Primary cutaneous cribriform tumor: A case report and literature review.

In the updated 5th edition of the WHO Classification of Skin Tumors, primary cutaneous cribriform carcinoma has been renamed cribriform tumor. This entity is a rare sweat gland neoplasm with undetermined malignant potential, with only 46 cases reported to date. Herein, we present a case of a 30-year-old female with a solitary nodule in the left thigh subcutaneous tissue. Histopathological examination revealed a well-defined dermal nodule composed of monomorphic, deeply staining cells arranged in solid nests, tubular, and cribriform patterns, with no recurrence or distant metastasis observed during a 1-year follow-up. Summarizing all 47 cases, they exhibited consistent, reproducible histological morphology and similar immunohistochemistry. Although the tumor nests lacked myoepithelial cells peripherally, all cleanly excised cases showed no recurrence or distant metastasis, suggesting a benign biological behavior. We argue against overtreatment.

Impact of Baseline Anxiety on Well-being in People with Post-COVID-19 Condition: A Secondary Analysis.

BACKGROUND: Post-COVID-19 condition (PCC) is associated with a host of psychopathological conditions including prominent anxiety symptoms. However, it is not known what effect anxious symptoms have on measures of well-being in individuals living with PCC. This study aims to evaluate anxiety's association with measures of well-being in people with PCC. METHODS: This is a post hoc analysis utilizing data from a placebo-controlled, randomized, double-blind clinical trial assessing the effect of vortioxetine on cognitive impairment in individuals with PCC (NCT05047952). Baseline data with respect to anxiety and well-being were collected using the Generalized Anxiety Disorder Scale, 7-Item (GAD-7), and the World Health Organization (WHO) Well-Being Index, 5-Item (WHO-5), respectively. A generalized linear model (GLM) analysis on baseline GAD-7 and WHO-5 scores was conducted with age, sex, employment status, education level, previous major depressive disorder (MDD) diagnosis, and confirmed COVID-19 cases as covariates. RESULTS: Data was analyzed in a sample of 144 participants (N = 144). After controlling for the aforementioned covariates, the results found that GAD-7 and WHO-5 scores had a significant negative correlation (ß = -0.053, p = <0.001), signifying that increased anxiety had adverse effects on the overall well-being of individuals with PCC. CONCLUSION: Herein, we observed a clinically meaningful level of anxiety in individuals with PCC. We also identified a robust correlation between anxiety in PCC and measures of general well-being. Our results require replication, providing the impetus for recommending screening and targeting anxious symptoms as a tactic to improve general well-being and outcomes in individuals with PCC.

Validation and optimal cut-off score of the World Health Organization Well-being Index (WHO-5) as a screening tool for depression among patients with schizophrenia.

BACKGROUND: The utility of the World Health Organization Wellbeing Index (WHO-5) as rapid screening tool for depression has not yet been researched in the context of schizophrenia. The goals of this study were twofold: (1) to test the psychometric properties of the WHO-5 in a sample of Arabic-speaking patients with schizophrenia from Lebanon, with particular emphasis on validating the WHO-5 as a screening tool for wellbeing and depression in patients with schizophrenia; and (2) to determine the optimal cut-off point to identify schizophrenia patients with depression. METHODS: Chronic, remitted patients with schizophrenia took part in this cross-sectional study between August and October 2023 (n = 117; mean age of 57.86 ± 10.88 years and 63.3% males). The Calgary Depression Scale for Schizophrenia (CDSS) was included as index of validity. For the validation of the WHO-5 scale, we performed a confirmatory factor analysis (CFA) using the original structure of the scale. To assess the discriminatory validity of the Arabic version of the WHO-5 as a screening tool for depression, we conducted a Receiver operating characteristic (ROC) curve analysis, taking the WHO-5 reversed score against the dichotomized CDSS score at a cut off value of 6. RESULTS: The results of CFA supported the originally proposed unidimensional structure of the measure, with good internal consistency reliability (α = 0.80), concurrent validity, and cross-sex measurement invariance. The WHO-5 showed a sensitivity of 0.8 and a specificity of 0.7 in the detection of depression with a cut-off point of 9.5. The validity of the WHO-5 as a screening tool for depression was supported by the excellent discrimination AUC value of 0.838. Based on this WHO-5 cut-off value, 42.6% of the patients were screened as having a depression. CONCLUSION: The study contributes to the field by showing that the WHO-5 is a concise and convenient self-report measure for quickly screening and monitoring depressive symptoms in patients with schizophrenia. It is therefore highly recommended to apply this cut-off point for screening and follow-up assessments. The current findings will hopefully encourage clinicians and researchers working in Arab settings, who are often confronted with significant time and resource constraints, to start using the WHO-5 to aid their efforts in mitigating depression in this vulnerable population and fostering research in this under-researched area.

