ABSTRACT
OBJETIVO: Estudiar la validez diagnóstica y aportar los valores de sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo de la versión española de la escala Screening for Somatoform Symptoms-2(SOMS-2) en una muestra de pacientes de AP. DISEÑO: Estudio de validación. Emplazamiento: Centros de salud de AP de Aragón y Baleares. PARTICIPANTES: Ciento nueve pacientes somatizadores prodecedentes de un ensayo clínico previo y 56 pacientes no somatizadores incluidos para la validación de la escala. MEDICIONES PRINCIPALES: Sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y α de Cronbach. RESULTADOS: De un total de 165 sujetos, el 75% fueron mujeres y el 60% presentó trastorno de somatización y/o trastorno de ansiedad o depresivo. La SOMS-2 de 53 ítems y con un punto de corte de 4 presentó una sensibilidad del 97%, una especificidad del 68%, un valor predictivo positivo del 85%, un valor predictivo negativo del 92% y una alta consistencia interna (α de Cronbach = 0,926). CONCLUSIONES: La versión española de la SOMS-2 constituye un instrumento de cribado eficaz, útil y de fácil administración para la evaluación de los trastornos somatomorfos en AP. Los resultados de sensibilidad, especificidad y consistencia interna son similares a los de estudios previos de validación de la SOMS-2 en otras lenguas europeas
OBJECTIVE: To study the diagnostic validity and to provide the sensitivity, specificity, positive predictive value and negative predictive value of the Spanish version of the Screening for Somatoform Symptoms-2 (SOMS-2) scale in a PC population sample. DESIGN: Validation study. SETTING: PC centres in Aragon and Balearic Islands, Spain. PARTICIPANTS: A sample of 109 patients from a clinical trial with somatoform disorders and 56 patients without somatoform disorder were included for the scale validation. Main outcome measures: Sensitivity, specificity, positive predictive value, negative predictive value and Cronbach's α coefficient. RESULTS: Of the total sample of 165 subjects, 75% were women and 60% had a diagnosis of somatization disorder and/or anxiety or depressive disorder. The 53-item version of the SOMS-2 with a cut-off point of 4 showed a sensitivity of 97%, a specificity of 68%, a positive predictive value of 85%, a negative predictive value of 92%, and high internal consistency (Cronbach α = 0.926). CONCLUSIONS: The Spanish version of the SOMS-2 seems to be a reliable screening tool, easy to complete and useful for the assessment of somatoform disorders in PC settings. The results for specificity, sensitivity, and internal consistency are similar to previous studies in other European languages
Subject(s)
Female , Humans , Male , Signs and Symptoms/education , Signs and Symptoms/methods , Primary Health Care/classification , Primary Health Care , Mentally Ill Persons/psychology , Signs and Symptoms/classification , Signs and Symptoms , Primary Health Care/methods , Primary Health Care , Mentally Ill Persons/classification , Sensitivity and SpecificityABSTRACT
OBJECTIVE: To study the diagnostic validity and to provide the sensitivity, specificity, positive predictive value and negative predictive value of the Spanish version of the Screening for Somatoform Symptoms-2 (SOMS-2) scale in a PC population sample. DESIGN: Validation study. SETTING: PC centres in Aragon and Balearic Islands, Spain. PARTICIPANTS: A sample of 109 patients from a clinical trial with somatoform disorders and 56 patients without somatoform disorder were included for the scale validation. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive predictive value, negative predictive value and Cronbach's α coefficient. RESULTS: Of the total sample of 165 subjects, 75% were women and 60% had a diagnosis of somatization disorder and/or anxiety or depressive disorder. The 53-item version of the SOMS-2 with a cut-off point of 4 showed a sensitivity of 97%, a specificity of 68%, a positive predictive value of 85%, a negative predictive value of 92%, and high internal consistency (Cronbach α=0.926). CONCLUSIONS: The Spanish version of the SOMS-2 seems to be a reliable screening tool, easy to complete and useful for the assessment of somatoform disorders in PC settings. The results for specificity, sensitivity, and internal consistency are similar to previous studies in other European languages.
