Validation of the Beck Depression Inventory for a Portuguese-speaking Chinese community in Brazil

A Pilot Cross-Sectional Study on the Level of Depression and Physical Activity among Students in Poland and Portugal in the Second Year of the COVID-19 Pandemic

Objectives: The aim of the study was to make a preliminary assessment of depression rates and levels of physical activity and the association between physical activity and depression among Polish and Portuguese students in the second year of the COVID-19 pandemic. Methods: A web-based online survey was conducted among students in Poland and Portugal (398 respondents—229 from Poland and 169 from Portugal) aged between 17 and 26 in October 2022. The level of depression was assessed by the Beck Depression Inventory (BDI) in Polish and in Portuguese. The level of physical activity was measured by the International Physical Activity Questionnaire (IPAQ) in Polish and in Portuguese. Results: Overall, 20–35% of respondents suffered from moderate depression, with a lower proportion among men. There were no differences in the percentage distribution of depression classification between Polish and Portuguese students. A decrease in the severity of depression was observed with increasing physical activity. In both countries, walking more often had the strongest effect on reducing depression scores. Conclusions: The continued and alarming prevalence of depressive disorders among university students in the year after the pandemic began had a significant impact on this population—further research on the impact of physical activity on mental health in different populations should be conducted to adjust the optimal level of physical activity for alleviating negative psychiatric symptoms.

Effect of aquatic exercise on mental health, functional autonomy, and oxidative damages in diabetes elderly individuals

This study investigated the effect of aquatic exercise on mental health, functional autonomy, and oxidative dysfunction in elderly with DM2. A total of 104 elderly were included in the longitudinal clinical study and were attributed to the diabetes group (n = 30) and the non-diabetic group (n = 29). Both groups were involved in the aquatic exercise (nine exercises; 3 sets x 1-minute duration each; linear intensity and frequency measured twice a week) for 12 weeks. The assessments of mental health, functional autonomy, and oxidative dysfunction were done. All results were evaluated at baseline and 12 weeks later. The values of the following variable scores decreased in the DM2 group after participation in the aquatic exercise: depression (-56 ± 2 scores; 57%), anxiety (-8.2 ± 2 scores; 41%), stress (-3.1 ± 0.3 scores; 32%), and sleep (-3. 7 ± 1.3 points; 51%); an improvement in Berg scores was observed (+53.1 ± 2 points; 8%), Tug tests (-6.1 ± 0.7 points; 25%), carbonyl groups (-0.048 ± 0.01 nnmol/mg/protein; 49%), and total thiol (+0.33 ± 0.08 nnmol/mg/protein; 83%). We have concluded that a linear intensity aquatic exercise program improves mental health, functional autonomy, and oxidative dysfunction in elderly with DM2.

Oxidative Stress Biomarkers and Quality of Life Are Contributing Factors of Muscle Pain and Lean Body Mass in Patients with Fibromyalgia

Simple Summary

Fibromyalgia (FM) is a disease that primarily affects women and causes pain all over the body, as well as anxiety, depression, fatigue, weight gain, a decreased quality of life, and difficulties doing daily duties. Although the cause of this disease has yet to be identified, research have been completed or are under underway with the goal of uncovering clues that can explain the disease’s symptoms and proper treatment. Our research looked into whether factors that increase inflammation in the body cause disease symptoms to worsen. Pain, lean mass, quality of life, sleep quality, muscle strength, depression, and probable factors that cause these symptoms to aggravate were assessed in the blood. Women with FM with more pain had a lower quality of life, and women with FM with lower lean mass had muscle weakness in addition to a lower quality of life. Our results recommend that initiatives be implemented to reduce inflammation, improve muscle mass and strength gain and increase the quality of life of these women.

Abstract

(1) The evidence points to an increase in oxygen reactive species as one of the possible causes of fibromyalgia (FM). In addition, it is plausible that an imbalance in redox markers can be associated with pain amplification and dynapenia in FM patients. The aim of our study was to investigate possible factors associated with muscle pain and lean body mass in FM patients. (2) Methods: This was a quantitative, exploratory and cross-sectional study of 47 patients with FM (53.45 + 7.32 years). We evaluated self-perceptions of muscle pain, lean body mass, body composition, quality of life, sleep quality, depression index, muscle performance and oxidative stress biomarkers. (3) Results: We observed that lower blood levels of antioxidants and poor quality of life explained 21% of the greater muscle pain. In addition, high blood levels of oxidative stress, worse muscle performance and poor quality of life explained 27% of the lower lean mass in patients with FM. (4) Conclusions: Larger amounts of lipid peroxidation and reductions in antioxidant levels, in addition to lower muscle performance and poor life quality, are possible independent contributors to greater muscle pain and lower lean body mass in FM patients.