Association between depressive symptoms and employment type of Korean workers: the Fifth Korean Working Conditions Survey.

BACKGROUND: This study analyzed the association between depressive symptoms and employment type, by considering both socioeconomic status and job stress factors. METHODS: We analyzed 27,369 participants (13,134 men and 14,235 women) using data from the fifth Korean Working Conditions Survey. The participants were divided into regular and precarious workers. Depressive symptoms were defined using the World Health Organization-5 Well-Being Index. A multivariate logistic regression analysis was performed to assess the association between depressive symptoms and employment type. RESULTS: Of the participants, 71.53% (N = 19578) were regular workers and 28.47% (N = 7791) were precarious workers. The weighted frequencies of participants with depressive symptoms (42.50%) were significantly higher than those of precarious workers (32.54%, p < 0.001). In the univariate and multivariate analyses, precarious workers had a significantly higher risk of depressive symptoms than regular workers (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.42-1.64; OR 1.16, 95% CI 1.07-1.26, respectively). The significant association between depressive symptoms and precarious workers has also been reflected in propensity score matched participants through crude and multivariate analysis (OR 1.54 [95% CI 1.43-1.66] and OR 1.15 [95% CI 1.04-1.26], respectively). CONCLUSIONS: The findings suggest that precarious workers may have a higher risk of depressive symptoms than regular workers. However, this is only a cross-sectional study. Therefore, further study is required to investigate the relevance association between depressive symptoms and employment types.

Validation of Chinese version of the 5-item WHO well-being index in type 2 diabetes mellitus patients.

BACKGROUND: For better disease management and improved prognosis, early identification of co-morbid depression in diabetic patients is warranted. the WHO-5 well-being index (WHO-5) has been used to screen for depression in diabetic patients, and its Chinese version (WHO-5-C) has been validated. However, its psychometric properties remain to be further validated in the type 2 diabetes patient population. The aim of our study was to examine the reliability and validity of the WHO-5-C in patients with type 2 diabetes mellitus. METHODS: The cross-sectional study was conducted on 200 patients from July 2014 to March 2015. All patients should complete the WHO-5-C, the Patient Health Questionnaire-9 (PHQ-9), the 20-item Problem Areas in Diabetes Scale (PAID-20), the Mini International Neuropsychiatric Interview (M.I.N.I), and Hamilton Rating Scale for Depression (HAM-D). Internal consistency of WHO-5 was revealed by Cronbach's alpha, and constructive validity by confirmatory factor analysis (CFA). Relationship with PHQ-9, HAM-D, and PAID-20 was examined for concurrent validity, and ROC analysis was performed for criterion validity. RESULTS: The WHO-5-C presented satisfactory reliability (Cronbach's alpha = 0.88). CFA confirmed the unidimensional factor structure of WHO-5-C. The WHO-5-C had significant negative correlation with HAM-D (r = -0.610), PHQ-9 (r = -0.694) and PAID-20 (r = -0.466), confirming good concurrent validity. Using M.I.N.I as the gold standard, the cut-off value of WHO-5-C was 42, with a sensitivity of 0.83 and specificity of 0.75. CONCLUSION: The WHO-5-C holds satisfactory reliability and validity that is suitable for depression screening in type 2 diabetes patients as a short and convenient instrument.

Stress/depression across the COVID-19 pandemic in Denmark.

