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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.
Decline in executive function has been noted in the prodromal stage of Alzheimer's disease (AD) and may presage more global cognitive declines. In this prospective longitudinal study, five measures of executive function were used to predict subsequent global cognitive decline in initially nondemented older adults. Of 71 participants, 15 demonstrated significant decline over a 1-year period on the Dementia Rating Scale (Mattis, 1988) and the remaining participants remained stable. In the year before decline, the decline group performed significantly worse than the no-decline group on two measures of executive function: the Color-Word Interference Test (CWIT; inhibition/switching condition) and Verbal Fluency (VF; switching condition). In contrast, decliners and non-decliners performed similarly on measures of spatial fluency (Design Fluency switching condition), spatial planning (Tower Test), and number-letter switching (Trail Making Test switching condition). Furthermore, the CWIT inhibition-switching measure significantly improved the prediction of decline and no-decline group classification beyond that of learning and memory measures. These findings suggest that some executive function measures requiring inhibition and switching provide predictive utility of subsequent global cognitive decline independent of episodic memory and may further facilitate early detection of dementia. (JINS, 2012, 18, 118–127)
Dentin is a load bearing multiphase composite composed of a ceramic phase, hydroxyapatite (HAP), a polymeric phase, collagen, and fluid filled porosity. In order to create better dentin replacements it is important to understand how applied load is naturally transferred between the phases during chewing and other stresses. To determine the apparent elastic modulus of HAP in dentin, applied stress over lattice strain in HAP, high energy wide angle x-ray diffraction measurements were performed on in situ loaded bovine dentin samples. It was determined that the average longitudinal apparent elastic modulus of HAP in dentin was 18.3±2.19GPa. This value is much lower than values predicted by the Voigt model when combined with volume fractions determined for the sample by thermo-gravimetric and chemical analysis. It has been determined that the decrease in apparent elastic modulus is most likely due to a decrease in the “bulk” elastic modulus of HAP due to nanometric effects.
There has been no comprehensive investigation of psychological health in Australia's Korean War veteran population, and few researchers are investigating the health of coalition Korean War veterans into old age.
To investigate the association between war service, anxiety, post-traumatic stress disorder (PTSD) and depression in Australia's 7525 surviving male Korean War veterans and a community comparison group.
A survey was conducted using a self-report postal questionnaire which included the PTSD Checklist, the Hospital Anxiety and Depression scale and the Combat Exposure Scale.
Post-traumatic stress disorder (OR 6.63, P <0.001), anxiety (OR 5.74, P <0.001) and depression (OR 5.45, P <0.001) were more prevalent in veterans than in the comparison group. These disorders were strongly associated with heavy combat and low rank.
Effective intervention is necessary to reduce the considerable psychological morbidity experienced by Korean War veterans. Attention to risk factors and early intervention will be necessary to prevent similar long-term psychological morbidity in veterans of more recent conflicts.