Level of Depression during the COVID-19 Pandemic in Poland—A Cross-Sectional Study

Objectives: The aim of this study was to assess the level of depression during the COVID-19 pandemic in Poland. Methods: The online survey was conducted among Polish adult citizens (204 respondents) with a positive SARS-CoV-2 test result. The level of depression was assessed by the Beck Depression Inventory in Polish. Results: Depressive symptoms of moderate or severe degree appeared in about every fourth person. Women were characterised with higher mean depression scores. In the group of men, significant correlations were found between mental condition and age—the higher the age, the higher the values of depression measures. Those who were asymptomatic with SARS-CoV-2 had the best results—a lack of depression, while those who were fully symptomatic had the worst results—major depressive disorder. Conclusions: There is a need for further research and monitoring of mental health in specific population groups. It is necessary to plan preventive measures to prevent the negative effects of the pandemic, especially in women. Specialist support should be implemented during and after the pandemic.

Amyloid-β PET Classification on Cognitive Aging Stages Using the Centiloid Scale

PROPOSE

This study aims to explore the use of the Centiloid (CL) method in amyloid-β PET quantification to evaluate distinct cognitive aging stages, investigating subjects' mismatch classification using different cut-points for amyloid-β positivity.

PROCEDURES

The CL equation was applied in four groups of individuals: SuperAgers (SA), healthy age-matched controls (AC), healthy middle-aged controls (MC), and Alzheimer's disease (AD). The amyloid-β burden was calculated and compared between groups and quantitative variables. Three different cut-points (Jack CR, Wiste HJ, Weigand SD, et al., Alzheimer's Dement 13:205-216, 2017; Salvadó G, Molinuevo JL, Brugulat-Serrat A, et al., Alzheimer's Res Ther 11:27, 2019; and Amadoru S, Doré V, McLean CA, et al., Alzheimer's Res Ther 12:22, 2020) were applied in CL values to differentiate the earliest abnormal pathophysiological accumulation of Aβ and the established Aβ pathology.

RESULTS

The AD group exhibited a significantly increased Aβ burden compared to the MC, but not AC groups. Both healthy control (MC and AC) groups were not significantly different. Visually, the SA group showed a diverse distribution of CL values compared with MC; however, the difference was not significant. The CL values have a moderate and significant relationship between Aβ visual read, RAVLT DR and MMSE. Depending on the cut-point used, 10 CL, 19 CL, or 30 CL, 7.5% of our individuals had a different classification in the Aβ positivity. For the AC group, we obtained about 40 to 60% of the individuals classified as positive.

CONCLUSION

SuperAgers exhibited a similar Aβ load to AC and MC, differing in cognitive performance. Independently of cut-point used (10 CL, 19 CL, or 30 CL), three SA individuals were classified as Aβ positive, showing the duality between the individual's clinics and the biological definition of Alzheimer's. Different cut-points lead to Aβ positivity classification mismatch in individuals, and an extra care is needed for individuals who have a CL value between 10 and 30 CL.

Depression as Compared to Level of Physical Activity and Internet Addiction among Polish Physiotherapy Students during the COVID-19 Pandemic

OBJECTIVES

The aim of the survey was to assess the level of depression correlated with physical activity and internet addiction among physiotherapy students of Polish universities during the COVID-19 pandemic.

METHODS

The survey was carried out via the internet among Polish physiotherapy students (141 respondents). The level of depression was assessed by the Beck Depression Inventory, physical activity by the International Physical Activity Questionnaire (IPAQ) in Polish and the level of internet addiction by the Kimberly Young Questionnaire.

RESULTS

It was found that 31% of those surveyed stated that they suffered from moderate or severe depression. The overwhelming majority of the respondents (92%) considered the level of their internet addiction as low. More physical activity had a positive effect on mental health. The overuse of the internet exacerbated depressive symptoms.

CONCLUSIONS

The prevalence of depression observed in students is mainly related to distant learning systems. Therefore, regular physical activity is recommended as it is associated with a lower level of depression. It is also advisable to provide students with necessary psychological care. Excessive use of social media is not recommended to elevate mood as it makes depression symptoms worse.

Circadian Strain, Light Exposure, and Depressive Symptoms in Rural Communities of Southern Brazil

Irregular light-dark cycles and circadian/sleep disturbances have been suggested as risk or co-occurring factors in depression. Among a set of metrics developed to quantify strain on the circadian system, social jetlag (SJL) has been put forward as a measure of the discrepancy between biological and social clocks. Here, we approached the question on whether light exposure and SJL would also be associated with depressive symptoms in Quilombola communities in Southern Brazil. These rural communities are void of potential confounders of modern lifestyles and show low levels of SJL. 210 Quilombolas (age range 16-92; 56% women) were asked about their sleep times and light exposure using the Munich ChronoType Questionnaire (MCTQ). The Beck Depression Inventory (BDI) was used to assess depressive symptoms. Additionally, we analyzed 7-day actimetry recordings in 124 subjects. BDI scores higher than 10 (having clinically significant depressive symptoms; controlled for age and sex in the multivariate analysis) were positively associated with SJL >1 h and negatively associated with median light exposure during the day, especially in the morning from 8:00 to 10:00. Our results suggest that low light exposure during the day, and higher levels of SJL are associated with depressive symptoms; longitudinal and experimental studies are needed to understand the underlying mechanisms. Nevertheless, we highlight the potential of treatment strategies aimed at decreasing circadian strain and insufficient light exposure, which are suggested as areas of further research in Psychiatry.

