Psychometric Properties and Factor Analysis of Family Accommodation Scale For Obsessive Compulsive Disorder-Interviewer-Rated-Thai Version (FAS-T)

Purpose

Obsessive compulsive disorder (OCD) is a longstanding and debilitating psychiatric disorder which is related to a level of distress in family members of patients who suffer from it. The Family Accommodation Scale (FAS) for OCD helps medical personnel have a clearer and deeper understanding of the pattern of family accommodation. This study aimed to translate FAS into Thai and examine its psychometric properties and factor analysis.

Patients and Methods

There were fifty participants who were relatives of OCD patients. Demographic data were collected along with completion of the FAS-T, the Patient Health Questionnaire (PHQ-9), the Pictorial Thai Quality of Life (PTQL), and the Thai Florida Obsessive Compulsive Inventory (FOCI-T), and then analyzed. The severity scales of FOCI-T from 44 OCD patients who had relatives participating in this study were collected from medical records and examined. Psychometric properties and factor analysis of FAS-T were tested.

Results

The average total score of FAS-T was 8.36±8.77 ranging between 0 to 25. The mean scores of FOCI-severity scale in relatives, PHQ-9, PTQL, and FOCI-severity scale in OCD patients, were 1.04±1.97, 4.04±3.73, 52.31±13.99, 8.95±4.36, respectively. The Cronbach’s coefficient alpha of FAS-T was 0.84, which demonstrated good internal consistency. The item-level CVI and scale-level CVI were at an excellent level. The Spearman’s rho between the FAS and FOCI symptom checklist, FOCI severity score, and PHQ-9 PTQL, were weakly correlated which implied acceptable discriminant validity. Exploratory Factor Analysis (EFA) suggested a three-factor solution as participation, modification, and facilitation.

Conclusion

The Family Accommodation Scale for Obsessive–Compulsive Disorder—Interviewer-Rated - Thai version is a psychometrically reliable and valid measure for assessing accommodation in family members of OCD patients.

Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis

BACKGROUND

Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.

METHODS

We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.

RESULTS

16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (-0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).

CONCLUSIONS

PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.

The Accuracy of the Patient Health Questionnaire-9 Algorithm for Screening to Detect Major Depression: An Individual Participant Data Meta-Analysis

BACKGROUND

Screening for major depression with the Patient Health Questionnaire-9 (PHQ-9) can be done using a cutoff or the PHQ-9 diagnostic algorithm. Many primary studies publish results for only one approach, and previous meta-analyses of the algorithm approach included only a subset of primary studies that collected data and could have published results.

OBJECTIVE

To use an individual participant data meta-analysis to evaluate the accuracy of two PHQ-9 diagnostic algorithms for detecting major depression and compare accuracy between the algorithms and the standard PHQ-9 cutoff score of ≥10.

METHODS

Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, Web of Science (January 1, 2000, to February 7, 2015). Eligible studies that classified current major depression status using a validated diagnostic interview.

RESULTS

Data were included for 54 of 72 identified eligible studies (n participants = 16,688, n cases = 2,091). Among studies that used a semi-structured interview, pooled sensitivity and specificity (95% confidence interval) were 0.57 (0.49, 0.64) and 0.95 (0.94, 0.97) for the original algorithm and 0.61 (0.54, 0.68) and 0.95 (0.93, 0.96) for a modified algorithm. Algorithm sensitivity was 0.22-0.24 lower compared to fully structured interviews and 0.06-0.07 lower compared to the Mini International Neuropsychiatric Interview. Specificity was similar across reference standards. For PHQ-9 cutoff of ≥10 compared to semi-structured interviews, sensitivity and specificity (95% confidence interval) were 0.88 (0.82-0.92) and 0.86 (0.82-0.88).

CONCLUSIONS

The cutoff score approach appears to be a better option than a PHQ-9 algorithm for detecting major depression.

Probability of major depression diagnostic classification using semi-structured versus fully structured diagnostic interviews

BACKGROUND

Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.AimsTo evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.

METHOD

Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.

RESULTS

A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15-3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98-10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7-15) (OR = 0.96; 95% CI = 0.56-1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26-0.97).

