Reliability and Validity of the Vietnamese Depression Interview (VDI)

Current instruments used to aid in the diagnosis of psychological disorders have limited effectiveness with clients from Asian backgrounds. The Vietnamese Depression Interview (VDI) is a diagnostic instrument created to assess the presence of current and lifetime history of major depressive disorder specifically among Vietnamese refugees and immigrants. The purpose of the present study is to provide a description of the VDI, while also noting it as a reliable and valid means by which to assess depression in Vietnamese individuals. Using the Longitudinal, Expert, and All Data (LEAD; Spitzer in Compr Psychiatry 24:399-411, 1983) standard and the VDI, experienced clinicians conducted the diagnosis process with 127 Vietnamese refugees and immigrants. Assessment of the reliability and validity of the VDI yielded good to excellent AUC and kappa values, indicating the reliability of the VDI and the agreement between the LEAD procedure and the VDI. These study results imply that the VDI performs successfully as a diagnostic instrument specifically created for Vietnamese refugees and immigrants in their native language. Current and future contributions of the VDI with Vietnamese individuals are discussed.

The impact of academic calendar cycle on coronary artery bypass outcomes: a comparison of teaching and non-teaching hospitals

Background

The commencement of new academic cycle in July is presumed to be associated with poor patient outcomes, although supportive evidence is limited for cardiac surgery patients. We sought to determine if the new academic cycle affected the outcomes of patients undergoing Coronary Artery Bypass Grafting.

Methods

A retrospective analysis was performed on 10-year nationwide in-hospital data from 1998–2007. Only patients who underwent CABG in the first and final academic 3-month calendar quarter were included. Generalized multivariate regression was used to assess indicators of hospital quality of care such as risk-adjusted mortality, total complications and “failure to rescue“ (FTOR) - defined as death after a complication.

Results

Of the 1,056,865 CABG operations performed in the selected calendar quarters, 698,942 were at teaching hospitals. The risk-adjusted mortality, complications and FTOR were higher in the beginning of the academic year [Odds ratio = 1.14, 1.04 and 1.19 respectively; p < 0.001 for all] irrespective of teaching status. However, teaching status was associated with lower mortality (OR 0.9) despite a higher complication rate (OR 1.02); [p < 0.05 for both]. The July Effect thus contributed to only a 2.4% higher FTOR in teaching hospitals compared to 19% in non teaching hospitals.

Conclusions

The July Effect is reflective of an overall increase in morbidity in all hospitals at the beginning of the academic cycle and it had a pronounced effect in non-teaching hospitals. Teaching hospitals were associated with lower mortality despite higher complication rates in the beginning of the academic cycle compared to non-teaching hospitals. The July effect thus cannot be attributed to presence of trainees alone.

Ultramini abstract

This study compares the July effect in teaching and non-teaching hospitals and demonstrates that this effect is not unique to teaching hospitals for CABG patients. In fact, teaching hospitals have somewhat better outcomes at the beginning of the academic cycle and the July effect is a much broader seasonal variation.

Impact of surgeon demographics and technique on outcomes after esophageal resections: a nationwide study

BACKGROUND

Thoracic, cardiac, and general surgeons perform esophageal resections in the United States. This article examines the impact of surgeon subspecialty on outcomes after esophagectomy.

METHODS

Esophagectomies performed between 1998 and 2008 were identified in the Nationwide Inpatient Sample. Surgeons were classified as thoracic, cardiac, or general surgeons if greater than 65% of their operative case mix was representative of their specialty. Surgeons with less than 65% of a specialty-specific case mix served as controls. Regression equations calculated the independent effect of surgeon specialty, surgeon volume, and operative approach (transhiatal versus transthoracic) on outcomes.

