ABSTRACT
OBJECTIVE: Presentation and validation of the Depressive Psychopathology Scale (DPS), a new, Spanish-language psychometric inventory, in a sample of Peruvian psychiatric patients. METHODS: From 1999 to 2001, the DPS, Zung Self-rating Depression Scale (ZSDS), and Major Depressive Disorder (MDD) module of the Structured Clinical Interview for DSM-IV Disorders (SCID) were administered to 226 nonpsychotic outpatients referred to the National Institute of Mental Health in Lima, Peru, for their initial clinical evaluation. In the evaluation, attending psychiatrists 1) corroborated the general diagnosis and presence or absence of MDD and 2) rated depression severity based on clinical opinion and on Clinical Global Im-pression-Severity scale criteria. RESULTS: Mean time to complete the DPS was 7.22 minutes (standard deviation, 3.99). Cronbach's alpha value was 0.86. For diagnosis of MDD, based on the SCID, area under receiver operating characteristic curve (AUROC) was 0.872 and the selected cutoff score (26/27) had 81.32 percent sensitivity and 80 percent specificity; based on the attending psychiatrists' evaluation, AUROC was 0.832 and the selected cutoff score (25/26) had 77.67 percent sensitivity and 72.32 percent specificity. The DPS was significantly correlated with the ZSDS (rho = 0.8, P < 0.001). Some DPS items ("depression worse in the morning," "appetite disturbances," "mood reactivity," and "hypersomnia") showed low loadings on the five factors extracted through principal component analysis and/or did not significantly correlate with depression parameters. CONCLUSIONS: The DPS can predict MDD and has convergent validity, as shown by its correlation with the ZSDS. However, additional psychometric studies are recommended to simplify and improve it.
OBJETIVO: Presentación y validación de la Escala de Psicopatología Depresiva (EPD), un nuevo inventario psicométrico en lengua española, en una muestra de pacientes psiquiátricos peruanos. MÉTODOS: De 1999 al 2001, se administraron la EPD, la Escala de Autoevaluación de la Depresión de Zung (ZSDS) y el módulo correspondiente al Trastorno Depresivo Mayor (TDM) de la Entrevista Clínica Estructurada para trastornos del DSM-IV (SCID) a 226 pacientes ambulatorios no psicóticos derivados al Instituto Nacional de Salud Mental de Lima para su evaluación clínica inicial. En la evaluación, los psiquiatras responsables 1) corroboraron el diagnóstico general y la presencia o ausencia de TDM, y 2) clasificaron la gravedad de la depresión con base en la opinión clínica y los criterios de gravedad de la Escala de Impresión Clínica Global. RESULTADOS: El tiempo medio para completar la EPD fue de 7,22 minutos (desviación estándar, 3,99). El valor del índice alfa de Cronbach fue de 0,86. Para el diagnóstico del TDM, basado en el SCID, el área bajo la curva ROC (de eficacia diagnóstica) fue de 0,872, y la puntuación discriminatoria seleccionada (26/27) mostró una sensibilidad de 81,32 por ciento y una especificidad de 80 por ciento; con base en la evaluación de los psiquiatras responsables, el área bajo la curva ROC fue de 0,832, y la puntuación discriminatoria seleccionada (25/26) mostró una sensibilidad de 77,67 por ciento y una especificidad de 72,32 por ciento. La EPD se correlacionó significativamente con la ZSDS (rho = 0,8, P < 0,001). Algunos elementos de la EPD ("depresión peor por la mañana", "alteraciones del apetito", "reactividad del estado de ánimo" e "hipersomnia") mostraron cargas bajas de los cinco factores extraídos mediante el análisis de los componentes principales o no se correlacionaron significativamente con los parámetros de depresión. CONCLUSIONES: La EPD puede predecir el TDM y tiene validez convergente, tal como lo demuestra su correlación con la ZSDS. Sin embargo, se recomienda realizar estudios psicométricos adicionales con objeto de simplificarla y mejorarla.
Subject(s)
Adult , Female , Humans , Male , Depression/diagnosis , Psychometrics/methods , Analysis of Variance , Culture , Depression/pathology , Diagnostic and Statistical Manual of Mental Disorders , Outpatients , Peru , Psychometrics/instrumentation , Reproducibility of Results , Self Report , Sensitivity and Specificity , Severity of Illness IndexABSTRACT
Objetivos: Identificar la sintomatología considerada como útil para diagnosticar depresión por médicos generales (MGs), el vocabulario local utilizado y comparar los síntomas listados con criterios diagnósticos estandarizados. Material y Métodos: Setenta y tres MGs participaron en una encuesta en Lima-Perú. Sesenta y cinco MGs respondieron a una pregunta abierta sobre listar síntomas útiles para realizar el diagnóstico de depresión. Los síntomas se clasificaron de acuerdo a los criterios requeridos para un diagnóstico de episodio depresivo mayor (criterio A, únicamente) del DSM-IV-TR (DSM) y para el episodio depresivo leve (F32.0) de la Clasificación Internacional de Enfermedades-10ma revisión (CIE). Resultados: Diverso vocabulario médico y coloquial fue utilizado para describir síntomas depresivos. Criterios suficientes para realizar un diagnóstico de depresión de acuerdo al CIE y el DSM fueron listados, respectivamente, por 32,3% y 16,9% de MGs. Conclusiones: Estos hallazgos pueden ayudar al desarrollo de intervenciones para mejorar el entrenamiento de los MGs y la calidad de atención en relación a la detección de depresión y evaluación de riesgo suicida. Sin embargo, casi un tercio de MGs fueron capaces de recordar suficientes síntomas depresivos para cumplir criterios para un diagnóstico según la CIE, referencia usada extensamente en servicios no-psiquiátricos.