Subject(s)
Primary Health Care , Somatoform Disorders/diagnosis , Adult , Female , Humans , Language , Male , Middle Aged , Predictive Value of Tests , Psychiatric Status Rating Scales , Sensitivity and SpecificityABSTRACT
OBJECTIVE: To assess changes in health related quality of life after a cognitive behavioural program for patients diagnosed with abridged somatization disorder in primary care. METHOD: A multicentre, randomized, parallel group, controlled trial was designed. 168 patients were recruited from 29 primary health care centres in Spain and were randomly assigned to one of the three study arms: treatment as usual improved with Smith's norms, individual cognitive behavioural treatment, and group cognitive behavioural treatment. Health-related quality of life was assessed using SF-36 Health Survey. RESULTS: Individual cognitive behavioural treatment achieves greater changes in health related quality of life than group cognitive behavioural therapy and treatment as usual. Improvement in health related quality of life was fully observed at 12 month, and partially at 6 months. The modality of intervention interacts with time in all dimensions except for Physical functioning and Vitality. Patients who received individual cognitive behavioural therapy treatment had better scores in Physical and Mental health summary measures at 12 month follow-up. CONCLUSIONS: Individual cognitive behavioural treatment is the most effective way to improve health related quality of life in abridged somatization disorder patients, and its effects are sustained over time. Also, regardless of the type of intervention, physical functioning improves compared with treatment as usual.
Subject(s)
Cognitive Behavioral Therapy/methods , Quality of Life , Somatoform Disorders/psychology , Somatoform Disorders/therapy , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Population Surveillance , Primary Health Care/methods , Primary Health Care/statistics & numerical data , Spain , Treatment OutcomeABSTRACT
OBJECTIVE: To evaluate the effectiveness and feasibility of a cognitive-behavioral program for patients in primary care units who were diagnosed as having abridged somatization disorder. METHOD: A multicenter, randomized controlled trial was designed. One hundred sixty-eight patients were recruited from 29 primary care units and randomly assigned to one of three arms: treatment as usual (TAU), individual cognitive-behavioral therapy (CBT), and group CBT. Somatic symptoms were measured using the Screening for Somatoform Disorders and the Severity of Somatic Symptoms scale. The Hamilton Anxiety Rating Scale and the Hamilton Depression Rating Scale were used to assess the severity of anxiety and depression. RESULTS: Individual CBT achieves greater changes in the Screening for Somatoform Disorders posttreatment compared with group CBT (mean [95% confidence interval], 14.17 [11.9-16.3] versus 11.63 [9.4-13.7], p < .001). These improvements were observed at 6 and 12 months (p < .001 and p < .001, respectively). For individual CBT versus TAU, the number-needed-to-treat was 8, whereas for group CBT versus TAU, the number-needed-to-treat was 9. Individual CBT treatment resulted in lower anxiety scores compared with group CBT and TAU (7.33 [5.4-9.2] versus 11.47 [9.4-13.9] versus 13.07 [10.9-15.2], p < .001) posttreatment. Individual CBT and group CBT were associated with sustained benefits at 12-month follow-up compared with TAU (8.6 [6.6-10.6] versus 9.28 [7.2-11.2] versus 16.2 [13.9-18.5], p < .001). Depressive symptoms were lower for individual CBT posttreatment than for TAU (6.96 [5.3-8.6] versus 10.87-12.7], p < .01). CONCLUSIONS: CBT in individual and group settings results in significant improvements in somatic symptoms among patients with somatoform abridged disorder compared with TAU. Individual CBT results in greater posttreatment improvements at 6-month and 12-month follow-ups. TRIAL REGISTRATION: current controlled trials identifier ISRCTN69944771.
