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Villarreal-Zegarra D, Barrera-Begazo J, Otazú-Alfaro S, Mayo-Puchoc N, Bazo-Alvarez JC, Huarcaya-Victoria J. Sensitivity and specificity of the Patient Health Questionnaire (PHQ-9, PHQ-8, PHQ-2) and General Anxiety Disorder scale (GAD-7, GAD-2) for depression and anxiety diagnosis: a cross-sectional study in a Peruvian hospital population. BMJ Open 2023; 13:e076193. [PMID: 37714674 PMCID: PMC10510859 DOI: 10.1136/bmjopen-2023-076193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/21/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVES The Patient Health Questionnaire (PHQ) and Generalised Anxiety Disorder Scale (GAD) are widely used screening tools, but their sensitivity and specificity in low-income and middle-income countries are lower than in high-income countries. We conducted a study to determine the sensitivity and specificity of different versions of these scales in a Peruvian hospital population. DESIGN Our study has a cross-sectional design. SETTING Our participants are hospitalised patients in a Peruvian hospital. The gold standard was a clinical psychiatric interview following ICD-10 criteria for depression (F32.0, F32.1, F32.2 and F32.3) and anxiety (F41.0 and F41.1). PARTICIPANTS The sample included 1347 participants. A total of 334 participants (24.8%) were diagnosed with depression, and 28 participants (2.1%) were diagnosed with anxiety. RESULTS The PHQ-9's≥7 cut-off point showed the highest simultaneous sensitivity and specificity when contrasted against a psychiatric diagnosis of depression. For a similar contrast against the gold standard, the other optimal cut-off points were: ≥7 for the PHQ-8 and ≥2 for the PHQ-2. In particular, the cut-off point ≥8 had good performance for GAD-7 with sensitivity and specificity, and cut-off point ≥10 had lower levels of sensitivity, but higher levels of specificity, compared with the cut-off point of ≥8. Also, we present the sensitivity and specificity values of each cut-off point in PHQ-9, PHQ-8, PHQ-2, GAD-7 and GAD-2. We confirmed the adequacy of a one-dimensional model for the PHQ-9, PHQ-8 and GAD-7, while all PHQ and GAD scales showed good reliability. CONCLUSIONS The PHQ and GAD have adequate measurement properties in their different versions. We present specific cut-offs for each version.
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Affiliation(s)
- David Villarreal-Zegarra
- Escuela de Medicina, Universidad César Vallejo, Trujillo, Peru
- Instituto Peruano de Orientación Psicológica, Lima, Peru
| | | | | | | | - Juan Carlos Bazo-Alvarez
- Research Department of Primary Care and Population Health, University College London (UCL), London, UK
| | - Jeff Huarcaya-Victoria
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Ica, Peru
- Unidad de Psiquiatría de Enlace, Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
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Dickerson J, Kelly B, Lockyer B, Bridges S, Cartwright C, Willan K, Shire K, Crossley K, Bryant M, Siddiqi N, Sheldon TA, Lawlor DA, Wright J, McEachan RR, Pickett KE. 'When will this end? Will it end?' The impact of the March-June 2020 UK COVID-19 lockdown response on mental health: a longitudinal survey of mothers in the Born in Bradford study. BMJ Open 2022; 12:e047748. [PMID: 35017230 PMCID: PMC8753090 DOI: 10.1136/bmjopen-2020-047748] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/09/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To explore clinically important increases in depression/anxiety from before to during the first UK COVID-19 lockdown and factors related to this change, with a particular focus on ethnic differences. DESIGN Pre-COVID-19 and lockdown surveys nested within two longitudinal Born in Bradford cohort studies. PARTICIPANTS 1860 mothers with a child aged 0-5 or 9-13, 48% Pakistani heritage. MAIN OUTCOME MEASURES ORs for a clinically important increase (5 points or more) in depression (eight item Patient Health Questionnaire (PHQ-8)) and anxiety (Generalised Anxiety Disorder Assessment (GAD-7)) in unadjusted regression analyses, repeated with exposures of interest separated by ethnicity to look for differences in magnitude of associations, and lived experience of mothers captured in open text questions. RESULTS The number of women reporting clinically important depression/anxiety increased from 11% to 20% (95% CI 10%-13%; 18%-22%) and from 10% to 16% (95% CI 8%-11%; 15%-18%), respectively. Increases in depression/anxiety were associated with loneliness (OR=8.37, 95% CI 5.70 to 12.27; 8.50, 