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Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
Rural and remote regions tend to be characterised by poorer socioeconomic conditions than urban areas, yet findings regarding differences in mental health between rural and urban areas have been inconsistent. This suggests that other features of these areas may reduce the impact of hardship on mental health. Little research has explored the relationship of financial hardship or deprivation with mental health across geographical areas.
Data were analysed from a large longitudinal Australian study of the mental health of individuals living in regional and remote communities. Financial hardship was measured using items from previous Australian national population research, along with measures of psychological distress (Kessler-10), social networks/support and community characteristics/locality, including rurality/remoteness (inner regional; outer regional; remote/very remote). Multilevel logistic regression modelling was used to examine the relationship between hardship, locality and distress. Supplementary analysis was undertaken using Australian Household, Income and Labour Dynamics in Australia (HILDA) Survey data.
2161 respondents from the Australian Rural Mental Health Study (1879 households) completed a baseline survey with 26% from remote or very remote regions. A significant association was detected between the number of hardship items and psychological distress in regional areas. Living in a remote location was associated with a lower number of hardships, lower risk of any hardship and lower risk of reporting three of the seven individual hardship items. Increasing hardship was associated with no change in distress for those living in remote areas. Respondents from remote areas were more likely to report seeking help from welfare organisations than regional residents. Findings were confirmed with sensitivity tests, including replication with HILDA data, the use of alternative measures of socioeconomic circumstances and the application of different analytic methods.
Using a conventional and nationally used measure of financial hardship, people residing in the most remote regions reported fewer hardships than other rural residents. In contrast to other rural residents, and national population data, there was no association between such hardship and mental health among residents in remote areas. The findings suggest the need to reconsider the experience of financial hardship across localities and possible protective factors within remote regions that may mitigate the psychological impact of such hardship.
In this study, we describe the monitoring of young broiler chicken vocalisation, with sound recorded and assessed at regular intervals throughout the life of the birds from day 1 to day 38, with a focus on the first week of life. We assess whether there are recognisable, and even predictable, vocalisation patterns based on frequency and sound spectrum analysis, which can be observed in birds at different ages and stages of growth within the relatively short life of the birds in commercial broiler production cycles. The experimental trials were carried out in a farm where the broiler where reared indoor, and audio recording procedures carried out over 38 days. The recordings were made using two microphones connected to a digital recorder, and the sonic data was collected in situations without disturbance of the animals beyond that created by the routine activities of the farmer. Digital files of 1 h duration were cut into short files of 10 min duration, and these sound recordings were analysed and labelled using audio analysis software. Analysis of these short sound files showed that the key vocalisation frequency and patterns changed in relation to increasing age and the weight of the broilers. Statistical analysis showed a significant correlation (P<0.001) between the frequency of vocalisation and the age of the birds. Based on the identification of specific frequencies of the sounds emitted, in relation to age and weight, it is proposed that there is potential for audio monitoring and comparison with ‘anticipated’ sound patterns to be used to evaluate the status of farmed broiler chicken.
Schistosomiasis is the generic name given to diseases caused by parasitic blood flukes of the genus Schistosoma. An older name, still widely used in Africa, is bilharzia. Of the three major species that commonly infect humans, two occur predominantly in Africa:
S. mansoni, a cause of intestinal schistosomiasis, also found in Brazil and the Caribbean; and
S. haematobium, the cause of urinary schistosomiasis, also found in the Middle East.
The third major species, S. japonicum, causes another form of intestinal schistosomiasis but is found only in the Far East. A minor species, S. intercalatum, causes infection but insignificant disease in small areas of Central Africa.
Schistosomiasis is typically a chronic infection. Adult worms slowly accumulate from early childhood over a period of 10 to 20 years, and the deposition of eggs in the tissues leads to fibrosis in the intestines and liver (S. mansoni) or the urinary tract (S. haematobium). Mild or moderate symptoms occur in most infected children: severe disease develops in later life in only a minority of these individuals. For detailed reviews of different aspects, the reader is referred to books edited by Jordan et al. (1993) and Mahmoud (2001).
Background. Jacobs and Bovasso reported (Psychological Medicine 2000, 30, 669–678) that maternal death in childhood and chronic severe depression in adulthood were associated with subsequent breast cancer. We have examined the effects of parental loss in childhood and psychiatric disorder in adult life on breast cancer risk using a national birth cohort study.
Method. Eighty-three cases of breast cancer were diagnosed in a study of 2253 women followed from birth to age 59 years. Cox proportional hazards models were used to test whether breast cancer rates were higher in women who experienced parental death and divorce before age 16, psychiatric disorders between 15 and 32 years, symptoms of anxiety and depression at 36 years, or use of antidepressant medication at 31 or 36 years than in women who did not have these experiences.
