Screening for anxiety and depression after stroke: Comparison of the Hospital Anxiety and Depression Scale and the Montgomery and Åsberg Depression Rating Scale

Objective

Anxiety and depression after stroke are frequent, but are often overlooked and not assessed. The aims of the study were to (1) assess the prevalence of anxiety and depression and (2) compare the performance of the Hospital Anxiety and Depression Scale (HADS) and Montgomery and Åsberg Depression Rating Scale (MADRS) as screening instruments for anxiety and depression disorders 4 months after stroke.

Methods

Stroke patients, consecutively admitted to a stroke unit, were assessed with HADS and MADRS 4 months after stroke (n=104). Depression and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV (SCID). Measures were compared in terms of correlations, sensitivity, specificity, positive and negative predictive value, overall agreement, kappa, and ROC curves, using DSM-IV diagnoses of “at least one current significant anxiety disorder” (Anxiety) and “any current depression” (Depression), as the clinical criteria.

Results

Anxiety occurred in 23% of patients and Depression in 19% (13% major depression, 3% minor depression, 4% dysthymia). For Anxiety, the optimal screening cut-off was 4 for HADS-A and 6 for HADS-total; for Depression, optimal cut-offs were 4 for HADS-D, 11 for HADS-total, and 8 for MADRS. At cut-offs commonly used in clinical practice for depression screening (HADS-D: 8, MADRS: 12), the MADRS performed marginally better than the HADS.

Conclusion

Anxiety is as prevalent as depression 4 months after stroke. MADRS and HADS-D perform acceptably as screening instruments for depression, and HADS-A for anxiety after stroke. However, lower HADS cut-offs than recommended for the general population should be considered for stroke patients.     

Impact of axis-I comorbidity and suicidal behavior disorders on sensitivity and specificity of the Mood Disorder Questionnaire in complex depressed inpatients

Objective

This study assessed the psychometric performance of the Mood Disorder Questionnaire (MDQ) and its modified MDQ7 version, to screen for bipolar disorders (BD) in depressive inpatients according to depression severity, number of current axis I psychiatric comorbidities and suicidal behavior disorders.

Methods

Depressed adult inpatients (n = 195) were consecutively enrolled. Psychiatric diagnoses were made using the standardized DSM-IV-TR structured interview MINI 5.0.0 and medical case notes. Depression severity was assessed with the Beck Depression Inventory and the Hamilton Depression Scale. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each MDQ version were evaluated in the whole sample and according to depression severity, current axis I psychiatric comorbidities and suicidal behavior.

Results

The occurrence and the number of axis I disorders affected performance of both versions. Among depressed patients with two or more comorbidities, PPV and NPV of the MDQ were 65% and 80%, respectively, and they were respectively 56.2% and 87.9% with MDQ7.Current suicidal behavior disorders also dramatically reduced the PPV of MDQ (from 81.2% to 63.3%) and MDQ7 (from 72.2% to 52.6%) but the NPV remained above 80%.The performance of both versions of the MDQ tended to improve with the severity of depression.

Conclusion

The MDQ is not a suitable screening instrument to diagnose BD in subjects with a complex major depressive episode and/or a current history of suicidal behavior. Nevertheless MDQ particularly in its modified version may be useful for ruling out the presence of BD among these complex patients.     

The Distress Thermometer as an ultra-short screening tool: A first validation study for mixed-cancer outpatients in Singapore

Introduction

Research has shown that single-item tools, like the Distress Thermometer (DT), are comparable to longer ones, like the Hospital Anxiety and Depression Scale (HADS). In this study, we tested the validity of the DT in a population of Singapore cancer outpatients, and determined the cut-off scores on the DT for clinically relevant distress and an impaired quality of life (QOL). We also documented the prevalence of anxiety, depression, and QOL impairments in this population.