95% CI 5.71 to 12.65, respectively); financial (6.23, 95% CI 3.96 to 9.80; 6.03, 95% CI 3.82 to 9.51), food (3.33, 95% CI 2.09 to 5.28; 3.46, 95% CI 2.15 to 5.58) and housing insecurity (3.29, 95% CI 2.36 to 4.58; 3.0, 95% CI 2.11 to 4.25); a lack of physical activity (3.13, 95% CI 2.15 to 4.56; 2.55, 95% CI 1.72 to 3.78); and a poor partner relationship (3.6, 95% CI 2.44 to 5.43; 5.1, 95% CI 3.37 to 7.62). The magnitude of associations between key exposures and worsening mental health varied between ethnic groups.Responses to open text questions illustrated a complex interplay of challenges contributing to mental ill health including: acute health anxieties; the mental load of managing multiple responsibilities; loss of social support and coping strategies; pressures of financial and employment insecurity; and being unable to switch off from the pandemic. CONCLUSIONS Mental ill health has worsened for many during the COVID-19 lockdown, particularly in those who are lonely and economically insecure. The magnitude of associations between key exposures and worsening mental health varied between ethnic groups. Mental health problems may have longer term consequences for public health and interventions that address the potential causes are needed.
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Affiliation(s)
- Josie Dickerson
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Brian Kelly
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Bridget Lockyer
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Sally Bridges
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christopher Cartwright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Kathryn Willan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Katy Shire
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Kirsty Crossley
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | - Najma Siddiqi
- Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
| | - Trevor A Sheldon
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Wolfson Institute for Population Health, Queen Mary University of London and Barts and The London School of Medicine and Dentistry, London, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit, The University of Bristol, Bristol, UK
- Population Health Science, University of Bristol Medical School, Bristol, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rosemary Rc McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Faculty of Life Sciences, University of Bradford, Bradford, UK
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Costantini L, Pasquarella C, Odone A, Colucci ME, Costanza A, Serafini G, Aguglia A, Belvederi Murri M, Brakoulias V, Amore M, Ghaemi SN, Amerio A. Screening for depression in primary care with Patient Health Questionnaire-9 (PHQ-9): A systematic review. J Affect Disord 2021; 279:473-483. [PMID: 33126078 DOI: 10.1016/j.jad.2020.09.131] [Citation(s) in RCA: 221] [Impact Index Per Article: 73.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/17/2020] [Accepted: 09/27/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Depression is a leading cause of disability. International guidelines recommend screening for depression and the Patient Health Questionnaire 9 (PHQ-9) has been identified as the most reliable screening tool. We reviewed the evidence for using it within the primary care setting. METHODS We retrieved studies from MEDLINE, Embase, PsycINFO, CINAHL and the Cochrane Library that carried out primary care-based depression screening using PHQ-9 in populations older than 12, from 1995 to 2018. RESULTS Forty-two studies were included in the systematic review. Most of the studies were cross-sectional (N=40, 95%), conducted in high-income countries (N=27, 71%) and recruited adult populations (N=38, 90%). The accuracy of the PHQ-9 was evaluated in 31 (74%) studies with a two-stage screening system, with structured interview most often carried out by primary care and mental health professionals. Most of the studies employed a cut-off score of 10 (N=24, 57%, total range 5 - 15). The overall sensitivity of PHQ-9 ranged from 0.37 to 0.98, specificity from 0.42 to 0.99, positive predictive value from 0.09 to 0.92, and negative predictive value from 0.8 to 1. LIMITATIONS Lack of longitudinal studies, small sample size, and the heterogeneity of primary-care settings limited the generalizability of our results. CONCLUSIONS PHQ-9 has been widely validated and is recommended in a two-stage screening process. Longitudinal studies are necessary to provide evidence of long-term screening effectiveness.
