The Depressive Psychopathology Scale: presentation and initial validation in a sample of Peruvian psychiatric patients.

OBJECTIVE: Presentation and validation of the Depressive Psychopathology Scale (DPS), a new, Spanish-language psychometric inventory, in a sample of Peruvian psychiatric patients. METHODS: From 1999 to 2001, the DPS, Zung Self-rating Depression Scale (ZSDS), and Major Depressive Disorder (MDD) module of the Structured Clinical Interview for DSM-IV Disorders (SCID) were administered to 226 nonpsychotic outpatients referred to the National Institute of Mental Health in Lima, Peru, for their initial clinical evaluation. In the evaluation, attending psychiatrists 1) corroborated the general diagnosis and presence or absence of MDD and 2) rated depression severity based on clinical opinion and on Clinical Global Im-pression-Severity scale criteria. RESULTS: Mean time to complete the DPS was 7.22 minutes (standard deviation, 3.99). Cronbach's alpha value was 0.86. For diagnosis of MDD, based on the SCID, area under receiver operating characteristic curve (AUROC) was 0.872 and the selected cutoff score (26/27) had 81.32% sensitivity and 80% specificity; based on the attending psychiatrists' evaluation, AUROC was 0.832 and the selected cutoff score (25/26) had 77.67% sensitivity and 72.32% specificity. The DPS was significantly correlated with the ZSDS (rho = 0.8, P < 0.001). Some DPS items ("depression worse in the morning," "appetite disturbances," "mood reactivity," and "hypersomnia") showed low loadings on the five factors extracted through principal component analysis and/or did not significantly correlate with depression parameters. CONCLUSIONS: The DPS can predict MDD and has convergent validity, as shown by its correlation with the ZSDS. However, additional psychometric studies are recommended to simplify and improve it.

The Depressive Psychopathology Scale: presentation and initial validation in a sample of Peruvian psychiatric patients / La Escala de Psicopatología Depresiva: presentación y validación inicial en una muestra de pacientes psiquiátricos peruanos

OBJECTIVE: Presentation and validation of the Depressive Psychopathology Scale (DPS), a new, Spanish-language psychometric inventory, in a sample of Peruvian psychiatric patients. METHODS: From 1999 to 2001, the DPS, Zung Self-rating Depression Scale (ZSDS), and Major Depressive Disorder (MDD) module of the Structured Clinical Interview for DSM-IV Disorders (SCID) were administered to 226 nonpsychotic outpatients referred to the National Institute of Mental Health in Lima, Peru, for their initial clinical evaluation. In the evaluation, attending psychiatrists 1) corroborated the general diagnosis and presence or absence of MDD and 2) rated depression severity based on clinical opinion and on Clinical Global Im-pression-Severity scale criteria. RESULTS: Mean time to complete the DPS was 7.22 minutes (standard deviation, 3.99). Cronbach's alpha value was 0.86. For diagnosis of MDD, based on the SCID, area under receiver operating characteristic curve (AUROC) was 0.872 and the selected cutoff score (26/27) had 81.32 percent sensitivity and 80 percent specificity; based on the attending psychiatrists' evaluation, AUROC was 0.832 and the selected cutoff score (25/26) had 77.67 percent sensitivity and 72.32 percent specificity. The DPS was significantly correlated with the ZSDS (rho = 0.8, P < 0.001). Some DPS items ("depression worse in the morning," "appetite disturbances," "mood reactivity," and "hypersomnia") showed low loadings on the five factors extracted through principal component analysis and/or did not significantly correlate with depression parameters. CONCLUSIONS: The DPS can predict MDD and has convergent validity, as shown by its correlation with the ZSDS. However, additional psychometric studies are recommended to simplify and improve it.

