High rates of depression anxiety and suicidal ideation among inpatients in general hospital in China.

Objective: To investigate the prevalence rates of depression anxiety and suicidal ideation among Chinese general hospital inpatients and to identify the potential associations with sociodemographics. Method: A cross-sectional survey was applied in a Chinese general hospital. A questionnaire set, including sociodemographic variables, Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder Scale-7 (GAD-7), was completed by the participants. Clinically significant depression (CSD) and clinically significant anxiety (CSA) were defined as a score above 10 on the two scales. CSD and CSA are proxy measures but not specific diagnoses of mental disorders. Results: Data from 1329 patients were included in the final analysis. 422 (31.8%) reported clinically significant depressive symptoms, 83 (6.3%) reported frequent suicidal ideation, and 204 (15.3%) reported clinically significant anxiety. Household income was negatively associated with CSD. Inpatients with lower household incomes and educational levels had higher rates of CSA. Middle-aged inpatients were more prone to suicidal ideation, and stable marital status was related to less suicidal ideation. Conclusion: Depression, anxiety, and suicidal ideation were determined to be common psychological problems in Chinese inpatients. Chinese medical personnel must pay attention to the mental health conditions of inpatients, particularly inpatients with lower income, educational levels, and poor marital status. Key Points This is one of the first studies focusing on the prevalence of depression and anxiety in Chinese hospitalized inpatients in non-psychiatric departments of a general hospital. The PHQ-9 and GAD-7 were determined to be potential screening tools to aid Chinese medical workers in recognizing depression and anxiety in nonpsychiatric departments. The prevalence of depression, anxiety and suicidal ideation was observed to be relatively high in inpatients, which requires more attention from Chinese clinicians.

Validation of the Chinese version of the PHQ-15 in a tertiary hospital.

BACKGROUND: This study aimed to investigate the reliability and validity of the Chinese version of the Patient Health Questionnaire (PHQ-15) in a tertiary hospital. METHODS: Using a cross-sectional study design, the Chinese version of the PHQ-15 was administered to a total of 1329 inpatients. To examine the discriminant validity of this questionnaire, we investigated the correlation of the PHQ-15 score with sociodemographic data and the PHQ-9 and GAD-7 scale scores. Exploratory factor analysis was performed to assess the internal consistency of the PHQ-15. To evaluate the consistency of this questionnaire with item response theory (IRT), IRT analysis was performed. RESULTS: The Chinese version of the PHQ-15 showed good reliability (Cronbach's alpha = 0.83). The correlations of the PHQ-15 scores with the PHQ-9 depression scale scores (r = 0.565) and the GAD-7 anxiety scale scores (r = 0.512) were moderate; these results suggested that the PHQ-15 had discriminant validity. We identified three factors, referred to as "cardiopulmonary," "gastrointestinal," and "pain/neurological," which explained 56 % of the total variance. A second-order factor analysis including these three factors produced an acceptable model. Several items (4, 8 and 11) displayed extreme floor effects. Additionally, item 4 displayed a very small variance of 0.35 and showed very small differences in its thresholds based on IRT analysis. CONCLUSIONS: The PHQ-15 scale had good reliability and high validity to detect patients with high somatic symptom severity in a Chinese tertiary hospital. Several of the current findings were consistent with previous research on the PHQ-15 in Western countries and in China. To improve the diagnostic quality of this questionnaire, items 4, 8 and 11 can be omitted.

[Study the effects of neuroplasticity on major depression disorder in rTMS combined with antidepressant treatments].

