diagnostic Utility ◽  
Predictive Values ◽  
Cut Score ◽  
Hockey Players ◽  
Active Controls ◽  
Number Naming

Abstract Purpose The King-Devick (KD) is a measure of rapid number naming used in the evaluation of sports-related concussion (SRC). Recent data from the Canadian Football League and Rugby Union suggest that the KD should not be used as a stand-alone measure of SRC. The purpose of this study was to examine the diagnostic utility of the KD in professional ice hockey players. Methods NHL players who were suspected of having a concussion were evaluated with the KD and either the SCAT3 or the SCAT5. Players who were evaluated and not diagnosed with concussion served as Active controls. A small group of non-Active control players was also tested twice and was included in the present study for comparison. Results 1605 players were evaluated with the KD at baseline. Of these, 53 were diagnosed with concussion, 76 were Active controls, and 11 were non-Active controls. Concussed players revealed a decline in performance from baseline to acute evaluation, t(52)=3.05, p<.01, d=.42 while Active controls significantly improved, t(75)=2.05, p<.05, d=.24. No significant change between baseline and acute testing was observed for non-Active controls. Using a cut score of any decline in performance from baseline to suspected injury evaluation yielded Sensitivity=64%, Specificity=61%, Positive Predictive Value=53% and Negative Predictive Value=71%. Conclusion Our data are consistent with previous studies suggesting that while the KD is useful in differentiating concussed and not concussed athletes acutely, the relatively low predictive values indicate that a decline in KD performance should not be used as a standalone measure to diagnose concussion.

scholarly journals Longitudinal, multidisciplinary, resident-driven intervention to increase immunisation rates for Medicaid, low-income and uninsured patients

2020 ◽  
Vol 9 (4) ◽  
pp. e000986
Author(s):  
Cynthia Cantu ◽  
Kristopher Koch ◽  
Ramon S Cancino
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Primary Care Practice ◽  
Care Practice ◽  
Waiting Room ◽  
Improvement Project ◽  
Vaccination Rates ◽  
Initial Intervention ◽  
Risk Patients ◽  
Academic Primary Care

IntroductionMore payers are closely linking reimbursement to high-value care outcomes such as immunisation rates. Despite this, there remain high rates of pneumonia and influenza-related hospitalisations generating hospital expenditures as high as $11 000 per hospitalisation. Vaccinating the public is an integral part of preventing poor health and utilisation outcomes and is particularly relevant to high-risk patients. As part of a multidisciplinary effort between family and internal medicine residency programmes, our goal was to improve vaccination rates to an average of 76% of eligible Medicaid, low-income and uninsured (MLIU) patients at an academic primary care practice.MethodsThe quality improvement project was completed over 3 months by three primary care resident groups. The setting was a suburban academic primary care practice and eligible patients were 18 years of age or older. Our aim was to increase immunisation rates of pneumococcal, influenza, varicella, herpes zoster virus and tetanus and diphtheria vaccination. There were 1690 patients eligible for the vaccination composite metric. Data were derived from the electronic health record and administrative data.InterventionsCohort 1 developed an initial intervention that consisted of a vaccine questionnaire for patients to complete while in the waiting room. Cohort 2 modified questionnaire after reviewing results from initial intervention. Cohort 3 recommended elimination of questionnaire and implementation of a bundled intervention approach.ResultsThere were minimal improvements in patient immunisation rates after using a patient-directed paper questionnaire. After implementation of multiple interventions via an improvement bundle, there were improvements in immunisation rates which were sustained and the result of special cause variation.ConclusionA key to improving immunisation rates for MLIU patients in this clinic was developing relationships with faculty and staff stakeholders. We received feedback from all the medical staff and then applied it to the interventions and made an impact in the average of vaccinations.

scholarly journals Maintaining public health insurance benefits: How primary care clinics help keep low-income patients insured

2017 ◽  
Vol 4 (3) ◽  
pp. 61-69 ◽  
Author(s):  
Rose L Harding ◽  
Jennifer D Hall ◽  
Jennifer DeVoe ◽  
Heather Angier ◽  
Rachel Gold ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Health Insurance ◽  
Low Income ◽  
Public Health Insurance ◽  
Insurance Benefits ◽  
Primary Care Clinics

scholarly journals Three Questions to Screen your Patients for Chemical, Food, and Drug Intolerances the Brief Environmental Exposure and Sensitivity Inventory (BREESI)

