Development and validation of a military fear avoidance questionnaire.

Chronic pain due to musculoskeletal injury is one of the leading causes of disability and reduced combat readiness in the U.S. Army. Unidimensional pain management systems are not effective in addressing the complex phenomenon of pain-related disability. Growing evidence has supported use of the Fear Avoidance Model (FAM) as a suitable model to address pain-related disability and chronicity from a multidimensional pain neuroscience approach. While several fear avoidance measurement tools exist, one that addresses the complexity of the Army environment encouraged the authors to develop and test the reliability and validity of a military specific questionnaire. This study developed and validated an Army specific fear avoidance screening, the Return to Duty Readiness Questionnaire (RDRQ), which subsequently demonstrated good psychometric properties. Reliability coefficients demonstrate high internal consistency values both during pilot study (α = 0.96) and validation study (α = 0.94, ωt = 0.94). A Correlation Coefficient of 0.74 when compared with the Fear Avoidance Components Scale (FACS) suggests good concurrent validity. Future study should include replication in a new army population, investigation of responsiveness, test-retest reliability, structural validity and establishing severity scores with minimal clinically important differences to enhance utility.

A Confirmatory Factor Analysis of the 'Return to Duty Readiness Questionnaire'.

The Readiness to Return to Duty Questionnaire (RDRQ) is a recently developed screening instrument for detecting fear-avoidance behavior in a military musculoskeletal pain population. The RDRQ was developed based on the Fear-Avoidance Model which postulates four factors resulting in overall fear-avoidance behavior. While research investigating the factor structure of the RDRQ does not exist, research investigating the factor structure of other measures of fear avoidance have found evidence of one and two factor solutions. In the present paper we assess the adequacy of the proposed factor structure of the RDRQ using confirmatory factor analysis. The results favor a three-factor model. Theoretical implications for research using the RDRQ are discussed.

The impact of wearable motion sensing technology on physical activity in older adults.

BACKGROUND AND PURPOSE: Physical activity provides substantial health benefits. Older adults are less physically active than the rest of the population, and interventions that promote physical activity are needed. In this meta-analysis, we investigate how different wearable activity trackers (pedometers and accelerometers) may impact physical activity levels in older adults. METHODS: We searched MEDLINE, Embase and CINAHL for randomized controlled trials including participants that were ≥65 years, using wearable activity trackers with the intent of increasing physical activity. Studies whose comparator groups were engaged in active or inactive interventions, such as continued a physical therapy program or goal-setting counseling, were not excluded simply for implementing co-interventions. We used random-effects models to produce standardized mean differences (SMDs) for physical activity outcomes. Heterogeneity was measured using I2. RESULTS: Nine studies met the eligibility criteria: Four using accelerometers, four using pedometers, and one comparing accelerometers and pedometers, for a total number of 939 participants. Using pooled data, we found a statistically significant effect of using accelerometers (SMD = 0.43 (95%CI 0.19-0.68), I2 = 1.6%, p = 0.298), but not by using pedometers (SMD = 0.17 (95%CI -0.08-0.43), I2 = 37.7%, p = 0.174) for increasing physical activity levels. DISCUSSION AND CONCLUSIONS: In this study, we found that accelerometers, alone or in combination with other co-interventions, increased physical activity in older adults however pedometers were not found to increase physical activity. The high risk of bias found in most studies limits these findings. High quality studies that isolate the effects of accelerometers on physical activity changes are needed.

Clinical characteristics of unipolar disorder and bipolar disorder according to the lifetime presence of recurrent panic attacks.

OBJECTIVES: The frequent comorbidity of panic and affective disorders has been described in previous studies. However, it is not clear how panic disorder comorbidity in unipolar disorder and bipolar disorder is related to illness course. METHODS: We compared lifetime clinical characteristics of illness and items of symptomatology in samples of individuals with bipolar I disorder (n = 290) and unipolar disorder (n = 335) according to the lifetime presence of recurrent panic attacks. RESULTS: We found significant differences in clinical course of illness characteristics that were shared across the unipolar and bipolar samples according to the lifetime presence of panic attacks. We also found a number of differences according to the presence of panic attacks that may be specific to the diagnostic group. CONCLUSIONS: Distinguishing patients who have mood disorder diagnoses, especially bipolar I disorder, according to the lifetime presence of panic attacks may not only be of use in clinical practice, but may also be informative for aetiological research, such as molecular genetic studies.

