Ingemar Engström

A Comparison of Psychometric Properties Between Internet and Paper Versions of Two Depression Instruments (BDI-II and MADRS-S) Administered to Clinic Patients

Background Self-report measures can guide clinical decisions and are useful when evaluating treatment outcomes. However, many clinicians do not use self-report measures systematically in their clinical practice. Internet-based questionnaires could facilitate administration, but the psychometric properties of the online version of an instrument should be explored before implementation. The recommendation from the International Test Commission is to test the psychometric properties of each questionnaire separately. Objective Our objective was to compare the psychometric properties of paper-and-pencil versions and Internet versions of two questionnaires measuring depressive symptoms. Methods The 87 participating patients were recruited from primary care and psychiatric care within the public health care system in Sweden. Participants completed the Beck Depression Inventory (BDI-II) and the Montgomery-Åsberg Depression Rating Scale—Self-rated (MADRS-S), both on paper and on the Internet. The order was randomized to control for order effects. Symptom severity in the sample ranged from mild to severe depressive symptoms. Results Psychometric properties of the two administration formats were mostly equivalent. The internal consistency was similar for the Internet and paper versions, and significant correlations were found between the formats for both MADRS-S (r = .84) and the BDI-II (r = .89). Differences between paper and Internet total scores were not statistically significant for either questionnaire nor for the MADRS-S question dealing with suicidality (item 9) when analyzed separately. The score on the BDI-II question about suicidality (item 9) was significantly lower when administered via the Internet compared with the paper score, but the difference was small (effect size, Cohen’s [d] = 0.14). There were significant main effects for order of administration on both questionnaires and significant interaction effects between format and order. This should not, however, pose a problem in clinical use as long as the administration format is not changed when repeated measurements are made. Conclusions The MADRS-S can be transferred to online use without affecting the psychometric properties in a clinically meaningful way. The full BDI-II also seems to retain its properties when transferred; however, the item measuring suicidality in the Internet version needs further investigation since it was associated with a lower score in this study. The use of online questionnaires offers clinicians a more practical way of measuring depressive symptoms and has the potential to save resources.

Randomized trial of Internet-based relapse prevention for partially remitted depression

Holländare F, Johnsson S, Randestad M, Tillfors M, Carlbring P, Andersson G, Engström I. Randomized trial of Internet‐based relapse prevention for partially remitted depression.

Inflammatory Bowel Disease in Children and Adolescents: a Somatic and Psychiatric Investigation

ABSTRACT. Twenty consecutive patients between 9 and 18 years of age with inflammatory bowel disease (IBD) [ulcerative colitis (UC) or Crohns disease (CD)] were assessed for the presence of psychiatric disorder. The prevalence of psychiatric disorder using the DSM‐111‐R criteria (Diagnostic and Statistical Manual 3rd ed., revised), was 60% in the IBD group compared to 15% in a matched control group (p=0.009). The psychiatric disturbances were mainly depressive or anxiety disorders. The IBD children also scored significantly higher (p=0.0028) on the Child Behaviour Checklist (CBCL) which was completed by the mothers. This indicates more behavioural problems in the IBD group than in the control group. The present study suggests that children and adolescents with IBD comprise a population at high risk for developing a psychiatric disorder that may not be overt but nevertheless plays an important interactive role in the course of the disease.

Multisubstance Use as a Feature of Addiction to Anabolic-Androgenic Steroids

The aim of this study was to explore and describe total drug use among anabolic-androgenic steroid (AAS) users and the reasons given for the use of these drugs. The study was based on semi-structured interviews and questionnaires involving 32 patients who were attending an addiction centre in Orebro, Sweden, for AAS use. The results indicated that a history of polysubstance use among the patients was frequent. Over half were using drugs of abuse and also taking various other pharmaceuticals. Almost half of the patients took human growth hormones, and almost half of the interviewed persons were drinking alcohol to a hazardous or harmful extent. The most common reason given for taking AAS and other hormones was to increase muscle mass and strength, but some participants also used insulin as a means of losing fat. Cannabis was used to improve sleep, heroin to decrease pain and amphetamine to increase endurance and burn fat. Our data suggest that most of the current AAS users who have been admitted to a treatment programme are multiple drug users with polysubstance dependence. The study stresses the importance of carefully examining total drug use as part of the assessment regimen for this group.

Parental Distress and Social Interaction in Families with Children with Inflammatory Bowel Disease

Twenty families who had children with inflammatory bowel disease (IBD) and 20 comparison families with healthy children were studied concerning parental distress and social interaction. The mothers in the IBD group scored very high on parental distress, whereas the fathers did not differ from the comparison group. Both parents in the IBD group reported significantly lower scores on a social support scale. The dimension of social integration was normal, but deeper relations and attachment were negatively affected among parents in the IBD group. The mental health of the children with IBD correlated with the social support, especially the qualitative aspects.

