Psychometric evaluation of the Hospital Anxiety and Depression Scale in Mexican adults with ischemic and hypertensive cardiomyopathy.

Background: Depression and anxiety are frequent comorbid conditions in cardiovascular diseases (CVDs); they are related to poor prognosis and higher mortality risk. Health providers need a clinical tool to identify these psychiatric conditions. The 14-item hospital anxiety and depression scale (HADS) is a screening tool used in patients with different medical conditions. Objective: The aim of this study was to evaluate the psychometric properties of the HADS Mexican Spanish version in a broad sample of Mexican patients with CVDs. Materials and Methods: A total of 953 individuals between 18 and 75 years old with ischemic or hypertensive cardiomyopathy were screened with the HADS Mexican Spanish version. Construct validity, internal consistency, and congruence coefficients of the scale were obtained. Results: The results showed two clear factors which correspond to the original two designated domains of the HADS, anxiety, and depression, with adequate reliability values (alpha > 0.80) and high congruence coefficients (> 0.90) when compared to the sample of other validation studies of the HADS. Conclusions: The present study adds evidence of the validity and reliability of the HADS to assess the presence of both depression and anxiety in Mexican patients with CVD. Its central contribution is that it demonstrates its capacity to differentiate the presence and severity of depression and anxiety in this population.

Antecedentes: La depresión y la ansiedad son afecciones comórbidas frecuentes en las enfermedades cardiovasculares; se relacionan con mal pronóstico y mayor riesgo de mortalidad. Los proveedores de salud requieren de una herramienta clínica para identificar estas condiciones psiquiátricas. La Escala de Ansiedad y Depresión Hospitalaria de 14 ítems (HADS) es una herramienta de detección utilizada en pacientes con diferentes afecciones médicas. Objetivo: Evaluar las ­propiedades psicométricas de la versión mexicana-española de la HADS en una amplia muestra de pacientes mexicanos con enfermedades cardiovasculares (ECV). Método: Un total de 953 individuos entre 18 y 75 años de edad con cardiomiopatía isquémica o hipertensiva se examinaron con la versión Mexicana en español de la HADS. Se obtuvieron la validez de constructo, la consistencia interna y los coeficientes de congruencia de la escala. Resultados: Los resultados mostraron dos factores que corresponden a los dos dominios designados originales de la HADS, ansiedad y depresión, con valores de confiabilidad adecuados (alfa > 0.80) y altos coeficientes de congruencia (> 0.90) en comparación con la muestra de otros estudios de validación de la HADS. Conclusiones: El presente estudio sustenta la validez y confiabilidad de la HADS para evaluar la presencia de depresión y ansiedad en pacientes Mexicanos con ECV. Su contribución central es su capacidad para diferenciar la presencia y la gravedad de la depresión y la ansiedad en esta población.

Professional Adversities and Protective Factors Associated with Suicidal Ideation in Mexican Psychiatrists.

BACKGROUND: Psychiatrists may be at an increased risk of suicide, since they encounter stressful factors in their everyday activities in addition to the sociodemographic factors for suicidal ideation reported for Mexican population. AIM OF THE STUDY: To determine whether experiences inherent to the profession were related to the self-report of suicidal ideation among Mexican psychiatrists or could be attributed to factors previously reported in the general population (age, marital status, presence of a mental disorder and not having received specialized treatment). METHODS: This was a cross-sectional retrospective study with 288 psychiatrists from Mexico who participated through an online survey where current working activities, self-reported mental health conditions (major depression, anxiety, burnout and suicidal ideation) and professional adversities (assaults, lawsuits, patients with suicidal ideation or who had committed suicide, perceived discrimination and social support) throughout the professional lifespan were evaluated. RESULTS: Twenty-two psychiatrists (7.6%) reported having had suicidal ideation at some point in their training in psychiatry or their professional lives as psychiatrists. Depression and burnout were the most important predictors for suicidal ideation while greater satisfaction with social support was the most important protector, followed by being married/living together and having other physicians in the family. CONCLUSIONS: Psychiatrist represent a risk population for suicidal ideation. As such, detection and attention are essential. Psychiatrists need to be encouraged to pursue healthy, lasting interpersonal relationships and seek professional help when required.