Results. There was no overall association between parental death, parental divorce or psychiatric disorder and the incidence of breast cancer. There was some evidence that women with more severe psychiatric disorders between the ages of 15 and 32 years were more likely to develop breast cancer early. The interaction between parental divorce and severe psychiatric disorder was non-significant (p=0·1); however, the group who experienced both these events had an increased breast cancer risk compared with those who experienced neither [hazard ratio (HR) 2·64, 95% confidence interval (CI) 1·13–6·19].
Conclusions. Our study does not provide strong support for the hypothesis that early loss or adult psychiatric disorders are associated with breast cancer. A meta-analysis is needed that uses data from all available cohort studies and investigates possible interactive effects on breast cancer risk.
No one within the tradition of medieval Islamic political philosophy contests the notion that human beings are political by nature. Indeed, in a now famous passage of his Muqaddima, Ibn Khald un (1332-1406) cites a corollary of that adage - namely, “human social organization is necessary” - with approval, using it to focus on what the philosophers mean by “regime” (siyāsa), especially “political regime.” As contrasted to the way the term is understood by the jurists and theologians, the philosophers understand the “political regime” to encompass
what is incumbent upon each of the inhabitants of the social organization with respect to his soul and moral habits so that they may entirely dispense with judges. They call the social organization that obtains what is required “the virtuous city” and the rules observed with respect to that “the political regime.” They are not intent upon the regime that the inhabitants of the community set down through statutes for the common interests, for this is something else. This virtuous city is rare according to them and unlikely to occur. They speak about it only as a postulate and an assumption.'
Genetic variation within 34 Pythium irregulare isolates was analyzed using restriction fragment length polymorphisms (RFLPs) as
genetic markers. Most isolates had two alleles at several codominant RFLP loci and were scored as heterozygous. Heterozygotes
were detected in F1 progeny from an in vitro cross and segregation ratios of the F2 progeny were not significantly different from
those expected for allelic variation in a diploid. This confirmed that outcrossing occurs and contributes to genetic variation within
the species. Phenetic analysis showed that isolates formed genetically related groups due to their host species and not due to
similarities in their geographical origins. All isolates originating from medic formed a discrete group and were highly differentiated
from the cereal and sub-clover isolates. The allelic distributions between isolates from these host-groups were significantly different.
Most isolates also showed significant differences in their pathogenicity between hosts, indicating that they varied in pathogenic
fitness and were better adapted to parasitising some hosts relative to others. These isolates were however, not necessarily more
pathogenic on their host of origin. This research provided estimates of the extent of genetic and pathogenic diversity within P.
irregulare and qualitative evidence for the occurrence of host-mediated selection and sexual outcrossing in the field.
In a fishing community on Lake Albert in Uganda the pattern of
intensity of Schistosoma mansoni infection 6 months after
treatment with praziquantel was found to be very similar to reinfection
patterns seen in previously studied endemic
communities: the profile peaks sharply at around the age of 10 years falling
away rapidly to much lower levels in adults.
This is in stark contrast to the patterns of water contact, which differ
greatly between fishing and non-fishing communities.
On Lake Albert, adults appear to be more heavily exposed than children.
From these observations we conclude that adults
are physiologically (perhaps immunologically) more resistant to infection
after treatment than children.
The relocation of several thousand members of the Kamba tribe from
the Kyulu Hills to the Thange valley near
Masongaleni in Kenya provides an excellent opportunity to study the
development of the immune response to schistosomiasis mansoni in a
population with little or no previous experience
of the infection. An adjacent, well-established
Kamba community with similar patterns of water contact provides a
suitable endemic control population. The immigrants
were, uniquely, examined shortly after their arrival in the endemic
area, while the prevalence of infection was still low.
At this time faecal egg counts peaked atypically around 30 years of
age. Over the next 12–18 months infection increased
rapidly, especially among teenagers, producing a pattern of infection
more typical of endemic communities. This
substantially narrows estimates of the time required to develop the
important determinants of the age–intensity profile,
supporting the notion that changes related to age per se,
rather than duration of infection, dominate. Age-dependent factors
might include behaviour or physiology, including immune response.
This paper provides the background for continuing
longitudinal studies on the development of immunological responses to this
We have investigated the effects of host age and sex on human antibody
isotype responses to Schistosoma mansoni and
Schistosoma japonicum adult worm (AW) and soluble egg (SEA) antigens,
using sera from subjects in Kenya and the
Philippines. Similar trends with age were observed between the two populations
despite host, parasite and environmental
differences between the two geographical locations. IgE to AW increased
whereas most isotype responses to SEA
decreased with age. IgG1, IgG3 and IgG4
subclass responses to adult worm, however, did not show a broadly rising
falling pattern with age. Males were found to have higher IgG1,
IgG4 and IgE to AW in both populations. This sex
difference remained significant in the Kenyan population even after controlling
statistically for confounding factors such
as age and differences in intensity of infection. Analysis of
S. mansoni and S. japonicum adult worm antigens reactive
IgE revealed a predominant 22 kDa band in both parasites. Only those individuals
with relatively high IgE titres
specifically reactive with S. mansoni or S. japonicum
AW had detectable IgE against Sj22 or Sm22.