Symptomatic and functional recovery in depression in later life

Objectives

Functional limitations give an indication of the total impact of diseases, such as depression, on individuals health and recovery. This study examines the change in several domains of functioning over 2 years in older persons depressed at baseline (non-remitted group and remitted group after 2 years) and in a non-depressed comparison group.

Methods

Data were used from a cohort study (Netherlands Study of Depression in Older persons [NESDO]) consisting of depressed older persons ≥?60 years (N?=?378) and a non-depressed comparison group (N?=?132) with 2 years of follow-up (attrition rate 24%). Functional limitations (outcome) were assessed with the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire every 6 months. Total scores and domain scores were used. Depression was classified according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria at baseline and at 2-year follow-up. Severity of depression (predictor) was assessed with the Inventory of Depressive Symptomatology (IDS) at 6-month intervals.

Results

Linear mixed models showed that the level of functional limitations differed between the three groups during 2 years of follow-up. The non-remitted group had the highest level of functional limitations during 2 years, followed by the remitted group. Stable low levels of functional limitations were found for the non-depressed group. Remission from depression was accompanied by improvements in functioning, however, compared to the non-depressed comparison group significant functional limitations remained. Higher severity of depression appeared as risk factor for a declining course of functioning, especially the social aspects of functioning.

Methodological considerations

Participants that were more severely depressed and more functionally impaired at baseline had higher attrition rates than the participants that were included in the analytical sample.

Conclusion

This study showed that depression in later life has long-term debilitating effects on functioning, enduring even after remission from depression. This implies that depression treatment in later life should aim broader than just symptomatic recovery, but also include functional recovery.

     

Hostile Mood and Social Strain During Daily Life: A Test of the Transactional Model

Background

Hostility is a multidimensional construct related to cardiovascular (CV) disease risk. Daily hostile mood and social interactions may precipitate stress-related CV responses in hostile individuals.

Purpose

Determine whether trait cognitive hostility best predicts daily hostile mood and social interactions relative to other trait hostility factors and explore the temporal links between these daily measures.

Methods

One hundred seventy-one participants completed assessments of four trait hostility scales. Participants completed an electronic diary across 3?days, assessing current hostile mood and social interaction quality.

Results

Multiple regression analyses revealed both affective and cognitive hostility to be significant predictors of daily hostile mood, and cognitive hostility alone to predict daily social strain. Additional analyses revealed previous social strain to predict elevated subsequent hostile mood.

Conclusions

Episodes of social strain may give rise to elevated hostile mood. Trait cognitive hostility may be an important factor in predicting daily social strain.     

Coping with Racism: The Impact of Prayer on Cardiovascular Reactivity and Post-stress Recovery in African American Women

Background

Prayer is often used to cope with racism-related stress. Little is known about its impact on cardiovascular function.

Purpose

This study examined how prayer coping relates to cardiovascular reactivity (CVR), post-stress recovery, and affective reactivity in response to racism-related stress.

Methods

African American women (n?=?81; mean age=20 years) reported their use of prayer coping on the Perceived Racism Scale and completed anger recall and racism recall tasks while undergoing monitoring of systolic and diastolic blood pressure (DBP), heart rate, heart rate variability (HRV), and hemodynamic measures. Prayer coping was examined for associations with CVR, recovery, and affective change scores using general linear models with repeated measures.

Results

Higher prayer coping was associated with decreased state stress and DBP reactivity during racism recall (p's?<?0.05) and with decreased DBP and increased HRV during racism recall recovery(p's?<?0.05).

Conclusions

Coping with racism by utilizing prayer may have cardiovascular benefits for African American women.     

Pain Fear Avoidance and Pain Acceptance: A Cross-Sectional Study Comparing Their Influence on Adjustment to Chronic Pain Across Three Samples of Patients

Background

Prior studies found that pain fear avoidance and pain acceptance are significantly associated with adjustment to chronic pain.

Purpose

The purpose of this study is to compare the influence of pain fear avoidance and pain acceptance on adjustment to chronic pain across three samples: patients with chronic back pain treated at primary care centres, patients with heterogeneous pain conditions treated at a pain clinic and patients with pain associated with inflammatory bowel disease.

Methods

Structural equation modelling was used to test for differences between groups in the linear relationships between variables.

Results

The model had the best fit for the group of patients with back pain. Three significant relationships were equal across the groups: experiential avoidance on pain fear avoidance, pain intensity on pain fear avoidance, and pain fear avoidance on negative mood.