BACKGROUND: Global estimates suggest strained mental health during the first year of the COVID-19 pandemic, but the lack of nationally representative and longitudinal data with clinically validated measures limits knowledge longer into the pandemic. METHODS: Data from 10 rounds of nationally representative surveys from Denmark tracked trends in risk of stress/depression from just before the first lockdown and through to April 2022. We focused on age groups and men and women in different living arrangements and controlled for seasonality in mental health that could otherwise be spuriously related to pandemic intensity. RESULTS: Prior to first lockdown, we observed a "parent gap", which closed with the first lockdown. Instead, a gender gap materialized, with women experiencing higher risks than men-and higher than levels predating first lockdown. Older respondents (+ 70 years) experienced increasing risks of stress/depression early in the pandemic, while all other groups experienced decreases. But longer into the pandemic, risks increased for all age groups and reached (and sometimes exceeded) levels from before first lockdown. CONCLUSION: Denmark had low infection rates throughout most of the pandemic, low mortality rates across the entire pandemic, and offered financial aid packages to curb financial strains. Despite this circumstance, initial improvements to mental health during the first lockdown in Denmark were short-lived. Two years of pandemic societal restrictions correspond with deteriorating mental health, as well as a change from a parenthood gap in mental health before first lockdown to a gender gap two years into the pandemic.

Concurrent validity of the anxiety symptom-scale compared to two well-being scales: results from the Lolland-Falster health study.

OBJECTIVE: To examine the concurrent validity of the Anxiety Symptom-scale against two well-being scales, the Cantril Ladder (CL) and World Health Organization Well-Being Index (WHO-5), to test the algorithm defining anxiety against these scales, and identify cut-off points for the Anxiety Symptom-scale sum score. SUBJECTS: 14,405 adult respondents completing all psychometric questions in the Lolland Falster Health Study. METHOD: Receiver operating characteristic analyses comparing Anxiety Symptom-scale WHO-5 and CL. RESULTS: 2.5% of respondents had an anxiety disorder (3% female and 2% male) according to the Anxiety Symptom-scale algorithm. The area under the curve (AUC) was 0.87 for CL and 0.90 for WHO-5 (using inverse scores), indicating high concordance with anxiety disorder as identified by the scale. A score solely ≥2 on item 10 is a relevant cut off to low wellbeing. Anxiety disorder covers a broad range on the scale's sum score, with 3 to 4 indicating low well-being in this population sample and a sensitivity of 0.85 - 0.99 against CL and WHO-5. CONCLUSION: The Anxiety Symptom-scale is a sensitive and valid instrument for the identification of patients in low well-being with symptoms of anxiety. A score ≥2 on the functional impact (Item 10) of all symptoms is a relevant indicator of anxiety associated with low well-being in this sample. A higher Anxiety Symptom-scale sum score is coherent with lower well-being, though without specific cut-off points. Further validation of the Anxiety Symptom-scale in a clinical setting is recommended.

Measuring the quality of life of long-term care service users in Japan: a cross-sectional questionnaire study.

BACKGROUND: In Japan's super-aging society, the number of long-term care service providers is increasing, and the quality of care is a matter of concern. One aspect of the quality of care is the user's quality of life. The questionnaires EQ-5D and WHO-5 are representative indicators of quality of life. Herein, we aimed to measure the quality of life in long-term care service users in Japan and to clarify the relationship between quality of life and the level of care required. METHODS: A questionnaire study was conducted in 106 facilities of 22 corporations. In addition to the EQ-5D and WHO-5, sex, age, and the level of care required were assessed by descriptive statistics. Bonferroni's multiple comparison test was used to analyze each quality of life score, and the differences by sex and age were analyzed multiple regression analyses, with each quality of life score as the objective variable. RESULTS: Of 4647 cases collected, 2830 were analyzed, with no missing data. Both indicators tended to be lower than the general older population. Those scores tended to be higher in females than males (EQ-5D: males, 0.58 ± 0.26; females, 0.60 ± 0.24; P = 0.06 and WHO-5: males, 13.8 ± 5.92; females 14.9 ± 5.70; P < 0.001). In terms of age, those under 65 years old with specific diseases had lower EQ-5D scores than those in other age groups (P < 0.001); however, WHO-5 scores did not differ by age. Multiple regression analysis showed a significant association between the EQ-5D score and level of care required, except for support-required level 1, which tended to worsen as the level of care required increased. Conversely, the WHO-5 score was significantly lower for care need levels 2, 4, and 5. CONCLUSIONS: The quality of life of long-term care service users was worse than that of the general older population, it tended to be low among males and those under 65 years old with specific diseases. Furthermore, it gradually decreased as the level of care required increased. It is important to monitor users' quality of life as a quality indicator of care, to improve and manage it.

