Relationship between daily rated depression symptom severity and the retrospective self-report on PHQ-9: A prospective ecological momentary assessment study on 80 psychiatric outpatients.

BACKGROUND: Depression-related negative bias in emotional processing and memory may bias accuracy of recall of temporally distal symptoms. We tested the hypothesis that when responding to the Patient Health Questionnaire (PHQ-9) the responses reflect more accurately temporally proximal than distal mood states. METHODS: Currently, depressed psychiatric outpatients (N = 80) with depression confirmed in semi-structured interviews had the Aware application installed on their smartphones for ecological momentary assessment (EMA). The severity of "low mood", "hopelessness", "low energy", "anhedonia", and "wish to die" was assessed on a Likert scale five times daily during a 12-day period, and thereafter, the PHQ-9 questionnaire was completed. We used auto- and cross-correlation analyses and linear mixed-effects multilevel models (LMM) to investigate the effect of time lag on the association between EMA of depression symptoms and the PHQ-9. RESULTS: Autocorrelations of the EMA of depressive symptom severity at two subsequent days were strong (r varying from 0.7 to 0.9; p < 0.001). "Low mood" was the least and "wish to die" the most temporally stable symptom. The correlations between EMA of depressive symptoms and total scores of the PHQ-9 were temporally stable (r from 0.3 to 0.6; p < 0.001). No effect of assessment time on the association between EMA data and the PHQ-9 emerged in the LMM. LIMITATIONS: Altogether 11.5 % of observations were missing. CONCLUSIONS: Despite fluctuations in severity of some of the depressive symptoms, patients with depression accurately recollect their most dominant symptoms, without a significant recall bias favouring the most recent days, when responding to the PHQ-9.

Homicide-suicide - an event hard to prevent and separate from homicide or suicide.

Suicide preceded by homicide is a rare but tragic event that often shocks the whole community. Annual rates show considerable variation, though not as great as the incidence of homicides. Within the industrialized nations, Finland's prevalence rates for homicide-suicide have been mid-range. The National Suicide Prevention Project recorded and carefully analysed all suicides committed in Finland during a 12-month period. In this material of almost 1400 suicides, 10 verified homicide-suicide cases were found. The perpetrator was male in all but one case, and all the victims were family, 9/10 being spouses and/or children. The most typical homicide-suicide seemed to be a man shooting a family member during a separation process. No perpetrator was found suffering from a psychotic disorder but three had major depression. The homicide-suicides were compared with the suicides and statistically significant differences emerged in two variables: shooting was more often the method used in the homicide-suicide cases, which, furthermore, were more likely to involve a divorce or recent rupture in another long-term intimate relationship. Sharing few common variables with either homicide or suicide, homicide-suicide appears to be a distinct phenomenon whose prevention would seem to be extremely difficult on the individual level. Since shooting is the most common method of homicide-suicide, firearm licenses should be more restricted.