Screening for mental disorders in leprosy patients: comparing the internal consistency and screening properties of HADS and GHQ-12.

OBJECTIVE: The aim of the study was to investigate the internal consistency and screening properties of the General Health Questionnaire-12 (GHQ-12) and the Hospital Anxiety and Depression Scale (HADS) in Turkish patients with leprosy. METHODS: The two screening instruments and a fully structured diagnostic interview (CIDI) were administered to 65 people drawn from all leprosy inpatient units in Turkey between March and June of 2001. The scales were evaluated using Cronbach's alpha and Receiver Operating Characteristics (ROC) analyses. For each scale, criterion validity was assessed for any psychiatric disorder, depressive disorder and anxiety disorder. RESULTS: The Cronbach alpha coefficients for the GHQ-12 and HADS were 0.84 and 0.81 respectively. For detecting any psychiatric disorder, the optimal cut-off for the GHQ-12 was 4/5 (sensitivity 0.82, specificity 0.62). The optimal cut-off for the HADS total score was 12/13 (sensitivity 0.80, specificity 0.77). CONCLUSION: The results indicate that the General Health Questionnaire-12 and Hospital Anxiety and Depression Scale have satisfactory internal consistency, and performed well to a similar extent for detecting psychiatric disorders in leprosy patients.

[Psychiatric problems, life quality and compliance in patients treated with haemodialysis and renal transplantation]. / Hemodiyalize Giren ve Böbrek Nakli Yapilan Hastalarda Ruhsal Sorunlar, Yasam Kalitesi ve Tedaviye Uyum.

OBJECTIVE: The major goal of this study is to compare the results of psychiatric morbidity and life quality evaluations in haemodialysis patients and renal transplantation recipients. Additionally, it aims to discuss risk factors for psychiatric morbidity, life quality and medical compliance of these patients in the light of literature review. METHOD: In this study, assessment instruments called Hospital Anxiety and Depression Scale, Short Form-36, Rotter's Internal-External Locus of Control Scale, Scale for Compliance of Renal Transplantation Recipients, and Questionnaire for Sociodemographic and Health Information were applied to 34 patients treated with haemodialysis and 30 renal transplantation recipients in the treatment programme for 5 years or longer period. RESULTS: 26.6% percent of renal transplantation recipients reported that they had been given unsufficient or no information before transplantation by their doctors. According to 46.6 percent of patients' relatives, patients' compliance for health behavior was in good level. Decrease in education level was predicted higher scores above cut-off point of depression subscale; patient group (renal transplantation versus haemodialysis), decreases in depression-anxiety levels, increase in scores for internal locus of control and marital status (unmarried versus married) predicted better quality of life, physical and mental. CONCLUSION: Findings of this study, such as unsufficient information before transplantation and low treatment compliance, suggest that more sophisticated psychosocial intervention programs focusing on these patients' quality of life, mental health and treatment compliance are necessary.

Public opinions and beliefs about the treatment of depression in urban Turkey.

BACKGROUND: Although attitudes towards psychiatric illness influence its presentation, detection, recognition, treatment adherence and rehabilitation, the lay public's opinions and beliefs about the treatment of depression have not been investigated sufficiently. OBJECTIVE: The aim of this study was to determine public opinions and beliefs about the treatment of depression and the influence of perception and causal attributions on attitudes towards treatment of depression in urban areas. METHODS: This study was carried out with a representative sample in Istanbul, which is the biggest metropolis in Turkey. Seven hundred and seven subjects completed the public survey form which consisted of 32 items rating attitudes towards depression. RESULTS: The public believes that psychological and social interventions are more effective than pharmacotherapy, and that the medicines used in treatment of depression are harmful and addictive. There was a general reluctance to consult a physician for depression, and psychiatrists were felt to be more helpful than general practitioners. The public viewed depression as treatable. A high educational level and perceiving depression as a disease is associated with positive beliefs and opinions about the treatment of depression; but the perception of depressive patients as aggressive is associated with negative beliefs and opinions about the treatment of depression. CONCLUSION: The beliefs that "psychological and social interventions are more effective than pharmacotherapy" and "antidepressants are harmful and addictive" must specifically be taken into account in clinical practice and in anti-stigma campaigns. Additional studies are needed to understand the public's tendency to conceptualise depression as a psychosocial problem. In clinical practice, depression should be introduced as a bio-psychosocial disease whatever its cause: biological, psychological or social. In addition, the differences between extreme worry and disease, and the lack of aggressiveness of depressive patients, must be emphasised.