OBJETIVO: Presentación y validación de la Escala de Psicopatología Depresiva (EPD), un nuevo inventario psicométrico en lengua española, en una muestra de pacientes psiquiátricos peruanos. MÉTODOS: De 1999 al 2001, se administraron la EPD, la Escala de Autoevaluación de la Depresión de Zung (ZSDS) y el módulo correspondiente al Trastorno Depresivo Mayor (TDM) de la Entrevista Clínica Estructurada para trastornos del DSM-IV (SCID) a 226 pacientes ambulatorios no psicóticos derivados al Instituto Nacional de Salud Mental de Lima para su evaluación clínica inicial. En la evaluación, los psiquiatras responsables 1) corroboraron el diagnóstico general y la presencia o ausencia de TDM, y 2) clasificaron la gravedad de la depresión con base en la opinión clínica y los criterios de gravedad de la Escala de Impresión Clínica Global. RESULTADOS: El tiempo medio para completar la EPD fue de 7,22 minutos (desviación estándar, 3,99). El valor del índice alfa de Cronbach fue de 0,86. Para el diagnóstico del TDM, basado en el SCID, el área bajo la curva ROC (de eficacia diagnóstica) fue de 0,872, y la puntuación discriminatoria seleccionada (26/27) mostró una sensibilidad de 81,32 por ciento y una especificidad de 80 por ciento; con base en la evaluación de los psiquiatras responsables, el área bajo la curva ROC fue de 0,832, y la puntuación discriminatoria seleccionada (25/26) mostró una sensibilidad de 77,67 por ciento y una especificidad de 72,32 por ciento. La EPD se correlacionó significativamente con la ZSDS (rho = 0,8, P < 0,001). Algunos elementos de la EPD ("depresión peor por la mañana", "alteraciones del apetito", "reactividad del estado de ánimo" e "hipersomnia") mostraron cargas bajas de los cinco factores extraídos mediante el análisis de los componentes principales o no se correlacionaron significativamente con los parámetros de depresión. CONCLUSIONES: La EPD puede predecir el TDM y tiene validez convergente, tal como lo demuestra su correlación con la ZSDS. Sin embargo, se recomienda realizar estudios psicométricos adicionales con objeto de simplificarla y mejorarla.

The Multicultural Quality of Life Index: presentation and validation.

RATIONALE AND OBJECTIVES: Quality of life has emerged as a crucial concept for the assessment of health and the planning of health care. Desirable features for the evaluation of quality of life include comprehensiveness, self-ratedness, cultural sensitivity, practicality and psychometric soundness. An attempt to meet these challenges led to the development of a brief multicultural quality of life instrument and to the appraisal of its applicability, reliability and validity. METHODS: The development of the proposed assessment instrument was based on a wide review of the literature and the engagement of a multicultural mental health scholarly team. Its validation was conducted on samples of psychiatric patients (n = 124) and hospital professionals (n = 53) in New York City. RESULTS: A new generic culture-informed and self-rate instrument, the Multicultural Quality of Life Index, has been developed. Its 10 items cover key aspects of the concept, from physical well-being to spiritual fulfilment. Concerning its applicability, mean time for completion was less than 3 minutes and 96% of raters found it easy to use. Test-retest reliability was high (r = 0.87). A Cronbach's α of 0.92 documented its internal consistency and a factor analysis revealed a strong structure. With regard to discriminant validity, a highly significant difference was found between the mean total scores of professionals (x = 8.41) and patients (x = 6.34) presumed to have different levels of quality of life. CONCLUSIONS: The Multicultural Quality of Life Index is a brief and culturally informed instrument that appears to be easy to complete, reliable, internally consistent and valid.

Diagnosticando depresión: síntomas y vocabulario usado por una muestra de médicos generales / Diagnosing depression: symptoms and vocabulary used by a sample of general practitioners