Subject(s)
Cognitive Behavioral Therapy/methods , Psychotherapy, Group/methods , Somatoform Disorders/therapy , Adult , Anxiety/psychology , Anxiety/therapy , Depression/psychology , Depression/therapy , Female , Humans , Male , Middle Aged , Severity of Illness Index , Somatoform Disorders/psychology , Treatment OutcomeABSTRACT
Introducción. La práctica de ejercicio físico y la exposición a la luz solar cada vez tiene mayor respaldo experimental sobre su eficacia antidepresiva coadyuvante en pacientes con depresión leve o moderada. Sin embargo, no hay información objetiva disponible sobre el grado de adherencia que los pacientes depresivos son capaces de desarrollar frente a estas recomendaciones en condiciones de práctica habitual, lo que limita la tendencia del clínico a prescribirlas. Métodos. Se estudia una muestra de 15 pacientes con un episodio depresivo de más de un mes de evolución con tratamiento antidepresivo a los que se les colocó un actígrafo en forma de reloj de pulsera capaz de medir la actividad física y la exposición a la luz durante las 24 horas del día. Una semana después de la evaluación basal estos pacientes fueron aleatorizados en 2 grupos. En el primero de ellos se les pedía en una breve nota por escrito de forma explícita y concreta que aumentaran la actividad física y la exposición a la luz solar, mientras que en el segundo grupo no. Resultados. En la semana posterior a la entrega de las recomendaciones, solo el primer grupo aumentó su actividad física y su exposición a la luz (14,3 y 25,8% respectivamente). Conclusión. Los pacientes con depresión muestran un buen nivel de adherencia a recomendaciones sobre su estilo de vida a corto plazo(AU)
Introduction. There is an increasing amount of evidence showing that physical activity and sun exposure are effective coadjuvant treatments for patients with mild to moderate depression. However, there is a lack of information regarding patient's adherence to these recommendations in daily clinical practice. Methods. We conducted a study including 15 depressive patients who had been under antidepressant treatment for at least one month. They wore a wrist-watch-like actimetry sensor to measure physical activity and sun exposure 24h a day. After one week of baseline assessment, patients were randomized into one of the two arms of the study. Patients in the experimental group received a brief note in which they were explicitly asked to increase both their physical activity level and time of sun exposure, while control group patients did not receive these explicit recommendations. Results. One week after recommendations were delivered, only patients in the experimental group had increased time of sun exposure and physical activity (25.8% and 14.3%, respectively). Conclusions. Depressive patients are able to follow prescribed lifestyle recommendations in the short-term(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Life Style , Exercise/physiology , Exercise/psychology , Depression/epidemiology , Depression/prevention & control , Motor Activity/physiology , Quality of Life/psychology , Depression/psychologyABSTRACT
INTRODUCTION: There is an increasing amount of evidence showing that physical activity and sun exposure are effective coadjuvant treatments for patients with mild to moderate depression. However, there is a lack of information regarding patient's adherence to these recommendations in daily clinical practice. METHODS: We conducted a study including 15 depressive patients who had been under antidepressant treatment for at least one month. They wore a wrist-watch-like actimetry sensor to measure physical activity and sun exposure 24 hours a day. After one week of baseline assessment, patients were randomised into one of the two arms of the study. Patients in the experimental group received a brief note in which they were explicitly asked to increase both their physical activity level and time of sun exposure, while control group patients did not receive these explicit recommendations. RESULTS: One week after recommendations were delivered, only patients in the experimental group had increased time of sun exposure and physical activity (25.8% and 14.3%, respectively). CONCLUSIONS: Depressive patients are able to follow prescribed lifestyle recommendations in the short-term.
Subject(s)
Depression/therapy , Exercise , Life Style , Patient Compliance/statistics & numerical data , Sunlight , Female , Humans , Male , Middle Aged , Pilot ProjectsABSTRACT
Frequent attenders account for a large proportion of primary care (PC) contacts, referrals, and prescriptions. Psychosocial and emotional distress is related to the high use of health services. Few studies have focused on the association between mental disorders assessed using structured interviews and frequent use of PC services.The aim of this study was to determine the factors associated with frequent attendance at primary healthcare units, focusing specifically on mental disorders. A two-phase screening epidemiological study comparing frequent attenders and routine attenders in five primary health care units was designed. Three hundred eighteen frequent attenders and 203 patients who attended the same units on a routine basis were compared. Sociodemographic and clinical data were obtained from statistical records and medical charts. Patients with a total score equal or higher than 7 points on the General Health Questionnaire-28 (GHQ-28) were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry. All the scores obtained on the GHQ were statistically different in the two populations. Frequency of mental disorders also differed significantly between both groups, with somatoform and affective disorders being the most prevalent ICD-10 categories among frequent attenders. The presence of depressive disorders and somatoform disorders is the most powerful predictive factor for frequent attendance. High comorbidity was found among frequent attenders with somatoform disorder. Frequent attendance at primary healthcare units is associated with depressive and somatoform disorders. Psychiatric comorbidity could be a confounder, particularly because affective and somatoform disorders often overlap in PC patients.