Comparative and functional fungal genomics
R. A. Dean, Center for Integrated Fungal Research Department of Plant Pathology 1200 Partners Building II Box 7251 North Carolina State University Raleigh NC 27695 USA,
T. Mitchell, North Carolina State University Department of Plant Pathology Campus Box 7251 Raleigh NC 27695–7251 USA,
R. Kulkarni, RTI 3040 Cornwallis Road Research Triangle Park NC 27709 USA,
N. Donofrio, North Carolina State University Department of Plant Pathology Campus Box 7251 Raleigh NC 27695–7251 USA,
A. Powell, North Carolina State University Department of Plant Pathology Campus Box 7251 Raleigh NC 27695–7251 USA,
Y. Y. Oh, North Carolina State University Department of Plant Pathology Campus Box 7251 Raleigh NC 27695–7251 USA,
S. Diener, North Carolina State University Department of Plant Pathology Campus Box 7253 Raleigh NC 27695–7253 USA,
H. Pan, RTI 3040 Cornwallis Road Research Triangle Park NC 27709 USA,
D. Brown, North Carolina State University Department of Plant Pathology Campus Box 7251 Raleigh NC 27695–7251 USA,
J. Deng, North Carolina State University Department of Plant Pathology Campus Box 7251 Raleigh NC 27695–7251 USA,
I. Carbone, North Carolina State University Department of Plant Pathology Campus Box 7244 Raleigh NC 27695–7244 USA,
D. J. Ebbole, Department of Plant Pathology and Microbiology Peterson Building Rm 120 MS# 2132 Texas A&M University College Station TX 77843–2132 USA,
M. Thon, Department of Computer Science 320C Peterson Building MS# 2132 Texas A&M University College Station TX 77843–2132 USA,
M. L. Farman, Department of Plant Pathology University of Kentucky 1405 Veterans Drive Lexington KY 40546–0312 USA,
M. J. Orbach, Department of Plant Pathology University of Arizona Forbes Room 105 PO Box 210036 Tucson AZ 85721–0036 USA,
C. Soderlund, Director of Bioinformatics Department of Plant Science 303 Forbes Building Tucson AZ 85721 USA,
J-R. Xu, Department of Botany and Plant Pathology 915 West State Street Purdue University West Lafayette IN 47906 USA,
Y-H. Lee, Seoul National University School of Agricultural Biotechnology Suwon 441–744 Korea,
N. J. Talbot, Department of Biological Sciences University of Exeter Hatherly Laboratories Prince of Wales Road Exeter EX4 4PS UK,
S. Coughlan, Agilent Technologies Inc. Little Falls Site 2850 Centerville Road Wilmington DE 19808 USA,
J. E. Galagan, The Broad Institute Massachusetts Institute of Technology 77 Massachusetts Avenue Cambridge MA 02139–4307 USA,
B. W. Birren, The Broad Institute Massachusetts Institute of Technology 77 Massachusetts Avenue Cambridge MA 02139–4307 USA
Rice blast disease, caused by the filamentous fungus Magnaporthe grisea, is a serious and recurrent problem in all rice-growing regions of the world (Talbot, 2003; Valent & Chumley, 1991). It is estimated that each year enough rice is destroyed by rice blast disease to feed 60 million people. Control of this disease is difficult; new host-specific forms develop quickly to overcome host resistance and chemical control is typically not cost effective (Ou, 1987). Infections occur when fungal spores land and attach themselves to leaves using a special adhesive released from the tip of each spore (Hamer et al., 1988). The germinating spore develops an appressorium, a specialized infection cell, which generates enormous turgor pressure – up to 8 MPa – that ruptures the leaf cuticle allowing invasion of the underlying leaf tissue (de Jong et al., 1997; Dean, 1997). Subsequent colonization of the leaf produces disease lesions from which the fungus sporulates and spreads to new plants. When rice blast infects young rice seedlings, whole plants often die, while spread of the disease to the stems, nodes or panicle of older plants results in nearly total loss of the rice grain. Recent reports have further shown that the fungus has the capacity to infect plant roots (Sesma & Osbourn, 2004). Different host-limited forms of Magnaporthe also infect a broad range of grass species including wheat, barley and millet.
Over the last few decades a rapid and extensive conversion of tropical forests to agricultural land has taken place resulting in mosaics of fragmented forest patches, pastures and farmland. While the effects of forest fragmentation on biodiversity have been intensively studied within the remaining forests, relatively little is known about the biodiversity in tropical farmland (Daily et al. 2001, Pimentel et al. 1992). Frugivorous birds are an important group of species in tropical farmland ecosystems. Frugivorous birds are significant seed dispersers and can play a prominent role in transporting seeds into disturbed areas and setting the stage for the regeneration of these systems. Isolated fleshy-fruited trees in agricultural landscapes have been shown to attract birds, leading to an increased seed rain and seedling establishment under their canopies (Carrière et al. 2002, Duncan & Chapman 1999, Guevara et al. 1986, 2004; Slocum & Horvitz 2000).