Effects of aquatic physiotherapy or health education program in women with fibromyalgia: a randomized clinical trial

Background: Different treatments have been proposed for Fibromyalgia, but only few studies have compared their effects on multiples outcomes over time. Objective: The objective of this study was to investigate the effects of aquatic physiotherapy (AP) or a health education program (HEP) in a sample of women with Fibromyalgia (FM). Methods: Forty-six women with FM, aged between 25 and 60 years old, whose BMI was less than 30, were assigned to either AP (27 women) or HEP (19 women) groups in a blind randomized clinical trial lasting eleven weeks. Pain (McGill Pain questionnaire), fatigue (Piper Fatigue Scale-Revised), functional capability (Fibromyalgia Impact questionnaire), anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory) and quality of sleep (Pittsburgh Sleep Quality Index) data were collected at baseline, after six weeks and post intervention. Two-factor mixed-model analysis of variance (ANOVAs) were used to examine the effects of the treatment on each outcome variable. Results: The AP and HEP interventions showed statistically significant within-group differences on all outcome measures except reducing the pain. Between-group differences was statistically significant only for impact of FM on the participant's life [F_(1.82,80.41) = 31,99; p ≤ 0.01] indicating that patients receiving HEP experienced a greater decrease in FIQ than those treated with AP. Conclusion: The findings do not allow to affirm that one intervention is superior to the other for the treatment of people with FM. Future studies should investigate whether the combination of HEP and PA can be effective and long-lasting.

Health literacy, depression, and stress among Chinese immigrants in South Korea

OBJECTIVES

This study examined health literacy, depression, and stress in Chinese immigrants living in South Korea, and analyzed factors related to these outcomes.

DESIGN

This is a cross-sectional, descriptive study.

SAMPLE

Participants were 128 adult Chinese immigrants living in the Jung-gu District of Seoul, South Korea. The majority of the participants were women and in their 40s; had a high school diploma; and were employed and married. Most had lived in Korea for 5-10 years.

MEASUREMENTS

Outcome variables were health literacy, depression, and immigrant stress; independent variables were sociodemographic characteristics, language proficiency, health, and behavioral factors. Hierarchical multiple regression models based on the conceptual framework were tested.

RESULTS

The major factor influencing health literacy was perceived economic status (p = 0.021). The factors related to depression were life satisfaction in China (p = 0.032), life satisfaction in Korea (p = 0.040), and stress perception in everyday life (p = 0.001).

CONCLUSIONS

As the number of immigrants rises, there is increasing demand for public-health-center-based health promotion programs for immigrants. It is recommended that local public health practitioners, including public health nurses, closely analyze the characteristics of their community and immigrants, and develop and implement customized programs accordingly.

Levels of 25-hydroxyvitamin D3, biochemical parameters and symptoms of depression and anxiety in healthy individuals

Growing evidence support the role of vitamin D in brain function and behavior. This study investigated the relationship between 25-hydroxyvitamin D₃ [25(OH)D₃] levels, biochemical profile and symptoms of depression and anxiety in healthy individuals. Symptoms of depression were assessed by the Beck Depression Inventory (BDI) and anxiety was evaluated with the State-Trait Anxiety Inventory (STAI). Our sample included 36 individuals, mostly women 27(75%), 36.39 ± 9.72 years old, non-smokers 31(86.1%), body mass index of 26.57 ± 3.92 kg/m², 27.95 ± 7.50% body fat. Participants were divided into those with 25(OH)D₃ levels lower than 40 ng/mL (mean 28.16 ± 7.07) and equal or higher than 40 ng/mL (mean 53.19 ± 6.32). Those with lower 25(OH)D₃ had higher levels of triacylglycerol, triacylglycerol/high density lipoprotein (HDL) ratio, high glucose and homeostatic model assessment of insulin resistance (HOMA-IR) index. No changes were observed in sociodemographic variables, body composition, inflammatory parameters and cortisol. Additionally, in the groups with low and high 25(OH)D₃ levels, STAI state, STAI trait and BDI scores were not statistically different. Levels of 25(OH)D₃ were inversely and independently associated with glucose and HOMA-IR, but not associated with triacylglycerol, depression and anxiety scores. Lower levels of 25(OH)D₃ were associated with dysfunction in glucose metabolism but not with depression and anxiety in healthy individuals.

Prevalence and factors associated with PTSD, anxiety and depression symptoms in Haitian migrants in southern Brazil

BACKGROUND

Prevalence rates of mental health disorders in migrants are controversial. The socio-historical and economic background of the host country may play an important role in the mental health status of migrants. As studies are mostly conducted in developed countries, researching migration in developing countries may add important information to scientific literature.

AIMS

This study aims to investigate the prevalence and factors associated with posttraumatic stress disorder (PTSD), anxiety and depression symptoms in Haitian migrants in southern Brazil.

METHODS

The sample comprises 66 participants selected from four different sites in three cities of a Brazilian southern state. Participants fulfilled a sociodemographic questionnaire, as well as instruments investigate traumatic events; post-migration difficulties and symptoms of PTSD, anxiety and depression. Linear regression models were utilized to investigate factors associated with PTSD, anxiety and depression symptoms.