Objective: To identify the symptomatology deemed by General Practitioners (GPs) as useful to diagnose depression, the local vocabulary used to describe it, and to compare the reported symptoms with standardized criteria. Material and Methods: Seventy-three GPs participated in a survey in Lima, Peru. Sixty-five GPs responded to an openended question to list symptoms useful to diagnose depression. Symptoms were classified according to criteria required for a Major Depressive Episode (Criterion-A only) of the DSM-IV-TR (DSM) and for a Mild Depressive Episode (F32.0) of the International Classification of Diseases-10th Revision (ICD). Results: Diverse medical and colloquial wording were used to describe depressive symptomatology. Sufficient criteria to make a diagnosis of depression according to the ICD and the DSM were listed, respectively, by 32.3% and 16.9% of GPs. Conclusions: These findings could aid in the development of training and quality improvement interventions to facilitate the detection of depression and suicide risk assessment. Still, almost one-third of GPs were able to directly recall sufficient depressive symptoms to meet criteria for an ICD diagnosis, a classification widely used in non-psychiatric settings.
Subject(s)
Humans , Male , Female , Depression , Depression/diagnosis , Physicians , Signs and SymptomsABSTRACT
OBJETIVE: The Multicultural Quality of Life Index is a concise instrument for comprehensive, culture-informed, and self-rated assessment of health-related quality of life. It is composed of 10 items (from physical well-being to global perception of quality of life). Each item is rated on a 10-point scale. The objective was to evaluate the reliability (test-retest), internal structure, discriminant validity, and feasibility of the Multicultural Quality of Life Index in Lima, Peru. METHOD: The reliability was studied in general medical patients (n = 30) hospitalized in a general medical ward. The Multicultural Quality of Life Index was administered in two occasions and the correlation coefficients ("r") between both interviews were calculated. Its discriminant validity was studied statistically comparing the average score in a group of patients with AIDS (with presumed lower quality of life, n = 50) and the average score in a group of dentistry students and professionals (with presumed higher quality of life, n = 50). Data on its applicability and internal structure were compiled from the 130 subjects. RESULTS: A high reliability correlation coefficient (r = 0.94) was found for the total score. The discriminant validity study found a significant difference between mean total score in the samples of presumed higher (7.66) and lower (5.32) quality of life. The average time to complete the Multicultural Quality of Life Index was less than 4 minutes and was reported by the majority of subjects as easily applicable. A high Cronbach's a (0.88) was also documented. CONCLUSIONS: The results reported that the Multicultural Quality of Life Index is reliable, has a high internal consistency, is capable of discriminating groups of presumed different quality of life levels, is quite efficient, and easy to use.
OBJETIVO: O índice Multicultural de Qualidade de Vida é um instrumento conciso para a avaliação ampla, culturalmente informada e auto-aplicável da qualidade de vida relativa à saúde. É composto de 10 itens (do bem-estar físico à percepção global da qualidade de vida). Cada item é classificado de acordo com uma escala de 10 pontos. O objetivo foi o de avaliar a confiabilidade (teste-reteste), estrutura interna, validade discriminante e a viabilidade do índice Multicultural de Qualidade de Vida em Lima, Peru. MÉTODO: A confiabilidade foi estudada em pacientes da clínica geral (n = 30) hospitalizados em uma enfermaria clínica geral. O índice Multicultural de Qualidade de Vida foi ministrado em duas ocasiões e os coeficientes de correlação ("r") entre ambas as entrevistas foram calculados. Sua validade discriminante foi estudada comparando estatisticamente o escore médio em um grupo de pacientes com AIDS (com presumida menor qualidade de vida, n = 50) e o escore médio em um grupo de estudantes e profissionais de odontologia (com presumida maior qualidade de vida, n = 50). Os dados sobre sua aplicabilidade e estrutura interna foram compilados a partir de 130 indivíduos. RESULTADOS: Achou-se um alto coeficiente de correlação de confiabilidade no escore total (r = 0,94). O estudo de validade discriminante encontrou diferença significativa entre o escore médio total nas amostras de qualidade de vida presumida mais alta (7,66) e mais baixa (5,32). O tempo médio para completar o índice Multicultural de Qualidade de Vida foi de menos de 4 minutos e foi relatado pela maioria dos indivíduos como facilmente aplicável. Foi também documentado um alto alfa de Cronbach (0,88). CONCLUSÕES: Os resultados relatam que o índice Multicultural de Qualidade de Vida é confiável, possui uma alta consistência interna, é capaz de discriminar grupos de diferentes níveis de qualidade de vida presumidos, é muito eficiente e é de fácil utilização.