The role of psycho-oncologic screenings in the detection and evaluation of depression in head and neck cancer aftercare patients.

PURPOSE: Cancer and morbidity during a therapeutic regimen can result in somatic and psychiatric impairment. We have evaluated the need of appropriate psychological screening by analyzing a large collective of head and neck cancer (HNC) patients with particularly burdensome symptoms. METHODS: HNC-aftercare patients were asked about somatic and psychological symptoms by means of standardized questionnaires of the European Organization for Research and Treatment of Cancer (EORTC Q30 and QLQ-H&N35). Patients with poor well-being values on the World Health Organization-5-Well-Being Index were screened for depression by using the Mini International Neuropsychiatric Interview, and adequate treatment was initiated, if necessary. RESULTS: Our sample consisted of 453 HNC-aftercare patients (average age 64.5 years; 72.0% male; 28.0% female). 25.1% showed abnormalities based on their WHO-5 questionnaire. A current major depressive episode was observed in 8.5% of the total study group. Patients with lip and oral cavity tumors showed the highest depression prevalence (18.9%). Time since initial HNC diagnosis showed no clear trend with regard to the number of depression cases. 50.0% of patients with a current major depressive episode consented to receiving assistance and/or therapy. Within the total study population, the most burdensome symptoms were found to be "dry mouth" (48.3%), "trouble doing strenuous activities" (46.0%), "trouble taking a long walk" (38.5%), and "worry" (35.5%). Aftercare patients with a depression diagnosis tended to have heavier symptom burdens than people without major depression. CONCLUSIONS: Despite the various cancer-related burdensome factors, prevalence levels of depression among the HNC-aftercare patients and the general population were similar. Nevertheless, since the number of diagnosed depression cases is high, the need for psychological treatment should be considered within the tumor collective. Furthermore, screening for depression should be implemented in clinical routines by using the appropriate standardized questionnaires.

The Reliability and Validity of the 5-Item Who Well-Being Index (WHO-5) amongst Doctors and Nurses in Nigeria.

BACKGROUND: The WHO-5 is a brief measure of psychological well-being. Validity studies for the WHO-5 are quite limited in sub-Saharan Africa and most importantly, no study has confirmed the unidimensional factor structure of the instrument in Nigeria. The aim of this research is to evaluate the reliability and determine the unidimensional factor structure of the WHO-5 well-being index in a population of medical doctors and nurses in Nigeria during the COVID-19 pandemic. METHODS: Overall, 464 medical doctors and nurses from various parts of Nigeria, completed the assessment between April and July 2020. The participants completed the WHO-5 well-being index and the 9-item Patient Health Questionnaire (PHQ-9). Principal Component Analysis (PCA) was carried out. The internal consistency of the WHO-5 was measured and external validity was determined as well. RESULTS: The inter-item correlations among the WHO-5 items ranged from 0.447 to 0.685. Internal consistency was adequate (Cronbach's alpha = 0.868). The corrected item-total correlations ranged from 0.596 to 0.750 with a mean of 0.693. PCA identified a single factor structure of the WHO-5. The WHO-5 significantly correlated with the PHQ-9 (r = -0.590), ascertaining convergent validity. CONCLUSION: The WHO-5 demonstrated satisfactory reliability and validity in our study population. It is therefore a suitable measure for the assessment of the mental well-being of healthcare professionals in our environment.

