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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.
A sub-sea permafrost drilling program was conducted near Prudhoe Bay, Alaska. Sub-sea permafrost was found at all offshore drill sites and was characterized as being ice bonded or unbonded. The unbonded sub-sea permafrost occurred in a thin layer at the sea bed; the near-shore thickness of this layer appears to be controlled by the bathymetry. The mean annual sea-bed temperatures were about —3.4°C at 203 m offshore, — 1.1°C at 481 m offshore and —0.7°C at 3370 m offshore. The thermal diffusivity was about 21 m2 a-1 for unbonded sandy gravel with silt. The sub-sea permafrost soils were sandy gravel with some silt overlain by a thin layer of silty sand which increased in thickness from a few meters near shore to about 14 m at 3370 m offshore. A few small ice lenses were found in a hole 195 m offshore but no massive ice was observed. Pore-water salt concentrations at the sea bed were 3-4 times that of normal sea-water where ice was frozen to the sea bed and 1–2 times that of normal sea-water otherwise. Preliminary laboratory experiments showed that the saturated hydraulic conductivity of the unbonded sub-sea permafrost was about 10–6–10–7 m s–1. The permeability of the subterranean permafrost was zero.
In the original publication of this article, the title was printed as “Four Preceramic Points Newly Discovered in Belize: A Comment on Stemp et al. (1996:279–299).” The article has been updated to the correct title. The authors apologize for this error.
Stemp et al. (2016) published data on 81 preceramic (Archaic) points from Belize, Central America. In this comment, we report four more chipped chert bifaces recently recovered in Belize (Figure 1). Based on metrics (Table 1), technology, and style, three are classified as Lowe and one as a Sawmill point (Kelly 1993; Lohse et al. 2006; Stemp et al. 2016).
Microscopic and textural observations were made on ice samples cored from Blue Glacier slightly below the equilibrium line to depths of 60 m. Observations were started within a few minutes after collection. Water was found in veins along three-grain intersections, in lenses on grain boundaries and in irregular shapes. Gas was found in bubbles in the interior of crystals, in bubbles touching veins, and locally in veins. Vein sizes showed some spread; average cross-sectional area was about 7 × 10−4 mm2 with no discernible, trend with texture or depth except within 7 m of the surface. Before the samples were examined they could have experienced a complex relaxation which could have changed them significantly. As a result it is not possible to determine the in situ size of veins, but an upper limit can be determined. Also it is not possible to predict intergranular water flux per unit area, but 1 × 10−1 m a−1 represents an upper limit. In coarse-grained ice the water flux density is likely to be even smaller, because of a low density of veins, and blocking by bubbles. This indicates that only a very small fraction of the melt-water production on a typical summer day can penetrate into the glacier on an intergranular scale except possibly near the surface. The existence of conduit-like features in several cores suggests that much melt water can nevertheless penetrate the ice locally without large-scale lateral movements along the glacier surface. The observed profile of ice temperature indicates that the intergranular water flux may be much smaller than the upper limit determined from the core samples.
Black Rapids Glacier is a 40 km long surge-type glacier in the central Alaska Range. In spring 1997 a wireline drill rig was set up at a location where the measured surface velocities are high and seasonal and annual velocity variations are large. The drilling revealed a layer of subglacial “till”, up to 7 m thick, that is believed to be water-saturated. At one location a string of instruments, containing three dual-axis tiltmeters and one piezometer, was successfully introduced into the till. The tiltmeters monitored the inclination of the borehole at the ice–till interface and at 1 and 2 m into the till, for 410 days. They showed that no significant deformation occurred in the upper 2 m of the till layer, and no significant amount of the basal motion was due to sliding of the ice over the till. The measured surface velocity at the drill site is about 60 m a−1, of which 20–30 m a can be accounted for by ice deformation. Almost the entire amount of basal motion, 30–40 m a−1, was taken up at a depth of > 2 m in the till, possibly in discrete shear layers, or as sliding of till over the underlying bedrock. We propose that the large-scale mobilization of such till layers is a key factor in initiating glacier surges.
Glacier response to climate can be characterized by a single time-scale when the glacier changes sufficiently slowly. Then the derivative of volume with respect to area defines a thickness scale similar to that of Jóhannesson and others, and the time-scale follows from it. Our version of the time-scale is different from theirs because it explicitly includes the effect of surface elevation on mass-balance rate, which can cause a major increase in the time-scale or even lead to unstable response. The time constant has a dual role, controlling both the rate and magnitude of response to a given climate change. Data from South Cascade Glacier, Washington, U.S.A., illustrate the ideas, some of the difficulty in obtaining accurate values for the thickness and time-scales, and the susceptibility of all response models to potentially large errors.
