Antoinette M. Pommer

Development of the Tilburg Pregnancy Distress Scale : The TPDS

BackgroundPregnant women with high levels of stress, depression and/or anxiety are at increased risk for adverse perinatal outcomes and impaired neurologic and emotional development of the offspring. Pregnancy specific instruments to measure psychological functioning during gestation are scarce and do not define items based on in-depth interviews of pregnant and recently delivered women. The current study developed a pregnancy specific scale that measures psychological functioning using in-depth interviews.MethodsThree focus groups were formed to discuss issues most relevant to pregnancy distress; 22 candidate items were derived for pilot testing (study I, n = 419) its psychometric properties by means of explorative factor analyses (EFA). This resulted in a 17-item TPDS which was further explored by confirmatory factor analyses (CFA) and concurrent and construct validity assessment (study II, n = 454).ResultsEFA in study I suggested a two component solution (negative affect (NA) and partner involvement (PI)). CFA in study II resulted in a higher order model of the NA subscale into three more subscales: NA regarding confinement, delivery and general health. TPDS, EPDS and GAD-7 were all significantly correlated.ConclusionsThe TPDS constitutes a valid and user friendly instrument to assess pregnancy distress. In addition to its proven ability to pick up pregnancy specific negative affect it also includes an important sub-scale measuring perceived partner involvement.

Managing co-morbid depression and anxiety in primary care patients with asthma and/or chronic obstructive pulmonary disease : Study protocol for a randomized controlled trial

BackgroundChronic Obstructive Pulmonary Disease (COPD) and asthma are common chronic diseases that are frequently accompanied by depression and/or anxiety. However, symptoms of depression and anxiety are often not recognized and therefore not treated. Currently, only a few studies have tested new clinical approaches that could improve the treatment of co-morbid depression and anxiety in these groups of patients.Methods/designThe present randomized controlled study will be conducted within the framework of PoZoB (Praktijk Ondersteuning Zuid-Oost Brabant), a large primary care organization in the Netherlands. Patients with asthma/COPD and co-morbid anxiety/depression will be included in order to test the effectiveness of a disease management approach to treat these co-morbid disorders. Important elements of this approach are: 1) systematic screening to improve detection of anxiety and depression 2) treatment in case of positive screening 3) monitoring of anxiety and depression 4) intensified treatment in case of non-remission (stepped care).DiscussionThe present study is a large primary care study on the treatment of co-morbid depression and anxiety in patients with asthma and COPD. Strengths of this study are its randomized design, the focus on implementation in primary care and the fact that it applies the latest findings on the treatment of depression and anxiety. First results are expected in 2012/2013.Trial registrationNetherlands Trial Register (NTR): NTR2626

Effectiveness of a stepped care intervention for anxiety and depression in people with diabetes, asthma or COPD in primary care: A randomized controlled trial.

BACKGROUND Depression and anxiety are common in people with a chronic somatic disease. Although guidelines recommend stepped care, the effectiveness of this approach has not been evaluated in people with diabetes, asthma, or COPD in primary care. METHODS 3559 People were sent screening questionnaires (41% response). Of 286 persons with anxiety and/or depression (Generalized Anxiety Disorder questionnaire, GAD-7, cut-off ≥ 8 and/or Patient Health Questionnaire, PHQ-9, cut-off ≥ 7), 46 were randomized into the intervention (stepped care and monitoring of symptoms; n = 23) or control (usual care) group (n = 23). Main outcomes were symptoms of anxiety and depression after the 12-months intervention and six months post intervention. Analysis of covariance was first adjusted for condition and baseline GAD-7/PHQ-9 scores and additionally for age, sex and education. RESULTS The intervention group had a significantly lower level of anxiety symptoms at the end of the program (GAD-7 6 ± 6 vs. 9 ± 6; Cohens d = 0.61). This effect was still present six months post intervention. The effect on depression was statistically significant in the first model (PHQ-9 6 ± 4 vs. 9 ± 6; p = 0.035), but not in the fully adjusted model (p = 0.099), despite a large effect size (d = 0.63). At six months post intervention there was no statistically significant difference in symptoms of depression between the two groups although the difference in symptoms was still clinically significant (Cohens d = 0.61). LIMITATIONS Many people were screened, but relatively few participated in the randomized controlled trial. CONCLUSIONS Stepped care with monitoring resulted in a lower level of symptoms of anxiety and depression in people with a chronic condition.

Evaluation of depressive symptoms in patients with coronary artery disease using the Montgomery Åsberg Depression Rating Scale.

The aim of this study was to evaluate, in patients with coronary artery disease (CAD), factor structure and psychometric properties of the Montgomery Åsberg Depression Rating Scale (MADRS) to identify patients with current major depressive episode (MDE). The construct validity of the MADRS against self-rating scales was also evaluated. Consecutive 522 CAD patients at admission to the cardiac rehabilitation program were interviewed for the severity of depressive symptoms using the MADRS and for current MDE using the structured MINI International Neuropsychiatric Interview. Also, all patients completed the Hospital Anxiety and Depression Scale and the Beck Depression Inventory-II. The MADRS had one-factor structure and high internal consistency (Cronbach’s coefficient &agr;=0.82). Confirmative factor analysis indicated an adequate fit: comparative fit index=0.95, normed fit index=0.91, and root mean square error of approximation=0.07. At a cut-off value of 10 or higher, the MADRS had good psychometric properties for the identification of current MDE (positive predictive value=42%, with sensitivity=88% and specificity=85%). There was also a moderate to strong correlation of MADRS scores with scores on self-rating depression scales. In sum, in CAD patients undergoing rehabilitation, the MADRS is a unidimensional instrument with high internal consistency and can be used for the identification of depressed CAD patients. The association between MADRS and self-rating depression scores is moderate to strong.

