Validation of the Beck Depression Inventory II in HIV-positive patients / Validación del Inventario de Depresión de Beck II en los pacientes VIH-positivos

OBJECTIVE: Research on depression among HIV-positive patients has been limited by the lack of a valid and reliable measure of depression. This project addresses this problem by exploring the internal consistency reliability and the concurrent and discriminant validity of the Beck Depression Inventory- II (BDI-II) using HIV-positive patients in Jamaica. METHOD: Patients from three HIV clinics in Jamaica (n = 191 patients; 61% female, 39% male, mean age 40.5 ± 10 years) were administered the BDI-II along with the Centre for Epidemiological Studies - Depression Scale (CES-D) and the Social Provisions Scale. RESULTS: Overall, the BDI-II was found to have a high degree of reliability (a = 0.89). The scale also had good concurrent validity as evidenced by a high correlation with scores on the CES-D (r = 0.74) and acceptable discriminant validity as demonstrated through a moderate correlation with the Social Provisions Scale (r = -0.42). This pattern of scores suggests that the majority of the variance underlying the BDI-II assesses depression (55%) while a smaller degree of the variability (18%) measures a conceptually similar but distinct concept. CONCLUSION: The BDI-II is a sufficiently reliable and valid measure for assessing depression in HIV-positive patients.

OBJETIVO: La investigación sobre la depresión entre los pacientes VIH-positivos ha estado limitada por la falta de una medida válida y confiable de la depresión. Este proyecto aborda este problema explorando la confiabilidad de la consistencia interna, así como la validez discriminate y concurrente del Inventario de la Depresión de Beck II (BDI-II) usando pacientes VIH-positivos en Jamaica. MÉTODO: A los pacientes de tres clínicas de VIH en Jamaica (n = 191 pacientes; 61% hembras, 39% varones, edadpromedio 40.5 ± 10 anos) se les aplicó el BDI-IIjunto con la Escala de Depresión (CES D) y la Escala de Provisiones Sociales - Centro de Estudios Epidemiológicos. RESULTADOS: En general, se halló que el BDI-II posee un alto grado de confiabilidad (a = 0.89). La escala poseía también una buena validez concurrente, como quedó evidenciado por la elevada correlación con las puntuaciones del CES-D (r = 0.74), Igualmente, se constató que posee una validez discriminante aceptable como lo demuestran las correlaciones moderadas con la Escala de Provisiones Sociales (r = -0.42). Este patrón de puntuaciones sugiere que la mayor parte de la varianza que subyace en el BDI-II da la medida de la depresión (55%), en tanto que un grado menor de la variabilidad (18%) mide un concepto de naturaleza similar pero claramente definido. CONCLUSIÓN: El BDI-II constituye una medida suficientemente confiable y válida para evaluar la depresión en pacientes VIH positivos.

Patterns of depressive symptoms among patients with HIV infection / Patrones de síntomas depresivos entre pacientes con infección por VIH

OBJECTIVE: To identify the level of depressive symptoms among patients with HIV infection and to examine the reported patterns of depressive symptoms not confounded by the physical manifestations of HIV-infection. METHOD: A total of 191 patients with HIV infection (75 males (39%) and 116 females (61%), mean age 40.48 ± 10 years), from three HIV clinics were administered the Beck Depression Inventory - II as well as a demographic questionnaire as part of a larger study. RESULTS: Moderate to severe depressive symptoms were reported by 17.3% of the HIV-infected patients with females reporting significantly higher levels of depressive symptoms than males. A principal components analysis identified three clusters of depressive symptoms: cognitive-affective, negative cognitions and somatic symptoms. The HIV-infected patients were found to display mainly cognitive-affective symptoms of depression. CONCLUSION: HIV-infected patients, especially female patients, may be at an increased risk of experiencing high levels of depressive symptoms. It is recommended that HIV-infected patients be routinely screened for depression, particularly cognitive-affective symptoms of depression.

OBJETIVO: Identificar el nivel de sintomas depresivos entre pacientes con infección por VIHy examinar los patrones reportados sobre los sintomas de depresión, no confundidos por las manifestaciones físicas de la infección por VIH. MÉTODO: A un total de 191 pacientes con infección por VIH (75 varones (39%) y 116 hembras (61%), con edadpromedio 40.45 ± 10 anos), de tres clinicas de VIH, se les aplicó el Inventario de Depresión de Beck II, asi como una encuesta demográfica como parte de un estudio más grande. RESULTADOS: Un 17.3% de los pacientes infectados por VIH, informaron sintomas depresivos de moderados a severos, reportando las hembras niveles de sintomas de depresión significativamente más altos que los varones. Un análisis de los componentes principales identificó tres grupos de sintomas depresivos: cognitivos afectivos, cogniciones negativas y sintomas somáticos. Se halló que los pacientes infectados por VIHpresentaban principalmente sintomas afectivos cognitivos de depresión. CONCLUSIÓN: Los pacientes infectados con VIH, especialmente las hembras, pueden hallarse en un mayor riesgo de experimentar niveles altos de sintomas depresivos. Se recomienda que los pacientes infectados con VIHsean sometidos deforma rutinaria a tamizajes de depresión, particularmente de los sintomas de depresión cognitivos afectivos.

Screening for postpartum depression

Postpartum depression, a potentially serious public health problem can be effectively treated. With the implementation of universal screening with a standardized, self-administered screening tool, in conjunction with appropriate education and training of health care providers to increase awareness of this problem and to impart greater diagnostic suspicion, identification of and early intervention for PPD can be facilitated. There is need for increased collaboration between Obstetric and Consultation Liaison Psychiatric Services, with particular emphasis on the prevention of psychiatric morbidity associated with pregnancy, thereby improving the quality of life for and interaction between mother and child. The establishment of a true Liaison Psychiatric Service dedicated to pregnancy and the postpartum period, with a Psychiatrist employed by the Obstetric Services, may be of great value.

Community-based prevention of substance abuse

Substance abuse is pervasive in a number of countries throughout the world, placing an enormous burden and strain on their healthcare systems. The relationship between crime and illicit drug use increases the significance of the problem facing countries worldwide. Jamaica has not only become a trans-shipment point for cocaine from South America, but recent Drug Enforcement Agency figures show Jamaica being responsible for 30 of cocaine trafficking into the United States of America. Though all segments of society are involved, disadvantaged groups are disproportionately affected. Substance use and abuse among adolescents is of particular concern. Supply reduction approaches have not been effective enough in reducing the prevalence of substance use and abuse in many countries throughout the world. Substance abuse prevention research over 25 years has led to the identification of a number of factors differentiating substance abusers from others. The presence of risk factors and the absence of protective facts contribute to an increase potential for drug abuse. The impact that these factors have is also determined by the level of psychological and social development of an individual. The presence of risk factors as well as the absence of protective factors leads to increased [quot ]exposure opportunity[quot ], exposure to a potential substance of abuse being closely associated with the potential for initial drug use, transition from initiation to regular use and subsequently dependence. One method of reducing [quot ]exposure opportunity[quot ] is community prevention. The basic aim of community prevention programmes is to decrease the rate of drug use in a population by enhancing protective factors and reversing or reducing risk factors