One of the questions still unanswered concerning the surge behavior of glaciers concerns their quasi-periodic occurrence. Some results on the phenomenological connection between local cumulative balance and surge initiation of Variegated Glacier, Alaska, U.S.A., are discussed here. Based on climate data from neighboring weather stations, an empirical relation between precipitation, temperature and local mass balance is established and used to reconstruct the annual balance at a location in the accumulation area back to 1905. Between the last four surges in 1946/47, 1964/65, 1982/83 and 1994/95, the ice-equivalent cumulative balance was 43.5 m on average, with a 1σ error of 1.2 m. Although the existence of a surge level cannot be directly interpreted in physical terms, it explains the variable length of the quiescent periods of Variegated Glacier by variations in the accumulation rate prior to the surge. We use the surge level to hindcast former unobserved surges, to compare the results with other surge datings obtained from photographs and to establish a complete surge history for Variegated Glacier for the 20th century.
When a mass balance is computed using an outdated map, that computation does not reveal the actual mass change. But older maps often must be used for practical reasons. We present a method by which, with a few additional measurements each year, a mass balance computed with an outdated map can be transformed into an actual mass change. This is done by taking into account the influence of changes in areal extent and changes in the surface elevation of the glacier since the map was made. This method is applied to South Cascade Glacier, Washington, U.S.A., as an example. The computed cumulative mass balance from 1970 to 1997 would have been 16% too negative if the 1970 map had not been updated. While the actual volume change of a glacier is relevant to hydrological studies, the change that would have occurred on a constant (or static) surface is more relevant to certain glacier dynamics problems and most climate problems. We term this the reference-surface balance and propose that such a balance, which deliberately omits the influence of changes in area and surface elevation, is better correlated to climatic variations than the conventional one, which incorporates those influences.
Measurement of geometry, motion, and mass balance from Variegated Glacier, Alaska portray conditions in this surge-type glacier close to the mid-point of its 20 year surge cycle. Comparison of longitudinal profiles of ice depth, surface slope, and surface speed indicate that the motion occurs largely by internal deformation assuming the ice deforms according to the experimental law of Glen. Surface speed is not noticeably affected by local surface slope on the scale of the ice thickness or smaller, but correlates well with slope determined on a longitudinal averaging scale about one order of magnitude larger than the ice depth. The rate of motion on Variegated Glacier agrees well with rates on non-surge type temperate glaciers which have similar depth and slope. Although the (low regime at the time of the measurements is apparently typical of temperate glaciers, a large discrepancy between the balance flux needed for steady state and the actual flux is indicative of a rapidly changing surface elevation profile and internal stress distribution.
Bore-hole photography demonstrates that the glacier bed was reached by cable-tool drilling in five bore holes in Blue Glacier, Washington. Basal sliding velocities measured by bore-hole photography, and confirmed by inclinometry, range from 0.3 to 3.0 cm/d and average 1.0 cm/d, much less than half the surface velocity of 15 cm/d. Sliding directions deviate up to 30° from the surface flow direction. Marked lateral and time variations in sliding velocity occur. The glacier bed consists of bedrock overlain by a ≈ 10 cm layer of active subsole drift, which intervenes between bedrock and ice sole and is actively involved in the sliding process. It forms a mechanically and visibly distinct layer, partially to completely ice-free, beneath the zone of debris-laden ice at the base of the glacier. Internal motions in the subsole drift include rolling of clasts caught between bedrock and moving ice. The largest sliding velocities occur in places where a basal gap, of width up to a few centimeters, intervenes between ice sole and subsole drift. The gap may result from ice—bed separation due to pressurization of the bed by bore-hole water. Water levels in bore holes reaching the bed drop to the bottom when good hydraulic connection is established with sub-glacial conduits; the water pressure in the conduits is essentially atmospheric. Factors responsible for the generally low sliding velocities are high bed roughness due to subsole drift, partial support of basal shear stress by rock friction, and minimal basal cavitation because of low water pressure in subglacial conduits. The observed basal conditions do not closely correspond to those assumed in existing theories of sliding.
The surface-perpendicular component of velocity and strain-rate have been determined at one site in the ablation area of Blue Glacier, Washington, U.S.A., where the total depth is about 250 m. The strain-rate is near zero at the surface but increases with depth to about 4% a−1 at 175 m. The results were obtained with the help of a finite deformation theory from the measured stretch of cables frozen into the ice.