RESULTS

Of the 40,589 patients who underwent esophagectomies, surgeon identifiers were available for 23,529 patients. Based on case mix, thoracic, cardiac, and general surgeons performed 3,027 (12.9%), 688 (2.9%), and 4,086 (17.4%) esophagectomies, respectively. Operative technique did not independently affect risk-adjusted outcomes-mortality, morbidity, and failure to rescue (defined as death after a complication). Surgeon volume independently lowered mortality and failure to rescue by 4% (p ≤ 0.002 for both), but not complications (p = 0.6). High-volume hospitals (>12 procedures/year) independently lowered mortality (adjusted odds ratio [AOR], 0.67, 95% confidence interval [CI], 0.46-0.96), and failure to rescue (AOR, 0.64; 95% CI, 0.44-0.94). Esophageal resections performed by general surgeons were associated with higher mortality (AOR, 1.87; 95% CI 1.02-3.45) and failure to rescue (AOR, 1.95; 95% CI, 1.06-3.61) but not complications (AOR, 0.97; 95% CI, 0.64-1.49).

CONCLUSIONS

General surgeons perform the major proportion of esophagectomies in the United States. Surgeon subspecialty is not associated with the risk of complications developing but instead is associated with mortality and failure to rescue from complications. Surgeon subspecialty case mix is an important determinant of outcomes for patients undergoing esophagectomy.

Development, reliability, and validity of the Posttraumatic Stress Disorder Interview for Vietnamese refugees: a diagnostic instrument for Vietnamese refugees

The Posttraumatic Stress Disorder Interview for Vietnamese Refugees (PTSD-IVR) was created specifically to assess for the presence of current and lifetime history of premigration, migration, encampment, and postmigration traumas in Vietnamese refugees. The purpose of the present study was to describe the development of and investigate the interrater and test-retest reliability of the PTSD-IVR and its validity in relation to the diagnoses obtained from the Longitudinal, Expert, and All Data (LEAD; Spitzer, 1983) standard. Clinicians conducted the diagnosis process with 127 Vietnamese refugees using the LEAD standard and the PTSD-IVR. Assessment of the reliability and validity of the PTSD-IVR yielded good to excellent AUC (area under the receiver operating characteristic curve; .86, .87) and κ values (.66, .74) indicating the reliability of the PTSD-IVR and the agreement between the LEAD procedure and the PTSD-IVR. The results of the present study suggest that the PTSD-IVR performs successfully as a diagnostic instrument specifically created for Vietnamese refugees in their native language.

Gender as a moderator between having an anxiety disorder diagnosis and coronary artery bypass grafting surgery (CABG) outcomes in rural patients

PURPOSE

This paper examines gender as a moderating variable between having an anxiety disorder diagnosis and coronary artery bypass grafting surgery (CABG) outcomes in rural patients.

METHODS

Using the 2008 Nationwide Inpatient Sample (NIS) database, 17,885 discharge records of patients who underwent a primary CABG surgery were identified. Independent variables included age, gender, race, median household income based on patient's ZIP code, primary expected payer, the Deyo, Cherkin, and Ciol Comorbidity Index, and an anxiety comorbidity diagnosis. Outcome variables included in-hospital length of stay and patient disposition (routine and nonroutine discharge). A 2 × 2 analysis of variance and logistic regression analyses were used to assess the interaction between gender and an anxiety disorder diagnosis on in-hospital length of stay and patient disposition.

FINDINGS

Twenty-seven percent of rural patients undergoing a CABG operation had a comorbid anxiety diagnosis. Rural patients who had nonroutine discharge were more likely to have comorbid anxiety diagnosis compared to rural patients who had a routine discharge. There was a significant interaction effect between having an anxiety diagnosis and gender on length of hospital stay but not for patient disposition.

CONCLUSIONS

Three findings were noteworthy. First, anxiety disorder is prevalent in rural patients who are undergoing a CABG operation. Second, anxiety was a significant independent predictor of both length of hospital stay and nonroutine discharge for patients receiving CABG surgery. Last, having an anxiety disorder diagnosis increased hospital stay for both males and females; however, females seemed to be impacted more than males.

Staged versus synchronous carotid endarterectomy and coronary artery bypass grafting: analysis of 10-year nationwide outcomes

BACKGROUND

The timing of operative interventions for patients with concurrent carotid and coronary artery disease is controversial. We evaluated nationwide data regarding staged or synchronous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) and compared the two approaches' outcome profiles.

