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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.
The Chengdu Plain is an agroecosystem that depends on the Dujiangyan (Capital River Weir) for its functioning. This system has been sustained at high levels of productivity for more than two thousand years, experiencing only a few disturbances that have disrupted its functioning. Integrating field and documentary research on ecological, market, and governance factors, this article discusses the remarkable resilience of this system from the late Qing to the present and identifies current threats to its resilience. When the ecology consists of patchy and diverse landscapes, markets allow for adaptation through exchange, and governance includes cross-cutting sources of authority and flexible property regimes, the ecosystem is more resilient—that is, better able to withstand disturbances and maintain its basic functions.
Anxiety symptoms gradually emerge during childhood and adolescence. Individual differences in behavioral inhibition (BI), an early-childhood temperament, may shape developmental paths through which these symptoms arise. Cross-sectional research suggests that level of early-childhood BI moderates associations between later anxiety symptoms and threat-related amygdala–prefrontal cortex (PFC) circuitry function. However, no study has characterized these associations longitudinally. Here, we tested whether level of early-childhood BI predicts distinct evolving associations between amygdala–PFC function and anxiety symptoms across development.
Eighty-seven children previously assessed for BI level in early childhood provided data at ages 10 and/or 13 years, consisting of assessments of anxiety and an fMRI-based dot-probe task (including threat, happy, and neutral stimuli). Using linear-mixed-effects models, we investigated longitudinal changes in associations between anxiety symptoms and threat-related amygdala–PFC connectivity, as a function of early-childhood BI.
In children with a history of high early-childhood BI, anxiety symptoms became, with age, more negatively associated with right amygdala–left dorsolateral-PFC connectivity when attention was to be maintained on threat. In contrast, with age, low-BI children showed an increasingly positive anxiety–connectivity association during the same task condition. Behaviorally, at age 10, anxiety symptoms did not relate to fluctuations in attention bias (attention bias variability, ABV) in either group; by age 13, low-BI children showed a negative anxiety–ABV association, whereas high-BI children showed a positive anxiety–ABV association.
Early-childhood BI levels predict distinct neurodevelopmental pathways to pediatric anxiety symptoms. These pathways involve distinct relations among brain function, behavior, and anxiety symptoms, which may inform diagnosis and treatment.
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.
Shallow ice cores were obtained from widely distributed sites across the West Antarctic ice sheet, as part of the United States portion of the International Trans-Antarctic Scientific Expedition (US ITASE) program. The US ITASE cores have been dated by annual-layer counting, primarily through the identification of summer peaks in non-sea-salt sulfate (nssSO42–) concentration. Absolute dating accuracy of better than 2 years and relative dating accuracy better than 1 year is demonstrated by the identification of multiple volcanic marker horizons in each of the cores, Tambora, Indonesia (1815), being the most prominent. Independent validation is provided by the tracing of isochronal layers from site to site using high-frequency ice-penetrating radar observations, and by the timing of mid-winter warming events in stable-isotope ratios, which demonstrate significantly better than 1 year accuracy in the last 20 years. Dating precision to ±1 month is demonstrated by the occurrence of summer nitrate peaks and stable-isotope ratios in phase with nssSO42–, and winter-time sea-salt peaks out of phase, with phase variation of <1 month. Dating precision and accuracy are uniform with depth, for at least the last 100 years.
In the early nineteenth century, a vocal minority of Britons, East Indians, and elite Indians educated in English publically asserted a novel “Indian” culture in favor of free trade, greater autonomy from London, liberty of the press, and polyglot education. The period under consideration overlapped with the early years of the so-called Bengal Renaissance and saw protonationalist articulations of self-determination for Indian governance and culture emerging from several new circumstances: James Silk Buckingham's journalistic critiques of company (mis)rule; Rammohun Roy's cosmopolitan agendas for religious and educational reform; Henry Derozio's and Kasiprasad Ghosh's bardic poetry; the rise of the “Young Bengal” movement as a result of both Derozio's teaching at the Hindu College as well as friction among various Hindu factions; and the proliferation of poetry published by anonymous men and women in the newspapers, weeklies, monthlies, quarterlies, and annuals of the day. The subject of the present chapter lies in an underexplored aspect of this last cultural arena – in the comic, often satiric, and usually self-consciously bad poetry that filled the pages of the India Gazette newspaper and other periodicals and that constituted a large bulk of Indian poetry in English. Without making claims for the quality of much of this verse – in many instances, its badness is part of its point – I will consider the aesthetics and politics of “light reading” in the periodical press as part of a distinctively local and Whiggish modernity, as a critical and satirical spirit relatively unmoored from metropolitan authority and open to unknown political and social futures.