Objetivos: Identificar la sintomatología considerada como útil para diagnosticar depresión por médicos generales (MGs), el vocabulario local utilizado y comparar los síntomas listados con criterios diagnósticos estandarizados. Material y Métodos: Setenta y tres MGs participaron en una encuesta en Lima-Perú. Sesenta y cinco MGs respondieron a una pregunta abierta sobre listar síntomas útiles para realizar el diagnóstico de depresión. Los síntomas se clasificaron de acuerdo a los criterios requeridos para un diagnóstico de episodio depresivo mayor (criterio A, únicamente) del DSM-IV-TR (DSM) y para el episodio depresivo leve (F32.0) de la Clasificación Internacional de Enfermedades-10ma revisión (CIE). Resultados: Diverso vocabulario médico y coloquial fue utilizado para describir síntomas depresivos. Criterios suficientes para realizar un diagnóstico de depresión de acuerdo al CIE y el DSM fueron listados, respectivamente, por 32,3% y 16,9% de MGs. Conclusiones: Estos hallazgos pueden ayudar al desarrollo de intervenciones para mejorar el entrenamiento de los MGs y la calidad de atención en relación a la detección de depresión y evaluación de riesgo suicida. Sin embargo, casi un tercio de MGs fueron capaces de recordar suficientes síntomas depresivos para cumplir criterios para un diagnóstico según la CIE, referencia usada extensamente en servicios no-psiquiátricos.

Objective: To identify the symptomatology deemed by General Practitioners (GPs) as useful to diagnose depression, the local vocabulary used to describe it, and to compare the reported symptoms with standardized criteria. Material and Methods: Seventy-three GPs participated in a survey in Lima, Peru. Sixty-five GPs responded to an openended question to list symptoms useful to diagnose depression. Symptoms were classified according to criteria required for a Major Depressive Episode (Criterion-A only) of the DSM-IV-TR (DSM) and for a Mild Depressive Episode (F32.0) of the International Classification of Diseases-10th Revision (ICD). Results: Diverse medical and colloquial wording were used to describe depressive symptomatology. Sufficient criteria to make a diagnosis of depression according to the ICD and the DSM were listed, respectively, by 32.3% and 16.9% of GPs. Conclusions: These findings could aid in the development of training and quality improvement interventions to facilitate the detection of depression and suicide risk assessment. Still, almost one-third of GPs were able to directly recall sufficient depressive symptoms to meet criteria for an ICD diagnosis, a classification widely used in non-psychiatric settings.

Using a brief 10-item generic measure of quality of life in English and Spanish speaking diabetic patients.

OBJECTIVES: Validation of the Multicultural Quality of Life Index (MQLI), a 10-item self-rated generic multilingual quality of life (QOL) measure in ethnically-diverse diabetic patients. METHODS: Diabetic adult patients (n = 180) in New York City completed the MQLI, English or Spanish version. Its internal consistency, factorial structure, and construct validity were analyzed. Depression screening (PHQ-9) scores were used to divide subjects into two sub-samples with presumed different QOL levels. RESULTS: A Cronbach's alpha of 0.92 demonstrated its internal consistency (English-version = 0.90, Spanish-version = 0.94). A one-single factor structure was documented (all items loadings > or = 0.64), accounting for 59% of the items variance in the total sample; similar results were found for each language version. Correlation of the MQLI and PHQ-9 scores yielded an r = -0.58. Mild negative correlations with self-disclosed diagnosis of depression or other mental disorders, diabetes duration, and abnormal sensation on foot exam were found, but were non-significant with other diabetes aspects (e.g., HbA1c, retinopathy). A significant difference (p < 0.001) between the scores of two subsamples with presumed different levels of QOL (means = 8.02 vs. 5.84) was found. CONCLUSIONS: The MQLI demonstrated coherence around the QOL concept. It correlated significantly with mental health (particularly depression), duration of diabetes, and possible neuropathy, but not with some diabetes-related factors. Its use in diabetic care settings is recommended, possibly supplemented by QOL diabetic-specific instruments.

Measuring cultural identity: validation of a modified Cortes, Rogler and Malgady Bicultural Scale in three ethnic groups in New York.