CONCLUSIONS

The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.Declaration of interestDrs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

A comparison of bivariate, multivariate random-effects, and Poisson correlated gamma-frailty models to meta-analyze individual patient data of ordinal scale diagnostic tests

Individual patient data (IPD) meta-analyses are increasingly common in the literature. In the context of estimating the diagnostic accuracy of ordinal or semi-continuous scale tests, sensitivity and specificity are often reported for a given threshold or a small set of thresholds, and a meta-analysis is conducted via a bivariate approach to account for their correlation. When IPD are available, sensitivity and specificity can be pooled for every possible threshold. Our objective was to compare the bivariate approach, which can be applied separately at every threshold, to two multivariate methods: the ordinal multivariate random-effects model and the Poisson correlated gamma-frailty model. Our comparison was empirical, using IPD from 13 studies that evaluated the diagnostic accuracy of the 9-item Patient Health Questionnaire depression screening tool, and included simulations. The empirical comparison showed that the implementation of the two multivariate methods is more laborious in terms of computational time and sensitivity to user-supplied values compared to the bivariate approach. Simulations showed that ignoring the within-study correlation of sensitivity and specificity across thresholds did not worsen inferences with the bivariate approach compared to the Poisson model. The ordinal approach was not suitable for simulations because the model was highly sensitive to user-supplied starting values. We tentatively recommend the bivariate approach rather than more complex multivariate methods for IPD diagnostic accuracy meta-analyses of ordinal scale tests, although the limited type of diagnostic data considered in the simulation study restricts the generalization of our findings.

Efficacy of home-based non-pharmacological interventions for treating depression: a systematic review and network meta-analysis of randomised controlled trials

OBJECTIVES

To systematically review and compare the efficacy of all available home-based non-pharmacological treatments of depression.

DESIGN

Systematic review and network meta-analysis of randomised controlled trials.

DATA SOURCES

Medline, Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched since inceptions to 7 August 2016.

ELIGIBILITY CRITERIA

Randomised controlled trials comparing the efficacy of home-based non-pharmacological interventions with usual care of patients with depression were included in the review.

MAIN OUTCOMES

Depression symptom scores and disease remission rates at the end of treatment.

RESULTS

Seventeen studies were included in the review. Home-based non-pharmacological interventions were categorised as (1) home-based psychological intervention, (2) home-based exercise intervention, (3) combined home-based psychological intervention with exercise intervention and (4) complementary medicine. Complementary medicine approaches were excluded from the meta-analysis due to heterogeneity. The standardised mean differences of post-treatment depression symptom scores between usual care groups and home-based psychological intervention, home-based exercise intervention and combined home-based psychological intervention with exercise intervention were âˆ'0.57 (95% CI âˆ'0.84 to âˆ'0.31), âˆ'1.03 (95% CI âˆ'2.89 to 0.82) and âˆ'0.78 (95% CI âˆ'1.09 to âˆ'0.47), respectively. These results suggest that only home-based psychological intervention and combined home-based psychological intervention with exercise intervention could significantly decrease depression scores. Compared with usual care groups, the disease remission rate was also significantly higher for home-based psychological intervention (pooled risk ratio=1.53; 95% CI 1.19 to 1.98) and combined home-based psychological intervention with exercise intervention (pooled risk ratio=3.47; 95% CI 2.11 to 5.70). Of all the studied interventions, combined home-based psychological intervention with exercise intervention had the highest probability of resulting in disease remission.

CONCLUSION

Our study confirms the efficacy of home-based psychological intervention and combined home-based psychological intervention with exercise intervention in the treatment of depression. Combined home-based psychological intervention and exercise intervention was the best treatment and should be considered for inclusion in clinical guidelines for managing depression.

Selective Cutoff Reporting in Studies of Diagnostic Test Accuracy: A Comparison of Conventional and Individual-Patient-Data Meta-Analyses of the Patient Health Questionnaire-9 Depression Screening Tool

