Major depression in primary care: making the diagnosis.
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ABSTRACT:
SUBMITTER: Ng CW
PROVIDER: S-EPMC5331132 | biostudies-literature | 2016 Nov
REPOSITORIES: biostudies-literature
Publications
Major depression in primary care: making the diagnosis.
Ng Chung Wai Mark CW How Choon How CH Ng Yin Ping YP
Singapore medical journal 20161101 11
Major depression is a common condition seen in the primary care setting, often presenting with somatic symptoms. It is potentially a chronic illness with considerable morbidity, and a high rate of relapse and recurrence. Major depression has a bidirectional relationship with chronic diseases, and a strong association with increased age and coexisting mental illnesses (e.g. anxiety disorders). Screening can be performed using clinical tools for major depression, such as the Patient Health Questio ...[more]
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Project description:ObjectiveThis study aims to assess the measurement properties of the Major Depression Inventory (MDI) in a clinical sample of primary care patients.DesignGeneral practitioners (GPs) handed out the MDI to patients aged 18-65 years on clinical suspicion of depression.SettingThirty-seven general practices in the Central Denmark Region participated in the study.PatientsData for 363 patients (65% females, mean age: 49.8 years, SD: 17.7) consulting their GP were included in the analysis.Main outcome measuresThe overall fit to the Rasch model, individual item and person fit, and adequacy of response categories were tested. Statistical tests for local dependency, unidimensionality, differential item functioning, and correct targeting of the scale were performed. The person separation reliability index was calculated. All analyses were performed using RUMM2030 software.ResultsItems 9 and 10 demonstrated misfit to the Rasch model, and all items demonstrated disordered response categories. After modifying the original six-point to a five-point scoring system, ordered response categories were achieved for all 10 items. The MDI items seemed well targeted to the population approached. Model fit was also achieved for core symptoms of depression (items 1-3) and after dichotomization of items according to diagnostic procedure.ConclusionDespite some minor problems with its measurement structure, the MDI seems to be a valid instrument for identification of depression among adults in primary care. The results support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure. Key points The Major Depression Inventory (MDI) is widely used for screening, diagnosis and monitoring of depression in general practice. This study demonstrates misfit of items 9 and 10 to the Rasch model and a need to modify the scoring system The findings support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure. Minor problems with measurement structure should be addressed in future revisions of the MDI.
| S-EPMC6454403 | biostudies-literature
Project description:Objective: This study aimed to assess the measurement properties of the Major Depression Inventory (MDI) in a clinical sample of primary care patients. Design: General practitioners (GPs) handed out the MDI to patients aged 18-65 years on clinical suspicion of depression. Setting: Thirty-seven general practices in the Central Denmark Region participated in the study. Patients: Data for 363 patients (65% females, mean age: 49.8 years, SD: 17.7) consulting their GP were included in the analysis. Main outcome measures: The overall fit to the Rasch model, individual item and person fit, and adequacy of response categories were tested. Statistical tests for local dependency, unidimensionality, differential item functioning, and correct targeting of the scale were performed. The person separation reliability index was calculated. All analyses were performed using RUMM2030 software. Results: Items 9 and 10 demonstrated misfit to the Rasch model, and all items demonstrated disordered response categories. After modifying the original six-point to a five-point scoring system, ordered response categories were achieved for all 10 items. The MDI items seemed well targeted to the population approached. Model fit was also achieved for core symptoms of depression (items 1-3) and after dichotomization of items according to diagnostic procedure. Conclusion: Despite some minor problems with its measurement structure, the MDI seems to be a valid instrument for identification of depression among adults in primary care. The results support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure. Key points The Major Depression Inventory (MDI) is widely used for screening, diagnosis and monitoring of depression in general practice. This study demonstrates misfit of items 9 and 10 to the Rasch model and a need to modify the scoring system The findings support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure. Minor problems with measurement structure should be addressed in future revisions of the MDI.
