Johann M. Vega-Dienstmaier

Validation of the Spanish Center for Epidemiological Studies Depression and Zung Self-Rating Depression Scales: A Comparative Validation Study

Background Depressive disorders are leading contributors to burden of disease in developing countries. Research aiming to improve their diagnosis and treatment is fundamental in these settings, and psychometric tools are widely used instruments to support mental health research. Our aim is to validate and compare the psychometric properties of the Spanish versions of the Center for Epidemiological Studies Depression Scale (CES-D) and the Zung Self-Rating Depression Scale (ZSDS). Methodology/Principal Findings A Spanish version of the CES-D was revised by 5 native Spanish speaking psychiatrists using as reference the English version. A locally standardized Spanish version of the ZSDS was used. These Spanish versions were administered to 70 patients with a clinical diagnosis of DSM-IV Major Depressive Episode (MDE), 63 without major depression but with clinical diagnosis of other psychiatric disorders (OPD), and 61 with no evidence of psychiatric disorders (NEP). For both scales, Cronbachs alpha (C-α) and Hierarchical McDonald Omega for polychoric variables (MD-Ω) were estimated; and receiver operating characteristics (ROC) analysis performed. For the CES-D and ZSDS scales, C-α was 0.93 and 0.89 respectively, while MD-Ω was 0.90 and 0.75 respectively. The area under the ROC curve in MDE+OPD was 0.83 for CES-D and 0.84 for ZSDS; and in MDE+NEP was 0.98 for CES-D and 0.96 for ZSDS. Cut-off scores (co) for the highest proportions of correctly classified (cc) individuals among MDE+OPD were ≥29 for CES-D (sensitivity (ss) = 77.1/specificity (sp) = 79.4%/(cc) = 78.2%) and ≥47 for ZSDS (ss = 85.7%/sp = 71.4%/cc = 78.9%). In the MDE+NEP, co were ≥24 for the CES-D (ss = 91.4%/sp = 96.7%/cc = 93.9%) and ≥45 for the ZSDS (ss = 91.4%/sp = 91.8%/cc = 91.6%). Conclusion Spanish versions of the CES-D and ZSDS are valid instruments to detect depression in clinical settings and could be useful for both epidemiological research and primary clinical settings in settings similar as those of public hospitals in Lima, Peru.

Lead levels and cognitive abilities in Peruvian children.

OBJECTIVE To study the relationship between blood lead levels and cognitive abilities of children exposed to this metal. METHOD This is a cross-sectional study that included 134 children aged 6 to 8.5 years old from 3 schools with different risks of lead exposure located in El Callao (Peru). Cognitive assessments were made by means of the Graphic Test of Reasoning (GTR) and the Kohs Block Design Test (KBDT). Blood lead levels and other laboratory tests were performed. RESULTS Children with lead > 10 ug/dl presented greater prevalence of low scores in the Graphic Test of Reasoning (18.9% vs. 7.1%, p = 0.049) and in the Kohs Block Design Test (KBDT) (39.6% vs. 18.6%, p = 0.01) compared with those with lower lead blood levels. A deficit of 1 category in the Graphic Test of Reasoning was associated with an increase in lead blood level of 16.78 ug/dl (assuming a linear relationship) and from 1 to 5.19 ug/dl (logarithmic model). For each 10 ug/dl of increase in lead levels, the Kohs Block Design Test decreases in 6.24 units (12.91 in males and 0.216 in females) (linear model), and an increase from 1 to 10 ug/dl corresponds to a drop of 16.44 points in the Kohs Block Design Test (31.19 in males and 3.98 in females) (logarithmic model). Considering the Graphic Test of Reasoning subscales, lead levels correlated negatively with the areas of numerical problems (rho = -0.445, p < 0.001), numerical relationships (rho = -0.365, p < 0.001), inferences (rho = -0.281, p = 0.002) and similarities (rho = -0.250, p = 0.005). CONCLUSIONS Lead levels were non-linearly associated with lower cognitive abilities, especially in males, being the numerical reasoning the most affected area.