Methods

One hundred and five patients (Mdn age = 51–60 years, 64% female, and 71% Chinese) diagnosed with various cancers participated in this study. They completed a standard socio-demographic form, the DT and the Problem List, the HADS, and the EuroQOL Quality of Life Scale (EQ-5D).

Results

Almost a third of patients had clinically significant emotional distress, with 15%–16% having probable levels of anxiety and depression. Almost half (41%–55%) had an impaired QOL compared to Singapore population norms. Receiver operating characteristic curve analyses identified an area under the curve of 0.89 (SE = 0.36, 95% CI [0.82, 0.96], p < .001) when compared to the HADS cut-off score of 15. A cut-off score of 5 on the DT had the best sensitivity (0.88) and specificity (0.81). Participants above the DT cut-off score of 5 reported significantly more emotional problems (worry, nervousness, depression, sadness), insurance/finance-related problems, and sleep problems. They also scored significantly lower on EQ-5D, with more QOL impairments in the domains of carrying out their usual activities and anxiety/depression.

Conclusion

Levels of distress, anxiety, depression, and QOL impairments are high in this population. The DT was found to be a valid tool for distress screening in the Singapore cancer population, with a recommended cut-off score of 5.     

Screening for depression and anxiety disorders in primary care patients

Mood and anxiety disorders are highly prevalent in primary health care. In this study we assessed performance of the Hospital Anxiety and Depression Scale (HADS) for screening of depression and anxiety disorders in a population of primary care patients. A total of 503 primary care patients consecutively admitted to the primary care medical center in Kaunas, Lithuania, completed the study. We found that the HADS subscale of depression (HADS-D) at a cutoff score of 6 or more showed the best performance screening for a major depressive episode diagnosed by means of the Mini International Neuropsychiatric Interview (MINI), with a sensitivity of 80%, specificity of 69%, positive predictive value of 80%, negative predictive value of 92%, and area under the receiver operating characteristic (ROC) curve of 0.75. Performance of the HADS-D against MINI diagnosis of dysthymia was weak. The HADS subscale of anxiety (HADS-A) at a cutoff score of 9 or more showed the best performance screening for MINI diagnosis of overall anxiety disorders, with a sensitivity of 77%, specificity of 75%, positive predictive value of 53%, negative predictive value of 90%, and area under the ROC curve of 0.76. These results suggest that in primary care patients HADS is an adequate screening instrument for the MINI diagnoses of major depressive episode, but not for dysthymia at a cutoff score of 6, and for anxiety disorders at a cutoff score of 9.     

Short Form 36 and Hospital Anxiety and Depression Scale. A comparison based on patients with testicular cancer

BACKGROUND: The aim of this study was to compare the scorings of anxiety and depression assessed by the Hospital Anxiety and Depression Scale (HADS-A [Anxiety] and HADS-D [Depression]) with the scorings on the eight subscales of Short Form 36 (SF-36) and the Physical (PCS) and Mental Component Summary (MCS) assessed by the same patients. METHOD: In a cross-sectional study 736 long-term survivors after treatment for testicular cancer (TC) completed HADS and SF-36. Pearson's correlation coefficients were calculated on item and scale level to assess the associations between the HADS and the SF-36 scales and, in particular, between HADS and PCS and MCS, respectively. Independent predictors for PCS and MCS were identified by linear regression analysis. RESULTS: HADS-A and HADS-D were significantly associated with the SF-36 summary scales. HADS-A explained 5% of the variance of PCS and 49% of the variance of MCS. The comparable figures for HADS-D were 10% and 45%, respectively. In the multivariate analysis the HADS-D scoring independently predicted the level of PCS together with the patients' educational level, long-lasting working disability and age (variance: 30%). Both HADS-D and HADS-A remained independent parameters for MCS (variance: 58%) together with the patient's civil status. HADS-D item D4 ("slowed down") was similarly associated with both PCS and MCS. CONCLUSION: In univariate analyses HADS-D and HADS-A were statistically associated with PCS and MCS. The highest r values were observed for the associations between HADS and MCS, in particular between HADS-A and MCS. In the multivariate analyses HADS-D, but not HADS-A, contributed to PCS, whereas both HADS-A and HADS-D were associated with MCS. This pattern of different predictions of the summary scales of SF-36 supports a clinical practice that anxiety and depression should be assessed separately. Additional use of a self-rating instrument for depression and anxiety, such as HADS, is recommended when SF-36 is used for quality of life (QL) assessment.     