Patient-reported outcomes in primary care patients with COPD: psychometric properties and usefulness of the Clinical COPD Questionnaire (CCQ). A cross-sectional study.

Background:Chronic obstructive pulmonary disease (COPD) is a common disease with considerable consequences for patients’ daily lives. The Clinical COPD Questionnaire (CCQ) was designed to measure these consequences in daily practice. Although the CCQ is widely used, its original structure has never been tested.Aims:This study examines the psychometric properties of the CCQ with regard to its latent structure in a sample of primary care patients with COPD.Methods:Two cross-sectional studies were conducted; in study 1 (N=243) exploratory analyses, including exploratory factor analysis (EFA) and Mokken scale analysis, were performed to explore the latent structure of the CCQ. In study 2 (N=244), confirmatory factor analysis (CFA) was conducted to evaluate the model fit of the structure found in study 1.Results:Both EFA and Mokken scale analysis revealed a structure of two dimensions (‘general impact’ α=0.91 and ‘cough’ α=0.84). This structure, however, was not confirmed in study 2, nor was the original structure. However, subsequently removing items that violated the assumption of a normal response distribution did result in an excellent model fit with two dimensions measuring ‘dyspnoea’ and ‘cough’ (CFA: comparative fit index (CFI) 0.98; normed fit index (NFI) 0.97; root mean squared error of approximation (RMSEA) 0.08 (0.04)).Conclusions:In primary care, factor analyses on the CCQ revealed a two-component structure measuring ‘general impact’, and ‘cough’. A shortened and more specific version of the CCQ could be regarded as a useful instrument to screen for exacerbations by measuring dyspnoea, coughing and producing phlegm.

Development of the Childbirth Perception Scale (CPS) : Perception of delivery and the first postpartum week

Some caregivers suggest a more positive experience of childbirth when giving birth at home. Since properly developed instruments that assess women’s perception of delivery and the early postpartum are missing, the aim of the current study is to develop a Childbirth Perception Scale (CPS). Three focus groups with caregivers, pregnant women, and women who recently gave birth were conducted. Psychometric properties of 23 candidate items derived from the interviews were tested with explorative factor analysis (EFA) (N = 495). Confirmatory factor analysis (CFA) was performed in another sample of women (N = 483) and confirmed a 12-item CPS. The EFA in sample I suggested a two-component solution: a subscale ‘perception of delivery’ (six items) and a subscale ‘perception of the first postpartum week’ (six items). The CFA in sample II confirmed an adequate model fit and a good internal consistency (α = .82). Multivariate linear regression showed a positive effect of home delivery on perception of delivery in multiparous but not in primiparous women. The 12-item CPS with two dimensions (perception of delivery and perception of first postpartum week) has adequate psychometric properties. In multiparous women, home delivery showed to be independently related to more positive perception of delivery.

Psychopathology in difficult asthma

Abstract Objective: Within the asthma population, difficult asthma (DA) is a severe condition in which patients present with frequent exacerbations, hospitalizations and emergency room visits. The identification and treatment of psychopathology is included in the management of DA. Psychopathology is supposed to predispose patients to DA or vice versa; psychopathology may develop as a consequence of DA. We reviewed the available literature on empirical findings regarding psychopathology in adult patients with DA. Methods: Studies in English language journals using MEDLINE, Cochrane and PsycINFO databases, were retrieved by an electronic search published from 1990 till July 2014. Results: Literature on psychopathology in DA is scarce. The search identified 16 articles of which only 6 articles were specifically about psychopathology in adult patients with DA. Almost half of the patients with DA had evidence of psychopathology at both syndrome and symptom level. Moreover, psychopathology appeared to be related to frequent exacerbations in patients with DA. Conclusions: This literature review suggests a high prevalence of psychopathology of patients with DA, although it remains unclear whether psychopathology occurs more often in DA compared to “stable asthma”. More research is needed on a possible role of psychopathology on clinical signs and symptoms in DA.

Tilburg Pregnancy Distress Scale

The following questions relate to the way you perceive your pregnancy. Circle the box that best reflects how you felt during the last 7 days. Please circle only one answer to each question Very often Fairly often Now and then Rarely or never 1. I am enjoying my pregnancy 2. I feel like my partner and I are enjoying the pregnancy together 3. I worry about the pregnancy 4. The pregnancy has brought my partner and I closer together 5. I worry about the delivery 6. I worry about the health of my baby 7. I worry about my job once the baby is born 8. I feel supported by my partner 9. I worry about our financial situation after childbirth 10. I am afraid I will lose self-control during delivery 11. I often think about choices concerning the delivery 12. The delivery is troubling me 13. I get very tense hearing stories about deliveries 14. I am concerned that the physical discomforts of pregnancy might persist after childbirth 15. I can really share my feelings with my partner 16. I worry about gaining too much weight Key to calculate scores