Brenda T. Fenton

Diagnostic interview for genetic studies (DIGS): inter-rater and test-retest reliability of the French version

Abstract The National Institute of Mental Health developed the semi-structured Diagnostic Interview for Genetic Studies (DIGS) for the assessment of major mood and psychotic disorders and their spectrum conditions. The DIGS was translated into French in a collaborative effort of investigators from sites in France and Switzerland. Inter-rater and test-retest reliability of the French version have been established in a clinical sample in Lausanne. Excellent inter-rater reliability was found for schizophrenia, bipolar disorder, major depression, and unipolar schizoaffective disorder while fair inter-rater reliability was demonstrated for bipolar schizoaffective disorder. Using a six-week test-retest interval, reliability for all diagnoses was found to be fair to good with the exception of bipolar schizoaffective disorder. The lower test-retest reliability was the result of a relatively long test-retest interval that favored incomplete symptom recall. In order to increase reliability for lifetime diagnoses in persons not currently affected, best-estimate procedures using additional sources of diagnostic information such as medical records and reports from relatives should supplement DIGS information in family-genetic studies. Within such a procedure, the DIGS appears to be a useful part of data collection for genetic studies on major mood disorders and schizophrenia in French-speaking populations.

Diagnostic interview for genetic studies (DIGS): inter-rater and test-retest reliability of alcohol and drug diagnoses.

The semi-structured diagnostic interview for genetic studies (DIGS) was developed to assess major mood and psychotic disorders and their spectrum manifestations in genetic studies. Our research group developed a French version of the DIGS and tested its inter-rater and test-retest reliability in psychiatric patients. In this article, we present estimates of the reliability of substance use and antisocial personality disorders. High kappa coefficients for inter-rater reliability were found for drug and alcohol as well as antisocial personality diagnoses and slightly lower kappas for test-retest reliability. Combined with evidence of the reliability of major mood and psychotic disorders, these findings support the suitability of the DIGS for studies of familial aggregation and comorbidity of psychiatric disorders including substance use and antisocial personality disorders.

A Systematic Review of Technology-assisted Self-Management Interventions for Chronic Pain: Looking Across Treatment Modalities.

Objectives:The use of technology to provide chronic pain self-management interventions has increased in the recent years. Individual studies have primarily focused on a single technology-assisted modality and direct comparisons of different technology-assisted modalities are rare. Thus, little is known about the relative strengths and weaknesses of each technology-assisted modality. Materials and Methods:This article is a systematic review of technology-assisted self-management interventions for chronic nonheadache, noncancer pain in adults. We examined 3 treatment modalities: telephone, interactive voice response, and Internet. Electronic searches of OVID MEDLINE, OVID PsychINFO, and the Cochrane Database of Systematic Reviews were conducted. Forty-four articles including 9890 participants were reviewed. Results:Across modalities, the existing evidence suggests that technology-assisted psychological interventions are efficacious for improving self-management of chronic pain in adults. All modalities have been shown to provide benefit and no clearly superior modality has emerged. The primary gaps in the literature are lack of in-person comparison groups, lack of direct comparison among technology-assisted modalities, and heterogeneity of methods and interventions that limit comparability across studies and modalities. Discussion:Future trials should focus on direct comparisons of technology-assisted interventions with in-person treatment and head to head comparisons of different technology-assisted modalities. Additional areas of focus include quantifying the cost of technology-assisted interventions, examining the effect of treatment “dose” on outcomes, and establishing guidelines for developing treatments for the technology-assisted environment.

Validation of the French version of the parental bonding instrument in adults

Abstract Poor parenting has long been considered a risk factor for psychopathology. Perceived levels of parental care and protection, as measured by the Parental Bonding Instrument (PBI), have demonstrated a nonspecific association with psychopathology. We translated the PBI into French and tested its structural validity in adults recruited from the general population. The French version of the PBI has comparable psychometric properties to the original version. Similar to recent findings, our results support a three-factor rather than the two-factor structure of care and overprotection posited by Parker, with the further partitioning of the protection factor into a positive (encouragement of behavioural freedom) and negative pole (denial of psychological autonomy).