Variegated Glacier is a surge-type glacier in the St Elias mountain range in Alaska. The interval between surges is about 20 years; the last one occurred in 1964 to 1965. This glacier has been studied extensively since 1973 (Bindschadler and others, 1977). Thus far, measurements of ice velocities have been restricted to the surface. They have been analyzed using geophysically measured ice depths, in order to estimate ice velocities in the ice mass and at the base (Bindschadler and others, 1978). From 1973 to 1977 the distribution of annual ice velocities along most of the length of the glacier can be explained primarily by internal deformation without major contribution from sliding at the base. However, the variation of surface velocity with time gives definite indication that sliding occurs in summer and that the average summer rate is increasing progressively from summer to summer and that in a zone 5 to 7 km below the head of the glacier the summer-to-summer increase in inferred sliding rate is especially rapid. This is a notably distinguishing feature, which is probably indicative of a build-up toward the next surge. In order to obtain direct information about sliding-rates and water pressures at the base in this zone, a bore hole was drilled to the bottom of the glacier about 6 km below the glacier head. Observations in the hole started in June 1978 and were continued until 31 July 1978. The hole connected to an englacial water system at a depth of 204 m whereupon the water level dropped gradually to about 100 m below the surface. The last 6 m above-the base at 356 m could be drilled only by means of a cable tool because of the presence of debris-rich ice. Upon reaching the bottom, the water level increased rapidly to the firn water table at about 8 m below surface. Large variations in water level of about 200 m occurred during the following period of observation of 35 d. Major events such as audible icequakes, heavy rainfalls, and a period of unusually high ablation were associated with abrupt increases of water level up to the firn water table. High water pressure at the bottom drove a flow of muddy and sandy water upward in the hole. Consequently high freezing rates in the lower 150 m of the hole produced a very rough bore-hole wall covered with ledges, coral-reef-like features, grooves, and pockets filled with sand. Near the bottom, embedded rocks stuck out of the bore-hole wall. These features were recognized by bore-hole television. The bore-hole bottom consisted of sand which continuously proliferated and washed into the hole. Attempts to remove this sand by means of a sand pump failed, the bailed-out sand being replaced immediately. From bore-hole inclinometry an internal deformation of the ice mass of 0.22 m d−1 was obtained. Together with average surface velocity of 0.47 m d−1 we get a sliding velocity of 0.25 m d−1, averaged over the time of observation. This result confirms the sliding velocities inferred from surface velocity measurements. It also lies on the exponential trend line of increasing summer-to-summer velocities showing a doubling of sliding velocities about every two years (Bindschadler and others, unpublished). This strongly indicates that the next surge is likely to occur in the early eighties. Input of water from the surface probably will play a role in triggering the surge.
The glacier bed, where basal sliding occurs, was reached by cable-tool drilling and sand-pump bailing in seven bore holes in Blue Glacier, Olympic National Park, Washington. Basal sliding velocities measured by bore-hole photography and confirmed by inclinometry are unexpectedly low, ranging from 0.3 to 3.0 cm/day and averaging 1.0 cm/day. This is much less than about half the surface velocity of 15 cm/day, which was the sliding-rate expected from earlier deformation measurements in bore holes made by thermal drilling alone.
A 51 mm diameter bore-hole camera allows observation of subglacial conditions, measurement of basal sliding rates, and study of internal structure and debris in ice at depth. The camera is simple in construction, field operation and maintenance. Water turbidity is a significant problem but it can be overcome by pumping.
The closure of water-filled glacier bore holes is considered and it is concluded that freezing due to conduction to the surrounding ice is usually the dominant process. On this basis englacial temperatures are obtained from a bore hole near the equilibrium line of Blue Glacier, U.S.A., where the ice thickness is about 125 m. Temperatures range from −0.03° C near the surface to −0.13° C at a depth of 105 m, with an estimated uncertainty of 0.02 or 0.03 deg. On the average the temperature is about 0.05 deg colder than the equilibrium temperature of ice and pure water. It is shown that at this temperature small amounts of water-soluble impurities play an important role in the thermal behavior of the ice. This leads to a new definition of temperate ice in terms of its effective heat capacity. The effective heat capacity of the Blue Glacier ice is apparently much larger than that of pure ice at the same temperature.
Temperatures have been measured at two sites in a temperate glacier (Blue Glacier, Washington, U.S.A.) to depths of 192 and 76 m. The accuracy, which varies between about 0.002 and 0.005 deg, is about an order of magnitude better than previously obtained. Except near the surface, temperatures vary linearly with depth but are in disagreement with the simplest model of a temperate glacier, being about 0.02 deg colder near the surface and 0.04 deg colder at 192 m depth.