Revisiting the dimensionality of the Hospital Anxiety and Depression Scale in an international sample of patients with ischaemic heart disease

Objective

Recently controversy has surrounded the dimensionality of the Hospital Anxiety and Depression Scale (HADS). We assessed the dimensionality of the HADS in a large international sample of patients with ischaemic heart disease (IHD) using confirmatory factor analysis (CFA). The analysis of an international sample enabled the current study to broaden knowledge gained from existing studies with small, regional samples.

Methods

Data from the HeartQoL study of patients with IHD (n = 6241, 22 countries speaking 15 languages) were analyzed using CFA.

Results

CFA indicated a hierarchical bifactor solution, with mostly strong item loadings on a general factor (explaining 73% of the variance), and weak to very weak loadings on orthogonal depression (16%) and anxiety (11%) subscales. The bifactor model fits the data significantly better than both the original bidimensional model and Dunbar's higher-order three-factor model.

Conclusion

These results, from a large international sample of patients with IHD, suggest that the HADS scale is dominated by a single general distress factor. Although the best CFA model fit was a hierarchical bifactor solution, the subscales had weak item loadings, providing little psychometric evidence of the ability of the HADS to differentiate anxiety and depressive symptoms. It is argued that clinicians and researchers working with patients with IHD should abandon the HADS and use alternative measures of depression and anxiety.     

Screening for anxiety and depression in dialysis patients: comparison of the Hospital Anxiety and Depression Scale and the Beck Depression Inventory

ObjectiveAlthough anxiety and depression are frequent comorbid disorders in dialysis patients, they remain underrecognized and often untreated. The aim of the study was to evaluate the Hospital Anxiety and Depression Scale (HADS), the Beck Depression Inventory (BDI) and a truncated version of the BDI, the Cognitive Depression Index (CDI), as screening tools for anxiety and depression in dialysis patients.MethodsA total of 109 participants (69.7% males), from four dialysis centers, completed the self-report symptom scales HADS and BDI. Depression and anxiety disorders were diagnosed with the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). The sensitivity, specificity, positive and negative predictive value, overall agreement, kappa and receiver operating characteristic (ROC) curves were assessed.ResultsDepressive disorders were found in 22% of the patients based on the SCID-I, while anxiety disorders occurred in 17%. The optimal screening cut-off score for depression was ≥7 for the HADS depression subscale (HADS-D), ≥14 for the HADS-total, ≥11 for the CDI and ≥17 for the BDI. The optimal screening cut-off for anxiety was ≥6 for the HADS anxiety subscale (HADS-A) and ≥14 for the HADS-total. At cut-offs commonly used in clinical practice for depression screening (HADS-D: 8; BDI: 16), the BDI performed slightly better than HADS-D.ConclusionThe BDI, CDI and HADS demonstrated acceptable performance as screening tools for depression, as did the HADS-A for anxiety, in our sample of dialysis patients. The recommended cut-off scores for each instrument were: ≥17 for BDI, ≥11 for CDI, ≥7 for HADS depression subscale, ≥6 for HADS anxiety subscale and ≥14 for HADS total. The CDI did not perform better than the BDI in our study. Lower cut-off for the HADS-A than recommended in medically ill patients may be considered when screening for anxiety in dialysis patients.     