In studies of diagnostic test accuracy, authors sometimes report results only for a range of cutoff points around data-driven "optimal" cutoffs. We assessed selective cutoff reporting in studies of the diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) depression screening tool. We compared conventional meta-analysis of published results only with individual-patient-data meta-analysis of results derived from all cutoff points, using data from 13 of 16 studies published during 2004-2009 that were included in a published conventional meta-analysis. For the "standard" PHQ-9 cutoff of 10, accuracy results had been published by 11 of the studies. For all other relevant cutoffs, 3-6 studies published accuracy results. For all cutoffs examined, specificity estimates in conventional and individual-patient-data meta-analyses were within 1% of each other. Sensitivity estimates were similar for the cutoff of 10 but differed by 5%-15% for other cutoffs. In samples where the PHQ-9 was poorly sensitive at the standard cutoff, authors tended to report results for lower cutoffs that yielded optimal results. When the PHQ-9 was highly sensitive, authors more often reported results for higher cutoffs. Consequently, in the conventional meta-analysis, sensitivity increased as cutoff severity increased across part of the cutoff range-an impossibility if all data are analyzed. In sum, selective reporting by primary study authors of only results from cutoffs that perform well in their study can bias accuracy estimates in meta-analyses of published results.

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.].

A study of diagnostic accuracy of the Florida Obsessive-Compulsive Inventory--Thai Version (FOCI-T)

BACKGROUND

The Florida Obsessive-Compulsive Inventory (FOCI) is a self-reported measure to assess the symptoms and severity of obsessive-compulsive disorder (OCD), which can be completed in five minutes. Although preliminary studies have shown its good psychometric properties, the study of receiver operating characteristics (ROC) to use it as a screening tool has never been reported elsewhere. This study aimed to use the ROC analysis to determine the optimal cut-off score of the Thai version of the FOCI (FOCI-T).

METHODS

A total of 197 participants completed the FOCI-T, the Patient Health Questionnaire (PHQ-9), and the Pictorial Thai Quality of Life (PTQL), and they were also interviewed with the Mini International Neuropsychiatric Interview (MINI) for their diagnosis. The ROC analyses of the FOCI-T Severity Scores were computed to determine the best cut-off score.

RESULTS

When the Thai version of the MINI was used in the interview, it was found that 38 participants were diagnosed with OCD, 43 participants were non-OCD, and 116 participants were healthy adults. The ROC analyses indicated that the FOCI-T Severity Scale could significantly distinguish OCD patients from non-OCD patients and healthy adults. The area under curve was estimated to be 0.945 (95%CI = 0.903-0.972). A cut-off score of ≥ 5 provided the best sensitivity (0.92) and specificity (0.82).

CONCLUSION

The Thai version of the Florida Obsessive-Compulsive Inventory has demonstrated its good predictive abilities, so it could be used as a brief screening tool to detect obsessive-compulsive disorder patients with high sensitivity and specificity.

Reliability and validity of the Thai self-report version of the Yale-Brown Obsessive-Compulsive Scale-Second Edition

PURPOSE

The self-report version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) has been developed to overcome the limitations of the clinician-administered version, which needs to be executed by trained personnel and is time consuming. The second edition of the Y-BOCS (Y-BOCS-II) was developed to address some limitations of the original version. However, there is no self-report version of the Y-BOCS-II at the moment. This study aimed to evaluate the psychometric properties of the developed Thai self-report version of the Yale-Brown Obsessive-Compulsive Scale-Second Edition (Y-BOCS-II-SR-T).

PATIENTS AND METHODS

Y-BOCS-II-SR-T was developed from the Thai version of the Yale-Brown Obsessive-Compulsive Scale-Second Edition (Y-BOCS-II-T). The Y-BOCS-II-SR-T, the Y-BOCS-II-T, the Thai version of the Florida Obsessive-Compulsive Inventory (FOCI-T), the Hamilton Rating Scale for Depression (HAM-D), the nine-item Patient Health Questionnaire (PHQ-9), and the Pictorial Thai Quality of Life (PTQL) instrument were administered to 52 obsessive-compulsive disorder (OCD) patients. Internal consistency for the Y-BOCS-II-SR-T was calculated with Cronbach's alpha coefficient (α), and the factor analyses were completed. Pearson's correlation was used in determining convergent and divergent validity among the other measures.

RESULTS

The mean score of the Y-BOCS-II-SR-T total score was 20.71±11.16. The internal consistencies of the Y-BOCS-II-SR-T total scores, the obsession subscale, and the compulsion subscale scores were excellent (α=0.94, α=0.90, and α=0.89, respectively). The correlation between each item and the Y-BOCS-II-SR-T total score showed strong correlation for all items. Confirmatory factor analysis with model modification showed adequate fit for obsession and compulsion factor models. The Y-BOCS-II-SR-T had strong correlation with the YBOCS-II-T and the FOCI-T (r s>0.90) and weaker correlation with the HAM-D, PHQ-9, and PTQL (r s<0.60), which implied good convergent and divergent validity.

