Screening for depressive disorders in outpatients with mild to moderate psoriasis: a study from North India.

BACKGROUND: Psoriasis and depressive disorders commonly occur together. Depressive disorders have an impact on the quality of life and the outcome of psoriasis. AIMS: The aim of this study was to test the feasibility of using a modification of the Hindi translation of the Patient Health Questionnaire-9 (PHQ-9) as a verbal, clinician administered, short screening questionnaire for detecting depressive disorders. MATERIALS AND METHODS: One hundred and four out-patients with psoriasis were recruited in the study. In the first stage of the study, socio-demographic data, Psoriasis Area Severity Index (PASI) score, and Dermatological Quality of Life (DLQI) score were recorded. The modified questionnaire was administered by the dermatologist. In the second stage, psychiatric diagnoses were confirmed using the Mini International Neuropsychiatric Interview. RESULTS: The prevalence of depressive disorders was 39.4%. Receiver operating curve (ROC) analysis showed that the questionnaire had a good discriminant ability in detecting depressive disorders (area under curve: 0.81, SE = 0.04, 95% confidence interval = 0.72-0.89). LIMITATIONS: The sample size is small and more studies are needed with the screening questions in different languages to validate the findings of the study. CONCLUSION: The questionnaire can be a useful screening instrument for detecting depressive disorders in patients with psoriasis.

Assessing clinical significance of treatment outcomes using the DASS-21.

Standard clinical significance classifications are based on movement between the "dysfunctional" and "functional" distributions; however, this dichotomy ignores heterogeneity within the "dysfunctional" population. Based on the methodology described by Tingey, Lambert, Burlingame, and Hansen (1996), the present study sought to present a 3-distribution clinical significance model for the 21-item version of the Depression Anxiety Stress Scales (DASS-21; P. F. Lovibond & Lovibond, 1995) using data from a normative sample (n = 2,914), an outpatient sample (n = 1,000), and an inpatient sample (n = 3,964). DASS-21 scores were collected at pre- and post-treatment for both clinical samples, and patients were classified into 1 of 5 categories based on whether they had made a reliable change and whether they had moved into a different functional range. Evidence supported the validity of the 3-distribution model for the DASS-21, since inpatients who were classified as making a clinically significant change showed lower symptom severity, higher perceived quality of life, and higher clinician-rated functioning than those who did not make a clinically significant change. Importantly, results suggest that the new category of recovering is an intermediate point between recovered and making no clinically significant change. Inpatients and outpatients have different treatment goals and therefore use of the concept of clinical significance needs to acknowledge differences in what constitutes a meaningful change.

A case control study of psychiatric morbidities among subjects with leprosy in Lagos, Nigeria.

OBJECTIVES: To determine the pattern of psychiatric morbidity prevalent among leprosy patients and to compare it with two control groups; those suffering from Tinea vesicolor and Normal subjects. DESIGN: Eighty-eight leprosy patients were matched for age and sex with those suffering from Tinea vesicolor as well as normal subjects. The subjects were assessed for psychiatric morbidity through a clinical interview with PSE-9. RESULTS: The prevalence of psychiatric morbidity among leprosy patients (580/1000) was significantly more than those with tinea vesicolor patients (182/1000) and normal subjects (148/1000) (p < 0.05). Depressive illness was the most common diagnosis in the three groups. CONCLUSIONS: Leprosy patients are more likely to manifest with psychiatric illness than those suffering from Tinea vesicolor and normal subjects.

Depressive status of leprosy patients in Bangladesh: association with self-perception of stigma.

Stigmatization by the general population and their negative attitudes towards leprosy negatively impacts on patients' mental health, and so too does patients' perception of that stigma. The objective of this present study is to assess the depressive status of leprosy patients, the patient perception of that stigma, and its association with their depressive status in Dhaka, Bangladesh. Subjects were 140 patients, and a selected comparison group of 135 local people without any chronic diseases. To evaluate depressive status, the Center for Epidemiologic Studies Depression scale (CES-D) Bengali version was applied. The patient group's depressive status was significantly more severe than that of the comparison group. Depressive status of those who answered affirmatively was significantly more severe than that of those who answered negatively for three responses to questions: 1) 'I have been physically attacked by people', 2) 'I feel people regard me as strange' and 3) 'I have been refused the purchase of something by a shopkeeper'. The results showed that the depressive status in leprosy patients was greater than that of the general public. Further, actual experiences of discrimination based on stigma associated with the depressive status of leprosy patients. Mental health care for patients, regulation of discriminatory action and education that would decrease social stigma among the general population, especially people who might often have contact with patients, seem necessary to improve the mental health of Bangladeshi leprosy patients.