CONTEXTE: L'OMS-5 est une brève mesure du bien-être psychologique. Les études de validité de l'OMS-5 sont assez limitées en Afrique subsaharienne et surtout, aucune étude n'a confirmé la structure factorielle unidimensionnelle de l'instrument au Nigeria. L'objectif de cette recherche est d'évaluer la fiabilité et la structure factorielle unidimensionnelle de l'indice de bien-être WHO-5 dans une population de médecins et d'infirmiers au Nigeria pendant la pandémie de COVID-19. MÉTHODES: Au total, 464 médecins et infirmières de diverses régions du Nigeria, ont complété l'évaluation entre avril et juillet 2020. Les participants ont rempli l'indice de bien-être de l'OMS-5 et le questionnaire sur la santé des patients en 9 points (PHQ-9). Une analyse en composantes principales (ACP) a été réalisée. La cohérence interne de l'OMS-5 a été mesurée et la validité externe a également été déterminée. RÉSULTATS: Les corrélations inter-items entre les items de l'OMS-5 varient de 0,447 à 0,685. La cohérence interne était adéquate (alpha de Cronbach = 0,868). Les corrélations itemtotal corrigées variaient de 0,596 à 0,750 avec une moyenne de 0,693. L'ACP a identifié une structure factorielle unique de l'OMS-5. L'OMS-5 a été significativement corrélé avec le PHQ- 9 (r = -0,590), ce qui atteste la validité convergente. CONCLUSION: L'OMS-5 a démontré une fiabilité et une validité satisfaisantes et la validité dans notre population d'étude. Il s'agit donc d'une mesure appropriée pour l'évaluation du bien-être mental des professionnels de santé dans notre environnement. Mots-clés: OMS-5, Bien-être, Fiabilité, Validité, Nigeria.

Predictors of the one-year-change in depressiveness in informal caregivers of community-dwelling people with dementia.

BACKGROUND: The care of people with dementia is usually carried out by their family members, which can cause objective und subjective burden and raise their risk of depressiveness. Thus, the aim of this study is to identify predictors of the change in depressiveness of informal caregivers over 1 year in order to be able to derive hypotheses for interventions that promise success. METHODS: The Bavarian Dementia Survey (BayDem) is a multi-center, longitudinal study conducted at three different sites in Bavaria, Germany. Participants were people with dementia and their informal caregivers. Data was collected at baseline and after 12 months by standardized face-to-face interviews in cooperation with local players. The informal caregivers' depressiveness was assessed with the WHO-5. Data was also collected on the people with dementia's cognition (MMSE), behavioral symptoms (NPI) and comorbidities (Charlson Comorbidity Index) as well as caregivers' social inclusion (LSNS), time spent on care and care contribution (RUD). For statistical analysis, a multiple regression model was used. RESULTS: The data of 166 people with dementia and their informal caregivers was analyzed. Of the latter, 46% were categorized as "likely depressed". The change in depressiveness over a year was significantly predicted by baseline depressiveness as well as an increase in the time informal caregivers spent supervising the person with dementia. CONCLUSIONS: Informal caregivers of people with dementia are at high risk of depression. The time spent supervising the person with dementia has a significant impact on increasing depressiveness. This highlights the importance of support services to provide the informal caregiver with relief and possibly reduce depressiveness.

Assessing mental well-being in a Sinhala speaking Sri Lankan population: validation of the WHO-5 well-being index.

PURPOSE: The WHO-5 well-being index is a widely used, short rating scale that measures subjective well-being. We translated the WHO-5 index into Sinhala and tested its psychometric properties including measurement invariance among diverse groups in a community sample in Sri Lanka. METHODS: The sample of 267 persons aged between 16 and 75 years was recruited from a semi-urban area. 219 completed a paper-based questionnaire and 48 responded to an online survey. Construct validity was tested for factorial validity (Confirmatory Factor Analysis -CFA), convergent validity and known group validity. Composite reliability for congeneric measures and test-retest reliability were also tested. Multi-group CFA (MG-CFA) was used to test measurement invariance. RESULTS: The translated Sinhala version demonstrated good content and face validity. Internal consistency reliability of the five items had a Cronbach's alpha of 0.85 and test-retest reliability over 2 weeks was satisfactory (Pearson r = 0.72, p < 0.001, ICC = 0.82). Confirmatory factor analysis supported factorial validity with a [Formula: see text] =4.99 (p = 0.28), a RMSEA of 0.03 (90% C.I. =0.00-0.10), a SRMR of 0.02, a TLI of 0.99 and a CFI of 0.99; factor loadings were between 0.55 and 0.89. Measurement invariance was acceptable for configural, metric and scalar invariance for gender. WHO-5 scores were significantly negatively correlated with the Patient Health Questionnaire (PHQ-9) (Pearson's r = - 0.45, p < 0.001) scores and the Kessler Psychological Distress Scale (K10) scores (Pearson's r = - 0.56, p < 0.001). CONCLUSION: The Sinhala translation of WHO-5 well-being index has shown acceptable psychometric properties and can be used for assessing mental well-being in the community in Sri Lanka. Further testing of the measure with larger and diverse (including different ethnic/cultural) groups are indicated to test measurement invariance of the measure.