CONCLUSION

The Y-BOCS-II-SR-T is a psychometrically sound and valid measure for assessing obsessive-compulsive symptoms.

Reliability and validity of the Thai version of the Yale-Brown Obsessive Compulsive Scale - Second Edition in clinical samples

PURPOSE

The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is regarded as the most acceptable tool for measuring obsessive-compulsive disorder symptom severity. Recently, the Yale-Brown Obsessive Compulsive Scale - Second Edition (Y-BOCS-II) was developed for better measurement. The study reported here aimed to evaluate the psychometric properties of the Thai version of the Yale-Brown Obsessive Compulsive Scale - Second Edition (Y-BOCS-II-T).

PATIENTS AND METHODS

The original version of the Y-BOCS-II was translated into Thai, which involved forward translation, synthesis of the translation, and back translation. Modification and cross-cultural adaptation were completed accordingly. The developed Y-BOCS-II-T, together with the Hamilton Rating Scale for Depression, was administered to 41 patients who had a primary diagnosis of obsessive-compulsive disorder. The patients then completed the Pictorial Thai Quality of Life instrument and Patient Health Questionnaire. Lastly, the Global Assessment of Functioning (GAF) and the Clinical Global Impression - Severity Scale (CGI-S) of all patients were blindly rated by another experienced psychiatrist who was not the interviewer.

RESULTS

The mean total score of the Yale-Brown Obsessive Compulsive Scale - Second Edition - Severity Scale (Y-BOCS-II-SS) and the Yale-Brown Obsessive Compulsive Scale - Second Edition - Symptom Checklist (Y-BOCS-II-SC) were 18.44 (standard deviation =10.51) and 15.85 (standard deviation =9.58), respectively. The Y-BOCS-II-T had satisfactory internal consistency (Cronbach's alpha =0.94 for the Severity Scale, and Kuder-Richardson Formula 20 =0.90 for the Symptom Checklist). Inter-rater reliability was excellent for both the Y-BOCS-II-SS and Y-BOCS-II-SC. Factor analysis of Y-BOCS-II-SS items revealed a two-factor component associated with obsession and compulsion. The Y-BOCS-II-SS correlated highly with the CGI-S and GAF (r =0.75 and -0.76, respectively), but the Y-BOCS-II-SC correlated moderately (r=0.42 for CGI-S; r=-0.39 for GAF). The Y-BOCS-II-SS and Y-BOCS-II-SC slightly to moderately correlated with the Hamilton Rating Scale for Depression, Patient Health Questionnaire, and Pictorial Thai Quality of Life, which might indicate the comorbidity depression and its effect on quality of life.

CONCLUSION

The Y-BOCS-II-T is a psychometrically reliable and valid measure for the assessment of both severity and characteristics of obsessive-compulsive symptoms in Thai clinical samples.

Development and validation of a screening instrument for bipolar spectrum disorder: The Mood Disorder Questionnaire Thai version

BACKGROUND

The Mood Disorder Questionnaire (MDQ) has been translated to many languages and has been used in many countries as a screening instrument for bipolar disorder. The main objective of this study was to evaluate validity of the Thai version of the MDQ as a screening instrument for bipolar disorder in a psychiatric outpatient sample, and to determine its optimum question #1 item threshold value for bipolar disorder.

METHODS

The English language Mood Disorder Questionnaire (MDQ) was translated into Thai. The process involved back-translation, cross-cultural adaptation, field testing of the prefinal version, as well as final adjustments. Two hundred and fifty major depressive disorder outpatients were further assessed by the Thai version of the MDQ and the Thai version of the Mini International Neuropsychiatric Interview (MINI). During the assessment, reliability and validity analyses, and receiver operating characteristic curve (ROC) analysis were performed.

RESULTS

The Thai version of the MDQ screening had adequate internal consistency (Cronbach's alpha =0.791, omega total =0.68, and omega hierarchical =0.69). The optimal question #1 item threshold value was at least five positive items, which yielded adequate sensitivity (76.5%), specificity (72.7%), positive predictive value (74.3%), and negative predictive value (75.0%). The ROC area under the curve (AUC) for this study was 0.82 (95% confidence interval: 0.70 to 0.90).

