Factors associated with being a false positive on the General Health Questionnaire

BACKGROUND: The General Health Questionnaire (GHQ) has been used extensively in community and primary care research as an alternative to longer, time-consuming and more expensive assessments of the common mental disorders of depression and anxiety. The sensitivity and specificity of the GHQ compared with longer more detailed assessments is between 70 and 80%. Though satisfactory, this raises the concern about the possibility of bias in relation to longer assessments. We studied socio-demographic factors that were associated with being a false positive on the GHQ in order to investigate any ascertainment bias in relation to more detailed assessments. METHOD: A total of 7,357 consecutive patients aged 16 and over, in five general practices in Cardiff, Bristol and Pontypridd, were invited to complete the 12-item GHQ. Of these, 1,154 patients scored 3 or more, our case definition on the GHQ, and completed a computerised version of the Revised Clinical Interview Schedule (CIS-R) together with a short socio-demographic questionnaire. RESULTS: Of the 1,154 subjects who were cases on the GHQ, 344 (30 %) (95% CI 27%-32%) were false positive and were not cases on the CIS-R. After adjustment for the other variables, including GHQ score, false positive subjects were more likely to be employed [odds ratio (OR) 2.7, 95% CI 1.4-5.3], owner-occupiers (OR 1.6, 95% CI 1.0-2.4) and to have a close friend or relative to talk to about personal problems (OR 2.2, 95 % CI 1.4-3.5). CONCLUSION: Our results suggest that in this study there was an ascertainment bias on the GHQ in relation to the CIS-R. Studies that use the GHQ to study the relationship between socio-economic status and common mental disorder could lead to biased estimates of association compared to studies that use the CIS-R. It is likely that the GHQ will lead to a higher estimate of prevalence than the CIS-R in subjects who are better off financially and who have better social support.     

Correlates of dysmorphic concern in people seeking cosmetic enhancement

OBJECTIVE: To determine the clinical correlates of dysmorphic concern in persons seeking cosmetic enhancement from cosmetic physicians. METHOD: A questionnaire survey of 137 patients attending the practices of two cosmetic physicians. RESULTS: Four subjects (2.9%; 95% CI = 0.8%-7.3%) had a diagnosis of body dysmorphic disorder (BDD), but many more expressed overconcern with physical appearance ('dysmorphic concern'). Dysmorphic concern accounted for a substantial amount of the variance for mood, social anxiety, and impairment in work and social functioning, while concerns related to how self or others perceive the putative flaw in appearance, impacted significantly on work and leisure activities, but did not apparently influence mood and social anxiety to any significant degree. CONCLUSIONS: Dysmorphic concern is a broad dimensional construct that is related to both inter- and intrapsychic distress and disablement associated with people seeking cosmetic enhancement     

PSYCHOLOGICAL DISTRESS AMONG INFORMAL SUPPORTERS OF FRAIL OLDER PEOPLE AT HOME AND IN INSTITUTIONS

Objective. Investigate presence of psychiatric morbidity in informal carers using 30-item General Health Questionnaire (GHQ) and examine which factors best predict psychiatric morbidity. Design. Two-year longitudinal, panel survey of informal supporters of frail elderly subjects, using semi-structured interview schedules. Subjects were those defined as frail after screening stratified random sample of people aged 65 or over. Setting. Informal supporters of frail elderly subjects residing in private households or residential or nursing homes in four UK districts. Respondents. 623 informal supporters of subjects living at home, 129 regular visitors of those in long-term care. Measure. 30-item GHQ (cross-sectional analysis). Results. Stepwise multiple regression indicated main predictors of high GHQ scores in key supporters were: subjects had at least three problems of behaviour (b=1.56, 95% CI 1.25–1.94); supporters had to alter working hours (b=1.70, 95% CI 1.15–2.51); supporters were female (b=1.26, 95% CI 1.06–1.50). The following variables predicted low GHQ scores: supporters able to leave subject all day (b=0.71, 95% CI 0.64–0.80); subjects never wandered (b=0.78, 95% CI 0.62–0.99); supporters were ‘other relatives’ or friends of subject (b=0.74, 95% CI 0.59–0.91). For visitors, spouses were most likely to have high GHQ scores (b=2.46, 95% CI 1.32–4.57). Conclusions. Results suggest the need for greater collaboration between formal and informal care. Little work has been carried out to ascertain which interventions are most effective in alleviating carer stress: a series of randomized controlled trials to determine long-term effectiveness of various interventions for different groups of carers is required. © 1997 John Wiley & Sons, Ltd.     