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Project description:BackgroundMolecular biomarkers are promising tools to be routinely used in clinical psychiatry. Among psychiatric diseases, major depression disorder (MDD) has gotten attention due to its growing prevalence and morbidity.MethodsWe tested some peripheral molecular parameters such as serum mature Brain-Derived Neurotrophic Factor (mBDNF), plasma C-Reactive Protein (CRP), serum cortisol (SC), and the salivary Cortisol Awakening Response (CAR), as well as the Pittsburgh sleep quality inventory (PSQI), as part of a multibiomarker panel for potential use in MDD diagnosis and evaluation of disease's chronicity using regression models, and ROC curve.ResultsFor diagnosis model, two groups were analyzed: patients in the first episode of major depression (MD: n = 30) and a healthy control (CG: n = 32). None of those diagnosis models tested had greater power than Hamilton Depression Rating Scale-6. For MDD chronicity, a group of patients with treatment-resistant major depression (TRD: n = 28) was tested across the MD group. The best chronicity model (p < 0.05) that discriminated between MD and TRD included four parameters, namely PSQI, CAR, SC, and mBDNF (AUC ROC = 0.99), with 96% of sensitivity and 93% of specificity.ConclusionThese results indicate that changes in specific biomarkers (CAR, SC, mBDNF and PSQI) have potential on the evaluation of MDD chronicity, but not for its diagnosis. Therefore, these findings can contribute for further studies aiming the development of a stronger model to be commercially available and used in psychiatry clinical practice.
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Project description:BACKGROUND: A diagnosis of depression is common in primary care practices, but data are lacking on the prevalence in Canadian practices. We describe the prevalence of the diagnosis among men and women, patient characteristics and drug treatment in patients diagnosed with depression in the primary care setting in Canada. METHODS: Using electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network, we examined whether the prevalence of a depression diagnosis varied by patient characteristics, the number of chronic conditions and the presence of the following chronic conditions: hypertension, diabetes, chronic obstructive pulmonary disease, osteoarthritis, dementia, epilepsy and parkinsonism. We used regression models to examine whether patient characteristics and type of comorbidity were associated with a depression diagnosis. RESULTS: Of the 304 412 patients who had at least 1 encounter with their primary care provider between Jan. 1, 2011, and Dec. 31, 2012, 14% had a diagnosis of depression. Current or past smokers and women with a high body mass index had higher rates of depression. One in 4 patients with a diagnosis of depression also had another chronic condition; those with depression had 1.5 times more primary care visits. About 85% of patients with depression were prescribed medication, most frequently selective serotonin reuptake inhibitors, followed by atypical antipsychotics. INTERPRETATION: Our data provide information on the prevalence of a depression diagnosis in primary care and associations with being female, having a chronic condition, smoking history and obesity in women. Our findings may inform research and assist primary care providers with early detection and interventions in at-risk patient populations.
| S-EPMC4251512 | biostudies-literature
Project description:BackgroundThe Major Depression Inventory (MDI) is widely used in Danish general practice as a screening tool to assess depression in symptomatic patients. Nevertheless, no validation studies of the MDI have been performed. The aim of this study was to validate the web-based version of the MDI against a fully structured telephone interview in a population selected on clinical suspicion of depression (ie, presence of two or three core symptoms of depression) in general practice.Materials and methodsGeneral practitioners (GPs) invited consecutive persons suspected of depression to complete the web-based MDI in a primary care setting. The validation was based on the Munich-Composite International Diagnostic Interview (M-CIDI) by phone. GPs in the 22 practices in our study included 132 persons suspected of depression. Depression was rated as yes/no according to the MDI and M-CIDI. Sensitivity, specificity, and positive predictive value of the International Classification of Diseases, Tenth Revision (ICD-10) algorithms of the MDI were examined.ResultsAccording to the M-CIDI interview, 87.9% of the included population was depressed and 64.4% was severely depressed. According to the MDI scale, 59.1% of the population was depressed and 31.8% was severely depressed. The sensitivity of the MDI for depression was 62.1% (95% confidence interval [95% CI]: 52.6-70.9) and the specificity was 62.5% (95% CI: 35.4-84.8). The sensitivity for severe depression was 42.2% (95% CI: 30.6-52.4) and the specificity was 85.1% (95% CI: 71.7-93.8). The receiver operating curve showed an area under the curve of 0.66 (95% CI: 0.52-0.81) for any depression and of 0.72 (95% CI: 0.63-0.81) for severe depression.ConclusionThe MDI is a conservative instrument for diagnosing ICD-10 depression in a clinical setting compared to the M-CIDI interview. Only a few false-positive diagnoses were identified when the MDI was used on clinical suspicion of depression.
| S-EPMC5505538 | biostudies-literature