Cultural identity is central to health. Acculturation may be formulated with a bicultural model, assessing in parallel the degree of identification with both the original and the host culture. The Cortes, Rogler and Malgady Bicultural Scale (CRM-BS) is composed of two subscales: "original" culture and "mainstream-United States" (US) culture. It was modified into three ethnic versions: Latino, Korean and Chinese. Validation of the CRM-BS was conducted using health professionals and psychiatric patients from the above three ethnic groups and a control sample of mainstream-US (main-US) health professionals in New York City (n = 394). Mean time of completion was 3.7 min and 73% judged it to be easy to use. Strong test-retest reliability correlation coefficients were found (original culture, 0.78; mainstream-US, 0.82). The internal consistency was documented by high Cronbach's alpha values (original culture, 0.88; mainstream-US, 0.80). Factorial analysis revealed two factors, the first one involving all the items of the original culture and the second all of the mainstream-US items. Concerning its discriminant validity, non-main-US subjects scored significantly higher than main-US subjects on the original culture subscale, and vice versa. Construct validity was assessed comparing intergenerational mean scores on both subscales; as generations become older, mean scores for the original culture decreased, while those for the "host" culture increased. Results for each specific ethnic version are also presented. Cutoff scores were calculated to categorize the involvement with the original culture or the host culture, both of them, or neither.

Development and validation of the Chinese version of the Multicultural Quality of Life Index (MQLI-Ch).

This study documents the validation study of the Multicultural Quality of Life Index, Chinese version (MQLI-Ch). This self-rated instrument is composed of ten items that correspond to multiple dimensions of the concept of quality of life. Each item is rated on a scale from 1 to 10, according to the subject's culture-informed understanding of the concept. The MQLI-Ch was tested on 144 Chinese subjects (124 psychiatric patients and 20 professionals). It was found to be quite efficient (about 3 min to be completed) and easy to use. A Cronbach's alpha of 0.94 demonstrated its internal consistency. The factor analysis of the ten items yielded one single factor, which accounted for 65.19% of the variance. The test-retest reliability correlation coefficient was 0.80. Its discriminant validity was documented by a highly significant difference (P < 0.001) between the mean scores of the two samples with presumed differences in quality of life. Thus, the MQLI-Ch showed high feasibility, internal structure, reliability and discriminant validity.

The Korean version of the Multicultural Quality of Life Index (MQLI-Kr): development and validation.

Our research team of multilingual and multicultural members designed comprehensive, yet efficient, culture-informed, and self-rated Multicultural Quality of Life Indexes for both English-speaking individuals and for growing immigrant groups in the United States. A Korean version of the Multicultural Quality of Life Index (MQLI-Kr) was developed as part of this multilingual project. The team tested the MQLI-Kr on 130 Koreans (100 psychiatric patients and 30 professionals). MQLI-Kr was quite efficient and easy to use. The internal consistency attained a Cronbach's alpha of 0.97 for the combined sample. A factor analysis yielded one single factor, which accounted for 81.5% of the items' variance. The test-retest reliability correlation coefficient of the MQLI-Kr was 0.85. Significant differences in the mean MQLI-Kr scores were observed between the patients' group and the professionals' group (p < 0.001). Thus the results of this study showed high feasibility, internal consistency, reliability, and discriminant validity for the MQLI-Kr.

Validation study of the Multicultural Quality of Life Index (MQLI) in a Peruvian sample.

OBJECTIVE: The Multicultural Quality of Life Index is a concise instrument for comprehensive, culture-informed, and self-rated assessment of health-related quality of life. It is composed of 10 items (from physical well-being to global perception of quality of life). Each item is rated on a 10-point scale. The objective was to evaluate the reliability (test-retest), internal structure, discriminant validity, and feasibility of the Multicultural Quality of Life Index in Lima, Peru. METHOD: The reliability was studied in general medical patients (n = 30) hospitalized in a general medical ward. The Multicultural Quality of Life Index was administered in two occasions and the correlation coefficients ("r") between both interviews were calculated. Its discriminant validity was studied statistically comparing the average score in a group of patients with AIDS (with presumed lower quality of life, n = 50) and the average score in a group of dentistry students and professionals (with presumed higher quality of life, n = 50). Data on its applicability and internal structure were compiled from the 130 subjects. RESULTS: A high reliability correlation coefficient (r = 0.94) was found for the total score. The discriminant validity study found a significant difference between mean total score in the samples of presumed higher (7.66) and lower (5.32) quality of life. The average time to complete the Multicultural Quality of Life Index was less than 4 minutes and was reported by the majority of subjects as easily applicable. A high Cronbach's a (0.88) was also documented. CONCLUSIONS: The results reported that the Multicultural Quality of Life Index is reliable, has a high internal consistency, is capable of discriminating groups of presumed different quality of life levels, is quite efficient, and easy to use.