A 4-year follow-up study of syndromal and sub-syndromal anxiety and depression symptoms in the general population

Background Our aims were to examine the stability of self-rated anxiety and depression symptoms and the predictors for change in case-level status after 4 years in a general population sample. Methods Prospective cohort study. Based on the total score on the Hospital Anxiety and Depression rating scale (HADS-T) in HUNT 2 (1995–1997), three groups were identified: Level 3 (n = 654, score ≥ 25 points), Level 2 (n = 654, score 19–24 points), and Level 1 (n = 1,308, score < 19 points). The groups were followed up with a mailed questionnaire after 4 years. Results Among the 1,326 (53% response rate) who participated in the follow-up, 816 (62%) had not changed symptom level. The number of participants that had crossed the HADS-T caseness level (19 points) was the same in both directions. In non-cases at baseline (Level 1), lack of friends (OR 2.34, 95% CI 1.28–4.27, P = 0.006) and previous episodes of depression (OR 2.90, 95% CI 1.76–4.78, P < 0.001) predicted HADS-T caseness at follow-up, while higher educational level (OR 0.66, 95% CI 0.46–0.96, P = 0.028) protected from developing caseness level of anxiety and depression. In HADS-T cases (Levels 2 and 3) at baseline, previous episode(s) of depression (OR 0.36, 95% CI 0.19–0.68, P = 0.002) and being unemployed (OR 0.58, 95% CI 0.34–1.00, P = 0.050) predicted HADS-T caseness at follow-up, whereas a higher educational level (OR 1.83, 95% CI 1.24–2.70, P = 0.002) was associated with remission from HADS-T caseness after 4 years. Conclusions Though symptom fluctuation was considerable, conventional HADS-T caseness (≥19 points) was a reliable and valid predictor for high long-term symptom stability of anxiety and depression in our general population sample.     

A randomised controlled trial of an educational intervention for depression among Asian women in primary care in the United Kingdom

OBJECTIVE: To determine the effect of patient education on patient perspectives and outcome of depression in a sample of Asian women in primary care. DESIGN: A randomised, clinical trial of "patient education" versus "usual care". SETTING: A general practice in London, which has a high proportion of Asians. SUBJECTS: Seventy patients with psychiatric morbidity (a score of 3 or more on the General Health Questionnaire 12) were recruited for the trial. OUTCOME MEASURES: Patient's explanatory models of illness (the patient's perspective on depression; recognition of depression as illness and recommend a medical intervention for this condition) and psychiatric morbidity at follow-up after two months were the primary outcome measures. RESULTS: One hundred and fifty-five women of Asian decent were contacted. One hundred and forty-eight (95.5%) agreed to take part in the study. Seventy (47.3%) were classed as cases of common mental disorder using the General Health Questionnaire 12. Thirty-five were randomly allocated to receive education about the nature, causes, prevalence and treatment of depression, 35 did not receive such information. There were no statistical differences between the two groups on baseline characteristics. Sixty-six (94.3%) subjects were followed up at two months. An intention to treat analysis showed that there was no difference in explanatory model measures between the two groups at the end of the study. However, more patients who received education were no longer cases (a score of 2 or less on the GHQ) (15/35; 42.9%) compared to controls (7/35; 20%) (p < 0.05) as did those with lower GHQ scores at entry (p < 0.03). Receipt of educational intervention (OR 3.4; 95% CI 1.01, 11.5) and lower GHQ scores at entry (OR 7.1; 95% CI 1.05, 30.2) remained significantly associated with recovery after adjusting for baseline variables using logistic regression. CONCLUSIONS: Patients with common mental disorders, especially those with milder forms of the condition, who received the educational material had a higher recovery rate than patients who do not receive such education. The mechanism for this improvement was unclear, not being reflected in patient's apparent understanding of depression nor explained by change in general practitioner's response. The results of this study need to be replicated.     