Subject(s)
Mental Disorders/epidemiology , Primary Health Care/statistics & numerical data , Somatoform Disorders/epidemiology , Adult , Aged , Comorbidity , Female , Humans , Male , Mental Disorders/diagnosis , Middle Aged , Prevalence , Somatoform Disorders/diagnosis , Spain/epidemiologyABSTRACT
BACKGROUND: Due to the high prevalence of depression, it is clinically relevant to improve the early identification and assessment of depressive episodes. The main objective of the present study was to examine the psychometric properties of the IDS-SR30 (Self-rated Inventory of Depressive Symptomatology) in a large Spanish sample of depressive patients. METHODS: This prospective, naturalistic, multicenter, nationwide epidemiological study conducted in Spain included 1595 adult patients (65.3% females) with a DSM-IV Major Depressive Disorder (MDD. IDS-SR30 and the Hamilton Depression Rating Scale (HDRS, 21 items)were administered to the sample. Data was collected during 2 routine visits. The second assessment was carried out after 10 ± 2 weeks after first assessment. RESULTS: The IDS-SR30 showed good internal consistency (α = 0.94) and high item total correlations (≥ 0.50) were found in 70% of the items. The convergent validity was 0.85. Results of the principal component analysis (PCA) and confirmatory factor analyses (CFA) showed that a three factor model (labelled mood/cognition, anxiety/somatic and sleep) is adequate for the current sample. CONCLUSIONS: The Spanish version of the IDS-SR30 seems a reliable, valid and useful tool for measuring depression symptomatology in Spanish population.
Subject(s)
Depression/diagnosis , Psychiatric Status Rating Scales , Self Report , Adolescent , Adult , Aged , Aged, 80 and over , Depression/epidemiology , Female , Humans , Male , Middle Aged , Principal Component Analysis , Psychometrics , Spain/epidemiology , Young AdultABSTRACT
To explore potential individual determinants of healthcare utilization in primary care (PC) using a structural equation modelling approach. Atotal of 638 patients from five PC units were randomly selected. Mental disorders, psychological distress and other psychological factors were assessed with the 28-item General Health Questionnaire (GHQ-28) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Medical records and ICD-10 diagnosis were used to measure somatic morbidity. There is a negative relationship between the presence of mental disorders and psychological well-being (-0.74), and a negative relationship with use of health services (-0.25). Age has a positive and significant relationship with the presence of chronic diseases (0.49), which has a positive and significant relationship with limitation of daily activities (0.18). This limitation has a positive relationship with poor perception of health (0.57) and with psychological well-being (0.03). Findings confirm the existence of specific pathways in PC health use. Health service use depends on the patient's psychological well-being and on the presence of chronic medical conditions. Healthcare professionals need to pay attention to the comorbidity of mental disorders and chronic medical conditions in order to identify frequent attenders and to decrease the inappropriate use of healthcare services.
Subject(s)
Health Services/statistics & numerical data , Mental Disorders/psychology , Mental Health , Adolescent , Adult , Chronic Disease/psychology , Female , Health Status , Health Surveys , Humans , Male , Mental Disorders/therapy , Middle Aged , Models, Theoretical , Primary Health Care/statistics & numerical data , Socioeconomic Factors , Young AdultABSTRACT
BACKGROUND: Cognitive dysfunction is common among depressed patients. However, the pattern and magnitude of impairment during episodes of major depressive disorder (MDD) through to clinical remission remains unclear. Heterogeneity of depressive patients and the lack of longitudinal studies may account for contradictory results in previous research. METHODS/DESIGN: This longitudinal study will analyze cognitive differences between CORE-defined melancholic depressed patients (n = 60) and non-melancholic depressed patients (n = 60). A comprehensive clinical and cognitive assessment will be performed at admission and after 6 months. Cognitive dysfunction in both groups will be longitudinally compared, and the persistence of cognitive impairment after clinical remission will be determined. DISCUSSION: The study of neuropsychological dysfunction and the cognitive changes through the different phases of depression arise a wide variety of difficulties. Several confounding variables must be controlled to determine if the presence of depression could be considered the only factor accounting for group differences.
