Measurement invariance testing of the patient health questionnaire-9 (PHQ-9) across people with and without diabetes mellitus from the NHANES, EMHS and UK Biobank datasets.

BACKGROUND: The prevalence of depression is higher among those with diabetes than in the general population. The Patient Health Questionnaire (PHQ-9) is commonly used to assess depression in people with diabetes, but measurement invariance of the PHQ-9 across groups of people with and without diabetes has not yet been investigated. METHODS: Data from three independent cohorts from the USA (n=1,886 with diabetes, n=4,153 without diabetes), Quebec, Canada (n= 800 with diabetes, n= 2,411 without diabetes), and the UK (n=4,981 with diabetes, n=145,570 without diabetes), were used to examine measurement invariance between adults with and without diabetes. A series of multiple group confirmatory factor analyses were performed, with increasingly stringent model constraints applied to assess configural, equal thresholds, and equal thresholds and loadings invariance, respectively. One-factor and two-factor (somatic and cognitive-affective items) models were examined. RESULTS: Results demonstrated that the most stringent models, testing equal loadings and thresholds, had satisfactory model fit in the three cohorts for one-factor models (RMSEA = .063 or below and CFI = .978 or above) and two-factor models (RMSEA = .042 or below and CFI = .989 or above). LIMITATIONS: Data were from Western countries only and we could not distinguish between type of diabetes. CONCLUSIONS: Results provide support for measurement invariance between groups of people with and without diabetes, using either a one-factor or a two-factor model. While the two-factor solution has a slightly better fit, the one-factor solution is more parsimonious. Depending on research or clinical needs, both factor structures can be used.

Psychotropic medication use among adolescents: United States, 2005-2010.

Approximately 6.0% of U.S. adolescents aged 12-19 reported psychotropic drug use in the past month. The use of antidepressants (3.2%) and attention deficit hyperactive disorder (ADHD) drugs (3.2%) was highest, followed by antipsychotics (1.0%); anxiolytics, sedatives, and hypnotics (0.5%); and antimanics (0.2%). Males (4.2%) were more likely than females (2.2%) to use ADHD drugs. Females (4.5%) were more likely than males (2.0%) to use antidepressants. Psychotropic drug use was higher among non-Hispanic white (8.2%) adolescents than non-Hispanic black (3.1%) and Mexican-American (2.9%) adolescents. About one-half of U.S. adolescents using psychotropic drugs in the past month had seen a mental health professional in the past year (53.3%). Prior studies have shown an increase in psychotropic medication use among adolescents. However, most studies were based on clinical samples or high-risk populations. This report provides the estimate of any psychotropic medication use in the past month among U.S. noninstitutionalized adolescents aged 12-19 during 2005-2010, using National Health and Nutrition Examination Survey (NHANES) data. Psychotropic medication is a type of drug used to treat clinical psychiatric symptoms or mental disorders. Specific psychotropic drug types addressed are antidepressants; medications for attention deficit hyperactive disorder (ADHD); anxiolytics, sedatives, and hypnotics (ASH); antimanics; and antipsychotics. Adolescents using psychotropic drugs are further examined by sex, race and Hispanic origin, and mental health professional consultation.

Disparities in rates of acute MI hospitalization and coronary procedures on the US-Mexico border.

BACKGROUND: Hospitalization rates for acute myocardial infarction can provide insight into the utilization of care by disadvantaged populations. However, these data have not been reported for the US-Mexico border region. METHODS: Hospital discharge public use data files for 2000 were obtained from the health departments of Arizona, California, and Texas. The diagnosis of acute myocardial infarction was based on International Classification of Diseases-9th Revision, Clinical Modification code 410 as a primary discharge diagnosis. In addition, cardiac catheterization, coronary angioplasty, and bypass grafting procedures were enumerated. Discharges were classified as occurring in hospitals in border counties and nonborder counties. RESULTS: Overall, 12,464 hospital discharges in border counties had acute myocardial infarction listed as the first diagnosis. Among those aged 45-64 and >or=65 years in border counties, Texas had the lowest discharge rates (eg, at >or=65 years: Texas 95, California 134 per 10,000), lower than in nonborder counties. Among those aged >or=65 years, rates in Texas also were lower in border than nonborder counties, a pattern not seen in other states. On the contrary, rates of catheterization and bypass grafting were highest in Texas, whereas the rates of bypass grafting were actually higher in border than in nonborder counties. In border and nonborder counties of the combined states, hospitalization rates of acute myocardial infarction in Hispanics were lower than those of non-Hispanics. Rates varied little between border and nonborder counties within ethnic groups. A similar pattern was observed for the hospital use of angioplasty and coronary bypass surgery. CONCLUSIONS: Our findings suggest possible underutilization of hospital in-patient care for coronary artery disease by Hispanics who were residents of Texas border counties. Further studies are needed to test this hypothesis using more recent data.

Diabetes hospitalization at the U.S.-Mexico border.

INTRODUCTION: The diabetes hospitalization rate for the region along the U.S. side of the U.S.-Mexico border is unknown, a situation that could limit the success of the Healthy Border 2010 program. To remedy this problem, we analyzed and compared hospital discharge data for Arizona, California, and Texas for the year 2000 and calculated the diabetes hospitalization rates. METHODS: We obtained hospital-discharge public-use data files from the health departments of three U.S. border states and looked for cases of diabetes. Only when diabetes was listed as the first diagnosis on the discharge record was it considered a case of diabetes for our study. Patients with cases of diabetes were classified as border county (BC) or nonborder county (NBC) residents. Comparisons between age-adjusted diabetes discharge rates were made using the z test. RESULTS: Overall, 1.2% (86,198) of the discharge records had diabetes listed as the primary diagnosis. BC residents had a significantly higher age-adjusted diabetes discharge rate than NBC residents. BC males had higher diabetes discharge rates than BC females or NBC males. In both the BCs and the NBCs, Hispanics had higher age-adjusted diabetes discharge rates than non-Hispanics. CONCLUSION: The results of this study provide a benchmark against which the effectiveness of the Healthy Border 2010 program can be measured.