2020 ◽  
Author(s):  
Raymond F Palmer ◽  
Carlos Roberto Jaén ◽  
Roger B. Perales ◽  
Rodolfo Rincon ◽  
Jacqueline Viramontes ◽  
...  
Keyword(s):  
Primary Care ◽  
Positive Predictive Value ◽  
Environmental Exposure ◽  
Health Care Professionals ◽  
Predictive Value ◽  
Primary Care Clinic ◽  
Diagnostic Tools ◽  
Care Clinic ◽  
Predictive Values ◽  
Chemical Intolerance

Abstract Background: The 50-item Quick Environmental Exposure and Sensitivity Inventory (QEESI) is a validated questionnaire used worldwide to assess intolerances to chemicals, foods, and/or drugs and has become the gold standard for assessing chemical intolerance (CI). Despite a reported prevalence of 8-33%, CI often goes undiagnosed in epidemiological studies and routine primary care. To enhance the QEESI’s utility, we developed the Brief Environmental Exposure and Sensitivity Inventory (BREESI) as a 3-item CI screening instrument. We tested the BREESI’s potential to predict whether an individual is likely to respond adversely to structurally unrelated chemicals, foods, and drugs. Methods: We recruited 286 adult participants from a university-based primary care clinic and through online participation. The positive and negative predictive values of the BREESI items were calculated against the full QEESI scores. Results: 90% of participants answering “yes” to all three items on the BREESI were classified as very suggestive of CI based upon the QEESI chemical intolerance and symptom scores both ≥ 40 (positive predictive value = 90%). For participants endorsing two items, 92% were classified as either very suggestive (39%) or Suggestive (53%) of CI (positive predictive value = 87%). Of those endorsing only one item, only 13% were found to be very suggestive of CI. However, 70% were classified as Suggestive. Of those answering “No” to all of the BREESI items, 99% were classified as not suggestive of CI (i.e., negative predictive value = 99%). Conclusions: The BREESI is a versatile screening tool for rapidly determining potential CI, with clinical and epidemiological applications. Together, the validated BREESI and QEESI provide much needed diagnostic tools that will help inform treatment protocols and teach health care professionals about Toxicant Induced Loss of Tolerance – the mechanism driving CI.

scholarly journals Treatment of depression and PTSD in primary care clinics serving uninsured low-income mostly Latina/o immigrants: A naturalistic prospective evaluation.

2019 ◽  
Vol 25 (4) ◽  
pp. 579-589 ◽  
Author(s):  
Stacey Kaltman ◽  
Maria Rosa Watson ◽  
Marcela Campoli ◽  
Adriana Serrano ◽  
Nicholas Talisman ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Prospective Evaluation ◽  
Primary Care Clinics ◽  
Treatment Of Depression

Healthy Habits Questionnaire Feasibility and Utility for High-Risk Children

2020 ◽  
Vol 59 (11) ◽  
pp. 978-987
Author(s):  
Nadine L. Camp ◽  
Rebecca C. Robert ◽  
Katherine P. Kelly
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Primary Care Providers ◽  
Overweight And Obesity ◽  
Care Practice ◽  
Healthy Weight ◽  
Care Providers ◽  
Minority Children ◽  
Healthy Habits ◽  
Intervention Protocol

The American Academy of Pediatrics provides guidance for pediatric primary care providers to promote healthy weight during childhood. Screening questions on diet and activity habits can help provider assessment and assist counseling for targeted behavior change. We implemented the parent completed, 10-item 5210 Healthy Habits Questionnaire (Ages 2-9 year) in our primary care practice serving low-income minority children with high rates of overweight and obesity. Adherence to the intervention protocol was high, and providers found the content and method of assessment useful for their counseling of individual patients. The aggregate Healthy Habits Questionnaire data provided a snapshot of the health habits in our local clinic population of children, prompting greater awareness for providers and informing their patient care.

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