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Affiliation(s)
- Luigi Costantini
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | | | - Anna Odone
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland; Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Vlasios Brakoulias
- School of Medicine, Western Sydney University, Blacktown Hospital, Sydney, NSW, Australia
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Nassir Ghaemi
- Department of Psychiatry, Tufts University, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Psychiatry, Tufts University, Boston, MA, USA
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The psychometric properties of depression screening tools in primary healthcare settings: A systematic review. J Affect Disord 2018; 225:503-522. [PMID: 28866295 DOI: 10.1016/j.jad.2017.08.060] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/04/2017] [Accepted: 08/20/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Consensus on a tool for depression screening among adults in primary healthcare (PHC) settings is lacking. This systematic review aimed to explore the psychometric properties of depression screening tools. METHODS A systematic literature search composed of four terms (screening AND psychometric AND depression AND primary healthcare) was conducted in PubMed, EMBASE, PsycINFO and MEDLINE, between January 1995 through October 2015. Studies that aimed to psychometrically test a depression screening tool among the general adult population in a PHC setting were included. Studies exploring the diagnostic properties of depression screening tools among specific populations were excluded. RESULTS Sixty publications, evaluating the psychometric properties of 55 tools or adaptations, were included. Studies were conducted in 24 countries and 18 languages on 48234 adults. The Patient Health Questionnaire-9 was the most evaluated tool with 14 studies evaluating its psychometric properties. Fifty-four studies reported on at least one measure of receiver operating characteristics. Sensitivity and specificity values ranged from 28% to 100% and 43% to 100%, respectively. Cronbach alpha values ranged from 0.56 to 0.94. Other forms of reliability and validity testing were less consistently and commonly reported. LIMITATIONS The inclusion of studies regardless of methodological quality or design may have limited generalizability, but allowed for a comprehensive and detailed overview of the current literature. CONCLUSIONS Depression screening tools vary in their psychometric properties. The PHQ-9 was the most extensively psychometrically tested tool. This systematic review may aid PHC professionals in choosing a depression screening tool for universal use as it provides a comprehensive overview of their psychometric properties.
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Husain N, Chaudhry N, Rhouma A, Sumra A, Tomenson B, Waheed W. Validation of the self-reporting questionnaire (SRQ 20) in British Pakistani and White European population in the United Kingdom. J Affect Disord 2016; 189:392-6. [PMID: 26499820 DOI: 10.1016/j.jad.2015.08.068] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/15/2015] [Accepted: 08/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The incidence of depression is difficult to determine because of low clinical depression detection rates in the primary care setting. This low level of detection is a significantly greater problem in people from ethnic minority communities. The availability of culturally validated screening questionnaires might help to improve the detection and treatment of depression. METHOD The aim of the study was to assess the validity of the self-reporting questionnaire SRQ 20, (English and Urdu versions) in white Europeans and British Pakistanis and to determine the optimum cut-off scores for detecting depression. Validation of the English and Urdu versions of the SRQ was conducted with a sample of white Europeans and British Pakistani participants. The semi-structured Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was used as the gold standard diagnostic interview, and receiver operating characteristic analysis was used to evaluate SRQ test performance. RESULTS The SRQ was completed by 1856 participants out of whom 651 completed the SCAN interview. The SRQ sensitivity, specificity, and predictive values versus SCAN indicated a cut-off score of 7 as optimum for white Europeans and a cut-off score of 6 for British Pakistanis. LIMITATIONS This study focused on depression alone and did not take into consideration comorbid conditions such as anxiety which might have affected the way respondents answered the questions and contributed to comparatively lower optimum cut-off scores in British Pakistanis. CONCLUSIONS The findings of this validation study provide evidence for high sensitivity and specificity of SRQ amongst both white Europeans and British Pakistanis. The SRQ can be used as a routine screening questionnaire for depression in English and Urdu speaking populations in the UK.