Conclusions

The associations between both pain fear avoidance and pain acceptance and adjustment to chronic pain vary depending on the pain condition and the type of health care centres where the patients are treated.     

Fear-Avoidance,Pain Acceptance and Adjustment to Chronic Pain: A Cross-Sectional Study on a Sample of 686 Patients with Chronic Spinal Pain

Background

Prior studies found a range of psychological factors related to the perception of pain, maintenance of pain and disability.

Purpose

The aim of this study was to investigate the role of pain fear-avoidance and pain acceptance in chronic pain adjustment. The influence of two diathesis variables (resilience and experiential avoidance) was also analyzed.

Methods

The sample was composed of 686 patients with chronic spinal pain. Structural equation modelling analyses were used to test the hypothetical model.

Results

Experiential avoidance was associated with pain fear-avoidance, and resilience was strongly associated with pain acceptance. Pain acceptance was negatively associated with negative mood, functional impairment and pain intensity. However, pain fear-avoidance was positively and significantly associated with negative mood but had no association with pain intensity. There was a path from functional impairment to pain fear-avoidance.

Conclusions

Resilience and experiential avoidance appear as variables which could explain individual differences in pain experience.     

Association between social isolation and inflammatory markers in depressed and non-depressed individuals: results from the MONICA/KORA study

Introduction

Depressed individuals not only suffer from chronic low grade inflammation, but also exhibit an inflammatory hyper-responsiveness to acute stress. We investigate whether chronic stress also induces an exaggerated inflammatory response in individuals with increased depression features. As model for chronic stress, social isolation was chosen.

Methods

Interleukin (IL)-6 and hs-CRP levels were assessed in 1547 subjects (847 men and 700 women), derived from the population-based MONICA/KORA study. Standardized questionnaires were used to assess depressed mood (depression and exhaustion subscale) and social isolation (social network index). The relationship between the two inflammatory markers, social isolation and depressed mood was examined taking into account interactions social isolation × depressed mood using multivariable linear regression models, adjusted for age, BMI, smoking, alcohol, and physical activity. Analyses were performed in men and women separately.

Results

We observed a significant interaction between depressed mood and social isolation regarding IL-6 and hs-CRP, respectively in men (p-value = 0.02 for IL-6 and <0.01 for hs-CRP), evidencing a substantial synergistic effect of social isolation, and depressed mood on inflammatory responses. Furthermore, depressed and socially isolated men had highly significantly elevated IL-6 levels (geometric mean: 3.76 vs. 1.92 pg/ml, p-value <0.01) and heightened hs-CRP levels (geometric mean: 2.01 vs. 1.39 mg/l, p = 0.08) in comparison with non-depressed and socially integrated men. In women, no significant associations were seen.

Conclusion

The interaction of depressed mood and social isolation elicits a substantial synergistic impact on inflammatory markers in men, but not in depressed women.     

Relationship between depressive symptoms and quality of life in Nigerian patients with schizophrenia

Purpose

Quality of life (QOL) in patients with schizophrenia is influenced by various factors such as depressive symptoms. This study assessed the relationship between depressive symptoms and QOL in outpatients with schizophrenia in Nigeria and evaluated the associated socio-demographic and clinical factors.

Methods

One hundred patients with 10th edition of the International Classification of Diseases diagnosis of schizophrenia participated in this study. Socio-demographic and clinical factors such as depression were assessed with Zung Self-rating Depression Scale and symptoms of schizophrenia with the Positive and Negative Syndrome Scale of schizophrenia (PANSS). The level of functioning was assessed with the Global Assessment of Functioning Scale. QOL was assessed using the brief version of the World Health Organisation Quality of Life Scale.

Results

There were 27 (27.0 %) patients with depression. The depressed patients reported significant lower scores in all QOL domains when compared with the non-depressed group. All QOL domains were significantly negatively correlated with the total PANSS and all its subscales (except for psychological domain with total PANSS and social relationship and environmental domains with PANSS positive). Severity of depressive symptoms was significantly negatively correlated with all QOL domains. Functioning was significantly positively correlated with all QOL domains except in the environmental domain. Multiple regression analysis showed that depressive symptoms predicted all QOL domains except the social relationship domain while negative symptoms predicted social relationship and environmental domains.

Conclusion

Depression is a common occurrence during the course of schizophrenia. Depressive and negative symptoms have a significant impact on the QOL of patients with schizophrenia.     

Prevalence, correlates, and symptom profiles of depression among men with a history of military service

Purpose

The purpose of this study was to examine the prevalence, correlates, and symptom profiles of depressive disorders in men with a history of military service.