The musculoskeletal diagnosis cohort: Examining pain and pain care among veterans

Abstract Musculoskeletal disorders (MSDs) are highly prevalent, painful, and costly disorders. The MSD Cohort was created to characterize variation in pain, comorbidities, treatment, and outcomes among patients with MSD receiving Veterans Health Administration care across demographic groups, geographic regions, and facilities. We searched electronic health records to identify patients treated in Veterans Health Administration who had ICD-9-CM codes for diagnoses including, but not limited to, joint, back, and neck disorders, and osteoarthritis. Cohort inclusion criteria were 2 or more outpatient visits occurring within 18 months of one another or one inpatient visit with an MSD diagnosis between 2000 and 2011. The first diagnosis is the index date. Pain intensity numeric rating scale (NRS) scores, comorbid medical and mental health diagnoses, pain-related treatments, and other characteristics were collected retrospectively and prospectively. The cohort included 5,237,763 patients; their mean age was 59, 6% were women, 15% identified as black, and 18% reported severe pain (NRS ≥ 7) on the index date. Nontraumatic joint disorder (27%), back disorder (25%), and osteoarthritis (21%) were the most common MSD diagnoses. Patients entering the cohort in recent years had more concurrent MSD diagnoses and higher NRS scores. The MSD Cohort is a rich resource for collaborative pain-relevant health service research.

Construct validity of the French version of the Dyadic Adjustment Scale.

The Dyadic Adjustment Scale (DAS) and its revised version (RDAS) are measures of the quality of dyadic relationships. The goal of this study was to assess the properties of the French version of this self-rating instrument by testing the most commonly proposed models of the English version using confirmatory factor analysis. Our study sample included 1,131 parents of school children recruited in the general population in the French-speaking part of Switzerland. Data analysis revealed an excellent fit of the unique-factor solution for both the DAS and RDAS. Alternatively, our analyses also showed a good fit for the hierarchical solution of the DAS. These results provide evidence for similar psychometric properties of the French version of the DAS as compared to the original English version.

Spouse similarity for temperament, personality and psychiatric symptomatology

Assortative mating for psychiatric characteristics has significant implications for treatment as well as genetic studies. This paper presents data on spouse similarity for personality and temperament traits as well as psychiatric symptomatology from a non-clinical sample. Second/third and sixth/seventh grade school children of several communities as well as their parents (N=376 couples) completed self-rating scales on personality (EPQ), temperament (DOTS-R) and psychiatric symptomatology (SCL-90R). Significant positive but rather low spouse associations were found for psychiatric symptomatology and the personality trait Psychoticism, while positive statistical trends were observed for several temperament dimensions. Spouse similarity for psychiatric symptomatology was independent of similarity for personality traits and that for personality traits was independent of underlying temperament traits. Spouse similarity was symmetric between husbands and wives and did not significantly depend on psychiatric symptomatology or demographic variables. In conclusion, our non-clinical data support the existence of significant spouse similarity for psychiatric symptomatology and personality as suggested by clinical studies. In addition, a trend for temperament resemblance was also observed. Our finding that spouse similarity for temperament, personality and psychiatric symptomatology were largely independent highlights the necessity of simultaneous assessment of these psychiatric domains in the search for the underlying characteristics conditioning non-random mate selection.

High rates of child hypertension associated with obesity: a community survey in China, India and Mexico.