RESULTS

PTSD prevalence in the sample was 9.1%. Depression and anxiety symptoms were in the clinical range of 10.6%-13.6% of participants, respectively. A number of traumatic events, acculturation difficulties, discrimination and low social support were associated with the investigated mental health disorders.

CONCLUSION

The results point to the importance of public policies in promoting better social and mental health support for migrants. Providing information to the Brazilian population about migration may improve receptiveness in the host society.

Depressive symptoms, quality of sleep, and disease control in women with asthma

PURPOSE

A large number of asthmatic patients, particularly females, present inadequate disease control. Depressive symptoms are reportedly common in asthma and have been related to poor disease control, but the mechanism of this association is still unclear. Poor quality sleep, frequently observed in asthmatics, is also a manifestation of depression and has been related to uncontrolled asthma. This study aimed to investigate the relationship between depressive symptoms, sleep quality, and asthma control.

METHODS

This was a cross-sectional study of 123 women with previous diagnosis of asthma from a reference center in Fortaleza, Brazil. Depressive symptoms were assessed by the Beck Depression Inventory (BDI); quality of sleep was evaluated by the Pittsburgh Sleep Quality Index (PSQI), daytime sleepiness by the Epworth Sleepiness Scale (ESS), and asthma control by the Asthma Control Test (ACT).

RESULTS

Inadequate asthma control (ACT <20) was found in 94 (76.4 %) subjects, depressive symptoms in 92 (74.8 %), poor quality sleep (PSQI >5) in 99 (80.49 %), and excessive daytime sleepiness (ESS ≥10) in 34 (27.64 %). Depressive symptoms were associated with both poor quality sleep (R = 0.326) and inadequate asthma control (R = -0.299). Regression analysis showed that depressive symptoms and sleep quality were independent predictors of the level of asthma control.

CONCLUSION

Asthma control in women is independently associated with depressive symptoms and quality of sleep, suggesting that these patients might benefit from simple measures to promote healthy sleep behavior and sleep hygiene and also that routine screening for depression can be relevant, particularly, in poorly controlled cases.

Adaptation and Latent Structure of the Swahili Version of Beck Depression Inventory-II in a Low Literacy Population in the Context of HIV

Objective

We set out to adapt the Beck Depression Inventory (BDI)-II in Kenya and examine its factorial structure.

Methods

In the first phase we carried out in-depth interviews involving 29 adult members of the community to elicit their understanding of depression and identify aspects of the BDI-II that required adaptation. In the second phase, a modified version of BDI-II was administered to 221 adults randomly selected from the community to allow for the evaluation of its psychometric properties. In the third phase of the study we evaluated the discriminative validity of BDI-11 by comparing a randomly chosen community sample (n = 29) with caregivers of adolescents affected by HIV (n = 77).

Results

A considerable overlap between the BDI symptoms and those generated in the interviews was observed. Relevant idioms and symptoms such as ‘thinking too much’ and ‘Kuchoka moyo (having a tired heart)’ were identified. The administration of the BDI had to be modified to make it suitable for the low literacy levels of our participants. Fit indices for several models (one factorial, two-factor model and a three factor model) were all within acceptable range. Evidence indicated that while multidimensional models could be fitted, the strong correlations between the factors implied that a single factor model may be the best suited solution (alpha [0.89], and a significant correlation with locally identified items [r = 0.51]) confirmed the good psychometric properties of the adapted BDI-II. No evidence was found to support the hypothesis that somatization was more prevalent. Lastly, caregivers of HIV affected adolescents had significantly higher scores compared to adults randomly selected from the community F(1, 121) = 23.31, p < .001 indicating the discriminative validity of the adapted BDI = II.

Conclusions

With an adapted administration procedure, the BDI-II provides an adequate measure of depressive symptoms which can be used alongside other measures for proper diagnosis in a low literacy population.

Quality of Life in Caregivers of ADHD Children and Diabetes Patients

INTRODUCTION

Studies have shown that the presence of attention-deficit hyperactivity disorder (ADHD) causes great impairment in academic, social, and professional activities as well as in the quality of life (QoL) of its patients. Similarly, the impact caused by other chronic disorders, such as diabetes, in the patient's QoL has been emphasized in many studies. Despite its relevance, no study has yet investigated whether ADHD caregivers and diabetic patients would have similar QoL impairment.

OBJECTIVES

This study was conducted in order to compare the QoL scores among ADHD caregivers and diabetic patients.

METHODS

We evaluated 63 caregivers of ADHD children treated at the Child and Adolescent Psychiatric Unit at the Federal University of São Paulo (UPIA-UNIFESP) and 52 adult diabetic patients. Subjects were assessed with the World Health Organization quality of Life-Bref Version (WHOQOL-BREF), the Beck and Hamilton depression scales, and the Adult Self-Report Scale.

RESULTS

When compared to the Brazilian normative data, ADHD caregivers had significantly lower scores in the social relations and environment WHOQOL domains. ADHD caregivers and diabetic patients had similar impairment in all WHOQOL domains except for the physical domain.