Validation study of the Multicultural Quality of Life Index (MQLI) in a Peruvian sample / Estudo de validação do índice de Qualidade Multicultural (IQVM) em uma amostra peruana

OBJETIVE: The Multicultural Quality of Life Index is a concise instrument for comprehensive, culture-informed, and self-rated assessment of health-related quality of life. It is composed of 10 items (from physical well-being to global perception of quality of life). Each item is rated on a 10-point scale. The objective was to evaluate the reliability (test-retest), internal structure, discriminant validity, and feasibility of the Multicultural Quality of Life Index in Lima, Peru. METHOD: The reliability was studied in general medical patients (n = 30) hospitalized in a general medical ward. The Multicultural Quality of Life Index was administered in two occasions and the correlation coefficients ("r") between both interviews were calculated. Its discriminant validity was studied statistically comparing the average score in a group of patients with AIDS (with presumed lower quality of life, n = 50) and the average score in a group of dentistry students and professionals (with presumed higher quality of life, n = 50). Data on its applicability and internal structure were compiled from the 130 subjects. RESULTS: A high reliability correlation coefficient (r = 0.94) was found for the total score. The discriminant validity study found a significant difference between mean total score in the samples of presumed higher (7.66) and lower (5.32) quality of life. The average time to complete the Multicultural Quality of Life Index was less than 4 minutes and was reported by the majority of subjects as easily applicable. A high Cronbach's a (0.88) was also documented. CONCLUSIONS: The results reported that the Multicultural Quality of Life Index is reliable, has a high internal consistency, is capable of discriminating groups of presumed different quality of life levels, is quite efficient, and easy to use.

OBJETIVO: O índice Multicultural de Qualidade de Vida é um instrumento conciso para a avaliação ampla, culturalmente informada e auto-aplicável da qualidade de vida relativa à saúde. É composto de 10 itens (do bem-estar físico à percepção global da qualidade de vida). Cada item é classificado de acordo com uma escala de 10 pontos. O objetivo foi o de avaliar a confiabilidade (teste-reteste), estrutura interna, validade discriminante e a viabilidade do índice Multicultural de Qualidade de Vida em Lima, Peru. MÉTODO: A confiabilidade foi estudada em pacientes da clínica geral (n = 30) hospitalizados em uma enfermaria clínica geral. O índice Multicultural de Qualidade de Vida foi ministrado em duas ocasiões e os coeficientes de correlação ("r") entre ambas as entrevistas foram calculados. Sua validade discriminante foi estudada comparando estatisticamente o escore médio em um grupo de pacientes com AIDS (com presumida menor qualidade de vida, n = 50) e o escore médio em um grupo de estudantes e profissionais de odontologia (com presumida maior qualidade de vida, n = 50). Os dados sobre sua aplicabilidade e estrutura interna foram compilados a partir de 130 indivíduos. RESULTADOS: Achou-se um alto coeficiente de correlação de confiabilidade no escore total (r = 0,94). O estudo de validade discriminante encontrou diferença significativa entre o escore médio total nas amostras de qualidade de vida presumida mais alta (7,66) e mais baixa (5,32). O tempo médio para completar o índice Multicultural de Qualidade de Vida foi de menos de 4 minutos e foi relatado pela maioria dos indivíduos como facilmente aplicável. Foi também documentado um alto alfa de Cronbach (0,88). CONCLUSÕES: Os resultados relatam que o índice Multicultural de Qualidade de Vida é confiável, possui uma alta consistência interna, é capaz de discriminar grupos de diferentes níveis de qualidade de vida presumidos, é muito eficiente e é de fácil utilização.