Psychometric evaluation of the Hospital Anxiety and Depression Scale in Mexican adults with ischemic and hypertensive cardiomyopathy.

Background: Depression and anxiety are frequent comorbid conditions in cardiovascular diseases (CVDs); they are related to poor prognosis and higher mortality risk. Health providers need a clinical tool to identify these psychiatric conditions. The 14-item hospital anxiety and depression scale (HADS) is a screening tool used in patients with different medical conditions. Objective: The aim of this study was to evaluate the psychometric properties of the HADS Mexican Spanish version in a broad sample of Mexican patients with CVDs. Materials and Methods: A total of 953 individuals between 18 and 75 years old with ischemic or hypertensive cardiomyopathy were screened with the HADS Mexican Spanish version. Construct validity, internal consistency, and congruence coefficients of the scale were obtained. Results: The results showed two clear factors which correspond to the original two designated domains of the HADS, anxiety, and depression, with adequate reliability values (alpha > 0.80) and high congruence coefficients (> 0.90) when compared to the sample of other validation studies of the HADS. Conclusions: The present study adds evidence of the validity and reliability of the HADS to assess the presence of both depression and anxiety in Mexican patients with CVD. Its central contribution is that it demonstrates its capacity to differentiate the presence and severity of depression and anxiety in this population.

Antecedentes: La depresión y la ansiedad son afecciones comórbidas frecuentes en las enfermedades cardiovasculares; se relacionan con mal pronóstico y mayor riesgo de mortalidad. Los proveedores de salud requieren de una herramienta clínica para identificar estas condiciones psiquiátricas. La Escala de Ansiedad y Depresión Hospitalaria de 14 ítems (HADS) es una herramienta de detección utilizada en pacientes con diferentes afecciones médicas. Objetivo: Evaluar las propiedades psicométricas de la versión mexicana-española de la HADS en una amplia muestra de pacientes mexicanos con enfermedades cardiovasculares (ECV). Método: Un total de 953 individuos entre 18 y 75 años de edad con cardiomiopatía isquémica o hipertensiva se examinaron con la versión Mexicana en español de la HADS. Se obtuvieron la validez de constructo, la consistencia interna y los coeficientes de congruencia de la escala. Resultados: Los resultados mostraron dos factores que corresponden a los dos dominios designados originales de la HADS, ansiedad y depresión, con valores de confiabilidad adecuados (alfa > 0.80) y altos coeficientes de congruencia (> 0.90) en comparación con la muestra de otros estudios de validación de la HADS. Conclusiones: El presente estudio sustenta la validez y confiabilidad de la HADS para evaluar la presencia de depresión y ansiedad en pacientes Mexicanos con ECV. Su contribución central es su capacidad para diferenciar la presencia y la gravedad de la depresión y la ansiedad en esta población.

Psychometric evaluation of the Hospital Anxiety and Depression Scale in Mexican adults with ischemic and hypertensive cardiomyopathy / Evaluación psicométrica de la Escala de Ansiedad y Depresión Hospitalaria en adultos Mexicanos con cardiopatía isquémica e hipertensiva

Abstract Background: Depression and anxiety are frequent comorbid conditions in cardiovascular diseases (CVDs); they are related to poor prognosis and higher mortality risk. Health providers need a clinical tool to identify these psychiatric conditions. The 14-item hospital anxiety and depression scale (HADS) is a screening tool used in patients with different medical conditions. Objective: The aim of this study was to evaluate the psychometric properties of the HADS Mexican Spanish version in a broad sample of Mexican patients with CVDs. Materials and Methods: A total of 953 individuals between 18 and 75 years old with ischemic or hypertensive cardiomyopathy were screened with the HADS Mexican Spanish version. Construct validity, internal consistency, and congruence coefficients of the scale were obtained. Results: The results showed two clear factors which correspond to the original two designated domains of the HADS, anxiety, and depression, with adequate reliability values (alpha > 0.80) and high congruence coefficients (> 0.90) when compared to the sample of other validation studies of the HADS. Conclusions: The present study adds evidence of the validity and reliability of the HADS to assess the presence of both depression and anxiety in Mexican patients with CVD. Its central contribution is that it demonstrates its capacity to differentiate the presence and severity of depression and anxiety in this population.