Methods

Data were obtained from the 2006 Behavioral Risk Factor Surveillance System survey. Multivariable logistic regressions were used to identify correlates of lifetime and current depression. Regularly occurring symptom profiles were identified via cluster analysis.

Results

Prevalence of lifetime and current depression was similar in men with and without a history of military service. Younger age was positively, and black minority status, being in a relationship and self-reported good health were negatively associated with a lifetime diagnosis of depression. Other minority status (non-Hispanic, non-black) was positively, and older age, some college, being in a relationship, and self-reported good health were negatively associated with current depression. A cluster of younger men who experience significant depressive symptoms but may not report depressed mood or anhedonia was identified.

Conclusions

Depression is as prevalent in men with a history of military service as it is in men without a history. Research should focus on subpopulations of men with a history of military service in which depression may be more prevalent or burdensome. Younger men with significant depressive symptoms may be missed by standard depression screens and still be at elevated risk for negative outcomes associated with depression.     

Bright light treatment of depression for older adults [ISRCTN55452501]

Background

The incidence of insomnia and depression in the elder population is significant. It is hoped that use of light treatment for this group could provide safe, economic, and effective rapid recovery.

Methods

In this home-based trial we treated depressed elderly subjects with bright white (8,500 Lux) and dim red (<10 Lux) light for one hour a day at three different times (morning, mid-wake and evening). A placebo response washout was used for the first week. Wake treatment was conducted prior to the initiation of treatment, to explore antidepressant response and the interaction with light treatment. Urine and saliva samples were collected during a 24-hour period both before and after treatment and assayed for aMT6s and melatonin respectively to observe any change in circadian timing. Subjects wore a wrist monitor to record light exposure and wrist activity. Daily log sheets and weekly mood (GDS) and physical symptom (SAFTEE) scales were administered. Each subject was given a SCID interview and each completed a mood questionnaire (SIGH-SAD-SR) before and after treatment. Also, Hamilton Depression Rating (SIGH-SAD version) interviews were conducted by a researcher who was blind to the treatment condition. A control group of healthy, age-matched, volunteers was studied for one day to obtain baseline data for comparison of actigraphy and hormone levels.

Results

Eighty-one volunteers, between 60 and 79 years old, completed the study. Both treatment and placebo groups experienced mood improvement. Average GDS scores improved 5 points, the Hamilton Depression Rating Scale (HDRS) 17 scores (extracted from the self-rated SIGH-SAD-SR) improved 6 points. There were no significant treatment effects or time-by-treatment interactions. No significant adverse reactions were observed in either treatment group. The assays of urine and saliva showed no significant differences between the treatment and placebo groups. The healthy control group was active earlier and slept earlier but received less light than the depressed group at baseline.

Conclusion

Antidepressant response to bright light treatment in this age group was not statistically superior to placebo. Both treatment and placebo groups experienced a clinically significant overall improvement of 16%.     

Death and suicide among former child and adolescent psychiatric patients

Background

Postnatal depression has received considerable research and clinical attention, however anxiety and stress in the postpartum has been relatively ignored. Along with the widespread use of the Edinburgh Postnatal Depression Scale (EPDS), depression has become the marker for postnatal maladjustment. Symptoms of anxiety tend to be subsumed within diagnoses of depression, which can result in anxiety being minimized or overlooked in the absence of depression. Some researchers have identified the need to distinguish between postnatal depression and anxiety, and to discern cases where depression and anxiety co-exist. The aim of this study was to assess the prevalence of postnatal distress using the EPDS and the Depression Anxiety Stress Scales (DASS-21).

Method

As part of a larger cross-sectional study, the EPDS and DASS-21 were administered to a convenience sample of 325 primiparous mothers, who ranged in age from 18 to 44 years (M = 32 years). Recruited through mother's groups and health centres in Melbourne Australia, inclusion was limited to mothers whose babies were aged between 6 weeks and 6 months. Analyses included comparisons between the classifications of women according to the EPDS and the DASS-21, and an exploration of the extent to which the EPDS identified anxious-depressed women.

Results

The EPDS identified 80 women (25%) as possibly depressed (using a cut-off of over 9), of which the DASS-21 corroborated 58%. In the total sample, 61 women (19%) were classified by the DASS-21 to be depressed. Using broader criteria for distress, it was revealed by the DASS-21 that a further 33 women (10%) showed symptoms of anxiety and stress without depression. A total of 41 women (13%) had symptoms of anxiety either in isolation or in combination with depression. The DASS-21 identified 7% of the sample as being both anxious and depressed. This at-risk sub-group had higher mean EPDS and DASS-depression scores than their depressed-only counterparts.