CONCLUSION

The Thai version of the MDQ had some useful psychometric properties for screening for bipolar disorder in a mood disorder clinic setting, with a recommended question #1 item threshold value of at least five positive items.

Reliability and validity of the Thai version of the WHO-Five Well-Being Index in primary care patients

AIMS

Because of the high patient load in Thailand, we need a practical measurement to help primary physicians detect depression. This study aimed to examine the reliability and validity of the Thai version of the World Health Organization-Five Well-Being Index (WHO-5-T), which is short and easy to use as a screening tool for major depression in primary care patients.

METHODS

The English version of the WHO-Five Well-Being Index was translated into Thai. Back-translations, cross-cultural adaptation and field testing of the pre-final version with final adjustments were performed accordingly. The WHO-5-T was administered randomly to 300 patients in our primary care clinic. Then the patients were further assessed using the Mini International Neuropsychiatric Interview and the Hamilton Rating Scale for Depression as the gold standard of diagnosis and symptom severity, respectively.

RESULTS

Completed data were obtained from 274 respondents. Their mean age was 44.6 years [standard deviation (SD) = 14.7] and 73.7% of them were female. The mean WHO-5-T score was 14.32 (SD = 5.26). The WHO-5-T had a satisfactory internal consistency (Cronbach's alpha = 0.87) and showed moderate convergent validity with the Hamilton Rating Scale for Depression (r = -0.54; P < 0.001). The optimal cut-off score of the WHO-5-T <12 revealed a sensitivity of 0.89 and a specificity of 0.71 in detecting depression. The area under the curve in this study was 0.86 (SD = 0.03, 95% confidence interval 0.81 to 0.89).

CONCLUSIONS

The Thai version of the WHO-Five Well-Being Index was found to be a reliable and valid self-assessment to screen for major depression in primary care setting at a cut-off point of <12.

How do general practitioners in Thailand diagnose and treat patients presenting with anxiety and depression?

AIMS

To examine general practitioners' (GPs') diagnosis of a case vignette presenting both anxiety and depression symptoms, and to understand their treatment preferences for the case.

METHODS

A total of 1193 copies of a questionnaire were sent to doctors in primary care settings throughout Thailand. The questionnaire inquired about GPs' demographic information and training background, as well as common psychiatric diagnoses and drug prescriptions to patients in their practise. A case vignette of a patient presenting both anxiety and depression symptoms was then given, and GPs were asked to describe their diagnosis and treatment preferences. For comparison, postal questionnaires of the same case vignette were also sent to 40 psychiatrists practising in general hospitals, asking their opinion about the diagnosis and treatment preferences.

RESULTS

A total of 434 questionnaires (36.4%) were returned. GPs reported that 37.7% of their patients suffered from anxiety disorders while 28.4% suffered from depressive disorders. For the patient in the case vignette, GPs made a diagnosis of anxiety disorders (53.5%) more often than depressive disorders (31.9%), whereas the psychiatrists at the general hospitals made a diagnosis of depressive disorders (54%) more often than anxiety disorders (9.1%). One-third of the GPs prescribed only anxiolytics, while 15.4% prescribed only antidepressants. The most commonly prescribed antidepressant by GPs was amitriptyline, which 93% of GPs used at a dosage below 50 mg/day. Only 5.8% of them prescribed fluoxetine as antidepressant. The most frequently prescribed anxiolytic drug was diazepam (65.4%). The most common combination of drugs prescribed was amitriptyline and diazepam (38.7%).

CONCLUSION

Compared to psychiatrists, GPs were more likely to diagnose anxiety than depression in patients with the same set of symptoms. They also preferred to use amitriptyline to treat depression, and prescribed the drug at a low dose. GPs in Thailand should be encouraged to prescribe fluoxetine for treatment of depression because it is safer and more convenient to use than tricyclic antidepressants.

Reliability and validity of the Thai version of the PHQ-9

BACKGROUND

Most depression screening tools in Thailand are lengthy. The long process makes them impractical for routine use in primary care. This study aims to examine the reliability and validity of a Thai version Patient Health Questionnaire (PHQ-9) as a screening tool for major depression in primary care patients.

