Psychometric properties of the EQ-5D-5L in patients with major depression: factor analysis and Rasch analysis.

BACKGROUND: The EQ-5D is one of the most recommended questionnaires for cost-effectiveness studies. AIMS: To study the psychometric properties of the EQ-5D-5L in patients with major depression. METHODS: This prospective observational study included 433 patients with major depression who completed the EQ-5D-5L and Patient Health Questionnaire-9 (PHQ-9) questionnaires at baseline, of whom 310 also did six months later. The structural validity was assessed by confirmatory factor analysis, the item functioning by item response analysis, and reliability by Cronbach's alpha. Convergent validity and known-groups validity was studied using the PHQ-9 and a general health question. To assess responsiveness effect sizes were calculated. RESULTS: The results supported the unidimensionality and showed adequate item functioning, with somewhat age-related item differential functioning for the mobility dimension. Cronbach's alpha was 0.77. The EQ-5D-5L showed a high correlation with the PHQ-9 and general health. The more severe the depression level and the poorer the general health, the lower the EQ-5D-5L scores (p < 0.001). Responsiveness parameters showed moderate changes among "improved" patients. CONCLUSIONS: These findings support the adequate psychometric properties of the EQ-5D-5L in patients with major depression. It could be very useful for clinicians and researchers as an outcome measure and for use in economic evaluation.

Peripheral Inflammatory Parameters in Late-Life Depression: A Systematic Review.

Depressive disorders appear relatively frequently in older patients, and therefore represent an important disease burden worldwide. Given the high levels of inflammatory parameters found in depressed elderly patients, the "inflammaging" hypothesis is gaining strength. In this systematic review, we summarize current evidence regarding the relationship between inflammatory parameters and late-life depression, with a unique focus on longitudinal studies to guarantee temporality. According to the data summarized in this review, the levels of some proinflammatory parameters-especially interleukin (IL)-8, IL-6, and tumor necrosis factor (TNF)-α-could serve as biomarkers for the future development of depressive symptoms in elderly patients. Proinflammatory cytokines seem to be associated with the future development of clinically significant depression, irrespective of baseline scores, thus indicating that inflammation temporally precedes and increases depression risk. As insufficient research has been conducted in this field, further prospective studies are clearly warranted.

Prognostic Value of Affective Symptoms in First-Admission Psychotic Patients.

BACKGROUND: Very little research has been conducted in patients with first-episode psychosis using a dimensional approach. Affective dimensional representations might be useful to predict the clinical course and treatment needs in such patients. METHODS: Weincluded 112 patients with first-episode psychosis in a longitudinal-prospective study with a five-year follow-up (N = 82). Logistic analyses were performed to determine the predictive factors associated with depressive, manic, activation, and dysphoric dimensions. RESULTS: High scores on the depressive dimension were associated with the best prognosis. On the other hand, high scores on the activation dimension and the manic dimension were associated with a poorer prognosis in terms of relapses. Only the dysphoric dimension was not associated with syndromic or functional prognosis. CONCLUSION: Ourresults suggest that the pattern of baseline affective symptoms helps to predict the course of psychotic illness. Therefore, the systematic assessment of affective symptoms would enable us to draw important conclusions regarding patients' prognosis. Interventions for patients with high scores on manic or activation dimensions could be beneficial in decreasing relapses in first-episode psychosis.

Predictors of suicide in first-episode affective and nonaffective psychotic inpatients: five-year follow-up of patients from a catchment area in Vitoria, Spain.

OBJECTIVE: To determine the baseline demographic and clinical characteristics associated with suicide attempts over 5 years following a first admission for psychosis and to assess the relationship between suicidal behavior during 5-year follow-up and clinical factors. METHOD: All inpatients consecutively admitted between February 1997 and January 1999 with a first psychotic episode from a specific catchment area in Spain were included at baseline; they were followed up yearly over a 5-year period with an extensive protocol that included the Structured Clinical Interview for DSM-IV, the Positive and Negative Syndrome Scale, and the 21-item Hamilton Rating Scale for Depression. The primary outcome measure was suicide attempts. Comorbidity with alcohol and drug abuse was recorded, as were all suicidal acts made by patients over the follow-up period. Relationships between suicidal outcome and baseline clinical features were examined. Logistic regression modeling was used to test the significance and independence of associations of relevant factors to suicidal status. RESULTS: Of 83 first-episode psychotic patients, 14.5% displayed suicidal behavior within the 5 years following the first admission, and 2.4% died by suicide. Suicide rate was 0.48%/ year and attempt rate was 2.89%/year, with a 1.5-fold (95% CI = 1.07 to 2.22) greater risk for each depressive symptom at index episode and with an 8-fold (95% CI = 1.45 to 44.40) higher risk among patients with baseline stimulant abuse (cocaine and amphetamine). CONCLUSIONS: Patients with a first-episode psychotic disorder seemed to be a high-risk population for suicidal behavior. Depressive symptoms during the index psychotic episode and comorbidity with stimulant abuse at baseline were relevant predictive factors for suicidal behavior during the first years of first affective and nonaffective psychotic episodes.