Disability and perceived stress in primary care patients with major depression / Discapacidad y estrés percibido en pacientes de atención primaria con depresión mayor

BACKGROUND: Major depressive disorder (MDD) is highly prevalent in the Spanish primary care (PC) setting and the leading cause of disability in Spain. The aim of this study was to evaluate several key psychometric properties of the Sheehan Disability Scale (SDS) in patients with or without MDD and varying degrees of symptom severity using the Patient Health Questionnaire-9 (PHQ-9). METHOD: A total of 1,704 PC patients participating in the PsicAP clinical trial completed the SDS and PHQ-9. We evaluated the factor structure, measurement invariance across gender, internal consistency, and the discriminative and predictive validity. RESULTS: Confirmatory factor analyses revealed a unifactorial model of the SDS containing 4 items (SDS-4) with the best model fit (CFI: .99; GFI: .99; TLI: 96; RMSEA: .10). This model contained the three life domain items (work, family, and social life) plus perceived stress (PS) with significant loadings. The internal consistency of the SDS-4 was acceptable in patients with or without MDD, regardless of symptom severity. The SDS-4 also showed good discriminative capacity and acceptable predictive validity in all subsamples. CONCLUSIONS: These findings support the use of the SDS-4 to assess depression-related disability in patients at Spanish primary care centres

ANTECEDENTES: el Trastorno Depresivo Mayor (TDM) es muy prevalente en la atención primaria (AP) española y es la principal causa de discapacidad en España. En este trabajo se estudiaron algunas propiedades psicométricas de la Escala de Discapacidad de Sheehan (SDS) en pacientes con o sin TDM y con varios niveles de severidad de síntomas, usando el Patient Health Questionnaire-9 (PHQ-9). MÉTODO: 1.704 pacientes de AP que participaron en el ensayo clínico PsicAP cumplimentaron la SDS y el PHQ-9. Se estudió la estructura factorial, medida de invarianza de género, consistencia interna, validez discriminativa y la validez predictiva. RESULTADOS: el análisis factorial confirmatorio mostró un modelo unifactorial con 4 ítems (SDS-4) con un buen ajuste (CFI: .99; GFI: .99; TLI: 96; RMSEA: .10). Este modelo contenía los tres ítems de esferas de la vida (trabajo, familia y vida social) más el ítem de estrés percibido con cargas significativas. La consistencia interna de la SDS-4 fue aceptable en pacientes con MDD y con diferente severidad de síntomas depresivos. También se halló una buena validez discriminativa y aceptable validez predictiva. CONCLUSIONES: nuestros hallazgos respaldan el uso de la SDS-4 cuando se evalúe la discapacidad relacionada con la depresión en centros de AP españoles

Disability and perceived stress in primary care patients with major depression.

BACKGROUND: Major depressive disorder (MDD) is highly prevalent in the Spanish primary care (PC) setting and the leading cause of disability in Spain. The aim of this study was to evaluate several key psychometric properties of the Sheehan Disability Scale (SDS) in patients with or without MDD and varying degrees of symptom severity using the Patient Health Questionnaire-9 (PHQ-9). METHOD: A total of 1,704 PC patients participating in the PsicAP clinical trial completed the SDS and PHQ-9. We evaluated the factor structure, measurement invariance across gender, internal consistency, and the discriminative and predictive validity. RESULTS: Confirmatory factor analyses revealed a unifactorial model of the SDS containing 4 items (SDS-4) with the best model fit (CFI: .99; GFI: .99; TLI: 96; RMSEA: .10). This model contained the three life domain items (work, family, and social life) plus perceived stress (PS) with significant loadings. The internal consistency of the SDS-4 was acceptable in patients with or without MDD, regardless of symptom severity. The SDS-4 also showed good discriminative capacity and acceptable predictive validity in all subsamples. CONCLUSIONS: These findings support the use of the SDS-4 to assess depression-related disability in patients at Spanish primary care centres.