METHODS

From Nationwide Inpatient Sample database 1998 to 2007, we identified 6,153 (28.9%) patients who underwent CEA before or after CABG during the same hospital admission but not on the same day (STAGED) and 16,639 patients who underwent both procedures on the same day (SYNC). Hierarchic multivariable regression was used to assess the independent effect of operative strategy on mortality, neurologic and overall complications, and charges.

RESULTS

Mean age (69.5±9.0 years) and Charlson-Deyo score (4.6±1.5) were similar for both groups. Mortality (4.2% vs 4.5%) or neurologic complications (3.5% vs 3.9%) were similar between the STAGED and SYNC groups (p>0.7 for both). The STAGED patients had higher morbidity (48.4% vs 42.6%; odds ratio [OR] 1.8; 95% confidence interval [CI], 1.5 to 2.2; p<0.001) and more cardiac (OR, 1.5; 95% CI, 1.4 to 1.7; p<0.001), wound (OR, 2.1; 95% CI, 1.8 to 2.4; p<0.001), respiratory (OR, 1.2; 95% CI, 1.1 to 1.3; p=0.001), and renal complications (OR, 1.2; 95% CI, 1.03 to 1.3; p<0.001). In SYNC patients, on-pump CABG increased stroke rates (OR, 1.6; 95% CI, 1.3 to 1.9; p<0.001). The STAGED procedures were independently associated with higher hospital charges by $23,328 (p<0.001).

CONCLUSIONS

We identified no significant difference in mortality or neurologic complications between STAGED and SYNC approaches. Staged procedures were associated with a greater risk of overall complications and higher hospital charges than SYNC. On-pump CABG was associated with higher stroke rates in SYNC patients.

Illness Intrusiveness Mediates the Relationship Between Heart Failure Severity and Depression in Older Adults

Depression frequently co-occurs in heart failure (HF) patients, causing significant interference and negative health outcomes. This case-controlled study explored the construct of illness intrusiveness and examined its relationship to HF severity and depression. Older veterans ( n = 104) with an HF diagnosis completed a one-time assessment that included demographics, depressive symptoms (Geriatric Depression Scale), the Illness Intrusiveness Rating Scale (IIRS), and HF quality of life and functional abilities (Kansas City Cardiomyopathy Questionnaire [KCCQ]). Analyses included exploratory correlations between IIRS and KCCQ items, a confirmatory factor analysis (IIRS), and formal mediational analyses. Results indicated that the IIRS had adequate internal consistency and concurrent validity, with support for its established three-factor model. Regression analyses indicated that illness intrusiveness mediated HF illness severity and depression. In conclusion, illness intrusiveness may be a better indicator of depression than illness severity (HF symptoms); thus research methods and interventions targeted at reducing illness intrusiveness merit further investigation.

Depression and geographic status as predictors for coronary artery bypass surgery outcomes

PURPOSE

To examine the relationships between depression, geographic status, and clinical outcomes following a coronary artery bypass grafting (CABG) surgery.

METHODS

Using the 2004 Nationwide Inpatient Sample database, we identified 63,061 discharge records of patients who underwent a primary CABG surgery (urban 57,247 and rural 5,814). We analyzed 7 demographic variables, 19 preoperative medical and psychiatric variables, and 2 outcome variables (ie, in-hospital mortality and length of stay). Logistic regression and multivariable regression analyses were used to assess urban-rural status and depression as independent predictors of in-hospital mortality and length of stay.

FINDINGS

Rural patients were more likely to have a comorbid depression diagnosis compared to urban patients (urban = 19.4%, rural = 21.4%, P < .001). After adjusting for confounding factors, having a comorbid depression diagnosis (B= 1.10, P < .001) and residing in a rural area (B= .986, P < .05) were associated with an increased length of in-hospital stay following CABG surgery. Furthermore, having a depression diagnosis (OR = 1.63, 95% CI = 1.45-2.21) and residing in a rural area (OR = 1.43, 95% CI = .896-1.45) were associated with an increased likelihood of in-hospital mortality.