Characteristics associated with anxiety,depressive symptoms,and quality-of-life in a large cohort of implantable cardioverter defibrillator recipients

Objective

Although most patients with implantable cardioverter defibrillators (ICDs) adjust well, some have considerable psychological distress. Factors associated with psychological adjustment in ICD-recipients are still not well understood. Our purpose was to describe quality-of-life (QoL) and prevalence of self-reported symptoms of anxiety and depression in a large national cohort of ICD-recipients, and to determine socio-demographic, clinical, and ICD-related factors associated with these variables.

Methods

A cross-sectional, correlational design was used. All eligible adult ICD-recipients in the Swedish ICD- and Pacemaker Registry were invited to participate. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS), and QoL with the EuroQol-5D.

Results

A total of 3067 ICD-recipients (66 ± 11 years, 80% male) were included. The mean HADS score was 3.84 ± 3.70 for anxiety symptoms and 2.99 ± 3.01 for symptoms of depression. The mean EQ-5D index score was 0.82 ± 0.21. The probability of symptoms of anxiety and depression was associated with younger age, living alone, and a previous history of myocardial infarction or heart failure. Additionally, female ICD-recipients had a higher probability of symptoms of anxiety. A higher level of ICD-related concerns was most prominently related to symptoms of anxiety, depressive symptoms and poorer QoL, while number of shocks, ICD-indication and time since implantation were not independently related.

Conclusions

In this large cohort of ICD-recipients, the association of ICD-related concerns with symptoms of anxiety, depressive symptoms, and poor QoL suggests that ICD specific factors should be addressed in order to improve outcomes.     

Anxiety and depression in cancer patients: relation between the Hospital Anxiety and Depression Scale and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire

BACKGROUND: The emotional functioning (EF) dimension of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C33) and the Hospital Anxiety and Depression Scale (HADS) evaluate anxiety and depression. We wanted to compare cancer patients' responses to EF with those to HADS, as well as the impact of anxiety and depression on the quality of life (QL) dimensions of the EORTC QLQ C33. METHOD: A total of 568 cancer patients completed both the EORTC QLQ C33 and HADS at the same occasion. The association between the patients' EF scorings and their HADS scores was analyzed by multiple linear regression. Gender and age were included as covariates. RESULTS: Statistically significant negative relations were found between EF and HADS-A (anxiety), HADS-D (depression) and HADS-T (total score), respectively, with the highest correlation coefficient for HADS-A. Older patients and males reported less emotional distress assessed by the EF scale than younger ones and females with comparable HADS-T or HADS-D scores. Both HADS-A and HADS-D were significantly related to other QL dimensions, and depression was a stronger predictor for reduced QL than anxiety. CONCLUSION: The EF dimension of EORTC QLQ C33 predominantly assesses anxiety, whereas depression is rated to a lesser degree. Combined with significant age and gender relations, this implies a risk of underdiagnosed depression, if the EORTC QLQ C33 is used as the only instrument to screen for psychological distress in cancer patients. As depression has a stronger impact on global QL of cancer patients than anxiety, the use of an additional instrument is recommended for assessment of depression.     

The validity of the Hospital Anxiety and Depression Scale. An updated literature review

OBJECTIVE: To review the literature of the validity of the Hospital Anxiety and Depression Scale (HADS). METHOD: A review of the 747 identified papers that used HADS was performed to address the following questions: (I) How are the factor structure, discriminant validity and the internal consistency of HADS? (II) How does HADS perform as a case finder for anxiety disorders and depression? (III) How does HADS agree with other self-rating instruments used to rate anxiety and depression? RESULTS: Most factor analyses demonstrated a two-factor solution in good accordance with the HADS subscales for Anxiety (HADS-A) and Depression (HADS-D), respectively. The correlations between the two subscales varied from.40 to.74 (mean.56). Cronbach's alpha for HADS-A varied from.68 to.93 (mean.83) and for HADS-D from.67 to.90 (mean.82). In most studies an optimal balance between sensitivity and specificity was achieved when caseness was defined by a score of 8 or above on both HADS-A and HADS-D. The sensitivity and specificity for both HADS-A and HADS-D of approximately 0.80 were very similar to the sensitivity and specificity achieved by the General Health Questionnaire (GHQ). Correlations between HADS and other commonly used questionnaires were in the range.49 to.83. CONCLUSIONS: HADS was found to perform well in assessing the symptom severity and caseness of anxiety disorders and depression in both somatic, psychiatric and primary care patients and in the general population.     