METHODS

The English language PHQ-9 was translated into Thai. The process involved back-translation, cross-cultural adaptation, field testing of the pre-final version, as well as final adjustments. The PHQ-9 was then administered among 1,000 patients in family practice clinic. Of these 1,000 patients, 300 were further assessed by the Thai version of the Mini International Neuropsychiatric Interview (MINI) and the Thai version of the Hamilton Rating Scale for Depression (HAM-D). These tools served as gold-standards for diagnosing depression and for assessing symptom severity, respectively. In the assessment, reliability and validity analyses, and receiver operating characteristic curve analysis were performed.

RESULTS

Complete data were obtained from 924 participants and 279 interviewed respondents. The mean age of the participants was 45.0 years (SD = 14.3) and 73.7% of them were females. The mean PHQ-9 score was 4.93 (SD = 3.75). The Thai version of the PHQ-9 had satisfactory internal consistency (Cronbach's alpha = 0.79) and showed moderate convergent validity with the HAM-D (r = 0.56; P < 0.001). The categorical algorithm of the PHQ-9 had low sensitivity (0.53) but very high specificity (0.98) and positive likelihood ratio (27.37). Used as a continuous measure, the optimal cut-off score of PHQ-9 >/= 9 revealed a sensitivity of 0.84, specificity of 0.77, positive predictive value (PPV) of 0.21, negative predictive value (NPV) of 0.99, and positive likelihood ratio of 3.71. The area under the curve (AUC) in this study was 0.89 (SD = 0.05, 95% CI 0.85 to 0.92).

CONCLUSION

The Thai version of the PHQ-9 has acceptable psychometric properties for screening for major depression in general practice with a recommended cut-off score of nine or greater.

Psychiatric services in primary care settings: a survey of general practitioners in Thailand

Background

General Practitioners (GPs) in Thailand play an important role in treating psychiatric disorders since there is a shortage of psychiatrists in the country. Our aim was to examine GP's perception of psychiatric problems, drug treatment and service problems encountered in primary care settings.

Methods

We distributed 1,193 postal questionnaires inquiring about psychiatric practices and service problems to doctors in primary care settings throughout Thailand.

Results

Four hundred and thirty-four questionnaires (36.4%) were returned. Sixty-seven of the respondents (15.4%) who had taken further special training in various fields were excluded from the analysis, giving a total of 367 GPs in this study. Fifty-six per cent of respondents were males and they had worked for 4.6 years on average (median = 3 years). 65.6% (SD = 19.3) of the total patients examined had physical problems, 10.7% (SD = 7.9) had psychiatric problems and 23.9% (SD = 16.0) had both problems. The most common psychiatric diagnoses were anxiety disorders (37.5%), alcohol and drugs abuse (28.1%), and depressive disorders (29.2%). Commonly prescribed psychotropic drugs were anxiolytics and antidepressants. The psychotropic drugs most frequently prescribed were diazepam among anti-anxiety drugs, amitriptyline among antidepressant drugs, and haloperidol among antipsychotic drugs.

Conclusion

Most drugs available through primary care were the same as what existed 3 decades ago. There should be adequate supply of new and appropriate psychotropic drugs in primary care. Case-finding instruments for common mental disorders might be helpful for GPs whose quality of practice was limited by large numbers of patients. However, the service delivery system should be modified in order to maintain successful care for a large number of psychiatric patients.

Suicide in Thailand during the period 1998-2003

The aim of this study was to examine the characteristic features of suicides in Thailand between 1998 and 2003. Collected data during 1998-2003 from the Bureau of Policy and Strategy, Ministry of Public Health were analyzed to reveal the mortality from suicide according to age, gender, rate and methods of suicides. Suicide rates were found to have increased to a peak of 8.6 per 100 000 (5290 suicides) in 1999 and then to have decreased to 7.1 per 100 000 in 2003. The average suicide rate during 1998-2003 was 7.9 per 100 000 with a male to female ratio of 3.4:1. Male suicide reached a peak for those aged 25-29 years (21.9 per 100 000) while female suicide showed less variation with age. Hanging was the most common method used, followed by ingestion of agricultural toxic substances. Suicide was most prevalent in upper northern region where HIV infection might be related to the high prevalence. Suicide prevention program should focus on males in early adulthood, and particular measures should be conducted to reduce risk factors related to HIV infection among people in northern Thailand.