Predictors of the short-term responder rate of Electroconvulsive therapy in depressive disorders - a population based study

BackgroundThe aim of the present study is to investigate the responder rate of Electroconvulsive therapy, ECT, in clinical routine work and to define clinical characteristics predictive of response to ECT. The main hypothesis is that the responder rate of ECT might be lower in clinical routine than in controlled trials.MethodsThis is a population-based study of all patients (N = 990) treated with ECT for depressive disorders, between 2008–2010 in eight hospitals in Sweden. Patients with Clinical Global Impression-Improvement scores of 1 or 2 (much improved) within one week after ECT were considered responders to ECT. The predictive values of single clinical variables were tested by means of chi-squared tests and the relative importance was tested in a logistic regression analysis.ResultsThe responder rate was 80.1%. A higher proportion of older patients (>50 years) responded (84.3% vs. 74.2%, p < 0.001). Psychotically depressed patients responded better (88.9% vs. 81.5% for severely depressed and 72.8% for mildly depressed, p < 0.001). There were no significant differences in responder rates between patients suffering from bipolar, first or recurrent major depressive syndromes, or a depressive episode of schizoaffective disorder. Patients with personality disorder had a lower responder rate (66.2% vs. 81.4%, p < 0.001). Also, outpatients had a lower responder rate (66.3%) compared to inpatients (83.4%, p < 0.001). In the logistic regression analysis, inpatient status, psychotic symptoms, absence of schizoaffective disorder and older age were independent factors associated with response to ECT.ConclusionsThis study focuses exclusively on the short term responder rate with ECT in clinical practice. Similarly to results from controlled trials a high responder rate is reported. Older patients, more severely ill patients, psychotically ill patients and patients without personality disorders had the highest responder rates. Inpatients may have better outcome with ECT than outpatients.

Family Interaction and Locus of Control in Children and Adolescents with Inflammatory Bowel Disease

This study showed that children and adolescents with inflammatory bowel disease (IBD) had a more external locus of control than did matched diabetic and healthy children. An external locus of control correlated with severity of physical illness and presence of psychiatric disorders. It also correlated significantly with family dysfunction, which was found to be more common in the IBD group than in the groups compared. Tendencies toward a tense and negative family climate were observed in the IBD families. Awareness of the interaction between physical and psychosocial factors in IBD is essential in the management of therapy.

A pilot study of a family-based treatment for adolescent anorexia nervosa : 18- and 36-month follow-ups

The current study evaluated the outcome of family-based treatment for female adolescents with anorexia nervosa (N = 32), at the Anorexia-Bulimia Outpatient Unit in Göteborg, Sweden. Patients/parents were assessed pre-treatment, at 18- and 36-month follow-ups concerning eating disorder symptoms, general psychopathology, family climate and BMI. At the 36-month follow-up, 75% of the patients were in full remission with reduction in eating disorder symptoms and internalizing problems and they experienced a less distant and chaotic atmosphere in their families. These results show that family-based treatment appears to be effective in adolescent anorexia nervosa patients regarding areas examined in this study.

Higher drive for thinness in adolescent males with insulin-dependent diabetes mellitus compared with healthy controls.

Eating behaviour in adolescent males with insulin‐dependent diabetes mellitus (IDDM) living in central Sweden was compared with that of healthy age‐matched male controls using the Eating Disorder Inventory for Children and an interview. The patients were heavier than controls (p= 0.004) and had higher Drive for Thinness scores (p= 0.002). None was diagnosed as having a current eating disorder.

Estimation of the population “at risk” for eating disorders in a non-clinical Swedish sample: A repeated measure study

Objective: To estimate the late-adolescent population “at risk” for eating disorders (EDs), establish its stability over time using repeated measures, and analyse its social and demographic background factors. Method: The Eating Disorder Inventory (EDI) and a number of related questions were administered to students in their last year of high school in five Swedish towns in 1993 (n=3855) and 1998 (n=2925). Results: It was found that 6% of girls were “at risk” for eating disorders with no increase over time. There was an association between this risk and certain socio-demographic factors (living alone, moving away from home early, excessive physical training and experiences of bullying). No differences were found between cities of different size. Conclusion: A considerable proportion of girls in late adolescence are preoccupied with weight and dieting, and may be considered “at risk” for developing a clinical eating disorder. This proportion seems to be fairly stable over time.