CONCLUSIONS

Rural patients were more likely than urban ones to have a depression diagnosis. Depression was a significant independent predictor of both in-hospital mortality and length of stay for patients receiving CABG surgery. Also, rural patients had increased lengths of in-hospital stay as well as in-hospital mortality rates compared to those who resided in urban areas.

Autonomic cardiovascular dysregulation as a potential mechanism underlying depression and coronary artery bypass grafting surgery outcomes

BACKGROUND

Coronary artery bypass grafting (CABG) is often used to treat patients with significant coronary heart disease (CHD). To date, multiple longitudinal and cross-sectional studies have examined the association between depression and CABG outcomes. Although this relationship is well established, the mechanism underlying this relationship remains unclear. The purpose of this study was twofold. First, we compared three markers of autonomic nervous system (ANS) function in four groups of patients: 1) Patients with coronary heart disease and depression (CHD/Dep), 2) Patients without CHD but with depression (NonCHD/Dep), 3) Patients with CHD but without depression (CHD/NonDep), and 4) Patients without CHD and depression (NonCHD/NonDep). Second, we investigated the impact of depression and autonomic nervous system activity on CABG outcomes.

METHODS

Patients were screened to determine whether they met some of the study's inclusion or exclusion criteria. ANS function (i.e., heart rate, heart rate variability, and plasma norepinephrine levels) were measured. Chi-square and one-way analysis of variance were performed to evaluate group differences across demographic, medical variables, and indicators of ANS function. Logistic regression and multiple regression analyses were used to assess impact of depression and autonomic nervous system activity on CABG outcomes.

RESULTS

The results of the study provide some support to suggest that depressed patients with CHD have greater ANS dysregulation compared to those with only CHD or depression. Furthermore, independent predictors of in-hospital length of stay and non-routine discharge included having a diagnosis of depression and CHD, elevated heart rate, and low heart rate variability.

CONCLUSIONS

The current study presents evidence to support the hypothesis that ANS dysregulation might be one of the underlying mechanisms that links depression to cardiovascular CABG surgery outcomes. Thus, future studies should focus on developing and testing interventions that targets modifying ANS dysregulation, which may lead to improved patient outcomes.

The impact of obesity on long-term survival after coronary artery bypass grafting

BACKGROUND

Obesity is a well-known risk factor for coronary artery disease. The objective of our study was to examine the impact of obesity on long-term survival after coronary artery bypass grafting (CABG).

MATERIALS AND METHODS

Using prospectively gathered data, we reviewed records of 1163 consecutive patients who underwent isolated primary CABG between 1997 and 2007. We compared outcomes of obese patients (body mass index [BMI] > or = 30 kg/m(2); n = 472) and non-obese patients (BMI < 30 kg/m(2); n = 691). Long-term survival was assessed by using Kaplan-Meier curves generated by log-rank tests and adjusted for confounding factors with Cox logistic regression analysis.

RESULTS

Obese patients were slightly younger (60 +/- 8 versus 63 +/- 9y; P < 0.0001), were less likely to be current tobacco smokers (30% versus 41%; P < 0.0001), had a higher incidence of diabetes (51% versus 33%; P < 0.0001), and had a lower incidence of cerebral vascular disease (18% versus 24%; P = 0.009) than non-obese patients. The two groups of patients had similar 30-d rates of mortality (1.3% versus 1.5%; P = 0.8) and major adverse cardiac events (2.3% versus 2.5%; P = 0.9). Adjusted Cox regression survival curves were also similar between the two groups of patients (adjusted hazard ratio, 1.2; 95% confidence interval, 0.8-1.8; P = 0.28).

CONCLUSIONS

Obese patients who underwent CABG had 30-d mortality rates and early outcomes similar to those of non-obese patients. Long-term survival was also similar between these two groups of patients after adjustment for confounding variables.

Associations among pain, PTSD, mTBI, and heart rate variability in veterans of Operation Enduring and Iraqi Freedom: a pilot study

OBJECTIVE

The objective of the study was to determine if there is dysregulated autonomic nervous system activity as manifested by depressed heart rate variability (HRV) among veterans of Operations Enduring and Iraqi Freedom (OEF/OIF).

