Prevalence estimation and validation of new instruments in psychiatric research: An application of latent class analysis and sensitivity analysis.

Prevalence and validation studies rely on imperfect reference standard (RS) diagnostic instruments which can bias prevalence and test characteristic estimates. We illustrate two methods to account for RS misclassification. Latent class analysis (LCA) combines information from multiple imperfect measures of an unmeasurable “latent” condition to estimate sensitivity (Se) and specificity (Sp) of each measure. Simple algebraic sensitivity analysis (SA) uses researcher-specified RS misclassification rates to correct prevalence and test characteristic estimates, and can succinctly summarize a range of scenarios with Monte Carlo simulation. We applied LCA to a validation study of a new substance use disorder (SUD) screener and a larger prevalence study. A traditional validation study analysis that assumed an error-free RS (SCID) estimated the screener had 86% Se/75% Sp. Validation study estimates from LCA were 91% Se/81% Sp (screener) and 73% Se/98% Sp (SCID). SA in the prevalence study suggested the prevalence of SUD was underestimated by 22% by assuming the SCID to be error-free. LCA and SA can assist investigators in relaxing the unrealistic assumption of perfect RSs in reporting prevalence and validation study results

Predictors of depression recovery in HIV-infected individuals managed through measurement-based care in infectious disease clinics

Treatment of comorbid chronic disease, such as depression, in people living with HIV/AIDS (PLWHA) increasingly falls to HIV treatment providers. Guidance in who will best respond to depression treatment and which patient-centered symptoms are best to target is limited

Knowledge, attitudes and practices regarding depression among primary health care providers in Fako division, Cameroon

Abstract Background Mental health and mental illness are often overlooked in the management of patients in our health services. Depression is a common mental disorder worldwide. Recognising and managing mental illnesses such as depression by primary health care providers (PHCPs) is crucial. This study describes the knowledge, attitudes and practices (KAP) of PHCPs regarding depression in Fako Division. Methods A cross-sectional study was conducted among PHCPs (general practitioners, nurses, pharmacy attendants and social workers) in public-owned health facilities in the four health districts in Fako Division. Participants were selected by a consecutive convenience sampling. A structured questionnaire including the Depression Attitude Questionnaire (DAQ) was used to collect information about their socio-demographic characteristics, professional qualifications and KAP about depression. Results The survey had a response rate of 56.7%. Most of the 226 participants (92.9%) were aware that depression needs medical intervention. Only 1.8% knew a standard tool used to diagnose depression. Two-thirds agreed that majority of the cases of depression encountered originate from recent misfortune. About 66% felt uncomfortable working with depressed patients. Also, 45.1% of PHCPs did not know if psychotropic drugs were available at pharmacies within their health area. Very few (15.2%) reported to have prescribed psychotropic drugs. Less than half (49.1%) of the participants had prior formal training in mental health. Conclusion PHCPs in Fako Division tend to have limited knowledge and poor attitudes regarding depression. Practices towards diagnosis and management of depression tend to be inadequate. There is an urgent need to train PHCPs in mental health in general and depression diagnosis and management in particular

The Depression Treatment Cascade in Primary Care: A Public Health Perspective

Major depressive disorder (MDD) is common and costly. Primary care remains a major access point for depression treatment, yet the successful clinical resolution of depression in primary care is uncommon. The clinical response to depression suffers from a “treatment cascade”: the affected individual must access health care, be recognized clinically, initiate treatment, receive adequate treatment, and respond to treatment. Major gaps currently exist in primary care at each step along this treatment continuum. We estimate that 12.5% of primary care patients have had MDD in the past year; of those with MDD, 47% are recognized clinically, 24% receive any treatment, 9% receive adequate treatment, and 6% achieve remission. Simulations suggest that only by targeting multiple steps along the depression treatment continuum (e.g. routine screening combined with collaborative care models to support initiation and maintenance of evidence-based depression treatment) can overall remission rates for primary care patients be substantially improved