Resumen Antecedentes: La depresión y la ansiedad son afecciones comórbidas frecuentes en las enfermedades cardiovasculares; se relacionan con mal pronóstico y mayor riesgo de mortalidad. Los proveedores de salud requieren de una herramienta clínica para identificar estas condiciones psiquiátricas. La Escala de Ansiedad y Depresión Hospitalaria de 14 ítems (HADS) es una herramienta de detección utilizada en pacientes con diferentes afecciones médicas. Objetivo: Evaluar las propiedades psicométricas de la versión mexicana-española de la HADS en una amplia muestra de pacientes mexicanos con enfermedades cardiovasculares (ECV). Método: Un total de 953 individuos entre 18 y 75 años de edad con cardiomiopatía isquémica o hipertensiva se examinaron con la versión Mexicana en español de la HADS. Se obtuvieron la validez de constructo, la consistencia interna y los coeficientes de congruencia de la escala. Resultados: Los resultados mostraron dos factores que corresponden a los dos dominios designados originales de la HADS, ansiedad y depresión, con valores de confiabilidad adecuados (alfa > 0.80) y altos coeficientes de congruencia (> 0.90) en comparación con la muestra de otros estudios de validación de la HADS. Conclusiones: El presente estudio sustenta la validez y confiabilidad de la HADS para evaluar la presencia de depresión y ansiedad en pacientes Mexicanos con ECV. Su contribución central es su capacidad para diferenciar la presencia y la gravedad de la depresión y la ansiedad en esta población.

[A validation of the MOS-HIV quality of life measure in HIV-infected patients in Mexico]. / Validación mexicana de la escala MOS-HIV de calidad de vida en pacientes infectados por el VIH.

OBJECTIVE: To validate the Medical Outcomes Study HIV Health Survey (MOS-HIV) quality of life instrument for its application in clinical research in Mexico. METHODS: The data for this study were collected between April, 2002, and February, 2004. An expert committee combined two Spanish-language translations of the MOS-HIV questionnaire. The new questionnaire's feasibility was assessed in a group of 32 HIV-infected persons by measuring how long they took to complete the questionnaire and the numbers of items they left unanswered. The questionnaire was then applied to a group of 120 HIV-positive patients and to a control group of 102 HIV-negative individuals. The following questionnaire characteristics were evaluated: (1) internal reliability (Cronbach alpha coefficient), (2) discriminant validity (the receiver operating characteristic (ROC) curves derived from the scores of the two groups), and (3) convergent validity (the Spearman correlation coefficients for the scores of the HIV-positive patients on the 11 MOS-HIV dimensions and their scores on the analog visual scale of the European Quality of Life 5-Dimensional format (EQ-5D) questionnaire, a list of symptoms, the viral load, and the CD4 cell count). RESULTS: The mean response time with the questionnaire was 10 minutes and 22 seconds, and the mean number of unanswered items was 0.62. With each of the 11 dimensions of the questionnaire, the Cronbach alpha coefficient was at least 0.75. The mean scores obtained by the two groups were different for 9 of the 11 dimensions, and the 95% confidence intervals of the areas under the ROC curves did not include the value of 0.5 for 8 of the dimensions. The absolute value of the Spearman correlation coefficient was less than 0.3 for the CD4 cell count and for the viral load, and it was greater than 0.3 for each dimension and the scores on the list of symptoms and on the analog visual scale of the EQ-5D questionnaire. CONCLUSIONS: The MOS-HIV measure is valid for use in clinical research among HIV-infected persons in Mexico.