Conclusion

The prevalence of anxiety and stress in the present study points to the importance of assessing postnatal women for broader indicators of psychological morbidity than that of depression alone. The DASS-21 appears to be a useful instrument for this purpose.     

The suicidal process: age of onset and severity of suicidal behaviour

Purpose

The concept of the suicidal process implies a progression from behaviour of relatively low intent to completed suicide. Evidence from the literature has given rise to the speculation that the age of onset of an early form of the suicidal process may be associated with the ultimate seriousness of suicidal behaviour. This study was designed to test the hypothesis that early onset of the first stage of the suicidal process, a wish to die, is associated with increases in the ultimate position along the suicidal process dimension.

Methods

Questions on the appearance and timing of suicidal process components (a death wish, ideation, plan, or attempt) were embedded in a telephone survey on mental health and addictions in the workforce. Records of those that had experienced suicidal behaviour were examined for the effects on the age of onset of the first death wish as a function of the level of severity of suicidal behaviour, gender, and depression.

Results

The findings showed that increases in suicidal intent were associated with lowered age of the first death wish. This pattern held true for depressed and non-depressed persons alike.

Conclusions

The results support the notion that the early onset of a supposed precursor of suicidal behaviour, a death wish in this case, adds to its ability to portend more serious problem levels in later stages of life. Furthermore, mood operates independently in its association with the timing of such suicidal behaviour, suggesting that the effect of a relatively youthful appearance of a wish to die cannot be explained by early onset depression.     

Risk factors for suicide behaviors in the observational schizophrenia outpatient health outcomes (SOHO) study

Background

Dercum’s disease is characterised by pronounced pain in the adipose tissue and a number of associated symptoms. The condition is usually accompanied by generalised weight gain. Many of the associated symptoms could also be signs of depression. Depression in Dercum’s disease has been reported in case reports but has never been studied using an evidence-based methodology. The aim of this study was to examine the presence of depression in patients with Dercum’s disease compared to obese controls that do not experience any pain.

Methods

A total of 111 women fulfilling the clinical criteria of Dercum’s disease were included. As controls, 40 obese healthy women were recruited. To measure depression, the Montgomery Åsberg Depression Rating Scale (MADRS) was used.

Results

According to the total MADRS score, less than half of the patients were classified as having “no depression” (44%), the majority had “light” or “moderate depression” (55%) and one individual had “severe depression” in the Dercum group. In the control groups, the majority of the patients were classified as having “no depression” (85%) and a small number had “light depression” (15%). There was a statistically significant difference for the total MADRS score between the two groups (p?=?0.014).

Conclusion

The results indicate that the patients with Dercum’s disease are more likely to suffer from depression than controls.     

Presentation and Neurobiology of Anhedonia in Mood Disorders: Commonalities and Distinctions

Purpose of Review

To focus on the clinical and behavioral presentation of anhedonia in mood disorders, as well as the differences and commonalities in the underlying neurocircuitry.

Recent Findings

Evidence suggests that depression is characterized by hypofunction of the reward system, while bipolar disorder manifests dysregulation of the behavioral activation system that increases goal-directed reward behavior. Importantly, strong evidence does not exist to suggest significant differences in anhedonia severity between depressed unipolar and bipolar patients, suggesting that there are more nuanced fluctuations in reward processing deficits in bipolar patients depending on their state. Both euthymic unipolar and bipolar patients frequently report residual reward dysfunction, which highlights the potential of reward processing deficits that give rise to the clinical symptom of anhedonia to be trait factors of mood disorders; however, the possibility that therapies are not adequately treating anhedonia could also explain the presence of residual symptoms.

Summary

Reward processing represents a potential diagnostic and treatment marker for mood disorders. Further research should systematically explore the facets of reward processing in at-risk, affected, and remitted patients.

     

Pain Hypervigilance is Associated with Greater Clinical Pain Severity and Enhanced Experimental Pain Sensitivity Among Adults with Symptomatic Knee Osteoarthritis

Background

Pain hypervigilance is an important aspect of the fear-avoidance model of pain that may help explain individual differences in pain sensitivity among persons with knee osteoarthritis (OA).

Purpose

The purpose of this study was to examine the contribution of pain hypervigilance to clinical pain severity and experimental pain sensitivity in persons with symptomatic knee OA.