Depression,not anxiety,is independently associated with 5-year hospitalizations and mortality in patients with ischemic heart disease

Objective

The objective of the current study was to examine whether depression and anxiety are independently associated with 5-year cardiac-related hospitalizations and all-cause mortality in patients with ischemic heart disease (IHD).

Methods

Patients treated for MI, angina, or ischemic heart failure (N = 610) were recruited from Holbæk Hospital, Denmark. All patients completed the Hospital Anxiety and Depression Scale (HADS) in December 2005. Data regarding patient characteristics at baseline, and hospitalizations and deaths during follow-up were collected from Danish population-based registers. Cox and negative binomial regression analyses were performed to examine the relationship between depression, anxiety and the endpoints.

Results

At baseline, 71 (11.6%) patients reported depression and 120 (19.7%) reported anxiety. Models including both depression and anxiety showed that depression was independently associated with time to first cardiac-related hospitalization, cumulative number and length of cardiac-related hospitalizations, and all-cause mortality, while anxiety was only associated with the total length of hospitalizations (all p-values < .05). After adding sociodemographic and clinical factors, depression remained associated with the number (incidence rate ratio (IRR) = 2.00, 95% confidence interval (CI): 1.44–2.77) and length of cardiac-related hospitalizations (IRR = 3.69, 95% CI: 2.75–4.96), and all-cause mortality (hazard ratio (HR) = 2.12, 95% CI: 1.13–3.96). The associations between depression and time to first hospitalization and between anxiety and length of stay were eliminated.

Conclusions

The current study showed that depression, and not anxiety, is associated with the number and length of cardiac-related hospitalizations and all-cause mortality in IHD patients, independent of traditional risk factors. In order to improve health outcomes, better awareness and treatment of depression in IHD patients are crucial.     

Determinants of quality of life in the acute stage following stroke

Objective

This study aimed to investigate the factors influence the quality of life (QOL) of survivors of an acute stroke.

Methods

For 422 stroke patients, assessments were made within two weeks of the index event. QOL was measured using the World Health Organization Quality of Life-Abbreviated form (WHOQOL-BREF), which has four domains related to physical factors, psychological factors, social relationships, and environmental context. Associations of each four WHOQOL-BREF domain score with socio-demographic characteristics (age, sex, education, marital status, religion, and occupation), stroke severity (National Institutes of Health Stroke Scale), physical disability (Barthel Index), cognitive function (Mini-Mental Status Examination: MMSE), grip strength, and psychological distress (Hospital Anxiety and Depression Scale depression and anxiety subscale: HADS-D and HADS-A) were investigated using the linear regression models.

Results

Higher physical domain scores were independently associated with higher MMSE scores, stronger hand-grip strength, and lower HADS-D and HADS-A scores; higher psychological domain scores were independently associated with higher educational level, higher MMSE scores, and lower HADS-D and HADS-A scores; higher social relationships domain scores were independently associated with lower HADS-D and HADS-A scores; and higher environmental domain scores were independently associated with higher educational level, higher MMSE scores, and lower HADS-D scores.

Conclusion

Psychological distress and impaired cognitive function were independently associated with lower QOL in patients with acute stroke. However, stroke severity, physical disability and other socio-demographic factors were less significantly associated with QOL. These findings underscore the importance of psychological interventions for improving QOL during the acute phase following stroke.     