CONCLUSION

ADHD affects the QoL of the patient's caregiver, with similar impairment, when compared to the QoL of diabetic patients. These results emphasize the need for assessing QoL of the caregivers as part of the treatment strategies. They also emphasize the need for future studies with larger sample sizes comparing how the QOL is impacted in different chronic disorders.

Brief psychological intervention after self-harm: randomised controlled trial from Pakistan

BACKGROUND

Self-harm is a major risk factor for completed suicide.

AIMS

To determine the efficacy of a brief psychological intervention - culturally adapted manual-assisted problem-solving training (C-MAP) - delivered following an episode of self-harm compared with treatment as usual (TAU).

METHOD

The study was a randomised controlled assessor-masked clinical trial (trial registration: ClinicalTrials.gov NCT01308151). All patients admitted after an episode of self-harm during the previous 7 days to the participating medical units of three university hospitals in Karachi, Pakistan, were included in the study. A total of 250 patients were screened and 221 were randomly allocated to C-MAP plus treatment as usual (TAU) or to TAU alone. All patients were assessed at baseline, at 3 months (end of intervention) and at 6 months after baseline. The primary outcome measure was reduction in suicidal ideation at 3 months. The secondary outcome measures included hopelessness, depression, coping resources and healthcare utilisation.

RESULTS

A total of 108 patients were randomised to the C-MAP group and 113 to the TAU group. Patients in the C-MAP group showed statistically significant improvement on the Beck Scale for Suicide Ideation and Beck Hopelessness Inventory, which was sustained at 3 months after the completion of C-MAP. There was also a significant reduction in symptoms of depression compared with patients receiving TAU.

CONCLUSIONS

The positive outcomes of this brief psychological intervention in patients attempting self-harm are promising and suggest that C-MAP may have a role in suicide prevention.

Assessment of depression in medical patients: a systematic review of the utility of the Beck Depression Inventory-II

To perform a systematic review of the utility of the Beck Depression Inventory for detecting depression in medical settings, this article focuses on the revised version of the scale (Beck Depression Inventory-II), which was reformulated according to the DSM-IV criteria for major depression. We examined relevant investigations with the Beck Depression Inventory-II for measuring depression in medical settings to provide guidelines for practicing clinicians. Considering the inclusion and exclusion criteria seventy articles were retained. Validation studies of the Beck Depression Inventory-II, in both primary care and hospital settings, were found for clinics of cardiology, neurology, obstetrics, brain injury, nephrology, chronic pain, chronic fatigue, oncology, and infectious disease. The Beck Depression Inventory-II showed high reliability and good correlation with measures of depression and anxiety. Its threshold for detecting depression varied according to the type of patients, suggesting the need for adjusted cut-off points. The somatic and cognitive-affective dimension described the latent structure of the instrument. The Beck Depression Inventory-II can be easily adapted in most clinical conditions for detecting major depression and recommending an appropriate intervention. Although this scale represents a sound path for detecting depression in patients with medical conditions, the clinician should seek evidence for how to interpret the score before using the Beck Depression Inventory-II to make clinical decisions.

Effects of passive upper extremity joint mobilization on pain sensitivity and function in participants with secondary carpometacarpal osteoarthritis: a case series

OBJECTIVE

The purpose of this case series is to report on the effects of passive joint mobilization (PJM) of the shoulder, elbow, and wrist on pain intensity, pain sensitivity, and function in elderly participants with secondary carpometacarpal osteoarthritis (CMC OA).

METHODS

Fifteen inpatients from the Department of Physical Therapy, Residenze Sanitarie Assistenziali, Collegno (Italy), with secondary CMC OA (70-90 years old) were included in this study. All patients received PJM of the dominant arm (shoulder, elbow, and wrist) for 4 sessions for 2 weeks. Pain severity was measured by visual analog scale, and pain sensitivity was measured with pressure pain threshold (PPT) at CMC joint, at the tubercle of the scaphoid bone, and at the unciform apophysis of the hamate bone. Tip and tripod pinch strength were measured by a pinch gauge.

RESULTS

Passive joint mobilization reduced pain severity after the first follow-up by 30%, in addition to increased PPT by 13% in the hamate bone. Strength was enhanced after treatment. Tripod pinch increased by 18% in the dominant hand after treatment.

CONCLUSIONS

This case series provides preliminary evidence that PJM of upper extremity joints diminished pain and may increase PPT tip and tripod pinch in some participants with secondary CMC OA.

The effectiveness of a manual therapy and exercise protocol in patients with thumb carpometacarpal osteoarthritis: a randomized controlled trial

STUDY DESIGN

Double-blind, randomized controlled trial.

OBJECTIVE

To examine the effectiveness of a manual therapy and exercise approach relative to a placebo intervention in individuals with carpometacarpal (CMC) joint osteoarthritis (OA).

BACKGROUND

Recent studies have reported the outcomes of exercise, joint mobilization, and neural mobilization interventions used in isolation in patients with CMC joint OA. However, it is not known if using a combination of these interventions as a multimodal approach to treatment would further improve outcomes in this patient population.