Suicide in the north of Thailand

OBJECTIVE

To examine the characteristics of complete suicide in the North of Thailand from 1998-2002.

MATERIAL AND METHOD

Data of suicide in the North of Thailand were obtained from the Bureau of Policy and Strategy, Ministry of Public Health and analyzed mortality from suicides during 1998-2002 classified by gender and methods.

RESULTS

The suicide rate in the North for both genders was the highest among all regions of Thailand (average rate of 13.9 per 100,000 population during 1998-2002). The ratio of male to female was 3.6:1. There was a peak age group for male suicides (aged 25-34 years) while female suicides showed less variation with age. Hanging was the most common suicide method followed by the use of agricultural toxic substances. Suicides were most prevalent in the upper northern region and high suicide rates occurred in Chiangmai, Lampoon, Phayao, Chiangrai, and Phrae provinces.

CONCLUSION

The suicide rate in the upper northern Thailand was found to be considerably high. Therefore, suicide prevention programs should be given priority in this region, particularly in Chiangmai and Lampoon provinces.

Factors associated with obesity among workers in a metropolitan waterworks authority

To examine the relationship of socio-demographic characteristics, psychological factors, knowledge, attitude and behavior towards obesity among Metropolitan Waterworks Authority (MWWA) officers, a cross-sectional study was conducted between July and September, 2004. Two hundred and eighty-eight obese [body mass index (BMI) > or = 25 kg/m2] and 106 non-obese persons, aged 20-60 years, were recruited as study subjects. Data were collected by a self-administered questionnaire, comprised of three parts: socio-demographic; psychological factors (depression and stress); and knowledge, attitude, behavior related to obesity. Univariate analyses and Logistic regression models were used to study the association between obesity and possible risk factors. The results demonstrate significant associations between older age and obesity. Volunteers in the age groups of 40-49 and 50-59 years had a significantly higher risk of being obese than the age group of less than 40 years (adjusted OR = 3.4, 95% Cl = 1.1-11.1 and adjusted OR = 10.4, 95% CI = 3.3-32.7, respectively). Volunteers with unhealthy behaviors were at significantly higher risk than those with healthy behaviors (adjusted OR = 10.3, 95% CI = 2.0-52.4) while persons with moderately healthy behaviors also had increased risk, but to a lesser extent (adjusted OR = 4.5, 95% CI = 1.7-11.4). There were no associations between psychological factors and obesity in this group of volunteers. When we focused on whether they consumed more food when they were stressed, it was found that the obese consumed significantly more food during stress (p-value = 0.003). Watching television, videos, or playing computer continuously for more than 3 hours, were significantly associated with obesity. We conclude that although the obese have a good knowledge and attitude towards obesity, they still practise unhealthy behavior, have a sedentary lifestyle, and over eat when they are stressed. Future research regarding behavioral modification should be implemented at both community and country levels.

Dramatic nondipole effects in low-energy photoionization: experimental and theoretical study of Xe 5s

The Xe 5s nondipole photoelectron parameter gamma is obtained experimentally and theoretically from threshold to approximately 200 eV photon energy. Significant nondipole effects are seen even in the threshold region of this valence shell photoionization. In addition, contrary to previous understanding, clear evidence of interchannel coupling among quadrupole photoionization channels is found.

Development of the Thai Depression Inventory

The Thai Depression Inventory was developed as a self-rating instrument for measuring the severity of depression. The items used were based on widely used Western scales and on common manifestations and idioms of distress among depressed Thai subjects. The scale was tested with 50 depressed patients using the Hamilton Rating Scale for Depression as an external standard. The internal reliability and concurrent validity were good (Cronbach alpha = 0.858; r = 0.72). The items of psychomotor retardation and loss of libido were poorly correlated with the total score. Factor analysis revealed five distinct factors which accounted for 59.8 per cent of the total variance. Anxiety-insomnia factor was the predominant factor. For major depressive patients, the Thai Depression Inventory total score is 35 or above. The Thai Depression Inventory is a culturally appropriate instrument for measuring the severity of depression with satisfactory reliability and validity.