Psychiatric morbidity in the clients of social workers

Newly referred clients (N = 141) in two inner city Social Service department settings were interviewed using the Present State Examination and the Social Maladjustment Schedule and screened by social workers using the GHQ and the Case Review Form. 73% of cases were GHQ positive, using the 4/5 cut off on the GHQ-28. Receiver Operating Characteristic analysis showed that the GHQ cut-off point which maximised sensitivity and specificity in the present sample was 10/11. PSE/ID/CATEGO analysis identified 25% of the sample as "cases" (ID 6-8) and 28% as "threshold disorders" (ID 5). Using a straightforward "present/absent" assessment of "caseness" social workers misclassified more than a third of the PSE cases and correctly identified half of the non-cases. The results are discussed.     

Psychological morbidity and caregiver burden in parents of children with Tourette's disorder and psychiatric comorbidity

OBJECTIVE: To investigate the mental health and caregiver burden in parents of children with Tourette's disorder (TD) compared with parents of children with asthma. METHOD: A cross-sectional cohort survey was conducted at TD and pediatric asthma hospital outpatient clinics over a 6-month period. Main outcome measures were parent mental health (General Health Questionnaire [GHQ]-28) and caregiver burden (Child and Adolescent Impact Assessment) scores. RESULTS: The response rate achieved was 89.7%. Of the parents of children with TD, 76.9% achieved caseness on the GHQ-28 compared with 34.6% of the parents of children with asthma; this effect remained significant after controlling for demographic variables. Parents of children with TD also experienced greater caregiver burden, and this burden was significantly correlated with GHQ caseness. CONCLUSIONS: Parents of children with TD are at risk of psychiatric morbidity; an intervention targeting caregiver burden might be helpful in reducing this.     

Psychiatric disorders in young adult intercountry adoptees: an epidemiological study

OBJECTIVE: The prevalences of psychiatric disorders in young adult intercountry adoptees and nonadopted young adults from the general population were compared. METHOD: In the Netherlands, a total of 1,484 young adult intercountry adoptees (72.5% of the original sample at age 10-15 years) and 695 nonadopted subjects (78.1% of the original sample) of comparable age from the general population were interviewed by using a standardized psychiatric interview generating DSM-IV diagnoses. RESULTS: The adopted young adults were 1.52 times as likely to meet the criteria for an anxiety disorder as the nonadopted young adults; the 95% confidence interval (CI) was 1.15-2.00. The adoptees were 2.05 (95% CI=1.32-3.17) times as likely to meet the criteria for substance abuse or dependence. The adopted men were 3.76 (95% CI=1.69-8.37) times as likely to have a mood disorder as nonadopted men, while for women there was no significant difference between adoptees and nonadoptees. No significant difference for the diagnosis of disruptive disorder was found. For all diagnoses together, adoptees with low and middle parental socioeconomic status in childhood did not differ from the comparison subjects, while adoptees with high parental socioeconomic status were 2.17 times (95% CI=1.50-3.13) as likely to meet the criteria for a disorder as nonadoptees with high parental socioeconomic status. CONCLUSIONS: Intercountry adoptees run a higher risk of having severe mental health problems in adulthood than nonadoptees of the same age. The risk of later malfunctioning differs for different disorders and different groups of adoptees.     

Use of complementary therapies in patients with Parkinson's disease in Singapore.