OBJECTIVE: To explore the effects of neuroplasticity on major depression disorder (MDD) with event related potentials (ERPs) of mismatch negativity (MMN) and sensory gating potentials P50 for repetitive transcranial magnetic stimulation (rTMS) combined with antidepressant treatments. METHODS: A total of 159 patients with MDD randomly divided into two groups: 75 patients in group A was administrated rTMS treatment for 2 weeks (15 days), and continues to give antidepressant of selective serotonin reuptake inhibitor (SSRI) regularly. 84 patients in group B was consistently administered the similar antidepressant. The 24-item Hamilton Depression Scale (HAMD-24), MMN latency, S1-P50 amplitude, S2-P50 amplitude and S2-P50/S1-P50 amplitude ratio, and the percentages of abnormal P50 (S2-P50/S1-P50 > or = 0.5) were assessed and measured before treatment, at the 2nd and the 10th weekend after treatment in two treatment groups. Meanwhile, 90 normal control cases was set up as control group (group C). Results At 2th and 10th week after treatment, the HAMD-24 scores were reduced remarkably than those before treatment in group A and B (P < 0.001), and the scores in group A was lower than that in group B (P < 0.001). MMN latencies and S-P50 amplitudes after treatment in group A were significant shorter and lower than those before treatment in group A and after treatment in group B (P < 0.05) (except for intergroup comparison of S2-P50, amplitude after treatment weeks). No significant difference was found in S2-P50/S1-P50 ratio ( except for after treatment 2 weeks ) and percentage of abnormal P50 between group A after treatment and group C (P > 0.05). There were no statistical significance difference of ERPs between after treatment 2 weeks and 10 weeks in group A (P > 0.05). No statistical differences of ERPs between before and after treatment in group B (P > 0.05) was observed. CONCLUSION: rTMS combined with antidepressant therapy was superior to single antidepressant treatment, and marked improved automatic processing and sensory gating of the brain senior functional electrical physiological index. rTMS might induce effects of long-term potentiation/long-term depression like plasticity on brain, and keep brain function in a dynamic stability and balance. MMN and P50 maybe become neuroplasticity index reflecting relevant the brain senior function.

Patient-doctor concordance of perceived mental health service needs in Chinese hospitalized patients: a cross-sectional study.

BACKGROUND: To assess the subjective concordance on mental health service needs in hospitalized patients between patients and doctors in China. METHODS: A cross-sectional study was performed in one day. All hospitalized inpatients from selected departments of West China Hospital were recruited as potential participants. A questionnaire set including demographic variables and the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-item scale (GAD-7) questionnaires were completed by the included patients. They and their doctors in-charge were asked if they perceived that the patients needed mental health services. RESULTS: The overall response rate in patients was 84.25% and the final sample consisted of 1,273 patients. Among those, 605 patients (47.53%) themselves believed that they needed mental health services, whereas only 345 patients (27.10%) were deemed to be in need of mental health services only by their doctors. Kappa statistics showed that the concordance rate between patients and doctors was low in the total patient group (kappa =0.055) and in the group of patients with significant depression or anxiety (kappa =0.080). A logistic regression analysis showed that the ward where the patients were treated was related to a consistent recognition of mental health needs (OR =1.667). CONCLUSIONS: The concordance between Chinese inpatient perception and doctor evaluation of mental health service needs for these patients was low. Therefore, it seems necessary to develop effective strategies to improve the detection rate, such as the use of screening-instruments and the training of health professionals in the detection of psycho-social distress.

Prevalence and strong association of high somatic symptom severity with depression and anxiety in a Chinese inpatient population.

BACKGROUND: The prevalence of the high somatic symptom severity (HSSS) and its associations with sociodemographic factors, depression, and anxiety has not been surveyed in inpatient populations at general hospitals. METHODS: A sample including 1329 inpatients in a Chinese general hospital was surveyed using Chinese version of 15-item patient health questionnaire (PHQ-15), 9-item patient health questionnaire, and generalized anxiety disorder 7-item scale. RESULTS: A total of 27.8% (n = 369) of the participants had HSSS (PHQ-15 ≥ 10). The multivariate regression showed that HSSS was significantly associated with depression (adjusted odds ratio [aOR], 5.219), anxiety (aOR, 5.810), or depression or anxiety (aOR, 5.338) but neither with sex, age, marital status, education status, household income, nor 7 kinds of physical disease systems. DISCUSSION: The symptom profile and high prevalence of HSSS, and its association with clinically significant depression and anxiety in this inpatient population were mostly consistent to that documented by studies in other populations.