Validación mexicana de la escala MOS-HIV de calidad de vida en pacientes infectados por el VIH / A validation of the MOS-HIV quality of life measure in HIV-infected patients in Mexico

OBJETIVO: Validar la escala de calidad de vida MOS-HIV (Medical Outcomes Study HIV Health Survey) para su aplicación en investigación clínica, en México. MÉTODOS: Los datos para esta validación se recogieron entre abril de 2002 y febrero de 2004. Un comité de expertos realizó una síntesis de dos traducciones al castellano del cuestionario MOS-VIH, cuya factibilidad se valoró midiendo tiempos de respuesta y números de ítems no resueltos en un grupo de 32 personas. Se aplicó el cuestionario a un grupo de pacientes infectados por el virus de la inmunodeficiencia humana (VIH+) y un grupo de referencia. Se evaluaron la consistencia interna (coeficiente a de Cronbach), la validez discriminante (curvas de eficacia diagnóstica -curvas ROC- derivadas de las puntuaciones de los dos grupos) y la validez convergente (coeficiente de correlación de Spearman entre la puntuación del grupo de pacientes VIH+ y las puntuaciones en la escala visual analógica (EVA) del cuestionario EQ-5D y en una lista de síntomas, la carga viral y el recuento de linfocitos T CD4+). RESULTADOS: El tiempo medio de respuesta del cuestionario fue 10 min y 22 s, y el número medio de ítems sin resolver, 0,62. En las 11 dimensiones, el coeficiente a de Cronbach fue mayor de 0,75. Las puntuaciones medias obtenidas por los dos grupos fueron distintas en nueve dimensiones y los intervalos de confianza del 95 por ciento de las áreas bajo las curvas ROC no incluyeron el valor 0,5 en ocho dimensiones. El valor absoluto del coeficiente de correlación de Spearman fue menor de 0,3 respecto del número de linfocitos T CD4+ y de la carga viral, y mayor de 0,3 entre cada dimensión y respecto de las puntuaciones en la lista de síntomas y en la EVA del cuestionario EQ-5D. CONCLUSIONES: La escala MOS-HIV está validada para su uso en investigación, en la población mexicana infectada por el VIH.

OBJECTIVE: To validate the Medical Outcomes Study HIV Health Survey (MOS-HIV) quality of life instrument for its application in clinical research in Mexico. METHODS: The data for this study were collected between April, 2002, and February, 2004. An expert committee combined two Spanish-language translations of the MOS-HIV questionnaire. The new questionnaire's feasibility was assessed in a group of 32 HIV-infected persons by measuring how long they took to complete the questionnaire and the numbers of items they left unanswered. The questionnaire was then applied to a group of 120 HIV-positive patients and to a control group of 102 HIV-negative individuals. The following questionnaire characteristics were evaluated: (1) internal reliability (Cronbach alpha coefficient), (2) discriminant validity (the receiver operating characteristic (ROC) curves derived from the scores of the two groups), and (3) convergent validity (the Spearman correlation coefficients for the scores of the HIV-positive patients on the 11 MOS-HIV dimensions and their scores on the analog visual scale of the European Quality of Life 5-Dimensional format (EQ-5D) questionnaire, a list of symptoms, the viral load, and the CD4 cell count). RESULTS: The mean response time with the questionnaire was 10 minutes and 22 seconds, and the mean number of unanswered items was 0.62. With each of the 11 dimensions of the questionnaire, the Cronbach alpha coefficient was at least 0.75. The mean scores obtained by the two groups were different for 9 of the 11 dimensions, and the 95 percent confidence intervals of the areas under the ROC curves did not include the value of 0.5 for 8 of the dimensions. The absolute value of the Spearman correlation coefficient was less than 0.3 for the CD4 cell count and for the viral load, and it was greater than 0.3 for each dimension and the scores on the list of symptoms and on the analog visual scale of the EQ-5D questionnaire. CONCLUSIONS: The MOS-HIV measure is valid for use in clinical research among HIV-infected persons in Mexico.