To determine the frequency and spectrum of complementary therapy (CT) use and its association with sociodemographic or disease-specific characteristics among Asian patients with Parkinson's disease (PD) in Singapore, we interviewed 159 patients using a structured questionnaire. Sixty-one percent (95% CI=55-67) of participants used at least one type of CT for PD, of which the most common were traditional medicine, acupuncture, and vitamins/health supplements. Among CT users, 40% (95% CI=32-48) subjectively reported some improvement of their symptoms. However, only 16% informed their physicians of their use of CT. Due to unequal follow-up times, a survival analysis approach was adopted for statistical analysis. The rate of starting CT use was 1.2/100 person months. At 3 years after PD diagnosis, 48% had started using CT. Among a subgroup of participants, those with a baseline Unified Parkinson's Disease Rating Scale motor score of more than 16 were 2.5 times more likely to use CT compared to those with a baseline score of 16 or less (P=0.031; 95% CI=1.1-5.8). CT use was not associated with age of onset of PD or other sociodemographic factors. The use of CT is high among Asian PD patients. Patients with more severe motor dysfunction at onset are more likely to use CT.     

Obstetric complications and Apgar score in early-onset schizophrenic patients with prominent positive and prominent negative symptoms

The objective of the study was to find associations between obstetric complications (OCs) history and schizophrenia course and symptoms. We analysed the obstetric and psychiatric history of 50 DSM IV schizophrenic subjects who experienced their first schizophrenia episode in adolescence, and 30 healthy controls. Obstetrical data and Apgar scores were obtained from medical records and evaluated with the Lewis and Murray Scale. Based on patients' documentation [including longitudinal evaluation with Positive and Negative Syndrome Scale (PANSS)] the symptom profile and the course of schizophrenia were determined. Results: we distinguished two major groups of patients: with prominent negative and prominent positive symptoms. Schizophrenics with prominent negative symptoms and a chronic schizophrenia course had significantly more definite OCs and lower Apgar scores than patients with prominent positive symptoms and controls. Subjects who had a positive OCs history were more than four times likely to develop schizophrenia in adolescence than those without such a history (OR=4.64; 95% CI=1.29-17.51) with the likelihood of developing schizophrenia with prominent negative symptoms especially high (OR=7.31; 95% CI=1.80-29.65). An Apgar score of between 0 and 3 after birth was associated with an increased risk for developing schizophrenia (OR=2.25; 95% CI=0.56-9.12), especially with prominent negative symptoms (OR=3.71; 95% CI=0.84-16.32). The findings support the hypothesis of a role of OCs in developing early-onset schizophrenia and suggest the associations of the OCs history with a specific symptoms profile (prominent negative symptoms) and a chronic course of schizophrenia.     

Correlation of physician and patient rated quality of life during antipsychotic treatment in outpatients with schizophrenia

Perception of quality of life (QOL) may differ depending on the perspective. This 12-month, prospective, naturalistic study compared QOL ratings in outpatients on antipsychotic treatment for schizophrenia both from a "subjective" patient rated and an "objective" physician rated perspective. Included were 1462 patients. Two scales were used to assess patient and physician perspectives: the Subjective Well-being on Neuroleptics (SWN) scale and the Quality of Life Scale (QLS). Linear correlation was found between both ratings: 10 points on the SWN corresponded to 9.35 points on the QLS. Spearman's correlation coefficients increased over time up to r=0.71 at Month 12. Patients were grouped into four cohorts depending on the degree of concordance between SWN and QLS ratings. Several factors affecting the concordance of both ratings were identified. Compared to the cohort with QLS=SWN, higher QOL ratings by the physician (QLS>SWN) were more likely in females than in males (OR=1.36; 95% CI 1.00 - 1.85) and in older than in younger patients (50 years: OR=0.58, 95% CI 0.34 - 0.998), but less likely in patients with high baseline CGI-severity (CGI >4; OR=0.63; 95% CI 0.47 - 0.86) or treatment with oral typicals before baseline (OR=0.53; 95% CI 0.31 - 0.91). Higher QOL ratings by the patient (SWN>QLS) were less likely in patients with psychotherapy before baseline (OR=0.54; 95% CI 0.36 - 0.81), medication intolerability before baseline (OR=0.53; 95% CI 0.36 - 0.78) or patient request of treatment change at baseline (OR=0.64; 95% CI 0.42 - 0.96). The combination of several factors predicted concordant ratings, including male sex, young age, high CGI at baseline, and psychotherapy prior to the study.     