Subject(s)
Cognition Disorders/diagnosis , Depressive Disorder/diagnosis , Adolescent , Adult , Clinical Protocols , Cognition Disorders/epidemiology , Cohort Studies , Comorbidity , Depressive Disorder/epidemiology , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/epidemiology , Diagnosis, Differential , Diagnostic Errors , Female , Humans , Longitudinal Studies , Male , Middle Aged , Neuropsychological Tests , Psychiatric Status Rating Scales/statistics & numerical data , Severity of Illness IndexABSTRACT
The present article reviews recent studies analyzing the association between health-related quality of life (HRQoL) and personality in inflammatory bowel disease (IBD). HRQoL is especially important in chronic diseases, since the strategic goals of treatment are to relieve symptoms, delay progression and improve functional quality. Some studies show that HRQoL in patients with IBD is significantly lower than that in the general population. Few studies have analyzed the association between personality and IBD and the results are contradictory. The most prevalent personality disorders in IBD are avoidant personality disorder and obsessive-compulsive personality disorder. Some results of a longitudinal study corroborating impaired HRQoL in these patients and the presence of one or more personality disorders in 57% of the sample are discussed.
Subject(s)
Inflammatory Bowel Diseases/complications , Inflammatory Bowel Diseases/psychology , Personality Disorders/etiology , Quality of Life , Adult , Female , Humans , Male , Personality Disorders/epidemiologyABSTRACT
BACKGROUND: Somatoform disorders are characterized by the presence of multiple somatic symptoms without an organic cause that completely explains their symptoms. These patients generate a high cost in health services. We aim to evaluate the effectiveness and feasibility of a cognitive-behaviour therapy (CBT) programme, administered in group and individual formats in primary care for patients who are diagnosed with abridged somatization disorder. DESIGN: Multicentre, randomized, controlled trial involving 3 groups, one of which is the control group consisting of standardized recommended treatment for somatization disorder in primary care (Smith's norms) and the 2 others, the intervention groups, consisting of cognitive-behavioural therapy (10 sessions) administered in individual format (intervention group 1) or in group format (intervention group 2). SETTING: 29 primary care health centres in the province of Zaragoza and 3 primary care health centres in the province of Mallorca, Spain. SAMPLE: N = 204 patients, (68 in each of the three groups), aged 18-65 years, able to understand and read Spanish, who fulfil Escobar's criteria of Abridgged Somatization Disorder (SSI 4,6), stable with pharmacotherapy over the previous month, and who will remain stable for the next 3 months in the doctor's opinion, having signed informed consent. CONTROL GROUP: Standardized recommended treatment for somatization disorder in primary care (Smith's norms). INTERVENTION group: 10 weekly sessions of CBT, following a protocol designed by Prof. Escobar's group at UMDNJ, USA. There are 2 different treatment conditions: individual and group format. MEASUREMENTS: Survey on the use of health services, number and severity of somatic symptoms, anxiety, depression, quality of life and clinical global impression. The interviewers will not know which group the patient belongs to (blind). The assessments will be carried out at baseline, post-treatment, 6 months and 12 post-treatment. MAIN VARIABLES: Utilization of health services, number and severity of somatic symptoms. ANALYSIS: The analysis will be per intent to treat. We will use the general linear models of the SPSS v.15 statistical package, to analyse the effect of treatment on the result variable (utilization of health services, number and severity of somatic symptoms). DISCUSSION: It is necessary to develop more effective psychological treatments for somatoform disorders. This randomised clinical trial will determine whether cognitive behaviour therapy, both in group or in individual format, is effective for the treatment of these patients. TRIAL REGISTRATION: Current controlled trials ISRCTN69944771.