Recent studies have reported cognitive asymmetries in patients with
Alzheimer's disease (AD) and in individuals with apolipoprotein E
ε4 (APOE ε4) genotype who are in the preclinical phase of AD.
This increased frequency of cognitive asymmetry, typically defined as a
significant discrepancy (in either direction) between verbal and spatial
abilities, often occurs despite an absence of differences on traditional
measures of central tendency (i.e., mean test scores). We prospectively
studied the relationship between APOE genotype and two modality-specific
executive-function tasks: The Verbal Fluency and Design Fluency tests of
the Delis-Kaplan Executive Function System (D-KEFS) in 52 normal
functioning older adult participants who were grouped according to the
presence (n = 24) or absence (n = 28) of the APOE
ε4 allele. Nondemented older adults with the APOE ε4 allele
demonstrated a greater frequency of cognitive asymmetric profile on the
new switching conditions of the Verbal and Design Fluency measures than
the APOE non-ε4 individuals. This study further supports the utility
of assessing cognitive asymmetry for the detection of subtle cognitive
differences in individuals at-risk for AD, and suggests that dual-task
executive function tests (i.e., fluency plus switching) may serve as a
useful preclinical marker of AD. (JINS, 2005, 11,
Memory tests that are in a recall format have almost universally
measured accuracy in terms of the number of target items reported by the
examinee. However, this traditional scoring method can, in certain cases,
result in artificially inflated memory accuracy scores. That is, just as a
“yes” response bias and high false-positive rate on
recognition testing can artificially inflate a patient's hit rate,
so, too, a liberal response bias and high intrusion rate on recall testing
can artificially inflate a patient's level of target recall.
Recognition tests correct for this problem by using a discriminability
measure that provides a single score of hit rate relative to
false-positive rate; however, recall tests rarely provide a single score
of recall accuracy that corrects for intrusion rate. In the present study,
we examined the utility of a new recall discriminability measure that
analyzes target recall relative to intrusion rate. Patients with
Alzheimer's disease (AD) or Huntington's disease (HD) were
administered the CVLT–II, which provides both the traditional
measure of target recall and a new measure of recall discriminability. The
results indicate that the new recall discriminability measure was superior
to the traditional level of target recall measure in distinguishing the
recall performance of AD and HD patients. Implications of these results
for clinical practice and theories of memory disorder in dementia are
discussed. (JINS, 2005, 11, 708–715.)
Questions remain about the long-term health impacts of the 1991 Gulf War on its veterans.
To measure psychological disorders in Australian Gulf War veterans and a military comparison group and to explore any association with exposure to Gulf War-related psychological stressors.
Prevalences of DSM–IV psychological disorders were measured using the Composite International Diagnostic Interview. Gulf War-related psychological stressors were measured using a service experience questionnaire.
A total of 31% of male Gulf War veterans and 21% of the comparison group met criteria for a DSM–IVdisorder first present in the post-Gulf War period. The veterans were at greater risk of developing post-Gulf War anxiety disorders including post-traumatic stress disorder, affective disorders and substance use disorders. The prevalence of such disorders remained elevated a decade after deployment. The findings can be explained partly as a ‘war-deployment effect‘. There was a strong dose–response relationship between psychological disorders and number of reported Gulf War-related psychological stressors.
Service in the 1991 Gulf War is associated with increased risk of psychological disorders and these are related to stressful experiences.
We use in-situ real-time spectroscopic ellipsometry to observe the breakdown of silicon epitaxy during growth by hot-wire chemical vapor deposition (HWCVD) on Si (100) substrates. Representative data is presented for the two types of epitaxy breakdown that we have observed: 1) an immediate transition to hydrogenated amorphous silicon (a-Si:H), and 2) a slower transition where a-Si:H cones nucleate and grow until they eclipse further epitaxial growth. Simple models, consistent with transmission-electron and atomic-force micrographs, describe the evolution of both types of breakdown showing that real-time spectroscopic ellipsometry is a useful tool for monitoring the growth of epitaxial silicon.