Comparison of the Hospital Anxiety and Depression Scale and the Center for Epidemiological Studies Depression Scale for detecting depression in women with breast or gynecologic cancer

Objective

Depression is common in cancer patients but frequently undetected. Consensus regarding validity and optimal thresholds of screening measures is lacking. We investigated the validity of the Hospital Anxiety and Depression Scale (HADS-D) and Center for Epidemiological Studies Depression Scale (CES-D) relative to a referent diagnostic standard in women with breast or gynecologic cancer.

Method

Participants were 100 patients who completed the CES-D and HADS-D within a larger study. The Mini International Neuropsychiatric Interview was the criterion standard. Sensitivity, specificity, predictive values and likelihood ratios for various thresholds were calculated using receiver operating characteristics. Participants were assigned to two diagnostic groups: ‘major depressive disorder’ or ‘any depressive disorder’.

Results

Separate analyses were conducted whereby participants found to be receiving depression/anxiety treatment at the time of validation (n= 28) were excluded. Both measures had good internal consistency and criterion validity. There were no statistical differences in global accuracy between the measures for detecting either group. For optimal sensitivity and specificity in both groups, generally recommended thresholds were lowered for the HADS-D. For the CES-D, the threshold was lowered for ‘any depressive disorder’ and raised for ‘major depressive disorder’. Negative predictive values associated with our recommended cutoffs were excellent, but positive predictive values were poor.

Conclusions

The HADS-D and CES-D have acceptable properties and are equivalent for detecting depression in this population. Depending on the purpose of screening, the CES-D may be more suitable for identifying major depression. Threshold choice may have serious implications for screening program effectiveness, and the use of generally recommended thresholds should be cautious.     

Diagnostic accuracy of self-rating scales for screening of depression in coronary artery disease patients

ObjectiveWe evaluated the internal consistency and psychometric properties of the Hospital Anxiety and Depression Scale (HADS) and the Beck Depression Inventory-II (BDI-II) for screening of major depressive episodes (MDE) in coronary artery disease (CAD) patients undergoing rehabilitation.MethodsFive-hundred and twenty-two consecutive CAD patients (72% men; mean age 58 ± 9 years) attending a rehabilitation program 2 weeks after inpatient treatment for acute ischemic cardiac events completed the HADS depression subscale (HADS-D), HADS anxiety subscale (HADS-A) and the BDI-II. Interview outcome using the Mini International Neuropsychiatric Interview (MINI) for current MDE according to the DSM-IV-TR criteria was considered as the gold standard.ResultsFifty-six (11%) patients had a current MDE. The HADS-D, HADS-A, HADS-total and BDI-II had high internal consistency. Area under the ROC curve was the highest for the BDI-II followed by the HADS. Optimal cut-off values for screening of MDE were ≥ 5 for the HADS-D, ≥ 8 for the HADS-A and ≥ 14 for the HADS-total and for the BDI-II. At optimal cut-off values the BDI-II had slightly superior psychometric properties when compared to the HADS. However, positive predictive values were low for the HADS and for the BDI-II.ConclusionsIn CAD patients undergoing rehabilitation, the HADS and BDI-II had high internal consistency. Screening for MDE at optimal cut-off values the BDI-II was slightly superior when compared to the HADS. Positive predictive values for the BDI-II and for the HADS were low indicating that a large proportion of patients with positive screening results did not meet criteria for MDE.     

Mediterranean diet is associated on symptoms of depression and anxiety in patients with bronchiectasis

Background

The aim was to measure symptoms of depression and anxiety in patients with bronchiectasis and evaluate their relationship with a Mediterranean diet.

Methods

This cross-sectional study recruited patients with bronchiectasis at four Spanish centers. Patients completed the hospital anxiety and depression scale (HADS) and the Mediterranean diet questionnaire (PREDIMED). Demographic, health and outcome data were recorded from medical charts. Logistic regression was used to determine the predictors of elevated symptoms of depression and anxiety (HADS≥11).

