Psychiatric screening of alcohol and drug patients: the validity of the GHQ-60

Comparison of psychiatric comorbidity in treatment-seeking, opioid-dependent patients with versus without chronic pain

AIM

To compare psychiatric morbidity in treatment-seeking, opioid-dependent patients with versus without chronic pain.

DESIGN

A retrospective comparative cohort design was used involving record linkage from routinely collected, nationally held data sets. Data were managed within a Scottish Government-certified Safe Haven.

SETTING AND PARTICIPANTS

Participants comprised all patients of an NHS Substance Misuse Service in the East of Scotland (n = 467) who were in treatment during 2005 and had been in treatment for varying lengths of time. Their mean age at study inception was 35.0 years in the chronic pain group and 32.1 years; 68% of the chronic pain group and 74% of the no pain group were male.

MEASUREMENTS

The outcomes were (a) psychiatric comorbidity assessed at study inception using the 28-item General Health Questionnaire and the Clinical Outcomes in Routine Evaluation-Outcome Measure and (b) receipt of at least one prescription for a psychiatric condition during a 5-year period following study inception. The independent variable was chronic pain measured at study inception using the Brief Pain Inventory-Short Form.

FINDINGS

A total of 246 (52.7%) reported chronic pain and 221 (47.3%) did not. A higher proportion of patients with chronic pain had at least one psychiatric morbidity (62.4 versus 46.3%, P < 0.001). At the study inception, a higher proportion of patients with chronic pain were prescribed anxiolytics (49.0 versus 39.1%, P = 0.015) and antimanic drugs (9.9 compared with 4.9%, P = 0.015).

CONCLUSIONS

Patients of opioid treatment services in Scotland who report chronic pain may have a higher prevalence of psychiatric comorbidity than those who do not.

The use of the hospital anxiety and depression scale in an outpatient alcohol treatment clinic

Objectives: To validate the hospital anxiety and depression scale (HAD) in an outpatient alcohol treatment centre.

Methods: Forty three patients referred to an alcohol outpatient treatment centre completed the HAD which was validated against the external criteria of the Montgomery-Asberg Depression Rating Scale and the Clinical Anxiety Scale.

Results: The HAD performed well operating at a cut-off of 7/8 for the depression scale and for the anxiety scale of the HAD the optimal cut-off value was 10/11.

Conclusion: The HAD is acceptable to patients and its use in alcohol treatment clinics is recommended as a screening instrument for anxiety and depression which can easily be administered by non-psychiatrists.

Suicide attempts in a sample of patients from a general hospital

BACKGROUND

Suicide in Mexico has risen steadily in recent years, increasing by 156% in the last two decades. The study of suicide precursors, such as suicide attempts, has also become an important public health topic. The aim of this study is to establish the prevalence of suicide attempts in a general hospital setting and its association with alcohol, depression, and other factors.

METHODS

A cross-sectional survey of a sample of patients was carried out in all three service units (inpatient, outpatient, and the emergency room) of a general hospital in Mexico City. All patients were randomly selected to participate regardless of the reason for initial hospital admission. Each patient was administered a series of psychological and demographic scales including the Beck Depression Inventory, the Beck Hopelessness Inventory, the General Health Questionnaire, a suicide assessment scale, a scale for alcohol consumption, and several measurements of alcohol-related problems.

RESULTS

The final sample was made up of 1,094 patients of both genders (68% women), aged 18-65 years. A lifetime prevalence of suicide attempts of 6.1% (95% confidence interval [CI] of 4.7-7.7%) was found. Multiple logistic regression was used to obtain estimations of the association between lifetime suicide attempt and other factors. Marital status, age, depressed mood, hopelessness, Goldberg's 30-item version of the General Health Questionnaire, and high levels of alcohol consumption were all associated with the suicide attempt.

CONCLUSIONS

Prevalence of lifetime suicide attempts was mainly related to being young, divorced, or widowed, and to feeling depressed, hopeless, and under undesirable psychological distress.

Concordance between two measures of depression in the Hispanic Health and Nutrition Examination Survey

A concordance analysis between the Center for Epidemiologic Studies Depression Scale (CES-D) and the National Institute of Mental Health (NIMH) Diagnostic Interview Schedule (DIS) for current major depression was conducted using data from Cuban Americans and Puerto Rican respondents to the Hispanic Health and Nutrition Examination Survey (HHANES). Overall agreement between the two depression measures was relatively high, which suggested that the CES-D might be appropriate as a first-stage screening instrument for community-based surveys of clinical depression. Female gender and indicators of social class (education, income, poverty index, and employment) were related to low specificity and low agreement. The estimated cutoff points of the CES-D that best predicted DIS current major depression were different between the two ethnic groups; 17 for Cuban Americans, and 20 for Puerto Ricans. A receiver operating characteristics (ROC) curve analysis revealed that the traditional method of defining CES-D cases by summing the scores for each item was superior to counting only the persistent symptoms, that is, those present nearly everyday.

Temporomandibular disorders: assessment of psychological factors

Factors such as psychological stress, anxiety, depression, oral habits, and chronic pain behaviors have been found in subgroups of Temporomandibular Disorders (TMD) patients. This paper reviews the current status of diagnostic methods and instruments designed to identify various psychological factors. The authors offer the following general conclusions: Although the DSM-III-R has significant limitations, it is currently the most common gold standard with which other psychological instruments are compared. There are several specific assessment instruments, such as the Beck Depression Inventory and the Zung Self-Rating Depression Scale, which have been found to have acceptable sensitivity and specificity scores. In addition, certain simple screening questions may be cost-effective for the identification of psychological factors. Because of studies indicating that the dentists' recognition of psychological factors is inaccurate, a brief screening questionnaire may be useful in TMD patients. The literature does not support the routine use of the MMPI. A major conclusion of this review is that there are several psychological instruments available which have demonstrated reasonable validity through a blind comparison with a gold standard. There is need for further development and testing of brief screening instruments using clinical decision methods.