Public attitudes to depression in urban Turkey - the influence of perceptions and causal attributions on social distance towards individuals suffering from depression.

BACKGROUND: The aim of this study was to determine public attitudes towards patients with depression and the influence of perception and causal attributions on social distance towards individuals suffering from depression in urban areas. METHODS: This study was carried out with a representative sample in Istanbul which is the biggest metropolis in Turkey. Seven hundred and seven subjects completed the public survey form which consisted of ten items screening the demographic features and health status of the participants, and 32 items rating attitudes towards depression. RESULTS: The respondents' attitudes towards depression were very negative and nearly half of the subjects perceived people with depression as dangerous. More than half of the subjects stated that they would not marry a person with depression, and nearly half of the subjects stated that they would not rent their house to a person with depression. One-quarter of the subjects stated that depressive patients should not be free in the community. The subjects who considered depression as a disease and who believed that weakness of personality and social problems cause depression had negative attitudes towards depression. CONCLUSIONS: In Istanbul, people recognise depression well, but their attitudes towards it are fairly negative. The urban public has unfavourable attitudes towards depression and a tendency to isolate patients from the society. Notwithstanding the high prevalence, there is still considerable stigmatisation associated with depression.

[Psychiatric disorders and disability among leprosy patients; a review]. / Leprasi Olan Hastalarda Ruhsal Bozukluklar ve Yetiyitimi: Bir Gözden Geçirme.

As a gross estimate, leprosy currently affects 11-16 million patients worldwide There are currently 3600 registered patients in Turkey. The social stigma connected to leprosy makes this disease completely different from others. Even nowadays people affected by leprosy have to leave their village or are socially isolated. The physical deformity ratio is approximately 25% in other countries whereas it is more than half in Turkey. The prevalence of mental disorders among leprosy patients is higher than that among the general population. Depression is the most common psychiatric disorder among leprosy patients. Another important finding is that the long duration of the illness and physical handicaps raise the risk of psychiatric disorders. Nevertheless, the results of two studies conducted in Turkey on this subject contradict the results of international studies. Leprosy patients experience functional disabilities that limit their lives and ability to establish relation ships with others both in social and occupational fields. The physical disability rate is high (75%) in Turkey. A review of the literature revealed several papers on the psychosocial aspects of illness but few references to the degree or pattern of psychiatric disorders among leprosy patients. The main purpose of this paper is to review psychiatric disorders and disabilities in leprosy patients and to obtain concrete results.

[Relatives' beliefs and attitudes towards schizophrenia: an epidemiological investigation]. / Sizofrenisi olan hastalarin yakinlarinin sizofreniye yönelik tutumlari.

OBJECTIVE: To examine relatives' beliefs and attitudes towards schizophrenia. METHOD: Data were derived from the demographic and schizophrenia modules of the questionnaire developed for the survey called "Attitudes Towards Mental Disorders". The questionnaire was administered 98 adult relatives of schizophrenic patients who had participated in psychiatric outpatient treatment programs in Istanbul, Izmir and Adana. RESULTS: Although all identified the case described as a mental disorder, only 76.5% determined the term schizophrenia as a mental disorder. Social problems (62.9%) and weakness of will (65.3%) were the most commonly endorsed causes of schizophrenia. Almost all of the respondents preferred medical methods and psychiatrists for the treatment of schizophrenic patients. 72.2% of the sample held the opinion that people with schizophrenia are dangerous and 91.8% believed that these patients could not take responsibility for their own lives. The attitudes of the subjects living in Istanbul and those who stated that "schizophrenia is an illness or a mental disorder" were more negative than the others with respect to social distance characteristics. CONCLUSION: Most of the relatives of schizophrenic patients identified a mental disorder when a schizophrenia case was described, but they had insufficient information about the term schizophrenia. Labeling patients as mentally ill had a negative effect on relatives' attitudes towards schizophrenia. The results of this study underlined the need for education programs for the relatives of patients, and the demands of the relatives concerning treatment modalities with psychosocial components.