Results

Of the 205 participants recruited, 37 (18.0%) had elevated anxiety-related scores and 26 (12.7%) had elevated depression-related scores (HADS≥11). Increased symptoms of depression were significantly associated with being unemployed, a lower education, older age, comorbidity, major dyspnea, worse quality of life (QOL) and a lower PREDIMED score. Increased symptoms of anxiety were significantly associated with more exacerbations, worse QOL and a lower PREDIMED score. Regression analyses indicated that, after adjustment, QOL and the PREDIMED score predicted elevated symptoms of depression and QOL predicted elevated symptoms of anxiety.

Conclusions

The prevalence of elevated symptoms of depression and anxiety is high in patients with bronchiectasis and greater adherence to a Mediterranean diet is associated with a lower likelihood of having these symptoms, particularly for depression.     

Assessment of the performances of AcuStar HIT and the combination with heparin-induced multiple electrode aggregometry: A retrospective study

Background

Early diagnosis of immune heparin-induced thrombocytopenia (HIT) is challenging. HemosIL® AcuStar HIT and heparin-induced multiple electrode aggregometry (HIMEA) were recently proposed as rapid diagnostic methods.

Objectives

We conducted a study to assess performances of AcuStar HIT-IgG (PF4-H) and AcuStar HIT-Ab (PF4-H). The secondary objective was to compare the performances of the combination of Acustar HIT and HIMEA with standardised clinical diagnosis.

Methods

Sera of 104 suspected HIT patients were retrospectively tested with AcuStar HIT. HIMEA was performed on available sera (n = 81). The clinical diagnosis was established by analysing in a standardized manner the patient’s medical records. These tests were also compared with PF4-Enhanced®, LTA, and SRA in subsets of patients. Thresholds were determined using ROC curve analysis with clinical outcome as reference.

Results

Using the recommended thresholds (1.00 AU), the negative predictive value (NPV) of HIT-IgG and HIT-Ab were 100.0% (95% CI: 95.9%-100.0% and 95.7%-100.0%). The positive predictive value (PPV) were 64.3% (95% CI: 35.1%-87.2.2%) and 45.0% (95% CI: 23.2%-68.6%), respectively. Using our thresholds (HIT-IgG: 2.89 AU, HIT-Ab: 9.41 AU), NPV of HIT-IgG and HIT-Ab were 100.0% (95% CI: 96.0%-100.0% and 96.1%-100.0%). PPV were 75.0% (95% CI: 42.7%-94.5%) and 81.8% (95% CI: 48.3%-97.7%), respectively. Of the 79 patients with a medium-high pretest probability score, 67 were negative using HIT-IgG (PF4-H) test at our thresholds. HIMEA was performed on HIT-IgG positive patients. Using this combination, only one patient on 79 was incorrectly diagnosed.

Conclusion

Acustar HIT showed good performances to exclude the diagnosis of HIT. Combination with HIMEA improves PPV.     

Adaptive screening for depression — Recalibration of an item bank for the assessment of depression in persons with mental and somatic diseases and evaluation in a simulated computer-adaptive test environment

Objective

This study conducted a simulation study for computer-adaptive testing based on the Aachen Depression Item Bank (ADIB), which was developed for the assessment of depression in persons with somatic diseases. Prior to computer-adaptive test simulation, the ADIB was newly calibrated.

Methods

Recalibration was performed in a sample of 161 patients treated for a depressive syndrome, 103 patients from cardiology, and 103 patients from otorhinolaryngology (mean age 44.1, SD = 14.0; 44.7% female) and was cross-validated in a sample of 117 patients undergoing rehabilitation for cardiac diseases (mean age 58.4, SD = 10.5; 24.8% women). Unidimensionality of the itembank was checked and a Rasch analysis was performed that evaluated local dependency (LD), differential item functioning (DIF), item fit and reliability. CAT-simulation was conducted with the total sample and additional simulated data.