Methods

We analyzed cross-sectional data from 168 adults with symptomatic knee OA. Quantitative sensory testing was used to measure sensitivity to heat pain, pressure pain, and cold pain, as well as temporal summation of heat pain, a marker of central sensitization.

Results

Pain hypervigilance was associated with greater clinical pain severity, as well as greater pressure pain. Pain hypervigilance was also a significant predictor of temporal summation of heat pain.

Conclusions

Pain hypervigilance may be an important contributor to pain reports and experimental pain sensitivity among persons with knee OA.     

Social support and physical activity as moderators of life stress in predicting baseline depression and change in depression over time in the Women’s Health Initiative

Purpose

To determine whether social support and/or physical activity buffer the association between stressors and increasing risk of depression symptoms at baseline and at 3-year follow-up.

Methods

This is a secondary analysis of data from the Women’s Health Initiative Observational Study. 91,912 community-dwelling post-menopausal women participated in this prospective cohort study. Depression symptoms were measured at baseline and 3 years later; social support, physical activity, and stressors were measured at baseline.

Results

Stressors at baseline, including verbal abuse, physical abuse, caregiving, social strain, negative life events, financial stress, low income, acute pain, and a greater number of chronic medical conditions, were all associated with higher levels of depression symptoms at baseline and new onset elevated symptoms at 3-year follow-up. Social support and physical activity were associated with lower levels of depressive symptoms. Contrary to expectation, more social support at baseline strengthened the association between concurrent depression and physical abuse, social strain, caregiving, and low income. Similarly, more social support at baseline increased the association between financial stress, income, and pain on new onset depression 3 years later. Physical activity similarly moderated the effect of caregiving, income, and pain on depression symptoms at baseline.

Conclusion

Stressors, social support, and physical activity showed predicted main effect associations with depression. Multiplicative interactions were small in magnitude and in the opposite direction of what was expected.     

The association of depression and posttraumatic stress disorder with the metabolic syndrome in a multi-ethnic cohort: the HELIUS study

Purpose

Depression and posttraumatic stress disorder (PTSD) may be linked to the metabolic syndrome (MetS). Consistency of this association across ethnic groups and the influence of comorbidity of depression/PTSD were examined.

Methods

Cross-sectional baseline data from the HELIUS study were used (4527 Dutch, 2999 South-Asian Surinamese, 4058 African Surinamese, 2251 Ghanaian, 3522 Turkish and 3825 Moroccan participants). The Patient Health Questionnaire-9 (PHQ-9) (score range 0–27) measured depressive symptoms. A 9-item questionnaire (score range 0–9) measured PTSD symptoms. The MetS was defined according to the International Diabetes Federation. The association of a depressed mood (PHQ-9 sum score?≥?10) and severe PTSD symptoms (sum score?≥?7) with the MetS was examined using logistic regression. Interaction with ethnicity and between a depressed mood and severe PTSD symptoms was tested.

Results

A depressed mood was associated with the MetS [OR (95% CI)?=?1.37 (1.24–1.51)] in the total sample and consistent across ethnic groups (p values for interaction all >?0.05). Severe PTSD symptoms were significantly associated with the MetS in the Dutch [OR (95% CI)?=?1.71 (1.07–2.73)]. The South-Asian Surinamese, Turks and Moroccans showed weaker associations than the Dutch (p values for interaction all <?0.05). A depressed mood and severe PTSD symptoms did not interact in the association with the MetS (p values for interaction?>?0.05).

Conclusions

A depressed mood was consistently associated with the MetS across ethnic groups, but the association between severe PTSD symptoms and the MetS maybe ethnicity dependent. The association with the MetS was not different in case of depressed mood/severe PTSD symptoms comorbidity.

     

Mood instability, mental illness and suicidal ideas: results from a household survey

Purpose

There is weak and inconsistent evidence that mood instability (MI) is associated with depression, post traumatic stress disorder (PTSD) and suicidality although the basis of this is unclear. Our objectives were first to test whether there is an association between depression and PTSD, and MI and secondly whether MI exerts an independent effect on suicidal thinking over and above that explained by common mental disorders.

Methods

We used data from the Adult Psychiatric Morbidity Survey 2007 (N = 7,131). Chi-square tests were used to examine associations between depression and PTSD, and MI, followed by regression modelling to examine associations between MI and depression, and with PTSD. Multiple logistic regression analyses were used to assess the independent effect of MI on suicidal thinking, after adjustment for demographic factors and the effects of common mental disorder diagnoses.