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Affiliation(s)
- Nusrat Husain
- University of Manchester, Jean McFarlane Building, University Place, Oxford Road, Manchester M13 9PL, UK; Lancashire Care NHS Foundation Trust, The Lantern Centre, Vicarage Lane, Preston PR2 8DY, UK.
| | - Nasim Chaudhry
- University of Manchester, Jean McFarlane Building, University Place, Oxford Road, Manchester M13 9PL, UK
| | - Abdulhakim Rhouma
- Lancashire Care NHS Foundation Trust, The Lantern Centre, Vicarage Lane, Preston PR2 8DY, UK
| | - Altaf Sumra
- Lancashire Care NHS Foundation Trust, The Lantern Centre, Vicarage Lane, Preston PR2 8DY, UK
| | - Barbara Tomenson
- University of Manchester, Jean McFarlane Building, University Place, Oxford Road, Manchester M13 9PL, UK
| | - Waquas Waheed
- Lancashire Care NHS Foundation Trust, The Lantern Centre, Vicarage Lane, Preston PR2 8DY, UK; NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Centre for Primary Care, University of Manchester, Manchester, UK
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Ferrari S, Burian R, Hahn E, Chaudhry N, Chaudhry IB, Husain N, Ta TMT, Diefenbacher A, Qureshi A, Berardi D, Braca M, Tarricone I. Somatization among ethnic minorities and immigrants: Why does it matter to Consultation Liaison Psychiatry? J Psychosom Res 2015; 79:85-6. [PMID: 25840950 DOI: 10.1016/j.jpsychores.2015.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 01/29/2015] [Accepted: 02/16/2015] [Indexed: 11/24/2022]
Affiliation(s)
- S Ferrari
- Department of Diagnostic-Clinical Medicine and Public Health, Section of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy.
| | - R Burian
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelical Hospital Königin Elisabeth Herzberge, Berlin, Germany.
| | - E Hahn
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Germany.
| | - N Chaudhry
- University of Manchester, Lancashire Care Early Intervention Service, Manchester, UK.
| | - I B Chaudhry
- University of Manchester, Lancashire Care Early Intervention Service, Manchester, UK.
| | - N Husain
- University of Manchester, Lancashire Care Early Intervention Service, Manchester, UK.
| | - T M T Ta
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelical Hospital Königin Elisabeth Herzberge, Berlin, Germany; Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Germany.
| | - A Diefenbacher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelical Hospital Königin Elisabeth Herzberge, Berlin, Germany
| | - A Qureshi
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - D Berardi
- Bologna Trans-cultural Psychosomatic Team, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy.
| | - M Braca
- Bologna Trans-cultural Psychosomatic Team, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - I Tarricone
- Bologna Trans-cultural Psychosomatic Team, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy.
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Dell'Osso B, Albert U, Atti AR, Carmassi C, Carrà G, Cosci F, Del Vecchio V, Di Nicola M, Ferrari S, Goracci A, Iasevoli F, Luciano M, Martinotti G, Nanni MG, Nivoli A, Pinna F, Poloni N, Pompili M, Sampogna G, Tarricone I, Tosato S, Volpe U, Fiorillo A. Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice. Neuropsychiatr Dis Treat 2015; 11:1885-909. [PMID: 26257524 PMCID: PMC4525786 DOI: 10.2147/ndt.s83130] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
More than half a century after their discovery, benzodiazepines (BDZs) still represent one of the largest and most widely prescribed groups of psychotropic compounds, not only in clinical psychiatry but also in the entire medical field. Over the last two decades, however, there has been an increased focus on the development of antidepressants and antipsychotics on the part of the pharmaceutical industry, clinicians, and researchers, with a reduced interest in BDZs, in spite of their widespread clinical use. As a consequence, many psychiatric residents, medical students, nurses, and other mental health professionals might receive poor academic teaching and training regarding these agents, and have the false impression that BDZs represent an outdated chapter in clinical psychopharmacology. However, recent advances in the field, including findings concerning epidemiology, addiction risk, and drug interactions, as well as the introduction of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with related diagnostic changes, strongly encourage an updated appraisal of the use of BDZs in clinical practice. During a recent thematic event convened with the aim of approaching this topic in a critical manner, a group of young Italian psychiatrists attempted to highlight possible flaws in current teaching pathways, identify the main clinical pros and cons regarding current use of BDZs in clinical practice, and provide an updated overview of their use across specific clinical areas and patient populations. The main results are presented and discussed in this review.