Results

Recalibration resulted in a strictly unidimensional item bank with 36 items, showing good Rasch model fit (item fit residuals < |2.5|) and no DIF or LD. CAT simulation revealed that 13 items on average were necessary to estimate depression in the range of − 2 and + 2 logits when terminating at SE ≤ 0.32 and 4 items if using SE ≤ 0.50. Receiver Operating Characteristics analysis showed that θ estimates based on the CAT algorithm have good criterion validity with regard to depression diagnoses (Area Under the Curve ≥ .78 for all cut-off criteria).

Conclusion

The recalibration of the ADIB succeeded and the simulation studies conducted suggest that it has good screening performance in the samples investigated and that it may reasonably add to the improvement of depression assessment.     

Mindfulness-based cognitive therapy for people with diabetes and emotional problems: Long-term follow-up findings from the DiaMind randomized controlled trial

Objective

The DiaMind trial showed beneficial immediate effects of mindfulness-based cognitive therapy (MBCT) on emotional distress, but not on diabetes distress and HbA_1c. The aim of the present report was to examine if the effects would be sustained after six month follow-up.

Methods

In the DiaMind trial, 139 outpatients with diabetes (type-I or type-II) and a lowered level of emotional well-being were randomized into MBCT (n = 70) or a waiting list with treatment as usual (TAU: n = 69). Primary outcomes were perceived stress, anxiety and depressive symptoms, and diabetes distress. Secondary outcomes were, among others, health status, and glycemic control (HbA_1c).

Results

Compared to TAU, MBCT showed sustained reductions at follow-up in perceived stress (p < .001, d = .76), anxiety (p < .001, assessed by HADS d = .83; assessed by POMS d = .92), and HADS depressive symptoms (p = .004, d = .51), but not POMS depressive symptoms when using Bonferroni correction for multiple testing (p = .016, d = .48). No significant between-group effect was found on diabetes distress and HbA_1c.

Conclusion

This study showed sustained benefits of MBCT six months after the intervention on emotional distress in people with diabetes and a lowered level of emotional well-being.

Trial registration

Dutch Trial Register NTR2145, http://www.trialregister.nl.     

Role of baseline depressive symptoms in the development of depressive episode in patients receiving antiviral therapy for Hepatitis C infection

Objective

This study aimed to evaluate the symptom profile and the role of baseline depressive symptoms in the development of depressive episode in patients receiving pegylated IFN-alpha and ribavirin.

Methods

82 consecutive patients with HCV infection in whom combination of pegylated interferon-α 2a/2b and ribavirin was prescribed were assessed at baseline and thereafter at 2, 4, 8 and 12 weeks. At the baseline, patients were assessed on Patient Health Questionnaire (PHQ-9), Mini International Neuropsychiatric Interview (MINI) and Beck Depression Inventory (BDI-II). Thereafter patients were assessed on PHQ-9 and when ever found to have Major Depressive Disorder as per PHQ-9, they were assessed on MINI. Those found to have Major Depressive Episode (MDE) on MINI were rated on BDI-II for phenomenology and severity of depression.

Results

Common symptoms of pegylated IFN-alpha and ribavirin induced MDE include sadness, irritability, work inhibition, sleep disturbance, fatigability and loss of appetite. Presence of certain depressive symptoms i.e., presence of little interest or pleasure in doing things, feeling tired or having little energy, poor appetite, social withdrawal and work inhibition at the baseline were associated with development of depression during the course of pegylated IFN-alpha plus ribavirin therapy.

Conclusion

Depressive symptoms in patients with pegylated IFN-alpha and ribavirin induced MDE are influenced by the symptoms of depression prior to starting of pegylated IFN-alpha and ribavirin combination. A short screening questionnaire may be constructed which will include the symptoms which predict the development of depression to screen patients at high risk for the development of depression.