Salud mental en médicos que realizan el servicio rural, urbano-marginal en salud en el Perú: Un estudio de línea base

The disadvantageous conditions in which young physicians have to do their rural and sub-urban health service (SERUMS) may put them in a high risk for mental disorders. This study aims to establish the baseline levels of depression and alcohol use problems among those physicians scheduled to complete their SERUMS during the period 2011-2012. The Center for Epidemiologic Studies Depression Scale (CES-D) and the Alcohol Use Disorders Identification Test (AUDIT) were administered as screening tests to 493 physicians. Depression scores were met by 26% females and 14.5% males, and alcohol use problem scores were met by 22% females and 26% males. Overall, 39% persons scored for either of both mental health entities. Mental health problems seem to be common among young physicians scheduled to migrate to their SERUMS. These problems must be addressed to avoid greater risks.

Feasibility, acceptability and clinical utility of the Cultural Formulation Interview: mixed-methods results from the DSM-5 international field trial

BackgroundThere is a need for clinical tools to identify cultural issues in diagnostic assessment.AimsTo assess the feasibility, acceptability and clinical utility of the DSM-5 Cultural Formulation Interview (CFI) in routine clinical practice.MethodMixed-methods evaluation of field trial data from six countries. The CFI was administered to diagnostically diverse psychiatric out-patients during a diagnostic interview. In post-evaluation sessions, patients and clinicians completed debriefing qualitative interviews and Likert-scale questionnaires. The duration of CFI administration and the full diagnostic session were monitored.ResultsMixed-methods data from 318 patients and 75 clinicians found the CFI feasible, acceptable and useful. Clinician feasibility ratings were significantly lower than patient ratings and other clinician-assessed outcomes. After administering one CFI, however, clinician feasibility ratings improved significantly and subsequent interviews required less time.ConclusionsThe CFI was included in DSM-5 as a feasible, acceptable and useful cultural assessment tool.

Common Mental Disorders in Public Transportation Drivers in Lima, Peru

Background Traffic related injuries are leading contributors to burden of disease worldwide. In developing countries a high proportion of them can be attributed to public transportation vehicles. Several mental disorders including alcohol and drug abuse, psychotic disorders, mental stress, productivity pressure, and low monetary income were found predictors of high rates of traffic related injuries in public transportation drivers. The goal of this study was to estimate the prevalence of common mental disorders in the population of public transportation drivers of buses and rickshaws in Lima, Peru. Methodology/Principal Findings Cross sectional study. A sample of bus and rickshaw drivers was systematically selected from formal public transportation companies using a snowball approach. Participants completed self-administered questionnaires for assessing major depressive episode, anxiety symptoms, alcohol abuse, and burnout syndrome. Socio demographic information was also collected. The analyses consisted of descriptive measurement of outcomes taking into account both between and within cluster standard deviation (BCSD and WCSD). A total of 278 bus and 227 rickshaw drivers out of 25 companies agreed to participate in the study. BCSD for major depressive episode, anxiety symptoms and burnout syndrome was not found significant (p>0.05). The estimated prevalence of each variable was 13.7% (IC95%: 10.7–16.6%), 24.1% (IC95%: 19.4–28.8%) and 14.1% (IC95%: 10.8–17.4%) respectively. The estimated prevalence of alcohol abuse was 75.4% (IC95%: 69–81.7%, BCSD = 12.2%, WCSD = 41.9%, intra class correlation (ICC): 7.8%). Conclusion Common mental disorders such as alcohol abuse, major depressive episode, anxiety symptoms and burnout syndrome presented higher rates in public transportation drivers than general population.

Trastornos mentales en pacientes hospitalizadas en tratamiento con glucocorticoides

OBJETIVO. Estudiar la prevalencia de transtornos mentales en pacientes hospitalizadas en tratamiento con corticoides y sus correlaciones. METODO. Se estudio a 40 pacientes en tratamiento con corticoides mediante una encuesta que incluye preguntas sobre sueno, algunas partes del SCID (para examinar depresion, mania/hipomania y ansiedad), el Mini-Mental Status Examination y las pruebas de retencion de digitos directa e inversa. RESULTADOS. Al momento de la entrevista, la prevalencia de transtornos mentales en general fue 87.5 por ciento; depresion, 37.5 por ciento;mania/hipomania, 20 por ciento;ansiedad, 65 por ciento; falla cognitiva, 25 por ciento; falla en la retencion de digitos directa, 47.5 por ciento; falla en la retencion de digitos inversa, 60 por ciento; y alteraciones del sueno, 77.5 por ciento. El 12.5 por ciento de pacientes presento delirio p psicosis en algun momento de la corticoterapia. Las pacientes que recibieron >52 mg/dia de prednisona o su equivalente (ultimo cuartil de dosis) tuvieron menos prevalencia de transtornos mentales en general (p