[The knowledge and attitudes of the public towards depression: an Istanbul population sample]. / Depresyon ile ilgili bilgi ve tutumlar: Istanbul ornegi.

OBJECTIVE: To assess the public's knowledge and attitudes towards depression and associated sociodemographic factors. METHOD: The survey was conducted in 2000 using face-to-face interviews in the homes of 707 adults in 24 different districts of Istanbul. Logistic regression analysis was used to assess the influence of sociodemographic factors on attitudes towards depression. RESULTS: The results indicate that 78.9% diagnosed the depression vignette as a mental disorder. 86.6% of the sample considered "social environmental factors" and 68.2% "weak personality" to be as the cause of depression. 43.4% of the population thought that people with depression are aggressive, and 22.8% believe that their freedom should be restricted. 51.9% percent of the subjects thought that the patient defined in the vignette should consult a physician. 94.5% percent of the respondents who thought of depression as an illness believe that depression is treatable and 54.9% of the respondents consider that the drugs used to treat depression have serious side effects. When the effect of sociodemographic factors on community attitudes was analyzed by logistic regression, age was found to have the most significant influence on community attitudes towards depression. CONCLUSION: The results suggest that the public identifies depression as an illness, has a tendency to perceive depression as a social problem, believes that depression could be treated by drugs, has incorrect knowledge about drugs and treatment, and is in doubt about the acceptance of depressive patients in society.

[The Well-Being Questionnaire-12: an evaluation of its validity and reliability in Turkish people with end-stage renal disease]. / Ruhsal Esenlik Anketi 12: Türkçe formun son dönem böbrek yetmezligi olan hastalarda geçerlik ve güvenilirlik calismasi.

OBJECTIVE: The aim of the present investigation was to test the psychometric properties of the Turkish version of the Well-Being Questionnaire-12 (WBQ-12) in patients with end-stage renal disease. METHOD: The subjects included in the study were patients with end-stage renal disease treated in Hemodialysis Unit of Baskent University Medical Hospital. The Patient Information Sheet, the Mini Mental Test, the WBQ-12, the Hospital Anxiety and Depression Scale (HAD) were applied to a total of 60 patients ranging from 19-71 years old. The WBQ-12 was applied for test-retest reliability assessment in 3-7 days after first interview. RESULTS: The item-total score correlation of the WBQ-12's items was 0.43, Cronbach's alpha coefficient was 0.87, and test-retest correlation coefficient was 0.80. The optimum cut-off score for the WBQ-12 with respect to detecting anxiety and/or depressive disorder was determined to be 10. Using this cut-off point, the sensitivity, specificity, positive predictive value, and negative predictive value of the WBQ-12 were 0.87, 0.73, 0.50 and 0.92, respectively. CONCLUSION: This short instrument is easy to administer and may be considered a useful tool for both clinicians and researchers to assess the psychological well-being of patients with end-stage renal disease which has high psychiatric comorbidity, and causes disability in high level.

[Dysthymic disorder in primary health care]. / Birinci basamak saglik hizmetlerinde distimik bozukluk.

OBJECTIVE: The aim of this study was to investigate the epidemiological and clinical characteristics of dysthymic disorder of the primary health care level. METHOD: Parts of the Composite International Diagnostic Interview (i.e. sections on demographic variables and depressive and dysthymic disorders) the General Health Assessment Form, the Brief Disability Questionnaire, and a Patient Assessment Form were applied to 1997 consecutive patients seen by primary care physicians in 10 cities. RESULTS: The frequency of dysthymic disorder according to DSM-IV criteria in the primary care patients studied was 3.5%. "Fatigue or loss of energy", "diminished ability to think or concentrate", "indecisiveness", "insomnia" and "hopelessness" were the most frequent symptoms. 73.9% of patients with dysthymic disorder also had a chronic disorder and 78.3% of patients with dysthymic disorder met the criteria for major depressive disorder. 71.4% of patients with dysthymic disorder presented only somatic complaints to general practitioners. Disability ratios were higher in patients with dysthymic disorder than in patients without. General practitioners recognised depression in only 13.8% of patients with dysthymic disorder. CONCLUSION: General practitioners can not recognise dysthymic disorder in primary health care patients. This result emphasises the need for research on the failure to recognise dysthymic disorder in primary health care patients.