Endothelial nitric oxide synthase gene single-nucleotide polymorphism predicts cerebral vasospasm after aneurysmal subarachnoid hemorrhage.

Vasospasm is a major cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). Studies have shown a link between single-nucleotide polymorphisms (SNPs) in the endothelial nitric oxide synthase (eNOS) gene and the incidence of coronary spasm and aneurysms. Alterations in the eNOS T-786 SNP may lead to an increased risk of post-aSAH cerebral vasospasm. In this prospective clinical study, 77 aSAH patients provided genetic material and were followed for the occurrence of vasospasm. In multivariate logistic regression analysis, genotype was the only factor predictive of vasospasm. The odds ratio (OR) for symptomatic vasospasm in patients with one T allele was 3.3 (95% confidence interval (CI): 1.1 to 10.0, P=0.034) and 10.9 for TT. Patients with angiographic spasm were 3.6 times more likely to have a T allele (95% CI: 1.3 to 9.6, P=0.013; for TT: OR 12.6). Patients with severe vasospasm requiring endovascular therapy were more likely to have a T allele (OR 3.5, 95% CI: 1.3 to 9.5, P=0.016; for TT: OR 12.0). Patients with the T allele of the eNOS gene are more likely to have severe vasospasm. Presence of this genotype may allow the identification of individuals at high risk for post-aSAH vasospasm and lead to early treatment and improved outcome.     

Homocysteine, methylenetetrahydrofolate reductase C677T polymorphism and cognitive impairment: the health in men study

High total plasma homocysteine (tHcy) has been associated with cognitive impairment in later life, but it is unclear if this association is causal or is due to confounding. The C677T polymorphism of the 5,10 methylenetetrahydrofolate reductase gene (MTHFR) increases basal tHcy, but its contribution to cognitive impairment has not been established. We designed this study to determine if tHcy is causally related to cognitive impairment in later life by investigating its association with high tHcy and the MTHFR-C677T polymorphism. We recruited 1778 older men from the Health in Men Study cohort and established caseness on the basis of the participants' scores on a Telephone Interview for Cognitive Status score 27 in 2008. Exposure to tHcy, gene status and other variables of interest were obtained from assessments 4-7 years earlier. Multivariate logistic regression showed that the odds of cognitive impairment increased with a doubling of tHcy (adjusted odds ratio, OR 1.36; 95% confidence interval, 95% CI 1.02-1.82). Compared with the wild CC genotype, participants with the MTHFR-TT genotype had 46% greater odds of cognitive impairment (OR 1.46, 95% CI 1.01-2.11, P=0.043). The results of this study are consistent with, but do not prove the hypothesis that high tHcy causes cognitive impairment in later life.     

Prevalence of depression and correlates of depressive symptoms for residents in the urban part of Jeju Island, Korea

AIMS: This study examined the prevalence of depression and depressive symptoms, and the correlates of depressive symptoms, and proposes some methods for reducing risk of depression in residents of the urban part of Jeju Island in Korea. METHODS: In all, 1050 residents were selected using multiphasic cluster sampling to represent each district. Of the 981 respondents, 413 were men and 568 were women. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to evaluate depression (CES-D score over 25) and depressive symptoms (CES-D score over 21). Multiple logistic regression analysis was performed for comparisons. RESULTS: The prevalence of depression in males and females was comparable, at 9.47 and 11.36%, respectively. The prevalence of depressive symptoms in men was 15.01%, while in women the level rose to 18.37%. Those with high self-assessed level of stress scores were significantly more likely to have depressive symptoms than those with low self-assessed level of stress scores (odds ratio (OR) = 5.73 (95% confidence interval (95% CI), 1.29-25.36)). Residents at high risk of problem drinking (CAGE score over 3) were significantly more likely to have depressive symptoms than those with a CAGE score under 1 (OR = 3.43 95% CI, 1.77-6.66). Respondents who slept poorly had more depressive symptoms than respondents who slept well (OR = 2.11 95% CI, 1.37-3.23). Females were significantly more likely to have more depressive symptoms than males (OR = 1.70 95% CI, 1.08-2.68). CONCLUSIONS: The prevalence of depression and depressive symptoms in urban Jeju Island is similar to that in a nation-wide sample. By providing intensive mental health services to those who have high stress levels, problem drinking, and poor health behavior, early detection of depressive symptoms in the community will be important for improving general health status.     