PARTICIPANTS AND SETTING

The study used a convenience sample of OEF/OIF veterans (n = 28) seen at a Level II Polytrauma Network Site at the Michael E. DeBakey VA Medical Center. Participants were similar to other OEF/OIF veterans who received care at this site.

DESIGN

Cross sectional study.

MEASURES

Time domain analysis (standard deviation of beat-to-beat intervals [SDNN]) of HRV, diagnoses of mild traumatic brain injury and post-traumatic stress disorder (PTSD), and pain ratings from medical records.

RESULTS

As a group, the sample evidenced markedly depressed HRV (as reflected by SDNN) as compared with available age and gender corrected normative data. Pain (71%), PTSD (57%), and mild traumatic brain injury (mTBI) (64%) were prevalent. Thirty-six percent had all three measures (P3). Pain and P3 were significantly and negatively associated with SDNN (r = -0.460, P = 0.014; r = -0.373, P = 0.05, respectively).

CONCLUSIONS

These preliminary findings support the high prevalence of depressed HRV and P3 among veterans seen in a level II Polytrauma Center. The findings also suggest a possible synergistic effect of pain, PTSD, and mTBI on depressed HRV. The nature and implications of these relationships require additional research to elucidate.

The association between bullying dynamics and psychological distress

This study examined the association between past experience of victimization (PEV), perceived risk of victimization (PRV), and nonspecific psychological distress (NSPD). Repeated measures-analysis of variance and hierarchical regression analyses were conducted on 186 seventh grade middle school students from an urban university-research-affiliated school. Results indicated that gender, PEV, and PRV significantly predicted NSPD. There were no gender differences in either the total number of past experience of victimization or depressive and/or anxious feelings reported. However, the types of victimization experienced as well as perceived risk of victimization appeared to be gender-related in that boys were significantly higher than girls on past experience of physical aggression and property aggression but significantly lower than girls on past experience of emotional aggression and perceived risk of victimization. In gender-specific analyses, PRV mediated the effects of PEV on NSPD for girls but not boys. The reasons for these findings, as well as implications for social policies and future directions, are discussed.

A Psychometric Evaluation of the Rorschach Comprehensive System's Perceptual Thinking Index

In this study, we investigated evidence for reliability and validity of the Perceptual Thinking Index (PTI; Exner, 2000a, 2000b) among an adult inpatient population. We conducted reliability and validity analyses on 107 patients who met the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision; American Psychiatric Association, 2000) criteria for a schizophrenia-spectrum disorder (SSD) or mood disorder with no psychotic features (MD). Results provided support for interrater reliability as well as internal consistency of the PTI. Furthermore, the PTI was an effective index in differentiating SSD patients from patients diagnosed with an MD. Finally, the PTI demonstrated adequate diagnostic statistics that can be useful in the classification of patients diagnosed with SSD and MD. We discuss methodological issues, implications for assessment practice, and directions for future research.

C-reactive protein, leukocytes, and fever after central IL 1 and alpha-MSH in aged rabbits

Aged and young unanesthetized rabbits with intracerebroventricular cannulas were tested in experiments designed to determine whether increases in plasma C-reactive protein (CRP) level and leukocytosis can be rapidly induced by central administration of crude buffy-coat supernatant commonly called endogenous pyrogen or interleukin 1 (IL 1). The results indicate that both acute-phase responses occur during fever caused by central administration of this supernatant and that they are generally detectable within 2 h. Although the febrile response was smaller in aged female rabbits, there was no decline in CRP or leukocyte responses, an observation that was not predicted. The antipyretic neuropeptide alpha-melanocyte-stimulating hormone (alpha-MSH) reduced fever caused by central IL 1 more effectively in the aged rabbits. alpha-MSH likewise inhibited the CRP and leukocyte responses to central IL 1. The results confirm that CRP and leukocyte responses can be driven by a central IL 1 signal and further indicate that the response can occur rapidly, consistent with direct central nervous system control of the acute-phase responses. The findings indicate that the acute-phase responses depend in part on the age of the host and that the responses can be modulated by an endogenous central nervous system peptide with known antipyretic and immune modulatory properties.