METHODS

Sixty patients, 90% female (mean ± SD age, 82 ± 6 years), with CMC joint OA were randomly assigned to receive a multimodal manual treatment approach that included joint mobilization, neural mobilization, and exercise, or a sham intervention, for 12 sessions over 4 weeks. The primary outcome measure was pain. Secondary outcome measures included pressure pain threshold over the first CMC joint, scaphoid, and hamate, as well as pinch and strength measurements. All outcome measures were collected at baseline, immediately following the intervention, and at 1 and 2 months following the end of the intervention. Mixed-model analyses of variance were used to examine the effects of the interventions on each outcome, with group as the between-subject variable and time as the within-subject variable.

RESULTS

The mixed-model analysis of variance revealed a group-by-time interaction (F = 47.58, P<.001) for pain intensity, with the patients receiving the multimodal intervention experiencing a greater reduction in pain compared to those receiving the placebo intervention at the end of the intervention, as well as at 1 and 2 months after the intervention (P<.001; all group differences greater than 3.0 cm, which is greater than the minimal clinically important difference of 2.0 cm). A significant group-by-time interaction (F = 3.19, P = .025) was found for pressure pain threshold over the hamate bone immediately after the intervention; however, the interaction was no longer significant at 1 and 2 months postintervention.

CONCLUSION

This clinical trial provides evidence that a combination of joint mobilization, neural mobilization, and exercise is more beneficial in treating pain than a sham intervention in patients with CMC joint OA. However, the treatment approach has limited value in improving pressure pain thresholds, as well as pinch and grip strength. Future studies should include several therapists, a measure of function, and long-term outcomes.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN37143779.

LEVEL OF EVIDENCE

Therapy, level 1b.

Radial nerve mobilisation had bilateral sensory effects in people with thumb carpometacarpal osteoarthritis: a randomised trial

QUESTION

In people with thumb carpometacarpal osteoarthritis, does radial nerve mobilisation to the affected hand reduce pressure pain sensitivity in the contralateral hand?

DESIGN

Secondary analysis of data from a randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis.

PARTICIPANTS

Sixty people with thumb CMC osteoarthritis in the dominant hand aged 70-90 years.

INTERVENTIONS

The experimental group received sliding mobilisation of the radial nerve and the control group received a non-therapeutic dose of intermittent ultrasound, on the affected side for six sessions over four weeks.

OUTCOME MEASURES

On the contralateral side, pressure pain thresholds at the lateral epicondyle, thumb CMC joint, tubercle of the scaphoid bone, and hamate bone were assessed before and after the intervention with follow-up at 1 and 2 months.

RESULTS

No important baseline differences were noted between groups. At the end of the intervention period, the experimental group had significantly a higher (ie, better) pressure pain threshold than the control group at the lateral epicondyle by 1.5kg/cm(2) (95% CI 0.2 to 2.2), CMC joint by 1.2kg/cm(2) (95% CI 0.5 to 2.0), scaphoid bone by 1.0kg/cm(2) (95% CI 0.2 to 1.8) and hamate bone by 1.9kg/cm(2) (95% CI 1.0 to 2.7). Although mean values in the experimental group remained better than the control group at all sites at both follow-up assessments, these differences were not statistically significant.

CONCLUSION

Radial nerve gliding applied to the symptomatic hand induced hypoalgesic effects on the contralateral hand in people with CMC osteoarthritis, suggesting bilateral hypoalgesic effects of the intervention.

Enhancing rigour in the validation of patient reported outcome measures (PROMs): bridging linguistic and psychometric testing

Background

A strong consensus exists for a systematic approach to linguistic validation of patient reported outcome measures (PROMs) and discrete methods for assessing their psychometric properties. Despite the need for robust evidence of the appropriateness of measures, transition from linguistic to psychometric validation is poorly documented or evidenced. This paper demonstrates the importance of linking linguistic and psychometric testing through a purposeful stage which bridges the gap between translation and large-scale validation.

Findings

Evidence is drawn from a study to develop a Welsh language version of the Beck Depression Inventory-II (BDI-II) and investigate its psychometric properties. The BDI-II was translated into Welsh then administered to Welsh-speaking university students (n = 115) and patients with depression (n = 37) concurrent with the English BDI-II, and alongside other established depression and quality of life measures. A Welsh version of the BDI-II was produced that, on administration, showed conceptual equivalence with the original measure; high internal consistency reliability (Cronbach’s alpha = 0.90; 0.96); item homogeneity; adequate correlation with the English BDI-II (r = 0.96; 0.94) and additional measures; and a two-factor structure with one overriding dimension. Nevertheless, in the student sample, the Welsh version showed a significantly lower overall mean than the English (p = 0.002); and significant differences in six mean item scores. This prompted a review and refinement of the translated measure.

Conclusions

Exploring potential sources of bias in translated measures represents a critical step in the translation-validation process, which until now has been largely underutilised. This paper offers important findings that inform advanced methods of cross-cultural validation of PROMs.