Case-control and qualitative study of attrition in a community epilepsy programme in rural India.

Dropout from epilepsy programmes is a serious problem in developing countries and has not been systematically studied before. We set up a community-based programme for children with epilepsy in rural India. The aim of this study was to assess reasons for dropout. We assessed medical and sociodemographic variables for their effect on dropout at 12 months using an unmatched case-control design on 32 cases and 62 controls. We also interviewed the parents of 32 children who dropped out of treatment, using a topic schedule. Two-thirds of the dropouts occurred within the first 6 months of treatment. Severely impaired children were more likely to drop out (odds ratio 4.60, 95% CI: 1.0-21.0) and families who had tried AEDs before were less likely to do so (odds ratio 0.12, 95% CI: 0.015-0.88). Denial of diagnosis, access problems and symptom resolution were the other main reasons underlying attrition. Active ascertainment methods should be reconsidered in community programmes. Very poor families without a male head or with long journey times are at high risk of dropout. People with severe impairments need appropriate integrated rehabilitation.     

Psychiatric health in a sexually transmitted infections clinic: effect on reattendance

BACKGROUND AND OBJECTIVES: Sexually transmitted infections (STIs) remain a public health priority, but associated psychological morbidity has recently been ignored. One aspect of STI control is test of cure and further treatment at follow-up clinic appointments. We chose reattendance rates as a measure of compliance and assessed whether reattendance was related to psychological morbidity. METHODS: 938 STI clinic patients were offered the Hospital Anxiety and Depression Scale (HAD) and staff rated each patient's psychological health. Predictors of attendance, caseness and staff recognition were assessed by logistic regression. RESULTS: 401/774 [51.9%; 95% confidence interval (CI): 48.3-55.4%] patients, who completed the HAD, scored above threshold. Staff rated 151/743 (20.4%) patients as having "psychological problems." HAD caseness was not associated with attending arranged follow-up [adjusted odds ratio (adj. OR): 0.83 (0.49-2.05)]. Patients rated with psychological problems by staff were more likely to attend [adj. OR: 1.91 (1.02-3.60)]. CONCLUSIONS: Half of our sample had significant anxiety and staff should be more aware of this suffering. Our work suggests that such awareness might improve subsequent attendance.     

Family history of stroke among Mexican-American and non-Hispanic white patients with stroke and TIA: implications for the feasibility and design of stroke genetics research

Family history of stroke may differ by ethnicity. This study examined the associations of ethnicity and stroke risk factors with family history of stroke using data from the Brain Attack Surveillance in Corpus Christi Project. A random sample of stroke/transient ischemic attack cases was interviewed about family history of stroke (n = 524). Thirty-six percent of the cases reported a family history of stroke, with 26% reporting a parental and 13% a sibling history. Compared to non-Hispanic whites (NHWs), Mexican-Americans (MAs) were two times (OR = 2.07; 95% CI: 1.09-3.95) more likely to have a sibling with stroke. More MAs (8.1%; 95% CI: 4.6-11.6) had living siblings with stroke compared to NHWs (1.9%; 95% CI: 0.1-3.8). Since MAs are more likely to have living siblings with stroke compared with NHWs, MAs may be a more feasible population for family stroke studies than predominantly white populations.     