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Affiliation(s)
- Bernardo Dell'Osso
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy ; Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA
| | - Umberto Albert
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Torino, Italy
| | - Anna Rita Atti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Carrà
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Marco Di Nicola
- Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, Italy
| | - Silvia Ferrari
- Department of Diagnostic-Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Arianna Goracci
- Department of Molecular Medicine and Clinical Department of Mental Health, University of Siena, Siena, Italy
| | - Felice Iasevoli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging, and Clinical Science, University G.d Annunzio, Chieti-Pescara, Italy
| | - Maria Giulia Nanni
- Section of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Alessandra Nivoli
- Psychiatric Institute, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy ; Bipolar Disorder Unit, CIBERSAM, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Federica Pinna
- Department of Public Health, Clinical and Molecular Medicine, Unit of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Nicola Poloni
- Department of Clinical and Experimental Medicine, Psychiatric Division, University of Insubria, Varese, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Ilaria Tarricone
- Department of Medical and Surgical Sciences, Bologna University, Bologna, Italy
| | - Sarah Tosato
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Umberto Volpe
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Naples SUN, Naples, Italy
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Tarricone I, Stivanello E, Ferrari S, Colombini N, Bolla E, Braca M, Giubbarelli C, Costantini C, Cazzamalli S, Mimmi S, Tedesco D, Menchetti M, Rigatelli M, Maso E, Balestrieri M, Vender S, Berardi D. Migrant pathways to community mental health centres in Italy. Int J Soc Psychiatry 2012; 58:505-11. [PMID: 21813479 DOI: 10.1177/0020764011409523] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many studies indicate that migrants in western countries have limited access to and low utilization of community mental health centres (CMHCs) despite the high prevalence of mental disorders. AIMS We aimed to compare migrant pathways to care across four CMHCs located in different Italian provinces and to identify pathway to care predictors. METHODS Migrants attending the four CMHCs between 1 July 1999 and 31 December 2007 were included in the study. Data were gathered retrospectively from clinical data sets and chart review. RESULTS Five hundred and eleven (511) migrants attended the four CMHCs, 61% were referred by GPs or other health services and 39% followed non-medical pathways to care (self-referral or through social and voluntary organizations), with important site variations. Younger age and being married were predictors of medical pathways to care; lacking a residence permit and having a diagnosis of substance abuse were related to non-medical pathways. CONCLUSIONS Pathways to CMHCs are complex and influenced by many factors. Non-medical pathways to care seem to be frequent among migrants in Italy. More attention should be paid to developing psychiatric consultation liaison models that also encompass the social services and voluntary organizations.
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Naeem F, Ayub M, Masood K, Gul H, Khalid M, Farrukh A, Shaheen A, Waheed W, Chaudhry HR. Prevalence and psychosocial risk factors of PTSD: 18 months after Kashmir earthquake in Pakistan. J Affect Disord 2011; 130:268-74. [PMID: 21071091 DOI: 10.1016/j.jad.2010.10.035] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 10/17/2010] [Accepted: 10/17/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND On average in a year 939 earthquakes of a magnitude between 5 and 8 on the Richter scale occur around the world. In earthquakes developing countries are prone to large-scale destruction because of poor structural quality of buildings, and preparedness for earthquakes. On 8th October 2005, a major earthquake hit the remote and mountainous region of northern Pakistan and Kashmir. We wanted to find out the rate of PTSD in a randomly selected sample of participants living in earthquake area and the correlates of the PTSD. METHOD The study was conducted 18 months after the earthquake. We selected a sample of men and women living in the houses and tents for interviews. Using well established instruments for PTSD and general psychiatric morbidity we gathered information from over 1200 people in face to face interviews. We gathered information about trauma exposure and loss as well. RESULTS 55.2% women and 33.4% men suffered from PTSD. Living in a joint family was protective against the symptoms of PTSD. Dose of exposure to trauma was associated with the symptoms of PTSD. Living in a tent was associated with general psychiatric morbidity but not with PTSD. LIMITATIONS We used questionnaire instead of interviews to detect the symptoms of psychiatric disorders. CONCLUSIONS The symptoms of PTSD are common 18 months after the earthquake and they are specifically associated with the dose of trauma exposure. This may have implications for rehabilitation of this population.
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Affiliation(s)
- Farooq Naeem
- Lahore Institute of Research and Development, Lahore, Pakistan
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Tarricone I, Braca M, Atti AR, Pedrini E, Morri M, Poggi F, Melega S, Nolet M, Tonti L, Berardi D. Clinical features and pathway to care of migrants referring to the Bologna Transcultural Psychiatric Team. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/17542860802560314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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