Sample size requirements for the internal validation of psychiatric scales

The ratio of subjects to variables (N/p), as a rule to calculate the sample size required in internal validity studies on measurement scales, has been recommended without any strict theoretical or empirical basis being provided. The purpose of the present study was to develop a tool to determine sample size for these studies in the field of psychiatry. First, a literature review was carried out to identify the distinctive features of psychiatric scales. Then, two simulation methods were developed to generate data according to: (1) the model for factor structure derived from the literature review and (2) a real dataset. This enabled the study of the quality of solutions obtained from principal component analysis or Exploratory Factor Analysis (EFA) on various sample sizes. Lastly, the influence of sample size on the precision of Cronbach's alpha coefficient was examined. The N/p ratio rule is not upheld by this study: short scales do not allow smaller sample size. As a rule of thumb, if one's aim is to reveal the factor structure, a minimum of 300 subjects is generally acceptable but should be increased when the number of factors within the scale is large, when EFA is used and when the number of items is small.

Short-term effects of neurodynamic mobilization in 15 patients with secondary thumb carpometacarpal osteoarthritis

OBJECTIVE

The purpose of this study is to evaluate whether neurodynamic mobilization of the median nerve improves pressure pain threshold (PPT) and pinch and grip strength in patients with secondary thumb carpometacarpal osteoarthritis (TCOA).

METHOD

Fifteen patients with secondary TCOA (13 women and 2 men) between 70 and 90 years old were received by neurodynamic therapy. All patients received median nerve mobilization of the dominant hand by sliding technique during 4 sessions over 2 weeks. The outcome measures of this case series were monitored by using PPT measured by algometry as PPT at the trapeziometacarpal (TM) joint, tubercle of the scaphoid bone, and the unciform apophysis of the hamate bone. Tip and tripod pinch strength was also measured. Grip strength was measured by a grip dynamometer. These variables were measured at pretreatment, 5 minutes posttreatment, 1 week (first follow-up [FU]) and 2 weeks after treatment (second FU).

RESULTS

Pressure pain threshold in the TM joint was 3.54 ± 0.04 kg/cm(2). After treatment, it increased to 4.38 ± 0.04 kg/cm(2) (P < .01) and maintained in the first FU (4.27 ± 0.04 kg/cm(2), P < .02) and second FU (4.08 ± 0.04 kg/cm(2), P < .02). In contrast, we found no differences in PPT in the other studied structures after treatment. Similarly, tip and tripod pinch strength remained without change after treatment. Grip strength was 10.77 ± 0.18 kg, and after treatment, it increased to 11.55 ± 0.16 kg (P < .05) and maintained in first FU (11.73 ± 0.18 kg, P < .02) and second FU (11.2 ± 0.17 kg, P < .05).

CONCLUSIONS

Median nerve mobilization decreased pain in the TM joint and increased grip strength in this group of patients with TCOA.

The Portuguese Version of the Beck Depression Inventory-II (BDI-II)

Beck Depression Inventory-II (BDI-II) is one of the most popular and widely investigated instruments for assessing the severity of depressive symptomatology. The authors developed a Portuguese version of the inventory. This paper presents two studies: one with a college student sample (n = 547) and another with a community sample (n = 200). Reliability, factor structure, and validity data were obtained. The Portuguese version presents a good internal consistency, a factor structure very similar to the one obtained by Beck, Steer, and Brown (1996 ) with the original version, and presents an adequate convergent validity with the Center for Epidemiologic Studies of Depression Scale. Confirmatory factor analysis provides support for the fit of a two-factor model.

Depressive morbidity and gender in community-dwelling Brazilian elderly: systematic review and meta-analysis

BACKGROUND

Although studies indicate that community-dwelling elderly have a lower prevalence of major depression compared with younger age groups, prevalence estimates in Brazil show that clinically significant depressive symptoms (CSDS) and depression are frequent in the older population. However, a systematic review and meta-analysis of prevalence of and factors associated with depressive disorders and symptoms in elderly Brazilians has not previously been reported. The aims were (i) to perform a survey of studies dating from 1991 to 2009 on the prevalence of depressive disorders and CSDS in elderly Brazilians residing in the community; (ii) to determine depression prevalence and identify associated factors; and (iii) develop a meta-analysis to indicate the combined prevalence and the influence of gender on depressive morbidity in this population.

METHODS

Studies were selected from articles dated between January 1991 and May 2009, extracted from Medline, LILACS and SciELO databases.

RESULTS

A total of 17 studies were found, 13 with CSDS, 1 with major depression alone and 3 with major depression and dysthymia, involving the evaluation of 15,491 elderly people. The average age of participants varied between 66.5 and 84.0 years. Prevalence rates of 7.0% for major depression, 26.0% for CSDS, and 3.3% for dysthymia were found. The odds ratios for major depression and CSDS were greater among women. There was a significant association between major depression or CSDS and cardiovascular diseases.

CONCLUSION

The review indicates greater prevalence of both major depression and CSDS compared to rates reported in the international literature, while the prevalence of dysthymia was found to be similar. The high prevalence of CSDS and its significant association with cardiovascular diseases reinforces the importance of evaluating subthreshold depressive symptoms in the elderly in the community.

