Update of the standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population.

INTRODUCTION: PHQ-4, consisting of PHQ-2 and GAD-2, is a widely used screening instrument for depressive and anxiety symptoms in clinical settings and in epidemiological studies. In the present study we provide an update of normative data from the German general population. METHODS: Data was collected in two randomly selected samples representative of the German general population in 2020 (N = 2503) and 2021 (N = 2519). We computed percentile norm values for the total sample (N = 5022) and for different age groups, stratified by gender. RESULTS: Compared to previous data, only minor changes in normative values were observed. 95 %-thresholds were at a score of 6-7 for the PHQ-4, and 3-4 for PHQ-2 and GAD-2 respectively. The scales showed acceptable reliability with McDonald's omega of ω = 0.77 for PHQ-2, ω = 0.78 for GAD-2, and ω = 0.85 for PHQ-4. LIMITATIONS: Lack of a diagnostic gold standard and suboptimal response proportion (44.2 %) are limitations of this study. CONCLUSION: This update supports the continued use of PHQ-4 scales as reliable instruments. For psychometric application, the reported normative data for PHQ-2, GAD-2 and PHQ-4 facilitates more up-to-date comparisons.

Predictors of change in depressive symptoms in older and multimorbid patients: a longitudinal analysis of the multicare cohort.

BACKGROUND: Depression in older adults is becoming an increasing concern. As depressive symptoms change over time, it is important to understand the determinants of change in depressive symptoms. The aim of our study is to use a longitudinal study design to explore the predictors of change, remission and incident depression in older patients with multimorbidity. METHODS: Data from the MultiCare cohort study were used. The cohort studied 3,189 multimorbid general practice patients aged 65-85. Data were collected during personal interviews. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS-15). Predictors of change in depressive symptoms were determined using multivariate linear regression, while multivariate logistic regression was used to analyze predictors of remission and incident depression. Models included depressive symptoms at baseline and follow-up, socio-demographics and data on health status and social support. RESULTS: Overall, 2,746 participants with complete follow-up data were analyzed. Mean age was 74.2 years, 59.2% were female, and 11.3% were classified as depressed at baseline. Burden of multimorbidity and social support were statistically significant predictors in all regression analyses. Further predictors of change in depressive symptoms were: income, pain, nursing grade, self-rated health and self-efficacy. LIMITATIONS: The sample size for prediction of remission limited statistical certainty. Assessment of depressive symptoms using GDS-15 differs from routine clinical diagnoses of depression. CONCLUSIONS: Predictors of change in depressive symptoms in older multimorbid patients are similar to those predicting remission and incident depression, and do not seem to differ significantly from other older patient populations with depressive symptoms.

Clinical and economic outcomes of a collaborative cardiology care program.

OBJECTIVES: We evaluated a collaborative care program aimed at improving cooperation among general practitioners (GPs) and cardiologists in Baden-Wuerttemberg, Germany. The program focused on improving care for patients with chronic cardiac conditions. STUDY DESIGN: We conducted a retrospective cohort study. The observation period was 2 years. METHODS: The study was based on claims data and compared groups of patients who participated in the collaborative care program (GP-centered care and the cardiology contract) with patients receiving usual care. The evaluation focused on care coordination, quality, health service utilization, and costs in patients with heart failure, coronary heart disease, heart rhythm disorders, and/or valvular heart disease (disease cohorts). Multivariable regression models were used to adjust for differences in patient characteristics between the groups. RESULTS: Across all disease cohorts, participation in the collaborative care program was associated with better care coordination and improved quality in a broad range of indicators (pharmacotherapy and vaccination). Results showed lower emergency service utilization and hospitalizations, lower consultation frequencies with GPs and specialists, and a shift from inpatient to outpatient procedures. Program participation resulted in higher costs for outpatient cardiologist treatment, but disease-specific costs were lower overall. CONCLUSIONS: The results underline evidence that health care service programs that strengthen collaboration between GPs and cardiologists can substantially improve the care of patients with chronic cardiac conditions while simultaneously reducing costs.

Performance of the adapted Diabetes Complications Severity Index translated to ICD-10.

OBJECTIVES: To assess the performance of the adapted Diabetes Complications Severity Index (aDCSI) translated to International Classification of Diseases, Tenth Revision (ICD-10) in predicting hospitalizations, mortality, and healthcare-associated costs. STUDY DESIGN: Retrospective closed cohort study based on secondary data analysis. METHODS: We translated the aDCSI to ICD-10 and calculated aDCSI scores based on health insurance claims data. To assess predictive performance, we used multivariate regression models to calculate risk ratios (RRs) of hospitalizations and mortality and linear predictors of cost. RESULTS: We analyzed a sample of 157,115 patients with diabetes mellitus. RRs of hospitalizations (total and cause specific) rose with increasing aDCSI scores. Predicting total hospitalizations over a 4-year period, unadjusted RRs were 1.22 for an aDCSI score of 1 (compared with a score of 0), 1.55 for a score of 2, 1.77 for a score of 3, 2.11 for a score of 4, and 2.72 for scores of 5 and higher. Cause-specific hospitalizations and mortality showed similar results. Costs clearly increased in each successive score category. CONCLUSIONS: Our study supports the validity of the aDCSI as a severity measure for complications of diabetes, as it correlates to and predicts total and cause-specific hospitalizations, mortality, and costs. The aDCSI's performance in ICD-10-coded data is comparable with that in International Classification of Diseases, Ninth Revision-coded data.