Abstract Background: Hypertension is a significant risk factor for cardiovascular disease, and epidemiological evidence suggests that it is increasing in parallel with obesity in children and adolescents in low- and middle-income countries. Aim: To identify and determine the relationship between overweight, obesity and hypertension in a community sample of school children. Methods: Anthropometric data were collected from 12,730 school children aged 12–18 years in China, India and Mexico as part of the Community Interventions for Health programme, an international study evaluating community interventions to reduce non-communicable disease by addressing the three main risk factors of tobacco use, unhealthy diets and physical inactivity. Logistic regression was used to examine the association of body mass index and gender and hypertension. Results: Prevalence rates of hypertension were 5·2% in China, 10·1% in India and 14·1% in Mexico, and pre-hypertension rates in China, India and Mexico were 13·4%, 9·4% and 11·2%, respectively. Overweight and obesity prevalence rates varied by country and were 16·6% in China, 4·1% in India and 37·1% in Mexico. In all countries there was a significant association between overweight and obesity and rates of hypertension. Overweight children were 1·7–2·3 times more likely to be hypertensive and obese children 3·5–5·5 more likely to show hypertension than those of normal weight. Conclusions: Rates of hypertension and overweight and obesity are high in school children in China, India and Mexico, and increased bodyweight is a significant risk factor for hypertension.

Successful Up-Scaled Population Interventions to Reduce Risk Factors for Non-Communicable Disease in Adults: Results from the International Community Interventions for Health (CIH) Project in China, India and Mexico

Background Non-communicable disease (NCD) is increasing rapidly in low and middle-income countries (LMIC), and is associated with tobacco use, unhealthy diet and physical inactivity. There is little evidence for up-scaled interventions at the population level to reduce risk in LMIC. Methods The Community Interventions for Health (CIH) program was a population-scale community intervention study with comparator population group undertaken in communities in China, India, and Mexico, each with populations between 150,000-250,000. Culturally appropriate interventions were delivered over 18-24 months. Two independent cross-sectional surveys of a stratified sample of adults aged 18-64 years were conducted at baseline and follow-up. Results A total of 6,194 adults completed surveys at baseline, and 6,022 at follow-up. The proportion meeting physical activity recommendations decreased significantly in the control group (C) (44.1 to 30.2%), but not in the intervention group (I) (38.0 to 36.1%), p<0.001. Those eating ≥5 portions of fruit and vegetables daily decreased significantly in C (19.2 to 17.2%), but did not change in I (20.0 to 19.6%,), p=0.013. The proportion adding salt to food was unchanged in C (24.9 to 25.3%) and decreased in I (25.9 to 19.6%), p<0.001. Prevalence of obesity increased in C (8.3 to 11.2%), with no change in I (8.6 to 9.7%,) p=0.092. Concerning tobacco, for men the difference-in-difference analysis showed that the reduction in use was significantly greater in I compared to C (p=0.014) Conclusions Up-scaling known health promoting interventions designed to reduce the incidence of NCD in whole communities in LMIC is feasible, and has measurable beneficial outcomes on risk factors for NCD, namely tobacco use, diet, and physical inactivity.

Multiple Sources of Prescription Payment and Risky Opioid Therapy Among Veterans

Background: Opioid overdose and other related harms are a major source of morbidity and mortality among US Veterans, in part due to high-risk opioid prescribing. Objectives: We sought to determine whether having multiple sources of payment for opioids—as a marker for out-of-system access—is associated with risky opioid therapy among veterans. Research Design: Cross-sectional study examining the association between multiple sources of payment and risky opioid therapy among all individuals with Veterans Health Administration (VHA) payment for opioid analgesic prescriptions in Kentucky during fiscal year 2014–2015. Measures: Source of payment categories: (1) VHA only source of payment (sole source); (2) sources of payment were VHA and at least 1 cash payment [VHA+cash payment(s)] whether or not there was a third source of payment; and (3) at least one other noncash source: Medicare, Medicaid, or private insurance [VHA+noncash source(s)]. Our outcomes were 2 risky opioid therapies: combination opioid/benzodiazepine therapy and high-dose opioid therapy, defined as morphine equivalent daily dose ≥90 mg. Results: Of the 14,795 individuals in the analytic sample, there were 81.9% in the sole source category, 6.6% in the VHA+cash payment(s) category, and 11.5% in the VHA+noncash source(s) category. In logistic regression, controlling for age and sex, persons with multiple payment sources had significantly higher odds of each risky opioid therapy, with those in the VHA+cash having significantly higher odds than those in the VHA+noncash source(s) group. Conclusions: Prescribers should examine the prescription monitoring program as multiple payment sources increase the odds of risky opioid therapy.