A narrative review of the Beck Depression Inventory (BDI) and implications for its use in an alcohol-dependent population

The findings from the present study reveal that the Beck Depression Inventory (BDI) is a reliable and valid instrument for measuring depression in a variety of populations. This realization should enable nurses and other health professionals to utilize the tool with added confidence and assurance. * The main finding was that the BDI would probably be a reliable and valid screening tool in an alcohol-dependent population. This conclusion appears to echo the relationship that alcohol consumption generally has with depression. This finding is important to those practitioners using the BDI in this population in that it provides further evidence to enhance their practical experience. Abstract A psychometric evaluation of the Beck Depression Inventory (BDI) was carried out on contemporary studies to ascertain its suitability for use in an alcohol-dependent population. Three criteria were used for this: factor analysis, test-retest reliability and internal consistency reliability. Factor analysis revealed that its structure is consistent with either two or three factor models, depending on the population. Test-retest results concluded that the correlation coefficient remained above the recommended threshold and internal consistency reliability highlighted alpha coefficient results consistently above suggested scores, leading to the conclusion that the BDI is probably an effective screening tool in an alcohol-dependent population.

The mental health of Korean immigrants in São Paulo, Brazil

This study investigated the frequency of lifetime mental disorders among Korean immigrants in the city of São Paulo, Brazil. Snowball sampling with multiple focuses was used to recruit Korean immigrants older than 18 years and living in São Paulo. A total of 324 Korean immigrants were selected and their mental status was evaluated using a structured interview, namely the Portuguese or the Korean version of the Composite International Diagnostic Interview 2.1. The diagnoses of mental disorders were made according to the ICD-10. The frequency of any lifetime psychiatric disorder was 41.9%. The frequencies of main disorders were: anxiety disorder, 13% (post-traumatic stress disorder, 9.6%); mood disorder, 8.6%; somatoform disorders, 7.4%; dissociative disorder, 4.9%; psychotic disorder, 4.3%; eating disorder, 0.6%; any substance (tobacco, alcohol, drugs) use disorder, 23.1%. The frequency of any psychiatric disorder except alcohol and tobacco use disorders was 26.2%. Korean immigrants have more psychiatric disorders than the Korean population in Korea, particularly post-traumatic stress disorder, and almost the same rate as the Brazilian population. Mental health authorities should promote a healthier integration and the development of culturally sensitive mental health programs for Korean immigrants.

Cross-cultural equivalence of the Beck Depression Inventory: a five-country analysis from the ODIN study

BACKGROUND

The Beck Depression Inventory (BDI) has demonstrated excellent psychometric properties and good performance as a screening measure in different contexts and languages. However, comparison of its structure across countries and languages remains understudied. Measurement invariance is a prerequisite for considering the BDI equivalent across versions, and for using it to make valid and interpretable comparisons of the severity of depression among different groups.

METHODS

As part of a five-country (UK, Ireland, Spain, Norway, and Finland), two-stage epidemiological study of depressive disorder, 7934 persons were screened using the BDI. The item equivalence and measurement invariance of the BDI across the samples of the five countries was tested using Item Response Theory (IRT) and Multiple Indicators Multiple Causes (MIMIC) models.

RESULTS

Overall results support the factorial validity of the BDI, with a unidimensional structure. Item 19 (weight loss) presented a clear misfit in the five countries. IRT models, as well as MIMIC models, suggest that complete measurement invariance cannot be assumed across the five countries. The Spanish sample accounted for the majority of the differences, with a moderate to low Differential Item Functioning for the other countries on the different items.

CONCLUSIONS

The BDI could be used cross-culturally in Europe, with particular cautions regarding the Spanish sample, and with the constraints and limits pointed out for the present results. The methodology used for the present work is suggested as a soundness approach for testing the cross-cultural validity of severity rating scales.

Validity of the Beck Depression Inventory in the postpartum period

Objective. While there is a recommendation to screen for postpartum depression (PPD), there are worries about the validity of instruments other than the Edinburgh Postnatal Depression Scale; little is known about the construct validity of one of the most used screening instruments, the Beck Depression Inventory, in this period. Methods. This study evaluated the validity and reliability of the BDI in a population-based sample of women and their spouses (n=772) in the postpartum. Additionally, we compared factor scores within the couple. Results. Exploratory factor analysis demonstrated a two-factor solution (depressive symptoms and somatic symptoms), accounting for 44.01% of the total variance. Internal consistency was good (Cronbach's α=0.90). Women had higher scores than their partners in both factors (P<0.001), but not a higher proportion of the total score attributable to somatic symptoms. Conclusion. With little factor variance between women and men, and a similar proportion of somatic symptoms, these results should be taken to reinforce the validity of the BDI in the postpartum.

Inventário de Depressão de Beck - BDI: validação fatorial para mulheres com câncer

Este estudo teve por objetivo validar fatorialmente o Inventário de Depressão de Beck - BDI para uma amostra de 208 mulheres com câncer. A validação fatorial do BDI foi realizada por meio da análise fatorial, método de extração dos componentes principais e rotação oblimin, tendo sido identificadas duas soluções fatoriais, uma bifatorial - sendo F1 composto por 8 itens (a = 0,82) denominado "visão negativa de si mesmo", explicando 32,4% da variância e F2 com 5 itens (a = 0,77) denominado "função física", explicando 8% da variância - e outra unifatorial com 13 itens, com fidedignidade altamente satisfatória (a = 0,86) denominada "depressão", explicando 38% da variância total.