Results

There are high rates of MI in depression and PTSD and the presence of MI increases the odds of depression by 10.66 [95 % confidence interval (CI) 7.51–15.13] and PTSD by 8.69 (95 % CI 5.90–12.79), respectively, after adjusting for other factors. Mood instability independently explained suicidal thinking, multiplying the odds by nearly five (odds ratio 4.82; 95 % CI 3.39–6.85), and was individually by some way the most important single factor in explaining suicidal thoughts.

Conclusions

MI is strongly associated with depression and PTSD. In people with common mental disorders MI is clinically significant as it acts as an additional factor exacerbating the risk of suicidal thinking. It is important to enquire about MI as part of clinical assessment and treatment studies are required.     

Shared Decision-Making: a Systematic Review Focusing on Mood Disorders

Purpose of Review

This study aims to provide a review of the randomized controlled studies evaluating the effects of shared decision-making (SDM) intervention in comparison to care as usual in patients with mood disorders.

Recent Findings

Of the 14 randomized controlled studies identified, only three 6-month studies evaluated the interest of SDM interventions using decision aids in depressed patients. All of them showed that the intervention effectively improved patient satisfaction and engagement in the decision-making process. Only one study in patients with bipolar disorder (BD) showed improvement of depressive symptoms, functioning, and quality of life. Other included studies were collaborative care interventions using a SDM approach in patients with depression in specific populations depending on age, gender, income, and physical comorbidities. All of them showed significant improvement in depression outcomes or medication adherence.

Summary

SDM interventions using decision aids and collaborative care showed evidence of improvements in the management of depression. Stronger evidence of SDM interest in BD is needed.

     

Risk Indicators of Depressed Mood Among Sex-Trade Workers and Implications for HIV Risk Behaviour

Objectives:

To determine the prevalence of depressed mood among people who have traded sex for money in the Saskatoon Health Region (SHR), the adjusted risk factors for depressed mood among this sample, and if depressed mood was associated with decreased self-efficacy for safe sexual practices and injection drug use.

Methods:

Two-hundred ninety-nine people who have traded sex for money were surveyed with validated instruments for measuring risk behaviours, depressed mood, and self-efficacy for safe sexual practices.

Results:

The sample consisted primarily of low-income, poorly educated Aboriginal women, many of whom also indicated using injection drugs. Using the 16-point score cut-off for the Center for Epidemiologic Studies Depression Scale, 84.6% of participants had depressed mood. When the cut-off score was 23 points or higher, 65.9% had depressed mood. After multivariate analysis, covariates that had an independent association with depressed mood included injecting a drug in the past 4 weeks (OR 1.59; 95% CI 1.2 to 1.8), suffering the death or permanent separation from a parent before the age of 18 (OR 2.09; 95% CI 1.05 to 4.15), and physical assault or abuse by a partner in adult life (OR 2.79; 95% CI 1.38 to 5.64). Depressed mood was associated with lower self-efficacy scores for safe sexual behaviours.

Conclusions:

Our study suggests that high rates of depressed mood among people who have traded sex for money is associated with injection drug use and low self-efficacy for safe sexual health practices. These findings are important and may help explain the high rates of human immunodeficiency virus within the SHR.     

Validation of the Mood and Feelings Questionnaire (MFQ) and Short Mood and Feelings Questionnaire (SMFQ) in New Zealand help‐seeking adolescents

Objective

This study examines the reliability and validity of the Mood and Feelings Questionnaire (MFQ) and Short Mood and Feelings Questionnaire (SMFQ) for measuring depression in New Zealand help‐seeking adolescents.

Method

A sample of 183 adolescents completed the 33‐item MFQ, which includes all 13 items on the SMFQ, at three time points during a trial of a computerized intervention for depression.

Results

Both the MFQ and SMFQ demonstrated good to excellent Cronbach's alphas, moderate to strong item‐total score correlations, moderate to strong correlations with quality of life and anxiety measures, and strong correlations with the clinician‐rated Children's Depression Rating Scale—Revised and the Reynolds Adolescent Depression Scale 2 at all time points, indicating good reliability and content, convergent, and concurrent validities, respectively. Favoring sensitivity over specificity, the optimal cut‐off value for differentiating depressed from nondepressed cases for the MFQ was ≥28 and for the SMFQ was ≥12. Both instruments demonstrated satisfactory diagnostic accuracy and sensitivity to change.

Conclusion

The MFQ and SMFQ are free and simple instruments that can be used to identify depression and measure symptom change in New Zealand help‐seeking adolescents.