A pilot randomised trial comparing a mindfulness-based stress reduction course, a locally-developed stress reduction intervention and a waiting list control group in a real-life municipal health care setting.

BACKGROUND: The purpose of the present study was to conduct a pilot randomised controlled trial (RCT) to lend support to a larger effectiveness RCT comparing Mindfulness-Based Stress Reduction (MBSR), a locally-developed stress reduction intervention (LSR) and a waiting list control group in a Danish municipal health care center setting. METHODS: A three-armed parallel pilot RCT was conducted among 71 adults who contacted a Danish municipal health care center due to stress-related problems. Recruitment was made between January and April 2018 and followed usual procedures. EXCLUSION CRITERIA: 1) acute treatment-demanding clinical depression or diagnosis of psychosis or schizophrenia, 2) abuse of alcohol, drugs, medicine, 3) pregnancy. Randomisation was performed by an independent data manager using the REDCap electronic data capture tool. The primary outcome was a description of RCT feasibility (recruitment and retention rates regarding intervention participation and 12-week follow-up). Secondary outcomes were completion rates regarding questionnaire data and proposed effect-estimates of outcome measures considered to be used in the following real RCT. Type of intervention and outcome assessment were not blinded. RESULTS: We recruited 71 of 129 eligible individuals from the target population (55, 95%CI: 46-64). Forty-two (59%) were females. Median age: 44 years (1-quartile:34, 3-quartile:50). Twenty-nine (41%) had < 16 years of education. Forty-eight (68%) were employed; 30 of these 48 (63%) were on sick leave. Mean scores for perceived stress (PSS): 25.4 ± 5.3; symptoms of anxiety and depression (SCL-5): 2.9 ± 0.6, and well-being (WHO-5): 31.7 ± 8.5 indicated a need for intervention. 16/24 (67, 95%CI: 45 to 84) who were allocated to MBSR and 17/23 (74, 95%CI: 52 to 90) who were allocated to LSR participated in ≥5 sessions. The loss to follow-up at 12 weeks: MBSR: 5 (21% (95% CI: 7 to 42), LSR: 5 (22% (95% CI: 7 to 44) and waiting list: 4 (17% (95% CI: 5 to 37). This was acceptable and evenly distributed. The results indicated MBSR to be superior. CONCLUSIONS: An RCT assessing the effectiveness of stress reduction interventions in a real-life municipal health care setting is feasible among adults with a clear need for stress reduction interventions based on scores on mental health. TRIAL REGISTRATION: ClinicalTrials.gov. Identifier: NCT03663244. Registered September 10, 2018.

Psychometric properties of the Five-item World Health Organization Well-being Index used in mental health services: Protocol for a systematic review.

AIMS: To synthesize evidence of the psychometric properties of the Five-item World Health Organization Well-being Index in mental health settings and critically appraise the methodologies of the included studies. DESIGN: Protocol for a systematic psychometric review. METHODS: The review protocol has been registered in the International Prospective Register for Systematic Reviews. The bibliographic databases MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Library, and Web of Science will be searched for relevant studies. The psychometric properties of each study will be evaluated according to the Consensus-based Standards for the Selection of Health Measurements Instruments. DISCUSSION: The results of our psychometric review will synthesize the psychometric properties of the Five-item World Health Organization Well-being Index in mental health settings and identify possible gaps in the literature regarding methodological quality and its reliability, validity, and responsiveness to change. IMPACT: The evaluation of patient well-being is important, and the Five-item World Health Organization Well-being Index is an increasingly used patient-reported outcome measure. It is simple to collect, free to use, and consists of five questions using positive health statements. Although the number of studies assessing the validity, reliability, and responsiveness of the questionnaire is increasing worldwide, there is a need to summarize the existing evidence of the psychometric properties of this questionnaire. The proposed study's findings will contribute to future research recommendations and help midwives and nurses in different settings pick an effective, appropriate questionnaire to evaluate patient well-being.