Is depression severity the sole cause of psychotic symptoms during an episode of unipolar major depression? A study both between and within subjects.

BACKGROUND: Despite the common clinical assumption that psychosis is an indicator of severity in depression, it is not known what determines the presence of psychotic features in major depression. Our aim was to answer the question: Is depression severity the sole cause of psychotic symptoms during an episode of unipolar major depression? METHODS: In a sample of 585 patients from the UK, meeting criteria for both DSM-IV and ICD-10 major recurrent depression, we assessed measures of severity of depression and the presence of psychotic features, both within and between subjects. RESULTS: Within patients, psychotic episodes tended to be more severe than non-psychotic episodes. However, between patients there was wide variation in severity in both those that did, and did not, experience psychotic episodes. LIMITATIONS: We used retrospective interview information together with case note data. Our cases may not be typical of usual case loads because they were selected to avoid family history of bipolar illness or schizophrenia. CONCLUSIONS: Individuals with a predisposition to psychotic features tend to display such features during more severe episodes of depression. However, patients with no history of psychosis may experience non-psychotic depressive episodes of equal or greater severity, in terms of depressive symptomatology, compared to patients with psychotic depression. Thus, there is individual variation in susceptibility to psychosis during mood episodes and severity is not the sole determinant.

Clinical differences between bipolar and unipolar depression.

It is commonly -- but wrongly -- assumed that there are no important differences between the clinical presentations of major depressive disorder and bipolar depression. Here we compare clinical course variables and depressive symptom profiles in a large sample of individuals with major depressive disorder (n=593) and bipolar disorder (n=443). Clinical characteristics associated with a bipolar course included the presence of psychosis, diurnal mood variation and hypersomnia during depressive episodes, and a greater number of shorter depressive episodes. Such features should alert a clinician to a possible bipolar course. This is important because optimal management is not the same for bipolar and unipolar depression.

Differences in depressive symptom profile between males and females.

BACKGROUND: It is widely held that there are no differences in the symptom profile of male and female depression. Studies to date that have found differences have used different methodologies and had inconsistent findings. Here we compare the clinical profile of major depression for men and women from a sample of almost 600 well-characterized individuals with recurrent major depressive disorder (MDD). METHODS: Subjects were recruited as part of a large genetic-epidemiological study of MDD. Clinical assessments included semi-structured interviews and case-note review. Clinical profiles during 'worst ever' (WE) depressive episode were scored using the OPCRIT checklist. Profiles for 199 males were compared to 399 females. RESULTS: Females with depression tended to have an earlier age-at-onset (p<0.0001), exhibited more frequent depressive episodes (p<0.005), had a greater number of depressive symptoms (p<0.001), and reported much higher rates of atypical depressive features (p<0.007) during their WE episode of depression. Logistic regression analysis identified that earlier age-at-onset of depression, excessive self-reproach and diminished libido were the best predictors of female depression. LIMITATIONS: Retrospective recall by subjects of depressive symptoms, which may be prone to recall bias. CONCLUSIONS: There are differences in the clinical course and symptom profile of male and female depression. Further study is required to identify the biological correlates of these differences and to characterize their clinical importance.

Clinical presentation of postnatal and non-postnatal depressive episodes.

BACKGROUND: The relationship of postnatal (postpartum) depression (PND) to episodes of depression occurring at other times is not well understood. Despite a number of studies of clinical presentation, there is little consistency in the literature. We have undertaken within- and between-individual comparisons of the clinical presentation of postnatal (PN) and non-postnatal (NPN) depressive episodes in women with recurrent depression. METHOD: In a sample of well-characterized, parous women meeting DSM-IV and ICD-10 criteria for recurrent major depressive disorder, the clinical presentation of episodes of major depression with onset within 4 weeks of giving birth (PND group, n=50) were compared with (i) the non-postnatal episodes of women with PND, and (ii) episodes of major depression in parous women who had not experienced episodes of mood disorder in relation to childbirth (NPND group, n=132). In addition, the non-postnatal episodes of the PND group of women were compared with the depressive episodes of the NPND group. RESULTS: The small number of differences found between PN and NPN depressive episodes, such as reduced early morning wakening in postnatal episodes, are likely to be explicable by the context of having a new baby rather than by any difference in the nature of the underlying depression. CONCLUSIONS: The results do not point to substantial differences in clinical presentation between episodes of major depression occurring in relation to childbirth and at other times. Other avenues of research are therefore required to demonstrate a specific relationship between childbirth and depression.