Associations between prostate cancer-related anxiety and health-related quality of life

There are uncertainties about prostate cancer‐related anxiety's (PCRA) associations with health‐related quality of life (HRQOL) and major depression, and these could affect the quality of mental healthcare provided to prostate cancer patients. Addressing these uncertainties will provide more insight into PCRA and inform further research on the value of PCRA prevention. The goals of this study were to measure associations between PCRA and HRQOL at domain and subdomain levels, and to evaluate the association between PCRA and probable (ie, predicted major) depression

Role of Mediators in Reducing Antepartum Depressive Symptoms in Rural Low-Income Women Receiving a Culturally Tailored Cognitive Behavioral Intervention

Although cognitive behavioral interventions (CBIs) have demonstrated effectiveness for reducing depressive symptoms in the general population, the mechanism for reducing antepartum depressive symptoms (APDS) in rural low-income and minority women is unknown. This study tested the hypothesis that reducing stress and negative thinking, enhancing self-esteem, and increasing social-support will mediate the effect of a CBI on reducing APDS in rural low-income and minority women. Our findings show that CBI may work through reducing stress and negative thinking and enhancing self-esteem, but not social support. The findings also suggest that mental health care providers should emphasize these activities to reduce antepartum depressive symptoms

A national study of moral distress among U.S. internal medicine physicians during the COVID-19 pandemic

Background There have been no studies to date of moral distress during the COVID-19 pandemic in national samples of U.S. health workers. The purpose of this study was to determine, in a national sample of internal medicine physicians (internists) in the U.S.: 1) the intensity of moral distress; 2) the predictors of moral distress; 3) the outcomes of moral distress. Methods We conducted a national survey with an online panel of internists, representative of the membership of the American College of Physicians, the largest specialty organization of physicians in the United States, between September 21 and October 8, 2020. Moral distress was measured with the Moral Distress Thermometer, a one-item scale with a range of 0 (“none”) to 10 (“worst possible”). Outcomes were measured with short screening scales. Results The response rate was 37.8% (N = 810). Moral distress intensity was low (mean score = 2.4, 95% CI, 2.2–2.6); however, 13.3% (95% CI, 12.1% - 14.5%) had a moral distress score greater than or equal to 6 (“distressing”). In multiple linear regression models, perceived risk of death if infected with COVID-19 was the strongest predictor of higher moral distress (β (standardized regression coefficient) = 0.26, p < .001), and higher perceived organizational support (respondent belief that their health organization valued them) was most strongly associated with lower moral distress (β = -0.22, p < .001). Controlling for other factors, high levels of moral distress, but not low levels, were strongly associated (adjusted odds ratios 3.0 to 11.5) with screening positive for anxiety, depression, posttraumatic stress disorder, burnout, and intention to leave patient care. Conclusions The intensity of moral distress among U.S. internists was low overall. However, the 13% with high levels of moral distress had very high odds of adverse mental health outcomes. Organizational support may lower moral distress and thereby prevent adverse mental health outcomes

Investigating differences in treatment effect estimates between propensity score matching and weighting: A demonstration using STAR*D trial data

The choice of propensity score (PS) implementation influences treatment effect estimates not only because different methods estimate different quantities, but also because different estimators respond in different ways to phenomena such as treatment effect heterogeneity and limited availability of potential matches. Using effectiveness data, we describe lessons learned from sensitivity analyses with matched and weighted estimates

Prevalence and Comorbidity of Psychiatric Diagnoses Based on Reference Standard in an HIV+ Patient Population

To study the prevalence of psychiatric comorbidity based on reference standard diagnostic criteria in patients with human immunodeficiency virus (HIV). Psychiatric illness is common in patients with HIV and has been associated with negative health behaviors and poorer clinical outcomes. Among those persons with psychiatric illness, psychiatric comorbidity (multiple simultaneous diagnoses) is associated with increased psychiatric severity and higher HIV risk behaviors