Progress monitoring and feedback delivered in routine psychiatric care: Beneficial but not reaching those thought to need it most.

Objective: The study evaluated the use and effectiveness of a progress monitoring system routinely operational in a private mental health care setting. Method: In a nonrandomized trial in which 778 consecutively admitted patients underwent a 2-week cognitive behavioral therapy intervention, the effectiveness of therapists choosing to use progress monitoring feedback to frame therapist-patient discussions about individuals' progress was evaluated. Results: Patients engaged in discussions involving progress monitoring feedback during the intervention achieved a more consistent recovery rate. Furthermore, individuals that were not-on-track to achieve a positive outcome experienced a boost to recovery immediately after receiving feedback. However, evidence suggested that therapists were not using progress monitoring to primarily focus additional resources on not-on-track patients. Conclusion: Progress monitoring feedback benefited patient recovery. However, guidelines could improve the system by directing therapists to use feedback primarily with patients not on course for a positive therapeutic outcome.

[Depressive symptoms in early rheumatoid arthritis : Within the rheumatism network ADAPTHERA]. / Depressive Symptomatik bei früher rheumatoider Arthritis : Innerhalb des Rheumanetzwerks ADAPTHERA.

BACKGROUND AND OBJECTIVE: For patients with established rheumatoid arthritis and also early arthritis an increased prevalence of depression has been described. For a better understanding of depression in early arthritis patients, depression prevalences of a German early arthritis cohort were examined, with a focus on disease activity, anti-CCP status, disease duration and functional capacity over a period of 2 years. MATERIAL AND METHODS: The evaluation was based on the early arthritis cohort ADAPTHERA from Rhineland-Palatinate. The inclusion criterion was a symptom duration before diagnosis of a maximum of 1 year. Data from the disease activity score 28 (DAS28), the Health Assessment Questionnaire (HAQ, functional status), the WHO-5 Well-Being Index (WHO-5, well-being and depressive symptoms) and the Patient Health Questionnaire-9 (PHQ-9, depressive symptoms) were collected. RESULTS: At the beginning, 43.5% of patients had depressive symptoms (WHO-5 > 28). After the 2 year follow-up the percentage of patients with depressive symptoms had reduced to 20.8%. Correlations with disease activity according to DAS28 and the function of HAQ could be confirmed. There was no correlation between depressive symptoms and anti-CCP status (p = 0.431) or duration from symptom onset to diagnosis (p = 0.671). CONCLUSION: Screening of early arthritis patients for the presence of depressive symptoms is of essential importance. Patients seem to be at high risk of developing depressive symptoms especially at the beginning of the disease and when showing high disability and poor results on disease activity score (DAS28 and visual analog scale).

The Reliable Change Index (RCI) of the WHO-5 in primary prevention of mental disorders. A measurement-based pilot study in positive psychiatry.

INTRODUCTION: Primary prevention of mental disorders is a major issue in positive psychiatry. Adjustment disorder is one of the very few discrete mental disorders linked to an etiological factor, namely psychosocial stressors given rise to a maladaptive reaction with a course of symptoms vanishing with the removal of the stressor. We have focused on a measurement-based method to prevent the development of an adjustment disorder. AIM: The aim of this study has been to analyze from an ongoing Worklife Barometer Survey in which the World Health Organization Well-Being Scale (WHO-5) has been applied to prevent distress leading to an adjustment disorder. METHODS: Persons identified with a decrease of 15 points in their repeatedly WHO-5 ratings over three months were through a brief psychological intervention by experienced psychologists. The Reliable Change Index (RCI) was used to determine the clinically meaningful change in the WHO-5 ratings. RESULTS: Within the group who received the psychological intervention (N = 1338), 35% of the persons were identified by the RCI analysis to have developed a clinically reliable change in the WHO-5 at the time of the intervention. The remaining 65% of the persons obtained changes in the WHO-5 which might be considered as spontaneous fluctuations. In the month after the intervention, the persons with a clinically reliable change in the WHO-5 were restored. CONCLUSION: In this measurement-based pilot study, the repeatedly WHO-5 ratings identified a group of persons with a clinically reliable change in WHO-5 and a clinically significant improvement after a brief psychological intervention.