Temporal trend of amyotrophic lateral sclerosis incidence in southern Europe: a population study in the health district of Ferrara, Italy

Data about the temporal trend of amyotrophic lateral sclerosis (ALS) incidence in southern Europe are scarce. Incidence studies on ALS have been carried out in the health district of Ferrara, Italy, since 1960s. We expanded the previous studies from 1964 to 2009. The study was prospective with a subsequent retrospective intensive survey of multiple sources of case ascertainment. All patients with a definite and probable ALS according to the original El Escorial criteria were selected. There were 130 incident cases in the years 1964-2009 giving an average annual crude incidence of 1.82 per 100,000 population (95% CI 1.53-2.17). An incidence increase during the study period was estimated in women (χ(2) test for trend = 7.19, p < 0.01) and in the elderly (χ(2) test for trend = 7.803, p < 0.01). The age-adjusted incidence was stable over time in both women (1.19 per 100,000, 95% CI 0.90-1.52) and men (1.45 per 100,000, 95% CI 0.12-1.84). The annual number of new ALS cases in the study population followed the Poisson distribution in both sexes as well as in the elderly group of the population. The present findings suggest that ALS incidence is nearly stable over time. The crude incidence increase we estimated over time among women is mainly explained by population ageing. The increasing incidence in the elderly population was likely the consequence of an increasing precision in ALS diagnosis in the elderly since the increasing attention and care over time of neurologic elderly patients that likely concern elderly women more than previous time periods rather than better case ascertainment of diagnosed patients. The present findings do not support the role of specific environmental factors in ALS pathogenesis.     

A preliminary study of EAT and BITE scores for one school year in Bermuda: increased early anorexic measures related to socio-economic factors

BACKGROUND: Bermuda is a unique heterogeneous ethnic population in which it is possible to study the interaction of ethnicity, culture, gender and economic factors that influence abnormal eating attitudes. METHOD: A cross-sectional survey of 836 adolescents, one total school year in Bermuda. The BITE and EAT self-report questionnaires were administered in a classroom setting. The analysis was for caseness and for total scores. Caseness represents possible developing anorexic or bulimic eating disorder pathology for this non-adult population. RESULTS: 7.3% fulfilled EAT caseness, 0.24% fulfilled BITE caseness. There was no gender or ethnic difference for caseness. Multivariate analysis for EAT caseness found Odds Ratios of 2.89 (95% CI 1.37, 6.11) for Manual maternal job status. CONCLUSION: Despite the limitation of a questionnaire analysis, lower socioeconomic status increases the risk of possible eating disorder pathology in this adolescent population. Developing anorexic eating attitudes were more prevalent compared to bulimic attitudes for schoolchildren in this unique cultural setting.     

The Hospital Anxiety and Depression Scale depression subscale, but not the Beck Depression Inventory-Fast Scale, identifies patients with acute coronary syndrome at elevated risk of 1-year mortality

OBJECTIVE: The objective of this study was to investigate the use of short-form depression scales in assessing 1-year mortality risk in a national sample of patients with acute coronary syndrome (ACS). METHODS: Patients with ACS (N=598) completed either the Hospital Anxiety and Depression Scale depression subscale (HADS-D) or the Beck Depression Inventory-Fast Scale (BDI-FS). Their mortality status was assessed at 1 year. RESULTS: Cox proportional hazards modeling showed that patients depressed at baseline (combining HADS-D and BDI-FS depressed cases) were more likely to die within 1 year [hazard ratio (HR)=2.8, 95% CI=1.4-5.7, P=.005], even when controlling for major medical and demographic variables (HR=4.1, 95% CI=1.6-10.3, P=.003). Scoring above the threshold on the HADS-D predicted mortality (HR=4.2, 95% CI=1.8-10.0, P=.001), but scoring above the threshold on the BDI-FS did not (HR=1.8, 95% CI=0.6-5.6, P=.291). CONCLUSION: The HADS-D predicted increased risk of 1-year mortality in patients with ACS.