Before we turn to the poetry printed in the biweekly India Gazette in the 1820s, a brief overview of the periodical press will be helpful. From the turn of the century until 1818, the press had been strictly censored in accordance with Governor General Richard Wellesley's Regulations for the Control and Guidance of Newspapers (1799), according to which every printer was required to print his name at the bottom of the newspaper, every editor and proprietor of a newspaper needed to register his name and address with the Chief Secretary of the Government, and no paper was to be published at all until it had been inspected by the Chief Secretary or his proxy, with the sole and harsh “penalty for offending against any of” these regulations “to be immediate embarkation for Europe.
Between 30 and 60% of adults with unipolar or bipolar disorders exhibit
impairments across multiple domains. However, little is known about
impaired functioning in youth with mood disorders.
To examine the prevalence of objective, subjective and observer-rated
disability in a large, representative sample of young people with a
primary mood disorder.
Individuals aged 16–25 years presenting to youth mental health services
for the first time with a primary mood disorder participated in a
systematic diagnostic and clinical assessment. Impairment was assessed
using objective (unemployment or disability payments), observer- (Social
and Occupational Functioning Assessment Scale; SOFAS) and self-rated
measures (role functioning according to the Brief Disability
Of 1241 participants (83% unipolar; 56% female), at least 30% were
functionally impaired on the objective, self-rated and/or observer-rated
measures, with 16% impaired according to all three criteria. Even when
current distress levels were taken into account, daily use of cannabis
and/or nicotine were significantly associated with impairment, with odds
ratios (OR) ranging from about 1.5 to 3.0. Comorbid anxiety disorders
were related to lower SOFAS scores (OR = 2–5).
Levels of disability were significant, even in those presenting for
mental healthcare for the first time. Functional impairment did not
differ between unipolar and bipolar cases, but some evidence suggested
that females with bipolar disorder were particularly disabled. The
prevalence of comorbid disorders (50%) and polysubstance use (28%) and
their association with disability indicate that more meaningful
indicators of mood episode outcomes should focus on functional rather
than symptom-specific measures. The association between functioning and
nicotine use requires further exploration.
Britain's geographical status has fluctuated between an island and a peninsula of Europe several times over the past 500 kya, as sea-levels rose and fell in response to global climate change. In this paper, we outline the currently available lithological and biological evidence for these fluctuations and use it to help construct an heuristic biogeographical framework of human colonisation, settlement, and abandonment, proposing mechanisms that are coupled with both regional palaeogeographical evolution and global climatic change. When used as a means of interpreting the archaeological record, the implications of this framework suggests not only that large-scale socio-culturally relevant patterns may indeed exist in the lithic record, but that these may possibly be understood as part of the ebb and flow of different regional populations, measured against the backdrop of changing climates and landscapes. It is suggested that the Clactonian and Acheulean may represent separate pulses of colonisation, possibly by different European populations, following abandonment during the height of glacial periods: the Clactonian reflecting an early recolonisation event during climatic amelioration, the Acheulean representing a second wave during the main interglacial. This phenomenon is recurrent, being observable during the first two post-Anglian inter glacials. Other patterns in the lithic record are argued to reflect specific endemic technological developments among insular hominid populations during periods of isolation from mainland Europe. These represent some of the few patterns in the British Acheulean that cannot be interpreted more parsimoniously in terms of raw materials.
In late February and early March 2002, an archaeological watching brief at Lynford Quarry, Mundford, Norfolk revealed a palaeochannel with a dark organic fill containing in situ mammoth remains and associated Mousterian stone tools and debitage buried under 2–3 m of bedded sands and gravels. Well-preserved in situ Middle Palaeolithic open air sites are very unusal in Europe and exceedingly rare within a British context. As such, the site was identified as being of national and international importance, and was subsequently excavated by the Norfolk Archaeological Unit with funding provided by English Heritage through the Aggregates Levy Sustainability Fund.
This report presents some of the initial results of the excavation. It sets out how the site was excavated, outlines the stratigraphic sequence for the site, and presents some provisional findings of the excavation based on the results of the assessment work carried out by project specialists and Norfolk Archaeological Unit staff.
Agomelatine is a new antidepressant, licensed for the treatment of unipolar major depression, with a mode of action that combines activation of melatonin receptors with blockade of 5-HT2C receptors. Agomelatine is notable for its short duration of action in the body and modest side-effect burden; however, a number of theoretical and practical challenges have limited its adoption into mainstream treatment in the UK. Current meta-analyses show marginal clinical benefits of agomelatine relative to placebo and an association with occasional increases in liver transaminases. Theoretically it is not clear whether agomelatine does block brain 5-HT2C receptors in humans at therapeutic doses and the optimum daily timing of administration in depression has not been clearly established. However, agomelatine's novel mode of action justifies further study, perhaps with the eventual aim of matching its use in depression to patients with specific disturbances in circadian rhythm.
To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.
Information about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.
Infants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.
Daily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.
Most of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.