Prevalence of depression, quality of life and antidepressant treatment in the Danish General Suburban Population Study.

BACKGROUND: The Danish General Suburban Population Study (GESUS), the objective of which is to facilitate epidemiological and genetic research, has included the Major Depression Inventory (MDI) and the WHO-Five Well-Being Index (WHO-5) among the medical health questionnaires. We were thus in a position to compare the 2-week prevalence of ICD-10 depression in the period from 2010 to 2012 with our previous Danish general population study from 2003, in which the MDI was also included. AIMS: The aim of our analysis was not only to evaluate the point prevalence of ICD-10 depression but also to describe the prevalence of antidepressants received by the respondents in the GESUS study and the correspondence to their subjective well-being on the WHO-5 questionnaire. METHODS: To evaluate the validity (scalability) of the MDI and the WHO-5 in the GESUS study we performed the non-parametric Mokken analysis. The scalability of the MDI and the WHO-5 was quite acceptable. RESULTS: In total, 14,787 respondents were available from a response rate of 50%. The 2-week prevalence of ICD-10 depression was 2.3%, which is rather similar to the 2.8% in our 2003 study. The rate of people receiving antidepressants increased consistently with increasing severity of ICD-10 depression. CONCLUSION: This study has confirmed that the use of the MDI to obtain an ICD-10 depression diagnosis gives rather conservative estimates of the 2-week prevalence of depression in the Danish general population. The prescription of antidepressants depends on the severity of the ICD-10 depression diagnosis.

A psychometric evaluation of the Icelandic version of the WHO-5.

The psychometric properties of the Icelandic version of the World Health Organization five wellbeing index (WHO-5) were evaluated using two samples, a randomly selected sample (N = 3,896) from the Icelandic National Registry and a convenience sample of primary care patients (N = 126). The factor structure of the scale was tested with confirmatory factor analysis (CFA). The correlation between the WHO-5 and other measures of depression and anxiety were calculated to assess the scale's convergent and divergent validity. The discriminant validity of the WHO-5 was explored with a receiver operating analysis compared to the Mini International Neuropsychiatric Interview. The CFA indicated that the factor structure of the WHO-5 was one-dimensional and factorial invariant between groups. The internal reliability of the WHO-5 was adequate and the convergent, divergent and discriminant validity of the WHO-5 was supported. It is concluded that the psychometric properties of the Icelandic version of the WHO-5 are satisfactory.

Comparison of health-related quality-of-life measurement instruments in diabetic patients.

The objective of the study was to compare three different questionnaires (Short Form (SF)-6D, EuroQuol (EQ)-5D and WHO-5) to establish which one is more sensitive and which one gives an adequate assessment of the quality of life in patients with diabetes. In an observational and transversal study with duration of 4 months, in 5 Bulgarian cities, 146 patients were randomly selected. The following quality-of-life measuring instruments were applied: 146 questionnaires SF-6D, 146 questionnaires EQ-5D and 103 questionnaires of WHO-5. Descriptive statistics, chi-Square and correlation coefficients were used for data analysis. The study assessed the quality of life of patients suffering from diabetes mellitus with a mean age of 57.39 years (standard deviation (SD) 17.087); 95% confidence interval (CI) 54.60-60.19; 76% of the patients had diabetes type 2. The patients received a mean SF-6D score of 0.6290, an EQ-5D score of 0.6272, a visual analogue scale score of 0.7158 and a WHO-5 score of 0.4635. Preferences measured by the SF-6D and by the EQ-5D showed significant correlations with one another, and the Pearson coefficient was r = 0.906 (p < 0.01). The most current version of SF-6D, based on the 2002 model, was found to be valid and reliable when compared to the EQ-5D and is a questionnaire alternative to assess preferences in economic analysis carried out in health care.